Disorders - Eating Disorders
Buerger, A., Ernst, V., Wolter, V., Huss, M., Kaess, M., Hammerle, F.
Eating disorders are difficult to treat and often associated with morbidity and mortality. Universal prevention approaches are increasingly focusing on enhancing skills, but few eating disorder programs are available for under-15-year-olds. This study aimed to develop and examine a school-based universal prevention program ('MaiStep') for adolescent boys and girls. A three-arm randomized controlled trial with baseline, post-intervention and 12-month follow-up was conducted with 1654 adolescents (M = 13.35, SD 0.76). 'MaiStep' was delivered by psychologists in the first intervention group (IG1) and teachers in the second intervention group (IG2), and compared to an active control group (ACG). Primary outcomes were eating disorder-related risk factors measured with scales of the Eating Disorder Inventory-2 (e.g. 'drive for thinness', 'interoceptive awareness'), cognitions and affect related to the body (Body Shape Questionnaire, BSQ-8), and behaviors (Body Image Avoidance Questionnaire, BIAQ). The total sample (N1) was divided into a healthy subsample (N2) and a sample fulfilling DSM-5 criteria for a subthreshold eating disorder (N3) measured with the self-report Structured Inventory for Anorexic and Bulimic Syndromes (SIAB-S). Significant improvements in 'interoceptive awareness' (EDI-2) and lower BIAQ scores emerged in N1 at post-intervention and at 12-month follow-up (F(4; 3038) = 3.068, p =.016, etapart 2 = 0.004 and F(4; 2900) = 2.993, p =.018, etapart 2 = 0.004) and in N2 at post-intervention and at 12-month follow-up (F(4; 2812) = 3.147, p =.014, etapart 2 = 0.004 and F(4; 2684) = 3.674, p =.005, etapart 2 = 0.005). The healthy subsample N2 additionally showed significantly lower scores on 'drive for thinness' (EDI-2) and on the BSQ-8c at post-intervention (F(2; 1446) = 3.091, p =.046, etapart 2 = 0.004 and F(2; 1453) = 3.505, p =.030, etapart 2 = 0.005) but not at 12-month follow-up. No significant results emerged for N3. The positive findings of improved 'interoceptive awareness' (EDI-2) and reduced body image avoidance (BIAQ) indicate that broad disseminated universal prevention under the age of 15 is possible. Trial registration MaiStep is registered at the German Clinical Trials Register (DRKS00005050). Copyright © 2019 Elsevier Inc.
Preventive Medicine, 123 : 324-332
- Year: 2019
- Problem: Eating Disorders (any)
- Type: Randomised controlled trials
-
Stage: Universal prevention
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
, Other Psychological Interventions, Other service delivery and improvement interventions
Stice, E., Rohde, P., Shaw, H., Gau, J. M.
OBJECTIVE: This report evaluates a dissonance-based group eating disorder treatment designed to be a cost-effective front-line transdiagnostic treatment that could be more widely implemented than extant treatments that are more intensive and expensive relative to a supportive mindfulness group treatment typical of that offered at colleges.
METHOD: Young women with eating disorders (N = 84) were randomized to 8-week dissonance-based Body Project treatment (BPT) or supportive mindfulness treatment, completing diagnostic interviews and questionnaires at pretest, posttest, and 6-month follow up.
RESULTS: Regarding primary outcomes, by 6-month follow up 77% of BPT participants no longer met diagnosis for an eating disorder versus 60% of supportive mindfulness participants (relative risk ratio = 2.22; 95% CI [1.01, 4.93]), though groups did not differ on eating disorder symptom change. Regarding secondary outcomes, BPT versus supportive mindfulness participants showed significantly lower dissonance about affirming the thin ideal at posttest and 6-month follow up (d = .38 and .32), body dissatisfaction at posttest and 6-month follow up (d = .62 and .62), negative affect at posttest and 6-month follow up (d = .49 and .48), and functional impairment (d = .36) at 6-month follow up; differences in thin-ideal internalization and abstinence from binge eating and compensatory behaviors were not significant.
