How investment in e-therapy could improve access to eating disorder treatment

1 Jun, 2021

In the lead up to World Eating Disorders Action Day, InsideOut Institute and University of Sydney PhD researcher Sarah Barakat explains the need for equity in access to treatment and what she’s learned from our Binge Eating e-Therapy Program (BEeT).

The focus for World Eating Disorders Action Day 2020 is “Equity for Eating Disorders”. It emphasises the need to ensure eating disorders are receiving equitable attention, research and program funding, that eating disorders affect a diverse global population and there is equity in access to treatment and recovery.

The total number of people with an eating disorder globally is estimated to be 55.5 million, according to a recent study published by The Lancet Psychiatry.

That number, sadly, is expected to increase over the next decade and with it, the need for services.

However, currently only about one in five individuals with an eating disorder are accessing treatment or evidence-based care. Around 60% of clinicians are experiencing difficulty referring clients for treatment.

The reasons for this are varied.

Approximately one in five individuals with an eating disorder are accessing treatment or evidence-based care. Around 60% of clinicians are experiencing difficulty referring clients for treatment.

Barriers to treatment

Firstly, where you live often determines your treatment. Specialist services for eating disorders are mainly concentrated in large metropolitan centers. Access to care in rural and remote areas can be inadequate and, in many cases, non-existent, according to the National Eating Disorders Collaboration.

Indeed, our own database of clinicians shows they are clustered around the major cities and a recent report shows there are no specialist eating disorder services that operate within regional areas of Australia.

Another barrier is often the expense of treatment. A 2012 study found the average cost of treating bulimia nervosa was $6,000, for anorexia nervosa it was $84,000 per individual.

So even if you are living in a metropolitan area, meeting the cost of seeing an eating disorder specialist or clinician can be challenging.

A digital solution?

One solution is developing a stepped care model that’s supported by digital treatment programs.

In essence, stepped care means reserving a high-level therapeutic skill for patients who are much more severe in their presentation of the eating disorder symptoms.

For example, individuals who might be presenting with early signs of an eating disorder, or negative body image, can be referred to programs that require less intensive support than what a complete face to face treatment program would require.

Research shows us that supported self-help treatment options demand about a fifth of the contact hours required for a complete Cognitive Behavioural Therapy (CBT) course.

With all this mind, here at InsideOut we’re developing treatment options that break through some of those geographical and socio-economic barriers by going digital.

InsideOut - in collaboration with NSW Health - is currently examining the effectiveness of a self-help, online treatment program for individuals with Bulimia Nervosa titled Binge Eating e-Therapy (BEeT).

BEeT is a 10-session program based upon CBT, which has the most evidence for binge eating behaviours.

Pre-recorded interviews with a therapist, Claudia, guide the patient through each of those 10 sessions.

There’s psychoeducation, educational information about the nature of the illness, personal stories, as well as recordings of people who've gone through a similar CBT program to provide the user with encouragement and support.

There are also interactive activities around monitoring eating and thoughts, to bring the user’s awareness to the same things we would during face-to-face therapy.

Early data on the effectiveness of the program has been promising.

A pilot study of 25 females who met criteria for bulimia nervosa had a dropout rate of only 16% - low compared to other studies of online CBT programs, which range from about 35 to 82%.

We saw a significant decrease in binge episodes, binge days, and the loss of control that the person experienced during that episode.

There was also significant decrease in attitudinal measures around eating concern, shape concern and dietary restraint.

We’ve taken those positive early indications further to a randomised control trial to test out how well this program is going to work within our existing healthcare system.

While recruitment is still underway, so far we've got 95 participants who've been considered eligible from 258 screening calls distributed into three different groups – the first has 12 weeks to work their way through 12 online sessions on their own, in addition to the self-guided learning, the second group has a zoom call with a clinician for half an hour each week and the third group is the wait-list group.

In terms of quantitative data, it’s too early to tell but qualitative feedback has so far been positive.

Users have reported BEeT is comprehensive, that it’s helped them make good progress, given hope and that it’s been life changing.

While developing digital treatments takes time and money, we know that they can be effective in levelling the playing field when it comes to access to treatment and recovery.

We're recruiting volunteers with Binge-Eating (16+) for a free 12-week trial of a new online therapy, BEeT, as part of a research study. Find out more 👉🏻

Further reading

Getting Help Early

Strategies for Regular Eating

What is Binge Eating Disorder?

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