151
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The role of functional assessment in third wave behavioral interventions: foundations and future directions for a fourth wave. Curr Opin Psychol 2015. [DOI: 10.1016/j.copsyc.2014.12.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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152
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Forman EM, Butryn ML. A new look at the science of weight control: how acceptance and commitment strategies can address the challenge of self-regulation. Appetite 2015; 84:171-80. [PMID: 25445199 PMCID: PMC4314333 DOI: 10.1016/j.appet.2014.10.004] [Citation(s) in RCA: 131] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 08/09/2014] [Accepted: 10/02/2014] [Indexed: 11/28/2022]
Abstract
The current manuscript proposes an acceptance-based, self-regulation framework for understanding the challenge of weight maintenance and describes how this framework can be integrated into the behavioral treatment of obesity. According to this framework, intrinsic drives to consume palatable, high-calorie food interact with a modern environment in which high calorie foods are easily accessible. This combination produces a chronic desire to eat unhealthy foods that exists in opposition to individuals' weight control goals. Similarly, low energy expenditure requirements reduce physical activity. We suggest that individuals vary in their responsivity to cues that motivate overeating and sedentary behavior, and that those higher in responsivity need specialized self-regulatory skills to maintain healthy eating and exercise behaviors. These skills include an ability to tolerate uncomfortable internal reactions to triggers and a reduction of pleasure, behavioral commitment to clearly-defined values, and metacognitive awareness of decision-making processes. So-called "acceptance-based" interventions based on these skills have so far proven efficacious for weight control, especially for those who are the most susceptible to eating in response to internal and external cues (as predicted by the model). Despite the current empirical support for the postulated model, much remains to be learned including whether acceptance-based interventions will prove efficacious in the longer-term.
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153
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Mills P, Newman EF, Cossar J, Murray G. Emotional maltreatment and disordered eating in adolescents: testing the mediating role of emotion regulation. CHILD ABUSE & NEGLECT 2015; 39:156-166. [PMID: 25129874 DOI: 10.1016/j.chiabu.2014.05.011] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Revised: 05/13/2014] [Accepted: 05/15/2014] [Indexed: 06/03/2023]
Abstract
The present study aimed to determine if emotion regulation mediates the relationship between emotional maltreatment and disordered eating behavior in adolescents. Participants were 222 secondary school pupils (aged 14-18 years) from a state high school in the UK. Standardized questionnaire measures were used to gather self-report data on emotional abuse and emotional neglect, functional and dysfunctional emotion regulation strategies and disordered eating behavior. Results showed that disordered eating was associated with emotional abuse, dysfunctional emotion regulation and being female. Multiple mediation analysis found an indirect relationship between emotional abuse and disordered eating through dysfunctional emotion regulation. Interestingly, emotional neglect predicted lower levels of functional emotion regulation. The findings support previous research showing emotion regulation to mediate the relationship between childhood abuse and disordered eating in adults and a differential effect of abuse and neglect on emotion regulation. Longitudinal studies are required to confirm the direction of relationships; however these data suggest that dysfunctional emotion regulation is a significant variable in the development of disordered eating and may be a useful target for intervention.
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Affiliation(s)
- Pamela Mills
- School of Health in Social Science, University of Edinburgh, Edinburgh EH8 9AG, UK; NHS Borders Child and Adolescent Mental Health Service, The Andrew Lang Unit, Viewfield Lane, Selkirk TD7 4LJ, UK
| | - Emily Frances Newman
- School of Health in Social Science, University of Edinburgh, Edinburgh EH8 9AG, UK
| | - Jill Cossar
- School of Health in Social Science, University of Edinburgh, Edinburgh EH8 9AG, UK
| | - George Murray
- NHS Borders Child and Adolescent Mental Health Service, The Andrew Lang Unit, Viewfield Lane, Selkirk TD7 4LJ, UK
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154
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Mindfulness-based interventions for binge eating: a systematic review and meta-analysis. J Behav Med 2014; 38:348-62. [DOI: 10.1007/s10865-014-9610-5] [Citation(s) in RCA: 103] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 11/12/2014] [Indexed: 10/24/2022]
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155
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Compare A, Tasca GA. The Rate and Shape of Change in Binge Eating Episodes and Weight: An Effectiveness Trial of Emotionally Focused Group Therapy for Binge-Eating Disorder. Clin Psychol Psychother 2014; 23:24-34. [DOI: 10.1002/cpp.1932] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 10/22/2014] [Accepted: 10/23/2014] [Indexed: 11/11/2022]
Affiliation(s)
- Angelo Compare
- Human and Social Science; University of Bergamo and Human Factors and Technology in Healthcare Research Centre; Bergamo Italy
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156
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Cooper JL, O'Shea AE, Atkinson MJ, Wade TD. Examination of the difficulties in emotion regulation scale and its relation to disordered eating in a young female sample. Int J Eat Disord 2014; 47:630-9. [PMID: 24659541 DOI: 10.1002/eat.22278] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Revised: 02/20/2014] [Accepted: 03/11/2014] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Difficulties with emotion regulation is considered an important maintaining factor of disordered eating. One of the most commonly used measures of this construct is the Difficulties in Emotion Regulation Scale (DERS). The aim of this study was to explore the factor structure of this measure in young females and to examine its reliability and validity with respect to disordered eating. METHOD Females aged 17-25 years (M age = 19.6 years, N = 486) were examined in the analyses. Confirmatory factor analyses were conducted followed by regression analyses examining the DERS subscales as predictors of eating disorder severity and disordered eating behaviors. RESULTS The original 6-factor 36-item model did not fit well and analyses indicated a 6-factor 30-item solution was a more suitable fit for our population. Validity and reliability of the 30-item solution were found to be acceptable. Regression analyses also indicated the 36- and 30-item models were able to adequately predict eating disorder severity and disordered eating behaviors with the "Awareness" and "Goals" subscales being predictors of the former, and the "Impulsivity" subscale being a significant predictor of the latter. DISCUSSION The overall findings suggest that an abbreviated version of the DERS might be more appropriate than the original version with young females and that this measure exhibits stronger relationships with eating disorder severity and disordered eating behaviors than the longer version. Further examinations of the psychometric properties of the DERS with clinical populations are indicated.
