Internet-based Interventions for Eating Disorders

http://www.nedc.com.au/e-bulletin-number-eighteen#article-one

As societies around the world become digitalised, the field of e-mental health has expanded in tandem. E-mental health refers to the use of information and communication technology, particularly the internet, to support and improve mental health conditions and mental health care (Aardoom, Dingemans, Spinhoven, & Van Furth, 2013). E-mental health comes with the benefit of being able to provide anonymous and easily accessible services in a convenient and cost efficient format.

The internet has already shown to be a suitable medium to offer effective interventions for patients with different kinds of psychological disorders, including alcohol abuse, depression, anxiety disorders, and post-traumatic stress disorder (ter Huurne et al., 2013). This type of care also has significant potential in effectively treating and support those with eating disorders, particularly given the social, geographical, financial, accessibility and motivation barriers experienced by a significant number of patients who subsequently do not seek or receive mental health care.

Technology-enhanced programs offer unique opportunities to integrate education, prevention, early detection, and early intervention around eating disorders. Several internet-based eating disorder prevention programs have been introduced and empirically tested:

1. Student Bodies – an eight-week, structured cognitive behavioural (CBT) program including moderated discussion groups, targeting eating disorder attitudes and behaviours in college-aged women at risk of developing an eating disorder. The program has been effective in reducing weight and shape concerns in samples in the USA and Germany (Beinter, Jacobi, & Barr, 2012), and an adapted version of Student Bodies showed promising effects on eating disorder symptoms in a sample of women with sub-threshold eating disorders (Volker, Jacobi, & Barr, 2011)
2. Set Your Body Free – an eight-week manualised CBT prevention program targeting body dissatisfaction and disordered eating in adult women. In a study comparing the relative success of face-to-face and internet approaches for this program, Paxton et al. (2007) found the gains achieved at the end of treatment were slightly more pronounced with those who received face-to-face intervention than the internet-based intervention. However, at 6-month follow-up, the gains made in both groups were no different from each other
3. Body Project – a dissonance-based eating disorder prevention program, targeting female college students. The activities motivate participants to reduce pursuit of the thin ideal, decreasing body dissatisfaction, unhealthy weight-control behaviours, negative affect, and eating disorder symptoms. Stice et al. (2012) reported that a preliminary trial of a prototype internet version of the program (eBody Project) was as effective as a four week group intervention
4. ES[S]PRIT – is a flexible program linking prevention and early intervention (Bauer et al., 2009). The program follows a stepped-care approach combining various support components of increasing intensity. These components comprise psycho-education, symptom monitoring, supportive feedback, peer support, and professional online counseling. Online screening procedures assess attitudes, behaviours and symptoms related to eating disorders and provide tailored feedback to participants throughout their participation. In the case of occurrence of severe self-reported eating disorder symptoms, participants are encouraged to seek more intense help. It is assumed that the program counteracts the development of eating disorders and in cases where onset cannot be prevented facilitates timely access to more intense support
5. ProYouth – is a program for high school students that is designed to prevent the onset of eating disorder symptoms. The program consists of several modules that can be flexibly combined by users depending on their individual needs for support. Its acceptability, reach and effectiveness are currently being investigated in seven European countries, in various target populations and health-care systems. Researchers are also exploring best-practice strategies for the implementation and dissemination of the program (Minarik et al., 2013).

In spite of the growing body of literature concerning the development and uptake of e-health programs, there are some significant gaps in the literature that warrant further research:

1. There are few direct comparisons of different internet-based treatments for eating disorders, as well as a lack of direct comparisons of internet-based treatments and face-to-face treatments for eating disorders
2. There is a lack of cost-effectiveness analyses for internet-based treatments of eating disorders, which is important for the implementation of such interventions, particularly in light of ongoing pressure for savings in healthcare
3. To date, we know little about what types of individuals benefit from internet-based treatments. Future studies need to focus on the reasons for treatment dropout and non-compliance, since this could help develop ideas and strategies that could improve the effectiveness of treatment programs. It would also be interesting to investigate whether the amount of support can be diminished over the course of a treatment program (i.e. as participants’ overall health improves).

It is unlikely that technology-enhanced programs will replace current best practice face-to-face treatments. However, they do offer an important complimentary function, providing improved uptake, adherence, completion and acceptability compared with a conventional intervention. Furthermore, technology-enhanced systems can facilitate the connection between different levels of care and thus improve the coordination and delivery of services.

References:

Aardoom, J. J. Dingemans, A. E., Spinhoven, P., & Van Furth, E. F. (2013). Treating Eating Disorders Over the Internet: A Systematic Review and Future Research Directions. International Journal of Eating Disorders, 46, 539-552.

Bauer, S., Moessner, M., Wolf, M., Haug, S., & Kordy, H. (2009). ES[S]PRIT – An internet-based programme for the prevention and early intervention of eating disorders in college students. British Journal of Guidance & Counselling, 37(3), 327-336.

Beintner, I., Jacobi, C., & Taylor, C. B. (2012). Effects of an Internet-based prevention programme for eating disorders in the USA and Germany – A meta-analytic review. European Eating Disorders Review, 20(1), 1-8.

Minarik, C., Moessner, M., Ozer, F., & Bauer, S. (2013). Implementation and dissemination of an Internet-based program for prevention and early intervention in eating disorders. Psychiatrische Praxis, 40(6), 332-338.

Paxton, S., McLean, S. A., Gollings, E. K., Faulkner, C., & Wertheim, E. H. (2007). Comparison of face-to-face internet interventions for body image and eating problems in adult women: An RCT. International Journal of Eating Disorders, 40, 692–704.

Stice, E., Rohde, P., Durant, S., & Shaw, H. (2012). A preliminary trial of a prototype internet dissonance-based eating disorder prevention program for young women with body image concerns. Journal of Consulting and Clinical Psychology, 80, 907–916.

ter Huurne, E. D., Postel, M. G., de Haan, H. A., Drossaert, C. H., & DeJong, C. A. (2013). Web-Based Treatment Program Using Intensive Therapeutic Contact for Patients with Eating Disorders: Before-After Study. Journal of Medical Internet Research, 15(2), e12.

Volker, U., Jacobi, C., & Taylor, C. (2011). Adaption and evaluation of an Internet-based prevention program for eating disorders in a sample of women with subclinical eating disorder symptoms: A pilot study. Eating and Weight Disorders, 16(4), e270-e273.