Research Article

Online Cognitive–Behavioural Treatment of Bulimic Symptoms: A Randomized Controlled Trial

  1. Jeroen Ruwaard1,2,*,
  2. Alfred Lange1,
  3. Janneke Broeksteeg2,
  4. Aitziber Renteria-Agirre2,
  5. Bart Schrieken2,
  6. Conor V. Dolan1,
  7. Paul Emmelkamp1

Article first published online: 1 FEB 2012

DOI: 10.1002/cpp.1767

Additional Information

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

Author Information

  1. 1

    Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands

  2. 2

    Interapy PLC, Amsterdam, The Netherlands

*Jeroen Ruwaard, Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands.
E-mail: j.j.ruwaard@uva.nl, research@interapy.nl

Publication History

  1. Article first published online: 1 FEB 2012
  2. Manuscript Revised: 16 DEC 2011
  3. Manuscript Accepted: 16 DEC 2011
  4. Manuscript Received: 11 MAY 2011

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Keywords:

  • Cognitive Behaviour Therapy/Methods;
  • Bulimia Nervosa;
  • Computer-assisted Protocol-directed Therapy;
  • Controlled Clinical Trials;
  • Internet Intervention;
  • Bibliotherapy
Background

Manualized cognitive–behavioural treatment (CBT) is underutilized in the treatment of bulimic symptoms. Internet-delivered treatment may reduce current barriers.

Objective

This study aimed to assess the efficacy of a new online CBT of bulimic symptoms.

Method

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.

Outcome Measures

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.

Results

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.

Conclusion

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.
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