Effectiveness of a Web-Based Cognitive Behavioral Self-Help Intervention for Binge Eating Disorder: A Randomized Clinical Trial.

Importance: Binge eating disorder (BED) is one of the most frequent eating pathologies and imposes substantial emotional and physical distress, yet insufficient health care resources limit access to specialized treatment. Web-based self-help interventions emerge as a promising solution, offering more accessible care. Objective: To examine the effectiveness of a web-based cognitive behavioral self-help intervention for individuals with BED. Design, Setting, and Participants: This 2-arm, parallel-group randomized clinical trial conducted from January 15, 2021, to August 3, 2022, in Germany and other German-speaking countries enrolled patients aged 18 to 65 years who met the diagnostic criteria for BED (according to the Diagnostic and Statistical Manual of Mental Disorders [Fifth Edition]). Data analysis occurred between January 27 and September 4, 2023, following our statistical analysis plan. Interventions: Participants were randomized to a web-based self-help intervention or a waiting-list control condition. Main Outcomes and Measures: The primary outcome was a change in objective binge eating episodes from baseline to after treatment. Secondary outcomes included global eating pathology, clinical impairment, work capacity, well-being, comorbid psychopathology, self-esteem, and emotion regulation. Results: A total of 1602 patients were screened, of whom 154 (mean [SD] age, 35.93 [10.59] years; 148 female [96.10%]) fulfilled the criteria for BED and were randomized (77 each to the intervention and control groups). The web-based intervention led to significant improvements in binge eating episodes (Cohen d, -0.79 [95% CI, -1.17 to -0.42]; P < .001), global eating psychopathology (Cohen d, -0.71 [95% CI, -1.07 to -0.35]; P < .001), weekly binge eating (Cohen d, -0.49 [95% CI, -0.74 to -0.24]; P < .001), clinical impairment (Cohen d, -0.75 [95% CI, -1.13 to -0.37]; P < .001), well-being (Cohen d, 0.38 [95% CI, 0.01 to 0.75]; P = .047), depression (Cohen d, -0.49 [95% CI, -0.86 to -0.12]; P = .01), anxiety (Cohen d, -0.37 [95% CI, -0.67 to -0.07]; P = .02), self-esteem (Cohen d, 0.36 [95% CI, 0.13 to 0.59]; P = .003), and emotion regulation (difficulties: Cohen d, -0.36 [95% CI, -0.65 to -0.07]; P = .01 and repertoire: Cohen d, 0.52 [95% CI, 0.19 to 0.84]; P = .003). Conclusion and Relevance: In this randomized clinical trial of a web-based self-help intervention for patients with BED, the findings confirmed its effectiveness in reducing binge eating episodes and improving various mental health outcomes, highlighting a scalable solution to bridge the treatment gap for this condition. Trial Registration: ClinicalTrials.gov Identifier: NCT04876183.

Measuring Alliance and Symptom Severity in Psychotherapy Transcripts Using Bert Topic Modeling.

We aim to use topic modeling, an approach for discovering clusters of related words ("topics"), to predict symptom severity and therapeutic alliance in psychotherapy transcripts, while also identifying the most important topics and overarching themes for prediction. We analyzed 552 psychotherapy transcripts from 124 patients. Using BERTopic (Grootendorst, 2022), we extracted 250 topics each for patient and therapist speech. These topics were used to predict symptom severity and alliance with various competing machine-learning methods. Sensitivity analyses were calculated for a model based on 50 topics, LDA-based topic modeling, and a bigram model. Additionally, we grouped topics into themes using qualitative analysis and identified key topics and themes with eXplainable Artificial Intelligence (XAI). Symptom severity could be predicted with highest accuracy by patient topics ( r =0.45, 95%-CI 0.40, 0.51), whereas alliance was better predicted by therapist topics ( r =0.20, 95%-CI 0.16, 0.24). Drivers for symptom severity were themes related to health and negative experiences. Lower alliance was correlated with various themes, especially psychotherapy framework, income, and everyday life. This analysis shows the potential of using topic modeling in psychotherapy research allowing to predict several treatment-relevant metrics with reasonable accuracy. Further, the use of XAI allows for an analysis of the individual predictive value of topics and themes. Limitations entail heterogeneity across different topic modeling hyperparameters and a relatively small sample size.

