1
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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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2
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Mensinger JL. Traumatic stress, body shame, and internalized weight stigma as mediators of change in disordered eating: a single-arm pilot study of the Body Trust® framework. Eat Disord 2022; 30:618-646. [PMID: 34634212 DOI: 10.1080/10640266.2021.1985807] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
To enhance access to evidence-based treatment it is increasingly important to evaluate scalable virtual programs that support the needs of those struggling with disordered eating. This study described a scientifically grounded, trauma-informed framework known as Body Trust,® and aimed to pilot test the preliminary effectiveness and mechanisms of change in a Body Trust® program to improve disordered eating. Using quality outcomes data, we examined 70 mostly white (87%) female-identifying (97%) individuals enrolled in a 6-module online program based in the Body Trust® framework (Mage = 45.5 ±10.9; MBMI = 33.7 ±8.0). Putative mediators included traumatic stress, internalized weight stigma, and body shame. Outcomes were objective and subjective binge episodes, overvaluation of weight and shape, and eating concerns. Generalized estimating equations were applied to determine pre-to-post changes. We applied Montoya's MEMORE macro, the joint-significance test, and calculated 95% Monte Carlo confidence intervals to assess mediation. Significant pre-to-post improvements with medium to large effect sizes were detected for all outcomes and mediators (ps<.008). All hypothesized mechanisms supported mediation. Using the Body Trust® framework shows early promise for alleviating disordered eating symptoms through targeting traumatic stress, body shame, and internalized weight stigma. Given the program's use of mindfulness techniques, future research should test target mechanisms like interoception.
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Affiliation(s)
- Janell L Mensinger
- M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, United States
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3
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Sedgewick F, Leppanen J, Austin A, Tchanturia K. Different pathways, same goals: A large-scale qualitative study of autistic and non-autistic patient-generated definitions of recovery from an eating disorder. EUROPEAN EATING DISORDERS REVIEW 2022; 30:580-591. [PMID: 34820930 DOI: 10.1002/erv.2873] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 11/05/2021] [Accepted: 11/07/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Definitions of recovery from an eating disorder (ED) have generally been formulated around clinical conceptualisations, rather than based on the views of patients. This paper therefore asked those with lived experience of ED for their own definitions of recovery. METHOD Data were collected as part of an online study looking at EDs, autism and relationships. About 173 participants identified as recovered from ED and gave free-response definitions of recovery. Responses were subject to thematic analysis. RESULTS Seven major themes were identified: Weight restoration, lack of ED behaviours, thoughts and behaviours, cognitions, emotional responses, getting on with life, and ongoing challenges. CONCLUSIONS Many definitions of recovery given by those who have lived experience of ED echoed those used by clinicians and researchers. There were also points of divergence around the ongoing challenges of recovery. Our findings highlight the need for continuing support post-weight restoration to facilitate the successful long-term recovery for those with ED.
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Affiliation(s)
- Felicity Sedgewick
- Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- School of Education, University of Bristol, Bristol, UK
| | - Jenni Leppanen
- Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Amelia Austin
- Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Kate Tchanturia
- Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Trust, London, UK
- Department of Psychology, Illia State University, Tbilisi, Georgia
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4
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Yim SH, Spencer L, Gordon G, Allen KL, Musiat P, Schmidt U. Views on online self-help programmes from people with eating disorders and their carers in UK. Eur J Public Health 2021; 31:i88-i93. [PMID: 34240155 PMCID: PMC8495677 DOI: 10.1093/eurpub/ckab046] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background Digitalizing the healthcare system has been declared a priority by the UK
government. People with eating disorders (EDs), especially those with
bulimia nervosa (BN) or binge eating disorder (BED), and ED carers may
benefit from online self-help programmes, due to the shame and stigma
associated with EDs and barriers in accessing treatment, skills-training or
support. Qualitative studies are needed to explore stakeholders’
needs, attitudes to and views about online self-help, to optimize
intervention design and delivery. Methods Focus groups and telephone interviews were conducted with people with BN or
BED, and carers of people with anorexia nervosa, between March and September
2018 in the UK. Results People with EDs and carers perceived online self-help positively in the
context of barriers to seeking and accessing treatment and support, despite
some seeing it as inferior to face-to-face support. Most reported little
experience with online interventions. Participants thought the disadvantages
of online interventions could be overcome by reminders, progress summaries,
regular engagement and engaging with peers. Receiving guidance was seen as
an important functionality in the intervention by people with EDs. Conclusions People with EDs and their carers are aware of the potential benefits of
online self-help despite having little experience with this form of
intervention. A stepped-care approach that utilizes technology-based
interventions as a first step and makes such interventions available
directly to the consumer may fit the attitudes and needs of stakeholders.
The study provides a foundation for future research on design and delivery
of ED online self-help.
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Affiliation(s)
- See Heng Yim
- Section of Eating Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Lucy Spencer
- Section of Eating Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Gemma Gordon
- Section of Eating Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Karina L Allen
- Section of Eating Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,The Eating Disorders Service, Maudsley Hospital, South London and Maudsley NHS Foundation Trust, London, UK
| | - Peter Musiat
- Section of Eating Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Ulrike Schmidt
- Section of Eating Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,The Eating Disorders Service, Maudsley Hospital, South London and Maudsley NHS Foundation Trust, London, UK
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5
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Couturier J, Pellegrini D, Miller C, Bhatnagar N, Boachie A, Bourret K, Brouwers M, Coelho JS, Dimitropoulos G, Findlay S, Ford C, Geller J, Grewal S, Gusella J, Isserlin L, Jericho M, Johnson N, Katzman DK, Kimber M, Lafrance A, Leclerc A, Loewen R, Loewen T, McVey G, Norris M, Pilon D, Preskow W, Spettigue W, Steinegger C, Waite E, Webb C. The COVID-19 pandemic and eating disorders in children, adolescents, and emerging adults: virtual care recommendations from the Canadian consensus panel during COVID-19 and beyond. J Eat Disord 2021; 9:46. [PMID: 33863388 PMCID: PMC8050997 DOI: 10.1186/s40337-021-00394-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 03/11/2021] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE The COVID-19 pandemic has had detrimental effects on mental health. Literature on the impact on individuals with eating disorders is slowly emerging. While outpatient eating disorder services in Canada have attempted to transition to virtual care, guidelines related to optimal virtual care in this field are lacking. As such, the objective of our Canadian Consensus Panel was to develop clinical practice guidelines related to the provision of virtual care for children, adolescents, and emerging adults living with an eating disorder, as well as their caregivers, during the COVID-19 pandemic and beyond. METHODS Using scoping review methodology (with literature in databases from 2000 to 2020 and grey literature from 2010 to 2020), the Grading of Recommendations, Assessment, Development, and Evaluation system, the Appraisal of Guidelines, Research and Evaluation tool, and a panel of diverse stakeholders from across Canada, we developed high quality treatment guidelines that are focused on virtual interventions for children, adolescents, and emerging adults with eating disorders, and their caregivers. RESULTS Strong recommendations were supported specifically in favour of in-person medical evaluation when necessary for children, adolescents, and emerging adults, and that equity-seeking groups and marginalized youth should be provided equal access to treatment. For children and adolescents, weak recommendations were supported for telehealth family-based treatment (FBT) and online guided parental self-help FBT. For emerging adults, internet cognitive-behavioural therapy (CBT)-based guided self-help was strongly recommended. Weak recommendations for emerging adults included CBT-based group internet interventions as treatment adjuncts, internet-based relapse prevention Maudsley Model of Anorexia Nervosa Treatment for Adults (MANTRA) guided self-help, telehealth relapse prevention using MANTRA, and guided CBT-based smartphone apps as treatment adjuncts. For caregivers of children and adolescents, weak recommendations were supported for virtual parent meal support training, and moderated online caregiver forums and support groups. For caregivers of emerging adults, guided parental self-help CBT was strongly recommended, and unguided caregiver psychoeducation self-help was weakly recommended. CONCLUSIONS Several gaps for future work were identified including the impact of sex, gender, race, and socioeconomic status on virtual care among children, adolescents, and emerging adults with eating disorders, as well as research on more intensive services, such as virtual day hospitals.
