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1 Results: Eating Disorder Psychopathology EDE-Q total, d= 0.93* EDI 2 DfT, d= 0.71* Mastertextforma bearbeiten Subj. + obj. binges, d= 0.52 Zweite Ebene Dritte Ebene - Vierte Ebene - Fünfte Ebene t-tests tests [pre-fu]; Cohen s d[pre-fu] 1. Development 2. Aims 3. Method 4. Results

2 Summary and Discussion Overall, in the completer group, risk factors and early symptoms improved significantly and mostly stable until 6mo FU with moderate to large ES Mastertextforma bearbeiten Zweite Ebene In addition, underweight participants ( ) showed a statistically and clinically significant and stable increase Dritte in BMI; Ebene but inconsistent pattern of change for secondary -outcomes Vierte Ebene - Fünfte Ebene Overall, subgroup of low weight participants (BMI 19-21) seems to benefit most! group effects affected by outliers

3 Targeted Prevention for Women at-risk for AN: SB-AN Mastertextforma bearbeiten Zweite Ebene Dritte Ebene - Vierte Ebene At-risk for AN - Fünfte Ebene 10/ /2010 Pilot study RCT Student Bodies TM -AN

4 Conclusions Institut für Klinische Psychologie und Psychotherapie, Goetz-Stiftungsprofessur für Essstörungen und assoziierte Störungen 1. Identification of risk groups for AN is possible: 14% of girls (11-17yrs.) Mastertextforma and 8% of young bearbeiten women (18-30 yrs.) can be considered d at risk based on our predefined d criteria i Zweite Ebene 2. Universal preventive Dritte interventions Ebene for AN are neither feasible nor promising i in terms of reduction of AN onset - Vierte Ebene - Fünfte Ebene 3. Indicated interventions focussing on reduction of symptom progression or subclinical i l syndrome progression in HR samples may be the only choice 4. It remains unclear, whether in HR girls il a parental intervention before the onset of the disorder shows promise 5. Overall, increasing i awareness of the disorder d in parents, physicians, school authorities and in the public seems most important

5 Thanks to.. Institut für Klinische Psychologie und Psychotherapie, Goetz-Stiftungsprofessur für Essstörungen und assoziierte Störungen Research Assistants Jana Bittner Hana Benier Julia Fleischhack Anke Heinrich Franziska Heyde Karolin Knöspel Linda Krause Tina Krüger Cäcilia Luong Carolin Müller Ilka Schober Jan-Philipp Stein Laura-Charlotte Syniawa Lisa Taubert Anne Zeugner Interviewers Katharina Abel Linda Engbrocks Melanie Hausdorf Maria Heinig Marco Holzmann Denise Kain Francie Kriegel Claudia Lange Katharina Liebscher Monique Lippmann Janka Lubinova Lotta Maaß Nicole Müller Maria Obst Sören Paul Juliane Penner Johannes Sperling Anne Ueck Dagmar Uhlmann

6 Institut für Klinische Psychologie und Psychotherapie, Goetz-Stiftungsprofessur für Essstörungen und assoziierte Störungen Mastertextforma bearbeiten Zweite Ebene Dritte Ebene - Vierte Ebene - Fünfte Ebene Thank you very much for your attention! Supported by the Swiss Anorexia nervosa Foundation and Else Kröner-Fresenius Foundation

7 Why do parents refuse to participate p (N=42)? Insufficient awareness of problem, participation not considered helpful (N=30): Dont`t see problem, low BMI is genetic disposition, thinness is good, true for all young girls, don`t have time for such bullshit Let sleeping dogs lie (N=1) Daughter is reluctant (N=5) Time constraints (N=7) Pediatrician: No reason to worry (N=5) Participation no longer considered necessary (N=2) Family did not appear to interview (N=7) Other reasons (N=7)

8 Results: Associated Psychopathology Depression (BDI), d= 0.31 Mastertextforma Knowledge, bearbeitend= 1.54* Zweite Ebene Dritte Ebene - Vierte Ebene - Fünfte Ebene General Psychopathology (BSI) d=0.37 t-tests tests [pre-fu]; Cohen s d[pre-fu] 1. Development 2. Aims 3. Method 4. Results

