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MacNeil BA, Leung PC. Evaluating thinking styles in adults with an eating disorder: Associations with life satisfaction, psychological symptoms, and treatment engagement. J Psychiatr Res 2022; 153:30-36. [PMID: 35793577 DOI: 10.1016/j.jpsychires.2022.06.055] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 05/18/2022] [Accepted: 06/24/2022] [Indexed: 11/30/2022]
Abstract
Cognitive weaknesses have been implicated as a vulnerability factor in the development and maintenance of eating disorders. Despite this, cognitive styles are not routinely assessed in adult outpatient eating disorder programs and little is known about how they may impact patients' functional outcomes, psychological symptoms, or treatment engagement. The aim of this study was to evaluate thinking styles (i.e., cognitive rigidity and attention to detail) among adults attending specialized outpatient treatment for an eating disorder and assess whether such styles were associated with participants' satisfaction with life, psychological symptoms, and engagement in the outpatient group therapy program. Demographic and physical health information was collected from 95 adults who were eligible for an outpatient program. Participants completed the Detail and Flexibility Questionnaire, Satisfaction with Life Scale, Beck Depression Inventory second edition, and Beck Anxiety Inventory. Elevated scores for cognitive rigidity and attention to detail were transdiagnostic rather than specific to eating disorder diagnoses. Cognitive rigidity and attention to detail were associated with lower satisfaction with life, and increased anxiety and depression. Cognitive styles of cognitive rigidity and attention to detail were not associated with engagement in treatment or treatment completion. Cognitive patterns may be important for clinicians to evaluate as part of routine outpatient care given that they occur transdiagnostically and are linked with psychological symptoms and functional outcomes for adults struggling with an eating disorder.
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Affiliation(s)
- Brad A MacNeil
- College of Health Sciences, Department of Behavioral Sciences, Doctoral Clinical Psychology Program, Midwestern University, 19555 N 59th Ave, Glendale, AZ, 85308, USA.
| | - Pauline C Leung
- Forensic Program, Ontario Shores Centre for Mental Health Sciences, 700 Gordon St, Whitby, ON, L1N 5S9, Canada
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2
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Keegan E, Waller G, Wade TD. A systematic review and meta-analysis of a 10-session cognitive behavioural therapy for non-underweight eating disorders. CLIN PSYCHOL-UK 2022. [DOI: 10.1080/13284207.2022.2075257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Ella Keegan
- Blackbird Initiative, Órama Research Institute, Flinders University, Adelaide, Australia
| | - Glenn Waller
- Department of Psychology, University of Sheffield, Sheffield, United Kingdom
| | - Tracey D. Wade
- Blackbird Initiative, Órama Research Institute, Flinders University, Adelaide, Australia
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Calugi S, Sartirana M, Frostad S, Dalle Grave R. Enhanced cognitive behavior therapy for severe and extreme anorexia nervosa: An outpatient case series. Int J Eat Disord 2021; 54:305-312. [PMID: 33247462 DOI: 10.1002/eat.23428] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 11/19/2020] [Accepted: 11/19/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The study aimed to assess outcomes in patients with severe and extreme anorexia nervosa managed with enhanced cognitive behavior therapy (CBT-E) in a real-world outpatient setting. METHOD Thirty patients with anorexia nervosa and body mass index (BMI) <16 aged ≥17 years were recruited from consecutive referrals to an eating disorder service clinic offering outpatient CBT-E. BMI and Eating Disorder Examination Questionnaire (EDE-Q), Brief Symptom Inventory (BSI), and Clinical Impairment Assessment (CIA) scores were recorded at admission, end of treatment, and 20- and 60-week follow-ups for treatment completers. RESULTS Twenty patients (66.7%) completed the treatment and showed both considerable weight gain (Cohen's f = 1.43), and significantly reduced scores for clinical impairment (f = 1.26) and eating-disorder (f = 1.03) and general psychopathology (f = 0.99). Changes remained stable at both follow-ups. About half of the patients who completed treatment had a BMI ≥18.5 at the end of treatment and follow-ups. DISCUSSION CBT-E seems suitable and promising for patients with severe and extreme anorexia nervosa seeking treatment in a real-world clinical setting, provided that their medical conditions are stable, and they have no current major depressive episodes or substance abuse; it may represent a valid alternative to inpatient treatment for those who are able to sustain engagement in a full course of outpatient treatment.
