Web-based treatment for adolescents with bulimia
24 September 2009
Research led by Natalie Pretorius and Ulrike Schmidt from the Institute of Psychiatry at King’s, and published in Behaviour and Research Therapy tested a web-based cognitive-behavioural intervention (CBT) for adolescents with bulimia nervosa (BN) or related disorders. The research was carried out in collaboration with colleagues from other eating disorder services and the leading UK eating disorder charity beat.
101 young people suffering from BN were recruited from across the UK. Their treatment consisted of online CBT entitled ‘Overcoming Bulimia Online’, along with peer support via online message boards and weekly email support from a clinician. Participants’ bulimic symptoms and use of services were assessed before and after treatment. Researchers also took into account participants’ views of the treatment package and established that young people liked this form of intervention. Over the course of treatment participants showed significant and lasting improvements in eating disorder symptoms which included a reduction in bingeing, purging and dietary constrictions as well as improved weight and shape concerns.
Professor Schmidt said: ‘Many young people with bulimia initially do not know how to ask for help. They often suffer in silence as they see they bulimia as a shameful secret. Our web-based intervention overcomes some of the barriers to accessing care that young people face. Many of them told us that doing the web-programme and making positive changes through this, helped them, for the first time, to be able to talk to their families about their problem and to ask for face-to-face therapy’.
BN and related disorders typically develop in adolescence and are common in teenage girls. Without treatment, bulimia often has a chronic, relapsing course with a major long-term impact on the person’s emotional and physical health and quality of life. CBT is the treatment of choice for adults with this disorder, based on a significant body of research and is recommended by the National Institute for Health and Clinical Excellence (NICE). However, the evidence base for treatment of adolescents with BN is as yet extremely limited.
Early intervention for adolescents with BN is highly desirable to prevent chronicity and suffering, but must take account of the fact that these young people often find it difficult to use traditional routes for accessing care, i.e. via their general practitioner. Internet-based CBT may bridge this gap as many adolescents are computer literate and socialise well via electronic means. This approach fits in with clinical priorities and is supported by the NICE eating disorders guidelines as it encourages the use of guided self-help.
Professor Schmidt concluded: ‘This approach has potential for use as a first step in the treatment of adolescents with bulimia, but we need to learn a lot more about how it compares against other treatments, how best to make it widely accessible and what level of support is needed to make it most effective’.
The study was funded by a Medical Research Council (MRC) trial platform grant and was supported by the Mental Health Research Network (MHRN).
Reference to original paper: Pretorius N, Arcelus J, Beecham J, Dawson H, Doherty F, Eisler I, Gallagher C, Gowers S, Isaacs G, Johnson-Sabine E, Jones A, Newell C, Morris J, Richards L, Ringwood S, Rowlands L, Simic M, Treasure J, Waller G, Williams C, Yi I, Yoshioka M, Schmidt U. Cognitive-behavioural therapy for adolescents with bulimic symptomatology: the acceptability and effectiveness of internet-based delivery. Behav Res Ther. 2009 Sep;47(9):729-36.
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