A brief online emotion-based intervention to provide early support for adult patients with binge eating disorders awaiting NHS treatment: intervention acceptability, early feasibility and optimisation.

Background Eating disorders (EDs) affect up to 3.4 million people in the UK, with towering mortality rates and healthcare costs.

Patients suffer from “traumatic” long waiting times, leading to worsening of symptoms, even higher healthcare costs, and lower likelihood of responding to treatment.

Current recommended treatment does not address the underlying emotional difficulties faced by patients with EDs, which could explain the high relapse rates of 50-60%.

We have created a brief online psychoeducational intervention that targets difficulties in emotional functioning, with promising initial feedback. Its acceptability and feasibility remain to be tested.

Aims To assess and enhance the acceptability and early feasibility of a brief emotion-focused intervention for adults on an NHS waiting list for treatment for binge-eating.

Objectives Assess acceptability and early feasibility of the intervention Explore ED health care staff views around barriers to adoption of the intervention Determine variations in ED care pathways in England Refine the online intervention based on findings Assess the acceptability of study processes and clinical outcomes and look for signs of clinical improvement Design Three-phase mixed methods study involving Southern Health NHS Foundation Trust and the South London and Maudsley (SLaM) NHS Foundation Trust.

Throughout the study we will work with a Stakeholder and a PPI group.

Intervention The brief self-guided emotion-focused intervention comprises (beta-version): Five short videos each targeting a specific aspect of emotional difficulties Workbook Booklet to support practice of newly acquired skills.

Methods Phase 1: Embed the beta-version of the intervention within the LifeGuide+ platform to make it more interactive and engaging. Phase 2 i.

Iterative case-series with 30 adults in two waves Fifteen adults who binge-eat and are awaiting treatment at Southern Health Trust will be given access to the intervention.

They will complete questionnaires (about ED behaviours and emotions) before/after the intervention and provide feedback (via an interview) at the end. Patterns/duration of use will be recorded by the LifeGuide+ platform. Feedback will be used to make changes to the intervention. A second wave of the case-series will be undertaken with 15 adults awaiting treatment at SLaM Trust. ii.

Focus groups with ED health care staff Two focus groups with 5-10 healthcare staff from the two NHS Trusts will explore risks, benefits, and barriers to adoption of the intervention in an NHS setting. iii.

National survey of ED services A brief online survey sent to all adult ED services in England will ask about their care pathways/management of waiting lists.

An integrative analysis of i-iii will consider feasibility and acceptability of the intervention, study processes and outcome measures. Phase 3: Suggested intervention changes will be collated, prioritised and used to optimise the intervention. Anticipated Impact and Dissemination An academic and conference paper on acceptability and early feasibility.

A funding application for a controlled feasibility study to pave the way for a future definitive trial.

Longer term, we hope this intervention will be used in NHS settings around England to complement current care pathways and reduce human/financial costs associated with long waitlists and lack of emotional support.