title: CBT4BN: A Randomized Controlled Trial of Online Chat and Face-to-Face Group Therapy for Bulimia Nervosa.
abstract: OBJECTIVE
  Although cognitive-behavioral therapy (CBT) represents the first-line evidence-based psychotherapy for bulimia nervosa (BN), most individuals seeking treatment do not have access to this specialized intervention. We compared an Internet-based manualized version of CBT group therapy for BN conducted via a therapeutic chat group (CBT4BN) to the same treatment conducted via a traditional face-to-face group therapy (CBTF2F).
  
  
  METHODS
  In a two-site, randomized, controlled noninferiority trial, we tested the hypothesis that CBT4BN would not be inferior to CBTF2F. A total of 179 adult patients with BN (2.6% males) received up to 16 sessions of group CBT over 20 weeks in either CBT4BN or CBTF2F, and outcomes were compared at the end of treatment and at the 12-month follow-up.
  
  
  RESULTS
  At the end of treatment, CBT4BN was inferior to CBTF2F in producing abstinence from binge eating and purging. However, by the 12-month follow-up, CBT4BN was mostly not inferior to CBTF2F. Participants in the CBT4BN condition, but not CBTF2F, continued to reduce their binge-eating and purging frequency from the end of treatment to the 12-month follow-up.
  
  
  CONCLUSIONS
  CBT delivered online in a group chat format appears to be an efficacious treatment for BN, although the trajectory of recovery may be slower than face-to-face group therapy. Online chat groups may increase accessibility of treatment and represent a cost-effective approach to service delivery. However, barriers in service delivery such as state-specific license and ethical guidelines for online therapists need to be addressed.
authors.affiliation: Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, N.C., USA.
authors.forename: Stephanie C
authors.initials: SC
authors.lastname: Zerwas
authors.forename: Hunna J
authors.initials: HJ
authors.lastname: Watson
authors.forename: Sara M
authors.initials: SM
authors.lastname: Hofmeier
authors.forename: Michele D
authors.initials: MD
authors.lastname: Levine
authors.forename: Robert M
authors.initials: RM
authors.lastname: Hamer
authors.forename: Ross D
authors.initials: RD
authors.lastname: Crosby
authors.forename: Cristin D
authors.initials: CD
authors.lastname: Runfola
authors.forename: Christine M
authors.initials: CM
authors.lastname: Peat
authors.forename: Jennifer R
authors.initials: JR
authors.lastname: Shapiro
authors.forename: Benjamin
authors.initials: B
authors.lastname: Zimmer
authors.forename: Markus
authors.initials: M
authors.lastname: Moessner
authors.forename: Hans
authors.initials: H
authors.lastname: Kordy
authors.forename: Marsha D
authors.initials: MD
authors.lastname: Marcus
authors.forename: Cynthia M
authors.initials: CM
authors.lastname: Bulik
mesh_terms: D052018:Bulimia Nervosa / Q000628:therapy*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D011615:Psychotherapy, Group / Q000379:methods*; D017216:Telemedicine / Q000379:methods*; D016896:Treatment Outcome