1
|
Vollert B, Yim SH, Görlich D, Beintner I, Gordon G, Musiat P, Schmidt U, Jacobi C. Using web-based, guided self-help to bridge the waiting time for face-to-face out-patient treatment for bulimic-spectrum disorders: randomised controlled trial. BJPsych Open 2024; 10:e53. [PMID: 38404025 PMCID: PMC10897701 DOI: 10.1192/bjo.2023.629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/27/2024] Open
Abstract
BACKGROUND Although effective treatments for bulimic-spectrum eating disorders exist, access is often delayed because of limited therapist availability and lengthy waiting lists. Web-based self-help interventions have the potential to bridge waiting times for face-to-face treatment and overcome existing treatment gaps. AIMS This study aims to assess the effectiveness of a web-based guided self-help intervention (everyBody Plus) for patients with bulimia nervosa, binge eating disorder and other specified feeding and eating disorders who are waiting for out-patient treatment. METHOD A randomised controlled trial was conducted in Germany and the UK. A total of 343 patients were randomly assigned to the intervention 'everyBody Plus' or a waitlist control condition. The primary outcome was the number of weeks after randomisation until a patient achieved a clinically relevant improvement in core symptoms for the first time. Secondary outcomes included eating disorder attitudes and behaviours, and general psychopathology. RESULTS At 6- and 12-month follow-up, the probability of being abstinent from core symptoms was significantly larger for the intervention group compared with the control group (hazard ratio: 1.997, 95% CI 1.09-3.65; P = 0.0249). The intervention group also showed larger improvements in eating disorder attitudes and behaviours, general psychopathology, anxiety, depression and quality of life, compared with the control group at most assessment points. Working alliance ratings with the online therapist were high. CONCLUSIONS The self-help intervention everyBody Plus, delivered with relatively standardised online guidance, can help bridge treatment gaps for patients with bulimic-spectrum eating disorders, and achieve faster and greater reductions in core symptoms.
Collapse
Affiliation(s)
- Bianka Vollert
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Germany
| | - See Heng Yim
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, King's College London, UK
| | - Dennis Görlich
- Institute of Biostatistics and Clinical Research, Westfälische Wilhelms-Universität Münster, Germany
| | - Ina Beintner
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Germany
| | - Gemma Gordon
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, King's College London, UK; and Forward College, Lisbon, Portugal
| | - Peter Musiat
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, King's College London, UK
| | - Ulrike Schmidt
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, King's College London, UK; and South London and Maudsley NHS Foundation Trust, London, UK
| | - Corinna Jacobi
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Germany
| |
Collapse
|
2
|
Kerber A, Beintner I, Burchert S, Knaevelsrud C. Effects of a Self-Guided Transdiagnostic Smartphone App on Patient Empowerment and Mental Health: Randomized Controlled Trial. JMIR Ment Health 2023; 10:e45068. [PMID: 37930749 PMCID: PMC10660244 DOI: 10.2196/45068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 08/01/2023] [Accepted: 08/04/2023] [Indexed: 11/07/2023] Open
Abstract
BACKGROUND Mental disorders impact both individuals and health systems. Symptoms and syndromes often remain undetected and untreated, resulting in chronification. Besides limited health care resources, within-person barriers such as the lack of trust in professionals, the fear of stigmatization, or the desire to cope with problems without professional help contribute to the treatment gap. Self-guided mental health apps may support treatment seeking by reducing within-person barriers and facilitating mental health literacy. Digital mental health interventions may also improve mental health related self-management skills and contribute to symptom reduction and the improvement of quality of life. OBJECTIVE This study aims to investigate the effects of a self-guided transdiagnostic app for mental health on help seeking, reduced stigma, mental health literacy, self-management skills, mental health symptoms, and quality of life using a randomized controlled design. METHODS Overall, 1045 participants (recruited via open, blinded, and web-based recruitment) with mild to moderate depression or anxiety-, sleep-, eating-, or somatization-related psychopathology were randomized to receive either access to a self-guided transdiagnostic mental health app (MindDoc) in addition to care as usual or care as usual only. The core features of the app were regular self-monitoring, automated feedback, and psychological courses and exercises. The coprimary outcomes were mental health literacy, mental health-related patient empowerment and self-management skills (MHPSS), attitudes toward help seeking, and actual mental health service use. The secondary outcomes were psychopathological symptom burden and quality of life. Data were collected at baseline and 8 weeks and 6 months after randomization. Treatment effects were investigated using analyses of covariance, including baseline variables as predictors and applying multiple imputation. RESULTS We found small but robust between-group effects for MHPSS (Cohen d=0.29), symptoms burden (Cohen d=0.28), and quality of life (Cohen d=0.19) 8 weeks after randomization. The effects on MHPSS were maintained at follow-up. Follow-up assessments also showed robust effects on mental health literacy and preliminary evidence for the improvement of help seeking. Predictors of attrition were lower age and higher personality dysfunction. Among the non-attritors, predictors for deterioration were less outpatient treatment and higher initial symptom severity. CONCLUSIONS A self-guided transdiagnostic mental health app can contribute to lasting improvements in patient empowerment. Symptoms of common mental disorders and quality of life improved faster in the intervention group than in the control group. Therefore, such interventions may support individuals with symptoms of 1 or more internalizing disorders, develop health-centered coping skills, prevent chronification, and accelerate symptom improvement. Although the effects for individual users are small and predictors of attrition and deterioration need to be investigated further, the potential public health impact of a self-guided intervention can be large, given its high scalability. TRIAL REGISTRATION German Clinical Trials Register DRKS00022531; https://drks.de/search/de/trial/DRKS00022531.
Collapse
Affiliation(s)
- André Kerber
- Department of Clinical-Psychological Intervention, Freie Universität Berlin, Berlin, Germany
| | | | - Sebastian Burchert
- Department of Clinical-Psychological Intervention, Freie Universität Berlin, Berlin, Germany
| | - Christine Knaevelsrud
- Department of Clinical-Psychological Intervention, Freie Universität Berlin, Berlin, Germany
| |
Collapse
|
3
|
Beintner I, Kerber A, Dominke C, Voderholzer U. Improving Mild to Moderate Depression With an App-Based Self-Guided Intervention: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e46651. [PMID: 37878374 PMCID: PMC10632923 DOI: 10.2196/46651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 09/06/2023] [Accepted: 09/11/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND Depression is one of the most prevalent mental disorders and frequently co-occurs with other mental disorders. Despite the high direct and indirect costs to both individuals and society, more than 80% of those diagnosed with depression remain with their primary care physician and do not receive specialized treatment. Self-guided digital interventions have been shown to improve depression and, due to their scalability, have a large potential public health impact. Current digital interventions often focus on specific disorders, while recent research suggests that transdiagnostic approaches are more suitable. OBJECTIVE This paper presents the protocol for a study that aims to assess the efficacy of a self-guided transdiagnostic app-based self-management intervention in patients with mild or moderate depression with and without comorbid mental disorders. Specifically, we are investigating the impact of the intervention on symptoms of depression, quality of life, anxiety symptoms, and mental health-related patient empowerment and self-management skills. METHODS The intervention under investigation, MindDoc with Prescription, is a self-guided digital intervention aimed at supporting individuals with mild to moderate mental disorders from the internalizing spectrum, including depression. The app can be used as a low-threshold psychosocial intervention. Up to 570 adult patients will be randomized to either receive the intervention in addition to care as usual or only care as usual. We are including adults with a permanent residency in Germany and mild or moderate depression according to International Classification of Diseases, 10th Revision, criteria (F32.0, F32.1, F33.0, and F33.1). Clinical interviews will be conducted to confirm the diagnosis. Data will be collected at baseline as well as 8 weeks and 6 months after randomization. The primary outcome will be depression symptom severity after 8 weeks. Secondary outcomes will be quality of life, anxiety symptom severity, and patient empowerment and self-management behaviors. Data will be analyzed using multiple imputations, using the intention-to-treat principle, while sensitivity analyses will be based on additional imputation strategies and a per-protocol analysis. RESULTS Recruitment for the trial started on February 7, 2023, and the first participant was randomized on February 14, 2023. As of September 5, 2023, 275 participants have been included in the trial and 176 have provided the primary outcome. The rate of missing values in the primary outcome is approximately 20%. CONCLUSIONS Data from this efficacy trial will be used to establish whether access to the intervention is associated with an improvement in depression symptoms in individuals diagnosed with mild or moderate depression. The study will contribute to expanding the evidence base on transdiagnostic digital interventions. TRIAL REGISTRATION German Registry of Clinical Trials DRKS00030852; https://drks.de/search/de/trial/DRKS00030852. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/46651.
