Online help for teen eating disorders

Eating disorders are serious mental illnesses, resulting in mortality rates that are almost twice as high as other psychiatric disorders – especially among young people.

To help combat the substantial harmful effects that eating disorders have on psychological, physical and social functioning, Flinders University Lecturer in Psychology and clinical psychologist Dr Ryan Balzan is conducting a trial to examine the effects of metacognitive training (MCT) for eating disorders.

MCT works by targeting the cognitive biases, or irregular thinking and reasoning strategies, linked to disordered eating symptoms. Originally developed as a therapy for people with psychosis, this is first time MCT has been adapted to suit an adolescent eating disorder population.

Dr Balzan is currently recruiting up to 40 adolescents with anorexia nervosa across South Adelaide to investigate the feasibility of the online treatment program in an eating disorder population.

This study sits within the Blackbird Initiative, a part of the Órama Institute for Mental Health, Wellbeing and Neuroscience at Flinders University, which has launched a website for promoting its research and evidence-based interventions that focus on recovery for eating disorders and poor body image issues.

The MCT program – which will feature youth-friendly audio-visual treatment modules with interactive exercises – is being viewed as a complement to existing treatments.

Images from the online modules which require participants to ‘switch’ between the different visual interpretations (woman’s face or saxophone player?; duck or rabbit?), which encourages a more flexible—rather than rigid—thinking style.

Dr Balzan believes these developments will bridge a significant gap in treating young people with eating disorders that needs urgent attention.

“Anorexia nervosa, in particular, is a difficult disorder to treat and runs a chronic course unless assertive early intervention is provided,” says Dr Balzan.

“Symptoms of the illness most commonly first occur in early to late adolescence; 3.9% of adolescent females meet a diagnosis for anorexia nervosa by the age of 19.

“Early intervention in adolescents is critical to help mitigate the impact of anorexia nervosa and offers the greatest chance of improving long-term outcomes. However, treatment outcomes for existing interventions remain sub-optimal, with over two-thirds of adolescents with anorexia nervosa failing to fully recover within two years after receiving inpatient or outpatient treatment.”

MCT encourages people to reflect on their thinking, particularly the cognitive distortions that might underlie usual experiences. It also offers alternative thinking strategies, which encourages critical reflection and may help people to avoid falling for the same ‘cognitive traps’ over and over again.

Evidence from Dr Balzan’s previous studies has shown that cognitive biases contribute to the onset and maintenance of delusional beliefs, and that targeting these biases with interventions like MCT can reduce the severity of delusions and the distress they cause.

Dr Balzan believes MCT has high applicability to people with anorexia nervosa, as their beliefs about the importance of weight, shape and control over eating are typically resistant to change and held with high conviction – similar to many delusional beliefs observed in psychosis.

“We have also observed the processes that maintain these disordered eating beliefs share similarities to those that maintain delusions, such as the tendency to disregard logic in favour of evidence drawn from personal experiences,” says Dr Balzan.

“We believe focussing on the irregular thinking processes associated with anorexia nervosa, rather than the specific content of beliefs, makes MCT a less confrontational treatment approach for adolescents with anorexia nervosa.

“MCT focuses on normalising thinking distortions, which means it may help to overcome the stigma of anorexia nervosa.”


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College of Education, Psychology and Social Work