Cognitive-behavioural therapy for adolescents with bulimic symptomatology: The acceptability and effectiveness of internet-based delivery
Abstract
Background The evidence base for the treatment of adolescents with bulimia nervosa (BN) is limited.Aims To assess the feasibility, acceptability, and clinical outcomes of a web-based cognitive-behavioural (CBT) intervention for adolescents with bulimic symptomatology.Method 101 participants were recruited from eating disorders clinics or from beat, a UK-wide eating disorders charity. The programme consisted of online CBT sessions ('Overcoming Bulimia Online'), peer support via message boards, and email support from a clinician. Participants' bulimic symptomatology and service utilisation were assessed by interview at baseline and at three and six months. Participants' views of the treatment package were also determined.Results There were significant improvements in eating disorder symptoms and service contacts from baseline to three months, which were maintained at six months. Participants' views of the intervention were positive.Conclusions The intervention has the potential for use as a first step in the treatment of adolescents with bulimic symptomatology.
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For bulimia nervosa, online delivery of CBT-based self-help treatment programs improves binge eating and related psychopathology.
“For eating disorders, significant research on online delivery of CBT based self-help treatment programs has been conducted with bulimia nervosa [29-33], showing that binge eating and related psychopathology can be improved with the use of Internet programs.”
From Acceptance and efficacy of a guided internet self-help treatment program for obese patients with binge eating disorder (2011) · cites this paper as [30]
Cites
Binge eating: nature, assessment, and treatment
(1994) · Choice Reviews Online · doi:10.5860/choice.31-4640 · Cited by 1,801 · see citing works
Binge Eating: Nature, Assessment and Treatment
Hanson, K., & Pasulka, P. S. (1994) · Journal of Parenteral and Enteral Nutrition · doi:10.1177/014860719401800419 · Cited by 1,166 · see citing works
National Collaborating Centre for Mental Health
Veale, D. M. (2006) · Research Portal (King's College London) · Cited by 941 · see citing works
Costing psychiatric interventions.
Beecham, J. K., & Knapp, M. R. J. (1992) · Kent Academic Repository (University of Kent) · Cited by 710 · see citing works
Self-citationSlade, M., & Thornicroft, G. (2025) · doi:10.1093/med/9780198898818.003.0007 · Cited by 679 · see citing works
Help-seeking behaviour in men and women with common mental health problems: cross-sectional study
Oliver, M. I., Pearson, N., Coe, N., & Gunnell, D. (2005) · British Journal of Psychiatry · doi:10.1192/bjp.186.4.297 · Cited by 558 · see citing works
Comparability of telephone and face-to-face interviews in assessing axis I and II disorders
Rohde, P., Lewinsohn, P. M., & Seeley, J. R. (1997) · American Journal of Psychiatry · doi:10.1176/ajp.154.11.1593 · Cited by 522 · see citing works
GELLATLY, J., BOWER, P., HENNESSY, S., RICHARDS, D., GILBODY, S., & LOVELL, K. (2007) · Psychological Medicine · doi:10.1017/s0033291707000062 · Cited by 419 · cited 1× · see citing works
“A recent MRC-funded review of self-help in depression has confirmed that supported self-help is more effective than unsupported self-help, and that telephone and face-to-face support are equally efficacious (Gellatly et al., 2007).”
Time trends in eating disorder incidence
Currin, L. G., Schmidt, U. H., Treasure, J. L., & Jick, H. (2005) · The British Journal of Psychiatry · doi:10.1192/bjp.186.2.132 · Cited by 362 · see citing works
Self-citationPrevention of Eating Disorders in At-Risk College-Age Women
Taylor, C. B., Bryson, S., Luce, K. H., Cunning, D., Doyle, A. C., Abascal, L. B., Rockwell, R., Dev, P., Winzelberg, A. J., & Wilfley, D. E. (2006) · Archives of General Psychiatry · doi:10.1001/archpsyc.63.8.881 · Cited by 354 · cited 2× · see citing works
“Only a handful of studies have explored the use of CD-ROM or web-based interactive programmes prevention for women at risk of an eating disorder (Jacobi et al., 2007; Taylor et al., 2006) or treatment of adults with BN (Carrard et al.”