Collapse
Affiliation(s)
| | - André Kerber
- Division of Clinical-Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | | | - Ulrich Voderholzer
- Schoen Clinic Roseneck, Prien am Chiemsee, Germany
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg, Germany
| |
Collapse
|
4
|
Vollert B, Müller L, Jacobi C, Trockel M, Beintner I. Effectiveness of an App-Based Short Intervention to Improve Sleep: Randomized Controlled Trial. JMIR Ment Health 2023; 10:e39052. [PMID: 36943337 PMCID: PMC10131838 DOI: 10.2196/39052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 09/15/2022] [Accepted: 09/30/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND A growing body of evidence for digital interventions to improve sleep shows promising effects. The interventions investigated so far have been primarily web-based; however, app-based interventions may reach a wider audience and be more suitable for daily use. OBJECTIVE This study aims to evaluate the intervention effects, adherence, and acceptance of an unguided app-based intervention for individuals who wish to improve their sleep. METHODS In a randomized controlled trial, we evaluated the effects of an app-based short intervention (Refresh) to improve sleep compared with a waitlist condition. Refresh is an 8-week unguided intervention covering the principles of cognitive behavioral therapy for insomnia (CBT-I) and including a sleep diary. The primary outcome was sleep quality (insomnia symptoms) as self-assessed by the Regensburg Insomnia Scale (RIS). The secondary outcomes were depression (9-item Patient Health Questionnaire [PHQ-9] score) and perceived insomnia-related impairment. RESULTS We included 371 participants, of which 245 reported poor sleep at baseline. About 1 in 3 participants who were allocated to the intervention group never accessed the intervention. Active participants completed on average 4 out of 8 chapters. Retention rates were 67.4% (n=250) at postassessment and 57.7% (n=214) at the 6-month follow-up. At postintervention, insomnia symptoms in the intervention group had improved more than those in the waitlist group, with a small effect (d=0.26) in the whole sample and a medium effect (d=0.45) in the subgroup with poor sleep. Effects in the intervention group were maintained at follow-up. Perceived insomnia-related impairment also improved from pre- to postassessment. No significant intervention effect on depression was detected. Working alliance and acceptance were moderate to good. CONCLUSIONS An app-based, unguided intervention is a feasible and effective option to scale-up CBT-I-based treatment, but intervention uptake and adherence need to be carefully addressed. TRIAL REGISTRATION ISRCTN Registry ISRCTN53553517; https://www.isrctn.com/ISRCTN53553517.
Collapse
Affiliation(s)
- Bianka Vollert
- Department of Clinical Psychology and Psychotherapy, Faculty of Psychology, Technische Universität Dresden, Dresden, Germany
| | - Luise Müller
- Department of Clinical Psychology and Psychotherapy, Faculty of Psychology, Technische Universität Dresden, Dresden, Germany
| | - Corinna Jacobi
- Department of Clinical Psychology and Psychotherapy, Faculty of Psychology, Technische Universität Dresden, Dresden, Germany
| | - Mickey Trockel
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Ina Beintner
- Department of Clinical Psychology and Psychotherapy, Faculty of Psychology, Technische Universität Dresden, Dresden, Germany
| |
Collapse
|
5
|
Netter AL, Beintner I, Brakemeier EL. Adding an app-based intervention to the Cognitive Behavioral Analysis System of Psychotherapy (CBASP): Proof-of-Concept in Routine Outpatient Psychotherapy Treatment (Preprint). JMIR Form Res 2021; 6:e35482. [PMID: 35943764 PMCID: PMC9399836 DOI: 10.2196/35482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 02/03/2022] [Accepted: 02/03/2022] [Indexed: 01/12/2023] Open
Abstract
Background The Cognitive Behavioral Analysis System of Psychotherapy (CBASP) is an empirically supported psychotherapeutic treatment developed specifically for persistent depressive disorder. However, given the high rates of nonresponse and relapse, there is a need for optimization. Studies suggest that outcomes can be improved by increasing the treatment dose via, for example, the continuous web-based application of therapy strategies between sessions. The strong emphasis in CBASP on the therapeutic relationship, combined with limited therapeutic availabilities, encourages the addition of web-based interventions to face-to-face therapy in terms of blended therapy. Objective The aim of this study was to test an app-based intervention called CBASPath, which was designed to be used as a blended therapy tool. CBASPath offers 8 sequential modules with app-based exercises to facilitate additional engagement with the therapy content and a separate exercise to conduct situational analyses within the app at any time. Methods CBASPath was tested in an open pilot study as part of routine outpatient CBASP treatment. Participating patients were asked to report their use patterns and blended use (integrated use of the app as part of therapy sessions) at 3 assessment points over the 6-month test period and rate the usability and quality of and their satisfaction with CBASPath. Results The results of the pilot trial showed that 93% (12/13) of participants used CBASPath as a blended tool during their therapy and maintained this throughout the study period. Overall, they reported good usability and quality ratings along with high user satisfaction. All participants showed favorable engagement with CBASPath; however, the frequency of use differed widely among the participants and assessment points. Situational analysis was used by all participants, and the number of completed modules ranged from 1 to 7. All participants reported blended use, although the frequency of integration in the face-to-face sessions varied widely. Conclusions Our findings suggest that the digital augmentation of complex and highly interactive CBASP therapy in the form of blended therapy with CBASPath is feasible in routine outpatient care. Therapeutic guidance might contribute to high adherence and increase patient self-management. A few adjustments, such as saving entries directly in the app, could facilitate higher user engagement. A randomized controlled trial is now needed to investigate the efficacy and added value of this blended approach. In the long term, CBASPath could help optimize persistent depressive disorder treatment and reduce relapse by intensifying therapy and providing long-term patient support through the app.
Collapse
Affiliation(s)
- Anna-Lena Netter
- Department of Clinical Psychology and Psychotherapy, Philipps University of Marburg, Marburg, Germany
| | | | - Eva-Lotta Brakemeier
- Department of Clinical Psychology and Psychotherapy, University of Greifswald, Greifswald, Germany
| |
Collapse
|
6
|
Kuso S, Nitsch M, Zeiler M, Simek M, Adamcik T, Dey M, Berger T, Krieger T, Weisel KK, Zarski AC, Ebert DD, Schaub MP, Moser CT, Botella C, Baños R, Herrero R, Etchemendy E, Nacke B, Beintner I, Vollert B, Schmidt-Hantke J, Hütter K, Jacobi C, Waldherr K. Stakeholders' views on online interventions to prevent common mental health disorders in adults implemented into existing healthcare systems in Europe. Eur J Public Health 2021; 31:i55-i63. [PMID: 34240157 PMCID: PMC8495679 DOI: 10.1093/eurpub/ckab043] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Online preventive interventions can help to reduce the incidence of mental disorders. Whereas knowledge on stakeholders' attitudes and factors relevant for successfully integrating online treatment into existing healthcare systems is available, knowledge is scarce for online prevention. METHODS Stakeholders from Germany, Switzerland, Austria and Spain were surveyed. Potential facilitators/delivery staff (e.g. psychologists, psychotherapists) completed an online questionnaire (n = 183), policy makers (i.e. from the governing sector or health insurance providers) participated in semi-structured interviews (n = 16) and target groups/potential users of mental illness prevention (n = 49) participated in ten focus groups. Thematic analysis was used to identify their experiences with and attitudes and needs regarding online programmes to prevent mental disorders. Additionally, it was examined which groups they consider underserved and which factors they consider as fostering and hindering for reach, adoption, implementation and maintenance (cf. RE-AIM model) when integrating online prevention into existing healthcare systems. RESULTS Main advantages of online mental illness prevention are perceived in low structural and psychological barriers. Lack of personal contact, security, privacy and trust concerns were discussed as disadvantages. Relevant needs are high usability and target group appropriateness, evidence for effectiveness and the use of motivational tools. CONCLUSIONS Positive attitudes among stakeholders are the key for successful integration of online mental illness prevention into existing healthcare systems. Potential facilitators/delivery staff must receive training and support to implement these programmes; the programmes must be attractive and continuously evaluated, updated and promoted to ensure ongoing reach; and existing infrastructure and contextual factors must be considered.
