Sep. 15, 2008 The University of North Carolina at Chapel Hill is leading a novel clinical trial to compare the effectiveness of online cognitive behavioral therapy, delivered through a Web site and augmented with therapist-moderated, weekly online chat sessions, to face-to-face group therapy for the treatment of bulimia nervosa.
"For individuals with bulimia nervosa – an eating disorder characterized by binge eating and purging behaviors – face-to-face cognitive behavioral therapy or CBT has long been considered the gold standard of treatment," said Cynthia M. Bulik, Ph.D., William and Jeanne Jordan Distinguished Professor of Eating Disorders and director of the UNC Eating Disorders Program, who is the study's principal investigator.
The Western Psychiatric Institute and Clinic (WPIC) of the University of Pittsburgh Medical Center will also take part in the study. Marsha D. Marcus, Ph.D., Professor of Psychiatry and Psychology and Service Chief of the Center for Overcoming Problem Eating (COPE), serves as the principal investigator at the Pittsburgh site.
Bulik said group therapy provides additional benefits compared to individual therapy for some people, such as gaining from the understanding and experience of other group members. Group therapy also costs less than individual therapy and produces similar outcomes.
Unfortunately, for several different reasons CBT does not reach everyone who needs treatment. People who live in remote rural areas, for example, often do not have access to CBT-trained therapists. Other people cringe at the thought of driving to and parking at a medical center. The price of gas is a new obstacle that can stand in the way of getting CBT.
"As a way to overcome these challenges," Bulik said, "we've developed a Web site that will deliver the same content as traditional, manual-based cognitive behavioral therapy, but it will take advantage of all the bells and whistles – such as sound, animation and video – that make the best Web sites so compelling."
Bulik and colleagues plan to recruit 180 people with bulimia nervosa to take part in the study: 90 at UNC and 90 at Pittsburgh. Half will be randomized to receive CBT with weekly face-to-face group therapy sessions over a 20-week period. The other half will receive Web-based CBT with weekly online group therapy chat sessions. The researchers call this mode of delivery "CBT4BN."
The chat sessions will be hosted on a secure server and moderated by experienced therapists at both sites. Each chat session participant will meet with the moderator in person in the early stages of the study, before the online chats begin. To measure the effectiveness of the intervention, follow-up assessments on each participant will be conducted at 3 months, 6 months and 12 months after the end of treatment.
"This study will allow us to test several hypotheses," Bulik said. "These include whether CBT4BN will be as effective as traditional CBT in reducing binge eating and purging, and whether CBT4BN will reduce the attrition or dropout rate among study participants."
Marcus said, "If CBT4BN is as effective as CBT delivered in an in-person format, we will be able to provide CBT to individuals who currently are unable to obtain specialty care for the disorder."
Serving as consultants in the study are Scott Crow, M.D., from the University of Minnesota Eating Disorders Research Program; and Hans Kordy, Ph.D., Director of the Center for Psychotherapy Research at the University of Heidelberg in Germany. Kordy's group has been working with Bulik's group for past two years on developing and refining technology-advanced deliveries of therapeutic interventions.
This study is funded by the National Institute of Mental Health with additional funding from the Alexander von Humboldt Foundation.
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