Implementing a condensed dialectical behavior therapy skills group for binge-eating behaviors in adolescents

Evaluating Emotional Eating in Children from the Perspective of Parents: Psychometric Properties of the Parent Version of the Emotional Eating Scale Adapted for Children and Adolescents

BACKGROUND

Emotional eating is associated with adverse health outcomes in children, including elevated weight status. Currently, there is not a well-validated parent-report measure of emotional eating for young children. This study assessed the reliability and validity of the 10-item parent version of the Emotional Eating Scale Adapted for Children and Adolescents (EES-C) Short-Form.

METHODS

The participants were 207 parents and 144 children from the southern United States. They completed the parent- and child-report EES-C Short-Form and responded to measures related to child eating behaviors, mood, and gratitude.

RESULTS

The parent-report EES-C Short-Form demonstrated good internal consistency reliability (Cronbach's alpha = 0.94). Test-retest reliability was also supported, as evidenced by a medium correlation (ICC = 0.56, p < 0.001) between parent-rated emotional eating across two time points. Additionally, the measure demonstrated a significant correlation with a scale of emotional overeating (r = 0.25, p < 0.001)-a theoretically related construct. Supporting discriminant validity, the measure was not significantly related to a measure of parent-reported gratitude (r = 0.07, p = 0.30). A unidimensional model provided good fit for the data (CFI = 0.997, SRMR = 0.046).

CONCLUSIONS

The results from the current study provide preliminary evidence supporting the reliability and validity of the parent version of the EES-C Short-Form. For the purpose of screening children in school or primary care settings, the EES-C Short-Form may be practical and helpful in identifying children who may be at risk of developing adverse health outcomes or more-severe eating disorder pathology.

Negative urgency, distress tolerance, and symptoms of substance use, eating, and borderline personality disorders in treatment-seeking young people

OBJECTIVE

Negative urgency (NU) and distress tolerance (DT) are two similar yet distinct constructs with putative transdiagnostic relevance, particularly across psychopathology characterized by impulsivity (e.g., substance use disorders [SUD], eating disorders featuring binging and/or purging ED-B/P, and borderline personality disorder [BPD]). Yet, there remains a lack of research into NU and DT across SUD, ED-B/P, and BPD symptomatology in clinical populations. The present study sought to elucidate the transdiagnostic utility of NU and DT across impulsive-type psychology by examining the unique and interactive roles of NU and DT across SUD, ED-B/P, and BPD symptomatology within a treatment-seeking sample of young people.

METHOD

Participants (N = 385; 62.3% female; aged 16-25 years) were recruited from youth health services across Melbourne, Australia. Participants completed an online survey including self-report measures of NU and DT as well as SUD, ED-B/P, and BPD symptoms. Mixed effects logistic regression was used to explore unique and interactive associations of NU and DT with symptoms.

RESULTS

Both NU (adjusted odds ratio [ORadj ] = 1.22; 95% confidence interval [CI] = [1.16, 1.28]) and global DT (ORadj  = 0.59; 95% CI = [0.47, 0.74]) uniquely predicted symptoms. However, associations with global DT and most of its components differed across psychopathology types. No significant interactions between NU and DT in predicting symptoms were found.

CONCLUSIONS

These results support the transdiagnostic utility of NU across SUD, ED-B/P, and BPD, while suggesting the role of DT across these disorders is more nuanced. These findings have important implications for NU and DT as potential intervention targets.

Binge-eating adolescent treatment (BEAT) - findings from a pilot study on effects and acceptance of a blended treatment program for youth with loss of control eating

BACKGROUND

Loss of Control Eating (LOC) is the most prevalent form of eating disorder pathology in youth, but research on evidence-based treatment in this group remains scarce. We assessed for the first time the effects and acceptance of a blended treatment program for youth between 14 and 24 years with LOC (Binge-eating Adolescent Treatment, BEAT).

METHODS

Twenty-four youths (mean age 19.1 years) participated in an active treatment of nine-weeks including three face-to-face workshops and six weekly email-guided self-help sessions, followed by four email guided follow-up sessions, one, three, six and 12 months after the active treatment. All patients completed a two-weeks waiting-time period before treatment begin (within-subject waitlist control design).

