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Alliance matters: but how much? A systematic review on therapeutic alliance and outcome in patients with anorexia nervosa and bulimia nervosa. Eat Weight Disord 2022; 27:1279-1295. [PMID: 34374966 PMCID: PMC9079014 DOI: 10.1007/s40519-021-01281-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 07/23/2021] [Indexed: 12/26/2022] Open
Abstract
PURPOSE Patients with eating disorders (ED) pose a high-risk group regarding relapse. The understanding of factors contributing to a better outcome is much-needed. Therapeutic alliance (TA) is one important, pantheoretical variable in the treatment process, which has shown to be connected with outcome. This review looks into a possible predictive effect of TA on outcome as well as related variables. METHODS A systematic review with pre-determined inclusion criteria following the PRISMA guidelines was conducted for studies published since 2014. Three previous reviews including studies up until 2014 were analyzed for studies matching our inclusion criteria. A total of 26 studies were included. RESULTS The results were heterogeneous between different patient groups. Regarding the predictive effect of TA, in adolescent samples, the TA of either the patients or their parents seems to impact outcome as well as completion. For adults, results are mixed, with a tendency to a greater impact of TA for anorexia nervosa (AN) patients, while some samples of adult bulimia nervosa (BN) patients did not find any relation between TA and outcome. CONCLUSION The effect of TA on clinical outcome depends on the patient group. TA has a greater impact on adolescents, irrespective of diagnosis, and on adults with AN. The examined studies have different limitations which include small sample sizes and questionable study design. The examination of motivation as a potential influencing factor is recommended. LEVEL OF EVIDENCE Level I, systematic review.
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Manasse SM, Lampe EW, Srivastava P, Payne-Reichert A, Mason TB, Juarascio AS. Momentary associations between fear of weight gain and dietary restriction among individuals with binge-spectrum eating disorders. Int J Eat Disord 2022; 55:541-552. [PMID: 35088433 PMCID: PMC9377790 DOI: 10.1002/eat.23686] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 01/17/2022] [Accepted: 01/17/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Fear of weight gain (FOWG) is increasingly implicated in the maintenance of binge-spectrum eating disorders (EDs; e.g., bulimia nervosa [BN], binge-eating disorder [BED]) through the pathway of increased dietary restriction. However, particularly in binge-spectrum EDs, research is nascent and based on retrospective self-report. To improve treatment outcomes, it is critical to better understand the momentary relations between FOWG and dietary restriction. METHOD Sixty-seven adults with binge spectrum EDs completed a 7-14-day ecological momentary assessment protocol that included items regarding FOWG, ED behaviors, and types of dietary restriction (e.g., attempted restraint vs. actual restriction) several times per day. Multilevel models were used to evaluate reciprocal associations between FOWG and dietary restriction, and to evaluate the indirect of effects of dietary restriction on the relation between FOWG and binge eating. RESULTS While main effects were not statistically significant, ED presentation significantly moderated the association between increases in FOWG at time1 and both attempted and actual avoidance of enjoyable foods at time2 such that those with BN-spectrum EDs were more likely to avoid enjoyable foods following increased FOWG compared to those with BED-spectrum EDs. Engagement in restriction at time1 was not associated with decreased FOWG at time2. DISCUSSION Prospective associations between FOWG and restriction suggest that individuals with BN may be more likely to restrict their eating following increased FOWG. These findings suggest FOWG may be an important target for future treatments.
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Affiliation(s)
- Stephanie M Manasse
- Center for Weight Eating and Lifestyle Science (WELL Center), Drexel University, Philadelphia, Pennsylvania, USA
| | - Elizabeth W Lampe
- Center for Weight Eating and Lifestyle Science (WELL Center), Drexel University, Philadelphia, Pennsylvania, USA
- Department of Psychology, Drexel University, Philadelphia, Pennsylvania, USA
| | - Paakhi Srivastava
- Center for Weight Eating and Lifestyle Science (WELL Center), Drexel University, Philadelphia, Pennsylvania, USA
| | - Adam Payne-Reichert
- Center for Weight Eating and Lifestyle Science (WELL Center), Drexel University, Philadelphia, Pennsylvania, USA
| | - Tyler B Mason
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Adrienne S Juarascio
- Center for Weight Eating and Lifestyle Science (WELL Center), Drexel University, Philadelphia, Pennsylvania, USA
- Department of Psychology, Drexel University, Philadelphia, Pennsylvania, USA
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Identification of central symptoms in Internet addictions and depression among adolescents in Macau: A network analysis. J Affect Disord 2022; 302:415-423. [PMID: 35065088 DOI: 10.1016/j.jad.2022.01.068] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 01/10/2022] [Accepted: 01/13/2022] [Indexed: 01/02/2023]
Abstract
BACKGROUND Internet addiction (IA) and depression are common among adolescents and often are co-occurring. This study examined the network structures of IA and depressive symptoms (depression hereafter) in adolescents. METHODS A total of 1,009 adolescents were recruited. IA and depression were measured using the Internet Addiction Test (IAT) and the 9 items-Patient Health Questionnaire (PHQ-9), respectively. A network analysis was conducted to identify central symptoms and bridge symptoms using centrality indices. Network stability was evaluated using the case-dropping procedure. The Network Comparison Test (NCT) was conducted to examine whether network characteristics differed by gender. RESULTS Network analysis revealed that nodes IAT-15 ("Preoccupation with the Internet"), IAT-2 ("Neglect chores to spend more time online"), PHQ-6 ("Guilty"), and IAT-16 ("Request an extension for longer time spent online") were the most central symptoms within the model of coexisting IA and depression. The most important bridge symptom was node IAT-11 ("Anticipation for future online activities"), followed by IAT-12 ("Fear that life is boring and empty without the Internet") and IAT-19 ("Spend more time online over going out with others"). Gender did not significantly influence the network structure. The IA and depression network model showed a high degree of stability. CONCLUSION The central symptoms along with key bridge symptoms identified could be potentially targeted when treating and preventing IA and depression among adolescents.
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Nelson JD, Cuellar AE, Cheskin LJ, Fischer S. Eating Disorders and Posttraumatic Stress Disorder: A Network Analysis of the Comorbidity. Behav Ther 2022; 53:310-322. [PMID: 35227406 DOI: 10.1016/j.beth.2021.09.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 09/10/2021] [Accepted: 09/18/2021] [Indexed: 11/02/2022]
Abstract
Eating disorders (EDs) and posttraumatic stress disorder (PTSD) commonly co-occur, but the mechanisms driving this co-occurrence are not well understood. The current study explored the relationships between symptoms of ED and PTSD in a sample of male and female undergraduate students in order to identify pathways that may maintain the comorbidity. Network analysis was conducted in a sample of 344 first-year undergraduates to visualize partial correlations between each symptom in the comorbidity. Core symptoms, bridge symptoms, and direct pathways between ED and PTSD symptoms were identified. The PTSD symptoms negative emotions (strength = 1.13) and negative beliefs (strength = 1.11) were the strongest symptoms in the network. The strongest bridge nodes were the ED symptoms restriction (bridge strength = 3.32) and binge eating (bridge strength = 2.63). The strongest edges between ED and PTSD nodes were between binge eating and concentration (part r = .16), restriction and sleep (part r = .14), and binge eating and positive emotions (part r = .11). Findings suggest that PTSD symptoms related to negative alterations in cognitions and mood may be highly influential in the ED-PTSD network due to their relatedness to all other symptoms. The pathway between binge eating and inability to experience positive emotions suggest that the comorbidity may be partially maintained through an affect regulation function of binge eating.
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Grassie HL, Kennedy SM, Halliday ER, Bainter SA, Ehrenreich-May J. Symptom-level networks of youth- and parent-reported depression and anxiety in a transdiagnostic clinical sample. Depress Anxiety 2022; 39:211-219. [PMID: 35072967 DOI: 10.1002/da.23241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 11/19/2021] [Accepted: 01/08/2022] [Indexed: 11/09/2022] Open
Abstract
Depression and anxiety disorders confer a significant public health concern for youth and their co-occurrence places youth at a higher risk for poorer psychosocial outcomes. In the present study, we use network analysis to investigate the role of and interactions among individual depression and anxiety symptoms in a treatment-seeking clinical sample. METHODS We estimate regularized partial correlation networks for youth- and parent reported symptoms in a transdiagnostic sample of youth (N = 417, ages 8-18). We examined features of the symptom-level networks such as network stability, centrality, bridge symptoms, and communities in both youth- and parent-reported networks. RESULTS Results indicate stable networks with disorder-specific clustering, such that symptoms were more interconnected within compared to between disorders. Symptoms related to self-comparison to peers and negative views of the future were most central in both networks. Symptoms of depression and anxiety were connected by worries for the future and hopelessness in the youth-reported network, whereas self-comparison to peers and low self-efficacy were bridge symptoms in the parent network. Distinct symptom clusters emerged in the parent- and youth-reported networks. CONCLUSIONS Our findings indicate that negative self-evaluation, negative views of the future, and repetitive negative thinking more generally are influential symptoms in the presentation and co-occurrence of depression and anxiety and as such may be promising targets in the treatment and prevention of depression and anxiety in youth.
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Affiliation(s)
- Hannah L Grassie
- Department of Psychology, University of Miami, Coral Gables, Florida, USA
| | - Sarah M Kennedy
- Department of Psychiatry, Medical Campus, University of Colorado Anschutz, Aurora, Colorado, USA
| | | | - Sierra A Bainter
- Department of Psychology, University of Miami, Coral Gables, Florida, USA
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Sala M, Vanzhula I, Roos CR, Levinson CA. Mindfulness and Eating Disorders: A Network Analysis. Behav Ther 2022; 53:224-239. [PMID: 35227400 DOI: 10.1016/j.beth.2021.07.002] [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: 02/03/2021] [Revised: 07/19/2021] [Accepted: 07/27/2021] [Indexed: 12/27/2022]
Abstract
Higher trait mindfulness may be protective against eating disorder (ED) pathology. However, little is understood about which specific mindfulness processes connect to specific ED symptoms. This study (N = 1,056 undergraduates) used network analysis at the symptom/process level to identify: (1) central nodes, or symptoms/processes with the greatest collective connection with all other symptoms/processes; and (2) bridge nodes, or symptoms/processes driving interconnection between mindfulness processes and ED symptoms. We conducted analyses both with and without food- and body-related mindfulness items. Central nodes included: describing how one feels in detail, expressing how one feels in words, and feeling guilty about eating due to shape/weight. Bridge nodes connecting higher mindfulness processes with lower ED symptoms included: the eating disorder symptom, being uncomfortable about others seeing one eat, and the mindfulness process, not criticizing oneself for having irrational/inappropriate emotions. Bridge nodes connecting higher mindfulness processes with higher ED symptoms included: noticing sensations of the body moving when walking and noticing how food/drinks affect thoughts, bodily sensations, and emotions. Findings suggest that future research should explore whether mindfulness-based interventions for EDs may be more effective by targeting mindfulness processes related to describing, expressing, and accepting emotions, accepting discomfort when eating with others, and reducing hyper-focus on and reactivity to food-and-body related sensations.
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Affiliation(s)
- Margaret Sala
- Ferkauf Graduate School of Psychology, Yeshiva University
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Hartmann S, Pruessner L, Rubel JA, Lalk C, Barnow S, Timm C. Applying a web-based self-help intervention for bulimia nervosa in routine care: Study protocol for a randomized controlled trial. Internet Interv 2022; 28:100512. [PMID: 35251938 PMCID: PMC8894237 DOI: 10.1016/j.invent.2022.100512] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 02/11/2022] [Accepted: 02/15/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Individuals with bulimia nervosa (BN) experience persistent episodes of binge eating and inappropriate compensatory behavior associated with impaired physical and mental health. Despite the existence of effective treatments, many individuals with BN remain untreated, leading to a high burden and an increased risk of chronicity. Web-based interventions may help facilitate access to evidence-based treatments for BN by reducing barriers to the health care system. METHODS The present study will investigate the effectiveness of a web-based self-help intervention for BN in a two-armed randomized controlled trial. Individuals diagnosed with BN (N = 152) will be randomly assigned to either (1) an intervention group receiving a 12-week web-based intervention or (2) a waitlist control group with delayed access to the intervention. Further assessments will be scheduled 6 (mid-treatment) and 12 (post-treatment) weeks after baseline. Changes in the number of binge eating episodes and compensatory behaviors will be examined as primary outcomes. Secondary outcomes include global eating pathology, functional impairments, well-being, comorbid psychopathology, self-esteem, and emotion regulation abilities. DISCUSSION Adding web-based interventions into routine care is a promising approach to overcome the existing treatment gap for patients with BN. Therefore, the current study will test the effectiveness of a web-based intervention for BN under standard clinical care settings. TRIAL REGISTRATION ClinicalTrials.gov, Identifier: NCT04876196 (registered on May 6th, 2021).
