Psychological treatments for bulimia nervosa and binging.
Psychological treatments for bulimia nervosa and binging.
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DOI：
10.1002/14651858.cd000562.pub3
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发表时间：
2009-10-07
期刊：
影响因子：
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通讯作者：
Kashyap, Priyanka
中科院分区：
文献类型：
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作者：
Hay, Phillipa Pj;Bacaltchuk, Josue;Kashyap, Priyanka
背景：针对神经性暴食症(CBT-BN)和其他常见的相关综合征，如暴饮暴食障碍，已经开发了一种特定的基于人工的认知行为疗法(CBT)。目的：评价CBT、CBT-BN等心理疗法对成人神经性暴食症或相关反复暴饮暴食综合征的治疗效果。检索策略：手工检索自第一期以来的《国际饮食障碍杂志》；数据库检索MEDLINE、Extramed、EMBASE、PancINFO、Current Contents、Lilacs、SCISEARCH、CENTAL和Cochrane Collaboration Depression、焦虑症和神经症控制试验；采用引文列表检索和个人方法联系作者。检索日期2007年6月。选择标准：对患有神经性暴食症、暴饮暴食障碍和/或进食障碍的成年人进行心理治疗的随机对照试验(EDNOS)，采用标准化的结果方法，且辍学率低于50%。数据收集和分析：使用Review Manager软件程序对数据进行分析。计算二元结果数据的相对风险。对连续变量结果数据计算标准化平均差值。应用随机效应模型。主要结果：纳入48项研究(3054名参与者)。这篇综述支持了CBT，特别是CBT-BN在治疗神经性暴食症和(但由于试验数量较少)相关饮食障碍综合症方面的疗效。其他心理疗法也是有效的，特别是长期的人际心理疗法。使用高度结构化的CBT治疗手册的自助方法很有希望。暴露和反应预防并没有提高CBT的疗效。在患有神经性贪食症或类似饮食障碍的人中，单靠心理疗法不太可能减轻或改变体重。AUTHORS的结论：有少量证据表明CBT对神经性贪食症和类似症状的有效性，但试验质量非常不稳定，样本量往往很小。需要更多和更大规模的试验，特别是对暴饮暴食障碍和其他EDNOS综合征的试验。有必要为那些既有体重又有饮食障碍的人开发更有效的治疗方法。
BACKGROUND: A specific manual-based form of cognitive behavioural therapy (CBT) has been developed for the treatment of bulimia nervosa (CBT-BN) and other common related syndromes such as binge eating disorder. Other psychotherapies and modifications of CBT are also used.OBJECTIVES: To evaluate the efficacy of CBT, CBT-BN and other psychotherapies in the treatment of adults with bulimia nervosa or related syndromes of recurrent binge eating.SEARCH STRATEGY: Handsearch of The International Journal of Eating Disorders since first issue; database searches of MEDLINE, EXTRAMED, EMBASE, PsycInfo, CURRENT CONTENTS, LILACS, SCISEARCH, CENTRAL and the The Cochrane Collaboration Depression, Anxiety & Neurosis Controlled Trials Register; citation list searching and personal approaches to authors were used. Search date June 2007.SELECTION CRITERIA: Randomised controlled trials of psychotherapy for adults with bulimia nervosa, binge eating disorder and/or eating disorder not otherwise specified (EDNOS) of a bulimic type which applied a standardised outcome methodology and had less than 50% drop-out rate.DATA COLLECTION AND ANALYSIS: Data were analysed using the Review Manager software program. Relative risks were calculated for binary outcome data. Standardised mean differences were calculated for continuous variable outcome data. A random effects model was applied.MAIN RESULTS: 48 studies (n = 3054 participants) were included. The review supported the efficacy of CBT and particularly CBT-BN in the treatment of people with bulimia nervosa and also (but less strongly due to the small number of trials) related eating disorder syndromes.Other psychotherapies were also efficacious, particularly interpersonal psychotherapy in the longer-term. Self-help approaches that used highly structured CBT treatment manuals were promising. Exposure and Response Prevention did not enhance the efficacy of CBT.Psychotherapy alone is unlikely to reduce or change body weight in people with bulimia nervosa or similar eating disorders.AUTHORS' CONCLUSIONS: There is a small body of evidence for the efficacy of CBT in bulimia nervosa and similar syndromes, but the quality of trials is very variable and sample sizes are often small. More and larger trials are needed, particularly for binge eating disorder and other EDNOS syndromes. There is a need to develop more efficacious therapies for those with both a weight and an eating disorder.