Dialectical behavior therapy for binge eating disorder

A systematic review of impulsivity in eating disorders

The purpose of this paper is to conduct a systematic review of the current literature that examines impulsivity in individuals with eating disorders (ED). Studies were obtained from Embase, Pubmed and Psycinfo, and were included if they assessed impulsivity in individuals over 18 years of age with an ED diagnosis and published in the last 10 years. The methodological quality of the studies was rated. Twelve studies were included in this review, with methodological quality varying across studies. Findings suggest that impulsivity is best assessed multi-modally, with a combination of self-report, behavioural and physiological measures. In general, impulsivity was found to differentiate individuals with EDs from controls, as well as across diagnostic subtypes. The current findings have important clinical implications for our understanding and treatment of both impulsivity and eating disorders.

Personality dimensions in bulimia nervosa, binge eating disorder, and obesity

OBJECTIVE

The purpose of this investigation was to examine differences in personality dimensions among individuals with bulimia nervosa, binge eating disorder, non-binge eating obesity, and a normal-weight comparison group as well as to determine the extent to which these differences were independent of self-reported depressive symptoms.

METHOD

Personality dimensions were assessed using the Multidimensional Personality Questionnaire in 36 patients with bulimia nervosa, 54 patients with binge eating disorder, 30 obese individuals who did not binge eat, and 77 normal-weight comparison participants.

RESULTS

Participants with bulimia nervosa reported higher scores on measures of stress reaction and negative emotionality compared to the other 3 groups and lower well-being scores compared to the normal-weight comparison and the obese samples. Patients with binge eating disorder scored lower on well-being and higher on harm avoidance than the normal-weight comparison group. In addition, the bulimia nervosa and binge eating disorder groups scored lower than the normal-weight group on positive emotionality. When personality dimensions were reanalyzed using depression as a covariate, only stress reaction remained higher in the bulimia nervosa group compared to the other 3 groups and harm avoidance remained higher in the binge eating disorder than the normal-weight comparison group.

CONCLUSIONS

The higher levels of stress reaction in the bulimia nervosa sample and harm avoidance in the binge eating disorder sample after controlling for depression indicate that these personality dimensions are potentially important in the etiology, maintenance, and treatment of these eating disorders. Although the extent to which observed group differences in well-being, positive emotionality, and negative emotionality reflect personality traits, mood disorders, or both, is unclear, these features clearly warrant further examination in understanding and treating bulimia nervosa and binge eating disorder.

The efficacy of self-help group treatment and therapist-led group treatment for binge eating disorder

OBJECTIVE

The purpose of this investigation was to compare three types of treatment for binge eating disorder to determine the relative efficacy of self-help group treatment compared to therapist-led and therapist-assisted group cognitive-behavioral therapy.

METHOD

A total of 259 adults diagnosed with binge eating disorder were randomly assigned to 20 weeks of therapist-led, therapist-assisted, or self-help group treatment or a waiting list condition. Binge eating as measured by the Eating Disorder Examination was assessed at baseline, at end of treatment, and at 6 and 12 months, and outcome was assessed using logistic regression and analysis of covariance (intent-to-treat).

RESULTS

At end of treatment, the therapist-led (51.7%) and the therapist-assisted (33.3%) conditions had higher binge eating abstinence rates than the self-help (17.9%) and waiting list (10.1%) conditions. However, no between-group differences in abstinence rates were observed at either of the follow-up assessments. The therapist-led condition also showed more reductions in binge eating at end of treatment and follow-up assessments compared to the self-help condition, and treatment or waiting period completion rates were higher in the therapist-led (88.3%) and waiting list (81.2%) conditions than in the therapist-assisted (68.3%) and self-help (59.7%) conditions.

CONCLUSIONS

Therapist-led group cognitive-behavioral treatment for binge eating disorder led to higher binge eating abstinence rates, greater reductions in binge eating frequency, and lower attrition compared to group self-help treatment. Although these findings indicate that therapist delivery of group treatment is associated with better short-term outcome and less attrition than self-help treatment, the lack of group differences at follow-up suggests that self-help group treatment may be a viable alternative to therapist-led interventions.

