Effectiveness of a web-based treatment program using intensive therapeutic support for female patients with bulimia nervosa, binge eating disorder and eating disorders not otherwise specified: study protocol of a randomized controlled trial

BMC Psychiatry

Cor AJ DeJong¹  Hein A de Haan³  Marloes G Postel²  Elke D ter Huurne³ 

[1] Behavioural Science Institute, Radboud University Nijmegen, Montessorilaan 3, P.O. Box 9104, 6500 HE Nijmegen, The Netherlands;Department of Psychology Health & Technology, University of Twente, P.O. Box 217, 7500 AE Enschede, The Netherlands;Nijmegen Institute for Scientist Practitioners in Addiction, Toernooiveld 5, P.O. Box 6909, 6503 GK Nijmegen, The Netherlands

关键词: Asynchronous support;    Intensive therapeutic support;    e-health;    Web-based treatment program;    Randomized controlled trial;    Eating disorders not otherwise specified;    Binge eating disorder;    Bulimia nervosa;    Eating disorders;   

Others  :  1123886
DOI  :  10.1186/1471-244X-13-310

 received in 2012-05-22, accepted in 2013-11-11,  发布年份 2013

【 摘 要 】

Background

Disordered eating behavior and body dissatisfaction affect a large proportion of the Dutch population and account for severe psychological, physical and social morbidity. Yet, the threshold for seeking professional care is still high. In the Netherlands, only 7.5% of patients with bulimia nervosa and 33% of patients with anorexia nervosa are treated within the mental health care system. Easily accessible and low-threshold interventions, therefore, are needed urgently. The internet has great potential to offer such interventions. The aim of this study is to determine whether a web-based treatment program for patients with eating disorders can improve eating disorder psychopathology among female patients with bulimia nervosa, binge eating disorder and eating disorders not otherwise specified.

Methods/design

This randomized controlled trial will compare the outcomes of an experimental treatment group to a waiting list control group. In the web-based treatment program, participants will communicate personally and asynchronously with their therapists exclusively via the internet. The first part of the program will focus on analyzing eating attitudes and behaviors. In the second part of the program participants will learn how to change their attitudes and behaviors. Participants assigned to the waiting list control group will receive no-reply email messages once every two weeks during the waiting period of 15 weeks, after which they can start the program. The primary outcome measure is an improvement in eating disorder psychopathology as determined by the Eating Disorder Examination Questionnaire. Secondary outcomes include improvements in body image, physical and mental health, body weight, self-esteem, quality of life, and social contacts. In addition, the participants’ motivation for treatment and their acceptability of the program and the therapeutic alliance will be measured. The study will follow the recommendations in the CONSORT statement relating to designing and reporting on RCTs.

Discussion

This study protocol presents the design of a RCT for evaluating the effectiveness of a web-based treatment program using intensive therapeutic support for female patients with bulimia nervosa, binge eating disorder and eating disorders not otherwise specified.

Trial registration

The protocol for this study is registered with the Netherlands Trial Registry NTR2415.

