A pilot trial of an online guided self-help cognitive behavioral therapy program for bulimia nervosa and binge eating disorder in Japanese patients

BackgroundThe purpose of this study was to develop an internet-based Guided Self-Help CBT (iGSH-CBT) for Bulimia Nervosa (BN) / Binge Eating Disorder (BED) for Japanese patients and to test its feasibility.MethodsA single-arm feasibility study. After baseline assessment, patients underwent a 16-week iGSH-CBT program, our Japanese adaption of the European-based Salut BN program. During the treatment period, weekly email support from trained counselors was provided. Evaluations were performed at baseline, after 8 weeks, at the end of the 16-week intervention, and at 2 months after treatment had ended. The primary outcome measure was the change in the weekly frequency of objective binging. Secondary outcomes were the change in the weekly frequency of objective purge episodes, responses on self-report questionnaires of the frequencies of binging and purging, psychopathological characteristics of eating disorders found on BITE, EDE-Q, EDI-2, HADS and EQ-5D, measurements of motivation, and completion of intervention (vs. dropout).ResultsParticipants were 9 female outpatients with BN (n = 5) or BED (n = 4), of whom 8 (88.9%) attended the assessment at the end of the 16-week intervention. Mean age was 28 years (SD = 7.9). Percent change of the weekly frequency of objective binging was -4.40%, and at the end of the 16-week intervention 25% of the participants had achieved symptom abstinence.ConclusionsNo adverse events were observed during the treatment period and follow-up, and the implementation and operation of the program could be performed without any major problems, confirming the feasibility of iGSH-CBT for BN and BED for Japanese patients. Although no significant change was observed in the weekly frequency of objective binging, the abstinence rate from bulimic behaviors of those who completed the assessments was 25.0% at the end of treatment, and the drop-out rate was 11.1%. iGSH-CBT may be an acceptable and possibly even a preferred method of CBT delivery for Japanese patients with BN or BED, and our Japanese adaptation of Salut BN seems feasible.Trial registrationUMIN, UMIN000031962. Registered 1 April 2018 - Retrospectively registered, https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R00003633

The Potential of Technology-Based Psychological Interventions for Anorexia and Bulimia Nervosa: A Systematic Review and Recommendations for Future Research

Background: Previous studies have shown an unmet need in the treatment of eating disorders. In the last decade, interest in technology-based interventions (TBIs) (including computer-and Internet-based interventions [CBIs] or mobile interventions) for providing evidence-based therapies to individuals with different mental disorders has increased. Objective: The aim of this review was to systematically evaluate the potential of TBIs in the field of eating disorders, namely for anorexia nervosa (AN) and bulimia nervosa (BN),for both prevention and treatment, and also for carers of eating disorder patients. Methods: A systematic literature search was conducted using Medline and PsycINFO. Bibliographies of retrieved articles were also reviewed without date or study type restrictions. Results: Forty studies resulting in 45 publications reporting outcomes fulfilled the inclusion criteria: 22 randomized controlled trials, 2 controlled studies, and 16 uncontrolled studies. In total, 3646 patients were included. Overall, the studies provided evidence for the efficacy of guided CBIs, especially for BN patients and for compliant patients. Furthermore, videoconferencing also appeared to be a promising approach. Evaluation results of Internet-based prevention of eating disorders and Internet-based programs for carers of eating disorder patients were also encouraging. Finally, there was preliminary evidence for the efficacy of mobile interventions. Conclusions: TBIs may be an additional way of delivering evidence-based treatments to eating disorder patients and their use is likely to increase in the near future. TBIs may also be considered for the prevention of eating disorders and to support carers of eating disorder patients. Areas of future research and important issues such as guidance, therapeutic alliance, and dissemination are discussed

The Potential of Technology-Based Psychological Interventions for Anorexia and Bulimia Nervosa: A Systematic Review and Recommendations for Future Research

