Table 4 Cognitive-behavioural programs (with discussion group) for emerging adults (18–25 years)

Jacobi et al. [40]

RCT

At risk of EDs

n = 51 SB + 

n = 52 waitlist control

SB + : 8-week/sessions cognitive-behavioural program with asynchronous moderated discussion group, journals, psychoeducation. Differs from traditional SB because adapted for subthreshold EDs by adding weekly symptom checklist and some body image exercises

EDE-Q, WCS, EDI, BSI, BDI, SCID, compliance with program

At 6-month follow-up, SB + showed significantly greater improvements in ED-related attitudes, vs. controls (medium effect sizes). SB + group showed 67% (95% CI 20–87%) greater reductions in combined rates of subjective and objective binges and 86% (95% CI = 63–95%) greater reduction in purging episodes. Rates of participants abstinent from all symptoms of disordered eating were significantly higher in SB + vs. control. Post-hoc subgroup analyses: effect on EDE-Q scores was larger/more effective in participants with binge eating than those in pure restricting subgroup

Taylor et al. [42]

RCT

High risk of EDs

n = 91 intervention

n = 94 waitlist control

Image and Mood: derived from SB, but 10 weekly sessions instead of usual 8 weekly sessions, cognitive behavioural program with asynchronous moderated discussion group; also differed by addressing ED risk factors

EDE, EDE-Q, SCID, BDI

ED attitudes and behaviours improved significantly more in intervention vs. control group from baseline to 2-year follow-up (moderate effect size); ED onset rate was 27% lower in intervention group vs. control (not significant). Among those with highest shape concerns, ED onset rate was significantly lower in the intervention (20%) vs. control (42%) at 2-year follow-up. Intervention might reduce ED onset for those at highest risk

Saekow et al. [43]

RCT (pilot)

High-risk for EDs

n = 14 SB-ED

n = 27 waitlist control (study completers)

SB-ED: 10-weekly sessions of a cognitive behavioural program with asynchronous moderated discussion group and text-based coaching (provided individualized weekly feedback)

EDE-Q, WCS, BMI, CES-D, CIA, feasibility, acceptability

SB-ED intervention had significant, medium to large effects for reduction of eating-related psychopathology, weight concerns, and psychosocial impairment, compared to waitlist controls from pre- to post-intervention. Completers rated SB-ED as very acceptable

Volker et al. [41]

RCT

At-risk of EDs (sample is same as Jacobi et al. 2012)

n = 51 SB + 

n = 52 assessment only control

SB + : 8-weekly sessions of a cognitive-behavioural program with asynchronous moderated discussion group, journals, psychoeducation. Differs from traditional SB because adapted for subthreshold EDs, by adding weekly symptom checklist and some body image exercises

Moderators (SCID [modified], BMI, EDI-2 [drive for thinness subscale]) and Mediators (EDE-Q -shape concern subscale)

Women with higher baseline purge rates and restrictive eating might need more intensive interventions SB + effects on the reduction of binge rate were weaker for participants with higher baseline BMI and for participants with lower baseline purge rates; SB + effects on reduction of ED pathology were weaker for participants with higher baseline purge and with initial restrictive eating. No moderators of the intervention effect on restrictive eating were identified

Manwaring et al. [39]

Cross-section from Taylor et al. 2006 RCT

At-risk of EDs

n = 244 consented; 209 with complete post-test data and 192 at 1-year follow-up

SB: 8-weekly/sessions of a cognitive-behavioural program with asynchronous moderated discussion group, journals, psychoeducation. Had a “booster” session available for 2 weeks 31 pprox.. 9 months following program cessation

SB utilization (e.g., number of main topic screens visited, discussion postings made or read, journal entries made, etc.), EDE-Q (restraint, eating, weight, shape concern subscales)

Total weeks participation and frequency of utilizing the online web pages/journals predicted pre- to post-treatment changes (lower scores) in EDE-Q restraint but not in other ED symptoms. Use of online discussion board was not associated with any of the outcomes from pre- to post-treatment. Treatment gains were maintained from post-treatment to 1-year follow-up. No evidence booster session was beneficial

Jacobi et al. [32]

RCT

At-risk of EDs

n = 47 SB

n = 50 waitlist control

SB: 8-weekly sessions of a cognitive behavioural program with asynchronous moderated discussion group, journals, psychoeducation. This version was adapted for a German population: text, culture-specific changes (e.g. German nutrition recommendations)

