Search

Objective: Our ability to predict responsiveness to digital interventions for eating disorders has thus far been poor, potentially for three reasons: (1) there has been a narrow set of predictors explored; (2) prediction has mostly focused on symptom change, ignoring other aspects of the user journey (uptake, early engagement); and (3) there is an excessive focus on the unique effects of predictors rather than the combined contributions of a predictor set. We evaluated the univariate and multivariate effects of outcome predictors in the context of a randomized trial (n = 398) of digitally delivered interventions for recurrent binge eating. Method: Thirty baseline variables were selected as predictors, ranging from specific symptoms, to key protective factors, to technological acceptance, and to online treatment attitudes. Outcomes included uptake, early engagement, and remission. Univariate (d) and multivariate (D) standardized mean differences were calculated to estimate the individual and combined effects of predictors, respectively. Results: At the univariate level, few predictors produced an effect size larger than what is considered small (d >.20) across outcomes. However, our multivariate approach enhanced prediction (Ds =.65 to 1.12), producing accuracy rates greater than chance (63%–71% accuracy). Less than half of the chosen variables proved to be useful in contributing to predictions in multivariate models. Conclusion: Findings suggest that accuracy in outcome prediction from digitally delivered interventions may be better driven by the aggregation of many small effects rather than one or several largely influential predictors. Replication with different data streams (sensor, neuroimaging) would be useful. Public Significance: Our ability to predict who will and will not benefit from digital interventions for eating disorders has been poor. We highlight the viability of a multivariate approach to outcome prediction, whereby prediction may be better driven by the aggregation of many small effects rather than one or a few influential predictors. [ABSTRACT FROM AUTHOR]

This study examined the sustained and moderating effects of a behavioural sleep intervention for autistic children in a randomised controlled trial. Autistic children (5–13 years) with sleep problems were randomised to the Sleeping Sound intervention or Treatment as Usual (TAU). At 12-month follow-up (n = 150), caregivers of children in the Sleeping Sound group reported greater reduction in child sleep problems compared to TAU (p <.001, effect size: − 0.4). The long-term benefits of the intervention were greater for children taking sleep medication, children of parents who were not experiencing psychological distress, and children with greater autism severity. The Sleeping Sound intervention demonstrated sustained improvements in child sleep. Identified moderators may inform treatment by indicating which subgroups may benefit from further support. [ABSTRACT FROM AUTHOR]

Introduction: Studies in transdiagnostic eating disorder (ED) samples suggest supported online self-help programs (eTherapies) are effective and may improve access to treatment; however, their evaluation in those with binge-eating disorder (BED) is limited. Given BED's high prevalence and low levels of treatment uptake, further eTherapy evaluation is needed to broaden access to effective, evidencebased treatment options. The aim of this study was to investigate the acceptability, feasibility, and preliminary efficacy of a supported eTherapy for those with BED or subthreshold BED, and to examine symptom change across the duration of therapy. Method: Nineteen women with BED completed a supported, 10-session Cognitive Behavioural Therapy-based eTherapy in an uncontrolled, pre-post, and 3 months follow up intervention study. Key outcomes were assessed by the Eating Disorder Examination Questionnaire (EDE-Q): objective binge episode (OBE) frequency and ED psychopathology. Feasibility was evaluated via program adherence and dropout, whilst acceptability was assessed through participant feedback posttreatment. Weekly symptom change (ED psychopathology) during treatment was assessed by the Eating Disorder Examination - Questionnaire Short (EDE-QS). Results: Generalised estimating equations showed statistically and clinically significant reductions in OBEs and ED psychopathology (large effects) posttreatment, with these decreases maintained at follow up. Across weekly assessment, a marked slowing in the rate of change in ED psychopathology was observed after four sessions of the program. Program feasibility was high (i.e., 84% of content completed), as was program acceptability (i.e., 93% of participants expressed high levels of satisfaction). Discussion: These results support the acceptability, feasibility, and preliminary efficacy of a supported eTherapy program for those with BED and suggest the variability of symptom change across the duration of therapy. Future research should further investigate findings in an adequately powered randomised controlled trial. [ABSTRACT FROM AUTHOR]

