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Grilo CM. Treatment of Eating Disorders: Current Status, Challenges, and Future Directions. Annu Rev Clin Psychol 2024; 20:97-123. [PMID: 38211625 DOI: 10.1146/annurev-clinpsy-080822-043256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
Specific psychological treatments have demonstrated efficacy and represent the first-line approaches recommended for anorexia nervosa, bulimia nervosa, and binge-eating disorder. Unfortunately, many patients, particularly those with anorexia nervosa, do not derive sufficient benefit from existing treatments, and better or alternative treatments for eating disorders are needed. Less progress has been made in developing pharmacologic options for eating disorders. No medications approved for anorexia nervosa exist, and only one each exists for bulimia nervosa and for binge-eating disorder; available data indicate that most patients fail to benefit from available medications. Longer and combined treatments have generally not enhanced outcomes. This review presents emerging findings from more complex and clinically relevant adaptive treatment designs, as they offer some clinical guidance and may serve as models for future enhanced treatment research.
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Affiliation(s)
- Carlos M Grilo
- Department of Psychiatry and Department of Psychology, Yale University, New Haven, Connecticut, USA;
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Melisse B, van den Berg E, de Beurs E. Effectiveness of web-based guided self-help cognitive behavioral therapy-enhanced for binge-eating disorder: An implementation study. Int J Eat Disord 2024; 57:1379-1389. [PMID: 37876352 DOI: 10.1002/eat.24079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 10/06/2023] [Accepted: 10/06/2023] [Indexed: 10/26/2023]
Abstract
INTRODUCTION Web-based guided self-help cognitive behavioral therapy-enhanced (CBT-E) is a 12-weeks, 12-sessions, digitalized version of part II of the self-help book Overcoming Binge Eating. This intervention is effective when offered under controlled circumstances in a randomized-controlled-trial. It is unknown how patients with binge-eating disorder (BED) respond to this intervention when offered in real-world clinical-settings. The aim of this study is to examine post-intervention effectiveness of guided self-help CBT-E for BED in real-world settings. METHOD The present study used a cohort-design examining the effectiveness of web-based guided self-help CBT-E according to an intention-to-treat (ITT) analysis. BED patients (n = 278) were assessed pre- and post-intervention. The primary outcome was reduction in binge-eating episodes. Other outcomes were full-recovery (EDE-Q score <2.77 and abstinence from binge-eating episodes), impaired psychosocial functioning, defined as secondary impairment, and general psychopathology post-intervention. RESULTS The number of binge-eating episodes reduced by an average of 16 binge-eating episodes per 4 weeks pre-intervention to five binge-eating episodes during the last 4 weeks of treatment. Abstinence from binge eating was reported by 30%, and 28% reported full recovery. Effect sizes (Cohen's d) were large (d ≥ 1.0) for all outcome measures. There were no differences in outcomes between the ITT and the completers sample. DISCUSSION Guided self-help CBT-E is associated with significant improvements. The effects of guided self-help CBT-E offered in a real-world-setting are comparable to self-help CBT-E offered in a randomized-controlled-trial. However, it should be noted that comparisons with randomized-controlled-trials requires caution. Longer-term follow-up data are necessary to measure persistence of treatment benefits. PUBLIC SIGNIFICANCE Offering CBT-E as a web-based guided self-help intervention has several benefits for patients with BED. Guided self-help CBT-E is associated with significant improvements on the short term when offered in real-world clinical settings.
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Affiliation(s)
- Bernou Melisse
- Novarum Center for Eating Disorders & Obesity, Amstelveen, The Netherlands
- Section Clinical Psychology, Leiden University, Leiden, The Netherlands
- Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands
| | - Elske van den Berg
- Novarum Center for Eating Disorders & Obesity, Amstelveen, The Netherlands
| | - Edwin de Beurs
- Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands
- Research Department, Arkin Mental Health Institute, Amsterdam, The Netherlands
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van Beers E, Melisse B, de Jonge M, Peen J, van den Berg E, de Beurs E. Web-based guided self-help cognitive behavioral therapy-enhanced versus treatment as usual for binge-eating disorder: a randomized controlled trial protocol. Front Psychiatry 2024; 15:1332360. [PMID: 38435976 PMCID: PMC10904459 DOI: 10.3389/fpsyt.2024.1332360] [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: 11/09/2023] [Accepted: 01/29/2024] [Indexed: 03/05/2024] Open
Abstract
Binge-eating disorder (BED) is a psychiatric disorder characterized by recurrent episodes of eating a large amount of food in a discrete period of time while experiencing a loss of control. Cognitive behavioral therapy-enhanced (CBT-E) is a recommended treatment for binge-eating disorder and is typically offered through 20 sessions. Although binge-eating disorder is highly responsive to CBT-E, the cost of treating these patients is high. Therefore, it is crucial to evaluate the efficacy of low-intensity and low-cost treatments for binge-eating disorder that can be offered as a first line of treatment and be widely disseminated. The proposed noninferiority randomized controlled trial aims to determine the efficacy of web-based guided self-help CBT-E compared to treatment-as-usual CBT-E. Guided self-help will be based on a self-help program to stop binge eating, will be shorter in duration and lower intensity, and will require fewer therapist hours. Patients with binge-eating disorder (N = 180) will be randomly assigned to receive guided self-help or treatment-as-usual. Assessments will take place at baseline, mid-treatment, at the end of treatment, and at 20- and 40-weeks post-treatment. Treatment efficacy will be measured by examining the reduction in binge-eating days in the previous 28 days between baseline and the end of treatment between groups, with a noninferiority margin (Δ) of 1 binge-eating day. Secondary outcomes will include full remission, body shape dissatisfaction, therapeutic alliance, clinical impairment, health-related quality of life, attrition, and an economic evaluation to assess cost-effectiveness and cost-utility. The moderators examined will be baseline scores, demographic variables, and body mass index. It is expected that guided self-help is noninferior in efficacy compared to treatment-as-usual. The proposed study will be the first to directly compare the efficacy and economically evaluate a low-intensity and low-cost binge-eating disorder treatment compared to treatment-as-usual. If guided self-help is noninferior to treatment-as-usual in efficacy, it can be widely disseminated and used as a first line of treatment for patients with binge-eating disorder. The Dutch trial register number is R21.016. The study has been approved by the Medical Research Ethics Committees United on May 25th, 2021, case number NL76368.100.21.
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Affiliation(s)
- Ella van Beers
- Novarum Center for Eating Disorders & Obesity, Amstelveen, Netherlands
| | - Bernou Melisse
- Novarum Center for Eating Disorders & Obesity, Amstelveen, Netherlands
- Utrecht University, Department of Clinical Psychology, Utrecht, Netherlands
| | - Margo de Jonge
- Novarum Center for Eating Disorders & Obesity, Amstelveen, Netherlands
| | - Jaap Peen
- Department of Research, Arkin Mental Health Institute, Amsterdam, Netherlands
| | - Elske van den Berg
- Novarum Center for Eating Disorders & Obesity, Amstelveen, Netherlands
- Department of Research, Arkin Mental Health Institute, Amsterdam, Netherlands
| | - Edwin de Beurs
- Department of Research, Arkin Mental Health Institute, Amsterdam, Netherlands
- Leiden University, Department of Clinical Psychology, Leiden, Netherlands
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Faller J, Perez JK, Mihalopoulos C, Chatterton ML, Engel L, Lee YY, Le PH, Le LKD. Economic evidence for prevention and treatment of eating disorders: An updated systematic review. Int J Eat Disord 2024; 57:265-285. [PMID: 38111296 DOI: 10.1002/eat.24113] [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: 06/06/2023] [Revised: 11/22/2023] [Accepted: 11/28/2023] [Indexed: 12/20/2023]
Abstract
OBJECTIVE This systematic review updates an existing review examining the cost-effectiveness of interventions to prevent and treat eating disorders (EDs). METHOD Literature search was conducted in Academic Search Complete, MEDLINE, CINAHL, PsycINFO, EconLit, Global Health, ERIC, Health Business Elite, and Health Policy Reference Center electronic databases, capturing studies published between March 2017 to April 2023. Hand-searching was conducted as supplementary including gray literature search. Included articles were (1) full economic evaluations or return-on-investment studies, (2) in English and (3) aimed at prevention and treatment of any ED. Included studies were added and synthesized with previously reviewed studies. Screening and extraction followed PRISMA guidelines. Quality assessment was conducted using the Drummond checklist. PROSPERO registration CRD42021287464. RESULTS A total of 28 studies were identified, including 15 published after the previous review. There were nine prevention, seven anorexia nervosa (AN) treatment, five bulimia nervosa (BN) treatment, four binge-eating disorder (BED), and three non-specific ED treatment studies. Findings indicate value-for-money evidence supporting all interventions. Quality assessment showed studies were fair-to-good quality. DISCUSSION There has been significant growth in cost-effectiveness studies over the last 5 years. Findings suggest that interventions to prevent and treat ED offer value for money. Interventions such as Featback (ED prevention and non-specific ED treatment); focal psychodynamic therapy, enhanced cognitive behavioral therapy, and high-calorie refeeding (AN treatment); stepped-care with assisted self-help and internet-based cognitive behavioral therapy (BN treatment); and cognitive behavioral therapy guided self-help intervention (BED treatment) have good quality economic evidence. Further research in implementation of interventions is required. PUBLIC SIGNIFICANCE STATEMENT The increasing prevalence of ED globally has significant impact on healthcare systems, families, and society. This review is showcasing the value for money of interventions of eating disorders prevention and treatment. This review found that existing interventions offers positive economic benefit for the healthcare system.
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Affiliation(s)
- Jan Faller
- Monash University Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Joahna Kevin Perez
- Monash University Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Cathrine Mihalopoulos
- Monash University Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Deakin University, Burwood, Victoria, Australia
| | - Mary Lou Chatterton
- Monash University Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Lidia Engel
- Monash University Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Yong Yi Lee
- Monash University Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- School of Public Health, The University of Queensland, Herston, Queensland, Australia
- Queensland Centre for Mental Health Research, Wacol, Queensland, Australia
| | - Phuong Hong Le
- Monash University Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Long Khanh-Dao Le
- Monash University Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Vuillier L, Greville-Harris M, Talbot CV, May L, Moseley RL. Early evaluation of a DBT-informed online intervention for people with eating disorders. J Eat Disord 2024; 12:9. [PMID: 38243262 PMCID: PMC10799469 DOI: 10.1186/s40337-024-00974-5] [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: 09/20/2023] [Accepted: 01/16/2024] [Indexed: 01/21/2024] Open
Abstract
OBJECTIVES Eating disorders (EDs) have a worldwide prevalence of 7.8%, with towering mortality rates and high healthcare costs. The current recommended treatment for EDs principally works by directly targeting ED thoughts and behaviours, but recovery rates are low. A multifaceted link between difficulties with emotions and EDs is now widely established, and newer third-wave therapies that aim to address these underlying emotion difficulties are promising. The current study piloted an online emotion self-help intervention which was co-developed with clinicians and people with lived experienced of EDs. The intervention aimed to specifically address difficulties with emotion identification and regulation, as well as unhelpful beliefs about emotions, which are believed to give rise to and maintain ED thoughts and behaviours. METHOD We recruited 39 people with self-reported EDs to test this intervention over a one-week period. Our participants were asked to complete a series of questionnaires measuring emotion processes and psychopathology on Day 1 (T1) before being given access to the intervention. Participants were then asked to practice the newly acquired skills for seven days, before taking the same questionnaires on Day 9 (T2). We also asked participants to qualitatively report on their experience of the intervention. RESULTS We found significant improvements in ED psychopathology (ED-15), depression (PHQ-9), and anxiety (GAD-7) pre- to post-intervention, with medium to large effect sizes. All our emotion variables namely alexithymia (TAS-20), difficulties regulating emotions (DERS-SF), and unhelpful beliefs about emotions (EBQ) also showed significant changes post-intervention with medium to large effect sizes. Most importantly, changes in emotion regulation processes were linked to improved eating psychopathology. The qualitative analysis corroborated this finding, highlighting how the intervention helped them form new beliefs about emotions, which helped them reduce ED behaviours. DISCUSSION Significant improvements in emotion processing and regulations, as well as psychopathology, along with positive qualitative feedback, suggest that the intervention effectively met its aims of increasing awareness of the link between emotions and eating psychopathology, providing help to identify and regulate emotions, and normalising emotional experiences. While our results are promising, further research is required to assess its effectiveness longer term and in clinical settings.
