Hostname: page-component-76fb5796d-9pm4c Total loading time: 0 Render date: 2024-04-27T14:55:14.326Z Has data issue: false hasContentIssue false
  • English
  • Français

Efficacy of a transdiagnostic cognitive-behavioral intervention for eating disorder psychopathology delivered through a smartphone app: a randomized controlled trial

Published online by Cambridge University Press:  25 September 2020

Jake Linardon ,
Adrian Shatte ,
John Rosato  and
Matthew Fuller-Tyszkiewicz
Jake Linardon*
Affiliation:
School of Psychology, Deakin University, 1 Gheringhap Street, Geelong, VIC 3220, Australia
Adrian Shatte
Affiliation:
Federation University, School of Science, Engineering & Information Technology, Melbourne, Australia
John Rosato
Affiliation:
School of Psychology, Deakin University, 1 Gheringhap Street, Geelong, VIC 3220, Australia
Matthew Fuller-Tyszkiewicz
Affiliation:
School of Psychology, Deakin University, 1 Gheringhap Street, Geelong, VIC 3220, Australia Center for Social and Early Emotional Development, Deakin University, Burwood, Victoria 3125, Australia
*
Author for correspondence: Jake Linardon, E-mail: Jake.linardon@deakin.edu.au
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Although effective treatments exist for diagnostic and subthreshold-level eating disorders (EDs), a significant proportion of affected individuals do not receive help. Interventions translated for delivery through smartphone apps may be one solution towards reducing this treatment gap. However, evidence for the efficacy of smartphones apps for EDs is lacking. We developed a smartphone app based on the principles and techniques of transdiagnostic cognitive-behavioral therapy for EDs and evaluated it through a pre-registered randomized controlled trial.

Methods

Symptomatic individuals (those who reported the presence of binge eating) were randomly assigned to the app (n = 197) or waiting list (n = 195). Of the total sample, 42 and 31% exhibited diagnostic-level bulimia nervosa and binge-eating disorder symptoms, respectively. Assessments took place at baseline, 4 weeks, and 8 weeks post-randomization. Analyses were intention-to-treat. The primary outcome was global levels of ED psychopathology. Secondary outcomes were other ED symptoms, impairment, and distress.

Results

Intervention participants reported greater reductions in global ED psychopathology than the control group at post-test (d = −0.80). Significant effects were also observed for secondary outcomes (d's = −0.30 to −0.74), except compensatory behavior frequency. Symptom levels remained stable at follow-up. Participants were largely satisfied with the app, although the overall post-test attrition rate was 35%.

Conclusion

Findings highlight the potential for this app to serve as a cost-effective and easily accessible intervention for those who cannot receive standard treatment. The capacity for apps to be flexibly integrated within current models of mental health care delivery may prove vital for addressing the unmet needs of people with EDs.

