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Testing the interaction of thinness/restriction and negative affect reduction expectancies on disordered eating behavior. Eat Behav 2022; 47:101663. [PMID: 36067649 DOI: 10.1016/j.eatbeh.2022.101663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 08/16/2022] [Accepted: 08/24/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Thinness/restriction expectancies (i.e., perceived rewards from thinness/dietary restriction) and negative affect reduction expectancies (i.e., beliefs that eating will reduce negative emotions) are associated with disordered eating, but have largely been studied in isolation despite evidence that individuals can endorse these expectancies simultaneously. Guided by the goal conflict model, we hypothesized that for individuals reporting high levels of one type of expectancy, stronger endorsement of the second expectancy category would be associated with more dietary restriction, binge eating, and compensatory behaviors. A secondary aim included testing an adapted goal conflict model. DESIGN Interaction effects were tested using multiple linear and negative binomial regressions. Exploratory indirect effect models tested the adapted goal conflict model. Given gender differences, hypotheses were tested separately by gender. MEASURES Participants (N = 406, 54.2% female, non-Hispanic White = 68.8%, Mage = 20.99, MBMI = 25.05) completed measures of thinness/restriction expectancies, negative affect expectancies, dietary restriction, binge eating, and compensatory behaviors (e.g., purging, laxative/diuretic use, compensatory exercise). RESULTS No statistically significant interaction of thinness/restriction and negative affect expectancies on disordered eating was observed for either the male or female sample. Main effects models revealed consistent findings across subsamples. Greater thinness/restriction expectancies were associated with more dietary restriction, binge eating, and compensatory behaviors. Greater negative affect reduction expectancies were associated with more binge eating. Exploratory indirect effect models yielded significant effects of each expectancy category on disordered eating. CONCLUSION Expectancies may be independent risk factors for disordered eating. Disordered eating prevention and intervention efforts may benefit from explicitly targeting thinness/restriction and negative affect expectancies.
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Onnink CM, Konstantinidou Y, Moskovich AA, Karekla MK, Merwin RM. Acceptance and commitment therapy (ACT) for eating disorders: A systematic review of intervention studies and call to action. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2022. [DOI: 10.1016/j.jcbs.2022.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Rossi E, Cassioli E, Martelli M, Melani G, Hazzard VM, Crosby RD, Wonderlich SA, Ricca V, Castellini G. Attachment insecurity predicts worse outcome in patients with eating disorders treated with enhanced cognitive behavior therapy: A one-year follow-up study. Int J Eat Disord 2022; 55:1054-1065. [PMID: 35735601 PMCID: PMC9543332 DOI: 10.1002/eat.23762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 06/08/2022] [Accepted: 06/08/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE This study aimed to explore the role of attachment insecurity in predicting a worse longitudinal trend of eating disorder (ED) psychopathology and body uneasiness in patients with Anorexia Nervosa (AN) or Bulimia Nervosa (BN) treated with Enhanced Cognitive Behavior Therapy, considering the longitudinal interplay between these dimensions. METHOD In total, 185 patients with AN or BN performed the baseline assessment, and 123 were re-evaluated after 1 year of treatment. Participants completed questionnaires evaluating ED psychopathology (Eating Disorders Examination Questionnaire) and body uneasiness (body uneasiness test). For the assessment of adult attachment, the Experiences in Close Relationships-Revised was administered at baseline. Bivariate latent change score analysis within the structural equation modeling framework was performed to investigate the evolution of ED psychopathology and body uneasiness, their longitudinal interplay, and the role of attachment style as an outcome predictor. RESULTS After treatment, all psychopathological features showed an overall improvement. Higher baseline levels of body uneasiness predicted a worse course of ED psychopathology. The change in body uneasiness over time depended on changes over time in ED psychopathology, but not vice versa. Insecure attachment predicted a worse longitudinal trend of ED psychopathology, and, through this impairment, it indirectly maintained higher levels of body uneasiness, as confirmed by mediation analyses. DISCUSSION The role of attachment insecurity as a predictor of treatment outcome suggests the need for an integration of the cognitive-behavioral conceptualization of EDs with a developmental perspective that considers attachment-related issues. PUBLIC SIGNIFICANCE STATEMENT Considering the burden of EDs in terms of public health and the unsatisfactory response to standard treatments, the identification of outcome predictors is of considerable clinical interest. This study demonstrated that attachment insecurity was associated with worse longitudinal trends of ED psychopathology and body uneasiness in patients with AN and BN treated with CBT-E, highlighting the importance of personalizing treatment programs taking into account a developmental perspective on these disorders.
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Affiliation(s)
- Eleonora Rossi
- Psychiatry Unit, Department of Health SciencesUniversity of FlorenceFlorenceItaly
| | - Emanuele Cassioli
- Psychiatry Unit, Department of Health SciencesUniversity of FlorenceFlorenceItaly
| | - Michela Martelli
- Psychiatry Unit, Department of Health SciencesUniversity of FlorenceFlorenceItaly
| | - Giulia Melani
- Psychiatry Unit, Department of Health SciencesUniversity of FlorenceFlorenceItaly
| | - Vivienne M. Hazzard
- Department of Psychiatry & Behavioral SciencesUniversity of Minnesota Medical SchoolMinneapolisMinnesotaUSA
| | - Ross D. Crosby
- Sanford Center for Biobehavioral ResearchFargoNorth DakotaUSA
| | | | - Valdo Ricca
- Psychiatry Unit, Department of Health SciencesUniversity of FlorenceFlorenceItaly
| | - Giovanni Castellini
- Psychiatry Unit, Department of Health SciencesUniversity of FlorenceFlorenceItaly
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Saunokonoko AJ, Mars M, Sattmann-Frese WJ. The significance of the father-daughter relationship to understanding and treating Bulimia Nervosa: a Hermeneutic Phenomenological Study. COGENT PSYCHOLOGY 2022. [DOI: 10.1080/23311908.2022.2095721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Affiliation(s)
| | - M. Mars
- Torrens University Australia, Pyrmont, New South Wales, Australia
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García-Fernández G, Krotter A, García-Pérez Á, Aonso-Diego G, Secades-Villa R. Pilot randomized trial of cognitive-behavioral treatment plus contingency management for quitting smoking and weight gain prevention among smokers with overweight or obesity. Drug Alcohol Depend 2022; 236:109477. [PMID: 35525238 DOI: 10.1016/j.drugalcdep.2022.109477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 04/20/2022] [Accepted: 04/21/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Post-cessation weight gain is a risk factor for relapse among quitters. The primary study aim was to evaluate, among smokers with overweight or obesity, the feasibility and acceptability of a cognitive-behavioral treatment (CBT) plus contingency management (CM) for quitting smoking and weight control. The secondary aim was to examine preliminary tobacco abstinence and weight change outcomes. METHODS In an 8-week pilot randomized clinical trial, 41 participants (Mage = 52.73, SD = 10.91, 56.1% females) with overweight or obesity (MBMI = 31.86, SD = 4.7) received a CBT for both quitting smoking and weight gain prevention (n = 24) or the same treatment plus CM (n = 17), consisting of providing incentives contingent upon smoking abstinence biochemically verified. RESULTS Recruitment success rate was 80.39% (41/51), completion rate was 90.24% (37/41), and mean number of sessions attended (out of 15 possible) was 13.20 (SD = 3.1). Mean satisfaction rating for the treatment (1-10 likert-type scale with 10 being most satisfactory) was 9.73 (SD =.61). Preliminary efficacy data indicated that the CM group achieved higher abstinence rates compared with the CBT condition (100% vs. 58.33%, p = .007). Abstinent participants increased 1.25 kg (SD = 1.79) their baseline body weight at the end of treatment (p = .001). CONCLUSIONS Providing weight gain prevention strategies and CM within a smoking cessation treatment seems feasible and acceptable. Preliminary data indicated that including CM facilitates tobacco abstinence rates, nevertheless no advantage for CM was found for weight control.
