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Zhong J, Zhang Y, Sun Y, Wang Q, Dong G, Li X. The efficacy of internet-based cognitive behavioral therapy for adult binge spectrum eating disorders: A meta-analysis. J Affect Disord 2024; 361:684-692. [PMID: 38936703 DOI: 10.1016/j.jad.2024.06.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 06/20/2024] [Accepted: 06/22/2024] [Indexed: 06/29/2024]
Abstract
OBJECTIVE Internet-Based Cognitive Behavioral Therapy (iCBT) is an innovative modality of cognitive-behavioral intervention that presents a promising therapeutic strategy for individuals diagnosed with binge spectrum eating disorders. This study employed a meta-analysis methodology to assess the clinical effectiveness and acceptability of iCBT. METHODS We conducted searches in databases such as PubMed, Embase, Web of Science, Cochrane Library, and PsycINFO, collecting literature that met the inclusion criteria until August 5, 2023. RESULTS A comprehensive analysis was conducted, encompassing a total of 11 randomized controlled studies that satisfied the predetermined criteria for inclusion. The summary results demonstrated that iCBT could significantly improve the pathological features related to eating in patients with binge spectrum eating disorders and also significantly reduce the frequency of binge episodes. Additionally, iCBT could ameliorate the depressive and anxious emotions of patients with binge spectrum eating disorders and boost their self-esteem. Furthermore, a notable disparity in dropout rates was seen in comparison to the control group. LIMITATION Heterogeneity across studies,limitations of self-assessment scales and potential publication bias. CONCLUSION iCBT can effectively assist patients with binge spectrum eating disorders in improving clinical symptoms. However, it is important to use caution when interpreting the findings of this study, as there are limitations pertaining to the quantity and quality of the included studies.
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Affiliation(s)
- Jianan Zhong
- Department of Psychiatry, The First Hospital of China Medical University, Shenyang, China
| | - Yihan Zhang
- Department of Psychiatry, The First Hospital of China Medical University, Shenyang, China
| | - Yifan Sun
- Department of Psychology, The People's Hospital of Liaoning Province, The People's Hospital of China Medical University, Shenyang, China
| | - Qi Wang
- Department of Psychiatry and Psychology, General Hospital of Northern Theater Command, Shenyang, China
| | - Guanxi Dong
- Department of Psychiatry, The First Hospital of China Medical University, Shenyang, China
| | - Xiaobai Li
- Department of Psychiatry, The First Hospital of China Medical University, Shenyang, China.
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D'Adamo L, Laboe A, Goldberg J, Howe C, Fennig M, DePietro B, Firebaugh ML, Cooper Z, Wilfley D, Fitzsimmons-Craft E. Development and usability testing of an online platform for provider training and implementation of cognitive-behavioral therapy guided self-help for eating disorders. RESEARCH SQUARE 2024:rs.3.rs-4409969. [PMID: 38854104 PMCID: PMC11160899 DOI: 10.21203/rs.3.rs-4409969/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2024]
Abstract
Background Most individuals with eating disorders (EDs) do not receive treatment, and those who do receive care typically do not receive evidence-based treatment, partly due to lack of accessible provider training. This study developed a novel "all-in-one" online platform for disseminating training for mental health providers in cognitive-behavioral therapy guided self-help (CBTgsh) for EDs and supporting its implementation. The aim of the study was to obtain usability data from the online platform prior to evaluating its effects on provider training outcomes and patient ED symptom outcomes in an open pilot trial. Methods Nine mental health provider participants (n = 4 in Cycle 1; n = 5 in Cycle 2) and 9 patient participants (n = 4 in Cycle 1; n = 5 in Cycle 2) were enrolled over two cycles of usability testing. In Cycle 1, we recruited providers and patients separately to complete brief platform testing sessions. In Cycle 2, we recruited provider-patient dyads; providers completed training using the platform and subsequently delivered CBTgsh to a patient for three weeks. Usability was assessed using the System Usability Scale (SUS), the Usefulness, Satisfaction, and Ease of Use Questionnaire (USE), and semi-structured interviews. Results Interview feedback converged on two themes for providers (applicability of program for real-world use, platform structure and function) and two themes for patients (barriers and facilitators to engagement, perceived treatment effects). SUS and USE scores were in the "average" to "good" ranges across cycles. Conclusions Findings from this study demonstrate preliminary feasibility and acceptability of the online platform. Data collected in this study will inform further refinements to the online platform. The platform's effects on provider training outcomes and patient ED symptom outcomes will be evaluated in an open pilot trial. Given the wide treatment gap for EDs and barriers to dissemination and implementation of evidence-based treatments, the online platform represents a scalable solution that could improve access to evidence-based care for EDs.
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Lebow J, Billings M, Mattke A, Partain P, Gewirtz O'Brien J, Narr C, Breland R, Jacobson RM, Loeb K, Sim L. Does embedding pediatric eating disorder treatment in primary care bridge the access gap? Eat Disord 2024; 32:283-296. [PMID: 38206038 DOI: 10.1080/10640266.2023.2299592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
Given the numerous barriers to accessing child and adolescent eating disorder treatment, there is a need for innovation in how this care is delivered. Primary care-based eating disorder treatment has established proof-of-concept, yet it is unclear whether this model can bridge the treatment-access gap. This retrospective chart review study compared demographic and illness characteristics of 106 adolescents (M age = 15.1 years) SD = 1.8 consecutively evaluated in a primary care-based eating disorder clinic with 103 adolescent patients (M age = 15.2 years) SD = 2.2 seen consecutively in a specialty eating disorder clinic at the same medical center. Relative to adolescents in specialty care, those in the primary care group presented at a significantly higher BMI percentile, had less weight suppression, a shorter illness duration, lower rates of amenorrhea and lower scores on the EDE-Q Dietary Restraint subscale. In addition, more patients in the primary care group identified as non-white and had government/public assistance insurance compared to those in the specialty group. The results suggest that, compared to traditional specialty care clinics, embedded eating disorder treatment in primary care may reach a more racially and socioeconomically diverse group of adolescents when they are earlier in the course of their illness. Future research determining the relative effectiveness of this model as compared to interventions delivered in specialty care is needed.
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Affiliation(s)
- Jocelyn Lebow
- Department of Psychiatry and Psychology, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
- Department of Pediatric and Adolescent Medicine, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Marcie Billings
- Department of Pediatric and Adolescent Medicine, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Angela Mattke
- Department of Pediatric and Adolescent Medicine, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Paige Partain
- Department of Pediatric and Adolescent Medicine, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | | | - Cassandra Narr
- Department of Nursing, University of Minnesota, Minneapolis, Minnesota, USA
| | - Renee Breland
- Department of Pediatric and Adolescent Medicine, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Robert M Jacobson
- Department of Pediatric and Adolescent Medicine, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
- Department of Quantitative Health Science Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Katharine Loeb
- Chicago Center for Evidence, Based Treatment, Chicago, IL, USA
| | - Leslie Sim
- Department of Psychiatry and Psychology, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
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Haas A, Laboe AA, McGinnis CG, Firebaugh ML, Shah J, Bardone-Cone AM, Pike KM, Taylor CB, Wilfley DE, Fitzsimmons-Craft EE. Adapting a mobile app to support patients with anorexia nervosa following post-acute care: perspectives from eating disorder treatment center stakeholders. Front Digit Health 2023; 5:1099718. [PMID: 37274762 PMCID: PMC10235779 DOI: 10.3389/fdgth.2023.1099718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 05/05/2023] [Indexed: 06/06/2023] Open
Abstract
Introduction Anorexia nervosa (AN) is a harmful, life-threatening illness. Patients with severe AN often receive acute treatment but, upon discharge, experience high relapse rates. Evidence-based, outpatient treatment following acute care is critical to preventing relapse; however, numerous barriers (e.g., location, financial limitations, low availability of providers) preclude individuals from accessing treatment. mHealth technologies may help to address these barriers, but research on such digital approaches for those with AN is limited. Further, such technologies should be developed with all relevant stakeholder input considered from the outset. As such, the present study aimed to garner feedback from eating disorder (ED) treatment center providers on (1) the process of discharging patients to outpatient services, (2) their experiences with technology as a treatment tool, and (3) how future mHealth technologies may be harnessed to offer the most benefit to patients in the post-acute period. Methods Participants (N = 11, from 7 ED treatment centers across the United States) were interviewed. To analyze the data for this study, each interview was manually transcribed and analyzed using components of Braun and Clarke's six-phase thematic analysis framework (Braun & Clarke, 2006). Results Participants indicated proactively securing outpatient care for their patients, but mentioned several barriers their patients face in accessing evidence-based ED treatment. All participants had some experience using various technologies for treatment (e.g., teletherapy, self-monitoring apps), and mentioned a high level of interest in the development of a new app to be used by patients recently discharged from acute treatment for AN. Participants also offered suggestions of effective and relevant content for a potential app and adjunctive social networking component for post-acute care of AN. Discussion Overall, participants expressed positive attitudes toward the integration of an app into the care flow, suggesting the high potential benefit of harnessing technology to support individuals recovering from AN.