Keywords

Binge eatingdigital interventioneating disordersrandomized controlled trialsmartphone app
Type
Original Article
Information
Psychological Medicine , Volume 52 , Issue 9 , July 2022 , pp. 1679 - 1690
Check for updates
Copyright
Copyright © The Author(s) 2020. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Andersson, G. (2016). Internet-delivered psychological treatments. Annual Review of Clinical Psychology, 12, 157–179. doi: 10.1146/annurev-clinpsy-021815-093006.CrossRefGoogle ScholarPubMed
Arean, P. A., Hallgren, K. A., Jordan, J. T., Gazzaley, A., Atkins, D. C., Heagerty, P. J., & Anguera, J. A. (2016). The use and effectiveness of mobile apps for depression: Results from a fully remote clinical trial. Journal of Medical Internet Research, 18, e330. doi: 10.2196/jmir.6482.CrossRefGoogle ScholarPubMed
Bohn, K., Doll, H. A., Cooper, Z., O'Connor, M., Palmer, R. L., & Fairburn, C. G. (2008). The measurement of impairment due to eating disorder psychopathology. Behaviour Research and Therapy, 46, 1105–1110. doi: 10.1016/j.brat.2008.06.012.CrossRefGoogle ScholarPubMed
Chen, E. Y., Cacioppo, J., Fettich, K., Gallop, R., McCloskey, M. S., Olino, T., & Zeffiro, T. A. (2016). An adaptive randomized trial of dialectical behavior therapy and cognitive behavior therapy for binge-eating. Psychological Medicine, 47, 703–717. doi: 10.1017/S0033291716002543.CrossRefGoogle ScholarPubMed
Cohen, J. (1992). A power primer. Psychological Bulletin, 112, 155–159. doi: 10.1037/0033-2909.112.1.155.CrossRefGoogle ScholarPubMed
Cro, S., Morris, T. P., Kenward, M. G., & Carpenter, J. R. (2016). Reference-based sensitivity analysis via multiple imputation for longitudinal trials with protocol deviation. The Stata Journal, 16, 443–463. doi: 10.1177/1536867X1601600211.CrossRefGoogle ScholarPubMed
Crow, S. J., & Smiley, N. (2010). Costs and cost-effectiveness in eating disorders. In The Oxford handbook of eating disorders (pp. 480). Oxford: Oxford University Press.Google Scholar
Crow, S. J., Stewart Agras, W., Halmi, K., Mitchell, J. E., & Kraemer, H. C. (2002). Full syndromal versus subthreshold anorexia nervosa, bulimia nervosa, and binge eating disorder: A multicenter study. International Journal of Eating Disorders, 32, 309–318. doi: 10.1002/eat.10088.CrossRefGoogle ScholarPubMed
Deloitte Access Economics. (2012). Paying the price: The economic and social impact of eating disorders in Australia. New South Wales: The Butterfly Foundation. Retrieved from http://thebutterflyfoundation.org.au/wp-content/up.Google Scholar
de Zwaan, M., Herpertz, S., Zipfel, S., Svaldi, J., Friederich, H.-C., Schmidt, F., … Schade-Brittinger, C. (2017). Effect of internet-based guided self-help vs individual face-to-face treatment on full or subsyndromal binge eating disorder in overweight or obese patients: The INTERBED randomized clinical trial. JAMA Psychiatry, 74, 987–995. doi: 10.1001/jamapsychiatry.2017.2150.CrossRefGoogle ScholarPubMed
Donkin, L., Christensen, H., Naismith, S. L., Neal, B., Hickie, I. B., & Glozier, N. (2011). A systematic review of the impact of adherence on the effectiveness of e-therapies. Journal of Medical Internet Research, 13, e52. doi: 10.2196/jmir.1772.CrossRefGoogle ScholarPubMed
Fairburn, C. G. (2008). Cognitive behavior therapy and eating disorders. New York, NY: Guilford Press.Google ScholarPubMed
Fairburn, C. G., & Beglin, S. (1994). Assessment of eating disorders: Interview or self-report questionnaire? International Journal of Eating Disorders, 16, 363–370. doi: 10.1002/1098-108X.3.0.CO;2-#>CrossRefGoogle ScholarPubMed
Fairburn, C. G., & Rothwell, E. R. (2015). Apps and eating disorders: A systematic clinical appraisal. International Journal of Eating Disorders, 48, 1038–1046. doi: 10.1002/eat.22398.CrossRefGoogle ScholarPubMed