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Affiliation(s)
- Gloria García-Fernández
- Department of Psychology, Addictive Behaviours Research Group, University of Oviedo, Plaza Feijoo S-N, Oviedo 33003, Spain.
| | - Andrea Krotter
- Department of Psychology, Addictive Behaviours Research Group, University of Oviedo, Plaza Feijoo S-N, Oviedo 33003, Spain
| | - Ángel García-Pérez
- Department of Psychology, Addictive Behaviours Research Group, University of Oviedo, Plaza Feijoo S-N, Oviedo 33003, Spain
| | - Gema Aonso-Diego
- Department of Psychology, Addictive Behaviours Research Group, University of Oviedo, Plaza Feijoo S-N, Oviedo 33003, Spain
| | - Roberto Secades-Villa
- Department of Psychology, Addictive Behaviours Research Group, University of Oviedo, Plaza Feijoo S-N, Oviedo 33003, Spain
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56
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An Z, Krug I, Portingale J, Butler D. Mirror, mirror, on the wall: During pandemics, how can self-perception research in people with eating disorders happen at all? J Eat Disord 2022; 10:89. [PMID: 35773747 PMCID: PMC9245860 DOI: 10.1186/s40337-022-00608-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 06/09/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND 'Classic' embodiment illusions (e.g., the feeling of owning another person's hand) involves a three-way interaction between visual, proprioceptive, and tactile stimuli. These illusions have been studied in eating disorder (ED) populations given the potential implications for better understanding and improving body image concerns. Recently, several studies have employed 'tactile-reduced' methods mainly relying on the integration of visual and proprioceptive information to induce embodiment illusions in non-ED populations. To date, there has been no substantial review of these tactile-reduced approaches to consider their potential research and clinical utility in ED populations. METHOD This review sought to examine and integrate studies across three areas. Firstly, those that employed tactile-reduced embodiment techniques in non-ED populations. Secondly, those that used classic embodiment techniques to compare whether ED and non-ED populations differ in their susceptibility to embodiment. Thirdly, studies that investigated whether experiencing classic or tactile-reduced embodiment techniques can improve image-related concerns. RESULTS For the first aim five studies were identified, all of which found that tactile-reduced methods consistently induced embodiment illusions in non-ED individuals. For the second aim, seven studies comparing ED and non-ED samples were found. ED patients were more susceptible to embodiment than non-ED samples in four studies, less susceptible in one study, and equally susceptible in two studies. Finally, for aim three, amongst the seven studies that used classic or tactile-reduced embodiment methods in ED populations, six reported improvements in self-perception (i.e., reduced body size overestimation, decreased body dissatisfaction and fear of gaining weight). CONCLUSIONS Along with the classic approach, tactile-reduced embodiment approaches have implications for ED research and clinical practice, particularly for situations when face-to-face contact with people are restricted. Suggestions are provided for future researchers who wish to ensure best practice for planning embodiment research involving classic and tactile-reduced approaches.
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Affiliation(s)
- Zhen An
- Melbourne School of Psychological Sciences, The University of Melbourne, Redmond Barry Building, Level 7, Room 707, Melbourne, VIC, 3010, Australia
| | - Isabel Krug
- Melbourne School of Psychological Sciences, The University of Melbourne, Redmond Barry Building, Level 7, Room 707, Melbourne, VIC, 3010, Australia.
| | - Jade Portingale
- Melbourne School of Psychological Sciences, The University of Melbourne, Redmond Barry Building, Level 7, Room 707, Melbourne, VIC, 3010, Australia
| | - David Butler
- The Cairnmillar Institute, Hawthorn East, VIC, Australia
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Keegan E, Waller G, Wade TD. A systematic review and meta-analysis of a 10-session cognitive behavioural therapy for non-underweight eating disorders. CLIN PSYCHOL-UK 2022. [DOI: 10.1080/13284207.2022.2075257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Ella Keegan
- Blackbird Initiative, Órama Research Institute, Flinders University, Adelaide, Australia
| | - Glenn Waller
- Department of Psychology, University of Sheffield, Sheffield, United Kingdom
| | - Tracey D. Wade
- Blackbird Initiative, Órama Research Institute, Flinders University, Adelaide, Australia
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So BPH, Lai DKH, Cheung DSK, Lam WK, Cheung JCW, Wong DWC. Virtual Reality-Based Immersive Rehabilitation for Cognitive- and Behavioral-Impairment-Related Eating Disorders: A VREHAB Framework Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19105821. [PMID: 35627357 PMCID: PMC9141870 DOI: 10.3390/ijerph19105821] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/07/2022] [Accepted: 05/09/2022] [Indexed: 11/16/2022]
Abstract
Virtual reality (VR) technology is one of the promising directions for rehabilitation, especially cognitive rehabilitation. Previous studies demonstrated successful rehabilitation in motor, cognitive, and sensorial functions using VR. The objective of this review is to summarize the current designs and evidence on immersive rehabilitation interventions using VR on cognitive- or behavioral-related eating disorders, which was mapped using a VREHAB framework. Two authors independently searched electronic databases, including PubMed, Web of Science, Scopus, CINAHL, EMBASE, and Cochrane Library. Ten (n = 10) articles were eligible for review. Treatments for anorexia nervosa and binge eating disorder/bulimia nervosa were reported through enhanced/experimental cognitive behavior therapy (ECT), cue exposure therapy (CET), and body exposure therapy (BET) via the virtual environment. Some studies reported that the VR effects were superior or comparable to traditional treatments, while the effects may last longer using VR technology. In addition, VR was perceived as acceptable and feasible among patients and therapists and could be valuable for supplementing existing therapies, relieving manpower and caregiver burdens. Future studies may consider incorporating haptic, smell, and biofeedback to improve the experience, and thus the effects of the treatments for the users.
