Comparing Internet and Day Treatment Programs for BN

Online programs had good long-term results in this Swedish study.

Many persons with binge eating disorder (BED) never receive treatment because programs are not available to them due to access to treatment and cost, for example. One way to make binge eating treatment more accessible may be using an internet-based approach, according to a group of Swedish researchers.

Dr. Louise Hogdahl and colleagues at the Karolinska Institut, Stockholm, designed a study involving an initial group of 150 participants with bulimic eating disorders. The participants were randomly assigned to one of two types of internet-based treatments: a purely online treatment approach with a self-help guide in book format, and an intensive 16-week day program. Of the 120 who started treatment, 98 were assigned to the internet treatment program (ICBT) and 22 to the day treatment program (DPP). The study ran from October 2009 through February 2013 (Internet Interventions. 2023.31:100598).

The internet-only group

Two types of internet-based programs (ICBT) were used, BIB-ICBT and Salut BN. For 24 weeks, both internet groups had weekly asynchronous contact with a therapist, two face-to-face (zoom) meetings, and a focus on behavioral modification and psychoeducation, cognitive restructuring, and relapse prevention. Treatment required about 10 minutes per week per patient, as well as two hours per patient for the face-to-face appointments. The BIB-ICBT group also read a translation of the manual Overcoming Binge Eating ( ), which offered six treatment modules, including topics such as getting started, regular eating, and alternatives to binge eating. The Salut BN group used a CBT-based online program with 7 modules, including motivation, self-observation, and relapse prevention. Although most completed the study, only 20% completed all treatment steps. The authors noted that these rates are similar to results in prior treatment studies, where 18% and 37% of patients eventually dropped out of the studies (Int J Eat Disord. 2006. 39:117; J Clin Psychiatry. 2018. 79:16).

Day treatment

The day treatment group (DPP) took part in a 16-week intensive group treatment approach that included psychodynamic theory and group therapy, individual therapy, daily meals, body knowledge, and psychoeducation. Each group included 8 members who took part for 3.5 hours a day. Before treatment started, patients had 3 individual motivational sessions and had signed a contract noting that the goals of treatment, for example, were to break destructive eating patterns, normalize eating and weight, and to work on personal growth. It underlined the importance of daily attendance, and it was mandatory to eat the meals served.

Over time, comparable results

Both treatments led to comparable effects. Eating disorder pathology, self-image, and clinical symptoms improved significantly in both treatment groups. Although the day program had larger effects, the single significant difference was diagnostic remission after treatment: 51% of the participants were in remission in the internet treatment program, while 88% were in remission in the day program. At one year-follow-up, those in the internet program had continued to improve, as did the day treatment group. However, the internet group had a 36% dropout rate, while there were no dropouts in the day program.

In both treatment groups, there was significant improvement from the preliminary questionnaire results in Eating Disorder Examination-Q (EDE-Q) scores, self-image, and impairment. Binge eating and purging were significantly lessened in the DPP group but not in the ICBT group, and no difference was found for exercise. The authors concluded that cognitive behavioral therapy via the internet should be considered a potential alternative in routine practice; they also suggested that further trials be done.

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