Self-help Intervention Research Articles

Scalable Technology for Adolescents and Youth to Reduce Stress in the Treatment of Common Mental Disorders in Jordan: Protocol for a Randomized Controlled Trial.

Young people in low- and middle-income countries encounter significant barriers to accessing mental health support due to various factors, including a substantial treatment gap and limited health care budgets allocated to mental health. Using innovative strategies, such as scalable digital self-help psychological interventions, offers a potential solution for improving access to mental health support. However, digital mental health interventions come with their own set of challenges, including issues related to low user engagement. Chatbots, with their interactive and engaging nature, may present a promising avenue for the delivery of these interventions. This study aims to explore the effectiveness of a newly developed World Health Organization (WHO) digital mental health intervention, titled Scalable Technology for Adolescents and Youth to Reduce Stress (STARS). A single-blind, 2-arm randomized controlled trial will be conducted nationally across Jordan. Participants will include 344 young adults, aged 18-21 years, currently residing in Jordan. Inclusion criteria are heightened levels of psychological distress as determined through the 10-item Kessler Psychological Distress Scale (≥20). Assessment measures will be conducted at baseline, 1-week post intervention, and 3-month follow-up. Following baseline assessments, eligible participants will be randomized to receive STARS or enhanced usual care. The primary outcomes are the reduction of symptoms of depression and anxiety (Hopkins Symptom Checklist, 25 subscales) at 3-month follow-up. Secondary outcomes include general functioning (WHO Disability Assessment Schedule 2.0), well-being (WHO-5 Well-Being Index), personal problems (Psychological Outcomes Profile), and agency (State Hope Scale subscale). The study was funded in January 2020 by the Research for Health in Humanitarian Crises Programme (Elhra) and recruitment for the trial started on July 16, 2023. As of November 15, 2023, we randomized 228 participants. This trial intends to contribute to the growing digital mental health evidence base by exploring technological solutions to address global public health challenges. Given the widespread use of technology globally, even in resource-constrained settings, and the high adoption rates among adolescents and young individuals, digital initiatives such as STARS present promising opportunities for the future of mental health care in low- and middle-income countries. ISRCTN Registry ISRCTN10152961; https://www.isrctn.com/ISRCTN10152961. DERR1-10.2196/54585.

Changes in insomnia and binge-eating symptom severity before and after treatment of eating disorders in individuals with non-low-weight binge-spectrum disorders.

Although emerging research suggests insomnia is a significant problem among people with eating disorders, little is known about how insomnia symptoms may serve as risk factors for eating disorder symptoms, treatment outcome, and relapse. University students with non-low-weight eating disorders (N = 89) completed a mobile guided self-help cognitive behavioural intervention for eating disorders. Insomnia and binge-eating symptoms were assessed at pre-treatment and end-of-treatment using the Insomnia Severity Index and Eating Pathology Symptoms Inventory. Multiply imputed datasets were used to test associations between insomnia and binge eating before, during and after treatment. Insomnia was positively associated with binge-eating symptoms prior to treatment (r = 0.47). Baseline insomnia symptoms were associated with binge-eating symptoms at end-of-treatment (est = 0.269). Eating disorder treatment modestly reduced insomnia (d = -0.38); however, about half of people with clinically significant insomnia prior to treatment remained symptomatic. Insomnia symptoms and binge-eating symptoms did not change concurrently during treatment. Overall, results support an association between insomnia and binge eating. Although eating disorder treatment may impact insomnia, many individuals remained symptomatic for sleep problems, suggesting the need for follow-up treatments, such as cognitive behavioural therapy for insomnia, or the development of integrated insomnia-eating disorder treatments. Future studies are needed to examine causal links between insomnia and eating disorder symptoms, and test if insomnia predicts relapse after eating disorder treatment.

