Treatment Delivery Strategies for Eating Disorders

Paulo P.P. Machado; Tânia F. Rodrigues

Disclosures

Curr Opin Psychiatry. 2019;32(6):498-503. 

In This Article

Abstract and Introduction

Abstract

Purpose of review: The traditional model of treatment delivery, based on a psychotherapeutic intervention delivered by a trained professional, in a one-to-one relationship, occurring in a treatment setting context (e.g., clinic, private office, and hospital), highly restricts access to the best standards of care to all of those in need. In this article, we will be focusing on treatment delivering methods for eating disorders that depart from the traditional mode of delivery. We will focus on the use of self-help strategies, both in a pure self-help format, and with external minimal support, guided self-help. We will additionally review the evidence on the use of internet and mobile technology (m-Health) for delivering treatment.

Recent findings: Internet-based self-help interventions based on cognitive behavioral approaches have shown to be superior to no treatment for patients diagnosed with bulimia nervosa, binge eating disorder, and other specified feeding or eating disorders with binge/purge characteristics. Although face-to-face, traditional, interventions seem to be more effective than internet-based ones, the latter might have cost benefits and constitute a viable first line of treatment in a stepped care model, or as an alternative to a waitlist while treatment is not available. Other forms of mobile health (e.g., mobile apps) have experienced a surge but remain under researched.

Summary: Mobile health and the internet are promising media for delivering eating disorder treatment. However, more research is needed to determine the utility of internet-based treatments by comparing them to traditional face-to-face treatments for eating disorders, and explore the moderators and mediators impacting adherence and outcome.

Introduction

Traditional modes of psychosocial treatment delivery for eating disorders have been mainly based on a psychotherapeutic intervention delivered by a trained professional, in a one-to-one relationship, occurring in a treatment setting context (e.g., clinic, private office, and hospital). And, although considerable progress has been made in the treatment of eating disorders, namely cognitive behavioral treatment (CBT)[1] of bulimia nervosa (BN) and binge eating disorder (BED), there is still a discrepancy between the current knowledge in terms of efficacious treatments, and the usual clinical practice in community settings.[2] One of the current priorities of the field is to make empirically supported interventions (ESI) widely available to all those in need, bridging what have been described as the research-practice gap. However, although training professionals and disseminating ESI might increase the quality of care, it won't be enough to address the treatment gap and provide effective service for all of those in need.

Eating disorders are notorious for its 'hidden' quality, in that many cases remain undetected,[3] or that those in need fail to seek or get care,[4] creating another discrepancy, one between the number of those in need of treatment and the proportion of those actually getting it, or a treatment gap.[5] A recent review[6] on perceived barriers toward getting help for eating disorders concluded that the most salient perceived barriers to seeking treatment were: stigma and shame associated with eating disorders; denial or failure to perceive the severity of the disorder; practical barriers to treatment access (e.g., cost, transportation, and lack of time for treatment); low motivation for treatment; negative attitudes toward seeking treatment; and lack of knowledge about treatment resources.

In addition, Kazdin[7] has identified the traditional model of treatment delivery as one of the most important factors explaining this treatment gap. Alternatively, more recent models of treatment delivery are available, and can be used to deliver evidence-based interventions, and directly address the previously identified barriers to treatment, and its availability.

In this article, we will be focusing on treatment delivering methods for eating disorders that depart from the traditional mode of delivery. We will focus on the use of self-help strategies, both in a pure self-help format, and with external minimal support, guided self-help (GSH). We will additionally review the evidence on the use of internet and mobile technology (m-Health) for delivering treatment. This includes the use mobile devices such as smartphones and tablets that allow the use of mobile applications (apps) or accessing the internet mobile adapted sites. To identify recent developments, in the field, we searched for previous relevant systematic reviews and meta-analysis; studies published in the last 2 years; and recently registered trials.

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