Skip to main content

Table 3 Internet CBT-based guided self-help for emerging adults

From: The COVID-19 pandemic and eating disorders in children, adolescents, and emerging adults: virtual care recommendations from the Canadian consensus panel during COVID-19 and beyond

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
  1. aNo control condition
  2. bNo randomization
  3. cSome discrepancies between study findings
  4. dLarge effect sizes for changes in ED symptoms scale [70] and weight phobia [71] and from baseline to post-treatment.
  5. Bibliography:
  6. RCTs – Aardoom 2016 [61], Aardoom 2017 [65], Aardoom 2016 [64], Fichter 2012 [63], Fichter 2013 [67], Fichter 2011 [66], Sanchez-Ortiz 2011 [62]
  7. Observational studies: Open trials – Pretorius 2009 [68], Carrard 2011 [69]; Controlled study – Fernandez-Aranda 2009 [70]; Case series – Nevonen 2006 [71]; Case report – Kindermann 2016 [72]