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Arbour G, Legendre M, Langlois MF, Bégin C. Novel Guided Self-Help for the treatment of Binge Eating Disorder: Feasibility, Acceptability, and Preliminary Efficacy. CAN J DIET PRACT RES 2024:1-8. [PMID: 39158977 DOI: 10.3148/cjdpr-2024-013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/21/2024]
Abstract
Purpose: Binge eating disorder (BED) is a prevalent eating disorder. Many individuals with BED do not receive evidence-based care due to many barriers. This preliminary study evaluated the feasibility, acceptability, and potential efficacy of a manualized guided self-help (GSH) intervention with support in the form of a culturally adapted manual for a French-Canadian population.Method: Twenty-two women with overweight or obesity meeting the BED diagnostic criteria participated in an 8-week open trial. The GSH programme combined a self-help book and weekly support phone calls. Participants were assessed at baseline, at week 4, postintervention, and 12 weeks following its end. Feasibility was measured by attrition rates, participation, and satisfaction. Acceptability was measured by a questionnaire based on the Theoretical Framework of Acceptability. Potential efficacy outcomes were objective binge eating days, eating disorder symptomatology, depressive symptoms, and propensity to eat intuitively.Results: The GSH programme has proven feasible (4.5% attrition, 91% completion, 95.5% satisfaction) and acceptable. Potential efficacy results showed promising improvements on all outcomes (19% abstinence, 70.9% reduction in objective binge eating days).Conclusion: Although preliminary, this programme warrants further study as it may be an efficient and cost-effective way to deliver GSH for BED patients with accessibility barriers.
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Affiliation(s)
| | | | - Marie-France Langlois
- Centre de recherche du CHUS, Sherbrooke, QC
- Department of Medicine, Division of Endocrinology, Université de Sherbrooke, Sherbrooke, QC
| | - Catherine Bégin
- School of Psychology, Université Laval, Québec, QC
- Centre Nutrition, santé et société (NUTRISS), Institut sur la nutrition et les aliments fonctionnels (INAF), Université Laval, Québec, QC
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Christensen SH, Heinrichsen M, Møhl B, Rubæk L, Byrialsen KK, Ojala O, Hellner C, Pagsberg AK, Bjureberg J, Morthorst B. Internet-delivered emotion regulation therapy for adolescents engaging in non-suicidal self-injury and their parents: A qualitative, online focus group study. Psychol Psychother 2024. [PMID: 39148399 DOI: 10.1111/papt.12541] [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: 02/22/2024] [Accepted: 07/08/2024] [Indexed: 08/17/2024]
Abstract
OBJECTIVES We explore adolescents' and their parents' experiences of internet-based emotion regulation therapy for non-suicidal self-injury (NSSI). DESIGN A qualitative study nested within a controlled feasibility trial. METHODS Online, semi-structured focus group interviews were conducted with outpatient adolescents with NSSI aged 13-17 years (n = 9) and their parents (n = 8) who had received therapist-guided Internet-delivered Emotion Regulation Individual Therapy for Adolescents (IERITA). Transcripts were analysed using reflexive thematic analysis. RESULTS Three main themes were generated: (1) Fatigue - barriers to and during treatment, comprised of two sub-themes 'Arriving to services exhausted, needing motivation, and leaving feeling abandoned' and 'the burden of IERITA and the consequences of fatigue', (2) inter- and intrapersonal insights as facilitators of change and (3) Online, written contact with the therapist is beneficial and contributes with less pressure, comprised of three sub-themes 'the therapist behind the screen is essential', 'less pressure sitting alone: the physical absence of a therapist' and 'engaging on your own terms, in your own tempo'. Themes were consistent among adolescents and parents. CONCLUSION Fatigue due to therapeutic engagement and previous help-seeking processes created barriers for engagement. Emotion regulation therapy was experienced as beneficial leading to inter- and intra-personal insights, facilitating change of maladaptive patterns. Therapists were regarded as indispensable, and the internet-based format did not hinder therapeutic alliance. The written format allowed for reflection and alleviated the pressure of relating to the therapist. Further research should explore experiences of other online treatment formats (e.g. synchronous or video-based) with regard to benefits, fatigue and therapist interaction.
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Affiliation(s)
- Sofie Heidenheim Christensen
- Child and Adolescent Mental Health Center, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health, University of Copenhagen, Copenhagen, Denmark
| | - Michella Heinrichsen
- Child and Adolescent Mental Health Center, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
| | - Bo Møhl
- Department of Communication and Psychology, Aalborg University, Aalborg, Denmark
| | - Lotte Rubæk
- Self-Injury Team, Child and Adolescent Mental Health Services, Copenhagen, Denmark
| | - Katherine Krage Byrialsen
- Child and Adolescent Mental Health Center, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
| | - Olivia Ojala
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institute, & Stockholm Health Care Services, Stockholm, Sweden
| | - Clara Hellner
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institute, & Stockholm Health Care Services, Stockholm, Sweden
| | - Anne Katrine Pagsberg
- Child and Adolescent Mental Health Center, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health, University of Copenhagen, Copenhagen, Denmark
| | - Johan Bjureberg
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institute, & Stockholm Health Care Services, Stockholm, Sweden
- Department of Psychology, Stanford University, Stanford, California, USA
| | - Britt Morthorst
- Child and Adolescent Mental Health Center, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health, University of Copenhagen, Copenhagen, Denmark
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Gorder J, Gonzales DT, Murray SB. Updates in the treatment of eating disorders in 2023: a year in review in eating disorders: the Journal of treatment & Prevention. Eat Disord 2024; 32:254-265. [PMID: 38738831 DOI: 10.1080/10640266.2024.2349352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/14/2024]
Abstract
Empirical evidence is unequivocal in illustrating that the majority of patients with eating disorders will not fully recover during treatment. To that end, the need for optimized treatment approaches and improved patient outcomes cannot be overstated. While empirical efforts are underway to optimize outcomes, this article reviews treatment-related research findings published in Eating Disorders: The Journal of Treatment & Prevention during 2023. Importantly, this review encapsulates research addressing (i) between-session patient behaviors, (ii) the integration of technology into treatment approaches, (iii) methods to augment emotional regulation in the context of eating disorder treatment, (iv) methods to measure progress, and potentially risk markers for patient dropout, during treatment, (v) optimizing treatment approaches for inpatient settings, and (vi) augmenting family therapy-based approaches. Incorporating novel technological advances may be critical in enhancing the scalability of eating disorder treatments, since treatment uptake remains an ongoing challenge for the field. Moreover, expanding the scope of non-outpatient eating disorder treatment settings, while ensuring fidelity to theoretical models developed in outpatient settings, is critical as treatment is effectively administer across the spectrum of levels of patient care.
