Characterising illness stages and recovery trajectories of eating disorders in young people via remote measurement technology (STORY): a multi-centre prospective cohort study protocol.

BACKGROUND: Eating disorders (EDs) are serious, often chronic, conditions associated with pronounced morbidity, mortality, and dysfunction increasingly affecting young people worldwide. Illness progression, stages and recovery trajectories of EDs are still poorly characterised. The STORY study dynamically and longitudinally assesses young people with different EDs (restricting; bingeing/bulimic presentations) and illness durations (earlier; later stages) compared to healthy controls. Remote measurement technology (RMT) with active and passive sensing is used to advance understanding of the heterogeneity of earlier and more progressed clinical presentations and predictors of recovery or relapse. METHODS: STORY follows 720 young people aged 16-25 with EDs and 120 healthy controls for 12 months. Online self-report questionnaires regularly assess ED symptoms, psychiatric comorbidities, quality of life, and socioeconomic environment. Additional ongoing monitoring using multi-parametric RMT via smartphones and wearable smart rings ('Oura ring') unobtrusively measures individuals' daily behaviour and physiology (e.g., Bluetooth connections, sleep, autonomic arousal). A subgroup of participants completes additional in-person cognitive and neuroimaging assessments at study-baseline and after 12 months. DISCUSSION: By leveraging these large-scale longitudinal data from participants across ED diagnoses and illness durations, the STORY study seeks to elucidate potential biopsychosocial predictors of outcome, their interplay with developmental and socioemotional changes, and barriers and facilitators of recovery. STORY holds the promise of providing actionable findings that can be translated into clinical practice by informing the development of both early intervention and personalised treatment that is tailored to illness stage and individual circumstances, ultimately disrupting the long-term burden of EDs on individuals and their families.

A randomised controlled feasibility trial of intermittent theta burst stimulation with an open longer-term follow-up for young people with persistent anorexia nervosa (RaISE): Study protocol.

OBJECTIVE: We present the protocol of a feasibility randomised controlled trial (RCT) of intermittent theta burst stimulation (iTBS) for young people with anorexia nervosa (AN). Effective first-line psychological therapies exist for young people with AN, but little is known about how to treat those who do not respond. Non-invasive neuromodulation, such as iTBS, could address unmet treatment needs by targeting neurocircuitry associated with the development and/or maintenance of AN. DESIGN: Sixty-six young people (aged 13-30 years) with persistent AN will be randomly allocated to receive 20 sessions of real or sham iTBS over the left dorsolateral prefrontal cortex in addition to their usual treatment. Outcomes will be measured at baseline, post-treatment (1-month post-randomisation) and 4-months post-randomisation (when unblinding will occur). Additional open follow-ups will be conducted at 12- and 24-months post-randomisation. The primary feasibility outcome is the proportion of participants retained in the study at 4-months. Secondary outcomes include AN symptomatology, other psychopathology, quality of life, service utilisation, neurocognitive processes, and neuroimaging measures. DISCUSSION: Findings will inform the development of a future large-scale RCT. They will also provide exploratory data on treatment efficacy, and neural and neurocognitive predictors and correlates of treatment response to iTBS in AN.

Autopsy of a failed trial part 2: Outcomes, challenges, and lessons learnt from the DAISIES trial.

OBJECTIVE: The relative merits of inpatient or day-treatment for adults with anorexia nervosa (AN) are unknown. The DAISIES trial aimed to establish the non-inferiority of a stepped-care day patient treatment (DPT) approach versus inpatient treatment as usual (IP-TAU) for improving body mass index (BMI) at 12 months in adults with AN. The trial was terminated due to poor recruitment. This paper presents outcomes and investigates the reasons behind the trial's failure. METHOD: Fifteen patients with AN (of 53 approached) participated and were followed-up to 6 or 12 months. Summary statistics were calculated due to low sample size, and qualitative data concerning treatment experiences were analysed using thematic analysis. RESULTS: At baseline, participants in both trial arms rated stepped-care DPT as more acceptable. At 12 months, participants' BMIs had increased in both trial arms. Qualitative analysis highlighted valued and challenging aspects of care across settings. Only 6/12 sites opened for recruitment. Among patients approached, the most common reason for declining participation was their treatment preference (n = 12/38). CONCLUSIONS: No conclusions can be drawn concerning the effectiveness of IP-TAU and stepped-care DPT, but the latter was perceived more positively. Patient-related, service-related and systemic factors (COVID-19) contributed to the trial's failure. Lessons learnt can inform future studies.

Autopsy of a failed trial part 1: A qualitative investigation of clinician's views on and experiences of the implementation of the DAISIES trial in UK-based intensive eating disorder services.

