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Schleider JL, Smith AC, Graham AK. Timing matters in (mis)identifying moderators and mediators of digital interventions for eating disorders: Commentary on McClure et al. (2023). Int J Eat Disord 2024; 57:1141-1144. [PMID: 38450821 PMCID: PMC11093699 DOI: 10.1002/eat.24185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 02/23/2024] [Accepted: 02/23/2024] [Indexed: 03/08/2024]
Abstract
This commentary addresses the challenges in identifying consistent moderators and mediators of psychological treatments for eating disorders (EDs), as highlighted by McClure et al. (International Journal of Eating Disorders, 2023) in their systematic review. Specifically, we discuss the often-overlooked importance of temporal context (when an intervention is delivered), alongside sociodemographic and symptom type (for whom an intervention is delivered), in understanding and optimizing treatment engagement and effectiveness. We outline how individuals' fluctuating levels of motivation and receptivity across different "pivotal moments" in the help-seeking process-including initial outreach and self-screening, ongoing care engagement, and post-discharge-can dynamically impact interventions' relevance and impacts. We also overview how Just-In-Time Adaptive Interventions in digital mental health interventions can be harnessed to simultaneously consider "when" and "for whom" ED interventions can exert the greatest benefits. We conclude with several recommendations for conducting ED intervention and implementation research that integrate timing into support delivery and study design, enabling a deeper understanding of not just how and for whom, but when, ED interventions can be most effective.
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Affiliation(s)
- Jessica L Schleider
- Department of Medical Social Sciences, Northwestern University, Chicago, Illinois, USA
| | - Arielle C Smith
- Department of Medical Social Sciences, Northwestern University, Chicago, Illinois, USA
| | - Andrea K Graham
- Department of Medical Social Sciences, Northwestern University, Chicago, Illinois, USA
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2
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Karam Jones AM, Fitzsimmons-Craft EE, D'Adamo L, Eichen DM, Graham AK, Kolko Conlon RP, Balantekin KN, Welch RR, Agras WS, Wilson GT, Wilfley DE. A pilot study evaluating online training for therapist delivery of interpersonal psychotherapy for eating disorders. Int J Eat Disord 2024. [PMID: 38623931 DOI: 10.1002/eat.24197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 03/03/2024] [Accepted: 03/04/2024] [Indexed: 04/17/2024]
Abstract
OBJECTIVE Individuals with eating disorders (EDs) often do not receive evidence-based care, such as interpersonal psychotherapy (IPT), partly due to lack of accessible training in these treatments. The standard method of training (i.e., in-person workshops) is expensive and time consuming, prompting a need for more scalable training tools. The primary aim of this pilot and open trial was to examine the effects of an IPT online training platform on training outcomes (i.e., IPT fidelity, knowledge, and acceptance) and, secondarily, whether online training was different from in-person training (using a comparative sample from a separate study) in terms of training outcomes and patient symptoms. METHOD Participants were therapists (N = 60) and student patients (N = 42) at 38 college counseling centers. Therapists completed baseline questionnaires and collected data from a student patient with ED symptoms. Therapists then participated in an IPT online training program and completed post-training assessments. RESULTS Following online training, acceptance of evidence-based treatments, therapist knowledge of IPT, therapist acceptance of IPT, and treatment fidelity increased; acceptance of online training was high at baseline and remained stable after training. Using the 90% confidence interval on outcome effect sizes, results suggested IPT online training was not different from in-person training on most outcomes. Results are based on 60% of therapists who originally enrolled due to high dropout rate of therapist participants. CONCLUSIONS Findings from this preliminary pilot study support the use of IPT online training, which could increase access to evidence-based ED treatment and improve patient care. PUBLIC SIGNIFICANCE Lack of accessible therapist training has contributed to many therapists not delivering, and therefore many patients not receiving, evidence-based treatment. This study evaluated a highly disseminable online training and compared outcomes to traditional in-person training and found that training and patient outcomes were not different. Online training has the potential to enhance access to evidence-base care, which could in turn optimize patient outcomes.
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Affiliation(s)
- Anna M Karam Jones
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
- University of California San Diego, San Diego, California, USA
| | | | - Laura D'Adamo
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Dawn M Eichen
- University of California San Diego, San Diego, California, USA
| | - Andrea K Graham
- Department of Medical Social Sciences, Northwestern University, Chicago, Illinois, USA
| | - Rachel P Kolko Conlon
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Katherine N Balantekin
- Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, New York, USA
| | - R Robinson Welch
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - W Stewart Agras
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, USA
| | - G Terence Wilson
- Graduate School of Applied and Professional Psychology, Rutgers, The State University of New Jersey, Piscataway, New Jersey, USA
| | - Denise E Wilfley
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
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Fitzsimmons-Craft EE, Wilfley DE, Accurso EC, Balantekin KN, Celio Doyle A, Eisenberg D, Firebaugh ML, Flatt RE, Goel NJ, Graham AK, Jacobi C, Jones Bell M, Monterubio GE, Newman MG, Sadeh-Sharvit S, Taylor K, Weissman RS. Nurturing innovation, catalyzing change: Honoring the legacy of Dr. C. Barr Taylor in the eating disorders field. Int J Eat Disord 2024; 57:543-547. [PMID: 38297971 DOI: 10.1002/eat.24145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 01/10/2024] [Indexed: 02/02/2024]
Abstract
This Virtual Issue of the International Journal of Eating Disorders honors the legacy of the late Dr. C. Barr Taylor in the eating disorders (EDs) field. For decades, Dr. Taylor led the way in not only conducting the research needed to achieve the ultimate goal of making affordable, accessible, and evidence-based care for EDs available to all, but also nurturing the next generation of scientific leaders and innovators. Articles included in this Virtual Issue are a selection of Dr. Taylor's published works in the Journal in the past decade, spanning original research, ideas worth researching, commentaries, and a systematic review. We hope this Virtual Issue will inspire the next generation of research in EDs, and equally, if not more importantly, the next generation of young investigators in the field. We urge the field to continue and build upon Dr. Taylor's vision-to increase access to targeted prevention and intervention for EDs in innovative and forward-thinking ways-while embracing his unique and powerful mentorship style to lift up early career investigators and create a community of leaders to address and solve our field's biggest challenges.
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Affiliation(s)
- Ellen E Fitzsimmons-Craft
- Department of Psychiatry, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Denise E Wilfley
- Department of Psychiatry, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Erin C Accurso
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA
| | - Katherine N Balantekin
- Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, New York, USA
| | | | - Daniel Eisenberg
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California, USA
| | - Marie-Laure Firebaugh
- Department of Psychiatry, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Rachael E Flatt
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Neha J Goel
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Andrea K Graham
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Corinna Jacobi
- Technische Universität Dresden, Chair of Clinical Psychology and E-Mental Health, Dresden, Germany
| | | | | | - Michelle G Newman
- Department of Psychology and Psychiatry, The Pennsylvania State University, University Park, Pennsylvania, USA
| | | | - Katherine Taylor
- Dissemination and Training Division, Virginia National Center for PTSD, Virginia, USA
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Meyerhoff J, Kornfield R, Lattie EG, Knapp AA, Kruzan KP, Jacobs M, Stamatis CA, Taple BJ, Beltzer ML, Berry AB, Reddy M, Mohr DC, Graham AK. From formative design to service-ready therapeutic: A pragmatic approach to designing digital mental health interventions across domains. Internet Interv 2023; 34:100677. [PMID: 37808416 PMCID: PMC10551833 DOI: 10.1016/j.invent.2023.100677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 08/30/2023] [Accepted: 09/27/2023] [Indexed: 10/10/2023] Open
Abstract
As digital mental health interventions (DMHIs) proliferate, there is a growing need to understand the complexities of moving these tools from concept and design to service-ready products. We highlight five case studies from a center that specializes in the design and evaluation of digital mental health interventions to illustrate pragmatic approaches to the development of digital mental health interventions, and to make transparent some of the key decision points researchers encounter along the design-to-product pipeline. Case studies cover different key points in the design process and focus on partnership building, understanding the problem or opportunity, prototyping the product or service, and testing the product or service. We illustrate lessons learned and offer a series of questions researchers can use to navigate key decision points in the digital mental health intervention (DMHI) development process.
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Affiliation(s)
- Jonah Meyerhoff
- Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, 750 N Lake Shore Drive, 10th Floor, Chicago, IL 60611, United States of America
| | - Rachel Kornfield
- Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, 750 N Lake Shore Drive, 10th Floor, Chicago, IL 60611, United States of America
| | - Emily G. Lattie
- Center for Behavioral Intervention Technologies, Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 750 N Lake Shore Drive, 10th Floor, Chicago, IL 60611, United States of America
| | - Ashley A. Knapp
- Center for Behavioral Intervention Technologies, Department of Psychological and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, 750 N Lake Shore Drive, 10th Floor, Chicago, IL 60611, United States of America
| | - Kaylee P. Kruzan
- Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, 750 N Lake Shore Drive, 10th Floor, Chicago, IL 60611, United States of America
| | - Maia Jacobs
- Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, 750 N Lake Shore Drive, 10th Floor, Chicago, IL 60611, United States of America
- Department of Computer Science, Northwestern University, MUDD 2233 Tech Drive, 3rd Floor, Evanston, IL 60208, United States of America
| | - Caitlin A. Stamatis
- Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, 750 N Lake Shore Drive, 10th Floor, Chicago, IL 60611, United States of America
| | - Bayley J. Taple
- Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, 750 N Lake Shore Drive, 10th Floor, Chicago, IL 60611, United States of America
| | - Miranda L. Beltzer
- Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, 750 N Lake Shore Drive, 10th Floor, Chicago, IL 60611, United States of America
| | - Andrew B.L. Berry
- Center for Behavioral Intervention Technologies, Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 750 N Lake Shore Drive, 10th Floor, Chicago, IL 60611, United States of America
| | - Madhu Reddy
- Donald Bren School of Information and Computer Sciences, University of California – Irvine, 6210 Donald Bren Hall, Irvine, CA 92697, United States of America
| | - David C. Mohr
- Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, 750 N Lake Shore Drive, 10th Floor, Chicago, IL 60611, United States of America
| | - Andrea K. Graham
- Center for Behavioral Intervention Technologies, Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 750 N Lake Shore Drive, 10th Floor, Chicago, IL 60611, United States of America
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Laboe AA, D'Adamo L, Grammer AC, McGinnis CG, Davison GM, Balantekin KN, Graham AK, Smolar L, Taylor CB, Wilfley DE, Fitzsimmons-Craft EE. The relation of food insecurity to eating disorder characteristics and treatment-seeking among adult respondents to the National Eating Disorders Association online screen. Eat Behav 2023; 50:101776. [PMID: 37390519 PMCID: PMC10542957 DOI: 10.1016/j.eatbeh.2023.101776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 06/22/2023] [Accepted: 06/23/2023] [Indexed: 07/02/2023]
Abstract
BACKGROUND Food insecurity (FI), characterized by limited or uncertain access to adequate food, has been associated with eating disorders (EDs). This study explored whether FI was associated with ED behaviors, ED diagnosis, current treatment status, and treatment-seeking intentions among adults who completed an online ED screen. METHODS Respondents to the National Eating Disorders Association online screening tool self-reported demographics, FI, height and weight, past 3-month ED behaviors, and current treatment status. Respondents were also asked an optional question about treatment-seeking intentions. Hierarchical regressions evaluated relations between FI and ED behaviors, treatment status, and treatment-seeking intentions. Logistic regressions explored differences in probable ED diagnosis by FI status. RESULTS Of 8714 respondents, 25 % screened at risk for FI. FI was associated with greater binge eating (R2Change = 0.006), laxative use (R2Change = 0.001), and presence of dietary restriction (R2Change = 0.001, OR: 1.32) (ps < .05). Having FI was associated with greater odds of screening positive for a probable ED or as high risk for an ED (ps < .05). FI was not associated with current treatment status or treatment-seeking intentions (ps > .05). CONCLUSIONS Findings add to existing literature supporting a relation between FI and EDs. Implications include a need to disseminate EDs screening and treatment resources to populations affected by FI and to tailor treatments to account for barriers caused by FI.
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Affiliation(s)
- Agatha A Laboe
- Department of Psychiatry, Washington University School of Medicine, Mailstop 8134-29-2100, 660 S. Euclid Ave., St. Louis, MO 63110, USA.
| | - Laura D'Adamo
- Department of Psychiatry, Washington University School of Medicine, Mailstop 8134-29-2100, 660 S. Euclid Ave., St. Louis, MO 63110, USA; Department of Psychological and Brain Sciences, Center for Weight, Eating, and Lifestyle Science (WELL Center), Drexel University, 3201 Chestnut St., Philadelphia, PA 19104, USA
| | - Anne Claire Grammer
- Department of Psychiatry, Washington University School of Medicine, Mailstop 8134-29-2100, 660 S. Euclid Ave., St. Louis, MO 63110, USA
| | - Claire G McGinnis
- Department of Psychiatry, Washington University School of Medicine, Mailstop 8134-29-2100, 660 S. Euclid Ave., St. Louis, MO 63110, USA
| | - Genevieve M Davison
- Department of Psychiatry, Washington University School of Medicine, Mailstop 8134-29-2100, 660 S. Euclid Ave., St. Louis, MO 63110, USA
| | - Katherine N Balantekin
- Department of Exercise and Nutrition Sciences, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY 14214, USA
| | - Andrea K Graham
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Lauren Smolar
- National Eating Disorders Association, New York, NY, USA
| | - C Barr Taylor
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305, USA; Center for m(2)Health, Palo Alto University, 5150 El Camino Real, Los Altos, CA 94022, USA
| | - Denise E Wilfley
- Department of Psychiatry, Washington University School of Medicine, Mailstop 8134-29-2100, 660 S. Euclid Ave., St. Louis, MO 63110, USA
| | - Ellen E Fitzsimmons-Craft
- Department of Psychiatry, Washington University School of Medicine, Mailstop 8134-29-2100, 660 S. Euclid Ave., St. Louis, MO 63110, USA
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Harris A, Jordan N, Carroll AJ, Graham AK, Wilson C, Wilson FA, Berkel C, Smith JD. A budget impact analysis of cost to implement a whole child health focused, family-based intervention in primary care for children with elevated BMI. Implement Sci Commun 2023; 4:59. [PMID: 37277878 DOI: 10.1186/s43058-023-00429-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 04/16/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND Although the cost of implementing evidence-based interventions (EBIs) is a key determinant of adoption, lack of cost information is widespread. We previously evaluated the cost of preparing to implement Family Check-Up 4 Health (FCU4Health), an individually tailored, evidence-based parenting program that takes a whole child approach, with effects on both behavioral health and health behavior outcomes, in primary care settings. This study estimates the cost of implementation, including preparation. METHODS We assessed the cost of FCU4Health across the preparation and implementation phases spanning 32 months and 1 week (October 1, 2016-June 13, 2019) in a type 2 hybrid effectiveness-implementation study. This family-level randomized controlled trial took place in Arizona with n = 113 predominantly low-income, Latino families with children ages > 5.5 to < 13 years. Using electronic cost capture and time-based activity-driven methods, budget impact analysis from the perspective of a future FCU4Health adopting entity-namely, ambulatory pediatric care clinicians-was used to estimate the cost of implementation. Labor costs were based on 2021 Bureau of Labor Statistics Occupational Employment Statistics, NIH-directed salary cap levels or known salaries, plus fringe benefits at a standard rate of 30%. Non-labor costs were based on actual amounts spent from receipts and invoices. RESULTS The cost of FCU4Health implementation to 113 families was $268,886 ($2380 per family). Actual per family cost varied widely, as individual tailoring resulted in families receiving a range of 1-15 sessions. The estimated cost of replicating implementation for future sites ranged from $37,636-$72,372 ($333-$641 per family). Using our previously reported preparation costs (i.e., $174,489; $1544 per family), with estimated replication costs of $18,524-$21,836 ($164-$193 per family), the total cost of delivering FCU4Health was $443,375 ($3924 per family), with total estimated replication costs of $56,160-$94,208 ($497-$834 per family). CONCLUSIONS This study provides a baseline for costs associated with implementation of an individually tailored parenting program. Results provide critical information for decision makers and a model for future economic analysis and can be used to inform optimization thresholds for implementation and, when necessary, benchmarks for program adaptation to promote scale-up. TRIAL REGISTRATION This trial was prospectively registered on January 6, 2017, at ClinicalTrials.gov (NCT03013309).
