Web-Based Intervention Found to Improve Eating Disorders

By John Henry Dreyfuss, MDalert.com staff.

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  • In a randomized, controlled trial, the Featback intervention was found to reduce rates of eating disorders among a Dutch population.
  • Web-based intervention also helped to reduce rates of eating-disorder comorbid psychopathologies.
  • Featback helped participants reduce rates of symptoms of anorexia nervosa, bulimia nervosa, and binge eating disorder in a statistically significant manner.
  • Therapist support did not further improve the efficacy of the Featback intervention but it did improve patient satisfaction.

A fully automated internet-based self-monitoring and feedback intervention, Featback, (Figure 1) was found to be statistically effective in reducing eating disorders and comorbid psychopathologies, according to a recent publication in the Journal of Internet Medical Research. According to the report, Featback comprises psychoeducation and a fully automated self-monitoring and feedback system.

 

Figure 1. The website of the Featback web-based intervention
for the treatment of eating disorders.
(Source: Featback.nl.)

While supplemental therapist support enhanced patient satisfaction with the intervention, it did not increase the effectiveness of the intervention. “Automated interventions such as Featback can provide widely disseminable and easily accessible care. Such interventions could be incorporated within a stepped-care approach in the treatment of eating disorders and help to bridge the gap between mental disorders and mental health care services,” the authors wrote.

“Interestingly, our results show a discrepancy between the added value of therapist support in terms of effectiveness (no added value of therapist support) and satisfaction with the intervention (added value of therapist support). The fact that therapist support did increase the satisfaction of participants significantly might well be due to the empathy, warmth, and attention of the therapists,” they added.

Eating disorders are disabling for many people and can lead to a number of other clinically significant medical phenomena (Figures 2 and 3). Still many patients with eating disorders do not receive appropriate care. This team from the Leiden University Medical Center in The Netherlands suggested that internet-based interventions have the potential to reduce these unmet needs by providing easily accessible healthcare services.

 

Figure 2. The erosion on the lower teeth was caused by bulimia.
For comparison, the upper teeth were restored with porcelain veneers.
(Sources: Wikipedia/By Jeffrey Dorfman/Creative Commons CC BY-SA 3.0.)

“Although we did provide a diagnostic impression of the study sample using the EDE-Q, it must be emphasized that the resulting classifications provide only an approximation of DSM-5 classifications as there are limitations to the use of the EDE-Q in evaluating the diagnostic criteria of ED,” the authors noted.

 

Figure 2. Russell's sign, named after British psychiatrist Gerald Russell,
is a sign defined as calluses on the knuckles or back of the hand
due to repeated self-induced vomiting over long periods of time.
(Sources: Wikipedia/By Kyukyusha - Own work.)
The Analysis

The team initiated this study in order to investigate the efficacy of an internet-based intervention to improve the symptoms of eating disorders. The randomized, controlled trial included 354 participants aged 16 years or older with self-reported eating disorder symptoms, including symptoms of anorexia nervosa, bulimia nervosa (Figure 4), and binge eating disorder.

Participants were recruited via the Featback website and the website of a Dutch pro-recovery–focused e-community for young women with eating disorders. They were then randomly assigned to receive either Featback; Featback supplemented with low-intensity (weekly) digital therapist support; Featback supplemented with high-intensity (3x/wk) digital therapist support; or a waiting-list control condition.

 

Figure 3. The effects of bulimia on the body.
(Sources Wikipedia/Office of Women's Health.)

Internet-administered self-report questionnaires were completed at baseline, post-intervention (ie, 8 weeks after baseline), and at 3- and 6-month follow-up. “The primary outcome measure was ED psychopathology. Secondary outcome measures were symptoms of depression and anxiety, perseverative thinking, and ED-related quality of life. Statistical analyses were conducted according to an intent-to-treat approach using linear mixed models,” the authors explained.

Results showed that participants assigned to the 3 Featback conditions achieved superior outcomes versus those assigned to a waiting list in reducing bulimic psychopathology (d=−0.16, 95% confidence interval [CI]=−0.31 to −0.01), symptoms of depression and anxiety (d=−0.28, 95% CI=−0.45 to −0.11), and perseverative thinking (d=−0.28, 95% CI=−0.45 to −0.11).

The researchers found no added value of therapist support with regard to symptom reduction. However, participants who received therapist support were significantly more satisfied with the intervention than those who did not receive it. “No significant differences between the Featback conditions supplemented with low- and high-intensity therapist support were found regarding the effectiveness and satisfaction with the intervention,” the researchers found.


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