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Affiliation(s)
- Steffen Hartmann
- Department of Psychology, Heidelberg University, Hauptstr. 47-51, 69117 Heidelberg, Germany,Corresponding author.
| | - Luise Pruessner
- Department of Psychology, Heidelberg University, Hauptstr. 47-51, 69117 Heidelberg, Germany
| | - Julian A. Rubel
- Psychotherapy Research Unit, University of Giessen, Otto-Behaghel-Straße 10, 35394 Giessen, Germany
| | - Christopher Lalk
- Psychotherapy Research Unit, University of Giessen, Otto-Behaghel-Straße 10, 35394 Giessen, Germany
| | - Sven Barnow
- Department of Psychology, Heidelberg University, Hauptstr. 47-51, 69117 Heidelberg, Germany
| | - Christina Timm
- Department of Psychology, Heidelberg University, Hauptstr. 47-51, 69117 Heidelberg, Germany
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Ventura-León J, Caycho-Rodríguez T, Talledo-Sánchez K, Casiano-Valdivieso K. Depression, COVID-19 Anxiety, Subjective Well-being, and Academic Performance in University Students With COVID-19-Infected Relatives: A Network Analysis. Front Psychol 2022; 13:837606. [PMID: 35222215 PMCID: PMC8867004 DOI: 10.3389/fpsyg.2022.837606] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 01/17/2022] [Indexed: 12/12/2022] Open
Abstract
This study aimed to examine the relationship between anxiety, depression, subjective well-being, and academic performance in Peruvian university health science students with COVID-19-infected relatives. Eight hundred two university students aged 17-54 years (Mean 21.83; SD = 5.31); 658 females (82%) and 144 males (18%); who completed the Patient Health Questionnaire-2, Coronavirus Anxiety Scale, Subjective Well-being Scale (SWB), and Self-reporting of Academic Performance participated. A partial unregularized network was estimated using the ggmModSelect function. Expected influence (EI) values were calculated to identify the central nodes and a two-tailed permutation test for the difference between the two groups (COVID-19 infected and uninfected). The results reveal that a depression and well-being node (PHQ1-SWB3) presents the highest relationship. The most central nodes belonged to COVID-19 anxiety, and there are no global differences between the comparison networks; but at the local level, there are connections in the network of COVID-19-infected students that are not in the group that did not present this diagnosis. It is concluded that anxious-depressive symptomatology and its relationship with well-being and evaluation of academic performance should be considered in order to understand the impact that COVID-19 had on health sciences students.
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Affiliation(s)
- José Ventura-León
- Department of Health Sciences, Universidad Privada del Norte (UPN), Lima, Peru
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Berta A, Miguel Ángel C, Clara GS, Rubén H. A bibliometric analysis of 10 years of research on symptom networks in psychopathology and mental health. Psychiatry Res 2022; 308:114380. [PMID: 34999293 DOI: 10.1016/j.psychres.2021.114380] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 12/21/2021] [Accepted: 12/29/2021] [Indexed: 11/18/2022]
Abstract
Psychopathology networks consist of aspects (e.g., symptoms) of mental disorders (nodes) and the connections between those aspects (edges). This article aims to analyze the research literature on network analysis in psychopathology and mental health for the last ten years. Statistical descriptive analysis was complemented with two bibliometric techniques: performance analysis and co-word analysis. There is an increase in publications that has passed from 1 article published in 2010 to 172 papers published in 2020. The 398 articles in the sample have 1,910 authors in total, being most of them occasional contributors. The Journal of Affective Disorders is the one with the highest number of publications on network analysis in psychopathology and mental health, followed by the Journal of Abnormal Psychology and Psychological Medicine stand out. The present study shows that this perspective in psychopathology and mental health is a recent field of study, but with solid advances in recent years from a wide variety of researchers, mainly from USA and Europe, who have extensively studied symptom networks in depression, anxiety, and post-traumatic stress disorders. However, gaps are identified in other psychological behaviors such as suicide, populations such as the elderly, and gender studies.
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Affiliation(s)
- Ausín Berta
- School of Psychology, Personality, Evaluation and Clinical Psychology Department, Complutense University of Madrid, Spain.
| | - Castellanos Miguel Ángel
- School of Psychology, Psychobiology and Methodology in Behavioral Sciences Department, Complutense University of Madrid, Spain
| | - González-Sanguino Clara
- School of Psychology, Personality, Evaluation and Clinical Psychology Department, Complutense University of Madrid, Spain
| | - Heradio Rubén
- Department of Computer Systems and Software Engineering, National Distance Education University, Madrid, Spain
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Chen Y, Guo L, Wu M, Zhang L, He Q, Zheng Y, Wu L, Zheng H, Chen J. Network Analysis of Eating Disorders Symptoms Co-occurring With Impulsive Personality Traits and Negative Mood States in Patients With Bulimia Nervosa. Front Psychiatry 2022; 13:899757. [PMID: 35664494 PMCID: PMC9157589 DOI: 10.3389/fpsyt.2022.899757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 04/28/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Bulimia nervosa (BN) is characterized by recurrent episodes of eating large amounts of food without control. Studies have found positive correlations of BN symptoms with impulsive traits and negative affect. However, the network relationship supporting BN symptoms is unclear. METHODS The study participants included female BN patients (146) and healthy controls (HCs, 146). The participants were matched for age. All participants completed the Eating Disorder Examination Questionnaire 6.0, Barratt Impulsiveness Scale-11, Beck Anxiety Inventory, and Beck Depression Inventory. We characterized the centrality parameters of BN, impulsiveness, and anxiety and depression symptoms of BN patients compared with HCs. RESULTS Among all symptoms in the constructed BN group network, Shape dissatisfaction had the highest strength. In the BN group network, three clusters of symptoms ("ED-specific symptoms," "impulsivity," and "anxiety and depression") were linked to each other by several symptoms. Compared to the HC network, impulsiveness was strongly associated with Concerns about Others Seeing One Eat in the BN network. CONCLUSION This study shows that ED-specific symptoms, i.e., Shape dissatisfaction, play a key role in BN. The cognition of "shape dissatisfaction" is a basis, and impulsivity and emotional symptoms are maintaining factors that may lead to BN development.
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Affiliation(s)
- Yan Chen
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lei Guo
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mengting Wu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lei Zhang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qianqian He
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuchen Zheng
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lin Wu
- Military Medical Psychology School, Air Force Medical University, Xi'an, China
| | - Hui Zheng
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jue Chen
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Lydecker JA, Simpson L, Smith SR, White MA, Grilo CM. Preoccupation in bulimia nervosa, binge-eating disorder, anorexia nervosa, and higher weight. Int J Eat Disord 2022; 55:76-84. [PMID: 34713460 PMCID: PMC8963447 DOI: 10.1002/eat.23630] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 09/15/2021] [Accepted: 10/07/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Preoccupation (excessive and constant thoughts) about shape/weight and food/eating is thought to be prominent in individuals with eating disorders but has received much less research than overt behavioral features. This study examined the significance and distinctiveness of different foci of preoccupation in individuals categorized with different forms of eating disorders and in individuals with higher weight. METHOD Participants (N = 1,363) completed a web-based survey with established measures of eating-disorder psychopathology and depression. The current study compared preoccupation among individuals with core features of bulimia nervosa (BN; n = 144), binge-eating disorder (BED; n = 576), anorexia nervosa (AN; n = 48), and higher body weight (body mass index [BMI] ≥ 25) without eating-disorder features (higher weight [HW]; n = 595). Associations of each type of preoccupation with other eating-disorder psychopathology and depression were examined both between and within study groups. RESULTS Preoccupation with shape/weight and with food/eating showed a graded pattern of statistically significant differences: AN and BN had higher preoccupation than BED, which was higher than HW. Within BN, BED, and AN study groups, correlation magnitudes of shape/weight and food/eating preoccupation with eating-disorder psychopathology and depression did not differ significantly. Within the HW group, shape/weight preoccupation was significantly more strongly correlated than food/eating preoccupation with overvaluation, body dissatisfaction, and depression. DISCUSSION The preoccupation cognitive style, as well as focus, appears associated with other facets of eating-disorder psychopathology and depression. If results are confirmed among individuals with formal diagnoses, clinicians addressing maladaptive cognitions in cognitive-behavioral therapy should consider the role of preoccupation. Future research should investigate whether preoccupation predicts or moderates eating disorder treatment outcomes.
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Affiliation(s)
- Janet A. Lydecker
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Lauren Simpson
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA,Amherst College, Amherst, MA USA
| | - Shannon R. Smith
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Marney A. White
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA,Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT
| | - Carlos M. Grilo
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA,Department of Psychology, Yale University, New Haven, CT
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Temperament and psychopathology in early childhood predict body dissatisfaction and eating disorder symptoms in adolescence. Behav Res Ther 2022; 151:104039. [PMID: 35139437 PMCID: PMC8923907 DOI: 10.1016/j.brat.2022.104039] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 12/10/2021] [Accepted: 01/14/2022] [Indexed: 01/08/2023]
Abstract
Eating disorders (ED) are highly impairing and dangerous conditions that typically onset in adolescence. However, very few prospective studies have examined early childhood risk factors for ED pathology. Given well-established links between temperament and psychopathology, examination of these factors could inform prevention efforts. The current multi-method, multi-informant prospective longitudinal study tested whether laboratory-observed and parent-reported temperament and psychiatric disorders at ages 3 and 6 (N = 609) predict body dissatisfaction at ages 12 and 15 and dimensional symptoms of EDs (anorexia nervosa [AN] and bulimia nervosa [BN]) at age 15 (n = 458) in a community sample. Results indicated that early childhood temperament (positive and negative emotionality, perceptual sensitivity, impulsivity, less shyness) and childhood psychopathology (anxiety, oppositional defiant, attention deficit/hyperactivity, and depressive disorders), predicted body dissatisfaction in adolescence. In addition, childhood perceptual sensitivity and oppositional defiant and depressive disorders predicted AN symptoms. Demographic characteristics (female sex, lower levels of fathers' education, and parental marital status) in childhood predicted body dissatisfaction and AN symptoms. No temperament or psychopathology variables predicted BN symptoms. This study is an important first step toward continuing to identify areas of focus for future research on early childhood risk factors for ED symptoms and body dissatisfaction.
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Kenny B, Orellana L, Fuller-Tyszkiewicz M, Moodie M, Brown V, Williams J. Depression and eating disorders in early adolescence: A network analysis approach. Int J Eat Disord 2021; 54:2143-2154. [PMID: 34625986 DOI: 10.1002/eat.23627] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 09/29/2021] [Accepted: 09/30/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Eating disorders (EDs) and depression are among the most debilitating and pervasive mental illnesses. Although they often co-occur, the relationship between EDs and depression remains poorly understood. This study used network analysis to explore the symptom-level relationship between EDs and depression among a sample of Australian adolescents completing their first year of secondary school. METHOD Adolescents (N = 4,421) aged between 10 and 15 years completed the Centre for Epidemiological Depression Scale and the Eating Disorder Examination-Questionnaire. Network structure was estimated using the Gaussian graphical model and node centrality was assessed using one-step expected influence (EI) and bridge EI. RESULTS "Depressed," "lonely," and "low energy" were identified as core symptoms of depression. "Shape and weight dissatisfaction," "desire to lose weight," and "preoccupation with shape or weight" were identified as core ED symptoms. "Irritable," "social eating," and "depressed" were identified as the most important nodes connecting (i.e., bridging) symptoms of depression and EDs. DISCUSSION This study provides an important symptom-level conceptualization of the association between depression and ED symptoms in a community sample of adolescents. This preliminary evidence may guide the development of public health prevention and early intervention programs. Future research should be conducted to address the study limitations (e.g., cross-sectional design).
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Affiliation(s)
- Bridget Kenny
- Faculty of Health, School of Health and Social Development, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Liliana Orellana
- Biostatistics Unit, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Matthew Fuller-Tyszkiewicz
- Centre for Social and Early Emotional Development, Deakin University, Melbourne, Victoria, Australia.,Faculty of Health, School of Psychology, Deakin University, Geelong, Victoria, Australia
| | - Marj Moodie
- Faculty of Health, School of Health and Social Development, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia.,Faculty of Health, Deakin Health Economics, Deakin University, Geelong, Victoria, Australia
| | - Vicki Brown
- Faculty of Health, School of Health and Social Development, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia.,Faculty of Health, Deakin Health Economics, Deakin University, Geelong, Victoria, Australia
| | - Joanne Williams
- Faculty of Health, School of Health and Social Development, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia.,School of Health Sciences, Swinburne University of Technology, Hawthorn, Victoria, Australia
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Ahamed SK, Barek MA, Roy UK, Kouser M, Reza MS, Mannan AB, Alam MA, Uddin SMN. A review on association and correlation of genetic variants with eating disorders and obesity. FUTURE JOURNAL OF PHARMACEUTICAL SCIENCES 2021. [DOI: 10.1186/s43094-021-00250-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Now, eating disorders and obesity and their correlations are danger signal in worldwide which is caused by multifactor and associated with significant mortality and morbidity.
Main body
Every aspect of a patient’s life is influenced by eating disorders and obesity and their correlations. Due to frequent seeing of obese patients, eating disorders have been included in the review as they can sometimes be associated with obesity. However, it should be noted that most patients having eating disorder are at risk to be obese or overweight. This research explores the risk factors for the two disorders, as well as the assessment of medical complications and treatment recommendations for the disorders. In these two disorders, there is also a correlation. The essential consideration is that eating disorders are impulse-control disorders which are similar to addictive behaviors in some aspects. So it is a crying need to treat a patient with obesity and eating disorders simultaneously to ensure success. Genome-wide association studies (GWASs) have increased our knowledge of the pathophysiology of eating disorders (EDs) and obesity and their correlation.
