Bulimia: Guided self-help from the Internet is promising
(Vienna 27th March 2013) About 200,000 Austrian women suffer once in their lifetime from an eating disorder, but only six per cent get admitted – owing to the huge inhibition threshold – to get treated at a psychiatric facility. A current study conducted at the University Department of Paediatric and Adolescent Psychiatry at the MedUni Vienna demonstrates that success in the treatment of bulimia nervosa is also possible with guided self-help on the Internet.
"Bulimia nervosa is a disorder causing a feeling of shame that prevents many of those affected by it to avail of professional help", says Gudrun Wagner, psychologist at the MedUni Vienna. At the beginning of the guided self-help via the Internet or a book, psychiatric examination and establishment of a therapeutic relationship with the psychologist who supports the patient with the execution of the self-help programme takes place. Thereafter, everything takes place electronically.
From the diet to abnormal eating behaviour
The start of a Bulimia nervosa (BN) disorder is often preceded by a diet from which primarily young women slide into abnormal eating behaviour. Patients suffering from Bulimia nervosa are of normal weight, but find themselves to be too fat and hence try to eat less. "Maintaining the diet may lead to binge eating, and girls suffer from a loss of control and eat uninhibitedly. As compensatory measures, the young women induce vomiting intentionally or try to control weight gain with the help of laxatives. A vicious circle", says Wagner, who has led the current study with Andreas Karwautz.
In a study recently published in the British Journal of Psychiatry, which was conducted jointly with the Parkland-Klinik in Bad Wildungen (Germany), the efficacy of the guided self-help via the Internet programme "Salut BN" was compared on 155 patients with the self-help book "Conquer the Bulimia" that has been evaluated several times.
The result: the success rate is the same. Immediately after the seven months of continuous self-therapy, 46 per cents of the patients on the Internet and 48 per cent of the patients with the book showed signs of improvement; in other words, the symptoms had abated significantly. The rate remained stable even with the follow-up examination 18 months later. Says Wagner: "The success rate is similar with face-to-face therapy."
The self-help programmes are based on elements from the cognitive-behavioural therapy and contain modules comprising motivation, monitoring the abnormal eating behaviour and its change, communication of problem-solving strategies, cognitive restructuring, self-assertiveness training and prevention of relapse.
Many patients, who still showed pronounced symptoms after the self-help programme, finally gave in to additional psychotherapy on their own initiative: 41 per cent of those who were supported via the Internet and 27 per cent of the patients, who had worked with the book, availed of a face-to-face therapy at the end.
Service: The British Journal of Psychiatry
“Internet-delivered cognitive-behavioural therapy v. conventional guided self-help for bulimia nervosa: long-term evaluation of a randomized controlled trial.” G. Wagner, E. Penelo, C. Wanner, P. Gwinner, M. Trofaier, H. Imgart, K. Waldherr, C. Wöber-Bingöl, A. Karwautz. BJP, doi:10.1192/bjp.bp.111.098582.