Evaluation and deployment of evidence based patient self-management support program for bulimia nervosa
Abstract
Objective This article presents initial results from a European multi-centre study to determine the effectiveness and feasibility of an online self-help treatment support program for Bulimia Nervosa (BN).Method The online program is based on Cognitive Behavioral Therapy (CBT) and consists of seven steps that patients work through progressively. An overall sample of 141 women suffering from BN used the program over a 6-month period. Patients were supported by three face-to-face evaluation interviews with a therapist, and a weekly e-mail contact. Data on general psychopathology and specific eating disorder symptoms were also collected at the evaluation interviews.Results Initial results from the Swiss sample (N=41) showed significant improvement of overall psychological health (p<.001) as measured by the Symptom Checklist (SCL-90R), and for all dimensions of the Eating Disorder Inventory (EDI-2).Conclusion An online Self-Help program for BN can be used effectively to reduce eating disorder symptoms in Bulimic patients and user feedback showed that this approach contributed to increase patient involvement and service availability. Additional data from the other centers will further inform the efficacy and impact of this approach.
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TBIs can reach people who live in remote areas or those with disabilities and without easy access to healthcare services.
“TBIs hold the opportunity to reach people who live in remote areas or those with disabilities and without easy access to healthcare services.15–17”
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 [29]
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“Four studies compared program adherence for participants who completed or did not complete the post-treatment assessment [27, 28, 35, 36].”
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“…countries as part of the European research project SALUT, showed reduction of eating disorder symptoms and psychopathology from all four countries (Carrard et al., 2010, 2006; Fernandez-Aranda et al., 2009; Liwowsky, Cebulla, & Fichter, 2006; Nevonen, Mark, Levin, Lindstrom, & Paulson-Karlsson,…”
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“Carrard et al (2006) used a CBT-based online programme in combination with supportive weekly e-mail contacts in a first evaluation of the Salut project in Europe.”
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“…effectiveness of an Internet-based intervention for the complete sample as well as for subsamples (SALUT, (Carrard, Fernandez-Aranda, et al., 2011; Carrard et al., 2006; Fernandez-Aranada et al., 2008, 2009; Liwowsky, Cebulla, & Fichter, 2006; Nevonen, Mark, Levin, Lindstrom, & Paulson-Karlsson,…”
BackgroundResultInfluentialDoes internet-based prevention reduce the risk of relapse for anorexia nervosa?
Fichter, M. M., Quadflieg, N., Nisslmüller, K., Lindner, S., Osen, B., Huber, T., & Wünsch‐Leiteritz, W. (2012) · Behaviour Research and Therapy · doi:10.1016/j.brat.2011.12.003 · Cited by 117 · see citing works
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“, 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.”
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“14 The literature on Internet-based programs for BN, 7,8 however, is scarce and therefore warrants further investigation.”
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“Overall participants expressed good satisfaction with the online programme, found it easy to use and underlined that guidance, delivered by weekly e-mail contacts, was a predominant factor that helped them complete the 4-month programme (Carrard et al., 2006; Fernandez-Aranda, Nunez et al., 2009; Liwowsky et al., 2006…”
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“In the first study, 17% of the first sample with BN reported being “abstainers” (i.e., no longer binged or purged), 69% reported reduced binge behavior, and 59% reported reduced purge behavior (Carrard et al., 2006).”
InfluentialA cross‐cultural comparison of the eating disorder inventory
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“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.”
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“A number of studies have also shown the efficacy of online CBT self-help for BN (Sanchez-Ortiz, Munro, Stahl et al., 2011; Pretorius et al., 2009; Carrard et al., 2006, 2010).”
BackgroundInternet-based relapse prevention for anorexia nervosa: nine- month follow-up
Fichter, M. M., Quadflieg, N., & Lindner, S. (2013) · Journal of Eating Disorders · doi:10.1186/2050-2974-1-23 · Cited by 41 · see citing works
“For eating disorders, until recently the few existing studies on internet-based interventions have focused mainly on bulimia nervosa (BN) [15,17-23] and binge eating disorder (BED) [24-27].”
