Examining Hope as a Transdiagnostic Mechanism of Change Across Anxiety Disorders and CBT Treatment Protocols

Developing a hope-focused intervention to prevent mental health problems and improve social outcomes for young women who are not in education, employment, or training (NEET): A qualitative co-design study in deprived coastal communities in South-East England

Young women who are not in education, employment, or training (NEET) experience poorer health and social outcomes compared to non-NEET young women and to NEET young men, especially in deprived areas with intersecting inequalities. The evidence on effective public health approaches is scarce. Interventions that target hope, which NEET young women notably lack, offer a promising theory-driven and intuitive means to prevent mental health problems and improve social outcomes. Hope can be defined as a goal-focused mindset comprising self-agency (motivation and self-belief) and pathways (identifying routes to achieving goals). Hope is implicated in a variety of evidence-based psychosocial interventions for young people, but is not directly targeted by existing prevention programmes for NEET populations. The current study used a phased qualitative research design and participatory methods to model a hope-focused intervention for NEET young women. Phase 1 investigated population needs and intervention parameters through semi-structured interviews with 28 key informants living or working in disadvantaged coastal communities in South-East England. The sample comprised eight NEET young women, four family members, and 16 practitioners from relevant support organisations. Phase 2 refined intervention parameters and outcomes through co-design sessions with four NEET young women, followed by a theory of change workshop with 10 practitioners. The resulting intervention model is articulated as a mentor-supported, in-person psychosocial intervention that builds hope by enhancing positive sense of self and time spent in meaningful activities, before explicitly teaching the skills needed to identify, set, and pursue personally meaningful goals.

Differences in mental indicators and state-hope related to the level of engagement in social unrest: Israel 2023

Background

This study examined the interplay between engagement in social unrest, mental indicators, state-hope and demographic variables. In addition, mental indicators and state-hope were compared in line with levels of engagement in social unrest.

Methods

In a cross-sectional study, conducted from March 23 to April 10, 2023, 2031 Israelis were recruited via a survey company. Participants completed self-report questionnaires to assess engagement in social unrest, anxiety, social unrest related distress, state-hope and demographic variables.

Results

Participants with higher engagement in social unrest, who opposed the law reform, were prone to higher levels of social unrest related distress, anxiety, and lower levels of state-hope compared to those not engaged in social unrest activities or those who supported the law reform.

Conclusions

Concerns regarding unmet mental health needs, during and following social unrest, regardless of the engagement level, should be actively addressed by mental health professionals and health policy makers.

Hope and anxiety

Anxiety-related disorders continue to be one of the most prevalent and burdensome psychiatric disorders. Research has examined resilience factors, such as hope, that can build resilience toward or mitigate the impact of anxiety disorders. The following review provides a summary of hope as a factor of resilience as well as a mechanism of change in reducing levels of anxiety. First, hope and anxiety are conceptualized as future-oriented traits. Then, hope as a source of resilience against trait anxiety is discussed. The article then discusses the moderate, indirect relationship between hope and general as well as specific forms of anxiety before providing empirical support for hope as a mechanism of change in the reduction of anxiety. Finally, considerations for future study of hope and anxiety are discussed.

Co-producing principles to guide health research: an illustrative case study from an eating disorder research clinic

BACKGROUND

There is significant value in co-produced health research, however power-imbalances within research teams can pose a barrier to people with lived experience of an illness determining the direction of research in that area. This is especially true in eating disorder research, where the inclusion of co-production approaches lags other research areas. Appealing to principles or values can serve to ground collaborative working. Despite this, there has not been any prior attempt to co-produce principles to guide the work of a research group and serve as a basis for developing future projects.

METHODS

The aim of this piece of work was to co-produce a set of principles to guide the conduct of research within our lived experience led research clinic, and to offer an illustrative case for the value of this as a novel co-production methodology. A lived experience panel were recruited to our eating disorder research group. Through an iterative series of workshops with the members of our research clinic (composed of a lived experience panel, clinicians, and researchers) we developed a set of principles which we agreed were important in ensuring both the direction of our research, and the way in which we wanted to work together.

