Self-Help Interventions for Eating Disorders

Kathryn Trottier, Ph.D

A trip to your nearest major bookstore is likely to reveal a large section devoted entirely to the topic of “self-help.”  This section is likely to contain a vast array of books, videotapes, DVDs, audiotapes and CD-ROMs written or created for the general public.  These materials offer information and advice on how to deal with a wide range of problems from physical and psychological disorders to life crises such as divorce or losing a job.  The quality and usefulness of these materials varies widely.

It is no secret that treatment resources for eating disorders are in short supply.  Specialized treatment programs for eating disorders are in great demand.  However, intensive treatment is expensive and there are only a small number of available specialized programs and healthcare professionals.  In response to this need, some experts in the field have developed self-help interventions for eating disorders.  These self-help programs aim to provide individuals struggling with eating disorders with some of the tools and information used in specialized treatments in order to help them to stop engaging in eating disorder behaviours. 


What are self-help interventions for eating disorders?

When healthcare professionals and researchers talk about self-help interventions, they are typically referring to structured programs that were developed based on psychological treatments that are known to be effective.  Self-help interventions of this type involve more than just providing information or offering support – they require the participant to follow the advice given in the program, and to complete “homework” type exercises and tasks with the goal of gaining new skills in order to help overcome the eating disorder.  This is not to suggest that self-help groups led by “laypeople” or non-professionals are not helpful to people with eating disorders.  Nonetheless, there has been a recent increased interest in professionally developed self-help interventions for eating disorders and several of these programs have been shown to be effective in well-controlled research studies.


Cognitive behavioural self-help

Most of the professionally developed self-help interventions for eating disorders are based on the principles of cognitive behavioural therapy (CBT).  More than 50 well-controlled research studies examining treatments for bulimia nervosa have been conducted.  On the basis of this research, individual CBT is widely considered the treatment of choice among healthcare professionals.  CBT has also been shown to be an effective treatment for binge eating disorder.  In the first stage of CBT, the focus in on establishing control over eating through education and behavioural strategies aimed at normalizing eating and preventing eating disordered behaviours.  Self-monitoring is also used to help individuals to normalize their eating, and to identify eating disordered thoughts and triggers for symptoms.  The second stage continues to focus on establishing normalized eating, especially with respect to stopping dieting behaviours.  This stage also focuses on problem solving skills, and identifying and changing problematic thoughts and beliefs.  The third stage focuses on maintaining change and preventing relapse.  Unfortunately, CBT for bulimia and binge eating disorder is not widely available because it is expensive, time consuming (usually four to six months), and there is a lack of trained therapists.  However, because CBT is a structured therapy based on educational, behavioural, and cognitive principles, it readily lends itself to translation into a self-help format.  Cognitive behavioural self-help programs teach individuals how to use the behavioural and cognitive strategies, which research has found to be effective, on their own, in order to overcome their eating disorders.


Guided self-help

In its “pure” form, individuals use self-help materials (books, videotapes, DVDs, CD-ROMs, etc.) on their own.  However, self-help materials can also be used in combination with guidance from a healthcare professional or even a layperson.  The benefit to using self-help materials along with guidance from a specialist therapist is that using a self-help manual can significantly reduce the number of therapy sessions and overall length of treatment required because clients are able to learn much of the information and do much of the “work” on their own, outside of the therapy sessions.  One obvious and important implication of this is that it reduces the overall cost of the therapy to the client.  However, healthcare professionals need not have expertise in the area of eating disorders in order to help their clients or patients use self-help materials.  Professionally developed self-help materials contain much of the expert knowledge needed to help individuals overcome their eating disorders.  The role of a non-specialist healthcare professional in a self-help program is to act as a helper and source of support for the individual struggling with an eating disorder.  Non-specialist healthcare professionals can effectively offer clarification of the self-help materials, answer questions, and modify the self-help program to fit the needs of the individual.  One particularly important aspect and benefit of “guided” self-help is that it involves helping the participant to remain on task.  In order to ideally benefit from a self-help intervention, participants need to read the materials, follow the advice provided, and complete the recommended tasks or exercises.  A layperson is also able to offer many of these benefits of guided self-help.


