Advertisement

E-Health Interventions for Eating Disorders: Emerging Findings, Issues, and Opportunities

  • Jiska J. Aardoom
  • Alexandra E. Dingemans
  • Eric F. Van Furth
Eating Disorders (C Grilo, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Eating Disorders

Abstract

This study aimed to review the emerging findings regarding E-health interventions for eating disorders and to critically discuss emerging issues as well as challenges for future research. Internet-based cognitive behavioral therapy and guided self-help have demonstrated promising results in terms of reducing eating disorder psychopathology. Emerging findings also suggest that E-health interventions reach an underserved population and improve access to care. The use of smartphone applications is becoming increasingly popular and has much potential although their clinical utility and effectiveness is presently unknown and requires investigation. Important challenges include the diagnostic process in E-health interventions, the optimization of E-health within existing health care models, and the investigation and implementation of blended care. More high-quality research is needed to bring the field forward and to determine the place for E-health in our health care service delivery systems.

Keywords

E-health Internet interventions Eating disorders Treatment Self-help 

Notes

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. 1.
    American Psychiatric Association: Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC, 2013.Google Scholar
  2. 2.
    Hudson JI, Hiripi E, Pope Jr HG, Kessler RC. The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biol Psychiatry. 2007;61:348–58.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Arcelus J, Mitchell AJ, Wales J, Nielsen S. Mortality rates in patients with anorexia nervosa and other eating disorders. A meta-analysis of 36 studies. Arch Gen Psychiatry. 2011;68:724–31.CrossRefPubMedGoogle Scholar
  4. 4.
    Agh T, Kovacs G, Pawaskar M, Supina D, Inotai A, Voko Z. Epidemiology, health-related quality of life and economic burden of binge eating disorder: A systematic literature review. Eat Weight Disord. 2015;20:1–12.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    De Jong H, Oldershaw A, Sternheim L, Samarawickrema N, Kenyon MD, Broadbent H, et al. Quality of life in anorexia nervosa, bulimia nervosa and eating disorder not-otherwise-specified. J Eat Disord. 2013;1:43.CrossRefGoogle Scholar
  6. 6.
    Zabala MJ, Macdonald P, Treasure J. Appraisal of caregiving burden, expressed emotion and psychological distress in families of people with eating disorders: A systematic review. Eur Eat Disord Rev. 2009;17:338–49.CrossRefPubMedGoogle Scholar
  7. 7.
    de la Rie S, van Furth E, de Koning A, Noordenbos G, Donker M. The quality of life of family caregivers of eating disorder patients. Eat Disord. 2005;13:345–51.CrossRefPubMedGoogle Scholar
  8. 8.
    Stuhldreher N, Konnopka A, Wild B, Herzog W, Zipfel S, Löwe B, et al. Cost-of-illness studies and cost-effectiveness analyses in eating disorders: a systematic review. Int J Eat Disord. 2012;45:476–91.CrossRefPubMedGoogle Scholar
  9. 9.
    Keski-Rahkonen A, Hoek HW, Susser ES, Linna MS, Sihvola E, Raevuori A, et al. Epidemiology and course of anorexia nervosa in the community. Am J Psychiat. 2007;164:1259–65.CrossRefPubMedGoogle Scholar
  10. 10.
    Hart LM, Granillo MT, Jorm AF, Paxton SJ. Unmet need for treatment in the eating disorders: a systematic review of eating disorder specific treatment seeking among community cases. Clin Psychol Rev. 2011;31:727–35.CrossRefPubMedGoogle Scholar
  11. 11.
    Becker AE, Hadley Arrindell A, Perloe A, Fay K, Striegel-Moore RH. A qualitative study of perceived social barriers to care for eating disorders: perspectives from ethnically diverse health care consumers. Int J Eat Disord. 2010;43:633–47.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Cachelin FM, Striegel-Moore RH. Help seeking and barriers to treatment in a community sample of Mexican American and European American women with eating disorders. Int J Eat Disord. 2006;39:154–61.CrossRefPubMedGoogle Scholar
  13. 13.
    de la Rie S, Noordenbos G, Donker M, van Furth E. Evaluating the treatment of eating disorders from the patient’s perspective. Int J Eat Disord. 2006;39:667–76.CrossRefPubMedGoogle Scholar
