The Potential of Internet-Based Programs for Eating Disorder Prevention in Students

  • Katajun Lindenberg
  • Markus Moessner
  • Stephanie Bauer


Transition from high school to college is known to be a phase in which students are particularly vulnerable to develop mental disorders. Almost half of female college students display disturbed eating behaviors or try to lose weight, indicating the rationale to target this age cohort with eating disorder (ED) prevention. Using the potential of information and communication technologies (ICT) to enhance health-care interventions, the Center for Psychotherapy Research in Heidelberg has developed the internet-based program Es[s]prit for prevention and early intervention of ED. Following a stepped care approach from universal to targeted prevention up to early intervention, Es[s]prit contains modules of increasing intensity, i.e., psychoeducation, peer support, monitoring, consultation chat, and face-to-face counseling. These technology-enhanced modules enable individualization of support according to participants’ needs: Healthy students remain on low-intensity levels, whereas high-risk individuals are invited to participate in the monitoring program that observes symptom courses continuously and provides supportive feedback. An automated alarm system identifies deteriorations and indicates referral to more intensive modules, i.e., the consultation chat, where the anonymous contact can be used to motivate individuals to seek more intensive treatment, i.e., face-to-face counseling. We present results on a sample of N = 1582 college-age students. Es[s]prit was found to be feasible for large populations and well accepted. This technology-enhanced prevention strategy appears especially promising for the prevention of behavioral disorders such as ED. Furthermore, individualized, stepped care approaches can be applied to other areas of health and disease, such as maintenance treatment and monitoring of patients with multiple illness episodes.


Eating Disorder Anorexia Nervosa Eating Disorder Bulimia Nervosa Eating Disorder Symptom 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



Anorexia nervosa


Anorexia nervosa total severity index (SEED)


Body mass index


Bulimia nervosa


Bulimia nervosa total severity index (SEED)


Eating disorders


Eating disorders not otherwise specified


Information and communication technology


Short Evaluation of Eating Disorders (Bauer et al. 2005)


Weight Concern Scale (Killen et al. 1994)



This work has been partially funded by the Klaus Tschira Foundation gGmbH.


