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Effectiveness of a Digital Cognitive Behavior Therapy-Guided Self-Help Intervention for Eating Disorders in College Women: A Cluster Randomized Clinical Trial
Eating disorders (EDs) are common, serious psychiatric disorders on college campuses, yet most affected individuals do not receive treatment. Digital interventions have the potential to bridge this gap. To determine whether a coached, digital, cognitive behavior therapy (CBT) intervention improves o...
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| Published in: | JAMA network open 2020-08, Vol.3 (8), p.e2015633-e2015633 |
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| creator | Fitzsimmons-Craft, Ellen E Taylor, C Barr Graham, Andrea K Sadeh-Sharvit, Shiri Balantekin, Katherine N Eichen, Dawn M Monterubio, Grace E Goel, Neha J Flatt, Rachael E Karam, Anna M Firebaugh, Marie-Laure Jacobi, Corinna Jo, Booil Trockel, Mickey T Wilfley, Denise E |
| description | Eating disorders (EDs) are common, serious psychiatric disorders on college campuses, yet most affected individuals do not receive treatment. Digital interventions have the potential to bridge this gap.
To determine whether a coached, digital, cognitive behavior therapy (CBT) intervention improves outcomes for college women with EDs compared with referral to usual care.
This cluster randomized trial was conducted from 2014 to 2018 at 27 US universities. Women with binge-purge EDs (with both threshold and subthreshold presentations) were recruited from enrolled universities. The 690 participants were followed up for up to 2 years after the intervention. Data analysis was performed from February to September 2019.
Universities were randomized to the intervention, Student Bodies-Eating Disorders, a digital CBT-guided self-help program, or to referral to usual care.
The main outcome was change in overall ED psychopathology. Secondary outcomes were abstinence from binge eating and compensatory behaviors, as well as ED behavior frequencies, depression, anxiety, clinical impairment, academic impairment, and realized treatment access.
A total of 690 women with EDs (mean [SD] age, 22.12 [4.85] years; 414 [60.0%] White; 120 [17.4%] Hispanic; 512 [74.2%] undergraduates) were included in the analyses. For ED psychopathology, there was a significantly greater reduction in the intervention group compared with the control group at the postintervention assessment (β [SE], -0.44 [0.10]; d = -0.40; t1387 = -4.23; P |
| doi_str_mv | 10.1001/jamanetworkopen.2020.15633 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_7489868</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2438993776</sourcerecordid><originalsourceid>FETCH-LOGICAL-a364t-1d295f5a880ab549e86fa20793a8f5f0f820eccf7da45a26524447b5bbb4ab523</originalsourceid><addsrcrecordid>eNpdksFu1DAURSMEolXpLyALNmxSHDt2nC6QShjaSpWQYBBLy0meMx4cO9jJoPZj-q14aKlKV7b07j321btZ9qbAJwXGxfutGpWD-bcPP_0E7oRgkiaMU_osOySsKnMqMHv-6H6QHce4xTgJC1pz9jI7oERwxip-mN2utIZuNjtwECPyGin0yQxmVhY1fnBmP0IfYaN2xge03kBQ03V-vpgeevQNrM4vwE7o0s0QEmQ23iGdlCs1GzckVvShhxCRcQloLQyAfvgR3Ck6Q41dYvKhr8r1fjQ3CdlY40yXXl8Ho-yr7IVWNsLx_XmUff-8WjcX-dWX88vm7CpXlJdzXvSkZpopIbBqWVmD4FoRXNVUCc001oJg6Dpd9apkinBGyrKsWta2bZkMhB5lH-6409KO0HcpSFBWTsGMKlxLr4z8f-LMRg5-J6tS1IKLBHh3Dwj-1wJxlqOJHVibluWXKElJRV3TquJJ-vaJdOuX4FI8STivalwlZFKd3qm64GMMoB8-U2C5b4J80gS5b4L824Rkfv04zoP1397pHz2wt7A</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2667907898</pqid></control><display><type>article</type><title>Effectiveness of a Digital Cognitive Behavior Therapy-Guided Self-Help Intervention for Eating Disorders in College Women: A Cluster Randomized Clinical Trial</title><source>Publicly Available Content (ProQuest)</source><creator>Fitzsimmons-Craft, Ellen E ; Taylor, C Barr ; Graham, Andrea K ; Sadeh-Sharvit, Shiri ; Balantekin, Katherine N ; Eichen, Dawn M ; Monterubio, Grace E ; Goel, Neha J ; Flatt, Rachael E ; Karam, Anna M ; Firebaugh, Marie-Laure ; Jacobi, Corinna ; Jo, Booil ; Trockel, Mickey T ; Wilfley, Denise E</creator><creatorcontrib>Fitzsimmons-Craft, Ellen E ; Taylor, C Barr ; Graham, Andrea K ; Sadeh-Sharvit, Shiri ; Balantekin, Katherine N ; Eichen, Dawn M ; Monterubio, Grace E ; Goel, Neha J ; Flatt, Rachael E ; Karam, Anna M ; Firebaugh, Marie-Laure ; Jacobi, Corinna ; Jo, Booil ; Trockel, Mickey T ; Wilfley, Denise E</creatorcontrib><description>Eating disorders (EDs) are common, serious psychiatric disorders on college campuses, yet most affected individuals do not receive treatment. Digital interventions have the potential to bridge this gap.
