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[The Importance of Social Exchange for Internet-based Eating Disorder Prevention]. Prax Kinderpsychol Kinderpsychiatr 2020; 68:728-741. [PMID: 31957562 DOI: 10.13109/prkk.2019.68.8.728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The Importance of Social Exchange for Internet-based Eating Disorder Prevention Internet-based interventions have the potential to complement routine care mental health services. Yet, dissemination and implementation into routine care is challenging and often fails. From a public health point of view, facilitating access to care and dissemination of prevention have great potential to reduce eating disorder related suffering in the general population. In order to exploit that potential effective strategies to involve users in internet-based prevention are of utmost importance. User-behaviors of N = 980 predominantly female (80 %) participants with an average age of 19.4 years (SD = 7.0) of an internet-based intervention for the prevention of eating disorders (ProYouth) were analyzed. Specifically, differences in users' pathways between early and late phases of participation were compared in order to identify patterns of program utilization that are associated with elevated adherence. During their first login, users explore all modules of the platform. Enduring participation is characterized by increased usage of the modules that offer social exchange with other participants, i. e. the forums and the chat. Static modules, e. g., psychoeducation, are rarely accessed after the first login. Additionally, enduring users were more often female, older, and displayed higher levels of psychological impairment (ps < .001). The results support the relevance of social exchange for the adherence in internet-based interventions for the prevention of eating disorders.
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52
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Haderlein TP. Efficacy of technology-based eating disorder treatment: A meta-analysis. CURRENT PSYCHOLOGY 2019. [DOI: 10.1007/s12144-019-00448-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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53
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Fitzsimmons-Craft EE, Balantekin KN, Eichen DM, Graham AK, Monterubio GE, Sadeh-Sharvit S, Goel NJ, Flatt RE, Saffran K, Karam AM, Firebaugh ML, Trockel M, Taylor CB, Wilfley DE. Screening and offering online programs for eating disorders: Reach, pathology, and differences across eating disorder status groups at 28 U.S. universities. Int J Eat Disord 2019; 52:1125-1136. [PMID: 31268183 PMCID: PMC6996115 DOI: 10.1002/eat.23134] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 06/19/2019] [Accepted: 06/21/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The Internet-based Healthy Body Image (HBI) Program, which uses online screening to identify individuals at low risk of, high risk of, or with an eating disorder (ED) and then directs users to tailored, evidence-based online or in-person interventions to address individuals' risk or clinical status, was deployed at 28 U.S. universities as part of a randomized controlled trial. The purpose of this study is to report on: (a) reach of HBI, (b) screen results, and (c) differences across ED status groups. METHOD All students on participating campuses ages 18 years or older were eligible, although recruitment primarily targeted undergraduate females. RESULTS The screen was completed 4,894 times, with an average of 1.9% of the undergraduate female student body on each campus taking the screen. ED risk in participating students was high-nearly 60% of students screened were identified as being at high risk for ED onset or having an ED. Key differences emerged across ED status groups on demographics, recruitment method, ED pathology, psychiatric comorbidity, and ED risk factors, highlighting increasing pathology and impairment in the high-risk group. DISCUSSION Findings suggest efforts are needed to increase reach of programs like HBI. Results also highlight the increasing pathology and impairment in the high-risk group and the importance of programs such as HBI, which provide access to timely screening and intervention to prevent onset of clinical EDs.
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Affiliation(s)
| | | | - Dawn M. Eichen
- Department of Pediatrics, University of California, San Diego, San Diego, CA, USA
| | - Andrea K. Graham
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
| | - Grace E. Monterubio
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Shiri Sadeh-Sharvit
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA,Center for mHealth, Palo Alto University, Palo Alto, CA, USA,Baruch Ivcher School of Psychology, Interdisciplinary Center, Herzliya, Israel
| | - Neha J. Goel
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA,Institute for Inclusion, Inquiry and Innovation (iCubed), Virginia Commonwealth University, Richmond, VA, USA
| | - Rachael E. Flatt
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA,Center for mHealth, Palo Alto University, Palo Alto, CA, USA
| | - Kristina Saffran
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Anna M. Karam
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Marie-Laure Firebaugh
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Mickey Trockel
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - C. Barr Taylor
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA,Center for mHealth, Palo Alto University, Palo Alto, CA, USA
| | - Denise E. Wilfley
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
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Graham AK, Wildes JE, Reddy M, Munson SA, Taylor CB, Mohr DC. User-centered design for technology-enabled services for eating disorders. Int J Eat Disord 2019; 52:1095-1107. [PMID: 31313370 PMCID: PMC7265747 DOI: 10.1002/eat.23130] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 06/17/2019] [Accepted: 06/19/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Technology-enabled services frequently have limited reach and suboptimal engagement when implemented in real-world settings. One reason for these implementation failures is that technology-enabled services are not designed for the users and contexts in which they will be implemented. User-centered design is an approach to designing technologies and services that is grounded in information from the stakeholders who will be using or impacted by them, and the contexts for implementation. The purpose of this article is to present user-centered design methods that can be applied to technology-enabled services for eating disorders. METHOD We provide an overview of the user-centered design process, which is iterative and involves stakeholders throughout. One model is presented that depicts six phases of a user-centered design process: investigate, ideate, prototype, evaluate, refine and develop, and validate. RESULTS We then review how user-centered design approaches can be applied to designing technology-enabled services for patients with eating disorders, and we integrate a hypothetical case example that demonstrates the application of these techniques to designing a technology-enabled service for binge eating. Most of the user-centered design techniques can be implemented relatively quickly, allowing us to rapidly learn what stakeholders want and to identify problems before devoting time and resources to developing and delivering technologies and services. DISCUSSION Through this work, we show how designing services that fit into the patterns and routines that stakeholders already are doing can ensure that services are relevant to stakeholders and meet their needs, potentially improving engagement and clinical impact. RESUMEN Los servicios habilitados tecnológicamente frecuentemente tienen un alcance limitado y un involucramiento subóptimo cuando son implementados en escenarios del mundo real. Una razón para estas fallas de implementación es que los servicios habilitados tecnológicamente no están diseñados para los usuarios y contextos en los que serán implementados. El diseño centrado en el usuario es un abordaje para diseñar tecnologías y servicios que está basado en información de las partes interesadas que estarán haciendo uso o impactados por ellos, y los contextos para implementación. El propósito de este estudio es presentar métodos de diseños centrados en el usuario que pueden ser aplicados a servicios habilitados tecnológicamente para trastornos de la conducta alimentaria. Ofrecemos una visión general del proceso de diseño centrado en el usuario, que es iterative e involucra a las partes interesadas a lo largo de todo el proceso. Hemos presentado un modelo que describe seis fases de un proceso de diseño centrado en el usuario: investigar, idear, crear prototipos, evaluar, refinar y desarrollar, y validar. Luego revisamos cómo estos abordajes de diseño centrado en el usuario pueden ser aplicados para diseñar servicios habilitados tecnológicamente para pacientes con trastornos de la conducta alimentaria, e integramos un ejemplo de caso hipotético que demuestra la aplicación de estas técnicas para diseñar un servicio habilitado tecnológicamente para comer en atracones. Muchas de las técnicas de diseño centrado en el usuario pueden ser implementadas relativamente rápido, lo que nos permite aprender rápidamente lo que las partes interesadas quieren e identificar los problemas antes de dedicarles tiempo y recursos al desarrollo y entrega de tecnologías y servicios. A través de este trabajo, mostramos cómo el diseño de servicios que se ajustan a los patrones y rutinas que las partes interesadas ya están haciendo puede garantizar que los servicios sean relevantes para los interesados y que satisfagan sus necesidades, lo que podría mejorar la participación y el impacto clínico.
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Affiliation(s)
- Andrea K. Graham
- Center for Behavioral Intervention Technologies, Northwestern University
- Department of Medical Social Sciences, Northwestern University
| | - Jennifer E. Wildes
- Department of Psychiatry & Behavioral Neuroscience, The University of Chicago
| | - Madhu Reddy
- Department of Communication Studies, Northwestern University
| | - Sean A. Munson
- Department of Human Centered Design & Engineering, University of Washington
| | - C. Barr Taylor
- Center for mHealth, Palo Alto University
- Department of Psychiatry, Stanford University
| | - David C. Mohr
- Center for Behavioral Intervention Technologies, Northwestern University
- Department of Preventive Medicine, Northwestern University
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Sadeh-Sharvit S. Use of Technology in the Assessment and Treatment of Eating Disorders in Youth. Child Adolesc Psychiatr Clin N Am 2019; 28:653-661. [PMID: 31443882 DOI: 10.1016/j.chc.2019.05.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
For countless young people, technology plays an essential role in their lives. However, its many advantages have not yet been widely applied to the treatment of youth with eating disorders. This article looks at how smartphone applications, Web conferencing, and other developments could widen the range of care available in a field where suitable support can be hard to find. Various barriers to treatment exist, such as cost, access, and the stigma attached to eating disorders, but existing and new technologies could overcome those obstacles, if clinicians are willing and able to meet the requirements associated with digitally enhanced treatment.
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Affiliation(s)
- Shiri Sadeh-Sharvit
- Baruch Ivcher School of Psychology, Interdisciplinary Center, Kanfei Nesharim 1, Herzliya 4610101, Israel; Center for m(2)Health, Palo Alto University, Palo Alto, CA, USA.
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56
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Barakat S, Maguire S, Smith KE, Mason TB, Crosby RD, Touyz S. Evaluating the role of digital intervention design in treatment outcomes and adherence to eTherapy programs for eating disorders: A systematic review and meta-analysis. Int J Eat Disord 2019; 52:1077-1094. [PMID: 31328815 DOI: 10.1002/eat.23131] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 06/14/2019] [Accepted: 06/19/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Despite the existence of reviews which document the effectiveness of online therapies, there is little consensus regarding the exact components of online treatment delivery that are most effective in maintaining user engagement and reducing eating disorder (ED) symptomology. The current review and meta-analysis aimed to determine which components of web-based, ED self-help interventions are associated with lower attrition and improved therapeutic outcome. METHOD A systematic search of electronic databases (PsycINFO, Medline, Web of Science, Scopus) was conducted for published studies of web-based interventions for EDs and a meta-analysis of the final included studies was performed. Each intervention was coded across four dimensions, including the multimedia channels employed (e.g., text, audio, videos), degree of user interactivity (e.g., online self-monitoring, skills exercises), level of automated feedback (e.g., reminders, personalized feedback), and technological device through which the program was accessed (e.g., smartphone, computer). RESULTS A final 23 papers were included. The results of meta-regressions indicated that higher scores on the multimedia subscale were associated with greater ED symptom improvement in treatment groups. Conversely, a higher degree of feedback in the treatment group was associated with a group difference in ED psychopathology favoring the control group. Other intervention components were not associated with treatment outcome or dropout. DISCUSSION The results are discussed in relation to limitations of the scale used to quantify digital intervention features, as well as the limited diversity and technological sophistication of available ED digital interventions. Such findings indicate the importance of understanding the digital components, which differentiate online therapeutic programs.
