Internet-based Cognitive Behaviour Therapy for the Prevention, Treatment and Relapse Prevention of Eating Disorders: A Systematic Review

Background and ObjectivesEating disorders (EDs) are undertreated worldwide. In the UK the lag between recognition of symptoms and treatment ranges from about 15 months to in excess of two years. Internet-based Cognitive Behaviour Therapy (ICBT) could be a viable alternative to face-to-face Cognitive Behaviour Therapy (CBT) that avoids the negative impacts of delayed interventions. Based on evidence from randomised controlled trials (RCTs) this systematic review investigated the effectiveness of minimally guided self-help ICBT, without face-to-face therapy, for the prevention, treatment and relapse prevention of all types of EDs in adults. MethodsThe electronic databases MEDLINE, PsychINFO, CENTRAL, Scopus, and Web of Science were searched between 1991 to 2021. Inclusion criteria specified RCTs with ICBT versus inactive comparison groups. The Cochrane Risk of Bias Tool was used for quality assessments. Qualitative synthesis and meta-analyses were conducted. ResultsFindings showed medium and large significant beneficial effect sizes for the prevention and treatment studies, respectively, whereas relapse prevention yielded mainly small non-significant beneficial effect sizes. Only the treatment studies reached clinical significance and cognitive symptoms improved more than behavioural symptoms. ConclusionsThis systematic review reinforces the vital need to provide evidence-based Internet interventions at times when face-to-face treatment is not an option as has been the case during the COVID-19 pandemic. Although ICBT is a promising intervention for eating disorders in adults and may be more effective than face-to-face CBT for treating cognitive symptoms further high-quality ED RCTs are required to increase the evidence-base and enable more precise meta-analyses to reach definitive conclusions. HighlightsO_LIFindings showed medium and large significant beneficial effect sizes for the prevention and treatment studies, respectively, whereas relapse prevention yielded mainly small non-significant beneficial effect sizes. C_LIO_LIFor the treatment studies, 35% of effect estimates were clinically important. None of the effect estimates for either the prevention or the relapse prevention studies reached clinical significance. C_LIO_LIThere were statistically significant improvements on comorbid depression and anxiety for the treatment programmes. C_LIO_LICognitive symptoms improved more than behavioural symptoms and it is suggested that ICBT may be more effective than face-to-face CBT for treating cognitive symptoms. C_LI