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Longer-term Effects of Interpersonal Psychotherapy, Behavior Therapy, and Cognitive Behavior Therapy

Christopher G. Fairburn, DM, FRCPsych; Rosemary Jones, MSc; Robert C. Peveler, DPhil, MRCPsych; R. A. Hope, PhD, MRCPsych; Marianne O'Connor

Arch Gen Psychiatry. 1993;50(6):419-428.

Abstract
Objective
To determine whether cognitive behavior therapy (CBT) for bulimia nervosa has a specific therapeutic effect and determine whether a simplified behavioral treatment (BT) of CBT is as effective as the full treatment.

Design
Randomized controlled trial involving three psychological treatments. Two planned comparisons, CBT with interpersonal psychotherapy (IPT), and CBT with BT. Closed 12-month follow-up period. Independent assessors.

Setting
Secondary referral center.

Patients
Seventy-five consecutively referred patients with bulimia nervosa. Patients with concurrent anorexia nervosa were excluded.

Interventions
Cognitive behavior therapy, IPT, BT conducted on an individual outpatient basis. There were nineteen sessions over 18 weeks. Six experienced therapists administered all three treatments. There was no concurrent treatment.

Main Outcome Measure
Frequency of binge eating and purging.

Results
High rate (48%) of attrition and withdrawl among the patients who received BT. Over follow-up, few patients undergoing BT met criteria for a good outcome (cessation of all forms of binge eating and purging). Patients in the CBT and IPT treatments made equivalent, substantial, and lasting changes across all areas of symptoms, although there were clear temporal differences in the pattern of response, with IPT taking longer to achieve its effects.

Conclusions
Bulimia nervosa may be treated successfully without focusing directly on the patient's eating habits and attitudes to shape and weight. Cognitive behavior therapy and IPT achieved equivalent effects through the operation of apparently different mediating mechanisms. A further comparison of CBT and IPT is warranted. The behavioral version of CBT was markedly less effective than the full treatment.

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