Research findings suggest that guided self-help based on CBT can be effective in treating bulimia nervosa and binge eating disorder as well.5 Guided self-help can be defined as a psychological treatment where the patient takes home a standardized treatment, which is often written down in book form or available through some other media, and primarily works through it independently but also has the guidance of a therapist or coach. This guidance is primarily supportive or facilitative in nature and is meant to support the patient in working through the standardized treatment themselves.
The amount of contact in guided self-help is minimized relative to standard treatment approaches. It is acceptable to patients, highly cost-effective, and can be implemented successfully by a wide variety of individuals (eg, nurses, non-specialists with no formal clinical qualifications). For these reasons, as of 2017, the United Kingdom National Institute for Health and Care Excellence (NICE) guidelines for EDs recommend guided self-help CBT as the first-line treatment for adults with bulimia nervosa and binge eating disorder.6
Interpersonal psychotherapy is another treatment for bulimia nervosa and binge eating disorder. It assumes that ED symptoms develop and are maintained in an interpersonal context. Specifically, interpersonal problems may contribute to negative affect and low self-esteem, which can in turn lead to the use of ED behaviors as a coping strategy.7 Engaging in ED behaviors can further intensify social difficulties, perpetuating the cycle. Interpersonal psychotherapy works to break this cycle by helping patients improve relationships and communication and resolve interpersonal issues.
Interpersonal psychotherapy typically includes 15 to 20 sessions over 4 to 5 months. During the early part of treatment, the onset and maintenance of the ED are linked to at least one of four identified problem areas (ie, interpersonal deficits, interpersonal role disputes, role transitions, grief) and interpersonal goals are developed. The focus of treatment then transitions to working towards these goals. During this process, the therapist helps the patient recognize the connections between improvement in ED symptoms and positive changes in interpersonal functioning.
The research-practice gap
Many international, evidence-based clinical treatment guidelines recommend use of these evidence- based psychological treatments for EDs. Despite the recommendations, when individuals with EDs receive care, it is frequently not evidence- based treatment. Referred to as the research-practice gap, this is the discrepancy between what is known about effective treatment and what is actually provided to patients who receive care. Indeed, the number of ED specialist clinicians who report adhering to evidence-based protocols is between 6% and 35%. Far more clinicians report using an eclectic mix of techniques derived from both evidence-based treatments and techniques with no evidence for efficacy.8 Furthermore, even when clinicians say they are using an evidence-based treatment for EDs, key elements may be omitted.9
Dr Fitzsimmons-Craft is Assistant Professor of Psychiatry, and Dr Wilfley is the Scott Rudolph University Professor of Psychiatry, Medicine, Pediatrics, and Psychological and Brain Sciences, Washington University School of Medicine, St. Louis, MO. The authors report no conflicts of interest concerning the subject matter of this article.
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