Copyright of International Journal of Eating Disorders is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Empirically validated digital interventions for recurrent binge eating typically target numerous hypothesized change mechanisms via the delivery of different modules, skills, and techniques. Emerging evidence suggests that interventions designed to target and isolate one key change mechanism may also produce meaningful change in core symptoms. Although both 'broad' and 'focused' digital programs have demonstrated efficacy, no study has performed a direct, head-to-head comparison of the two approaches. We addressed this through a randomized non-inferiority trial. Method: Participants with recurrent binge eating were randomly assigned to a broad (n = 199) or focused digital intervention (n = 199), or a waitlist (n = 202). The broad program targeted dietary restraint, mood intolerance, and body image disturbances, while the focused program exclusively targeted dietary restraint. Primary outcomes were eating disorder psychopathology and binge eating frequency. Results: In intention-to-treat analyses, both intervention groups reported greater improvements in primary and secondary outcomes than the waitlist, which were sustained at an 8-week follow-up. The focused intervention was not inferior to the broad intervention on all but one outcome, but was associated with higher rates of attrition and non-compliance. Conclusion: Focused digital interventions that are designed to target one key change mechanism may produce comparable symptom improvements to broader digital interventions, but appear to be associated with lower engagement. [ABSTRACT FROM AUTHOR]

Background: Behavioural sleep problems are common in children with autism spectrum disorder (ASD); however, evidence for the efficacy of behavioural sleep interventions is limited. This study examined the efficacy of a brief behavioural sleep intervention in autistic children. It was hypothesised that the intervention would reduce overall child sleep problems (primary outcome), in addition to improvements in children's social, emotional, cognitive, academic functioning, and quality of life, and parent/caregivers' stress, quality of life, and mental health (secondary outcomes). Methods: A randomised controlled trial was conducted with participants randomised via a computer‐generated sequence to the sleeping sound intervention (n = 123) or treatment as usual (n = 122) group. Participants comprised 245 children with an ASD diagnosis. Inclusion criteria were as follows: confirmation of DSM IV or DSM‐5 diagnosis of ASD, participants aged between 5 and 13 years and parent/caregiver report of moderate–severe sleep problems. Exclusion criteria were as follows: parent/caregiver intellectual disability or lacking sufficient English to complete questionnaires; and child participant with co‐occurring medical conditions known to impact sleep. The intervention group received the sleeping sound intervention (2 × 50‐min face‐to‐face sessions plus follow‐up phone call) by a trained clinician. Results: Change in children's sleep problems was measured by the Children's Sleep Habits Questionnaire (CSHQ) at 3 months post randomisation. Parents/caregivers of children in the intervention group reported a reduction in child sleep problems at 3 months post randomisation (effect size: E.S −0.7). There were also small effects in a number of child (internalising symptoms, emotional behavioural disturbance and quality of life) and parent/caregiver (mental health, parenting stress and quality of life) outcomes; however, these did not remain significant when controlling for multiple comparisons. Conclusions: The sleeping sound ASD intervention is an efficacious and practical way to reduce sleep problems for autistic children. This brief behavioural intervention has the potential to be embedded easily into the Australian healthcare system. [ABSTRACT FROM AUTHOR]

Objective: The authors aimed to test the impact of an acceptance-facilitating intervention (AFI) on acceptance ratings and usage patterns of digital interventions for binge eating.Method: Participants with recurrent binge eating (N=398) were randomly assigned to an AFI or control condition. The AFI was an educational video providing information about digital interventions, including their capabilities, benefits, evidence base, and misconceptions. The primary outcome was acceptance of digital interventions. Secondary outcomes included drivers of acceptance and usage patterns.Results: The AFI group reported higher scores than the control group on acceptance, effort expectancy, facilitating conditions, motivations, and positive attitudes toward digital interventions. No group differences were observed on uptake or adherence rates at follow-up.Conclusion: AFIs can positively influence participants' acceptance of digital interventions for binge eating and can address common barriers associated with their use. Further research is needed to understand how AFIs can best facilitate help seeking and treatment engagement in this population. [ABSTRACT FROM AUTHOR]

