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Chen G, Wang X, Barnhart WR, Fu Y, He J. Exploring the moderating roles of dispositional mindfulness and body image flexibility in the association between body dissatisfaction and disordered eating in Chinese adolescents. J Clin Psychol 2024; 80:1998-2013. [PMID: 38781606 DOI: 10.1002/jclp.23706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 04/06/2024] [Accepted: 05/10/2024] [Indexed: 05/25/2024]
Abstract
OBJECTIVES Previous research suggests potential moderating roles of dispositional mindfulness and body image flexibility in the association between body dissatisfaction and disordered eating. However, relevant research is mainly conducted on adult women from Western countries, and limited evidence exists for adolescent samples, especially from non-Western contexts (e.g., China). Thus, this study aimed to examine the moderating roles of dispositional mindfulness and body image flexibility in the relationship between body dissatisfaction and disordered eating in Chinese adolescents. METHOD We recruited 545 Chinese adolescents (53.9% boys, aged 12-16 years) who completed measures of body dissatisfaction, dispositional mindfulness, body image flexibility, and disordered eating. Moderation analyses were examined with PROCESS macro on SPSS. RESULTS In separate models, both higher dispositional mindfulness and body image flexibility weakened relationships between body dissatisfaction and disordered eating. However, when both dispositional mindfulness and body image flexibility were entered into the same moderation model, only body image flexibility showed a significant moderating effect. DISCUSSION Both dispositional mindfulness and body image flexibility may weaken the association between body dissatisfaction and disordered eating in adolescents. However, body image flexibility might have a stronger effect than dispositional mindfulness. These findings suggest that interventions aimed at reducing body dissatisfaction to prevent disordered eating in adolescents may pay more attention to adolescents' body image flexibility.
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Affiliation(s)
- Gui Chen
- Department of Psychology, College of Educational Science, Hengyang Normal University, Hengyang, Hunan, China
| | - Xingchang Wang
- Department of Psychology, College of Educational Science, Hengyang Normal University, Hengyang, Hunan, China
| | - Wesley R Barnhart
- Department of Psychology, Bowling Green State University, Bowling Green, Ohio, USA
| | - Yuru Fu
- Division of Applied Psychology, School of Humanities and Social Science, The Chinese University of Hong Kong, Shenzhen, Guangdong, China
| | - Jinbo He
- Division of Applied Psychology, School of Humanities and Social Science, The Chinese University of Hong Kong, Shenzhen, Guangdong, China
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Peterson CB, Weber E, Sim L. Optimizing treatment environments for trait sensitivity in eating disorders. Eat Disord 2024; 32:325-339. [PMID: 38291724 DOI: 10.1080/10640266.2024.2306429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
Research has identified trait sensitivity as a potential risk factor and treatment target of eating disorders. Conceptualizations of trait sensitivity have depicted individuals with high and low trait sensitivity metaphorically as orchids and dandelions, highlighting their responsiveness to environmental conditions and associated outcomes. While orchids require careful tending to survive, with such care, they emerge extraordinary. In contrast, dandelions can survive a broad range of environmental conditions. Within a scientific framework, trait sensitivity can be conceptualized as neurobiologically-based, with heightened sensory, interoceptive, interpersonal, and emotional processing. While trait sensitivity may increase susceptibility to eating disorders, when therapists view these traits through the lens of environmental responsiveness, they can facilitate their client's inherent resilience and potential. Incorporating a model of trait sensitivity into eating disorders treatment using psychoeducation, modifying environmental stimuli, and selecting optimal interventions has the potential to increase treatment engagement, deepen therapeutic collaboration, and improve outcomes.
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Affiliation(s)
- Carol B Peterson
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Elise Weber
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Leslie Sim
- Department of Psychiatry and Psychology, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
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Gopan H, Rajkumar E, Gopi A, Romate J. Mindfulness-based interventions for body image dissatisfaction among clinical population: A systematic review and meta-analysis. Br J Health Psychol 2024; 29:488-509. [PMID: 38097499 DOI: 10.1111/bjhp.12710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 11/30/2023] [Indexed: 04/09/2024]
Abstract
PURPOSE Mindfulness-based interventions (MBIs) are well-validated interventions to enhance the favourable body image of individuals. Despite their wide application, the efficacy of MBIs in reducing body image dissatisfaction (BID) among various clinical populations remains unclear. This study aims to expand the literature on MBIs for BID and identify effective types of MBIs for reducing BID in diverse clinical populations for future research and practice. METHODS A systematic search for studies published in English on the effectiveness of MBIs for BID among the clinical population was done on APA PsycNet, PubMed, Science Direct, Web of Science and Google Scholar databases in August 2023. Of the 1962 articles initially identified, 17 were found eligible and evaluated based on the JBI checklist. RESULTS Random effects meta-analyses on six MBIs revealed their effectiveness in reducing BID among the clinical population (SMD = -.59 and 95% CI = -1.03 to -.15, p = .009), with Acceptance and Commitment Therapy (ACT) (SMD = -1.29, 95% CI = -2.06 to -.52, p = .001) and My Changed Body (MyCB) (SMD = -.24, 95% CI = -.46 to -.01, p = .04) reporting significant effect sizes. Among the patients with breast cancer, MyCB (SMD = -.24, 95% CI = -.46 to -.01, p = .04) showed a significant effect size. CONCLUSIONS MBIs appear to be promising interventions in reducing BID among the clinical population. However, findings should be considered cautiously due to the possible publication bias, high heterogeneity and fewer available studies.