RESULTS

The number of weekly LOC episodes substantially decreased during both the waiting-time (effect size d = 0.45) and the active treatment (d = 1.01) period and remained stable during the subsequent 12-months follow-up (d = 0.20). The proportion of patients with full-threshold binge-eating disorder (BED) diagnoses decreased and transformed into LOC during the study course, while the abstainer rate of LOC increased. Values for depressive symptoms (d = 1.5), eating disorder pathology (d = 1.29) and appearance-based rejection sensitivity (d = 0.68) all improved on average from pretreatment to posttreatment and remained stable or further improved during follow-up (d between 0.11 and 0.85). Body weight in contrast remained constant within the same period. Treatment satisfaction among completers was high, but so was the dropout rate of 45.8% at the end of the 12-months follow-up.

CONCLUSIONS

This first blended treatment study BEAT might be well suited to decrease core symptoms of LOC, depressive symptoms and appearance-based rejection sensitivity. More research is needed to establish readily accessible interventions targeted more profoundly at age-salient maintaining factors such as appearance-based rejection sensitivity, while at the same time keeping dropout rates at a low level.

TRIAL REGISTRATION

The trial was registered at the German Clinical Trials Register (ID: DRKS00014580; registration date: 21/06/2018).

Evidence Based Update on Psychosocial Treatments for Eating Disorders in Children and Adolescents

Eating disorders (EDs) are life-threatening psychiatric illnesses that occur in adolescents. Unfortunately, limited randomized controlled trials exist to address EDs in this vulnerable population. The current review updates a prior Journal of Clinical Child and Adolescent Psychology review from 2015. The recommendations in this review build upon those that were previously published. This update was completed through a systematic search of three major scientific databases (PsychInfo, Pubmed, and Cochrane) from 2015 to 2022 (inclusively) from three databases, employing relevant medial subject headings. Additionally, expert colleagues were asked for additional literature to include. Thirty-one new studies were added to this review. Psychosocial treatments included family therapies, individual therapy, cognitive-behavioral therapy, interpersonal psychotherapy, cognitive training, dialectical behavioral therapy, and more recently, virtual or telehealth-based practices and guided self-help modalities for carers of youth with EDs. Using the Journal of Clinical Child and Adolescent Psychology's methodological review criteria, this update found behavioral family-based treatment modalities (FBT) for both adolescent anorexia nervosa and bulimia nervosa met well-established treatment criteria. To date, there were no well-established treatments found for child and adolescent avoidant-restrictive food intake disorder, or binge eating disorder. Internet facilitated cognitive-behavioral therapy and family-based therapy were found to be possibly efficacious for binge eating disorder. Family-based treatment was found to be possibly efficacious for avoidant restrictive food intake disorder, with other clinical trials for cognitive treatment modalities under way. Ongoing research examining treatments for eating disorders in children and adolescents broadly is needed.

Addressing Structural Racism Is Critical for Ameliorating the Childhood Obesity Epidemic in Black Youth

Racism and childhood obesity are both pervasive factors adversely affecting the health and wellbeing of children and adolescents in the United States. The association between racism and obesity has been touched upon in the literature; yet most work has focused on a few dimensions of intersectionality of these two domains at one time. The renewed focus on structural racism as the primary contributor to distress of Black individuals in the United States has highlighted the urgency of identifying the contributions of racism to the childhood obesity epidemic. The current article is not a complete review of the literature, rather, it is meant to take a broad narrative review of the myriad ways in which racism contributes to the obesity epidemic in Black youth to serve as a call to action for more research, prevention, and intervention. The current article illustrates how a number of mechanisms for the etiology and maintenance of obesity are heavily influenced by racism and how addressing racism is critical for ameliorating the childhood obesity epidemic.

