Early results are mixed, but hopeful.
The world-wide Web has delivered information and education to homes and offices around the world. Two new Web-based programs in Germany and the United Kingdom have sought to improve follow-up by patients and to bring information and support to caregivers of and patients with anorexia nervosa (AN).
The MotivATE program
In the United Kingdom, up to a third of those referred for psychological treatment do not go beyond the initial diagnosis (Psychiatr Bull. 2018; 33:26). To study this further, a research team from Bournemouth University and the NHS Foundation Trust, Poole, UK, designed a fully automated, Web-based program, MotivATE, to increase treatment uptake.
The authors note many reasons a person might not follow an initial referral for treatment, including ambivalence about change, denial about the illness, perception of loss of control over life and choices, leading to a passive approach to treatment and recovery, and previous negative experiences in medical settings, among others. MotivATE was designed to address some of these patient barriers by using information, motivational tools, interactive activities, and life stories from others with eating disorders.
The design
Research was conducted using a two-arm, single-consent Zelen randomized controlled study. (A Zelen randomized consent design involves randomizing study participants prior to consent and then only collecting consent from those in the active condition.) All adult referrals to the Kimmeridge Court Eating Disorders service I Dorset UK, from October 24, 2016 to October 23, 2017 were identified for potential inclusion in the study. A total of 313 participants took part in the study; 156 (49.8%) were randomized to treatment as usual, and 157 (50.2%) were randomized to receive the additional offer to access the MotivATE program.
Results were mixed. Overall, uptake of assessments was low, and those who were randomized to MotivATE were not more likely to take the next step, going through with assessment. However, those who actually took the time to register online with MotivATE were about 9 times more likely to follow through. One possible interpretation is that such interventions could be helpful when used, but as currently used, people are not very likely to utilize them
An intervention designed to help caregivers
Caregivers of persons with AN can often be central to recovery, yet they often report high levels of distress, self-blame, and insufficient knowledge to help their loved ones. A group is currently recruiting caregivers for a Web-based program aimed at those who care for individuals with AN (Internet Interventions.2019; 16:76).
Dr. Lucy Spencer and colleagues at King’s College, London, and the London School of Economics, the Maudsley Foundation and the University of Dresden, Dresden, Germany, and the Institut fur Bometrie and Klinische Forschung, Munster, Germany, have designed a multi-site, two-country, three-country randomized controlled trial comparing three web-based programs. The programs are: (1) We Can (with clinician messaging support, (2) therapist-guided We Can-Ind (with moderated carer chatroom support), and (3) peer-guided We Can-Forum (online forum support only). The researchers are still recruiting participants.
In each of the three conditions, given over 12 weeks, carers will have access to 8 online modules, and a new module will be released one week after completion of the previous module. Carers also will have access to a moderated online forum, where they can communicate with other participants during and after the intervention.
The study will recruit 303 family members and friends who care for adult or teens over 16 years of age with AN. One family member will be eligible to participate. When possible, individuals with AN cared for by these caregivers will also be recruited into the study to assess whether participation in We Can is associated with changes in eating disorder symptoms, or with the experience of receiving care. The participants will complete a number of self-report questionnaires before the intervention begins, then at 4 weeks, 3 months, and 6 months, and 12 months after randomization. Primary outcome variables include carer symptoms of anxiety and depression; secondary outcome variables will be measured in both carers and patients, and include eating disorder symptoms and symptoms of alcohol and drug use and quality of life, caregiving behavior.
These studies demonstrate some of the variety of ways in which technology might assist in supporting eating disorders treatment.
