This document discusses online resources for the treatment of eating disorders. It begins by outlining some key statistics about eating disorders, including their high mortality rate and low treatment rates. It then discusses how treatment resistance is common, due to factors like shame, stigma, and cost concerns. The document proposes that online counseling can help address some of these barriers through features like anonymity, accessibility, and lower costs. It examines different online counseling modalities and treatments, like CBT and support groups. It also discusses ethical considerations, the need for specialized online counseling training, and challenges like the lack of nonverbal cues. Finally, it acknowledges the role of pro-eating disorder websites and potential for online resources to both help and harm those with eating disorders

1. Online Resources for
Treatment of Eating
Disorders
JULIA GLASSMAN
FINAL TECH PLAN
PACE UNIVERSITY

2. Eating Disorders
 Eating disorders are serious and complex disorders that affect sufferers
both mentally and physically.
 Current data statistics indicate that nearly 24 million Americans of various
ages, genders, and ethnicities meet the criteria for a DSM-5 diagnoses for
an eating disorder.
 Additionally, eating disorders have the highest mortality rate of any mental
illness, but despite these statistics, only 1 out of 10 individuals suffering with
an eating disorder are receiving treatment for these deadly disorders.
(ANAD, 2014)

3. Treatment Resistance
 Treatment resistance is a common phenomenon in patients with eating
disorders, and even if patients are engaged in some form of treatment,
the dropout rates for these programs are high averaging drop-out rates
between 30-50%. (Knowles, et al., 2013) Treatment resistance may be the
result of a variety of factors, such as:
 Shame
 Fear of stigma
 Lack of awareness of the disorder
 Denial
 Availability to treatment services
 Mistrust of the system
 Cost concerns

4. Online Counseling
 As technology continues to advance, the internet has been able to
provide some useful treatment alternatives that can diminish some of the
barriers and/or resistance to treatment.
 There are many features unique to online treatment that are able to
combat some of the barriers to treatment discussed above:
 Invisibility
 Anonymity
 Greater accessibility
 Cost effectiveness

5. Online Counseling Modalities
 Synchronous:
 Videoconferencing
 Phone conferencing
 Instant messaging
 chat
 Asynchronous:
 Email
 Text messaging
 Blogs/online journals
 Forums
 Discussion boards

6. Treatments
 CBT
 Psycho-education
 Online Support Groups

7. Ethical Considerations
 Informed consent
 Complete description of services offered
 Security risks and safeguards
 Therapeutic benefits, risks and limitations
 General ground rules
 Client contingency plans
 Confidentiality
 Risks
 Percautions
 Knowing the identity and location of client

8. Online Counselors
 Competence in online treatment services will require different counseling
skill sets and specialized training and a much more comprehensive
knowledge of electronic communication and technology than in
traditional practice.
 Counselors should thoroughly understand how to use the different
technologies, feel comfortable using these technologies, and feel
competent to deliver effective care using these different technologies.
(Kinley, et al., 2012)

9. Lack of Facial Cues and Voice Tone
 One of the major concerns regarding online counseling is the lack of voice
tonality and facial cues in an online counseling relationship. Online
counselors should receive specialized training to be able to develop the
skill set to effectively communicate knowledge, empathy and positive
reinforcement and encouragement to clients using the different online
counseling mediums. (Kinley, et al, 2012)
 Online counselors will also receive training to help them develop
communication techniques to enhance their expressiveness in text to
make up for the lack of tonality and facial cues. For example, using
emoticons, parenthetical expressions, ‘voice’ accentuation (e.g. cap
locks, asterisks), trailers to indicate a pause in thinking, acronyms (e.g. LOL),
or exclamation points. (Kraus, et al., 2012)

10. Pro-Anorexia Movement
 The internet has been a strong basis for support for eating disorders, but it has
also been a platform for the Pro-Anorexia (pro-ana) movement. The Pro-
anorexia movement promotes eating disorders as lifestyle choices and not a
disease. Users on these websites often exchange ‘tips’ on how to achieve and
maintain a low body weight by using dangerous and unhealthy strategies,
such as starving or purging, and also provide ‘thinsperational’ content, such as
photos of extremely thin models or motivational statement promoting extreme
thinness. Many of these websites also include group forums and/or interactive
messaging. (Rodgers, et al., 2012) Having pro-ana information on the internet
can not only perpetuate an eating disorder, but can also be one of the factors
that initiates an eating disorder. For example, studies have provided estimates
that suggest that as high as 40% of the adolescent users on the internet are
searching for dieting tips and information. (Rodgers, et al, 2012)

11. Interview
 What are your views regarding online counseling?
 I believe that online counseling should be used when other options are not
available. Because so many psychotherapists are already using this
delivery model, I am certain that online counseling will become
increasingly mainstreamed and acceptable among most practitioners as
we continue to rely on digital technology. The inevitability of this has
forced me to accept the limitations of such a practice. These include
greater vulnerability to HIPPA violations, technical difficulties, challenges
for the therapist in sensing subtleties in body language or voice intonations
that may be crucial for diagnosing and offering continued support, just to
name a few.