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Affiliation(s)
- Jane L Cooper
- School of Psychology, Flinders University, Adelaide, South Australia
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157
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Effects of Rumination and Acceptance on Body Dissatisfaction in Binge Eating Disorder. EUROPEAN EATING DISORDERS REVIEW 2014; 22:338-45. [DOI: 10.1002/erv.2312] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Revised: 07/08/2014] [Accepted: 07/09/2014] [Indexed: 12/26/2022]
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158
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Kelly NR, Cotter EW, Mazzeo SE. Examining the role of distress tolerance and negative urgency in binge eating behavior among women. Eat Behav 2014; 15:483-9. [PMID: 25064303 DOI: 10.1016/j.eatbeh.2014.06.012] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 04/11/2014] [Accepted: 06/12/2014] [Indexed: 01/30/2023]
Abstract
The current study examined whether distress tolerance and negative urgency moderate the link between depressive symptoms and binge eating frequency, and between disordered eating attitudes and binge eating frequency. Young adult women (N=186) completed questionnaires assessing depressive symptoms, cognitive restraint, eating, shape and weight concerns, distress tolerance, impulsivity (including negative urgency), and binge eating. After controlling for body mass index, race/ethnicity, and other domains of impulsivity, negative urgency was significantly associated with binge eating above and beyond the influence of disordered eating attitudes and depressive symptoms. Distress tolerance, in contrast, was not associated with binge eating. In addition, neither negative urgency nor distress tolerance moderated the associations between disordered eating attitudes and binge eating frequency, or between depressive symptoms and binge eating. Results support the additive role of difficulties responding adaptively to distress in binge eating frequency, above and beyond the influence of emotional distress. Findings highlight the potential value of focusing on negative urgency in targeted treatments for binge eating among women. Importantly, results from the current study differ from those of previous research; these discrepancies could be the result of variations in sample characteristics and approaches to the assessment of binge eating behavior. Additional research, including longitudinal studies and research using "real-time" assessment strategies, such as ecological momentary assessment, is necessary to elucidate further the role of various emotion regulation strategies in maintaining binge eating behavior in adult women.
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Affiliation(s)
- Nichole R Kelly
- Department of Psychology, Virginia Commonwealth University; Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), Section on Growth and Obesity (SGO), Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH).
| | | | - Suzanne E Mazzeo
- Department of Psychology, Virginia Commonwealth University; Department of Pediatrics, Virginia Commonwealth University
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159
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Valentine SE, Bankoff SM, Poulin RM, Reidler EB, Pantalone DW. The Use of Dialectical Behavior Therapy Skills Training as Stand-Alone Treatment: A Systematic Review of the Treatment Outcome Literature. J Clin Psychol 2014. [DOI: 10.1002/jclp.22114 10.1002/jclp.22114/abstract] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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160
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Valentine SE, Bankoff SM, Poulin RM, Reidler EB, Pantalone DW. The use of dialectical behavior therapy skills training as stand-alone treatment: a systematic review of the treatment outcome literature. J Clin Psychol 2014; 71:1-20. [PMID: 25042066 DOI: 10.1002/jclp.22114] [Citation(s) in RCA: 104] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Dialectical behavior therapy (DBT) skills training is currently being administered as stand-alone treatment across a variety of clinical settings, serving diverse client populations. However, there is little empirical support for this use. METHOD In this systematic review, we identified 17 trials employing a treatment that included DBT skills training in the absence of the other DBT modalities. RESULTS While the literature reviewed provides preliminary evidence of the utility of DBT skills training to address a range of mental health and behavioral problems, methodological limitations of published studies preclude us from drawing strong conclusions about the efficacy of skills training as a stand-alone treatment. CONCLUSION We present an overview of the implementation of DBT skills training across clinical settings and populations. We found preliminary evidence supporting the use of DBT skills training as a method of addressing a range of behaviors. We provide recommendations for future research.
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Affiliation(s)
- Sarah E Valentine
- Massachusetts General Hospital/Harvard Medical School; Suffolk University
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161
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Bice MR, Ball J, Ramsey AT. Relations between mindfulness and mental health outcomes: need fulfillment as a mediator. INTERNATIONAL JOURNAL OF MENTAL HEALTH PROMOTION 2014. [DOI: 10.1080/14623730.2014.931066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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162
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Ben-Porath DD, Federici A, Wisniewski L, Warren M. Dialectical Behavior Therapy: Does It Bring About Improvements in Affect Regulation in Individuals with Eating Disorders? JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2014. [DOI: 10.1007/s10879-014-9271-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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163
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Svaldi J, Tuschen-Caffier B, Trentowska M, Caffier D, Naumann E. Differential caloric intake in overweight females with and without binge eating: Effects of a laboratory-based emotion-regulation training. Behav Res Ther 2014; 56:39-46. [DOI: 10.1016/j.brat.2014.02.008] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Revised: 02/20/2014] [Accepted: 02/26/2014] [Indexed: 12/01/2022]
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164
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Katterman SN, Kleinman BM, Hood MM, Nackers LM, Corsica JA. Mindfulness meditation as an intervention for binge eating, emotional eating, and weight loss: a systematic review. Eat Behav 2014; 15:197-204. [PMID: 24854804 DOI: 10.1016/j.eatbeh.2014.01.005] [Citation(s) in RCA: 334] [Impact Index Per Article: 33.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Revised: 11/23/2013] [Accepted: 01/22/2014] [Indexed: 12/18/2022]
Abstract
Mindfulness-based approaches are growing in popularity as interventions for disordered eating and weight loss. Initial research suggests that mindfulness meditation may be an effective intervention for binge eating; however, no systematic review has examined interventions where mindfulness meditation was the primary intervention and no review has examined its effect on subclinical disordered eating or weight. Using the PRISMA method for systematic reviews, we reviewed 14 studies that investigated mindfulness meditation as the primary intervention and assessed binge eating, emotional eating, and/or weight change. Results suggest that mindfulness meditation effectively decreases binge eating and emotional eating in populations engaging in this behavior; evidence for its effect on weight is mixed. Additional research is warranted to determine comparative effectiveness and long-term effects of mindfulness training.
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Affiliation(s)
- Shawn N Katterman
- Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL, United States
| | - Brighid M Kleinman
- Department of Behavioral Sciences, Bellarmine University, Louisville, KY, United States
| | - Megan M Hood
- Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL, United States
| | - Lisa M Nackers
- Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL, United States
| | - Joyce A Corsica
- Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL, United States.
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165
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Tolerating Distress After Trauma: Differential Associations Between Distress Tolerance and Posttraumatic Stress Symptoms. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2014. [DOI: 10.1007/s10862-014-9413-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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166
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Zack S, Saekow J, Kelly M, Radke A. Mindfulness Based Interventions for Youth. JOURNAL OF RATIONAL-EMOTIVE AND COGNITIVE-BEHAVIOR THERAPY 2014. [DOI: 10.1007/s10942-014-0179-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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167
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Berg KC, Peterson CB, Crosby RD, Cao L, Crow SJ, Engel SG, Wonderlich SA. Relationship between daily affect and overeating-only, loss of control eating-only, and binge eating episodes in obese adults. Psychiatry Res 2014; 215:185-91. [PMID: 24200217 PMCID: PMC3946886 DOI: 10.1016/j.psychres.2013.08.023] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Revised: 08/08/2013] [Accepted: 08/09/2013] [Indexed: 11/29/2022]
Abstract
The two objectives of the current study were: (1) to identify daily patterns of negative affect (NA) in obese individuals; and (2) to determine whether daily affect patterns were related to overeating without loss of control (OE-only), loss of control eating without overeating (LOC-only), and binge eating (BE) episodes. Fifty obese (BMI=40.3 ± 08.5) adults (84.0% female) completed a two-week ecological momentary assessment protocol during which they completed assessments of NA and indicated whether their eating episodes were characterized by OE and/or LOC. Latent growth mixture modeling (LGMM) was used to identify daily trajectories of NA. GEE analysis was used to determine whether daily affect trajectories were differentially related to the frequency of OE-only, LOC-only, and BE episodes. The LGMM analyses identified nine unique trajectories of NA. Significantly higher frequencies of OE-only and BE episodes occurred on days characterized by high or increasing levels of NA. There were no significant differences between classes for the frequency of LOC-only episodes. These data suggest that NA may act as an antecedent to OE-only and BE episodes and that targeting "problematic affect days" may reduce the occurrence of OE-only and BE episodes among obese individuals.
