On April 18th, 2009 Dr. Stewart Agras will be among five national speakers to present in Towson, Maryland at The Center for Eating Disorders’ annual professional symposium, Eating Disorders: State of the Art Treatment. Dr. Agras is currently a Professor Emeritus of Psychiatry at Stanford University School of Medicine and has made significant contributions to the field of eating disorder treatment through his extensive research over the last twenty years. At this year’s symposium, Dr. Agras will deliver the most up-to-date treatment information for professionals in his talk, Improving the Treatment of Bulimia . He responded to some of our questions about this topic and we’ve posted them in today’s blog.
Dr. Agras, how have the treatments for bulimia nervosa changed and progressed over time? What do you think has driven these changes?
“When the number of individuals with bulimia began to increase in clinics during the 1970’s no treatment for bulimia nervosa had been described in the literature. This led researchers at Oxford University (UK) and Stanford to develop cognitive-behavioral therapy based, in part, on clinical insights into the disorder and using elements from the behavioral treatments of binge eating and depression. Subsequent research studies over the years refined the treatment, adding elements such as attention to interpersonal triggers of binge eating. Hence, the changes were largely driven by research studies and more extensive clinical experience with this difficult patient group.”
Why is cognitive behavioral therapy (CBT) considered the “treatment of choice” for bulimia nervosa?
“A fairly large number of controlled studies have shown that CBT is more effective than medication (both tricyclic antidepressants and SSRI), supportive-expressive psychotherapy, stress management, and interpersonal psychotherapy (IPT). However, in a large-scale controlled trial interpersonal therapy was as effective as CBT at 1-year follow-up. Hence, the evidence clearly suggests that CBT is the treatment of choice and that it will act more quickly than IPT.”
What is guided self-help (GSH) and is it beneficial for patients who are struggling with bulimia nervosa?
“Guided self-help is a shortened version of CBT in which the patient is encouraged to read a book describing the disorder and its treatment and is “coached” by a therapist in brief 20-30 minute sessions. Within the session the emphasis is on using the book to solve problems. A number of small scale trials have shown that GSH is about as effective as full CBT, and one large-scale trial has confirmed this finding. Hence, GSH is clearly effective for at least some patients who are struggling with bulimia nervosa, and the question arises whether GSH should be used as a first step in the treatment of bulimia nervosa.”
Many thanks to Dr. Stewart Agras for his responses and participation in today’s blog. The Center for Eating Disorders is happy to present eating disorder professionals with the opporuntinity to hear Dr. Agras speak live at the symposium on April 18th. Additionally, he has several recent publications that are available from Gurze Books online.
To download the symposium program brochure or to register for the April 18th symposium, please visit our events page. This event is open to all professionals who treat patients with eating disorders and has been approved for 6.25 CEUs for physicians, nurses, psychologists, social workers and counselors and 6.5 credits for dietitians. The discounted registration rate expires on April 10th and space is limited so don’t delay! Please call (410) 938-4593 if you have any questions.
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