12. Interview Cont’d
 What are some of the benefits that you believe that online counseling can provide?
 Certainly, online counseling offers a viable option for those clients who may be
homebound (e.g., with a disability) or unable to access services otherwise (e.g.,
clients who live in areas where counseling is unavailable). Also, I believe online
counseling could work for those who have an already well-established relationship
with their practitioner and wish to remain with them if they move away. The benefit, in
this case, would apply to those who might have difficulty establishing rapport with
another practitioner or might need infrequent check-ins during difficult times. With
online counseling, clients also have an opportunity to "meet" with the therapist in a
more relaxed way, if they don't have to rush to get to their appointments, if they are
bedridden or physically compromised, or if they are inviting their therapist to also be
part of their environment rather than meeting therapist at the office. Finally, online
counseling through programs like IChat, for example, offers the opportunity to have
others, such as family members, join the session if they cannot physically come to the
office. This is particularly true for those who live out of town.

13. Interview Cont’d
 How do you feel about the use of mental health applications for devices
such as cell phones, iPads, or computers?
 I believe that some of these could be quite useful as long as they are not a
substitute for proper diagnosis and treatment by a skilled practitioner. For
example, an application that offers practical tools for calming or thinking
before acting impulsively might be very beneficial for a large number of
people who would never seek therapy, but need regular reminders about
how to navigate through stressful times.

14. Interview Cont’d
 What benefits do you think online counseling could bring to treatment of
eating disorders?
 I am not a trained eating disorder specialist, but I believe online counseling
coupled with outpatient eating disorder programs, meetings, such as
overeaters anonymous, and regular support from a nutritionist and other
medical professionals might be a beneficial piece of this larger integrated
system, particularly if the practitioner collaborates with these other
professionals. Using email, clients might be able to send emails containing
some of their writing. Overall, however, the limitations I've mentioned
above would still apply to supporting a client in this area as well.

15. References
 ANAD (2014). Eating Disorder Statistics. National Association of Anorexia
Nervosa and Associated Disorders. Obtained from: http://www.anad.org/get-
information/about-eating-disorders/eating-disorders-
statistics/?gclid=CKOZh6Lvhr4CFY1xOgodsXYAQQ
 Darcy, A. M., & Dooley, B. (2007). A clinical profile of participants in an online
support group. European Eating Disorders Review, 15(3), 185-195.
doi:10.1002/erv.775
 Dölemeyer, R., Tietjen, A., Kersting, A., & Wagner, B. (2013). Internet-based
interventions for eating disorders in adults: a systematic review. BMC Psychiatry,
13(1), 1-16. doi:10.1186/1471-244X-13-207
 Gulec, H., Moessner, M., Mezei, A., Kohls, E., Túry, F., & Bauer, S. (2011). Internet-
Based Maintenance Treatment for Patients With Eating Disorders. Professional
Psychology: Research & Practice, 42(6), 479-486. doi:10.1037/a0025806
 Hofmann, S., Asnaani, A., Vonk, I., Sawyer, A., & Fang, A. (2012). The Efficacy of
Cognitive Behavioral Therapy: A Review of Meta-analyses. Cognitive Therapy &
Research, 36(5), 427-440. doi:10.1007/s10608-012-9476-1

16. References Cont’d
 Huurne, E. D., Postel, M. G., de Haan, H. A., & DeJong, C. J. (2013). Effectiveness of a web-
based treatment program using intensive therapeutic support for female patients with
bulimia nervosa, binge eating disorder and eating disorders not otherwise specified: study
protocol of a randomized controlled trial. BMC Psychiatry, 13(1), 1-22. doi:10.1186/1471-
244X-13-310
 Kinley, A., Zibrik, L., Cordeiro, J., Lauscher, H., Ho, K. (2012) TeleHealth for Mental Health
and Substance Use. BC Ministry of Health, Mental Health and Substance Use. Obtained
from: http://ehealth.med.ubc.ca/files/2013/04/TeleMental-Health-Literature-Review-
FINAL.pdf
 Kraus, R., Stricker, G., Speyer, C., (2010). Online Counseling: A Handbook for Mental Health
Professionals. Elsevier Incorporated.
 Leung, S., Joyce Ma, L., & Russell, J. (2013). An open trial of self-help behaviours of clients
with eating disorders in an online programme. Journal Of Advanced Nursing, 69(1), 66-76.
doi:10.1111/j.1365-2648.2012.05988.x
 Mitchell, J. E., Peterson, C. B. (2005) Assessment of Eating Disorders. Guilford Publications
Inc. Obtained from:
http://books.google.com/books?id=yiJCVUKZW6EC&printsec=frontcover&dq=online+ass
essment+for+eating+disorders&hl=en&sa=X&ei=qYZhU-
zFBJHLsQTPmIDIDw&ved=0CE4Q6AEwAg#v=onepage&q=internet&f=false

17. References Cont’d
 Pettersen, G., Rosenvinge, J. H., & Wynn, R. (2011). Eating disorders and
psychoeducation - patients' experiences of healing processes. Scandinavian
Journal Of Caring Sciences, 25(1), 12-18. doi:10.1111/j.1471-6712.2010.00783.x
 Rodgers, R. F., Skowron, S., & Chabrol, H. (2012). Disordered Eating and Group
Membership Among Members of a Pro-anorexic Online Community. European
Eating Disorders Review, 20(1), 9-12. doi:10.1002/erv.1096
 Rummell, C. M., & Joyce, N. R. (2010). 'So wat do u want to wrk on 2day?': The
Ethical Implications of Online Counseling. Ethics & Behavior, 20(6)
 Walstrom, M. K. (2000). "You Know, Who's the Thinnest?": Combating
Surveillance and Creating Safety in Coping with Eating Disorders Online.
Cyberpsychology & Behavior, 3(5), 761-783. doi:10.1089/10949310050191755