Moderators and predictors of response to cognitive behaviour therapy for pediatric obsessive-compulsive disorder: A systematic review

We report a systematic review of moderators of CBT efficacy for pediatric OCD relative to other treatments. CENTRAL, MEDLINE, EMBASE, CINAHL, and PsycINFO were searched for RCTs reporting on effect moderation for CBT outcomes. Five studies (N = 365) examined 17 variables with three significant moderators identified. Compared to pill-placebo, CBT monotherapy was not effective for children with a family history of OCD but was for those without a family history. For children with a family history, CBT plus sertraline efficacy was attenuated but remained significant. For children with tics, CBT but not sertraline remained superior to pill-placebo. For non-responders to initial treatment with CBT, continuing CBT was inferior to commencing sertraline for those with tics but was not different for those without tics. A supplementary review identified older age, symptom and impairment severity, co-morbidity and family accommodation as consistent predictors of a poorer outcome to CBT. Current evidence for moderation effects is post-hoc, from single RCTs, has small Ns and requires replication. The review identifies family history of OCD and the presence of tics as factors requiring further examination in properly conducted trials and about which clinicians need to show care in their treatment recommendations

Informing mHealth and Web-Based Eating Disorder Interventions: Combining Lived Experience Perspectives With Design Thinking Approaches

Background: App-based interventions designed to prevent and treat eating disorders have considerable potential to overcome known barriers to treatment seeking. Existing apps have shown efficacy in terms of symptom reduction; however, uptake and retention issues are common. To ensure that apps meet the needs and preferences of those for whom they were designed, it is critical to understand the lived experience of potential users and involve them in the process of design, development, and delivery. However, few app-based interventions are pretested on and co-designed with end users before randomized controlled trials. Objective: To address the issue, this study used a highly novel design thinking approach to provide the context and a lived experience perspective of the end user, thus allowing for a deeper level of understanding. Methods: In total, 7 young women (mean age 25.83, SD 5.34, range 21-33 years) who self-identified as having a history of body image issues or eating disorders were recruited. Participants were interviewed about their lived experience of body image and eating disorders and reported their needs and preferences for app-based eating disorder interventions. Traditional (thematic analysis) and novel (empathy mapping; visually depicting and empathizing with the user’s personal experience) analyses were performed, providing a lived experience perspective of eating disorders and identifying the needs and preferences of this population in relation to app-based interventions for eating disorders. Key challenges and opportunities for app-based eating disorder interventions were also identified. Results: Findings highlighted the importance of understanding and identifying problematic eating disorder symptoms for the user, helpful practices for recovery that identify personal values and goals, the role of social support in facilitating hope, and aspects of usability to promote continued engagement and recovery. Conclusions: Practical guidance and recommendations are described for those developing app-based eating disorder interventions. These findings have the potential to inform practices to enhance participant uptake and retention in the context of app-based interventions for this population

Predictors And Moderators Of Cognitive-Behavioural Therapy Outcomes In Childhood Obsessive-Compulsive Disorder

Obsessive-compulsive disorder (OCD) can be a chronic and impairing condition affecting up to 3% of children and adolescents. While previous research has established cognitivebehavioural therapy (CBT) as the psychological treatment of choice, some children and adolescents do not experience disorder remission following CBT. The aim of this research was to better understand predictors and moderators of CBT treatment for children and adolescents with OCD. Study 1 was a systematic review of this treatment outcome literature. PsycINFO, EMBASE, CENTRAL, and PubMed databases were searched and studies were selected for the review based on pre-determined inclusion criteria. A range of factors were identified as predictors of CBT treatment outcome including OCD symptom severity, functional impairment, family accommodation, comorbidity, and therapeutic process factors. Study 2 used the outcomes of Study 1 to complete predictor and moderation analyses using data obtained from a completed randomised controlled non-inferiority trial comparing telephone delivered CBT to clinic-based CBT in a sample of 72 adolescents with OCD. Results showed no predictors of treatment outcome, however maternal accommodation of OCD symptoms predicted outcome in face-to-face CBT. Maternal accommodation and conduct disorder symptoms moderated the effect of treatment condition on outcome. These findings indicate that predictors and moderators of treatment outcome may differentiate between treatment modalities