RESULTS

Six key principles were developed using this process. They were that research should aim to be: 1) real world-offering a clear and concrete benefit to people with eating disorders, 2) tailored-suitable for marginalised groups and people with atypical diagnoses, 3) hopeful-ensuring that hope for recovery was centred in treatment, 4) experiential-privileging the 'voice' of people with eating disorders, 5) broad-encompassing non-standard therapeutic treatments and 6) democratic-co-produced by people with lived experience of eating disorders.

CONCLUSIONS

We reflect on some of the positives as well as limitations of the process, highlighting the importance of adequate funding for longer-term co-production approaches to be taken, and issues around ensuring representation of minority groups. We hope that other health research groups will see the value in co-producing principles to guide research in their own fields, and will adapt, develop, and refine this novel methodology.

The mediating role of social connectedness and hope in the relationship between group membership continuity and mental health problems in vulnerable young people

BACKGROUND

There is growing evidence of a beneficial effect of social group processes on well-being and mental health.

AIMS

To investigate the role of group membership continuity in reducing mental ill-health among young people who were already vulnerable pre-pandemic, and to understand the social and psychological mechanisms of the benefits of group memberships for vulnerable young people.

METHOD

This study takes a cross-sectional design, using survey data from a sample of 105 young people aged 16-35 years, collected approximately 1 year after the global COVID-19 outbreak (January to July 2021). Correlational and path analyses were used to test the associations between group membership continuity and mental health problems (depression, anxiety, psychotic-like experiences) and the mediation of these associations by hope and social connectedness (in-person and online). To correct for multiple testing, the Benjamini-Hochberg procedure was implemented for all analyses. Indirect effects were assessed with coverage of 99% confidence intervals.

RESULTS

Multiple prior group memberships were associated with preservation of group memberships during the COVID-19 pandemic. In-person social connectedness, online social connectedness and hope mediated the relationship between group membership continuity and mental health problem symptoms.

CONCLUSIONS

The results suggest that clinical and public health practice should support vulnerable young people to foster and maintain their social group memberships, hopefulness and perceived sense of social connectedness as means of helping to prevent exacerbation of symptoms and promote recovery of mental health problems, particularly during significant life events.

Psychological Outcomes and Mechanisms of Mindfulness-Based Training for Generalised Anxiety Disorder: A Systematic Review and Meta-Analysis

This systematic review aimed to identify 1) the effect of mindfulness training on pre-post measures of anxiety and attention among adults experiencing high levels of generalised anxiety; and 2) the impact of predictors, mediators and moderators on post-intervention changes in anxiety or attention. Trait mindfulness and distress measures were included as secondary outcomes. A systematic search was conducted in November 2021 in electronic databases using relevant search terms. Eight articles comprising four independent studies were included (N = 334). All studies included participants diagnosed with generalised anxiety disorder (GAD) who participated in an 8-week manualised program. The meta-analysis indicated that mindfulness training had a large effect on anxiety symptoms (g = -1.92, 95%CI[-3.44, -0.40]) when compared to inactive (i.e., care as usual, waitlist) or non-specified (i.e., condition not defined) controls. However, a significant effect was not found when compared to active controls. Effects for depression, worry and trait mindfulness did not reach statistical significance, despite small-large effect sizes favouring mindfulness compared to inactive/non-specified controls. Our narrative review found evidence that changes in aspects of trait mindfulness mediate anxiety reduction following mindfulness training. However, a small number of studies were available for inclusion in the review, with high risk of bias and low certainty of evidence present. Overall, the findings support the use of mindfulness training programs for GAD and indicate mechanisms that may differ from those involved in other cognitive therapy approaches. Further RCTs with evidence-based controls are needed to clarify techniques most beneficial for generalised anxiety to support individually tailored treatment.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12144-023-04695-x.