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Affiliation(s)
- Julianna Gorder
- Department of Psychiatry & Behavioral Sciences, Keck School of Medicine of USC, University of Southern California, Los Angeles, California, USA
| | - Danielle T Gonzales
- Department of Psychiatry & Behavioral Sciences, Keck School of Medicine of USC, University of Southern California, Los Angeles, California, USA
| | - Stuart B Murray
- Department of Psychiatry & Behavioral Sciences, Keck School of Medicine of USC, University of Southern California, Los Angeles, California, USA
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4
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McClure Z, Fuller-Tyszkiewicz M, Messer M, Linardon J. Predictors, mediators, and moderators of response to digital interventions for eating disorders: A systematic review. Int J Eat Disord 2024; 57:1034-1048. [PMID: 37886906 DOI: 10.1002/eat.24078] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 10/05/2023] [Accepted: 10/06/2023] [Indexed: 10/28/2023]
Abstract
OBJECTIVE Digital interventions show promise as an effective prevention or self-management option for eating disorders (EDs). However, it remains unclear how, for whom, and through what mechanisms they work in this population, as a synthesis of outcome predictors, moderators, and mediators is lacking. This systematic review synthesized empirical research investigating predictors, mediators, and moderators of response to digital interventions for EDs. METHOD Six databases were searched (PROSPERO CRD42022295565) for studies that assessed predictors, moderators, or mediators of response (i.e., uptake, drop-out, engagement, and symptom level change) to a digital prevention or treatment program for EDs. Variables were grouped into several overarching categories (demographic, symptom severity, psychological, etc.) and were synthesized qualitatively across samples without a formally diagnosed ED (typically prevention-focused) and samples with a formally diagnosed ED (typically treatment-focused). RESULTS Eighty-six studies were included. For studies recruiting samples without a formal diagnosis (n = 70 studies), most predictors explored were statistically unrelated to outcome, although participant age, baseline symptom severity, confidence to change, motivation, and program engagement showed preliminary evidence of prognostic potential. No robust moderators or mediators were identified. Few studies recruiting samples with a formal diagnosis emerged (n = 16), of which no reliable predictors, moderators, or mediators were identified. DISCUSSION It remains unclear how, for whom, and under what circumstances digital programs targeting EDs work. We offer several recommendations for future research with the aim of advancing understanding of client characteristics and intervention elements that signal success from this intervention modality. PUBLIC SIGNIFICANCE Digital interventions have shown potential as an effective, scalable, and accessible intervention option for EDs. However, responsiveness varies, so advancing understanding of predictors, mediators, and moderators of outcome to digital interventions for EDs is needed. Such knowledge is important for enabling safe and efficient treatment matching, and for informing future development of effective digital interventions.
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Affiliation(s)
- Zoe McClure
- School of Psychology, Deakin University, Geelong, Victoria, Australia
| | - Matthew Fuller-Tyszkiewicz
- School of Psychology, Deakin University, Geelong, Victoria, Australia
- Centre for Social and Early Emotional Development, Deakin University, Burwood, Victoria, Australia
| | - Mariel Messer
- School of Psychology, Deakin University, Geelong, Victoria, Australia
| | - Jake Linardon
- School of Psychology, Deakin University, Geelong, Victoria, Australia
- Centre for Social and Early Emotional Development, Deakin University, Burwood, Victoria, Australia
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5
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van Beers E, Melisse B, de Jonge M, Peen J, van den Berg E, de Beurs E. Web-based guided self-help cognitive behavioral therapy-enhanced versus treatment as usual for binge-eating disorder: a randomized controlled trial protocol. Front Psychiatry 2024; 15:1332360. [PMID: 38435976 PMCID: PMC10904459 DOI: 10.3389/fpsyt.2024.1332360] [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: 11/09/2023] [Accepted: 01/29/2024] [Indexed: 03/05/2024] Open
Abstract
Binge-eating disorder (BED) is a psychiatric disorder characterized by recurrent episodes of eating a large amount of food in a discrete period of time while experiencing a loss of control. Cognitive behavioral therapy-enhanced (CBT-E) is a recommended treatment for binge-eating disorder and is typically offered through 20 sessions. Although binge-eating disorder is highly responsive to CBT-E, the cost of treating these patients is high. Therefore, it is crucial to evaluate the efficacy of low-intensity and low-cost treatments for binge-eating disorder that can be offered as a first line of treatment and be widely disseminated. The proposed noninferiority randomized controlled trial aims to determine the efficacy of web-based guided self-help CBT-E compared to treatment-as-usual CBT-E. Guided self-help will be based on a self-help program to stop binge eating, will be shorter in duration and lower intensity, and will require fewer therapist hours. Patients with binge-eating disorder (N = 180) will be randomly assigned to receive guided self-help or treatment-as-usual. Assessments will take place at baseline, mid-treatment, at the end of treatment, and at 20- and 40-weeks post-treatment. Treatment efficacy will be measured by examining the reduction in binge-eating days in the previous 28 days between baseline and the end of treatment between groups, with a noninferiority margin (Δ) of 1 binge-eating day. Secondary outcomes will include full remission, body shape dissatisfaction, therapeutic alliance, clinical impairment, health-related quality of life, attrition, and an economic evaluation to assess cost-effectiveness and cost-utility. The moderators examined will be baseline scores, demographic variables, and body mass index. It is expected that guided self-help is noninferior in efficacy compared to treatment-as-usual. The proposed study will be the first to directly compare the efficacy and economically evaluate a low-intensity and low-cost binge-eating disorder treatment compared to treatment-as-usual. If guided self-help is noninferior to treatment-as-usual in efficacy, it can be widely disseminated and used as a first line of treatment for patients with binge-eating disorder. The Dutch trial register number is R21.016. The study has been approved by the Medical Research Ethics Committees United on May 25th, 2021, case number NL76368.100.21.