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Affiliation(s)
- Alexandra Harris
- Health Sciences Integrated PhD Program, Center for Education in Health Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Neil Jordan
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Allison J Carroll
- Center for Prevention Implementation Methodology, Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Andrea K Graham
- Center for Behavioral Intervention Technologies, Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Fernando A Wilson
- Department of Population Health Sciences, University of Utah Intermountain Healthcare, Spencer Fox Eccles School of Medicine, College of Social and Behavioral Science Department of Economics, Matheson Center for Health Care Studies, University of Utah, Salt Lake City, UT, USA
| | - Cady Berkel
- Population Health & Integrated Behavioral Health, College of Health Solutions, Arizona State University, Tempe, AZ, USA
| | - Justin D Smith
- Department of Population Health Sciences, University of Utah Intermountain Healthcare, University of Utah School of Medicine, Salt Lake City, UT, USA.
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D’Adamo L, Paraboschi L, Grammer AC, Fennig M, Graham AK, Yaeger LH, Newman MG, Wilfley DE, Taylor CB, Eisenberg D, Fitzsimmons-Craft EE. Reach and uptake of digital mental health interventions based on cognitive-behavioral therapy for college students: A systematic review. J Behav Cogn Ther 2023; 33:97-117. [PMID: 37724304 PMCID: PMC10506850 DOI: 10.1016/j.jbct.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Abstract
Background Mental health problems are increasing in prevalence among college students, yet few students receive treatment due to barriers such as insufficient resources in college counseling centers. Digital mental health interventions (DMHIs) have potential to overcome barriers and offer accessible, evidence-based care to college students. However, to evaluate the true public health impact of evidence-based DMHIs, it is important to assess the reach and uptake rates of DMHIs on college campuses. Objectives We conducted a systematic review to examine the reach (i.e., % of invited students who express interest) and uptake (i.e., % of enrolled participants who initiate an intervention) of DMHIs based on cognitive-behavioral therapy (CBT) for college students. Methods Eight databases were searched. Inclusion criteria included: (1) college population; (2) experimental design; (3) CBT-based intervention; (4) intervention targeting specific mental health conditions; and (5) digital intervention. Reach and uptake rates were calculated from data reported. A systematic narrative review framework was used to synthesize results. Results Of 10,315 articles screened, 90 were included. Seventeen studies (19%) reported sufficient data to calculate reach; 35 studies (39%) reported uptake rates. Of studies that reported reach or uptake, most evaluated unguided (n = 20) or guided (n = 16) self-help programs. Measurement methods varied widely. Overall reach was low, whereas uptake was high among enrolled participants. Discussion Despite evidence that improving reach and uptake can increase the public health impact of DMHIs, most studies did not report on either outcome. Suggested practices to improve these outcomes, and their reporting, are discussed.
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Affiliation(s)
- Laura D’Adamo
- Department of Psychiatry, Washington University School of Medicine, Mailstop 8134-29-2100, 660 S. Euclid Ave., St. Louis, MO 63110, USA
- Department of Psychological and Brain Sciences and Center for Weight, Eating, and Lifestyle Science (WELL Center), Drexel University, 3201 Chestnut St. Philadelphia, PA 19104, USA
| | - Layna Paraboschi
- Department of Psychiatry, Washington University School of Medicine, Mailstop 8134-29-2100, 660 S. Euclid Ave., St. Louis, MO 63110, USA
| | - Anne Claire Grammer
- Department of Psychiatry, Washington University School of Medicine, Mailstop 8134-29-2100, 660 S. Euclid Ave., St. Louis, MO 63110, USA
| | - Molly Fennig
- Department of Psychiatry, Washington University School of Medicine, Mailstop 8134-29-2100, 660 S. Euclid Ave., St. Louis, MO 63110, USA
| | - Andrea K. Graham
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 633 N St Clair St, Chicago, IL 60611, USA
| | - Lauren H. Yaeger
- Washington University School of Medicine, 660 S Euclid Ave, St. Louis, MO 63110, USA
| | - Michelle G. Newman
- Department of Psychology, The Pennsylvania State University, 371 Moore Building, University Park, PA 16801, USA
| | - Denise E. Wilfley
- Department of Psychiatry, Washington University School of Medicine, Mailstop 8134-29-2100, 660 S. Euclid Ave., St. Louis, MO 63110, USA
| | - C. Barr Taylor
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305, USA
- Center for m Health, Palo Alto University, 5150 El Camino Real, Los Altos, CA 94022, USA
| | - Daniel Eisenberg
- Department of Health Policy and Management, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Ellen E. Fitzsimmons-Craft
- Department of Psychiatry, Washington University School of Medicine, Mailstop 8134-29-2100, 660 S. Euclid Ave., St. Louis, MO 63110, USA
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Flynn RL, Massion TA, Kosmas JA, Smith SR, Mastronardi CN, Graham AK. Positive affect dysregulation and its relation to binge eating size and frequency. Front Psychol 2023; 14:1146549. [PMID: 37284471 PMCID: PMC10239925 DOI: 10.3389/fpsyg.2023.1146549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 05/02/2023] [Indexed: 06/08/2023] Open
Abstract
Negative affect is an established predictor of binge eating, yet less is known about positive affect. Low positive affect has been theorized to increase binge eating, but a better understanding is needed on the relationship between positive affect and binge eating frequency and size. Participants were 182 treatment-seeking adults (76% self-identified as female; 45% self-identified their race as Black and 40% as White; and 25% self-identified their ethnicity as Hispanic/Latino) with self-reported recurrent binge eating (≥12 binge episodes in the past 3 months). Participants completed the positive and negative affect schedule (PANAS) survey and the eating disorder examination to assess frequency of objective binge episodes (OBEs) and subjective binge episodes (SBEs) over the past 3 months. OBEs and SBEs also were combined to yield total binge episodes over the past 3 months. Independent t-tests and linear regression analyses were used to test associations between positive affect scores and binge episode size and frequencies, and to compare low versus higher positive affect on binge frequency. Additional exploratory models were conducted controlling for negative affect, identity characteristics, and socio-demographic variables. Lower positive affect was significantly associated with more frequent total binge episodes, but not OBEs and SBEs when assessed independently. Findings remained consistent when controlling for covariates and when comparing individuals with the lowest versus higher positive affect levels. Overall, results lend support to the theory that low positive affect is associated with binge eating. Increasing positive affect may be an important treatment consideration for those with recurrent binge eating.
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Affiliation(s)
- Rebecca L. Flynn
- Center for Behavioral Intervention Technologies, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Thomas A. Massion
- Center for Behavioral Intervention Technologies, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Jacqueline A. Kosmas
- Center for Behavioral Intervention Technologies, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Shannon R. Smith
- Center for Behavioral Intervention Technologies, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Carli N. Mastronardi
- Center for Behavioral Intervention Technologies, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Andrea K. Graham
- Center for Behavioral Intervention Technologies, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
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Graham AK, Fitzsimmons-Craft EE, Sadeh-Sharvit S, Balantekin KN, Eichen DM, Firebaugh ML, Goel NJ, Monterubio GE, Karam AM, Flatt RE, Jo B, Jacobi C, Wilfley DE, Taylor CB, Trockel M. Moderators and mediators of a digital cognitive behavior therapy-guided self-help intervention for eating disorders: Informing future design efforts. J Consult Clin Psychol 2023; 91:280-284. [PMID: 36634022 PMCID: PMC10198808 DOI: 10.1037/ccp0000786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE The Student Bodies-Eating Disorders intervention (SB-ED), a digital cognitive behavior therapy-guided self-help intervention for college women with an eating disorder, is effective for reducing eating disorder psychopathology. The purpose of this study was to evaluate moderators and mediators of the SB-ED intervention. To our knowledge, this is the first evaluation of clinical mediators of a digital intervention for women with eating disorders. METHOD This is an exploratory secondary analysis of a cluster randomized trial comparing the SB-ED intervention to referral to usual care among 690 women at 27 United States colleges. Moderators included body mass index (BMI), race, ethnicity, weight/shape concerns, eating disorder impairment, thin ideal internalization, depression, anxiety, and motivation for treatment, assessed at baseline. Thin ideal internalization and depressive symptoms were tested as predictors at postintervention and mediators at 2-year follow-up. Outcome was change in global eating disorder psychopathology. RESULTS BMI moderated the effect of the intervention at follow-up (but not posttreatment), with individuals with a lower BMI experiencing more continued improvements in eating disorder psychopathology following the intervention than individuals with a higher BMI. Thin ideal internalization mediated the effect of the intervention at follow-up, and depression partially mediated the effect of the intervention at follow-up. CONCLUSIONS Results of the mediator analyses suggest that helping college women reduce inflated internalization of the thin ideal and improve depressive symptoms leads to improvements in eating disorder psychopathology. Results also suggest opportunities to optimize the intervention so individuals across the BMI spectrum experience ongoing improvements over time. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Andrea K. Graham
- Center for Behavioral Intervention Technologies, Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | | | | | - Dawn M. Eichen
- Department of Pediatrics, University of California, San Diego, San Diego, California
| | - Marie-Laure Firebaugh
- Department of Psychiatry, Washington University School of Medicine, St Louis, Missouri
| | - Neha J. Goel
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia
| | - Grace E. Monterubio
- Department of Psychiatry, Washington University School of Medicine, St Louis, Missouri
| | - Anna M. Karam
- Department of Psychiatry, Washington University School of Medicine, St Louis, Missouri
| | - Rachael E. Flatt
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Booil Jo
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - Corinna Jacobi
- Institute of Clinical Psychology and Psychotherapy, Technische Universität, Dresden, Germany
| | - Denise E. Wilfley
- Department of Psychiatry, Washington University School of Medicine, St Louis, Missouri
| | - C. Barr Taylor
- Center for mHealth, Palo Alto University, Palo Alto, California
- Institute of Clinical Psychology and Psychotherapy, Technische Universität, Dresden, Germany
| | - Mickey Trockel
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
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10
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Lyon A, Munson SA, Reddy M, Schueller SM, Agapie E, Yarosh S, Dopp AR, von Thiele Schwarz U, Doherty G, Graham AK, Kruzan K, Kornfeld R. Bridging HCI and Implementation Science for Innovation Adoption and Public Health Impact. Ext Abstr Hum Factors Computing Syst 2023; 2023:336. [PMID: 38585487 PMCID: PMC10999072 DOI: 10.1145/3544549.3574132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
Human computer interaction (HCI) and implementation science (IS) each have been applied to improve the adoption and delivery of innovative health interventions, and the two fields have complementary goals, foci, and methods. While the IS community increasingly draws on methods from HCI, there are many unrealized opportunities for HCI to draw from IS and to catalyze bidirectional collaborations. This workshop will explore similarities and differences between fields, with a goal of articulating a research agenda at their intersection.
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Affiliation(s)
- Aaron Lyon
- University of Washington Seattle, Washington, USA
| | | | - Madhu Reddy
- University of California Irvine Irvine, California, USA
| | | | - Elena Agapie
- University of California Irvine Irvine, California, USA
| | | | - Alex R Dopp
- RAND Corporation Santa Monica, California, USA
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11
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Kosmas JA, Wildes JE, Graham AK, O'Connor SM. The role of stress in the association among food insecurity, eating disorder pathology, and binge eating-related appetitive traits. Eat Behav 2023; 49:101709. [PMID: 36822033 PMCID: PMC10238633 DOI: 10.1016/j.eatbeh.2023.101709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 02/10/2023] [Accepted: 02/13/2023] [Indexed: 02/17/2023]
Abstract
PURPOSE Growing literature demonstrates a positive association between food insecurity (FI) and eating disorder pathology. Additionally, FI has been associated with two appetitive traits strongly linked to binge eating, food responsiveness and emotional overeating. However, little research has investigated factors that might help to explain these associations. One hypothesis is that experiencing FI may increase stress, and that eating disorder pathology, particularly binge eating-related phenotypes, may serve as a coping strategy. This study explores stress as a potential mechanism in the association between FI and general eating disorder pathology, as well as two appetitive traits strongly associated with binge eating (food responsiveness and emotional overeating). METHODS Cis-gender women (N = 634) completed online questionnaires assessing FI, stress, eating disorder pathology (measured via the total score on the Short Eating Disorder Examination Questionnaire), and binge eating-related appetitive traits (measured via the Adult Eating Behavior Questionnaire). Cross-sectional indirect effects analyses with a 1000-sample bootstrap were used to test pathways among FI, stress, and eating-related constructs. RESULTS FI was significantly associated with eating disorder pathology and associated appetitive traits (ps < 0.001). Stress explained a significant proportion of the correlation between FI and each eating-related construct. CONCLUSIONS Our findings extend prior research on the relationships between FI, eating disorder pathology, and binge eating-related appetitive traits to provide preliminary evidence that stress may act as an underlying mechanism. Future studies should use longitudinal designs to assess the prospective relationships among these constructs.
