Abstract
BackgroundMany patients with eating disorders do not receive help for their symptoms, even though these disorders have severe morbidity. The Internet may offer alternative low-threshold treatment interventions.ObjectiveThis study evaluated the effects of a Web-based cognitive behavioral therapy (CBT) intervention using intensive asynchronous therapeutic support to improve eating disorder psychopathology, and to reduce body dissatisfaction and related health problems among patients with eating disorders.MethodsA two-arm open randomized controlled trial comparing a Web-based CBT intervention to a waiting list control condition (WL) was carried out among female patients with bulimia nervosa (BN), binge eating disorder (BED), and eating disorders not otherwise specified (EDNOS). The eating disorder diagnosis was in accordance with the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, and was established based on participants’ self-report. Participants were recruited from an open-access website, and the intervention consisted of a structured two-part program within a secure Web-based application. The aim of the first part was to analyze participant’s eating attitudes and behaviors, while the second part focused on behavioral change. Participants had asynchronous contact with a personal therapist twice a week, solely via the Internet. Self-report measures of eating disorder psychopathology (primary outcome), body dissatisfaction, physical health, mental health, self-esteem, quality of life, and social functioning were completed at baseline and posttest.ResultsA total of 214 participants were randomized to either the Web-based CBT group (n=108) or to the WL group (n=106) stratified by type of eating disorder (BN: n=44; BED: n=85; EDNOS: n=85). Study attrition was low with 94% of the participants completing the posttest assignment. Overall, Web-based CBT showed a significant improvement over time for eating disorder psychopathology (F 97=63.07, P<.001, d=.82) and all secondary outcome measures (effect sizes between d=.34 to d=.49), except for Body Mass Index. WL participants also improved on most outcomes; however, effects were smaller in this group with significant between-group effects for eating disorder psychopathology (F 201=9.42, P=.002, d=.44), body dissatisfaction (F 201=13.16, P<.001, d=.42), physical health (F 200=12.55, P<.001, d=.28), mental health (F 203=4.88, P=.028, d=.24), self-esteem (F 202=5.06, P=.026, d=.20), and social functioning (F 205=7.93, P=.005, d=.29). Analyses for the individual subgroups BN, BED, and EDNOS showed that eating disorder psychopathology improved significantly over time among Web-based CBT participants in all three subgroups; however, the between-group effect was significant only for participants with BED (F 78=4.25, P=.043, d=.61).ConclusionsWeb-based CBT proved to be effective in improving eating disorder psychopathology and related health among female patients with eating disorders.Trial RegistrationNederlands Trial Register (NTR): NTR2415; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2415 (Archived by WebCite at http://www.webcitation.org/6T2io3DnJ).
Highlights
In the Netherlands, eating disorders have a lifetime prevalence of 1.74% [1], and these disorders account for severe psychological, physical, and social morbidity
J Med Internet Res 2015 | vol 17 | iss. 6 | e152 | p.1 ter Huurne et al Conclusions: Web-based cognitive behavioral therapy (CBT) proved to be effective in improving eating disorder psychopathology and related health among female patients with eating disorders
Our study shows that Web-based CBT is effective in reducing eating disorder psychopathology in participants with eating disorders in comparison with a waiting list control group
Summary
In the Netherlands, eating disorders have a lifetime prevalence of 1.74% [1], and these disorders account for severe psychological, physical, and social morbidity. Low-threshold Internet interventions may reach patients with less advanced disorders and prevent their condition from progressing. In the past few years, several Internet interventions have been developed for patients with eating disorders, and a recent review showed that these treatments can be effective in reducing eating disorder psychopathology, binge eating, and purging, as well as in improving quality of life [10]. Studies conducted among patients with EDNOS mostly included interventions aimed at (indicated) prevention or early intervention in eating disorders [12,13,14]. Some interventions proved to be effective, most studies included only adolescents and young women [12,13], while the EDNOS subgroup includes a broader population of patients with eating disorder symptoms.
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