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Affiliation(s)
- Ella van Beers
- Novarum Center for Eating Disorders & Obesity, Amstelveen, Netherlands
| | - Bernou Melisse
- Novarum Center for Eating Disorders & Obesity, Amstelveen, Netherlands
- Utrecht University, Department of Clinical Psychology, Utrecht, Netherlands
| | - Margo de Jonge
- Novarum Center for Eating Disorders & Obesity, Amstelveen, Netherlands
| | - Jaap Peen
- Department of Research, Arkin Mental Health Institute, Amsterdam, Netherlands
| | - Elske van den Berg
- Novarum Center for Eating Disorders & Obesity, Amstelveen, Netherlands
- Department of Research, Arkin Mental Health Institute, Amsterdam, Netherlands
| | - Edwin de Beurs
- Department of Research, Arkin Mental Health Institute, Amsterdam, Netherlands
- Leiden University, Department of Clinical Psychology, Leiden, Netherlands
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6
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Vuillier L, Greville-Harris M, Talbot CV, May L, Moseley RL. Early evaluation of a DBT-informed online intervention for people with eating disorders. J Eat Disord 2024; 12:9. [PMID: 38243262 PMCID: PMC10799469 DOI: 10.1186/s40337-024-00974-5] [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: 09/20/2023] [Accepted: 01/16/2024] [Indexed: 01/21/2024] Open
Abstract
OBJECTIVES Eating disorders (EDs) have a worldwide prevalence of 7.8%, with towering mortality rates and high healthcare costs. The current recommended treatment for EDs principally works by directly targeting ED thoughts and behaviours, but recovery rates are low. A multifaceted link between difficulties with emotions and EDs is now widely established, and newer third-wave therapies that aim to address these underlying emotion difficulties are promising. The current study piloted an online emotion self-help intervention which was co-developed with clinicians and people with lived experienced of EDs. The intervention aimed to specifically address difficulties with emotion identification and regulation, as well as unhelpful beliefs about emotions, which are believed to give rise to and maintain ED thoughts and behaviours. METHOD We recruited 39 people with self-reported EDs to test this intervention over a one-week period. Our participants were asked to complete a series of questionnaires measuring emotion processes and psychopathology on Day 1 (T1) before being given access to the intervention. Participants were then asked to practice the newly acquired skills for seven days, before taking the same questionnaires on Day 9 (T2). We also asked participants to qualitatively report on their experience of the intervention. RESULTS We found significant improvements in ED psychopathology (ED-15), depression (PHQ-9), and anxiety (GAD-7) pre- to post-intervention, with medium to large effect sizes. All our emotion variables namely alexithymia (TAS-20), difficulties regulating emotions (DERS-SF), and unhelpful beliefs about emotions (EBQ) also showed significant changes post-intervention with medium to large effect sizes. Most importantly, changes in emotion regulation processes were linked to improved eating psychopathology. The qualitative analysis corroborated this finding, highlighting how the intervention helped them form new beliefs about emotions, which helped them reduce ED behaviours. DISCUSSION Significant improvements in emotion processing and regulations, as well as psychopathology, along with positive qualitative feedback, suggest that the intervention effectively met its aims of increasing awareness of the link between emotions and eating psychopathology, providing help to identify and regulate emotions, and normalising emotional experiences. While our results are promising, further research is required to assess its effectiveness longer term and in clinical settings.
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Affiliation(s)
- Laura Vuillier
- Department of Psychology, Bournemouth University, Poole, UK.
| | | | - C V Talbot
- Department of Psychology, Bournemouth University, Poole, UK
| | - L May
- Southern Health University NHS Foundation Trust, Southampton, UK
| | - R L Moseley
- Department of Psychology, Bournemouth University, Poole, UK
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7
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Matheson EL, Smith HG, Amaral ACS, Meireles JFF, Almeida MC, Linardon J, Fuller-Tyszkiewicz M, Diedrichs PC. Using Chatbot Technology to Improve Brazilian Adolescents' Body Image and Mental Health at Scale: Randomized Controlled Trial. JMIR Mhealth Uhealth 2023; 11:e39934. [PMID: 37335604 DOI: 10.2196/39934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 12/21/2022] [Accepted: 04/10/2023] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND Accessible, cost-effective, and scalable mental health interventions are limited, particularly in low- and middle-income countries, where disparities between mental health needs and services are greatest. Microinterventions (ie, brief, stand-alone, or digital approaches) aim to provide immediate reprieve and enhancements in mental health states and offer a novel and scalable framework for embedding evidence-based mental health promotion techniques into digital environments. Body image is a global public health issue that increases young peoples' risk of developing more severe mental and physical health issues. Embedding body image microinterventions into digital environments is one avenue for providing young people with immediate and short-term reprieve and protection from the negative exposure effects associated with social media. OBJECTIVE This 2-armed, fully remote, and preregistered randomized controlled trial assessed the impact of a body image chatbot containing microinterventions on Brazilian adolescents' state and trait body image and associated well-being outcomes. METHODS Geographically diverse Brazilian adolescents aged 13-18 years (901/1715, 52.54% girls) were randomized into the chatbot or an assessment-only control condition and completed web-based self-assessments at baseline, immediately after the intervention time frame, and at 1-week and 1-month follow-ups. The primary outcomes were mean change in state (at chatbot entry and at the completion of a microintervention technique) and trait body image (before and after the intervention), with the secondary outcomes being mean change in affect (state and trait) and body image self-efficacy between the assessment time points. RESULTS Most participants who entered the chatbot (258/327, 78.9%) completed ≥1 microintervention technique, with participants completing an average of 5 techniques over the 72-hour intervention period. Chatbot users experienced small significant improvements in primary (state: P<.001, Cohen d=0.30, 95% CI 0.25-0.34; and trait body image: P=.02, Cohen d range=0.10, 95% CI 0.01-0.18, to 0.26, 95% CI 0.13-0.32) and secondary outcomes across various time points (state: P<.001, Cohen d=0.28, 95% CI 0.22-0.33; trait positive affect: P=.02, Cohen d range=0.15, 95% CI 0.03-0.27, to 0.23, 95% CI 0.08-0.37; negative affect: P=.03, Cohen d range=-0.16, 95% CI -0.30 to -0.02, to -0.18, 95% CI -0.33 to -0.03; and self-efficacy: P=.02, Cohen d range=0.14, 95% CI 0.03-0.25, to 0.19, 95% CI 0.08-0.32) relative to the control condition. Intervention benefits were moderated by baseline levels of concerns but not by gender. CONCLUSIONS This is the first large-scale randomized controlled trial assessing a body image chatbot among Brazilian adolescents. Intervention attrition was high (531/858, 61.9%) and reflected the broader digital intervention literature; barriers to engagement were discussed. Meanwhile, the findings support the emerging literature that indicates microinterventions and chatbot technology are acceptable and effective web-based service provisions. This study also offers a blueprint for accessible, cost-effective, and scalable digital approaches that address disparities between health care needs and provisions in low- and middle-income countries. TRIAL REGISTRATION Clinicaltrials.gov NCT04825184; http://clinicaltrials.gov/ct2/show/NCT04825184. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1186/s12889-021-12129-1.
