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Currently submitted to: Journal of Medical Internet Research

Date Submitted: Aug 12, 2019
Open Peer Review Period: Aug 12, 2019 - Aug 20, 2019
(currently open for review)

Internet-Based Cognitive Behavioral Therapy With Real-Time Therapist Support via Videoconference for Patients With Bulimia nervosa and Binge-eating disorder: Pilot Single-Arm Trial

  • Sayo Hamatani; 
  • Noriko Numata; 
  • Kazuki Matsumoto; 
  • Chihiro Sutoh; 
  • Hanae Ibuki; 
  • Keiko Oshiro; 
  • Mari Tanaka; 
  • Rikukage Setsu; 
  • Yohei Kawasaki; 
  • Yoshiyuki Hirano; 
  • Eiji Shimizu; 



A major problem in providing mental health services is the lack of access to treatment, especially in remote areas. Thus far, no clinical studies have demonstrated the feasibility of Internet-based cognitive behavioral therapy (ICBT) with real-time therapist support via videoconference for bulimia nervosa (BN) and binge-eating disorder (BED) at the same time in Japan.


To evaluate the feasibility of ICBT via videoconference for patients with BN or BED.


Five Japanese subjects (mean age 35.4 ± 9.2 years) with BN and BED received 16 weekly sessions of individualized ICBT via videoconference with real-time therapist support. Treatment included CBT tailored specifically to the presenting diagnosis. The primary outcome was a reduction in the Eating Disorder Examination interview-16 (EDE 16) for BN and BED: the combined objective binge and purging episodes; objective binge episodes; purging episodes. The secondary outcomes were the EDE-Q, the Bulimic Investigatory Test, Edinburgh, body mass index for eating symptoms, the Motivational Ruler for motivation to change, the EuroQol-5 Dimension for quality of life, the Patient Health Questionnaire-9 for depression, the Generalized Anxiety Disorder questionnaire-7 for anxiety, and the Working Alliance Inventory-Short Form (WAI-SF). All outcomes were assessed at week 1 (baseline) and at weeks 8 (mid intervention), and 16 (post intervention) during therapy. Patients were asked about adverse events at each session. For the primary analysis, treatment-related changes were assessed by comparing participant scores and the 95% confidence intervals using the paired t-test.


Although the mean combined objective binge episodes and purging episodes improved from 47.60 to 13.60 (71% reduction) and showed a medium effect size (Cohen’s d, -0.76), there was no significant reduction in the combined these episodes (EDE 16D, -41; 95% confidence interval -2.089, 0.576; P = 0.17). There were no significant treatment-related changes in the secondary outcomes. The WAI-SF scores remained consistently high (64.8–66.0) during treatment.


ICBT via videoconference is feasible in Japanese patients with BN and BED. Clinical Trial: UMIN000029426


Please cite as:

Hamatani S, Numata N, Matsumoto K, Sutoh C, Ibuki H, Oshiro K, Tanaka M, Setsu R, Kawasaki Y, Hirano Y, Shimizu E

Internet-Based Cognitive Behavioral Therapy With Real-Time Therapist Support via Videoconference for Patients With Bulimia nervosa and Binge-eating disorder: Pilot Single-Arm Trial

JMIR Preprints. 12/08/2019:15738

DOI: 10.2196/preprints.15738


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