Exposure treatments for bulimia nervosa: Procedure, efficacy, and mechanisms

Cognitive-behavioral therapy has been heralded as the most efficacious intervention for bulimia nervosa. The value of adding exposure with response prevention to cognitive techniques has been widely debated. Part 1 of this review examines the use and effectiveness of exposure treatments for bulimia nervosa. Models of bulimia nervosa which advocate the use of exposure techniques are evaluated. In addition, we examine methodological shortcomings that have hindered our ability to evaluate the efficacy of exposure treatments for this disorder. In Part 2, we place exposure treatments for bulimia nervosa into a broader learning theory context by examining rationales for the use of these techniques based on classical, operant, and social learning theories. In addition, we examine evidence for assumed mechanisms of action of various exposure-based approaches, and focus on models of cue reactivity based on research in the substance abuse area that have significant implications for understanding conditioning processes in bulimia nervosa. Finally, we present guidelines for enhancing laboratory and treatment research that investigate these behavioral principles in bulimia nervosa.