Internet-Based CBT for Bulimic Symptomatology

A study published in Behaviour Research and Therapy found a significant improvement in eating disorder symptoms (behavior and cognitions), among adolescent participants (n=101) with bulimia nervosa (BN) or bulimic symptomatology following the completion of an internet-based cognitive behavior therapy (CBT) intervention. These findings suggest that an internet-based approach could serve as an initial intervention for adolescents with bulimic symptomatology.

Pretorius, N., Arcelus, J., Beecham, J., Dawson, H., Doherty, F., Eisler, I.,…Schmidt, U. (2009) Cognitive-behavioural therapy for adolescents with bulimic symptomatology: The acceptability and effectiveness of internet-based delivery. Behaviour Research and Therapy, 47(9), 729-736.

Internet-Based CBT Can Facilitate a Strong Working Alliance

A recent pilot study found that internet-based cognitive behavior therapy (CBT) may facilitate a working alliance that is comparable in quality to the alliance formed in face-to-face therapy settings. The working, or therapeutic, alliance is a key tenet of CBT, and research suggests that it is crucial to positive therapeutic outcomes. The current study compares the working alliance between client and therapist in an internet-based intervention and in face-to-face treatment for depression.

Participants were randomized into two groups; one group (n= 25) received the internet-based treatment and the second group (n=28) received face-to-face treatment. Both groups received 8 weeks of manualized CBT treatment for depression, which was based on a standard, evidence-based CBT manual for depression. Treatment was delivered by therapists trained in CBT specifically for this study, and involved an introduction to CBT, behavioral analysis, activity scheduling, cognitive restructuring, promotion of social competence, psychoeducation, relapse prevention, and a life review module. Patients in the face-to-face condition attended weekly one-hour sessions and were given weekly homework assignments. In the online condition, the treatment manual was adapted for use as a highly structured internet based treatment manual, and included writing and homework assignments based on the CBT approach. Writing assignments lasted 45-minutes and were scheduled regularly, two times per week. Therapists then provided written feedback within one working day. Working alliance was assessed with the Working Alliance Inventory (WAI) at mid-point and post-treatment.

Ratings of the working alliance between the internet condition and face-to-face condition did not differ significantly. At post-treatment, there were positive correlations between clients’ ratings of the working alliance and treatment outcome for the online group, and at both mid and post treatment for the face-to-face group. The results of this preliminary research suggest that internet-based CBT may promote a working alliance comparable to that which is found in face-to-face treatment and produce positive treatment outcomes.

Preschl, B., Maercker, A., Wagner, B. (2011). The working alliance in a randomized controlled trial comparing online with face-to-face cognitive-behavioral therapy for depression. BMC Psychiatry, 11(189), doi: 10.1186/1471-244X-11-189

Internet-Based CBT for Binge Eating Disorder

A recent study published in Behaviour Research and Therapy found that a Cognitive Behavior Therapy (CBT) based self-help treatment program for binge eating disorder (BED) could be successfully implemented online. BED is characterized by recurrent episodes of binge eating with a sense of loss of control, marked distress, and without the presence of compensatory behaviors (e.g., purging). Previous research indicates that CBT is an effective treatment for BED and associated symptoms and psychopathology. The current study sought to implement an internet-based CBT self-help program for this population.

Participants included 74 women, ages 18 to 60, who met full or sub-threshold diagnostic criteria for BED. Measures included the Eating Disorders in Obesity (EDO) questionnaire, the Eating Disorder Examination-Questionnaire (EDE-Q), the Eating Disorder Inventory-2 (EDI-2), and the Three-Factor Eating Questionnaire (TFEQ). Participants were first assessed at baseline using the EDO and then randomly assigned to two groups: (1) an internet group, which consisted of a 6-month internet guided self-help treatment intervention followed by a six-month follow-up period, and (2) a control group, which consisted of a 6-month waitlist. The treatment program included daily self-monitoring, identifying binge triggers and automatic thoughts, cognitive restructuring, and relapse prevention. Additionally, two psychologists worked as coaches and provided weekly guidance to participants. Participants were reassessed following treatment, and again at a 6-month follow-up period.

The Internet self-help treatment program had positive effects on the symptoms associated with eating disorders. Outcome variables such as drive for thinness, body dissatisfaction and shape concern improved significantly. Participants also showed improvements in impulse regulation and self-esteem. These findings suggest that a CBT-based self-help treatment program for BED can be successfully implemented online and maintain treatment efficacy.

Carrard I., Crépin, C., Rouget, P., Lam, T., Golay, A., & Van der Linden, M. (2011). Randomised controlled trial of a guided self-help treatment on the Internet for binge eating disorder.  Behaviour Research and Therapy, 43, 482-491.