【 授权许可】

   
2013 ter Huurne et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Smink FR, Van Hoeken D, Hoek HW: Epidemiology of eating disorders: incidence, prevalence and mortality rates. Current Psychiatry Rep 2012, 14(4):406-414.
• [2]Preti A, Girolamo G, Vilagut G, Alonso J, Graaf R, Bruffaerts R, Demyttenaere K, Pinto-Meza A, Haro JM, Morosini P, et al.: The epidemiology of eating disorders in six European countries: results of the ESEMeD-WMH project. J Psychiatric Res 2009, 43(14):1125-1132.
• [3]Fairburn CG, Cooper Z, Bohn K, O’Connor ME, Doll HA, Palmer RL: The severity and status of eating disorder NOS: implications for DSM-V. Behav Res Ther 2007, 45(8):1705-1715.
• [4]Machado PP, Machado BC, Goncalves S, Hoek HW: The prevalence of eating disorders not otherwise specified. Int J Eat Disord 2007, 40(3):212-217.
• [5]Agras WS: The consequences and costs of the eating disorders. Psychiatr Clin North Am 2001, 24(2):371-379.
• [6]Stice E, Marti CN, Shaw H, Jaconis M: An 8-year longitudinal study of the natural history of threshold, subthreshold, and partial eating disorders from a community sample of adolescents. J Abnorm Psychol 2009, 118(3):587-597.
• [7]NICE: Eating disorders: full guideline. 2004.
• [8]Hart LM, Granillo MT, Jorm AF, Paxton SJ: Unmet need for treatment in the eating disorders: a systematic review of eating disorder specific treatment seeking among community cases. Clin Psychol Rev 2011, 31(5):727-735.
• [9]Keski-Rahkonen A, Hoek HW, Linna MS, Raevuori A, Sihvola E, Bulik CM, Rissanen A, Kaprio J: Incidence and outcomes of bulimia nervosa: a nationwide population-based study. Psychol Med 2009, 39(5):823-831.
• [10]Keski-Rahkonen A, Hoek HW, Susser ES, Linna MS, Sihvola E, Raevuori A, Bulik CM, Kaprio J, Rissanen A: Epidemiology and course of anorexia nervosa in the community. Am J Psychiatry 2007, 164(8):1259-1265.
• [11]Banasiak SJ, Paxton SJ, Hay P: Evaluating accessible treatments for bulimic eating disorders in primary care. Aust J Prim Health 1998, 4(3):147-155.
• [12]Schmidt U: Getting technical. Eur Eat Disord Rev 2003, 11(3):147-154.
• [13]Becker AE, Hadley Arrindell A, Perloe A, Fay K, Striegel-Moore RH: A qualitative study of perceived social barriers to care for eating disorders: perspectives from ethnically diverse health care consumers. Int J Eat Disord 2010, 43(7):633-647.
• [14]Evans EJ, Hay PJ, Mond J, Paxton SJ, Quirk F, Rodgers B, Jhajj AK, Sawoniewska MA: Barriers to help-seeking in young women with eating disorders: a qualitative exploration in a longitudinal community survey. Eat Disord 2011, 19(3):270-285.
• [15]Cachelin FM, Striegel-Moore RH: Help seeking and barriers to treatment in a community sample of Mexican American and European American women with eating disorders. Int J Eat Disord 2006, 39(2):154-161.
• [16]Leibert T, Archer J Jr, Munson J, York G: An exploratory study of client perceptions of internet counseling and the therapeutic alliance. J Ment Health Couns 2006, 28:69-83.
• [17]Skårderud F: Sh@me in cyberspace: relationships without faces: the E-media and eating disorders. Eur Eat Disord Rev 2003, 11(3):155-169.
• [18]Winzelberg AJ, Luce KH, Abascal LB: Internet-based treatment strategies. In Handbook of eating disorders and obesity. Edited by Thompson JK. New Jersey: John Wiley; 2004:279-296.
• [19]Burns JM, Durkin LA, Nicholas J: Mental health of young people in the United States: what role can the internet play in reducing stigma and promoting help seeking? J Adolesc Health 2009, 45(1):95-97.
• [20]Postel MG, De Haan HA, Ter Huurne ED, Becker ES, De Jong CA: Effectiveness of a web-based intervention for problem drinkers and reasons for dropout: randomized controlled trial. J Med Internet Res 2010, 12(4):e68.
