Using web-based, guided self-help to bridge the waiting time for face-to-face out-patient treatment for bulimic-spectrum disorders: randomised controlled trial.

BACKGROUND: Although effective treatments for bulimic-spectrum eating disorders exist, access is often delayed because of limited therapist availability and lengthy waiting lists. Web-based self-help interventions have the potential to bridge waiting times for face-to-face treatment and overcome existing treatment gaps. AIMS: This study aims to assess the effectiveness of a web-based guided self-help intervention (everyBody Plus) for patients with bulimia nervosa, binge eating disorder and other specified feeding and eating disorders who are waiting for out-patient treatment. METHOD: A randomised controlled trial was conducted in Germany and the UK. A total of 343 patients were randomly assigned to the intervention 'everyBody Plus' or a waitlist control condition. The primary outcome was the number of weeks after randomisation until a patient achieved a clinically relevant improvement in core symptoms for the first time. Secondary outcomes included eating disorder attitudes and behaviours, and general psychopathology. RESULTS: At 6- and 12-month follow-up, the probability of being abstinent from core symptoms was significantly larger for the intervention group compared with the control group (hazard ratio: 1.997, 95% CI 1.09-3.65; P = 0.0249). The intervention group also showed larger improvements in eating disorder attitudes and behaviours, general psychopathology, anxiety, depression and quality of life, compared with the control group at most assessment points. Working alliance ratings with the online therapist were high. CONCLUSIONS: The self-help intervention everyBody Plus, delivered with relatively standardised online guidance, can help bridge treatment gaps for patients with bulimic-spectrum eating disorders, and achieve faster and greater reductions in core symptoms.

Service evaluation of multi-family therapy for anorexia groups between 2013-2021 in a specialist child and adolescent eating disorders service.

The aims of the service evaluation were to examine the effectiveness of multi-family therapy for anorexia nervosa (MFT-AN) on family relationships, as well as to understand families' experiences of MFT in a specialist child and adolescent eating disorders service between 2013-2021. Mixed-methods were used (t-tests and reflexive thematic analysis). Delivery was in-person in 2013-2019, and moved online from 2020 due to COVID-19. Responses from a total of 57 families and 190 people were analysed. MFT improved family functioning from pre-to post MFT as measured by the Systemic Clinical Observation in Routine Evaluation (SCORE-15). Sub-group analysis by family roles showed that at four-month follow-up, the effects were no longer significant among parents. On the contrary, preliminary analysis showed that although young people did not report any improvement at post-intervention, family functioning was reported to increase at follow-up. Four themes were constructed: being together as a family and as a group; individuality: everyone's recovery is different; MFT as an emotion 'hotpot', and in-person versus virtual groups: not a one-size-fits-all. More robust follow-up data are needed to ascertain the effects of online MFT-AN.

The Effectiveness and Feasibility of Psychological Interventions for Populations Under Ongoing Threat: A Systematic Review.

Current views of psychological therapies for trauma typically assume the traumatic event to be in the past. Yet, individuals who live in contexts of ongoing organized violence or experience intimate partner violence (IPV) may continue to be (re)exposed to related traumatic events or have realistic fears of their recurrence. This systematic review considers the effectiveness, feasibility, and adaptations of psychological interventions for individuals living with ongoing threat. PsychINFO, MEDLINE, and EMBASE were searched for articles that examined psychological interventions in contexts of ongoing threat of either IPV or organized violence and used trauma-related outcome measures. The search was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data on study population, ongoing threat setting and design, intervention components, evaluation methods, and outcomes were extracted, and study quality was assessed using the Mixed-Method Appraisal Tool. Eighteen papers featuring 15 trials were included (12 on organized violence and 3 on IPV). For organized violence, most studies showed moderate to large effects in reducing trauma-related symptoms when compared to waitlists. For IPV, findings were varied. Most studies made adaptations related to culture and ongoing threat and found that providing psychological interventions was feasible. The findings, albeit preliminary with mixed methodological quality, showed psychological treatments can be beneficial and should not be withheld in the context of ongoing organized violence and IPV. Clinical and research recommendations are discussed.

The effectiveness and cultural adaptations of psychological interventions for eating disorders in East Asia: A systematic scoping review.