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Affiliation(s)
- Hrishi Gopan
- Department of Psychology, Central University of Karnataka, Kalaburagi, India
| | - Eslavath Rajkumar
- Department of Liberal Arts, Indian Institute of Technology Bhilai, Durg, Chhattisgarh, India
| | - Aswathy Gopi
- Department of Psychology, Central University of Karnataka, Kalaburagi, India
| | - John Romate
- Department of Psychology, Central University of Karnataka, Kalaburagi, India
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Hendricks E, Jenkinson E, Falconer L, Griffiths C. How effective are psychosocial interventions at improving body image and reducing disordered eating in adult men? A systematic review. Body Image 2023; 47:101612. [PMID: 37683303 DOI: 10.1016/j.bodyim.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 08/07/2023] [Accepted: 08/15/2023] [Indexed: 09/10/2023]
Abstract
Disordered eating and body image concerns significantly impact a growing number of men. This systematic review assessed the evidence of the effectiveness of psychosocial interventions to improve body image and eating pathology in men. Searches were conducted in December 2022 in 13 databases (PsycINFO, MEDLINE, CINAHL Plus, AMED, PubMed, Scopus, Cochrane, EMBASE, ASSIA, British Nursing Index, Wiley and OpenGrey). Studies that quantitatively evaluated psychosocial interventions and reported pre-post body image or disordered eating outcomes in men aged 18 years and over were eligible. Articles including boys, uncontrolled designs, or not in English were excluded. Findings were narratively synthesised and presented according to intervention approach. Quality was assessed using EPHPP. Eight studies including six RCTs were reviewed. Five were assessed as being moderate quality and three as weak. Evidence from moderate quality studies suggested that dissonance-based interventions showed promising improvements in body image and disordered eating for up to six months post-intervention in men with and without body dissatisfaction. Evidence for media literacy and psychoeducational interventions was limited. Findings were limited by heterogeneity in outcome measures and homogeneity of participants preventing generalisability. Robust research with longer follow-ups is needed to confirm effectiveness.
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Affiliation(s)
- Emma Hendricks
- School of Social Sciences, University of the West of England, Bristol BS16 1QY, UK.
| | - Elizabeth Jenkinson
- School of Social Sciences, University of the West of England, Bristol BS16 1QY, UK
| | - Laura Falconer
- School of Social Sciences, University of the West of England, Bristol BS16 1QY, UK
| | - Catrin Griffiths
- Faculty of Medicine, Health and Life Science, Swansea University, Swansea SA1 8EN, UK
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Choquette EM, Flux MC, Moseman SE, Chappelle S, Naegele J, Upshaw V, Morton A, Paulus MP, Feinstein JS, Khalsa SS. The impact of floatation therapy on body image and anxiety in anorexia nervosa: a randomised clinical efficacy trial. EClinicalMedicine 2023; 64:102173. [PMID: 37936658 PMCID: PMC10626164 DOI: 10.1016/j.eclinm.2023.102173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 08/05/2023] [Accepted: 08/08/2023] [Indexed: 11/09/2023] Open
Abstract
Background Body image disturbance and anxiety are core features of anorexia nervosa (AN), a psychiatric disorder with one of the highest mortality rates. This study examined the efficacy of a novel non-pharmacological treatment, floatation-REST (Reduced Environmental Stimulation Therapy) on body image disturbance and anxiety in inpatients with AN. Methods This parallel group randomised controlled trial compared floatation-REST vs. care as usual in women and girls hospitalised for treatment of AN in Tulsa, Oklahoma, USA. Participants were randomised on a 2:1 ratio to receive eight, twice-weekly, 60-min floatation-REST sessions for 4 weeks, in addition to care as usual, or to receive care as usual. The primary outcome was the average change in body dissatisfaction from pre- to post-float as measured by the Photographic Figure Rating Scale. The secondary outcome was the average change in anxiety from pre- to post-float as measured by the state version of the State Trait Anxiety Inventory. Longitudinal effects of floatation-REST on body dissatisfaction were also examined. All analyses were conducted using the intention-to-treat principle. Planned linear mixed models tested the effect of floatation-REST vs. care as usual. The trial was preregistered (clinicaltrials.govNCT03610451). Findings Between March 16, 2018 and February 25, 2021, 133 participants were screened for eligibility, and 86 were consented. Eighteen were excluded after consent, for a final randomisation sample of 68 participants (45 floatation-REST; 23 care as usual). There were two session by condition interactions on body dissatisfaction (p = 0.00026) and state