Self-Help in Eating Disorders

Self-treatment approaches have been discussed for some time as an alternative to existing psychotherapeutic and pharmacological treatment approaches, including within the context of “stepped-care models” (Mitchell et al. 2011; Ramklint et al. 2012). The majority are based on therapy manuals that contain essential elements of CBT approaches. In therapy research, a step-by-step approach to the treatment of mental disorders has been advocated in recent years, not least for economic reasons. The first stage consists of “low-threshold” therapy approaches. In the literature, terms such as self-help (SH), self-treatment, self-change, or bibliotherapy are used for this purpose. In the revised S3 guideline (AWMF 2018), “self-management” is used instead of self-help, as the studies included in the meta-analyses are approaches based on structured evaluated programs and thus differ from traditional self-help groups. Self-help manuals have been developed that follow the guidelines of cognitive-behavioral therapy approaches (CBT approaches) and can be carried out independently by affected individuals with minimal therapeutic support (guided, GSH) or without (pure, PSH). Such self-management programs for patients with eating disorders are available in online and offline versions and range from pure self-help using a book (bibliotherapy), an app, or a computer program, to programs with occasional therapist contact and guided self-help programs. In addition to personal contact, these therapist contacts can take place in an audio and video chat program or in writing in a chat or via email, with the latter allowing asynchronous communication. The supportive short contacts take less time than psychotherapy sessions, and their content is not psychotherapeutic in the narrower sense.