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Group therapy for people with bulimia nervosa: systematic review and meta-analysis

Published online by Cambridge University Press:  15 November 2013

A. Polnay ,
V. A. W. James ,
L. Hodges ,
G. D. Murray ,
C. Munro  and
S. M. Lawrie
A. Polnay*
Affiliation:
Edinburgh Psychotherapy Department, Royal Edinburgh Hospital, Edinburgh, UK Division of Psychiatry, University of Edinburgh, Royal Edinburgh Hospital, Edinburgh, UK
V. A. W. James
Affiliation:
Scottish Mental Health Research Network, Kennedy Tower, Royal Edinburgh Hospital, Edinburgh, UK
L. Hodges
Affiliation:
Division of Psychiatry, University of Edinburgh, Royal Edinburgh Hospital, Edinburgh, UK
G. D. Murray
Affiliation:
Centre for Population Health Sciences, University of Edinburgh Medical School, Teviot Place, Edinburgh, UK
C. Munro
Affiliation:
Anorexia Nervosa Intensive Treatment Team, Royal Edinburgh Hospital, Edinburgh, UK
S. M. Lawrie
Affiliation:
Division of Psychiatry, University of Edinburgh, Royal Edinburgh Hospital, Edinburgh, UK Scottish Mental Health Research Network, Kennedy Tower, Royal Edinburgh Hospital, Edinburgh, UK MRF/MRC CRTF Programme for Mental Health (‘PsySTAR’), Kennedy Tower, Royal Edinburgh Hospital, Edinburgh, UK
*
*Address for correspondence: A. Polnay, Division of Psychiatry, University of Edinburgh, Kennedy Tower, Royal Edinburgh Hospital, Edinburgh EH10 5HF, UK. (Email: adam.polnay@nhs.net)
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Abstract

Background

Approximately 25% of people with bulimia nervosa (BN) who undertake therapy are treated in groups. National guidelines do not discriminate between group and individual therapy, yet each has potential advantages and disadvantages and it is unclear how their effects compare. We therefore evaluated how group therapy for BN compares with individual therapy, no treatment, or other therapies, in terms of remission from binges and binge frequency.

Method

We performed a systematic review and meta-analysis of randomized controlled trials of group therapies for BN, following standard guidelines.

Results

A total of 10 studies were included. Studies were generally small with unclear risk of bias. There was low-quality evidence of a clinically relevant advantage for group cognitive behavioural therapy (CBT) over no treatment at therapy end. Remission was more likely with group CBT versus no treatment [relative risk (RR) 0.77, 95% confidence interval (CI) 0.62–0.96]. Mean weekly binges were lower with group CBT versus no treatment (2.9 v. 6.9, standardized mean difference = −0.56, 95% CI −0.96 to −0.15). One study provided low-quality evidence that group CBT was inferior compared with individual CBT to a clinically relevant degree for remission at therapy end (RR 1.24, 95% CI 1.03–1.50); there was insufficient evidence regarding frequency of binges.

Conclusions

Conclusions could only be reached for CBT. Low-quality evidence suggests that group CBT is effective compared with no treatment, but there was insufficient or very limited evidence about how group and individual CBT compared. The risk of bias and imprecise estimates of effect invite further research to refine and increase confidence in these findings.

Keywords

Bulimia nervosacognitive behavioural therapygroup therapysystematic review
Type
Review Article
Information
Psychological Medicine , Volume 44 , Issue 11 , August 2014 , pp. 2241 - 2254
Copyright
Copyright © Cambridge University Press 2013 

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