EDI-drive for thinness and body dissatisfaction subscales, EDE-Q, WCS, SCL-90R, BMI, SCID, compliance and general satisfaction, knowledge (e.g., information about nutrition, EDs, exercise)

SB participants maintained their improvements regarding desire to be thin and acquired knowledge about healthy eating, exercise, EDs at 3-month follow-up. Low effect sizes for total group. SB was very effective in high-risk women subgroup (n = 10 in SB, n = 12 in control), achieving significantly better changes from pre- to post-intervention and sustained at 3-month follow-up weight/shape concerns and knowledge test with larger effect sizes than for total group

Taylor et al. [33]

RCT

At-risk of EDs

n = 206 SB

n = 215 waitlist control

SB: 8-weekly sessions of a cognitive-behavioural program with asynchronous moderated discussion group, journals, psychoeducation

Time to onset of a subclinical/clinical ED, WCS, EDI-drive for thinness and bulimia, EDE-Q, CES-D, MSPSS, adherence

Significant reduction in weight/shape concerns in SB group vs. control at post-intervention, 1-year and 2-year follow-up. While no overall significant difference in onset of EDs between SB and controls, the SB group significantly reduced onset of EDs in 2 subgroups: participants with an elevated BMI (≥ 25) at baseline and those with baseline compensatory behaviours (vomiting, laxative, diuretic, diet pill use, driven exercise)

Low et al. [34]

RCT

At-risk of EDs

n = 14 SB and moderated discussion

n = 19 SB and unmoderated discussion

n = 14 SB alone

n = 14 controls

SB: 8-weekly sessions of a cognitive-behavioural program to address issues related to risk for EDs. Participants randomized to: SB with moderated (clinical psychologist) discussion, SB with unmoderated discussion, SB with no discussion, or control

EDI (drive for thinness, bulimia, body dissatisfaction), WCS, SATAQ (internalization and awareness), BMI, program utilization (frequency, duration of log ins)

Participation in SB resulted in better outcomes (reduced risk for eating and body image concerns) across all groups compared to controls; benefits of SB continued at 8–9-month follow-up. Participants in SB and unmoderated discussion group appeared to have the greatest reduction in ED risk. Decrease in ED risk was also associated with more time spent using the program. Moderation of discussion group may not be essential for good outcomes

Zabinski et al. [35]

RCT

At-risk of EDs

n = 27 SB

n = 29 control

SB: 8-weekly sessions of a cognitive-behavioural program, journals, psychoeducation; moderated discussion board was electronic bulletin board

BSQ, EDI (drive for thinness and bulimia), EDE-Q (global, restraint, eating, shape and weight concern), BMI, online social support scale, feedback about program

Both SB and controls significantly improved over time on most measures (BSQ, EDE-Q global, shape, weight). Effect sizes suggest that SB did impact the intervention group (both groups improved on BSQ but the means show that SB group reduced body image dissatisfaction to a greater extent than controls). All significant differences (except BMI) were between baseline and post-intervention and were maintained at 10- week follow-up

Celio et al. [36]

RCT

At-risk of EDs

n = 27 SB

n = 25 BT

n = 24 waitlist control

SB: 8-weekly sessions of a cognitive-behavioural program with asynchronous moderated discussion group, journals, psychoeducation

Body Traps (BT): face-to-face, psychoeducational class taught by a grad student. Met for 2 h/week over 8 weeks. Included lectures and group discussion and had same readings as SB group

EDE-Q and BSQ (weight, eating, restraint and shape concerns subscales), EDI (drive for thinness and bulimia subscales), compliance with programs

At post-treatment, SB group had significant reductions in weight/shape concerns and disordered eating attitudes vs. controls; at 4-month follow-up disordered behaviours (body image dissatisfaction) were also reduced (strongest results at follow-up). No significant effects were found between controls and BT group. Compliance was better with SB than BT. Among high-risk participants, SB was significantly more effective than BT and controls in reducing weight/shape concern at post-treatment and 4-month follow-up

Winzelberg et al. [37]

RCT

At-risk of EDs

n = 24 SB

n = 20 control

SB: 8-weekly sessions of a cognitive-behavioural program with asynchronous moderated discussion group, journals, psychoeducation

BSQ, EDI (drive for thinness and bulimia), EDE-Q (weight concerns and shape concerns), OSSS, compliance to program, frequency and theme of discussion group postings

