By Danielle Keenan-Miller, Ph.D.
Studies conducted in the last three decades have repeatedly shown that psychotherapy is more effective in treating bulimia than antidepressants, placebos, or control conditions where people do not receive treatment (e.g. Lindardon et al., 2017). However, most people who are seeking treatment want to know more than just whether therapy is better than taking a pill-- they also want to know what the odds are that they will recover fully and what they can do to maximize their chances of completely beating bulimia.
A new study from Lindardon & Wade (2018) answers those questions. What makes this study unique is that they used an approach called meta analysis. A meta-analysis is a type of research study that statistically combines the results of many other studies. This kind of research design is important because any one study is subject to bias, or quirks in the results that come from the specifics of how the treatment was implemented or how the outcomes were measured. However, when many studies with a large number of participants are pooled, the overall results are more reliable, and we can compare the studies to see if certain kinds of procedures led to better or worse results.
In this meta-analysis, the authors combined the results of 45 research studies testing 78 psychotherapy conditions. From this data, the authors were able to ask what percentage of people getting therapy were able to fully recover from binge eating-- that is, stop binge eating and purging entirely. They found that about one third of people in these study trials were completely abstinent from both binging and purging; nearly two thirds of people were able to completely stop binge eating.
This study also points to some features of the treatment that made people more likely to be able to completely stop binging and purging. First, treatment was more likely to be successful when it was led by a clinician, rather than delivered in a self-help format. Unsurprisingly, people who completed all of the treatment sessions were more likely to be fully recovered than people who dropped out part way through. The type of therapy also mattered: recovery rates were highest in cognitive-behavioral and family-based treatments, and lowest in general supportive and interpersonal types of therapies.
These findings suggest that it is possible to completely recover from bulimia, even after a relatively short course of therapy as part of a treatment trial. People seeking treatment would benefit from seeking out an evidence-based treatment with high success rates, working with a psychologist or other type of mental health clinician, and sticking it out all the way through treatment. This study should also be a reminder to psychologists who are developing and testing treatments for bulimia that we still have a lot of work to do in helping many of our clients to achieve their goal of putting bulimia fully behind them.
Lindardon, J. & Wade, T.D. (2018). How many individuals achieve symptom abstinence following psychological treatments for bulimia nervosa? A meta-analytic review. International Journal of Eating Disorders, 51, 287-294.
Lindardon, J., Wade, T., De la Piedad Garcia, X., & Brennan, L. (2017). The efficacy of cognitive-behavioral therapy for eating disorders: A systematic review and meta-analysis. Journal of Consulting and Clinical Psychology, 85, 1080-1094.