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Thomas PC, Curtis K, Potts HWW, Bark P, Perowne R, Rookes T, Rowe S. Behavior Change Techniques Within Digital Interventions for the Treatment of Eating Disorders: Systematic Review and Meta-Analysis. JMIR Ment Health 2024; 11:e57577. [PMID: 39088817 PMCID: PMC11327638 DOI: 10.2196/57577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 05/23/2024] [Accepted: 05/25/2024] [Indexed: 08/03/2024] Open
Abstract
BACKGROUND Previous systematic reviews of digital eating disorder interventions have demonstrated effectiveness at improving symptoms of eating disorders; however, our understanding of how these interventions work and what contributes to their effectiveness is limited. Understanding the behavior change techniques (BCTs) that are most commonly included within effective interventions may provide valuable information for researchers and developers. Establishing whether these techniques have been informed by theory will identify whether they target those mechanisms of action that have been identified as core to changing eating disorder behaviors. It will also evaluate the importance of a theoretical approach to digital intervention design. OBJECTIVE This study aims to define the BCTs within digital self-management interventions or minimally guided self-help interventions for adults with eating disorders that have been evaluated within randomized controlled trials. It also assessed which of the digital interventions were grounded in theory and the range of modes of delivery included. METHODS A literature search identified randomized controlled trials of digital intervention for the treatment of adults with eating disorders with minimal therapist support. Each digital intervention was coded for BCTs using the established BCT Taxonomy v1; for the application of theory using an adapted version of the theory coding scheme (TCS); and for modes of delivery using the Mode of Delivery Ontology. A meta-analysis evaluated the evidence that any individual BCT moderated effect size or that other potential factors such as the application of theory or number of modes of delivery had an effect on eating disorder outcomes. RESULTS Digital interventions included an average of 14 (SD 2.6; range 9-18) BCTs. Self-monitoring of behavior was included in all effective interventions, with Problem-solving, Information about antecedents, Feedback on behavior, Self-monitoring of outcomes of behavior, and Action planning identified in >75% (13/17) of effective interventions. Social support and Information about health consequences were more evident in effective interventions at follow-up compared with postintervention measurement. The mean number of modes of delivery was 4 (SD 1.6; range 2-7) out of 12 possible modes, with most interventions (15/17, 88%) being web based. Digital interventions that had a higher score on the TCS had a greater effect size than those with a lower TCS score (subgroup differences: χ21=9.7; P=.002; I²=89.7%) within the meta-analysis. No other subgroup analyses had statistically significant results. CONCLUSIONS There was a high level of consistency in terms of the most common BCTs within effective interventions; however, there was no evidence that any specific BCT contributed to intervention efficacy. The interventions that were more strongly informed by theory demonstrated greater improvements in eating disorder outcomes compared to waitlist or treatment-as-usual controls. These results can be used to inform the development of future digital eating disorder interventions. TRIAL REGISTRATION PROSPERO CRD42023410060; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=410060.
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Affiliation(s)
- Pamela Carien Thomas
- Department of Epidemiology & Applied Clinical Research, Division of Psychiatry, University College London, London, United Kingdom
| | - Kristina Curtis
- Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
| | - Henry W W Potts
- UCL Institute of Health Informatics, University College London, London, United Kingdom
| | - Pippa Bark
- UCL Cancer Institute, University College London, London, United Kingdom
| | - Rachel Perowne
- Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
| | - Tasmin Rookes
- UCL Research Department of Primary Care and Population Health, University College London, London, United Kingdom
| | - Sarah Rowe
- Department of Epidemiology & Applied Clinical Research, Division of Psychiatry, University College London, London, United Kingdom
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Holgersen G, Abdi-Dezfuli SE, Friis Darrud S, Stornes Espeset EM, Bircow Elgen I, Nordgreen T. Adolescents' perspectives on a novel digital treatment targeting eating disorders: a qualitative study. BMC Psychiatry 2024; 24:423. [PMID: 38840080 PMCID: PMC11155031 DOI: 10.1186/s12888-024-05866-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 05/26/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND Eating disorders in adolescence are associated with high psychological distress, impaired function and high comorbidity. Despite the severity, eating disorders remain highly underdiagnosed and untreated. Digital technology provides promising opportunities for treatment, however studies focusing on digital treatments for adolescents with eating disorders are lacking. The main aim of this study was to explore the perspectives of adolescents with lived experience of eating disorders on factors they deemed to be relevant in the development of a novel digital treatment. METHODS A qualitative intervention development study using semi-structured individual interviews. Data collection, coding and analysis were conducted using the principles of reflexive thematic analysis. Participants were adolescents aged 16-19 years, with a self-reported diagnosis of anorexia nervosa, bulimia nervosa or binge eating disorder, currently in the final phase or completed psychological treatment for an eating disorder within the last five years. RESULTS A total of 16 adolescents participated in the study, all females. Mean age was 17 ½ years (SD = 1.01). An in-depth understanding of the adolescents' perspectives was developed into three themes: Facilitating self-awareness and readiness to change; Strengthening interpersonal relationships and decreasing social isolation; Ensuring feeling seen and motivating regular use. CONCLUSIONS This study provides a unique insight into the perspectives of adolescents with lived experience of eating disorders. The uptake and engagement can be optimized in a novel digital treatment for eating disorders by taking the adolescents perspectives into consideration.
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Affiliation(s)
- Guri Holgersen
- Division of Psychiatry, Haukeland University Hospital, Post OfficeBox 1400, Bergen, N-5021, Norway.
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
| | | | | | | | - Irene Bircow Elgen
- Division of Psychiatry, Haukeland University Hospital, Post OfficeBox 1400, Bergen, N-5021, Norway
- Department of Child and Adolescent Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Tine Nordgreen
- Division of Psychiatry, Haukeland University Hospital, Post OfficeBox 1400, Bergen, N-5021, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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Penwell TE, Smith M, Ortiz SN, Brooks G, Thompson-Brenner H. Traditional versus virtual partial hospital programme for eating disorders: Feasibility and preliminary comparison of effects. EUROPEAN EATING DISORDERS REVIEW 2024; 32:163-178. [PMID: 37677002 DOI: 10.1002/erv.3031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 08/07/2023] [Accepted: 08/21/2023] [Indexed: 09/09/2023]
Abstract
OBJECTIVE Minimal research has examined teletherapy for group or intensive eating disorder (ED) treatment, particularly partial hospital programme (PHP). This study compared treatment outcomes for individuals treated before and after a pandemic-driven implementation of virtual PHP. METHOD Patients received care at ED treatment centres using the Renfrew Unified Treatment for Eating Disorders and Comorbidity. Patients treated with virtual PHP were compared to patients treated with traditional PHP. Measures of ED symptomology and behaviours, depressive symptoms, anxiety severity, anxiety sensitivity, experiential avoidance, mindfulness, and body mass index (BMI; reported for anorexia nervosa [AN] patients only) were collected at intake and discharge. Multiple regression analyses were conducted to examine the effect of treatment group on outcomes, controlling for intake score, comorbidity, discharge status, AN diagnosis, and step-down status. RESULTS Differences in treatment type were only found for binge eating frequency, with those in virtual PHP reporting significantly lower binge eating episodes at discharge than those in traditional PHP. Body mass index showed significantly less improvement in virtual PHP than in traditional PHP. CONCLUSIONS Preliminary results suggest virtual PHP is feasible and effective, potentially increasing access to evidence-based, intensive ED treatment. However, additional research is needed to establish efficacious support for weight gain among individuals with AN in virtual programs.
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Affiliation(s)
| | | | - Shelby N Ortiz
- Department of Psychology, Miami University, Oxford, OH, USA
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Berardi C, Antonini M, Jordan Z, Wechtler H, Paolucci F, Hinwood M. Barriers and facilitators to the implementation of digital technologies in mental health systems: a qualitative systematic review to inform a policy framework. BMC Health Serv Res 2024; 24:243. [PMID: 38408938 PMCID: PMC10898174 DOI: 10.1186/s12913-023-10536-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 12/28/2023] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND Despite the potential for improved population mental health and wellbeing, the integration of mental health digital interventions has been difficult to achieve. In this qualitative systematic review, we aimed to identify barriers and facilitators to the implementation of digital technologies in mental healthcare systems, and map these to an implementation framework to inform policy development. METHODS We searched Medline, Embase, Scopus, PsycInfo, Web of Science, and Google Scholar for primary research articles published between January 2010 and 2022. Studies were considered eligible if they reported barriers and/or facilitators to the integration of any digital mental healthcare technologies. Data were extracted using EPPI-Reviewer Web and analysed thematically via inductive and deductive cycles. RESULTS Of 12,525 references identified initially, 81 studies were included in the final analysis. Barriers and facilitators were grouped within an implementation (evidence-practice gap) framework across six domains, organised by four levels of mental healthcare systems. Broadly, implementation was hindered by the perception of digital technologies as impersonal tools that add additional burden of care onto both providers and patients, and change relational power asymmetries; an absence of resources; and regulatory complexities that impede access to universal coverage. Facilitators included person-cantered approaches that consider patients' intersectional features e.g., gender, class, disability, illness severity; evidence-based training for providers; collaboration among colleagues; appropriate investment in human and financial resources; and policy reforms that tackle universal access to digital health. CONCLUSION It is important to consider the complex and interrelated nature of barriers across different domains and levels of the mental health system. To facilitate the equitable, sustainable, and long-term digital transition of mental health systems, policymakers should consider a systemic approach to collaboration between public and private sectors to inform evidence-based planning and strengthen mental health systems. PROTOCOL REGISTRATION The protocol is registered on PROSPERO, CRD42021276838.
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Affiliation(s)
- Chiara Berardi
- Newcastle Business School, The University of Newcastle, Hunter St & Auckland St, 2300, Newcastle, NSW, Australia.
| | - Marcello Antonini
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, Australia
- Department of Health Policy, London School of Economics and Political Science, London, WC2A 2AE, UK
| | - Zephanie Jordan
- Newcastle Business School, The University of Newcastle, Hunter St & Auckland St, 2300, Newcastle, NSW, Australia
| | - Heidi Wechtler
- Newcastle Business School, The University of Newcastle, Hunter St & Auckland St, 2300, Newcastle, NSW, Australia
| | - Francesco Paolucci
- Newcastle Business School, The University of Newcastle, Hunter St & Auckland St, 2300, Newcastle, NSW, Australia
| | - Madeleine Hinwood
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
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Byrne SM, Fursland A. New understandings meet old treatments: putting a contemporary face on established protocols. J Eat Disord 2024; 12:26. [PMID: 38336928 PMCID: PMC10854196 DOI: 10.1186/s40337-024-00983-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 02/01/2024] [Indexed: 02/12/2024] Open
Abstract
In the twenty years since the publication of the most widely used treatment manuals describing evidence-based therapies for eating disorders, there have been some substantial advances in the field. New methods of delivering treatments have been trialled and our perception of mental health has advanced; significant cultural changes have led to shifts in our societal landscape; and new technologies have allowed for more in-depth research to be conducted. As a result, our understanding of eating disorders and their treatment has broadened considerably. However, these new insights have not necessarily been translated into improved clinical practice. This paper highlights the changes we consider to have had the greatest impact on our work as experienced clinical psychologists in the field and suggests a list of new learnings that might be incorporated into clinical practice and research design.
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Affiliation(s)
- Susan M Byrne
- University of Western Australia, Perth, WA, Australia.