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Affiliation(s)
- Bryan Pak-Hei So
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong 999077, China;
| | - Derek Ka-Hei Lai
- Department of Computing, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong 999077, China;
| | - Daphne Sze-Ki Cheung
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong 999077, China;
- Research Institute of Smart Ageing, The Hong Kong Polytechnic University, Hong Kong 999077, China
- Centre for Gerontological Nursing, School of Nursing, The Hong Kong Polytechnic University, Hong Kong 999077, China
| | - Wing-Kai Lam
- Sports Information and External Affairs Centre, Hong Kong Sports Institute, Hong Kong 999077, China;
| | - James Chung-Wai Cheung
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong 999077, China;
- Research Institute of Smart Ageing, The Hong Kong Polytechnic University, Hong Kong 999077, China
- Correspondence: (J.C.-W.C.); (D.W.-C.W.); Tel.: +852-2766-7673 (J.C.-W.C.); +852-2766-7669 (D.W.-C.W.)
| | - Duo Wai-Chi Wong
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong 999077, China;
- Correspondence: (J.C.-W.C.); (D.W.-C.W.); Tel.: +852-2766-7673 (J.C.-W.C.); +852-2766-7669 (D.W.-C.W.)
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Tecuta L, Schumann R, Ballardini D, Tomba E. The Need to Control Thoughts in Eating Disorder Outpatients: A Longitudinal Study on Its Modification and Association with Eating Disorder Symptom Improvement. J Clin Med 2022; 11:jcm11082205. [PMID: 35456298 PMCID: PMC9028067 DOI: 10.3390/jcm11082205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 04/05/2022] [Accepted: 04/12/2022] [Indexed: 11/16/2022] Open
Abstract
The metacognition of needing to control thoughts has been implicated in eating disorders (EDs)—specifically, in association with the drive for thinness and over-control. To date, it has yet to be investigated longitudinally in ED outpatients undergoing CBT-based treatment. The current study aims to examine whether endorsing a need to control thoughts undergoes modifications during CBT-based treatment for EDs and whether its modification correlates with treatment response in terms of reduced ED symptomatology. Seventy female ED outpatients (34 with AN, 29 with BN, 7 with OSFED) were assessed at baseline and at the end of treatment with the Metacognitions Questionnaire (MCQ), the Eating Attitudes Test (EAT-40), and the General Health Questionnaire (GHQ). Post-treatment, significant reductions were observed in MCQ-need to control thoughts. Using hierarchical linear regression analyses such decreases significantly explained the variance in observed reductions in EAT-oral control and to a lesser extent, reductions in EAT-bulimia and food preoccupation and EAT-dieting. These results underscore the importance of metacognitive change in EDs and the potential utility of CBT-based treatment in its modification. Improving ED outcomes may warrant broadening the therapeutic target of over-control and a sense of loss of control beyond dysfunctional eating behaviors to include maladaptive metacognitions that concern the need to control thoughts.
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Affiliation(s)
- Lucia Tecuta
- Department of Psychology, University of Bologna, 40127 Bologna, Italy;
| | - Romana Schumann
- Eating Disorder Clinic “Centro Gruber”, 40125 Bologna, Italy; (R.S.); (D.B.)
| | | | - Elena Tomba
- Department of Psychology, University of Bologna, 40127 Bologna, Italy;
- Correspondence: ; Tel.: +39-05-1209-1339
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General and body-related self-conscious emotions predict facets of restrictive eating in undergraduate women. Eat Behav 2022; 45:101624. [PMID: 35334287 DOI: 10.1016/j.eatbeh.2022.101624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 03/02/2022] [Accepted: 03/06/2022] [Indexed: 11/24/2022]
Abstract
It is well understood that mood intolerance is a predictor of eating disorder (ED) symptoms. However, it is unclear whether intolerance of specific emotional experiences predicts ED symptoms. The current study used an ecological momentary assessment design to assess associations between the intensity and intolerance of general and body-related self-conscious emotions and facets of restrictive eating. Participants were 151 female undergraduate students (Mage = 18.99, SD = 1.30 years) who completed six surveys per day for 10 consecutive days. Participants reported on the intensity and intolerance of general and body-related shame, guilt, envy, and embarrassment and cognitive restraint (thoughts about restrictive eating) and behavioral restriction (act of restrictive eating) facets of restrictive eating. Data were analyzed using multilevel modeling. Based on the between-person findings, participants higher on intensity and intolerance of general and body-related self-conscious emotions experienced higher levels of cognitive restraint and behavioral restriction relative to individuals with lower levels of the emotion intensity and intolerance predictors on average. Based on the within-person findings, experiencing a higher intolerance of body-related self-conscious emotions compared to one's average was particularly important when examining behavioral restriction. Experiencing a higher intolerance of body-related envy was able to predict increased behavioral restriction at the time of the next report. These findings may inform tailored treatment targets for mood intolerance and restrictive eating.
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Novack K, Dufour R, Picard L, Booij L, Chadi N. An Intensive Ambulatory Care Program for Adolescents with Eating Disorders Combining In-Person and Virtual Care: Protocol for a Single-Site Naturalistic Trial (Preprint). JMIR Res Protoc 2022; 11:e37420. [DOI: 10.2196/37420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 09/18/2022] [Accepted: 09/21/2022] [Indexed: 11/13/2022] Open
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Cassioli E, Rossi E, Vizzotto C, Malinconi V, Vignozzi L, Ricca V, Castellini G. Avoidant Attachment Style Moderates the Recovery of Healthy Sexuality in Women With Anorexia Nervosa Treated With Enhanced Cognitive Behavior Therapy (CBT-E): A 2-Year Follow-Up Study. J Sex Med 2022; 19:347-355. [PMID: 35000889 DOI: 10.1016/j.jsxm.2021.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 11/25/2021] [Accepted: 12/02/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Insecure Attachment style has been associated with interpersonal problems in persons with Anorexia Nervosa (AN), and it might moderate the recovery of healthy sexuality in these subjects. AIM The aim of the present 2-year follow-up study was to evaluate the role of insecure attachment style as a moderator of the recovery of healthy sexuality in women with AN. METHODS 63 Italian women with AN treated with a multidisciplinary approach including Enhanced Cognitive Behavior Therapy were evaluated by means of a clinical interview and self-administered questionnaires. Individual psychotherapy sessions were administered by experienced psychotherapists over the course of at least 40 weeks (median number of sessions = 43, range: 38-50); trained dieticians provided personalized nutritional counselling to facilitate weight recovery. The assessment was performed at baseline (T0) and after 1 (T1) and 2 (T2) years. OUTCOMES The administered questionnaires investigated general psychopathology (SCL-90-R), eating disorder-specific psychopathology (EDE-Q), female sexuality (FSFI) and adult attachment style (ECR). RESULTS At baseline, avoidant attachment style was associated with all domains of sexual dysfunction. Longitudinal analysis showed a significant decrease in both eating disorder-specific psychopathology and sexual dysfunctions at follow-up evaluations. However, only 45% of remitted subjects also recovered healthy sexuality: these women reported significantly lower avoidance scores than those who only recovered from AN. Moderation analysis indicated that sexual desire did not increase in participants with higher levels of avoidant attachment. CLINICAL IMPLICATIONS These novel findings highlighted the importance of the assessment of adult attachment in the clinical setting, for better characterization and treatment of persons suffering from AN. STRENGTHS & LIMITATIONS The long follow-up duration, the multidisciplinary nature of the treatment, and the novelty of the topic were major strengths of the study, whereas the limited sample size and the absence of biological data were the main limitations. CONCLUSION This study highlighted the crucial role of avoidant attachment in the relationship between AN and sexual dysfunctions, underlining the importance of integrating treatments with attachment-focused interventions. Cassioli E, Rossi E, Vizzotto C, et al. Avoidant Attachment Style Moderates the Recovery of Healthy Sexuality in Women With Anorexia Nervosa Treated With Enhanced Cognitive Behavior Therapy (CBT-E): A 2-Year Follow-Up Study. J Sex Med 2022;19:347-355.
