Smartphone-Supported Cognitive-Behavioral Therapy in Binge-Eating Disorder: An Exploratory Randomized Trial

To assess the feasibility of a smartphone app delivering just-in-time adaptive interventions as an adjunct to cognitive-behavioral therapy (CBT) adapted to binge-eating disorder (BED), estimate its effects assuming superiority over CBT alone, and document safety and target engagement.

A single-center, assessor-blinded, parallel feasibility study randomized adults aged 18-65 years with full-syndrome or subthreshold BED to smartphone-supported CBT (SmartCBT) or standard CBT (DRKS00024597). Both arms received 16 individual 50-min CBT sessions over 4 months. Assessments were conducted at baseline (T0), midtreatment (T1), posttreatment (T2), and 3-month follow-up (T3). Feasibility was determined regarding recruitment, attrition, dropout, adherence, assessment completion, app use, and acceptance. Further, eating disorder symptoms, mental and physical health, weight management behavior, safety, and target engagement (i.e., skill use) were assessed.

Over a 7-month recruitment period, 28 of 50 eligible volunteers were included and randomized 1:1 to SmartCBT or CBT. In the modified intent-to-treat sample (N = 25; SmartCBT: 13, CBT: 12), the feasibility of SmartCBT was further supported regarding attrition, dropout, adherence, treatment completion, app use, and acceptance; however, assessment completion was moderate. Clinical improvements were found in both arms, but differential results were affected by baseline differences and moderate assessment completion in the SmartCBT arm. Safety was documented, and support for target engagement was found.

This exploratory study provides evidence for the feasibility of app-supported CBT for BED. With few procedural refinements, the protocol can be used in a confirmatory randomized-controlled trial with long-term follow-up to evaluate efficacy and determine treatment mechanisms.

German Clinical Trials Register, https://www.drks.de, DRKS00024597.