Grange, D. L., Crosby, R., Rathouz, P., & Leventhal, B. (2007) · Archives of General Psychiatry · doi:10.1001/archpsyc.64.9.1049 · Cited by 339 · see citing works
Grosser, R. C. (1994) · The Journal of Nervous and Mental Disease · doi:10.1097/00005053-199407000-00029 · Cited by 311 · see citing works
Schmidt, U., Lee, S., Beecham, J., Perkins, S., Treasure, J., Yi, I., Winn, S., Robinson, P., Murphy, R., Keville, S., et al. (2009) · American Journal of Psychiatry · doi:10.1176/foc.7.4.foc512 · Cited by 298 · see citing works
Self-citationChakraborty, H. (2009) · doi:10.3768/rtipress.2009.mr.0009.0903 · Cited by 298 · see citing works
Prevalence and Long-Term Course of Lifetime Eating Disorders in an Adult Australian Twin Cohort
Wade, T. D., Bergin, J. L., Tiggemann, M., Bulik, C. M., & Fairburn, C. G. (2006) · Australian & New Zealand Journal of Psychiatry · doi:10.1080/j.1440-1614.2006.01758.x · Cited by 286 · see citing works
Schmidt, U. H., Lee, S., Beecham, J. K., Perkins, S., Treasure, J. L., Yi, I., Winn, S., Robinson, P. H., Murphy, R., Keville, S., et al. (2007) · American Journal of Psychiatry · doi:10.1176/ajp.2007.164.4.591 · Cited by 275 · see citing works
Self-citationA Handbook of Statistical Analysis using SPSS
Landau, S., & Everitt, B. J. (2003) · Research Portal (King's College London) · Cited by 176 · see citing works
Palmer, R. L., Birchall, H. M., McGrain, L., & Sullivan, V. (2002) · The British Journal of Psychiatry · doi:10.1192/bjp.181.3.230 · Cited by 96 · see citing works
Carrard, I., Rouget, P., Fernández-Aranda, F., Volkart, A.-C., Damoiseau, M., & Lam, T. (2006) · International Journal of Medical Informatics · doi:10.1016/j.ijmedinf.2005.07.031 · Cited by 88 · cited 2× · see citing works
“, 2006) or treatment of adults with BN (Carrard et al., 2006; Fernández-Aranda et al., 2008; Sanchez-Ortiz et al., submitted for publication; Schmidt et al., 2008), but they have had promising results.”
Maintenance of internet‐based prevention: A randomized controlled trial
Jacobi, C., Morris, L., Beckers, C., Bronisch‐Holtze, J., Winter, J., Winzelberg, A. J., & Taylor, C. B. (2006) · International Journal of Eating Disorders · doi:10.1002/eat.20344 · Cited by 87 · see citing works
Internet-Based Cognitive-Behavioral Therapy for Bulimia Nervosa: A Controlled Study
Fernández-Aranda, F., Núñez, A., Martínez, C., Krug, I., Cappozzo, M., Carrard, I., Rouget, P., Jiménez-Murcia, S., Granero, R., Penelo, E., et al. (2009) · CyberPsychology & Behavior · doi:10.1089/cpb.2008.0123 · Cited by 80 · cited 2× · see citing works
“, 2006) or treatment of adults with BN (Carrard et al., 2006; Fernández-Aranda et al., 2008; Sanchez-Ortiz et al., submitted for publication; Schmidt et al., 2008), but they have had promising results.”
