Cognitive-Behavior Therapy with Eating Disorders: The Role of Medications in Treatment
Bowers, Wayne A., Andersen, Arnold E., Journal of Cognitive Psychotherapy
Cognitive-behavioral therapy has demonstrated efficacy in the treatment of bulimia nervosa, but there is less empirical data on its usefulness with anorexia nervosa or binge-eating disorder. The use of cognitive-behavioral therapy (CBT) is recommended as the first line of treatment for bulimia nervosa and strongly recommended in combination when medications alone have not been effective. Combined treatment also improves symptoms such as anxiety, depression, and dietary restriction. Empirical studies support the usefulness of CBT with binge-eating disorder and suggest higher remission rates with combined treatment. No single psychotherapy or medicine alone is effective in treating anorexia nervosa. CBT is typically used as part of a comprehensive treatment program with nutritional rehabilitation and prudent use of medication. Both CBT and medication may have benefits in maintaining gains for anorexia nervosa patients after inpatient treatment. More research on CBT alone and in combination with medication is needed to adequately understand the respective roles of these therapies in a comprehensive treatment of eating disorders.
Keywords: cognitive therapy; eating disorders; medications; combined treatment
Cognitive-behavioral therapy (CBT) has become one of the most prominent treatment models in mental health (Wonderlich, Mitchell, Swan-Kremier, Peterson, & Crow, 2004). Initially designed as an outpatient treatment, CBT has been adapted and used in a wide range of settings including crisis intervention, day treatment, partial hospital programs, and inpatient units (Bowers, Andersen, & Evans, 2004). CBT has been recommended as a primary approach in the treatment of eating disorders (American Psychiatric Association, 2000) and been called the "gold standard" in the treatment of bulimia nervosa (Mitchell, Peterson, Myers, & Wonderlich, 2001).
Like many psychiatric disorders, eating disorders have been treated using medications, psychotherapy, and at times a combination of medications and psychotherapy. Unlike other disorders, there is less uniformity and understanding of the role of medications when treating eating disorders, especially anorexia nervosa (Steinglass & Walsh, 2004). Crow and Brown (2003) suggest that a number of medications (primarily antidepressants) are of some benefit in the treatment of eating disorders but that there is considerable room for improvement. Peterson and Mitchell (1999) identify positive findings in the treatment of bulimia nervosa and binge- eating disorder with the use of antidepressant medications. Preliminary studies suggest that the use of fluoxetine and psychotherapy may be helpful in preventing relapse for individuals with anorexia nervosa after their weight has returned to normal (Kaye, Nataga, et al., 2001). Additionally, Brewerton (2004) has indicated that recent advances in the understanding of the neurobiological aspects of eating disorders offer encouraging possibilities for the use of atypical antipsychotics in the treatment of anorexia nervosa (Mitchell, de Zwaan, & Roerig, 2003).
Among eating disorders, bulimia nervosa has the most empirical research regarding treatment outcome (Brewerton, 2004). A wide range of medicines has been studied in the treatment of bulimia nervosa with encouraging results (Steinglass & Walsh, 2004). The most widely explored medicines are the antidepressants (tricyclics, monoamine oxidase inhibitors, serotonin reuptake inhibitors), with the serotonin reuptake inhibitors (SSRIs) having found the most favor in treatment studies (Romano, Halmi, Sarkar, Koke, & Lee, 2002; Steinglass & Walsh, 2004; Walsh, Hadigan, Devlin, Gladis, & Roose, 1991). Antidepressant medications decrease depressive symptoms, improve mood, and may have a role in relapse prevention (Steinglass & Walsh, 2004). Additionally, SSRIs have demonstrated their usefulness in reducing binge frequency and ending binge-purge behavior (Bacaltchuk, Hay, & Mari, 2000). …