Investigating the Efficacy of an Online Binge Eating Disorder Group Intervention for Under 18s
Conditions: Binge Eating Disorder
Sponsor: Coventry and Warwickshire Partnership NHS Trust

Investigating the efficacy of an online BED Group for under 18s V2.1 
 
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Evaluation of Pilot Online Binge Eating Disorder Group Intervention in under 18s. 
Short Title: Evaluation of Pilot Online Binge Eating Disorder Group in under 18s. 
Research Protocol Version 2.1 31/03/2023 
 
IRAS Number 
320293 
 
Research Question 
Can the guided self-help protocol be delivered as an online group intervention?  
 
Core Research Group 
Dominique Muhumuza, Coventry Warwickshire NHS Partnership Trust and Newman University (Chief 
Investigator; email: dominique.muhumuza@covwarkpt.nhs.uk) 
Dr Florbela Soares Teixeira, Newman University (Study Manager; email: 
f.soaresteixeira@staff.newman.ac.uk) 
Dr Yolanda Juanola, Coventry and Warwickshire Partnership NHS Trust 
Kay Wright, Coventry and Warwickshire Partnership NHS Trust 
Wendy Craig, Coventry and Warwickshire Partnership NHS Trust 
Sarah Jarvis, Coventry and Warwickshire Partnership NHS Trust 
 
Stakeholders 
 
The following stakeholder groups have been identified: 
• 
RISE Eating Disorder service users (current) who are diagnosed with a Binge Eating Disorder 
• 
RISE Clinicians (including Psychologists, Cognitive Behavioural Therapy Therapists, Dieticians, 
and Assistant Psychologists) 
• 
Non-client-facing service providers such as Service Managers and Commissioners/members of 
Clinical Commissioning Groups 
 
 
Funding 
This piece of research is being supported by the RISE Eating Disorder service at Coventry & 
Warwickshire Partnership NHS Trust and is not externally funded. 
 
Sponsor 
Coventry Warwickshire Partnership NHS Trust 
 
Timeline 
Start Date: 1st February 2023 
 
Duration: 6 months 
 
 

Investigating the efficacy of an online BED Group for under 18s V2.1 
 
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Background and Rationale 
 
The National Institute for Health and Care Excellence (NICE) Guidelines (2017) recommend cognitive 
behavioural therapy (CBT) group therapy as an intervention for Binge Eating Disorders (BEDs). These 
guidelines do not differentiate between what is offered to adults and what is offered to under 18s for 
BED. Downey (2014) identified that there is limited research on group interventions for Binge Eating 
Disorder.  Further, BED was only established as a diagnosis in the Diagnostic and Statistical Manual of 
Mental Disorders 5th Edition (American Psychiatric Association, 2013; DSM-5), which means that 
research is still in the early stages (Kober & Boswell, 2017).  
 
Malhotra & Baker (2019) highlight that group therapy is an effective method of treatment for a variety 
of psychiatric and behavioural disorders. They found that it affects patients positively through the 
Yalom Therapeutic Factors (Yalom & Leszcz, 2020). For example, patients realising that there are others 
similar to them, improving their self-concept by assisting others and witnessing the success of other 
group members allows them to envision themselves also succeeding have all been shown to be 
beneficial. Rørtveit et al. (2021) found that a group program was thought to be an essential part of 
treatment. Jones (2019) also found that a CBT group intervention showed improvements for the 
participants and helped them regain control of their eating. Yu et al (2021) compared an online BEG 
group intervention to a face-to-face group amongst adults and found that the online option was feasible 
and effective. These studies were undertaken within the adult BED population and no paper was found 
evaluating the effectiveness or feasibility of a group intervention for under 18s.  
 