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Affiliation(s)
- Laura Vuillier
- Department of Psychology, Bournemouth University, Poole, UK.
| | | | - C V Talbot
- Department of Psychology, Bournemouth University, Poole, UK
| | - L May
- Southern Health University NHS Foundation Trust, Southampton, UK
| | - R L Moseley
- Department of Psychology, Bournemouth University, Poole, UK
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Russell H, Aouad P, Le A, Marks P, Maloney D, Touyz S, Maguire S. Psychotherapies for eating disorders: findings from a rapid review. J Eat Disord 2023; 11:175. [PMID: 37794513 PMCID: PMC10548609 DOI: 10.1186/s40337-023-00886-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 09/11/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Psychotherapy is considered central to the effective treatment of eating disorders-focusing on behavioural, psychological, and social factors that contribute to the illness. Research indicates psychotherapeutic interventions out-perform placebo, waitlist, and/or other treatments; but, outcomes vary with room for major improvement. Thus, this review aims to (1) establish and consolidate knowledge on efficacious eating disorder psychotherapies; (2) highlight select emerging psychotherapeutic interventions; and (3) identify knowledge gaps to better inform future treatment research and development. METHODS The current review forms part of a series of Rapid Reviews published in a special issue in the Journal of Eating Disorders to inform the development of the Australian-government-funded National Eating Disorder Research and Translation Strategy 2021-2031. Three databases were searched for studies published between 2009 and 2023, published in English, and comprising high-level evidence studies (meta-analyses, systematic reviews, moderately sized randomised controlled studies, moderately sized controlled-cohort studies, and population studies). Data pertaining to psychotherapies for eating disorders were synthesised and outlined in the current paper. RESULTS 281 studies met inclusion criteria. Behavioural therapies were most commonly studied, with cognitive-behavioural and family-based therapies being the most researched; and thus, having the largest evidence-base for treating anorexia nervosa, bulimia nervosa, and binge eating disorder. Other therapies, such as interpersonal and dialectical behaviour therapies also demonstrated positive treatment outcomes. Emerging evidence supports specific use of Acceptance and Commitment; Integrative Cognitive Affective; Exposure; Mindfulness; and Emotionally-Focused therapies; however further research is needed to determine their efficacy. Similarly, growing support for self-help, group, and computer/internet-based therapeutic modalities was noted. Psychotherapies for avoidant/restrictive food intake disorder; other, and unspecified feeding and eating disorders were lacking evidence. CONCLUSIONS Currently, clinical practice is largely supported by research indicating that behavioural and cognitive-behavioural psychotherapies are most effective for the treatment of eating disorders. However, the efficacy of psychotherapeutic interventions varies across studies, highlighting the need for investment and expansion of research into enhanced variants and novel psychotherapies to improve illness outcomes. There is also a pressing need for investigation into the whole range of eating disorder presentations and populations, to determine the most effective interventions.
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Affiliation(s)
- Haley Russell
- InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, Level 2, Charles Perkins Centre (D17), University of Sydney, Sydney, NSW, 2006, Australia
| | - Phillip Aouad
- InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, Level 2, Charles Perkins Centre (D17), University of Sydney, Sydney, NSW, 2006, Australia.
| | - Anvi Le
- Healthcare Management Advisors, Melbourne, Australia
| | - Peta Marks
- InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, Level 2, Charles Perkins Centre (D17), University of Sydney, Sydney, NSW, 2006, Australia
| | - Danielle Maloney
- InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, Level 2, Charles Perkins Centre (D17), University of Sydney, Sydney, NSW, 2006, Australia
- Sydney Local Health District, New South Wales Health, Sydney, Australia
| | - Stephen Touyz
- InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, Level 2, Charles Perkins Centre (D17), University of Sydney, Sydney, NSW, 2006, Australia
| | - Sarah Maguire
- InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, Level 2, Charles Perkins Centre (D17), University of Sydney, Sydney, NSW, 2006, Australia
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Rom S, Miskovic-Wheatley J, Barakat S, Aouad P, Kim M, Fuller-Tyszkiewicz M, Maguire S. The acceptability, feasibility, and preliminary efficacy of a supported online self-help treatment program for binge-eating disorder. Front Psychiatry 2023; 14:1229261. [PMID: 37860164 PMCID: PMC10584326 DOI: 10.3389/fpsyt.2023.1229261] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 09/06/2023] [Indexed: 10/21/2023] Open
Abstract
Introduction Studies in transdiagnostic eating disorder (ED) samples suggest supported online self-help programs (eTherapies) are effective and may improve access to treatment; however, their evaluation in those with binge-eating disorder (BED) is limited. Given BED's high prevalence and low levels of treatment uptake, further eTherapy evaluation is needed to broaden access to effective, evidence-based treatment options. The aim of this study was to investigate the acceptability, feasibility, and preliminary efficacy of a supported eTherapy for those with BED or subthreshold BED, and to examine symptom change across the duration of therapy. Method Nineteen women with BED completed a supported, 10-session Cognitive Behavioural Therapy-based eTherapy in an uncontrolled, pre-post, and 3 months follow up intervention study. Key outcomes were assessed by the Eating Disorder Examination Questionnaire (EDE-Q): objective binge episode (OBE) frequency and ED psychopathology. Feasibility was evaluated via program adherence and dropout, whilst acceptability was assessed through participant feedback post-treatment. Weekly symptom change (ED psychopathology) during treatment was assessed by the Eating Disorder Examination - Questionnaire Short (EDE-QS). Results Generalised estimating equations showed statistically and clinically significant reductions in OBEs and ED psychopathology (large effects) post-treatment, with these decreases maintained at follow up. Across weekly assessment, a marked slowing in the rate of change in ED psychopathology was observed after four sessions of the program. Program feasibility was high (i.e., 84% of content completed), as was program acceptability (i.e., 93% of participants expressed high levels of satisfaction). Discussion These results support the acceptability, feasibility, and preliminary efficacy of a supported eTherapy program for those with BED and suggest the variability of symptom change across the duration of therapy. Future research should further investigate findings in an adequately powered randomised controlled trial.
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Affiliation(s)
- Sean Rom
- Faculty of Health, School of Psychology, Deakin University, Geelong, VIC, Australia
- InsideOut Institute, The University of Sydney and Sydney Local Health District, Sydney, NSW, Australia
| | - Jane Miskovic-Wheatley
- InsideOut Institute, The University of Sydney and Sydney Local Health District, Sydney, NSW, Australia
| | - Sarah Barakat
- InsideOut Institute, The University of Sydney and Sydney Local Health District, Sydney, NSW, Australia
| | - Phillip Aouad
- InsideOut Institute, The University of Sydney and Sydney Local Health District, Sydney, NSW, Australia
| | | | | | - Sarah Maguire
- InsideOut Institute, The University of Sydney and Sydney Local Health District, Sydney, NSW, Australia
- Sydney Local Health District, Sydney, NSW, Australia
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Melisse B, Blankers M, van den Berg E, de Jonge M, Lommerse N, van Furth E, Dekker J, de Beurs E. Economic evaluation of web-based guided self-help cognitive behavioral therapy-enhanced for binge-eating disorder compared to a waiting list: A randomized controlled trial. Int J Eat Disord 2023; 56:1772-1784. [PMID: 37306246 DOI: 10.1002/eat.24003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 05/17/2023] [Accepted: 05/17/2023] [Indexed: 06/13/2023]
Abstract
INTRODUCTION The aim is to perform an economic evaluation alongside a randomized controlled trial comparing guided self-help cognitive behavioral therapy-enhanced (CBT-E) for binge-eating disorder (BED) to a waiting list control condition. METHODS BED patients (N = 212) were randomly assigned to guided self-help CBT-E or the 3-month waiting list. Measurements took place at baseline and the end-of-treatment. The cost-effectiveness analysis was performed using the number of binge-eating episodes during the last 28 days as an outcome indicator according to the eating disorder examination. A cost-utility analysis was performed using the EuroQol-5D. RESULTS The difference in societal costs over the 3 months of the intervention between both conditions was €679 (confidence interval [CI] 50-1330). The incremental costs associated with one incremental binge eating episode prevented in the guided self-help condition was approximately €18 (CI 1-41). From a societal perspective there was a 96% likelihood that guided self-help CBT-E led to a greater number of binge-eating episodes prevented, but at higher costs. Each additional quality-adjusted life year (QALY) gained was associated with incremental costs of €34,000 (CI 2494-154,530). With a 95% likelihood guided self-help CBT-E led to greater QALY gain at higher costs compared to waiting for treatment. Based on the National Institute for Health and Clinical Excellence willingness-to-pay threshold of €35,000 per QALY, guided self-help CBT-E can be considered cost-effective with a likelihood of 95% from a societal perspective. DISCUSSION Guided self-help CBT-E is likely a cost-effective treatment for BED in the short-term (3-month course of treatment). Comparison to treatment-as-usual is recommended for future research, as it enables an economic evaluation with a longer time horizon. PUBLIC SIGNIFICANCE Offering treatment remotely has several benefits for patients suffering from binge-eating disorders. Guided self-help CBT-E is an efficacious and likely cost-effective treatment, reducing binge eating and improving quality-of-life, albeit at higher societal costs.
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Affiliation(s)
- Bernou Melisse
- Novarum Center for Eating Disorders & Obesity, Amstelveen, The Netherlands
- Section Clinical Psychology, Leiden University, Leiden, The Netherlands
| | - Matthijs Blankers
- Research Department, Arkin Mental Health Institute, Amsterdam, The Netherlands
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
- Department of Psychiatry, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Elske van den Berg
- Novarum Center for Eating Disorders & Obesity, Amstelveen, The Netherlands
| | - Margo de Jonge
- Novarum Center for Eating Disorders & Obesity, Amstelveen, The Netherlands
| | - Nick Lommerse
- Research Department, Arkin Mental Health Institute, Amsterdam, The Netherlands
| | - Eric van Furth
- GGZ Rivierduinen Eating Disorders Ursula, Leiden, The Netherlands
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
| | - Jack Dekker
- Research Department, Arkin Mental Health Institute, Amsterdam, The Netherlands
| | - Edwin de Beurs
- Section Clinical Psychology, Leiden University, Leiden, The Netherlands
- Research Department, Arkin Mental Health Institute, Amsterdam, The Netherlands
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Rom S, Miskovic‐Wheatley J, Barakat S, Aouad P, Fuller‐Tyszkiewicz M, Maguire S. Evaluating the feasibility and potential efficacy of a brief eTherapy for binge-eating disorder: A pilot study. Int J Eat Disord 2022; 55:1614-1620. [PMID: 35986579 PMCID: PMC9804415 DOI: 10.1002/eat.23803] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 08/05/2022] [Accepted: 08/05/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVE For those with binge-eating disorder (BED), access to evidence-based, face-to-face treatment is often constrained by clinician availability and high treatment costs. Emerging evidence suggests online therapy (eTherapy) may navigate these barriers and reduce binge-eating symptomatology; however, less evaluation has been done in those with BED, particularly with briefer programs targeting early change. This study investigated the feasibility and potential efficacy of a brief, supported eTherapy in those with BED or subthreshold BED. METHOD Participants were 19 women with BED who completed a four-session eTherapy. This was a single-arm, pre-post intervention study, with participants completing weekly content and attending telehealth sessions. Key outcomes were assessed by the Eating Disorder Examination Questionnaire-Short (EDE-QS): objective binge episode days, loss of control over eating days, and eating disorder (ED) psychopathology via a total EDE-QS score. RESULTS Generalized and linear mixed models showed significantly reduced loss of control over eating days and ED psychopathology. Program feasibility was high, with strong program adherence and a below average attrition rate. DISCUSSION Pilot results support the feasibility and potential efficacy of a brief, behavioral-focused eTherapy program in reducing ED pathology in those with BED. Future research should further investigate findings in an adequately powered randomized controlled trial. PUBLIC SIGNIFICANCE This study suggests that a brief, behavioral-focused online therapy, guided by non-expert clinicians, can be successfully administered to those with binge-eating disorder (BED) and may be efficacious at reducing eating disorder and other related symptomatology. Brief eTherapies that are effective, accessible, and rapidly available may facilitate earlier intervention in illness and improve treatment outcomes for individuals who experience this common and distressing disorder.
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Affiliation(s)
- Sean Rom
- School of PsychologyDeakin UniversityGeelongVictoriaAustralia,InsideOut Institute, Central Clinical School, Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
| | - Jane Miskovic‐Wheatley
- InsideOut Institute, Central Clinical School, Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
| | - Sarah Barakat
- InsideOut Institute, Central Clinical School, Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia,School of PsychologyThe University of SydneySydneyNew South WalesAustralia
| | - Phillip Aouad
- InsideOut Institute, Central Clinical School, Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
| | | | - Sarah Maguire
- InsideOut Institute, Central Clinical School, Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia,Sydney Local Health DistrictSydneyNew South WalesAustralia
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Vega J, Bell BT, Taylor C, Xie J, Ng H, Honary M, McNaney R. Detecting Mental Health Behaviors Using Mobile Interactions: Exploratory Study Focusing on Binge Eating. JMIR Ment Health 2022; 9:e32146. [PMID: 35086064 PMCID: PMC9086876 DOI: 10.2196/32146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 01/16/2022] [Accepted: 01/17/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Binge eating is a subjective loss of control while eating, which leads to the consumption of large amounts of food. It can cause significant emotional distress and is often accompanied by purging behaviors (eg, meal skipping, overexercising, or vomiting). OBJECTIVE The aim of this study was to explore the potential of mobile sensing to detect indicators of binge-eating episodes, with a view toward informing the design of future context-aware mobile interventions. METHODS This study was conducted in 2 stages. The first involved the development of the DeMMI (Detecting Mental health behaviors using Mobile Interactions) app. As part of this, we conducted a consultation session to explore whether the types of sensor data we were proposing to capture were useful and appropriate, as well as to gather feedback on some specific app features relating to self-reporting. The second stage involved conducting a 6-week period of data collection with 10 participants experiencing binge eating (logging both their mood and episodes of binge eating) and 10 comparison participants (logging only mood). An optional interview was conducted after the study, which discussed their experience using the app, and 8 participants (n=3, 38% binge eating and n=5, 63% comparisons) consented. RESULTS The findings showed unique differences in the types of sensor data that were triangulated with the individuals' episodes (with nearby Bluetooth devices, screen and app use features, mobility features, and mood scores showing relevance). Participants had a largely positive opinion about the app, its unobtrusive role, and its ease of use. Interacting with the app increased participants' awareness of and reflection on their mood and phone usage patterns. Moreover, they expressed no privacy concerns as these were alleviated by the study information sheet. CONCLUSIONS This study contributes a series of recommendations for future studies wishing to scale our approach and for the design of bespoke mobile interventions to support this population.