• [21]Cunningham JA, Wild TC, Cordingley J, Van Mierlo T, Humphreys K: A randomized controlled trial of an internet-based intervention for alcohol abusers. Addiction 2009, 104(12):2023-2032.
• [22]Saitz R, Helmuth ED, Aromaa SE, Guard A, Belanger M, Rosenbloom DL: Web-based screening and brief intervention for the spectrum of alcohol problems. Prev Med 2004, 39(5):969-975.
• [23]Griffiths KM, Christensen H, Jorm AF, Evans K, Groves C: Effect of web-based depression literacy and cognitive-behavioural therapy interventions on stigmatising attitudes to depression: randomised controlled trial. Br J Psychiatry 2004, 185:342-349.
• [24]Spek V, Cuijpers P, Nyklicek I, Riper H, Keyzer J, Pop V: Internet-based cognitive behaviour therapy for symptoms of depression and anxiety: a meta-analysis. Psychol Med 2007, 37(3):319-328.
• [25]Warmerdam L, Smit F, Van Straten A, Riper H, Cuijpers P: Cost-utility and cost-effectiveness of internet-based treatment for adults with depressive symptoms: randomized trial. J Med Internet Res 2010, 12(5):e53.
• [26]Lange A, van de Ven JP, Schrieken B, Emmelkamp PM: Interapy, treatment of posttraumatic stress through the Internet: a controlled trial. J Behav Ther Exp Psychiatry 2001, 32(2):73-90.
• [27]Carlbring P, Nilsson-Ihrfelt E, Waara J, Kollenstam C, Buhrman M, Kaldo V, Soderberg M, Ekselius L, Andersson G: Treatment of panic disorder: live therapy vs. self-help via the internet. Behav Res Ther 2005, 43(10):1321-1333.
• [28]Hedman E, Andersson E, Ljotsson B, Andersson G, Ruck C, Lindefors N: Cost-effectiveness of Internet-based cognitive behavior therapy vs. cognitive behavioral group therapy for social anxiety disorder: results from a randomized controlled trial. Behav Res Ther 2011, 49(11):729-736.
• [29]Bauwer S, Moessner M, Wolf M, Haug S, Kordy H: ES[S]PRIT–an Internet-based programme for the prevention and early intervention of eating disorders in college students. Br J Guid Couns 2009, 37(3):327-336.
• [30]Beintner I, Jacobi C, Taylor CB: Effects of an Internet-based prevention programme for eating disorders in the USA and Germany–a meta-analytic review. Eur Eat Disord Rev 2012, 20(1):1-8.
• [31]Aardoom JJ, Dingemans AE, Spinhoven P, Van Furth EF: Treating eating disorders over the internet: a systematic review and future research directions. Int J Eat Disord 2013, 46(6):539-552.
• [32]Gellatly J, Bower P, Hennessy S, Richards D, Gilbody S, Lovell K: What makes self-help interventions effective in the management of depressive symptoms? Meta-analysis and meta-regression. Psychol Med 2007, 37(9):1217-1228.
• [33]Palmqvist B, Carlbring P, Andersson G: Internet-delivered treatments with or without therapist input: does the therapist factor have implications for efficacy and cost? Expert Rev Pharmacoecon Outcomes Res 2007, 7(3):291-297.
• [34]Andersson G, Cuijpers P: Internet-based and other computerized psychological treatments for adult depression: a meta-analysis. Cognitive Behav Ther 2009, 38(4):196-205.
• [35]Carrard I, Crepin C, Rouget P, Lam T, Golay A, Van der Linden M: Randomised controlled trial of a guided self-help treatment on the internet for binge eating disorder. Behav Res Ther 2011, 49(8):482-491.
• [36]Carrard I, Fernandez-Aranda F, Lam T, Nevonen L, Liwowsky I, Volkart AC, Rouget P, Golay A, Van Der Linden M, Norring C: Evaluation of a guided internet self-treatment programme for bulimia nervosa in several european countries. Eur Eat Disord Rev 2011, 19(2):138-149.
• [37]Ruwaard J, Lange A, Broeksteeg J, Renteria-Agirre A, Schrieken B, Dolan CV, Emmelkamp P: Online cognitive-behavioural treatment of bulimic symptoms: a randomized controlled trial. Clinical Psychol Psychother 2013, 20(4):308-318.
• [38]Ter Huurne ED, Postel MG, De Jong CA: Web-based intensive therapeutic contact for eating disorders. Psychiatr Serv 2013, 64(7):711.
