Does therapist guidance improve uptake, adherence and outcome from a CD-ROM based cognitive-behavioral intervention for the treatment of bulimia nervosa?

BackgroundWe recently demonstrated the efficacy and feasibility of a novel CD-ROM based cognitive-behavioral multi-media self-help intervention for the treatment of bulimia nervosa. What is not known in CD-ROM treatments is how to best to deliver and support such packages in clinical practice. In particular, it is of great importance to identify to what extent such packages can be offered stand alone, and to what extent additional support from a practitioner is required.ObjectiveThe aim of the present study was to examine whether the addition of therapist support to the CD-ROM intervention would improve treatment uptake, adherence and outcome.MethodTwo cohorts of patients with full or partial bulimia nervosa referred to a catchment area based eating disorder service were offered an eight session CD-ROM-based cognitive-behavioral self-help treatment (“Overcoming Bulimia”). The first cohort received minimal guidance only and the second cohort were offered three brief focused support sessions with a therapist. The two cohorts were compared on treatment uptake, adherence and outcome.ResultsPatients in both groups improved significantly. There were no significant differences between the two groups in terms of treatment uptake, adherence or outcome, except that the therapist guidance group more often achieved remission from excessive exercise at follow-up.DiscussionThese findings provide further support for the acceptability and efficacy of the CD-ROM intervention for bulimia nervosa. Brief focused therapist guidance did not confer any significant additional benefits. This result has important implications for the widespread adoption of such approaches.