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Douglas L. Bechard, MD
Adventist Health System

Cognitive-Behavioral Therapy for Bulimia Nervosa

Wednesday, April 25th, 2012

Purpose of Technology

Cognitive behavioral therapy (CBT) for bulimia nervosa (BN) is intended to reduce or eliminate the core symptoms of binge eating, purging, and compensatory behaviors associated with the disorder. CBT is a form of psychotherapy, and when tailored to treat BN, the therapist helps the patient identify distorted thinking patterns, recognize and change inaccurate beliefs, relate to others in more positive ways, and change binge eating and purging behaviors. CBT includes educational, behavioral, and cognitive therapy elements. Treatments typically require weekly or biweekly sessions over several months or longer, depending on the severity of the disorder.

Questions addressed in this report include:

  • Does CBT improve or eliminate the core and compensatory symptoms associated with BN?
  • Does CBT lead to abstinence and relapse prevention in BN?
  • How does CBT compare with alternative treatments or waitlist (WL) controls regarding symptom improvement, abstinence, and relapse in BN?
  • Is CBT safe for patients with BN?
  • Have definitive patient selection criteria been established for the use of CBT for the treatment of BN?

These questions provide a framework for review and synthesis of the best available evidence, which is presented in this report, along with the Hayes Ratings for the technology. This report also provides background information about the condition being treated, a description of the technology, and the context for development of the technology. Other key elements addressed in the report include the regulatory status; applicable Medicare and commercial payer coverage policies; relevant ICD-9 and ICD-10 diagnosis codes; cost and cost effectiveness; credentialing; hospital length of stay; need for large case management; and ongoing and future clinical trials of the technology.

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