A Randomised Controlled Trial of Clinician Supported vs Pure Self-Help Delivery of Online Cognitive Behaviour Therapy for Bulimia Nervosa
Background. Concerns regarding high dropout rates and poor adherence that are commonly associated with online self-help treatments have prompted researchers to explore ways in which engagement and completion rates can be improved for these interventions. This trial aimed to investigate the added benefit of clinician support as an adherence- and outcome- facilitating mechanism when paired alongside an online cognitive behaviour therapy self-help intervention for bulimia nervosa, Binge Eating eTherapy. Methods. Participants aged between 16 to 65 years who met DSM-5 criteria for full or subthreshold bulimia nervosa (n = 114) were randomised to complete an online self-help intervention either in a completely independent, pure self-help manner (n = 38), with adjunct clinician support in the form of weekly 30-minute videoconferencing sessions (n = 37) or a no-treatment waitlist control (n = 39). The primary outcome was frequency of objective binge episodes. Secondary outcomes were frequencies of compensatory behaviours, eating disorder (ED) psychopathology, psychological distress and quality of life. Assessments took place at baseline, post-treatment (12 weeks) and follow up (24 weeks). Results. No significant difference in dropout rates were apparent between pure self-help (31.6%) and clinician supported arms (34.7%). Baseline to post-treatment decreases in objective binge episode frequency were significantly greater for clinician-supported participants as compared to WLC, but they were not for pure self-help arm. However, due to continued improvements got the pure self-help across follow up, both arms outperformed WLC when analysed as an overall rate of change across three timepoints. Participants in both supported and unsupported arms achieved significant post- treatment reductions in ED psychopathology in comparison to WLC, with effects maintained at follow up. Conclusion. These findings support the efficacy of BEeT as an accessible, low- resource intervention for individuals with BN and suggest that online self-help interventions can be successfully disseminated either as a clinician-supported or self-directed treatment.
Note: This research is in the process of being submitted for publication.
Presented at the following conferences:
Barakat, S., Sidari, M., Kim, M., Hazelton, J., Lymer, S., Cunich, M., Maloney, D., Russell, J., Hay, P., Madden, S., Miskovic-Wheatley, J., Touyz, S., & Maguire, S. (2022). Harnessing digital interventions to broaden the treatment landscape for eating disorders: Findings from a multi-site randomized controlled trial of Binge Eating eTherapy. Australia and New Zealand Academy for Eating Disorders (ANZAED) 2022 Conference, Sydney, Australia – Oral Presentation
Barakat, S., Touyz, S., Maloney, D., Russell, J., Hay, P., Cunich, M., Lymer, S., Kim, M., Madden, S., Hazelton, J., Sidari, M., Miskovic-Wheatley, J., & Maguire, S. (2022). Use of Emerging Technologies to Improve Treatment Accessibility for Eating Disorders: Findings from a multi-site randomized controlled trial of Binge Eating eTherapy. Eating Disorder Research Society (EDRS) 2022 Conference, Philadelphia, USA – Oral Presentation
