Jessica Yu

Adherence to evidence-based guidelines among diabetes self-management apps

Smartphone apps can provide real-time, interactive self-management aid to individuals with diabetes. It is currently unclear whether existing diabetes self-management apps follow evidence-based guidelines. The purpose of this study was to evaluate the extent to which existing diabetes self-management apps address the seven self-management behaviors recommended by the American Association of Diabetes Educators (the AADE7™). The term “diabetes” identified relevant self-management apps via the Apple App Store search engine in March 2012. Ratings were based on app descriptions and downloads. Chi-square analyses assessed differences in apps based on developer type. Apps promoted a median of two AADE7™ skills. Overall reliability between description and download ratings was good (kappa = .66). Reliability of individual skills was variable (kappa = .25 to .91). Most diabetes apps do not conform to evidence-based recommendations, and future app reviews would benefit from testing app performance. Future apps may also benefit from theory-based designs.

Binge/purge thoughts in nonsuicidal self-injurious adolescents: An ecological momentary analysis

OBJECTIVE Adolescents who self-injure often engage in bingeing/purging (BP). Ecological momentary assessment (EMA) has potential to offer insight into the relationship between self-injury and BP. The aims of this study were to examine the frequency and context of BP using EMA in a sample of nonsuicidal self-injurious (NSSI) adolescents. METHOD Thirty adolescents with a history of NSSI responded to questions regarding self-destructive thoughts/behaviors using a palm-pilot device. Descriptive analyses compared thought/behavior contexts during reports of BP and NSSI thoughts/behaviors (occurring together vs. individually). RESULTS BP thoughts were present in 22 (73%) participants, occurring on 32% of the person-days recorded; 59% of these participants actually engaged in BP behavior. Seventy-nine percent of BP thoughts co-occurred with other self-destructive thoughts. Adolescents were more often with friends/peers than alone or with family when having BP thoughts. Worry and pressure precipitated both BP and NSSI thoughts, but perceived criticism and feelings of rejection/hurt were associated more often with BP thoughts than with NSSI thoughts. DISCUSSION BP thoughts and behaviors were common in this sample, often occurring with other self-destructive thoughts. Future EMA research is needed to address the function of BP symptoms, the contextual variables that increase risk for BP thoughts, and the factors that predict the transition of thoughts into behaviors in adolescents with and without self-injury.

Defining Recovery in Adult Bulimia Nervosa

To examine how different definitions of recovery lead to varying rates of recovery, maintenance of recovery, and relapse in bulimia nervosa (BN), end-of-treatment (EOT) and follow-up data were obtained from 96 adults with BN. Combining behavioral, physical, and psychological criteria led to recovery rates between 15.5% and 34.4% at EOT, though relapse was approximately 50%. Combining these criteria and requiring abstinence from binge eating and purging when defining recovery may lead to lower recovery rates than those found in previous studies; however, a strength of this definition is that individuals who meet this criteria have no remaining disordered behaviors or symptoms.

Stress eating and sleep disturbance as mediators in the relationship between depression and obesity in low-income, minority women

The purpose of this study was to explore potential mediators of the relationship between depression and obesity in a sample of low-income, minority women. Data were extracted from a sample of 535 women enrolled in a weight loss intervention for the prevention of type 2 diabetes. Using a non-parametric bootstrapping procedure, the potential mediation effects of stress eating and sleep disturbance on the relationship between depression and obesity were tested. Results of a single mediation model indicated that depressive symptomatology was significantly associated with obesity (β=0.800, SE=0.290, p=0.006), and that stress eating (β=0.166, 95% CI [0.046, 0.328]) and sleep disturbance (β=1.032, 95% CI [0.612, 1.427]) were significant independent mediators of this relationship. Sleep disturbance remained a significant mediator in a combined mediation model (β=1.009, 95% CI [0.653, 1.399]). Findings add to the growing literature on the psychosocial factors implicated in the link between depression and obesity, particularly among disadvantaged populations. Future longitudinal research should aim to establish causal pathways between obesity, stress eating, sleep disturbance, and depression.

