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Klooster IT, Kip H, van Gemert-Pijnen L, Crutzen R, Kelders S. A systematic review on eHealth technology personalization approaches. iScience 2024; 27:110771. [PMID: 39290843 PMCID: PMC11406103 DOI: 10.1016/j.isci.2024.110771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 03/05/2024] [Accepted: 08/15/2024] [Indexed: 09/19/2024] Open
Abstract
Despite the widespread use of personalization of eHealth technologies, there is a lack of comprehensive understanding regarding its application. This systematic review aims to bridge this gap by identifying and clustering different personalization approaches based on the type of variables used for user segmentation and the adaptations to the eHealth technology and examining the role of computational methods in the literature. From the 412 included reports, we identified 13 clusters of personalization approaches, such as behavior + channeling and environment + recommendations. Within these clusters, 10 computational methods were utilized to match segments with technology adaptations, such as classification-based methods and reinforcement learning. Several gaps were identified in the literature, such as the limited exploration of technology-related variables, the limited focus on user interaction reminders, and a frequent reliance on a single type of variable for personalization. Future research should explore leveraging technology-specific features to attain individualistic segmentation approaches.
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Affiliation(s)
- Iris Ten Klooster
- Centre for eHealth and Wellbeing Research, Department of Psychology, Health, and Technology, University of Twente, Enschede, The Netherlands
| | - Hanneke Kip
- Centre for eHealth and Wellbeing Research, Department of Psychology, Health, and Technology, University of Twente, Enschede, The Netherlands
- Department of Research, Stichting Transfore, Deventer, the Netherlands
| | - Lisette van Gemert-Pijnen
- Centre for eHealth and Wellbeing Research, Department of Psychology, Health, and Technology, University of Twente, Enschede, The Netherlands
| | - Rik Crutzen
- Department of Health Promotion, Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Saskia Kelders
- Centre for eHealth and Wellbeing Research, Department of Psychology, Health, and Technology, University of Twente, Enschede, The Netherlands
- Optentia Research Focus Area, North-West University, Vaal Triangle Campus, Vanderbijlpark, South Africa
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Mitlash A, Rapsey C, Treharne GJ, Scarf D. Adapting an Online Guided Self-Help CBT Programme Targeting Disordered Eating for Students in Aotearoa New Zealand: A Qualitative Study. Nutrients 2024; 16:2905. [PMID: 39275221 PMCID: PMC11396848 DOI: 10.3390/nu16172905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2024] [Revised: 08/21/2024] [Accepted: 08/27/2024] [Indexed: 09/16/2024] Open
Abstract
Disordered eating is a significant issue in university student populations. Currently, access to interventions is limited. Online interventions present an innovative way to increase accessibility to treatment for those in need. The current study explored how an online intervention for disordered eating (everyBody) could be modified to suit the needs of university students in Aotearoa New Zealand. Aotearoa New Zealand is a unique cultural context, with an indigenous population that has a high incidence rate of disordered eating, highlighting the need to adapt everyBody to the local context. Individual interviews were conducted with nine students currently at university in Aotearoa New Zealand, aged between 18 and 33 years old (five females, four males). Three first-order themes were identified using template analysis. The themes indicate that participants perceived the programme as acceptable and feasible for use with Aotearoa New Zealand's university student population. Furthermore, the themes provide insight into potential adaptions to the programme to facilitate engagement and uptake. The suggested changes were largely consistent with previous research on E-therapy design (e.g., content length, therapeutic alliance), and also highlight changes specific to fit Aotearoa New Zealand's cultural context. The findings have implications for universities and other funders deciding on services for students with disordered eating and eating disorders.
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Affiliation(s)
- Alisa Mitlash
- Department of Psychology, University of Otago, P.O. Box 56, Dunedin 9054, New Zealand
| | - Charlene Rapsey
- Department of Psychological Medicine, Otago Medical School, P.O. Box 56, Dunedin 9054, New Zealand
| | - Gareth J Treharne
- Department of Psychology, University of Otago, P.O. Box 56, Dunedin 9054, New Zealand
| | - Damian Scarf
- Department of Psychology, University of Otago, P.O. Box 56, Dunedin 9054, New Zealand
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Thomas PC, Curtis K, Potts HWW, Bark P, Perowne R, Rookes T, Rowe S. Behavior Change Techniques Within Digital Interventions for the Treatment of Eating Disorders: Systematic Review and Meta-Analysis. JMIR Ment Health 2024; 11:e57577. [PMID: 39088817 PMCID: PMC11327638 DOI: 10.2196/57577] [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: 02/20/2024] [Revised: 05/23/2024] [Accepted: 05/25/2024] [Indexed: 08/03/2024] Open
Abstract
BACKGROUND Previous systematic reviews of digital eating disorder interventions have demonstrated effectiveness at improving symptoms of eating disorders; however, our understanding of how these interventions work and what contributes to their effectiveness is limited. Understanding the behavior change techniques (BCTs) that are most commonly included within effective interventions may provide valuable information for researchers and developers. Establishing whether these techniques have been informed by theory will identify whether they target those mechanisms of action that have been identified as core to changing eating disorder behaviors. It will also evaluate the importance of a theoretical approach to digital intervention design. OBJECTIVE This study aims to define the BCTs within digital self-management interventions or minimally guided self-help interventions for adults with eating disorders that have been evaluated within randomized controlled trials. It also assessed which of the digital interventions were grounded in theory and the range of modes of delivery included. METHODS A literature search identified randomized controlled trials of digital intervention for the treatment of adults with eating disorders with minimal therapist support. Each digital intervention was coded for BCTs using the established BCT Taxonomy v1; for the application of theory using an adapted version of the theory coding scheme (TCS); and for modes of delivery using the Mode of Delivery Ontology. A meta-analysis evaluated the evidence that any individual BCT moderated effect size or that other potential factors such as the application of theory or number of modes of delivery had an effect on eating disorder outcomes. RESULTS Digital interventions included an average of 14 (SD 2.6; range 9-18) BCTs. Self-monitoring of behavior was included in all effective interventions, with Problem-solving, Information about antecedents, Feedback on behavior, Self-monitoring of outcomes of behavior, and Action planning identified in >75% (13/17) of effective interventions. Social support and Information about health consequences were more evident in effective interventions at follow-up compared with postintervention measurement. The mean number of modes of delivery was 4 (SD 1.6; range 2-7) out of 12 possible modes, with most interventions (15/17, 88%) being web based. Digital interventions that had a higher score on the TCS had a greater effect size than those with a lower TCS score (subgroup differences: χ21=9.7; P=.002; I²=89.7%) within the meta-analysis. No other subgroup analyses had statistically significant results. CONCLUSIONS There was a high level of consistency in terms of the most common BCTs within effective interventions; however, there was no evidence that any specific BCT contributed to intervention efficacy. The interventions that were more strongly informed by theory demonstrated greater improvements in eating disorder outcomes compared to waitlist or treatment-as-usual controls. These results can be used to inform the development of future digital eating disorder interventions. TRIAL REGISTRATION PROSPERO CRD42023410060; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=410060.
