Psychotherapies for eating disorders: findings from a rapid review
Authors: Russell Haley , Aouad Phillip , Le Anvi , Marks Peta , Maloney Danielle ,   National Eating Disorder Research Consortium, Aouad Phillip , Barakat Sarah , Boakes Robert , Brennan Leah , Bryant Emma , Byrne Susan , Caldwell Belinda , Calvert Shannon , Carroll Bronny , Castle David , Caterson Ian , Chelius Belinda , Chiem Lyn , Clarke Simon , Conti Janet , Crouch Lexi , Dammery Genevieve , Dzajkovski Natasha , Fardouly Jasmine , Feneley John , Foroughi Nasim , Fuller-Tyszkiewicz Mathew , Fursland Anthea , Gonzalez-Arce Veronica , Gouldthorp Bethanie , Griffin Kelly , Griffiths Scott , Hambleton Ashlea , Hannigan Amy , Hart Mel , Hart Susan , Hay Phillipa , Hickie Ian , Kay-Lambkin Francis , King Ross , Kohn Michael , Koreshe Eyza , Krug Isabel , Linardon Jake , Long Randall , Long Amanda , Madden Sloane , Maguire Sarah , Maloney Danielle , Marks Peta , McLean Siân , Meddick Thy , Miskovic-Wheatley Jane , Mitchison Deborah , O’Kearney Richard , Ong Shu Hwa , Paterson Roger , Paxton Susan , Pehlivan Melissa , Pepin Genevieve , Phillipou Andrea , Piccone Judith , Pinkus Rebecca , Raykos Bronwyn , Rhodes Paul , Rieger Elizabeth , Rockett Karen , Rodan Sarah , Russell Janice , Russell Haley , Salter Fiona , Sawyer Susan , Shelton Beth , Singh Urvashnee , Smith Sophie , Smith Evelyn , Spielman Karen , Squire Sarah , Thomson Juliette , Tiggemann Marika , Touyz Stephen , Utpala Ranjani , Vartanian Lenny , Vatter Sabina , Wallis Andrew , Ward Warren , Wells Sarah , Wertheim Eleanor , Wilksch Simon , Williams Michelle , Touyz Stephen , Maguire Sarah 
Published: October 2023

Background

Psychotherapy is considered central to the effective treatment of eating disorders—focusing on behavioural, psychological, and social factors that contribute to the illness. Research indicates psychotherapeutic interventions out-perform placebo, waitlist, and/or other treatments; but, outcomes vary with room for major improvement. Thus, this review aims to (1) establish and consolidate knowledge on efficacious eating disorder psychotherapies; (2) highlight select emerging psychotherapeutic interventions; and (3) identify knowledge gaps to better inform future treatment research and development.

Methods

The current review forms part of a series of Rapid Reviews published in a special issue in the Journal of Eating Disorders to inform the development of the Australian-government-funded National Eating Disorder Research and Translation Strategy 2021–2031. Three databases were searched for studies published between 2009 and 2023, published in English, and comprising high-level evidence studies (meta-analyses, systematic reviews, moderately sized randomised controlled studies, moderately sized controlled-cohort studies, and population studies). Data pertaining to psychotherapies for eating disorders were synthesised and outlined in the current paper.

Results

281 studies met inclusion criteria. Behavioural therapies were most commonly studied, with cognitive-behavioural and family-based therapies being the most researched; and thus, having the largest evidence-base for treating anorexia nervosa, bulimia nervosa, and binge eating disorder. Other therapies, such as interpersonal and dialectical behaviour therapies also demonstrated positive treatment outcomes. Emerging evidence supports specific use of Acceptance and Commitment; Integrative Cognitive Affective; Exposure; Mindfulness; and Emotionally-Focused therapies; however further research is needed to determine their efficacy. Similarly, growing support for self-help, group, and computer/internet-based therapeutic modalities was noted. Psychotherapies for avoidant/restrictive food intake disorder; other, and unspecified feeding and eating disorders were lacking evidence.

Conclusions

Currently, clinical practice is largely supported by research indicating that behavioural and cognitive-behavioural psychotherapies are most effective for the treatment of eating disorders. However, the efficacy of psychotherapeutic interventions varies across studies, highlighting the need for investment and expansion of research into enhanced variants and novel psychotherapies to improve illness outcomes. There is also a pressing need for investigation into the whole range of eating disorder presentations and populations, to determine the most effective interventions.