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Cited by 153Eating Disorders and BehaviorsDigital Mental Health InterventionsNutrition, Health and Food Behavior

Effect of Internet-Based Guided Self-help vs Individual Face-to-Face Treatment on Full or Subsyndromal Binge Eating Disorder in Overweight or Obese Patients: The INTERBED Randomized Clinical Trial

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de Zwaan, Martina, Herpertz, Stephan, Zipfel, Stephan, Svaldi, Jennifer, Friederich, Hans-Christoph, Schmidt, Frauke, Mayr, Andreas, Lam, Tony +2 more·2017·JAMA Psychiatry
DOI 10.1001/jamapsychiatry.2017.2150PMC PMC5710472
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Abstract

Importance: Although cognitive behavioral therapy (CBT) represents the criterion standard for treatment of binge eating disorder (BED), most individuals do not have access to this specialized treatment. Objective: To evaluate the efficacy of internet-based guided self-help (GSH-I) compared with traditional, individual face-to-face CBT. Design, Setting, and Participants: The Internet and Binge Eating Disorder (INTERBED) study is a prospective, multicenter, randomized, noninferiority clinical trial (treatment duration, 4 months; follow-ups, 6 months and 1.5 years). A volunteer sample of 178 adult outpatients with full or subsyndromal BED were recruited from 7 university-based outpatient clinics from August 1, 2010, through December 31, 2011; final follow-up assessment was in April 2014. Data analysis was performed from November 30, 2014, to May 27, 2015. Interventions: Participants received 20 individual face-to-face CBT sessions of 50 minutes each or sequentially completed 11 internet modules and had weekly email contacts. Main Outcomes and Measures: The primary outcome was the difference in the number of days with objective binge eating episodes (OBEs) during the previous 28 days between baseline and end of treatment. Secondary outcomes included OBEs at follow-ups, eating disorder and general psychopathologic findings, body mass index, and quality of life. Results: A total of 586 patients were screened, 178 were randomized, and 169 had at least one postbaseline assessment and constituted the modified intention-to-treat analysis group (mean [SD] age, 43.2 [12.3] years; 148 [87.6%] female); the 1.5-year follow-up was available in 116 patients. The confirmatory analysis using the per-protocol sample (n = 153) failed to show noninferiority of GSH-I (adjusted effect, 1.47; 95% CI, -0.01 to 2.91; P = .05). Using the modified intention-to-treat sample, GSH-I was inferior to CBT in reducing OBE days at the end of treatment (adjusted effect, 1.63; 95% CI, 0.17-3.05; P = .03). Exploratory longitudinal analyses also showed the superiority of CBT over GSH-I by the 6-month (adjusted effect, 0.36; 95% CI, 0.23-0.55; P < .001) but not the 1.5-year follow-up (adjusted effect, 0.91; 95% CI, 0.54-1.50; P = .70). Reductions in eating disorder psychopathologic findings were significantly higher in the CBT group than in the GSH-I group at 6-month follow-up (adjusted effect, -0.4; 95% CI, -0.68 to -0.13; P = .005). No group differences were found for body mass index, general psychopathologic findings, and quality of life. Conclusions and Relevance: Face-to-face CBT leads to quicker and greater reductions in the number of OBE days, abstinence rates, and eating disorder psychopathologic findings and may be a better initial treatment option than GSH-I. Internet-based guided self-help remains a viable, slower-acting, low-threshold treatment alternative compared with CBT for adults with BED. Trial Registration: isrctn.org Identifier: ISRCTN40484777 and germanctr.de Identifier: DRKS00000409.

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  • GSH cognitive-behavioural therapy can be used for more severe disorders as a supplementary treatment.

    “Based on the findings of innovative eating disorder studies that guided self-help (GSH) cognitive–behavioural therapy can be used for more severe disorders as a supplementary treatment,17,18 the application of GSH to personality pathology has been suggested.”

    From Recovery-focused self-help intervention using vodcasts for patients with personality disorder: Feasibility randomised controlled trial (2024) · cites this paper as [18]

    The Methods and Results describe guided self-help for patients with full or subsyndromal binge-eating disorder, and the Conclusions call it a viable treatment option for this population. But the trial tested it instead of face-to-face CBT, and the Conclusions describe it as an alternative in stepped care—not as a supplementary treatment alongside CBT. (LLM, conf=0.88)

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  • Support sessions with participants were primarily facilitated by trained research assistants, contrasting with previous studies that have employed clinical psychologists in this role.

