Melissa Jayne Atkinson

Objective: Many people relapse following treatment for Anorexia nervosa (AN). Internalization of appearance‐related societal biases, including weight stigma, idealization of thinness, and body self‐objectification, is related to eating disorder (ED) onset and maintenance, but their association with AN recovery is unclear. Method: We recruited 425 women using Prolific: 136 with self‐reported active AN, 143 who self‐reported being recovered, and 146 controls with no ED history. They completed online measures of ED symptoms, internalized weight stigma, thin‐ideal internalization, and self‐objectification. Group differences were examined using two MANCOVAs: one based on self‐reported recovery status and one using ED symptom scores instead. We also compared those whose symptom scores did and did not match their self‐reported recovery status. Finally, unsupervised machine learning explored whether internalized bias profiles mapped onto recovery status. Results: Using self‐reported status, the active group scored highest on all biases, followed by the recovered group, then controls (ps ≤ 0.002 ). When symptoms defined recovery, recovered participants no longer differed from controls (ps ≥ 0.92 ), whereas the active AN group scored higher than the other groups (ps ≤ 0.001 ). Participants who identified as recovered but scored above the symptom cut‐off resembled the active group, whereas those below the cut‐off resembled controls. Machine learning identified two severity‐based clusters: active AN participants were concentrated in a high‐bias cluster, controls in a low‐bias cluster, and recovered participants were split across these clusters. Discussion: Internalized societal biases are strongly associated with AN recovery status, especially when it is defined based on symptom levels rather than self‐report. These biases may represent important targets for aftercare interventions.

Unrealistic beauty standards have negative effects on women's well‐being. Feminism can act as a protective barrier against these effects by promoting broader beauty standards and resistance to social/gender norms. However, such work often assumes that all feminists are alike. In contrast, a recent multiple identity perspective suggests that resistance to social norms in feminists is further qualified by their identification with women. In consequence, we explored how feminist identification and identification with women interact to predict reactions to idealised (vs. non‐idealised) beauty imagery. Participants ( N = 433) were shown idealised or non‐idealised beauty imagery and completed different body image measures (resistance, beliefs about beauty, body enhancement, etc.). In partial support of the multiple identity perspective, only ‘distinctive feminists’ (high feminist identification and low identification with women) adopted broader conceptualisations of beauty in reaction to idealised imagery. Additionally, feminist identification (regardless of identification with women) was predictive of participants' reactions to idealised images, such as emotional responses and motivation to challenge women's portrayals. However, we found no direct or qualified links between feminism and body image outcomes and body enhancement behaviours, suggesting that feminists' body image is affected by unrealistic beauty standards in the same way as non‐feminists'.

Objective: Mindfulness‐based interventions (MBIs) show promise in reducing risk factors for disordered eating. Digital delivery offers scalable reach, but effects vary and engagement is generally suboptimal—potentially due to the length, complexity, and variation in content. Identifying the most effective and engaging components is necessary to streamline interventions. Guided by the multiphase optimization strategy (MOST), this study assessed the feasibility of a factorial trial to evaluate whether including emotion regulation (ER) and self‐compassion (SC) enhances the effects of decentred awareness and acceptance (DA + A, observing thoughts and feelings as separate from the self) in a digital MBI. Method: A 2 × 2 factorial design tested four intervention conditions. Each included DA + A content, with or without added ER and/or SC. Participants ( N = 92, M = 21.1 years, range = 18–32) were randomized and given 3‐weeks' access. Feasibility outcomes included recruitment, retention, data analysis, engagement, and acceptability. Intervention outcomes—weight and shape concerns, negative affect, mindfulness, ER, and SC—were assessed at baseline, postintervention, and 1‐month follow‐up. Results: Recruitment exceeded targets. Retention was acceptable (58% completed postintervention and 59% follow‐up assessments). All planned analyses for the main trial were feasible. Engagement met preregistered criteria (77%–85% completed Module 1 across ER and SC conditions; mean of four modules). Acceptability was high ( M = 4.28/5). Participants valued reminders and provided design suggestions. Discussion: Findings support progression to a fully powered optimization trial. This study demonstrates that MOST can be embedded within a pilot study, providing a foundation to develop more effective, engaging, and scalable interventions.