Evaluation of a Web-Based Self-Help Intervention for Patients With Generalized Anxiety Disorder: Protocol for a Randomized Controlled Trial.

BACKGROUND: Generalized anxiety disorder (GAD) is a highly prevalent and severely distressing condition that can lead to functional impairments and is considered one of the most difficult anxiety disorders to treat. Following new technological developments, a highly structured cognitive behavioral therapy (CBT) approach that has already shown success in face-to-face psychotherapy can be implemented: internet-delivered CBT (iCBT). There is now evidence for the efficacy of both guided and unguided iCBT interventions for GAD regarding symptom reduction. OBJECTIVE: To establish the usefulness of such interventions, we plan to evaluate the efficacy of a web-based self-help program (Selfapy) for GAD in a relatively large sample. We aim to assess effects beyond symptom reduction, including effects on well-being, functioning, and mental health literacy, as well as the effect on health care burden, while testing the intervention in conditions comparable to routine care. METHODS: Patients (n=156) who have been diagnosed with GAD, are aged between 18 and 65 years, have internet access, and have sufficient German language skills will be recruited for this study. The intervention group (n=78) will receive access to the 12-week self-help web-based program Selfapy. The waitlist control group (n=78) will receive no intervention in the context of the study. However, both groups will be allowed to access further health care services (eg, psychotherapy, medication), reflecting current routine care in Germany. Outcome measures will be assessed at baseline (T1) and 6 weeks (T2) and 12 weeks (T3) after the start of the intervention. The primary outcome will be generalized anxiety symptoms and quality of life at T3. Additional outcomes include depression, work capacity, therapy-related expenses and burdens, health literacy, and negative effects. RESULTS: By May 2023, all participants had finished the trial and the report was being prepared for publication. CONCLUSIONS: Web-based interventions may be an important addition to the German health care system to reduce barriers to treatment access. Further, they may prove cost-effective for the treatment of GAD. TRIAL REGISTRATION: Deutsches Register Klinischer Studien DRKS00023799; https://tinyurl.com/22bds38x. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/41440.

On the current psychotherapeutic situation for persons with pornography use disorder in Germany.

Background and aims: For the first time, the ICD-11 provides the diagnosis compulsive sexual behavior disorder (CSBD) that can be assigned for pornography use disorder (PUD). This study aimed to estimate the prevalence of PUD and associated consequences in Germany, to identify the psychotherapy demand among likely PUD (lPUD) cases and the treatment supply in different psychotherapeutic settings, to survey psychotherapists' level of expertise regarding PUD, and to identify predictors for psychotherapy demand. Methods: Four studies were conducted: 1. Online study in the general population (n = 2070; m = 48.9%, f = 50.8%, d = 0.2%), 2. Survey among practicing psychotherapists (n = 983), 3. Survey of psychotherapists in psychotherapeutic outpatient clinics (n = 185), 4. Interviews with psychotherapeutic inpatient clinics (n = 28). Results: The estimated prevalence of lPUD in the online study was 4.7% and men were 6.3 times more often affected than women. Compared to individuals without PUD, individuals with lPUD more often indicated negative consequences in performance-related areas. Among lPUD cases, 51.2% of men and 64.3% of women were interested in a specialized PUD treatment. Psychotherapists reported 1.2%-2.9% of lPUD cases among their patients. 43.2%-61.5% of psychotherapists stated to be poorly informed about PUD. Only 7% of psychotherapeutic inpatient clinics provided specific treatments to patients with PUD. While, among other factors, negative consequences attributed to lPUD were predictive for psychotherapy demand, weekly pornography consumption, subjective well-being, and religious attachment were not. Discussion and conclusions: Although PUD occurs quite often in Germany, availability of mental health care services for PUD is poor. Specific PUD treatments are urgently needed.

Applying a web-based self-help intervention for bulimia nervosa in routine care: Study protocol for a randomized controlled trial.

