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Background: Pre-diagnostic stages of psychotic illnesses, including 'clinical high risk' (CHR), are marked by sleep disturbances. These sleep disturbances appear to represent a key aspect in the etiology and maintenance of psychotic disorders. We aimed to examine the relationship between self-reported sleep dysfunction and attenuated psychotic symptoms (APS) on a day-to-day basis. Methods: Seventy-six CHR young people completed the Experience Sampling Methodology (ESM) component of the European Union Gene-Environment Interaction Study, collected through PsyMate® devices, prompting sleep and symptom questionnaires 10 times daily for 6 days. Bayesian multilevel mixed linear regression analyses were performed on time-variant ESM data using the brms package in R. We investigated the day-to-day associations between sleep and psychotic experiences bidirectionally on an item level. Sleep items included sleep onset latency, fragmentation, and quality. Psychosis items assessed a range of perceptual, cognitive, and bizarre thought content common in the CHR population. Results: Two of the seven psychosis variables were unidirectionally predicted by previous night's number of awakenings: every unit increase in number of nightly awakenings predicted a 0.27 and 0.28 unit increase in feeling unreal or paranoid the next day, respectively. No other sleep variables credibly predicted next-day psychotic symptoms or vice-versa. Conclusion: In this study, the relationship between sleep disturbance and APS appears specific to the item in question. However, some APS, including perceptual disturbances, had low levels of endorsement amongst this sample. Nonetheless, these results provide evidence for a unidirectional relationship between sleep and some APS in this population. [ABSTRACT FROM AUTHOR]

Objective: Dialectical behavior therapy (DBT) is an evidence-based treatment for disorders characterized by recurrent binge eating. Yet, access to specialized treatment like DBT remains limited. To increase the accessibility of DBT, we developed a DBT skills training app (Resilience: eDBT) for the management of eating disorder (ED) symptoms. This paper delineates the developmental process of Resilience and tests its usability., Methods: Descriptive information on the development and features of Resilience is provided, including its framework, content structure and delivery formats, functionality, data storage procedure, and privacy protocols. Usability was assessed via a mixed methods approach in 10 symptomatic individuals. Qualitative data were organized based on an existing framework, which included six themes: usability, visual design, user engagement, content, therapeutic persuasiveness, and therapeutic alliance., Results: Resilience demonstrated good usability via a Systems Usability Scale score of 85.5, which exceeded the recommended cutoff of 68. Positive aspects of the app, according to interview data, were the ease of use and the visual design, while the addition of peer support was suggested as an opportunity for improvement., Discussion: A novel DBT-based app may serve as an acceptable, low-intensity option or adjunct to traditional treatment for targeting ED symptoms that emerge in daily life. However, notable limitations include the small sample size and the single time point at which the usability assessment was conducted., (© 2024 The Author(s). International Journal of Eating Disorders published by Wiley Periodicals LLC.)

Objective: To compare all other specified feeding or eating disorders (OSFED) groups (atypical anorexia nervosa [AN], purging disorder [PD], night eating syndrome [NES], subthreshold bulimia nervosa [sub-BN], and subthreshold binge-eating disorder [sub-BED]) to threshold eating disorders (EDs [AN, BN, and BED]) and control groups (CGs) on measures of eating and general psychopathology., Method: We conducted a comprehensive search in PsycINFO, Medline, Embase, and CINAHL on all published studies from January 2013 to February 2024 using DSM-5 diagnostic criteria via clinical interviews or well-established diagnostic tools. We also undertook a quality appraisal using an adapted version of the Downs and Black criteria and registered the review with PROSPERO (ID: CRD42022314495)., Results: Overall, our meta-analyses (n = 33 eligible studies) indicated that the combined OSFED and several specific OSFED subtypes displayed comparable levels of eating psychopathology to full-threshold EDs. Our systematic review (n = 33 eligible studies) found individuals with OSFED to have comparable levels of eating and general psychopathology to full-threshold EDs, but higher levels of eating and general psychopathology than CGs. These findings were specifically attributed to atypical AN and NES. There was a lack of evidence available for sub-BN and sub-BED. Studies mainly met the quality appraisal criteria. The main limitations identified in the included studies were insufficient reporting of their statistical power (78%) and no adjusting for potential confounding factors (67%)., Discussion: Findings support the conceptualization of atypical AN, and NES as clinically significant EDs with similar severity to full-threshold EDs., (© 2024 The Author(s). International Journal of Eating Disorders published by Wiley Periodicals LLC.)

While much research has explored the impacts of social media use, less is known about what factors drive use. The present study examined the relationships between potential drivers of social media use; namely social media literacy, motivations, and internalisation of appearance ideals, and determined whether they work in combination or individually to predict a range of social media uses and behaviours over time, including intensity, frequency, exposure to fitness and celebrity content, photo editing, appearance comparisons, and types of use. Australian adolescent girls (n = 704) and boys (n = 938) aged 11-16 years completed online surveys at baseline and 6-month follow-up. Bivariate correlations and multiple regressions were performed separately by gender. Results revealed weak associations between drivers and found they uniquely contributed to social media behaviours, though this was dependent on use outcome. Thin- and muscular-internalisation were related to some appearance-focused use (e.g., comparisons, following celebrity and fitness accounts) among girls and boys, respectively. Critical thinking was associated with lower Snapchat use among boys and motivations were related to intensity and type of use (i.e., viewing, posting). These findings suggest multicomponent holistic interventions targeting numerous drivers may be most appropriate in modifying social media behaviours among adolescents., Competing Interests: Declaration of Competing Interest The authors have no known conflict of interests to disclose., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

