Efficacy of psychotherapy for bulimia nervosa and binge‐eating disorder on self‐esteem improvement: Meta‐analysis

Abstract

Objectives: This meta‐analysis examined the effects of psychotherapy for bulimia nervosa (BN) and binge‐eating disorder (BED) on self‐esteem improvement. Method Randomized controlled trials (RCTs) of psychological treatments that assessed self‐esteem change in eating disorders were included. Thirty‐four RCTs were included; most sampled BED and then BN. Hedge’s g effects were entered into random effects models. Results Psychotherapy for BN led to significantly greater post‐treatment improvements in self‐esteem than control conditions (g = 0.45; 95% CI [0.17, 0.73]). This effect was smaller when only analysing low risk of bias trials (g = 0.28; 95% CI [0.05, 0.51]). Psychotherapy for BED also led to significantly greater post‐treatment improvements in self‐esteem than controls (g = 0.20; 95% CI [0.05, 0.35]), with some evidence that guided self‐help was associated with the largest effects. This effect, however, was overestimated after adjustment for publication bias (g = 0.10; 95% CI [−0.05, 0.26]). There was no evidence that cognitive‐behavioural therapy was superior to non‐cognitive‐behavioural therapy interventions in improving self‐esteem. There was no relationship between symptom improvement and self‐esteem improvement in a meta‐regression. Conclusions Psychotherapy may lead to small improvements in self‐esteem in BN and BED. Additional RCTs with follow‐up assessments are required to make more definitive conclusions about the effects of psychotherapy for eating disorders on self‐esteem in the long‐term.

Publication
European Eating Disorders Review
Date
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