A systematic review of cognitive behavior therapy and dialectical behavior therapy for adolescent eating disorders

BACKGROUND

Eating disorders have serious psychological and physical consequences. Current evidence-based treatments for adolescents with eating disorders have modest effects, underscoring the need to improve current treatment approaches. Cognitive behavior therapy (CBT) and dialectical behavior therapy (DBT) have been proposed as alternative treatment options, with burgeoning research in this area. This review aims to summarize and critically analyze the current literature on the feasibility, acceptability, effectiveness, and efficacy of CBT and DBT for adolescent eating disorders, and then proposes areas of future research.

METHODS

PsycINFO and PubMed were searched using the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines to identify studies examining the feasibility, acceptability, effectiveness and/or efficacy of CBT or DBT for adolescent eating disorders.

RESULTS

Eligible studies (N = 50; CBT: n = 40, DBT: n = 10) indicated that both treatments are reasonably feasible, acceptable, and possibly effective for adolescent eating disorders across diagnoses and levels of care, though efficacy trials are lacking.

CONCLUSIONS

CBT and DBT demonstrate promise as alternatives to family-based approaches for adolescent eating disorders. Adequately powered trials to establish the effectiveness and efficacy of CBT and DBT are needed, particularly ones that compare these treatments against other leading approaches. Despite high rates of relapse and likelihood for severe and enduring illness, there is a dearth of evidence-based treatment options for adolescents with eating disorders. Potentially viable but less well-studied treatments for adolescents with eating disorders include cognitive behavior therapy (CBT) and dialectical behavior therapy (DBT). This systematic review of CBT and DBT for adolescent eating disorders focuses on feasibility (i.e., how easy it was to implement the treatment), acceptability (i.e., how well the intervention was received by patients and therapists), effectiveness (i.e., how well the intervention performed under routine, real-world circumstances), and efficacy (i.e., how well the intervention performed in highly-controlled research settings). This review concludes that research supports the feasibility and acceptability of these approaches, as well as preliminary evidence of their effectiveness. However, the field is lacking studies that systematically compare CBT and DBT to other evidence-based approaches. Recommendations to advance research on CBT and DBT for adolescent eating disorders are provided, including a call for efficacy studies that clarify their performance compared to other leading approaches.

Canadian practice guidelines for the treatment of children and adolescents with eating disorders

OBJECTIVES

Eating disorders are common and serious conditions affecting up to 4% of the population. The mortality rate is high. Despite the seriousness and prevalence of eating disorders in children and adolescents, no Canadian practice guidelines exist to facilitate treatment decisions. This leaves clinicians without any guidance as to which treatment they should use. Our objective was to produce such a guideline.

METHODS

Using systematic review, the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system, and the assembly of a panel of diverse stakeholders from across the country, we developed high quality treatment guidelines that are focused on interventions for children and adolescents with eating disorders.

RESULTS

Strong recommendations were supported specifically in favour of Family-Based Treatment, and more generally in terms of least intensive treatment environment. Weak recommendations in favour of Multi-Family Therapy, Cognitive Behavioural Therapy, Adolescent Focused Psychotherapy, adjunctive Yoga and atypical antipsychotics were confirmed.

CONCLUSIONS

Several gaps for future work were identified including enhanced research efforts on new primary and adjunctive treatments in order to address severe eating disorders and complex co-morbidities.

Incorporating Meta-Emotions in Integrative Cognitive-Affective Therapy to Treat Comorbid Bulimia Nervosa and Substance Use Disorders in a Latina American

Individuals with co-occurring eating and substance use disorders have poorer psychosocial adjustment than those with only eating pathology or substance misuse patterns; these complex cases are often challenging to treat in clinical settings. Eating and substance use disorders share personality, affective, and cognitive etiologic factors, suggesting the importance and opportunities to treat them simultaneously in an integrative intervention approach. The integrative cognitive-affective therapy (ICAT) validated to treat bulimia nervosa follows an evidence-based conceptual framework; it addresses many shared risk factors that underlie eating and substance use disorders. A Latina American with comorbid bulimia nervosa, alcohol and cocaine use disorders, and bipolar I disorder was treated using ICAT; therapy was augmented with an explicit examination of, and cognitive restructuring surrounding, negative meta-emotions. ICAT and treatment around meta-emotions were delivered in the context of an intensive outpatient program. Over the course of 15 individual sessions and at 1-month follow-up, the patient reported a decrease in dietary restraint, binge eating episodes, body dissatisfaction, and negative attitudes toward obesity and alcohol and cocaine abuse, and maintained a stable weight. The patient also saw improvements in depression- and anxiety-related symptoms, and self-evaluation. This case supports the flexibility and benefits of examining meta-emotion philosophy in the context of ICAT for the treatment of co-occurring eating and substance use disorders for adults in a clinical setting.

An investigation into adolescents' experience of cognitive behavioural therapy within a child and adolescent mental health service

Cognitive Behavioural Therapy (CBT) is frequently referenced within NICE (National Institute for Clinical Excellence) guidance and is a recommended psychological therapy for a number of different mental health disorders for both adults and children. This is due to the current body of quantitative research around CBT demonstrating its efficacy for a range of mental health difficulties. However, CBT has not been as well addressed within the qualitative field and this gap in research is even more obvious when looking at CBT conducted with children and adolescents. This interpretative phenomenological study explored adolescents' experiences of a course of CBT within a Child and Adolescent Mental Health Service (CAMHS) in a one-to-one format. Three female adolescents who had completed an agreed contract of therapy with the CBT service took part in semi-structured interviews. Four superordinate themes emerged from analysis and highlighted components within CBT that were important to the sample. These were engagement, the therapeutic relationship, the impact of CBT on change and the manner in which CBT was delivered. The findings are discussed with relevance to current policy and pertinent literature as well as implications for service delivery and future research.