Hope therapy

Research over the past three decades has established that hope is related to positive outcomes. Hope therapy was originally developed to optimize successful goals pursuits by increasing hopeful thought. Here, we briefly review the current state of hope therapy research and offer directions for future investigations. We note that hope therapy has been adapted to be delivered in different formats, by providers from various professional backgrounds, and to participants presenting with a variety of chronic health conditions. We suggest there is a need to reach a consensus about what characterizes hope therapy. Further, we note the need for well-designed trials to test potential mechanisms of change. We believe that these future directions will result in a more efficacious hope therapy that can be widely disseminated.

Evaluation of a culturally adapted cognitive behavior therapy-based, third-wave therapy manual

BACKGROUND

Recommendations for psychotherapy have evolved over the years, with cognitive behavioral therapy (CBT) taking precedence since its inception within clinical guidelines in the United Kingdom and United States. The use of CBT for severe mental illness is now more common globally.

AIM

To investigate the feasibility and acceptability of a culturally adapted, CBT-based, third-wave therapy manual using the Comprehend, Cope, and Connect approach with individuals from a diverse population presenting to primary and secondary healthcare services.

METHODS

A pilot study was used to assess the feasibility and acceptability of the manualised intervention. Outcome measures were evaluated at baseline, post-intervention and 12 wk-follow up. 32 participants with mental health conditions aged 20-53 years were recruited. Assessments were completed at three time points, using Clinical Outcomes in Routine Evaluation (CORE), Hospital Anxiety and Depression Scale (HADS), Bradford Somatic Inventory and World Health Organization Disability Assessment Schedule 2.0 (WHODAS). The Patient Experience Ques-tionnaire was completed post-treatment.

RESULTS

Repeated measures of analysis of variance associated with HADS depression, F (2, 36) = 12.81, P < 0.001, partial η² = 0.42 and HADS anxiety scores, F (2, 26) = 9.93, P < 0.001, partial η² = 0.36; CORE total score and WHODAS both showed significant effect F (1.25, 18.72) = 14.98, P < 0.001, partial η² = 0.5. and F (1.29, 14.18) = 6.73, P < 0.001, partial η² = 0.38 respectively.

CONCLUSION

These results indicate the effectiveness and acceptability of the culturally adapted, CBT-based, third-wave therapy manual intervention among minoritized groups with moderate effect sizes. Satisfaction levels and acceptability were highly rated. The viability and cost-effectiveness of this approach should be explored further to support universal implementation across healthcare systems.

Credibility and expectancy of smartphone-based cognitive behavioral therapy among adults with body dysmorphic disorder

BACKGROUND

Few patients receive cognitive behavioral therapy, the gold-standard for body dysmorphic disorder (CBT-BDD). Smartphones can make evidence-based interventions, like CBT-BDD, more accessible and scalable. A key question is: how do patients view it? Low credibility and expectancy would likely translate to low uptake and engagement outside of research settings, diminishing the impact. Thus, it is important to understand patients' beliefs about digital CBT-BDD.

METHODS

We compared credibility and expectancy in a coach-guided app-based CBT-BDD trial (N=75) to a previous in-person CBT-BDD trial (N = 55). We further examined the relationship of perceptions of digital CBT-BDD to baseline clinical and demographic factors and dropout.

RESULTS

Credibility did not differ between the in-person (M=19.3) and digital (M=18.3) trials, p=.24. Expectancy for improvement was moderately higher for in-person (M=58.4) than digital (M=48.3) treatment, p=.005. In the digital trial, no demographic variables were associated with credibility or expectancy. Better BDD-related insight and past non-CBT BDD therapy were associated with greater expectancy. Credibility was associated with lower likelihood of dropout.

DISCUSSION

Digital CBT-BDD was regarded as similarly credible to in-person CBT-BDD but with lower expectancy. Tailored expectancy-enhancing strategies could strengthen this novel approach, particularly among those with poorer insight and without prior BDD treatment.

