Abstract
There is a wealth of data indicating the effectiveness of cognitive behavioral therapy in the treatment of bulimia nervosa. However, the best evidence indicates a treatment success rate of 50%. The purpose of this paper is to briefly describe cognitive behavioral treatment of bulimia nervosa and to offer suggestions on how this therapy approach may be tailored to best serve the needs of individual clients. Such tailoring should ultimately lead to even greater treatment success.
Similar content being viewed by others
References
Agras, W. S., Crow, S. J., Halmi, K. A., Mitchell, J. A., Wilson, G. T., & Kraemer, H. C. (2000). Outcome predictors for the cognitive behavior treatment of bulimia nervosa: Data from a multi-site study. American Journal of Psychiatry, 157, 1302–1308.
Agras, W. S., Rossiter, E. M., Arnow, B., Schneider, J. A., Telch, C. F, Raeburn, S. D., Bruce, B., Perl, M., & Koran, L. (1992). Pharmacologic and cognitive behavioral treatment for BN: A controlled comparison. American Journal of Psychiatry, 149, 82–87.
Agras, W. S., Schneider, J. A., Arnow, B., Raeburn, S. D., & Telch, C. F. (1989). Cognitive behavioral and response prevention treatments for bulimia nervosa. Journal of Consulting and Clinical Psychology, 57, 215–221.
Agras, W., Walsh, B., Fairburn, C., Wilson, G., & Kraemer, H. (2000). A multi-center comparison of cognitive-behavioral therapy and interpersonal psychotherapy for bulimia nervosa. Archives of General Psychiatry, 57, 459–466.
American Psychiatric Association. (1980). Diagnostic and statistical manual of mental disorders, third edition. Washington, DC: Author.
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders, (4th ed.), text revision. Washington, DC.
Anderson, D. A., & Maloney, K. C. (2001). The efficacy of cognitive-behavioral therapy on core symptoms of bulimia nervosa. Clinical Psychology Review, 21, 971–988.
Beck, A. T. (1976). Cognitive therapy and the emotional disorders. New York: International Universities Press.
Bulik, C. M., Sullivan, P. F., Carter, F. A., McIntosh, V. V., & Joyce, P. R. (1998). The role of exposure with response prevention in the cognitive behavioral therapy for bulimia nervosa. Psychological Medicine, 28, 611–623.
Bulik, C. M., Sullivan, P. F., Carter, F. A., McIntosh, V. V., & Joyce, P. R. (1999). Predictors of rapid and sustained response to cognitive-behavioral therapy for bulimia nervosa. International Journal of Eating Disorders, 26, 137–144.
Carter, F. A., McIntosh, V. V. W., Joyce, P. R., Sullivan, P. F., & Bulik, C. M. (2003). Role of exposure with response prevention in cognitive behavioral therapy for bulimia nervosa: Three-year follow-up results. International Journal of Eating Disorders, 33, 127–135.
Chen, E., Touyz, S. W., Beaumont, P. J. V., Fairburn, C. G., Griffiths, R., Butlow, P., Russell, J., Schotte, D. E., Gertler, R., & Basten, C. (2003). Comparison of group and individual cognitive-behavioral therapy for patients with bulimia nervosa. International Journal of Eating Disorders, 33, 241–254.
Cooper. P. J., & Steere, J. (1995). A comparison of two psychological treatments for bulimia nervosa: Implications for models of maintenance. Behaviour Research and Therapy, 33, 875–885.
Crow, S. J., Agras, W. S., Halmi, K, Mitchell, J. E., & Kraemer, H. C. (2002). Full syndromal versus subthreshold anorexia nervosa, bulimia nervosa and binge eating disorder: A multicenter study. International Journal of Eating Disorders, 32, 309–318.
Davis, R., McVey, G., Heinmaa, M., Rockert, W., & Kennedy, S. (1999). Sequencing of cognitive-behavioral treatments for bulimia nervosa. International Journal of Eating Disorders, 25, 361–374.
Davis, R., Olmstead, M., Rockert, W., Marques, T., & Dolhanty, J. (1997). Group psychoeducation for bulimia nervosa with and without additional psychotherapy process sessions. International Journal of Eating Disorders, 22, 25–34.
Fairburn, C. G. (1997). Eating disorders. In D. M. Clark & C. G. Fairburn (Eds.), The science and practice of cognitive behaviour therapy (pp. 209–242). Oxford: Oxford University Press.
Fairburn, C. G. (1997). Interpersonal psychotherapy for bulimia nervosa. In D. M. Garner & P. E. Garfinkel (Eds), Handbook of treatment for eating disorders (pp. 278–294). New York: Guilford Press.
Fairburn, C. G., Cooper, Z., & Cooper, P. J. (1986). The clinical features and maintenance of bulimia nervosa. In K. D. Brownell & J. D. Foreyt (eds.), Handbook of eating disorders: Physiology, psychology, and treatment of obesity, anorexia, and bulimia (pp. 389–404). New York, NY: Basic Books Inc Publishers.