To determine whether a coached, digital, cognitive behavior therapy (CBT) intervention improves outcomes for college women with EDs compared with referral to usual care.
This cluster randomized trial was conducted from 2014 to 2018 at 27 US universities. Women with binge-purge EDs (with both threshold and subthreshold presentations) were recruited from enrolled universities. The 690 participants were followed up for up to 2 years after the intervention. Data analysis was performed from February to September 2019.
Universities were randomized to the intervention, Student Bodies-Eating Disorders, a digital CBT-guided self-help program, or to referral to usual care.
The main outcome was change in overall ED psychopathology. Secondary outcomes were abstinence from binge eating and compensatory behaviors, as well as ED behavior frequencies, depression, anxiety, clinical impairment, academic impairment, and realized treatment access.
A total of 690 women with EDs (mean [SD] age, 22.12 [4.85] years; 414 [60.0%] White; 120 [17.4%] Hispanic; 512 [74.2%] undergraduates) were included in the analyses. For ED psychopathology, there was a significantly greater reduction in the intervention group compared with the control group at the postintervention assessment (β [SE], -0.44 [0.10]; d = -0.40; t1387 = -4.23; P < .001), as well as over the follow-up period (β [SE], -0.39 [0.12]; d = -0.35; t1387 = -3.30; P < .001). There was not a significant difference in abstinence from any ED behaviors at the postintervention assessment (odds ratio, 1.48; 95% CI, 0.48-4.62; P = .50) or at follow-up (odds ratio, 1.51; 95% CI, 0.63-3.58; P = .36). Compared with the control group, the intervention group had significantly greater reductions in binge eating (rate ratio, 0.82; 95% CI, 0.70-0.96; P = .02), compensatory behaviors (rate ratio, 0.68; 95% CI, 0.54-0.86; P < .001), depression (β [SE], -1.34 [0.53]; d = -0.22; t1387 = -2.52; P = .01), and clinical impairment (β [SE], -2.33 [0.94]; d = -0.21; t1387 = -2.49; P = .01) at the postintervention assessment, with these gains sustained through follow-up for all outcomes except binge eating. Groups did not differ in terms of academic impairment. The majority of intervention participants (318 of 385 participants [83%]) began the intervention, whereas only 28% of control participants (76 of 271 participants with follow-up data available) sought treatment for their ED (odds ratio, 12.36; 95% CI, 8.73-17.51; P < .001).
In this cluster randomized clinical trial comparing a coached, digital CBT intervention with referral to usual care, the intervention was effective in reducing ED psychopathology, compensatory behaviors, depression, and clinical impairment through long-term follow-up, as well as realizing treatment access. No difference was found between the intervention and control groups for abstinence for all ED behaviors or academic impairment. Given its scalability, a coached, digital, CBT intervention for college women with EDs has the potential to address the wide treatment gap for these disorders.