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Affiliation(s)
- Kelly C. Berg
- University of Minnesota, Department of Psychiatry, Minneapolis, MN USA,Correspondence concerning this article should be addressed to Kelly C. Berg, Ambulatory Research Center, Department of Psychiatry, University of Minnesota, F282/2A West, 2450 Riverside Avenue, Minneapolis, MN 55454. Telephone: 612.625.1632.
| | - Carol B. Peterson
- University of Minnesota, Department of Psychiatry, Minneapolis, MN USA
| | - Ross D. Crosby
- Neuropsychiatric Research Institute, Fargo, ND USA,University of North Dakota School of Medicine and Health Sciences, Department of Clinical Neuroscience, Fargo, ND USA
| | - Li Cao
- Neuropsychiatric Research Institute, Fargo, ND USA
| | - Scott J. Crow
- University of Minnesota, Department of Psychiatry, Minneapolis, MN USA
| | - Scott G. Engel
- Neuropsychiatric Research Institute, Fargo, ND USA,University of North Dakota School of Medicine and Health Sciences, Department of Clinical Neuroscience, Fargo, ND USA
| | - Stephen A. Wonderlich
- Neuropsychiatric Research Institute, Fargo, ND USA,University of North Dakota School of Medicine and Health Sciences, Department of Clinical Neuroscience, Fargo, ND USA
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168
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Harris J, Steele AM. Have we lost our minds? The siren song of reductionism in eating disorder research and theory. Eat Disord 2014; 22:87-95. [PMID: 24365532 DOI: 10.1080/10640266.2014.857532] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Jim Harris
- a Department of Psychology , Southern Methodist University , Dallas , Texas , USA
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169
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Svaldi J, Trentowska M, Bender C, Naumann E, Tuschen-Caffier B. Pilotstudie zur Effektivität eines Emotionsregulationstrainings bei Frauen mit Binge-Eating-Störung. ACTA ACUST UNITED AC 2014. [DOI: 10.1024/1661-4747/a000174] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Negative Emotionen sind ein häufiger Auslöser von Essanfällen bei Personen mit Binge-Eating-Störung (BES). Erste Untersuchungen haben gezeigt, dass Defizite in der Emotionsregulation (ER) den Zusammenhang von negativen Emotionen und Essanfällen mediieren. Vor diesem Hintergrund erhielten im Rahmen einer Pilotstudie 14 Frauen mit BES ein ER-Training in der Gruppe. Indikatoren für die Effektivität des Trainings waren Anzahl der Episoden und Tage mit objektiven Essanfällen, Körperunzufriedenheit, sowie Depressivität vor Studienbeginn (T0), nach 8 Wochen Wartezeit (T1) und nach dem 8-wöchigen ER-Training (T2). Während es keine Veränderungen von T0 zu T1 gab, zeigte sich eine signifikante Reduktion der Symptomatik in allen erhobenen Variablen von T1 zu T2. Die Ergebnisse der Pilotstudie unterstützen die Relevanz der ER bezüglich der Reduktion von Essanfällen und damit die Notwendigkeit gut implementierter Therapiestudien, die die Effektivität von ER-Trainings in der Veränderung der Psychopathologie der BES untersuchen. Zudem sind weitere Studien, die die Rolle der ER bei der Aufrechterhaltung der BES klären, notwendig.
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Affiliation(s)
- Jennifer Svaldi
- Abteilung Klinische Psychologie und Psychotherapie, Universität Freiburg
| | - Monika Trentowska
- Abteilung Klinische Psychologie und Psychotherapie, Universität Freiburg
| | - Caroline Bender
- Abteilung Klinische Psychologie und Psychotherapie, Universität Freiburg
| | - Eva Naumann
- Abteilung Klinische Psychologie und Psychotherapie, Universität Freiburg
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170
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Carmel A, Fruzzetti AE, Rose ML. Dialectical behavior therapy training to reduce clinical burnout in a public behavioral health system. Community Ment Health J 2014; 50:25-30. [PMID: 24346223 DOI: 10.1007/s10597-013-9679-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Accepted: 12/03/2013] [Indexed: 11/28/2022]
Abstract
There is a risk of experiencing clinical burnout among therapists providing treatment to clients with borderline personality disorder (BPD), a complex, costly and difficult-to-treat psychiatric disorder. Dialectical behavior therapy (DBT) is an evidence-based treatment of BPD that has been widely disseminated. There is only one published study that has examined pre and post scores of burnout among clinicians who receive training in DBT, and none that have taken place within a public behavioral health system in the United States where resources for community-based agencies are limited and demands are high. The current study examined the rates of burnout among therapists treating clients with BPD within a large, urban public behavioral health system. The study included a sample of nine clinicians and showed significantly decreased scores of burnout after participants attended a series of DBT trainings over a period of 13 months. There were several key limitations to internal validity including the lack of a control group. Similar evaluations of training outcomes are needed to address the widespread occurrence of burnout among community-based clinicians providing treatment to clients with BPD in order to enhance the quality of patient care.
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Affiliation(s)
- Adam Carmel
- Department of Psychiatry and Behavioral Sciences, University of Washington, Box 359911, Seattle, WA, 98104, USA,
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171
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Miller-Matero LR, Armstrong R, McCulloch K, Hyde-Nolan M, Eshelman A, Genaw J. To eat or not to eat; is that really the question? An evaluation of problematic eating behaviors and mental health among bariatric surgery candidates. Eat Weight Disord 2014; 19:377-82. [PMID: 24878835 DOI: 10.1007/s40519-014-0118-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 03/20/2014] [Indexed: 11/24/2022] Open
Abstract
Problematic eating behaviors, such as emotional eating, and food addiction, may affect weight; however, little is known about these eating behaviors, especially among those seeking bariatric surgery. Therefore, the purpose of this study was to estimate the prevalence of problematic eating behaviors and to investigate their relationship with other eating behaviors, body mass index (BMI), and psychiatric symptoms. There were 142 patients who completed a required psychiatric evaluation prior to bariatric surgery. Of these, 16.9 % met criteria for a food addiction and 25.4-40.7 % endorsed emotional eating, depending on type of emotional eating. The number of food addiction symptoms endorsed was related to emotional eating. Both food addiction and emotional eating were related to anxiety and depressive symptoms. However, surprisingly, BMI was not related to a food addiction diagnosis, emotional eating scores, or psychiatric symptoms. Results from this study suggest that problematic eating behaviors are occurring among bariatric surgery candidates. Furthermore, this study may help to address the conflicting research regarding the effects of psychiatric symptoms on weight-loss outcomes. Perhaps it is the problematic eating behaviors (e.g., food addiction and emotional eating) that are associated with psychiatric symptoms that could be influencing outcomes. Future research should evaluate treatments for problematic eating behaviors and whether treatments improve weight-loss success.