Collapse
Affiliation(s)
- Stefanie Kuso
- Ferdinand Porsche FernFH-Distance Learning University of Applied Sciences, Wiener Neustadt 2700, Austria
| | - Martina Nitsch
- Ferdinand Porsche FernFH-Distance Learning University of Applied Sciences, Wiener Neustadt 2700, Austria
| | - Michael Zeiler
- Department for Child and Adolescent Psychiatry, Medical University of Vienna, Vienna 1090, Austria
| | - Monika Simek
- Department for Child and Adolescent Psychiatry, Medical University of Vienna, Vienna 1090, Austria
| | - Tanja Adamcik
- Ferdinand Porsche FernFH-Distance Learning University of Applied Sciences, Wiener Neustadt 2700, Austria
| | - Michelle Dey
- Swiss Research Institute for Public Health and Addiction ISGF, Associated to the University of Zurich, Zurich, Switzerland
| | - Thomas Berger
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Tobias Krieger
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Kiona K Weisel
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Anna-Carlotta Zarski
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - David D Ebert
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Michael P Schaub
- Swiss Research Institute for Public Health and Addiction ISGF, Associated to the University of Zurich, Zurich, Switzerland
| | - Christian T Moser
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Christina Botella
- Jaume I University, Castellón, Spain.,CIBER Pathophysiology of Obesity and Nutrition (CB06/03), Carlos III Institute of Health, Madrid, Spain
| | - Rosa Baños
- CIBER Pathophysiology of Obesity and Nutrition (CB06/03), Carlos III Institute of Health, Madrid, Spain.,Department of Personality, Evaluation and Psychological Treatments, University of Valencia, Valencia, Spain
| | - Rocio Herrero
- CIBER Pathophysiology of Obesity and Nutrition (CB06/03), Carlos III Institute of Health, Madrid, Spain.,Department of Personality, Evaluation and Psychological Treatments, University of Valencia, Valencia, Spain
| | - Ernestina Etchemendy
- CIBER Pathophysiology of Obesity and Nutrition (CB06/03), Carlos III Institute of Health, Madrid, Spain.,Department of Personality, Evaluation and Psychological Treatments, University of Valencia, Valencia, Spain
| | - Barbara Nacke
- Department of Clinical Psychology and Psychotherapy, TU Dresden, Dresden, Germany
| | - Ina Beintner
- Department of Clinical Psychology and Psychotherapy, TU Dresden, Dresden, Germany
| | - Bianka Vollert
- Department of Clinical Psychology and Psychotherapy, TU Dresden, Dresden, Germany
| | | | - Kristian Hütter
- Department of Clinical Psychology and Psychotherapy, TU Dresden, Dresden, Germany
| | - Corinna Jacobi
- Department of Clinical Psychology and Psychotherapy, TU Dresden, Dresden, Germany
| | - Karin Waldherr
- Ferdinand Porsche FernFH-Distance Learning University of Applied Sciences, Wiener Neustadt 2700, Austria
| |
Collapse
|
7
|
Kerber A, Beintner I, Burchert S, Knaevelsrud C. Does app-based unguided self-management improve mental health literacy, patient empowerment and access to care for people with mental health impairments? Study protocol for a randomised controlled trial. BMJ Open 2021; 11:e049688. [PMID: 34266843 PMCID: PMC8286775 DOI: 10.1136/bmjopen-2021-049688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Mental disorders pose a huge burden to both individuals and health systems. Symptoms and syndromes often remain undetected and untreated, resulting in comorbidity and chronification. Besides limited resources in healthcare systems, the treatment-gap is-to a large extent-caused by within-person barriers impeding early treatment seeking. These barriers include a lack of trust in professionals, fear of stigmatisation, or the desire to cope with problems without professional help. While unguided self-management interventions are not designed to replace psychotherapy, they may support early symptom assessment and recognition by reducing within-person barriers. Digital self-management solutions may also reduce inequalities in access to care due to external factors such as regional unavailability of services. METHODS AND ANALYSIS Approximately 1100 patients suffering from mild to moderate depressive, anxiety, sleep, eating or somatisation-related mental disorders will be randomised to receive either a low-threshold unguided digital self-management tool in the form of a transdiagnostic mental health app or care as usual. The primary outcomes will be mental health literacy, patient empowerment and access to care while secondary outcomes will be symptom distress and quality of life. Additional moderator and predictor variables are negative life events, personality functioning, client satisfaction, mental healthcare service use and application of self-management strategies. Data will be collected at baseline as well as 8 weeks and 6 months after randomisation. Data will be analysed using multiple imputation and analysis of covariance employing the intention-to-treat principle, while sensitivity analyses will be based on different multiple imputation parameters and a per-protocol analysis. ETHICS AND DISSEMINATION Approval was obtained from the Ethics Committee of the Faculty of Educational Science and Psychology at the Freie Universität Berlin. The results will be submitted to peer-reviewed specialised journals and presented at national and international conferences. TRIAL REGISTERATION The trial has been registered in the DRKS trial register (DRKS00022531);Pre-results.
Collapse
Affiliation(s)
- André Kerber
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | | | - Sebastian Burchert
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Christine Knaevelsrud
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| |
Collapse
|
8
|
Schmidt-Hantke J, Vollert B, Hagner F, Beintner I, Hütter K, Nitsch M, Jacobi C, Waldherr K. Stakeholders' perspectives on online interventions to improve mental health in eating disorder patients and carers in Germany. Eur J Public Health 2021; 31:i80-i87. [PMID: 34240153 PMCID: PMC8266537 DOI: 10.1093/eurpub/ckab057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Eating disorders are causing severe consequences for those affected as well as a high burden for their carers. Although there is a substantial need for psychological assistance, different factors are hindering access to support. Internet-based interventions can help to overcome these barriers. To date, there is only little knowledge on attitudes of potential users, facilitators (e.g. psychologists) and decision makers (e.g. health insurances) regarding these interventions. METHODS We conducted focus groups with potential users (N = 30) and semi-structured interviews with potential decision makers (N = 4). Potential facilitators (N = 41) participated in an online survey. Stakeholders' experiences, attitudes, and their needs regarding Internet-based interventions for eating disorder patients and carers were assessed. Furthermore, hindering and fostering factors related to reach, adoption, implementation and maintenance were analyzed. RESULTS About two-thirds of the participating facilitators have heard or read about Internet-based interventions in general. In contrast, the other stakeholders mentioned to have no or little experience with such interventions. Factors like anonymity, availability and cost-effectiveness were seen as major advantages. Also disadvantages, e.g. lack of personal contact, limitations by disease severity and concerns on data safety, were mentioned. Stakeholders stated the need for interventions which are usable, evidence-based, tailored and provide personal support. CONCLUSION Stakeholders considered Internet-based programmes to have more advantages than disadvantages. Effort should be put in providing systematic education to address prejudices. When offering an online intervention, stakeholders' needs, as well as a continuous evaluation and adaptation, have to be taken into account.
Collapse
Affiliation(s)
- Juliane Schmidt-Hantke
- TU Dresden, Faculty of Psychology, Institute of Clinical Psychology and Psychotherapy, Dresden, Germany
| | - Bianka Vollert
- TU Dresden, Faculty of Psychology, Institute of Clinical Psychology and Psychotherapy, Dresden, Germany
| | - Franziska Hagner
- TU Dresden, Faculty of Psychology, Institute of Clinical Psychology and Psychotherapy, Dresden, Germany
| | - Ina Beintner
- TU Dresden, Faculty of Psychology, Institute of Clinical Psychology and Psychotherapy, Dresden, Germany
| | - Kristian Hütter
- TU Dresden, Faculty of Psychology, Institute of Clinical Psychology and Psychotherapy, Dresden, Germany
| | - Martina Nitsch
- Ferdinand Porsche FernFH-Distance Learning University of Applied Sciences, Wiener Neustadt, Austria
| | - Corinna Jacobi
- TU Dresden, Faculty of Psychology, Institute of Clinical Psychology and Psychotherapy, Dresden, Germany
| | - Karin Waldherr
- Ferdinand Porsche FernFH-Distance Learning University of Applied Sciences, Wiener Neustadt, Austria
| |
Collapse
|
9
|
Voderholzer U, Beintner I, Backes B, Esguerra E, Hessler-Kaufmann J. Implementing Videoconference CBT for Depression in Routine Outpatient Care: Outcome, Working Alliance, and Influence of Patients’ Technology Commitment. Verhaltenstherapie 2021. [DOI: 10.1159/000513643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
<b><i>Background:</i></b> While videoconference cognitive behavioral therapy (V-CBT) has shown promising results in controlled studies, data from routine care are rare. We examined (1) changes in depressive symptoms and life satisfaction during V-CBT in German routine outpatient care for patients with depressive disorders, (2) the quality of the established working alliance, and (3) the influence of working alliance and the patients’ technology commitment on outcomes. <b><i>Patients and Methods:</i></b> Patients with primary diagnoses of depressive disorders were treated with V-CBT and concurrent internet-guided self-help via the MindDoc program, which operates within the regulations of the German health care system. The patients completed the 9-item Patient Health Questionnaire (PHQ-9) for depressive symptoms, an item on life satisfaction before and after treatment, the Working Alliance Inventory (WAI), and the Technology Commitment questionnaire for beliefs about handling technology. <b><i>Results:</i></b> Fifty-nine patients (71.2% female) with a mean age of 44.46 years (SD = 12.86) were included in the analyses. Longitudinal multilevel mixed models revealed improvements in depressive symptoms (Cohen’s <i>d</i> = 1.27) and life satisfaction (<i>d</i> = 0.80). The working alliance was good and showed a positive association with outcome, while technology commitment did not. <b><i>Conclusion:</i></b> V-CBT seems effective in reducing depressive symptoms, increasing life satisfaction, and establishing a good working alliance in routine care.