• [39]Postel MG, De Jong CAJ, De Haan HA: Does E-therapy for problem drinking reach hidden populations? [3]. Am J Psychiatr 2005, 162(12):2393.
• [40]Ter Huurne ED, Postel MG, De Haan HA, Drossaert CH, DeJong CA: Web-based treatment program using intensive therapeutic contact for patients with eating disorders: before-after study. J Med Internet Res 2013, 15(2):e12.
• [41]CBS: ICT use by persons to personal characteristics. Den Haag/Heerlen: Centraal Bureau voor de Statistiek; 2012.
• [42]Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E, Hergueta T, Baker R, Dunbar GC: The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry 1998, 59(Suppl 20):22-33. quiz 34–57
• [43]van Vliet IM, Leroy H, Van Megen HJGM, M.I.N.I: M.I.N.I: International neuropsychiatrisch interview: Nederlandse versie 5.0.0. 2000.
• [44]Van Vliet IM, De Beurs E: Het Mini Internationaal Neuropsychiatrisch Interview (MINI-Plus): een kort diagnostisch interview voor DSM-IV en ICD-10 stoornissen. Tijdschr Psychiatr 2007, 49:393-397.
• [45]Brownley KA, Berkman ND, Sedway JA, Lohr KN, Bulik CM: Binge eating disorder treatment: a systematic review of randomized controlled trials. Int J Eat Disord 2007, 40(4):337-348.
• [46]Shapiro JR, Berkman ND, Brownley KA, Sedway JA, Lohr KN, Bulik CM: Bulimia nervosa treatment: a systematic review of randomized controlled trials. Int J Eat Disord 2007, 40(4):321-336.
• [47]Wilson GT, Grilo CM, Vitousek KM: Psychological treatment of eating disorders. Am Psychol 2007, 62(3):199-216.
• [48]Britt E, Hudson SM, Blampied NM: Motivational interviewing in health settings: a review. Patient Educ Couns 2004, 53(2):147-155.
• [49]Miller JH, Moyers T: Motivational interviewing in substance abuse: applications for occupational medicine. Occup Med 2002, 17(1):51-65. iv
• [50]Martin DJ, Garske JP, Davis MK: Relation of the therapeutic alliance with outcome and other variables: a meta-analytic review. J Consult Clin Psychol 2000, 68(3):438-450.
• [51]Sly R, Morgan JF, Mountford VA, Lacey JH: Predicting premature termination of hospitalised treatment for anorexia nervosa: the roles of therapeutic alliance, motivation, and behaviour change. Eating behaviors 2013, 14(2):119-123.
• [52]Knaevelsrud C, Maercker A: Internet-based treatment for PTSD reduces distress and facilitates the development of a strong therapeutic alliance: a randomized controlled clinical trial. BMC psychiatry 2007, 7:13. BioMed Central Full Text
• [53]Sucala M, Schnur JB, Constantino MJ, Miller SJ, Brackman EH, Montgomery GH: The therapeutic relationship in e-therapy for mental health: a systematic review. J Med Internet Res 2012, 14(4):e110.
• [54]Fairburn CG, Beglin SJ: Assessment of eating disorders: interview or self-report questionnaire? Int J Eat Disord 1994, 16(4):363-370.
• [55]Van Furth EF: Nederlandse vertaling van de EDE-Q. Leidschendam: Robert Fleury Stichting; 2000.
• [56]Fairburn CG, Cooper Z: The eating disorder examination. In Binge eating: nature, assessment and treatment. 12th edition. Edited by Fairburn CG, Wilson GT. New York: Guilford Press; 1993:317-360.
• [57]Mond JM, Hay PJ, Rodgers B, Owen C, Beumont PJV: Validity of the eating disorder examination questionnaire (EDE-Q) in screening for eating disorders in community samples. Behav Res Ther 2004, 42(5):551-567.
• [58]Black CMD, Wilson GT: Assessment of eating disorders: interview versus questionnaire. Int J Eat Disord 1996, 20(1):43-50.
• [59]Carter JC, Aimé AA, Mills JS: Assessment of bulimia nervosa: a comparison of interview and self-report questionnaire methods. Int J Eat Disord 2001, 30(2):187-192.
• [60]Wilfley DE, Schwartz MB, Spurrell EB, Fairburn CG: Assessing the specific psychopathology of binge eating disorder patients: interview or self-report? Behav Res Ther 1997, 35(12):1151-1159.
