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Kim YR, An Z, Han SW, Ko JK, Hwa Kwag K. Recovery-focused self-help intervention using vodcasts for patients with personality disorder: feasibility randomised controlled trial. BJPsych Open 2024; 10:e31. [PMID: 38229480 PMCID: PMC10897696 DOI: 10.1192/bjo.2023.647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 11/23/2023] [Accepted: 12/14/2023] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND Availability of long-term psychological interventions for personality disorders is limited because of their high intensity and cost. Research in evidence-based, low-intensity interventions is needed. AIMS This study aimed to examine the feasibility, acceptability and potential impact of a low-intensity, digital guided self-help (GSH) intervention that is focused on emotion regulation, recovery-oriented and provides in-the-moment delivery for patients with personality disorders. METHOD We conducted a single-blind feasibility trial. A total of 43 patients with a personality disorder were recruited and randomly assigned to either a GSH arm (n = 22) or a treatment-as-usual arm (n = 21). The GSH intervention included a series of short videos offering psychoeducation and support, personalised feedback using text messages, and supportive telephone calls, for 4 weeks in addition to treatment as usual. Outcomes of emotional disturbance, emotion dysregulation, self-harm behaviours and decentring ability were measured at baseline, 4 weeks (end of intervention) and 8 weeks (follow-up). RESULTS All patients who attended the first session continued until the last session. There was an interaction effect between time and group on anxiety (P = 0.027, Δη2 = 0.10), where the GSH group showed a significant reduction in anxiety at follow-up (P = 0.003, d = 0.25). The GSH group increased in decentring ability at the end of intervention (P = 0.007, d = -0.65), and the decrease in self-harm behaviours continued until follow-up (P = 0.02, d = 0.57). CONCLUSIONS The results suggest that a personalised digital GSH with a focus on recovery could reduce anxiety and self-harm behaviours at short-term follow-up.
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Affiliation(s)
- Youl-Ri Kim
- Institute of Eating Disorders and Mental Health, Inje University, South Korea; and Department of Psychiatry, Ilsan Paik Hospital, Inje University, South Korea
| | - Zhen An
- Institute of Eating Disorders and Mental Health, Inje University, South Korea
| | - Soo Wan Han
- Institute of Eating Disorders and Mental Health, Inje University, South Korea
| | - Jeong Kyung Ko
- Institute of Eating Disorders and Mental Health, Inje University, South Korea
| | - Kyung Hwa Kwag
- Institute of Eating Disorders and Mental Health, Inje University, South Korea
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Albano G, Salerno L, Cardi V, Brockmeyer T, Ambwani S, Treasure J, Lo Coco G. Patient and mentor language style matching as a predictor of working alliance, engagement with treatment as usual, and eating disorders symptoms over the course of an online guided self-help intervention for anorexia nervosa. EUROPEAN EATING DISORDERS REVIEW 2023; 31:135-146. [PMID: 35983983 PMCID: PMC10087304 DOI: 10.1002/erv.2948] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 06/29/2022] [Accepted: 08/07/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The aim of this study was to examine the processes involved in a guided self-help (GSH) pre-treatment intervention (RecoveryMANTRA) for patients with anorexia nervosa (AN), by measuring the levels of patient/mentor Language Style Matching (LSM). RecoveryMANTRA was supported by student mentors or peer mentors (recovered individuals) over six weekly chat-based sessions. We examined whether LSM during RecoveryMANTRA predicted patients'working alliance with the clinic therapist, motivation, eating disorder (ED) and general psychopathology. A further aim was to examine differences in LSM between student mentors and peer mentors. METHOD 87 AN adults received RecoveryMANTRA plus treatment as usual. The LSM algorithm was used to calculate verbal attunement between patient and mentor. Participants were assessed at baseline and at the end of the intervention. RESULTS Both early (1st session) and late (6th session) LSM predicted higher working alliance with the clinic therapist. Moreover, late LSM predicted lower EDs symptoms at the end of the RecoveryMANTRA intervention. Patient/peer mentor dyads showed higher late verbal attunement than patient/student mentor dyads. CONCLUSIONS These findings suggests that in the early phase of treatment relational aspects can impact on engagement with treatment. Verbal attunement in a GSH for AN is associated with working alliance and better clinical outcome.
