Wednesday, October 27, 2010

Acceptance and Commitment Therapy Vs. Cognitive Therapy for the Treatment of Comorbid Eating Pathology

Recently, a group of researchers at Drexel University--including Dr. James Herbert, who we interviewed about mindfulness over the summer--conducted a study comparing Acceptance and Commitment Therapy (ACT) and Cognitive Therapy (CT) for disordered eating. Juarascio and colleagues looked at people in treatment with "subclinical eating pathology"--meaning that most people identified problematic eating behavior but didn't qualify for an official eating disorder diagnosis.

Although CBT is considered the gold-standard for eating disorder treatment, some research indicates only 30-50% of people completely stop binging and purging, according to research cited by the authors. Consequently, there seems to be some room for improvement.

This study appears to have been culled from the leftovers from a previous study of ACT and CT treatment for anxiety and depression (Foreman et al., 2007), that it was pulled from the same data set. It looks like the authors found that a number of participants (N = 55) from the data set reported eating disordered behavior and ran additional analyses on these individuals.

This study is what is known as an effectiveness study. It doesn't have the control of an efficacy study, but it plays out closer to what happens in real life. This makes it more naturalistic. (Click here for a quick explanation of efficacy vs. effectiveness.)

Participants agreed to the study and were randomly assigned to either an ACT or a CT therapist. These were students at a post-baccalaureate institution who received treatment from one of 23 doctoral students trained in both ACT and CT. Therapy was not conducted through a manual or protocol, as would happen in an efficacy study.

The researchers predicted people who received ACT would show greater improvements than those who received CT, and analyses supported this hypothesis. Although CT lead to small improvements in eating disorder behavior, ACT led to very large improvements.

Because treatment wasn't manualized, we don't know exactly what components of CT and ACT were drawn upon in therapy. In addition, CT participants didn't necessarily receive gold-standard CT protocols for eating disordered behavior. In fact, as they note, the researchers are not certain if  eating disordered behavior was a focus. And, as was noted, the eating disordered problems were generally subclinical. For these reasons, this study cannot be considered a test of a gold-standard cognitive behavioral treatment for eating disorders against ACT.

That said, this study has wonderful real world validity. If someone with eating disordered problems walked into a CT or an ACT therapist's office, this is the kind of treatment he or she may be likely to receive. Fewer clinicians use the kind of manualized treatments that are used in more controlled studies (e.g., RCT's), although knowledge of manualized treatments can be very useful in real world practice.

This study provides pretty good evidence for the effectiveness of ACT in addressing eating disordered behavior. ACT promotes greater mindfulness, acceptance, and movement towards valued directions; by contrast, CT focuses on changing the content of one's thinking. Results suggest ACT processes of change may be more appropriate for individuals with eating disordered problems than CT processes.

Drs. Forman and Herbert have large collection of their research available as PDF's on their Drexel research lab page. Click here to download a copy of the article.

For the full citation:

Juarascio, A. S., Forman, E. M., & Herbert, J. D. (2010). Acceptance and Commitment Therapy versus Cognitive Therapy for the treatment of comorbid eating pathology. Behavior Modification, 34(2), 175-190.

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