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Affiliation(s)
- Julio Vega
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | | | | | - Jue Xie
- Department of Human Centred Computing, Monash University, Clayton, Australia
| | - Heidi Ng
- Department of Human Centred Computing, Monash University, Clayton, Australia
| | | | - Roisin McNaney
- Department of Human Centred Computing, Monash University, Clayton, Australia
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11
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Challenges in eating disorder diagnosis and management among family physicians and trainees: a qualitative study. J Eat Disord 2022; 10:45. [PMID: 35361258 PMCID: PMC8968091 DOI: 10.1186/s40337-022-00570-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 03/24/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Family physicians are one of the first points of contact for individuals with eating disorders (EDs) seeking care and treatment, but training in this area is suboptimal and insufficient. Specialized ED treatment programs often have long wait lists, and family physicians are responsible for patients care in the interim. The aim of this study was to identify the learning needs and challenges faced by Canadian family physicians and trainees when caring for patients with EDs. METHODS We recruited six family medicine residents and five family physicians practicing in an academic unit in the Department of Family Medicine of a medical school in urban southwestern Ontario, Canada. We used purposive sampling, focusing on residents and faculty physicians from the department and conducted one focus group for the residents and another for the faculty physicians, exploring their clinical knowledge and challenges when managing ED patients. The focus groups were audio-recorded and transcribed verbatim prior to thematic coding. RESULTS Physicians and residents faced challenges in discussing, screening, and managing patients with EDs. Three themes that emerged from the qualitative data highlighted training needs related to: (a) improving communication skills when treating a patient with an ED, (b) more effective screening and diagnosis in primary care practice, and (c) optimizing management strategies for patients with an ED, especially patients who are waiting for more intensive treatment. A fourth theme that emerged was the distress experienced by family physicians as they try best to manage and access care for their patients with EDs. CONCLUSION Addressing the learning needs identified in this study through continuing education offerings could aid family physicians in confidently providing effective, evidence-based care to patients with EDs. Improvement in training and education could also alleviate some of the distress faced by family physicians in managing patients with EDs. Ultimately, system changes to allow more efficient and appropriate levels of care for patients with EDs, removing the burden from family medicine, are critical as EDs are on the rise. A person with an eating disorder will normally seek care from their family physician first. These conditions can dramatically reduce the quality of a person's life and health. Family physicians therefore need to know how best to help these patients or refer them to a more intensive level of care, which often has long wait lists. We asked a group of family physicians and a group of family medicine trainees about their experiences with patients with eating disorders and about the information they wished they had to help these patients. The results show that they need more information on how to talk to a patient about eating disorders without judgement, how to diagnose a patient with an eating disorder, and then what treatment and management is needed while they wait for more intensive treatment for sicker patients. The physicians and trainees both talked about the stress and worry that they faced when treating patients with eating disorders. Besides their lack of training about these conditions, family physicians also described difficulties when trying to access timely specialized services for their patients. Physicians can experience moral distress when they know that their patients need higher level care, but there are systemic barriers to specialized programs that block their patients from getting the care they need when they need it.
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12
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Grilo CM, Thompson-Brenner H, Shingleton RM, Thompson DR, Franko DL. Clinical moderators and predictors of cognitive-behavioral therapy by guided-self-help versus therapist-led for binge-eating disorder: Analysis of aggregated clinical trials. Int J Eat Disord 2021; 54:1875-1880. [PMID: 34472114 PMCID: PMC8492524 DOI: 10.1002/eat.23601] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/06/2021] [Accepted: 08/24/2021] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Cognitive-behavioral therapy (CBT)-therapist-led (CBTth) and guided-self-help (CBTgsh)-has efficacy for binge-eating disorder (BED) but many patients do not benefit sufficiently. We examined predictors and moderators for these two CBT methods. METHOD Data were aggregated from randomized controlled trials (RCTs) testing psychosocial treatments for BED in the U.S. Predictors and moderators of outcomes (treatment completion and binge-eating remission) were examined in N = 457 participants who received either CBTgsh (N = 164) or CBTth (N = 293). RESULTS Analyses, adjusting for demographic/clinical variables, indicated CBTth was significantly superior to CBTgsh for treatment completion (odds ratio [OR] = 20.0) and remission (OR = 14.6). For remission, analyses revealed significant predictors (age, treatment length, Weight Concern), a moderator (weight concern [OR = 5.13]), and a significant interaction between CBT-type and treatment length (OR = 2.66). For CBTgsh, longer treatment was associated with less remission, whereas for CBTth, longer treatment was associated with greater remission. For CBTgsh, 44.1% with low weight concern versus 56.3% with high weight concern achieved remission whereas for CBTth, 43.5% with high weight concern and 61.0% with low weight concern achieved remission. DISCUSSION Analyses of aggregated RCT BED data, adjusting for demographic/clinical characteristics, indicated superiority (large effect-sizes) in treatment outcomes of CBTth over CBTgsh and that Weight Concern moderated outcomes.
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Affiliation(s)
- Carlos M. Grilo
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | | | | | | | - Debra L. Franko
- Department of Applied Psychology, Northeastern University, Boston, MA
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13
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Jenkins PE, Luck A, Violato M, Robinson C, Fairburn CG. Clinical and cost-effectiveness of two ways of delivering guided self-help for people with an eating disorder: A multi-arm randomized controlled trial. Int J Eat Disord 2021; 54:1224-1237. [PMID: 33998020 DOI: 10.1002/eat.23554] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 04/26/2021] [Accepted: 05/10/2021] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Increasing the availability and accessibility of evidence-based treatments for eating disorders is an important goal. This study investigated the effectiveness and cost-effectiveness of guided self-help via face-to-face meetings (fGSH) and a more scalable method, providing support via email (eGSH). METHOD A pragmatic, randomized controlled trial was conducted at three sites. Adults with binge-eating disorders were randomized to fGSH, eGSH, or a waiting list condition, each lasting 12 weeks. The primary outcome variable for clinical effectiveness was overall severity of eating psychopathology and, for cost-effectiveness, binge-free days, with explorative analyses using symptom abstinence. Costs were estimated from both a partial societal and healthcare provider perspective. RESULTS Sixty participants were included in each condition. Both forms of GSH were superior to the control condition in reducing eating psychopathology (IRR = -1.32 [95% CI -1.77, -0.87], p < .0001; IRR = -1.62 [95% CI -2.25, -1.00], p < .0001) and binge eating. Attrition was higher in eGSH. Probabilities that fGSH and eGSH were cost-effective compared with WL were 93% (99%) and 51% (79%), respectively, for a willingness to pay of £100 (£150) per additional binge-free day. DISCUSSION Both forms of GSH were associated with clinical improvement and were likely to be cost-effective compared with a waiting list condition. Provision of support via email is likely to be more convenient for many patients although the risk of non-completion is greater.
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Affiliation(s)
- Paul E Jenkins
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK.,Oxford Health NHS Foundation Trust, Oxford, UK
| | - Amy Luck
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Mara Violato
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Dowling NA, Merkouris SS, Rodda SN, Smith D, Aarsman S, Lavis T, Lubman DI, Austin DW, Cunningham JA, Battersby MW, O SC. GamblingLess: A Randomised Trial Comparing Guided and Unguided Internet-Based Gambling Interventions. J Clin Med 2021; 10:2224. [PMID: 34063826 PMCID: PMC8196610 DOI: 10.3390/jcm10112224] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 05/10/2021] [Accepted: 05/13/2021] [Indexed: 12/11/2022] Open
Abstract
There is little evidence relating to the effects of adding guidance to internet-based gambling interventions. The primary aim was to compare the effectiveness of an online self-directed cognitive-behavioural gambling program (GamblingLess) with and without therapist-delivered guidance. It was hypothesised that, compared to the unguided intervention, the guided intervention would result in superior improvements in gambling symptom severity, urges, frequency, expenditure, psychological distress, quality of life and help-seeking. A two-arm, parallel-group, randomised trial with pragmatic features and three post-baseline evaluations (8 weeks, 12 weeks, 24 months) was conducted with 206 gamblers (106 unguided; 101 guided). Participants in both conditions reported significant improvements in gambling symptom severity, urges, frequency, expenditure, and psychological distress across the evaluation period, even after using intention-to-treat analyses and controlling for other low- and high-intensity help-seeking, as well as clinically significant changes in gambling symptom severity (69% recovered/improved). The guided intervention resulted in additional improvements to urges and frequency, within-group change in quality of life, and somewhat higher rates of clinically significant change (77% cf. 61%). These findings, which support the delivery of this intervention, suggest that guidance may offer some advantages but further research is required to establish when and for whom human support adds value.
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Affiliation(s)
- Nicki A. Dowling
- School of Psychology, Deakin University, Geelong, VIC 3220, Australia; (S.S.M.); (S.A.); (D.W.A.)
- Melbourne Graduate School of Education, University of Melbourne, Parkville, VIC 3010, Australia
| | - Stephanie S. Merkouris
- School of Psychology, Deakin University, Geelong, VIC 3220, Australia; (S.S.M.); (S.A.); (D.W.A.)
| | - Simone N. Rodda
- School of Psychology, Deakin University, Geelong, VIC 3220, Australia; (S.S.M.); (S.A.); (D.W.A.)
- School of Population Health, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand;
- Turning Point, Eastern Health, 110 Church St, Richmond, VIC 3121, Australia
| | - David Smith
- College of Medicine and Public Health, Flinders University, Bedford Park, SA 5042, Australia; (D.S.); (M.W.B.)
| | - Stephanie Aarsman
- School of Psychology, Deakin University, Geelong, VIC 3220, Australia; (S.S.M.); (S.A.); (D.W.A.)
| | - Tiffany Lavis
- School of Psychology, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA 5000, Australia;
| | - Dan I. Lubman
- Turning Point, Eastern Health and Monash Addiction Research Centre, Eastern Health Clinical School, Richmond, VIC 3121, Australia;
| | - David W. Austin
- School of Psychology, Deakin University, Geelong, VIC 3220, Australia; (S.S.M.); (S.A.); (D.W.A.)
| | - John A. Cunningham
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London WC2R 2LS, UK;
- Centre for Addiction and Mental Health, Toronto, ON M6J 1H4, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON M5T 1R8, Canada
| | - Malcolm W. Battersby
- College of Medicine and Public Health, Flinders University, Bedford Park, SA 5042, Australia; (D.S.); (M.W.B.)
| | - Seung Chul O
- Faculty of Health, Deakin University, Geelong, VIC 3220, Australia;
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Tannous WK, Hay P, Girosi F, Heriseanu AI, Ahmed MU, Touyz S. The economic cost of bulimia nervosa and binge eating disorder: a population-based study. Psychol Med 2021; 52:1-15. [PMID: 33998425 DOI: 10.1017/s0033291721000775] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND The most common eating disorders (EDs) are bulimia nervosa (BN) and binge eating disorder (BED), serious psychiatric illnesses that have devastating effects on the physical and psychological wellbeing of sufferers. EDs range in complexity and severity but can be life-threatening without appropriate treatment. Although it is well-known that quality of life impacts is high for ED sufferers, research regarding fiscal and related costs is severely limited. The aim of this study was to understand economic and other costs of EDs at the community level. METHOD Data were derived from 2017 household community representative structured interview of 2977 people aged ⩾ 15 years in South Australia. ED diagnoses, health systems, productivity, transaction, out-of-pocket expenses and other related costs of BN and BED were used to estimate the economic burden of EDs in South Australia. RESULTS The annual total economic cost of EDs in 2018 was estimated at $84 billion for South Australia. This included $81 billion from the burden of disease as the result of years lived with disability (YLD) ($62 billion) and years of life lost ($19 billion). The health system costs, productivity and tax revenue loss to the Australian economy were estimated at $1 billion, $1.6 billion and $0.6 billion, respectively. CONCLUSIONS The YLD average cost in 2018 in South Australia was $296 649 per person. This is two-thirds of the costs borne by individuals and the wider economy. Prevention and management initiatives for EDs need to take into account these costs when assessing their potential benefits.
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Affiliation(s)
- Wadad Kathy Tannous
- Translational Health Research Institute, School of Medicine, Western Sydney University, NSW, Australia
| | - Phillipa Hay
- Translational Health Research Institute, School of Medicine, Western Sydney University, NSW, Australia
| | - Federico Girosi
- Translational Health Research Institute, School of Medicine, Western Sydney University, NSW, Australia
| | - Andreea I Heriseanu
- School of Psychology and InsideOut Institute, University of Sydney, Camperdown, NSW, Australia
| | - Moin Uddin Ahmed
- Translational Health Research Institute, School of Medicine, Western Sydney University, NSW, Australia
| | - Stephen Touyz
- School of Psychology and InsideOut Institute, University of Sydney, Camperdown, NSW, Australia
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16
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Grilo CM, Ivezaj V, Duffy AJ, Gueorguieva R. Randomized Controlled Trial of Treatments for Loss-of-Control Eating Following Bariatric Surgery. Obesity (Silver Spring) 2021; 29:689-697. [PMID: 33694287 PMCID: PMC7995173 DOI: 10.1002/oby.23124] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 12/15/2020] [Accepted: 12/23/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Loss-of-control (LOC) eating postoperatively is a consistent predictor of suboptimal longer-term bariatric surgery outcomes. This randomized controlled trial examined the effectiveness of two guided self-help treatments (cognitive behavioral therapy [gshCBT] and behavioral weight loss [gshBWL]) compared with a control (CON) for reducing LOC eating and weight. METHODS A total of 140 patients with recurrent LOC eating approximately 6 months after bariatric surgery were randomly assigned (5:5:2 ratio) to one of three conditions: gshCBT (n = 56), gshBWL (n = 60), or CON (n = 24). Three-month treatments were delivered by trained allied health clinicians to increase generalizability to bariatric surgery settings. Independent assessments were performed by doctoral research-clinicians using established interviews/measures; posttreatment outcomes were obtained for 89% of patients. RESULTS Mixed models revealed significant improvements for LOC eating frequency and weight loss but no significant differences between treatments; race neither predicted (main effect) nor moderated (interaction effect) treatment outcomes. Intent-to-treat categorical analyses of abstinence from LOC eating (30% for gshCBT, 27% for gshBWL, 38% for CON) and proportion attaining 5% weight loss (20%, 22%, 17%) revealed no significant differences between treatments; non-White participants had a higher proportion achieving LOC eating abstinence but a lower proportion attaining 5% weight loss compared with White participants. CONCLUSIONS In this 12-week randomized controlled trial following bariatric surgery, significant LOC eating reductions and weight loss did not differ significantly between treatments. Race was associated with posttreatment categorical outcomes.