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Affiliation(s)
- Jacqueline A Kosmas
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, USA; Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, USA
| | - Jennifer E Wildes
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, USA
| | - Andrea K Graham
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, USA
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12
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Graham AK, Kosmas JA, Massion TA. Designing Digital Interventions for Eating Disorders. Curr Psychiatry Rep 2023; 25:125-138. [PMID: 36928767 DOI: 10.1007/s11920-023-01415-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/21/2023] [Indexed: 03/18/2023]
Abstract
PURPOSE OF REVIEW Digital (i.e., online, mobile) interventions have potential to increase access to care for people with eating disorders, but engagement with digital interventions has been challenging. Human-centered design is a methodology that centralizes the design of technologies on the people who will be using them and the settings in which they will be implemented, to yield solutions with high engagement and clinical impact. The paper presents an overview of the human-centered design process, followed by a review of publications that have applied design methods to digital interventions for eating disorders. RECENT FINDINGS Design research has been conducted via needs assessments, prototyping and usability studies, and during ongoing delivery of digital eating disorder interventions. There has been growing research applying design methods to digital interventions for eating disorders. Additional opportunities include designing for implementation, designing for equity, and designing for the optimization of digital interventions over time.
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Affiliation(s)
- Andrea K Graham
- Center for Behavioral Intervention Technologies, Northwestern University Feinberg School of Medicine, 750 N. Lake Shore Drive, 10 Floor, Chicago, IL, USA. .,Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 750 N. Lake Shore Drive, 10 Floor, Chicago, IL, USA.
| | - Jacqueline A Kosmas
- Center for Behavioral Intervention Technologies, Northwestern University Feinberg School of Medicine, 750 N. Lake Shore Drive, 10 Floor, Chicago, IL, USA.,Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 750 N. Lake Shore Drive, 10 Floor, Chicago, IL, USA
| | - Thomas A Massion
- Center for Behavioral Intervention Technologies, Northwestern University Feinberg School of Medicine, 750 N. Lake Shore Drive, 10 Floor, Chicago, IL, USA.,Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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13
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Sadeh-Sharvit S, Idan O, Fowler LA, Fitzsimmons-Craft EE, Firebaugh ML, Smith A, Graham AK, Goel NJ, Flatt RE, Balantekin KN, Monterubio GE, Karam AM, Funk B, Trockel MT, Wilfley DE, Taylor CB. Digital guided self-help for eating disorders: thematic analysis of participant text messages to coaches. Eat Disord 2023; 31:191-199. [PMID: 36178245 PMCID: PMC10587906 DOI: 10.1080/10640266.2022.2110698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Digital guided self-help for eating disorders (GSH-ED) can reduce treatment disparities. Understanding program participants' interests throughout the program can help adapt programs to the service users' needs. Participants were 383 college students receiving a digital GSH-ED, who were each assigned a coach to help them better utilize the intervention through text correspondence. A thematic and affective analysis of the texts participants had sent found they primarily focused on: strategies for changing their ED-related cognitions, behaviors, and relationships; describing symptoms without expressing an active endeavor to change; and participants' relationship with their coach. Most texts also expressed affect, demonstrating emotional engagement with the intervention. Findings suggest that participants in GSH-ED demonstrate high involvement with the intervention, and discuss topics that are similar to those reported in clinician-facilitated interventions. The themes discussed by digital program participants can inform future iterations of GSH-ED, thereby increasing scalability and accessibility of digital evidence-based ED interventions.
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Affiliation(s)
- Shiri Sadeh-Sharvit
- Center for mHealth, Palo Alto University, Palo Alto, CA, USA
- Stanford University Department of Psychiatry and Behavioral Sciences, Stanford, CA, USA
- Baruch Ivcher School of Psychology, Interdisciplinary Center, Herzliya, Israel
| | - Orly Idan
- Baruch Ivcher School of Psychology, Interdisciplinary Center, Herzliya, Israel
| | - Lauren A. Fowler
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | | | - Marie-Laure Firebaugh
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Arielle Smith
- Center for mHealth, Palo Alto University, Palo Alto, CA, USA
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Andrea K. Graham
- Department of Medical Social Science, Northwestern University, Chicago, IL, USA
| | - Neha J. Goel
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Rachael E. Flatt
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Grace E. Monterubio
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Anna M. Karam
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | | | - Mickey T. Trockel
- Stanford University Department of Psychiatry and Behavioral Sciences, Stanford, CA, USA
| | - Denise E. Wilfley
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - C. Barr Taylor
- Center for mHealth, Palo Alto University, Palo Alto, CA, USA
- Stanford University Department of Psychiatry and Behavioral Sciences, Stanford, CA, USA
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14
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Voss C, Liu J, Chang A, Kosmas JA, Biehl A, Flynn RL, Kruzan KP, Wildes JE, Graham AK. Weight Loss Expectations of Adults With Binge Eating: Cross-sectional Study With a Human-Centered Design Approach. JMIR Form Res 2023; 7:e40506. [PMID: 36853750 PMCID: PMC10015344 DOI: 10.2196/40506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 12/17/2022] [Accepted: 01/03/2023] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND People tend to overestimate their expectations for weight loss relative to what is achievable in a typical evidence-based behavioral weight management program, which can impact treatment satisfaction and outcomes. We are engaged in formative research to design a digital intervention that addresses binge eating and weight management; thus, understanding expectations among this group can inform more engaging intervention designs to produce a digital intervention that can achieve greater clinical success. Studies examining weight loss expectations have primarily focused on people who have overweight or obesity. Only one study has investigated weight loss expectations among people with binge eating disorder, a population that frequently experiences elevated weight and shape concerns and often presents to treatment with the goal of losing weight. OBJECTIVE The aim of the study is to investigate differences in weight loss expectations among people with varying levels of binge eating to inform the design of a digital intervention for binge eating and weight management. Such an evaluation may be crucial for people presenting for a digital intervention, given that engagement and dropout are notable problems for digital behavior change interventions. We tested the hypotheses that (1) people who endorsed some or recurrent binge eating would expect to lose more weight than those who did not endorse binge eating and (2) people who endorsed a more severe versus a low or moderate overvaluation of weight and shape would have higher weight loss expectations. METHODS A total of 760 adults (n=504, 66% female; n=441, 58% non-Hispanic White) completed a web-based screening questionnaire. One-way ANOVAs were conducted to explore weight loss expectations for binge eating status as well as overvaluation of shape and weight. RESULTS Weight loss expectations significantly differed by binge eating status. Those who endorsed some and recurrent binge eating expected to lose more weight than those who endorsed no binge eating. Participants with severe overvaluation of weight or shape expected to lose the most weight compared to those with low or moderate levels of overvaluation of weight and shape. CONCLUSIONS In the sample, people interested in a study to inform a digital intervention for binge eating and weight management overestimated their expectations for weight loss. Given that weight loss expectations can impact treatment completion and success, it may be important to assess and modify weight loss expectations among people with binge eating prior to enrolling in a digital intervention. Future work should design and test features that can modify these expectations relative to individuals' intended treatment goals to facilitate engagement and successful outcomes in a digital intervention.
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Affiliation(s)
- Claire Voss
- Center for Behavioral Intervention Technologies, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Jianyi Liu
- Center for Behavioral Intervention Technologies, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Angela Chang
- Center for Behavioral Intervention Technologies, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Jacqueline A Kosmas
- Center for Behavioral Intervention Technologies, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Abigail Biehl
- Center for Behavioral Intervention Technologies, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Rebecca L Flynn
- Center for Behavioral Intervention Technologies, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Kaylee P Kruzan
- Center for Behavioral Intervention Technologies, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Jennifer E Wildes
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, United States
| | - Andrea K Graham
- Center for Behavioral Intervention Technologies, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
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15
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Brown KL, Graham AK, Perera RA, LaRose JG. Eating to cope: Advancing our understanding of the effects of exposure to racial discrimination on maladaptive eating behaviors. Int J Eat Disord 2022; 55:1744-1752. [PMID: 36205358 PMCID: PMC9742121 DOI: 10.1002/eat.23820] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 09/09/2022] [Accepted: 09/19/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Racial discrimination is a stressor for young Black women that leads to poor health outcomes, including maladaptive eating. This study presents findings on racial discrimination and maladaptive eating behaviors (overeating, LOC eating) using ecological momentary assessment (EMA). METHODS Black emerging adult women (N = 27) with overweight or obesity participated in a 14-day EMA study examining exposure to racial discrimination, eating behaviors, and racial identity. Frequencies and chi-square tests were used to characterize the type of racial discrimination experienced and frequency of overeating. Mixed effect ordinal logistic regression models were used to assess the relation between racial discrimination and maladaptive eating. Moderation analysis was conducted by creating interaction terms for discrimination and racial identity variables. RESULTS 81.5% of participants reported experiencing racial discrimination. Young Black women reporting exposure to racial discrimination were more likely to endorse higher levels of both overeating and LOC eating compared to times when discrimination was not experienced (p < .0001). Racial identity moderated the link between racial discrimination and maladaptive eating (overeating, LOC) such that reporting greater levels of private regard buffered the deleterious effect of racial discrimination. Higher levels of public regard exacerbated the association between racial discrimination and both overeating, and LOC. Higher centrality worsened the relation between racial discrimination and LOC. CONCLUSION Young Black women might use maladaptive eating to cope with exposure to racial discrimination, which underscores the importance of examining the link between racism and disordered eating, particularly among Black women submerged in a society that continuously exposes them to racial discrimination. PUBLIC SIGNIFICANCE Emerging adult Black women are exposed to racial discrimination daily. In theory, exposure to racial discrimination could contribute to overeating and loss of control eating in this population. Using ecological momentary assessment, to capture experiences and eating behaviors in the moment they occur, this project quantified the magnitude of racial discrimination and how it was associated with maladaptive eating behaviors. Further, it examined ways in which racial identity was linked to this association.
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Affiliation(s)
- Kristal Lyn Brown
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, VA,Department of Medicine, Johns Hopkins University, School of Medicine, Division of General Internal Medicine, Baltimore MD
| | - Andrea K. Graham
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Robert A. Perera
- Department of Biostatistics, Virginia Commonwealth University School of Medicine, Richmond, VA
| | - Jessica Gokee LaRose
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, VA
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16
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Graham AK, Fitzsimmons‐Craft EE. Accelerating the research-to-practice translation of eating disorder apps and other digital interventions: Commentary on O'Leary and Torous (2022). Int J Eat Disord 2022; 55:1635-1638. [PMID: 36111655 PMCID: PMC9825992 DOI: 10.1002/eat.23811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 08/25/2022] [Accepted: 08/27/2022] [Indexed: 01/11/2023]
Abstract
Smartphone apps are increasingly being developed to address mental health problems, including eating disorders. Yet a review by O'Leary and Torous (2022) revealed the dearth of publicly available evidence-based apps for eating disorders, despite growing research in this area in recent years. The lack of publicly available evidence-based apps is problematic for society and reflects a gap in the research-to-practice translation of the advances that have been made through academic research in this area. We detail barriers that academic researchers face to such translation, including the lack of incentives and pathways for making these interventions available beyond the academic institutions in which they are often created. The effective translation of eating disorder apps, and other digital approaches, from research to practice will require new approaches, including bolstering successful and sustainable translation through partnerships across sectors, being more proactive toward research-to-practice translation, and designing more sustainable digital interventions. Harnessing such approaches can improve the availability of evidence-based eating disorder apps and other digital approaches. Additionally, academic researchers are encouraged to be advocates within their institutions and with funding agencies to find ways to better incentivize and fund these efforts.
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Affiliation(s)
- Andrea K. Graham
- Center for Behavioral Intervention Technologies, Department of Medical Social SciencesNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
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17
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Grammer AC, Shah J, Laboe AA, McGinnis CG, Balantekin KN, Graham AK, Smolar L, Taylor CB, Wilfley DE, Fitzsimmons-Craft EE. Predictors of treatment seeking and uptake among respondents to a widely disseminated online eating disorders screen in the United States. Int J Eat Disord 2022; 55:1252-1258. [PMID: 35719123 PMCID: PMC9444923 DOI: 10.1002/eat.23760] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/21/2022] [Accepted: 06/03/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To explore predictors of treatment seeking and uptake among individuals following an online eating disorders (EDs) screen in the U.S. disseminated by the National Eating Disorders Association. METHOD Respondents who screened at risk or positive for a probable ED from 04/2019 to 05/2021 (N = 263,530) were eligible to complete a 2-month follow-up survey that assessed treatment seeking and uptake after being offered referral options following screening. Analyses were conducted using chi-square tests or logistic regressions. RESULTS Sixty thousand thirty-four respondents (22.8%) opted-in to the follow-up survey, of whom 2276 (3.8%) completed it. Of the final analytic sample (n = 1922), 35.7% of respondents reported seeking and 22.4% reported receiving treatment. Treatment seeking and uptake were more common among respondents who were female, White, or >24 years of age; uptake was more common among respondents who were non-Hispanic or higher income. Elevated shape/weight concerns were significantly, albeit modestly, associated with reduced likelihood to receive treatment. DISCUSSION Demographic differences in treatment seeking and uptake highlight the need to optimize ED screening tools/feedback to meet the needs of underserved groups and to address stereotypes and structural barriers that may interfere. Research is also needed to identify barriers to uptake among those with elevated shape/weight concerns. PUBLIC SIGNIFICANCE Relatively low rates of treatment seeking and uptake were observed, particularly among underserved groups, 2 months following a widely disseminated online eating disorders screen. Optimization of online eating disorder screening tools and delivery of feedback and referral information may be needed to increase health care utilization.