Fairburn, C. G., Cooper, Z., Doll, H. A., & O'Connor, M. (2000). The natural course of bulimia nervosa and binge eating disorder in young women. Archives of General Psychiatry, 57, 659–665.
Fairburn, C. G., Cooper, Z., & Shafran, R. (2003). Cognitive behavioral therapy for eating disorders: A ‘transdiagnostic’ theory and treatment. Behaviour Research and Therapy, 41, 509–528.
Fairburn, C. G., Jones, R., Peveler, R., Carr, S. J., Solomon, R. A., O'Connor, M. E., Burton, J., & Hope, R. A. (1991). Three psychological treatments for bulimia nervosa. Archives General Psychiatry, 48, 463–469.
Fairburn, C. G., Marcus, M. D., & Wilson, G. T. (1993a). Cognitive-behavioral therapy for being eating and bulimia nervosa: A comprehensive treatment manual. In C. G. Fairburn & G. T. Wilson (Eds.), Binge Eating: Nature, Assessment and Treatment (pp. 361–405). New York: The Guilford Press.
Fairburn, C. G., Norman, P. A., Welch, S. L., O'Connor, M. E., Doll, H. A., & Peveler, R. C. (1995). A prospective study of outcome in bulimia nervosa and long-term effects of three psychological treatments. Archives General Psychiatry, 52, 304–312.
Fairburn, C. G., Peveler, R. C., Jones, R., Hope, R. A., & Doll, H. A. (1993b). Predictors of 12-month outcome in bulimia nervosa and the influence of attitudes to shape and weight. Journal of Consulting and Clinical Psychology, 61, 696–698.
Fairburn, C. G., Peveler, R. C., Jones, R., Hope, R. A., & O'Connor, M. E. (1993c). Psychotherapy and bulimia nervosa: Longer-term effects of interpersonal psychotherapy, behavioral therapy and cognitive behavioral therapy. Archives of General Psychiatry, 50, 419–428.
Fairburn, C. G., Stice, E., Cooper, Z., Doll, H. A., Norman, P. A., & O'Connor, M. E. (2003). Understanding persistence in bulimia nervosa: A 5-year naturalistic study. Journal of Consulting and Clinical Psychology, 71, 103–109.
Garner, D. M., Olmstead, M., & Polivy, J. (1984). Eating Disorders Inventory Manual. Psychological Assessment Resources: New York.
Garner, D. M., Rockert, W., Davis, R., Garner, M. V., Olmstead, M., & Eagle, M. (1993). Comparison of cognitive-behavioral and supportive-expressive therapy for bulimia nervosa. American Journal of Psychiatry, 150, 37–46.
Garner, D. M., Fairburn, C. G., & Davis, R. (1987). Cognitive behavioral treatment of bulimia nervosa: A critical appraisal. Behavior Modification, 11, 398-431.
Garner, D. M., & Needleman, L. D. (1997). Sequencing and integration of treatments. In D. M. Garner & P. E. Garfinkel (Eds.), Handbook of treatment for eating disorders (2ed., pp. 50–63). New York: Guilford Press.
Halmi, K. A., Agras, W. S., Mitchell, J., Wilson, T., Crow, S., Bryson, S. W., & Kraemer, H. (2002). Relapse predictors of patients with bulimia nervosa who achieved abstinence through cognitive behavioral therapy. Archives of General Psychiatry, 59, 1105–1109.
Hartmann, A., Herzog, T., & Drinkmann, A. (1992). Psychotherapy of bulimia nervosa: What is effective? A meta-analysis. Journal of Psychosomatic Research, 36, 159–167.
Jones, R., Peveler, R. C., Hope, R. A., & Fairburn, C. G. (1993). Changes during treatment for bulimia nervosa: A comparison of three psychological treatments. Behaviour Research and Therapy 31, 479–485.
Kendall, P. C. (1998). Directing misperceptions: Researching the issues facing manual-based treatments. Clinical Psychology: Science and Practice, 5, 396–399.
Leitenberg, H., Rosen, J. C., Gross, J., Nudelman, S., & Vara, L. S. (1988). Exposure plus response prevention treatment of bulimia nervosa. Journal of Consulting and Clinical Psychology, 36, 535–541.
Leung, N., Waller, G., & Thomas, G. (2000). Outcome of group cognitive-behavioral therapy for bulimia nervosa: The role of core beliefs. Behaviour Research and Therapy, 38, 145–156.
Linehan, M. M. (1993). Cognitive behavioral treatment of borderline personality disorder. New York: Guilford.
Mahon, J. (2000). Invited paper: Dropping out from psychological treatment for eating disorders: What are the issues? European Eating Disorders Review, 8, 196–216.
Marlatt, G. A., & Gordon, J. R. (1985). Relapse prevention: Maintenance strategies in the treatment of addictive behaviors. New York: Guilford Press.
Miller, W. R. (1995). Motivational Enhancement Therapy with drug abusers. University of New Mexico. Unpublished therapist manual.
Miller, K. J., & Mizes, J. S. (2000). Comparative treatments for eating disorders. New York: Springer Publishing Company.
