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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
Open accessAbstract
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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“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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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
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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 (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]
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In the citing paper
“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
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“The use of remote treatment across the internet has been increasing and its effectiveness has been demonstrated for various intractable diseases [11-14].”
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“According to a systematic review of internet-based CBT for depression, anxiety disorder, and other functional disorders, including chronic pain, the CBT for chronic pain showed small to medium effect size from 10 RCT studies with low levels of evidence.”
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Metadata
- 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)
- 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
- green
- www.ncbi.nlm.nih.gov
- 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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