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Affiliation(s)
- Emanuele Cassioli
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Eleonora Rossi
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Camilla Vizzotto
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Viola Malinconi
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Linda Vignozzi
- Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio," University of Florence, Florence, Italy
| | - Valdo Ricca
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Giovanni Castellini
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy.
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Abstract
PURPOSE OF REVIEW This review summarizes recent developments in cognitive-behavioural therapy for eating disorders (CBT-ED). More specifically, the past five years were covered, with the latest UK and Dutch guidelines for eating disorders as a starting benchmark, and with special consideration of the past 18 months. RECENT FINDINGS The new research can be divided into findings that have: (1) reinforced our existing understanding of CBT-ED's models and impact; (2) advanced our understanding and the utility of CBT-ED, including its application for the 'new' disorder Avoidant/Restrictive Food Intake Disorder (ARFID); (3) suggested new directions, which require further exploration in clinical and research terms. These include learning from the circumstances of the COVID-19 pandemic. SUMMARY CBT-ED has developed substantially in the past 5 years, with consolidation of its existing evidence base, further support for real-life implementation, extension of methods used, and the development of new approaches for working with younger people - particularly in the form of treatments for ARFID. Over the past 18 months, even more promising changes in delivery occurred in response to the COVID19 pandemic, showing that we can adapt our methods in order to work effectively via remote means. Challenges remain regarding poor outcomes for anorexia nervosa.
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Affiliation(s)
- Sandra Mulkens
- Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine, and Life Sciences, School for Mental Health and Neuroscience
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Glenn Waller
- Clinical and Applied Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, UK
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Halbeisen G, Paslakis G. All I Need Is Two: The Clinical Potential of Adding Evaluative Pairing Procedures to Cognitive Behavioral Therapy for Changing Self-, Body- and Food-Related Evaluations. J Clin Med 2021; 10:4703. [PMID: 34682826 PMCID: PMC8539260 DOI: 10.3390/jcm10204703] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 10/05/2021] [Accepted: 10/11/2021] [Indexed: 11/16/2022] Open
Abstract
Pairing procedures are among the most frequently used paradigms for modifying evaluations of target stimuli related to oneself, an object, or a specific situation due to their repeated pairing with evaluative sources, such as positive or negative images or words. Because altered patterns of evaluations can be linked to the emergence and maintenance of disordered cognitions and behaviors, it has been suggested that pairing procedures may provide a simple yet effective means of complementing more complex intervention approaches, such as cognitive behavioral therapy (CBT). Here, we summarize recent studies that explored the clinical potential of pairing procedures for improving self-esteem, body satisfaction, and food and consumption preferences. While no study has yet combined pairing procedures with CBT, there are several successful examples of pairing procedures in clinically relevant domains and clinical populations. We discuss potential sources of heterogeneity among findings, provide methodological recommendations, and conclude that pairing procedures may bear clinical potential as an add-on to classical psychotherapy.
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Affiliation(s)
- Georg Halbeisen
- University Clinic for Psychosomatic Medicine and Psychotherapy, Medical Faculty, Campus East-Westfalia, Ruhr-University Bochum, Virchowstr. 65, 33312 Luebbecke, Germany;
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Claes L, Kiekens G, Boekaerts E, Depestele L, Dierckx E, Gijbels S, Schoevaerts K, Luyckx K. Are Sensitivity to Punishment, Sensitivity to Reward and Effortful Control Transdiagnostic Mechanisms Underlying the Eating Disorder/Obesity Spectrum? Nutrients 2021; 13:nu13103327. [PMID: 34684327 PMCID: PMC8541040 DOI: 10.3390/nu13103327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 09/20/2021] [Accepted: 09/20/2021] [Indexed: 11/16/2022] Open
Abstract
Although it has been postulated that eating disorders (EDs) and obesity form part of a broad spectrum of eating- and weight-related disorders, this has not yet been tested empirically. In the present study, we investigated interindividual differences in sensitivity to punishment, sensitivity to reward, and effortful control along the ED/obesity spectrum in women. We used data on 286 patients with eating disorders (44.6% AN-R, 24.12% AN-BP, and 31.82% BN), 126 healthy controls, and 640 Class II/III obese bariatric patients (32.81% Class II and 67.19% Class III) with and without binge eating. Participants completed the behavioral inhibition and behavioral activation scales, as well as the effortful control scale, to assess sensitivity to punishment and reward and effortful control. Results showed that patients with EDs scored significantly higher on punishment sensitivity (anxiety) compared to healthy controls and Class II/III obese patients; the different groups did not differ significantly on reward sensitivity. Patients with binge eating or compensatory behaviors scored significantly lower on effortful control than patients without binge eating. Differences in temperamental profiles along the ED/obesity spectrum appear continuous and gradual rather than categorical. This implies that it may be meaningful to include emotion regulation and impulse regulation training in the treatment of both EDs and obesity.
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Affiliation(s)
- Laurence Claes
- Faculty of Psychology and Educational Sciences, KU Leuven, 3000 Leuven, Belgium; (G.K.); (K.L.)
- Faculty of Medicine and Health Sciences, University Antwerp, 2000 Antwerp, Belgium
- Correspondence: ; Tel.: +32-16-32-61-33
| | - Glenn Kiekens
- Faculty of Psychology and Educational Sciences, KU Leuven, 3000 Leuven, Belgium; (G.K.); (K.L.)
- Center for Contextual Psychiatry, Department of Neurosciences, KU Leuven, 3000 Leuven, Belgium
| | - Els Boekaerts
- Obesity Centre Hasselt, Jessa Hospital, 3500 Hasselt, Belgium; (E.B.); (S.G.)
| | - Lies Depestele
- Psychiatric Hospital Alexianen Zorggroep Tienen, 3300 Tienen, Belgium; (L.D.); (E.D.); (K.S.)
| | - Eva Dierckx
- Psychiatric Hospital Alexianen Zorggroep Tienen, 3300 Tienen, Belgium; (L.D.); (E.D.); (K.S.)
