A systematic review and meta-analysis of a 10-session cognitive behavioural therapy for non-underweight eating disorders

ABSTRACT

Objective

Treatment guidelines recommend that people with non-underweight eating disorders should receive up to 20 sessions of eating-disorder-focused cognitive behavioural therapy (CBT-ED). The present study reviewed ten studies of 10-session cognitive behavioural therapy for non-underweight patients (CBT-T).

Method

We conducted a systematic review using four electronic databases and contacted researchers in the field for unpublished data. Random effects meta-analyses were conducted to pool within-group effect sizes.

Results

From pre-treatment to post-treatment, medium to very large effect sizes were observed for eating disorder psychopathology, clinical impairment, depression, anxiety, and weekly frequencies of objective bingeing and vomiting. Furthermore, the effect of CBT-T appears to last after treatment with eating disorder psychopathology remaining below the norm for non-clinical females at follow-up. The dropout rate from CBT-T was 39%, and 65% of completers achieved a good outcome.

Conclusions

While results should be interpreted as preliminary due to a number of limitations, the present study suggests that CBT-T is a promising treatment for people with non-underweight eating disorders, which can achieve a good outcome in half the time currently recommended in treatment guidelines. The present study, therefore, provides valuable justification for future randomised controlled trials directly comparing short and long forms of CBT-ED as well as examining who does best with which version.

KEY POINTS

What is already known about this topic:

• (1) Treatment guidelines recommend that people with non-underweight eating disorders receive up to 20 sessions of eating-disorder-focused cognitive behavioural therapy (CBT-ED).

• (2) For non-underweight eating disorders, evidence suggests that the improvement trajectory stabilises by the twelfth session.

• (3) Evaluation of briefer CBT-ED treatments will inform cost-effectiveness and more timely access to treatment.

What this topic adds:

• (1) Our evaluation of CBT-T, a 10-session form of CBT-ED, revealed medium to very large improvements for all treatment outcomes and a dropout rate of 39%.

• (2) CBT-T is a promising treatment for people with non-underweight eating disorders, with 65% of completers achieving a good outcome in half the time currently recommended in treatment guidelines.

• (3) Future controlled studies should directly compare CBT-T to longer forms of CBT-ED to determine whether 10 sessions are as effective as longer treatment.

KEYWORDS:

• CBT-T
• brief therapy
• cognitive behavioural therapy
• non-underweight eating disorders
• outcomes
• dropout

Acknowledgement

The authors would like to thank Marcela Radunz and Sophie Travers for their help with screening, extraction, and the quality assessment.

Disclosure statement

TW and GW receive royalties on the CBT-T manual.

Data availability statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Supplemental material

Supplemental data for this article can be accessed at https://doi.org/10.1080/13284207.2022.2075257

Additional information

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.