This article is more than 5 years old. Information may no longer be current.

In-person cognitive behavioral therapy more effective for binge eating disorder

In-person cognitive behavioral therapy was more effective than internet-based guided self-help for binge-eating disorder in overweight or obese adults, according to recent findings.

“Although CBT is considered to be the criterion standard treatment of [binge-eating disorder], this intervention is not offered areawide, leading to delayed delivery of adequate treatment,” Martina de Zwaan, MD, of Hannover Medical School, Germany, and colleagues wrote. “An alternative to traditional face-to-face CBT and a potential means to disseminate adequate treatment is structured self-help... So far, only a few randomized clinical trials of patients with [binge-eating disorder] have evaluated manualized self-help interventions.”

To compare efficacy of internet-based guided self-help with in-person CBT, researchers conducted a randomized clinical trial among 178 adult volunteers with full or subsyndromal binge-eating disorder from seven university-based outpatient clinics. Study participants were randomly assigned to receive 20 individual in-person CBT sessions of 50 minutes each or complete 11 internet modules with weekly email contact. The intention-to-treat analysis group included 169 participants with a mean age of 43.2 years. Follow-up occurred 1.5 years after baseline among 116 participants.

Confirmatory analysis using a per-protocol sample of 153 participants did not indicate noninferiority of internet-based guided self-help (adjusted effect = 1.47; 95% CI, –0.01 to 2.91; P = .05).

Among the intention-to-treat sample, internet-based guided self-help was inferior to CBT for decreased objective binge eating at treatment end (adjusted effect = 1.63; 95% CI, 0.17-3.05; P = .03).

Exploratory longitudinal analyses indicated superiority of CBT vs. internet-based guided self-help by 6 months (adjusted effect size = 0.36; 95% CI, 0.23-0.55; P < .001) but not at 1.5-year follow-up.

Participants who received CBT exhibited significantly higher reductions in eating disorder psychopathologic findings at 6-month follow-up (adjusted effect size = –0.4; 95% CI, –0.68 to –0.13; P = .005), compared with those who received internet-based guided self-help.

BMI, general psychopathologic findings and quality of life did not significantly differ between treatment groups.

“Overall, our results suggest that face-to-face CBT is likely to be a better initial treatment option compared with [internet-based guided self-help]. Face to- face CBT leads to quicker and greater reductions in the number of [objective binge eating] days, abstinence rates, and eating disorder psychopathologic findings,” the researchers wrote. “However, given that improvements were significant in both treatment conditions, the effect size of the difference of the main outcome between treatment conditions was small, and there were no statistical differences between the treatment conditions at 1.5 years after treatment, [internet-based guided self-help] remains a viable, low-threshold treatment alternative for this patient population.” – by Amanda Oldt

Disclosure: de Zwaan reports serving on advisory boards, giving lectures, and receiving travel grants within the past 3 years from Novo Nordisk and Danone and authoring books and articles on psychotherapy of eating disorders published by Thieme, Springer, Routledge, and Elsevier. Please see the study for a full list of relevant financial disclosures.