A single-arm pilot study of guided self-help treatment based cognitive behavioral therapy for bulimia nervosa in Japanese clinical settings

Setsu, Rikukage; Asano, Kenichi; Numata, Noriko; Tanaka, Mari; Ibuki, Hanae; Yamamoto, T.; Uragami, R.; Matsumoto, Junko; Hirano, Yoshiyuki; Iyo, Masaomi; Shimizu, Eiji; Nakazato, Michiko

doi:10.1186/s13104-018-3373-y

Cited by 7 publications

(20 citation statements)

References 21 publications

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“…The results of this research are consistent with a previous RCT in the United States that used ICBT via videoconference and reported reductions in combined objective binge and purging episodes, objective binge episodes, and purging episodes (69%, 68%, and 70%, respectively) [18]. Our previous study with face-to-face CBT reported reduced combined objective binge and purging episodes, objective binge episodes, and purging episodes (51%, 50%, and 52%, respectively) [8]. This study has resulted in changes similar to our previous study.…”

Section: Discussionsupporting

confidence: 90%

“…The protocol included the following modules: assessment; explanation of CBT, motivation and goal setting, education on bulimia nervosa and how to keep a dietary diary, psychological education and monitoring for overeating behavior, psychological education and monitoring of diet, reforming of dietary habits (mindful diet), psychological education and self-monitoring of compensatory behavior, stress management and relaxation, understanding perfectionism, interpersonal relationships and assertions, acquisition of skills to associate with emotions (emotional adjustment, mindfulness, tolerance of distress, alexithymia), attention to body image, and prevention of recurrence. These modules are a development of those used in our previous study of face-to-face CBT for patients with bulimia nervosa in Japan [8,35].…”

Section: Methodsmentioning

confidence: 99%

“…Several meta-analyses of randomized controlled trials (RCTs) that included wait list controls have reported that cognitive behavioral therapy (CBT) is effective for bulimia nervosa and binge-eating disorder [3,4-7]. Our research group has recently conducted a single-arm study that confirmed the effectiveness of guided self-help CBT for Japanese patients with bulimia nervosa [8]. Although previous studies have shown the effectiveness of CBT for bulimia nervosa and binge-eating disorder, the patients who reside in rural areas or far from specialized treatment institutions cannot receive evidence-based therapy such as CBT.…”

Section: Introductionmentioning

confidence: 99%

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Internet-Based Cognitive Behavioral Therapy via Videoconference for Patients With Bulimia Nervosa and Binge-Eating Disorder: Pilot Prospective Single-Arm Feasibility Trial

Hamatani¹,

Numata²,

Matsumoto³

et al. 2019

JMIR Form Res

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BackgroundA major problem in providing mental health services is the lack of access to treatment, especially in remote areas. Thus far, no clinical studies have demonstrated the feasibility of internet-based cognitive behavioral therapy (ICBT) with real-time therapist support via videoconference for bulimia nervosa and binge-eating disorder in Japan.ObjectiveThe goal of the research was to evaluate the feasibility of ICBT via videoconference for patients with bulimia nervosa or binge-eating disorder.MethodsSeven Japanese subjects (mean age 31.9 [SD 7.9] years) with bulimia nervosa and binge-eating disorder received 16 weekly sessions of individualized ICBT via videoconference with real-time therapist support. Treatment included CBT tailored specifically to the presenting diagnosis. The primary outcome was a reduction in the Eating Disorder Examination Edition 16.0D (EDE 16D) for bulimia nervosa and binge-eating disorder: the combined objective binge and purging episodes, objective binge episodes, and purging episodes. The secondary outcomes were the Eating Disorders Examination Questionnaire, Bulimic Investigatory Test, Edinburgh, body mass index for eating symptoms, Motivational Ruler for motivation to change, EuroQol-5 Dimension for quality of life, 9-item Patient Health Questionnaire for depression, 7-item Generalized Anxiety Disorder scale for anxiety, and Working Alliance Inventory–Short Form (WAI-SF). All outcomes were assessed at week 1 (baseline) and weeks 8 (midintervention) and 16 (postintervention) during therapy. Patients were asked about adverse events at each session. For the primary analysis, treatment-related changes were assessed by comparing participant scores and 95% confidence intervals using the paired t test.ResultsAlthough the mean combined objective binge and purging episodes improved from 47.60 to 13.60 (71% reduction) and showed a medium effect size (Cohen d=–0.76), there was no significant reduction in the combined episodes (EDE 16D –41; 95% CI –2.089 to 0.576; P=.17). There were no significant treatment-related changes in secondary outcomes. The WAI-SF scores remained consistently high (64.8 to 66.0) during treatment.ConclusionsICBT via videoconference is feasible in Japanese patients with bulimia nervosa and binge-eating disorder.Trial RegistrationUMIN Clinical Trials Registry UMIN000029426; https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000033419

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Section: Discussionsupporting

confidence: 90%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Internet-Based Cognitive Behavioral Therapy via Videoconference for Patients With Bulimia Nervosa and Binge-Eating Disorder: Pilot Prospective Single-Arm Feasibility Trial

Hamatani¹,

Numata²,

Matsumoto³

et al. 2019

JMIR Form Res

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“…A sample size of 140 with 70 per group is estimated be sufficient to test the hypothesis based on previously published BN remission rates of 45% for CBT-E and 25% for TAU [29]. A sample size of 66 patients per treatment group is required to detect a difference of this magnitude with an 80% power for the primary analysis.…”