ClinicalTrials.gov Identifier: NCT02076464.</description><identifier>ISSN: 2574-3805</identifier><identifier>EISSN: 2574-3805</identifier><identifier>DOI: 10.1001/jamanetworkopen.2020.15633</identifier><identifier>PMID: 32865576</identifier><language>eng</language><publisher>United States: American Medical Association</publisher><subject>Adolescent ; Adult ; Behavior modification ; Clinical trials ; Cognition & reasoning ; Cognitive behavioral therapy ; Cognitive Behavioral Therapy - methods ; Colleges & universities ; Eating disorders ; Feeding and Eating Disorders - therapy ; Female ; Humans ; Internet ; Intervention ; Online Only ; Original Investigation ; Psychiatry ; Psychopathology ; Self Care ; Self help ; Treatment Outcome ; United States ; Young Adult</subject><ispartof>JAMA network open, 2020-08, Vol.3 (8), p.e2015633-e2015633</ispartof><rights>2020. This work is published under https://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>Copyright 2020 Fitzsimmons-Craft EE et al. .</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-a364t-1d295f5a880ab549e86fa20793a8f5f0f820eccf7da45a26524447b5bbb4ab523</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/2667907898?pq-origsite=primo$$EHTML$$P50$$Gproquest$$Hfree_for_read</linktohtml><link.rule.ids>230,314,776,780,881,25732,27903,27904,36991,36992,44569</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32865576$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Fitzsimmons-Craft, Ellen E</creatorcontrib><creatorcontrib>Taylor, C Barr</creatorcontrib><creatorcontrib>Graham, Andrea K</creatorcontrib><creatorcontrib>Sadeh-Sharvit, Shiri</creatorcontrib><creatorcontrib>Balantekin, Katherine N</creatorcontrib><creatorcontrib>Eichen, Dawn M</creatorcontrib><creatorcontrib>Monterubio, Grace E</creatorcontrib><creatorcontrib>Goel, Neha J</creatorcontrib><creatorcontrib>Flatt, Rachael E</creatorcontrib><creatorcontrib>Karam, Anna M</creatorcontrib><creatorcontrib>Firebaugh, Marie-Laure</creatorcontrib><creatorcontrib>Jacobi, Corinna</creatorcontrib><creatorcontrib>Jo, Booil</creatorcontrib><creatorcontrib>Trockel, Mickey T</creatorcontrib><creatorcontrib>Wilfley, Denise E</creatorcontrib><title>Effectiveness of a Digital Cognitive Behavior Therapy-Guided Self-Help Intervention for Eating Disorders in College Women: A Cluster Randomized Clinical Trial</title><title>JAMA network open</title><addtitle>JAMA Netw Open</addtitle><description>Eating disorders (EDs) are common, serious psychiatric disorders on college campuses, yet most affected individuals do not receive treatment. Digital interventions have the potential to bridge this gap.
To determine whether a coached, digital, cognitive behavior therapy (CBT) intervention improves outcomes for college women with EDs compared with referral to usual care.
This cluster randomized trial was conducted from 2014 to 2018 at 27 US universities. Women with binge-purge EDs (with both threshold and subthreshold presentations) were recruited from enrolled universities. The 690 participants were followed up for up to 2 years after the intervention. Data analysis was performed from February to September 2019.
Universities were randomized to the intervention, Student Bodies-Eating Disorders, a digital CBT-guided self-help program, or to referral to usual care.
The main outcome was change in overall ED psychopathology. Secondary outcomes were abstinence from binge eating and compensatory behaviors, as well as ED behavior frequencies, depression, anxiety, clinical impairment, academic impairment, and realized treatment access.
A total of 690 women with EDs (mean [SD] age, 22.12 [4.85] years; 414 [60.0%] White; 120 [17.4%] Hispanic; 512 [74.2%] undergraduates) were included in the analyses. For ED psychopathology, there was a significantly greater reduction in the intervention group compared with the control group at the postintervention assessment (β [SE], -0.44 [0.10]; d = -0.40; t1387 = -4.23; P < .001), as well as over the follow-up period (β [SE], -0.39 [0.12]; d = -0.35; t1387 = -3.30; P < .001). There was not a significant difference in abstinence from any ED behaviors at the postintervention assessment (odds ratio, 1.48; 95% CI, 0.48-4.62; P = .50) or at follow-up (odds ratio, 1.51; 95% CI, 0.63-3.58; P = .36). Compared with the control group, the intervention group had significantly greater reductions in binge eating (rate ratio, 0.82; 95% CI, 0.70-0.96; P = .02), compensatory behaviors (rate ratio, 0.68; 95% CI, 0.54-0.86; P < .001), depression (β [SE], -1.34 [0.53]; d = -0.22; t1387 = -2.52; P = .01), and clinical impairment (β [SE], -2.33 [0.94]; d = -0.21; t1387 = -2.49; P = .01) at the postintervention assessment, with these gains sustained through follow-up for all outcomes except binge eating. Groups did not differ in terms of academic impairment. The majority of intervention participants (318 of 385 participants [83%]) began the intervention, whereas only 28% of control participants (76 of 271 participants with follow-up data available) sought treatment for their ED (odds ratio, 12.36; 95% CI, 8.73-17.51; P < .001).