OBJECTIVE: There has been no review on eating disorder-focused psychological interventions in East Asia. The aims of this systematic scoping review were to summarize existing and forthcoming studies and to synthesize the cultural adaptations and effectiveness of the interventions identified. METHOD: Five databases (PubMed, Embase, Global Health, Medline, PsychInfo) and seven trial registries were searched. Studies examining eating disorder (ED)-focused psychological interventions in East Asia were included. Narrative synthesis was used for the analysis. RESULTS: Eighteen published studies and 14 ongoing/completed but unpublished studies were included. Most published studies were uncontrolled and five were feasibility studies. Among the ongoing studies, 71% are randomized controlled trials. Cognitive therapies were the main approach used, including individual cognitive behavioral therapy (CBT), internet CBT, group CBT, guided self-help, and cognitive remediation therapy. Cultural adaptations were mostly related to language, communication style and tailoring the dietary requirements to local diets. Interventions were shortened to increase acceptability and reduce financial and time burden to patients. Overall, studies showed good acceptability, completion rates and positive effects on ED symptoms (indicated by moderate to large effect sizes or statistical significance). DISCUSSION: Studies were underpowered and uncontrolled, thus precluding meaningful interpretations of effectiveness to be made. However, the psychological interventions were acceptable and showed promise in delivery. Digital and group interventions seemed to be the most feasible given barriers in the local health systems. More controlled studies, as well as studies on children and adolescents, are needed in future. PUBLIC SIGNIFICANCE: This is the first systematic scoping review examining psychological interventions for eating disorders in East Asia. Research in eating disorders has largely focused on White people and in Western countries. This review will be helpful for clinicians and researchers to understand the current state of the field through a non-Eurocentric lens, to identify gaps and plan future research.

OBJETIVO: No se ha realizado ninguna revisión sobre las intervenciones psicológicas centradas en los trastornos de la conducta alimentaria en Asia Oriental. Los objetivos de esta revisión sistemática fueron resumir los estudios existentes y futuros y sintetizar las adaptaciones culturales y la eficacia de las intervenciones identificadas. MÉTODO: Se realizaron búsquedas en cinco bases de datos (PubMed, Embase, Global Health, Medline, PsychInfo) y siete registros de ensayos. Se incluyeron los estudios que examinaban las intervenciones psicológicas centradas en los trastornos de conducta alimentaria (TCA) en Asia Oriental. Para el análisis se utilizó la síntesis narrativa. RESULTADOS: Se incluyeron 18 estudios publicados y 14 estudios en curso/terminados pero no publicados. La mayoría de los estudios publicados eran no controlados y cinco eran estudios de viabilidad. Entre los estudios en curso, el 71% son ensayos controlados aleatorios. Las terapias cognitivas fueron el principal enfoque utilizado, incluida la terapia cognitivo-conductual (TCC) individual, la TCC por Internet, la TCC grupal, la autoayuda guiada y la terapia de remediación cognitiva. Las adaptaciones culturales estuvieron relacionadas sobre todo con el idioma, el estilo de comunicación y la adaptación de los requisitos dietéticos a las dietas locales. Las intervenciones se acortaron para aumentar la aceptabilidad y reducir la carga económica y de tiempo para los pacientes. En general, los estudios mostraron una buena aceptabilidad, tasas de finalización y efectos positivos sobre los síntomas de TCA (indicados por tamaños del efecto de moderados a grandes o significación estadística). DISCUSIÓN: Los estudios no tenían la potencia suficiente y no estaban controlados, lo que impide realizar interpretaciones significativas de la efectividad. Sin embargo, las intervenciones psicológicas eran aceptables y prometedoras. Las intervenciones digitales y grupales parecían ser las más factibles dadas las barreras existentes en los sistemas de salud locales. En el futuro serán necesarios más estudios controlados, así como estudios sobre niños y adolescentes.

Patients' experiences of clinical team meetings (ward rounds) at an adult in-patient eating disorders ward: mixed-method service improvement project.

