The project REBOOT protocol: Evaluating a personalized inhibitory control training as an adjunct to cognitive behavioral therapy for bulimia nervosa and binge‐eating disorder

BACKGROUND A 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 (BN) and binge-eating disorder (BED) at the same time in Japan. OBJECTIVE To evaluate the feasibility of ICBT via videoconference for patients with BN or BED. METHODS Five Japanese subjects (mean age 35.4 ± 9.2 years) with BN and BED 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 interview-16 (EDE 16) for BN and BED: the combined objective binge and purging episodes; objective binge episodes; purging episodes. The secondary outcomes were the EDE-Q, the Bulimic Investigatory Test, Edinburgh, body mass index for eating symptoms, the Motivational Ruler for motivation to change, the EuroQol-5 Dimension for quality of life, the Patient Health Questionnaire-9 for depression, the Generalized Anxiety Disorder questionnaire-7 for anxiety, and the Working Alliance Inventory-Short Form (WAI-SF). All outcomes were assessed at week 1 (baseline) and at weeks 8 (mid intervention), and 16 (post intervention) 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 the 95% confidence intervals using the paired t-test. RESULTS Although the mean combined objective binge episodes and purging episodes improved from 47.60 to 13.60 (71% reduction) and showed a medium effect size (Cohen’s d, -0.76), there was no significant reduction in the combined these episodes (EDE 16D, -41; 95% confidence interval -2.089, 0.576; P = 0.17). There were no significant treatment-related changes in the secondary outcomes. The WAI-SF scores remained consistently high (64.8–66.0) during treatment. CONCLUSIONS ICBT via videoconference is feasible in Japanese patients with BN and BED. CLINICALTRIAL UMIN000029426

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

JMIR Formative Research ◽

10.2196/15738 ◽

2019 ◽

Vol 3 (4) ◽

pp. e15738 ◽

Cited By ~ 1

Author(s):

Sayo Hamatani ◽

Noriko Numata ◽

Kazuki Matsumoto ◽

Chihiro Sutoh ◽

Hanae Ibuki ◽

...

Keyword(s):

Eating Disorder ◽

Cognitive Behavioral Therapy ◽

Bulimia Nervosa ◽

Binge Eating ◽

Real Time ◽

Binge Eating Disorder ◽

Behavioral Therapy ◽

Cognitive Behavioral ◽

Secondary Outcomes ◽

Therapist Support

Background A 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. Objective The goal of the research was to evaluate the feasibility of ICBT via videoconference for patients with bulimia nervosa or binge-eating disorder. Methods Seven 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. Results Although 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. Conclusions ICBT via videoconference is feasible in Japanese patients with bulimia nervosa and binge-eating disorder. Trial Registration UMIN Clinical Trials Registry UMIN000029426; https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000033419

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