Internet-Based Cognitive-Behavioral Therapy for Bulimia Nervosa: A Controlled Study
Open accessAbstract
The object of this study was to examine the effectiveness of an Internet-based therapy (IBT) for bulimia nervosa (BN) as compared to a waiting list (WL). Sixty-two female BN patients, diagnosed according to DSM-IV criteria, were assigned to either the IBT or a WL. The control participants (WL) were matched to the IBT group in terms of age, duration of the disorder, number of previous treatments, and severity of the disorder. Assessment measures included the EDI, SCL-90-R, BITE, the TCI-R, and other clinical and psychopathological indices, which were administrated before and after the treatment. Considering the IBT, while the mean scores were lower at the end of the treatment for some EDI scales (bulimic, interpersonal distrust, maturity fears, and total score) and the BITE symptomatology subscale, the mean BMI was higher at posttherapy. Predictors of good IBT outcome were higher scores on the EDI perfectionism scale and EAT and a higher minimum BMI. Drop-out (after IBT 35.5% of cases) was related to higher SCL-anxiety scores, a lower hyperactivity, a lower minimum BMI, and lower TCI-reward dependence scores. At the end of the treatment, bingeing and vomiting abstinence rates differed significantly between the two groups. Results suggest that an online self-help approach appears to be a valid treatment option for BN when compared to a WL control group, especially for people who present a lower severity of their eating disorder (ED) symptomatology and some specific personality traits.
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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 [31]
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“…anxiety scores, lower hyperactivity, and lower reward dependence showed to be predictors of dropout in an internet-based CBT for patients with BN (Fernandez-Aranda et al., 2009), and more severe depression and lower self-directedness in a guided self-help intervention with weekly e-mail support…”
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“…depression symptoms, lower selfdirectedness (Wagner et al., 2015), more anxiety symptoms, lower hyperactivity, lower BMI, lower reward dependence (Fernandez-Aranda et al., 2009), andmore binges and vomiting (Carrard et al., 2006),whereas in one study no predictors were found (Carrard et al.,…”
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“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].”
BackgroundMethodSelf-citationErford, B. T., Richards, T., Peacock, E., Voith, K., McGair, H., Muller, B. E., Duncan, K., & Chang, C. Y. (2013) · Journal of Counseling & Development · doi:10.1002/j.1556-6676.2013.00083.x · Cited by 12 · see citing works
Szabó, K., Czeglédi, E., Babusa, B., Szumska, I., Túry, F., Sándor, I., & Bauer, S. (2015) · European Eating Disorders Review · doi:10.1002/erv.2345 · Cited by 11 · see citing works
Internetbasierte Ansätze in der Therapie von Essstörungen
Fichter, M. M., Quadflieg, N., Nisslmüller, K., Lindner, S., Voderholzer, U., Wünsch‐Leiteritz, W., Osen, B., Huber, T., Zahn, S., Meermann, R., et al. (2011) · Der Nervenarzt · doi:10.1007/s00115-010-3228-9 · Cited by 9 · see citing works
Crepaldi, M., Colombo, V. M., Baldassini, D., Mottura, S., & Antonietti, A. (2017) · Lecture notes in computer science · doi:10.1007/978-3-319-72323-5_11 · Cited by 9 · see citing works
Telehealth approaches to obsessive-compulsive related disorders
Brand, J., & Mckay, D. (2012) · Psychotherapy Research · doi:10.1080/10503307.2011.650655 · Cited by 9 · see citing works
“It is an improvement from Fernandez-Aranda et al. (2009), in that the participants were randomized, and follow-up data were included to examine the maintenance of treatment gains. It also differs from Fernandez-Aranda et al. (2009) in treatment modality.”
BackgroundInfluentialMatherne, C. E., Watson, H. J., Fassnacht, D. B., Ali, K., Zerwas, S. C., Peat, C. M., Runfola, C. D., Levine, M. D., Marcus, M. D., Zimmer, B., et al. (2022) · European Eating Disorders Review · doi:10.1002/erv.2898 · Cited by 7 · see citing works
Smith, T. E., Williams, J. M., Richards, K. V., & Panisch, L. S. (2017) · International Journal of Systemic Therapy · doi:10.1080/08975353.2017.1368812 · Cited by 8 · see citing works
“…Stallard, & Velleman, 2010), as well as for adults with a variety of mental health conditions, including depression (Kessler et al., 2009) anxiety disorders (Titov, Andrews, Schwencke, Drobny, & Einstein, 2008), and eating disorders (Fernández-Aranda et al., 2009; Ljotsson et al., 2007).”
BackgroundOhsako, N., Kimura, H., Hashimoto, T., Hosoda, Y., Inaba, Y., Iyo, M., & Nakazato, M. (2023) · BioPsychoSocial Medicine · doi:10.1186/s13030-023-00294-1 · Cited by 5 · see citing works
“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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Renteria‐Agirre, A., & Lange, A. (2009) · Directieve therapie · doi:10.1007/bf03087845 · Cited by 5 · see citing works
“In de studies van Carrard et al. (2006), Ljotsson et al. (2007) en Fernández-Aranda et al. (2009) stopte tussen de 31% en 36% van de deelnemers voortijdig.”
