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Remmerswaal KC, Batelaan NM, van Oppen P, Scholten WD, van Balkom AJ. Multifaceted, Brief Intensive Home-Based Exposure Treatment in Patients with Obsessive-Compulsive Disorder Who are Nonresponsive to Regular Cognitive Behavior Therapy: An Uncontrolled Pilot Study. J Psychiatr Pract 2024; 30:297-307. [PMID: 39058530 PMCID: PMC11280449 DOI: 10.1097/pra.0000000000000796] [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] [Indexed: 07/28/2024]
Abstract
OBJECTIVE To test a multifaceted treatment program for patients with obsessive-compulsive disorder (OCD) who did not respond to regular cognitive behavior therapy (CBT). The treatment addresses several factors that may play a role in maintaining OCD. METHODS We designed a treatment consisting of a 6-day intensive, individual exposure in vivo with response prevention (ERP) format, with 24 therapist-assisted treatment hours at the patient's home and 12 self-controlled ERP hours, including behavioral activation and family interventions. Next, we investigated the effect (obsessive-compulsive symptoms, comorbidity, functioning, quality of life, OCD-related interaction patterns) and feasibility (dropout, treatment satisfaction, and organization) of this program using pre-post-tests, pre-follow-up tests, and qualitative data from patients, family members, and therapists. RESULTS In a sample of 22 participants, obsessive-compulsive symptoms (Y-BOCS pre: 28.7, post: 15.9; Wilcoxon S-R tests P<0.01) improved significantly, as did most other effect measures. Results were largely, but not completely, preserved at 3-month follow-up. There was only 1 dropout. Patients, family members, and therapists were satisfied with the treatment. Implementation of the treatment did not pose difficulties. CONCLUSIONS In nonresponders with OCD, a multifaceted, brief, intensive home-based ERP program targeting factors maintaining OCD is promising and feasible. Extra care is needed to maintain improvement.
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Russell H, Aouad P, Le A, Marks P, Maloney D, Touyz S, Maguire S. Psychotherapies for eating disorders: findings from a rapid review. J Eat Disord 2023; 11:175. [PMID: 37794513 PMCID: PMC10548609 DOI: 10.1186/s40337-023-00886-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 09/11/2023] [Indexed: 10/06/2023] Open
Abstract
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.
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Affiliation(s)
- Haley Russell
- InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, Level 2, Charles Perkins Centre (D17), University of Sydney, Sydney, NSW, 2006, Australia
| | - Phillip Aouad
- InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, Level 2, Charles Perkins Centre (D17), University of Sydney, Sydney, NSW, 2006, Australia.
| | - Anvi Le
- Healthcare Management Advisors, Melbourne, Australia
| | - Peta Marks
- InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, Level 2, Charles Perkins Centre (D17), University of Sydney, Sydney, NSW, 2006, Australia
| | - Danielle Maloney
- InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, Level 2, Charles Perkins Centre (D17), University of Sydney, Sydney, NSW, 2006, Australia
- Sydney Local Health District, New South Wales Health, Sydney, Australia
| | - Stephen Touyz
- InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, Level 2, Charles Perkins Centre (D17), University of Sydney, Sydney, NSW, 2006, Australia
| | - Sarah Maguire
- InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, Level 2, Charles Perkins Centre (D17), University of Sydney, Sydney, NSW, 2006, Australia
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3
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Greenberg JL, Jacobson NC, Hoeppner SS, Bernstein EE, Snorrason I, Schwartzberg A, Steketee G, Phillips KA, Wilhelm S. Early response to cognitive behavioral therapy for body dysmorphic disorder as a predictor of outcomes. J Psychiatr Res 2022; 152:7-13. [PMID: 35700586 PMCID: PMC9447469 DOI: 10.1016/j.jpsychires.2022.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 04/14/2022] [Accepted: 06/06/2022] [Indexed: 10/18/2022]
Abstract
Individuals with body dysmorphic disorder (BDD) suffer from distressing or impairing preoccupations with perceived imperfections in their appearance. This often-chronic condition is associated with significant functional impairment and elevated rates of psychiatric comorbidity and morbidity, including depression, substance use disorders, and suicidality. Cognitive behavioral therapy (CBT) for BDD has been shown to be efficacious. However, this intervention is long (up to 24 weeks) relative to many manualized approaches for other related conditions, there is a significant shortage of clinicians trained in CBT for BDD, and some patients drop out of treatment and/or do not respond. Thus, there is great interest in understanding and predicting who is most likely to respond, to better allocate clinical resources. This secondary data analysis of participants enrolled in prior uncontrolled and controlled studies of CBT for BDD explored whether early response to CBT, operationalized as percentage change in symptom severity within the first four weeks and the first 12 weeks of this 24-week treatment, predicts clinical outcomes for patients with BDD (n = 90). The findings indicated that minimal early symptom change was not indicative of eventual non-response. This suggests that patients and clinicians should not be discouraged by limited early improvement but should instead continue with a full course of treatment before reevaluating progress and alternative interventions. Overall, the results support the view that treatment success is more likely if a longer CBT protocol is followed. More work is needed to understand mechanisms of change and thus match optimal interventions to patient characteristics.