  14. 14.
    Berkman NDL. Outcomes of eating disorders: a systematic review of the literature. Int J Eat Disord. 2007;40:293–309.CrossRefPubMedGoogle Scholar
  15. 15.
    Reas DL, Williamson DA, Martin CK, Zucker NL. Duration of illness predicts outcome for bulimia nervosa: a long-term follow-up study. Int J Eat Disord. 2000;27:428–34.CrossRefPubMedGoogle Scholar
  16. 16.
    Fichter MM, Quadflieg N, Hedlund S. Twelve-year course and outcome predictors of anorexia nervosa. Int J Eat Disord. 2006;39:87–100.CrossRefPubMedGoogle Scholar
  17. 17.
    Keel PK, Mitchell JE. Outcome in bulimia nervosa. Am J Psychiatry. 1997;154:313–21.CrossRefPubMedGoogle Scholar
  18. 18.•
    Aardoom JJ, Dingemans AE, Spinhoven P, van Furth EF. Treating eating disorders over the internet: a systematic review and future research directions. Int J Eat Disord. 2013;46:539–52. This is one of the first studies to systematically review the literature with respect to Internet-based treatments for eating disorders, including directions for future research.CrossRefPubMedGoogle Scholar
  19. 19.•
    Fairburn CG, Rothwell ER. Apps and eating disorders: a systematic clinical appraisal. Int J Eat Disord. 2015;48:1038–46. This is one of the first studies to identify, characterize, and evaluate the clinical utility of smartphone apps for individuals with eating disorders or eating disorder professionals.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Juarascio AS, Manasse SM, Goldstein SP, Forman EM, Butryn ML. Review of smartphone applications for the treatment of eating disorders. Eur Eat Disord Rev. 2015;23:1–11.CrossRefPubMedGoogle Scholar
  21. 21.
    Dolemeyer R, Tietjen A, Kersting A, Wagner B. Internet-based interventions for eating disorders in adults: a systematic review. BMC Psychiatry. 2013;13:207.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Shingleton RM, Richards LK, Thompson-Brenner H. Using technology within the treatment of eating disorders: a clinical practice review. Psychotherapy. 2013;50:576–82.CrossRefPubMedGoogle Scholar
  23. 23.•
    Loucas CE, Fairburn CG, Whittington C, Pennant ME, Stockton S, Kendall T. E-therapy in the treatment and prevention of eating disorders: a systematic review and meta-analysis. Behav Res Ther. 2014;63:122–31. This is the first published meta-analysis in the field of E-health for eating disorders, inlcuding prevention-, treatment-, and relapse prevention studies.CrossRefPubMedCentralGoogle Scholar
  24. 24.•
    Bauer S, Moessner M. Harnessing the power of technology for the treatment and prevention of eating disorders. Int J Eat Disord. 2013;46:508–15. This is one of the first reviews to focus on the use of technology in prevention, treatment, relapse prevention, and carer support.CrossRefPubMedGoogle Scholar
  25. 25.
    Schlegl S, Burger C, Schmidt L, Herbst N, Voderholzer U. The potential of technology-based psychological interventions for anorexia and bulimia nervosa: A systematic review and recommendations for future research. J Med Internet Res. 2015;17:e85.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Ambwani S, Cardi V, Treasure J. Mobile self-help interventions for anorexia nervosa: conceptual, ethical, and methodological considerations for clinicians and researchers. Prof Psychol Res Pr. 2014;45:316–23.CrossRefGoogle Scholar
  27. 27.
    Wagner G, Penelo E, Wanner C, Gwinner P, Trofaier ML, Imgart H, et al. Internet-delivered cognitive-behavioural therapy v. conventional guided self-help for bulimia nervosa: Long-term evaluation of a randomised controlled trial. Br J Psychiatry. 2013;202:135–41.CrossRefPubMedGoogle Scholar
  28. 28.
    ter Huurne ED, de Haan HA, Postel MG, van der Palen J, VanDerNagel JE, DeJong CA. Web-based cognitive behavioral therapy for female patients with eating disorders: Randomized controlled trial. J Med Internet Res. 2015;17:e152.CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.•
    Ruwaard J, Lange A, Broeksteeg J, Renteria-Agirre A, Schrieken B, Dolan CV, et al. Online cognitive behavioural treatment of bulimic symptoms: a randomized controlled trial. Clin Psychol Psychother. 2012;20:308–18. This is one of the first large randomized controlled trials investigating online cognitive behavioural treatment in the treatment of bulimia nervosa. This is also one of the few E-health treatment studies that included a relatively longterm follow-up period (i.e. one year).CrossRefPubMedGoogle Scholar
