Evaluating digital enhanced cognitive behaviour therapy for eating disorders

Summary

Digital enhanced cognitive behaviour therapy (Digital CBTe) is a digital intervention for people experiencing binge eating disorder. Digital CBTe was piloted at two NHS sites: the Dorset All Age Eating Disorders Service piloted the self-help model and Kent and Medway All Age Eating Disorders Service piloted a guided self-help model. We led the real-world evaluation programme, and Health Innovation Wessex carried out the real-world evaluations at both sites. The evaluations showed clinically meaningful improvements for patients who completed the programme and highlighted potential benefits for staff and services, including improved patient flow and reduced treatment intensity. Findings have supported further spread of Digital CBTe across NHS mental health services.

Challenge

There is significant unmet need in eating disorder treatment and care across the UK. According to Beat, the UK’s eating disorder charity, around 1.25 million people are affected by an eating disorder. Binge eating is a key feature of bulimia nervosa and binge eating disorder and affects people of all genders, ages and socioeconomic backgrounds.

Many people do not seek treatment due to stigma and shame, and those who do often face long waiting times. Services therefore need more accessible, evidence‑based treatment options that can be delivered flexibly and at scale, while maintaining clinical effectiveness and patient safety.

Approach

Digital CBTe is a digital adaptation of enhanced cognitive behaviour therapy, developed by the Centre for Research on Eating Disorders at Oxford (CREDO) and delivered by Credo Therapies Ltd. The programme can be accessed via a mobile app or website and used either independently or with support from a trained non‑specialist supporter.

Health Innovation KSS and Health Innovation Wessex supported two NHS pilot projects funded by NHS England and the Office for Life Sciences. These pilots explored:

• a self‑help model delivered through Dorset Healthcare University NHS Foundation Trust
• a guided self‑help model delivered through North East London NHS Foundation Trust for the Kent and Medway All-Age Eating Disorders Service

Evaluation activity took place between 2023 and 2025, with communications and dissemination following in late 2025.

Health Innovation KSS contributed by:

• supporting NHS pilot sites to participate in real‑world evaluation
• supporting Health Innovation Wessex in the delivery of the independent real-world evaluation
• coordinating dissemination through the Health Innovation Network
• sharing findings via websites, social media and learning events
• convening a national online learning event in October 2025, attended by 70 participants from commissioning organisations, NHS trusts and academic institutions

Evaluation findings have also informed peer‑reviewed publications, with one article published in December 2025 and further work in progress.

Impact

Patient impact

Across both pilots, patients who completed Digital CBTe reported statistically and clinically significant reductions in:

• frequency of objective binge eating
• eating disorder‑related symptoms
• the impact of eating problems on daily life
• symptoms of depression

Sample sizes were small, and this is noted within the evaluation findings.

Health and care system impact

Staff involved in both pilots reported:

• improved patient flow
• reduced treatment intensity required after programme completion
• improved confidence and job satisfaction

These findings suggest that Digital CBTe may offer services an additional treatment option within existing care pathways.

“Following on from the pilot we are now able to offer our adult patients in the community service the guided self-help version of Digital CBTe as one of our first-line interventions.” – Catherine Birtwell, CBT Lead in Eating Disorders  and BABCP Accredited Therapist for Dorset All Age Eating Disorders Service

“This has been an innovative pilot study to be a part of. Our team have enjoyed supporting our patients to engage with the digital programme; and have appreciated the opportunity to develop our skills with an additional treatment method.” – Natasha Shaw, Senior CBT Therapist, Interim Clinical Lead, Kent & Medway Eating Disorders Service

Spread and adoption

Findings from the pilots have supported further exploration of Digital CBTe across the NHS:

• Credo Therapies is working with additional NHS mental health trusts across the UK to expand access
• Following a national dissemination event, implementation is being explored with five additional mental health NHS trusts
• Findings are being shared via NHSE, Integrated Care Boards, NHS trusts and the wider Health Innovation Network to inform decision‑making and potential integration into care pathways

Scalability

Digital CBTe is designed to be scalable across different healthcare settings through its digital delivery model. The combination of self‑help and guided self‑help formats allows services to adapt delivery based on local capacity and patient need.

The use of real‑world evaluation has supported learning about how the intervention fits within NHS services and has informed improvements to Digital CBTe, including changes to support processes and eligibility criteria. National dissemination through learning events, publications and networks has enabled wider awareness and interest beyond the original pilot sites.

“The support from Health Innovation Wessex and Health Innovation KSS was instrumental in helping us evaluate and understand the real-world impact of Digital CBTe. Whilst each pilot offered a different perspective on how Digital CBTe can fit into the care pathway, overall it has helped to shape our future roadmap.” – Dr Lisa Debrou, former Chief Clinical Officer, Credo Therapies

Find out more

1. Read the full Kent and Medway evaluation
2. Read the full Dorset evaluation
3. Digital CBTe learning event case study and webinar recording
4. Peer‑reviewed publication from the Dorset pilot (December 2025)