Web-based self-help program proves effective in treating binge eating disorder

By Dr. Priyom Bose, Ph.D.May 19 2024Reviewed by Benedette Cuffari, M.Sc.

A recent JAMA Network Open study assesses the effectiveness of web-based self-help interventions in alleviating binge eating disorder (BED).

Study: Effectiveness of a Web-Based Cognitive Behavioral Self-Help Intervention for Binge Eating Disorder. Image Credit: fizkes / Shutterstock.com

What is BED?

BED is defined as recurrent episodes of uncontrolled overeating that lead to obesity, type 2 diabetes, and hypertension. Prolonged BED ultimately reduces the affected individuals' quality of life, negatively impacts social relationships, and compromises occupational performance. Thus, timely intervention is crucial to prevent BED progression to a chronic state that can lead to premature death.

Previous studies have demonstrated that cognitive behavioral therapy (CBT) is an effective BED intervention, as this treatment can effectively manage various psychiatric conditions, including bulimia nervosa and anorexia nervosa. Nevertheless, several barriers, such as clinician unawareness, treatment costs, and sociocultural stigma, prevent many patients from seeking in-person psychotherapy.

Rapid technological advancements have created new avenues to reduce these barriers and make BED treatments more accessible. In fact, web-based cognitive behavioral interventions have recently gained significant popularity due to their ease of implementation, availability, reduced social stigma, and cost-effectiveness.

Although preliminary and small-scale studies have indicated the benefits associated with web-based cognitive behavioral interventions for BED, more rigorous scientific investigations are needed to assess the effectiveness of this strategy.

About the study

In the current study, researchers discuss the results of a randomized clinical trial (RCT) evaluating the effectiveness of a web-based cognitive behavioral self-help intervention for BED. The team assessed changes in eating disorder symptoms, well-being, comorbid psychopathology, eating disorder symptoms, self-esteem, emotion regulation, and clinical impairment. Weekly symptom monitoring and ecological momentary assessment (EMA) were used to identify real-time changes in binge eating.

Study participants were recruited from all regions of Germany, in addition to German-speaking individuals from other European countries. German-speaking individuals between 18 and 65 years of age, smartphone owners, and those who were diagnosed with BED based on the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) were considered.

Study participants were randomly assigned to a waiting list (control) or web-based treatment group. All participants were assessed at baseline, six weeks from baseline or mid-treatment, and post-treatment at 12 weeks following baseline.

The core curriculum included six mandatory modules involving psychoeducation, self-monitoring of binge eating, emotion regulation videos, audio, texts, and interactive exercises. The intervention used a sequential module-access strategy to engage the participants in a more personalized manner, in which a new module became accessible after completing the preceding module.

Study findings

A change in BED patterns was observed from baseline to 12 weeks of the web-based cognitive behavioral self-help intervention. Of 1,602 patients, 154 fulfilled all eligibility criteria and were recruited for the study. Among the selected participants, 77 were randomized to the intervention group and 77 to the control group.

The intervention group outperformed the control group in terms of reporting a lower number of binge-eating episodes. The intervention group also significantly improved global eating psychopathology and clinical impairment.

The intervention's efficacy exceeded or was similar to previously documented digital interventions, as well as in-person guided and unguided self-help interventions for BED. Notably, the levels of improvement observed in the intervention group were consistent with or surpassed those associated with in-person CBT interventions, thus confirming the clinical applicability of web-based cognitive behavioral self-help interventions.

The effectiveness of a web-based cognitive behavioral self-help intervention is not limited to an individual's comorbidities, such as obesity. The intervention was found to also improve the overall quality of life of the participants. Promoting accessibility to psychological treatment facilities improved the depressive symptoms, self-esteem, emotion regulation, and well-being of patients with BED.

Notably, the current study allowed participants of either group to seek additional professional assistance, which may have accounted for a minor improvement in depressive symptoms and global eating psychopathology observed in the control group.

The positive effects of web-based cognitive behavioral self-help intervention were dependent on participants' motivation, their attitudes toward online interventions, demographic characteristics, and treatment expectations.

Conclusions

The current study demonstrated that a web-based intervention improved participants' overall well-being with BED. Thus, accessibility to effective treatment options will likely help patients with BED and alleviate their adverse health conditions.

Importantly, the current study has some limitations, including the under-representation of male and older age groups in the study cohort. The self-report study design also increases vulnerability to social desirability, which may lead to biased observations. In the future, researchers must design novel methodologies, such as double-blind designs, to minimize these biases.