Gestufte Prävention von Essstörungen mit YoungEs[s]prit - Wirksamkeit eines Internet-vermittelten Präventionsprogramms bei Schülern

Kurzfassung Essstörungen sind aufgrund ihrer Häufigkeit, ihres Schweregrads und der geringen Heilungschancen Besorgnis erregend. Therapieangebote werden aufgrund der Stigmatisierung von Essstörungen und Schamgefühlen der Betroffenen oft nicht ausreichend in Anspruch genommen. Junge Menschen suchen zunehmend das Internet zur Informationssuche und zum Erfahrungsaustausch. Es bietet sich daher an, die Reichweite und die Verfügbarkeit des Internets zu nutzen, um Informationen über Essstörungen und Hilfsangebote für Betroffene leicht zugänglich zu machen. YoungEs[s]prit ist ein Internet-vermitteltes Programm für Schülerinnen und Schüler zur Gesundheitsförderung, Prävention und Früherkennung von Essstörungen. Es beinhaltet Module zur frühen Intervention bei ersten Anzeichen der Erkrankung und Schnittstellen zur Vermittlung erkrankter Teilnehmer in das reguläre Versorgungssystem. Hierbei werden die Möglichkeiten des Internets genutzt, um das Programm flexibel und adaptiv zu gestalten und es mit relativ geringem Aufwand großen Populationen anzubieten. Der Aufbau des Programms folgt einem Stepped Care Ansatz. Es umfasst fünf gestufte, d.h. in der Intensität der Betreuung aufeinander aufbauende Komponenten, die es ermöglichen, die Unterstützung den individuellen Bedürfnissen des einzelnen Teilnehmers anzupassen. Zum Nachweis der Wirksamkeit dieses Präventionsprogramms wurde eine prospektive, randomisierte Studie mit Kontrollgruppe durchgeführt. Teilnehmer waren 896 Schülerinnen und Schüler aus 18 Schulen der Stadt- und Landkreise Heilbronn und Neckar-Odenwald-Kreis. Als Hauptzielkriterium wurde die Entwicklung von Essstörungen (Inzidenzrate) innerhalb eines Jahres herangezogen, wobei eine Essstörung nach den Kriterien einer mindestens nicht näher bezeichneten Essstörung (EDNOS) definiert wurde. Die Messung erfolgte über einen validierten Essstörungs- Fragebogen (SEED) sowie einige Zusatzfragen zur Erfassung des Zeitaspektes. Ohne Unterstützung durch das Programm erkrankten im Untersuchungszeitraum 9,6% der Jugendlichen, während die Erkrankungsrate in der Interventionsgruppe lediglich 5,9% betrug. Durch den Einsatz von YoungEs[s]prit konnte somit die Inzidenzrate von Essstörungen um 39% im Vergleich zur Kontrollgruppe gesenkt werden (Log Rank χ 2=4.29, df=1, p=.019). Unseres Wissens nach ist dies die erste Studie, die eine Reduktion der Inzidenzrate durch eine gestufte Präventionsstrategie in einer universellen Population von Schülerinnen und Schülern nachweisen konnte

E-Health for Individualized Prevention of Eating Disorders

In the field of illness prevention, it is becoming increasingly important that effective treatments be broadly disseminated and easily accessible to large populations located over wide geographical areas. The internet offers many opportunities to improve illness prevention and has become an important tool for both providers and users. An increasing number of users are looking for help on web-pages, in forums and chat rooms, to access information and exchange experiences with other users or counselors. Appetite for Life is an Internet-based program for the prevention of eating disorders (ED) in college students. It provides individualized support to students at-risk of developing an ED. Depending on initial screening results, specific program modules are recommended to the user, matching their individual needs. The program contains a web-page with psychoeducational information on ED, an anonymous forum to receive and provide peer support, a supportive monitoring and feedback program and a chat platform, which can be used to communicate with professional counselors and other users. If needed, users can be referred to face-to-face counseling

An analysis of integrated health care for Internet Use Disorders in adolescents and adults