Conclusion
This review enlightens on the summary of eating disorder, obesity, genotypic traits, molecular relations, interaction, correlation, and effect of eating disorder and obesity which outline potential future directions and clinical implications for patients with EDs and obesity.
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Perthes K, Kirschbaum-Lesch I, Legenbauer T, Holtmann M, Hammerle F, Kolar DR. Emotion regulation in adolescents with anorexia and bulimia nervosa: Differential use of adaptive and maladaptive strategies compared to healthy adolescents. Int J Eat Disord 2021; 54:2206-2212. [PMID: 34542185 DOI: 10.1002/eat.23608] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 09/08/2021] [Accepted: 09/09/2021] [Indexed: 01/29/2023]
Abstract
OBJECTIVE Adolescents with anorexia (AN) and bulimia nervosa (BN) often struggle with emotion regulation (ER). These difficulties have predominantly been assessed across emotions, without considering adaptive and maladaptive ER separately. We compared adolescents with AN or BN to healthy adolescents (HCs) regarding the adaptive and maladaptive ER of three emotions. METHOD A treatment-seeking sample of 197 adolescents (atypical/full-threshold AN: N = 118, atypical/full-threshold BN: N = 32; HC: N = 47) reported emotion-specific ER with the FEEL-KJ questionnaire. Mixed models were calculated for adaptive and maladaptive ER to assess differences between emotions (anxiety, anger, and sadness) and groups (AN, BN, and HC). RESULTS Main effects of emotion (p < .001) and group (p < .001) were found, but no interaction effects were found (p > .05). Post hoc tests showed lower maladaptive and higher adaptive ER for anxiety than anger or sadness (p < .001). AN and BN reported lower adaptive (p < .001) and higher maladaptive ER than HCs (p < .001). BN showed the highest levels of maladaptive ER (p = .009). DISCUSSION The differences between AN and BN in adaptive and maladaptive ER should be considered. Furthermore, investigating differences in ER of other emotions in eating disorders might be promising.
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Affiliation(s)
- Karin Perthes
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medicine of the Johannes Gutenberg-University, Mainz, Germany
| | - Inken Kirschbaum-Lesch
- LWL University Hospital Hamm for Child and Adolescent Psychiatry, Psychotherapy and Psychosomatic, Ruhr University Bochum, Hamm, Germany
| | - Tanja Legenbauer
- LWL University Hospital Hamm for Child and Adolescent Psychiatry, Psychotherapy and Psychosomatic, Ruhr University Bochum, Hamm, Germany
| | - Martin Holtmann
- LWL University Hospital Hamm for Child and Adolescent Psychiatry, Psychotherapy and Psychosomatic, Ruhr University Bochum, Hamm, Germany
| | - Florian Hammerle
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medicine of the Johannes Gutenberg-University, Mainz, Germany
| | - David R Kolar
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medicine of the Johannes Gutenberg-University, Mainz, Germany.,Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
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67
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Wong VZ, Christian C, Levinson CA. The unique and moderated relationships across repetitive negative thinking and disordered eating behaviors in adolescent girls. Eat Behav 2021; 43:101560. [PMID: 34492594 DOI: 10.1016/j.eatbeh.2021.101560] [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: 12/14/2020] [Revised: 08/18/2021] [Accepted: 08/27/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Repetitive negative thinking (RNT) is associated with eating disorder (ED) symptoms, but few studies have evaluated how RNT may relate to specific ED behaviors (e.g., fasting, binge eating). Furthermore, little research has examined RNT in adolescent girls, a critical population for ED development. Concern over mistakes perfectionism (i.e., preoccupation with and overvaluation of errors) and social appearance anxiety are transdiagnostic risk factors for EDs that may be amplified by RNT, contributing to the development of ED behaviors. METHOD The current study (N = 332 female high school students) explored RNT in an adolescent sample and tested whether RNT was uniquely associated with fasting/binge eating and moderated the relationships between social appearance anxiety/perfectionism and fasting/binge eating. RESULTS RNT was not associated with fasting and did not significantly moderate the relationship between social appearance anxiety/perfectionism and fasting. RNT was positively associated with binge eating but did not moderate the relationship between social appearance anxiety/perfectionism and binge eating. CONCLUSIONS RNT may contribute differentially to specific ED behaviors such as fasting and binge eating during ED development. If replicated in prospective data, these findings suggest targeting RNT in adolescence may decrease binge eating.
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Affiliation(s)
- Valerie Z Wong
- Drexel University, Department of Psychological & Brain Sciences, United States of America
| | - Caroline Christian
- University of Louisville, Department of Psychological & Brain Sciences, United States of America
| | - Cheri A Levinson
- University of Louisville, Department of Psychological & Brain Sciences, United States of America.
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68
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Levinson CA, Hunt RA, Keshishian AC, Brown ML, Vanzhula I, Christian C, Brosof LC, Williams BM. Using individual networks to identify treatment targets for eating disorder treatment: a proof-of-concept study and initial data. J Eat Disord 2021; 9:147. [PMID: 34736538 PMCID: PMC8567590 DOI: 10.1186/s40337-021-00504-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 10/23/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Eating disorders (EDs) are severe mental illnesses, with high morbidity, mortality, and societal burden. EDs are extremely heterogenous, and only 50% of patients currently respond to first-line treatments. Personalized and effective treatments for EDs are drastically needed. METHODS The current study (N = 34 participants with an ED diagnosis collected throughout the United States) aimed to investigate best methods informing how to select personalized treatment targets utilizing idiographic network analysis, which could then be used for evidence based personalized treatment development. We present initial data collected via experience sampling (i.e., ecological momentary assessment) over the course of 15 days, 5 times a day (75 total measurement points) that were used to select treatment targets for a personalized treatment for EDs. RESULTS Overall, we found that treatment targets were highly variable, with less than 50% of individuals endorsing central symptoms related to weight and shape, consistent with current treatment response rates for treatments designed to target those symptoms. We also found that different aspects of selection methods (e.g., number of items, type of centrality measure) impacted treatment target selection. CONCLUSIONS We discuss implications of these data, how to use idiographic network analysis to personalize treatment, and identify areas that need future research. TRIAL REGISTRATION Clinicaltrials.gov, NCT04183894. Registered 3 December 2019-Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04183894 . NCT04183894 (ClinicalTrials.gov identifier).
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Affiliation(s)
- Cheri A Levinson
- Department of Psychological and Brain Sciences, University of Louisville, Life Sciences Building, Louisville, KY, 40292, USA.
| | - Rowan A Hunt
- Department of Psychological and Brain Sciences, University of Louisville, Life Sciences Building, Louisville, KY, 40292, USA
| | - Ani C Keshishian
- Department of Psychological and Brain Sciences, University of Louisville, Life Sciences Building, Louisville, KY, 40292, USA
| | - Mackenzie L Brown
- Department of Psychological and Brain Sciences, University of Louisville, Life Sciences Building, Louisville, KY, 40292, USA
| | - Irina Vanzhula
- Department of Psychological and Brain Sciences, University of Louisville, Life Sciences Building, Louisville, KY, 40292, USA
| | - Caroline Christian
- Department of Psychological and Brain Sciences, University of Louisville, Life Sciences Building, Louisville, KY, 40292, USA
| | - Leigh C Brosof
- Department of Psychological and Brain Sciences, University of Louisville, Life Sciences Building, Louisville, KY, 40292, USA
| | - Brenna M Williams
- Department of Psychological and Brain Sciences, University of Louisville, Life Sciences Building, Louisville, KY, 40292, USA
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69
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Levinson CA, Ralph-Nearman C, Brown ML, Gardner T, Cardi V, Treasure J, Purves K, Eley TC. A pilot randomized control trial of online exposure for eating disorders and mechanisms of change delivered after discharge from intensive eating disorder care: A registered report. Int J Eat Disord 2021; 54:2066-2074. [PMID: 34480773 PMCID: PMC9886130 DOI: 10.1002/eat.23603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 08/26/2021] [Accepted: 08/26/2021] [Indexed: 02/01/2023]
Abstract
More than 50% of individuals with an eating disorder (ED) will readmit to treatment within 6 months of treatment discharge and often due to persistent cognitive ED pathology. Interventions addressing unremitted cognitive ED pathology following discharge from intensive treatment are crucial to prevent readmission. Imaginal exposure therapy facilitates the approach of feared stimuli not accessible in everyday life (e.g., rapidly gaining weight). In the current pilot randomized control trial (RCT), participants will be randomly assigned to a five-session online imaginal exposure condition (n = 65) or a control online writing and thinking intervention (n = 65) within a month of discharge from intensive treatment. Exposure participants write about and imagine an ED fear and control participants will write about their ED generally. We will examine the feasibility and acceptability of the treatment conditions and whether imaginal exposure is more effective in preventing readmission than the control condition. We will test the efficacy of the imaginal exposure treatment in reducing ED symptoms and fears of food and weight gain, and whether fear learning is a mechanism of change related to ED pathology. Ultimately, this research will lead to the development of an easily deployable readmission prevention treatment based on fear conditioning targets.
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Affiliation(s)
- Cheri A. Levinson
- Department of Psychological & Brain Sciences, University of Louisville, Louisville, Kentucky, USA
- Kings College London, Psychological Medicine, Academic Psychiatry and Social, Genetic and Developmental Psychiatry Centre, London, UK
| | - Christina Ralph-Nearman
- Department of Psychological & Brain Sciences, University of Louisville, Louisville, Kentucky, USA
- Kings College London, Psychological Medicine, Academic Psychiatry and Social, Genetic and Developmental Psychiatry Centre, London, UK
| | - Mackenzie L. Brown
- Department of Psychological & Brain Sciences, University of Louisville, Louisville, Kentucky, USA
- Kings College London, Psychological Medicine, Academic Psychiatry and Social, Genetic and Developmental Psychiatry Centre, London, UK
| | - Taylor Gardner
- Department of Psychological & Brain Sciences, University of Louisville, Louisville, Kentucky, USA
- Kings College London, Psychological Medicine, Academic Psychiatry and Social, Genetic and Developmental Psychiatry Centre, London, UK
| | - Valentina Cardi
- Department of Psychological & Brain Sciences, University of Louisville, Louisville, Kentucky, USA
- Kings College London, Psychological Medicine, Academic Psychiatry and Social, Genetic and Developmental Psychiatry Centre, London, UK
| | - Janet Treasure
- Department of Psychological & Brain Sciences, University of Louisville, Louisville, Kentucky, USA
- Kings College London, Psychological Medicine, Academic Psychiatry and Social, Genetic and Developmental Psychiatry Centre, London, UK
| | - Kirstin Purves
- Department of Psychological & Brain Sciences, University of Louisville, Louisville, Kentucky, USA
- Kings College London, Psychological Medicine, Academic Psychiatry and Social, Genetic and Developmental Psychiatry Centre, London, UK
| | - Thalia C. Eley
- Department of Psychological & Brain Sciences, University of Louisville, Louisville, Kentucky, USA
- Kings College London, Psychological Medicine, Academic Psychiatry and Social, Genetic and Developmental Psychiatry Centre, London, UK
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Network analysis of anxiety and depressive symptoms among nursing students during the COVID-19 pandemic. J Affect Disord 2021; 294:753-760. [PMID: 34375200 PMCID: PMC8433813 DOI: 10.1016/j.jad.2021.07.072] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 07/14/2021] [Accepted: 07/16/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND The 2019 coronavirus disease (COVID-19) pandemic has impacted the mental health and well-being of medical personnel, including nursing students. Network analysis provides a deeper characterization of symptom-symptom interactions in mental disorders. The aim of this study was to elucidate characteristics of anxiety and depressive symptom networks of Chinese nursing students during the COVID-19 pandemic. METHOD A total of 932 nursing students were included. Anxiety and depressive symptom were measured using the seven-item Generalized Anxiety Disorder Scale (GAD-7) and two-item Patient Health Questionnaire (PHQ-2), respectively. Central symptoms and bridge symptoms were identified via centrality indices and bridge centrality indices, respectively. Network stability was examined using the case-dropping procedure. RESULTS Irritability, Uncontrollable worry, Trouble relaxing, and Depressed mood had the highest centrality values. Three bridge symptoms (Depressed mood, Nervousness, and Anhedonia) were also identified. Neither gender nor region of residence was associated with network global strength, distribution of edge weights or individual edge weights. LIMITATIONS Data were collected in a cross-sectional study design, therefore, causal relations and dynamic changes between anxiety and depressive symptoms over time could not be inferred. Generalizability of findings may be limited to Chinese nursing students during a particular phase of the current pandemic. CONCLUSIONS Irritability, Uncontrollable worry, Trouble relaxing, and Depressed mood constituted central symptoms maintaining the anxiety-depression network structure of Chinese nursing students during the pandemic. Timely, systemic multi-level interventions targeting central symptoms and bridge symptoms may be effective in alleviating co-occurring experiences of anxiety and depression in this population.