Mussell, M. P., Mitchell, J. E., Crosby, R. D., Fulkerson, J. A., Hoberman, H. M., & Romano, J. L. (2000). Commitment to treatment goals in prediction of group cognitive behavioral therapy treatment outcome for women with bulimia nervosa. Journal of Consulting and Clinical Psychology, 68, 432–437.
Prochaska, J. O., Velicer, W. F., Rossi, J. S., Goldstein, M. G., Marcus B. H., Rakowski, W., Fiore, C., Harlow, L., Redding, C. A., Rosenbloom, D., & Rossi, S. R. (1994). Stages of change and decisional balance for 12 problem behaviors. Health Psychology, 13, 39–46.
Ricca, V., Mannucci, E., Zucchi, T., Rotella, C. M., & Faravelli, C. (2000). Cognitive-behavioral therapy for bulimia nervosa and binge eating disorder, Psychotherapy and Psychosomatics, 69, 287–295.
Stice, R., Burton, E. M., & Shaw, H. (2004). Prospective Relations Between Bulimic Pathology, Depression, and Substance Abuse: Unpacking Comorbidity in Adolescent Girls. Journal of Consulting and Clinical Psychology, 72, 62–71.
Telch, C. F. (1997). Skills training for adaptive affect regulation in a woman with binge eating disorder. International Journal of Eating Disorders, 22, 77–81.
Treasure, J. L., Katzman, M., Schmidt, U., Troop, N., Todd, G., & de Silva, P. (1999). Engagement and outcome in treatment of bulimia nervosa: First phase of a sequential design comparing motivation enhancement therapy and cognitive-behavioral therapy. Behaviour Research and Therapy, 37, 405–418.
Tuschen, B., & Bent H. (1995). Intensive brief inpatient treatment of bulimia nervosa. In K. D. Brownell & C. G. Fairburn (Eds.), Eating disorders and obesity: A comprehensive handbook (pp. 354–369). New York: Guilford Press.
Walsh, B. T., Wilson, G. T., Loeb, K. L., Devlin, M. J., Pike, K. M., Roose, S. P., Fleiss, J., & Waternaux, C. (1997). Medication and psychotherapy in the treatment of bulimia nervosa. American Journal of Psychiatry, 154, 523–531.
Wilfley, D. E., Agras, W. S., Telch, C. F., Rossiter, E. M., Schneider, J. A., Golomb Cole, A., Sifford, L., & Raeburn, S. D. (1993). Group cognitive behavioral therapy and group interpersonal psychotherapy for the nonpurging bulimic individual: A controlled comparison. Journal of Consulting and Clinical Psychology, 61, 296–305.
Wilfley, D. E., Zoler Dounchis, J., &Welch, R. R. (2000). Interpersonal psychotherapy. In K. J. Miller & J. S. Mizes (Eds.). Comparative treatments for eating disorders (pp. 128–159) New York: Springer Publishing Company, Inc.
Williamson, D. A., & Netermeyer, S. B. (2000). Cognitive-behavioral therapy. In K. J. Miller & J. S. Mizes (Eds.). Comparative treatments for eating disorders (pp. 61–81) New York: Springer Publishing Company, Inc.
Wilson, G. T., & Fairburn, C. G. (1993). Cognitive treatments for eating disorders. Journal of Consulting and Clinical Psychology, 61, 261–269.
Wilson, G. T., & Fairburn, C. G. (1998). Treatment of eating disorders. In P. E. Nathan & J. M. Gorman (Eds.), Treatments that work (pp. 501–530). New York: Oxford University Press.
Wilson, G. T., Fairburn, C. G., & Agras, W. S. (1997). Cognitive behavioral therapy for bulimia nervosa. In D. M. Garner & P. Garfinkel (Eds.) Handbook of treatments for eating disorders (2nd ed., pp. 67–93.) New York: Guilford Press.
Wilson, G. T., Fairburn, C. G., Agras, W. S, Walsh, B. T., & Kraemer, H. (2002). Cognitive-behavioral therapy for bulimia nervosa: time course and mechanisms of change. Journal of Consulting and Clinical Psychology, 70, 267–274.
Wilson, G. T., Loeb, K. L., Walsh, B. T., Laboubvie, R., Petkova, E., Liu, X., & Waternaux, C. (1999). Psychological versus pharmacological treatments of bulimia nervosa: predictors and processes of change. Journal of Consulting and Clinical Psychology, 67, 451–459.
Wilson, G. T., & Pike, K. M. (2001). Eating disorders. In D. H. Barlow (Ed), Clinical Handbook of Psychological Disorders, A step-by-step treatment manual (pp. 332–275).
Wiser, S., & Telch, C. F. (1999). Dialectical behavioral therapy for binge-eating disorder. Journal of Clinical Psychology, 55, 755–768.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Epstein, E.M., Sloan, D.M. Tailoring Cognitive Behavioral Therapy for Individuals Diagnosed with Bulimia Nervosa. J Contemp Psychother 35, 317–330 (2005). https://doi.org/10.1007/s10879-005-6695-8
Issue Date:
DOI: https://doi.org/10.1007/s10879-005-6695-8