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Marques CC, Palmeira L, Castilho P, Rodrigues D, Mayr A, Pina TS, Pereira AT, Castelo-Branco M, Goss K. Online Compassion Focused Therapy for overeating: Feasibility and acceptability pilot study. Int J Eat Disord 2024; 57:410-422. [PMID: 38124655 DOI: 10.1002/eat.24118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 12/08/2023] [Accepted: 12/08/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE This pilot study aims to investigate the feasibility, acceptability, and potential effectiveness of online Compassion Focused Therapy for overeating (CFT-OE). METHOD Eighteen Portuguese women seeking treatment for overeating were enrolled in this study, and 15 participants completed the CFT-OE. This was a single-arm study. Participants were assessed at pre- and post-intervention and 3-month follow-up. All participants completed measures assessing binge eating, cognitive restraint, uncontrolled eating, emotional eating, general eating psychopathology, general and body shame, self-criticism, self-compassion, and fears of self-compassion. RESULTS The treatment attrition rate was 16.7%, which is relatively low compared to other similar online interventions. Participants gave positive feedback on the program and indicated they would recommend it to people with similar difficulties. CFT-OE improved self-compassion and reduced eating psychopathology symptoms, general and body shame, self-criticism, and fears of self-compassion. Clinical significance analysis showed that the majority of participants were classified as in recovery in all measures at post-intervention and 3-month follow-up. DISCUSSION Preliminary results suggest that the online CFT-OE program is an acceptable and feasible intervention. Results also suggest that CFT-OE is beneficial for the treatment of women with difficulties with overeating. A future randomized controlled trial is necessary to establish the effectiveness of the CFT-OE. PUBLIC SIGNIFICANCE This study indicates that online CFT-OE is a feasible and adequate intervention for women who struggle with overeating. This therapy showed promising results in reducing eating disorder symptoms, shame, and self-criticism and improving self-compassion. As an online intervention, CFT-OE may be more accessible and offer an alternative to in-person therapy.
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Affiliation(s)
- Cristiana C Marques
- Faculty of Psychology and Educational Sciences, Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC), University of Coimbra, Coimbra, Portugal
- Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), Institute for Nuclear Sciences Applied to Health (ICNAS), University of Coimbra, Coimbra, Portugal
- Faculty of Medicine, Institute of Psychological Medicine, University of Coimbra, Coimbra, Portugal
| | - Lara Palmeira
- Faculty of Psychology and Educational Sciences, Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC), University of Coimbra, Coimbra, Portugal
- Portucalense Psychology Institute (I2P), Portucalense University, Porto, Portugal
| | - Paula Castilho
- Faculty of Psychology and Educational Sciences, Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC), University of Coimbra, Coimbra, Portugal
| | - Dírcea Rodrigues
- Department of Endocrinology, Diabetes and Metabolism, Coimbra Hospital and University Centre, Coimbra, Portugal
| | - Andreas Mayr
- Department of Medical Biometrics, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany
| | - Tiago Soares Pina
- Department of Nutrition and Dietetics, Coimbra Hospital and University Centre, Coimbra, Portugal
| | - Ana Telma Pereira
- Faculty of Medicine, Institute of Psychological Medicine, University of Coimbra, Coimbra, Portugal
| | - Miguel Castelo-Branco
- Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), Institute for Nuclear Sciences Applied to Health (ICNAS), University of Coimbra, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Kenneth Goss
- Coventry & Warwickshire Partnership Trust, Coventry Eating Disorder Service, Coventry, UK
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Fitterman-Harris HF, Davis GG, Bedard SP, Cusack CE, Levinson CA. Digital Mental Health Interventions: Differences in Diet Culture Intervention Framing. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 21:24. [PMID: 38248489 PMCID: PMC10815398 DOI: 10.3390/ijerph21010024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 12/14/2023] [Accepted: 12/20/2023] [Indexed: 01/23/2024]
Abstract
Diet culture is a societal norm that ranks thin bodies as superior to other body types and has been associated with negative outcomes, such as eating disorders. Wellness has evolved into a term that is often used to promote diet culture messages. One possible way to combat diet culture is through single-session, digital mental health interventions (DMHIs), which allow for increased access to brief public health treatments. The framing of DMHIs is critical to ensure that the target population is reached. Participants (N = 397) were enrolled in a single-session DMHI, which was framed as either a Diet Culture Intervention (n = 201) or a Wellness Resource (n = 196). Baseline group differences in eating disorder pathology, body image, weight stigma concerns, fat acceptance, and demographic characteristics were analyzed. Across groups, participants reported moderately high eating disorder pathology, low-to-moderate levels of body dissatisfaction, moderate levels of fat acceptance, and either very low or very high weight stigma concerns. Participants in the Diet Culture Intervention group reported higher levels of fat acceptance than those in the Wellness Resource group (p < 0.001). No other framing group differences were identified, though post hoc analyses revealed differences based on recruitment source (i.e., social media versus undergraduate research portal). This study found that framing a DMHI as targeting diet culture or as a Wellness Resource can result in the successful recruitment of individuals at risk of disordered eating. Framing a DMHI as a Wellness Resource may increase recruitment of individuals with low levels of fat acceptance, which may be particularly important for dismantling diet culture, disordered eating, and weight stigma concerns. Future research should assess DMHI framing in other populations, such as men and adolescents.
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Affiliation(s)
- Hannah F. Fitterman-Harris
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, KY 40292, USA; (S.P.B.); (C.E.C.); (C.A.L.)
| | - Gabrielle G. Davis
- College of Education and Human Development, University of Louisville, Louisville, KY 40292, USA;
| | - Samantha P. Bedard
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, KY 40292, USA; (S.P.B.); (C.E.C.); (C.A.L.)
- Department of Psychology, University of Wyoming, Laramie, WY 82071, USA
| | - Claire E. Cusack
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, KY 40292, USA; (S.P.B.); (C.E.C.); (C.A.L.)
| | - Cheri A. Levinson
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, KY 40292, USA; (S.P.B.); (C.E.C.); (C.A.L.)
- Department of Pediatrics, Division of Child and Adolescent Psychiatry and Psychology, University of Louisville, Louisville, KY 40292, USA
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Barakat S, Burton AL, Cunich M, Hay P, Hazelton JL, Kim M, Lymer S, Madden S, Maloney D, Miskovic-Wheatley J, Rogers D, Russell J, Sidari M, Touyz S, Maguire S. A randomised controlled trial of clinician supported vs self-help delivery of online cognitive behaviour therapy for Bulimia Nervosa. Psychiatry Res 2023; 329:115534. [PMID: 37844353 DOI: 10.1016/j.psychres.2023.115534] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 10/02/2023] [Accepted: 10/06/2023] [Indexed: 10/18/2023]
Abstract
High dropout rates and poor adherence associated with digital interventions have prompted research into modifications of these treatments to improve engagement and completion rates. This trial aimed to investigate the added benefit of clinician support when paired alongside a ten-session, online cognitive behaviour therapy (CBT) self-help intervention for bulimia nervosa (BN). As part of a three-arm, phase II randomised controlled trial, 114 participants (16 years or over) with full or subthreshold BN were randomly assigned to complete the intervention in a self-help mode (with administrative researcher contact; n = 38), with adjunct clinician support (weekly 30-minute videoconferencing sessions; n = 37), or a no-treatment waitlist control (WLC; n = 39). Baseline to post-treatment (12-weeks) decreases in objective binge episode frequency were significantly greater for clinician-supported participants as compared to WLC, but not for self-help when compared to WLC. However, due to continued improvements for self-help across follow-up (24-weeks), both arms outperformed WLC when analysed as an overall rate of change across three timepoints. Clinician-supported participants outperformed self-help in regards to laxative use and dietary restraint. Our results demonstrate that good clinical outcomes can be achieved with a relatively brief online CBT-based program even in the absence of structured clinical support, indicating a possible overreliance upon clinician support as a primary adherence-facilitating mechanism.
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Affiliation(s)
- Sarah Barakat
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, University of Sydney and Sydney Local Health District, Sydney, NSW 2006, Australia; School of Psychology, University of Sydney, Sydney, NSW, Australia.
| | - Amy L Burton
- School of Psychology, University of Sydney, Sydney, NSW, Australia; Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia; Graduate School of Health, University of Technology Sydney, Sydney NSW, Australia
| | - Michelle Cunich
- Sydney Health Economics Collaborative, Sydney Local Health District, Camperdown, NSW, Australia; Boden Initiative, Charles Perkins Centre, Faculty of Medicine and Health (Central Clinical School), University of Sydney, Sydney, NSW, Australia; Co-Lead, Implementation and Policy, Cardiovascular Initiative, University of Sydney, Camperdown, NSW, Australia
| | - Phillipa Hay
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, NSW, Australia; Mental Health Services South Western Sydney Local Health District, Campbelltown, NSW, Australia
| | - Jessica L Hazelton
- School of Psychology, University of Sydney, Sydney, NSW, Australia; Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - Marcellinus Kim
- Sydney Local Health District Mental Health Services, Royal Prince Alfred Hospital, Sydney, Australia
| | - Sharyn Lymer
- Boden Initiative, Charles Perkins Centre, Faculty of Medicine and Health (Central Clinical School), University of Sydney, Sydney, NSW, Australia
| | - Sloane Madden
- Department of Psychological Medicine, Sydney Children's Hospital Network, Sydney, NSW, Australia; Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Danielle Maloney
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, University of Sydney and Sydney Local Health District, Sydney, NSW 2006, Australia
| | - Jane Miskovic-Wheatley
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, University of Sydney and Sydney Local Health District, Sydney, NSW 2006, Australia
| | - Daniel Rogers
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, University of Sydney and Sydney Local Health District, Sydney, NSW 2006, Australia
| | - Janice Russell
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, University of Sydney and Sydney Local Health District, Sydney, NSW 2006, Australia; Sydney Local Health District Mental Health Services, Royal Prince Alfred Hospital, Sydney, Australia
| | - Morgan Sidari
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, University of Sydney and Sydney Local Health District, Sydney, NSW 2006, Australia; Queensland Eating Disorder Service, Metro North Hospital and Health, Brisbane, QLD, Australia
| | - Stephen Touyz
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, University of Sydney and Sydney Local Health District, Sydney, NSW 2006, Australia
| | - Sarah Maguire
- InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, University of Sydney and Sydney Local Health District, Sydney, NSW 2006, Australia
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Rom S, Miskovic-Wheatley J, Barakat S, Aouad P, Kim M, Fuller-Tyszkiewicz M, Maguire S. The acceptability, feasibility, and preliminary efficacy of a supported online self-help treatment program for binge-eating disorder. Front Psychiatry 2023; 14:1229261. [PMID: 37860164 PMCID: PMC10584326 DOI: 10.3389/fpsyt.2023.1229261] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 09/06/2023] [Indexed: 10/21/2023] Open
Abstract
Introduction Studies in transdiagnostic eating disorder (ED) samples suggest supported online self-help programs (eTherapies) are effective and may improve access to treatment; however, their evaluation in those with binge-eating disorder (BED) is limited. Given BED's high prevalence and low levels of treatment uptake, further eTherapy evaluation is needed to broaden access to effective, evidence-based treatment options. The aim of this study was to investigate the acceptability, feasibility, and preliminary efficacy of a supported eTherapy for those with BED or subthreshold BED, and to examine symptom change across the duration of therapy. Method Nineteen women with BED completed a supported, 10-session Cognitive Behavioural Therapy-based eTherapy in an uncontrolled, pre-post, and 3 months follow up intervention study. Key outcomes were assessed by the Eating Disorder Examination Questionnaire (EDE-Q): objective binge episode (OBE) frequency and ED psychopathology. Feasibility was evaluated via program adherence and dropout, whilst acceptability was assessed through participant feedback post-treatment. Weekly symptom change (ED psychopathology) during treatment was assessed by the Eating Disorder Examination - Questionnaire Short (EDE-QS). Results Generalised estimating equations showed statistically and clinically significant reductions in OBEs and ED psychopathology (large effects) post-treatment, with these decreases maintained at follow up. Across weekly assessment, a marked slowing in the rate of change in ED psychopathology was observed after four sessions of the program. Program feasibility was high (i.e., 84% of content completed), as was program acceptability (i.e., 93% of participants expressed high levels of satisfaction). Discussion These results support the acceptability, feasibility, and preliminary efficacy of a supported eTherapy program for those with BED and suggest the variability of symptom change across the duration of therapy. Future research should further investigate findings in an adequately powered randomised controlled trial.