Background: Previous studies have shown an unmet need in the treatment of eating disorders. In the last decade, interest in technology-based interventions (TBIs) (including computer-and Internet-based interventions [CBIs] or mobile interventions) for providing evidence-based therapies to individuals with different mental disorders has increased. Objective: The aim of this review was to systematically evaluate the potential of TBIs in the field of eating disorders, namely for anorexia nervosa (AN) and bulimia nervosa (BN),for both prevention and treatment, and also for carers of eating disorder patients. Methods: A systematic literature search was conducted using Medline and PsycINFO. Bibliographies of retrieved articles were also reviewed without date or study type restrictions. Results: Forty studies resulting in 45 publications reporting outcomes fulfilled the inclusion criteria: 22 randomized controlled trials, 2 controlled studies, and 16 uncontrolled studies. In total, 3646 patients were included. Overall, the studies provided evidence for the efficacy of guided CBIs, especially for BN patients and for compliant patients. Furthermore, videoconferencing also appeared to be a promising approach. Evaluation results of Internet-based prevention of eating disorders and Internet-based programs for carers of eating disorder patients were also encouraging. Finally, there was preliminary evidence for the efficacy of mobile interventions. Conclusions: TBIs may be an additional way of delivering evidence-based treatments to eating disorder patients and their use is likely to increase in the near future. TBIs may also be considered for the prevention of eating disorders and to support carers of eating disorder patients. Areas of future research and important issues such as guidance, therapeutic alliance, and dissemination are discussed

Internet-based relapse prevention for anorexia nervosa: nine- month follow-up

To study the longer term effects of an internet-based CBT intervention for relapse prevention (RP) in anorexia nervosa

A Systematic Review of Predictors of, and Reasons for, Adherence to Online Psychological Interventions.

This author manuscript is made available following 12 month embargo from the date of publication (March 8 2016) in accordance with publisher copyright policy. The final publication is available at Springer via http://dx.doi.org/10.1007/s12529-016-9556-9.PURPOSE: A key issue regarding the provision of psychological therapy in a self-guided online format is low rates of adherence. The aim of this systematic review was to assess both quantitative and qualitative data on the predictors of adherence, as well as participant reported reasons for adhering or not adhering to online psychological interventions. METHODS: Database searches of PsycINFO, Medline, and CINAHL identified 1721 potentially relevant articles published between 1 January 2000 and 25 November 2015. A further 34 potentially relevant articles were retrieved from reference lists. Articles that reported predictors of, or reasons for, adherence to an online psychological intervention were included. RESULTS: A total of 36 studies met the inclusion criteria. Predictors assessed included demographic, psychological, characteristics of presenting problem, and intervention/computer-related predictors. Evidence suggested that female gender, higher treatment expectancy, sufficient time, and personalized intervention content each predicted higher adherence. Age, baseline symptom severity, and control group allocation had mixed findings. The majority of assessed variables however, did not predict adherence. CONCLUSIONS: Few clear predictors of adherence emerged overall, and most results were either mixed or too preliminary to draw conclusions. More research of predictors associated with adherence to online interventions is warranted

Screening, assessment and diagnosis in the eating disorders : findings from a rapid review

Background: Limited screening practices, minimal eating disorder training in the healthcare professions, and barriers related to help-seeking contribute to persistent low rates of eating disorder detection, significant unmet treatment need, and appreciable associated disease burden. The current review sought to broadly summarise the literature and identify gaps relating to the screening, assessment, and diagnosis of eating disorders within Western healthcare systems. Methods: This paper forms part of a Rapid Review series scoping the evidence base for the field of eating disorders, conducted to inform the Australian National Eating Disorders Research and Translation Strategy 2021–2031, funded and released by the Australian Government. ScienceDirect, PubMed and Ovid/Medline were searched for studies published between 2009 and mid 2021 in English. High-level evidence such as meta-analyses, large population studies and Randomised Control Trials were prioritised through purposive sampling. Data from selected studies relating to Screening, Assessment and Diagnosis of eating disorders were synthesised and are disseminated in the current review. Results: Eighty seven studies were identified, 38% relating to screening and 62% to assessment and diagnosis. The majority of screening studies were conducted in university student samples, showing high prevalence but only modest improvements in help-seeking in those studies that followed up post-screen. In healthcare settings, clinicians continue to have difficulty identifying eating disorder presentations, particularly Binge Eating Disorder, Other Specified Feeding or Eating Disorders, and sub-threshold eating disorders. This is preceded by inadequate and frequently homogenous screening mechanisms and exacerbated by considerable personal and health-system barriers, including self-stigma and lack of resourcing. While all groups are at risk of delayed or no diagnosis, those at particular risk include LGBTQ+ and gender diverse individuals, individuals living in larger bodies, and males. Conclusions: A majority of individuals with eating disorders remain undiagnosed and untreated despite a high prevalence of these conditions and increased advocacy in recent years. Research into improving detection and clinician diagnostic skill is extremely limited. Innovative empirical research is strongly recommended to address significant individual and health-system barriers currently preventing appropriate and timely intervention for many

