Adapting an Online Guided Self-Help CBT Programme Targeting Disordered Eating for Students in Aotearoa New Zealand: A Qualitative Study
Abstract
:1. Introduction
1.1. Challenges of E-Therapy Interventions
1.2. Current Study
2. Materials and Methods
2.1. Design
2.2. Researcher Description
2.3. Participants
2.4. Recruitment
2.5. Online Intervention Programme Content
2.6. Individual Interview Procedure
2.7. Analytic Approach
3. Results
3.1. Theme 1: Acceptable Programme Content with Consideration of Contextual Nuances
“I’m pretty happy with it [the programme] overall. I think it’s covered like all the bases really well. And it’s done in quite an engaging way. And yeah, I think it’s a really cool thing.”(Harry)
“[referring to his thoughts on the personal stories] Yeah, I mean, I’ll be I’ll be completely honest with you. They sounded a little bit like ChatGPT [AI software] wrote them.”(Tom)
“…if you don’t have a personal story that you can sort of relate to or see similarities, then it could be even more isolating, like, ‘oh, do I really have an issue, if you know, my issue doesn’t compare to these other people’s’ kind of thing, because it could set up a comparison, especially with, with this sort of thinking, because most people with disordered eating, it does stem from comparison….”(Anna)
“[discussing the social media challenge]…there is personally, no way I would do that. Like, maybe if it was a different challenge, because I think having a challenge is really good.”(Bella)
“[discussing the self-monitoring logs]. Like once again, I think it could help a lot of people but there are also quite a few people, I think at least in my case, while I was going through like, the worst of it, that, that would be something that would be more destructive than positive for me. So I think it would just be important to like have a grain of salt on like, logging stuff about yourself, like for each person if that’s actually benefiting them, because I think that could be, yeah, could go either way.”(Jack)
“I feel like that could be more up to the individual and how comfortable, they are on like, either calls or, like face to face, or like over text, I think it would be helpful to have it either on call or like face to face. But yeah, I think for some people, that might be too much. So I think it should just be more individualised.”(Jack)
“But the problem is, it’s just inflation with affordability. We can’t really solve it of course, but it would be great to mention.”(Jimmy)
“…I felt like one of the main things that was bad for recovery was other people who had eating disorders, but like, weren’t fully aware of it, but talked about it as if it was normal…And it does affect like, basically everyone I’ve talked to with an eating disorder, and maybe even how to like approach people about that.”(Jack)
3.2. Theme 2: Engagement and Retaining Users
“[discussing how to make students aware of the programme] And services through like, [student association], like the support, because I thought people didn’t like use, [student] support at all. But then I came across my friends who like actually go through the support things. And I was like, Okay, this is like a big deal. So think, [student support] is a good area for this.”(Amrita)
“Giving like progress points, could be nice to make you want to keep going because if, you know, if it shows that you are actually improving, it might make you want to keep going.”(Anna)
“In regards to the programme, I think I would just say that acknowledging that being a student is hard. Like, our schedules are kind of all over the place…Because more often than not, you see all these programmes come up with all these like, like dietary plans, kind of thing that just aren’t realistic to fit into the lifestyle of a student. You know, telling you to make all these really fancy meals, when maybe sometimes you come home from school, and you’ve got maybe 20 min to make your dinner and you just can’t really be bothered, because you’re tired from the day. So I think just acknowledging that and just being aware of that….”(Anna)
[As students], you always hear about, you know, I didn’t I couldn’t afford to eat, so I just didn’t have dinner, or I always forget breakfast kind of thing. Like you don’t, you don’t really think it’s an issue as a student, because you hear so many people do it. It’s not quite disordered eating. Because it’s, you know, as students, it’s true, our schedules are so erratic, that sometimes you do skip a meal or something like that. But I think, you know, it does sort of make you think about oh, is, do I actually have disordered eating? Or is it just the student lifestyle kind of thing.”