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Affiliation(s)
- Jennifer Couturier
- McMaster University, Hamilton, ON, Canada.
- McMaster Children's Hospital, 1200 Main St W, Hamilton, Ontario, L8N 3Z5, Canada.
| | | | - Catherine Miller
- Canadian Mental Health Association - Waterloo Wellington, Waterloo, ON, Canada
| | | | | | - Kerry Bourret
- St. Joseph's Care Group - Thunder Bay, Thunder Bay, ON, Canada
| | | | | | | | - Sheri Findlay
- McMaster University, Hamilton, ON, Canada
- McMaster Children's Hospital, 1200 Main St W, Hamilton, Ontario, L8N 3Z5, Canada
| | - Catherine Ford
- Ontario Ministry of Health and Long-Term Care, Toronto, ON, Canada
| | - Josie Geller
- The University of British Columbia, Vancouver, BC, Canada
| | | | | | | | | | - Natasha Johnson
- McMaster University, Hamilton, ON, Canada
- McMaster Children's Hospital, 1200 Main St W, Hamilton, Ontario, L8N 3Z5, Canada
| | | | | | | | - Anick Leclerc
- McMaster Children's Hospital, 1200 Main St W, Hamilton, Ontario, L8N 3Z5, Canada
| | | | | | - Gail McVey
- University of Toronto, Toronto, ON, Canada
| | | | | | - Wendy Preskow
- National Initiative for Eating Disorders, Toronto, ON, Canada
| | | | | | | | - Cheryl Webb
- McMaster University, Hamilton, ON, Canada
- McMaster Children's Hospital, 1200 Main St W, Hamilton, Ontario, L8N 3Z5, Canada
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6
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Morgan AA, Landers AL, Simpson JE, Russon JM, Case Pease J, Dolbin‐MacNab ML, Bland KN, Jackson JB. The transition to teletherapy in marriage and family therapy training settings during COVID-19: What do the data tell us? JOURNAL OF MARITAL AND FAMILY THERAPY 2021; 47:320-341. [PMID: 33742728 PMCID: PMC8250895 DOI: 10.1111/jmft.12502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 02/11/2021] [Accepted: 02/14/2021] [Indexed: 06/12/2023]
Abstract
In the wake of the COVID-19 pandemic, little is known about how university training programs transitioned to teletherapy. This study describes the transition of two university marriage and family therapy (i.e., master's and doctoral) training clinics to teletherapy and presents preliminary analyses of the types of clients and cases that converted to teletherapy. A series of chi-square analyses, a t-test, a logistic regression model, and a multiple linear regression model were employed. Four key findings emerged: (1) most cases converted to teletherapy; (2) Hispanic ethnicity was the only demographic characteristic to significantly predict conversion to teletherapy; (3) individual cases were significantly more likely to convert to teletherapy than relational cases; and (4) the number of prior in-person sessions attended significantly predicted conversion to teletherapy. Teletherapy conversion implications are discussed across four systemic levels: client, student trainee, supervision, and larger systems.
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Affiliation(s)
- Amy A. Morgan
- Department of Family ScienceSchool of Public HealthUniversity of MarylandCollege ParkMDUSA
| | - Ashley L. Landers
- Department of Human Development and Family ScienceCollege of Liberal Arts and Human SciencesVirginia TechBlacksburg & Falls ChurchVAUSA
| | - Jessica E. Simpson
- Department of Family Social ScienceCollege of Education and Human DevelopmentUniversity of MinnesotaSt PaulMNUSA
| | - Jody M. Russon
- Department of Human Development and Family ScienceCollege of Liberal Arts and Human SciencesVirginia TechBlacksburg & Falls ChurchVAUSA
| | - Jenene Case Pease
- Department of Human Development and Family ScienceCollege of Liberal Arts and Human SciencesVirginia TechBlacksburg & Falls ChurchVAUSA
| | - Megan L. Dolbin‐MacNab
- Department of Human Development and Family ScienceCollege of Liberal Arts and Human SciencesVirginia TechBlacksburg & Falls ChurchVAUSA
| | - Krista N. Bland
- Department of Human Development and Family ScienceCollege of Liberal Arts and Human SciencesVirginia TechBlacksburg & Falls ChurchVAUSA
| | - Jeffrey B. Jackson
- Department of Human Development and Family ScienceCollege of Liberal Arts and Human SciencesVirginia TechBlacksburg & Falls ChurchVAUSA
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7
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Lawford BJ, Hinman RS, Nelligan RK, Keefe F, Rini C, Bennell KL. "I Could Do It in My Own Time and When I Really Needed It": Perceptions of Online Pain Coping Skills Training For People With Knee Osteoarthritis. Arthritis Care Res (Hoboken) 2020; 72:1736-1746. [PMID: 31628723 DOI: 10.1002/acr.24093] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 10/15/2019] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To qualitatively explore the perceptions and experiences of people with knee osteoarthritis (OA) who used an online automated pain coping skills training program (PCST). METHODS This was a descriptive qualitative study (based on interpretivist methodology) embedded within a randomized controlled trial. Individual semistructured interviews were conducted with 12 people with knee OA who had participated in an 8-week automated online PCST program while also receiving exercise advice and support from a physical therapist via Skype. Interviews in this study focused specifically on the online PCST program, rather than the physical therapy component. Interviews were audiorecorded, transcribed verbatim, and thematically analyzed. RESULTS Five themes arose: 1) easy to understand and follow (clearly explained, presented well), 2) better able to cope with pain (controlling pain, helping relax, pacing self, incorporating skills into exercise program), 3) anonymity and flexibility (no judgement by clinician, work at own pace, accessibility), 4) not always relatable or engaging (some techniques not useful, Americanization of the program, annoying character examples, time consuming and slow-paced), and 5) support from clinician desirable (follow-up from a clinician would be beneficial, worked in tandem with physical therapist-prescribed exercise, desire referral to the program by a trusted source). CONCLUSION People with knee OA had generally positive experiences using an online PCST program, suggesting that online PCST is a broadly acceptable and accessible way to help people with OA to manage their pain. User engagement may be enhanced by redesigning some aspects of the program and by provision of support from a clinician.
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Affiliation(s)
| | - Rana S Hinman
- The University of Melbourne, Parkville, Victoria, Australia
| | | | | | - Christine Rini
- Hackensack University Medical Center, Hackensack, New Jersey, and Georgetown University School of Medicine, Washington, DC
| | - Kim L Bennell
- The University of Melbourne, Parkville, Victoria, Australia
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8
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Yim SH, Bailey E, Gordon G, Grant N, Musiat P, Schmidt U. Exploring Participants' Experiences of a Web-Based Program for Bulimia and Binge Eating Disorder: Qualitative Study. J Med Internet Res 2020; 22:e17880. [PMID: 32965235 PMCID: PMC7542406 DOI: 10.2196/17880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 06/26/2020] [Accepted: 07/19/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Guided cognitive behavioral self-help is a recommended first-line treatment for eating disorders (EDs) such as bulimia nervosa (BN) or binge eating disorder (BED). Online versions of such self-help programs are increasingly being studied in randomized controlled trials (RCTs), with some evidence that they can reduce ED symptoms, although intervention dropout is variable across interventions. However, in-depth research into participants' experiences and views on the acceptability of web-based interventions is limited. OBJECTIVE This is a qualitative process study of participants' experiences of everyBody Plus, a web-based cognitive behavioral intervention, integrated into a large RCT to aid the interpretation of the main trial's results. To our knowledge, this is the first such study in digital intervention for EDs research to include real-time feedback into the qualitative analysis. This study aims to build upon the emerging literature by qualitatively exploring participants' experiences of a web-based intervention for BN and BED. METHODS Participants were those who took part in the UK arm of a larger RCT investigating the efficacy of the everyBody Plus intervention. Reflexive thematic analysis was completed on 2 sources of data from the online platform: real-time feedback quotes provided at the end of completing a module on the platform (N=104) and semistructured telephone interview transcripts (n=12). RESULTS Four main themes were identified. The first theme identified positive and negative user experiences, with a desire for a more customized and personalized intervention. Another theme positively reflected on how flexible and easy the intervention was to embed into daily life, compared with the silo of face-to-face therapy. The third theme identified how the intervention had a holistic impact cognitively, emotionally, interpersonally, and behaviorally. The final theme was related to how the intervention was not a one size fits all and how the perceived usefulness and relevance were often dependent on participants' demographic and clinical characteristics. CONCLUSIONS Overall, participants reported positive experiences with the use of the everyBody Plus web-based intervention, including flexibility of use and the potential to holistically impact people's lives. The participants also provided valuable suggestions for how similar future web-based interventions could be improved and, in the context of EDs, how programs can be designed to be more inclusive of people by encompassing different demographic and clinical characteristics.