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Affiliation(s)
- Simona Calugi
- Department of Eating and Weight Disorders, Villa Garda Hospital, Garda, Italy
| | | | - Stein Frostad
- Department of Mental Health Research, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
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Melisse B, de Beurs E, van Furth EF. Eating disorders in the Arab world: a literature review. J Eat Disord 2020; 8:59. [PMID: 33292520 PMCID: PMC7646071 DOI: 10.1186/s40337-020-00336-x] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 10/07/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The prevalence of eating disorders has been assumed to be low in the Arab world, due to the alleged absence of the thin ideal. However, the Arab world is undergoing rapid sociocultural changes, and there are reports of an increase of the desire to be thin. This literature review therefore provides point-prevalence of Arabs at high risk for eating disorders, and a comprehensive synthesis of correlates of eating disorder symptoms, eating disorder-related variables and of a high risk for eating disorders. METHOD Several electronic databases were searched for published, peer-reviewed studies between 1986 and 2019 involving several key terms. From 317 screened studies, 81, mainly cross-sectional, were included. Preferred Reporting Items for Systematic reviews and meta-analyses was used as guidance and the quality of studies were assessed using the Newcastle-Ottawa scale. RESULTS Estimates of individuals at high risk for eating disorders ranged from 2 to 54.8%. The eating disorder-related variables identified were desire to be thin, body dissatisfaction, disturbed-, and dieting- eating behavior. Identified correlates were increased affluence, media use, western influences, and obesity. An additional finding was that in some cases eating disorders were expressed somatically rather than psychiatrically. DISCUSSION In the Arab world, females were most at risk for eating disorders and eating disorder symptoms. Sociocultural changes gave rise to the thin ideal and the prevalence of obesity, increasing the risk for the development of eating disorder-related variables and eating disorders. The literature on eating disorders in the Arab world suffers from potential limitations due to the use of non-validated assessment tools. Further research is necessary, particularly on the development and validation of a culturally sensitive assessment tool. Improved knowledge is likely to increase the number of people seeking treatment and decrease the stigma of psychotherapy.
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Affiliation(s)
- Bernou Melisse
- Novarum Center for Eating Disorders & Obesity, Jacob Obrechtstraat 92, 1071, KR, Amsterdam, the Netherlands.
- Rivierduinen Eating Disorders Ursula, Sandifortdreef 19, 2333 ZZ, Leiden, Netherlands.
- Department of Psychiatry, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, Netherlands.
| | - Edwin de Beurs
- Arkin Mental Health Institute, research department, Klaprozenweg 111, 1033 NN, Amsterdam, the Netherlands
- Leiden University, Section Clinical Psychology, Wassenaarseweg 52, 2333 AK, Leiden, the Netherlands
| | - Eric F van Furth
- Rivierduinen Eating Disorders Ursula, Sandifortdreef 19, 2333 ZZ, Leiden, Netherlands
- Department of Psychiatry, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, Netherlands
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Atwood ME, Friedman A. A systematic review of enhanced cognitive behavioral therapy (CBT-E) for eating disorders. Int J Eat Disord 2020; 53:311-330. [PMID: 31840285 DOI: 10.1002/eat.23206] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Revised: 11/03/2019] [Accepted: 11/04/2019] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To review the literature examining the efficacy and effectiveness of enhanced cognitive behavioral therapy (CBT-E) for adults and older adolescents with eating disorders. METHOD A systematic search of the literature (using PsycINFO and PubMed) was conducted in order to identify relevant publications (randomized controlled trials [RCTs] and uncontrolled trials) up to June 2019. Effect sizes were reported for outcomes including treatment attrition and remission rates, eating disorder behaviors, body mass index (BMI), and core eating disorder psychopathology. The Downs and Black checklist was used to assess the quality of included studies. RESULTS Twenty studies (10 RCTs and 10 uncontrolled trials) met criteria for inclusion. Support was found for the efficacy and effectiveness of CBT-E for the full spectrum of eating disorders, with respect to reducing eating disorder behaviors and core psychopathology. BMI also increased, with large effects, for individuals with AN. However, the majority of the randomized trials included in this review did not demonstrate superiority of CBT-E over comparison treatments, particularly in the longer-term. Furthermore, rates of attrition and remission for CBT-E among individuals without AN did not appear to differ from rates for CBT-BN. DISCUSSION There is evidence to support CBT-E as an efficacious and effective treatment for adults and older adolescents with a range of eating disorder diagnoses. Future research would benefit from directly comparing CBT-E to CBT-BN, expanding measured outcomes to include driven exercise and subjective binge eating, increasing consistency in the definition and measurement of outcomes, and exploring factors associated with treatment retention.
