CBT4BN: A Randomized Controlled Trial of Online Chat and Face-to-Face Group Therapy for Bulimia Nervosa

S.C. Zerwas, Hunna Watson, S.M. Hofmeier, M.D. Levine, R.M. Hamer, R.D. Crosby, C.D. Runfola, C.M. Peat, J.R. Shapiro, B. Zimmer, M. Moessner, H. Kordy, M.D. Marcus, C.M. Bulik

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    Abstract

    © 2016 S. Karger AG, Basel.Objective: Although cognitive-behavioral therapy (CBT) represents the first-line evidence-based psychotherapy for bulimia nervosa (BN), most individuals seeking treatment do not have access to this specialized intervention. We compared an Internet-based manualized version of CBT group therapy for BN conducted via a therapeutic chat group (CBT4BN) to the same treatment conducted via a traditional face-to-face group therapy (CBTF2F). Method: In a two-site, randomized, controlled noninferiority trial, we tested the hypothesis that CBT4BN would not be inferior to CBTF2F. A total of 179 adult patients with BN (2.6% males) received up to 16 sessions of group CBT over 20 weeks in either CBT4BN or CBTF2F, and outcomes were compared at the end of treatment and at the 12-month follow-up. Results: At the end of treatment, CBT4BN was inferior to CBTF2F in producing abstinence from binge eating and purging. However, by the 12-month follow-up, CBT4BN was mostly not inferior to CBTF2F. Participants in the CBT4BN condition, but not CBTF2F, continued to reduce their binge-eating and purging frequency from the end of treatment to the 12-month follow-up. Conclusions: CBT delivered online in a group chat format appears to be an efficacious treatment for BN, although the trajectory of recovery may be slower than face-to-face group therapy. Online chat groups may increase accessibility of treatment and represent a cost-effective approach to service delivery. However, barriers in service delivery such as state-specific license and ethical guidelines for online therapists need to be addressed.
    Original languageEnglish
    Pages (from-to)47-53
    JournalPsychotherapy and Psychosomatics
    Volume86
    Issue number1
    DOIs
    Publication statusPublished - 2016

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    Bulimia Nervosa
    Group Psychotherapy
    Randomized Controlled Trials
    Cognitive Therapy
    Bulimia
    Therapeutics
    Licensure
    Psychotherapy
    Internet
    Guidelines
    Costs and Cost Analysis

    Cite this

    Zerwas, S.C. ; Watson, Hunna ; Hofmeier, S.M. ; Levine, M.D. ; Hamer, R.M. ; Crosby, R.D. ; Runfola, C.D. ; Peat, C.M. ; Shapiro, J.R. ; Zimmer, B. ; Moessner, M. ; Kordy, H. ; Marcus, M.D. ; Bulik, C.M. / CBT4BN: A Randomized Controlled Trial of Online Chat and Face-to-Face Group Therapy for Bulimia Nervosa. In: Psychotherapy and Psychosomatics. 2016 ; Vol. 86, No. 1. pp. 47-53.
    @article{a7fa8a1c1f434dafa2563d1ee304920e,
    title = "CBT4BN: A Randomized Controlled Trial of Online Chat and Face-to-Face Group Therapy for Bulimia Nervosa",
    abstract = "{\circledC} 2016 S. Karger AG, Basel.Objective: Although cognitive-behavioral therapy (CBT) represents the first-line evidence-based psychotherapy for bulimia nervosa (BN), most individuals seeking treatment do not have access to this specialized intervention. We compared an Internet-based manualized version of CBT group therapy for BN conducted via a therapeutic chat group (CBT4BN) to the same treatment conducted via a traditional face-to-face group therapy (CBTF2F). Method: In a two-site, randomized, controlled noninferiority trial, we tested the hypothesis that CBT4BN would not be inferior to CBTF2F. A total of 179 adult patients with BN (2.6{\%} males) received up to 16 sessions of group CBT over 20 weeks in either CBT4BN or CBTF2F, and outcomes were compared at the end of treatment and at the 12-month follow-up. Results: At the end of treatment, CBT4BN was inferior to CBTF2F in producing abstinence from binge eating and purging. However, by the 12-month follow-up, CBT4BN was mostly not inferior to CBTF2F. Participants in the CBT4BN condition, but not CBTF2F, continued to reduce their binge-eating and purging frequency from the end of treatment to the 12-month follow-up. Conclusions: CBT delivered online in a group chat format appears to be an efficacious treatment for BN, although the trajectory of recovery may be slower than face-to-face group therapy. Online chat groups may increase accessibility of treatment and represent a cost-effective approach to service delivery. However, barriers in service delivery such as state-specific license and ethical guidelines for online therapists need to be addressed.",
    author = "S.C. Zerwas and Hunna Watson and S.M. Hofmeier and M.D. Levine and R.M. Hamer and R.D. Crosby and C.D. Runfola and C.M. Peat and J.R. Shapiro and B. Zimmer and M. Moessner and H. Kordy and M.D. Marcus and C.M. Bulik",
    year = "2016",
    doi = "10.1159/000449025",
    language = "English",
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    pages = "47--53",
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    Zerwas, SC, Watson, H, Hofmeier, SM, Levine, MD, Hamer, RM, Crosby, RD, Runfola, CD, Peat, CM, Shapiro, JR, Zimmer, B, Moessner, M, Kordy, H, Marcus, MD & Bulik, CM 2016, 'CBT4BN: A Randomized Controlled Trial of Online Chat and Face-to-Face Group Therapy for Bulimia Nervosa' Psychotherapy and Psychosomatics, vol. 86, no. 1, pp. 47-53. https://doi.org/10.1159/000449025