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Affiliation(s)
- Pamela Carien Thomas
- Department of Epidemiology & Applied Clinical Research, Division of Psychiatry, University College London, London, United Kingdom
| | - Kristina Curtis
- Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
| | - Henry W W Potts
- UCL Institute of Health Informatics, University College London, London, United Kingdom
| | - Pippa Bark
- UCL Cancer Institute, University College London, London, United Kingdom
| | - Rachel Perowne
- Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
| | - Tasmin Rookes
- UCL Research Department of Primary Care and Population Health, University College London, London, United Kingdom
| | - Sarah Rowe
- Department of Epidemiology & Applied Clinical Research, Division of Psychiatry, University College London, London, United Kingdom
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Messer M, Fuller-Tyszkiewicz M, Liu C, Anderson C, Linardon J. A randomized controlled trial of an online single session intervention for body image in individuals with recurrent binge eating. Int J Eat Disord 2024; 57:1668-1679. [PMID: 38619359 DOI: 10.1002/eat.24213] [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: 02/09/2024] [Revised: 03/27/2024] [Accepted: 03/28/2024] [Indexed: 04/16/2024]
Abstract
OBJECTIVE Theoretical models highlight body image disturbances as central to the maintenance of eating disorders, with empirical evidence finding negative body image to be a robust predictor of treatment nonresponse, relapse and symptom persistence. Accessible, scalable, and inexpensive interventions that can effectively target negative body image across the eating disorders are needed. We developed an online single session intervention (SSI) for negative body image and evaluated its acceptability and efficacy in a randomized controlled trial in individuals with recurrent binge eating. METHOD Participants with recurrent binge eating were randomly assigned to the SSI (n = 99) or a waitlist (n = 101). Assessments were conducted at baseline, 4 week follow-up, and 8 week follow-up. RESULTS 81% of participants accessed the SSI, demonstrating reasonable uptake. However, issues with attrition were apparent; a 32% study dropout rate was observed at posttest, while a 58% dropout rate was observed at follow-up. 87% of participants who completed satisfaction measures would recommend the SSI. SSI participants experienced greater improvements in negative body image at both 4 (d = -0.65) and 8 week (d = -0.74) follow-up. Significant between-group effects were also observed on most other secondary symptom measures, though no differences were found for motivations and help-seeking beliefs and intentions. CONCLUSION Body image-focused self-guided SSIs for recurrent binge are largely accepted by those who are retained in the trial, but are associated with significant attrition. Although SSIs are not intended to replace standard treatment, they may help with short-term symptom management and could play an important role in eating disorder care. PUBLIC SIGNIFICANCE Single session interventions (SSI) are a potentially accessible, scalable, and cost-effective way to deliver evidence-based treatment content to people with eating disorders. This study shows that an online (SSI) designed to target body image among people with recurrent binge eating is accepted and produced short-term symptom relief.
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Affiliation(s)
- Mariel Messer
- School of Psychology, Deakin University, Geelong, Victoria, Australia
| | - Matthew Fuller-Tyszkiewicz
- School of Psychology, Deakin University, Geelong, Victoria, Australia
- Center for Social and Early Emotional Development, Deakin University, Burwood, Victoria, Australia
| | - Claudia Liu
- School of Psychology, Deakin University, Geelong, Victoria, Australia
| | - Cleo Anderson
- School of Psychology, Deakin University, Geelong, Victoria, Australia
| | - Jake Linardon
- School of Psychology, Deakin University, Geelong, Victoria, Australia
- Center for Social and Early Emotional Development, Deakin University, Burwood, Victoria, Australia
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Kasson E, Szlyk HS, Li X, Constantino-Pettit A, Smith AC, Vázquez MM, Wilfley DE, Taylor CB, Fitzsimmons-Craft EE, Cavazos-Rehg P. Eating disorder symptoms and comorbid mental health risk among teens recruited to a digital intervention research study via two online approaches. Int J Eat Disord 2024; 57:1518-1531. [PMID: 38445416 PMCID: PMC11262972 DOI: 10.1002/eat.24186] [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: 09/08/2023] [Revised: 02/21/2024] [Accepted: 02/22/2024] [Indexed: 03/07/2024]
Abstract
INTRODUCTION It is crucial to identify and evaluate feasible, proactive ways to reach teens with eating disorders (EDs) who may not otherwise have access to screening or treatment. This study aimed to explore the feasibility of recruiting teens with EDs to a digital intervention study via social media and a publicly available online ED screen, and to compare the characteristics of teens recruited by each approach in an exploratory fashion. METHOD Teens aged 14-17 years old who screened positive for a clinical/subclinical ED or at risk for an ED and who were not currently in ED treatment completed a baseline survey to assess current ED symptoms, mental health comorbidities, and barriers to treatment. Bivariate analyses were conducted to examine differences between participants recruited via social media and those recruited after completion of a widely available online EDs screen (i.e., National Eating Disorders Association [NEDA] screen). RESULTS Recruitment of teens with EDs using the two online approaches was found to be feasible, with 934 screens completed and a total of 134 teens enrolled over 6 months: 77% (n = 103) via social media 23% (n = 31) via the NEDA screen. Mean age of participants (N = 134) was 16 years old, with 49% (n = 66) identifying as non-White, and 70% (n = 94) identifying as a gender and/or sexual minority. Teens from NEDA reported higher ED psychopathology scores (medium effect size) and more frequent self-induced vomiting and driven exercise (small effect sizes). Teens from NEDA also endorsed more barriers to treatment, including not feeling ready for treatment and not knowing where to find a counselor or other resources (small effect sizes). DISCUSSION Online recruitment approaches in this study reached a large number of teens with an interest in a digital intervention to support ED recovery, demonstrating the feasibility of these outreach methods. Both approaches reached teens with similar demographic characteristics; however, teens recruited from NEDA reported higher ED symptom severity and barriers to treatment. Findings suggest that proactive assessment and intervention methods should be developed and tailored to meet the needs of each of these groups. PUBLIC SIGNIFICANCE This study examined the feasibility of recruiting teens with EDs to a digital intervention research study via social media and NEDA's online screen, and demonstrated differences in ED symptoms among participants by recruitment approach.
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Affiliation(s)
- Erin Kasson
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Hannah S Szlyk
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Xiao Li
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Anna Constantino-Pettit
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Arielle C Smith
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Melissa M Vázquez
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Denise E Wilfley
- Department of Psychology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - C Barr Taylor
- Department of Psychiatry and Behavioral Science, Stanford University School of Medicine, Stanford, California, USA
- Center for m2Health, Palo Alto University, Palo Alto, California, USA
| | | | - Patricia Cavazos-Rehg
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
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Lock J. Improving Access to Evidence-Based Treatments for Eating Disorders Among Youths: Where We are as a Field. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2024; 22:342-343. [PMID: 38988460 PMCID: PMC11231476 DOI: 10.1176/appi.focus.20230033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Subscribe] [Scholar Register] [Indexed: 07/12/2024]
Affiliation(s)
- James Lock
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
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Corberán M, Arnáez S, Saman Y, Pascual-Vera B, García-Soriano G, Roncero M. Cognitive training via mobile app for addressing eating disorders' cognitions in adolescents: a randomized control trial protocol. BMC Psychol 2024; 12:268. [PMID: 38745260 PMCID: PMC11092152 DOI: 10.1186/s40359-024-01772-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Accepted: 05/08/2024] [Indexed: 05/16/2024] Open
Abstract
During adolescence, individuals are particularly vulnerable to developing eating disorders (EDs). To address the dysfunctional beliefs linked to these disorders, a new mobile app has been developed. This app, called GG eating disorders-Adolescents (GGED-AD), was created based on CBT to help adolescents work on their self-dialogue related to the core beliefs of eating disorders. The objective is to present the protocol for a randomized controlled trial to explore the efficacy of GGED-AD.Methods The study will be carried out in adolescents aged 13 to 16 from an educational center in the Valencian Community. The participants will be randomized into two groups: the experimental group will use the GGED-AD app during 14 consecutive days for approximately 5 min each day; and the control group will use a neutral app (GGNEUTRAL) during the same time. Both groups will complete instruments that assess dysfunctional beliefs related to eating disorders, eating symptoms, symptoms of depression and anxiety, body satisfaction and self-esteem before and after the intervention. A follow-up will be conducted one month later.Results A decrease in the degree of ascription to dysfunctional beliefs associated with eating disorders and eating symptomatology is expected, as well as an increase in body satisfaction and the self-esteem of the participants of the experimental group.Discussion The app in this study could help tackle and prevent ED-related symptoms in adolescents.Trial registration NCT06039514.
