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Portingale J, Butler D, Krug I. Novel online enfacement illusion for investigating self-perception in mental disorders: an experimental study protocol. J Eat Disord 2024; 12:94. [PMID: 38970110 PMCID: PMC11229022 DOI: 10.1186/s40337-024-01026-8] [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: 03/18/2024] [Accepted: 05/17/2024] [Indexed: 07/07/2024] Open
Abstract
BACKGROUND Remote research methods and interventions for mental health disorders have become increasingly important, particularly for conditions like eating disorders (EDs). Embodiment illusions, which induce feelings of ownership over another person?s body or body parts, offer valuable insights into the mechanisms underlying self-perception issues in EDs and potential interventions. However, existing research using these illusions has been limited to face-to-face settings. We illustrate a novel online protocol to induce the enfacement illusion (embodiment illusion principles applied to one's face) in an ED-based sample. METHODS Participants complete a 2-hr virtual session with a researcher. First, baseline trait/state ED psychopathology measures and a self-face recognition task occur. Second, participants experience two testing blocks of the enfacement illusion involving synchronously and asynchronously mimicking a pre-recorded actor's facial expressions. After each block, subjective and objective enfacement illusion measures occur alongside state ED psychopathology reassessment. DISCUSSION Successfully inducing enfacement illusions online could provide an affordable, accessible virtual approach to further elucidate the mechanistic role of self-perception disturbances across psychopathologies such as EDs. Moreover, this protocol may represent an innovative, remotely-delivered intervention strategy, as 'enfacement' over another face could update negative self-representations in a cost-effective, scalable manner.
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Affiliation(s)
- Jade Portingale
- School of Psychological Sciences, The University of Melbourne, Melbourne, VIC, 3051, Australia.
| | - David Butler
- Faculty of Psychology and Counselling, The Cairnmillar Institute, Melbourne, VIC, Australia
- Department of Psychology, Counselling and Therapy, LaTrobe University, Melbourne, VIC, Australia
| | - Isabel Krug
- School of Psychological Sciences, The University of Melbourne, Melbourne, VIC, 3051, Australia
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Özer Ö, Köksal B, Altinok A. Understanding university students' attitudes and preferences for internet-based mental health interventions. Internet Interv 2024; 35:100722. [PMID: 38356613 PMCID: PMC10864831 DOI: 10.1016/j.invent.2024.100722] [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: 09/13/2023] [Revised: 01/04/2024] [Accepted: 01/31/2024] [Indexed: 02/16/2024] Open
Abstract
Internet-based interventions are recognised as a practical approach to address mental health issues. The acceptance and utilisation of such interventions are closely linked to user attitudes and preferences. This study aims to examine the predictors of university students' attitudes towards internet-based interventions. Additionally, it seeks to elucidate students' preferences regarding crucial features of these interventions, such as the format, delivery mode, content type, and structural components, to understand better what makes these interventions appealing and practical for university students. A total of 273 university students (comprising 68 % females and 32 % males) participated in the study. The data collection instruments employed were the Personal Information Form, Internet-Based Intervention Preference Survey, E-therapy Attitude Measure (ETAM), Digital Literacy Scale, Patient Health Questionnaire-9, and the Generalized Anxiety Disorder-7 (GAD-7). The data were analysed utilising descriptive statistics, Pearson correlation analysis, and multiple linear regression analysis. The multiple regression analysis revealed digital literacy as a predictive factor for attitudes towards internet-based interventions. Demographic variables, such as age and gender, and psychological variables, such as depression and anxiety levels, were found not to be associated with attitudes towards these interventions. While students are actively seeking mental health information online, a significant majority remain unaware of internet-based interventions. They show a preference for interventions offering greater human interaction, including face-to-face guidance and video content featuring people. Participants favour completing one or two sessions of the intervention weekly. Desired features of internet-based interventions include self-assessment scales, relatable characters, voice relaxation exercises, practical daily life activity tasks, and weekly reminders throughout the process. In conclusion, initiatives aimed at enhancing digital literacy levels could foster more positive attitudes towards internet-based interventions among students. Developers creating Internet-Based Interventions (IBI) for university students should consider these preferences.
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Affiliation(s)
- Ömer Özer
- Department of Social Work and Consultancy, Open Education Faculty, Anadolu University, Eskisehir, Turkiye
| | - Burak Köksal
- Counseling and Guidance Center, Gaziosmanpaşa University, Tokat, Turkiye
| | - Ahmet Altinok
- Department of Psychology, Experimental Psychology, University of Groningen, Groningen, the Netherlands
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O'Connor P, Donohue G, Morrissey J, Needham M, Hargadon L, O'Toole C. An exploration of patient experiences of transitioning to a remote day programme following inpatient treatment in an adult eating disorder service. J Psychiatr Ment Health Nurs 2023; 30:1192-1202. [PMID: 37392056 DOI: 10.1111/jpm.12949] [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: 07/01/2022] [Revised: 01/30/2023] [Accepted: 06/13/2023] [Indexed: 07/02/2023]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Traditionally, treatment for eating disorders (EDs) has been provided on an inpatient or outpatient basis, but more recently other levels of treatment provision to include, day care (DC) and community outreach programmes, have been developed. There is limited research exploring the experience of patients who have transitioned from inpatient ED treatment to a remote DC treatment. This lack of knowledge can impact mental health nurses' understanding of what that experience is like for patients and hence may influence the efficacy of collaboration and inclusion between patients and nurses. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: This research addresses this dearth of knowledge and adds to our understanding of patients' experiences of attending a remote DC programme following a period of inpatient treatment for an ED. This is an important study for nurses and other mental health professionals working with people in ED treatment, as it highlights the specific challenges and anxieties of transitioning from inpatient to a remote DC programme and the individualized supports advisable during this process. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: This research provides a basis on which nurses can understand and address the challenges experienced by patients after transitioning to a less intensive supportive ED programme. The understanding of these experiences will enhance the therapeutic alliance between the nurse and patient, which will in turn support the patient in increasing agency as they progress through their recovery. This research provides a foundation on which to develop specific supports that need to be in place to help patients manage the anxieties they experience as they transition to a less intense and remote treatment. Findings from these lived experiences can be used to support the development of similar DC programmes for EDs in other settings. ABSTRACT INTRODUCTION: Day care (DC) treatment for people with an eating disorder (ED) provides for an easier transition from hospital to home, along with a treatment milieu where patients can maintain occupational and social functioning and allow for the transfer of newly acquired skills to everyday life. AIM To explore patients' experiences of attending a remote day programme following intense inpatient treatment in an adult ED service. METHOD A qualitative descriptive methodology informed the study. In-depth semi-structured interviews were conducted with 10 consenting patients. A thematic analysis framework was used to guide the process of data analysis. RESULTS Three themes reflected participants' experiences: 'Moving On: Preparing for Change', 'Navigating a New Support System' and 'Increasing Agency'. DISCUSSION An underlying issue for participants was an ongoing but changing experience of anxiety. While anticipatory anxiety is evident in preparing for discharge, this is replaced with a real-time anxiety as they endeavour to negotiate an effective support network. IMPLICATIONS FOR PRACTICE The findings from this study provide a basis on which mental health nurses can develop timely and effective treatment and support systems with patients who are transitioning from a high support inpatient ED programme to a less intensive ED remote DC programme.
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Affiliation(s)
| | | | - Jean Morrissey
- Trinity Centre for Practice and Healthcare Innovation, School of Nursing and Midwifery, Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - Mary Needham
- St. Patricks Mental Health Services, Dublin, Ireland
| | - Leah Hargadon
- St. Patricks Mental Health Services, Dublin, Ireland
| | - Clare O'Toole
- St. Patricks Mental Health Services, Dublin, Ireland
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4
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Daugelat MC, Pruccoli J, Schag K, Giel KE. Barriers and facilitators affecting treatment uptake behaviours for patients with eating disorders: A systematic review synthesising patient, caregiver and clinician perspectives. EUROPEAN EATING DISORDERS REVIEW 2023; 31:752-768. [PMID: 37352132 DOI: 10.1002/erv.2999] [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: 03/24/2023] [Revised: 05/22/2023] [Accepted: 06/04/2023] [Indexed: 06/25/2023]
Abstract
OBJECTIVE A significant treatment gap exists between persons affected by eating disorders (ED), and those engaging with treatment services. This systematic review aims to provide a thorough understanding of the barriers and facilitators affecting eating disorder treatment engagement, including a synthesis of the perspectives of patients, caregivers and healthcare professionals. METHOD This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies were retrieved from three databases (PubMed, PsycInfo, Web of Science) and were screened and assessed independently by two raters. A thematic analysis was completed to determine the key barriers and facilitators reported by the included studies. RESULTS A total of 73 studies were included. From these studies, 12 barriers and 13 facilitators were identified. Patients reported stigma, shame and guilt as the most prominent barrier affecting their engagement with treatment services. Meanwhile, caregivers and healthcare professionals reported a lack of eating disorder knowledge of clinicians as the most important barrier. Positive social support was cited as the most prominent facilitator to promote help-seeking. DISCUSSION Patients, caregivers and healthcare professionals experience a variety of barriers and facilitators to treatment uptake for ED. Interventions addressing barriers and facilitators could increase treatment engagement, including anti-stigma campaigns and positive peer-support interventions.
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Affiliation(s)
- Melissa-Claire Daugelat
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, Tübingen, Germany
- Centre of Excellence for Eating Disorders Tübingen (KOMET), University of Tübingen, Tübingen, Germany
| | - Jacopo Pruccoli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Regional Center for Feeding and Eating Disorders in the Developmental Age, Pediatric Neuropsychiatry Unit, Bologna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Kathrin Schag
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, Tübingen, Germany
- Centre of Excellence for Eating Disorders Tübingen (KOMET), University of Tübingen, Tübingen, Germany
| | - Katrin Elisabeth Giel
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, Tübingen, Germany
- Centre of Excellence for Eating Disorders Tübingen (KOMET), University of Tübingen, Tübingen, Germany
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Arellano-Alvarez P, Muñoz-Guerrero B, Ruiz-Barranco A, Garibay-Nieto N, Hernandez-Lopez AM, Aguilar-Cuarto K, Pedraza-Escudero K, Fuentes-Corona Z, Villanueva-Ortega E. Barriers in the Management of Obesity in Mexican Children and Adolescents through the COVID-19 Lockdown-Lessons Learned and Perspectives for the Future. Nutrients 2023; 15:4238. [PMID: 37836521 PMCID: PMC10574799 DOI: 10.3390/nu15194238] [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: 09/04/2023] [Revised: 09/21/2023] [Accepted: 09/24/2023] [Indexed: 10/15/2023] Open
Abstract
The COVID-19 lockdown caused health system issues, including the need for long-term care for patients with conditions like childhood obesity. We wanted to know how the lockdown had changed our patients' health and which variables had greater influence in preventing and managing overweight and obesity in kids and teens during and after the lockdown. METHODS Our study comprised two phases. The initial descriptive cross-sectional phase included surveys of children who are overweight or obese and their parents/guardians from the Pediatric Obesity Clinic at the Child Welfare Unit (UBI, acronym in Spanish) in the Hospital General de México "Dr. Eduardo Liceaga" (n = 129). The participants were studied to explore changes in lifestyle, physical activity, sleep patterns, eating behaviors, food consumption, anxiety, and depression. In the second phase, the biochemical, body composition, and anthropometric parameters of 29 pre-COVID-19 patients were compared before and after the lockdown. RESULTS The survey showed more moderate anxiety and depression, alterations in sleep, physical inactivity, and an increase in the consumption of animal products, fruits, cereals, tubers, sugary drinks, and ultra-processed food. In the study's comparative phase, we observed a substantial increase in BMI z-score (p = 0.01), waist circumference (p < 0.001), fat mass (p < 0.001), percentage of adiposity (p = 0.002), and basal glucose (p = 0.047) and a drop in lean mass (p = 0.008). CONCLUSIONS The pandemic led to a loss of routines and socioeconomic changes that made it difficult to address weight and obesity in young people. The results show that managing obesity in our patients involves considering both lifestyle and the social environment. This encourages us to consider a comprehensive and personalized approach.