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71
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Sleep Quality and Eating Disorder-Related Psychopathologies in Patients with Night Eating Syndrome and Binge Eating Disorders. J Clin Med 2021; 10:jcm10194613. [PMID: 34640635 PMCID: PMC8509793 DOI: 10.3390/jcm10194613] [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: 09/12/2021] [Revised: 10/01/2021] [Accepted: 10/05/2021] [Indexed: 12/02/2022] Open
Abstract
Night eating syndrome (NES) is an eating disorder (ED) characterized by nocturnal ingestion (NI), evening hyperphagia, morning anorexia, as well as mood and sleep disturbances. This study compared subjective and objective sleep quality and ED-related psychopathologies in patients seeking treatment for ED. Method: The sample was composed of 170 women, aged 18–68, who were referred for an ED assessment from 2011 to 2020. The participants were divided into three subgroups: NES-NI only (n = 30), NES+ binge eating (BE) (including binge eating disorders or bulimia nervosa (n = 52), and BE-only (n = 88). The measures consisted of a psychiatric evaluation, objective sleep monitoring measured by an actigraph for 1 week, a subjective sleep self-report, and ED-related psychopathology questionnaires. Results: Objective sleep monitoring revealed significant group differences, with higher sleep efficiency in participants with BE-only and longer sleep durations for the NES-NI only group. Subjectively, the BE-only group described a significantly lower sleep quality than either the NES-NI only or the NES+BE groups. ED-related psychopathology was lower in the NES-NI-only group. A stepwise linear regression revealed that general psychopathology (the brief symptom inventory total score) was a significant predictor of subjective sleep quality. Conclusion: NES-NI-only was correlated with less psychopathology, but with more subjective and objective sleep disturbances. These results lend weight to the supposition that NES lies on a continuum of ED psychopathologies, and that NES-NI-only appears to be a separate entity from NES+BE and BE-only in terms of its psychopathology.
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72
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Manasse SM, Lampe EW, Abber SR, Butler R, Gillikin L, Trainor C. Exposure-enhanced cognitive behavioral therapy for adolescents with binge eating: An initial case series. Clin Child Psychol Psychiatry 2021; 26:1124-1136. [PMID: 34237236 DOI: 10.1177/13591045211028963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Binge eating (BE) often develops during adolescence and is associated with deleterious psychological and physical consequences. Current treatments for adolescents achieve suboptimal results, likely due to failure to adequately address fear of weight gain (FOWG) which maintains BE. Thus, exposure treatment (the most powerful intervention for fear) may be a promising approach. However, exposure treatment has only minimally tested in adults with BE and never tested in adolescents. Thus, the current study is the first to evaluate a 4-session exposure module within a 12-session standard cognitive behavioral therapy for adolescents with BE. We recruited adolescents with BE (N = 5) and examined treatment feasibility, acceptability, and preliminary effects on FOWG and eating pathology. Overall, the 4-session exposure module was feasible and acceptable and showed preliminary evidence that it could reduce FOWG. However, several participants did not endorse significant fears of weight gain; rather, these participants reported that fears of deprivation or social judgment were more related to their BE. Future research should test higher doses of exposure and further examine the role of fear of deprivation/social judgment. Finally, future iterations of this treatment could include more parent involvement or test exposure in combination with treatments other than cognitive behavioral therapy, such as family-based treatment.
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Affiliation(s)
- Stephanie M Manasse
- Center for Weight, Eating, and Lifestyle Science, 6527Drexel University, Philadelphia, PA, USA
| | - Elizabeth W Lampe
- Center for Weight, Eating, and Lifestyle Science, 6527Drexel University, Philadelphia, PA, USA
- Department of Psychology, 6527Drexel University, Philadelphia, PA, USA
| | - Sophie R Abber
- Center for Weight, Eating, and Lifestyle Science, 6527Drexel University, Philadelphia, PA, USA
- Department of Psychology, 6527Drexel University, Philadelphia, PA, USA
| | - Rachel Butler
- Department of Psychology, 6558Temple University, Philadelphia, PA, USA
| | - Lindsay Gillikin
- Center for Weight, Eating, and Lifestyle Science, 6527Drexel University, Philadelphia, PA, USA
| | - Claire Trainor
- Center for Weight, Eating, and Lifestyle Science, 6527Drexel University, Philadelphia, PA, USA
- Department of Psychology, 6527Drexel University, Philadelphia, PA, USA
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73
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Martini M, Marzola E, Brustolin A, Abbate-Daga G. Feeling imperfect and imperfectly feeling: A network analysis on perfectionism, interoceptive sensibility, and eating symptomatology in anorexia nervosa. EUROPEAN EATING DISORDERS REVIEW 2021; 29:893-909. [PMID: 34510651 DOI: 10.1002/erv.2863] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 08/13/2021] [Accepted: 08/20/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVE In recent years, the network analysis (NA) methodology has been applied to identify the central features of the psychopathology of anorexia nervosa (AN) and specific connections to previously recognized vulnerabilities. However, an NA investigating both multidimensional perfectionism and interoceptive sensibility in connection to eating symptomatology is currently missing. METHOD A total of 260 individuals (139 patients with AN, 121 healthy control individuals) completed the Frost Multidimensional Perfectionism Scale, the Multidimensional Assessment of Interoceptive Awareness and the Eating Disorders Inventory-2. Using state-of-the-art techniques, we estimated a main network with data from all participants and then compared the two separated networks. We checked the variables for empirical overlap through goldbricker, combined as suggested and implemented the empirical measure of the bridge nodes. RESULTS Ineffectiveness and need for control over self and body (resulting from combining Asceticism and Drive for Thinness) were the most central nodes, whereas perfectionistic evaluative concerns (resulting from combining Doubts about Actions and Concern over Mistakes) and mistrust in body sensations were the bridge nodes. No significant differences between the patient and control networks emerged. CONCLUSIONS Perfectionistic evaluative concerns and mistrust in body sensations could be key components in the relationships among perfectionism, interoceptive sensibility and eating symptomatology.
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Affiliation(s)
- Matteo Martini
- Department of Neuroscience "Rita Levi Montalcini", Eating Disorders Center, University of Turin, Turin, Italy
| | - Enrica Marzola
- Department of Neuroscience "Rita Levi Montalcini", Eating Disorders Center, University of Turin, Turin, Italy
| | - Annalisa Brustolin
- Department of Neuroscience "Rita Levi Montalcini", Eating Disorders Center, University of Turin, Turin, Italy
| | - Giovanni Abbate-Daga
- Department of Neuroscience "Rita Levi Montalcini", Eating Disorders Center, University of Turin, Turin, Italy
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74
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Svicher A, Fioravanti G, Casale S. Identifying the central symptoms of problematic social networking sites use through network analysis. J Behav Addict 2021; 10:767-778. [PMID: 34437299 PMCID: PMC8997205 DOI: 10.1556/2006.2021.00053] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 04/29/2021] [Accepted: 07/25/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Problematic social media use (PSMU) has received growing attention in the last fifteen years. Even though PSMU has been extensively studied, its internal structure is not fully understood. We used network analysis to evaluate which symptoms and associations between symptoms are most central to PSMU - as assessed by the Generalized Problematic Internet Use Scale-2 adapted for PSMU - among undergraduates. METHOD Network analysis was applied to a large gender-balanced sample of undergraduates (n = 1344 participants; M = 51.9%; mean age = 22.50 ± 2.20 years). RESULTS The most central nodes in the network were the difficulty of controlling one's own use of social media, the tendency to think obsessively about going online, the difficulties in resisting the urge to use social media and the preference for communicating with people online rather than face-to-face. This last element was strongly associated with a general preference for online social interactions and the feeling of being more comfortable online. The network was robust to stability and accuracy tests. The mean levels of symptoms and symptom centrality were not associated. CONCLUSIONS Deficient self-regulation and preference for online communication were the most central symptoms of PSMU, suggesting that these symptoms should be prioritized in theoretical models of PSMU and could also serve as important treatment targets for PSMU interventions.
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Affiliation(s)
- Andrea Svicher
- Department of Health Sciences, Section of Psychology, University of Florence, Italy
| | - Giulia Fioravanti
- Department of Health Sciences, Section of Psychology, University of Florence, Italy
| | - Silvia Casale
- Department of Health Sciences, Section of Psychology, University of Florence, Italy,Corresponding author. Email
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75
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Huang S, Lai X, Li Y, Luo Y, Wang Y. Understanding juveniles' problematic smartphone use and related influencing factors: A network perspective. J Behav Addict 2021; 10:811-826. [PMID: 34406975 PMCID: PMC8997212 DOI: 10.1556/2006.2021.00048] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 05/26/2021] [Accepted: 07/03/2021] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND AND AIMS To understand the interaction between problematic smartphone use (PSU) and related influencing factors (individual variables, family environment, and school environment) and to determine the most influential factors affecting the use of smartphones by juveniles to implement effective interventions in the future. METHODS A total of 3,442 children and adolescents (3,248 actual participants (males = 1,638, average age = 12.27 ± 2.36)) were included in the study. This study measured juveniles' PSU and its influencing factors: individual variables (4 factors), family environments (13 factors), and school environments (5 factors). This study employed a network analysis approach for data assessment. RESULTS This study found that there were several central influencing factors (such as self-control ability, loss of control, parent-child relationship, and peer attitudes towards smartphone use) and bridge factors (such as peer attitudes towards smartphone use, peer pressure for smartphone use, and fear of missing out). DISCUSSION AND CONCLUSIONS Juveniles' PSU included several core symptoms and critical influencing factors. Intervention based on these factors may be effective, timely, and inexpensive.
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Affiliation(s)
- Shunsen Huang
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
| | - Xiaoxiong Lai
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
| | - Yajun Li
- School of Education, Henan University, Kaifeng, China
| | - Yuhan Luo
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China,Collaborative Innovation Centre of Assessment for Basic Education Quality, Beijing Normal University, Beijing, China
| | - Yun Wang
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China,Corresponding author. E-mail:
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76
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Kim KM, Kim H, Kim D, Kim JW. The analysis of network structure among the depressive symptoms in a clinical sample of children and adolescents. Asian J Psychiatr 2021; 62:102748. [PMID: 34243062 DOI: 10.1016/j.ajp.2021.102748] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/24/2021] [Accepted: 06/25/2021] [Indexed: 10/20/2022]
Abstract
The symptoms of depressive disorder in children and adolescents vary widely and have complex interconnections with each other. This study aimed to identify the network structures among individual depressive symptoms in clinically referred children and adolescents. A total of 464 children and adolescents who visited the outpatient psychiatry clinic in South Korea were enrolled. The Children's Depression Inventory (CDI) was used to assess depressive symptoms. To construct the network structure and estimate the centrality indices among individual symptoms, the Gaussian graphical model was utilized with the tuning parameter to minimize the extended Bayesian information criterion. Among all symptoms, self-hatred had the highest strength centrality, followed by crying and self-deprecation. Among 191 valid edges constituting the CDI symptom network, sadness-crying, school work difficulty-school performance decrement, disobedience-fights, misbehavior-low self-esteem, self-deprecation-self-blame, school dislike-lack of friendship, self-hatred-negative body image, anhedonia-social withdrawal, self-hatred-suicidal ideation, crying-irritability, and sadness-loneliness showed significantly higher weights than the other edges. The present study identified the network structure among depressive symptoms in children and adolescents. Future studies including more symptoms of depression are warranted to provide insights into the underlying mechanisms of child and adolescent depression.
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Affiliation(s)
- Kyoung Min Kim
- Department of Psychiatry, College of Medicine, Dankook University, Cheonan, Republic of Korea; Department of Psychiatry, Dankook University Hospital, Cheonan, Republic of Korea
| | - Haebin Kim
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea; Workplace Mental Health Institute, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Dohyun Kim
- Department of Psychiatry, College of Medicine, Dankook University, Cheonan, Republic of Korea; Department of Psychiatry, Dankook University Hospital, Cheonan, Republic of Korea
| | - Jae-Won Kim
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea; Division of Child and Adolescent Psychiatry, Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea.
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77
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Wong VZ, Christian C, Hunt RA, Levinson CA. Network investigation of eating disorder symptoms and positive and negative affect in a clinical eating disorder sample. Int J Eat Disord 2021; 54:1202-1212. [PMID: 33819357 DOI: 10.1002/eat.23511] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 03/24/2021] [Accepted: 03/24/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Growing literature suggests that emotions influence the maintenance of eating disorder (ED) symptoms. However, most research has studied the relationship between ED symptoms and affect broadly (i.e., negative affect [NA], positive affect [PA]), rather than examining models comprised of multiple specific affective states (e.g., upset, proud). METHOD The current study (N = 196 individuals with EDs) used network analysis to examine the most interconnected (i.e., central) NA and PA states in EDs and test the complex associations between specific NA, PA, and ED symptoms. We estimated two networks: one with affective states only and another with affective states and ED symptoms. RESULTS Feeling distressed, afraid, attentive, and determined were the most central symptoms in the affect-only network. ED symptoms related to overvaluation of weight and shape, including affect-based ED symptoms (i.e., guilt about eating), were central in the network of affect and ED symptoms. Guilt about eating and shame were central bridge symptoms across affect and ED symptom clusters, meaning that they were each strongly connected across clusters, and may represent important pathways among affect and ED symptoms. DISCUSSION Limitations include the cross-sectional and between-person nature of these analyses, from which we cannot derive causal or within-persons processes. Clinical interventions that target central and bridge symptoms (e.g., fear, shame) may disrupt the reinforcing cycle of NA in EDs that may contribute to ED behaviors. Future research should examine relationships among affective states and ED symptoms in longitudinal and intraindividual network models to develop more effective treatments for EDs.
