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Carrière K, Siemers N, Thapar S, Knäuper B. Proof-of-concept testing of a mobile application-delivered mindfulness exercise for emotional eaters: RAIN delivered as a step-by-step image sequence. Mhealth 2024; 10:24. [PMID: 39114459 PMCID: PMC11304094 DOI: 10.21037/mhealth-23-56] [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: 09/25/2023] [Accepted: 03/05/2024] [Indexed: 08/10/2024] Open
Abstract
Background Over fifty percent of individuals with overweight and obesity are emotional eaters. Emotional eating can be theorized as a conditioned response to eat for reasons that are not associated with physiological hunger. We conducted this proof-of-concept study to gather evidence that a mobile app that delivers a common non-meditative mindfulness exercise called RAIN, in a step-by-step image sequence can improve emotional eating and other outcomes over a 3-week period. Methods Forty-nine Canadian adults who self reported as emotional eaters (mean age =30.7 years) were recruited through social media and participated in a workshop in which RAIN and its use on the app were introduced. Participants were asked to use the app every time that they experienced a non-homeostatic craving to eat for three weeks. Emotional eating, reactivity to food cravings, perceived loss of control around food, distress tolerance, and eating-specific mindfulness were assessed pre- and post-intervention. Results Improvements on all outcomes were found (r-range, -0.58 to -0.28). The feasibility of the mobile application was demonstrated by a low attrition rate (8%), high user satisfaction, and strong app engagement metrics. Conclusions The data provide proof-of-concept evidence that a mobile app that delivers a mindfulness exercise in a step-by-step image sequence has potential to be effective and thus identifies a new approach that may reduce emotional eating in an accessible and affordable manner.
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Affiliation(s)
- Kimberly Carrière
- Department of Psychology, Faculty of Science, McGill University, Montreal, QC, Canada
- Division of Gastroenterology and Hepatology, Faculty of Medicine, McGill University, Montreal, QC, Canada
- Department of Health, Kinesiology, and Applied Physiology, Concordia University, Montreal, QC, Canada
| | - Nellie Siemers
- Department of Psychology, Faculty of Science, McGill University, Montreal, QC, Canada
| | - Serena Thapar
- Department of Psychology, Faculty of Science, McGill University, Montreal, QC, Canada
| | - Bärbel Knäuper
- Department of Psychology, Faculty of Science, McGill University, Montreal, QC, Canada
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2
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El Sherbini A, Rosenson RS, Al Rifai M, Virk HUH, Wang Z, Virani S, Glicksberg BS, Lavie CJ, Krittanawong C. Artificial intelligence in preventive cardiology. Prog Cardiovasc Dis 2024; 84:76-89. [PMID: 38460897 DOI: 10.1016/j.pcad.2024.03.002] [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: 03/03/2024] [Accepted: 03/03/2024] [Indexed: 03/11/2024]
Abstract
Artificial intelligence (AI) is a field of study that strives to replicate aspects of human intelligence into machines. Preventive cardiology, a subspeciality of cardiovascular (CV) medicine, aims to target and mitigate known risk factors for CV disease (CVD). AI's integration into preventive cardiology may introduce novel treatment interventions and AI-centered clinician assistive tools to reduce the risk of CVD. AI's role in nutrition, weight loss, physical activity, sleep hygiene, blood pressure, dyslipidemia, smoking, alcohol, recreational drugs, and mental health has been investigated. AI has immense potential to be used for the screening, detection, and monitoring of the mentioned risk factors. However, the current literature must be supplemented with future clinical trials to evaluate the capabilities of AI interventions for preventive cardiology. This review discusses present examples, potentials, and limitations of AI's role for the primary and secondary prevention of CVD.
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Affiliation(s)
- Adham El Sherbini
- Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | - Robert S Rosenson
- Cardiometabolics Unit, Mount Sinai Hospital, Mount Sinai Heart, NY, United States of America
| | - Mahmoud Al Rifai
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, United States of America
| | - Hafeez Ul Hassan Virk
- Harrington Heart & Vascular Institute, Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, OH, United States of America
| | - Zhen Wang
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, United States of America; Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, United States of America
| | - Salim Virani
- Section of Cardiology, The Aga Khan University, Texas Heart Institute, Baylor College of Medicine, Houston, TX, United States of America
| | - Benjamin S Glicksberg
- The Hasso Plattner Institute for Digital Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA, USA
| | - Chayakrit Krittanawong
- Cardiology Division, NYU Langone Health and NYU School of Medicine, New York, NY, United States of America.
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Reilly EE, Gorrell S, Johnson C, Duffy A, Blalock DV, Mehler P, Johnson M, Le Grange D, Rienecke RD. Characterising use of recovery record among a large, transdiagnostic sample of adults with eating disorders across higher levels of care. EUROPEAN EATING DISORDERS REVIEW 2024; 32:404-416. [PMID: 37997259 PMCID: PMC10994750 DOI: 10.1002/erv.3053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 10/13/2023] [Accepted: 11/13/2023] [Indexed: 11/25/2023]
Abstract
OBJECTIVE Smartphone applications (i.e., apps) designed to target mental health symptoms have received increasing public and empirical attention, including in eating disorder|eating disorders (EDs) treatment. While some data have begun to characterise app users in non-controlled settings, there is limited information on use of apps in higher levels of care (e.g., partial hospitalisation or residential treatment programs) for EDs. METHOD This study aimed to explore metrics of use while in treatment for a commonly used ED-focused mobile app (Recovery Record) among individuals enroled in intensive outpatient, partial hospitalisation, residential, or inpatient treatments (N = 2042). RESULTS Results indicated that older individuals and participants with binge eating disorder demonstrated more frequent app engagement compared to younger participants and other ED diagnoses, respectively. Individuals entering at intensive outpatient and partial hospitalisation levels of care, as well as those with routine discharges engaged more frequently with RR compared to individuals entering in inpatient or residential treatment, and those with non-routine discharges. CONCLUSIONS Our data provide initial descriptions of how RR may be used within higher levels of care for adults with EDs. Further work is needed to establish the benefit of these apps in clinical settings for EDs over and above standard treatment, better characterise for whom these apps provide benefit, and identify how best to tailor the experience to promote engagement across the full spectrum of ED patients.
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Affiliation(s)
- Erin E Reilly
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA
| | - Sasha Gorrell
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA
| | - Craig Johnson
- Eating Recovery Center/Pathlight Mood & Anxiety Center, Denver, Colorado, USA
| | - Alan Duffy
- Eating Recovery Center/Pathlight Mood & Anxiety Center, Denver, Colorado, USA
| | - Dan V Blalock
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, Durham, North Carolina, USA
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, USA
| | - Philip Mehler
- Eating Recovery Center/Pathlight Mood & Anxiety Center, Denver, Colorado, USA
- Acute Center for Eating Disorders at Denver Health, Denver, Colorado, USA
- University of Colorado School of Medicine, Denver, Colorado, USA
| | - Madelyn Johnson
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA
| | - Daniel Le Grange
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA
- Department of Psychiatry & Behavioral Neuroscience, The University of Chicago (Emeritus), Chicago, Illinois, USA
| | - Renee D Rienecke
- Eating Recovery Center/Pathlight Mood & Anxiety Center, Denver, Colorado, USA
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, Illinois, USA
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4
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Schlegl S, Maier J, Dieffenbacher A, Voderholzer U. Efficacy of a therapist-guided smartphone-based intervention to support recovery from bulimia nervosa: Study protocol of a randomized controlled multi-centre trial. EUROPEAN EATING DISORDERS REVIEW 2024; 32:350-362. [PMID: 37936300 DOI: 10.1002/erv.3047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 10/23/2023] [Accepted: 10/24/2023] [Indexed: 11/09/2023]
Abstract
OBJECTIVE Although inpatient treatment is highly effective for patients with bulimia nervosa (BN), some patients show a resurgence of symptoms and relapse after discharge. Therefore, the aim of this study is to evaluate the efficacy of a guided smartphone-based aftercare intervention following inpatient treatment to support recovery. METHOD 172 female patients with BN (DSM-5: 307.51) will be randomized to receive a 16-week smartphone-based aftercare intervention (German version of 'Recovery Record') with therapist feedback as an add-on element to treatment as usual (TAU) or TAU alone. Assessments will take place at baseline (discharge, T0), during the intervention (after 4 weeks, T1), post-intervention (after 16 weeks, T2) and at 6-month follow-up (T3). Primary outcome will be remission at T2. Moderator and mediator analyses will investigate for whom the aftercare intervention suits best and how it works. CONCLUSIONS This is the first randomized controlled trial to examine a guided smartphone-based aftercare intervention following inpatient treatment of patients with BN. We expect that this innovative aftercare intervention is highly accepted by the patients and that it has the potential to support recovery after inpatient treatment and thereby could contribute to improving aftercare for patients with BN.
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Affiliation(s)
- Sandra Schlegl
- Department of Psychiatry and Psychotherapy (LMU), University Hospital of Munich (LMU), Munich, Germany
| | - Julia Maier
- Department of Psychiatry and Psychotherapy (LMU), University Hospital of Munich (LMU), Munich, Germany
| | - Anna Dieffenbacher
- Department of Psychiatry and Psychotherapy (LMU), University Hospital of Munich (LMU), Munich, Germany
| | - Ulrich Voderholzer
- Department of Psychiatry and Psychotherapy (LMU), University Hospital of Munich (LMU), Munich, Germany
- Department of Psychiatry and Psychotherapy, University Hospital of Freiburg, Freiburg, Germany
- Schoen Clinic Roseneck, Prien am Chiemsee, Germany
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5
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Chiang CP, Hayes D, Panagiotopoulou E. Apps targeting anorexia nervosa in young people: a systematic review of active ingredients. Transl Behav Med 2023; 13:406-417. [PMID: 36753537 PMCID: PMC10255767 DOI: 10.1093/tbm/ibad003] [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] [Indexed: 02/10/2023] Open
Abstract
Evaluating the presence of behavior change techniques (BCTs) in mHealth apps could be used to better understand what "active ingredients" contribute to outcomes. Despite the early onset of Anorexia Nervosa (AN) and the increasing use of mobile apps to seek mental healthcare among young people, BCTs underpinning mHealth apps targeting AN have never been systematically examined. This review systematically identified and analyzed BCTs underpinning apps targeted at reducing AN in young people in an attempt to understand their active components. Apps were searched and screened in Apple Store and Google Play. Six apps that met the inclusion criteria and were coded by trained researchers against the BCT Taxonomy V1. Overall, 22 of 93 possible BCTs were identified. The most common were "Information about health consequences," "Social support (unspecified)," and "Information about antecedents". Identified BCTs suggested potential overlaps with traditional clinical treatments for AN, such as cognitive behavioral therapy and family-based therapy. Further investigation is required to evaluate the apps' usability and effectiveness.
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Affiliation(s)
- Clara P Chiang
- Research Department of Clinical, Educational & Health Psychology, University College London (UCL), London, UK
- Education & Training, Anna Freud National Centre for Children and Families, London, UK
| | - Daniel Hayes
- Research Department of Clinical, Educational & Health Psychology, University College London (UCL), London, UK
- Evidence Based Practice Unit, UCL and the Anna Freud National Centre for Children and Families (AFNCCF), London, UK
- Research Department of Behavioural Science and Health, Institute of Epidemiology & Health Care, University College London, London WC1E 7HB, UK
| | - Elena Panagiotopoulou
- Research Department of Clinical, Educational & Health Psychology, University College London (UCL), London, UK
- Education & Training, Anna Freud National Centre for Children and Families, London, UK
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6
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Dufour R, Novack K, Picard L, Chadi N, Booij L. The use of technology in the treatment of youth with eating disorders: A scoping review. J Eat Disord 2022; 10:182. [PMID: 36434657 PMCID: PMC9700893 DOI: 10.1186/s40337-022-00697-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 11/08/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Adolescence and young adulthood is a high-risk period for the development of eating disorders. In recent years, there has been an increase in use of technology-based interventions (TBIs) for the treatment of eating disorders. The objective of this study was to determine the types of technology used for eating disorder treatment in youth and their effectiveness. METHODS A scoping review was conducted according to PRISMA-ScR guidelines. Four databases were searched. Eligible articles included: (1) a TBI (2) participants with a mean age between 10- and 25-years and meeting DSM-IV or DSM-5 criteria for any eating disorder and (3) qualitative or quantitative designs. Quantitative and qualitative studies were assessed for quality. RESULTS The search identified 1621 articles. After screening of titles and abstracts, 130 articles were read in full and assessed for eligibility by two raters. Forty-nine (29 quantitative and 20 qualitative, observational, or mixed methods studies) met inclusion criteria. Quality ratings indicated that 78% of quantitative studies had a low risk of bias and 22% had a moderate risk. Technologies reviewed in our study included videoconference therapy, mobile applications, and online self-help. We considered interventions used both within sessions with clinicians as well as those used in between sessions by patients alone. Fifteen of 18 (83%) quantitative studies found that TBIs reduce eating disorder symptomatology, with nine of those reporting medium-to-large effect sizes. Qualitative data was of high quality and suggested that virtual interventions are acceptable in this population. CONCLUSIONS Although identified studies are of high quality, they are limited in number. More research is needed, particularly regarding videoconferencing and mobile applications. Nonetheless, TBIs show promise for the treatment of eating disorders in youth. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Rachel Dufour
- Sainte-Justine Hospital Research Centre, Montreal, Canada.,Department of Psychology, Concordia University, Montreal, Canada
| | - Kaylee Novack
- Sainte-Justine Hospital Research Centre, Montreal, Canada.,Department of Psychiatry and Addictology, Université de Montréal, Montreal, Canada.,Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Louis Picard
- Division of Adolescent Medicine, Department of Pediatrics, Sainte-Justine University Hospital Centre, 3175 Chemin de La Côte-Ste-Catherine, Montreal, QC, H3T 1C5, Canada
| | - Nicholas Chadi
- Sainte-Justine Hospital Research Centre, Montreal, Canada. .,Division of Adolescent Medicine, Department of Pediatrics, Université de Montréal, Montreal, Canada. .,Division of Adolescent Medicine, Department of Pediatrics, Sainte-Justine University Hospital Centre, 3175 Chemin de La Côte-Ste-Catherine, Montreal, QC, H3T 1C5, Canada.