Background: Although effective treatments exist for diagnostic and subthreshold-level eating disorders (EDs), a significant proportion of affected individuals do not receive help. Interventions translated for delivery through smartphone apps may be one solution towards reducing this treatment gap. However, evidence for the efficacy of smartphones apps for EDs is lacking. We developed a smartphone app based on the principles and techniques of transdiagnostic cognitive-behavioral therapy for EDs and evaluated it through a pre-registered randomized controlled trial. Methods: Symptomatic individuals (those who reported the presence of binge eating) were randomly assigned to the app (n = 197) or waiting list (n = 195). Of the total sample, 42 and 31% exhibited diagnostic-level bulimia nervosa and binge-eating disorder symptoms, respectively. Assessments took place at baseline, 4 weeks, and 8 weeks post-randomization. Analyses were intention-to-treat. The primary outcome was global levels of ED psychopathology. Secondary outcomes were other ED symptoms, impairment, and distress. Results: Intervention participants reported greater reductions in global ED psychopathology than the control group at post-test (d = −0.80). Significant effects were also observed for secondary outcomes (d's = −0.30 to −0.74), except compensatory behavior frequency. Symptom levels remained stable at follow-up. Participants were largely satisfied with the app, although the overall post-test attrition rate was 35%. Conclusion: Findings highlight the potential for this app to serve as a cost-effective and easily accessible intervention for those who cannot receive standard treatment. The capacity for apps to be flexibly integrated within current models of mental health care delivery may prove vital for addressing the unmet needs of people with EDs. [ABSTRACT FROM AUTHOR]

Background: Smartphone-based interventions are a potentially effective way to minimize alcohol-related harm in young adult, non-dependent drinkers. This pilot study is the first to evaluate the benefits and feasibility of a personalized alcohol harm-minimization intervention delivered via smartphones. Methods: Within a single-blind, randomized controlled design, 45 young adults were randomly assigned to either the intervention app (n = 25; 18 females; Mage = 21.36 years, SDage = 4.15 years) or the control app (n = 20; 18 females; Mage = 22.75; SDage = 4.41). The two primary outcomes were frequency of risky drinking and drinking-related harms, and the secondary outcome was frequency of protective behavioral strategies (PBS) use. All outcomes were measured at baseline and immediately post-intervention. Using the Enlight framework [1], usability was evaluated via structured one-on-one phone interviews with a subgroup of six participants from the intervention group (3 females; Mage = 19.5 years, SDage = 1.64). Results: There was no significant reduction in the primary outcomes from baseline to post-intervention across the groups. For the secondary outcome, the application of PBS within drinking contexts increased at follow-up for those in the intervention group but not for control participants. End-users rated the app as highly usable but had some concerns with repetition of the app-recommended strategies. Conclusions: This intervention, designed to reduce risky drinking behaviors among young adults, was rated as highly usable and was shown to increase the application of harm minimization strategies within drinking contexts. While the intervention and its delivery show promise, it did not appear to mitigate risky drinking behaviors. Implications of this research and future directions are discussed. Trial Registration: This trial is registered at the Australian New Zealand Clinical Trials Registry: BLINDED. [ABSTRACT FROM AUTHOR]

