Adherence to e-therapy for adults with eating disorders: a systematic review. A retrospective case series investigation of blended internet-based cognitive-behavioural therapy (ICBT) and face-to-face cognitive-behavioural therapy (CBT) in the treatment of adults with eating disorders
Filgate, Eleanor Megan
Background: Eating disorder (ED) researchers continue to explore the effectiveness of e-therapy in improving symptoms and its treatment acceptability, however issues relating to poor uptake, adherence and dropout pose a challenge. Within this portfolio, the systematic review aimed to explore adherence to e-therapy for the treatment of ED, specifically exploring rates and predictors of uptake, completion, and dropout from randomised controlled trials (RCT) of ED e-therapy. The empirical project aimed to explore in-depth symptom change for ED cases engaged in blended internet-based cognitive behavioural therapy (ICBT) and face-to-face ED input. Acceptability of blended input was also explored. Methods: For the systematic review, literature searches were undertaken in March and September 2017 across EMBASE, PsycINFO, MEDLINE, Ovid and Cochrane Central Register of Controlled Trials (CENTRAL) and ProQuest databases. Key papers were assessed against five quality criteria (random assignment to groups, blinding to treatment allocation, quality of content, level of contact, sample size with sufficient power). Using a retrospective case series design, the empirical project explored changes over time of ED, anxiety, depression, quality of life (QoL), motivation for change, overall psychological functioning and clinician-rated/patient-rated improvement. Standardised health assessment measures captured symptoms over multiple time-points, and data was analysed using t-tests, multi-level modelling (MLM) and visual analysis. Acceptability of treatment was tentatively explored using an open feedback questionnaire. Results: Systematic review results identified intervention (content, acceptability, delivery method/location), participant (nature of symptoms, BMI, education, prior therapy, personality, views on e-therapy) and therapist-related factors (therapeutic support) were indicated in predicting uptake, completion and dropout across ED e-therapy. In the empirical project, study findings were inconclusive regarding symptom change attributable to blended input. Model fit improved when severity of ED symptoms predicted overall psychological functioning and patient-rated improvement over time, however findings were non-significant – potentially due to the study being underpowered. Conclusions: Promising evidence exists for ED e-therapy as an acceptable treatment option, however understanding which content nurtures engagement best is needed. Further research is needed into the factors predicting ED blended treatment outcome.