“…I think it [the programme] will help people understand and realise like, what they’re going through, and then it’s not wrong to like, seek help and like, talk about it.”(Amrita)
“Having a shorter version just to dip your toes in and see, you know, ‘is this something I’m interested in’, ‘is it something that can help me’…could be useful.”(Anna)
3.3. Theme 3: Ethics and Management of Personal Information
“…help things or programs, kind of like this [online ED programme], where you don’t necessarily have to go see a doctor…I think those are good because then you’re not worried that like, the whole universe is gonna find out.”(Bella)
“I guess there still is a bit of a stigma. So I think kind of like an online program like this might be good because you can kind of do it without having to sit down in front of anybody or open up and be vulnerable. And yeah, I just think for a lot of people, it’s a really uncomfortable kind of topic to talk about, especially for like males. It’s not something that like most people like talking about or opening up about. So I think, yeah, having an option that can be done online, or just having a coach that talks to you virtually, is really, really helpful.”(Harry)
“I feel like a good mix, or that they do have that kind of background, but they’re also more relatable as well. It’s like, just like a happy medium. Because sometimes if you talk to someone who’s like, fully trained and a doctor, it’s all medical. And you’re kind of cool yep, whatever. But when it’s someone you can relate to a little bit more, you tend to take in a bit better. So a wee happy medium between the two.”(Lucy)
“[discussing her thoughts on coaches] Yeah, that kind of whole match of, you know, figuring out whether you feel like, you can relate to this person and feel like they would understand you in the way that you kind of want to be understood. It’s really a big thing.”(Rose)
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- Alhaj, O.A.; Fekih-Romdhane, F.; Sweidan, D.H.; Saif, Z.; Khudhair, M.F.; Ghazzawi, H.; Nadar, M.S.; Alhajeri, S.S.; Levine, M.P.; Jahrami, H. The Prevalence and Risk Factors of Screen-Based Disordered Eating among University Students: A Global Systematic Review, Meta-Analysis, and Meta-Regression. Eat. Weight. Disord. 2022, 27, 3215–3243. [Google Scholar] [CrossRef]
- Limone, P.; Toto, G.A. Factors That Predispose Undergraduates to Mental Issues: A Cumulative Literature Review for Future Research Perspectives. Front. Public Health 2022, 10, 831349. [Google Scholar] [CrossRef] [PubMed]
- Jang, K.; Canggra, B.; Moradi, S.; Riordan, B.; Chan, J.; Hunter, J.; Scarf, D. Mental Health at University: A Social Identity Approach. In Global Perspectives of University Sudents; Esteves, D., Pinheiro, P., Scarf, D., Arahanga-Doyle, H., Hunter, J.A., Eds.; Nova: New York, NY, USA, 2019; pp. 27–46. ISBN 978-1-5361-5745-1. [Google Scholar]
- van den Berg, P.; Thompson, J.K.; Obremski-Brandon, K.; Coovert, M. The Tripartite Influence Model of Body Image and Eating Disturbance: A Covariance Structure Modeling Investigation Testing the Mediational Role of Appearance Comparison. J. Psychosom. Res. 2002, 53, 1007–1020. [Google Scholar] [CrossRef] [PubMed]
- Bakalar, J.L.; Shank, L.M.; Vannucci, A.; Radin, R.M.; Tanofsky-Kraff, M. Recent Advances in Developmental and Risk Factor Research on Eating Disorders. Curr. Psychiatry Rep. 2015, 17, 42. [Google Scholar] [CrossRef]