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Affiliation(s)
- Paulina Arellano-Alvarez
- Pediatric Obesity Clinic at Child Welfare Unit (UBI, Acronym in Spanish) of The Hospital General de México “Dr. Eduardo Liceaga”, Mexico City 06720, Mexico; (P.A.-A.); (B.M.-G.); (A.R.-B.); (N.G.-N.); (A.M.H.-L.); (K.A.-C.); (K.P.-E.); (Z.F.-C.)
- Master’s and Doctorate Program in Medical, Dental and Health Sciences, Universidad Nacional Autónoma de México, Mexico City 04510, Mexico
| | - Brenda Muñoz-Guerrero
- Pediatric Obesity Clinic at Child Welfare Unit (UBI, Acronym in Spanish) of The Hospital General de México “Dr. Eduardo Liceaga”, Mexico City 06720, Mexico; (P.A.-A.); (B.M.-G.); (A.R.-B.); (N.G.-N.); (A.M.H.-L.); (K.A.-C.); (K.P.-E.); (Z.F.-C.)
| | - Alejandra Ruiz-Barranco
- Pediatric Obesity Clinic at Child Welfare Unit (UBI, Acronym in Spanish) of The Hospital General de México “Dr. Eduardo Liceaga”, Mexico City 06720, Mexico; (P.A.-A.); (B.M.-G.); (A.R.-B.); (N.G.-N.); (A.M.H.-L.); (K.A.-C.); (K.P.-E.); (Z.F.-C.)
| | - Nayely Garibay-Nieto
- Pediatric Obesity Clinic at Child Welfare Unit (UBI, Acronym in Spanish) of The Hospital General de México “Dr. Eduardo Liceaga”, Mexico City 06720, Mexico; (P.A.-A.); (B.M.-G.); (A.R.-B.); (N.G.-N.); (A.M.H.-L.); (K.A.-C.); (K.P.-E.); (Z.F.-C.)
| | - Ana María Hernandez-Lopez
- Pediatric Obesity Clinic at Child Welfare Unit (UBI, Acronym in Spanish) of The Hospital General de México “Dr. Eduardo Liceaga”, Mexico City 06720, Mexico; (P.A.-A.); (B.M.-G.); (A.R.-B.); (N.G.-N.); (A.M.H.-L.); (K.A.-C.); (K.P.-E.); (Z.F.-C.)
| | - Karina Aguilar-Cuarto
- Pediatric Obesity Clinic at Child Welfare Unit (UBI, Acronym in Spanish) of The Hospital General de México “Dr. Eduardo Liceaga”, Mexico City 06720, Mexico; (P.A.-A.); (B.M.-G.); (A.R.-B.); (N.G.-N.); (A.M.H.-L.); (K.A.-C.); (K.P.-E.); (Z.F.-C.)
| | - Karen Pedraza-Escudero
- Pediatric Obesity Clinic at Child Welfare Unit (UBI, Acronym in Spanish) of The Hospital General de México “Dr. Eduardo Liceaga”, Mexico City 06720, Mexico; (P.A.-A.); (B.M.-G.); (A.R.-B.); (N.G.-N.); (A.M.H.-L.); (K.A.-C.); (K.P.-E.); (Z.F.-C.)
| | - Zendy Fuentes-Corona
- Pediatric Obesity Clinic at Child Welfare Unit (UBI, Acronym in Spanish) of The Hospital General de México “Dr. Eduardo Liceaga”, Mexico City 06720, Mexico; (P.A.-A.); (B.M.-G.); (A.R.-B.); (N.G.-N.); (A.M.H.-L.); (K.A.-C.); (K.P.-E.); (Z.F.-C.)
| | - Erendira Villanueva-Ortega
- Pediatric Obesity Clinic at Child Welfare Unit (UBI, Acronym in Spanish) of The Hospital General de México “Dr. Eduardo Liceaga”, Mexico City 06720, Mexico; (P.A.-A.); (B.M.-G.); (A.R.-B.); (N.G.-N.); (A.M.H.-L.); (K.A.-C.); (K.P.-E.); (Z.F.-C.)
- Master’s and Doctorate Program in Medical, Dental and Health Sciences, Universidad Nacional Autónoma de México, Mexico City 04510, Mexico
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Baudinet J, Konstantellou A, Hambleton A, Bialluch K, Hurford G, Stewart CS. Do People Want the 'New Normal'? A Mixed Method Investigation of Young Person, Parent, and Clinician Experience and Preferences for Eating Disorder Treatment Delivery in the Post-COVID-19 World. Nutrients 2023; 15:3732. [PMID: 37686764 PMCID: PMC10490168 DOI: 10.3390/nu15173732] [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: 07/31/2023] [Revised: 08/16/2023] [Accepted: 08/18/2023] [Indexed: 09/10/2023] Open
Abstract
Eating disorder treatment was predominantly provided online during the COVID-19 pandemic, which has continued into the post-pandemic world. This mixed method study explored young person, parent/caregiver, and clinician experiences of child and adolescent eating disorder treatment. In total, 90 participants (25 young people, 49 parents/caregivers, and 16 clinicians) completed online surveys about the experience of online working. Data were compared to similar data collected by the same service earlier in the pandemic. The results show that preferences are largely unchanged since 2020; online treatment is considered helpful and acceptable by all groups. Nevertheless, face-to-face assessment sessions (young people: 52.2%; and parents/caregivers: 68.9%) and final sessions (young people: 82.6%; and parents/caregivers: 82.2%) were preferred compared to online. There was also a preference for early treatment sessions to either be always or mostly face-to-face (young people: 65.2%; and parents/caregivers: 73.3%). The middle and latter parts of treatment were a time when preferences shifted slightly to a more hybrid mode of delivery. Participants reported finding engagement with the therapist (young people: 70.6%; and parents/caregivers: 52.5%) easier during face-to-face treatment. Stepping away from the binary of online or face-to-face, the current data suggest that a hybrid and flexible model is a way forward with current findings providing insights into how to structure this.
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Affiliation(s)
- Julian Baudinet
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), 16 De Crespigny Park, London SE5 8AD, UK
- Maudsley Centre for Child and Adolescent Eating Disorders (MCCAED), Maudsley Hospital, De Crespigny Park, London SE5 8AZ, UK
| | - Anna Konstantellou
- Maudsley Centre for Child and Adolescent Eating Disorders (MCCAED), Maudsley Hospital, De Crespigny Park, London SE5 8AZ, UK
| | - Ashlea Hambleton
- InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, Charles Perkins Centre (D17), University of Sydney, Camperdown, NSW 2006, Australia
| | - Katrin Bialluch
- Maudsley Centre for Child and Adolescent Eating Disorders (MCCAED), Maudsley Hospital, De Crespigny Park, London SE5 8AZ, UK
| | - Georgina Hurford
- Maudsley Centre for Child and Adolescent Eating Disorders (MCCAED), Maudsley Hospital, De Crespigny Park, London SE5 8AZ, UK
| | - Catherine S. Stewart
- Maudsley Centre for Child and Adolescent Eating Disorders (MCCAED), Maudsley Hospital, De Crespigny Park, London SE5 8AZ, UK
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Dol A, van Gemert-Pijnen L, Schwartz LM, Velthuijsen H, Bode C. Exploring tailored virtual emotion regulation approaches for individuals with emotional eating. J Eat Disord 2023; 11:134. [PMID: 37573369 PMCID: PMC10422816 DOI: 10.1186/s40337-023-00856-2] [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: 01/21/2023] [Accepted: 08/01/2023] [Indexed: 08/14/2023] Open
Abstract
BACKGROUND Emotional eating is a complex problem fostering obesity and resulting from maladaptive emotion regulation. Traditional behavioural weight loss interventions have shown insignificant effect. They can be improved by targeting the specific needs of individuals with emotional eating. OBJECTIVE The current study explored a tailored online approach with the aim to positively influence affect (positive and negative) and emotion regulation by applying one of three exercises: body scan, opposite action, and positive reappraisal. DESIGN An embedded mixed-method design (questionnaire data (t0, t1, t2) and perceived usefulness of exercises in t2) was used to evaluate the effects of a two-week online quasi-experimental pilot study. SUBJECTS/SETTING In total, 80 participants with self-reported emotional eating difficulties (DEBQ-E; Memo = 3.48, SD = .64, range 1.62-4.92) finished baseline measurements; 15 completed the intervention. The study sample was predominantly female (95%), from 18 till 66 (Mage = 38,0 ± SD = 14.25). RESULTS Participants reported that the exercises helped them to pay attention to their physical sensations, and to see positive aspects in negative matters. The exercises were considered difficult by the participants, with too little explanation, and dull, due to minor variation. The observed changes revealed small, and moreover, not significant improvements of the three exercises on positive and negative affect and overall emotion dysregulation. Although the quantitative results did not reach significance, the qualitative data highlighted which aspects of the tailored exercises may have contributed to mood and emotion regulation outcomes. A notable observation in the present study is the substantial dropout rate, with the number of participants decreasing from 80 at baseline (T0) to 15 at the post-intervention stage (T2). CONCLUSIONS Future studies should identify tailored online exercises in emotion regulation skills in more detail and explore the contexts in which they are most effective in a personalized virtual coach virtual coach to be developed for individuals with emotional eating. Given the high dropout rate, more emphasis should be given to a proper presentation of the exercises, as well as more explanation of their usefulness and how to perform them.