Background and aims Although first treatment approaches for Internet Use Disorders (IUDs) have proven to be effective, health care utilization remained low. New service models focus on integrated health care systems, which facilitate access and reduce burdens of health care utilization, and stepped-care interventions, which efficiently provide individualized therapy. Methods An integrated health care approach for IUD intended to (a) be easily accessible and comprehensive, (b) cover a variety of comorbid syndromes, and (c) take heterogeneous levels of impairment into account was investigated in a one-armed prospective intervention study on n = 81 patients, who were treated from 2012 to 2016. Results First, patients showed significant improvement in Compulsive Internet Use over time, as measured by hierarchical linear modeling. Effect sizes of outcome change from baseline to 6-month follow-up ranged from d = 0.48 to d = 1.46. Second, differential effects were found depending on patients’ compliance, demonstrating that high compliance resulted in significantly higher rates of change. Third, patients referred to minimal interventions did not differ significantly in amount of change from patients referred to intensive psychotherapy. Discussion Tailored interventions result in higher efficiency through optimized resource allocation and equal amounts of symptom change in all treatment conditions. Moreover, comprehensive, low-threshold interventions seem to increase health service utilization

Koreanische Serie besorgt Pädagogen und Psychologen

Katajun Lindenberg, Professorin für Kinder- und Jugendlichenpsychotherapie an der Goethe-Universität, erklärt, warum der Serienhit „Squid Game“ für Kinder und Jugendliche nicht geeignet ist

Überprüfung der Effekte dissonanzbasierter Primärprävention von Internet- und Computerspielabhängigkeit in der Jahrgangsstufe 5 auf die Einstellung zum Gaming: eine Pilotstudie

Hintergrund: Das Kindesalter wurde bei der Entwicklung von wirksamen Präventions- und Interventionsprogrammen bei Computerspiel- und Internetabhängigkeit bisher kaum berücksichtigt. PROTECTdissonanz wurde daher als 1-stündiges dissonanzbasiertes universelles Primärpräventionsprogramm für die Klassenstufe 5 konzipiert. Die vorliegende Pilotstudie überprüft die unmittelbaren Effekte der Dissonanzinduktion auf die Einstellung zum Gaming. Methodik: In einem einarmigen A+B-Design mit drei Messzeitpunkten (T0, T1, T2) wurde die Einstellung zum Gaming anhand des Gaming Attitude Test (GAT) erfasst. In die Baselinesequenz (Sequenz A, T0 bis T1, Teilstichprobe) wurden N = 83 Schüler_innen eingeschlossen (Alter: M = 10.27; SD = 0.48) und in die Interventionssequenz (Sequenz B, T1 bis T2, Gesamtstichprobe) N = 200 Schüler_innen (Alter: M = 10.24; SD = 0.47). Akzeptanz und Zufriedenheit wurden nach der Intervention erfasst. Ergebnisse: Hierarchisch lineare Wachstumsmodelle zeigten eine signifikante Reduktion der GAT-Symptome durch die Intervention, sowohl im Gesamtwert des GAT als auch auf der Subskala „Bagatellisierung negativer Konsequenzen“. Im natürlichen Verlauf (Baselinesequenz A) zeigten sich keine Veränderungen. Die Schüler_innen bewerteten PROTECTdissonanz zudem mit einer hohen Zufriedenheit. Schlussfolgerungen: Eine kurze, gezielte übung zur Dissonanzinduktion zeigt unmittelbare Effekte auf ein Einstellungsmaß zum Gaming. Zur Weiterverfolgung dieses vielversprechenden Ansatzes sollte in künftigen Studien untersucht werden, ob sich eine verringerte Bagatellisierung negativer Konsequenzen von Gaming im Sinne der kognitiven Dissonanztheorie auch tatsächlich in einer Verhaltensänderung widerspiegelt.Objective: To date, childhood has hardly been considered in the development of effective prevention and intervention programs for gaming disorder and Internet addiction. PROTECTdissonance was therefore designed as a 1-hour dissonance-based, universal primary prevention program for grade 5 high-school students. This pilot study examines the immediate effects of dissonance induction on attitudes toward gaming. Method: A single-arm A+B design with three measurement points (T0, T1, T2) assessed attitudes toward gaming using the Gaming Attitude Test (GAT). The baseline sequence (sequence A, T0 to T1, subsample) included N = 83 high-school students (age: M = 10.27; SD = 0.48) and the intervention sequence (sequence B, T1 to T2, total sample) included N = 200 pupils (age: M = 10.24; SD = 0.47). Acceptance and satisfaction were recorded after the intervention. Results: Hierarchical linear growth models showed a significant reduction of GAT symptoms through the intervention, both in the total GAT score and on the subscale “Trivialization of Negative Consequences.” There were no changes in the natural course (baseline sequence A). Pupils correspondingly reported a high rate of satisfaction with PROTECTdissonance. Conclusions: A brief, targeted dissonance-induction exercise shows immediate effects on an attitudinal measure of gaming. To follow up on this promising approach, future studies should investigate whether reduced trivialization of negative consequences of gaming is actually reflected in behavioral change