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Affiliation(s)
- Sean Rom
- Faculty of Health, School of Psychology, Deakin University, Geelong, VIC, Australia
- InsideOut Institute, The University of Sydney and Sydney Local Health District, Sydney, NSW, Australia
| | - Jane Miskovic-Wheatley
- InsideOut Institute, The University of Sydney and Sydney Local Health District, Sydney, NSW, Australia
| | - Sarah Barakat
- InsideOut Institute, The University of Sydney and Sydney Local Health District, Sydney, NSW, Australia
| | - Phillip Aouad
- InsideOut Institute, The University of Sydney and Sydney Local Health District, Sydney, NSW, Australia
| | | | | | - Sarah Maguire
- InsideOut Institute, The University of Sydney and Sydney Local Health District, Sydney, NSW, Australia
- Sydney Local Health District, Sydney, NSW, Australia
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Hay PJ, Rankin R, Ramjan L, Conti J. Current approaches in the recognition and management of eating disorders. Med J Aust 2023; 219:127-134. [PMID: 37356068 DOI: 10.5694/mja2.52008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 04/25/2023] [Accepted: 05/02/2023] [Indexed: 06/27/2023]
Abstract
Eating disorders are now well acknowledged mental health problems that are common and present in people from diverse sociodemographic backgrounds. The past decade has seen a rapid expansion in research into eating disorder interventions. In response to the increasing burden of eating disorders, the Australian Government Department of Health and Aged Care has implemented significant policy changes to improve patient access to Medicare and inpatient treatment facilities. There are several international clinical practice guidelines and a robust evidence base particularly for first line care with specific psychological therapies, including guidelines for the management of eating disorders in individuals with a high weight. Medications play an important adjunct role in care, and novel neuromodulating treatments, such as psychostimulants, are under study. There is emerging evidence for increased person-centred care, with more choice in the form of alternatives to hospital inpatient programs and more respectful consideration of care for all who experience an eating disorder, including people with high weight.
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Affiliation(s)
- Phillipa J Hay
- Translational Health Research Institute, Western Sydney University, Sydney, NSW
- South Western Sydney Local Health District, Sydney, NSW
| | - Rebekah Rankin
- Translational Health Research Institute, Western Sydney University, Sydney, NSW
| | | | - Janet Conti
- Translational Health Research Institute, Western Sydney University, Sydney, NSW
- Western Sydney University, Sydney, NSW
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Yun J, Shin J, Lee H, Kim DJ, Choi IY, Kim M. Characteristics and Potential Challenges of Digital-Based Interventions for Children and Young People: Scoping Review. J Med Internet Res 2023; 25:e45465. [PMID: 37058340 PMCID: PMC10148209 DOI: 10.2196/45465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 02/15/2023] [Accepted: 02/27/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND Digital health technologies are becoming increasingly available to children and young people and their families. However, there are no scoping reviews that provide both an overview of the characteristics of digital interventions for children and young people and potential challenges to be considered when developing and implementing them. OBJECTIVE This study aimed to systematically review scientific publications to identify the current characteristics and potential complications of digital interventions for children and young people. METHODS This scoping review was conducted using the framework of Arksey and O'Malley and adheres to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for scoping reviews. A search of 5 databases (PubMed, Scopus, Embase, MEDLINE, and CINAHL) and Google Scholar was performed for eligible clinical trials published between January 1, 2018, and August 19, 2022. RESULTS The initial search of the 5 databases yielded 3775 citations; duplicates and those not meeting the inclusion criteria were eliminated. In total, 34 articles were included in the final review and relevant information, such as the descriptive characteristics and potential challenges, were classified. Mental health (26/34, 76%) was the most common target for the digital intervention for children and young people, exceeding physical health (8/34, 24%) by more than 3 times. In addition, a substantial number of digital interventions were dedicated solely to children and young people. Digital interventions for children and young people were more likely to be delivered via computers (17/34, 50%) rather than smartphones (13/34, 38%). More than one-third of the studies (13/34, 38%) applied cognitive behavioral theory as the theory of digital interventions. The duration of the digital intervention for children and young people was more likely to vary depending on the target user rather than the target disease. Intervention components were classified into 5 categories: guidance, task and activity, reminder and monitoring, supportive feedback, and reward system. Potential challenges were subcategorized into ethical, interpersonal, and societal challenges. For ethical challenges, the consent of children and young people or caregivers, potential risk of adverse events, and data privacy issues were considered. For interpersonal challenges, the engagement of children and young people was affected by the preference or barrier of caregivers to participate in studies. For societal challenges, restricted ethnicity in recruitment, limited availability of digital technology, differences in internet use patterns between girls and boys, unified clinical settings, and language barriers were described. CONCLUSIONS We identified potential challenges and provided suggestions about ethical, interpersonal, and societal aspects to consider when developing and deploying digital-based interventions for children and young people. Our findings provide a thorough overview of the published literature and may serve as a comprehensive, informative foundation for the development and implementation of digital-based interventions for children and young people.
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Affiliation(s)
- Jinsoo Yun
- College of Nursing, Yonsei University, Seoul, Republic of Korea
| | - Jaeyong Shin
- Department of Preventive Medicine, College of Medicine, Yonsei University, Seoul, Republic of Korea
| | - Hyerim Lee
- Department of Psychology, College of Liberal Arts, Yonsei University, Seoul, Republic of Korea
| | - Dai-Jin Kim
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - In-Young Choi
- Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Meelim Kim
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, San Diego, CA, United States
- Health IT Center, Yonsei University Health System, Seoul, Republic of Korea
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12
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The efficacy of randomised controlled trials of guided and unguided self-help interventions for the prevention and treatment of eating disorders in young people: A systematic review and preliminary meta-analysis. J Behav Ther Exp Psychiatry 2023; 78:101777. [PMID: 36215935 DOI: 10.1016/j.jbtep.2022.101777] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 07/29/2022] [Accepted: 08/18/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND OBJECTIVES Guided and unguided self-help prevention and treatment interventions for eating disorders delivered via traditional book format or internet delivery have been widely researched, but no reviews have focused specifically on young people. The aim of this systematic review and meta-analysis was to examine the efficacy of randomised controlled trials of self-help interventions for eating disorders in young people with a mean age between 13 and 24 years. METHODS A total of 8 intervention groups across 7 publications of self-help interventions which were prevention and treatment trials for eating disorders, were identified (N = 985 participants; mean pooled age = ∼19 years). RESULTS There was a significant very small effect (pooled g = -0.17) of self-help interventions at post-treatment which was non-significant at follow-up (pooled g = -0.14). No evidence of publication bias was found. LIMITATIONS There were limitations of the review, including a lack of active treatment comparisons, a small number of trials included, and few studies included an age range. CONCLUSIONS Results from this preliminary meta-analysis suggest very small but significant effects, however further studies are required to determine whether self-help approaches are effective for prevention and treatment of eating disorder symptoms in young people. Future meta-analyses should include a larger number of trials, and younger age range of children to examine the efficacy of self-help interventions for eating disorders in young people.
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13
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Wiberg AC, Ghaderi A, Danielsson HB, Safarzadeh K, Parling T, Carlbring P, Jansson M, Welch E. Internet-based cognitive behavior therapy for eating disorders - Development and feasibility evaluation. Internet Interv 2022; 30:100570. [PMID: 36110307 PMCID: PMC9468502 DOI: 10.1016/j.invent.2022.100570] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 08/20/2022] [Accepted: 08/29/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Eating disorders (ED) are severe psychiatric conditions, characterized by decreased quality of life and high mortality. However, only a minority of patients with ED seek care and very few receive treatment. Internet-delivered cognitive behavioral therapy (ICBT) has the potential to increase access to evidence-based treatments. AIMS The aims of the present study were to (1) develop and evaluate the usability of an Internet-delivered guided self-help treatment based on Enhanced Cognitive Behavioral Therapy (ICBT-E) for patients with full or subthreshold bulimia nervosa (BN) or binge eating disorder (BED) with a user centered design process, and (2) to evaluate its feasibility and preliminary outcome in a clinical environment. METHOD The study was undertaken in two stages. In Stage I, a user-centered design approach was applied with iterative phases of prototype development and evaluation. Participants were eight clinicians and 30 individuals with current or previous history of ED. In Stage II, 41 patients with full or subthreshold BN or BED were recruited to a single-group open trial to evaluate the feasibility and preliminary outcome of ICBT-E. Primary outcome variables were diagnostic status and self-rated ED symptoms. RESULTS The user-centered design process was instrumental in the development of the ICBT-E, by contributing to improvements of the program and to the content being adapted to the needs and preferences of end-users. The overall usability of the program was found to be good. ICBT-E targets key maintaining factors in ED by introducing healthy eating patterns and addressing over-evaluation of weight and shape. The results indicate that ICBT-E, delivered in a clinical setting, is a feasible and promising treatment for full or subthreshold BN or BED, with a high level of acceptability observed and treatment completion of 73.2 %. Participation in ICBT-E was associated with significant symptom reductions in core ED symptomology, functional impairment as well as depressive symptoms, and the results were maintained at the 3-month follow-up. CONCLUSIONS ICBT-E was developed with end-users' preferences in mind, in accordance with the identified recommendations, and the program was perceived as usable by end-users. The study demonstrated the potential of ICBT-E, which marks a step forward in the effort to make powerful, empirically supported psychological interventions targeting ED more widely available and accessible.
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Affiliation(s)
- Anne-Charlotte Wiberg
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Ata Ghaderi
- Department of Clinical Neuroscience, Karolinska Institutet, Nobels väg 9, 17177 Stockholm, Sweden
| | | | - Kousha Safarzadeh
- Student Health Center, Lund University, Sandgatan 3, 22350 Lund, Sweden
| | - Thomas Parling
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Per Carlbring
- Department of Psychology, Stockholm University, 106 91 Stockholm, Sweden
| | - Magdalena Jansson
- Stockholm Center for Eating Disorders, Stockholm County Council, Wollmar Yxkullsgatan 27B, 118 50 Stockholm, Sweden
| | - Elisabeth Welch
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
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14
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Dufour R, Novack K, Picard L, Chadi N, Booij L. The use of technology in the treatment of youth with eating disorders: A scoping review. J Eat Disord 2022; 10:182. [PMID: 36434657 PMCID: PMC9700893 DOI: 10.1186/s40337-022-00697-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 11/08/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Adolescence and young adulthood is a high-risk period for the development of eating disorders. In recent years, there has been an increase in use of technology-based interventions (TBIs) for the treatment of eating disorders. The objective of this study was to determine the types of technology used for eating disorder treatment in youth and their effectiveness. METHODS A scoping review was conducted according to PRISMA-ScR guidelines. Four databases were searched. Eligible articles included: (1) a TBI (2) participants with a mean age between 10- and 25-years and meeting DSM-IV or DSM-5 criteria for any eating disorder and (3) qualitative or quantitative designs. Quantitative and qualitative studies were assessed for quality. RESULTS The search identified 1621 articles. After screening of titles and abstracts, 130 articles were read in full and assessed for eligibility by two raters. Forty-nine (29 quantitative and 20 qualitative, observational, or mixed methods studies) met inclusion criteria. Quality ratings indicated that 78% of quantitative studies had a low risk of bias and 22% had a moderate risk. Technologies reviewed in our study included videoconference therapy, mobile applications, and online self-help. We considered interventions used both within sessions with clinicians as well as those used in between sessions by patients alone. Fifteen of 18 (83%) quantitative studies found that TBIs reduce eating disorder symptomatology, with nine of those reporting medium-to-large effect sizes. Qualitative data was of high quality and suggested that virtual interventions are acceptable in this population. CONCLUSIONS Although identified studies are of high quality, they are limited in number. More research is needed, particularly regarding videoconferencing and mobile applications. Nonetheless, TBIs show promise for the treatment of eating disorders in youth. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Rachel Dufour
- Sainte-Justine Hospital Research Centre, Montreal, Canada.,Department of Psychology, Concordia University, Montreal, Canada
| | - Kaylee Novack
- Sainte-Justine Hospital Research Centre, Montreal, Canada.,Department of Psychiatry and Addictology, Université de Montréal, Montreal, Canada.,Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Louis Picard
- Division of Adolescent Medicine, Department of Pediatrics, Sainte-Justine University Hospital Centre, 3175 Chemin de La Côte-Ste-Catherine, Montreal, QC, H3T 1C5, Canada
| | - Nicholas Chadi
- Sainte-Justine Hospital Research Centre, Montreal, Canada. .,Division of Adolescent Medicine, Department of Pediatrics, Université de Montréal, Montreal, Canada. .,Division of Adolescent Medicine, Department of Pediatrics, Sainte-Justine University Hospital Centre, 3175 Chemin de La Côte-Ste-Catherine, Montreal, QC, H3T 1C5, Canada.