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Affiliation(s)
- Aranka Dol
- Department of Psychology, Health and Technology, University of Twente, De Zul 10, 7522 NJ Enschede, The Netherlands
- Research Group New Business & ICT, Hanze University of Applied Sciences, Groningen, The Netherlands
| | - Lisette van Gemert-Pijnen
- Department of Psychology, Health and Technology, University of Twente, De Zul 10, 7522 NJ Enschede, The Netherlands
| | - Lysanne M. Schwartz
- Department of Psychology, Health and Technology, University of Twente, De Zul 10, 7522 NJ Enschede, The Netherlands
| | - Hugo Velthuijsen
- Research Group New Business & ICT, Hanze University of Applied Sciences, Groningen, The Netherlands
| | - Christina Bode
- Department of Psychology, Health and Technology, University of Twente, De Zul 10, 7522 NJ Enschede, The Netherlands
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Linardon J, Shatte A, McClure Z, Fuller-Tyszkiewicz M. A broad v. focused digital intervention for recurrent binge eating: a randomized controlled non-inferiority trial. Psychol Med 2023; 53:4580-4591. [PMID: 35621217 PMCID: PMC10388300 DOI: 10.1017/s0033291722001477] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 04/27/2022] [Accepted: 05/04/2022] [Indexed: 12/21/2022]
Abstract
BACKGROUND Empirically validated digital interventions for recurrent binge eating typically target numerous hypothesized change mechanisms via the delivery of different modules, skills, and techniques. Emerging evidence suggests that interventions designed to target and isolate one key change mechanism may also produce meaningful change in core symptoms. Although both 'broad' and 'focused' digital programs have demonstrated efficacy, no study has performed a direct, head-to-head comparison of the two approaches. We addressed this through a randomized non-inferiority trial. METHOD Participants with recurrent binge eating were randomly assigned to a broad (n = 199) or focused digital intervention (n = 199), or a waitlist (n = 202). The broad program targeted dietary restraint, mood intolerance, and body image disturbances, while the focused program exclusively targeted dietary restraint. Primary outcomes were eating disorder psychopathology and binge eating frequency. RESULTS In intention-to-treat analyses, both intervention groups reported greater improvements in primary and secondary outcomes than the waitlist, which were sustained at an 8-week follow-up. The focused intervention was not inferior to the broad intervention on all but one outcome, but was associated with higher rates of attrition and non-compliance. CONCLUSION Focused digital interventions that are designed to target one key change mechanism may produce comparable symptom improvements to broader digital interventions, but appear to be associated with lower engagement.
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Affiliation(s)
- Jake Linardon
- School of Psychology, Deakin University, 1 Gheringhap Street, Geelong, VIC 3220, Australia
- Center for Social and Early Emotional Development, Deakin University, Burwood, Victoria, 3125, Australia
| | - Adrian Shatte
- Federation University, School of Engineering, Information Technology & Physical Sciences, Melbourne, Australia
| | - Zoe McClure
- School of Psychology, Deakin University, 1 Gheringhap Street, Geelong, VIC 3220, Australia
| | - Matthew Fuller-Tyszkiewicz
- School of Psychology, Deakin University, 1 Gheringhap Street, Geelong, VIC 3220, Australia
- Center for Social and Early Emotional Development, Deakin University, Burwood, Victoria, 3125, Australia
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Linardon J, Fuller‐Tyszkiewicz M. The promise of single session interventions for eating disorders: Lessons to be learned from research on digital mental health. Commentary on Schleider et al. (2023). Int J Eat Disord 2023; 56:867-870. [PMID: 36987714 PMCID: PMC10947428 DOI: 10.1002/eat.23947] [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: 03/15/2023] [Revised: 03/19/2023] [Accepted: 03/20/2023] [Indexed: 03/30/2023]
Abstract
Schleider et al. propose that single session interventions (SSIs) could be a promising path toward catalyzing innovation in the development of accessible interventions for eating disorders (EDs). In this commentary, we contend that the arguments made by Schleider et al. raise many unresolved questions that continue to arise in the broader field. Drawing from our experiences with-and lessons learned from-developing, evaluating, and disseminating digital health interventions, we discuss four key empirical questions that should be addressed in order to realize the full potential of SSIs and other innovations in intervention delivery. These include: (i) for whom do we deliver an SSI; (ii) what are the optimal treatment mechanisms to target; (iii) what constitutes a "good" outcome; and (iv) where and how might we embed innovations like these. The SSI approach is a fruitful area of research enquiry, and we hope that this commentary generates further discussion and high-quality, collaborative work related to improving treatment accessibility and clinical outcomes among people with EDs.
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Affiliation(s)
- Jake Linardon
- School of PsychologyDeakin University1 Gheringhap StreetGeelongVictoria3220Australia
- Center for Social and Early Emotional DevelopmentDeakin UniversityBurwoodVictoria3125Australia
| | - Matthew Fuller‐Tyszkiewicz
- School of PsychologyDeakin University1 Gheringhap StreetGeelongVictoria3220Australia
- Center for Social and Early Emotional DevelopmentDeakin UniversityBurwoodVictoria3125Australia
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Barakat S, Maguire S. Accessibility of Psychological Treatments for Bulimia Nervosa: A Review of Efficacy and Engagement in Online Self-Help Treatments. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:ijerph20010119. [PMID: 36612445 PMCID: PMC9819826 DOI: 10.3390/ijerph20010119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/13/2022] [Accepted: 12/14/2022] [Indexed: 05/30/2023]
Abstract
Bulimia nervosa is an eating disorder characterised by marked impairment to one's physical health and social functioning, as well as high rates of chronicity and comorbidity. This literature review aims to summarise existing academic research related to the symptom profile of BN, the costs and burden imposed by the illness, barriers to the receipt of care, and the evidence base for available psychological treatments. As a consequence of well-documented difficulties in accessing evidence-based treatments for eating disorders, efforts have been made towards developing innovative, diverse channels to deliver treatment, with several of these attempting to harness the potential of digital platforms. In response to the increasing number of trials investigating the utility of online treatments, this paper provides a critical review of previous attempts to examine digital interventions in the treatment of eating disorders. The results of a focused literature review are presented, including a detailed synthesis of a knowledgeable selection of high-quality articles with the aim of providing an update on the current state of research in the field. The results of the review highlight the potential for online self-help treatments to produce moderately sized reductions in core behavioural and cognitive symptoms of eating disorders. However, concern is raised regarding the methodological limitations of previous research in the field, as well as the high rates of dropout and poor adherence reported across most studies. The review suggests directions for future research, including the need to replicate previous findings using rigorous study design and methodology, as well as further investigation regarding the utility of clinician support and interactive digital features as potential mechanisms for offsetting low rates of engagement with online treatments.
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Affiliation(s)
- Sarah Barakat
- InsideOut Institute for Eating Disorders, University of Sydney, Sydney Local Health District, Camperdown 2050, Australia
- School of Psychology, University of Sydney, Camperdown 2050, Australia
| | - Sarah Maguire
- InsideOut Institute for Eating Disorders, University of Sydney, Sydney Local Health District, Camperdown 2050, Australia
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11
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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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12
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Linardon J, Westrupp EM, Macdonald JA, Mikocka-Walus A, Stokes MA, Greenwood CJ, Youssef GJ, Teague S, Hutchinson D, Sciberras E, Fuller-Tyszkiewicz M. Monitoring Australian parents' shifting receptiveness to digital mental health interventions during the COVID-19 pandemic. Aust N Z J Psychiatry 2022; 56:1503-1514. [PMID: 34963330 DOI: 10.1177/00048674211065985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Nascent evidence indicates that the mental health of parents and children has markedly declined during the COVID-19 pandemic. Considering disruptions to traditional face-to-face mental health services resultant from stay-at-home orders, the potential value of digital mental health interventions has become extremely apparent. Despite this, uptake of digital interventions remains poor, indicating that a better understanding is needed of factors that determine a willingness to use digital platforms. METHOD The present multi-wave, longitudinal study of 2365 Australian parents explored between-person and within-person predictors of intentions to use digital interventions during the pandemic. RESULTS More than one-third of parents reported likely use of a self-guided and therapist-guided digital intervention, with the most endorsed reason for use being to support their child's mental health. Between-person baseline predictors of higher intention ratings were parent's prior mental illness, not living with a partner and recent environmental stressors. Within-person predictors of higher intention ratings were endorsement of mindful parenting strategies, child access to the Internet, better perceived management of child's education, lower social support and financial hardship. CONCLUSION Findings demonstrate that willingness to engage in digital interventions fluctuates in response to changing circumstances. Identifying novel ways to increase acceptance and uptake of digital interventions based on modifiable predictors established here is needed to realize the full potential of these modes of care in times of need.
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Affiliation(s)
- Jake Linardon
- Centre for Social and Early Emotional Development and School of Psychology, Deakin University, Geelong, VIC, Australia
| | - Elizabeth M Westrupp
- Centre for Social and Early Emotional Development and School of Psychology, Deakin University, Geelong, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
- Judith Lumley Centre, La Trobe University, Melbourne, VIC, Australia
| | - Jacqui A Macdonald
- Centre for Social and Early Emotional Development and School of Psychology, Deakin University, Geelong, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
- Murdoch Children's Research Institute, Melbourne Royal Children's Hospital, Melbourne, VIC, Australia
| | - Antonina Mikocka-Walus
- Centre for Social and Early Emotional Development and School of Psychology, Deakin University, Geelong, VIC, Australia
| | - Mark A Stokes
- Centre for Social and Early Emotional Development and School of Psychology, Deakin University, Geelong, VIC, Australia
| | - Christopher J Greenwood
- Centre for Social and Early Emotional Development and School of Psychology, Deakin University, Geelong, VIC, Australia
| | - George J Youssef
- Centre for Social and Early Emotional Development and School of Psychology, Deakin University, Geelong, VIC, Australia
| | - Samantha Teague
- Centre for Social and Early Emotional Development and School of Psychology, Deakin University, Geelong, VIC, Australia
| | - Delyse Hutchinson
- Centre for Social and Early Emotional Development and School of Psychology, Deakin University, Geelong, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
- Murdoch Children's Research Institute, Melbourne Royal Children's Hospital, Melbourne, VIC, Australia
- The National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Emma Sciberras
- Centre for Social and Early Emotional Development and School of Psychology, Deakin University, Geelong, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
- Murdoch Children's Research Institute, Melbourne Royal Children's Hospital, Melbourne, VIC, Australia
| | - Matthew Fuller-Tyszkiewicz
- Centre for Social and Early Emotional Development and School of Psychology, Deakin University, Geelong, VIC, Australia
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13
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Serur Y, Dikstein H, Shilton T, Gothelf D, Latzer Y, Lewis Y, Enoch-Levy A, Pessach I, Gur E, Stein D. The emotional-behavioral state of Israeli adolescent and young adult females with anorexia nervosa during the COVID19 pandemic. J Eat Disord 2022; 10:145. [PMID: 36209127 PMCID: PMC9547577 DOI: 10.1186/s40337-022-00668-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 09/30/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND During the COVID-19 pandemic in Israel, the number of patients with eating disorders (EDs) seeking treatment increased significantly. The present study sought to evaluate whether, during the pandemic (2020-21), patients with anorexia nervosa (AN) would show more ED-related, comorbid, and COVID-19-related symptoms in comparison to a naturalistic control group, and whether differences would be found between adult and adolescent patients with AN. We also examined attitudes to telemedicine use during the pandemic in patients receiving long-distance interventions. METHODS Using online self-report questionnaires, we assessed general and COVID-19-specific symptoms with a secure digital platform (REDCap®) in 36 female adolescents with AN, 35 female adults with AN, and 25 female controls. RESULTS Compared with controls, patients with AN showed more symptoms of EDs, anxiety, depression, and post-traumatic stress disorder (PTSD), elevated suicidal ideation, more COVID-related emotional-behavioral disturbances, and lower resilience. Adult patients with AN fared worse than adolescent patients on most of these measures. Adult patients using telemedicine during the COVID-19 pandemic showed fewer positive attitudes toward this treatment than adolescents (telemedicine was offered to all, but used by 18/35 adolescents and 21/36 adults with AN). Last, elevated COVID-19-related symptomatology was correlated with more symptoms of ED, anxiety, depression and PTSD, and with lower resilience. CONCLUSIONS Our findings suggest that the emotional-behavioral state of Israeli females with AN, particularly adults, was worse during the COVID-19 pandemic in comparison to controls. Many patients did not use telemedicine for their treatment. Adult patients using telemedicine were less satisfied with it than adolescent patients.