We assessed the bi-directional relationships between upward appearance comparisons on social media with body dissatisfaction (BD) and disordered eating (DE) in women's daily lives and the potential moderating effect of trait self-objectification on these relationships. Women (N = 315) completed a baseline measure of trait self-objectification, then reported momentary experiences of social media-based appearance comparisons (upward, lateral, downward), body satisfaction, and DE urges (restrict food intake, exercise, overeat) for seven days. We hypothesized that upward (relative to no) comparisons would predict lower body satisfaction and higher DE urges, while lateral and downward (relative to no) comparisons would predict higher body satisfaction and lower DE urges. We expected these relationships to be bi-directional and moderated by trait self-objectification. Multilevel modelling results revealed complex bi-directional relationships. Upward comparisons predicted lower body satisfaction and increased urges to restrict food intake, which in turn predicted increased upward comparisons. Unexpectedly, urges to restrict food intake predicted all comparison types. We observed somewhat unanticipated bi-directional relationships between lateral comparisons and exercise urges, and between downward comparisons and body satisfaction. Uni-directional relationships emerged between upward comparisons and the urge to overeat. Trait self-objectification moderated very few of these relationships. These findings support the non-uniform impact of appearance comparisons on body image and eating concerns and highlight the complexity of daily social media-body image dynamics. Future research using refined measures over extended periods is needed to elucidate these relationships further and inform targeted interventions., (© 2024. The Author(s).)

Introduction: The bidirectional relationship between disease activity and mental health in inflammatory bowel disease (IBD) has prompted investigations into the efficacy of psychotherapeutic interventions such as acceptance and commitment therapy (ACT) on biopsychosocial outcomes. We aimed to examine the efficacy of an ACT program (intervention) in comparison with a cognitive behavioral therapy-informed psychoeducation program (active control) for individuals with IBD and coexistent psychological distress. Both programs were delivered online through a hybrid format (i.e., therapist-led and participant-led sessions)., Methods: A total of 120 adults with IBD were randomized to either the intervention (N = 61) or active control groups (N = 59). Efficacy was determined using linear mixed models for group differences, in rate of changes in study outcomes, between baseline, postintervention, and 3-month follow-up., Results: The primary outcome health-related quality of life significantly improved in the intervention group when compared with the active control group, with a significantly different rate of change observed from baseline to postintervention ( t [190] = 2.15, P = 0.033) in favor of the intervention group with a medium effect size (β = 0.41, mean difference = 0.07, 95% confidence interval 0.01-0.12, P = 0.014). Similarly, the secondary outcome Crohn's disease activity significantly reduced in the intervention group when compared with the active control group, with a significantly different rate of change observed from baseline to 3-month follow-up ( t [90] = -2.40, P = 0.018) in favor of the intervention group with a large effect size (β = -0.77, mean difference = -9.43, 95% confidence interval -13.72 to -5.13, P < 0.001) ( P = 0.014). Furthermore, when observing the rate of change in outcomes over time for the groups separately, anxiety symptoms and pain significantly improved in the intervention group only, and conversely, ulcerative colitis activity and stress symptoms significantly improved in the active control group only. All other outcomes (N = 14) significantly improved over time in both groups including IBD activity, gastrointestinal unhelpful thinking patterns, visceral anxiety, fatigue interference, fatigue severity, fatigue frequency, psychological inflexibility, self-efficacy, resilience, current health status, depression symptoms, IBD control, and pain catastrophizing; however, these changes were not significantly different between the groups., Discussion: Both programs were of benefit to people with IBD and distress. However, ACT offers a significant added benefit for health-related quality of life and self-reported Crohn's disease activity and may be a useful adjuvant therapy in integrated IBD care., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of The American College of Gastroenterology.)

Body positive social media content, and especially content that does not contain photos of bodies, has been shown to be helpful for body image compared to idealized social media content. However, body positive content is heterogenous and little is known regarding which types of content may be most helpful. This study examined self-reported body image and mood effects of different types of body positive content among women. A sample of 176 women, mean (SD) age = 21.77 (2.35) was recruited. Participants viewed body positive stimuli that were grouped into 14 different categories to represent the heterogenous nature of this social media content, including a text only category. Each image was rated in terms of its perceived effect on body image and mood. Findings suggested that the text-only category was rated most highly in terms of generating positive feelings towards the body and positive affect. Moreover, the comparative benefit of the text-only category was larger among women with higher BMI, and participants reporting closer proximity to the images, although not consistently across outcomes. Further work focused on understanding the effects of different types of body positive content is warranted., Competing Interests: Declaration of Competing Interest The authors report no conflict of interest., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objective: Theoretical models highlight body image disturbances as central to the maintenance of eating disorders, with empirical evidence finding negative body image to be a robust predictor of treatment nonresponse, relapse and symptom persistence. Accessible, scalable, and inexpensive interventions that can effectively target negative body image across the eating disorders are needed. We developed an online single session intervention (SSI) for negative body image and evaluated its acceptability and efficacy in a randomized controlled trial in individuals with recurrent binge eating., Method: Participants with recurrent binge eating were randomly assigned to the SSI (n = 99) or a waitlist (n = 101). Assessments were conducted at baseline, 4 week follow-up, and 8 week follow-up., Results: 81% of participants accessed the SSI, demonstrating reasonable uptake. However, issues with attrition were apparent; a 32% study dropout rate was observed at posttest, while a 58% dropout rate was observed at follow-up. 87% of participants who completed satisfaction measures would recommend the SSI. SSI participants experienced greater improvements in negative body image at both 4 (d = -0.65) and 8 week (d = -0.74) follow-up. Significant between-group effects were also observed on most other secondary symptom measures, though no differences were found for motivations and help-seeking beliefs and intentions., Conclusion: Body image-focused self-guided SSIs for recurrent binge are largely accepted by those who are retained in the trial, but are associated with significant attrition. Although SSIs are not intended to replace standard treatment, they may help with short-term symptom management and could play an important role in eating disorder care., Public Significance: Single session interventions (SSI) are a potentially accessible, scalable, and cost-effective way to deliver evidence-based treatment content to people with eating disorders. This study shows that an online (SSI) designed to target body image among people with recurrent binge eating is accepted and produced short-term symptom relief., (© 2024 The Authors. International Journal of Eating Disorders published by Wiley Periodicals LLC.)