| | - Linda Booij
- Sainte-Justine Hospital Research Centre, Montreal, Canada.,Department of Psychology, Concordia University, Montreal, Canada.,Department of Psychiatry and Addictology, Université de Montréal, Montreal, Canada.,Department of Psychiatry, McGill University, Montreal, Canada
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15
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Mensinger JL. Traumatic stress, body shame, and internalized weight stigma as mediators of change in disordered eating: a single-arm pilot study of the Body Trust® framework. Eat Disord 2022; 30:618-646. [PMID: 34634212 DOI: 10.1080/10640266.2021.1985807] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
To enhance access to evidence-based treatment it is increasingly important to evaluate scalable virtual programs that support the needs of those struggling with disordered eating. This study described a scientifically grounded, trauma-informed framework known as Body Trust,® and aimed to pilot test the preliminary effectiveness and mechanisms of change in a Body Trust® program to improve disordered eating. Using quality outcomes data, we examined 70 mostly white (87%) female-identifying (97%) individuals enrolled in a 6-module online program based in the Body Trust® framework (Mage = 45.5 ±10.9; MBMI = 33.7 ±8.0). Putative mediators included traumatic stress, internalized weight stigma, and body shame. Outcomes were objective and subjective binge episodes, overvaluation of weight and shape, and eating concerns. Generalized estimating equations were applied to determine pre-to-post changes. We applied Montoya's MEMORE macro, the joint-significance test, and calculated 95% Monte Carlo confidence intervals to assess mediation. Significant pre-to-post improvements with medium to large effect sizes were detected for all outcomes and mediators (ps<.008). All hypothesized mechanisms supported mediation. Using the Body Trust® framework shows early promise for alleviating disordered eating symptoms through targeting traumatic stress, body shame, and internalized weight stigma. Given the program's use of mindfulness techniques, future research should test target mechanisms like interoception.
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Affiliation(s)
- Janell L Mensinger
- M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, United States
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16
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Rom S, Miskovic‐Wheatley J, Barakat S, Aouad P, Fuller‐Tyszkiewicz M, Maguire S. Evaluating the feasibility and potential efficacy of a brief eTherapy for binge-eating disorder: A pilot study. Int J Eat Disord 2022; 55:1614-1620. [PMID: 35986579 PMCID: PMC9804415 DOI: 10.1002/eat.23803] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 08/05/2022] [Accepted: 08/05/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVE For those with binge-eating disorder (BED), access to evidence-based, face-to-face treatment is often constrained by clinician availability and high treatment costs. Emerging evidence suggests online therapy (eTherapy) may navigate these barriers and reduce binge-eating symptomatology; however, less evaluation has been done in those with BED, particularly with briefer programs targeting early change. This study investigated the feasibility and potential efficacy of a brief, supported eTherapy in those with BED or subthreshold BED. METHOD Participants were 19 women with BED who completed a four-session eTherapy. This was a single-arm, pre-post intervention study, with participants completing weekly content and attending telehealth sessions. Key outcomes were assessed by the Eating Disorder Examination Questionnaire-Short (EDE-QS): objective binge episode days, loss of control over eating days, and eating disorder (ED) psychopathology via a total EDE-QS score. RESULTS Generalized and linear mixed models showed significantly reduced loss of control over eating days and ED psychopathology. Program feasibility was high, with strong program adherence and a below average attrition rate. DISCUSSION Pilot results support the feasibility and potential efficacy of a brief, behavioral-focused eTherapy program in reducing ED pathology in those with BED. Future research should further investigate findings in an adequately powered randomized controlled trial. PUBLIC SIGNIFICANCE This study suggests that a brief, behavioral-focused online therapy, guided by non-expert clinicians, can be successfully administered to those with binge-eating disorder (BED) and may be efficacious at reducing eating disorder and other related symptomatology. Brief eTherapies that are effective, accessible, and rapidly available may facilitate earlier intervention in illness and improve treatment outcomes for individuals who experience this common and distressing disorder.
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Affiliation(s)
- Sean Rom
- School of PsychologyDeakin UniversityGeelongVictoriaAustralia,InsideOut Institute, Central Clinical School, Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
| | - Jane Miskovic‐Wheatley
- InsideOut Institute, Central Clinical School, Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
| | - Sarah Barakat
- InsideOut Institute, Central Clinical School, Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia,School of PsychologyThe University of SydneySydneyNew South WalesAustralia
| | - Phillip Aouad
- InsideOut Institute, Central Clinical School, Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
| | | | - Sarah Maguire
- InsideOut Institute, Central Clinical School, Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia,Sydney Local Health DistrictSydneyNew South WalesAustralia
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17
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Monteleone AM, Pellegrino F, Croatto G, Carfagno M, Hilbert A, Treasure J, Wade T, Bulik CM, Zipfel S, Hay P, Schmidt U, Castellini G, Favaro A, Fernandez-Aranda F, Il Shin J, Voderholzer U, Ricca V, Moretti D, Busatta D, Abbate-Daga G, Ciullini F, Cascino G, Monaco F, Correll CU, Solmi M. Treatment of eating disorders: A systematic meta-review of meta-analyses and network meta-analyses. Neurosci Biobehav Rev 2022; 142:104857. [PMID: 36084848 PMCID: PMC9813802 DOI: 10.1016/j.neubiorev.2022.104857] [Citation(s) in RCA: 75] [Impact Index Per Article: 37.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 08/27/2022] [Accepted: 09/02/2022] [Indexed: 02/07/2023]
Abstract
MONTELEONE, A.M., F. Pellegrino, G. Croatto, M. Carfagno, A. Hilbert, J. Treasure, T. Wade, C. Bulik, S. Zipfel, P. Hay, U. Schmidt, G. Castellini, A. Favaro, F. Fernandez-Aranda, J. Il Shin, U. Voderholzer, V. Ricca, D. Moretti, D. Busatta, G. Abbate-Daga, F. Ciullini, G. Cascino, F. Monaco, C.U. Correll and M. Solmi. Treatment of Eating Disorders: a systematic meta-review of meta-analyses and network meta-analyses. NEUROSCI BIOBEHAV REV 21(1) XXX-XXX, 2022.- Treatment efficacy for eating disorders (EDs) is modest and guidelines differ. We summarized findings/quality of (network) meta-analyses (N)MA of randomized controlled trials (RCTs) in EDs. Systematic meta-review ((N)MA of RCTs, ED, active/inactive control), using (anorexia or bulimia or eating disorder) AND (meta-analy*) in PubMed/PsycINFO/Cochrane database up to December 15th, 2020. Standardized mean difference, odds/risk ratio vs control were summarized at end of treatment and follow-up. Interventions involving family (family-based therapy, FBT) outperformed active control in adults/adolescents with anorexia nervosa (AN), and in adolescents with bulimia nervosa (BN). In adults with BN, individual cognitive behavioural therapy (CBT)-ED had the broadest efficacy versus active control; also, antidepressants outperformed active. In mixed age groups with binge-eating disorder (BED), psychotherapy, and lisdexamfetamine outperformed active control. Antidepressants, stimulants outperformed placebo, despite lower acceptability, as did CBT-ED versus waitlist/no treatment. Family-based therapy is effective in AN and BN (adolescents). CBT-ED has the largest efficacy in BN (adults), followed by antidepressants, as well as psychotherapy in BED (mixed). Medications have short-term efficacy in BED (adults).
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Affiliation(s)
| | | | | | - Marco Carfagno
- Department of Psychiatry, University of Campania L. Vanvitelli, Naples, Italy
| | - Anja Hilbert
- Integrated Research and Treatment Center AdiposityDiseases, Behavioral Medicine Research Unit, Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany
| | - Janet Treasure
- King's College London, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Tracey Wade
- Flinders Institute for Mental Health and Well-Being, the Blackbird Initiative, Flinders University, South Australia, Australia
| | - Cynthia M Bulik
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, USA; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital, Tuebingen, Germany; Centre of Excellence for Eating Disorders Tuebingen (KOMET), Germany
| | - Phillipa Hay
- Translational Health Research Institute, School of Medicine, Western Sydney University, Australia
| | - Ulrike Schmidt
- King's College London, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Giovanni Castellini
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Angela Favaro
- Neurosciences Department, University of Padua, Padua, Italy
| | - Fernando Fernandez-Aranda
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL and CIBERobn, ISCIII, Barcelona, Spain
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ulrich Voderholzer
- Schoen Clinic Roseneck, Prien am Chiemsee, Germany; Clinic for Psychiatry and Psychotherapy, University Hospital Freiburg, Freiburg, Germany; Clinic for Psychiatry and Psychotherapy, University Hospital of Munich, Munich, Germany
| | - Valdo Ricca
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Davide Moretti
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Daniele Busatta
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Giovanni Abbate-Daga
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy
| | - Filippo Ciullini
- Department of General Psychology, University of Padova, Padova, Italy
| | - Giammarco Cascino
- Department of Medicine, Surgery and Dentistry 'Scuola Medica Salernitana', Section of Neurosciences, University of Salerno, Salerno, Italy
| | | | - Christoph U Correll
- Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA; Department of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA; Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, NY, USA; Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
| | - Marco Solmi
- Department of Psychiatry, University of Ottawa, Ottawa, Ontario, Canada; Department of Mental Health, The Ottawa Hospital, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada; Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
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18
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Rohrbach PJ, Dingemans AE, Spinhoven P, Van Ginkel JR, Fokkema M, Wilderjans TF, Bauer S, Van Furth EF. Effectiveness of an online self-help program, expert-patient support, and their combination for eating disorders: Results from a randomized controlled trial. Int J Eat Disord 2022; 55:1361-1373. [PMID: 35906929 PMCID: PMC9796760 DOI: 10.1002/eat.23785] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 07/07/2022] [Accepted: 07/07/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Many individuals with an eating disorder do not receive appropriate care. Low-threshold interventions could help bridge this treatment gap. The study aim was to evaluate the effectiveness of Featback, a fully automated online self-help intervention, online expert-patient support and their combination. METHOD A randomized controlled trial with a 12-month follow-up period was conducted. Participants aged 16 or older with at least mild eating disorder symptoms were randomized to four conditions: (1) Featback, a fully automated online self-help intervention, (2) chat or email support from a recovered expert patient, (3) Featback with expert-patient support and (4) a waiting list control condition. The intervention period was 8 weeks and there was a total of six online assessments. The main outcome constituted reduction of eating disorder symptoms over time. RESULTS Three hundred fifty five participants, of whom 43% had never received eating disorder treatment, were randomized. The three active interventions were superior to a waitlist in reducing eating disorder symptoms (d = -0.38), with no significant difference in effectiveness between the three interventions. Participants in conditions with expert-patient support were more satisfied with the intervention. DISCUSSION Internet-based self-help, expert-patient support and their combination were effective in reducing eating disorder symptoms compared to a waiting list control condition. Guidance improved satisfaction with the internet intervention but not its effectiveness. Low-threshold interventions such as Featback and expert-patient support can reduce eating disorder symptoms and reach the large group of underserved individuals, complementing existing forms of eating disorder treatment. PUBLIC SIGNIFICANCE STATEMENT Individuals with eating-related problems who received (1) a fully automated internet-based intervention, (2) chat and e-mail support by a recovered individual or (3) their combination, experienced stronger reductions in eating disorder symptoms than those who received (4) usual care. Such brief and easy-access interventions play an important role in reaching individuals who are currently not reached by other forms of treatment.