- Favaro, A.; Busetto, P.; Collantoni, E.; Santonastaso, P. The Age of Onset of Eating Disorders. In Age of Onset of Mental Disorders: Etiopathogenetic and Treatment Implications; de Girolamo, G., McGorry, P.D., Sartorius, N., Eds.; Springer International Publishing: Cham, Switzerland, 2019; pp. 203–216. ISBN 978-3-319-72619-9. [Google Scholar]
- Harrer, M.; Adam, S.H.; Messner, E.-M.; Baumeister, H.; Cuijpers, P.; Bruffaerts, R.; Auerbach, R.P.; Kessler, R.C.; Jacobi, C.; Taylor, C.B.; et al. Prevention of Eating Disorders at Universities: A Systematic Review and Meta-Analysis. Int. J. Eat. Disord. 2020, 53, 813–833. [Google Scholar] [CrossRef]
- Hudson, J.I.; Hiripi, E.; Pope, H.G.; Kessler, R.C. The Prevalence and Correlates of Eating Disorders in the National Comorbidity Survey Replication. Biol. Psychiatry 2007, 61, 348–358. [Google Scholar] [CrossRef] [PubMed]
- Ward, Z.J.; Rodriguez, P.; Wright, D.R.; Austin, S.B.; Long, M.W. Estimation of Eating Disorders Prevalence by Age and Associations With Mortality in a Simulated Nationally Representative US Cohort. JAMA Netw. Open 2019, 2, e1912925. [Google Scholar] [CrossRef] [PubMed]
- Eisenberg, D.; Nicklett, E.J.; Roeder, K.; Kirz, N.E. Eating Disorder Symptoms Among College Students: Prevalence, Persistence, Correlates, and Treatment-Seeking. J. Am. Coll. Health 2011, 59, 700–707. [Google Scholar] [CrossRef]
- Oakley Browne, M.A.; Elisabeth Wells, J.; Mcgee, M.A. Twelve-Month and Lifetime Health Service Use in Te Rau Hinengaro: The New Zealand Mental Health Survey. Aust. N. Z. J. Psychiatry 2006, 40, 855–864. [Google Scholar] [CrossRef]
- Feldkamp, J. The Rise of TikTok: The Evolution of a Social Media Platform During COVID-19. In Digital Responses to COVID-19: Digital Innovation, Transformation, and Entrepreneurship during Pandemic Outbreaks; Hovestadt, C., Recker, J., Richter, J., Werder, K., Eds.; Springer International Publishing: Cham, Switzerland, 2021; pp. 73–85. ISBN 978-3-030-66611-8. [Google Scholar]
- Haenlein, M.; Anadol, E.; Farnsworth, T.; Hugo, H.; Hunichen, J.; Welte, D. Navigating the New Era of Influencer Marketing: How to Be Successful on Instagram, TikTok, & Co. Calif. Manag. Rev. 2020, 63, 5–25. [Google Scholar] [CrossRef]
- Twenge, J.M.; Martin, G.N.; Spitzberg, B.H. Trends in U.S. Adolescents’ Media Use, 1976–2016: The Rise of Digital Media, the Decline of TV, and the (near) Demise of Print. Psychol. Pop. Media Cult. 2019, 8, 329–345. [Google Scholar] [CrossRef]
- Villanti, A.C.; Johnson, A.L.; Ilakkuvan, V.; Jacobs, M.A.; Graham, A.L.; Rath, J.M. Social Media Use and Access to Digital Technology in US Young Adults in 2016. J. Med. Internet Res. 2017, 19, e7303. [Google Scholar] [CrossRef]
- Dane, A.; Bhatia, K. The Social Media Diet: A Scoping Review to Investigate the Association between Social Media, Body Image and Eating Disorders amongst Young People. PLOS Glob. Public Health 2023, 3, e0001091. [Google Scholar] [CrossRef] [PubMed]
- Kazdin, A.E.; Fitzsimmons-Craft, E.E.; Wilfley, D.E. Addressing Critical Gaps in the Treatment of Eating Disorders. Int. J. Eat. Disord. 2017, 50, 170–189. [Google Scholar] [CrossRef]
- Fitzsimmons-Craft, E.E.; Taylor, C.B.; Graham, A.K.; Sadeh-Sharvit, S.; Balantekin, K.N.; Eichen, D.M.; Monterubio, G.E.; Goel, N.J.; Flatt, R.E.; Karam, A.M.; et al. Effectiveness of a Digital Cognitive Behavior Therapy–Guided Self-Help Intervention for Eating Disorders in College Women: A Cluster Randomized Clinical Trial. JAMA Netw. Open 2020, 3, e2015633. [Google Scholar] [CrossRef]
