Translation of findings from a randomised controlled trial to real-world implementation of an online self-help program in an Australian youth mental health service

Abstract

Background: Despite the availability of evidence-based treatments for bulimia nervosa (BN), there exist numerous barriers in being able to these treatments. Developing new cost-effective and accessible delivery mechanisms is essential to ensure early receipt of treatment. This has been further emphasized as a result of the COVID-19 pandemic, which has increased demands for flexible, by-distance treatment options. Binge Eating eTherapy (BEeT) is one of the first online CBT programs for eating disorders in Australia.

Aims: The trial aims to compare the effectiveness of engaging in the BEeT program in a purely independent manner to use of BEeT in conjunction with regular support from a non-specialist clinician (30 min videoconferencing session per week) to waitlist control.

Methods: BEeT consists of ten one-hour interactive, multi-media sessions and includes an inbuilt calendar with self-monitoring tools. This presentation will deliver key findings from a multisite, three-arm randomised controlled trial (RCT) of BEeT involving 114 participants with full or sub-threshold bulimia nervosa.

Results: The trial aimed to compare the effectiveness of pure self-help BEeT vs clinician-supported BEeT vs WLC. Baseline to post-treatment decreases in objective binge episode (OBE) frequency was greater for clinician supported as compared to WLC (d: 0.74, p= .004), however this was not the case for pure self-help (d: 0.40, p = .349). Pure self-help participants did display a further decrease in OBEs at follow up and as a result outperformed WLC when analysed as an overall rate of change across three timepoints of baseline, post-treatment and follow up. This presentation will also provide an overview of our progress in collaborative effort with “headspace”, a nation-wide youth mental health service in Australia, to provide a brief, four-week version of the BEeT intervention to children and young people (12-25 years old) experiencing mild to moderate symptoms of binge-eating or compensatory behaviour.

Conclusions: When considered alongside the largely equal number of participants who no longer met criteria full threshold BN at post-treatment and follow-up, these findings challenge the long-standing assumption held by the field that clinician supported interventions are more effective than pure self-help and suggest a unique benefit of unsupported use.