Theoretical and Empirical Developments of the Mindfulness-Acceptance-Commitment(MAC) Approach to Performance Enhancement

As long as athletes strive to attain optimal performance states and consistently reach high performance goals, psychological interventions will be used to assist in the development of skill and the maintenance of performance. In the pursuit of these goals, newer evidence-driven models based on mindfulness- and acceptance-based approaches have been designed to achieve these ends. Based upon questionable efficacy data for traditional psychological skills training procedures that emphasize reduction or control of internal processes, mindfulness- and acceptance-based approaches develop skills of nonjudging mindful awareness, mindful attention, and experiential acceptance to aid in the pursuit of valued goals. The most formalized and researched mindfulness- and acceptance-based approach within sport psychology is the manualized Mindfulness-Acceptance-Commitment (MAC) protocol. In the 8 years since the MAC was first developed and presented, and the 5 years since the first publication on the protocol, the MAC program has accumulated a continually growing empirical base for both its underlying theory and intervention efficacy as a performance enhancement intervention. This article reviews the empirical and theoretical foundations of the mindfulness- and acceptance-based approaches in general, and MAC in particular; reviews the accumulated empirical findings in support of the MAC approach for performance enhancement; and presents recent MAC developments and suggested future directions.

Eating disorders and multi-level models of emotion: an integrated model

This paper examines the relationship between emotions, depression and eating disorders. Initially, a review is undertaken of the current state of the research and clinical literature with regard to emotional factors in eating disorders. This literature is then integrated within a version of the multi-level model of emotion proposed by Power and Dalgleish. The aim of this paper is to incorporate a basic emotions, multi-modal perspective into developing a new emotions-based model that offers a theoretical understanding of psychological mechanisms in eating disorders. Within the new Schematic Propositional Analogical Associative Representation System model applied to eating disorders, it is argued that the emotions of anger and disgust are of importance in eating disorders and that the eating disorder itself operates as an inhibitor of emotions within the self. It is hoped that the development of a multi-levelled model of eating disorders will allow for the construction of number of specific testable hypotheses that are relevant to future research into the psychological treatment and understanding of eating disorders.

Psychological treatments for bulimia nervosa and binging

BACKGROUND

A specific manual-based form of cognitive behavioural therapy (CBT) has been developed for the treatment of bulimia nervosa (CBT-BN) and other common related syndromes such as binge eating disorder. Other psychotherapies and modifications of CBT are also used.

OBJECTIVES

To evaluate the efficacy of CBT, CBT-BN and other psychotherapies in the treatment of adults with bulimia nervosa or related syndromes of recurrent binge eating.

SEARCH STRATEGY

Handsearch of The International Journal of Eating Disorders since first issue; database searches of MEDLINE, EXTRAMED, EMBASE, PsycInfo, CURRENT CONTENTS, LILACS, SCISEARCH, CENTRAL and the The Cochrane Collaboration Depression, Anxiety & Neurosis Controlled Trials Register; citation list searching and personal approaches to authors were used. Search date June 2007.

SELECTION CRITERIA

Randomised controlled trials of psychotherapy for adults with bulimia nervosa, binge eating disorder and/or eating disorder not otherwise specified (EDNOS) of a bulimic type which applied a standardised outcome methodology and had less than 50% drop-out rate.

DATA COLLECTION AND ANALYSIS

Data were analysed using the Review Manager software program. Relative risks were calculated for binary outcome data. Standardised mean differences were calculated for continuous variable outcome data. A random effects model was applied.

MAIN RESULTS

48 studies (n = 3054 participants) were included. The review supported the efficacy of CBT and particularly CBT-BN in the treatment of people with bulimia nervosa and also (but less strongly due to the small number of trials) related eating disorder syndromes.Other psychotherapies were also efficacious, particularly interpersonal psychotherapy in the longer-term. Self-help approaches that used highly structured CBT treatment manuals were promising. Exposure and Response Prevention did not enhance the efficacy of CBT.Psychotherapy alone is unlikely to reduce or change body weight in people with bulimia nervosa or similar eating disorders.

AUTHORS' CONCLUSIONS

There is a small body of evidence for the efficacy of CBT in bulimia nervosa and similar syndromes, but the quality of trials is very variable and sample sizes are often small. More and larger trials are needed, particularly for binge eating disorder and other EDNOS syndromes. There is a need to develop more efficacious therapies for those with both a weight and an eating disorder.

