Internet-based self-help program shown to be effective in treating binge eating disorder

Recent JAMA Network Open The study evaluates the effectiveness of internet-based self-help interventions in alleviating binge eating disorder (BED).

Study: Efficacy of a Web-Based Cognitive Behavioral Self-Help Intervention for Binge Eating Disorder. Image credit: fizkes / Shutterstock.com

What is BED?

BED is defined as repeated episodes of uncontrolled binge eating that lead to obesity, type 2 diabetes and hypertension. Prolonged BED ultimately reduces the quality of life of affected individuals, negatively affects social relationships and compromises professional performance. Thus, early intervention is crucial to prevent BED from progressing into a chronic condition that can lead to early death.

Previous studies have shown that cognitive behavioral therapy (CBT) is an effective BED intervention, as this therapy can effectively manage various psychiatric conditions, including bulimia nervosa and anorexia nervosa. However, many barriers, such as physician ignorance, treatment costs, and sociocultural stigma, prevent many patients from seeking psychotherapy in person.

Rapid technological advances have created new avenues to lower these barriers and make BED treatments more accessible. In fact, Internet-based cognitive behavioral interventions have recently gained considerable popularity due to their ease of implementation, availability, reduced social stigma, and cost-effectiveness.

Although preliminary and small-scale studies have shown the benefits associated with Internet-based cognitive-behavioral interventions for BED, more rigorous scientific investigations are needed to evaluate the effectiveness of this strategy.

About the study

In the current study, researchers discuss the results of a randomized clinical trial (RCT) evaluating the effectiveness of an online cognitive behavioral self-help intervention for BED. The team assessed changes in eating disorder symptoms, well-being, psychopathology comorbidity, eating disorder symptoms, self-esteem, emotion regulation, and clinical decline. Weekly symptom monitoring and ecological momentary assessment (EMA) were used to detect real-time changes in binge eating.

Study participants were recruited from all regions of Germany, in addition to German-speaking individuals from other European countries. German-speaking people between the ages of 18 and 65, smartphone owners, and those diagnosed with BED according to the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition).

Study participants were randomly assigned to a waitlist (control) or a web-based treatment group. All participants were assessed at baseline, six weeks from baseline or mid-treatment, and post-treatment at 12 weeks post-treatment.

The core curriculum included six mandatory modules that included psychoeducation, self-monitoring of binge eating, emotion regulation videos, audio, texts, and interactive exercises. The intervention used a sequential module access strategy to engage participants in a more personalized way, in which a new module was accessed after completion of the previous module.

Study findings

A change in BED patterns was observed from baseline to 12 weeks of the web-based cognitive behavioral self-help intervention. Of the 1,602 patients, 154 met all eligibility criteria and were recruited into the study. Of the selected participants, 77 were randomized to the intervention group and 77 to the control group.

The intervention group outperformed the control group in reporting fewer episodes of binge eating. The intervention group also significantly improved global eating psychopathology and clinical impairment.

The effectiveness of the intervention exceeded or was similar to previously documented digital interventions, as well as guided and unguided self-help interventions for BED. Specifically, the levels of improvement observed in the intervention group were consistent with or exceeded those associated with interpersonal CBT interventions, thus confirming the clinical applicability of Internet-based cognitive behavioral self-help interventions.

The effectiveness of an online cognitive behavioral self-help intervention is not limited to an individual’s comorbidities such as obesity. The intervention was also found to improve participants’ overall quality of life. Promoting accessibility to psychological treatment facilities improved depressive symptoms, self-esteem, emotion regulation, and well-being in patients with BED.

Specifically, the current study allowed participants from both groups to seek additional professional help, which may have accounted for a small improvement in depressive symptoms and global eating psychopathology seen in the control group.

Positive effects of online cognitive behavioral self-help intervention depended on participants’ motivation, attitudes toward online interventions, demographic characteristics, and treatment expectations.

conclusions

The current study showed that a web-based intervention improved the overall well-being of participants with BED. Thus, access to effective treatment options will likely help BED patients and alleviate their adverse health conditions.

Importantly, the current study has some limitations, including the underrepresentation of males and older age groups in the study cohort. The self-report study design also increases vulnerability to social desirability, which can lead to biased observations. In the future, researchers should design new methodologies, such as double-blind designs, to minimize these biases.