Male Body Image: men’s body dissatisfaction, psychosocial correlates, and the role of masculine norms

Background. Pressures to conform to a mesomorphic body ideal; perceived stigmatising attitudes that characterise body dissatisfaction as feminine, weak, and undesirable for men and boys, and the internalisation of these attitudes; and dominant Western masculine gender norms have been implicated as deleterious influences in their contribution to male body dissatisfaction. While men’s body dissatisfaction as it relates to muscularity or body fat concerns has received considerable attention in the research literature, and despite preliminary evidence indicating the importance of height as a domain of male body dissatisfaction, there is a paucity of research investigating men’s experience of height dissatisfaction. Furthermore, the interplay between physical characteristics, body image evaluation and investment, and the nature and influence of salient sociocultural factors is yet to be clarified as they relate to men’s body dissatisfaction. It is important to develop such an understanding in order to conceptualise the nature and extent to which these factors present gender-specific challenges to the recognition and awareness body dissatisfaction and eating disorders in men, as well as informing the development of interventions to attenuate existing barriers for men to seek and receive appropriate treatment for such concerns.Objectives. The overarching thesis aim was to investigate men’s experience of body dissatisfaction, psychological correlates of body dissatisfaction, and salient sociocultural factors that influence men’s relationship with their body image. In particular, the function of masculine norms in the context of men’s body dissatisfaction is a focal area of inquiry and a central theme throughout the thesis.The research within the thesis is structured into three separate but conceptually interrelated studies, with the findings of earlier thesis studies informing the objectives and design of subsequent studies. The objectives of each study are summarised below:Study 1. The aim of Study 1 was to undertake an exploratory investigation to obtain information about men’s experience, perspectives, and opinions as they relate to male body dissatisfaction and the social and cultural context in which men’s physical appearance operates. Study 1 was conducted with an aim to identify avenues of novel and meaningful inquiry to be examined in subsequent thesis studies.Study 2. Study 2 aimed to further explore a novel and relatively under-studied domain of men’s body dissatisfaction: height dissatisfaction. Study 2 also examined the nature and extent to which Western male gender norms, and conformity to these norms, influence men’s height dissatisfaction.Study 3. Study 3 used data obtained at the first wave of data collection from Australian Longitudinal Study on Male Health (“Ten to Men” study). This parent data provided a valuable opportunity to undertake analyses that were informed by the findings from Studies 1 and 2 using a large data set comprising of a nation-wide, robustly recruited sample of Australian men. To capitalise on the potential to explore this data, Study 3 firstly aimed to examine conformity to masculine norms as a moderator of the relationship between a body image-related variable (i.e., weight perception or body mass index) and mental health outcomes (i.e., depression symptoms or wellbeing) using data from the Adult and Young Men cohort. A secondary objective of Study 3 was to use these same data from the Adult and Young Men cohort in a series of post-hoc analyses to examine theoretically relevant variables such as body mass index, depression and wellbeing. Young Men’s experience of bullying was also examined in the post-hoc analyses.The Ten to Men study also included a variable relating to eating disorder diagnoses in participants aged 10-17. Thus, Study 3 was also undertaken with a third aim to describe the characteristics of a subset of males aged 10 -17 from the Ten to Men study who, via self- or parent-report, endorsed a history of an eating disorder. The findings from the component of Study 3 addressing this aim are reported separately from the large-scale data analysis.Overview of the research method. The research project is comprised of three separate studies, each with a distinct objective, design, participant population, and methodology.Study 1. Study 1 is a mixed-method design. A series of focus groups were undertaken with N= 40 male university students and analysed using thematic analysis. A separate sample of N=86 men from a community and university student population completed an online survey to obtain quantitative data, and results were summarised using descriptive statistics.Study 2. Study 2 is also a mixed-method design. A purposive sample of men were recruited from an online forum dedicated to short-statured individuals. Online interviews were conducted with 15 men, and data were analysed using thematic analysis. A total of 86 men (including interview participants) completed an online survey, and a simple moderation model was examined to investigate whether conformity to masculine norms moderated the relationship between men’s actual height and their level of height dissatisfaction.Study 3. Study 3 is a secondary analysis of data. Firstly, data from the Adult (N = 13,884) and Young Men (N = 1,017) cohort was used to undertake exploratory moderation analyses whereby conformity to masculine norms was examined as a moderator in the context of a series of bivariate relationships. Post-hoc analyses were also conducted on these data to investigate differences between groups. Separate multivariate analyses compared participants on the basis of weight perception and BMI category on outcomes of age, conformity to masculine norms, depression symptoms, and wellbeing. Post-hoc analyses also examined a dichotomous