Wiberg Anne-Charlotte, Ghaderi Ata, Danielsson Hanna Broberg, Safarzadeh Kousha, Parling Thomas, Carlbring Per, Jansson Magdalena, Welch Elisabeth
Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden.
Department of Clinical Neuroscience, Karolinska Institutet, Nobels väg 9, 17177 Stockholm, Sweden.
Internet Interv. 2022 Aug 30;30:100570. doi: 10.1016/j.invent.2022.100570. eCollection 2022 Dec.
Eating disorders (ED) are severe psychiatric conditions, characterized by decreased quality of life and high mortality. However, only a minority of patients with ED seek care and very few receive treatment. Internet-delivered cognitive behavioral therapy (ICBT) has the potential to increase access to evidence-based treatments.
The aims of the present study were to (1) develop and evaluate the usability of an Internet-delivered guided self-help treatment based on Enhanced Cognitive Behavioral Therapy (ICBT-E) for patients with full or subthreshold bulimia nervosa (BN) or binge eating disorder (BED) with a user centered design process, and (2) to evaluate its feasibility and preliminary outcome in a clinical environment.
The study was undertaken in two stages. In Stage I, a user-centered design approach was applied with iterative phases of prototype development and evaluation. Participants were eight clinicians and 30 individuals with current or previous history of ED. In Stage II, 41 patients with full or subthreshold BN or BED were recruited to a single-group open trial to evaluate the feasibility and preliminary outcome of ICBT-E. Primary outcome variables were diagnostic status and self-rated ED symptoms.
The user-centered design process was instrumental in the development of the ICBT-E, by contributing to improvements of the program and to the content being adapted to the needs and preferences of end-users. The overall usability of the program was found to be good. ICBT-E targets key maintaining factors in ED by introducing healthy eating patterns and addressing over-evaluation of weight and shape. The results indicate that ICBT-E, delivered in a clinical setting, is a feasible and promising treatment for full or subthreshold BN or BED, with a high level of acceptability observed and treatment completion of 73.2 %. Participation in ICBT-E was associated with significant symptom reductions in core ED symptomology, functional impairment as well as depressive symptoms, and the results were maintained at the 3-month follow-up.
ICBT-E was developed with end-users' preferences in mind, in accordance with the identified recommendations, and the program was perceived as usable by end-users. The study demonstrated the potential of ICBT-E, which marks a step forward in the effort to make powerful, empirically supported psychological interventions targeting ED more widely available and accessible.
饮食失调是严重的精神疾病，其特征是生活质量下降和高死亡率。然而，只有少数饮食失调患者寻求治疗，接受治疗的人更是寥寥无几。基于互联网的认知行为疗法（ICBT）有可能增加获得循证治疗的机会。
本研究的目的是：（1）通过以用户为中心的设计过程，开发并评估一种基于强化认知行为疗法（ICBT-E）的互联网引导自助治疗方案，用于治疗完全型或亚阈值型神经性贪食症（BN）或暴饮暴食症（BED）患者；（2）在临床环境中评估其可行性和初步疗效。
本研究分两个阶段进行。在第一阶段，采用以用户为中心的设计方法，进行原型开发和评估的迭代阶段。参与者包括8名临床医生和30名有当前或既往饮食失调史的个体。在第二阶段，招募了41名完全型或亚阈值型BN或BED患者参加单组开放试验，以评估ICBT-E的可行性和初步疗效。主要结局变量为诊断状态和自我报告的饮食失调症状。
以用户为中心的设计过程有助于ICBT-E的开发，推动了程序的改进，并使内容适应了最终用户的需求和偏好。该程序的总体可用性良好。ICBT-E通过引入健康的饮食模式并解决对体重和体型的过度评估，针对饮食失调的关键维持因素。结果表明，在临床环境中提供的ICBT-E是一种可行且有前景的治疗完全型或亚阈值型BN或BED的方法，观察到其接受度很高，治疗完成率为73.2%。参与ICBT-E与饮食失调核心症状、功能损害以及抑郁症状的显著减轻相关，并且这些结果在3个月随访时得以维持。
ICBT-E的开发考虑了最终用户的偏好，符合已确定的建议，并且该程序被最终用户认为是可用的。该研究证明了ICBT-E的潜力，这标志着在使针对饮食失调的强大、有实证支持的心理干预更广泛可得和可及的努力中向前迈出了一步。