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Affiliation(s)
- Yaffa Serur
- Pediatric Psychosomatic Department, Sheba Medical Center, Safra Children's Hospital, Tel Hashomer, Israel.,Psychatric Division, Sheba Medical Center, Safra Children's Hospital, Tel Hashomer, Israel.,Sheba Medical Center, Safra Children's Hospital, Tel Hashomer, Israel
| | - Hadar Dikstein
- Pediatric Psychosomatic Department, Sheba Medical Center, Safra Children's Hospital, Tel Hashomer, Israel.,Psychatric Division, Sheba Medical Center, Safra Children's Hospital, Tel Hashomer, Israel.,Sheba Medical Center, Safra Children's Hospital, Tel Hashomer, Israel
| | - Tal Shilton
- Psychiatric Division, Psychiatric Department, Sheba Medical Center, Safra Children's Hospital, 5265601, Tel Hashomer, Israel.,Psychatric Division, Sheba Medical Center, Safra Children's Hospital, Tel Hashomer, Israel.,Sheba Medical Center, Safra Children's Hospital, Tel Hashomer, Israel.,Department of Psychiatry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Doron Gothelf
- Psychiatric Division, Psychiatric Department, Sheba Medical Center, Safra Children's Hospital, 5265601, Tel Hashomer, Israel.,Psychatric Division, Sheba Medical Center, Safra Children's Hospital, Tel Hashomer, Israel.,Sheba Medical Center, Safra Children's Hospital, Tel Hashomer, Israel.,Department of Psychiatry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Latzer
- Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel.,Psychiatric Division, Eating Disorders Institution, Rambam Health Care Campus, Haifa, Israel
| | - Yael Lewis
- Shalvatah Mental Health Center, Hod Hasharon, Israel
| | - Adi Enoch-Levy
- Pediatric Psychosomatic Department, Sheba Medical Center, Safra Children's Hospital, Tel Hashomer, Israel.,Psychatric Division, Sheba Medical Center, Safra Children's Hospital, Tel Hashomer, Israel.,Sheba Medical Center, Safra Children's Hospital, Tel Hashomer, Israel
| | - Itai Pessach
- Sheba Medical Center, Safra Children's Hospital, Tel Hashomer, Israel.,Department of Psychiatry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eitan Gur
- Center for the Treatment of Eating Disorders and Obesity, Sheba Medical Center, Tel Hashomer, Israel
| | - Daniel Stein
- Pediatric Psychosomatic Department, Sheba Medical Center, Safra Children's Hospital, Tel Hashomer, Israel. .,Psychatric Division, Sheba Medical Center, Safra Children's Hospital, Tel Hashomer, Israel. .,Sheba Medical Center, Safra Children's Hospital, Tel Hashomer, Israel. .,Department of Psychiatry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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14
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Cerea S, Doron G, Manoli T, Patania F, Bottesi G, Ghisi M. Cognitive training via a mobile application to reduce some forms of body dissatisfaction in young females at high-risk for body image disorders: A randomized controlled trial. Body Image 2022; 42:297-306. [PMID: 35908296 DOI: 10.1016/j.bodyim.2022.07.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 07/05/2022] [Accepted: 07/14/2022] [Indexed: 11/18/2022]
Abstract
Body dissatisfaction has been related to Body Image Disorders (BIDs) such as Eating Disorders (EDs) and Body Dysmorphic Disorder (BDD). This study investigates the efficacy of a mHealth app in reducing body dissatisfaction, BDD/ED symptoms and related features. Ninety-five women who were identified as high-risk of developing BIDs (using the Structured Clinical Interview for DSM-5) were randomized into: immediate-use App (iApp group; n = 47) and delayed-use App (dApp group; n = 48). The iApp group started using the app at baseline for 16 days (T1). The dApp group started using the app at T1 for 16 days. Participants completed questionnaires at baseline (T0), 16 days from baseline (T1), and 32 days from baseline (T2). Repeated measure Multivariate Analysis of Variance (MANOVA) showed Group (iApp vs. dApp) × Time (T0 vs. T1) interactions indicating decrease in BDD symptoms and body dissatisfaction related to EDs in the iApp group at T1. The Reliable Change Index indicated changes on extreme body dissatisfaction/BDD symptoms for 34.74% of participants. Although preliminary, these findings highlight that a mHeatlh app might reduce BDD symptoms and body dissatisfaction related to EDs in women at high-risk for BIDs. Effects on ED symptoms and associated features seem more limited.
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Affiliation(s)
- Silvia Cerea
- Department of General Psychology, University of Padova, Padova, Italy.
| | - Guy Doron
- Baruch Ivcher School of Psychology, Reichman University (IDC) Herzliya, Israel.
| | - Teresa Manoli
- Department of General Psychology, University of Padova, Padova, Italy
| | - Federica Patania
- Department of General Psychology, University of Padova, Padova, Italy
| | - Gioia Bottesi
- Department of General Psychology, University of Padova, Padova, Italy
| | - Marta Ghisi
- Department of General Psychology, University of Padova, Padova, Italy; U.O.C. Hospital Psychology, University-Hospital of Padova, Padova, Italy
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15
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The role of pre-existing knowledge and knowledge acquisition in internet-based cognitive-behavioural therapy for eating disorders. COMPUTERS IN HUMAN BEHAVIOR 2022. [DOI: 10.1016/j.chb.2022.107332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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16
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Linardon J, Shatte A, Rosato J, Fuller-Tyszkiewicz M. Efficacy of a transdiagnostic cognitive-behavioral intervention for eating disorder psychopathology delivered through a smartphone app: a randomized controlled trial. Psychol Med 2022; 52:1679-1690. [PMID: 32972467 DOI: 10.1017/s0033291720003426] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Although effective treatments exist for diagnostic and subthreshold-level eating disorders (EDs), a significant proportion of affected individuals do not receive help. Interventions translated for delivery through smartphone apps may be one solution towards reducing this treatment gap. However, evidence for the efficacy of smartphones apps for EDs is lacking. We developed a smartphone app based on the principles and techniques of transdiagnostic cognitive-behavioral therapy for EDs and evaluated it through a pre-registered randomized controlled trial. METHODS Symptomatic individuals (those who reported the presence of binge eating) were randomly assigned to the app (n = 197) or waiting list (n = 195). Of the total sample, 42 and 31% exhibited diagnostic-level bulimia nervosa and binge-eating disorder symptoms, respectively. Assessments took place at baseline, 4 weeks, and 8 weeks post-randomization. Analyses were intention-to-treat. The primary outcome was global levels of ED psychopathology. Secondary outcomes were other ED symptoms, impairment, and distress. RESULTS Intervention participants reported greater reductions in global ED psychopathology than the control group at post-test (d = -0.80). Significant effects were also observed for secondary outcomes (d's = -0.30 to -0.74), except compensatory behavior frequency. Symptom levels remained stable at follow-up. Participants were largely satisfied with the app, although the overall post-test attrition rate was 35%. CONCLUSION Findings highlight the potential for this app to serve as a cost-effective and easily accessible intervention for those who cannot receive standard treatment. The capacity for apps to be flexibly integrated within current models of mental health care delivery may prove vital for addressing the unmet needs of people with EDs.
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Affiliation(s)
- Jake Linardon
- School of Psychology, Deakin University, 1 Gheringhap Street, Geelong, VIC 3220, Australia
| | - Adrian Shatte
- Federation University, School of Science, Engineering & Information Technology, Melbourne, Australia
| | - John Rosato
- School of Psychology, Deakin University, 1 Gheringhap Street, Geelong, VIC 3220, Australia
| | - Matthew Fuller-Tyszkiewicz
- School of Psychology, Deakin University, 1 Gheringhap Street, Geelong, VIC 3220, Australia
- Center for Social and Early Emotional Development, Deakin University, Burwood, Victoria 3125, Australia
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17
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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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18
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Gonzalez C, Ramirez M, Mata-Greve F, Diaz A, Duran MC, Johnson M, Grote N, Areán PA. Acceptability of virtual therapy for postpartum women during COVID-19: A national mixed methods study. Front Psychiatry 2022; 13:893073. [PMID: 36159918 PMCID: PMC9500288 DOI: 10.3389/fpsyt.2022.893073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 08/17/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Postpartum depression (PPD) affects one in eight women in the U.S., with rates increasing due to the COVID-19 pandemic. Given the unique circumstances of COVID-19, virtual therapy might be a unique way to overcome barriers to mental health services. The study sought to explore the acceptability of virtual therapy among women in the postpartum period. METHODS Using an online recruitment mixed methods approach, we collected data from a U.S. national cross-sectional sample of women (N = 479) who gave birth in the last 12 months. FINDINGS Results show that 66% of women endorsed items consistent with possible depression during the COVID-19 pandemic. Only 27% accessed therapy services during the postpartum period. While 88% were open to engaging in virtual therapy services, 12% identified several major concerns with virtual therapy, namely: (1) preference for in-person therapy (2) no perceived need for therapy (3) uncomfortable with virtual therapy, and (4) lack of privacy. Of note, 36% more Latinas reported dissatisfaction with quality of care received during virtual therapy compared to non-Latina participants. Despite a major shift to virtual care with COVID-19, future work is needed to make virtual mental health services more accessible for women with PPD.
