An Internet-Based Intervention for Eating Disorders & the Role of Different Levels of Therapist Support: A Randomized Controlled Trial
|
If you are the presenter of this abstract (or if you cite this abstract in a talk or on a poster), please show the QR code in your slide or poster (QR code contains this URL). |
Abstract
Background: Featback is an Internet-based intervention for eating disorder symptoms, providing an anonymous and easily accessible service. It exists of several components: psychoeducation, a fully automated monitoring and feedback system, and therapist support.
Objective: This paper presents the results of a randomized controlled trial, specifically: 1) the effectiveness of (the different components of) Featback, 2) predictors of intervention responses, 3) practical experiences with Featback.
Methods: Participants (N = 354) with mild to severe eating disorder symptoms were randomly assigned to one of the four conditions: 1) Basic Featback consisting of psycho education and a fully automated monitoring and feedback system, 2) Featback supplemented with low-intensity (weekly) therapist support via e-mail, chat or Skype 3) Featback supplemented with high-intensity (three times a week) therapist support via e-mail, chat or Skype, 4) a waiting list. Participants were assessed at baseline, post-intervention (8 weeks), and at 3- and 6-month follow-up (the latter except for participants in the waiting list condition). Lineair mixed model analyses were conducted to investigate the effectiveness of Featback.
Results: Participants in the Featback conditions supplemented with low- and high-intensity therapist support were more satisfied with their received intervention (mean grade of 7.1 and 7.4 respectively) than participants in the Basic Featback condition (mean grade 5.0). Overall, participants in all four conditions showed significant improvements over time with respect to eating disordered behaviors and attitudes, symptoms of anxiety and depression, perseverative thinking (i.e. worry and rumination), eating disorder-related quality of life and measures of self-esteem and mastery. Participants in the three Featback conditions showed larger improvements from baseline to post-intervention with respect to excessive exercising, dietary restraint and symptoms of depression and anxiety as compared to participants in the waiting list condition. Long-term follow-up results demonstrated significantly more improvements in eating disorder-related quality of life for participants who received Featback supplemented with high-intensity support as compared to participants who received low-intensity support. No differences over time were found between the four condition with respect to motivation to change, binge eating episodes, worry and rumination, self-esteem and mastery. Finally, predictor analyses revealed that participants with higher baseline perceived ability and readiness to change, less comorbid symptoms of anxiety and depression and lower levels of perseverative thinking showed better outcomes in terms of global eating disorder psychopathology.
Conclusions: Participants in all conditions showed significant improvements over time, although Featback was more effective in reducing several eating disordered behaviors and comorbid symptoms of depression and anxiety as compared to the waiting list condition. With the exception of eating disordered-related quality of life, preliminary results do not demonstrate significant differences in outcome measures between the different intervention conditions. This suggests that Featback without therapist support is just as effective as Featback with therapist support, despite the fact that participants were rather unsatisfied when having received the intervention without therapist support. Further analyses will need to provide more insight into potential moderators and mediators of intervention responses, as well as the cost-effectiveness of the different interventions.
Objective: This paper presents the results of a randomized controlled trial, specifically: 1) the effectiveness of (the different components of) Featback, 2) predictors of intervention responses, 3) practical experiences with Featback.
Methods: Participants (N = 354) with mild to severe eating disorder symptoms were randomly assigned to one of the four conditions: 1) Basic Featback consisting of psycho education and a fully automated monitoring and feedback system, 2) Featback supplemented with low-intensity (weekly) therapist support via e-mail, chat or Skype 3) Featback supplemented with high-intensity (three times a week) therapist support via e-mail, chat or Skype, 4) a waiting list. Participants were assessed at baseline, post-intervention (8 weeks), and at 3- and 6-month follow-up (the latter except for participants in the waiting list condition). Lineair mixed model analyses were conducted to investigate the effectiveness of Featback.
Results: Participants in the Featback conditions supplemented with low- and high-intensity therapist support were more satisfied with their received intervention (mean grade of 7.1 and 7.4 respectively) than participants in the Basic Featback condition (mean grade 5.0). Overall, participants in all four conditions showed significant improvements over time with respect to eating disordered behaviors and attitudes, symptoms of anxiety and depression, perseverative thinking (i.e. worry and rumination), eating disorder-related quality of life and measures of self-esteem and mastery. Participants in the three Featback conditions showed larger improvements from baseline to post-intervention with respect to excessive exercising, dietary restraint and symptoms of depression and anxiety as compared to participants in the waiting list condition. Long-term follow-up results demonstrated significantly more improvements in eating disorder-related quality of life for participants who received Featback supplemented with high-intensity support as compared to participants who received low-intensity support. No differences over time were found between the four condition with respect to motivation to change, binge eating episodes, worry and rumination, self-esteem and mastery. Finally, predictor analyses revealed that participants with higher baseline perceived ability and readiness to change, less comorbid symptoms of anxiety and depression and lower levels of perseverative thinking showed better outcomes in terms of global eating disorder psychopathology.
Conclusions: Participants in all conditions showed significant improvements over time, although Featback was more effective in reducing several eating disordered behaviors and comorbid symptoms of depression and anxiety as compared to the waiting list condition. With the exception of eating disordered-related quality of life, preliminary results do not demonstrate significant differences in outcome measures between the different intervention conditions. This suggests that Featback without therapist support is just as effective as Featback with therapist support, despite the fact that participants were rather unsatisfied when having received the intervention without therapist support. Further analyses will need to provide more insight into potential moderators and mediators of intervention responses, as well as the cost-effectiveness of the different interventions.
Medicine 2.0® is happy to support and promote other conferences and workshops in this area. Contact us to produce, disseminate and promote your conference or workshop under this label and in this event series. In addition, we are always looking for hosts of future World Congresses. Medicine 2.0® is a registered trademark of JMIR Publications Inc., the leading academic ehealth publisher.
This work is licensed under a Creative Commons Attribution 3.0 License.