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

Abstract

Background Feeding and eating disorders are associated with significant illness burden and costs, yet access to evidence-based care is limited. Low intensity psychological interventions have the potential to increase such access. Methods A systematic review and meta-analysis were conducted on the use of low intensity psychological interventions for the treatment of feeding and eating disorders. Studies comparing low intensity psychological 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. Results Thirty-three studies met the inclusion criteria, comprising 3665 participants, and 30 studies were included in the meta-analysis. Compared to high intensity therapies, low intensity 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). Low intensity psychological interventions were superior to non-eating disorder specific psychological interventions and waiting list controls across all three primary outcomes. Conclusion Overall, findings suggest that low intensity psychological interventions can successfully treat eating disorder symptoms. Few potential moderators had a statistically significant effect on outcome. The number of studies for many comparisons was low and the methodological quality of the studies was poor, therefore results should be interpreted with caution. More research is needed to establish the effectiveness of low intensity psychological interventions for children and young people, as well as for individuals with anorexia nervosa, avoidant/restrictive food intake disorder, pica and rumination disorder.

Internet-delivered cognitive behavior therapy versus treatment as usual for anxiety and depression among Latin American university students: A randomized clinical trial.

“…However, these results were robust given their consistency across per-protocol sensitivity analyses, preregistered disaggregated analyses, and post hoc exploratory subgroup analyses. The 37%-50% of students who experienced joint remission of both GAD-7 and PHQ-9 were comparable to the 38%-56% pooled response-remission rates for guided i-interventions and higher than the 21%-35% pooled response-remission rates for self-guided i-interventions found in a meta-analysis of prior controlled trials for depression (Karyotaki et al, 2018) and comparable to the 35%-70% pooled responseremission rates found in a separate meta-analysis of i-CBT for anxiety, depression, and other common behavioral health problems (Andersson et al, 2019;Davey et al, 2023;Simon et al, 2023).…”

Internet-delivered cognitive behavior therapy versus treatment as usual for anxiety and depression among Latin American university students: A randomized clinical trial.

“…However, these results were robust given their consistency across per-protocol sensitivity analyses, preregistered disaggregated analyses, and post hoc exploratory subgroup analyses. The 37%-50% of students who experienced joint remission of both GAD-7 and PHQ-9 were comparable to the 38%-56% pooled response-remission rates for guided i-interventions and higher than the 21%-35% pooled response-remission rates for self-guided i-interventions found in a meta-analysis of prior controlled trials for depression (Karyotaki et al, 2018) and comparable to the 35%-70% pooled responseremission rates found in a separate meta-analysis of i-CBT for anxiety, depression, and other common behavioral health problems (Andersson et al, 2019;Davey et al, 2023;Simon et al, 2023).…”

A Timely Update: An Umbrella Review and Meta‐Meta‐Analysis of Psychotherapy for Non‐Underweight Eating Disorders

“…Lastly, Davey, Bennett, et al. (2023) included in their review of program‐led focused interventions remission ( k = 11, SMD = 3.01, 95% CI: 1.93–4.69) and diagnostic statistical manual (DSM) severity specifier ( k = 14, SMD = −0.60, 95% CI: −0.74 to −0.45) as outcomes. The majority (8/10) of included meta‐analyses assessed publication bias and typically found it to be low, although this could vary between diagnosis and intervention type in some reviews (e.g., Bruns et al.…”

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.…”

Internet-delivered cognitive behavior therapy versus treatment as usual for anxiety and depression among Latin American university students: A randomized clinical trial.

“…However, these results were robust given their consistency across per-protocol sensitivity analyses, preregistered disaggregated analyses, and post hoc exploratory subgroup analyses. The 37%-50% of students who experienced joint remission of both GAD-7 and PHQ-9 were comparable to the 38%-56% pooled response-remission rates for guided i-interventions and higher than the 21%-35% pooled response-remission rates for self-guided i-interventions found in a meta-analysis of prior controlled trials for depression (Karyotaki et al, 2018) and comparable to the 35%-70% pooled responseremission rates found in a separate meta-analysis of i-CBT for anxiety, depression, and other common behavioral health problems (Andersson et al, 2019;Davey et al, 2023;Simon et al, 2023).…”

A Timely Update: An Umbrella Review and Meta‐Meta‐Analysis of Psychotherapy for Non‐Underweight Eating Disorders

“…Lastly, Davey, Bennett, et al. (2023) included in their review of program‐led focused interventions remission ( k = 11, SMD = 3.01, 95% CI: 1.93–4.69) and diagnostic statistical manual (DSM) severity specifier ( k = 14, SMD = −0.60, 95% CI: −0.74 to −0.45) as outcomes. The majority (8/10) of included meta‐analyses assessed publication bias and typically found it to be low, although this could vary between diagnosis and intervention type in some reviews (e.g., Bruns et al.…”

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.…”

Internet-delivered cognitive behavior therapy versus treatment as usual for anxiety and depression among Latin American university students: A randomized clinical trial.

“…However, these results were robust given their consistency across per-protocol sensitivity analyses, preregistered disaggregated analyses, and post hoc exploratory subgroup analyses. The 37%-50% of students who experienced joint remission of both GAD-7 and PHQ-9 were comparable to the 38%-56% pooled response-remission rates for guided i-interventions and higher than the 21%-35% pooled response-remission rates for self-guided i-interventions found in a meta-analysis of prior controlled trials for depression (Karyotaki et al, 2018) and comparable to the 35%-70% pooled responseremission rates found in a separate meta-analysis of i-CBT for anxiety, depression, and other common behavioral health problems (Andersson et al, 2019;Davey et al, 2023;Simon et al, 2023).…”

A Timely Update: An Umbrella Review and Meta‐Meta‐Analysis of Psychotherapy for Non‐Underweight Eating Disorders

“…Lastly, Davey, Bennett, et al. (2023) included in their review of program‐led focused interventions remission ( k = 11, SMD = 3.01, 95% CI: 1.93–4.69) and diagnostic statistical manual (DSM) severity specifier ( k = 14, SMD = −0.60, 95% CI: −0.74 to −0.45) as outcomes. The majority (8/10) of included meta‐analyses assessed publication bias and typically found it to be low, although this could vary between diagnosis and intervention type in some reviews (e.g., Bruns et al.…”

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.…”