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Affiliation(s)
- Gaia Albano
- Department of Psychology, Educational Science and Human Movement, University of Palermo, Palermo, Italy
| | - Laura Salerno
- Department of Psychology, Educational Science and Human Movement, University of Palermo, Palermo, Italy
| | - Valentina Cardi
- Department of Psychological Medicine, King's College London, London, UK.,Department of General Psychology, University of Padova, Padova, Italy
| | - Timo Brockmeyer
- Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Suman Ambwani
- Department of Psychology, Dickinson College, Carlisle, Pennsylvania, USA
| | - Janet Treasure
- Department of Psychological Medicine, King's College London, London, UK
| | - Gianluca Lo Coco
- Department of Psychology, Educational Science and Human Movement, University of Palermo, Palermo, Italy
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Yakın E, Raynal P, Chabrol H. Distinguishing between healthy and pathological orthorexia: a cluster analytic study. Eat Weight Disord 2022; 27:325-334. [PMID: 33826119 DOI: 10.1007/s40519-021-01178-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 03/22/2021] [Indexed: 02/07/2023] Open
Abstract
PURPOSE This study represents a first attempt to explore the typology of female adults from a large non-clinical sample based on healthy orthorexia (HO) and pathological orthorexia (orthorexia nervosa, ON). METHODS 1245 female adults (Mage = 38.04, SD = 9.73) completed a set of questionnaires assessing orthorexic behaviors, intuitive eating, self-esteem, perceived social support as well as eating disorders, depressive and anxiety symptoms. RESULTS Cluster analysis based on HO and ON scores yielded 4 distinct groups: "Healthy orthorexia cluster" (HO), "Orthorexia Nervosa cluster" (ON), "Low Orthorexia cluster" (LO) and "In-between Orthorexia cluster" (IBO). The HO and ON clusters represented individuals with, respectively, healthy and pathological interest in healthy diet. The LO cluster represented those with no particular interest in healthy eating and the IBO cluster showed that ON and HO behaviors can be associated in some individuals. Among all clusters, the ON cluster displayed highest levels of ED, anxiety and depressive symptoms. Inversely, the HO cluster displayed highest levels of intuitive eating, self-esteem and perceived social support. CONCLUSION Altogether, findings from this study support the bidimensional structure of orthorexic eating behavior and further suggest that ON and HO behaviors can be associated in some individuals. Our findings further provide evidence for the assumption that ON and HO could be seen, respectively, as maladaptive and protective eating behaviors. LEVEL OF EVIDENCE V, descriptive study.
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Affiliation(s)
- Ecem Yakın
- Centre d'Etudes et de Recherches en Psychopathologie et Psychologie de la Santé, Université de Toulouse-Jean Jaurès, UT2J, 5 allées Antonio Machado, 31058, Toulouse, France.
