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Is Online Counseling Effective for the Treatment of Bulimia Nervosa?

Two recent randomized control research studies suggest that it is, and that telemedicine or online counseling for bulimia nervosa is also well liked and accepted by those that have tried it, however some critics maintain that in-person CBT is still the better choice.

  • A summary of some of the recent research looking to evaluate the effectiveness of online CBT for bulimia nervosa
  • Some of the criticisms of online the current research
  • A discussion on whether online CBT for bulimia is right for you
  • Links to further reading (references)

CBT for Bulimia Nervosa

Cognitive Behavioral Therapy (CBT) helps people change the way they think to change the way they feel and act as well. It is one of the most tested counseling methods and is proven effective in the treatment of a wide array of disorders, from depression, to substance abuse – to eating disorders.

At present, CBT is considered the most effective ‘gold standard’ treatment for bulimia nervosa. 1

Trained CBT practitioners are not available in many rural and remote areas. CBT delivered online or over the telephone could open access to life saving treatment to people who might otherwise not have contact with such appropriate professionals. Recent and ongoing research has looked to evaluate whether the remote delivery of CBT to people with Bulimia Nervosa is effective and accepted.

Research Results

1. In 2008, researchers at the North Dakota School of Medicine and Health Sciences used a randomized trial to compare how well CBT delivered by telephone compared to CBT delivered in person. Half of the 128 study participants with Bulimia Nervosa were randomly assigned to receive telemedicine CBT, while the other half received in person CBT counseling.

  • The researchers found that while those that received counseling in person did marginally better in some areas, both methods were considered basically equally effective. Subjects who received the telephone counseling reported feeling satisfied with their treatment.  2

2. In august 2009, researchers in the UK published the results of a study that aimed to evaluate the effectiveness of online CBT for the treatment of Bulimia Nervosa. They had a subject pool of 101 people between the ages of 13 and 20 with bulimia nervosa or an eating disorder not otherwise specified with bulimic symptoms.

These subjects then participated in a multi month online CBT program that included online interactive sessions, email support from a clinician, a message board and homework/workshop assignments.

  • The researchers found that the treatment program caused improvement in number of binge eating episodes, episodes of vomiting, laxative use, BMI and eating disorder symptoms level (overall). They also report that subjects viewed the program favorably and recommend the interventions as a potential first action in the treatment of bulimia for teens. 3

Criticisms of Online CBT for Bulimia Nervosa

Although the UK study does show an improvement in symptoms severity, the improvements made were not as great as those typically witnessed after face-to face counseling for bulimia nervosa. Additionally, many teen participants did not complete much of the program. 4

Is Online CBT for Bulimia Right for You?

Online or telephone delivered CBT for the treatment of Bulimia Nervosa certainly shows a great deal of promise, and in some studies, shows results that compare to face to face counseling. Because of this, if you live in an area without appropriate in-person counseling, remotely delivered CBT for bulimia might be a good option and you may want to discuss this option with your primary caregiver.

Because the research does not yet conclusively support CBT for bulimia nervosa delivered online, if you do have access to in person CBT counseling, this may still be the better solution, at least until further research can clarify the issue a bit more.

At present, The University of North Carolina, Chapel Hill and the National Institute of Mental Health are running a 5 year comparison trial of online group CBT therapy with face to face group therapy for the treatment of bulimia nervosa.

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Page last updated Apr 06, 2011

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