Section: Sample Size Calculationmentioning

confidence: 99%

“…There have been few studies regarding the effects of psychological treatments for EDs in Japan. A single-arm pilot study provided preliminary evidence about the feasibility of guided self-help treatments based on CBT [29], but there have been no RCTs of psychological treatments that include formal protocols or treatment manuals. The lack of supporting evidence is most likely one of the reasons that ED-focused CBT has not been widely implemented in Japan.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of enhanced cognitive behavior therapy for bulimia nervosa in Japan: a randomized controlled trial protocol

Ohara

Sekiguchi

Takakura

et al. 2020

BioPsychoSocial Med

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Background: The effectiveness of psychotherapeutic interventions for eating disorders (EDs) is widely studied in Europe, North America, and Australia/New Zealand. However, few controlled studies and no randomized controlled trials (RCTs) have been conducted in Japan despite the relatively high prevalence of EDs in the Japanese population. The aim of this study is to evaluate the effect of enhanced cognitive behavior therapy (CBT-E), an evidence-supported ED-focused form of cognitive behavior therapy (CBT), for the treatment of bulimia nervosa (BN) in Japan. Methods/design: This multicenter RCT will compare CBT-E with treatment as usual (TAU), which is widely used in Japan. A group of 140 adult outpatients with a Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) diagnosis of BN, ≥18 years of age, a body mass index (BMI) > 17.5 and < 40 kg/m 2 will be randomly assigned to CBT-E or TAU. Participants will be stratified by intervention site and BN severity. CBT-E participants will receive 20 sessions of focused form CBT-E for 20 weeks. Those in the TAU group will receive routine treatment provided by specialists. Assessment will be performed in a blinded manner prior to the start of treatment, after 6 weeks of treatment, at the end of treatment (20 weeks), and at follow-up at 40 and 80 weeks after the start of treatment. The primary outcome is the remission of BN, defined by the absence, in the previous 4 weeks, of symptoms required to meet the DSM-5 criteria for a diagnosis of BN. Secondary outcomes include the levels of ED psychopathology and impairment due to the ED, anxiety, depression, family function, and satisfaction with treatment. Discussion: This will be the first RCT conducted in Japan to compare CBT-E and TAU for the treatment of BN. If CBT-E is found to be more effective than TAU, then the evidence would support its wider use for patients with BN in Japan. Because it is possible to train therapists who do not possess extensive specialist experience, wider use is also likely to be practically feasible. In addition, demonstrating the effectiveness of CBT-E in Japan would demonstrate that it could be successfully extended to additional world cultures and regions.

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The effectiveness and cultural adaptations of psychological interventions for eating disorders in East Asia: A systematic scoping review

Yim,

Schmidt

2023

Intl J Eating Disorders

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ObjectiveThere has been no review on eating disorder‐focused psychological interventions in East Asia. The aims of this systematic scoping review were to summarize existing and forthcoming studies and to synthesize the cultural adaptations and effectiveness of the interventions identified.MethodFive databases (PubMed, Embase, Global Health, Medline, PsychInfo) and seven trial registries were searched. Studies examining eating disorder (ED)‐focused psychological interventions in East Asia were included. Narrative synthesis was used for the analysis.ResultsEighteen published studies and 14 ongoing/completed but unpublished studies were included. Most published studies were uncontrolled and five were feasibility studies. Among the ongoing studies, 71% are randomized controlled trials. Cognitive therapies were the main approach used, including individual cognitive behavioral therapy (CBT), internet CBT, group CBT, guided self‐help, and cognitive remediation therapy. Cultural adaptations were mostly related to language, communication style and tailoring the dietary requirements to local diets. Interventions were shortened to increase acceptability and reduce financial and time burden to patients. Overall, studies showed good acceptability, completion rates and positive effects on ED symptoms (indicated by moderate to large effect sizes or statistical significance).DiscussionStudies were underpowered and uncontrolled, thus precluding meaningful interpretations of effectiveness to be made. However, the psychological interventions were acceptable and showed promise in delivery. Digital and group interventions seemed to be the most feasible given barriers in the local health systems. More controlled studies, as well as studies on children and adolescents, are needed in future.Public significanceThis is the first systematic scoping review examining psychological interventions for eating disorders in East Asia. Research in eating disorders has largely focused on White people and in Western countries. This review will be helpful for clinicians and researchers to understand the current state of the field through a non‐Eurocentric lens, to identify gaps and plan future research.

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A single-arm pilot study of guided self-help treatment based cognitive behavioral therapy for bulimia nervosa in Japanese clinical settings

Cited by 7 publications

References 21 publications

Internet-Based Cognitive Behavioral Therapy via Videoconference for Patients With Bulimia Nervosa and Binge-Eating Disorder: Pilot Prospective Single-Arm Feasibility Trial

Internet-Based Cognitive Behavioral Therapy via Videoconference for Patients With Bulimia Nervosa and Binge-Eating Disorder: Pilot Prospective Single-Arm Feasibility Trial

Effectiveness of enhanced cognitive behavior therapy for bulimia nervosa in Japan: a randomized controlled trial protocol

The effectiveness and cultural adaptations of psychological interventions for eating disorders in East Asia: A systematic scoping review

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