In this cluster randomized clinical trial comparing a coached, digital CBT intervention with referral to usual care, the intervention was effective in reducing ED psychopathology, compensatory behaviors, depression, and clinical impairment through long-term follow-up, as well as realizing treatment access. No difference was found between the intervention and control groups for abstinence for all ED behaviors or academic impairment. Given its scalability, a coached, digital, CBT intervention for college women with EDs has the potential to address the wide treatment gap for these disorders.
ClinicalTrials.gov Identifier: NCT02076464.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Behavior modification</subject><subject>Clinical trials</subject><subject>Cognition & reasoning</subject><subject>Cognitive behavioral therapy</subject><subject>Cognitive Behavioral Therapy - methods</subject><subject>Colleges & universities</subject><subject>Eating disorders</subject><subject>Feeding and Eating Disorders - therapy</subject><subject>Female</subject><subject>Humans</subject><subject>Internet</subject><subject>Intervention</subject><subject>Online Only</subject><subject>Original Investigation</subject><subject>Psychiatry</subject><subject>Psychopathology</subject><subject>Self Care</subject><subject>Self help</subject><subject>Treatment Outcome</subject><subject>United States</subject><subject>Young Adult</subject><issn>2574-3805</issn><issn>2574-3805</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>PIMPY</sourceid><recordid>eNpdksFu1DAURSMEolXpLyALNmxSHDt2nC6QShjaSpWQYBBLy0meMx4cO9jJoPZj-q14aKlKV7b07j321btZ9qbAJwXGxfutGpWD-bcPP_0E7oRgkiaMU_osOySsKnMqMHv-6H6QHce4xTgJC1pz9jI7oERwxip-mN2utIZuNjtwECPyGin0yQxmVhY1fnBmP0IfYaN2xge03kBQ03V-vpgeevQNrM4vwE7o0s0QEmQ23iGdlCs1GzckVvShhxCRcQloLQyAfvgR3Ck6Q41dYvKhr8r1fjQ3CdlY40yXXl8Ho-yr7IVWNsLx_XmUff-8WjcX-dWX88vm7CpXlJdzXvSkZpopIbBqWVmD4FoRXNVUCc001oJg6Dpd9apkinBGyrKsWta2bZkMhB5lH-6409KO0HcpSFBWTsGMKlxLr4z8f-LMRg5-J6tS1IKLBHh3Dwj-1wJxlqOJHVibluWXKElJRV3TquJJ-vaJdOuX4FI8STivalwlZFKd3qm64GMMoB8-U2C5b4J80gS5b4L824Rkfv04zoP1397pHz2wt7A</recordid><startdate>20200803</startdate><enddate>20200803</enddate><creator>Fitzsimmons-Craft, Ellen E</creator><creator>Taylor, C Barr</creator><creator>Graham, Andrea K</creator><creator>Sadeh-Sharvit, Shiri</creator><creator>Balantekin, Katherine N</creator><creator>Eichen, Dawn M</creator><creator>Monterubio, Grace E</creator><creator>Goel, Neha J</creator><creator>Flatt, Rachael E</creator><creator>Karam, Anna M</creator><creator>Firebaugh, Marie-Laure</creator><creator>Jacobi, Corinna</creator><creator>Jo, Booil</creator><creator>Trockel, Mickey T</creator><creator>Wilfley, Denise E</creator><general>American Medical Association</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20200803</creationdate><title>Effectiveness of a Digital Cognitive Behavior Therapy-Guided Self-Help Intervention for Eating Disorders in College Women: A Cluster Randomized Clinical Trial</title><author>Fitzsimmons-Craft, Ellen E ; Taylor, C Barr ; Graham, Andrea K ; Sadeh-Sharvit, Shiri ; Balantekin, Katherine N ; Eichen, Dawn M ; Monterubio, Grace E ; Goel, Neha J ; Flatt, Rachael E ; Karam, Anna M ; Firebaugh, Marie-Laure ; Jacobi, Corinna ; Jo, Booil ; Trockel, Mickey T ; Wilfley, Denise E</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-a364t-1d295f5a880ab549e86fa20793a8f5f0f820eccf7da45a26524447b5bbb4ab523</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Behavior modification</topic><topic>Clinical trials</topic><topic>Cognition & reasoning</topic><topic>Cognitive behavioral therapy</topic><topic>Cognitive Behavioral Therapy - methods</topic><topic>Colleges & universities</topic><topic>Eating disorders</topic><topic>Feeding and Eating Disorders - therapy</topic><topic>Female</topic><topic>Humans</topic><topic>Internet</topic><topic>Intervention</topic><topic>Online Only</topic><topic>Original Investigation</topic><topic>Psychiatry</topic><topic>Psychopathology</topic><topic>Self Care</topic><topic>Self help</topic><topic>Treatment Outcome</topic><topic>United States</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Fitzsimmons-Craft, Ellen E</creatorcontrib><creatorcontrib>Taylor, C Barr</creatorcontrib><creatorcontrib>Graham, Andrea K</creatorcontrib><creatorcontrib>Sadeh-Sharvit, Shiri</creatorcontrib><creatorcontrib>Balantekin, Katherine N</creatorcontrib><creatorcontrib>Eichen, Dawn M</creatorcontrib><creatorcontrib>Monterubio, Grace E</creatorcontrib><creatorcontrib>Goel, Neha J</creatorcontrib><creatorcontrib>Flatt, Rachael E</creatorcontrib><creatorcontrib>Karam, Anna M</creatorcontrib><creatorcontrib>Firebaugh, Marie-Laure</creatorcontrib><creatorcontrib>Jacobi, Corinna</creatorcontrib><creatorcontrib>Jo, Booil</creatorcontrib><creatorcontrib>Trockel, Mickey T</creatorcontrib><creatorcontrib>Wilfley, Denise E</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Publicly Available Content (ProQuest)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>JAMA network open</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Fitzsimmons-Craft, Ellen E</au><au>Taylor, C Barr</au><au>Graham, Andrea K</au><au>Sadeh-Sharvit, Shiri</au><au>Balantekin, Katherine N</au><au>Eichen, Dawn M</au><au>Monterubio, Grace E</au><au>Goel, Neha J</au><au>Flatt, Rachael E</au><au>Karam, Anna M</au><au>Firebaugh, Marie-Laure</au><au>Jacobi, Corinna</au><au>Jo, Booil</au><au>Trockel, Mickey T</au><au>Wilfley, Denise E</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effectiveness of a Digital Cognitive Behavior Therapy-Guided Self-Help Intervention for Eating Disorders in College Women: A Cluster Randomized Clinical Trial</atitle><jtitle>JAMA network open</jtitle><addtitle>JAMA Netw Open</addtitle><date>2020-08-03</date><risdate>2020</risdate><volume>3</volume><issue>8</issue><spage>e2015633</spage><epage>e2015633</epage><pages>e2015633-e2015633</pages><issn>2574-3805</issn><eissn>2574-3805</eissn><abstract>Eating disorders (EDs) are common, serious psychiatric disorders on college campuses, yet most affected individuals do not receive treatment. Digital interventions have the potential to bridge this gap.
To determine whether a coached, digital, cognitive behavior therapy (CBT) intervention improves outcomes for college women with EDs compared with referral to usual care.
This cluster randomized trial was conducted from 2014 to 2018 at 27 US universities. Women with binge-purge EDs (with both threshold and subthreshold presentations) were recruited from enrolled universities. The 690 participants were followed up for up to 2 years after the intervention. Data analysis was performed from February to September 2019.
Universities were randomized to the intervention, Student Bodies-Eating Disorders, a digital CBT-guided self-help program, or to referral to usual care.
The main outcome was change in overall ED psychopathology. Secondary outcomes were abstinence from binge eating and compensatory behaviors, as well as ED behavior frequencies, depression, anxiety, clinical impairment, academic impairment, and realized treatment access.
