Online CBT of Bulimic Symptoms: An RCT (2012/2013)

Ruwaard, J., Lange, A., Broeksteeg, J., Renteria-Agirre, A., Schrieken, B., Dolan, C.V., & Emmelkamp, P. (2013). Online cognitive behavioral treatment of bulimic symptoms: A randomized controlled trial. Clinical Psychology & Psychotherapy, 20, 4, 308-318. doi: 10.1002/cpp.1767

Abstract 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.