Disordered eating and the relationships with post-traumatic stress, self-criticism, and fear of compassion

Section one reports on a quantitative systematic literature review examining the relationship between post-traumatic stress disorder and eating disorders within a military population. Six academic databases were systematically searched using key words related to the concepts of post-traumatic stress disorder, eating disorders, and military personnel and veterans. The findings suggested that there is a significant positive association between post-traumatic stress disorder and eating disorders within a military population. Females were at a greater likelihood than males of experiencing co-occurring post-traumatic stress disorder and eating disorders. Furthermore, longitudinal studies suggested a directional relationship wherein military personnel and veterans experiencing post-traumatic stress disorder were later more likely to engage in disordered eating behaviours. However, the majority of research reviewed was cross-sectional and related to US military veterans, therefore the area would benefit from additional studies, particularly those examining international active military service members and veterans. Section two reports on an empirical study examining the effect of fear of compassion on the relationship between self-criticism and disordered eating within an adult population. Individuals across the spectrum of disordered eating took part in an online survey. A series of mediation models were employed in order to explore the relationships between self-criticism, fear of compassion, and disordered eating. Findings indicated that the relationships between two forms of self-criticism, namely self-critical rumination and self-criticism in relation to a sense of personal inadequacy, and disordered eating were mediated by fear of both showing compassion to oneself and receiving compassion from others. These results highlight a need for the assessment of fear of compassion within therapeutic interventions for people who experience disordered eating, particularly in clients who experience high levels of self-criticism. Section three includes a critical appraisal of the thesis. It includes a summary of overall findings in addition to reflections upon key decision-making points

Racial/ethnic differences in binge-eating prevalence, clinical and cognitive symptoms, and treatment retention/outcome in a community hospital weight-management sample

Research suggests binge eating (BE) is equally prevalent across racial/ethnic groups. However, the majority of data concerning the assessment and treatment of BE come from clinical trials or specialty clinics where racial/ethnic minorities are underrepresented. Data regarding symptoms and treatment are needed from urban clinical settings where minorities are more likely to seek treatment. The current study assessed racial/ethnic group differences in BE prevalence, clinical and cognitive symptoms, and treatment retention in an ethnically-diverse weight loss treatment-seeking sample. Participants included 127 Hispanic, 204 African-American and 99 Caucasian adults who completed self-report measures of BE frequency, distress, eating-related cognitive symptoms including shape and weight concerns and dietary restraint, depression, stress, and treatment barriers. Data concerning number of treatment sessions attended and body mass index (BMI) were collected at 6-month follow up. The first study developed and validated the Dimensional Assessment of Loss of Control Eating (DALC) scale. The 2-factor DALC demonstrated good internal consistency and convergent, construct and incremental validity. The DALC contributed to variance in eating pathology and depression beyond existing BE measures. The second study examined racial/ethnic differences in BE prevalence, eating-related cognitive symptoms, and BMI. As hypothesized, no racial/ethnic differences in BE frequency were found and the rate of recurrent BE was 20% to 30%; participants with recurrent BE had higher BMIs, levels of depression, and global eating pathology than individuals without; African-American participants with BE had higher BMIs than other racial/ethnic groups, controlling for demographic variables. The hypotheses that Hispanic participants have higher weight and shape concerns, and that African-Americans have higher levels of restraint, were not supported. The third study examined the hypothesis that ethnicity is associated with obesity treatment retention and outcome. African-American participants had lower retention rates than Hispanics and Caucasians combined, and had lower levels of obesity-based stigma, which accounted for their lower retention rates. African-Americans lost less weight than Caucasians but this difference disappeared after accounting for age and income. The findings suggest high BE rates among racial/ethnic minorities at a common entry point for health services utilization. Stigma and African-American ethnicity should be considered when developing retention interventions