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Affiliation(s)
- Carlos M. Grilo
- Yale School of Medicine, Department of Psychiatry, New Haven, CT, USA
- Yale University, Department of Psychology, New Haven, CT, USA
| | - Valentina Ivezaj
- Yale School of Medicine, Department of Psychiatry, New Haven, CT, USA
| | - Andrew J Duffy
- Yale School of Medicine, Department of Surgery, New Haven, CT, USA
| | - Ralitza Gueorguieva
- Yale School of Medicine, Department of Psychiatry, New Haven, CT, USA
- Yale School Public Health, Department of Biostatistics, New Haven, CT, USA
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Clarke G, Sheppler CR, Firemark AJ, Rawlings AM, Dickerson JF, Leo MC. Augmenting usual care SSRIs with cognitive behavioral therapy for insomnia to improve depression outcomes in youth: Design of a randomized controlled efficacy-effectiveness trial. Contemp Clin Trials 2020; 91:105967. [PMID: 32114185 PMCID: PMC7263975 DOI: 10.1016/j.cct.2020.105967] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 02/21/2020] [Accepted: 02/22/2020] [Indexed: 01/01/2023]
Abstract
IMPORTANCE Extant treatments for youth depression are only modestly effective. Alternative approaches are needed to improve health outcomes. A novel approach to improve depression outcomes is suggested by epidemiological studies finding that insomnia often predates and may contribute to depression risk. We test whether treating insomnia among youth starting a new course of SSRI antidepressants improves depression outcomes. This paper describes our study design. DESIGN 2-arm randomized controlled efficacy-effectiveness trial. SETTING A large non-profit health maintenance organization. PARTICIPANTS 165 adolescents aged 12-19 with research-confirmed depression and insomnia diagnoses, starting a new episode of selective serotonin reuptake inhibitor (SSRI) antidepressant treatment prescribed by their usual care provider. INTERVENTIONS Two sleep interventions, each 6-7 sessions, both overlaying "treatment as usual" (TAU) SSRIs: a sleep hygiene (SH) attention control condition, and cognitive-behavioral therapy for insomnia (CBTI). CONCLUSIONS AND RELEVANCE If CBT-I improved sleep is shown to improve depression-related outcomes, this may provide an additional, easily tolerated intervention for an important public health target. TRIAL REGISTRATION clinicaltrials.gov, NCT02290496, https://clinicaltrials.gov/ct2/show/NCT02290496.
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Affiliation(s)
- Greg Clarke
- Kaiser Permanente Northwest, Center for Health Research, 3800 N Interstate Ave, Portland, OR 97227, USA.
| | - Christina R Sheppler
- Kaiser Permanente Northwest, Center for Health Research, 3800 N Interstate Ave, Portland, OR 97227, USA.
| | - Alison J Firemark
- Kaiser Permanente Northwest, Center for Health Research, 3800 N Interstate Ave, Portland, OR 97227, USA.
| | - Andreea M Rawlings
- Kaiser Permanente Northwest, Center for Health Research, 3800 N Interstate Ave, Portland, OR 97227, USA.
| | - John F Dickerson
- Kaiser Permanente Northwest, Center for Health Research, 3800 N Interstate Ave, Portland, OR 97227, USA.
| | - Michael C Leo
- Kaiser Permanente Northwest, Center for Health Research, 3800 N Interstate Ave, Portland, OR 97227, USA.
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Hildebrandt T, Michaeledes A, Mayhew M, Greif R, Sysko R, Toro-Ramos T, DeBar L. Randomized Controlled Trial Comparing Health Coach-Delivered Smartphone-Guided Self-Help With Standard Care for Adults With Binge Eating. Am J Psychiatry 2020; 177:134-142. [PMID: 32008396 DOI: 10.1176/appi.ajp.2019.19020184] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Cognitive-behavioral therapy (CBT) has shown efficacy in the treatment of eating disorders. The authors conducted a randomized controlled telemedicine trial of CBT-guided self-help (CBT-GSH) assisted with a smartphone app, Noom Monitor, for binge eating with or without purging. They hypothesized that coach-delivered CBT-GSH telemedicine sessions plus Noom Monitor would yield greater reductions in symptoms of binge eating, purging, and eating disorders compared with standard care. METHODS Fifty-two-week outcomes for CBT-GSH plus Noom Monitor (N=114) were compared with outcomes for standard care (N=111) among members of an integrated health care system in the Pacific Northwest. Patients in the health system who met inclusion criteria were ≥18 years old, had a body mass index ≥18.5, met criteria for DSM-5 binge eating disorder or bulimia nervosa, had 12 months of continuous health care enrollment in Kaiser Permanente Northwest, and had a personal smartphone. Participants received eight CBT-GSH telemedicine sessions over 12 weeks administered by health coaches, and outcomes were assessed at baseline and at weeks 4, 8, 12, 26, and 52. The use of available treatment offered within the Kaiser Permanente health care system was permitted for participants assigned to standard care. RESULTS Participants who received CBT-GSH plus Noom Monitor reported significant reductions in objective binge-eating days (β=-0.66, 95% CI=-1.06, -0.25; Cohen's d=-1.46, 95% CI=-4.63, -1.09) and achieved higher rates of remission (56.7% compared with 30%; number needed to treat=3.74) at 52 weeks compared with participants in standard care, none of whom received any eating disorder treatment during the intervention period (baseline and weeks 1-12). Similar patterns emerged for compensatory behaviors (vomiting, use of laxatives, and excessive exercise; 76.3% compared with 56.8%; number needed to treat=5.11), eating disorder symptoms (body shape, weight, eating concerns, and dietary restraint), and clinical impairment (Cohen's d=-10.07, -2.15). CONCLUSIONS These results suggest that CBT-GSH plus Noom Monitor delivered via telemedicine by routine-practice health coaches in a nonacademic health care system yields reductions in symptoms and impairment over 52 weeks compared with standard care.
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Affiliation(s)
- Tom Hildebrandt
- The Department of Psychiatry, Eating and Weight Disorders Program, Icahn School of Medicine at Mount Sinai, New York (Hildebrandt, Greif, Sysko), Noom, Inc., New York (Michaeledes, Toro-Ramos); Kaiser Permanente Center for Health Research, Portland, Ore. (Mayhew); and Kaiser Permanente Washington Health Research Institute, Seattle (DeBar)
| | - Andreas Michaeledes
- The Department of Psychiatry, Eating and Weight Disorders Program, Icahn School of Medicine at Mount Sinai, New York (Hildebrandt, Greif, Sysko), Noom, Inc., New York (Michaeledes, Toro-Ramos); Kaiser Permanente Center for Health Research, Portland, Ore. (Mayhew); and Kaiser Permanente Washington Health Research Institute, Seattle (DeBar)
| | - Meghan Mayhew
- The Department of Psychiatry, Eating and Weight Disorders Program, Icahn School of Medicine at Mount Sinai, New York (Hildebrandt, Greif, Sysko), Noom, Inc., New York (Michaeledes, Toro-Ramos); Kaiser Permanente Center for Health Research, Portland, Ore. (Mayhew); and Kaiser Permanente Washington Health Research Institute, Seattle (DeBar)
| | - Rebecca Greif
- The Department of Psychiatry, Eating and Weight Disorders Program, Icahn School of Medicine at Mount Sinai, New York (Hildebrandt, Greif, Sysko), Noom, Inc., New York (Michaeledes, Toro-Ramos); Kaiser Permanente Center for Health Research, Portland, Ore. (Mayhew); and Kaiser Permanente Washington Health Research Institute, Seattle (DeBar)
| | - Robyn Sysko
- The Department of Psychiatry, Eating and Weight Disorders Program, Icahn School of Medicine at Mount Sinai, New York (Hildebrandt, Greif, Sysko), Noom, Inc., New York (Michaeledes, Toro-Ramos); Kaiser Permanente Center for Health Research, Portland, Ore. (Mayhew); and Kaiser Permanente Washington Health Research Institute, Seattle (DeBar)
| | - Tatiana Toro-Ramos
- The Department of Psychiatry, Eating and Weight Disorders Program, Icahn School of Medicine at Mount Sinai, New York (Hildebrandt, Greif, Sysko), Noom, Inc., New York (Michaeledes, Toro-Ramos); Kaiser Permanente Center for Health Research, Portland, Ore. (Mayhew); and Kaiser Permanente Washington Health Research Institute, Seattle (DeBar)
| | - Lynn DeBar
- The Department of Psychiatry, Eating and Weight Disorders Program, Icahn School of Medicine at Mount Sinai, New York (Hildebrandt, Greif, Sysko), Noom, Inc., New York (Michaeledes, Toro-Ramos); Kaiser Permanente Center for Health Research, Portland, Ore. (Mayhew); and Kaiser Permanente Washington Health Research Institute, Seattle (DeBar)
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Chevinsky JD, Wadden TA, Chao AM. Binge Eating Disorder in Patients with Type 2 Diabetes: Diagnostic and Management Challenges. Diabetes Metab Syndr Obes 2020; 13:1117-1131. [PMID: 32341661 PMCID: PMC7166070 DOI: 10.2147/dmso.s213379] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 03/26/2020] [Indexed: 12/21/2022] Open
Abstract
Type 2 diabetes mellitus (T2DM) is associated with an increased risk of disordered eating behaviors including binge eating disorder (BED). Comorbid BED in patients with T2DM has been associated with adverse clinical outcomes such as higher body mass index (BMI) and depressive symptoms. Identifying and addressing this disorder in patients with T2DM is a significant challenge for health-care providers. The purpose of this narrative review is to discuss current perspectives on BED in the context of T2DM with implications for screening and management of these highly comorbid conditions. BED continues to be underrecognized and underdiagnosed. However, there are established tools that providers can use to screen for BED such as the SCOFF Questionnaire and Questionnaire on Eating and Weight Patterns-5. There are several effective treatments for BED including cognitive behavioral therapy, interpersonal therapy, and lisdexamfetamine dimesylate. However, few studies have examined the effects of these treatments in patients with co-morbid T2DM and BED.
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Affiliation(s)
| | - Thomas A Wadden
- Perelman School of Medicine at the University of Pennsylvania, Department of Psychiatry, Philadelphia, PA, USA
| | - Ariana M Chao
- Perelman School of Medicine at the University of Pennsylvania, Department of Psychiatry, Philadelphia, PA, USA
- University of Pennsylvania School of Nursing, Department of Biobehavioral Health Sciences, Philadelphia, PA, USA
- Correspondence: Ariana M Chao University of Pennsylvania School of Nursing, 418 Curie Blvd, Philadelphia, PA19104, USATel +1215-746-7183Fax +1215-898-2878 Email
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The ReThink study: a 3-arm parallel randomized trial of cognitive bias modification, with and without adherence promotion, for adolescent anxiety disorder: trial design and protocol. BMC Psychiatry 2019; 19:306. [PMID: 31640613 PMCID: PMC6805380 DOI: 10.1186/s12888-019-2296-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 09/20/2019] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Anxiety disorders are the most common mental health problem among youth, contribute to reduced quality of daily life, and are associated with high rates of comorbidity. However, treatment rates for anxiety are very low, causing a sizeable treatment gap. There is an immediate need to identify treatment interventions that are effective, affordable, and can be delivered easily to the youth population. Cognitive Bias Modification (CBM) is one potentially effective intervention that could reach youth on a large scale, especially when self-administered at home. Thus, we aim to assess the benefit of CBM to treat youth anxiety. Further, we aim to test whether adding an adherence promotion (AP) component to the CBM intervention can improve outcomes, and whether CBM delivered both with and without the AP component is cost effective. METHODS This is a 12-month randomized controlled trial (RCT) conducted within an existing healthcare system. Potentially eligible youth (ages 12 to 17) will be identified by reviewing the electronic health record (EHR) for clinical anxiety diagnoses, which are then confirmed via research interview. We aim to enroll 498 participants and randomize them 1:1:1 to one of three arms: Arm 1 is a Low-Ratio version of the CBM program (nearly identical to the other CBM versions, but minimally effective); Arm 2 is a High-Ratio "active" CBM program; and Arm 3 is the High-Ratio CBM program with an added AP component. Participants will complete assessments at baseline, 1-, 3-, 6- and 12-months post-baseline. Youth in all three arms will self-administer the CBM program at home and will be asked to complete twelve intervention sessions over a four-week period. Arm 3 participants (High-Ratio CBM + AP) will also receive up to four telephone calls from phone coaches during the intervention period to provide technical assistance, encouragement, and motivational enhancement to increase adherence. The primary clinical outcome will be anxiety remission at 6-month follow-up. DISCUSSION This study protocol describes the method and design for an RCT to test whether self-administered CBM both with and without adherence promotion can be an effective at-home treatment for anxious youth. TRIAL REGISTRATION ClinicalTrials.gov : NCT02156531, First Posted June 5, 2014.