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Affiliation(s)
- Anneliese Haas
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States
| | - Agatha A. Laboe
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States
| | - Claire G. McGinnis
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States
| | - Marie-Laure Firebaugh
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States
| | - Jillian Shah
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States
| | - Anna M. Bardone-Cone
- Department of Psychology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Kathleen M. Pike
- Department of Psychiatry, Columbia University, New York, NY, United States
| | - C. Barr Taylor
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
- Center for m2Health, Palo Alto University, Palo Alto, CA, United States
| | - Denise E. Wilfley
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States
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Fitzsimmons-Craft EE, Laboe AA, McGinnis C, Firebaugh ML, Shah J, Wallendorf M, Jacobi C, Bardone-Cone AM, Pike KM, Taylor CB, Wilfley DE. A pilot randomized controlled trial of a cognitive-behavioral therapy guided self-help mobile app for the post-acute treatment of anorexia nervosa: A registered report. Int J Eat Disord 2023; 56:654-661. [PMID: 36609861 PMCID: PMC10019771 DOI: 10.1002/eat.23891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 12/21/2022] [Accepted: 12/21/2022] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Relapse following acute treatment for anorexia nervosa (AN) is common. Evidence suggests cognitive-behavioral therapy (CBT) may be useful in the post-acute period, but few patients have access to trained providers. mHealth technologies have potential to increase access to high-quality care for AN, including in the post-acute period. The aim of this study is to estimate the preliminary feasibility and effectiveness of a CBT-based mobile intervention plus treatment as usual (TAU), offered with and without an accompanying social networking feature. METHOD In the current pilot randomized controlled trial, women with AN who have been discharged from acute treatment in the past 2 months (N = 90) will be randomly assigned to a CBT-based mobile intervention plus treatment as usual (TAU), a CBT-based mobile intervention including social networking plus TAU, or TAU alone. We will examine feasibility, acceptability, and preliminary effectiveness of the three conditions in terms of reducing eating disorder psychopathology, reducing frequency of eating disorder behaviors, achieving weight maintenance, reducing depression and suicidal ideation, and reducing clinical impairment. We will examine rehospitalization and full recovery rates in an exploratory fashion. We will also examine whether the mobile intervention and social networking feature change the proposed targets and whether changes in targets are associated with benefit, as well as conduct exploratory analyses to identify within-mobile intervention predictors and moderators of outcome. DISCUSSION Ultimately, this research may lead to increased access to evidence-based treatment for individuals with AN and prevention of the extreme negative consequences that can result from this serious disorder. PUBLIC SIGNIFICANCE Relapse after acute treatment for anorexia nervosa is common, and few patients have access to trained providers to support them following acute care. This study will pilot a coached mobile app, including a social networking component, for this population. If ultimately successful, our approach could greatly increase access to evidence-based treatment for individuals with anorexia nervosa and ultimately prevent the extreme negative consequences that can result from this serious disorder.
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Affiliation(s)
| | - Agatha A. Laboe
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Claire McGinnis
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Marie-Laure Firebaugh
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Jillian Shah
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Michael Wallendorf
- Division of Biostatistics, Washington University School of Medicine, St. Louis, MO, USA
| | - Corinna Jacobi
- Department of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Anna M. Bardone-Cone
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kathleen M. Pike
- Department of Psychiatry, Columbia University, New York, NY, USA
| | - C. Barr Taylor
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
- Center for mHealth, Palo Alto University, Palo Alto, CA, USA
| | - Denise E. Wilfley
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
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Eating Disorder Screening and Treatment in a Medically Underserved Southern State: Data Collected by a Legislative Eating Disorder Council and Implications for Statewide Assessment. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2023; 50:342-355. [PMID: 36472704 DOI: 10.1007/s10488-022-01240-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2022] [Indexed: 12/12/2022]
Abstract
Healthcare providers play a key role in early identification of eating disorders (EDs), especially in underserved states where ED treatment resources are lacking. Currently, there is little known about ED screening and treatment practices in underserved states. The current study assessed current ED screening and treatment practices among healthcare providers in an underserved state using data collected by a government-formed state ED council. Healthcare providers (N = 242; n = 209 behavioral health providers; n = 33 medical providers) practicing in Kentucky completed a brief, anonymous survey on ED screening and treatment practices, comfort with screening for EDs, and interest in continued education. Over half of healthcare providers indicated screening for EDs, with the majority using a clinical interview. After identification of ED symptoms, providers reported a combination of treating in-house, referring out, or seeking consultation. In bivariate analyses, medical providers were significantly more likely than behavioral health providers to use a screening tool specifically designed for EDs. The majority of medical providers indicated that they received education about EDs and feel knowledgeable about ED screening tools, though most reported infrequent use of these screening tools in their practice. Nearly all behavioral health and medical providers expressed interest in continuing education on ED screening and treatment. These findings indicate a need for, and interest in, education on evidence-based ED screening and treatment resources in underserved states and demonstrate the utility of a state ED council to collect these data to inform future education and treatment strategies.
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Rutsztein G, Scappatura ML, Elizathe L, Leonardelli E, Murawski B, Lievendag L, Sanday J, Falivelli MBB, Bidacovich G, Keegan E. Efficacy of an integrated program (PIA-2) to reduce the risk for problems related to eating, weight and body image in female adolescents from Argentina. Int J Eat Disord 2023; 56:758-769. [PMID: 36757140 DOI: 10.1002/eat.23900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 01/10/2023] [Accepted: 01/10/2023] [Indexed: 02/10/2023]
Abstract
OBJECTIVE This study aimed to examine the efficacy of an integrated program (PIA-2) to reduce the risk for problems related to eating, weight and body image in female adolescents from Argentina. METHOD A quasi-experimental study was conducted by comparing an experimental group versus a control group. The final sample included 509 girls aged 13-18 (M = 15.39 and SD = 1.30) from nine schools located in three geographical regions. They provided data at three assessment time points: baseline, post-intervention and a 3-month follow-up. Dependent variables included skipping breakfast, physical activity, eating disorder risk and thin-ideal internalization. The program was carried out in three 90-minute sessions within usual school hours, at 1-week intervals. RESULTS Participants who received the intervention decreased more than the control group in skipping breakfast month by month. However, a significant effect of the intervention was not found on physical activity, eating disorder risk, and thin-ideal internalization. DISCUSSION The presence of mixed findings shows the need to adjust the intervention to enhance the results. The importance of working jointly with other Latin American countries is emphasized, in order to promote the growth of the field of prevention, regarding cultural particularities shared by our societies. PUBLIC SIGNIFICANCE Integrated programs aimed at reducing risk factors for the entire spectrum of problems related to eating, weight and body image could lead to beneficial and more efficient effects. However, their development is still incipient in Latin America. PIA-2 Program, designed for female adolescents, produced positive results in one of the four variables studied, decreasing the weekly frequency of skipping breakfast among adolescents. This is pioneering research in Argentina and the region since very few studies on integrated prevention have been published in Latin America. It is crucial to continue with efforts aimed at developing programs that are suited to the specific needs of the population of Latin American countries. In this aspect, our study is undoubtedly an important contribution.
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Affiliation(s)
| | | | - Luciana Elizathe
- Facultad de Psicología, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Eduardo Leonardelli
- Facultad de Psicología, Universidad de Buenos Aires, Buenos Aires, Argentina.,Pontificia Universidad Católica, Buenos Aires, Argentina.,Universidad Favaloro, Buenos Aires, Argentina
| | - Brenda Murawski
- Facultad de Psicología, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Leonora Lievendag
- Facultad de Psicología, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Julieta Sanday
- Facultad de Psicología, Universidad de Buenos Aires, Buenos Aires, Argentina
| | | | - Germán Bidacovich
- Facultad de Psicología, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Eduardo Keegan
- Facultad de Psicología, Universidad de Buenos Aires, Buenos Aires, Argentina
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Moreno R, Buckelew SM, Accurso EC, Raymond-Flesch M. Disparities in access to eating disorders treatment for publicly-insured youth and youth of color: a retrospective cohort study. J Eat Disord 2023; 11:10. [PMID: 36694235 PMCID: PMC9875472 DOI: 10.1186/s40337-022-00730-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 12/28/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Eating disorders are associated with substantial morbidity and mortality that can be minimized by timely access to evidence-based treatment. However, disparate access to eating disorders treatment may contribute to significant health disparities amongst marginalized groups. This study examined the association between insurance type (public vs. private) and receipt of recommended mental health treatment in a sample of racially/ethnically diverse youth who presented to an adolescent medicine clinic with malnutrition secondary to disordered eating. METHODS A retrospective chart review was conducted for youth ages 11-25 years (N = 1060) who presented to an urban adolescent medicine specialty program between June 1, 2012 and December 31, 2019 for malnutrition secondary to disordered eating. Bivariate and logistic regression analyses examined the association between insurance type (public vs. private) and other demographic/clinical factors on receipt of recommended treatment within six months of the initial evaluation. RESULTS Patients with public insurance were one third as likely to receive recommended treatment as patients with private insurance (AOR = 3.23; 95% CI = 1.99, 4.52), after adjusting for demographic and clinical factors. Latinx (AOR = 0.49; 95% CI = 0.31, 0.77) and Asian (AOR = 0.55; 95% CI = 0.32, 0.94) patients were half as likely to receive recommended treatment as White patients. CONCLUSIONS Access to evidence-based mental health treatment is a necessary first step towards health equity for individuals with eating disorders. Additional work is needed to dismantle systemic inequities that contribute to disparities in care for youth of color and those with public insurance.