variable reflecting bullying experience in the Young Men cohort. An analysis of variance probed for an interaction between bullying and weight perception on participants’ wellbeing, and logistic regression was used to estimate the bivariate relationship between weight perception or body mass index (respectively) and bullying experience.The second component of Study 3 involved the description of a subset of boys, aged 10-17 (N= 25) with a self- or parent-reported eating disorder. This subset is described in terms of the frequency of lifetime diagnoses and current experience of symptoms or treatment, body mass index, and co-occurring chronic conditions. For reference, the frequency rates of co-occurring chronic conditions from the remainder of the sample are reported for illustrative purposes, but not subjected to statistical analyses.Results. The key findings for each of the three thesis studies are summarised below, and are also illustrated in Figure 1.Study 1. Study 1 demonstrates that men experience a range of attitudes and experiences relating to their body image and body dissatisfaction. The importance of peers as a source of body comparison, and men’s immediate social network in influencing attitudes towards appearance investment, diet and exercise behaviour, and knowledge of muscle-building supplements (including anabolic steroids) was also apparent. Finally, masculine gender norms were implicated in men’s unwillingness to disclose their body dissatisfaction to friends or seek professional support.Study 2. The qualitative and quantitative data from Study 2 provides compelling evidence to suggest that height dissatisfaction is a salient domain within men’s body dissatisfaction. Themes identified from the interview data suggests that height dissatisfaction may have nuanced differences compared to muscularity or body fat dissatisfaction, particularly in terms of men’s perception that height is frequently used as a heuristic for masculinity. The results of the moderation analyses undertaken using the Study 2 survey data showed that the extent to which participants conformed to Western masculine norms moderated the relationship between actual height and height dissatisfaction, such that higher levels of conformity to masculine norms exacerbated the relationship between height and height dissatisfaction.Study 3. The exploratory analyses of the Young Men and Adult cohorts of Ten to Men show males who perceived their weight as either underweight or overweight report higher levels of depression symptoms and poorer wellbeing, relative to those who perceive their weight as acceptable. Conformity to masculine norms only moderated this relationship for a subset of Young Men who perceived their weight as overweight. For these young men, higher adherence to conformity to masculine norms attenuated the relationship between weight status and poorer outcomes in terms of depression and wellbeing. However, this moderation effect requires cautious interpretation – particularly due to the same effect not being observed in the adult sample.The descriptive analysis of the subset of Australian boys aged between 10 – 17 years old, who reported a history of an eating disorder (N = 25, 1.19% of same-aged Ten to Men cohort) was conducted. Sixteen of these 25 boys (0.99% of the same-aged cohort) reported experiencing an eating disorder or receiving treatment for an eating disorder in the past 12 months. Interestingly, this subset demonstrated a variety of weight statuses, with a notable proportion of the subset recording a body mass index score above the 85th percentile for their age and gender. The subset also reported high levels of co-occurring psychological and developmental conditions, relative to the frequency rates for these conditions in the remainder of the cohort.Conclusions. The results of the research project, in their aggregate, demonstrate that men’s body dissatisfaction is influenced by biological, psychological, and sociocultural factors. This thesis illustrates the interplay between physical characteristics (i.e., biological factors such as height, muscularity, or adiposity) that connote masculinity (i.e., a social factor); and the extent to which men internalise social messages relating to appearance, adhere to masculine norms; and place importance upon their masculine status (i.e., psychological processes). Masculinity, and in particular conformity to masculine norms, is speculated to be situated at the nexus between the many influences on men’s body dissatisfaction. Conformity to masculine norms was identified as a significant moderator within both Studies 2 and 3. While the results of the analyses indicate that the effect size attributable to the conformity as a moderating variable is modest, it is speculated that the results underestimate the size of the moderation effect due to the limitations associated with measuring conformity to masculine norms as a single construct. Consequently, important information that defines the multidimensional and complex nature of this construct was unable to be identified. Thus, it is recommended that future research requires a measurement tool that captures each domain of masculine norms. Demonstrative of the usefulness of employing a mixed-method design for the project, the qualitative components of the research project yielded rich data to further explore the nuances of masculinity in the context of men’s body image. The results of the thematic analyses in Studies 1 and 2 provide compelling argument for men’s perception that physical traits are used as a heuristic for their masculine status; the internalisation of this perceived judgment; the importance of the physical embodiment of masculinity in men’s perception of their social, professional, and romantic success; and the role of masculine norms in influencing both men’s appearance investment and their disclosure of body dissatisfaction to others

