Abstract
BackgroundDespite the availability of effective treatments for bulimia nervosa (BN), a number of barriers to accessibility exist. Examples include access to trained clinicians, the expense of treatment, geographical limitations, and personal limitations such as stigma regarding help seeking. Self-help interventions, delivered via a digital platform, have the potential to overcome treatment gaps by providing patients with standardised, evidence-based treatments that are easily accessible, cost-effective, and require minimal clinician support. Equally, it is important to examine the shortcomings of digital interventions when compared to traditional to face-to-face delivery (e.g., high dropout rates) in order to maximise the therapeutic effectiveness of online, self-help interventions.MethodsA three-arm, multisite randomised controlled trial will be conducted in Australia examining the effectiveness and cost-effectiveness of a newly developed online self-help intervention, Binge Eating eTherapy (BEeT), in a sample of patients with full or sub-threshold BN. The BEeT program consists of 10, multimedia sessions delivering the core components of cognitive behaviour therapy. Eligible participants will be randomised to one of three groups: independent completion of BEeT as a purely self-help program, completion of BEeT alongside clinician support (in the form of weekly telemedicine sessions), or waitlist control. Assessments will take place at baseline, weekly, post-intervention, and three-month follow up. The primary outcome is frequency of objective binge episodes. Secondary outcomes include frequency of other core eating disorder behavioural symptoms and beliefs, psychological distress, and quality of life. Statistical analyses will examine treatment effectiveness, feasibility, acceptability and cost effectiveness.DiscussionThere is limited capacity within the mental health workforce in Australia to meet the demand of people seeking treatment for eating disorders. This imbalance has only worsened following outbreak of the COVID-19 pandemic. Further research is required into innovative digital modes of treatment delivery with the capacity to service mental health needs in an accessible and affordable manner. Self-help programs may also appeal to individuals who are more reluctant to engage in traditional face-to-face treatment formats. This study will provide rigorous evidence on how to diversify treatment options for individuals with BN, ensuring more people with the illness can access evidence-based treatment.The study has been registered with the Australia New Zealand Clinical Trials Registry (ANZCTR Registration Number: ACTRN12619000123145p). Registered 22 January 2019, https://www.australianclinicaltrials.gov.au/anzctr/trial/ACTRN12619000123145.
Highlights
Bulimia nervosa (BN) is an eating disorder (ED) characterised by recurrent objective binge episodes followed by behaviours intended to compensate for the food eaten during the binge [1]
**T0 = baseline assessment, T1 = 12 week assessment, T3 = 24 week assessment (3 month follow up), T3 = 36 week assessment 1 Body mass index (BMI) measured in fourth week of participation
Should the results demonstrate the Binge Eating eTherapy (BEeT) program to be an effective intervention, this research has the potential to change the treatment landscape for individuals with bulimia nervosa (BN)
Summary
Bulimia nervosa (BN) is an eating disorder (ED) characterised by recurrent objective binge episodes followed by behaviours intended to compensate for the food eaten during the binge [1]. Epidemiological research conducted on an Australian sample from 1998 to 2008 has identified an upward trend in core symptoms BN including objective binge episodes and extreme dieting [3]. These findings are concerning given the significant physical and psychological impairments imposed by BN [4]. The impacts of the illness are only worsened by personal barriers of shame and stigma associated with disordered eating behaviours, which function to discourage help seeking and result in worsening of untreated symptoms [9]. It is important to examine the shortcomings of digital interventions when compared to traditional to face-to-face delivery (e.g., high dropout rates) in order to maximise the therapeutic effectiveness of online, self-help interventions
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