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Affiliation(s)
- Carmen Gonzalez
- Department of Communication, University of Washington, Seattle, WA, United States.,Department of Health Services, School of Public Health, University of Washington, Seattle, WA, United States.,Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, United States.,School of Social Work, University of Washington, Seattle, WA, United States
| | - Magaly Ramirez
- Department of Communication, University of Washington, Seattle, WA, United States.,Department of Health Services, School of Public Health, University of Washington, Seattle, WA, United States.,Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, United States.,School of Social Work, University of Washington, Seattle, WA, United States
| | - Felicia Mata-Greve
- Department of Communication, University of Washington, Seattle, WA, United States.,Department of Health Services, School of Public Health, University of Washington, Seattle, WA, United States.,Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, United States.,School of Social Work, University of Washington, Seattle, WA, United States
| | - Autumn Diaz
- Department of Communication, University of Washington, Seattle, WA, United States.,Department of Health Services, School of Public Health, University of Washington, Seattle, WA, United States.,Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, United States.,School of Social Work, University of Washington, Seattle, WA, United States
| | - Miriana C Duran
- Department of Communication, University of Washington, Seattle, WA, United States.,Department of Health Services, School of Public Health, University of Washington, Seattle, WA, United States.,Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, United States.,School of Social Work, University of Washington, Seattle, WA, United States
| | - Morgan Johnson
- Department of Communication, University of Washington, Seattle, WA, United States.,Department of Health Services, School of Public Health, University of Washington, Seattle, WA, United States.,Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, United States.,School of Social Work, University of Washington, Seattle, WA, United States
| | - Nancy Grote
- Department of Communication, University of Washington, Seattle, WA, United States.,Department of Health Services, School of Public Health, University of Washington, Seattle, WA, United States.,Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, United States.,School of Social Work, University of Washington, Seattle, WA, United States
| | - Patricia A Areán
- Department of Communication, University of Washington, Seattle, WA, United States.,Department of Health Services, School of Public Health, University of Washington, Seattle, WA, United States.,Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, United States.,School of Social Work, University of Washington, Seattle, WA, United States
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19
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Linardon J, Messer M, Rodgers RF, Fuller‐Tyszkiewicz M. A systematic scoping review of research on COVID-19 impacts on eating disorders: A critical appraisal of the evidence and recommendations for the field. Int J Eat Disord 2022; 55:3-38. [PMID: 34773665 PMCID: PMC8646470 DOI: 10.1002/eat.23640] [Citation(s) in RCA: 89] [Impact Index Per Article: 44.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 10/31/2021] [Accepted: 11/02/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Research investigating the effects of COVID-19 on eating disorders is growing rapidly. A comprehensive evaluation of this literature is needed to identify key findings and evidence gaps to better inform policy decisions related to the management of eating disorders during and after this crisis. We conducted a systematic scoping review synthesizing and appraising this literature. METHOD Empirical research on COVID-19 impacts on eating disorder severity, prevalence, and demand for treatment was searched. No sample restrictions were applied. Findings (n = 70 studies) were synthesized across six themes: (a) suspected eating disorder cases during COVID-19; (b) perceived pandemic impacts on symptoms; (c) symptom severity pre versus during the pandemic; (d) pandemic-related correlates of symptom severity; (e) impacts on carers/parents; and (f) treatment experiences during COVID-19. RESULTS Pandemic impacts on rates of probable eating disorders, symptom deterioration, and general mental health varied substantially. Symptom escalation and mental health worsening during-and due to-the pandemic were commonly reported, and those most susceptible included confirmed eating disorder cases, at-risk populations (young women, athletes, parent/carers), and individuals highly anxious or fearful of COVID-19. Evidence emerged for increased demand for specialist eating disorder services during the pandemic. The forced transition to online treatment was challenging for many, yet telehealth alternatives seemed feasible and effective. DISCUSSION Evidence for COVID-19 effects is mostly limited to participant self-report or retrospective recall, cross-sectional and descriptive studies, and samples of convenience. Several novel pathways for future research that aim to better understand, monitor, and support those negatively affected by the pandemic are formulated.
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Affiliation(s)
- Jake Linardon
- School of PsychologyDeakin UniversityGeelongVictoriaAustralia,Center for Social and Early Emotional DevelopmentDeakin UniversityBurwoodVictoriaAustralia
| | - Mariel Messer
- School of PsychologyDeakin UniversityGeelongVictoriaAustralia
| | - Rachel F. Rodgers
- APPEAR, Department of Applied PsychologyNortheastern UniversityBostonMassachusettsUSA,Department of Psychiatric Emergency & Acute CareLapeyronie Hospital, CHRU MontpellierMontpellierFrance,Department of PsychologySapienza University of RomeRomeItaly
| | - Matthew Fuller‐Tyszkiewicz
- School of PsychologyDeakin UniversityGeelongVictoriaAustralia,Center for Social and Early Emotional DevelopmentDeakin UniversityBurwoodVictoriaAustralia
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Cascino G, Marciello F, Abbate-Daga G, Balestrieri M, Bertelli S, Carpiniello B, Corrivetti G, Favaro A, Renna C, Ricca V, Salvo P, Segura-Garcia C, Todisco P, Volpe U, Zeppegno P, Monteleone P, Monteleone AM. How Is the History of Early Traumatic Exposure Associated With the Psychopathological Outcomes of COVID-19 Related Lockdown and Subsequent Re-opening in People With Eating Disorders? Front Psychiatry 2021; 12:789344. [PMID: 34955933 PMCID: PMC8692284 DOI: 10.3389/fpsyt.2021.789344] [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: 10/04/2021] [Accepted: 11/15/2021] [Indexed: 12/14/2022] Open
Abstract
The negative impact of COVID-19 pandemic on people with Eating Disorders (EDs) has been documented. The aim of this study was to evaluate whether a history of traumatic experiences during childhood or adolescence was associated with a higher degree of psychopathological worsening during COVID-19 related lockdown and in the following re-opening period in this group of people. People with EDs undergoing a specialist ED treatment in different Italian services before the spreading of COVID-19 pandemic (n = 312) filled in an online survey to retrospectively evaluate ED specific and general psychopathology changes after COVID-19 quarantine. Based on the presence of self-reported traumatic experiences, the participants were split into three groups: patients with EDs and no traumatic experiences, patients with EDs and childhood traumatic experiences, patients with EDs and adolescent traumatic experiences. Both people with or without early traumatic experiences reported retrospectively a worsening of general and ED-specific psychopathology during the COVID 19-induced lockdown and in the following re-opening period. Compared to ED participants without early traumatic experiences, those with a self-reported history of early traumatic experiences reported heightened anxious and post-traumatic stress symptoms, ineffectiveness, body dissatisfaction, and purging behaviors. These differences were seen before COVID-19 related restrictions as well as during the lockdown period and after the easing of COVID-19 related restrictions. In line with the "maltreated ecophenotype" theory, these results may suggest a clinical vulnerability of maltreated people with EDs leading to a greater severity in both general and ED-specific symptomatology experienced during the exposure to the COVID-19 pandemic.
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Affiliation(s)
- Giammarco Cascino
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, Salerno, Italy
| | - Francesca Marciello
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, Salerno, Italy
| | - Giovanni Abbate-Daga
- Department of Neuroscience, Eating Disorders Center for Treatment and Research, University of Turin, Turin, Italy
| | | | - Sara Bertelli
- Department of Mental Health, ASST Santi Paolo e Carlo, Milan, Italy
| | - Bernardo Carpiniello
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | | | - Angela Favaro
- Department of Neuroscience, University of Padova, Padua, Italy
| | - Caterina Renna
- Mental Health Department, Center for the Treatment and Research on Eating Disorders, ASL Lecce, Lecce, Italy
| | - Valdo Ricca
- Psychiatry Unit, Department of Neurological and Psychiatric Sciences, University of Florence, Florence, Italy
| | - Pierandrea Salvo
- Eating Disorders Centre Portogruaro, AULSS 4 Veneto Orientale, San Donà di Piave, Italy
| | - Cristina Segura-Garcia
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Patrizia Todisco
- Eating Disorders Unit, Casa di Cura “Villa Margherita”, Arcugnano, Italy
| | - Umberto Volpe
- Section of Clinical Psychiatry, Department of Clinical Neurosciences/DIMSC, Università Politecnica delle Marche, Ancona, Italy
| | - Patrizia Zeppegno
- Department of Translational Medicine, Psychiatry Institute, Università del Piemonte Orientale, Novara, Italy
| | - Palmiero Monteleone
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, Salerno, Italy
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Messer M, Linardon J. Exploring the role of feeling fat in individuals categorized with bulimia nervosa, binge-eating disorder and overweight/obesity. Eat Weight Disord 2021; 26:2617-2623. [PMID: 33570744 DOI: 10.1007/s40519-021-01119-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 01/19/2021] [Indexed: 10/22/2022] Open
Abstract
PURPOSE Despite featuring in prominent theoretical models, the role of "feeling fat" in certain eating and weight disorder presentations remains poorly understood. This study compared levels of feeling fat between people categorized with referable bulimia nervosa (BN) symptoms, binge-eating disorder (BED) symptoms, and overweight/obesity, and examined the unique associations of feeling fat on measures of eating pathology and functional impairment within each of these subgroups. METHODS Data were analyzed from 977 participants who met criteria referable to BN symptoms (n = 419), BED symptoms (n = 346), or overweight/obesity without ED psychopathology (n = 212) based on self-report symptom frequency. RESULTS Analysis of variance revealed that feeling fat levels were highest in the referable BN group, followed by the referable BED group, and then the overweight/obese subgroup. Multiple regressions revealed that feeling fat contributed additional variance to functional impairment and key cognitive (e.g., eating concerns) and behavioural (e.g., dietary restraint) symptoms only among those who met criteria referable to BN. CONCLUSION Overall, findings suggest that the experience of feeling fat may be an important component of body image particularly among individuals with BN-type symptoms. Present findings may also have implications for the assessment and treatment of feeling fat among different eating and weight disorder presentations. LEVEL OF EVIDENCE Cross-sectional descriptive study, Level V.