Body dysmorphic disorder in adolescents

Body dysmorphic disorder (BDD) is a relatively common condition in adolescents; however, there is very limited research in this area. This review summarises the existing literature and reports on the clinical phenomenology of BDD, including prevalence, diagnostic features, aetiology, and treatment. The authors identify a number of single case reports and one case series documenting cognitive behaviour therapy (CBT) for BDD, with successful symptom reduction and maintenance of gains over small follow-up periods. Clinical treatment recommendations suggest that CBT be offered as a first line treatment for adolescent BDD, coupled with a selective serotonin reuptake inhibitor in patients suffering from moderate or severe functional impairment. However, given the small body of evidence and limited understanding of the condition, further research into this area is required

Does masculinity moderate the relationship of height with height dissatisfaction? Findings from an Internet forum for short statured men

Research suggests that height is fundamental to Western conceptualisations of masculinity. However, researchers are yet to examine whether individual differences in conformity to Western masculine norms can help to explain why men experience height dissatisfaction. Thus, we investigated conformity to Western masculine norms as a moderator of the relationship between men's height and height dissatisfaction. Men experiencing height dissatisfaction (N = 249) were recruited from an Internet forum that functions as a discussion space for short-statured individuals. Results indicated that shorter men and more masculine men reported greater height dissatisfaction. As hypothesised, we observed a significant interaction between height and masculinity, such that the strength of the relationship of short stature with height dissatisfaction was stronger for more masculine men. Crucially, results from a Johnson-Neyman analysis indicated that it was only for men extremely low in their endorsement of masculine norms (i.e., the 2 percentile or lower) that the relationship of height with height dissatisfaction was nonsignificant, suggesting that, in the near-absence of masculine norm conformity, height no longer contributes to male body dissatisfaction. Whilst acknowledging that our findings require further exploration, we propose that conformity to masculine norms may be an influential factor in males’ experience of height dissatisfaction

“Guys don't talk about their bodies”: a qualitative investigation of male body dissatisfaction and sociocultural influences in a sample of 40 Australian males