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Sánchez-Ortiz, V. C., Munro, C., Startup, H. M., Treasure, J. L., & Schmidt, U. H. (2011) · European Eating Disorders Review · doi:10.1002/erv.1074 · Cited by 39 · see citing works
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“Questionnaire anamnestique pour les troubles alimentaire (QATA; Carrard et al., 2006) The QATA was developed by the University Hospital of Geneva, to obtain information about binge eating behaviour, and compensatory measures over the previous three months to ascertain DSM-IV eating disorder diagnosis.”
MethodSelf-citationBarakat, 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
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“These reasons for choosing self-help have been cited in previous studies of computerized CBT [8,15,16] and seem to represent a key attraction of the self-help approach for those who do not wish to pursue traditional routes of treatment.”
Evaluation of a new Internet-based self-help guide for patients with bulimic symptoms in Sweden
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Treating eating disorders using the internet
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Treatment dropout in web-based cognitive behavioral therapy for patients with eating disorders
ter Huurne, E. D., Postel, M. G., de Haan, H. A., van der Palen, J., & DeJong, C. A. J. (2017) · Psychiatry Research · doi:10.1016/j.psychres.2016.11.034 · Cited by 25 · see citing works
“…al., 2013), such as a higher frequency of (subjective) binge eating (Carrard et al., 2006; Ljotsson et al., 2007), a higher frequency of vomiting (Carrard et al., 2006), more concerns about body shape (Carrard et al., 2011a), and a higher drive for thinness in treatment dropouts (Carrard et al.,…”
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“They hold the opportunity to reach people who live in remote areas or those with disabilities and without easy access to health care services (Anderson et al., 2013; Benavides-Vaello, Strode & Sheeran, 2013; Carrard et al., 2006).”
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“Recently, CBT for patients with eating disorders has been increasingly provided via the internet [9-13].”
BackgroundMethodResultOnline counselling for eating disorders: Reaching an underserved population?
Moessner, M., & Bauer, S. (2012) · Journal of Mental Health · doi:10.3109/09638237.2011.643512 · Cited by 22 · see citing works
“In the field of ED, ICT-based programs have been developed and evaluated for the prevention (e.g. Bauer et al., 2009; Taylor et al., 2006), aftercare (Bauer et al., 2003), self-help, and treatment support (Carrard et al., 2006; Sánchez-Ortiz et al., 2010; Shapiro et al., 2010).”
MethodAn open trial of self‐help behaviours of clients with eating disorders in an online programme
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BackgroundEnhancing quality of life in people with disordered eating using an online self-help programme
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“Numerous European studies using a self-help approach have shown that Internet-based interventions can improve eating disorder symptoms, general psychopathology, self-esteem, depression and general life satisfaction [16-20].”
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“, 2009), andmore binges and vomiting (Carrard et al., 2006),whereas in one study no predictors were found (Carrard et al.”
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“However, research suggests that more attention should be paid to people with psychological conditions, including those who self-harm [13], those who experience eating disorders [14], and those with various other mental disorders [15] because these conditions affect different aspects of daily functioning.”
BackgroundYom‐Tov, E., Klomek, A. B., Mandel, O., Hadas, A., & Fennig, S. (2018) · JMIR Mental Health · doi:10.2196/mental.8212 · Cited by 14 · see citing works
“There are also a number of promising alternative Internet-based delivery systems for the treatment of ED patients, although most are still in an early phase of development [17,18].”
BackgroundHögdahl, L., Birgegård, A., Norring, C. E. A., Lapidoth, J. D. M., Andersson, M., & Björck, C. (2022) · Internet Interventions · doi:10.1016/j.invent.2022.100598 · Cited by 14 · see citing works
“Salut BN has been evaluated in several studies (Wagner et al., 2013; Carrard et al., 2011b; Carrard et al., 2006; Fern ´ andez-Aranda et al., 2009; Liwowsky et al., 2006; Nevonen and Broberg, 2006a) with significant improvement in ED symptoms and general psychopathology, although results varied…”
Wagner, G., Wagner, G., Penelo, E., Nobis, G., Mayerhofer, A., Schau, J., Spitzer, M., Imgart, H., & Karwautz, A. F. K. (2013) · Neuropsychiatrie · doi:10.1007/s40211-013-0062-x · Cited by 13 · see citing works
“Only a few studies have explored the use of new technology as CD-ROM or Internet-based programmes in the treatment of BN in adults [9–12, 14], and only one in adolescents, and promising results have been found [4].”
