Treating eating disorders
The development and dissemination of effective treatments
Eating disorders (anorexia nervosa, bulimia nervosa and related conditions) are common, often chronic and disabling, and sometimes fatal. Professor Chris Fairburn from the Department of Psychiatry and his colleagues have made considerable advances into the understanding and treatment of these conditions.
Until the 1970s the only recognised eating disorder was anorexia nervosa. However, in the mid 1970s there were sporadic reports of a new eating disorder marked by frequent episodes of uncontrolled overeating (binge eating) followed by self-induced vomiting. In 1979 the disorder was named bulimia nervosa. It was said to be 'intractable'.
At the same time Chris Fairburn was collecting cases of bulimia nervosa and investigating the fine-grained effects of precise behavioural interventions designed to perturb specific facets of the condition. Doing so suggested that it was maintained by a limited number of interconnected psychological processes. On this basis he formulated the 'cognitive behavioural theory' of bulimia nervosa and developed a theory-driven treatment, a specific form of cognitive behaviour therapy (CBT-BN).
The success of cognitive behavioural therapy
In a ground-breaking study of the treatment, based in Oxford, and published in 1993, Chris and his colleagues compared CBT-BN to two alternative psychological therapies. They found that CBT-BN produced a complete and lasting cure in almost half the cases, quite unlike the other two treatments. These results were replicated in 2000, together with an American team. As a result of these successes, and further replications elsewhere, the National Institute of Clinical Excellence (NICE) recommended that 'All patients with bulimia nervosa should receive cognitive behavioural therapy'. This was the first time NICE had endorsed a psychological treatment for any disorder.
It is estimated that 96,500 people in England and Wales alone could be cured if they received a course of CBT-BN. However, many people do not come forward for treatment or it may not be available in their area. Therefore, Chris Fairburn developed a simplified version designed as a self-help guide. His 1995 book, Overcoming Binge Eating has sold over 150,000 copies and has been translated into many languages. It is one of the most studied self-help programmes available and its effectiveness has been confirmed in at least 12 controlled studies.
In the late 1990s Chris, together with Zafra Cooper and Roz Shafran, set about developing an 'enhanced' form of CBT-BN suitable for all eating disorders (CBT-E) including anorexia nervosa. They published their results in 2009 and 2013 showing that 80% of patients completed the treatment and three-quarters of these made a full recovery. There is no other treatment with this clinical range or level of effectiveness.
Training in delivering CBT-E
Naturally, there is worldwide interest from clinicians in being trained to deliver CBT-E. This has led Chris and his team to shift their research onto how best to disseminate psychological treatments. The result has been the development of 'web-centred training', a means of training large numbers of therapists simultaneously. It is currently being tested in a pilot study involving all eligible therapists across a country in Europe. Chris is a Wellcome Principal Research Fellow. This entire programme of research has been funded by the Wellcome Trust.