anxiety (p < 0.0001), such that the floatation-REST group exhibited acute (i.e., pre- to post-session) reductions in body dissatisfaction (floatation-REST group mean change (Δm) = -0.43; 95% CI -0.56 to -0.30, p < 0.0001, Cohen's d = 0.23), and acute reductions in anxiety (floatation-REST group Δm = -15.75; 95% CI -17.95 to -13.56, p < 0.0001, Cohen's d = 1.52); however, the care as usual group exhibited no significant changes. With regard to longitudinal results, there was a significant time by treatment interaction between baseline and immediately post intervention (p = 0.012) and baseline and six-month follow up (p = 0.0019). At immediately post intervention, there was a trending reduction in body dissatisfaction for the floatation-REST group (Δm = -0.41, 95% CI -0.86 to 0.03, p = 0.068) and care as usual group (Δm = 0.61; 95% CI -0.04 to 1.27, p = 0.070). At six-months post-intervention, the floatation-REST group exhibited lower body dissatisfaction (Δm = -0.91; 95% CI -1.37 to -0.45, p = 0.0020, Cohen's d = 0.53) whereas the care as usual group reported no change in body dissatisfaction (Δm = 0.35; 95% CI -0.28 to 0.98, p = 0.96) relative to baseline. There were no adverse events related to the trial during the study. Interpretation Our findings suggest that Floatation-REST decreased body dissatisfaction compared to care as usual acutely after each float session and at six-month follow-up. Floatation-REST has potential utility for the treatment of body image disturbance and anxiety in AN. These results may be limited by some generalisability concerns given the recruitment of a modest sample receiving inpatient treatment at a single site. Funding The William K. Warren Foundation.
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Affiliation(s)
| | | | - Scott E. Moseman
- Laureate Eating Disorders Program, Saint Francis Health System, Tulsa, Oklahoma, USA
| | | | | | - Valerie Upshaw
- Laureate Institute for Brain Research, Tulsa, Oklahoma, USA
| | - Alexa Morton
- Laureate Institute for Brain Research, Tulsa, Oklahoma, USA
| | - Martin P. Paulus
- Laureate Institute for Brain Research, Tulsa, Oklahoma, USA
- Oxley College of Health Sciences, University of Tulsa, Tulsa, Oklahoma, USA
| | - Justin S. Feinstein
- Laureate Institute for Brain Research, Tulsa, Oklahoma, USA
- Float Research Collective, Kihei, Hawaii, USA
| | - Sahib S. Khalsa
- Laureate Institute for Brain Research, Tulsa, Oklahoma, USA
- Oxley College of Health Sciences, University of Tulsa, Tulsa, Oklahoma, USA
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Peschel SKV, Fürtjes S, Voss C, Sigrist C, Berwanger J, Ollmann TM, Kische H, Rückert F, Koenig J, Beesdo-Baum K. Temporal associations between experiential avoidance and disordered eating behaviors in adolescents and young adults: findings from an epidemiological cohort study with ecological momentary assessment. Eat Weight Disord 2023; 28:58. [PMID: 37405497 DOI: 10.1007/s40519-023-01584-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 06/27/2023] [Indexed: 07/06/2023] Open
Abstract
PURPOSE Previous studies linking experiential avoidance (EA) and eating pathology have largely relied on single measurements based on traditional retrospective questionnaires. Taking advantage of available repeated assessments of EA and disordered eating behaviors (DEBs) in the everyday lives of young people from an epidemiological cohort, we aimed to investigate ecologically valid temporal associations between these constructs. METHODS A random population sample of N = 1180 14-21-year-olds from Dresden, Germany, participated at baseline (2015/2016). As part of smartphone-based ecological momentary assessment (EMA), participants reported on engagement in EA and four DEBs (skipping eating, eating large amounts of food, loss-of-control eating, and restrained eating) up to eight times per day for four days. Multilevel modeling of concurrent and time-lagged associations between EA and DEBs, was conducted among those with at least 50% EMA-compliance (n = 1069). RESULTS EA was associated with higher concurrent levels of all four types of concurrent DEBs. In addition, EA significantly predicted subsequent levels of restrained eating. Only loss-of-control eating significantly predicted subsequent EA, and this effect depended on the timespan between consecutive assessments. When this timespan was short, higher Loss-of-control eating predicted lower subsequent EA, while it predicted higher subsequent EA when the timespan was longer. CONCLUSION The present findings suggest that EA is temporally closely linked to greater engagement in DEBs, supporting theoretical assumptions that DEBs may serve an attempted avoidance function in the context of unpleasant inner experiences. Future studies may benefit from examining samples with more pronounced eating pathology. LEVEL OF EVIDENCE Level IV: Evidence obtained from multiple time series with or without the intervention, such as case studies.