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Affiliation(s)
- Ruby Moreno
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA
| | - Sara M Buckelew
- Division of Adolescent & Young Adult Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Erin C Accurso
- Department of Psychiatry and Behavioral Sciences, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Marissa Raymond-Flesch
- Division of Adolescent & Young Adult Medicine, University of California, San Francisco, San Francisco, CA, USA. .,Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA, USA.
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Barakat S, Maguire S. Accessibility of Psychological Treatments for Bulimia Nervosa: A Review of Efficacy and Engagement in Online Self-Help Treatments. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:ijerph20010119. [PMID: 36612445 PMCID: PMC9819826 DOI: 10.3390/ijerph20010119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/13/2022] [Accepted: 12/14/2022] [Indexed: 05/30/2023]
Abstract
Bulimia nervosa is an eating disorder characterised by marked impairment to one's physical health and social functioning, as well as high rates of chronicity and comorbidity. This literature review aims to summarise existing academic research related to the symptom profile of BN, the costs and burden imposed by the illness, barriers to the receipt of care, and the evidence base for available psychological treatments. As a consequence of well-documented difficulties in accessing evidence-based treatments for eating disorders, efforts have been made towards developing innovative, diverse channels to deliver treatment, with several of these attempting to harness the potential of digital platforms. In response to the increasing number of trials investigating the utility of online treatments, this paper provides a critical review of previous attempts to examine digital interventions in the treatment of eating disorders. The results of a focused literature review are presented, including a detailed synthesis of a knowledgeable selection of high-quality articles with the aim of providing an update on the current state of research in the field. The results of the review highlight the potential for online self-help treatments to produce moderately sized reductions in core behavioural and cognitive symptoms of eating disorders. However, concern is raised regarding the methodological limitations of previous research in the field, as well as the high rates of dropout and poor adherence reported across most studies. The review suggests directions for future research, including the need to replicate previous findings using rigorous study design and methodology, as well as further investigation regarding the utility of clinician support and interactive digital features as potential mechanisms for offsetting low rates of engagement with online treatments.
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Affiliation(s)
- Sarah Barakat
- InsideOut Institute for Eating Disorders, University of Sydney, Sydney Local Health District, Camperdown 2050, Australia
- School of Psychology, University of Sydney, Camperdown 2050, Australia
| | - Sarah Maguire
- InsideOut Institute for Eating Disorders, University of Sydney, Sydney Local Health District, Camperdown 2050, Australia
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Christian C, Levinson CA. An integrated review of fear and avoidance learning in anxiety disorders and application to eating disorders. NEW IDEAS IN PSYCHOLOGY 2022. [DOI: 10.1016/j.newideapsych.2022.100964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Wiberg AC, Ghaderi A, Danielsson HB, Safarzadeh K, Parling T, Carlbring P, Jansson M, Welch E. Internet-based cognitive behavior therapy for eating disorders - Development and feasibility evaluation. Internet Interv 2022; 30:100570. [PMID: 36110307 PMCID: PMC9468502 DOI: 10.1016/j.invent.2022.100570] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 08/20/2022] [Accepted: 08/29/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Eating disorders (ED) are severe psychiatric conditions, characterized by decreased quality of life and high mortality. However, only a minority of patients with ED seek care and very few receive treatment. Internet-delivered cognitive behavioral therapy (ICBT) has the potential to increase access to evidence-based treatments. AIMS The aims of the present study were to (1) develop and evaluate the usability of an Internet-delivered guided self-help treatment based on Enhanced Cognitive Behavioral Therapy (ICBT-E) for patients with full or subthreshold bulimia nervosa (BN) or binge eating disorder (BED) with a user centered design process, and (2) to evaluate its feasibility and preliminary outcome in a clinical environment. METHOD The study was undertaken in two stages. In Stage I, a user-centered design approach was applied with iterative phases of prototype development and evaluation. Participants were eight clinicians and 30 individuals with current or previous history of ED. In Stage II, 41 patients with full or subthreshold BN or BED were recruited to a single-group open trial to evaluate the feasibility and preliminary outcome of ICBT-E. Primary outcome variables were diagnostic status and self-rated ED symptoms. RESULTS The user-centered design process was instrumental in the development of the ICBT-E, by contributing to improvements of the program and to the content being adapted to the needs and preferences of end-users. The overall usability of the program was found to be good. ICBT-E targets key maintaining factors in ED by introducing healthy eating patterns and addressing over-evaluation of weight and shape. The results indicate that ICBT-E, delivered in a clinical setting, is a feasible and promising treatment for full or subthreshold BN or BED, with a high level of acceptability observed and treatment completion of 73.2 %. Participation in ICBT-E was associated with significant symptom reductions in core ED symptomology, functional impairment as well as depressive symptoms, and the results were maintained at the 3-month follow-up. CONCLUSIONS ICBT-E was developed with end-users' preferences in mind, in accordance with the identified recommendations, and the program was perceived as usable by end-users. The study demonstrated the potential of ICBT-E, which marks a step forward in the effort to make powerful, empirically supported psychological interventions targeting ED more widely available and accessible.
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Affiliation(s)
- Anne-Charlotte Wiberg
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Ata Ghaderi
- Department of Clinical Neuroscience, Karolinska Institutet, Nobels väg 9, 17177 Stockholm, Sweden
| | | | - Kousha Safarzadeh
- Student Health Center, Lund University, Sandgatan 3, 22350 Lund, Sweden
| | - Thomas Parling
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Per Carlbring
- Department of Psychology, Stockholm University, 106 91 Stockholm, Sweden
| | - Magdalena Jansson
- Stockholm Center for Eating Disorders, Stockholm County Council, Wollmar Yxkullsgatan 27B, 118 50 Stockholm, Sweden
| | - Elisabeth Welch
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
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Jarman HK, McLean SA, Rodgers R, Fuller-Tyszkiewicz M, Paxton S, O'Gorman B, Harris E, Shatte A, Bishop K, Baumann T, Mahoney D, Daugelat MC, Yager Z. Informing mHealth and Web-Based Eating Disorder Interventions: Combining Lived Experience Perspectives With Design Thinking Approaches. JMIR Form Res 2022; 6:e38387. [PMID: 36315225 PMCID: PMC9664336 DOI: 10.2196/38387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 08/05/2022] [Accepted: 08/19/2022] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND App-based interventions designed to prevent and treat eating disorders have considerable potential to overcome known barriers to treatment seeking. Existing apps have shown efficacy in terms of symptom reduction; however, uptake and retention issues are common. To ensure that apps meet the needs and preferences of those for whom they were designed, it is critical to understand the lived experience of potential users and involve them in the process of design, development, and delivery. However, few app-based interventions are pretested on and co-designed with end users before randomized controlled trials. OBJECTIVE To address the issue, this study used a highly novel design thinking approach to provide the context and a lived experience perspective of the end user, thus allowing for a deeper level of understanding. METHODS In total, 7 young women (mean age 25.83, SD 5.34, range 21-33 years) who self-identified as having a history of body image issues or eating disorders were recruited. Participants were interviewed about their lived experience of body image and eating disorders and reported their needs and preferences for app-based eating disorder interventions. Traditional (thematic analysis) and novel (empathy mapping; visually depicting and empathizing with the user's personal experience) analyses were performed, providing a lived experience perspective of eating disorders and identifying the needs and preferences of this population in relation to app-based interventions for eating disorders. Key challenges and opportunities for app-based eating disorder interventions were also identified. RESULTS Findings highlighted the importance of understanding and identifying problematic eating disorder symptoms for the user, helpful practices for recovery that identify personal values and goals, the role of social support in facilitating hope, and aspects of usability to promote continued engagement and recovery. CONCLUSIONS Practical guidance and recommendations are described for those developing app-based eating disorder interventions. These findings have the potential to inform practices to enhance participant uptake and retention in the context of app-based interventions for this population.