Intuitive eating has been found to protect against disordered eating and preserve well-being. Yet, there are methodological (length), conceptual (inconsideration of medical, value-based, and access-related reasons for food consumption), and psychometric (item wording) concerns with its most common measure, the Intuitive Eating Scale-2 (IES-2). To address these concerns, we developed the IES-3 and investigated its psychometric properties with U.S. community adults. Across three online studies, we evaluated the IES-3's factorial validity using exploratory factor analysis (EFA; Study 1; N = 957; M age  = 36.30), as well as confirmatory factor analysis (CFA), exploratory structural equation modeling (ESEM), bifactor-CFA, and bifactor-ESEM (Study 2; N = 1152; M age  = 40.95), and cross-validated the optimal model (Study 3; N = 884; M age  = 38.54). We examined measurement invariance across samples and time, differential item functioning (age, body mass index [BMI], gender), composite reliability, and validity. Study 1 revealed a 12-item, 4-factor structure (unconditional permission to eat, eating for physical reasons, reliance on hunger and satiety cues, body-food choice congruence). In Study 2, a bifactor-ESEM model with a global intuitive eating factor and four specific factors best fit the data, which was temporally stable across three weeks. This model also had good fit in Study 3 and, across Studies 2 and 3, and was fully invariant and lacked measurement bias in terms of age, gender, and BMI. Associations between latent IES-3 factors and age, gender, and BMI were invariant across Studies 2 and 3. Composite reliability and validity (relationships with disordered eating, embodiment, body image, well-being, and distress; negligible relationship with impression management) of the retained model were also supported. The 12-item IES-3 demonstrates strong psychometric properties in U.S. community adults. Research is now needed using the IES-3 in other cultural contexts and social identity groups., Competing Interests: Declaration of competing interest None., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

This study provides the first examination of the frequency, characteristics, and dynamics surrounding daily experiences of OCD-relevant intrusions among non-clinical participants (N = 54, N obs  = 2314) using ecological momentary assessment. It also examines the extent to which self-related constructs-participants' feared-self beliefs and their tendency to conceal aspects of self-relate to such intrusive phenomena. Participants completed a baseline questionnaire before reporting state depressed mood and intrusions up to five times per day (at semi-random intervals) for 14 days. Results suggest that questionnaire measures may result in underreporting of the frequency of intrusions, with most participants (80%) reporting at least one intrusion across the momentary observations, and 20% of observations indicating intrusive phenomena experienced since the previous momentary report. Baseline factors including OCD-related beliefs and feared self were related to the proportion of intrusions experienced, whereas self-concealment was not. Within the moment, state feared-self predicted intrusion-related distress, duration, perceived importance, the urge to act, and the need to control thoughts. The urge to conceal within the moment was significant but negatively related to perceived importance and the urge to act. Overall, this study provides evidence for the relevance of momentary measures of intrusions, and adds to evidence for self-beliefs in the dynamics of the disorder., Competing Interests: Declaration of competing interest The authors declare no conflict of interest., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objective: Extending on previous findings that computerized Memory Specificity Training (c-MeST) improves memory specificity and depressive symptoms in Major Depressive Disorder (MDD) in adults, this study aimed to assess the effects of c-MeST in youth with MDD on memory specificity and depression in addition to other treatment., Methods: Participants aged 15-25 (N = 359, 76 % female; M age = 19.2, SD = 3.1), receiving predominantly psychological therapy or counseling (85 %) and/or antidepressants (52 %) were randomized to usual care and c-MeST or usual care. Cognitive and clinical outcomes were assessed at baseline and at one, three, and six-month follow-ups., Results: The usual care and c-MeST group reported higher memory specificity at one-month (d = 0.42, p = .022), but not at three or six months (d's < 0.15, p's > 0.05). The rate of MDE was numerically lower in the c-MeST group at each follow-up time-point, but group was not a statistically significant predictor at one month (64 % usual care and c-MeST vs. 68 % usual care, OR = 0.81, p = .606), three months (67 % usual care and c-MeST vs. 72 % usual care, OR = 0.64, p = .327) or six months (55 % usual care and c-MeST vs. 68 % usual care, OR = 0.56, p = .266). The usual care and c-MeST group did report lower depressive symptoms at one month (d = 0.42, p = .023) and six-months (d = 0.84, p = .001), but not three-months (d = 0.13, p > .05)., Conclusions: c-MeST may reduce symptoms in youth with MDD when provided alongside other treatments. However, there are significant limitations to this inference, including high attrition in the study and a need for more data on the acceptability of the intervention., Competing Interests: Declaration of competing interest One of the authors, Prof. Filip Raes is one of the developers of face-to-face MeST and of the online, computerized MeST (c-MeST). Prof. Raes has historically received payments for training workshops and presentations related to face-to-face MeST. This has not occurred in the last several years. There are no other competing interests to declare., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

The management of stress has evolved in recent years due to widespread availability of mobile-device applications (apps) and their capacity to deliver psychological interventions. We evaluated the efficacy of mental health apps on stress and sought to identify characteristics associated with effect size estimates. Sixty-nine randomised controlled trials (RCTs) were included. Random effects meta-analyses were performed and putative moderators were examined at univariate and multivariate (combinations and interactions) levels. From 78 comparisons, we observed a small but significant pooled effect of apps over control conditions on perceived stress levels ( g  = 0.27; 95% CI = 0.20, 0.34; I 2  = 68%). This effect weakened after taking into account small-study bias according to the trim-and-fill procedure ( g  = 0.10; 95% CI = 0.02, 0.19; I 2  = 78%). Delivery of apps with stress monitoring features produced smaller efficacy estimates, although this association interacted with other trial features (small sample size and inactive control group) in multivariate analyses, suggesting that this effect may have been explained by features characteristic of low-quality trials. Mental health apps appear to have small, acute effects on reducing perceived stress. Future research should shift focus towards identifying change mechanisms, longitudinal outcomes, features that facilitate sustained app usage, and tangible pathways to integrating apps into real-world clinical settings.

