Guided Recovery: An Interpretative Phenomenological Analysis of Service Users’ Experiences of Guided Self-Help for Bulimic and Binge Eating Disorders

Abstract

The efficacy of Cognitive Behavioral Therapy-based Guided Self-Help for mild to moderate bulimia and binge eating disorders has been well supported. However, limited research has explored in-depth individual experiences of this treatment approach. In depth semi-structured interviews were conducted with four individuals who had completed Cognitive Behavioral Therapy based Guided Self Help (CBT-GSH) for bulimic or binge eating disorders. The interviews were transcribed verbatim and subsequently analysed using Interpretative Phenomenological Analysis (IPA). Three superordinate themes emerged: Autonomy and volition; A dynamic relationship: the guided and the guide; and The unwanted friend. The reciprocal nature of the guide/guided relationship was identified as integral to the success of the therapeutic approach. However, participants expressed initial uncertainty towards the therapeutic process, and experienced an uncomfortable dissonance between a lack of volition in therapy seeking and the need to continually self-prescribe CBT-GSH. The findings affirm the central role of the guide in promoting motivation to engage with therapy and highlight the potential benefits of in-session weighing. However, it may be necessary to provide additional support on commencing CBT-GSH to address concerns about the therapeutic approach in this group.

Experiences of computer‐based and conventional self‐help interventions for eating disorders: A systematic review and meta‐synthesis of qualitative research

“…In the second conceptualization, despite accessibility and flexibility being noted as advantages, they were not the main reasons that attracted the participants. GSH as a “second‐best” option was noted in several papers (e.g., McClay et al (); Plateau et al ()), such as “there isn't much help out there…a long waiting list…” (McClay et al, ).…”

“…For example, in the study by Traviss et al () where some self‐help guides were interviewed, one of them observed that participants with more positive outcomes were those who were “willing to take more responsibility.” Leung et al () also included ideas about “taking control” instead of “letting ED control you,” and “…[the program] makes me more determined to fix myself.” It is clear that engagement with the program was seen as being effortful. As illustrated by Plateau et al (), participants used words such as “allow,” “try,” “have to” to describe the process. In this respect, computer‐based GSH was seen as more effective than book‐based GSH because it did not allow unstructured browsing (Sanchez‐Ortiz et al ()): “it took you through step by step… the computer can do much more than a book… you just skip through [in a book] whereas if it's on the computer you have to go step by step and then you can't move on until you've thought about it and done it so that, I think was a lot more effective.”…”

“…Participants were initially often skeptical about GSH as shown particularly in McClay et al () and Plateau et al (), but were willing to “give this a go” as other options were not available or had been exhausted (McClay et al, ; Pretorius et al, ). Traviss et al () particularly looked at “what works for whom.” The guides interviewed mentioned those with more positive treatment outcomes were “more realistic” or had “no expectation” toward the intervention outcome, or toward the extent, the guides contributed.…”

“…In terms of qualities of a guide, being "nonjudgmental" was widely mentioned. Other identified qualities included being patient and honest (Plateau et al, 2018), as well as respectful, flexible, responsive, and taking on the role of a "facilitator" rather than a "therapist" (Traviss et al, 2013).…”

“…It is clear that engagement with the program was seen as being effortful. As illustrated by Plateau et al (2018), participants used words such as "allow," "try," "have to" to describe the process. In this respect, computer-based GSH was seen as more effective than bookbased GSH because it did not allow unstructured browsing (Sanchez-Ortiz et al (2011)): "it took you through step by step… the computer can do much more than a book… you just skip through [in a book] whereas if it's on the computer you have to go step by step and then you can't move on until you've thought about it and done it so that, I think was a lot more effective.…”