Collapse
|
10
|
Vollert B, von Bloh P, Eiterich N, Beintner I, Hütter K, Taylor CB, Jacobi C. Recruiting participants to an Internet-based eating disorder prevention trial: Impact of the recruitment strategy on symptom severity and program utilization. Int J Eat Disord 2020; 53:476-484. [PMID: 32112593 DOI: 10.1002/eat.23250] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 02/05/2020] [Accepted: 02/09/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Using data from a randomized controlled trial, we examined two different strategies to recruit participants for an indicated preventive intervention (StudentBodies-AN) for women at risk for anorexia nervosa and compared symptom severity and program utilization in participants recruited through each strategy. METHOD We recruited participants by announcing the study (a) in lectures at universities and handing out screening questionnaires (face-to-face recruitment) and (b) through different media channels, and the participants completed the screening questionnaire on our study website (media-based recruitment). We compared symptom severity and program utilization between the two groups. RESULTS A total of 4,646 women (face-to-face: 3,741, media-based: 905) were screened and 168 women (face-to-face: 114, media-based: 54) were randomized to the intervention. We found a statistically and clinically significant association between recruitment strategy and symptom severity: Participants who were recruited through media were more likely to fulfill the inclusion criteria (40.6% vs. 13.3%; p < .001) and endorsed significantly more frequently core behaviors and attitudes of disordered eating (EDE global score: 2.72 vs. 2.17, p < .05; Weight Concerns Scale [WCS] score: 66.05 vs. 56.40, p < .05) at baseline than participants recruited face-to-face. Also, participants recruited through media were more likely to log onto the program (χ2 = 5.06; p = .029) and accessed more of the intervention. DISCUSSION Recruitment through media seems both more feasible and suitable to reach individuals in need of indicative prevention, and should be part of a multimodal recruitment package. Future studies should be explicitly designed to investigate the impact of recruitment modality on reach and effectiveness including cost-effectiveness analyses.
Collapse
Affiliation(s)
- Bianka Vollert
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Paula von Bloh
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Nadine Eiterich
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Ina Beintner
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Kristian Hütter
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Craig Barr Taylor
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA.,Center for m2 Health, Palo Alto University, Palo Alto, California, USA
| | - Corinna Jacobi
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| |
Collapse
|
11
|
Beintner I, Vollert B, Zarski AC, Bolinski F, Musiat P, Görlich D, Ebert DD, Jacobi C. Adherence Reporting in Randomized Controlled Trials Examining Manualized Multisession Online Interventions: Systematic Review of Practices and Proposal for Reporting Standards. J Med Internet Res 2019; 21:e14181. [PMID: 31414664 PMCID: PMC6713038 DOI: 10.2196/14181] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 06/07/2019] [Accepted: 06/27/2019] [Indexed: 02/02/2023] Open
Abstract
Background Adherence reflects the extent to which individuals experience or engage with the content of online interventions and poses a major challenge. Neglecting to examine and report adherence and its relation to outcomes can compromise the interpretation of research findings. Objective The aim of this systematic review is to analyze how adherence is accounted for in publications and to propose standards for measuring and reporting adherence to online interventions. Methods We performed a systematic review of randomized controlled trials on online interventions for the prevention and treatment of common mental disorders (depression, anxiety disorders, substance related disorders, and eating disorders) published between January 2006 and May 2018 and indexed in Medline and Web of Science. We included primary publications on manualized online treatments (more than 1 session and successive access to content) and examined how adherence was reported in these publications. Results We identified 216 publications that met our inclusion criteria. Adherence was addressed in 85% of full-text manuscripts, but only in 31% of abstracts. A median of three usage metrics were reported; the most frequently reported usage metric (61%) was intervention completion. Manuscripts published in specialized electronic health journals more frequently included information on the relation of adherence and outcomes. Conclusions We found substantial variety in the reporting of adherence and the usage metrics used to operationalize adherence. This limits the comparability of results and impedes the integration of findings from different studies. Based on our findings, we propose reporting standards for future publications on online interventions.
Collapse
Affiliation(s)
- Ina Beintner
- Faculty of Psychology, School of Science, Technische Universität Dresden, Dresden, Germany
| | - Bianka Vollert
- Faculty of Psychology, School of Science, Technische Universität Dresden, Dresden, Germany
| | - Anna-Carlotta Zarski
- Institute of Psychology, Faculty of Humanities, Social Sciences, and Theology, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Felix Bolinski
- Department of Clinical, Neuro- and Developmental Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Peter Musiat
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Dennis Görlich
- Institute of Biostatistics and Clinical Research, Faculty of Medicine, Westfälische Wilhelms-Universität Münster, Münster, Germany
| | - David Daniel Ebert
- Institute of Psychology, Faculty of Humanities, Social Sciences, and Theology, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Corinna Jacobi
- Faculty of Psychology, School of Science, Technische Universität Dresden, Dresden, Germany
| |
Collapse
|
12
|
Beintner I, Emmerich OLM, Vollert B, Taylor CB, Jacobi C. Promoting positive body image and intuitive eating in women with overweight and obesity via an online intervention: Results from a pilot feasibility study. Eat Behav 2019; 34:101307. [PMID: 31220739 DOI: 10.1016/j.eatbeh.2019.101307] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 06/07/2019] [Accepted: 06/10/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Body dissatisfaction and dietary restraint are established risk factors for eating disorders and are also prevalent in individuals who are overweight and obese. Studies have shown that online prevention programs can lower these risk factors. The aim of this feasibility pilot study was to estimate effects of a 12-week online health promotion and eating disorder prevention program in a sample of women with overweight or obesity, but without binge eating. METHODS The program was evaluated in an uncontrolled pre-post-follow-upstudy over 12 months. Outcome measures were eating disorder related cognitions and attitudes. Participants were recruited via flyers, online posts, press releases, and mailings through cooperating health insurances. RESULTS 371 women who completed the screening met the inclusion criteria. 323 women took part in the baseline assessment and were granted access to the intervention. 50 women completed all sessions. An intention-to-treat analysis showed significant and long-term reductions in weight and shape concerns, restrictive eating and increases in life satisfaction and self-esteem (d = 0.31-0.86), and a short-term increase in fruit and vegetable consumption (d = 0.70). CONCLUSION everyBody fit seems a feasible program for improving body image and reducing disordered eating in overweight and obese women, with medium to large effects on various outcomes. The efficacy of the intervention needs to be established in a randomized controlled trial.
