Efficacy of psychotherapy for bulimia nervosa and binge-eating disorder on self-esteem improvement: meta-analysis

OBJECTIVES: This meta-analysis examined the effects of psychotherapy for bulimia nervosa (BN) and binge-eating disorder (BED) on self-esteem improvement. METHOD: Randomized controlled trials (RCTs) of psychological treatments that assessed self-esteem change in eating disorders were included. Thirty-four RCTs were included; most sampled BED and then BN. Hedge's g effects were entered into random effects models. RESULTS: Psychotherapy for BN led to significantly greater post-treatment improvements in self-esteem than control conditions (g = 0.45; 95% CI [0.17, 0.73]). This effect was smaller when only analysing low risk of bias trials (g = 0.28; 95% CI [0.05, 0.51]). Psychotherapy for BED also led to significantly greater post-treatment improvements in self-esteem than controls (g = 0.20; 95% CI [0.05, 0.35]), with some evidence that guided self-help was associated with the largest effects. This effect, however, was overestimated after adjustment for publication bias (g = 0.10; 95% CI [-0.05, 0.26]). There was no evidence that cognitive-behavioural therapy was superior to non-cognitive-behavioural therapy interventions in improving self-esteem. There was no relationship between symptom improvement and self-esteem improvement in a meta-regression. CONCLUSIONS: Psychotherapy may lead to small improvements in self-esteem in BN and BED. Additional RCTs with follow-up assessments are required to make more definitive conclusions about the effects of psychotherapy for eating disorders on self-esteem in the long-term.