Within RISE Eating Disorders Service, based in Coventry and Warwickshire Partnership NHS Trust 
(CWPT) individuals diagnosed with BED are offered guided CBT self-help based on the book Overcoming 
Binge Eating by Christopher Fairburn (2013). Due to the growing evidence that group therapy can be 
beneficial for adults with BED, we aim to explore whether or not this is also effective in under 18s. The 
large geographical area that the CWPT RISE service covers led us to developing the intervention for 
online use with the aim of increasing attendance and continued participation. The protocol for this BED 
group intervention has been developed using the current format for individual interventions based on 
Christopher Fairburn’s book as a guide. The benefits of the research are that people on a waiting list 
will be offered treatment earlier. 
 
Aims 
The aim of our study is to assess whether the group intervention can be delivered per the protocol 
and obtain feedback from the participants of any recommended amendments/adaptations.  
Methods 
This research will: 
 
1. Review individuals on the RISE Eating Disorder treatment waiting list for Binge Eating Disorder 
to assess their suitability for an online group intervention. Individuals will be reviewed in order 
on the waiting list. 
2. A carer information session will be held online to discuss their role throughout the research. 
3. An online one hour group intervention will be delivered once a week for 10 weeks. 
4. Follow-up questionnaires will be distributed to carers 1 month after completion of group. 
 
 
 
 
 
Participants 

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Individuals on the RISE Eating Disorders Treatment Waiting List will be reviewed by the RISE clinicians 
who will be facilitating the group intervention for suitability.  
Inclusion criteria 
• 
Diagnosed with Binge Eating Disorder 
• 
Under 18 prior to the group starting 
• 
Speaks English  
Exclusion criteria 
• 
If underweight 
• 
If have a serious physical illness 
• 
If pregnant 
• 
Physical Health problems due to eating problem 
• 
If mental health needs to be stabilised 
• 
If significant problem with alcohol, drugs, or repeated self-harm 
• 
Not in a place to start (changes upcoming or ongoing) 
Procedure 
Individuals from the treatment waiting list meeting the inclusion criteria will be approached by CWPT 
RISE study team clinicians to ask if they are interested in taking part in the research study. Those who 
express and interest will be offered a face-to-face review appointment with two clinicians, including 
the chief investigator. If, from the review, it is felt that it is appropriate to offer them the study group 
intervention, it will be explained to them in detail and they will be handed a Patient Information Sheet 
(PIS), one for themselves and one for their parent / carer. They will be given a week to decide 
whether or not they would like to take part in the study after which time a clinician will contact them 
via telephone to ask them what they have decided and to answer any questions. The chief 
investigator will ensure that the individual is truly interested in the approach and that there is no 
coercion. Consent forms will be sent via email, which they will be asked to send back signed 
electronically and send back via email. Once the individual and their parents/carers have signed the 
consent forms, the parent /carer will be invited to attend an introductory information session online. 
This session will explain the principles of the group and how they can support the young person 
throughout the course of the group. Baseline questionnaires will be completed pre-intervention. 
Group intervention 
The BEG intervention protocol is a separate attached document. The outline of the group consists of: 
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Investigating the efficacy of an online BED Group for under 18s V2.1 
 
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Upon completion of the group, the participants will be asked to complete the questionnaires again.  
Participants will undertake a follow-up appointment face-to-face or online at one month post 
research intervention to complete the questionnaires again and to assess whether or not they 
continue to require RISE Eating Disorder Service support. If further support is required from the RISE 
Eating Disorders service, this be will offered by the team. If a need is identified for support that is not 
offered by the RISE Eating Disorder service, they will be signposted and/or referred to the appropriate 
service. If they no longer require treatment and are able to manage their binges, they will then be 
discharged for the service.  
Measures 
Questionnaires will be completed at baseline (pre-intervention), at completion of group and at one 
month post-intervention. Individuals will also be provided with an online feedback form at the end of 
the last group session to complete anonymously to assess their experience of the group.  
The questionnaires used are: Eating Disorder Examination – Questionnaire (EDE-Q), Revised Children’s 
Anxiety and Depression Scale (RCADS) Child and RCADS Parent. These are the standard questionnaires 
used within the service to monitor eating behaviours and mood. The EDE-Q was chosen over a 
specific binge eating one as this allows to monitor if the eating behaviours change to a different type 
of eating behaviour as it measures restriction and binging.  
The results will be analysed quantitively with repeated measures statistical tests. We are looking for 
the EDE-Q scores to reduce which would suggest a reduction in symptoms. Furthermore, we are 
monitoring mood through the RCADS to see if there is any change in their mood following the 
treatment.  
The feedback form will be utilised qualitatively via content analysis to highlight any changes that the 
participants would suggest to the group and the space to express verbally how they experienced the 
group.  
Anticipated impact and dissemination 
 