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Affiliation(s)
- Lisa Renee Miller-Matero
- Behavioral Health, Henry Ford Health System, Henry Ford Hospital, 2799 W. Grand Blvd. CFP-2, Detroit, MI, 48202, USA,
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172
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Wallace LM, Masson PC, Safer DL, von Ranson KM. Change in emotion regulation during the course of treatment predicts binge abstinence in guided self-help dialectical behavior therapy for binge eating disorder. J Eat Disord 2014; 2:35. [PMID: 25516798 PMCID: PMC4267713 DOI: 10.1186/s40337-014-0035-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 11/14/2014] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Dialectical behavior therapy (DBT), which appears to be an effective treatment for binge eating disorder (BED), focuses on teaching emotion regulation skills. However, the role of improved emotion regulation in predicting treatment outcome in BED is uncertain. METHODS This secondary analysis explored whether change in self-reported emotion regulation (as measured by the Difficulties in Emotion Regulation Scale) during treatment was associated with abstinence from binge eating at post-treatment and 4-, 5-, and 6-month follow-up in individuals who received a guided self-help adaptation of DBT for BED. Participants were 60 community-based men and women with BED who received a self-help manual and six 20-minute support phone calls. RESULTS Greater improvement in self-reported emotion regulation between pre- and post-treatment predicted abstinence from binge eating at post-treatment, 4-, 5-, and 6-month follow-up. However, some follow-up results were no longer significant when imputed data was excluded, suggesting that the effect of emotion regulation on binge abstinence may be strongest at 4-month follow-up but decline across a longer duration of follow-up. CONCLUSIONS This study provides preliminary support for the theoretical role played by improved emotion regulation in achieving binge eating abstinence. If this finding is replicated with larger samples, further research should identify specific techniques to help more individuals to effectively regulate their emotions over a longer duration.
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Affiliation(s)
- Laurel M Wallace
- Department of Psychology, University of Calgary, 2500 University Drive NW, Calgary, Alberta Canada
| | - Philip C Masson
- Department of Psychology, University of Calgary, 2500 University Drive NW, Calgary, Alberta Canada
| | - Debra L Safer
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California USA
| | - Kristin M von Ranson
- Department of Psychology, University of Calgary, 2500 University Drive NW, Calgary, Alberta Canada
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173
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Compare A, Calugi S, Marchesini G, Shonin E, Grossi E, Molinari E, Dalle Grave R. Emotionally focused group therapy and dietary counseling in binge eating disorder. Effect on eating disorder psychopathology and quality of life. Appetite 2013; 71:361-8. [PMID: 24060270 DOI: 10.1016/j.appet.2013.09.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Revised: 07/20/2013] [Accepted: 09/08/2013] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To test the effect on psychopathology and quality of life of Emotionally Focused Therapy (EFT), Dietary Counseling (DC), and Combined Treatment (CT) in treatment-seeking patients with Binge Eating Disorder (BED) and obesity. METHODS Utilizing an observational study design, 189 obese adult patients with BED were treated by manualized therapy protocols. An independent assessment of health-related quality of life (Obesity-Related Well-Being questionnaire - ORWELL-97), attitudes toward eating (Eating Inventory - EI), binge eating (Binge Eating Scale - BES) and body uneasiness (Body Uneasiness Test - BUT) was performed at baseline, end-of-treatment, and six-month follow-up. These data are the secondary outcomes of a previously published treatment study. RESULTS A higher dropout rate was observed in the DC compared to the EFT and CT groups, while body weight decreased significantly in all three groups. Pre-post scores on the BES, BUT Global Severity Index, and EI Hunger subscale significantly decreased in the CT and EFT groups (but not the DC group). At six-month follow-up, 71% of participants in CT and 46% of participants in EFT had a BES score below the threshold of attention for BED (≤16), whereas no participants in the DC group reached this target. Finally the ORWELL-97 score decreased significantly in all groups, but significantly more so in the CT and EFT groups. CONCLUSION Results support the utility of combining EFT and DC in the treatment of patients with BED and obesity, emphasizing the usefulness of techniques focused on cognitive emotional processing for changing eating disorder psychopathology and quality of life.
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Affiliation(s)
- Angelo Compare
- Human and Social Science Department, University of Bergamo, P.le S. Agostino, 2, 24129 Bergamo, Italy.
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174
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Lynch TR, Gray KLH, Hempel RJ, Titley M, Chen EY, O’Mahen HA. Radically open-dialectical behavior therapy for adult anorexia nervosa: feasibility and outcomes from an inpatient program. BMC Psychiatry 2013; 13:293. [PMID: 24199611 PMCID: PMC3875355 DOI: 10.1186/1471-244x-13-293] [Citation(s) in RCA: 66] [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: 03/31/2013] [Accepted: 09/26/2013] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Anorexia Nervosa (AN) is a highly life-threatening disorder that is extremely difficult to treat. There is evidence that family-based therapies are effective for adolescent AN, but no treatment has been proven to be clearly effective for adult AN. The methodological challenges associated with studying the disorder have resulted in recommendations that new treatments undergo preliminary testing prior to being evaluated in a randomized clinical trial. The aim of this study was to provide preliminary evidence on the effectiveness of a treatment program based on a novel adaptation of Dialectical Behavior Therapy (DBT) for adult Anorexia Nervosa (Radically Open-DBT; RO-DBT) that conceptualizes AN as a disorder of overcontrol. METHODS Forty-seven individuals diagnosed with Anorexia Nervosa-restrictive type (AN-R; mean admission body mass index = 14.43) received the adapted DBT inpatient program (mean length of treatment = 21.7 weeks). RESULTS Seventy-two percent completed the treatment program demonstrating substantial increases in body mass index (BMI; mean change in BMI = 3.57) corresponding to a large effect size (d = 1.91). Thirty-five percent of treatment completers were in full remission, and an additional 55% were in partial remission resulting in an overall response rate of 90%. These same individuals demonstrated significant and large improvements in eating-disorder related psychopathology symptoms (d = 1.17), eating disorder-related quality of life (d = 1.03), and reductions in psychological distress (d = 1.34). CONCLUSIONS RO-DBT was associated with significant improvements in weight gain, reductions in eating disorder symptoms, decreases in eating-disorder related psychopathology and increases in eating disorder-related quality of life in a severely underweight sample. These findings provide preliminary support for RO-DBT in treating AN-R suggesting the importance of further evaluation examining long-term outcomes using randomized controlled trial methodology.