- Beintner, I.; Jacobi, C.; Taylor, C.B. Effects of an Internet-Based Prevention Programme for Eating Disorders in the USA and Germany—A Meta-Analytic Review. Eur. Eat. Disord. Rev. 2012, 20, 1–8. [Google Scholar] [CrossRef] [PubMed]
- Murphy, R.; Straebler, S.; Cooper, Z.; Fairburn, C.G. Cognitive Behavioral Therapy for Eating Disorders. Psychiatr. Clin. 2010, 33, 611–627. [Google Scholar] [CrossRef]
- Aardoom, J.J.; Dingemans, A.E.; Van Furth, E.F. E-Health Interventions for Eating Disorders: Emerging Findings, Issues, and Opportunities. Curr. Psychiatry Rep. 2016, 18, 42. [Google Scholar] [CrossRef]
- Barakat, S.; Burton, A.L.; Cunich, M.; Hay, P.; Hazelton, J.L.; Kim, M.; Lymer, S.; Madden, S.; Maloney, D.; Miskovic-Wheatley, J.; et al. A Randomised Controlled Trial of Clinician Supported vs. Self-Help Delivery of Online Cognitive Behaviour Therapy for Bulimia Nervosa. Psychiatry Res. 2023, 329, 115534. [Google Scholar] [CrossRef]
- Linardon, J.; Shatte, A.; Tepper, H.; Fuller-Tyszkiewicz, M. A Survey Study of Attitudes toward, and Preferences for, e-Therapy Interventions for Eating Disorder Psychopathology. Int. J. Eat. Disord. 2020, 53, 907–916. [Google Scholar] [CrossRef]
- Aardoom, J.J.; Dingemans, A.E.; Spinhoven, P.; van Ginkel, J.R.; de Rooij, M.; Furth, E.F. van Web-Based Fully Automated Self-Help With Different Levels of Therapist Support for Individuals With Eating Disorder Symptoms: A Randomized Controlled Trial. J. Med. Internet Res. 2016, 18, e5709. [Google Scholar] [CrossRef] [PubMed]
- Linardon, J.; King, T.; Shatte, A.; Fuller-Tyszkiewicz, M. Usability Evaluation of a Cognitive-Behavioral App-Based Intervention for Binge Eating and Related Psychopathology: A Qualitative Study. Behav. Modif. 2022, 46, 1002–1020. [Google Scholar] [CrossRef]
- Kass, A.E.; Trockel, M.; Safer, D.L.; Sinton, M.M.; Cunning, D.; Rizk, M.T.; Genkin, B.H.; Weisman, H.L.; Bailey, J.O.; Jacobi, C.; et al. Internet-Based Preventive Intervention for Reducing Eating Disorder Risk: A Randomized Controlled Trial Comparing Guided with Unguided Self-Help. Behav. Res. Ther. 2014, 63, 90–98. [Google Scholar] [CrossRef]
- Linardon, J.; Messer, M.; Lee, S.; Rosato, J. Perspectives of E-Health Interventions for Treating and Preventing Eating Disorders: Descriptive Study of Perceived Advantages and Barriers, Help-Seeking Intentions, and Preferred Functionality. Eat. Weight. Disord. 2021, 26, 1097–1109. [Google Scholar] [CrossRef] [PubMed]
- Ali, K.; Fassnacht, D.B.; Farrer, L.M.; Rieger, E.; Moessner, M.; Bauer, S.; Griffiths, K.M. Recruitment, Adherence and Attrition Challenges in Internet-Based Indicated Prevention Programs for Eating Disorders: Lessons Learned from a Randomised Controlled Trial of ProYouth OZ. J. Eat. Disord. 2022, 10, 1. [Google Scholar] [CrossRef]
- Linardon, J.; Fuller-Tyszkiewicz, M. Attrition and Adherence in Smartphone-Delivered Interventions for Mental Health Problems: A Systematic and Meta-Analytic Review. J. Consult. Clin. Psychol. 2020, 88, 1–13. [Google Scholar] [CrossRef] [PubMed]
- Nitsch, M.; Dimopoulos, C.N.; Flaschberger, E.; Saffran, K.; Kruger, J.F.; Garlock, L.; Wilfley, D.E.; Taylor, C.B.; Jones, M. A Guided Online and Mobile Self-Help Program for Individuals With Eating Disorders: An Iterative Engagement and Usability Study. J. Med. Internet Res. 2016, 18, e7. [Google Scholar] [CrossRef]
