Acute Augmentations to Psychological Therapies in Eating Disorders: A Systematic Review and Meta-Analysis

PURPOSE OF REVIEW

The purpose of this systematic review and meta-analysis was to examine the use and efficacy of acute augmentation therapies in eating disorders.

RECENT FINDINGS

A meta-analysis addressing this topic across psychological disorders found augmentation significantly improved therapy outcome with strongest findings for augmentations targeting biological mechanisms; however, only one study examined eating disorders. Our systematic review identified 29 studies examining people with eating disorders (N = 1831 participants, 93.7% female), of which 17 RCTs (n = 1162 participants) were included in the meta-analysis. Small subgroups of acute augmentations were identified. Adding acute augmentations to an intervention was effective in 72.4% of studies, with a significant effect on eating disorder outcomes (Hedges' g = 0.14, 95% CI: [0.02, 0.26]). Acute augmentation looks to be a promising approach regardless of weight status or whether it is added to treatment as usual or a single therapy approach.

Psychotherapies for eating disorders: findings from a rapid review

BACKGROUND

Psychotherapy is considered central to the effective treatment of eating disorders-focusing on behavioural, psychological, and social factors that contribute to the illness. Research indicates psychotherapeutic interventions out-perform placebo, waitlist, and/or other treatments; but, outcomes vary with room for major improvement. Thus, this review aims to (1) establish and consolidate knowledge on efficacious eating disorder psychotherapies; (2) highlight select emerging psychotherapeutic interventions; and (3) identify knowledge gaps to better inform future treatment research and development.

METHODS

The current review forms part of a series of Rapid Reviews published in a special issue in the Journal of Eating Disorders to inform the development of the Australian-government-funded National Eating Disorder Research and Translation Strategy 2021-2031. Three databases were searched for studies published between 2009 and 2023, published in English, and comprising high-level evidence studies (meta-analyses, systematic reviews, moderately sized randomised controlled studies, moderately sized controlled-cohort studies, and population studies). Data pertaining to psychotherapies for eating disorders were synthesised and outlined in the current paper.

RESULTS

281 studies met inclusion criteria. Behavioural therapies were most commonly studied, with cognitive-behavioural and family-based therapies being the most researched; and thus, having the largest evidence-base for treating anorexia nervosa, bulimia nervosa, and binge eating disorder. Other therapies, such as interpersonal and dialectical behaviour therapies also demonstrated positive treatment outcomes. Emerging evidence supports specific use of Acceptance and Commitment; Integrative Cognitive Affective; Exposure; Mindfulness; and Emotionally-Focused therapies; however further research is needed to determine their efficacy. Similarly, growing support for self-help, group, and computer/internet-based therapeutic modalities was noted. Psychotherapies for avoidant/restrictive food intake disorder; other, and unspecified feeding and eating disorders were lacking evidence.

CONCLUSIONS

Currently, clinical practice is largely supported by research indicating that behavioural and cognitive-behavioural psychotherapies are most effective for the treatment of eating disorders. However, the efficacy of psychotherapeutic interventions varies across studies, highlighting the need for investment and expansion of research into enhanced variants and novel psychotherapies to improve illness outcomes. There is also a pressing need for investigation into the whole range of eating disorder presentations and populations, to determine the most effective interventions.

Emotional regulation and body dissatisfaction: the mediating role of anger in young adult women

Introduction

Emotion regulation difficulties have an important role in the presence of negative self-image. These problems in the self-regulation of emotion could lead to negative emotional processes (such as anger) that can lead to body dissatisfaction. Therefore, the aim of the present study was to examine emotion regulation difficulties than can negatively impact self-image and to understand if anger acts as mediator in the relationship between emotion regulation and body dissatisfaction.

Methods

A cross-sectional study was carried out comprising 565 young adult women aged 18-30 years. The participants were administered the Difficulties in Emotion Regulation Scale (DERS), the State-Trait Anger Expression Inventory 2 (STAXI-2), and the Body Dissatisfaction dimension of the Eating Disorder Inventory-2 (EDI-2). The proposed hypotheses were tested by path analysis in MPlus 8.0.

