Carers of people with anorexia nervosa: an evaluation of an online web-based skills intervention with and without clinician support

Overcoming Anorexia Online (OAO), 7 modules plus hard copies of an additional two workbooks, providing them with information on how to take care of their own well-being (Workbook 8) and additional information on treatments and resources (Workbook 9). Module 1 gives key information regarding symptoms and diagnosis and discusses myths and misconceptions.Carers are introduced to the systemic cognitive-behavioral approach underpinning the intervention. They are introduced to the 5-area approach to conceptualizing and understanding problems and the process of CBT. Module 2 focuses on helping carers to understand why people value their anorexia nervosa (AN) and the implications this has for their willingness to engage with treatment and for change, using the ‘Stages of Change’ model. It focuses on developing the skills needed to communicate effectively with a person who is ambivalent about change by teaching carers the principles of motivational interviewing. Module 3 addresses how AN affects families and uses the 5 -area approach to help carers to identify and understand how unhelpful behaviors and avoidance can result from difficult situations by teaching them to formulate their own and their loved one’s difficulties and to assess how their own reactions relate to and impact on each other by acting to ‘‘keep the AN going.’’ It also teaches people how to develop a plan to ‘break out’’ of these inter-relating vicious cycles in a manner that is appropriate to the developmental and illness stage of the sufferer. Module 4 concerns how to talk about meal support with the sufferer, make a collaborative plan to address this need and suggests tools and techniques for giving meal support. Module 5 is about risk and prognosis, including understanding and talking about medical risk with the sufferer and how to prepare for an appointment with health professionals. Module 6 tackles understanding the function of difficult behaviors such as bingeing, purging, or self-harm and helping to support the person to stop these. Module 7 This deals with relapse prevention—helping carers to identify the risk of relapse, helping the sufferer to maintain improvement, avoiding entering the cycle of reassurance, dealing with set-backs and looking for support. Modules are offered weekly over a 7-week period. Adherence was monitored via logging on to the online modules. Clinical guidance was provided by email or telephone by a Masters level trainee psychologist once a week. The intervention was only offered to carers and the each module took around 1 hour to complete.