Face-to-face therapy best to treat binge eating disorder

(Reuters Health) - - People should opt for face-to-face cognitive behavioral therapy if they’re looking for the fastest way to address their binge eating disorder, suggests a new study from Germany.

Researchers found that while an internet-based self-help program did help people binge eat less often, face-to-face therapy led to a larger and faster reduction in binge eating episodes.

“Although there is evidence that structured self-help treatments based on cognitive-behavioral therapy may be effective for patients, it was unclear how the effects of an Internet-based application are in comparison with cognitive-behavioral therapy,” said senior author Anja Hilbert, of the University of Leipzig Medical Center.

People with binge eating disorder repeatedly eat very large quantities of food in a short period of time, Hilbert and colleagues write in JAMA Psychiatry.

About 1.9 percent of people around the world will have binge eating disorder during their lives, they add.

“Cognitive-behavioral therapy is the most well-established treatment for adults with binge-eating disorder,” Hilbert told Reuters Health in an email.

Self-help programs also showed promise in some research, however.

For the new study, the researchers randomly assigned 178 overweight or obese patients with binge eating disorder to participate in 20 50-minute face-to-face cognitive behavioral therapy sessions or 11 internet-based self-help sessions. The treatments took four months.

Hilbert said the face-to-face therapy was delivered during individual sessions and focused on nutrition, body image and stress. The self-help program on the internet covered similar topics and patients could move through the program at their own pace. Those in the self-help group met with a specialist before starting the program and also received weekly emails.

At the start of the study, the participants reported an average of 14 days with binge eating episodes during the past 28 days. By the end of treatment, that fell to about 4 days among those in the self-help group and about 2 days among the cognitive-behavioral therapy group.

After six months, those in the self-help group reported an average of about 5 binge eating days during the past 28 days, compared to about 3 among the cognitive-behavioral therapy group.

The proportion of patients who were no longer binge eating was also higher among those in the cognitive-behavioral therapy group than among those in the self-help group at both points.

In an analysis of 116 of the patients followed for a year and a half, there was no difference between the two groups.

Hilbert said the better results among the cognitive-behavioral therapy group are likely due to it being more intense than self-help and being paired with therapist support.

She said the results showing cognitive-behavioral therapy worked faster than self-help should be considered during treatment decisions since patients usually need their problems resolved as early as possible.

“However, (self-help) was confirmed as a viable alternative to (cognitive-behavioral therapy), and may be offered to patients with reduced access to (cognitive-behavioral therapy) or who do not wish to participate in an individual psychotherapy,” she said.

Dr. Evelyn Attia, professor of psychiatry at Columbia University Medical Center in New York, said it’s important to explore other treatments for binge eating disorder since cognitive-behavioral therapy may not always be available.

“If somebody with binge eating disorder walked into a doctor’s office, there are a range of treatments that are shown to be helpful,” said Attia, who was not involved with the new study.

For example, she said, some people may be prescribed medications found to help people with binge eating disorder, including antidepressants and the stimulant marketed by Shire as Vyvanse, which was approved in 2015 for use in people with moderate to severe binge eating disorder.

Attia also echoed the author’s statement that self-help programs should not be discounted. This study also showed a significant reduction in the self-help group - and electronic programs have improved since this study was conducted, she said.

SOURCE: JAMA Psychiatry, online August 2, 2017.