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Affiliation(s)
- Sarah Barakat
- School of Psychology, University of Sydney, Sydney, New South Wales, Australia
| | - Sarah Maguire
- InsideOut Institute for Eating Disorders, Boden Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Kathryn E Smith
- Center for Bio-behavioral Research, Sanford Research, Fargo, North Dakota.,Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota
| | - Tyler B Mason
- Department of Preventive Medicine, University of Southern California, Los Angeles, California
| | - Ross D Crosby
- Center for Bio-behavioral Research, Sanford Research, Fargo, North Dakota.,Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota
| | - Stephen Touyz
- School of Psychology, University of Sydney, Sydney, New South Wales, Australia
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57
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McLean SA, Caldwell B, Roberton M. Reach Out and Recover: Intentions to seek treatment in individuals using online support for eating disorders. Int J Eat Disord 2019; 52:1137-1149. [PMID: 31298791 DOI: 10.1002/eat.23133] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 06/19/2019] [Accepted: 06/21/2019] [Indexed: 01/19/2023]
Abstract
OBJECTIVE The aim of this study was to explore characteristics and treatment-seeking intentions of consumers accessing an online resource for eating disorders support, Reach Out and Recover (ROAR). Factors associated with treatment-seeking intent among visitors to ROAR were also examined. METHOD Participants were 200 visitors to the website aged 18 to 60 plus. The majority of participants (93.5%) identified as women. Responses to self-report questions assessing treatment-seeking intention, eating disorder symptoms and their impact on health, and attitudes to treatment were collected. RESULTS Participants experienced a range of eating disorder symptoms, yet the majority (86.0%) was not receiving treatment. Importantly, of those not in treatment, the majority (82.6%) indicated that they planned to get treatment. In addition, more than half of participants (52.9%) downloaded a report to present to their health practitioner to facilitate communication with a health professional. Intention to seek treatment and download of the report were positively associated with motivation to change, confidence to achieve change, greater frequency of binge eating, and greater recognition of the impact of eating disorder symptoms on relationships and well-being but not with stigma or ambivalence. DISCUSSION Study findings indicated that the ROAR website was accessed by individuals for whom it was designed, namely those experiencing eating disorder symptoms who are not receiving treatment. Encouragingly, participants had strong intentions to seek treatment, and the majority downloaded a report that could be used to facilitate the first step toward treatment. Greater focus on enhancing motivation and confidence to change may further promote treatment-seeking.
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Affiliation(s)
- Siân A McLean
- Institute for Health and Sport, Victoria University, Melbourne, Victoria, Australia.,School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia.,Victorian Centre of Excellence in Eating Disorders, Melbourne Health, Melbourne, Victoria, Australia
| | - Belinda Caldwell
- Victorian Centre of Excellence in Eating Disorders, Melbourne Health, Melbourne, Victoria, Australia
| | - Michelle Roberton
- Victorian Centre of Excellence in Eating Disorders, Melbourne Health, Melbourne, Victoria, Australia
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58
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Heesacker M, Perez C, Quinn MS, Benton S. Computer-assisted psychological assessment and psychotherapy for collegians. J Clin Psychol 2019; 76:952-972. [PMID: 31476251 DOI: 10.1002/jclp.22854] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE This article reviews research on computerized and computer-assisted psychological assessment and psychotherapy for college and university students. METHOD Published reviews of outcome research on the topic are reviewed, along with individual clinical trials and other relevant studies not covered by reviews, as well as reviews of closely-related research. RESULTS Computer-assisted assessment and psychotherapy have proven effective with collegians across samples, nations, and presenting concerns. CONCLUSIONS Currently-available digital technologies can address these mental health service delivery challenges: cost, limited human resources, failure of students to seek help, stigmatization of collegians seeking help, premature termination, inadequate process and outcome data to assess and improve treatment effectiveness, and lack of real-time data-based treatment selection.
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Affiliation(s)
- Martin Heesacker
- Department of Psychology, University of Florida, Gainesville, Florida
| | - Caroline Perez
- Department of Counseling Psychology and Community Services, University of North Dakota, Grand Forks, North Dakota
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59
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A randomized controlled trial of unguided internet cognitive behaviour therapy for perfectionism in adolescents: Impact on risk for eating disorders. Behav Res Ther 2019; 120:103429. [DOI: 10.1016/j.brat.2019.103429] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 05/29/2019] [Accepted: 06/17/2019] [Indexed: 12/31/2022]
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60
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Rohrbach PJ, Dingemans AE, Spinhoven P, Van den Akker-Van Marle E, Van Ginkel JR, Fokkema M, Moessner M, Bauer S, Van Furth EF. A randomized controlled trial of an Internet-based intervention for eating disorders and the added value of expert-patient support: study protocol. Trials 2019; 20:509. [PMID: 31420063 PMCID: PMC6697984 DOI: 10.1186/s13063-019-3574-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 07/12/2019] [Indexed: 12/24/2022] Open
Abstract
Background E-mental health has become increasingly popular in interventions for individuals with eating disorders (EDs). It has the potential to offer low-threshold interventions and guide individuals to the needed care more promptly. Featback is such an Internet-based intervention and consists of psychoeducation and a fully automated monitoring and feedback system. Preliminary findings suggest Featback to be (cost-)effective in reducing ED symptomatology. Additionally, e-mail or chat support by a psychologist did not enhance the effectiveness of Featback. Support by an expert patient (someone with a lived experience of an ED) might be more effective, since that person can effectively model healthy behavior and enhance self-efficacy in individuals struggling with an ED. The present study aims to replicate and build on earlier findings by further investigating the (cost-)effectiveness of Featback and the added value of expert-patient support. Methods The study will be a randomized controlled trial with a two-by-two factorial design with repeated measures. The four conditions will be (1) Featback, in which participants receive automated feedback on a short monitoring questionnaire weekly, (2) Featback with weekly e-mail or chat support from an expert patient, (3) weekly support from an expert patient, and (4) a waiting list. Participants who are 16 years or older and have at least mild self-reported ED symptoms receive a baseline measure. Subsequently, they are randomized to one of the four conditions for 8 weeks. Participants will be assessed again post-intervention and at 3, 6, 9, and 12 months follow-up. The primary outcome measure will be ED psychopathology. Secondary outcome measures are experienced social support, self-efficacy, symptoms of anxiety and depression, user satisfaction, intervention usage, and help-seeking attitudes and behaviors. Discussion The current study is the first to investigate e-mental health in combination with expert-patient support for EDs and will add to the optimization of the delivery of Internet-based interventions and expert-patient support. Trial registration Netherlands Trial Register, NTR7065. Registered on 7 June 2018. Electronic supplementary material The online version of this article (10.1186/s13063-019-3574-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Pieter J Rohrbach
- GGZ Rivierduinen Eetstoornissen Ursula, Postbox 405, Sandifortdreef 19, 2300 AK, Leiden, the Netherlands.
| | - Alexandra E Dingemans
- GGZ Rivierduinen Eetstoornissen Ursula, Postbox 405, Sandifortdreef 19, 2300 AK, Leiden, the Netherlands.,Institute of Psychology, Leiden University, Leiden, the Netherlands
| | - Philip Spinhoven
- Institute of Psychology, Leiden University, Leiden, the Netherlands.,Department of Psychiatry, Leiden University Medical Center, Leiden, the Netherlands
| | - Elske Van den Akker-Van Marle
- Department of Biomedical Data Sciences, Section Medical Decision Making, Leiden University Medical Center, Leiden, the Netherlands
| | | | | | - Markus Moessner
- Center for Psychotherapy Research, University of Heidelberg, Heidelberg, Germany
| | - Stephanie Bauer
- Center for Psychotherapy Research, University of Heidelberg, Heidelberg, Germany
| | - Eric F Van Furth
- GGZ Rivierduinen Eetstoornissen Ursula, Postbox 405, Sandifortdreef 19, 2300 AK, Leiden, the Netherlands.,Department of Psychiatry, Leiden University Medical Center, Leiden, the Netherlands
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61
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Mehl A, Rohde P, Gau JM, Stice E. Disaggregating the predictive effects of impaired psychosocial functioning on future DSM-5 eating disorder onset in high-risk female adolescents. Int J Eat Disord 2019; 52:817-824. [PMID: 30977531 PMCID: PMC6609485 DOI: 10.1002/eat.23082] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 03/27/2019] [Accepted: 03/27/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Impaired psychosocial functioning previously emerged as the only risk factor to predict future onset of each of the four Diagnostic and Statistical Manual of Mental Disorder (5th ed.) (DSM-5) eating disorders. The goal of this follow-up report was to refine understanding of this newly identified risk factor. METHOD Combining data from women at risk for eating disorders because of body image concerns (N = 1,153, mean age = 18.5 years, SD = 4.2), we investigated which subdomain(s) and individual item(s) of psychosocial functioning (friends, family, school, and work) at baseline predicted onset of any eating disorder, using Cox regression (CRA) and classification tree analysis (CTA). RESULTS Psychosocial impairment with friends, family, and at school, but not at work, significantly increased risk for disorder onset over 3-year follow-up in univariate models. A one-unit increase in each domain raw score was associated with a 107, 22, and 43% increased hazard of eating disorder onset, respectively. Multivariate CRA found friends functioning, with a 92% increased hazard of disorder onset, contributed the strongest unique effect. CTA suggested that loneliness was the most potent risk factor with a threefold increased onset risk (eating disorder incidence for high vs. low scorers was 27 and 8%). Three friends functioning items and one school functioning item produced additional CTA branches. DISCUSSION Results refine understanding of the relation of psychosocial impairment to future onset of eating disorders, suggesting that peer functioning is the most critical. Data imply it would be useful to target young women with impaired psychosocial functioning in prevention programs.
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Affiliation(s)
- Annette Mehl
- Institute of Psychology, University of Heidelberg, Hauptstraße 47-51, 69120 Heidelberg, Germany
| | - Paul Rohde
- Oregon Research Institute, 1776 Millrace Drive, Eugene Oregon, 97403, USA
| | - Jeff M. Gau
- Oregon Research Institute, 1776 Millrace Drive, Eugene Oregon, 97403, USA
| | - Eric Stice
- Oregon Research Institute, 1776 Millrace Drive, Eugene Oregon, 97403, USA
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62
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Bauer S, Bilić S, Ozer F, Moessner M. Dissemination of an Internet-Based Program for the Prevention and Early Intervention in Eating Disorders. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2019; 48:25-32. [PMID: 31050585 DOI: 10.1024/1422-4917/a000662] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Objective: Research on the dissemination of e-mental health interventions is in an early stage, so that little is known about the reach, costs, participant characteristics, and patterns of program utilization associated with different recruitment strategies and access paths. This study investigated differences between user groups informed about an Internet-based program for the prevention and early intervention in eating disorders via different recruitment channels. Method: Participant characteristics and user behavior of 3548 participants in the Internet-based program ProYouth were analyzed. Participants were informed about ProYouth via different channels (e. g., print materials, high school, Internet). Results: Results indicate significant relationships between access paths and both user characteristics and program utilization. Participants who were informed about ProYouth at their high schools were more likely to be male, younger, and at lower risk of developing eating disorders. In contrast, other recruitment channels (e. g., Internet, print materials) resulted in participants with significantly higher risk and symptom levels who used the program more frequently and with higher intensity. Conclusion: Efforts aimed at the dissemination of Internet-based interventions should consider the effects that different recruitment channels and access paths may have on sample composition and utilization of the intervention.
