A Little Support Goes a Long Way: A Mixed-Methods Pilot Study of Supported Digital CBTe for Recurrent Binge Eating

Eating disorders characterized by recurrent binge eating are prevalent, impairing, and undertreated. Digital programme-led interventions may increase access to recommended treatments, but completion rates are variable. Adding brief human support to digital programmes may improve completion and outcomes.

To evaluate the feasibility, acceptability, and preliminary effectiveness of Supported Digital CBTe, the digital programme-led version of Enhanced Cognitive Behavior Therapy (CBT-E) augmented with brief audio support calls delivered by a non-specialist supporter.

A mixed-methods single-arm pilot study was conducted entirely remotely with 19 adults with recurrent binge eating. Fifteen participants completed assessments at pre- and post-programme and 6-month follow-up. Post-treatment qualitative interviews (n = 13) explored experiences of the support calls.

Treatment completion was high (15/19 or 79% for all 12 sessions). All participants who completed a satisfaction survey (n = 11) rated both the programme and support calls as helpful. Thematic analysis identified four functions of support (accountability, sense-making, reflection, and encouragement) and three considerations for how support is delivered (initial uncertainty, comfortable without camera on, and concerns about support ending). Among those who completed the programme, improvements with large effect sizes were observed in binge eating frequency, eating disorder psychopathology, and clinical impairment at post-programme and follow-up.

Supported Digital CBTe appears feasible, acceptable, and clinically promising for adults with recurrent binge eating. Brief non-specialist audio support may enhance completion. Further research should evaluate clinical and cost-effectiveness.