TY - JOUR AU - Brown, Theresa AU - Nauman Vogel, Emily AU - Adler, Sarah AU - Bohon, Cara AU - Bullock, Kim AU - Nameth, Katherine AU - Riva, Giuseppe AU - Safer, Debra L AU - Runfola, Cristin D PY - 2020 DA - 2020/4/23 TI - Bringing Virtual Reality From Clinical Trials to Clinical Practice for the Treatment of Eating Disorders: An Example Using Virtual Reality Cue Exposure Therapy JO - J Med Internet Res SP - e16386 VL - 22 IS - 4 KW - virtual reality KW - exposure therapy KW - eating disorders KW - translational research KW - technological innovation UR - http://www.jmir.org/2020/4/e16386/ UR - https://doi.org/10.2196/16386 UR - http://www.ncbi.nlm.nih.gov/pubmed/32324145 DO - 10.2196/16386 ID - info:doi/10.2196/16386 ER - TY - JOUR AU - Funk, Burkhardt AU - Sadeh-Sharvit, Shiri AU - Fitzsimmons-Craft, Ellen E AU - Trockel, Mickey Todd AU - Monterubio, Grace E AU - Goel, Neha J AU - Balantekin, Katherine N AU - Eichen, Dawn M AU - Flatt, Rachael E AU - Firebaugh, Marie-Laure AU - Jacobi, Corinna AU - Graham, Andrea K AU - Hoogendoorn, Mark AU - Wilfley, Denise E AU - Taylor, C Barr PY - 2020 DA - 2020/2/19 TI - A Framework for Applying Natural Language Processing in Digital Health Interventions JO - J Med Internet Res SP - e13855 VL - 22 IS - 2 KW - Digital Health Interventions Text Analytics (DHITA) KW - digital health interventions KW - eating disorders KW - guided self-help KW - natural language processing KW - text mining AB - Background: Digital health interventions (DHIs) are poised to reduce target symptoms in a scalable, affordable, and empirically supported way. DHIs that involve coaching or clinical support often collect text data from 2 sources: (1) open correspondence between users and the trained practitioners supporting them through a messaging system and (2) text data recorded during the intervention by users, such as diary entries. Natural language processing (NLP) offers methods for analyzing text, augmenting the understanding of intervention effects, and informing therapeutic decision making. Objective: This study aimed to present a technical framework that supports the automated analysis of both types of text data often present in DHIs. This framework generates text features and helps to build statistical models to predict target variables, including user engagement, symptom change, and therapeutic outcomes. Methods: We first discussed various NLP techniques and demonstrated how they are implemented in the presented framework. We then applied the framework in a case study of the Healthy Body Image Program, a Web-based intervention trial for eating disorders (EDs). A total of 372 participants who screened positive for an ED received a DHI aimed at reducing ED psychopathology (including binge eating and purging behaviors) and improving body image. These users generated 37,228 intervention text snippets and exchanged 4285 user-coach messages, which were analyzed using the proposed model. Results: We applied the framework to predict binge eating behavior, resulting in an area under the curve between 0.57 (when applied to new users) and 0.72 (when applied to new symptom reports of known users). In addition, initial evidence indicated that specific text features predicted the therapeutic outcome of reducing ED symptoms. Conclusions: The case study demonstrates the usefulness of a structured approach to text data analytics. NLP techniques improve the prediction of symptom changes in DHIs. We present a technical framework that can be easily applied in other clinical trials and clinical presentations and encourage other groups to apply the framework in similar contexts. UR - https://www.jmir.org/2020/2/e13855 UR - https://doi.org/10.2196/13855 UR - http://www.ncbi.nlm.nih.gov/pubmed/32130118 DO - 10.2196/13855 ID - info:doi/10.2196/13855 ER - TY - JOUR AU - Aupperle, Robin Leora AU - Paulus, Martin P AU - Kuplicki, Rayus AU - Touthang, James AU - Victor, Teresa AU - Yeh, Hung-Wen AU - Khalsa, Sahib S PY - 2020 DA - 2020/1/28 TI - Web-Based Graphic Representation of the Life Course of Mental Health: Cross-Sectional Study Across the Spectrum of Mood, Anxiety, Eating, and Substance Use Disorders JO - JMIR Ment Health SP - e16919 VL - 7 IS - 1 KW - mental health KW - life history KW - psychosocial factors KW - depression KW - anxiety KW - substance use disorders KW - eating disorders AB - Background: Although patient history is essential for informing mental health assessment, diagnosis, and prognosis, there is a dearth of standardized instruments measuring time-dependent factors relevant to psychiatric disorders. Previous research has demonstrated the potential utility of graphical representations, termed life charts, for depicting the complexity of the course of mental illness. However, the implementation of these assessments is limited by the exclusive focus on specific mental illnesses (ie, bipolar disorder) and the lack of intuitive graphical interfaces for data collection and visualization. Objective: This study aimed to develop and test the utility of the Tulsa Life Chart (TLC) as a Web-based, structured approach for obtaining and graphically representing historical information on psychosocial and mental health events relevant across a spectrum of psychiatric disorders. Methods: The TLC interview was completed at baseline by 499 participants of the Tulsa 1000, a longitudinal study of individuals with depressive, anxiety, substance use, or eating disorders and healthy comparisons (HCs). All data were entered electronically, and a 1-page electronic and interactive graphical representation was developed using the Google Visualization Application Programming Interface. For 8 distinct life epochs (periods of approximately 5-10 years), the TLC assessed the following factors: school attendance, hobbies, jobs, social support, substance use, mental health treatment, family structure changes, negative and positive events, and epoch and event-related mood ratings. We used generalized linear mixed models (GLMMs) to evaluate trajectories of each domain over time and by sex, age, and diagnosis, using case examples and Web-based interactive graphs to visualize data. Results: GLMM analyses revealed main or interaction effects of epoch and diagnosis for all domains. Epoch by diagnosis interactions were identified for mood ratings and the number of negative-versus-positive events (all P values <.001), with all psychiatric groups reporting worse mood and greater negative-versus-positive events than HCs. These differences were most robust at different epochs, depending on diagnosis. There were also diagnosis and epoch main effects for substance use, mental health treatment received, social support, and hobbies (P<.001). User experience ratings (each on a 1-5 scale) revealed that participants found the TLC pleasant to complete (mean 3.07, SD 1.26) and useful for understanding their mental health (mean 3.07, SD 1.26), and that they were likely to recommend it to others (mean 3.42, SD 0.85). Conclusions: The TLC provides a structured, Web-based transdiagnostic assessment of psychosocial history relevant for the diagnosis and treatment of psychiatric disorders. Interactive, 1-page graphical representations of the TLC allow for the efficient communication of historical life information that would be useful for clinicians, patients, and family members. UR - http://mental.jmir.org/2020/1/e16919/ UR - https://doi.org/10.2196/16919 UR - http://www.ncbi.nlm.nih.gov/pubmed/32012081 DO - 10.2196/16919 ID - info:doi/10.2196/16919 ER - TY - JOUR AU - Goodday, Sarah M AU - Atkinson, Lauren AU - Goodwin, Guy AU - Saunders, Kate AU - South, Matthew AU - Mackay, Clare AU - Denis, Mike AU - Hinds, Chris AU - Attenburrow, Mary-Jane AU - Davies, Jim AU - Welch, James AU - Stevens, William AU - Mansfield, Karen AU - Suvilehto, Juulia AU - Geddes, John PY - 2020 DA - 2020/1/15 TI - The True Colours Remote Symptom Monitoring System: A Decade of Evolution JO - J Med Internet Res SP - e15188 VL - 22 IS - 1 KW - symptom assessment KW - signs and symptoms KW - digital health KW - ecological momentary assessment KW - mood disorders UR - https://www.jmir.org/2020/1/e15188 UR - https://doi.org/10.2196/15188 UR - http://www.ncbi.nlm.nih.gov/pubmed/31939746 DO - 10.2196/15188 ID - info:doi/10.2196/15188 ER - TY - JOUR AU - Wahl, Deborah Ronja AU - Villinger, Karoline AU - Blumenschein, Michael AU - König, Laura Maria AU - Ziesemer, Katrin AU - Sproesser, Gudrun AU - Schupp, Harald Thomas AU - Renner, Britta PY - 2020 DA - 2020/1/7 TI - Why We Eat What We Eat: Assessing Dispositional and In-the-Moment Eating Motives by Using Ecological Momentary Assessment JO - JMIR Mhealth Uhealth SP - e13191 VL - 8 IS - 1 KW - mHealth KW - eating KW - motivation KW - mobile app KW - EMA KW - in-the-moment KW - disposition KW - trait KW - state AB - Background: Why do we eat? Our motives for eating are diverse, ranging from hunger and liking to social norms and affect regulation. Although eating motives can vary from eating event to eating event, which implies substantial moment-to-moment differences, current ways of measuring eating motives rely on single timepoint questionnaires that assess eating motives as situation-stable dispositions (traits). However, mobile technologies including smartphones allow eating events and motives to be captured in real time and real life, thus capturing experienced eating motives in-the-moment (states). Objective: This study aimed to examine differences between why people think they eat (trait motives) and why they eat in the moment of consumption (state motives) by comparing a dispositional (trait) and an in-the-moment (state) assessment of eating motives. Methods: A total of 15 basic eating motives included in The Eating Motivation