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Affiliation(s)
| | - Emma Bailey
- King's College London, London, United Kingdom
| | | | - Nina Grant
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | | | - Ulrike Schmidt
- King's College London, London, United Kingdom.,South London and Maudsley NHS Foundation Trust, London, United Kingdom
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9
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eHealth Treatments for Compulsive Overeating: a Narrative Review. CURRENT ADDICTION REPORTS 2020. [DOI: 10.1007/s40429-020-00312-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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10
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Bakland M, Rosenvinge JH, Wynn R, Sørlie V, Sundgot-Borgen J, Fostervold Mathisen T, Hanssen TA, Jensen F, Innjord K, Pettersen G. A new treatment for eating disorders combining physical exercise and dietary therapy (the PED-t): experiences from patients who dropped out. Int J Qual Stud Health Well-being 2020; 15:1731994. [PMID: 32081086 PMCID: PMC7048200 DOI: 10.1080/17482631.2020.1731994] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Purpose: Eating disorders (ED) are complex and severe illnesses where evidence-based treatment is needed to recover. However, about half of the patients with ED do not respond to treatments currently available, which call for efforts to expand the portfolio of treatments. The aim of this study was to explore experiences from patients who dropped out of a new treatment for bulimia nervosa and binge ED, combining physical exercise and dietary therapy (PED-t).Methods: We conducted open-ended face-to-face interviews. The interviews were transcribed verbatim and the data were analysed with a phenomenological hermeneutical approach.Results: Three themes emerged: "standing on the outside", "unmet expectations" and "participation not a waste of time". Feelings of standing on the outside were elicited by being different from other group members and having challenges with sharing thoughts. Unmet expectations were related to treatment content and intensity, as well as the development of unhealthy thoughts and behaviours. Finally, some positive experiences were voiced.Conclusion: A need to clarify pre-treatment expectations and refining criteria for treatment suitability is indicated. The findings have contributed to the chain of clinical evidence regarding the PED-t and may lead to treatment modifications improving the treatment and thereby reducing drop out.
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Affiliation(s)
- Maria Bakland
- Department of Health and Care Science, UiT - The Artic University of Norway, Tromsø, Norway
| | - Jan H Rosenvinge
- Department of Psychology, UiT - The Artic University of Norway, Tromsø, Norway
| | - Rolf Wynn
- Department of Clinical Medicine, UiT - The Artic University of Norway, Tromsø, Norway.,Division of Addictions and Mental Health, University Hospital of North Norway, Tromsø, Norway
| | - Venke Sørlie
- Center for clinical nursing research, Lovisenberg Deaconal University College, Oslo, Norway
| | | | | | - Tove Aminda Hanssen
- Department of Health and Care Science, UiT - The Artic University of Norway, Tromsø, Norway.,Department of Heart Disease, University Hospital of North Norway, Tromsø, Norway
| | - Franziska Jensen
- Department of Language and Culture, UiT - The Artic University of Norway, Tromsø, Norway.,Department of Education, UiT - The Artic University of Norway, Tromsø, Norway.,The Eating Disorder Association "Spisfo", Tromsø, Norway
| | | | - Gunn Pettersen
- Department of Health and Care Science, UiT - The Artic University of Norway, Tromsø, Norway
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11
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Bakland M, Rosenvinge JH, Wynn R, Sundgot-Borgen J, Fostervold Mathisen T, Liabo K, Hanssen TA, Pettersen G. Patients' views on a new treatment for Bulimia nervosa and binge eating disorder combining physical exercise and dietary therapy (the PED-t). A qualitative study. Eat Disord 2019; 27:503-520. [PMID: 30664397 DOI: 10.1080/10640266.2018.1560847] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
A new group based treatment for patients with bulimia nervosa (BN) and binge eating disorder (BED), combining guided Physical Exercise and Dietary therapy (PED-t), has shown the capacity to alleviate BN and BED symptoms. The PED-t is run by therapists with a professional background in sport sciences and nutrition, which in many clinical settings is an uncommon group of professionals. The symptom reduction effects using the PED-t need validation from patients who have been given this kind of treatment, as negative experiences may impinge further clinical implementation. To explore such experiences, semistructural interviews were conducted with 15 participants. The interviews were transcribed and analyzed using a systematic text condensation approach. Overall, patients experienced the format and content of the PED-t as beneficial and as providing tools to manage BN- and BED symptoms. The patients' experiences of therapist credibility was enhanced by their appreciation of the therapists' professional background. Finally, some treatment modifications were suggested. Overall, the PED-t may thus be offered to patients with BN and BED, by a new set of professionals, and in uncommon settings. This possibility calls for future effectiveness studies integrating both parametric and experiential data.
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Affiliation(s)
- Maria Bakland
- Department of Health and Care Science, UiT - The Artic University of Norway, Tromsø, Norway
| | - Jan H Rosenvinge
- Department of Psychology, UiT - The Artic University of Norway, Tromsø, Norway
| | - Rolf Wynn
- Department of Clinical Medicine, UiT - The Artic University of Norway, Tromsø, Norway.,Division of Addictions and Mental Health, University Hospital of North Norway, Tromsø, Norway
| | | | | | - Kristin Liabo
- Institute for Health Research, University of Exeter Medical School, Exeter, UK
| | - Tove Aminda Hanssen
- Department of Heart Disease, University Hospital of North Norway, Tromsø, Norway
| | - Gunn Pettersen
- Department of Health and Care Science, UiT - The Artic University of Norway, Tromsø, Norway
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12
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Yim SH, Schmidt U. Experiences of computer-based and conventional self-help interventions for eating disorders: A systematic review and meta-synthesis of qualitative research. Int J Eat Disord 2019; 52:1108-1124. [PMID: 31343088 DOI: 10.1002/eat.23142] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 07/02/2019] [Accepted: 07/05/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Self-help interventions have been demonstrated to be effective in treating bulimic-type eating disorders (EDs). In particular, computer-based interventions have received increasing attention due to their potential to reach a wider population. This systematic review aimed to synthesize findings from qualitative studies on users' experiences of self-help interventions for EDs and to develop an exploratory framework. METHOD A systematic review and meta-synthesis on seven peer-reviewed qualitative studies on structured computer and book-based self-help interventions for EDs was conducted using Noblit and Hare's (1988) 7-phase meta-ethnography. Four of the selected studies investigated computer-based self-help programs, and three of the studies investigated book-based guided self-help programs. RESULTS Six concepts were synthesized. They included intervention-related factors (anonymity and privacy; accessibility and flexibility; guidance) and user-related factors (agency/autonomy; self-motivation; and expectations/attitudes). The study revealed the "machine-like" and relational properties of the computer; the expansion of treatment time and space in psychological interventions, the changing role of the medical health professional from a "therapist" to a "guide," and a change from understanding interventions as a conclusive treatment plan to a starting point or stepping stone toward recovery. DISCUSSION Computer-based self-help interventions should take advantage of the "machine-like" properties of a computer (neutrality, availability, etc.) as well as its ability to facilitate human interactions. Users should also be facilitated to have a realistic understanding of the purpose of self-help interventions and the place of self-help interventions in their broader treatment plans to moderate expectations and attitudes.