Randomised controlled trial of CD–ROM-based cognitive–behavioural self-care for bulimia nervosa
Schmidt, U. H., Andiappan, M., Grover, M., Robinson, S., Perkins, S., Dugmore, O., Landau, S., Treasure, J. L., Eisler, I., & Williams, C. J. (2008) · The British Journal of Psychiatry · doi:10.1192/bjp.bp.107.046607 · Cited by 69 · see citing works
Self-citationCognitive‐behavioural therapy for adolescents with bulimia nervosa
Wilson, G. T., & Sysko, R. (2006) · European Eating Disorders Review · doi:10.1002/erv.668 · Cited by 68 · see citing works
Shapiro, J. R., Reba‐Harrelson, L., Dymek-Valentine, M., Woolson, S., Hamer, R. M., & Bulik, C. M. (2007) · European Eating Disorders Review · doi:10.1002/erv.787 · Cited by 59 · see citing works
Understanding well–being in the evolutionary context of brain development
Keverne, E. B. (2004) · Philosophical Transactions of the Royal Society B Biological Sciences · doi:10.1098/rstb.2004.1517 · Cited by 57 · see citing works
Bara‐Carril, N., Williams, C. J., Pombo‐Carril, M. G., Reid, Y., Murray, K. A., Aubin, S., Harkin, P. J. R., Treasure, J. L., & Schmidt, U. H. (2004) · International Journal of Eating Disorders · doi:10.1002/eat.10267 · Cited by 53 · see citing works
Self-citationSelf-Help Interventions for Mental Health Problems
Lewis, G., Anderson, L., Araya, R., Elgie, R., Harrison, G. L., Proudfoot, J. G., Schmidt, U. H., Sharp, D., Weightman, A. L., & Williams, C. (2003) · PsycEXTRA Dataset · doi:10.1037/e616692007-001 · Cited by 45 · see citing works
Self-citationLule, E., Rosen, J. E., Singh, S., Knowles, J. C., & Behrman, J. R. (2006) · Cited by 36 · see citing works
Snaith, P. R. (1998) · The British Journal of Psychiatry · doi:10.1192/bjp.173.3.193 · Cited by 32 · see citing works
Murray, K. A., Schmidt, U. H., Pombo‐Carril, M. G., Grover, M., Alenya, J., Treasure, J. L., & Williams, C. M. (2004) · Computers in Human Behavior · doi:10.1016/j.chb.2004.11.014 · Cited by 29 · see citing works
Self-citationKent, A., Lacey, J. H., & McCluskey, S. E. (1992) · Journal of Psychosomatic Research · doi:10.1016/0022-3999(92)90084-f · Cited by 20 · see citing works
Internet-based cognitive-behavioral therapy for bulimia nervosa: A controlled study
Fernandez-Aranada, F., Santamaría, J., Nunez, A., Martínez, C., Krug, I., Cappozzo, M., Carrard, I., Rouget, P., Jiménez‐Múrcia, S., Granero, R., et al. (2008) · European Psychiatry · doi:10.1016/j.eurpsy.2008.01.1022 · Cited by 6 · see citing works
Assessment of eating disorders: interview or self-report questionnaire
Fairburn, C. G., & Beglin, S. J. (1994) · International Journal of Eating Disorders · doi:10.1002/1098-108x(199412)16:4
Luce (1999) · doi:10.1002/(sici)1098-108x(199904)25:3
Flagged first, then by citations
Cited by
Sorted by citations
Moberg, C., Niles, A., & Beermann, D. (2019) · Journal of Medical Internet Research · doi:10.2196/12556 · Cited by 157 · see citing works
Treating eating disorders over the internet: A systematic review and future research directions
Aardoom, J. J., Dingemans, A. E., Spinhoven, P., & Van Furth, E. F. (2013) · International Journal of Eating Disorders · doi:10.1002/eat.22135 · Cited by 158 · see citing works
Reducing eating disorder symptoms and risk factors using the internet: A meta‐analytic review
Melioli, T., Bauer, S., Franko, D. L., Moessner, M., Ozer, F., Chabrol, H., & Rodgers, R. F. (2016) · International Journal of Eating Disorders · doi:10.1002/eat.22477 · Cited by 147 · see citing works
Jacobi, C., Völker, U., Trockel, M. T., & Taylor, C. B. (2012) · Behaviour Research and Therapy · doi:10.1016/j.brat.2011.09.013 · Cited by 138 · see citing works
Schlegl, S., Bürger, C., Schmidt, L., Herbst, N., & Voderholzer, U. (2015) · Journal of Medical Internet Research · doi:10.2196/jmir.3554 · Cited by 123 · see citing works
“…Leung et al [56] 8 modules, 3 months “Overcoming Bulimia” (adapted for adolescents) (uncontrolled study) BN (N=61); EDNOS (N=40) Pretorius et al [57] 7 modules, 4-7 months “SALUT” (RCT) BN (N=126) Wagner et al [58] Internet-based therapist-delivered treatment Mitchell et al [62] Internet-based…”
InfluentialBarakat, S., Maguire, S., Smith, K. E., Mason, T. B., Crosby, R. D., & Touyz, S. (2019) · International Journal of Eating Disorders · doi:10.1002/eat.23131 · Cited by 77 · see citing works