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Affiliation(s)
- Stephanie K V Peschel
- Behavioral Epidemiology, Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany.
| | - Sophia Fürtjes
- Behavioral Epidemiology, Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Catharina Voss
- Behavioral Epidemiology, Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Christine Sigrist
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Johanna Berwanger
- Behavioral Epidemiology, Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Theresa M Ollmann
- Behavioral Epidemiology, Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Hanna Kische
- Behavioral Epidemiology, Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Frank Rückert
- Behavioral Epidemiology, Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Julian Koenig
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Katja Beesdo-Baum
- Behavioral Epidemiology, Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
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Brewerton TD. The integrated treatment of eating disorders, posttraumatic stress disorder, and psychiatric comorbidity: a commentary on the evolution of principles and guidelines. Front Psychiatry 2023; 14:1149433. [PMID: 37252137 PMCID: PMC10213703 DOI: 10.3389/fpsyt.2023.1149433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 04/18/2023] [Indexed: 05/31/2023] Open
Abstract
Psychiatric comorbidity is the norm in the assessment and treatment of eating disorders (EDs), and traumatic events and lifetime PTSD are often major drivers of these challenging complexities. Given that trauma, PTSD, and psychiatric comorbidity significantly influence ED outcomes, it is imperative that these problems be appropriately addressed in ED practice guidelines. The presence of associated psychiatric comorbidity is noted in some but not all sets of existing guidelines, but they mostly do little to address the problem other than referring to independent guidelines for other disorders. This disconnect perpetuates a "silo effect," in which each set of guidelines do not address the complexity of the other comorbidities. Although there are several published practice guidelines for the treatment of EDs, and likewise, there are several published practice guidelines for the treatment of PTSD, none of them specifically address ED + PTSD. The result is a lack of integration between ED and PTSD treatment providers, which often leads to fragmented, incomplete, uncoordinated and ineffective care of severely ill patients with ED + PTSD. This situation can inadvertently promote chronicity and multimorbidity and may be particularly relevant for patients treated in higher levels of care, where prevalence rates of concurrent PTSD reach as high as 50% with many more having subthreshold PTSD. Although there has been some progress in the recognition and treatment of ED + PTSD, recommendations for treating this common comorbidity remain undeveloped, particularly when there are other co-occurring psychiatric disorders, such as mood, anxiety, dissociative, substance use, impulse control, obsessive-compulsive, attention-deficit hyperactivity, and personality disorders, all of which may also be trauma-related. In this commentary, guidelines for assessing and treating patients with ED + PTSD and related comorbidity are critically reviewed. An integrated set of principles used in treatment planning of PTSD and trauma-related disorders is recommended in the context of intensive ED therapy. These principles and strategies are borrowed from several relevant evidence-based approaches. Evidence suggests that continuing with traditional single-disorder focused, sequential treatment models that do not prioritize integrated, trauma-focused treatment approaches are short-sighted and often inadvertently perpetuate this dangerous multimorbidity. Future ED practice guidelines would do well to address concurrent illness in more depth.
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ZHAO W, CHONG YY, CHIEN WT. Effectiveness of cognitive-based interventions for improving body image of breast cancer patients: A systematic review and meta-analysis. Asia Pac J Oncol Nurs 2023; 10:100213. [PMID: 37089782 PMCID: PMC10120298 DOI: 10.1016/j.apjon.2023.100213] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 02/16/2023] [Indexed: 02/25/2023] Open
Abstract
Objective Breast cancer patients often suffer from body image disturbance due to impairment of their body/appearance resulting from surgeries, other cancer treatments, and/or their complications. Cognitive-based interventions (CBIs) have recently been adopted for patients having breast cancer but their effects on improving body image are uncertain. This systematic review aimed to examine the effects of CBIs on body image in these patients, identify the optimal dose, characteristics, and/or component(s) of an effective intervention for these patients to inform future research and practice. Methods According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework, ten online databases and five search engines were used to search for eligible studies. Quality appraisal of included studies and meta-analysis results were conducted using Rob 2 and Grading of Recommendations Assessment, Development and Evaluation profiler Guideline Development Tool, respectively. RevMan and comprehensive meta-analysis software were used to perform data analysis and synthesis. Results Eleven eligible randomized controlled trials (RCTs) examining the effects of cognitive behavioral, acceptance and commitment, mindfulness, and self-compassion therapies were reviewed. Results of the meta-analysis showed that CBIs significantly reduced negative body image perception (Standardised Mean Difference, SMD = -0.49, 95% confidence interval [CI], [-0.87, -0.11], I 2 = 81%, 6 RCTs, 758 participants), when compared to the control groups (mainly usual care) at immediately post-intervention; in which, CBT-based (SMD = -0.37, 95% CI (-0.60, -0.13), I 2 = 0%) and group-based (SMD = -0.38, 95% CI (-0.62, -0.13), I 2 = 0%) programs had more consistent and significant effects. Conclusions In view of the highly heterogeneous and limited RCTs identified, high-quality controlled trials of CBIs for improving the body image of patients having breast cancer are suggested. Systematic review registration PROSPERO, CRD42021259173.