Fuller-Tyszkiewicz, M., Richardson, B., Klein, B., Skouteris, H., Christensen, H., Austin, D., … Arulkadacham, L. (2018). A mobile app–based intervention for depression: End-user and expert usability testing study. JMIR Mental Health, 5, e54. doi:10.2196/mental.9445.CrossRefGoogle ScholarPubMed
Google. (2019). Number of smartphone users worldwide. Retrieved from https://www.statista.com/statistics/330695/number-of-smartphone-users-worldwide/.Google Scholar
Heron, K. E., & Smyth, J. M. (2010). Ecological momentary interventions: Incorporating mobile technology into psychosocial and health behaviour treatments. British Journal of Health Psychology, 15, 1–39. doi: 10.1348/135910709X466063.CrossRefGoogle ScholarPubMed
Hildebrandt, T., Michaeledes, A., Mayhew, M., Greif, R., Sysko, R., Toro-Ramos, T., & DeBar, L. (2020). Randomized controlled trial comparing health coach-delivered smartphone-guided self-help with standard care for adults with binge eating. American Journal of Psychiatry, 177, 134–142. doi: 10.1176/appi.ajp.2019.19020184.CrossRefGoogle ScholarPubMed
Hildebrandt, T., Michaelides, A., Mackinnon, D., Greif, R., DeBar, L., & Sysko, R. (2017). Randomized controlled trial comparing smartphone assisted versus traditional guided self-help for adults with binge eating. International Journal of Eating Disorders, 50, 1313–1322. doi: 10.1002/eat.22781.CrossRefGoogle ScholarPubMed
Hotzel, K., von Brachel, R., Schmidt, U., Rieger, E., Kosfelder, J., & Hechler, T. (2014). An internet-based program to enhance motivation to change in females with symptoms of an eating disorder: A randomized controlled trial. Psychological Medicine, 44, 1947–1963. doi: 10.1017/S0033291713002481.CrossRefGoogle ScholarPubMed
Juarascio, A. S., Manasse, S. M., Goldstein, S. P., Forman, E. M., & Butryn, M. L. (2015). Review of smartphone applications for the treatment of eating disorders. European Eating Disorders Review, 23, 1–11.CrossRefGoogle ScholarPubMed
Juarascio, A. S., Parker, M. N., Lagacey, M. A., & Godfrey, K. M. (2018). Just-in-time adaptive interventions: A novel approach for enhancing skill utilization and acquisition in cognitive behavioral therapy for eating disorders. International Journal of Eating Disorders, 51, 826–830. doi: 10.1002/eat.22924.CrossRefGoogle ScholarPubMed
Kazantzis, N., Whittington, C., Zelencich, L., Kyrios, M., Norton, P. J., & Hofmann, S. G. (2016). Quantity and quality of homework compliance: A meta-analysis of relations with outcome in cognitive behavior therapy. Behavior Therapy, 47, 755–772.CrossRefGoogle ScholarPubMed
Kazdin, A. E., Fitzsimmons-Craft, E. E., & Wilfley, D. E. (2017). Addressing critical gaps in the treatment of eating disorders. International Journal of Eating Disorders, 50, 170–189. doi: 10.1002/eat.22670.CrossRefGoogle ScholarPubMed
Khadjesari, Z., Murray, E., Kalaitzaki, E., White, I. R., McCambridge, J., Thompson, S. G., … Godfrey, C. (2011). Impact and costs of incentives to reduce attrition in online trials: Two randomized controlled trials. Journal of Medical Internet Research, 13, e26. doi:10.2196/jmir.1523.CrossRefGoogle ScholarPubMed
Klump, K. L., Bulik, C. M., Kaye, W. H., Treasure, J., & Tyson, E. (2009). Academy for eating disorders position paper: Eating disorders are serious mental illnesses. International Journal of Eating Disorders, 42, 97–103.CrossRefGoogle ScholarPubMed
Kroenke, K., Spitzer, R. L., Williams, J. B., & Löwe, B. (2009). An ultra-brief screening scale for anxiety and depression: The PHQ–4. Psychosomatics, 50, 613–621. doi: 10.1016/S0033-3182(09)70864-3.Google ScholarPubMed
Linardon, J. (2018). Rates of abstinence following psychological or behavioral treatments for binge-eating disorder: Meta-analysis. International Journal of Eating Disorders, 51, 1–13. doi: 10.1002/eat.22897.CrossRefGoogle ScholarPubMed
