Internet-delivered cognitive-behavioural therapy v. conventional guided self-help for bulimia nervosa: Long-term evaluation of a randomised controlled trial

Eva Penelo, PhD, Laboratori d'Estadística Aplicada, Departament de Psicobiologia i Metodologia de les Ciències de la Salut, Universitat Autònoma de Barcelona, Spain
The British journal of psychiatry: the journal of mental science (Impact Factor: 7.99). 12/2012; 202(2). DOI: 10.1192/bjp.bp.111.098582
Source: PubMed


BACKGROUND: Cognitive-behavioural therapy (CBT)-based guided self-help is recommended as a first step in the treatment of bulimia nervosa. AIMS: To evaluate in a randomised controlled trial ( registration number: NCT00461071) the long-term effectiveness of internet-based guided self-help (INT-GSH) compared with conventional guided bibliotherapy (BIB-GSH) in females with bulimia nervosa. METHOD: A total of 155 participants were randomly assigned to INT-GSH or BIB-GSH for 7 months. Outcomes were assessed at baseline, month 4, month 7 and month 18. RESULTS: The greatest improvement was reported after 4 months with a continued reduction in eating disorder symptomatology reported at month 7 and 18. After 18 months, 14.6% (n = 7/48) of the participants in the INT-GSH group and 25% (n = 7/28) in the BIB-GSH group were abstinent from binge eating and compensatory measures, 43.8% (n = 21/48) and 39.2% (n = 11/28) respectively were in remission. No differences regarding outcome between the two groups were found. CONCLUSIONS: Internet-based guided self-help for bulimia nervosa was not superior compared with bibliotherapy, the gold standard of self-help. Improvements remain stable in the long term.

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Available from: Andreas F K Karwautz, Oct 01, 2014
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    • "In terms of the primary outcome measure, it is expected that both treatment conditions will be superior to the waiting list control condition (for example, [4,18]). Although there is a limited amount of evidence in eating disorders, it is hypothesised that both treatments (face-to-face and email GSH) will be comparable in terms of effectiveness (for example, [24]) in reducing binge eating frequency (see also [21]). It is expected that similar results will be found with secondary outcome measures, drop-out and cost-effectiveness, although these variables have not yet been studied in detail in this way. "
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    ABSTRACT: Background Guided self-help is a recommended first-step treatment for bulimia nervosa, binge eating disorder and atypical variants of these disorders. Further research is needed to compare guided self-help that is delivered face-to-face versus via email. Methods/Design This clinical trial uses a randomised, controlled design to investigate the effectiveness of providing guided self-help either face-to-face or via e-mail, also using a delayed treatment control condition. At least 17 individuals are required per group, giving a minimum N of 51. Discussion Symptom outcomes will be assessed and estimates of cost-effectiveness made. Results are proposed to be disseminated locally and internationally (through submission to conferences and peer-reviewed journals), and will hopefully inform local service provision. The trial has been approved by an ethics review board and was registered with NCT01832792 on 9 April 2013.
    Full-text · Article · May 2014 · Trials
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    • "The treatment of ED has been a challenge for both clinicians and researchers (Tasca & Machado, 2013) with significant efforts being made to enhance its effectiveness and accessibility. Previous research has shown that guided self-help (GSH) based on cognitive behaviour therapy (CBT) can be a low-intensity, easily delivered and effective strategy in treating patients with BN, BED and EDNOS (National Institute for Clinical Excellence, 2004; Sanchez-Ortiz & Schmidt, 2010; Sysko & Walsh, 2008; Wagner et al., 2013). However, there is no clear evidence on who would benefit from the treatment (e.g. "
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    ABSTRACT: The aims of this study were to investigate the number of sessions and time required for a clinical meaningful symptomatic change with a guided self-help treatment and to assess the predictive value of early response and other potential predictors of end-of-treatment clinical status. Participants were 42 patients with a diagnosis of bulimia nervosa or ED not otherwise specified. Survival analyses (Kaplan-Meier) were performed to estimate the median time required to attain a 51% reduction in bulimic symptoms. Logistic regression was used to assess predictors of symptom remission. Results showed that the median time to achieve a 51% reduction in binge and purge frequencies was 3.68 and 3.77, respectively. This change occurred at session 3 for 50% of the participants. Early response was the most significant predictor of binge eating remission. No pretreatment predictors of time to achieve early response were found. These results have implications for allocating treatment resources in a stepped-care intervention model. Copyright © 2013 John Wiley & Sons, Ltd and Eating Disorders Association.
    Full-text · Article · Jan 2014 · European Eating Disorders Review
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    • "For eating disorders, until recently the few existing studies on internet-based interventions have focused mainly on bulimia nervosa (BN) [15,17-23] and binge eating disorder (BED) [24-27]. Meanwhile, research on internet therapy has expanded. "
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    ABSTRACT: Background To study the longer term effects of an internet-based CBT intervention for relapse prevention (RP) in anorexia nervosa. Methods 210 women randomized to the RP intervention group (full and partial completers) or the control group were assessed for eating and general psychopathology. Multiple regression analysis identified predictors of favorable course concerning Body Mass Index (BMI). Logistic regression analysis identified predictors of adherence to the RP program. Results Most variables assessed showed more improvement for the RP than for the control group. However, only some scales reached statistical significance (bulimic behavior and menstrual function, assessed by expert interviewers blind to treatment condition). Very good results (BMI) were seen for the subgroup of “full completers” who participated in all nine monthly RP internet-based intervention sessions. “Partial completers” and controls (the latter non-significantly) underwent more weeks of inpatient treatment during the study period than “full completers”, indicating better health and less need for additional treatment among the “full completers”. Main long-term predictors for favorable course were adherence to RP, more spontaneity, and more ineffectiveness. Main predictors of good adherence to RP were remission from lifetime mood and lifetime anxiety disorder, a shorter duration of eating disorder, and additional inpatient treatment during RP. Conclusions Considering the high chronicity of AN, internet-based relapse prevention following intensive treatment appears to be promising.
    Full-text · Article · Jul 2013 · International Journal of Eating Disorders
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