Results

The results indicated that anger had a positive significant effect on body dissatisfaction as well as the non-acceptance of emotional responses, the lack of emotional awareness, and the lack of emotional clarity. Of all the dimensions of emotional regulation difficulties, impulse control difficulty was the dimension which had a positive significant indirect effect on body dissatisfaction explained by increased anger.

Discussion

The present study suggests the importance of emotion regulation in the prevention of body dissatisfaction. Impulse control difficulty may be the key emotion regulation emotion in explaining the increments of anger that lead to body dissatisfaction. Among young adults, the promotion of positive body image can be promoted by helping this population to self-regulate their anger impulses.

Effectiveness of an innovative treatment protocol for misophonia in children and adolescents: Design of a randomized controlled trial

Background

Misophonia is a recently identified disorder in which individuals experience intense, uncontrollable and disproportional irritation, anger or disgust when confronted with specific sounds or stimuli associated with these sounds. Prevalence rates in children and adolescents are currently still to be investigated. The reported average age of onset is around 13 years, in clinical practice children from 8 years old are referred.Misophonia is associated with avoidance and anticipation anxiety, possibly leading to serious educational and social consequences for children and families. Worldwide, no evidence-based treatment exists specifically for children and adolescents with misophonia.This article presents the design of a randomized controlled trial testing the effectiveness of cognitive behavioral therapy (CBT) combined with psychomotor therapy (PMT) for misophonia in children and adolescents (aged 8-18).

Methods

In total, 82 patients will be randomly assigned to a treatment condition or waiting list condition of 3 months (WCG). Treatment consists of 7 weekly group therapy sessions (1.5 h CBT plus 1.5 h PMT) and a follow-up after 3 weeks. Pre and post treatment assessments will be conducted during a baseline assessment, after 3 and 6 months. The primary outcome will be assessed by the Amsterdam Misophonia Scale - Youth (AMISOS-Y) and secondary outcomes (e.g. quality of life) and putative predictors (e.g. parenting burden) will be studied.

Conclusion

This trial is the first study worldwide testing the effectiveness of a combined CBT plus PMT protocol for misophonia in children and adolescents. If proven effective, this protocol provides an innovation to improve care for youth with misophonia.

Effectiveness of Body Psychotherapy. A Systematic Review and Meta-Analysis

Despite the growing relevance and applicability of elements based on and derived from the embodied mind paradigm, body psychotherapy (BPT) appears not to be a well-established treatment option. This might be due to a lack of proof for its efficacy. We searched electronic databases (Pubmed MEDLINE, PsycInfo, and PSYNDEX) for randomized controlled trials (RCTs) examining predefined BPT interventions. A total of 2,180 references were screened, of which 113 studies were scrutinized in detail and 18 RCTs finally included. The observed effect size (ES) demonstrated medium effects of BPT on primary outcomes psychopathology and psychological distress. In case of significant statistical heterogeneity, exploratory subgroup analyses revealed diagnosis and the degree of control group activity as noteworthy moderators. For secondary outcomes, evidence was scarce, and an improvement could be demonstrated only for coping abilities. The identified evidence indicates that BPT is beneficial for a wide spectrum of psychic suffering. There is a strong need for high-quality studies with bigger samples and for well-defined diagnostic entities to underpin its effectiveness.

BEATVIC, a body-oriented resilience therapy using kickboxing exercises for people with a psychotic disorder: a feasibility study

BACKGROUND

People with a psychotic disorder have an increased risk of becoming the victim of a crime. To prevent victimization a body-oriented resilience therapy using kickboxing exercises was developed. This study aims to explore the feasibility of the therapy, to improve the therapy protocol and to explore suitable outcomes for a RCT.

METHODS

Twenty-four adults with a psychotic disorder received 20 weekly group sessions in which potential risk factors for victimization and strategies for dealing with them were addressed. Sessions were evaluated weekly. During pre and post assessment participants completed questionnaires on, among other, victimization, aggression regulation and social functioning.

RESULTS

The short recruitment period indicates the interest in such an intervention and the willingness of clients to participate. Mean attendance was 85.3 and 88% of the participants completed fifteen or more sessions. The therapy protocol was assessed as adequate and exercises as relevant with some small improvements to be made. The victimization and aggression regulation questionnaires were found to be suitable outcome measurements for a subsequent RCT.