Higher Education Institutes (HEIs) have been met with an unprecedented demand on their student counselling and wellbeing services in recent years with the impacts of COVID‐19 and high rates of mental health concerns amongst student populations. Online mental health programs offer one solution by providing students with quick and easy access to effective therapeutic content. The Focused Minds Program is an evidence‐based eight‐module online self‐guided cognitive behavioural intervention that targets the transdiagnostic risk factor of perfectionism and has been shown to decrease depression, anxiety, and disordered eating. The program was implemented at a UK university between 2021 and 2023. Recruitment occurred via departmental emails, academic staff, and the university's counselling staff and website. Participants were provided with access to the intervention for 6‐weeks and completed weekly surveys of psychosocial measures. The trial's implementation was assessed using the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework: reach (uptake via the recruitment channels), effectiveness (outcomes on psychometric measures of mental wellbeing), adoption (staff and organisational support), implementation (intervention engagement and attrition), and maintenance (continued implementation across the trial period). Key barriers to successful implementation, as well as proposed solutions, are discussed to guide future online mental health interventions provided in HEIs.

[This corrects the article DOI: 10.2196/44220.].

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author).

Objective: Increasing effectiveness and sustainability of universal school‐based eating disorder prevention is needed. This study adapted two existing selective prevention programmes for universal delivery, investigating feasibility, acceptability, and preliminary effects when delivered by trained teachers to classes of mixed‐gender adolescents.Method: A three‐arm controlled pilot study with Year 9 students (N = 288; M_age = 13.61 SD_age = .50). Three schools in south Wales and south‐west England were allocated to mindfulness‐based intervention (MBI), dissonance‐based intervention (DBI), or classes‐as‐usual (CAU) control. Self‐reported eating disorder risk factors were collected at baseline, 6‐week post‐intervention, and 2‐month follow‐up. Focus groups were conducted post‐intervention.Results: Delivery and evaluation were feasible, allowing for flexibility in scheduling, with good retention. Student and teacher ratings indicated moderate acceptability of both interventions, with recommendations for refinement. Mixed model analyses, controlling for baseline, showed significant effects of condition across post‐intervention and follow‐up for body esteem (DBI > CAU; Cohen's d = .34) and positive affect (MBI > CAU, d = .58). For girls only, both MBI and DBI improved body satisfaction and internalization, and the MBI additionally resulted in improved weight and shape concerns, negative affect, and life disengagement (d's = .39–1.12), across post‐intervention and follow‐up.Discussion: Selective eating disorder prevention programmes based on cognitive dissonance and mindfulness can be delivered universally in schools, by teachers, allowing for appropriate flexibility necessary for real world implementation. Moderate acceptability indicates areas for improving content and delivery; positive effects on key outcomes are encouraging. These findings provide support for further robust evaluation.Public Significance: Existing universal eating disorder prevention is limited by small effects and reliance on highly trained facilitators. This study is the first to adapt mindfulness‐ and dissonance‐based interventions for delivery by teachers, to adolescents of all genders in a classroom setting. Delivery was largely feasible and acceptable, and both interventions showed significant effects across key risk factors for eating disorders, with larger effect sizes than found previously. This underpins further robust evaluation.

