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

Abstract

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

Review of the current empirical literature on using videoconferencing to deliver individual psychotherapies to adults with mental health problems

“…Most other studies identified by the search examined smaller single group samples for bulimia and related disorders, reporting reductions in bulimic symptoms (Abrahamssom, Ahlund, Ahrin, & Alfonsson, 2018 ; Hamatani et al, 2019 ; Simpson et al, 2006 ) and satisfaction with the online modality (Abrahamssom et al, 2018 ; Simpson et al, 2005 ).…”

Effectiveness of Videoconference-Delivered Cognitive Behavioral Therapy for Adults With Psychiatric Disorders: Systematic and Meta-Analytic Review

“…Another approach to improve accessibility to CBT for individuals residing in remote areas is to utilize a videoconferencing system [18][19][20]. In comparison to ICBT, videoconference-delivered CBT (VCBT) has the advantage of enabling remote treatment through interactive real-time communication between the therapist and the patient, which makes it similar to face-to-face CBT.…”

Cognitive‐behavioral therapy in the time of coronavirus: Clinician tips for working with eating disorders via telehealth when face‐to‐face meetings are not possible

“…In part, this is because evidence-based treatments have been predicated largely on face-toface contact (e.g., monitoring risk; the weighing of patients- Waller & Mountford, 2015). There are some preliminary studies showing that telehealth can be beneficial in treating eating disorders and obesity (e.g., Abrahamsson, Ahlund, Ahrin, & Alfonsson, 2018; Byrne, Crosby, & Le Grange, 2017; Cassin et al, 2016;Giel et al, 2015;Hamatani et al, 2019;Sockalingam et al, 2017), but fewer substantial studies that support this approach (e.g., Ertelt et al, 2011;Mitchell et al, 2008). Kazdin, Fitzsimmons-Craft, and Wilfley (2017) have identified telehealth as requiring further study and development, though the limited evidence to date suggests we can deliver effective therapies for eating disorders at a distance with thoughtful planning and careful delivery (Sproch & Anderson, 2019).…”