Predictors of Symptom Trajectories After Cognitive-Behavioral Therapy in Adolescents With an Age-Adapted Diagnosis of Binge-Eating Disorder

Although evidence demonstrated efficacy of cognitive-behavioral therapy (CBT) in adolescents with binge-eating disorder (BED), treatment response is heterogeneous. This study uniquely examined baseline predictors of symptom trajectories in N = 73 adolescents (12-20 years) with an age-adapted diagnosis of BED (i.e., based on objective and subjective binge-eating episodes). Based on evidence from adult BED, dietary restraint, overvaluation of weight/shape, and depressive symptoms were used to predict changes in abstinence from binge eating and eating disorder psychopathology after 4 months of individual, face-to-face CBT using growth models. Longitudinal trajectories of abstinence from objective and subjective binge eating and global eating disorder psychopathology assessed via the Eating Disorder Examination were modeled for five time points (pre- and posttreatment, 6-, 12-, and 24-month follow-up). Beyond significant, positive effects for time, no significant predictors for abstinence from binge eating emerged. In addition to significant decreases in eating disorder psychopathology over time, higher pretreatment dietary restraint and overvaluation of weight/shape significantly predicted greater decreases in eating disorder psychopathology over time. Consistent with research in adult BED, adolescents with higher than lower eating disorder-specific psychopathology especially benefit from CBT indicating that restrained eating and overvaluation of weight/shape may be BED-specific prognostic characteristic across developmental stages. Future predictor studies with an additional focus on potential age-specific predictors, such as family factors, and within-treatment processes may be critical in further evaluating treatment-related symptom trajectories in adolescent BED.

A systematic review of cognitive behavior therapy and dialectical behavior therapy for adolescent eating disorders

BACKGROUND

Eating disorders have serious psychological and physical consequences. Current evidence-based treatments for adolescents with eating disorders have modest effects, underscoring the need to improve current treatment approaches. Cognitive behavior therapy (CBT) and dialectical behavior therapy (DBT) have been proposed as alternative treatment options, with burgeoning research in this area. This review aims to summarize and critically analyze the current literature on the feasibility, acceptability, effectiveness, and efficacy of CBT and DBT for adolescent eating disorders, and then proposes areas of future research.

METHODS

PsycINFO and PubMed were searched using the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines to identify studies examining the feasibility, acceptability, effectiveness and/or efficacy of CBT or DBT for adolescent eating disorders.

RESULTS

Eligible studies (N = 50; CBT: n = 40, DBT: n = 10) indicated that both treatments are reasonably feasible, acceptable, and possibly effective for adolescent eating disorders across diagnoses and levels of care, though efficacy trials are lacking.

CONCLUSIONS

CBT and DBT demonstrate promise as alternatives to family-based approaches for adolescent eating disorders. Adequately powered trials to establish the effectiveness and efficacy of CBT and DBT are needed, particularly ones that compare these treatments against other leading approaches. Despite high rates of relapse and likelihood for severe and enduring illness, there is a dearth of evidence-based treatment options for adolescents with eating disorders. Potentially viable but less well-studied treatments for adolescents with eating disorders include cognitive behavior therapy (CBT) and dialectical behavior therapy (DBT). This systematic review of CBT and DBT for adolescent eating disorders focuses on feasibility (i.e., how easy it was to implement the treatment), acceptability (i.e., how well the intervention was received by patients and therapists), effectiveness (i.e., how well the intervention performed under routine, real-world circumstances), and efficacy (i.e., how well the intervention performed in highly-controlled research settings). This review concludes that research supports the feasibility and acceptability of these approaches, as well as preliminary evidence of their effectiveness. However, the field is lacking studies that systematically compare CBT and DBT to other evidence-based approaches. Recommendations to advance research on CBT and DBT for adolescent eating disorders are provided, including a call for efficacy studies that clarify their performance compared to other leading approaches.

Two decades of mindfulness-based interventions for binge eating: A systematic review and meta-analysis

OBJECTIVE

Mindfulness-based interventions (MBIs) are being increasingly used as interventions for eating disorders including binge eating. This systematic review and meta-analysis aimed to assess two decades of research on the efficacy of MBIs in reducing binge eating severity.