Survey (ie, liking, habit, need and hunger, health, convenience, pleasure, traditional eating, natural concerns, sociability, price, visual appeal, weight control, affect regulation, social norms, and social image) were assessed in 35 participants using 2 methodological approaches: (1) a single timepoint dispositional assessment and (2) a smartphone-based ecological momentary assessment (EMA) across 8 days (N=888 meals) capturing eating motives in the moment of eating. Similarities between dispositional and in-the-moment eating motive profiles were assessed according to 4 different indices of profile similarity, that is, overall fit, shape, scatter, and elevation. Moreover, a visualized person × motive data matrix was created to visualize and analyze between- and within-person differences in trait and state eating motives. Results: Similarity analyses yielded a good overall fit between the trait and state eating motive profiles across participants, indicated by a double-entry intraclass correlation of 0.52 (P<.001). However, although trait and state motives revealed a comparable rank order (r=0.65; P<.001), trait motives overestimated 12 of 15 state motives (P<.001; d=1.97). Specifically, the participants assumed that 6 motives (need and hunger, price, habit, sociability, traditional eating, and natural concerns) are more essential for eating than they actually were in the moment (d>0.8). Furthermore, the visualized person × motive data matrix revealed substantial interindividual differences in intraindividual motive profiles. Conclusions: For a comprehensive understanding of why we eat what we eat, dispositional assessments need to be extended by in-the-moment assessments of eating motives. Smartphone-based EMAs reveal considerable intra- and interindividual differences in eating motives, which are not captured by single timepoint dispositional assessments. Targeting these differences between why people think they eat what they eat and why they actually eat in the moment may hold great promise for tailored mobile health interventions facilitating behavior changes. UR - https://mhealth.jmir.org/2020/1/e13191 UR - https://doi.org/10.2196/13191 UR - http://www.ncbi.nlm.nih.gov/pubmed/31909719 DO - 10.2196/13191 ID - info:doi/10.2196/13191 ER - TY - JOUR AU - Tregarthen, Jenna AU - Paik Kim, Jane AU - Sadeh-Sharvit, Shiri AU - Neri, Eric AU - Welch, Hannah AU - Lock, James PY - 2019 DA - 2019/11/21 TI - Comparing a Tailored Self-Help Mobile App With a Standard Self-Monitoring App for the Treatment of Eating Disorder Symptoms: Randomized Controlled Trial JO - JMIR Ment Health SP - e14972 VL - 6 IS - 11 KW - mobile health KW - smartphone KW - mobile apps KW - eating disorders KW - cognitive behavioral therapy KW - mental health KW - intervention study AB - Background: Eating disorders severely impact psychological, physical, and social functioning, and yet, the majority of individuals with eating disorders do not receive treatment. Mobile health apps have the potential to decrease access barriers to care and reach individuals who have been underserved by traditional treatment modalities. Objective: The objective of this study was to evaluate the effectiveness of a tailored, fully automated self-help version of Recovery Record, an app developed for eating disorders management. We examined differences in eating disorder symptom change in app users that were randomized to receive either a standard, cognitive behavioral therapy–based version of the app or a tailored version that included algorithmically determined clinical content aligned with baseline and evolving user eating disorder symptom profiles. Methods: Participants were people with eating disorder symptoms who did not have access to traditional treatment options and were recruited via the open-access Recovery Record app to participate in this randomized controlled trial. We examined both continuous and categorical clinical improvement outcomes (measured with the self-report Eating Disorder Examination Questionnaire [EDE-Q]) in both intervention groups. Results: Between December 2016 and August 2018, 3294 Recovery Record app users were recruited into the study, out of which 959 were considered engaged, completed follow-up assessments, and were included in the analyses. Both study groups achieved significant overall outcome improvement, with 61.6% (180/292) of the tailored group and 55.4% (158/285) of the standard group achieving a clinically meaningful change in the EDE-Q, on average. There were no statistically significant differences between randomized groups for continuous outcomes, but a pattern of improvement being greater in the tailored group was evident. The rate of remission on the EDE-Q at 8 weeks was significantly greater in the group receiving the tailored version (d=0.22; P≤.001). Conclusions: This is the first report to compare the relative efficacy of two versions of a mobile app for eating disorders. The data suggest that underserved individuals with eating disorder symptoms may benefit clinically from a self-help app and that personalizing app content to specific clinical presentations may be more effective in promoting symptomatic remission on the EDE-Q than content that offers a generic approach. Trial Registration: ClinicalTrials.gov NCT02503098; https://clinicaltrials.gov/ct2/show/NCT02503098. UR - http://mental.jmir.org/2019/11/e14972/ UR - https://doi.org/10.2196/14972 UR - http://www.ncbi.nlm.nih.gov/pubmed/31750837 DO - 10.2196/14972 ID - info:doi/10.2196/14972 ER - TY - JOUR AU - Ralph-Nearman, Christina AU - Arevian, Armen C AU - Puhl, Maria AU - Kumar, Rajay AU - Villaroman, Diane AU - Suthana, Nanthia AU - Feusner, Jamie D AU - Khalsa, Sahib S PY - 2019 DA - 2019/10/29 TI - A Novel Mobile Tool (Somatomap) to Assess Body Image Perception Pilot Tested With Fashion Models and Nonmodels: Cross-Sectional Study JO - JMIR Ment Health SP - e14115 VL - 6 IS - 10 KW - body image KW - body perception KW - body representation KW - body image disorder KW - eating disorder KW - mobile health KW - mental health KW - mobile app KW - digital health AB - Background: Distorted perception of one’s body and appearance, in general, is a core feature of several psychiatric disorders including anorexia nervosa and body dysmorphic disorder and is operative to varying degrees in nonclinical populations. Yet, body image perception is challenging to assess, given its subjective nature and variety of manifestations. The currently available methods have several limitations including restricted ability to assess perceptions of specific body areas. To address these limitations, we created Somatomap, a mobile tool that enables individuals to visually represent their perception of body-part sizes and shapes as well as areas of body concerns and record the emotional valence of concerns. Objective: This study aimed to develop and pilot test the feasibility of a novel mobile tool for assessing 2D and 3D body image perception. Methods: We developed a mobile 2D tool consisting of a manikin figure on which participants outline areas of body concern and indicate the nature, intensity, and emotional valence of the concern. We also developed a mobile 3D tool consisting of an avatar on which participants select individual body parts and use sliders to manipulate their size and shape. The tool was pilot tested on 103 women: 65 professional fashion models, a group disproportionately exposed to their own visual appearance, and 38 nonmodels from the general population. Acceptability was assessed via a usability rating scale. To identify areas of body concern in 2D, topographical body maps were created by combining assessments across individuals. Statistical body maps of group differences in body concern were subsequently calculated using the formula for proportional z-score. To identify areas of body concern in 3D, participants’ subjective estimates from the 3D avatar were compared to corresponding measurements of their actual body parts. Discrepancy scores were calculated based on the difference between the perceived and actual body parts and evaluated using multivariate analysis of covariance. Results: Statistical body maps revealed different areas of body concern between models (more frequently about thighs and buttocks) and nonmodels (more frequently about abdomen/waist). Models were more accurate at estimating their overall body size, whereas nonmodels tended to underestimate the size of individual body parts, showing greater discrepancy scores for bust, biceps, waist, hips, and calves but not shoulders and thighs. Models and nonmodels reported high ease-of-use scores (8.4/10 and 8.5/10, respectively), and the resulting 3D avatar closely resembled their actual body (72.7% and 75.2%, respectively). Conclusions: These pilot results suggest that Somatomap is feasible to use and offers new opportunities for assessment of body image perception in mobile settings. Although further testing is needed to determine the applicability of this approach to other populations, Somatomap provides unique insight into how humans perceive and represent the visual characteristics of their body. UR - http://mental.jmir.org/2019/10/e14115/ UR - https://doi.org/10.2196/14115 UR - http://www.ncbi.nlm.nih.gov/pubmed/31469647 DO - 10.2196/14115 ID - info:doi/10.2196/14115 ER - TY - JOUR AU - Hamatani, Sayo AU - Numata, Noriko AU - Matsumoto, Kazuki AU - Sutoh, Chihiro AU - Ibuki, Hanae AU - Oshiro, Keiko AU - Tanaka, Mari AU - Setsu, Rikukage AU - Kawasaki, Yohei AU - Hirano, Yoshiyuki AU - Shimizu, Eiji PY - 2019 DA - 2019/10/23 TI - Internet-Based Cognitive Behavioral Therapy via Videoconference for Patients With Bulimia Nervosa and Binge-Eating Disorder: Pilot Prospective Single-Arm Feasibility