Web-Based Fully Automated Self-Help With Different Levels of Therapist Support for Individuals With Eating Disorder Symptoms: A Randomized Controlled Trial

• Published in: Journal of medical Internet research 2016-06, Vol.18 (6), p.e159-e159
• Main Authors: Aardoom, Jiska J, Dingemans, Alexandra E, Spinhoven, Philip, van Ginkel, Joost R, de Rooij, Mark, van Furth, Eric F
• Format: Article
• Language: English
• Subjects: Adult; Anorexia; Anxiety; Automation; Binge eating; Bulimia; Clinical trials; Community mental health services; Comorbidity; Confidence intervals; Eating disorders; Effectiveness; Feedback; Feeding and Eating Disorders - psychology; Feeding and Eating Disorders - therapy; Female; Health Behavior; Humans; Internet; Intervention; Male; Mental depression; Mental disorders; Mental health; Mental health care; Mental health services; Middle Aged; Original Paper; Psychoeducational treatment; Psychopathology; Quality of Life; Questionnaires; Recovery; Satisfaction; Self help; Self report; Self-Help Groups; Selfmonitoring; Surveys and Questionnaires; Symptoms; Telemedicine - methods; Therapists; Value; Websites; Young women
• ISSN: 1438-8871; 1439-4456; 1438-8871
• DOI: 10.2196/jmir.5709

Despite the disabling nature of eating disorders (EDs), many individuals with ED symptoms do not receive appropriate mental health care. Internet-based interventions have potential to reduce the unmet needs by providing easily accessible health care services. This study aimed to investigate the effectiveness of an Internet-based intervention for individuals with ED symptoms, called "Featback." In addition, the added value of different intensities of therapist support was investigated. Participants (N=354) were aged 16 years or older with self-reported ED symptoms, including symptoms of anorexia nervosa, bulimia nervosa, and binge eating disorder. Participants were recruited via the website of Featback and the website of a Dutch pro-recovery-focused e-community for young women with ED problems. Participants were randomized to: (1) Featback, consisting of psychoeducation and a fully automated self-monitoring and feedback system, (2) Featback supplemented with low-intensity (weekly) digital therapist support, (3) Featback supplemented with high-intensity (3 times a week) digital therapist support, and (4) a waiting list control condition. 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 3 Featback conditions were superior 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). No added value of therapist support was found in terms of symptom reduction although participants who received therapist support were significantly more satisfied with the intervention than those who did not receive supplemental therapist support. 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 fully automated Internet-based self-monitoring and feedback intervention Featback was effective in reducing ED and comorbid psychopathology. Supplemental therapist support enhanc