Evaluation of a Web-Based Skills Intervention for Carers of People With Anorexia Nervosa: A Randomized Controlled Trial.

Evaluation of a web-based skills intervention for carers of people with anorexia nervosa: A randomized controlled trial.

Int J Eat Disord. 2013 May 25;
Hoyle D, Slater J, Williams C, Schmidt U, Wade TD

OBJECTIVE: To investigate the feasibility and usefulness of an online information and skills development intervention for carers of individuals with anorexia nervosa (AN) and individuals with AN. METHOD: Thirty-seven carers and seventeen individuals with AN were recruited; carers completed the intervention Overcoming Anorexia Online (OAO), with random allocation to receiving additional clinician guidance (OAO-G) or no guidance (OAO-NoG). Level of expressed emotion, distress, depressive symptoms, experience of caregiving, and impact of eating disorder symptoms were assessed in carers and perceptions of changes in their carers’ expressed emotion were assessed in individuals with AN. Participants completed questionnaires at pre-intervention, post-intervention and 3-month follow-up. RESULTS: Significant reductions were found for carer intrusiveness, negative experiences of caregiving, and the impact of starvation and guilt. Within group effect sizes suggested mixed findings with respect to whether greater benefits were conferred for carers receiving clinician guidance. Decreases in perceived intrusiveness of the carer by the individual with AN were associated with a large effect size. DISCUSSION: Results demonstrate the feasibility and usefulness of an online intervention for carers. Further examination of the efficacy of the intervention for both carers and individuals with AN is warranted. © 2013 Wiley Periodicals, Inc. (Int J Eat Disord 2013). HubMed – eating


Measured physical activity in anorexia nervosa: Features and treatment outcome.

Int J Eat Disord. 2013 May 25;
El Ghoch M, Calugi S, Pellegrini M, Milanese C, Busacchi M, Carlo Battistini N, Bernabè J, Dalle Grave R

OBJECTIVE: To assess the role of measured physical activity (PA) in anorexia nervosa treatment outcome, and to compare the PA of patients with anorexia nervosa with age-matched controls. METHOD: PA was assessed by means of Sense Wear Armband before and after a cognitive-behavioral inpatient treatment in 53 consecutive females with anorexia nervosa, and in 53 healthy age-matched controls. RESULTS: At baseline, patients with anorexia nervosa exhibited a higher duration of moderate-vigorous PA (MVPA?3 Metabolic Equivalent Tasks (METs)) than controls (t?=?2.91; p?=?.004). Dropouts had higher duration (sec) and expenditure (kcal·day(-1) ) of MVPA than completers. At the end of treatment, completers had a higher number of daily steps, MVPA duration, and expenditure than controls. However, PA was not correlated to eating disorder psychopathology either before or after treatment. CONCLUSIONS: PA is higher in patients with anorexia nervosa than age-matched controls both before and after treatment, and is associated with treatment dropout. © 2013 Wiley Periodicals, Inc. (Int J Eat Disord 2013). HubMed – eating


‘Small Changes’ to Diet and Physical Activity Behaviors for Weight Management.

Obes Facts. 2013; 6(3): 228-238
Hills AP, Byrne NM, Lindstrom R, Hill JO

Obesity is associated with numerous short- and long-term health consequences. Low levels of physical activity and poor dietary habits are consistent with an increased risk of obesity in an obesogenic environment. Relatively little research has investigated associations between eating and activity behaviors by using a systems biology approach and by considering the dynamics of the energy balance concept. A significant body of research indicates that a small positive energy balance over time is sufficient to cause weight gain in many individuals. In contrast, small changes in nutrition and physical activity behaviors can prevent weight gain. In the context of weight management, it may be more feasible for most people to make small compared to large short-term changes in diet and activity. This paper presents a case for the use of small and incremental changes in diet and physical activity for improved weight management in the context of a toxic obesogenic environment. Copyright © 2013 S. Karger GmbH, Freiburg. HubMed – eating


Technology-Based Interventions for Mental Health in Tertiary Students: Systematic Review.

J Med Internet Res. 2013; 15(5): e101
Farrer L, Gulliver A, Chan JK, Batterham PJ, Reynolds J, Calear A, Tait R, Bennett K, Griffiths KM

BACKGROUND: Mental disorders are responsible for a high level of disability burden in students attending university. However, many universities have limited resources available to support student mental health. Technology-based interventions may be highly relevant to university populations. Previous reviews have targeted substance use and eating disorders in tertiary students. However, the effectiveness of technology-based interventions for other mental disorders and related issues has not been reviewed. OBJECTIVE: To systematically review published randomized trials of technology-based interventions evaluated in a university setting for disorders other than substance use and eating disorders. METHODS: The PubMed, PsycInfo, and Cochrane Central Register of Controlled Trials databases were searched using keywords, phrases, and MeSH terms. Retrieved abstracts (n=1618) were double screened and coded. Included studies met the following criteria: (1) the study was a randomized trial or a randomized controlled trial, (2) the sample was composed of students attending a tertiary institution, (3) the intervention was delivered by or accessed using a technological device or process, (4) the age range of the sample was between 18 and 25 years, and (5) the intervention was designed to improve, reduce, or change symptoms relating to a mental disorder. RESULTS: A total of 27 studies met inclusion criteria for the present review. Most of the studies (24/27, 89%) employed interventions targeting anxiety symptoms or disorders or stress, although almost one-third (7/24, 29%) targeted both depression and anxiety. There were a total of 51 technology-based interventions employed across the 27 studies. Overall, approximately half (24/51, 47%) were associated with at least 1 significant positive outcome compared with the control at postintervention. However, 29% (15/51) failed to find a significant effect. Effect sizes were calculated for the 18 of 51 interventions that provided sufficient data. Median effect size was 0.54 (range -0.07 to 3.04) for 8 interventions targeting depression and anxiety symptoms and 0.84 (range -0.07 to 2.66) for 10 interventions targeting anxiety symptoms and disorders. Internet-based technology (typically involving cognitive behavioral therapy) was the most commonly employed medium, being employed in 16 of 27 studies and approximately half of the 51 technology-based interventions (25/51, 49%). Distal and universal preventive interventions were the most common type of intervention. Some methodological problems were evident in the studies, with randomization methods either inadequate or inadequately described, few studies specifying a primary outcome, and most of the studies failing to undertake or report appropriate intent-to-treat analyses. CONCLUSIONS: The findings of this review indicate that although technological interventions targeting certain mental health and related problems offer promise for students in university settings, more high quality trials that fully report randomization methods, outcome data, and data analysis methods are needed. HubMed – eating



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