Factors determining uptake of a CD-ROM-based CBT self-help treatment for bulimia: Patient characteristics and subjective appraisals of self-help treatment

Background: Cognitive-behavioural self-help treatments are widely advocated as the first step in the management of bulimia nervosa. Very little is known about the characteristics and attitudes of patients who are able to utilize self-help treatments. Aims: The aim of this study was to identify whether there are any pretreatment differences in patient characteristics and patients' expectations about computerized self-help between those who do or do not take up this type of treatment. Subjects and Methods: 81 patients who were offered a CD-ROM-based self-help treatment for bulimia nervosa completed baseline assessments including a questionnaire assessing their attitudes to and past experiences with self-help, confidence in using a computer and knowledge about and ability to manage aspects of their eating disorder. Results: Patients who did not take up the CD-ROM-based treatment had a significantly lower expectation of the usefulness of self-help for themselves but not for others. There were no baseline differences between groups in terms of mean BMI and symptom severity, in particular there were no differences in previous utilization of self-help or attitudes to previous self-help, or differences in confidence in using a computer. Qualitative comments of participants who failed to take up the package highlighted a diverse range of concerns and anxieties about computer treatment, some of which were based on misunderstandings about this treatment. Conclusions: These findings show that patients' views about self-help need to be carefully explored and misconceptions corrected if self-help treatment is to be considered by a subgroup of patients. Copyright (C) 2003 John Wiley & Sons, Ltd and Eating Disorders Association.