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Affiliation(s)
- Emily L Matheson
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
| | - Harriet G Smith
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
| | - Ana C S Amaral
- Federal Institute of Education, Science and Technology of Southeast of Minas Gerais, Barbacena, Brazil
| | - Juliana F F Meireles
- Department of Family and Community Medicine, School of Community Medicine, University of Oklahoma Health Science Center, Tulsa, OK, United States
| | - Mireille C Almeida
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Jake Linardon
- School of Psychology, Deakin University, Geelong, Victoria, Australia
| | | | - Phillippa C Diedrichs
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
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8
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Farahimanesh S, Serino S, Tuena C, Di Lernia D, Wiederhold BK, Bernardelli L, Riva G, Moradi A. Effectiveness of a Virtual-Reality-Based Self-Help Intervention for Lowering the Psychological Burden during the COVID-19 Pandemic: Results from a Randomized Controlled Trial in Iran. J Clin Med 2023; 12:jcm12052006. [PMID: 36902793 PMCID: PMC10004117 DOI: 10.3390/jcm12052006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 02/13/2023] [Accepted: 02/22/2023] [Indexed: 03/06/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic. In this framework, digital self-help interventions have the potential to provide flexible and scalable solutions for delivering evidence-based treatments that do not necessitate face-to-face meetings. OBJECTIVE as part of a multicentric project, the purpose of the current randomized controlled trial was to evaluate the efficacy of a Virtual-Reality-based self-help intervention (namely, COVID Feel Good) in lowering the psychological distress experienced during the COVID-19 pandemic in Iran. METHODS 60 participants were randomly assigned to the experimental (COVID Feel Good intervention group) or the control (no-treatment control group) condition. At the beginning of the intervention (Day 0), at the end of the intervention (Day 7), and after a 2-week follow-up (Day 21), measurements of depressive and anxiety levels, general distress, perceived levels of stress, hopelessness (primary outcome measures), perceived interpersonal closeness with the social world, and fear of COVID-19 (secondary outcome measure) were collected. The protocol consists of two integrated parts: the first part includes a relaxing 10-min three-hundred-sixty-degree (360°) video, while the second one includes social tasks with specified objectives. RESULTS In terms of the primary outcomes, participants in the COVID Feel Good intervention group improved in depression, stress, anxiety, and perceived stress but not hopelessness. Secondary outcome results showed an improvement in perceived social connectedness and a substantial decrease in fear of COVID-19. CONCLUSIONS these findings on the efficacy of COVID Feel Good training add to the growing body of evidence demonstrating the feasibility of digital self-help interventions in promoting well-being during this unique period.
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Affiliation(s)
- Sharareh Farahimanesh
- Institute for Cognitive and Brain Sciences, Shahid Beheshti University, Tehran 1983969411, Iran
- Institute for Cognitive Science Studies, Tehran 1658344575, Iran
- Correspondence:
| | - Silvia Serino
- Department of Psychology, Università Cattolica del Sacro Cuore, 20123 Milan, Italy
| | - Cosimo Tuena
- Applied Technology for Neuropsychology Lab, IRCCS Istituto Auxologico Italiano, 20145 Milan, Italy
| | - Daniele Di Lernia
- Humane Technology Lab, Università Cattolica del Sacro Cuore, 20123 Milan, Italy
| | - Brenda K. Wiederhold
- Virtual Reality Medical Center, La Jolla, CA 92037, USA
- Virtual Reality Medical Institute, 1200 Brussels, Belgium
| | | | - Giuseppe Riva
- Applied Technology for Neuropsychology Lab, IRCCS Istituto Auxologico Italiano, 20145 Milan, Italy
- Humane Technology Lab, Università Cattolica del Sacro Cuore, 20123 Milan, Italy
| | - Alireza Moradi
- Institute for Cognitive Science Studies, Tehran 1658344575, Iran
- Faculty of Psychology & Education, Department of Psychology, Kharazmi University, Tehran 1571914911, Iran
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9
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Allen KL, Mountford VA, Elwyn R, Flynn M, Fursland A, Obeid N, Partida G, Richards K, Schmidt U, Serpell L, Silverstein S, Wade T. A framework for conceptualising early intervention for eating disorders. EUROPEAN EATING DISORDERS REVIEW 2023; 31:320-334. [PMID: 36426567 PMCID: PMC10100476 DOI: 10.1002/erv.2959] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 09/27/2022] [Accepted: 11/10/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE This paper outlines the evidence base for early intervention for eating disorders; provides a global overview of how early intervention for eating disorders is provided in different regions and settings; and proposes policy, service, clinician and research recommendations to progress early intervention for eating disorders. METHOD AND RESULTS Currently, access to eating disorder treatment often takes many years or does not occur at all. This is despite neurobiological, clinical and socioeconomic evidence showing that early intervention may improve outcomes and facilitate full sustained recovery from an eating disorder. There is also considerable variation worldwide in how eating disorder care is provided, with marked inequalities in treatment provision. Despite these barriers, there are existing evidence-based approaches to early intervention for eating disorders and progress is being made in scaling these. CONCLUSIONS We propose action steps for the field that will transform eating disorder service provision and facilitate early detection, treatment and recovery for everyone affected by eating disorders, regardless of age, socioeconomic status and personal characteristics.
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Affiliation(s)
- Karina L Allen
- Eating Disorders Outpatients Service, Maudsley Hospital, South London and Maudsley NHS Foundation Trust, London, UK.,Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Victoria A Mountford
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,LightHouse Arabia, Dubai, United Arab Emirates
| | - Rosiel Elwyn
- Thompson Institute, University of the Sunshine Coast, Gubbi Gubbi Country, Queensland, Australia
| | - Michaela Flynn
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - Nicole Obeid
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Georgina Partida
- Eating Disorders Outpatients Service, Maudsley Hospital, South London and Maudsley NHS Foundation Trust, London, UK
| | - Katie Richards
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Ulrike Schmidt
- Eating Disorders Outpatients Service, Maudsley Hospital, South London and Maudsley NHS Foundation Trust, London, UK.,Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Lucy Serpell
- Department of Clinical, Educational and Health Psychology, University College London, London, UK.,Eating Disorder Service, North East London NHS Foundation Trust, Essex, UK
| | | | - Tracey Wade
- Flinders Institute for Mental Health and Wellbeing, Flinders University, Adelaide, South Australia, Australia
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Sadeh-Sharvit S, Idan O, Fowler LA, Fitzsimmons-Craft EE, Firebaugh ML, Smith A, Graham AK, Goel NJ, Flatt RE, Balantekin KN, Monterubio GE, Karam AM, Funk B, Trockel MT, Wilfley DE, Taylor CB. Digital guided self-help for eating disorders: thematic analysis of participant text messages to coaches. Eat Disord 2023; 31:191-199. [PMID: 36178245 PMCID: PMC10587906 DOI: 10.1080/10640266.2022.2110698] [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] [Indexed: 11/03/2022]
Abstract
Digital guided self-help for eating disorders (GSH-ED) can reduce treatment disparities. Understanding program participants' interests throughout the program can help adapt programs to the service users' needs. Participants were 383 college students receiving a digital GSH-ED, who were each assigned a coach to help them better utilize the intervention through text correspondence. A thematic and affective analysis of the texts participants had sent found they primarily focused on: strategies for changing their ED-related cognitions, behaviors, and relationships; describing symptoms without expressing an active endeavor to change; and participants' relationship with their coach. Most texts also expressed affect, demonstrating emotional engagement with the intervention. Findings suggest that participants in GSH-ED demonstrate high involvement with the intervention, and discuss topics that are similar to those reported in clinician-facilitated interventions. The themes discussed by digital program participants can inform future iterations of GSH-ED, thereby increasing scalability and accessibility of digital evidence-based ED interventions.