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Affiliation(s)
- Mariel Messer
- School of Psychology, Deakin University, 1 Gheringhap Street, Geelong, VIC, 3220, Australia.
| | - Jake Linardon
- School of Psychology, Deakin University, 1 Gheringhap Street, Geelong, VIC, 3220, Australia
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Monteleone P. Eating Disorders in the Era of the COVID-19 Pandemic: What Have We Learned? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312381. [PMID: 34886107 PMCID: PMC8657195 DOI: 10.3390/ijerph182312381] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 11/23/2021] [Indexed: 01/23/2023]
Affiliation(s)
- Palmiero Monteleone
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, 84081 Baronissi, Italy
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23
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Sideli L, Lo Coco G, Bonfanti RC, Borsarini B, Fortunato L, Sechi C, Micali N. Effects of COVID-19 lockdown on eating disorders and obesity: A systematic review and meta-analysis. EUROPEAN EATING DISORDERS REVIEW 2021; 29:826-841. [PMID: 34460991 PMCID: PMC8652707 DOI: 10.1002/erv.2861] [Citation(s) in RCA: 92] [Impact Index Per Article: 30.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/27/2021] [Accepted: 08/09/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVE This systematic review and meta-analysis aimed to examine: the pooled prevalence of symptomatic behaviours and mental health deterioration amongst individuals with eating disorders (EDs) and obesity during the COVID-19 confinement. Moreover, we examined changes in EDs and distress before and during the confinement, and the association between psychosocial factors and EDs symptoms. METHOD A systematic search was carried out in biomedical databases from January 2020 to January 2021. Both cross-sectional and longitudinal studies that used quantitative measures of ED symptoms and psychological distress during and after the COVID-19 confinement were included. RESULTS A total of 26 studies met inclusion criteria (n = 3399, 85.7% female). The pooled prevalence of symptomatic deterioration in EDs was 65% (95% CI[48,81], k = 10). The pooled prevalence of increased weight in obesity was 52% (95% CI[25,78], k = 4). More than half of the participants experienced depression and anxiety. Moreover, at least 75% of the individuals with EDs reported shape and eating concerns, and increased thinking about exercising. However, the pooled analyses of longitudinal studies showed no significant differences from pre-pandemic levels to the first lockdown phase in Body Mass Index and ED symptoms, whereas only few studies suggested increased distress, particularly among individuals with anorexia nervosa. CONCLUSIONS The majority of individuals with EDs and obesity reported symptomatic worsening during the lockdown. However, further longitudinal studies are needed to identify vulnerable groups, as well as the long-term consequences of COVID-19.
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Affiliation(s)
- Lucia Sideli
- Department of Human ScienceLUMSA UniversityRomeItaly
| | - Gianluca Lo Coco
- Department of Psychology, Educational Science and Human MovementUniversity of PalermoPalermoItaly
| | - Rubinia Celeste Bonfanti
- Department of Psychology, Educational Science and Human MovementUniversity of PalermoPalermoItaly
| | - Bianca Borsarini
- Department of PsychiatryFaculty of MedicineUniversity of GenevaGenevaSwitzerland
| | - Lucia Fortunato
- Department of Psychology, Educational Science and Human MovementUniversity of PalermoPalermoItaly
| | - Cristina Sechi
- Department of Pedagogy, Psychology, PhilosophyUniversity of CagliariCagliariItaly
| | - Nadia Micali
- Department of PsychiatryFaculty of MedicineUniversity of GenevaGenevaSwitzerland
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Torous J, Bucci S, Bell IH, Kessing LV, Faurholt-Jepsen M, Whelan P, Carvalho AF, Keshavan M, Linardon J, Firth J. The growing field of digital psychiatry: current evidence and the future of apps, social media, chatbots, and virtual reality. World Psychiatry 2021; 20:318-335. [PMID: 34505369 PMCID: PMC8429349 DOI: 10.1002/wps.20883] [Citation(s) in RCA: 242] [Impact Index Per Article: 80.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
As the COVID-19 pandemic has largely increased the utilization of telehealth, mobile mental health technologies - such as smartphone apps, vir-tual reality, chatbots, and social media - have also gained attention. These digital health technologies offer the potential of accessible and scalable interventions that can augment traditional care. In this paper, we provide a comprehensive update on the overall field of digital psychiatry, covering three areas. First, we outline the relevance of recent technological advances to mental health research and care, by detailing how smartphones, social media, artificial intelligence and virtual reality present new opportunities for "digital phenotyping" and remote intervention. Second, we review the current evidence for the use of these new technological approaches across different mental health contexts, covering their emerging efficacy in self-management of psychological well-being and early intervention, along with more nascent research supporting their use in clinical management of long-term psychiatric conditions - including major depression; anxiety, bipolar and psychotic disorders; and eating and substance use disorders - as well as in child and adolescent mental health care. Third, we discuss the most pressing challenges and opportunities towards real-world implementation, using the Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework to explain how the innovations themselves, the recipients of these innovations, and the context surrounding innovations all must be considered to facilitate their adoption and use in mental health care systems. We conclude that the new technological capabilities of smartphones, artificial intelligence, social media and virtual reality are already changing mental health care in unforeseen and exciting ways, each accompanied by an early but promising evidence base. We point out that further efforts towards strengthening implementation are needed, and detail the key issues at the patient, provider and policy levels which must now be addressed for digital health technologies to truly improve mental health research and treatment in the future.
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Affiliation(s)
- John Torous
- Division of Digital Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Massachusetts Mental Health Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Sandra Bucci
- Digital Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
- Centre for Health Informatics, University of Manchester, Manchester, UK
| | - Imogen H Bell
- Orygen, Melbourne, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Lars V Kessing
- Psychiatric Center Copenhagen, Rigshospitalet, Copenhagen, Denmark
- Copenhagen Affective Disorder Research Center, Copenhagen, Denmark
| | - Maria Faurholt-Jepsen
- Psychiatric Center Copenhagen, Rigshospitalet, Copenhagen, Denmark
- Copenhagen Affective Disorder Research Center, Copenhagen, Denmark
| | - Pauline Whelan
- Digital Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
- Centre for Health Informatics, University of Manchester, Manchester, UK
| | - Andre F Carvalho
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- IMPACT (Innovation in Mental and Physical Health and Clinical Treatment) Strategic Research Centre, Deakin University, Geelong, VIC, Australia
| | - Matcheri Keshavan
- Division of Digital Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Massachusetts Mental Health Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Jake Linardon
- Deakin University, Centre for Social and Early Emotional Development and School of Psychology, Burwood, VIC, Australia
| | - Joseph Firth
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
- NICM Health Research Institute, Western Sydney University, Westmead, NSW, Australia
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Ilagan GS, Heatherington L. Advancing the understanding of factors that influence client preferences for race and gender matching in psychotherapy. COUNSELLING PSYCHOLOGY QUARTERLY 2021. [DOI: 10.1080/09515070.2021.1960274] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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26
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Linardon J, King T, Shatte A, Fuller-Tyszkiewicz M. Usability Evaluation of a Cognitive-Behavioral App-Based Intervention for Binge Eating and Related Psychopathology: A Qualitative Study. Behav Modif 2021; 46:1002-1020. [PMID: 34075803 DOI: 10.1177/01454455211021764] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Despite their promise as a scalable intervention modality for binge eating and related problems, reviews show that engagement of app-based interventions is variable. Issues with usability may account for this. App developers should undertake usability testing so that any problems can be identified and fixed prior to dissemination. We conducted a qualitative usability evaluation of a newly-developed app for binge eating in 14 individuals with a diagnostic- or subthreshold-level binge eating symptoms. Participants completed a semi-structured interview and self-report measures. Qualitative data were organized into six themes: usability, visual design, user engagement, content, therapeutic persuasiveness, and therapeutic alliance. Qualitative and quantitative results indicated that the app demonstrated good usability. Key advantages reported were its flexible content-delivery formats, level of interactivity, easy-to-understand information, and ability to track progress. Concerns with visual aesthetics and lack of professional feedback were raised. Findings will inform the optimal design of app-based interventions for eating disorder symptoms.
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Affiliation(s)
| | | | - Adrian Shatte
- Federation University, School of Engineering, Information Technology & Physical Sciences, Berwick, AU-VIC, Australia
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27
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Linardon J, Messer M, Lee S, Rosato J. Perspectives of e-health interventions for treating and preventing eating disorders: descriptive study of perceived advantages and barriers, help-seeking intentions, and preferred functionality. Eat Weight Disord 2021; 26:1097-1109. [PMID: 32959274 DOI: 10.1007/s40519-020-01005-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 08/31/2020] [Indexed: 02/06/2023] Open
Abstract
PURPOSE Digital interventions that consider end-user needs, preferences, and concerns may address suboptimal rates of e-health uptake, usage, and engagement. We explored target-user perspectives of e-health treatment and prevention programs for eating disorders (EDs), with a focus on investigating (1) perceived advantages and barriers of e-health; (2) help-seeking intentions; and (3) preferences for different digital functionality, device types, and content-delivery formats. METHODS Survey data were analysed from 722 community-based participants. Participants were categorized into one of four groups based on symptom presentation and severity, ranging from low risk to probable bulimia nervosa or binge-eating disorder. RESULTS e-health advantages that received the highest endorsement (~ 84%) were "always there in times of need" and "travel not required". e-health barriers that received the highest endorsement (~ 50%) were concerns about data privacy and the accuracy of content presented. Nearly three-quarters reported an intention to use an e-health platform for preventing or treating EDs. Preference ratings were highest for programs to be available on all digital devices (relative to restricting the program to one type of device) and for content to be presented via graphics and video tutorials (rather than audio-based). e-health functionality that received highest preference ratings (~ 80%) were added clinician support, tailored feedback, strategies to change unhelpful ED thoughts, screening scales to assess symptoms, ED psychoeducation, and just-in-time intervention prompts. Preference and intention ratings were strikingly similar across all subgroups. CONCLUSION Findings may inform the development and design of e-health platforms that meet the needs of people at different stages of an ED. LEVEL OF EVIDENCE Level V, cross-sectional descriptive study.
