Entered
25/06/03 AUSTRALIAN
STUDY ON SUCCESSFUL ONLINE
THERAPEUTIC COMMUNITY OF PRACTICE.
Gollings,
E. K. (2003) A Comparison of an Internet-Based and Face-To-Face
Group Intervention to Modify Body Dissatisfaction and Disturbed
Eating in Young Women. Doctor of Psychology Thesis, University of
Melbourne.
Can
people change significantly in a short period with intensive group
therapy, a classic form of a community of practice, even if it was
only online ?
Almost
one in four Australian women have serious body image and eating
disorders. Many young women have a fear of fatness, a desire to
be thinner, have weight concerns, appearance dissatisfaction, a
discrepancy between self and ideal body size, distorted size perception
and body schema. These thoughts and actions affect the affective,
cognitive, behavioural, or perceptual domains. Over eight weeks,
Gollings facilitated alternative therapeutic interventions to two
groups of young adult Australian women who were overly-concerned
about their body image to determine if their attitudes could dramatically
change.
Methodology
Two
versions of group therapy were selected to provide a safe and supporting
environment where participants could discuss their image, eating,
and interpersonal problems with each other. 40 participants with
a mean age of 22 years were randomly allocated to the Face-To-Face
group program (19 of 20 completed the program) or the
Internet-Based group program (18 of 20 completed the program).
The latter group had one formally appointed electronic chat group
therapy time (no audio, no visual) as well as a devoted healthcare
website (photo image of participants) with an unmediated chat room.
Chat conversation protocolsl were provided. A group would formally
interact one night a week over an 8-session period. Participants
were assessed using seven separate affective and cognitive self-rating
questionnaires. Homework assignments were given weekly. These were
administered before, at the end and two months after the intervention
to detect changes.
RESULTS
For
both interventions responses to all questionnaires showed statistically
significant improvements in affective and cognitive domains on average
and this change lasted at least two months after therapy.
When
the two groups were pooled, significant improvements across time
from baseline to end of treatment were seen on all outcome measures
(body dissatisfaction, body image avoidance behaviours, dietary
restraint, extreme weight loss behaviours, drive for thinness, bulimic
pathology, binge eating frequency, eating pathology, depression,
anxiety and self-esteem). Furthermore, these improvements were maintained
from end of treatment to follow-up.
There
were no significant between-group differences found. There
now is demonstrated efficacy of psychotherapeutic intervention programs
over the internet.
The following illustration is the responses seen from the Brief
Symptom questionnaire and is a representative example of the responses
seen in the other questionnaires used.
The researcher concludes that although this is shows positive findings
for the Internet-Based therapeutic modality a lot more work needs
to be done before the efficacy of this modality can be confirmed.
The researcher states that it is '…still
largely in the process of being investigated and researched.'
The
qualitative analyses have suggested that participants in the Internet
group found it to be an acceptable, helpful, and feasible approach
to treatment delivery. 43 % of this group were content to choose
the internet-based program as their first choice delivery mode at
the end of the program. However, 57 % of this group would prefer
a Face-To-Face delivery intervention mode next time. They wanted
to develop more solid friendships within a group, to talk directly
to people and easily get two-way continuous feedback, and be able
to see others' feelings and emotions.'
Historical
and Current Findings of Online Interventions
Positives
A readily
accessible communication tool, in some cases the only tool
available.
A more accessible
and profound learning resource.
More Disclosure.
Seems less intimidating a communication tool boosting the disclosure
of more personal information. All participants felt 'more confident
in sharing and expressing emotions than in a Face-to-Face group.'
"More direct way of communicating and that the messages were
more open and honest." Some participants would have "felt
too embarrassed having to face people." They would have been
distracted by their own anxiety in speaking in front of a group.
More Deeper
and Accurate Disclosure. Unhindered by time pressures, online
writing can be cathartic.Typing produces clarity in thought and
feeling. It was clear that typing produced an 'externalisation
of an individual's problems with their issues appearing before
them.' The researcher added that 'Writing has a recursive nature,
where individuals have the opportunity of editing their comments
and an opportunity to tell a story about themselves in a different
way than in Face-to-Face therapy where there are different social
pressures and demands.'
"I didn't need to think so much about what I was saying.
It wasn't as awkward as when you're actually in front of somebody,
and it was easier to talk about personal things."
"The messages and thoughts of others seem clearer…and
you actually could really think about what you wanted to say as
well."
Negatives
Less Resolution
of Problem. It seems to compromise the therapeutic relationship.
Can real healthy two-way communication happen in the absence of
adequate verbal and visual cues ? Can warmth and compassion be
communicated via text ? Disclosure was fine online but little
opportunity 'to explore some of the deeper and more underlying
issues they were facing.'
Less Empathy.
Eight out of 14 respondents (57 %) found it difficult to develop
close bonds with other group members. It made it difficult to
"really get to know each other."
Greater
compliance problems. It may not be as motivating to perservere
compared to a group you know personally.
Fragmented
Conversations. An online chat tool delivers stilted conversations.
Too many conversations are happening at the same time. This causes
undue anxiety because of time-pressured response speeds to a thread.
Once a message scrolls off the screen it is hard to trace and
impossible to retrieve since chat message boards are not normally
saved by the host. Secondly, inherently there is inadequate group
mediation with "conversations going round in circles and
its hard to really extrapolate things."
Technological
Hitches - Ocassional down time for individual computers due
to ISP difficulties. For less internet-savvy users this could
be even a greater obstacle.
RESEARCHER CONCLUSIONS
'Internet-based treatments are not being developed to replace
face-to-face therapy but rather to be used as an adjunct to
face-to-face consultations or as an alternative mode
of treatment delivery to increase access to care for those individuals
who are usually unable to benefit from traditional psychological
services. This new mode of treatment delivery has demonstrated
impressive changes in body dissatisfaction, and its utility
and efficacy should continue to be examined with different psychological
problems.'
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HUMAN LEARNING -
NATURAL DRIFT TO LOOSE COMMUNITIES OF PRACTICE