| | - Linda Booij
- Sainte-Justine Hospital Research Centre, Montreal, Canada.,Department of Psychology, Concordia University, Montreal, Canada.,Department of Psychiatry and Addictology, Université de Montréal, Montreal, Canada.,Department of Psychiatry, McGill University, Montreal, Canada
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7
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Wayda-Zalewska M, Grzegorzewski P, Kot E, Skimina E, Santangelo PS, Kucharska K. Emotion Dynamics and Emotion Regulation in Anorexia Nervosa: A Systematic Review of Ecological Momentary Assessment Studies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13659. [PMID: 36294238 PMCID: PMC9603728 DOI: 10.3390/ijerph192013659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 10/18/2022] [Accepted: 10/19/2022] [Indexed: 06/16/2023]
Abstract
Altered emotion dynamics and emotion regulation (ER) have been indicated in theoretical descriptions of abnormal emotional functioning, which contributes to the development and maintenance of anorexia nervosa (AN). Ecological momentary assessment (EMA) has recently become popular in research on eating disorders. It is a source of new insights into the psychopathology of AN as it enables intensive long-term tracking of everyday experiences and behaviours of individuals through repeated self-reports. The following systematic review aims to synthesize research on the use of EMA when evaluating emotion dynamics and ER in AN. Specific studies were identified with the use of MEDLINE, PsycINFO, and Scopus databases. A supplemental search was performed in reference lists of the relevant publications. As a result, 27 publications were identified and included in the systematic review. The findings from the reviewed studies point to various disturbed components of emotion dynamics as well as to unique associations of maladaptive ER strategies with specific abnormalities in emotion dynamics in AN. Limitations of the studies were discussed as well. An outlook for further research in the field was provided in the last section of the paper.
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Affiliation(s)
| | - Piotr Grzegorzewski
- Institute of Psychology, Cardinal Stefan Wyszyński University in Warsaw, 01938 Warsaw, Poland
| | - Emilia Kot
- Faculty of Psychology, University of Warsaw, 00183 Warsaw, Poland
| | - Ewa Skimina
- Institute of Psychology, Cardinal Stefan Wyszyński University in Warsaw, 01938 Warsaw, Poland
| | | | - Katarzyna Kucharska
- Institute of Psychology, Cardinal Stefan Wyszyński University in Warsaw, 01938 Warsaw, Poland
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8
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Wenig V, Janetzke H. "That You Just Know You're Not Alone and Other People Have Gone through It Too." Eating Disorder Recovery Accounts on Instagram as a Chance for Self-Help? A Qualitative Interview Study among People Affected and Self-Help Experts. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11334. [PMID: 36141606 PMCID: PMC9517556 DOI: 10.3390/ijerph191811334] [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: 08/22/2022] [Accepted: 09/04/2022] [Indexed: 06/16/2023]
Abstract
In addition to the professional treatment of eating disorders, the use of self-help groups has become increasingly important. Social media offers new possibilities for self-help, not only as online groups but also in increased access to recovery stories of people with similar diseases. People with eating disorders use the internet and social media depending on their motivation in different ways. Eating disorder recovery stories on social media have not yet been systematically used in treatment as appropriate guidelines are still lacking. This study provides an initial insight into the possibilities of using social media for self-help for eating disorders. Due to the exploratory nature, a qualitative design was used, combining interviews with people who have a recovery account on Instagram (n = 6) and self-help experts (n = 2). The results show that recovery stories on Instagram could serve as door openers for further treatment, motivation for therapy, a first step towards behaviour change, and support for existing therapies. If affected people can cope with the self-protection strategies, they can use Instagram positively for themselves and their disease. Nevertheless, there is a risk of negative influence as well as a risk of content and time overload. Therapeutic personnel can use these results to improve existing support services.
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Affiliation(s)
- Vanessa Wenig
- Institute of Health and Nursing Science, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Hanna Janetzke
- Department of Health, Nursing, Management, University of Applied Sciences Neubrandenburg, 17033 Neubrandenburg, Germany
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9
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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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10
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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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11
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Philippe TJ, Sikder N, Jackson A, Koblanski ME, Liow E, Pilarinos A, Vasarhelyi K. Digital Health Interventions for Delivery of Mental Health Care: Systematic and Comprehensive Meta-Review. JMIR Ment Health 2022; 9:e35159. [PMID: 35551058 PMCID: PMC9109782 DOI: 10.2196/35159] [Citation(s) in RCA: 58] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 02/28/2022] [Accepted: 03/02/2022] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has shifted mental health care delivery to digital platforms, videoconferencing, and other mobile communications. However, existing reviews of digital health interventions are narrow in scope and focus on a limited number of mental health conditions. OBJECTIVE To address this gap, we conducted a comprehensive systematic meta-review of the literature to assess the state of digital health interventions for the treatment of mental health conditions. METHODS We searched MEDLINE for secondary literature published between 2010 and 2021 on the use, efficacy, and appropriateness of digital health interventions for the delivery of mental health care. RESULTS Of the 3022 records identified, 466 proceeded to full-text review and 304 met the criteria for inclusion in this study. A majority (52%) of research involved the treatment of substance use disorders, 29% focused on mood, anxiety, and traumatic stress disorders, and >5% for each remaining mental health conditions. Synchronous and asynchronous communication, computerized therapy, and cognitive training appear to be effective but require further examination in understudied mental health conditions. Similarly, virtual reality, mobile apps, social media platforms, and web-based forums are novel technologies that have the potential to improve mental health but require higher quality evidence. CONCLUSIONS Digital health interventions offer promise in the treatment of mental health conditions. In the context of the COVID-19 pandemic, digital health interventions provide a safer alternative to face-to-face treatment. However, further research on the applications of digital interventions in understudied mental health conditions is needed. Additionally, evidence is needed on the effectiveness and appropriateness of digital health tools for patients who are marginalized and may lack access to digital health interventions.
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Affiliation(s)
- Tristan J Philippe
- Department of Cellular & Physiological Sciences, The University of British Columbia, Vancouver, BC, Canada.,Department of Psychiatry, The University of British Columbia, Vancouver, BC, Canada
| | | | - Anna Jackson
- School of Social Work, The University of British Columbia, Vancouver, BC, Canada
| | - Maya E Koblanski
- Department of Cellular & Physiological Sciences, The University of British Columbia, Vancouver, BC, Canada.,Department of Psychology, The University of British Columbia, Vancouver, BC, Canada
| | - Eric Liow
- Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - Andreas Pilarinos
- Vancouver Coastal Health Research Institute, Vancouver, BC, Canada.,School of Population and Public Health, The University of British Columbia, Vancouver, BC, Canada
| | - Krisztina Vasarhelyi
- Vancouver Coastal Health Research Institute, Vancouver, BC, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
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Vega J, Bell BT, Taylor C, Xie J, Ng H, Honary M, McNaney R. Detecting Mental Health Behaviors Using Mobile Interactions: Exploratory Study Focusing on Binge Eating. JMIR Ment Health 2022; 9:e32146. [PMID: 35086064 PMCID: PMC9086876 DOI: 10.2196/32146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 01/16/2022] [Accepted: 01/17/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Binge eating is a subjective loss of control while eating, which leads to the consumption of large amounts of food. It can cause significant emotional distress and is often accompanied by purging behaviors (eg, meal skipping, overexercising, or vomiting). OBJECTIVE The aim of this study was to explore the potential of mobile sensing to detect indicators of binge-eating episodes, with a view toward informing the design of future context-aware mobile interventions. METHODS This study was conducted in 2 stages. The first involved the development of the DeMMI (Detecting Mental health behaviors using Mobile Interactions) app. As part of this, we conducted a consultation session to explore whether the types of sensor data we were proposing to capture were useful and appropriate, as well as to gather feedback on some specific app features relating to self-reporting. The second stage involved conducting a 6-week period of data collection with 10 participants experiencing binge eating (logging both their mood and episodes of binge eating) and 10 comparison participants (logging only mood). An optional interview was conducted after the study, which discussed their experience using the app, and 8 participants (n=3, 38% binge eating and n=5, 63% comparisons) consented. RESULTS The findings showed unique differences in the types of sensor data that were triangulated with the individuals' episodes (with nearby Bluetooth devices, screen and app use features, mobility features, and mood scores showing relevance). Participants had a largely positive opinion about the app, its unobtrusive role, and its ease of use. Interacting with the app increased participants' awareness of and reflection on their mood and phone usage patterns. Moreover, they expressed no privacy concerns as these were alleviated by the study information sheet. CONCLUSIONS This study contributes a series of recommendations for future studies wishing to scale our approach and for the design of bespoke mobile interventions to support this population.
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Affiliation(s)
- Julio Vega
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | | | | | - Jue Xie
- Department of Human Centred Computing, Monash University, Clayton, Australia
| | - Heidi Ng
- Department of Human Centred Computing, Monash University, Clayton, Australia
| | | | - Roisin McNaney
- Department of Human Centred Computing, Monash University, Clayton, Australia
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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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Wasil AR, Palermo EH, Lorenzo-Luaces L, DeRubeis RJ. Is There an App for That? A Review of Popular Apps for Depression, Anxiety, and Well-Being. COGNITIVE AND BEHAVIORAL PRACTICE 2021. [DOI: 10.1016/j.cbpra.2021.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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15
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Naccache B, Mesquida L, Raynaud JP, Revet A. Smartphone application for adolescents with anorexia nervosa: an initial acceptability and user experience evaluation. BMC Psychiatry 2021; 21:467. [PMID: 34563166 PMCID: PMC8466747 DOI: 10.1186/s12888-021-03478-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 09/15/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Anorexia Nervosa (AN) is a key target for E-Health programs considering the many barriers hindering patients' access to care and the disorder's severity. Although these programs have become more common and effective, they often have low adherence, especially among youth. This can hinder their implementation and effectiveness in real-world settings. User experience partly overlaps with the acceptability field and may provide insight into factors affecting adherence and adoption of E-Health programs. This study aimed to explore early acceptability and user experience of a companion app prototype for adolescents with AN using user-centered design methods. METHODS We developed a prototype containing self-help material and emotions and behaviors evaluation and management features. Then we conducted a mixed evaluation combining semi structured focus group interviews and questionnaires in a clinician group and an AN patient group. We analyzed data using thematic analysis and descriptive statistics. RESULTS The app's overall appeal was adequate. The user experience questionnaire revealed the weakest dimensions, including novelty, dependability, and efficiency versus stimulation (i.e., ability to induce motivation to use the product) and perspicuity (i.e., easy to understand, to get familiar with). The qualitative data analysis revealed three central axes: acceptability, features, and use. We identified acceptability barriers and facilitators such as the importance of design and customization, especially for adolescents. Psychoeducation was a major feature for participants, as patients highlighted the difficulties they encountered when seeking disorders-related information. CONCLUSIONS This study shows the importance of including users in the different stages of an e-health intervention development, in order to identify their needs, general use and compliance patterns, to improve adherence and adoption of the program and its effectiveness.