Background: Eating disorder (ED) research has embraced a network perspective of psychopathology, which proposes that psychiatric disorders can be conceptualized as a complex system of interacting symptoms. However, existing intervention studies using the network perspective have failed to find that symptom reductions coincide with reductions in strength of associations among these symptoms. We propose that this may reflect failure of alignment between network theory and study design and analysis. We offer hypotheses for specific symptom associations expected to be disrupted by an app-based intervention, and test sensitivity of a range of statistical metrics for identifying this intervention-induced disruption., Methods: Data were analyzed from individuals with recurrent binge eating who participated in a randomized controlled trial of a cognitive-behavioral smartphone application. Participants were categorized into one of three groups: waitlist ( n = 155), intervention responder ( n = 49), and intervention non-responder ( n = 77). Several statistical tests (bivariate associations, network-derived strength statistics, network invariance tests) were compared in ability to identify change in network structure., Results: Hypothesized disruption to specific symptom associations was observed through change in bivariate correlations from baseline to post-intervention among the responder group but were not evident from symptom and whole-of-network based network analysis statistics. Effects were masked when the intervention group was assessed together, ignoring heterogeneity in treatment responsiveness., Conclusion: Findings are consistent with our contention that study design and analytic approach influence the ability to test network theory predictions with fidelity. We conclude by offering key recommendations for future network theory-driven interventional studies.

Background: Psychological interventions are a promising area for fatigue management in patients with inflammatory bowel disease (IBD). However, most interventions trialled to date have been pilots with limited direct input from patients about the type of intervention they want. Thus, this study aimed to explore patient preferences for a psychological IBD fatigue intervention., Methods: An international online cross-sectional survey was conducted with adults with self-reported IBD. A conjoint analysis was employed to elicit, through a series of forced-choice scenarios, patient preferences for a fatigue intervention. For this study, the attributes manipulated across these forced-choice scenarios were type of intervention, modality of delivery, and duration of intervention., Results: Overall, 834 people with IBD were included in analysis. Respondents ranked the type of psychological intervention as most important for overall preference (with cognitive-behavioral therapy (CBT) preferred over the other approaches), followed by modality of delivery, but placed very little importance on how long the intervention runs for. Patients with IBD appear to most strongly preference a short online CBT intervention for managing their IBD-related fatigue., Conclusion: This study helps provide therapists and program developers clear direction on patient preferences when it comes to developing new psychological programs that address fatigue in IBD., (© 2024. The Author(s).)

Objective: A growing body of research, primarily cross-sectional, suggests a relationship between the practice of tracking one's food intake and exercise behaviors using fitness-tracking smartphone applications ("apps") or wearable devices ("wearables") and disordered eating symptomatology. The aim of the present study was to explore longitudinal relationships between fitness tracking and disordered eating outcomes among college-aged women, as well as to determine whether the individual-level risk factors of pre-existing eating concerns, perfectionism, and rumination about food moderated the relationship., Method: N = 68 female undergraduates used the MyFitnessPal app for 8 weeks while completing a series of self-report measures., Results: At the trait level, fitness tracking frequency was positively associated with weight/shape concerns, but not with the other outcome measures. Daily levels of fitness tracking did not predict next-day levels for any of the outcome measures. Within-day fitness tracking at one timepoint was associated with lower reports of dietary restraint efforts at the next timepoint. None of the proposed moderators significantly interacted with the relationships over time., Discussion: These results suggest that while those who engage in fitness tracking may experience higher weight/shape concerns as a trait, over time fitness tracking was not associated with an increase in concerns. Further work exploring whether fitness tracking may affect particular subgroups in different ways is warranted., (© 2024 The Authors. International Journal of Eating Disorders published by Wiley Periodicals LLC.)

Background: Difficulties with inhibitory control have been identified in eating disorders (EDs) and neurodevelopmental disorders (NDs; including attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder), and there appear to be parallels between the expression of these impairments. It is theorised that impairments in inhibitory control within NDs may represent a unique vulnerability for eating disorders (EDs), and this same mechanism may contribute to poorer treatment outcomes. This review seeks to determine the state of the literature concerning the role of inhibitory control in the overlap of EDs and neurodivergence., Method: A scoping review was conducted to summarise extant research, and to identify gaps in the existing knowledge base. Scopus, Medline, PsycInfo, Embase, and ProQuest were systematically searched. Studies were included if the study measured traits of ADHD or autism, and symptoms of ED, and required participants to complete a performance task measure of inhibitory control. Where studies included a cohort with both an ND and ED, these results had to be reported separately from cohorts with a singular diagnosis. Studies were required to be published in English, within the last 10 years., Results: No studies explored the relationship between autism and EDs using behavioural measures of inhibitory control. Four studies exploring the relationship between ADHD and EDs using behavioural measures of inhibitory control met selection criteria. These studies showed a multifaceted relationship between these conditions, with differences emerging between domains of inhibitory control. ADHD symptoms predicted poorer performance on measures of response inhibition in a non-clinical sample; this was not replicated in clinical samples, nor was there a significant association with EDs. Both ADHD and ED symptoms are associated with poor performance on attentional control measures; where these diagnoses were combined, performance was worse than for those with a singular diagnosis of ADHD. This was not replicated when compared to those with only ED diagnoses., Conclusion: Impairments in attentional control may represent a unique vulnerability for the development of an ED and contribute to poor treatment outcomes. Further research is needed to explore the role of inhibitory control in EDs, ADHD and autism, including the use of both self-report and behavioural measures to capture the domains of inhibitory control., (© 2024. The Author(s).)

