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A randomized controlled trial of internet-based cognitive-behavioural therapy for bulimia nervosa or related disorders in a student population

  • V. C. Sánchez-Ortiz (a1), C. Munro (a2), D. Stahl (a3), J. House (a4), H. Startup (a2), J. Treasure (a1), C. Williams (a5) and U. Schmidt (a1)...

Abstract

Background

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.

Method

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.

Results

Students who had immediate iCBT showed significantly greater improvements at 3 and 6 months than those receiving WL/DTC in ED and other symptoms.

Conclusions

iCBT with e-mail support is efficacious in students with bulimic disorders and has lasting effects.

Copyright

Corresponding author

*Address for correspondence: Professor U. Schmidt, Section of Eating Disorders (PO59), Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK. (Email: u.schmidt@iop.kcl.ac.uk)

References

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Bara-Carril, N, Williams, CJ, Pombo-Carril, MG, Reid, Y, Murray, K, Aubin, S, Harkin, PJR, Treasure, J, Schmidt, U (2004). A preliminary investigation into the feasibility and efficacy of a CD-ROM-based cognitive-behavioral self-help intervention for bulimia nervosa. International Journal of Eating Disorders 35, 538548.
beat (2009). Choice or Chance? Ending the Information Lottery. Beat Eating Disorders, beat. Charity number 801343 2009 (http://www.b-eat.co.uk/Publications/Reports).
Brown, H, Prescott, R (2006). Applied Mixed Models in Medicine, 2nd edn. John Wiley & Sons: New York.
Carlbring, P, Gunnarsdottir, M, Hedensjo, L, Andersson, G, Ekselius, L, Furmark, T (2007). Treatment of social phobia: randomised trial of internet-delivered cognitive-behavioural therapy with telephone support. British Journal of Psychiatry 190, 123128.
Carrard, I, Rouget, P, Fernandez-Aranda, F, Volkart, AC, Damoiseau, M, Lam, T (2006). Evaluation and deployment of evidence based patient self-management support program for bulimia nervosa. International Journal of Medical Informatics 75, 101109.
Centre for Economic Performance (2006). The Depression Report: A New Deal for Anxiety and Depression. London School of Economics and Political Science: London, UK.
Cohen, J (1988). Statistical Power Analysis for the Behavioral Sciences. Academic Press: New York.
Currin, L (2006). Primary Care Management of Eating Disorders: From Diagnosis to Referral. Ph.D. thesis, Institute of Psychiatry, King's College London, UK.
Fairburn, CG, Cooper, Z (1993). The Eating Disorder Examination, 12th edn. In Binge Eating: Nature, Assessment and Treatment (ed. Fairburn, C. G. and Wilson, G. T.), pp. 317360. Guilford Press: New York.
Fairburn, CG, Cooper, Z, Doll, HA, O'Connor, ME, Bohn, K, Hawker, DM, Wales, BA, Palmer, R (2009). Transdiagnostic cognitive-behavioral therapy for patients with eating disorders: a two-site trial with 60-week follow-up. American Journal of Psychiatry 166, 311319.
Fairburn, CG, Welch, SL, Norman, PA, O'Connor, ME (1996). Bias and bulimia nervosa: how typical are clinic cases? American Journal of Psychiatry 153, 386391.
Fernandez-Aranda, F, Nunez, A, Martinez, C, Krug, I, Cappozzo, M, Carrard, I, Rouget, P, Jiménez-Murcia, S, Granero, R, Penelo, E, Santamaría, J, Lam, T (2008). Internet-based cognitive-behavioral therapy for bulimia nervosa: a controlled study. Cyberpsychology and Behavior 12, 3741.
Gellatly, J, Bower, P, Hennessy, S, Richards, D, Gilbody, S, Lovell, K (2007). What makes self-help interventions effective in the management of depressive symptoms? Meta-analysis and meta-regression. Psychological Medicine 37, 12171228.
Hoek, HW, van Hoeken, D (2003). Review of the prevalence and incidence of eating disorders. International Journal of Eating Disorders 34, 383396.
Jacobi, C, Morris, L, Beckers, C, Bronisch-Holtze, J, Winter, J, Winzelberg, AJ, Taylor, CB (2007). Maintenance of internet-based prevention: a randomized controlled trail. International Journal of Eating Disorders 40, 114119.
Jacobs-Pilipski, MJ, Wilfley, DE, Crow, SJ, Walsh, BT, Lilenfeld, LR, West, DS, Berkowitz, RI, Hudson, JI, Fairburn, CG (2007). Placebo response in binge eating disorder. International Journal of Eating Disorders 40, 204211.
Keel, PK (2007). Purging disorder: subthreshold variant or full-threshold eating disorder? International Journal of Eating Disorders 40, S89S94.
Ljotsson, B, Lundin, C, Mitsell, K, Carlbring, P, Ramklint, M, Ghaderi, A (2007). Remote treatment of bulimia nervosa and binge eating disorder: a randomized trial of Internet-assisted cognitive behavioural therapy. Behaviour Research and Therapy 45, 649661.
Marks, IM, Kenwright, M, McDonough, M, Whittaker, M, Mataix-Cols, D (2004). Saving clinicians' time by delegating routine aspects of therapy to a computer: a randomized controlled trial in phobia/panic disorder. Psychological Medicine 34, 9–17.