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Affiliation(s)
- Benjamin Naccache
- Service Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, CHU de Toulouse, Hôpital Purpan, Place du Dr Baylac, TSA 40031, 31059, Toulouse cedex 9, France.
| | - Laure Mesquida
- grid.414282.90000 0004 0639 4960Service Universitaire de Psychiatrie de l’Enfant et de l’Adolescent, CHU de Toulouse, Hôpital Purpan, Place du Dr Baylac, TSA 40031, 31059 Toulouse cedex 9, France
| | - Jean-Philippe Raynaud
- grid.414282.90000 0004 0639 4960Service Universitaire de Psychiatrie de l’Enfant et de l’Adolescent, CHU de Toulouse, Hôpital Purpan, Place du Dr Baylac, TSA 40031, 31059 Toulouse cedex 9, France ,grid.15781.3a0000 0001 0723 035XCERPOP, Université de Toulouse, Inserm, UPS, Toulouse, France
| | - Alexis Revet
- grid.414282.90000 0004 0639 4960Service Universitaire de Psychiatrie de l’Enfant et de l’Adolescent, CHU de Toulouse, Hôpital Purpan, Place du Dr Baylac, TSA 40031, 31059 Toulouse cedex 9, France ,grid.15781.3a0000 0001 0723 035XCERPOP, Université de Toulouse, Inserm, UPS, Toulouse, France ,grid.411175.70000 0001 1457 2980CIC 1436, Team PEPSS « Pharmacologie En Population cohorteS et biobanqueS », Toulouse University Hospital, Toulouse, France
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An Italian Case Study for Assessing Nutrient Intake through Nutrition-Related Mobile Apps. Nutrients 2021; 13:nu13093073. [PMID: 34578951 PMCID: PMC8465951 DOI: 10.3390/nu13093073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 08/26/2021] [Accepted: 08/29/2021] [Indexed: 12/13/2022] Open
Abstract
National food consumption surveys are crucial for monitoring the nutritional status of individuals, defining nutrition policies, estimating dietary exposure, and assessing the environmental impact of the diet. The methods for conducting them are time and resource-consuming, so they are usually carried out after extended periods of time, which does not allow for timely monitoring of any changes in the population’s dietary patterns. This study aims to compare the results of nutrition-related mobile apps that are most popular in Italy, with data obtained with the dietary software Foodsoft 1.0, which was recently used in the Italian national dietary survey IV SCAI. The apps considered in this study were selected according to criteria, such as popularity (downloads > 10,000); Italian language; input characteristics (daily dietary recording ability); output features (calculation of energy and macronutrients associated with consumption), etc. 415 apps in Google Play and 226 in the iTunes Store were examined, then the following five apps were selected: YAZIO, Lifesum, Oreegano, Macro and Fitatu. Twenty 24-hour recalls were extracted from the IV SCAI database and inputted into the apps. Energy and macronutrient intake data were compared with Foodsoft 1.0 output. Good agreement was found between the selected apps and Foodsoft 1.0 (high correlation index), and no significant differences were found in the mean values of energy and macronutrients, except for fat intakes. In conclusion, the selected apps could be a suitable tool for assessing dietary intake.
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Taylor CB, Graham AK, Flatt RE, Waldherr K, Fitzsimmons-Craft EE. Current state of scientific evidence on Internet-based interventions for the treatment of depression, anxiety, eating disorders and substance abuse: an overview of systematic reviews and meta-analyses. Eur J Public Health 2021; 31:i3-i10. [PMID: 32918448 PMCID: PMC8495688 DOI: 10.1093/eurpub/ckz208] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND ICare represents a consortium of European Investigators examining the effects of online mental health care for a variety of common mental health disorders provided in a variety of settings. This article provides an overview of the evidence of effectiveness for Internet-based treatment for four common mental health disorders that are the focus of much of this work: depression, anxiety, substance abuse and eating disorders. METHODS The overview focused primarily on systematic reviews and meta-analyses identified through PubMed (Ovid) and other databases and published in English. Given the large number of reviews specific to depression, anxiety, substance abuse and/or eating disorders, we did not focus on reviews that examined the effects of Internet-based interventions on mental health disorders in general. Each article was reviewed and summarized by one of the senior authors, and this review was then reviewed by the other senior authors. We did not address issues of prevention, cost-effectiveness, implementation or dissemination, as these are addressed in other reviews in this supplement. RESULTS Across Internet-based intervention studies addressing depression, anxiety, substance abuse and eating disorders primarily among adults, almost all reviews and meta-analyses found that these interventions successfully reduce symptoms and are efficacious treatments. Generally, effect sizes for Internet-based interventions treating eating disorders and substance abuse are lower compared with interventions for depression and anxiety. CONCLUSIONS Given the effectiveness of Internet-based interventions to reduce symptoms of these common mental health disorders, efforts are needed to examine issues of how they can be best disseminated and implemented in a variety of health care and other settings.
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Affiliation(s)
- C Barr Taylor
- Center for m2Health, Palo Alto University, Palo Alto, CA, USA.,Department of Psychiatry & Behavioral Sciences, Stanford University, Palo Alto, CA, USA
| | - Andrea K Graham
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
| | - Rachael E Flatt
- Center for m2Health, Palo Alto University, Palo Alto, CA, USA.,Department of Psychiatry & Behavioral Sciences, Stanford University, Palo Alto, CA, USA
| | - Karin Waldherr
- FernFH Distance Learning University of Applied Sciences, Wiener Neustadt, Austria
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18
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Lukas CA, Eskofier B, Berking M. A Gamified Smartphone-Based Intervention for Depression: Randomized Controlled Pilot Trial. JMIR Ment Health 2021; 8:e16643. [PMID: 34283037 PMCID: PMC8335612 DOI: 10.2196/16643] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 03/01/2020] [Accepted: 04/21/2021] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Available smartphone-based interventions for depression predominantly use evidence-based strategies from cognitive-behavioral therapy (CBT), but patient engagement and reported effect sizes are small. Recently, studies have demonstrated that smartphone-based interventions combining CBT with gamified approach-avoidance bias modification training (AAMT) can foster patient engagement and reduce symptoms of several mental health problems. OBJECTIVE Based on these findings, we developed a gamified smartphone-based intervention, mentalis Phoenix (MT-Phoenix), and hypothesized the program would both engage patients and produce preliminary evidence for the reduction of depressive symptoms. METHODS To test this hypothesis, we evaluated MT-Phoenix in a randomized controlled pilot trial including 77 individuals with elevated depression scores (Patient Health Questionnaire-9 scores ≥5). Participants were either instructed to train for 14 days with MT-Phoenix or assigned to a waitlist control condition. Engagement with the intervention was measured by assessing usage data. The primary outcome was reduction in depressive symptom severity at postassessment. RESULTS Data from this pilot trial shows that participants in the intervention group used the smartphone-based intervention for 46% of all days (6.4/14) and reported a significantly greater reduction of depressive symptoms than did participants in the control condition (F1,74=19.34; P=.001), with a large effect size (d=1.02). Effects were sustained at a 3-month follow-up. CONCLUSIONS A gamified smartphone-based intervention combining CBT with AAMT may foster patient engagement and effectively target depressive symptoms. Future studies should evaluate the effectiveness of this intervention in a phase 3 trial using clinical samples. Moreover, the intervention should be compared to active control conditions. TRIAL REGISTRATION German Clinical Trial Registry DRKS00012769; https://tinyurl.com/47mw8du7.
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Affiliation(s)
- Christian Aljoscha Lukas
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Bjoern Eskofier
- Department of Computer Science, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Matthias Berking
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
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19
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Wasil AR, Patel R, Cho JY, Shingleton RM, Weisz JR, DeRubeis RJ. Smartphone apps for eating disorders: A systematic review of evidence-based content and application of user-adjusted analyses. Int J Eat Disord 2021; 54:690-700. [PMID: 33534176 DOI: 10.1002/eat.23478] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 01/15/2021] [Accepted: 01/16/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To examine the frequency of evidence-based treatment elements in popular smartphone apps for eating disorders (EDs), and to characterize the extent to which real-world users encounter different elements. METHOD We searched the Apple App Store and Google Play Store for apps offering treatment or support to individuals with EDs. Then, we created a codebook of 47 elements found in evidence-based treatments for EDs. We examined the presence or absence of each element within each ED app. We also acquired estimates of the monthly active users (MAU) of each app. RESULTS The ED apps (n = 28) included a median of nine elements of empirically supported treatments (mean = 9.46, SD = 6.28). Four apps accounted for 96% of all MAU. MAU-adjusted analyses revealed that several elements are reaching more users than raw frequency tallies would suggest. For example, assessments were included in 32% of apps, but 84% of users used an app with assessments. Similar trends were found for cognitive restructuring (21% of apps, 56% of MAU), activity scheduling (39%, 57%), and self-monitoring (14%, 46%). Problem solving, exposure, and relapse prevention strategies, elements that are prominent in face-to-face empirically supported treatments, were rarely included in the apps. DISCUSSION Evidence-based content is commonly included in ED apps, with certain elements reaching more users than others. Additionally, the top four apps are responsible for nearly all active users. We recommend that ED clinicians and researchers familiarize themselves with these apps-those that patients are most likely to encounter.
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Affiliation(s)
- Akash R Wasil
- Department of Psychology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Raveena Patel
- Department of Psychology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jin Young Cho
- Department of Psychology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - John R Weisz
- Department of Psychology, Harvard University, Cambridge, Massachusetts, USA
| | - Robert J DeRubeis
- Department of Psychology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Devakumar A, Jay Modh, Saket B, Baumer EPS, De Choudhury M. A Review on Strategies for Data Collection, Reflection, and Communication in Eating Disorder Apps. PROCEEDINGS OF THE SIGCHI CONFERENCE ON HUMAN FACTORS IN COMPUTING SYSTEMS. CHI CONFERENCE 2021; 2021:547. [PMID: 35615054 PMCID: PMC9128313 DOI: 10.1145/3411764.3445670] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Abstract
Eating disorders (EDs) constitute a mental illness with the highest mortality. Today, mobile health apps provide promising means to ED patients for managing their condition. Apps enable users to monitor their eating habits, thoughts, and feelings, and offer analytic insights for behavior change. However, not only have scholars critiqued the clinical validity of these apps, their underlying design principles are not well understood. Through a review of 34 ED apps, we uncovered 11 different data types ED apps collect, and 9 strategies they employ to support collection and reflection. Drawing upon personal health informatics and visualization frameworks, we found that most apps did not adhere to best practices on what and how data should be collected from and reflected to users, or how data-driven insights should be communicated. Our review offers suggestions for improving the design of ED apps such that they can be useful and meaningful in ED recovery.
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Affiliation(s)
| | - Jay Modh
- Georgia Institute of Technology, Atlanta, GA, USA
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21
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Lindgreen P, Lomborg K, Clausen L. Patient use of a self-monitoring app during eating disorder treatment: Naturalistic longitudinal cohort study. Brain Behav 2021; 11:e02039. [PMID: 33459532 PMCID: PMC8035428 DOI: 10.1002/brb3.2039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 12/08/2020] [Accepted: 12/29/2020] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To explore patients' use of the self-monitoring app Recovery Record during 26 weeks of naturalistic eating disorder treatment. METHODS Selected patient characteristics at baseline were explored as predictors of app use using linear regression. Patients were grouped according to diagnosis (anorexia versus bulimia), and mixed-effects analyses were used to explore differences in app use between diagnoses across four time periods (weeks 1-4; weeks 5-8; weeks 9-12; weeks 13-26). RESULTS Eighty-four patients were included of which 41 had anorexia and 43 had bulimia. The total number of logs varied greatly (mean (SD): 592 (628.50)), and patient app activity almost ceased at week 13. Increasing age and no previous eating disorder treatment predicted increased app activity (p = .007; p = .039, respectively). Patients with anorexia logged over four times more often than patients with bulimia in the last time period (median (CI): 4.27 (1.28;14.31); p = .018). Time predicted declining app use (all p ≤ .007). CONCLUSION Future research on long-term app engagement should investigate associations between patients' app use and changes in their eating disorder symptom severity over time.
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Affiliation(s)
- Pil Lindgreen
- Department of Child and Adolescent PsychiatryAarhus University HospitalAarhusDenmark
| | - Kirsten Lomborg
- Clinical ResearchSteno Diabetes Center CopenhagenGentofteDenmark
- Department of Clinical MedicineFaculty of HealthAarhus UniversityAarhusDenmark
| | - Loa Clausen
- Department of Child and Adolescent PsychiatryAarhus University HospitalAarhusDenmark
- Department of Clinical MedicineFaculty of HealthAarhus UniversityAarhusDenmark
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Hurley OA. Sport Cyberpsychology in Action During the COVID-19 Pandemic (Opportunities, Challenges, and Future Possibilities): A Narrative Review. Front Psychol 2021; 12:621283. [PMID: 33746838 PMCID: PMC7977283 DOI: 10.3389/fpsyg.2021.621283] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 02/01/2021] [Indexed: 11/30/2022] Open
Abstract
Interest in sport cyberpsychology has become more popular over the last decade, primarily due to the increased use of technology and the online world, including social media, within sport settings (Hurley, 2018). In 2020, this became even more apparent for many athletes, their support teams and their sport organisations, when their professional and social worlds became cyber-dominated due to the COVID-19 pandemic. Many challenges were encountered by: (i) the athletes, in their efforts to remain active and well during this time when all competitions were cancelled and (ii) the healthcare professionals, working with these athletes, in their efforts to continue to support the athletes, when severe travel restrictions and social distancing were in place for considerable periods of time. The purpose of this paper, using a narrative review process, is to present and scrutinise an array of Internet interventions, remote psychological supports and applications (apps) that the athletes and their support personnel used to help them meet their physical, social, and emotional needs during the pandemic. The beneficial and restrictive features of these online options will be presented. Two main themes will be considered in order to focus this discussion, namely, (i) the potential physical and mental opportunities and challenges using the online world extensively during this time presented for the individuals working in sport and (ii) suggestions for how such online interventions used by the athletes, their coaches and sport science personnel during the pandemic may be maintained in some positive ways into the future, to help the athletes prepare for their upcoming competitions, their training and their future careers when they retire from elite sport.