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Affiliation(s)
- Pieter J. Rohrbach
- GGZ Rivierduinen Eating Disorders UrsulaLeidenNetherlands
- Department of PsychiatryLeiden University Medical CenterLeidenNetherlands
| | | | - Philip Spinhoven
- Department of PsychiatryLeiden University Medical CenterLeidenNetherlands
- Methodology and Statistics Research Unit, Institute of PsychologyLeiden UniversityLeidenNetherlands
| | - Joost R. Van Ginkel
- Methodology and Statistics Research Unit, Institute of PsychologyLeiden UniversityLeidenNetherlands
| | - Marjolein Fokkema
- Methodology and Statistics Research Unit, Institute of PsychologyLeiden UniversityLeidenNetherlands
| | - Tom F. Wilderjans
- Methodology and Statistics Research Unit, Institute of PsychologyLeiden UniversityLeidenNetherlands
- Leiden Institute for Brain and CognitionLeiden University Medical CenterLeidenNetherlands
- Research Group of Quantitative Psychology and Individual Differences, Faculty of Psychology and Educational SciencesKU LeuvenLeuvenBelgium
| | - Stephanie Bauer
- Center for Psychotherapy ResearchUniversity Hospital HeidelbergGermany
| | - Eric F. Van Furth
- GGZ Rivierduinen Eating Disorders UrsulaLeidenNetherlands
- Department of PsychiatryLeiden University Medical CenterLeidenNetherlands
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19
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Stoeten C, de Haan HA, Postel MG, Brusse-Keizer M, Ter Huurne ED. Therapeutic Alliance in Web-Based Treatment for Eating Disorders: Secondary Analysis of a Randomized Controlled Trial. JMIR Form Res 2022; 6:e33813. [PMID: 35771608 PMCID: PMC9284349 DOI: 10.2196/33813] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 04/20/2022] [Accepted: 04/24/2022] [Indexed: 11/16/2022] Open
Abstract
Background In face-to-face therapy for eating disorders, therapeutic alliance (TA) is an important predictor of symptom reduction and treatment completion. To date, however, little is known about TA during web-based cognitive behavioral therapy (web-CBT) and its association with symptom reduction, treatment completion, and the perspectives of patients versus therapists. Objective This study aimed to investigate TA ratings measured at interim and after treatment, separately for patients and therapists; the degree of agreement between therapists and patients (treatment completers and noncompleters) for TA ratings; and associations between patient and therapist TA ratings and both eating disorder pathology and treatment completion. Methods A secondary analysis was performed on randomized controlled trial data of a web-CBT intervention for eating disorders. Participants were 170 females with bulimia nervosa (n=33), binge eating disorder (n=68), or eating disorder not otherwise specified (n=69); the mean age was 39.6 (SD 11.5) years. TA was operationalized using the Helping Alliance Questionnaire (HAQ). Paired t tests were conducted to assess the change in TA from interim to after treatment. Intraclass correlations were calculated to determine cross-informant agreement with regard to HAQ scores between patients and therapists. A total of 2 stepwise regressive procedures (at interim and after treatment) were used to examine which HAQ scores predicted eating disorder pathology and therapy completion. Results For treatment completers (128/170, 75.3%), the HAQ-total scores and HAQ-Helpfulness scores for both patients and therapists improved significantly from interim to post treatment. For noncompleters (42/170, 24.7%), all HAQ scores decreased significantly. For all HAQ scales, the agreement between patients and therapists was poor. However, the agreement was slightly better after treatment than at interim. Higher patient scores on the helpfulness subscale of the HAQ at interim and after treatment were associated with less eating disorder psychopathology. A positive association was found between the HAQ-total patient scores at interim and treatment completion. Finally, posttreatment HAQ-total patient scores and posttreatment HAQ-Helpfulness scores of therapists were positively associated with treatment completion. Conclusions Our study showed that TA in web-CBT is predictive of eating disorder pathology and treatment completion. Of particular importance is patients’ confidence in their abilities as measured with the HAQ-Helpfulness subscale when predicting posttreatment eating disorder pathology and treatment completion.
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Affiliation(s)
- Claudia Stoeten
- Tactus Addiction Care, Deventer, Netherlands
- Mediant, Hengelo, Netherlands
| | - Hein Arnoud de Haan
- Tactus Addiction Care, Deventer, Netherlands
- Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Nijmegen, Netherlands
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20
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Philippe TJ, Sikder N, Jackson A, Koblanski ME, Liow E, Pilarinos A, Vasarhelyi K. Digital Health Interventions for Delivery of Mental Health Care: Systematic and Comprehensive Meta-Review. JMIR Ment Health 2022; 9:e35159. [PMID: 35551058 PMCID: PMC9109782 DOI: 10.2196/35159] [Citation(s) in RCA: 67] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 02/28/2022] [Accepted: 03/02/2022] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has shifted mental health care delivery to digital platforms, videoconferencing, and other mobile communications. However, existing reviews of digital health interventions are narrow in scope and focus on a limited number of mental health conditions. OBJECTIVE To address this gap, we conducted a comprehensive systematic meta-review of the literature to assess the state of digital health interventions for the treatment of mental health conditions. METHODS We searched MEDLINE for secondary literature published between 2010 and 2021 on the use, efficacy, and appropriateness of digital health interventions for the delivery of mental health care. RESULTS Of the 3022 records identified, 466 proceeded to full-text review and 304 met the criteria for inclusion in this study. A majority (52%) of research involved the treatment of substance use disorders, 29% focused on mood, anxiety, and traumatic stress disorders, and >5% for each remaining mental health conditions. Synchronous and asynchronous communication, computerized therapy, and cognitive training appear to be effective but require further examination in understudied mental health conditions. Similarly, virtual reality, mobile apps, social media platforms, and web-based forums are novel technologies that have the potential to improve mental health but require higher quality evidence. CONCLUSIONS Digital health interventions offer promise in the treatment of mental health conditions. In the context of the COVID-19 pandemic, digital health interventions provide a safer alternative to face-to-face treatment. However, further research on the applications of digital interventions in understudied mental health conditions is needed. Additionally, evidence is needed on the effectiveness and appropriateness of digital health tools for patients who are marginalized and may lack access to digital health interventions.
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Affiliation(s)
- Tristan J Philippe
- Department of Cellular & Physiological Sciences, The University of British Columbia, Vancouver, BC, Canada.,Department of Psychiatry, The University of British Columbia, Vancouver, BC, Canada
| | | | - Anna Jackson
- School of Social Work, The University of British Columbia, Vancouver, BC, Canada
| | - Maya E Koblanski
- Department of Cellular & Physiological Sciences, The University of British Columbia, Vancouver, BC, Canada.,Department of Psychology, The University of British Columbia, Vancouver, BC, Canada
| | - Eric Liow
- Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - Andreas Pilarinos
- Vancouver Coastal Health Research Institute, Vancouver, BC, Canada.,School of Population and Public Health, The University of British Columbia, Vancouver, BC, Canada
| | - Krisztina Vasarhelyi
- Vancouver Coastal Health Research Institute, Vancouver, BC, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
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21
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Potential benefits and limitations of machine learning in the field of eating disorders: current research and future directions. J Eat Disord 2022; 10:66. [PMID: 35527306 PMCID: PMC9080128 DOI: 10.1186/s40337-022-00581-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 04/17/2022] [Indexed: 12/02/2022] Open
Abstract
Advances in machine learning and digital data provide vast potential for mental health predictions. However, research using machine learning in the field of eating disorders is just beginning to emerge. This paper provides a narrative review of existing research and explores potential benefits, limitations, and ethical considerations of using machine learning to aid in the detection, prevention, and treatment of eating disorders. Current research primarily uses machine learning to predict eating disorder status from females' responses to validated surveys, social media posts, or neuroimaging data often with relatively high levels of accuracy. This early work provides evidence for the potential of machine learning to improve current eating disorder screening methods. However, the ability of these algorithms to generalise to other samples or be used on a mass scale is only beginning to be explored. One key benefit of machine learning over traditional statistical methods is the ability of machine learning to simultaneously examine large numbers (100s to 1000s) of multimodal predictors and their complex non-linear interactions, but few studies have explored this potential in the field of eating disorders. Machine learning is also being used to develop chatbots to provide psychoeducation and coping skills training around body image and eating disorders, with implications for early intervention. The use of machine learning to personalise treatment options, provide ecological momentary interventions, and aid the work of clinicians is also discussed. Machine learning provides vast potential for the accurate, rapid, and cost-effective detection, prevention, and treatment of eating disorders. More research is needed with large samples of diverse participants to ensure that machine learning models are accurate, unbiased, and generalisable to all people with eating disorders. There are important limitations and ethical considerations with utilising machine learning methods in practice. Thus, rather than a magical solution, machine learning should be seen as an important tool to aid the work of researchers, and eventually clinicians, in the early identification, prevention, and treatment of eating disorders.
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22
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Linardon J, Messer M, Shatte A, Greenwood CJ, Rosato J, Rathgen A, Skvarc D, Fuller-Tyszkiewicz M. Does the Method of Content Delivery Matter? Randomized Controlled Comparison of an Internet-Based Intervention for Eating Disorder Symptoms With and Without Interactive Functionality. Behav Ther 2022; 53:508-520. [PMID: 35473653 DOI: 10.1016/j.beth.2021.12.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 12/05/2021] [Accepted: 12/06/2021] [Indexed: 12/13/2022]
Abstract
Despite their potential as a scalable, cost-effective intervention format, self-guided Internet-based interventions for eating disorder (ED) symptoms continue to be associated with suboptimal rates of adherence and retention. Improving this may depend on the design of an Internet intervention and its method of content delivery, with interactive programs expected to be more engaging than static, text-based programs. However, causal evidence for the added benefits of interactive functionality is lacking. We conducted a randomized controlled comparison of an Internet-based intervention for ED symptoms with and without interactive functionality. Participants were randomized to a 4-week interactive (n = 148) or static (n = 145) version of an Internet-based, cognitive-behavioral program. The interactive version included diverse multimedia content delivery channels (video tutorials, graphics, written text), a smartphone app allowing users to complete the required homework exercises digitally (quizzes, symptom tracking, self-assessments), and progress monitoring features. The static version delivered identical intervention content but only via written text, and contained none of those interactive features. Dropout rates were high overall (58%), but were significantly-yet slightly-lower for the interactive (51%) compared to the static intervention (65%). There were no significant differences in adherence rates and symptom-level improvements between the two conditions. Adding basic interactive functionality to a digital intervention may help with study retention. However, present findings challenge prior speculations that interactive features are crucial for enhancing user engagement and symptom improvement.
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Affiliation(s)
| | | | | | - Christopher J Greenwood
- Deakin University, Murdoch Children's Research Institute and University of Melbourne; Royal Children's Hospital
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23
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Kim JP, Sadeh-Sharvit S, Welch HA, Neri E, Tregarthen J, Lock J. Eating disorders early app use mediates treatment effect on clinical improvement. Int J Eat Disord 2022; 55:382-387. [PMID: 34904745 DOI: 10.1002/eat.23652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 11/04/2021] [Accepted: 11/29/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Eating disorders (EDs) contribute considerably to the global burden of disease. However, most affected individuals do not receive treatment. Mobile apps present an enormous opportunity to increase access to mental healthcare services. This study examined whether the degree of usage of a self-help app for EDs mediated the app's effects on the clinical response by individuals with EDs. METHOD App usage measures included the total number of cognitive-behavioral meal logs, total number of days spent using the app, and the last day the app was used during the study period. Mediation analysis was performed using the MacArthur framework. RESULTS All usage variables met the analytic requirements for testing mediation (group means (sd) for app and standard app, respectively: logs = 74 (108) vs. 51.4 (88.1), days spent = 14.3 (17.5) vs. 10.6 (15.0), p-values from Wilcox rank sum tests p < .01). Regression coefficients indicated mediation effects. The mediation effects demonstrated support that increased engagement (as measured by logs and time spent on the app) was related to an increased likelihood of achieving a significant clinical change by the end of the trial. DISCUSSION Greater and longer engagement in an ED app mediates its efficacy in terms of ED remission.