NICE (2004). Eating Disorders: Core Interventions in the Treatment and Management of Anorexia Nervosa, Bulimia Nervosa and Related Eating Disorders. Clinical Guideline 9. National Institute of Clinical Excellence: London (www.nice.org.uk).
Oliver, MI, Pearson, N, Coe, N, Gunnell, D (2005). Help-seeking behaviour in men and women with common mental health problems: cross-sectional study. British Journal of Psychiatry 186, 297301.
Paxton, SJ, McLean, SA, Gollings, EK, Faulkner, C, Wertheim, EH (2007). Comparison of face-to-face and internet interventions for body image and eating problems in adult women: an RCT. International Journal of Eating Disorders 40, 692704.
Perkins, SJ, Murphy, R, Schmidt, U, Williams, C (2006). Self-help and guided self-help for eating disorders. Cochrane Database of Systematic Reviews (Online), 3, CD004191.
Proudfoot, J, Ryden, C, Everitt, B, Shapiro, DA, Goldberg, D, Mann, A, Tylee, A, Marks, I, Gray, JA (2004). Clinical efficacy of computerised cognitive-behavioural therapy for anxiety and depression in primary care: randomised controlled trial. British Journal of Psychiatry 185, 4654.
Reas, DL, Williamson, DA, Martin, CK, Zucker, NL (2000). Duration of illness predicts outcome for bulimia nervosa: a long-term follow-up study. International Journal of Eating Disorders 27, 428434.
Rohde, P, Lewinsohn, PM, Seeley, JR (1997). Comparability of telephone and face-to-face interviews in assessing axis I and II disorders. American Journal of Psychiatry 154, 15931598.
Sánchez-Ortiz, V, Munro, C, Schmidt, U (2007). Views and perceptions of an internet based CBT package: a qualitative study. In International Conference of Eating Disorders [oral presentation]. Academy of Eating Disorders: Baltimore.
Sánchez-Ortiz, V, Schmidt, U (2010). Self-help approaches for bulimia nervosa and binge eating disorders. In The Treatment of Eating Disorders (ed. Grillo, C. and Mitchell, J.), pp. 359371. Guilford Press: New York.
Schmidt, U, Andiappan, M, Grover, M, Robinson, S, Perkins, S, Dugmore, O, Treasure, J, Landau, S, Eisler, I, Williams, C (2008). A randomised controlled trial of the effectiveness of a CD-ROM-based cognitive-behavioural self-care intervention for bulimia nervosa. British Journal of Psychiatry 193, 493500.
Sell, L, Robson, P (1998). Perceptions of college life, emotional well-being and patterns of drug and alcohol use among Oxford undergraduates. Oxford Review of Education 24, 235243.
Shapiro, JR, Berkman, ND, Brownley, KA, Sedway, JA, Lohr, KN, Bulik, CM (2007 a). Bulimia nervosa treatment: a systematic review of randomized controlled trials. International Journal of Eating Disorders 40, 321336.
Shapiro, JR, Reba-Harrelson, L, Dymek-Valentine, M, Woolson, SL, Hamer, RM, Bulik, CM (2007 b). Feasibility and acceptability of CD-ROM-based cognitive-behavioural treatment for binge-eating disorder. European Eating Disorders Review 15, 175184.
Siegel, S, Castellan, NJ Jr. (1988). Nonparametric Statistics for the Behavioral Sciences. McGraw-Hill: New York.
Simes, R (1986). An improved Bonferroni procedure for multiple tests of significance. Biometrika 73, 751754.
Simon, J, Schmidt, U, Pilling, S (2005). The health service use and cost of eating disorders. Psychological Medicine 35, 15431551.
Taylor, CB, Bryson, S, Luce, KH, Cunning, D, Doyle, AC, Abascal, LB, Rockwell, R, Dev, P, Winzelberg, AJ, Wilfley, DE (2006). Prevention of eating disorders in at-risk college-age women. Archives of General Psychiatry 63, 881888.
The Royal College of Psychiatrists (2003). The Mental Health of Students in Higher Education. Council report CR112 (http://www.rcpsych.ac.uk/files/pdfversion/cr112.pdf).
The WHOQOL Group (1998). Development of the World Health Organization WHOQOL-BREF quality of life assessment. The WHOQOL Group. Psychological Medicine 28, 551558.
Treasure, J, Schmidt, U, Hugo, P (2005). Mind the gap: service transition and interface problems for patients with eating disorders. British Journal of Psychiatry 187, 398400.
Treasure, J, Schmidt, U, Troop, N, Tiller, J, Todd, G, Keilen, M, Dodge, E (1994). First step in managing bulimia nervosa: controlled trial of therapeutic manual. British Medical Journal 308, 686689.
Williams, C, Aubin, S, Cottrell, D, Harkin, PJR (1998). Overcoming Bulimia: A Self-Help Package. University of Leeds Press: Leeds, UK.
Wilson, GT, Grilo, CM, Vitousek, KM (2007). Psychological treatment of eating disorders. American Psychologist 62, 199216.
Zigmond, AS, Snaith, RP (1983). The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica 67, 361370.
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Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
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