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Affiliation(s)
- Olivia A. Hurley
- Department of Technology and Psychology, Institute of Art, Design, and Technology, Dublin, Ireland
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Citrome L. Binge Eating Disorder: A Psychiatrist's Commentary on Clinical Considerations. Clin Ther 2020; 43:7-16. [PMID: 33308878 DOI: 10.1016/j.clinthera.2020.10.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 10/28/2020] [Accepted: 10/29/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE Of the 3 major eating disorders, anorexia nervosa, bulimia nervosa, and binge eating disorder (BED), BED is the most common and exists in the practices of most primary care and psychiatric clinicians. However, BED often goes unrecognized and thus untreated. METHODS Reviewed in this commentary are the basic elements in the diagnosis of BED, demographic and clinical characteristics, screening options, the importance of comorbidities, pathophysiology, and available treatments. FINDINGS Psychological treatments, including cognitive-behavioral therapy, interpersonal therapy, and behavioral weight loss, have been recommended as first-line options and are supported by several different meta-analytic reviews. Lisdexamfetamine is currently the only medication approved by the US Food and Drug Administration for the treatment of BED. Effect sizes for lisdexamfetamine versus placebo for response, remission, and avoidance of relapse in BED are robust, but its use may be limited by tolerability. This is also the case for topiramate, an anticonvulsant that has been used "off-label" to treat BED. IMPLICATIONS Additional medication choices approved by the US Food and Drug Administration for the treatment of BED are needed. Moving forward, opportunities to leverage modern technology to broaden access to treatment are highly desirable.
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Liu JY, Xu KK, Zhu GL, Zhang QQ, Li XM. Effects of smartphone-based interventions and monitoring on bipolar disorder: A systematic review and meta-analysis. World J Psychiatry 2020; 10:272-285. [PMID: 33269223 PMCID: PMC7672788 DOI: 10.5498/wjp.v10.i11.272] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 09/25/2020] [Accepted: 10/12/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Recently, there has been a range of studies about smartphone-based interventions and monitoring for reducing symptoms of bipolar disorder (BD). However, their efficacy for BD remains unclear.
AIM To compare the effect of smartphone-based interventions and monitoring with control methods in treating patients with BD.
METHODS A systematic literature search was performed on PubMed, Embase, Clinical trials, psycINFO, Web of Science, and Cochrane Library. Randomized clinical trials (RCTs) or single-group trials in which smartphone-based interventions and monitoring were compared with control methods or baseline in patients with symptoms of BD were included. Data were synthesized using a random-effects or a fixed-effects model to analyze the effects of psychological interventions and monitoring delivered via smartphone on psychiatric symptoms in patients with BD. The primary outcome measures were set for mania and depression symptoms. Subgroups were created to explore which aspects of smartphone interventions are relevant to the greater or lesser efficacy of treating symptoms.
RESULTS We identified ten articles, including seven RCTs (985 participants) and three single-group trials (169 participants). Analysis of the between-group study showed that smartphone-based interventions were effective in reducing manic [g = -0.19, 95% confidence interval (CI): -0.33 to -0.04, P = 0.01] and depressive (g = -0.28, 95%CI: -0.55 to -0.01, P < 0.05) symptoms. In within-group analysis, smartphone-based interventions significantly reduced manic (g = 0.17, 95%CI: 0.04 to 0.30, P < 0.01) and depressive (g = 0.48, 95%CI: 0.18 to 0.78) symptoms compared to the baseline. Nevertheless, smartphone-based monitoring systems significantly reduced manic (g = 0.27, 95%CI: 0.02 to 0.51, P < 0.05) but not depressive symptoms. Subgroup analysis indicated that the interventions with psychoeducation had positive effects on depressive (g = -0.62, 95%CI: -0.81 to -0.43, P < 0.01) and manic (g = -0.24, 95%CI: -0.43 to -0.06, P = 0.01) symptoms compared to the controlled conditions, while the interventions without psychoeducation did not (P > 0.05). The contacts between therapists and patients that contributed to the implementation of psychological therapy reduced depression symptoms (g = -0.47, 95%CI: -0.75 to -0.18, P = 0.01).
CONCLUSION Smartphone-based interventions and monitoring have a significant positive impact on depressive and manic symptoms of BD patients in between-group and within-group analysis.
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Affiliation(s)
- Jia-Yuan Liu
- Department of Medical Psychology, Chaohu Clinical Medical College, Anhui Medical University, Hefei 230032, Anhui Province, China
- Department of Anesthesia, First Clinical Medical College, Anhui Medical University, Hefei 230032, Anhui Province, China
| | - Kang-Kang Xu
- Department of Clinical Medicine, Second Clinical Medical College, Anhui Medical University, Hefei 230032, Anhui Province, China
| | - Guang-Lin Zhu
- Department of Clinical Medicine, Second Clinical Medical College, Anhui Medical University, Hefei 230032, Anhui Province, China
| | - Qi-Qi Zhang
- Department of Clinical Medicine, First Clinical Medical College, Anhui Medical University, Hefei 230032, Anhui Province, China
| | - Xiao-Ming Li
- Department of Medical Psychology, Chaohu Clinical Medical College, Anhui Medical University, Hefei 230032, Anhui Province, China
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25
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Neumayr C, Voderholzer U, Schlegl S. Psych-APP-Therapie: Smartphonebasierte Interventionen in der Psychotherapie – Eine systematische Übersichtsarbeit. VERHALTENSTHERAPIE 2020. [DOI: 10.1159/000510954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
<b><i>Hintergrund:</i></b> Technologiebasierte Interventionen haben in der Psychotherapie an Bedeutung gewonnen. Ein versorgungsrelevanter Ansatz sind Mental Health Apps. Ziel dieser systematischen Übersichtsarbeit ist es (1) international evaluierte Apps zu den Störungsbildern Depressionen, Angststörungen und Essstörungen zu identifizieren, (2) deren Verfügbarkeit in deutschen App-Stores sowie (3) in deutscher Sprache zu prüfen und (4) ihre Effektivitätsergebnisse aus randomisiert-kontrollierten (Pilot-)Studien (RCTs) darzustellen. <b><i>Methode:</i></b> Die Übersichtsarbeit wurde in Anlehnung an das PRISMA Statement durchgeführt und ausgewertet. Eine systematische Recherche (2007–2018) der Datenbanken PubMed, PsychINFO sowie PSYNDEX wurde durchgeführt. Zudem fand eine Beurteilung der methodischen Qualität sowie der Effektivitätsergebnisse der (Pilot-)RCTs statt. <b><i>Ergebnisse:</i></b> Es wurden 2’571 Abstracts identifiziert und 47 Publikationen eingeschlossen (<i>N</i> = 32 unterschiedliche Apps; <i>N</i> = 24 [Pilot-]RCTs). Die Qualität der (Pilot-)RCTs ist überwiegend als gut bis moderat einzustufen. Die Ergebnisse waren heterogen (keine bis große Effekte [Cohens <i>d</i>] zwischen den Gruppen: –0,01; KI [–0,36; 0,34] bis 1,49; KI [1,00; 1,99]). Vier Apps mit einer Evaluation durch (Pilot-)RCTs sind in den deutschen App-Stores verfügbar – eine in deutscher Sprache. <b><i>Schlussfolgerungen:</i></b> Es liegt international eine Vielzahl von ersten App-Evaluationen zu den Störungsbildern vor, die Verfügbarkeit ausreichend evaluierter deutschsprachiger Apps in den deutschen App-Stores ist aber extrem limitiert. Englischsprachige, bereits evaluierte Apps könnten in das Deutsche übersetzt und – genauso wie schon verfügbare, aber nicht evaluierte deutschsprachige Apps – in RCTs inkl. Katamnesedaten evaluiert werden. So könnten smartphonebasierte Interventionen im Rahmen des “Digitalen-Versorgungs-Gesetzes” als ergänzendes Element in der Psychotherapie an Bedeutung gewinnen.
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26
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Schlegl S, Neumayr C, Voderholzer U. Therapist-guided smartphone-based aftercare for inpatients with severe anorexia nervosa (SMART-AN): Study protocol of a randomized controlled trial. Int J Eat Disord 2020; 53:1739-1745. [PMID: 32735053 DOI: 10.1002/eat.23357] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 07/14/2020] [Accepted: 07/14/2020] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Inpatient treatment for patients with anorexia nervosa (AN) is recommended in extreme or severe cases after failure of outpatient treatment and is highly effective. However, a number of patients show symptom increase and relapse after discharge. The aim of this study is to evaluate the efficacy of a therapist-guided smartphone-based aftercare intervention for inpatients with AN to support symptom stabilization. METHOD A total of 186 female patients with a DSM-5 diagnosis of AN (307.1) will be randomized either to receive a 16-week smartphone-based aftercare intervention with therapist feedback as add-on to treatment as usual (TAU) or TAU alone. Data will be assessed at discharge (= baseline, T0), after 16 weeks (= end of the aftercare intervention, T1) and after 10 months (= 6-month follow-up, T2). Primary outcome will be overall eating disorder symptomatology (Eating Disorder Examination Global score). Secondary outcome measures will include body mass index, depression, motivation to change, self-efficacy, patient satisfaction with and adherence to the smartphone-based aftercare intervention as well as rehospitalization rate. DISCUSSION This study will be the first randomized controlled trial to examine a therapist-guided smartphone-based aftercare intervention for inpatients with AN. Results may reveal whether and to which extent this novel intervention can support symptom stabilization after inpatient treatment.
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Affiliation(s)
- Sandra Schlegl
- Department of Psychiatry and Psychotherapy, University Hospital of Munich (LMU), Munich, Germany
| | | | - Ulrich Voderholzer
- Department of Psychiatry and Psychotherapy, University Hospital of Munich (LMU), Munich, Germany.,Schoen Clinic Roseneck, Prien am Chiemsee, Germany.,Department of Psychiatry and Psychotherapy, University Hospital of Freiburg, Freiburg, Germany
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27
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Maramis C, Moulos I, Ioakimidis I, Papapanagiotou V, Langlet B, Lekka I, Bergh C, Maglaveras N. A smartphone application for semi-controlled collection of objective eating behavior data from multiple subjects. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2020; 194:105485. [PMID: 32464588 DOI: 10.1016/j.cmpb.2020.105485] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 03/04/2020] [Accepted: 03/29/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND & OBJECTIVE The study of eating behavior has made significant progress towards understanding the association of specific eating behavioral patterns with medical problems, such as obesity and eating disorders. Smartphones have shown promise in monitoring and modifying unhealthy eating behavior patterns, often with the help of sensors for behavior data recording. However, when it comes to semi-controlled deployment settings, smartphone apps that facilitate eating behavior data collection are missing. To fill this gap, the present work introduces ASApp, one of the first smartphone apps to support researchers in the collection of heterogeneous objective (sensor-acquired) and subjective (self-reported) eating behavior data in an integrated manner from large-scale, naturalistic human subject research (HSR) studies. METHODS This work presents the overarching and deployment-specific requirements that have driven the design of ASApp, followed by the heterogeneous eating behavior dataset that is collected and the employed data collection protocol. The collected dataset combines objective and subjective behavior information, namely (a) dietary self-assessment information, (b) the food weight timeseries throughout an entire meal (using a portable weight scale connected wirelessly), (c) a photograph of the meal, and (d) a series of quantitative eating behavior indicators, mainly calculated from the food weight timeseries. The designed data collection protocol is quick, straightforward, robust and capable of satisfying the requirement of semi-controlled HSR deployment. RESULTS The implemented functionalities of ASApp for research assistants and study participants are presented in detail along with the corresponding user interfaces. ASApp has been successfully deployed for data collection in an in-house testing study and the SPLENDID study, i.e., a real-life semi-controlled HSR study conducted in the cafeteria of a Swedish high-school in the context of an EC-funded research project. The two deployment studies are described and the promising results from the evaluation of the app with respect to attractiveness, usability, and technical soundness are discussed. Access details for ASApp are also provided. CONCLUSIONS This work presents the requirement elucidation, design, implementation and evaluation of a novel smartphone application that supports researchers in the integrated collection of a concise yet rich set of heterogeneous eating behavior data for semi-controlled HSR.
