Linardon Jake, Anderson Cleo, McClure Zoe, Liu Claudia, Messer Mariel, Jarman Hannah K, Fuller-Tyszkiewicz Matthew
SEED Lifespan Strategic Research Centre, School of Psychology, Faculty of Health, Deakin University, Geelong, Australia.
Psychol Med. 2024 Dec 9;54(16):1-12. doi: 10.1017/S0033291724002800.
Dialectical behavior therapy (DBT) is a specialized treatment that has a growing evidence base for binge-spectrum eating disorders. However, cost and workforce capacity limit wide-scale uptake of DBT since it involves over 20 in-person sessions with a trained professional (and six sessions for guided self-help format). Interventions translated for delivery through modern technology offer a solution to increase the accessibility of evidence-based treatments. We developed the first DBT-specific skills training smartphone application (: ) for binge-spectrum eating disorders and evaluated its efficacy in a randomized clinical trial.
Participants reporting recurrent binge eating were randomized to ( = 287) or a waitlist ( = 289). Primary outcomes were objective binge eating episodes and global levels of eating disorder psychopathology. Secondary outcomes were behavioral and cognitive symptoms, psychological distress, and the hypothesized processes of change (mindfulness, emotion regulation, and distress tolerance).
Intention-to-treat analyses showed that the intervention group reported greater reductions in objective binge eating episodes (incidence rate ratio = 0.69) and eating disorder psychopathology ( = -0.68) than the waitlist at 6 weeks. Significant group differences favoring the intervention group were also observed on secondary outcomes, except for subjective binge eating, psychological distress, and distress tolerance. Primary symptoms showed further improvements from 6 to 12 weeks. However, dropout rate was high (48%) among the intervention group, and engagement decreased over the study period.
A novel, low-intensity DBT skills training app can effectively reduce symptoms of eating disorders. Scalable apps like these may increase the accessibility of evidence-based treatments.
辩证行为疗法（DBT）是一种专门的治疗方法，对于暴饮暴食谱系障碍的证据基础日益增多。然而，成本和劳动力能力限制了DBT的广泛采用，因为它需要与训练有素的专业人员进行超过20次面对面治疗（引导式自助形式为6次）。通过现代技术进行的干预措施提供了一种提高循证治疗可及性的解决方案。我们开发了首个针对暴饮暴食谱系障碍的特定DBT技能训练智能手机应用程序（: ），并在一项随机临床试验中评估了其疗效。
报告反复暴饮暴食的参与者被随机分为干预组（ = 287）或等待名单组（ = 289）。主要结局是客观暴饮暴食发作次数和饮食障碍精神病理学的总体水平。次要结局是行为和认知症状、心理困扰以及假设的改变过程（正念、情绪调节和痛苦耐受）。
意向性分析表明，在6周时，干预组报告的客观暴饮暴食发作次数（发病率比 = 0.69）和饮食障碍精神病理学（ = -0.68）的减少幅度大于等待名单组。在次要结局方面，除了主观暴饮暴食、心理困扰和痛苦耐受外，也观察到了有利于干预组的显著组间差异。主要症状在6至12周之间进一步改善。然而，干预组的退出率很高（48%），并且在研究期间参与度有所下降。
一种新颖的、低强度的DBT技能训练应用程序可以有效减轻饮食障碍症状。像这样可扩展的应用程序可能会提高循证治疗的可及性。