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Affiliation(s)
- Hannah K Jarman
- School of Psychology, Deakin University, Geelong, Australia
- Centre for Social and Early Emotional Development, School of Psychology, Deakin University, Melbourne, Australia
| | - Siân A McLean
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Rachel Rodgers
- Applied Psychology Program for Eating and Appearance Research, Department of Applied Psychology, Northeastern University, Boston, MA, United States
- Department of Psychiatric Emergency & Acute Care, Lapeyronie Hospital, Centre Hospitalier Regional Universitaire Montpellier, Montpellier, France
| | - Matthew Fuller-Tyszkiewicz
- School of Psychology, Deakin University, Geelong, Australia
- Centre for Social and Early Emotional Development, School of Psychology, Deakin University, Melbourne, Australia
| | - Susan Paxton
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Beth O'Gorman
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| | - Emily Harris
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| | - Adrian Shatte
- Department of Planning, Performance & Analytics, James Cook University, Townsville, Australia
| | - Katie Bishop
- School of Psychology, Deakin University, Geelong, Australia
| | - Tahlia Baumann
- School of Psychology, University of Queensland, Brisbane, Australia
| | - Danielle Mahoney
- School of Psychology, University of Queensland, Brisbane, Australia
| | - Melissa-Claire Daugelat
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, Tübingen, Germany
- Centre of Excellence for Eating Disorders, University of Tübingen, Tübingen, Germany
| | - Zali Yager
- Institute for Health and Sport, Victoria University, Melbourne, Australia
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Kruzan KP, Fitzsimmons-Craft EE, Dobias M, Schleider JL, Pratap A. Developing, Deploying, and Evaluating Digital Mental Health Interventions in Spaces of Online Help- and Information-Seeking. PROCEDIA COMPUTER SCIENCE 2022; 206:6-22. [PMID: 37063642 PMCID: PMC10104522 DOI: 10.1016/j.procs.2022.09.081] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The internet is frequently the first point of contact for people seeking support for their mental health symptoms. Digital interventions designed to be deployed through the internet have significant promise to reach diverse populations who may not have access to, or are not yet engaged in, treatment and deliver evidence-based resources to address symptoms. The liminal nature of online interactions requires designing to prioritize needs detection, intervention potency, and efficiency. Real-world implementation, data privacy and safety are equally important and can involve transparent partnerships with stakeholders in industry and non-profit organizations. This commentary highlights challenges and opportunities for research in this space, grounded in learnings from multiple research projects and teams aligned with this effort.
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Affiliation(s)
- Kaylee P. Kruzan
- Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | | | - Mallory Dobias
- Department of Psychology, Stony Brook University, Stony Brook, NY 11794, USA
| | | | - Abhishek Pratap
- Center for Addiction and Mental Health, Toronto, ON, M5T 1R8 Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, M5T 1R8, Canada
- Vector Institute for Artificial Intelligence, Toronto, ON, M5T 1R8, Canada
- Kings College London, London, WC2R 2LS, UK
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, WA 98195, USA
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14
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Associations between probable eating disorders and healthcare use among post-9/11 veteran men and women. J Psychosom Res 2022; 157:110811. [PMID: 35413512 DOI: 10.1016/j.jpsychores.2022.110811] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 03/28/2022] [Accepted: 03/30/2022] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Healthcare use is elevated among individuals with eating disorders (EDs); however, most people with EDs do not receive ED-specific care, likely due to factors such as the cost and availability of treatment as well as stigma. U.S. military veterans historically have been understudied in ED research. We investigated healthcare use and barriers to care among recently separated veteran men and women. METHOD In this cross-sectional study, 1494 participants completed an online or paper survey assessing ED symptoms, healthcare use, and logistical and attitudinal barriers to care. We estimated logistic regression models to investigate the association of ED status with healthcare use variables and examined gender similarities and differences in barriers to care. RESULTS Men and women with probable EDs reported low rates of ED treatment but greater healthcare use, during military service and since separating from service, compared to veterans without probable EDs (odds ratios = 1.57-7.05). Large proportions of participants reported that they did not know where to get help for EDs and that treatment is too costly. There were few gender differences in barriers to care (Cramer's V = 0.02-0.32). CONCLUSION Veterans reported high healthcare use but low rates of ED treatment. Findings underscore the need to increase the reach and accessibility of ED treatment in potentially vulnerable groups.
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15
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Hamatani S, Matsumoto K, Takahashi J, Shiko Y, Ozawa Y, Niitsu T, Hirano Y, Shimizu E. Feasibility of guided internet-based cognitive behavioral therapy for patients with anorexia nervosa. Internet Interv 2022; 27:100504. [PMID: 35257002 PMCID: PMC8897312 DOI: 10.1016/j.invent.2022.100504] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 02/03/2022] [Accepted: 02/09/2022] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE The objective of the present study was to investigate the feasibility of guided internet cognitive behavioral therapy (ICBT) for anorexia nervosa. METHODS We conducted a prospective single-arm study between January 2020 and March 2021. The intervention was built using videos, web programs, and chat tools. The intervention program was largely based on metacognitive training. Participants performed the self-help program once a week for 12 consecutive weeks. The primary outcome was the global Eating Disorder Examination Questionnaire (EDE-Q) score. Secondary outcomes included clinical symptoms of eating disorders, metacognitive function, body mass index, depression, and generalized anxiety. The main statistical analysis examined whether the EDE-Q score and other outcomes at the end of the intervention differed from the baseline. RESULTS Fourteen participants underwent the trial treatment, and 13 completed the intervention. There was a significant reduction in the global EDE-Q score from 3.48 (SD = 1.4) to 2.54 (SD = 1.5, p = 0.02, Cohen's d = 0.75) from baseline to post-intervention. Some EDE-Q subscales and body checking questionnaire scale demonstrated statistically significant improvements, with moderate to large effect sizes. Although there was no significant improvement in body mass index, metacognitive function, or depressive symptoms, there was a significant improvement in the severity of generalized anxiety (M = -4.0, p = 0.01, Cohen's d = 0.95). No adverse events were observed. DISCUSSION Our findings suggest that guided ICBT for anorexia nervosa is well accepted by female patients and practical as a telemedicine approach that improves symptoms. In the future, tightly controlled randomized controlled trials should be conducted for efficacy verification.
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Affiliation(s)
- Sayo Hamatani
- Research Center for Child Mental Development, Chiba University, Japan
- Learning and Behavior Science, Linköping University, Sweden
- Research Center for Child Mental Development, University of Fukui, Japan
- Corresponding author at: Research Center for Child Mental Development, University of Fukui, 23-3 Matsuokashimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui 910-1193, Japan.
| | - Kazuki Matsumoto
- Research Center for Child Mental Development, Chiba University, Japan
- Laboratory of Neuropsychology, Kanazawa University, Japan
| | - Jumpei Takahashi
- Department of Child Psychiatry, Chiba University Hospital, Japan
| | - Yuki Shiko
- Biostatistics Section, Clinical Research Center, Chiba University Hospital, Japan
| | - Yoshihito Ozawa
- Biostatistics Section, Clinical Research Center, Chiba University Hospital, Japan
| | - Tomihisa Niitsu
- Department of Psychiatry, Graduate School of Medicine, Chiba University, Japan
| | - Yoshiyuki Hirano
- Research Center for Child Mental Development, Chiba University, Japan
| | - Eiji Shimizu
- Research Center for Child Mental Development, Chiba University, Japan
- Department of Cognitive Behavioral Physiology, Graduate School of Medicine, Chiba University, Japan
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16
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Carrard I, Bucher Della Torre S. A study protocol for a preliminary randomised controlled trial assessing the acceptability and effectiveness of two eating disorders prevention interventions in Switzerland: The HEIDI BP-HW project. PLoS One 2021; 16:e0259796. [PMID: 34780528 PMCID: PMC8592424 DOI: 10.1371/journal.pone.0259796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 10/26/2021] [Indexed: 11/25/2022] Open
Abstract
Because of the serious consequences of eating disorders on young women’s lives and because of the lack of specialised care facilities, assessing and implementing evidence-based prevention interventions is necessary. Switzerland, like other Western countries, has high prevalence rates of eating disorders. However, no prevention interventions have been evaluated in this country so far. This paper presents the protocol of a preliminary study with the aim to evaluate the acceptability and effectiveness of two interventions, the Body Project (BP) and the Healthy Weight Program (HW), for female students from French-speaking Switzerland. These two interventions were chosen because they have been widely evaluated and they proved to be effective in various countries. They take place in groups and include four weekly sessions over one month. Because of the pandemic situation, the group sessions will take place online on an collaborative platform. The design is a three-arm randomised controlled study. Ninety female students aged 18–25 and presenting with at least moderate body dissatisfaction will be randomised into three groups: (1) one-month BP intervention, (2) one-month HW intervention, and (3) one-month waiting-list control group followed by the BP intervention. Assessments of body dissatisfaction, thin-ideal internalisation, dietary restraint, negative affect, and eating disorder psychopathology will be conducted before and after the interventions or waiting list and after a one-month follow-up. ANCOVA and ANOVA with repeated measures will be used to assess group differences and follow-up stability. Acceptability will be assessed with a questionnaire on participants’ satisfaction with the interventions, group discussion at the end of the intervention, and with participants’ rate of attendance to the group sessions. The study results will provide additional data on these two eating disorders prevention interventions and will suggest ways for their dissemination and further evaluation in Switzerland.