Kass, A. E., Trockel, M., Safer, D. L., Sinton, M. M., Cunning, D., Rizk, M. T., Genkin, B. H., Weisman, H. L., Bailey, J. O., Jacobi, C., et al. (2014) · Behaviour Research and Therapy · doi:10.1016/j.brat.2014.09.010 · Cited by 71 · see citing works
Integrating technology into cognitive behavior therapy for adolescent depression: a pilot study
Kobak, K. A., Mundt, J. C., & Kennard, B. (2015) · Annals of General Psychiatry · doi:10.1186/s12991-015-0077-8 · Cited by 63 · see citing works
Isabelle, C., Christelle, C., Patrick, R., Tony, L., Martial, V. D. L., & Alain, G. (2011) · Clinical Practice & Epidemiology in Mental Health · doi:10.2174/1745017901107010008 · Cited by 51 · see citing works
McClay, C.-A., Waters, L., Schmidt, U., & Williams, C. (2016) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465814000484 · Cited by 41 · see citing works
Barakat, S., Maguire, S., Surgenor, L., Donnelly, B., Miceska, B., Fromholtz, K., Russell, J., Hay, P., & Touyz, S. (2017) · Behavioral Sciences · doi:10.3390/bs7030039 · Cited by 37 · see citing works
Mayer, C.-H., & Oosthuizen, R. M. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17082829 · Cited by 32 · see citing works
Cognitive behavioural therapy self-help for depression: an overview
Ridgway, N., & Williams, C. (2011) · Journal of Mental Health · doi:10.3109/09638237.2011.613956 · Cited by 28 · see citing works
Self-citationBenjet, C., Wittenborn, A., Gutierrez-García, R. A., Albor, Y. C., Contreras, E. V., Hernández, S. C., Valdés-García, K. P., Monroy, I. R., Peláez Cedrés, A. J., Hernández Uribe, P. C., et al. (2020) · Journal of Adolescent Health · doi:10.1016/j.jadohealth.2020.01.025 · Cited by 21 · see citing works
A Pilot Open Trial of a Digital Mindfulness-Based Intervention for Anorexia Nervosa
Sala, M., Levinson, C. A., Kober, H., & Roos, C. R. (2023) · Behavior Therapy · doi:10.1016/j.beth.2023.01.003 · Cited by 19 · see citing works
Barakat, S., Touyz, S., Maloney, D., Russell, J., Hay, P., Cunich, M., Lymer, S., Kim, M., Madden, S., Miskovic-Wheatley, J., et al. (2021) · Journal of Eating Disorders · doi:10.1186/s40337-021-00482-w · Cited by 14 · see citing works
- Authors
- Pretorius, N., Arcelus, J., Beecham, J., Dawson, H., Doherty, F., Eisler, I., Gallagher, C., Gowers, S., Isaacs, G., Johnson-Sabine, E., Jones, A., Newell, C., Morris, J., Richards, L., Ringwood, S., Rowlands, L., Simic, M., Treasure, J., Waller, G., Williams, C., Yi, I., Yoshioka, M., & Schmidt, U.
- Affiliations
- King's College London (GB)
- Leicester General Hospital (GB)
- University of Kent (GB)
- Royal Edinburgh Hospital (GB)
- University of Liverpool (GB)
- South London and Maudsley NHS Foundation Trust (GB)
- St Ann’s Hospital (GB)
- University of Glasgow (GB)
- Corresponding author
- Schmidt, U.
- ORCID
- Venue
- Behaviour Research and Therapy
- Publisher
- Elsevier BV
- Published
- 2009-09
- Volume
- 47
- Issue
- 9
- Pages
- 729-736
- ISSN
- 0005-7967 (ISSN-L)
- OpenAlex
- W2166674575
- Cited by
- 97
- References
- 34
- Citations by year
- 2026: 2 · 2025: 5 · 2024: 2 · 2023: 1 · 2022: 2 · 2021: 6 · 2020: 4 · 2019: 6 · 2018: 4 · 2017: 2 · 2016: 4 · 2015: 9 · 2014: 7 · 2013: 10 · 2012: 13
- FWCI
- 11.65
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Behaviour Research and Therapy (publishedVersion)
- PubMed (publishedVersion)
- London School of Economics and Political Science Research Online (London School of Economics and Political Science) (submittedVersion)
- Kent Academic Repository (University of Kent) (submittedVersion)
- Research Portal (King's College London) (submittedVersion)
- Funders
- National Institute for Health and Care Research (RP-PG-0606-1043)
- Medical Research Council
- Topics
- Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
- Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Keywords
- bulimia nervosa, adolescents, internet-based cognitive behavioral therapy, online intervention, eating disorders, treatment acceptability, feasibility, peer support, email support, service utilization, eating disorder symptoms
- MeSH terms
- Adolescent, Adult, Bulimia, Female, Humans, Male, Patient Acceptance of Health Care, Therapy, Computer-Assisted, Cognitive Behavioral Therapy, Patient Satisfaction, Internet
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