title: The potential of technology-based psychological interventions for anorexia and bulimia nervosa: a systematic review and recommendations for future research.
abstract: BACKGROUND
  Previous studies have shown an unmet need in the treatment of eating disorders. In the last decade, interest in technology-based interventions (TBIs) (including computer- and Internet-based interventions [CBIs] or mobile interventions) for providing evidence-based therapies to individuals with different mental disorders has increased.
  
  
  OBJECTIVE
  The aim of this review was to systematically evaluate the potential of TBIs in the field of eating disorders, namely for anorexia nervosa (AN) and bulimia nervosa (BN), for both prevention and treatment, and also for carers of eating disorder patients.
  
  
  METHODS
  A systematic literature search was conducted using Medline and PsycINFO. Bibliographies of retrieved articles were also reviewed without date or study type restrictions.
  
  
  RESULTS
  Forty studies resulting in 45 publications reporting outcomes fulfilled the inclusion criteria: 22 randomized controlled trials, 2 controlled studies, and 16 uncontrolled studies. In total, 3646 patients were included. Overall, the studies provided evidence for the efficacy of guided CBIs, especially for BN patients and for compliant patients. Furthermore, videoconferencing also appeared to be a promising approach. Evaluation results of Internet-based prevention of eating disorders and Internet-based programs for carers of eating disorder patients were also encouraging. Finally, there was preliminary evidence for the efficacy of mobile interventions.
  
  
  CONCLUSIONS
  TBIs may be an additional way of delivering evidence-based treatments to eating disorder patients and their use is likely to increase in the near future. TBIs may also be considered for the prevention of eating disorders and to support carers of eating disorder patients. Areas of future research and important issues such as guidance, therapeutic alliance, and dissemination are discussed.
authors.affiliation: Department of Psychiatry and Psychotherapy, University of Munich, München, Germany. sandra.schlegl@med.uni-muenchen.de.
authors.forename: Sandra
authors.identifier: http://orcid.org/0000-0003-1791-7379
authors.initials: S
authors.lastname: Schlegl
authors.forename: Carolina
authors.identifier: http://orcid.org/0000-0001-7126-0107
authors.initials: C
authors.lastname: Bürger
authors.forename: Luise
authors.identifier: http://orcid.org/0000-0002-6297-2791
authors.initials: L
authors.lastname: Schmidt
authors.forename: Nirmal
authors.identifier: http://orcid.org/0000-0002-6825-7027
authors.initials: N
authors.lastname: Herbst
authors.forename: Ulrich
authors.identifier: http://orcid.org/0000-0003-0261-3145
authors.initials: U
authors.lastname: Voderholzer
mesh_terms: D000293:Adolescent; D000328:Adult; D000855:Anorexia / Q000523:psychology / Q000628:therapy*; D020811:Biomedical Technology / Q000379:methods*; D052018:Bulimia Nervosa / Q000523:psychology / Q000628:therapy*; D006801:Humans; D020407:Internet; D011613:Psychotherapy / Q000379:methods*; D055815:Young Adult
keywords: Internet; anorexia nervosa; bulimia nervosa; cognitive behavioral therapy; computers; mobile phone
references.citation: Psychol Serv. 2012 May;9(2):111-31
references.pmid: 22662727
references.citation: Behav Res Ther. 2012 Sep;50(9):544-50
references.pmid: 22728647
references.citation: Eur Eat Disord Rev. 2011 Jul-Aug;19(4):342-8
references.pmid: 21394832
references.citation: J Eat Disord. 2013 Jul 30;1:23
references.pmid: 24999404
references.citation: Br J Psychiatry. 1989 Jun;154:807-12
references.pmid: 2597887
references.citation: J Abnorm Child Psychol. 2007 Jun;35(3):379-91
references.pmid: 17243014
references.citation: Psychother Psychosom. 2007;76(4):196-202
references.pmid: 17570957
references.citation: Eur Eat Disord Rev. 2012 Jan;20(1):1-8
references.pmid: 21796737
references.citation: J Clin Psychol. 2009 Jan;65(1):53-75
references.pmid: 19051274
references.citation: Psychol Med. 2011 Dec;41(12):2581-91
references.pmid: 21733215
references.citation: Eur Eat Disord Rev. 2008 Mar;16(2):84-93
references.pmid: 17879223
references.citation: Health Technol Assess. 2006 Sep;10(33):iii, xi-xiv, 1-168