| | - Patrick Raynal
- Centre d'Etudes et de Recherches en Psychopathologie et Psychologie de la Santé, Université de Toulouse-Jean Jaurès, UT2J, 5 allées Antonio Machado, 31058, Toulouse, France
| | - Henri Chabrol
- Centre d'Etudes et de Recherches en Psychopathologie et Psychologie de la Santé, Université de Toulouse-Jean Jaurès, UT2J, 5 allées Antonio Machado, 31058, Toulouse, France
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4
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Barakat S, Maguire S, Smith KE, Mason TB, Crosby RD, Touyz S. Evaluating the role of digital intervention design in treatment outcomes and adherence to eTherapy programs for eating disorders: A systematic review and meta-analysis. Int J Eat Disord 2019; 52:1077-1094. [PMID: 31328815 DOI: 10.1002/eat.23131] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 06/14/2019] [Accepted: 06/19/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Despite the existence of reviews which document the effectiveness of online therapies, there is little consensus regarding the exact components of online treatment delivery that are most effective in maintaining user engagement and reducing eating disorder (ED) symptomology. The current review and meta-analysis aimed to determine which components of web-based, ED self-help interventions are associated with lower attrition and improved therapeutic outcome. METHOD A systematic search of electronic databases (PsycINFO, Medline, Web of Science, Scopus) was conducted for published studies of web-based interventions for EDs and a meta-analysis of the final included studies was performed. Each intervention was coded across four dimensions, including the multimedia channels employed (e.g., text, audio, videos), degree of user interactivity (e.g., online self-monitoring, skills exercises), level of automated feedback (e.g., reminders, personalized feedback), and technological device through which the program was accessed (e.g., smartphone, computer). RESULTS A final 23 papers were included. The results of meta-regressions indicated that higher scores on the multimedia subscale were associated with greater ED symptom improvement in treatment groups. Conversely, a higher degree of feedback in the treatment group was associated with a group difference in ED psychopathology favoring the control group. Other intervention components were not associated with treatment outcome or dropout. DISCUSSION The results are discussed in relation to limitations of the scale used to quantify digital intervention features, as well as the limited diversity and technological sophistication of available ED digital interventions. Such findings indicate the importance of understanding the digital components, which differentiate online therapeutic programs.
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Affiliation(s)
- Sarah Barakat
- School of Psychology, University of Sydney, Sydney, New South Wales, Australia
| | - Sarah Maguire
- InsideOut Institute for Eating Disorders, Boden Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Kathryn E Smith
- Center for Bio-behavioral Research, Sanford Research, Fargo, North Dakota.,Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota
| | - Tyler B Mason
- Department of Preventive Medicine, University of Southern California, Los Angeles, California
| | - Ross D Crosby
- Center for Bio-behavioral Research, Sanford Research, Fargo, North Dakota.,Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota
| | - Stephen Touyz
- School of Psychology, University of Sydney, Sydney, New South Wales, Australia
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Albano G, Hodsoll J, Kan C, Lo Coco G, Cardi V. Task-sharing interventions for patients with anorexia nervosa or their carers: a systematic evaluation of the literature and meta-analysis of outcomes. Int Rev Psychiatry 2019; 31:367-381. [PMID: 30950660 DOI: 10.1080/09540261.2019.1588711] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The eating disorder clinical and scientific community advocates for the use of a shared approach to healthcare that actively involves patients and carers. A systematic review of the literature on guided self-help or self-help in anorexia nervosa (targeting either the individual affected by the illness or their carers) and meta-analyses of studies using randomised controlled designs for the evaluation of the outcomes: (1) drop-out from end-of-treatment assessment, (2) body mass index (BMI), (3) anxiety, (4) depression and (5) quality of life, were undertaken. Guided self-help was directed to patients in 15 studies and to carers in seven studies. The interventions were based on a variety of theoretical models, used different formats (books and digital materials), and were delivered by individuals with a range of experiences and expertise (e.g. individuals with lived experience of the illness, graduate students, or clinically trained professionals). Guided self-help was associated with significantly lower drop-out from the completion of end-of-treatment assessments compared to a control condition. There was an improvement in carers' wellbeing from skill-sharing interventions. Guided self-help may facilitate patients' treatment engagement and also improve carers' wellbeing.
