Dissemination in the internet age: Taming a wild thing

Abstract

These are times full of promise for eating disorder treatment with the convergence of two powerful influences, treatments that work and the means to reach ever increasing numbers of people who need them with the aid of modern communication technologies. As identified in the comprehensive reviews by Bauer and Moessner 1 and Fairburn and Wilson, 2 interventions are gaining more and more traction across the spectrum of prevention, early intervention and treatment of eating disorders. Enhanced cognitive behavioral therapy for eating disorders is proving particularly versatile in treating the diverse range of eating disorders found in community settings. Further, use of the internet to extend community access to effective interventions, provide tailored feedback to outpatients or individuals at a distance, and support carers of patients, to name but a few examples, have been shown to have positive outcomes. But how can we maximize these opportunities? What are the potential difficulties of these technologies that we may need to understand and negotiate both to make the possibility of widespread dissemination of effective treatments reality and to reduce the needs for treatment? The authors of the previous reviews 1,2 have raised a number of crucial points in relation to these questions. I would like to expand on their observations in two broad areas: first, by considering the importance of extending focus beyond the individual into the population and public policy and public health domains and; second, by greater exploration, understanding, and management of the potentially problematic aspects of internet intervention delivery and the internet environment in relation to eating disorders. Beyond the IndividualDespite improvements in treatments and means of delivery, Hart et al. 3 have identified that between 67 and 83% of eating disorder cases have unmet need for treatment. Although structural barriers such as cost and geography play a part, fear of stigma and shame play a key role in the low proportion of treatment seeking. Stigmatizing attitudes about eating disorders have been shown to include beliefs that eating disorders are inconsequential and indeed may have advantages, and that people with eating disorders are untrustworthy, vain, attention-seeking, and personally responsible for their disorders and thus not deserving of sympathy or understanding. In addition, people with eating disorders should just ''pull themselves together.'' In this environment, it is not surprising that fear of stigmatization (including by health professionals) and shame have been found to be barriers to treatment seeking. Until these unsupportive community attitudes have been changed, our effective treatments will be under-used.Currently, however, we have little information about how best to achieve this goal. Would increased knowledge about the pressures and complex etiologic pathways involved in the development of eating disorders reduce blaming attitudes or would a deeper understanding of the suffering of people with eating disorders ...

Universal prevention efforts should address eating disorder pathology across the weight spectrum: Implications for screening and intervention on college campuses

“…Online approaches to screening, prevention, and treatment can increase reach and offset in-person clinical demands by (1) enabling widespread identification of mental and behavioral health issues using minimal resources from campus clinicians and other relevant stakeholders; (2) informing clinical decision-making to ensure interventions are precisely delivered to match individuals’ needs; and (3) utilizing low-cost, low resource-intensive programs as first-line interventions while conserving in-person services for those most in need (Bauer & Moessner, 2013; Fairburn & Wilson, 2013; Kazdin & Blase, 2011; Paxton, 2013). One example of a comprehensive, online approach to ED screening and intervention is the Healthy Body Image program (HBI), an Internet-based program for delivering screening and intervention that aims to reduce the incidence and prevalence of EDs (Jones, Kass et al, 2014; Wilfley et al, 2013).…”

Internet-based preventive intervention for reducing eating disorder risk: A randomized controlled trial comparing guided with unguided self-help

“…Translating interventions into disseminable mediums that are readily deliverable, rely less on specialists, and can be tailored for varied levels of risk and symptom profiles is a priority. Internet-based interventions overcome translational barriers and enable rapid dissemination (Kazdin & Blase, 2011; Paxton, 2013). Online interventions have been successfully used to reduce eating disorder risk factors or for the treatment or prevention of eating disorders (Bauer & Moessner, 2013; Bauer, Moessner, Wolf, Haug, & Kordy, 2009; Carrard et al, 2011; Carrard et al, 2010; Jacobi, Volker, Trockel, & Taylor, 2012; Lindenberg, Moessner, Harney, McLaughlin, & Bauer, 2011; Ljotsson et al, 2007; Paxton, McLean, Gollings, Faulkner, & Wertheim, 2007; Pretorius et al, 2009; Sánchez-Ortiz et al, 2010; Stice, Rohde, Durant, & Shaw, 2012; Taylor et al, 2006).…”

“…These interventions have been tested in comparison to face-to-face treatments as well as educational materials or wait-list control conditions, and have demonstrated reductions in eating risk factors, eating disorder onset, eating disorder symptoms, or relapse (Bauer & Moessner, 2013). Internet-based interventions are often associated with high user acceptability given their accessible and anonymous format (Abascal, Bruning Brown, Winzelberg, Dev, & Taylor, 2004; Lenhart, Purcell, Smith, & Zickuhr, 2010; Luce et al, 2005; Moessner & Bauer, 2012; Shaw, Stice, & Becker, 2009); however, anonymous online platforms can also be met with user dropout given the reduced accountability than face-to-face treatments or met with reduced engagement if technological innovations/enhancements are not released at the same speed as that of our rapidly-changing technological landscape (Paxton, 2013). Moreover, overcoming access-to-care barriers through the use of internet-based platforms requires strong, collaborative partnerships and ongoing attention to uptake and sustainability to ensure successful implementation (Paxton, 2013).…”

Pitfalls, Potentials, and Ethics of Online Survey Research: LGBTQ and Other Marginalized and Hard-to-Access Youths

“…In social work, online dissemination may also "extend community access to effective interventions" ( Paxton, 2013, p. 525), potentially decreasing pressure on offline interventions by providing information directly to individuals. Whereas LGBTQ young people often do not pursue help in offline contexts as a result of discrimination, they frequently seek advice from peers and access resources online ( Craig & McInroy, 2014;McDermott & Roen, 2012;Paxton, 2013). This may also be true of other socially marginalized youth populations (for example, ethnoracialized youths, youths engaging in risky or illegal behavior).…”

“…This may also be true of other socially marginalized youth populations (for example, ethnoracialized youths, youths engaging in risky or illegal behavior). Provision of online resources related to or derived from research may facilitate information seeking among youths, providing a strong motivation for online dissemination ( Paxton, 2013).…”