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Affiliation(s)
- See Heng Yim
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Section of Eating Disorders, London, UK
| | - Ulrike Schmidt
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Section of Eating Disorders, London, UK.,The Eating Disorders Service, Maudsley Hospital, South London and Maudsley NHS Foundation Trust, London, UK
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13
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Verhoeks C, Teunissen D, van der Stelt-Steenbergen A, Lagro-Janssen A. Women's expectations and experiences regarding e-health treatment: A systematic review. Health Informatics J 2019; 25:771-787. [PMID: 28764600 PMCID: PMC6769287 DOI: 10.1177/1460458217720394] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
There is a gap in knowledge of women's perceptions of e-health treatment. This review aims to investigate women's expectations and experiences regarding e-health. A search was conducted in MEDLINE, EMBASE, CINAHL and PsycInfo in March 2016. We included articles published between 2000 and March 2016, reporting on e-health interventions. The initial search yielded 2987 articles. Eventually, 16 articles reporting on 16 studies were included. Barriers to e-health treatment were lower for women than barriers to face-to-face treatment, such as feelings of shame and time constraints. Women were able to develop an online therapeutic relationship. As reduced feelings of obligation and lack of motivation were women's greatest challenges in completing e-health treatment, they expressed a wish for more support during e-health treatment, preferably blended care. e-Health lowers the threshold for women to seek healthcare. Combining e-health interventions with face-to-face sessions may enhance women's motivation to complete treatment.
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Abstract
The authors provide an overview of the current state of research on self-help interventions for eating disorders. The efficacy of different forms of self-help interventions for bulimia nervosa, binge eating disorder, and other eating disorders at various stages of the care pathway (from prevention to relapse prevention) is described. Cost-effectiveness studies are also presented. Moderators of outcome, such as guidance and adherence, are discussed. Overall, the findings are promising and support the use of self-help interventions in the treatment of bulimic disorders, across the stages of the care pathway. Less is known about the use of self-help in anorexia nervosa.
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Affiliation(s)
- See Heng Yim
- Section of Eating Disorders, King's College London, Institute of Psychiatry, Psychology and Neuroscience, PO Box 59, 16, De Crespigny Park, London SE5 8AF, UK.
| | - Ulrike Schmidt
- Section of Eating Disorders, King's College London, Institute of Psychiatry, Psychology and Neuroscience, PO Box 59, 16, De Crespigny Park, London SE5 8AF, UK; The Eating Disorders Service, Maudsley Hospital, South London and Maudsley NHS Foundation Trust, London, UK
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Cronström A, Dahlberg LE, Nero H, Ericson J, Hammarlund CS. 'I would never have done it if it hadn't been digital': a qualitative study on patients' experiences of a digital management programme for hip and knee osteoarthritis in Sweden. BMJ Open 2019; 9:e028388. [PMID: 31129601 PMCID: PMC6537991 DOI: 10.1136/bmjopen-2018-028388] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES To investigate the experiences of a digital management programme for hip and knee osteoarthritis (OA), including education and exercises as well as an option to chat with an assigned physical therapist for feedback, questions and support. SETTING This study was conducted at a regional hospital in the southern part of Sweden. METHODS Nineteen patients (10 women), median age of 66 (q1-q3, 57-71) years, with confirmed hip or knee OA were interviewed after completing their first 6 weeks in the programme, using a semistructured interview guide. The interviews were transcribed verbatim and were qualitatively analysed using systematic text condensation. RESULTS Three categories emerged during the interviews:(1) Management options for mitigating the consequences of OA; (2) Experiences of the digital programme and (3) Perceived effects of the digital programme over time. The participants had mostly positive experiences of the programme. Particularly important for these experiences were no waiting list, the flexibility of taking part in the programme with regards to location and time and the possibility to have daily contact with a physical therapist. These aspects were also emphasised as advantages compared with traditional care. CONCLUSIONS Digital management of OA, including education and exercise, was experienced as a valid alternative to traditional treatment in enabling the implementation of OA guidelines in a wider community. Easy access, exercising at one's own convenience, flexible options, daily follow-up and support by a physical therapist were mentioned as the most important features. In addition, the results will contribute to further development and improvement of digital OA management programmes.
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Affiliation(s)
- Anna Cronström
- Orthopaedics, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Leif E Dahlberg
- Orthopaedics, Department of Clinical Sciences, Lund University, Lund, Sweden
- Skåne University Hospital, Lund, Sweden
| | - Håkan Nero
- Orthopaedics, Department of Clinical Sciences, Lund University, Lund, Sweden
| | | | - Catharina Sjödahl Hammarlund
- Department of Health Sciences, Lund University, Lund, Sweden
- The PRO-CARE Group, School of Health and Society, Kristianstad University, Kristianstad, Sweden
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Hoskins JI, Blood L, Stokes HR, Tatham M, Waller G, Turner H. Patients' experiences of brief cognitive behavioral therapy for eating disorders: A qualitative investigation. Int J Eat Disord 2019; 52:530-537. [PMID: 30741438 DOI: 10.1002/eat.23039] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 01/21/2019] [Accepted: 01/22/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Although it is important to analyze the effectiveness of new therapies, it is also necessary to consider how patients experience them. This is particularly important if we are to maximize treatment acceptability and reduce attrition. This study examined patient experiences of a new 10-session cognitive-behavioral therapy (CBT-T), using a qualitative approach. METHOD The sample was 17 patients with a diagnosis of bulimia nervosa who had received CBT-T (including treatment completers and non-completers) within the previous 2 years. Sample size was determined by saturation of the emergent themes. Responses were analyzed using a six-step thematic analysis process. RESULTS Rated acceptability and effectiveness of CBT-T were high. Five themes emerged, with subthemes. The key elements of patient experience of the therapy were: the therapeutic relationship; the nature of the therapy; its challenging but beneficial aspects; ending therapy; and the overall experience of CBT-T (including comparison with other therapies). DISCUSSION The findings build on the effectiveness research for CBT-T, suggesting that it is an acceptable therapy that addresses many of the same themes that matter to patients as other therapies. The findings show that patients were positive about CBT-T relative to other therapies, and offer suggestions as to how CBT-T might be delivered to emphasize the importance of the time-limited nature of the therapy.
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Affiliation(s)
- Jessica I Hoskins
- Eating Disorders Service, Southern Health NHS Foundation Trust, Southampton, United Kingdom
| | - Lauren Blood
- Norfolk Community Eating Disorders Service, Cambridgeshire and Peterborough NHS Foundation Trust, Cambridgeshire, United Kingdom
| | - Holly R Stokes
- Eating Disorders Service, Southern Health NHS Foundation Trust, Southampton, United Kingdom
| | - Madeleine Tatham
- Norfolk Community Eating Disorders Service, Cambridgeshire and Peterborough NHS Foundation Trust, Cambridgeshire, United Kingdom
| | - Glenn Waller
- Department of Psychology, University of Sheffield, Sheffield, United Kingdom
| | - Hannah Turner
- Eating Disorders Service, Southern Health NHS Foundation Trust, Southampton, United Kingdom
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Plateau CR, Brookes FA, Pugh M. Guided Recovery: An Interpretative Phenomenological Analysis of Service Users’ Experiences of Guided Self-Help for Bulimic and Binge Eating Disorders. COGNITIVE AND BEHAVIORAL PRACTICE 2018. [DOI: 10.1016/j.cbpra.2017.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Pettersen G, Rosenvinge JH, Bakland M, Wynn R, Mathisen TF, Sundgot-Borgen J. Patients' and therapists' experiences with a new treatment programme for eating disorders that combines physical exercise and dietary therapy: the PED-t trial. A qualitative study protocol. BMJ Open 2018; 8:e018708. [PMID: 29317417 PMCID: PMC5781017 DOI: 10.1136/bmjopen-2017-018708] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 11/09/2017] [Accepted: 11/29/2017] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Women with bulimia nervosa and binge eating disorder often suffer for many years before they seek professional help. Evidence-based treatments like cognitive-behavioural therapy (CBT) might be poorly accessible, and about 50% of those who receive CBT respond to it. Such outcome may reflect the heterogeneous nature of eating disorders, and addressing this heterogeneity calls for expanding the portfolio of treatment options. In particular, it is important to explore such options' acceptability, tolerability and affordability expressed through experiences with the treatment. This protocol outlines the rationale and design of a qualitative study. It captures experiences from patients and therapists who were involved in a randomised controlled trial (RCT) exploring the efficacy of a new group-based treatment programme combining physical exercise and dietary therapy. METHODS AND ANALYSIS 15 patients with bulimia nervosa or binge eating disorder, 10 therapists (physical trainers and dietitians) and 6-10 patients who dropped out of the RCT will be semistructurally interviewed. All interviews will be analysed using a systematic text condensation approach. ETHICS AND DISSEMINATION Results will be presented in peer-reviewed international journals, and at relevant international conferences. Key findings will be available to study participants as well as to patient organisations and health authorities. The overall study meets the intent and requirements of the Health Research Act and the Declaration of Helsinki. It is approved by the regional committee for medical research ethics (2013/1871). TRIAL REGISTRATION NUMBER NCT02079935; Pre-results.