Collapse
Affiliation(s)
- Ina Beintner
- Chair of Clinical Psychology and E-Mental-Health, Technische Universität Dresden, 01062 Dresden, Germany.
| | | | - Bianka Vollert
- Chair of Clinical Psychology and E-Mental-Health, Technische Universität Dresden, 01062 Dresden, Germany
| | - C Barr Taylor
- Department of Psychiatry and Behavioral Sciences, Stanford University Medical Center, Stanford, CA, USA; Center for m(2) Health, Palo Alto University, Palo Alto, CA, USA
| | - Corinna Jacobi
- Chair of Clinical Psychology and E-Mental-Health, Technische Universität Dresden, 01062 Dresden, Germany
| |
Collapse
|
13
|
Spencer L, Schmidt-Hantke J, Allen K, Gordon G, Potterton R, Musiat P, Hagner F, Beintner I, Vollert B, Nacke B, Görlich D, Beecham J, Bonin EM, Jacobi C, Schmidt U. A web-based intervention for carers of individuals with anorexia nervosa (We Can): Trial protocol of a randomised controlled trial investigating the effectiveness of different levels of support. Internet Interv 2019; 16:76-85. [PMID: 30775267 PMCID: PMC6364327 DOI: 10.1016/j.invent.2018.02.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 02/17/2018] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Anorexia nervosa (AN) is a life-threatening mental disorder that is associated with substantial caregiver burden. Carers of individuals with AN report high levels of distress and self-blame, and insufficient knowledge to help their loved ones. However, carers can have a very important role to play in aiding recovery from AN, and are often highly motivated to assist in the treatment process. This manuscript presents the protocol for a randomised controlled trial (RCT) of We Can, a web-based intervention for carers for people with AN. The study aims to investigate the effectiveness of We Can delivered with different intensities of support. METHODS The study takes the form of a multi-site, two-country, three group RCT, comparing We Can (a) with clinician messaging support (We Can-Ind), (b) with moderated carer chatroom support (We Can-Chat) and (c) with online forum only (We Can-Forum). Participants will be 303 carers of individuals with AN as well as, where possible, the individuals with AN themselves. Recruitment will be via specialist eating disorder services and carer support services in the UK and Germany. Randomisation of carers to one of the three intervention conditions in a 1:1:1 ratio will be stratified by whether or not the individual with AN has (a) agreed to participate in the study and (b) is a current inpatient. The We Can intervention will be provided to carers online over a period of 12 weeks. Participants will complete self-report questionnaires at pre-intervention (T1), mid-intervention (mediators only; 4-weeks post-randomisation), post-intervention (T2; 3-months post randomisation), and 6 months (T3) and 12 months (T4) after randomisation. The primary outcome variables are carer symptoms of depression and anxiety. Secondary outcome variables will be measured in both carers and individuals with AN. Secondary carer outcome variables will include alcohol and drug use and quality of life, caregiving behaviour, and the acceptability and use of We Can and associated supports. Secondary outcomes measured in individuals with AN will include eating disorder symptoms, and symptoms of depression and anxiety. The study will also evaluate the cost-effectiveness of the three We Can conditions, and test for mediators and moderators of the effects of We Can. The trial is registered at the International Standard Randomisation Controlled Trial Number (ISRCTN) database, registration number: ISRCTN11399850. DISCUSSION The study will provide insight into the effectiveness of We Can and its optimal method/s of delivery.
Collapse
Key Words
- AESED, accommodation and enabling scale for eating disorders
- AN, anorexia nervosa
- AQoL-8D, assessment of quality of Life-8D
- AUDIT, alcohol use disorders identification test
- Anorexia nervosa
- BDSEE, brief dyadic scale of expressed emotion
- BFI-10, Big Five – 10 item version
- BMI, body mass index
- CASK, caregiver skills scale
- CD-RISC-10, Connor–Davidson resilience scale-10
- CEQ, adapted credibility/expectancy questionnaire
- CSRI, client service receipt inventory
- Carer support
- DUDIT, drug use disorders identification test
- E-treatment
- ECI, experience of caregiving inventory
- EDE-Q, eating disorder examination-questionnaire
- EDSIS, eating disorders symptom impact scale
- GAD-7, generalized anxiety disorder (GAD)-7 scale
- ICare
- Mental health
- OAO, overcoming anorexia online
- Online interventions
- PHQ-9, patient health questionnaire 9-item depression scale
- RCT, randomised controlled trial
- RSE, rosenberg self-esteem scale
- WAI-SR, adapted working alliance inventory – short revised
- WHOQOL, World Health Organisation quality of life scale
- We Can-Chat, We Can with moderated carer chatroom support
- We Can-Forum, We Can with online forum support only
- We Can-Ind, We Can with clinician email support
Collapse
Affiliation(s)
- Lucy Spencer
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Section of Eating Disorders, PO Box 59, 16, De Crespigny Park, London, SE5 8AF, UK
| | - Juliane Schmidt-Hantke
- Technische Universität Dresden, Institut für Klinische Psychologie & Psychotherapie, Chemnitzer Str. 46, D-01187 Dresden, Germany
| | - Karina Allen
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Section of Eating Disorders, PO Box 59, 16, De Crespigny Park, London, SE5 8AF, UK
- The Eating Disorders Service, Maudsley Hospital, South London & Maudsley NHS Foundation Trust, UK
| | - Gemma Gordon
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Section of Eating Disorders, PO Box 59, 16, De Crespigny Park, London, SE5 8AF, UK
| | - Rachel Potterton
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Section of Eating Disorders, PO Box 59, 16, De Crespigny Park, London, SE5 8AF, UK
| | - Peter Musiat
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Section of Eating Disorders, PO Box 59, 16, De Crespigny Park, London, SE5 8AF, UK
| | - Franziska Hagner
- Technische Universität Dresden, Institut für Klinische Psychologie & Psychotherapie, Chemnitzer Str. 46, D-01187 Dresden, Germany
| | - Ina Beintner
- Technische Universität Dresden, Institut für Klinische Psychologie & Psychotherapie, Chemnitzer Str. 46, D-01187 Dresden, Germany
| | - Bianka Vollert
- Technische Universität Dresden, Institut für Klinische Psychologie & Psychotherapie, Chemnitzer Str. 46, D-01187 Dresden, Germany
| | - Barbara Nacke
- Technische Universität Dresden, Institut für Klinische Psychologie & Psychotherapie, Chemnitzer Str. 46, D-01187 Dresden, Germany
| | - Dennis Görlich
- Westfälische Wilhelms-Universität Münster, Institut für Biometrie und Klinische Forschung, Schmedingstraße 56, Münster, Germany
| | - Jennifer Beecham
- Personal Social Services Research Unit, London School of Economics and Political Science, Houghton Street, London WC2A 2AE, UK
| | - Eva-Maria Bonin
- Personal Social Services Research Unit, London School of Economics and Political Science, Houghton Street, London WC2A 2AE, UK
| | - Corinna Jacobi
- Technische Universität Dresden, Institut für Klinische Psychologie & Psychotherapie, Chemnitzer Str. 46, D-01187 Dresden, Germany
| | - Ulrike Schmidt
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Section of Eating Disorders, PO Box 59, 16, De Crespigny Park, London, SE5 8AF, UK
- The Eating Disorders Service, Maudsley Hospital, South London & Maudsley NHS Foundation Trust, UK
| |
Collapse
|
14
|
Beintner I, Görlich D, Berger T, Ebert DD, Zeiler M, Herrero Camarano R, Waldherr K, Jacobi C. Interrelations between participant and intervention characteristics, process variables and outcomes in online interventions: A protocol for overarching analyses within and across seven clinical trials in ICare. Internet Interv 2019; 16:86-97. [PMID: 30775268 PMCID: PMC6364443 DOI: 10.1016/j.invent.2018.05.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 05/23/2018] [Accepted: 05/23/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND It is well known that web-based interventions can be effective treatments for various conditions. Less is known about predictors, moderators, and mediators of outcome and especially interrelations between participant and interventions characteristics, process variables and outcomes in online interventions. Clinical trials often lack statistical power to detect variables that affect intervention effects and their interrelations. Within ICare, we can investigate the interrelation of potential predictor and process variables in a large sample. METHOD The ICare consortium postulated a model of interrelations between participant and intervention characteristics, process variables and outcomes in online interventions. We will assess general and disorder-specific interrelations between characteristics of the intervention, characteristics of the participants, adherence, working alliance, early response, and intervention outcomes in a sample of over 7500 participants from seven clinical trials evaluating 15 online interventions addressing a range of mental health conditions and disorders, using an individual participant data meta-analyses approach. DISCUSSION/CONCLUSION Existing research tends to support the efficacy of online mental health interventions, but the knowledge base regarding factors that affect intervention effects needs to be expanded. The overarching analyses using data from the ICare intervention trials will add considerably to the evidence.