- Yim, S.H.; Bailey, E.; Gordon, G.; Grant, N.; Musiat, P.; Schmidt, U. Exploring Participants’ Experiences of a Web-Based Program for Bulimia and Binge Eating Disorder: Qualitative Study. J. Med. Internet Res. 2020, 22, e17880. [Google Scholar] [CrossRef]
- Nacke, B.; Beintner, I.; Görlich, D.; Vollert, B.; Schmidt-Hantke, J.; Hütter, K.; Taylor, C.B.; Jacobi, C. everyBody–Tailored Online Health Promotion and Eating Disorder Prevention for Women: Study Protocol of a Dissemination Trial. Internet Interv. 2019, 16, 20–25. [Google Scholar] [CrossRef]
- Beintner, I.; Emmerich, O.L.M.; Vollert, B.; Taylor, C.B.; Jacobi, C. Promoting Positive Body Image and Intuitive Eating in Women with Overweight and Obesity via an Online Intervention: Results from a Pilot Feasibility Study. Eat. Behav. 2019, 34, 101307. [Google Scholar] [CrossRef]
- Vollert, B.; Beintner, I.; Musiat, P.; Gordon, G.; Görlich, D.; Nacke, B.; Schmidt-Hantke, J.; Potterton, R.; Spencer, L.; Grant, N.; et al. Using Internet-Based Self-Help to Bridge Waiting Time for Face-to-Face Outpatient Treatment for Bulimia Nervosa, Binge Eating Disorder and Related Disorders: Study Protocol of a Randomized Controlled Trial. Internet Interv. 2019, 16, 26–34. [Google Scholar] [CrossRef] [PubMed]
- Vollert, B.; Yim, S.H.; Görlich, D.; Beintner, I.; Gordon, G.; Musiat, P.; Schmidt, U.; Jacobi, C. Using Web-Based, Guided Self-Help to Bridge the Waiting Time for Face-to-Face out-Patient Treatment for Bulimic-Spectrum Disorders: Randomised Controlled Trial. BJPsych Open 2024, 10, e53. [Google Scholar] [CrossRef]
- Brooks, J.; King, N. Doing Template Analysis: Evaluating an End-of-Life Care Service; SAGE Publications, Ltd.: London, UK, 2014; ISBN 978-1-4739-4706-1. [Google Scholar]
- King, N. Using Templates in the Thematic Analysis of Text. In Essential Guide to Qualitative Methods in Organizational Research; SAGE Publications Ltd.: London, UK, 2004; pp. 257–270. ISBN 978-0-7619-4888-9. [Google Scholar]
- DiCicco-Bloom, B.; Crabtree, B.F. The Qualitative Research Interview. Med. Educ. 2006, 40, 314–321. [Google Scholar] [CrossRef]
- Skivington, K.; Matthews, L.; Simpson, S.A.; Craig, P.; Baird, J.; Blazeby, J.M.; Boyd, K.A.; Craig, N.; French, D.P.; McIntosh, E.; et al. A New Framework for Developing and Evaluating Complex Interventions: Update of Medical Research Council Guidance. BMJ 2021, 374, n2061. [Google Scholar] [CrossRef] [PubMed]
- Cuijpers, P.; Auerbach, R.P.; Benjet, C.; Bruffaerts, R.; Ebert, D.; Karyotaki, E.; Kessler, R.C. The World Health Organization World Mental Health International College Student Initiative: An Overview. Int. J. Methods Psychiatr. Res. 2019, 28, e1761. [Google Scholar] [CrossRef]
- Malterud, K.; Siersma, V.D.; Guassora, A.D. Sample Size in Qualitative Interview Studies: Guided by Information Power. Qual. Health Res. 2016, 26, 1753–1760. [Google Scholar] [CrossRef]
- Laboe, A.A.; McGinnis, C.G.; Fennig, M.; Zucker, K.; Wu, E.; Shah, J.; Levitan, J.; Firebaugh, M.-L.; Bardone-Cone, A.M.; Pike, K.M.; et al. Development and Usability Testing of a Cognitive-Behavioral Therapy-Guided Self-Help Mobile App and Social Media Group for the Post-Acute Treatment of Anorexia Nervosa. Eat. Behav. 2024, 53, 101865. [Google Scholar] [CrossRef] [PubMed]