- Department of Clinical Psychology, Vrije Universiteit Brussel, 1050 Brussels, Belgium
| | - Sylvia Gijbels
- Obesity Centre Hasselt, Jessa Hospital, 3500 Hasselt, Belgium; (E.B.); (S.G.)
| | - Katrien Schoevaerts
- Psychiatric Hospital Alexianen Zorggroep Tienen, 3300 Tienen, Belgium; (L.D.); (E.D.); (K.S.)
| | - Koen Luyckx
- Faculty of Psychology and Educational Sciences, KU Leuven, 3000 Leuven, Belgium; (G.K.); (K.L.)
- UNIBS, University of the Free State, Bloemfontein 9300, South Africa
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Irrational Beliefs and Their Role in Specific and Non-Specific Eating Disorder Symptomatology and Cognitive Reappraisal in Eating Disorders. J Clin Med 2021; 10:jcm10163525. [PMID: 34441821 PMCID: PMC8397039 DOI: 10.3390/jcm10163525] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 08/03/2021] [Accepted: 08/04/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Research on which specific maladaptive cognitions characterize eating disorders (ED) is lacking. This study explores irrational beliefs (IBs) in ED patients and controls and the association between IBs and ED-specific and non-specific ED symptomatology and cognitive reappraisal. METHODS 79 ED outpatients with anorexia nervosa, bulimia nervosa, or other specified feeding or eating disorders and 95 controls completed the Attitudes and Beliefs Scale-2 (ABS-2) for IBs. ED outpatients also completed the Eating Disorder Inventory-3 (EDI-3) for ED-specific (EDI-3-ED Risk) and non-specific (EDI-3-General Psychological Maladjustment) symptomatology; General Health Questionnaire (GHQ) for general psychopathology; Emotion Regulation Questionnaire (ERQ) for cognitive reappraisal. RESULTS Multivariate analysis of variance with post hoc comparisons showed that ED outpatients exhibit greater ABS-2-Awfulizing, ABS-2-Negative Global Evaluations, and ABS-2-Low Frustration Tolerance than controls. No differences emerged between ED diagnoses. According to stepwise linear regression analyses, body mass index (BMI) and ABS-2-Awfulizing predicted greater EDI-3-ED Risk, while ABS-2-Negative Global Evaluations and GHQ predicted greater EDI-3-General Psychological Maladjustment and lower ERQ-Cognitive Reappraisal. CONCLUSION Awfulizing and negative global evaluation contribute to better explaining ED-specific and non-specific ED symptoms and cognitive reappraisal. Therefore, including them, together with BMI and general psychopathology, when assessing ED patients and planning cognitive-behavioral treatment is warranted.
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Mountford VA, Allen KL, Tchanturia K, Eilender C, Schmidt U. Implementing evidence-based individual psychotherapies for adults with eating disorders in a real world clinical setting. Int J Eat Disord 2021; 54:1238-1249. [PMID: 33719036 DOI: 10.1002/eat.23504] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 03/03/2021] [Accepted: 03/03/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVE This study aimed to evaluate the effectiveness of evidenced-based psychological treatments (specifically, Cognitive-Behaviour Therapy for Eating Disorders [CBT-ED] and Maudsley Anorexia Nervosa Treatment for Adults [MANTRA]) for a transdiagnostic eating disorder population in a routine clinical setting. In particular, it aimed to determine the extent to which treatment was provided in line with current clinical guidelines (NICE, 2017) and how effective treatment was in improving eating disorder and general psychopathology. METHOD Three hundred and seventy-nine participants meeting criteria for DSM-5 anorexia nervosa, bulimia nervosa, binge-eating disorder or other specified feeding or eating disorder completed pre- and posttreatment measures of eating disorder pathology and general distress. Clinicians recorded weight and episodes of bingeing and purging. RESULTS Ninety seven percent of participants received treatment in line with evidence-based psychotherapies. Treatment was completed by 59.9% of the whole sample. Using stringent criteria and ITT analysis 21.4% met criteria for remission at end of treatment. In the underweight sample, there was a significant increase in BMI, averaging 1.38 kg/m2 over treatment, with similar outcomes for MANTRA and CBT-ED. DISCUSSION These findings, in a large transdiagnostic population, add to emerging literature on the translation of evidence-based psychotherapies to real-world clinical settings. Our results converge well with prior similar studies. Findings highlight the need for routine data collection in services and for the ongoing improvement of treatments for the eating disorders.
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Affiliation(s)
- Victoria A Mountford
- Eating Disorder Service, South London and Maudsley NHS Foundation Trust, Middle House, Maudsley Hospital, London, UK.,Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK.,Maudsley Health, Abu Dhabi, UAE
| | - Karina L Allen
- Eating Disorder Service, South London and Maudsley NHS Foundation Trust, Middle House, Maudsley Hospital, London, UK.,Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Kate Tchanturia
- Eating Disorder Service, South London and Maudsley NHS Foundation Trust, Middle House, Maudsley Hospital, London, UK.,Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Cara Eilender
- Eating Disorder Service, South London and Maudsley NHS Foundation Trust, Middle House, Maudsley Hospital, London, UK.,Department of Clinical Psychology, University College London, London, UK
| | - Ulrike Schmidt
- Eating Disorder Service, South London and Maudsley NHS Foundation Trust, Middle House, Maudsley Hospital, London, UK.,Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
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68
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Beilharz F, Sukunesan S, Rossell SL, Kulkarni J, Sharp G. Development of a Positive Body Image Chatbot (KIT) With Young People and Parents/Carers: Qualitative Focus Group Study. J Med Internet Res 2021; 23:e27807. [PMID: 34132644 PMCID: PMC8277317 DOI: 10.2196/27807] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 04/08/2021] [Accepted: 05/24/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Body image and eating disorders represent a significant public health concern; however, many affected individuals never access appropriate treatment. Conversational agents or chatbots reflect a unique opportunity to target those affected online by providing psychoeducation and coping skills, thus filling the gap in service provision. OBJECTIVE A world-first body image chatbot called "KIT" was designed. The aim of this study was to assess preliminary acceptability and feasibility via the collection of qualitative feedback from young people and parents/carers regarding the content, structure, and design of the chatbot, in accordance with an agile methodology strategy. The chatbot was developed in collaboration with Australia's national eating disorder support organization, the Butterfly Foundation. METHODS A conversation decision tree was designed that offered psychoeducational information on body image and eating disorders, as well as evidence-based coping strategies. A version of KIT was built as a research prototype to deliver these conversations. Six focus groups were conducted using online semistructured interviews to seek feedback on the KIT prototype. This included four groups of people seeking help for themselves (n=17; age 13-18 years) and two groups of parents/carers (n=8; age 46-57 years). Participants provided feedback on the cartoon chatbot character design, as well as the content, structure, and design of the chatbot webchat. RESULTS Thematic analyses identified the following three main themes from the six focus groups: (1) chatbot character and design, (2) content presentation, and (3) flow. Overall, the participants provided positive feedback regarding KIT, with both young people and parents/carers generally providing similar reflections. The participants approved of KIT's character and engagement. Specific suggestions were made regarding the brevity and tone to increase KIT's interactivity. CONCLUSIONS Focus groups provided overall positive qualitative feedback regarding the content, structure, and design of the body image chatbot. Incorporating the feedback of lived experience from both individuals and parents/carers allowed the refinement of KIT in the development phase as per an iterative agile methodology. Further research is required to evaluate KIT's efficacy.