Collapse
Affiliation(s)
- Ina Beintner
- Technische Universität Dresden, School of Science, Department of Psychology, Chair of Clinical Psychology and E-Mental-Health, Dresden, Germany
| | - Dennis Görlich
- Westfälische Wilhelms-Universität Münster, Institut für Biometrie und Klinische Forschung, Schmedingstraße 56, Münster, Germany
| | - Thomas Berger
- Universität Bern, Department of Clinical Psychology and Psychotherapy, Bern, Switzerland
| | - David Daniel Ebert
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Department of Clinical Psychology and Psychotherapy, Nägelsbachstr 25a, Erlangen, Germany
| | - Michael Zeiler
- Medizinische Universität Wien, Department for Child and Adolescent Psychiatry, Waehringer Guertel 18-20, Vienna, Austria
| | | | - Karin Waldherr
- Ferdinand PorscheFernFH Distance-Learning University of Applied Sciences, Wien, Austria
| | - Corinna Jacobi
- Technische Universität Dresden, School of Science, Department of Psychology, Chair of Clinical Psychology and E-Mental-Health, Dresden, Germany
| | | |
Collapse
|
15
|
Beintner I, Jacobi C. Internet-based aftercare for women with bulimia nervosa following inpatient treatment: The role of adherence. Internet Interv 2019; 15:67-75. [PMID: 30723692 PMCID: PMC6350217 DOI: 10.1016/j.invent.2018.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 11/06/2018] [Accepted: 11/07/2018] [Indexed: 11/03/2022] Open
Abstract
Facing poor long-term outcome and high relapse rates in the treatment of bulimia nervosa, we developed an Internet-based aftercare program for women with severe and chronic bulimia nervosa following inpatient treatment based on previous experiences with self-directed targeted prevention and early intervention programs delivered online. The aim of the present study was to examine adherence to the program in detail, to explore potential variables that predict adherence and to analyze whether adherence affects outcomes. We analyzed data from 126 women in the intervention group of a randomized controlled trial. 107 women (85%) logged on to the program platform at least once. These women opened on average 42.8% (SD = 31.9%) of all assigned program pages. Adherence declined during the course of the intervention. Adherence was not associated with the number of outpatient treatment sessions received during the intervention period. Adherence was not related to overall illness severity or duration at baseline. However, excessive exercise at hospital discharge (which may be a sign of insufficient motivation to change eating disorder related behaviors) seems to play some small role in adherence. Adherence did not affect intervention outcomes. Based on our findings, we would like to advocate further research on online aftercare interventions for women with severe and chronic bulimia nervosa.
Collapse
Affiliation(s)
| | - Corinna Jacobi
- Chair of Clinical Psychology, E-Mental-Health, Technische Universität Dresden, 01062 Dresden, Germany
| |
Collapse
|
16
|
Beintner I, Jacobi C. Are we overdosing treatment? Secondary findings from a study following women with bulimia nervosa after inpatient treatment. Int J Eat Disord 2018; 51:899-905. [PMID: 30070386 DOI: 10.1002/eat.22894] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 05/15/2018] [Accepted: 05/15/2018] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Provision of eating disorder (ED) treatment in practice is often guided by national health service structures rather than evidence-based treatment recommendations. Especially for more severely or chronically ill patients, clinicians seem to advocate a "the more the better" strategy of treatment provision. Exploring the dose-response relationship in ED treatment may shed light on both beneficial and detrimental effects of prolonged treatment provision. METHOD We utilized data from 64 women from the treatment-as-usual (TAU) group of a randomized controlled trial on Internet-based aftercare for women with bulimia nervosa who had received inpatient treatment. We examined the relationship between treatment duration and dose and (1) baseline patient characteristics and (2) treatment outcomes (abstinence from binge eating and compensatory behaviors, frequency of binge eating and vomiting, thin ideal internalization, and general psychopathology) at 18-month follow up. RESULTS On average, the women in our study were hospitalized for 9 weeks and most received high doses of subsequent outpatient psychotherapy (median: 45 sessions). The severity of symptoms that a patient experienced at hospital admission or discharge was largely unrelated to the amount of outpatient treatment she subsequently received. Longer inpatient treatments or higher doses of subsequent outpatient treatment did not result in more favorable outcomes. DISCUSSION Our findings suggest that, instead of providing costly long treatment without evidenced benefit to patients, there is a need for further exploration of and discussion about the risks and benefits of providing high doses of treatment for both individuals and the health care system.
Collapse
Affiliation(s)
- Ina Beintner
- Technische Universität Dresden, Institute of Clinical Psychology and Psychotherapy, Chemnitzer Straße 46, 01187, Dresden, Germany
| | - Corinna Jacobi
- Technische Universität Dresden, Institute of Clinical Psychology and Psychotherapy, Chemnitzer Straße 46, 01187, Dresden, Germany
| |
Collapse
|
17
|
Beecham J, Bonin EM, Görlich D, Baños R, Beintner I, Buntrock C, Bolinski F, Botella C, Ebert DD, Herrero R, Potterton R, Riper H, Schmidt U, Waldherr K, Weisel K, Zarski AC, Zeiler M, Jacobi C. Assessing the costs and cost-effectiveness of ICare internet-based interventions (protocol). Internet Interv 2018; 16:12-19. [PMID: 30775260 PMCID: PMC6364355 DOI: 10.1016/j.invent.2018.02.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 02/19/2018] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Mental health problems are common and place a burden on the individual as well as on societal resources. Despite the existence of evidence-based treatments, access to treatment is often prevented or delayed due to insufficient health care resources. Effective internet-based self-help interventions have the potential to reduce the risk for mental health problems, to successfully bridge waiting time for face-to-face treatment and to address inequities in access. However, little is known about the cost-effectiveness of such interventions. This paper describes the study protocol for the economic evaluation of the studies that form the ICare programme of internet-based interventions for the prevention and treatment of a range of mental health problems. METHODS An overarching work package within the ICare programme was developed to assess the cost-effectiveness of the internet-based interventions alongside the clinical trials. There are two underlying tasks in the ICare economic evaluation. First, to develop schedules that generate equivalent and comparable information on use of services and supports across seven countries taking part in clinical trials of different interventions and second, to estimate unit costs for each service and support used. From these data the cost per person will be estimated by multiplying each participant's use of each service by the unit cost for that service. Additionally, productivity losses will be estimated. This individual level of cost data matches the level of outcome data used in the clinical trials. Following the analyses of service use and costs data, joint analysis of costs and outcomes will be undertaken to provide findings on the relative cost-effectiveness of the interventions, taking both a public sector and a societal perspective. These analyses use a well-established framework, the Production of Welfare approach, and standard methods and techniques underpinned by economic theory. DISCUSSION/CONCLUSION Existing research tends to support the effectiveness of internet-based interventions, but there is little information on their cost-effectiveness compared to 'treatment as usual'. The economic evaluation of ICare interventions will add considerably to this evidence base.
Collapse
Affiliation(s)
- Jennifer Beecham
- Personal Social Services Research Unit, London School of Economics and Political Science, Houghton Street, London WC2A 2AE, UK,Personal Social Services Research Unit, University of Kent, Canterbury, UK,Corresponding author at: Personal Social Services Research Unit, London School of Economics and Political Science, Houghton Street, London WC2A 2AE, UK.