CONCLUSIONS: Whereas both treatments appeared effective, BPT produced larger effects and significantly greater remission of eating disorder diagnoses than a credible alternative treatment, which is very rare for trials that have compared active eating disorder treatments. Results suggest it would be useful to refine BPT and conduct target engagement research and efficacy trials. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
Journal of Consulting & Clinical Psychology, 87(1) : 79-90
- Year: 2019
- Problem: Eating Disorders (any)
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Supportive therapy, Mindfulness based therapy, Cognitive dissonance therapy
Stice, E., Marti, C. N., Shaw, H., Rohde, P.
Many trials have provided support for dissonance-based eating disorder prevention programs. This meta-analytic review characterized the average intervention effects and tested whether various intervention, participant, and facilitator features correlated with larger effects to guide implementation of optimally effective versions of this program. We identified 56 trials that evaluated 68 dissonance-based eating disorder prevention programs (7808 participants). Average intervention effect sizes (d) relative to minimal intervention control conditions and credible alternative interventions (respectively) were 0.57 and 0.31 for thin-ideal internalization, 0.42 and 0.18 for body dissatisfaction, 0.37 and 0.17 for dieting, 0.29 and 0.21 for negative affect, and 0.31 and 0.13 for eating disorder symptoms. As hypothesized, effects were larger for interventions with more dissonance-inducing activities, more group sessions, and larger group sizes, as well as when delivered in-person versus on-line, sessions were recorded, participation was voluntary, body dissatisfaction was required, participants were mid-adolescents or adults (versus older adolescence), there were more ethnic minority participants, groups were led by clinicians versus researchers and at least two facilitators, and when facilitators received more training and supervision. Unexpectedly from a dissonance-induction perspective, effects were larger when participants were compensated. Results offer directions for maximizing the benefits of implementation efforts with dissonance-based eating disorder prevention programs, and may hold lessons for preventing other public health problems with dissonance-based interventions. Copyright © 2019 Elsevier Ltd
Clinical Psychology Review, 70 : 91-107
- Year: 2019
- Problem: Eating Disorders (any)
- Type: Systematic reviews
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Stage: Universal prevention
, At risk (indicated or selected prevention)
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Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
, Cognitive dissonance therapy, Technology, comparing delivery mode (e.g. online vs. face-to-face)
Harrer, M., Adam, S. H., Baumeister, H., Cuijpers, P., Karyotaki, E., Auerbach, R. P., Kessler, R. C., Bruffaerts, R., Berking, M., Ebert, D. D.
OBJECTIVES: Mental health disorders are highly prevalent among university students. Universities could be an optimal setting to provide evidence-based care through the Internet. As part of the World Mental Health International College Student initiative, this systematic review and meta-analysis synthesizes data on the efficacy of Internet-based interventions for university students' mental health. METHOD(S): A systematic literature search of bibliographical databases (CENTRAL, MEDLINE, and PsycINFO) for randomized trials examining psychological interventions for the mental health (depression, anxiety, stress, sleep problems, and eating disorder symptoms), well-being, and functioning of university students was performed through April 30, 2018. RESULT(S): Forty-eight studies were included. Twenty-three studies (48%) were rated to have low risk of bias. Small intervention effects were found on depression (g = 0.18, 95% confidence interval [CI; 0.08, 0.27]), anxiety (g = 0.27, 95% CI [0.13, 0.40]), and stress (g = 0.20, 95% CI [0.02, 0.38]). Moderate effects were found on eating disorder symptoms (g = 0.52, 95% CI [0.22-0.83]) and role functioning (g = 0.41, 95% CI [0.26, 0.56]). Effects on well-being were non-significant (g = 0.15, 95% CI [-0.20, 0.50]). Heterogeneity was moderate to substantial in many analyses. After adjusting for publication bias, effects on anxiety were not significant anymore. DISCUSSION: Internet interventions for university students' mental health can have significant small-to-moderate effects on a range of conditions. However, more research is needed to determine student subsets for which Internet-based interventions are most effective and to explore ways to increase treatment effectiveness. Copyright © 2018 John Wiley & Sons, Ltd.
