title: Online cognitive behavioral therapy for bulimic type disorders, delivered in the community by a nonclinician: qualitative study.
abstract: BACKGROUND
  Cognitive behavioral therapy is recommended in the National Institute for Clinical Excellence guidelines for the treatment of bulimia nervosa. In order to make this treatment option more accessible to patients, interactive online CBT programs have been developed that can be used in the user's own home, in privacy, and at their convenience. Studies investigating online CBT for bulimic type eating disorders have provided promising results and indicate that, with regular support from a clinician or trained support worker, online CBT can be effective in reducing bulimic symptoms. Two main factors distinguish this study from previous research in this area. First, the current study recruited a wide range of adults with bulimic type symptoms from the community. Second, the participants in the current study had used cCBT with support from a nonclinical support worker rather than a specialist eating disorder clinician.
  
  
  OBJECTIVE
  To investigate participants' experiences of using an online self-help cognitive behavioral therapy (CBT) package (Overcoming Bulimia Online) for bulimia nervosa (BN) and eating disorders not otherwise specified (EDNOS).
  
  
  METHODS
  Eight participants with a mean age of 33.9 years took part in semi-structured interviews. Interviews were transcribed and analyzed using a 6-step thematic analysis process.
  
  
  RESULTS
  Saturation was achieved, and 7 themes were identified in the dataset. These were: (1) conceptualizing eating disorders, (2) help-seeking behavior, (3) aspects of the intervention, (4) motivation to use the online package, (5) privacy and secrecy with regard to their eating problems, (6) recovery and the future, and (7) participant engagement describing individuals' thoughts on taking part in the online research study.
  
  
  CONCLUSIONS
  Participants suggested that online CBT self-help represented a generally desirable and acceptable treatment option for those with bulimic type eating problems, despite some difficulties with motivation and implementation of some elements of the package.
  
  
  BACKGROUND
  International Standard Randomized Controlled Trial Number of the original RCT that this study is based on: ISRCTN41034162; http://www.controlled-trials.com/ISRCTN41034162 (Archived by WebCite at http://www.webcitation.org/6Ey9sBWTV).
authors.affiliation: Institute of Health and Wellbeing, Mental Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom.
authors.forename: Carrie-Anne
authors.initials: CA
authors.lastname: McClay
authors.forename: Louise
authors.initials: L
authors.lastname: Waters
authors.forename: Ciaran
authors.initials: C
authors.lastname: McHale
authors.forename: Ulrike
authors.initials: U
authors.lastname: Schmidt
authors.forename: Christopher
authors.initials: C
authors.lastname: Williams
mesh_terms: D000328:Adult; D002032:Bulimia / Q000628:therapy*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D006801:Humans; D009042:Motivation; D009862:Online Systems