A broad v. focused digital intervention for recurrent binge eating: a randomized controlled non-inferiority trial

Abstract

Background Empirically validated digital interventions for recurrent binge eating typically target numerous hypothesized change mechanisms via the delivery of different modules, skills, and techniques. Emerging evidence suggests that interventions designed to target and isolate one key change mechanism may also produce meaningful change in core symptoms. Although both ‘broad’ and ‘focused’ digital programs have demonstrated efficacy, no study has performed a direct, head-to-head comparison of the two approaches. We addressed this through a randomized non-inferiority trial. Method Participants with recurrent binge eating were randomly assigned to a broad (n = 199) or focused digital intervention (n = 199), or a waitlist (n = 202). The broad program targeted dietary restraint, mood intolerance, and body image disturbances, while the focused program exclusively targeted dietary restraint. Primary outcomes were eating disorder psychopathology and binge eating frequency. Results In intention-to-treat analyses, both intervention groups reported greater improvements in primary and secondary outcomes than the waitlist, which were sustained at an 8-week follow-up. The focused intervention was not inferior to the broad intervention on all but one outcome, but was associated with higher rates of attrition and non-compliance. Conclusion Focused digital interventions that are designed to target one key change mechanism may produce comparable symptom improvements to broader digital interventions, but appear to be associated with lower engagement.

Predictors, mediators, and moderators of response to digital interventions for eating disorders: A systematic review

“…Participant age showed promise as a factor predictive of drop‐out , with nine out of 21 studies ( n = 70–680; 19 RCTs) finding younger age to predict a higher likelihood of drop‐out (Beintner, Emmerich, et al, 2019; Flatt et al, 2022; Linardon, Broadbent, et al, 2022; Linardon, Messer, et al, 2022; Linardon, Messer, Shatte, et al, 2021; Linardon, Shatte, et al, 2022; Linardon, Shatte, Rosato, & Fuller‐Tyszkiewicz, 2020; Mensinger, 2021; Rohde et al, 2017). In studies finding a significant association, samples mostly consisted of female participants who were highly symptomatic or were at risk of disordered eating.…”

Exploration of the individual and combined effects of predictors of engagement, dropout, and change from digital interventions for recurrent binge eating

“…Data were derived from a RCT evaluating the efficacy of two self‐guided digital intervention programs against a waitlist control for recurrent binge eating (Linardon, Shatte, et al, 2022). One‐hundred‐ninety‐nine participants were randomized to a broad program, 199 to a focused program, and 202 to a waitlist.…”

“…Individuals were eligible if they were aged 18+ years, had access to the Internet and a smartphone, and reported the presence of recurrent binge eating, defined as one episode, on average, a fortnight over the past 3 months. Participants who met eligibility criteria then completed baseline assessments, after which they were randomly allocated to one of the three study conditions (see Linardon, Shatte, et al, 2022).…”

“…We address these limitations through a wider predictor and outcome set, and through examination of both the univariate and multivariate effects of numerous participant baseline characteristics in predicting digital intervention outcomes from data collected as part of a randomized controlled trial (RCT) (Linardon, Shatte, et al, 2022). We opted for outcomes that represent key milestones across the user journey experience, and included uptake, completion of psychoeducational component of the program (the first module), and symptom‐level change.…”

Investigating change in network structure of eating disorder symptoms after delivery of a smartphone app-based intervention

“…Participants were those with self-reported recurrent binge eating (defined as one episode of objective binge eating per every two weeks, on average, over the past three months) enrolled in a three-arm RCT comparing a waitlist to either a broad (app-based program designed to target multiple mechanisms symptoms) or focused (web-based program designed to isolate one key mechanism) self-guided digital intervention (Linardon, Shatte, McClure, & Fuller-Tyszkiewicz, 2023). Participants were recruited from advertisements distributed throughout the first author's psychoeducational website for eating disorders, which showcases passive information about eating disorders, including their causes, consequences, prevalence, and help options (see Linardon, Rosato, & Messer, 2020a;Linardon, Shatte, Messer, Firth, & Fuller-Tyszkiewicz, 2020b;Linardon, Shatte, Rosato, & Fuller-Tyszkiewicz, 2020c for further detail).…”