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Fang S, Ding D, Ji P, Huang M, Hu K. Cognitive Defusion and Psychological Flexibility Predict Negative Body Image in the Chinese College Students: Evidence from Acceptance and Commitment Therapy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16519. [PMID: 36554399 PMCID: PMC9778665 DOI: 10.3390/ijerph192416519] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 12/05/2022] [Accepted: 12/05/2022] [Indexed: 06/17/2023]
Abstract
Body dissatisfaction is a global phenomenon. Despite the significant cultural difference, most research on negative body image was conducted in Western countries. How do cognitive fusion and psychological flexibility relate to negative body image in the Chinese population? In the present study, this question was investigated through the intervention technique, Acceptance and Commitment Therapy (ACT). Here, 86 young Chinese university students with high negative physical self were invited, in which 42 students received 10 sessions of group-based ACT intervention in a clinical setting while the remained acted as the control group with no intervention. Pretests showed no statistical differences in negative body image between these two groups, while both cognitive fusion and psychological flexibility predicted negative body image. Post-pre tests showed no change in the control group, while enhanced cognitive defusion and psychological flexibility in the ACT group. Individual differences in psychological flexibility and cognitive defusion enhancement predicted improved body image. A strong association of implicit body image with Fatness and Shortness changes suggested that although with individual differences, those components could be internalized during the intervention in the College students.
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Affiliation(s)
- Shuanghu Fang
- School of Educational Science, Anhui Normal University, Wuhu 241000, China
| | - Dongyan Ding
- School of Educational Science, Anhui Normal University, Wuhu 241000, China
| | - Pingping Ji
- School of Educational Science, Anhui Normal University, Wuhu 241000, China
| | - Mingjie Huang
- School of Educational Science, Anhui Normal University, Wuhu 241000, China
| | - Kesong Hu
- Department of Psychology, Lake Superior State University, Sault Ste. Marie, MI 49783, USA
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Onnink CM, Konstantinidou Y, Moskovich AA, Karekla MK, Merwin RM. Acceptance and commitment therapy (ACT) for eating disorders: A systematic review of intervention studies and call to action. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2022. [DOI: 10.1016/j.jcbs.2022.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Efficacy of Eat Breathe Thrive: A randomized controlled trial of a yoga-based program. Body Image 2022; 42:427-439. [PMID: 35985168 DOI: 10.1016/j.bodyim.2022.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 07/11/2022] [Accepted: 07/12/2022] [Indexed: 11/21/2022]
Abstract
Evidence positions yoga as a promising intervention for enhancing positive embodiment and supporting the prevention of, and recovery from, eating disorders (EDs) by reducing ED symptomatology and building skills that facilitate an ongoing, embodied sense of wellbeing. However, yoga-based programs are few and rigorous literature on their efficacy is limited. This study examined the efficacy and feasibility of a yoga-based program called Eat Breathe Thrive (EBT) which aims to prevent EDs and support embodiment. Participants (N = 168, 93.5 % women) from a community sample in the United States and United Kingdom, ages 18-65, were randomly allocated to a 2-h, 7-week EBT program or waitlist-control condition. Compared to controls, EBT participants experienced significant decreases in ED behaviors, depression, and difficulties regulating emotions. They reported significantly greater use of mindfulness skills, such as interoceptive awareness, mindful self-care, and mindful eating. After a single session, participants reported immediate improvement in their sense of well-being, indicating increased state positive embodiment. Most effects were sustained at 6-month follow-up. The majority of individuals attended most sessions. Self-reported treatment integrity was excellent. Directions for future research are proposed. Results support the efficacy and feasibility of an integrated yoga intervention that fosters positive ways of inhabiting the body.
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12
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Barney JL, Barrett TS, Lensegrav-Benson T, Quakenbush B, Twohig MP. Examining a mediation model of body image-related cognitive fusion, intuitive eating, and eating disorder symptom severity in a clinical sample. Eat Weight Disord 2022; 27:2181-2192. [PMID: 35122638 DOI: 10.1007/s40519-021-01352-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 12/21/2021] [Indexed: 11/26/2022] Open
Abstract
PURPOSE This study sought to explore the associations between Intuitive Eating (IE), eating disorder (ED) symptom severity, and body image-related cognitive fusion within a clinical sample. IE was also examined as a possible mediator in the relationship between body image-related fusion and ED symptoms. METHODS This study includes cross-sectional analyses with data from 100 adult females and 75 adolescent females seeking residential treatment for an ED. Self-reported demographic information, ED symptoms, IE behaviors, and body image-related cognitive fusion were collected from participants within the first week of treatment following admission to the same residential ED treatment facility. RESULTS ED symptom severity was significantly negatively associated with three of the four domains of IE; unconditional permission to eat, reliance on hunger and satiety cues, and body-food choice congruence. A significant mediational effect of IE on the relationship between body image-related fusion and ED symptoms through IE behaviors was observed (β = 11.3, SE = 0.003, p < 0.001). This effect was only observed for the unconditional permission to eat (β = 0.13, p = 0.003) and reliance on hunger and satiety cues (β = 0.10, p = 0.005) domains of IE when the domains were subsequently analyzed individually. CONCLUSION Unconditional permission to eat and reliance on hunger and satiety cues appear to be particularly influential domains of IE in the relationship between body image-related fusion and ED symptom severity. It is possible that changes in these IE domains may be mechanisms through which body image-related fusion influences ED symptoms. Future longitudinal research is needed to better understand the relationship between body image-related cognitive fusion and IE and the potential for targeting these constructs specifically in the context of ED treatment. LEVEL OF EVIDENCE Level V, cross-sectional analysis from descriptive study.
