Cognitive behavioural therapy compared to control conditions in treating bulimia nervosa and binge-eating disorder: A systematic review and meta-analysis.
Angeliki L Sioziou, Anastasios Stefanou, Felicia Dimitrakopoulou et al.
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In 30 seconds
This systematic review and meta-analysis examined randomized controlled trials of cognitive behavioural therapy (CBT) versus control conditions for bulimia nervosa and binge-eating disorder. Across 42 trials involving 2807 participants, CBT was more effective than waitlists for remission (RR = 3.21, 95% CI: 2.15; 4.81) and reducing binge-eating frequency (SMD = -.88, 95% CI: -1.08; -.69). Compared with self-help, the remission benefit was smaller, and the difference in binge-eating frequency was not significant. Evidence for other inactive comparators was scarce.
Key findings
- Against waitlists, CBT increased remission (RR = 3.21, 95% CI: 2.15; 4.81).
- Against waitlists, CBT reduced binge-eating frequency (SMD = -.88, 95% CI: -1.08; -.69).
- Compared with self-help, remission effects were attenuated (RR = 1.53, 95% CI 1.19; 1.95), while binge-frequency effects were not significant (SMD = -.14, 95% CI: -.32; .04).
- The review included 42 RCTs with 2807 participants randomized.
Why it matters
The estimated benefit of CBT depends on what it is compared with. Waitlist comparisons show larger effects than comparisons with self-help, so results from less rigorous controls may overstate the advantage relative to active alternatives. This distinction is important when interpreting treatment evidence and underscores the value of trials using credible psychological placebos or other therapies as comparators.
What to keep in mind
Data were scarce for other inactive comparators, limiting conclusions about CBT relative to those controls.