BackgroundCaractéristiques et évidences empiriques des traitements psychologiques basés sur Internet
Hohl, É., Berger, T., Bergström, J., Andersson, G., & Caspar, F. (2010) · Journal de Thérapie Comportementale et Cognitive · doi:10.1016/j.jtcc.2010.04.002 · Cited by 4 · see citing works
Internetgestützte Nachsorge bei Bulimia nervosa
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Harper, K. M. (2019) · Carolina Digital Repository (University of North Carolina at Chapel Hill) · doi:10.17615/j997-0s97 · Cited by 3 · see citing works
Persönlichkeitsdiagnostik in der Online-Psychotherapieforschung
Tibubos, A. N., Zwerenz, R., Brähler, E., & Beutel, M. E. (2018) · Zeitschrift für Psychiatrie Psychologie und Psychotherapie · doi:10.1024/1661-4747/a000353 · Cited by 3 · see citing works
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Jeong, S., Kim, H., Lho, S. K., Hwang, I., Mun, S., Kim, S., Lim, H., Kim, H., Shin, M.-S., & Moon, W. (2025) · Journal of Medical Internet Research · doi:10.2196/65892 · Cited by 2 · see citing works
Rodrigues, T. F., Silva, R., Fernández‐Aranda, F., & Machado, P. P. P. (2024) · Nutrients · doi:10.3390/nu16203452 · Cited by 2 · see citing works
“For instance, cognitive behavioral therapy (CBT) with interoceptive exposure was effective in increasing interoceptive awareness in patients diagnosed with bulimia nervosa [66] and binge eating disorder [67].”
BackgroundSelf-citationInvestigation of the Effect of Playing Sports on Social Appearance Anxiety
Öcal, Z. S. S., & Kayhan, R. F. (2023) · International Journal of Disabilities Sports & Health Sciences · doi:10.33438/ijdshs.1355462 · Cited by 2 · see citing works
Fichter, M. M., Quadflieg, N., & Lindner, S. (2013) · Zeitschrift für Psychiatrie Psychologie und Psychotherapie · doi:10.1024/1661-4747/a000176 · Cited by 1 · see citing works
Hulpverlening voor psychische problematiek via het world wide web
Lange, A., Ruwaard, J., & Schrieken, B. (2009) · UvA-DARE (University of Amsterdam) · Cited by 1 · see citing works
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Advances in the Prevention and Management of Obesity and Eating Disorders
Sainsbury, A., & da Luz, F. Q. (2018) · MDPI eBooks · doi:10.3390/books978-3-03842-854-1 · Cited by 1 · see citing works
Managing emotions through eating
Foran, A. I. (2015) · City Research Online (City University London) · Cited by 1 · see citing works
Anorexia nervosa: Benefits of recovery-oriented websites
Hersey, S. L., & Roysircar‐Sodowsky, G. (2014) · PsycEXTRA Dataset · doi:10.1037/e549552014-001 · Cited by 1 · see citing works
“Some research has shown favorable outcomes for Internet support for BN (Pretorius et al., 2009; Fernandez-Aranda et al., 2009), including the use of a guided self-help program (Nevonen, Mark, Levin, Lindstrom, & Paulson-Karlsson, 2006).”
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De toekomst van de psychotherapie en de psychotherapeut
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Arbit, S. E., Kirsch, A. C., Nowakowski, L. M., Meagher, M., Karl, A. N., Blum, A. L., Assink, M., & Conley, C. S. (2026) · Eating Behaviors · doi:10.1016/j.eatbeh.2026.102070
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- Authors
- Fernández-Aranda, F., Núñez, A., Martínez, C., Krug, I., Cappozzo, M., Carrard, I., Rouget, P., Jiménez-Murcia, S., Granero, R., Penelo, E., Santamaría, J., & Lam, T.
- Affiliations
- Department of Psychiatry, University Hospital of Bellvitge, Barcelona, Spain.
- Bellvitge University Hospital (ES)
- Instituto de Salud Carlos III (ES)
- University Hospital of Geneva (CH)
- Universitat Autònoma de Barcelona (ES)
- NetUnion (Switzerland) (CH)
- Venue
- CyberPsychology & Behavior
- Publisher
- SAGE Publications
- Published
- 2009-02
- Volume
- 12
- Issue
- 1
- Pages
- 37-41
- ISSN
- 1094-9313 (ISSN-L)
- 1557-8364
- OpenAlex
- W2030658636
- Cited by
- 80
- References
- 19
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 1 · 2023: 4 · 2022: 3 · 2021: 1 · 2020: 3 · 2019: 4 · 2018: 4 · 2017: 4 · 2016: 5 · 2015: 8 · 2014: 3 · 2013: 10 · 2012: 9
- FWCI
- 6.70
- Type
- journal article
- Language
- en
- Open access
- green
- ddd.uab.cat
- Locations
- CyberPsychology & Behavior (publishedVersion)
- PubMed (publishedVersion)
- Dipòsit Digital de Documents de la UAB (Universitat Autònoma de Barcelona) (submittedVersion, cc-by-nc-nd)
- Zenodo (CERN European Organization for Nuclear Research) (submittedVersion, other-oa)
- Funders
- European Commission
- 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
- bulimia nervosa, internet-based cognitive behavioral therapy, online self-help, treatment outcome predictors, perfectionism, reward dependence, eating disorder symptoms, treatment discontinuation, female patients
- MeSH terms
- Adult, Female, Humans, Patient Dropouts, Severity of Illness Index, Therapy, Computer-Assisted, Cognitive Behavioral Therapy, Chi-Square Distribution, Matched-Pair Analysis, Treatment Outcome, Telemedicine, Statistics, Nonparametric, Internet, Bulimia Nervosa, Young Adult
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