9 Develpment of SB AN (Ricarda s version) Session 1 Session 2 Session 3 Session 4 Session 5 Session 6 Session 7 Session 8 Session 9 Session 10 1 Willkommen Willkommen Willkommen Willkommen Willkommen Willkommen Willkommen Willkommen Willkommen Willkommen 2 Programmeinführung Checklist Essverhalten Checklist Essverhalten Checklist Essverhalten Checklist Essverhalten Checklist Essverhalten Checklist Essverhalten Checklist Essverhalten Checklist Essverhalten Checkliste Essverhalten 3 Checklist Information 1 Information 2 Ziele setzen S4 Ernährung 1 Ernährung 2 Ernährung 3 Sport 1 -Sport 2 -FBn Körperbild S8 Essverhalten -was sind ED? S1 -Heißhunger S2 Körperbild / Essverhalten -Grundlagen S1 -Bedürfnisse meines -verbotene NM S2 -welche Sportarten - exzessiver Sport -Essanfall S2 - gesundes Essvh. Körpers machen mir Spaß? -WCS S8 - warum es kein -Entstehung EA S5 S4 -Angst vor Wunschgewicht -Behandlung von Information 4 -Zwischenmahlzeiten Normalgewicht SB-Tagebuch -Ziele überprüfen gibt S4 ED S5 -Warum Diäten nicht S4 -vegetarisch/vegan verbotene (Körperbild, was sagt die Essverhalten, S8) Wissenschaft (Sportverhalten, S7) -Ursachen S1 -Folgen S2 restriktives Essvh. 4 Motivation SB-Tagebuch Einführung Motivation: mein Leben in 5 Jahren ohne / mit Veränderung Essverhalten (Mantra 13) funktionieren S4 -Stimmung & -Merken wann satt S3 Nahrungsmittel Mastertextforma -Teufelskreis der Diät Ernährung bearbeiten -Die Wahrheit h über Diätpillen S4 -Umgang Zweite schmerzhafte Perfektionismus EbeneSelbstwertgefühl S1 SB-Tagebuch Essanfälle Motivation: Ich in 5 Jahren Gefühlen II S4. -Was tun, wenn Gefühle hinderlich sind S4 -Checkliste hohe Dritte Ebene - Pause von schmerzhaften Gefühlen machen - Experiment pinker Elefant Gefühle erkennen und ausdrücken -Perfektionismus S7 Ansprüche -Gut genug sein stärken - Selbstkritik -Umgang mit Kritik und kritischen Kommentaren S7 - Vierte Ebene - Fünfte Ebene -Ernährungsmythen S3 -Konflikte in zwischenmenschl. Beziehungen S6 -Übung Durchsetzungsvermögen g -Hindernisse / hilfreiche Gedanken S6 -Umgang mit Frustration Achtsamkeit S2 -radical acceptance SB-Tagebuch Schmerzhafte Gefühle SB-Tagebuch S8 5 Schönheitsideale Körper1 Information 3 SB-Tagebuch SB-Tagebuch SB-Tagebuch Ressourcen SB-Tagebuch Genusstraining: Lektüre: True im Wandel der negative Gedanken und Konflikte und Frustration Hören Thighs Zeit Gefühle 6 Lektüre: Blog J. K. Rowling -Ansichten über meinen Körper S1 -Kulturelle Ideale S1 Funktionalität gestörten Essverhaltens (Norbo Ergebnisse) Perfektionismus Umgang mit Kritik -pos. Erfahrungen schaffen S5 -auf meine Wünsche hören noch mehr Ideen Umgang mit schmerzhaften Gefühlen S3 Genusstraining -warum wichtig? - Geschmack unterscheiden -Umgang Stress S2 Genusstraining Fühlen Genusstraining Konsistenzen Genusstraining Schmecken Spieglein Spieglein (3) -dem Körper etwas Gutes tun S5 Zusammenfassung Sitzung 10, Verabschiedung 7 Zusammenfassung/ Aussicht Lektüre: Minnesota Hunger Experiment 8 Zusammenfassung/ Aussicht Lektüre: Filmbearbeitung Hollywood Zusammenfassung/ Aussicht Körper 2 Schönheitsideale: Werbung Ralph Lauren Lektüre: Marokkanisches Bad Genusstraining: Riechen Körperbild -Entwicklung Körperbild S1 -FBn Körperbild S8 9 Zusammenfassung/Aussicht Lektüre: Körper akzeptieren Zusammenfassung/ Aussicht Bild von meinem Körper: Vermeidungsverhalten abbauen konkrete Übungen S6 Lektüre magersüchtiges Mädchen Zusammenfassung/ Aussicht -Spiegelein Spieglein (1) S3 -Brief an Körper S4 Lektüre: dünne Körper setzen Maßstäbe? Zusammenfassung/ Aussicht Spieglein Spieglein (2) S4 Lektüre: weibliche Identität Zusammenfassung/ Aussicht Lektüre: bulimische Eistänzerin Zusammenfassung/ Aussicht Literaturempfehlungen und Websites S8 Rückblick SB-AN Revised content for SB-AN new content for SB-AN Motivation Information Body & Beauty Emotions/ Coping Feeding Exercise

