Online Cognitive–Behavioural Treatment of Bulimic Symptoms: A Randomized Controlled Trial
Abstract
Background: Manualized cognitive–behavioural treatment (CBT) is underutilized in the treatment of bulimic symptoms. Internet‐delivered treatment may reduce current barriers. Objective: This study aimed to assess the efficacy of a new online CBT of bulimic symptoms. Method: Participants with bulimic symptoms (n = 105) were randomly allocated to online CBT, bibliotherapy or waiting list/delayed treatment condition. Data were gathered at pre‐treatment, post‐treatment and 1‐year follow‐up. Outcome Measures: The primary outcome measures were the Eating Disorder Examination Questionnaire (EDE‐Q) and the frequency of binge eating and purging episodes. The secondary outcome measure was the Body Attitude Test. Results: Dropout from Internet treatment was 26%. Intention‐to‐treat ANCOVAs of post‐test data revealed that the EDE‐Q scores and the frequency of binging and purging reduced more in the online CBT group compared with the bibliotherapy and waiting list groups (pooled between‐group effect size: d = 0.9). At 1‐year follow‐up, improvements in the online CBT group had sustained. Conclusion: This study identifies online CBT as a viable alternative in the treatment of bulimic symptoms. Copyright © 2012 John Wiley & Sons, Ltd. Key Practitioner Message: In comparison with no treatment and unsupported bibliotherapy, online CBT induces strong reductions in bulimic symptoms. Internet‐delivered treatment may provide an acceptable treatment alternative for bulimic patients who are reticent about face‐to‐face contact. Therapist support appears to be a critical determinant of treatment adherence and effectiveness. Unsupported bibliotherapy may have only small immediate effects but may increase the probability of recovery in the long term by promoting positive attitudes towards treatment.
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A small between-group effect size (Cohen's d = 0.40) is expected.
“A small between-group effect size (Cohen’ s d = 0.40) is expected.”
The a priori sample size calculation was based on results from previous studies that implemented Internet-based programs in the treatment of eating disorders.
“The a priori sample size calculation was based on results from previous studies that implemented Internet-based programs in the treatment of EDs [58–60].”
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- Authors
- Ruwaard, J., Lange, A., Broeksteeg, J., Renteria‐Agirre, A., Schrieken, B., Dolan, C. V., & Emmelkamp, P.
- Affiliations
- University of Amsterdam (NL)
- Interapy PLC Amsterdam The Netherlands
- Venue
- Clinical Psychology & Psychotherapy
- Publisher
- Wiley
- Published
- 2012-02
- Volume
- 20
- Issue
- 4
- Pages
- 308-318
- ISSN
- 1063-3995 (ISSN-L)
- 1099-0879
- OpenAlex
- W1890419868
- Cited by
- 75
- References
- 54
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 4 · 2023: 7 · 2022: 6 · 2021: 2 · 2020: 7 · 2019: 3 · 2018: 6 · 2017: 6 · 2016: 3 · 2015: 7 · 2014: 8 · 2013: 10 · 2012: 1
- FWCI
- 9.46
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Clinical Psychology & Psychotherapy (publishedVersion)
- PubMed (publishedVersion)
- UvA-DARE (University of Amsterdam) (submittedVersion)
- VU Research Portal (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- bulimic symptoms, internet-based cognitive behavioral therapy, online therapy, bibliotherapy, binge eating, purging, eating disorder symptoms, body image, medication adherence, therapist support, long-term treatment outcomes
- MeSH terms
- Adult, Analysis of Variance, Bibliotherapy, Bulimia, Female, Follow-Up Studies, Humans, Netherlands, Patient Compliance, Patient Dropouts, Psychiatric Status Rating Scales, Waiting Lists, Cognitive Behavioral Therapy, Treatment Outcome, Internet
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