The Role of Regular Eating and Self-Monitoring in the Treatment of Bulimia Nervosa: A Pilot Study of an Online Guided Self-Help CBT Program

Abstract

Background: Despite cognitive behavioural therapy (CBT) being regarded as the first-line treatment option for bulimia nervosa (BN), barriers such as its time-consuming and expensive nature limit patient access. In order to broaden treatment availability and affordability, the efficacy and convenience of CBT could be improved through the use of online treatments and selective emphasis on its most ‘potent’ components of which behavioural techniques form the focus. Method: Twenty-six individuals with BN were enrolled in an online CBT-based self-help programme and 17 completed four weeks of regular eating and food-monitoring using the online Food Diary tool. Participants were contacted for a weekly check-in phone call and had their bulimic symptom severity assessed at five time points (baseline and weeks 1–4). Results: There was a significant decrease in the frequency of self-reported objective binge episodes, associated loss of control and objective binge days reported between pre- and post-treatment measures. Significant improvements were also observed in most subscales of the Eating Disorder Examination-Questionnaire. Conclusion: This study provides encouraging preliminary evidence of the potential of behavioural techniques of online CBT in the treatment of BN. Online therapy with this focus is potentially a viable and practical form of treatment delivery in this illness group. These preliminary findings support the need for larger studies using control groups.

Evaluating the role of digital intervention design in treatment outcomes and adherence to eTherapy programs for eating disorders: A systematic review and meta‐analysis

“…The mean number interventions sessions across the 23 studies was 8.35 ( SD = 2.85). The number of sessions varied from one session (Barakat et al, ) to 16 sessions (Jones et al, ). The length of the interventions also varied greatly across the studies from 3 weeks (Cardi et al, ) to 28 weeks (Wagner et al, ), with a mean duration of 13.78 weeks ( SD = 6.88).…”

“…One study (Aardoom et al, ) employed a four‐arm RCT design and examined several levels of clinician support including no support, low‐intensity support (contact once/week), and high‐intensity support (contact three times/week) via the participants' choice of email, online chat, or teleconference. Overall, asynchronous support was employed for the majority of studies ( n = 13) with synchronous support used in only four studies (Aardoom et al, ; Barakat et al, ; Shapiro et al, ; Strandskov et al, ).…”

“…The most commonl type of automated feedback was generic reminders delivered via SMS, email, or the eTherapy platform (n = 13). Eleven studies reported using motivational on‐screen pop‐ups, tips, or advice; five studies reported providing nonpersonalized feedback (simple, corrective, confirmative, or diagnostic) to participants on their progress (Aardoom et al, ; Barakat et al, ; Leung et al, ; Shapiro et al, ; Wagner et al, ); and eight studies reported providing personalized feedback (explanatory and elaborative responses inclusive of specific recommendations) to participants. Twelve studies endorsed only one of the four feedback channels (55%), seven studies endorsed two feedback channels (32%), one study endorsed three feedback channels (5%), and two studies endorsed all four feedback channels (18%).…”

“…The mean sample size across the 23 studies was 120 (SD = 84.46, N total = 2,754) and ranged from 26 participants (Barakat et al, 2017) to 354 participants (Aardoom et al, 2016). The mean age of participants was 29.67 years (SD = 7.53).…”

Eating disorders in the time of COVID-19

“…The extension of online and alternate methods of delivering care from brief guided self-help CBT ([e.g. [5]) to more comprehensive care is urgently needed.…”