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W. Stewart Agras, MD; B. Timothy Walsh, MD; Christopher G. Fairburn, MD; G. Terence Wilson, PhD; Helena C. Kraemer, PhD

Arch Gen Psychiatry. 2000;57:459-466.

Background  Research suggests that cognitive-behavioral therapy (CBT) is the most effective psychotherapeutic treatment for bulimia nervosa. One exception was a study that suggested that interpersonal psychotherapy (IPT) might be as effective as CBT, although slower to achieve its effects. The present study is designed to repeat this important comparison.

Method  Two hundred twenty patients meeting DSM-III-R criteria for bulimia nervosa were allocated at random to 19 sessions of either CBT or IPT conducted over a 20-week period and evaluated for 1 year after treatment in a multisite study.

Results  Cognitive-behavioral therapy was significantly superior to IPT at the end of treatment in the percentage of participants recovered (29% [n=32] vs 6% [n=7]), the percentage remitted (48% [n=53] vs 28% [n=31]), and the percentage meeting community norms for eating attitudes and behaviors (41% [n=45] vs 27% [n=30]). For treatment completers, the percentage recovered was 45% (n=29) for CBT and 8% (n=5) for IPT. However, at follow-up, there were no significant differences between the 2 treatments: 26 (40%) CBT completers had recovered at follow-up compared with 17 (27%) IPT completers.

Conclusions  Cognitive-behavioral therapy was significantly more rapid in engendering improvement in patients with bulimia nervosa than IPT. This suggests that CBT should be considered the preferred psychotherapeutic treatment for bulimia nervosa.

From the Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, Calif (Drs Agras and Kraemer); the Department of Psychiatry, Columbia University College of Physicians and Surgeons and the New York State Psychiatric Institute, New York (Dr Walsh); the Department of Psychiatry, Oxford University, Oxford, England (Dr Fairburn); and the Department of Psychology, Rutgers University, New Brunswick, NJ (Dr Wilson).

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