references.pmid: 16959169
references.citation: Med 2 0. 2012 Aug 14;1(2):e3
references.pmid: 25075231
references.citation: Clin Psychol Psychother. 2013 Jul-Aug;20(4):308-18
references.pmid: 22298417
references.citation: J Consult Clin Psychol. 2004 Oct;72(5):914-9
references.pmid: 15482051
references.citation: Int J Eat Disord. 2007 Jul;40(5):399-408
references.pmid: 17497708
references.citation: Br J Psychiatry. 2005 Feb;186:132-5
references.pmid: 15684236
references.citation: Child Adolesc Psychiatr Clin N Am. 2011 Jan;20(1):135-53
references.pmid: 21092918
references.citation: Int J Eat Disord. 2004 Sep;36(2):123-43
references.pmid: 15282683
references.citation: Br J Psychiatry. 2008 Dec;193(6):493-500
references.pmid: 19043154
references.citation: BMJ. 2010;340:c332
references.pmid: 20332509
references.citation: Behav Res Ther. 2009 Jun;47(6):451-3
references.pmid: 19356743
references.citation: Int J Eat Disord. 2007 Dec;40(8):692-704
references.pmid: 17702020
references.citation: Nord J Psychiatry. 2006;60(6):463-8
references.pmid: 17162454
references.citation: Eur Eat Disord Rev. 2013 Jul;21(4):315-22
references.pmid: 23677740
references.citation: Int J Eat Disord. 2011 Dec;44(8):687-91
references.pmid: 22072405
references.citation: Psychol Med. 2011 Feb;41(2):407-17
references.pmid: 20406523
references.citation: PLoS One. 2011;6(3):e18001
references.pmid: 21483704
references.citation: J Consult Clin Psychol. 2012 Aug;80(4):700-6
references.pmid: 22545736
references.citation: Psychol Med. 2013 Dec;43(12):2477-500
references.pmid: 23217606
references.citation: Cogn Behav Ther. 2011;40(2):82-97
references.pmid: 25155812
references.citation: Int J Eat Disord. 2001 Mar;29(2):125-38
references.pmid: 11429975
references.citation: Eur Eat Disord Rev. 2013 Jul;21(4):323-9
references.pmid: 23520152
references.citation: Eur Eat Disord Rev. 2011 Mar-Apr;19(2):138-49
references.pmid: 20859989
references.citation: Int J Eat Disord. 2009 Apr;42(3):222-7
references.pmid: 18951452
references.citation: J Consult Clin Psychol. 2012 Oct;80(5):907-16
references.pmid: 22506791
references.citation: Gen Hosp Psychiatry. 2013 Jul-Aug;35(4):332-8
references.pmid: 23664503
references.citation: Int J Eat Disord. 2007 Apr;40(3):212-7
references.pmid: 17173324
references.citation: Int J Eat Disord. 1994 Dec;16(4):363-70
references.pmid: 7866415
references.citation: BMC Psychiatry. 2010;10:54
references.pmid: 20598127
references.citation: Behav Res Ther. 2007 Apr;45(4):649-61
references.pmid: 16899213
references.citation: Health Psychol. 2014 Dec;33(12):1558-67
references.pmid: 25020152
references.citation: Int J Eat Disord. 2010 Jul;43(5):405-19
references.pmid: 19544556
references.citation: Behav Res Ther. 2012 Mar;50(3):180-90
references.pmid: 22317754
references.citation: Br J Psychiatry. 2013 Feb;202:135-41
references.pmid: 23222037
references.citation: Expert Rev Neurother. 2012 Jul;12(7):861-9; quiz 870
references.pmid: 22853793
references.citation: CNS Spectr. 2009 Feb;14(2 Suppl 3):34-40
references.pmid: 19238128
references.citation: Acta Psychiatr Scand. 1983 Jun;67(6):361-70
references.pmid: 6880820
references.citation: Int J Eat Disord. 2004 May;35(4):538-48
references.pmid: 15101069
references.citation: Psychol Med. 2007 Mar;37(3):319-28
references.pmid: 17112400
references.citation: Clin Psychol Rev. 2012 Jun;32(4):329-42
references.pmid: 22466510
references.citation: Psychol Med. 1979 May;9(2):273-9
references.pmid: 472072
references.citation: Clin Psychol Rev. 2012 Aug;32(6):454-66
references.pmid: 22705583
references.citation: Eat Disord. 2014;22(3):244-60
references.pmid: 24456277
references.citation: Clin Psychol Rev. 2011 Dec;31(8):1247-58
references.pmid: 21963670
references.citation: Nervenarzt. 2011 Sep;82(9):1107-17
references.pmid: 21755336
references.citation: Cyberpsychol Behav. 2009 Feb;12(1):37-41
references.pmid: 19006463
references.citation: Cogn Behav Ther. 2009;38(2):66-82
references.pmid: 20183688
references.citation: J Telemed Telecare. 2003;9 Suppl 1:S37-8
references.pmid: 12952717
references.citation: J Adv Nurs. 2013 Jan;69(1):66-76
references.pmid: 22448710
references.citation: Clin Psychol Rev. 2014 Mar;34(2):158-76
references.pmid: 24508686
