Do online support groups help for
eating disorders?

Because they are easy to access, online support groups have great potential to help those with eating disorders.

Researchers at Stanford University are examining whether online support groups offer the same benefits traditional groups provide to people with eating disorders, and if they have other pros and cons that face-to-face support groups may not.

It's important for psychologists to conduct research in the area, because electronic support groups "will become a big issue for those in our field," said Barr Taylor, MD, a Stanford psychiatrist involved in the studies. "These online support groups have a lot of potential, because they're so easy to access," he said. "But we still need to learn more about making them useful in treating various disorders."

In one of the team's studies, now in press at Computers and Human Behavior, Andrew Winzelberg, a doctoral student in counseling psychology at Stanford, and colleagues analyzed the content of 300 messages in an online eating disorders support group.

The online eating disorders support group consisted of about 70 people, mostly in their teens, who had anorexia or bulimia and were in recovery from their illness. Winzelberg found four categories of messages:

• 31 percent disclosed information about participants' personal lives and their battles with eating disorders;
• 23 percent gave information to other members in the form of medical, psychological and nutritional advice;
• 16 percent gave emotional support; and
• 15 percent involved other kinds of information such as seeking help about love relationships, parents and school.

In addition, 37 percent of the messages were sent between 7 a.m. and 7 p.m.; 32 from 7 p.m. to 11 p.m., and 31 percent between 11 p.m. and 7 a.m.

The kinds of messages sent "seem to reflect the same patterns you find in face-to-face groups--it's just that they're doing it over the computer," said Winzelberg. Member support crossed demographic boundaries, he added, with teen-agers giving advice and support to 35-year-olds.

The findings on when people sent messages features an additional benefit, Winzelberg said: "There aren't a lot of friends you can usually call at 2 or 3 a.m."

The data also showed a potential drawback for unregulated support groups Winzelberg believes: "12 percent of participants' messages gave inaccurate or unhealthy information, such as providing tips on how to purge without getting caught. While that's a risk in traditional support groups as well, it's more likely that someone in those groups will step in with immediate corrective feedback because they're face-to-face and in real time," he said.

Online prevention

To study more closely what works in online support groups, in a second study Winzelberg and Taylor created their own support and prevention group for women at risk of developing an eating disorder.

The team gave 27 female Stanford students a CD-ROM psychoeducational intervention package that the students could use whenever they wanted to over an eight-week period. The educational material included information on gaining a positive body image, healthy dieting and eating disorders. In addition, participants could send anonymous notes to each other over e-mail.

The intervention was moderated by a psychologist, Kathleen Eldredge, PhD, who facilitated group discussion, provided information and directed participants on ways to effectively use the program. (Because the team believes not enough is known about the efficacy of online psychotherapy, Eldredge did not act as a therapist).

The team compared participants' improvement on a range of body image measures with 30 controls who had not yet received the intervention. The groups received the measures at baseline, post-treatment and at a three-month follow-up.

The treatment group made significant improvements in their body image compared to controls, Winzelberg said. In addition, those who completed a section of the program on healthy weight regulation reported adopting healthier eating behaviors and reducing their drive for thinness.

On a less positive note, "participants didn't support one another very much--they disclosed their own concerns, but they didn't empathize with each other,"Winzelberg said. A probable explanation for the lack of support is that participants had not seen supportive e-mail statements modeled for them, while those in the previous naturalistic study had the chance to observe such statements before posting messages, he said.

Fostering group support

A third study is trying to correct the problems of the second one, including the lack of support and the lack of structure, Winzelberg said. The team modified the original program so it is available through the World Wide Web, and structured it as an eight-week program with weekly assignments on specific topics. In this study, they're also able to track which parts of the program participants used and when. As with the previous two studies, participants can also send notes to each other.

The study is being conducted at two sites: Stanford and California State University, San Diego. To foster support, Eldredge now alerts the group through e-mail about a group member's request for feedback on a specific problem. She also encourages other members to share similar experiences and what they did to cope.

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Although there are no results yet, the researchers are excited by responses from the women who are showing more support for each other and report that they are learning from the material, Taylor said. Some of those positive changes are witnessed by a higher overall percentage of notes posted by participants, including more notes of empathy, he said.

Next, the team plans a similar study that is tailored for high school students.

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