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Affiliation(s)
- Gunn Pettersen
- Department of Health and Care Sciences, Faculty of Health Sciences, The Arctic University of Norway, Tromsø, Norway
| | - Jan H Rosenvinge
- Department of Psychology, Faculty of Health Sciences, UiT-The Arctic University of Norway, Tromsø, Norway
| | - Maria Bakland
- Department of Health and Care Sciences, Faculty of Health Sciences, The Arctic University of Norway, Tromsø, Norway
| | - Rolf Wynn
- Department of Clinical Medicine, Faculty of Health Sciences, UiT-The Arctic University of Norway, Tromsø, Norway
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Zerwas SC, Watson HJ, Hofmeier SM, Levine MD, Hamer RM, Crosby RD, Runfola CD, Peat CM, Shapiro JR, Zimmer B, Moessner M, Kordy H, Marcus MD, Bulik CM. CBT4BN: A Randomized Controlled Trial of Online Chat and Face-to-Face Group Therapy for Bulimia Nervosa. PSYCHOTHERAPY AND PSYCHOSOMATICS 2017; 86:47-53. [PMID: 27883997 PMCID: PMC5143175 DOI: 10.1159/000449025] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 08/02/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Although cognitive-behavioral therapy (CBT) represents the first-line evidence-based psychotherapy for bulimia nervosa (BN), most individuals seeking treatment do not have access to this specialized intervention. We compared an Internet-based manualized version of CBT group therapy for BN conducted via a therapeutic chat group (CBT4BN) to the same treatment conducted via a traditional face-to-face group therapy (CBTF2F). METHOD In a two-site, randomized, controlled noninferiority trial, we tested the hypothesis that CBT4BN would not be inferior to CBTF2F. A total of 179 adult patients with BN (2.6% males) received up to 16 sessions of group CBT over 20 weeks in either CBT4BN or CBTF2F, and outcomes were compared at the end of treatment and at the 12-month follow-up. RESULTS At the end of treatment, CBT4BN was inferior to CBTF2F in producing abstinence from binge eating and purging. However, by the 12-month follow-up, CBT4BN was mostly not inferior to CBTF2F. Participants in the CBT4BN condition, but not CBTF2F, continued to reduce their binge-eating and purging frequency from the end of treatment to the 12-month follow-up. CONCLUSIONS CBT delivered online in a group chat format appears to be an efficacious treatment for BN, although the trajectory of recovery may be slower than face-to-face group therapy. Online chat groups may increase accessibility of treatment and represent a cost-effective approach to service delivery. However, barriers in service delivery such as state-specific license and ethical guidelines for online therapists need to be addressed.
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Affiliation(s)
- Stephanie C. Zerwas
- Department of Psychiatry, University of North Carolina at Chapel Hill, CB 7160, Chapel Hill, NC 27599
| | - Hunna J. Watson
- Department of Psychiatry, University of North Carolina at Chapel Hill, CB 7160, Chapel Hill, NC 27599,School of Paediatrics and Child Health, Faculty of Medicine, Dentistry, and Health Sciences, The University of Western Australia, Stirling Highway, Crawley, Western Australia, Australia 6009,School of Psychology and Speech Pathology, Faculty of Health Sciences, Curtin University, Kent Street, Bentley, Western Australia, Australia 6102
| | - Sara M. Hofmeier
- Department of Psychiatry, University of North Carolina at Chapel Hill, CB 7160, Chapel Hill, NC 27599
| | - Michele D. Levine
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, 3811 O’Hara Street, Pittsburgh, PA 15213
| | - Robert M. Hamer
- Department of Psychiatry, University of North Carolina at Chapel Hill, CB 7160, Chapel Hill, NC 27599,Department of Biostatistics, University of North Carolina at Chapel Hill, CB 7160, Chapel Hill, NC 27599
| | - Ross D. Crosby
- Neuropsychiatric Research Institute, 120 Eighth Street South Fargo, ND 58107,Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, ND 58102
| | | | - Christine M. Peat
- Department of Psychiatry, University of North Carolina at Chapel Hill, CB 7160, Chapel Hill, NC 27599,Department of Neurosurgery, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599
| | - Jennifer R. Shapiro
- Department of Psychiatry, University of North Carolina at Chapel Hill, CB 7160, Chapel Hill, NC 27599
| | - Benjamin Zimmer
- Center for Psychotherapy Research, University of Heidelberg, Bergheimer Str. 54, 69115 Heidelberg, Germany
| | - Markus Moessner
- Center for Psychotherapy Research, University of Heidelberg, Bergheimer Str. 54, 69115 Heidelberg, Germany
| | - Hans Kordy
- Center for Psychotherapy Research, University of Heidelberg, Bergheimer Str. 54, 69115 Heidelberg, Germany
| | - Marsha D. Marcus
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, 3811 O’Hara Street, Pittsburgh, PA 15213
| | - Cynthia M. Bulik
- Department of Psychiatry, University of North Carolina at Chapel Hill, CB 7160, Chapel Hill, NC 27599,Department of Nutrition, University of North Carolina at Chapel Hill, CB 7160, Chapel Hill, NC 27599,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Lenhard F, Vigerland S, Engberg H, Hallberg A, Thermaenius H, Serlachius E. "On My Own, but Not Alone" - Adolescents' Experiences of Internet-Delivered Cognitive Behavior Therapy for Obsessive-Compulsive Disorder. PLoS One 2016; 11:e0164311. [PMID: 27711249 PMCID: PMC5053512 DOI: 10.1371/journal.pone.0164311] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 09/18/2016] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Childhood Obsessive-Compulsive Disorder (OCD) is a prevalent and impairing condition that can be effectively treated with Cognitive Behavior Therapy (CBT). However, a majority of children and adolescents do not have access to CBT. Internet-delivered CBT (ICBT) has been suggested as a way to increase availability to effective psychological treatments. Yet, the research on ICBT in children and adolescents has been lagging behind significantly both when it comes to quantitative as well as qualitative studies. The aim of the current study was to describe the experience of ICBT in adolescents with OCD. METHOD Eight adolescents with OCD that had received ICBT were interviewed with qualitative methodology regarding their experiences of the intervention. Data was summarized into thematic categories. RESULTS Two overarching themes were identified, autonomy and support, each consisting of three primary themes (self-efficacy, flexibility, secure self-disclosure and clinician support, parental support, identification/normalization, respectively). CONCLUSIONS The experiential hierarchical model that was identified in this study is, in part, transferrable to previous research. In addition, it highlights the need of further study of important process variables of ICBT in young patient populations.
