New self-help technology set to combat eating disorders

A new interactive multi-media self-help package for people diagnosed with eating disorders developed by a medical researcher at the University of Glasgow is now set to be delivered over the internet to adolescent sufferers.

The package, initially developed as a CD-ROM cognitive-behavioural self-help tool for the treatment of the eating disorder bulimia nervosa (BN), is set to revolutionise therapy. Bulimia nervosa is a common and disabling condition with significant personal, social and relationship costs.

University of Glasgow psychiatrist Dr Chris Williams and colleagues from the Institute of Psychiatry, London have now been awarded £191,000 from the Medical Research Council to launch an on-line version of the innovation, which is to be delivered to adolescents and young adults (aged 13 to 20) affected by bulimia nervosa.

Initial trials of the first stand-alone computerised treatment for eating disorder patients have been very successful and all patients involved in the pilot made significant improvements. The CD-ROM proved to be particularly effective in reducing vomiting and laxative abuse. This is important, as research has revealed that an early reduction in vomiting is a good predictor of positive longer-term outcomes in the treatment of bulimia.

Many patients with bulimia nervosa find it hard to access evidence based treatment such as cognitive-behavioural therapy (CBT). Although it is one of the preferred treatments for emotional and behavioural problems, CBT is labour intensive, and often not readily available.

Eating disorders are an increasing problem is Scotland, with about 10% of young women affected by such conditions. Given the rise in the number of sufferers and the under-provision of eating disorder services, a major challenge is to make treatment more accessible. Now, computer-based packages such as this are helping to bridge the treatment gap.

The shame and secretiveness surrounding bulimia makes computer-based treatment particularly appealing to sufferers. Other key advantages of the interactive intervention are that it allows an individually tailored delivery, it uses a variety of media, and a mixture of teaching styles to facilitate the learning of self-management.

A recent study into the usefulness of the CD-ROM involving 47 sufferers of bulimia revealed significant reductions in binging and self-induced vomiting. The pilot programme, run by the Eating Disorders Unit at South London and Maudsley NHS Trust lasted for 8 weeks and provided the treatment without any therapist input.

Modules include sessions on why people develop eating disorders, how to fight craving for food and how to break the vicious circle of Bulimia. Each session takes about 45 minutes at the computer and is backed up by additional support to put the learning into practice.

Dr Chris Williams from the University of Glasgow said: "Eating disorders becoming very widespread in society. Not enough people are able to get treatment, but computer based approaches can offer people new ways to access much needed help. The CD-ROM and internet packages aim to provide another treatment option for people -and our experience to date is that this can be as effective as seeing a specialist practitioner. Many people feel really ashamed of the symptoms of bulimia such as bingeing and vomiting or purging of food. Some may actually prefer to use a CD-ROM rather than see a practitioner as a result. The computer-guided self-help treatment program for Bulimia has real potential to be utilised in routine clinical practice - especially as a first step to care."

Only three short sessions of 20 minutes of clinician time is required to introduce the use of the CD-ROM, compared with a typical individual treatment time of 12 hours. The intervention has considerable potential for use in primary care and other settings as a first step in BN treatment.