Academic journal article Journal of Eating Disorders

Internet-Based Relapse Prevention for Anorexia Nervosa: Nine- Month Follow-Up

Academic journal article Journal of Eating Disorders

Internet-Based Relapse Prevention for Anorexia Nervosa: Nine- Month Follow-Up

Article excerpt

Author(s): Manfred Maximilian Fichter[sup.1,2], Norbert Quadflieg[sup.1] and Susanne Lindner[sup.1]


Anorexia nervosa (AN) is a serious mental disorder with very high rates for chronicity and mortality. In order to reduce chronicity and counteract mortality in AN patients, better and more effective treatments are needed. However, we also need more effective programs for maintaining an improved level of mental health that was achieved through face-to-face therapy; effective relapse prevention over longer periods of time following intensive treatment is truly essential for AN patients. Technological developments of communication media in the past years and decades have brought about new options for clinical research and practice. The development of guidelines for psychotherapy based on empirical results from RCTs (randomly controlled trials) and the development of detailed manuals for use in psychotherapy treatment studies has been very helpful for the next stage of using electronic media and the internet to convey relevant information and interventions to patients suffering from physical or mental disorders.

Internet-based programs can also reach patients or persons at risk who can only be reached with great difficulties by more traditional approaches [1]. There is hardly any limitation in the number of persons who can be reached by an internet-based program. Such programs, however, must not replace traditional service delivery; rather, they should complement and extend the options for medical and psychotherapeutic treatment in situations where there still is a great need [2].

There are a significant number of controlled internet-based studies for primary, secondary, and tertiary prevention for physical disorders, mostly delivering interventions for asthma [3], cardiological disorders [4], management of work-related stress [5], the promotion of physical activity to improve health in general [6], and diabetes mellitus [7]. Parallel to these internet-based developments concerning physical disorders, far more than a hundred randomized controlled studies utilize internet-based forms of psychotherapy in a wider sense. Moreover, there have been systematic reviews and meta-analyses concerning internet-based interventions for depression and anxiety disorders combined [8], psychological interventions in general [9], and for depression only [10]. Other controlled studies have dealt with internet-based psychotherapy for posttraumatic stress disorder [11], anxiety disorders [12] including panic disorder and various phobias, and depression [13]. Generally, results of RCTs employing internet-based forms of psychotherapy for physical as well as mental disorders have shown promising results concerning symptom reduction, number of medical consultations, number of sick days, and improvement of coping skills. Internet-based psychotherapeutic approaches can make creative use of a variety of technological options, for example of multiple colors, cartoons or moving animations, and auditory enhancements at crucial points in the process; they can be accompanied by (therapist-guided) internet chat groups, partially or fully automated e-mail and SMS-support [14, 15], and standardized telephone contacts to give feedback or encourage participants to use the program conscientiously. Bauer et al. [16], for example, describe successful therapist-guided internet chat groups for relapse prevention following inpatient treatment for mood, personality, and somatoform disorders.

For eating disorders, until recently the few existing studies on internet-based interventions have focused mainly on bulimia nervosa (BN) [15, 17-23] and binge eating disorder (BED) [24-27]. Meanwhile, research on internet therapy has expanded. One group addressed users' views and the relevance of individual parts of the program [28, 29], while another group compared online versus face-to-face delivery of cognitive behavioral therapy to BN patients [30]. …

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