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Affiliation(s)
- Molly E Atwood
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California
| | - Aliza Friedman
- Department of Psychology, Ryerson University, Toronto, Ontario, Canada
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Dahlenburg SC, Gleaves DH, Hutchinson AD. Treatment outcome research of enhanced cognitive behaviour therapy for eating disorders: a systematic review with narrative and meta-analytic synthesis. Eat Disord 2019; 27:482-502. [PMID: 30632926 DOI: 10.1080/10640266.2018.1560240] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Enhanced cognitive behaviour therapy (CBT-E) has recently generated interest as a potentially useful treatment for eating disorders (ED). In the current study, we conducted a systematic review of the outcome literature on CBT-E, with both narrative and meta-analytic synthesis. We included single-group uncontrolled pre-post design studies and randomised control trials (RCTs) of CBT-E, which allowed us to include a larger number of studies, and also compare the two methodologies in terms of effect size. The primary analysis included 15 CBT-E studies with a total of 948 participants. Narrative synthesis examined bingeing and purging episodes, BMI change, and follow-up results. A large, statistically significant effect supported CBT-E as a treatment for all EDs (g = 1.06). When comparing methodologies, both pre-post design studies (g = 1.26) and RCTs (g = 0.82) yielded large effects. Narrative synthesis outlined reductions in ED behaviours and increases in BMI which were maintained at follow-up. Limitations include that further RCTs of CBT-E are needed to establish clinical effectiveness of this treatment approach for all EDs; however, results from narrative exploration indicate this endeavour would be worthwhile. Despite the limitations, this study provides additional support for CBT-E as a successful treatment across the range of EDs.
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Affiliation(s)
- Sophie C Dahlenburg
- School of Psychology, Social Work and Social Policy, University of South Australia , Adelaide , South Australia , Australia
| | - David H Gleaves
- School of Psychology, Social Work and Social Policy, University of South Australia , Adelaide , South Australia , Australia
| | - Amanda D Hutchinson
- School of Psychology, Social Work and Social Policy, University of South Australia , Adelaide , South Australia , Australia
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Strandskov SW, Ghaderi A, Andersson H, Parmskog N, Hjort E, Wärn AS, Jannert M, Andersson G. Effects of Tailored and ACT-Influenced Internet-Based CBT for Eating Disorders and the Relation Between Knowledge Acquisition and Outcome: A Randomized Controlled Trial. Behav Ther 2017; 48:624-637. [PMID: 28711113 DOI: 10.1016/j.beth.2017.02.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 02/21/2017] [Accepted: 02/25/2017] [Indexed: 11/16/2022]
Abstract
This is the first trial to investigate the outcome of tailored and ACT-influenced, cognitive behavioral Internet treatment for eating disorder psychopathology, and the relation between knowledge acquisition and outcome. This study utilized a randomized controlled design, with computer-based allocation to treatment or waiting list control group. Participants were recruited via advertisements in social media and newspapers in Sweden. Participants fulfilling the criteria for bulimia nervosa (BN), or Eating Disorder Not Otherwise Specified (EDNOS), with a BMI above 17.5, were enrolled in the study (N = 92). The treatment group received an Internet-based, ACT-influenced CBT intervention, developed by the authors, for eating disorders. The treatment lasted 8 weeks, and was adapted to the participant's individual needs. A clinician provided support. The main outcome measures were eating disorder symptoms and body shape dissatisfaction. Intent-to-treat analysis showed that the treatment group (n = 46) improved significantly on eating disorder symptoms and body dissatisfaction, compared with the waiting list control group (n = 46), with small to moderate effect sizes (between group effects, d = 0.35-0.64). More than a third of the participants in the treatment group (36.6%), compared to 7.1% in the waiting list control condition, made clinically significant improvements. Results showed a significant increase in knowledge in the treatment group compared to the waiting list control group (between group effect, d = 1.12), but we found no significant correlations between knowledge acquisition and outcome (r= -0.27 to -r = 0.23). The results provide preliminary support for Internet-based, tailored, and ACT-influenced treatment, based on CBT for participants with eating disorder psychopathology.