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Affiliation(s)
- Jane Paik Kim
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, USA
| | - Shiri Sadeh-Sharvit
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, USA.,Center for m2Health, Palo Alto University, Palo Alto, California, USA
| | - Hannah A Welch
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, USA
| | - Eric Neri
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, USA
| | | | - James Lock
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, USA
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24
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Bevens W, Weiland T, Gray K, Jelinek G, Neate S, Simpson-Yap S. Attrition Within Digital Health Interventions for People With Multiple Sclerosis: Systematic Review and Meta-analysis. J Med Internet Res 2022; 24:e27735. [PMID: 35138262 PMCID: PMC8867299 DOI: 10.2196/27735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 06/06/2021] [Accepted: 10/14/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Digital health interventions have revolutionized multiple sclerosis (MS) care by supporting people with MS to better self-manage their disease. It is now understood that the technological elements that comprise this category of digital health interventions can influence participant engagement in self-management programs, and people with MS can experience significant barriers, influenced by these elements, to remaining engaged during a period of learning. It is essential to explore the influence of technological elements in mitigating attrition. OBJECTIVE This study aimed to examine the study design and technological elements of documented digital health interventions targeted at people with MS-digital health interventions that were intended to support a program of engagement over a defined period-and to explore how these correlated with attrition among participants of randomized controlled trials (RCTs). METHODS We conducted a systematic review and meta-analysis of RCTs (n=32) describing digital health self-management interventions for people with MS. We analyzed attrition in included studies, using a random-effects model and meta-regression to measure the association between potential moderators. RESULTS There were no measured differences in attrition between the intervention and control arms; however, some of the heterogeneity observed was explained by the composite technological element score. The pooled attrition rates for the intervention and control arms were 14.7% and 15.6%, respectively. CONCLUSIONS This paper provides insight into the technological composition of digital health interventions designed for people with MS and describes the degree of attrition in both study arms. This paper will aid in the design of future studies in this area, particularly for digital health interventions of this type.
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Affiliation(s)
- William Bevens
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Carlton, Australia
| | - Tracey Weiland
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Carlton, Australia
| | - Kathleen Gray
- Centre for Digital Transformation of Health, The University of Melbourne, Carlton, Australia
| | - George Jelinek
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Carlton, Australia
| | - Sandra Neate
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Carlton, Australia
| | - Steve Simpson-Yap
- Centre for Epidemiology and Biostatistics, The University of Melbourne, Carlton, Australia
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25
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Barakat S, Touyz S, Maloney D, Russell J, Hay P, Cunich M, Lymer S, Kim M, Madden S, Miskovic-Wheatley J, Maguire S. Supported online cognitive behavioural therapy for bulimia nervosa: a study protocol of a randomised controlled trial. J Eat Disord 2021; 9:126. [PMID: 34649625 PMCID: PMC8515319 DOI: 10.1186/s40337-021-00482-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 09/21/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Despite the availability of effective treatments for bulimia nervosa (BN), a number of barriers to accessibility exist. Examples include access to trained clinicians, the expense of treatment, geographical limitations, and personal limitations such as stigma regarding help seeking. Self-help interventions, delivered via a digital platform, have the potential to overcome treatment gaps by providing patients with standardised, evidence-based treatments that are easily accessible, cost-effective, and require minimal clinician support. Equally, it is important to examine the shortcomings of digital interventions when compared to traditional to face-to-face delivery (e.g., high dropout rates) in order to maximise the therapeutic effectiveness of online, self-help interventions. METHODS A three-arm, multisite randomised controlled trial will be conducted in Australia examining the effectiveness and cost-effectiveness of a newly developed online self-help intervention, Binge Eating eTherapy (BEeT), in a sample of patients with full or sub-threshold BN. The BEeT program consists of 10, multimedia sessions delivering the core components of cognitive behaviour therapy. Eligible participants will be randomised to one of three groups: independent completion of BEeT as a purely self-help program, completion of BEeT alongside clinician support (in the form of weekly telemedicine sessions), or waitlist control. Assessments will take place at baseline, weekly, post-intervention, and three-month follow up. The primary outcome is frequency of objective binge episodes. Secondary outcomes include frequency of other core eating disorder behavioural symptoms and beliefs, psychological distress, and quality of life. Statistical analyses will examine treatment effectiveness, feasibility, acceptability and cost effectiveness. DISCUSSION There is limited capacity within the mental health workforce in Australia to meet the demand of people seeking treatment for eating disorders. This imbalance has only worsened following outbreak of the COVID-19 pandemic. Further research is required into innovative digital modes of treatment delivery with the capacity to service mental health needs in an accessible and affordable manner. Self-help programs may also appeal to individuals who are more reluctant to engage in traditional face-to-face treatment formats. This study will provide rigorous evidence on how to diversify treatment options for individuals with BN, ensuring more people with the illness can access evidence-based treatment. The study has been registered with the Australia New Zealand Clinical Trials Registry (ANZCTR Registration Number: ACTRN12619000123145p). Registered 22 January 2019, https://www.australianclinicaltrials.gov.au/anzctr/trial/ACTRN12619000123145 .
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Affiliation(s)
- Sarah Barakat
- InsideOut Institute, Central Clinical School, The University of Sydney | Sydney Local Health District, Sydney, Australia.
- School of Psychology, The University of Sydney, Sydney, Australia.
| | - Stephen Touyz
- InsideOut Institute, Central Clinical School, The University of Sydney | Sydney Local Health District, Sydney, Australia
| | - Danielle Maloney
- InsideOut Institute, Central Clinical School, The University of Sydney | Sydney Local Health District, Sydney, Australia
| | - Janice Russell
- InsideOut Institute, Central Clinical School, The University of Sydney | Sydney Local Health District, Sydney, Australia
- Sydney Local Health District Mental Health Services, Royal Prince Alfred Hospital, Sydney, Australia
| | - Phillipa Hay
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, Australia
- Camden and Campbelltown Hospitals, South Western Sydney Local Health District, Campbelltown, Australia
| | - Michelle Cunich
- Charles Perkins Centre, Faculty of Medicine and Health (Central Clinical School), The University of Sydney, Sydney, Australia
- Sydney Institute for Women, Children and Their Families, Sydney Local Health District Camperdown, Camperdown, Australia
- Sydney Health Economics Collaborative, Sydney Local Health District, Camperdown, Australia
| | - Sharyn Lymer
- Charles Perkins Centre, Faculty of Medicine and Health (Central Clinical School), The University of Sydney, Sydney, Australia
| | - Marcellinus Kim
- Sydney Local Health District Mental Health Services, Royal Prince Alfred Hospital, Sydney, Australia
| | - Sloane Madden
- Department of Psychological Medicine, Children's Hospital at Westmead, Sydney, Australia
| | - Jane Miskovic-Wheatley
- InsideOut Institute, Central Clinical School, The University of Sydney | Sydney Local Health District, Sydney, Australia
| | - Sarah Maguire
- InsideOut Institute, Central Clinical School, The University of Sydney | Sydney Local Health District, Sydney, Australia
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26
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Lin JA, Hartman-Munick SM, Kells MR, Milliren CE, Slater WA, Woods ER, Forman SF, Richmond TK. The Impact of the COVID-19 Pandemic on the Number of Adolescents/Young Adults Seeking Eating Disorder-Related Care. J Adolesc Health 2021; 69:660-663. [PMID: 34266715 PMCID: PMC8415773 DOI: 10.1016/j.jadohealth.2021.05.019] [Citation(s) in RCA: 86] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 05/24/2021] [Accepted: 05/24/2021] [Indexed: 01/06/2023]
Abstract
PURPOSE The COVID-19 pandemic has led to the development and worsening of eating disorder (ED) symptoms in adolescents and young adults. In order to examine COVID-19-related trends in ED care-seeking at our institution. METHODS We used interrupted time series regression to examine pre- and postpandemic monthly summary data of the following: (1) ED-related inpatient admissions for medical stabilization; (2) ED-related hospital bed-days; (3) completed outpatient ED assessments; and (4) ED outpatient care-related inquiries at a children's hospital in Boston, MA. RESULTS Inpatient admissions, hospital bed-days, and outpatient care-related inquiries increased on average over time postpandemic compared to stable volume over time prepandemic (p < .01). Outpatient assessments decreased precipitously initially following COVID-19-related limitations, and rose quickly back to baseline. CONCLUSION These results indicate increased need for ED-related care during the pandemic. Bolstering resources to meet the needs of these vulnerable patients is critical as the effects of the pandemic continue to be felt.
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Affiliation(s)
- Jessica A. Lin
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, Massachusetts,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts,Address correspondence to: Jessica A. Lin, M.D., Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, 300 Longwood Ave, Boston, MA 02115
| | - Sydney M. Hartman-Munick
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, Massachusetts,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Meredith R. Kells
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, Illinois
| | - Carly E. Milliren
- Institutional Centers for Clinical and Translational Research, Boston Children’s Hospital, Boston, Massachusetts
| | - Wallis A. Slater
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, Massachusetts
| | - Elizabeth R. Woods
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, Massachusetts,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Sara F. Forman
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, Massachusetts,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Tracy K. Richmond
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, Massachusetts,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
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27
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Naccache B, Mesquida L, Raynaud JP, Revet A. Smartphone application for adolescents with anorexia nervosa: an initial acceptability and user experience evaluation. BMC Psychiatry 2021; 21:467. [PMID: 34563166 PMCID: PMC8466747 DOI: 10.1186/s12888-021-03478-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 09/15/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Anorexia Nervosa (AN) is a key target for E-Health programs considering the many barriers hindering patients' access to care and the disorder's severity. Although these programs have become more common and effective, they often have low adherence, especially among youth. This can hinder their implementation and effectiveness in real-world settings. User experience partly overlaps with the acceptability field and may provide insight into factors affecting adherence and adoption of E-Health programs. This study aimed to explore early acceptability and user experience of a companion app prototype for adolescents with AN using user-centered design methods. METHODS We developed a prototype containing self-help material and emotions and behaviors evaluation and management features. Then we conducted a mixed evaluation combining semi structured focus group interviews and questionnaires in a clinician group and an AN patient group. We analyzed data using thematic analysis and descriptive statistics. RESULTS The app's overall appeal was adequate. The user experience questionnaire revealed the weakest dimensions, including novelty, dependability, and efficiency versus stimulation (i.e., ability to induce motivation to use the product) and perspicuity (i.e., easy to understand, to get familiar with). The qualitative data analysis revealed three central axes: acceptability, features, and use. We identified acceptability barriers and facilitators such as the importance of design and customization, especially for adolescents. Psychoeducation was a major feature for participants, as patients highlighted the difficulties they encountered when seeking disorders-related information. CONCLUSIONS This study shows the importance of including users in the different stages of an e-health intervention development, in order to identify their needs, general use and compliance patterns, to improve adherence and adoption of the program and its effectiveness.
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Affiliation(s)
- Benjamin Naccache
- Service Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, CHU de Toulouse, Hôpital Purpan, Place du Dr Baylac, TSA 40031, 31059, Toulouse cedex 9, France.
| | - Laure Mesquida
- grid.414282.90000 0004 0639 4960Service Universitaire de Psychiatrie de l’Enfant et de l’Adolescent, CHU de Toulouse, Hôpital Purpan, Place du Dr Baylac, TSA 40031, 31059 Toulouse cedex 9, France
| | - Jean-Philippe Raynaud
- grid.414282.90000 0004 0639 4960Service Universitaire de Psychiatrie de l’Enfant et de l’Adolescent, CHU de Toulouse, Hôpital Purpan, Place du Dr Baylac, TSA 40031, 31059 Toulouse cedex 9, France ,grid.15781.3a0000 0001 0723 035XCERPOP, Université de Toulouse, Inserm, UPS, Toulouse, France
| | - Alexis Revet
- grid.414282.90000 0004 0639 4960Service Universitaire de Psychiatrie de l’Enfant et de l’Adolescent, CHU de Toulouse, Hôpital Purpan, Place du Dr Baylac, TSA 40031, 31059 Toulouse cedex 9, France ,grid.15781.3a0000 0001 0723 035XCERPOP, Université de Toulouse, Inserm, UPS, Toulouse, France ,grid.411175.70000 0001 1457 2980CIC 1436, Team PEPSS « Pharmacologie En Population cohorteS et biobanqueS », Toulouse University Hospital, Toulouse, France
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28
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Overcome Death Anxiety: The Development of an Online Cognitive Behaviour Therapy Programme for Fears of Death. BEHAVIOUR CHANGE 2021. [DOI: 10.1017/bec.2021.14] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
AbstractEmerging research suggests that death anxiety is a transdiagnostic construct, which may underpin a number of mental illnesses. Although cognitive behaviour therapy (CBT) has been found to be the most effective treatment for death anxiety, no self-guided treatments for this construct exist at present. Furthermore, there is a growing need for accessible, scalable and cost-effective psychological treatments. To address these gaps, we created Overcome Death Anxiety (ODA), an online CBT-based programme which specifically targets fears of death. ODA was designed to be a fully automated, standalone, yet individualised online treatment. The present study outlines the development and structure of this programme using responses from four users to illustrate feasibility. Research is needed to examine the efficacy and usability of ODA with a larger clinical sample.
