In the moments when people are binge eating or purging, they are often alone with a computer nearby. Quick internet searches can lead to support in the form of online forums, blogs, and new research (like this site). Can therapy, either individually or as part of a group, serve as an effective new tool that could be conveniently available online? A few new studies released online this month explore the current status of online treatments.
How would therapy work online? The ideal form might include live, streaming video with a therapist, but other forms include email-based discussions and self-help material delivered online. All of these internet interventions, as they are used to treat eating disorders, were reviewed in a study released online last week in the International Journal of Eating Disorders.
Generally speaking, it seems that internet based therapies can be helpful for binge eating and bulimia, but we have no idea how they directly compare to face-to-face therapy. Even if we assume that face-to-face therapy is better, is it so much better that it justifies the extra time/cost? Many people aren’t able or willing to participate in face-to-face individual therapy. While this if often an issue of lack of finances, insurance coverage, and access to healthcare, these problems are unlikely to be solved anytime soon. As a cheaper and less time intensive alternative, how can internet based therapy be helpful?
In their review, Jiska Aardoom and her colleagues found that people suffering from binge eating tended to benefit more from internet-based therapy than people suffering from bulimia or restrictive eating. This may have less to do with the online part of therapy, however, and more to do with how people with binge eating generally respond to treatment.
Across all the studies reviewed, people seeking treatment generally reported positive experiences. Patterns for negative experiences included feeling that the online treatment was impersonal or required too much self-discipline. In a separate commentary on technology in treating eating disorders, Susan Ringwood argues that internet-based therapy lacks the human connection and compassion that is critical to treatment in face-to-face therapy.
In Aardoom’s review, along with another review and two commentaries published online this month, researchers discuss how we should respond to internet-based therapy. Despite varying personal beliefs about the quality of face-to-face vs internet therapy, there appears to be a market for internet therapy. Given that the current eating disorder studies show that people in internet-based therapies tend to do better than those on a wait-list, it seems clear that internet-based therapy can help people who otherwise aren’t able to access other forms of treatment.
Decades ago psychologists were arguing that short-term, structured therapies (e.g. cognitive behavior therapy) would do patients an injustice compared to traditional long-term therapy with intensive meetings 3-4 times weekly (e.g. psychoanalysis). Today that argument seems outdated and often irrelevant. In another twenty years, how might that debate seem similar to our current debate over internet-based therapy?
Dr. Gupta is a professor at Barnard College of Columbia University and provides individual therapy at Tribeca Psychology
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