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Holgersen G, Abdi-Dezfuli SE, Friis Darrud S, Stornes Espeset EM, Bircow Elgen I, Nordgreen T. Adolescents' perspectives on a novel digital treatment targeting eating disorders: a qualitative study. BMC Psychiatry 2024; 24:423. [PMID: 38840080 PMCID: PMC11155031 DOI: 10.1186/s12888-024-05866-1] [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: 02/08/2024] [Accepted: 05/26/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND Eating disorders in adolescence are associated with high psychological distress, impaired function and high comorbidity. Despite the severity, eating disorders remain highly underdiagnosed and untreated. Digital technology provides promising opportunities for treatment, however studies focusing on digital treatments for adolescents with eating disorders are lacking. The main aim of this study was to explore the perspectives of adolescents with lived experience of eating disorders on factors they deemed to be relevant in the development of a novel digital treatment. METHODS A qualitative intervention development study using semi-structured individual interviews. Data collection, coding and analysis were conducted using the principles of reflexive thematic analysis. Participants were adolescents aged 16-19 years, with a self-reported diagnosis of anorexia nervosa, bulimia nervosa or binge eating disorder, currently in the final phase or completed psychological treatment for an eating disorder within the last five years. RESULTS A total of 16 adolescents participated in the study, all females. Mean age was 17 ½ years (SD = 1.01). An in-depth understanding of the adolescents' perspectives was developed into three themes: Facilitating self-awareness and readiness to change; Strengthening interpersonal relationships and decreasing social isolation; Ensuring feeling seen and motivating regular use. CONCLUSIONS This study provides a unique insight into the perspectives of adolescents with lived experience of eating disorders. The uptake and engagement can be optimized in a novel digital treatment for eating disorders by taking the adolescents perspectives into consideration.
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Affiliation(s)
- Guri Holgersen
- Division of Psychiatry, Haukeland University Hospital, Post OfficeBox 1400, Bergen, N-5021, Norway.
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
| | | | | | | | - Irene Bircow Elgen
- Division of Psychiatry, Haukeland University Hospital, Post OfficeBox 1400, Bergen, N-5021, Norway
- Department of Child and Adolescent Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Tine Nordgreen
- Division of Psychiatry, Haukeland University Hospital, Post OfficeBox 1400, Bergen, N-5021, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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Dalton B, Davies MR, Flynn M, Hutchings-Hay C, Potterton R, Breen O'Byrne E, Kilonzo C, Belli SR, Gallop L, Gordon G, Keeler J, Minnock I, Phillips M, Robinson L, Snashall E, Toloza C, Walo L, Cole J, Schmidt U. Virtually delivered guided self-help for binge eating disorder and bulimia nervosa: findings from a service evaluation. Behav Cogn Psychother 2024; 52:211-225. [PMID: 38263907 DOI: 10.1017/s1352465823000607] [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: 01/25/2024]
Abstract
BACKGROUND Timely intervention is beneficial to the effectiveness of eating disorder (ED) treatment, but limited capacity within ED services means that these disorders are often not treated with sufficient speed. This service evaluation extends previous research into guided self-help (GSH) for adults with bulimic spectrum EDs by assessing the feasibility, acceptability, and preliminary effectiveness of virtually delivered GSH using videoconferencing. METHOD Patients with bulimia nervosa (BN), binge eating disorder (BED) and other specified feeding and eating disorders (OSFED) waiting for treatment in a large specialist adult ED out-patient service were offered virtually delivered GSH. The programme used an evidence-based cognitive behavioural self-help book. Individuals were supported by non-expert coaches, who delivered the eight-session programme via videoconferencing. RESULTS One hundred and thirty patients were allocated to a GSH coach between 1 September 2020 and 30 September 2022; 106 (82%) started treatment and 78 (60%) completed treatment. Amongst completers, there were large reductions in ED behaviours and attitudinal symptoms, measured by the ED-15. The largest effect sizes for change between pre- and post-treatment were seen for binge eating episode frequency (d = -0.89) and concerns around eating (d = -1.72). Patients from minoritised ethnic groups were over-represented in the non-completer group. CONCLUSIONS Virtually delivered GSH is feasible, acceptable and effective in reducing ED symptoms amongst those with bulimic spectrum disorders. Implementing virtually delivered GSH reduced waiting times, offering a potential solution for long waiting times for ED treatment. Further research is needed to compare GSH to other brief therapies and investigate barriers for patients from culturally diverse groups.