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Affiliation(s)
- Isabelle Carrard
- Department of Nutrition and Dietetics, School of Health Sciences, University of Applied Sciences and Arts Western Switzerland (HES-SO), Geneva, Switzerland
- * E-mail:
| | - Sophie Bucher Della Torre
- Department of Nutrition and Dietetics, School of Health Sciences, University of Applied Sciences and Arts Western Switzerland (HES-SO), Geneva, Switzerland
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17
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Reas DL, Isomaa R, Solhaug Gulliksen K, Levallius J. Clinicians as a critical link: Understanding health professionals' beliefs and attitudes toward anorexia nervosa, bulimia nervosa, and binge eating disorder. Scand J Psychol 2021; 62:775-779. [PMID: 34569633 DOI: 10.1111/sjop.12777] [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: 09/14/2020] [Accepted: 08/02/2021] [Indexed: 11/26/2022]
Abstract
Understanding the perspectives of health professionals remains an understudied issue, yet may help bridge research-practice gaps and pinpoint important areas for education, training, and research. This study investigated attitudes toward anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED) among Nordic health professionals specialized within the eating disorder (ED) field. Participants (n = 144) completed a modified ED-version of the Illness Perception Questionnaire which assessed attitudes and beliefs toward perceived symptom controllability, severity, treatment effectiveness, and views on the prognosis of AN, BN, and BED. Personal enjoyment and level of comfort working with AN, BN, and BED were also assessed. The majority agreed or strongly agreed that patients with AN, BN, and BED were not responsible for their illness, and viewed the illnesses as psychological rather than medical in etiology. AN was viewed as the most severe and enduring, followed by BN, then BED. Treatment for BN was viewed as being more highly effective than treatments for either AN or BED. Professionals rated significantly less enjoyment and less confidence working with BED. To conclude, both commonalities and differences in attitudes toward AN, BN and BED were found in terms of perceived symptom controllability, views on severity, treatment effectiveness, and anticipated prognosis. In particular, findings emphasized the need for additional training in the management of BED among Nordic healthcare professionals.
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Affiliation(s)
- Deborah Lynn Reas
- Division of Mental Health and Addiction, Regional Department for Eating Disorders, Oslo University Hospital, Oslo, Norway.,Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
| | - Rasmus Isomaa
- Department of Social Services and Health Care, Fredrikakliniken, Jakobstad, Finland.,Faculty of Education and Welfare Studies, Åbo Akademi University, Vasa, Finland
| | - Kjersti Solhaug Gulliksen
- The Norwegian Psychological Association, Oslo, Norway.,The Institute of Eating Disorders, Hunger House, Oslo, Norway
| | - Johanna Levallius
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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18
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Robertson A, Thornton C. Challenging rigidity in Anorexia (treatment, training and supervision): questioning manual adherence in the face of complexity. J Eat Disord 2021; 9:104. [PMID: 34419156 PMCID: PMC8379880 DOI: 10.1186/s40337-021-00460-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 08/03/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Anorexia Nervosa is a debilitating illness. While there have been many advancements to treatment protocols and outcomes for people with eating disorders, the field acknowledges there remains considerable room for improvement. This timely Special Edition of the Journal of Eating Disorders has invited those of us in the field to consider a range of topics in aid of this task, including potential modifications and implementation of evidence-based practice, specific and common psychotherapy factors, treatment manuals, adherence and individualising treatment approaches for individuals and families. BODY: In this paper, we briefly outline the key manualised treatments currently available to treat children, adolescents and adults with Anorexia Nervosa, considering the benefits, potential reasons for adaptations and limitations. We then review the current evidence for training strict adherence to treatment manuals which is often a key focus in training and supervision, questioning the association of increased treatment adherence with improved therapeutic outcome. We then summarise some key evidence behind other therapeutic factors which have been demonstrated to affect outcome regardless of which manual is implemented, such as readiness to change and therapeutic alliance. CONCLUSION The paper concludes with implications and considerations for future research, clinical guidelines, training and supervision, highlighting the need to consider the therapeutic relationship and processes alongside manual content to conduct best evidence-informed practice.
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19
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Ametaj AA, Wilner Tirpak J, Cassiello-Robbins C, Snow R, Rassaby MM, Beer K, Sauer-Zavala S. A Preliminary Investigation of Provider Attitudes Toward a Transdiagnostic Treatment: Outcomes from Training Workshops with the Unified Protocol. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 48:668-682. [PMID: 33538945 DOI: 10.1007/s10488-020-01101-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2020] [Indexed: 10/22/2022]
Abstract
Evidence-based psychological treatments (EBPTs) for common mental health conditions are efficacious but remain underutilized in clinical service settings. Novel transdiagnostic and modular approaches that treat several disorders simultaneously promise to address common barriers to the dissemination and implementation of traditional EBPTs. Despite the promise that transdiagnostic treatments hold, the claims that these interventions can be more easily disseminated and implemented have not been widely tested. The present study examined whether a transdiagnostic treatment, the Unified Protocol (UP), addresses some barriers to dissemination and implementation for clinicians. Exploratory aims of the current study were to examine the effects of a UP introductory training workshop on clinician attitudes and behaviors by: (1) evaluating UP knowledge and treatment delivery, (2) determining relationships between clinician characteristics and their knowledge acquisition, satisfaction with UP, and UP penetration, and (3) exploring clinicians' perceptions of the UP's characteristics utilizing mixed methods. Workshop participants showed a good understanding of UP treatment concepts following training, and over a third of survey respondents reported use of the intervention 6-months after training. Positive attitudes toward EBPTs and fewer years of clinical practice were associated with greater satisfaction with the UP. Clinicians held positive views of the UP's flexibility and relative advantage over standard EBPTs but held negative views toward the manual's design and packaging. Overall, our findings suggest that clinicians may view transdiagnostic treatments such as the UP favorably and may consider them appealing over standard EBPTs. However, barriers associated with traditional EBPTs may extend to transdiagnostic treatments like the UP.
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Affiliation(s)
- Amantia A Ametaj
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA. .,Department of Epidemiology, Harvard T. H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02215, USA.
| | | | - Clair Cassiello-Robbins
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA.,Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
| | - Rachel Snow
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Madeleine M Rassaby
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Kelsey Beer
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
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20
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McLean SA, Hurst K, Smith H, Shelton B, Freeman J, Goldstein M, Jeffrey S, Heruc G. Credentialing for eating disorder clinicians: a pathway for implementation of clinical practice standards. J Eat Disord 2020; 8:62. [PMID: 33292654 PMCID: PMC7607662 DOI: 10.1186/s40337-020-00332-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 10/02/2020] [Indexed: 11/18/2022] Open
Abstract
Advances are needed to ensure safe and effective treatment is available for people with eating disorders. Recently developed clinical practice and training standards for mental health professionals and dietitians represent a significant step in this direction by providing a consensus statement on eating disorder treatment as a foundation on which to build competent practice. This commentary argues that a credentialing system could promote implementation of these practice standards through formal recognition of qualifications, knowledge, training and professional activities to meet minimum standards for delivery of safe and effective eating disorder treatment. Drivers for credentialing include the imperative to provide safe and effective care, promotion of workforce development in eating disorder practice and, importantly, readily available and transparent information for referrers, consumers, and carers to identify health professionals credentialed to provide eating disorder treatment. However, a number of factors must be considered to ensure that credentialing does not restrict access to care, such as prohibitively narrow criteria to become credentialed, absence of pathways for education, training, or professional development opportunities, and lack of consultation with or endorsement by stakeholders of the credentialing criteria, application and approval processes, and ways of identifying credentialed practitioners. Further work, including development of credentialing criteria and aligned training opportunities, currently being undertaken by the Australia & New Zealand Academy for Eating Disorders and the National Eating Disorders Collaboration in consultation with stakeholders in the eating disorders sector and health professions will advance understanding of the feasibility of a system of credentialing for eating disorders within Australia and New Zealand. The availability of clinical practice and training standards, supported by implementation pathways, including credentialing of eating disorders practitioners, aim to improve quality of life, reduce financial burden, and close the treatment gap.
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Affiliation(s)
- Siân A McLean
- Australia & New Zealand Academy for Eating Disorders, Melbourne, Australia.
