CPG for Eating Disorders

A 9.3.3.1. Adult patients with BED can be offered a specifically adapted form ofCBT. (Adopted from recommendation 8.2.7.4. of the NICE CPG).9.3.3.2. What is the safety of CBT in patients with BED?The answer is based on the evidence described for CBT efficacy where studies are brieflydescribed (question 9.3.3.1.): in the NICE CPG (2004) 30 and in two quality RCT (1++ and 1+)that were not considered in the aforementioned guide but were included in the high-qualitySRSE (1++) published in the years 2006 31 and 2007 245 . The updated search has identified onemore RCT. Question 9.3.3.1. briefly describes the studies.Scientific EvidenceThere is limited evidence to indicate that there are significant differences between CBTand waiting list in the number of dropouts for any reason by the end of treatment (4RCTs; N=222;Agras, 1995 246 ; Gorin, 2001 247 ,Telch, 1990 248 ,Wilfley, 1993 235 ; RR:1.86;95% CI: 1.10 to 3.15; NNT: 7; 95% CI: 4 to 34).There is not sufficient evidence to indicate that there are significant differencesbetween CBT and IPT in the number of dropouts for any reason by the end of treatment(2 RCTs; N=198; Wilfley, 1993 235 and 2002 249 ; RR: 1.89; 95% CI: 0.89 to 4.02).There is insufficient evidence to indicate that there are significant differences betweenCBT and BWC in the number of dropouts for any reason by the end of treatment (1RCT; N=37: Nauta, 2000 250 ; RR: 0.76; 95% CI: 0.18 to 3.29).The RCT (Hilbert, 2004 252 ; Gorin, 2003 251 ; Peterson, 2001 255 and 1998 256 ) did not reportany adverse effects. The overall dropout rate in one of the RCT (Gorin, 2003) 251 was34% and, in another RCT (Hilbert, 2004) 252 , 14% in each treatment group.In an RCT (Shapiro, 2007) 254 that compared group CBT to CBT-CDROM and wait-list,dropouts in each group were as follows: CD-ROM 32%; group CBT 41%; and wait-list9%. The CBT-CD programme has better acceptability than group CBT in patients withBED.RCT1+RCT1+RCT1+RCT1+RCT1++Summary of the Evidence(See summary of the evidence for psychological treatment)Recommendations(See recommendations 9.GP.12. and 9.GP.17.)111CLINICAL PRACTICE GUIDELINE FOR EATING DISORDERS