We report a systematic review of moderators of CBT efficacy for pediatric OCD relative to other treatments. CENTRAL, MEDLINE, EMBASE, CINAHL, and PsycINFO were searched for RCTs reporting on effect moderation for CBT outcomes. Five studies (N = 365) examined 17 variables with three significant moderators identified. Compared to pill-placebo, CBT monotherapy was not effective for children with a family history of OCD but was for those without a family history. For children with a family history, CBT plus sertraline efficacy was attenuated but remained significant. For children with tics, CBT but not sertraline remained superior to pill-placebo. For non-responders to initial treatment with CBT, continuing CBT was inferior to commencing sertraline for those with tics but was not different for those without tics. A supplementary review identified older age, symptom and impairment severity, co-morbidity and family accommodation as consistent predictors of a poorer outcome to CBT. Current evidence for moderation effects is post-hoc, from single RCTs, has small Ns and requires replication. The review identifies family history of OCD and the presence of tics as factors requiring further examination in properly conducted trials and about which clinicians need to show care in their treatment recommendations.
Background
App-based interventions designed to prevent and treat eating disorders have considerable potential to overcome known barriers to treatment seeking. Existing apps have shown efficacy in terms of symptom reduction; however, uptake and retention issues are common. To ensure that apps meet the needs and preferences of those for whom they were designed, it is critical to understand the lived experience of potential users and involve them in the process of design, development, and delivery. However, few app-based interventions are pretested on and co-designed with end users before randomized controlled trials.
Objective
To address the issue, this study used a highly novel design thinking approach to provide the context and a lived experience perspective of the end user, thus allowing for a deeper level of understanding.
Methods
In total, 7 young women (mean age 25.83, SD 5.34, range 21-33 years) who self-identified as having a history of body image issues or eating disorders were recruited. Participants were interviewed about their lived experience of body image and eating disorders and reported their needs and preferences for app-based eating disorder interventions. Traditional (thematic analysis) and novel (empathy mapping; visually depicting and empathizing with the user’s personal experience) analyses were performed, providing a lived experience perspective of eating disorders and identifying the needs and preferences of this population in relation to app-based interventions for eating disorders. Key challenges and opportunities for app-based eating disorder interventions were also identified.
Results
Findings highlighted the importance of understanding and identifying problematic eating disorder symptoms for the user, helpful practices for recovery that identify personal values and goals, the role of social support in facilitating hope, and aspects of usability to promote continued engagement and recovery.
Conclusions
Practical guidance and recommendations are described for those developing app-based eating disorder interventions. These findings have the potential to inform practices to enhance participant uptake and retention in the context of app-based interventions for this population.
Background. Contemporary scholarship has established that increasing numbers of men are experiencing body dissatisfaction. However, as a consequence of the enduring assumption that body dissatisfaction is a feminine domain, male body dissatisfaction is associated with considerable stigma. Objective. The current study aimed to explore and describe men's experience with body dissatisfaction and investigate sociocultural influences in the context of male body image. Of particular interest was to obtain, from men, perceptions of stigma and gender bias relating to male body dissatisfaction. Methods. Seven focus groups were conducted with a total of 40 Australian male university students, aged between 17-53 years (M=20.40; SD = 6.31). To analyse the data, two independent raters adhered to Braun and Clarke's (2006) protocol for thematic analysis. Results. Seven themes were identified: 1) Body dissatisfaction is less dangerous for men compared to women, 2) Lack of representation of male body dissatisfaction in the media, 3) Friendship group norms influence appearance investment, 4) Steroids as dangerous and socially undesirable, 5) Muscles signal dedication, but not intellect, 6) Masculine norms obstruct disclosure of body dissatisfaction, and 7) Professional help as a last resort. Conclusions. Participants' responses illustrate the importance of gender norms in the context of male body image, highlight the influence of peers on appearance investment, and reflect that appearance concerns and emotional expression continue to be associated with femininity (and thus, are undesirable for men). Key points 1. Male body dissatisfaction was perceived as less normative, associated with less risk, and treated with less sensitivity in social discourse than female body dissatisfaction.
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