Effectiveness of web‐based guided self‐help cognitive behavioral therapy‐enhanced for binge‐eating disorder: An implementation study

Abstract

IntroductionWeb‐based guided self‐help cognitive behavioral therapy‐enhanced (CBT‐E) is a 12‐weeks, 12‐sessions, digitalized version of part II of the self‐help book Overcoming Binge Eating. This intervention is effective when offered under controlled circumstances in a randomized‐controlled‐trial. It is unknown how patients with binge‐eating disorder (BED) respond to this intervention when offered in real‐world clinical‐settings. The aim of this study is to examine post‐intervention effectiveness of guided self‐help CBT‐E for BED in real‐world settings.MethodThe present study used a cohort‐design examining the effectiveness of web‐based guided self‐help CBT‐E according to an intention‐to‐treat (ITT) analysis. BED patients (n = 278) were assessed pre‐ and post‐intervention. The primary outcome was reduction in binge‐eating episodes. Other outcomes were full‐recovery (EDE‐Q score <2.77 and abstinence from binge‐eating episodes), impaired psychosocial functioning, defined as secondary impairment, and general psychopathology post‐intervention.ResultsThe number of binge‐eating episodes reduced by an average of 16 binge‐eating episodes per 4 weeks pre‐intervention to five binge‐eating episodes during the last 4 weeks of treatment. Abstinence from binge eating was reported by 30%, and 28% reported full recovery. Effect sizes (Cohen's d) were large (d ≥ 1.0) for all outcome measures. There were no differences in outcomes between the ITT and the completers sample.DiscussionGuided self‐help CBT‐E is associated with significant improvements. The effects of guided self‐help CBT‐E offered in a real‐world‐setting are comparable to self‐help CBT‐E offered in a randomized‐controlled‐trial. However, it should be noted that comparisons with randomized‐controlled‐trials requires caution. Longer‐term follow‐up data are necessary to measure persistence of treatment benefits.Public SignificanceOffering CBT‐E as a web‐based guided self‐help intervention has several benefits for patients with BED. Guided self‐help CBT‐E is associated with significant improvements on the short term when offered in real‐world clinical settings.