Psychotherapy, guided self-help best for binge eating

Certain kinds of talk therapy and guided self-help are both more likely than behavioral weight loss treatment to keep people free from binge eating disorder, according to a new study.

In prior research, these treatments for binge eating have had similar short-term results. Long-term data, however, have been lacking, according to the report in the Archives of General Psychiatry for January.

To investigate, Dr. G. Terence Wilson, from Rutgers University in Piscataway, New Jersey and colleagues assigned 205 men and women with binge eating disorder to six months of treatment with either 20 sessions of interpersonal psychotherapy, 20 sessions of behavioral weight loss treatment, or 10 sessions of guided self-help cognitive behavioral therapy.

Interpersonal psychotherapy is a short-term treatment that focuses on how people relate to others. Cognitive behavioral therapy is also relatively short-term, but focuses on emotional responses to situations.

In the guided self-help treatment used in the study, patients used a cognitive behavioral manual under guidance from a therapist. The behavioral weight loss treatment included some calorie restriction, and exercise.

Subjects were all overweight or obese and had been diagnosed with binge eating disorder.

When the researchers looked at the rate of binge eating immediately after treatment, and six months later, there were no differences between the groups.

Two years later, however, "both interpersonal therapy and cognitive behavior therapy/guided self-help were significantly more effective than behavioral weight loss therapy in terms of remission from binge eating," according to the investigators.

About 60 percent of the interpersonal therapy and cognitive behavior therapy/guided self-help groups were in remission after two years, compared with about 40 percent of the behavioral weight loss group.

Those with low self-esteem and very severe binge eating symptoms also benefited more from interpersonal psychotherapy.

Based on the results, the authors suggest that doctors try cognitive behavior therapy/guided self-help treatment first, except in patients with low self-esteem and severe symptoms, who should receive interpersonal psychotherapy.

SOURCE: Archives of General Psychiatry, January 2010.