The effects of eating disorder psychotherapy in adults: a meta-analysis of randomized controlled trials

Cognitive behavioral therapy (CBT) is considered a first-line treatment for eating disorders (EDs), yet remission rates remain modest and several non-CBT psychotherapies also demonstrate therapeutic efficacy. To our knowledge, this is the first meta-analysis to synthesize randomized controlled trial (RCT) evidence that pools CBT and non-CBT guided psychotherapies for all ED presentations against controls to determine controlled treatment effects. This study updated a previous CBT meta-analysis and expanded the search to include non-CBT psychotherapy studies, such as dialectical-behavioral therapy, interpersonal psychotherapy, and emotion-focused therapy. A total of 47 RCTs (57 comparisons, N = 3,018) comparing CBT and non-CBT psychotherapy to controls (primarily waitlist or care-as-usual) in adults were included. The primary outcome was ED psychopathology in which Hedges’ g was used for continuous outcomes and relative risks were used for binary outcomes. Analyses were conducted using the metapsyTools R package. Psychotherapy produced a large overall effect on ED psychopathology for all diagnoses combined (g = 0.96, 95% CI: 0.79; 1.14), with comparable effects for bulimia nervosa (g = 0.97) and binge-eating disorder (g = 0.95). No significant difference was found between CBT and non-CBT approaches. Treatment abstinence rates were 0.37 versus 0.18 in controls (RR = 3.79, 95% CI: 2.98; 4.83). Effects on secondary outcomes were significant for binge eating, shape/weight/eating concerns, and vomiting episodes. Effects were attenuated in studies with low risk of bias. Both CBT and non-CBT psychotherapies demonstrate large effects on ED symptoms compared with controls, although a substantial proportion of patients do not achieve clinically meaningful improvement. These findings support the use of psychotherapy as a first-line treatment, although there remains a need for improved therapeutic approaches. Cognitive behavioural therapy (CBT) is the current gold-standard treatment for eating disorders, but many people still don’t fully recover. Other types of therapy also show promise, and an updated study is needed to compare the effectiveness. This review combines the results from 47 clinical trials (including 3,018 adults) testing both CBT and non-CBT therapies for eating disorders against control groups (such as waitlists or care-as-usual) in adults. The findings demonstrated large improvements in eating disorder symptoms overall following psychotherapy. The results were similar for bulimia nervosa and binge-eating disorder. CBT and non-CBT psychotherapy types were found to work similarly well. After treatment, 37% of people stopped binge eating compared to only 18% in the control groups. Therapy also helped reduce vomiting episodes, and concerns about shape, weight, and eating. However, the benefits were smaller in the highest-quality studies. Psychotherapy is clearly effective for eating disorders when compared to no psychotherapy or care-as-usual. Still, a large number of people do not improve enough. Psychotherapy should remain the gold-standard treatment, but better approaches are still needed.