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Affiliation(s)
- Anne Claire Grammer
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jillian Shah
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Agatha A Laboe
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Claire G McGinnis
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Katherine N Balantekin
- Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, New York, USA
| | - Andrea K Graham
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Lauren Smolar
- National Eating Disorders Association, New York, New York, USA
| | - C Barr Taylor
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
- Center for m2Health, Palo Alto University, Palo Alto, California, USA
| | - Denise E Wilfley
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
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18
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Psihogios AM, Lane-Fall MB, Graham AK. Adolescents Are Still Waiting on a Digital Health Revolution: Accelerating Research-to-Practice Translation Through Design for Implementation. JAMA Pediatr 2022; 176:545-546. [PMID: 35404381 DOI: 10.1001/jamapediatrics.2022.0500] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Alexandra M Psihogios
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Meghan B Lane-Fall
- Perelman School of Medicine, University of Pennsylvania, Philadelphia.,Penn Implementation Science Center at the Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Andrea K Graham
- Center for Behavioral Intervention Technologies, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Northwestern University Feinberg School of Medicine, Chicago, Illinois
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19
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Liu J, Munson SA, Chang A, Voss C, Graham AK. Understanding self-monitoring to inform a mobile intervention for binge eating and weight management: A proof-of-concept randomized trial. Int J Eat Disord 2022; 55:642-652. [PMID: 35277986 PMCID: PMC9314870 DOI: 10.1002/eat.23700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 02/24/2022] [Accepted: 02/24/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study explored consumers' perspectives on self-monitoring, a common feature in behavioral interventions that helps inform consumers' progress and answer their questions, to learn what outcome metrics matter to consumers and whether self-selection of these metrics leads to greater engagement (i.e., compliance, satisfaction) in self-monitoring than monitoring only default options. METHODS In a proof-of-concept randomized trial, 48 adult participants were randomly assigned to "clinician-determined monitoring" or "clinician + self-determined monitoring" conditions. Before starting monitoring, all participants shared outcomes that would matter to them in a mobile intervention for binge eating and weight management. Then, for 3 weeks, participants in the "clinician-determined" condition monitored their weight and binge-eating episodes, and participants in the "clinician + self-determined" condition monitored these and another metric of their choosing. After, satisfaction and compliance were assessed. RESULTS Participants identified 116 metrics, grouped into 12 themes, that mattered to them. During monitoring, participants in the "clinician + self-determined" condition monitored 41 metrics. Surprisingly, participants in the "clinician-determined" condition also monitored metrics besides weight and binge eating. This resulted in a failure of our experimental manipulation, which represents a significant limitation of this research. No significant differences emerged in satisfaction or compliance between conditions. DISCUSSION Although our proof-of-concept trial yielded null quantitative results, findings also suggested binge eating and weight management interventions may benefit from including an individually customizable monitoring option in addition to default metrics, warranting testing in future research. PUBLIC SIGNIFICANCE Examining consumers' self-monitoring preferences for a mobile intervention for binge eating and weight management revealed a variety of metrics that matter to consumers, although binge eating and weight were still most valued. Findings from our proof-of-concept trial suggest design implications of encouraging an individually customizable monitoring option, in addition to default metrics, which needs to be tested in future research over a longer period and during actual mobile intervention delivery.
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Affiliation(s)
- Jianyi Liu
- Center for Behavioral Intervention TechnologiesNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
- Department of Psychiatry & Behavioral ScienceNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Sean A. Munson
- Human Centered Design & EngineeringUniversity of WashingtonSeattleWashingtonUSA
| | - Angela Chang
- Center for Behavioral Intervention TechnologiesNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
- Department of Medical Social SciencesNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Claire Voss
- Center for Behavioral Intervention TechnologiesNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Andrea K. Graham
- Center for Behavioral Intervention TechnologiesNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
- Department of Medical Social SciencesNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
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20
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Goel NJ, Jennings Mathis K, Egbert AH, Petterway F, Breithaupt L, Eddy KT, Franko DL, Graham AK. Accountability in promoting representation of historically marginalized racial and ethnic populations in the eating disorders field: A call to action. Int J Eat Disord 2022; 55:463-469. [PMID: 35092322 PMCID: PMC9305786 DOI: 10.1002/eat.23682] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 01/10/2022] [Accepted: 01/12/2022] [Indexed: 11/24/2022]
Abstract
Promoting representation of historically marginalized racial and ethnic populations in the eating disorders (EDs) field among professionals and the populations studied and served has long been discussed, with limited progress. This may be due to a reinforcing feedback loop in which individuals from dominant cultures conduct research and deliver treatment, participate in research, and receive diagnoses and treatment. This insularity maintains underrepresentation: EDs in historically marginalized populations are understudied, undetected, and undertreated. An Early Career Investigators Workshop generated recommendations for change that were not inherently novel but made apparent that accountability is missing. This paper serves as a call to action to spearhead a paradigm shift from equality to equity in the ED field. We provide a theoretical framework, suggest ways to disrupt the feedback loop, and summarize actionable steps to increase accountability in ED leadership and research toward enhancing racial/ethnic justice, equity, diversity, and inclusion (JEDI). These actionable steps are outlined in the service of challenging our field to reflect the diversity of our global community. We must develop and implement measurable metrics to assess our progress toward increasing diversity of underrepresented racial/ethnic groups and to address JEDI issues in our providers, patients, and research participants.
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Affiliation(s)
- Neha J. Goel
- Department of PsychologyVirginia Commonwealth UniversityRichmondVirginiaUSA
| | | | - Amy H. Egbert
- Department of Psychiatry and Human BehaviorThe Miriam Hospital/Warren Alpert Medical School of Brown UniversityProvidenceRhode IslandUSA
| | - Felicia Petterway
- Eating Disorders Clinical and Research ProgramMassachusetts General HospitalBostonMassachusettsUSA,Department of PsychiatryHarvard Medical SchoolBostonMassachusettsUSA
| | - Lauren Breithaupt
- Eating Disorders Clinical and Research ProgramMassachusetts General HospitalBostonMassachusettsUSA,Department of PsychiatryHarvard Medical SchoolBostonMassachusettsUSA
| | - Kamryn T. Eddy
- Eating Disorders Clinical and Research ProgramMassachusetts General HospitalBostonMassachusettsUSA,Department of PsychiatryHarvard Medical SchoolBostonMassachusettsUSA
| | - Debra L. Franko
- Eating Disorders Clinical and Research ProgramMassachusetts General HospitalBostonMassachusettsUSA,Department of Applied PsychologyNortheastern UniversityBostonMassachusettsUSA
| | - Andrea K. Graham
- Department of Medical Social SciencesNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
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21
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Cohen KA, Graham AK, Lattie EG. Aligning students and counseling centers on student mental health needs and treatment resources. J Am Coll Health 2022; 70:724-732. [PMID: 32432973 PMCID: PMC7677163 DOI: 10.1080/07448481.2020.1762611] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 04/03/2020] [Accepted: 04/26/2020] [Indexed: 05/19/2023]
Abstract
ObjectiveTo recognize gaps between students' expectations of college counseling centers and centers' current practices and to identify strategies to improve care from both clinicians and students. Participants: As part of an ongoing study on mobile technologies for stress management, we gathered data from counseling center clinicians and students at two large Midwestern universities. Methods: Clinicians completed online questionnaires on their current practices and interest in digital mental health tools. Students and clinicians completed co-design workshops. In subsequent individual interviews, students identified barriers to care. Results: Both students and clinicians recognized a need for stress management and mental health support outside of counseling sessions. Conclusions: Students and clinicians recognize barriers to face-to-face therapy and are eager to collaborate to identify opportunities to address barriers to mental health services. We discuss digital mental health tools as a potential opportunity for support and benefits of including students in discussions of treatment resources.
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Affiliation(s)
- Katherine A. Cohen
- Department of Psychiatry & Behavioral Sciences, Northwestern University, Chicago, IL, USA
| | - Andrea K. Graham
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
| | - Emily G. Lattie
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
- Department of Medical Social Sciences, Northwestern University, 750 N Lake Shore Drive, 10th Floor, Chicago, IL, 60611, USA. .
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22
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Flatt RE, Karam AM, Fitzsimmons-Craft EE, Balantekin KN, Graham AK, Eichen DM, Monterubio GE, Goel NJ, Fowler LA, Sadeh-Sharvit S, Wilfley D, Mazina V, Taylor CB, Trockel M. Psychometric properties of the Perceived Benefits of Thinness Scale in college-aged women. Body Image 2022; 40:103-109. [PMID: 34896896 PMCID: PMC8891087 DOI: 10.1016/j.bodyim.2021.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 11/16/2021] [Accepted: 11/22/2021] [Indexed: 10/19/2022]
Abstract
Thin ideal internalization is a risk factor for disordered eating behaviors, poor body image, and eating disorders (EDs). This paper evaluated the psychometric properties of a novel measure, the Perceived Benefits of Thinness Scale (PBTS), which assesses how individuals feel being thinner would affect various aspects of their lives. Three separate studies with unique samples of college-aged women over 18 years were conducted to assess reliability and validity. In Study 1, exploratory and confirmatory factor analyses suggested all PBTS items loaded onto one factor that was distinct from a measure of weight and shape concerns. A large correlation between changes in PTBS scores and changes in ED psychopathology scores over 8 months (r = .57, p < .01) suggested sensitivity to change. Greater severity in ED pathology was also associated with higher scores on the PBTS. In Study 2, the PBTS showed good test-retest reliability (r = .84, p < .001) and, in Study 3, expected correlations with existing measures of thin ideal internalization (rs = .38-.60, ps < .001). Overall, the PBTS displayed good factor structure, reliability, concurrent validity, and sensitivity to change. By emphasizing social, emotional, and quality of life benefits, the PBTS may serve clinicians, researchers, and patients in understanding thin ideal internalization and associated ED risk.
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Affiliation(s)
- Rachael E. Flatt
- Department of Psychology & Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Anna M. Karam
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | | | | | - Andrea K. Graham
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
| | - Dawn M. Eichen
- Department of Pediatrics, University of California, San Diego, San Diego, CA, USA
| | - Grace E. Monterubio
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Neha J. Goel
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Lauren A. Fowler
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Shiri Sadeh-Sharvit
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA,Center for m2Health, Palo Alto University, Palo Alto, CA, USA,Baruch Ivcher School of Psychology, Interdisciplinary Center, Herzliya, Israel
| | - Denise Wilfley
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Varvara Mazina
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, USA,Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, MA, USA
| | - C. Barr Taylor
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA,Center for m2Health, Palo Alto University, Palo Alto, CA, USA
| | - Mickey Trockel
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
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23
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Lattie EG, Stiles-Shields C, Graham AK. An overview of and recommendations for more accessible digital mental health services. Nat Rev Psychol 2022; 1:87-100. [PMID: 38515434 PMCID: PMC10956902 DOI: 10.1038/s44159-021-00003-1] [Citation(s) in RCA: 59] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/27/2021] [Indexed: 03/23/2024]
Abstract
Mental health concerns are common, and various evidence-based interventions for mental health conditions have been developed. However, many people have difficulty accessing appropriate mental health care and this has been exacerbated by the COVID-19 pandemic. Digital mental health services, such as those delivered by mobile phone or web-based platforms, offer the possibility of expanding the reach and accessibility of mental health care. To achieve this goal, digital mental health interventions and plans for their implementation must be designed with the end users in mind. In this Review, we describe the evidence base for digital mental health interventions across various diagnoses and treatment targets. Then, we explain the different formats for digital mental health intervention delivery, and offer considerations for their use across key age groups. We discuss the role that the COVID-19 pandemic has played in emphasizing the value of these interventions, and offer considerations for ensuring equity in access to digital mental health interventions among diverse populations. As healthcare providers continue to embrace the role that technology can play in broadening access to care, the design and implementation of digital mental healthcare solutions must be carefully considered to maximize their effectiveness and accessibility.
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Affiliation(s)
- Emily G. Lattie
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
| | - Colleen Stiles-Shields
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Andrea K. Graham
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
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24
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Fu E, Neubert SW, Chang A, Smith JD, Graham AK. Characterizing behavior change techniques used in the self-management of binge eating and weight: Applying a user-centered design approach. Eat Behav 2022; 44:101591. [PMID: 34920208 PMCID: PMC8885842 DOI: 10.1016/j.eatbeh.2021.101591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 10/15/2021] [Accepted: 11/30/2021] [Indexed: 01/03/2023]
Abstract
User-centered design methods aim to increase intervention engagement by focusing on consumers' needs and preferences. We conducted a needs assessment (the first step in user-centered design) via a digital diary study to understand how individuals with recurrent binge eating (≥12 episodes in 3 months) and obesity (BMI ≥30 kg/m2) manage these problems in their day-to-day lives and the approaches they use to change their behavior. Specifically, we applied the Behavior Change Technique (BCT)-Taxonomy to characterize which standardized BCTs individuals use to change binge eating and health-related behaviors and their motivations to use them, to inform the design of a mobile intervention. We analyzed qualitative data from 22 adults (64% female, 32% White) who submitted 176 diary entries. For each entry, we coded the BCTs used, motivation for use, and whether the BCT(s) were perceived as beneficial for behavior change. Across participants, investigators identified 50 of the 93 standardized BCTs (54%). Each participant used an average of 12 (SD = 4) BCTs, most commonly Behavior Substitution (72.3%), Distraction (68.2%), Goal Setting (Behavior) (63.6%), Action Planning (59.1%) and Adding Objects to the Environment (59.1%). More BCTs were coded as beneficial (49%) versus detrimental (24%) or neutral (27%). Techniques were most commonly motivated by preventing binge eating (95.5%), losing weight (95.5%), reducing unhealthy food choices (90.9%), or managing stress (59.1%). Results help inform how interventions could be designed to support consumers in changing binge eating and weight-related behaviors, although such designs would need to be tested for their impact on engagement and outcomes.
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Affiliation(s)
- Emily Fu
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Sarah W Neubert
- Weinberg College of Arts and Sciences, Northwestern University, Evanston, IL, United States of America
| | - Angela Chang
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, United States of America
| | - J D Smith
- Department of Population Health Sciences, University of Utah Spencer Fox Eccles School of Medicine, Salt Lake City, UT, United States of America
| | - Andrea K Graham
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, United States of America.
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25
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Mohr DC, Kwasny MJ, Meyerhoff J, Graham AK, Lattie EG. The effect of depression and anxiety symptom severity on clinical outcomes and app use in digital mental health treatments: Meta-regression of three trials. Behav Res Ther 2021; 147:103972. [PMID: 34600398 DOI: 10.1016/j.brat.2021.103972] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 09/17/2021] [Accepted: 09/21/2021] [Indexed: 10/20/2022]
Abstract
A large number of trials have consistently shown that guided digital mental health treatments (DMHTs) are effective for depression and anxiety. As DMHTs are adopted by healthcare organizations, payers, and employers, they are often considered most appropriate for people with mild-to-moderate levels of symptom severity. Thus, the aim of this study was to examine the effects of symptom severity on depression and anxiety outcomes and app use across three trials of a guided DMHT, IntelliCare. Participants were categorized into mild, moderate, moderately severe, and severe symptom severity groups on depression and anxiety. All symptom severity groups showed significant reductions in depression and anxiety in a clear ordinal pattern, with the mild symptom severity group showing the smallest changes and the severe symptom group showing the largest improvements. Those with the lowest levels of educational attainment showed the largest symptom improvement. Baseline symptom severity was not significantly related to app use. App use was significantly related to depression and anxiety outcomes. These findings suggest that depression and anxiety symptom severity is not useful in determining who should be referred to a guided DMHT.
