Internet-based treatments for eating disorders (ED) can improve treatment access and reduce frequency of binge eating and purging.
Advantages of Online ED Treatment
Even though binge eating disorder (BED) represents a severe mental health condition, which can be treated efficaciously, treatment-seeking behavior and the access to treatment are limited. One study lists the following essential barriers to treatment seeking of individuals suffering from BED:
personal feelings of shame or fear (e.g., worries about being judged, discriminated against, or stigmatized for their ED, as well as fear of change and therapy itself)
ED‐related perceptions and beliefs (e.g., the belief that EDs are not a real problem, are not serious, and can be handled personally)
lack of access and availability of treatment (e.g., financial considerations, lack of knowledge about available treatment or resources, and lack of convenient or available treatments)
aspects of treatment itself (e.g., lack of helpful and knowledgeable providers, overly stringent entry criteria, availability of resources other than professional treatment)
The difficult accessibility of treatments is especially prevalent for people living in remote or rural areas, or in areas with a low supply of psychiatrists per capita (psychiatrists per 100,000 individuals). A 2018 research report says that patients residing in an area with few psychiatrists per capita were less likely to receive follow-up care compared with patients residing in an area with more psychiatrists per capita.
In comparison, Internet-based treatments are advantageous since they are time- and location-independent, can be accessed anonymously, and thus might reduce feelings of shame and fear. They also require less implementation efforts and could be more cost-effective (less resources and infrastructure needed) than face-to-face interventions.
Efficacy of Online ED Treatment
A group of researchers analyzed 21 studies of Internet-based treatments for eating disorder, and concluded that Internet‐based treatments were superior to waiting lists in reducing ED psychopathology, frequency of binge eating and purging, and in improving (ED‐related) quality of life.
Researchers say that Internet‐based treatment is more effective for individuals with less comorbid psychopathology, binge eating as opposed to restrictive problems, and individuals with binge eating disorder as opposed to bulimia nervosa. In addition, the guidance of a therapist (e.g., via email) seems to increase the positive effects of Internet-based treatments.
Overall, these 21 studies suggest that internet‐based treatment is of limited value in reducing purging behaviors, is of value in reducing binge eating and is of particular value in reducing ED psycho pathology (e.g., maladaptive cognitions).
Additionally, Internet-based treatments appear to be highly acceptable to patients. Participants indicated that the treatments were useful and pleasant, and easy to use. Participants furthermore indicated that they liked the convenience and flexibility of the treatments and regarded the treatments as helpful in overcoming (some of their) problems.
It was noted that although flexibility is reported as a major advantage in Internet‐based treatment, it also requires a lot of self‐discipline and motivation, which some participants reported struggling with.
Regan, Pamela, et al. “Initial treatment seeking from professional health care providers for eating disorders: A review and synthesis of potential barriers to and facilitators of ‘first contact.’” Eating Disorder, vol. 50, no. 3, 2017, pp. 190-209.
Jones, Jenna M., et al. “Factors that Affect Choice of Mental Health Provider and Receipt of Outpatient Mental Health Treatment.” The Journal of Behavioral Health Services & Research, vol. 45, 2018, pp. 614–626.
Munsch, Simone, et al. “Binge-eating disorder treatment goes online – feasibility, usability, and treatment outcome of an Internet-based treatment for binge-eating disorder: study protocol for a three-arm randomized controlled trial including an immediate treatment, a waitlist, and a placebo control group.” Trials, vol. 20, 2019, p. 128.
Aardoom, Jiska J., et al. “Treating eating disorders over the internet: A systematic review and future research directions.” International Journal of Eating Disorders, vol. 46, no. 6, 2013, pp. 539-552.