Abstract Despite theoretical arguments that brief app-based interventions could be a useful adjunct to longer traditional treatment programs, there has been limited evaluation of the acceptability, feasibility, and efficacy of these micro-interventions. In the present study, 247 women from the general population were randomly assigned to the intervention or wait-list control condition, and provided measurement of body satisfaction and related constructs (body image importance, confidence dealing with body image issues, eating pathology, and self-esteem) at baseline and 21-days (post-intervention). During the 21-day period, the treatment group received access to an eHealth platform containing a series of brief video activities (e.g., gratitude tasks, breathing, and relaxation) previously demonstrated in experimental studies to improve body satisfaction. Findings showed greater improvements in body satisfaction at post-intervention for the intervention group than the waitlist controls (Cohen's d =.42). Use of the intervention content was associated with immediate increases in state-like body satisfaction ratings, and the magnitude of these in-the-moment improvements was predictive of greater post-intervention symptom improvement and retention (p s <.05). However, the intervention did not produce change in constructs related to body satisfaction (Cohen's d ranged from 0.02 to 0.13). Overall, findings offer support for micro-interventions as a spot treatment for specific symptoms, and possible means to maintain engagement and motivation within a broader treatment program. Highlights • We evaluated efficacy and acceptability of a micro-intervention for body satisfaction. • The content produced immediate symptom reduction at time of use and post-intervention. • Attrition rates were high, suggesting need to augment with motivational content. • Micro-interventions have potential as an adjunct to traditional therapies, such as CBT. [ABSTRACT FROM AUTHOR]

Copyright of International Journal of Eating Disorders is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Internationally, there are few interventions that promote healthy lifestyles in the out-of-home care (OOHC) sector. The aim of this quantitative study was to measure the efficacy of the Healthy Eating, Active Living (HEAL) programme for young people who live in residential OOHC and their carers. Seventy young people and 177 carers were recruited between August 2012 and October 2014 from 48 residential care units across metropolitan Melbourne and regional Victoria, Australia. The HEAL programme included educational sessions for young people, and professional development for carers to foster healthy eating and physical activity. Young people and carers completed questionnaires measuring behavioural, psychosocial and motivational outcomes. Objective measures of height and weight were collected for young people and self-reported by carers. The findings revealed no evidence for the efficacy of the HEAL intervention for either young people or carers. The most likely explanation for the null result was difficulties associated with: (1) collecting quantitative data for evaluative purposes in vulnerable populations (particularly the impact of attrition on statistical power); and (2) implementing interventions in complex environments. We conclude with a summary of lessons learnt and recommendations for future research in this unique setting. Copyright © 2017 John Wiley & Sons, Ltd. Key Practitioner Messages There are a number of challenges inherent to collecting longitudinal data and/or employing a randomised trial design in this setting. Researchers working in this area need to acknowledge the critical need for this type of research but also consider alternative approaches to data collection., It is integral that organisational practices and/or policies are in place so that a HEAL philosophy is embedded in the residential OOHC culture; in other words, HEAL becomes a part of each organisation's values, goals and shared expectations. [ABSTRACT FROM AUTHOR]

Purpose: While intervention effects in target outcomes have typically been tested based on change from baseline to post-intervention, such approaches typically ignore individual differences in change, including time taken to see improvement. The present study demonstrates how weekly patient-reported data may be used to augment traditional pre-post intervention evaluations in order to gain greater insights into treatment efficacy.Methods: Two hundred and fifty-two adolescent boys and girls (M age = 13.6 years, SD = 0.6 years) from four secondary schools in Victoria, Australia, were assigned by school into control (n = 88) or intervention (n = 164) groups. The intervention group participated in a 6-week course designed to improve subjective wellbeing (SWB) by fostering resilience, coping skills, and self-esteem. In addition to baseline, post-intervention, and 3-month follow-up assessments of SWB, intervention group participants also completed weekly summarise of affective experiences for the duration of the intervention phase.Results: While standard pre-post data showed significant improvement in SWB for the intervention group relative to controls, weekly data showed individual differences in the trajectory of change during this intervention phase; low SWB individuals experienced initial worsening of symptoms followed by improvement in the second half of the intervention phase, whereas high SWB individuals experienced initial gains, followed by a plateau from Week 4 onwards.Conclusions: Addition of weekly data provided greater insights into intervention effects by: (1) contradicting the notion that early responsiveness to treatment is predictive of level of improvement by post-intervention, and (2) providing data-based insights into ways to enhance the intervention. [ABSTRACT FROM AUTHOR]