- Shah, J.; DePietro, B.; D’Adamo, L.; Firebaugh, M.-L.; Laing, O.; Fowler, L.A.; Smolar, L.; Sadeh-Sharvit, S.; Taylor, C.B.; Wilfley, D.E.; et al. Development and Usability Testing of a Chatbot to Promote Mental Health Services Use among Individuals with Eating Disorders Following Screening. Int. J. Eat. Disord. 2022, 55, 1229–1244. [Google Scholar] [CrossRef] [PubMed]
- Lewis, J.R. Sample Sizes for Usability Studies: Additional Considerations. Hum. Factors 1994, 36, 368–378. [Google Scholar] [CrossRef]
- Virzi, R.A. Refining the Test Phase of Usability Evaluation: How Many Subjects Is Enough? Hum. Factors 1992, 34, 457–468. [Google Scholar] [CrossRef]
- Kruger, L.J.; Rodgers, R.F.; Long, S.J.; Lowy, A.S. Individual Interviews or Focus Groups? Interview Format and Women’s Self-Disclosure. Int. J. Social. Res. Methodol. 2019, 22, 245–255. [Google Scholar] [CrossRef]
- Houston, S. Beyond Social Constructionism: Critical Realism and Social Work. Br. J. Social. Work. 2001, 31, 845–861. [Google Scholar] [CrossRef]
- Juarascio, A.S.; Goldstein, S.P.; Manasse, S.M.; Forman, E.M.; Butryn, M.L. Perceptions of the Feasibility and Acceptability of a Smartphone Application for the Treatment of Binge Eating Disorders: Qualitative Feedback from a User Population and Clinicians. Int. J. Med. Inform. 2015, 84, 808–816. [Google Scholar] [CrossRef] [PubMed]
- Muir, S.; Newell, C.; Griffiths, J.; Walker, K.; Hooper, H.; Thomas, S.; Thomas, P.W.; Arcelus, J.; Day, J.; Appleton, K.M. MotivATE: A Pretreatment Web-Based Program to Improve Attendance at UK Outpatient Services Among Adults With Eating Disorders. JMIR Res. Protoc. 2017, 6, e146. [Google Scholar] [CrossRef]
- Nitsch, M.; Adamcik, T.; Kuso, S.; Zeiler, M.; Waldherr, K. Usability and Engagement Evaluation of an Unguided Online Program for Promoting a Healthy Lifestyle and Reducing the Risk for Eating Disorders and Obesity in the School Setting. Nutrients 2019, 11, 713. [Google Scholar] [CrossRef]
- Wiberg, A.-C.; Ghaderi, A.; Danielsson, H.B.; Safarzadeh, K.; Parling, T.; Carlbring, P.; Jansson, M.; Welch, E. Internet-Based Cognitive Behavior Therapy for Eating Disorders—Development and Feasibility Evaluation. Internet Interv. 2022, 30, 100570. [Google Scholar] [CrossRef]
- Yim, S.H.; Spencer, L.; Gordon, G.; Allen, K.L.; Musiat, P.; Schmidt, U. Views on Online Self-Help Programmes from People with Eating Disorders and Their Carers in UK. Eur. J. Public Health 2021, 31, i88–i93. [Google Scholar] [CrossRef]
- Graham, A.K.; Kosmas, J.A.; Massion, T.A. Designing Digital Interventions for Eating Disorders. Curr. Psychiatry Rep. 2023, 25, 125–138. [Google Scholar] [CrossRef]
- Durie, M. Whaiora: Māori Health Development, 2nd ed.; Auckland, N.Z., Ed.; Oxford University Press: Oxford, UK, 1998; ISBN 978-0-19-558403-5. [Google Scholar]
- Te’evale, T. Body Image and Its Relation to Obesity for Pacific Minority Ethnic Groups in New Zealand: A Critical Analysis. Pac. Health Dialog. 2011, 17, 33–53. [Google Scholar]
- Talwar, R.; Carter, J.; Gleaves, D. New Zealand Female Body Image: What Roles Do Ethnicity and Body Mass Play? N. Z. J. Psychol. 2012, 41, 69–75. [Google Scholar]
- Nemani, M.J.; Thorpe, H. “My Thighs Can Squash You”: Young Māori and Pasifika Wāhine Celebration of Strong Brown Bodies. Youth 2023, 3, 971–990. [Google Scholar] [CrossRef]
- Houkamau, C.; Stronge, S.; Warbrick, I.; Dell, K.; Mika, J.; Newth, J.; Sibley, C.; Kha, K.L. Cultural Efficacy Predicts Body Satisfaction for Māori. PLoS ONE 2021, 16, e0253426. [Google Scholar] [CrossRef]