10 Student Bodies-AN: sessions Mastertextforma bearbeiten Zweite Ebene Dritte Ebene - Vierte Ebene - Fünfte Ebene Motivation Information Body & Beauty Emotions/ Coping Nutrition Exercise

11 Design -Main Study- Wait list T0 T1 Process T2 T3 T6 T6 T6 R Screening Pre Post FU FU FU FU E@T N=5,500 N=600 N= weeks 6 weeks 6 months

12 % at risk by age groups (pilot and main study; N=1.605)

13 Explorative Analyses: Effect Sizes -Pilot 2- # d s calculated for mean differences pre post using presds; positive ES indicate improvements, negative ES deteriorations on the respective measure

14 Explorative Analyses: Risk Status -Pilot 2- Code Screening Pre Post Completers rr14r HR Ba, C esp Clin A R A, C esp eö03r HR A, Bb C esp C esp ez18r HR Bb, C Perf/ SE A A te09l HR A, Ba, C Perf Ba R A, C Perf hi21i HR A, Bb, C Perf/ esp Clin A ce29i HR A, Ba A Ba HR A, Bb, C li16i R A, C Perf/ SE HR A, Bb, Perf Perf ul18r R A, C esp R A, C esp A cc22r R A, C Perf A A Dropouts T2, but logged on at least once: uv19z HR A, Bb, C SE R A, C esp uu10i R A, C Perf R A, C Perf, esp ra14r R A, C Fam R A, C Fam nu20r R R A, C Perf, A, C esp/ Fam SE, esp, Fam ri14r R A, C esp HR A, Bb iv30r R A, C Perf R A, C esp ra25t R A, C Fam R A, C ED fam Parents who never logged on: ce26l HR Ba, C Perf HR Ba, CPerf nf23r HR Bb, C Fam C ao08r R A, C Fam HR Bb, C Fam rc04r R A, C Fam la12l R A, C Perf/ SE/ esp R A, C Fam+eSp HR: High Risk risk combination BC or AB or ABC R: Risk risk combination AC Clin: clinical impression of eating problem

15 Comparison to other prevention programs Mastertextforma bearbeiten ANCOVA of post-scores using pre-scores as covariates Variable p post ES Zweite Ebene WCS a 0.20 Dritte y Ebene EDE Q Dietary Restraint 0.035* 0.28 Eating - Vierte Concerns Ebene 0.017* 0.30 Weight -Concerns Fünfte Ebene 0.041* 0.23 Shape Concerns 0.037* 0.23 Weight & Shape Combined 0.045* EDI 2 Drive Di for Thinness 0.010* 010* BDI ERB Negative Emotion Regulation ! Controlled ES Wilfley et al., Development 2. Aims 3. Method 4. Outcomes

