Issue 18 | Internet-Based Interventions, Training and Support
About this resource
Issue 18 | December 2013
Welcome to the December edition of the NEDC e-Bulletin.
With many services closing or decreasing availability at this time of year, we are highlighting some key online resources available to both people affected by eating disorders and professionals who provide services to those with an eating disorder.
We hope you enjoy this month's edition and if you would like to suggest topics or events to be featured in future editions of the e-bulletin, please contact us at email@example.com.
Feature Article: Internet-based interventions for eating disorders
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:
- 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)
- 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
- 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
- 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 counselling. 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
- 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:
- 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
- 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
- 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.
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.
Online Training for Eating Disorders Professionals
Within Australia there are many different opportunities for professionals to advance their knowledge and expertise in the field of eating disorders including opportunities for online training.
The InsideOut Institute for Eating Disorders offers an online learning program which addresses the nature, identification, assessment and treatment of eating disorders. This program was funded by and developed in collaboration with NSW Health and combines text based learning, videos, interactive elements and quizzes.
We spoke to Dr Sarah Maguire from InsideOut about the advantages of engaging in professional development using online platforms.
What do you think are the benefits of online training?
Online training is standardised learning and is guaranteed to meet learning objectives just as with traditional face-to-face delivery. However, in addition to this, online training provides ready access without inconvenience and the ability to self-pace learning. Online training is often also lower cost, or provides more for the cost, due to economies of scale and the decreased costs of delivery.
What do people need to consider when deciding whether to do professional development online?
They need to consider making some time and space available for the learning. Although, the learning can be more flexible because you’re doing it online it’s going to work much better if you set aside time and space to complete it.
You need to consider the technical requirements and make sure you’re working from the right device. Most online programs communicate technical requirements in advance, so you should have a look and make sure you meet them.
You also need to consider the cost of the program and its relationship to your CPD learning points. If the program is registered with the relevant professional bodies, that’s going to be very advantageous however you should also ensure that the cost of the program is reasonable and in line with the number of points it provides you.
What kind of supports are available for people completing courses online?
Our online course program has a helpline that you can email or call anytime with any problems and you will be responded to usually within 24 hours. Most programs have an avenue through which you can ask for assistance and people should make use of these systems if they need help.
I also think it’s important to ask around and make sure that the program you are purchasing is designed on a platform using software that you are going to be able to stream effectively over your device. Our program is on a platform that was designed by e-Learning professionals has a broad so there are very rarely any problems streaming the program. Other programs are designed by individuals on software that’s freely available so there is varying quality.
Online professional development opportunities can be found on the NEDC website.
To find out more about InsideOut’s online training visit their website.
Accessing online support
E-mental health involves the delivery of mental health services by phone and online applications that utilise technology to extend the reach of mental health service support. Services are able to deliver confidential, flexible, individually tailored mental health support that may not be achievable in the same time frame via other treatment modalities.
E-mental health services offer:
- less threatening or difficult modes of contact which can occur at a pace set by the consumer
- flexible access to services through preferred methods of contact
- Immediacy of access regardless of geographic location and proximity to traditional forms of support
- Access at low cost and in flexible, non-stigmatising ways
The internet is increasingly being recognised as an important and powerful complement to traditional phone based and face-to-face services. Evidence shows that access to information, counselling and online self-help programs plays an important role in suicide prevention, crisis advice and treatment of mental health issues.
Butterfly Foundation's ED Hope Service
Under its Teleweb (Telephone Counselling, Self Help and Web-based support) measure the federal Department of Health funds Butterfly Foundation’s National Support Line and Web Counselling Service, ED HOPE. The service provides free, confidential support for anyone with a question about eating disorders or negative body image, including sufferers, carers, family and friends, teachers, employers and more.
ED HOPE is open Monday to Friday 8am to 9pm AEST daylight savings adjusted (except national public holidays).
Phone: 1800 ED HOPE / 1800 33 4673
In addition to this federally funded service, several other organisations also provide online support.
Eating Disorders Victoria Recovery Chatroom, Eating Disorders Victoria
Eating Disorders Victoria (EDV) provides online support through The Eating Disorders Victoria Recovery Chatroom. The service provides an opportunity for people living with an eating disorder (16 years & over) to communicate with others and give and receive the mutual understanding and support that is vital to promote a full recovery. The Recovery Chatroom is moderated by trained volunteers who ensure it remains a safe and supportive environment. The Recovery Chatroom is intended as a means of support and communication; it does not provide any form of counselling and is not intended to be a substitute for professional/medical advice.
e-Therapy Program, Centre for Eating and Dieting Disorders
The Centre for Eating and Dieting Disorders (CEDD) in NSW is currently developing an eTherapy program for people with bulimia nervosa or binge eating disorder. This program is being developed by a team of expert clinicians working in collaboration with an eSimulation team at Macquarie University. It will provide evidence based treatment in an online environment.
The program is due to be released in December 2013. You can also find links from the program website to other self-help guides for those with an eating disorder.
NEDC Knowledge Hub
The NEDC website has been developed as a one stop portal to make eating disorders information accessible to everyone. The online Knowledge Hub is the only research clearinghouse that focuses exclusively on eating disorders research. It provides a central location for the latest, evidence based information relevant to the prevention, identification, early intervention and management of eating disorders and is updated regularly.
You can also find events, professional development and other evidence-based resources. If you are aware of a resource or event that could be added to the Knowledge Hub, please contact us.
Happy Holidays from the NEDC
We here at the NEDC would like to thank you all for your support in 2013. We hope you have a great holiday season and a excellent new year. We look forward to providing you with all of the latest evidence based research and information about eating disorders in 2014.
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