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Affiliation(s)
- Sandra Weineland Strandskov
- Linköping University; Närhälsan, Research and Development Center, Primary Health Care, Södra Älsvborg, Borås, Sweden.
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Linardon J, Brennan L. The effects of cognitive-behavioral therapy for eating disorders on quality of life: A meta-analysis. Int J Eat Disord 2017; 50:715-730. [PMID: 28430364 DOI: 10.1002/eat.22719] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 02/26/2017] [Accepted: 03/16/2017] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Meta-analyses have documented the efficacy of cognitive-behavioral therapy (CBT) for reducing symptoms of eating disorders. However, it is not known whether CBT for eating disorders can also improve quality of life (QoL). This meta-analysis therefore examined the effects of CBT for eating disorders on subjective QoL and health-related quality of life (QoL). METHOD Studies that assessed QoL before and after CBT for eating disorders were searched in the PsycInfo and Medline database. Thirty-four articles met inclusion criteria. Pooled within and between-groups Hedge's g were calculated at post-treatment and follow-up for treatment changes on both subjective and HRQoL using a random effects model. RESULTS CBT led to significant and modest improvements in subjective QoL and HRQoL from pre to post-treatment and follow-up. CBT led to greater subjective QoL improvements than inactive (i.e., wait-list) and active (i.e., a combination of bona fide therapies, psychoeducation) comparisons. CBT also led to greater HRQoL improvements than inactive, but not active, comparisons. Prepost QoL improvements were larger in studies that delivered CBT individually and by a therapist or according to the cognitive maintenance model of eating disorders (CBT-BN or CBT-E); though this was not replicated at follow-up CONCLUSIONS: Findings provide preliminary evidence that CBT for eating disorders is associated with modest improvements in QOL, and that CBT may be associated with greater improvements in QOL relative to comparison conditions.
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Affiliation(s)
- Jake Linardon
- School of Psychology, Australian Catholic University, 115 Victoria Parade/Locked Bag 4115, Melbourne, Victoria, 3065, Australia
| | - Leah Brennan
- School of Psychology, Australian Catholic University, 115 Victoria Parade/Locked Bag 4115, Melbourne, Victoria, 3065, Australia
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Ágh T, Kovács G, Supina D, Pawaskar M, Herman BK, Vokó Z, Sheehan DV. A systematic review of the health-related quality of life and economic burdens of anorexia nervosa, bulimia nervosa, and binge eating disorder. Eat Weight Disord 2016; 21:353-364. [PMID: 26942768 PMCID: PMC5010619 DOI: 10.1007/s40519-016-0264-x] [Citation(s) in RCA: 199] [Impact Index Per Article: 24.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 02/17/2016] [Indexed: 12/15/2022] Open
Abstract
PURPOSE To perform a systematic review of the health-related quality of life (HRQoL) and economic burdens of anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED). METHODS A systematic literature search of English-language studies was performed in Medline, Embase, PsycINFO, PsycARTICLES, Academic Search Complete, CINAHL Plus, Business Source Premier, and Cochrane Library. Cost data were converted to 2014 Euro. RESULTS Sixty-nine studies were included. Data on HRQoL were reported in 41 studies (18 for AN, 17 for BN, and 18 for BED), on healthcare utilization in 20 studies (14 for AN, 12 for BN, and 8 for BED), and on healthcare costs in 17 studies (9 for AN, 11 for BN, and only 2 for BED). Patients' HRQoL was significantly worse with AN, BN, and BED compared with healthy populations. AN, BN, and BED were associated with a high rate of hospitalization, outpatient care, and emergency department visits. However, patients rarely received specific treatment for their eating disorder. The annual healthcare costs for AN, BN, and BED were €2993 to €55,270, €888 to €18,823, and €1762 to €2902, respectively. CONCLUSIONS AN, BN, and BED have a serious impact on patient's HRQoL and are also associated with increased healthcare utilization and healthcare costs. The burden of BED should be examined separately from that of BN. The limited evidence suggests that further research is warranted to better understand the differences in long-term HRQoL and economic burdens of AN, BN, and BED.