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Affiliation(s)
- Fabian Lenhard
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Sarah Vigerland
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Hedvig Engberg
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Anna Hallberg
- Östersund Child and Adolescent Mental Health Service, Östersunds sjukhus, 831 83 Östersund, Sweden
| | - Hanna Thermaenius
- Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Eva Serlachius
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
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Nitsch M, Dimopoulos CN, Flaschberger E, Saffran K, Kruger JF, Garlock L, Wilfley DE, Taylor CB, Jones M. A Guided Online and Mobile Self-Help Program for Individuals With Eating Disorders: An Iterative Engagement and Usability Study. J Med Internet Res 2016; 18:e7. [PMID: 26753539 PMCID: PMC4726867 DOI: 10.2196/jmir.4972] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 10/28/2015] [Accepted: 11/11/2015] [Indexed: 11/20/2022] Open
Abstract
Background Numerous digital health interventions have been developed for mental health promotion and intervention, including eating disorders. Efficacy of many interventions has been evaluated, yet knowledge about reasons for dropout and poor adherence is scarce. Most digital health intervention studies lack appropriate research design and methods to investigate individual engagement issues. User engagement and program usability are inextricably linked, making usability studies vital in understanding and improving engagement. Objective The aim of this study was to explore engagement and corresponding usability issues of the Healthy Body Image Program—a guided online intervention for individuals with body image concerns or eating disorders. The secondary aim was to demonstrate the value of usability research in order to investigate engagement. Methods We conducted an iterative usability study based on a mixed-methods approach, combining cognitive and semistructured interviews as well as questionnaires, prior to program launch. Two separate rounds of usability studies were completed, testing a total of 9 potential users. Thematic analysis and descriptive statistics were used to analyze the think-aloud tasks, interviews, and questionnaires. Results Participants were satisfied with the overall usability of the program. The average usability score was 77.5/100 for the first test round and improved to 83.1/100 after applying modifications for the second iteration. The analysis of the qualitative data revealed five central themes: layout, navigation, content, support, and engagement conditions. The first three themes highlight usability aspects of the program, while the latter two highlight engagement issues. An easy-to-use format, clear wording, the nature of guidance, and opportunity for interactivity were important issues related to usability. The coach support, time investment, and severity of users’ symptoms, the program’s features and effectiveness, trust, anonymity, and affordability were relevant to engagement. Conclusions This study identified salient usability and engagement features associated with participant motivation to use the Healthy Body Image Program and ultimately helped improve the program prior to its implementation. This research demonstrates that improvements in usability and engagement can be achieved by testing and adjusting intervention design and content prior to program launch. The results are consistent with related research and reinforce the need for further research to identify usage patterns and effective means for reducing dropout. Digital health research should include usability studies prior to efficacy trials to help create more user-friendly programs that have a higher likelihood of “real-world” adoption.
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Affiliation(s)
- Martina Nitsch
- Ferdinand Porsche Distance Learning University of Applied Sciences, Vienna, Austria.
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Perceptions of the feasibility and acceptability of a smartphone application for the treatment of binge eating disorders: Qualitative feedback from a user population and clinicians. Int J Med Inform 2015; 84:808-16. [PMID: 26113461 DOI: 10.1016/j.ijmedinf.2015.06.004] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Revised: 04/27/2015] [Accepted: 06/09/2015] [Indexed: 01/12/2023]
Abstract
BACKGROUND Binge eating, a major public health problem, is characterized by recurrent episodes of out-of-control eating in which an individual consumes an unusually large amount of food in a discrete time period. Limitations of existing treatments for binge eating (both in-person psychotherapy and guided self-help) indicate that smartphone applications (apps) may be an ideal alternative or enhancement. An app for binge eating could aid treatment dissemination, engagement, and/or compliance. However, no research to date has examined user perceptions of a therapeutic app for binge eating, which is critical for development. OBJECTIVES The purposes of the current study were to conceptualize a potential app for binge eating and obtain feedback regarding feasibility and acceptability from target users (i.e., individuals with binge eating) and clinicians specializing in the treatment of binge eating. METHODS Our team conceptualized a smartphone app that contained self-help material, functions to monitor behavior, and provisions of in-the-moment interventions. We presented this app (e.g., feature explanations, mock screen shots) through phone interviews with clinicians who specialize in the treatment of binge eating (n=10), and focus groups with individuals experiencing binge eating (n=11). Participants were asked to discuss customization, user burden, terminology, attrition, data visualization, comprehensiveness, reminders, feasibility, acceptability, and perceived effectiveness of the proposed app. Thematic analyses were conducted from qualitative data (e.g., audio recordings and interview notes) obtained via the focus groups and interviews. RESULTS Results indicated that our proposed app would be highly feasible and acceptable to users and clinicians, though concerns about the degree of personalization and customizability were noted. CONCLUSIONS The current study details highly specific feedback and ideas regarding essential app features from target users and clinicians. This information is critical for the development of future apps to treat binge eating. Ways in which data obtained from the current study may be generalized to the development of therapeutic apps for other psychological disorders is discussed.
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Sjöström M, Umefjord G, Stenlund H, Carlbring P, Andersson G, Samuelsson E. Internet-based treatment of stress urinary incontinence: 1- and 2-year results of a randomized controlled trial with a focus on pelvic floor muscle training. BJU Int 2015; 116:955-64. [PMID: 25683075 PMCID: PMC4690161 DOI: 10.1111/bju.13091] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Objectives To evaluate the long-term effects of two non-face-to-face treatment programmes for stress urinary incontinence (SUI) based on pelvic floor muscle training (PFMT). Subjects and Methods The present study was a randomized controlled trial with online recruitment of 250 community-dwelling women aged 18–70 years with SUI ≥ one time/week. Diagnosis was based on validated self-assessed questionnaires, 2-day bladder diary and telephone interview with a urotherapist. Consecutive computer-generated block randomization was carried out with allocation by an independent administrator to 3 months of treatment with either an internet-based treatment programme (n = 124) or a programme sent by post (n = 126). Both interventions focused mainly on PFMT. The internet group received continuous e-mail support from a urotherapist, whereas the postal group trained on their own. Follow-up was performed after 1 and 2 years via self-assessed postal questionnaires. The primary outcomes were symptom severity (International Consultation on Incontinence Questionnaire Short Form [ICIQ-UI SF]) and condition-specific quality of life (ICIQ-Lower Urinary Tract Symptoms Quality of Life [ICIQ-LUTSqol]). Secondary outcomes were the Patient Global Impression of Improvement, health-specific quality of life (EQ-visual analogue scale [EQ-VAS]), use of incontinence aids, and satisfaction with treatment. There was no face-to-face contact with the participants at any time. Analysis was based on intention-to-treat. Results We lost 32.4% (81/250) of participants to follow-up after 1 year and 38.0% (95/250) after 2 years. With both interventions, we observed highly significant (P < 0.001) improvements with large effect sizes (>0.8) for symptoms and condition-specific quality of life (QoL) after 1 and 2 years, respectively. No significant differences were found between the groups. The mean (sd) changes in symptom score were 3.7 (3.3) for the internet group and 3.2 (3.4) for the postal group (P = 0.47) after 1 year, and 3.6 (3.5) for the internet group and 3.4 (3.3) for the postal group (P = 0.79) after 2 years. The mean changes (sd) in condition-specific QoL were 5.5 (6.5) for the internet group and 4.7 the for postal group (6.5) (P = 0.55) after 1 year, and 6.4 (6.0) for the internet group and 4.8 (7.6) for the postal group (P = 0.28) after 2 years. The proportions of participants perceiving they were much or very much improved were similar in both intervention groups after 1 year (internet, 31.9% [28/88]; postal, 33.8% [27/80], P = 0.82), but after 2 years significantly more participants in the internet group reported this degree of improvement (39.2% [29/74] vs 23.8% [19/80], P = 0.03). Health-specific QoL improved significantly in the internet group after 2 years (mean change in EQ-VAS, 3.8 [11.4], P = 0.005). We found no other significant improvements in this measure. At 1 year after treatment, 69.8% (60/86) of participants in the internet group and 60.5% (46/76) of participants in the postal group reported that they were still satisfied with the treatment result. After 2 years, the proportions were 64.9% (48/74) and 58.2% (46/79), respectively. Conclusion Non-face-to-face treatment of SUI with PFMT provides significant and clinically relevant improvements in symptoms and condition-specific QoL at 1 and 2 years after treatment.
