Research Summary

Can Web-Based Guided Self-Help Match Traditional Therapy for Adults with Binge-Eating Disorder?

Anthony Calabro, MA

Key Highlights

  • Web-based guided self-help was noninferior to treatment as usual in reducing binge-eating episodes at the end of treatment and at 20 weeks after treatment.
  • Both interventions led to significant decreases in binge eating, with no differences in dropout or full remission rates.
  • The web-based program required less therapist involvement and fewer sessions yet achieved comparable outcomes.
  • Findings suggest web-based guided self-help could expand access to effective care amid workforce shortages and long waiting lists.

In a randomized clinical trial of 187 adults with binge-eating disorder (BED), investigators found that web-based guided self-help was noninferior to comprehensive treatment as usual in reducing binge-eating episodes both immediately after treatment and 20 weeks later.

These findings demonstrate that a shorter, less resource-intensive web-based intervention can achieve results comparable to standard cognitive behavior therapy–enhanced (CBT-E) care, suggesting a viable standalone option for BED treatment.

Binge-eating disorder, the most prevalent eating disorder, is marked by recurrent episodes of excessive food intake accompanied by distress but without compensatory behaviors. It affects up to 1.8% of women and 0.7% of men globally and is linked to medical and psychosocial impairment. Standard treatment typically involves CBT-E delivered in individual sessions. However, given high demand, limited therapist availability, and growing interest in cost-effective, scalable mental health interventions, evidence supporting guided self-help models remains critical. Although prior trials have hinted at comparable outcomes, direct comparisons with treatment-as-usual CBT-E have been scarce.

This two-arm, noninferiority randomized clinical trial was conducted between November 2021 and October 2024 at a specialized eating disorder center in the Netherlands. Adults with BED were randomized 1:1 to receive either 12 weeks of web-based guided self-help or 20 weeks of standard CBT-E delivered by videoconference. The primary outcome was the number of objective binge-eating episodes, measured at the end of treatment and again 20 weeks later. Secondary outcomes included binge-free days, remission, body dissatisfaction, clinical impairment, and body mass index (BMI). Statistical analyses included linear mixed models and multilevel regression methods. Intention-to-treat and per-protocol analyses were performed.

Of the 207 adults screened, 187 were enrolled (mean age, 38.1 years; 85.6% female). At the end of treatment, participants in the guided self-help group reported fewer binge-eating episodes (mean, 3.24; 95% CI, 2.42–4.33) compared with those receiving treatment as usual (mean, 4.06; 95% CI, 3.17–5.20), with a nonsignificant between-group contrast estimate (−0.82 [95% CI, −1.86 to 0.21]; P = .12).

At 20 weeks after treatment, the mean number of binge episodes remained slightly lower in the guided self-help group (1.27 [95% CI, 0.81–1.97] vs 1.84 [95% CI, 1.24–2.73]; P = .17). Full remission and abstinence rates were similar between groups at all time points, and dropout rates were comparable (22.6% vs 19.1%). BMI remained stable in the guided self-help group but increased slightly among those receiving treatment as usual. Although participants in the CBT-E group reported stronger therapeutic alliance and less clinical impairment at follow-up, these differences did not affect the main treatment outcomes.

The study’s limitations include the absence of interview-based data at 40 weeks after treatment, lack of control over participants’ posttreatment interventions, and the single-center design within a specialized setting, which may limit generalizability. Furthermore, secondary outcomes were exploratory and not adjusted for multiple comparisons.

“In this randomized clinical trial, web-based guided self-help was noninferior to treatment as usual in reducing binge eating, despite its shorter duration and lower level of therapist involvement,” the authors concluded. “These results suggest more evidence for the effectiveness of web-based mental health care, which is an important finding amid global challenges with mental health staff shortages, long waiting lists, and high treatment costs.”

Reference:
van Beers E, Melisse B, Poelstra P, et al. Web-based guided self-help vs treatment as usual for binge-eating disorder: a randomized clinical trial. JAMA Netw Open. 2025;8(10):e2536644. doi:10.1001/jamanetworkopen.2025.36644