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In-person therapy best for body image problems

NEW YORK (Reuters Health) - Both Internet-based therapy and face-to-face counseling can help women with high levels of body dissatisfaction feel better about themselves, a new study shows.

However, the traditional in-person therapy is better than the cyber approach for improving both image concerns and disordered eating, Dr. Susan J. Paxton of La Trobe University in Bundoora, Melbourne, Australia and colleagues found.

Therapy delivered via the Internet is becoming increasingly popular, Paxton and her team point out, and it offers the advantage of privacy and anonymity as well as greater accessibility than in-person care. Nonetheless, computer-based interventions may have disadvantages, such as increasing the likelihood of miscommunication due to the absence of "nonverbal and auditory cues," they add.

The researchers compared the effectiveness of eight weekly small-group therapy sessions led by a therapist when delivered in person or by the internet to 116 women, 18 to 35 years old, all of whom had disordered eating and were highly unsatisfied with their bodies. Forty-two of the women participated in the face-to-face group, 37 received counseling via the Internet, and 37 were assigned to a delayed treatment group that served as a "control" comparison.

Both therapy groups showed large improvements in their scores on tests of body image, shape concerns and eating attitudes and behaviors compared to the control group, although improvements in the face-to-face group were greater.

The women also showed lower levels of psychopathology after participating in the in-person sessions, but computer sessions didn't reduce psychopathology.

Face-to-face therapy participants also attended more sessions than the Internet group, and the more sessions participants completed, the greater their improvement,

By six months after therapy ended, however, there was no difference between the face-to-face and Internet groups.

"The present study provides strong support for the efficacy of face-to-face body image interventions for young adult women when accessible, and on-line synchronous internet interventions when they are not," Paxton and her colleagues conclude.

SOURCE: International Journal of Eating Disorders, December 2007

David Baxter PhD

Late Founder
Interesting. I do think online counselling and online support groups are helpful, and certainly for people in remote areas or who for other reasons cannot access face-to-face therapy, but I also do believe that if you have a choice seeing a therapist in person is more effective.

I know that as a therapist I rely on nonverbal signals and what is not said almost as much as what is said, and those features are missing in online interactions.
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