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Affiliation(s)
- Tamás Ágh
- Syreon Research Institute, 119 Thököly Street, 1146, Budapest, Hungary.
| | - Gábor Kovács
- Syreon Research Institute, 119 Thököly Street, 1146, Budapest, Hungary
| | - Dylan Supina
- Formerly of Shire, 300 Shire Way, Lexington, MA, 02421, USA
| | | | | | - Zoltán Vokó
- Syreon Research Institute, 119 Thököly Street, 1146, Budapest, Hungary.,Department of Health Policy and Health Economics, Faculty of Social Sciences, Eötvös Loránd University, 1/a Pázmány Péter Street, 1117, Budapest, Hungary
| | - David V Sheehan
- University of South Florida College of Medicine, 12901 Bruce B. Downs Boulevard, Tampa, FL, 33612, USA
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Abstract
Cognitive behavioral therapy (CBT) for anorexia nervosa (AN), based on Beck's cognitive theory, was developed in a "generic" form in the early eighties. In recent years, however, improved knowledge of the mechanisms involved in maintaining eating disorder psychopathology has led to the development of a "specific" form of CBT, termed CBT-E (E = enhanced), designed to treat all forms of eating disorders, including AN, from outpatient to inpatient settings. Although more studies are required to assess the relative effectiveness of CBT-E with respect to other available treatments, the data indicate that in outpatient settings it is both viable and promising for adults and adolescents with AN. Encouraging results are also emerging from inpatient CBT-E, particularly in adolescents, and clinical services offering CBT-E at different levels of care are now offered in several countries around the world. However, CBT-E requires dissemination in order to become widely available to patients.
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Affiliation(s)
- Riccardo Dalle Grave
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Montebaldo, 89, I-37016, Garda, VR, Italy.
| | - Marwan El Ghoch
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Montebaldo, 89, I-37016, Garda, VR, Italy.
| | - Massimiliano Sartirana
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Montebaldo, 89, I-37016, Garda, VR, Italy.
| | - Simona Calugi
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Montebaldo, 89, I-37016, Garda, VR, Italy.
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Abstract
BACKGROUND Recent quantitative studies provide support for an "enhanced" transdiagnostic approach of Cognitive Behaviour Therapy (CBT-E) for eating disorders; however it is not yet known how recipients of CBT-E experience therapy. AIMS The current study used a qualitative approach to explore service users' experiences of CBT-E. METHOD Individuals with a diagnosis of bulimia nervosa and who had completed CBT-E from one service in Wales were invited to participate. Semi-structured interviews were completed with eight individuals and analysed using Interpretative Phenomenological Analysis (IPA). RESULTS Participants valued both specific and non-specific elements of CBT-E. Therapist specialism in eating disorders was considered to enhance therapist empathy. The most helpful aspects specific to CBT-E were gaining insight into maintenance cycles and experiential learning. The most challenging aspects of CBT-E were changing behaviours and cognitions "in the moment" and in the longer-term. CONCLUSIONS The implication of therapist specialism and empathy is further discussed, as well as the difficulty for CBT-E in changing service users' long-standing core beliefs.
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Groff SE. Is Enhanced Cognitive Behavioral Therapy an Effective Intervention in Eating Disorders? A Review. ACTA ACUST UNITED AC 2015; 12:272-88. [DOI: 10.1080/15433714.2013.835756] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Fuglset TS, Endestad T, Landrø NI, Rø Ø. Brain structure alterations associated with weight changes in young females with anorexia nervosa: a case series. Neurocase 2015; 21:169-77. [PMID: 24460514 DOI: 10.1080/13554794.2013.878728] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Structural brain changes associated with starvation and clinical measurements were explored in four females with anorexia nervosa with different clinical course, at baseline and 1-year follow-up, after receiving intensive inpatient treatment at a specialized eating disorder unit. Global volume alterations were associated with weight changes. Regional volume alterations were also associated with weight changes, with the largest changes occurring in the nucleus accumbens, amygdala, pallidum, and putamen. Largest changes in cortical thickness occurred in the frontal and temporal lobes. The results are preliminary; however, they show that fluctuations in weight are associated with brain volume alterations, especially gray matter. We suggest that these parts of the brain are vulnerable to starvation and malnutrition, and could be a part of the pathophysiology of AN.