- The Bouverie Centre, School of Psychology & Public Health, La Trobe University, Melbourne, 3056, Australia.
| | - Kim Hurst
- Australia & New Zealand Academy for Eating Disorders, Melbourne, Australia
- Eating Disorder Service, Robina Private Hospital, Robina, Australia
- School of Psychology, Griffith University, Gold Coast, Australia
| | - Hilary Smith
- National Eating Disorders Collaboration, Melbourne, Australia
| | - Beth Shelton
- National Eating Disorders Collaboration, Melbourne, Australia
| | - Jeremy Freeman
- Australia & New Zealand Academy for Eating Disorders, Melbourne, Australia
| | - Mandy Goldstein
- Australia & New Zealand Academy for Eating Disorders, Melbourne, Australia
- Mandy Goldstein Psychology, Sydney, Australia
- Department of Psychology, Macquarie University, Sydney, Australia
| | - Shane Jeffrey
- Australia & New Zealand Academy for Eating Disorders, Melbourne, Australia
- River Oak Health, Brisbane, Australia
- Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Gabriella Heruc
- Australia & New Zealand Academy for Eating Disorders, Melbourne, Australia
- School of Medicine, Western Sydney University, Campbelltown, Australia
- Eating Disorder Service, Northern Sydney Local Health District, Sydney, Australia
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21
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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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22
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Challenges and opportunities for enhanced cognitive behaviour therapy (CBT-E) in light of COVID-19. COGNITIVE BEHAVIOUR THERAPIST 2020; 13:e14. [PMID: 34191937 PMCID: PMC7264449 DOI: 10.1017/s1754470x20000161] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 04/19/2020] [Accepted: 04/27/2020] [Indexed: 01/18/2023]
Abstract
In the past few weeks, coronavirus disease 2019 (COVID-19) has dramatically expanded across the world. To limit the spread of COVID-19 and its negative consequences, many countries have applied strict social distancing rules. In this dramatic situation, people with eating disorders are at risk of their disorder becoming more severe or relapsing. The risk comes from multiple sources including fears of infection and the effects of social isolation, as well as the limited availability of adequate psychological and psychiatric treatments. A potential practical solution to address some of these problems is to deliver enhanced cognitive behaviour therapy (CBT-E), an evidence-based treatment for all eating disorders, remotely. In this guidance we address three main topics. First, we suggest that CBT-E is suitable for remote delivery and we consider the challenges and advantages of delivering it in this way. Second, we discuss new problems that patients with eating disorders may face in this period. We also highlight potential opportunities for adapting some aspects of CBT-E to address them. Finally, we provide guidelines about how to adapt the various stages, strategies and procedures of CBT-E for teletherapy use in the particular circumstances of COVID-19.
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Puls HC, Schmidt R, Herpertz S, Zipfel S, Tuschen-Caffier B, Friederich HC, Gerlach F, Mayr A, Lam T, Schade-Brittinger C, de Zwaan M, Hilbert A. Adherence as a predictor of dropout in Internet-based guided self-help for adults with binge-eating disorder and overweight or obesity. Int J Eat Disord 2020; 53:555-563. [PMID: 31891225 DOI: 10.1002/eat.23220] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 11/28/2019] [Accepted: 12/15/2019] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Internet-based guided self-help (GSH-I) is an efficacious treatment for adults with binge-eating disorder (BED) and overweight or obesity. Although broadly accessible, high dropout from GSH-I has been reported. However, little is known about the factors explaining dropout from GSH-I, including patients' adherence to treatment. METHOD Within a randomized trial on the treatment of BED, adherence to 4-month GSH-I was objectively assessed in N = 89 patients with BED and overweight or obesity. Objective adherence and subjective treatment evaluation were evaluated as predictors of dropout from GSH-I, defined as having accessed 5 or less of 11 modules. Cutoffs with optimal sensitivity and specificity were derived using Receiver Operating Characteristics curves analysis, and baseline sociodemographic and clinical correlates were determined. RESULTS According to our definition, n = 22 (24.7%) patients were defined as dropouts. Results of the full logistic regression model accounted for 72% of the variance in dropout and all objective adherence parameters (i.e., number of messages exchanged, days with a completed food diary, and days spent per module), but not patients' subjective GSH-I evaluation significantly predicted dropout. Specifically, not completing the food diary in week 7 had maximized sensitivity and specificity in predicting dropout. Patients' body mass index was positively associated with the number of messages exchanged between patients and coaches. No other associations between baseline variables and objective adherence were found. DISCUSSION Patients at risk for dropout from GSH-I can be reliably identified via monitoring of objective adherence and may be provided with additional interventions to prevent dropout.
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Affiliation(s)
- Hans-Christian Puls
- Integrated Research and Treatment Center Adiposity Diseases, Behavioral Medicine Unit, Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Leipzig, Germany
| | - Ricarda Schmidt
- Integrated Research and Treatment Center Adiposity Diseases, Behavioral Medicine Unit, Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Leipzig, Germany
| | - Stephan Herpertz
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University, Ruhr-University Bochum, Bochum, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tuebingen, Tuebingen, Germany
| | - Brunna Tuschen-Caffier
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Freiburg, Freiburg im Breisgau, Germany
| | - Hans-Christoph Friederich
- Department of General Internal Medicine and Psychosomatics, Medical University Hospital Heidelberg, Heidelberg, Germany
| | - Frauke Gerlach
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Andreas Mayr
- Department of Medical Biometry, Informatics and Epidemiology, Faculty of Medicine, University of Bonn, Bonn
| | - Tony Lam
- NetUnion Sàrl, Lausanne, Switzerland
| | | | - Martina de Zwaan
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Anja Hilbert
- Integrated Research and Treatment Center Adiposity Diseases, Behavioral Medicine Unit, Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Leipzig, Germany
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Efficacy and cost-effectiveness of Internet-based selective eating disorder prevention: study protocol for a randomized controlled trial within the ProHEAD Consortium. Trials 2019; 20:91. [PMID: 30700318 PMCID: PMC6354385 DOI: 10.1186/s13063-018-3161-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 12/22/2018] [Indexed: 01/21/2023] Open
Abstract
Background The development of efficacious, cost-effective, and widely accessible programs for the prevention of eating disorders (EDs) is crucial in order to reduce the ED-related burden of illness. Programs using dissonance-based and cognitive behavioral approaches are most effective for the selective prevention of ED. Internet-based delivery is assumed to maximize the reach and impact of preventive efforts. However, the current evidence for Internet-based ED prevention is limited. The present trial evaluates the efficacy and cost-effectiveness of two new interventions (based on dissonance theory and principles of cognitive behavioral therapy (CBT)) that are implemented as add-ons to the existing Internet-based ED prevention program ProYouth. Methods The trial is one of five sub-projects of the German multicenter consortium ProHEAD. It is a three-arm, parallel, randomized controlled superiority trial. Participants will be randomized to (1) the online program ProYouth (active control condition) or (2) ProYouth plus a structured dissonance-based module or (3) ProYouth plus a CBT-based chat group intervention. As part of ProHEAD, a representative school-based sample of N = 15,000 students (≥ 12 years) will be screened for mental health problems. N = 309 participants at risk for ED (assessed with the Weight Concerns Scale (WCS) and the Short Evaluation of Eating Disorders (SEED)) will be included in the present trial. Online assessments will be conducted at baseline, at end of intervention (6 weeks), at 6 months follow-up, and — as part of ProHEAD — at 12 and 24 months follow-up. The primary outcome is ED-related impairment (assessed with the Child version of the Eating Disorder Examination-Questionnaire (ChEDE-Q)) at the end of the intervention. Secondary outcomes include ED-related symptomatology at follow-up, ED-related stigma, ED-related help-seeking, and acceptance of and compliance with the interventions. For the health economic evaluation data on costs of the interventions, healthcare utilization and health-related quality of life will be assessed. Discussion This is the first study augmenting a flexible prevention approach such as ProYouth with structured evidence-based modules in order to overcome some of the key limitations in the current practice of ED prevention. Trial registration German Clinical Trials Register (DRKS), DRKS00014679. Registered on 25 April 2018. Electronic supplementary material The online version of this article (10.1186/s13063-018-3161-y) contains supplementary material, which is available to authorized users.
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Le Grange D, Gorrell S, Hughes EK, Accurso EC, Yeo M, Pradel M, Sawyer SM. Delivery of Family-Based Treatment for Adolescent Anorexia Nervosa in a Public Health Care Setting: Research Versus Non-Research Specialty Care. Front Psychiatry 2019; 10:1001. [PMID: 32038332 PMCID: PMC6987240 DOI: 10.3389/fpsyt.2019.01001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 12/18/2019] [Indexed: 11/27/2022] Open
Abstract
UNLABELLED Comparing evidence-based psychotherapy (EBP) to usual care typically demonstrates the superiority of EBPs, although this has not been studied for eating disorders EBPs such as family-based treatment (FBT). The current study set out to examine weight outcomes for adolescents with anorexia nervosa who received FBT through a randomized clinical research trial (RCT, n = 54) or non-research specialty care (n = 56) at the same specialist pediatric eating disorder service. Weight was recorded throughout outpatient treatment (up to 18 sessions over 6 months), as well as at 6- and 12-month follow-up. Survival curves were used to examine time to weight restoration [greater than 95% median body mass index (mBMI)] as predicted by type of care (RCT vs. non-research specialty care), baseline clinical and demographic characteristics, and their potential interaction. Results did not indicate a significant main effect for type of care, but there was a significant effect for baseline weight (p = .03), such that weight restoration was achieved faster across both treatment types for those with a higher initial %mBMI. These data suggest that weight restoration achieved in non-research specialty care FBT was largely similar to that achieved in a controlled research trial. CLINICAL TRIAL REGISTRATION http://www.anzctr.org.au/, identifier ACTRN12610000216011.