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Byford S, Petkova H, Stuart R, Nicholls D, Simic M, Ford T, Macdonald G, Gowers S, Roberts S, Barrett B, Kelly J, Kelly G, Livingstone N, Joshi K, Smith H, Eisler I. Alternative community-based models of care for young people with anorexia nervosa: the CostED national surveillance study. HEALTH SERVICES AND DELIVERY RESEARCH 2019. [DOI: 10.3310/hsdr07370] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Evidence suggests that investing in specialist eating disorders services for young people with anorexia nervosa could have important implications for the NHS, with the potential to improve health outcomes and reduce costs through reductions in the number and length of hospital admissions.
Objectives
The primary objectives were to evaluate the costs and cost-effectiveness of alternative community-based models of service provision for young people with anorexia nervosa and to model the impact of potential changes to the provision of specialist services.
Design
Observational surveillance study using the Child and Adolescent Psychiatry Surveillance System.
Setting
Community-based secondary or tertiary child and adolescent mental health services (CAMHS) in the UK and the Republic of Ireland.
Participants
A total of 298 young people aged 8–17 years in contact with CAMHS for a first episode of anorexia nervosa in accordance with Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, diagnostic criteria.
Interventions
Community-based specialist eating disorders services and generic CAMHS.
Main outcome measures
Children’s Global Assessment Scale (CGAS) score (primary outcome) and percentage of median expected body mass index (BMI) for age and sex (%mBMI) (secondary outcome) were assessed at baseline and at 6 and 12 months.
Data sources
Data were collected by clinicians from clinical records.
Results
Total costs incurred by young people initially assessed in specialist eating disorders services were not significantly different from those incurred by young people initially assessed in generic CAMHS. However, adjustment for baseline covariates resulted in observed differences favouring specialist services (costs were lower, on average) because of the significantly poorer clinical status of the specialist group at baseline. At the 6-month follow-up, mean %mBMI was significantly higher in the specialist group, but no other significant differences in outcomes were evident. Cost-effectiveness analyses suggest that initial assessment in a specialist service has a higher probability of being cost-effective than initial assessment in generic CAMHS, as determined by CGAS score and %mBMI. However, no firm conclusion can be drawn without knowledge of society’s willingness to pay for improvements in these outcomes. Decision modelling did not support the hypothesis that changes to the provision of specialist services would generate savings for the NHS, with results suggesting that cost per 10-point improvement in CGAS score (improvement from one CGAS category to the next) varies little as the percentage of participants taking the specialist or generic pathway is varied.
Limitations
Follow-up rates were lower than expected, but the sample was still larger than has been achieved to date in RCTs carried out in this population in the UK, and an exploration of the impact of missing cost and outcome data produced very similar results to those of the main analyses.
Conclusions
The results of this study suggest that initial assessment in a specialist eating disorders service for young people with anorexia nervosa may have a higher probability of being cost-effective than initial assessment in generic CAMHS, although the associated uncertainty makes it hard to draw firm conclusions. Although costs and outcomes were similar, young people in specialist services were more severely ill at baseline, suggesting that specialist services were achieving larger clinical effectiveness gains without the need for additional expenditure. The results did not suggest that providing more specialist services would save money for the NHS, given similar costs and outcomes, so decisions about which service type to fund could be made with reference to other factors, such as the preferences of patients and carers.
Future work
Data on measures of quality of life capable of generating quality-adjusted life-years are needed to confirm the cost-effectiveness of specialist services.
Trial registration
Current Controlled Trials ISRCTN12676087.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 7, No. 37. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Sarah Byford
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Hristina Petkova
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Ruth Stuart
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Dasha Nicholls
- Department of Medicine, Imperial College London, London, UK
| | - Mima Simic
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Tamsin Ford
- Institute of Health Research, Department of Psychological Sciences, University of Exeter Medical School, University of Exeter, Exeter, UK
| | | | | | - Sarah Roberts
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Barbara Barrett
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | | | - Grace Kelly
- School of Social Sciences, Education and Social Work, Queen’s University Belfast, Belfast, UK
| | - Nuala Livingstone
- School of Social Sciences, Education and Social Work, Queen’s University Belfast, Belfast, UK
| | - Kandarp Joshi
- Child and Adolescent Mental Health Service, Royal Cornhill Hospital, NHS Grampian, Aberdeen, UK
- Mental Health Division, University of Aberdeen, Aberdeen, UK
| | | | - Ivan Eisler
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
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Mehl A, Rohde P, Gau JM, Stice E. Disaggregating the predictive effects of impaired psychosocial functioning on future DSM-5 eating disorder onset in high-risk female adolescents. Int J Eat Disord 2019; 52:817-824. [PMID: 30977531 PMCID: PMC6609485 DOI: 10.1002/eat.23082] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 03/27/2019] [Accepted: 03/27/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Impaired psychosocial functioning previously emerged as the only risk factor to predict future onset of each of the four Diagnostic and Statistical Manual of Mental Disorder (5th ed.) (DSM-5) eating disorders. The goal of this follow-up report was to refine understanding of this newly identified risk factor. METHOD Combining data from women at risk for eating disorders because of body image concerns (N = 1,153, mean age = 18.5 years, SD = 4.2), we investigated which subdomain(s) and individual item(s) of psychosocial functioning (friends, family, school, and work) at baseline predicted onset of any eating disorder, using Cox regression (CRA) and classification tree analysis (CTA). RESULTS Psychosocial impairment with friends, family, and at school, but not at work, significantly increased risk for disorder onset over 3-year follow-up in univariate models. A one-unit increase in each domain raw score was associated with a 107, 22, and 43% increased hazard of eating disorder onset, respectively. Multivariate CRA found friends functioning, with a 92% increased hazard of disorder onset, contributed the strongest unique effect. CTA suggested that loneliness was the most potent risk factor with a threefold increased onset risk (eating disorder incidence for high vs. low scorers was 27 and 8%). Three friends functioning items and one school functioning item produced additional CTA branches. DISCUSSION Results refine understanding of the relation of psychosocial impairment to future onset of eating disorders, suggesting that peer functioning is the most critical. Data imply it would be useful to target young women with impaired psychosocial functioning in prevention programs.
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Affiliation(s)
- Annette Mehl
- Institute of Psychology, University of Heidelberg, Hauptstraße 47-51, 69120 Heidelberg, Germany
| | - Paul Rohde
- Oregon Research Institute, 1776 Millrace Drive, Eugene Oregon, 97403, USA
| | - Jeff M. Gau
- Oregon Research Institute, 1776 Millrace Drive, Eugene Oregon, 97403, USA
| | - Eric Stice
- Oregon Research Institute, 1776 Millrace Drive, Eugene Oregon, 97403, USA
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Abstract
The authors provide an overview of the current state of research on self-help interventions for eating disorders. The efficacy of different forms of self-help interventions for bulimia nervosa, binge eating disorder, and other eating disorders at various stages of the care pathway (from prevention to relapse prevention) is described. Cost-effectiveness studies are also presented. Moderators of outcome, such as guidance and adherence, are discussed. Overall, the findings are promising and support the use of self-help interventions in the treatment of bulimic disorders, across the stages of the care pathway. Less is known about the use of self-help in anorexia nervosa.
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Affiliation(s)
- See Heng Yim
- Section of Eating Disorders, King's College London, Institute of Psychiatry, Psychology and Neuroscience, PO Box 59, 16, De Crespigny Park, London SE5 8AF, UK.
| | - Ulrike Schmidt
- Section of Eating Disorders, King's College London, Institute of Psychiatry, Psychology and Neuroscience, PO Box 59, 16, De Crespigny Park, London SE5 8AF, UK; The Eating Disorders Service, Maudsley Hospital, South London and Maudsley NHS Foundation Trust, London, UK
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24
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Schotanus-Dijkstra M, Drossaert CHC, Pieterse ME, Walburg JA, Bohlmeijer ET, Smit F. Towards sustainable mental health promotion: trial-based health-economic evaluation of a positive psychology intervention versus usual care. BMC Psychiatry 2018; 18:265. [PMID: 30139332 PMCID: PMC6107956 DOI: 10.1186/s12888-018-1825-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 07/23/2018] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Mental well-being could be promoted and protected by positive psychology (PP) based interventions. Such interventions may be appealing for people at risk of anxiety and depressive disorders, but health-economic evaluations are scarce. The aim was to examine the cost-effectiveness of a PP intervention. METHODS Participants with suboptimal levels of mental well-being were randomly assigned to an email guided PP-intervention (n = 137) or a wait-list control group (n = 138) with access to usual care (UC). At baseline and 6 months follow-up, data were collected on health care costs. Outcomes of interest were flourishing mental health and treatment response on anxiety and depressive symptoms. RESULTS Bootstrapped mean incremental cost-effectiveness ratios were €2359 ($2899) for flourishing, €2959 ($3637) for anxiety and €2578 ($3168) for depression, suggesting appreciable health gains for low additional costs. At a willingness to pay ceiling of €10,000 ($12,290) for a treatment response, the probability that the intervention is deemed cost-effective ranged between 90 and 93%. CONCLUSIONS The guided PP intervention appears to be a promising strategy as seen from both a public health and a health-economic perspective, especially when there is some willingness to pay. When the PP-intervention is scaled up, then outcome monitoring is recommended to better guarantee the longer term cost-effectiveness of the intervention. TRIAL REGISTRATION The Netherlands National Trial Register NTR4297. Registered on 29 November 2013. The NTR is part of the WHO Primary Registries.
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Affiliation(s)
- Marijke Schotanus-Dijkstra
- Centre for eHealth and Well-being Research, Department of Psychology, Health and Technology, University of Twente, P.O. Box 217, 7500 AE Enschede, The Netherlands
| | - Constance H. C. Drossaert
- Centre for eHealth and Well-being Research, Department of Psychology, Health and Technology, University of Twente, P.O. Box 217, 7500 AE Enschede, The Netherlands
| | - Marcel E. Pieterse
- Centre for eHealth and Well-being Research, Department of Psychology, Health and Technology, University of Twente, P.O. Box 217, 7500 AE Enschede, The Netherlands
| | - Jan A. Walburg
- Centre for eHealth and Well-being Research, Department of Psychology, Health and Technology, University of Twente, P.O. Box 217, 7500 AE Enschede, The Netherlands
| | - Ernst T. Bohlmeijer
- Centre for eHealth and Well-being Research, Department of Psychology, Health and Technology, University of Twente, P.O. Box 217, 7500 AE Enschede, The Netherlands
| | - Filip Smit
- Department of Public Mental Health, Trimbos Institute, Utrecht, The Netherlands
- Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
- Department of Clinical, Neuro and Developmental Psychology, EMGO Institute for Health and Care Research, VU University, Amsterdam, The Netherlands
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25
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Plateau CR, Brookes FA, Pugh M. Guided Recovery: An Interpretative Phenomenological Analysis of Service Users’ Experiences of Guided Self-Help for Bulimic and Binge Eating Disorders. COGNITIVE AND BEHAVIORAL PRACTICE 2018. [DOI: 10.1016/j.cbpra.2017.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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26
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Le LKD, Hay P, Mihalopoulos C. A systematic review of cost-effectiveness studies of prevention and treatment for eating disorders. Aust N Z J Psychiatry 2018; 52:328-338. [PMID: 29113456 DOI: 10.1177/0004867417739690] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Eating disorders are serious mental disorders and are associated with substantial economic and social burden. The aim of this study is to undertake a systematic review of the cost-effectiveness studies of both preventive and treatment interventions for eating disorder. METHOD Electronic databases (including the Cochrane Controlled Trial Register, MEDLINE, PsycINFO, Academic Search Complete, Global Health, CINAHL complete, Health Business Elite, Econlit, Health Policy Reference Center and ERIC) were searched for published cost-effectiveness studies of eating disorder prevention and treatment including papers published up to January 2017. The quality of studies was assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. RESULTS In all, 13 studies met the review inclusion criteria as full cost-effectiveness studies and 8 were published since 2011. The studies included three modelled and one trial-based study focused on prevention, two trial-based and one modelled study for anorexia nervosa treatment and three trial-based studies for bulimia nervosa treatment. The remaining studies targeted binge-eating disorder or non-specific eating disorder treatment. The average percent of CHEERS checklist items reported was 71% (standard deviation 21%). Eating disorder interventions were mainly cost-saving or more effective and more costly compared to comparators; however, some results did not reach statistical significance. In the two studies that achieved 100% CHEERS checklist, one study reported that a cognitive dissonance intervention might be cost-effective for prevention of anorexia nervosa and bulimia nervosa with a 90% participation rate and the second study supported lisdexamfetamine to be cost-effective in the treatment of binge-eating disorder. Insufficient evidence for long-term cost-effectiveness (e.g. over 2 years) was found. CONCLUSION Cost-effectiveness studies in eating disorder appear to be increasing in number over the last 6 years. Findings were inconsistent and no firm conclusion can be drawn with regard to comparative value-for-money conclusions. However, some promising interventions were identified. Further research with improved methodology is required.