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Affiliation(s)
- David C Mohr
- Center for Behavioral Intervention Technologies, Northwestern University, Chicago, IL, USA.
| | - Mary J Kwasny
- Center for Behavioral Intervention Technologies, Northwestern University, Chicago, IL, USA
| | - Jonah Meyerhoff
- Center for Behavioral Intervention Technologies, Northwestern University, Chicago, IL, USA
| | - Andrea K Graham
- Center for Behavioral Intervention Technologies, Northwestern University, Chicago, IL, USA
| | - Emily G Lattie
- Center for Behavioral Intervention Technologies, Northwestern University, Chicago, IL, USA
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26
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Fowler LA, Hampl SE, Dreyer Gillette ML, Staiano AE, Kracht CL, Graham AK, Gabbert S, Springstroh K, Thomas F, Nelson L, Hampp AE, Carlson JA, Welch R, Wilfley DE. Translating Family-Based Behavioral Treatment for Childhood Obesity into a User-Friendly Digital Package for Delivery to Low-Income Families through Primary Care Partnerships: The MO-CORD Study. Child Obes 2021; 17:S30-S38. [PMID: 34569844 PMCID: PMC8575055 DOI: 10.1089/chi.2021.0174] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Background: Significant gaps exist in access to evidence-based pediatric weight management interventions, especially for low-income families. As a part of the Centers for Disease Control and Prevention's Childhood Obesity Research Demonstration project 3.0 (CORD), the Missouri CORD (MO-CORD) team aims to increase access to and dissemination of an efficacious pediatric obesity treatment, family-based behavioral treatment (FBT), among low-income families. This article describes the MO-CORD team's approach to translating FBT into a digital package for delivery to low-income families through primary care practices. Methods: Using digital technology, the primary care setting, and existing reimbursement mechanisms, the MO-CORD team is developing a scalable user-centered design informed treatment package of FBT. This package will be implemented in primary care clinics and delivered to children (5-12 years) with obesity from low-income households in rural and urban communities. The digital platform includes three main components: (1) provider and interventionist training, (2) interventionist-facing materials, and (3) family-facing treatment materials. User-centered design techniques and continuous iterative stakeholder feedback are utilized to emphasize tailoring to a low-income population, along with scalability and sustainability of the digital package. Conclusions: The MO-CORD project addresses the critical need to increase access to obesity treatment for children from low-income households and establishes a platform for future large-scale (i.e., nation-wide) dissemination of evidence-based pediatric weight-management interventions. This study determines whether the digital FBT package can be implemented within real-world settings to create a system by which children with obesity and their families can be effectively treated in primary care settings.
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Affiliation(s)
- Lauren A. Fowler
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Sarah E. Hampl
- Center for Children's Healthy Lifestyles & Nutrition, Children's Mercy Hospital, Kansas City, MO, USA
| | | | | | | | - Andrea K. Graham
- Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Sherri Gabbert
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Kelly Springstroh
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Fanice Thomas
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | | | - Aubrie E. Hampp
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Jordan A. Carlson
- Center for Children's Healthy Lifestyles & Nutrition, Children's Mercy Hospital, Kansas City, MO, USA
| | - Robinson Welch
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Denise E. Wilfley
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
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27
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Wilfley DE, Fowler LA, Hampl SE, Dreyer Gillette ML, Staiano AE, Graham AK, Grammer AC, Nelson L, Carlson JA, Brown DS, Gabbert S, Springstroh K, Thomas F, Ramel M, Welch R, Johnson W. Implementation of a Scalable Family-Based Behavioral Treatment for Childhood Obesity Delivered through Primary Care Clinics: Description of the Missouri Childhood Obesity Research Demonstration Study Protocol. Child Obes 2021; 17:S39-S47. [PMID: 34569843 PMCID: PMC8575056 DOI: 10.1089/chi.2021.0175] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background: Significant gaps exist in access to evidence-based pediatric weight management interventions, especially for low-income families who are disproportionately affected by obesity. As a part of the Centers for Disease Control and Prevention's Childhood Obesity Research Demonstration project (CORD 3.0), the Missouri team (MO-CORD) aims to increase access to and dissemination of an efficacious pediatric obesity treatment, specifically family-based behavioral treatment (FBT), for low-income families. Methods/Design: The implementation pilot study is a multisite matched-comparison group pilot of packaged FBT in pediatric clinics for low-income children with obesity, of ages 5 to 12 years old. The study is implemented in two Missouri pediatric primary care clinical sites, Freeman Health System Pediatric Clinics (rural Joplin) and Children's Mercy Hospital Pediatric Clinics (urban Kansas City). The design focuses on pragmatism through utilization of PRECIS (Pragmatic Explanatory Continuum Indicator Summary) domains, such as open eligibility criteria, limited follow-up intensity, reliance on medical records for creating a usual care comparison group data, and unobtrusive measurement of participant and provider adherence. The evaluation focuses on effectiveness as well as implementation outcomes and barriers to inform implementation scale up. Conclusions: Findings from this study will advance both science and practice by providing novel and immediately useful information to families, health care providers, health care organizations, payers, and other state Medicaid plans by developing and optimizing evidence-based pediatric weight management treatment for implementation and dissemination in health systems to address health disparities among low-income populations most affected by overweight and obesity.
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Affiliation(s)
- Denise E. Wilfley
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Lauren A. Fowler
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | | | | | | | | | - Anne Claire Grammer
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | | | | | | | - Sherri Gabbert
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Kelly Springstroh
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Fanice Thomas
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Melissa Ramel
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Robinson Welch
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
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28
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Graham AK, Kwasny MJ, Lattie EG, Greene CJ, Gupta NV, Reddy M, Mohr DC. Targeting subjective engagement in experimental therapeutics for digital mental health interventions. Internet Interv 2021; 25:100403. [PMID: 34401363 PMCID: PMC8350581 DOI: 10.1016/j.invent.2021.100403] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 04/30/2021] [Accepted: 05/18/2021] [Indexed: 11/21/2022] Open
Abstract
Engagement is a multifaceted construct and a likely mechanism by which digital interventions achieve clinical improvements. To date, clinical research on digital mental health interventions (DMHIs) has overwhelmingly defined engagement and assessed its association with clinical outcomes through the objective/behavioral metrics of use of or interactions with a DMHI, such as number of log-ins or time spent using the technology. However, engagement also entails users' subjective experience. Research is largely lacking that tests the relationship between subjective metrics of engagement and clinical outcomes. The purpose of this study is to present a proof-of-concept exploratory evaluation of the association between subjective engagement measures of a mobile DMHI with changes in depression and anxiety. Adult primary care patients (N = 146) who screened positive for depression or anxiety were randomized to receive a DMHI, IntelliCare, immediately or following an 8-week waitlist. Subjective engagement was measured via the Usefulness, Satisfaction, and Ease of Use (USE) Questionnaire. Across both conditions, results showed that individuals who perceived a mobile intervention as more useful, easy to use and learn, and satisfying had greater improvements in depression and anxiety over eight weeks. Findings support our proposed experimental therapeutics framework that hypothesizes objective/behavioral and subjective engagement metrics as mechanisms that lead to changes in clinical outcomes, as well as support directing intervention design efforts for DMHIs to target the user experience.
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Affiliation(s)
- Andrea K. Graham
- Center for Behavioral Intervention Technologies, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Mary J. Kwasny
- Center for Behavioral Intervention Technologies, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Emily G. Lattie
- Center for Behavioral Intervention Technologies, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Carolyn J. Greene
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Translational Research Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Neha V. Gupta
- Departments of Psychiatry and Internal Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Madhu Reddy
- Department of Communication Studies, Northwestern University, Chicago, IL, USA
| | - David C. Mohr
- Center for Behavioral Intervention Technologies, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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29
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Graham AK, Greene CJ, Powell T, Lieponis P, Lunsford A, Peralta CD, Orr LC, Kaiser SM, Alam N, Berhane H, Kalan O, Mohr DC. Lessons learned from service design of a trial of a digital mental health service: Informing implementation in primary care clinics. Transl Behav Med 2021; 10:598-605. [PMID: 32766862 DOI: 10.1093/tbm/ibz140] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Implementing a digital mental health service in primary care requires integration into clinic workflow. However, without adequate attention to service design, including designing referral pathways to identify and engage patients, implementation will fail. This article reports results from our efforts designing referral pathways for a randomized clinical trial evaluating a digital service for depression and anxiety delivered through primary care clinics. We utilized three referral pathways: direct to consumer (e.g., digital and print media, registry emails), provider referral (i.e., electronic health record [EHR] order and provider recommendation), and other approaches (e.g., presentations, word of mouth). Over the 5-month enrollment, 313 individuals completed the screen and reported how they learned about the study. Penetration was 13%, and direct to consumer techniques, most commonly email, had the highest yield. Providers only referred 16 patients through the EHR, half of whom initiated the screen. There were no differences in referral pathway based on participants' age, depression severity, or anxiety severity at screening. Ongoing discussions with providers revealed that the technologic implementation and workflow design may not have been optimal to fully affect the EHR-based referral process, which potentially limited patient access. Results highlight the importance of designing and evaluating referral pathways within service implementation, which is important for guiding the implementation of digital services into practice. Doing so can ensure that sustained implementation is not left to post-evaluation bridge-building. Future efforts should assess these and other referral pathways implemented in clinical practice outside of a research trial.
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Affiliation(s)
- Andrea K Graham
- Center for Behavioral Intervention Technologies, Northwestern University, Chicago, IL, USA.,Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
| | - Carolyn J Greene
- Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Thomas Powell
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | | | - Amanda Lunsford
- Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Chris D Peralta
- Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - L Casey Orr
- Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Susan M Kaiser
- Center for Behavioral Intervention Technologies, Northwestern University, Chicago, IL, USA.,Department of Preventive Medicine, Northwestern University, Chicago, IL, USA
| | - Nameyeh Alam
- Center for Behavioral Intervention Technologies, Northwestern University, Chicago, IL, USA.,Department of Preventive Medicine, Northwestern University, Chicago, IL, USA
| | | | - Ozan Kalan
- Actualize Therapy, Inc., Chicago, IL, USA
| | - David C Mohr
- Center for Behavioral Intervention Technologies, Northwestern University, Chicago, IL, USA.,Department of Preventive Medicine, Northwestern University, Chicago, IL, USA
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30
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Taylor CB, Graham AK, Flatt RE, Waldherr K, Fitzsimmons-Craft EE. Current state of scientific evidence on Internet-based interventions for the treatment of depression, anxiety, eating disorders and substance abuse: an overview of systematic reviews and meta-analyses. Eur J Public Health 2021; 31:i3-i10. [PMID: 32918448 PMCID: PMC8495688 DOI: 10.1093/eurpub/ckz208] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND ICare represents a consortium of European Investigators examining the effects of online mental health care for a variety of common mental health disorders provided in a variety of settings. This article provides an overview of the evidence of effectiveness for Internet-based treatment for four common mental health disorders that are the focus of much of this work: depression, anxiety, substance abuse and eating disorders. METHODS The overview focused primarily on systematic reviews and meta-analyses identified through PubMed (Ovid) and other databases and published in English. Given the large number of reviews specific to depression, anxiety, substance abuse and/or eating disorders, we did not focus on reviews that examined the effects of Internet-based interventions on mental health disorders in general. Each article was reviewed and summarized by one of the senior authors, and this review was then reviewed by the other senior authors. We did not address issues of prevention, cost-effectiveness, implementation or dissemination, as these are addressed in other reviews in this supplement. RESULTS Across Internet-based intervention studies addressing depression, anxiety, substance abuse and eating disorders primarily among adults, almost all reviews and meta-analyses found that these interventions successfully reduce symptoms and are efficacious treatments. Generally, effect sizes for Internet-based interventions treating eating disorders and substance abuse are lower compared with interventions for depression and anxiety. CONCLUSIONS Given the effectiveness of Internet-based interventions to reduce symptoms of these common mental health disorders, efforts are needed to examine issues of how they can be best disseminated and implemented in a variety of health care and other settings.
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Affiliation(s)
- C Barr Taylor
- Center for m2Health, Palo Alto University, Palo Alto, CA, USA.,Department of Psychiatry & Behavioral Sciences, Stanford University, Palo Alto, CA, USA
| | - Andrea K Graham
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
| | - Rachael E Flatt
- Center for m2Health, Palo Alto University, Palo Alto, CA, USA.,Department of Psychiatry & Behavioral Sciences, Stanford University, Palo Alto, CA, USA
| | - Karin Waldherr
- FernFH Distance Learning University of Applied Sciences, Wiener Neustadt, Austria
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Venkatesh A, Chang A, Green EA, Randall T, Gallagher R, Wildes JE, Graham AK. Perceived Facilitators and Barriers to Engaging with a Digital Intervention among Those with Food Insecurity, Binge Eating, and Obesity. Nutrients 2021; 13:2458. [PMID: 34371967 PMCID: PMC8308534 DOI: 10.3390/nu13072458] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 07/13/2021] [Accepted: 07/15/2021] [Indexed: 12/11/2022] Open
Abstract
Interventions that address binge eating and food insecurity are needed. Engaging people with lived experience to understand their needs and preferences could yield important design considerations for such interventions. In this study, people with food insecurity, recurrent binge eating, and obesity completed an interview-based needs assessment to learn facilitators and barriers that they perceive would impact their engagement with a digital intervention for managing binge eating and weight. Twenty adults completed semi-structured interviews. Responses were analyzed using thematic analysis. Three themes emerged. Participants shared considerations that impact their ability to access the intervention (e.g., cost of intervention, cost of technology, accessibility across devices), ability to complete intervention recommendations (e.g., affordable healthy meals, education to help stretch groceries, food vouchers, rides to grocery stores, personalized to budget), and preferred intervention features for education, self-monitoring, personalization, support, and motivation/rewards. Engaging people with lived experiences via user-centered design methods revealed important design considerations for a digital intervention to meet this population's needs. Future research is needed to test whether a digital intervention that incorporates these recommendations is engaging and effective for people with binge eating and food insecurity. Findings may have relevance to designing digital interventions for other health problems as well.
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Affiliation(s)
- Anu Venkatesh
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA; (A.V.); (A.C.)
| | - Angela Chang
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA; (A.V.); (A.C.)
| | - Emilie A. Green
- Department of Psychology, Rosalind Franklin University for Medical Sciences, Chicago, IL 60064, USA;
| | - Tianna Randall
- Weinberg College of Arts and Sciences, Northwestern University, Evanston, IL 60208, USA; (T.R.); (R.G.)
| | - Raquel Gallagher
- Weinberg College of Arts and Sciences, Northwestern University, Evanston, IL 60208, USA; (T.R.); (R.G.)
| | - Jennifer E. Wildes
- Department of Psychiatry & Behavioral Neuroscience, University of Chicago, Chicago, IL 60611, USA;
| | - Andrea K. Graham
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA; (A.V.); (A.C.)
