Cognitive behavioural therapy (CBT) is the treatment with the strongest evidence base for bullimia nervosa however, access to health services and costs are major barriers to receiving treatment. Eating disorders place a high burden on the health system, with total annual costs estimated at $99.9 million [1]. Consequently, developing new delivery mechanisms to ensure early receipt of evidence based treatment is essential.
With seeding funds from NSW Health, the Centre for Eating and Dieting Disorders have developed as part of the actions arising from The NSW Service Plan for Eating Disorders, a ten session online CBT program. We recently completed a pilot of the CBT program demonstrating it successfully reduces illness severity in bullimia nervosa patients. With our service and government partners we are seeking funding to conduct a randomised controlled trial of guided online CBT, compared to a waitlist control in three local health district settings – an eating disorder outpatient clinic, an adult community mental health team, and a headspace clinic. 128 participants who meet current diagnostic criteria for bullimia nervosa will be recruited across three sites and randomly assigned to guided online CBT or waitlist.
Pre and post assessments of eating disorder psychopathology, binging and purging and general mental health will be conducted via comprehensive online e-screen assessment. Assessment of eating disorder behaviours is built in to each weekly session. Participants will be followed up at one month post-treatment. In a secondary analysis participants will be grouped according to treatment setting, and program effectiveness compared to determine if health outcomes and costs are effected by the setting in which treatment is delivered. A health economic analysis of the online program compared to face-to-face delivery (modelled cost effectiveness analysis (CEA)) and wait-list control (within trial CEA) will be conducted, to inform future decision making and policy development. Should the program prove effective existing statewide structures exist to ensure its broad implementation which could result in early access to evidence based care for many.
Collaborators: local health districts (Northern Sydney, South Western Sydney), NSW Ministry of Health, Butterfly Foundation
[1] The Butterfly Foundation. Paying the Price – The economic and social impact of eating disorders in Australia, 2012.