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Affiliation(s)
- Francesca Beilharz
- Monash Alfred Psychiatry Research Centre, Monash University, Melbourne, Australia
| | - Suku Sukunesan
- Swinburne Business School, Swinburne University of Technology, Melbourne, Australia
| | - Susan L Rossell
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia.,Psychiatry, St Vincent's Hospital, Melbourne, Australia
| | - Jayashri Kulkarni
- Monash Alfred Psychiatry Research Centre, Monash University, Melbourne, Australia
| | - Gemma Sharp
- Monash Alfred Psychiatry Research Centre, Monash University, Melbourne, Australia
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Abstract
Research findings strongly suggest that cognitive behavioral therapy for the eating disorders (CBT-ED) is more effective than other treatments for bulimia nervosa (BN) and for binge eating disorder (BED), although interpersonal psychotherapy appears to be equally effective for BED. Evidence for the effectiveness of CBT-ED for the persistent (adult) form of anorexia nervosa (AN) is insufficient at present and is essentially absent for AN in adolescents except for some evidence from uncontrolled trials. This article begins with an overview of the early studies in the development of CBT-ED that showed a similar effectiveness of other symptom-focused psychotherapies-a finding that was neglected at the time. Later developments are then considered, including comparisons of CBT-ED with other psychotherapies, efforts to develop Internet-based training and treatment, and electronic applications for treatment. Finally, implications of the findings for future short- and long-term research and for clinical practice are considered.
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Affiliation(s)
- W Stewart Agras
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California 94305, USA; ,
| | - Cara Bohon
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California 94305, USA; ,
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70
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Wasil AR, Patel R, Cho JY, Shingleton RM, Weisz JR, DeRubeis RJ. Smartphone apps for eating disorders: A systematic review of evidence-based content and application of user-adjusted analyses. Int J Eat Disord 2021; 54:690-700. [PMID: 33534176 DOI: 10.1002/eat.23478] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 01/15/2021] [Accepted: 01/16/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To examine the frequency of evidence-based treatment elements in popular smartphone apps for eating disorders (EDs), and to characterize the extent to which real-world users encounter different elements. METHOD We searched the Apple App Store and Google Play Store for apps offering treatment or support to individuals with EDs. Then, we created a codebook of 47 elements found in evidence-based treatments for EDs. We examined the presence or absence of each element within each ED app. We also acquired estimates of the monthly active users (MAU) of each app. RESULTS The ED apps (n = 28) included a median of nine elements of empirically supported treatments (mean = 9.46, SD = 6.28). Four apps accounted for 96% of all MAU. MAU-adjusted analyses revealed that several elements are reaching more users than raw frequency tallies would suggest. For example, assessments were included in 32% of apps, but 84% of users used an app with assessments. Similar trends were found for cognitive restructuring (21% of apps, 56% of MAU), activity scheduling (39%, 57%), and self-monitoring (14%, 46%). Problem solving, exposure, and relapse prevention strategies, elements that are prominent in face-to-face empirically supported treatments, were rarely included in the apps. DISCUSSION Evidence-based content is commonly included in ED apps, with certain elements reaching more users than others. Additionally, the top four apps are responsible for nearly all active users. We recommend that ED clinicians and researchers familiarize themselves with these apps-those that patients are most likely to encounter.
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Affiliation(s)
- Akash R Wasil
- Department of Psychology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Raveena Patel
- Department of Psychology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jin Young Cho
- Department of Psychology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - John R Weisz
- Department of Psychology, Harvard University, Cambridge, Massachusetts, USA
| | - Robert J DeRubeis
- Department of Psychology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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71
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Calugi S, Sartirana M, Frostad S, Dalle Grave R. Enhanced cognitive behavior therapy for severe and extreme anorexia nervosa: An outpatient case series. Int J Eat Disord 2021; 54:305-312. [PMID: 33247462 DOI: 10.1002/eat.23428] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 11/19/2020] [Accepted: 11/19/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The study aimed to assess outcomes in patients with severe and extreme anorexia nervosa managed with enhanced cognitive behavior therapy (CBT-E) in a real-world outpatient setting. METHOD Thirty patients with anorexia nervosa and body mass index (BMI) <16 aged ≥17 years were recruited from consecutive referrals to an eating disorder service clinic offering outpatient CBT-E. BMI and Eating Disorder Examination Questionnaire (EDE-Q), Brief Symptom Inventory (BSI), and Clinical Impairment Assessment (CIA) scores were recorded at admission, end of treatment, and 20- and 60-week follow-ups for treatment completers. RESULTS Twenty patients (66.7%) completed the treatment and showed both considerable weight gain (Cohen's f = 1.43), and significantly reduced scores for clinical impairment (f = 1.26) and eating-disorder (f = 1.03) and general psychopathology (f = 0.99). Changes remained stable at both follow-ups. About half of the patients who completed treatment had a BMI ≥18.5 at the end of treatment and follow-ups. DISCUSSION CBT-E seems suitable and promising for patients with severe and extreme anorexia nervosa seeking treatment in a real-world clinical setting, provided that their medical conditions are stable, and they have no current major depressive episodes or substance abuse; it may represent a valid alternative to inpatient treatment for those who are able to sustain engagement in a full course of outpatient treatment.
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Affiliation(s)
- Simona Calugi
- Department of Eating and Weight Disorders, Villa Garda Hospital, Garda, Italy
| | | | - Stein Frostad
- Department of Mental Health Research, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
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MacDonald DE, McFarlane T, Dionne MM, Trottier K, Olmsted MP. Development, Feasibility, and Acceptability of a Brief, Adjunctive Cognitive-Behavioral Intervention Aimed at Encouraging Rapid Response to Intensive Eating Disorder Treatment. COGNITIVE AND BEHAVIORAL PRACTICE 2021. [DOI: 10.1016/j.cbpra.2020.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Reward Learning Through the Lens of RDoC: a Review of Theory, Assessment, and Empirical Findings in the Eating Disorders. Curr Psychiatry Rep 2021; 23:2. [PMID: 33386514 DOI: 10.1007/s11920-020-01213-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/17/2020] [Indexed: 01/19/2023]
Abstract
PURPOSE OF REVIEW Reward-related processes may represent important transdiagnostic factors underlying eating pathology. Using the NIMH Research Domain Criteria as a guide, the current article reviews theories, behavioral and self-report assessments, and empirical findings related to reward learning in the eating disorders. RECENT FINDINGS Data from behavioral tasks suggest deficits in reinforcement learning, which may become more pronounced with increasing disorder severity and duration. Self-report data strongly implicate positive eating and thinness/restriction expectancies (an element of reward prediction error) in the onset and maintenance of eating pathology. Finally, self-report measures of habit strength demonstrate relationships with eating pathology and illness duration; however, behavioral task data do not support relationships between eating pathology and a propensity towards general habit development. Existing studies are limited, but provide preliminary support for the presence of abnormal reward learning in eating disorders. Continued research is needed to address identified gaps in the literature.