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Taylor CB, Graham AK, Flatt RE, Waldherr K, Fitzsimmons-Craft EE. Corrigendum to: Current state of scientific evidence on Internet-based interventions for the treatment of depression, anxiety, eating disorders and substance abuse: an overview of systematic reviews and meta-analyses. Eur J Public Health 2021; 31:i94. [PMID: 34240161 PMCID: PMC8266528 DOI: 10.1093/eurpub/ckab104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- C Barr Taylor
- Center for m2Health, Palo Alto University, Palo Alto, CA, USA.,Department of Psychiatry & Behavioral Sciences, Stanford University, Palo Alto, CA, USA
| | - Andrea K Graham
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
| | - Rachael E Flatt
- Center for m2Health, Palo Alto University, Palo Alto, CA, USA.,Department of Psychiatry & Behavioral Sciences, Stanford University, Palo Alto, CA, USA
| | - Karin Waldherr
- FernFH Distance Learning University of Applied Sciences, Wiener Neustadt, Austria
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Graham AK, Weissman RS, Mohr DC. Resolving Key Barriers to Advancing Mental Health Equity in Rural Communities Using Digital Mental Health Interventions. JAMA Health Forum 2021; 2:e211149. [DOI: 10.1001/jamahealthforum.2021.1149] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Andrea K. Graham
- Center for Behavioral Intervention Technologies, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - David C. Mohr
- Center for Behavioral Intervention Technologies, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Graham AK, Neubert SW, Chang A, Liu J, Fu E, Green EA, Kornfield R, Nicholas J. Applying User-Centered Design Methods to Understand Users' Day-to-Day Experiences Can Inform a Mobile Intervention for Binge Eating and Weight Management. Front Digit Health 2021; 3:651749. [PMID: 34713124 PMCID: PMC8521863 DOI: 10.3389/fdgth.2021.651749] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 04/06/2021] [Indexed: 12/18/2022] Open
Abstract
Introduction: Weight loss apps to date have not directly addressed binge eating. To inform the design of a new mobile behavioral intervention that addresses binge eating and weight management, we applied user-centered design methods to qualitatively assess how target intervention consumers experience these conditions in their day-to-day lives. Methods: The participants were 22 adults with self-reported obesity (body mass index ≥30) and recurrent binge eating (≥12 episodes in 3 months) who were interested in losing weight and reducing binge eating. The participants completed a digital diary study, which is a user-centered design technique for capturing individuals' day-to-day experiences in relevant contexts. Qualitative data describing the participants' experiences with binge eating and obesity were analyzed using thematic analysis. The results were then used to create personas (i.e., character archetypes of different intervention consumers). Results: The participants described triggers for binge eating and indicated that binge eating and excess weight negatively impact their mental health, physical health, and quality of life. The resulting personas reflected five different struggles individuals with these health problems experience in managing their binge eating and weight. Conclusions: Individuals with binge eating and obesity have varying precipitants of problematic eating as well as varying motivations for and challenges to behavior change. To meet the needs of all who seek intervention, an ideal intervention design will account for variations in these factors and be relevant to diverse experiences. Insights from the diary study and resulting personas will inform the next phases of the user-centered design process of iteratively designing prototypes and testing the intervention in practice.
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Affiliation(s)
- Andrea K. Graham
- Center for Behavioral Intervention Technologies, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Sarah W. Neubert
- Weinberg College of Arts and Sciences, Northwestern University, Evanston, IL, United States
| | - Angela Chang
- Center for Behavioral Intervention Technologies, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Jianyi Liu
- Center for Behavioral Intervention Technologies, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Department of Psychiatry and Behavioral Science, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Emily Fu
- Department of Psychiatry and Behavioral Science, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Emilie A. Green
- Weinberg College of Arts and Sciences, Northwestern University, Evanston, IL, United States
| | - Rachel Kornfield
- Center for Behavioral Intervention Technologies, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Jennifer Nicholas
- Orygen, Melbourne, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
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35
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Wildes JE, Bedell A, Graham AK, Kells M. Brain-gut psychotherapies: Promising tools to address gastrointestinal problems in patients with eating disorders. Int J Eat Disord 2021; 54:1063-1067. [PMID: 34013611 PMCID: PMC8962673 DOI: 10.1002/eat.23555] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 05/11/2021] [Accepted: 05/11/2021] [Indexed: 12/16/2022]
Abstract
Gastrointestinal (GI) problems are common in individuals with eating disorders (EDs) and associated with distress, impairment, and increased healthcare utilization. GI symptoms may be exacerbated by meals and other interventions central to ED recovery thereby contributing to negative clinical outcomes. Informed by models emphasizing the role of the brain-gut axis in the expression of GI symptoms, this article describes a program of research to adapt "brain-gut psychotherapies" for EDs. First, the role of the brain-gut axis in GI symptoms is described, and evidence-based brain-gut psychotherapies are reviewed, with an emphasis on cognitive behavioral therapy for GI disorders and gut-directed hypnotherapy. Next, future directions for research in EDs to (a) understand the impact of GI symptoms on illness course and outcome; (b) clarify target engagement; (c) evaluate brain-gut psychotherapies; and (d) optimize intervention reach and delivery are described. We present a conceptual model that emphasizes GI-specific anxiety and altered gut physiology as targets of brain-gut psychotherapies in EDs, and discuss several issues that need to be addressed in designing clinical trials to test these interventions. We also describe how engagement with multidisciplinary stakeholders and use of digital tools could speed translation from the laboratory to clinical settings.
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Affiliation(s)
- Jennifer E. Wildes
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, Illinois
| | - Alyse Bedell
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, Illinois
| | - Andrea K. Graham
- Center for Behavioral Intervention Technologies, Northwestern University, Chicago, Illinois,Department of Medical Social Sciences, Northwestern University, Chicago, Illinois
| | - Meredith Kells
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, Illinois
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36
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Graham AK, Munson SA, Reddy M, Neubert SW, Green EA, Chang A, Spring B, Mohr DC, Wildes JE. Integrating User-Centered Design and Behavioral Science to Design a Mobile Intervention for Obesity and Binge Eating: Mixed Methods Analysis. JMIR Form Res 2021; 5:e23809. [PMID: 33970114 PMCID: PMC8145081 DOI: 10.2196/23809] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 12/01/2020] [Accepted: 12/24/2020] [Indexed: 12/13/2022] Open
Abstract
Background Accounting for how end users engage with technologies is imperative for designing an efficacious mobile behavioral intervention. Objective This mixed methods analysis examined the translational potential of user-centered design and basic behavioral science to inform the design of a new mobile intervention for obesity and binge eating. Methods A total of 22 adults (7/22, 32% non-Hispanic White; 8/22, 36% male) with self-reported obesity and recurrent binge eating (≥12 episodes in 3 months) who were interested in losing weight and reducing binge eating completed a prototyping design activity over 1 week. Leveraging evidence from behavioral economics on choice architecture, participants chose treatment strategies from 20 options (aligned with treatment targets composing a theoretical model of the relation between binge eating and weight) to demonstrate which strategies and treatment targets are relevant to end users. The process by which participants selected and implemented strategies and their change in outcomes were analyzed. Results Although prompted to select one strategy, participants selected between 1 and 3 strategies, citing perceived achievability, helpfulness, or relevance as selection reasons. Over the week, all practiced a strategy at least once; 82% (18/22) struggled with implementation, and 23% (5/22) added a new strategy. Several themes emerged on successes and challenges with implementation, yielding design implications for supporting users in behavior change. In postexperiment reflections, 82% (18/22) indicated the strategy was helpful, and 86% (19/22) planned to continue use. One-week average within-subject changes in weight (–2.2 [SD –5.0] pounds) and binge eating (–1.6 [SD –1.8] episodes) indicated small clinical improvement. Conclusions Applying user-centered design and basic behavioral science yielded design insights to incorporate personalization through user choice with guidance, which may enhance engagement with and potential efficacy of digital health interventions.
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Affiliation(s)
- Andrea K Graham
- Center for Behavioral Intervention Technologies, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Sean A Munson
- Department of Human Centered Design & Engineering, University of Washington, Seattle, WA, United States
| | - Madhu Reddy
- Center for Behavioral Intervention Technologies, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Department of Communication Studies, Northwestern University, Chicago, IL, United States
| | - Sarah W Neubert
- Center for Behavioral Intervention Technologies, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Weinberg College of Arts and Sciences, Northwestern University, Evanston, IL, United States
| | - Emilie A Green
- Center for Behavioral Intervention Technologies, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Weinberg College of Arts and Sciences, Northwestern University, Evanston, IL, United States
| | - Angela Chang
- Center for Behavioral Intervention Technologies, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Bonnie Spring
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - David C Mohr
- Center for Behavioral Intervention Technologies, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Jennifer E Wildes
- Department of Psychiatry & Behavioral Neuroscience, University of Chicago, Chicago, IL, United States
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Fitzsimmons-Craft EE, Taylor CB, Newman MG, Zainal NH, Rojas-Ashe EE, Lipson SK, Firebaugh ML, Ceglarek P, Topooco N, Jacobson NC, Graham AK, Kim HM, Eisenberg D, Wilfley DE. Harnessing mobile technology to reduce mental health disorders in college populations: A randomized controlled trial study protocol. Contemp Clin Trials 2021; 103:106320. [PMID: 33582295 PMCID: PMC8089064 DOI: 10.1016/j.cct.2021.106320] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 01/27/2021] [Accepted: 02/09/2021] [Indexed: 12/21/2022]
Abstract
About a third of college students struggle with anxiety, depression, or an eating disorder, and only 20-40% of college students with mental disorders receive treatment. Inadequacies in mental health care delivery result in prolonged illness, disease progression, poorer prognosis, and greater likelihood of relapse, highlighting the need for a new approach to detect mental health problems and engage college students in services. We have developed a transdiagnostic, low-cost mobile mental health targeted prevention and intervention platform that uses population-level screening to engage college students in tailored services that address common mental health problems. We will test the impact of this mobile mental health platform for service delivery in a large-scale trial across 20+ colleges. Students who screen positive or at high-risk for clinical anxiety, depression, or an eating disorder and who are not currently engaged in mental health services (N = 7884) will be randomly assigned to: 1) intervention via the mobile mental health platform; or 2) referral to usual care (i.e., campus health or counseling center). We will test whether the mobile mental health platform, compared to referral, is associated with improved uptake, reduced clinical cases, disorder-specific symptoms, and improved quality of life and functioning. We will also test mediators, predictors, and moderators of improved mental health outcomes, as well as stakeholder-relevant outcomes, including cost-effectiveness and academic performance. This population-level approach to service engagement has the potential to improve mental health outcomes for the millions of students enrolled in U.S. colleges and universities.
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Affiliation(s)
- Ellen E Fitzsimmons-Craft
- Department of Psychiatry, Washington University School of Medicine, Mailstop 8134-29-2100, 660 S. Euclid Ave., St. Louis, MO 63110, USA.
| | - C Barr Taylor
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA; Center for m(2)Health, Palo Alto University, Palo Alto, CA, USA.
| | - Michelle G Newman
- Department of Psychology, Penn State University, University Park, PA, USA.
| | - Nur Hani Zainal
- Department of Psychology, Penn State University, University Park, PA, USA.
| | | | - Sarah Ketchen Lipson
- Department of Health Law Policy and Management, Boston University School of Public Health, Boston, MA, USA.
| | - Marie-Laure Firebaugh
- Department of Psychiatry, Washington University School of Medicine, Mailstop 8134-29-2100, 660 S. Euclid Ave., St. Louis, MO 63110, USA.
| | - Peter Ceglarek
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, USA.
| | - Naira Topooco
- Center for m(2)Health, Palo Alto University, Palo Alto, CA, USA; Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.
| | - Nicholas C Jacobson
- Departments of Biomedical Data Science and Psychiatry, Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA.
| | - Andrea K Graham
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA.
| | - Hyungjin Myra Kim
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA.
| | - Daniel Eisenberg
- Department of Health Policy and Management, Fielding School of Public Health, University of California at Los Angeles, Los Angeles, CA, USA.
| | - Denise E Wilfley
- Department of Psychiatry, Washington University School of Medicine, Mailstop 8134-29-2100, 660 S. Euclid Ave., St. Louis, MO 63110, USA.
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Balantekin KN, Grammer AC, Fitzsimmons-Craft EE, Eichen DE, Graham AK, Monterubio GE, Firebaugh ML, Karam AM, Sadeh-Sharvit S, Goel NJ, Flatt RE, Trockel MT, Taylor CB, Wilfley DE. Overweight and obesity are associated with increased eating disorder correlates and general psychopathology in university women with eating disorders. Eat Behav 2021; 41:101482. [PMID: 33609964 PMCID: PMC8131224 DOI: 10.1016/j.eatbeh.2021.101482] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 01/26/2021] [Accepted: 01/31/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Examine how eating disorder (ED) correlates, ED-related clinical impairment, general psychopathology, and ED diagnoses differ across weight statuses in a sample of university women with EDs. METHOD Participants were 690 women from 28 U.S. universities who screened positive for an ED (with the exception of anorexia nervosa [AN]) and participated in the Healthy Body Image Program study. ED correlates, ED-related clinical impairment, general psychopathology (i.e., depression and anxiety), and ED diagnoses were compared across weight statuses (i.e., healthy weight, overweight, obesity) using analyses of variance and chi-square tests. RESULTS Women with EDs and overweight or obesity had higher levels of, perceived benefit of thinness, depressive symptoms, anxiety, and weight/shape concerns (obesity only) than those with healthy weight (ps ≤ .017). Compared to those with healthy weight, those with obesity had higher rates of clinical and sub-clinical binge eating disorder and lower rates of bulimia nervosa (p < .001). DISCUSSION Overweight and obesity in individuals with EDs, excluding AN, are associated with greater severity of ED correlates, ED-related clinical impairment, and co-morbid general psychopathology. The current study highlights the need to consider weight status in ED treatment and for optimization of ED treatments to address shared risk factors between EDs and overweight and obesity.