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Affiliation(s)
- Christos Maramis
- Department of Medicine, School of Life Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Ioannis Moulos
- Department of Medicine, School of Life Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Ioakimidis
- Department of Biosciences and Nutrition, Karolinska Institute, Stockholm, Sweden
| | - Vasileios Papapanagiotou
- Department of Electrical & Computer Engineering, School of Engineering, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Billy Langlet
- Department of Biosciences and Nutrition, Karolinska Institute, Stockholm, Sweden
| | - Irini Lekka
- Department of Medicine, School of Life Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Nicos Maglaveras
- Department of Medicine, School of Life Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
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28
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Manning V, Piercy H, Garfield JBB, Lubman DI. Personalized Approach Bias Modification Smartphone App ("SWIPE") to Reduce Alcohol Use Among People Drinking at Hazardous or Harmful Levels: Protocol for an Open-Label Feasibility Study. JMIR Res Protoc 2020; 9:e21278. [PMID: 32795989 PMCID: PMC7455870 DOI: 10.2196/21278] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/13/2020] [Accepted: 07/14/2020] [Indexed: 01/15/2023] Open
Abstract
Background Alcohol accounts for 5.1% of the global burden of disease and injury, and approximately 1 in 10 people worldwide develop an alcohol use disorder. Approach bias modification (ABM) is a computerized cognitive training intervention in which patients are trained to “avoid” alcohol-related images and “approach” neutral or positive images. ABM has been shown to reduce alcohol relapse rates when delivered in residential settings (eg, withdrawal management or rehabilitation). However, many people who drink at hazardous or harmful levels do not require residential treatment or choose not to access it (eg, owing to its cost, duration, inconvenience, or concerns about privacy). Smartphone app–delivered ABM could offer a free, convenient intervention to reduce cravings and consumption that is accessible regardless of time and place, and during periods when support is most needed. Importantly, an ABM app could also easily be personalized (eg, allowing participants to select personally relevant images as training stimuli) and gamified (eg, by rewarding participants for the speed and accuracy of responses) to encourage engagement and training completion. Objective We aim to test the feasibility and acceptability of “SWIPE,” a gamified, personalized alcohol ABM smartphone app, assess its preliminary effectiveness, and explore in which populations the app shows the strongest indicators of effectiveness. Methods We aim to recruit 500 people who drink alcohol at hazardous or harmful levels (Alcohol Use Disorders Identification Test score≥8) and who wish to reduce their drinking. Recruitment will be conducted through social media and websites. The participants’ intended alcohol use goal (reduction or abstinence), motivation to change their consumption, and confidence to change their consumption will be measured prior to training. Participants will be instructed to download the SWIPE app and complete at least 2 ABM sessions per week for 4 weeks. Recruitment and completion rates will be used to assess feasibility. Four weeks after downloading SWIPE, participants will be asked to rate SWIPE’s functionality, esthetics, and quality to assess acceptability. Alcohol consumption, craving, and dependence will be measured prior to commencing the first session of ABM and 4 weeks later to assess whether these variables change significantly over the course of ABM. Results We expect to commence recruitment in August 2020 and complete data collection in March 2021. Conclusions This will be the first study to test the feasibility, acceptability, and preliminary effectiveness of a personalized, gamified ABM intervention smartphone app for hazardous or harmful drinkers. Results will inform further improvements to the app, as well as the design of a statistically powered randomized controlled trial to test its efficacy relative to a control condition. Ultimately, we hope that SWIPE will extend the benefits of ABM to the millions of individuals who consume alcohol at hazardous levels and wish to reduce their use but cannot or choose not to access treatment. Trial Registration Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12620000638932p; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12620000638932p International Registered Report Identifier (IRRID) PRR1-10.2196/21278
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Affiliation(s)
- Victoria Manning
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Richmond, Victoria, Australia.,Turning Point, Eastern Health, Richmond, Victoria, Australia
| | - Hugh Piercy
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Richmond, Victoria, Australia.,Turning Point, Eastern Health, Richmond, Victoria, Australia
| | - Joshua Benjamin Bernard Garfield
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Richmond, Victoria, Australia.,Turning Point, Eastern Health, Richmond, Victoria, Australia
| | - Dan Ian Lubman
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Richmond, Victoria, Australia.,Turning Point, Eastern Health, Richmond, Victoria, Australia
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29
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Anastasiadou D, Folkvord F, Brugnera A, Cañas Vinader L, SerranoTroncoso E, Carretero Jardí C, Linares Bertolin R, Muñoz Rodríguez R, Martínez Nuñez B, Graell Berna M, Torralbas-Ortega J, Torrent-Solà L, Puntí-Vidal J, Carrera Ferrer M, Muñoz Domenjó A, Diaz Marsa M, Gunnard K, Cusido J, Arcal Cunillera J, Lupiañez-Villanueva F. An mHealth intervention for the treatment of patients with an eating disorder: A multicenter randomized controlled trial. Int J Eat Disord 2020; 53:1120-1131. [PMID: 32383503 DOI: 10.1002/eat.23286] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 04/21/2020] [Accepted: 04/21/2020] [Indexed: 01/17/2023]
Abstract
OBJECTIVE The current multicentre randomized controlled trial assessed the clinical efficacy of a combined mHealth intervention for eating disorders (EDs) based on cognitive behavioral therapy (CBT). METHOD A total of 106 ED patients from eight different public and private mental health services in Spain were randomly assigned to two parallel groups. Patients of the experimental group (N = 53) received standard face-to-face CBT plus a mobile intervention through an application called "TCApp," which provides self-monitoring and an online chat with the therapist. The control group (N = 53) received standard face-to-face CBT only. Patients completed self-report questionnaires on ED symptomatology, anxiety, depression, and quality of life, before and after treatment. RESULTS Significant reductions in primary and secondary outcomes were observed for participants of both groups, with no differences between groups. Results also suggested that the frequency with which patients attended their referral mental health institution after the intervention was lower for patients in the experimental group than for those in the control group. DISCUSSION The current study showed that CBT can help to reduce symptoms relating to ED, regardless of whether its delivery includes online components in addition to traditional face-to-face treatment. Besides, the additional component offered by the TCApp does not appear to be promising from a purely therapeutic perspective but perhaps as a cost-effective tool, reducing thus the costs and time burden associated with weekly visits to health professionals.
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Affiliation(s)
- Dimitra Anastasiadou
- Department of Information and Communication Sciences, Universitat Oberta de Catalunya, Barcelona, Spain.,Open Evidence Research Group, Universitat Oberta de Catalunya, Barcelona, Spain
| | - Frans Folkvord
- Open Evidence Research Group, Universitat Oberta de Catalunya, Barcelona, Spain.,Tilburg School of Humanities and Digital Sciences, Tilburg University, Tilburg, The Netherlands
| | - Agostino Brugnera
- Department of Human and Social Sciences, University of Bergamo, Bergamo, Italy
| | - Laura Cañas Vinader
- Child and Adolescent Psychiatry and Psychology Department, Sant Joan de Déu Hospital of Barcelona, Esplugues de Llobregat, Spain.,Children and Adolescent Mental Health Research Group, Sant Joan de Déu Research Institut, Esplugues de Llobregat, Spain
| | - Eduardo SerranoTroncoso
- Child and Adolescent Psychiatry and Psychology Department, Sant Joan de Déu Hospital of Barcelona, Esplugues de Llobregat, Spain.,Children and Adolescent Mental Health Research Group, Sant Joan de Déu Research Institut, Esplugues de Llobregat, Spain
| | | | | | - Rudiger Muñoz Rodríguez
- Child and Adolescent Psychiatry and Psychology Service, Niño Jesús University Children's Hospital, Madrid, Spain
| | - Beatriz Martínez Nuñez
- Child and Adolescent Psychiatry and Psychology Service, Niño Jesús University Children's Hospital, Madrid, Spain
| | - Montserrat Graell Berna
- Child and Adolescent Psychiatry and Psychology Service, Niño Jesús University Children's Hospital, Madrid, Spain
| | - Jordi Torralbas-Ortega
- Child and Adolescent Mental Health Service, Parc Taulí Foundation, Research and Innovation Institute Parc Taulí (I3PT) - Autonomous University of Barcelona, Sabadell, Spain
| | - Lidia Torrent-Solà
- Child and Adolescent Mental Health Service, Parc Taulí Foundation, Research and Innovation Institute Parc Taulí (I3PT) - Autonomous University of Barcelona, Sabadell, Spain
| | - Joaquim Puntí-Vidal
- Child and Adolescent Mental Health Service, Parc Taulí Foundation, Research and Innovation Institute Parc Taulí (I3PT) - Autonomous University of Barcelona, Sabadell, Spain.,Department of Clinical and Health Psychology, Autonomous University of Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
| | - Maria Carrera Ferrer
- Eating Disorders Programme IBSMIA, University Hospital Son Espases, Palma de Mallorca, Spain
| | | | - Marina Diaz Marsa
- Eating Disorders Unit, San Carlos University Hospital, Madrid, Spain
| | - Katarina Gunnard
- Eating Disorders Unit, Quirón Dexeus University Hospital, Barcelona, Spain
| | - Jordi Cusido
- Board Member, HealthApp SL, Sabadell, Spain.,Department of Engineering Projects, Universitat Politècnica de Catalunya, Barcelona, Spain
| | - Jordina Arcal Cunillera
- Board Member, HealthApp SL, Sabadell, Spain.,Department of Engineering Projects, Universitat Politècnica de Catalunya, Barcelona, Spain
| | - Francisco Lupiañez-Villanueva
- Department of Information and Communication Sciences, Universitat Oberta de Catalunya, Barcelona, Spain.,Open Evidence Research Group, Universitat Oberta de Catalunya, Barcelona, Spain
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30
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Matheson BE, Bohon C, Lock J. Family-based treatment via videoconference: Clinical recommendations for treatment providers during COVID-19 and beyond. Int J Eat Disord 2020; 53:1142-1154. [PMID: 32533799 PMCID: PMC7323318 DOI: 10.1002/eat.23326] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 05/22/2020] [Accepted: 05/23/2020] [Indexed: 12/20/2022]
Abstract
The necessity to employ distance-based methods to deliver on-going eating disorder care due to the novel coronavirus (COVID-19) pandemic represents a dramatic and urgent shift in treatment delivery. Yet, TeleHealth treatments for eating disorders in youth have not been adequately researched or rigorously tested. Based on clinical experience within our clinic and research programs, we aim to highlight the common challenges clinicians may encounter in providing family-based treatment (FBT) via TeleHealth for children and adolescents with anorexia nervosa and bulimia nervosa. We also discuss possible solutions and offer practical considerations for providers delivering FBT in this format. Additional research in TeleHealth treatment for eating disorders in youth may lead to improved access, efficiency, and effectiveness of FBT delivered via videoconferencing.
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Affiliation(s)
- Brittany E. Matheson
- Department of Psychiatry and Behavioral SciencesStanford University School of MedicineStanfordCaliforniaUSA
| | - Cara Bohon
- Department of Psychiatry and Behavioral SciencesStanford University School of MedicineStanfordCaliforniaUSA
| | - James Lock
- Department of Psychiatry and Behavioral SciencesStanford University School of MedicineStanfordCaliforniaUSA
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31
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Keshen A, Helson T, Ali S, Dixon L, Tregarthen J, Town J. Efficacy and acceptability of self-monitoring via a smartphone application versus traditional paper records in an intensive outpatient eating disorder treatment setting. EUROPEAN EATING DISORDERS REVIEW 2020; 28:473-479. [PMID: 32050044 DOI: 10.1002/erv.2727] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 01/10/2020] [Accepted: 01/23/2020] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Although self-monitoring is an important part of eating disorder treatment, non-adherence is commonly observed among patients asked to maintain paper food records. This study aims to compare the efficacy and acceptability of electronic self-monitoring via Recovery Record to self-monitoring via traditional paper records, in an intensive outpatient (IOP) eating disorder treatment for adults. METHOD Ninety patients were recruited from an IOP eating disorder clinic and randomly assigned to the experimental or control condition. Those in the control condition received the standard treatment delivered by the IOP programme, including the use of paper records for self-monitoring. Those in the experimental condition received the same treatment but used Recovery Record for self-monitoring. RESULTS The results did not demonstrate statistically significant group differences over time on eating disorder symptomatology, and there were no statistically significant group differences on acceptability or adherence. CONCLUSIONS Our pilot efficacy data do not support superiority of the app over paper records in an IOP setting, so proceeding to a larger efficacy trial is not warranted. Future studies should aim to determine whether the app is efficacious as an adjunct to less intensive treatment or to further explore adherence and acceptability outcomes in studies with larger sample sizes. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02484794.
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Affiliation(s)
- Aaron Keshen
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada.,Eating Disorder Program, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Thomas Helson
- Eating Disorder Program, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Sarrah Ali
- Eating Disorder Program, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Laura Dixon
- Eating Disorder Program, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | | | - Joel Town
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
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32
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Hildebrandt T, Michaeledes A, Mayhew M, Greif R, Sysko R, Toro-Ramos T, DeBar L. Randomized Controlled Trial Comparing Health Coach-Delivered Smartphone-Guided Self-Help With Standard Care for Adults With Binge Eating. Am J Psychiatry 2020; 177:134-142. [PMID: 32008396 DOI: 10.1176/appi.ajp.2019.19020184] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Cognitive-behavioral therapy (CBT) has shown efficacy in the treatment of eating disorders. The authors conducted a randomized controlled telemedicine trial of CBT-guided self-help (CBT-GSH) assisted with a smartphone app, Noom Monitor, for binge eating with or without purging. They hypothesized that coach-delivered CBT-GSH telemedicine sessions plus Noom Monitor would yield greater reductions in symptoms of binge eating, purging, and eating disorders compared with standard care. METHODS Fifty-two-week outcomes for CBT-GSH plus Noom Monitor (N=114) were compared with outcomes for standard care (N=111) among members of an integrated health care system in the Pacific Northwest. Patients in the health system who met inclusion criteria were ≥18 years old, had a body mass index ≥18.5, met criteria for DSM-5 binge eating disorder or bulimia nervosa, had 12 months of continuous health care enrollment in Kaiser Permanente Northwest, and had a personal smartphone. Participants received eight CBT-GSH telemedicine sessions over 12 weeks administered by health coaches, and outcomes were assessed at baseline and at weeks 4, 8, 12, 26, and 52. The use of available treatment offered within the Kaiser Permanente health care system was permitted for participants assigned to standard care. RESULTS Participants who received CBT-GSH plus Noom Monitor reported significant reductions in objective binge-eating days (β=-0.66, 95% CI=-1.06, -0.25; Cohen's d=-1.46, 95% CI=-4.63, -1.09) and achieved higher rates of remission (56.7% compared with 30%; number needed to treat=3.74) at 52 weeks compared with participants in standard care, none of whom received any eating disorder treatment during the intervention period (baseline and weeks 1-12). Similar patterns emerged for compensatory behaviors (vomiting, use of laxatives, and excessive exercise; 76.3% compared with 56.8%; number needed to treat=5.11), eating disorder symptoms (body shape, weight, eating concerns, and dietary restraint), and clinical impairment (Cohen's d=-10.07, -2.15). CONCLUSIONS These results suggest that CBT-GSH plus Noom Monitor delivered via telemedicine by routine-practice health coaches in a nonacademic health care system yields reductions in symptoms and impairment over 52 weeks compared with standard care.