A self-help mobile messaging intervention to improve subthreshold depressive symptoms among older adults in a socioeconomically deprived region of Brazil (PRODIGITAL): a pragmatic, two-arm randomised controlled trial

Subthreshold depression is a risk factor for major depression and is associated with increased morbidity and mortality, especially in older adults. There is emerging evidence that digital interventions, including self-help interventions, may reduce depressive symptoms. We aimed to evaluate the effectiveness of a mobile messaging intervention at reducing subthreshold depressive symptoms among older adults in Brazil. PRODIGITAL was a single blind, two-arm, individually randomised controlled trial conducted in 46 primary care clinics in the city of Guarulhos, Brazil. Individuals aged 60+ years were contacted by phone following a randomly ordered list for a screening assessment. Those who presented with anhedonia and/or depressed mood (Patient Health Questionnaire (PHQ)-2≥1), and who subsequently scored between 5 and 9 on the PHQ-9 were invited to participate. The intervention arm received the 'Viva Vida' digital self-help intervention consisting of automated multi-media messages sent via WhatsApp. Forty-eight audio and visual messages based on psychoeducation and behavioural activation were automatically delivered over six weeks. The control arm received a single message containing information about depression. The primary outcome was the difference in mean PHQ-9 scores between treatment arms at the three-month follow-up. All primary analyses were performed according to allocated arm with imputed data. The trial is registered with ReBEC, RBR-6c7ghfd. Participants were recruited between 8 September 2021 and 19 August 2022. Of the 454 participants enrolled, 223 were randomised to the intervention arm, 231 to the control arm. Participants' mean age was 65.3 years (SD 5.0) and 64.0% (n=292) were female. A total of 385 (84.8%) completed the three-month follow-up assessment; no difference in mean PHQ-9 scores between the treatment arms was observed (adjusted difference:-0.61; 95% CI:-1.75, 0.53; p=0.29). These results demonstrate that the Viva Vida digital self-help intervention did not help to improve subthreshold depressive symptoms amongst older adults. Further research is needed to understand why this self-help intervention was not effective in this population, and to explore how it might be adapted to achieve this goal. São Paulo Research Foundation and UK Joint Global Health Trials.

Protocol for a cluster randomised controlled trial to evaluate effectiveness of a self-help group intervention to encourage smoke-free homes in slums of Kochi(Kochi Intervention for tobacco smoke free homes-KIFT)

Background Exposure to second hand smoke (SHS) is a cause for heart disease and lung cancer among non- smokers. This cluster randomized control trial will evaluate the effectiveness of a tobacco smoke free home intervention in reducing exposure to second hand smoke. Protocol The intervention will be conducted among 30 clusters in urban and peri-urban areas of Kochi, India. The sample size is 300 per arm and 15 clusters to detect a minimal difference of 0.03ng/ml in cotinine levels between groups, at 80% power with a two-sided alfa of 0.05 considering variable cluster size. A baseline survey will be undertaken to identify smokers. Data related to smoking, indoor smoking, nicotine dependence, blood pressure (BP) of smokers, morbidity experienced, and lung volume Fev1/Fev6 of smokers will be measured. Urine cotinine, morbidity, BP of spouse and child will be assessed. Air quality monitors measuring PM2.5 will be placed in homes. Trained self-help group women and frontline health workers will implement the intervention. The intervention will consist of monthly home visits to educate the smoker on the harms of second-hand smoke using 3 A’s. The circle of influencers around the smoking men will also be contacted by the members of self-help group to provide support to stop smoking within homes and to quit. They will then organize two-three meetings of community leaders and heads of women’s groups, present data on harms of SHS, and explain the rationale for establishing smoke free homes in their community for a duration of six months. After the intervention a post assessment will be conducted and this will be repeated after six months. Ethics and dissemination The trial protocol was approved by the Institutional Ethical Committee of Amrita Institute of Medical Sciences. Results will be submitted to open access peer reviewed journals and shared with other stakeholders. Trial registration CTRI/2021/06/034478

SoundMind Trial: a study protocol for a randomised controlled trial for online acceptance and commitment therapy and sound therapy for tinnitus

IntroductionTinnitus is a common ailment that affects 10%–15% of adults worldwide. Comorbidities associated with tinnitus often include hearing loss, emotional distress and sleep disorders, with insomnia being a common issue...