Background: The bidirectional relationship between inflammatory bowel disease (IBD) flare-ups and depression/anxiety symptoms has prompted investigations into psychotherapy to improve health-related quality of life (HRQoL) by targeting depression and anxiety. Acceptance commitment therapy (ACT) is effective in improving symptoms of depression and anxiety in people with chronic diseases, yet minimal research has examined ACT's effectiveness for IBD. This study examines the feasibility, acceptability, and preliminary efficacy of the ACTforIBD program, an online program codesigned with consumers to deliver ACT to those with IBD., Methods: Adults with IBD and symptoms of mild-moderate distress were randomized to ACTforIBD or an active control (psychoeducation) condition. Participants completed 8 weekly, 1-hour sessions, 4 of which were therapist facilitated. Feasibility was based on recruitment and retention and acceptability was derived from postprogram satisfaction measures. Preliminary efficacy was determined by group differences in rate of change in study outcomes from baseline to postprogram., Results: Of 62 participants (89% women, 11% men; mean age  33 years), 55 completed the program (ACTforIBD: n = 26 [83.9%]; active control: n = 29 [93.5%]). Adherence and acceptability were high in the ACTforIBD group, with 80% of participants completing all self-directed modules and 78% of participants expressing satisfaction with the program. Significant and marginally significant group × time interactions were found for anxiety symptoms (b = -1.89; 95% confidence interval, -3.38 to -0.42) and psychological HRQoL (b = -0.04; 95% confidence interval, -0.07 to 0.01), showing decreased anxiety and increased psychological HRQoL in the intervention group., Conclusions: ACTforIBD is feasible, acceptable, and improved anxiety symptoms, and psychological HRQoL. This highlights the need for a full-scale randomized controlled trial to further examine the program's efficacy., (© 2023 Crohn’s & Colitis Foundation. Published by Oxford University Press on behalf of Crohn’s & Colitis Foundation.)

The current study explored perspectives of those with inflammatory bowel disease (IBD) and comorbid anxiety and/or depression on a hybrid acceptance and committment therapy (ACT) intervention, compared to an active control. This qualitative study was nested within a randomized controlled trial (RCT) where an experimental group received an 8-week blended delivery ACTforIBD intervention (four sessions telehealth, four sessions pre-recorded self-directed), while an active control group received a psychoeducation program of similar intensity. Semi-structured interviews were conducted post-intervention and at a 3-month follow-up. Themes were interpreted using reflexive thematic analysis. Twenty individuals participated; ten in each condition. Seven themes were constructed, including three shared themes between groups: I Am Worth Advocating For, Present Moment Is My Biggest Ally, and Ambivalence About Self-Directed Modules. Two themes were identified for the ACTforIBD group: Symptoms Are Going to Happen and Moving Toward Values while two themes identified from the ActiveControl group were: Reset and Refresh and It's Ok to Say No. Acceptance and values modules from ACTforIBD were perceived as useful in reducing psychological distress for those with IBD, while the ActiveControl group felt their program affirmed existing effective coping strategies. Access to external resources for self-directed modules and networking may increase engagement with content long term., (© 2024. The Author(s).)

Causal inference is often the goal of psychological research. However, most researchers refrain from drawing causal conclusions based on non-experimental evidence. Despite the challenges associated with producing causal evidence from non-experimental data, it is crucial to address causal questions directly rather than avoiding them. Here we provide a clear, non-technical overview of the fundamental concepts (including the counterfactual framework and related assumptions) and tools that permit causal inference in non-experimental data, intended as a starting point for readers unfamiliar with the literature. Certain tools, such as the target trial framework and causal diagrams, have been developed to assist with the identification and reduction of potential biases in study design and analysis and the interpretation of findings. We apply these concepts and tools to a motivating example from the body image field. We assert that more precise and detailed elucidation of the barriers to causal inference within one's study is arguably a key first step in the enhancement of non-experimental research and future intervention development and evaluation., Competing Interests: Declaration of Competing Interest None., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objectives: The current study aimed to investigate the impact of oxytocin on emotion recognition, trust, body image, affect, and anxiety and whether eating disorder (ED) symptoms moderated any of these relationships., Method: Participants (n = 149) were female university students, who were randomly allocated to receive in a double-blind nature, a single dose of oxytocin intranasal spray (n = 76) or a placebo (saline) intranasal spray (n = 73). Participants were asked to complete an experimental measure of emotion recognition and an investor task aimed to assess trust., Results: The oxytocin group exhibited better overall performance on the emotion recognition task (especially with recognising positive emotions), and a decline in state positive affect than the control group at post-intervention. However, these effects were not moderated by ED symptom severity, nor were effects found for state anxiety, negative affect, body image and recognising negative emotions in the emotion recognition task., Conclusion: The current findings contribute to the growing literature on oxytocin, emotion recognition and positive affect and suggest that ED pathology does not moderate these relationships. Future research would benefit from examining the efficacy of an oxytocin intervention using a within-subjects, cross-over design, in those with sub-clinical and clinical EDs, as well as healthy controls., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Krug et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Impairments in empathy are well established in anorexia nervosa (AN). It is unclear, however, whether these deficits only occur in the acute phases of AN due to neurocognitive impacts of starvation (often referred to as context-dependent, or state-like), or if deficits remain once remission has been achieved (trait-like). This debate is commonly referred to as the 'state vs trait' debate., Objective: This systematic review aims to summarise existing literature regarding empathy in AN, and to investigate whether empathy deficits in AN are state- or trait-based., Method: A total of 1014 articles were identified, and seven articles remained after the screening process. These seven articles, comparing empathy across three groups (acute AN, remission of AN, and non-clinical controls), were evaluated and summarised in accordance with PRISMA guidelines. Articles were required to have included all three groups and report on either cognitive empathy and/or emotional empathy., Results: The majority of studies were of satisfactory quality. The results identified were inconsistent, with few articles lending some support to the 'state' hypothesis and others producing nonsignificant results., Conclusions: There is minimal literature comparing empathy in acute and remission phases of AN. While there were some inconsistencies in included articles, some data indicate that there may be slight improvements to emotional and cognitive empathy following recovery of AN. Further research is needed to better enrich knowledge regarding the role of state vs trait with regard to neurocognitive difficulties experienced by individuals with AN., Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display&#95;record.php?RecordID=335669, identifier CRD42022335669., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Gray, Enticott, Fuller-Tyszkiewicz and Kirkovski.)