AIMS: Ward rounds are key to treatment-related decision-making, but are often stressful. This project aimed to explore and improve patients' experiences of the clinical team meeting (CTM; historically known as ward round) in an adult in-patient eating disorders unit. A mixed-method approach was adopted with in vivo observations, two focus groups and an interview. Six patients participated. Two former patients contributed to data analysis, co-production of service improvement initiatives and write-up. RESULTS: The mean CTM duration was 14.3 min. Patients spoke half of the time, followed by psychiatry colleagues. 'Request' was the most discussed category. Three themes were identified: CTMs are important but impersonal, a sense of palpable anxiety was generated and staff and patients had divergent views regarding CTM goals. CLINICAL IMPLICATIONS: The co-produced changes to CTMs were implemented and improved patient's experiences despite COVID-19 challenges. Factors beyond CTMs, including the ward's power hierarchy, culture and language, need addressing to facilitate shared decision-making.

Views on online self-help programmes from people with eating disorders and their carers in UK.

BACKGROUND: Digitalizing the healthcare system has been declared a priority by the UK government. People with eating disorders (EDs), especially those with bulimia nervosa (BN) or binge eating disorder (BED), and ED carers may benefit from online self-help programmes, due to the shame and stigma associated with EDs and barriers in accessing treatment, skills-training or support. Qualitative studies are needed to explore stakeholders' needs, attitudes to and views about online self-help, to optimize intervention design and delivery. METHODS: Focus groups and telephone interviews were conducted with people with BN or BED, and carers of people with anorexia nervosa, between March and September 2018 in the UK. RESULTS: People with EDs and carers perceived online self-help positively in the context of barriers to seeking and accessing treatment and support, despite some seeing it as inferior to face-to-face support. Most reported little experience with online interventions. Participants thought the disadvantages of online interventions could be overcome by reminders, progress summaries, regular engagement and engaging with peers. Receiving guidance was seen as an important functionality in the intervention by people with EDs. CONCLUSIONS: People with EDs and their carers are aware of the potential benefits of online self-help despite having little experience with this form of intervention. A stepped-care approach that utilizes technology-based interventions as a first step and makes such interventions available directly to the consumer may fit the attitudes and needs of stakeholders. The study provides a foundation for future research on design and delivery of ED online self-help.

Exploring Participants' Experiences of a Web-Based Program for Bulimia and Binge Eating Disorder: Qualitative Study.

BACKGROUND: Guided cognitive behavioral self-help is a recommended first-line treatment for eating disorders (EDs) such as bulimia nervosa (BN) or binge eating disorder (BED). Online versions of such self-help programs are increasingly being studied in randomized controlled trials (RCTs), with some evidence that they can reduce ED symptoms, although intervention dropout is variable across interventions. However, in-depth research into participants' experiences and views on the acceptability of web-based interventions is limited. OBJECTIVE: This is a qualitative process study of participants' experiences of everyBody Plus, a web-based cognitive behavioral intervention, integrated into a large RCT to aid the interpretation of the main trial's results. To our knowledge, this is the first such study in digital intervention for EDs research to include real-time feedback into the qualitative analysis. This study aims to build upon the emerging literature by qualitatively exploring participants' experiences of a web-based intervention for BN and BED. METHODS: Participants were those who took part in the UK arm of a larger RCT investigating the efficacy of the everyBody Plus intervention. Reflexive thematic analysis was completed on 2 sources of data from the online platform: real-time feedback quotes provided at the end of completing a module on the platform (N=104) and semistructured telephone interview transcripts (n=12). RESULTS: Four main themes were identified. The first theme identified positive and negative user experiences, with a desire for a more customized and personalized intervention. Another theme positively reflected on how flexible and easy the intervention was to embed into daily life, compared with the silo of face-to-face therapy. The third theme identified how the intervention had a holistic impact cognitively, emotionally, interpersonally, and behaviorally. The final theme was related to how the intervention was not a one size fits all and how the perceived usefulness and relevance were often dependent on participants' demographic and clinical characteristics. CONCLUSIONS: Overall, participants reported positive experiences with the use of the everyBody Plus web-based intervention, including flexibility of use and the potential to holistically impact people's lives. The participants also provided valuable suggestions for how similar future web-based interventions could be improved and, in the context of EDs, how programs can be designed to be more inclusive of people by encompassing different demographic and clinical characteristics.

