Web-Based Guided Self-Help Noninferior to Standard Treatment for Binge-Eating Disorder
Key Clinical Summary
- A randomized clinical trial found web-based guided self-help noninferior to standard treatment for binge-eating disorder.
- The digital intervention reduced binge episodes comparably, with fewer therapist hours and shorter duration.
- Findings support scalable, cost-effective psychological care amid global mental health staff shortages.
According to a noninferiority randomized clinical trial published in JAMA Network Open, web-based guided self-help may be an effective standalone treatment for binge-eating disorder (BED).
Conducted at a specialized center for eating disorders in the Netherlands, the trial’s 187 participants (85.6% female, mean age 38.1 years) were randomized to receive either 12 weeks of web-based guided self-help (n = 93) or 20 weeks of treatment as usual (n = 94), which was an individualized, focused version of cognitive behavioral therapy-enhanced (CBT-E).
As their primary outcome, the researchers assessed the difference in the number of objective binge-eating episodes at the end of treatment and at 20 weeks after treatment. They also evaluated several secondary outcomes, including full remission, dropout, and therapeutic alliance following treatment. Linear mixed model analyses with restricted maximum likelihood estimation, multilevel negative binomial regression, and multilevel binary logistic regression were used to compare the 2 treatment groups.
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Using a noninferiority margin of 1 additional binge episode, the researchers found that the web-based intervention was noninferior to treatment as usual at the end of treatment (−0.82 [95% CI, −1.86 to 0.21]; P = .12) and 20 weeks after treatment (−0.58 [95% CI, −1.41 to 0.26]; P = .17). Patients in the web-based guided self-help group also reported slightly fewer binge episodes than those receiving treatment as usual at the end of treatment (3.24 vs 4.06 episodes) and at 20-week follow-up (1.27 vs 1.84 episodes).
In their secondary analyses, the authors noted that there was not a significant difference in dropout or full remission rates, though patients in the treatment-as-usual group had stronger therapeutic alliance at the end of treatment than those in the web-based self-help group.
“Although there was stronger therapeutic alliance in the treatment-as-usual group at the end of treatment, this does not appear to be a barrier to successful treatment effect, suggesting that neither session length nor scripted protocol adherence influenced treatment outcomes,” wrote Ella van Beers, Novarum Centre for Eating Disorders and Obesity, Amstelveen, the Netherlands, and study coauthors.
While the authors acknowledge the need for replication in more heterogenous populations, they emphasize that their findings highlight web-based self-help as an effective and efficient approach to broadening treatment access.
“These results suggest more evidence for the effectiveness of web-based mental health care, which is an important finding amid global challenges with mental health staff shortages, long waiting lists, and high treatment costs,” they concluded.