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Affiliation(s)
- Shiri Sadeh-Sharvit
- Center for mHealth, Palo Alto University, Palo Alto, CA, USA
- Stanford University Department of Psychiatry and Behavioral Sciences, Stanford, CA, USA
- Baruch Ivcher School of Psychology, Interdisciplinary Center, Herzliya, Israel
| | - Orly Idan
- Baruch Ivcher School of Psychology, Interdisciplinary Center, Herzliya, Israel
| | - Lauren A. Fowler
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | | | - Marie-Laure Firebaugh
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Arielle Smith
- Center for mHealth, Palo Alto University, Palo Alto, CA, USA
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Andrea K. Graham
- Department of Medical Social Science, Northwestern University, Chicago, IL, USA
| | - Neha J. Goel
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Rachael E. Flatt
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Grace E. Monterubio
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Anna M. Karam
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | | | - Mickey T. Trockel
- Stanford University Department of Psychiatry and Behavioral Sciences, Stanford, CA, USA
| | - Denise E. Wilfley
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - C. Barr Taylor
- Center for mHealth, Palo Alto University, Palo Alto, CA, USA
- Stanford University Department of Psychiatry and Behavioral Sciences, Stanford, CA, USA
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Exploring experiences and needs of perinatal women in digital healthcare: A meta-ethnography of qualitative evidence. Int J Med Inform 2023; 169:104929. [PMID: 36435014 DOI: 10.1016/j.ijmedinf.2022.104929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 11/08/2022] [Accepted: 11/11/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The aim of this review is to identify, appraise, and synthesize the available qualitative evidence on the experiences and needs of perinatal women by using digital technologies in healthcare. METHODS This review was consolidated following the eMERGe meta-ethnography reporting guidance. We conducted a comprehensive search in eight databases from inception to 12 October 2021. Published and unpublished qualitative and mixed-method studies published in English were included. The methodological quality was assessed using the critical appraisal skill program checklist. A meta-ethnographic synthesis was used according to Noblit and Hare's seven-step iterative process. RESULTS A total of 3,843 articles were retrieved, and 27 qualitative studies pertaining to 3,775 perinatal women from 13 countries across different ethnicities were included. Four overarching themes emerged for the aspect of experiences: (1) normalization of experience, (2) attainment of valuable knowledge, (3) empowerment and self-confidence boosting, and (4) beneficial features of digital platforms. For the aspect of needs, the derived themes included the following: (1) necessity of credible resources, (2) importance of personalization, (3) concern about cybersecurity, and (4) urging additional support. Our line-of-argument for interpreting the perinatal women's experiences can offer a much greater engagement in digital healthcare, while the findings on the perinatal women's needs can add value for improving the design of digital healthcare in the future. CONCLUSION This review offers a deeper understanding of the perinatal women's experiences and needs when using digital technologies in healthcare. Our findings provide meaningful recommendations for clinical practice and future research.
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Cardi V, Meregalli V, Di Rosa E, Derrigo R, Faustini C, Keeler JL, Favaro A, Treasure J, Lawrence N. A community-based feasibility randomized controlled study to test food-specific inhibitory control training in people with disinhibited eating during COVID-19 in Italy. Eat Weight Disord 2022; 27:2745-2757. [PMID: 35666376 PMCID: PMC9169443 DOI: 10.1007/s40519-022-01411-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 04/25/2022] [Indexed: 11/25/2022] Open
Abstract
PURPOSE The aim of this study was to expand the evidence on the feasibility and impact of food-specific inhibitory control training in a community sample of people with disinhibited eating. METHODS Recruitment and data collection were conducted during the COVID-19 outbreak, in Italy. Ninety-four adult individuals with disinhibited eating were randomised to one of two conditions: App-based food-specific inhibitory control training or waiting list. Participants were assessed at baseline, end of intervention (2 weeks following baseline) and follow-up (one week later). The assessment measures included questionnaires about eating behaviour and mood. RESULTS Seventy-three percent of the sample reported a diagnosis of binge eating disorder, and 20.4% a diagnosis of bulimia nervosa. Retention rates were 77% and 86% for the food-specific inhibitory control training and the waiting list conditions, respectively. Almost half of the participants allocated to the training condition completed the "recommended" dose of training (i.e., 10 or more sessions). Those in the training condition reported lower levels of wanting for high-energy dense foods (p < 0.05), a trend for lower levels of perceived hunger (p = 0.07), and lower levels of depression (p < 0.05). Binge eating symptoms, disinhibition, wanting for high-energy dense foods, stress and anxiety were significantly lower at end of intervention, compared to baseline (p < .05). CONCLUSION Findings corroborated the feasibility of food-specific inhibitory control training, and its impact on high-energy dense foods liking. The study expands the evidence base for food-specific inhibitory control training by highlighting its impact on perceived hunger and depression. The mechanisms underlying these effects remain to be clarified. LEVEL OF EVIDENCE Level I, Evidence obtained from at least one properly designed randomized controlled trials; systematic reviews and meta-analyses; experimental studies.
