Evaluating the role of digital intervention design in treatment outcomes and adherence to eTherapy programs for eating disorders: a systematic review and meta-analysis
Abstract
OBJECTIVE: Despite the existence of reviews which document the effectiveness of online therapies, there is little consensus regarding the exact components of online treatment delivery that are most effective in maintaining user engagement and reducing eating disorder (ED) symptomology. The current review and meta-analysis aimed to determine which components of web-based, ED self-help interventions are associated with lower attrition and improved therapeutic outcome. METHOD: A systematic search of electronic databases (PsycINFO, Medline, Web of Science, Scopus) was conducted for published studies of web-based interventions for EDs and a meta-analysis of the final included studies was performed. Each intervention was coded across four dimensions, including the multimedia channels employed (e.g., text, audio, videos), degree of user interactivity (e.g., online self-monitoring, skills exercises), level of automated feedback (e.g., reminders, personalized feedback), and technological device through which the program was accessed (e.g., smartphone, computer). RESULTS: A final 23 papers were included. The results of meta-regressions indicated that higher scores on the multimedia subscale were associated with greater ED symptom improvement in treatment groups. Conversely, a higher degree of feedback in the treatment group was associated with a group difference in ED psychopathology favoring the control group. Other intervention components were not associated with treatment outcome or dropout. DISCUSSION: The results are discussed in relation to limitations of the scale used to quantify digital intervention features, as well as the limited diversity and technological sophistication of available ED digital interventions. Such findings indicate the importance of understanding the digital components, which differentiate online therapeutic programs.
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CBT is the therapeutic approach in a majority of guided self-help interventions; a meta-analysis reported CBT-based interventions in 79% of included studies.
“CBT comprises the therapeutic approach for a majority of these guided self-help interventions: a meta-analysis of transdiagnostic, binge-eating targeted eTherapies (i.e., digitally delivered evidence-based therapy) reported CBT-based interventions in 79% of included studies (22).”
From The acceptability, feasibility, and preliminary efficacy of a supported online self-help treatment program for binge-eating disorder (2023) · cites this paper as [22]
Supported online self-help programs (eTherapies) are effective in transdiagnostic eating disorder samples and may improve access to treatment.
“Studies in transdiagnostic eating disorder (ED) samples suggest supported online self-help programs (eTherapies) are effective and may improve access to treatment”
From The acceptability, feasibility, and preliminary efficacy of a supported online self-help treatment program for binge-eating disorder (2023) · cites this paper as [22]
eTherapies' efficacy in reducing ED and binge-eating symptomatology in transdiagnostic ED samples has growing evidence across multiple meta-analyses, with small to medium average effect sizes.
“Moreover, their efficacy in reducing ED and binge-eating symptomatology in transdiagnostic ED samples has growing evidence across multiple meta-analyses, with small to medium average effect sizes reported (22, 25–27).”
From The acceptability, feasibility, and preliminary efficacy of a supported online self-help treatment program for binge-eating disorder (2023) · cites this paper as [22]
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- Authors
- Barakat, S., Maguire, S., Smith, K. E., Mason, T. B., Crosby, R. D., & Touyz, S.
- Affiliations
- The University of Sydney (AU)
- University of North Dakota (US)
- University of Southern California (US)
- Corresponding author
- Barakat, Sarah
- Venue
- International Journal of Eating Disorders
- Publisher
- Wiley
- Published
- 2019-07-22
- Volume
- 52
- Issue
- 10
- Pages
- 1077-1094
- ISSN
- 0276-3478 (ISSN-L)
- 1098-108X
- OpenAlex
- W2963953472
- Cited by
- 77
- References
- 83
- Citations by year
- 2026: 10 · 2025: 9 · 2024: 14 · 2023: 11 · 2022: 11 · 2021: 11 · 2020: 10 · 2019: 1
- FWCI
- 1.30
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- International Journal of Eating Disorders (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
- Keywords
- eating disorders, digital interventions, medication adherence, attrition, multimedia content, automated feedback, user interactivity, smartphone access, treatment outcomes
- MeSH terms
- Feeding and Eating Disorders, Humans, Health Behavior, Treatment Outcome, Telemedicine
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