Objective: The aim of the current study was to evaluate parental perceptions of the acceptability of a brief behavioural sleep intervention for autistic children (aged 5-13 years) using the Theoretical Framework of Acceptability (TFA).Methods: Qualitative data were collected during a large randomised controlled trial evaluating the efficacy of the Sleeping Sound intervention: 123 families were randomised to the intervention group, of which 115 (93%) completed at least one intervention session and 82 (67%) provided qualitative evaluation data in the 3-month follow-up survey. Consultation records from intervention sessions and parent surveys were qualitatively analysed post hoc using a hybrid approach to thematic analysis.Results: Findings were categorised under the seven themes of the TFA (affective attitude, burden, ethicality, intervention coherence, opportunity costs, perceived effectiveness, self-efficacy) in addition to three themes that were defined following inductive and deductive coding (barriers to implementation, facilitators to implementation, suggestions for improvement). Participants spoke positively about their experience participating in the intervention and perceived the intervention to be appropriate and effective. Most parents (95.5%) reported that they would recommend the Sleeping Sound intervention to other families of autistic children. Barriers to implementation included child and parent anxiety, child health problems, parental preferences, family circumstances, and other (e.g., school holidays). Facilitators to implementation included family support and consistency with strategies.Conclusions: The Sleeping Sound intervention was considered acceptable to parents of autistic children as evidenced by largely positive feedback regarding their experience. The results highlighted areas for improvement which can be used to inform future iterations of the intervention. [ABSTRACT FROM AUTHOR]

Extending on previous findings that computerized Memory Specificity Training (c-MeST) improves memory specificity and depressive symptoms in Major Depressive Disorder (MDD) in adults, this study aimed to assess the effects of c-MeST in youth with MDD on memory specificity and depression in addition to other treatment. Participants aged 15–25 (N = 359, 76 % female; M age = 19.2, SD = 3.1), receiving predominantly psychological therapy or counseling (85 %) and/or antidepressants (52 %) were randomized to usual care and c-MeST or usual care. Cognitive and clinical outcomes were assessed at baseline and at one, three, and six-month follow-ups. The usual care and c-MeST group reported higher memory specificity at one-month (d = 0.42, p =.022), but not at three or six months (d 's < 0.15, p 's > 0.05). The rate of MDE was numerically lower in the c-MeST group at each follow-up time-point, but group was not a statistically significant predictor at one month (64 % usual care and c-MeST vs. 68 % usual care, OR = 0.81, p =.606), three months (67 % usual care and c-MeST vs. 72 % usual care, OR = 0.64, p =.327) or six months (55 % usual care and c-MeST vs. 68 % usual care, OR = 0.56, p =.266). The usual care and c-MeST group did report lower depressive symptoms at one month (d = 0.42, p =.023) and six-months (d = 0.84, p =.001), but not three-months (d = 0.13, p >.05). c-MeST may reduce symptoms in youth with MDD when provided alongside other treatments. However, there are significant limitations to this inference, including high attrition in the study and a need for more data on the acceptability of the intervention. • Overgeneral memory appears to maintain depressive symptoms. • Computerized memory specificity training (c-MeST) improved memory specificity. • Depressive symptoms were reduced at one and six-month follow-up. • The effects occurred in addition to receiving other mental health support. • C-MeST may be a beneficial adjunct for youth with major depressive disorder. [ABSTRACT FROM AUTHOR]