METHODS

We searched PubMed, Scopus and Cochrane Library for trials assessing the use of MBIs to treat binge eating severity in both clinical and non-clinical samples. The systematic review and meta-analysis was pre-registered at PROSPERO (CRD42020182395).

RESULTS

Twenty studies involving 21 samples (11 RCT and 10 uncontrolled samples) met inclusion criteria. Random effects meta-analyses on the 11 RCT samples (n = 618: MBIs n = 335, controls n = 283) showed that MBIs significantly reduced binge eating severity (g = -0.39, 95% CI -0.68, -0.11) at end of trial, but was not maintained at follow-up (g = -0.06, 95% CI, -0.31, 0.20, k = 5). No evidence of publication bias was detected. On the Cochrane Risk of Bias Tool 2, trials were rarely rated at high risk of bias and drop-out rates did not differ between MBIs and control groups. MBIs also significantly reduced depression, and improved both emotion regulation and mindfulness ability.

CONCLUSION

MBIs reduce binge eating severity at the end of trials. Benefits were not maintained at follow-up; however, only five studies were assessed. Future well-powered trials should focus on assessing diversity better, including more men and people from ethnic minority backgrounds.

Adolescent Engagement in a Binge-Eating Behavioral Health Intervention: Influence of Perceptions of Physical Appearance and Locus of Control

Traditional weight management approaches focused solely on weight loss as a measure of success may lead youth to internalize negative beliefs about their appearance, and feel they have little control over their health. We examined how perceptions of appearance and health-related locus of control (HRLOC) influenced engagement and outcomes in a behavioral health intervention for binge eating. Thirty adolescents aged 14-18 years completed measures of self-perception, HRLOC, and eating behaviors. Half (n = 15) completed baseline assessments only, while the other half participated in a 10-week intervention targeting dysregulated eating behaviors. Analyses revealed negative perceptions of physical appearance and internal HRLOC were higher at baseline among youth who completed the intervention compared to those who completed baseline assessments only. Among those completing the intervention, however, greater internal HRLOC and more positive perception of physical appearance at baseline was associated with greater reduction in objective binge episodes and emotional eating post-intervention. Findings of the present study suggest that while having a more negative perception of one's appearance may initially motivate youth to participate in weight-related interventions, such perceptions can actually lead to poorer health outcomes, and further supports the extant literature on the benefits of interventions that engender positive body image.

Emotional Eating and Weight Status in Adolescents: A Systematic Review

BACKGROUND

Despite evidence that emotional eating is associated with weight gain in adults, less is known about this association in adolescents. The purpose of the current study was to conduct a systematic review to assess the association between emotional eating and weight status in adolescents. This study also sought to describe existing measures of emotional eating in adolescents and explore weight-loss interventions that assessed emotional eating in relation to weight status in this population.

METHODS

Two independent reviewers searched the database PubMed for published or in press peer-reviewed studies that assessed the association between emotional eating and weight status in adolescents aged 12 to 19 years. Studies were excluded from this review if they were not written in the English language, did not include a measure of emotional eating, or were a dissertation study.

RESULTS

A total of 13 studies met full inclusion criteria and were included in the systematic review. Of the six longitudinal studies in the review, only one found a prospective association between emotional eating and weight status. The Dutch Eating Behavior Questionnaire was the most widely used measure of emotional eating in the systematic review (n = 6; 46.2%). The one intervention study included in this review found that baseline emotional eating was not associated with weight outcomes 2 years following gastric bypass surgery in obese Swedish adolescents (13-18 years).

CONCLUSIONS

While there were some inconsistent findings across the studies included in this review, taken as a whole, the results largely do not support an association between emotional eating and elevated weight status or reduced weight loss in adolescents.