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Eik-Nes TT, Vrabel K, Raman J, Clark MR, Berg KH. A Group Intervention for Individuals With Obesity and Comorbid Binge Eating Disorder: Results From a Feasibility Study. Front Endocrinol (Lausanne) 2021; 12:738856. [PMID: 34803910 PMCID: PMC8597950 DOI: 10.3389/fendo.2021.738856] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 09/30/2021] [Indexed: 11/13/2022] Open
Abstract
PURPOSE A common challenge among a subgroup of individuals with obesity is binge eating, that exists on a continuum from mild binge eating episodes to severe binge eating disorder (BED). BED is common among bariatric patients and the prevalence of disordered eating and ED in bariatric surgery populations is well known. Conventional treatments and assessment of obesity seldom address the underlying psychological mechanisms of binge eating and subsequent obesity. This study, titled PnP (People need People) is a psychoeducational group pilot intervention for individuals with BED and obesity including patients with previous bariatric surgery. Design, feasibility, and a broad description of the study population is reported. MATERIAL AND METHODS A total of 42 patients were from an obesity clinic referred to assessment and treatment with PnP in a psychoeducational group setting (3-hour weekly meetings for 10 weeks). Of these, 6 (14.3%) patients had a previous history of bariatric surgery. Feasibility was assessed by tracking attendance, potentially adverse effects and outcome measures including body mass index (BMI), eating disorder pathology, overvaluation of shape and weight, impairment, self-reported childhood difficulties, alexithymia, internalized shame as well as health related quality of life (HRQoL). RESULTS All 42 patients completed the intervention, with no adverse effects and a high attendance rate with a median attendance of 10 sessions, 95% CI (8.9,9.6) and 0% attrition. Extent of psychosocial impairment due to eating disorder pathology, body dissatisfaction and severity of ED symptoms were high among the patients at baseline. Additionally, self-reported childhood difficulties, alexithymia, and internalized shame were high among the patients and indicate a need to address underlying psychological mechanisms in individuals with BED and comorbid obesity. Improvement of HRQoL and reduction of binge eating between baseline and the end of the intervention was observed with a medium effect. CONCLUSION This feasibility study supports PnP as a potential group psychoeducational intervention for patients living with BED and comorbid obesity. Assessments of BED and delivery of this intervention may optimize selection of candidates and bariatric outcomes. These preliminary results warrant further investigation via a randomized control trial (RCT) to examine the efficacy and effectiveness of PnP.
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Affiliation(s)
- Trine T. Eik-Nes
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
- Stjørdal Community Mental Health Centre, Levanger Hospital, Levanger, Norway
- *Correspondence: Trine T. Eik-Nes,
| | | | - Jayanthi Raman
- Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Melinda Rose Clark
- Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Kjersti Hognes Berg
- Stjørdal Community Mental Health Centre, Levanger Hospital, Levanger, Norway
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Williams L, Naidoo D, Spies R. Practicing psychologists’ understanding of the athletic-body ideal internalisation: Implications for classification and treatment. JOURNAL OF PSYCHOLOGY IN AFRICA 2020. [DOI: 10.1080/14330237.2020.1842594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Lindi Williams
- Community Psychosocial Research (COMPRES), North-West University, Potchefstroom, South Africa
| | - Del Naidoo
- Centre for Psychological Services and Career Development (PysCad), University of Johannesburg, Soweto, South Africa
| | - Ruan Spies
- Community Psychosocial Research (COMPRES), North-West University, Potchefstroom, South Africa
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Bucharová M, Malá A, Kantor J, Svobodová Z. Arts Therapies Interventions and Their Outcomes in the Treatment of Eating Disorders: Scoping Review Protocol. Behav Sci (Basel) 2020; 10:E188. [PMID: 33316926 PMCID: PMC7763866 DOI: 10.3390/bs10120188] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 12/02/2020] [Accepted: 12/03/2020] [Indexed: 11/29/2022] Open
Abstract
Arts therapies (AsTs) are considered a valuable intervention for people with eating disorders, however the range of research studies and the comparison between the types of arts therapies are unknown. The goal of the future scoping review is to explore the therapeutic outcomes addressed by arts therapists in research studies on people with eating disorders and compare the different types of arts-based interventions. This scoping review will be conducted in accordance with the Joanna Briggs Institute methodology. Included will be research studies and sources oriented towards people with eating disorders of all ages and AsTs of any type (art therapy, drama therapy, music therapy, dance/movement therapy, and expressive therapies). There is no language/publication period limitation. The following databases will be searched: CINAHL Plus, EMBASE, MEDLINE (OvidSP), ProQuest Central, PsycINFO, PubMed, Scopus, and Web of Science. Sources of unpublished studies and grey literature will include Google Scholar, MedNar, clinical trials, and current controlled trials. Titles/abstracts and full texts of studies will be assessed against the inclusion criteria, and the data extracted by two independent reviewers. Based on the results, we will compare the types of AsTs according to the research designs, country/settings, intervention methods/materials, adverse effects reported, and therapeutic outcomes related to AsTs.
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Affiliation(s)
- Monika Bucharová
- Palacky University Evidence-Based Education Working Team: Mentee Centre, and Institute of Special Education Studies, Faculty of Education, Palacky University, 779 00 Olomouc, Czech Republic; (A.M.); (J.K.)
| | - Andrea Malá
- Palacky University Evidence-Based Education Working Team: Mentee Centre, and Institute of Special Education Studies, Faculty of Education, Palacky University, 779 00 Olomouc, Czech Republic; (A.M.); (J.K.)
| | - Jiří Kantor
- Palacky University Evidence-Based Education Working Team: Mentee Centre, and Institute of Special Education Studies, Faculty of Education, Palacky University, 779 00 Olomouc, Czech Republic; (A.M.); (J.K.)
