Skip to main content
Log in

Efficacy of technology-based eating disorder treatment: A meta-analysis

  • Published:
Current Psychology Aims and scope Submit manuscript

Abstract

Technology-based interventions have been shown to reduce maladaptive eating behaviors and associated risk factors. Though several reviews have examined the effectiveness of technology-based interventions for eating problems, this is the first meta-analysis focused solely on controlled trials that include participants with threshold eating disorders. Eleven eligible studies were identified. Significant effects favoring technology-based interventions over waitlist/minimal intervention control were found for global eating pathology, eating concern, objective binge episodes, dietary restraint, shape concern, weight concern, bulimia, drive for thinness, and interoceptive awareness. Limitations of the study include evidence of non-random variation in some pooled effect sizes and a lack of studies with anorexia nervosa patients. The results provide preliminary support for technology-based intervention as a promising strategy for the treatment of threshold eating disorders.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Notes

  1. Fernandez-Aranda et al. (2009) kindly provided additional effect size data upon request.

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. https://doi.org/10.1002/eat.22135.

    Article  Google Scholar 

  • American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.

    Google Scholar 

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

    Book  Google Scholar 

  • Barak, A., & Grohol, J. M. (2011). Current and future trends in internet-supported mental health interventions. Journal of Technology in Human Services, 29, 155–196.

    Article  Google Scholar 

  • Bauer, S., & Moessner, M. (2013). Harnessing the power of technology for the treatment and prevention of eating disorders. International Journal of Eating Disorders, 46, 508–515. https://doi.org/10.1002/eat.22109.

    Article  Google Scholar 

  • Berg, K. C., Peterson, C. B., Frazier, P., & Crow, S. J. (2012). Psychometric evaluation of the eating disorder examination and eating disorder examination-questionnaire: A systematic review of the literature. International Journal of Eating Disorders, 45(3), 428–438.

    Article  Google Scholar 

  • Borenstein, M., Higgins, J. P. T., Hedges, L. V., & Rothstein, H. R. (2017). Basics of meta-analysis: I2 is not an absolute measure of heterogeneity. Research Synthesis Methods, 8, 5–18. https://doi.org/10.1002/jrsm.1230.

    Article  PubMed  Google Scholar 

  • Borzekowski, D. L. G., Leith, J., Medoff, D. R., Potts, W., Dixon, L. B., Balis, T., et al. (2009). Use of the internet and other Media for Health Information among Clinic Outpatients with Serious Mental Illness. Psychiatric Services, 60, 1265–1268. https://doi.org/10.1176/ps.2009.60.9.1265.

    Article  PubMed  Google Scholar 

  • Cachelin, F. M., & Striegel-Moore, R. H. (2006). Help seeking and barriers to treatment in a community sample of Mexican American and European American women with eating disorders. International Journal of Eating Disorders, 39, 154–161.

    Article  Google Scholar 

  • Carlbring, P., Andersson, G., Cuijpers, P., Riper, H., & Hedman-Lagerlöf, E. (2018). Internet-based vs. face-to-face cognitive behavior therapy for psychiatric and somatic disorders: An updated systematic review and meta-analysis. Cognitive Behaviour Therapy, 47(1), 1–18. https://doi.org/10.1080/16506073.2017.1401115.

    Article  PubMed  Google Scholar 

  • Carrard, I., Crépin, C., Rouget, P., Lam, T., der Linden Martial, V., & Golay, A. (2011a). Acceptance and efficacy of a guided internet self-help treatment program for obese patients with binge eating disorder. Clinical Practice and Epidemiology in Mental Health: CP & EMH, 7, 8–18.

    Article  Google Scholar 

  • Carrard, I., Crépin, C., Rouget, P., Lam, T., Golay, A., & Van der Linden, M. (2011b). Randomised controlled trial of a guided self-help treatment on the internet for binge eating disorder. Behaviour Research and Therapy, 49, 482–491. https://doi.org/10.1016/j.brat.2011.05.004.

    Article  PubMed  Google Scholar 

  • Cohen, J. (1988). The effect size index: d. In Statistical Power Analysis for the behavioral sciences (2nd ed, pp. 20–26). New Jersey: Lawrence Erlbaum Associates.

  • Cooper, Z., & Fairburn, C. (1987). The eating disorder examination: A semi-structured interview for the assessment of the specific psychopathology of eating disorders. International Journal of Eating Disorders, 6, 1–8.

    Article  Google Scholar 

  • Donker, T., Blankers, M., Hedman, E., Ljótsson, B., Petrie, K., & Christensen, H. (2015). Economic evaluations of internet interventions for mental health: A systematic review. Psychological Medicine, 45(16), 3357–3376. https://doi.org/10.1017/S0033291715001427.