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Affiliation(s)
- Valerie Z Wong
- Department of Psychology, Yale University, New Haven, Connecticut, USA
| | - Caroline Christian
- Department of Psychological & Brain Sciences, University of Louisville, Louisville, Kentucky, USA
| | - Rowan A Hunt
- Department of Psychological & Brain Sciences, University of Louisville, Louisville, Kentucky, USA
| | - Cheri A Levinson
- Department of Psychological & Brain Sciences, University of Louisville, Louisville, Kentucky, USA
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78
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de Vos JA, Radstaak M, Bohlmeijer ET, Westerhof GJ. The psychometric network structure of mental health in eating disorder patients. EUROPEAN EATING DISORDERS REVIEW 2021; 29:559-574. [PMID: 33949742 PMCID: PMC8252750 DOI: 10.1002/erv.2832] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 03/17/2021] [Accepted: 03/30/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Psychometric network analysis has led to new possibilities to assess the structure and dynamics of psychiatric disorders. The current study focuses on mental health networks in patients with anorexia nervosa, bulimia nervosa, binge eating disorder and other specified eating disorders (EDs). METHOD Network analyses were applied with five mental health domains (emotional, psychological and social well-being, and general and specific psychopathology) among 905 ED patients. Also, networks of 36 underlying symptoms related to the domains were estimated. The network stability, structure and (bridge) centrality of the nodes were assessed for the total group and each ED type. Network differences between the ED types were also examined. RESULTS ED psychopathology was only weakly connected with the well-being domains. Psychological well-being was the most central node in the domain network. The most central nodes in the symptom network were feeling depressed, feeling worthless, purpose in life and self-acceptance. Bridge symptoms between well-being and psychopathology were self-acceptance, environmental mastery, interested in life and feeling depressed. There were no network differences between the ED types in both the domain and symptom networks. CONCLUSIONS This study shows novel associations between well-being and psychopathology in ED patients. Central domains and their underlying symptoms may be especially important to consider in treatment for promoting mental health in ED patients.
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Affiliation(s)
- Jan Alexander de Vos
- Department of Psychology, Health and TechnologyCentre for eHealth and Wellbeing ResearchUniversity of TwenteEnschedeThe Netherlands
- Stichting Human ConcernCentrum voor eetstoornissenAmsterdamThe Netherlands
| | - Mirjam Radstaak
- Department of Psychology, Health and TechnologyCentre for eHealth and Wellbeing ResearchUniversity of TwenteEnschedeThe Netherlands
| | - Ernst T. Bohlmeijer
- Department of Psychology, Health and TechnologyCentre for eHealth and Wellbeing ResearchUniversity of TwenteEnschedeThe Netherlands
| | - Gerben J. Westerhof
- Department of Psychology, Health and TechnologyCentre for eHealth and Wellbeing ResearchUniversity of TwenteEnschedeThe Netherlands
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79
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Cusack CE, Christian C, Drake JE, Levinson CA. A network analysis of eating disorder symptoms and co-occurring alcohol misuse among heterosexual and sexual minority college women. Addict Behav 2021; 118:106867. [PMID: 33639368 DOI: 10.1016/j.addbeh.2021.106867] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 01/27/2021] [Accepted: 02/01/2021] [Indexed: 10/22/2022]
Abstract
Eating disorders and alcohol misuse are common problems among college women. Individually, both have high prevalence rates and are associated with a significant economic burden. Yet eating disorders and alcohol misuse also frequently present simultaneously, which may increase symptom severity and related impairment. These associations are especially important to test in sexual minority populations, as symptoms may present differently, and the prevalence and personal cost of these disorders may be even higher for this group. The present study (N = 1072 undergraduate college women) used network analysis to identify pathways, central symptoms, and bridge symptoms across alcohol misuse and eating disorder symptoms. A network comparison test was used to determine if the network structure differed between heterosexual women (n = 923) and sexual minority women (n = 149). For the overall network, cognitive restraint, excessive exercise, and frequency of binge drinking, were the most central symptoms. Bridge symptoms included drinking in the morning, purging, alcohol-related guilt, and muscle building. Heterosexual and sexual minority women did not differ significantly in network structure or global strength. Regardless of sexual orientation, prevention efforts for eating disorders and alcohol misuse among college women should target central and bridge symptoms.
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Abstract
Empirical publications inspired by the network approach to psychopathology have increased exponentially in the twenty-first century. The central idea that an episode of mental disorder arises from causal interactions among its symptomatic elements has especially resonated with those clinical scientists whose disenchantment with traditional categorical and dimensional approaches to mental illness has become all too apparent. As the field has matured, conceptual and statistical concerns about the limitations of network approaches to psychopathology have emerged, inspiring the development of novel methods to address these concerns. Rather than reviewing the vast empirical literature, I focus instead on the issues and controversies regarding this approach and sketch directions where the field might go next.
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Affiliation(s)
- Richard J. McNally
- Department of Psychology, Harvard University, Cambridge, Massachusetts 02138, USA
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81
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Monteleone AM, Cascino G. A systematic review of network analysis studies in eating disorders: Is time to broaden the core psychopathology to non specific symptoms. EUROPEAN EATING DISORDERS REVIEW 2021; 29:531-547. [PMID: 33942439 PMCID: PMC8251923 DOI: 10.1002/erv.2834] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 03/31/2021] [Accepted: 04/06/2021] [Indexed: 12/15/2022]
Abstract
Objective Network theory considers mental disorders as the product of symptom interaction. A growing number of studies employing this methodology has been conducted in eating disorders (EDs). We aimed to review those studies to provide evidence and limitations for a novel conceptualisation of EDs. Methods According to PRISMA guidelines and PICOS criteria, studies eligible for inclusion were those employing network analysis in people with a clinically defined diagnosis of ED. Twenty‐five studies were included and were analysed in relation to diagnosis, comorbidity, and treatment outcome. Results Despite the central role of overvaluation of body shape and weight and cognitive restraint across ED diagnoses, ineffectiveness, interoceptive awareness and affective problems appear central symptoms. Ineffectiveness and interoceptive awareness emerge as bridge symptoms promoting comorbidity in people with anorexia nervosa and in mixed ED samples. Although few studies assessed treatment outcome, there is evidence supporting the predictive role of central network nodes. Conclusions Ineffectiveness, interoceptive ability and affective problems may be included in the core ED psychopathology, in addition to ED‐specific symptoms. Network analysis is a promising method to reconceptualize comorbidity. Future studies are recommended to include general psychopathology in ED networks, to assess connections with the external field and clinical meaning of network connectivity. Overvaluation of body shape and weight and cognitive restraint appear as central nodes across eating disorder diagnoses and ages. In addition to specific symptoms, ineffectiveness, low interoceptive ability and affective problems also emerge as central nodes in eating disorders. There is some evidence to point to ineffectiveness and low interoceptive ability as bridge nodes promoting psychiatric comorbidity. Only few studies assessed treatment outcome through the network analysis approach
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Affiliation(s)
| | - Giammarco Cascino
- Department of Medicine, Surgery and Dentistry 'Scuola Medica Salernitana', Section of Neurosciences, University of Salerno, Salerno, Italy
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82
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Byrne ME, Tanofsky-Kraff M, Lavender JM, Parker MN, Shank LM, Swanson TN, Ramirez E, LeMay-Russell S, Yang SB, Brady SM, Zenno A, Chivukula KK, Kelly NR, Yanovski JA. Bridging executive function and disinhibited eating among youth: A network analysis. Int J Eat Disord 2021; 54:721-732. [PMID: 33502799 PMCID: PMC8119329 DOI: 10.1002/eat.23476] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 01/14/2021] [Accepted: 01/14/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Poorer executive function (EF) has been linked to disinhibited eating in youth, suggesting poor EF predisposes toward obesity, yet the specific nature and extent of interconnections between facets of these domains is unclear. Network analysis provides a promising framework for elucidating the relationship between poor EF and disinhibited eating, and offers insights into potential maintenance processes. METHOD Among youth ages 8-17 years, a regularized partial correlation network of EF and disinhibited eating facets was estimated to examine expected influence centrality and bridge expected influence. Computerized neurocognitive tasks assessed EF variables, including decision-making, general and food-related inhibitory control, delayed gratification, cognitive flexibility, and working memory. Disinhibited eating variables included total carbohydrate-fat intake at a laboratory test meal and self-reported eating in the absence of hunger, emotional eating, and loss-of-control eating severity. RESULTS In the current sample (N = 248; Mage = 12.5; 54.8% female; 43.5% non-Hispanic White; 25.8% non-Hispanic Black; BMI %ile = 65.8 ± 27.8), emotional eating in response to depressive symptoms emerged as a central symptom in the network. Carbohydrate-fat intake had the highest bridge expected influence and was most strongly connected to general inhibitory control (part r = .14). DISCUSSION The link between general inhibitory control and objective palatable food intake may be particularly salient in maintaining maladaptive eating behavior. Interventions targeting behavioral disinhibition may disrupt associations among a network of disinhibited eating facets in youth and should be targets for longitudinal research.
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Affiliation(s)
- Meghan E. Byrne
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USU), 4301 Jones Bridge Road, Bethesda, MD, 20814
- Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Department of Health and Human Services (DHHS), 10 Center Drive, Bethesda, MD, 20892
| | - Marian Tanofsky-Kraff
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USU), 4301 Jones Bridge Road, Bethesda, MD, 20814
- Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Department of Health and Human Services (DHHS), 10 Center Drive, Bethesda, MD, 20892
- Military Cardiovascular Outcomes Research (MiCOR) Program, Department of Medicine, USU, 4301 Jones Bridge Road, Bethesda, MD, 20814
| | - Jason M. Lavender
- Military Cardiovascular Outcomes Research (MiCOR) Program, Department of Medicine, USU, 4301 Jones Bridge Road, Bethesda, MD, 20814
- Metis Foundation, 300 Convent St #1330, San Antonio, TX 78205, USA
| | - Megan N. Parker
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USU), 4301 Jones Bridge Road, Bethesda, MD, 20814
- Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Department of Health and Human Services (DHHS), 10 Center Drive, Bethesda, MD, 20892
| | - Lisa M. Shank
- Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Department of Health and Human Services (DHHS), 10 Center Drive, Bethesda, MD, 20892
- Military Cardiovascular Outcomes Research (MiCOR) Program, Department of Medicine, USU, 4301 Jones Bridge Road, Bethesda, MD, 20814
- Metis Foundation, 300 Convent St #1330, San Antonio, TX 78205, USA
| | - Taylor N. Swanson
- Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Department of Health and Human Services (DHHS), 10 Center Drive, Bethesda, MD, 20892
- Military Cardiovascular Outcomes Research (MiCOR) Program, Department of Medicine, USU, 4301 Jones Bridge Road, Bethesda, MD, 20814
| | - Eliana Ramirez
- Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Department of Health and Human Services (DHHS), 10 Center Drive, Bethesda, MD, 20892
| | - Sarah LeMay-Russell
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USU), 4301 Jones Bridge Road, Bethesda, MD, 20814
- Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Department of Health and Human Services (DHHS), 10 Center Drive, Bethesda, MD, 20892
| | - Shanna B. Yang
- Nutrition Department, Clinical Center, NIH, DHHS, 10 Center Drive, Bethesda, MD, 20892
| | - Sheila M. Brady
- Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Department of Health and Human Services (DHHS), 10 Center Drive, Bethesda, MD, 20892
| | - Anna Zenno
- Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Department of Health and Human Services (DHHS), 10 Center Drive, Bethesda, MD, 20892
| | - K. Karthik Chivukula
- Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Department of Health and Human Services (DHHS), 10 Center Drive, Bethesda, MD, 20892
| | - Nichole R. Kelly
- Department of Counseling Psychology and Human Services, Prevention Science Institute, College of Education, University of Oregon, 1215 University of Oregon, Eugene, OR, 97403
| | - Jack A. Yanovski
- Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Department of Health and Human Services (DHHS), 10 Center Drive, Bethesda, MD, 20892
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Beauchamp MT, Allison KC, Lundgren JD. The nature of night eating syndrome: Using network analysis to understand unique symptomological relationships. Int J Eat Disord 2021; 54:733-744. [PMID: 33675062 DOI: 10.1002/eat.23497] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 02/19/2021] [Accepted: 02/19/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Despite the initial characterization of night eating syndrome (NES) in 1955, the definition and operationalization of its symptoms has varied considerably. To standardize the definition of NES and its symptoms, Allison et al. developed research diagnostic criteria. Even so, conceptualization and intervention of NES remains guided by medical models, which assume that pathology is driven by a distinct, underlying causal mechanism. Conversely, recent work on other eating disorders (EDs) has used network analysis to reconceptualize ED psychopathology and treatment by identifying (a) unique relationships between key symptoms, and (b) the symptoms most central to specific EDs. The present study examined NES symptoms through network analysis to identify the most central symptoms within the NES network. METHOD Regularized partial correlation networks were estimated using 144 individuals in a community sample diagnosed with NES. Participants completed semi-structured interviews, self-report measures, and food/sleep diaries to measure NES symptoms, nonspecific health domains (e.g., sleep disturbance, overall mood, stress, and circadian rhythm functioning), and transdiagnostic ED symptoms. RESULTS Depressed mood, poor sleep quality, and a strong urge to eat upon awakening at night were highly central to the psychopathology network for NES and were significantly more central than most other NES symptoms and nonspecific health domains. DISCUSSION This study provides insight on the unique symptomological relationships of NES and sets the stage for future work that can identify causal linkages among NES symptoms. These symptoms represent key elements of the core psychopathology of NES and should represent primary targets for intervention.