Linardon, J. (2020). Can acceptance, mindfulness, and self-compassion be learnt by smartphone apps? A systematic and meta-analytic review of randomized controlled trials. Behavior Therapy, 51, 646–658. doi: 10.1016/j.beth.2019.10.002.CrossRefGoogle Scholar
Linardon, J., Brennan, L., & de la Piedad Garcia, X. (2016). Rapid response to eating disorder treatment: A systematic review and meta-analysis. International Journal of Eating Disorders, 49, 905–919.CrossRefGoogle ScholarPubMed
Linardon, J., Cuijpers, P., Carlbring, P., Messer, M., & Fuller-Tyszkiewicz, M. (2019). The efficacy of app-supported smartphone interventions for mental health problems: A meta-analysis of randomized controlled trials. World Psychiatry, 18, 325–336. doi: 10.1002/wps.20673.CrossRefGoogle ScholarPubMed
Linardon, J., de la Piedad Garcia, X., & Brennan, L. (2016). Predictors, moderators and mediators of treatment outcome following manualised cognitive-behavioural therapy for eating disorders: A systematic review. European Eating Disorders Review, 25, 3–12. doi: 10.1002/erv.2492.CrossRefGoogle ScholarPubMed
Linardon, J., Fairburn, C. G., Fitzsimmons-Craft, E. E., Wilfley, D. E., & Brennan, L. (2017). The empirical status of the third-wave behaviour therapies for the treatment of eating disorders: A systematic review. Clinical Psychology Review, 58, 125–140. doi: 10.1016/j.cpr.2017.10.005.CrossRefGoogle ScholarPubMed
Linardon, J., & Fuller-Tyszkiewicz, M. (2020). Attrition and adherence in smartphone-delivered interventions for mental health problems: A systematic and meta-analytic review. Journal of Consulting and Clinical Psychology, 88, 1–13. doi: 10.1037/ccp0000459.CrossRefGoogle ScholarPubMed
Linardon, J., Rosato, J., & Messer, M. (2020). Break binge eating: Reach, engagement, and user profile of an Internet-based psychoeducational and self-help platform for eating disorders. International Journal of Eating Disorders. doi: 10.1002/eat.23356.CrossRefGoogle ScholarPubMed
Linardon, J., Shatte, A., Messer, M., Firth, J., & Fuller-Tyszkiewicz, M. (in press). E-mental health interventions for the treatment and prevention of eating disorders: An updated systematic review and meta-analysis. Journal of Consulting and Clinical Psychology. doi: 10.1037/ccp0000575.Google Scholar
Linardon, J., Shatte, A., Tepper, H., & Fuller-Tyszkiewicz, M. (2020). A survey study of attitudes toward, and preferences for, e-therapy interventions for eating disorder psychopathology. International Journal of Eating Disorders, 53, 907–916. doi: 10.1002/eat.23268.CrossRefGoogle ScholarPubMed
Linardon, J., Wade, T., De la Piedad Garcia, X., & Brennan, L. (2017). The efficacy of cognitive-behavioral therapy for eating disorders: A systematic review and meta-analysis. Journal of Consulting and Clinical Psychology, 85, 1080–1094. doi: 10.1037/ccp0000245.CrossRefGoogle ScholarPubMed
Loucas, C. E., Fairburn, C. G., Whittington, C., Pennant, M. E., Stockton, S., & Kendall, T. (2014). E-therapy in the treatment and prevention of eating disorders: A systematic review and meta-analysis. Behaviour Research and Therapy, 63, 122–131. doi: 10.1016/j.brat.2014.09.011.CrossRefGoogle ScholarPubMed
Mak, W. W., Tong, A. C., Yip, S. Y., Lui, W. W., Chio, F. H., Chan, A. T., & Wong, C. C. (2018). Efficacy and moderation of mobile app-based programs for mindfulness-based training, self-compassion training, and cognitive behavioral psychoeducation on mental health: Randomized controlled noninferiority trial. JMIR Mental Health, 5, e60. doi: 10.2196/mental.8597.CrossRefGoogle ScholarPubMed
Melioli, T., Bauer, S., Franko, D. L., Moessner, M., Ozer, F., Chabrol, H., & Rodgers, R. F. (2015). Reducing eating disorder symptoms and risk factors using the internet: A meta-analytic review. International Journal of Eating Disorders, 49, 19–31. doi: 10.1002/eat.22477.CrossRefGoogle ScholarPubMed