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Affiliation(s)
- Daniel Le Grange
- Department of Psychiatry, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States.,Department of Psychiatry & Behavioral Neuroscience, The University of Chicago, Chicago, IL, United States
| | - Sasha Gorrell
- Department of Psychiatry, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Elizabeth K Hughes
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia.,Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Erin C Accurso
- Department of Psychiatry, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Michele Yeo
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
| | - Martin Pradel
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
| | - Susan M Sawyer
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia.,Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Department of Adolescent Medicine, Royal Children's Hospital, Melbourne, VIC, Australia
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Griffiths S, Rossell SL, Mitchison D, Murray SB, Mond JM. Pathways into treatment for eating disorders: A quantitative examination of treatment barriers and treatment attitudes. Eat Disord 2018; 26:556-574. [PMID: 30222057 DOI: 10.1080/10640266.2018.1518086] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Most individuals with eating disorders do not receive treatment for their eating disorder. Closing this "treatment gap" requires a quantitative examination of individuals' attitudes towards accessing various types of treatment and of individuals' perceived barriers to seeking treatment. Thus, we recruited a sample of 425 individuals with either diagnosed or undiagnosed eating disorders and asked them to complete a survey assessing treatment attitudes, treatment barriers, and eating disorder symptom severity. Undiagnosed individuals reported more positive attitudes towards novel Internet- and smartphone-delivered treatments, and stronger barriers relating to eating disorders mental health literacy, than diagnosed individuals. Nevertheless, both diagnosed and undiagnosed individuals were broadly more positive towards established (i.e., non-novel) treatments than novel treatments. The strongest barriers to seeking treatment were fear of losing control, fear of change, and finding motivation to change. Eating disorder symptoms were positively associated with the strength of most treatment barriers. Results were broadly unchanged after adjusting for individuals' past experiences of treatment. In conclusion, the development and dissemination of novel treatments and the provision of eating disorders mental health literacy may offer promising potential pathways into treatment for individuals with undiagnosed eating disorders. Nevertheless, researchers must pay attention to and improve, individuals' attitudes towards accessing these novel treatments. The positive correlations of symptom severity with treatment barrier strength highlights the importance of early intervention for individuals with eating disorders. Finally, the fear of losing control may be a uniquely salient treatment barrier for individuals with eating disorders that requires greater attention in future research on eating disorder treatment seeking.
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Affiliation(s)
- Scott Griffiths
- a Melbourne School of Psychological Sciences , University of Melbourne , Melbourne , Australia
| | - Susan L Rossell
- b Centre for Mental Health, Faculty of Health Arts and Design , Swinburne University , Melbourne , Australia.,c Psychiatry , St Vincent's Hospital , Melbourne , Australia.,d Monash Alfred Psychiatry Research Centre , Central Clinical School Monash University and Alfred Hospital , Melbourne , Australia
| | - Deborah Mitchison
- e Department of Psychology , Macquarie University , Sydney , Australia
| | - Stuart B Murray
- f Department of Psychiatry , University of California San Francisco , San Francisco , CA , USA
| | - Jonathan M Mond
- g Centre for Rural Health , University of Tasmania , Launceston , Australia.,h Centre for Health Research , Western Sydney University , Sydney , Australia
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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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O'Connor M, Morgan KE, Bailey-Straebler S, Fairburn CG, Cooper Z. Increasing the Availability of Psychological Treatments: A Multinational Study of a Scalable Method for Training Therapists. J Med Internet Res 2018; 20:e10386. [PMID: 29884606 PMCID: PMC6015265 DOI: 10.2196/10386] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 04/07/2018] [Accepted: 04/08/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND One of the major barriers to the dissemination and implementation of psychological treatments is the scarcity of suitably trained therapists. A highly scalable form of Web-centered therapist training, undertaken without external support, has recently been shown to have promise in promoting therapist competence. OBJECTIVE The aim of this study was to conduct an evaluation of the acceptability and effectiveness of a scalable independent form of Web-centered training in a multinational sample of therapists and investigate the characteristics of those most likely to benefit. METHODS A cohort of eligible therapists was recruited internationally and offered access to Web-centered training in enhanced cognitive behavioral therapy, a multicomponent, evidence-based, psychological treatment for any form of eating disorder. No external support was provided during training. Therapist competence was assessed using a validated competence measure before training and after 20 weeks. RESULTS A total of 806 therapists from 33 different countries expressed interest in the study, and 765 (94.9%) completed a pretraining assessment. The median number of training modules completed was 15 out of a possible 18 (interquartile range, IQR: 4-18), and 87.9% (531/604) reported that they treated at least one patient during training as recommended. Median pretraining competence score was 7 (IQR: 5-10, range: 0-19; N=765), and following training, it was 12 (IQR: 9-15, range: 0-20; N=577). The expected change in competence scores from pretraining to posttraining was 3.5 (95% CI 3.1-3.8; P<.001). After training, 52% (300/574) of therapists with complete competence data met or exceeded the competence threshold, and 45% (95% CI 41-50) of those who had not met this threshold before training did so after training. Compliance with training predicted both an increase in competence scores and meeting or exceeding the competence threshold. Expected change in competence score increased for each extra training module completed (0.19, 95% CI 0.13-0.25), and those who treated a suitable patient during training had an expected change in competence score 1.2 (95% CI 0.4-2.1) points higher than those who did not. Similarly, there was an association between meeting the competence threshold after training and the number of modules completed (odds ratio, OR=1.11, 95% CI 1.07-1.15), and treating at least one patient during training was associated with competence after training (OR=2.2, 95% CI 1.2-4.1). CONCLUSIONS Independent Web-centered training can successfully train large numbers of therapists dispersed across a wide geographical area. This finding is of importance because the availability of a highly scalable method of training potentially increases the number of people who might receive effective psychological treatments.
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Affiliation(s)
- Marianne O'Connor
- Centre for Research on Dissemination at Oxford, Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Katy E Morgan
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, University of London, London, United Kingdom
| | - Suzanne Bailey-Straebler
- Centre for Research on Dissemination at Oxford, Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Christopher G Fairburn
- Centre for Research on Dissemination at Oxford, Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Zafra Cooper
- Centre for Research on Dissemination at Oxford, Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- Department of Psychiatry, Yale School of Medicine, Yale University, New Haven, CT, United States
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Moessner M, Bauer S. Maximizing the public health impact of eating disorder services: A simulation study. Int J Eat Disord 2017; 50:1378-1384. [PMID: 29076172 DOI: 10.1002/eat.22792] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 10/04/2017] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Although effective interventions for eating disorders (ED) are available, the impact of health care services on a population level is far from satisfactory. A mathematical model of how health care for ED affects the population's disease burden can stimulate discussions and provide guidance about promising strategies to reduce ED-related suffering on the population level. METHOD The current health care situation for ED is modeled taking into account the reach and effectiveness of prevention, treatment, and aftercare, as well as incidence rates, relapse rates, and rates for spontaneous remissions. A first-order Markov model is applied and the effect of changes in single service parameters on the populations overall disease burden are simulated. RESULTS Improvements of treatment utilization and the reach of prevention programs would have the largest effects on the population's disease burden. Improving the efficacy of treatment, prevention, and aftercare show only limited effects. DISCUSSION In order to maximize the public health impact of health care for ED new models of treatment delivery as well as public health approaches to the prevention of ED are critical.
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Affiliation(s)
- Markus Moessner
- Center for Psychotherapy Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Stephanie Bauer
- Center for Psychotherapy Research, University Hospital Heidelberg, Heidelberg, Germany
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Forbush KT, Hagan KE, Kite BA, Chapa DAN, Bohrer BK, Gould SR. Understanding eating disorders within internalizing psychopathology: A novel transdiagnostic, hierarchical-dimensional model. Compr Psychiatry 2017; 79:40-52. [PMID: 28755757 DOI: 10.1016/j.comppsych.2017.06.009] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 05/22/2017] [Accepted: 06/22/2017] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Several problems with the classification and diagnosis of eating disorders (EDs) have been identified, including proliferation of 'other specified' diagnoses, within-disorder heterogeneity, and frequent diagnostic migration over time. Beyond problems within EDs, past research suggested that EDs fit better in a spectrum of internalizing psychopathology (characterized by mood and anxiety disorders) than in a separate diagnostic class. PURPOSE To develop a transdiagnostic, hierarchical-dimensional model relevant to ED psychopathology that: 1) reduces diagnostic heterogeneity, 2) includes important dimensions of internalizing psychopathology that are often excluded from ED diagnostic models, and 3) predicts clinical impairment. PROCEDURES Goldberg's (2006) method and exploratory structural equation modeling were used to identify a hierarchical model of internalizing in community-recruited adults with EDs (N=207). FINDINGS The lowest level of the hierarchy was characterized by 15 factors that defined specific aspects of eating, mood, and anxiety disorders. At the two-factor level, Internalizing bifurcated into Distress (low well-being, body dissatisfaction, suicidality, dysphoria, ill temper, traumatic intrusions) and Fear-Avoidance (claustrophobia, social avoidance, panic symptoms, dietary restricting, excessive exercise, and compulsions). Results showed that the lowest level of the hierarchy predicted 67.7% of the variance in clinical impairment. In contrast, DSM eating, mood, and anxiety disorders combined predicted 10.6% of the variance in impairment secondary to an ED. CONCLUSIONS The current classification model represents an improvement over traditional nosologies for predicting clinically relevant outcomes for EDs.
