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ABSTRACT Objective Methods Results Discussion Dialectical behavior therapy (DBT) is an evidence‐based treatment for disorders characterized by recurrent binge eating. Yet, access to specialized treatment like DBT remains limited. To increase the accessibility of DBT, we developed a DBT skills training app (Resilience: eDBT) for the management of eating disorder (ED) symptoms. This paper delineates the developmental process of Resilience and tests its usability.Descriptive information on the development and features of Resilience is provided, including its framework, content structure and delivery formats, functionality, data storage procedure, and privacy protocols. Usability was assessed via a mixed methods approach in 10 symptomatic individuals. Qualitative data were organized based on an existing framework, which included six themes: usability, visual design, user engagement, content, therapeutic persuasiveness, and therapeutic alliance.Resilience demonstrated good usability via a Systems Usability Scale score of 85.5, which exceeded the recommended cutoff of 68. Positive aspects of the app, according to interview data, were the ease of use and the visual design, while the addition of peer support was suggested as an opportunity for improvement.A novel DBT‐based app may serve as an acceptable, low‐intensity option or adjunct to traditional treatment for targeting ED symptoms that emerge in daily life. However, notable limitations include the small sample size and the single time point at which the usability assessment was conducted. [ABSTRACT FROM AUTHOR]

Background: Difficulties with inhibitory control have been identified in eating disorders (EDs) and neurodevelopmental disorders (NDs; including attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder), and there appear to be parallels between the expression of these impairments. It is theorised that impairments in inhibitory control within NDs may represent a unique vulnerability for eating disorders (EDs), and this same mechanism may contribute to poorer treatment outcomes. This review seeks to determine the state of the literature concerning the role of inhibitory control in the overlap of EDs and neurodivergence. Method: A scoping review was conducted to summarise extant research, and to identify gaps in the existing knowledge base. Scopus, Medline, PsycInfo, Embase, and ProQuest were systematically searched. Studies were included if the study measured traits of ADHD or autism, and symptoms of ED, and required participants to complete a performance task measure of inhibitory control. Where studies included a cohort with both an ND and ED, these results had to be reported separately from cohorts with a singular diagnosis. Studies were required to be published in English, within the last 10 years. Results: No studies explored the relationship between autism and EDs using behavioural measures of inhibitory control. Four studies exploring the relationship between ADHD and EDs using behavioural measures of inhibitory control met selection criteria. These studies showed a multifaceted relationship between these conditions, with differences emerging between domains of inhibitory control. ADHD symptoms predicted poorer performance on measures of response inhibition in a non-clinical sample; this was not replicated in clinical samples, nor was there a significant association with EDs. Both ADHD and ED symptoms are associated with poor performance on attentional control measures; where these diagnoses were combined, performance was worse than for those with a singular diagnosis of ADHD. This was not replicated when compared to those with only ED diagnoses. Conclusion: Impairments in attentional control may represent a unique vulnerability for the development of an ED and contribute to poor treatment outcomes. Further research is needed to explore the role of inhibitory control in EDs, ADHD and autism, including the use of both self-report and behavioural measures to capture the domains of inhibitory control. [ABSTRACT FROM AUTHOR]

Objectives: The current study aimed to investigate the impact of oxytocin on emotion recognition, trust, body image, affect, and anxiety and whether eating disorder (ED) symptoms moderated any of these relationships. Method: Participants (n = 149) were female university students, who were randomly allocated to receive in a double-blind nature, a single dose of oxytocin intranasal spray (n = 76) or a placebo (saline) intranasal spray (n = 73). Participants were asked to complete an experimental measure of emotion recognition and an investor task aimed to assess trust. Results: The oxytocin group exhibited better overall performance on the emotion recognition task (especially with recognising positive emotions), and a decline in state positive affect than the control group at post-intervention. However, these effects were not moderated by ED symptom severity, nor were effects found for state anxiety, negative affect, body image and recognising negative emotions in the emotion recognition task. Conclusion: The current findings contribute to the growing literature on oxytocin, emotion recognition and positive affect and suggest that ED pathology does not moderate these relationships. Future research would benefit from examining the efficacy of an oxytocin intervention using a within-subjects, cross-over design, in those with sub-clinical and clinical EDs, as well as healthy controls. [ABSTRACT FROM AUTHOR]