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Affiliation(s)
- Marshall T Beauchamp
- Department of Psychology, Stony Brook University, Stony Brook, New York, USA
- Department of Psychology, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Kelly C Allison
- Department of Psychiatry, Pereleman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jennifer D Lundgren
- Department of Psychology, University of Missouri-Kansas City, Kansas City, Missouri, USA
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84
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McGlinchey E, Kirby K, McElroy E, Murphy J. The Role of Emotional Regulation in Anxiety and Depression Symptom Interplay and Expression among Adolescent Females. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2021. [DOI: 10.1007/s10862-021-09883-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
AbstractDepression and anxiety are highly comorbid constructs. However little is known about the mechanisms that underpin this comorbidity/connectivity or the divergence between constructs that seems to occur in adolescence. The current study targeted emotion regulation (ER) as a potential plausible mechanism for explaining how anxiety and depression symptoms in adolescence might begin to connect, perpetuate, and ultimately diverge from one another. Using data from a cross-sectional school-based study, of adolescent females (age 11–18 years; N = 615; majority were white (97.7%)), we modelled variation in ER using latent profile analysis. Then, using network analysis (NA), we generated separate depression-anxiety symptom networks for adolescents at varying levels of ER. Three latent classes of ER were identified (low ER 15%, intermediate ER 34%, high ER 51%). The results of the network comparison test found no significant differences in global strength between the ‘low ER’ and the ‘intermediate ER’ ability network. This study is among the first to attempt to model change in depression-anxiety symptom connectivity in adolescence in relation to a common contextual/risk factor. The current study therefore offers a unique contribution to the examination of the role of transdiagnostic factors in the study of adolescent depression and anxiety from a network perspective, and provides a promising framework for the study of ER among anxiety and depression symptomatology in adolescence.
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85
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Christian C, Williams BM, Hunt RA, Wong VZ, Ernst SE, Spoor SP, Vanzhula IA, Tregarthen JP, Forbush KT, Levinson CA. A network investigation of core symptoms and pathways across duration of illness using a comprehensive cognitive-behavioral model of eating-disorder symptoms. Psychol Med 2021; 51:815-824. [PMID: 31907093 DOI: 10.1017/s0033291719003817] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND In the past decade, network analysis (NA) has been applied to psychopathology to quantify complex symptom relationships. This statistical technique has demonstrated much promise, as it provides researchers the ability to identify relationships across many symptoms in one model and can identify central symptoms that may predict important clinical outcomes. However, network models are highly influenced by node selection, which could limit the generalizability of findings. The current study (N = 6850) tests a comprehensive, cognitive-behavioral model of eating-disorder symptoms using items from two, widely used measures (Eating Disorder Examination Questionnaire and Eating Pathology Symptoms Inventory). METHODS We used NA to identify central symptoms and compared networks across the duration of illness (DOI), as chronicity is one of the only known predictors of poor outcome in eating disorders (EDs). RESULTS Our results suggest that eating when not hungry and feeling fat were the most central symptoms across groups. There were no significant differences in network structure across DOI, meaning the connections between symptoms remained relatively consistent. However, differences emerged in central symptoms, such that cognitive symptoms related to overvaluation of weight/shape were central in individuals with shorter DOI, and behavioral central symptoms emerged more in medium and long DOI. CONCLUSIONS Our results have important implications for the treatment of individuals with enduring EDs, as they may have a different core, maintaining symptoms. Additionally, our findings highlight the importance of using comprehensive, theoretically- or empirically-derived models for NA.
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Affiliation(s)
- Caroline Christian
- Department of Psychological & Brain Sciences, University of Louisville, Louisville, KY, United States of America
| | - Brenna M Williams
- Department of Psychological & Brain Sciences, University of Louisville, Louisville, KY, United States of America
| | - Rowan A Hunt
- Department of Psychological & Brain Sciences, University of Louisville, Louisville, KY, United States of America
| | - Valerie Z Wong
- Department of Psychology, Yale University New Haven, CT, United States of America
| | - Sarah E Ernst
- Department of Psychological & Brain Sciences, University of Louisville, Louisville, KY, United States of America
| | - Samantha P Spoor
- Department of Psychological & Brain Sciences, University of Louisville, Louisville, KY, United States of America
| | - Irina A Vanzhula
- Department of Psychological & Brain Sciences, University of Louisville, Louisville, KY, United States of America
| | | | - Kelsie T Forbush
- Department of Psychology, University of Kansas, Lawrence, KS, United States of America
| | - Cheri A Levinson
- Department of Psychological & Brain Sciences, University of Louisville, Louisville, KY, United States of America
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86
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Vanzhula IA, Kinkel-Ram SS, Levinson CA. Perfectionism and Difficulty Controlling Thoughts Bridge Eating Disorder and Obsessive-Compulsive Disorder Symptoms: A Network Analysis. J Affect Disord 2021; 283:302-309. [PMID: 33578342 DOI: 10.1016/j.jad.2021.01.083] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 01/10/2021] [Accepted: 01/30/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Eating disorders (ED) and obsessive-compulsive disorder (OCD) are highly comorbid, but little is known about how this comorbidity is maintained. Prior research suggests that obsessive thoughts and perfectionism may be shared maintenance factors for EDs and OCD. METHODS The current study used network analysis to (1) identify bridge pathways in an ED-OCD comorbidity network and (2) test if perfectionism symptoms bridge between ED-OCD symptoms in a combined network model including ED, OCD, and Perfectionism symptoms. Participants (N = 1,619) were a mixed sample of undergraduate students and individuals diagnosed with EDs. RESULTS Difficulty controlling thoughts was the symptom with the highest bridge centrality in both models, connecting with ED-related worry and doubts. In the ED-OCD-Perfectionism comorbidity network, doubts about simple everyday things and repeating things over and over bridged between ED and OCD symptoms. Additionally, specific and distinct pathways were identified between OCD and two types of ED pathology: restricting (checking compulsions and rigidity around food) and binge eating (hoarding and binge eating symptoms). LIMITATIONS Due to the cross-sectional nature of the data, no directional inferences can be made. Due to a higher OCD symptom prevalence rate than reported in previous studies, our undergraduate sample may not be representative of other college populations. CONCLUSIONS The presence of intrusive cognitions and maladaptive perfectionism may contribute to the maintenance of co-occurring ED and OCD symptoms. These findings begin to delineate specific pathways among OCD and ED symptoms, which can be used in the development of interventions to disrupt connections among these disorders.
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Affiliation(s)
- Irina A Vanzhula
- University of Louisville, Department of Psychological & Brain Sciences
| | | | - Cheri A Levinson
- University of Louisville, Department of Psychological & Brain Sciences.
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87
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Jones PJ, Ma R, McNally RJ. Bridge Centrality: A Network Approach to Understanding Comorbidity. MULTIVARIATE BEHAVIORAL RESEARCH 2021; 56:353-367. [PMID: 31179765 DOI: 10.1080/00273171.2019.1614898] [Citation(s) in RCA: 434] [Impact Index Per Article: 144.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Recently, researchers in clinical psychology have endeavored to create network models of the relationships between symptoms, both within and across mental disorders. Symptoms that connect two mental disorders are called "bridge symptoms." Unfortunately, no formal quantitative methods for identifying these bridge symptoms exist. Accordingly, we developed four network statistics to identify bridge symptoms: bridge strength, bridge betweenness, bridge closeness, and bridge expected influence. These statistics are nonspecific to the type of network estimated, making them potentially useful in individual-level psychometric networks, group-level psychometric networks, and networks outside the field of psychopathology such as social networks. We first tested the fidelity of our statistics in predicting bridge nodes in a series of simulations. Averaged across all conditions, the statistics achieved a sensitivity of 92.7% and a specificity of 84.9%. By simulating datasets of varying sample sizes, we tested the robustness of our statistics, confirming their suitability for network psychometrics. Furthermore, we simulated the contagion of one mental disorder to another, showing that deactivating bridge nodes prevents the spread of comorbidity (i.e., one disorder activating another). Eliminating nodes based on bridge statistics was more effective than eliminating nodes high on traditional centrality statistics in preventing comorbidity. Finally, we applied our algorithms to 18 group-level empirical comorbidity networks from published studies and discussed the implications of this analysis.
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Affiliation(s)
| | - Ruofan Ma
- Department of Psychology, University of Waterloo
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88
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Aloi M, Rania M, Carbone EA, Caroleo M, Calabrò G, Zaffino P, Nicolò G, Carcione A, Coco GL, Cosentino C, Segura-Garcia C. Metacognition and emotion regulation as treatment targets in binge eating disorder: a network analysis study. J Eat Disord 2021; 9:22. [PMID: 33588943 PMCID: PMC7885411 DOI: 10.1186/s40337-021-00376-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 02/03/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND This study aims to examine the underlying associations between eating, affective and metacognitive symptoms in patients with binge eating disorder (BED) through network analysis (NA) in order to identify key variables that may be considered the target for psychotherapeutic interventions. METHODS A total of 155 patients with BED completed measures of eating psychopathology, affective symptoms, emotion regulation and metacognition. A cross-sectional network was inferred by means of Gaussian Markov random field estimation using graphical LASSO and the extended Bayesian information criterion (EBIC-LASSO), and central symptoms of BED were identified by means of the strength centrality index. RESULTS Impaired self-monitoring metacognition and difficulties in impulse control emerged as the symptoms with the highest centrality. Conversely, eating and affective features were less central. The centrality stability coefficient of strength was above the recommended cut-off, thus indicating the stability of the network. CONCLUSIONS According to the present NA findings, impaired self-monitoring metacognition and difficulties in impulse control are the central nodes in the psychopathological network of BED whereas eating symptoms appear marginal. If further studies with larger samples replicate these results, metacognition and impulse control could represent new targets of psychotherapeutic interventions in the treatment of BED. In light of this, metacognitive interpersonal therapy could be a promising aid in clinical practice to develop an effective treatment for BED.
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Affiliation(s)
- Matteo Aloi
- Outpatient Unit for Clinical Research and Treatment of Eating Disorders, University Hospital "Mater Domini", Catanzaro, Italy.,Department of Health Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Marianna Rania
- Outpatient Unit for Clinical Research and Treatment of Eating Disorders, University Hospital "Mater Domini", Catanzaro, Italy.,Department of Health Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Elvira Anna Carbone
- Outpatient Unit for Clinical Research and Treatment of Eating Disorders, University Hospital "Mater Domini", Catanzaro, Italy.,Department of Health Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Mariarita Caroleo
- Outpatient Unit for Clinical Research and Treatment of Eating Disorders, University Hospital "Mater Domini", Catanzaro, Italy.,Department of Health Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Giuseppina Calabrò
- Outpatient Unit for Clinical Research and Treatment of Eating Disorders, University Hospital "Mater Domini", Catanzaro, Italy.,Department of Health Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Paolo Zaffino
- Department of Experimental and Clinical Medicine, School of Computer and Biomedical Engineering, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Giuseppe Nicolò
- Third Centre of Cognitive Psychotherapy - Italian School of Cognitive Psychotherapy (SICC), Rome, Italy
| | - Antonino Carcione
- Third Centre of Cognitive Psychotherapy - Italian School of Cognitive Psychotherapy (SICC), Rome, Italy
| | - Gianluca Lo Coco
- Department of Psychology, Educational Science and Human Movement, University of Palermo, Palermo, Italy
| | - Carlo Cosentino
- Department of Experimental and Clinical Medicine, School of Computer and Biomedical Engineering, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Cristina Segura-Garcia
- Outpatient Unit for Clinical Research and Treatment of Eating Disorders, University Hospital "Mater Domini", Catanzaro, Italy. .,Department of Medical and Surgical Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy.