16 Comparison to other prevention programs Mastertextforma bearbeiten Cohen s d Zweite Ebene Variable adjusted post ES WCS Dritte Ebene EDE Q Dietary Restraint - Vierte Ebene 0.28* 0.23 Eating Concerns - Fünfte Ebene 0.30* 0.25 Weight Concerns 0.23* 0.21 Shape Concerns 0.23* 0.23 EDI 2 Drive for Thinness 0.28* 0.33* BDI ERB Negative Emotion Regulation 0.08! Controlled ES Jacobi et al., under review 1. Development 2. Aims 3. Method 4. Outcomes

17 6 month FU ES of SB+ Variable ALLE COMPLETER N=64/62 ESSANFÄLLE N=43/32 RESTRIKTIV N=8/18 Wissenstest.77 (***).90 (***).42 WCS.34 ( t ) Mastertextforma bearbeiten Purging Subjektive Essanfälle Objektive Essanfälle Essanfälle gesamt Restriktives Essverhalten.40 (*).39 ( Zweite Ebene t ) ( t ).56(*) Dritte Ebene (*) - Vierte Ebene.33 ( t ).64 (**).40 ( t ) -.06 EDE-Q Restraint - Fünfte Ebene (*).69 (**) Eating Concern.53 (**).69 (**) -.08 Weight Concern.47 (*).67 (**) -.28 Shape Concern.51 (*).61 (*) -.10 Total.59 (**).76 (**) -.21 EDI-2 Schlankheitsstreben.52 (**).65 (**) -.13 Bulimie i.45 (*).73 (**) -.27 Körperliche Unzufriedenheit.70 (**).82 (**) -.05 BDI 1. Hintergrund 2. Zielsetzung Methoden Fragen -.09 BSI (GSI) Development 2. Aims 3. Method 4. Outcomes

18 Development of SB+ outcomes WCS t EDE-Q Restraint * EDE-Q EatCon ** d=.34 d=.52 d=.53 Mastertextforma bearbeiten Zweite Ebene Dritte Ebene - Vierte Ebene - Fünfte Ebene EDE-Q Total ** d=.59 EDE-Q WeiCon * d=.47 EDE-Q ShaCon * d=.51 SB+ KG 1. Development 2. Aims 3. Method 4. Outcomes

19 Reasons for dropout ** Reasons: Why do parents refuse to participate in although their daughters are at risk for AN? N total N HR* N R** Girls at risk Parents reached for Parents interviewed Eating problems no (longer an) pilot issue 2 / daughter is well/ gained 48 (55.2%) 23 (52.3%) 25 (58.1%) some N= 152 weight N= 126 (100%) N= 29 (23.0%) Daughter Of these: Nis involved = in competitive Of these: sports N = ( needs 63 to be thin ) 5 (5.7%) = 3 (6.8%) 2 (4.7%) HR 78 HR Of these: N HR 15 (12%) N R = 74 N R = 63 N R = 15 (12%) Daughter has already started treatment: medical 4 (4.6%) 4 (9.1%) 0 (0.0%) psychotherapeutic 1 (1.1%) 1 (2.3%) 0 (0.0%) We have been talking to daughter No contact about info the problem, no Participation further 9 refused** (10.3%) 4 (9.1%) 5 (11.6%) help needed N= 20 N= 87 (68.5%) No reason told, parents are reluctant 6 (6.9%) 4 (9.1%) 2 (4.7%) Daughter is reluctant 5 (5.7%) 1 (2.3%) 4 (9.3%) Contact info Daughter has started specialized incorrect treatment for ED No response to letter 2 (2.3%) 1 (2.3%) 1 (2.3%) N= 10 (7.9%) Time constraints N= 6 3 (3.4%) 2 (4.5%) 1 (2.3%) AN at the time of first assessment (screening), now successfully treated 1 (1.1%) 0 (0.0%) 1 (2.3%) Parents did not come to arranged appointment 3 (3.4%) 2 (4.5%) 1 (2.3%)