    Article  PubMed  Google Scholar 

  • Duval, S., & Tweedie, R. (2000). Trim and fill: A simple funnel-plot–based method of testing and adjusting for publication Bias in meta-analysis. Biometrics, 56, 455–463. https://doi.org/10.1111/j.0006-341X.2000.00455.x.

    Article  PubMed  Google Scholar 

  • Egger, M., Smith, G. D., Schneider, M., & Minder, C. (1997). Bias in meta-analysis detected by a simple, graphical test. Bmj, 315(7109), 629–634.

    Article  Google Scholar 

  • Eichhorn, K. C. (2008). Soliciting and providing social support over the internet: An investigation of online eating disorder support groups. Journal of Computer-Mediated Communication, 14, 67–78. https://doi.org/10.1111/j.1083-6101.2008.01431.x.

    Article  Google Scholar 

  • Eisenberg, D., Nicklett, E. J., Roeder, K., & Kirz, N. E. (2011). Eating disorder symptoms among college students: Prevalence, persistence, correlates, and treatment-seeking. Journal of American College Health, 59, 700–707. https://doi.org/10.1080/07448481.2010.546461

  • Fairburn, C. G., & Beglin, S. J. (1994). Assessment of eating disorders: Interview or self-report questionnaire? International Journal of Eating Disorders, 16, 363–370.

    Article  Google Scholar 

  • Fernandez-Aranda, F., Nunez, A., Martinez, C., Krug, I., Cappozzo, M., Carrard, I., … Lam, T. (2009). Internet-based cognitive-behavioral therapy for bulimia nervosa: A controlled study. Cyberpsychology & Behavior : The Impact of the Internet, Multimedia and Virtual Reality on Behavior and Society, 12(1). https://doi.org/10.1089/cpb.2008.0123

  • Fichter, M. M., Quadflieg, N., Nisslmüller, K., Lindner, S., Osen, B., Huber, T., & Wünsch-Leiteritz, W. (2012). Does internet-based prevention reduce the risk of relapse for anorexia nervosa? Behaviour Research and Therapy, 50, 180–190. https://doi.org/10.1016/j.brat.2011.12.003.

    Article  PubMed  Google Scholar 

  • Fox, S., & Duggan, M. (2013). Health Online 2013. Retrieved from http://pewinternet.org/~/media//Files/Reports/PIP_HealthOnline.pdf. Accessed 21 Oct 2018

  • Garner, D. M., Olmstead, M. P., & Polivy, J. (1983). Development and validation of a multidimensional eating disorder inventory for anorexia nervosa and bulimia. International Journal of Eating Disorders, 2, 15–34.

    Article  Google Scholar 

  • Green, M., Kroska, A., Herrick, A., Bryant, B., Sage, E., Miles, L., et al. (2018). A preliminary trial of an online dissonance-based eating disorder intervention. Eating Behaviors, 31, 88–98.

    Article  Google Scholar 

  • Hedges, L. V. (1981). Distribution theory for Glass’s estimator of effect size and related estimators. Journal of Educational Statistics, 6, 107–128. https://doi.org/10.3102/10769986006002107.

    Article  Google Scholar 

  • Higgins, J., & Green, S. (2011). Cochrane handbook for systematic reviews of interventions. The Cochrane collaboration. Retrieved from www.handbook.cochrane.org.

  • Higgins, J., Thompson, S. G., Deeks, J. J., & Altman, D. G. (2003). Measuring inconsistency in meta-analyses. BMJ, 327, 557–560.

    Article  Google Scholar 

  • Hutton, H. E., Wilson, L. M., Apelberg, B. J., Avila Tang, E., Odelola, O., Bass, E. B., & Chander, G. (2011). A systematic review of randomized controlled trials: Web-based interventions for smoking cessation among adolescents, college students, and adults. Nicotine & Tobacco Research, 13(4), 227–238.

    Article  Google Scholar 

  • Kass, A. E., Trockel, M., Safer, D. L., Sinton, M. M., Cunning, D., Rizk, M. T., et al. (2014). Internet-based preventive intervention for reducing eating disorder risk: A randomized controlled trial comparing guided with unguided self-help. Behaviour Research and Therapy, 63, 90–98. https://doi.org/10.1016/j.brat.2014.09.010.