Hope and PTSD

This paper reviews the present literature examining how hope relates to PTSD and broader functioning after a trauma, including potential underlying mechanisms and significant factors impacting these relationships and the role of hope as a mechanism of change within interventions for PTSD. First, the ways in which trauma impacts hope are discussed. Afterwards, an overview is provided of cross-sectional and prospective research indicating that greater hope reduces the risk of PTSD and promotes positive outcomes of adversity. Next, potential underlying mechanisms and determinants of the relationship between hope and adjustment are explored, including adaptive appraisals, productive coping, and social support. Finally, evidence supporting the role of hope as a mechanism of change in treatments for PTSD is reviewed.

Therapeutic Community Gardening as a Green Social Prescription for Mental Ill-Health: Impact, Barriers, and Facilitators from the Perspective of Multiple Stakeholders

The UK government has invested £5.77 million in green social prescribing to prevent and tackle mental ill-health. Therapeutic community gardening, one type of green social prescription, provides a range of health outcomes. However, for increased accessibility, a greater understanding of how it impacts mental health and the facilitators and barriers to referral, uptake, and attendance by individuals with mental health problems is required. We conducted and thematically analysed interviews with thirteen stakeholders including social prescribing link workers and garden staff; and focus groups with twenty garden members. The mechanisms by which therapeutic community gardening were suggested to impact mental health were by engaging members with nature and the outdoors, providing hope for the future and facilitating social support and relationships. Factors facilitating referral, uptake, and attendance included a holistic and person-centred approach, which is flexible around health needs. Barriers included awareness of the full offering of therapeutic community gardens and accessibility, in terms of physical location and waiting lists. Given that nature-based interventions have the potential to protect and enhance population health and offer cost savings through reduced reliance on other health services; overcoming these barriers is key to ensuring that therapeutic community gardening is more widely available as an additional mental health treatment.

Group Cognitive-Behavioral Therapy in a Sample of Dutch Intimate Partner Violence Perpetrators: Development of a Coding Manual for Therapist Interventions

This qualitative study investigated which types of interventions are made by group therapists during group cognitive-behavioral therapy (GCBT) with individuals who have perpetrated intimate partner violence (IPV) in the "Not 'Losing It' Anymore"(NLIA) outpatient programs across the Netherlands. Audio recordings of group sessions (N = 60) facilitated by 13 co-therapist teams across 25 different groups were analyzed using the general inductive approach. Fifteen distinct therapist interventions were identified, categorized, and described using examples from the data. Two categories of interventions could be distinguished: CBT interventions and process-oriented interventions. In future research the coding manual can be tested for interrater reliability and might be used in research on the effectiveness of GCBT therapist interventions.

The practice of hope in public health interventions: a qualitative single-case study

This study examines hope practices in the context of participation in a public health intervention. Theoretically, the study builds upon Cheryl Mattingly’s notion of hope as a practice, which renders the possibility of examining participants actions, interactions and challenges with participating. This analytical lens contributes knowledge about how interventions are incorporated into participants’ hopes for a future life and the consequences of intervening in peoples’ everyday lives. The study builds on empirical material from a pilot study of the primary preventive intervention known as TOF (Tidlig Opsporing og Forebyggelse—a Danish acronym for ‘Early Detection and Prevention’) which aimed to identify high risk individuals and provide targeted preventive services. A by-product of a larger qualitative study, itself based on the TOF pilot study in 2019, this single-case study illustrates how participants’ life situation influence how they interpret and manage activities in a public health intervention. The study shows how the practice of hope in public health interventions is closely linked to participants’ own interpretations of how participation can lead to a life worth living. The findings, which show that participants’ needs, and life situation influence the ways in which they respond to an intervention, adds to the complexity in intervention research. Further, the study illustrates some of the ethical challenges that arise when researchers intervene in people’s everyday life. It reinforces the need for ongoing critical reflection and attention to be directed at how those being studied articulate and practice hope.