Objective: Digital interventions show promise as an effective prevention or self‐management option for eating disorders (EDs). However, it remains unclear how, for whom, and through what mechanisms they work in this population, as a synthesis of outcome predictors, moderators, and mediators is lacking. This systematic review synthesized empirical research investigating predictors, mediators, and moderators of response to digital interventions for EDs. Method: Six databases were searched (PROSPERO CRD42022295565) for studies that assessed predictors, moderators, or mediators of response (i.e., uptake, drop‐out, engagement, and symptom level change) to a digital prevention or treatment program for EDs. Variables were grouped into several overarching categories (demographic, symptom severity, psychological, etc.) and were synthesized qualitatively across samples without a formally diagnosed ED (typically prevention‐focused) and samples with a formally diagnosed ED (typically treatment‐focused). Results: Eighty‐six studies were included. For studies recruiting samples without a formal diagnosis (n = 70 studies), most predictors explored were statistically unrelated to outcome, although participant age, baseline symptom severity, confidence to change, motivation, and program engagement showed preliminary evidence of prognostic potential. No robust moderators or mediators were identified. Few studies recruiting samples with a formal diagnosis emerged (n = 16), of which no reliable predictors, moderators, or mediators were identified. Discussion: It remains unclear how, for whom, and under what circumstances digital programs targeting EDs work. We offer several recommendations for future research with the aim of advancing understanding of client characteristics and intervention elements that signal success from this intervention modality. Public Significance: Digital interventions have shown potential as an effective, scalable, and accessible intervention option for EDs. However, responsiveness varies, so advancing understanding of predictors, mediators, and moderators of outcome to digital interventions for EDs is needed. Such knowledge is important for enabling safe and efficient treatment matching, and for informing future development of effective digital interventions. [ABSTRACT FROM AUTHOR]

The coronavirus disease 2019 (COVID‐19) pandemic led to a global surge in videoconferencing use for work/study‐related reasons. Although these platforms heighten exposure to one's image, the implications of videoconferencing use on body image and eating concerns remain scantly examined. This study sought to investigate, in an Australian sample, whether videoconferencing for work/study‐related reasons predicted increases in body dissatisfaction (BD), urge to engage in disordered eating (DE; restrictive eating, exercise, overeating/purging), and negative mood at the state level. Participants (N = 482, 78.8% women, Mage = 20.5 years [SD = 5.3]) completed baseline demographic measures, accompanied by an ecological momentary assessment (EMA) of videoconferencing for work/study‐related reasons, BD, DE urges, and negative mood six times a day for 7 days via a smartphone application. Most participants (n = 429; 89.0%) reported state‐based videoconferencing use during the EMA phase. Consistent with expectations, state‐based videoconferencing use was associated with an increase in state‐level urges to engage in exercise. However, contrary to predictions, state‐based videoconferencing use was linked to a decrease in state‐level BD at the next assessment point and failed to predict negative mood and urges to engage in restrictive eating or overeating/purging at the state level. Given the simplified measure of videoconferencing use, the current research is considered preliminary and future replication and extension, using more nuanced measures, is warranted. Highlights: State videoconferencing use predicted increased urges for exercise, but not negative mood, or urges for binge‐eating/purging or restrictive eatingState videoconferencing use predicted decreased body dissatisfaction (i.e., increased body satisfaction)Encourage future research into the nuances of videoconferencing use and potential consequences of interface design features [ABSTRACT FROM AUTHOR]

Objectives: Cognitive flexibility and psychological distress, such as depression and anxiety, have been implicated in the aetiology of Anorexia Nervosa (AN). Despite the known associations between eating disorder (ED) symptoms, depression, anxiety, and cognitive flexibility, the specific pathways that connect these constructs are unclear. We therefore used network analysis to examine the relationship between these symptoms in an AN sample. Methods: One hundred and ninety‐three treatment‐seeking individuals diagnosed with AN (95.6% female, M = 26.89 [SD = 9.45] years old) completed self‐report measures assessing depression, anxiety, cognitive flexibility, and ED symptoms. To determine each symptom's influence in the network, we calculated the expected influence. Results: The two relationships with the greatest edges were those between (1) weight/shape concerns and eating/dietary restraint and (2) weight/shape concerns and psychological distress (a measure that combined depression and anxiety). Cognitive flexibility was not connected to weight/shape concerns but had negative partial associations with eating concerns/dietary restraint and psychological distress. There was also a slight, non‐zero connection between eating concerns/dietary restraint and psychological distress. Conclusions: The findings underscore the importance of weight/shape, eating/dietary concerns, and psychological distress in the AN network and suggest that addressing cognitive flexibility may be a useful target for eating concerns/dietary restraint and psychological distress. Future studies assessing the longitudinal course of psychopathology within the AN network structure may help in identifying whether specific symptoms function as risk factors or maintaining factors for this co‐occurrence. [ABSTRACT FROM AUTHOR]