  30. 30.
    Baumeister H, Reichler L, Munzinger M, Lin J. The impact of guidance on Internet-based mental health interventions: a systematic review. Internet Interv. 2015;1:205–15.CrossRefGoogle Scholar
  31. 31.
    Hogdahl L, Birgegard A, Bjorck C. How effective is bibliotherapy-based self-help cognitive behavioral therapy with Internet support in clinical settings? Results from a pilot study. Eat Weight Disord. 2013;18:37–44.CrossRefPubMedGoogle Scholar
  32. 32.
    Leung SF, Ma JLC, Russell J. Enhancing quality of life in people with disordered eating using an online self-help programme. J Eat Disord. 2013;1:9.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Leung SF, Ma J, Russell J. Enhancing motivation to change in eating disorders with an online self-help program. Int J Ment Health Nurs. 2013;22:329–39.CrossRefPubMedGoogle Scholar
  34. 34.
    Hotzel K, von Brachel R, Schmidt U, Rieger E, Kosfelder J, Hechler T, et al. An Internet-based program to enhance motivation to change in females with symptoms of an eating disorder: a randomized controlled trial. Psychol Med. 2014;44:1947–63.CrossRefPubMedGoogle Scholar
  35. 35.
    Cardi V, Lounes N, Kan C, Treasure J. Meal support using mobile technology in anorexia nervosa. Contextual differences between inpatient and outpatient settings. Appetite. 2013;60:33–9.CrossRefPubMedGoogle Scholar
  36. 36.
    Cardi V, Clarke A, Treasure J. The use of guided self-help incorporating a mobile component in people with eating disorders: A pilot study. Eur Eat Disord Rev. 2013;21:315–22.CrossRefPubMedGoogle Scholar
  37. 37.
    Mohr DC, Ho J, Duffecy J, Reifler D, Sokol L, Burns MN, et al. Effect of telephone-administered vs face-to-face cognitive behavioral therapy on adherence to therapy and depression outcomes among primary care patients. JAMA. 2012;307:2278–85.CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Gulec H, Moessner M, Tury F, Fiedler P, Mezei A, Bauer S. A randomized controlled trial of an internet-based posttreatment care for patients with eating disorders. Telemed J E Health. 2014;20:916–22.CrossRefPubMedGoogle Scholar
  39. 39.
    Unikel C, Sánchez M, Trujillo E, Bauer S, Moessner M. Internet-based aftercare program for patients with bulimia nervosa in Mexico: a pilot study. Revista Mexicana de Trastornos Alimentarios. 2015;6:64–9.CrossRefGoogle Scholar
  40. 40.
    Fichter MM, Quadflieg N, Lindner S. Internet-based relapse prevention for anorexia nervosa: nine- month follow-up. J Eat Disord. 2013;1:23.CrossRefPubMedPubMedCentralGoogle Scholar
  41. 41.
    Higgins JPT, Green S: Cochrane Handbook for Systematic Reviews of Interventions. Version 5.1.0. 2011.Google Scholar
  42. 42.
    Carter JC, Blackmore E, Sutandar-Pinnock K, Woodside DB. Relapse in anorexia nervosa: a survival analysis. Psychol Med. 2004;34:671–9.CrossRefPubMedGoogle Scholar
  43. 43.
    Carter JC, Mercer-Lynn KB, Norwood SJ, Bewell-Weiss CV, Crosby RD, Woodside DB, et al. A prospective study of predictors of relapse in anorexia nervosa: implications for relapse prevention. Psychiatry Res. 2012;200:518–23.CrossRefPubMedGoogle Scholar
  44. 44.
    McFarlane T, Olmsted MP, Trottier K. Timing and prediction of relapse in a transdiagnostic eating disorder sample. Int J Eat Disord. 2008;41:587–93.CrossRefPubMedGoogle Scholar
  45. 45.
    Wagner G, Penelo E, Nobis G, Mayrhofer A, Wanner C, Schau J, et al. Predictors for good therapeutic outcome and drop-out in technology assisted guided self-help in the treatment of bulimia nervosa and bulimia like phenotype. Eur Eat Disord Rev. 2015;23:163–9.CrossRefPubMedGoogle Scholar
  46. 46.
    von Brachel R, Hotzel K, Hirschfeld G, Rieger E, Schmidt U, Kosfelder J, et al. Internet-based motivation program for women with eating disorders: eating disorder pathology and depressive mood predict dropout. J Med Internet Res. 2014;16:e92.CrossRefGoogle Scholar
  47. 47.
    Tregarthen J, Lock J, Darcy A: Development of a smartphone application for eating disorder self-monitoring. Int J Eat Disord 2015; in press.Google Scholar
  48. 48.
    Mitchell JE, Agras S, Crow S, Halmi K, Fairburn CG, Bryson S, et al. Stepped care and cognitive-behavioural therapy for bulimia nervosa: randomised trial. Br J Psychiatry. 2011;198:391–7.CrossRefPubMedPubMedCentralGoogle Scholar
