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Evaluation of an Internet-delivered support program for patients with bulimic symptomatology

Güleç, Hayriye

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Eating disorders are often characterized by multiple illness episodes and chronic courses. Despite well established and effective treatment options, a considerable number of patients fail to respond to these treatments or drop-out prematurely. Even after successful treatment, patients experience a high risk of relapse that is particularly pronounced in the first months following treatment termination. Maintenance of treatment gains and promotion of continued recovery is highly relevant to improve outcome and ultimately reduce the burden of illness. Interventions based on new technologies have the potential to extend the reach of treatment providers and to provide such maintenance support at reasonable cost and effort. Acknowledging the widespread use of communication technologies in today’s world and the increasing evidence to support the potential of e-health interventions in prevention, self-help, treatment and maintenance treatment of patients with eating disorders, the three studies presented in this dissertation were concerned with developing and evaluating an Internet-based support program as a step-down strategy for patients with bulimic symptomatology following discharge from treatment. Thus far, no study has addressed patients with BN and related EDNOS using the Internet at post-treatment. The program was developed within a European collaboration and followed an individually tailored intervention strategy which incorporated several modules of differing intensity. In the first study, the feasibility of the program was investigated among 22 participants who utilized the online program for four months. The results indicated the viability of an individually tailored intervention strategy in a heterogeneous sample with high satisfaction and acceptance ratings. In the second study, the efficacy of the intervention in maintaining and/or enhancing treatment gains was studied among 105 women who had received treatment for an eating disorder with bulimic symptomatology in routine care against a wait-list TAU control condition. It was hypothesized that intervention group participants would improve more compared to the control group participants at the end of the four-month intervention period on eating disorder related outcomes. In addition, the feasibility of the program was investigated within a larger sample. The program proved feasible and well-accepted. In tendency, participants of the aftercare intervention showed better results on all outcome measures, but the efficacy could not be demonstrated. Further research and larger trials are needed to determine the optimum intensity and duration of the intervention as well as patient characteristics associated with outcome. The third study was concerned with the text analyses of the moderated group chat sessions of the program to study relevant online themes of the chat interactions following treatment termination. In addition, the linguistic predictors of eating disorder related and general psychological well-being were investigated. The results indicate that using a higher ratio of words related to family of origin was significantly associated with improvements in eating disorder related attitudes, emotional distress, and a reduction in the frequency of binge eating episodes. This is the first study to show the importance of family level variables through sufferers’ own words after the end of treatment and may speak to the use of family-based treatment beyond treatment termination. In sum, the Internet-based intervention to address patients with bulimic symptomatology after discharge was feasible, well-accepted and associated with accelerated improvements on eating disorder related attitudes and general psychological well-being compared to a TAU condition although its efficacy could not be demonstrated in terms of statistical significance. A higher ratio of using family of origin words emerged as a linguistic predictor of improvement. Overall, the three studies discussed here add to the limited knowledge in the field of technology-enhanced interventions for eating disorders and may stimulate further research activities.

Item Type: Dissertation
Supervisor: Fiedler, Prof. Dr. Peter
Date of thesis defense: 2 June 2014
Date Deposited: 30 Jan 2015 10:01
Date: 2015
Faculties / Institutes: The Faculty of Behavioural and Cultural Studies > Institute of Psychology
Subjects: 150 Psychology
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