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Affiliation(s)
- Marta Corberán
- Departamento de Personalidad, Evaluación y Tratamientos Psicológicos. Facultad de Psicología y Logopedia, Universitat de València, Av. Blasco Ibañez, 21, Valencia, 46010, Spain
| | - Sandra Arnáez
- Departamento de Personalidad, Evaluación y Tratamientos Psicológicos. Facultad de Psicología y Logopedia, Universitat de València, Av. Blasco Ibañez, 21, Valencia, 46010, Spain
| | - Yuliya Saman
- Departamento de Personalidad, Evaluación y Tratamientos Psicológicos. Facultad de Psicología y Logopedia, Universitat de València, Av. Blasco Ibañez, 21, Valencia, 46010, Spain
| | - Belén Pascual-Vera
- Departamento Departamento de Personalidad, Evaluación y Tratamientos Psicológicos, Facultad de Psicología, UNED, C/Juan Rosal, 10, Madrid, 28040, Spain
| | - Gemma García-Soriano
- Departamento de Personalidad, Evaluación y Tratamientos Psicológicos. Facultad de Psicología y Logopedia, Universitat de València, Av. Blasco Ibañez, 21, Valencia, 46010, Spain
| | - María Roncero
- Departamento de Personalidad, Evaluación y Tratamientos Psicológicos. Facultad de Psicología y Logopedia, Universitat de València, Av. Blasco Ibañez, 21, Valencia, 46010, Spain.
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McClure Z, Fuller-Tyszkiewicz M, Messer M, Linardon J. Predictors, mediators, and moderators of response to digital interventions for eating disorders: A systematic review. Int J Eat Disord 2024; 57:1034-1048. [PMID: 37886906 DOI: 10.1002/eat.24078] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 10/05/2023] [Accepted: 10/06/2023] [Indexed: 10/28/2023]
Abstract
OBJECTIVE Digital interventions show promise as an effective prevention or self-management option for eating disorders (EDs). However, it remains unclear how, for whom, and through what mechanisms they work in this population, as a synthesis of outcome predictors, moderators, and mediators is lacking. This systematic review synthesized empirical research investigating predictors, mediators, and moderators of response to digital interventions for EDs. METHOD Six databases were searched (PROSPERO CRD42022295565) for studies that assessed predictors, moderators, or mediators of response (i.e., uptake, drop-out, engagement, and symptom level change) to a digital prevention or treatment program for EDs. Variables were grouped into several overarching categories (demographic, symptom severity, psychological, etc.) and were synthesized qualitatively across samples without a formally diagnosed ED (typically prevention-focused) and samples with a formally diagnosed ED (typically treatment-focused). RESULTS Eighty-six studies were included. For studies recruiting samples without a formal diagnosis (n = 70 studies), most predictors explored were statistically unrelated to outcome, although participant age, baseline symptom severity, confidence to change, motivation, and program engagement showed preliminary evidence of prognostic potential. No robust moderators or mediators were identified. Few studies recruiting samples with a formal diagnosis emerged (n = 16), of which no reliable predictors, moderators, or mediators were identified. DISCUSSION It remains unclear how, for whom, and under what circumstances digital programs targeting EDs work. We offer several recommendations for future research with the aim of advancing understanding of client characteristics and intervention elements that signal success from this intervention modality. PUBLIC SIGNIFICANCE Digital interventions have shown potential as an effective, scalable, and accessible intervention option for EDs. However, responsiveness varies, so advancing understanding of predictors, mediators, and moderators of outcome to digital interventions for EDs is needed. Such knowledge is important for enabling safe and efficient treatment matching, and for informing future development of effective digital interventions.
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Affiliation(s)
- Zoe McClure
- School of Psychology, Deakin University, Geelong, Victoria, Australia
| | - Matthew Fuller-Tyszkiewicz
- School of Psychology, Deakin University, Geelong, Victoria, Australia
- Centre for Social and Early Emotional Development, Deakin University, Burwood, Victoria, Australia
| | - Mariel Messer
- School of Psychology, Deakin University, Geelong, Victoria, Australia
| | - Jake Linardon
- School of Psychology, Deakin University, Geelong, Victoria, Australia
- Centre for Social and Early Emotional Development, Deakin University, Burwood, Victoria, Australia
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de Sousa EM, Resende TRO, Alvarenga MDS, Raposo A, Teixeira-Lemos E, Guiné R, Alturki HA, de Carvalho PHB. Psychometric Evaluation of the Food Life Questionnaire-Short Form among Brazilian Adult Women. Nutrients 2024; 16:927. [PMID: 38612959 PMCID: PMC11013054 DOI: 10.3390/nu16070927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 03/17/2024] [Accepted: 03/21/2024] [Indexed: 04/14/2024] Open
Abstract
Measures of beliefs and attitudes toward food have generally been limited to the measurement of more pathological eating attitudes (e.g., disordered eating). The Food Life Questionnaire (FLQ) and its short form (FLQ-SF) were developed to examine attitudes toward a broader range of foods; however, the factor structure of the FLQ-SF was not confirmed in any study with young women. In the present study, we performed a psychometric evaluation of the Brazilian Portuguese translation of the FLQ-SF in a sample of 604 women. We evaluated the factor structure using a two-step, split-sample exploratory and confirmatory factor analytic approach. Results supported a four-factor structure (i.e., weight concern, diet-health orientation, belief in a diet-health linkage, and food and pleasure) with 18 items (χ2/df = 2.09; CFI = 0.95; TLI = 0.94; RMSEA = 0.05 (90% CI = 0.04; 0.06; p > 0.05); and SRMR = 0.08). Additionally, we found good internal consistency for all FLQ-SF subscales (McDonald's ω = 0.79-0.89) and convergent validity with measures of feelings, beliefs, and behaviors involved in food attitudes. Collectively, these results support the use of the FLQ-SF in Brazilian women and provide a foundation to expand the literature on beliefs and attitudes toward food in this population.
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Affiliation(s)
- Edilene Márcia de Sousa
- Body Image and Eating Disorders Research Group (NICTA), Federal University of Juiz de Fora, Governador Valadares 35010-180, MG, Brazil; (E.M.d.S.); (T.R.O.R.)
| | - Thainá Richelli Oliveira Resende
- Body Image and Eating Disorders Research Group (NICTA), Federal University of Juiz de Fora, Governador Valadares 35010-180, MG, Brazil; (E.M.d.S.); (T.R.O.R.)
| | | | - António Raposo
- CBIOS (Research Center for Biosciences and Health Technologies), Universidade Lusófona de Humanidades e Tecnologias, Campo Grande 376, 1749-024 Lisboa, Portugal
| | - Edite Teixeira-Lemos
- CERNAS Research Centre, Polytechnic University of Viseu, 3504-510 Viseu, Portugal; (E.T.-L.); (R.G.)
| | - Raquel Guiné
- CERNAS Research Centre, Polytechnic University of Viseu, 3504-510 Viseu, Portugal; (E.T.-L.); (R.G.)
| | - Hmidan A. Alturki
- King Abdulaziz City for Science & Technology, Wellness and Preventive Medicine Institute—Health Sector, Riyadh 11442, Saudi Arabia;
| | - Pedro Henrique Berbert de Carvalho
- Body Image and Eating Disorders Research Group (NICTA), Federal University of Juiz de Fora, Governador Valadares 35010-180, MG, Brazil; (E.M.d.S.); (T.R.O.R.)