International journal of methods in psychiatric research, 28(2) : e1759
- Year: 2019
- Problem: Anxiety Disorders (any), Depressive Disorders, Eating Disorders (any)
- Type: Systematic reviews
-
Stage: Universal prevention
, At risk (indicated or selected prevention)
, Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Technology, interventions delivered using technology (e.g. online, SMS)
Hay, P. J., Touyz, S., Claudino, A. M., Lujic, S., Smith, C. A., Madden, S.
Background: Clinical guidelines recommend outpatient care for the majority of people with an eating disorder. The optimal use of inpatient treatment or combination of inpatient and partial hospital care is disputed and practice varies widely. Objective(s): To assess the effects of treatment setting (inpatient, partial hospitalisation, or outpatient) on the reduction of symptoms and increase in remission rates in people with: 1. Anorexia nervosa and atypical anorexia nervosa; 2. Bulimia nervosa and other eating disorders. Search Method(s): We searched Ovid MEDLINE (1950- ), Embase (1974- ), PsycINFO (1967- ) and the Cochrane Central Register of Controlled Trials (CENTRAL) to 2 July 2018. An earlier search of these databases was conducted via the Cochrane Common Mental Disorders Controlled Trial Register (CCMD-CTR) (all years to 20 November 2015). We also searched the WHO International Clinical Trials Registry Platform and ClinicalTrials.gov (6 July 2018). We ran a forward citation search on the Web of Science to identify additional reports citing any of the included studies, and screened reference lists of included studies and relevant reviews identified during our searches. Selection Criteria: We included randomised controlled trials that tested the efficacy of inpatient, outpatient, or partial hospital settings for treatment of eating disorder in adults, adolescents, and children, whose diagnoses were determined according to the DSM-5, or other internationally accepted diagnostic criteria. We excluded trials of treatment setting for medical or psychiatric complications or comorbidities (e.g. hypokalaemia, depression) of an eating disorder. Data Collection and Analysis: We followed standard Cochrane procedures to select studies, extract and analyse data, and interpret and present results. We extracted data according to the DSM-5 criteria. We used the Cochrane tool to assess risk of bias. We used the mean (MD) or standardised mean difference (SMD) for continuous data outcomes, and the risk ratio (RR) for binary outcomes. We included the 95% confidence interval (CI) with each result. We presented the quality of the evidence and estimate of effect for weight or body mass index (BMI) and acceptability (number who completed treatment), in a 'Summary of findings' table for the comparison for which we had sufficient data to conduct a meta-analysis. Main Result(s): We included five trials in our review. Four trials included a total of 511 participants with anorexia nervosa, and one trial had 55 participants with bulimia nervosa. Three trials are awaiting classification, and may be included in future versions of this review. We assessed a risk of bias from lack of blinding of participants and therapists in all trials, and unclear risk for allocation concealment and randomisation in one study. We had planned four comparisons, and had data for meta-analyses for one. For anorexia nervosa, there may be little or no difference between specialist inpatient care and active outpatient or combined brief hospital and outpatient care in weight gain at 12 months after the start of treatment (standardised mean difference (SMD) -0.22, 95% CI -0.49 to 0.05; 2 trials, 232 participants; low-quality evidence). People may be more likely to complete treatment when randomised to outpatient care settings, but this finding is very uncertain (risk ratio (RR) 0.75, 95% CI 0.64 to 0.88; 3 trials, 319 participants; very low-quality evidence). We downgraded the quality of the evidence for these outcomes because of risks of bias, small numbers of participants and events, and variable level of specialist expertise and intensity of treatment. We had no data, or data from only one trial for the primary outcomes for each of the other three comparisons. No trials measured weight or acceptance of treatment for anorexia nervosa, when comparing inpatient care provided by a specialist eating disorder service and health professionals and a waiting list, no active treatment, or treatment as usual. There was no clear difference in weight gain between settings, and only slightly more acceptance for the partial hospital setting over specialist inpatient care for weight restoration in anorexia nervosa. There was no clear difference in weight gain or acceptability of treatment between specialist inpatient care and partial hospital care for bulimia nervosa, and other binge eating disorders. Authors' conclusions: There was insufficient evidence to conclude whether any treatment setting was superior for treating people with moderately severe (or less) anorexia nervosa, or other eating disorders. More research is needed for all comparisons of inpatient care versus alternate care. Copyright © 2019 The Cochrane Collaboration.