  1. Bauer S, Kordy K. E-mental-health. Heidelberg: Springer; 2008.CrossRefGoogle Scholar
  2. Bauer S, Winn S, Schmidt U, Kordy H. Eur Eat Disord Rev. 2005;13:191–200.CrossRefGoogle Scholar
  3. Bauer S, Moessner M, Wolf M, Haug S, Kordy H. Brit J Guid Couns. 2009;37:327–36.CrossRefGoogle Scholar
  4. Bundeszentrale für gesundheitliche Aufklärung (BZgA). Themenschwerpunkte: Prävention von ernährungsabhängigen Krankheiten. Retrieved 30 June, 2007, from
  5. Cachelin FM, Striegel-Moore RH, Regan PC. Eur Eat Disord Rev. 2006;14:422–9.CrossRefGoogle Scholar
  6. Celio AA, Winzelberg AJ, Wilfley DE, Eppstein-Harald D, Springer, EA, Dev P, Taylor, CB. J Consult Clin Psych. 2000;68:650–7.CrossRefGoogle Scholar
  7. Delinsky SS, Wilson GT. Eating Behaviors. 2008;9:82–90.PubMedCrossRefGoogle Scholar
  8. Dyson R, Renk K. J Clin Psychol. 2006;62:1231–44.PubMedCrossRefGoogle Scholar
  9. Fairburn CG, Cooper Z, Shafran R, Bohn K, Hawker DM, Murphy R, Straebler S. In: Fairburn CG, editor. Cognitive behavior therapy and eating disorders. New York: Guilford; 2008. p. 136–46.Google Scholar
  10. Festinger L. A theory of cognitive dissonance. Evanston: Row & Peterson; 1957.Google Scholar
  11. Fingeret MC, Warren CS, Cepeda-Benito A, Gleaves DH. Eating Disorders: J Treat Prevent. 2006;14:191–213.Google Scholar
  12. French SA, Jeffery RW. Health Psychol. 1994;13:195–212.PubMedCrossRefGoogle Scholar
  13. Grilo CM. Eating and weight disorders. New York: Psychology Press; 2006.Google Scholar
  14. Hesse-Biber S, Marino M. J Psychol. 1996;125:199–216.Google Scholar
  15. Hoek HW. Curr Opin Psychiatr. 2006;19:389–94.CrossRefGoogle Scholar
  16. Holm-Denoma JM, Joiner TE, Vohs KD, Heatherton TF. Health Psychol. 2008;27:3–9.CrossRefGoogle Scholar
  17. Jacobi C, Hayward C, de Zwaan M, Kraemer HC, Agras W. Psychol Bull. 2004;130:19–65.PubMedCrossRefGoogle Scholar
  18. Kann L, Kinchen SA, Williams BI, Ross JG, Lowry R, Grunbaum JA, Kolbe LJ. Youth risk behavior surveillance -United States, 1999. MMWR CDC Surveillance Summaries. 2000;49:1–96.Google Scholar
  19. Killen JD, Taylor CB, Hayward C, Wilson DM, Haydel F, Hammer LD, Robinson TN, Litt I, Varady A, Kraemer H. Int J Eat Disorder. 1994;16:227–38.CrossRefGoogle Scholar
  20. Lowry R, Galuska DA, Fulton JE, Wechsler H, Kann L, Collins JL. Am J Prev Med. 2000;18:18–27.PubMedCrossRefGoogle Scholar
  21. Meyer DF. J College Stud Psychother. 2001;15:23–36.CrossRefGoogle Scholar
  22. Moessner M, Zimmer B, Wolf M, Bauer S. In: Bauer S, Kordy H, editors. E-mental-health. Heidelberg: Springer; 2008.Google Scholar
  23. Percevic R, Gallas C, Arikan L, Moessner M, Kordy H. Psychotherapeut. 2006;51:395–7.CrossRefGoogle Scholar
  24. Reas DL, Williamson DA, Martin CK, Zucker NL. Int J Eat Disorder. 2000;27:428–34.CrossRefGoogle Scholar
  25. Schmidt U, Andiappan M, Grover M, Robinson S, Perkins S, Dugmore O, Landau S, Treasure J, Eisler I, Williams C. Brit J Psychiat. 2008;193:493–500.PubMedCrossRefGoogle Scholar
  26. Stice E. Psychol Bull. 2002;128:825–48.PubMedCrossRefGoogle Scholar
  27. Stice E, Shaw H. Psychol Bull. 2004;130:206–27.PubMedCrossRefGoogle Scholar
  28. Stice E, Marti CN, Spoor S, Presnell K, Shaw H. J Consult Clin Psych. 2008;76:329–40.CrossRefGoogle Scholar
  29. Stice E, Marti CN, Shaw H, Jaconis M. J Abnorm Psychol. 2009;118:587–97.PubMedCrossRefGoogle Scholar
  30. Striegel-Moore RH, Dohm FA, Kraemer H, Taylor CB, Daniels S, Crawford PB, Schreiber GB. Am J Psychiat. 2003;160:1326–31.PubMedCrossRefGoogle Scholar
  31. Taylor CB, Bryson S, Luce KH, Cunning D, Doyle AC, Abascal LB, Rockwell R, Dev P, Winzelberg AJ, Wilfley DE. Arch Gen Psychiat. 2006;63:881–8.PubMedCrossRefGoogle Scholar
  32. Waller G, Schmidt U, Treasure J, Murray K, Aleyna J, Emanuelli F, Crockett J, Yeomans M. Psychiatric Bull. 2009;33:26–9.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Katajun Lindenberg
    • 1
  • Markus Moessner
  • Stephanie Bauer
  1. 1.Center for Psychotherapy ResearchUniversity Hospital HeidelbergHeidelbergGermany

Personalised recommendations