- Eating Disorders Program, Institute of Psychiatry (AMBULIM), University of São Paulo, São Paulo 05403-010, SP, Brazil
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10
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Anderson C, Fuller-Tyszkiewicz M, Messer M, Linardon J. Target-user preferences, motivations, and acceptance for a dialectical behaviour therapy smartphone application for eating disorders. Eat Weight Disord 2024; 29:17. [PMID: 38411711 PMCID: PMC10899409 DOI: 10.1007/s40519-024-01646-8] [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: 10/27/2023] [Accepted: 02/15/2024] [Indexed: 02/28/2024] Open
Abstract
PURPOSE Evidence shows that dialectical behavioural therapy (DBT) is efficacious for eating disorders (ED), yet few people have access to specialized treatments like DBT. Translating key DBT skills for delivery via a smartphone application may broaden the dissemination of evidence-based interventions. However, prior to developing a DBT-based app, it is crucial to gather information on target-user needs and preferences. Assessing overall acceptance and identifying predictors of acceptance, informed by the UTAUT framework, is also important. This process ensures not only a demand for such an app, but also that users receive content and features tailored to their needs. METHOD This study aimed to understand target-user preferences of DBT-based apps for EDs by assessing willingness to engage, overall acceptance levels, and preferred functionality/content delivery modes (n = 326 symptomatic participants). RESULTS Eighty-eight percent indicated they would be willing to use a DBT-based ED app if it were available. Acceptance levels of a DBT app were high (64%), which was uniquely predicted by performance expectancy (perceptions of how beneficial an intervention is) and facilitating conditions (expectations of technological infrastructure and support in interventions) in path analysis. Content perceived as important to contain were emotion regulation techniques, tailored intervention strategies, and psychoeducation. CONCLUSION Findings generate important information about target-user preferences of a DBT-based app for EDs, highlighting necessary design principles for apps of this kind. Level of evidence Level V, cross-sectional descriptive study.
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Affiliation(s)
- Cleo Anderson
- School of Psychology, Deakin University, 1 Gheringhap Street, Geelong, VIC, 3220, Australia.
| | | | - Mariel Messer
- School of Psychology, Deakin University, 1 Gheringhap Street, Geelong, VIC, 3220, Australia
| | - Jake Linardon
- Center for Social and Emotional Development, Deakin University, Burwood, VIC, 3125, Australia
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Bohrer BK, Chen Y, Christensen KA, Forbush KT, Thomeczek ML, Richson BN, Chapa DAN, Jarmolowicz DP, Gould SR, Negi S, Perko VL, Morgan RW. A pilot multiple-baseline study of a mobile cognitive behavioral therapy for the treatment of eating disorders in university students. Int J Eat Disord 2023; 56:1623-1636. [PMID: 37213077 PMCID: PMC10765960 DOI: 10.1002/eat.23987] [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: 11/21/2022] [Revised: 04/26/2023] [Accepted: 04/26/2023] [Indexed: 05/23/2023]
Abstract
OBJECTIVE Eating disorders (EDs) are serious psychiatric disorders associated with substantial morbidity and mortality that are prevalent among university students. Because many students do not receive treatment due to lack of access on university campuses, mobile-health (mHealth) adaptations of evidence-based treatments represent an opportunity to increase treatment accessibility and engagement. The purpose of this study was to test the initial efficacy of Building Healthy Eating and Self-Esteem Together for University Students (BEST-U), which is a 10-week mHealth self-guided cognitive-behavioral therapy (CBT-gsh) app that is paired with a brief 25-30-min weekly telehealth coaching, for reducing ED psychopathology in university students. METHOD A non-concurrent multiple-baseline design (N = 8) was used to test the efficacy of BEST-U for reducing total ED psychopathology (primary outcome), ED-related behaviors and cognitions (secondary outcomes), and ED-related clinical impairment (secondary outcome). Data were examined using visual analysis and Tau-BC effect-size calculations. RESULTS BEST-U significantly reduced total ED psychopathology and binge eating, excessive exercise, and restriction (effect sizes ranged from -0.39 to -0.92). Although body dissatisfaction decreased, it was not significant. There were insufficient numbers of participants engaging in purging to evaluate purging outcomes. Clinical impairment significantly reduced from pre-to-post-treatment. DISCUSSION The current study provided initial evidence that BEST-U is a potentially efficacious treatment for reducing ED symptoms and ED-related clinical impairment. Although larger-scale randomized controlled trials are needed, BEST-U may represent an innovative, scalable tool that could reach greater numbers of underserved university students than traditional intervention-delivery models. PUBLIC SIGNIFICANCE Using a single-case experimental design, we found evidence for the initial efficacy of a mobile guided-self-help cognitive-behavioral therapy program for university students with non-low weight binge-spectrum eating disorders. Participants reported significant reductions in ED symptoms and impairment after completion of the 10-week program. Guided self-help programs show promise for filling an important need for treatment among university students with an ED.
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Affiliation(s)
- Brittany K. Bohrer
- Department of Psychiatry, University of California San Diego Health Eating Disorders Center for Treatment and Research, San Diego, California, USA
| | - Yiyang Chen
- Department of Psychology, University of Kansas, Lawrence, Kansas, USA
| | - Kara A. Christensen
- Department of Psychology, University of Nevada, Las Vegas, Las Vegas, Nevada, USA
| | - Kelsie T. Forbush
- Department of Psychology, University of Kansas, Lawrence, Kansas, USA
| | | | | | | | | | - Sara R. Gould
- Children’s Mercy Hospital, Kansas City, Missouri, USA
| | - Sonakshi Negi
- Department of Psychology, University of Kansas, Lawrence, Kansas, USA
| | - Victoria L. Perko
- University of New Mexico Health Science Center, Albuquerque, New Mexico, USA
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12
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Barakat S, Maguire S. Accessibility of Psychological Treatments for Bulimia Nervosa: A Review of Efficacy and Engagement in Online Self-Help Treatments. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:ijerph20010119. [PMID: 36612445 PMCID: PMC9819826 DOI: 10.3390/ijerph20010119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/13/2022] [Accepted: 12/14/2022] [Indexed: 05/30/2023]
Abstract
Bulimia nervosa is an eating disorder characterised by marked impairment to one's physical health and social functioning, as well as high rates of chronicity and comorbidity. This literature review aims to summarise existing academic research related to the symptom profile of BN, the costs and burden imposed by the illness, barriers to the receipt of care, and the evidence base for available psychological treatments. As a consequence of well-documented difficulties in accessing evidence-based treatments for eating disorders, efforts have been made towards developing innovative, diverse channels to deliver treatment, with several of these attempting to harness the potential of digital platforms. In response to the increasing number of trials investigating the utility of online treatments, this paper provides a critical review of previous attempts to examine digital interventions in the treatment of eating disorders. The results of a focused literature review are presented, including a detailed synthesis of a knowledgeable selection of high-quality articles with the aim of providing an update on the current state of research in the field. The results of the review highlight the potential for online self-help treatments to produce moderately sized reductions in core behavioural and cognitive symptoms of eating disorders. However, concern is raised regarding the methodological limitations of previous research in the field, as well as the high rates of dropout and poor adherence reported across most studies. The review suggests directions for future research, including the need to replicate previous findings using rigorous study design and methodology, as well as further investigation regarding the utility of clinician support and interactive digital features as potential mechanisms for offsetting low rates of engagement with online treatments.