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Affiliation(s)
- Gaia Albano
- a Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience , King's College London , London , UK.,b Department of Psychology Educational Science and Human Movement , University of Palermo , Palermo , Italy
| | - John Hodsoll
- c Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience , King's College London , London , UK
| | - Carol Kan
- a Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience , King's College London , London , UK
| | - Gianluca Lo Coco
- b Department of Psychology Educational Science and Human Movement , University of Palermo , Palermo , Italy
| | - Valentina Cardi
- a Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience , King's College London , London , UK
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Kim YR, Cardi V, Lee GY, An S, Kim J, Kwon G, Kim JW, Eom JS, Treasure J. Mobile Self-Help Interventions as Augmentation Therapy for Patients with Anorexia Nervosa. Telemed J E Health 2018; 25:740-747. [PMID: 30325700 DOI: 10.1089/tmj.2018.0180] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Background: It has been suggested that patients with anorexia nervosa (AN) who are resistant to first-line treatment would benefit from second-level interventions targeting specific features, an adaptive form of intervention. Guided self-help programs administered via mobile technology have the dual focus of instigating behavior change and managing anxiety associated with eating disorders in the moment and in users' naturalistic environments. Introduction: We evaluated the feasibility, acceptability, and preliminary augmentative effects of mobile-based, guided self-help interventions (Recovery vodcasts) after initial unsuccessful first-line treatments for patients with AN. Materials and Methods: Patients with AN who were unsuccessful in their treatments were recruited to access Recovery vodcasts as augmentation treatment for 3 weeks in Korea. Acceptability and feasibility of the intervention were evaluated, and qualitative feedback was collected. Preliminary treatment effects of adding the Recovery vodcasts were assessed, including eating disorder pathology, anxiety and depression symptoms, and body mass index. Results: The Recovery vodcasts were acceptable for patients with AN. The patients' psychopathologies of eating disorders improved with augmentation of the vodcasts in their first-line treatments. In addition, there was a tendency toward improvement of affective symptoms. The participants' feedback suggested that the intervention could be improved. Conclusions: The study demonstrated that the Recovery vodcasts were well accepted by Korean patients with AN. Moreover, augmentation of the Recovery vodcasts could facilitate improvements in psychopathology of eating disorders, anxiety, and mood symptoms for patients with AN.
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Affiliation(s)
- Youl-Ri Kim
- 1Department of Neuropsychiatry, Seoul Paik Hospital, Inje University, Seoul, South Korea.,2Institute of Eating Disorders and Mental Health, Inje University, Seoul, South Korea
| | - Valentina Cardi
- 3Section of Eating Disorders, Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
| | - Gi Young Lee
- 2Institute of Eating Disorders and Mental Health, Inje University, Seoul, South Korea
| | - Sohyun An
- 2Institute of Eating Disorders and Mental Health, Inje University, Seoul, South Korea
| | - Jione Kim
- 2Institute of Eating Disorders and Mental Health, Inje University, Seoul, South Korea
| | - Gemma Kwon
- 2Institute of Eating Disorders and Mental Health, Inje University, Seoul, South Korea
| | - Jong Won Kim
- 4Department of Healthcare Information Technology, Inje University, Gimhae, South Korea
| | - Jin-Sup Eom
- 5Department of Psychology, Chungbuk National University, Cheongju, South Korea
| | - Janet Treasure
- 3Section of Eating Disorders, Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
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Anastasiadou D, Folkvord F, Lupiañez-Villanueva F. A systematic review of mHealth interventions for the support of eating disorders. EUROPEAN EATING DISORDERS REVIEW 2018; 26:394-416. [DOI: 10.1002/erv.2609] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 05/09/2018] [Accepted: 05/12/2018] [Indexed: 12/15/2022]
Affiliation(s)
- Dimitra Anastasiadou
- Department of Information and Communication Sciences; Universitat Oberta de Catalunya; Barcelona Spain
- Open Evidence Research; Universitat Oberta de Catalunya; Barcelona Spain
| | - Frans Folkvord
- Department of Information and Communication Sciences; Universitat Oberta de Catalunya; Barcelona Spain
- Open Evidence Research; Universitat Oberta de Catalunya; Barcelona Spain
- Behavioural Science Institute; Radboud University; Nijmegen The Netherlands
- Communication Science Department; Amsterdam University; Amsterdam The Netherlands
| | - Francisco Lupiañez-Villanueva
- Department of Information and Communication Sciences; Universitat Oberta de Catalunya; Barcelona Spain
- Open Evidence Research; Universitat Oberta de Catalunya; Barcelona Spain
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8
