Binge Eating
2. Psychotherapy
James E Mitchell, M.D.
Treatment of BED
Overall
Evidence
↓ BE
↓ Wt
++
++
+/-
+++
+++
+/-
Interpersonal Therapy
++
+++
+/-
Behavioral Weight Loss
+
+
++
Dialectic Behavior Therapy
+
+++
+/-
Psychotherapy
Self-Help/
Guided Self-Help
Cognitive Behavior Therapy
Gerald Klerman, MD
Myrna Weissman, PhD
Denise Wilfley, PhD
BED: CBT vs. IPT
(Wilfley et al, 1999)
N = 162
18
16
14
12
10
CBT
IPT
8
6
4
2
0
Pre
Post
4 mos.
8 mos.
12 mos.
Marsha Linehan, PhD
Debra Safer, PhD
Christy Telch, PhD
Eunice Chen, PhD
Clinician Manual
Integrative
Cognitive-Affective Therapy
for the
Treatment of Bulimia Nervosa
and Binge-Eating Disorder
Steve Wonderlich, PhD
Wonderlich, S.A., Peterson, C., Mitchell, J.E., Crow, S.J.,
Smith, T.L. , & Klein, M.
Supported by NIH Grant R34 MH077571
ICAT Description
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21 sessions
Clinician Manual and Patient Workbook
PDA/Paper Wallet Coping Skills
PDA/Paper Wallet Insert for Coping Skills
ICAT Clinical Targets
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Motivational Enhancement
Emotion Identification
Meal Planning
Relationship Skills
Self Regulation Skills
Self Discrepancy Reduction
Theoretical Underpinnings of ICAT
• Intensive Opening Phase
• Self Monitoring
• Disrupt Dieting
CBT for BN
Fairburn
Wilson
Agras
Marcus
Motivational
Interviewing
Vitousek
• Recognizing Ambivalence
Treasure/Schmidt • Positive Function of Disorder
Geller
Emotion Focused
Interventions
Greenberg
Heatherton and
Baumeister
Barlow
• Binge/Purge as Escape from
Negative Emotion
• Diet as Avoiding Negative Emotion
Theoretical Underpinnings of ICAT (Cont’d)
Self-Discrepancy
Theory
Strauman
• Actual, Ideal, Ought, Feared Selves
Structural Analysis of Benjamin
Social Behavior
• Relationship Problems and
Interpersonal Patterns
• Self directed Style
Relapse Prevention
• Lapse Training
• Skill Maintenance
Marlatt
Chris Fairburn, MD
CBT-E
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Refinement of prior CBT
Addresses also:
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Mood intolerance
Clinical perfectionism
Core low self-esteem
Interpersonal difficulties
CBT-E
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Transdiagnostic
Diagnostic migration among ED
ED are essentially “cognitive disorders”
Core psychopathology
- Overvaluation of shape and weight
(- Subgroup core is to control eating)
Self-help
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Pure Self-help
Supervised or Assisted Self-help
Frequent Problems with Research on Self-help
1.
2.
3.
4.
5.
Non-randomization
Inadequate Control Groups
Small Sample Sizes/Underpowered
Lack of Standardized Assessments
Brief Follow-ups
Technology-assisted Areas
1.
2.
3.
4.
5.
6.
7.
8.
9.
Internet Treatment or Prevention
Chat Groups
E-mail Treatment
CD-ROM Treatment
Telehealth Treatment
Stepped Care
PDAs
Text Messaging
Virtual Reality
ES[S]PRIT:
An Internet-based program early intervention of
eating disorders
Center for Psychotherapy Research
CD-ROM and ED Treatment
Thought Restructuring
[email protected]
Comments/Questions?