On the Internet: Online Discussion Groups, Motivational Interviewing

The Internet offers an attractive alternative source for information for people with eating disorders. Patients like the fact that they can make contact regardless of the place and time, which is especially helpful for those who are socially isolated and chronically ill. Writing down their thoughts also helps patients distance themselves from destructive or aggressive impulses. In addition, the anonymity of the Internet makes it easier and less threatening to search for help, especially for those who may be afraid or ashamed to speak openly about their illness. Online information also is in written form, which makes it available to those who cannot or do not want to actively take part in discussions or groups.

Dr. Martin Grunwald and Dorette Wesemann, of the University of Leipzig, Germany, analyzed the effects of online discussion groups for bulimia nervosa from an unmoderated online discussion forum (http://www.ab-server.de). The researchers followed communication threads to evaluate the aims of communication and how this took place within the forum, as well to study the characteristics of the postings and the number of users (Int J Eat Disord. 2008; 41:527). From October 2004 to May 2006, Grunwald and Wesemann evaluated 2,072 discussion units, or “threads.”

Findings: Most patients discussed problems

Problem-oriented threads featured communication between users that began with a central question or problem introduced by a forum visitor. This was the most frequently used thread, and made up 78.8% of the discussion units the authors analyzed. This type of thread operated very similarly to a face-to-face self-help group. Most of the comments were posted late in the evening, between 11:00 pm and 4:30 am (43%) or earlier in the evening, from 5:00 pm to 10:59 pm (37%). The “forum” was thus held mainly at night, when classic support and self-help programs are not available. The authors also noted there is evidence that contacts made during this type of forum also led to offline meetings, which would enable patients to establish personal contacts.

Another type of forum, communication-oriented threads (15% of all postings), centered on conversation rather than a problem, and often one user would contact another specifically by the individual’s screen name. Often it was the conversation, rather than a central problem, that interested these users. A third type of forum, termed meta-communication, featured discussions about the forum group itself. For example, users made general appeals to all forum members and offered encouragement to fight the illness, to deal with pro-disorder postings or other postings that provoked the users, and to discuss ways to better communicate among members. Two other types of threads featured mixed forms of communication. For example, in a primarily problem-oriented thread, acquaintances met and exchanged messages privately, and another thread included queries from postgraduate students or researchers seeking information.

The authors noted that their results show that the Internet offers people with eating disorders a means of forming groups, communicating and processing their illness, and can act as a safe and helpful resource for patients.

A second study: motivational interviewing for Internet groups

A pilot study by Dr. Kelly H. Webber and colleagues at the University of Kentucky, Lexington, examined the feasibility of using motivational interviewing with online weight-loss treatment groups (J Am Diet Assoc. 2008;108:1029). Motivational interviewing is a technique for building motivation for change, and may be one helpful for leading online groups, according to the authors.

Twenty women, all university employees with an average age of 40.6 years and a mean body mass index of 31.0 kg/m2 participated in the 8-week, minimal contact intervention. The women received weekly e-mail lessons and were randomized to one of two online groups using motivational interviewing, one with and one without additional discussion of personal values. Some of these values included the pros and cons of self-motivation, change and readiness for change and the relationship between these personal values and participation in a weight-loss program. Self-reported weights and degree of motivation were measured at baseline and again at 8 weeks.

Results at 8 weeks

Self-reported weight losses at 8 weeks were 1.5 kg (3.3 lb) in the motivational interviewing plus values discussion group and 2.7 kg (5.9 lb) in the motivational interviewing without values discussion group. According to the authors, the use of motivational interviewing for online groups seeking weight loss is acceptable to patients and also leads to increased motivation and improved weight loss.