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Kolar DR, Hammerle F, Jenetzky E, Huss M. Smartphone-Enhanced Low-Threshold Intervention for adolescents with Anorexia Nervosa (SELTIAN) waiting for outpatient psychotherapy: study protocol of a randomised controlled trial. BMJ Open 2017; 7:e018049. [PMID: 29061627 PMCID: PMC5665307 DOI: 10.1136/bmjopen-2017-018049] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION As smartphones are widely distributed nowadays, mental health apps seem to be a promising treatment tool. First self-help apps for eating disorders have been developed recently. However, studies assessing the efficacy of such apps are scarce. A smartphone app could prevent further weight reduction and increase commitment during waiting time for outpatient treatment, especially for adolescents with anorexia nervosa (AN). In this study protocol, a randomised controlled trial to assess the efficacy of a smartphone-enhanced low-threshold intervention for AN during waiting time is described. METHODS AND ANALYSIS 30 adolescents with AN aged 12-19 years will be recruited at three child and adolescent psychiatry centres in Germany. All participants will be randomised to consultations only or consultations and the use of the Jourvie Research app. The app will be installed either on their own smartphone or on a research device. The participants will receive biweekly to monthly consultations for 3 months to review meal plans and weight management with a clinician. In addition, the Jourvie Research app for meal, behaviour and emotion protocolling will be provided to the intervention group. The protocols will be discussed with a clinician during the consultations. Dialectical behaviour therapy-informed skills for tension regulation to increase compliance with the meal plan will be taught in the intervention group and the app will remind the participant of a skill in a moment of need. The primary outcome is the age-adjusted and height-adjusted weight gain in standard deviation score after 3 months. ETHICS AND DISSEMINATION Results will be disseminated at conferences and through peer-reviewed publications. The trial was approved by the ethics review board of the local medical association, Mainz, Germany, under the reference number 837.338.15. TRIAL REGISTRATION NUMBER German clinical trials register, reference number DRKS00008946.
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Affiliation(s)
- David R Kolar
- Department of Child and Adolescent Psychiatry, University Medicine Mainz, Mainz, Germany
| | - Florian Hammerle
- Department of Child and Adolescent Psychiatry, University Medicine Mainz, Mainz, Germany
| | - Ekkehart Jenetzky
- Department of Child and Adolescent Psychiatry, University Medicine Mainz, Mainz, Germany
| | - Michael Huss
- Department of Child and Adolescent Psychiatry, University Medicine Mainz, Mainz, Germany
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9
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Tang W, Kreindler D. Supporting Homework Compliance in Cognitive Behavioural Therapy: Essential Features of Mobile Apps. JMIR Ment Health 2017; 4:e20. [PMID: 28596145 PMCID: PMC5481663 DOI: 10.2196/mental.5283] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 06/02/2016] [Accepted: 02/15/2017] [Indexed: 11/16/2022] Open
Abstract
Cognitive behavioral therapy (CBT) is one of the most effective psychotherapy modalities used to treat depression and anxiety disorders. Homework is an integral component of CBT, but homework compliance in CBT remains problematic in real-life practice. The popularization of the mobile phone with app capabilities (smartphone) presents a unique opportunity to enhance CBT homework compliance; however, there are no guidelines for designing mobile phone apps created for this purpose. Existing literature suggests 6 essential features of an optimal mobile app for maximizing CBT homework compliance: (1) therapy congruency, (2) fostering learning, (3) guiding therapy, (4) connection building, (5) emphasis on completion, and (6) population specificity. We expect that a well-designed mobile app incorporating these features should result in improved homework compliance and better outcomes for its users.
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Affiliation(s)
- Wei Tang
- Discipline of Psychiatry, Department of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - David Kreindler
- Division of Youth Psychiatry, Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Centre for Mobile Computing in Mental Health, Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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10
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Abstract
PURPOSE OF REVIEW The objective of this paper is to review the role that hedonic factors, emotions and self-regulation systems have over eating behaviours from animal models to humans. RECENT FINDINGS Evidence has been found to suggest that for some high-risk individuals, obesity/binge eating may develop as an impulsive reaction to negative emotions that over time becomes a compulsive habit. Animal models highlight the neural mechanisms that might underlie this process and suggest similarities with substance use disorders. Emotional difficulties and neurobiological factors have a role in the aetiology of eating and weight disorders. Precise treatments targeted at these mechanisms may be of help for people who have difficulties with compulsive overeating.
