Low intensity psychological interventions for the treatment of feeding and eating disorders: a systematic review and meta-analysis

Abstract

Feeding and eating disorders are associated with significant illness burden and costs, yet access to evidence-based care is limited. Low intensity (LI) psychological interventions have the potential to increase such access. A systematic review and meta-analysis were conducted on the use of LI psychological interventions for the treatment of feeding and eating disorders. Studies comparing LI interventions against high intensity therapies and non-eating disorder specific psychological interventions were included, as well as those with waiting list control arms. There were three primary outcomes: eating disorder psychopathology, diagnostic and statistical manual of mental disorders (DSM) severity specifier-related outcomes and rates of remission/recovery.Thirty-three studies met the inclusion criteria, comprising 3665 participants, and 30 studies were included in the meta-analysis. Compared to high intensity therapies, LI psychological interventions were equivalent on reducing eating disorder psychopathology (g = -0.13), more effective at improving DSM severity specifier-related outcomes (g = -0.15), but less likely to achieve remission/recovery (risk ratio (RR) = 0.70). LI psychological interventions were superior to non-eating disorder specific psychological interventions and waiting list controls across all three primary outcomes. Overall, findings suggest that LI psychological interventions can successfully treat eating disorder symptoms. Few potential moderators had a statistically significant effect on outcome. Methodological quality of the studies was poor and therefore results should be interpreted with caution. More research is needed to establish the effectiveness of LI interventions for children and young people, as well as for individuals with anorexia nervosa, avoidant/restrictive food intake disorder (ARFID), pica and rumination disorder.

A novel methodology to develop low‐intensity psychological treatments

“…The topic guides were tailored accordingly for each stakeholder group but covered the same topics as the healthcare professionals' focus group: suitability of guided self‐help for children and young people with eating disorders, and preferences towards the content, structure and modes of delivering guided self‐help. The former findings are detailed in Davey, Micali, et al (2024), and the latter findings are reported here.…”

A novel methodology to develop low‐intensity psychological treatments

“…The topic guides were tailored accordingly for each stakeholder group but covered the same topics as the healthcare professionals' focus group: suitability of guided self‐help for children and young people with eating disorders, and preferences towards the content, structure and modes of delivering guided self‐help. The former findings are detailed in Davey, Micali, et al (2024), and the latter findings are reported here.…”

Clinical benefits of modifying the evening light environment in an acute psychiatric unit: A single-centre, two-arm, parallel-group, pragmatic effectiveness randomised controlled trial

“…The NNTs were between 7 and 12 for these outcomes, which matches that of other low-intensity interventions in clinical psychology or medicine. 38,39 The CGI-S and CGI-I are widely employed in RCTs in inpatient units and have clearly defined anchor points, 27,28,30,31 and the BVC is a measure of observed behaviour that has been validated and implemented in more than 20 countries. 40 Our findings, therefore, suggest some cause for optimism that modifying the evening light environment in a psychiatric inpatient unit could benefit a wide range of acute admitted inpatients.…”

Project Body Neutrality: Piloting a digital single‐session intervention for adolescent body image and depression

“…A single‐session body image course resulted in significant, pre‐ to post‐intervention improvements in body image with a moderate effect ( d = 0.54) (Nemesure et al, 2022). Moreover, a meta‐analysis found that low‐intensity interventions were more effective at addressing DSM‐5 severity related outcomes, and equivalent at reducing ED psychopathology, compared to high‐intensity interventions (Davey et al, 2023).…”

A novel methodology to develop low‐intensity psychological treatments

“…The topic guides were tailored accordingly for each stakeholder group but covered the same topics as the healthcare professionals' focus group: suitability of guided self‐help for children and young people with eating disorders, and preferences towards the content, structure and modes of delivering guided self‐help. The former findings are detailed in Davey, Micali, et al (2024), and the latter findings are reported here.…”

Clinical benefits of modifying the evening light environment in an acute psychiatric unit: A single-centre, two-arm, parallel-group, pragmatic effectiveness randomised controlled trial

“…The NNTs were between 7 and 12 for these outcomes, which matches that of other low-intensity interventions in clinical psychology or medicine. 38,39 The CGI-S and CGI-I are widely employed in RCTs in inpatient units and have clearly defined anchor points, 27,28,30,31 and the BVC is a measure of observed behaviour that has been validated and implemented in more than 20 countries. 40 Our findings, therefore, suggest some cause for optimism that modifying the evening light environment in a psychiatric inpatient unit could benefit a wide range of acute admitted inpatients.…”

Project Body Neutrality: Piloting a digital single‐session intervention for adolescent body image and depression

“…A single‐session body image course resulted in significant, pre‐ to post‐intervention improvements in body image with a moderate effect ( d = 0.54) (Nemesure et al, 2022). Moreover, a meta‐analysis found that low‐intensity interventions were more effective at addressing DSM‐5 severity related outcomes, and equivalent at reducing ED psychopathology, compared to high‐intensity interventions (Davey et al, 2023).…”

A novel methodology to develop low‐intensity psychological treatments

“…The topic guides were tailored accordingly for each stakeholder group but covered the same topics as the healthcare professionals' focus group: suitability of guided self‐help for children and young people with eating disorders, and preferences towards the content, structure and modes of delivering guided self‐help. The former findings are detailed in Davey, Micali, et al (2024), and the latter findings are reported here.…”

Clinical benefits of modifying the evening light environment in an acute psychiatric unit: A single-centre, two-arm, parallel-group, pragmatic effectiveness randomised controlled trial

“…The NNTs were between 7 and 12 for these outcomes, which matches that of other low-intensity interventions in clinical psychology or medicine. 38,39 The CGI-S and CGI-I are widely employed in RCTs in inpatient units and have clearly defined anchor points, 27,28,30,31 and the BVC is a measure of observed behaviour that has been validated and implemented in more than 20 countries. 40 Our findings, therefore, suggest some cause for optimism that modifying the evening light environment in a psychiatric inpatient unit could benefit a wide range of acute admitted inpatients.…”

Project Body Neutrality: Piloting a digital single‐session intervention for adolescent body image and depression

“…A single‐session body image course resulted in significant, pre‐ to post‐intervention improvements in body image with a moderate effect ( d = 0.54) (Nemesure et al, 2022). Moreover, a meta‐analysis found that low‐intensity interventions were more effective at addressing DSM‐5 severity related outcomes, and equivalent at reducing ED psychopathology, compared to high‐intensity interventions (Davey et al, 2023).…”