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Cook B, Engel S, Crosby R, Hausenblas H, Wonderlich S, Mitchell J. Pathological motivations for exercise and eating disorder specific health-related quality of life. Int J Eat Disord 2014; 47:268-72. [PMID: 24136170 PMCID: PMC4844088 DOI: 10.1002/eat.22198] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/06/2013] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To examine associations among pathological motivations for exercise with eating disorder (ED) specific health-related quality of life (HRQOL). METHOD Survey data assessing ED severity (i.e., Eating Disorder Diagnostic Survey), ED specific HRQOL (i.e., Eating Disorders Quality of Life Instrument), and pathological motivations for exercise (i.e., Exercise Dependence Scale) were collected from female students (N = 387) at seven universities throughout the United States. Regression analyses were conducted to examine the associations among exercise dependence, ED-specific HRQOL and ED severity, and the interaction of exercise dependence and ED severity on HRQOL scores. RESULTS The overall model examining the impact of ED severity and exercise dependence (independent variables) on HRQOL (dependent variable) was significant and explained 16.1% of the variance in HRQOL scores. Additionally, the main effects for ED severity and exercise dependence and the interaction among ED severity and exercise dependence were significant, suggesting that the combined effects of ED severity and exercise dependence significantly impacts HRQOL. DISCUSSION Our results suggest that pathological motivations for exercise may exacerbate ED's detrimental impact on HRQOL. Our results offer one possible insight into why exercise may be associated with deleterious effects on ED HRQOL. Future research is needed to elucidate the relationship among psychological aspects of exercise, ED, and HRQOL.
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Affiliation(s)
- Brian Cook
- Neuropsychiatric Research Institute, Fargo, ND,University of North Dakota School of Medicine and Health Sciences, Fargo, ND,Correspondence to: Dr. Brian Cook, Neuropsychiatric Research Institute, Clinical Research, 120 8th St South, Fargo, North Dakota, United States, 58103.
| | - Scott Engel
- Neuropsychiatric Research Institute, Fargo, ND,University of North Dakota School of Medicine and Health Sciences, Fargo, ND
| | - Ross Crosby
- Neuropsychiatric Research Institute, Fargo, ND,University of North Dakota School of Medicine and Health Sciences, Fargo, ND
| | | | - Stephen Wonderlich
- Neuropsychiatric Research Institute, Fargo, ND,University of North Dakota School of Medicine and Health Sciences, Fargo, ND
| | - James Mitchell
- Neuropsychiatric Research Institute, Fargo, ND,University of North Dakota School of Medicine and Health Sciences, Fargo, ND
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Li IC, Kuo HT, Lin KC, Wu YC. The effects of depressive symptoms on quality of life among institutionalized older adults in Taiwan. Perspect Psychiatr Care 2014; 50:58-64. [PMID: 24387615 DOI: 10.1111/ppc.12029] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Revised: 04/14/2013] [Accepted: 04/23/2013] [Indexed: 02/05/2023] Open
Abstract
PURPOSE To explore the effect of physical health status and depressive symptoms on quality of life (QOL) and to examine whether depressive symptoms mediate the effect of physical health status on the physical and mental components of QOL among institutionalized older adults. DESIGN AND METHODS A cross-sectional study was used to assess 306 residents from 73 long-term care facilities in Taipei, Taiwan. FINDINGS We found that depressive symptoms mediated the relationship between the number of chronic diseases and activities of daily living and physical components of QOL (z = -2.41, p = .016; z = 3.33, p < .001) as well as between the number of chronic diseases and mental components of QOL (z = -2.45, p = .014). PRACTICE IMPLICATIONS Our findings indicate that alleviating depressive symptoms can improve the QOL of older adults in long-term care facilities.
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Affiliation(s)
- I-Chuan Li
- Institute of Clinical and Community Health Nursing, National Yang-Ming University, Taipei, Taiwan
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