Treatment Delivery Strategies for Eating Disorders

Paulo P.P. Machado; Tânia F. Rodrigues


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

In This Article


Alternate models of treatment delivery for eating disorders previously reported had the promise of addressing several issues and barriers to treatment that would limit the impact of currently available empirically supported interventions. Mobile-health approaches, either apps or internet delivery interventions, that can now be accessed through mobile devices, have the potential to overcome geographical, and personal barriers, reaching users that otherwise would not receive or would delay needed treatment. These approaches allow users to access interventions anonymously, rapidly and at their own pace, and virtually everywhere. Given the appeal of apps and the internet, it is possible that m-Health interventions are particularly appropriate to younger users, which correspond to an at-risk population for developing eating disorders. New technologies also allow the integration of more sophisticated tools for monitoring, and ecological momentary assessment, of key symptoms, behaviors, cognitions and mood, and allow for immediate or almost immediate feedback, either automated or therapist initiated, and two-way communication.

However, with probably the exception of previously tested guided self-help interventions that were adapted for m-Health formats, these new modes of treatment delivery remain largely under studied. The technology, both internet and mobile devices, evolves at a pace that has not been compatible with testing its use. Most of the times, when a specific program has been tested, the technology on which it has been based has become obsolete (e.g., use of SMS – short message system, or CD-ROM based self-help manuals).

Analyzing current research, it also remains unclear whether mobile apps add value to traditional delivery modes of treatment. However, given the important role of self-monitoring in most psychotherapeutic treatments of eating disorders, mobile apps that include self-monitoring and assessment modules might be clinically useful.

The review of current literature on m-Health shows that internet-based interventions can constitute a valid alternative to traditional guided self-help interventions, and constitute a viable first line of interventions in a stepped care model. A new multisite RCT[29] will be conducted in Germany and the UK with the purpose of analyzing the effects and feasibility of an Internet-based self-help intervention (everyBody Plus) specifically designed for patients with BN, BED and OSFED, on a waiting list for outpatient face-to-face treatment.

Although promising, newly available treatment delivery strategies raise important issues and concerns. Namely, it is not clear if these approaches are adequate for everybody; there are legal and ethical issues around data security; and how to handle emergencies and patient deterioration during m-Health platforms use. Current research lags clearly behind the proliferation and use of m-Health apps.