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Zhou X, Bambling M, Edirippulige S. A mixed-method systematic review of text-based telehealth interventions in eating disorder management. JOURNAL OF HEALTH RESEARCH 2021. [DOI: 10.1108/jhr-03-2021-0179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Purpose
Eating disorders (EDs) is a major health condition affecting 9% of the global population and 10% of those with EDs lost their lives as a result. Text-based telehealth interventions (TTIs) seem to provide a low-cost and convenient treatment option; however, the evidence is scarce. This study aimed to synthesize evidence relating to the use of TTIs for the management of EDs.
Design/methodology/approach
Five databases were searched published between January 2020 and May 2019. The authors used keywords relating to telehealth and EDs. The authors used Joanna Briggs Institute's (JBI's) critical appraisal instrument to assess the methodology quality of included studies.
Findings
Fifteen studies were included in this mix-method systematic review and assessed for methodology quality. Email, web-based texting, text-messaging and online chat room were used as mode for deliver healthcare for patients with EDs. In the treatment phase, all studies (nine studies; n = 860 participants) showed effectiveness (for RCTs) and usefulness (for non-RCT studies). In the aftercare phase (six studies; n = 364 participants), the results regarding the effectiveness of TTIs were mixed. Two studies showed effectiveness whilst four studies did not find statistically significant change of ED outcomes.
Research limitations/implications
The qualities of these studies varied; firstly, 66% (n = 10) of the studies were non-randomized studies (e.g. single-arm trial, case report) with small samples. Moreover, one-fourth (n = 4) of the studies did not use validated instruments or indicate the instrument. Also, half (n = 7) of the studies used TTIs as adjunct to face-to-face treatment or bigger online treatment, it is hard to make conclusion that the changes were due to TTIs' effect. In addition, follow-up rate is not satisfactory, thus results should be interpreted cautiously.
Practical implications
TTIs seem to be promising for management of EDs, particularly in the treatment phase. This provides an important treatment option for health practitioners and people with EDs as an alternative or in adjunct with face-to-face services.
Originality/value
This is the first review to synthesis the use of TTIs for ED management.
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Neumayr C, Voderholzer U, Schlegl S. Psych-APP-Therapie: Smartphonebasierte Interventionen in der Psychotherapie – Eine systematische Übersichtsarbeit. VERHALTENSTHERAPIE 2020. [DOI: 10.1159/000510954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
<b><i>Hintergrund:</i></b> Technologiebasierte Interventionen haben in der Psychotherapie an Bedeutung gewonnen. Ein versorgungsrelevanter Ansatz sind Mental Health Apps. Ziel dieser systematischen Übersichtsarbeit ist es (1) international evaluierte Apps zu den Störungsbildern Depressionen, Angststörungen und Essstörungen zu identifizieren, (2) deren Verfügbarkeit in deutschen App-Stores sowie (3) in deutscher Sprache zu prüfen und (4) ihre Effektivitätsergebnisse aus randomisiert-kontrollierten (Pilot-)Studien (RCTs) darzustellen. <b><i>Methode:</i></b> Die Übersichtsarbeit wurde in Anlehnung an das PRISMA Statement durchgeführt und ausgewertet. Eine systematische Recherche (2007–2018) der Datenbanken PubMed, PsychINFO sowie PSYNDEX wurde durchgeführt. Zudem fand eine Beurteilung der methodischen Qualität sowie der Effektivitätsergebnisse der (Pilot-)RCTs statt. <b><i>Ergebnisse:</i></b> Es wurden 2’571 Abstracts identifiziert und 47 Publikationen eingeschlossen (<i>N</i> = 32 unterschiedliche Apps; <i>N</i> = 24 [Pilot-]RCTs). Die Qualität der (Pilot-)RCTs ist überwiegend als gut bis moderat einzustufen. Die Ergebnisse waren heterogen (keine bis große Effekte [Cohens <i>d</i>] zwischen den Gruppen: –0,01; KI [–0,36; 0,34] bis 1,49; KI [1,00; 1,99]). Vier Apps mit einer Evaluation durch (Pilot-)RCTs sind in den deutschen App-Stores verfügbar – eine in deutscher Sprache. <b><i>Schlussfolgerungen:</i></b> Es liegt international eine Vielzahl von ersten App-Evaluationen zu den Störungsbildern vor, die Verfügbarkeit ausreichend evaluierter deutschsprachiger Apps in den deutschen App-Stores ist aber extrem limitiert. Englischsprachige, bereits evaluierte Apps könnten in das Deutsche übersetzt und – genauso wie schon verfügbare, aber nicht evaluierte deutschsprachige Apps – in RCTs inkl. Katamnesedaten evaluiert werden. So könnten smartphonebasierte Interventionen im Rahmen des “Digitalen-Versorgungs-Gesetzes” als ergänzendes Element in der Psychotherapie an Bedeutung gewinnen.
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eHealth Treatments for Compulsive Overeating: a Narrative Review. CURRENT ADDICTION REPORTS 2020. [DOI: 10.1007/s40429-020-00312-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Guo L, Wu M, Zhu Z, Zhang L, Peng S, Li W, Chen H, Fernández-Aranda F, Chen J. Effectiveness and influencing factors of online education for caregivers of patients with eating disorders during COVID-19 pandemic in China. EUROPEAN EATING DISORDERS REVIEW 2020; 28:816-825. [PMID: 32852142 PMCID: PMC7461399 DOI: 10.1002/erv.2783] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/03/2020] [Accepted: 08/04/2020] [Indexed: 12/20/2022]
Abstract
Objective The goals were twofold: To estimate the depression and anxiety levels among caregivers of patients with eating disorders (ED) in China during the COVID‐19 pandemic when compared with a control group, and to assess whether an online education program was effective in decreasing the anxiety and depression of the caregivers of patients with ED, and associated factors. Method Caregivers of patients with ED (n = 254) and a comparison group of non‐ED caregivers (N = 254) were recruited at baseline. Additionally, caregivers of patients with ED were invited into a free 4‐week online education program, with an additional online group as support. Depression and anxiety levels were assessed at baseline and after the intervention. Results Caregivers of patients with ED showed significantly higher levels of depression and anxiety than the comparison group of non‐ED caregivers. The online education program showed no significant effect on decreasing depression and anxiety levels of caregivers of patients with ED overall. Caregivers who had older loved ones and not living with them were more likely to decrease their depression levels. Caregivers of patients with longer illness duration were less likely to decrease their anxiety levels. Discussion These results showed that caregivers of ED patients suffered more serious psychological distress during the pandemic. A more structured and intensive online intervention with a limited number of participants might be required to address caregivers' distress in post‐COVID‐19 China.
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Affiliation(s)
- Lei Guo
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mengting Wu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhuoying Zhu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lei Zhang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Sufang Peng
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wei Li
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Han Chen
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | | | - Jue Chen
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Ahmadiankalati M, Steins-Loeber S, Paslakis G. Review of Randomized Controlled Trials Using e-Health Interventions for Patients With Eating Disorders. Front Psychiatry 2020; 11:568. [PMID: 32595546 PMCID: PMC7304304 DOI: 10.3389/fpsyt.2020.00568] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 06/03/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND In a world of technological advancements, electronic devices and services seem to be a promising way to increase patients' engagement in treatment and to help manage their symptoms. Here, we identified and analyzed the current evidence of RCTs to evaluate the effectiveness and acceptability of e-health interventions in the eating disorder (ED) field. METHODS We screened an initial cluster of 581 papers. In the end, 12 RCTs in clinical ED cohorts were included. RESULTS Some studies were conceived as stand-alone interventions, while others were presented as add-ons to ED-specific treatments. Studies varied in the type of EDs under investigation and in the e-health intervention applied (with vs. without therapist support vs. blended interventions; smartphone- vs. web-based). Only four studies reported explicit acceptability measures. Out of those, two reported high acceptability, one reported low acceptability, and one reported no significant difference in acceptability between groups. Four studies reported higher effectiveness of the e-health intervention compared to the control condition, e.g., reduction in maladaptive eating behaviors. Regarding control groups, three used a wait list design and nine had another kind of intervention (e.g., face-to-face CBT, or treatment as usual) as control. DISCUSSION So far, the evidence for acceptability and effectiveness of e-health interventions in EDs is very limited. There is also a lack of studies in older patients, adolescents, men, sexual and ethnic minorities. Shame/stigma is discussed in the context of e-health interventions for EDs. It remains unclear how severity of EDs affects the effectiveness of e-health interventions, how patients can channel the knowledge they acquire from e-health interventions into their actual behaviors, and how such interventions can better fit the needs of the individual patient to increase acceptability and effectiveness.
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Affiliation(s)
- Mojtaba Ahmadiankalati
- Eating Disorders Unit, Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - Sabine Steins-Loeber
- Department of Clinical Psychology and Psychotherapy, University of Bamberg, Bamberg, Germany
| | - Georgios Paslakis
- Eating Disorders Unit, Toronto General Hospital, University Health Network, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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Smoktunowicz E, Barak A, Andersson G, Banos RM, Berger T, Botella C, Dear BF, Donker T, Ebert DD, Hadjistavropoulos H, Hodgins DC, Kaldo V, Mohr DC, Nordgreen T, Powers MB, Riper H, Ritterband LM, Rozental A, Schueller SM, Titov N, Weise C, Carlbring P. Consensus statement on the problem of terminology in psychological interventions using the internet or digital components. Internet Interv 2020; 21:100331. [PMID: 32577404 PMCID: PMC7305336 DOI: 10.1016/j.invent.2020.100331] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 05/18/2020] [Accepted: 05/31/2020] [Indexed: 12/21/2022] Open
Abstract
Since the emergence of psychological interventions delivered via the Internet they have differed in numerous ways. The wealth of formats, methods, and technological solutions has led to increased availability and cost-effectiveness of clinical care, however, it has simultaneously generated a multitude of terms. With this paper, we first aim to establish whether a terminology issue exists in the field of Internet-delivered psychological interventions. If so, we aim to determine its implications for research, education, and practice. Furthermore, we intend to discuss solutions to mitigate the problem; in particular, we propose the concept of a common glossary. We invited 23 experts in the field of Internet-delivered interventions to respond to four questions, and employed the Delphi method to facilitate a discussion. We found that experts overwhelmingly agreed that there were terminological challenges, and that it had significant consequences for conducting research, treating patients, educating students, and informing the general public about Internet-delivered interventions. A cautious agreement has been reached that formulating a common glossary would be beneficial for the field to address the terminology issue. We end with recommendations for the possible formats of the glossary and means to disseminate it in a way that maximizes the probability of broad acceptance for a variety of stakeholders.