Treatment outcomes of a CBT-based group intervention for adolescents with internet use disorders

Background and aims: Instances of Internet use disorders (IUD) including Internet gaming disorder (IGD) and non-gaming pathological Internet use (ng-PIU) have the extent that they are now a growing mental health issue. Individuals suffering from IUD show a large range of symptoms, high comorbidities and impairments in different areas of life. To date there is a lack of efficient and evidence-based treatment programs for such adolescents. The present registered single-arm trial (ClinicalTrials.gov: NCT03582839) aimed to investigate the long-term effects of a brief manualized cognitive behavioral therapy (CBT) program for adolescents with IUD. Methods: N = 54 patients (16.7% female), aged 9–19 years (M = 13.48, SD = 1.72) received the CBT group program PROTECT+. IUD symptom severity (primary outcome variable) as well as comorbid symptoms, risk-related variables and potentially protective skills (secondary outcome variables) were assessed at pretest, posttest, as well as 4 and 12 months after admission. Results: Patients showed a significant reduction in IUD symptom severity at the 12-month follow-up. Effect sizes were medium to large depending on the measure. Beyond the statistical significance, the clinical significance was confirmed using the reliable change index. Secondary outcome variables showed a significant reduction in self-reported depression, social anxiety, performance anxiety and school anxiety as well as in parental-reported general psychopathology. Discussion and conclusions: The present study shows long-term effects of a manual-based CBT treatment for adolescents suffering from IUD. The results indicate that even a 4-session brief intervention can achieve a medium to large effect over 12 months. Future work is needed to confirm the efficacy within a randomized controlled trial (RCT)

Problematic gaming in youth and its association with different dimensions of quality of life

Objective: The problematic use of computer games was included in the DSM-5 and in the ICD-11. Initial research revealed associa- tions between problematic gaming (PG) and quality of life (QoL). However, clarification is needed concerning which dimensions of the multidi- mensional construct QoL are particularly relevant for PG. Method: To answer this question empirically, we asked 503 parents (mean age: 47.63 years) to rate their 503 children (average age: 14.60 years) regarding QoL and PG, using validated questionnaires on parental assessments of adolescent PG and health-related QoL to collect the data. Correlation analyses were calculated to determine bivariate relations, and a multiple linear regression was used to conduct a multivariable analysis. Results: In the bivariate analyses, a higher severity of PG was associated with a lower health-related QoL in all five surveyed dimensions. In the multivariable model (corrected R2 = 0.35), we observed statistically significant associations between higher severity of PG and male sex and lower age of the adolescent as well as lower QoL in the dimensions of physical well-being and school environment. Conclusions: According to the findings of the present study, physical well-being and school environment should be especially focused on in preventive approaches against the development of PG in youth.Fragestellung: Der problematische Gebrauch von Computerspielen wurde in das DSM-5 und in das ICD-11 aufgenommen. Erste Untersuchungen ergaben Assoziationen zwischen problematischem Computerspiel (PC) und Lebensqualität (LQ). Es ist jedoch noch zu klären, welche Dimensionen des multidimensionalen Konstrukts LQ für PC besonders relevant sind. Methode: Um dieser Frage empirisch nach- zugehen, baten wir 503 Eltern (mittleres Alter: 47,63 Jahre), ihre 503 Kinder (mittleres Alter: 14,60 Jahre) bezüglich LQ und PC zu beurteilen. Zur Datenerhebung wurden validierte Fragebögen zur elterlichen Einschätzung des jugendlichen PC und der gesundheitsbezogenen LQ verwendet. Korrelationsanalysen wurden berechnet, um bivariate Beziehungen zu ermitteln, und eine multiple lineare Regression wurde verwendet, um eine multivariable Analyse durchzuführen. Ergebnisse: In den bivariaten Analysen ging in allen fünf erhobenen Dimensionen ein höherer Schweregrad des PC mit einer niedrigeren gesundheitsbezogenen LQ einher. Im multivariablen Modell (korrigiertes R2 = 0,35) beobachteten wir statistisch signifikante Assoziationen zwischen höherem Schweregrad des PC und männlichem Geschlecht und niedrigerem Alter des Jugend- lichen sowie geringerer LQ in den Dimensionen körperliches Wohlbefinden und schulisches Umfeld. Schlussfolgerungen: Nach den Ergebnissen der vorliegenden Studie sollten das körperliche Wohlbefinden und das schulische Umfeld bei präventiven Ansätzen gegen die Entwicklung von PC bei Jugendlichen besonders berücksichtigt werden