BackgroundGraham, L., & Walton, M. (2011) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465810000688 · Cited by 13 · see citing works
“(Carrard et al., 2006; Schmidt et al., 2008).”
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“These expectations have instigated the development of patient-centred e-health systems for diseases such as asthma, diabetes (Plougmann, Hejlesen, & Cavan, 2001), eating disorders ( Carrard, Rouget, Fernandez-Aranda, Volkart, Damoiseau, & Lam, 2006 ), and HIV/AIDS (Caceres, Gomez, Garcia, Gatell, & del Pozo, 2006).”
Modeling of species geographic distribution for assessing present needs for the ecological networks
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“Studies in patients with bulimia nervosa (BN) have demonstrated that group CBT (G-CBT) may achieve the same therapeutic effect as individual CBT with a lower cost per patient [13, 14].”
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“Several European studies have reported positive fi ndings and supported the use of self-help with online programme (Carrard et al., 2006, 2011; Ljotsson et al., 2007; Nevonen et al., 2006).”
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“First, it consists of 7 modules with concepts, examples and exercises: 1) moti - vation, 2) self-observation, 3) modification of behavior, 4) observation and modification of automatic thoughts, 5) problem solving, 6) self-affirmation, 7) conclusion and relapse prevention [23, 42].”
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“SMS has been identified as a promising intervention for mental health conditions such as bulimia nervosa, bipolar disorder, and dementia (Carrard et al., 2006; Huis In Het Veld et al., 2018; van den Heuvel et al., 2018).”
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Der psychotherapeutische Prozess in der Behandlung von Essanfällen
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Traiter l'addiction aux jeux de hasard et d'argent : un programme Internet
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“…sur des approches cognitivo-comportementales (cette thérapie se prêtant davantage à une adaptation au format informa-tique), ont ainsi été utilisés avec différents troubles comme la dépression [2], le stress post-traumatique [16], la phobie sociale [4] ou encore les troubles alimentaires [6, 20].”
LA CYBERTHÉRAPIE DANS LE TRAITEMENT DE L’HYPERPHAGIE BOULIMIQUE : RECENSION DE LA LITTÉRATURE
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“…sur Internet 6 6 Pretorius et al., 2009 101 HB et BN TCC (autosoin guidé 1 fois/sem.) sur Internet 3 3 Études non contrôlées non randomisées Carrard et al., 2006 45 BN et TANS TCC (autosoin guidé 1 fois/sem.) sur Internet 4 2 Nevonen et al., 2012 38 BN et TANS TCC (autosoin guidé 1…”
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- Authors
- Carrard, I., Rouget, P., Fernández-Aranda, F., Volkart, A.-C., Damoiseau, M., & Lam, T.
- Affiliations
- University Hospital of Geneva (CH)
- NetUnion (Switzerland) (CH)
- Corresponding author
- Carrard, Isabelle
- Venue
- International Journal of Medical Informatics
- Publisher
- Elsevier BV
- Published
- 2006-01
- Volume
- 75
- Issue
- 1
- Pages
- 101-109
- ISSN
- 1386-5056 (ISSN-L)
- OpenAlex
- W2041287714
- Cited by
- 88
- References
- 30
- Citations by year
- 2025: 3 · 2023: 1 · 2022: 3 · 2021: 2 · 2020: 1 · 2019: 3 · 2018: 2 · 2017: 2 · 2016: 8 · 2015: 2 · 2014: 4 · 2013: 11 · 2012: 7
- FWCI
- 5.78
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- International Journal of Medical Informatics (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
- bulimia nervosa, online self-help program, patient self-management, cognitive behavioral therapy, eating disorder symptoms, program effectiveness, feasibility, women
- MeSH terms
- Adolescent, Adult, Europe, Female, Humans, Self Care, Social Support, Program Evaluation, Evidence-Based Medicine, Internet, Bulimia Nervosa
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