| | - Eva-Maria Bonin
- Personal Social Services Research Unit, London School of Economics and Political Science, Houghton Street, London WC2A 2AE, UK
| | - Dennis Görlich
- Westfälische Wilhelms-Universität Münster, Institut für Biometrie und Klinische Forschung, Schmedingstraße 56, Münster, Germany
| | - Rosa Baños
- Universidad de Valencia, Spain,CIBERObn, Instituto Salud Carlos III, Spain
| | - Ina Beintner
- TechnischeUniversität Dresden, School of Science, Faculty of Psychology, Chair ofClinical Psychology and E-Mental-Health, 01062 Dresden, Germany
| | | | - Felix Bolinski
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, The Netherlands,Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Cristina Botella
- CIBERObn, Instituto Salud Carlos III, Spain,Jaume I University, Castellon, Spain
| | | | | | - Rachel Potterton
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Box P059, De Crespigny Park, London SE5 8AF, UK
| | - Heleen Riper
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, The Netherlands,Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Ulrike Schmidt
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Box P059, De Crespigny Park, London SE5 8AF, UK
| | - Karin Waldherr
- FernFH Distance Learning University of Applied Sciences, Zulingergasse 4, Wiener Neustadt, Austria
| | - Kiona Weisel
- Friedrich-Alexander Universität Erlangen-Nürnberg, Germany
| | - Anna-Carlotta Zarski
- Friedrich-Alexander Universität Erlangen-Nürnberg, Germany,Leuphana University, Innovation Incubator, Division Health Trainings Online, Lüneburg, Germany
| | - Michael Zeiler
- Medical University of Vienna, Department for Child and Adolescent Psychiatry, Waehringer Guertel 18-20, Vienna, Austria
| | - Corinna Jacobi
- TechnischeUniversität Dresden, School of Science, Faculty of Psychology, Chair ofClinical Psychology and E-Mental-Health, 01062 Dresden, Germany
| |
Collapse
|
18
|
Vollert B, Beintner I, Musiat P, Gordon G, Görlich D, Nacke B, Schmidt-Hantke J, Potterton R, Spencer L, Grant N, Schmidt U, Jacobi C. Using internet-based self-help to bridge waiting time for face-to-face outpatient treatment for Bulimia Nervosa, Binge Eating Disorder and related disorders: Study protocol of a randomized controlled trial. Internet Interv 2018; 16:26-34. [PMID: 30775262 PMCID: PMC6364326 DOI: 10.1016/j.invent.2018.02.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 02/19/2018] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Eating disorders are serious conditions associated with an impaired health-related quality of life and increased healthcare utilization and costs. Despite the existence of evidence-based treatments, access to treatment is often delayed due to insufficient health care resources. Internet-based self-help interventions may have the potential to successfully bridge waiting time for face-to-face outpatient treatment and, thus, contribute to overcoming treatment gaps. However, little is known about the feasibility of implementing such interventions into routine healthcare. The aim of this study is to analyze the effects and feasibility of an Internet-based self-help intervention (everyBody Plus) specifically designed for patients with Bulimia Nervosa, Binge Eating Disorder and other specified feeding and eating disorders (OSFED) on a waiting list for outpatient face-to-face treatment. The aim of this paper is to describe the study protocol. METHODS A multi-country randomized controlled trial will be conducted in Germany and the UK. N = 275 female patients awaiting outpatient treatment will be randomly allocated either to the guided online self-help intervention "everyBody Plus" or a waitlist control group condition without access to the intervention. everyBody Plus comprises eight weekly sessions that cover topics related to eating and exercise patterns, coping with negative emotions and stress as well as improving body image. Participants will receive weekly individualized feedback based on their self-monitoring and journal entries. Assessments will take place at baseline, post-intervention as well as at 6- and 12-months follow up. In addition, all participants will be asked to monitor core eating disorder symptoms weekly to provide data on the primary outcome. The primary outcome will be number of weeks after randomization until a patient achieves a clinically relevant improvement in core symptoms (BMI, binge eating, compensatory behaviors) for the first time. Secondary outcomes include frequency of core symptoms and eating disorder related attitudes and behaviors, as well as associated psychopathology. Additional secondary outcomes will be the participating therapists' confidence in treating eating disorders as well as perceived benefits of everyBody Plus for patients. DISCUSSION To the best of our knowledge, this is the first randomized controlled trial examining the effects of Internet-based self-help for outpatients with eating disorders awaiting face-to-face outpatient treatment. If proven to be effective and successfully implemented, Internet-based self-help programs might be used as a first step of treatment within a stepped-care approach, thus reducing burden and cost for both patients and health care providers.
Collapse
Affiliation(s)
- Bianka Vollert
- Technische Universität Dresden, Institut für Klinische Psychologie und Psychotherapie, Chemnitzer Str. 46, D-01187 Dresden, Germany,Corresponding author.
| | - Ina Beintner
- Technische Universität Dresden, Institut für Klinische Psychologie und Psychotherapie, Chemnitzer Str. 46, D-01187 Dresden, Germany
| | - Peter Musiat
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Box P059, De Crespigny Park, London SE5 8AF, UK
| | - Gemma Gordon
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Box P059, De Crespigny Park, London SE5 8AF, UK
| | - Dennis Görlich
- Westfälische Wilhelms-Universität Münster, Institute of Biostatistics and Clinical Research, Schmeddingstraße 56, Münster, Germany
| | - Barbara Nacke
- Technische Universität Dresden, Institut für Klinische Psychologie und Psychotherapie, Chemnitzer Str. 46, D-01187 Dresden, Germany
| | - Juliane Schmidt-Hantke
- Technische Universität Dresden, Institut für Klinische Psychologie und Psychotherapie, Chemnitzer Str. 46, D-01187 Dresden, Germany
| | - Rachel Potterton
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Box P059, De Crespigny Park, London SE5 8AF, UK
| | - Lucy Spencer
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Box P059, De Crespigny Park, London SE5 8AF, UK
| | - Nina Grant
- South London and Maudsley NHS Foundation Trust, Eating Disorders Outpatient Unit, The Maudsley Hospital, Denmark Hill, London SE5 8AF, UK
| | - Ulrike Schmidt
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Box P059, De Crespigny Park, London SE5 8AF, UK
| | - Corinna Jacobi
- Technische Universität Dresden, Institut für Klinische Psychologie und Psychotherapie, Chemnitzer Str. 46, D-01187 Dresden, Germany
| |
Collapse
|
19
|
Nacke B, Beintner I, Görlich D, Vollert B, Schmidt-Hantke J, Hütter K, Taylor CB, Jacobi C. everyBody-Tailored online health promotion and eating disorder prevention for women: Study protocol of a dissemination trial. Internet Interv 2018; 16:20-25. [PMID: 30775261 PMCID: PMC6364518 DOI: 10.1016/j.invent.2018.02.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 02/19/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Although there is extensive evidence for the efficacy of online eating disorder (ED) prevention programs in clinical trials, these programs have rarely been adopted beyond the trial phase and offered to a wider audience. As risk factors for eating disorders are partly associated with overweight and overweight in turn is correlated to disordered eating, this study will offer a combined eating disorder prevention program which also promotes a balanced lifestyle to normal weight and overweight individuals alike. The efficacy of the program has been proven in previous trials. The study aims to evaluate the dissemination of a combined eating disorder prevention and health promotion program (everyBody) to women of all age groups and varying levels of ED risk status in the general population. METHODS A dissemination trial will be conducted in German-speaking countries, including 4160 women from the general population. Participants will be screened to exclude participants who are likely to have an ED. Eligible participants will be allocated to one of five program arms based on their BMI and respective ED symptoms. The guided program consists of 4 to 12 weeks of weekly sessions offering CBT-based exercises, psychoeducational material, self-monitoring, and group discussions. Outcomes will be assessed according to the RE-AIM model, including measures of effectiveness, reach, adoption, implementation, and maintenance of the program. DISCUSSION/CONCLUSIONS This trial aims to disseminate a combined ED prevention and health promotion program in the general population, offering universal, selective and indicated prevention in one program. To our knowledge, it is the first trial to systematically evaluate dissemination efforts based on the RE-AIM model. This trial will be conducted as part of the EU-funded ICare (Integrating Technology into Mental Health Care Delivery in Europe) project.
Collapse
Affiliation(s)
- Barbara Nacke
- Technische Universität Dresden, Institut für Klinische Psychologie & Psychotherapie, Chemnitzer Str. 46, 01187 Dresden, Germany,Corresponding author.
| | - Ina Beintner
- Technische Universität Dresden, Institut für Klinische Psychologie & Psychotherapie, Chemnitzer Str. 46, 01187 Dresden, Germany
| | - Dennis Görlich
- Westfälische Wilhelms-Universität Münster, Institut für Biometrie und Klinische Forschung, Schmeddingstraße 56, 48149 Münster, Germany
| | - Bianka Vollert
- Technische Universität Dresden, Institut für Klinische Psychologie & Psychotherapie, Chemnitzer Str. 46, 01187 Dresden, Germany
| | - Juliane Schmidt-Hantke
- Technische Universität Dresden, Institut für Klinische Psychologie & Psychotherapie, Chemnitzer Str. 46, 01187 Dresden, Germany
| | - Kristian Hütter
- Technische Universität Dresden, Institut für Klinische Psychologie & Psychotherapie, Chemnitzer Str. 46, 01187 Dresden, Germany
| | - C. Barr Taylor
- Stanford School of Medicine, Psychiatry Department, 401 Quarry Rd, Stanford CA94305, USA
| | - Corinna Jacobi
- Technische Universität Dresden, Institut für Klinische Psychologie & Psychotherapie, Chemnitzer Str. 46, 01187 Dresden, Germany
| |
Collapse
|
20
|
Beintner I, Jacobi C. Impact of telephone prompts on the adherence to an Internet-based aftercare program for women with bulimia nervosa: A secondary analysis of data from a randomized controlled trial. Internet Interv 2017; 15:100-104. [PMID: 30792960 PMCID: PMC6371202 DOI: 10.1016/j.invent.2017.11.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 11/02/2017] [Accepted: 11/06/2017] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Poor adherence is a common challenge in self-directed mental health interventions. Research findings indicate that telephone prompts may be useful to increase adherence. METHOD Due to poor adherence in a randomized controlled trial evaluating an Internet-based aftercare program for women with bulimia nervosa we implemented regular short telephone prompts into the study protocol halfway through the trial period. Of the 126 women in the intervention group, the first 63 women were not prompted by telephone (unprompted group) and compared with 63 women who subsequently enrolled into the study and were attempted to prompt bimonthly by a research assistant (telephone prompt group). Completed telephone calls took less than 5 min and did not include any symptom-related counseling. RESULTS Most of the women in the telephone prompt group (67%) were reached only once or twice during the intervention period. However, overall adherence in the telephone prompt group was significantly higher than in the unprompted group (T = - 3.015, df = 124, p = 0.003). CONCLUSION Our findings from this secondary analysis suggest that telephone prompts can positively affect adherence to an Internet-based aftercare intervention directed at patients with bulimia nervosa.