OBJECTIVE: The DAISIES trial, comparing inpatient and stepped-care day patient treatment for adults with severe anorexia nervosa was prematurely terminated in March 2022 due to poor recruitment. This qualitative study seeks to understand the difficulties faced during the trial by investigating stakeholders' views on and experiences of its implementation. METHOD: Semi-structured interview and focus group transcripts, and trial management and oversight group meeting minutes from May 2020-June 2022 were analysed using thematic analysis. Participants were 47 clinicians and co-investigators involved with the DAISIES trial. The Non-Adoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework was applied to the interpretive themes to classify barriers and facilitators to implementation. RESULTS: Five themes were identified: incompatible participation interests; changing standard practice; concerns around clinical management; systemic capacity and capability issues; and Covid-19 disrupting implementation. Applying the NASSS framework indicated the greatest implementation challenges to arise with the adopters (e.g. patients, clinicians), the organisational systems (e.g. service capacity), and the wider socio-political context (e.g. Covid-19 closing services). CONCLUSIONS: Our findings emphasise the top-down impact of systemic-level research implementation challenges. The impact of the Covid-19 pandemic accentuated pre-existing organisational barriers to trial implementation within intensive eating disorder services, further limiting the capacity for research.

[Non-Invasive Brain Stimulation in the Treatment of Eating Disorders - A Narrative Review]. / Nicht-invasive Hirnstimulation als Behandlungsverfahren bei Essstörungen ­ ein narrativer Überblick.

OBJECTIVE: Treatment success in many patients with eating disorders (ED) is not substantial and sustainable. Therefore, there is an urgent need for the advancement of existing treatment approaches and novel innovative interventions. Non-invasive brain stimulation (NIBS) is such an innovative approach which has recently been introduced to the treatment of ED patients. This article is a narrative review concerning the most frequently used brain stimulation techniques in ED and the current evidence concerning the efficacy of treatment. METHODS: We conducted a literature search in the PubMed database concerning the topic NIBS in ED and identified 32 relevant articles. Only 9 of these articles described empirical studies in patients with ED. RESULTS: The studies were conducted in patients with different ED diagnoses, regarding different treatment targets, used different stimulation techniques and showed differences in frequency, duration and intensity of the stimulation. Some, but not all of these studies suggest ameliorations of ED symptoms, e. g. reduction of food craving, restrictive eating and ED-related cognitions. DISCUSSION: Evidence is scarce and heterogeneous, but overall, the evidence suggests that NIBS is a promising treatment approach in ED.

Intensive community and home-based treatments for eating disorders: a scoping review study protocol.

INTRODUCTION: Institutionally based intensive treatment modalities (inpatient, day patient and residential treatments) for eating disorders (EDs) are associated with high treatment costs and significant challenges for patients and carers, including access difficulties and disruption to daily routines. Intensive community and home-based treatments have been suggested as alternatives to institutionally based intensive treatments for other severe mental illnesses, with promising clinical, social and health economic outcomes. The possible advantages of these treatments have been proposed for EDs, but this emerging area of research has not yet been systematically investigated. This scoping review aims to map the available literature on intensive community and home treatments for EDs, focusing on their conceptualisation, implementation and clinical outcomes. METHODS: This proposed scoping review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol extension for Scoping Reviews checklist and the Joanna Briggs Institute Reviewer's Manual. This review will include any peer-reviewed study concerning intensive community and home-based treatments for any EDs, with no restrictions on geographical context or study design. Grey literature will also be considered. The literature search will be conducted in four databases: PubMed, PsycInfo, MEDLINE and Web of Science. Two researchers will independently screen the titles, abstracts and text of the returned articles for eligibility. Data charting and analysis will consist of a narrative description of the included studies, quantitative and qualitative findings relative to the aims of this scoping review. Gaps in the literature will be highlighted to inform future research, clinical practice, and policy. ETHICS AND DISSEMINATION: Ethical approval is not required as all data are available from public sources. The results of this scoping review will be disseminated through peer-reviewed publication, conference presentation, and social media.

A UK-wide survey of healthcare professionals' awareness, knowledge and skills of the impact of food insecurity on eating disorder treatment.

OBJECTIVE: Food insecurity (FI) is associated with significant adverse effects on health and well-being and increasingly recognised as a global problem. The current study explored the impact of FI on eating disorder (ED) clinical practice in the UK, aiming to assess healthcare professionals' (HCPs) knowledge, skills and views on the topic of FI in their patients. DESIGN: This study was an exploratory, mixed-methods, descriptive analysis of online survey data collected from ED HCPs in the UK between September and October 2022. MEASURES: A 15-item survey with rating and open-ended questions was circulated to ED professional organisations in the UK. Descriptive statistics were used to summarise quantitative data, including perceived prevalence of FI in ED clinical practice and confidence in knowledge on the topic. Descriptive content analyses provided insight into perspectives on FI screening and aspects to be included in guidance and resources. RESULTS: 93 ED HCPs completed the survey (40.9 % psychologists). Findings demonstrated healthcare providers' limited knowledge on FI and its relation to EDs, while they increasingly perceive it in their patients, as well as a general lack of available resources on how to address FI in ED treatment. HCPs stressed the need for practical guidance and formal training for dealing with FI in their patients, as well as implementing routine screening. CONCLUSION: These findings provide both important directions for future research and clinical applications related to screening, assessment, treatment and support of food-insecure patients with EDs.

