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 Researchers found that while an internet-based self-help program did
help people binge eat less often, face-to-face therapy led to a
larger and faster reduction in binge eating episodes.
"Although there is evidence that structured self-help treatments
based on cognitive-behavioral therapy may be effective for patients,
it was unclear how the effects of an Internet-based application are
in comparison with cognitive-behavioral therapy," said senior author
Anja Hilbert, of the University of Leipzig Medical Center.
People with binge eating disorder repeatedly eat very large
quantities of food in a short period of time, Hilbert and colleagues
write in JAMA Psychiatry.
About 1.9 percent of people around the world will have binge eating
disorder during their lives, they add.
"Cognitive-behavioral therapy is the most well-established treatment
for adults with binge-eating disorder," Hilbert told Reuters Health
in an email.
Self-help programs also showed promise in some research, however.
For the new study, the researchers randomly assigned 178 overweight
or obese patients with binge eating disorder to participate in 20
50-minute face-to-face cognitive behavioral therapy sessions or 11
internet-based self-help sessions. The treatments took four months.
Hilbert said the face-to-face therapy was delivered during
individual sessions and focused on nutrition, body image and stress.
The self-help program on the internet covered similar topics and
patients could move through the program at their own pace. Those in
the self-help group met with a specialist before starting the
program and also received weekly emails.
At the start of the study, the participants reported an average of
14 days with binge eating episodes during the past 28 days. By the
end of treatment, that fell to about 4 days among those in the
self-help group and about 2 days among the cognitive-behavioral
therapy group.
After six months, those in the self-help group reported an average
of about 5 binge eating days during the past 28 days, compared to
about 3 among the cognitive-behavioral therapy group.
The proportion of patients who were no longer binge eating was also
higher among those in the cognitive-behavioral therapy group than
among those in the self-help group at both points.
In an analysis of 116 of the patients followed for a year and a
half, there was no difference between the two groups.
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Hilbert said the better results among the cognitive-behavioral
therapy group are likely due to it being more intense than self-help
and being paired with therapist support.
She said the results showing cognitive-behavioral therapy worked
faster than self-help should be considered during treatment
decisions since patients usually need their problems resolved as
early as possible.
"However, (self-help) was confirmed as a viable alternative to
(cognitive-behavioral therapy), and may be offered to patients with
reduced access to (cognitive-behavioral therapy) or who do not wish
to participate in an individual psychotherapy," she said.
Dr. Evelyn Attia, professor of psychiatry at Columbia University
Medical Center in New York, said it's important to explore other
treatments for binge eating disorder since cognitive-behavioral
therapy may not always be available.
"If somebody with binge eating disorder walked into a doctor's
office, there are a range of treatments that are shown to be
helpful," said Attia, who was not involved with the new study.
For example, she said, some people may be prescribed medications
found to help people with binge eating disorder, including
antidepressants and the stimulant marketed by Shire as Vyvanse,
which was approved in 2015 for use in people with moderate to severe
binge eating disorder.
Attia also echoed the author's statement that self-help programs
should not be discounted. This study also showed a significant
reduction in the self-help group - and electronic programs have
improved since this study was conducted, she said.
SOURCE: http://bit.ly/2viWskg JAMA Psychiatry, online August 2,
2017.
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