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Affiliation(s)
- Malin Sjöström
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Göran Umefjord
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Hans Stenlund
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Per Carlbring
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Gerhard Andersson
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.,Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Eva Samuelsson
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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Experiences of a guided smartphone-based behavioral activation therapy for depression: A qualitative study. Internet Interv 2015. [DOI: 10.1016/j.invent.2014.12.002] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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A Survey of Attitudes towards Computerized Self-Help for Eating Disorders within a Community-Based Sample. Behav Cogn Psychother 2014; 44:65-78. [PMID: 25430776 DOI: 10.1017/s1352465814000484] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Bulimia nervosa (BN) is an eating disorder with many physical, psychological and social consequences. Guided self-help (GSH) is recommended in the treatment of BN (NICE, 2004). One of the ways in which to provide GSH is via the internet using evidence-based packages with regular support from a clinician or trained support worker. AIMS The aim of this community-based survey was to investigate attitudes towards online self-help for eating disorders and the support required whilst using such an approach. METHOD Two-hundred and fifty-three participants with bulimic symptoms completed the survey. The sample was recruited primarily online. The mean age was 29.11 years (SD = 8.67; min = 16, max = 64). RESULTS Attitudes towards online self-help (SH) for eating disorders were very positive. The inclusion of some form of support to accompany such an intervention was important to the majority of participants. Remote mediums of support such as e-mail, a forum and text messaging were most often selected as helpful. Most participants expressed a preference for weekly support contacts and for flexible support lengths that could respond to support needs as required. CONCLUSIONS Online self-help for eating disorders is a desirable treatment option for many individuals. The information gathered regarding preferences in the type, medium, duration and frequency of support could be used in the development of future self-help strategies in order to maximize uptake, retention and outcomes.
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Nyström E, Sjöström M, Stenlund H, Samuelsson E. ICIQ symptom and quality of life instruments measure clinically relevant improvements in women with stress urinary incontinence. Neurourol Urodyn 2014; 34:747-51. [PMID: 25154378 DOI: 10.1002/nau.22657] [Citation(s) in RCA: 112] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 06/24/2014] [Indexed: 11/09/2022]
Abstract
AIMS To determine whether changes in questionnaire scores on symptoms and condition-specific quality of life reflect clinically relevant improvements in women with stress urinary incontinence (SUI). METHODS We retrospectively analyzed questionnaires collected during a randomized controlled trial in women with SUI, that received pelvic floor muscle training (PFMT) in two different formats. We included 218 women that answered validated self-assessment questionnaires at baseline and at a 4-month follow-up. We registered changes on two questionnaires, the International Consultation on Incontinence Modular Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) and the Lower Urinary Tract Symptoms Quality of Life (ICIQ-LUTSqol). We compared these score changes to responses from the Patient Global Impression of Improvement (PGI-I) questionnaire. Differences were analyzed with the Spearman rho and one-way-ANOVA. The minimum important difference (MID) was the mean change in score for women that experienced a small improvement. RESULTS The PGI-I correlated significantly to both the ICIQ-UI SF (r = 0.547, P < 0.0001) and ICIQ-LUTSqol (r = 0.520, P < 0.0001). Thus, larger reductions in symptoms or quality of life scores were associated with greater impressions of improvement. The changes in ICIQ-UI SF and ICIQ-LUTSqol scores were significant across all PGI-I groups from "no change" to "very much improved" (P < 0.05). The MIDs were 2.52 (SD 2.56) for ICIQ-UI SF and 3.71 (SD 4.95) for ICIQ-LUTSqol. CONCLUSIONS The change in ICIQ-UI SF and ICIQ-LUTSqol scores after PFMT reflected clinically relevant improvements in women with SUI. The MIDs established for this population may facilitate future research, treatment evaluations, and comparisons between studies.
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Affiliation(s)
- E Nyström
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - M Sjöström
- Department of Public Health and Clinical Medicine, Unit of Clinical Research Center - Östersund, Umeå University, Umeå, Sweden
| | - H Stenlund
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - E Samuelsson
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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Björk AB, Sjöström M, Johansson EE, Samuelsson E, Umefjord G. Women's experiences of internet-based or postal treatment for stress urinary incontinence. QUALITATIVE HEALTH RESEARCH 2014; 24:484-493. [PMID: 24598777 DOI: 10.1177/1049732314524486] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Stress urinary incontinence is common and sometimes embarrassing. New, simple, and easily accessible treatments are needed. We telephone interviewed 21 women who participated in a randomized controlled study comparing two treatment programs based on instructions for pelvic floor muscle training. One program was Internet-based and included email support by a urotherapist; the other was sent by post. There was no face-to-face contact in either program. Our main aim was to explore the women's experiences of the Internet-based treatment. Grounded theory analysis revealed three categories: hidden but present, at a distance but close, and by myself but not alone. These were incorporated in a core category: acknowledged but not exposed. The leakage was often a well-hidden secret, but the study treatments lowered the barrier for seeking care. In the Internet group, a supportive patient-provider relationship developed despite the lack of face-to-face contact. Internet-based treatment programs can increase access to care and empower women.
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Lose A, Davies C, Renwick B, Kenyon M, Treasure J, Schmidt U. Process evaluation of the maudsley model for treatment of adults with anorexia nervosa trial. Part II: Patient experiences of two psychological therapies for treatment of anorexia nervosa. EUROPEAN EATING DISORDERS REVIEW 2014; 22:131-9. [PMID: 24590563 DOI: 10.1002/erv.2279] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 12/09/2013] [Accepted: 12/12/2013] [Indexed: 12/12/2022]
Abstract
OBJECTIVE This study is the second part of a process evaluation, embedded in the MOSAIC study, a large randomised controlled trial comparing two different psychological therapies, the Maudsley Model for Treatment of Adults with Anorexia Nervosa (MANTRA) and Specialist Supportive Clinical Management (SSCM). The study adopted a qualitative approach to examine patient experiences of the two treatments. METHOD Seventeen semi-structured interviews were conducted with Anorexia Nervosa and Eating Disorder Not Otherwise Specified-Anorexia Nervosa type patients, and transcripts were analysed thematically. RESULTS Patient responses yielded five main themes: positive and helpful aspects, beneficial outcomes, less helpful aspects, possible improvements to the treatments, and the therapeutic and external environment. The findings show clear differences and some overlaps between patients' views on MANTRA and SSCM. DISCUSSION Both therapies were experienced by patients as credible and largely helpful, albeit in different ways. These results are in agreement with those of therapists' views on these treatments.
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Affiliation(s)
- Anna Lose
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, King's College London, London, UK
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Beintner I, Jacobi C, Schmidt UH. Participation and outcome in manualized self-help for bulimia nervosa and binge eating disorder - a systematic review and metaregression analysis. Clin Psychol Rev 2014; 34:158-76. [PMID: 24508686 DOI: 10.1016/j.cpr.2014.01.003] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 01/07/2014] [Accepted: 01/14/2014] [Indexed: 02/02/2023]
Abstract
There is a growing body of research on manualized self-help interventions for bulimia nervosa (BN) and binge eating disorder (BED). Study and treatment dropout and adherence represent particular challenges in these studies. However, systematic investigations of the relationship between study, intervention and patient characteristics, participation, and intervention outcomes are lacking. We conducted a systematic literature review using electronic databases and hand searches of relevant journals. In metaregression analyses, we analyzed study dropout as well as more specific measures of treatment participation in manualized self-help interventions, their association with intervention characteristics (e.g. duration, guidance, intervention type [bibliotherapy, CD-ROM or Internet based intervention]) and their association with treatment outcomes. Seventy-three publications reporting on 50 different trials of manualized self-help interventions for binge eating and bulimia nervosa published through July 9th 2012 were identified. Across studies, dropout rates ranged from 1% to 88%. Study dropout rates were highest in CD-ROM interventions and lowest in Internet-based interventions. They were higher in samples of BN patients, samples of patients with higher degrees of dietary restraint at baseline, lower age, and lower body mass index. Between 6% and 88% of patients completed the intervention to which they had been assigned. None of the patient, study and intervention characteristics predicted intervention completion rates. Intervention outcomes were moderated by the provision of personal guidance by a health professional, the number of guidance sessions as well as participants' age, BMI, and eating disorder related attitudes (Restraint, Eating, Weight and Shape Concerns) at baseline (after adjusting for study dropout and intervention completion rates). Guidance particularly improved adherence and outcomes in samples of patients with bulimia nervosa; specialist guidance led to higher intervention completion rates and larger intervention effects on some outcomes than non-specialist guidance. Self-help interventions have a place in the treatment of BN and BED, especially if the features of their delivery and indications are considered carefully. To better determine who benefits most from what kind and "dosage" of self-help interventions, we recommend the use of consistent terminology as well as uniform standards for reporting adherence and participation in future self-help trials.
