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Introduction
Bulimia nervosa (BN) and Binge Eating Disorder (BED) are common and disabling conditions with significant personal, social and relationship costs (Simon, Schmidt and Pilling, 2005). Early intervention improves outcome, but without early intervention, the risk of a chronic relapsing course is high (Reas, Williamson, Martin and Zucker, 2000). Cognitive behaviour therapy (CBT) is considered the treatment of choice for bulimia nervosa (BN) and binge eating disorder (BED) (NICE, 2004).
The majority of people with eating disorders (EDs) do not access effective treatment (Hoek and van Hoeken, 2003). The reasons for this are complex: in many areas the availability of specialist services and interventions is limited. A study published by the Royal College of Psychiatrists reported that many sufferers do not receive CBT due to the inequitable distribution of appropriate Eating Disorders Services (Royal College of Psychiatrists, 2001). Commissioned specialist eating disorders services can range from full multidisciplinary teams to none at all. Nationally, there has been a dramatic increase in the numbers of sufferers presenting for treatment (Turnbull, Ward, Treasure, Jick and Derby, 1996). An increase in local referral rates and capacity pressure reflects this trend. It has been suggested that having to wait for treatment leads to poor engagement and treatment retention (Schmidt et al., 2008). Compensatory behaviours in eating disorders include bingeing and purging (vomiting, laxative abuse, diuretic abuse); these behaviours elicit high levels of shame and secrecy, and may act at barriers to help-seeking from GPs and Mental Health Services. To overcome these barriers and engage people in effective treatment without delay or disruption, new ways of service delivery need to be identified. Computer administered CBT (cCBT) may be able to bridge this gap.
Computer administered CBT approaches fit with national clinical priorities (Lewis et al., 2003) and eating disorders treatment guidelines (NICE, 2004), which encourage the use of appropriate self-help approaches. In general, people also report a preference for self-help to conventional health care for mental health problems (Oliver, Pearson, Coe and Gunnell, 2005). Computer administered CBT may have important advantages over more traditional manual based self-help intervention, which have been evaluated in this patient group (e.g. for review see Carter, 2002). First, computerized interventions using text and images, audio and video clips may...