20 Recruitment Main Study November, 2011 Dresden and Surrounding Area # of screens handed out N=5126 Returned screens N=1210 (23,6%) No consent (data cannot be used) N=87 Consent pending N=17 Data not yet entered N=34 Data entering completed N=1072 Screen+ N= 148 (13,8%) Not randomized (refused randomization, participation p in E@T) N=1 Screen- N=924 No contact information N=21 No feedback to mail, definitely N=22 Contact only via mail, no feedback so far N=1 No response to calls, no feedback to mail N=6 Not called so far N=4 Σ no contact/ no response N=50 Contact after screen N=94 (63,5% of screen+) T1 interviews completed N=41 Exclusion after screening (reported psychotherapeutic treatment) N=6 Declined participation N=42 (28,4% of screen+) Decision pending N=2 Scheduled T1 interviews N=3 Not randomized (do not fulfill risk criteria) N=10 Not randomized (fulfill exclusion criteria) N=1 Randomized N=29 =19,6% of screen+; 2,4% of returned screens Intervention group N=15 Control group N=14

21 Milestones Pilot study 1: Examination of the frequency of risk factors and their combinations Development of an Internet-based intervention on the basis of family-oriented treatment approaches for AN (Lock, 2004; Lock & LeGrange, 2005) Translation of program and technical implementation of both versions: d d

22 Milestones Pilot study 1: Examination of the frequency of risk factors and their combinations Development of the internet-based intervention on basis of family-oriented treatment approaches for AN (Lock, 2004; Lock & LeGrange, 2005) Translation of program and technical implementation of both versions: d d Pilot study 2: Test of program feasibility with parents

23 Milestones Pilot study 1: Examination of the frequency of risk factors and their combinations Development of the internet-based intervention on basis of family-oriented treatment approaches for AN (Lock, 2004; Lock & LeGrange, 2005) Translation of program and technical implementation of both versions: d d Pilot study 2: Test of program feasibility with parents Main study: RCT with N=200 HR girls, follow-ups up to 2 years

24 Frequency of Risk Factors, Retrospective Correlates and Early Symptoms Out of 701 girls, 409 (58%) fulfill at least one criterion (A or B or C) Indicators for AN-risk Operationalization WCS Cut-Off 42 Number of girls N (%) 136 (19,4 %) A Weight- and shape concerns EDI-2 Drive for thinness EDE-Q Global score 24,1 2, (14,2 %) 85 (12,1 %) EDI-2 Body dissatisfaction 40,5 0 (0 %) Weight criterion I < 90 % IBW # 150 (21,4 %) B Weight criterion (early symptom) Weight criterion II Weight criterion i III % IBW and 5% weight loss in the past 6 months >115% IBW and 10% weight loss in the past 6 months 39 (5,6 %) 0 (0%) Perfectionism (Frost) 78,3 110 (15,7 %) Perfectionism i (EDI-2) 22,22 75 (10,7 %) C Retrospective correlates and early symptom amenorrhea Low self esteem (Rosenberg) Amenorrhea 17,3 yes 10 (1,4 %) 6 (0.9 %) Excessive exercise yes 75 (10,7 %) Family hx of ED yes 70 (10,0)

25 Risikomerkmale (Screening) Indikator für AN- Risiko Operationalisierung Cut-Off A Figur- und Gewichtssorgen B - Auffällige gewichtsbezogene Eigenschaften (Frühsymptom) C Retrospektive Korrelate und Frühsymptom Amenorrhöe WCS EDI-2 Schlankheitsstreben Gewichtskriterium I Gewichtskriterium II Gewichtskriterium III Perfektionismus (Frost) Amenorrhöe Übermäßiger Sport ES in Familie 42 24,1 < 90 % IBW # % IBW und 5% Gewichtsverlust in letzten 6 Monaten >115% IBW und 10% Gewichtsverlust in letzten 6 Monaten 78,3 ja ja ja

26 Target Group for Preventive Intervention combinations of risk factors High risk BC or AB or ABC 78 (11.1%) Weight & shape concerns ns + weight criterion+ A A 55 AB 10 AC 74 Risk AB or AC or BC or ABC 74 (10.5%) Weight & shape concerns + correlate subclinical BN? B B 111 ABC 22 BC 46 C C 91 Weight criterion + correlate deniers?