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Affiliation(s)
- Jennifer L Barney
- Department of Psychology, Utah State University, 2810 Old Main Hill, Logan, UT, 84322, USA.
| | - Tyson S Barrett
- Department of Psychology, Utah State University, 2810 Old Main Hill, Logan, UT, 84322, USA
| | | | - Benita Quakenbush
- Avalon Hills Eating Disorder Specialists, 175 E 100 N, Logan, UT, 84321, USA
| | - Michael P Twohig
- Department of Psychology, Utah State University, 2810 Old Main Hill, Logan, UT, 84322, USA
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Fogelkvist M, Aila Gustafsson S, Kjellin L, Parling T. Predictors of outcome following a body image treatment based on acceptance and commitment therapy for patients with an eating disorder. J Eat Disord 2022; 10:90. [PMID: 35778769 PMCID: PMC9250252 DOI: 10.1186/s40337-022-00615-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 06/20/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND It is important to target body image in individuals with an eating disorder (ED). Acceptance and commitment therapy (ACT) has been trialed in a few studies for individuals with an ED. Although ACT outcomes in ED patients hold promise, studies of predictors are scarce. The aim of the present study was to explore differences in ED symptom outcome at two-year follow-up in subgroups of participants attending either treatment as usual (TAU), or a group intervention based on ACT targeting body image. Additionally, we aimed to compare subjective recovery experiences between groups. METHODS The study took place at a specialized ED outpatient clinic, and included patients diagnosed with an ED that had received prior treatment and achieved a somewhat regular eating pattern. Study participants were randomly assigned to continue TAU or to participate in a group intervention based on ACT for body image issues. Only participants that completed the assigned intervention and had completed follow up assessment by two-years were included. The total sample consisted of 77 women. RESULTS In general, ACT participants showed more favorable outcomes compared to TAU, and results were more pronounced in younger participants with shorter prior treatment duration and lower baseline depression ratings. Participants with restrictive ED psychopathology had three times higher ED symptom score change if participating in ACT in comparison to TAU. CONCLUSIONS An ACT group intervention targeting body image after initial ED treatment may further enhance treatment effects. There is a need for further investigation of patient characteristics that might predict response to body image treatment, particularly regarding ED subtypes and depression ratings.
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Affiliation(s)
- Maria Fogelkvist
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, 701 82, Örebro, Sweden.
| | - Sanna Aila Gustafsson
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, 701 82, Örebro, Sweden
| | - Lars Kjellin
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, 701 82, Örebro, Sweden
| | - Thomas Parling
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, and Stockholm Health Care Services, Region Stockholm, The Centre for Psychotherapy, Education and Research, Liljeholmstorget 7, 117 63, Stockholm, Sweden
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14
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Tone J, Chelius B, Miller YD. The effectiveness of a feminist-informed, individualised counselling intervention for the treatment of eating disorders: a case series study. J Eat Disord 2022; 10:70. [PMID: 35585630 PMCID: PMC9116079 DOI: 10.1186/s40337-022-00592-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 04/28/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Currently, there is limited empirical validation of feminist-informed or individualised interventions for the treatment of eating disorders. The aim of this study was to examine the effectiveness of a feminist-informed, individually delivered counselling intervention for the treatment of eating disorders at a community-based eating disorder treatment service. METHODS Eighty individuals aged between 17 and 64 years presenting to an outpatient eating disorder service were examined in a case series design at baseline, session 10, session 20 and end of treatment (session 30). Changes in eating disorder symptomology, depression, anxiety, stress, and mental health recovery over the course of treatment were examined in linear mixed model analyses. RESULTS The treatment intervention was effective in reducing eating disorder symptomology and stress and improving mental health recovery after 10 sessions in a sample of 80 eating disorder participants engaged with the treatment service. Reductions in eating disorder symptomology and stress and improvements to mental health recovery were maintained at session 20 and session 30. CONCLUSIONS The findings of this study provide preliminary support for feminist-informed and individualised interventions for the treatment of eating disorders in community-based settings.