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Affiliation(s)
- Sarah Barakat
- InsideOut Institute for Eating Disorders, University of Sydney, Sydney Local Health District, Camperdown 2050, Australia
- School of Psychology, University of Sydney, Camperdown 2050, Australia
| | - Sarah Maguire
- InsideOut Institute for Eating Disorders, University of Sydney, Sydney Local Health District, Camperdown 2050, Australia
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13
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Mensinger JL. Traumatic stress, body shame, and internalized weight stigma as mediators of change in disordered eating: a single-arm pilot study of the Body Trust® framework. Eat Disord 2022; 30:618-646. [PMID: 34634212 DOI: 10.1080/10640266.2021.1985807] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
To enhance access to evidence-based treatment it is increasingly important to evaluate scalable virtual programs that support the needs of those struggling with disordered eating. This study described a scientifically grounded, trauma-informed framework known as Body Trust,® and aimed to pilot test the preliminary effectiveness and mechanisms of change in a Body Trust® program to improve disordered eating. Using quality outcomes data, we examined 70 mostly white (87%) female-identifying (97%) individuals enrolled in a 6-module online program based in the Body Trust® framework (Mage = 45.5 ±10.9; MBMI = 33.7 ±8.0). Putative mediators included traumatic stress, internalized weight stigma, and body shame. Outcomes were objective and subjective binge episodes, overvaluation of weight and shape, and eating concerns. Generalized estimating equations were applied to determine pre-to-post changes. We applied Montoya's MEMORE macro, the joint-significance test, and calculated 95% Monte Carlo confidence intervals to assess mediation. Significant pre-to-post improvements with medium to large effect sizes were detected for all outcomes and mediators (ps<.008). All hypothesized mechanisms supported mediation. Using the Body Trust® framework shows early promise for alleviating disordered eating symptoms through targeting traumatic stress, body shame, and internalized weight stigma. Given the program's use of mindfulness techniques, future research should test target mechanisms like interoception.
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Affiliation(s)
- Janell L Mensinger
- M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, United States
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14
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Park T, Kim H, Song S, Griggs SK. Economic Evaluation of Pharmacist-Led Digital Health Interventions: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11996. [PMID: 36231307 PMCID: PMC9565470 DOI: 10.3390/ijerph191911996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/13/2022] [Accepted: 09/18/2022] [Indexed: 06/16/2023]
Abstract
There has been growing interest in integrating digital technologies in healthcare. The purpose of this study was to systematically review the economic value of pharmacist-led digital interventions. PubMed, Web of Science, and the Cochrane databases were searched to select studies that had conducted economic evaluations of digital interventions by pharmacists for the period from January 2001 to February 2022. Economic evidence from 14 selected studies was synthesized in our analysis. Pharmacists used telephones, computers, web-based interventions, videotapes, smartphones, and multiple technologies for their digital interventions. Prior studies have reported the results of telephone-based interventions to be cost-effective. Alternatively, these interventions were found to be cost-effective when reevaluated with recently cited willingness-to-pay thresholds. In addition, pharmacist-led interventions based on computers, web-based interventions, smartphones, and multiple technologies have been reported to be cost-effective in previous studies. However, videotape-based intervention was found cost-ineffective because there was no significant difference in outcomes between the intervention and the usual care groups. If this intervention had been intensive enough to improve outcomes in the intervention group, favorable cost-effectiveness results could have been obtained. The economic evidence in the previous studies represented short-term economic values. Economic evaluations of the long-term value of digital interventions are warranted in future studies.
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Affiliation(s)
- Taehwan Park
- Pharmacy Administration and Public Health, College of Pharmacy and Health Sciences, St. John’s University, Queens, NY 11439, USA
| | - Hyemin Kim
- College of Pharmacy and Health Sciences, St. John’s University, Queens, NY 11439, USA
| | - Seunghyun Song
- College of Pharmacy and Health Sciences, St. John’s University, Queens, NY 11439, USA
| | - Scott K. Griggs
- Pharmacy Administration, University of Health Sciences and Pharmacy in St. Louis, St. Louis, MO 63110, USA
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15
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Flatt RE, Thornton LM, Smith T, Mitchell H, Argue S, Baucom BRW, Deboeck PR, Adamo C, Kilshaw RE, Shi Q, Tregarthen J, Butner JE, Bulik CM. Retention, engagement, and binge-eating outcomes: Evaluating feasibility of the Binge-Eating Genetics Initiative study. Int J Eat Disord 2022; 55:1031-1041. [PMID: 35502471 PMCID: PMC9357123 DOI: 10.1002/eat.23726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 04/14/2022] [Accepted: 04/15/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Using preliminary data from the Binge-Eating Genetics Initiative (BEGIN), we evaluated the feasibility of delivering an eating disorder digital app, Recovery Record, through smartphone and wearable technology for individuals with binge-type eating disorders. METHODS Participants (n = 170; 96% female) between 18 and 45 years old with lived experience of binge-eating disorder or bulimia nervosa and current binge-eating episodes were recruited through the Recovery Record app. They were randomized into a Watch (first-generation Apple Watch + iPhone) or iPhone group; they engaged with the app over 30 days and completed baseline and endpoint surveys. Retention, engagement, and associations between severity of illness and engagement were evaluated. RESULTS Significantly more participants in the Watch group completed the study (p = .045); this group had greater engagement than the iPhone group (p's < .05; pseudo-R2 McFadden effect size = .01-.34). Overall, binge-eating episodes, reported for the previous 28 days, were significantly reduced from baseline (mean = 12.3) to endpoint (mean = 6.4): most participants in the Watch (60%) and iPhone (66%) groups reported reduced binge-eating episodes from baseline to endpoint. There were no significant group differences across measures of binge eating. In the Watch group, participants with fewer episodes of binge eating at baseline were more engaged (p's < .05; pseudo-R2 McFadden = .01-.02). Engagement did not significantly predict binge eating at endpoint nor change in binge-eating episodes from baseline to endpoint for both the Watch and iPhone groups. DISCUSSION Using wearable technology alongside iPhones to deliver an eating disorder app may improve study completion and app engagement compared with using iPhones alone.
