A randomized trial comparing the efficacy of cognitive-behavioral therapy for bulimia nervosa delivered via telemedicine versus face-to-face

James E. Mitchell, Ross D. Crosby, Stephen A. Wonderlich, Scott Crow, Kathy Lancaster, Heather Simonich, Lorraine Swan-Kremeier, Christianne Lysne, Tricia Cook Myers

Research output: Contribution to journalArticlepeer-review

128 Scopus citations


Objective: A major problem in the delivery of mental health services is the lack of availability of empirically supported treatment, particularly in rural areas. To date no studies have evaluated the administration of an empirically supported manual-based psychotherapy for a psychiatric condition via telemedicine. The aim of this study was to compare the relative efficacy and acceptability of a manual-based cognitive-behavioral therapy (CBT) for bulimia nervosa (BN) delivered in person to a comparable therapy delivered via telemedicine. Method: One hundred twenty-eight adults meeting DSM-IV criteria for BN or eating disorder-not otherwise specified with binge eating or purging at least once per week were recruited through referrals from clinicians and media advertisements in the targeted geographical areas. Participants were randomly assigned to receive 20 sessions of manual-based, CBT for BN over 16 weeks delivered either face-to-face (FTF-CBT) or via telemedicine (TV-CBT) by trained therapists. The primary outcome measures were binge eating and purging frequency as assessed by interview at the end of treatment, and again at 3- and 12-month follow-ups. Secondary outcome measures included other bulimic symptoms and changes in mood. Results: Retention in treatment was comparable for TV-CBT and FTF-CBT. Abstinence rates at end-of-treatment were generally slightly higher for FTF-CBT compared with TV-CBT, but differences were not statistically significant. FTF-CBT patients also experienced significantly greater reductions in eating disordered cognitions and interview-assessed depression. However, the differences overall were few in number and of marginal clinical significance. Conclusions: CBT for BN delivered via telemedicine was both acceptable to participants and roughly equivalent in outcome to therapy delivered in person.

Original languageEnglish (US)
Pages (from-to)581-592
Number of pages12
JournalBehaviour Research and Therapy
Issue number5
StatePublished - May 2008

Bibliographical note

Funding Information:
Funding for this study was provided by a grant funded jointly by the National Institute of Mental Health and the National Institute of Diabetes and Digestive and Kidney Diseases (R01-MHDK-58820), the National Institute of Mental Health (KO2 MH65919) and the Neuropsychiatric Research Institute.


  • Bulimia nervosa
  • Cognitive-behavioral therapy
  • Telemedicine


Dive into the research topics of 'A randomized trial comparing the efficacy of cognitive-behavioral therapy for bulimia nervosa delivered via telemedicine versus face-to-face'. Together they form a unique fingerprint.

Cite this