Cochrane Database of Systematic Reviews, 2019 (1) (no pagination)(CD010827) :
- Year: 2019
- Problem: Eating Disorders (any)
- Type: Systematic reviews
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Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Other service delivery and improvement interventions
Lock, J., Sadeh-Sharvit, S., LInsalata, A.
Treatments for avoidant/restrictive food intake disorder (ARFID) lack strong empirical support. There is a critical need to conduct adequately powered studies to identify effective treatments for ARFID. As a first step, the primary aim of this study was to assess the feasibility of conducting a randomized clinical trial (RCT) comparing Family-based Treatment for ARFID (FBT-ARFID) to usual care (UC). The primary outcomes were recruitment, attrition, suitability, and expectancy rates. The secondary aim was to assess changes in percent estimated body weight, eating related psychopathology, and parental self-efficacy from baseline to end of treatment/UC period in both groups. Recruitment rates were 1.87 per month; 28 children with ARFID and their families were randomized and attrition rate was 21%. Therapeutic suitability and expectancy rating suggested that FBT-ARFID was acceptable to families. Effect size (ES) differences on measures of weight and clinical severity were moderate to large, favoring FBT-ARFID over UC. Parental self-efficacy improvement also demonstrated a large ES favoring FBT-ARFID, which was correlated with improvements in ARFID symptoms. There is a research gap between our knowledge base on how to treat children with ARFID and clinical need. The data presented suggest that an RCT comparing FBT-ARFID and UC is feasible to conduct. Copyright © 2019 Wiley Periodicals, Inc.
International Journal of Eating Disorders, 52(6) : 746-751
- Year: 2019
- Problem: Eating Disorders (any)
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Family therapy
Plessow, F., Singhal, V., Toth, A. T., Micali, N., Eddy, K. T., Misra, M.
Objective: Estrogen replacement prevents worsening body dissatisfaction with weight gain in adolescents with anorexia nervosa. However, the impact of estrogen administration on eating disorder (ED) pathology in normal-weight young women with exercise-induced amenorrhea is unknown. We hypothesized that (1) normal-weight oligo-amenorrheic athletes (OA) would show greater ED pathology than eumenorrheic athletes (EA) and non-athletes (NA), and (2) 12 months of estrogen replacement would improve those symptoms. Trial design: Randomized trial. Method(s): One hundred seventeen OA, 50 EA, and 41 NA completed the Eating Disorder Inventory-2 (EDI-2) for measures of Drive for Thinness (DT) and Body Dissatisfaction (BD) and the Three-Factor Eating Questionnaire-R18 (TFEQ-R18). OA were then randomized to receive 100 mcg transdermal 17beta-estradiol with cyclic progesterone (PATCH), an oral contraceptive pill (30 mcg ethinyl estradiol + 0.15 mg desogestrel) (PILL), or no estrogen (E-) for 12 months. Data are reported for the subset that completed questionnaires at 0 and 12 months between 11/2009 and 10/2016. Result(s): OA showed higher EDI-2 DT and TFEQ-R18 Cognitive Restraint scores than EA and NA and higher EDI-2 BD scores than EA. Over 12 months, the E+ group (PATCH+PILL), compared to E-, showed improved trajectories for EDI-2 DT and BD scores. In 3-group comparisons, PATCH outperformed E- for decreases in EDI-2 DT and BD, and the PILL for TFEQ-R18 Uncontrolled Eating. Conclusion(s): In OA, 12 months of estrogen replacement improves ED pathology trajectories, emphasizing the broad importance of normalizing estrogen levels. Clinical Trial Registration: ClinicalTrials.gov identifier: NCT00946192. Copyright © 2018 Elsevier Ltd
Psychoneuroendocrinology, 102 : 273-280
- Year: 2019
- Problem: Eating Disorders (any)
- Type: Randomised controlled trials
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Stage: At risk (indicated or selected prevention)
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Treatment and intervention: Biological Interventions (any)
, Other biological interventions
Sepulveda, A. R., Anastasiadou, D., Parks, M., Gutierrez, E.