    “Support sessions with participants were primarily facilitated by trained research assistants, contrasting with previous studies that have employed clinical psychologists in this role (28, 29, 60).”

    From The acceptability, feasibility, and preliminary efficacy of a supported online self-help treatment program for binge-eating disorder (2023) · cites this paper as [60]

    The Methods (Treatment; page not available) say that participants in the guided self-help group had weekly email contacts and met coaches twice in person, and that each therapist delivered both treatments. The Discussion (Strengths and Limitations; page not available) describes the therapists as trained. Our copy does not identify them as clinical psychologists, so it does not fully support that part of the comparison; it also does not say that this study used trained research assistants. (LLM, conf=0.76)

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  • Abstinence rates in the current study (29.9%) were somewhat lower than those reported in various RCTs for BED (31%-61%).

    “Abstinence rates were somewhat lower in the current study (29.9%) compared to various RCTs for BED: guided selfhelp CBT-E (31% based on self-report, and 48% based on interviewdata) (Melisse, Berg, et al., 2023a), self-help CBT-ED (36% -46% based on interview-data) (de Zwaan et al., 2017; Hilbert et al., 2019), or inperson CBT-ED (36% -61% based on interview-data) (de Zwaan et al., 2017; Hilbert et”

    From Effectiveness of web-based guided self-help cognitive behavioral therapy-enhanced for binge-eating disorder: An implementation study (2024) · cites this paper as de Zwaan et al., 2017

  • The present study had a treatment completion rate of 91.7%, which is high compared with completion rates of other studies (33.2%-82.6%).

    “The present study had a treatment completion rate of 91.7%, which is high in comparison to completion rates of other studies.”

    From Effectiveness of web-based guided self-help cognitive behavioral therapy-enhanced for binge-eating disorder: An implementation study (2024) · cites this paper as de Zwaan et al., 2017

  • The use of remote treatment across the internet has been increasing and its effectiveness has been demonstrated for various intractable diseases.

    “The use of remote treatment across the internet has been increasing and its effectiveness has been demonstrated for various intractable diseases [11-14].”

    From Clinical effectiveness and cost-effectiveness of videoconference-based integrated cognitive behavioral therapy for chronic pain: randomized controlled trial. (2021) · cites this paper as [11]

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Research works printed but not linked: 10

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Authors
de Zwaan, M., Herpertz, S., Zipfel, S., Svaldi, J., Friederich, H.-C., Schmidt, F., Mayr, A., Lam, T., Schade-Brittinger, C., & Hilbert, A.
Affiliations
  • Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany2Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Erlangen, University of Erlangen-Nuremberg, Erlangen, Germany
  • Ruhr University Bochum (DE)
  • Universitätsklinikum Tübingen (DE)
  • University of Freiburg (DE)
  • University Hospital Heidelberg (DE)
  • Friedrich-Alexander-Universität Erlangen-Nürnberg (DE)
  • NetUnion (Switzerland) (CH)
  • Coordinating Centre for Clinical Trials, Philipps-University Marburg, Marburg, Germany
  • University Hospital Leipzig (DE)
ORCID
Venue
JAMA Psychiatry
Publisher
American Medical Association (AMA)
Published
2017-10-01
Volume
74
Issue
10
Pages
987
ISSN
2168-622X (ISSN-L)
DOI
10.1001/jamapsychiatry.2017.2150
PMC
PMC5710472
OpenAlex
W2741049910
Cited by
153
References
38
Citations by year
2026: 9 · 2025: 18 · 2024: 23 · 2023: 19 · 2022: 13 · 2021: 17 · 2020: 26 · 2019: 14 · 2018: 14
FWCI
18.32
Type
journal article
Language
en
Open access
Locations
  • JAMA Psychiatry (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
  • Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
  • Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
Keywords
binge eating disorder, cognitive behavioral therapy, overweight, obesity, non-inferiority, medication adherence, quality of life, body mass index, eating disorder psychopathology, treatment access barriers, university outpatient clinic, long-term follow-up, relapse prevention
MeSH terms
Adult, Aftercare, Female, Humans, Male, Middle Aged, Obesity, Quality of Life, Self Care, Therapy, Computer-Assisted, Health Behavior, Cognitive Behavioral Therapy, Body Mass Index, Treatment Outcome, Internet, Binge-Eating Disorder

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