Background: Contemporary scholarship has established that increasing numbers of men are experiencing body dissatisfaction. However, as a consequence of the enduring assumption that body dissatisfaction is a feminine domain, male body dissatisfaction is associated with considerable stigma. Objective: The current study aimed to explore and describe men's experience with body dissatisfaction and investigate sociocultural influences in the context of male body image. Of particular interest was to obtain, from men, perceptions of stigma and gender bias relating to male body dissatisfaction. Methods: Seven focus groups were conducted with a total of 40 Australian male university students, aged between 17 and 53 years (M = 20.40; SD = 6.31). To analyse the data, two independent raters adhered to Braun and Clarke's (Qualitative Research in Psychology, 3, 77–101, 2006) protocol for thematic analysis. Results: Seven themes were identified: (a) body dissatisfaction is less dangerous for men compared with women, (b) lack of representation of male body dissatisfaction in the media, (c) friendship group norms influence appearance investment, (d) steroids as dangerous and socially undesirable, (e) muscles signal dedication, but not intellect, (f) masculine norms obstruct disclosure of body dissatisfaction, and (g) professional help as a last resort. Conclusions: Participants' responses illustrate the importance of gender norms in the context of male body image, highlight the influence of peers on appearance investment, and reflect that appearance concerns and emotional expression continue to be associated with femininity (and thus, are undesirable for men)

Trivialized and overlooked: a qualitative investigation of men recruited from an Internet-based forum for short-statured individuals

Height frequently functions as a cue to the masculine status of men. Despite the socially prescribed ideal physique for men being tall, lean, and muscular, in the context of male body image research height remains underexplored relative to muscularity and body fat. We conducted a qualitative investigation of men’s experiences of height dissatisfaction, drawing upon a sample of 15 men ranging in height from 154 cm to 172 cm (M = 164.80, SD = 5.53), recruited from an Internet-based support group for short-statured individuals. Data were analyzed by 2 independent raters, and in accordance with thematic analysis procedures. Two main themes were identified: (a) the belief that others view short men as inferior and (b) experience of height dissatisfaction. A total of nine subthemes, which reflect key features within the data, were organized beneath the two main themes. Findings demonstrate that the consequences of short stature experienced by participants extend beyond body dissatisfaction to interpersonal processes and functioning in social, professional, and romantic domains. We suggest that height dissatisfaction primarily arises due to negative attributions relating to interpersonal experiences and internalized pejorative social attitudes toward men of short stature. In conclusion, short stature is a significant and pervasive issue for some men that is often—and unjustly—trivialized and overlooked

Young adults’ sexual health in the digital age: perspectives of care providers

This study examined care providers' views on young people's sexual health in the digital age. Young people have high rates of sexually transmitted infections (STIs), indicating sexual risk-taking behaviours. Adolescents transitioning to adulthood may be particularly at risk due to increased sexual behaviour and exposure to risk factors for unsafe sex, such as less parental monitoring. These risks may be accentuated in the digital age, where the availability of dating apps and pornography have potentially influenced young people's sexual behaviours. Care providers give a unique insight into sexual health in the digital age as they are able to identify changes over time.Qualitative semi-structured interviews were conducted with general practitioners, nurses, counsellors and university residential college staff (N\ua0=\ua015, six female) who work with young people aged 17 and 18. Interviews took 20-40\ua0min, and were recorded and transcribed verbatim. Transcripts were coded by the primary researcher and an independent coder using thematic analysis.We identified four themes depicting predictors for sexual risk-taking among young people: media influence on norms (influence on sexual behaviours, relationships and appearance), transition to adulthood (independence, social opportunity), communication difficulties (gender and sexuality differences, greater fear of pregnancy than STIs), and impulsive behaviour (disinhibition, substance use).Findings highlight targets for prevention of sexual risk-taking among adolescents, such as addressing changing norms depicted in media. Further, the complex interplay of contextual and individual factors highlights the need for more comprehensive theory and holistic approaches to STI prevention

On not being 'passed over'.

This conversation started in the context of Passover, a festival about Jewish identity, cultural narratives and continuity by passing on those messages forward. It is a story (‘data with soul'; Brown 2020) about the transformation from slavery to freedom and the birth of a nation. The festival incorporates words, food and rituals as forms of re-membering. This conversation aims to pass on how sharing cultural narratives in the context of training enriched the experience of the training group as a whole