E-mail as a therapeutic adjunct in the outpatient treatment of anorexia nervosa: Illustrative case material and discussion of the issues

Objective: To explore using adjunctive e-mail in treating anorexia nervosa. Method: Four treatment plans were supplemented by obligatory e-ma ii empha sizing patients' reports of specific eating-related behaviors. Office visit s occurred weekly to once every few months. E-mail contact occurred once to several times per week. Patients also saw other providers. Results: All pa tients have shown good clinical improvement. Patients provided their assess ments of contributions made by the use of e-mail and generally found it to be helpful. Discussion: E-mail has had excellent patient acceptability and adherence. Benefits have been attributed to increased therapeutic contact, "talking" on demand, and having to frequently confront one's integrity, hon esty, and eating behaviors. Little clinician time is needed for reading and responding to e-mails. Informed consent and confidentiality issues must be carefully addressed. Controlled trials are warranted to further evaluate t he roles that adjunctive e-mail may play in clinical research and practice. (C) 2001 by John Wiley & Sons, Inc.