Katherine Nameth

Thank you for the opportunity to review this work. This study addresses a critically needed area of research by investigating the effectiveness of an online treatment program for significant others of individuals with substance abuse, targeting the o...

Background: While social support benefits those in treatment for opioid use disorder, it is unclear how social support impacts patient outcomes.Objectives: This study examines how support person attitudes toward buprenorphine and their communication about substance use are associated with the well-being of patients receiving buprenorphine treatment.Methods: We analyzed cross-sectional baseline data from 219 buprenorphine patients (40% female) and their support persons (72% female). Patients were recruited from five community health centers and asked to nominate a support person. Patient outcomes included symptoms of depression, anxiety, impairment due to substance use, and perceived social support. Support persons predictors included their attitudes toward buprenorphine from four statements (e.g. "Buprenorphine is just replacing one drug for another") and communication using two items (e.g. comfort and effectiveness discussing substance use).Results: More stigmatizing attitudes, such as believing patients should quit on their own without medication, were associated with increased patient substance use-related impairment (F = 4.53, p = .01). Effective communication was associated with lower patient depression (F = 10.15, p < .001), anxiety (F = 4.73, p = .001), lower impairment (F = 6.46, p < .001), and higher perceived social support (F = 3.68, p = .007).Conclusions: This study highlights how support person attitudes and communication dynamics significantly affect the mental health and impairment of individuals receiving buprenorphine treatment. Interventions that reduce stigma and promote effective communication between patients and their loved ones could enhance treatment outcomes and overall well-being among patients with OUD.

Binge-eating disorder (BED) and bulimia nervosa (BN) have adverse psychological and medical consequences. Innovative interventions, like the integration of virtual reality (VR) with cue-exposure therapy (VR-CET), enhance outcomes for refractory patients compared to cognitive behavior therapy (CBT). Little is known about the feasibility and acceptability of translating VR-CET into real-world settings. To investigate this question, adults previously treated for BED or BN with at least one objective or subjective binge episode/week were recruited from an outpatient university eating disorder clinic to receive up to eight weekly one-hour VR-CET sessions. Eleven of 16 (68.8%) eligible patients were enrolled; nine (82%) completed treatment; and 82% (9/11) provided follow-up data 7.1 (SD = 2.12) months post-treatment. Overall, participant and therapist acceptability of VR-CET was high. Intent-to-treat objective binge episodes (OBEs) decreased significantly from 3.3 to 0.9/week (p < 0.001). Post-treatment OBE 7-day abstinence rate for completers was 56%, with 22% abstinent for 28 days at follow-up. Among participants purging at baseline, episodes decreased from a mean of one to zero/week, with 100% abstinence maintained at follow-up. The adoption of VR-CET into real-world clinic settings appears feasible and acceptable, with a preliminary signal of effectiveness. Findings, including some loss of treatment gains during follow-up may inform future treatment development.

Binge-eating disorder (BED) and bulimia nervosa (BN) have adverse psychological and medical consequences. Novel interventions, like the integration of virtual reality (VR) with cue-exposure therapy (VR-CET), enhance outcomes for refractory patients compared to cognitive behavior therapy (CBT). Little is known about the feasibility and acceptability of translating VR-CET into real-world settings. To investigate this question, adults previously treated for BED or BN with at least one objective or subjective binge episode/week were recruited from an outpatient University eating disorder clinic to receive up to eight weekly one-hour VR-CET sessions. Eleven of 16 (68.8%) eligible patients enrolled; nine (82%) completed treatment; 82% (9/11) provided follow-up data 7.1 (SD=2.12) months post-treatment. Overall, participant and therapist acceptability of VR-CET was high. Intent-to-treat objective binge episodes (OBEs) decreased significantly from 3.3 to 0.9/week (p < .001). Post-treatment OBE 7-day abstinence rate for completers was 56%, with 22% abstinent for 28 days at follow-up. Among participants purging at baseline, episodes decreased from a mean of one to zero/week, with 100% abstinence maintained at follow-up. The adoption of VR-CET into real-world clinic settings appears feasible and acceptable, with a preliminary signal of efficacy. Findings, including some loss of treatment gains during follow-up may inform future treatment development.