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Affiliation(s)
- Bethan Dalton
- South London and Maudsley NHS Foundation Trust, Maudsley Hospital, Denmark Hill, London, UK
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Molly R Davies
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Michaela Flynn
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Chloe Hutchings-Hay
- South London and Maudsley NHS Foundation Trust, Maudsley Hospital, Denmark Hill, London, UK
| | - Rachel Potterton
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Eleanor Breen O'Byrne
- South London and Maudsley NHS Foundation Trust, Maudsley Hospital, Denmark Hill, London, UK
| | - Charmaine Kilonzo
- South London and Maudsley NHS Foundation Trust, Maudsley Hospital, Denmark Hill, London, UK
| | - Stefano R Belli
- South London and Maudsley NHS Foundation Trust, Maudsley Hospital, Denmark Hill, London, UK
| | - Lucy Gallop
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Gemma Gordon
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Johanna Keeler
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Imelda Minnock
- South London and Maudsley NHS Foundation Trust, Maudsley Hospital, Denmark Hill, London, UK
| | - Matthew Phillips
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Lauren Robinson
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Emma Snashall
- South London and Maudsley NHS Foundation Trust, Maudsley Hospital, Denmark Hill, London, UK
| | - Cindy Toloza
- South London and Maudsley NHS Foundation Trust, Maudsley Hospital, Denmark Hill, London, UK
| | - Luiza Walo
- South London and Maudsley NHS Foundation Trust, Maudsley Hospital, Denmark Hill, London, UK
| | - Jason Cole
- South London and Maudsley NHS Foundation Trust, Maudsley Hospital, Denmark Hill, London, UK
| | - Ulrike Schmidt
- South London and Maudsley NHS Foundation Trust, Maudsley Hospital, Denmark Hill, London, UK
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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Mayer G, Lemmer D, Michelsen I, Schrader P, Friederich HC, Bauer S. Views of German mental health professionals on the use of digital mental health interventions for eating disorders: a qualitative interview study. J Eat Disord 2024; 12:32. [PMID: 38395950 PMCID: PMC10885453 DOI: 10.1186/s40337-024-00978-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 01/21/2024] [Indexed: 02/25/2024] Open
Abstract
INTRODUCTION Digital mental health interventions (DMHIs) are getting increasingly important for mental health care. In the case of eating disorders (EDs), DMHIs are still in early stages. Few studies so far investigated the views of mental health professionals for EDs on the integration of DMHIs in routine care. OBJECTIVE To gain insights into the experiences, perspectives, and expectations of mental health professionals for EDs regarding DMHIs and to identify requirements for the future integration of DMHIs into routine care. METHODS Semi-structured qualitative telephone interviews with 24 German mental health professionals treating patients with EDs were conducted. A content analysis following a deductive-inductive approach asked for experiences, advantages and chances, disadvantages and boundaries, desired functions and properties, target groups, and general conditions and requirements for DMHIs for patients with EDs. RESULTS Only few professionals reported experiences with DMHIs besides video-based psychotherapy during the pandemic. From the therapists' point of view, DMHIs have the potential to deliver low-threshold access for patients with EDs. Useful functionalities were seen in digital meal records, skills training, and psychoeducation. However, a stable therapeutic alliance was reported as an important prerequisite for the successful integration into care. Therapists expressed concerns in case of severe anorexia nervosa or suicidality. The participants felt to be informed inadequately on recent developments and on the evidence base of DMHIs. CONCLUSIONS Mental health professionals for EDs show positive attitudes towards DMHIs, however many barriers to the integration in routine care were observed. The highest potential was seen for the use of DMHIs in addition to outpatient care and in aftercare. Specific requirements for DMHIs are related to different areas of the healthcare spectrum and for the different symptom profiles in anorexia nervosa, bulimia nervosa and binge eating disorder. Targeted DMHIs are needed and appropriate especially for concepts of blended care.