Trial JO - JMIR Form Res SP - e15738 VL - 3 IS - 4 KW - bulimia nervosa KW - binge-eating disorder KW - cognitive behavioral therapy KW - internet-based cognitive behavioral therapy KW - videoconference AB - Background: A major problem in providing mental health services is the lack of access to treatment, especially in remote areas. Thus far, no clinical studies have demonstrated the feasibility of internet-based cognitive behavioral therapy (ICBT) with real-time therapist support via videoconference for bulimia nervosa and binge-eating disorder in Japan. Objective: The goal of the research was to evaluate the feasibility of ICBT via videoconference for patients with bulimia nervosa or binge-eating disorder. Methods: Seven Japanese subjects (mean age 31.9 [SD 7.9] years) with bulimia nervosa and binge-eating disorder received 16 weekly sessions of individualized ICBT via videoconference with real-time therapist support. Treatment included CBT tailored specifically to the presenting diagnosis. The primary outcome was a reduction in the Eating Disorder Examination Edition 16.0D (EDE 16D) for bulimia nervosa and binge-eating disorder: the combined objective binge and purging episodes, objective binge episodes, and purging episodes. The secondary outcomes were the Eating Disorders Examination Questionnaire, Bulimic Investigatory Test, Edinburgh, body mass index for eating symptoms, Motivational Ruler for motivation to change, EuroQol-5 Dimension for quality of life, 9-item Patient Health Questionnaire for depression, 7-item Generalized Anxiety Disorder scale for anxiety, and Working Alliance Inventory–Short Form (WAI-SF). All outcomes were assessed at week 1 (baseline) and weeks 8 (midintervention) and 16 (postintervention) during therapy. Patients were asked about adverse events at each session. For the primary analysis, treatment-related changes were assessed by comparing participant scores and 95% confidence intervals using the paired t test. Results: Although the mean combined objective binge and purging episodes improved from 47.60 to 13.60 (71% reduction) and showed a medium effect size (Cohen d=–0.76), there was no significant reduction in the combined episodes (EDE 16D –41; 95% CI –2.089 to 0.576; P=.17). There were no significant treatment-related changes in secondary outcomes. The WAI-SF scores remained consistently high (64.8 to 66.0) during treatment. Conclusions: ICBT via videoconference is feasible in Japanese patients with bulimia nervosa and binge-eating disorder. Trial Registration: UMIN Clinical Trials Registry UMIN000029426; https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000033419 UR - http://formative.jmir.org/2019/4/e15738/ UR - https://doi.org/10.2196/15738 UR - http://www.ncbi.nlm.nih.gov/pubmed/31647472 DO - 10.2196/15738 ID - info:doi/10.2196/15738 ER - TY - JOUR AU - Anastasiadou, Dimitra AU - Folkvord, Frans AU - Serrano-Troncoso, Eduardo AU - Lupiañez-Villanueva, Francisco PY - 2019 DA - 2019/5/31 TI - Mobile Health Adoption in Mental Health: User Experience of a Mobile Health App for Patients With an Eating Disorder JO - JMIR Mhealth Uhealth SP - e12920 VL - 7 IS - 6 KW - eating disorders KW - mental health KW - mHealth KW - mobile applications KW - focus groups AB - Background: Despite the worldwide growth in mobile health (mHealth) tools and the possible benefits for both patients and health care providers, the overall adoption levels of mHealth tools by health professionals remain relatively low. Objective: This study aimed (1) to investigate attitudes of health care providers and mHealth experts toward mHealth tools in the health context in general, and this study aimed (2) to test the acceptability and feasibility of a specific mHealth tool for patients with an eating disorder (ED), called TCApp, among patients and ED specialists. Methods: To this purpose, we conducted an explorative qualitative study with 4 in-depth group discussions with several groups of stakeholders: our first focus group was conducted with 11 experts on mHealth from the Catalan Association of Health Entities; the second focus group included 10 health care professionals from the Spanish College of Doctors of Barcelona; the third focus group involved 9 patients with an ED who had used the TCApp over a 12-week period, and the fourth and last focus group involved 8 ED specialists who had monitored such ED patients on the Web. Results: The focus groups showed that health care providers and mHealth experts reported barriers for mHealth adoption more often than facilitators, indicating that mHealth techniques are difficult to obtain and use. Most barriers were attributed to external factors relating to the human or organizational environment (ie, lack of time because of workload, lack of direct interest on a legislative or political level) rather than being attributed to internal factors relating to individual obstacles. The results of the mHealth intervention study indicate that the TCApp was considered as easy to use and useful, although patients and the ED specialists monitoring them on the Web reported different adoption problems, such as the inability to personalize the app, a lack of motivational and interactive components, or difficulties in adhering to the study protocol. Conclusions: In general, this paper indicates that both health professionals and patients foresee difficulties that need to be addressed before comprehensive adoption and usage of mHealth techniques can be effectively implemented. Such findings are in line with previous studies, suggesting that although they acknowledge their possible benefits and cost-effectiveness, health care providers are quite resistant and conservative about integrating mHealth technologies in their daily practice. UR - https://mhealth.jmir.org/2019/6/e12920/ UR - https://doi.org/10.2196/12920 UR - http://www.ncbi.nlm.nih.gov/pubmed/31199329 DO - 10.2196/12920 ID - info:doi/10.2196/12920 ER - TY - JOUR AU - Wang, Tao AU - Mentzakis, Emmanouil AU - Brede, Markus AU - Ianni, Antonella PY - 2019 DA - 2019/05/03 TI - Estimating Determinants of Attrition in Eating Disorder Communities on Twitter: An Instrumental Variables Approach JO - J Med Internet Res SP - e10942 VL - 21 IS - 5 KW - medical informatics KW - eating disorders KW - social media KW - attrition KW - emotions KW - social network KW - causality KW - instrumental variables AB - Background: The use of social media as a key health information source has increased steadily among people affected by eating disorders (EDs). Research has examined characteristics of individuals engaging in online communities, whereas little is known about discontinuation of engagement and the phenomenon of participants dropping out of these communities. Objective: This study aimed to investigate the characteristics of dropout behaviors among eating disordered individuals on Twitter and to estimate the causal effects of personal emotions and social networks on dropout behaviors. Methods: Using a snowball sampling method, we collected a set of individuals who self-identified with EDs in their Twitter profile descriptions, as well as their tweets and social networks, leading to 241,243,043 tweets from 208,063 users. Individuals’ emotions are measured from their language use in tweets using an automatic sentiment analysis tool, and network centralities are measured from users’ following networks. Dropout statuses of users are observed in a follow-up period 1.5 years later (from February 11, 2016 to August 17, 2017). Linear and survival regression instrumental variables models are used to estimate the effects of emotions and network centrality on dropout behaviors. The average levels of attributes among an individual’s followees (ie, people who are followed by the individual) are used as instruments for the individual’s attributes. Results: Eating disordered users have relatively short periods of activity on Twitter with one half of our sample dropping out at 6 months after account creation. Active users show more negative emotions and higher network centralities than dropped-out users. Active users tend to connect to other active users, whereas dropped-out users tend to cluster together. Estimation results suggest that users’ emotions and network centralities have causal effects on their dropout behaviors on Twitter. More specifically, users with positive emotions are more likely to drop out and have shorter lasting periods of activity online than users with negative emotions, whereas central users in a social network have longer lasting participation than peripheral users. Findings on users’ tweeting interests further show that users who attempt to recover from EDs are more likely to drop out than those who promote EDs as a lifestyle choice. Conclusions: Presence in online communities is strongly determined by the individual’s emotions and social networks, suggesting that studies analyzing and trying to draw condition and population characteristics through online health communities are likely to be biased. Future research needs to examine in more detail the links between individual characteristics and participation patterns if better understanding of the entire population is to be achieved. At the same time, such attrition dynamics need to be acknowledged and controlled when designing online interventions so as to accurately capture their intended populations. UR - https://www.jmir.org/2019/5/e10942/ UR - https://doi.org/10.2196/10942 UR - http://www.ncbi.nlm.nih.gov/pubmed/31066718 DO - 10.2196/10942 ID - info:doi/10.2196/10942 ER - TY - JOUR AU - McCaig, Duncan AU - Elliott, Mark T AU - Siew, Cynthia SQ AU - Walasek, Lukasz AU - Meyer, Caroline PY - 2019 DA - 2019/04/22 TI - Profiling Commenters on Mental Health–Related