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89
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AN-VR-BE. A Randomized Controlled Trial for Reducing Fear of Gaining Weight and Other Eating Disorder Symptoms in Anorexia Nervosa through Virtual Reality-Based Body Exposure. J Clin Med 2021; 10:jcm10040682. [PMID: 33578767 PMCID: PMC7916489 DOI: 10.3390/jcm10040682] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 02/03/2021] [Accepted: 02/07/2021] [Indexed: 12/18/2022] Open
Abstract
In vivo body exposure therapy is considered an effective and suitable intervention to help patients with anorexia nervosa (AN) reduce their body image disturbances (BIDs). However, these interventions have notable limitations and cannot effectively reproduce certain fears usually found in AN, such as the fear of gaining weight (FGW). The latest developments in virtual reality (VR) technology and embodiment-based procedures could overcome these limitations and allow AN patients to confront their FGW and BIDs. This study aimed to provide further evidence of the efficacy of an enhanced (by means of embodiment) VR-based body exposure therapy for the treatment of AN. Thirty-five AN patients (16 in the experimental group, 19 in the control group) participated in the study. FGW, BIDs, and other body-related and ED measures were assessed before and after the intervention and three months later. The experimental group received treatment as usual (TAU) and five additional sessions of VR-based body exposure therapy, while the control group received only TAU. After the intervention, ED symptoms were clearly reduced in both groups, with most of the changes being more noticeable in the experimental group. Specifically, after the intervention and at follow-up, significant group differences were found in the FGW and BIDs, with the experimental group showing significantly lower values than the control group. The current study provides new insights and encouraging findings in the field of exposure-based therapies in AN. VR technology might improve research and clinical practice in AN by providing new tools to help patients confront their core fears (i.e., food- or weight-related cues) and improve their emotional, cognitive, and behavioral responses to their body image.
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90
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Sahlan RN, Williams BM, Forrest LN, Saunders JF, Fitzsimmons-Craft EE, Levinson CA. Disordered eating, self-esteem, and depression symptoms in Iranian adolescents and young adults: A network analysis. Int J Eat Disord 2021; 54:132-147. [PMID: 32865853 PMCID: PMC8159574 DOI: 10.1002/eat.23365] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 07/30/2020] [Accepted: 07/30/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The network theory of psychopathology examines networks of interconnections across symptoms. Several network studies of disordered eating have identified central and bridge symptoms in Western samples, yet network models of disordered eating have not been tested in non-Western samples. The current study tested a network model of disordered eating in Iranian adolescents and college students, as well as models of co-occurring depression and self-esteem. METHOD Participants were Iranian college students (n= 637) and adolescents (n = 1,111) who completed the Eating Disorder Examination-Questionnaire (EDE-Q), Rosenberg Self-Esteem Scale (RSES) and Beck Depression Inventory, Second Edition (BDI-II). We computed six Glasso networks and identified central and bridge symptoms. RESULTS Central disordered eating nodes in most models were a desire to lose weight and discomfort when seeing one's own body. Central self-esteem and depression nodes were feeling useless and self-dislike, respectively. Feeling like a failure was the most common bridge symptom between disordered eating and depression symptoms. With exception of a few differences in some edges, networks did not significantly differ in structure. DISCUSSION Desire to lose weight was the most central node in the networks, which is consistent with sociocultural theories of disordered eating development, as well as prior network models from Western-culture samples. Feeling like a failure was the most central bridge symptom between depression and disordered eating, suggesting that very low self-esteem may be a shared correlate or risk factor for disordered eating and depression in Iranian adolescents and young adults.
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Affiliation(s)
- Reza N. Sahlan
- Department of Clinical Psychology, Iran University of Medical Sciences, Tehran, Iran
| | - Brenna M. Williams
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, Kentucky, USA
| | | | | | | | - Cheri A. Levinson
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, Kentucky, USA
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91
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Characterizing fear of weight gain and sensitivity to weight gain in individuals seeking weight loss treatment. Eat Weight Disord 2021; 26:385-393. [PMID: 32052312 DOI: 10.1007/s40519-020-00862-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 01/28/2020] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Weight concern, including fear of weight gain and sensitivity to weight gain, is indicative of disordered eating in individuals with underweight or healthy weight. It is unknown, however, whether or how these constructs present in individuals with excess weight, particularly among those with binge-eating disorder (BED). This study sought to characterize fear of weight gain and sensitivity to weight gain and examine their relationship with disordered eating and depression symptoms, in individuals seeking weight loss treatment, both with and without BED. METHODS Adults seeking weight loss treatment in an urban primary care clinic (N = 131) completed the Eating Disorder Examination interview and Beck Depression Inventory. Height and weight were collected. RESULTS Clinical levels of fear of weight gain and sensitivity to weight gain were present in this sample. Individuals with BED reported experiencing fear of weight gain (48.6%), significantly more than those without BED (20.9%); both groups reported similar and clinically elevated sensitivity to weight gain. Both constructs were related to greater levels of disordered eating and depression symptoms, at times based on BED status. Fear of weight gain was associated with overvaluation of weight and shape for those without BED only. Objective and subjective bulimic episodes were unrelated to fear of weight gain or sensitivity to weight gain, regardless of BED status. CONCLUSION Fear of weight gain and sensitivity to weight gain were common in this sample and may be maladaptive, as evidenced by associations with elevated eating psychopathology. Future studies should examine these variables within larger samples and should employ longitudinal designs. LEVEL OF EVIDENCE Level III: case-control analytic study.
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92
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Yang F, Fu M, Huang N, Ahmed F, Shahid M, Zhang B, Guo J, Lodder P. Network analysis of COVID-19-related PTSD symptoms in China: the similarities and differences between the general population and PTSD sub-population. Eur J Psychotraumatol 2021; 12:1997181. [PMID: 34900121 PMCID: PMC8654407 DOI: 10.1080/20008198.2021.1997181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Prevalent Post-traumatic Stress Disorder (PTSD) negatively affected individuals during the COVID-19 pandemic. Using network analyses, this study explored the construct of PTSD symptoms during the COVID-19 pandemic in China to identify similarities and differences in PTSD symptom network connectivity between the general Chinese population and individuals reporting PTSD. METHODS We conducted an online survey recruiting 2858 Chinese adults. PTSD symptoms were measured using the PCL-5 and PTSD was determined according to the DSM-5 criteria. RESULTS In the general population, self-destructive/reckless behaviours were on average the most strongly connected to other PTSD symptoms in the network. The five strongest positive connections were found between 1) avoidance of thoughts and avoidance of reminders, 2) concentration difficulties and sleep disturbance, 3) negative beliefs and negative trauma-related emotions, 4) irritability/anger and self-destructive/reckless behaviours, and 5) hypervigilance and exaggerated startle responses. Besides, negative connections were found between intrusive thoughts and trauma-related amnesia and between intrusive thoughts and self-destructive/reckless behaviours. Among individuals reporting PTSD, symptoms such as flashbacks and self-destructive/reckless behaviours were on average most strongly connected to other PTSD symptoms in the network. The five strongest positive connections were found between 1) concentration difficulty and sleep disturbance, 2) intrusive thoughts and emotional cue reactivity, 3) negative beliefs and negative trauma-related emotions, 4) irritability/anger and self-destructive/reckless behaviour, and 5) detachment and restricted affect. In addition, a negative connection was found between intrusive thoughts and self-destructive/reckless behaviours. CONCLUSION Our results indicate similarly positive connections between concentration difficulty and sleep disturbance, negative beliefs and negative trauma-related emotions, and irritability/anger and self-destructive/reckless behaviours in the general and PTSD-reported populations. We argue that self-destructive/reckless behaviours are a core symptom of COVID-19 related PTSD, worthy of more attention in future psychiatric programmers.
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Affiliation(s)
- Fan Yang
- Department of Health Policy and Management, School of Public Health, Peking University Health Science Center, Beijing, P.R. China
| | - Mingqi Fu
- Center for Social Security Studies, Wuhan University, Wuhan, P.R. China
| | - Ning Huang
- Department of Health Policy and Management, School of Public Health, Peking University Health Science Center, Beijing, P.R. China
| | - Farooq Ahmed
- Department of Anthropology, Quaid-i-Azam University, Islamabad, Pakistan.,Department of Anthropology, University of Washington, Seattle, WA, USA
| | - Muhammad Shahid
- School of insurance and Economics, University of international business and economics, Beijing, P.R. China
| | - Bo Zhang
- Department of Neurology and ICCTR Biostatistics and Research Design Center, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jing Guo
- Department of Health Policy and Management, School of Public Health, Peking University Health Science Center, Beijing, P.R. China
| | - Paul Lodder
- Department of Methodology and Statistics, Tilburg University, Tilburg, The Netherlands
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93
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Wichers M, Riese H, Hodges TM, Snippe E, Bos FM. A Narrative Review of Network Studies in Depression: What Different Methodological Approaches Tell Us About Depression. Front Psychiatry 2021; 12:719490. [PMID: 34777038 PMCID: PMC8581034 DOI: 10.3389/fpsyt.2021.719490] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 09/30/2021] [Indexed: 11/13/2022] Open
Abstract
The network theory of psychopathology proposes that mental disorders arise from direct interactions between symptoms. This theory provides a promising framework to understand the development and maintenance of mental disorders such as depression. In this narrative review, we summarize the literature on network studies in the field of depression. Four methodological network approaches are distinguished: (i) studies focusing on symptoms at the macro-level vs. (ii) on momentary states at the micro-level, and (iii) studies based on cross-sectional vs. (iv) time-series (dynamic) data. Fifty-six studies were identified. We found that different methodological approaches to network theory yielded largely inconsistent findings on depression. Centrality is a notable exception: the majority of studies identified either positive affect or anhedonia as central nodes. To aid future research in this field, we outline a novel complementary network theory, the momentary affect dynamics (MAD) network theory, to understand the development of depression. Furthermore, we provide directions for future research and discuss if and how networks might be used in clinical practice. We conclude that more empirical network studies are needed to determine whether the network theory of psychopathology can indeed enhance our understanding of the underlying structure of depression and advance clinical treatment.
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Affiliation(s)
- Marieke Wichers
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation, Groningen, Netherlands
| | - Harriëtte Riese
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation, Groningen, Netherlands
| | - Taylor M Hodges
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation, Groningen, Netherlands
| | - Evelien Snippe
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation, Groningen, Netherlands
| | - Fionneke M Bos
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation, Groningen, Netherlands.,University of Groningen, University Medical Center Groningen, Department of Psychiatry, Rob Giel Research Center, Groningen, Netherlands
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94
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Huang S, Lai X, Xue Y, Zhang C, Wang Y. A network analysis of problematic smartphone use symptoms in a student sample. J Behav Addict 2020; 9:1032-1043. [PMID: 33372911 PMCID: PMC8969737 DOI: 10.1556/2006.2020.00098] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 08/01/2020] [Accepted: 11/30/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND AND AIMS Previous research has established risk factors for problematic smartphone use (PSU), but few studies to date have explored the structure of PSU symptoms. This study capitalizes on network analysis to identify the core symptoms of PSU in a large sample of students. METHODS This research investigated 26,950 grade 4 students (male = 13,271) and 11,687 grade 8 students (male = 5,739) using the smartphone addiction proneness scale (SAPS). The collected data were analyzed using a network analysis method, which can provide centrality indexes to determine the core symptoms of PSU. The two networks from the different groups were compared using a permutation test. RESULTS The results indicated that the core symptoms of students' problematic smartphone use were the loss of control and continued excessive use across the two samples. DISCUSSION AND CONCLUSIONS These findings suggest that loss of control is a key feature of problematic smartphone use. The results also provide some evidence relevant to previous research from the perspective of network analysis and some suggestions for future treatment or prevention of students' problematic smartphone use.
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Affiliation(s)
- Shunsen Huang
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
| | - Xiaoxiong Lai
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
| | - Ye Xue
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
| | - Cai Zhang
- Collaborative Innovation Centre of Assessment Toward Basic Education Quality, Beijing Normal University, Beijing, China
| | - Yun Wang
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
- Corresponding author.
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95
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Levinson CA, Vanzhula IA, Smith TW, Stice E. Group and longitudinal intra-individual networks of eating disorder symptoms in adolescents and young adults at-risk for an eating disorder. Behav Res Ther 2020; 135:103731. [PMID: 33010651 PMCID: PMC7688499 DOI: 10.1016/j.brat.2020.103731] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 09/04/2020] [Accepted: 09/16/2020] [Indexed: 12/19/2022]
Abstract
Several studies have identified risk factors that predict future onset of eating disorders (ED) in adolescence, however, it is currently unknown how specific ED symptom dynamics operate both across time and within individuals. Advances in network methodologies allow for the study of how dynamic symptoms interrelate and predict each other within-persons and across time. In the current study, we used longitudinal group-level (N = 1272) (addressing symptom interrelations across people and across time; between-subjects, contemporaneous, and temporal networks) and intra-individual (symptom interrelations within each person and across time; contemporaneous and temporal networks) network analyses (subset n = 50) in prospective 48-month interview data in at-risk adolescents and young adults. We computed between-subject networks (how symptoms are associated on average, for group sample only), contemporaneous networks (how symptoms are associated at one time point, accounting for previous time points), and temporal networks (examining how symptoms predict each other across time). We replicated prior network results which suggest that overvaluation of weight and shape are central in at-risk adolescents and young adults. We found that individual networks (n = 1 networks) were highly variable across individuals. Overall, our results show how both group-level and longitudinal intra-individual network analysis can inform our understanding of how EDs develop in adolescence and point to the importance of conceptualizing development on an individual level of analysis.
