Online cognitive-behavioural treatment of bulimic symptoms: a randomized controlled trial

Jeroen Ruwaard, Alfred Lange, Janneke Broeksteeg, Aitziber Renteria-Agirre, Bart Schrieken, Conor V Dolan, Paul Emmelkamp

Research output: Contribution to JournalArticleAcademicpeer-review


BACKGROUND: Manualized cognitive-behavioural treatment (CBT) is underutilized in the treatment of bulimic symptoms. Internet-delivered treatment may reduce current barriers.

OBJECTIVE: This study aimed to assess the efficacy of a new online CBT of bulimic symptoms.

METHOD: Participants with bulimic symptoms (n = 105) were randomly allocated to online CBT, bibliotherapy or waiting list/delayed treatment condition. Data were gathered at pre-treatment, post-treatment and 1-year follow-up.

OUTCOME MEASURES: The primary outcome measures were the Eating Disorder Examination Questionnaire (EDE-Q) and the frequency of binge eating and purging episodes. The secondary outcome measure was the Body Attitude Test.

RESULTS: Dropout from Internet treatment was 26%. Intention-to-treat ANCOVAs of post-test data revealed that the EDE-Q scores and the frequency of binging and purging reduced more in the online CBT group compared with the bibliotherapy and waiting list groups (pooled between-group effect size: d = 0.9). At 1-year follow-up, improvements in the online CBT group had sustained.

CONCLUSION: This study identifies online CBT as a viable alternative in the treatment of bulimic symptoms.

Original languageEnglish
Pages (from-to)308-18
Number of pages11
JournalClinical Psychology and Psychotherapy
Issue number4
Publication statusPublished - 3 Feb 2012


  • Adult
  • Analysis of Variance
  • Bibliotherapy
  • Bulimia
  • Cognitive Therapy
  • Female
  • Follow-Up Studies
  • Humans
  • Internet
  • Netherlands
  • Patient Compliance
  • Patient Dropouts
  • Psychiatric Status Rating Scales
  • Treatment Outcome
  • Waiting Lists
  • Journal Article
  • Randomized Controlled Trial


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