Psychotherapeutic Change Mechanisms and Causal Psychotherapy: Applications to Child Abuse and Trauma

The study of change mechanisms in psychotherapy needs to be integrated with the causality of behavior, which leads to the concept of causal psychotherapy. Causal psychotherapy is posited as a useful adjunct to standard, evidence based psychotherapies for child and youth victims of abuse and trauma. The article illustrates six processes that could be involved in causal psychotherapy in this context, from the distal to the proximal. They include the distal mechanism of activation-inhibition coordination. The most proximal one relates to executive function. The intermediate levels include ones related to co-regulation (e.g., self control), analysis-synthesis, objectivity-subjectivity, and psychological reserve, which is a new concept in the domain of psychological change mechanisms. Each of the variables can vary from high to low, with the low end being more problematic. Psychotherapy can aim to bring the patient toward adaptive levels. The literature review focuses on psychotherapeutic change mechanisms, and standard psychotherapies for child/youth abuse/trauma, especially trauma-focused cognitive behavior therapy (TF-CBT). Then, it considers causal aspects of child/youth abuse and trauma, including PTSD. The discussion relates causal therapy to the question of unifying psychology and psychotherapy under the rubric of causality as a core integrative mechanism.

Early response to cognitive behavioral therapy for body dysmorphic disorder as a predictor of outcomes

Individuals with body dysmorphic disorder (BDD) suffer from distressing or impairing preoccupations with perceived imperfections in their appearance. This often-chronic condition is associated with significant functional impairment and elevated rates of psychiatric comorbidity and morbidity, including depression, substance use disorders, and suicidality. Cognitive behavioral therapy (CBT) for BDD has been shown to be efficacious. However, this intervention is long (up to 24 weeks) relative to many manualized approaches for other related conditions, there is a significant shortage of clinicians trained in CBT for BDD, and some patients drop out of treatment and/or do not respond. Thus, there is great interest in understanding and predicting who is most likely to respond, to better allocate clinical resources. This secondary data analysis of participants enrolled in prior uncontrolled and controlled studies of CBT for BDD explored whether early response to CBT, operationalized as percentage change in symptom severity within the first four weeks and the first 12 weeks of this 24-week treatment, predicts clinical outcomes for patients with BDD (n = 90). The findings indicated that minimal early symptom change was not indicative of eventual non-response. This suggests that patients and clinicians should not be discouraged by limited early improvement but should instead continue with a full course of treatment before reevaluating progress and alternative interventions. Overall, the results support the view that treatment success is more likely if a longer CBT protocol is followed. More work is needed to understand mechanisms of change and thus match optimal interventions to patient characteristics.

The mediating role of emotion regulation in transdiagnostic cognitive behavioural therapy for emotional disorders in primary care: Secondary analyses of the PsicAP randomized controlled trial

BACKGROUND

Emotional disorders are highly prevalent in primary care. Transdiagnostic cognitive behavior therapy (TD-CBT) is a promising treatment of emotional disorders. In this study, we evaluated several emotion regulation strategies as potential mediators of treatment outcomes in a clinical sample of primary care.

METHODS

A total of 1061 primary care patients were included in a randomized clinical trial comparing treatment-as-usual (TAU) to TD-CBT+TAU. Of these, 631 (TAU=316; TD-CBT+TAU=315) completed the full treatment and all pre- and post-treatment scales to assess symptoms (anxiety, depression, somatization), emotion regulation strategies (worry, rumination, negative metacognition, suppression, cognitive reappraisal), overall functioning, and quality of life (QoL).

RESULTS

Treatment and direct effects showed that TD-CBT+TAU was superior to TAU alone. On the multivariate mediation analysis of indirect effects, three maladaptive strategies (worry, rumination and negative metacognition) had significant effects on all emotional symptoms. Suppression was also significant for depression. Rumination and negative metacognition were significant mediators of functioning, while only negative metacognition was significant for QoL. Reappraisal had no effect on any outcome.

LIMITATIONS

We focused mainly on maladaptive cognitive emotion regulation strategies and only studied one behavioural strategy (suppression) and one adaptive strategy (reappraisal).

