Web-based cognitive behavioral therapy for female patients with eating disorders: randomized controlled trial
Open accessAbstract
BACKGROUND: Many patients with eating disorders do not receive help for their symptoms, even though these disorders have severe morbidity. The Internet may offer alternative low-threshold treatment interventions. OBJECTIVE: This study evaluated the effects of a Web-based cognitive behavioral therapy (CBT) intervention using intensive asynchronous therapeutic support to improve eating disorder psychopathology, and to reduce body dissatisfaction and related health problems among patients with eating disorders. METHODS: A two-arm open randomized controlled trial comparing a Web-based CBT intervention to a waiting list control condition (WL) was carried out among female patients with bulimia nervosa (BN), binge eating disorder (BED), and eating disorders not otherwise specified (EDNOS). The eating disorder diagnosis was in accordance with the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, and was established based on participants' self-report. Participants were recruited from an open-access website, and the intervention consisted of a structured two-part program within a secure Web-based application. The aim of the first part was to analyze participant's eating attitudes and behaviors, while the second part focused on behavioral change. Participants had asynchronous contact with a personal therapist twice a week, solely via the Internet. Self-report measures of eating disorder psychopathology (primary outcome), body dissatisfaction, physical health, mental health, self-esteem, quality of life, and social functioning were completed at baseline and posttest. RESULTS: A total of 214 participants were randomized to either the Web-based CBT group (n=108) or to the WL group (n=106) stratified by type of eating disorder (BN: n=44; BED: n=85; EDNOS: n=85). Study attrition was low with 94% of the participants completing the posttest assignment. Overall, Web-based CBT showed a significant improvement over time for eating disorder psychopathology (F97=63.07, P<.001, d=.82) and all secondary outcome measures (effect sizes between d=.34 to d=.49), except for Body Mass Index. WL participants also improved on most outcomes; however, effects were smaller in this group with significant between-group effects for eating disorder psychopathology (F201=9.42, P=.002, d=.44), body dissatisfaction (F201=13.16, P<.001, d=.42), physical health (F200=12.55, P<.001, d=.28), mental health (F203=4.88, P=.028, d=.24), self-esteem (F202=5.06, P=.026, d=.20), and social functioning (F205=7.93, P=.005, d=.29). Analyses for the individual subgroups BN, BED, and EDNOS showed that eating disorder psychopathology improved significantly over time among Web-based CBT participants in all three subgroups; however, the between-group effect was significant only for participants with BED (F78=4.25, P=.043, d=.61). CONCLUSIONS: Web-based CBT proved to be effective in improving eating disorder psychopathology and related health among female patients with eating disorders. TRIAL REGISTRATION: Nederlands Trial Register (NTR): NTR2415; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2415 (Archived by WebCite at http://www.webcitation.org/6T2io3DnJ).
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A meta-analysis of BED eTherapy programs found moderate pooled reductions in objective binge episode frequency (d = −0.77) and ED psychopathology (d = −0.71) across three studies.
“A meta-analysis of BED eTherapy programs found moderate pooled reductions in objective binge episode frequency (d = −0.77) and ED psychopathology (d = −0.71) across three studies (28–30).”
From The acceptability, feasibility, and preliminary efficacy of a supported online self-help treatment program for binge-eating disorder (2023) · cites this paper as [30]
The Results section, “Efficacy of Web-Based Treatment for Specific Eating Disorder Subgroups” (page unavailable), reports that web-based CBT improved eating-disorder psychopathology relative to the control group for participants with BED. This paper is an individual randomized trial, however; our copy does not report a three-study meta-analysis, pooled effect sizes of −0.77 and −0.71, or a reduction in objective binge-episode frequency. (LLM, conf=0.84)
Experimental — accuracy not yet measuredAll three included studies used superseded DSM-IV diagnostic criteria for BED diagnosis.
“All studies used superseded DSM-IV diagnostic criteria for BED diagnosis in their samples”
From The acceptability, feasibility, and preliminary efficacy of a supported online self-help treatment program for binge-eating disorder (2023) · cites this paper as [30]
The Methods > Measures passage says this trial assessed DSM-IV eating-disorder diagnoses using the EDQ-O and other baseline data. That supports the claim for this study’s BED sample, but this paper does not establish which diagnostic criteria the other two included studies used. (LLM, conf=0.86)
Experimental — accuracy not yet measuredInternet-based cognitive-behavioral therapy (ICBT) has been shown to be effective for eating disorders other than anorexia nervosa.
“Internet-based cognitive-behavioral therapy (ICBT) has been shown to be effective for eating disorders other than anorexia nervosa (ter Huurne et al., 2015)”
From Feasibility of guided internet-based cognitive behavioral therapy for patients with anorexia nervosa (2022) · cites this paper as ter Huurne et al., 2015
Two of the three included studies employed clinical psychologists in the support clinician role, with only one study utilising other health professionals.
“two employed clinical psychologists in the support clinician role (28, 29), with only one study utilising other health professionals (30).”
From The acceptability, feasibility, and preliminary efficacy of a supported online self-help treatment program for binge-eating disorder (2023) · cites this paper as [30]
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- Authors
- ter Huurne, E. D., de Haan, H. A., Postel, M. G., van der Palen, J., VanDerNagel, J. E., & DeJong, C. A.
- Affiliations
- Tactus Verslavingszorg (NL)
- Radboud University Nijmegen (NL)
- Venue
- Journal of Medical Internet Research
- Publisher
- JMIR Publications Inc.
- Published
- 2015-06-18
- Volume
- 17
- Issue
- 6
- Pages
- e152
- ISSN
- 1438-8871 (ISSN-L)
- PMC
- PMC4526949
- OpenAlex
- W2133827559
- Cited by
- 78
- References
- 44
- Citations by year
- 2026: 7 · 2025: 10 · 2024: 9 · 2023: 7 · 2022: 8 · 2021: 8 · 2020: 7 · 2019: 8 · 2018: 4 · 2017: 7 · 2016: 3
- FWCI
- 5.79
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- other-oa
- Locations
- Journal of Medical Internet Research (publishedVersion, other-oa)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- University of Twente Research Information (publishedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Radboud Repository (Radboud University) (submittedVersion)
- Radboud Repository (Radboud University) (submittedVersion, other-oa)
- University of Twente Research Information (submittedVersion, cc-by)
- University of Twente Research Information (submittedVersion, other-oa)
- 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
- internet-based cognitive behavioral therapy, eating disorders, bulimia nervosa, binge eating disorder, eating disorder not otherwise specified, body dissatisfaction, female patients, self-esteem, quality of life, social functioning, physical health, mental health, behavior change, attrition, waitlist control, low-threshold treatment, online intervention
- MeSH terms
- Adult, Feeding and Eating Disorders, Female, Humans, Mental Health, Middle Aged, Quality of Life, Self Concept, Therapy, Computer-Assisted, Cognitive Behavioral Therapy, Body Mass Index, Treatment Outcome, Internet, Bulimia Nervosa, Binge-Eating Disorder
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