Abstract
Background: Only a minority of people with eating disorders receive evidence-based psychological treatment. This is especially true for those with recurrent binge eating because the shame that accompanies binge eating affects help seeking and there is a shortage of therapists to provide psychological treatments. Digital programme-led interventions have the potential to overcome both barriers.
Objective: This study examined the acceptability and effectiveness of a new digital programme-led intervention directly based on enhanced cognitive behaviour therapy (CBT-E), which is an empirically supported psychological treatment for eating disorders.
Methods: One hundred and ten adults with recurrent binge eating (self-reporting characteristics consistent with binge eating disorder, bulimia nervosa, and similar conditions) were recruited through an advertisement on the website of the UK's national eating disorder charity, Beat. The intervention, called Digital CBTe, comprised 12 sessions over 8–12 weeks delivered autonomously (i.e., without external support). Participants completed self-report outcome measures of eating disorder features and secondary impairment at baseline, post-intervention, and 6-month follow-up.
Results: Most participants identified as female, White, and were living in the United Kingdom. Most participants (85%) self-reported features that resembled binge eating disorder, and the rest self-reported features that resembled bulimia nervosa (8%) and atypical bulimia nervosa (7%). On average, participants reported that the onset of their eating disorder was more than twenty years ago. Sixty-three percent of the participants completed Digital CBTe (i.e., completed active treatment sessions). Those who completed all sessions and the post-intervention assessment (n = 55, 50%) reported significant decreases in binge eating, eating disorder psychopathology, and secondary impairment at post-intervention. These improvements were maintained at follow-up. Large effect sizes were observed for all these outcomes using a completer analysis and post-intervention data (d = 0.91–1.43). Significant improvements were also observed for all outcomes at post-intervention in the intent-to-treat analysis, with medium-to-large effect sizes.
Discussion: A substantial proportion of those who completed Digital CBTe and the post-intervention assessment experienced marked improvements. This provides promising data to support the conduct of a fully powered trial to test the clinical and cost-effectiveness of autonomous Digital CBTe.
Objective: This study examined the acceptability and effectiveness of a new digital programme-led intervention directly based on enhanced cognitive behaviour therapy (CBT-E), which is an empirically supported psychological treatment for eating disorders.
Methods: One hundred and ten adults with recurrent binge eating (self-reporting characteristics consistent with binge eating disorder, bulimia nervosa, and similar conditions) were recruited through an advertisement on the website of the UK's national eating disorder charity, Beat. The intervention, called Digital CBTe, comprised 12 sessions over 8–12 weeks delivered autonomously (i.e., without external support). Participants completed self-report outcome measures of eating disorder features and secondary impairment at baseline, post-intervention, and 6-month follow-up.
Results: Most participants identified as female, White, and were living in the United Kingdom. Most participants (85%) self-reported features that resembled binge eating disorder, and the rest self-reported features that resembled bulimia nervosa (8%) and atypical bulimia nervosa (7%). On average, participants reported that the onset of their eating disorder was more than twenty years ago. Sixty-three percent of the participants completed Digital CBTe (i.e., completed active treatment sessions). Those who completed all sessions and the post-intervention assessment (n = 55, 50%) reported significant decreases in binge eating, eating disorder psychopathology, and secondary impairment at post-intervention. These improvements were maintained at follow-up. Large effect sizes were observed for all these outcomes using a completer analysis and post-intervention data (d = 0.91–1.43). Significant improvements were also observed for all outcomes at post-intervention in the intent-to-treat analysis, with medium-to-large effect sizes.
Discussion: A substantial proportion of those who completed Digital CBTe and the post-intervention assessment experienced marked improvements. This provides promising data to support the conduct of a fully powered trial to test the clinical and cost-effectiveness of autonomous Digital CBTe.
| Original language | English |
|---|---|
| Journal | Frontiers in Digital Health |
| Early online date | 17 Jan 2025 |
| DOIs | |
| Publication status | Published - 17 Jan 2025 |
| Externally published | Yes |
Data Availability Statement
The datasets generated during this study are not publicly available due to privacy protection concerns. Requests to access the datasets should be directed to the corresponding author.Acknowledgements
The authors would like to thank: Christopher Fairburn for invaluable mentorship and guidance throughout the process of this study, Victoria Harris for statistical support (through the NIHR BRC, Oxford), Beat (an eating disorder charity in the UK) for their support in the promotion of the study, and the Centre for Research on Eating Disorders at Oxford's Patient and Public Involvement (PPI) Contributors.Funding
The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This study was funded by the National Institute for Health and Care Research (NIHR) Oxford Health Biomedical Research Centre (BRC). This study is supported by the NIHR Oxford and Thames Valley Applied Research Collaboration (OTV ARC), Digital Health Theme. Rebecca Murphy is an NIHR Clinical Doctoral Research Fellow. The views expressed are those of the author(s) and not necessarily those of the NHS, NIHR, or the Department of Health and Social Care. The prior development of Digital CBTe was supported by a strategic award from the Wellcome Trust (094585).
| Funders | Funder number |
|---|---|
| National Institute for Health and Care Research |