Interpersonal psychotherapy for eating disorders: current perspectives

Psychology Research and Behavior Management Dovepress open access to scientific and medical research Review Psychology Research and Behavior Management downloaded from https://www.dovepress.com/ by 54.38.22.117 on 21-Dec-2018 For personal use only. Open Access Full Text Article Interpersonal psychotherapy for eating disorders: current perspectives This article was published in the following Dove Press journal: Psychology Research and Behavior Management Mario Miniati 1 Antonio Callari 1 Alessandra Maglio 1 Simona Calugi 2 1 Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy; 2Department of Eating and Weight Disorders, Villa Garda Hospital, Verona, Italy Introduction Rationale Correspondence: Mario Miniati Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Via Roma 67, 56100, Italy Email The overvaluation of shape, weight, and eating control are core psychopathological features of eating disorders (EDs) and have negative effects on intimate relationships.1 Extreme concern about eating control and its expressions negatively affect mood and cognition, damaging education and vocational performances, with up to 20% of subjects no longer able to function independently 10–20 years after the illness onset.2,3 Features of EDs can be directly maintained by interpersonal difficulties: both binge eating and dietary restraint tend to occur in the context of (or are exacerbated by) adverse interpersonal events. Several psychotherapeutic approaches for EDs encompass interpersonal difficulties, stating that lifetime interpersonal dysfunctions could be precursors, 353 submit your manuscript | www.dovepress.com Psychology Research and Behavior Management 2018:11 353–369 Dovepress © 2018 Miniati et al. This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms. php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php). http://dx.doi.org/10.2147/PRBM.S120584 Powered by TCPDF (www.tcpdf.org) Background: Interpersonal psychotherapy (IPT) is a time-limited and affect-, life-event-, and present-focused psychotherapy originally conceptualized for unipolar depression, and then adapted to the treatment of other disorders, including eating disorders (EDs). The purpose of this paper is to conduct a systematic review of studies on IPT for EDs. Methods: The authors performed literature searches, study selection, method, and quality evaluation independently. Data were summarized using a narrative approach. Results: Of the 534 papers retrieved, 37 studies met the inclusion criteria, and 15 were considered for the systematic review (randomized controlled trials and long-term follow-up studies derived from the randomized controlled trials). Their analysis revealed six main findings: 1) no significant differences between IPT and cognitive-behavioral therapy (CBT) were found when administered as monotherapy to patients with anorexia nervosa; 2) when administered as monotherapy to patients with bulimia nervosa (BN), IPT had lower outcomes than CBT and its enhanced version; 3) patients with BN who remitted with IPT showed a prolonged time spent in clinical remission, when followed up on the long term; 4) IPT and CBT, with different timings and methods, have both shown efficacy in the mid-term/long-term period in patients with BN; 5) CBT and its enhanced version produced rapid changes in the acute phase. IPT led to improvements occurring later, with slower changes that tended to maintain efficacy in the long term; 6) abstinence from binge eating with group IPT for binge eating disorder is stable and maintained (or further improved) in the long term. Conclusion: IPT is a reasonable, cost-effective alternative to CBT for the overall ED spectrum. Keywords: interpersonal psychotherapy, eating spectrum, bulimia nervosa, anorexia nervosa, binge-eating disorder, treatment efficacy Dovepress Psychology Research and Behavior Management downloaded from https://www.dovepress.com/ by 54.38.22.117 on 21-Dec-2018 For personal use only. Miniati et al prodromals, or sequelae of a full-blown ED.4 Interpersonal psychotherapy (IPT) is a time-limited, affect-, life-event-, and present-focused psychotherapy that emphasizes the interpersonal context of symptoms. Mainly based on Sullivan’s interpersonal theory and Bowlby’s attachment model and originally conceptualized for unipolar depression, IPT has been adapted for the treatment of other disorders, including EDs.5–9 In contrast to cognitive-behavior therapy for bulimia nervosa (CBT-BN), whose theoretical model was originally formulated in the 1980s, the adaptation of IPT to EDs derives from an empirically supported model.10,11 The rationale for applying IPT to EDs is clinical rather than theoretical: interpersonal difficulties are common in patients with EDs; they may predate the onset of EDs or be consequential, but always maintain the disorder through a number of mechanisms, especially during late adolescence and early adulthood. Patients become more isolated from the normalizing influence of their peers, and, as a result, their symptoms persist unchallenged. As in the classical IPT for depression, the patient and the therapist define a central “interpersonal problem” or “treatment focus”, falling into one (or more) of the following categories: 1) lack of intimacy and interpersonal deficits; 2) interpersonal role disputes (a conflict, overt or covert, in an important relationship); 3) role transitions (an unsettling major life change); 4) complicated grief (a complicated bereavement reaction following the death of a loved one, with difficulty reestablishing satisfying interpersonal ties in the absence of the deceased); and 5) life goals (specific focus of IPT for EDs), namely, problems with future life plans interfering with interpersonal functioning.12 Despite the rationale supporting the adaptation of IPT to EDs, IPT has been modified for anorexia nervosa (AN) and bulimia nervosa (BN) to some degree to its disadvantage when compared with CBT, presuming an equivalence in target and techniques between AN and BN.13 Objectives The main aim of this paper is to systematically review finding from clinical studies that tested IPT in EDs. We set out to systematically review the published literature on the topic in accordance with the PICOS process as follows: P —population: female and male patients of any age who met the diagnosis criteria for AN, BN, binge (...truncated)