Effectiveness of a Web-Based Cognitive Behavioral Self-Help Intervention for Binge Eating Disorder

Abstract

ImportanceBinge eating disorder (BED) is one of the most frequent eating pathologies and imposes substantial emotional and physical distress, yet insufficient health care resources limit access to specialized treatment. Web-based self-help interventions emerge as a promising solution, offering more accessible care.ObjectiveTo examine the effectiveness of a web-based cognitive behavioral self-help intervention for individuals with BED.Design, Setting, and ParticipantsThis 2-arm, parallel-group randomized clinical trial conducted from January 15, 2021, to August 3, 2022, in Germany and other German-speaking countries enrolled patients aged 18 to 65 years who met the diagnostic criteria for BED (according to the Diagnostic and Statistical Manual of Mental Disorders [Fifth Edition]). Data analysis occurred between January 27 and September 4, 2023, following our statistical analysis plan.InterventionsParticipants were randomized to a web-based self-help intervention or a waiting-list control condition.Main Outcomes and MeasuresThe primary outcome was a change in objective binge eating episodes from baseline to after treatment. Secondary outcomes included global eating pathology, clinical impairment, work capacity, well-being, comorbid psychopathology, self-esteem, and emotion regulation.ResultsA total of 1602 patients were screened, of whom 154 (mean [SD] age, 35.93 [10.59] years; 148 female [96.10%]) fulfilled the criteria for BED and were randomized (77 each to the intervention and control groups). The web-based intervention led to significant improvements in binge eating episodes (Cohen d, −0.79 [95% CI, −1.17 to −0.42]; P < .001), global eating psychopathology (Cohen d, −0.71 [95% CI, −1.07 to −0.35]; P < .001), weekly binge eating (Cohen d, −0.49 [95% CI, −0.74 to −0.24]; P < .001), clinical impairment (Cohen d, −0.75 [95% CI, −1.13 to −0.37]; P < .001), well-being (Cohen d, 0.38 [95% CI, 0.01 to 0.75]; P = .047), depression (Cohen d, −0.49 [95% CI, −0.86 to −0.12]; P = .01), anxiety (Cohen d, −0.37 [95% CI, −0.67 to −0.07]; P = .02), self-esteem (Cohen d, 0.36 [95% CI, 0.13 to 0.59]; P = .003), and emotion regulation (difficulties: Cohen d, −0.36 [95% CI, −0.65 to −0.07]; P = .01 and repertoire: Cohen d, 0.52 [95% CI, 0.19 to 0.84]; P = .003).Conclusion and RelevanceIn this randomized clinical trial of a web-based self-help intervention for patients with BED, the findings confirmed its effectiveness in reducing binge eating episodes and improving various mental health outcomes, highlighting a scalable solution to bridge the treatment gap for this condition.Trial RegistrationClinicalTrials.gov Identifier: NCT04876183

A Comparison of the Efficacy of Online HAPIFED versus Online Cognitive Behavioural Therapy for Binge Eating Disorder: A Randomized Controlled Trial

“…There is a growing scientific literature supporting the use of online interventions to treat people with eating disorders characterised by recurrent binge eating. Previous studies in this field have shown the efficacy of online self-help CBT interventions in reducing binge eating and improving mental health in people with binge/purge eating disorders or BED [54,55]. For instance, a recent RCT found that a 12-week online self-help CBT program that used exercises addressing risk factors for and the mechanisms of BED reduced binge eating, eating disorder psychopathology, emotion dysregulation, depression, and anxiety in people with BED [55,56].…”

“…Previous studies in this field have shown the efficacy of online self-help CBT interventions in reducing binge eating and improving mental health in people with binge/purge eating disorders or BED [54,55]. For instance, a recent RCT found that a 12-week online self-help CBT program that used exercises addressing risk factors for and the mechanisms of BED reduced binge eating, eating disorder psychopathology, emotion dysregulation, depression, and anxiety in people with BED [55,56]. The findings of the current RCT contribute to the literature in this field by showing that online treatments based on CBT or HAPIFED delivered in a group therapy format via videoconferencing are also an effective treatment option to assist people with BED.…”

Web-Based Cognitive Behavioral Treatment for Bulimia Nervosa

“…Possibly reducing the barriers of face-to-face treatments by being more flexible, accessible, and cost-efficient, web-based interventions have been developed to complement established therapies and are increasingly integrated into routine care settings . While meta-analyses suggest that web-based interventions may reduce eating disorder symptoms, there is a scarcity of research investigating treatments tailored to BN, and previous studies are often limited regarding their generalizability to clinical practice .…”

“…Possibly reducing the barriers of face-to-face treatments by being more flexible, accessible, and cost-efficient, web-based interventions have been developed to complement established therapies and are increasingly integrated into routine care settings. 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 While meta-analyses suggest that web-based interventions may reduce eating disorder symptoms, there is a scarcity of research investigating treatments tailored to BN, and previous studies are often limited regarding their generalizability to clinical practice. 17 , 18 , 19 , 20 , 24 , 25 , 27 Therefore, more research is needed to evaluate the effectiveness of web-based interventions targeting patients diagnosed with BN, especially when applied in naturalistic settings.…”