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Affiliation(s)
- Valentina Cardi
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
- Department of General Psychology, University of Padova, Via Venezia 8, 35131, Padua, Italy.
| | - Valentina Meregalli
- Department of Neurosciences, University of Padua, Padua, Italy
- Padua Neuroscience Center, University of Padua, Padua, Italy
| | - Elisa Di Rosa
- Department of General Psychology, University of Padova, Via Venezia 8, 35131, Padua, Italy
| | - Rossella Derrigo
- Department of General Psychology, University of Padova, Via Venezia 8, 35131, Padua, Italy
| | - Chiara Faustini
- Department of General Psychology, University of Padova, Via Venezia 8, 35131, Padua, Italy
| | - Johanna Louise Keeler
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Angela Favaro
- Department of Neurosciences, University of Padua, Padua, Italy
- Padua Neuroscience Center, University of Padua, Padua, Italy
| | - Janet Treasure
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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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] [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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Joubert C, Downing C, Kearns IJ. Selection process for admission to an academic nursing programme - A meta-synthesis. NURSE EDUCATION TODAY 2022; 116:105475. [PMID: 35839548 DOI: 10.1016/j.nedt.2022.105475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 06/22/2022] [Accepted: 07/06/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Student nurse selection has been a topic of debate for years. Poor nursing care has been attributed to uncaring attitudes, lack of motivation and poor training and mentoring. Student nurse selection requirements and the steps involved in the process have been a revolving debate. Internationally, the recruitment and selection process are being refined to align with recommendations from the Francis Inquiry to include a values assessment. OBJECTIVE To select, review and interpret evidence-based studies on student nurse selection; and develop and provide recommendations for nurse educators when selecting first-year student nurses as a holistic, integrative process fitting with caring and providing quality care. DESIGN Qualitative meta-synthesis. DATA SOURCES Electronic databases were used during data collection: Ebscohost, ScienceDirect, SAGE, Cinahl and Sabinet (SAePublications). Qualitative articles published in English or Afrikaans reporting on student selection processes and experiences were included in the data collection process. REVIEW METHODS Qualitative articles were systematically identified using the STARLITE principles. The articles were critically appraised for quality by employing the CASP method. RESULTS Fourteen articles were included. Thirteen of the articles were published in English. One PhD thesis was included, a seminal work conducted on student nurse selection in South Africa. Data analysis revealed three main themes: a reliance on the interview, alternative selection methods, and attributes as criteria for nursing selection. Within these themes, many different methods of student selection emerged. The benefits and challenges of these methods were identified, and a holistic admission process was ultimately most successful in selecting the correct student nurse. CONCLUSIONS The findings indicate there are many different student nurse selection processes. A holistic admission process is needed to select the best student nurse that displays caring attributes and provides quality nursing care.
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Affiliation(s)
- Christel Joubert
- University of Johannesburg, Department of Nursing, Johannesburg, South Africa.
| | - Charlene Downing
- University of Johannesburg, Department of Nursing, Johannesburg, South Africa.
| | - Irene J Kearns
- University of Johannesburg, Department of Nursing, Johannesburg, South Africa.
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15
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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: 0] [Impact Index Per Article: 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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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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Sandgren SS, Haycraft E, Arcelus J, Plateau CR. Evaluating a motivational and psycho-educational self-help intervention for athletes with mild eating disorder symptoms: A mixed methods feasibility study. EUROPEAN EATING DISORDERS REVIEW 2022; 30:250-266. [PMID: 35170147 PMCID: PMC9304319 DOI: 10.1002/erv.2891] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 12/20/2021] [Accepted: 02/01/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The primary aim was to assess the feasibility of undertaking a study evaluating the novel Motivational and Psycho-Educational Self-Help Programme for Athletes with Mild Eating Disorder Symptoms (MOPED-A). A mixed-methods approach was adopted to explore the feasibility of recruiting and retaining participants, and to evaluate the acceptability of measures, procedures and the intervention. A secondary aim was to explore the potential efficacy of MOPED-A in reducing athletes' eating disorder symptoms. METHOD Thirty-five athletes were recruited. Participation involved completing MOPED-A over a 6-week period and completing self-report measures at baseline (T1), post-intervention (T2) and 4-week follow-up (T3). A subsample (n = 15) completed an interview at T2. RESULTS Retention was good throughout the study (n = 28; 80%). Quantitative and qualitative feedback suggested the format, delivery, content and dosage of MOPED-A were acceptable. Athletes valued that the intervention was tailored to them, and this facilitated both participation and completion. Over a third of participants reported disclosing their eating difficulties and deciding to seek further support. Large reductions in eating disorder symptoms were detected at T2 and sustained at T3. CONCLUSIONS The MOPED-A intervention can be feasibly implemented, is acceptable to participants, and demonstrates potential for reducing symptoms in athletes. A larger, controlled trial is warranted.
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Affiliation(s)
- Sebastian S. Sandgren
- School of Sport, Exercise and Health SciencesLoughborough UniversityLoughboroughUK
- Department of Education and Sports ScienceUniversity of StavangerStavangerNorway
| | - Emma Haycraft
- School of Sport, Exercise and Health SciencesLoughborough UniversityLoughboroughUK
| | - Jon Arcelus
- School of MedicineInstitute of Mental HealthUniversity of NottinghamNottinghamUK
- Psychoneurobiology of Eating and Addictive Behaviors Group, Neurosciences Programme, Bellvitge Biomedical Research Institute (IDIBELL)BarcelonaSpain
| | - Carolyn R. Plateau
- School of Sport, Exercise and Health SciencesLoughborough UniversityLoughboroughUK
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Yang J, Menhas R, Dai J, Younas T, Anwar U, Iqbal W, Ahmed Laar R, Muddasar Saeed M. Virtual Reality Fitness (VRF) for Behavior Management During the COVID-19 Pandemic: A Mediation Analysis Approach. Psychol Res Behav Manag 2022; 15:171-182. [PMID: 35082540 PMCID: PMC8786389 DOI: 10.2147/prbm.s350666] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 12/31/2021] [Indexed: 12/11/2022] Open
Abstract
Background During the COVID-19 pandemic, cellphone health apps and virtual reality fitness for treating neurological disorders such as Parkinson’s were beneficial. Virtual reality has been used to treat PTSD, depression, anxieties, dementia, ADHD, dyslexia, and pain control in various settings. Virtual reality exercise has been studied for its effects on biological, mental, rehabilitation, behavior, and attitude management. Purpose This research aimed to find out the role of virtual reality fitness (VRF) for behavior management during the COVID-19 pandemic concerning the demographic characteristics of the study participants and the use of fitness and health apps. Methods The population for the current study was Chinese residents across China who were in home isolation during the early pandemic in China. According to the study objective, a convenience sampling method was used to collect the primary data through an online survey. SPSS-25 statistical software was used to analyze the demographic information and clean and prepare the data to test all proposed hypotheses. The proposed research framework was examined using the structural equation modeling (SEM) approach through SmartPLS 3.0 software. Results The structural equation model analysis shows that all the proposed hypotheses (H1: β = 0.137, t = 10.454, p = <0.000; H2: β = 0.256, t = 16.824, p = <0.000; H3: β = 0.418, t = 27.827, p = <0.000; H4: β = 0.133, t = 8.913, p = <0.000; H5: β = 0.076, t = 4.717, p = <0.000; H6: β = 0.162, t = 10.532, p = <0.000; H7: β = 0.384, t = 26.645, p = <0.000) are confirmed. Conclusion Fitness and health apps with virtual reality fitness play a substantial role in improving the overall quality of life and positively influencing behavior and attitude.