Mindfulness apps have become popular tools for addressing symptoms of depression and anxiety. Since the publication of earlier meta-analyses evaluating the efficacy of mindfulness apps for depression and anxiety symptoms, over 20 randomized controlled trials (RCTs) have been conducted. There is a need for an updated meta-analysis that quantifies the effects of mindfulness apps on these symptoms and tests for potential moderators.. Random effects meta-analyses were conducted on 45 RCTs. Small, significant effect sizes were found for symptoms of depression (N comp = 46, N = 5852, g = 0.24, 95% CI = 0.17, 0.31, NNT = 13.57) and anxiety (N comp = 48, N = 6082, g = 0.28, 95% CI = 0.21, 0.35, NNT = 11.47) in favour of mindfulness apps over control groups. This effect was not explained by symptom deterioration in participants allocated to control groups. Effects remained stable when restricting analyses to lower risk of bias and larger sample trials. No significant moderators were observed, except trials that offered monetary compensation produced larger effects on depression. Non-significant effects were observed when comparing mindfulness apps to active therapeutic comparisons (g = −0.15 depression, g = 0.10 anxiety), though the number of studies was low. Growing evidence indicates that mindfulness apps can acutely reduce symptoms of depression and anxiety, although higher quality studies with longer follow-ups are needed. • Conducted a meta-analysis of 45 trials of mindfulness apps on depression and anxiety. • Mindfulness apps led to small improvements in depression and anxiety relative to controls. • Mindfulness was not significantly different to active therapeutic comparisons. • Mindfulness apps may help improve symptoms of depression and anxiety to a modest degree. [ABSTRACT FROM AUTHOR]

Objective: In the past two decades, newer psychotherapy treatments have emerged for the treatment of major depression. This review aimed to comprehensively synthesize the evidence for mindfulness-based cognitive therapy (MBCT), acceptance and commitment therapy (ACT), and positive psychotherapy (PPT) in treating a current episode of major depression. Methods: A systematic search of the Ovid MEDLINE, Embase, PsycINFO, and Cochrane databases was conducted for randomized controlled trials ofMBCT, ACT, andPPTfor major depression. Standardized mean differences were calculated with Hedges' g to complete random-effects meta-analysis. Heterogeneity was assessed with the Cochran Q statistic and I2 statistic. Subgroup analysis was conducted to further investigate heterogeneity. Results: A random-effects meta-analysis of 15 studies (MBCT, N=7; ACT, N=4; PPT, N=4) revealed that all three therapies showed efficacy in reducing symptoms of depression with a small favorable effect, compared with all control conditions (N=946; Hedges' g=0.34; 95% confidence interval=0.14, 0.54; p<0.001). Cochrane's Q statistic (Q=32, df=15, p=0.007) suggested significant heterogeneity (I²=53%). A mixed-effects model test for subgroup differences showed significant differences between active controls and treatment-as-usual controls (χ²=15.3, df=1, p<0.001). Overall quality of evidence and publication bias were low. Conclusions: Meta-analysis shows that MBCT and ACT may be superior to inactive or treatment-as-usual controls and that PPT may be comparable to active controls for reducing symptoms of major depression after an acute course of therapy. However, the quality of the evidence was low. High-quality studies are needed to confirm the efficacy of these interventions. [ABSTRACT FROM AUTHOR]

Knowledge is a relevant concept in internet-based cognitive-behaviour therapy (I-CBT), yet little research has sought to understand the role of knowledge in I-CBT for eating disorders. This study addressed this gap. Data were analysed from 293 participants enrolled in a RCT of I-CBT for eating disorder symptoms. A test assessing knowledge of CBT principles and eating disorders was administered before and after I-CBT. Participants had high knowledge to begin with, correctly answering 72% of items. A significant increase in knowledge scores and knowledge confidence was observed after ICBT. While no relationship between the degree of knowledge gain and the degree of symptom improvement emerged, an increase in confidence in one's knowledge was associated with greater symptom improvement. Higher baseline knowledge levels predicted lower likelihood of drop-out and a higher likelihood of adherence, but were unrelated to symptom-level improvement. Findings suggest that while new knowledge can be acquired through I-CBT, the degree of knowledge gain alone is not sufficient to explain improvement in symptoms. Pre-existing knowledge levels may be an important prognostic indicator of patient progress and compliance to I-CBT. Ensuring that patients can correctly apply the key I-CBT skills may be more important than knowledge gain. • Participants improve their knowledge of CBT after internet-based interventions. • An increase in knowledge confidence predicts greater symptom improvement. • Higher baseline knowledge levels predicted lower dropout and greater compliance to I-CBT. • Knowledge may be an important prognostic indicator in I-CBT. [ABSTRACT FROM AUTHOR]