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When Less is More: Cognitive Behavior Therapy vs Psychoanalysis for Bulimia


Senior Member
As some people will have noticed, I'm not the biggest fan of CBT for ME/CFS. However, I thought I'd highlight this blog post as I thought it was interesting in terms of learning what one should look for when looking at trials of psychological interventions (admittedly, this might not be of interest to everybody, but perhaps a few anyway).

James C. Coyne is also an interesting blogger in general: he tends not to hold back in criticising trials, so it is interesting to see him praising a trial.

When Less is More: Cognitive Behavior Therapy vs Psychoanalysis for Bulimia

By James Coyne PhD
Posted: January 7, 2014

American Journal of Psychiatry published a noteworthy report of a randomized clinical trial (RCT) comparing cognitive behavior therapy to psychoanalytic therapy for bulimia.

Twenty sessions of cognitive behavior therapy over 5 months reducedbinge eating and purgingbetter than 2 years of weekly psychoanalytic psychotherapy. This was true for assessments both at five months (42% versus 6%), marking the ending the cognitive behavior therapy (CBT), and two years (45% versus 16%), marking the ending of the psychoanalytic psychotherapy. Overall, psychoanalytic psychotherapy did not do well, despite the greater intensity of treatment.

If that’s all that you needed to know, you can stop reading here. But continue on if you are interested in finding out more about good conduct and reporting of clinical trials, what’s special about this trial.

continues at: http://blogs.plos.org/mindthebrain/...e-behavior-therapy-vs-psychoanalysis-bulimia/

Roy S

former DC ME/CFS lobbyist
Illinois, USA

From the blog --
"Proponents of psychoanalytic psychotherapy often question whether the randomized control trial is even appropriate for its evaluation."
Quoted in the blog from elsewhere --
"The thesis advanced here is that the privileged status this movement accords such research as against in-depth case studies is unwarranted epistemologically and is potentially damaging both to the development of our understanding of the analytic process itself and to the quality of our clinical work. In a nonobjectivist hermeneutic paradigm best suited to psychoanalysis, the analyst embraces the existential uncertainty that accompanies the realization that there
are multiple good ways to be, in the moment and more generally in life, and that the choices he or she makes are always influenced by culture, by sociopolitical mind-set, by personal values, by countertransference, and by other factors in ways that are never fully known."


Senior Member
No control group, therefore no conclusions can be drawn. What's the percentage of people that get better in this timeframe without intervention?


คภภเє ɠรค๓թєl
The comparative psychotherapy literature consists of a few studies in which a reader can readily predict the outcome of comparisons of psychoanalytic psychotherapy versus other treatments between by simply looking atinvestigator allegiance. Yup, which therapy will produce the largest effect is better predicted by which treatment the investigator advocates, not the particular brand of therapy.

It is highly unusual in finding that any credible psychotherapy has a substantial advantage over any another.

some of the good qualities mentioned of the trial in the OP were:

  • Outcomes were evaluated by raters who were blind to treatment assignment.
  • Analyses were intent to treat, i.e., conducted with all patients who were originally randomized.

unlike some other trials we could mention. :b