A randomized efficacy trial of a cognitive-behavioral group intervention to prevent Internet Use Disorder onset in adolescents: The PROTECT study protocol

Background: The reduction of prevalence rates of Internet Use Disorder (IUD) and its effective treatment are at high priority in both public health and educational policies. School-based preventive interventions facilitate a low-threshold approach for individuals with IUD, who are typically characterized by high therapy avoidance. Moreover, indicated approaches which target adolescents at high-risk show larger effects than universal prevention programs. Simultaneously, they reduce unnecessary burden for the majority of high-school students that is not at-risk. The PROTECT group intervention for indicated prevention of IUD in school settings was developed based on these preventive strategies. Methods: Three-hundred and forty adolescents, aged 12–18 years, from 40 secondary schools in Germany, screened for high-risk of IUD onset, are randomly assigned to a) PROTECT preventive intervention group or b) assessment only control group. The tested intervention consists of a cognitive-behavioral 4-session brief-protocol. Follow-up assessments are at 1, 4 and 12 months after admission. Primary outcome is the 12-months incidence rate of IUD. Secondary outcomes are the reduction of IUD and comorbid symptoms as well as the promotion of problem solving, cognitive restructuring and emotion regulation skills. Conclusion: The indicated preventive intervention PROTECT follows the APA-guidelines for psychological prevention, i.e., it is theory- and evidence-based and addresses both risk-reduction and strength-promotion, it considers current research and epidemiology and ethical standards such as professional secrecy and is designed as a systemic intervention at the school-level. It is expected that the intervention decreases risk of IUD onset (incidence rate). Trial registration: ClinicalTrials.gov: NCT02907658

Effectiveness of cognitive behavioral therapy-based intervention in preventing gaming disorder and unspecified internet use disorder in adolescents: a cluster randomized clinical trial.

Question: Is manualized cognitive behavioral therapy–based indicated prevention effective in reducing symptoms of gaming disorder and unspecified internet use disorder and rates of these disorders in at-risk high school students? Findings: In this cluster randomized clinical trial of 422 at-risk adolescents with gaming disorder and unspecified internet use disorder, the PROTECT (Professioneller Umgang mit technischen Medien [Professional Use of Technical Media]) intervention group had a significantly greater reduction in symptoms over 12 months compared with the assessment-only control group (39.8% vs 27.7%). Differences in incidence rates did not reach significance. Meaning: Findings of this trial indicate that the PROTECT intervention in high schools is effective in reducing symptoms of gaming disorder and unspecified internet use disorder

Procrastination Predicts Future Internet Use Disorders in Adolescents but Not Vice Versa: Results from a 12-Month Longitudinal Study

Background: Use of Internet applications is often associated with postponing real-life obligations. Previous cross-sectional studies have reported a positive association between procrastination and Internet use disorders (IUDs). Further, procrastination is included in theoretical models explaining the development of IUDs. However, little is known about the temporal relationship; thus, longitudinal studies identifying the specific predictive direction are required. Methods: Using a cross-lagged panel design, a total of 240 students who were at high risk for IUDs, aged between 12 and 18 years (M = 15.17, SD = 1.66) were assessed at baseline (t1) and reassessed one year later (t2) with standardized measures for IUDs and procrastination. Results: Our results showed that IUD symptom severity at t2 was significantly predicted both by IUD symptom severity at t1 and procrastination at t1. However, procrastination at t2 was predicted only by procrastination at t1 but not by IUD symptom severity at t1. Conclusions: We could not find a reciprocal relationship between procrastination and IUD symptom severity. Procrastination appears to be a causal risk factor for IUDs, but not a consequence. As a modifiable risk factor, procrastination is a promising starting point for preventive and therapeutic interventions for IUDs