JMIR Publications

ABSTRACT

Background:

Binge eating disorder is highly prevalent and impairing, yet the national-guideline-recommended first-line treatment of guided self-help remains underused in routine National Health Service (NHS) care due to service- and patient-level barriers. Digital delivery of guided self-help offers a scalable way to address these challenges, but evidence from real-world NHS settings is limited.

Objective:

To pilot the digital, supported, programme-led (self-help) version of Enhanced Cognitive Behaviour Therapy (CBT-E) in a specialist adult eating disorder outpatient service within the UK’s NHS and assess its feasibility, acceptability, and preliminary clinical outcomes.

Methods:

The digital, supported programme-led treatment was offered to patients who self-reported features consistent with binge eating disorder and for whom a supported, programme-led treatment was appropriate. Patients completed the digital programme alongside remote support from a Mental Health and Wellbeing Practitioner. Self-report measures of eating disorder features, secondary impairment, and depressive features were completed before and after treatment. Patients and practitioners provided feedback through semi-structured interviews, and staff also completed a survey.

Results:

During the evaluation period, 36 patients started the programme and 30 either completed or discontinued the programme. These patients completed an average of 8 out of 12 sessions, with 17 finishing all active treatment sessions. Of the 16 who also completed post-intervention assessments, significant reductions were observed in binge eating frequency, eating disorder psychopathology, secondary impairment, and depressive symptoms. Qualitative feedback highlighted the programme’s accessibility, its role in keeping patients on track, and its positive impact on staff development and satisfaction. Some patients initially expressed scepticism about the digital format, and staff noted challenges for individuals with low motivation or co-occurring conditions.

Conclusions:

These findings suggest that the digital, supported programme-led version of CBT-E is feasible, acceptable, and shows promise in reducing binge eating and related impairments in adults within specialist NHS care. This approach may help increase delivery of national-guideline-recommended first-line treatment for binge eating disorder and address the persistent gap in access within routine services. Future research should explore ways to enhance initial patient acceptance of digital programmes and adapt this approach for individuals with low motivation or co-occurring conditions.