NEW ORLEANS -- E-mail may be useful as an adjunctive treatment for some anorexia nervosa patients, Dr. Joel Yager said at the annual meeting of the American Psychiatric Association.
Consider adjunctive e-mail therapy for patients and families who want to avoid hospitalization, said Dr. Yager, professor of psychiatry at the University of New Mexico in Albuquerque.
Theoretically adjunctive e-mail therapy may be more suitable for the anorexic patient who is shy obedient, harm avoidant, and diligent and who values honesty. E-mail does not work, however, for the more chaotic anorexic patient who tends to "bleed all over the screen".
E-mail allows patients to say things that they would not say in person, and they tend to have less trouble talking about embarrassing issues via e-mail.
In Dr. Yager's practice, patients using adjunctive e-mail therapy are required to e-mail him regularly to report on specific eating-related behavior. Office visits occur weekly to every few months while e-mail contacts occur weekly to several times a week. All of the patients have shown good clinical improvement.
Dr. Yager exchanged e-mails with a 17-year-old patient, who was 5 feet 4 inches tall and weighed 88 pounds when he first saw her. She exercised excessively and refused hospital care. "When I mentioned [e-mail therapy], there was a twinkle in her eye and she suddenly looked at me as if I cared about her," he said.
Unlike during office visits, she was very friendly and informal in her e-mails, referring to Dr. Yager at times as "Dr. Yagermeister" or "Dr. Dude."
E-mail allows for flexibility and engagement for the patient, which is particularly important for adolescent patients.
She sent three to four e-mails weekly for about 18 weeks and spent approximately 15-20 minutes writing each message. "She started not only to tell me about her behavior, which was the initial purpose of the e-mail therapy, but also about her thoughts, feelings, and emotions on issues such as school, boys, and weight gain," he said.
A typical response e-mail should entail brief comments that include acknowledgment of the patient's struggles and words of encouragement. When something of concern, such as a disturbed, depressed, or suicidal mood, arises in an e-mail, get on the phone, Dr. Yager said.
Patients have responded favorably to the use of adjunctive email, he said. …