Treatment:
Interpersonal Psychotherapy for Binge Eating Disorder
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Brief Summary
Interpersonal Psychotherapy for Binge Eating Disorder
Status: Strong Research Support
Description
Interpersonal Psychotherapy (IPT) for binge eating disorder is based on an intervention originally developed for the treatment of depression. In IPT, the focus is on interpersonal difficulties in the patient’s life. The connection between these problems and the development and maintenance of the eating disorder is identified at the beginning of treatment, but only implied thereafter. IPT for binge eating disorder is administered in either group or individual format, and is conducted in approximately twenty weekly sessions, which encompass three phases. The first phase of IPT is devoted to identifying specific interpersonal problems areas currently affecting the patient, and choosing which of these areas to focus on for the remainder of treatment. The four typical interpersonal problem domains are role disputes, role transitions, interpersonal deficits, and unresolved grief. Interpersonal precipitants of current binge eating episodes are highlighted during this phase. In the second phase of IPT for binge eating disorder, the therapist encourages the patient to take the lead in facilitating change in the interpersonal realm. The therapist’s role involves keeping the patient aware of the time frame of treatment and focused on the problem areas, clarifying issues raised by the patient, and encouraging change. The third phase covers maintenance of interpersonal gains and relapse prevention.
Key References (in reverse chronological order)
- Wilson, G.T., Wilfley, D.E., Agras, W.S., & Bryson, S.W. (2010).Psychological treatments for binge eating disorder. Archives of General Psychiatry, 67, 94-101.
- Wilfley, D.E., Welch, R.R., Stein, R.I., Spurrell, E.B., Cohen, L.R., Saelens, B.E., Dounchis, J.Z., Frank, M.A., Wiseman, C.V., & Matt, G.E. (2002). A randomized comparison of group cognitive-behavioral therapy and group interpersonal psychotherapy for the treatment of overweight individuals with binge-eating disorder. Archives of General Psychiatry, 59(8), 713-721.
- Wilfley, D. E., Agras, W. S., Telch, C. F., Rossiter, E. M., Schneider, J. A., Cole, A. G., Sifford, L., & Raeburn, S. D. (1993). Group cognitive-behavioral therapy and group interpersonal psychotherapy for the nonpurging bulimic individual: A controlled comparison. Journal of Consulting and Clinical Psychology, 61, 296-305.
Clinical Resources
- Wilfley, D.E., Mackenzie, K.R., Welch, R., Ayres, V., & Weissman, M.M. (2000). Interpersonal Psychotherapy for Group. New York: Basic Books.
- Wilfley, D.E., Grilo, C.M., & Rodin, J. (1997). Group psychotherapy for the treatment of bulimia nervosa and binge eating disorder: Research and clinical methods. In J.L. Spira (Ed.), Group therapy for medically ill patients (pp. 225-295). New York: Guilford Press.
- Klerman, G. L., Weissman, M. M., Rounsaville, B. J., & Chevron, E. S. (1984). Interpersonal psychotherapy of depression. New York: Basic Books.
Training Opportunities
- Contact Christopher G. Fairburn, DM, FRCPsych (Oxford University)
- Denise Wilfley, PhD. (Washington University) at [email protected] (research only)
Treatment Resources
Note: The resources provided below are intended to supplement not replace foundational training in mental health treatment and evidence-based practice
Cognitive-behavioral therapy (CBT) is no sure-fire cure for binge-eating disorder. Yet until now no other psychotherapy has been shown to be as effective against the disorder. CBT consists of strategies to help binge eaters normalize their eating habits. For instance, writing down foods eaten, times eating occurred, and the eating context helps binge eaters identify times and situations in which binge eating is more likely to occur and often makes it clear to them how chaotically they’ve been eating. The therapy also includes strategies to help binge eaters realize that, even if they are overweight, people are still going to like them.
Now interpersonal psychotherapy has been found to be as effective for binge-eating disorder as is cognitive-behavioral therapy in a study headed by Denise Wilfley, Ph.D., an associate professor of psychiatry and psychology at Washington University School of Medicine, and coworkers. They report their findings in the August Archives of General Psychiatry.
Interpersonal Problems
Interpersonal psychotherapy for binge-eating disorder helps people identify interpersonal problems that may predispose them to compulsive overeating and learn how to correct those difficulties. For instance, people with the disorder may lack the skills to make friends, so they turn to food when lonely. They may turn to the same solution after fighting with a partner, in which food provides some solace.
In 1993 Wilfley and coworkers reported evidence suggesting that interpersonal psychotherapy might be just as good a treatment for binge-eating disorder as cognitive-behavioral therapy. Because the study was based on a modest sample (56 participants), however, they decided to again pit interpersonal therapy against cognitive-behavioral therapy in treating the disorder, but this time using 162 subjects.
The subjects were randomly assigned to 20 weekly sessions of either cognitive-behavioral therapy or interpersonal psychotherapy. Although the sessions were group sessions, each participant also received individual sessions before, in the middle, and at the end of treatment to individualize the intervention for each participant.
Subjects’ binge-eating habits and weight were assessed before treatment, after the weekly treatment sessions ended, and at four-month intervals up to a year after treatment.
Binge-eating recovery rates, the researchers found, were comparable for both treatment groups immediately after treatment ended (79 percent for cognitive-behavioral therapy and 73 percent for interpersonal psychotherapy). Binge-eating recovery rates were also similar for both treatment groups one year after treatment had ended (59 percent for cognitive-behavioral therapy and 62 percent for interpersonal psychotherapy).
True, persons with binge-eating disorder often struggle with being overweight as well as with binge eating, and all of the 162 subjects in this study were overweight. Neither type of therapy led to a dramatic reduction in weight in a number of subjects. Specifically, there was a statistically significant average decrease in body-mass index for participants in both groups from baseline to the one-year follow-up, but the decrease was not enough to reduce the health risks associated with being considerably overweight.
Nonetheless, some individuals in each treatment group did manage to lose enough weight to benefit their health. These were the subjects who had abstained from binge eating at the end of treatment until the one-year follow-up.
Focus Away From Food
The finding that interpersonal psychotherapy is just as good as cognitive-behavioral therapy in halting binge eating and overconsumption should prove heartening to those who engage in both behaviors, one of the study’s co-authors, Brian Saelens, Ph.D., assistant professor of pediatrics at Cincinnati Children’s Hospital Medical Center, said. Interpersonal psychotherapy, he explained to Psychiatric News, “is a novel approach relative to many of the approaches that individuals with binge-eating disorder have tried before. It takes some of the focus away from food and eating—issues that individuals with binge-eating problems have often struggled with most of their lives.”
The study was supported by grants from the National Institute of Mental Health.
The study, “A Randomized Comparison of Group Cognitive-Behavioral Therapy and Group Interpersonal Psychotherapy for the Treatment of Overweight Individuals With Binge-Eating Disorder,” is posted on the Web at http://archpsyc.ama-assn.org/issues/v59n8/rfull/yoa20409.html. ▪