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Affiliation(s)
- Tom Hildebrandt
- The Department of Psychiatry, Eating and Weight Disorders Program, Icahn School of Medicine at Mount Sinai, New York (Hildebrandt, Greif, Sysko), Noom, Inc., New York (Michaeledes, Toro-Ramos); Kaiser Permanente Center for Health Research, Portland, Ore. (Mayhew); and Kaiser Permanente Washington Health Research Institute, Seattle (DeBar)
| | - Andreas Michaeledes
- The Department of Psychiatry, Eating and Weight Disorders Program, Icahn School of Medicine at Mount Sinai, New York (Hildebrandt, Greif, Sysko), Noom, Inc., New York (Michaeledes, Toro-Ramos); Kaiser Permanente Center for Health Research, Portland, Ore. (Mayhew); and Kaiser Permanente Washington Health Research Institute, Seattle (DeBar)
| | - Meghan Mayhew
- The Department of Psychiatry, Eating and Weight Disorders Program, Icahn School of Medicine at Mount Sinai, New York (Hildebrandt, Greif, Sysko), Noom, Inc., New York (Michaeledes, Toro-Ramos); Kaiser Permanente Center for Health Research, Portland, Ore. (Mayhew); and Kaiser Permanente Washington Health Research Institute, Seattle (DeBar)
| | - Rebecca Greif
- The Department of Psychiatry, Eating and Weight Disorders Program, Icahn School of Medicine at Mount Sinai, New York (Hildebrandt, Greif, Sysko), Noom, Inc., New York (Michaeledes, Toro-Ramos); Kaiser Permanente Center for Health Research, Portland, Ore. (Mayhew); and Kaiser Permanente Washington Health Research Institute, Seattle (DeBar)
| | - Robyn Sysko
- The Department of Psychiatry, Eating and Weight Disorders Program, Icahn School of Medicine at Mount Sinai, New York (Hildebrandt, Greif, Sysko), Noom, Inc., New York (Michaeledes, Toro-Ramos); Kaiser Permanente Center for Health Research, Portland, Ore. (Mayhew); and Kaiser Permanente Washington Health Research Institute, Seattle (DeBar)
| | - Tatiana Toro-Ramos
- The Department of Psychiatry, Eating and Weight Disorders Program, Icahn School of Medicine at Mount Sinai, New York (Hildebrandt, Greif, Sysko), Noom, Inc., New York (Michaeledes, Toro-Ramos); Kaiser Permanente Center for Health Research, Portland, Ore. (Mayhew); and Kaiser Permanente Washington Health Research Institute, Seattle (DeBar)
| | - Lynn DeBar
- The Department of Psychiatry, Eating and Weight Disorders Program, Icahn School of Medicine at Mount Sinai, New York (Hildebrandt, Greif, Sysko), Noom, Inc., New York (Michaeledes, Toro-Ramos); Kaiser Permanente Center for Health Research, Portland, Ore. (Mayhew); and Kaiser Permanente Washington Health Research Institute, Seattle (DeBar)
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Goreis A, Felnhofer A, Kafka JX, Probst T, Kothgassner OD. Efficacy of Self-Management Smartphone-Based Apps for Post-traumatic Stress Disorder Symptoms: A Systematic Review and Meta-Analysis. Front Neurosci 2020; 14:3. [PMID: 32038153 PMCID: PMC6992648 DOI: 10.3389/fnins.2020.00003] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 01/06/2020] [Indexed: 02/06/2023] Open
Abstract
Post-traumatic stress disorder (PTSD) symptoms are prevalent in both civilian and military service members. As the number of smartphone-based applications (apps) grows rapidly in health care, apps are also increasingly used to help individuals with subthreshold PTSD or full PTSD. Yet, if the apps are self-managed, the feasibility and efficacy of such interventions are still rather unclear in these two populations with PTSD symptoms. Hence, the present meta-analysis set out to evaluate the effect of self-management smartphone-based apps on PTSD and depressive symptoms in populations with subthreshold PTSD or full PTSD. Studies were included if they conducted randomized controlled trials or pre-post comparisons. Six studies (n = 2 randomized controlled trials) were identified for meta-analysis. In pre-post comparisons, N = 209 participants were included in the analyses. In randomized controlled trials, N = 87 participants received smartphone-based self-management interventions and N = 82 participants were in waitlist control conditions. Meta-analysis for pre-post comparisons concluded an effect of g = 0.55 (p < 0.001) regarding the overall reduction in PTSD symptoms (n = 6) and g = 0.45 (p < 0.001) for reduction in depressive symptoms (n = 5). Yet, in randomized controlled trials, no significant difference was found between app-based treatment and waitlist control groups (g = 0.09, p = 0.574). The duration of the interventions did not significantly influence the results. Overall, despite positive pre-post effects, current results indicate that smartphone-apps for PTSD patients are not significantly more effective than waitlist control conditions. Nevertheless, a combined smartphone and standard therapy approach may be a fruitful field for future research.
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Affiliation(s)
- Andreas Goreis
- Department for Clinical and Health Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria.,Outpatient Unit for Research, Teaching and Practice, Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Anna Felnhofer
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Johanna Xenia Kafka
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Thomas Probst
- Department for Psychotherapy and Biopsychosocial Health, Danube University Krems, Krems, Austria
| | - Oswald D Kothgassner
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
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Abstract
PURPOSE OF REVIEW The traditional model of treatment delivery, based on a psychotherapeutic intervention delivered by a trained professional, in a one-to-one relationship, occurring in a treatment setting context (e.g., clinic, private office, and hospital), highly restricts access to the best standards of care to all of those in need.In this article, we will be focusing on treatment delivering methods for eating disorders that depart from the traditional mode of delivery. We will focus on the use of self-help strategies, both in a pure self-help format, and with external minimal support, guided self-help. We will additionally review the evidence on the use of internet and mobile technology (m-Health) for delivering treatment. RECENT FINDINGS Internet-based self-help interventions based on cognitive behavioral approaches have shown to be superior to no treatment for patients diagnosed with bulimia nervosa, binge eating disorder, and other specified feeding or eating disorders with binge/purge characteristics. Although face-to-face, traditional, interventions seem to be more effective than internet-based ones, the latter might have cost benefits and constitute a viable first line of treatment in a stepped care model, or as an alternative to a waitlist while treatment is not available. Other forms of mobile health (e.g., mobile apps) have experienced a surge but remain under researched. SUMMARY Mobile health and the internet are promising media for delivering eating disorder treatment. However, more research is needed to determine the utility of internet-based treatments by comparing them to traditional face-to-face treatments for eating disorders, and explore the moderators and mediators impacting adherence and outcome.
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Neumayr C, Voderholzer U, Tregarthen J, Schlegl S. Improving aftercare with technology for anorexia nervosa after intensive inpatient treatment: A pilot randomized controlled trial with a therapist-guided smartphone app. Int J Eat Disord 2019; 52:1191-1201. [PMID: 31429974 DOI: 10.1002/eat.23152] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 07/25/2019] [Accepted: 07/31/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To evaluate the feasibility, acceptability, and preliminary efficacy of an innovative therapist-guided smartphone-based aftercare intervention following inpatient treatment of patients with severe anorexia nervosa (AN). METHOD Forty female patients with AN (ICD-10: F50.0/F50.1) (aged: 15-36 years) were randomized either to an 8-week smartphone-based aftercare intervention (German version of "Recovery Record") with therapist feedback as an adjunct to treatment as usual (intervention group [IG]) or to treatment as usual alone (control group [CG]). Body mass index (BMI) and eating disorder (ED) symptoms were assessed at discharge (baseline), postintervention (after 8 weeks), and at 6-month follow-up. Additionally, patients' satisfaction, adherence to the smartphone-based intervention, and postdischarge health care utilization were evaluated. RESULTS Patients showed a high level of adherence and reported a very high acceptance of the app and the aftercare intervention. We found at postintervention nonsignificant small to moderate between-group effect sizes favoring the IG regarding BMI (d = -0.24; 95% confidence interval [CI] [-0.90, 0.41]) and ED symptoms (Eating Disorder Examination-Questionnaire global: d = 0.56; 95% CI [-0.10, 1.22]). At 6-month follow-up, effects wore off and no significant differences between the IG and CG were evident. DISCUSSION This was the first study to evaluate a therapist-guided smartphone-based aftercare intervention for discharged inpatients with AN. Results suggest that such an intervention is highly accepted by patients and that it could support symptom stabilization or continued improvement as an add-on therapy to treatment as usual. A larger scale randomized controlled trial is now planned to further evaluate the efficacy of this aftercare intervention for patients with AN.
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Affiliation(s)
| | - Ulrich Voderholzer
- Schoen Clinic Roseneck, Prien am Chiemsee, Germany.,Department of Psychiatry and Psychotherapy, University Hospital of Freiburg, Freiburg, Germany.,Department of Psychiatry and Psychotherapy, Ludwig Maximilian University (LMU), Munich, Germany
| | | | - Sandra Schlegl
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University (LMU), Munich, Germany
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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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Robillard JM, Feng TL, Sporn AB, Lai JA, Lo C, Ta M, Nadler R. Availability, readability, and content of privacy policies and terms of agreements of mental health apps. Internet Interv 2019; 17:100243. [PMID: 30949436 PMCID: PMC6430038 DOI: 10.1016/j.invent.2019.100243] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 02/18/2019] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To assess the availability, readability, and privacy-related content of the privacy policies and terms of agreement of mental health apps available through popular digital stores. MATERIALS AND METHODS Popular smartphone app stores were searched using combinations of keywords "track" and "mood" and their synonyms. The first 100 apps from each search were evaluated for inclusion and exclusion criteria. Apps were assessed for availability of a privacy policy (PP) and terms of agreement (ToA) and if available, these documents were evaluated for both content and readability. RESULTS Most of the apps collected in the sample did not include a PP or ToA. PPs could be accessed for 18% of iOS apps and 4% of Android apps; whereas ToAs were available for 15% of iOS and 3% of Android apps. Many PPs stated that users' information may be shared with third parties (71% iOS, 46% Android). DISCUSSION Results demonstrate that information collection is occurring with the majority of apps that allow users to track the status of their mental health. Most of the apps collected in the initial sample did not include a PP or ToA despite this being a requirement by the store. The majority of PPs and ToAs that were evaluated are written at a post-secondary reading level and disclose that extensive data collection is occurring. CONCLUSION Our findings raise concerns about consent, transparency, and data sharing associated with mental health apps and highlight the importance of improved regulation in the mobile app environment.
