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A randomized trial comparing the efficacy of cognitive–behavioral therapy for bulimia nervosa delivered via telemedicine versus face-to-face
Open accessAbstract
Objective A major problem in the delivery of mental health services is the lack of availability of empirically supported treatment, particularly in rural areas. To date no studies have evaluated the administration of an empirically supported manual-based psychotherapy for a psychiatric condition via telemedicine. The aim of this study was to compare the relative efficacy and acceptability of a manual-based cognitive-behavioral therapy (CBT) for bulimia nervosa (BN) delivered in person to a comparable therapy delivered via telemedicine.Method One hundred twenty-eight adults meeting DSM-IV criteria for BN or eating disorder-not otherwise specified with binge eating or purging at least once per week were recruited through referrals from clinicians and media advertisements in the targeted geographical areas. Participants were randomly assigned to receive 20 sessions of manual-based, CBT for BN over 16 weeks delivered either face-to-face (FTF-CBT) or via telemedicine (TV-CBT) by trained therapists. The primary outcome measures were binge eating and purging frequency as assessed by interview at the end of treatment, and again at 3- and 12-month follow-ups. Secondary outcome measures included other bulimic symptoms and changes in mood.Results Retention in treatment was comparable for TV-CBT and FTF-CBT. Abstinence rates at end-of-treatment were generally slightly higher for FTF-CBT compared with TV-CBT, but differences were not statistically significant. FTF-CBT patients also experienced significantly greater reductions in eating disordered cognitions and interview-assessed depression. However, the differences overall were few in number and of marginal clinical significance.Conclusions CBT for BN delivered via telemedicine was both acceptable to participants and roughly equivalent in outcome to therapy delivered in person.
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“Studies have reported equivalent outcomes to those found in face-to-face groups for 125 clients with posttraumatic stress disorder [25, 29, 30] and seven clients with traumatic brain injury [28].”
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“One-on-one videoconferencing (a single client and clinician) is comparable with face-to-face interventions in terms of effectiveness, client ratings of the therapeutic relationship, client satisfaction [25, 29] and treatment retention [30] for a variety of psychological conditions [29].”
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Metadata
- Authors
- Mitchell, J. E., Crosby, R. D., Wonderlich, S. A., Crow, S., Lancaster, K., Simonich, H., Swan-Kremeier, L., Lysne, C., & Cook Myers, T.
- Affiliations
- University of North Dakota (US)
- University of Minnesota (US)
- Neuropsychiatric Research Institute (US)
- Corresponding author
- Mitchell, James E.
- Venue
- Behaviour Research and Therapy
- Publisher
- Elsevier BV
- Published
- 2008-05
- Volume
- 46
- Issue
- 5
- Pages
- 581-592
- ISSN
- 0005-7967 (ISSN-L)
- PMC
- PMC2633728
- OpenAlex
- W2136536038
- Cited by
- 210
- References
- 36
- Citations by year
- 2026: 4 · 2025: 3 · 2024: 11 · 2023: 11 · 2022: 14 · 2021: 20 · 2020: 19 · 2019: 10 · 2018: 12 · 2017: 12 · 2016: 17 · 2015: 15 · 2014: 9 · 2013: 14 · 2012: 16
- FWCI
- 8.52
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Behaviour Research and Therapy (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- U.S. Public Health Service (R01-MHDK-58820)
- National Institute of Mental Health (K02MH065919, R13MH081447, R01MH058820, R01MH059674, KO2 MH65919, R34MH077571)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
- Keywords
- bulimia nervosa, cognitive behavioral therapy, telemedicine, remote psychotherapy, face-to-face therapy, treatment acceptability, treatment retention, binge eating, purging, eating disorder cognitions, depression, rural mental health services
- MeSH terms
- Adult, Female, Humans, Male, Patient Dropouts, Cognitive Behavioral Therapy, Treatment Outcome, Patient Satisfaction, Telemedicine, Diagnostic and Statistical Manual of Mental Disorders, Bulimia Nervosa, Young Adult
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