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Affiliation(s)
- Stephanie Bauer
- Center for Psychotherapy Research, University Hospital Heidelberg, Germany
| | - Sally Bilić
- Center for Psychotherapy Research, University Hospital Heidelberg, Germany
| | - Fikret Ozer
- Center for Psychotherapy Research, University Hospital Heidelberg, Germany
| | - Markus Moessner
- Center for Psychotherapy Research, University Hospital Heidelberg, Germany
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63
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Sherman KA, Roper T, Kilby CJ. Enhancing self-compassion in individuals with visible skin conditions: randomised pilot of the 'My Changed Body' self-compassion writing intervention. Health Psychol Behav Med 2019; 7:62-77. [PMID: 34040839 PMCID: PMC8114345 DOI: 10.1080/21642850.2019.1587298] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Background: Abnormalities in the appearance of skin are commonly associated with compromised self-body perceptions, arising from physical manifestations of the skin condition that deviate from the individual's idealised body image. These body image concerns are associated with a range of psychological issues including anxiety, depression, fear of negative evaluation, and suicidal ideation. Unfortunately, stigma and embarrassment associated with these body image concerns mean that these issues are rarely discussed in clinical medical consultations. There is thus a need for highly accessible and acceptable interventions to address skin-related body image concerns. We have previously demonstrated that a web-based self-compassion focused therapeutic writing approach, the 'My Changed Body' intervention, is efficacious in addressing body image concerns of women in the breast cancer context. The aim of this experimental pilot study was to investigate the feasibility of applying the My Changed Body intervention to address visible skin-related body image concerns. Methods: Participants (N = 50) with a range of visible skin conditions provided online informed consent, then completed measures of demographic and medical history, body image disturbance, self-compassion and positive and negative affect. They were then randomly allocated either to an active control expressive writing condition (n = 25) or to the My Changed Body writing condition (n = 25). Participants were blind to their condition allocation. Immediately after completing their allocated writing exercise, participants completed self-compassion and affect measures. Results: Controlling for pre-writing body image disturbance, repeated measures ANCOVAs with fixed effects revealed that self-compassion and negative affect significantly improved after the My Changed Body writing exercise, compared to the control condition. There was no between groups difference at follow-up in positive affect. Conclusions: This study suggests that the My Changed Body writing intervention may provide benefit to individuals with visible skin conditions. A randomised controlled trial is needed to further confirm these results.
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Affiliation(s)
- Kerry A Sherman
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, Australia
| | - Tegan Roper
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, Australia
| | - Christopher Jon Kilby
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, Australia
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64
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Rodgers RF, Donovan E, Cousineau TM, McGowan K, Yates K, Cook E, Lowy AS, Franko DL. Ethnic and racial diversity in eating disorder prevention trials. Eat Disord 2019; 27:168-182. [PMID: 31084423 DOI: 10.1080/10640266.2019.1591824] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Recruiting diverse samples for prevention trials is challenging, but essential. This paper provides baseline data for four racial/ethnic groups from a randomized controlled trial of a mobile-based prevention intervention and systematically reviews recruitment trends in diversity across technology-based prevention studies. Female emerging adults completed measures of appearance esteem, body image flexibility, appearance comparison, and self-compassion. White participants reported lower body esteem and body image flexibility, and higher appearance comparison compared to Black and Asian participants. Latina participants evidenced higher appearance comparison compared to Black participants. The literature review revealed that while rates of diversity in previous trials vary, the majority of the participants were White. Efforts are needed to increase diversity in prevention trials.
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Affiliation(s)
- Rachel F Rodgers
- a APPEAR, Department of Applied Psychology , Northeastern University , Boston , MA , USA.,b Department of Psychiatric Emergency & Acute Care , Lapeyronie Hospital, CHRU Montpellier , Montpellier , France
| | | | | | | | - Kayla Yates
- a APPEAR, Department of Applied Psychology , Northeastern University , Boston , MA , USA
| | - Elizabeth Cook
- a APPEAR, Department of Applied Psychology , Northeastern University , Boston , MA , USA
| | - Alice S Lowy
- a APPEAR, Department of Applied Psychology , Northeastern University , Boston , MA , USA
| | - Debra L Franko
- a APPEAR, Department of Applied Psychology , Northeastern University , Boston , MA , USA
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Bauer S, Bilić S, Reetz C, Ozer F, Becker K, Eschenbeck H, Kaess M, Rummel-Kluge C, Salize HJ, Diestelkamp S, Moessner M. Efficacy and cost-effectiveness of Internet-based selective eating disorder prevention: study protocol for a randomized controlled trial within the ProHEAD Consortium. Trials 2019; 20:91. [PMID: 30700318 PMCID: PMC6354385 DOI: 10.1186/s13063-018-3161-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 12/22/2018] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The development of efficacious, cost-effective, and widely accessible programs for the prevention of eating disorders (EDs) is crucial in order to reduce the ED-related burden of illness. Programs using dissonance-based and cognitive behavioral approaches are most effective for the selective prevention of ED. Internet-based delivery is assumed to maximize the reach and impact of preventive efforts. However, the current evidence for Internet-based ED prevention is limited. The present trial evaluates the efficacy and cost-effectiveness of two new interventions (based on dissonance theory and principles of cognitive behavioral therapy (CBT)) that are implemented as add-ons to the existing Internet-based ED prevention program ProYouth. METHODS The trial is one of five sub-projects of the German multicenter consortium ProHEAD. It is a three-arm, parallel, randomized controlled superiority trial. Participants will be randomized to (1) the online program ProYouth (active control condition) or (2) ProYouth plus a structured dissonance-based module or (3) ProYouth plus a CBT-based chat group intervention. As part of ProHEAD, a representative school-based sample of N = 15,000 students (≥ 12 years) will be screened for mental health problems. N = 309 participants at risk for ED (assessed with the Weight Concerns Scale (WCS) and the Short Evaluation of Eating Disorders (SEED)) will be included in the present trial. Online assessments will be conducted at baseline, at end of intervention (6 weeks), at 6 months follow-up, and - as part of ProHEAD - at 12 and 24 months follow-up. The primary outcome is ED-related impairment (assessed with the Child version of the Eating Disorder Examination-Questionnaire (ChEDE-Q)) at the end of the intervention. Secondary outcomes include ED-related symptomatology at follow-up, ED-related stigma, ED-related help-seeking, and acceptance of and compliance with the interventions. For the health economic evaluation data on costs of the interventions, healthcare utilization and health-related quality of life will be assessed. DISCUSSION This is the first study augmenting a flexible prevention approach such as ProYouth with structured evidence-based modules in order to overcome some of the key limitations in the current practice of ED prevention. TRIAL REGISTRATION German Clinical Trials Register (DRKS), DRKS00014679 . Registered on 25 April 2018.
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Affiliation(s)
- Stephanie Bauer
- Center for Psychotherapy Research, University Hospital Heidelberg, Bergheimerstr. 54, 69115 Heidelberg, Germany
| | - Sally Bilić
- Center for Psychotherapy Research, University Hospital Heidelberg, Bergheimerstr. 54, 69115 Heidelberg, Germany
| | - Christina Reetz
- Center for Psychotherapy Research, University Hospital Heidelberg, Bergheimerstr. 54, 69115 Heidelberg, Germany
| | - Fikret Ozer
- Center for Psychotherapy Research, University Hospital Heidelberg, Bergheimerstr. 54, 69115 Heidelberg, Germany
| | - Katja Becker
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Philipps-University Marburg and Marburg Center for Mind, Brain and Behavior (MCMBB), Philipps-University Marburg, Marburg, Germany
| | - Heike Eschenbeck
- Department of Psychology, University of Education Schwäbisch Gmünd, Oberbettringer Str. 200, 73525 Schwäbisch Gmünd, Germany
| | - Michael Kaess
- Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, University Hospital Heidelberg, Blumenstraße 8, 69115 Heidelberg, Germany
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bolligenstr. 111, Stöckli, 3000 Bern 60, Switzerland
| | - Christine Rummel-Kluge
- Department of Psychiatry and Psychotherapy, Medical Faculty, Leipzig University, Semmelweisstraße 10, 04103 Leipzig, Germany
| | - Hans-Joachim Salize
- Mental Health Services Research Group, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, J5, 68159 Mannheim, Germany
| | - Silke Diestelkamp
- German Center for Addiction Research in Childhood and Adolescence, University Medical Center Hamburg-Eppendorf, Martinistr. 52, W29, 20246 Hamburg, Germany
| | - Markus Moessner
- Center for Psychotherapy Research, University Hospital Heidelberg, Bergheimerstr. 54, 69115 Heidelberg, Germany
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Šmahelová M, Čevelíček M, Nehybková E, Šmahel D, Čermák I. Is it Important to Talk About Technologies with Eating Disorder Clients? The Health-Care Professional Perspective. HEALTH COMMUNICATION 2019; 34:31-38. [PMID: 29028370 DOI: 10.1080/10410236.2017.1384354] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Nowadays, the use of digital technology is an important issue that should be addressed during the treatment of people who have eating disorders. The involvement or absence of this issue reflects the understanding, experience, and atttude of health-care professionals toward their clients' use of technology. The aim of the present study was to investigate the perceptions of health-care professionals and their assessment of their clients' usage of digital technology while developing strategies for treatment. Semistructured interviews with 30 professionals were performed from October 2015 to June 2016 and a thematic analysis was used to analyze the data. The health-care professionals' views could be summarized in three thematic groups: (1) technology use is not relevant for the cooperation; (2) technology use is relevant for the cooperation and addressed generally; and (3) technology use is relevant for the cooperation and addressed specifically. The results are discussed in relation to the theoretical model presented by Rodgers about the impact of technology on disordered eating behaviors and the implications for practice.
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Affiliation(s)
- Martina Šmahelová
- a Faculty of Social Studies, Institute for Research on Children, Youth and Families , Masaryk University
| | - Michal Čevelíček
- a Faculty of Social Studies, Institute for Research on Children, Youth and Families , Masaryk University
| | - Eliška Nehybková
- a Faculty of Social Studies, Institute for Research on Children, Youth and Families , Masaryk University
| | - David Šmahel
- a Faculty of Social Studies, Institute for Research on Children, Youth and Families , Masaryk University
| | - Ivo Čermák
- a Faculty of Social Studies, Institute for Research on Children, Youth and Families , Masaryk University
- b Department of Methodology , Czech Academy of Sciences, Institute of Psychology
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Ebert DD, Harrer M, Apolinário-Hagen J, Baumeister H. Digital Interventions for Mental Disorders: Key Features, Efficacy, and Potential for Artificial Intelligence Applications. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1192:583-627. [PMID: 31705515 DOI: 10.1007/978-981-32-9721-0_29] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Mental disorders are highly prevalent and often remain untreated. Many limitations of conventional face-to-face psychological interventions could potentially be overcome through Internet-based and mobile-based interventions (IMIs). This chapter introduces core features of IMIs, describes areas of application, presents evidence on the efficacy of IMIs as well as potential effect mechanisms, and delineates how Artificial Intelligence combined with IMIs may improve current practices in the prevention and treatment of mental disorders in adults. Meta-analyses of randomized controlled trials clearly show that therapist-guided IMIs can be highly effective for a broad range of mental health problems. Whether the effects of unguided IMIs are also clinically relevant, particularly under routine care conditions, is less clear. First studies on IMIs for the prevention of mental disorders have shown promising results. Despite limitations and challenges, IMIs are increasingly implemented into routine care worldwide. IMIs are also well suited for applications of Artificial Intelligence and Machine Learning, which provides ample opportunities to improve the identification and treatment of mental disorders. Together with methodological innovations, these approaches may also deepen our understanding of how psychological interventions work, and why. Ethical and professional restraints as well as potential contraindications of IMIs, however, should also be considered. In sum, IMIs have a high potential for improving the prevention and treatment of mental health disorders across various indications, settings, and populations. Therefore, implementing IMIs into routine care as both adjunct and alternative to face-to-face treatment is highly desirable. Technological advancements may further enhance the variability and flexibility of IMIs, and thus even further increase their impact in people's lives in the future.