Decision-making impairments in women with binge eating disorder

Even though eating is frequently driven by overindulgence and reward rather than by energy balance, few studies so far have analyzed decision-making processes and disturbances in feedback processing in women with binge eating disorder (BED). In an experimental study, 17 women with BED (DSM-IV) and 18 overweight healthy controls (HC) were compared in the game of dice task (GDT). This task assesses decision-making under risk with explicit rules for gains and losses. Additionally, differences in dispositional activation of the behavior inhibition and behavior approach system as well as cognitive flexibility were measured. Main results revealed that women with BED make risky decisions significantly more often than HC. Moreover, they show impaired capacities to advantageously utilize feedback processing. Even though these deficits were not related to disease-specific variables, they may be important for the daily decision-making behavior of women with BED, thus being relevant as a maintenance factor for the disorder.

Negative reinforcement eating expectancies, emotion dysregulation, and symptoms of bulimia nervosa

OBJECTIVE

Research suggests that emotion dysregulation or difficulties in the modulation of emotional experience constitute risk for eating disorders. Recent work has also highlighted the role of certain eating-related cognitions, specifically expectations of negative emotional reinforcement from eating, in the development of disturbed eating patterns. However, it is unclear whether these expectancies are merely a dimension of a general inability to regulate emotions effectively or rather a unique cognitive-affective risk factor for the development of an eating disorder. This study examines the unique contribution of eating expectancies to symptoms of bulimia nervosa (BN) after controlling for two dimensions of emotion dysregulation (alexithymia and experiential avoidance) previously implicated in the phenomenology of eating disorders.

METHOD

Participants were 115 undergraduate women who self-reported demographics, alexithymia, experiential avoidance, eating expectancies, and symptoms of BN.

RESULTS

Eating expectancies uniquely contributed 12.4% of the variance in symptoms of BN, F(2, 108) = 11.74, p < .001. The final model was statistically significant, F(6, 108) = 13.62, p < .001, and accounted for 40.0% of the variance in symptoms of BN.

DISCUSSION

These results suggest that individuals who expect eating to provide emotional relief may be especially susceptible to disordered eating. Findings are discussed in terms of emotional risk models and clinical interventions for BN.

Psychotherapy approaches for adolescents with eating disorders

PURPOSE OF REVIEW

Adolescence is the most common period for the onset of eating disorders, and early intervention is critical. Primary care providers should feel equipped to discuss psychotherapy approaches for eating disorders with adolescents and their families and to provide appropriate referrals. The present review focuses on six prominent treatment modalities and the evidence supporting each approach.

RECENT FINDINGS

Although the majority of studies about psychotherapy approaches for eating disorders focus on adult women, there is a growing body of research on effective treatments for an adolescent population. Family-based treatment (the 'Maudsley method') and supportive psychotherapy appear to be promising approaches for anorexia in teens. Treatments for bulimia yield extremely high relapse rates, but cognitive-behavioral therapy and family-based treatment are favored modalities. Dialectical behavior therapy and interpersonal psychotherapy may also be applicable to adolescent bulimia and binge eating. Most psychotherapists draw upon a variety of these treatment approaches, depending upon the patient's unique presentation. Regardless of the modality used, some degree of family involvement is important in limiting dropout and improving outcomes.

SUMMARY

Adolescent health providers need to be aware of the psychotherapy approaches recommended for teens with eating disorders in order to effectively refer patients to and collaborate with mental health providers.

Differential Treatment Response for Eating Disordered Patients With and Without a Comorbid Borderline Personality Diagnosis Using a Dialectical Behavior Therapy (DBT)-Informed Approach

Studies have reported conflicting findings regarding the impact on treatment for eating disorder patients comorbidly diagnosed with borderline personality disorder. The current investigation sought to investigate whether individuals diagnosed with an eating disorder vs. those comorbidly diagnosed with an eating disorder and borderline personality disorder differ on measures of eating disorders symptoms and/or general distress over the course of treatment. In light of the success of DBT in treating individuals diagnosed with borderline personality disorder, a group known to have considerable difficulties in regulating affect, the current study also sought to examine whether these two groups would differ on expectancies to regulate affect over the course of DBT-informed treatment. Results indicated that while a comorbid diagnosis of borderline personality disorder did not impact eating disorder treatment outcomes, those comorbidly diagnosed did present overall with higher levels of general distress and psychological disturbance. With respect to affect regulation, results indicated that at the beginning of treatment, eating disordered individuals who carried a comorbid diagnosis of BPD were significantly less able to regulate affect than patients without a comorbid borderline diagnosis. However, at the end of treatment there was no statistically significant difference between the two groups. The role of affect regulation in treating eating disordered individuals with a comorbid borderline personality disorder diagnosis is discussed.