Experiences of computer-based and conventional self-help interventions for eating disorders: A systematic review and meta-synthesis of qualitative research.

OBJECTIVE: Self-help interventions have been demonstrated to be effective in treating bulimic-type eating disorders (EDs). In particular, computer-based interventions have received increasing attention due to their potential to reach a wider population. This systematic review aimed to synthesize findings from qualitative studies on users' experiences of self-help interventions for EDs and to develop an exploratory framework. METHOD: A systematic review and meta-synthesis on seven peer-reviewed qualitative studies on structured computer and book-based self-help interventions for EDs was conducted using Noblit and Hare's (1988) 7-phase meta-ethnography. Four of the selected studies investigated computer-based self-help programs, and three of the studies investigated book-based guided self-help programs. RESULTS: Six concepts were synthesized. They included intervention-related factors (anonymity and privacy; accessibility and flexibility; guidance) and user-related factors (agency/autonomy; self-motivation; and expectations/attitudes). The study revealed the "machine-like" and relational properties of the computer; the expansion of treatment time and space in psychological interventions, the changing role of the medical health professional from a "therapist" to a "guide," and a change from understanding interventions as a conclusive treatment plan to a starting point or stepping stone toward recovery. DISCUSSION: Computer-based self-help interventions should take advantage of the "machine-like" properties of a computer (neutrality, availability, etc.) as well as its ability to facilitate human interactions. Users should also be facilitated to have a realistic understanding of the purpose of self-help interventions and the place of self-help interventions in their broader treatment plans to moderate expectations and attitudes.

OBJETIVO: Las intervenciones de auto-ayuda han demostrado ser efectivas para tratar trastornos de la conducta alimentaria (TCA) tipo bulímico. En particular, las intervenciones basadas en computadora han recibido una creciente atención debido al potencial de poder alcanzar una población más amplia. Esta revisión sistemática tuvo como objetivo el sintetizar los hallazgos de los estudios cualitativos de las experiencias de usuarios de intervenciones de auto-ayuda para TCAs y para desarrollar un marco exploratorio. MÉTODO: Se realize una revisión sistemática y meta-síntesis de siete artículos de estudios cualitativos revisados por pares sobre intervenciones estructuradas de auto-ayuda basadas en libro y en computadora para los TCAs utilizando la meta-etnografía de 7 fases de Noblit y Hare (1988). Cuatro de los estudios seleccionados investigaron programas de autoayuda basados en computadora, y tres de los estudios investigaron programas de autoayuda guiados basados en libros. RESULTADOS: Se sintetizaron seis conceptos. Incluían factores relacionados con la intervención (anonimato y privacidad; accesibilidad y flexibilidad; orientación) y factores relacionados con el usuario (agencia/autonomía; auto-motivación; y expectativas/actitudes). El estudio reveló que la computadora poseía propiedades "similares a una máquina" y propiedades relacionales; la expansión del tiempo y el espacio de tratamiento en las intervenciones psicológicas, el rol cambiante del profesional médico de un "terapeuta" a un "guía", y un cambio de la comprensión de las intervenciones como un plan de tratamiento concluyente a un punto de partida o paso hacia la recuperación. DISCUSIÓN: Las intervenciones de autoayuda basadas en computadora deben aprovechar las propiedades "similares a una máquina" de una computadora (neutralidad, disponibilidad, etc.) así como su capacidad para facilitar las interacciones humanas. Los usuarios también deben ser facilitados para tener una comprensión realista del propósito de las intervenciones de autoayuda y el lugar de las intervenciones de autoayuda en sus planes de tratamiento más amplios para moderar las expectativas y las actitudes.

Self-Help Treatment of Eating Disorders.

The authors provide an overview of the current state of research on self-help interventions for eating disorders. The efficacy of different forms of self-help interventions for bulimia nervosa, binge eating disorder, and other eating disorders at various stages of the care pathway (from prevention to relapse prevention) is described. Cost-effectiveness studies are also presented. Moderators of outcome, such as guidance and adherence, are discussed. Overall, the findings are promising and support the use of self-help interventions in the treatment of bulimic disorders, across the stages of the care pathway. Less is known about the use of self-help in anorexia nervosa.