We found a match
Your institution may have access to this item. Find your institution then sign in to continue.
- Title
Effectiveness of a Digital Cognitive Behavior Therapy–Guided Self-Help Intervention for Eating Disorders in College Women: A Cluster Randomized Clinical Trial.
- Authors
Fitzsimmons-Craft, Ellen E.; Taylor, C. Barr; Graham, Andrea K.; Sadeh-Sharvit, Shiri; Balantekin, Katherine N.; Eichen, Dawn M.; Monterubio, Grace E.; Goel, Neha J.; Flatt, Rachael E.; Karam, Anna M.; Firebaugh, Marie-Laure; Jacobi, Corinna; Jo, Booil; Trockel, Mickey T.; Wilfley, Denise E.
- Abstract
Key Points: Question: Does a coached, digital, cognitive behavior therapy (CBT) intervention result in improved outcomes among college women with eating disorders (EDs) compared with referral to usual care? Findings: In this cluster randomized clinical trial that included 690 women with binge-purge EDs from 27 US universities, the digital CBT intervention was superior to referral to usual care in decreasing ED psychopathology, compensatory behaviors, depression, and clinical impairment through long-term follow-up, as well as in realized treatment access. There was no difference in abstinence from all ED behaviors or academic impairment between groups. Meaning: These results support the efficacy of a coached, digital, CBT intervention for college women with EDs, which has the potential to bridge the treatment gap for this problem. This cluster randomized clinical trial examines whether a coached, digital, cognitive behavior therapy intervention improves outcomes for college women with eating disorders compared with referral to usual care. Importance: Eating disorders (EDs) are common, serious psychiatric disorders on college campuses, yet most affected individuals do not receive treatment. Digital interventions have the potential to bridge this gap. Objective: To determine whether a coached, digital, cognitive behavior therapy (CBT) intervention improves outcomes for college women with EDs compared with referral to usual care. Design, Setting, and Participants: This cluster randomized trial was conducted from 2014 to 2018 at 27 US universities. Women with binge-purge EDs (with both threshold and subthreshold presentations) were recruited from enrolled universities. The 690 participants were followed up for up to 2 years after the intervention. Data analysis was performed from February to September 2019. Interventions: Universities were randomized to the intervention, Student Bodies–Eating Disorders, a digital CBT-guided self-help program, or to referral to usual care. Main Outcomes and Measures: The main outcome was change in overall ED psychopathology. Secondary outcomes were abstinence from binge eating and compensatory behaviors, as well as ED behavior frequencies, depression, anxiety, clinical impairment, academic impairment, and realized treatment access. Results: A total of 690 women with EDs (mean [SD] age, 22.12 [4.85] years; 414 [60.0%] White; 120 [17.4%] Hispanic; 512 [74.2%] undergraduates) were included in the analyses. For ED psychopathology, there was a significantly greater reduction in the intervention group compared with the control group at the postintervention assessment (β [SE], −0.44 [0.10]; d = −0.40; t1387 = −4.23; P <.001), as well as over the follow-up period (β [SE], −0.39 [0.12]; d = −0.35; t1387 = −3.30; P <.001). There was not a significant difference in abstinence from any ED behaviors at the postintervention assessment (odds ratio, 1.48; 95% CI, 0.48-4.62; P =.50) or at follow-up (odds ratio, 1.51; 95% CI, 0.63-3.58; P =.36). Compared with the control group, the intervention group had significantly greater reductions in binge eating (rate ratio, 0.82; 95% CI, 0.70-0.96; P =.02), compensatory behaviors (rate ratio, 0.68; 95% CI, 0.54-0.86; P <.001), depression (β [SE], −1.34 [0.53]; d = −0.22; t1387 = −2.52; P =.01), and clinical impairment (β [SE], −2.33 [0.94]; d = −0.21; t1387 = −2.49; P =.01) at the postintervention assessment, with these gains sustained through follow-up for all outcomes except binge eating. Groups did not differ in terms of academic impairment. The majority of intervention participants (318 of 385 participants [83%]) began the intervention, whereas only 28% of control participants (76 of 271 participants with follow-up data available) sought treatment for their ED (odds ratio, 12.36; 95% CI, 8.73-17.51; P <.001). Conclusions and Relevance: In this cluster randomized clinical trial comparing a coached, digital CBT intervention with referral to usual care, the intervention was effective in reducing ED psychopathology, compensatory behaviors, depression, and clinical impairment through long-term follow-up, as well as realizing treatment access. No difference was found between the intervention and control groups for abstinence for all ED behaviors or academic impairment. Given its scalability, a coached, digital, CBT intervention for college women with EDs has the potential to address the wide treatment gap for these disorders. Trial Registration: ClinicalTrials.gov Identifier: NCT02076464
- Subjects
UNITED States; TREATMENT of eating disorders; COGNITIVE therapy; PSYCHOLOGY of college students; INTERNET; PATHOLOGICAL psychology; RESEARCH funding; STATISTICAL sampling; RANDOMIZED controlled trials; TREATMENT effectiveness
- Publication
JAMA Network Open, 2020, Vol 3, Issue 8, pe2015633
- ISSN
2574-3805
- Publication type
Academic Journal
- DOI
10.1001/jamanetworkopen.2020.15633