Correction to: Empowerment-Led Guided Self-Help Intervention for Symptom Burden in Breast Cancer Women Treated With Ovarian Function Suppression: A Randomized Trial Protocol

Correction to: Empowerment-Led Guided Self-Help Intervention for Symptom Burden in Breast Cancer Women Treated With Ovarian Function Suppression: A Randomized Trial Protocol

Digital Interventions in Psychotherapy

During the last 20 years, many digital interventions in psychotherapy have been developed and tested for a wide range of clinical problems. Digital interventions expand the range of treatment options and reach people who are unable or unwilling to take part in traditional psychotherapy. This article sheds light on various forms of digital interventions, such as unguided and guided self-help interventions, blended treatments, and video-based therapy, the practical use of Digital Health Applications (DiGA) in Germany, and the current state of research in digital interventions.

“The only way that they can access help quickly”: a qualitative exploration of key stakeholders’ perspectives on guided self-help interventions for children and young people with eating disorders

BackgroundThere is a significant unmet treatment need for children and young people (CYP) with eating disorders. Guided self-help interventions have the potential to expand access to evidence-based treatments. Guided self-help is a type of low intensity psychological intervention where individuals engage with a workbook or online programme, with the support of a health professional. Its primary aim is to equip patients and/or their caregivers with self-management skills. However, little is currently known about the acceptability and suitability of guided self-help interventions for CYP with eating disorders. This study aimed to explore the perspectives of three key stakeholder groups – CYP with lived experience of eating disorders, parents/carers, and healthcare professionals – on guided self-help for this population.MethodsQualitative focus groups and semi-structured interviews were conducted with 11 CYP (aged 13–19 years) with lived experience of eating disorders, 12 parents/carers, and 10 healthcare professionals. The study comprised a total of seven focus groups (including 2 with CYP, 3 with parent/carers, and 2 with healthcare professionals), as well as four semi-structured interviews (including 3 with CYP and 1 with a parent/carer). Discussion topics included past experiences of using/delivering guided self-help, the suitability of guided self-help for CYP with eating disorders, and preferences towards the content, structure and modes of guided self-help. Data were analysed using reflexive thematic analysis.ResultsThree themes were generated across all three stakeholder groups. Theme one, Bridging the gap, highlighted the role of guided self-help in increasing access to psychological support for CYP with eating disorders. Theme two, Timing matters, considered the suitability of guided self-help for CYP with eating disorders at different stages of illness and the care pathway. Theme three, One size does not fit all, emphasised the heterogeneity of eating disorders and the need for a personalised and flexible approach in guided self-help.ConclusionsFindings from this study lay a foundation for the future design and delivery of guided self-help interventions for CYP with eating disorders. Future work must consider these findings in the context of best available research evidence to optimise the potential utility of guided self-help for this population.

Effectiveness of the MyDiaMate application in reducing diabetes distress in adults with type 1 diabetes: Study protocol of the multi-national, randomised-controlled MyREMEDY trial.

Diabetes distress is common among people with type 1 diabetes (T1D), negatively affecting quality of life, self management, and diabetes outcomes. E-health-based interventions could be an effective and low-cost way to improve the psychological care for people with T1D experiencing diabetes distress. The MyREMEDY study aims to test the effectiveness of the online unguided self-help intervention MyDiaMate in decreasing diabetes distress in adults with T1D. MyDiaMate is based on Cognitive Behavioural Therapy and consists of eight modules, each focusing on a different aspect of living with T1D that is often experienced as burdensome (e.g. hypoglycaemia, fatigue). The effectiveness of MyDiaMate will be tested through a randomised-controlled trial across four European countries (the Netherlands, Germany, Spain and the United Kingdom). Six hundred and sixty adults (N = 165 per country) with T1D will be recruited and randomised with a balance of 2:1 into the intervention and care as usual groups. Intervention group members receive access to MyDiaMate for 6 months, care as usual group members receive access after 3 months for 3 months. Participants fill in questionnaires at 0 (baseline), 3 (effectiveness) and 6 months (follow-up). Primary outcome is diabetes distress at 3 months. Secondary outcomes are emotional well-being, psychological self-efficacy in relation to diabetes, social engagement, fatigue, and glycaemic outcomes. Moreover, logdata of MyDiaMate use is passively collected. Linear mixed model analyses will be used to test the effectiveness of MyDiaMate along with identifying which user subgroup benefits most from MyDiaMate use. Clinicaltrials.gov NCT06308549.

