Emma Louise Osborne

Background: Binge eating disorder (BED) is highly prevalent and impairing; yet, the UK national guideline–recommended first-line treatment of guided self-help (ie, supported program-led interventions in which content is delivered by the program with brief support) remains underused in routine National Health Service (NHS) care. Digital delivery offers a scalable approach, but evidence from real-world NHS settings is limited. Objective: This real-world evaluation aimed to pilot a supported digital program-led version of enhanced cognitive behavior therapy (CBT-E) in a specialist adult eating disorder outpatient service within the UK NHS and assess its implementation in routine practice, acceptability, and preliminary clinical outcomes. Methods: An independent evaluation service conducted this service evaluation in a specialist NHS eating disorder service. Adults assessed by NHS clinicians as having features consistent with BED and for whom a supported program-led intervention was considered appropriate were offered a 12-session digital CBT-E program (delivered over 8-12 weeks), with brief remote support from trained nonspecialist practitioners. Patients completed an in-program suitability assessment to ensure that the intervention was appropriate (eg, excluding those with suicidal ideation). Self-report measures of binge eating frequency, eating disorder psychopathology, secondary impairment, and depressive symptoms were collected before and after the program. Outcomes were analyzed using paired t tests. All patients were offered an optional interview. Semistructured interviews with 8 patients, 2 supporters, and a survey completed by 6 staff members were analyzed thematically to explore experiences of the intervention within the care pathway. Results: Between January and October 2024, 43 patients registered, and the program was deemed suitable for 36 (84%), all of whom completed preprogram assessments. Among these, 6 were still using the program at the end of the evaluation period, and 30 had either completed or discontinued the program. These patients (n=30) completed a mean of 8 of 12 sessions; 16 completed the full program and postprogram assessments. Among these 16, significant reductions were observed in binge eating frequency (mean 18.91, SD 11.28 to 1.88, SD 1.82; P<.001) and eating disorder psychopathology (mean 3.94, SD 1.20 to 1.85, SD 1.14; P<.001), with similar improvements in secondary impairment and depressive symptoms (both P<.001). Qualitative feedback highlighted the program’s accessibility, its role in keeping patients on track, and its positive impact on staff development and satisfaction. Some patients initially expressed skepticism about the digital format, and staff noted challenges for individuals with low motivation or co-occurring conditions. Conclusions: This evaluation suggests that the supported digital program-led version of CBT-E can be successfully implemented within a specialist NHS service and may lead to improvements in clinical outcomes. This approach may increase access to guideline-recommended first-line treatment for BED in routine care. Further research with larger samples and controlled designs is needed to confirm effectiveness and evaluate resource use and cost-effectiveness.

Background: Many individuals who experience binge eating face significant challenges in accessing timely and adequate treatment, often due to limited healthcare resources. To address this, the digital, programme-led (self-help) version of Enhanced Cognitive Behaviour Therapy (CBT-E) has been developed. This service improvement project piloted the digital programme with adults on a specialist eating disorder service waiting list in the UK’s National Health Service (NHS). Its aim was to assess the feasibility, acceptability, and preliminary clinical effects of a digital programme for adults on a waiting list for an eating disorder characterised by binge eating. Methods: The digital programme was offered to patients with eating problems characterised by binge eating (binge eating disorder or bulimia nervosa or atypical or subclinical threshold cases), for whom a programme-led treatment was appropriate and who were on a waiting list for a specialist outpatient service. Patients used the programme independently, without any additional support. They completed self-report measures assessing eating disorder features, secondary impairment, and features of depression before and after the programme. Patients provided feedback through semi-structured interviews, and staff completed a survey. Results: Fifty patients started the programme, and 19 completed all active programme sessions. Those who completed the full programme and the post-programme assessments ( n = 14) reported significant reductions in binge eating frequency, eating disorder psychopathology, secondary impairment, and features of depression. Qualitative feedback from patients and staff highlighted the programme’s value as a waiting list offer and its role in supporting patients’ progress towards recovery. Some patients expressed a desire for human interaction to help them better engage with the programme. Conclusions: These findings suggest that the digital, programme-led version of CBT-E is feasible, acceptable, and shows promise in reducing binge eating and related impairments in adults on a waiting list for a specialist outpatient eating disorder services. Offering this evidence-informed programme could help address the challenge of long delays in accessing care. Future research should focus on strategies to enhance patient engagement and adherence, improve human interaction within the programme, and explore ways to scale the intervention to benefit broader populations, including its use as an early intervention.

Drawing on extensive experience in training and supervising clinicians in enhanced cognitive behaviour therapy (CBT-E), we have identified ten prevalent misconceptions and communication gaps. These misunderstandings can impact the implementation of CBT-E and may potentially reduce its effectiveness. They include misconceptions regarding CBT-E’s flexibility, suitability for certain patient groups, real-world applicability, and alignment with anti-weight stigma principles. Such misunderstandings may make clinicians hesitant to recommend or deliver CBT-E appropriately. In the present paper, we address these misconceptions and gaps in communication and provide evidence-based guidance on CBT-E practice. We aim to enhance clinicians’ confidence in using CBT-E flexibly and appropriately, with the hope that this will improve its effectiveness. Key learning aims: (1) Recognise common misconceptions and communication gaps about enhanced cognitive behaviour therapy (CBT-E) for eating disorders. (2) Develop an understanding of how CBT-E can be implemented across diverse clinical settings and patient populations. (3) Strengthen therapists’ confidence in delivering CBT-E flexibly while maintaining fidelity to its evidence-based framework.

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.

Objective: Eating disorders characterized by binge eating are prevalent yet under‐recognized, limiting access to effective care. The digital, programme‐led (self‐help) version of Enhanced Cognitive Behavior Therapy (CBT‐E) offers a potentially scalable treatment. This study gathered insights from individuals with lived experience of binge eating (LE) and healthcare professionals (HCPs) to inform the design of a randomized controlled trial evaluating the intervention's effectiveness and to support early‐stage implementation planning. Method: Four focus groups were conducted with 20 participants (8 with LE, 12 HCPs). Discussions explored recruitment strategies, participant engagement, meaningful outcome measures, and barriers to implementation. Data were analyzed using thematic analysis. Results: Two overarching themes were identified: (1) Reach People in Accessible and Supportive Ways, and (2) Be Open to Different Experiences of Progress. Participants emphasized inclusive recruitment and compassionate, hopeful messaging. Stigma and limited recognition of binge eating were cited as recruitment barriers in healthcare settings. Both groups recommended community and online platforms to enhance reach. Participants stressed the importance of outcomes beyond symptom reduction (e.g., emotional well‐being) and qualitative methods to capture recovery narratives. Findings also highlighted implementation‐relevant factors, including how interventions are framed and delivered, and how engagement can be optimized. Discussion: Perspectives from individuals with LE and HCPs support a person‐centred trial aligned with the needs of those experiencing binge eating and those providing care, while considering both evaluative and implementation priorities. Findings inform strategies to enhance reach and understanding of digital intervention outcomes, contributing to trial designs that are consistent with real‐world care and meaningful to participants.

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

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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.