Online Cognitive–Behavioural Treatment of Bulimic Symptoms: A Randomized Controlled Trial
Article first published online: 1 FEB 2012
Copyright © 2012 John Wiley & Sons, Ltd.
Clinical Psychology & Psychotherapy
How to Cite
Ruwaard, J., Lange, A., Broeksteeg, J., Renteria-Agirre, A., Schrieken, B., Dolan, C. V. and Emmelkamp, P. (2012), Online Cognitive–Behavioural Treatment of Bulimic Symptoms: A Randomized Controlled Trial. Clin. Psychol. Psychother.. doi: 10.1002/cpp.1767
- Article first published online: 1 FEB 2012
- Manuscript Revised: 16 DEC 2011
- Manuscript Accepted: 16 DEC 2011
- Manuscript Received: 11 MAY 2011
- Cognitive Behaviour Therapy/Methods;
- Bulimia Nervosa;
- Computer-assisted Protocol-directed Therapy;
- Controlled Clinical Trials;
- Internet Intervention;
Manualized cognitive–behavioural treatment (CBT) is underutilized in the treatment of bulimic symptoms. Internet-delivered treatment may reduce current barriers.
This study aimed to assess the efficacy of a new online CBT of bulimic symptoms.
Participants with bulimic symptoms (n = 105) were randomly allocated to online CBT, bibliotherapy or waiting list/delayed treatment condition. Data were gathered at pre-treatment, post-treatment and 1-year follow-up.
The primary outcome measures were the Eating Disorder Examination Questionnaire (EDE-Q) and the frequency of binge eating and purging episodes. The secondary outcome measure was the Body Attitude Test.
Dropout from Internet treatment was 26%. Intention-to-treat ANCOVAs of post-test data revealed that the EDE-Q scores and the frequency of binging and purging reduced more in the online CBT group compared with the bibliotherapy and waiting list groups (pooled between-group effect size: d = 0.9). At 1-year follow-up, improvements in the online CBT group had sustained.
This study identifies online CBT as a viable alternative in the treatment of bulimic symptoms.
Key Practitioner Message
- In comparison with no treatment and unsupported bibliotherapy, online CBT induces strong reductions in bulimic symptoms.
- Internet-delivered treatment may provide an acceptable treatment alternative for bulimic patients who are reticent about face-to-face contact.
- Therapist support appears to be a critical determinant of treatment adherence and effectiveness.
- Unsupported bibliotherapy may have only small immediate effects but may increase the probability of recovery in the long term by promoting positive attitudes towards treatment.