Abstract B019: A machine learning approach to predicting smoking cessation outcomes among Spanish-speaking smokers who completed a culturally targeted intervention

Abstract Introduction: Among the Hispanic/Latinx population in the US, four of five leading causes of death are attributed to smoking. Few evidence-based interventions have been developed to improve smoking cessation for this population. Our team has demonstrated the efficacy of a culturally targeted, extended self-help intervention for Spanish-speaking smokers, estimating a smoking abstinence rate of 33% at 24 months, compared to 24% for usual care. Further efforts are needed to enhance this efficacious, low-cost, scalable intervention approach. Machine learning (ML) is one approach to increase understanding of the predictors of treatment outcomes and inform strategies to improve the intervention. Toward that goal, this secondary data analysis utilized the decision tree (DT) model to predict self-reported 7-day point prevalence abstinence at 18-month follow-up for participants receiving our intervention. Method: Data from participants who reported smoking status at an 18-month follow-up (N=332 of 714 enrolled, 36% abstinent) were randomly split (80:20) into training and test datasets based on smoking status. We entered demographics, psychosocial, and smoking variables collected at baseline as predictors in the model. In addition to handling missing values and normalizing numeric features, we employed the Synthetic Minority Over-sampling Technique (SMOTE) combined with Tomek links (SMOTE-Tomek) to improve inter-class separability. Recursive Feature Elimination (RFE) using DT was implemented to identify the most relevant predictors. The cross-validation (CV) pipeline incorporated preprocessing, feature selection, handling class-imbalance, over-sampling, and model training with a DT as the interpretable classifier. Hyperparameters were tuned using stratified K-fold (K=5) CV to optimize parameters using Grid search. F1 score was selected as the primary metric as it accounts for each class performance by combining the precision and recall metrics. Finally, the performance of the classifier was evaluated in 20% of the unseen dataset. Results: The DT classifier for the CV achieved the F1 score of 0.73 [95% CI 0.66, 0.77], revealing a reasonably good performance in identifying smokers at 18-months. RFE selected familism, age, affect, and confidence as the most relevant predictors of smoking status. Individuals who had lower familism scores (<138), combined with higher age (>50), were more likely to be smokers at 18 months. Individuals who had higher familism scores (>138) combined with higher negative affect (>42) were more likely to be smokers. Conclusion: This study provides the first step toward personalized care for smoking cessation among the Hispanic/Latinx population and demonstrates the potential of DT classifier to predict cessation outcomes among individuals who received and completed a culturally and linguistically targeted smoking cessation intervention. Our future analysis will compare this model with conventional statistical modeling approaches and other ML algorithms to identify the best-performing parsimonious model. Citation Format: Ranjita Poudel, K. Ruwani M. Fernando, Matthew B. Schabath, Steven K. Sutton, Thomas H. Brandon, Issam El Naqa, Vani N. Simmons. A machine learning approach to predicting smoking cessation outcomes among Spanish-speaking smokers who completed a culturally targeted intervention [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B019.

We Have Spent Time, Money, and Effort Making Self-Help Digital Mental Health Interventions: Is Anyone Going to Come to the Party?