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Affiliation(s)
- Jessica Tone
- School of Public Health and Social Work, Queensland University of Technology, Victoria Park Road, Kelvin Grove, QLD, 4059, Australia
| | - Belinda Chelius
- School of Public Health and Social Work, Queensland University of Technology, Victoria Park Road, Kelvin Grove, QLD, 4059, Australia. .,Eating Disorders Queensland, 51 Edmondstone Street, South Brisbane, QLD, 4101, Australia.
| | - Yvette D Miller
- School of Public Health and Social Work, Queensland University of Technology, Victoria Park Road, Kelvin Grove, QLD, 4059, Australia
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15
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Karekla M, Nikolaou P, Merwin RM. Randomized Clinical Trial Evaluating AcceptME-A Digital Gamified Acceptance and Commitment Early Intervention Program for Individuals at High Risk for Eating Disorders. J Clin Med 2022; 11:jcm11071775. [PMID: 35407386 PMCID: PMC8999727 DOI: 10.3390/jcm11071775] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/18/2022] [Accepted: 03/20/2022] [Indexed: 12/13/2022] Open
Abstract
Eating disorders (ED) constitute a serious public health issue affecting predominantly women and appearing typically in adolescence or early adulthood. EDs are extremely difficult to treat, as these disorders are ego-syntonic, and many patients do not seek treatment. It is vital to focus on the development of successful early-intervention programs for individuals presenting at risk and are on a trajectory towards developing EDs. This study is a randomized controlled trial evaluating an innovative digital gamified Acceptance and Commitment early-intervention program (AcceptME) for young females showing signs and symptoms of an ED and at high risk for an ED. Participants (n = 92; Mage = 15.30 years, SD = 2.15) received either AcceptME (n = 62) or a waitlist control (n = 30). Analyses indicated that the AcceptME program effectively reduced weight and shape concerns with large effects when compared to waitlist controls. Most participants scored below the at-risk cut-off (WCS score < 52) in the AcceptME at end-of-intervention (57.1%) compared to controls (7.1%), with odds of falling into the at-risk group being 14.5 times higher for participants in the control group. At follow-up, 72% of completers reported scores below the at-risk cut-off in the AcceptME group. The intervention also resulted in a decrease in ED symptomatology and increased body image flexibility. Overall, results suggest that the AcceptME program holds promise for early-intervention of young women at risk for developing an ED.
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Affiliation(s)
- Maria Karekla
- Department of Psychology, University of Cyprus, Nicosia 1678, Cyprus;
- Correspondence: ; Tel.: +357-2289-2100
| | - Patrisia Nikolaou
- Department of Psychology, University of Cyprus, Nicosia 1678, Cyprus;
| | - Rhonda M. Merwin
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, USA;
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16
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Leppanen J, Brown D, McLinden H, Williams S, Tchanturia K. The Role of Emotion Regulation in Eating Disorders: A Network Meta-Analysis Approach. Front Psychiatry 2022; 13:793094. [PMID: 35280172 PMCID: PMC8904925 DOI: 10.3389/fpsyt.2022.793094] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 01/11/2022] [Indexed: 12/11/2022] Open
Abstract
Background Previous theoretical models and reviews have documented a strong connection between emotion dysregulation eating disorder (ED) psychopathology among the general and clinical populations. The aim of this review was to build on this previous work by conducting a network meta-analysis to explore associations between adaptive and maladaptive emotion regulation strategies and ED psychopathology trans-diagnostically across the ED spectrum to identify areas of emotion dysregulation that have the strongest association with symptomatology. Methodology A total of 104 studies were included in the meta-analysis and correlation coefficient representing the associations between specific emotion regulation strategies and ED symptomatology were extracted. We ran a Bayesian random effects network meta-analysis and the initial network was well-connected with each emotion regulation strategy being linked to at least one other strategy. We also conducted a network meta-regression to explore whether between-study differences in body mass index (BMI), age, and whether the sample consisted of solely female participants explained any possible network inconsistency. Results The network meta-analysis revealed that ruminations and non-acceptance of emotions were most closely associated with ED psychopathology. There was no significant network inconsistency but two comparisons approached significance and thus meta-regressions were conducted. The meta-regressions revealed a significant effect of BMI such that the associations between different emotion regulation strategies and ED symptomatology were weaker among those with low BMI. Discussion The present findings build on previous work and highlight the role of rumination and difficulties with accepting emotions as key emotion regulation difficulties in EDs. Additionally, the finding that the associations were weaker among ED patients with low BMI may point toward a complex relationship between ED behaviors and emotion regulation. Taken together, our findings call for interventions that target emotion regulation, specifically rumination and difficulties accepting emotions, in the treatment of EDs. Systematic Review Registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021249996, PROSPERO, identifier: CRD42021249996.