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Affiliation(s)
- Ewelina Smoktunowicz
- Department of Psychology, SWPS University of Social Sciences and Humanities, Chodakowska 19, 31 03-815 Warsaw, Poland,Department of Psychology, Stockholm University, Frescati Hagvag 8, 114 19 Stockholm, Sweden
| | - Azy Barak
- Department of Counseling and Human Development, University of Haifa, Israel
| | - Gerhard Andersson
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Rosa M. Banos
- Universidad de Valencia, Valencia, Spain,CIBER Fisiopatologia Obesidad y Nutrición (CIBEROBN), Instituto Salud Carlos III, Madrid, Spain
| | - Thomas Berger
- Department of Clinical Psychology and Psychotherapy, University of Bern, Switzerland
| | - Cristina Botella
- CIBER Fisiopatologia Obesidad y Nutrición (CIBEROBN), Instituto Salud Carlos III, Madrid, Spain,Uiversitat Jaume I, Valencia, Spain
| | - Blake F. Dear
- Department of Psychology, Macquarie University, Sydney, Australia
| | - Tara Donker
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit, Amsterdam, the Netherlands
| | - David D. Ebert
- Faculty of Behavioural and Movement Sciences, Clinical, Neuro- & Developmental Psychology, Vrije Universiteit, Amsterdam, the Netherlands
| | | | | | - Viktor Kaldo
- Department of Psychology, Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden,Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Sweden
| | - David C. Mohr
- Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Northwestern University, Chicago, IL, USA
| | - Tine Nordgreen
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | | | - Heleen Riper
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit, Amsterdam, the Netherlands
| | - Lee M. Ritterband
- Center for Behavioral Health & Technology, Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville, VA, USA
| | - Alexander Rozental
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden,Institute of Child Health, UCL, London, UK
| | - Stephen M. Schueller
- Department of Psychological Science, University of California, Irvine, Irvine, CA, USA
| | - Nickolai Titov
- Department of Psychology, Macquarie University, Sydney, Australia
| | - Cornelia Weise
- Department of Psychology, Division of Clinical Psychology and Psychotherapy, Philipps–University of Marburg, Marburg, Germany
| | - Per Carlbring
- Department of Psychology, Stockholm University, Frescati Hagvag 8, 114 19 Stockholm, Sweden,Corresponding author at: Department of Psychology, SE-106 91 Stockholm, Sweden.
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Fernández-Aranda F, Casas M, Claes L, Bryan DC, Favaro A, Granero R, Gudiol C, Jiménez-Murcia S, Karwautz A, Le Grange D, Menchón JM, Tchanturia K, Treasure J. COVID-19 and implications for eating disorders. EUROPEAN EATING DISORDERS REVIEW 2020; 28:239-245. [PMID: 32346977 PMCID: PMC7267370 DOI: 10.1002/erv.2738] [Citation(s) in RCA: 246] [Impact Index Per Article: 61.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Fernando Fernández-Aranda
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain.,CIBER Fisiopatología Obesidad y Nutrición (CIBEROBN), Instituto Salud Carlos III, Madrid, Spain.,Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Miquel Casas
- Departamento de Psiquiatría y Medicina Legal, Universitat Autònoma de Barcelona, Barcelona, Spain.,CIBER Salud Mental (CIBERSAM), Instituto Salud Carlos III, Madrid, Spain.,Vall d'hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Laurence Claes
- Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Danielle Clark Bryan
- King's College London, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), London, UK
| | - Angela Favaro
- Department of Neuroscience, University of Padua and Neuroscience Center (PNC), University of Padua, Padua, Italy
| | - Roser Granero
- CIBER Fisiopatología Obesidad y Nutrición (CIBEROBN), Instituto Salud Carlos III, Madrid, Spain.,Department of Psychobiology and Methodology, Autonomous University of Barcelona, Barcelona, Spain
| | - Carlota Gudiol
- Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain.,Infectious Diseases Department, Hospital Universitari Bellvitge, Institut de Investigació Biomedica de Bellvitge (IDIBELL) and Institut Català d'Oncologia-Hospitalet, IDIBELL, Barcelona, Spain.,REIPI (Spanish Network for Research in Infectious Disease), Instituto de Salud Carlos III, Madrid, Spain
| | - Susana Jiménez-Murcia
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain.,CIBER Fisiopatología Obesidad y Nutrición (CIBEROBN), Instituto Salud Carlos III, Madrid, Spain.,Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Andreas Karwautz
- Eating Disorders Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Daniel Le Grange
- Eating Disorders Program, Department of Psychiatry, University of California, San Francisco, California, USA
| | - Jose M Menchón
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain.,Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain.,CIBER Salud Mental (CIBERSAM), Instituto Salud Carlos III, Madrid, Spain
| | - Kate Tchanturia
- King's College London, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), London, UK
| | - Janet Treasure
- King's College London, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), London, UK
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Weissman RS, Bauer S, Thomas JJ. Access to evidence-based care for eating disorders during the COVID-19 crisis. Int J Eat Disord 2020; 53:369-376. [PMID: 32338400 PMCID: PMC7267278 DOI: 10.1002/eat.23279] [Citation(s) in RCA: 100] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 04/10/2020] [Indexed: 01/02/2023]
Abstract
The COVID-19 pandemic has forced an abrupt change in the delivery of clinical services, including for individuals with an eating disorder. We present this Virtual Issue as a resource for the eating disorder community to showcase research published in the International Journal of Eating Disorders that provides information on effective strategies to help address the challenges arising from COVID-19-related disruptions. Articles included describe original research or systematic reviews on obstacles to health services use and strategies to improve access to care; technological tools to provide or enhance interventions; patients' and clinicians' attitudes or perspectives on using digital tools for clinical care; factors influencing therapeutic alliance; and ideas for improving reach and uptake of digital interventions. We hope that readers will find ways to observe and record their own experiences during this global crisis; the experiences of people at risk for developing or exhibiting an eating disorder; and the experiences of those who care for people with an eating disorder. These lived experiences will be invaluable in formulating hypotheses for future studies in service of advancing the understanding of eating disorders and improving interventions and policies for reducing the burden of suffering attributable to eating disorders.
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Affiliation(s)
- Ruth S. Weissman
- Department of PsychologyWesleyan UniversityMiddletownConnecticutUSA
| | - Stephanie Bauer
- Center for Psychotherapy ResearchUniversity Hospital HeidelbergHeidelbergGermany
| | - Jennifer J. Thomas
- Eating Disorders Clinical and Research ProgramMassachusetts General HospitalBostonMassachusettsUSA
- Department of PsychiatryHarvard Medical SchoolBostonMassachusettsUSA
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Cardi V, Albano G, Salerno L, Lo Coco G, Ambwani S, Schmidt U, Macdonald P, Treasure J. The Feasibility of Using Guided Self-Help in Anorexia Nervosa: An Analysis of Drop-Out From the Study Protocol and Intervention Adherence. Front Psychol 2020; 11:707. [PMID: 32373032 PMCID: PMC7178255 DOI: 10.3389/fpsyg.2020.00707] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 03/24/2020] [Indexed: 01/12/2023] Open
Abstract
The implementation of online technologies to promote wellbeing is increasingly becoming a worldwide priority. This study includes secondary analyses of data and examined drop-out rates in an online guided self-help intervention for patients with anorexia nervosa. Specifically, rates of drop-out at end of treatment (i.e., 6 weeks assessment), as well as intervention adherence (minimum of four of six online guided sessions) and differences between completers and drop-outs were examined. Motivation to change and associated patient variables were assessed as predictors of drop-out using structural equation modeling. Ninety-nine patients were randomized to the intervention arm of the trial. Data were available for 82 individuals, 67 of whom completed the 6 weeks assessment and attended a minimum of four online sessions. No significant differences were found between completers and drop-outs at baseline. At the end of the first week of participation, drop-outs from the 6 weeks assessment or the intervention reported less satisfaction with their work with the mentor delivering online guidance. Greater confidence in own ability to change and higher controlled motivation (willingness to change due to pressure from others) predicted lower drop-out rates from the 6 weeks assessment. Stronger alliance with the therapist at the treatment center and lower psychological distress were associated with greater autonomous motivation (self-directed motivation) and importance and ability to change. Data demonstrate that a novel online guided self-help intervention for patients with anorexia nervosa is feasible. Early satisfaction with the program and external pressure to change have a protective role against drop-out rates. Clinical Trial Registration:www.ClinicalTrials.gov, identifier NCT02336841.
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Affiliation(s)
- Valentina Cardi
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Gaia Albano
- Department of Psychology, Educational Sciences and Human Movement, University of Palermo, Palermo, Italy
| | - Laura Salerno
- Department of Psychology, Educational Sciences and Human Movement, University of Palermo, Palermo, Italy
| | - Gianluca Lo Coco
- Department of Psychology, Educational Sciences and Human Movement, University of Palermo, Palermo, Italy
| | | | - Ulrike Schmidt
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Pamela Macdonald
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Janet Treasure
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
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Kiekens G, Claes L. Non-Suicidal Self-Injury and Eating Disordered Behaviors: An Update on What We Do and Do Not Know. Curr Psychiatry Rep 2020; 22:68. [PMID: 33037934 PMCID: PMC7547297 DOI: 10.1007/s11920-020-01191-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/25/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE OF REVIEW The current report aims to summarize recent advances about the relationship between non-suicidal self-injury (NSSI) and eating disordered (ED) behaviors and highlights meaningful directions for future research. RECENT FINDINGS While there is solid evidence indicating a robust cross-sectional association between NSSI and ED behaviors, emerging evidence suggests that the temporal relationship between these behaviors may be bidirectional. Shared functions and risk factors may explain why these behaviors often co-develop. At the same time, little is still known about the psychosocial consequences of comorbid NSSI and ED engagement, and there is a lack of intervention studies that target these behaviors simultaneously. It is well-established that NSSI and ED behaviors frequently co-occur. The field should now turn to longitudinal designs to advance our understanding of the longer-term developmental and the shorter-term momentary relationship of these behaviors in daily life. Providing insight into these areas will help guide the deployment of evidence-based interventions that match the needs of clients who report comorbid NSSI and ED behaviors.
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Affiliation(s)
- Glenn Kiekens
- Faculty of Psychology and Educational Sciences, KU Leuven, Tiensestraat 102, box 3720, 3000, Leuven, Belgium. .,Department of Neurosciences, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium.
| | - Laurence Claes
- grid.5596.f0000 0001 0668 7884Faculty of Psychology and Educational Sciences, KU Leuven, Tiensestraat 102, box 3720, 3000 Leuven, Belgium ,grid.5284.b0000 0001 0790 3681Faculty of Medicine and Health Sciences (CAPRI), University of Antwerp, Antwerp, Belgium
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Bauer S, Goldschmidt A. Introduction to the special issue on advancing assessment of, and interventions for, eating disorders via innovative uses of technology. Int J Eat Disord 2019; 52:1073-1076. [PMID: 31578732 PMCID: PMC7477920 DOI: 10.1002/eat.23164] [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: 08/16/2019] [Revised: 08/17/2019] [Accepted: 08/18/2019] [Indexed: 12/16/2022]
Abstract
The aim of this editorial is to introduce a Special Issue of the International Journal of Eating Disorders on "Advancing Assessment of, and Interventions for, Eating Disorders via Innovative Uses of Technology." The 10 contributions to the Special Issue focus on the following main questions: (a) How can we optimize technology-enhanced interventions for eating disorders? (b) To what extent can technology help professionals to reach underserved populations? (c) How can innovative technology-enhanced tools improve assessment and treatment of eating disorders? The findings cumulatively suggest that technology can play a critical role in the detection and treatment of eating disorders, and may be used to enhance understanding of the etiology, maintenance, and course of these conditions. The contributions to this Special Issue have important implications for the conceptualization, design, and evaluation of technology-enhanced interventions as well as for the optimization of current assessment methods. Hopefully, they will stimulate future research in this quickly evolving field.
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Affiliation(s)
- Stephanie Bauer
- Center for Psychotherapy Research, University Hospital Heidelberg, Bergheimerstr. 54, 69115 Heidelberg, Germany;,Correspondence should be addressed to Stephanie Bauer, PhD, Center for Psychotherapy Research, University Hospital Heidelberg, Bergheimerstr. 54, 69115 Heidelberg, Germany; ; Phone: ++49-6221-567345
| | - Andrea Goldschmidt
- Department of Psychiatry & Human Behavior, Brown Medical School/The Miriam Hospital, 196 Richmond St., Providence, RI
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