Objective: Digital interventions show promise as an effective prevention or self-management option for eating disorders (EDs). However, it remains unclear how, for whom, and through what mechanisms they work in this population, as a synthesis of outcome predictors, moderators, and mediators is lacking. This systematic review synthesized empirical research investigating predictors, mediators, and moderators of response to digital interventions for EDs., Method: Six databases were searched (PROSPERO CRD42022295565) for studies that assessed predictors, moderators, or mediators of response (i.e., uptake, drop-out, engagement, and symptom level change) to a digital prevention or treatment program for EDs. Variables were grouped into several overarching categories (demographic, symptom severity, psychological, etc.) and were synthesized qualitatively across samples without a formally diagnosed ED (typically prevention-focused) and samples with a formally diagnosed ED (typically treatment-focused)., Results: Eighty-six studies were included. For studies recruiting samples without a formal diagnosis (n = 70 studies), most predictors explored were statistically unrelated to outcome, although participant age, baseline symptom severity, confidence to change, motivation, and program engagement showed preliminary evidence of prognostic potential. No robust moderators or mediators were identified. Few studies recruiting samples with a formal diagnosis emerged (n = 16), of which no reliable predictors, moderators, or mediators were identified., Discussion: It remains unclear how, for whom, and under what circumstances digital programs targeting EDs work. We offer several recommendations for future research with the aim of advancing understanding of client characteristics and intervention elements that signal success from this intervention modality., Public Significance: Digital interventions have shown potential as an effective, scalable, and accessible intervention option for EDs. However, responsiveness varies, so advancing understanding of predictors, mediators, and moderators of outcome to digital interventions for EDs is needed. Such knowledge is important for enabling safe and efficient treatment matching, and for informing future development of effective digital interventions., (© 2023 The Authors. International Journal of Eating Disorders published by Wiley Periodicals LLC.)

Objective: Our ability to predict responsiveness to digital interventions for eating disorders has thus far been poor, potentially for three reasons: (1) there has been a narrow set of predictors explored; (2) prediction has mostly focused on symptom change, ignoring other aspects of the user journey (uptake, early engagement); and (3) there is an excessive focus on the unique effects of predictors rather than the combined contributions of a predictor set. We evaluated the univariate and multivariate effects of outcome predictors in the context of a randomized trial (n = 398) of digitally delivered interventions for recurrent binge eating., Method: Thirty baseline variables were selected as predictors, ranging from specific symptoms, to key protective factors, to technological acceptance, and to online treatment attitudes. Outcomes included uptake, early engagement, and remission. Univariate (d) and multivariate (D) standardized mean differences were calculated to estimate the individual and combined effects of predictors, respectively., Results: At the univariate level, few predictors produced an effect size larger than what is considered small (d > .20) across outcomes. However, our multivariate approach enhanced prediction (Ds = .65 to 1.12), producing accuracy rates greater than chance (63%-71% accuracy). Less than half of the chosen variables proved to be useful in contributing to predictions in multivariate models., Conclusion: Findings suggest that accuracy in outcome prediction from digitally delivered interventions may be better driven by the aggregation of many small effects rather than one or several largely influential predictors. Replication with different data streams (sensor, neuroimaging) would be useful., Public Significance: Our ability to predict who will and will not benefit from digital interventions for eating disorders has been poor. We highlight the viability of a multivariate approach to outcome prediction, whereby prediction may be better driven by the aggregation of many small effects rather than one or a few influential predictors., (© 2024 The Authors. International Journal of Eating Disorders published by Wiley Periodicals LLC.)

Eating disorders (EDs) are characterized by multifaceted etiologies, difficulties in accessing care (especially in regional locations), and variable responsiveness to treatments. Digital technologies are viewed as an important innovation in the assessment and treatment of EDs. We discuss current implementation of these innovations as well as important future directions for the field., Competing Interests: Declaration of interests The authors declare no competing interests., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

The interactions between sleep problems, autism symptoms and emotional and behavioural difficulties were explored using network analysis in 240 autistic children (mean age: 8.8 years, range 5-13 years) with moderate to severe sleep problems. Findings revealed a highly connected and interpretable network, with three separate clusters identified of the modelled variables. Depression, anxiety and behavioural difficulties were the most central variables of the network. Depression, anxiety and restricted repetitive and stereotyped patterns behaviours (RRBs) were the strongest bridging variables in the network model, transmitting activation both within and between other symptom clusters. The results highlight that depression and anxiety were highly connected symptoms within the network, suggesting support in these areas could be helpful, as well as future research., (© 2024. The Author(s).)