The benefits of using semi-continuous and continuous models to analyze binge eating data: A Monte Carlo investigation

OBJECTIVE Change in binge eating is typically a primary outcome for interventions targeting individuals with eating pathology. A range of statistical models exist to handle these types of frequency distributions, but little empirical evidence exists to guide the appropriate choice of statistical model. METHOD Monte Carlo simulations were used to investigate the utility of semi-continuous models relative to continuous models in various situations relevant to binge eating treatment studies. RESULTS Semi-continuous models yielded more accurate estimates of the population, while continuous models were higher powered when higher levels of missing data were present. DISCUSSION The present findings generally support the use of semi-continuous models applied to binge eating data, with total sample sizes of roughly 200 being adequately powered to detect moderate treatment effects. However, models with a significant amount of missing data yielded more favorable power estimates for continuous models.

The Use of “Bug-in-the-Eye” Live Supervision for Training in Dialectical Behavior Therapy A Case Study

Dialectical behavior therapy (DBT) has been shown effective for the treatment of borderline personality disorder (BPD) and other high-risk, suicidal, and diagnostically complex populations. However, little has been written about how to train therapists in DBT’s highly structured framework of target hierarchies, behavioral chain analyses, and stylistic strategies. This case study illustrates the utility of a live supervision method known as “bug-in-the-eye” (BITE) in training a novice DBT therapist. “Willow,” a 35-year-old Hispanic female with BPD, engaged in 6 months of comprehensive DBT that included 25 individual therapy sessions. BITE supervision was implemented in Sessions 12 through 17. Therapist adherence to DBT was assessed from Sessions 8 to 21. Client and therapist satisfaction with BITE was assessed after Session 21. Results indicate that therapist adherence to DBT increased following the implementation of BITE supervision. In addition, both therapist and client found BITE supervision to be acceptable and minimally intrusive, with the therapist reporting increased confidence in delivering DBT. Furthermore, results indicate that DBT was effective in reducing Willow’s suicidal ideation and self-harm urges, decreasing her feelings and displays of intense fear and jealousy, and increasing her independence. Recommendations for implementing live supervision into DBT training settings are provided.

Illness Behavior and Care Seeking

Illness behavior, the belief that one is threatened by illness and in need of protective action, is typically initiated by changes in somatic experience and physical function that are interpreted as symptoms of an underlying threat to health. This interpretation involves matching of symptoms to schemas of illness. Schemas are products of personal experience, observations of and communication with others, and media exposure. The conviction and emotional worry that one is sick and the overuse of medical care in the absence of objective signs of disease may be sustained by the interplay between somatic sensation and emotional activation. We propose that a common mechanism underlies illness behavior for acute and chronic conditions and for somatoform disorders, and that the biological processes underlying the condition and the social processes surrounding the patient differentiate the observed differences in illness behaviors.

Changes in coping behavior in a randomized controlled trial of concurrent treatment for PTSD and alcohol dependence.

OBJECTIVE The current study examines changes in coping among 165 adults meeting DSM-IV criteria for co-morbid posttraumatic stress disorder (PTSD) and alcohol dependence (AD). METHOD Participants were randomized to receive naltrexone or placebo, with or without prolonged exposure (PE). All participants received supportive counseling focused on alcohol use (BRENDA). Assessments of coping, PTSD, and AD were conducted at pre-treatment, mid-treatment, post-treatment, 3-month follow-up, and 6-month follow-up. RESULTS Participants exhibited significant decreases in both avoidant coping and adaptive coping from pre-treatment to 6-month follow-up across all groups. Participants who received PE showed faster decreases in avoidant coping during this period than participants who did not receive PE. PTSD symptom reduction was associated with changes in both avoidant and adaptive coping across groups. Improvement in PTSD symptoms was related to a faster rate of reduction in avoidant coping in the PE groups compared to those receiving BRENDA alone. CONCLUSIONS The current results suggest that concurrent treatment for co-morbid PTSD-AD decreases avoidant and adaptive coping, and participants who show greater reductions in PTSD symptoms also show greater changes in coping style. Consistent with theorized mechanisms of change in PE, the addition of PE to supportive counseling for AD was associated with a greater reduction of avoidant coping than supportive counseling alone.