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Affiliation(s)
- Cheri A Levinson
- University of Louisville, Department of Psychological & Brain Sciences, Louisville, USA.
| | - Irina A Vanzhula
- University of Louisville, Department of Psychological & Brain Sciences, Louisville, USA
| | - Tosha Woods Smith
- Center of Excellence for Eating Disorders, School of Medicine, University of North Carolina, Chapel Hill, USA
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96
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Wang Y, Hu Z, Feng Y, Wilson A, Chen R. Changes in network centrality of psychopathology symptoms between the COVID-19 outbreak and after peak. Mol Psychiatry 2020; 25:3140-3149. [PMID: 32929212 PMCID: PMC7488637 DOI: 10.1038/s41380-020-00881-6] [Citation(s) in RCA: 91] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 09/02/2020] [Accepted: 09/03/2020] [Indexed: 12/20/2022]
Abstract
The current study investigated the mechanism and changes in psychopathology symptoms throughout the COVID-19 outbreak and after peak. Two studies were conducted separately in China during outbreak and the after peak stages, with 2540 participants were recruited from February 6 to 16, 2020, and 2543 participants were recruited from April 25 to May 5, 2020. The network models were created to explore the relationship between psychopathology symptoms both within and across anxiety and depression, with anxiety measured by the Generalized Anxiety Disorder-7 and depression measured by the Patient Health Questionnaire-9. Symptom network analysis was conducted to evaluate network and bridge centrality, and the network properties were compared between the outbreak and after peak. Noticeably, psychomotor symptoms such as impaired motor skills, restlessness, and inability to relax exhibited high centrality during the outbreak, which still relatively high but showed substantial remission during after peak stage (in terms of strength, betweenness, or bridge centrality). Meanwhile, symptoms of irritability (strength, betweenness, or bridge centrality) and loss of energy (bridge centrality) played an important role in the network after the peak of the pandemic. This study provides novel insights into the changes in central features during the different COVID-19 stages and highlights motor-related symptoms as bridge symptoms, which could activate the connection between anxiety and depression. The results revealed that restrictions on movement were associated with worsen in psychomotor symptoms, indicating that future psychological interventions should target motor-related symptoms as priority.
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Affiliation(s)
- Yuanyuan Wang
- National Clinical Research Center for Mental Disorders, Department of Psychiatry, and China National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
- Division of Psychology, Faculty of Health and Life Sciences, De Montfort University, Leicester, UK
| | - Zhishan Hu
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
| | - Yi Feng
- Mental Health Center, Central University of Finance and Economics, Beijing, China
- School of Psychology, Beijing Normal University, Beijing, China
| | - Amanda Wilson
- Division of Psychology, Faculty of Health and Life Sciences, De Montfort University, Leicester, UK
| | - Runsen Chen
- National Clinical Research Center for Mental Disorders, Department of Psychiatry, and China National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China.
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China.
- Department of Psychiatry, University of Oxford, Oxford, UK.
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97
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Levinson CA, Williams BM, Christian C. What are the emotions underlying feeling fat and fear of weight gain? J Affect Disord 2020; 277:146-152. [PMID: 32828001 DOI: 10.1016/j.jad.2020.08.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/29/2020] [Accepted: 08/08/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Eating disorders (EDs) are most always accompanied by cognitive-affective comorbidities, such as anxiety and depression. In addition to these common comorbidities, EDs are unique in that they are characterized by affective symptoms centered on body image and weight. Two of these primary, yet understudied, affective symptoms are feelings of fatness and fears of weight gain, which are theorized to be maintaining symptoms of EDs and are highly common in those with EDs. Despite the importance of these symptoms, there is no research characterizing which cognitive-affective symptoms contribute to feelings of fatness and fears of weight gain. METHODS The current study (N=168 individuals with an ED) tested cross-sectional and prospective models of cognitive-affect variables (negative affect, guilt, shame, fear of negative evaluation, anxiety sensitivity, and depression) to identify which thoughts and emotions were uniquely associated and prospectively predicted feelings of fatness and fear of weight gain. RESULTS Depression both cross-sectionally and prospectively predicted feeling fat over and above all other forms of affect. Fears of negative evaluation and depression were uniquely associated with fears of weight gain, and shame prospectively predicted fear of weight gain. LIMITATIONS Variables were self-reported, and the sample primarily consisted of women. Fear of weight gain and feelings of fatness were assessed using single items. CONCLUSIONS This research suggests that depression may be an important intervention target when individuals with an ED report feeling fat. Additionally, treatment targeting fear of negative evaluation, depression, and shame may decrease fears of weight gain.
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Affiliation(s)
- Cheri A Levinson
- Department of Psychological & Brain Sciences, University of Louisville, Life Sciences Building 317, Louisville, KY 40292, United States.
| | - Brenna M Williams
- Department of Psychological & Brain Sciences, University of Louisville, Life Sciences Building 317, Louisville, KY 40292, United States
| | - Caroline Christian
- Department of Psychological & Brain Sciences, University of Louisville, Life Sciences Building 317, Louisville, KY 40292, United States
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98
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Castellanos MÁ, Ausín B, Bestea S, González-Sanguino C, Muñoz M. A Network Analysis of Major Depressive Disorder Symptoms and Age- and Gender-Related Differences in People over 65 in a Madrid Community Sample (Spain). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17238934. [PMID: 33271788 PMCID: PMC7730667 DOI: 10.3390/ijerph17238934] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 11/24/2020] [Accepted: 11/27/2020] [Indexed: 11/27/2022]
Abstract
Major depressive disorder (MDD) is one of the most prevalent conditions among mental disorders in individuals over 65 years. People over 65 who suffer from MDD are often functionally impaired, chronically physically ill, and express cognitive problems. The concordance between a clinician-assessed MDD diagnosis in a primary care setting and MDD assessed with a structured clinical interview in older adults is only approximately 18%. Network analysis may provide an alternative statistical technique to better understand MDD in this population by a dimensional approach to symptomatology. The aim of this study was to carry out a network analysis of major depressive disorder (MDD) in people over 65 years old. A symptom network analysis was conducted according to age and gender in 555 people over 65, using a sample from the MentDis_ICF65+ Study. The results revealed different networks for men and women, and for the age groups 65–74 and 75–84. While depressive mood stood out in women, in men the network was more dispersed with fatigue or loss of energy and sleep disturbances as the main symptoms. In the 65–74 age group, the network was complex; however, in the 75–84 age group, the network was simpler with sleep disturbances as the central symptom. The gaps between the networks indicate the different characteristics of MDD in the elderly, with variations by gender and age, supporting the idea that MDD is a complex dynamic system that has unique characteristics in each person, rather than a prototypical classification with an underlying mental disorder. These unique characteristics can be taken into account in the clinical practice for detection and intervention of MDD.
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Affiliation(s)
- Miguel Ángel Castellanos
- Methodology in Behavioral Sciences Department, Campus de Somosaguas, School of Psychology, Psychobiology, Complutense University of Madrid, Ctra. de Húmera, s/n, 28223 Pozuelo de Alarcón, Madrid, Spain; (M.Á.C.); (S.B.)
| | - Berta Ausín
- Evaluation and Clinical Psychology Department, Campus de Somosaguas, School of Psychology, Personality, Complutense University of Madrid, Ctra. de Húmera, s/n, 28223 Pozuelo de Alarcón, Madrid, Spain; (C.G.-S.); (M.M.)
- Correspondence: ; Tel.: +34-649647082
| | - Sara Bestea
- Methodology in Behavioral Sciences Department, Campus de Somosaguas, School of Psychology, Psychobiology, Complutense University of Madrid, Ctra. de Húmera, s/n, 28223 Pozuelo de Alarcón, Madrid, Spain; (M.Á.C.); (S.B.)
| | - Clara González-Sanguino
- Evaluation and Clinical Psychology Department, Campus de Somosaguas, School of Psychology, Personality, Complutense University of Madrid, Ctra. de Húmera, s/n, 28223 Pozuelo de Alarcón, Madrid, Spain; (C.G.-S.); (M.M.)
| | - Manuel Muñoz
- Evaluation and Clinical Psychology Department, Campus de Somosaguas, School of Psychology, Personality, Complutense University of Madrid, Ctra. de Húmera, s/n, 28223 Pozuelo de Alarcón, Madrid, Spain; (C.G.-S.); (M.M.)
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99
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Schaumberg K, Reilly EE, Gorrell S, Levinson CA, Farrell NR, Brown TA, Smith KM, Schaefer LM, Essayli JH, Haynos AF, Anderson LM. Conceptualizing eating disorder psychopathology using an anxiety disorders framework: Evidence and implications for exposure-based clinical research. Clin Psychol Rev 2020; 83:101952. [PMID: 33221621 DOI: 10.1016/j.cpr.2020.101952] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 11/09/2020] [Accepted: 11/09/2020] [Indexed: 12/13/2022]
Abstract
Eating disorders (EDs) and anxiety disorders (ADs) evidence shared risk and significant comorbidity. Recent advances in understanding of anxiety-based disorders may have direct application to research and treatment efforts for EDs. The current review presents an up-to-date, behavioral conceptualization of the overlap between anxiety-based disorders and EDs. We identify ways in which anxiety presents in EDs, consider differences between EDs and ADs relevant to treatment adaptions, discuss how exposure-based strategies may be adapted for use in ED treatment, and outline directions for future mechanistic, translational, and clinical ED research from this perspective. Important research directions include: simultaneous examination of the extent to which EDs are characterized by aberrant avoidance-, reward-, and/or habit-based neurobiological and behavioral processes; improvement in understanding of how nutritional status interacts with neurobiological characteristics of EDs; incorporation of a growing knowledge of biobehavioral signatures in ED treatment planning; development of more comprehensive exposure-based treatment approaches for EDs; testing whether certain exposure interventions for AD are appropriate for EDs; and improvement in clinician self-efficacy and ability to use exposure therapy for EDs.
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Affiliation(s)
| | | | - Sasha Gorrell
- University of California, San Francisco, United States of America
| | - Cheri A Levinson
- University of Louisville, Department of Psychological & Brain Sciences, United States of America
| | | | - Tiffany A Brown
- University of California, San Diego, United States of America
| | - Kathryn M Smith
- Sanford Health, United States of America; University of Southern California, United States of America
| | | | | | - Ann F Haynos
- University of Minnesota, United States of America
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100
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Levinson CA, Christian C, Ram SS, Vanzhula I, Brosof LC, Michelson LP, Williams BM. Eating disorder symptoms and core eating disorder fears decrease during online imaginal exposure therapy for eating disorders. J Affect Disord 2020; 276:585-591. [PMID: 32794449 DOI: 10.1016/j.jad.2020.07.075] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 05/15/2020] [Accepted: 07/05/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Few evidence-based treatments for eating disorders (EDs) exist. Imaginal exposure therapy is a key component of effective treatment for anxiety disorders and post-traumatic stress disorder. However, imaginal exposure has not been systematically tested as a treatment for EDs. The current study aimed to develop and test online imaginal exposure as a treatment for EDs. METHODS The current study tested a four-week trial of online imaginal exposure for EDs (N = 229 participants with EDs recruited globally). Participants completed diagnostic interviews and four sessions of weekly online imaginal exposure, in which they wrote about and imagined a core ED fear (identified with a therapist). Participants completed measures of ED symptoms and fears (i.e., fear of weight gain, food) at pre-imaginal exposure, post-imaginal exposure, and six-month follow-up. Participants were recruited and participated in the protocol from November 2016 to October 2018. RESULTS All primary outcomes (ED symptoms, ED fears) significantly decreased at study completion and six-month follow-up with medium-to-large effect sizes. State anxiety across the exposure and follow-ups significantly decreased, specifically from initial sessions to follow-up. Worry, but not depression, significantly decreased. LIMITATIONS This study was an open case trial and did not include a control condition. CONCLUSIONS Significant decreases in ED symptoms and fears occurred during the course of imaginal exposure treatment. Online imaginal exposure is a feasible treatment for EDs and is associated with decreases in core ED symptomatology, which are comparable in magnitude to decreases seen from other evidence-based treatments. A future randomized-controlled trial is needed. CLINICAL TRIALS REGISTRATION ClinicalTrials.gov identifier NCT03712748.
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Affiliation(s)
- Cheri A Levinson
- Department of Psychological and Brain Sciences, 317 Life Sciences, University of Louisville, 317 Life Sciences, Louisville, KY 40292, United States.
| | - Caroline Christian
- Department of Psychological and Brain Sciences, 317 Life Sciences, University of Louisville, 317 Life Sciences, Louisville, KY 40292, United States
| | - Shruti Shankar Ram
- Department of Psychological and Brain Sciences, 317 Life Sciences, University of Louisville, 317 Life Sciences, Louisville, KY 40292, United States
| | - Irina Vanzhula
- Department of Psychological and Brain Sciences, 317 Life Sciences, University of Louisville, 317 Life Sciences, Louisville, KY 40292, United States
| | - Leigh C Brosof
- Department of Psychological and Brain Sciences, 317 Life Sciences, University of Louisville, 317 Life Sciences, Louisville, KY 40292, United States
| | - Lisa P Michelson
- Department of Psychological and Brain Sciences, 317 Life Sciences, University of Louisville, 317 Life Sciences, Louisville, KY 40292, United States
| | - Brenna M Williams
- Department of Psychological and Brain Sciences, 317 Life Sciences, University of Louisville, 317 Life Sciences, Louisville, KY 40292, United States
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