Collapse
Affiliation(s)
- Ina Beintner
- Corresponding author at: Technische Universität Dresden, Klinische Psychologie & Psychotherapie, Chemnitzer Str. 46, D-01187, Dresden.
| | | |
Collapse
|
21
|
Jacobi C, Beintner I, Fittig E, Trockel M, Braks K, Schade-Brittinger C, Dempfle A. Web-Based Aftercare for Women With Bulimia Nervosa Following Inpatient Treatment: Randomized Controlled Efficacy Trial. J Med Internet Res 2017; 19:e321. [PMID: 28939544 PMCID: PMC5630693 DOI: 10.2196/jmir.7668] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 06/11/2017] [Accepted: 07/04/2017] [Indexed: 02/03/2023] Open
Abstract
Background Relapse rates in bulimia nervosa (BN) are high even after successful treatment, but patients often hesitate to take up further treatment. An easily accessible program might help maintain treatment gains. Encouraged by the effects of Web-based eating disorder prevention programs, we developed a manualized, Web-based aftercare program (IN@) for women with BN following inpatient treatment. Objective The objective of this study was to determine the efficacy of the web-based guided, 9-month, cognitive-behavioral aftercare program IN@ for women with BN following inpatient treatment. Methods We conducted a randomized controlled efficacy trial in 253 women with DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, fourth edition) BN and compared the results of IN@ with treatment as usual (TAU). Assessments were carried out at hospital admission (T0), hospital discharge/baseline (T1), postintervention (T2; 9 months after baseline), 9-month follow-up (T3; 18 months after baseline). The primary outcome, abstinence from binge eating and compensatory behaviors during the 2 months preceding T2, was analyzed by intention to treat, using logistic regression analyses. Frequencies of binge eating and vomiting episodes, and episodes of all compensatory behaviors were analyzed using mixed effects models. Results At T2, data from 167 women were available. There were no significant differences in abstinence rates between the TAU group (n=24, 18.9%) and the IN@ group (n=27, 21.4%; odds ratio, OR=1.29; P=.44). The frequency of vomiting episodes in the IN@ group was significantly (46%) lower than in the TAU group (P=.003). Moderator analyses revealed that both at T2 and T3, women of the intervention group who still reported binge eating and compensatory behaviors after inpatient treatment benefited from IN@, whereas women who were already abstinent after the inpatient treatment did not (P=.004; P=.002). Additional treatment utilization was high in both groups between baseline and follow-up. Conclusions Overall, data from this study suggest moderate effects of IN@. High rates of outpatient treatment utilization after inpatient treatment may have obscured potential intervention effects on abstinence. An aftercare intervention might be more beneficial as part of a stepped-care approach. Trial Registration International Standard Randomized Controlled Trial Number (ISRCTN): 08870215; http://www.isrctn.com/ISRCTN08870215 (Archived by WebCite at http://www.webcitation.org/6soA5bIit)
Collapse
Affiliation(s)
- Corinna Jacobi
- Institut für Klinische Psychologie und Psychotherapie, Professur Klinische Psychologie & E-Mental Health, Technische Universität Dresden, Dresden, Germany
| | - Ina Beintner
- Institut für Klinische Psychologie und Psychotherapie, Professur Klinische Psychologie & E-Mental Health, Technische Universität Dresden, Dresden, Germany
| | - Eike Fittig
- Celenus Klinik Carolabad, Medizinisches Rehabilitationszentrum für Psychotherapie, Psychiatrie und Psychosomatik, Chemnitz, Germany
| | - Mickey Trockel
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | | | - Carmen Schade-Brittinger
- Koordinierungszentrum für Klinische Studien Marburg, Philipps-Universität Marburg, Marburg, Germany
| | - Astrid Dempfle
- Institut für Medizinische Informatik und Statistik, Universitätsklinikum Schleswig-Holstein, Christian-Albrechts-Universität zu Kiel, Kiel, Germany
| |
Collapse
|
22
|
Beintner I, Jacobi C, Schmidt UH. Participation and outcome in manualized self-help for bulimia nervosa and binge eating disorder - a systematic review and metaregression analysis. Clin Psychol Rev 2014; 34:158-76. [PMID: 24508686 DOI: 10.1016/j.cpr.2014.01.003] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 01/07/2014] [Accepted: 01/14/2014] [Indexed: 02/02/2023]
Abstract
There is a growing body of research on manualized self-help interventions for bulimia nervosa (BN) and binge eating disorder (BED). Study and treatment dropout and adherence represent particular challenges in these studies. However, systematic investigations of the relationship between study, intervention and patient characteristics, participation, and intervention outcomes are lacking. We conducted a systematic literature review using electronic databases and hand searches of relevant journals. In metaregression analyses, we analyzed study dropout as well as more specific measures of treatment participation in manualized self-help interventions, their association with intervention characteristics (e.g. duration, guidance, intervention type [bibliotherapy, CD-ROM or Internet based intervention]) and their association with treatment outcomes. Seventy-three publications reporting on 50 different trials of manualized self-help interventions for binge eating and bulimia nervosa published through July 9th 2012 were identified. Across studies, dropout rates ranged from 1% to 88%. Study dropout rates were highest in CD-ROM interventions and lowest in Internet-based interventions. They were higher in samples of BN patients, samples of patients with higher degrees of dietary restraint at baseline, lower age, and lower body mass index. Between 6% and 88% of patients completed the intervention to which they had been assigned. None of the patient, study and intervention characteristics predicted intervention completion rates. Intervention outcomes were moderated by the provision of personal guidance by a health professional, the number of guidance sessions as well as participants' age, BMI, and eating disorder related attitudes (Restraint, Eating, Weight and Shape Concerns) at baseline (after adjusting for study dropout and intervention completion rates). Guidance particularly improved adherence and outcomes in samples of patients with bulimia nervosa; specialist guidance led to higher intervention completion rates and larger intervention effects on some outcomes than non-specialist guidance. Self-help interventions have a place in the treatment of BN and BED, especially if the features of their delivery and indications are considered carefully. To better determine who benefits most from what kind and "dosage" of self-help interventions, we recommend the use of consistent terminology as well as uniform standards for reporting adherence and participation in future self-help trials.
Collapse
Affiliation(s)
- Ina Beintner
- Institut für Klinische Psychologie und Psychotherapie, Technische Universität Dresden, Chemnitzer Straße 46, 01187 Dresden, Germany.
| | - Corinna Jacobi
- Institut für Klinische Psychologie und Psychotherapie, Technische Universität Dresden, Chemnitzer Straße 46, 01187 Dresden, Germany.
| | - Ulrike H Schmidt
- King's College London, Institute of Psychiatry, Box P059, De Crespigny Park, London SE5 8AF, UK.
| |
Collapse
|
23
|
|
24
|
Beintner I, Jacobi C, Taylor CB. Effects of an Internet-based prevention programme for eating disorders in the USA and Germany--a meta-analytic review. Eur Eat Disord Rev 2011; 20:1-8. [PMID: 21796737 DOI: 10.1002/erv.1130] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
A cross-cultural comparison of a cognitive-behavioural, Internet-based, 8-week prevention programme for eating disorders (StudentBodies™) evaluated in the USA and in Germany was performed. Six US and four German randomized controlled trials with a total (N) of 990 female high school and college students were included in the review. Two of the US and two of the German trials explicitly addressed high risk samples in a selective prevention approach. Effect sizes for main outcomes (disordered eating, weight and shape concerns) were calculated at postintervention and at follow-up. The intervention was associated with moderate improvements in eating disorder-related attitudes, especially reductions of negative body image and the desire to be thin. The reported effects remained significant at follow-up. No clear differences between US and German samples could be found on any of the outcome measures at postintervention. In conclusion, StudentBodies™ seems equally suitable and effective for American and German students.
Collapse
Affiliation(s)
- Ina Beintner
- Institut für Klinische Psychologie und Psychotherapie, Technische Universität Dresden, Dresden, Germany.
| | | | | |
Collapse
|