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Affiliation(s)
- Julie M. Robillard
- Division of Neurology, Department of Medicine, The University of British Columbia, B404 - 4480 Oak Street, Vancouver, BC V6H 3N1, Canada
| | - Tanya L. Feng
- Division of Neurology, Department of Medicine, The University of British Columbia, B404 - 4480 Oak Street, Vancouver, BC V6H 3N1, Canada
| | - Arlo B. Sporn
- Division of Neurology, Department of Medicine, The University of British Columbia, B404 - 4480 Oak Street, Vancouver, BC V6H 3N1, Canada
| | - Jen-Ai Lai
- Division of Neurology, Department of Medicine, The University of British Columbia, B404 - 4480 Oak Street, Vancouver, BC V6H 3N1, Canada
| | - Cody Lo
- Division of Neurology, Department of Medicine, The University of British Columbia, B404 - 4480 Oak Street, Vancouver, BC V6H 3N1, Canada
| | - Monica Ta
- Division of Neurology, Department of Medicine, The University of British Columbia, B404 - 4480 Oak Street, Vancouver, BC V6H 3N1, Canada
| | - Roland Nadler
- University of Ottawa Centre for Health Law, Policy and Ethics, Common Law Section, Faculty of Law, University of Ottawa, 57 Louis Pasteur (Fauteux Hall), Ottawa, ON K1N 6N5, Canada
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Abstract
Binge eating disorder (BED) is the most common type of eating disorder. According to the most recent data available, the estimated lifetime prevalence of BED among US adults in the general population is 0.85% (men 0.42% and women 1.25%). Among psychiatric treatment populations, prevalence is several-fold higher. Although many people with BED are obese (BMI ≥ 30 kg/m2), roughly half are not. In the DSM-5, BED is defined by recurrent episodes of binge eating (eating in a discrete period of time, an amount of food larger than most people would eat in a similar amount of time under similar circumstances and a sense of lack of control over eating during the episode), occurring on average at least once a week for 3 months, and associated with marked distress. BED often goes unrecognized and thus untreated; in one study, 344 of 22,387 (1.5%) survey respondents met DSM-5 criteria for BED, but only 11 out of the 344 had ever been diagnosed with BED by a health-care provider. Psychiatric comorbidities are very common, with most adults with BED also experiencing anxiety disorders, mood disorders, impulse control disorders, or substance use disorders, suggesting that clinicians have patients in their practice with unrecognized BED. Multiple neurobiological explanations have been suggested for BED, including dysregulation in reward center and impulse control circuitry. Additionally, there is interplay between genetic influences and environmental stressors. Psychological treatments such as cognitive behavioral interventions have been recommended as first line and are supported by meta-analytic reviews; however, access to such treatments may be limited because of local availability and/or cost, and these treatments generally lead to little to no weight loss, although successfully eliminating binge eating can protect against future weight gain. Routine medication treatments for anxiety and depression do not necessarily ameliorate the symptoms of BED, but there are approved and emerging medication options, lisdexamfetamine and dasotraline, respectively, that specifically address the core drivers behind binge eating, namely obsessive thoughts and compulsive behaviors regarding food, resulting in marked decreases in binge eating behaviors as well as weight loss.
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Anastasiadou D, Folkvord F, Serrano-Troncoso E, Lupiañez-Villanueva F. Mobile Health Adoption in Mental Health: User Experience of a Mobile Health App for Patients With an Eating Disorder. JMIR Mhealth Uhealth 2019; 7:e12920. [PMID: 31199329 PMCID: PMC6592393 DOI: 10.2196/12920] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 03/19/2019] [Accepted: 04/23/2019] [Indexed: 12/19/2022] Open
Abstract
Background Despite the worldwide growth in mobile health (mHealth) tools and the possible benefits for both patients and health care providers, the overall adoption levels of mHealth tools by health professionals remain relatively low. Objective This study aimed (1) to investigate attitudes of health care providers and mHealth experts toward mHealth tools in the health context in general, and this study aimed (2) to test the acceptability and feasibility of a specific mHealth tool for patients with an eating disorder (ED), called TCApp, among patients and ED specialists. Methods To this purpose, we conducted an explorative qualitative study with 4 in-depth group discussions with several groups of stakeholders: our first focus group was conducted with 11 experts on mHealth from the Catalan Association of Health Entities; the second focus group included 10 health care professionals from the Spanish College of Doctors of Barcelona; the third focus group involved 9 patients with an ED who had used the TCApp over a 12-week period, and the fourth and last focus group involved 8 ED specialists who had monitored such ED patients on the Web. Results The focus groups showed that health care providers and mHealth experts reported barriers for mHealth adoption more often than facilitators, indicating that mHealth techniques are difficult to obtain and use. Most barriers were attributed to external factors relating to the human or organizational environment (ie, lack of time because of workload, lack of direct interest on a legislative or political level) rather than being attributed to internal factors relating to individual obstacles. The results of the mHealth intervention study indicate that the TCApp was considered as easy to use and useful, although patients and the ED specialists monitoring them on the Web reported different adoption problems, such as the inability to personalize the app, a lack of motivational and interactive components, or difficulties in adhering to the study protocol. Conclusions In general, this paper indicates that both health professionals and patients foresee difficulties that need to be addressed before comprehensive adoption and usage of mHealth techniques can be effectively implemented. Such findings are in line with previous studies, suggesting that although they acknowledge their possible benefits and cost-effectiveness, health care providers are quite resistant and conservative about integrating mHealth technologies in their daily practice.
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Affiliation(s)
- Dimitra Anastasiadou
- Department of Information and Communication Sciences, Universitat Oberta de Catalunya, Barcelona, Spain.,Open Evidence Research, Barcelona, Spain
| | - Frans Folkvord
- Open Evidence Research, Barcelona, Spain.,School of Humanities and Digital Sciences, Tilburg University, Tilburg, Netherlands
| | - Eduardo Serrano-Troncoso
- Child and Adolescent Psychiatry and Psychology Department, Hospital Sant Joan de Déu of Barcelona, Barcelona, Spain.,Children and Adolescent Mental Health Research Group, Institut de Recerca Sant Joan de Déu, Barcelona, Spain
| | - Francisco Lupiañez-Villanueva
- Department of Information and Communication Sciences, Universitat Oberta de Catalunya, Barcelona, Spain.,Open Evidence Research, Barcelona, Spain
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Srinivas P, Bodke K, Ofner S, Keith NR, Tu W, Clark DO. Context-Sensitive Ecological Momentary Assessment: Application of User-Centered Design for Improving User Satisfaction and Engagement During Self-Report. JMIR Mhealth Uhealth 2019; 7:e10894. [PMID: 30942698 PMCID: PMC6468333 DOI: 10.2196/10894] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 11/30/2018] [Accepted: 12/31/2018] [Indexed: 01/19/2023] Open
Abstract
Background Ecological momentary assessment (EMA) can be a useful tool for collecting real-time behavioral data in studies of health and health behavior. However, EMA administered through mobile technology can be burdensome, and it tends to suffer from suboptimal user engagement, particularly in low health-literacy populations. Objective This study aimed to report a case study involving the design and evaluation of a mobile EMA tool that supports context-sensitive EMA-reporting of location and social situations accompanying eating and sedentary behavior. Methods An iterative, user-centered design process with obese, middle-aged women seeking care in a safety-net health system was used to identify the preferred format of self-report measures and the look, feel, and interaction of the mobile EMA tool. A single-arm feasibility field trial with 21 participants receiving 12 prompts each day for momentary self-reports over a 4-week period (336 total prompts per participant) was used to determine user satisfaction with interface quality and user engagement, operationalized as response rate. A second trial among 38 different participants randomized to receive or not to receive a feature designed to improve engagement was conducted. Results The feasibility trial results showed high interface satisfaction and engagement, with an average response rate of 50% over 4 weeks. Qualitative feedback pointed to the need for auditory alerts. We settled on 3 alerts at 10-min intervals to accompany each EMA-reporting prompt. The second trial testing this feature showed a statistically significant increase in the response rate between participants randomized to receive repeat auditory alerts versus those who were not (60% vs 40%). Conclusions This paper reviews the design research and a set of design constraints that may be considered in the creation of mobile EMA interfaces personalized to users’ preferences. Novel aspects of the study include the involvement of low health-literacy adults in design research, the capture of data on time, place, and social context of eating and sedentary behavior, and reporting prompts tailored to an individual’s location and schedule. Trial Registration ClinicalTrials.gov NCT03083964; https://clinicaltrials.gov/ct2/show/NCT03083964
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Affiliation(s)
- Preethi Srinivas
- Indiana University, Center for Aging Research, Indianapolis, IN, United States.,Regenstrief Institute, Indianapolis, IN, United States
| | - Kunal Bodke
- Indiana University, Center for Aging Research, Indianapolis, IN, United States.,Regenstrief Institute, Indianapolis, IN, United States
| | - Susan Ofner
- Indiana University, School of Medicine, Department of Biostatistics, Indianapolis, IN, United States
| | - NiCole R Keith
- Indiana University, Center for Aging Research, Indianapolis, IN, United States.,Regenstrief Institute, Indianapolis, IN, United States.,Indiana University, School of Health and Human Sciences, Department of Kinesiology, Indianapolis, IN, United States
| | - Wanzhu Tu
- Indiana University, Center for Aging Research, Indianapolis, IN, United States.,Indiana University, School of Medicine, Department of Biostatistics, Indianapolis, IN, United States
| | - Daniel O Clark
- Indiana University, Center for Aging Research, Indianapolis, IN, United States.,Regenstrief Institute, Indianapolis, IN, United States.,Indiana University, School of Medicine, Department of Medicine, Indianapolis, IN, United States
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Gonçalves RFDM, Barreto DDA, Monteiro PI, Zangeronimo MG, Castelo PM, van der Bilt A, Pereira LJ. Smartphone use while eating increases caloric ingestion. Physiol Behav 2019; 204:93-99. [PMID: 30776379 DOI: 10.1016/j.physbeh.2019.02.021] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 02/12/2019] [Accepted: 02/14/2019] [Indexed: 12/28/2022]
Abstract
The use of smartphones during meals may possibly influence the number of ingested calories. We evaluated the influence of smartphones' distraction during eating on caloric intake. Physical (masticatory parameters, sex and body mass index - BMI); environmental (with or without distraction) and psychological (stress levels) variables were evaluated as confounding factors. Sixty-two adults were recruited for experimental snack tests performed on four different days. At baseline, we evaluated masticatory performance, swallowing threshold, masticatory frequency and body mass index (BMI). In the following three sessions, volunteers were presented a snack test in which participants ate under three experimental conditions: no distraction, using their smartphones, or reading a printed text. At the end of each session, total and nutritional compound stratified caloric intake was measured. Three-way mixed model ANOVA was used to test the effect of experimental condition on the total, carbohydrate and lipid caloric intakes. Hierarchical multiple linear regression models were used to estimate the influence of confounding factors on the total caloric intake. We found an effect of the condition (no distraction, smartphone or reading) on the total caloric (p = .007) and lipid intake (p = .002). When eating without distraction, the mean caloric intake was 535 (±164) kcal, in comparison to 591 (±203) kcal using smartphone (p = .05) and 622 (±226) kcal (p = .002) reading a text (no significant difference between distracters). Eating with distracters increased approximately 15% caloric ingestion. An interaction condition*sex effect was observed on lipid intake (p = .020). Energy intake was found to be dependent on sex and age, in which older men ingested more calories. Smartphone use during a meal increased caloric and lipid intake, depending on sex and age in young adults with complete dentition.
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Affiliation(s)
| | | | - Pâmela Ione Monteiro
- Health Sciences Department, Universidade Federal de Lavras, Lavras (UFLA), Minas Gerais, Brazil
| | | | - Paula Midori Castelo
- Department of Pharmaceutical Sciences, Universidade Federal de São Paulo (UNIFESP), Diadema, São Paulo, Brazil
| | - Andries van der Bilt
- Department of Oral-Maxillofacial Surgery, Prosthodontics and Special Dental Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Luciano José Pereira
- Health Sciences Department, Universidade Federal de Lavras, Lavras (UFLA), Minas Gerais, Brazil.
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Eikey EV, Booth KM, Chen Y, Zheng K. The Use of General Health Apps Among Users with Specific Conditions: Why College Women with Disordered Eating Adopt Food Diary Apps. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2018; 2018:1243-1252. [PMID: 30815166 PMCID: PMC6371267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
There is a myriad of mobile health applications designed to address a variety of health conditions. While these apps hold significant promise for the management of these conditions, users sometimes turn to general health apps, rather than those designed with their specific condition in mind, which can lead to unmet needs and worsened conditions. We outline one example by focusing on college women with disordered eating behaviors and their use of general food diary apps, rather than eating disorder-specific apps. We investigate the types of health apps they use and how they choose them, focusing on the role of motivations and search behavior. We found their initial motivation informs their search process, which results in their selection of general food diary apps. Researchers should consider app adoption as influenced by user motivations and navigation behavior, particularly when determining how and why general apps are used and how clinicians can help.
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Affiliation(s)
| | - Kayla M Booth
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Yunan Chen
- University of California, Irvine, Irvine, California, USA
| | - Kai Zheng
- University of California, Irvine, Irvine, California, USA
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Embacher Martin K, McGloin R, Atkin D. Body dissatisfaction, neuroticism, and female sex as predictors of calorie-tracking app use amongst college students. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2018; 66:608-616. [PMID: 29405860 DOI: 10.1080/07448481.2018.1431905] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 11/15/2017] [Accepted: 01/09/2018] [Indexed: 06/07/2023]
Abstract
Objective: This study investigated body dissatisfaction, neuroticism, and sex as potential predictors of calorie-tracking app usage amongst undergraduate college students. Participants: College students (N = 491) were recruited from a large northeastern university in October 2015. Methods: Participants completed an online survey asking about their sex, body dissatisfaction, neuroticism, and use of apps that track calories. Results: Analyses revealed that female sex and body dissatisfaction-but not neuroticism-were direct predictors of calorie-tracking app usage. Analyses also provided support for a causal sequence wherein neuroticism and body dissatisfaction mediate, in serial, the relationship between female sex and calorie-tracking app usage. Conclusions: The results from this study suggest that female college students are more likely to use calorie-tracking apps-a phenomenon which may be attributable to their higher levels of neuroticism and subsequent increased body dissatisfaction.