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Affiliation(s)
- Long Khanh-Dao Le
- 1 Deakin Health Economics, Deakin University, Burwood, VIC, Australia
| | - Phillipa Hay
- 2 School of Medicine and Translational Health Research Institute (THRI), Western Sydney University, Sydney, NSW, Australia
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27
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Leung SL, Barber JA, Burger A, Barnes RD. Factors associated with healthy and unhealthy workplace eating behaviours in individuals with overweight/obesity with and without binge eating disorder. Obes Sci Pract 2018; 4:109-118. [PMID: 29670748 PMCID: PMC5893464 DOI: 10.1002/osp4.151] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 12/15/2017] [Accepted: 12/19/2017] [Indexed: 11/24/2022] Open
Abstract
Objective Most Americans spend an average of 8 hours per day in the workplace. Current understanding of eating behaviours in the workplace and their association with overweight, obesity and binge eating disorder (BED) is limited. Workplace eating behaviours and weight‐related self‐efficacy were examined in a sample of 98 individuals with overweight or obesity, with or without BED. Design Participants completed the Weight Efficacy Lifestyle Questionnaire, Work and Social Adjustment Scale, Worker's Perception of Environmental Factors, and a Workplace Questionnaire. Results Eating unplanned food occurred on average 2.43 times per week (SD = 3.37), and eating unplanned food even when meals were brought from home occurred on average 1.28 times per week (SD = 1.84). Individuals with BED purchased lunch even when they brought food from home significantly more frequently than did individuals without BED. Those with BED also reported significantly poorer work and social adjustment related to binge eating as compared with those without BED. The most significant barriers to healthy eating in the workplace were coworker influence, eating more food in general and more junk food in response to stress, eating unplanned food at work and time constraints. Conclusions These factors may be important to target in weight‐loss treatment to increase individuals' weight loss success. As individuals with BED may be the most vulnerable to eating unplanned foods, clinicians may want to focus on this potential barrier in BED treatment.
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Affiliation(s)
- S L Leung
- Wyckoff Heights Medical Center Brooklyn NY USA
| | - J A Barber
- VA Connecticut Healthcare System West Haven CT USA.,Department of Psychiatry Yale University School of Medicine New Haven CT USA
| | - A Burger
- St Elizabeth Family Medicine Residency Youngstown OH USA
| | - R D Barnes
- Department of Psychiatry Yale University School of Medicine New Haven CT USA
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28
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König HH, Bleibler F, Friederich HC, Herpertz S, Lam T, Mayr A, Schmidt F, Svaldi J, Zipfel S, Brettschneider C, Hilbert A, de Zwaan M, Egger N. Economic evaluation of cognitive behavioral therapy and Internet-based guided self-help for binge-eating disorder. Int J Eat Disord 2018; 51:155-164. [PMID: 29345848 DOI: 10.1002/eat.22822] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 12/20/2017] [Accepted: 12/20/2017] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To determine the cost-effectiveness of individual face-to-face cognitive behavioral therapy (CBT) compared to therapist guided Internet-based self-help (GSH-I) in overweight or obese adults with binge-eating disorder (BED). METHOD Analysis was conducted alongside the multicenter randomized controlled INTERBED trial. CBT (n = 76) consisted of up to 20 individual therapy sessions over 4 months. GSH-I (n = 71) consisted of 11 modules combining behavioral interventions, exercises including a self-monitoring food diary, psychoeducation, and 2 face-to-face coaching sessions over 4 months. Assessments at baseline, after 4 months (post-treatment), as well as 6 and 18 months after the end of treatment included health care utilization and sick leave days to calculate direct and indirect costs. Binge-free days (BFD) were calculated as effect measure based on the German version of the Eating Disorder Examination. The incremental cost-effectiveness ratio (ICER) was determined, and net benefit regressions, adjusted for comorbidities and baseline differences, were used to derive cost-effectiveness acceptability curves. RESULTS After controlling for baseline differences, CBT was associated with non-significantly more costs (+€2,539) and BFDs (+40.1) compared with GSH-I during the 22-month observation period, resulting in an adjusted ICER of €63 per additional BFD. CBTs probability of being cost-effective increased above 80% only if societal willingness to pay (WTP) was ≥€250 per BFD. DISCUSSION We did not find clear evidence for one of the treatments being more cost-effective. CBT tends to be more effective but also more costly. If the societal WTP for an additional BFD is low, then our results suggest that GSH-I should rather be adopted.
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Affiliation(s)
- Hans-Helmut König
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics (HCHE), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Florian Bleibler
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics (HCHE), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hans-Christoph Friederich
- Department of General Internal Medicine and Psychosomatics, Medical University Hospital Heidelberg, Heidelberg, Germany.,Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - Stephan Herpertz
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University, Ruhr-University Bochum, Bochum, Germany
| | | | - Andreas Mayr
- Department of Medical Informatics, Biometry and Epidemiology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Frauke Schmidt
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany.,Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Erlangen, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Jennifer Svaldi
- Department of Clinical Psychology and Psychotherapy, University of Freiburg, Freiburg, Germany.,Department of Clinical Psychology and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, Tübingen, Germany
| | - Christian Brettschneider
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics (HCHE), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anja Hilbert
- Department of Medical Psychology and Medical Sociology, University of Leipzig Medical Center, Leipzig, Germany
| | - Martina de Zwaan
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany.,Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Erlangen, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Nina Egger
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics (HCHE), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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29
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Hildebrandt T, Michaelides A, Mackinnon D, Greif R, DeBar L, Sysko R. Randomized controlled trial comparing smartphone assisted versus traditional guided self-help for adults with binge eating. Int J Eat Disord 2017; 50:1313-1322. [PMID: 28960384 PMCID: PMC5755703 DOI: 10.1002/eat.22781] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 08/30/2017] [Accepted: 08/30/2017] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Guided self-help treatments based on cognitive-behavior therapy (CBT-GSH) are efficacious for binge eating. With limited availability of CBT-GSH in the community, mobile technology offers a means to increase use of these interventions. The purpose of this study was to test the initial efficacy of Noom Monitor, a smartphone application designed to facilitate CBT-GSH (CBT-GSH + Noom), on study retention, adherence, and eating disorder symptoms compared to traditional CBT-GSH. METHOD Sixty-six men and women with DSM-5 binge-eating disorder (BED) or bulimia nervosa (BN) were randomized to receive eight sessions of CBT-GSH + Noom (n = 33) or CBT-GSH (n = 33) over 12 weeks. Primary symptom outcomes were eating disorder examination objective bulimic episodes (OBEs), subjective bulimic episodes (SBEs), and compensatory behaviors. Assessments were collected at 0, 4, 8, 12, 24, and 36 weeks. Behavioral outcomes were modeled using zero-inflated negative-binomial latent growth curve models with intent-to-treat. RESULTS There was a significant effect of treatment on change in OBEs (β = -0.84, 95% CI = -1.49, -0.19) favoring CBT-GSH + Noom. Remission rates were not statistically different between treatments for OBEs (βlogit = -0.73, 95% CI = -1.86, 3.27; CBT-GSH-Noom = 17/27, 63.0% vs. CBT-GSH 11/27, 40.7%, NNT = 4.5), but CBT-GSH-Noom participants reported greater meal and snack adherence and regular meal adherence mediated treatment effects on OBEs. The treatments did not differ at the 6-month follow-up. DISCUSSION Smartphone applications for the treatment binge eating appear to have advantages for adherence, a critical component of treatment dissemination.
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Affiliation(s)
- Tom Hildebrandt
- Eating and Weight Disorders Program, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | - Rebecca Greif
- Eating and Weight Disorders Program, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Lynn DeBar
- Kaiser Permanente Center for Health Research, 3325 N. Interstate Ave. Portland, OR 97227
| | - Robyn Sysko
- Eating and Weight Disorders Program, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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30
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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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31
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Reducing the burden of suffering from eating disorders: Unmet treatment needs, cost of illness, and the quest for cost-effectiveness. Behav Res Ther 2017; 88:49-64. [PMID: 28110676 DOI: 10.1016/j.brat.2016.09.006] [Citation(s) in RCA: 99] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Revised: 09/13/2016] [Accepted: 09/15/2016] [Indexed: 01/27/2023]
Abstract
Eating disorders are serious mental disorders as reflected in significant impairments in health and psychosocial functioning and excess mortality. Despite the clear evidence of clinical significance and despite availability of evidence-based, effective treatments, research has shown a paradox of elevated health services use and, yet, infrequent treatment specifically targeting the eating disorder (i.e., high unmet treatment need). This review paper summarizes key studies conducted in collaboration with G. Terence Wilson and offers an update of the research literature published since 2011 in three research areas that undergirded our collaborative research project: unmet treatment needs, cost of illness, and cost-effectiveness of treatments. In regards to unmet treatment needs, epidemiological studies find that the number of individuals with an eating disorder who do not receive disorder-specific treatment continues to remain high. Cost-of-illness show that eating disorders are associated with substantial financial burdens for individuals, their family, and society, yet comprehensive examination of costs across public sectors is lacking. Cost measures vary widely, making it difficult to draw firm conclusions. Hospitalization is a major driver of medical costs incurred by individuals with an eating disorder. Only a handful of cost-effectiveness studies have been conducted, leaving policy makers with little information on which to base decisions about allocation of resources to help reduce the burden of suffering attributable to eating disorders.
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Selbsthilfe in der Behandlung von Essstörungen. PSYCHOTHERAPEUT 2017. [DOI: 10.1007/s00278-017-0189-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Akers L, Rohde P, Stice E, Butryn ML, Shaw H. Cost-effectiveness of achieving clinical improvement with a dissonance-based eating disorder prevention program. Eat Disord 2017; 25:263-272. [PMID: 28287919 PMCID: PMC6204073 DOI: 10.1080/10640266.2017.1297107] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Using data from an effectiveness trial delivered by college clinicians, we examined the cost-effectiveness of the dissonance-based Body Project program for reducing eating disorder symptoms in women with body dissatisfaction. The outcome of interest was individual-level change; 14.9% of Body Project participants attained clinically meaningful improvement vs. 6.7% of controls. Delivering the intervention costs approximately $70 (2012 U.S. dollars) per person. Incremental cost-effectiveness was $838 for each additional at-risk person reducing eating disorder symptomology to a clinically meaningful degree. These analyses demonstrate the economic value of the Body Project for college-age women with symptoms below the eating disorder diagnosis threshold.
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Affiliation(s)
- Laura Akers
- a Oregon Research Institute , Eugene , Oregon , USA
| | - Paul Rohde
- a Oregon Research Institute , Eugene , Oregon , USA
| | - Eric Stice
- a Oregon Research Institute , Eugene , Oregon , USA
| | - Meghan L Butryn
- b Department of Psychology , Drexel University , Philadelphia , Pennsylvania , USA
| | - Heather Shaw
- a Oregon Research Institute , Eugene , Oregon , USA
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Whiteford H, Weissman RS. Key factors that influence government policies and decision making about healthcare priorities: Lessons for the field of eating disorders. Int J Eat Disord 2017; 50:315-319. [PMID: 28221676 DOI: 10.1002/eat.22688] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 01/11/2017] [Accepted: 01/11/2017] [Indexed: 11/06/2022]
Abstract
Worldwide, the demand for healthcare exceeds what individuals and governments are able to afford. Priority setting is therefore inevitable, and mental health services have often been given low priority in the decision-making process. Drawing on established economic criteria, and specifically the work of Philip Musgrove, key factors which influence government decision-making about health priorities are reviewed. These factors include the size of the health burden, the availability of cost-effective interventions to reduce the burden, whether private markets can provide the necessary treatment efficiently, whether there are "catastrophic costs" incurred in accessing treatment, whether negative externalities arise from not providing care, and if the "rule of rescue" applies. Beyond setting priorities for resource allocation, governments also become involved where there is a need for regulation to maintain quality in the delivery of healthcare. By providing field-specific examples for each factor, we illustrate how advocates in the eating disorder field may use evidence to inform government policy about resource allocation and regulation in support of individuals with an eating disorder.
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Affiliation(s)
- Harvey Whiteford
- School of Public Health, University of Queensland, Queensland, Australia.,Institute of Health Metrics and Evaluation, University of Washington, Seattle, Washington
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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: 187] [Impact Index Per Article: 26.7] [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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Kass AE, Balantekin KN, Fitzsimmons-Craft EE, Jacobi C, Wilfley DE, Taylor CB. The economic case for digital interventions for eating disorders among United States college students. Int J Eat Disord 2017; 50:250-258. [PMID: 28152203 PMCID: PMC5391044 DOI: 10.1002/eat.22680] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 01/05/2017] [Accepted: 01/05/2017] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Eating disorders (EDs) are serious health problems affecting college students. This article aimed to estimate the costs, in United States (US) dollars, of a stepped care model for online prevention and treatment among US college students to inform meaningful decisions regarding resource allocation and adoption of efficient care delivery models for EDs on college campuses. METHODS Using a payer perspective, we estimated the costs of (1) delivering an online guided self-help (GSH) intervention to individuals with EDs, including the costs of "stepping up" the proportion expected to "fail"; (2) delivering an online preventive intervention compared to a "wait and treat" approach to individuals at ED risk; and (3) applying the stepped care model across a population of 1,000 students, compared to standard care. RESULTS Combining results for online GSH and preventive interventions, we estimated a stepped care model would cost less and result in fewer individuals needing in-person psychotherapy (after receiving less-intensive intervention) compared to standard care, assuming everyone in need received intervention. CONCLUSIONS A stepped care model was estimated to achieve modest cost savings compared to standard care, but these estimates need to be tested with sensitivity analyses. Model assumptions highlight the complexities of cost calculations to inform resource allocation, and considerations for a disseminable delivery model are presented. Efforts are needed to systematically measure the costs and benefits of a stepped care model for EDs on college campuses, improve the precision and efficacy of ED interventions, and apply these calculations to non-US care systems with different cost structures.