    Article  PubMed  PubMed Central  Google Scholar 

  • Khalsa, S. S., Portnoff, L. C., McCurdy-McKinnon, D., & Feusner, J. D. (2017). What happens after treatment? A systematic review of relapse, remission, and recovery in anorexia nervosa. Journal of Eating Disorders, 5. https://doi.org/10.1186/s40337-017-0145-3.

  • Loucas, C. E., Fairburn, C. G., Whittington, C., Pennant, M. E., Stockton, S., & Kendall, T. (2014). E-therapy in the treatment and prevention of eating disorders: A systematic review and meta-analysis. Behaviour Research and Therapy, 63, 122–131.

  • Ljotsson, B., Lundin, C., Mitsell, K., Carlbring, P., Ramklint, M., & Ghaderi, A. (2007). Remote treatment of bulimia nervosa and binge eating disorder: A randomized trial of internet-assisted cognitive behavioural therapy. Behaviour Research and Therapy, 45, 649–661. https://doi.org/10.1016/j.brat.2006.06.010.

    Article  PubMed  Google Scholar 

  • Melioli, T., Bauer, S., Franko, D. L., Moessner, M., Ozer, F., Chabrol, H., & Rodgers, R. F. (2016). Reducing eating disorder symptoms and risk factors using the internet: A meta-analytic review. International Journal of Eating Disorders, 49, 19–31. https://doi.org/10.1002/eat.22477.

    Article  Google Scholar 

  • Mitchell, J. E., & Crow, S. (2006). Medical complications of anorexia nervosa and bulimia nervosa. Current Opinion in Psychiatry, 19, 438–443.

    Article  Google Scholar 

  • Mitchell, J. E., Crosby, R. D., Wonderlich, S. A., Crow, S., Lancaster, K., Simonich, H., et al. (2008). A randomized trial comparing the efficacy of cognitive–behavioral therapy for bulimia nervosa delivered via telemedicine versus face-to-face. Behaviour Research and Therapy, 46, 581–592. https://doi.org/10.1016/j.brat.2008.02.004.

    Article  PubMed  PubMed Central  Google Scholar 

  • Mohr, D. C., Burns, M. N., Schueller, S. M., Clarke, G., & Klinkman, M. (2013). Behavioral intervention technologies: Evidence review and recommendations for future research in mental health. General Hospital Psychiatry, 35, 332–338.

    Article  Google Scholar 

  • Murphy, R., Straebler, S., Cooper, Z., & Fairburn, C. G. (2010). Cognitive behavioral therapy for eating disorders. The Psychiatric Clinics of North America, 33, 611–627. https://doi.org/10.1016/j.psc.2010.04.004

  • National Collaborating Centre for Mental Health (UK). (2004). Eating Disorders: Core Interventions in the Treatment and Management of Anorexia Nervosa, Bulimia Nervosa and Related Eating Disorders. Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK49304/

  • Perkins, S., Murphy, R., Schmidt, U., & Williams, C. (2006). Self-help and guided self-help for eating disorders. Cochrane Database of Systematic Reviews, (3). Retrieved from (Green et al., 2018; Wagner et al., 2016; Weineland Strandskov et al., 2017).

  • Pew Research Center (2018). Internet/Broadband Fact Sheet. Retrieved from http://www.pewinternet.org/fact-sheet/internet-broadband. Accessed 21 Oct 2018

  • Portnoy, D. B., Scott-Sheldon, L. A. J., Johnson, B. T., & Carey, M. P. (2008). Computer-delivered interventions for health promotion and behavioral risk reduction: A meta-analysis of 75 randomized controlled trials, 1988–2007. Preventive Medicine, 47, 3–16. https://doi.org/10.1016/j.ypmed.2008.02.014.

  • R Core Team, R. C. (2013). R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. Retrieved from http://www.R-project.org.

  • Riley, R. D., Higgins, J. P. T., & Deeks, J. J. (2011). Interpretation of random effects meta-analyses. BMJ, 342, d549. https://doi.org/10.1136/bmj.d549.

    Article  PubMed  Google Scholar 

  • Rogers, M. A., Lemmen, K., Kramer, R., Mann, J., & Chopra, V. (2017). Internet-delivered health interventions that work: Systematic review of meta-analyses and evaluation of website availability. Journal of Medical Internet Research, 19(3), e90. https://doi.org/10.2196/jmir.7111.

    Article  PubMed  PubMed Central  Google Scholar 

  • Sanchez-Ortiz, V. C., Munro, C., Stahl, D., House, J., Startup, H., Treasure, J., et al. (2011). A randomized controlled trial of internet-based cognitive-behavioural therapy for bulimia nervosa or related disorders in a student population. Psychological Medicine, 41, 407–417. https://doi.org/10.1017/S0033291710000711.