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Affiliation(s)
- Jenni Leppanen
- Department of Neuroimaging, Institute of Psychology, Psychiatry and Neuroscience, King's College London, London, United Kingdom
| | - Dalia Brown
- Department of Neuroimaging, Institute of Psychology, Psychiatry and Neuroscience, King's College London, London, United Kingdom
- School of Education, University of Bristol, Bristol, United Kingdom
| | - Hannah McLinden
- Department of Neuroimaging, Institute of Psychology, Psychiatry and Neuroscience, King's College London, London, United Kingdom
- School of Education, University of Bristol, Bristol, United Kingdom
| | - Steven Williams
- Department of Neuroimaging, Institute of Psychology, Psychiatry and Neuroscience, King's College London, London, United Kingdom
| | - Kate Tchanturia
- Department of Psychological Medicine, Institute of Psychology, Psychiatry and Neuroscience, King's College London, London, United Kingdom
- South London and Maudsley National Health Service (NHS) Foundation Trust National Eating Disorder Service, London, United Kingdom
- Psychology Department, Illia State University, Tbilisi, Georgia
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17
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Rieger E, Prasetya K, Christensen BK, Shou Y. Identifying the contingencies of self-worth associated with eating disorder symptoms: The use of choice-based conjoint analysis. Int J Eat Disord 2021; 54:2167-2179. [PMID: 34713917 DOI: 10.1002/eat.23634] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 10/19/2021] [Accepted: 10/19/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Self-worth contingent on shape/weight is a diagnostic criterion and key maintaining factor for eating disorders. However, the role of other contingencies of self-worth (i.e., domains in which self-worth is invested) is largely unknown. Moreover, research has relied on self-ratings of contingency strength, which are subject to distortion through socially desirable responding and limited self-awareness, and may have limitations in terms of ecological validity. To overcome these limitations, the present study investigated a broad range of contingencies of self-worth in relation to eating disorder pathology and employed a choice-based conjoint (CBC) approach for assessing these contingencies. METHOD Young women and men from the community (N = 428) completed a CBC task to assess the domains in which self-worth is invested, the Eating Disorder Examination Questionnaire (EDE-Q) to assess eating disorder symptomatology, and the Balanced Inventory of Desirable Responding to assess socially desirable responding. RESULTS Beta regression analyses showed that CBC thinness and athletic competence predicted higher scores on all EDE-Q scales. CBC muscularity and facial attractiveness predicted higher scores, while coping ability and quality of relationships predicted lower scores, on various aspects of eating disorder symptoms. CBC social acceptance predicted lower eating disorder symptoms in males only. DISCUSSION The findings suggest that a broader range of contingencies of self-worth beyond shape/weight are relevant to eating disorder pathology and should be considered as potential underlying mechanisms and treatment targets. In addition, this first use of the CBC method in eating disorder research provides initial support for its validity and utility.
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Affiliation(s)
- Elizabeth Rieger
- Research School of Psychology, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Kevin Prasetya
- Research School of Psychology, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Bruce K Christensen
- Research School of Psychology, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Yiyun Shou
- Research School of Psychology, Australian National University, Canberra, Australian Capital Territory, Australia
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18
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Fogelkvist M, Parling T, Kjellin L, Gustafsson SA. Live with your body – participants’ reflections on an acceptance and commitment therapy group intervention for patients with residual eating disorder symptoms. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2021. [DOI: 10.1016/j.jcbs.2021.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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19
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Selvi K, Parling T, Ljótsson B, Welch E, Ghaderi A. Two randomized controlled trials of the efficacy of acceptance and commitment therapy-based educational course for body shape dissatisfaction. Scand J Psychol 2020; 62:249-258. [PMID: 32979230 PMCID: PMC8048455 DOI: 10.1111/sjop.12684] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 08/24/2020] [Indexed: 01/07/2023]
Abstract
The main aim of this project was to explore the efficacy of Acceptance and Commitment Therapy (ACT)-based educational course in different formats (i.e., pure and guided self-help with different durations, and guided self-help with and without access to a discussion forum) for body shape dissatisfaction. Two randomized controlled studies (RCT) were carried out. In the first RCT, the participants were randomized to a 12- or 16-week guided self-help, a 16-week pure self-help, or a waitlist control condition. In the second RCT, the efficacy of 12-week guided self-help with or without access to a discussion forum was investigated. ACT-based self-help resulted in promising improvements in body shape dissatisfaction, and modest effects on general health indicators (i.e., symptom of depression, self-esteem, satisfaction with life, and quality of life). The findings also showed no additional effects of support, access to the online discussion forum, and longer duration of self-help, suggesting the 12-week self-help with or without support is a viable option for reducing body shape dissatisfaction.
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Affiliation(s)
- Kerim Selvi
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Psychology, Eskişehir Osmangazi University, Eskişehir, Turkey
| | - Thomas Parling
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Stockholm Health Care Services, The Centre for Psychotherapy, Education & Research, Region Stockholm, Stockholm, Sweden
| | - Brjánn Ljótsson
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Elisabeth Welch
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Stockholm Health Care Services, Stockholm Center for Eating Disorders, Region Stockholm, Stockholm, Sweden
| | - Ata Ghaderi
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Stockholm Health Care Services, Stockholm Center for Eating Disorders, Region Stockholm, Stockholm, Sweden
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