Recent work has served to dissociate two dimensions of trait body dissatisfaction: body dissatisfaction frequency and body dissatisfaction duration. The present study sought to evaluate whether body dissatisfaction frequency and body dissatisfaction duration are each associated with distinct patterns of appearance-related cognitive processing. It was hypothesized that speeded attentional engagement with idealized bodies is associated with higher frequency of body dissatisfaction episodes, while slowed attentional disengagement from such information may instead be associated with higher duration of body dissatisfaction episodes. Participants (238 women, 149 men) completed an attentional task capable of independently assessing attentional engagement with, and attentional disengagement from, idealized bodies. Participants also completed both trait and in vivo (i.e., ecological momentary assessment) measures of body dissatisfaction frequency and duration. Results showed that neither engagement nor disengagement bias index scores predicted variance in either body dissatisfaction frequency measures or body dissatisfaction duration measures. Findings suggest that either biased attentional engagement with, and disengagement from, idealized bodies do not associate with the frequency and duration of body dissatisfaction episodes, or there are other key moderating factors involved in the expression of body dissatisfaction-linked attentional bias., Competing Interests: Declaration of Competing Interest The authors declare no conflict of interest., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

The coronavirus disease 2019 (COVID-19) pandemic led to a global surge in videoconferencing use for work/study-related reasons. Although these platforms heighten exposure to one's image, the implications of videoconferencing use on body image and eating concerns remain scantly examined. This study sought to investigate, in an Australian sample, whether videoconferencing for work/study-related reasons predicted increases in body dissatisfaction (BD), urge to engage in disordered eating (DE; restrictive eating, exercise, overeating/purging), and negative mood at the state level. Participants (N = 482, 78.8% women, M age  = 20.5 years [SD = 5.3]) completed baseline demographic measures, accompanied by an ecological momentary assessment (EMA) of videoconferencing for work/study-related reasons, BD, DE urges, and negative mood six times a day for 7 days via a smartphone application. Most participants (n = 429; 89.0%) reported state-based videoconferencing use during the EMA phase. Consistent with expectations, state-based videoconferencing use was associated with an increase in state-level urges to engage in exercise. However, contrary to predictions, state-based videoconferencing use was linked to a decrease in state-level BD at the next assessment point and failed to predict negative mood and urges to engage in restrictive eating or overeating/purging at the state level. Given the simplified measure of videoconferencing use, the current research is considered preliminary and future replication and extension, using more nuanced measures, is warranted., (© 2023 The Authors. European Eating Disorders Review published by Eating Disorders Association and John Wiley & Sons Ltd.)

Objectives: Cognitive flexibility and psychological distress, such as depression and anxiety, have been implicated in the aetiology of Anorexia Nervosa (AN). Despite the known associations between eating disorder (ED) symptoms, depression, anxiety, and cognitive flexibility, the specific pathways that connect these constructs are unclear. We therefore used network analysis to examine the relationship between these symptoms in an AN sample., Methods: One hundred and ninety-three treatment-seeking individuals diagnosed with AN (95.6% female, M = 26.89 [SD = 9.45] years old) completed self-report measures assessing depression, anxiety, cognitive flexibility, and ED symptoms. To determine each symptom's influence in the network, we calculated the expected influence., Results: The two relationships with the greatest edges were those between (1) weight/shape concerns and eating/dietary restraint and (2) weight/shape concerns and psychological distress (a measure that combined depression and anxiety). Cognitive flexibility was not connected to weight/shape concerns but had negative partial associations with eating concerns/dietary restraint and psychological distress. There was also a slight, non-zero connection between eating concerns/dietary restraint and psychological distress., Conclusions: The findings underscore the importance of weight/shape, eating/dietary concerns, and psychological distress in the AN network and suggest that addressing cognitive flexibility may be a useful target for eating concerns/dietary restraint and psychological distress. Future studies assessing the longitudinal course of psychopathology within the AN network structure may help in identifying whether specific symptoms function as risk factors or maintaining factors for this co-occurrence., (© 2023 The Authors. British Journal of Clinical Psychology published by John Wiley & Sons Ltd on behalf of British Psychological Society.)

Few studies have examined the effectiveness of self-guided smartphone apps for suicide safety planning, despite their increasing use. Participants (n = 610) were self-selected users of the Beyond Now suicide prevention safety planning app with a history of suicidal thoughts and behaviours. Surveys were completed (baseline, one and three months), safety plan content and app usage data was shared. Repeated-measures ANOVAs examined changes in suicidal ideation and suicide-related coping over three months. Multiple regression models were used to predict suicidal ideation and suicide-related coping at one- and three-month follow-ups with plan-related variables: perceived usefulness, personalised content, app use time and co-authoring of the plan with a third party. Significant reductions in suicidal ideation and increases in suicide-related coping were found over three months. Higher suicide-related coping at three months predicted lower suicidal ideation. Higher perceived usefulness and personalised content at three months were associated with higher suicide-related coping, but not suicidal ideation. App use time and co-authoring were not significantly related to suicidal ideation or suicide-related coping. Practitioners should empower clients to create safety plans with personalised (not generic) strategies that a client perceives to be useful. Such plans may strengthen beliefs about coping with suicidal ideation, which in turn reduces suicidal ideation over time., Competing Interests: Declaration of competing interest At the time of the study, CR and GB were employees of Beyond Blue, who provide the Beyond Now app. GM was a key adviser in the development of the Beyond Now app. GM and RT have conducted paid evaluations of the app at Monash University and Deakin University., (Copyright © 2024. Published by Elsevier B.V.)

Purpose: Evidence shows that dialectical behavioural therapy (DBT) is efficacious for eating disorders (ED), yet few people have access to specialized treatments like DBT. Translating key DBT skills for delivery via a smartphone application may broaden the dissemination of evidence-based interventions. However, prior to developing a DBT-based app, it is crucial to gather information on target-user needs and preferences. Assessing overall acceptance and identifying predictors of acceptance, informed by the UTAUT framework, is also important. This process ensures not only a demand for such an app, but also that users receive content and features tailored to their needs., Method: This study aimed to understand target-user preferences of DBT-based apps for EDs by assessing willingness to engage, overall acceptance levels, and preferred functionality/content delivery modes (n = 326 symptomatic participants)., Results: Eighty-eight percent indicated they would be willing to use a DBT-based ED app if it were available. Acceptance levels of a DBT app were high (64%), which was uniquely predicted by performance expectancy (perceptions of how beneficial an intervention is) and facilitating conditions (expectations of technological infrastructure and support in interventions) in path analysis. Content perceived as important to contain were emotion regulation techniques, tailored intervention strategies, and psychoeducation., Conclusion: Findings generate important information about target-user preferences of a DBT-based app for EDs, highlighting necessary design principles for apps of this kind. Level of evidence Level V, cross-sectional descriptive study., (© 2024. The Author(s).)