• [61]Luce KH, Crowther JH: The reliability of the eating disorder examination–self-report questionnaire version (EDE-Q). Int J Eat Disord 1999, 25(3):349-351.
• [62]Reas DL, Grilo CM, Masheb RM: Reliability of the eating disorder examination-questionnaire in patients with binge eating disorder. Behav Res Ther 2006, 44(1):43-51.
• [63]Probst M, Van Coppenolle H, Vandereycken W: De Lichaams-Attitude-Vragenlijst (LAV) bij patiënten met eetstoornissen: onderzoeksresultaten. Bewegen & Hulpverlening 1992, 4:286-299.
• [64]Probst M, Van Coppenolle H, Vandereycken W: Further experience with the body attitude test. Eat Weight Disord 1997, 2(2):100-104.
• [65]Probst M, Van Coppenolle H, Vandereycken W: Actuele Themata uit de psychomotorische therapie. Leuven: Acco; 1998:79-90.
• [66]Probst M, Vandereycken W, Van Coppenolle H, Vanderlinden J: The body attitude test for patients with an eating disorder: psychometric characteristics of a new questionnaire. Eat Disord: J Treat Prev 1995, 3(2):133-144.
• [67]Marsden J, Gossop M, Stewart D, Best D, Farrell M, Lehmann P, Edwards C, Strang J: The Maudsley addiction profile (MAP): a brief instrument for assessing treatment outcome. Addiction 1998, 93(12):1857-1867.
• [68]Darke S, Ward J, Zador D, Swift G: A scale for estimating the health status of opioid users. Br J Addict 1991, 86(10):1317-1322.
• [69]Lovibond PF, Lovibond SH: The structure of negative emotional states: comparison of the depression anxiety stress scales (DASS) with the Beck depression and anxiety inventories. Behav Res Ther 1995, 33(3):335-343.
• [70]Antony MM, Cox BJ, Enns MW, Bieling PJ, Swinson RP: Psychometric properties of the 42-item and 21-item versions of the depression anxiety stress scales in clinical groups and a community sample. Psychol Assess 1998, 10(2):176-181.
• [71]Rosenberg M: Society and adolescent child. Princeton: Princeton University Press; 1965.
• [72]Blascovich J, Tomaka J: Measures of self-esteem. In Measures of personality and social psychological attitudes. Edited by Robinson JP, Shaver PR, Wrighsman LS. Ann Arbor: Institute for Social Research; 1993.
• [73]Lamers LM, Stalmeier PF, McDonnell J, Krabbe PF, Van Busschbach JJ: Measuring the quality of life in economic evaluations: the Dutch EQ-5D tariff. Ned Tijdschr Geneeskd 2005, 149(28):1574-1578.
• [74]Schippers GM, Broekman TG, Buchholz A: MATE 2.1: Handleiding en protocol. Nederlandse bewerking: G.M. Schippers & T.G. Broekman. Nijmegen: Bêta Boeken; 2007.
• [75]Schippers GM, Broekman TG, Buchholz A, Koeter MW, van den Brink W: Measurements in the addictions for triage and evaluation (MATE): an instrument based on the World Health Organization family of international classifications. Addiction 2010, 105(5):862-871.
• [76]De Weert-Van Oene GH, Schippers GM, De Jong CAJ, Schrijvers GAJP: Motivation for treatment in substance-dependent patients: psychometric evaluation of the TCU motivation for treatment scales. Eur Addict Res 2002, 8(1):2-9.
• [77]De Weert-Van Oene GH, De Jong CAJ, Jörg F, Schrijvers GJP: The helping alliance questionnaire: psychometric properties in patients with substance dependence. Subst Use Misuse 1999, 34(11):1549-1569.
• [78]Luborsky L, Barber JP, Siqueland L, Johnson S, Najavits LM, Frank A, Daley D: The revised helping alliance questionnaire (HAq-II): psychometric properties. J Psychother Pract Res 1996, 5(3):260-271.
• [79]Cohen J: A power primer. Psychol Bull 1992, 112(1):155-159.
• [80]Moher D, Hopewell S, Schulz KF, Montori V, Gotzsche PC, Devereaux PJ, Elbourne D, Egger M, Altman DG: CONSORT 2010 explanation and elaboration: updated guidelines for reporting parallel group randomised trials. Bmj 2010, 340:c869.