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Affiliation(s)
- Thomas R Lynch
- School of Psychology, University of Southampton, Highfield Campus, Southampton, UK.
| | - Katie LH Gray
- School of Psychology, University of Southampton, Highfield Campus, Southampton, UK
| | - Roelie J Hempel
- School of Psychology, University of Southampton, Highfield Campus, Southampton, UK
| | - Marian Titley
- Haldon Unit, Wonford Hospital, Devon Partnership Trust, Exeter, UK
| | - Eunice Y Chen
- Department of Psychology, Temple University, Philadelphia, PA, USA
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175
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Peat CM, Huang L, Thornton LM, Von Holle AF, Trace SE, Lichtenstein P, Pedersen NL, Overby DW, Bulik CM. Binge eating, body mass index, and gastrointestinal symptoms. J Psychosom Res 2013; 75:456-61. [PMID: 24182635 PMCID: PMC3817501 DOI: 10.1016/j.jpsychores.2013.08.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Revised: 08/14/2013] [Accepted: 08/17/2013] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Symptoms of both gastroesophageal reflux disease (GERD) and irritable bowel syndrome (IBS) are frequently reported by individuals who binge eat. Higher body mass index (BMI) has also been associated with these disorders and with binge eating (BE). However, it is unknown whether BE influences GERD/IBS and how BMI might affect these associations. Thus, we examined the potential associations among BE, GERD, IBS, and BMI. METHODS Participants were from the Swedish Twin study of Adults: Genes and Environment (STAGE) and provided information on disordered eating behavior, BMI, gastrointestinal (GI) disorders, and commonly comorbid psychiatric and somatic illnesses. Key features of GERD and IBS were identified to create modified definitions of both disorders that were used as primary outcome variables. Logistic regression models were applied to determine the association between BE and each GERD/IBS both independently and in the context of BMI and other commonly comorbid psychiatric and somatic morbidities. RESULTS Prevalence estimates for GERD and IBS were higher among women than men (all p-values<.001). Only the association between BE and IBS was significant in both men and women after adjustment for BMI and the psychiatric/somatic morbidities. CONCLUSION BE appears to be an important consideration in the presence of IBS symptoms in both men and women, even when considering the impact of BMI and other commonly comorbid conditions. This association underscores the importance of routine assessment of BE in patients presenting with IBS to effectively manage the concurrent presentation of these problems.
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Affiliation(s)
- Christine M. Peat
- Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina, USA,Correspondence to: Cynthia Bulik, PhD, Department of Psychiatry, University of North Carolina at Chapel Hill, CB #7160, 101 Manning Drive, Chapel Hill, NC 27599-7160, USA. Voice: (919) 843-1689; Fax: (919) 843-8802;
| | - Lu Huang
- Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Laura M. Thornton
- Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Ann F. Von Holle
- Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Sara E. Trace
- Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Paul Lichtenstein
- Department of Psychology, University of Southern California, Los Angeles, California, USA
| | - Nancy L. Pedersen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden,Department of Psychology, University of Southern California, Los Angeles, California, USA
| | - D. Wayne Overby
- Department of Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Cynthia M. Bulik
- Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina, USA,Department of Nutrition, University of North Carolina, Chapel Hill, North Carolina, USA
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176
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Cate R, Khademi M, Judd P, Miller H. Deficits in mentalization: a risk factor for future development of eating disorders among pre-adolescent girls. ACTA ACUST UNITED AC 2013. [DOI: 10.1080/21662630.2013.794497] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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177
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Abstract
Few treatments for eating disorders have established a base of empirical support, and those that have are still limited by high dropout rates and low abstinence rates. Thus, there is a critical need for innovative eating disorder treatments to fill this gap. The past decade has seen a surge in the development of novel treatments that address eating pathology. This review provides an overview of the emerging psychological treatments for eating disorders, including descriptions of the therapeutic rationales, treatment techniques, and research support. The review will cover face-to-face interventions that are provided in the context of individual or group psychotherapy. Treatments included in this review were organized into the following six categories based on their underlying therapeutic rationales: (1) cognition-focused approaches, (2) emotion regulation approaches, (3) exposure-based approaches, (4) motivational enhancement, (5) integrative approaches, and (6) family- and couple-based interventions.
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Affiliation(s)
- Kelly C Berg
- Department of Psychiatry, University of Minnesota, F282/2A West, 2450 Riverside Avenue, Minneapolis, MN, 55454, USA,
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178
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Morgan JR, Price M, Schmertz SK, Johnson SB, Masuda A, Calamaras M, Anderson PL. Cognitive processes as mediators of the relation between mindfulness and change in social anxiety symptoms following cognitive behavioral treatment. ANXIETY STRESS AND COPING 2013; 27:288-302. [PMID: 24147809 DOI: 10.1080/10615806.2013.839988] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The present study examined whether pretreatment mindfulness exerts an indirect effect on outcomes following cognitive-behavioral therapy (CBT). Cognitive processes of probability and cost bias (i.e., overestimations of the likelihood that negative social events will occur, and that these events will have negative consequences when they do occur) were explored as potential mediators of the relation between mindfulness and social anxiety symptom change. People with higher levels of mindfulness may be better able to benefit from treatments that reduce biases because mindfulness may aid in regulation of attention. Sixty-seven individuals with a primary diagnosis of social phobia identifying public speaking as their greatest fear received eight sessions of one of two types of exposure-based CBT delivered according to treatment manuals. Participants completed self-report measures of mindfulness, probability bias, cost bias, and social anxiety symptoms. Mediation hypotheses were assessed by a bootstrapped regression using treatment outcome data. Pretreatment mindfulness was not related to change in social anxiety symptoms from pre- to posttreatment. However, mindfulness had an indirect effect on treatment outcome via its association with probability bias, but not cost bias, at midtreatment. These findings were consistent across three metrics of social anxiety symptoms. Mindfulness may play a role in response to CBT among individuals with social phobia through its relation with probability bias--even when the treatment does not target mindfulness.
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Affiliation(s)
- Jessica R Morgan
- a Department of Psychology , Georgia State University , P.O. Box 5010, Atlanta , GA 30302-5010 , USA
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179
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Brown JF, Brown MZ, Dibiasio P. Treating Individuals With Intellectual Disabilities and Challenging Behaviors With Adapted Dialectical Behavior Therapy. JOURNAL OF MENTAL HEALTH RESEARCH IN INTELLECTUAL DISABILITIES 2013; 6:280-303. [PMID: 23914278 PMCID: PMC3725667 DOI: 10.1080/19315864.2012.700684] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Approximately one third of adults with intellectual and developmental disabilities have emotion dysregulation and challenging behaviors (CBs). Although research has not yet confirmed that existing treatments adequately reduce CBs in this population, dialectical behavior therapy (DBT) holds promise, as it has been shown to effectively reduce CBs in other emotionally dysregulated populations. This longitudinal single-group pilot study examined whether individuals with impaired intellectual functioning would show reductions in CBs while receiving standard DBT individual therapy used in conjunction with the Skills System (DBT-SS), a DBT emotion regulation skills curriculum adapted for individuals with cognitive impairment. Forty adults with developmental disabilities (most of whom also had intellectual disabilities) and CBs, including histories of aggression, self-injury, sexual offending, or other CBs, participated in this study. Changes in their behaviors were monitored over 4 years while in DBT-SS. Large reductions in CBs were observed during the 4 years. These findings suggest that modified DBT holds promise for effectively treating individuals with intellectual and developmental disabilities.