references.citation: Int J Med Inform. 2006 Jan;75(1):101-9
references.pmid: 16115793
references.citation: J Adolesc Health. 2004 Oct;35(4):290-6
references.pmid: 15450542
references.citation: Eat Disord. 2006 Jan-Feb;14(1):1-15
references.pmid: 16757445
references.citation: Clin Psychol Rev. 2011 Feb;31(1):89-103
references.pmid: 21130939
references.citation: BMC Psychiatry. 2013;13:207
references.pmid: 23919625
references.citation: Behav Res Ther. 2008 May;46(5):581-92
references.pmid: 18374304
references.citation: Int J Eat Disord. 2013 Jul;46(5):508-15
references.pmid: 23658102
references.citation: Behav Res Ther. 2012 Feb;50(2):93-9
references.pmid: 22137366
references.citation: J Am Med Inform Assoc. 2015 Apr;22(e1):e194-209
references.pmid: 25125686
references.citation: Neuropsychiatr. 2013;27(2):66-73
references.pmid: 23609487
references.citation: Psychol Med. 2009 May;39(5):705-12
references.pmid: 18812006
references.citation: J Med Internet Res. 2012;14(4):e110
references.pmid: 22858538
references.citation: MMW Fortschr Med. 2006 Aug 3;148(31-32):31-3
references.pmid: 16937874
references.citation: Psychol Med. 2008 Nov;38(11):1521-30
references.pmid: 18205964
references.citation: Arch Gen Psychiatry. 2005 Jul;62(7):776-81
references.pmid: 15997019
references.citation: Int J Ment Health Nurs. 2013 Aug;22(4):329-39
references.pmid: 22882349
references.citation: World Psychiatry. 2014 Feb;13(1):4-11
references.pmid: 24497236
references.citation: Eat Weight Disord. 2015 Mar;20(1):63-70
references.pmid: 24962794
references.citation: Clin Child Fam Psychol Rev. 2010 Sep;13(3):275-90
references.pmid: 20532980
references.citation: Body Image. 2012 Jan;9(1):1-11
references.pmid: 22119329
references.citation: J Trauma Stress. 2008 Dec;21(6):513-20
references.pmid: 19107724
references.citation: Expert Rev Pharmacoecon Outcomes Res. 2007 Jun;7(3):291-7
references.pmid: 20528315
references.citation: Am J Psychiatry. 2011 Aug;168(8):790-9
references.pmid: 21536689
references.citation: BMJ. 2008;337:a1655
references.pmid: 18824488
references.citation: PLoS One. 2010;5(10):e13196
references.pmid: 20967242
references.citation: Behav Res Ther. 2009 Sep;47(9):729-36
references.pmid: 19515360
references.citation: Health Qual Life Outcomes. 2008;6:28
references.pmid: 18426597
references.citation: Ann Behav Med. 2009 Aug;38(1):28-39
references.pmid: 19806416
references.citation: Clin Psychol Rev. 2011 Jul;31(5):727-35
references.pmid: 21501580
references.citation: Int J Eat Disord. 2006 Dec;39(8):667-76
references.pmid: 16868992
references.citation: Eur Eat Disord Rev. 2010 May;18(3):197-206
references.pmid: 20443203
references.citation: Psychol Med. 2014 Jul;44(9):1947-63
references.pmid: 24128818
references.citation: Int J Eat Disord. 2012 Mar;45(2):202-13
references.pmid: 21495052
references.citation: Psychol Med. 2007 Sep;37(9):1217-28
references.pmid: 17306044
references.citation: Eur Eat Disord Rev. 2013 May;21(3):215-23
references.pmid: 22949134
references.citation: Behav Cogn Psychother. 2011 Jul;39(4):443-56
references.pmid: 21208485
references.citation: Int J Eat Disord. 2010 Sep;43(6):549-59
references.pmid: 19718664
references.citation: Telemed J E Health. 2011 Jan-Feb;17(1):50-4
references.pmid: 21214382
references.citation: Int J Eat Disord. 2011 Dec;44(8):708-15
references.pmid: 22072408
references.citation: Br J Psychiatry. 1987 Jan;150:18-24
references.pmid: 3651670
references.citation: BMC Psychiatry. 2011;11:131
references.pmid: 21838902
references.citation: Clin Psychol Rev. 2009 Jul;29(5):410-20
references.pmid: 19403215
references.citation: Br J Psychiatry. 2007 Dec;191:471-3
references.pmid: 18055948
references.citation: Br J Clin Psychol. 2006 Nov;45(Pt 4):499-514
references.pmid: 17076960
references.citation: Curr Opin Psychiatry. 2006 Jul;19(4):389-94
references.pmid: 16721169
references.citation: Int J Eat Disord. 2006 Dec;39(8):633-8
references.pmid: 16937381
references.citation: Int J Eat Disord. 2006 Mar;39(2):154-61
references.pmid: 16252278
references.citation: J Clin Psychol. 1988 May;44(3):392-7
references.pmid: 3384966
references.citation: Int J Eat Disord. 2013 Sep;46(6):634-8
references.pmid: 23712500
references.citation: Int J Eat Disord. 2010 Sep;43(6):513-9
references.pmid: 19718672