Emotion regulation and binge eating in children

OBJECTIVE

To examine the ability to regulate emotions in children with binge eating.

METHOD

A community sample of 60 children ages 8-13 with at least one episode of loss of control (LOC) eating during the past 3 months and a matched control group without LOC (n = 60) underwent a clinical interview (Eating Disorder Examination adapted for Children) and completed self-report questionnaires assessing emotion regulation strategies, eating pathology, and depressive symptoms.

RESULTS

Children with LOC eating made a significantly higher use of dysfunctional emotion regulation strategies (p < .01), especially for the regulation of anxiety (p < .01). Maladaptive strategies were associated with greater depressiveness (p < .001). Use of adaptive emotion regulation strategies did not differ between children with and without LOC eating.

DISCUSSION

Results document an association between LOC eating and difficulties in regulating negative emotions in children. Interventions targeting LOC eating in children should include training for coping with negative emotions.

Enhancement Motives Mediate the Positive Association Between Mind/Body Awareness and College Student Drinking

This study was undertaken to examine the relationship between mindfulness and alcohol consumption among college students, with enhancement and coping motives evaluated as potential mediators. Differences between men and women in drinking and mindfulness (mind/body awareness specifically) were also considered. Undergraduate students (n = 212, 51% male) completed a survey that included measures of mindfulness, drinking motives, and drinking. Results indicated that greater mind/body awareness was associated with more alcohol use in men and women, and non-attachment to thoughts was associated with less drinking in men. Furthermore, enhancement but not coping motives were found to mediate these associations for men only. Results are discussed in terms of the theoretical implications for understanding the relationship between mindfulness and alcohol consumption.

Overview of treatment modalities in adolescent anorexia nervosa

The aim of this article is to scrutinize and compare the benefits of distinct treatment settings for anorexia nervosa (AN) and to review the different treatment modalities that have proven helpful in the management of young patients with AN. Evidence-based findings on the effect of different treatment methods for AN are limited. Besides different treatment settings, a multimodal treatment approach comprising nutritional rehabilitation, nutritional counseling, individual psychotherapy and family-based interventions emphazising a group psychoeducation program for parents is presented.

Emotion recognition, emotional awareness and cognitive bias in individuals with bulimia nervosa

Difficulties recognizing emotion have been reported for eating disordered individuals in relation to perception of emotions in others and emotional self-awareness. It remains unclear whether this is a perceptual or cognitive-affective problem. Clarification is sought and the question of a cognitive bias is addressed when interpreting facially expressed emotions. Twenty participants with bulimia nervosa (BN) and 20 normal controls (NC) were assessed for ability to recognize emotional and neutral expressions. Emotional self-awareness was also assessed. Significant differences were found for emotional self-awareness. For emotional faces, only a poorer recognition of the emotion, surprise, for BN was found. Problems with emotional self-awareness suggest a cognitive-affective disturbance in emotion recognition. Implications for therapy are discussed.

Evidence-based psychosocial treatments for eating problems and eating disorders

Eating disorders represent a significant source of psychological impairment among adolescents. However, most controlled treatment studies have focused on adult populations. This review provides a synthesis of existing data concerning the efficacy of various psychosocial interventions for eating disorders in adolescent samples. Modes of therapy examined in adolescent samples include family therapy, cognitive therapy, behavioral therapy, and cognitive behavioral therapy mostly in patients with anorexia nervosa. At this time, the evidence base is strongest for the Maudsley model of family therapy for anorexia nervosa. Evidence of efficacy for other treatments and other conditions is limited by several methodological factors including the small number of studies, failure to use appropriate control conditions or randomization procedures, and small sample sizes (i.e., fewer than 10 participants per treatment arm). Potential moderators and mediators of treatment effect are reviewed. Finally, results from adolescent studies are contrasted with those from adult studies of eating disorders treatment. Many studies of adult populations comprise late adolescent/young adult participants, suggesting that findings regarding the efficacy of cognitive behavioral therapy for bulimia nervosa in adults likely extend to older adolescent populations.