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Affiliation(s)
| | - Rory McGloin
- a University of Connecticut , Department of Communication in Storrs , Connecticut , USA
| | - David Atkin
- a University of Connecticut , Department of Communication in Storrs , Connecticut , USA
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Sinha Deb K, Tuli A, Sood M, Chadda R, Verma R, Kumar S, Ganesh R, Singh P. Is India ready for mental health apps (MHApps)? A quantitative-qualitative exploration of caregivers' perspective on smartphone-based solutions for managing severe mental illnesses in low resource settings. PLoS One 2018; 13:e0203353. [PMID: 30231056 PMCID: PMC6145572 DOI: 10.1371/journal.pone.0203353] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Accepted: 08/20/2018] [Indexed: 02/06/2023] Open
Abstract
Background Mobile application based delivery of psycho-social interventions may help reduce the treatment gap for severe mental illnesses (SMIs) and decrease the burden on caregivers. Apps developed in high income settings show effectiveness, but they suffer from lack of applicability in low resource scenarios due to the difference in technology penetration, affordability, and acceptance. Objective This study aimed to understand health technology usage, perceived needs, and acceptability of app based interventions in patients with SMIs to improve illness management and reduce caregiver burden. Methods The study was conducted in inpatient and outpatient settings of a tertiary care center in North India. A cross-sectional survey assessed smartphone and health app usage. Further, three focus group discussions evaluated the needs and apprehensions in using apps in management of SMIs. Results A total of 176 participants including 88 patients and 88 caregivers completed the survey. Smartphone ownership was similar to the national average (30%) in both caregivers (38.6%) and in patients (31.8%). Although subjects regularly used a third party app, health app usage was very low. Cost, unfamiliarity, and language were significant barriers to adoption. The focus group discussions provided insight into the various apprehensions of caregivers in using and in allowing patients to use smartphones and such apps. Caregivers wanted mobile apps for accessing information regarding services and resources available for people with SMI, and they felt such apps can be helpful if they could automate some of their routine caregiving activities. However, the significant difficulty was perceived in regards to the cost of the device, language of the medium, and unfamiliarity in using technology. Apprehensions that SMI patients might misuse technology, or damage the device were also prevalent. Conclusions The study systematically looks into the scope, design considerations and limitations of implementing a mobile technology based intervention for low resource settings. With only one-third of the patients and caregivers having access to smartphones and internet, parallel outreach strategies like IVRS should be actively considered while designing interventions. The difficulty of understanding and searching in a non-native language needs to be addressed. Hand holding of caregivers and frequent encouragement from treating doctors might significantly help in technology adoption and in surmounting the apprehensions related to using technology. To make the solution acceptable and useful to the already over-burdened caregivers, developers need to work closely with patients’ family members and follow a ground-up collaborative approach to app development. The scope of delivering mental health services through technology is immense in resource constrained settings like India, provided we, researchers, appreciate and accept the fact that in the varied landscape of a divergent economic, educational, and cultural milieu, a single solution will never suffice for all, and intervention modality matching with end user capacity will be of paramount importance in determining the success of the endeavor.
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Affiliation(s)
| | - Anupriya Tuli
- Department of Computer Science, IIIT-Delhi, Delhi, India
| | - Mamta Sood
- Department of Psychiatry, AIIMS, New Delhi, India
| | | | - Rohit Verma
- Department of Psychiatry, AIIMS, New Delhi, India
| | | | - Ragul Ganesh
- Department of Psychiatry, AIIMS, New Delhi, India
| | - Pushpendra Singh
- Department of Computer Science, IIIT-Delhi, Delhi, India
- * E-mail:
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Magee JC, Adut S, Brazill K, Warnick S. Mobile App Tools for Identifying and Managing Mental Health Disorders in Primary Care. CURRENT TREATMENT OPTIONS IN PSYCHIATRY 2018; 5:345-362. [PMID: 30397577 PMCID: PMC6214367 DOI: 10.1007/s40501-018-0154-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW Mental health apps are intriguing yet challenging tools for addressing barriers to treatment in primary care. In the current review, we seek to assist primary care professionals with evaluating and integrating mental health apps into practice. We briefly summarize two leading frameworks for evaluating mental health apps and conduct a systematic review of mental health apps across a variety of areas commonly encountered in primary care. RECENT FINDINGS Existing frameworks can guide professionals and patients through the process of identifying apps and evaluating dimensions such as privacy and security, credibility, and user experience. For specific apps, several problem areas appear to have relatively more scientific evaluation in the current app landscape, including PTSD, smoking, and alcohol use. Other areas such as eating disorders not only lack evaluation, but contain a significant subset of apps providing potentially harmful advice. SUMMARY Overall, individuals seeking mental health apps will likely encounter strengths such as symptom tracking and psychoeducational components, while encountering common weaknesses such as insufficient privacy settings and little integration of empirically-supported techniques. While mental health apps may have more promise than ever, significant barriers to finding functional, usable, effective apps remain for health professionals and patients alike.
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Affiliation(s)
- Joshua C Magee
- Miami University, Department of Psychology, 90 North Patterson Ave., Oxford, OH 45056
| | - Sarah Adut
- Miami University, Department of Psychology, 90 North Patterson Ave., Oxford, OH 45056
| | - Kevin Brazill
- University of Illinois College of Medicine at Urbana-Champaign/Carle Physician Group, Department of Family Medicine and Department of Psychiatry, 611 West Park St., Urbana, IL 61801
| | - Stephen Warnick
- University of Michigan Medical School, Department of Family Medicine and Department of Psychiatry, 1150 W. Medical Center Dr., M7300 Med Sci I, SPC 5625, Ann Arbor, MI 48109-5625
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Kim JP, Sadeh-Sharvit S, Darcy AM, Neri E, Vierhile M, Robinson A, Tregarthen J, Lock JD. The Utility and Acceptability of a Self-Help Smartphone Application for Eating Disorder Behaviors. JOURNAL OF TECHNOLOGY IN BEHAVIORAL SCIENCE 2018; 3:161-164. [PMID: 30374444 PMCID: PMC6203337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Smartphone applications (apps) for eating disorders are a promising approach to assist individuals who do not receive traditional treatment. This study examines usage characteristics, perceptions regarding the acceptability of a new self-help intervention developed for users with eating disorders, and associations between attitudes and use patterns. METHODS 189 individuals pilot-tested a personalized app-based program, and 133 completed the required components of the pilot-test over an 8-day period. Of these, 64 individuals (49%) completed an exit survey pertaining to acceptability. RESULTS Seventy percent of those who pilot-tested the app-based program completed the required components, i.e. a baseline review and then a 1-week assessment. Body mass index was associated with the total number of recorded meal logs. Study participants rated the app as highly suitable and acceptable, providing evidence of the feasibility and appropriateness of the program. CONCLUSION The app-based program demonstrated feasibility of deploying the app across user groups and high acceptability.
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Affiliation(s)
- Jane Paik Kim
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California
| | - Shiri Sadeh-Sharvit
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California
| | - Alison M. Darcy
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California
| | - Eric Neri
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California
| | - Molly Vierhile
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California
| | - Athena Robinson
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California
| | | | - James D. Lock
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California
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Abstract
PURPOSE OF REVIEW Mental health clinicians should understand how technologies augment, enhance, and provide alternate means for the delivery of mental healthcare. These technologies can be used asynchronously, in which the patient and the clinician need not be communicating at the same time. This contrasts with synchronous technologies, in which patient and clinician must communicate at the same time. RECENT FINDINGS The review is based on research literature and the authors' clinical and healthcare administration experiences. Asynchronous technologies can exist between a single clinician and a single patient, such as patient portal e-mail and messaging, in-app messaging, asynchronous telepsychiatry via store-and-forward video, and specialty patient-to-provider mobile apps. Asynchronous technologies have already been used in different countries with success, and can alleviate the psychiatric workforce shortage and improve barriers to access. Multiple studies referred to in this review demonstrate good retention and acceptability of asynchronous psychotherapy interventions by patients. Asynchronous technologies can alleviate access barriers, such as geographical, scheduling, administrative, and financial issues. It is important for clinicians to understand the efficacy, assess the ethics, and manage privacy and legal concerns that may arise from using asynchronous technologies.
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Juarascio AS, Parker MN, Lagacey MA, Godfrey KM. Just-in-time adaptive interventions: A novel approach for enhancing skill utilization and acquisition in cognitive behavioral therapy for eating disorders. Int J Eat Disord 2018; 51:826-830. [PMID: 30051495 PMCID: PMC6492029 DOI: 10.1002/eat.22924] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 06/10/2018] [Accepted: 06/17/2018] [Indexed: 12/18/2022]
Abstract
The most widely researched treatment for bulimia nervosa (BN) and binge-eating disorder (BED) is cognitive behavioral therapy (CBT), a present-focused, active, skill-oriented treatment. However, despite the success of CBT, many patients fail to achieve sufficient rates of skill utilization (i.e., the frequency with which a patient practices or uses therapeutic skills) or adequate skill acquisition (i.e., the ability to successfully perform a skill learned in treatment) by the end of treatment and outcomes suffer as a result. One method for improving skill acquisition and utilization in patients with BN or BED could be the augmentation of in-person treatment with just-in-time adaptive interventions (JITAIs), which use smartphone technology to deliver real-time interventions during app-identified moments of need. The current article discusses how novel JITAI systems that utilize machine learning or other predictive algorithms could be used to detect momentary risk for eating disordered behavior and provide tailored interventions to enhance outcomes. We will consider technologies that may help reduce patient burden and suggest avenues for future research on developing acceptable and effective JITAIs that can be used as an adjunct to CBT protocols.
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Affiliation(s)
| | - Megan N. Parker
- Department of Psychology; Drexel University; Philadelphia Pennsylvania
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Basterfield A, Dimitropoulos G, Bills D, Cullen O, Freeman VE. "I would love to have online support but I don't trust it": Positive and negative views of technology from the perspective of those with eating disorders in Canada. HEALTH & SOCIAL CARE IN THE COMMUNITY 2018; 26:604-612. [PMID: 29498122 DOI: 10.1111/hsc.12557] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/13/2018] [Indexed: 06/08/2023]
Abstract
This qualitative study aims to explore how individuals who are seeking help and support for eating disorders use various forms of technology. Fifteen participants, recruited from an Eating Disorder Program in a hospital setting and an eating disorder community support centre, voluntarily participated in focus groups and individual interviews in 2015. The authors used thematic analysis to code and analyse the qualitative data, and three themes were identified: safety, connection and technology development. This study identifies the need for technology use to be addressed and integrated into clinical services for eating disorders, as well as for safe and helpful technology tools to be developed for this population.
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Affiliation(s)
- Annie Basterfield
- Bariatric Surgery Program, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Gina Dimitropoulos
- Eating Disorder Program, Toronto General Hospital, University Health Network, Toronto, ON, Canada
- Faculty of Social Work, University of Calgary, Calgary, AB, Canada
- Matheson Centre for Mental Health Research Education, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, Calgary, AB, Canada
| | - Donna Bills
- Eating Disorders Program, Lakeridge Health, Oshawa, ON, Canada
| | - Olivia Cullen
- Faculty of Social Work, University of Calgary, Calgary, AB, Canada
| | - Victoria E Freeman
- Eating Disorder Program, Toronto General Hospital, University Health Network, Toronto, ON, Canada
- Young Adults Eating Disorders Program, Southlake Regional Health Centre, Newmarket, ON, Canada
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Sadeh-Sharvit S, Kim JP, Darcy AM, Neri E, Vierhile M, Robinson A, Tregarthen J, Lock JD. Subgrouping the users of a specialized app for eating disorders. Eat Disord 2018; 26:361-372. [PMID: 29452025 DOI: 10.1080/10640266.2018.1440043] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Although mobile technologies for eating disorders (EDs) are burgeoning, there is limited data about the clinical characteristics of individuals using specialized smartphone applications (apps) without accompanying traditional forms of treatment. This study evaluated whether the users of an ED app cluster in clinically meaningful groups. Participants were 1,280 app users (91.3% female; mean age 27) who reported not being in a weekly treatment for their ED. A hierarchical cluster analysis distinguished five groups of participants, all approximating DSM-5 ED categories. One cluster comprised of non-female, ethnically diverse users with Bulimia Nervosa features. Findings suggest that app users resemble known patient classifications.
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Affiliation(s)
- Shiri Sadeh-Sharvit
- a Department of Psychiatry and Behavioral Sciences , Stanford University , Stanford , California , USA
| | - Jane Paik Kim
- a Department of Psychiatry and Behavioral Sciences , Stanford University , Stanford , California , USA
| | - Alison M Darcy
- a Department of Psychiatry and Behavioral Sciences , Stanford University , Stanford , California , USA
| | - Eric Neri
- a Department of Psychiatry and Behavioral Sciences , Stanford University , Stanford , California , USA
| | - Molly Vierhile
- a Department of Psychiatry and Behavioral Sciences , Stanford University , Stanford , California , USA
| | - Athena Robinson
- a Department of Psychiatry and Behavioral Sciences , Stanford University , Stanford , California , USA
| | | | - James D Lock
- a Department of Psychiatry and Behavioral Sciences , Stanford University , Stanford , California , USA
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