Interpersonal Psychotherapy for Eating Disorders
Debbie Whight and the University of Leicester IPT Team
IPT and Bulimia Nervosa
IPT for Bulimia Nervosa (IPT-BN) was discovered to be effective when used as a control treatment for CBT during a randomised controlled trial for individuals with Bulimia Nervosa (BN) (Fairburn et al., 1991). IPT was not adapted specifically for BN in this treatment trial, and beyond limited initial psychoeducation, eating problems were not addressed during the treatment. It was hypothesised that since IPT shared some non-specific factors with CBT, its inclusion in the trial would highlight the benefits of cognitive behavioural techniques in CBT that were not present in IPT. However, while CBT was considered most effective, IPT also resulted in the improvement of eating disorder symptoms. This discovery led to the further development of IPT-BN as a viable treatment option, and it was manualised in 1993 (Fairburn, 1993).
Since its inception, IPT has been compared to CBT, the current treatment of choice, with equally positive results in both individual and group settings (Fairburn, 1997; Fairburn et al, 1993; Fairburn et al., 1991; Fairburn et al, 2000; Roth & Ross, 1988; Wilfley et al., 2003; Wilfley et al., 1993). Agras et al (2000) found that CBT was superior to IPT at the end of treatment however there was no significant difference between the two treatments at one year follow-up. Based on these findings, the NICE guidelines for eating disorders in the UK (NICE, 2004) recommends IPT as an alternative to CBT for the treatment of BN but patients should be informed that it could take longer that CBT to achieve comparable results.
The IPT Team in Leicester (UK) adapted IPT-BN further by bringing back the original components of IPT (psychoeducation, directive techniques, problem solving, modelling, role play and symptom review) and modifying the treatment for individuals with BN where the eating disorders problems are taken into consideration. Although they have been using this model of treatment for BN for more than 15 years, it has only recently been manualized (Whight et al, 2011). A pilot study of this modified treatment indicated early improvements in symptoms that are maintained at the end of treatment (Arcelus, 2009).
Wilfley (1993) described a group format for the treatment of non-purging Bulimia Nervosa with IPT. This was developed using Fairburn’s model of IPT-BN that was adapted for use in a group format. IPT was compared to CBT and waiting list treatment (control) in a randomised controlled trial for a 16 week course of treatment in a cohort of 56 women. At post therapy assessment both the IPT and the CBT groups had reduced symptoms of binge eating, whereas the control group did not. These improvements were sustained at 6 month and 12 month follow up.
IPT and Anorexia Nervosa
McIntosh et al, (2005) conducted a randomised controlled trial comparing IPT, CBT and nonspecific supportive clinical management for patients with Anorexia Nervosa. Of those completing treatment, nonspecific supportive clinical management, the control group, was superior to IPT and CBT.
IPT for Anorexia Nervosa is included in the January 2004 UK National Institute for Clinical Excellence (NICE) Guidelines for Practice.
For more information, contact Debbie Whight at Debbie.Whight@leicspart.nhs.uk
Bibliography
Agras, W.S., Walsh, B.T., Fairburn, C.G., Wilson, G.T. Kraemer, H.C. (2000); A multicenter comparison of cognitive-behavioural therapy and interpersonal psychotherapy for bulimia nervosa: Arch Gen Psych.; 57: 459-466
Arcelus, J., Whight, D., Langham, C., Baggott, J., McGrain, L., Meadows, L,, Meyer, C. (2009); A case series Evaluation of a modified version of interpersonal psychotherapy (IPT) for the treatment of bulimic eating disorders: A pilot study; Eur. Eat. Disorders Rev.; 17; 260-268
Fairburn, C. G., Kirk, J., O'Connor, M., & Cooper, P. J. (1986). A comparison of two psychological treatments for bulimia nervosa. Behav Res Ther, 24, 629-643.
Fairburn, C. G., Jones, R., Peveler, R. C., Carr, S. J., Solomon, R. A., O'Connor, M. E., Burton, J., & Hope, R. A. (1991). Three psychological treatments for bulimia nervosa: A comparative trial. Arch Gen Psychiatry, 48, 463-469.
Fairburn, C. G. (1992). Interpersonal psychotherapy for bulimia nervosa. In G. L. Klerman & M. W. Weissman (Eds.), New applications of interpersonal psychotherapy (pp.353-378). Washington, D. C.: American Psychiatric Press.
Fairburn, C. G., Jones, R., Peveler, R. C., Hope, R. A., & O'Connor, M. (1993). Psychotherapy and bulimia nervosa: The longer-term effects of interpersonal psychotherapy, behaviour therapy and cognitive behaviour therapy. Arch Gen Psychiatry, 50, 419-428.
Fairburn CG, Norman PA, Welch SL, O’Connor ME, Doll HA, Peveler RC (1995): A Prospective Study of Outcome in Bulimia Nervosa and the Long-term effects of Three Psychological Treatments. Arch Gen Psychiatry, 52, 304 – 312, April
McIntosh, V.V., Jordan, J., Carter, F.A., et al. (2005): Three psychotherapies for anorexia nervosa: a randomized, controlled trial. Am J Psychiatry; 162:741–747.
National Institute for Clinical Excellence: Eating disorders: anorexia nervosa, bulimia nervosa and related eating disorders; Understanding NICE guidance: a guide for people with eating disorders, their advocates and carers, and the public: N0407 1P 20k Jan 2004 (ABA)
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-behavioural therapy and group interpersonal psychotherapy for the nonpurging bulimic individual: A controlled comparison. Journal of Consulting and Clinical Psychology, 61, 296-305.
Wilfley, D.E., Frank, M.A., Welch, R., Spurrell, E.B., Rounsaville, B.J. (1998); Adapting Interpersonal Psychotherapy to a group format (IPT-G) for binge eating disorder: Toward a model for adapting empirically supported treatment; Psychotherapy Research; 8(4); 379-391
Wilfley, D.E., Mackenzie, K.R., Welch, R.R., Ayres, V.E., Weissman, M.M. (2000); Interpersonal Psychotherapy for group; Basic Books.
Whight, D.J., Meadows, L., McGrain, L.A., Langham, C.L., Baggott J.N., Arcelus, J.A. (2011) : IPT-BN(m): Interpersonal Psychotherapy for Bulimic Spectrum Disorders: A Treatment Guide; Troubador Press see also http://www.wix.com/leicesteript/ipt-leicester under the Training section.