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Affiliation(s)
- Gwendolyn Mayer
- Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
| | - Diana Lemmer
- Center for Psychotherapy Research, Heidelberg University Hospital, Bergheimer Str. 54, 69115, Heidelberg, Germany
| | - Ina Michelsen
- Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Pauline Schrader
- Center for Psychotherapy Research, Heidelberg University Hospital, Bergheimer Str. 54, 69115, Heidelberg, Germany
| | - Hans-Christoph Friederich
- Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
- German Center for Mental Health (DZPG), partner site Mannheim/Heidelberg/Ulm, Germany
| | - Stephanie Bauer
- Center for Psychotherapy Research, Heidelberg University Hospital, Bergheimer Str. 54, 69115, Heidelberg, Germany
- German Center for Mental Health (DZPG), partner site Mannheim/Heidelberg/Ulm, Germany
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Booij L, Israël M, Ferrari M, St-Hilaire A, Paquin-Hodge C, Allard M, Blaquière A, Dornik J, Freiwald S, Long SA, Monarque M, Pelletier WD, Thaler L, Yaffe M, Steiger H. Development of a transdiagnostic digital interactive application for eating disorders: psychometric properties, satisfaction, and perceptions on implementation in clinical practice. J Eat Disord 2023; 11:146. [PMID: 37644511 PMCID: PMC10466831 DOI: 10.1186/s40337-023-00871-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 08/15/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Given limited availability of informed treatments for people affected by eating disorders (EDs), there has been increasing interest in developing self-administered, technology-based ED interventions. However, many available interventions are limited to a specific ED diagnosis or assume that participants are ready to change. We developed a digital self-help application (called ASTrA) that was explicitly designed to be transdiagnostic and to help increase motivation for change. The aim of the present study was to describe the development and examine the psychometric properties, user satisfaction and rated potentials for practical use of our application. METHODS The content of our application was based on concepts derived from self-determination theory, the transtheoretical model of change, and cognitive theory. The application was developed by a multidisciplinary team of clinicians, researchers, staff members and individuals with lived ED experience, each being involved in all steps of the application's development. We tested validity, reliability, satisfaction and perceived feasibility for clinical implementation in an independent sample of 15 patients with an ED and 13 clinicians specialized in ED treatment. Psychometric properties were evaluated using descriptive statistics, correlations, content validity indices and intraclass coefficients. Differences in satisfaction ratings and perceived potential for clinical implementation of the application between clinicians and patients were examined using Mann-Whitney U tests. RESULTS The digital application showed excellent validity (mean i-CVI: .93, range: .86-.96) and internal reliability (all Cronbach alpha's > .88). Patients and clinicians both considered the application acceptable, appropriate, and feasible for use in clinical practice. CONCLUSIONS Findings suggest that our transdiagnostic interactive application has excellent psychometric properties. Furthermore, patients and clinicians alike were positive about the possible use of the application in clinical practice. The next step will be to investigate the application's effectiveness as an intervention to promote autonomous motivation and to facilitate remission in people on the waitlist for specialized ED treatment.
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Affiliation(s)
- Linda Booij
- Eating Disorders Continuum, Douglas Mental Health University Institute, Montreal West Island Integrated University Health and Social Service Centre, 6603-05 LaSalle Blvd, Montreal, QC, H4H 1R3, Canada.
- Department of Psychiatry, McGill University, Montreal, Canada.