| | - Zuzana Svobodová
- Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (Cochrane Czech Republic, Czech Evidence-Based Healthcare Centre: Joanna Briggs Institute Centre of Excellence, Masaryk University GRADE Centre), Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Kamenice 3, 625 00 Brno, Czech Republic;
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Sivyer K, Allen E, Cooper Z, Bailey‐Straebler S, O'Connor ME, Fairburn CG, Murphy R. Mediators of change in cognitive behavior therapy and interpersonal psychotherapy for eating disorders: A secondary analysis of a transdiagnostic randomized controlled trial. Int J Eat Disord 2020; 53:1928-1940. [PMID: 33150640 PMCID: PMC7756462 DOI: 10.1002/eat.23390] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 10/04/2020] [Accepted: 10/05/2020] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Understanding the mechanisms of action of psychological treatments is a key first step in refining and developing more effective treatments. The present study examined hypothesized mediators of change of enhanced cognitive behavior therapy (CBT-E) and interpersonal psychotherapy for eating disorders (IPT-ED). METHOD A series of mediation studies were embedded in a randomized controlled trial (RCT) comparing 20 weeks of CBT-E and IPT-ED in a transdiagnostic, non-underweight sample of patients with eating disorders (N = 130) consecutively referred to the service. Three hypothesized mediators of change in CBT-E (regular eating, weighing frequency, and shape checking) and the key hypothesized mediator of IPT-ED (interpersonal problem severity) were studied. RESULTS The data supported regular eating as being a mediator of the effect of CBT-E on binge-eating frequency. The findings were inconclusive regarding the role of the other putative mediators of the effects of CBT-E; and were similarly inconclusive for interpersonal problem severity as a mediator of the effect of IPT-ED. DISCUSSION This research highlights the potential benefits of embedding mediation studies within RCTs to better understand how treatments work. The findings supported the role of regular eating in reducing patients' binge-eating frequency. Other key hypothesized mediators of CBT-E and IPT-ED were not supported, although the data were not inconsistent with them. Key methodological issues to address in future work include the need to capture both behavioral and cognitive processes of change in CBT-E, and identifying key time points for change in IPT-ED.
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Affiliation(s)
- Katy Sivyer
- Department of PsychiatryOxford UniversityOxfordUK,Present address:
Department of PsychologyUniversity of PortsmouthPortsmouthUK,Present address:
Centre for Clinical and Community Applications of Health PsychologyUniversity of SouthamptonSouthamptonUK
| | - Elizabeth Allen
- Department of Medical StatisticsLondon School of Hygiene and Tropical MedicineLondonUK
| | - Zafra Cooper
- Department of PsychiatryOxford UniversityOxfordUK,Present address:
Department of PsychiatryYale School of MedicineNew HavenConnecticutUSA
| | - Suzanne Bailey‐Straebler
- Department of PsychiatryOxford UniversityOxfordUK,Present address:
Department of PsychiatryWeill Cornell Medical College, New York‐Presbyterian HospitalWhite PlainsNew YorkUSA
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Tecuta L, Gardini V, Digiuseppe R, Tomba E. Do metacognitions mediate the relationship between irrational beliefs, eating disorder symptoms and cognitive reappraisal? Psychother Res 2020; 31:483-492. [PMID: 33043823 DOI: 10.1080/10503307.2020.1831098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Objective: Cognitively oriented therapies, first-line treatment for eating disorders (EDs), still show room for improvement in treatment retention and outcomes. Despite the development of additional cognitive models and therapies, few studies examine the relationship between traditional and third-wave cognitive targets in EDs. The study explores the relationship between irrational beliefs (IBs) and metacognitions and their relationship with ED psychopathology and cognitive reappraisal in ED outpatients. Method: Seventy-seven patients (mean age 27.49 ± 12.28 years) were assessed with The Attitudes and Beliefs Scale-ABS-2, Meta-cognitions Questionnaire-MCQ-65, Eating Disorder Inventory 3-EDI-3, Eating Attitudes Test-EAT-40, Emotion Regulation Questionnaire-ERQ. Results: Correlational analyses showed that IBs and metacognitions significantly correlated with each other. Metacognitions partially mediated the relationship between IBs and ED-related general psychological maladjustment and completely mediated the relationship between IBs and ED symptom severity. Cognitive reappraisal was predicted only by IBs and metacognitions were not significant mediators. Conclusions: While IBs are sufficient in explaining ED-related psychopathology and reduced use of cognitive reappraisal, a potential integration of metacognitions about need to control thoughts in CBT models for EDs may offer incremental validity given their contribution to ED severity. Treatment implications include targeting metacognitions concerning need to control thoughts, as a potential maintenance mechanism of ED symptomatology through cognitive restructuring.
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Affiliation(s)
- Lucia Tecuta
- Department of Psychology, University of Bologna, Bologna, Italy
| | | | | | - Elena Tomba
- Department of Psychology, University of Bologna, Bologna, Italy
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Venturo-Conerly KE, Wasil AR, Dreier MJ, Lipson SM, Shingleton RM, Weisz JR. Why I recovered: A qualitative investigation of factors promoting motivation for eating disorder recovery. Int J Eat Disord 2020; 53:1244-1251. [PMID: 32691930 DOI: 10.1002/eat.23331] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 06/08/2020] [Accepted: 06/08/2020] [Indexed: 01/20/2023]
Abstract
OBJECTIVE It is difficult for individuals with eating disorders (EDs) to build and maintain motivation to recover. This challenge contributes to high rates of treatment dropout and relapse. To date, motivational interventions have been largely ineffective, and there is little research on factors that affect recovery motivation. To better understand recovery motivation and identify potential intervention targets, this study examines factors that affect recovery motivation in individuals with EDs. METHOD N = 13 participants completed qualitative interviews. All had been recovered from their diagnosed and treated ED for at least 1 year. We applied thematic analysis to interview transcripts in order to identify factors that had influenced recovery motivation and to classify their effects as helpful, harmful, or mixed. RESULTS Six main themes were identified, with subthemes detailed under each: (a) important people and groups (e.g., social circle, mentor), (b) actions and attitudes of others (e.g., judgmental responses, failure to intervene), (c) treatment-related factors (e.g., therapeutic skills, therapeutic alliance), (d) influential circumstances (e.g., removing triggers, pregnancy/children), (e) personal feelings and beliefs (e.g., obligation to others, hope for the future), and (f) the role of epiphanies (i.e., sudden insights or moments of change). DISCUSSION In this study, we identified potentially malleable factors that may affect ED recovery motivation (e.g., removing triggers, focusing on obligation to others, getting involved in meaningful causes, securing non-judgmental support, building hope for the future). These factors may be investigated as potential targets or strategies in motivational interventions for EDs.
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Affiliation(s)
| | - Akash R Wasil
- Department of Psychology, Harvard University, Cambridge, Massachusetts, USA.,Department of Psychology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Melissa J Dreier
- Department of Psychology, Harvard University, Cambridge, Massachusetts, USA.,Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sarah M Lipson
- Department of Psychology, Harvard University, Cambridge, Massachusetts, USA
| | | | - John R Weisz
- Department of Psychology, Harvard University, Cambridge, Massachusetts, USA
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