Online therapy can reduce symptoms of binge eating and bulimia

As video conferencing technology has improved, an increasing number of people are seeking psychotherapy online. Living in rural areas with few therapists nearby, wanting to continue with the same therapist during extended periods in another town/country, or simply desiring the convenience of therapy from home – all have lead to the popularity of online therapy.

However, the research is just beginning to catch up with the demand, especially in relation to online therapy for eating disorders. Two studies published/released online this month offer support for the use of online cognitive behavior therapy (CBT) for reducing binge eating and bulimic symptoms; though it remains unclear how online CBT compares to other treatments.

The first study, published in Behaviour Research and Therapy, was conducted in Dresden, Germany. Researchers assessed university students for symptoms of eating disorders (“subthreshold eating disorders”) and then randomly assigned them to either an online intervention program or a wait-list control. The online intervention was 8-sessions, based on CBT, and included an online discussion group and journaling. The program appeared to help students who experienced binge eating and purging. Compared to students who didn’t get any treatment or support in the wait-list control group, students in the online therapy group experienced a greater reduction in binging/purging.

The second study, conducted at the University of Amsterdam and released online last week, included a broader group of adults from the community but only those with bulimic symptoms. Like the first study, researchers randomly assigned participants to online CBT or a waitlist control. They also included a third group, “bibliotherapy,” in which participants were given a self-help book. The CBT offered in this study was stronger compared to the first study and lasted 20 sessions. As expected, participants in online CBT did better (reduced binging/purging) compared to those given a self-help book or those without treatment in the wait-list condition. 

It should be noted that many of the authors of the second study are employed by Interapy, an online therapy company in Germany.

Online CBT can be helpful for some people with symptoms of eating disorders. However, these two studies leave a few questions to be answered.

• What about people who meet full criteria for bulimia and binge eating disorder (versus people with only some of the symptoms) – is online CBT helpful for them also?
• How does online CBT compare to traditional, in-person CBT?
• How does online CBT compare to other forms of in-person therapy?

For people living in rural areas with limited therapy resources, online CBT may be helpful for reducing binge eating and purging. For those who have access to in-person therapy, it’s not clear how online CBT compares to other forms of treatment. 

Photo credit: Gregg Stokes