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Affiliation(s)
- Andrea E. Kass
- Department of Psychiatry & Behavioral Neuroscience, The University of Chicago, Chicago, IL, USA,Address correspondence to: Andrea E. Kass, Ph.D.; The University of Chicago, 5841 S. Maryland Avenue, MC 1000, Chicago, IL 60637; Telephone: 773-702-4186;
| | | | | | - Corinna Jacobi
- Technische Universität Dresden, Klinische Psychologie und Psychotherapie, Dresden, Germany
| | - Denise E. Wilfley
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - C. Barr Taylor
- Center for mHealth, Palo Alto University, Palo Alto, CA, and Stanford University, Stanford, Ca, USA
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Chen EY, Cacioppo J, Fettich K, Gallop R, McCloskey MS, Olino T, Zeffiro TA. An adaptive randomized trial of dialectical behavior therapy and cognitive behavior therapy for binge-eating. Psychol Med 2017; 47:703-717. [PMID: 27852348 PMCID: PMC7418949 DOI: 10.1017/s0033291716002543] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Early weak treatment response is one of the few trans-diagnostic, treatment-agnostic predictors of poor outcome following a full treatment course. We sought to improve the outcome of clients with weak initial response to guided self-help cognitive behavior therapy (GSH). METHOD One hundred and nine women with binge-eating disorder (BED) or bulimia nervosa (BN) (DSM-IV-TR) received 4 weeks of GSH. Based on their response, they were grouped into: (1) early strong responders who continued GSH (cGSH), and early weak responders randomized to (2) dialectical behavior therapy (DBT), or (3) individual and additional group cognitive behavior therapy (CBT+). RESULTS Baseline objective binge-eating-day (OBD) frequency was similar between DBT, CBT+ and cGSH. During treatment, OBD frequency reduction was significantly slower in DBT and CBT+ relative to cGSH. Relative to cGSH, OBD frequency was significantly greater at the end of DBT (d = 0.27) and CBT+ (d = 0.31) although these effects were small and within-treatment effects from baseline were large (d = 1.41, 0.95, 1.11, respectively). OBD improvements significantly diminished in all groups during 12 months follow-up but were significantly better sustained in DBT relative to cGSH (d = -0.43). At 6- and 12-month follow-up assessments, DBT, CBT and cGSH did not differ in OBD. CONCLUSIONS Early weak response to GSH may be overcome by additional intensive treatment. Evidence was insufficient to support superiority of either DBT or CBT+ for early weak responders relative to early strong responders in cGSH; both were helpful. Future studies using adaptive designs are needed to assess the use of early response to efficiently deliver care to large heterogeneous client groups.
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Affiliation(s)
- E. Y. Chen
- Department of Psychology, Temple University, Philadelphia, PA, USA
| | - J. Cacioppo
- Department of Psychology, The University of Chicago, Chicago, IL, USA
| | - K. Fettich
- Department of Psychology, Temple University, Philadelphia, PA, USA
| | - R. Gallop
- Department of Mathematics, West Chester University, West Chester, PA, USA
- Department of Psychiatry, Center for Psychotherapy Research, Perelman School of Medicine, University of Pennsylvania, USA
| | - M. S. McCloskey
- Department of Psychology, Temple University, Philadelphia, PA, USA
| | - T. Olino
- Department of Psychology, Temple University, Philadelphia, PA, USA
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Creed TA, Frankel SA, German RE, Green KL, Jager-Hyman S, Taylor KP, Adler AD, Wolk CB, Stirman SW, Waltman SH, Williston MA, Sherrill R, Evans AC, Beck AT. Implementation of transdiagnostic cognitive therapy in community behavioral health: The Beck Community Initiative. J Consult Clin Psychol 2016; 84:1116-1126. [PMID: 27379492 PMCID: PMC5125881 DOI: 10.1037/ccp0000105] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Progress bringing evidence-based practice (EBP) to community behavioral health (CBH) has been slow. This study investigated feasibility, acceptability, and fidelity outcomes of a program to implement transdiagnostic cognitive therapy (CT) across diverse CBH settings, in response to a policy shift toward EBP. METHOD Clinicians (n = 348) from 30 CBH programs participated in workshops and 6 months of consultation. Clinician retention was examined to assess feasibility, and clinician feedback and attitudes were evaluated to assess implementation acceptability. Experts rated clinicians' work samples at baseline, mid-, and end-of-consultation with the Cognitive Therapy Rating Scale (CTRS) to assess fidelity. RESULTS Feasibility was demonstrated through high program retention (i.e., only 4.9% of clinicians withdrew). Turnover of clinicians who participated was low (13.5%) compared to typical CBH turnover rates, even during the high-demand training period. Clinicians reported high acceptability of EBP and CT, and self-reported comfort using CT improved significantly over time. Most clinicians (79.6%) reached established benchmarks of CT competency by the final assessment point. Mixed-effects hierarchical linear models indicated that CTRS scores increased significantly from baseline to the competency assessment (p < .001), on average by 18.65 points. Outcomes did not vary significantly between settings (i.e., outpatient vs. other). CONCLUSIONS Even clinicians motivated by policy-change rather than self-nomination may feasibly be trained to deliver a case-conceptualization driven EBP with high levels of competency and acceptability. (PsycINFO Database Record
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Affiliation(s)
- Torrey A. Creed
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street Floor 2, Philadelphia, PA 19104
| | - Sarah A. Frankel
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street Floor 2, Philadelphia, PA 19104
| | - Ramaris E. German
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street Floor 2, Philadelphia, PA 19104
| | - Kelly L. Green
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street Floor 2, Philadelphia, PA 19104
| | - Shari Jager-Hyman
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street Floor 2, Philadelphia, PA 19104
| | - Kristin P. Taylor
- Corporal Michael J. Crescenz Veteran's Administration Medical Center, 3900 Woodland Avenue, Philadelphia, PA 19104
| | - Abby D. Adler
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street Floor 2, Philadelphia, PA 19104
| | - Courtney B. Wolk
- Center for Mental Health Policy and Services Research, Perelman School of Medicine, University of Pennsylvania. 3535 Market Street, Floor 3, Philadelphia, PA 19104
| | - Shannon W. Stirman
- Women's Health Sciences Division, National Center for Posttraumatic Stress Disorder, VA Boston Healthcare System, (116B-3), 150 South Huntington Avenue, Boston, 02130
| | - Scott H. Waltman
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street Floor 2, Philadelphia, PA 19104
| | - Michael A. Williston
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street Floor 2, Philadelphia, PA 19104
| | - Rachel Sherrill
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street Floor 2, Philadelphia, PA 19104
| | - Arthur C. Evans
- Philadelphia Department of Behavioral Health and Intellectual disAbility Services, 801 Market Street, Philadelphia, PA 19107
| | - Aaron T. Beck
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street Floor 2, Philadelphia, PA 19104
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Aardoom JJ, Dingemans AE, van Ginkel JR, Spinhoven P, Van Furth EF, Van den Akker-van Marle ME. Cost-utility of an internet-based intervention with or without therapist support in comparison with a waiting list for individuals with eating disorder symptoms: a randomized controlled trial. Int J Eat Disord 2016; 49:1068-1076. [PMID: 27441418 DOI: 10.1002/eat.22587] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/28/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To investigate the cost-utility of the internet-based intervention "Featback" provided with different levels of therapist support, in comparison to a waiting list. METHOD This economic evaluation was conducted from a societal perspective and was part of a randomized controlled trial in which participants (N = 354) with self-reported ED symptoms were randomized to: (1) 8 weeks of Featback, consisting of psychoeducation and a fully automated monitoring- and feedback system, (2) Featback with low-intensity (weekly) therapist support, (3) Featback with high-intensity (three times a week) therapist support, and (4) a waiting list. Participants were assessed at baseline, postintervention, and 3-month follow-up. Cost-utility acceptability curves were constructed. RESULTS No significant differences between the study conditions were found regarding quality-adjusted life-years (P = 0.55) and societal costs (P = 0.45), although the mean costs per participant were lowest in the Featback condition with low-intensity therapist support (€1951), followed by Featback with high-intensity therapist support (€2032), Featback without therapist support (€2102), and the waiting list (€2582). Featback seemed to be cost-effective as compared to the waiting list. No clear preference was found for Featback with or without therapist support. DISCUSSION A fully automated Internet-based intervention for ED symptoms with no, low-, or high-intensity therapist support represented good value for money when compared to a waiting list. This finding may have important implications for clinical practice, as both the unguided- and guided intervention could allow for more efficient care and widespread dissemination, potentially increasing the accessibility and availability of mental health care services for individuals with ED symptoms. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2016; 49:1068-1076).
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Affiliation(s)
- J J Aardoom
- Rivierduinen Eating Disorders Ursula, Leiden, The Netherlands
| | - A E Dingemans
- Rivierduinen Eating Disorders Ursula, Leiden, The Netherlands
| | - J R van Ginkel
- Institute of Education and Child Studies, Leiden University, Leiden, The Netherlands
| | - P Spinhoven
- Institute of Psychology, Leiden University, Leiden, The Netherlands.,Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
| | - E F Van Furth
- Rivierduinen Eating Disorders Ursula, Leiden, The Netherlands.,Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
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Liegl G, Boeckle M, Leitner A, Pieh C. A meta-analytic review of brief guided self-help education for chronic pain. Eur J Pain 2016; 20:1551-1562. [DOI: 10.1002/ejp.881] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2016] [Indexed: 02/01/2023]
Affiliation(s)
- G. Liegl
- Department of Psychotherapy and Biopsychosocial Health; Danube University Krems; Austria
- Department of Psychosomatic Medicine; Center for Internal Medicine and Dermatology; Charité - Universitätsmedizin Berlin; Germany
| | - M. Boeckle
- Department of Psychotherapy and Biopsychosocial Health; Danube University Krems; Austria
| | - A. Leitner
- Department of Psychotherapy and Biopsychosocial Health; Danube University Krems; Austria
| | - C. Pieh
- Department of Psychotherapy and Biopsychosocial Health; Danube University Krems; Austria
- Karl Landsteiner University of Health Sciences; Krems Austria
- Department of Psychosomatic Medicine; University of Regensburg; Germany
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Costa MB, Melnik T. Effectiveness of psychosocial interventions in eating disorders: an overview of Cochrane systematic reviews. EINSTEIN-SAO PAULO 2016; 14:235-77. [PMID: 27462898 PMCID: PMC4943360 DOI: 10.1590/s1679-45082016rw3120] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 05/21/2015] [Indexed: 02/07/2023] Open
Abstract
Eating disorders are psychiatric conditions originated from and perpetuated by individual, family and sociocultural factors. The psychosocial approach to treatment and prevention of relapse is crucial. To present an overview of the scientific evidence on effectiveness of psychosocial interventions in treatment of eating disorders. All systematic reviews published by the Cochrane Database of Systematic Reviews - Cochrane Library on the topic were included. Afterwards, as from the least recent date of these reviews (2001), an additional search was conducted at PubMed with sensitive search strategy and with the same keywords used. A total of 101 primary studies and 30 systematic reviews (5 Cochrane systematic reviews), meta-analysis, guidelines or narrative reviews of literature were included. The main outcomes were: symptomatic remission, body image, cognitive distortion, psychiatric comorbidity, psychosocial functioning and patient satisfaction. The cognitive behavioral approach was the most effective treatment, especially for bulimia nervosa, binge eating disorder and the night eating syndrome. For anorexia nervosa, the family approach showed greater effectiveness. Other effective approaches were interpersonal psychotherapy, dialectic behavioral therapy, support therapy and self-help manuals. Moreover, there was an increasing number of preventive and promotional approaches that addressed individual, family and social risk factors, being promising for the development of positive self-image and self-efficacy. Further studies are required to evaluate the impact of multidisciplinary approaches on all eating disorders, as well as the cost-effectiveness of some effective modalities, such as the cognitive behavioral therapy. RESUMO Transtornos alimentares são doenças psiquiátricas originadas de e perpetuadas por fatores individuais, familiares e socioculturais. A abordagem psicossocial é essencial para o tratamento e a prevenção de recaídas. Apresentar uma visão geral das evidências científicas sobre a efetividade das intervenções psicossociais no tratamento de transtornos alimentares. Foram incluídas todas as revisões sistemáticas publicadas no Banco de Dados de Revisões Sistemáticas da Cochrane Library. Posteriormente, a partir da data menos recente destas revisões (2001), realizou-se uma busca adicional no PubMed, com estratégia de busca sensibilizada e com os mesmos descritores utilizados antes. No total, foram incluídos 101 estudos primários e 30 revisões sistemáticas (5 revisões sistemáticas da Cochrane), metanálises, diretrizes ou revisões narrativas da literatura. Os principais desfechos foram remissão de sintomas, imagem corporal, distorção cognitiva, comorbidade psiquiátrica, funcionamento psicossocial e satisfação do paciente. A abordagem cognitivo-comportamental foi o tratamento mais efetivo, principalmente para bulimia nervosa, transtorno da compulsão alimentar periódica e síndrome do comer noturno. Para anorexia nervosa, a abordagem familiar demonstrou maior efetividade. Outras abordagens efetivas foram psicoterapia interpessoal, terapia comportamental dialética, terapia de apoio e manuais de autoajuda. Além disso, houve um número crescente de abordagens preventivas e promocionais que contemplaram fatores de risco individuais, familiares e sociais, sendo promissoras para o desenvolvimento da autoimagem positiva e autoeficácia. São necessários mais estudos que avaliem o impacto de abordagens multidisciplinares em todos transtornos alimentares, além da relação custo-efetividade de algumas modalidades efetivas, como a terapia cognitivo-comportamental.
