BackgroundWeb-based cognitive-behavioral therapeutic (CBT) apps have demonstrated efficacy but are characterized by poor adherence. Conversational agents may offer a convenient, engaging way of getting support at any time.ObjectiveThe objective of the study was to determine the feasibility, acceptability, and preliminary efficacy of a fully automated conversational agent to deliver a self-help program for college students who self-identify as having symptoms of anxiety and depression.MethodsIn an unblinded trial, 70 individuals age 18-28 years were recruited online from a university community social media site and were randomized to receive either 2 weeks (up to 20 sessions) of self-help content derived from CBT principles in a conversational format with a text-based conversational agent (Woebot) (n=34) or were directed to the National Institute of Mental Health ebook, “Depression in College Students,” as an information-only control group (n=36). All participants completed Web-based versions of the 9-item Patient Health Questionnaire (PHQ-9), the 7-item Generalized Anxiety Disorder scale (GAD-7), and the Positive and Negative Affect Scale at baseline and 2-3 weeks later (T2).ResultsParticipants were on average 22.2 years old (SD 2.33), 67% female (47/70), mostly non-Hispanic (93%, 54/58), and Caucasian (79%, 46/58). Participants in the Woebot group engaged with the conversational agent an average of 12.14 (SD 2.23) times over the study period. No significant differences existed between the groups at baseline, and 83% (58/70) of participants provided data at T2 (17% attrition). Intent-to-treat univariate analysis of covariance revealed a significant group difference on depression such that those in the Woebot group significantly reduced their symptoms of depression over the study period as measured by the PHQ-9 (F=6.47; P=.01) while those in the information control group did not. In an analysis of completers, participants in both groups significantly reduced anxiety as measured by the GAD-7 (F1,54= 9.24; P=.004). Participants’ comments suggest that process factors were more influential on their acceptability of the program than content factors mirroring traditional therapy.ConclusionsConversational agents appear to be a feasible, engaging, and effective way to deliver CBT.

Objective: Family-based treatment (FBT) is an evidence-based treatment for adolescent anorexia nervosa (AN), but many families cannot access it. This study evaluated feasibility, acceptability, and preliminary treatment effects of a parental guided self-help (GSH) version of FBT for adolescent AN.Method: This was a case-series design. Parents of medically stable adolescents (11-18 years) with DSM-5 AN were recruited over 12 months. Parents received online training in parental GSH FBT and 12 20-30 min GSH sessions by phone or online over 6 months. Recruitment, dropout, changes in weight, and eating-related psychopathology were assessed. Analyses used mixed modeling that included all data for all participants.Results: Of the 19 families that participated, most were white (94%) and from intact families (88%). Baseline median BMI (mBMI) percent was 85.01% (SD 5 4.31). Participants' mBMI percent increased to 97.31% (SD 6 7.48) at the end of treatment (EOT) (ES 5 2.06; CI5 0.13-3.99).Eating-related psychopathology improved by EOT (ES 5 0.58; CI5.04-1.21). Dropout rate was 21% during treatment and 33% during follow-up.Discussion: Parental GSH-FBT is feasible and acceptable to families willing to undertake online treatment. Follow-up data was only available for nine families (47%); thus further systematic evaluation is required before reaching conclusions about the efficacy of this approach. K E Y W O R D Sanorexia nervosa, family based treatment, guided self-helpeither EOT or FU.Linear mixed model analyses revealed that mBMI as well as parental sense of self-efficacy to combat AN significantly improved by EOT and these improvements persisted during the 3 month FU. See Table 1 for details on outcome measures. At EOT, 68% (N 5 13) of adolescents were weight remitted (i.e., mBMI > 94%), 26% (N 5 5) were partially remitted but not fully weight restored (i.e., 85%94% mBMI 1 EDE-Q within 1SD of community mean) was 45.5% (n 5 5), partial recovery (weight > 85% mBMI) was 45.5% (N 5 5), and one participant was unrecovered at EOT. Of the available data on nine participants at FU, 78% (N 5 7) were weight remitted and 22% (N 5 2) were partially remitted. Out of the 8 participants for whom follow-up data included both weight and EDE-Q scores, 37.5% were recoverd (N 5 3) and the remainder (62.5%; N 5 5)were categorized as partially recovered. | DISCUSSIONThis study examined the feasibility, acceptability, and clinical outcome of adolescents with AN treated by parental GSH-FBT. The study suggests that parental GSH-FBT is likely feasible because 73% of eligible families entered the study while only 21% did not complete treatment . The study population is reasonably representative because the demographic data of the current sample are similar to that of adolescent AN participants in clinical trials of FBT and similar to clinical populations with adolescent onset AN presenting for treatment (Stiles-Shields, Goldschmidt, Lock, & Le Grang...

Although mobile technologies for eating disorders (EDs) are burgeoning, there is limited data about the clinical characteristics of individuals using specialized smartphone applications (apps) without accompanying traditional forms of treatment. This study evaluated whether the users of an ED app cluster in clinically meaningful groups. Participants were 1,280 app users (91.3% female; mean age 27) who reported not being in a weekly treatment for their ED. A hierarchical cluster analysis distinguished five groups of participants, all approximating DSM-5 ED categories. One cluster comprised of non-female, ethnically diverse users with Bulimia Nervosa features. Findings suggest that app users resemble known patient classifications.

Objective Smartphone applications (apps) for eating disorders are a promising approach to assist individuals who do not receive traditional treatment. This study examines usage characteristics, perceptions regarding the acceptability of a new self-help intervention developed for users with eating disorders, and associations between attitudes and use patterns. Methods 189 individuals pilot-tested a personalized app-based program, and 133 completed the required components of the pilot-test over an 8-day period. Of these, 64 individuals (49%) completed an exit survey pertaining to acceptability. Results Seventy percent of those who pilot-tested the app-based program completed the required components, i.e. a baseline review and then a 1-week assessment. Body mass index was associated with the total number of recorded meal logs. Study participants rated the app as highly suitable and acceptable, providing evidence of the feasibility and appropriateness of the program. Conclusion The app-based program demonstrated feasibility of deploying the app across user groups and high acceptability.