Dialectical behavior therapy for clients with binge-eating disorder or bulimia nervosa and borderline personality disorder

OBJECTIVE

This treatment development study provides summary data for standard Dialectical Behavior Therapy (DBT) with minimal adaptation for 8 women with binge-eating disorder (BED) (5) or bulimia nervosa (BN) (3) and Borderline Personality Disorder (BPD).

METHOD

DBT involved 6 months of weekly skills group, individual DBT, therapist consultation team meeting, and 24-hour telephone coaching. Assessments were conducted at pre-, post-treatment, and 6-months follow-up and utilized standardized clinical interviews including the Eating Disorders Examination (EDE), Personality Disorders Exam, and the Structured Clinical Interview for DSM-IV.

RESULTS

From pre- to post-treatment, effect sizes for objective binge eating, total EDE scores and global adjustment were large and for number of non-eating disorder axis I disorders and for suicidal behavior and self-injury were medium. From pre- to 6-months follow-up, effect sizes were large for all these outcomes.

CONCLUSION

This provides promising pilot data for larger studies utilizing DBT for BED or BN and BPD.

Dialectical behavior therapy for substance abusers

Dialectical behavior therapy (DBT) is a well-established treatment for individuals with multiple and severe psychosocial disorders, including those who are chronically suicidal. Because many such patients have substance use disorders (SUDs), the authors developed DBT for Substance Abusers, which incorporates concepts and modalities designed to promote abstinence and to reduce the length and adverse impact of relapses. Among these are dialectical abstinence, "clear mind," and attachment strategies that include off-site counseling as well as active attempts to find patients who miss sessions. Several randomized clinical trials have found that DBT for Substance Abusers decreased substance abuse in patients with borderline personality disorder. The treatment also may be helpful for patients who have other severe disorders co-occurring with SUDs or who have not responded to other evidence-based SUD therapies.

Lifetime family violence exposure is associated with current symptoms of eating disorders among both young men and women

This study examines (a) whether different forms of lifetime family violence exposure are associated with current eating disorder symptoms among young adults, (b) whether current symptoms of depression and anxiety both mediate these links, and (c) whether findings differ by gender. Participants were 319 university students aged 18-20 years (56% male). Independent of gender, both direct victimization by family violence and witnessing family violence were associated with eating disorder symptoms. Symptoms of depression and anxiety partially mediated these associations, and results did not vary by gender. Findings suggest that depression and anxiety may play a role in the development and maintenance of eating disorder symptoms subsequent to repeated incidents of family violence exposure.

Mechanisms of Action in the Inverse Relationship Between Mindfulness and Psychological Distress

Both dispositional mindfulness and mindfulness-based interventions have been found to be associated with less psychological distress. The current study investigated three mechanisms by which mindfulness might exert its beneficial effects: emotion regulation, nonattachment, and reduced rumination. Correlational self-report data were collected from two independent, nonclinical samples of undergraduates. Structural equation modeling was then used to test the role of these three mechanisms in mediating the relationship between mindfulness and a psychological distress factor, consisting of measures for depressive and anxious symptomatology. The model was respecified based on the first sample and retested in the second sample. Results confirmed an inverse relationship between mindfulness and psychological distress. Furthermore, emotion regulation, nonattachment, and rumination significantly mediated this relationship.

Disordered eating attitudes and behaviors in overweight youth

Disordered eating attitudes and behaviors appear to be quite common in youth, and overweight youth have been identified as a subset of the population at particularly high risk for endorsing such symptoms. Overweight and eating disorder (ED) symptomatology independently confer significant threats to one's physical and psychosocial health, showing strong links with body weight gain and risk for ED development. When concurrent, the risk for negative health outcomes may be compounded. The purpose of this article is to review the current state of the literature as it concerns disordered eating and its correlates in overweight children and adolescents. Extant literature on the prevalence, distribution, correlates, and etiology of disordered eating attitudes and behaviors (i.e., negative attitudes toward shape and weight, unhealthy weight control behaviors, and binge eating) in overweight youth is reviewed and consolidated in order to make assessment and treatment recommendations for healthcare providers. The current literature suggests that early detection of disordered eating in overweight youth should be a priority to provide appropriate intervention, thereby helping to slow the trajectory of weight gain and prevent or reduce the long-term negative consequences associated with both conditions. Future research should focus on explicating developmental pathways, and on developing novel prevention and treatment interventions for overweight youth exhibiting disordered eating patterns.

