A new study suggests that internet-based cognitive behavioral therapy (ICBT) could be an effective treatment for bulimia nervosa (BN), offering hope to women who lack access to specialized care.
BN is a serious eating disorder marked by cycles of binge eating and compensatory behaviors such as self-induced vomiting. Beyond its physical risks—including dehydration and low blood pressure—it is linked to depression and self-harm. The condition, which often begins in adolescence, affects up to 3% of women during their lifetime.
While cognitive behavioral therapy (CBT) is recognized as one of the most effective treatments for BN, many patients struggle to access in-person therapy, particularly in regions without specialized clinics. To address this gap, researchers from Japan and Sweden tested whether CBT could be delivered effectively online.
Led by Dr. Sayo Hamatani of the University of Fukui, the team developed a 12-week guided ICBT program tailored for Japanese patients. Participants engaged in weekly online modules, supported by therapists, to challenge negative thoughts about dieting and body image while practicing strategies to resist binge–purge urges.
The randomized trial, published August 5, 2025, in JAMA Network Open, involved 61 women aged 13 to 65. Compared to those receiving usual care, participants in the ICBT group reported significantly fewer binge eating and purging episodes, with reductions averaging about 10 episodes over the study period.
Remission rates also rose sharply: only 13% of women in the usual care group achieved remission, versus 55% in the ICBT group. More than three-quarters of participants said they would choose the program again if needed.
“Our goal was to lower barriers to treatment and ensure people can access high-quality care no matter where they live,” Dr. Hamatani said. “Delivering CBT online makes it easier for patients in remote areas or with demanding schedules to stay in treatment, supporting earlier intervention.”
The researchers argue that integrating ICBT into healthcare systems, with insurance coverage, could expand access to effective treatment and prevent BN from worsening.
If adopted widely, online therapy could represent a major step forward in equitable mental healthcare for eating disorders.