Mond, J., Hay, P. J., Rodgers, B., & Owen, C. (2006). Eating disorder examination questionnaire (EDE-Q): Norms for young adult women. Behaviour Research and Therapy, 44, 53–62. doi: 10.1016/j.brat.2004.12.003.CrossRefGoogle ScholarPubMed
Pennesi, J., & Wade, T. D. (2016). A systematic review of the existing models of disordered eating: Do they inform the development of effective interventions? Clinical psychology review, 43, 175–192. doi: 10.1016/j.cpr.2015.12.004.CrossRefGoogle ScholarPubMed
Phillipou, A., Meyer, D., Neill, E., Tan, E. J., Toh, W. L., Van Rheenen, T. E., … Rossell, S. L. (2020). Eating and exercise behaviors in eating disorders and the general population during the COVID-19 pandemic in Australia: Initial results from the COLLATE project. International Journal of Eating Disorders, 53, 1158–1165.CrossRefGoogle ScholarPubMed
Saekow, J., Jones, M., Gibbs, E., Jacobi, C., Fitzsimmons-Craft, E. E., Wilfley, D., & Barr Taylor, C. (2015). StudentBodies-eating disorders: A randomized controlled trial of a coached online intervention for subclinical eating disorders. Internet Interventions, 2, 419–428. doi: 10.1016/j.invent.2015.10.004.CrossRefGoogle Scholar
Sánchez-Ortiz, V. C., Munro, C., Stahl, D., House, J., Startup, H., Treasure, J., … Schmidt, U. (2011). A randomized controlled trial of internet-based cognitive-behavioural therapy for bulimia nervosa or related disorders in a student population. Psychological Medicine, 41, 407–417. doi: 10.1017/S0033291710000711.CrossRefGoogle ScholarPubMed
Shatte, A. B., Hutchinson, D. M., & Teague, S. J. (2019). Machine learning in mental health: A scoping review of methods and applications. Psychological Medicine, 49, 1426–1448. doi: 10.1017/S003329171900015.CrossRefGoogle ScholarPubMed
Shatte, A. B., & Teague, S. J. (2020). Schema: An open-source, distributed mobile platform for deploying mHealth research tools and interventions. BMC Medical Research Methodology, 20, 1–12. doi: 10.1186/s12874-020-00973-5.CrossRefGoogle ScholarPubMed
Strandskov, S. W., Ghaderi, A., Andersson, H., Parmskog, N., Hjort, E., Wärn, A. S., … Andersson, G. (2017). Effects of tailored and ACT-influenced internet-based CBT for eating disorders and the relation between knowledge acquisition and outcome: A randomized controlled trial. Behavior Therapy, 48, 624–637. doi: 10.1016/j.beth.2017.02.002.CrossRefGoogle ScholarPubMed
Torous, J., Nicholas, J., Larsen, M. E., Firth, J., & Christensen, H. (2018). Clinical review of user engagement with mental health smartphone apps: Evidence, theory and improvements. Evidence-Based Mental Health, 21, 116–119. doi: 10.1136/eb-2018-102891.CrossRefGoogle ScholarPubMed
Tregarthen, J., Kim, J. P., Sadeh-Sharvit, S., Neri, E., Welch, H., & Lock, J. (2019). Comparing a tailored self-help mobile app with a standard self-monitoring app for the treatment of eating disorder symptoms: Randomized controlled trial. JMIR Mental Health, 6, e14972. doi: 10.2196/14972.CrossRefGoogle ScholarPubMed
Wagner, B., Nagl, M., Dölemeyer, R., Klinitzke, G., Steinig, J., Hilbert, A., & Kersting, A. (2016). Randomized controlled trial of an internet-based cognitive-behavioral treatment program for binge-eating disorder. Behavior Therapy, 47, 500–514. doi: 10.1016/j.beth.2016.01.006.CrossRefGoogle ScholarPubMed
Weissman, R. S., & Rosselli, F. (2017). Reducing the burden of suffering from eating disorders: Unmet treatment needs, cost of illness, and the quest for cost-effectiveness. Behaviour Research and Therapy, 88, 49–64. doi: 10.1016/j.brat.2016.09.006.CrossRefGoogle Scholar
Supplementary material: File

Linardon et al. supplementary material

Linardon et al. supplementary material

Download Linardon et al. supplementary material(File)
File 26.8 KB