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Affiliation(s)
- Julie F. Brown
- Justice Resource Institute-Integrated Clinical Services, Warwick, Rhode Island
| | | | - Paige Dibiasio
- Justice Resource Institute, Supports to Empower People (STEP), Cranston, Rhode Island
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180
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181
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Masson PC, von Ranson KM, Wallace LM, Safer DL. A randomized wait-list controlled pilot study of dialectical behaviour therapy guided self-help for binge eating disorder. Behav Res Ther 2013; 51:723-8. [PMID: 24029304 DOI: 10.1016/j.brat.2013.08.001] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Revised: 08/06/2013] [Accepted: 08/07/2013] [Indexed: 11/19/2022]
Abstract
This study examined the efficacy of guided self-help based on dialectical behaviour therapy (DBTgsh) for binge eating disorder (BED). Individuals (88.3% female; mean 42.8 years) were randomized to DBTgsh (n=30) or wait-list (WL; n=30). DBTgsh participants received an orientation, DBT manual, and six 20-min support calls over 13 weeks. All participants were assessed pre- and post-treatment using interview and self-report; also, DBTgsh participants were re-assessed six months post-treatment. At treatment end, DBTgsh participants reported significantly fewer past-month binge eating episodes than WL participants (6.0 versus 14.4) and significantly greater rates of abstinence from binge eating (40.0% versus 3.3%). At six-month follow-up, DBTgsh participants reported significantly improved quality of life and reduced ED psychopathology compared to baseline scores. In addition, most improvements in the DBTgsh group were maintained, although binge eating abstinence rates decreased to 30%. These preliminary positive findings indicate that DBTgsh may offer an effective, low-intensity treatment option for BED.
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Affiliation(s)
- Philip C Masson
- Department of Psychology, University of Calgary, 2500 University Drive NW, Calgary, Alberta T2N 1N4, Canada.
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182
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Masuda A, Hill ML. Mindfulness as therapy for disordered eating: a systematic review. ACTA ACUST UNITED AC 2013. [DOI: 10.2217/npy.13.36] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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183
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Gianini LM, White MA, Masheb RM. Eating pathology, emotion regulation, and emotional overeating in obese adults with Binge Eating Disorder. Eat Behav 2013; 14:309-13. [PMID: 23910772 PMCID: PMC4015336 DOI: 10.1016/j.eatbeh.2013.05.008] [Citation(s) in RCA: 156] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Revised: 01/25/2013] [Accepted: 05/08/2013] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The purpose of the current study was to examine the relationship among emotional regulation, emotional overeating, and general eating pathology in a treatment seeking sample of adults with Binge Eating Disorder (BED). METHOD The sample was composed of 326 adults (248 women, 78 men) who were obese and met DSM-IV-TR criteria for BED. Prior to treatment, participants completed the Difficulties in Emotion Regulation Scale (DERS), Emotional Overeating Questionnaire (EOQ), Beck Depression Inventory (BDI), and Eating Disorder Examination-Questionnaire (EDE-Q) as part of a larger assessment battery. RESULTS A series of hierarchical regression analyses indicated that difficulties with emotion regulation accounted for unique variance in both emotional overeating and general eating pathology above and beyond sex and negative affect. DISCUSSION Emotion regulation may play a significant role in the maintenance of emotional overeating and eating pathology in obese adults with BED.
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Affiliation(s)
| | | | - Robin M. Masheb
- Correspondence to: Robin M. Masheb, Ph.D., Department of Psychiatry, Yale University School of Medicine, 301 Cedar Street, P.O. Box 208098, New Haven, CT 06520-8090,
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184
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Koons CR, O’Rourke B, Carter B, Erhardt EB. Negotiating for Improved Reimbursement for Dialectical Behavior Therapy: A Successful Project. COGNITIVE AND BEHAVIORAL PRACTICE 2013. [DOI: 10.1016/j.cbpra.2013.01.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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185
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Stautz K, Cooper A. Impulsivity-related personality traits and adolescent alcohol use: A meta-analytic review. Clin Psychol Rev 2013; 33:574-92. [DOI: 10.1016/j.cpr.2013.03.003] [Citation(s) in RCA: 293] [Impact Index Per Article: 26.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Revised: 03/04/2013] [Accepted: 03/08/2013] [Indexed: 11/25/2022]
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186
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Mateos Rodríguez I, Cowdrey FA, Park RJ. Is there a place for mindfulness in the treatment of anorexia nervosa? ACTA ACUST UNITED AC 2013. [DOI: 10.1080/21662630.2013.795755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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187
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Yu J, Selby EA. The Interaction Between Affective Lability and Interpersonal Problems in Binge Eating. JOURNAL OF SOCIAL AND CLINICAL PSYCHOLOGY 2013. [DOI: 10.1521/jscp.2013.32.5.465] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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188
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Federici A, Wisniewski L. An intensive DBT program for patients with multidiagnostic eating disorder presentations: a case series analysis. Int J Eat Disord 2013; 46:322-31. [PMID: 23381784 DOI: 10.1002/eat.22112] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Revised: 12/30/2012] [Indexed: 11/07/2022]
Abstract
OBJECTIVE This study presents case-series data on a novel outpatient program that blends dialectical behavior therapy (DBT) with standard eating disorder (ED) interventions (i.e., food exposure, weight monitoring, cognitive modification, ED psychoeducation) for patients with complex and multidiagnostic ED presentations. METHOD Quantitative and qualitative data was collected on a sample of seven consecutively admitted women who presented with a severe ED, a history of several failed treatment attempts, pervasive emotion dysregulation, and significant Axis I or II psychiatric comorbidity (e.g., PTSD, borderline personality disorder). RESULTS Treatment was associated with reductions in ED symptoms, suicidal and self-injurious behaviors, treatment interfering behaviors, psychiatric and medical hospitalizations, and clinician burnout. DISCUSSION Overall, the results suggest that this blended DBT/cognitive behavior therapy for ED treatment model is a promising intervention for this complex and "hard to treat" population.