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Affiliation(s)
- Robert Turton
- Department of Psychological Medicine, Section of Eating Disorders, King's College London, Institute of Psychiatry, Psychology and Neuroscience, 103 Denmark Hill, London, SE5 8AZ, UK.
| | - Rayane Chami
- Department of Psychological Medicine, Section of Eating Disorders, King's College London, Institute of Psychiatry, Psychology and Neuroscience, 103 Denmark Hill, London, SE5 8AZ, UK
| | - Janet Treasure
- Department of Psychological Medicine, Section of Eating Disorders, King's College London, Institute of Psychiatry, Psychology and Neuroscience, 103 Denmark Hill, London, SE5 8AZ, UK
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11
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Selbsthilfe in der Behandlung von Essstörungen. PSYCHOTHERAPEUT 2017. [DOI: 10.1007/s00278-017-0189-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Aardoom JJ, Dingemans AE, Van Furth EF. E-Health Interventions for Eating Disorders: Emerging Findings, Issues, and Opportunities. Curr Psychiatry Rep 2016; 18:42. [PMID: 26946513 DOI: 10.1007/s11920-016-0673-6] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
This study aimed to review the emerging findings regarding E-health interventions for eating disorders and to critically discuss emerging issues as well as challenges for future research. Internet-based cognitive behavioral therapy and guided self-help have demonstrated promising results in terms of reducing eating disorder psychopathology. Emerging findings also suggest that E-health interventions reach an underserved population and improve access to care. The use of smartphone applications is becoming increasingly popular and has much potential although their clinical utility and effectiveness is presently unknown and requires investigation. Important challenges include the diagnostic process in E-health interventions, the optimization of E-health within existing health care models, and the investigation and implementation of blended care. More high-quality research is needed to bring the field forward and to determine the place for E-health in our health care service delivery systems.
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Affiliation(s)
- Jiska J Aardoom
- Rivierduinen Eating Disorders Ursula, P.O. Box 549, 2300 AM, Leiden, The Netherlands.
| | - Alexandra E Dingemans
- Rivierduinen Eating Disorders Ursula, P.O. Box 549, 2300 AM, Leiden, The Netherlands.
| | - Eric F Van Furth
- Rivierduinen Eating Disorders Ursula, P.O. Box 549, 2300 AM, Leiden, The Netherlands. .,Department of Psychiatry, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
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13
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Cardi V, Ambwani S, Crosby R, Macdonald P, Todd G, Park J, Moss S, Schmidt U, Treasure J. Self-Help And Recovery guide for Eating Disorders (SHARED): study protocol for a randomized controlled trial. Trials 2015; 16:165. [PMID: 25885697 PMCID: PMC4435653 DOI: 10.1186/s13063-015-0701-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 04/01/2015] [Indexed: 02/07/2023] Open
Abstract
Background We describe the theoretical rationale and protocol for Self-Help And Recovery guide for Eating Disorders (SHARED), a trial investigating whether a guided self-care intervention (Recovery MANTRA) is a useful addition to treatment as usual for individuals with anorexia nervosa. Recovery MANTRA, a 6-week self-care intervention supplemented by peer mentorship, is a module extension of the Maudsley Model of Treatment for Adults with Anorexia Nervosa and targets the maintenance factors identified by the cognitive-interpersonal model of the illness. Methods Patients accessing outpatient services for anorexia nervosa are randomized to either treatment as usual or treatment as usual plus Recovery MANTRA. Outcome variables include change in body weight at the end of the intervention (primary) and changes in body weight and eating disorder symptoms at immediate and extended follow-up (6-months; secondary). Change is also assessed for the domains identified by the theoretical model, including motivation, hope, confidence to change, positive mood, cognitive flexibility, therapeutic alliance and social adjustment. Feedback from peer mentors is gathered to understand the impact on their own well-being of providing guidance. Discussion Results from this exploratory investigation will determine whether a larger clinical trial is justifiable and feasible for this affordable intervention, which has potential for high reach and scalability. Trial registration ClinicalTrials.gov NCT02336841.