CONCLUSIONS

Targeting certain maladaptive emotion regulation strategies (worry, rumination, suppression, negative metacognition) as mediators for treatment with TD-CBT could reduce emotional symptoms and improve well-being. Negative metacognition was the most transdiagnostic strategy, whereas an adaptive strategy such as reappraisal was not a mediator. Thus, maladaptive emotion regulation strategies are key mediators in transdiagnostic therapy for emotional disorders in primary care.

Predictor variables of mental health in the Spanish population confined by COVID-19

BACKGROUND

Drastic changes in the lifestyle of individuals have been caused by coronarivus SARS-CoV-2 with lethal effects associated with COVID-19, which acts as a stressor for the population with adverse effects on mental health status. The aim was to identify which sociodemographic variables and psychological factors predict psychological disorders in the general Spanish population.

METHODS

The sample consisted of 699 people exposed to a confinement situation, where 402 (57.51%) were women and 297 (42.49%) were men, between 18 and 73 years old (M = 27.79; SD = 12.68). Different sociodemographic and psychological variables were assessed to see if they predicted levels of anxiety and depression.

RESULTS

The results identify the predictive capacity of some sociodemographic risk variables such as sex (β = .144; IC95% = 1.341-3.376) and living with people who are ill with COVID-19 (β = .088; IC95% = 1.157-6.785), as well as protective factors such as self-efficacy (β = -.126; IC95% = -0.282-0.066) and hope (β = -.429; IC95% = -0.591-0.408) in mental health. In predicting anxiety levels, self-efficacy and hope are protective factors, especially when living with people in essential services. In levels of depression, only hope is considered a protective factor in people living with patients infected by COVID-19.

CONCLUSIONS

This study is the first to advance in the understanding of sociodemographic and psychological variables in a Spanish sample subjected to the stressful and traumatic effects of the SARS-CoV-2 viral agent.

Clients’ Hope for Counseling as a Predictor of Outcome in Psychotherapy

Researchers have demonstrated links between general hope and symptoms of distress. Findings like these are important given the conceptual role of hope in psychotherapy theories like Frank and Frank’s contextual model. Existing literature, however, has involved researchers employing general hope measures despite hope being variable across domains rather than a general trait. The purpose of this study was to explore the relationships between hope for counseling and clients’ outcomes as well as the working alliance. Self-report data were collected from 103 clients in a doctoral training clinic. Evidence (from multilevel modeling) demonstrated that increases in working alliance predict increases in hope for counseling over the course of treatment and that increases in hope for counseling significantly predict decreases in distress over the course of counseling when working alliance and session number are controlled. We discuss implications for clinical practice and positively-oriented work in counseling psychology.

A Systematic Review and Lived-Experience Panel Analysis of Hopefulness in Youth Depression Treatment

Hopefulness is arguably of central importance to the recovery of youth with major or complex youth depression, yet it is unclear how hopefulness can best be enhanced in treatment. A narrative synthesis of published and grey literature was combined with new insights from a youth lived-experience panel (N = 15), focusing on to what extent and how specific psychological therapies and standard mental health care scaffold hopefulness as applied to depression among 14-25-year-olds. Thirty-one studies of variable quality were included in this review; thirteen were qualitative, thirteen quantitative, and five used mixed methods. Hopefulness is an important active ingredient of psychotherapies and standard mental health care in youth depression. Evidence suggests talking and activity therapies have moderate to large effects on hopefulness and that hopefulness can be enhanced in standard mental health care. However, varying intervention effects suggest a marked degree of uncertainty. Hopefulness is best scaffolded by a positive relational environment in which there is support for identifying and pursuing personally valued goals and engaging in meaningful activity. Animated (https://www.youtube.com/watch?v=o4690PdTGec) and graphical summaries (https://doi.org/10.13140/RG.2.2.27024.84487) are available.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40894-021-00167-0.