  49. 49.
    McClay AC, Waters L, Schmidt U, Williams C. A survey of attitudes towards computerized self-help for eating disorders within a community-based sample. Behav Cogn Psychother. 2014;28:1–14.Google Scholar
  50. 50.
    van der Vaart R, Witting M, Riper H, Kooistra L, Bohlmeijer ET, van Gemert-Pijnen L. Blending online therapy into regular face-to-face therapy for depression: content, ratio and preconditions according to patients and therapists using a Delphi study. BMC Psychiatry. 2014;14:355.CrossRefPubMedPubMedCentralGoogle Scholar
  51. 51.
    Kenter RMF, van de Ven PM, Cuijpers P, Koole G, Niamat S, Gerrits RS, et al. Costs and effects of Internet cognitive behavioral treatment blended with face-to-face treatment: results from a naturalistic study. Internet Interv. 2015;2:77–83.CrossRefGoogle Scholar
  52. 52.
    American Psychiatric Association. Diagnostic and Statistical Manual of mental disorders, fourth edition (DSM-IV). Washington: American Psychiatric Association; 1994.Google Scholar
  53. 53.
    Keel PK, Crow S, Davis TL, Mitchell JE. Assessment of eating disorders: comparison of interview and questionnaire data from a long-term follow-up study of bulimia nervosa. J Psychosom Res. 2002;53:1043–7.CrossRefPubMedGoogle Scholar
  54. 54.
    Moessner M, Fassnacht D, Bauer S: Online assessment of eating disorders: The Clinical and Research Inventory for Eating Disorders (CR-EAT). Mental Health & Prevention 2015; In press.Google Scholar
  55. 55.
    ter Huurne ED, de Haan HA, ten Napel-Schutz MC, Postel MG, Menting J, van der Palen J, et al. Is the Eating Disorder Questionnaire-Online (EDQ-O) a valid diagnostic instrument for the DSM-IV-TR classification of eating disorders? Compr Psychiatry. 2015;57:167–76.CrossRefPubMedGoogle Scholar
  56. 56.
    Aardoom JJ, Dingemans AE, Boogaard LH, van Furth EF. Internet and patient empowerment in individuals with symptoms of an eating disorder: a cross-sectional investigation of a pro-recovery focused e-community. Eat Behav. 2014;15:350–6.CrossRefPubMedGoogle Scholar
  57. 57.
    de Zwaan M, Herpertz S, Zipfel S, Tuschen-Caffier B, Friederich HC, Schmidt F, et al. INTERBED: Internet-based guided self-help for overweight and obese patients with full or subsyndromal binge eating disorder. A multicenter randomized controlled trial. Trials. 2012;13:220.CrossRefPubMedPubMedCentralGoogle Scholar
  58. 58.
    Jenkins PE, Luck A, Burrows A, Boughton N. Comparison of face-to-face versus email guided self-help for binge eating: study protocol for a randomised controlled trial. Trials. 2014;15:181.CrossRefPubMedPubMedCentralGoogle Scholar
  59. 59.
    Bulik CM, Marcus MD, Zerwas S, Levine MD, Hofmeier S, Trace SE, et al. CBT4BN versus CBTF2F: comparison of online versus face-to-face treatment for bulimia nervosa. Contemp Clin Trials. 2012;33:1056–64.CrossRefPubMedPubMedCentralGoogle Scholar
  60. 60.
    Schafer JL, Graham JW. Missing data: our view of the state of the art. Psychol Methods. 2002;7:147–77.CrossRefPubMedGoogle Scholar
  61. 61.
    Blankers M, Koeter MWJ, Schippers GM. Missing data approaches in eHealth research: simulation study and a tutorial for nonmathematically inclined researchers. J Med Internet Res. 2010;12:e54.CrossRefPubMedPubMedCentralGoogle Scholar
  62. 62.
    Graham JW. Missing data analysis: making it work in the real world. Annu Rev Psychol. 2009;60:549–76.CrossRefPubMedGoogle Scholar
  63. 63.
    Aardoom JJ, Dingemans AE, Spinhoven P, Roijen LH, van Furth EF. An Internet-based intervention for eating disorders consisting of automated computer-tailored feedback with or without supplemented frequent or infrequent support from a coach: Study protocol for a randomized controlled trial. Trials. 2013;14:340.CrossRefPubMedPubMedCentralGoogle Scholar
  64. 64.
    Crow SJ, Agras WS, Halmi KA, Fairburn CG, Mitchell JE, Nyman JA. A cost effectiveness analysis of stepped care treatment for bulimia nervosa. Int J Eat Disord. 2013;46:302–7.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Jiska J. Aardoom
    • 1
  • Alexandra E. Dingemans
    • 1
  • Eric F. Van Furth
    • 1
    • 2
  1. 1.Rivierduinen Eating Disorders UrsulaLeidenThe Netherlands
  2. 2.Department of PsychiatryLeiden University Medical CenterLeidenThe Netherlands

Personalised recommendations