Although there are no e-health or telehealth interventions for co-occurring ED and AOD use disorders, there has been some research conducted into the use of e-health interventions for single disorder ED. Systematic reviews of internet-based interventions for single disorder ED have found that ED symptoms, including bingeing and purging episodes, reduced significantly with the use of an internet-based therapy [1483, 1484]. In contrast, however, several studies reported poorer outcome, or no difference, for e-health interventions relative to waitlist and treatment-as-usual control groups [1485]. Notably, though, some studies that did not report significant findings are likely limited by methodological factors, such as small sample sizes.
There is no clear evidence as to which e-health intervention has the most empirical support for single disorder ED, although self-help CBT has been highlighted as an effective, accessible, time and cost effective alternative to clinician delivered CBT [1455, 1485, 1486]. The majority of studies have focused on internet-based CBT, with the online components ranging from e-mail-based therapy, adjunctive internet-based guidance, to online CBT. One review found that internet-based therapies that were bolstered by face-to-face contact via assessment and clinician support were associated with higher rates of therapeutic adherence and lower attrition from internet-based treatment [1484].
Guided self-help and self-help CBT for single disorder ED in particular have been shown to be effective in reducing the frequency of bingeing and purging, and improving ED psychopathology, but less effective than face-to-face psychotherapy in achieving abstinence [1453, 1455, 1483, 1486–1488]. These findings provide some support for the use of guided e-health interventions in the treatment of ED as an adjunct to other treatments [1487]. Unguided self-help initiatives do not appear to be effective at treating ED [1483, 1487].
A systematic review of smartphone applications for ED identified up to 20 interventions currently available for ED treatment [1487], with varying levels of empirically supported content. These apps mostly provide educational content, but some incorporate additional features such as self-assessment tools and referral infrastructure. In another systematic review, smartphone applications improved abstinence rates from bingeing and purging behaviours from baseline [1483]. Moreover, the increasing popularity and widespread use of smartphone applications suggests they could be an effective medium for delivering treatment once their clinical utility is established [1487]. However, most experts agree that the evidence for smartphone applications as treatment for ED is limited, as these applications are not necessarily founded on evidence-based principles [1487, 1489].