    Article  PubMed  Google Scholar 

  • Schlegl, S., Bürger, C., Schmidt, L., Herbst, N., & Voderholzer, U. (2015). The potential of technology-based psychological interventions for anorexia and bulimia nervosa: A systematic review and recommendations for future research. Journal of Medical Internet Research, 17, e85. https://doi.org/10.2196/jmir.3554.

    Article  PubMed  PubMed Central  Google Scholar 

  • Schmidt, U., Andiappan, M., Grover, M., Robinson, S., Perkins, S., Dugmore, O., et al. (2008). Randomised controlled trial of CD-ROM-based cognitive-behavioural self-care for bulimia nervosa. The British Journal of Psychiatry, 193, 493–500. https://doi.org/10.1192/bjp.bp.107.046607.

    Article  PubMed  Google Scholar 

  • Schoemaker, C., van Strien, T., & van der Staak, C. (1994). Validation of the eating disorders inventory in a nonclinical population using transformed and untransformed responses. International Journal of Eating Disorders, 15, 387–393.

    Article  Google Scholar 

  • Swanson, S. A., Crow, S. J., Le Grange, D., Swendsen, J., & Merikangas, K. R. (2011). Prevalence and correlates of eating disorders in adolescents: Results from the national comorbidity survey replication adolescent supplement. Archives of General Psychiatry, 68, 714–723.

    Article  Google Scholar 

  • ter Huurne, E. D., de Haan, H. A., Postel, M. G., van der Palen, J., VanDerNagel, J. E., & DeJong, C. A. (2015). Web-based cognitive behavioral therapy for female patients with eating disorders: Randomized controlled trial. Journal of Medical Internet Research, 17.

  • United States Census Bureau. (2014). Computer and Internet Acess in the United States: 2012. Retrieved from https://www.census.gov/data/tables/2012/demo/computer-internet/computer-use-2012.html. Accessed 15 Mar 2019

  • Viechtbauer, W. (2010). Conducting meta-analyses in R with the metafor package. Journal of Statistical Software, 36, 1–48.

    Article  Google Scholar 

  • Wagner, G., Penelo, E., Wanner, C., Gwinner, P., Trofaier, M.-L., Imgart, H., et al. (2013). Internet-delivered cognitive–behavioural therapy v. conventional guided self-help for bulimia nervosa: Long-term evaluation of a randomised controlled trial. The British Journal of Psychiatry, 202, 135–141. https://doi.org/10.1192/bjp.bp.111.098582.

    Article  PubMed  Google Scholar 

  • Wagner, B., Nagl, M., Dölemeyer, R., Klinitzke, G., Steinig, J., Hilbert, A., & Kersting, A. (2016). Randomized controlled trial of an internet-based cognitive-behavioral treatment program for binge-eating disorder. Behavior Therapy, 47, 500–514.

    Article  Google Scholar 

  • Wear, R. W., & Pratz, O. (1987). Test-retest reliability for the eating disorder inventory. International Journal of Eating Disorders, 6, 767–769.

    Article  Google Scholar 

  • Weineland Strandskov, S., Ghaderi, A., Andersson, H., Parmskog, N., Hjort, E., Wärn, A. S., et al. (2017). Effects of tailored and ACT-influenced internet-based CBT for eating disorders and the relation between knowledge acquisition and outcome: A randomized controlled trial. Behavior Therapy, 48, 624–637.

    Article  Google Scholar 

  • Zhao, Y., & Encinosa, W. (2011). An Update on Hospitalizations for Eating Disorders, 1999 to 2009. HCUP statistical brief #120. Agency for Healthcare Research and Quality. Retrieved from https://hcup-us.ahrq.gov/reports/statbriefs/sb120.jsp. Accessed 22 Oct 2018

  • Zickhur, K., & Smith, A. (2012). The power of mobile. Washington DC: Pew Internet & American Life Project. Retrieved from http://pewinternet.org/~/media//Files/Reports/2012/PIP_Digital_differences_041312.pdf. Accessed 21 Oct 2018

Download references

Acknowledgments

This material is the result of work supported with resources and use of the facilities at the VA Greater Los Angeles Healthcare System.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Taona Patricia Haderlein.

Ethics declarations

Disclaimer

The views expressed in this article are those of the author and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States Government.

Conflict of Interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Human or Animals Participants

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

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Haderlein, T.P. Efficacy of technology-based eating disorder treatment: A meta-analysis. Curr Psychol 41, 174–184 (2022). https://doi.org/10.1007/s12144-019-00448-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12144-019-00448-x

Keywords

Navigation