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Abstract
PURPOSE OF REVIEW The current systematic review sought to compare available evidence-based clinical treatment guidelines for all specific eating disorders. RECENT FINDINGS Nine evidence-based clinical treatment guidelines for eating disorders were located through a systematic search. The international comparison demonstrated notable commonalities and differences among these current clinical guidelines. SUMMARY Evidence-based clinical guidelines represent an important step toward the dissemination and implementation of evidence-based treatments into clinical practice. Despite advances in clinical research on eating disorders, a growing body of literature demonstrates that individuals with eating disorders often do not receive an evidence-based treatment for their disorder. Regarding the dissemination and implementation of evidence-based treatments, current guidelines do endorse the main empirically validated treatment approaches with considerable agreement, but additional recommendations are largely inconsistent. An increased evidence base is critical in offering clinically useful and reliable guidance for the treatment of eating disorders. Because developing and updating clinical guidelines is time-consuming and complex, an international coordination of guideline development, for example, across the European Union, would be desirable.
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Affiliation(s)
- Anja Hilbert
- Department of Medical Psychology and Medical Sociology, Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany
| | - Hans W. Hoek
- Parnassia Psychiatric Institute, The Hague
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Epidemiology, Columbia University, Mailman School of Public Health, New York, New York, USA
| | - Ricarda Schmidt
- Department of Medical Psychology and Medical Sociology, Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany
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Cooper Z, Bailey-Straebler S, Morgan KE, O'Connor ME, Caddy C, Hamadi L, Fairburn CG. Using the Internet to Train Therapists: Randomized Comparison of Two Scalable Methods. J Med Internet Res 2017; 19:e355. [PMID: 29046265 PMCID: PMC5666223 DOI: 10.2196/jmir.8336] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 09/15/2017] [Accepted: 09/16/2017] [Indexed: 12/04/2022] Open
Abstract
Background One of the major barriers to the dissemination and implementation of psychological treatments is the scarcity of suitably trained therapists. The currently accepted method of training is not scalable. Recently, a scalable form of training, Web-centered training, has been shown to have promise. Objective The goal of our research was to conduct a randomized comparison of the relative effects of independent and supported Web-centered training on therapist competence and investigate the persistence of the effects. Methods Eligible therapists were recruited from across the United States and Canada. They were randomly assigned to 1 of 2 forms of training in enhanced cognitive behavior therapy (CBT-E), a multicomponent evidence-based psychological treatment for any form of eating disorder. Independent training was undertaken autonomously, while supported training was accompanied by support from a nonspecialist worker. Therapist competence was assessed using a validated competence measure before training, after 20 weeks of training, and 6 months after the completion of training. Results A total of 160 therapists expressed interest in the study, and 156 (97.5%) were randomized to the 2 forms of training (81 to supported training and 75 to independent training). Mixed effects analysis showed an increase in competence scores in both groups. There was no difference between the 2 forms of training, with mean difference for the supported versus independent group being –0.06 (95% Cl –1.29 to 1.16, P=.92). A total of 58 participants (58/114, 50.9%) scored above the competence threshold; three-quarters (43/58, 74%) had not met this threshold before training. There was no difference between the 2 groups in the odds of scoring over the competence threshold (odds ratio [OR] 1.02, 95% CI 0.52 to 1.99; P=.96). At follow-up, there was no significant difference between the 2 training groups (mean difference 0.19, 95% Cl –1.27 to 1.66, P=.80). Overall, change in competence score from end of training to follow-up was not significant (mean difference –0.70, 95% CI –1.52 to 0.11, P=.09). There was also no difference at follow-up between the training groups in the odds of scoring over the competence threshold (OR 0.95, 95% Cl 0.34 to 2.62; P=.92). Conclusions Web-centered training was equally effective whether undertaken independently or accompanied by support, and its effects were sustained. The independent form of Web-centered training is particularly attractive as it provides a means of training large numbers of geographically dispersed therapists at low cost, thereby overcoming several obstacles to the widespread dissemination of psychological treatments.
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Affiliation(s)
- Zafra Cooper
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom.,Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States
| | | | - Katy E Morgan
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Caroline Caddy
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Layla Hamadi
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
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Kazdin AE, Fitzsimmons-Craft EE, Wilfley DE. Addressing critical gaps in the treatment of eating disorders. Int J Eat Disord 2017; 50:170-189. [PMID: 28102908 PMCID: PMC6169314 DOI: 10.1002/eat.22670] [Citation(s) in RCA: 181] [Impact Index Per Article: 25.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 12/21/2016] [Accepted: 12/22/2016] [Indexed: 12/11/2022]
Abstract
Remarkable progress has been made in developing psychosocial interventions for eating disorders and other mental disorders. Two priorities in providing treatment consist of addressing the research-practice gap and the treatment gap. The research-practice gap pertains to the dissemination of evidence-based treatments from controlled settings to routine clinical care. Closing the gap between what is known about effective treatment and what is actually provided to patients who receive care is crucial in improving mental health care, particularly for conditions such as eating disorders. The treatment gap pertains to extending treatments in ways that will reach the large number of people in need of clinical care who currently receive nothing. Currently, in the United States (and worldwide), the vast majority of individuals in need of mental health services for eating disorders and other mental health problems do not receive treatment. This article discusses the approaches required to better ensure: (1) that more people who are receiving treatment obtain high-quality, evidence-based care, using such strategies as train-the-trainer, web-centered training, best-buy interventions, electronic support tools, higher-level support and policy; and (2) that a higher proportion of those who are currently underserved receive treatment, using such strategies as task shifting and disruptive innovations, including treatment delivery via telemedicine, the Internet, and mobile apps.
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Affiliation(s)
- Alan E. Kazdin
- Department of Psychology, Yale University, New Haven, CT, USA
| | | | - Denise E. Wilfley
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
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34
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Le LKD, Barendregt JJ, Hay P, Mihalopoulos C. Prevention of eating disorders: A systematic review and meta-analysis. Clin Psychol Rev 2017; 53:46-58. [PMID: 28214633 DOI: 10.1016/j.cpr.2017.02.001] [Citation(s) in RCA: 141] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 02/09/2017] [Accepted: 02/10/2017] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To systematically review and quantify the effectiveness of Eating Disorder (ED) prevention interventions. METHODS Electronic databases (including the Cochrane Controlled Trial Register, MEDLINE, PsychInfo, EMBASE, and Scopus) were searched for published randomized controlled trials of ED prevention interventions from 2009 to 2015. Trials prior to 2009 were retrieved from prior reviews. RESULTS One hundred and twelve articles were included. Fifty-eight percent of trials had high risk of bias. Findings indicated small to moderate effect sizes on reduction of ED risk factors or symptoms which occurred up to three-year post-intervention. For universal prevention, media literacy (ML) interventions significantly reduced shape and weight concerns for both females (-0.69, confidence interval (CI): -1.17 to -0.22) and males (-0.32, 95% CI -0.57 to -0.07). For selective prevention, cognitive dissonance (CD) interventions were superior to control interventions in reducing ED symptoms (-0.32, 95% CI -0.52 to -0.13). Cognitive behavioural therapy (CBT) interventions had the largest effect size (-0.40, 95% CI -0.55 to -0.26) on dieting outcome at 9-month follow-up while the healthy weight intervention reduced ED risk factors and body mass index. No indicated prevention interventions were found to be effective in reducing ED risk factors. CONCLUSIONS There are a number of promising preventive interventions for ED risk factors including CD, CBT and ML. Whether these actually lower ED incidence is, however, uncertain. Combined ED and obesity prevention interventions require further research.
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Affiliation(s)
- Long Khanh-Dao Le
- Deakin University, Centre Population Health Research, Geelong, Australia.
| | - Jan J Barendregt
- School of Public Health, University of Queensland, Brisbane, Australia; Epigear International Pty Ltd, Queensland, Australia
| | - Phillipa Hay
- School of Medicine and Centre for Health Research, Western Sydney University, NSW, Australia
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