No significant differences between SB and control at post-intervention, but at 3-month follow-up significant differences were found between BSQ and EDI drive for thinness (favouring SB). Weekly compliance decreased during the intervention. Compliance significantly related to improvement on BSQ. High level of participation in discussion group, but participants reported receiving only a moderate level of social support from the group

Kass et al. [38]

RCT

At-risk of EDs

n = 74 SB and moderated discussion group

n = 77 SB and no discussion group

SB: 8-weekly sessions of a cognitive-behavioural program with asynchronous moderated discussion group, journals, psychoeducation

The comparator group received SB but without the discussion group component

WCS, EDE-Q, BDI-II, MES, body composition (BMI), adherence to program

Weight/shape concerns were reduced more significantly among SB group with guided discussion group than SB with no discussion group. Guided discussion group participants had 67% lower odds of having high-risk weight/shape concerns post-intervention. Those who logged into the program in the guided discussion group spent significantly more time using the program than did those in the no discussion group condition

Ohlmer et al. [44]

Open trial (pilot)

At-risk for AN specifically

n = 36

SB-AN: cognitive-behavioural prevention program for AN, modelled after SB + but expanded to 10 weekly sessions (instead of 8), each 45–90 min. Also added motivational interviewing elements, more psychoeducation on EDs, focus on restrictive eating; included online discussion group, weekly feedback, weekly symptom checklist

Feasibility, adherence, and acceptance; WCS, EDE-Q, EDI-2, BSI, BDI, FMPS, knowledge test

32 women at post-intervention and 26 at 6-month follow-up. High satisfaction with the program. Significant and stable improvements with medium to large effect sizes on most variables of disturbed eating (WCS, EDE-Q, EDI-2 drive for thinness) at post-intervention and 6-month follow-up. BDI improved significantly at 6-month follow-up. EDI-2 bulimia and body dissatisfaction and associated psychopathology showed inconsistent improvements with medium to small effect sizes. Low-weight and normal-weight group: effects were mostly comparable with overall effects; underweight group, significant increase in BMI at post and follow-up; binge eating group: total number of binges in past 28 days was lower at follow-up vs pre-intervention

Melioli et al. [45]

Meta-analysis

n = 20 studies

Student Bodies, My Body My Life, Student Bodies2, Student Bodies + , other internet-based prevention programs

For this meta-analysis: between-group effect sizes were calculated for ED symptoms and risk factors

BSQ, EDI (drive for thinness, bulimia, body dissatisfaction), EDE-Q, WCS, CES-D, SATAQ-3, PACS, BULIT-R, DEBQ-R, EWLB, BDI-SF, BDI-II, EAT-40, BITE

Compared with controls, internet-based programs significantly decreased body dissatisfaction, thin- ideal internalization, shape and weight concern, dietary restriction, drive for thinness, bulimic symptoms, purging frequency, and negative affect (small to moderate effect sizes). No evidence of negative effects of internet-based prevention programs

Beintner et al. [46]

Meta-analysis

n = 10 studies (6 US and 4 Germany)

n = 990 (504 SB, 486 waitlist control)

SB: 8-weekly sessions of a cognitive-behavioural program with asynchronous moderated discussion group, journals, psychoeducation

WCS, BSQ, EDI/EDI-2-drive for thinness, bulimia and body dissatisfaction, EDE-Q- restraint, eating concern, weight concern, shape concern

At post-intervention, moderate effect sizes were found across all studies for EDI-drive for thinness, WCS, BSQ; small effect sizes for EDI-bulimia and EDE-Q-restraint, eating concern, weight concern, shape concern. At follow-up (12 weeks-12 months), a moderate effect size was found for EDI-drive for thinness and body dissatisfaction subscales, WCS, BSQ, EDE-Q restraint, shape concern subscales. Effect sizes for EDI-bulimia and EDE-Q eating concern and weight concern subscales were small. SB associated with mild to moderate improvements in ED attitudes (especially reductions of negative body image and desire to be thin); reported effects generally maintained

Beitner et al. [47]

Meta-analysis

n = 10 studies (6 United States, 4 Germany)

n = 990 (504 SB, 486 waitlist control)

SB: 8-weekly sessions of a cognitive-behavioural program with asynchronous moderated discussion group, journals, psychoeducation

Participant adherence, EDI-drive for thinness and bulimia

Adherence predicted intervention effects on the EDI Drive for Thinness, but not on the EDI

Bulimia subscale. Adherence to SB proved to be high across a number of trials, settings, and countries (Germany and United States)