Although efficacious psychotherapies exist, a limited number of mental health care providers and significant demand make their accessibility a fundamental problem. Clinical researchers, funders, and investors alike have converged on self-help digital mental health interventions (self-help DMHIs) as a low-cost, low-burden, and broadly scalable solution to the global mental health burden. Consequently, exorbitant financial and time-based resources have been invested in developing, testing, and disseminating these interventions. However, the public's assumed desirability for self-help DMHIs by experts has largely proceeded without question. This commentary critically evaluates whether self-help DMHIs can, and will, reach their purported potential as a solution to the public burden of mental illness, with an emphasis on evaluating their real-world desirability. Our review finds that self-help DMHIs are often perceived as less desirable and credible than in-person treatments, with lower usage rates and, perhaps accordingly, clinical trials testing self-help DMHIs suffering from widespread recruitment challenges. We highlight two fundamental challenges that may be interfering with the desirability of, and engagement in, self-help DMHIs: (1) difficulty competing with technology companies that have advantages in resources, marketing, and user experience design (but may not be delivering evidence-based interventions) and (2) difficulty retaining (vs initially attracting) users. We discuss a range of potential solutions, including highlighting self-help DMHIs in public mental health awareness campaigns; public education about evidence-based interventions that can guide consumers to appropriate self-help DMHI selection; increased financial and expert support to clinical researchers for marketing, design, and user experience in self-help DMHI development; increased involvement of stakeholders in the design of self-help DMHIs; and investing in more research on ways to improve retention (versus initial engagement). We suggest that, through these efforts, self-help DMHIs may fully realize their promise for reducing the global burden of mental illness.

The clinical and cost effectiveness of internet-delivered self-help Acceptance and Commitment Therapy for family carers of people with dementia (iACT4CARERS): Study protocol for a randomised controlled trial with ethnically diverse family carers

BackgroundFollowing the successful completion of feasibility and acceptability studies of internet-delivered self-help Acceptance and Commitment Therapy for family carers of people with dementia (iACT4CARERS), a full-scale randomised controlled trial (RCT) evaluating its clinical and cost effectiveness will be conducted. This paper describes the design and protocol for a multi-site, parallel, single-blind, 2-arm RCT evaluating the clinical and cost effectiveness of iACT4CARERS plus treatment-as-usual (TAU) in comparison to TAU alone for reducing anxiety in family carers of people with dementia. Methods496 family carers aged ≥18 years, who are caring for a person with dementia, will be recruited from national healthcare services, general practices and community groups in England. Participants randomised to the intervention arm will receive iACT4CARERS over 12 weeks. Participants will complete outcome measures at baseline (0 weeks) and at 12-weeks and 24-weeks post-randomisation. The primary outcome and timepoint will be anxiety at 12 weeks. Secondary outcomes will include psychological flexibility, depression, and cost-effectiveness (cost per quality adjusted life years). Primary analyses will be by intention-to-treat and data will be analysed using linear mixed models. Fidelity and quality of implementation will be assessed and contextual factors associated with variation in outcomes identified in a process evaluation. ConclusionIf iACT4CARERS is found to be effective and affordable, this self-help intervention, including minimal contact with minimally trained therapists, has the potential to be rolled out widely within healthcare services in the UK, reducing inequality in access to psychological services among this population.Clinical trials registration: ISRCTN registry identifier ISRCTN45995725.

Cognitive behavioral self-help interventions for individuals experiencing psychosis: a systematic review.

Little is known about the effectiveness of cognitive behavioral therapy (CBT) specific self-help for psychosis, given that CBT is a highly recommended treatment for psychosis. Thus, research has grown regarding CBT-specific self-help for psychosis, warranting an overall review of the literature. A systematic literature review was conducted, following a published protocol which can be found at: https://www.crd.york.ac.uk/prospero/export_record_pdf.php. A search was conducted across Scopus, PubMed, PsycInfo, and Web of Science to identify relevant literature, exploring CBT-based self-help interventions for individuals experiencing psychosis. The PICO search strategy tool was used to generate search terms. A narrative synthesis was conducted of all papers, and papers were appraised for quality. Ten studies were included in the review. Seven papers found credible evidence to support the effectiveness of CBT-based self-help in reducing features of psychosis. Across the studies, common secondary outcomes included depression, overall psychological well-being, and daily functioning, all of which were also found to significantly improve following self-help intervention, as well as evidence to support its secondary benefit for depression, anxiety, overall well-being, and functioning. Due to methodological shortcomings, long-term outcomes are unclear.