- Research Centre, Douglas Mental Health University Institute, Montreal, Canada.
| | - Mimi Israël
- Eating Disorders Continuum, Douglas Mental Health University Institute, Montreal West Island Integrated University Health and Social Service Centre, 6603-05 LaSalle Blvd, Montreal, QC, H4H 1R3, Canada
- Department of Psychiatry, McGill University, Montreal, Canada
- Research Centre, Douglas Mental Health University Institute, Montreal, Canada
| | - Manuela Ferrari
- Department of Psychiatry, McGill University, Montreal, Canada
- Research Centre, Douglas Mental Health University Institute, Montreal, Canada
| | - Annie St-Hilaire
- Eating Disorders Continuum, Douglas Mental Health University Institute, Montreal West Island Integrated University Health and Social Service Centre, 6603-05 LaSalle Blvd, Montreal, QC, H4H 1R3, Canada
- Department of Psychiatry, McGill University, Montreal, Canada
- Research Centre, Douglas Mental Health University Institute, Montreal, Canada
| | - Chloé Paquin-Hodge
- Eating Disorders Continuum, Douglas Mental Health University Institute, Montreal West Island Integrated University Health and Social Service Centre, 6603-05 LaSalle Blvd, Montreal, QC, H4H 1R3, Canada
- Department of Psychiatry, McGill University, Montreal, Canada
- Research Centre, Douglas Mental Health University Institute, Montreal, Canada
| | - Melissa Allard
- Eating Disorders Continuum, Douglas Mental Health University Institute, Montreal West Island Integrated University Health and Social Service Centre, 6603-05 LaSalle Blvd, Montreal, QC, H4H 1R3, Canada
| | - Amélie Blaquière
- Eating Disorders Continuum, Douglas Mental Health University Institute, Montreal West Island Integrated University Health and Social Service Centre, 6603-05 LaSalle Blvd, Montreal, QC, H4H 1R3, Canada
| | - Julia Dornik
- Eating Disorders Continuum, Douglas Mental Health University Institute, Montreal West Island Integrated University Health and Social Service Centre, 6603-05 LaSalle Blvd, Montreal, QC, H4H 1R3, Canada
- Department of Psychiatry, McGill University, Montreal, Canada
| | - Shiri Freiwald
- Eating Disorders Continuum, Douglas Mental Health University Institute, Montreal West Island Integrated University Health and Social Service Centre, 6603-05 LaSalle Blvd, Montreal, QC, H4H 1R3, Canada
| | - Shawna A Long
- Eating Disorders Continuum, Douglas Mental Health University Institute, Montreal West Island Integrated University Health and Social Service Centre, 6603-05 LaSalle Blvd, Montreal, QC, H4H 1R3, Canada
| | - Marika Monarque
- Research Centre, Douglas Mental Health University Institute, Montreal, Canada
| | - William D Pelletier
- Eating Disorders Continuum, Douglas Mental Health University Institute, Montreal West Island Integrated University Health and Social Service Centre, 6603-05 LaSalle Blvd, Montreal, QC, H4H 1R3, Canada
- Department of Psychiatry, McGill University, Montreal, Canada
| | - Lea Thaler
- Eating Disorders Continuum, Douglas Mental Health University Institute, Montreal West Island Integrated University Health and Social Service Centre, 6603-05 LaSalle Blvd, Montreal, QC, H4H 1R3, Canada
- Department of Psychiatry, McGill University, Montreal, Canada
- Research Centre, Douglas Mental Health University Institute, Montreal, Canada
| | - Miriam Yaffe
- Eating Disorders Continuum, Douglas Mental Health University Institute, Montreal West Island Integrated University Health and Social Service Centre, 6603-05 LaSalle Blvd, Montreal, QC, H4H 1R3, Canada
| | - Howard Steiger
- Eating Disorders Continuum, Douglas Mental Health University Institute, Montreal West Island Integrated University Health and Social Service Centre, 6603-05 LaSalle Blvd, Montreal, QC, H4H 1R3, Canada.