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Affiliation(s)
- Ina Beintner
- Institut für Klinische Psychologie und Psychotherapie, Technische Universität Dresden, Chemnitzer Straße 46, 01187 Dresden, Germany.
| | - Corinna Jacobi
- Institut für Klinische Psychologie und Psychotherapie, Technische Universität Dresden, Chemnitzer Straße 46, 01187 Dresden, Germany.
| | - Ulrike H Schmidt
- King's College London, Institute of Psychiatry, Box P059, De Crespigny Park, London SE5 8AF, UK.
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Aardoom JJ, Dingemans AE, Spinhoven P, Van Furth EF. Treating eating disorders over the internet: a systematic review and future research directions. Int J Eat Disord 2013; 46:539-52. [PMID: 23674367 DOI: 10.1002/eat.22135] [Citation(s) in RCA: 102] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/24/2013] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To review the literature regarding internet-based treatment of eating disorders (ED). METHOD Relevant studies were identified by searching electronic databases (including Medline, Embase, PsycInfo, and Web of Science). Eligible studies evaluated an internet-based treatment for ED, or an ED treatment that included at least one internet-based component. RESULTS Twenty-one studies were included. Methodological quality varied. Internet-based treatments were superior to waiting lists in reducing ED psychopathology, frequency of binge eating and purging, and in improving (ED-related) quality of life. Internet-based treatment was more effective for individuals with less comorbid psychopathology, binge eating as opposed to restrictive problems, and individuals with binge eating disorder as opposed to bulimia nervosa. Higher levels of compliance were related to more improvements in ED symptoms. Study dropout ranged from 5.3 to 76.8%. Inclusion of face-to-face assessments and therapist support seemed to enhance study compliance. Overall, the internet can be considered an acceptable vehicle for delivering ED treatment. DISCUSSION Future research should determine the utility of internet-based treatment by comparing them to face-to-face treatment. Research should furthermore focus on unraveling predictors and mediators of treatment outcome, compliance, and dropout, respectively. Studies with good methodological quality are needed with reports according to CONSORT guidelines.
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Affiliation(s)
- Jiska J Aardoom
- Center for Eating Disorders 'Ursula', Leidschendam, The Netherlands
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Wagner G, Wagner G, Penelo E, Nobis G, Mayerhofer A, Schau J, Spitzer M, Imgart H, Karwautz A. Is technology assisted guided self-help successful in treating female adolescents with bulimia nervosa? NEUROPSYCHIATRIE : KLINIK, DIAGNOSTIK, THERAPIE UND REHABILITATION : ORGAN DER GESELLSCHAFT ÖSTERREICHISCHER NERVENÄRZTE UND PSYCHIATER 2013; 27:66-73. [PMID: 23609487 DOI: 10.1007/s40211-013-0062-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Accepted: 02/12/2013] [Indexed: 12/12/2022]
Abstract
OBJECTIVE This study aims to evaluate the long-term outcome of new technology assisted guided self-help in adolescents with bulimia nervosa (BN). METHOD One hundred and twenty-six patients with BN (29 adolescents and 97 adults) were randomly allocated to a cognitive behavioural therapy-based self-help program delivered by the Internet or bibliotherapy, both accompanied by e-mail guidance. Outcomes were assessed at baseline, month 4, 7 and 18 including remission rates and eating disorder associated psychopathology. RESULTS In all, 44% of adolescents vs. 38.7% of adults were in remission at month 7, and 55% of adolescents vs. 62.5% of adults were in remission at follow-up. Objective binge eating and compensatory behaviour improved significantly over time in both groups, with the highest decrease during the first 4 months. A significant decrease over time and no group differences have been found in almost all EDI-2 subscales. CONCLUSIONS E-mail guided self-help (delivered via the Internet or bibliotherapy) is equally effective for adolescents as for adults with BN, and can be recommended as an initial step of treatment for this younger age group.
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Affiliation(s)
- Gudrun Wagner
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
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McClay CA, Waters L, McHale C, Schmidt U, Williams C. Online cognitive behavioral therapy for bulimic type disorders, delivered in the community by a nonclinician: qualitative study. J Med Internet Res 2013; 15:e46. [PMID: 23502689 PMCID: PMC3636296 DOI: 10.2196/jmir.2083] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Revised: 11/16/2012] [Accepted: 12/19/2012] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Cognitive behavioral therapy is recommended in the National Institute for Clinical Excellence guidelines for the treatment of bulimia nervosa. In order to make this treatment option more accessible to patients, interactive online CBT programs have been developed that can be used in the user's own home, in privacy, and at their convenience. Studies investigating online CBT for bulimic type eating disorders have provided promising results and indicate that, with regular support from a clinician or trained support worker, online CBT can be effective in reducing bulimic symptoms. Two main factors distinguish this study from previous research in this area. First, the current study recruited a wide range of adults with bulimic type symptoms from the community. Second, the participants in the current study had used cCBT with support from a nonclinical support worker rather than a specialist eating disorder clinician. OBJECTIVE To investigate participants' experiences of using an online self-help cognitive behavioral therapy (CBT) package (Overcoming Bulimia Online) for bulimia nervosa (BN) and eating disorders not otherwise specified (EDNOS). METHODS Eight participants with a mean age of 33.9 years took part in semi-structured interviews. Interviews were transcribed and analyzed using a 6-step thematic analysis process. RESULTS Saturation was achieved, and 7 themes were identified in the dataset. These were: (1) conceptualizing eating disorders, (2) help-seeking behavior, (3) aspects of the intervention, (4) motivation to use the online package, (5) privacy and secrecy with regard to their eating problems, (6) recovery and the future, and (7) participant engagement describing individuals' thoughts on taking part in the online research study. CONCLUSIONS Participants suggested that online CBT self-help represented a generally desirable and acceptable treatment option for those with bulimic type eating problems, despite some difficulties with motivation and implementation of some elements of the package. TRIAL REGISTRATION International Standard Randomized Controlled Trial Number of the original RCT that this study is based on: ISRCTN41034162; http://www.controlled-trials.com/ISRCTN41034162 (Archived by WebCite at http://www.webcitation.org/6Ey9sBWTV).
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Affiliation(s)
- Carrie-Anne McClay
- Institute of Health and Wellbeing, Mental Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
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Fichter MM, Quadflieg N, Lindner S. Internet-based relapse prevention for anorexia nervosa: nine- month follow-up. J Eat Disord 2013; 1:23. [PMID: 24999404 PMCID: PMC4081799 DOI: 10.1186/2050-2974-1-23] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Accepted: 05/31/2013] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND To study the longer term effects of an internet-based CBT intervention for relapse prevention (RP) in anorexia nervosa. METHODS 210 women randomized to the RP intervention group (full and partial completers) or the control group were assessed for eating and general psychopathology. Multiple regression analysis identified predictors of favorable course concerning Body Mass Index (BMI). Logistic regression analysis identified predictors of adherence to the RP program. RESULTS Most variables assessed showed more improvement for the RP than for the control group. However, only some scales reached statistical significance (bulimic behavior and menstrual function, assessed by expert interviewers blind to treatment condition). Very good results (BMI) were seen for the subgroup of "full completers" who participated in all nine monthly RP internet-based intervention sessions. "Partial completers" and controls (the latter non-significantly) underwent more weeks of inpatient treatment during the study period than "full completers", indicating better health and less need for additional treatment among the "full completers". Main long-term predictors for favorable course were adherence to RP, more spontaneity, and more ineffectiveness. Main predictors of good adherence to RP were remission from lifetime mood and lifetime anxiety disorder, a shorter duration of eating disorder, and additional inpatient treatment during RP. CONCLUSIONS Considering the high chronicity of AN, internet-based relapse prevention following intensive treatment appears to be promising.
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Affiliation(s)
- Manfred Maximilian Fichter
- Department of Psychiatry and Psychotherapy, University of Munich (LMU), Nussbaumstraße 7, 80336 München, Germany ; Schön Klinik Roseneck affiliated with the Medical Faculty of the University of Munich (LMU), 83209 Prien, Germany
| | - Norbert Quadflieg
- Department of Psychiatry and Psychotherapy, University of Munich (LMU), Nussbaumstraße 7, 80336 München, Germany
| | - Susanne Lindner
- Department of Psychiatry and Psychotherapy, University of Munich (LMU), Nussbaumstraße 7, 80336 München, Germany
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