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Affiliation(s)
| | - Tamara Melnik
- Universidade Federal de São Paulo, São Paulo, SP, Brazil
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Austin SB. Accelerating Progress in Eating Disorders Prevention: A Call for Policy Translation Research and Training. Eat Disord 2016; 24:6-19. [PMID: 25880718 DOI: 10.1080/10640266.2015.1034056] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The public health burden of eating disorders is well documented, and over the past several decades, researchers have made important advances in the prevention of eating disorders and related problems with body image. Despite these advances, however, several critical limitations to the approaches developed to date leave the field far from achieving the large-scale impact that is needed. This commentary provides a brief review of what achievements in prevention have been made and identifies the gaps that limit the potential for greater impact on population health. A plan is then offered with specific action steps to accelerate progress in high-impact prevention, most compellingly by promoting a shift in priorities to policy translation research and training for scholars through the adoption of a triggers-to-action framework. Finally, the commentary provides an example of the application of the triggers-to-action framework as practiced at the Strategic Training Initiative for the Prevention of Eating Disorders, a program based at the Harvard T. H. Chan School of Public Health and Boston Children's Hospital. Much has been achieved in the nearly 30 years of research carried out for the prevention of eating disorders and body image problems, but several critical limitations undermine the field's potential for meaningful impact. Through a shift in the field's priorities to policy translation research and training with an emphasis on macro-environmental influences, the pace of progress in prevention can be accelerated and the potential for large-scale impact substantially improved.
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Affiliation(s)
- S Bryn Austin
- a Department of Social and Behavioral Sciences , Harvard T. H. Chan School of Public Health , Boston , Massachusetts , USA.,b Division of Adolescent and Young Adult Medicine, Boston Children's Hospital , Boston , Massachusetts , United States
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Perceptions of the feasibility and acceptability of a smartphone application for the treatment of binge eating disorders: Qualitative feedback from a user population and clinicians. Int J Med Inform 2015; 84:808-16. [PMID: 26113461 DOI: 10.1016/j.ijmedinf.2015.06.004] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Revised: 04/27/2015] [Accepted: 06/09/2015] [Indexed: 01/12/2023]
Abstract
BACKGROUND Binge eating, a major public health problem, is characterized by recurrent episodes of out-of-control eating in which an individual consumes an unusually large amount of food in a discrete time period. Limitations of existing treatments for binge eating (both in-person psychotherapy and guided self-help) indicate that smartphone applications (apps) may be an ideal alternative or enhancement. An app for binge eating could aid treatment dissemination, engagement, and/or compliance. However, no research to date has examined user perceptions of a therapeutic app for binge eating, which is critical for development. OBJECTIVES The purposes of the current study were to conceptualize a potential app for binge eating and obtain feedback regarding feasibility and acceptability from target users (i.e., individuals with binge eating) and clinicians specializing in the treatment of binge eating. METHODS Our team conceptualized a smartphone app that contained self-help material, functions to monitor behavior, and provisions of in-the-moment interventions. We presented this app (e.g., feature explanations, mock screen shots) through phone interviews with clinicians who specialize in the treatment of binge eating (n=10), and focus groups with individuals experiencing binge eating (n=11). Participants were asked to discuss customization, user burden, terminology, attrition, data visualization, comprehensiveness, reminders, feasibility, acceptability, and perceived effectiveness of the proposed app. Thematic analyses were conducted from qualitative data (e.g., audio recordings and interview notes) obtained via the focus groups and interviews. RESULTS Results indicated that our proposed app would be highly feasible and acceptable to users and clinicians, though concerns about the degree of personalization and customizability were noted. CONCLUSIONS The current study details highly specific feedback and ideas regarding essential app features from target users and clinicians. This information is critical for the development of future apps to treat binge eating. Ways in which data obtained from the current study may be generalized to the development of therapeutic apps for other psychological disorders is discussed.
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Samnaliev M, Noh HL, Sonneville KR, Austin SB. The economic burden of eating disorders and related mental health comorbidities: An exploratory analysis using the U.S. Medical Expenditures Panel Survey. Prev Med Rep 2014; 2:32-4. [PMID: 26844048 PMCID: PMC4721298 DOI: 10.1016/j.pmedr.2014.12.002] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Very little is known about the economic burden of eating disorders (ED) and related mental health comorbidities. Methods Using 5 years of data from the U.S. Medical Expenditures Panel Survey, we estimated the difference in annual health care costs, employment status, and earned income (2011 US$) between individuals with current ED compared to those without ED. We further estimated the contribution of mental health comorbidities to these disparities in health care costs, employment and earnings. Results Individuals with ED had greater annual health care costs ($1869, p = 0.012), lower but borderline significant employment rates (OR = 0.67, 95% CIs [0.41, 1.09]), and lower but not statistically significant earnings among those who were employed ($2093, p = 0.48), compared to individuals without ED. Among individuals with ED, the presence of mental health comorbidities was associated with higher but not statistically significant health care costs ($1993, p = 0.17), lower borderline significant odds of employment (OR = 0.41, 95% CIs [0.14, 1.20]), and significantly lower earnings ($19,374, p < 0.01). Conclusions Treatment and prevention of ED may have broader economic benefits in terms of heath care savings and gains in work productivity than previously recognized. This exploratory study justifies large scale evaluations of the societal economic impact of eating disorders and comorbidities. Eating disorders were associated with greater health care costs. Eating disorders were associated with lower rates of employment and earnings. Mental health comorbidities contributed substantially to these disparities. Treatment and prevention of ED may have broad economic benefits to society.
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Affiliation(s)
- Mihail Samnaliev
- Clinical Research Center, Boston Children's Hospital, United States
| | | | - Kendrin R Sonneville
- Boston Children's Hospital, Division of Adolescent Medicine, Boston, MA, United States
| | - S Bryn Austin
- Boston Children's Hospital, Division of Adolescent Medicine, Boston, MA, United States
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Cachelin FM, Shea M, Phimphasone P, Wilson GT, Thompson DR, Striegel RH. Culturally adapted cognitive behavioral guided self-help for binge eating: a feasibility study with Mexican Americans. CULTURAL DIVERSITY & ETHNIC MINORITY PSYCHOLOGY 2014; 20:449-457. [PMID: 25045955 PMCID: PMC4107360 DOI: 10.1037/a0035345] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Objective was to test feasibility and preliminary efficacy of a culturally adapted cognitive-behavioral self-help program to treat binge eating and related problems in Mexican Americans. Participants were 31 women recruited from the Los Angeles area and diagnosed with binge eating disorder, recurrent binge eating, or bulimia nervosa. Participants completed a culturally adapted version of a CBT-based self-help program with 8 guidance sessions over a 3-month period. Treatment efficacy was evaluated in terms of binge eating, psychological functioning, and weight loss. Intent-to-treat analyses revealed 35.5% abstinence from binge eating at posttreatment and 38.7% diagnostic remission. Results indicated significant pretreatment to posttreatment improvement on distress level, BMI, eating disorder psychopathology, and self-esteem. Satisfaction with the program was high. Findings demonstrate that the program is acceptable, feasible, and efficacious in reducing binge eating and associated symptoms for Mexican American women. Study provides "proof of concept" for implementation of culturally adapted forms of evidence-based programs.
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Affiliation(s)
- Fary M Cachelin
- Department of Psychology, University of North Carolina at Charlotte
| | - Munyi Shea
- Department of Psychology, California State University
| | | | - G Terence Wilson
- Graduate School of Applied and Professional Psychology, Rutgers, The State University of New Jersey
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Jenkins PE, Luck A, Burrows A, Boughton N. Comparison of face-to-face versus email guided self-help for binge eating: study protocol for a randomised controlled trial. Trials 2014; 15:181. [PMID: 24886555 PMCID: PMC4035724 DOI: 10.1186/1745-6215-15-181] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Accepted: 05/08/2014] [Indexed: 01/18/2023] Open
Abstract
Background Guided self-help is a recommended first-step treatment for bulimia nervosa, binge eating disorder and atypical variants of these disorders. Further research is needed to compare guided self-help that is delivered face-to-face versus via email. Methods/Design This clinical trial uses a randomised, controlled design to investigate the effectiveness of providing guided self-help either face-to-face or via e-mail, also using a delayed treatment control condition. At least 17 individuals are required per group, giving a minimum N of 51. Discussion Symptom outcomes will be assessed and estimates of cost-effectiveness made. Results are proposed to be disseminated locally and internationally (through submission to conferences and peer-reviewed journals), and will hopefully inform local service provision. The trial has been approved by an ethics review board and was registered with ClinicalTrials.gov NCT01832792 on 9 April 2013.
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Affiliation(s)
- Paul E Jenkins
- Cotswold House Eating Disorders Service, Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK.
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48
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Zendegui EA, West JA, Zandberg LJ. Binge eating frequency and regular eating adherence: the role of eating pattern in cognitive behavioral guided self-help. Eat Behav 2014; 15:241-3. [PMID: 24854811 DOI: 10.1016/j.eatbeh.2014.03.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2013] [Revised: 12/24/2013] [Accepted: 03/04/2014] [Indexed: 11/25/2022]
Abstract
Cognitive behavioral guided self-help (CBTgsh) is an evidence-based, brief, and cost-effective treatment for eating disorders characterized by recurrent binge eating. However, more research is needed to improve patient outcomes and clarify treatment components most associated with symptom change. A main component of CBTgsh is establishing a regular pattern of eating to disrupt dietary restriction, which prior research has implicated in the maintenance of binge eating. The present study used session-by-session assessments of regular eating adherence and weekly binge totals to examine the association between binge frequency and regular eating in a sample of participants (n = 38) receiving 10 sessions of CBTgsh for recurrent binge eating. Analyses were conducted using Hierarchical Linear Modeling (HLM) to allow for data nesting, and a likelihood ratio test determined which out of three regression models best fit the data. Results demonstrated that higher regular eating adherence (3 meals and 2-3 planned snacks daily) was associated with lower weekly binge frequency in this sample, and both the magnitude and direction of the association were maintained after accounting for individual participant differences in binge and adherent day totals. Findings provide additional empirical support for the cognitive behavioral model informing CBTgsh. Possible clinical implications for treatment emphasis and sequencing in CBTgsh are discussed.
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Affiliation(s)
- Elaina A Zendegui
- Rutgers, The State University of New Jersey, Graduate School of Applied and Professional Psychology, 41 Gordon Road, Suite C, Piscataway, NJ 08854, USA.
| | - Julia A West
- Rutgers, The State University of New Jersey, Graduate School of Applied and Professional Psychology, 41 Gordon Road, Suite C, Piscataway, NJ 08854, USA.
| | - Laurie J Zandberg
- Rutgers, The State University of New Jersey, Graduate School of Applied and Professional Psychology, 41 Gordon Road, Suite C, Piscataway, NJ 08854, USA.
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49
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Sonntag M, König HH, Konnopka A. The estimation of utility weights in cost-utility analysis for mental disorders: a systematic review. PHARMACOECONOMICS 2013; 31:1131-54. [PMID: 24293216 DOI: 10.1007/s40273-013-0107-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
OBJECTIVE To systematically review approaches and instruments used to derive utility weights in cost-utility analyses (CUAs) within the field of mental disorders and to identify factors that may have influenced the choice of the approach. METHODS We searched the databases DARE (Database of Abstracts of Reviews of Effects), NHS EED (National Health Service Economic Evaluation Database), HTA (Health Technology Assessment), and PubMed for CUAs. Studies were included if they were full economic evaluations and reported quality-adjusted life-years as the health outcome. Study characteristics and instruments used to estimate utility weights were described and a logistic regression analysis was conducted to identify factors associated with the choice of either the direct (e.g. standard gamble) or the preference-based measure (PBM) approach (e.g. EQ-5D). RESULTS We identified 227 CUAs with a maximum in 2009, 2010, and 2012. Most CUAs were conducted in depression, dementia, or psychosis, and came from the US or the UK, with the EQ-5D being the most frequently used instrument. The application of the direct approach was significantly associated with depression, psychosis, and model-based studies. The PBM approach was more likely to be used in recent studies, dementia, Europe, and empirical studies. Utility weights used in model-based studies were derived from only a small number of studies. LIMITATIONS We only searched four databases and did not evaluate the quality of the included studies. CONCLUSIONS Direct instruments and PBMs are used to elicit utility weights in CUAs with different frequencies regarding study type, mental disorder, and country.
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Affiliation(s)
- Michael Sonntag
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany,
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Rosenbaum DL, White KS. The Role of Anxiety in Binge Eating Behavior: A Critical Examination of Theory and Empirical Literature. Health Psychol Res 2013; 1:e19. [PMID: 26973904 PMCID: PMC4768578 DOI: 10.4081/hpr.2013.e19] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Revised: 01/03/2013] [Accepted: 01/04/2013] [Indexed: 11/23/2022] Open
Abstract
The purpose of this manuscript is to expand the understanding of binge eating by reviewing the role of aspects of negative affect. Specifically, this paper will present evidence for further investigation of the bearing that anxiety may have in binge eating development and maintenance. A comprehensive review of the literature regarding the relation of binge eating and anxiety was performed. Valuable contributions have been made to the binge eating literature regarding some aspects of negative affect (i.e., depression); however, outside of bulimia nervosa studies, much of the theoretical and empirical binge eating research to date has not directly addressed the role of anxiety. Research supports expansion of investigations of negative emotionality and binge eating to include specific study of anxiety. Greater inclusivity and specificity in the unique contributions of various negative emotions may further the development of temporal models and intervention efforts.
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Affiliation(s)
- Diane L Rosenbaum
- Department of Psychology, University of Missouri - Saint Louis , St. Louis, MO, USA
| | - Kamila S White
- Department of Psychology, University of Missouri - Saint Louis , St. Louis, MO, USA
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