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Affiliation(s)
| | - Anne Claire Grammer
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | | | - Dawn E Eichen
- Department of Pediatrics, University of California San Diego, San Diego, CA, USA
| | - Andrea K Graham
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
| | - Grace E Monterubio
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Marie-Laure Firebaugh
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Anna M Karam
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Shiri Sadeh-Sharvit
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA; Center for m(2)Health, Palo Alto University, Palo Alto, CA, USA; Baruch Ivcher School of Psychology, Interdisciplinary Center, Herzliya, Israel
| | - Neha J Goel
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA; Institute for Inclusion, Inquiry and Innovation (iCubed), Virginia Commonwealth University, Richmond, VA, USA
| | - Rachael E Flatt
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Mickey T Trockel
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - C Barr Taylor
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA; Center for m(2)Health, Palo Alto University, Palo Alto, CA, USA
| | - Denise E Wilfley
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
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Chang A, Winquist NW, Wescott AB, Lattie EG, Graham AK. Systematic review of digital and non-digital non-pharmacological interventions that target quality of life and psychological outcomes in adults with systemic lupus erythematosus. Lupus 2021; 30:1058-1077. [PMID: 33779388 DOI: 10.1177/09612033211005085] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Patients with systemic lupus erythematous (SLE) experience psychological comorbidities and impaired quality of life (QOL). We conducted a systematic review to examine the efficacy of non-pharmacological interventions for improving psychological outcomes and/or QOL in patients with SLE. To expand on a previous systematic review in this area and enhance our understanding of efficacious interventions for this population, our search included quasi-experimental and experimental studies of interventions delivered or supported by remote methods (including digitally) or in person. METHODS A comprehensive literature search was conducted with a research librarian using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was registered before data extraction on the international prospective register of systematic reviews PROSPERO Web site (CRD42020154962). The search included controlled-vocabulary and title/abstract terms related to non-pharmacological interventions for SLE published through October 2019 in MEDLINE (Ovid), Cochrane Library databases (Wiley), Embase (Elsevier), CINAHL (EBSCO), PsycINFO (EBSCO), Web of Science (Clarivate), ACM Digital (Association of Computer Machinery), and IEEE Xplore. Studies were synthesized using a systematic narrative synthesis framework. Risk of bias was assessed. RESULTS Twenty-three studies were included: 21 randomized controlled trials and two quasi-experimental studies. Non-pharmacological diet, physical activity, psychological, and course-based interventions improved QOL and psychological outcomes, and were delivered in traditional settings (e.g., hospital) or remotely. No studies assessing digital non-pharmacological interventions were identified in our search. Quality assessments showed serious risk of bias for the two quasi-experimental studies, and high risk of bias in a subset of experimental studies. CONCLUSIONS Non-pharmacological interventions benefit patients with SLE. Future research should include more representative samples in rigorous evaluations and consider ways to incorporate digital technologies to increase accessibility.
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Affiliation(s)
- Angela Chang
- Center for Behavioral Intervention Technologies, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Nathan W Winquist
- Center for Behavioral Intervention Technologies, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Annie B Wescott
- Galter Health Sciences Library and Learning Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Emily G Lattie
- Center for Behavioral Intervention Technologies, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Andrea K Graham
- Center for Behavioral Intervention Technologies, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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40
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Hayes JF, Balantekin KN, Graham AK, Strube MJ, Bickel WK, Wilfley DE. Implementation intentions for weight loss in college students with overweight and obesity: a proof-of-concept randomized controlled trial. Transl Behav Med 2021; 11:359-368. [PMID: 32359068 PMCID: PMC7963295 DOI: 10.1093/tbm/ibaa038] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
One in three college students have overweight or obesity and are in need of brief, simple weight loss interventions. Implementation intentions, a strategy that connects a goal-aligned behavior to a cue, facilitate goal attainment of health behaviors but have not been applied as a standalone treatment for weight loss. The purpose of this study was to examine the efficacy of an implementation intention weight loss intervention in college students. In this three-arm, proof-of-concept, randomized controlled trial, college students with overweight/obesity (N = 95) were randomized to one of three conditions: an implementation intention group (IMP), an enhanced implementation intention group (IMP+) that included text message reminders and fluency training (i.e., training for speed and accuracy), and a control goal intention group (GOL) for 4 weeks. Participants completed anthropometric and self-report assessments pretreatment and posttreatment and experience-sampling assessments during the study to assess how implementation intentions contribute to behavior change. Across the sample, IMP and IMP+ groups reported significantly more goal-congruent behaviors than the GOL group. However, no between-condition differences emerged for weight and diet outcomes. Across conditions, students lost a statistically significant amount of weight, improved diet quality, and reduced caloric intake (ps < .05). Setting implementation intentions was associated with increased behaviors consistent with weight loss goals. Moreover, participants in all groups lost a statistically significant amount of weight. Incorporating implementation intentions into weight loss interventions, and testing the efficacy of this approach on weight loss over a longer duration, may be beneficial for college students with overweight/obesity.
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Affiliation(s)
- Jacqueline F Hayes
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI, USA
| | | | - Andrea K Graham
- Department of Medical Social Sciences and Preventive Medicine; Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Michael J Strube
- Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, MO, USA
| | - Warren K Bickel
- Department of Psychology, Psychiatry, and Behavioral Medicine, Virginia Tech Carilion School of Medicine, Virginia Tech University, Roanoke, VA, USA
| | - Denise E Wilfley
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
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Nicholas J, Knapp AA, Vergara JL, Graham AK, Gray EL, Lattie EG, Kwasny MJ, Mohr DC. An Exploratory Brief Head-To-Head Non-Inferiority Comparison of an Internet-Based and a Telephone-Delivered CBT Intervention for Adults with Depression. J Affect Disord 2021; 281:673-677. [PMID: 33246650 PMCID: PMC7856098 DOI: 10.1016/j.jad.2020.11.093] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 07/28/2020] [Accepted: 11/08/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Telephone-administered psychotherapy (tCBT) and internet-based treatments (iCBT) may overcome barriers to mental health treatment. TCBT has demonstrated efficacy similar to traditional psychotherapy, however, few studies have compared iCBT to efficacious interventions. This exploratory study examined the noninferiority of iCBT relative to tCBT. We also explored pretreatment moderators of outcome and assessed treatment dropout. METHODS As a secondary exploratory analysis of a 304-participant randomized noninferiority trial, we compared iCBT, the first level of a stepped-care intervention, with tCBT on depression outcome after 5 weeks of treatment (prior to stepping). Multiple linear regression models were fit to examine moderators of 5-week depression. Differences in dropout were examined using Kaplan-Meier survival analysis. RESULTS After 5 weeks of treatment, both interventions significantly reduced depression severity. The effect size difference between the two interventions was d=0.004 [90% CI=-0.19 to 0.19]; the CI did not cross the non-inferiority margin. Pretreatment depression was significantly associated with depression at week 5. The relationship between cognitive strategy usefulness and depression at week 5 differed between interventions, controlling for pretreatment depression. There was no significant difference in dropout between interventions. LIMITATIONS Given the stepped-care trial design, iCBT and tCBT could not be compared at the end of treatment or follow-up. Analyses were exploratory and should be interpreted with caution. CONCLUSIONS A large sample, powered for noninferiority, found iCBT no less efficacious than tCBT at reducing depression symptoms after five weeks of treatment.
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Affiliation(s)
- Jennifer Nicholas
- Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Northwestern University, Chicago Illinois, USA.
| | - Ashley A Knapp
- Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Northwestern University, Chicago Illinois, USA
| | - Jessica L Vergara
- Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Northwestern University, Chicago Illinois, USA
| | - Andrea K Graham
- Center for Behavioral Intervention Technologies, Department of Medical Social Sciences, Northwestern University, Chicago Illinois, USA
| | - Elizabeth L Gray
- Biostatistics Collaboration Center, Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago Illinois, USA
| | - Emily G Lattie
- Center for Behavioral Intervention Technologies, Department of Medical Social Sciences, Northwestern University, Chicago Illinois, USA
| | - Mary J Kwasny
- Biostatistics Collaboration Center, Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago Illinois, USA
| | - David C Mohr
- Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Northwestern University, Chicago Illinois, USA
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Graham AK, Lattie EG, Powell BJ, Lyon AR, Smith JD, Schueller SM, Stadnick NA, Brown CH, Mohr DC. Implementation strategies for digital mental health interventions in health care settings. ACTA ACUST UNITED AC 2020; 75:1080-1092. [PMID: 33252946 DOI: 10.1037/amp0000686] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
U.S. health care systems are tasked with alleviating the burden of mental health, but are frequently underprepared and lack workforce and resource capacity to deliver services to all in need. Digital mental health interventions (DMHIs) can increase access to evidence-based mental health care. However, DMHIs commonly do not fit into the day-to-day activities of the people who engage with them, resulting in a research-to-practice gap for DMHI implementation. For health care settings, differences between digital and traditional mental health services make alignment and integration challenging. Specialized attention is needed to improve the implementation of DMHIs in health care settings so that these services yield high uptake, engagement, and sustainment. The purpose of this article is to enhance efforts to integrate DMHIs in health care settings by proposing implementation strategies, selected and operationalized based on the discrete strategies established in the Expert Recommendations for Implementing Change project, that align to DMHI-specific barriers in these settings. Guidance is offered in how these strategies can be applied to DMHI implementation across four phases commonly distinguished in implementation science using the Exploration, Preparation, Implementation, Sustainment Framework. Next steps to advance research in this area and improve the research-to-practice gap for implementing DMHIs are recommended. Applying implementation strategies to DMHI implementation will enable psychologists to systematically evaluate this process, which can yield an enhanced understanding of the factors that facilitate implementation success and improve the translation of DMHIs from controlled trials to real-world settings. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Andrea K Graham
- Center for Behavioral Intervention Technologies, Northwestern University
| | - Emily G Lattie
- Center for Behavioral Intervention Technologies, Northwestern University
| | | | - Aaron R Lyon
- Department of Psychiatry and Behavioral Sciences, University of Washington
| | - Justin D Smith
- Center for Prevention Implementation Methodology, Northwestern University
| | | | | | - C Hendricks Brown
- Center for Prevention Implementation Methodology, Northwestern University
| | - David C Mohr
- Center for Behavioral Intervention Technologies, Northwestern University
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Graham AK, Greene CJ, Kwasny MJ, Kaiser SM, Lieponis P, Powell T, Mohr DC. Coached Mobile App Platform for the Treatment of Depression and Anxiety Among Primary Care Patients: A Randomized Clinical Trial. JAMA Psychiatry 2020; 77:906-914. [PMID: 32432695 PMCID: PMC7240649 DOI: 10.1001/jamapsychiatry.2020.1011] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 03/09/2020] [Indexed: 02/05/2023]
Abstract
Importance Depression and anxiety are common and disabling. Primary care is the de facto site for treating these mental health problems but is typically underresourced to meet the burden of these demands. Objective To evaluate the efficacy of a mobile intervention platform, IntelliCare, for addressing depression and anxiety among primary care patients. Design, Setting, and Participants Two-arm randomized clinical trial at internal medicine clinics at the University of Arkansas for Medical Sciences. Adult primary care patients (N = 146) who screened positive for depression on the Patient Health Questionnaire-8 (PHQ; score ≥ 10) or anxiety on the Generalized Anxiety Disorder-7 (GAD-7; score ≥ 8) were recruited between July 17, 2018, and December 14, 2018. Interventions The coach-supported platform composed of a suite of apps, was delivered over 8 weeks. Wait list control participants received treatment as usual for 8 weeks, then the mobile platform. Main Outcomes and Measures Primary outcomes were changes in depression (PHQ-9) and anxiety (GAD-7) during the intervention period. Secondary outcomes were differences in the proportion of patients who achieved recovery (PHQ-9/GAD-7 <5 or 50% improvement from baseline), sustainment of intervention effects during 2-month follow-up, and app use during the intervention period. Results One hundred forty-six patients were included (119 of 146 were women [81.5%]; mean [SD] age, 42.3 [13.8] years). Of the 146 patients, 122 (83.6%) were diagnosed as having depression and 131 (89.7%) were diagnosed as having anxiety. A greater proportion of intervention vs wait list control participants achieved recovery from depression (n = 38 of 64 [59%] vs n = 18 of 58 [31%]; odds ratio, 3.25; 95% CI, 1.54-6.86) and anxiety (n = 37 of 65 [57%] vs n = 25 of 66 [38%]; odds ratio, 2.17; 95% CI, 1.08-4.36). Sustained effects were observed for depression (slope, 0.01; 95% CI, -0.09 to 0.10; P = .92) and anxiety scores (slope, 0.02; 95% CI, -0.08 to 0.12; P = .67) during follow-up. App use was high, with a median of 93 and 98 sessions among participants with depression and anxiety, respectively. Conclusions and Relevance In this trial, a mobile intervention app was effective for depression and anxiety among primary care patients. Findings also support designing digital mental health interventions as platforms containing simple, brief apps that can be bundled by users to meet their needs. Trial Registration ClinicalTrials.gov Identifier: NCT03500536.
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Affiliation(s)
- Andrea K. Graham
- Center for Behavioral Intervention Technologies, Northwestern University, Chicago, Illinois
- Department of Medical Social Sciences, Northwestern University, Chicago, Illinois
| | - Carolyn J. Greene
- Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock
| | - Mary J. Kwasny
- Center for Behavioral Intervention Technologies, Northwestern University, Chicago, Illinois
- Department of Preventive Medicine, Northwestern University, Chicago, Illinois
| | - Susan M. Kaiser
- Center for Behavioral Intervention Technologies, Northwestern University, Chicago, Illinois
- Department of Preventive Medicine, Northwestern University, Chicago, Illinois
| | | | - Thomas Powell
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock
| | - David C. Mohr
- Center for Behavioral Intervention Technologies, Northwestern University, Chicago, Illinois
- Department of Preventive Medicine, Northwestern University, Chicago, Illinois
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Fitzsimmons-Craft EE, Balantekin KN, Graham AK, DePietro B, Laing O, Firebaugh ML, Smolar L, Park D, Mysko C, Funk B, Taylor CB, Wilfley DE. Preliminary data on help-seeking intentions and behaviors of individuals completing a widely available online screen for eating disorders in the United States. Int J Eat Disord 2020; 53:1556-1562. [PMID: 32542896 PMCID: PMC7978480 DOI: 10.1002/eat.23327] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 05/26/2020] [Accepted: 05/27/2020] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Scaling an online screen that provides referrals may be key in closing the treatment gap for eating disorders (EDs), but we need to understand respondents' help-seeking intentions and behaviors after receiving screen results. This study reported on these constructs among respondents to the National Eating Disorders Association online screen who screened positive or at high risk for an ED. METHOD Respondents completed the screen over 18 months (February 9, 2018-August 28, 2019). Those screening positive or at high risk for an ED (n = 343,072) had the option to provide data on help-seeking intentions (after screen completion) and behaviors (2-month follow-up). RESULTS Of eligible respondents, 4.8% (n = 16,396) provided data on help-seeking intentions, with only 33.7% of those reporting they would seek help. Only 7.6% of eligible respondents opted in to the 2-month follow-up, with 10.6% of those completing it (n = 2,765). Overall, 8.9% of respondents to the follow-up reported being in treatment when they took the screen, 15.5% subsequently initiated treatment, and 75.5% did not initiate/were not already in treatment. DISCUSSION Preliminary results suggest that among the small minority who provided data, only one-third expressed help-seeking intentions and 16% initiated treatment. Online screening should consider ways to increase respondents' motivation for and follow-through with care.