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Affiliation(s)
- Anita Federici
- Cleveland Center for Eating Disorders, Cleveland, Ohio 44122, USA
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189
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Watson HJ, Fursland A, Bulik CM, Nathan P. Subjective binge eating with compensatory behaviors: a variant presentation of bulimia nervosa. Int J Eat Disord 2013; 46:119-26. [PMID: 22911884 DOI: 10.1002/eat.22052] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/13/2012] [Indexed: 11/10/2022]
Abstract
OBJECTIVES To determine whether a variant bulimic-type presentation, whereby one meets criteria for bulimia nervosa (BN) except that binge eating episodes are not objectively large (i.e., "subjective bulimia nervosa," SBN), has comparable clinical severity to established eating disorders, particularly BN. METHOD Treatment-seeking adults with BN (N = 112), SBN (N = 28), anorexia nervosa restricting type (AN-R) (N = 45), and AN-binge/purge type (AN-B/P) (N = 24) were compared. RESULTS Overall, SBN could not be meaningfully distinguished from BN. SBN and BN had equivalent eating pathology, depression and anxiety symptoms, low quality of life, impulsivity, Axis I comorbidity, and lifetime psychiatric history, and comparable clinical severity to AN-R and AN-B/P. DISCUSSION Individuals with SBN, differing from BN only by the smaller size of their binge eating episodes, had a form of eating disorder comparable in clinical severity to threshold AN and BN and warranting clinical attention. Health professionals and the community require greater awareness of this variant to optimize detection, treatment-seeking, and outcomes.
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Affiliation(s)
- Hunna J Watson
- Center for Clinical Interventions, Department of Health in Western Australia, Perth, Australia.
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190
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Ramacciotti CE, Coli E, Marazziti D, Segura-García C, Brambilla F, Piccinni A, Dell'osso L. Therapeutic options for binge eating disorder. Eat Weight Disord 2013; 18:3-9. [PMID: 23757245 DOI: 10.1007/s40519-013-0003-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Accepted: 05/22/2012] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE This article addresses the state of the art concerning the treatment of binge eating disorder (BED). Pharmacological and psychotherapeutic strategies, together with issues concerning the involvement in bariatric surgery are considered. METHOD A Medline enquiry of published articles was performed using the following keywords: BED, pharmacological treatment, duloxetine, venlafaxine, SSRI, psychotherapy, bariatric surgery; reviews and single-case studies were also analyzed. RESULTS Psychological interventions that have shown efficacy in the treatment of Bulimia Nervosa have also been tested in BED with positive results, in particular modified cognitive behavioral therapy, interpersonal therapy and dialectical behavior therapy. In addition pharmacotherapy with SSRIs is successful in transiently reducing binge-eating and body weight; the SNRI duloxetine is effective for reducing binge eating, and global severity of illness with a controversial effect on body weight; both topiramate and sibutramine seem promising, but their use is restricted due to labeling and side effect limitations, respectively. Finally, adequate psychological/pharmacological support can help BED patients obtain positive outcomes from bariatric surgery. CONCLUSION Studies on BED treatment are burdened by several limitations as selection biases (e.g. mostly women and overweight), small samples, high drop-out rates and placebo response.
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Affiliation(s)
- Carla E Ramacciotti
- Section of Psychiatry, Department of Psychiatry, Pharmacology, Neurobiology and Biotechnologies, University of Pisa, Via Roma 67, 56100, Pisa, Italy,
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191
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Erb S, Farmer A, Mehlenbeck R. A Condensed Dialectical Behavior Therapy Skills Group for Binge Eating Disorder: Overcoming Winter Challenges. J Cogn Psychother 2013; 27:338-358. [DOI: 10.1891/0889-8391.27.4.338] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Although binge eating disorder (BED) is a recent diagnostic category, research for efficacious and effective treatment is well underway. This case study describes a dialectical behavior therapy (DBT) skills group for BED implemented in an outpatient community clinic. Although based on Safer, Telch, and Chen’s (2009) manual for BED and bulimia nervosa (BN), notable adaptations included shortening the group’s duration from 20 to 12 weeks, adding an interpersonal effectiveness module and DBT-informed “Holiday Plan” worksheets, and providing inclement weather alternatives. Despite the added challenges associated with winter treatment of BED (e.g., holiday meals, weather-related schedule interruptions), the 3 women who completed treatment no longer met criteria for BED at termination and their feedback suggested that the treatment was highly acceptable. Group members demonstrated clinically significant reductions in disordered eating behavior and improvements in self-esteem, emotion regulation, and quality of life. Treatment gains were maintained at 1-year follow-up. Our discussion includes treatment implications and recommendations for future research.
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192
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Nowakowski ME, McFarlane T, Cassin S. Alexithymia and eating disorders: a critical review of the literature. J Eat Disord 2013; 1:21. [PMID: 24999402 PMCID: PMC4081716 DOI: 10.1186/2050-2974-1-21] [Citation(s) in RCA: 156] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Accepted: 04/25/2013] [Indexed: 02/05/2023] Open
Abstract
Alexithymia is characterized by difficulties identifying feelings and differentiating between feelings and bodily sensations, difficulties communicating feelings, and a concrete cognitive style focused on the external environment. Individuals with eating disorders have elevated levels of alexithymia, particularly difficulties identifying and describing their feelings. A number of theoretical models have suggested that individuals with eating disorders may find emotions unacceptable and/or frightening and may use their eating disorder symptoms (i.e., restricting food intake, bingeing, and/or purging) as a way to avoid or cope with their feelings. The current critical review synthesizes the literature on alexithymia and eating disorders and examines alexithymia levels across eating disorders (i.e., anorexia nervosa, bulimia nervosa, and eating disorder not otherwise specified), the role of alexithymia in binge eating disorder, and the influence of alexithymia on the development of eating disorders as well as treatment outcome. The clinical implications of the research conducted to date and directions for future research are discussed.
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Affiliation(s)
- Matilda E Nowakowski
- Department of Psychology, Ryerson University, 350 Victoria Street, Toronto, Ontario M5B 2K3, Canada
| | - Traci McFarlane
- Department of Psychology, Ryerson University, 350 Victoria Street, Toronto, Ontario M5B 2K3, Canada ; Eating Disorder Program, The Toronto General Hospital, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada
| | - Stephanie Cassin
- Department of Psychology, Ryerson University, 350 Victoria Street, Toronto, Ontario M5B 2K3, Canada
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193
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Forman EM, Hoffman KL, Juarascio AS, Butryn ML, Herbert JD. Comparison of acceptance-based and standard cognitive-based coping strategies for craving sweets in overweight and obese women. Eat Behav 2013; 14:64-8. [PMID: 23265404 DOI: 10.1016/j.eatbeh.2012.10.016] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2012] [Revised: 08/12/2012] [Accepted: 10/24/2012] [Indexed: 10/27/2022]
Abstract
Existing strategies for coping with food cravings are of unknown efficacy and rely on principles that have been shown to have paradoxical effects. The present study evaluated novel, acceptance-based strategies for coping with craving by randomly assigning 48 overweight women to either an experimental psychological acceptance-oriented intervention or a standard cognitive reappraisal/distraction intervention. Participants were required to carry a box of sweets on their person for 72 h while abstaining from any consumption of sweets. Results suggested that the acceptance-based coping strategies resulted in lower cravings and reduced consumption, particularly for those who demonstrate greater susceptibility to the presence of food and report a tendency to engage in emotional eating.