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Affiliation(s)
- David Daniel Ebert
- Department of Clinical Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1881 BT, Amsterdam, The Netherlands.
| | - Mathias Harrer
- Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | | | - Harald Baumeister
- Clinical Psychology and Psychotherapy, University of Ulm, Ulm, Germany
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Domhardt M, Steubl L, Baumeister H. Internet- and Mobile-Based Interventions for Mental and Somatic Conditions in Children and Adolescents. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2018; 48:33-46. [PMID: 30422059 DOI: 10.1024/1422-4917/a000625] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
This meta-review integrates the current meta-analysis literature on the efficacy of internet- and mobile-based interventions (IMIs) for mental disorders and somatic diseases in children and adolescents. Further, it summarizes the moderators of treatment effects in this age group. Using a systematic literature search of PsycINFO and MEDLINE/PubMed, we identified eight meta-analyses (N = 8,417) that met all inclusion criteria. Current meta-analytical evidence of IMIs exists for depression (range of standardized mean differences, SMDs = .16 to .76; 95 % CI: -.12 to 1.12; k = 3 meta-analyses), anxiety (SMDs = .30 to 1.4; 95 % CI: -.53 to 2.44; k = 5) and chronic pain (SMD = .41; 95 % CI: .07 to .74; k = 1) with predominantly nonactive control conditions (waiting-list; placebo). The effect size for IMIs across mental disorders reported in one meta-analysis is SMD = 1.27 (95 % CI: .96 to 1.59; k = 1), the effect size of IMIs for different somatic conditions is SMD = .49 (95 % CI: .33 to .64; k = 1). Moderators of treatment effects are age (k = 3), symptom severity (k = 1), and source of outcome assessment (k = 1). Quality ratings with the AMSTAR-2-checklist indicate acceptable methodological rigor of meta-analyses included. Taken together, this meta-review suggests that IMIs are efficacious in some health conditions in youths, with evidence existing primarily for depression and anxiety so far. The findings point to the potential of IMIs to augment evidence based mental healthcare for children and adolescents.
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Affiliation(s)
- Matthias Domhardt
- Department of Clinical Psychology and Psychotherapy, University of Ulm, Germany
| | - Lena Steubl
- Department of Clinical Psychology and Psychotherapy, University of Ulm, Germany
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, University of Ulm, Germany
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Abstract
PURPOSE OF REVIEW Internet prevention of eating disorders is a relatively new field that is expanding rapidly. We review randomized controlled trial designs examining the efficacy of Internet prevention in eating disorders that have emerged from 2016. RECENT FINDINGS Our literature search identified five studies that used randomized controlled trial designs to examine the efficacy of Internet prevention in eating disorders. All of the studies represented indicated prevention, that is, young women who have body image concerns. Three specific approaches were examined: media literacy, cognitive dissonance, and cognitive behavior therapy. All studies indicated significantly more impact of the intervention than a control condition, with between group effect sizes at follow-up ranging from 0.24 to 0.42. SUMMARY Although Internet interventions for eating disorders may be less effective than face-to-face interventions, and attrition increases when populations are used that reflect real-world usage, these interventions have an important role in a stepped-care approach. Future research should make direct comparisons of different Internet programs with a view to helping us understand who will gain most benefit out of which approach, including who requires moderated Internet approaches and who does not.
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Wilksch SM, O'Shea A, Taylor CB, Wilfley D, Jacobi C, Wade TD. Online prevention of disordered eating in at-risk young-adult women: a two-country pragmatic randomized controlled trial. Psychol Med 2018; 48:2034-2044. [PMID: 29233196 PMCID: PMC6171351 DOI: 10.1017/s0033291717003567] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Disordered eating (DE) is a widespread, serious problem. Efficacious prevention programs that can be delivered at-scale are needed. METHODS A pragmatic randomized controlled trial of two online programs was conducted. Participants were young-adult women from Australia and New Zealand seeking to improve their body image. Media Smart-Targeted (MS-T) and Student Bodies (SB) were both 9-module interventions released weekly, whilst control participants received positive body image information. Primary [Eating Disorder Examination-Questionnaire (EDE-Q) Global], secondary (DE risk factors) and tertiary (DE) outcome measures were completed at baseline, post-program, 6- and 12-month follow-up. RESULTS Baseline was completed by 608 women (M age = 20.71 years); 33 were excluded leaving 575 randomized to: MS-T (N = 191); SB (N = 190) or control (N = 194). Only 66% of those randomized to MS-T or SB accessed the intervention and were included in analyses with controls; 78% of this sample completed measures subsequent to baseline. Primary intent-to-treat (ITT) analyses revealed no differences between groups, while measure completer analyses found MS-T had significantly lower EDE-Q Global than controls at 12-month follow-up. Secondary ITT analyses found MS-T participants reported significantly higher quality of life-mental relative to both SB and controls (6-month follow-up), while MS-T and controls had lower clinical impairment relative to SB (post-program). Amongst measure completers, MS-T scored significantly lower than controls and SB on 5 variables. Of those with baseline DE, MS-T participants were significantly less likely than controls to have DE at 12-month follow-up. CONCLUSIONS Given both programs were not therapist-moderated, MS-T has potential to achieve reductions in DE risk at low implementation costs.
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Affiliation(s)
- Simon M Wilksch
- School of Psychology,Flinders University,South Australia,Australia
| | - Anne O'Shea
- School of Psychology,Flinders University,South Australia,Australia
| | - C Barr Taylor
- Department of Psychiatry,Stanford University Medical Center,Stanford,California,USA
| | - Denise Wilfley
- Department of Psychology,Washington University in St. Louis,St. Louis,Missouri,USA
| | - Corinna Jacobi
- Institute of Clinical Psychology and Psychotherapy,Technische Universität Dresden,Dresden,Germany
| | - Tracey D Wade
- School of Psychology,Flinders University,South Australia,Australia
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Apolinário-Hagen J, Harrer M, Kählke F, Fritsche L, Salewski C, Ebert DD. Public Attitudes Toward Guided Internet-Based Therapies: Web-Based Survey Study. JMIR Ment Health 2018; 5:e10735. [PMID: 29764797 PMCID: PMC5974457 DOI: 10.2196/10735] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 05/03/2018] [Accepted: 05/03/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Internet interventions have been proposed to improve the accessibility and use of evidence-based psychological treatments. However, little is known about attitudes toward such treatments, which can be an important barrier to their use. OBJECTIVE This study aimed to (1) determine attitudes toward guided internet interventions, (2) assess its acceptability compared with other internet-based formats, and (3) explore predictors of acceptance. METHODS A convenience-sample Web-based survey (N=646) assessed attitudes toward guided internet therapies (ie, perceived usefulness and helpfulness, and advantage relative to face-to-face therapy), preferences for delivery modes (ie, e-preference: guided internet interventions, unguided internet interventions, or videoconferencing psychotherapy), and potential predictors of attitudes and preferences: sociodemographics, help-seeking-related variables, attachment style, and perceived stress. RESULTS Although most participants perceived internet interventions as useful or helpful (426/646, 65.9%), a few indicated their advantage relative to face-to-face therapy (56/646, 8.7%). Most participants preferred guided internet interventions (252/646, 39.0%) over videoconferencing psychotherapy (147/646, 22.8%), unguided internet interventions (124/646, 19.2%), and not using internet interventions (121/646, 18.8%; missing data: 1/646, 0.2%). Attachment avoidance and stress were related to e-preference (all P<.05). Moreover, preference for therapist-guided internet interventions was higher for individuals who were aware of internet-based treatment (χ26=12.8; P=.046). CONCLUSIONS Participants assessed therapist-guided internet interventions as helpful, but not equivalent to face-to-face therapies. The vast majority (523/646, 81.0%) of the participants were potentially willing to use internet-based approaches. In lieu of providing patients with only one specific low-intensity treatment, implementation concepts should offer several options, including guided internet interventions, but not limited to them. Conversely, our results also indicate that efforts should focus on increasing public knowledge about internet interventions, including information about their effectiveness, to promote acceptance and uptake.
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Affiliation(s)
| | - Mathias Harrer
- Department of Clinical Psychology and Psychotherapy, Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Fanny Kählke
- Department of Clinical Psychology and Psychotherapy, Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Lara Fritsche
- Institute of Psychology, Department of Health Psychology, University of Hagen, Hagen, Germany
| | - Christel Salewski
- Institute of Psychology, Department of Health Psychology, University of Hagen, Hagen, Germany
| | - David Daniel Ebert
- Department of Clinical Psychology and Psychotherapy, Alexander-University Erlangen-Nuremberg, Erlangen, Germany
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Ebert DD, Van Daele T, Nordgreen T, Karekla M, Compare A, Zarbo C, Brugnera A, Øverland S, Trebbi G, Jensen KL, Kaehlke F, Baumeister H. Internet- and Mobile-Based Psychological Interventions: Applications, Efficacy, and Potential for Improving Mental Health. EUROPEAN PSYCHOLOGIST 2018. [DOI: 10.1027/1016-9040/a000318] [Citation(s) in RCA: 207] [Impact Index Per Article: 34.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Abstract. The majority of mental health disorders remain untreated. Many limitations of traditional psychological interventions such as limited availability of evidence-based interventions and clinicians could potentially be overcome by providing Internet- and mobile-based psychological interventions (IMIs). This paper is a report of the Taskforce E-Health of the European Federation of Psychologists’ Association and will provide an introduction to the subject, discusses areas of application, and reviews the current evidence regarding the efficacy of IMIs for the prevention and treatment of mental disorders. Meta-analyses based on randomized trials clearly indicate that therapist-guided stand-alone IMIs can result in meaningful benefits for a range of indications including, for example, depression, anxiety, insomnia, or posttraumatic stress disorders. The clinical significance of results of purely self-guided interventions is for many disorders less clear, especially with regard to effects under routine care conditions. Studies on the prevention of mental health disorders (MHD) are promising. Blended concepts, combining traditional face-to-face approaches with Internet- and mobile-based elements might have the potential of increasing the effects of psychological interventions on the one hand or to reduce costs of mental health treatments on the other hand. We also discuss mechanisms of change and the role of the therapist in such approaches, contraindications, potential limitations, and risk involved with IMIs, briefly review the status of the implementation into routine health care across Europe, and discuss confidentiality as well as ethical aspects that need to be taken into account, when implementing IMIs. Internet- and mobile-based psychological interventions have high potential for improving mental health and should be implemented more widely in routine care.
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Affiliation(s)
- David D. Ebert
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University of Erlangen-Nürnberg, Erlangen, Germany
| | - Tom Van Daele
- Department of Applied Psychology, Thomas More University of Applied Sciences, Antwerp, Belgium
| | - Tine Nordgreen
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Maria Karekla
- Department of Psychology, University of Cyprus, Nicosia, Republic of Cyprus
| | - Angelo Compare
- Human Factors and Technology in Healthcare, University of Bergamo, Bergamo, BG, Italy
| | - Cristina Zarbo
- Department of Human and Social Science, University of Bergamo, Bergamo, Italy
| | - Agostino Brugnera
- Department of Human and Social Science, University of Bergamo, Bergamo, Italy
| | | | - Glauco Trebbi
- Trebbipsicologie, Luxembourg & Societé Luxembourgeoise de Psychologie SLP, Luxembourg
| | | | - Fanny Kaehlke
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University of Erlangen-Nürnberg, Erlangen, Germany
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, University of Ulm, Germany
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Čevelíček M, Šmahelová M, Šmahel D. Professionals’ Reflections About the Impact of Digital Technologies on Eating Disorders. BASIC AND APPLIED SOCIAL PSYCHOLOGY 2018. [DOI: 10.1080/01973533.2018.1446833] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Melioli T, Rispal M, Hart LM, Chabrol H, Rodgers RF. French mental health first aid guidelines for eating disorders: an exploration of user characteristics and usefulness among college students. Early Interv Psychiatry 2018; 12:229-233. [PMID: 27578164 DOI: 10.1111/eip.12369] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 04/13/2016] [Accepted: 06/12/2016] [Indexed: 11/28/2022]
Abstract
AIM The literature has highlighted that strategies to increase appropriate and timely treatment seeking for eating disorders (EDs) are needed. The aim of this study was to use the Internet to disseminate guidelines for providing first aid to individuals suffering from ED among college students. METHODS Users were invited to complete two surveys: an initial one assessing user characteristics and, 28 days later, a questionnaire assessing the perceived usefulness of the guidelines. A sample of 651 college students (M age = 22, standard deviation (SD) = 3.9) responded to the first questionnaire and 50 completed the second questionnaire (M age = 22.2, SD = 2.6). RESULTS The guidelines were downloaded 1174 times and 56% of users reported finding them useful. CONCLUSIONS College students might be particularly interested in learning more about ED and the guidelines could be valuable to address the gap in available resources for ED-related mental health literacy.
