Abstract
Background:
Due to the gap between treatment supply and demand, there are long waiting-lists for patients with binge eating disorder, and an urgent need to increase their access to specialized treatment. Guided self-help CBT-E may have advantages for the patient if its efficacy can be established.
Objective:
The aim of this study is to examine the efficacy of guided self-help CBT-E compared to a delayed treatment control condition.
Methods:
A single-blind two-arm RCT evaluating guided self-help CBT-E according to an intention-to-treat analysis. A total of 180 patients were randomly assigned to the guided self-help CBT-E (N = 90) or to the delayed treatment control condition (N = 90), in which guided self-help CBT-E was provided after the initial 12 week delay. Primary outcome was reduction in binges, secondary outcome was full recovery at end-of-treatment as measured by the eating disorder examination. In addition, dropout rates were assessed in both conditions. A linear mixed model analysis was performed to compare treatment outcomes at the end-of-treatment. An additional analysis was conducted by a mixed ANOVA to measure between- and within group effects up to 24 weeks follow-up. The eating disorder examination-questionnaire and clinical impairment assessment were conducted pre- and post-treatment and during follow-up.
Results:
Objective binges reduced from on average 19 to 3 binges and 40% showed full recovery at end-of-treatment in the guided self-help CBT-E group, the delayed treatment control group had 16 binges at start and at end-of-treatment they had 13 binges and 6.7% showed full recovery. Between-group effect size (Cohen’s d) was 1.0 for objective binges. At follow-up, after both groups had received treatment, there was no longer a difference between groups. The guided self-help CBT-E group had 3 binges and 39% was fully recovered, the delayed treatment group had 3 binges and 29% showed full recovery. Of the total of 180 participants, 142 (78.9%) completed treatment. Treatment drop-out appeared to be associated with gender, level of education, and number of objective binges at baseline, but not with treatment condition.
Conclusions:
This is the first study to investigate the efficacy of guided self-help CBT-E. Guided self-help CBT-E appeared to be an efficacious treatment as an alternative to wait lists. The present findings underscore international guidelines recommending this form of treatment for binge eating disorder. Clinical Trial: The study protocol is registered with the Netherlands Trial Registry NTR (NTR 7994) since 6 September 2019. Study approval was given in August 2019 by the Medical Research Ethics Committees United (MEC-U) (referencenumber NL 6958.100.19) in Nieuwegein, the Netherlands
Due to the gap between treatment supply and demand, there are long waiting-lists for patients with binge eating disorder, and an urgent need to increase their access to specialized treatment. Guided self-help CBT-E may have advantages for the patient if its efficacy can be established.
Objective:
The aim of this study is to examine the efficacy of guided self-help CBT-E compared to a delayed treatment control condition.
Methods:
A single-blind two-arm RCT evaluating guided self-help CBT-E according to an intention-to-treat analysis. A total of 180 patients were randomly assigned to the guided self-help CBT-E (N = 90) or to the delayed treatment control condition (N = 90), in which guided self-help CBT-E was provided after the initial 12 week delay. Primary outcome was reduction in binges, secondary outcome was full recovery at end-of-treatment as measured by the eating disorder examination. In addition, dropout rates were assessed in both conditions. A linear mixed model analysis was performed to compare treatment outcomes at the end-of-treatment. An additional analysis was conducted by a mixed ANOVA to measure between- and within group effects up to 24 weeks follow-up. The eating disorder examination-questionnaire and clinical impairment assessment were conducted pre- and post-treatment and during follow-up.
Results:
Objective binges reduced from on average 19 to 3 binges and 40% showed full recovery at end-of-treatment in the guided self-help CBT-E group, the delayed treatment control group had 16 binges at start and at end-of-treatment they had 13 binges and 6.7% showed full recovery. Between-group effect size (Cohen’s d) was 1.0 for objective binges. At follow-up, after both groups had received treatment, there was no longer a difference between groups. The guided self-help CBT-E group had 3 binges and 39% was fully recovered, the delayed treatment group had 3 binges and 29% showed full recovery. Of the total of 180 participants, 142 (78.9%) completed treatment. Treatment drop-out appeared to be associated with gender, level of education, and number of objective binges at baseline, but not with treatment condition.
Conclusions:
This is the first study to investigate the efficacy of guided self-help CBT-E. Guided self-help CBT-E appeared to be an efficacious treatment as an alternative to wait lists. The present findings underscore international guidelines recommending this form of treatment for binge eating disorder. Clinical Trial: The study protocol is registered with the Netherlands Trial Registry NTR (NTR 7994) since 6 September 2019. Study approval was given in August 2019 by the Medical Research Ethics Committees United (MEC-U) (referencenumber NL 6958.100.19) in Nieuwegein, the Netherlands
| Original language | English |
|---|---|
| Number of pages | 19 |
| Volume | 25 |
| DOIs | |
| Publication status | Published - 2023 |