Breaking the silence of eating disorders with the hope of an online self-help programme
Sau Fong Leung
Lecturer, School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR
Lai Chong Ma
Professor, Department of Social Work, The Chinese University of Hong Kong, Hong Kong SAR
Janice Russell
Professor, Discipline of Psychiatry, The University of Sydney, Sydney, NSW
PP: 245 - 257
Abstract
Eating disorders are a serious debilitating health problem, causing impairments in physical and psychosocial functioning and significantly affecting sufferers' quality of life. New technologies are being developed to meet the diverse treatment needs of people with eating disorders. This qualitative study examined participants' views of an Internet-based self-help programme developed in the Asia-Pacific region for people with eating disorders. The aim of the study was to explore how the self-help programme facilitated individuals' recovery and identify the factors that contribute to the success in the programme.
A purposive sample of 12 people with anorexia nervosa (n=4), bulimia nervosa (n=2), binge eating disorder (n=1) and eating disorder not otherwise specified (n=5) participated in the study. The data were collected primarily by telephone interview. The programme was found to improve individuals' awareness of eating disorders, their motivation, eating disorder symptoms and health. Recovery was enhanced by individuals' determination and motivation to get better, the support available, their perseverance, sense of control, and personal confidence, and facilitating living environment.
Keywords
eating disorders; self-help; online self-help programme; recovery
Article Text
Eating disorders are a global health problem. Female adolescents and young women are most at risk of developing these conditions, characterised by significant disturbances in eating habits or weight-control behaviour resulting in a clinically significant impairment of physical or psychosocial functioning (Fairburn & Harrison, 2003). They are amongst the most serious psychiatric disorders (Klump et al., 2009) and can cause substantial morbidity and mortality. In a meta-analysis of research into the mortality of mental disorders in the 1990s, eating disorders were shown to have the highest risk of premature death from both natural and unnatural causes (Harris & Barraclough, 1998). Death from suicide and complications are common amongst individuals with anorexia nervosa (Millar et al., 2005; Sullivan, 1995). The major complications include cardiac arrhythmia, metabolic disturbance, electrolyte imbalance, hypoglycaemia, dehydration, and renal failure.
Eating disorders often become a chronic illness with a significant effect on individuals' quality of life. The severity and chronic nature of the illness exert negative effects on various life domains such as physical functioning, employment, finances, interpersonal relationships, and social and role functioning (Herzog et al., 1986; Mitchell et al., 1985). Sufferers of eating disorders report more impaired quality of life than those with other psychiatric disorders (e.g., alcohol abuse and somatoform disorder) and physical illnesses (e.g., angina and cystic fibrosis), even after recovery of symptoms (Jenkins et al., 2011; Spitzer et al., 1995).
The treatment of eating disorders is complex and expensive. Sufferers have little access to treatment (Hoek & van Hoeken, 2003), and the obstacles to treatment may be related to shame, guilt, denial, fear of stigmatisation, poor motivation to change, geographical isolation, inadequate health care resources, and unaffordable treatment. Shame and stigma can encourage individuals with eating disorders to avoid or postpone treatment (Becker et al., 2010). Poor motivation often leads to low volition to engage in treatment (Darcy et al., 2010). The geographical and financial constraints on individuals can impede their access to care (Becker et al., 2010; Cachelin et al., 2001). Internet-based intervention offers a valuable opportunity to enable wider access to healthcare services, improve sufferers' self-management and enhance health outcomes (Forkner-Dunn, 2003). This intervention approach may best suit the needs of individuals with eating disorders by reducing their resistance to treatment, improving their access to service at a low cost and engaging them in their own care.
Studies have examined the efficacy of Internet-based self-help approaches for the treatment of bulimia nervosa in several European countries, including Germany, Switzerland, Sweden and Spain (Carrard et al., 2011, 2006; Ljotsson et al., 2007; Liwowsky, Cebulla, & Fichter 2006; Nevonen et al., 2006). The findings of these studies indicate that Internet-based self-help programmes can improve the severity of symptoms, general psychopathology, depression, self-esteem, and general life satisfaction. Treated individuals show a significant reduction in dietary restraint, weight phobia, bingeing, self-induced vomiting, and excessive physical activity (Carrard et al., 2011; Ljotsson et al., 2007; Nevonen et al., 2006). The results of these studies on Internet-based self-help programmes are encouraging, and this innovative therapy approach could be expanded in the Asia-Pacific region for the treatment of eating disorders. Cognitive-behavioral therapy approach has been used in various Internet-based interventions conducted in European countries and many are found to be effective to improve symptoms of eating disorders such as binge eating and self-induced vomiting (Ljotsson et al., 2007; Nevonen et al., 2006). This approach could be more effective by incorporating with motivational enhancement and psycho-education into the study reported here on an Internet-based intervention in the Asia-Pacific region.
Aim of the study
This paper is drawn from a pilot study of an Internet-based self-help programme developed in the Asia-Pacific region by the first author using mixed research method. The aim of the study was to examine the feasibility and preliminary evidence on effectiveness of the programme and identify the factors that contribute to the success of self-help for eating disorders. This paper focuses on the qualitative part of the study and explores participants' views of how the programme facilitated their recovery from eating disorders.
The preliminary results of the quantitative part of the study, involving 280 participants, identified that a significant number of eating-disordered clients (n = 176, 62.9%) engaged in self-help as a result of participation in the programme. It was used by a small majority of participants (43.2%) who were not receiving treatment, and others (56.8%) used it as an adjunct to conventional treatment or usual care. Improvements were shown in participants' psychopathology of eating disorders, depression, anxiety, motivational stage of change, and perceived health status from baseline to 1- and 3-month follow-ups. The programme was shown to have potential benefits for individuals with eating disorders and seemed to be well accepted by a sizeable proportion of participants who continued to use it in the course of their illness.
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