Can we change binge eating behaviour by interventions addressing food-related impulsivity? A systematic review.

BACKGROUND: An extensive amount of research has underlined the potential role of impulsivity in the development and maintenance of binge eating behaviour. Food-related impulsivity has particularly received attention given its close relationship with overeating and binge eating episodes. Besides the available evidence, our understanding regarding the effectiveness of treatment modalities for binge eating targeting impulsivity and related constructs (e.g., food craving, inhibitory control, and reward sensitivity) is limited. Thus, this systematic review aimed to investigate whether binge eating behaviour is changeable by interventions that are impulsivity-focused and food-related and whether one of these interventions is superior to the others. METHOD: A search on PubMed and PsycINFO was performed for relevant articles published up to September 2020. Studies delivering food-related impulsivity treatment to individuals suffering from binge eating episodes and including a control condition without this treatment were investigated. Following the search, 15 studies meeting the eligibility criteria were analysed. RESULTS: Analyses revealed that available impulsivity-focused approaches can be categorised as psychotherapy, pharmacotherapy, computer-assisted cognitive training, and direct neuromodulation interventions. Regarding their effectiveness, it appeared that all of these approaches might be promising to change food-related impulsivity in individuals with binge eating episodes, particularly to decrease binge eating symptoms. However, a superior intervention approach in this early state of evidence could not be determined, although food-related cue exposure, transcranial direct current stimulation, and the combination of several interventions seem fruitful. CONCLUSION: Efforts to treat binge eating behaviour with interventions focusing on food-related impulsivity appear to be promising, particularly concerning binge eating frequency, and also for food craving and inhibitory control. Given limited research and varying methods, it was not possible to conclude whether one impulsivity-focused intervention can be considered superior to others.

A Pilot Event-Related Potentials Study on Mechanisms Underlying a tDCS-Enhanced Food-Specific Response Inhibition Task for Patients With Binge Eating Disorder.

Behavioural studies demonstrate alterations in cognitive functioning, particularly impaired response inhibition and increased attentional bias towards food in binge eating disorder (BED). This pilot study aimed to investigate the neurophysiological processing of a food-specific inhibition training combined with anodal transcranial direct current stimulation (tDCS) of the right dorsolateral prefrontal cortex (DLPFC) in 16 patients with BED (mean age = 38.6, mean BMI = 33.7 kg/m2). Patients performed a food-specific antisaccade task at baseline (T0) and in a cross-over design with verum vs. sham stimulation at T1 and T2. We investigated (i) event-related potentials (ERPs; N2, ERN and P3 amplitudes) while executing the task at baseline, (ii) whether baseline ERPs would predict task performance at T1 and T2 and (iii) associations between ERPs, eating disorder pathology and impulsivity at baseline. The mean amplitude of N2 was less pronounced in erroneous saccades (ES) than correct saccades (CS), whereas ERN and P3 mean amplitudes were more pronounced in ES. Moreover, the P3 mean amplitude of ES predicted the percentage of ES at both follow up-measurements irrespective of the applied stimulation (sham vs. verum). N2 in trials with correct saccades were negatively correlated with nonplanning trait impulsivity, while P3 in erroneous antisaccade trials was negatively correlated with food-related impulsivity. Overall, the findings of reduced ERN, enhanced P3 and N2 amplitude might be interpreted as difficulties in response inhibition towards food in individuals with BED. In particular, P3 predicts task outcome at follow-up and might represent a potential marker for inhibitory control processes.

Habit reversal training and educational group treatments for children with tourette syndrome: A preliminary randomised controlled trial.

Quality of life of children with Tourette Syndrome (TS) is impacted greatly by its symptoms and their social consequences. Habit Reversal Training (HRT) is effective but has not, until now, been empirically evaluated in groups. This randomised controlled trial evaluated feasibility and preliminary efficacy of eight HRT group sessions compared to eight Education group sessions. Thirty-three children aged 9-13 years with TS or Chronic Tic Disorder took part. Outcomes evaluated were tic severity and quality of life (QoL). Tic severity improvements were found in both groups. Motor tic severity (Yale Global Tic Severity Scale) showed greatest improvements in the HRT group. Both groups showed a strong tendency toward improvements in patient reported QoL. In conclusion, group-based treatments for TS are feasible and exposure to other children with tics did not increase tic expression. HRT led to greater reductions in tic severity than Education. Implications, such as cost-effectiveness of treatment delivery, are discussed.