Effects of a self-guided digital mental health self-help intervention for Syrian refugees in Egypt: A pragmatic randomized controlled trial

Background Digital mental health interventions for smartphones, such as the World Health Organization (WHO) Step-by-Step (SbS) program, are potentially scalable solutions to improve access to mental health and psychosocial support in refugee populations. Our study objective was to evaluate the effectiveness of SbS as self-guided intervention with optional message-based contact-on-demand (COD) support on reducing psychological distress, functional impairment, symptoms of posttraumatic stress disorder (PTSD), and self-identified problems in a sample of Syrian refugees residing in Egypt. Methods and findings We conducted a 2-arm pragmatic randomized controlled trial. A total of 538 Syrians residing in Egypt with elevated levels of psychological distress (Kessler Psychological Distress Scale; K10 > 15) and reduced psychosocial functioning (WHODAS 2.0 > 16) were randomized into SbS + CAU (N = 266) or CAU only (N = 272). Primary outcomes were psychological distress (Hopkins Symptom Checklist 25) and impaired functioning (WHO Disability Assessment Schedule 2.0) at 3-month follow-up. Secondary outcomes were symptoms of PTSD (PTSD Checklist for DSM-5 short form, PCL-5 short) and self-identified problems (Psychological Outcomes Profiles Scale, PSYCHLOPS). Intention-to-treat (ITT) analyses showed significant but small effects of condition on psychological distress (mean difference: −0.15; 95% CI: −0.28, −0.02; p = .02) and functioning (mean difference: −2.04; 95% CI: −3.87, −0.22; p = .02) at 3-month follow-up. There were no significant differences between groups on symptoms of PTSD and self-identified problems. Remission rates did not differ between conditions on any of the outcomes. COD was used by 9.4% of participants for a median of 1 contact per person. The main limitations are high intervention dropout and low utilization of COD support. Conclusions The trial provides a real-world implementation case, showing small positive effects of a digital, potentially scalable and self-guided mental health intervention for Syrian refugees in Egypt in reducing psychological distress and improving overall functioning. Further user-centered adaptations are required to improve adherence and effectiveness while maintaining scalability. Trial registration German Register for Clinical Studies DRKS00023505.

The influence of therapy quality on outcomes from behavioural activation and guided self-help treatments for depression in adults with intellectual disabilities.

We report the effect of quality of therapy delivery on outcomes in a randomized, controlled trial of behavioural activation (BA) and guided self-help (GSH) for depression in adults with intellectual disabilities. A study specific measure of quality was used in a linear mixed effect model to determine the effects therapy and therapy quality on therapy outcome. There was a significant interaction between quality and treatment type, with lower quality therapy associated with better outcome for GSH but poorer outcome for BA, with little difference in outcomes at higher levels of therapy quality. Factors suggesting high quality in individualized BA may indicate problematic engagement for GSH. More research into processes in therapy for people with intellectual disabilities is required.

Novel Guided Self-Help for the treatment of Binge Eating Disorder: Feasibility, Acceptability, and Preliminary Efficacy.

Purpose: Binge eating disorder (BED) is a prevalent eating disorder. Many individuals with BED do not receive evidence-based care due to many barriers. This preliminary study evaluated the feasibility, acceptability, and potential efficacy of a manualized guided self-help (GSH) intervention with support in the form of a culturally adapted manual for a French-Canadian population.Method: Twenty-two women with overweight or obesity meeting the BED diagnostic criteria participated in an 8-week open trial. The GSH programme combined a self-help book and weekly support phone calls. Participants were assessed at baseline, at week 4, postintervention, and 12 weeks following its end. Feasibility was measured by attrition rates, participation, and satisfaction. Acceptability was measured by a questionnaire based on the Theoretical Framework of Acceptability. Potential efficacy outcomes were objective binge eating days, eating disorder symptomatology, depressive symptoms, and propensity to eat intuitively.Results: The GSH programme has proven feasible (4.5% attrition, 91% completion, 95.5% satisfaction) and acceptable. Potential efficacy results showed promising improvements on all outcomes (19% abstinence, 70.9% reduction in objective binge eating days).Conclusion: Although preliminary, this programme warrants further study as it may be an efficient and cost-effective way to deliver GSH for BED patients with accessibility barriers.

