de Zwaan M, et al. – This study scrutinized the efficacy of internet–based guided self–help (GSH–I) compared to the traditional, individual face–to–face cognitive behavioral therapy (CBT). It was determined that face–to–face CBT resulted in rapid and greater reductions in the number of objective binge eating episode (OBE) days, abstinence rates, and eating disorder psychopathologic findings. It could serve as an improved initial therapeutic choice than GSH–I. Internet–based guided self–help was a viable, slower–acting, low–threshold treatment alternative compared with CBT, for adults with BED.

Methods

• The scheme of this Internet and Binge Eating Disorder (INTERBED) study was a prospective, multicenter, randomized, noninferiority clinical trial (treatment duration, 4 months; follow-ups, 6 months and 1.5 years).
• The enrollment comprised of 178 adult outpatients with full or subsyndromal BED, from 7 university-based outpatient clinics from August 1, 2010, through December 31, 2011.
• The final follow-up analysis was carried out in April 2014.
• Data analysis was performed from November 30, 2014, to May 27, 2015.
• As a part of the interventions, enrollees received 20 individual face-to-face CBT sessions of 50 minutes each or sequentially completed 11 internet modules and had weekly email contacts.
• The primary outcome was the variation in the number of days with objective binge eating episodes (OBEs) during the previous 28 days between baseline and end of treatment.
• Secondary outcomes included OBEs at follow-ups, eating disorder and general psychopathologic findings, body mass index, and quality of life.

Results

• 586 patients were screened.
• Among these, 178 were randomized, and 169 had at least one postbaseline assessment and constituted the modified intention-to-treat analysis group (mean [SD] age, 43.2 [12.3] years; 148 [87.6%] female); the 1.5-year follow-up was available in 116 patients.
• The confirmatory analysis using the per-protocol sample (n = 153) failed to illustrate the noninferiority of GSH-I (adjusted effect, 1.47; 95% CI, -0.01 to 2.91; P = .05).
• GSH-I was found to be inferior to CBT in reducing OBE days at the end of treatment (adjusted effect, 1.63; 95% CI, 0.17-3.05; P = .03), through the modified intention-to-treat sample.
• Moreover, the exploratory longitudinal analyses demonstrated the superiority of CBT over GSH-I by the 6-month (adjusted effect, 0.36; 95% CI, 0.23-0.55; P < .001) but not the 1.5-year follow-up (adjusted effect, 0.91; 95% CI, 0.54-1.50; P = .70).
• Reductions in eating disorder psychopathologic results were notably higher in the CBT group than in the GSH-I group at 6-month follow-up (adjusted effect, -0.4; 95% CI, -0.68 to -0.13; P = .005).
• There were no group variations for body mass index, general psychopathologic findings, and quality of life.