CONCLUSION

The results support the feasibility of the BEATVIC therapy. Participants subjectively evaluated the intervention as helpful in their attempt to gain more self-esteem and assertiveness. With some minor changes in the protocol the effects of BEATVIC can be tested in a RCT.

TRIAL REGISTRATION

The trial registration number (TRN) is 35949 (date submitted 09/11/2018). Retrospectively registered.

Force production parameters as behavioural measures for anger expression and control: The Method of Stamp Strike Shout

This study presents first test results of a new performance-based, psychomotor method to measure anger expression and control, based on voice expression and physical force production in directional movement of arms and legs, called the Method of Stamp Strike Shout (MSSS). Recorded are the standardized impact of stamping on a force plate, hitting a punching bag, and the amplitude of shouting in a microphone at various force levels. The premise is, that these body behaviours stand for the ‘urge to act or shout’ that belongs to anger-related emotions. The MSSS is meant to be applied in addition to potentially biased self-report questionnaires and has been designed for diagnostic as well as therapeutic purposes in clinical practice. First, this paper focusses on the instrumentation, internal structure and reliability of the MSSS. An explorative study in a student sample (n = 104) shows correlation patterns between increasing and decreasing levels of force production within each subtest (Stamp, Strike and Shout) and between the three subtests. We found excellent internal consistency of the three subtests and high test-retest reliability. The parameters of increasing and decreasing force levels form the slopes of what we call a force pyramid. To adjust for the clustering within persons, aggregated outcomes were calculated: sum scores per subtest as an indication of total force produced, two linear contrast scores to indicate the rate of increase / decrease, and two quadratic contrast scores as measures of the curvature of the slopes. On all subtests, all aggregated scores showed differences between men and women, also when controlled for weight. To test the validity of the MSSS, the second part of the paper examines the relationship between force parameters and anger coping style, measured by the Self-Expression and Control Scale (SECS). The results suggest that the Shout subtest was the most sensitive indicator for anger coping style, showing negative correlations with Anger In, for women as well as men. For women, higher amplitude was also associated with higher Anger Out and lower amplitude with higher Anger Control. The Stamp subtest showed weak positive correlations with the Anger In subscales, whereas no correlations were found on the Strike subtest. Further, a more robust comparison was made between two groups of participants who reported to have an internalizing versus an externalizing anger coping style. Results indicated that internalizing women as well as men used less force than externalizing participants on all three subtests, especially on the Shout subtest. This was confirmed by lower mean sum scores on the Shout subtest for internalizing women compared with externalizing women. No differences in linear contrast scores were shown between internalizing and externalizing participants. The quadratic contrast scores suggested differences of the curvation of the slopes between women with more or less anger control when stamping, and men with more or less anger control when striking. As this is an explorative study, findings should be interpreted with caution.

Emotion Regulation as a Transdiagnostic Feature Among Eating Disorders: Cross-sectional and Longitudinal Approach

Emotion regulation (ER) difficulties are observed in eating disorders (EDs). However, few studies have explored ER before and after treatment. The aims are as follows: to explore ER difficulties across ED types and a healthy control (HC) group (Study 1) and to assess pretreatment and post-treatment changes among ED types (Study 2). In Study 1, adult women with EDs (n = 438) and HC (n = 126) completed an assessment including Eating Disorders Inventory-2, Difficulties in Emotion Regulation Scale and Symptom Checklist-90-Revised. Patients in Study 2 (n = 69) were also reassessed after treatment. All ED types reported worse ER compared with HC (p < .001); also, ER differences were found between ED types. Prospective analyses show ER improvements after treatment (p < .001; |d| = 0.51), especially in patients with bulimia nervosa (p < .001; |d| = 1.03; Reliable Change Index = 9.79) with greater improvement in those with a better treatment outcome (p = .034). In conclusion, emotion dysregulation is a part of all forms of EDs. Furthermore, emotional dysregulation can be modified. ED treatments for anorexia nervosa and binge eating disorder might be enhanced by targeting ER skills. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.