Accessibility of Psychological Treatments for Bulimia Nervosa: A Review of Efficacy and Engagement in Online Self-Help Treatments

Abstract

Bulimia nervosa is an eating disorder characterised by marked impairment to one’s physical health and social functioning, as well as high rates of chronicity and comorbidity. This literature review aims to summarise existing academic research related to the symptom profile of BN, the costs and burden imposed by the illness, barriers to the receipt of care, and the evidence base for available psychological treatments. As a consequence of well-documented difficulties in accessing evidence-based treatments for eating disorders, efforts have been made towards developing innovative, diverse channels to deliver treatment, with several of these attempting to harness the potential of digital platforms. In response to the increasing number of trials investigating the utility of online treatments, this paper provides a critical review of previous attempts to examine digital interventions in the treatment of eating disorders. The results of a focused literature review are presented, including a detailed synthesis of a knowledgeable selection of high-quality articles with the aim of providing an update on the current state of research in the field. The results of the review highlight the potential for online self-help treatments to produce moderately sized reductions in core behavioural and cognitive symptoms of eating disorders. However, concern is raised regarding the methodological limitations of previous research in the field, as well as the high rates of dropout and poor adherence reported across most studies. The review suggests directions for future research, including the need to replicate previous findings using rigorous study design and methodology, as well as further investigation regarding the utility of clinician support and interactive digital features as potential mechanisms for offsetting low rates of engagement with online treatments.

Sociodemographic and clinical characteristics of treated and untreated adults with bulimia nervosa or binge-eating disorder recruited for a large-scale research study

“…Some participants were recruited from a digital self-help platform, demonstrating demand for less intensive and more diversified channels of treatment. Digital self-help and eTherapy interventions could be suitable for less symptomatic presentations, and may reduce barriers of cost, geography, privacy concerns, and stigma, and fit within a stepped care model of health service provision [ 36 ]. While clinician-led psychotherapy or medication management through doctor’s offices and clinics has been the traditional mode of treatment delivery, the COVID-19 pandemic has led to a dramatic expansion of telehealth services.…”

Web-Based Cognitive Behavioral Treatment for Bulimia Nervosa

“…[12][13][14][15] Possibly reducing the barriers of face-to-face treatments by being more flexible, accessible, and cost-efficient, web-based interventions have been developed to complement established therapies and are increasingly integrated into routine care settings. [16][17][18][19][20][21][22][23][24][25][26] While meta-analyses suggest that web-based interventions may reduce eating disorder symptoms, there is a scarcity of research investigating treatments tailored to BN, and previous studies are often limited regarding their generalizability to clinical practice. [17][18][19][20]24,25,27 Therefore, more research is needed to evaluate the effectiveness of web-based interventions targeting patients diagnosed with BN, especially when applied in naturalistic settings.…”

“…[16][17][18][19][20][21][22][23][24][25][26] While meta-analyses suggest that web-based interventions may reduce eating disorder symptoms, there is a scarcity of research investigating treatments tailored to BN, and previous studies are often limited regarding their generalizability to clinical practice. [17][18][19][20]24,25,27 Therefore, more research is needed to evaluate the effectiveness of web-based interventions targeting patients diagnosed with BN, especially when applied in naturalistic settings.…”

“…Possibly reducing the barriers of face-to-face treatments by being more flexible, accessible, and cost-efficient, web-based interventions have been developed to complement established therapies and are increasingly integrated into routine care settings . While meta-analyses suggest that web-based interventions may reduce eating disorder symptoms, there is a scarcity of research investigating treatments tailored to BN, and previous studies are often limited regarding their generalizability to clinical practice .…”

O impacto da pandemia de COVID-19 em indivíduos com anorexia

“…Em relação à bulimia, a taxa de prevalência ao longo da vida para o sexo feminino é duas vezes maior do que para o sexo masculino, com estimativas de 2,59% e 1,21%, respectivamente. Nos Estados Unidos, a prevalência ao longo da vida de bulimia em homens e mulheres foi estimada em 0,5% e 1,5% (Barakat & Maguire, 2023;Patel et al, 2018). O gênero feminino, geralmente, é o mais impactado pelas pressões sociais, econômicas e culturais associadas aos padrões estéticos, ficando mais suscetível aos transtornos alimentares, representando 95% dos casos (Kirsten et al, 2009).…”