The patient's account of relapse and recovery in anorexia nervosa: a qualitative study

OBJECTIVE

The purpose of this study was to explore the subjective accounts of weight-recovered female patients, who met DSMIV criteria for anorexia nervosa (AN), regarding their views of their illness following weight restoration.

METHOD

Qualitative semi-structured interviews were administered to 15 participants to ascertain their perspective of the factors that either contributed to their maintaining a healthy weight, or the factors involved in their having relapsed over the follow-up period.

RESULTS

Qualitative analyses revealed six core categories: internal motivation to change, recovery as a work in progress, the perceived value of the treatment experience, developing supportive relationships, awareness and tolerance of negative emotion and self-validation.

DISCUSSION

This study provides valuable information about the way in which AN patients experience their illness and highlight the factors that help or hinder recovery. These findings may help enhance relapse prevention programs and potentially enhance our ability to identify and target those individuals at the greatest risk of relapsing.

Entwicklung und Validierung eines Fragebogens zur standardisierten Selbsteinschätzung emotionaler Kompetenzen (SEK-27)

Theoretischer Hintergrund: Defizite und Ressourcen im Bereich der allgemeinen Emotionsregulation spielen eine wichtige Rolle bei Entstehung, Aufrechterhaltung und Behandlung psychischer Störungen. Fragestellung: Um möglichst viele Bereiche des konstruktiven Umgangs mit negativen Emotionen ökonomisch erfassen zu können, wurde der Fragebogen zur Selbsteinschätzung Emotionaler Kompetenzen (SEK-27) entwickelt und validiert. Methode: Anhand von zwei nicht-klinischen (N = 952) und drei klinischen Stichproben (N = 238) wurden verschiedene Indikatoren der Testgüte bestimmt. Ergebnisse: Die Befunde sprechen für die ausreichende bis sehr gute Reliabilität, Validität und Veränderungssensitivität des Fragebogens. Schlussfolgerungen: Mit dem SEK-27 steht ein ökonomischer Fragebogen mit angemessenen psychometrischen Eigenschaften zur Selbsteinschätzung des konstruktiven Umgangs mit negativen Emotionen zur Verfügung.

Efficacy of the third wave of behavioral therapies: a systematic review and meta-analysis

During the last two decades a number of therapies, under the name of the third wave of cognitive behavior therapy (CBT), have been developed: acceptance and commitment therapy (ACT), dialectical behavior therapy (DBT), cognitive behavioral analysis system of psychotherapy (CBASP), functional analytic psychotherapy (FAP), and integrative behavioral couple therapy (IBCT). The purposes of this review article of third wave treatment RCTs were: (1) to describe and review them methodologically, (2) to meta-analytically assess their efficacy, and (3) to evaluate if they currently fulfil the criteria for empirically supported treatments. There are 13 RCTs both in ACT and DBT, 1 in CBASP, 2 in IBCT, and none in FAP. The conclusions that can be drawn are that the third wave treatment RCTs used a research methodology that was significantly less stringent than CBT studies; that the mean effect size was moderate for both ACT and DBT, and that none of the third wave therapies fulfilled the criteria for empirically supported treatments. The article ends with suggestions on how to improve future RCTs to increase the possibility of them becoming empirically supported treatments.

Is there a place for obesity in DSM-V?

OBJECTIVE

To revisit the merits and problems inherent in considering obesity, or some aspect of obesity, as a mental or behavioral disorder.

METHOD

The author suggests shifting the focus from the state of obesity to the process of nonhomeostatic overeating that results in obesity. Studies are reviewed that pertain to various models of nonnormative overeating including eating disorder models that stress the form of overeating, substance use disorder models focusing on its consequences, and affect regulation or stress response models focusing on its function.

RESULTS

Studies focusing on abnormal eating patterns, including binge eating and night eating suggest that such patterns may be related to the development of obesity. While the literature pertaining to substance use and other models of nonhomeostatic overeating is beginning to mount, current evidence is mostly preliminary and indirect.

CONCLUSION

An attempt to devise diagnostic criteria based on the above models raises multiple difficulties, since the phenomena central to each model are dimensional, common, and variably associated with distress or dysfunction. A detailed understanding of the neurobiological relationships among eating behavior, reward systems, and affect regulation systems will enable a more meaningful consideration of these models and will facilitate specific treatment for disorders of overeating.

