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Table 17 Cognitive behavioural therapy for Bulimia Nervosa

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

Certainty assessment

Impact

Certainty

Importance

№ of studies

Study design

Risk of bias

Inconsistency

Indirectness

Imprecision

Other considerations

CBT vs FBT - Remission (assessed with: abstinence from BP for 4 weeks)

 2

randomised trials

not serious

not serious

not serious

not serious

none

RCT n = 130 aged 12–18 years. 18 sessions over 6 months. 20% remitted in CBT group versus 39% remitted in FBT group (p < 0.04, NNT = 5). RCT n = 85 (guided self care CBT) remitted 6/44 in CBT group versus 4/41 in family group. no significant difference.

HIGH

CRITICAL

CBT vs. Psychodynamic - Remission Rates (assessed with: Diagnostic Criteria)

 1

randomised trials

not serious

not serious

not serious

not serious

none

one RCT 81 females mean age 18.7 years (range 14–20). 33.3% remitted in the CBT group and 31.0% in the psychodynamic group. No significant differences.

Mean of 37 sessions. Both groups improved, there were small between groups effect sizes for binge eating (d = 0.23) and purging (d = 0.26) in favour of CBT and for eating concern (d = 0.35) in favour of PDT.

HIGH

CRITICAL

Binge Purge Behaviour (assessed with: EDE)

 2

Case Series

very serious a,b

not serious

not serious

not serious

none

Two large case series (n = 68 including 2 males, 66 females, and n = 34 all female). Total age range 12–19. Number of sessions 16–20. Frequency of binge and purge episodes decreased significantly pre to post treatment.

VERY LOW

CRITICAL

very serious a,b

not serious

not serious

not serious

none

Case series of 68 adolescents - EDE significantly improved global EDE score from 3.6 to 1.8 from pre to post treatment.

VERY LOW

CRITICAL

Binge Purge Frequency (assessed with: Frequency), Psychological Symptoms (EDE or EAT)

 5

Case Reports

very serious a,b

not serious

not serious

not serious

none

Case reports involving 9 patients in total. Frequency of binge and purge behaviours described as decreased.

VERY LOW

CRITICAL

very serious a,b

not serious

not serious

not serious

none

7 cases -EDE or EAT significantly improved.

VERY LOW

CRITICAL

  1. Explanations
  2. ano randomization
  3. bno control condition
  4. Bibliography:
  5. RCT – Le Grange 2015 [50], Schmidt 2007 [49] (CBT vs. FBT) Stefini 2017 [107] (CBT vs. psychodynamic)
  6. Case Series - Dalle Grave 2015 [108], Lock 2005 [109]
  7. Case Reports – Schapman-Williams 2006 [110], Cooper 2007 [111], Anbar 2005 [112], Schapman-Williams 2007 [113], Sysko 2011 [114]