Background: Digital mindfulness-based interventions (MBIs) are a promising approach to deliver accessible and scalable mindfulness training and have been shown to improve a range of health outcomes. However, the success of digital MBIs is reliant on adequate engagement, which remains a crucial challenge. Understanding people’s experiences of using digital MBIs and identifying the core factors that facilitate or act as barriers to engagement is essential to inform intervention development and maximize engagement and outcomes. Objective: This study aims to systematically map the literature on people’s experiences of using digital MBIs that target psychosocial variables (eg, anxiety, depression, distress, and well-being) and identify key barriers to and facilitators of engagement. Methods: We conducted a scoping review to synthesize empirical qualitative research on people’s experiences of using digital MBIs. We adopted a streamlined approach to ensure that the evidence could be incorporated into the early stages of intervention development. The search strategy identified articles with at least one keyword related to mindfulness, digital, user experience, and psychosocial variables in their title or Inclusion criteria specified that articles must have a qualitative component, report on participants’ experiences of using a digital MBI designed to improve psychosocial variables, and have a sample age range that at least partially overlapped with 16 to 35 years. Qualitative data on user experience were charted and analyzed using inductive thematic synthesis to generate understandings that go beyond the content of the original studies. We used the Quality of Reporting Tool to critically appraise the included sources of evidence. Results: The search identified 530 studies, 22 (4.2%) of which met the inclusion criteria. Overall, the samples were approximately 78% female and 79% White; participants were aged between 16 and 69 years; and the most used measures in intervention studies were mindfulness, psychological flexibility, and variables related to mental health (including depression, anxiety, stress, and well-being). All studies were judged to be adequately reported. We identified 3 themes characterizing barriers to and facilitators of engagement: responses to own practice (ie, negative reactions to one’s own practice are common and can deplete motivation), making mindfulness a habit (ie, creating a consistent training routine is essential yet challenging), and leaning on others (ie, those engaging depend on someone else for support). Conclusions: The themes identified in this review provide crucial insights as to why people frequently stop engaging with digital MBIs. Researchers and developers should consider using person-based coparticipatory methods to improve acceptability of and engagement with digital MBIs, increase their effectiveness, and support their translation to real-world use. Such strategies must be grounded in relevant literature and meet the priorities and needs of the individuals who will use the interventions.

The field of mindfulness practice and research has expanded over recent years and become more established in the public consciousness. In this paper we explore four key tensions for the mindfulness community to hold in awareness. These include: Mindfulness for me vs. mindfulness for others (an awareness of the loss of the spiritual and collective elements historically essential to mindfulness), Mindfulness for some vs. mindfulness for all (understanding why mindfulness may be more appealing for some more than others), The whole vs. the sum of its parts (the need to understand the mechanisms of mindfulness and still preserve its integrity), and Improving access vs. preserving fidelity (balancing modifications to address issues such as accessibility with retaining core components). Recognising such challenges is a vital aspect of ensuring that mindfulness researchers and practitioners continue to work in a way that retains authenticity and trust within this burgeoning field and helps to support engagement from a diverse range of people across the modern world.

BACKGROUND Digital mindfulness-based interventions (MBIs) are a promising approach to deliver accessible and scalable mindfulness training and have been shown to improve a range of health outcomes. However, the success of digital MBIs is reliant on adequate engagement, which remains a crucial challenge. Understanding people’s experiences of using digital MBIs and identifying the core factors that facilitate or act as barriers to engagement is essential to inform intervention development and maximize engagement and outcomes. OBJECTIVE This study aims to systematically map the literature on people’s experiences of using digital MBIs that target psychosocial variables (eg, anxiety, depression, distress, and well-being) and identify key barriers to and facilitators of engagement. METHODS We conducted a scoping review to synthesize empirical qualitative research on people’s experiences of using digital MBIs. We adopted a streamlined approach to ensure that the evidence could be incorporated into the early stages of intervention development. The search strategy identified articles with at least one keyword related to mindfulness, digital, user experience, and psychosocial variables in their title or Inclusion criteria specified that articles must have a qualitative component, report on participants’ experiences of using a digital MBI designed to improve psychosocial variables, and have a sample age range that at least partially overlapped with 16 to 35 years. Qualitative data on user experience were charted and analyzed using inductive thematic synthesis to generate understandings that go beyond the content of the original studies. We used the Quality of Reporting Tool to critically appraise the included sources of evidence. RESULTS The search identified 510 studies, 22 (4.3%) of which met the inclusion criteria. Overall, the samples were approximately 78% female and 79% White; participants were aged between 16 and 69 years; and the most used measures in intervention studies were mindfulness, psychological flexibility, and variables related to mental health (including depression, anxiety, stress, and well-being). All studies were judged to be adequately reported. We identified 3 themes characterizing barriers to and facilitators of engagement: responses to own practice (ie, negative reactions to one’s own practice are common and can deplete motivation), making mindfulness a habit (ie, creating a consistent training routine is essential yet challenging), and leaning on others (ie, those engaging depend on someone else for support). CONCLUSIONS The themes identified in this review provide crucial insights as to why people frequently stop engaging with digital MBIs. Researchers and developers should consider using person-based coparticipatory methods to improve acceptability of and engagement with digital MBIs, increase their effectiveness, and support their translation to real-world use. Such strategies must be grounded in relevant literature and meet the priorities and needs of the individuals who will use the interventions.