Guided Self-Help and Eating Disorders

This chapter discusses guided self-help and self-help interventions for patients with eating disorders. Self-help describes the use of printed or digital resources (e.g., books, workbooks, and videoclips) that individuals can access in their own time and environment to gather information and develop skills about the management of their symptoms and unhelpful behaviors, thoughts, and emotions. When the use of these resources is facilitated by a health professional or a less expert individual (e.g., someone with lived experience of the illness, a psychology postgraduate), then the intervention is defined as “guided self-help.” The form of guidance differs across settings and can include “online” sessions (either face-to-face, through a web platform such as Zoom, Teams, and Skype, or via telephone) or “offline” support, for example, through emails or text messages. In the eating disorders literature, guided self-help has been delivered and evaluated more often than self-help, especially to target binge eating symptoms. In this condition, guided self-help has been found superior to a comparison condition (mostly waiting list or minimal therapeutic input) in reducing binge eating and eating disorder psychopathology. In anorexia nervosa, guided self-help and self-help have been studied far less, due to clinical concerns regarding the severity of symptoms and patients’ ambivalence to change. Nevertheless, the published studies have identified the potential of guided self-help to improve motivation to change and reduce dropout in patients. Guided self-help and self-help resources have been offered to patients’ carers too, and associated with improved skills to cope with eating disorder symptoms and behaviors. This chapter describes findings from studies that evaluated guided self-help or self-help interventions for patients with eating disorders and highlights the changes that these interventions have witnessed over the years. In recent years, for example, there has been a shift from face-to-face, book-based interventions delivered by highly specialized professionals, toward digital interventions, offering online materials, and delivered by people with less intensive training, including individuals with lived experience of the illness. This model holds great potential in terms of acceptability and wide dissemination. Open questions remain with regard to how patient-level (age, illness severity, and motivation to change) and intervention-level variables (e.g., type of guidance received, duration of intervention, and way of delivery) can impact on the efficacy and effectiveness of guided self-help and self-help for patients with eating disorders and their carers.