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Affiliation(s)
- Jake Linardon
- School of Psychology, Deakin University, 1 Gheringhap Street, Geelong, VIC, 3220, Australia.
| | - Mariel Messer
- School of Psychology, Deakin University, 1 Gheringhap Street, Geelong, VIC, 3220, Australia
| | - Sohee Lee
- Faculty of Health and Environmental Science, Auckland University of Technology, Private Bag 92006, Auckland, 1142, New Zealand
| | - John Rosato
- School of Psychology, Deakin University, 1 Gheringhap Street, Geelong, VIC, 3220, Australia
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Nutley SK, Falise AM, Henderson R, Apostolou V, Mathews CA, Striley CW. Impact of the COVID-19 Pandemic on Disordered Eating Behavior: Qualitative Analysis of Social Media Posts. JMIR Ment Health 2021; 8:e26011. [PMID: 33465035 PMCID: PMC7842857 DOI: 10.2196/26011] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 01/04/2021] [Accepted: 01/16/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND A growing body of evidence is suggesting a significant association between the COVID-19 pandemic and population-level mental health. Study findings suggest that individuals with a lifetime history of disordered eating behavior may be negatively affected by COVID-19-related anxiety, and prevention measures may disrupt daily functioning and limit access to treatment. However, data describing the influence of the COVID-19 pandemic on disordered eating behaviors are limited, and most findings focus on individuals in treatment settings. OBJECTIVE The aim of this study is to characterize the experiences of Reddit users worldwide who post in eating disorder (ED)-related discussion forums describing the influence of the COVID-19 pandemic on their overall mental health and disordered eating behavior. METHODS Data were collected from popular subreddits acknowledging EDs as their primary discussion topic. Unique discussion posts dated from January 1 to May 31, 2020 that referenced the COVID-19 pandemic were extracted and evaluated using inductive, thematic data analysis. RESULTS Six primary themes were identified: change in ED symptoms, change in exercise routine, impact of quarantine on daily life, emotional well-being, help-seeking behavior, and associated risks and health outcomes. The majority of users reported that the COVID-19 pandemic and associated public health prevention measures negatively impacted their psychiatric health and contributed to increased disordered eating behaviors. Feelings of isolation, frustration, and anxiety were common. Many individuals used Reddit forums to share personal experiences, seek advice, and offer shared accountability. CONCLUSIONS Reddit discussion forums have provided a therapeutic community for individuals to share experiences and provide support for peers with ED during a period of increased psychiatric distress. Future research is needed to assess the impact of the COVID-19 pandemic on disordered eating behavior and to evaluate the role of social media discussion forums in mental health treatment, especially during periods of limited treatment access.
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Affiliation(s)
- Sara K Nutley
- Department of Epidemiology, University of Florida, Gainesville, FL, United States
| | - Alyssa M Falise
- Department of Epidemiology, University of Florida, Gainesville, FL, United States
| | - Rebecca Henderson
- Department of Anthropology, University of Florida, Gainesville, FL, United States
| | - Vasiliki Apostolou
- Department of Epidemiology, University of Florida, Gainesville, FL, United States
| | - Carol A Mathews
- Department of Psychiatry, University of Florida, Gainesville, FL, United States
| | - Catherine W Striley
- Department of Epidemiology, University of Florida, Gainesville, FL, United States
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Monteleone AM, Cascino G, Barone E, Carfagno M, Monteleone P. COVID-19 Pandemic and Eating Disorders: What Can We Learn About Psychopathology and Treatment? A Systematic Review. Curr Psychiatry Rep 2021; 23:83. [PMID: 34674064 PMCID: PMC8528944 DOI: 10.1007/s11920-021-01294-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/09/2021] [Indexed: 12/26/2022]
Abstract
PURPOSE OF REVIEW This systematic review aims to collect evidence regarding the impact of the SarsCov-2 pandemic on people affected by eating disorders (EDs) targeting the following variables: psychopathology changes, mechanisms of vulnerability or resilience, and perception of treatment modifications during the pandemic. RECENT FINDINGS Since the beginning of the pandemic, a mental health deterioration has been detected in the general population and especially in people affected by pre-existing psychiatric conditions. Furthermore, mental healthcare has moved toward online treatment. ED people showed a trend toward worsening of ED-specific psychopathology and impairment in general psychopathology. The most common vulnerability mechanisms were social isolation and feelings of uncertainty, while heightened self-care and reduced social pressure were resilience factors. The online treatment, although raising many concerns related to its quality, was considered the best alternative to the face-to-face approach. These findings may support the idea that stressful events contribute to the exacerbation of ED psychopathology and highlight the relevance of internalizing symptoms in EDs. The identification of putative risk and resilience variables as well as of subjective factors affecting online treatment perception may inform healthcare professionals and may promote more personalized approaches.
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Affiliation(s)
| | - Giammarco Cascino
- grid.11780.3f0000 0004 1937 0335Department of Medicine, Surgery and Dentistry ‘Scuola Medica Salernitana,’ Section of Neurosciences, University of Salerno, Salerno, Italy
| | - Eugenia Barone
- grid.9841.40000 0001 2200 8888Department of Psychiatry, University of Campania “Luigi Vanvitelli,”, Naples, Italy
| | - Marco Carfagno
- grid.9841.40000 0001 2200 8888Department of Psychiatry, University of Campania “Luigi Vanvitelli,”, Naples, Italy
| | - Palmiero Monteleone
- grid.11780.3f0000 0004 1937 0335Department of Medicine, Surgery and Dentistry ‘Scuola Medica Salernitana,’ Section of Neurosciences, University of Salerno, Salerno, Italy
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30
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Schlegl S, Maier J, Meule A, Voderholzer U. Eating disorders in times of the COVID-19 pandemic-Results from an online survey of patients with anorexia nervosa. Int J Eat Disord 2020; 53:1791-1800. [PMID: 32841413 PMCID: PMC7461418 DOI: 10.1002/eat.23374] [Citation(s) in RCA: 138] [Impact Index Per Article: 34.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 08/11/2020] [Accepted: 08/11/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The COVID-19 pandemic and the resulting public restrictions pose a psychological burden for humans worldwide and may be particularly detrimental for individuals with mental disorders. Therefore, the current study explored effects of the COVID-19 pandemic on eating disorder (ED) symptoms and other psychological aspects in former inpatients with anorexia nervosa (AN). METHOD One-hundred and fifty-nine patients with AN-discharged from inpatient treatment in 2019-completed an online survey on contact history with COVID-19, changes in ED symptoms and other psychological aspects, health care utilization, and strategies patients employed to cope during the pandemic. RESULTS Approximately 70% of patients reported that eating, shape and weight concerns, drive for physical activity, loneliness, sadness, and inner restlessness increased during the pandemic. Access to in-person psychotherapies and visits at the general practitioner (including weight checks) decreased by 37% and 46%, respectively. Videoconference therapy was used by 26% and telephone contacts by 35% of patients. Patients experienced daily routines, day planning and enjoyable activities as the most helpful among the most used coping strategies. DISCUSSION The COVID-19 pandemic poses great challenges to patients with AN. ED-related thoughts and behaviors may be used as dysfunctional coping mechanisms to regain control over the current circumstances. E-mental health interventions appear to be promising for supporting AN patients during these hard times. Furthermore, interventions addressing symptoms of depression and anxiety, as well as intolerance of uncertainty might help them manage their ED symptoms.
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Affiliation(s)
- Sandra Schlegl
- Department of Psychiatry and PsychotherapyUniversity Hospital, Ludwig‐Maximilians‐UniversityMunichGermany
| | - Julia Maier
- Department of Psychiatry and PsychotherapyUniversity Hospital, Ludwig‐Maximilians‐UniversityMunichGermany
| | - Adrian Meule
- Department of Psychiatry and PsychotherapyUniversity Hospital, Ludwig‐Maximilians‐UniversityMunichGermany,Schoen Clinic RoseneckPrien am ChiemseeGermany
| | - Ulrich Voderholzer
- Department of Psychiatry and PsychotherapyUniversity Hospital, Ludwig‐Maximilians‐UniversityMunichGermany,Schoen Clinic RoseneckPrien am ChiemseeGermany,Department of Psychiatry and PsychotherapyUniversity Hospital of FreiburgGermany
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31
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Linardon J, Rosato J, Messer M. Break Binge Eating: Reach, engagement, and user profile of an Internet-based psychoeducational and self-help platform for eating disorders. Int J Eat Disord 2020; 53:1719-1728. [PMID: 32776693 DOI: 10.1002/eat.23356] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 07/05/2020] [Accepted: 07/05/2020] [Indexed: 01/05/2023]
Abstract
OBJECTIVES Internet-based psychoeducational and self-help platforms hold promise for alleviating existing help-seeking barriers and addressing the unmet needs of people with eating disorders (EDs). In this paper, we report data related to the reach, engagement, and visitor profile of Break Binge Eating, an online platform designed to provide evidence-based information and self-help strategies for people at all stages of an ED. METHOD Two sources of data were presented: (a) usage data from platform visitors generated through Google Analytics; and (b) characteristics of a sample of platform visitors (n = 786). RESULTS In 13 months, approximately 46,311 unique users worldwide have accessed this platform, with usage rates rapidly increasing each month. Most visitors came from organic searches (when ED-related information is directly searched in a browser). Self-help content was the most accessed material, and 81% of the sample stated that their reason for accessing the platform was to get help. Sample visitors were highly symptomatic; 52% met criteria resembling a threshold ED and 87% engaged in at least one ED behavior in the past month. Across different symptomatic subgroups, ∼50% were unsure whether they needed help, ∼80% were not receiving any help, and ∼75% were highly concerned with their symptoms. CONCLUSION This online platform has broad reach and is engaging its intended audience. It is an aim of this platform to improve mental health literacy, facilitate symptom recognition and improvement, and alleviate help-seeking barriers. Evaluating whether this platform is achieving its intended aims in a randomized controlled trial is the next step.
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Affiliation(s)
- Jake Linardon
- School of Psychology, Deakin University, Geelong, Victoria, Australia
| | - John Rosato
- School of Psychology, Deakin University, Geelong, Victoria, Australia
| | - Mariel Messer
- School of Psychology, Deakin University, Geelong, Victoria, Australia
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Fernández-Aranda F, Munguía L, Mestre-Bach G, Steward T, Etxandi M, Baenas I, Granero R, Sánchez I, Ortega E, Andreu A, Moize VL, Fernández-Real JM, Tinahones FJ, Diegüez C, Frühbeck G, Le Grange D, Tchanturia K, Karwautz A, Zeiler M, Favaro A, Claes L, Luyckx K, Shekriladze I, Serrano-Troncoso E, Rangil T, Meler MEL, Soriano-Pacheco J, Carceller-Sindreu M, Bujalance-Arguijo S, Lozano M, Linares R, Gudiol C, Carratala J, Sanchez-Gonzalez J, Machado PP, Håkansson A, Túry F, Pászthy B, Stein D, Papezová H, Bax B, Borisenkov MF, Popov SV, Kim YR, Nakazato M, Godart N, van Voren R, Ilnytska T, Chen J, Rowlands K, Treasure J, Jiménez-Murcia S. COVID Isolation Eating Scale (CIES): Analysis of the impact of confinement in eating disorders and obesity-A collaborative international study. EUROPEAN EATING DISORDERS REVIEW 2020; 28:871-883. [PMID: 32954595 PMCID: PMC7537123 DOI: 10.1002/erv.2784] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 08/04/2020] [Indexed: 02/06/2023]
Abstract
Confinement during the COVID‐19 pandemic is expected to have a serious and complex impact on the mental health of patients with an eating disorder (ED) and of patients with obesity. The present manuscript has the following aims: (1) to analyse the psychometric properties of the COVID Isolation Eating Scale (CIES), (2) to explore changes that occurred due to confinement in eating symptomatology; and (3) to explore the general acceptation of the use of telemedicine during confinement. The sample comprised 121 participants (87 ED patients and 34 patients with obesity) recruited from six different centres. Confirmatory Factor Analyses (CFA) tested the rational‐theoretical structure of the CIES. Adequate goodness‐of‐fit was obtained for the confirmatory factor analysis, and Cronbach alpha values ranged from good to excellent. Regarding the effects of confinement, positive and negative impacts of the confinement depends of the eating disorder subtype. Patients with anorexia nervosa (AN) and with obesity endorsed a positive response to treatment during confinement, no significant changes were found in bulimia nervosa (BN) patients, whereas Other Specified Feeding or Eating Disorder (OSFED) patients endorsed an increase in eating symptomatology and in psychopathology. Furthermore, AN patients expressed the greatest dissatisfaction and accommodation difficulty with remote therapy when compared with the previously provided face‐to‐face therapy. The present study provides empirical evidence on the psychometric robustness of the CIES tool and shows that a negative confinement impact was associated with ED subtype, whereas OSFED patients showed the highest impairment in eating symptomatology and in psychopathology.