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Affiliation(s)
- Rachael E. Flatt
- Department of PsychiatryUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
- Department of Psychology and NeuroscienceUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Laura M. Thornton
- Department of PsychiatryUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Tosha Smith
- Department of PsychiatryUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Hannah Mitchell
- Department of PsychologyEast Tennessee State UniversityJohnson CityTennesseeUSA
| | | | | | | | - Colin Adamo
- Department of PsychologyUniversity of UtahSalt Lake CityUtahUSA
| | | | - Qinxin Shi
- Department of PsychologyUniversity of UtahSalt Lake CityUtahUSA
| | | | | | - Cynthia M. Bulik
- Department of PsychiatryUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
- Department of NutritionUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
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16
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Linardon J, Shatte A, Rosato J, Fuller-Tyszkiewicz M. Efficacy of a transdiagnostic cognitive-behavioral intervention for eating disorder psychopathology delivered through a smartphone app: a randomized controlled trial. Psychol Med 2022; 52:1679-1690. [PMID: 32972467 DOI: 10.1017/s0033291720003426] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Although effective treatments exist for diagnostic and subthreshold-level eating disorders (EDs), a significant proportion of affected individuals do not receive help. Interventions translated for delivery through smartphone apps may be one solution towards reducing this treatment gap. However, evidence for the efficacy of smartphones apps for EDs is lacking. We developed a smartphone app based on the principles and techniques of transdiagnostic cognitive-behavioral therapy for EDs and evaluated it through a pre-registered randomized controlled trial. METHODS Symptomatic individuals (those who reported the presence of binge eating) were randomly assigned to the app (n = 197) or waiting list (n = 195). Of the total sample, 42 and 31% exhibited diagnostic-level bulimia nervosa and binge-eating disorder symptoms, respectively. Assessments took place at baseline, 4 weeks, and 8 weeks post-randomization. Analyses were intention-to-treat. The primary outcome was global levels of ED psychopathology. Secondary outcomes were other ED symptoms, impairment, and distress. RESULTS Intervention participants reported greater reductions in global ED psychopathology than the control group at post-test (d = -0.80). Significant effects were also observed for secondary outcomes (d's = -0.30 to -0.74), except compensatory behavior frequency. Symptom levels remained stable at follow-up. Participants were largely satisfied with the app, although the overall post-test attrition rate was 35%. CONCLUSION Findings highlight the potential for this app to serve as a cost-effective and easily accessible intervention for those who cannot receive standard treatment. The capacity for apps to be flexibly integrated within current models of mental health care delivery may prove vital for addressing the unmet needs of people with EDs.
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Affiliation(s)
- Jake Linardon
- School of Psychology, Deakin University, 1 Gheringhap Street, Geelong, VIC 3220, Australia
| | - Adrian Shatte
- Federation University, School of Science, Engineering & Information Technology, Melbourne, Australia
| | - John Rosato
- School of Psychology, Deakin University, 1 Gheringhap Street, Geelong, VIC 3220, Australia
| | - Matthew Fuller-Tyszkiewicz
- School of Psychology, Deakin University, 1 Gheringhap Street, Geelong, VIC 3220, Australia
- Center for Social and Early Emotional Development, Deakin University, Burwood, Victoria 3125, Australia
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17
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O'Leary T, Torous J. Smartphone apps for eating disorders: An overview of the marketplace and research trends. Int J Eat Disord 2022; 55:625-632. [PMID: 35175640 DOI: 10.1002/eat.23690] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 02/02/2022] [Accepted: 02/02/2022] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Apps purporting to assist with the management of eating disorders are proliferating; although less is known about (a) the safety or efficacy of the apps on the marketplaces and (b) if the research evidence supports dissemination of these apps. In this research forum, we seek to synthesize the current data and provide practical considerations around the use and research of these apps. METHODS A search of the iOS and Google Play stores was conducted in June 2021 to identify publicly available apps targeting eating disorders. A PubMed search was also conducted in June 2021 to identify relevant publications around smartphone apps for eating disorders. RESULTS Sixty-five apps that support the treatment of eating disorders were identified and coded across 105 data points on the publicly available mindApps.org website. The literature search revealed 13 articles. Seven percent of marketplaces apps offered any research support and the 13 published studies focused on only four apps. DISCUSSION There is a need for more translational research on smartphone apps for eating disorders. Current marketplace offerings present risks that may not be balanced by their limited evidence. Research efforts should focus on offering evidenced-based apps for the marketplace. Clinicians should weigh known and emerging risks and benefits of these apps within the context of research gaps when making decisions around use.
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Affiliation(s)
- Theodora O'Leary
- School of Medicine, Tufts University, Boston, Massachusetts, USA
| | - John Torous
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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18
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Liu J, Munson SA, Chang A, Voss C, Graham AK. Understanding self-monitoring to inform a mobile intervention for binge eating and weight management: A proof-of-concept randomized trial. Int J Eat Disord 2022; 55:642-652. [PMID: 35277986 PMCID: PMC9314870 DOI: 10.1002/eat.23700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 02/24/2022] [Accepted: 02/24/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study explored consumers' perspectives on self-monitoring, a common feature in behavioral interventions that helps inform consumers' progress and answer their questions, to learn what outcome metrics matter to consumers and whether self-selection of these metrics leads to greater engagement (i.e., compliance, satisfaction) in self-monitoring than monitoring only default options. METHODS In a proof-of-concept randomized trial, 48 adult participants were randomly assigned to "clinician-determined monitoring" or "clinician + self-determined monitoring" conditions. Before starting monitoring, all participants shared outcomes that would matter to them in a mobile intervention for binge eating and weight management. Then, for 3 weeks, participants in the "clinician-determined" condition monitored their weight and binge-eating episodes, and participants in the "clinician + self-determined" condition monitored these and another metric of their choosing. After, satisfaction and compliance were assessed. RESULTS Participants identified 116 metrics, grouped into 12 themes, that mattered to them. During monitoring, participants in the "clinician + self-determined" condition monitored 41 metrics. Surprisingly, participants in the "clinician-determined" condition also monitored metrics besides weight and binge eating. This resulted in a failure of our experimental manipulation, which represents a significant limitation of this research. No significant differences emerged in satisfaction or compliance between conditions. DISCUSSION Although our proof-of-concept trial yielded null quantitative results, findings also suggested binge eating and weight management interventions may benefit from including an individually customizable monitoring option in addition to default metrics, warranting testing in future research. PUBLIC SIGNIFICANCE Examining consumers' self-monitoring preferences for a mobile intervention for binge eating and weight management revealed a variety of metrics that matter to consumers, although binge eating and weight were still most valued. Findings from our proof-of-concept trial suggest design implications of encouraging an individually customizable monitoring option, in addition to default metrics, which needs to be tested in future research over a longer period and during actual mobile intervention delivery.
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Affiliation(s)
- Jianyi Liu
- Center for Behavioral Intervention TechnologiesNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
- Department of Psychiatry & Behavioral ScienceNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Sean A. Munson
- Human Centered Design & EngineeringUniversity of WashingtonSeattleWashingtonUSA
| | - Angela Chang
- Center for Behavioral Intervention TechnologiesNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
- Department of Medical Social SciencesNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Claire Voss
- Center for Behavioral Intervention TechnologiesNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Andrea K. Graham
- Center for Behavioral Intervention TechnologiesNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
- Department of Medical Social SciencesNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
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19
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Denecke K, Schmid N, Nüssli S. Implementation of Cognitive Behavioral Therapy in e-Mental Health Apps: Literature Review. J Med Internet Res 2022; 24:e27791. [PMID: 35266875 PMCID: PMC8949700 DOI: 10.2196/27791] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 07/27/2021] [Accepted: 12/28/2021] [Indexed: 12/24/2022] Open
Abstract
Background To address the matter of limited resources for treating individuals with mental disorders, e–mental health has gained interest in recent years. More specifically, mobile health (mHealth) apps have been suggested as electronic mental health interventions accompanied by cognitive behavioral therapy (CBT). Objective This study aims to identify the therapeutic aspects of CBT that have been implemented in existing mHealth apps and the technologies used. From these, we aim to derive research gaps that should be addressed in the future. Methods Three databases were screened for studies on mHealth apps in the context of mental disorders that implement techniques of CBT: PubMed, IEEE Xplore, and ACM Digital Library. The studies were independently selected by 2 reviewers, who then extracted data from the included studies. Data on CBT techniques and their technical implementation in mHealth apps were synthesized narratively. Results Of the 530 retrieved citations, 34 (6.4%) studies were included in this review. mHealth apps for CBT exploit two groups of technologies: technologies that implement CBT techniques for cognitive restructuring, behavioral activation, and problem solving (exposure is not yet realized in mHealth apps) and technologies that aim to increase user experience, adherence, and engagement. The synergy of these technologies enables patients to self-manage and self-monitor their mental state and access relevant information on their mental illness, which helps them cope with mental health problems and allows self-treatment. Conclusions There are CBT techniques that can be implemented in mHealth apps. Additional research is needed on the efficacy of the mHealth interventions and their side effects, including inequalities because of the digital divide, addictive internet behavior, lack of trust in mHealth, anonymity issues, risks and biases for user groups and social contexts, and ethical implications. Further research is also required to integrate and test psychological theories to improve the impact of mHealth and adherence to the e–mental health interventions.
