Eight years ago, researchers at the University of North Carolina at Chapel Hill launched a new kind of clinical trial to compare the effectiveness of online therapy -- delivered through group chat sessions -- to face-to-face group therapy for the treatment of bulimia nervosa, an eating disorder marked by recurrent episodes of binge eating (or eating an unusually large amount of food and feeling out of control) coupled with purging behaviors such as vomiting, laxative abuse, or excessive exercise.
Now results from the study, published online by the journal Psychotherapy and Psychosomatics, show that online group therapy can be just as effective as face-to-face treatment, although the pace of recovery may be slower.
"Bulimia nervosa is a devastating and sometimes deadly illness, and research has shown for years that cognitive-behavioral therapy (CBT) for bulimia is the most effective treatment, said Stephanie Zerwas, PhD, first author of the study, associate professor of psychiatry in the UNC School of Medicine, and clinical director of the UNC Center of Excellence for Eating Disorders. "I know that too many people have to travel for hours to find expert eating disorders treatment. Online treatment could help us bridge that gap."
In the study, 179 adults started 16 sessions of group therapy with a therapist at one of two study sites: UNC-Chapel Hill and Western Psychiatric Institute and Clinic (WPIC) of the University of Pittsburgh Medical Center. Assignment to either the online group or the traditional face-to-face group was completely random.
Researchers compared the results of the two groups at the end of treatment, and then again 12 months later. Immediately after treatment, the face-to-face group produced better results than the online group, when it came to helping patients reach a point where they were completely free of binge eating and purging. But by the 12-month follow-up, the gap in treatment results between the two groups had narrowed dramatically; neither method of delivery (online versus face-to-face therapy) was better than the other.
"We have evidence-based treatments that are effective for many people with bulimia, but many people don't have access to specialist care," said Cynthia M. Bulik, PhD, Distinguished Professor of Eating Disorders at UNC, founding director of the UNC Center of Excellence for Eating Disorders, and director of the Center for Eating Disorders Innovation at Karolinska Institutet in Stockholm, Sweden. "This study encourages us to use technology to bring treatment to the patients who can't come to us."
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Zerwas, S. C., Watson, H. J., Hofmeier, S. M., Levine, M. D., Hamer, R. M., Crosby, R. D., ... & Moessner, M. (2016). CBT4BN: A Randomized Controlled Trial of Online Chat and Face-to-Face Group Therapy for Bulimia Nervosa. Psychotherapy and Psychosomatics, 86(1), 47-53. DOI: 10.1159/000449025