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Affiliation(s)
| | - Katherine N Balantekin
- Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, New York, USA
| | - Andrea K Graham
- Department of Medical Social Sciences, Northwestern University, Chicago, Illinois, USA
| | - Bianca DePietro
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Olivia Laing
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Marie-Laure Firebaugh
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Lauren Smolar
- National Eating Disorders Association, New York, New York, USA
| | - Dan Park
- National Eating Disorders Association, New York, New York, USA
| | - Claire Mysko
- National Eating Disorders Association, New York, New York, USA
| | - Burkhardt Funk
- Institute of Information Systems, Leuphana University, Lüneburg, Germany
| | - C Barr Taylor
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
- Center for m2Health, Palo Alto University, Palo Alto, California, USA
| | - Denise E Wilfley
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
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Fitzsimmons-Craft EE, Taylor CB, Graham AK, Sadeh-Sharvit S, Balantekin KN, Eichen DM, Monterubio GE, Goel NJ, Flatt RE, Karam AM, Firebaugh ML, Jacobi C, Jo B, Trockel MT, Wilfley DE. Effectiveness of a Digital Cognitive Behavior Therapy-Guided Self-Help Intervention for Eating Disorders in College Women: A Cluster Randomized Clinical Trial. JAMA Netw Open 2020; 3:e2015633. [PMID: 32865576 PMCID: PMC7489868 DOI: 10.1001/jamanetworkopen.2020.15633] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 06/22/2020] [Indexed: 12/29/2022] Open
Abstract
Importance Eating disorders (EDs) are common, serious psychiatric disorders on college campuses, yet most affected individuals do not receive treatment. Digital interventions have the potential to bridge this gap. Objective To determine whether a coached, digital, cognitive behavior therapy (CBT) intervention improves outcomes for college women with EDs compared with referral to usual care. Design, Setting, and Participants This cluster randomized trial was conducted from 2014 to 2018 at 27 US universities. Women with binge-purge EDs (with both threshold and subthreshold presentations) were recruited from enrolled universities. The 690 participants were followed up for up to 2 years after the intervention. Data analysis was performed from February to September 2019. Interventions Universities were randomized to the intervention, Student Bodies-Eating Disorders, a digital CBT-guided self-help program, or to referral to usual care. Main Outcomes and Measures The main outcome was change in overall ED psychopathology. Secondary outcomes were abstinence from binge eating and compensatory behaviors, as well as ED behavior frequencies, depression, anxiety, clinical impairment, academic impairment, and realized treatment access. Results A total of 690 women with EDs (mean [SD] age, 22.12 [4.85] years; 414 [60.0%] White; 120 [17.4%] Hispanic; 512 [74.2%] undergraduates) were included in the analyses. For ED psychopathology, there was a significantly greater reduction in the intervention group compared with the control group at the postintervention assessment (β [SE], -0.44 [0.10]; d = -0.40; t1387 = -4.23; P < .001), as well as over the follow-up period (β [SE], -0.39 [0.12]; d = -0.35; t1387 = -3.30; P < .001). There was not a significant difference in abstinence from any ED behaviors at the postintervention assessment (odds ratio, 1.48; 95% CI, 0.48-4.62; P = .50) or at follow-up (odds ratio, 1.51; 95% CI, 0.63-3.58; P = .36). Compared with the control group, the intervention group had significantly greater reductions in binge eating (rate ratio, 0.82; 95% CI, 0.70-0.96; P = .02), compensatory behaviors (rate ratio, 0.68; 95% CI, 0.54-0.86; P < .001), depression (β [SE], -1.34 [0.53]; d = -0.22; t1387 = -2.52; P = .01), and clinical impairment (β [SE], -2.33 [0.94]; d = -0.21; t1387 = -2.49; P = .01) at the postintervention assessment, with these gains sustained through follow-up for all outcomes except binge eating. Groups did not differ in terms of academic impairment. The majority of intervention participants (318 of 385 participants [83%]) began the intervention, whereas only 28% of control participants (76 of 271 participants with follow-up data available) sought treatment for their ED (odds ratio, 12.36; 95% CI, 8.73-17.51; P < .001). Conclusions and Relevance In this cluster randomized clinical trial comparing a coached, digital CBT intervention with referral to usual care, the intervention was effective in reducing ED psychopathology, compensatory behaviors, depression, and clinical impairment through long-term follow-up, as well as realizing treatment access. No difference was found between the intervention and control groups for abstinence for all ED behaviors or academic impairment. Given its scalability, a coached, digital, CBT intervention for college women with EDs has the potential to address the wide treatment gap for these disorders. Trial Registration ClinicalTrials.gov Identifier: NCT02076464.
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Affiliation(s)
| | - C Barr Taylor
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
- Center for m 2 Health, Palo Alto University, Palo Alto, California
| | - Andrea K Graham
- Department of Medical Social Sciences, Northwestern University, Chicago, Illinois
| | - Shiri Sadeh-Sharvit
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
- Center for m 2 Health, Palo Alto University, Palo Alto, California
- Interdisciplinary Center, Baruch Ivcher School of Psychology, Herzliya, Israel
| | | | - Dawn M Eichen
- Department of Pediatrics, University of California, San Diego, San Diego
| | - Grace E Monterubio
- Department of Psychiatry, Washington University School of Medicine, St Louis, Missouri
| | - Neha J Goel
- Department of Psychology, Virginia Commonwealth University, Richmond
- Institute for Inclusion, Inquiry, and Innovation (iCubed), Virginia Commonwealth University, Richmond
| | - Rachael E Flatt
- Department of Psychology and Neurosciences, University of North Carolina at Chapel Hill, Chapel Hill
| | - Anna M Karam
- Department of Psychiatry, Washington University School of Medicine, St Louis, Missouri
| | - Marie-Laure Firebaugh
- Department of Psychiatry, Washington University School of Medicine, St Louis, Missouri
| | - Corinna Jacobi
- Institute of Clinical Psychology and Psychotherapy, Technische Universität, Dresden, Germany
| | - Booil Jo
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - Mickey T Trockel
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - Denise E Wilfley
- Department of Psychiatry, Washington University School of Medicine, St Louis, Missouri
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Smith MJ, Graham AK, Sax R, Spencer ES, Razzano L, Smith JD, Jordan N. Costs of preparing to implement a virtual reality job interview training programme in a community mental health agency: A budget impact analysis. J Eval Clin Pract 2020; 26:1188-1195. [PMID: 31631470 PMCID: PMC7167372 DOI: 10.1111/jep.13292] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 08/13/2019] [Accepted: 09/05/2019] [Indexed: 11/28/2022]
Abstract
RATIONAL, AIMS AND OBJECTIVES Individual Placement and Support (IPS) is an evidence based strategy for facilitating employment among adults with severe mental illness (SMI) where staff may lead mock job interviews to prepare clients for real-world interviews (a method with limited scalability and cost effectiveness). A virtual reality job interview training program (VR-JIT)-delivered via the internet-has demonstrated efficacy for increasing employment among adults with SMI. Now, VR-JIT is being implemented with a community mental health agency (CMHA) and evaluated for its effectiveness within IPS. This study is a budget impact analysis, evaluating the costs of preparing a CMHA to implement VR-JIT. METHOD Implementation preparation occurred over 7 months from October 1, 2016 to April 30, 2017. CMHA staff (n = 15) and external research partners (n = 3) tracked their hours completing implementation preparation activities. Salaries plus a 28% fringe benefit rate were used to derive a per-hour salary amount for each individual and applied to each activity. Non-labor equipment costs were obtained from purchase receipts. A budget impact analysis evaluated the expenditures associated with preparing the CMHA to implement VRJIT. RESULTS The total implementation preparation costs equaled $25,482. Labor costs equaled $22,882 and non-labor costs equaled $2,600. In total, 655 person-hours were spent preparing for VR-JIT implementation (e.g., preparing lab space, training, and supervising operations). CONCLUSIONS This study presents an initial evaluation of the budget impact of preparing to implement VR-JIT in a CMHA. Cost considerations for future implementation preparation will be discussed. Given that the cost to prepare to implement an intervention can hinder its adoption, results provide an important analysis for decision-makers that may enhance uptake. Future work will determine the cost-effectiveness of VR-JIT implemented within IPS. This study is registered at http://clinicaltrials.gov, NCT = 03049813, "Virtual Reality Job Interview Training: An Enhancement to Supported Employment in Severe Mental Illness."
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Affiliation(s)
- Matthew J. Smith
- School of Social Work, University of Michigan, Ann Arbor, Michigan, USA
| | - Andrea K. Graham
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Rachel Sax
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | | | - Lisa Razzano
- Thresholds Inc., Chicago, Illinois, USA
- Department of Psychiatry, University of Illinois, Chicago, Illinois, USA
| | - Justin D. Smith
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Neil Jordan
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital, Hines, Illinois, USA
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Orr LC, Graham AK, Mohr DC, Greene CJ. Engagement and Clinical Improvement Among Older Adult Primary Care Patients Using a Mobile Intervention for Depression and Anxiety: Case Studies. JMIR Ment Health 2020; 7:e16341. [PMID: 32673236 PMCID: PMC7381055 DOI: 10.2196/16341] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 03/11/2020] [Accepted: 04/16/2020] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Technology-based mental health interventions are an increasingly attractive option for expanding access to mental health services within the primary care system. Older adults are among the groups that could potentially benefit from the growing ubiquity of technology-based mental health interventions; however, older adults are perceived to be averse to using technology and have reported barriers to use. OBJECTIVE The aim of this paper is to present a case study of 3 participants from a clinical trial evaluating IntelliCare, an evidence-based mobile intervention for depression and anxiety, among adults recruited from primary care clinics. Our report of these 3 participants, who were aged 60 years or older, focuses on their engagement with the IntelliCare service (ie, app use, coach communication) and clinical changes in depression or anxiety symptoms over the intervention period. METHODS The 3 case study participants were offered IntelliCare with coaching for 8 weeks. The intervention consisted of 5 treatment intervention apps that support a variety of psychological skills, a Hub app that contained psychoeducational content and administered weekly assessments, and coaching for encouragement, accountability, and technical assistance as needed. The 3 case study participants were selected to reflect the overall demographics of participants within the trial and because their interactions with IntelliCare provided a good illustration of varied experiences regarding engagement with the intervention. RESULTS The 3 participants' unique experiences with the intervention are described. Despite potential barriers and experiencing some technical glitches, the participants showed proficient ability to use the apps, high levels of participation through frequent app use and coach interaction, and decreased depression and anxiety scores. At the end of the 8-week intervention, each of these 3 participants expressed great enthusiasm for the benefit of this program through feedback to their coach, and they each identified a number of ways they had seen improvements in themselves. CONCLUSIONS These 3 cases provide examples of older individuals who engaged with and benefitted from the IntelliCare service. Although the results from these 3 cases may not generalize to others, they provide an important, informed perspective of the experiences that can contribute to our understanding of how older adults use and overcome barriers to mental health technologies. The findings also contribute toward the ultimate goal of ensuring that the IntelliCare intervention is appropriate for individuals of all ages.
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Affiliation(s)
- L Casey Orr
- Center for Health Services Research, Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Andrea K Graham
- Center for Behavioral Intervention Technologies, Northwestern University, Chicago, IL, United States
| | - David C Mohr
- Center for Behavioral Intervention Technologies, Northwestern University, Chicago, IL, United States
| | - Carolyn J Greene
- Center for Health Services Research, Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock, AR, United States
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Taylor CB, Fitzsimmons‐Craft EE, Graham AK. Digital technology can revolutionize mental health services delivery: The COVID-19 crisis as a catalyst for change. Int J Eat Disord 2020; 53:1155-1157. [PMID: 32449523 PMCID: PMC7280562 DOI: 10.1002/eat.23300] [Citation(s) in RCA: 91] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 05/08/2020] [Accepted: 05/08/2020] [Indexed: 01/21/2023]
Abstract
The unprecedented COVID-19 crisis presents an imperative for mental health care systems to make digital mental health interventions a routine part of care. Already because of COVID-19, many therapists have rapidly moved to using telehealth in place of in-person contact. In response to this shift, Waller and colleagues compiled a series of expert recommendations to help clinicians pivot to delivering teletherapy to address eating disorders during COVID-19. However, numerous barriers still impede widespread adoption and implementation of digital interventions. In this commentary, we aim to extend the recommendations for clinicians offered by Waller and colleagues by presenting a roadmap of the systems- and policy-level requirements that are needed. We advocate for addressing barriers associated with training, licensing, safety, privacy, payment, and evaluation, as these factors have greatly limited use of these promising interventions. We also indicate that longer-term goals should include introducing truly innovative digital mental health practices, such as stepped-care models and simultaneously providing preventive and self-management services in addition to clinical services, into the health care system. Now is the time to catalyze change and comprehensively address the barriers that have prevented widespread delivery of these efficacious digital services to the millions of people who would benefit.
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Affiliation(s)
- C. Barr Taylor
- Department of Psychiatry and Behavioral SciencesStanford University School of MedicineStanfordCaliforniaUSA,Center for m2Health, Palo Alto UniversityPalo AltoCaliforniaUSA
| | | | - Andrea K. Graham
- Center for Behavioral Intervention Technologies, Department of Medical Social SciencesNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
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Jennings Mathis K, Anaya C, Rambur B, Bodell LP, Graham AK, Forney KJ, Anam S, Wildes JE. Workforce Diversity in Eating Disorders: A Multi-Methods Study. West J Nurs Res 2020; 42:1068-1077. [PMID: 32266857 DOI: 10.1177/0193945920912396] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Despite growing recognition of the importance of workforce diversity in health care, limited research has explored diversity among eating disorder (ED) professionals globally. This multi-methods study examined diversity across demographic and professional variables. Participants were recruited from ED and discipline-specific professional organizations. Participants' (n = 512) mean age was 41.1 years (SD = 12.5); 89.6% (n=459) of participants identified as women, 84.1% (n = 419) as heterosexual/straight, and 73.0% (n = 365) as White. Mean years working in EDs was 10.7 years (SD = 9.2). Qualitative analysis revealed three themes resulting in a theoretical framework to address barriers to increasing diversity. Perceived barriers were the following: "stigma, bias, stereotypes, myths"; "field of eating disorders pipeline"; and "homogeneity of the existing field." Findings suggest limited workforce diversity within and across nations. The theoretical model suggests a need for focused attention to the educational pipeline, workforce homogeneity, and false assumptions about EDs, and it should be tested to evaluate its utility within the EDs field.
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Affiliation(s)
| | - Carolina Anaya
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, USA
| | - Betty Rambur
- College of Nursing, University of Rhode Island, Kingston, RI, USA
| | - Lindsay P Bodell
- Department of Psychology, Western University, London, ON, Canada
| | - Andrea K Graham
- Departments of Medical Social Sciences and Preventive Medicine, Northwestern University, Evanston, IL, USA
| | - K Jean Forney
- Department of Psychology, Ohio University, Athens, OH, USA
| | - Seeba Anam
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, USA
| | - Jennifer E Wildes
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, USA
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