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Affiliation(s)
- Kerstin Denecke
- Institute for Medical Informatics, Bern University of Applied Sciences, Biel, Switzerland
| | | | - Stephan Nüssli
- Institute for Medical Informatics, Bern University of Applied Sciences, Biel, Switzerland
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20
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Rubeis G. iHealth: The ethics of artificial intelligence and big data in mental healthcare. Internet Interv 2022; 28:100518. [PMID: 35257003 PMCID: PMC8897624 DOI: 10.1016/j.invent.2022.100518] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 01/11/2022] [Accepted: 02/24/2022] [Indexed: 01/13/2023] Open
Abstract
The concept of intelligent health (iHealth) in mental healthcare integrates artificial intelligence (AI) and Big Data analytics. This article is an attempt to outline ethical aspects linked to iHealth by focussing on three crucial elements that have been defined in the literature: self-monitoring, ecological momentary assessment (EMA), and data mining. The material for the analysis was obtained by a database search. Studies and reviews providing outcome data for each of the three elements were analyzed. An ethical framing of the results was conducted that shows the chances and challenges of iHealth. The synergy between self-monitoring, EMA, and data mining might enable the prevention of mental illness, the prediction of its onset, the personalization of treatment, and the participation of patients in the treatment process. Challenges arise when it comes to the autonomy of users, privacy and data security of users, and potential bias.
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21
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Kim JP, Sadeh-Sharvit S, Welch HA, Neri E, Tregarthen J, Lock J. Eating disorders early app use mediates treatment effect on clinical improvement. Int J Eat Disord 2022; 55:382-387. [PMID: 34904745 DOI: 10.1002/eat.23652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 11/04/2021] [Accepted: 11/29/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Eating disorders (EDs) contribute considerably to the global burden of disease. However, most affected individuals do not receive treatment. Mobile apps present an enormous opportunity to increase access to mental healthcare services. This study examined whether the degree of usage of a self-help app for EDs mediated the app's effects on the clinical response by individuals with EDs. METHOD App usage measures included the total number of cognitive-behavioral meal logs, total number of days spent using the app, and the last day the app was used during the study period. Mediation analysis was performed using the MacArthur framework. RESULTS All usage variables met the analytic requirements for testing mediation (group means (sd) for app and standard app, respectively: logs = 74 (108) vs. 51.4 (88.1), days spent = 14.3 (17.5) vs. 10.6 (15.0), p-values from Wilcox rank sum tests p < .01). Regression coefficients indicated mediation effects. The mediation effects demonstrated support that increased engagement (as measured by logs and time spent on the app) was related to an increased likelihood of achieving a significant clinical change by the end of the trial. DISCUSSION Greater and longer engagement in an ED app mediates its efficacy in terms of ED remission.
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Affiliation(s)
- Jane Paik Kim
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, USA
| | - Shiri Sadeh-Sharvit
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, USA.,Center for m2Health, Palo Alto University, Palo Alto, California, USA
| | - Hannah A Welch
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, USA
| | - Eric Neri
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, USA
| | | | - James Lock
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, USA
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22
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Cooper M, Reilly EE, Siegel JA, Coniglio K, Sadeh-Sharvit S, Pisetsky EM, Anderson LM. Eating disorders during the COVID-19 pandemic and quarantine: an overview of risks and recommendations for treatment and early intervention. Eat Disord 2022; 30:54-76. [PMID: 32644868 PMCID: PMC7929530 DOI: 10.1080/10640266.2020.1790271] [Citation(s) in RCA: 103] [Impact Index Per Article: 51.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Individuals with eating disorders (EDs) are at significant risk for increases in symptomatology and diminished treatment access during the COVID-19 pandemic. Environmental precautions to limit coronavirus spread have affected food availability and access to healthy coping mechanisms, and have contributed to weight-stigmatizing social media messages that may be uniquely harmful to those experiencing EDs. Additionally, changes in socialization and routine, stress, and experiences of trauma that are being experienced globally may be particularly deleterious to ED risk and recovery. This paper presents a brief review of the pertinent literature related to the risk of EDs in the context of COVID-19 and offers suggestions for modifying intervention efforts to accommodate the unique challenges individuals with EDs and providers may be experiencing in light of the ongoing public health crisis.
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Affiliation(s)
- Marita Cooper
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, Maryland, USA
| | - Erin E. Reilly
- Department of Psychology, Hofstra University, Hempstead, New York, USA
| | | | - Kathryn Coniglio
- Department of Psychology, Rutgers, The State University of New Jersey, New Jersey, USA
| | | | - Emily M. Pisetsky
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, Minnesota, USA
| | - Lisa M. Anderson
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, Minnesota, USA
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23
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Mensinger JL, Cox SA, Henretty JR. Treatment Outcomes and Trajectories of Change in Patients Attributing Their Eating Disorder Onset to Anti-obesity Messaging. Psychosom Med 2021; 83:777-786. [PMID: 34267090 PMCID: PMC8428859 DOI: 10.1097/psy.0000000000000962] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 02/05/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Given the increased prevalence of eating disorders (EDs) among individuals higher on the weight spectrum, we aimed to 1) report the prevalence of ED patients in higher levels of care (residential, partial hospitalization, and intensive outpatient) attributing the onset of their ED to anti-obesity messaging, 2) report the most commonly recollected sources of those messages, and 3) determine if those attributing the onset of their ED to anti-obesity messaging a) enter, b) exit, and c) respond to treatment differently from peers who did not. METHODS This retrospective cohort study used data from 2901 patients receiving ED treatment in higher levels of care at a US-based center between 2015 and 2018. Multilevel models examined differences in ED symptoms and trajectories of change over time. NVivo was used to analyze the patients' comments about sources of messages. RESULTS Eighteen percent attributed their ED onset to anti-obesity messaging, 45% did not, and 37% were unsure. Of those providing comments, the most common sources included the following: educational curriculum/school context (45.9%), media/Internet (24.7%), health care (10.4%), family (9%), and peer bullying (3.7%). At admission, patients attributing their ED onset to anti-obesity messaging had more severe ED symptoms than those who did not (γ = 0.463, standard error [SE] = 0.086, p < .001) and those who were unsure (γ = 0.288, SE = 0.089, p < .001); no differences were evident at discharge (p > .483). During phase 2 of treatment, patients attributing their ED onset to anti-obesity messaging improved faster than those who did not (γ = 0.003, SE = 0.001, p = .008) and those who were unsure (γ = 0.003, SE = 0.001, p = .014). CONCLUSIONS Anti-obesity messaging may put vulnerable individuals at risk for EDs. We recommend increasing weight bias training for school personnel and health care professionals. To reduce health disparities, we also suggest the promotion of weight-neutral health-enhancing self-care practices in media and public health campaigns, legislative policies, and health care overall.