Online Forums: A Methodological Example Focusing on Eating Disorder–Related Commenters JO - JMIR Ment Health SP - e12555 VL - 6 IS - 4 KW - mental health KW - eating disorders KW - social media KW - social networks AB - Background: Understanding the characteristics of commenters on mental health–related online forums is vital for the development of effective psychological interventions in these communities. The way in which commenters interact can enhance our understanding of their characteristics. Objective: Using eating disorder–related (EDR) forums as an example, this study detailed a methodology that aimed to determine subtypes of mental health–related forums and profile their commenters based on the other forums to which they contributed. Methods: The researchers identified all public EDR forums (with ≥500 contributing commenters between March 2017 and February 2018) on a large Web-based discussion platform (Reddit). A mixed-methods approach comprising network analysis with community detection, text mining, and manual review identified subtypes of EDR forums. For each subtype, another network analysis with community detection was conducted using the EDR forum commenter overlap between 50 forums on which the commenters also commented. The topics of forums in each detected community were then manually reviewed to identify the shared interests of each subtype of EDR forum commenters. Results: Six subtypes of EDR forums were identified, to which 14,024 commenters had contributed. The results focus on 2 subtypes—proeating disorder and thinspiration—and communities of commenters within both subtypes. Within the proeating disorder subtype, 3 communities of commenters were detected that related to the body and eating, mental health, and women, appearance, and mixed topics. With regard to the thinspiration group, 78.17% (849/1086) of commenters had also commented on pornographic forums and 16.66% (181/1086) had contributed to proeating disorder forums. Conclusions: The article exemplifies a methodology that provides insight into subtypes of mental health–related forums and the characteristics of their commenters. The findings have implications for future research and Web-based psychological interventions. With the publicly available data and code provided, researchers can easily reproduce the analyses or utilize the methodology to investigate other mental health–related forums. UR - http://mental.jmir.org/2019/4/e12555/ UR - https://doi.org/10.2196/12555 UR - http://www.ncbi.nlm.nih.gov/pubmed/31008715 DO - 10.2196/12555 ID - info:doi/10.2196/12555 ER - TY - JOUR AU - Jacobi, Corinna AU - Hütter, Kristian AU - Völker, Ulrike AU - Möbius, Katharina AU - Richter, Robert AU - Trockel, Mickey AU - Jones Bell, Megan AU - Lock, James AU - Taylor, C Barr PY - 2018 DA - 2018/12/14 TI - Efficacy of a Parent-Based, Indicated Prevention for Anorexia Nervosa: Randomized Controlled Trial JO - J Med Internet Res SP - e296 VL - 20 IS - 12 KW - anorexia nervosa KW - indicated prevention KW - internet KW - parental intervention KW - randomized controlled trial AB - Background: Web-based preventive interventions can reduce risk and incidence of bulimia and binge eating disorders among young high-risk women. However, their specific effects on core symptoms of anorexia nervosa (AN) are rather weak. Objective: The primary objective of this study was to evaluate the efficacy of an indicated, parent-based, Web-based preventive program Eltern als Therapeuten (E@T) in reducing risk factors and symptoms of AN. Methods: Girls aged between 11 and 17 years were screened by selected risk factors and early symptoms of AN. At-risk families were then randomized to E@T or an assessment-only control condition. Assessments took place at pre- and postintervention (6 weeks later) and at 6- and 12-month follow-up (FU). Results: A total of 12,377 screening questionnaires were handed out in 86 German schools, and 3941 including consent returned. Overall, 477 (447/3941, 12.10%) girls were identified as at risk for AN and 256 of those could be contacted. In all, 66 families (66/256, 25.8% of those contacted) were randomized to the E@T or a wait-list control condition, 43 (43/66, 65%) participated in postassessments, and 27 (27/66, 41%) in 12-month FUs. Due to low participation and high dropout rates of parents, recruitment was terminated prematurely. At 12-month FU, girls’ expected body weight (EBW) percentage was significantly greater for intervention participants compared with control participants (group by time interaction beta=21.0 [CI 5.81 to 36.13], P=.007; group by time squared interaction beta=−15.5 [CI −26.6 to −4.49], P=.007; estimated Cohen d=0.42]. No other significant effects were found on risk factors and attitudes of disturbed eating. Conclusions: Despite a significant increase in girls’ EBW percentage, parental participation and adherence to the intervention were low. Overall, parent-based, indicated prevention for children at risk for AN does not seem very promising, although it might be useful for parents who engage in the intervention. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): 18614564; http://www.isrctn.com/ISRCTN18614564 (Archived by WebCite at http://www.webcitation.org/74FTV1EpF). UR - http://www.jmir.org/2018/12/e296/ UR - https://doi.org/10.2196/jmir.9464 UR - http://www.ncbi.nlm.nih.gov/pubmed/30552078 DO - 10.2196/jmir.9464 ID - info:doi/10.2196/jmir.9464 ER - TY - JOUR AU - van den Boer, Janet AU - van der Lee, Annemiek AU - Zhou, Lingchuan AU - Papapanagiotou, Vasileios AU - Diou, Christos AU - Delopoulos, Anastasios AU - Mars, Monica PY - 2018 DA - 2018/09/04 TI - The SPLENDID Eating Detection Sensor: Development and Feasibility Study JO - JMIR Mhealth Uhealth SP - e170 VL - 6 IS - 9 KW - chewing sensor KW - weight management KW - obesity prevention KW - overweight KW - PPG sensor KW - in-ear microphone KW - mobile phone AB - Background: The available methods for monitoring food intake—which for a great part rely on self-report—often provide biased and incomplete data. Currently, no good technological solutions are available. Hence, the SPLENDID eating detection sensor (an ear-worn device with an air microphone and a photoplethysmogram [PPG] sensor) was developed to enable complete and objective measurements of eating events. The technical performance of this device has been described before. To date, literature is lacking a description of how such a device is perceived and experienced by potential users. Objective: The objective of our study was to explore how potential users perceive and experience the SPLENDID eating detection sensor. Methods: Potential users evaluated the eating detection sensor at different stages of its development: (1) At the start, 12 health professionals (eg, dieticians, personal trainers) were interviewed and a focus group was held with 5 potential end users to find out their thoughts on the concept of the eating detection sensor. (2) Then, preliminary prototypes of the eating detection sensor were tested in a laboratory setting where 23 young adults reported their experiences. (3) Next, the first wearable version of the eating detection sensor was tested in a semicontrolled study where 22 young, overweight adults used the sensor on 2 separate days (from lunch till dinner) and reported their experiences. (4) The final version of the sensor was tested in a 4-week feasibility study by 20 young, overweight adults who reported their experiences. Results: Throughout all the development stages, most individuals were enthusiastic about the eating detection sensor. However, it was stressed multiple times that it was critical that the device be discreet and comfortable to wear for a longer period. In the final study, the eating detection sensor received an average grade of 3.7 for wearer comfort on a scale of 1 to 10. Moreover, experienced discomfort was the main reason for wearing the eating detection sensor <2 hours a day. The participants reported having used the eating detection sensor on 19/28 instructed days on average. Conclusions: The SPLENDID eating detection sensor, which uses an air microphone and a PPG sensor, is a promising new device that can facilitate the collection of reliable food intake data, as shown by its technical potential. Potential users are enthusiastic, but to be successful wearer comfort and discreetness of the device need to be improved. UR - http://mhealth.jmir.org/2018/9/e170/ UR - https://doi.org/10.2196/mhealth.9781 UR - http://www.ncbi.nlm.nih.gov/pubmed/30181111 DO - 10.2196/mhealth.9781 ID - info:doi/10.2196/mhealth.9781 ER - TY - JOUR AU - Clus, Damien AU - Larsen, Mark Erik AU - Lemey, Christophe AU - Berrouiguet, Sofian PY - 2018 DA - 2018/04/27 TI - The Use of Virtual Reality in Patients with Eating Disorders: Systematic Review JO - J Med Internet Res SP - e157 VL - 20 IS - 4 KW - virtual reality exposure therapy KW - feeding and eating disorders KW - binge-eating disorder KW - anorexia nervosa KW - bulimia nervosa AB - Background: Patients with eating disorders are characterized by pathological eating habits and a tendency to overestimate their weight and body shape. Virtual reality shows promise for the evaluation and management of patients with eating disorders. This technology, when accepted by this population, allows immersion in virtual environments, assessment, and therapeutic approaches, by exposing users to high-calorie foods or changes in body shape. Objective: To better understand the value of virtual reality, we conducted a review of the literature, including clinical studies proposing the use of virtual reality for the evaluation and management of patients with eating disorders. Methods: We searched PubMed, PsycINFO, ScienceDirect, the Cochrane Library, Scopus, and Web of Science up to April 2017. We created the list of keywords based on two domains: virtual reality and eating disorders. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses to identify, select, and critically appraise relevant research while minimizing bias. Results: The initial database searches identified 311 articles, 149 of which we removed as duplicates. We analyzed the resulting set of 26 unique studies that met the inclusion criteria. Of these, 8 studies were randomized controlled trials, 13 were nonrandomized studies, and 5 were clinical trials with only 1 participant. Most articles focused on clinical populations (19/26, 73%), with the remainder reporting case-control studies (7/26, 27%). Most of the studies used visual immersive equipment (16/26, 62%) with a head-mounted display (15/16, 94%). Two main areas of interest emerged from these studies: virtual work on patients’ body image (7/26, 27%) and exposure to virtual food stimuli (10/26, 38%). Conclusions: We conducted a broad analysis of studies on the use of virtual reality in patients with eating disorders. This review of the literature showed that virtual reality is an acceptable and promising therapeutic tool for patients with eating disorders. UR - http://www.jmir.org/2018/4/e157/ UR - https://doi.org/10.2196/jmir.7898 UR - http://www.ncbi.nlm.nih.gov/pubmed/29703715 DO - 10.2196/jmir.7898 ID - info:doi/10.2196/jmir.7898 ER - TY - JOUR AU - Yom-Tov, Elad AU - Brunstein-Klomek, Anat AU - Mandel, Or AU - Hadas, Arie AU - Fennig, Silvana PY - 2018 DA - 2018/02/22 TI - Inducing Behavioral Change in Seekers of Pro-Anorexia Content Using Internet Advertisements: Randomized Controlled Trial JO - JMIR Ment Health SP - e6 VL - 5 IS - 1 KW - anorexia nervosa KW - bulimia nervosa KW - eating disorders KW - online advertising KW - online behavior KW - Pro-ana AB - Background: The influence of pro-anorexia (pro-ana) websites is debated, with studies indicating both negative and positive effects, as well as significant variation in the effects of different websites for those suffering from eating disorders (EDs) and the general population. Online advertising, known to induce behavioral change both online and in the physical world, has not been used so far to modify the search behavior of people seeking pro-ana content. Objective: The objective of this randomized controlled trial (RCT) was to examine if online advertisements (ads) can change online search behaviors of users who are looking for online pro-ana content. Methods: Using the Bing Ads system, we conducted an RCT to randomly expose the searchers for pro-ana content to 10 different ads referring people to one of the three websites: the National Eating Disorders Association, the National Institutes of Mental Health, and MyProAna. MyProAna is a pro-ana website that was found in a previous study to be associated with less pathological online behaviors than other pro-ana websites. We followed participants exposed and unexposed to the ads to explore their past and future online searches. The ads were shown 25,554 times and clicked on 217 times. Results: Exposure to the ads was associated with a decrease in searches for pro-ana and self-harm content. Reductions were greatest among those referred to MyProAna (reduction of 34.0% [73/215] and 37.2% [80/215] for pro-ana and self-harm, respectively) compared with users who were referred elsewhere (reduction of 15.47% [410/2650] and 3.21% [85/2650], respectively), and with users who were not shown the ads, who increased their behaviors (increase of 57.12% [6462/11,314] and 4.07% [461/11,314], respectively). In addition, those referred to MyProAna increased their search for treatment, as did control users, who did so to a lesser extent. However, users referred elsewhere decreased their searches for this content. Conclusions: We found that referring users interested in ED-related content to specific pro-ana communities might lessen their maladaptive online search behavior. This suggests that those who are preoccupied with EDs can be redirected to less pathological online searches through appropriate pathways. Trial Registration: ClinicalTrials.gov NCT03439553; https://clinicaltrials.gov/show/NCT03439553 (Archived by WebCite at http://www.webcitation.org/6xNYnxYlw) UR - http://mental.jmir.org/2018/1/e6/ UR - https://doi.org/10.2196/mental.8212 UR - http://www.ncbi.nlm.nih.gov/pubmed/29472176 DO - 10.2196/mental.8212 ID - info:doi/10.2196/mental.8212 ER - TY - JOUR AU - Stapleton, Jerod L AU - Manne, Sharon L AU - Day, Ashley K AU - Levonyan-Radloff, Kristine AU - Pagoto, Sherry L PY - 2018 DA - 2018/02/20 TI - Healthy Body Image Intervention Delivered to Young Women via Facebook Groups: Formative Study of Engagement and Acceptability JO - JMIR Res Protoc SP - e54 VL - 7 IS - 2 KW - body image KW - dissonance-based intervention KW - indoor tanning bed KW - social media KW - Facebook KW - behavioral intervention KW - prevention AB - Background: There is increasing interest in using social media sites such as Facebook to deliver health interventions so as to expose people to content while they are engaging in their usual social media habit. This formative intervention development study is novel in describing a preliminary test of using the secret group feature of Facebook to deliver a behavioral intervention targeting users of indoor tanning beds to reduce their risk of skin cancer. Intervention content was designed to challenge body image-related constructs associated with indoor tanning through the use of dissonance-inducing content. Objective: To evaluate engagement with and acceptability of using a secret Facebook group to deliver a healthy body image intervention to young women engaged in indoor tanning. Methods: Seventeen young women completed a baseline survey and joined a secret Facebook group with intervention content delivered via daily posts for 4 weeks. Engagement data was extracted and acceptability was measured via a follow-up survey. Results: The study had a high retention rate (94%, [16/17]). On average, posts were viewed by 91% of participants, liked by 35%, and commented on by 26%. The average comment rate was highest (65%) for posts that elicited comments by directly posing questions or discussion topics to the group. Average intervention acceptability ratings were highly positive and participants reported feeling connected to the group and its topic. Average rates of past 1-month indoor tanning reported following the intervention were lower than the baseline rate (P=.08, Cohen d=0.47). Conclusions: This study is novel in demonstrating participant engagement with and acceptability of using Facebook secret groups to deliver a dissonance-inducing intervention approach that utilizes group-based discussions related to body image. The study is also unique within the field of skin cancer prevention by demonstrating the potential value of delivering an indoor tanning intervention within an interactive social media format. The findings suggest that Facebook metrics of intervention post engagement (ie, likes and comments) may vary based on post types and that designing specifically labeled discussion posts may be helpful for soliciting engagement as well as challenging beliefs. UR - http://www.researchprotocols.org/2018/2/e54/ UR - https://doi.org/10.2196/resprot.9429 UR - http://www.ncbi.nlm.nih.gov/pubmed/29463495 DO - 10.2196/resprot.9429 ID - info:doi/10.2196/resprot.9429 ER - TY - JOUR AU - Carter, Allison AU - Forrest, Jamie I AU - Kaida, Angela PY - 2017 DA - 2017/02/09 TI - Association Between Internet Use and Body Dissatisfaction Among Young Females: Cross-Sectional Analysis of the Canadian Community Health Survey JO - J Med Internet Res SP - e39 VL - 19 IS - 2 KW - body satisfaction KW - Internet use KW - girls KW - young women KW - Canada AB - Background: Recent research suggests Internet exposure, including Facebook use, is positively correlated with body dissatisfaction, especially among girls and young women. Canada has one of the highest Internet access rates in the world, yet no previous study has examined this relationship using nationally representative data. Objective: Our objective was to evaluate the relationship between Internet use and body dissatisfaction among a national, population-based sample of Canadian females 12-29 years of age. Methods: We used cross-sectional data from the Canadian Community Health Survey 2011-2012. Body dissatisfaction was measured using a 5-point Likert scale and defined as “very dissatisfied/dissatisfied” with one’s body. The explanatory variable was time spent using the Internet per week in the past 3 months, ranging from none/<1 hour to >20 hours. We used multinomial logistic regression to investigate whether greater Internet use was associated with increasing odds of being very dissatisfied/dissatisfied, neutral, or satisfied with one’s body, using very satisfied as the referent. Probability survey sampling weights were applied to all analyses. Results: Of 2983 included participants, sampled to represent 940,786 young Canadian females, most were 20-29 years old (61.98%) and living in households with an annual income Can $80,000 or more (44.61%). The prevalence of body dissatisfaction was 14.70%, and 25- to 29-year-olds were more likely than 12- to 14-year-olds to be very dissatisfied or dissatisfied with their body (20.76% vs 6.34%). Few (5.01%) reported none/<1 hour of Internet use, over half (56.93%) reported 1-10 hours, and one-fifth (19.52%) reported spending >20 hours online per week. Adjusting for age and income, the odds of being very dissatisfied/dissatisfied, relative to very satisfied, were greater in the highest versus lowest Internet use group (adjusted odds ratio [AOR] 3.03, 95% CI 1.19-7.70). The AORs for this level of body dissatisfaction increased across increasing levels of Internet use, ranging from 0.88 (95% CI 0.35-2.21) to 3.03 (95% CI 1.19-7.70). Additionally, those who spent 11-14 hours online were more likely to be neutral (AOR 3.66, 95% CI 1.17-11.45) and those who spent 15-20 hours online were more likely to be neutral (AOR 4.36, 95% CI 1.18-16.13) or satisfied (AOR 2.82, 95% CI 1.14-7.01) with their bodies, relative to very satisfied, compared with those spending no time or <1 hour online. Conclusions: A substantial proportion of Canadian females 12-29 years of age spent large amounts of time (>20 hours) on the Internet each week, and body dissatisfaction was significantly more likely among this group. Those who spent 11-20 hours online were also more likely to be less satisfied with their bodies. Efforts are needed to support girls and young women to achieve and maintain a positive body image in today’s digital age. UR - http://www.jmir.org/2017/2/e39/ UR - https://doi.org/10.2196/jmir.5636 UR - http://www.ncbi.nlm.nih.gov/pubmed/28183688 DO - 10.2196/jmir.5636 ID - info:doi/10.2196/jmir.5636 ER - TY - JOUR AU - Nitsch, Martina AU - Dimopoulos, Christina N AU - Flaschberger, Edith AU - Saffran, Kristina AU - Kruger, Jenna F AU - Garlock, Lindsay AU - Wilfley, Denise E AU - Taylor, Craig B AU - Jones, Megan PY - 2016 DA - 2016/01/11 TI - A Guided Online and Mobile Self-Help Program for Individuals With EatingDisorders: An Iterative Engagement and Usability Study JO - J Med Internet Res SP - e7 VL - 18 IS - 1 KW - usability study KW - engagement KW - adherence KW - dropout KW - digital health intervention KW - online program KW - self-help KW - eating disorder KW - mobile application AB - Background: Numerous digital health interventions have been developed for mental health promotion and intervention, including eating disorders. Efficacy of many interventions has been evaluated, yet knowledge about reasons for dropout and poor adherence is scarce. Most digital health intervention studies lack appropriate research design and methods to investigate individual engagement issues. User engagement and program usability are inextricably linked, making usability studies vital in understanding and improving engagement. Objective: The aim of this study was to explore engagement and corresponding usability issues of the Healthy Body Image Program—a guided online intervention for individuals with body image concerns or eating disorders. The secondary aim was to demonstrate the value of usability research in order to investigate engagement. Methods: We conducted an iterative usability study based on a mixed-methods approach, combining cognitive and semistructured interviews as well as questionnaires, prior to program launch. Two separate rounds of usability studies were completed, testing a total of 9 potential users. Thematic analysis and descriptive statistics were used to analyze the think-aloud tasks, interviews, and questionnaires. Results: Participants were satisfied with the overall usability of the program. The average usability score was 77.5/100 for the first test round and improved to 83.1/100 after applying modifications for the second iteration. The analysis of the qualitative data revealed five central themes: layout, navigation, content, support, and engagement conditions. The first three themes highlight usability aspects of the program, while the latter two highlight engagement issues. An easy-to-use format, clear wording, the nature of guidance, and opportunity for interactivity were important issues related to usability. The coach support, time investment, and severity of users’ symptoms, the program’s features and effectiveness, trust, anonymity, and affordability were relevant to engagement. Conclusions: This study identified salient usability and engagement features associated with participant motivation to use the Healthy Body Image Program and ultimately helped improve the program prior to its implementation. This research demonstrates that improvements in usability and engagement can be achieved by testing and adjusting intervention design and content prior to program launch. The results are consistent with related research and reinforce the need for further research to identify usage patterns and effective means for reducing dropout. Digital health research should include usability studies prior to efficacy trials to help create more user-friendly programs that have a higher likelihood of “real-world” adoption. UR - http://www.jmir.org/2016/1/e7/ UR - https://doi.org/10.2196/jmir.4972 UR - http://www.ncbi.nlm.nih.gov/pubmed/26753539 DO - 10.2196/jmir.4972 ID - info:doi/10.2196/jmir.4972 ER - TY - JOUR AU - ter Huurne, Elke D AU - de Haan, Hein A AU - Postel, Marloes G AU - van der Palen, Job AU - VanDerNagel, Joanne EL AU - DeJong, Cornelis AJ PY - 2015 DA - 2015/06/18 TI - Web-Based Cognitive Behavioral Therapy for Female Patients With Eating Disorders: Randomized Controlled Trial JO - J Med Internet Res SP - e152 VL - 17 IS - 6 KW - eating disorders KW - bulimia nervosa KW - binge-eating disorder KW - eating disorders not otherwise specified KW - randomized controlled trial KW - eHealth KW - Web-based treatment KW - asynchronous therapeutic support KW - treatment effectiveness KW - cognitive behavioral therapy AB - Background: Many patients with eating disorders do not receive help for their symptoms, even though these disorders have severe morbidity. The Internet may offer alternative low-threshold treatment interventions. Objective: This study evaluated the effects of a Web-based cognitive behavioral therapy (CBT) intervention using intensive asynchronous therapeutic support to improve eating disorder psychopathology, and to reduce body dissatisfaction and related health problems among patients with eating disorders. Methods: A two-arm open randomized controlled trial comparing a Web-based CBT intervention to a waiting list control condition (WL) was carried out among female patients with bulimia nervosa (BN), binge eating disorder (BED), and eating disorders not otherwise specified (EDNOS). The eating disorder diagnosis was in accordance with the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, and was established based on participants’ self-report. Participants were recruited from an open-access website, and the intervention consisted of a structured two-part program within a secure Web-based application. The aim of the first part was to analyze participant’s eating attitudes and behaviors, while the second part focused on behavioral change. Participants had asynchronous contact with a personal therapist twice a week, solely via the Internet. Self-report measures of eating disorder psychopathology (primary outcome), body dissatisfaction, physical health, mental health, self-esteem, quality of life, and social functioning were completed at baseline and posttest. Results: A total of 214 participants were randomized to either the Web-based CBT group (n=108) or to the WL group (n=106) stratified by type of eating disorder (BN: n=44; BED: n=85; EDNOS: n=85). Study attrition was low with 94% of the participants completing the posttest assignment. Overall, Web-based CBT showed a significant improvement over time for eating disorder psychopathology (F97=63.07, P<.001, d=.82) and all secondary outcome measures (effect sizes between d=.34 to d=.49), except for Body Mass Index. WL participants also improved on most outcomes; however, effects were smaller in this group with significant between-group effects for eating disorder psychopathology (F201=9.42, P=.002, d=.44), body dissatisfaction (F201=13.16, P<.001, d=.42), physical health (F200=12.55, P<.001, d=.28), mental health (F203=4.88, P=.028, d=.24), self-esteem (F202=5.06, P=.026, d=.20), and social functioning (F205=7.93, P=.005, d=.29). Analyses for the individual subgroups BN, BED, and EDNOS showed that eating disorder psychopathology improved significantly over time among Web-based CBT participants in all three subgroups; however, the between-group effect was significant only for participants with BED (F78=4.25, P=.043, d=.61). Conclusions: Web-based CBT proved to be effective in improving eating disorder psychopathology and related health among female patients with eating disorders. Trial Registration: Nederlands Trial Register (NTR): NTR2415; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2415 (Archived by WebCite at http://www.webcitation.org/6T2io3DnJ). UR - http://www.jmir.org/2015/6/e152/ UR - https://doi.org/10.2196/jmir.3946 UR - http://www.ncbi.nlm.nih.gov/pubmed/26088580 DO - 10.2196/jmir.3946 ID - info:doi/10.2196/jmir.3946 ER - TY - JOUR AU - von Brachel, Ruth AU - Hötzel, Katrin AU - Hirschfeld, Gerrit AU - Rieger, Elizabeth AU - Schmidt, Ulrike AU - Kosfelder, Joachim AU - Hechler, Tanja AU - Schulte, Dietmar AU - Vocks, Silja PY - 2014 DA - 2014/03/31 TI - Internet-Based Motivation Program for Women With Eating Disorders: Eating Disorder Pathology and Depressive Mood Predict Dropout JO - J Med Internet Res SP - e92 VL - 16 IS - 3 KW - attrition KW - Web-based treatment KW - eHealth, eating disorders KW - motivation to change KW - anorexia nervosa KW - bulimia nervosa KW - bootstrapping KW - survival analysis AB - Background: One of the main problems of Internet-delivered interventions for a range of disorders is the high dropout rate, yet little is known about the factors associated with this. We recently developed and tested a Web-based 6-session program to enhance motivation to change for women with anorexia nervosa, bulimia nervosa, or related subthreshold eating pathology. Objective: The aim of the present study was to identify predictors of dropout from this