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Affiliation(s)
- Tiffany Melioli
- Center of study and research on psychopatology and health psychology (CERPPS), Toulouse, France
| | - Magali Rispal
- Center of study and research on psychopatology and health psychology (CERPPS), Toulouse, France
| | - Laura M Hart
- Population Mental Health Group, Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia.,School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Henri Chabrol
- Center of study and research on psychopatology and health psychology (CERPPS), Toulouse, France
| | - Rachel F Rodgers
- Department of Counseling and Applied Educational Psychology, Northeastern University, Boston, Massachusetts, USA
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Vollert B, Beintner I, Musiat P, Gordon G, Görlich D, Nacke B, Schmidt-Hantke J, Potterton R, Spencer L, Grant N, Schmidt U, Jacobi C. Using internet-based self-help to bridge waiting time for face-to-face outpatient treatment for Bulimia Nervosa, Binge Eating Disorder and related disorders: Study protocol of a randomized controlled trial. Internet Interv 2018; 16:26-34. [PMID: 30775262 PMCID: PMC6364326 DOI: 10.1016/j.invent.2018.02.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 02/19/2018] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Eating disorders are serious conditions associated with an impaired health-related quality of life and increased healthcare utilization and costs. Despite the existence of evidence-based treatments, access to treatment is often delayed due to insufficient health care resources. Internet-based self-help interventions may have the potential to successfully bridge waiting time for face-to-face outpatient treatment and, thus, contribute to overcoming treatment gaps. However, little is known about the feasibility of implementing such interventions into routine healthcare. The aim of this study is to analyze the effects and feasibility of an Internet-based self-help intervention (everyBody Plus) specifically designed for patients with Bulimia Nervosa, Binge Eating Disorder and other specified feeding and eating disorders (OSFED) on a waiting list for outpatient face-to-face treatment. The aim of this paper is to describe the study protocol. METHODS A multi-country randomized controlled trial will be conducted in Germany and the UK. N = 275 female patients awaiting outpatient treatment will be randomly allocated either to the guided online self-help intervention "everyBody Plus" or a waitlist control group condition without access to the intervention. everyBody Plus comprises eight weekly sessions that cover topics related to eating and exercise patterns, coping with negative emotions and stress as well as improving body image. Participants will receive weekly individualized feedback based on their self-monitoring and journal entries. Assessments will take place at baseline, post-intervention as well as at 6- and 12-months follow up. In addition, all participants will be asked to monitor core eating disorder symptoms weekly to provide data on the primary outcome. The primary outcome will be number of weeks after randomization until a patient achieves a clinically relevant improvement in core symptoms (BMI, binge eating, compensatory behaviors) for the first time. Secondary outcomes include frequency of core symptoms and eating disorder related attitudes and behaviors, as well as associated psychopathology. Additional secondary outcomes will be the participating therapists' confidence in treating eating disorders as well as perceived benefits of everyBody Plus for patients. DISCUSSION To the best of our knowledge, this is the first randomized controlled trial examining the effects of Internet-based self-help for outpatients with eating disorders awaiting face-to-face outpatient treatment. If proven to be effective and successfully implemented, Internet-based self-help programs might be used as a first step of treatment within a stepped-care approach, thus reducing burden and cost for both patients and health care providers.
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Affiliation(s)
- Bianka Vollert
- Technische Universität Dresden, Institut für Klinische Psychologie und Psychotherapie, Chemnitzer Str. 46, D-01187 Dresden, Germany,Corresponding author.
| | - Ina Beintner
- Technische Universität Dresden, Institut für Klinische Psychologie und Psychotherapie, Chemnitzer Str. 46, D-01187 Dresden, Germany
| | - Peter Musiat
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Box P059, De Crespigny Park, London SE5 8AF, UK
| | - Gemma Gordon
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Box P059, De Crespigny Park, London SE5 8AF, UK
| | - Dennis Görlich
- Westfälische Wilhelms-Universität Münster, Institute of Biostatistics and Clinical Research, Schmeddingstraße 56, Münster, Germany
| | - Barbara Nacke
- Technische Universität Dresden, Institut für Klinische Psychologie und Psychotherapie, Chemnitzer Str. 46, D-01187 Dresden, Germany
| | - Juliane Schmidt-Hantke
- Technische Universität Dresden, Institut für Klinische Psychologie und Psychotherapie, Chemnitzer Str. 46, D-01187 Dresden, Germany
| | - Rachel Potterton
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Box P059, De Crespigny Park, London SE5 8AF, UK
| | - Lucy Spencer
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Box P059, De Crespigny Park, London SE5 8AF, UK
| | - Nina Grant
- South London and Maudsley NHS Foundation Trust, Eating Disorders Outpatient Unit, The Maudsley Hospital, Denmark Hill, London SE5 8AF, UK
| | - Ulrike Schmidt
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Box P059, De Crespigny Park, London SE5 8AF, UK
| | - Corinna Jacobi
- Technische Universität Dresden, Institut für Klinische Psychologie und Psychotherapie, Chemnitzer Str. 46, D-01187 Dresden, Germany
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Nacke B, Beintner I, Görlich D, Vollert B, Schmidt-Hantke J, Hütter K, Taylor CB, Jacobi C. everyBody-Tailored online health promotion and eating disorder prevention for women: Study protocol of a dissemination trial. Internet Interv 2018; 16:20-25. [PMID: 30775261 PMCID: PMC6364518 DOI: 10.1016/j.invent.2018.02.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 02/19/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Although there is extensive evidence for the efficacy of online eating disorder (ED) prevention programs in clinical trials, these programs have rarely been adopted beyond the trial phase and offered to a wider audience. As risk factors for eating disorders are partly associated with overweight and overweight in turn is correlated to disordered eating, this study will offer a combined eating disorder prevention program which also promotes a balanced lifestyle to normal weight and overweight individuals alike. The efficacy of the program has been proven in previous trials. The study aims to evaluate the dissemination of a combined eating disorder prevention and health promotion program (everyBody) to women of all age groups and varying levels of ED risk status in the general population. METHODS A dissemination trial will be conducted in German-speaking countries, including 4160 women from the general population. Participants will be screened to exclude participants who are likely to have an ED. Eligible participants will be allocated to one of five program arms based on their BMI and respective ED symptoms. The guided program consists of 4 to 12 weeks of weekly sessions offering CBT-based exercises, psychoeducational material, self-monitoring, and group discussions. Outcomes will be assessed according to the RE-AIM model, including measures of effectiveness, reach, adoption, implementation, and maintenance of the program. DISCUSSION/CONCLUSIONS This trial aims to disseminate a combined ED prevention and health promotion program in the general population, offering universal, selective and indicated prevention in one program. To our knowledge, it is the first trial to systematically evaluate dissemination efforts based on the RE-AIM model. This trial will be conducted as part of the EU-funded ICare (Integrating Technology into Mental Health Care Delivery in Europe) project.
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Affiliation(s)
- Barbara Nacke
- Technische Universität Dresden, Institut für Klinische Psychologie & Psychotherapie, Chemnitzer Str. 46, 01187 Dresden, Germany,Corresponding author.
| | - Ina Beintner
- Technische Universität Dresden, Institut für Klinische Psychologie & Psychotherapie, Chemnitzer Str. 46, 01187 Dresden, Germany
| | - Dennis Görlich
- Westfälische Wilhelms-Universität Münster, Institut für Biometrie und Klinische Forschung, Schmeddingstraße 56, 48149 Münster, Germany
| | - Bianka Vollert
- Technische Universität Dresden, Institut für Klinische Psychologie & Psychotherapie, Chemnitzer Str. 46, 01187 Dresden, Germany
| | - Juliane Schmidt-Hantke
- Technische Universität Dresden, Institut für Klinische Psychologie & Psychotherapie, Chemnitzer Str. 46, 01187 Dresden, Germany
| | - Kristian Hütter
- Technische Universität Dresden, Institut für Klinische Psychologie & Psychotherapie, Chemnitzer Str. 46, 01187 Dresden, Germany
| | - C. Barr Taylor
- Stanford School of Medicine, Psychiatry Department, 401 Quarry Rd, Stanford CA94305, USA
| | - Corinna Jacobi
- Technische Universität Dresden, Institut für Klinische Psychologie & Psychotherapie, Chemnitzer Str. 46, 01187 Dresden, Germany
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77
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BodiMojo: Efficacy of a Mobile-Based Intervention in Improving Body Image and Self-Compassion among Adolescents. J Youth Adolesc 2018; 47:1363-1372. [DOI: 10.1007/s10964-017-0804-3] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 12/28/2017] [Indexed: 10/18/2022]
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78
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Lüttke S, Hautzinger M, Fuhr K. E-Health in Diagnostik und Therapie psychischer Störungen. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2018; 61:263-270. [DOI: 10.1007/s00103-017-2684-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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79
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Taylor CB, Ruzek JI, Fitzsimmons-Craft EE, Graham AK, Balantekin KN. A systematic digital approach to implementation and dissemination of eating disorders interventions to large populations identified through online screening: implications for post-traumatic stress. Mhealth 2018; 4:25. [PMID: 30598986 PMCID: PMC6289086 DOI: 10.21037/mhealth.2018.05.06] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 05/29/2018] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND We describe an approach to implementation and dissemination that focuses on changing outcomes variables within a large, defined population and attempts to provide cost-effective opportunities and resources-which might include the provision of both digital and traditional interventions-to address individual needs and interests. We present a case example of how aspects of this model are being applied to increase reach, engagement and outcomes for individuals who complete a national eating disorders screen, and are likely to have an eating disorder but who are not in treatment. We then describe how this model can apply to post-traumatic stress (PTS) and conclude with a discussion of limitations and issues with the model. METHODS The National Eating Disorders Association (NEDA) provides online screening for eating disorders. RESULTS From February 2017 through March 2018, over 200,000 individuals completed the NEDA screen. Of these, 96% screened positive or at risk for an eating disorder, and most of those who screened positive for a clinical/subclinical eating disorder were not currently in treatment. Less than 10% engaged in self-help or guided self-help online digital program, or expressed interest in calling a helpline for referral to treatment. CONCLUSIONS A systematic digital approach to implementation and dissemination has the potential to increase the number of individuals who benefit from interventions in defined populations. Uptake rates need to be improved.
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Affiliation(s)
- C. Barr Taylor
- Center for m2 Health, Palo Alto University, Palo Alto, CA, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA
| | - Josef I. Ruzek
- Center for m2 Health, Palo Alto University, Palo Alto, CA, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA
- National Center for PTSD, Dissemination and Training Division, Veterans Affairs Palo Alto Health Care System (VAPAHCS), Menlo Park, USA
| | | | - Andrea K. Graham
- Department of Medical Social Sciences, Northwestern University, IL, USA
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80
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Baumeister H, Lin J, Ebert DD. [Internet- and mobile-based approaches : Psycho-social diagnostics and treatment in medical rehabilitation]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2017; 60:436-444. [PMID: 28224187 DOI: 10.1007/s00103-017-2518-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Technology-based approaches for psychosocial diagnostics and interventions provide an attractive opportunity to optimize medical rehabilitation. Based on an Internet- and mobile-based assessment of existing functional health impairments, appropriate planning, implementation of corresponding courses of action as well as outcome assessment can take place. This can be implemented in the form of Internet- and mobile-based interventions (IMI).The present article provides an overview of the basic knowledge of IMI and their evidence base both in general and in particular for their use in medical rehabilitation. Important aspects of internet and mobile-based psycho-social diagnostics are discussed subsequently. Finally, an outlook for the use of Internet- and mobile-based diagnostics and interventions in medical rehabilitation is given.