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Affiliation(s)
- Valentina Cardi
- King's College London, Institute of Psychiatry, Psychological Medicine, Section of Eating Disorders, The Basement, P059, 103 Denmark Hill, London, SE5 8AF, UK.
| | - Suman Ambwani
- Department of Psychology, Dickinson College, P.O. Box 1773, Carlisle, PA, 17013, USA.
| | - Ross Crosby
- Neuropsychiatric Research Institute, 700 First Ave. South, Fargo, ND, 58103, USA.
| | - Pamela Macdonald
- King's College London, Institute of Psychiatry, Psychological Medicine, Section of Eating Disorders, The Basement, P059, 103 Denmark Hill, London, SE5 8AF, UK.
| | - Gill Todd
- King's College London, Institute of Psychiatry, Psychological Medicine, Section of Eating Disorders, The Basement, P059, 103 Denmark Hill, London, SE5 8AF, UK.
| | - Jinhong Park
- Department of Psychology, Carleton College, 1 N. College St., Northfield, MN, 55057, USA.
| | - Sara Moss
- King's College London, Institute of Psychiatry, Psychological Medicine, Section of Eating Disorders, The Basement, P059, 103 Denmark Hill, London, SE5 8AF, UK.
| | - Ulrike Schmidt
- King's College London, Institute of Psychiatry, Psychological Medicine, Section of Eating Disorders, The Basement, P059, 103 Denmark Hill, London, SE5 8AF, UK.
| | - Janet Treasure
- King's College London, Institute of Psychiatry, Psychological Medicine, Section of Eating Disorders, The Basement, P059, 103 Denmark Hill, London, SE5 8AF, UK.
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14
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Schlegl S, Bürger C, Schmidt L, Herbst N, Voderholzer U. The potential of technology-based psychological interventions for anorexia and bulimia nervosa: a systematic review and recommendations for future research. J Med Internet Res 2015; 17:e85. [PMID: 25840591 PMCID: PMC4397416 DOI: 10.2196/jmir.3554] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2014] [Revised: 09/28/2014] [Accepted: 10/20/2014] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Previous studies have shown an unmet need in the treatment of eating disorders. In the last decade, interest in technology-based interventions (TBIs) (including computer- and Internet-based interventions [CBIs] or mobile interventions) for providing evidence-based therapies to individuals with different mental disorders has increased. OBJECTIVE The aim of this review was to systematically evaluate the potential of TBIs in the field of eating disorders, namely for anorexia nervosa (AN) and bulimia nervosa (BN), for both prevention and treatment, and also for carers of eating disorder patients. METHODS A systematic literature search was conducted using Medline and PsycINFO. Bibliographies of retrieved articles were also reviewed without date or study type restrictions. RESULTS Forty studies resulting in 45 publications reporting outcomes fulfilled the inclusion criteria: 22 randomized controlled trials, 2 controlled studies, and 16 uncontrolled studies. In total, 3646 patients were included. Overall, the studies provided evidence for the efficacy of guided CBIs, especially for BN patients and for compliant patients. Furthermore, videoconferencing also appeared to be a promising approach. Evaluation results of Internet-based prevention of eating disorders and Internet-based programs for carers of eating disorder patients were also encouraging. Finally, there was preliminary evidence for the efficacy of mobile interventions. CONCLUSIONS TBIs may be an additional way of delivering evidence-based treatments to eating disorder patients and their use is likely to increase in the near future. TBIs may also be considered for the prevention of eating disorders and to support carers of eating disorder patients. Areas of future research and important issues such as guidance, therapeutic alliance, and dissemination are discussed.
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Affiliation(s)
- Sandra Schlegl
- Department of Psychiatry and Psychotherapy, University of Munich, München, Germany.