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Affiliation(s)
- Jingning Yang
- School of Physical Education, Soochow University, Suzhou, Jiangsu Province, People’s Republic of China
| | - Rashid Menhas
- Research Center of Sports Social Sciences, School of Physical Education and Sports, Soochow University, Suzhou, Jiangsu Province, People’s Republic of China
- Correspondence: Rashid Menhas Research Center of Sports Social Sciences, School of Physical Education and Sports, Soochow University, Suzhou, Jiangsu Province, People’s Republic of China Email
| | - Jianhui Dai
- School of Physical Education, Soochow University, Suzhou, Jiangsu Province, People’s Republic of China
- Jianhui Dai School of Physical Education and Sports, Soochow University, Suzhou, Jiangsu Province, People’s Republic of China Email
| | - Tehmina Younas
- Department of Obstetrics and Gynecology, Social Security Hospital Gujrat, Punjab, Islamic Republic of Pakistan
| | - Usama Anwar
- School of Energy, Soochow University, Suzhou, Jiangsu Province, People’s Republic of China
| | - Waseem Iqbal
- School of Energy, Soochow University, Suzhou, Jiangsu Province, People’s Republic of China
| | - Rizwan Ahmed Laar
- College of Physical Education, Hubei Normal University, Huangshi, Hubei Province, People’s Republic of China
| | - Muhammad Muddasar Saeed
- International Education College Chinese and Western Medicine Clinic, Dalian Medical University, Dalian, Liaoning Province, People’s Republic of China
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A Virtual Reality-Based Self-Help Intervention for Dealing with the Psychological Distress Associated with the COVID-19 Lockdown: An Effectiveness Study with a Two-Week Follow-Up. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18158188. [PMID: 34360479 PMCID: PMC8346162 DOI: 10.3390/ijerph18158188] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 07/27/2021] [Accepted: 07/28/2021] [Indexed: 12/17/2022]
Abstract
The aim of this study is to investigate the effectiveness of a novel self-administered at-home daily virtual reality (VR)-based intervention (COVID Feel Good) for reducing the psychological burden experienced during the COVID-19 lockdown in Italy. A total of 40 individuals who had experienced at least two months of strict social distancing measures followed COVID Feel Good between June and July 2020 for one week. Primary outcome measures were depression, anxiety, and stress symptoms, perceived stress levels, and hopelessness. Secondary outcomes were the experienced social connectedness and the level of fear experienced during the COVID-19 pandemic. Linear mixed-effects models were fitted to evaluate the effectiveness of the intervention. Additionally, we also performed a clinical change analysis on primary outcome measures. As concerning primary outcome measures, participants exhibited improvements from baseline to post-intervention for depression levels, stress levels, general distress, and perceived stress (all p < 0.05) but not for the perceived hopelessness (p = 0.110). Results for the secondary outcomes indicated an increase in social connectedness from T0 to T1 (p = 0.033) but not a significant reduction in the perceived fear of coronavirus (p = 0.412). Among these study variables, these significant improvements were maintained from post-intervention to the 2-week follow-up (p > 0.05). Results indicated that the intervention was associated with good clinical outcomes, low-to-no risks for the treatment, and no adverse effects or risks. Globally, evidence suggests a beneficial effect of the proposed protocol and its current availability in 12 different languages makes COVID Feel Good a free choice for helping individuals worldwide to cope with the psychological distress associated with the COVID-19 crisis, although large scale trials are needed to evaluate its efficacy.
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Moghimi E, Davis C, Rotondi M. The Efficacy of eHealth Interventions for the Treatment of Adults Diagnosed With Full or Subthreshold Binge Eating Disorder: Systematic Review and Meta-analysis. J Med Internet Res 2021; 23:e17874. [PMID: 34283028 PMCID: PMC8335602 DOI: 10.2196/17874] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 12/18/2020] [Accepted: 05/13/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND There has been a recent rise in the use of eHealth treatments for a variety of psychological disorders, including eating disorders. OBJECTIVE This meta-analysis of randomized controlled trials is the first to evaluate the efficacy of eHealth interventions specifically for the treatment of binge eating disorder (characterized by compulsive overconsumption of food, in a relatively short period, and without compensatory behaviors such as purging or fasting). METHODS A search on the electronic databases PubMed, Web of Science, Embase, MEDLINE, and CINAHL was conducted for randomized controlled trials that compared the efficacy of eHealth treatment interventions with waitlist controls. RESULTS From the databases searched, 3 studies (298 participants in total) met the inclusion criteria. All interventions were forms of internet-based guided cognitive behavioral therapy. The results of the analysis demonstrated that when compared with waitlist controls, individuals enrolled in eHealth interventions experienced a reduction in objective binge episodes (standardized mean difference [SMD] -0.77, 95% CI -1.38 to -0.16) and eating disorder psychopathology (SMD -0.71, 95% CI -1.20 to -0.22), which included shape (SMD -0.61, 95% CI -1.01 to -0.22) and weight concerns (SMD -0.91, 95% CI -1.33 to -0.48). There was no significant difference in BMI between the eHealth interventions and controls (SMD -0.01, 95% CI -0.40 to 0.39). CONCLUSIONS These findings provide promising results for the use of internet-based cognitive behavioral therapy for binge eating disorder treatment and support the need for future research to explore the efficacy of these eHealth interventions.
