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Meta-analysis of the effects of cognitive-behavioral therapy for binge-eating-type disorders on abstinence rates in nonrandomized effectiveness studies: comparable outcomes to randomized, controlled trials?

OBJECTIVE: The efficacy of cognitive-behavioral therapy (CBT) for eating disorders is well-established. The extent to which CBT tested in controlled research settings generalizes to real-world circumstances is unknown. We conducted a meta-analysis of nonrandomized studies of CBT for eating disorders, with three aims: (a) to estimate the prevalence of patients who achieve binge-purge abstinence after CBT in routine practice; (b) to compare these estimates with those derived from two recent meta-analyses of randomized controlled trials (RCTs) of CBT for bulimia nervosa (BN) and binge-eating disorder (BED); (c) to examine whether the degree of clinical representativeness of studies was associated with effect sizes. METHOD: Twenty-seven studies, mainly involving BN, were included. Pooled event rates were calculated using random effects models. RESULTS: The percentage of treatment completers who achieved abstinence at post-treatment was 42.1% (95% CI = 34.7-50.0). The intention-to-treat (ITT) estimate was lower (34.6% [95% CI = 29.3-40.4]). However, abstinence rates varied across diagnoses, such that the completer and ITT analysis abstinence estimates were larger for BED samples (completer = 50.2%, 95% CI = 29.4-70.9; ITT = 47.2%, 95% CI = 29.8-65.2) than for BN (completer = 37.4%, 95% CI = 29.1-46.5; ITT = 29.8%, 95% CI = 24.9-35.3) and atypical eating disorder samples (completer = 37.8%, 95% CI = 20.2-59.3; ITT = 28.8%, 95% CI = 18.2-42.4). No relationship between the degree of clinical representativeness and the effect size was observed, and our estimates were highly comparable to those observed in recent meta-analyses of RCTs. DISCUSSION: Findings suggest that CBT for eating disorder can be effectively delivered in real-world settings. This study provides evidence for the generalizability of CBT from controlled research settings to routine clinical services.

History

Journal

International journal of eating disorders

Volume

51

Issue

12

Pagination

1303 - 1311

Publisher

John Wiley & Sons

Location

Chichester, Eng.

eISSN

1098-108X

Language

eng

Publication classification

C1 Refereed article in a scholarly journal

Copyright notice

2018, Wiley Periodicals, Inc.