The aim of this study was to test the hypothesis that a negative reaction to the illness would be reduced through the "Collaborative Care Skills Workshops" programme among Spanish caregivers of relatives with an eating disorder. Caregivers were randomly allocated to either the skill-based workshops (n = 32) or psycho-educational workshops (n = 31), and assessments were carried out over time (T0 vs. T1 vs. T2). There were no significant differences between interventions on primary or secondary caregiver outcomes or among the patients themselves. However, caregivers in both interventions showed greater improvement at T2 on accommodating and enabling behaviours and an improvement at T1 in terms of psychological distress and appraisals towards the caregiving experience. Eating pathology, psychological distress, and some indices of psychosocial adjustment were significantly lower among the patients following both interventions (T1). Overall, both interventions may be able to help caregivers and patients to decrease their psychological distress. Highlights: Involvement of family members in the treatment could be the best resource for aiding in their relative's recovery. This is the first controlled study to test the effectiveness of the Collaborative Care Skills Workshops in Spanish caregivers. Both interventions could be implemented as both help Spanish caregivers and patients. Copyright © 2018 John Wiley & Sons, Ltd and Eating Disorders Association.
European Eating Disorders Review, 27(3) : 247-262
- Year: 2019
- Problem: Eating Disorders (any)
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Psychoeducation, Skills training
Castillo, I., Solano, S., Sepulveda, A. R.
Obesity and eating disorders are currently two significant health problems in Mexico. The aim of this study was to examine the effects of an integrated prevention program on university students through an exploratory controlled study that targeted specific predisposing factors of disordered eating and obesity related to healthy eating, physical activity, body image satisfaction and perceived pressure to be thin. A total of 388 university students participated (264 females and 124 males) and were assigned either to an intervention condition or one of the two control conditions (study skills vs. nonintervention); each comprised of a total of eight workshops lasting 90 min. The program did not have any effect on the male students. In contrast, there was an interaction effect for time and group in thin-ideal internalization (eta2 = 0.04) and in disordered eating attitudes/behaviours (eta2 = 0.03); both showed improvements over time only among the female sample. Though, the effect size was insignificant, which means that the effectiveness of this integrated prevention program was limited. Integrated prevention approaches to eating and weight-related problems are still nascent in Mexico, and further research in this field is warranted so as to fine tune future prevention programs. Copyright © 2019 John Wiley & Sons, Ltd and Eating Disorders Association.
European Eating Disorders Review., :
- Year: 2019
- Problem: Eating Disorders (any)
- Type: Controlled clinical trials
-
Stage: Universal prevention
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Treatment and intervention: Psychological Interventions (any)
, Other Psychological Interventions, Cognitive dissonance therapy
Voelker, D. K., Petrie, T. A., Huang, Q., Chandran, A.
Female athletes are at risk for eating disorders due to the experience and internalization of pressures regarding various aspects of their bodies, including weight and appearance. Evaluating programs that address psychosocial antecedents and may reduce female athletes' risk is critical. We examined Bodies in Motion, a program based on cognitive dissonance and mindful self-compassion principles that integrates components of social media. Female athletes across nine NCAA athletic departments were assigned to Bodies in Motion (n = 57) or a wait-list control group (n = 40). Athletic department personnel were trained in the standardized program. Data were collected at three time-points - baseline, post-program, and three to four months later. Using Holm's algorithm to control for multiple comparisons, repeated measures ANOVAs showed that, after program completion, Bodies in Motion athletes reported less thin-ideal internalization, as compared to the control athletes, over time. We also observed varying group trajectories in outcome responses upon visual inspection of profile plots. These findings serve as the basis for future research suggestions involving larger sample sizes and prolonged measurement of outcomes. Copyright © 2019 Elsevier Ltd. All rights reserved.
