Using a Vodcast to Combat Restrictive Eating

Cell phones and portable media are put to work combating intrusive thoughts.

People with eating disorders often find it hard to combat obsessions and ritualistic behaviors surrounding food and exercise. Dr. Janet Treasure and colleagues have found a very creative way to use modern technology to help patients combat these intrusive thoughts.

Dr. Treasure noted that the generation of intrusive images plays a key role in the normal development of appetite and the drive to eat, but persons with eating disorders have difficulty controlling obsessive images and rituals around food. Her group theorized that an intervention could restore the balance between normal and pathological intrusions in people with eating disorders. The researchers designed a vodcast (a small video file played on a mobile phone or portable media device), with audible and visual components, to target eating related psychopathology in a small study of 4 consecutive patients (Eur Eat Disorders Rev 2010; 18:515).

After testing various approaches, the researchers selected a vodcast that concentrated on motivational reflection, and that encouraged the participant to step back and think of the broader consequences of not eating. The aim was to help the individual reconsider and overcome restrictive eating behavior. Patients were also given a self-help guide provided within the Maudsley Model.

The program

In the first session, the therapist introduced the patient to the educational materials in the form of a discussion about eating/drinking problems common to people with eating disorders. The therapist and patient defined the target problem eating behaviors and noted the importance and confidence of making changes in each area. Participants were asked to record their eating behaviors, along with any anxiety and meal-related intrusive thoughts; these were added to a food diary kept for 2 days (1 week day and 1 weekend day). In the next session, the diaries were reviewed along with the educational materials. The procedure for the behavioral experiment involving the vodcast was introduced in this session. The patients completed a visual analog scale measuring the concepts of hunger, fullness and desire and rated the level of intrusions. This was followed by a 5-minute period of either watching the vodcast or just sitting quietly.

The patients were offered a choice of one of three bottles of differently flavored fruit smoothies, and asked to drink the smoothie, as much and as quickly as was comfortable to do so, within 15 minutes. After the 15 minutes had lapsed, they completed the rating scales and returned to the therapist, where they discussed how they experienced the procedure and the therapist continued to focus the discussion round the educational material. At the end of the session, the participants were asked to complete the food diaries during the following week.

Using the vodcasts at home

All women were given a DVD with three vodcasts to play at home on their iPODs and cell phones. Two weeks later, the women were re-interviewed about their experience. All four women rated the use of the vodcasts at home as useful emphasizing that the sound of the voice and the music were the most helpful—the voice in particular helped them identify with the material and helped them to relax. The music was relaxing, too. The women found that positive framing of eating and nutrition was beneficial and creased their level of motivation and provided them with a new perspective on nutrition and eating.

More of the smoothie was consumed in the test meal with the vodcast than without the vodcast, and this was associated with a reduction in anxiety in three of four women. Three used the vodcasts at home and found they provided support and motivation. After three months, the weight of the three participants with restrictive anorexia nervosa had increased and they continued with further treatment on an outpatient basis. The fourth patients had a more difficult time. She continued a rigid pattern of fasting until the evening, when her meal was followed by binge eating and vomiting.

Dr. Treasure notes that there is some evidence that vodcasts may be useful in supporting changes in eating behaviors. Thev odcast is best suited for individuals who are ambivalent about eating and is perhaps most appropriate for those with restricting-type AN. The benefits of the vodcast are that it is simple, discreet, and mobile.