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15
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Boggiano MM, Burgess EE, Turan B, Soleymani T, Daniel S, Vinson LD, Lokken KL, Wingo BC, Morse A. Motives for eating tasty foods associated with binge-eating. Results from a student and a weight-loss seeking population. Appetite 2014; 83:160-166. [PMID: 25169880 PMCID: PMC4962333 DOI: 10.1016/j.appet.2014.08.026] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 07/01/2014] [Accepted: 08/20/2014] [Indexed: 12/18/2022]
Abstract
The aim of this study was to use the Palatable Eating Motives Scale (PEMS) to determine if and what motives for eating tasty foods (e.g., junk food, fast food, and desserts) are associated with binge-eating in two diverse populations. BMI and scores on the PEMS, Yale Food Addiction Scale (YFAS), and Binge-eating Scale (BES) were obtained from 247 undergraduates at the University of Alabama at Birmingham (UAB) and 249 weight-loss seeking patients at the UAB EatRight program. Regression analyses revealed that eating tasty foods to forget worries and problems and help alleviate negative feelings (i.e., the 4-item Coping motive) was associated with binge-eating independently of any variance in BES scores due to sex, age, ethnicity, BMI, other PEMS motives, and YFAS scores in both students (R² = .57) and patients (R² = .55). Coping also was associated with higher BMI in students (p < 0.01), and in patients despite their truncated BMI range (p < 0.05). Among students, the motives Conformity and Reward Enhancement were also independently associated with binge-eating. For this younger sample with a greater range of BES scores, eating for these motives, but not for Social ones, may indicate early maladaptive eating habits that could later develop into disorders characterized by binge-eating if predisposing factors are present. Thus, identifying one's tasty food motive or motives can potentially be used to thwart the development of BED and obesity, especially if the motive is Coping. Identifying one's PEMS motives should also help personalize conventional treatments for binge-eating and obesity toward improved outcomes.
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Affiliation(s)
- M M Boggiano
- Department of Psychology, University of Alabama at Birmingham, USA.
| | - E E Burgess
- Department of Psychology, University of Alabama at Birmingham, USA
| | - B Turan
- Department of Psychology, University of Alabama at Birmingham, USA
| | - T Soleymani
- Department of Nutrition Sciences, University of Alabama at Birmingham, USA
| | - S Daniel
- Department of Nutrition Sciences, University of Alabama at Birmingham, USA
| | - L D Vinson
- Department of Nutrition Sciences, University of Alabama at Birmingham, USA
| | - K L Lokken
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, USA
| | - B C Wingo
- Department of Nutrition Sciences, University of Alabama at Birmingham, USA
| | - A Morse
- Department of Psychology, University of Alabama at Birmingham, USA
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Arcelus J, Witcomb GL, Mitchell A. Prevalence of eating disorders amongst dancers: a systemic review and meta-analysis. EUROPEAN EATING DISORDERS REVIEW 2014; 22:92-101. [PMID: 24277724 DOI: 10.1002/erv.2271] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Revised: 10/21/2013] [Accepted: 10/22/2013] [Indexed: 11/12/2022]
Abstract
Eating disorders in dancers are thought to be common, but the exact rates remain to be clarified. The aim of this study is to systematically compile and analyse the rates of eating disorders in dancers. A literature search, appraisal and meta-analysis were conducted. Thirty-three relevant studies were published between 1966 and 2013 with sufficient data for extraction. Primary data were extracted as raw numbers or confidence intervals. Risk ratios and 95% confidence intervals were calculated for controlled studies. The overall prevalence of eating disorders was 12.0% (16.4% for ballet dancers), 2.0% (4% for ballet dancers) for anorexia, 4.4% (2% for ballet dancers) for bulimia and 9.5% (14.9% for ballet dancers) for eating disorders not otherwise specified (EDNOS). The dancer group had higher mean scores on the EAT-26 and the Eating Disorder Inventory subscales. Dancers, in general, had a higher risk of suffering from eating disorders in general, anorexia nervosa and EDNOS, but no higher risk of suffering from bulimia nervosa. The study concluded that as dancers had a three times higher risk of suffering from eating disorders, particularly anorexia nervosa and EDNOS, specifically designed services for this population should be considered.
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Affiliation(s)
- Jon Arcelus
- Loughborough University Centre for Research into Eating Disorders (LUCRED), Loughborough University, Loughborough, Leicestershire, UK; Eating Disorders Service, Leicester Partnership Trust, Bennion Centre, Leicester Glenfield Hospital, Leicester, UK
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