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Moses JC, Adibi S, Shariful Islam SM, Wickramasinghe N, Nguyen L. Application of Smartphone Technologies in Disease Monitoring: A Systematic Review. Healthcare (Basel) 2021; 9:889. [PMID: 34356267 PMCID: PMC8303662 DOI: 10.3390/healthcare9070889] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 07/03/2021] [Accepted: 07/09/2021] [Indexed: 12/21/2022] Open
Abstract
Technologies play an essential role in monitoring, managing, and self-management of chronic diseases. Since chronic patients rely on life-long healthcare systems and the current COVID-19 pandemic has placed limits on hospital care, there is a need to explore disease monitoring and management technologies and examine their acceptance by chronic patients. We systematically examined the use of smartphone applications (apps) in chronic disease monitoring and management in databases, namely, Medline, Web of Science, Embase, and Proquest, published from 2010 to 2020. Results showed that app-based weight management programs had a significant effect on healthy eating and physical activity (p = 0.002), eating behaviours (p < 0.001) and dietary intake pattern (p < 0.001), decreased mean body weight (p = 0.008), mean Body Mass Index (BMI) (p = 0.002) and mean waist circumference (p < 0.001). App intervention assisted in decreasing the stress levels (paired t-test = 3.18; p < 0.05). Among cancer patients, we observed a high acceptance of technology (76%) and a moderately positive correlation between non-invasive electronic monitoring data and questionnaire (r = 0.6, p < 0.0001). We found a significant relationship between app use and standard clinical evaluation and high acceptance of the use of apps to monitor the disease. Our findings provide insights into critical issues, including technology acceptance along with regulatory guidelines to be considered when designing, developing, and deploying smartphone solutions targeted for chronic patients.
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Affiliation(s)
- Jeban Chandir Moses
- School of Information Technology, Deakin University, 1 Gheringhap St, Geelong, VIC 3220, Australia;
| | - Sasan Adibi
- School of Information Technology, Deakin University, 1 Gheringhap St, Geelong, VIC 3220, Australia;
| | | | - Nilmini Wickramasinghe
- Iverson Health Innovation Research Institute, Swinburne University of Technology, Hawthorn, VIC 3122, Australia;
| | - Lemai Nguyen
- Department of Information Systems and Business Analytics, Deakin Business School, 221 Burwood Highway, Burwood, VIC 3125, Australia;
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Abstract
Research findings strongly suggest that cognitive behavioral therapy for the eating disorders (CBT-ED) is more effective than other treatments for bulimia nervosa (BN) and for binge eating disorder (BED), although interpersonal psychotherapy appears to be equally effective for BED. Evidence for the effectiveness of CBT-ED for the persistent (adult) form of anorexia nervosa (AN) is insufficient at present and is essentially absent for AN in adolescents except for some evidence from uncontrolled trials. This article begins with an overview of the early studies in the development of CBT-ED that showed a similar effectiveness of other symptom-focused psychotherapies-a finding that was neglected at the time. Later developments are then considered, including comparisons of CBT-ED with other psychotherapies, efforts to develop Internet-based training and treatment, and electronic applications for treatment. Finally, implications of the findings for future short- and long-term research and for clinical practice are considered.
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Affiliation(s)
- W Stewart Agras
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California 94305, USA; ,
| | - Cara Bohon
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California 94305, USA; ,
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Cheng VWS. Recommendations for Implementing Gamification for Mental Health and Wellbeing. Front Psychol 2020; 11:586379. [PMID: 33365001 PMCID: PMC7750532 DOI: 10.3389/fpsyg.2020.586379] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 11/13/2020] [Indexed: 12/13/2022] Open
Abstract
Gamification is increasingly being proposed as a strategy to increase engagement for mental health and wellbeing technologies. However, its implementation has been criticized as atheoretical, particularly in relation to behavior change theory and game studies theories. Definitions of the term “gamification” vary, sometimes widely, between and within academic fields and the effectiveness of gamification is yet to be empirically established. Despite this, enthusiasm for developing gamified mental health technologies, such as interventions, continues to grow. There is a need to examine how best to implement gamification in mental health and wellbeing technologies in a way that takes quick production cycles into account while still emphasizing empirical investigation and building a rigorous evidence base. With reference to game studies and the medical (eHealth/mHealth) literature, this article interrogates gamification for mental health and wellbeing by examining core properties of the game form. It then explores how gamification can best be conceptualized and implemented for mental health and wellbeing goals from conceptualization through to iterative co-development and evaluation that accommodates software development schedules. Finally, it summarizes its conceptual analysis into recommendations for researchers and designers looking to do so. These recommendations are: (1) assess suitability, (2) implement to support, (3) assess acceptability, (4) evaluate impact, and (5) document comprehensively. These recommendations aim to encourage clear language, unified terminology, the application and evaluation of theory, comprehensive and constant documentation, and transparent evaluation of outcomes.
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Sadeh-Sharvit S, Fitzsimmons-Craft EE, Taylor CB, Yom-Tov E. Predicting eating disorders from Internet activity. Int J Eat Disord 2020; 53:1526-1533. [PMID: 32706444 PMCID: PMC8011598 DOI: 10.1002/eat.23338] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 06/16/2020] [Accepted: 06/16/2020] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Eating disorders (EDs) compromise the health and functioning of affected individuals, but it can often take them several years to acknowledge their illness and seek treatment. Early identification of individuals with EDs is a public health priority, and innovative approaches are needed for such identification and ultimate linkage with evidence-based interventions. This study examined whether Internet activity data can predict ED risk/diagnostic status, potentially informing timely interventions. METHOD Participants were 936 women who completed a clinically validated online survey for EDs, and 231 of them (24.7%) contributed their Internet browsing history. A machine learning algorithm used key attributes from participants' Internet activity histories to predict their ED status: clinical/subclinical ED, high risk for an ED, or no ED. RESULTS The algorithm reached an accuracy of 52.6% in predicting ED risk/diagnostic status, compared to random decision accuracy of 38.1%, a relative improvement of 38%. The most predictive Internet search history variables were the following: use of keywords related to ED symptoms and websites promoting ED content, participant age, median browsing events per day, and fraction of daily activity at noon. DISCUSSION ED risk or clinical status can be predicted via machine learning with moderate accuracy using Internet activity variables. This model, if replicated in larger samples where it demonstrates stronger predictive value, could identify populations where further assessment is merited. Future iterations could also inform tailored digital interventions, timed to be provided when target online behaviors occur, thereby potentially improving the well-being of many individuals who may otherwise remain undetected.
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Affiliation(s)
- Shiri Sadeh-Sharvit
- Baruch Ivcher School of Psychology, Interdisciplinary Center, Herzliya, Israel,Center for m2Health, Palo Alto University, Palo Alto, CA, USA
| | | | - C. Barr Taylor
- Center for m2Health, Palo Alto University, Palo Alto, CA, USA,Stanford University, Stanford, CA, USA
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