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Affiliation(s)
- Evan M Forman
- Department of Psychology, Drexel University, 245 N. 15th Street, MS 626, Philadelphia, PA 19102, USA.
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194
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Dialectical Behavior Therapy for Adolescents: Theory, Treatment Adaptations, and Empirical Outcomes. Clin Child Fam Psychol Rev 2012; 16:59-80. [DOI: 10.1007/s10567-012-0126-7] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Voderholzer U, Cuntz U, Schlegl S. [Eating disorders: state of the art research and future challenges]. DER NERVENARZT 2012; 83:1458-67. [PMID: 23104604 DOI: 10.1007/s00115-012-3686-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Eating disorders are a common mental disorder during adolescence and young adulthood. While prevalence rates of eating disorders dramatically increased during the second half of the last century, these rates have remained relatively stable over the last 20 years. According to ICD-10 eating disorders are diagnostically categorized as anorexia nervosa, bulimia nervosa and atypical eating disorders or eating disorders not otherwise specified. Concerning the etiology, genetic factors are involved, especially in anorexia nervosa, as well as psychological and sociocultural factors. Evidence-based recommendations are available for the treatment of bulimia nervosa and binge eating disorder and in this context cognitive behavioral therapy is seen as the first choice. In contrast, the state of knowledge concerning the treatment of anorexia nervosa is still limited, especially concerning effective treatments for adults. Recent data only provide evidence for the effectiveness of family therapy for adolescents. Due to the lack of high quality studies, research on therapy for anorexia nervosa is a future challenge.
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Affiliation(s)
- U Voderholzer
- Schön Klinik Roseneck, Am Roseneck 6, 83209, Prien am Chiemsee, Deutschland.
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196
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The role of body image flexibility in the relationship between disordered eating cognitions and disordered eating symptoms among non-clinical college students. Eat Behav 2012; 13:240-5. [PMID: 22664403 DOI: 10.1016/j.eatbeh.2012.03.006] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2011] [Revised: 02/09/2012] [Accepted: 03/22/2012] [Indexed: 11/22/2022]
Abstract
OBJECTIVE A growing body of evidence suggests that rigid and inflexible regulation and coping are at the core of psychopathology, including disordered eating (DE) problems. Employing two cross-sectional studies, the present paper investigated whether body image flexibility (BIF), a specific type of psychological flexibility, mediates the relations between DE cognitions and overall DE pathology. METHOD Ethnically diverse non-clinical college undergraduates (Study 1 N=208; Study 2 N=178) completed an anonymous online survey. RESULTS BIF was found to partially mediate the relationship between DE cognitions and overall DE pathology after controlling for gender and body mass index (BMI). DISCUSSION Our findings suggest that the link between DE cognitions and overall DE pathology is established in part through an inflexible and avoidant coping style specific to negative body image. Clinical implications include targeting BIF as a mechanism of change and treating DE pathology with acceptance- and mindfulness-based behavioral interventions.
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197
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Abstract
Binge eating disorder (BED) is the most prevalent eating disorder in adults, and individuals with BED report greater general and specific psychopathology than non-eating disordered individuals. The current paper reviews research on psychological treatments for BED, including the rationale and empirical support for cognitive behavioral therapy (CBT), interpersonal psychotherapy (IPT), dialectical behavior therapy (DBT), behavioral weight loss (BWL), and other treatments warranting further study. Research supports the effectiveness of CBT and IPT for the treatment of BED, particularly for those with higher eating disorder and general psychopathology. Guided self-help CBT has shown efficacy for BED without additional pathology. DBT has shown some promise as a treatment for BED, but requires further study to determine its long-term efficacy. Predictors and moderators of treatment response, such as weight and shape concerns, are highlighted and a stepped-care model proposed. Future directions include expanding the adoption of efficacious treatments in clinical practice, testing adapted treatments in diverse samples (e.g., minorities and youth), improving treatment outcomes for nonresponders, and developing efficient and cost-effective stepped-care models.
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Affiliation(s)
- Juliette M. Iacovino
- Department of Psychology, Washington University in St. Louis, Campus Box 1125, One Brookings Drive, St. Louis, MO 63130, USA,
| | - Dana M. Gredysa
- Department of Psychology, Washington University in St. Louis, Campus Box 1125, One Brookings Drive, St. Louis, MO 63130, USA
| | - Myra Altman
- Department of Psychiatry, Washington University School of Medicine, Campus Box 8134, 660S Euclid, St. Louis, MO 63110, USA
| | - Denise E. Wilfley
- Department of Psychiatry, Washington University School of Medicine, Campus Box 8134, 660S Euclid, St. Louis, MO 63110, USA
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198
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Kearney DJ, Milton ML, Malte CA, McDermott KA, Martinez M, Simpson TL. Participation in mindfulness-based stress reduction is not associated with reductions in emotional eating or uncontrolled eating. Nutr Res 2012; 32:413-20. [PMID: 22749177 DOI: 10.1016/j.nutres.2012.05.008] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Revised: 05/13/2012] [Accepted: 05/18/2012] [Indexed: 11/28/2022]
Abstract
The adverse health effects and increasing prevalence of obesity in the United States make interventions for obesity a priority in health research. Diet-focused interventions generally do not result in lasting reductions in weight. Behavioral interventions that increase awareness of eating cues and satiety have been postulated to result in healthier eating habits. We hypothesized that participation in a program called mindfulness-based stress reduction (MBSR) would positively influence the eating behaviors and nutritional intake of participants through changes in emotional eating (EE), uncontrolled eating (UE), and type and quantity of food consumed. Forty-eight veterans at a large urban Veterans Administration medical center were assessed before MBSR, after MBSR, and 4 months later. For all participants (N = 48), MBSR participation was not associated with significant changes in EE or UE. In addition, there were no significant differences in the intake of energy, fat, sugar, fruit, or vegetables at either follow-up time point as compared with baseline. Enhanced mindfulness skills and reduced depressive symptoms were seen over time with medium to large effect sizes. Changes in mindfulness skills were significantly and negatively correlated with changes in EE and UE over time. Overall, there was no evidence that participation in MBSR was associated with beneficial changes in eating through reductions in disinhibited eating or significant changes in dietary intake. Randomized studies are needed to further define the relationship between mindfulness program participation and eating behaviors.
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199
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Federici A, Wisniewski L, Ben-Porath D. Description of an Intensive Dialectical Behavior Therapy Program for Multidiagnostic Clients With Eating Disorders. JOURNAL OF COUNSELING AND DEVELOPMENT 2012. [DOI: 10.1002/j.1556-6676.2012.00041.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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200
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Trepal HC, Boie I, Kress VE. A Relational Cultural Approach to Working With Clients With Eating Disorders. JOURNAL OF COUNSELING AND DEVELOPMENT 2012. [DOI: 10.1002/j.1556-6676.2012.00043.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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