Enhancing Integrative Cognitive-Affective Therapy with ecological momentary interventions: A pilot trial.

OBJECTIVE: Although current treatments are effective for some patients with eating disorders, a large number of patients remain partially or fully symptomatic post-treatment. This may be related to poor utilization of treatment skills outside of the therapy office. Smartphone applications that can detect and intervene during moments of need could facilitate such skill use between sessions. METHOD: Individuals (N = 16) participated in a small pilot open trial where they received 21 sessions of in-person Integrative Cognitive-Affective Therapy (ICAT) therapy an app (iCAT+) that delivers ecological momentary interventions (EMI) in response to user-entered data. Data were collected on the feasibility and acceptability of this treatment approach and on preliminary indicators of treatment outcomes. RESULTS: Participants found iCAT+ as a treatment augmentation acceptable and indicated it had clinical utility as an adjunct to in-person therapy, although analyses indicated poor compliance with data entry needed to trigger EMI delivery. This suggests that long-term use of EMI requiring ongoing data entry is infeasible. CONCLUSIONS: We describe lessons learned from our initial pilot trial and future directions for the development of impactful EMI systems that can be used to augment in-person therapies.

Relationships between nonappearance self-discrepancy, weight discrepancy, and binge eating disorder symptoms.

PURPOSE: Self-discrepancy (i.e., perceived differences between one's actual self and personal standards) has been associated with binge eating disorder (BED) symptoms. However, little is known about how weight discrepancy (i.e., the difference between one's actual and ideal weights) interacts with or is distinguished from nonappearance self-discrepancy (discrepancy unrelated to weight or shape) in predicting BED severity. The current study examined how these two forms of discrepancy independently and interactively relate to BED and associated symptoms to elucidate how facets of self-discrepancy may operate to precipitate and maintain BED. METHODS: Adults with BED (N = 111) completed questionnaires and interviews prior to treatment that assessed self-discrepancy (computerized selves) and weight discrepancy (assessed during the Eating Disorder Examination [EDE]) as predictors of global eating disorder (ED) symptomatology (EDE Global score), depression (Beck Depression Inventory), anxiety (State-Trait Anxiety Inventory), self-esteem (Rosenberg Self-Esteem Scale), and ED-related impairment (Clinical Impairment Assessment). RESULTS: Multivariate regression models indicated nonappearance self-discrepancy and weight discrepancy were not significantly related to the severity of global ED symptoms, but both independently predicted impairment (ps < 0.05). Nonappearance self-discrepancy, but not weight discrepancy, was also associated with higher depression (p = 0.001), anxiety (p < 0.001), and lower self-esteem (p < 0.001). CONCLUSION: These findings suggest distinct associations of weight discrepancy and nonappearance self-discrepancy with ED and related symptoms, as well as each of these constructs' relevance to everyday functioning in BED. The results also highlight potential avenues for future research to examine mechanistic pathways by which self-discrepancy influences BED severity. LEVEL OF EVIDENCE: V, descriptive cross-sectional study.