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Affiliation(s)
- Harald Baumeister
- Institut für Psychologie und Pädagogik, Abteilung für Klinische Psychologie und Psychotherapie, Universität Ulm, Albert-Einstein-Allee 47, 89069, Ulm, Deutschland.
| | - Jiaxi Lin
- Institut für Psychologie, Abteilung für Rehabilitationspsychologie und Psychotherapie, Universität Freiburg, Freiburg, Deutschland
| | - David Daniel Ebert
- Institut für Psychologie, Abteilung für Klinische Psychologie und Psychotherapie, Universität Erlangen, Erlangen, Deutschland
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81
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Kindermann S, Moessner M, Ozer F, Bauer S. Associations between eating disorder related symptoms and participants' utilization of an individualized Internet-based prevention and early intervention program. Int J Eat Disord 2017; 50:1215-1221. [PMID: 28921689 DOI: 10.1002/eat.22774] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 08/10/2017] [Accepted: 08/14/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Flexible, individualized interventions allow participants to adjust the intensity of support to their current needs. Between-persons, participants with greater needs can receive more intense support, within-persons, participants can adjust utilization to their current level of symptoms. The purpose of the present study was to analyze associations between ED-related symptoms and utilization of the individualized program ProYouth both between- and within-persons, aiming to investigate whether participants adapt utilization intensity to their current needs. METHOD Generalized estimated equations (GEEs) were used to analyze log data on program utilization (monthly page visits, monthly use of chats and forum) assessed via server logs and self-reported data on ED-related symptoms from N = 394 ProYouth participants who provided longitudinal data for at least two months. RESULTS Between-persons, page visits per month were significantly associated with compensatory behavior, body dissatisfaction, and binge eating. Monthly use of the more intense modules with personal support chat and forum was associated with the frequency of compensatory behavior. Within-persons, unbalanced nutrition and dieting showed the strongest associations with monthly page visits. Monthly use of chats and forum was significantly associated with compensatory behavior and unbalanced nutrition and dieting. DISCUSSION Results indicate that program utilization is associated with ED-related symptoms between- as well as within-persons. The individualized, flexible approach of ProYouth thus seems to be a promising way for Internet-based provision of combined prevention and early intervention programs addressing ED.
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Affiliation(s)
- Sally Kindermann
- Center for Psychotherapy Research, University Hospital Heidelberg, Bergheimer Str. 54, Heidelberg, 69115, Germany
| | - Markus Moessner
- Center for Psychotherapy Research, University Hospital Heidelberg, Bergheimer Str. 54, Heidelberg, 69115, Germany
| | - Fikret Ozer
- Center for Psychotherapy Research, University Hospital Heidelberg, Bergheimer Str. 54, Heidelberg, 69115, Germany
| | - Stephanie Bauer
- Center for Psychotherapy Research, University Hospital Heidelberg, Bergheimer Str. 54, Heidelberg, 69115, Germany
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de Zwaan M, Herpertz S, Zipfel S, Svaldi J, Friederich HC, Schmidt F, Mayr A, Lam T, Schade-Brittinger C, Hilbert A. Effect of Internet-Based Guided Self-help vs Individual Face-to-Face Treatment on Full or Subsyndromal Binge Eating Disorder in Overweight or Obese Patients: The INTERBED Randomized Clinical Trial. JAMA Psychiatry 2017; 74:987-995. [PMID: 28768334 PMCID: PMC5710472 DOI: 10.1001/jamapsychiatry.2017.2150] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
IMPORTANCE Although cognitive behavioral therapy (CBT) represents the criterion standard for treatment of binge eating disorder (BED), most individuals do not have access to this specialized treatment. OBJECTIVE To evaluate the efficacy of internet-based guided self-help (GSH-I) compared with traditional, individual face-to-face CBT. DESIGN, SETTING, AND PARTICIPANTS The Internet and Binge Eating Disorder (INTERBED) study is a prospective, multicenter, randomized, noninferiority clinical trial (treatment duration, 4 months; follow-ups, 6 months and 1.5 years). A volunteer sample of 178 adult outpatients with full or subsyndromal BED were recruited from 7 university-based outpatient clinics from August 1, 2010, through December 31, 2011; final follow-up assessment was in April 2014. Data analysis was performed from November 30, 2014, to May 27, 2015. INTERVENTIONS Participants received 20 individual face-to-face CBT sessions of 50 minutes each or sequentially completed 11 internet modules and had weekly email contacts. MAIN OUTCOMES AND MEASURES The primary outcome was the difference in the number of days with objective binge eating episodes (OBEs) during the previous 28 days between baseline and end of treatment. Secondary outcomes included OBEs at follow-ups, eating disorder and general psychopathologic findings, body mass index, and quality of life. RESULTS A total of 586 patients were screened, 178 were randomized, and 169 had at least one postbaseline assessment and constituted the modified intention-to-treat analysis group (mean [SD] age, 43.2 [12.3] years; 148 [87.6%] female); the 1.5-year follow-up was available in 116 patients. The confirmatory analysis using the per-protocol sample (n = 153) failed to show noninferiority of GSH-I (adjusted effect, 1.47; 95% CI, -0.01 to 2.91; P = .05). Using the modified intention-to-treat sample, GSH-I was inferior to CBT in reducing OBE days at the end of treatment (adjusted effect, 1.63; 95% CI, 0.17-3.05; P = .03). Exploratory longitudinal analyses also showed the superiority of CBT over GSH-I by the 6-month (adjusted effect, 0.36; 95% CI, 0.23-0.55; P < .001) but not the 1.5-year follow-up (adjusted effect, 0.91; 95% CI, 0.54-1.50; P = .70). Reductions in eating disorder psychopathologic findings were significantly higher in the CBT group than in the GSH-I group at 6-month follow-up (adjusted effect, -0.4; 95% CI, -0.68 to -0.13; P = .005). No group differences were found for body mass index, general psychopathologic findings, and quality of life. CONCLUSIONS AND RELEVANCE Face-to-face CBT leads to quicker and greater reductions in the number of OBE days, abstinence rates, and eating disorder psychopathologic findings and may be a better initial treatment option than GSH-I. Internet-based guided self-help remains a viable, slower-acting, low-threshold treatment alternative compared with CBT for adults with BED. TRIAL REGISTRATION isrctn.org Identifier: ISRCTN40484777 and germanctr.de Identifier: DRKS00000409.
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Affiliation(s)
- Martina de Zwaan
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany,Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Erlangen, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Stephan Herpertz
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University, Ruhr-University Bochum, Bochum, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, Tübingen, Germany
| | - Jennifer Svaldi
- Department of Clinical Psychology and Psychotherapy, University of Tübingen, Tübingen, Germany,Department of Clinical Psychology and Psychotherapy, University of Freiburg, Freiburg, Germany
| | - Hans-Christoph Friederich
- Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany,Department of General Internal Medicine and Psychosomatics, Medical University Hospital Heidelberg, Heidelberg, Germany
| | - Frauke Schmidt
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany,Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Erlangen, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Andreas Mayr
- Department of Medical Informatics, Biometry, and Epidemiology, University of Erlangen-Nuremberg, Erlangen, Germany
| | | | | | - Anja Hilbert
- Department of Medical Psychology and Medical Sociology, University of Leipzig Medical Center, Leipzig, Germany
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83
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Strandskov SW, Ghaderi A, Andersson H, Parmskog N, Hjort E, Wärn AS, Jannert M, Andersson G. Effects of Tailored and ACT-Influenced Internet-Based CBT for Eating Disorders and the Relation Between Knowledge Acquisition and Outcome: A Randomized Controlled Trial. Behav Ther 2017; 48:624-637. [PMID: 28711113 DOI: 10.1016/j.beth.2017.02.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 02/21/2017] [Accepted: 02/25/2017] [Indexed: 11/16/2022]
Abstract
This is the first trial to investigate the outcome of tailored and ACT-influenced, cognitive behavioral Internet treatment for eating disorder psychopathology, and the relation between knowledge acquisition and outcome. This study utilized a randomized controlled design, with computer-based allocation to treatment or waiting list control group. Participants were recruited via advertisements in social media and newspapers in Sweden. Participants fulfilling the criteria for bulimia nervosa (BN), or Eating Disorder Not Otherwise Specified (EDNOS), with a BMI above 17.5, were enrolled in the study (N = 92). The treatment group received an Internet-based, ACT-influenced CBT intervention, developed by the authors, for eating disorders. The treatment lasted 8 weeks, and was adapted to the participant's individual needs. A clinician provided support. The main outcome measures were eating disorder symptoms and body shape dissatisfaction. Intent-to-treat analysis showed that the treatment group (n = 46) improved significantly on eating disorder symptoms and body dissatisfaction, compared with the waiting list control group (n = 46), with small to moderate effect sizes (between group effects, d = 0.35-0.64). More than a third of the participants in the treatment group (36.6%), compared to 7.1% in the waiting list control condition, made clinically significant improvements. Results showed a significant increase in knowledge in the treatment group compared to the waiting list control group (between group effect, d = 1.12), but we found no significant correlations between knowledge acquisition and outcome (r= -0.27 to -r = 0.23). The results provide preliminary support for Internet-based, tailored, and ACT-influenced treatment, based on CBT for participants with eating disorder psychopathology.
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Affiliation(s)
- Sandra Weineland Strandskov
- Linköping University; Närhälsan, Research and Development Center, Primary Health Care, Södra Älsvborg, Borås, Sweden.
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84
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Watson HJ, Goodman EL, McLagan NB, Joyce T, French E, Willan V, Egan SJ. Quality of randomized controlled trials in eating disorder prevention. Int J Eat Disord 2017; 50:459-470. [PMID: 28489337 DOI: 10.1002/eat.22712] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 02/15/2017] [Accepted: 02/15/2017] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To investigate the quality of randomized controlled trials (RCTs) of eating disorder prevention. METHOD A systematic literature search was conducted in Medline, PsycINFO, Embase, Scopus, and the Cochrane Collaboration Library to January 2016. Studies were included if they were RCTs that tested an eating disorder prevention program. We identified 96 studies with a total 15,350 participants (91% female, M age = 17 years) and rated quality with the Quality Rating Scale (QRS; Moncrieff et al., 2001). RESULTS The mean QRS score was 62% (SD = 13%). Several standards of quality were not frequently fulfilled (i.e., failed to achieve an optimal rating), for example, power calculation (85%), intent-to-treat analysis (54%), blinding of assessor (75%), representative sample (78%), adequate sample size (75%), and appropriate duration of trial including follow-up (67%). QRS was positively and significantly associated with publication year, number of authors, and PubMed-indexation. DISCUSSION Given the majority of eating disorder prevention studies had problems with trial quality, it is recommended that future RCTs follow quality checklists and CONSORT guidelines, that RCTs are registered, and protocols published in advance. In addition, funding bodies are called on to deliver the support needed to ensure that preventions for eating disorders are efficiently and cost-effectively achieved.