27 Flowchart -Pilot 2- Girls at risk Parents reached for Parents interviewed Parents included (pre) pilot 2 N= 152 N= 126 (100%) N= 29 (23.0%) N= 20 (15.5%) Of these: N HR = 78 Of these: N HR = 63 Of these: N HR = 15 (12%) N R = 74 N R = 63 N R = 15 (12%) Of these: N HR = 9 (7%) N R = 12 (9.5%) No contact info Participation refused** N= 20 N= 87 (68.5%) Contact info incorrect N= 6 No response to letter N= 10 (7.9%) Parents interviewed (post) N= 10 (8%) Of these: N HR = 6 (5%) N R = 4 (3%)

28 Adherence: # of pages read Mean % of pages read Mean % of pages read Number of who users all users all logged on users Session logged on at least once (n=20) (n=15) S ,0 50,6 S2 8 8,5 11,3 S3 6 12,4 16,5 S4 5 16,9 22,6 S5 7 16,5 25,1 S6 5 20,0 26,7 Mean 18,8 25,5

29 SB+: moderator variables of remission (binges or compensatory behavior) 1. Participants with initial binge eating (obj. / subj.) were more likely to achieve remission than participants not experiencing binges Mastertextforma bearbeiten Zweite Ebene 2. Participants with initial restrictive eating behavior were less likely to achieve remission than participants without Dritte restrictive Ebene eating - Vierte Ebene - Fünfte Ebene (Fittig et al., 2008) 3. For the subgroup of bingeing participants most of the outcomes showed larger ES compared to the overall sample (Völker et al., in press; Jacobi et al., in press) 1. Development 2. Aims 3. Method 4. Outcomes

30 Why tailored prevention for AN? So far, only 2 studies could show that preventive intervention in high risk samples is able to reduce the development of subclinical/full blown EDs (Stice et Mastertextforma bearbeiten al., 2008; Taylor et al., 2006) Zweite Ebene This only applies to bulimic and binge eating symptoms Dritte Ebene - Vierte Ebene - Fünfte Ebene Inclusion criteria were non-specific (WCS, sometimes compensatory behavior, BMI in SB studies as yet in the upper range of normal weight [MW 23,3; SD 2,8]) (Beintner et al., in press) Need for adapting SB for women with AN-specific risk factors (low BMI and/or restrictive ti eating behavior) 1. Development 2. Aims 3. Method 4. Outcomes

31 Summary and Discussion Evaluate the efficacy of program in RCT with longer FU-period Mastertextforma bearbeiten Development of booster sessions for underweight participants Zweite Ebene Dritte Ebene Contentual and technical adaptions according to participants - Vierte feedback Ebeneand mod s experience - Fünfte Ebene

32 SB+: moderator variables of remission (binges or compensatory behavior) 1. Participants with initial binge eating (obj. / subj.) were more likely to achieve remission than participants not experiencing binges Mastertextforma bearbeiten Zweite Ebene 2. Participants with initial restrictive eating behavior were less likely to achieve remission than participants without Dritte restrictive Ebene eating - Vierte Ebene - Fünfte Ebene (Fittig et al., 2008) 3. For the subgroup of bingeing participants most of the outcomes showed larger ES compared to the overall sample (Völker et al., in press; Jacobi et al., in press) 1. Development 2. Aims 3. Method 4. Outcomes

33 Why tailored prevention for AN? So far, only 2 studies could show that preventive intervention in high risk samples is able to reduce the development of subclinical/full blown EDs (Stice et Mastertextforma bearbeiten al., 2008; Taylor et al., 2006) Zweite Ebene This only applies to bulimic and binge eating symptoms Dritte Ebene - Vierte Ebene - Fünfte Ebene Inclusion criteria were non-specific (WCS, sometimes compensatory behavior, BMI in SB studies as yet in the upper range of normal weight [MW 23,3; SD 2,8]) (Beintner et al., in press) Need for adapting SB for women with AN-specific risk factors (low BMI and/or restrictive ti eating behavior) 1. Development 2. Aims 3. Method 4. Outcomes

34 Interactive Elements: Cognitive-behavioral Exercises Mastertextforma bearbeiten Zweite Ebene Dritte Ebene - Vierte Ebene - Fünfte Ebene 1. Development 2. Aims 3. Method 4. Results

