A randomised controlled trial of internet-based Cognitive-Behavioural Therapy for Bulimia Nervosa or related disorders in a student population, submitted for publication

Section of Eating Disorders, Institute of Psychiatry, King's College London, UK.
Psychological Medicine (Impact Factor: 5.94). 02/2011; 41(2):407-17. DOI: 10.1017/S0033291710000711
Source: PubMed


Bulimic eating disorders are common among female students, yet the majority do not access effective treatment. Internet-based cognitive-behavioural therapy (iCBT) may be able to bridge this gap.
Seventy-six students with bulimia nervosa (BN) or eating disorder not otherwise specified (EDNOS) were randomly assigned to immediate iCBT with e-mail support over 3 months or to a 3-month waiting list followed by iCBT [waiting list/delayed treatment control (WL/DTC)]. ED outcomes were assessed with the Eating Disorder Examination (EDE) at baseline, 3 months and 6 months. Other outcomes included depression, anxiety and quality of life.
Students who had immediate iCBT showed significantly greater improvements at 3 and 6 months than those receiving WL/DTC in ED and other symptoms.
iCBT with e-mail support is efficacious in students with bulimic disorders and has lasting effects.

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    • "Disorders has been formed to improve access to treatment through the States for Treatment Access and Research program, which focuses on educational work and lobbying legislators (Gregorio, 2009). Given the demand for eating disorder services and the limited supply of treatment resources, work on increasing access to treatment has tended to focus on internet-based solutions, such as cognitive behavioral therapy for bulimia nervosa (Carrard et al., 2011; Graham & Walton, 2011; Ljotsson et al., 2007; Sánchez-Ortiz et al., 2011). However, ensuring that more patients receive adequate help is not merely a question of improving access to services. "
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    ABSTRACT: Lack of patient motivation and dropout are common problems in the treatment of eating disorders. The present study explored patient experiences with open access to specialist eating disorder services through a drop-in program aiming to enable early identification of eating disorders, address motivational problems, and strengthen the therapeutic alliance. Semi-structured qualitative interviews were used to explore the experiences of 11 individuals attending the program. Results suggest that drop-in access may strengthen the therapeutic alliance, motivate engagement in treatment, and reduce dropout. Strengths and weaknesses of the program are discussed and the need for more systematic research is elaborated.
    Full-text · Article · May 2014 · Eating disorders
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    • "for adolescents with AN (Lock et al., 2010; Godart et al., 2012), therapist-aided and self-care versions of cognitive-behavioural therapy (CBT) for adolescents and adults with BN (e.g. Fairburn et al., 2009; Mitchell et al., 2011; Schmidt et al., 2007; 2008; Lavender et al., 2012; Sánchez-Ortiz et al., 2011; Carrard et al., 2010), and treating binge eating in BED (e.g. Carrard et al., 2011, De Zwaan et al., 2012). "

    Preview · Article · Nov 2013 · European Eating Disorders Review
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    • "When groups were compared for EDE-Q total, moderate to high effect sizes were found in three studies [16,18,19], while in the two studies of Carrard and colleagues [12,13] these effect sizes were only small to moderate, as were the results of the EDE-Q subscales. In the remaining two studies assessing EDE-Q subscales [16,19], effect sizes between groups were high with the one exception in the “Restraint” subscale, that was only significant in the study conducted by Sanchez-Ortiz et al. [19]. In two studies [12,16] the EDI-2 was implemented in addition to the EDE-Q to aid treatment outcome assessment. "
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    ABSTRACT: This systematic review evaluates the efficacy of internet-based interventions for the treatment of different eating disorders in adults. A search for peer reviewed journal articles detailing Randomised Control Trials (RCT) and Controlled Trials (CT) addressing participants with eating disorders aged at least 16 was completed in the electronic databases Web of Science, PsycInfo and PubMed. The quality of the included articles was assessed, results were reviewed and effect sizes and corresponding confidence intervals were calculated. Eight studies, including a total of N = 609 participants, fulfilled the selection criteria and were included. The majority of treatments applied in these studies were based on CBT principles. Six studies described guided self-help interventions that showed significant symptom reduction in terms of primary and secondary outcomes regarding eating behaviour and abstinence rates. These studies produced significant medium to high effect sizes both within and between the groups after utilisation of guided self-help programs or a self-help book backed up with supportive e-mails. The two remaining studies utilised a specific writing task or e-mail therapy that did not follow a structured treatment program. Here, no significant effects could be found. Treatment dropout rates ranged from 9% to 47.2%. Furthermore, reductions in other symptoms, for example depression and anxiety, and an increase in quality of life were found by four studies. Overall, the results support the value of internet-based interventions that use guided self-help to tackle eating disorders, but further research is needed due to the heterogeneity of the studies.
    Full-text · Article · Aug 2013 · BMC Psychiatry
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