How Technology Is Treating Eating Disorders

Introduction

Eating disorders, such as anorexia nervosa and bulimia nervosa, can be some of the most difficult problems for medical practitioners to treat, since the available treatments are often expensive, not widely available, and not particularly effective. With the growing acceptance and ubiquity of technology, from mobile devices to virtual reality, there are a plethora of options available for monitoring and treating those with eating disorders. It is hoped that these technologies may hold the key to improving treatment of eating disorders, perhaps even leading to a cure for some of them. The technologies can be employed in a variety of ways to elicit the desired responses during treatment programs. In the future, these technologies may replace existing treatments entirely or be implemented into current care programs in an effort to make them more effective.

The Use of Mobile Devices

Most eating disorders can be traced back to adolescence, at a point where unhealthy weight control behaviors begin. These may include fasting, vomiting, or laxative abuse, all of which can commonly lead to obesity and eating disorders. In studies involving adolescents it was found that engaging in these behaviors increased the risk of binge eating with loss of control by six times, increased by three times the risk for being overweight, and increased by two to five times the risk for extreme weight control behaviors such as the use of diet pills and self-induced vomiting. In another study fasting was found to be the best predictor for the onset of binge eating and bulimia nervosa five years later. These studies indicate that catching and treating such behavior early on is a key to avoiding harmful behavior later.

As of 2011, smartphones had become the most commonly used cellular phone device and were expected to overtake PCs as the most common Web access device by 2013, while by the end of 2010 over 8,000 health related apps were available for users to download. This kind of ubiquity in society makes these devices perfect for integration into behavioral health programs. Apps available for Blackberry, iPhones, and Android platforms exist for clinical assessment, symptom monitoring, resource location, tracking treatment progress, and two-way communication between providers and other clinical resources. Currently, these apps and the devices can be used to record therapy sessions and track appointments, act as virtual coaches that instruct patients to practice therapeutic skills, or even for monitoring psychological variables.

There are some specific ways that these devices can be used for the treatment of eating disorders. One study followed the use of vodcasts, or video clips, as an effective treatment method. Most patients positively endorsed the vodcasts, noting that they increased awareness of knowledge and skills while being practical, calming, and soothing for the patient. The vodcasts were broken into groups that each offered some form of therapeutic strategy. There were "recovery stories" from former patients and "supporting eating" vodcasts that sought to instill hope and offer practical strategies that supported behavioral change. These were the vodcasts most used and endorsed by patients suffering from anorexia nervosa. The patients that were suffering from bulimia nervosa, on the other hand, found vodcasts that endorsed "precise planning" and "interpersonal relationships" to be the most helpful.

Regardless of the type of help that was deemed most useful, none of it could have reached the patient in time to offer any real assistance without the use of smartphones. The use of mobile technology allows the delivery of treatment in real-time to patients while they are in natural settings, promising management in a range of health behaviors. Particularly for eating disorders, which often carry a stigma that keeps many people from seeking help, the ability to access information and treatment in a comfortable non-judgmental setting is essential. Previous treatments for patients diagnosed with anorexia nervosa have found high medical risk of treatment and a high resistance to change in patients. A pilot study incorporating mobile technology found that it can be useful in preparing such patients for therapy, support compliance and prevent relapse.

The Use of Virtual Reality

Many times a distorted body image drives the behavior and influences the information processing that may be associated with eating disorders. Several studies have concluded that a thin ideal is internalized and contributes to body dissatisfaction, since the ideal is unattainable, thereby fostering dieting and negative effects that increase risk for eating disorders. Virtual reality devices may hold the key to breaking this destructive pattern of behavior.

Virtual reality has been used to induce the illusory perception of a fake limb or fake hand becoming part of the user's body. When implemented in this manner, a user believes that he or she is controlling an appendage that is an extension of their own bodies and, in this way, the user accepts the rearrangement of the sensory experience. By adapting an imaging rescripting method that was developed for the treatment of post-traumatic stress disorder, researchers developed a specific body-image rescripting protocol based on virtual reality and used it in an experimental cognitive therapy.

The virtual reality tools showed promise as a treatment for modifying the locked negative body image. The rescripting protocol based on virtual reality was able to achieve good results in the long term with both obese and binge-eating patients and it may be as good or better than other approaches involving nutritional and cognitive behavioral therapies. However, in order for the treatment to be effective, there should be a body image protocol that targets body dissatisfaction and the inclusion of a social support program that helps the patient cope with interpersonal stress. When applied in such a manner, virtual reality shows promise as an effective treatment method.

Other Technology Uses

There are several other area where technology can help improve patient outcomes for eating disorders. Technology administered psychotherapy has been performed via telephone, email, or videoconferencing. In several studies many of these methods were shown to have some efficacy. Researchers sent mass emails to potential patients and then engaged them in email treatment for three months, finding that they were able to reach roughly twenty percent of patients who were recruited out of a large group that may otherwise not seek treatment. Technology-delivered therapies that are combine with a high level of therapist interaction yield greater results than the least interactive email interventions.

Self-help and guided self-help offer two other forms of technology-aided therapy. Guided self-help has shown particular promise in the treatment of patients with eating disorders. The therapies can be administered with online sessions and weekly supportive emails. Participants in the studies reported satisfaction with the program and reduced eating disorder symptoms. 17% of patients in the study who suffered from bulimia nervosa reported being "abstainers," while 69% reported reduced binge behavior and 59% reported reduced purge behavior. One potential drawback to such programs remains the high dropout rate among participants, however.

Technology can also improve outcomes when used as an adjunct to care and for aftercare treatment. As an adjunct to treatment, technology can be used to provide reminders to avoid certain triggers for eating disorders and to send and receive text messages regarding binge and purge episodes. Many participants reported high satisfaction with these programs and showed decreases in both binging and purging episodes. Aftercare includes a forum for peer support, professional consultation during group, individual chat sessions, and symptom monitoring with feedback messages. Over 75% of participants rated the program as "good" or "excellent" and said it helped them cope with their problems more effectively.

Conclusion

Technology has the potential to help reach patients in ways that have never been possible before. Treatment for eating disorders has often been ineffective and difficult to initiate due to the stigma surrounding the conditions. Advances in technology make it far more likely that patients will enter care for their symptoms and receive effective treatment over the long term. The use of mobile technology enables healthcare professionals to maintain close contact throughout treatment and promising technologies like virtual reality offer ways to break through the negative body images that cause these disorders. As technology continues to progress it may offer even more exciting prospects for those who suffer with these disorders, including eventually offering a cure.

References

Cardi, V., Clarke, A., & Treasure, J. The use of guided self-help incorporating a mobile component in people with eating disorders: A pilot study. European Eating Disorders Review, 21(4), 315-322.

Luxton, D.D., McCann, R.A., Bush, N.E., Mishkind, M.C., & Reger, G.M. (2011). mHealth for mental health: Integrating smartphone technology in behavioral healthcare. Professional Psychology: Research and Practice, 42(6), 505-512.

Riva, G. The key to unlocking the virtual body: Virtual reality in the treatment of obesity and eating disorders. Journal of Diabetes Science and Technology, 5(2), 283-292.

Shingleton, R.M., Richards, L.K., & Thompson-Brenner, H. Using technology within the treatment of eating disorders: A clinical practice review. Psychotherapy, 50(4).