If effective, the group intervention will be offered as a treatment option to service users from the RISE 
Eating Disorder Service going forward. The results will be disseminated through scientific papers and 
conferences. If the intervention is successful it might encourage services from other organisations to 
adopt this approach. 
 
 
Ethics/regulatory approvals 
Declaration of Helsinki 
The Chief Investigator will ensure that this study is conducted in accordance with the principles of the 
Declaration of Helsinki. 
Guidelines for Good Clinical Practice 
The Chief Investigator will ensure that this study is conducted in full conformity with relevant 
regulations and with the ICH Guidelines for Good Clinical Practice (CPMP/ICH/135/95) July 1996. 

Investigating the efficacy of an online BED Group for under 18s V2.1 
 
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Approvals 
The research protocol, intervention protocol, informed consent forms, and participant / carer 
information sheets will be submitted to the Health Research Authority (HRA) and the CWPT R&D office 
for local approval. 
The Chief Investigator will submit and, where necessary, obtain approval from the above parties for 
all substantial amendments to the original approved documents. 
Data monitoring 
The study may be monitored or audited for compliance with the Department of Health Research 
Governance Framework for Health and Social Care 2005. 
Patient confidentiality 
Study participants will be assigned a unique study identifier on recruitment. All data collected 
thereafter will be assigned to this study identifier. The study staff will ensure that the participants’ 
anonymity is maintained. All documents will be stored securely and only accessible by study staff and 
authorised personnel. The study will comply with the Data Protection Act.  
Ethical Considerations 
Protecting patients’ dignity is a critical part of this study.  Study procedures, data handling and storage 
have been scrutinized to ensure that any privacy issues are mitigated. 
All data will be kept strictly confidential. 
Patient and Public Involvement 
Service user involvement was sought. Feedback was positive in regards to the group and structure 
and recommendations have been taken into consideration. 
End of study 
End of study will be when all data has been collected, analysed and an end of study report produced. 
Long term storage 
All data will be kept electronically password protected. Only person who has access is the Chief 
Investigator. This will be archived for 5 years and destroyed following this. 
 
 
 
 
 

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References 
 
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Schmidt, U. (2020). First episode rapid early intervention for eating disorders (FREED): 
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American Psychiatric Association. (2013). Diagnostic and statistical manual of mental 
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Austin, A., Flynn, M., Shearer, J., Long, M., Allen, K., Mountford, V. A., ... & Schmidt, U. (2022). 
The first episode rapid early intervention for eating disorders‐upscaled study: clinical 
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Downey, J. (2014). Group therapy for adolescents living with an eating disorder: a scoping 
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Fairburn, C. G. (2013). Overcoming binge eating: The proven program to learn why you binge 
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Jones, K. (2019). Binge eating disorder: the effectiveness of brief group treatment. Mental 
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Kober, H., & Boswell, R. G. (2018). Potential psychological & neural mechanisms in binge 
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Malhotra A, Baker J. (2022). Group Therapy. In: StatPearls. StatPearls Publishing, Treasure 
Island (FL).  

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National Institute for Health and Care Excellence. (2017). Eating disorders: recognition and 
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https://www.nice.org.uk/guidance/ng69/resources/eating-disorders-recognition-and-
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Rørtveit, K., Furnes, PhD, B., Dysvik, PhD, E., & Ueland, PhD, V. (2021). Patients’ Experience of 
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