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Affiliation(s)
- Fernando Fernández-Aranda
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain.,CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Barcelona, Spain.,Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Lucero Munguía
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain.,Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Gemma Mestre-Bach
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain.,Universidad Internacional de La Rioja, Logroño, La Rioja, Spain
| | - Trevor Steward
- Melbourne School of Psychological Sciences, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Mikel Etxandi
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain
| | - Isabel Baenas
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain.,CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Barcelona, Spain
| | - Roser Granero
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Barcelona, Spain.,Department of Psychobiology and Methodology, School of Psychology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Isabel Sánchez
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain.,CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Barcelona, Spain
| | - Emilio Ortega
- Endocrinology and Nutrition Division, Hospital Clinic and Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Madrid, Spain
| | - Alba Andreu
- Endocrinology and Nutrition Division, Hospital Clinic and Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Spain
| | - Violeta L Moize
- Endocrinology and Nutrition Division, Hospital Clinic and Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Madrid, Spain
| | - Jose M Fernández-Real
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Barcelona, Spain.,Unit of Diabetes, Endocrinology and Nutrition, Hospital de Girona Dr. Josep Trueta and Institut d'Investigació Biomèdica de Girona (IDIBGI), Girona, Spain
| | - Francisco J Tinahones
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Barcelona, Spain.,Department of Endocrinology and Nutrition, Virgen de la Victoria University Hospital and Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
| | - Carlos Diegüez
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Barcelona, Spain.,Department of Physiology, CIMUS, University of Santiago de Compostela-Instituto de Investigación Sanitaria, Santiago de Compostela, Spain
| | - Gema Frühbeck
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Barcelona, Spain.,Metabolic Research Laboratory, Clínica Universidad de Navarra, University of Navarra-IdiSNA, Pamplona, Spain
| | - Daniel Le Grange
- Eating Disorders Program, Department of Psychiatry, University of California, San Francisco, California, USA
| | - Kate Tchanturia
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,D. Uznadze Institute of Psychology, Ilia State University, Tbilisi, Georgia
| | - Andreas Karwautz
- Eating Disorders Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Michael Zeiler
- Eating Disorders Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Angela Favaro
- Department of Neuroscience, University of Padua and Neuroscience Center (PNC), Padua, Italy
| | - Laurence Claes
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium.,Faculty of Medicine and Health Sciences, University Antwerp, Antwerp, Belgium
| | - Koen Luyckx
- Faculty of Medicine and Health Sciences, University Antwerp, Antwerp, Belgium.,UNIBS, University of the Free State, Bloemfontein, South Africa
| | - Ia Shekriladze
- D. Uznadze Institute of Psychology, Ilia State University, Tbilisi, Georgia
| | - Eduardo Serrano-Troncoso
- Child and Adolescent Psychiatry and Psychology Department, Hospital Sant Joan de Déu and Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
| | - Teresa Rangil
- Department of Psychiatry, Germans Trias i Pujol University Hospital-IGTP, Barcelona, Spain.,Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Jose Soriano-Pacheco
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau e Institut d'Investigació Biomèdica Sant Pau (IIB-Sant Pau), Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), ISCIII, Madrid, Spain
| | - Mar Carceller-Sindreu
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau e Institut d'Investigació Biomèdica Sant Pau (IIB-Sant Pau), Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), ISCIII, Madrid, 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
| | - Jordi Carratala
- 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
| | | | - Paulo Pp Machado
- Psychotherapy and Psychopathology Research Unit - Psychology Research Center, School of Psychology, University of Minho, Braga, Portugal
| | - Anders Håkansson
- Department of Clinical Sciences Lund, Psychiatry, Faculty of Medicine, Lund University, Lund, Sweden.,Gambling Disorder Unit, Malmö Addiction Center, Malmö, Sweden
| | - Ferenc Túry
- Institute of Behavioural Sciences, Semmelweis University, Budapest, Hungary
| | - Bea Pászthy
- Institute of Behavioural Sciences, Semmelweis University, Budapest, Hungary.,1st Department of Paediatrics, Semmelweis University, Budapest, Hungary
| | - Daniel Stein
- Safra Children's Hospital, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Hana Papezová
- Department of Psychiatry, 1st Medical Faculty of Charles University, Prague, Czech Republic
| | - Brigita Bax
- Vilnius University Eating Disorders Center, Vilnius, Lithuania
| | - Mikhail F Borisenkov
- Institute of Physiology Komi Science Center UB RAS, Syktyvkar, Russian Federation
| | - Sergey V Popov
- Institute of Physiology Komi Science Center UB RAS, Syktyvkar, Russian Federation
| | - Youl-Ri Kim
- Department of Psychiatry, Seoul Paik Hospital, Inje University, Seoul, South Korea
| | - Michiko Nakazato
- International University of Health and Welfare - Psychiatry, Narita, Japan
| | - Nathalie Godart
- CESP, Univ. Paris-Sud, UVSQ, INSERM U 1178, Université Paris-Saclay [Paris-Saclay University], Villejuif, France.,Department of Psychiatry, Institut Mutualiste Montsouris, School of Medicine, Université Paris Descartes, Paris, France.,UFR des Sciences de la Santé Simone Veil (UVSQ), Praticienne Hospitalière, Fondation Santé des Etudiants de France, Paris, France
| | | | - Tetiana Ilnytska
- Institute of Psychiatry of Taras Shevchenko, National University of Kyiv, Kyiv, Ukraine
| | - Jue Chen
- Department of Clinical Psychology, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Katie Rowlands
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Janet Treasure
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Susana Jiménez-Murcia
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain.,CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Barcelona, Spain.,Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
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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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Rodgers RF, Lombardo C, Cerolini S, Franko DL, Omori M, Fuller‐Tyszkiewicz M, Linardon J, Courtet P, Guillaume S. The impact of the COVID-19 pandemic on eating disorder risk and symptoms. Int J Eat Disord 2020; 53:1166-1170. [PMID: 32476175 PMCID: PMC7300468 DOI: 10.1002/eat.23318] [Citation(s) in RCA: 272] [Impact Index Per Article: 68.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 05/17/2020] [Accepted: 05/17/2020] [Indexed: 12/12/2022]
Abstract
The current COVID-19 pandemic has created a global context likely to increase eating disorder (ED) risk and symptoms, decrease factors that protect against EDs, and exacerbate barriers to care. Three pathways exist by which this pandemic may exacerbate ED risk. One, the disruptions to daily routines and constraints to outdoor activities may increase weight and shape concerns, and negatively impact eating, exercise, and sleeping patterns, which may in turn increase ED risk and symptoms. Relatedly, the pandemic and accompanying social restrictions may deprive individuals of social support and adaptive coping strategies, thereby potentially elevating ED risk and symptoms by removing protective factors. Two, increased exposure to ED-specific or anxiety-provoking media, as well as increased reliance on video conferencing, may increase ED risk and symptoms. Three, fears of contagion may increase ED symptoms specifically related to health concerns, or by the pursuit of restrictive diets focused on increasing immunity. In addition, elevated rates of stress and negative affect due to the pandemic and social isolation may also contribute to increasing risk. Evaluating and assessing these factors are key to better understanding the impact of the pandemic on ED risk and recovery and to inform resource dissemination and targets.
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Affiliation(s)
- Rachel F. Rodgers
- APPEAR, Department of Applied PsychologyNortheastern UniversityBostonMassachusettsUSA,Department of Psychiatric Emergency & Acute Care Lapeyronie Hospital, CHRU MontpellierMontpellierFrance,Department of PsychologySapienza University of RomeRomeItaly
| | | | - Silvia Cerolini
- Department of PsychologySapienza University of RomeRomeItaly
| | - Debra L. Franko
- APPEAR, Department of Applied PsychologyNortheastern UniversityBostonMassachusettsUSA
| | - Mika Omori
- Department of PsychologyOchanomizu UniversityTokyoJapan
| | | | - Jake Linardon
- School of PsychologyDeakin UniversityMelbourneVictoriaAustralia
| | - Philippe Courtet
- Department of Psychiatric Emergency & Acute Care Lapeyronie Hospital, CHRU MontpellierMontpellierFrance
| | - Sebastien Guillaume
- Department of Psychiatric Emergency & Acute Care Lapeyronie Hospital, CHRU MontpellierMontpellierFrance
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Weissman RS, Klump KL, Rose J. Conducting eating disorders research in the time of COVID-19: A survey of researchers in the field. Int J Eat Disord 2020; 53:1171-1181. [PMID: 32449555 PMCID: PMC7280663 DOI: 10.1002/eat.23303] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 05/12/2020] [Indexed: 12/24/2022]
Abstract
The COVID-19 pandemic has impacted research around the globe and required shuttering of research programs and the implementation of procedural adjustments to ensure safety. This study sought to document COVID-19's impact on eating disorders (ED) research, which may be particularly susceptible to such disruptions, given its focus on individuals who are physically and emotionally vulnerable. We invited ED researchers from editorial boards and scientific organizations to complete a quantitative/qualitative survey about: COVID-19's current and future impact on ED research; areas of concern about research disruptions; and effective strategies for conducting and supporting research during and after COVID-19. Among 187 participants, many had moved studies online and/or shutdown part of their research. Across position types (permanent, 52.7%; temporary, 47.3%), participants reported high concern about data collection, recruitment, and securing future funding. Those holding temporary positions reported significantly greater concern about COVID-19's impact on their career and greater stress than participants in permanent positions. Strategies for dealing with research disruptions included: employing technology; reprioritizing goals/tasks; and encouraging collaboration. Results underscore the high levels of stress and disruption caused by COVID-19. We echo calls by our respondents for support for early career scholars and advocacy for additional resources for research and scientists.
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Affiliation(s)
| | - Kelly L. Klump
- Department of PsychologyMichigan State UniversityLansingMichiganUSA
| | - Jennifer Rose
- Department of PsychologyWesleyan UniversityMiddletownConnecticutUSA
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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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