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Guided Internet-Based Cognitive Behavior Therapy for Women With Bulimia Nervosa: A Randomized Clinical Trial
Sayo Hamatani1,2,3, Kazuki Matsumoto4, Gerhard Andersson5,6,7
1Research Center for Child Mental Development, University of Fukui, Fukui, Japan.
JAMA Network Open
|August 5, 2025
Summary
Internet-based cognitive behavior therapy (ICBT) significantly reduced bulimia nervosa symptoms in a Japanese trial. This guided ICBT shows promise for improving treatment accessibility for women with this eating disorder.
Area of Science:
- Psychiatry
- Clinical Psychology
- Eating Disorders
Background:
- Bulimia nervosa prevalence is rising, yet effective treatment access is limited.
- The efficacy and acceptability of internet-based cognitive behavior therapy (ICBT) for bulimia nervosa in East Asia are not well-established.
Purpose of the Study:
- To evaluate the effectiveness and acceptability of a guided ICBT program for treating bulimia nervosa in women in Japan.
Main Methods:
- A randomized clinical trial involving 61 women with bulimia nervosa across 7 Japanese university hospitals.
- Participants received either usual care or usual care plus a 12-week therapist-guided ICBT program tailored to Japanese culture.
- Bulimia nervosa symptom severity was assessed using the weekly frequency of binge eating and compensatory behaviors.
Main Results:
- Guided ICBT significantly reduced the weekly frequency of binge eating and compensatory behaviors compared to the control group (adjusted mean difference: 9.84 episodes; P=.01; Cohen d=0.73).
- Sensitivity analyses confirmed the robustness of these findings.
- The intervention group showed a significant decrease in bulimia symptoms.
Conclusions:
- Therapist-guided ICBT is effective and acceptable for treating bulimia nervosa in women in Japan.
- Integrating guided ICBT into usual care can enhance access to effective treatments for bulimia nervosa.
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