Telemedicine vs. In-Person Therapy to Treat Bulimia Nervosa

For patients, the ‘what’ of treatment
was more important than the ‘how.’

Newer ways of delivering mental health services are bringing many treatment options to people with eating disorders. For example, telemedicine or the internet can now be used to deliver therapy to people who live in areas with limited access to mental health professionals. Numerous authors, such as Mair and Whitten (Br Med J 2000; 320:1517), have reported that delivery of mental health services through telemedicine is equivalent to traditional in-person service for treating both children and adults with depression. EDR Board member Dr. James Mitchell and colleagues have shown that delivering a manual-based empirically supported treatment for bulimia nervosa (BN) via telemedicine was generally as successful as delivering the treatment in person (Behav Res Ther 2008;46:581).

Dr. Mitchell and his colleagues recently conducted a randomized controlled trial of an empirically supported treatment for bulimia nervosa (BN) delivered in person or via telemedicine (Int J Eat Disord 2011; 44:687). They sought to assess the effect that telemedicine might have on the therapeutic alliance by examining data collected during the group’s earlier randomized study of CBT for BN delivered either face-to-face or via telemedicine.

Two groups of patients were studied. Fifty-eight patients were enrolled in a face-to-face CBT program where they met with six doctoral-level psychologists; 58 others were enrolled in a telemedicine CBT program. Both those in the face-to-face program and those in the telemedicine program completed the Working Alliance Inventory (WAI), a 36-question questionnaire in which respondents rate aspects (task, goal, and bond) of their experiences in psychotherapy or counseling. All patients and therapists completed the WAI at 2, 8, and 16 weeks. At the 2-week point, patients completed the suitability of treatment and expectation of success measures.

The study groups included 33 patients with BN and 25 with eating disorders not otherwise specified (EDNOS) in the face-to-face group, and 29 with BN and 29 with EDNOS in the telemedicine group.

Patients and therapists preferred different approaches

The researchers found that therapists generally endorsed greater differences between the treatment delivery methods than did patients, and most preferred the face-to-face treatment method. The patients did not seem to have a strong preference for either delivery method. In addition, patients did not have significantly different preferences for suitability of treatment or likelihood of success of a treatment method. Both patients and therapists felt their initial agreement about therapeutic goals and working toward these goals increased significantly throughout treatment.

One important limitation of the study, according to the authors, is the observed attrition rate. Patients discontinued therapy throughout the study. Although the attrition rate was higher than expected, it was consistent with such rates observed in other large randomized studies. The reasons for attrition were not analyzed.