Do Mindfulness Interventions Improve Obesity Rates in Children and Adolescents: A Review of the Evidence

Mindfulness interventions have shown promise in improving self-regulation, depression, anxiety, and stress levels across all ages. Obesity rates in children are rising worldwide. It has been postulated that through improvements in self-regulation with mindfulness interventions, obesity rates can be improved in children and adolescents. In this review, we attempt to explain how mindfulness interventions may impact obesity rates and obesity-related complications and give the current state of evidence for the following mindfulness interventions: Mindful Eating, Mindfulness-Based Stress Reduction, Yoga, Spirituality, and Dialectical Behavior Therapy.

The moderating effects of mindful eating on the relationship between emotional functioning and eating styles in overweight and obese women

PURPOSE

The aim of the current study was to examine the moderating effect of mindful eating on the relationship between emotional functioning and eating styles in overweight and obese women.

METHODS

One hundred and eighty four overweight and obese adult women (BMI 30.12 ± 3.77 kg/m²) were assessed with the Difficulties in Emotion Regulation Scale, the Positive and Negative Affect Schedule, the Three Factor Eating Questionnaire and the Mindful Eating Scale.

RESULTS

Mindful eating significantly moderated several of the relationships between emotional functioning and eating styles. At all levels of mindful eating, emotion dysregulation and negative affect are both associated with greater emotional eating, but with stronger associations for high levels of mindful eating. For people low in mindful eating, both emotion dysregulation and negative affect are associated with lower restrictive eating, and neither of them are associated with uncontrolled eating. For people high in mindful eating, neither emotion dysregulation nor negative affect are associated with restrictive eating, and only negative affect is associated with greater uncontrolled eating.

CONCLUSION

When mindful eating techniques are included as part of an intervention for overweight or obese individuals, it is even more important that those interventions should also include techniques to reduce emotion dysregulation and negative affect.

LEVEL OF EVIDENCE

Level V, descriptive study.

Endorsement of Binge Eating Symptoms in a Sample of Predominantly Non-Hispanic Black Adolescents

Binge eating disorder (BED) as well as individual subthreshold binge eating symptoms are related to deleterious physical and socioemotional outcomes among adolescents. The present study examined the prevalence of specific binge eating behaviors among a sample of primarily non-Hispanic Black outpatients presenting to weight management and endocrinology clinics. Analyses are based on 103 adolescents (69.9% female, 66.9% non-Hispanic Black) who endorsed one or more binge eating symptoms on a nonstandardized clinical assessment patterned after Diagnostic Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria. The most commonly endorsed symptom was eating in excess of what is considered normal (71.8%), while least commonly endorsed symptoms included guilt, distress, and embarrassment due to overeating (17.5% to 26.2%). More than half of the participants endorsed multiple specific binge eating symptoms. The level of subthreshold symptomatology reported underscores the importance of developmental and cultural tailoring of prevention and intervention efforts to address these behaviors as a means of curbing clinical-level onset of BED.

The role of self-monitoring metacognition sub-function and negative urgency related to binge severity

OBJECTIVE

This study aims to test a model where low self-monitoring (a sub-function of first-person domain of metacognition) and high negative urgency lead to a worsening of binge severity through the mediation of emotional dysregulation in patients with binge eating disorder (BED).

METHOD

Forty non-BED-obese and 46 BED-obese patients completed a battery of tests assessing metacognition and psychopathology. To test our hypothesized model, a structural equation model (SEM) using maximum likelihood estimation was conducted.

RESULTS

BED-obese patients had significantly higher scores in BES, UPPS-P Negative urgency, and DERS total score, and lower MSAS self-monitoring than non-BED-obese, while no differences emerged in the MSAS others-monitoring subscale. The structural model demonstrated very good fit indexes (χ² = 1.377, df = 2; p = .502, CMIN/DF = 0.688, CFI = 1.000, RMSEA = 0.000, TLI = 1.047) and all paths were significant in the predicted directions.

CONCLUSIONS

These preliminary findings show that, low self-monitoring and high negative urgency lead BED-obese patients to express the worsening of binge severity through the mediation of emotional dysregulation. This knowledge may be helpful in the clinical practice to develop a tailor-made treatment. Accordingly, an approach through Metacognitive Interpersonal Therapy could be attempted in BED-obese patients with these characteristics. Highlights Patients with BED exhibited low self-monitoring and high negative urgency. Binge severity was mediated by high level of emotional dysregulation. Metacognitive Interpersonal Therapy may be useful for BED patients.