- Department of Psychiatry, McGill University, Montreal, Canada.
- Research Centre, Douglas Mental Health University Institute, Montreal, Canada.
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Clemente-Suárez VJ, Ramírez-Goerke MI, Redondo-Flórez L, Beltrán-Velasco AI, Martín-Rodríguez A, Ramos-Campo DJ, Navarro-Jiménez E, Yáñez-Sepúlveda R, Tornero-Aguilera JF. The Impact of Anorexia Nervosa and the Basis for Non-Pharmacological Interventions. Nutrients 2023; 15:2594. [PMID: 37299557 PMCID: PMC10255390 DOI: 10.3390/nu15112594] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 05/29/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023] Open
Abstract
Anorexia nervosa is a psychiatric disorder with an unknown etiology that is characterized by an individual's preoccupation with their weight and body structure while denying the severity of their low body weight. Due to the fact that anorexia nervosa is multifaceted and may indicate the coexistence of genetic, social, hormonal, and psychiatric disorders, a description of non-pharmacological interventions can be used to ameliorate or reduce the symptoms of this condition. Consequently, the purpose of the present narrative review is to describe the profile's context in the anorexic person as well as the support they would require from their family and environment. In addition, it is aimed at examining preventative and non-pharmacological interventions, such as nutritional interventions, physical activity interventions, psychological interventions, psychosocial interventions, and physical therapy interventions. To reach the narrative review aims, a critical review was conducted utilizing both primary sources, such as scientific publications, and secondary sources, such as bibliographic indexes, web pages, and databases. Nutritional interventions include nutritional education and an individualized treatment for each patient, physical activity interventions include allowing patients to perform controlled physical activity, psychological interventions include family therapy and evaluation of the existence of other psychological disorders, psychosocial interventions include management of the relationship between the patient and social media and physical therapy interventions include relaxation massages and exercises to relieve pain. All these non-pharmacological interventions need to be individualized based on each patient's needs.
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Affiliation(s)
- Vicente Javier Clemente-Suárez
- Faculty of Sports Sciences, Universidad Europea de Madrid, Tajo Street, s/n, 28670 Madrid, Spain; (V.J.C.-S.); (M.I.R.-G.); (J.F.T.-A.)
| | - Maria Isabel Ramírez-Goerke
- Faculty of Sports Sciences, Universidad Europea de Madrid, Tajo Street, s/n, 28670 Madrid, Spain; (V.J.C.-S.); (M.I.R.-G.); (J.F.T.-A.)
| | - Laura Redondo-Flórez
- Department of Health Sciences, Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, C/Tajo s/n, Villaviciosa de Odón, 28670 Madrid, Spain;
| | - Ana Isabel Beltrán-Velasco
- Psychology Department, Facultad de Ciencias de la Vida y la Naturaleza, Universidad Antonio de Nebrija, 28240 Madrid, Spain;
| | - Alexandra Martín-Rodríguez
- Faculty of Sports Sciences, Universidad Europea de Madrid, Tajo Street, s/n, 28670 Madrid, Spain; (V.J.C.-S.); (M.I.R.-G.); (J.F.T.-A.)
| | - Domingo Jesús Ramos-Campo
- LFE Research Group, Department of Health and Human Performance, Faculty of Physical Activity and Sport Science-INEF, Universidad Politécnica de Madrid, 28040 Madrid, Spain
| | | | - Rodrigo Yáñez-Sepúlveda
- Faculty of Education and Social Sciences, Universidad Andres Bello, Viña del Mar 2520000, Chile;
| | - José Francisco Tornero-Aguilera
- Faculty of Sports Sciences, Universidad Europea de Madrid, Tajo Street, s/n, 28670 Madrid, Spain; (V.J.C.-S.); (M.I.R.-G.); (J.F.T.-A.)
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