35 Mastertextforma bearbeiten Zweite Ebene Dritte Ebene - Vierte Ebene - Fünfte Ebene 1. Development 2. Aims 3. Method 4. Results

36 Risk Factors, Markers, and Retrospective Correlates for AN Pregnancy complic./ gestat. age Preterm birth/birth trauma Season of birth Ethnicity Female gender Genetic factors Birth High-concern parenting Infant sleep pattern diff. Feeding and gastrointest. problems Digestive problems, picky eating, AN symptoms Eating conflicts meal struggles Early health problems Adoption & foster care Acculturation OCD Comments about weight & shape Childhood anxiety dis. Neg. self-evaluation evaluation neg. affectivity perfectionism, etc. Sexual abuse/ Adverse life events Highlevel exercise Pubertal timingi BDD Weight concerns/ dieting Adolescent age OCPD & traits / loneliness, shyness, inferiority 5y. 10y. 15y. 20y. Type: Risk factor Marker Retrosp. Correlate Both AN onset

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40 Reasons for dropout ** Reasons: Why do parents refuse to participate in although their daughters are at risk for AN? N total N HR* N R** Girls at risk Parents reached for Parents interviewed Eating problems no (longer an) pilot issue 2 / daughter is well/ gained 48 (55.2%) 23 (52.3%) 25 (58.1%) some N= 152 weight N= 126 (100%) N= 29 (23.0%) Daughter Of these: Nis involved = in competitive Of these: sports N = ( needs 63 to be thin ) 5 (5.7%) = 3 (6.8%) 2 (4.7%) HR 78 HR Of these: N HR 15 (12%) N R = 74 N R = 63 N R = 15 (12%) Daughter has already started treatment: medical 4 (4.6%) 4 (9.1%) 0 (0.0%) psychotherapeutic 1 (1.1%) 1 (2.3%) 0 (0.0%) We have been talking to daughter No contact about info the problem, no Participation further 9 refused** (10.3%) 4 (9.1%) 5 (11.6%) help needed N= 20 N= 87 (68.5%) No reason told, parents are reluctant 6 (6.9%) 4 (9.1%) 2 (4.7%) Daughter is reluctant 5 (5.7%) 1 (2.3%) 4 (9.3%) Contact info Daughter has started specialized incorrect treatment for ED No response to letter 2 (2.3%) 1 (2.3%) 1 (2.3%) N= 10 (7.9%) Time constraints N= 6 3 (3.4%) 2 (4.5%) 1 (2.3%) AN at the time of first assessment (screening), now successfully treated 1 (1.1%) 0 (0.0%) 1 (2.3%) Parents did not come to arranged appointment 3 (3.4%) 2 (4.5%) 1 (2.3%)

41 Why Early Interventions for AN? 1. Poor prognosis of AN (mortality, psychological, physical and social consequences) 2. Limited treatment efficacy 3. At least some risk factors are known, replicated (others are probable risk factors) and modifiable 4. Subclinical eating disorders are more common than full syndrome eating disorders, considerable overlap Fairburn et al., 2007; Favaro et al., 2003

42 Objectives 1. To examine the frequency of established risk factors and/or retrospective correlates/early symptoms in girls aged years 2. To develop and evaluate the efficacy of a family-oriented Internet-based intervention for parents of girls at high risk for AN 3. To reduce or prevent symptom progression of core symptoms of AN, s. a. weight loss, excessive weight and shape concerns and restrictive eating

43 Results: Acceptance Overall evaluation: good (1,7), In general, how comprehensible did find the phrasing of the program Mastertextforma bearbeiten content? Zweite Ebene not at all somewhat considerable Dritte Ebene highly - Vierte Ebene In general, how thoroughly - Fünfte Ebene did you work on the sessions? not at all somewhat considerably highly How satisfied have you been with your moderator s weekly feedback? not at all somewhat considerably highly 1. Development 2. Aims 3. Method 4. Results

44 Interactive Elements: Journal Mastertextforma bearbeiten Zweite Ebene Dritte Ebene - Vierte Ebene - Fünfte Ebene 1. Development 2. Aims 3. Method 4. Results

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