Bridging the gap: a mixed-methods real-world pilot of a digital intervention for adults with binge eating

TL;DR

A digital self-help therapy program for binge eating was tested and found to be feasible and effective in reducing symptoms while waiting for specialist care.

Contribution

This study is one of the first to pilot a digital, self-guided CBT-E program for binge eating in a real-world NHS waiting list setting.

Findings

Patients who completed the program reported significant reductions in binge eating frequency and depression symptoms.

Qualitative feedback showed the program was acceptable and helpful for those on a waiting list.

Some patients desired more human interaction to improve engagement with the program.

Abstract

Many individuals who experience binge eating face significant challenges in accessing timely and adequate treatment, often due to limited healthcare resources. To address this, the digital, programme-led (self-help) version of Enhanced Cognitive Behaviour Therapy (CBT-E) has been developed. This service improvement project piloted the digital programme with adults on a specialist eating disorder service waiting list in the UK’s National Health Service (NHS). Its aim was to assess the feasibility, acceptability, and preliminary clinical effects of a digital programme for adults on a waiting list for an eating disorder characterised by binge eating.

The digital programme was offered to patients with eating problems characterised by binge eating (binge eating disorder or bulimia nervosa or atypical or subclinical threshold cases), for whom a programme-led treatment was appropriate and who were on a waiting list for a specialist outpatient service. Patients used the programme independently, without any additional support. They completed self-report measures assessing eating disorder features, secondary impairment, and features of depression before and after the programme. Patients provided feedback through semi-structured interviews, and staff completed a survey.

Fifty patients started the programme, and 19 completed all active programme sessions. Those who completed the full programme and the post-programme assessments (n = 14) reported significant reductions in binge eating frequency, eating disorder psychopathology, secondary impairment, and features of depression. Qualitative feedback from patients and staff highlighted the programme’s value as a waiting list offer and its role in supporting patients’ progress towards recovery. Some patients expressed a desire for human interaction to help them better engage with the programme.

These findings suggest that the digital, programme-led version of CBT-E is feasible, acceptable, and shows promise in reducing binge eating and related impairments in adults on a waiting list for a specialist outpatient eating disorder services. Offering this evidence-informed programme could help address the challenge of long delays in accessing care. Future research should focus on strategies to enhance patient engagement and adherence, improve human interaction within the programme, and explore ways to scale the intervention to benefit broader populations, including its use as an early intervention.

The online version contains supplementary material available at 10.1186/s40337-025-01487-5.

This project tested the digital self-help version of Enhanced Cognitive Behaviour Therapy (CBT-E) for adults with eating disorders involving binge eating who were on a waiting list for a specialist eating disorder service in the UK’s National Health Service (NHS). Patients used the digital programme on their own, without support from a healthcare professional. Those who completed it reported fewer binge eating episodes, eating disorder symptoms, and feelings of depression. Both patients and NHS staff found the programme helpful for those on the waiting list and useful in supporting recovery. However, some patients felt they would have benefited from more guidance. Overall, the programme was practical, well-received, and led to positive outcomes. The programme could help ease pressure on the NHS while allowing patients to access care more quickly. More research is needed, including a controlled clinical trial, to confirm that the programme is effective and good value for money.

The online version contains supplementary material available at 10.1186/s40337-025-01487-5.

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