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                  121984.pdf (publisher's version ) (Open Access)Although many people suffer from eating disorders, which have high mortality and severe morbidity, only a small number of affected people in the Netherlands are treated by mental health professionals. Eating disorders are often not recognized. Many patients do not ask for help because of shame, a lack of awareness, or denial of the disorder. Even when the disorder is recognized, it is difficult to motivate patients to seek help. As a result, many patients are in urgent need of help.1 p

Cor A. J. De Jong

Elke D. ter Huurne

Francine Cournos

Marloes G. Postel

Stephen M. Goldfinger

Huurne, E.D. ter

Postel, M.G.

Jong, C.A.J. de

Radboud Repository

Web-based intensive therapeutic contact for eating disorders

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Psychiatric Services

Web-Based Intensive Therapeutic Contact for Eating Disorders

Although many people suffer from eating disorders, which have high mortality and severe morbidity, only a small number of affected people in the Netherlands are treated by mental health professionals. Eating disorders are often not recognized. Many patients do not ask for help because of shame, a lack of awareness, or denial of the disorder. Even when the disorder is recognized, it is difficult to motivate patients to seek help. As a result, many patients are in urgent need of help

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ter Huurne, E.D.

Postel, Marloes Gerda

de Jong, Cor A.J.

University of Twente Research Information

FRONTL INE REPORTS Francine Cournos, M.D., and Stephen M. Goldfinger, M.D., EditorsThe Frontline Reports column fea-tures short descriptions of novelapproaches to mental health prob-lems or creative applications of es-tablished concepts. Material shouldbe 350 to 750 words long. Sendmaterial toFrancineCournos,M.D.,at the New York State PsychiatricInstitute (fc15@columbia.edu) orto Stephen M. Goldfinger, M.D.,at SUNY Downstate Medical Cen-ter (smgoldfingermd@aol.com).Web-Based IntensiveTherapeutic Contactfor Eating DisordersAlthough many people suffer fromeating disorders, which have highmortality and severe morbidity, onlya small number of affected people inthe Netherlands are treated by mentalhealth professionals. Eating disordersare often not recognized.Many patientsdo not ask for help because of shame,a lack of awareness, or denial of thedisorder. Even when the disorder isrecognized, it is difficult to motivatepatients to seek help. As a result, manypatients are in urgent need of help.To reach and treat more patientswith eating disorders, Tactus AddictionTreatment developed a Web-basedtreatment program that uses intensivetherapeutic contact. Such a programhas already been shown to be a suitablemedium for effective interventions forpatients with alcohol abuse, depression,and anxiety disorders. Various interven-tions for patients with eating disordersare available online, but they primarilyconsist of guided self-help interven-tions. For some patients this form oftreatment is effective, but intensivetreatmentwith the support of a therapistis frequently needed. Therefore, per-sonal support of a therapist is integratedas a main element in our Web-basedintervention. During the program,patients communicate with their per-sonal therapists twice a week. To keepthe threshold as low as possible, thecommunication occurs asynchronouslyand via the Internet. This means thatpatients can participate in their personalenvironment at any time they prefer.Patients may also request an in-personor telephone contact supplementary tothe online contacts. The therapist thenmakes an appointment to call the pa-tient, or the patient is invited to come tothe treatment location. Another uniquecharacteristic of the program is that it istargeted to patients with all types ofeating disorders. The information andall assignments are adjusted to theindividual patient.The Web-based intervention isbased on the principles of cognitive-behavioral therapy and motivationalinterviewing. In part 1, patients ana-lyze their eating attitudes and behav-iors. Part 2 focuses on behavioralchange. During the program, patientsreceive messages, assignments, exer-cises, and psychoeducation from theirtherapists. The program includes fourassignments and at least seven con-tacts in part 1 and six assignments andat least 14 contacts in part 2. Exam-ples of part 1 assignments are dailyregistering of eating behavior and re-lated thoughts and feelings, analyz-ing eating situations, and describingadvantages and disadvantages of thedisorder. Part 2 assignments includesetting goals in regard to eating, exer-cising, checking weight, and (if applica-ble) compensation behaviors, changingthoughts, changing behaviors, improv-ing self-image, and writing a relapseprevention plan. The average dura-tion of the program is 15 weeks. Aftercompleting the program, patients canparticipate in an aftercare programconsisting of six weekly sessions.In June 2009, our intervention wasfirst tested in a population of 28 pa-tients with eating disorders who wererecruited via the Web site of a Dutchpatient organization. The main aim ofthis pilot study was to evaluate pa-tients’ satisfaction and program feasi-bility. Initial effectiveness data werealso measured. In addition to the reg-ular online research questionnaires,the researcher interviewed each pa-tient by telephone. The results of thepilot study were positive and suggestedthat the program was an acceptableand feasible intervention for patientswith eating disorders. Several sugges-tions for improvement were receivedand implemented. Based on the pos-itive results, in January 2010 the pro-gram was made widely available via theInternet for all patients with eatingdisorders. To highlight the interven-tion and to recruit patients, a nation-wide press statement was released, andrelevant health care institutions wereinformed about the intervention.As a result, a total of 165 patientsstarted the Web-based intervention in2010. To evaluate the program, all pa-tients were asked to complete onlineself-report measures at baseline, post-treatment, and six-week and six-monthfollow-up. Results showed that theWeb-based intervention successfully changedeating disorder psychopathology, withmost of the improvements sustained atthe six-month follow-up. Physical andmental health also improved, and pa-tients were much more satisfied withtheir body image. The patients evaluatedthe support of the therapist as mostimportant, confirming our assumptionsat the start of program development. Toprove the efficacy of the program, westarted a randomized controlled trial inMarch 2011. We expect those results tobe available in January 2014.Because of the wide availability ofthe Internet, our successful interven-tion is accessible for all patients witheating disorders in the Netherlands.We think it can easily be transformedto a worldwide intervention by trans-lating the program to other languages.Elke D. ter Huurne, M.Sc.Marloes G. Postel, Ph.D.Cor A. J. De Jong, M.D., Ph.D.Ms. ter Huurne and Dr. Postel are affiliatedwith Tactus Addiction Treatment, Institut-enweg 1 7521 PH Enschede, the Nether-lands (e-mail: e.terhuurne@tactus.nl). Ms.ter Huurne is also with Nijmegen Institutefor Scientist Practitioners in Addiction,Nijmegen, the Netherlands, where Dr. DeJong is affiliated. Dr. Postel is also with theDepartment of Psychology Health and Tech-nology, University of Twente, Enschede, theNetherlands. Dr. De Jong is also with theBehavioural Science Institute, RadboudUniversity Nijmegen.PSYCHIATRIC SERVICES ' ps.psychiatryonline.org ' July 2013 Vol. 64 No. 7 711

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Web-based intensive therapeutic contact for eating disorders

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