Table 3 Internet CBT-based guided self-help for emerging adults
Certainty assessment | Impact | Certainty | Importance | ||||||
|---|---|---|---|---|---|---|---|---|---|
№ of studies | Study design | Risk of bias | Inconsistency | Indirectness | Imprecision | Other considerations | |||
Outcomes: ED psychopathology (SEED, EDE-Q) | |||||||||
2 | randomized trials | not serious | not serious | not serious | not serious | none | 1 RCT [61] and a subsequent study [65] with emerging adults with AN, BN, BED, and EDNOS (total n = 87 Featback; n = 88 Featback + low-intensity therapist support; n = 89 Featback + high-intensity therapist support; n = 90 waitlist control). Baseline levels of ED psychopathology were found to moderate intervention response. The 3 Featback conditions were superior to waiting list control in reducing bulimic psychopathology (SEED and EDE-Q scores). No added value of therapist support was found in symptom reduction but did improve intervention satisfaction; no significant differences between Featback conditions, and no effects were found regarding anorectic psychopathology. | ⨁⨁⨁⨁ HIGH | CRITICAL |
Outcomes: costs (related to intervention, health care utilization, medication; assessed using Health and Labor Questionnaire) | |||||||||
1 | randomized trials | not serious | not serious | not serious | not serious | none | 1 subsequent study [64] to the Featback RCT [61]: no significant differences between the study conditions were found regarding societal costs. Mean costs per participant were lowest in the Featback condition with low-intensity therapist support, followed by Featback with high-intensity therapist support, Featback without therapist support, and waiting list. Featback seems to be cost-effective vs. waitlist. | ⨁⨁⨁⨁ HIGH | CRITICAL |
Outcomes: BMI (Weight gain) | |||||||||
2 | randomized trials | not serious | not serious | not serious | not serious | none | 1 RCT with individuals with AN (n = 128 VIA intervention; n = 130 control) for relapse prevention [63]. Intervention completers gained significantly more weight than treatment as usual controls. At 9-month follow-up of this RCT [67] (at 9-month follow-up, n = 92 VIA intervention; n = 120 control), very good results for BMI were seen for full completers of the intervention. Predictors for favourable course (concerning BMI) were adherence to intervention, more spontaneity, and better self-esteem. | ⨁⨁⨁⨁ HIGH | CRITICAL |
Outcomes: dropout rate | |||||||||
1 | randomized trials | not serious | not serious | not serious | not serious | none | A subsequent study [66] to the VIA RCT [63] reported VIA was well-received and highly feasible with a moderate dropout rate (15.5%). | ⨁⨁⨁⨁ HIGH | CRITICAL |
Outcomes: ED symptoms (frequency of binge eating, vomiting, etc.) | |||||||||
5 | observational studies | very seriousa,b | seriousc | not serious | not serious | Strong associationd | 2 open trials (total n = 228), 1 controlled study (n = 31 intervention; n = 31 waitlist control), 1 case series (n = 38), 1 case report (n = 1) all with those with BN and/or EDNOS. Both open trials had significant improvements in ED symptoms at follow-up [68, 69]. In the controlled study, binge eating and vomiting abstinence rates differed significantly between the internet and control groups at post-treatment, favouring the internet group [70]. The case series saw significant decreases in vomiting and weight phobia, but when bingeing and vomiting decreased, exercise increased [71]. The case report did not see an improvement in ED symptoms during the intervention, although it involved ProYouth, which is used for ED prevention and early intervention [72]. | ⨁⨁◌◌ LOW | CRITICAL |
1 | randomized trials | not serious | not serious | not serious | not serious | none | 1 RCT with BN and EDNOS participants (n = 38 Overcoming Bulimia Online intervention; n = 38 waitlist/delayed treatment control) [62]. The intervention group had higher rates of cessation from binge eating and purging vs. delayed treatment condition, who experienced little change in cessation rates at follow-up. Intervention group gains were maintained or continued to improve at follow-up. | ⨁⨁⨁⨁ HIGH | CRITICAL |