Acceptance-based skill acquisition and cognitive reappraisal in a culturally responsive treatment for binge eating in adolescence

Emotional overeating, or eating in excess to soothe negative emotions, is a high-risk behavior for the future development of the binge-eating disorder (BED). The Emotional Overeating Intervention (EOI) is a culturally responsive, 10-week condensed dialectical behavior therapy (DBT) skills group intervention for adolescents endorsing emotional-overeating and binge-eating behaviors. The present study served as a secondary analysis of the intervention data, with the aim of using quantitative measures and qualitative interviews to examine intervention acceptability and DBT skill acquisition. Data were analyzed using descriptive statistics for quantitative surveys and qualitative content analysis for interviews. Among the 15 adolescents (M_age = 15.40 years; 73.3% identifying as female; 100% identifying as Black) who participated in the EOI pilot trial, most identified learning acceptance-based DBT skills, particularly radical acceptance, as both highly acceptable and the most useful aspect of treatment. Participants reported increases in distress tolerance appraisal and emotion regulation cognitive reappraisal scale scores from baseline to post-intervention. Accordingly, acceptance-based DBT skills may be associated with change-based cognitive strategies, which may contribute to improvements in emerging BED pathology. Findings serve as an initial step in informing preventative models of scalable interventions for subthreshold BED among adolescents, by identifying variables that warrant investigation as potential mechanisms of change.

A developmental framework of binge-eating disorder based on pediatric loss of control eating

Although binge-eating disorder may manifest in childhood, a significantly larger proportion of youth report episodes involving a loss of control while eating, the hallmark feature of binge eating that predicts excess weight gain and obesity. Adults with binge-eating disorder often report that symptoms emerged during childhood or adolescence, suggesting that a developmental perspective of binge eating may be warranted. Thus, loss of control eating may be a marker of prodromal binge-eating disorder among certain susceptible youth. The present article offers a broad developmental framework of binge-eating disorder and proposes areas of future research to determine which youths with loss of control eating are at risk for persistent and exacerbated behavior that may develop into binge-eating disorder and adult obesity. To this end, this article provides an overview of loss of control eating in childhood and adolescence, including its characterization, etiology, and clinical significance, with a particular focus on associations with metabolic risk, weight gain, and obesity. A conceptual model is proposed to further elucidate the mechanisms that may play a role in determining which youths with loss of control are at greatest risk for binge-eating disorder and obesity. Ways in which treatments for adult binge-eating disorder may inform approaches to reduce loss of control eating and prevent excess weight gain in youth are discussed. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Impact on mindfulness, emotion regulation, and emotional overeating of a DBT skills training group: a pilot study

PURPOSE

The current study investigated the impact of a modified Dialectical Behavior Therapy skills (DBT) training group for patients at a hospital outpatient weight management clinic. Emotional eating is a problematic strategy for managing unpleasant feelings that can have a deleterious impact on weight management. DBT addresses emotional dysregulation via incorporation of skills aimed at coping with unpleasant affect.

METHODS

This study examines outcomes for 18 patients who participated in a 12-week DBT skills building group. A pre-post design with 3-month follow-up investigated the impact of the group on emotional eating, psychological distress, emotion regulation, and mindfulness.

RESULTS

Four repeated measures ANOVAs were run to assess for changes related to life difficulties and functioning, emotional overeating, emotion regulation, and mindfulness. Fisher's LSD tests assessed for linear and quadratic trends. Improvements in mindfulness, emotion regulation, and emotional overeating were found; these were maintained at follow-up.

CONCLUSIONS

This study demonstrated the utility of a group-based intervention aimed at improving emotion regulation and mindfulness skills among weight management patients. Further study is needed to determine whether improvements in the constructs studied in this research would translate to improved weight management outcomes and in determining the pathway for improvements.

LEVEL OF EVIDENCE

Level IV, multiple time series with intervention.