Novel treatment options for eating disorders (EDs) are critically needed to enhance treatment outcomes and reduce the rates of treatment dropouts. On average, only 50% of individuals receiving evidence-based care remit, whereas 24% drop out before treatment completion. One particularly promising direction involves integrating virtual reality (VR) with existing evidence-based treatments (EBTs) such as cue exposure therapy (CET). Across psychiatric disorders, VR-based interventions are demonstrating at least preliminary efficacy and noninferiority to traditional treatments. Furthermore, VR technology has become increasingly portable, resulting in improved acceptance, increased access, and reductions in cost. However, more efficient research processes may be needed to uncover the potential benefits of these rapid technological advances. This viewpoint paper reviews existing empirical support for integrating VR with EBTs (with a focus on its use with EDs) and proposes key next steps to more rapidly bring this innovative technology-based intervention into real-world clinic settings, as warranted. VR-CET for EDs is used to illustrate a suggested process for developing such treatment enhancements. We recommend following a deployment-focused model of intervention development and testing to enable rapid implementation of robust, practice-ready treatments. In addition, our review highlights the need for a comprehensive clinical protocol that supports clinicians and researchers in the implementation and testing of VR-CET and identifies key missing protocol components with rationale for their inclusion. Ultimately, this work may lead to a more complete understanding of the full potential of the applications and integrations of VR into mental health care globally.

BACKGROUND Most obesity management interventions do not achieve sustained behavior change and, thus, do not result in long term weight loss. A promising approach to weight loss involves mindful eating coaching, which increases awareness of internal cues including hunger and satiety. The purpose of this study was to evaluate the use of a novel technology that promotes mindful eating and drinking behaviors by providing contextual, real-time micro-nudges on wrist-worn wearable devices. OBJECTIVE Evaluate the use of a novel technology, promoting mindful eating and drinking behaviors using contextual micro-nudges on a wrist-worn device, and assess how it facilitates behavior change and weight loss. METHODS Participants used the mindful eating technology for 5 weeks. The primary outcomes of interest collected at the end of the intervention were user acceptability and engagement. Secondary outcomes collected before and at the end of the intervention were mindfulness while eating, consumptions behaviors, and weight loss. RESULTS 17 overweight and obese people completed the intervention. They found the technology to be highly acceptable: 75% reported that using the wearable on their dominant hand felt natural; 88% found it convenient to keep their phone nearby and use the wearable all day; 75% did not find the wearable’s vibrations (haptic) associated with the micro-nudges to be disruptive to the meal experience; 88% enjoyed having the Klue metrics visible on their wearable at all times. On average, the duration of the intervention was 34.2 days (SD 1.2). On average, participants used the app for all but 1.8 (SD 2.0) days, 13.0 (SD 1.0) hours per day when active, received to 27.2 micro-nudges (notifications) per day and engaged in 13.9 daily interactive coaching moments. Moreover, 94% of participants significantly improved their scores on the validated Mindful Eating Questionnaire (P=.001). Similarly, 94% of participants reported improving at least one consumption behavior during the study and 77% reported improving three or more consumption behaviors (e.g., eating more mindfully, remaining well hydrated). Average weight loss was 1.3kg (SD 2.3, P=0.03). CONCLUSIONS The novel technology evaluated in this study provided real-time micro-nudges on a wrist-worn wearable that were acceptable to users and used frequently. Technologies such as these that interact with the user in-the-moment as behaviors are developing may lead to sustained engagement and could have a significant role in increasing mindful eating and producing positive behavior changes associated with successful weight loss. CLINICALTRIAL Stanford e-Protocol #39068