Research evidence

The available research evidence suggests that self-help programs can be beneficial for treating both bulimia nervosa and binge eating disorder.  Cognitive behavioural self-help interventions consistently result in significant reductions in episodes of binge eating and purging, as well as in weight and shape concerns; and some individuals are able to stop bingeing and/or purging altogether with the help of these interventions.  Some studies have directly compared the effectiveness of guided and unguided (or “pure”) self-help programs in order to determine which is more effective.  For example, Carter and Fairburn (1998)1 compared the effectiveness of guided and unguided cognitive behavioural self-help treatments for binge eating disorder.  Both self-help treatments resulted in significant reductions in binge eating and neither treatment was better than the other.  Ghaderi and Scott (2003)2 studied the effectiveness of guided and unguided self-help treatments for both binge eating disorder and bulimia nervosa.  Both self-help treatments resulted in significant reductions in binge eating, dieting, and weight and shape concerns, but no improvement in frequency of vomiting was found with either form of self help.  These researchers also found no benefit of guided self-help over unguided self-help.  However, other studies have found that guided self-help provides benefits superior to unguided self-help among individuals with bulimia and binge eating disorder3 and the results of one study suggest that guided self-help can be as effective as individual CBT4.
 

Is self-help right for you?

Although interest in self-help interventions for eating disorders is high, research in this area is relatively new.  Consequently, we do not yet know who is most likely to benefit from self-help interventions.  A study aimed at answering this question is currently being conducted at The Eating Disorder Program at the Toronto General Hospital.  In the meantime, clinical experience and intuition suggests that for individuals with bulimia or binge eating disorder, self-help interventions are likely to be most beneficial to individuals who have low symptom frequencies (i.e., low binge and/or purge frequency) and who are motivated to overcome their eating disorder.  Self-help interventions for anorexia nervosa are under-researched.  Preliminary results from one study suggest that a telephone-guided self-help intervention administered before admission to a specialist inpatient treatment for anorexia may be beneficial in reducing the length of treatment required in the inpatient program5.

Self-help treatments may be good first-line treatments for most individuals with bulimia or binge eating disorder.  However, if a cognitive behavioural self-help intervention does not result in significant improvements in an individual’s eating behaviour and other eating disorder symptoms, then referral to specialist treatment should be considered.  For those individuals already referred to specialist treatment, the waiting lists are typically long – individuals spend many months waiting for assessments and subsequently for treatment.  Self-help interventions may help these individuals to improve their quality of life while waiting for assessment and treatment, and may also reduce the length of treatment required in specialist programs.


How to increase your potential to benefit from self-help

  • Set aside time when you are not distracted to work through the self-help materials.
  • Take time to think about, and reflect on, how the information provided applies to you and your situation.
  • Commit to doing the recommended tasks and exercises.  Many of the recommended tasks and exercises require frequent practice (e.g., incorporating feared or forbidden foods) and some of them will need to be done several times a day (e.g., eating at breakfast, lunch and dinnertime).
  • Schedule time for yourself to work on your recovery.
  • Use the support of others to help you work through and stick to the self-help program
  • Prepare yourself for it to be difficult.  Recovering from an eating disorder is hard work.  Often recovering from an eating disorder involves feeling worse before you feel better.
  • Recognise and affirm yourself for each small step you take towards better well-being
  • Remind yourself that you are worth the effort.


Self-help resources

Fairburn, C.G. (1995). Overcoming Binge Eating. New York: Guilford Press.

McCabe, R.E., McFarlane, T., & Olmsted, M.P. (2003). The Overcoming Bulimia Workbook: Your comprehensive, step-by-step guide to recovery. California: New Harbinger.

Schmidt, U.  (1993). Getting Better Bit(e) by Bit(e): A survival kit for sufferers of bulimia nervosa and binge eating disorders. United Kingdom: Psychology Press Ltd.


References

1. Carter, J.C., & Fairburn, C.G. (1998). Cognitive-behavioral self-help for binge eating disorder: A controlled effectiveness study. Journal of Consulting and Clinical Psychology, 66, 616-623.

2. Ghaderi, A. & Scott, B. (2003). Pure and guided self-help for full and sub-threshold bulimia nervosa and binge eating disorder. British Journal of Clinical Psychology, 42, 257-269.

3. Loeb, K.L., Wilson, G.T., Gilbert, J.S., & Labouvie, E. (2000). Guided and unguided self-help for binge eating. Behaviour Research & Therapy, 38, 259-272.

4. Perkins, S. & Schmidt, Ulrike. (2005). Self-help for eating disorders. In S. Wonderlich, J.E. Mitchell, M. de Zwaan, & H. Steiger. (Eds.), Eating Disorders Review: Part 1. (pp. 87-104.) United Kingdom: Radcliffe Publishing Ltd.

5. Thiels, C., Schmidt, U., Treasure, J., Garthe, R., & Troop, N. (1998). Guided self-change for bulimia nervosa incorporating use of self-care manual. American Journal of Psychiatry, 155, 947-953.

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