(PS5-65) Overcoming Dysfunctional Perceptive-Reactive Systems: The effectiveness of Brief Strategic Therapy for Binge Eating Disorder

Brief Strategic Therapy (BST) has been in development in Italy and Europe with considerable promise to further aid the treatment of eating disorders (Pietrabissa et al., 2019). BST has been particularly targeted at improving outpatient treatment of Binge Eating Disorder (BED), supporting those clients who were not able to achieve recovery with Cognitive Behavioral Therapy (CBT) alone (Cuijpers, 2024). While CBT for BED focuses on stabilizing eating behaviors and changing distorted body image cognitions (Fairburn et al., 1993), BST provides strategies that target dysfunctional perceptive-reactive systems by identifying clients’ repeated ineffective problem-solving attempts that inadvertently maintain or exacerbate eating pathology, and using strategic dialog to reframe attempted solutions as threatening and dangerous (i.e., fearing restricting rather than binging) (Nardone and Salvini, 2007; Nardone and Brook Barbieri, 2010). The purpose of this study was to evaluate the long-term effectiveness of BST for BED in a naturalistic setting. At a state-funded community psychotherapy clinic and at a private clinic that accepts private-funded and public-funded clients in Ireland, data was collected from 35 clients seeking treatment for BED. The Clinical Impairment Assessment questionnaire (Bohn & Fairburn, 2008) and the Eating Disorder Examination Questionnaire (Fairburn & Beglin, 1994) were completed at pretreatment, posttreatment, 6 months and 12 months follow up. Twenty-nine clients completed therapy (71% female and 29% male), and received an average of 8.83 (SD = 1.51). Six clients prematurely discontinued therapy (50% female and 50% male). and received an average of 3.67 (SD = 1.75) therapy sessions. All standardized mean difference points estimate effects (Hedges' g) were statistically significant at the p ≤ .001 level posttreatment and at follow up, and indicated huge (g > 2.0; Sawilowsky, 2009) statistically significant improvements in all areas assessed (psychological impairment g = -4.83, 95%CI [-5.09,-2.88]; restraint g = -3.37, 95%CI [-3.49, -1.97]; eating concerns g = -4.63 95%CI [-5.03, -2.73]; shape concerns g = -4.13, 95%CI [-4.78,-2.69];  weight concerns = -5.00, 95%CI [-6.82,-3.31]). For comparison, a recent meta-analysis of binge eating disorder treatments found large (0.8 < d > 1.2) statistically significant improvements in eating disorder symptomology among clients who received psychotherapy that were maintained through up to 1 year after the conclusion of therapy (Hilbert et al., 2020). Therefore, the results from the study in Ireland suggest BST may be a strong and superior treatment in reducing eating disorder symptoms among clients with BED.