- Wilson, G.T.; Vitousek, K.M. Self-Monitoring in the Assessment of Eating Disorders. Psychol. Assess. 1999, 11, 480–489. [Google Scholar] [CrossRef]
- Swain-Campbell, N.R.; Surgenor, L.J.; Snell, D.L. An Analysis of Consumer Perspectives Following Contact with an Eating-Disorders Service. Aust. N. Z. J. Psychiatry 2001, 35, 99–103. [Google Scholar] [CrossRef]
- Agras, W.S.; Bohon, C. Cognitive Behavioral Therapy for the Eating Disorders. Annu. Rev. Clin. Psychol. 2021, 17, 417–438. [Google Scholar] [CrossRef] [PubMed]
- Fairburn, C.G.; Marcus, M.D.; Wilson, G.T. Cognitive-Behavioral Therapy for Binge Eating and Bulimia Nervosa: A Comprehensive Treatment Manual. In Binge Eating: Nature, Assessment, and Treatment; Guilford Press: New York, NY, USA, 1993; pp. 361–404. ISBN 978-0-89862-995-8. [Google Scholar]
- Fairburn, C.G.; Cooper, Z.; Shafran, R. Cognitive Behaviour Therapy for Eating Disorders: A “Transdiagnostic” Theory and Treatment. Behav. Res. Ther. 2003, 41, 509–528. [Google Scholar] [CrossRef]
- Hildebrandt, T.; Latner, J. Effect of Self-Monitoring on Binge Eating: Treatment Response or ‘Binge Drift’? Eur. Eat. Disord. Rev. 2006, 14, 17–22. [Google Scholar] [CrossRef]
- Latner, J.D.; Wilson, G.T. Self-Monitoring and the Assessment of Binge Eating. Behav. Ther. 2002, 33, 465–477. [Google Scholar] [CrossRef]
- Waller, G.; Evans, J.; Pugh, M. Food for Thought: A Pilot Study of the Pros and Cons of Changing Eating Patterns within Cognitive-Behavioural Therapy for the Eating Disorders. Behav. Res. Ther. 2013, 51, 519–525. [Google Scholar] [CrossRef]
- Waller, G.; Raykos, B. Behavioral Interventions in the Treatment of Eating Disorders. Psychiatr. Clin. North. Am. 2019, 42, 181–191. [Google Scholar] [CrossRef]
- Nichols, S.; Gusella, J. Food for Thought: Will Adolescent Girls with Eating Disorders Self-Monitor in a CBT Group? Can. Child. Adolesc. Psychiatr. Rev. 2003, 12, 37–39. [Google Scholar] [PubMed]
- Tregarthen, J.; Kim, J.P.; Sadeh-Sharvit, S.; Neri, E.; Welch, H.; Lock, J. Comparing a Tailored Self-Help Mobile App With a Standard Self-Monitoring App for the Treatment of Eating Disorder Symptoms: Randomised Controlled Trial. JMIR Ment. Health 2019, 6, e14972. [Google Scholar] [CrossRef] [PubMed]
- Clark, M.T.R.; Manuel, J.; Lacey, C.; Pitama, S.; Cunningham, R.; Jordan, J. Reimagining Eating Disorder Spaces: A Qualitative Study Exploring Māori Experiences of Accessing Treatment for Eating Disorders in Aotearoa New Zealand. J. Eat. Disord. 2023, 11, 22. [Google Scholar] [CrossRef] [PubMed]
- Foliaki, S.A.; Kokaua, J.; Schaaf, D.; Tukuitonga, C. Twelve-Month and Lifetime Prevalences of Mental Disorders and Treatment Contact Among Pacific People in Te Rau Hinengaro: The New Zealand Mental Health Survey. Aust. N. Z. J. Psychiatry 2006, 40, 924–934. [Google Scholar] [CrossRef]
- Lacey, C.; Cunningham, R.; Rijnberg, V.; Manuel, J.; Clark, M.T.R.; Keelan, K.; Pitama, S.; Huria, T.; Lawson, R.; Jordan, J. Eating Disorders in New Zealand: Implications for Māori and Health Service Delivery. Int. J. Eat. Disord. 2020, 53, 1974–1982. [Google Scholar] [CrossRef]
- Parker, L.L.; Harriger, J.A. Eating Disorders and Disordered Eating Behaviors in the LGBT Population: A Review of the Literature. J. Eat. Disord. 2020, 8, 51. [Google Scholar] [CrossRef]
- Abbott, M.W.; Durie, M.H. A Whiter Shade of Pale: Taha Maori and Professional Psychology Training. N. Z. J. Psychol. 1987, 16, 58–71. [Google Scholar]
