Department of Psychiatry, Washington University School of Medicine, St Louis, Missouri.
Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California.
JAMA Netw Open. 2020 Aug 3;3(8):e2015633. doi: 10.1001/jamanetworkopen.2020.15633.
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.
DESIGN, SETTING, AND PARTICIPANTS: 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.
饮食失调（EDs）是大学校园里常见的严重精神疾病，但大多数受影响的个体并未接受治疗。数字干预有可能弥合这一差距。
确定与转介至常规护理相比，经教练指导的数字认知行为疗法（CBT）干预是否能改善患有 ED 的女大学生的结果。
设计、地点和参与者：这是一项在 2014 年至 2018 年期间在美国 27 所大学进行的集群随机试验。从参与的大学招募了患有暴食-催吐 ED（既有阈下表现又有阈上表现）的女性。690 名参与者在干预后最多进行了 2 年的随访。数据分析于 2019 年 2 月至 9 月进行。
将大学随机分配到干预组、Student Bodies-Eating Disorders，即数字 CBT 引导的自助程序，或转介至常规护理。
主要结果是 ED 精神病理学的总体变化。次要结果是暴食和补偿行为的戒除，以及 ED 行为频率、抑郁、焦虑、临床损伤、学业损伤和实际治疗机会。
共纳入 690 名患有 ED 的女性（平均[SD]年龄 22.12[4.85]岁；414[60.0%]为白人；120[17.4%]为西班牙裔；512[74.2%]为本科生）进行分析。对于 ED 精神病理学，干预组在干预后评估时与对照组相比，有显著更大的降低（β[SE]，-0.44[0.10]；d=-0.40；t1387=-4.23；P<0.001），并且在随访期间也有显著降低（β[SE]，-0.39[0.12]；d=-0.35；t1387=-3.30；P<0.001）。在干预后评估时（优势比，1.48；95%置信区间，0.48-4.62；P=0.50）或随访时（优势比，1.51；95%置信区间，0.63-3.58；P=0.36），两组在任何 ED 行为的戒除方面均无显著差异。与对照组相比，干预组的暴食（比率比，0.82；95%置信区间，0.70-0.96；P=0.02）、补偿行为（比率比，0.68；95%置信区间，0.54-0.86；P<0.001）、抑郁（β[SE]，-1.34[0.53]；d=-0.22；t1387=-2.52；P=0.01）和临床损伤（β[SE]，-2.33[0.94]；d=-0.21；t1387=-2.49；P=0.01）的减少在干预后评估时显著更大，除了暴食行为外，这些改善在随访期间持续存在。两组在学业损伤方面没有差异。大多数干预组参与者（385 名参与者中的 318 名[83%]）开始了干预，而只有对照组（271 名有随访数据的参与者中的 76 名[28%]）寻求了 ED 的治疗（优势比，12.36；95%置信区间，8.73-17.51；P<0.001）。
在这项比较教练指导的数字 CBT 干预与转介至常规护理的集群随机临床试验中，干预在减少 ED 精神病理学、补偿行为、抑郁和临床损伤方面是有效的，并且通过长期随访，以及实现治疗机会，都得到了改善。在所有 ED 行为的戒除或学业损伤方面，干预组与对照组之间没有差异。鉴于其可扩展性，针对患有 ED 的女大学生的教练指导的数字、CBT 干预有可能解决这些疾病的广泛治疗差距。
ClinicalTrials.gov 标识符：NCT02076464。