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Affiliation(s)
- Hunna J Watson
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,School of Paediatrics and Child Health, The University of Western Australia, Perth, Western Australia, Australia.,School of Psychology and Speech Pathology, Curtin University, Perth, Western Australia, Australia
| | - Erica L Goodman
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Department of Clinical Psychology, University of North Dakota, Grand Forks, North Dakota
| | - Nicole B McLagan
- School of Psychology and Speech Pathology, Curtin University, Perth, Western Australia, Australia
| | - Tara Joyce
- School of Psychology and Speech Pathology, Curtin University, Perth, Western Australia, Australia
| | - Elizabeth French
- School of Psychology and Speech Pathology, Curtin University, Perth, Western Australia, Australia
| | - Vivienne Willan
- School of Psychology and Speech Pathology, Curtin University, Perth, Western Australia, Australia
| | - Sarah J Egan
- School of Psychology and Speech Pathology, Curtin University, Perth, Western Australia, Australia
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85
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Klein JP, Gerlinger G, Knaevelsrud C, Bohus M, Meisenzahl E, Kersting A, Röhr S, Riedel-Heller SG, Sprick U, Dirmaier J, Härter M, Hegerl U, Hohagen F, Hauth I. [Internet-based interventions in the treatment of mental disorders : Overview, quality criteria, perspectives]. DER NERVENARZT 2017; 87:1185-1193. [PMID: 27649987 DOI: 10.1007/s00115-016-0217-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Mental disorders are frequently not or only insufficiently treated. Internet-based interventions offer the potential of closing the existing gaps in the treatment of mental disorders; however, it is very difficult for patients and providers to choose from the numerous interventions available. OBJECTIVE The aim of this study was to develop a set of quality criteria that can help patients and care providers to identify recommendable internet-based interventions. METHODS A selective literature search was carried out and the existing evidence on internet-based interventions in the treatment of mental disorders was collated. A panel of experts then developed quality criteria based on existing models for the systematic assessment of telemedicine applications. RESULTS Internet-based interventions are effective in the treatment of a broad range of mental disorders. The best evidence is available for depression and anxiety disorders. A set of criteria is proposed for the evaluation of available internet-based interventions using a checklist. These criteria have to be developed further with input from other stakeholders. DISCUSSION When taking these quality criteria into account, evidence-based interventions available on the internet can make an important contribution to improvement of the care of patients with mental disorders.
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Affiliation(s)
- J P Klein
- Klinik für Psychiatrie und Psychotherapie, Universität zu Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland.
| | - G Gerlinger
- Deutsche Gesellschaft für Psychiatrie und Psychotherapie, Psychosomatik und Nervenheilkunde, Berlin, Deutschland
| | - C Knaevelsrud
- Klinische Psychologie und Psychotherapie, Freie Universität Berlin, Berlin, Deutschland
| | - M Bohus
- Institut für Psychiatrische und Psychosomatische Psychotherapie, Zentralinstitut für Seelische Gesundheit Mannheim, Universität Heidelberg, Mannheim, Deutschland.,Fakultät für Gesundheit, Universität Antwerpen, Antwerpen, Belgien
| | - E Meisenzahl
- Klinik für Psychiatrie und Psychotherapie, LMU München, München, Deutschland
| | - A Kersting
- Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Universität Leipzig, Leipzig, Deutschland
| | - S Röhr
- Institut für Sozialmedizin, Arbeitsmedizin und Public Health (ISAP), Universität Leipzig, Leipzig, Deutschland
| | - S G Riedel-Heller
- Institut für Sozialmedizin, Arbeitsmedizin und Public Health (ISAP), Universität Leipzig, Leipzig, Deutschland
| | - U Sprick
- St. Alexius/St. Josef Krankenhaus, Medizinische Fakultät der Heinrich-Heine-Universität Düsseldorf, Neuss, Deutschland
| | - J Dirmaier
- Institut und Poliklinik für Medizinische Psychologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - M Härter
- Institut und Poliklinik für Medizinische Psychologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - U Hegerl
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universität Leipzig, Leipzig, Deutschland
| | - F Hohagen
- Klinik für Psychiatrie und Psychotherapie, Universität zu Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland
| | - I Hauth
- Zentrum für Neurologie, Psychiatrie, Psychotherapie, Alexianer St. Joseph Krankenhaus, Berlin, Deutschland
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86
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Kass AE, Balantekin KN, Fitzsimmons-Craft EE, Jacobi C, Wilfley DE, Taylor CB. The economic case for digital interventions for eating disorders among United States college students. Int J Eat Disord 2017; 50:250-258. [PMID: 28152203 PMCID: PMC5391044 DOI: 10.1002/eat.22680] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 01/05/2017] [Accepted: 01/05/2017] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Eating disorders (EDs) are serious health problems affecting college students. This article aimed to estimate the costs, in United States (US) dollars, of a stepped care model for online prevention and treatment among US college students to inform meaningful decisions regarding resource allocation and adoption of efficient care delivery models for EDs on college campuses. METHODS Using a payer perspective, we estimated the costs of (1) delivering an online guided self-help (GSH) intervention to individuals with EDs, including the costs of "stepping up" the proportion expected to "fail"; (2) delivering an online preventive intervention compared to a "wait and treat" approach to individuals at ED risk; and (3) applying the stepped care model across a population of 1,000 students, compared to standard care. RESULTS Combining results for online GSH and preventive interventions, we estimated a stepped care model would cost less and result in fewer individuals needing in-person psychotherapy (after receiving less-intensive intervention) compared to standard care, assuming everyone in need received intervention. CONCLUSIONS A stepped care model was estimated to achieve modest cost savings compared to standard care, but these estimates need to be tested with sensitivity analyses. Model assumptions highlight the complexities of cost calculations to inform resource allocation, and considerations for a disseminable delivery model are presented. Efforts are needed to systematically measure the costs and benefits of a stepped care model for EDs on college campuses, improve the precision and efficacy of ED interventions, and apply these calculations to non-US care systems with different cost structures.
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Affiliation(s)
- Andrea E. Kass
- Department of Psychiatry & Behavioral Neuroscience, The University of Chicago, Chicago, IL, USA,Address correspondence to: Andrea E. Kass, Ph.D.; The University of Chicago, 5841 S. Maryland Avenue, MC 1000, Chicago, IL 60637; Telephone: 773-702-4186;
| | | | | | - Corinna Jacobi
- Technische Universität Dresden, Klinische Psychologie und Psychotherapie, Dresden, Germany
| | - Denise E. Wilfley
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - C. Barr Taylor
- Center for mHealth, Palo Alto University, Palo Alto, CA, and Stanford University, Stanford, Ca, USA
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87
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Aardoom JJ, Dingemans AE, Fokkema M, Spinhoven P, Van Furth EF. Moderators of change in an Internet-based intervention for eating disorders with different levels of therapist support: What works for whom? Behav Res Ther 2017; 89:66-74. [DOI: 10.1016/j.brat.2016.11.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 11/18/2016] [Accepted: 11/21/2016] [Indexed: 12/23/2022]
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Zerwas SC, Watson HJ, Hofmeier SM, Levine MD, Hamer RM, Crosby RD, Runfola CD, Peat CM, Shapiro JR, Zimmer B, Moessner M, Kordy H, Marcus MD, Bulik CM. CBT4BN: A Randomized Controlled Trial of Online Chat and Face-to-Face Group Therapy for Bulimia Nervosa. PSYCHOTHERAPY AND PSYCHOSOMATICS 2017; 86:47-53. [PMID: 27883997 PMCID: PMC5143175 DOI: 10.1159/000449025] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 08/02/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Although cognitive-behavioral therapy (CBT) represents the first-line evidence-based psychotherapy for bulimia nervosa (BN), most individuals seeking treatment do not have access to this specialized intervention. We compared an Internet-based manualized version of CBT group therapy for BN conducted via a therapeutic chat group (CBT4BN) to the same treatment conducted via a traditional face-to-face group therapy (CBTF2F). METHOD In a two-site, randomized, controlled noninferiority trial, we tested the hypothesis that CBT4BN would not be inferior to CBTF2F. A total of 179 adult patients with BN (2.6% males) received up to 16 sessions of group CBT over 20 weeks in either CBT4BN or CBTF2F, and outcomes were compared at the end of treatment and at the 12-month follow-up. RESULTS At the end of treatment, CBT4BN was inferior to CBTF2F in producing abstinence from binge eating and purging. However, by the 12-month follow-up, CBT4BN was mostly not inferior to CBTF2F. Participants in the CBT4BN condition, but not CBTF2F, continued to reduce their binge-eating and purging frequency from the end of treatment to the 12-month follow-up. CONCLUSIONS CBT delivered online in a group chat format appears to be an efficacious treatment for BN, although the trajectory of recovery may be slower than face-to-face group therapy. Online chat groups may increase accessibility of treatment and represent a cost-effective approach to service delivery. However, barriers in service delivery such as state-specific license and ethical guidelines for online therapists need to be addressed.
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Affiliation(s)
- Stephanie C. Zerwas
- Department of Psychiatry, University of North Carolina at Chapel Hill, CB 7160, Chapel Hill, NC 27599
| | - Hunna J. Watson
- Department of Psychiatry, University of North Carolina at Chapel Hill, CB 7160, Chapel Hill, NC 27599,School of Paediatrics and Child Health, Faculty of Medicine, Dentistry, and Health Sciences, The University of Western Australia, Stirling Highway, Crawley, Western Australia, Australia 6009,School of Psychology and Speech Pathology, Faculty of Health Sciences, Curtin University, Kent Street, Bentley, Western Australia, Australia 6102
| | - Sara M. Hofmeier
- Department of Psychiatry, University of North Carolina at Chapel Hill, CB 7160, Chapel Hill, NC 27599
| | - Michele D. Levine
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, 3811 O’Hara Street, Pittsburgh, PA 15213
| | - Robert M. Hamer
- Department of Psychiatry, University of North Carolina at Chapel Hill, CB 7160, Chapel Hill, NC 27599,Department of Biostatistics, University of North Carolina at Chapel Hill, CB 7160, Chapel Hill, NC 27599
| | - Ross D. Crosby
- Neuropsychiatric Research Institute, 120 Eighth Street South Fargo, ND 58107,Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, ND 58102
| | | | - Christine M. Peat
- Department of Psychiatry, University of North Carolina at Chapel Hill, CB 7160, Chapel Hill, NC 27599,Department of Neurosurgery, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599
| | - Jennifer R. Shapiro
- Department of Psychiatry, University of North Carolina at Chapel Hill, CB 7160, Chapel Hill, NC 27599
| | - Benjamin Zimmer
- Center for Psychotherapy Research, University of Heidelberg, Bergheimer Str. 54, 69115 Heidelberg, Germany
| | - Markus Moessner
- Center for Psychotherapy Research, University of Heidelberg, Bergheimer Str. 54, 69115 Heidelberg, Germany
| | - Hans Kordy
- Center for Psychotherapy Research, University of Heidelberg, Bergheimer Str. 54, 69115 Heidelberg, Germany
| | - Marsha D. Marcus
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, 3811 O’Hara Street, Pittsburgh, PA 15213
| | - Cynthia M. Bulik
- Department of Psychiatry, University of North Carolina at Chapel Hill, CB 7160, Chapel Hill, NC 27599,Department of Nutrition, University of North Carolina at Chapel Hill, CB 7160, Chapel Hill, NC 27599,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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89
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Weissman RS. Fifty volumes of scholarship on eating disorders. Int J Eat Disord 2017; 50:3-8. [PMID: 28025874 DOI: 10.1002/eat.22653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 11/16/2016] [Indexed: 11/08/2022]
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Watson HJ, Joyce T, French E, Willan V, Kane RT, Tanner-Smith EE, McCormack J, Dawkins H, Hoiles KJ, Egan SJ. Prevention of eating disorders: A systematic review of randomized, controlled trials. Int J Eat Disord 2016; 49:833-62. [PMID: 27425572 DOI: 10.1002/eat.22577] [Citation(s) in RCA: 114] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Revised: 05/25/2016] [Accepted: 05/31/2016] [Indexed: 12/12/2022]
Abstract
OBJECTIVE This systematic review evaluated the efficacy of universal, selective, and indicated eating disorder prevention. METHOD A systematic literature search was conducted in Medline, PsycINFO, Embase, Scopus, and the Cochrane Collaboration Library databases to January 2016. Studies were included if they were randomized, controlled trials (RCT) and tested an eating disorder prevention program. We retrieved 13 RCTs of universal prevention (N = 3,989 participants, 55% female, M age = 13.0 years), 85 RCTs of selective prevention (N = 11,949 participants, 99% female, M age = 17.6 years), and 8 RCTs of indicated prevention (N = 510 participants, 100% female, M age = 20.1 years). Meta-analysis was performed with selective prevention trials. As there were a limited number of universal and indicated trials, narrative synthesis was conducted. RESULTS Media literacy had the most support for universal prevention. Most universal approaches showed significant modest effects on risk factors. Dissonance-based was the best supported approach for selective prevention. Cognitive-behavior therapy (CBT), a healthy weight program, media literacy, and psychoeducation, were also effective for selective prevention and effects were maintained at follow-up. CBT was supported for indicated prevention and effects were maintained at follow-up. DISCUSSION The modest effects for universal prevention were likely due to floor effects. The evidence for selective prevention suggests that empirically supported approaches should be disseminated on a wider basis. Our findings suggest CBT should be offered for indicated populations. Overall, results suggest efficacy of several prevention programs for reducing risk for eating disorders, and that wider dissemination is required. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Hunna J Watson
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. .,Department of Health in Western Australia, Eating Disorders Program, Princess Margaret Hospital for Children, Perth, Australia. .,Department of Health in Western Australia, Centre for Clinical Interventions, Perth, Australia. .,Faculty of Medicine, Dentistry, and Health Sciences, School of Paediatrics and Child Health, The University of Western Australia, Perth, Australia. .,Faculty of Health Sciences, School of Psychology and Speech Pathology, Curtin University, Perth, Australia.
