Bulimia nervosa (BN), a serious eating disorder marked by cycles of binge eating and purging, affects millions of women worldwide. If left untreated, it can cause severe physical and mental health issues, including dehydration, low blood pressure, depression, and even self-harm. Research shows BN often begins in adolescence, with up to three percent of women experiencing it during their lifetime.
Cognitive behavioral therapy (CBT) has long been recognized as an effective treatment, helping patients challenge harmful beliefs about dieting and body image while breaking the binge-purge cycle. However, access to specialist care remains a barrier, particularly for those living far from treatment centers.
A new study led by Dr. Sayo Hamatani at the University of Fukui, in collaboration with researchers across Japan and Sweden, suggests online CBT could bridge this gap. Published in JAMA Network Open on August 5, 2025, the research marks the first Asia-based trial of guided internet-based CBT (ICBT) for BN.
“We aimed to reduce barriers to specialist care and provide high-quality treatment regardless of location,” said Hamatani. “Online therapy allows patients in remote areas or with busy schedules to receive consistent treatment, supporting early intervention and preventing progression to more severe illness.”
The 12-week guided ICBT program combined therapist support with weekly self-help modules tailored for Japanese patients. The study recruited 61 women aged 13 to 65, randomly assigning them to either the online therapy group or a usual-care control group. Participants practiced strategies to resist urges to binge and purge, confront triggers safely, and reframe negative body image beliefs.
Results were striking. Women in the ICBT group reported an average reduction of 10 binge or purge episodes compared to baseline, and the proportion achieving remission jumped from 13% with usual care to 55% with online therapy. More than 75% of participants said they would use the program again if needed, highlighting its accessibility and acceptability.
The findings underscore the potential of online CBT as a transformative tool for BN treatment, particularly for patients who face logistical or geographic barriers to care. Hamatani emphasized, “With insurance support and integration into healthcare systems, guided online therapy could reach many more people and play a critical role in treating bulimia.”
Supported by the Japan Society for the Promotion of Science and the Lotte Research Promotion Grant, the study points toward a future where high-quality mental healthcare can be delivered equitably and effectively, improving quality of life for those living with BN.
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