This study examined the sustained and moderating effects of a behavioural sleep intervention for autistic children in a randomised controlled trial. Autistic children (5-13 years) with sleep problems were randomised to the Sleeping Sound intervention or Treatment as Usual (TAU). At 12-month follow-up (n = 150), caregivers of children in the Sleeping Sound group reported greater reduction in child sleep problems compared to TAU (p < .001, effect size: - 0.4). The long-term benefits of the intervention were greater for children taking sleep medication, children of parents who were not experiencing psychological distress, and children with greater autism severity. The Sleeping Sound intervention demonstrated sustained improvements in child sleep. Identified moderators may inform treatment by indicating which subgroups may benefit from further support., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Mindfulness apps have become popular tools for addressing symptoms of depression and anxiety. Since the publication of earlier meta-analyses evaluating the efficacy of mindfulness apps for depression and anxiety symptoms, over 20 randomized controlled trials (RCTs) have been conducted. There is a need for an updated meta-analysis that quantifies the effects of mindfulness apps on these symptoms and tests for potential moderators.. Random effects meta-analyses were conducted on 45 RCTs. Small, significant effect sizes were found for symptoms of depression (N comp  = 46, N = 5852, g = 0.24, 95% CI = 0.17, 0.31, NNT = 13.57) and anxiety (N comp  = 48, N = 6082, g = 0.28, 95% CI = 0.21, 0.35, NNT = 11.47) in favour of mindfulness apps over control groups. This effect was not explained by symptom deterioration in participants allocated to control groups. Effects remained stable when restricting analyses to lower risk of bias and larger sample trials. No significant moderators were observed, except trials that offered monetary compensation produced larger effects on depression. Non-significant effects were observed when comparing mindfulness apps to active therapeutic comparisons (g = -0.15 depression, g = 0.10 anxiety), though the number of studies was low. Growing evidence indicates that mindfulness apps can acutely reduce symptoms of depression and anxiety, although higher quality studies with longer follow-ups are needed., Competing Interests: Declaration of Competing Interest The authors declare no conflict of interest., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

The mental health care available for depression and anxiety has recently undergone a major technological revolution, with growing interest towards the potential of smartphone apps as a scalable tool to treat these conditions. Since the last comprehensive meta-analysis in 2019 established positive yet variable effects of apps on depressive and anxiety symptoms, more than 100 new randomized controlled trials (RCTs) have been carried out. We conducted an updated meta-analysis with the objectives of providing more precise estimates of effects, quantifying generalizability from this evidence base, and understanding whether major app and trial characteristics moderate effect sizes. We included 176 RCTs that aimed to treat depressive or anxiety symptoms. Apps had overall significant although small effects on symptoms of depression (N=33,567, g=0.28, p<0.001; number needed to treat, NNT=11.5) and generalized anxiety (N=22,394, g=0.26, p<0.001, NNT=12.4) as compared to control groups. These effects were robust at different follow-ups and after removing small sample and higher risk of bias trials. There was less variability in outcome scores at post-test in app compared to control conditions (ratio of variance, RoV=-0.14, 95% CI: -0.24 to -0.05 for depressive symptoms; RoV=-0.21, 95% CI: -0.31 to -0.12 for generalized anxiety symptoms). Effect sizes for depression were significantly larger when apps incorporated cognitive behavioral therapy (CBT) features or included chatbot technology. Effect sizes for anxiety were significantly larger when trials had generalized anxiety as a primary target and administered a CBT app or an app with mood monitoring features. We found evidence of moderate effects of apps on social anxiety (g=0.52) and obsessive-compulsive (g=0.51) symptoms, a small effect on post-traumatic stress symptoms (g=0.12), a large effect on acrophobia symptoms (g=0.90), and a non-significant negative effect on panic symptoms (g=-0.12), although these results should be considered with caution, because most trials had high risk of bias and were based on small sample sizes. We conclude that apps have overall small but significant effects on symptoms of depression and generalized anxiety, and that specific features of apps - such as CBT or mood monitoring features and chatbot technology - are associated with larger effect sizes., (© 2024 World Psychiatric Association.)

Objective: To validate the original and a shortened version of the Detail and Flexibility (DFlex) Questionnaire., Method: Confirmatory factor analyses, internal consistency, and discriminant validity estimates were conducted within individuals with a diagnosis of an eating disorder (ED) (n = 124), an anxiety disorder and/or depression (n = 219), and a community sample (n = 852) (Part 1). Convergent validity of the DFlex through comparisons with the Autism Spectrum Quotient, Wisconsin Card Sorting Task, and Group Embedded Figures Task was undertaken within a combined ED and community sample (N = 68). Test-retest reliability of the DFlex was also examined across 2 years in a community sample (N = 85) (Part 2)., Results: The original factor structure of the DFlex was not supported. Hence, a shortened version, the DFlex-Revised, was developed. Good discriminant validity was obtained for the DFlex and DFlex-Revised, however, support for convergent validity was mixed. Finally, the 2-year test-retest reliability for the two DFlex versions was found to be low, suggesting potential malleability in construct over this timeframe., Conclusions: Further research is needed to validate the DFlex in clinical and non-clinical populations using different neurocognitive tests. Test-retest, using varied time intervals, should also be assessed., (© 2023 The Authors. European Eating Disorders Review published by Eating Disorders Association and John Wiley & Sons Ltd.)