Psychological Medicine

Original Articles

A randomized controlled trial of an Internet-based cognitive-behavioural skills package for carers of people with anorexia nervosa

M. Grovera1, U. Naumanna1, L. Mohammad-Dara1, D. Glennona1, S. Ringwooda1, I. Eislera1, C. Williamsa1, J. Treasurea1 and U. Schmidta1 c1

a1 King's College London, Institute of Psychiatry, Section of Eating Disorders, London, UK


Background Anorexia nervosa (AN) poses a major burden on families. Carers (e.g. parents or partners) of people with AN are often highly distressed and may inadvertently respond in ways that can contribute to the maintenance of the disorder, e.g. through high levels of over-involvement and criticism [also known as expressed emotion (EE)]. This study aimed to evaluate the efficacy of a novel web-based systemic cognitive-behavioural (CBT) intervention for carers of people with AN, designed to reduce carer distress and teach skills in how to offer effective support.

Method Carers of people with AN (n=64) were randomly allocated to either the web-intervention, overcoming anorexia online, with limited clinician supportive guidance (by email or phone), or to ad-hoc usual support from the UK patient and carer organization Beat. Carer outcomes were assessed at post-treatment (4 months) and follow-up (6 months).

Results Compared with the control intervention, web-based treatment significantly reduced carers' anxiety and depression (primary outcome) at post-treatment, with a similar trend in carers' EE. Other secondary outcomes did not favour the online intervention. Gains were maintained at follow-up.

Conclusions This is the first ever study to use an online CBT program to successfully reduce carer distress and improve carers' ability to support the person with AN.

(Received December 09 2010)

(Revised March 26 2011)

(Accepted April 12 2011)

(Online publication May 20 2011)


c1 Address for correspondence: U. Schmidt, M.D., Ph.D., FRCPsych, PO 59, Section of Eating Disorders, Institute of Psychiatry, 103, Denmark Hill, London SE5 8AF, UK. (Email: