InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, University of Sydney and Sydney Local Health District, Sydney, NSW 2006, Australia; School of Psychology, University of Sydney, Sydney, NSW, Australia.
School of Psychology, University of Sydney, Sydney, NSW, Australia; Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia; Graduate School of Health, University of Technology Sydney, Sydney NSW, Australia.
Psychiatry Res. 2023 Nov;329:115534. doi: 10.1016/j.psychres.2023.115534. Epub 2023 Oct 9.
High dropout rates and poor adherence associated with digital interventions have prompted research into modifications of these treatments to improve engagement and completion rates. This trial aimed to investigate the added benefit of clinician support when paired alongside a ten-session, online cognitive behaviour therapy (CBT) self-help intervention for bulimia nervosa (BN). As part of a three-arm, phase II randomised controlled trial, 114 participants (16 years or over) with full or subthreshold BN were randomly assigned to complete the intervention in a self-help mode (with administrative researcher contact; n = 38), with adjunct clinician support (weekly 30-minute videoconferencing sessions; n = 37), or a no-treatment waitlist control (WLC; n = 39). Baseline to post-treatment (12-weeks) decreases in objective binge episode frequency were significantly greater for clinician-supported participants as compared to WLC, but not for self-help when compared to WLC. However, due to continued improvements for self-help across follow-up (24-weeks), both arms outperformed WLC when analysed as an overall rate of change across three timepoints. Clinician-supported participants outperformed self-help in regards to laxative use and dietary restraint. Our results demonstrate that good clinical outcomes can be achieved with a relatively brief online CBT-based program even in the absence of structured clinical support, indicating a possible overreliance upon clinician support as a primary adherence-facilitating mechanism.
高辍学率和数字干预措施的低依从性促使人们研究这些治疗方法的改进，以提高参与度和完成率。这项试验旨在研究在为神经性贪食症（BN）提供十次在线认知行为疗法（CBT）自助干预的同时，增加临床医生支持的额外益处。作为一项三臂、二期随机对照试验的一部分，114 名（16 岁及以上）患有完全或亚阈值 BN 的参与者被随机分配在自助模式下完成干预（行政研究人员联系；n=38）、附加临床医生支持（每周 30 分钟视频会议；n=37）或无治疗等待名单对照（WLC；n=39）。与 WLC 相比，接受临床医生支持的参与者在基线至治疗后（12 周）客观暴食发作频率的降低明显更大，但与 WLC 相比，自助组则不然。然而，由于自助组在随访期间（24 周）持续改善，因此当从三个时间点的总体变化率进行分析时，这两个组都优于 WLC。在泻药使用和饮食控制方面，接受临床支持的参与者表现优于自助组。我们的结果表明，即使没有结构化的临床支持，相对简短的在线基于 CBT 的方案也可以实现良好的临床结果，这表明可能过度依赖临床医生支持作为主要的依从性促进机制。