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Affiliation(s)
- Elnaz Moghimi
- School of Kinesiology and Health Science, Faculty of Health, York University, Toronto, ON, Canada
| | - Caroline Davis
- School of Kinesiology and Health Science, Faculty of Health, York University, Toronto, ON, Canada
| | - Michael Rotondi
- School of Kinesiology and Health Science, Faculty of Health, York University, Toronto, ON, Canada
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Jenkins PE, Luck A, Violato M, Robinson C, Fairburn CG. Clinical and cost-effectiveness of two ways of delivering guided self-help for people with an eating disorder: A multi-arm randomized controlled trial. Int J Eat Disord 2021; 54:1224-1237. [PMID: 33998020 DOI: 10.1002/eat.23554] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 04/26/2021] [Accepted: 05/10/2021] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Increasing the availability and accessibility of evidence-based treatments for eating disorders is an important goal. This study investigated the effectiveness and cost-effectiveness of guided self-help via face-to-face meetings (fGSH) and a more scalable method, providing support via email (eGSH). METHOD A pragmatic, randomized controlled trial was conducted at three sites. Adults with binge-eating disorders were randomized to fGSH, eGSH, or a waiting list condition, each lasting 12 weeks. The primary outcome variable for clinical effectiveness was overall severity of eating psychopathology and, for cost-effectiveness, binge-free days, with explorative analyses using symptom abstinence. Costs were estimated from both a partial societal and healthcare provider perspective. RESULTS Sixty participants were included in each condition. Both forms of GSH were superior to the control condition in reducing eating psychopathology (IRR = -1.32 [95% CI -1.77, -0.87], p < .0001; IRR = -1.62 [95% CI -2.25, -1.00], p < .0001) and binge eating. Attrition was higher in eGSH. Probabilities that fGSH and eGSH were cost-effective compared with WL were 93% (99%) and 51% (79%), respectively, for a willingness to pay of £100 (£150) per additional binge-free day. DISCUSSION Both forms of GSH were associated with clinical improvement and were likely to be cost-effective compared with a waiting list condition. Provision of support via email is likely to be more convenient for many patients although the risk of non-completion is greater.
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Affiliation(s)
- Paul E Jenkins
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK.,Oxford Health NHS Foundation Trust, Oxford, UK
| | - Amy Luck
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Mara Violato
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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22
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Yim SH, Bailey E, Gordon G, Grant N, Musiat P, Schmidt U. Exploring Participants' Experiences of a Web-Based Program for Bulimia and Binge Eating Disorder: Qualitative Study. J Med Internet Res 2020; 22:e17880. [PMID: 32965235 PMCID: PMC7542406 DOI: 10.2196/17880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 06/26/2020] [Accepted: 07/19/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Guided cognitive behavioral self-help is a recommended first-line treatment for eating disorders (EDs) such as bulimia nervosa (BN) or binge eating disorder (BED). Online versions of such self-help programs are increasingly being studied in randomized controlled trials (RCTs), with some evidence that they can reduce ED symptoms, although intervention dropout is variable across interventions. However, in-depth research into participants' experiences and views on the acceptability of web-based interventions is limited. OBJECTIVE This is a qualitative process study of participants' experiences of everyBody Plus, a web-based cognitive behavioral intervention, integrated into a large RCT to aid the interpretation of the main trial's results. To our knowledge, this is the first such study in digital intervention for EDs research to include real-time feedback into the qualitative analysis. This study aims to build upon the emerging literature by qualitatively exploring participants' experiences of a web-based intervention for BN and BED. METHODS Participants were those who took part in the UK arm of a larger RCT investigating the efficacy of the everyBody Plus intervention. Reflexive thematic analysis was completed on 2 sources of data from the online platform: real-time feedback quotes provided at the end of completing a module on the platform (N=104) and semistructured telephone interview transcripts (n=12). RESULTS Four main themes were identified. The first theme identified positive and negative user experiences, with a desire for a more customized and personalized intervention. Another theme positively reflected on how flexible and easy the intervention was to embed into daily life, compared with the silo of face-to-face therapy. The third theme identified how the intervention had a holistic impact cognitively, emotionally, interpersonally, and behaviorally. The final theme was related to how the intervention was not a one size fits all and how the perceived usefulness and relevance were often dependent on participants' demographic and clinical characteristics. CONCLUSIONS Overall, participants reported positive experiences with the use of the everyBody Plus web-based intervention, including flexibility of use and the potential to holistically impact people's lives. The participants also provided valuable suggestions for how similar future web-based interventions could be improved and, in the context of EDs, how programs can be designed to be more inclusive of people by encompassing different demographic and clinical characteristics.
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Affiliation(s)
| | - Emma Bailey
- King's College London, London, United Kingdom
| | | | - Nina Grant
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | | | - Ulrike Schmidt
- King's College London, London, United Kingdom.,South London and Maudsley NHS Foundation Trust, London, United Kingdom
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23
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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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24
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Linardon J, Shatte A, Tepper H, Fuller-Tyszkiewicz M. A survey study of attitudes toward, and preferences for, e-therapy interventions for eating disorder psychopathology. Int J Eat Disord 2020; 53:907-916. [PMID: 32239725 DOI: 10.1002/eat.23268] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 03/13/2020] [Accepted: 03/15/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE E-therapy shows promise as a solution to the barriers that stand in the way of people receiving eating disorder (ED) treatment. Despite the potential for e-therapy to reduce the well-known treatment gap, little is known about public views and perspectives on this mode of intervention delivery. This study explored attitudes toward, and preferences for, e-therapy among individuals spanning the spectrum of eating pathology. METHOD Survey data assessing e-therapy attitudes and preferences were analyzed from 713 participants recruited from the public. Participants were categorized into one of five subgroups based on the type of self-reported ED symptoms and severity/risk level, ranging from high risk to a probable threshold or subthreshold ED. RESULTS Attitudes toward e-therapies appeared to be relatively positive; participants largely supported health care insurance coverage of costs for e-therapies, and were optimistic about the wide-ranging benefits of e-therapy. Although three-quarters of participants expressed a preference for face-to-face therapy, a significant percentage of participants (∼50%) reported an intention to use an e-therapy program for current or future eating problems, with intention ratings highest (70%) among those with probable bulimia nervosa (BN). Variables associated with an e-therapy preference were not currently receiving psychotherapy, more positive e-therapy attitudes, and greater stigma associated with professional help-seeking. Variables associated with e-therapy intentions were more positive e-therapy attitudes and a probable BN classification. CONCLUSIONS Present findings have important implications for increasing online intervention acceptance, engagement, and help-seeking among those at different stages of illness.
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Affiliation(s)
- Jake Linardon
- School of Psychology, Deakin University, Geelong, Victoria, Australia
| | - Adrian Shatte
- School of Science, Engineering and Information Technology, Federation University, Victoria, Melbourne, Australia
| | - Hannah Tepper
- School of Psychology, Deakin University, Geelong, Victoria, Australia
| | - Matthew Fuller-Tyszkiewicz
- School of Psychology, Deakin University, Geelong, Victoria, Australia.,Center for Social and Early Emotional Development, Deakin University, Burwood, Victoria, Australia
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25
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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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