Objective: To validate the original and a shortened version of the Detail and Flexibility (DFlex) Questionnaire. Method: Confirmatory factor analyses, internal consistency, and discriminant validity estimates were conducted within individuals with a diagnosis of an eating disorder (ED) (n = 124), an anxiety disorder and/or depression (n = 219), and a community sample (n = 852) (Part 1). Convergent validity of the DFlex through comparisons with the Autism Spectrum Quotient, Wisconsin Card Sorting Task, and Group Embedded Figures Task was undertaken within a combined ED and community sample (N = 68). Test‐retest reliability of the DFlex was also examined across 2 years in a community sample (N = 85) (Part 2). Results: The original factor structure of the DFlex was not supported. Hence, a shortened version, the DFlex‐Revised, was developed. Good discriminant validity was obtained for the DFlex and DFlex‐Revised, however, support for convergent validity was mixed. Finally, the 2‐year test‐retest reliability for the two DFlex versions was found to be low, suggesting potential malleability in construct over this timeframe. Conclusions: Further research is needed to validate the DFlex in clinical and non‐clinical populations using different neurocognitive tests. Test‐retest, using varied time intervals, should also be assessed. Highlights: A revised shortened version of the DFlex (DFlex‐Revised) was developed.Findings support the factor structure of the DFlex‐Revised in eating disorders, anxiety/depression, and community groups.Good internal consistency and discriminant validity were obtained for both DFlex versions.The DFlex and DFlex‐Revised demonstrated some instability over a 2‐year period. [ABSTRACT FROM AUTHOR]

The management of stress has evolved in recent years due to widespread availability of mobile-device applications (apps) and their capacity to deliver psychological interventions. We evaluated the efficacy of mental health apps on stress and sought to identify characteristics associated with effect size estimates. Sixty-nine randomised controlled trials (RCTs) were included. Random effects meta-analyses were performed and putative moderators were examined at univariate and multivariate (combinations and interactions) levels. From 78 comparisons, we observed a small but significant pooled effect of apps over control conditions on perceived stress levels ( g  = 0.27; 95% CI = 0.20, 0.34; I 2  = 68%). This effect weakened after taking into account small-study bias according to the trim-and-fill procedure ( g  = 0.10; 95% CI = 0.02, 0.19; I 2  = 78%). Delivery of apps with stress monitoring features produced smaller efficacy estimates, although this association interacted with other trial features (small sample size and inactive control group) in multivariate analyses, suggesting that this effect may have been explained by features characteristic of low-quality trials. Mental health apps appear to have small, acute effects on reducing perceived stress. Future research should shift focus towards identifying change mechanisms, longitudinal outcomes, features that facilitate sustained app usage, and tangible pathways to integrating apps into real-world clinical settings.

Background: Eating disorder (ED) research has embraced a network perspective of psychopathology, which proposes that psychiatric disorders can be conceptualized as a complex system of interacting symptoms. However, existing intervention studies using the network perspective have failed to find that symptom reductions coincide with reductions in strength of associations among these symptoms. We propose that this may reflect failure of alignment between network theory and study design and analysis. We offer hypotheses for specific symptom associations expected to be disrupted by an app-based intervention, and test sensitivity of a range of statistical metrics for identifying this intervention-induced disruption., Methods: Data were analyzed from individuals with recurrent binge eating who participated in a randomized controlled trial of a cognitive-behavioral smartphone application. Participants were categorized into one of three groups: waitlist ( n = 155), intervention responder ( n = 49), and intervention non-responder ( n = 77). Several statistical tests (bivariate associations, network-derived strength statistics, network invariance tests) were compared in ability to identify change in network structure., Results: Hypothesized disruption to specific symptom associations was observed through change in bivariate correlations from baseline to post-intervention among the responder group but were not evident from symptom and whole-of-network based network analysis statistics. Effects were masked when the intervention group was assessed together, ignoring heterogeneity in treatment responsiveness., Conclusion: Findings are consistent with our contention that study design and analytic approach influence the ability to test network theory predictions with fidelity. We conclude by offering key recommendations for future network theory-driven interventional studies.