Computer-delivered personalized feedback intervention for hazardous drinkers with elevated anxiety sensitivity: A pilot randomized controlled trial

Hazardous drinkers with emotional vulnerabilities (e.g., elevated anxiety sensitivity) remain an underserved group. This study aimed to evaluate the feasibility, acceptability, and initial efficacy of a single session remotely-delivered personalized feedback intervention (PFI) targeting alcohol (mis)use and anxiety sensitivity among college students. Hazardous drinkers with elevated anxiety sensitivity (N = 125; 76.8% female; M_age = 22.14; 66.4% racial/ethnic minorities) were randomized to receive the integrated PFI (n = 63) or attention control (n = 62). Follow-up assessments were conducted one-week, one-month and three-months post-intervention. Latent growth curve modeling was used to test pilot outcomes. It was feasible to recruit and retain hazardous drinking students with elevated anxiety sensitivity through follow-up with no group differences in retention. The integrated PFI was rated as more acceptable than the control with medium/large differences (p's < 0.004; d's = 0.54-0.80). The integrated PFI group had statistically significantly greater change in primary outcomes: motivation, hazardous alcohol use, and anxiety sensitivity (p's < 0.05; d's = 0.08-0.37) with larger within-group effect sizes (d's = 0.48-0.61) than in control (d's = 0.26-0.54). Despite a small sample size, this one-session intervention offers promise among a high-risk group of drinkers with emotional vulnerabilities. The computer-based format may allow for mass distribution of a low-cost intervention in the future; however, follow-up testing in larger samples is needed.

Examining the longitudinal effects and potential mechanisms of hope on COVID-19 stress, anxiety, and well-being

Hope is a cognitive trait that predicts both resilience to and recovery from anxiety and stress-related disorders. The present study examines the prospective associations of hope with subsequent anxiety, stress, and well-being during the COVID-19 pandemic. Perceived emotional control, a transdiagnostic vulnerability factor, was also examined as a potential mediator of these relationships. American adults (N = 822) were recruited during the COVID-19 pandemic using Amazon mTURK and structural equation modeling was used to examine how trait hope predicted outcomes approximately one month later. Higher hope was associated with greater well-being and perceived emotional control, as well as lower levels of anxiety and COVID-19 perceived stress. Results also indicated an indirect effect of hope with all outcomes via perceived emotional control. These findings suggest that hope may associated with resilience to the chronic stressors associated with the COVID-19 pandemic.

Peer mentorship as an adjunct intervention for the treatment of eating disorders: A pilot randomized trial

OBJECTIVE

Peer mentorship has been shown to be helpful for other mental health conditions, but it has been understudied for patients with eating disorders. The goal of the present study was to evaluate the feasibility and efficacy of peer mentorship for individuals with eating disorders by conducting a randomized controlled trial (RCT).

TRIAL DESIGN

Parallel three-arm pilot RCT with 1:1:1 allocation to peer mentorship, social support mentorship (active comparison intervention), and waiting list.

METHOD

Sixty outpatients with anorexia nervosa (AN), bulimia nervosa (BN), or binge-eating disorder (BED) were randomly assigned to a condition. Outcome measures, including eating disorder symptoms and general psychopathology, were completed at baseline, mid-, and postintervention.

RESULTS

Session attendance and acceptability ratings were higher in peer mentorship than social support mentorship. More participants in social support mentorship (39%) dropped out compared to peer mentorship (5%). In intent-to-treat analysis, peer mentorship showed greater reductions in body dissatisfaction and anxiety compared with both control groups. Compared with social support mentorship, peer mentorship had greater reductions in depression. Compared with waiting list, peer mentorship had greater reduction in binge eating days/week in patients with BN/BED and restriction days/week in patients with AN. Peer mentorship did not impact body mass index or reentry into higher level of care.

DISCUSSION

This pilot RCT provides preliminary evidence that peer mentorship is effective for some cognitive and behavioral symptoms of eating disorders as an adjunct to outpatient treatment. Additional studies are needed to evaluate the efficacy of peer mentorship in absence of treatment.