    CBT4BN: A Randomized Controlled Trial of Online Chat and Face-to-Face Group Therapy for Bulimia Nervosa. / Zerwas, S.C.; Watson, Hunna; Hofmeier, S.M.; Levine, M.D.; Hamer, R.M.; Crosby, R.D.; Runfola, C.D.; Peat, C.M.; Shapiro, J.R.; Zimmer, B.; Moessner, M.; Kordy, H.; Marcus, M.D.; Bulik, C.M.

    In: Psychotherapy and Psychosomatics, Vol. 86, No. 1, 2016, p. 47-53.

    Research output: Contribution to journalArticle

    TY - JOUR

    T1 - CBT4BN: A Randomized Controlled Trial of Online Chat and Face-to-Face Group Therapy for Bulimia Nervosa

    AU - Zerwas, S.C.

    AU - Watson, Hunna

    AU - Hofmeier, S.M.

    AU - Levine, M.D.

    AU - Hamer, R.M.

    AU - Crosby, R.D.

    AU - Runfola, C.D.

    AU - Peat, C.M.

    AU - Shapiro, J.R.

    AU - Zimmer, B.

    AU - Moessner, M.

    AU - Kordy, H.

    AU - Marcus, M.D.

    AU - Bulik, C.M.

    PY - 2016

    Y1 - 2016

    N2 - © 2016 S. Karger AG, Basel.Objective: Although cognitive-behavioral therapy (CBT) represents the first-line evidence-based psychotherapy for bulimia nervosa (BN), most individuals seeking treatment do not have access to this specialized intervention. We compared an Internet-based manualized version of CBT group therapy for BN conducted via a therapeutic chat group (CBT4BN) to the same treatment conducted via a traditional face-to-face group therapy (CBTF2F). Method: In a two-site, randomized, controlled noninferiority trial, we tested the hypothesis that CBT4BN would not be inferior to CBTF2F. A total of 179 adult patients with BN (2.6% males) received up to 16 sessions of group CBT over 20 weeks in either CBT4BN or CBTF2F, and outcomes were compared at the end of treatment and at the 12-month follow-up. Results: At the end of treatment, CBT4BN was inferior to CBTF2F in producing abstinence from binge eating and purging. However, by the 12-month follow-up, CBT4BN was mostly not inferior to CBTF2F. Participants in the CBT4BN condition, but not CBTF2F, continued to reduce their binge-eating and purging frequency from the end of treatment to the 12-month follow-up. Conclusions: CBT delivered online in a group chat format appears to be an efficacious treatment for BN, although the trajectory of recovery may be slower than face-to-face group therapy. Online chat groups may increase accessibility of treatment and represent a cost-effective approach to service delivery. However, barriers in service delivery such as state-specific license and ethical guidelines for online therapists need to be addressed.

    AB - © 2016 S. Karger AG, Basel.Objective: Although cognitive-behavioral therapy (CBT) represents the first-line evidence-based psychotherapy for bulimia nervosa (BN), most individuals seeking treatment do not have access to this specialized intervention. We compared an Internet-based manualized version of CBT group therapy for BN conducted via a therapeutic chat group (CBT4BN) to the same treatment conducted via a traditional face-to-face group therapy (CBTF2F). Method: In a two-site, randomized, controlled noninferiority trial, we tested the hypothesis that CBT4BN would not be inferior to CBTF2F. A total of 179 adult patients with BN (2.6% males) received up to 16 sessions of group CBT over 20 weeks in either CBT4BN or CBTF2F, and outcomes were compared at the end of treatment and at the 12-month follow-up. Results: At the end of treatment, CBT4BN was inferior to CBTF2F in producing abstinence from binge eating and purging. However, by the 12-month follow-up, CBT4BN was mostly not inferior to CBTF2F. Participants in the CBT4BN condition, but not CBTF2F, continued to reduce their binge-eating and purging frequency from the end of treatment to the 12-month follow-up. Conclusions: CBT delivered online in a group chat format appears to be an efficacious treatment for BN, although the trajectory of recovery may be slower than face-to-face group therapy. Online chat groups may increase accessibility of treatment and represent a cost-effective approach to service delivery. However, barriers in service delivery such as state-specific license and ethical guidelines for online therapists need to be addressed.

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    DO - 10.1159/000449025

    M3 - Article

    VL - 86

    SP - 47

    EP - 53

    JO - Psychotherapy and Psychosomatics

    JF - Psychotherapy and Psychosomatics

    SN - 0033-3190

    IS - 1

    ER -