Objective-To examine acceptability, attrition, adherence, and preliminary efficacy of mobile phone short message service (SMS; text messaging) for monitoring healthy behaviors in children.Design-All randomized children received a brief psychoeducational intervention and then either monitored target behaviors via SMS with feedback, via paper diaries (PD), or participated in a nomonitoring control (C) for 8 weeks. Setting-University of North Carolina at Chapel Hill HospitalsParticipants-Fifty-eight children (age 5 -13) and parents participated; 31 completed (SMS: 13/18, PD: 7/18, C: 11/22).Intervention-Children and parents participated in a total of three group education sessions (one session weekly for three weeks) to encourage increasing physical activity and decreasing screen time and sugar sweetened beverage consumption.Main Outcome Measures-Treatment acceptability, attrition, and adherence to self-monitoring. Analysis-Descriptive statistics and nonparametric tests were used to analyze differences across time and group.Results-Children in SMS had somewhat lower attrition (28%) than both PD (61%) and C (50%), and significantly greater adherence to self-monitoring than PD (43% vs 19%, p < 0.02).Conclusions and Implications-SMS may be a useful tool for self-monitoring healthy behaviors in children although the efficacy of this approach needs further study. Implications suggest that novel technologies may play a role in improving health.

Bulimia nervosa (BN) is characterized by symptoms of binge eating and compensatory behavior, and overevaluation of weight and shape, which often co-occur with symptoms of anxiety and depression. However, there is little research identifying which specific BN symptoms maintain BN psychopathology and how they are associated with symptoms of depression and anxiety. Network analyses represent an emerging method in psychopathology research to examine how symptoms interact and may become self-reinforcing. In the current study of adults with a DSM-IV diagnosis of BN (N = 196), we used network analysis to identify the central symptoms of BN, as well as symptoms that may bridge the association between BN symptoms and anxiety and depression symptoms. Results showed that fear of weight gain was central to BN psychopathology, whereas binge eating, purging, and restriction were less central in the symptom network. Symptoms related to sensitivity to physical sensations (e.g., changes in appetite, feeling dizzy, wobbly) were identified as bridge symptoms between BN, and anxiety and depressive symptoms. We discuss our findings with respect to cognitive-behavioral treatment approaches for BN. These findings suggest that treatments for BN should focus on fear of weight gain, perhaps through exposure therapies. Further, interventions focusing on exposure to physical sensations may also address BN psychopathology, as well as co-occurring anxiety and depressive symptoms.

Summary Objective Maintaining weight loss results in childhood obesity treatment is difficult to achieve. Self‐management techniques such as self‐monitoring are associated with increased weight loss and maintenance. This study analyzes whether self‐monitoring of lifestyle behaviours through a short message service maintenance treatment (SMSMT) via mobile phones with personalized feedback positively effects weight, lifestyle behaviours and psychological well‐being in obese children. Methods After 3 months of behavioural lifestyle treatment, 141 overweight and obese children (7–12 years) were randomly assigned to an intervention group receiving SMSMT for 9 months (n = 73) or to the control group (n = 68). The intervention group sent weekly self‐monitoring data on exercise and eating behaviour and their mood via mobile phones. In return, they received tailored feedback messages. Primary treatment outcomes were weight, eating behaviour and psychological well‐being, i.e. competence, self‐esteem and quality of life. Secondary outcome was adherence to the SMSMT. Data were analyzed with mixed modelling. Results SMSMT did not improve treatment outcomes. Controls gained temporarily in physical health scores (P = 0.01). SMSMT completers sent on average every 2 weeks an SMS. Children who had greater weight loss during the first 3 months of lifestyle treatment sent more SMSs (P = 0.04). Conclusions We did not find a positive effect of SMSMT on weight, eating behaviour or psychological well‐being in obese children. SMSMT seems to be a feasible method of treatment delivery. Future research should study variations of SMSMT to investigate how SMSMT can be more effective.

In a consensus-building process a group of experts from 19 European countries (COST Action B6) adapted the terms partial and full remission, relapse, recovery, and recurrence according to principles described by Frank et al. for depression. The empirical validity of the operationalizations was illustrated by longitudinal data on the post treatment course of 233 anorectic and 422 bulimic patients (diagnosed according to DSM-IIIR) from the German Project TR-EAT. These data were collected 2.5 years after admission using the Longitudinal Interval Follow-up Evaluation (LIFE) and statistically explored by survival-analysis. It was demonstrated that these consensus definitions measure what they intend to measure. They open a longitudinal perspective in that one can learn not only whether, but also when and with what probability patients change for the better or worse. Data suggest that persistence of symptom improvement has different implications for anorexia and bulimia nervosa. For example, relapse prevention would be most beneficial for bulimic patients for about 4 months after key symptoms remit, while this would be of less importance for anorexic patients. It is discussed whether and how this longitudinal approach can contribute to an empirically based rationale for targeted and individualized treatment.

The aftercare intervention was efficacious in enhancing treatment outcome after discharge from inpatient treatment.

The paper introduces the construction and scoring principles of the Short Evaluation of Eating Disorders (SEED), which was developed for the assessment of the key eating disorders symptoms. The questionnaire uses six items and allows the calculation of two severity indices for anorexia and bulimia nervosa symptoms. Data from two patient and one non-patient sample as well as therapist ratings are used to investigate different validity aspects of the SEED. Overall, the analyses underline the validity of the instrument. Recommendations for future research activities on the SEED are outlined.

The development of a text messaging (SMS) based intervention for the aftercare treatment of bulimia nervosa is reported. The programme is offered to bulimic patients for 6 months following discharge from inpatient psychotherapy in a German hospital for psychosomatic medicine. The intervention consists of weekly messages from the patients on their bulimic symptomatology and a corresponding weekly feedback that is a mixture of pre-programmed parts and individually tailored information. An ongoing pilot study is described, designed to investigate the acceptance, the practicability, and the effectiveness of the intervention. Preliminary results indicate that the programme is well-accepted and gives support to bulimic patients after finishing inpatient treatment. Advantages and limitations of the use of the SMS intervention programme in the treatment of bulimia nervosa are discussed.

Objective: Although cognitive-behavioral therapy (CBT) represents the first-line evidence-based psychotherapy for bulimia nervosa (BN), most individuals seeking treatment do not have access to this specialized intervention. We compared an Internet-based manualized version of CBT group therapy for BN conducted via a therapeutic chat group (CBT4BN) to the same treatment conducted via a traditional face-to-face group therapy (CBTF2F). Method: In a two-site, randomized, controlled noninferiority trial, we tested the hypothesis that CBT4BN would not be inferior to CBTF2F. A total of 179 adult patients with BN (2.6% males) received up to 16 sessions of group CBT over 20 weeks in either CBT4BN or CBTF2F, and outcomes were compared at the end of treatment and at the 12-month follow-up. Results: At the end of treatment, CBT4BN was inferior to CBTF2F in producing abstinence from binge eating and purging. However, by the 12-month follow-up, CBT4BN was mostly not inferior to CBTF2F. Participants in the CBT4BN condition, but not CBTF2F, continued to reduce their binge-eating and purging frequency from the end of treatment to the 12-month follow-up. Conclusions: CBT delivered online in a group chat format appears to be an efficacious treatment for BN, although the trajectory of recovery may be slower than face-to-face group therapy. Online chat groups may increase accessibility of treatment and represent a cost-effective approach to service delivery. However, barriers in service delivery such as state-specific license and ethical guidelines for online therapists need to be addressed.