Cognitive Behavioral Therapy for the Eating Disorders, Now and Future

Toshihiko Nagata1j

1jDepartment of Neuropsychiatry, Osaka City University Medical School

The Oxford cognitive behavioral therapyiCBTjmanual for bulimia nervosaiFairburn, C. et al. 1981;1993jis currently most popular and standard in the treatment for bulimia nervosa through the numerous multi„Ÿcenter randomized controlled trials. The CBT consists of three stages. 1st stage is behavioral approach to reduce binge eating frequency by inducing the regular eating, 2nd stage is the more cognitive and problem solving approach to reduce restricting food intakes, and 3rd stage is to maintain the effect and to prevent relapse.

Despite the documented efficacy of CBT for bulimia nervosa, a substantial number of patients fail to complete the treatment or respond to this intervention. To maximize the effect and to prevent premature drop out from CBT, motivational interviewing has been proposed. Dialectical behavior therapy is the psychotherapy of choice for bulimia nervosa patients with multi„Ÿimpulsivity or borderline personality disorder.

Finally, the Oxford group proposed the next generation of CBT for BN, e.g. enhanced CBTiCBT„ŸEjbased transdiagnostic theory focusing on the factors that make the eating disorder persistent. For the last two decades, the CBT for BN has made a lot of progress, however we need to modify the CBT to be economically adapted for the mental healthcare in Japan.

Japanese Journal of Cognitive Terapy, 1 : 57„Ÿ66, 2008

Key WordsFcognitive behavioral therapy, bulimia nervosa, interpersonal therapy, motivational interviewing, transdiagnostic theory