BACKGROUND: Individuals with bulimia nervosa (BN) experience persistent episodes of binge eating and inappropriate compensatory behavior associated with impaired physical and mental health. Despite the existence of effective treatments, many individuals with BN remain untreated, leading to a high burden and an increased risk of chronicity. Web-based interventions may help facilitate access to evidence-based treatments for BN by reducing barriers to the health care system. METHODS: The present study will investigate the effectiveness of a web-based self-help intervention for BN in a two-armed randomized controlled trial. Individuals diagnosed with BN (N = 152) will be randomly assigned to either (1) an intervention group receiving a 12-week web-based intervention or (2) a waitlist control group with delayed access to the intervention. Further assessments will be scheduled 6 (mid-treatment) and 12 (post-treatment) weeks after baseline. Changes in the number of binge eating episodes and compensatory behaviors will be examined as primary outcomes. Secondary outcomes include global eating pathology, functional impairments, well-being, comorbid psychopathology, self-esteem, and emotion regulation abilities. DISCUSSION: Adding web-based interventions into routine care is a promising approach to overcome the existing treatment gap for patients with BN. Therefore, the current study will test the effectiveness of a web-based intervention for BN under standard clinical care settings. TRIAL REGISTRATION: ClinicalTrials.gov, Identifier: NCT04876196 (registered on May 6th, 2021).

Integrating a web-based intervention into routine care of binge-eating disorder: Study protocol for a randomized controlled trial.

Background: Although binge eating disorder (BED) is the most common eating pathology and carries a high mental and physical burden, access to specialized treatment is limited due to patient-related barriers and insufficient healthcare resources. Integrating web-based self-help programs into clinical care for BED may address this treatment gap by making evidence-based eating disorder interventions more accessible. Methods: A two-armed randomized controlled trial will be conducted to evaluate the effectiveness of a web-based self-help intervention for BED in routine care settings. Patients aged 18-65 years fulfilling the diagnostic criteria for BED (N = 152) will be randomly allocated to (1) an intervention group receiving a 12-week web-based self-help program or (2) a waitlist control group with delayed access to the intervention. The primary outcome will be the number of binge eating episodes. Secondary outcomes include global eating pathology, functional impairments, work capacity, well-being, comorbid psychopathology, self-esteem, and emotion regulation abilities. Measurements will be conducted at baseline (study entrance), 6 weeks after baseline (mid-treatment), and 12 weeks after baseline (post-treatment). To capture outcomes and treatment mechanisms in real-time, traditional self-reports will be combined with weekly symptom monitoring and ecological momentary assessment. Discussion: Evaluating the effectiveness of web-based interventions is essential to overcome the treatment gap for patients with BED. When adequately integrated into standard care, these programs have the potential to alleviate the high burden of BED for individuals, their families, and society. Trial registration: https://clinicaltrials.gov/ct2/show/NCT04876183, Identifier: NCT04876183 (registered on May 6th, 2021).

[Empirically based developmental and behavioral intervention programs targeting the core symptoms and language development in toddlers and preschool children with autism spectrum disorder]. / Empirisch untersuchte entwicklungsorientierte und verhaltenstherapeutisch basierte Therapieprogramme zur Verbesserung der Kernsymptome und der Sprachentwicklung bei Klein- und Vorschulkindern mit Autismus-Spektrum-Störungen.

Empirically based developmental and behavioral intervention programs targeting the core symptoms and language development in toddlers and preschool children with autism spectrum disorder Abstract. This systematic review summarizes findings of articles included in the German AWMF-S3 clinical guideline on early intervention in autism spectrum disorders (ASD). We present the current state-of the art of evidence-based interventions for toddlers and preschool-aged children with ASD, specifically targeting the core symptoms and language development. We included studies on manualized developmental and behavioral interventions for children with ASD aged <7 years according to DSM-III(R), DSM-IV(TR), DSM-5, and ICD-10. The publication dates ranged from 1 January 2011 to 31 August 2018 or as included in the NICE-children guidelines. Studies were included by an iterative hierarchy: systematic review > randomized-controlled trial > clinically controlled trial. Outcome measures were core ASD symptoms and precursor abilities, or language abilities. The interventions were collated by (1) frequency and (2) approach. The studies focused on low-intensive interventions targeting parental synchrony, the child's initiations, reciprocity, joint attention, play and imitation skills as well as comprehensive interventions. Improvement of core ASD symptoms regarding social communication was observed for low-intensive training of parental synchrony and child's reciprocity as well as for low-intensive comprehensive developmental interventions implementing natural-learning paradigms. High-frequency discrete trial interventions did not improve social communication. Language abilities improved by comprehensive interventions. In conclusion, intervention recommendations are summarized.