Immediate effects of chocolate on experimentally induced mood states

In this work two hypotheses were tested: (1) that eating a piece of chocolate immediately affects negative, but not positive or neutral mood, and (2) that this effect is due to palatability. Experiment 1 (48 normal-weight and healthy women and men) examined the effects of eating a piece of chocolate and drinking water on negative, positive and neutral mood states induced by film clips. Eating chocolate reduced negative mood compared to drinking water, whereas no or only marginal effects were found on neutral and positive moods. Experiment 2 (113 normal-weight and healthy women and men) compared effects of eating palatable and unpalatable chocolate on negative mood, and examined the duration of chocolate-induced mood change. Negative mood was improved after eating palatable chocolate as compared to unpalatable chocolate or nothing. This effect was short lived, i.e., it disappeared after 3 min. In both experiments, chocolate-induced mood improvement was associated with emotional eating. The present studies demonstrate that eating a small amount of sweet food improves an experimentally induced negative mood state immediately and selectively and that this effect of chocolate is due to palatability. It is hypothesized that immediate mood effects of palatable food contribute to the habit of eating to cope with stress.

Maintenance of binge eating through negative mood: a naturalistic comparison of binge eating disorder and bulimia nervosa

OBJECTIVE

To examine negative mood as a proximal antecedent and reinforcing condition of binge eating in binge eating disorder (BED) and bulimia nervosa (BN).

METHOD

Using an ecological momentary assessment design, 20 women with BED, 20 women with BN, and 20 nonclinical control women were recruited from the community, provided with a portable minicomputer, and asked to rate their mood and list their thoughts at randomly-generated beep sounds and before, during, and after episodes of eating.

RESULTS

In both eating disorder groups mood before binge eating was more negative than before regular eating and at random assessment. Binge eating was followed by a deterioration of mood. The BED group revealed less antecedent negative mood than the BN group and less concomitant negative cognitions about food/eating and stress.

CONCLUSION

Affect regulation difficulties likely lead to binge eating in both disorders, but binge eating may not be effective for regulating overall mood.

How emotions affect eating: a five-way model

Despite the importance of affective processes in eating behaviour, it remains difficult to predict how emotions affect eating. Emphasizing individual differences, previous research did not pay full attention to the twofold variability of emotion-induced changes of eating (variability across both individuals and emotions). By contrast, the present paper takes into account both individual characteristics and emotion features, and specifies five classes of emotion-induced changes of eating: (1) emotional control of food choice, (2) emotional suppression of food intake, (3) impairment of cognitive eating controls, (4) eating to regulate emotions, and (5) emotion-congruent modulation of eating. These classes are distinguished by antecedent conditions, eating responses and mediating mechanisms. They point to basic functional principles underlying the relations between emotions and biologically based motives: interference, concomitance and regulation. Thus, emotion-induced changes of eating can be a result of interference of eating by emotions, a by-product of emotions, and a consequence of regulatory processes (i.e., emotions may regulate eating, and eating may regulate emotions).

Treating emotion dysregulation in a couples context: a pilot study of a couples skills group intervention

This article reports the development of a couple-based intervention in which at least one partner had experienced chronic difficulties in emotion regulation, operationalized as having participated in a yearlong dialectical behavior therapy (DBT) skills training group. Integrating dialectical behavior therapy and cognitive-behavioral couple therapy, this group intervention taught couples emotion regulation, communication, and problem-solving skills, and led them through an exploration of how strong feelings affect and are affected by their relationship. The effects of treatment were evaluated in terms of relationship satisfaction and individual well-being. Sizeable treatment effects were found in several domains, including a reduction in DBT graduates' depressive symptoms and emotion dysregulation, and an increase in their partners' relationship satisfaction and confidence in their graduate spouses' ability to regulate emotions.

Preventing excessive weight gain in adolescents: interpersonal psychotherapy for binge eating

The most prevalent disordered eating pattern described in overweight youth is loss of control (LOC) eating, during which individuals experience an inability to control the type or amount of food they consume. LOC eating is associated cross-sectionally with greater adiposity in children and adolescents and seems to predispose youth to gain weight or body fat above that expected during normal growth, thus likely contributing to obesity in susceptible individuals. No prior studies have examined whether LOC eating can be decreased by interventions in children or adolescents without full-syndrome eating disorders or whether programs reducing LOC eating prevent inappropriate weight gain attributable to LOC eating. Interpersonal psychotherapy, a form of therapy that was designed to treat depression and has been adapted for the treatment of eating disorders, has shown efficacy in reducing binge eating episodes and inducing weight stabilization among adults diagnosed with binge eating disorder. In this paper, we propose a theoretical model of excessive weight gain in adolescents at high risk for adult obesity who engage in LOC eating and associated overeating patterns. A rationale is provided for interpersonal psychotherapy as an intervention to slow the trajectory of weight gain in at-risk youth, with the aim of preventing or ameliorating obesity in adulthood.