A total of 690 women with EDs (mean [SD] age, 22.12 [4.85] years; 414 [60.0%] White; 120 [17.4%] Hispanic; 512 [74.2%] undergraduates) were included in the analyses. For ED psychopathology, there was a significantly greater reduction in the intervention group compared with the control group at the postintervention assessment (β [SE], -0.44 [0.10]; d = -0.40; t1387 = -4.23; P < .001), as well as over the follow-up period (β [SE], -0.39 [0.12]; d = -0.35; t1387 = -3.30; P < .001). There was not a significant difference in abstinence from any ED behaviors at the postintervention assessment (odds ratio, 1.48; 95% CI, 0.48-4.62; P = .50) or at follow-up (odds ratio, 1.51; 95% CI, 0.63-3.58; P = .36). Compared with the control group, the intervention group had significantly greater reductions in binge eating (rate ratio, 0.82; 95% CI, 0.70-0.96; P = .02), compensatory behaviors (rate ratio, 0.68; 95% CI, 0.54-0.86; P < .001), depression (β [SE], -1.34 [0.53]; d = -0.22; t1387 = -2.52; P = .01), and clinical impairment (β [SE], -2.33 [0.94]; d = -0.21; t1387 = -2.49; P = .01) at the postintervention assessment, with these gains sustained through follow-up for all outcomes except binge eating. Groups did not differ in terms of academic impairment. The majority of intervention participants (318 of 385 participants [83%]) began the intervention, whereas only 28% of control participants (76 of 271 participants with follow-up data available) sought treatment for their ED (odds ratio, 12.36; 95% CI, 8.73-17.51; P < .001).
In this cluster randomized clinical trial comparing a coached, digital CBT intervention with referral to usual care, the intervention was effective in reducing ED psychopathology, compensatory behaviors, depression, and clinical impairment through long-term follow-up, as well as realizing treatment access. No difference was found between the intervention and control groups for abstinence for all ED behaviors or academic impairment. Given its scalability, a coached, digital, CBT intervention for college women with EDs has the potential to address the wide treatment gap for these disorders.
ClinicalTrials.gov Identifier: NCT02076464.</abstract><cop>United States</cop><pub>American Medical Association</pub><pmid>32865576</pmid><doi>10.1001/jamanetworkopen.2020.15633</doi><oa>free_for_read</oa></addata></record> |
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| subjects | Adolescent Adult Behavior modification Clinical trials Cognition & reasoning Cognitive behavioral therapy Cognitive Behavioral Therapy - methods Colleges & universities Eating disorders Feeding and Eating Disorders - therapy Female Humans Internet Intervention Online Only Original Investigation Psychiatry Psychopathology Self Care Self help Treatment Outcome United States Young Adult |
| title | Effectiveness of a Digital Cognitive Behavior Therapy-Guided Self-Help Intervention for Eating Disorders in College Women: A Cluster Randomized Clinical Trial |
| url | http://sfxeu10.hosted.exlibrisgroup.com/loughborough?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-27T02%3A03%3A11IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Effectiveness%20of%20a%20Digital%20Cognitive%20Behavior%20Therapy-Guided%20Self-Help%20Intervention%20for%20Eating%20Disorders%20in%20College%20Women:%20A%20Cluster%20Randomized%20Clinical%20Trial&rft.jtitle=JAMA%20network%20open&rft.au=Fitzsimmons-Craft,%20Ellen%20E&rft.date=2020-08-03&rft.volume=3&rft.issue=8&rft.spage=e2015633&rft.epage=e2015633&rft.pages=e2015633-e2015633&rft.issn=2574-3805&rft.eissn=2574-3805&rft_id=info:doi/10.1001/jamanetworkopen.2020.15633&rft_dat=%3Cproquest_pubme%3E2438993776%3C/proquest_pubme%3E%3Cgrp_id%3Ecdi_FETCH-LOGICAL-a364t-1d295f5a880ab549e86fa20793a8f5f0f820eccf7da45a26524447b5bbb4ab523%3C/grp_id%3E%3Coa%3E%3C/oa%3E%3Curl%3E%3C/url%3E&rft_id=info:oai/&rft_pqid=2667907898&rft_id=info:pmid/32865576&rfr_iscdi=true |