Group Therapy for Binge Eating

Binge eating disorder is characterized by a person having frequent episodes of eating what others would consider an abnormally large amount of food, while at the same time feeling out of control — the personal feels like they are unable to control what or how much is being eaten.

According to government statistics, people with binge eating disorder are considered clinically obese, but plenty of people can engage in binge eating while maintaining an average or less-than-obese weight. Binge eating disorder probably affects 2 to 3 percent of all adults.
People with a binge eating problem often experience:

• Eating much more rapidly than usual.
• Eating until uncomfortably full.
• Eating large amounts of food, even when not physically hungry.
• Eating alone out of embarrassment at the quantity of food being eaten.
• Feelings of disgust, depression, or guilt after overeating.

Binge eating disorder is a serious mental health concern that, left unchecked, can ruin a person’s life with the feeling of being out of control. The resulting weight gain can also contribute to a person’s poor self-image and self-esteem.

Group therapy is one treatment method used to help people who have binge eating disorder. There are many different kinds of group therapy available, and recently researchers (Peterson et al., 2009) compared three different types of group therapy treatment to gauge their effectiveness in treating binge eating:

• A traditional therapist-led psychotherapy group
• A therapist-assisted group (where the therapist played a secondary role in the group)
• A self-help group

Here’s how the researchers described these three groups: “In the therapist-led CBT groups, a doctoral-level psychotherapist provided psychoeducation during the first half of each session and homework review and discussion during the second half. In the therapist-assisted CBT groups, participants watched a psychoeducational videotape (a specific tape was designed for each session) during the first half of each session, and during the second half a doctoral-level psychotherapist joined the group to review homework and lead a discussion. In the self-help groups, participants watched a psychoeducational videotape during the first half of each session and conducted their own homework review and discussion during the second half. Participants rotated as facilitators for this group.”

The researchers assigned 259 adults to one of these three groups (plus a fourth — a waiting list for treatment, used as a control group). They tested for the severity of binge eating using abstinent rates from binge eating, as well as a measure called the Eating Disorder Examination at the start of treatment, at the end of treatment, and then two more times at followups at 6 and 12 months. Ideally, we’re looking for treatments that would reduce the person’s rate at engaging in binge eating behavior — the higher the abstinent rate, the more effective the treatment. The most effective treatment would have someone no longer engaging in binge eating altogether.

Their findings? “At end of treatment, the therapist-led (51.7%) and the therapist-assisted (33.3%) conditions had higher binge eating abstinence rates than the self-help (17.9%) and waiting list (10.1%) conditions.”

So let’s put these numbers into some context. Getting help from a professional therapist resulted in the most effective treatment at this point — 5 out of 10 people got significantly better, and in the group therapy where a therapist assisted, 3 out of 10 people were helped. But even in the self-help condition, nearly 2 out of 10 people were helped, nearly double that of the control group. In that context, getting some help is better than none at all. And time alone does help some people get better on their own. Patients in the therapist-led group had the highest rate of abstinence and the fewest dropouts at end of treatment.

But here’s where things get really interesting. What about those abstinent rates measured 6 and 12 months after treatment was completed? After all, effective treatment needs to stick in order to prove it’s better than nothing at all. The researchers found no differences between the groups’ abstinent rates at these two followups.

Leave it to the researchers to the best possible light onto their findings:

Therapist-led group cognitive-behavioral treatment for binge eating disorder led to higher binge eating abstinence rates, greater reductions in binge eating frequency, and lower attrition compared to group self-help treatment. Although these findings indicate that therapist delivery of group treatment is associated with better short-term outcome and less attrition than self-help treatment, the lack of group differences at follow-up suggests that self-help group treatment may be a viable alternative to therapist-led interventions.

Well, that’s the kicker then, isn’t it? What use is a professional intervention if you can’t tell it apart from the self-help group (or worse yet, the control group) after treatment is over?

What this research really demonstrates quite well is how any targeted intervention is better than none at all. And that watching a psychoeducational video and then having a discussion about it with a group of other people may be just as effective as a professionally-led psychotherapy group, in the long run.

Reference:

Peterson, C.B., Mitchell, J.E., Crow, S.J., Crosby, R.D. & Wonderlich, S.A. (2009). The Efficacy of Self-Help Group Treatment and Therapist-Led Group Treatment for Binge Eating Disorder. Am J Psychiatry. DOI: 10.1176/appi.ajp.2009.09030345