Naltrexone and cognitive behavioral coping skills therapy for the treatment of alcohol drinking and eating disorder features in alcohol-dependent women: a randomized controlled trial

BACKGROUND

Despite important gender differences in drinking patterns, physiological effects of alcohol, and co-occurring psychiatric conditions, relatively little is known about the efficacy of naltrexone for the treatment of alcohol dependence in women. This study investigated the safety and efficacy of naltrexone in combination with Cognitive Behavioral Coping Skills Therapy (CBCST) in a sample of alcohol-dependent women, some with comorbid eating pathology.

METHODS

One hundred three women meeting DSM-IV criteria for alcohol dependence (29 with comorbid eating disturbances) were randomized to receive either naltrexone 50 mg or placebo for 12 weeks in addition to weekly group CBCST. Subjects were enrolled between October 1995 and December 2000 at an outpatient research clinic.

RESULTS

No significant differences were observed on the primary outcomes of time to first drinking day, time to first day of heavy drinking, or the percentage of participants who continued to meet the criteria for alcohol dependence. Secondary analyses revealed that naltrexone significantly delayed the time to the second (chi2=5.37, p=0.02) and third (chi2=4.35, p=0.04) drinking days among subjects who did not maintain abstinence from alcohol. Among those with eating disturbances, symptoms of eating pathology improved during treatment, but the effects did not differ according to medication condition.

CONCLUSION

When used in conjunction with CBCST, naltrexone did not significantly improve drinking outcomes in the overall sample of alcohol-dependent women. However, naltrexone may be of benefit to women who are unable to maintain total abstinence from alcohol. For women with concurrent eating pathology, participation in treatment for alcoholism may be associated with improvements in eating pathology.

Binge eating disorder treatment: a systematic review of randomized controlled trials

OBJECTIVE

The Research Triangle Institute-University of North Carolina Evidence Based Practice Center (RTI-EPC) systematically reviewed evidence on efficacy of treatment for binge eating disorder (BED), harms associated with treatments, factors associated with treatment efficacy, and differential outcome by sociodemographic characteristics.

METHOD

We searched six major databases for studies on the treatment of BED published from 1980 to September, 2005, in all languages against a priori inclusion/exclusion criteria and focused on eating, psychiatric or psychological, or biomarker outcomes.

RESULTS

Twenty-six studies, including medication-only, medication plus behavioral intervention, and behavioral intervention only designs, met inclusion criteria. The strength of the evidence for medication and behavioral interventions was moderate, for self-help and other interventions was weak, for treatment-related harms was strong, for factors associated with efficacy of treatment was weak, and for differential outcome by sociodemographic factors was nonexistent. Individual or group CBT reduces binge eating and improves abstinence rates for up to 4 months after treatment but does not lead to weight loss. Medications may play a role in treating BED patients.

CONCLUSION

The literature regarding treatment efficacy for BED is variable. Future directions include the identification of optimal interventions that are associated with both sustained abstinence from binge eating and permanent weight loss.

What's driving the binge in binge eating disorder?: A prospective examination of precursors and consequences

OBJECTIVE

Previous research, mostly using retrospective reports, indicated a relation of negative affect and dietary restraint with the occurrence of binge episodes in binge eating disorder (BED). We employed Ecological Momentary Assessment (EMA) to better understand precursors and consequences of binge eating.

METHOD

Thirty-three females with BED carried a handheld computer for 7 days, and were periodically prompted to indicate their current emotions, hunger, and binge status.

RESULTS

Negative mood and hunger were significantly higher at prebinge than at nonbinge times, but negative mood was even higher at postbinge. Participants attributed binge episodes to mood more frequently than to hunger or abstinence violation.

CONCLUSION

The finding that negative mood is actually heightened subsequent to a binge suggests the need to further investigate what is reinforcing about a binge, including possible escape from self-awareness. Strengths of EMA technology are discussed, as well as its broad utility in BED assessment and treatment.