Monday, August 31, 2020

Digital CBT May Reduce Eating Disorder Symptoms in College Women

A digital cognitive-behavioral therapy (CBT) intervention that includes personal coaching may help to reduce several symptoms of eating disorders in college women. As reported today in JAMA Network Open, women who received the digital CBT had greater reductions in negative eating-related thoughts or beliefs and the frequency of binge eating compared with women who were referred to usual university care.

“Current treatment delivery efforts for [eating disorders] on college campuses are hindered by factors such as limited counseling center capacity and access to evidence-based treatments. College students report additional barriers, including lack of time and stigma,” wrote Ellen Fitzsimmons-Craft, Ph.D., of Washington University in St. Louis and colleagues. “Digital technologies, highlighted as the future of psychiatry, have the potential to improve mental health care on college campuses by overcoming [these] barriers.”

Fitzsimmons-Craft and colleagues recruited women who had screened positive for a DSM-5 eating disorder excluding anorexia nervosa (which requires more intense medical monitoring) from 27 universities across the country. In total, 690 women were randomly assigned to participate in the online CBT program Student Bodies–Eating Disorders (SB-ED) or receive usual care, which involved a referral and encouragement to attend their university counseling center.

The women in the SB-ED group received access to the self-help CBT program for eight months with a personal coach. SB-ED includes modules that teach such skills as improving body image, regulating emotions, addressing shape-checking behaviors, and challenging negative thoughts. The program also includes meal planning and tracking tools and a personal log. The coaches provided regular feedback and support using an in-program chat function. 

The primary assessment was change in the Eating Disorder Examination-Questionnaire (EDE-Q), which assesses the severity of negative eating-related thoughts or beliefs. The investigators also measured changes in binge eating, compensatory behaviors (vomiting, laxative use, excess exercise), depressive symptoms, and academic problems (such as withdrawing from courses or taking a leave of absence). 

After eight months, EDE-Q scores decreased from 3.62 to 2.70 in the SB-ED group and 3.55 to 3.05 in the usual care group, which was a significant difference. The women in the SB-ED group also reported fewer binge-eating and compensatory behaviors as well as fewer depressive symptoms. There was no difference between SB-ED and usual care in terms of the total number of women who achieved abstinence from all eating disorder behaviors, withdrew from a course, or took a leave of absence.

“Finally, with regard to realized treatment access, the [SB-ED] intervention was far superior,” Fitzsimmons-Craft and colleagues wrote. “83% of students offered the intervention began it, whereas only 28% of students in the control group reported seeking treatment for their ED at any point.”

For related information, see Handbook of Assessment and Treatment of Eating Disorders, by APA Publishing.

(Image: iStock/martin-dm)


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