Motivation is an important predictor of change in anorexia nervosa and preliminary evidence is provided that motivation can be improved in this population. Further investigations, however, of ways of improving motivation in this population need to be conducted, along with the impact of motivational changes on treatment outcome.

BackgroundSleep disturbances are common in young people and have consequences for academic, social, emotional, and behavioral development. The most effective treatment is cognitive behavioral therapy for insomnia (CBT-I), with evidence suggesting that it is efficacious even when delivered digitally.ObjectiveThere are no commercially available digitally delivered CBT-I programs for use by young people. The aim of this project was to develop a smartphone app that delivers CBT-I to young people to improve sleep.MethodsTo inform the development of the app, young people (N=21) aged between 12 and 16 years attended one of the 3 focus groups (each with 4-10 participants). These focus groups were conducted at different stages of the development process such that the process could be iterative. Participants were asked the reasons why they might use an app to help them sleep, the kinds of features or functions that they would like to see in such an app, and any concerns they may have in using the app. Data were analyzed using a thematic analysis approach. Of the issues discussed by the participants, the researchers selected themes associated with content, functionality, and accessibility and user experience to examine, as these were most informative for the app design process.ResultsIn terms of content, young people were interested in receiving information about recommended sleep guidelines and personalized information for their age group. They reported that keeping a sleep diary was acceptable, but they should be able to complete it flexibly, in their own time. They reported mixed views about the use of the phone’s accelerometer. Young people felt that the functionality of the app should include elements of game playing if they were to remain engaged with the app. Flexibility of use and personalized features were also desirable, and there were mixed views about the schedule of notifications and reminders. Participants reported that for the app to be accessible and usable, it should be from a trusted developer, have engaging aesthetics, have a layout that is easy to navigate, not rely on Internet coverage, and preferably be free. Participants felt that being able to conceal the purpose of the app from peers was an advantage and were willing to provide personal information to use the app if the purpose and use of that information was made clear. Overall, participants endorsed the use of the app for sleep problems among their age group and reported motivation to use it.ConclusionsThe Sleep Ninja is a fully-automated app that delivers CBT-I to young people, incorporating the features and information that young people reported they would expect from this app. A pilot study testing the feasibility, acceptability, and efficacy of the Sleep Ninja is now underway.

Written emotional expression using Pennebaker's paradigm has been shown to produce significant improvements in health and psychological functioning in student groups and some clinical groups. This paradigm has not been examined with respect to disordered eating or its associated psychopathology. The current study examined 98 female university students (mean age ¼ 22.75 years, SD ¼ 8.31) who were randomly assigned to either an emotional expression writing condition relating to past trauma, or a control writing condition that focused on future planning. The students repeated the writing task on three occasions in 1 week. All measures were completed at baseline and 10-week follow-up; measures of distress were additionally completed after each occasion of writing. A significant two-way interaction was found for ineffectiveness and disordered eating showing both variables to decrease in the planning compared to the emotional expression condition over time. A significant threeway interaction for externalised self-perception showed different levels of denial coping affected the helpfulness of both writing paradigms. Investigation of a variety of forms of structured therapeutic writing is advocated with clinical eating disorder populations.