| | - Tara Joyce
- Department of Health in Western Australia, Eating Disorders Program, Princess Margaret Hospital for Children, Perth, Australia
| | - Elizabeth French
- Faculty of Health Sciences, School of Psychology and Speech Pathology, Curtin University, Perth, Australia
| | - Vivienne Willan
- Faculty of Health Sciences, School of Psychology and Speech Pathology, Curtin University, Perth, Australia
| | - Robert T Kane
- Faculty of Health Sciences, School of Psychology and Speech Pathology, Curtin University, Perth, Australia
| | - Emily E Tanner-Smith
- Department of Human and Organizational Development, Peabody Research Institute, Vanderbilt University, Nashville
| | - Julie McCormack
- Department of Health in Western Australia, Eating Disorders Program, Princess Margaret Hospital for Children, Perth, Australia
| | - Hayley Dawkins
- Faculty of Health Sciences, School of Psychology and Speech Pathology, Curtin University, Perth, Australia
| | - Kimberley J Hoiles
- Department of Health in Western Australia, Eating Disorders Program, Princess Margaret Hospital for Children, Perth, Australia
| | - Sarah J Egan
- Faculty of Health Sciences, School of Psychology and Speech Pathology, Curtin University, Perth, Australia
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Meinlschmidt G, Lee JH, Stalujanis E, Belardi A, Oh M, Jung EK, Kim HC, Alfano J, Yoo SS, Tegethoff M. Smartphone-Based Psychotherapeutic Micro-Interventions to Improve Mood in a Real-World Setting. Front Psychol 2016; 7:1112. [PMID: 27516747 PMCID: PMC4963605 DOI: 10.3389/fpsyg.2016.01112] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 07/11/2016] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Using mobile communication technology as new personalized approach to treat mental disorders or to more generally improve quality of life is highly promising. Knowledge about intervention components that target key psychopathological processes in terms of transdiagnostic psychotherapy approaches is urgently needed. We explored the use of smartphone-based micro-interventions based on psychotherapeutic techniques, guided by short video-clips, to elicit mood changes. METHOD As part of a larger neurofeedback study, all subjects-after being randomly assigned to an experimental or control neurofeedback condition-underwent daily smartphone-based micro-interventions for 13 consecutive days. They were free to choose out of provided techniques, including viscerosensory attention, emotional imagery, facial expression, and contemplative repetition. Changes in mood were assessed in real world using the Multidimensional Mood State Questionnaire (scales: good-bad, GB; awake-tired, AT; and calm-nervous, CN). RESULTS Twenty-seven men participated on at least 11 days and were thus included in the analyses. Altogether, they underwent 335, generally well-tolerated, micro-intervention sessions, with viscerosensory attention (178 sessions, 53.13%) and contemplative repetition (68 sessions, 20.30%) being the most frequently applied techniques. Mixed models indicated that subjects showed better mood [GB: b = 0.464, 95%confidence interval (CI) [0.068, 0.860], t (613.3) = 2.298, p = 0.022] and became more awake [AT: b = 0.514, 95%CI [0.103, 0.925], t (612.4) = 2.456, p = 0.014] and calmer [CN: b = 0.685, 95%CI [0.360, 1.010], t (612.3) = 4.137, p < 0.001] from pre- to post-micro-intervention. These mood improvements from pre- to post-micro-intervention were associated with changes in mood from the 1st day until the last day with regard to GB mood (r = 0.614, 95%CI [0.297, 0.809], p < 0.001), but not AT mood (r = 0.279, 95%CI [-0.122, 0.602], p = 0.167) and CN mood (r = 0.277, 95%CI [0.124, 0.601], p = 0.170). DISCUSSION Our findings provide evidence for the applicability of smartphone-based micro-interventions eliciting short-term mood changes, based on techniques used in psychotherapeutic approaches, such as mindfulness-based psychotherapy, transcendental meditation, and other contemplative therapies. The results encourage exploring these techniques' capability to improve mood in randomized controlled studies and patients. Smartphone-based micro-interventions are promising to modify mood in real-world settings, complementing other psychotherapeutic interventions, in line with the precision medicine approach. The here presented data were collected within a randomized trial, registered at ClinicalTrials.gov (Identifier: NCT01921088) https://clinicaltrials.gov/ct2/show/NCT01921088.
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Affiliation(s)
- Gunther Meinlschmidt
- Division of Clinical Psychology and Epidemiology, Department of Psychology, University of BaselBasel, Switzerland; Faculty of Medicine, Ruhr-University BochumBochum, Germany
| | - Jong-Hwan Lee
- Department of Brain and Cognitive Engineering, Korea University Seoul, South Korea
| | - Esther Stalujanis
- Division of Clinical Psychology and Psychiatry, Department of Psychology, University of Basel Basel, Switzerland
| | - Angelo Belardi
- Division of Clinical Psychology and Psychiatry, Department of Psychology, University of Basel Basel, Switzerland
| | - Minkyung Oh
- Department of Brain and Cognitive Engineering, Korea University Seoul, South Korea
| | - Eun Kyung Jung
- Department of Brain and Cognitive Engineering, Korea University Seoul, South Korea
| | - Hyun-Chul Kim
- Department of Brain and Cognitive Engineering, Korea University Seoul, South Korea
| | - Janine Alfano
- Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel Basel, Switzerland
| | - Seung-Schik Yoo
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical SchoolBoston, MA, USA; Incheon St. Mary's Hospital, The Catholic University of KoreaIncheon, South Korea
| | - Marion Tegethoff
- Division of Clinical Psychology and Psychiatry, Department of Psychology, University of Basel Basel, Switzerland
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92
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Aardoom JJ, Dingemans AE, Spinhoven P, van Ginkel JR, de Rooij M, van Furth EF. Web-Based Fully Automated Self-Help With Different Levels of Therapist Support for Individuals With Eating Disorder Symptoms: A Randomized Controlled Trial. J Med Internet Res 2016; 18:e159. [PMID: 27317358 PMCID: PMC4930527 DOI: 10.2196/jmir.5709] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 04/08/2016] [Accepted: 05/13/2016] [Indexed: 11/23/2022] Open
Abstract
Background Despite the disabling nature of eating disorders (EDs), many individuals with ED symptoms do not receive appropriate mental health care. Internet-based interventions have potential to reduce the unmet needs by providing easily accessible health care services. Objective This study aimed to investigate the effectiveness of an Internet-based intervention for individuals with ED symptoms, called “Featback.” In addition, the added value of different intensities of therapist support was investigated. Methods Participants (N=354) were aged 16 years or older with self-reported ED symptoms, including symptoms of anorexia nervosa, bulimia nervosa, and binge eating disorder. Participants were recruited via the website of Featback and the website of a Dutch pro-recovery–focused e-community for young women with ED problems. Participants were randomized to: (1) Featback, consisting of psychoeducation and a fully automated self-monitoring and feedback system, (2) Featback supplemented with low-intensity (weekly) digital therapist support, (3) Featback supplemented with high-intensity (3 times a week) digital therapist support, and (4) a waiting list control condition. Internet-administered self-report questionnaires were completed at baseline, post-intervention (ie, 8 weeks after baseline), and at 3- and 6-month follow-up. The primary outcome measure was ED psychopathology. Secondary outcome measures were symptoms of depression and anxiety, perseverative thinking, and ED-related quality of life. Statistical analyses were conducted according to an intent-to-treat approach using linear mixed models. Results The 3 Featback conditions were superior to a waiting list in reducing bulimic psychopathology (d=−0.16, 95% confidence interval (CI)=−0.31 to −0.01), symptoms of depression and anxiety (d=−0.28, 95% CI=−0.45 to −0.11), and perseverative thinking (d=−0.28, 95% CI=−0.45 to −0.11). No added value of therapist support was found in terms of symptom reduction although participants who received therapist support were significantly more satisfied with the intervention than those who did not receive supplemental therapist support. No significant differences between the Featback conditions supplemented with low- and high-intensity therapist support were found regarding the effectiveness and satisfaction with the intervention. Conclusions The fully automated Internet-based self-monitoring and feedback intervention Featback was effective in reducing ED and comorbid psychopathology. Supplemental therapist support enhanced satisfaction with the intervention but did not increase its effectiveness. Automated interventions such as Featback can provide widely disseminable and easily accessible care. Such interventions could be incorporated within a stepped-care approach in the treatment of EDs and help to bridge the gap between mental disorders and mental health care services. Trial Registration Netherlands Trial Registry: NTR3646; http://www.trialregister.nl/trialreg/admin/ rctview.asp?TC=3646 (Archived by WebCite at http://www.webcitation.org/6fgHTGKHE)
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93
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Moessner M, Minarik C, Özer F, Bauer S. Can an internet-based program for the prevention and early intervention in eating disorders facilitate access to conventional professional healthcare? J Ment Health 2016; 25:441-447. [PMID: 26850624 DOI: 10.3109/09638237.2016.1139064] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND The majorities of individual suffering from eating disorders do not seek or receive adequate professional treatment. Internet-based approaches promise to facilitate access to conventional healthcare by providing an easy-access, low-threshold contact. AIM The current study investigated whether an Internet-based program for the prevention and early intervention for eating disorders (ProYouth) may contribute to the actual and intended uptake of professional care. Characteristics of individuals who seek help are explored as well as barriers to help-seeking. METHOD The sample included 453 ProYouth participants who were surveyed three months after registration. Actual help-seeking behavior, intended help-seeking, potential help-seeking, and barriers to help-seeking were assessed. RESULTS Within three months of participation, 43 individuals (9.5%) took up treatment, 32 (7.8%) intended to start treatment, and 163 (43.1%) of the remaining reported that they would seek professional help in case of need (potential help-seeking). Approximately 50% of (potential) help-seekers stated that participation in ProYouth has changed their attitude towards help-seeking. Mental health literacy and shame/stigma were the most frequently mentioned barriers. CONCLUSIONS This is the first study indicating that an online program for prevention and early intervention may serve as facilitator in accessing conventional healthcare.
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Affiliation(s)
- Markus Moessner
- a Center for Psychotherapy Research, University Hospital Heidelberg , Heidelberg , Germany and
| | | | - Fikret Özer
- a Center for Psychotherapy Research, University Hospital Heidelberg , Heidelberg , Germany and
| | - Stephanie Bauer
- a Center for Psychotherapy Research, University Hospital Heidelberg , Heidelberg , Germany and
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