Power of a Few Vagrant Words: Effects of Direct and Indirect Suggestions for Self-Representation in Art-Based Online Interventions

ABSTRACT This study compares two groups of university students with differing instructions participating in an object drawing task as a part of an art therapy-based self-help online intervention. The intervention aimed to help participants enhance positive mood and subjective feeling of self-control and reduce negative mood. The object task contained suggestive elements in the instructions similar to self-hypnosis with an indirect and a direct way of formulation. Quantitative (positive affect and negative affect scale and Self-Assessment Manikin scale) and qualitative methods (text and picture rating) were used to investigate the difference between the outcome effects on the two groups. The results found a significant decrease in negative mood for indirect suggestion, while a significant increase of positive mood for the direct suggestion condition. Based on qualitative analyses, findings indicated that hidden implications in the art-making instructions modified the chosen imaginary and emotional changes related to art-making. Suggestions in the instructions can make a difference in one’s mood and this should also be considered while designing guidelines for self-hypnosis.

Effectiveness and predictors of psychotherapy in eating disorders: state-of-the-art and future directions.

Psychotherapy is the cornerstone of the multidisciplinary treatment approach for eating disorders. This review examines recent evidence regarding effectiveness, predictors, and mechanisms of change of psychotherapy in eating disorders, providing a road map for clinicians and researchers. Family-based treatments (FBT) are effective in adolescents with anorexia nervosa and bulimia nervosa. Evidence-based psychotherapies for anorexia nervosa have no evidence of superiority compared with treatment as usual (TAU) in adults with anorexia nervosa. Cognitive-behavioural therapy (CBT) is the first-choice psychotherapy recommended for adults with bulimia nervosa and binge-eating disorder (BED). Self-help interventions have some evidence of effectiveness in nonunderweight individuals with eating disorders. Early symptom improvement and adolescent age predict more favourable outcomes. Evidence-based psychotherapies can be suggested for eating disorders, although follow-up data are needed. Beyond anorexia nervosa, bulimia nervosa, and BED, there is no evidence of psychotherapy effectiveness in other eating disorders. The effectiveness of novel (e.g. 'third-wave') psychotherapies, treatment delivery modality (e.g. internet-delivered), and adjunctive interventions (e.g. virtual reality) needs to be further explored. A broader definition of recovery is recommended, including behavioural, physical, and psychological criteria. Predictors and mechanisms of changes have not been studied enough: quantitative and qualitative studies are needed to promote more tailored and individualized psychotherapy interventions.

Associations Between Weight Discrimination, Eating-Disorder-Related Psychiatric Impairment, and Eating-Disorder Treatment Interest Across the Weight Spectrum.

Only approximately 20% of college students with an eating disorder (ED) seek treatment. One barrier to seeking treatment is weight discrimination. Past research demonstrates that experiencing weight discrimination is associated with increased ED risk and decreased in-person treatment engagement. Weight discrimination may be a particularly relevant treatment barrier for students who have a higher body weight given their higher likelihood of experiencing weight discrimination. College students with a probable ED diagnosis (N = 372; Mage = 23.94; 73.12% women, 18.55% men, 6.18% another gender; 11.29% Asian, 4.57% Black, 12.63% Hispanic, 83.60% White, 4.84% Native American, and 0.54% another race) completed an online self-report survey that included the Clinical Impairment Assessment (CIA), Experience of Weight Discrimination (EWD) Scale, and a 0-100 scale to indicate interest in participating in virtual guided self-help ED treatment. Linear regression showed significant positive relationships between weight discrimination and ED-related psychiatric impairment and treatment interest. Elevations in CIA scores corroborate past literature that suggested that weight discrimination was positively related to ED psychopathology. Contrary to past research, college students who experienced weight discrimination had greater treatment interest. Students who experience weight discrimination may view virtual self-guided treatment as less weight-stigmatizing due to the "do-it-yourself" approach and no in-person interactions. Findings highlight the potential impacts of weight discrimination on acceptability of ED-related care. Future research is needed to identify ways to reduce weight discrimination and promote weight-inclusive practices in the medical system.

A Study of Self-help Intervention System for Social Anxiety in Vitiligo Based on Cognitive Behavioral Therapy

A Study of Self-help Intervention System for Social Anxiety in Vitiligo Based on Cognitive Behavioral Therapy