Body image, 28 : 149-158
- Year: 2019
- Problem: Eating Disorders (any)
- Type: Controlled clinical trials
-
Stage: At risk (indicated or selected prevention)
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Treatment and intervention: Psychological Interventions (any)
, Mindfulness based therapy, Cognitive dissonance therapy
Summers, B. J., Cougle, J. R.
BACKGROUND: Previous research suggests that computerized interpretation bias modification (IBM) techniques may be useful for modifying thoughts and behaviours relevant to eating pathology; however, little is known about the utility of IBM for decreasing specific eating disorder (ED) symptoms (e.g. bulimia, drive for thinness). AIMS: The current study sought to further examine the utility of IBM for ED symptoms via secondary analyses of an examination of IBM for individuals with elevated body dysmorphic disorder (BDD) symptoms (see Summers and Cougle, 2016), as these disorders are both characterized by threat interpretation biases of ambiguous appearance-related information. METHOD(S): We recruited 41 participants for a randomized trial comparing four sessions of IBM aimed at modifying problematic social and appearance-related threat interpretation biases with a placebo control training (PC). RESULT(S): At 1-week post-treatment, and relative to the PC, the IBM group reported greater reductions in negative/threat interpretations of ambiguous information in favour of positive/benign biases. Furthermore, among individuals with high pre-treatment bulimia symptoms, IBM yielded greater reductions in bulimia symptoms compared with PC at post-treatment. No treatment effects were observed on drive for thinness symptoms. CONCLUSION(S): The current study suggests that cognitive interventions for individuals with primary BDD symptoms may improve co-occurring ED symptoms such as bulimia.
Behavioural and cognitive psychotherapy, 46(6) : 676-689
- Year: 2018
- Problem: Eating Disorders (any), Bulimia Nervosa
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
, Attention/cognitive bias modification
, Technology, interventions delivered using technology (e.g. online, SMS)
Vasileva, S., Mesana, L., Pruce, D., Syed, I. A.
Objectives: Eating disorders affect 2-4% of young adults. Technology in healthcare is changing treatment delivery. Previous meta-analysis of clinical trials have demonstrated promising, but inconclusive results of online and app-based interventions (e-therapies), urging improved methods in future trials. Uncertainty also exists about effectiveness in real-world settings. Objectives of this review are to identify and review recent comparative trials and real-world evidence (RWE) assessing efficacy/effectiveness of e-health technologies in preventing and treating eating disorder. Method(s): A previous systematic literature review (SLR) of e-therapies in eating disorder captured relevant trials published prior to July 2014. Additional searches were run on Medline, Embase and trial registries to identify trials since 2014 and all RWE from database inception until June 2018. Studies assessing efficacy/effectiveness of e-therapies versus other or no therapy were included. We also ran targeted searches to identify trials including therapist, which were excluded from previous SLR. Result(s): Eighteen additional trials were included but no RWE was identified. Internet-based interventions were the most commonly evaluated therapies but the search identified little evidence from single studies on smartphone applications, telemedicine, text messaging and video therapies. Most studies comparing internet-based therapies to waiting lists showed reduction in eating disorder symptoms and improvement on eating disorder scales. Majority of the studies comparing internet-based (mostly therapist-led interventions) or chat to face-to-face therapies reported similar efficacy. Limited evidence was identified comparing therapist-involved therapies (i.e., video therapies, text messaging, email therapies, telemedicine) and non-therapist involved smartphone applications with face-to-face or waiting lists. Conclusion(s): Similar to previous SLR, recent trials showed efficacy of internet-based interventions versus waitlist, but similar efficacy to face-to-face therapy. Potential cost-savings with internet-based interventions versus face-to-face therapies, given the similar efficacy, is yet to be determined. Further research is required to assess effectiveness of e-therapies in real-life settings in treating and preventing eating disorders. Copyright © 2018
Value in Health, 21 (Supplement 3) : S277
- Year: 2018
- Problem: Eating Disorders (any)
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
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Treatment and intervention: Service Delivery & Improvement, Technology, interventions delivered using technology (e.g. online, SMS), Technology, comparing delivery mode (e.g. online vs. face-to-face)