Web program. Methods: A total of 179 women took part in the study. We used survival analyses (Cox regression) to investigate the predictive effect of eating disorder pathology (assessed by the Eating Disorders Examination-Questionnaire; EDE-Q), depressive mood (Hopkins Symptom Checklist), motivation to change (University of Rhode Island Change Assessment Scale; URICA), and participants’ age at dropout. To identify predictors, we used the least absolute shrinkage and selection operator (LASSO) method. Results: The dropout rate was 50.8% (91/179) and was equally distributed across the 6 treatment sessions. The LASSO analysis revealed that higher scores on the Shape Concerns subscale of the EDE-Q, a higher frequency of binge eating episodes and vomiting, as well as higher depression scores significantly increased the probability of dropout. However, we did not find any effect of the URICA or age on dropout. Conclusions: Women with more severe eating disorder pathology and depressive mood had a higher likelihood of dropping out from a Web-based motivational enhancement program. Interventions such as ours need to address the specific needs of women with more severe eating disorder pathology and depressive mood and offer them additional support to prevent them from prematurely discontinuing treatment. UR - http://www.jmir.org/2014/3/e92/ UR - https://doi.org/10.2196/jmir.3104 UR - http://www.ncbi.nlm.nih.gov/pubmed/24686856 DO - 10.2196/jmir.3104 ID - info:doi/10.2196/jmir.3104 ER - TY - JOUR AU - Jones, Megan AU - Taylor Lynch, Katherine AU - Kass, Andrea E AU - Burrows, Amanda AU - Williams, Joanne AU - Wilfley, Denise E AU - Taylor, C Barr PY - 2014 DA - 2014/02/27 TI - Healthy Weight Regulation and Eating Disorder Prevention in High School Students: A Universal and Targeted Web-Based Intervention JO - J Med Internet Res SP - e57 VL - 16 IS - 2 KW - healthy weight regulation KW - universal and targeted delivery KW - school-based intervention KW - prevention KW - adolescents AB - Background: Given the rising rates of obesity in children and adolescents, developing evidence-based weight loss or weight maintenance interventions that can be widely disseminated, well implemented, and are highly scalable is a public health necessity. Such interventions should ensure that adolescents establish healthy weight regulation practices while also reducing eating disorder risk. Objective: This study describes an online program, StayingFit, which has two tracks for universal and targeted delivery and was designed to enhance healthy living skills, encourage healthy weight regulation, and improve weight/shape concerns among high school adolescents. Methods: Ninth grade students in two high schools in the San Francisco Bay area and in St Louis were invited to participate. Students who were overweight (body mass index [BMI] >85th percentile) were offered the weight management track of StayingFit; students who were normal weight were offered the healthy habits track. The 12-session program included a monitored discussion group and interactive self-monitoring logs. Measures completed pre- and post-intervention included self-report height and weight, used to calculate BMI percentile for age and sex and standardized BMI (zBMI), Youth Risk Behavior Survey (YRBS) nutrition data, the Weight Concerns Scale, and the Center for Epidemiological Studies Depression Scale. Results: A total of 336 students provided informed consent and were included in the analyses. The racial breakdown of the sample was as follows: 46.7% (157/336) multiracial/other, 31.0% (104/336) Caucasian, 16.7% (56/336) African American, and 5.7% (19/336) did not specify; 43.5% (146/336) of students identified as Hispanic/Latino. BMI percentile and zBMI significantly decreased among students in the weight management track. BMI percentile and zBMI did not significantly change among students in the healthy habits track, demonstrating that these students maintained their weight. Weight/shape concerns significantly decreased among participants in both tracks who had elevated weight/shape concerns at baseline. Fruit and vegetable consumption increased for both tracks. Physical activity increased among participants in the weight management track, while soda consumption and television time decreased. Conclusions: Results suggest that an Internet-based, universally delivered, targeted intervention may support healthy weight regulation, improve weight/shape concerns among participants with eating disorders risk, and increase physical activity in high school students. Tailored content and interactive features to encourage behavior change may lead to sustainable improvements in adolescent health. UR - http://www.jmir.org/2014/2/e57/ UR - https://doi.org/10.2196/jmir.2995 UR - http://www.ncbi.nlm.nih.gov/pubmed/24583683 DO - 10.2196/jmir.2995 ID - info:doi/10.2196/jmir.2995 ER - TY - JOUR AU - McClay, Carrie-Anne AU - Waters, Louise AU - McHale, Ciaran AU - Schmidt, Ulrike AU - Williams, Christopher PY - 2013 DA - 2013/03/15 TI - Online Cognitive Behavioral Therapy for Bulimic Type Disorders, Delivered in the Community by a Nonclinician: Qualitative Study JO - J Med Internet Res SP - e46 VL - 15 IS - 3 KW - bulimia nervosa KW - self-help KW - cCBT KW - qualitative research KW - cognitive behavioral therapy AB - Background: Cognitive behavioral therapy is recommended in the National Institute for Clinical Excellence guidelines for the treatment of bulimia nervosa. In order to make this treatment option more accessible to patients, interactive online CBT programs have been developed that can be used in the user’s own home, in privacy, and at their convenience. Studies investigating online CBT for bulimic type eating disorders have provided promising results and indicate that, with regular support from a clinician or trained support worker, online CBT can be effective in reducing bulimic symptoms. Two main factors distinguish this study from previous research in this area. First, the current study recruited a wide range of adults with bulimic type symptoms from the community. Second, the participants in the current study had used cCBT with support from a nonclinical support worker rather than a specialist eating disorder clinician. Objective: To investigate participants’ experiences of using an online self-help cognitive behavioral therapy (CBT) package (Overcoming Bulimia Online) for bulimia nervosa (BN) and eating disorders not otherwise specified (EDNOS). Methods: Eight participants with a mean age of 33.9 years took part in semi-structured interviews. Interviews were transcribed and analyzed using a 6-step thematic analysis process. Results: Saturation was achieved, and 7 themes were identified in the dataset. These were: (1) conceptualizing eating disorders, (2) help-seeking behavior, (3) aspects of the intervention, (4) motivation to use the online package, (5) privacy and secrecy with regard to their eating problems, (6) recovery and the future, and (7) participant engagement describing individuals’ thoughts on taking part in the online research study. Conclusions: Participants suggested that online CBT self-help represented a generally desirable and acceptable treatment option for those with bulimic type eating problems, despite some difficulties with motivation and implementation of some elements of the package. Trial Registration: International Standard Randomized Controlled Trial Number of the original RCT that this study is based on: ISRCTN41034162; http://www.controlled-trials.com/ISRCTN41034162 (Archived by WebCite at http://www.webcitation.org/6Ey9sBWTV) UR - http://www.jmir.org/2013/3/e46/ UR - https://doi.org/10.2196/jmir.2083 UR - http://www.ncbi.nlm.nih.gov/pubmed/23502689 DO - 10.2196/jmir.2083 ID - info:doi/10.2196/jmir.2083 ER - TY - JOUR AU - Syed-Abdul, Shabbir AU - Fernandez-Luque, Luis AU - Jian, Wen-Shan AU - Li, Yu-Chuan AU - Crain, Steven AU - Hsu, Min-Huei AU - Wang, Yao-Chin AU - Khandregzen, Dorjsuren AU - Chuluunbaatar, Enkhzaya AU - Nguyen, Phung Anh AU - Liou, Der-Ming PY - 2013 DA - 2013/02/13 TI - Misleading Health-Related Information Promoted Through Video-Based Social Media: Anorexia on YouTube JO - J Med Internet Res SP - e30 VL - 15 IS - 2 KW - Medical Informatics KW - Internet KW - Online videos KW - YouTube KW - Eating Disorder KW - Anorexia Nervosa KW - Social Network AB - Introduction: The amount of information being uploaded onto social video platforms, such as YouTube, Vimeo, and Veoh, continues to spiral, making it increasingly difficult to discern reliable health information from misleading content. There are thousands of YouTube videos promoting misleading information about anorexia (eg, anorexia as a healthy lifestyle). Objective: The aim of this study was to investigate anorexia-related misinformation disseminated through YouTube videos. Methods: We retrieved YouTube videos related to anorexia using the keywords anorexia, anorexia nervosa, proana, and thinspo on October 10, 2011.Three doctors reviewed 140 videos with approximately 11 hours of video content, classifying them as informative, pro-anorexia, or others. By informative we mean content describing the health consequences of anorexia and advice on how to recover from it; by pro-anorexia we mean videos promoting anorexia as a fashion, a source of beauty, and that share tips and methods for becoming and remaining anorexic. The 40 most-viewed videos (20 informative and 20 pro-anorexia videos) were assessed to gauge viewer behavior. Results: The interrater agreement of classification was moderate (Fleiss’ kappa=0.5), with 29.3% (n=41) being rated as pro-anorexia, 55.7% (n=78) as informative, and 15.0% (n=21) as others. Pro-anorexia videos were favored 3 times more than informative videos (odds ratio [OR] 3.3, 95% CI 3.3-3.4, P<.001). Conclusions: Pro-anorexia information was identified in 29.3% of anorexia-related videos. Pro-anorexia videos are less common than informative videos; however, in proportional terms, pro-anorexia content is more highly favored and rated by its viewers. Efforts should focus on raising awareness, particularly among teenagers, about the trustworthiness of online information about beauty and healthy lifestyles. Health authorities producing videos to combat anorexia should consider involving celebrities and models to reach a wider audience. More research is needed to study the characteristics of pro-anorexia videos in order to develop algorithms that will automatically detect and filter those videos before they become popular. UR - http://www.jmir.org/2013/2/e30/ UR - https://doi.org/10.2196/jmir.2237 UR - http://www.ncbi.nlm.nih.gov/pubmed/23406655 DO - 10.2196/jmir.2237 ID - info:doi/10.2196/jmir.2237 ER - TY - JOUR AU - ter Huurne, Elke D AU - Postel, Marloes G AU - de Haan, Hein A AU - Drossaert, Constance H.C AU - DeJong, Cor A.J PY - 2013 DA - 2013/02/04 TI - Web-Based Treatment Program Using Intensive Therapeutic Contact for Patients With Eating Disorders: Before-After Study JO - J Med Internet Res SP - e12 VL - 15 IS - 2 KW - Eating disorders KW - eHealth KW - Internet KW - Web-based treatment KW - Intensive therapeutic contact KW - Program evaluation KW - Treatment effectiveness. AB - Background: Although eating disorders are common in the Netherlands, only a few patients are treated by mental health care professionals. To reach and treat more patients with eating disorders, Tactus Addiction Treatment developed a web-based treatment program with asynchronous and intensive personalized communication between the patient and the therapist. Objective: This pilot study evaluated the web-based treatment program using intensive therapeutic contact in a population of 165 patients with an eating disorder. Methods: In a pre-post design with 6-week and 6-month follow-ups, eating disorder psychopathology, body dissatisfaction, Body Mass Index, physical and mental health, and quality of life were measured. The participant’s satisfaction with the web-based treatment program was also studied. Attrition data were collected, and participants were classified as noncompleters if they did not complete all 10 assignments of the web-based treatment program. Differences in baseline characteristics between completers and noncompleters were studied, as well as reasons for noncompletion. Furthermore, differences in treatment effectiveness, treatment adherence, and baseline characteristics between participants of the three major eating disorder diagnostic groups EDNOS (n=115), BN purging (n=24), and BN nonpurging (n=24) were measured. Results: Of the 165 participants who started the web-based treatment program, 89 participants (54%) completed all of the program assignments (completers) and 76 participants (46%) ended the program prematurely (noncompleters). Severe body dissatisfaction and physical and mental health problems seemed to have a negative impact on the completion of the web-based treatment program. Among the participants who completed the treatment program, significant improvements were found in eating disorder psychopathology (F=54.6, df = 68, P<.001, d=1.14). Body dissatisfaction, quality of life, and physical and mental health also significantly improved, and almost all of these positive effects were sustained up to 6 months after the participants had completed the web-based treatment program. Body Mass Index improved only within the group of participants suffering from obesity. The improvement in eating disorder psychopathology occurred in all three eating disorder diagnostic groups, and the percentage of completers did not differ significantly between these groups. Participants’ satisfaction with the treatment program, as well as with their therapist, was high, and participants indicated that they would recommend the program to other patients with eating disorders. Conclusions: The results of this study suggest that the web-based treatment program has the potential to improve eating disorder psychopathology in patients with different types of eating disorders. UR - http://www.jmir.org/2013/2/e12/ UR - https://doi.org/10.2196/jmir.2211 UR - http://www.ncbi.nlm.nih.gov/pubmed/23380291 DO - 10.2196/jmir.2211 ID - info:doi/10.2196/jmir.2211 ER - TY - JOUR AU - Yom-Tov, Elad AU - Fernandez-Luque, Luis AU - Weber, Ingmar AU - Crain, Steven P PY - 2012 DA - 2012/11/07 TI - Pro-Anorexia and Pro-Recovery Photo Sharing: A Tale of Two Warring Tribes JO - J Med Internet Res SP - e151 VL - 14 IS - 6 KW - Medical Informatics KW - Internet KW - Photo KW - Eating Disorder KW - Anorexia Nervosa KW - Social Network AB - Background: There is widespread use of the Internet to promote anorexia as a lifestyle choice. Pro-anorexia content can be harmful for people affected or at risk of having anorexia. That movement is actively engaged in sharing photos on social networks such as Flickr. Objective: To study the characteristics of the online communities engaged in disseminating content that encourages eating disorders (known as “pro-anorexia”) and to investigate if the posting of such content is discouraged by the posting of recovery-oriented content. Methods: The extraction of pro-anorexia and pro-recovery photographs from the photo sharing site Flickr pertaining to 242,710 photos from 491 users and analyzing four separate social networks therein. Results: Pro-anorexia and pro-recovery communities interact to a much higher degree among themselves than what is expected from the distribution of contacts (only 59-72% of contacts but 74-83% of comments are made to members inside the community). Pro-recovery users employ similar words to those used by pro-anorexia users to describe their photographs, possibly in order to ensure that their content appears when pro-anorexia users search for images. Pro-anorexia users who are exposed to comments from the opposite camp are less likely to cease posting pro-anorexia photographs than those who do not receive such comments (46% versus 61%), and if they cease, they do so approximately three months later. Our observations show two highly active communities, where most interaction is within each community. However, the pro-recovery community takes steps to ensure that their content is visible to the pro-anorexia community, both by using textual descriptions of their photographs that are similar to those used by the pro-anorexia group and by commenting to pro-anorexia content. The latter activity is, however, counterproductive, as it entrenches pro-anorexia users in their stance. Conclusions: Our results highlight the nature of pro-anorexia and pro-recovery photo sharing and accentuate the need for clinicians to be aware of such content and its effect on their patients. Our findings suggest that some currently used interventions are not useful in helping pro-anorexia users recover. Thus, future work should focus on new intervention methods, possibly tailored to individual characteristics. UR - http://www.jmir.org/2012/6/e151/ UR - https://doi.org/10.2196/jmir.2239 UR - http://www.ncbi.nlm.nih.gov/pubmed/23134671 DO - 10.2196/jmir.2239 ID - info:doi/10.2196/jmir.2239 ER - TY - JOUR AU - Peebles, Rebecka AU - Wilson, Jenny L AU - Litt, Iris F AU - Hardy, Kristina K AU - Lock, James D AU - Mann, Julia R AU - Borzekowski, Dina LG PY - 2012 DA - 2012/10/25 TI - Disordered Eating in a Digital Age: Eating Behaviors, Health, and Quality of Life in Users of Websites With Pro-Eating Disorder Content JO - J Med Internet Res SP - e148 VL - 14 IS - 5 KW - Eating disorder KW - social network KW - anorexia nervosa KW - bulimia nervosa KW - pro-eating disorder website KW - pro-anorexia website KW - pro-bulimia website KW - pro-ED KW - pro-ana KW - pro-mia AB - Background: Much concern has been raised over pro-eating disorder (pro-ED) website communities, but little quantitative research has been conducted on these websites and their users. Objective: To examine associations between levels of pro-ED website usage, disordered eating behaviors, and quality of life. Methods: We conducted a cross-sectional, Internet-based survey of adult pro-ED website users. Main outcomes were Eating Disorder Examination Questionnaire (EDE-Q) and Eating Disorder Quality of Life (EDQOL) scores. Results: We included responses from 1291 participants; 1254 (97.13%) participants were female. Participants had an average age of 22.0 years and a mean body mass index of 22.1 kg/m2; 24.83% (296/1192) were underweight; 20.89% (249/1192) were overweight or obese. Over 70% of participants had purged, binged, or used laxatives to control their weight; only 12.91% (163/1263) were in treatment. Mean EDE-Q scores were above the 90th percentile and mean EDQOL scores were in the severely impaired range. When compared with moderate and light usage, heavy pro-ED website usage was associated with higher EDE-Q global (4.89 vs 4.56 for medium and 4.0 for light usage, P < .001) and EDQOL total scores (1.64 vs 1.45 for medium and 1.25 for light usage, P < .001), and more extreme weight loss behaviors and harmful post-website usage activities. In a multivariate model, the level of pro-ED website usage remained a significant predictor of EDE-Q scores. Conclusions: Pro-ED website visitors reported many disordered eating behaviors, although few had been treated. Heavy users reported poorer quality of life and more disordered eating behaviors. UR - http://www.jmir.org/2012/5/e148/ UR - https://doi.org/10.2196/jmir.2023 UR - http://www.ncbi.nlm.nih.gov/pubmed/23099628 DO - 10.2196/jmir.2023 ID - info:doi/10.2196/jmir.2023 ER -