- Adams, J.; Dickinson, P.; Asiasiga, L. Mental Health Promotion for Gay, Lesbian, Bisexual, Transgender and Intersex New Zealanders. J. Prim. Health Care 2013, 5, 105–113. [Google Scholar] [CrossRef]
- Arnett, J.J. The Neglected 95%: Why American Psychology Needs to Become Less American. Am. Psychol. 2008, 63, 602–614. [Google Scholar] [CrossRef]
- Munford, R.; Walsh-Tapiata, W. Community Development: Working in the Bicultural Context of Aotearoa New Zealand. Community Dev. J. 2006, 41, 426–442. [Google Scholar] [CrossRef]
Module | Content |
---|---|
Module 1 Balanced eating | Introduction, setting personal goals, psychoeducation on eating disorders, regular eating and balanced eating habits, meal planning and meal tracking, mindful eating activity |
Module 2 Coping well | Psychoeducation about emotional triggers, dealing with triggers activity, mindfulness activity |
Module 3 Thinking well | Psychoeducation about automatic thoughts, the thin ideal and social comparison, cognitive restructuring, monitoring logs, behavioural experiments, mindfulness activity |
Module 4 Body wellness | Psychoeducation about body image and healthy exercise, values, decreasing shape checking and body avoidance, assessing exercise habits |
Module 5 Media wellness | Psychoeducation about the media, social media challenges |
Module 6 Relationship wellness and relapse prevention | Psychoeducation about interpersonal relationships, interpersonal communication activity, relapse prevention plan |
Themes in Hierarchical Order | Overview of Theme Content |
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| This is about what participants thought about the content of the modules. This was a big theme as a lot of the discussion was focused on the module content. Overall, the participants thought the content was relevant and suitable. However, participants also discussed content that may need modification, and new content that may need to be included. |
| This theme is about what participants perceived may act as facilitators or barriers in student’s engagement with the programme. They also suggested how the programme could be promoted to students. |
| Confidentiality and privacy were important to the participants. They perceived the anonymity of the programme as an advantage. However, participants demonstrated differences in preference for the level of professionalism and relatedness within their coach. |
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© 2024 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
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Mitlash, A.; Rapsey, C.; Treharne, G.J.; Scarf, D. Adapting an Online Guided Self-Help CBT Programme Targeting Disordered Eating for Students in Aotearoa New Zealand: A Qualitative Study. Nutrients 2024, 16, 2905. https://doi.org/10.3390/nu16172905
Mitlash A, Rapsey C, Treharne GJ, Scarf D. Adapting an Online Guided Self-Help CBT Programme Targeting Disordered Eating for Students in Aotearoa New Zealand: A Qualitative Study. Nutrients. 2024; 16(17):2905. https://doi.org/10.3390/nu16172905
Chicago/Turabian StyleMitlash, Alisa, Charlene Rapsey, Gareth J. Treharne, and Damian Scarf. 2024. "Adapting an Online Guided Self-Help CBT Programme Targeting Disordered Eating for Students in Aotearoa New Zealand: A Qualitative Study" Nutrients 16, no. 17: 2905. https://doi.org/10.3390/nu16172905