Cognitive behavior therapy for eating disorders: progress and problems

Beginning with the application of operant conditioning principles as part of inpatient treatment, cognitive behavior therapy (CBT) for anorexia nervosa (AN) has been insufficiently studied. Its efficacy remains in question. By contrast, manual-based CBT is the first-line treatment of choice for bulimia nervosa (BN) although its effects are limited. More effective methods are needed for non-responders to current therapy. Despite its well-established efficacy, CBT for BN is relatively rarely used in the US. Research on dissemination is a priority. Modified CBT and behavioral weight control programs seem comparably effective in reducing binge eating in Binge Eating Disorder (BED). Long-term maintenance of weight loss in these obese patients, however, remains a challenge. Self-help and other brief, cost-effective methods work for subsets of both BN and BED patients, demonstrating that treatment be administered within a stepped-care framework.