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Affiliation(s)
- Jennifer L. Greenberg
- Massachusetts General Hospital and Harvard Medical School, 185 Cambridge Street, Suite 2000, Boston, MA, 02114, USA,Corresponding author. (J.L. Greenberg)
| | - Nicholas C. Jacobson
- Massachusetts General Hospital and Harvard Medical School, 185 Cambridge Street, Suite 2000, Boston, MA, 02114, USA,Geisel School of Medicine at Dartmouth College, 46 Centerra Parkway, EverGreen Center, Suite 315, Lebanon, NH, 03766, USA
| | - Susanne S. Hoeppner
- Massachusetts General Hospital and Harvard Medical School, 185 Cambridge Street, Suite 2000, Boston, MA, 02114, USA
| | - Emily E. Bernstein
- Massachusetts General Hospital and Harvard Medical School, 185 Cambridge Street, Suite 2000, Boston, MA, 02114, USA
| | - Ivar Snorrason
- Massachusetts General Hospital and Harvard Medical School, 185 Cambridge Street, Suite 2000, Boston, MA, 02114, USA.
| | - Anna Schwartzberg
- Massachusetts General Hospital and Harvard Medical School, 185 Cambridge Street, Suite 2000, Boston, MA, 02114, USA.
| | - Gail Steketee
- Boston University School of Social Work, 264 Bay State Rd, Boston, MA, 02215, USA.
| | - Katharine A. Phillips
- Rhode Island Hospital and Alpert Medical School of Brown University, 222 Richmond St, Providence, RI, 02903, USA,New York-Presbyterian Hospital and Weill Cornell Medical College, 315 East 62nd Street, New York, 10065, USA
| | - Sabine Wilhelm
- Massachusetts General Hospital and Harvard Medical School, 185 Cambridge Street, Suite 2000, Boston, MA, 02114, USA.
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Presseller EK, Lampe EW, Michael ML, Trainor C, Fan SC, Juarascio AS. Latent trajectories of symptom change during cognitive-behavior therapy predict post-treatment worsening of symptoms: a preliminary examination among outpatients with bulimia-spectrum eating disorders. Eat Weight Disord 2022; 27:2257-2264. [PMID: 34981464 PMCID: PMC8724000 DOI: 10.1007/s40519-021-01348-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 12/15/2021] [Indexed: 11/29/2022] Open
Abstract
PURPOSE Up to 44% of individuals with bulimia nervosa (BN) experience worsening of symptoms after cognitive behavior therapy (CBT). Identifying risk for post-treatment worsening of symptoms using latent trajectories of change in eating disorder (ED) symptoms during treatment could allow for personalization of treatment to improve long-term outcomes METHODS: Participants (N = 56) with BN-spectrum EDs received 16 sessions of CBT and completed digital self-monitoring of eating episodes and ED behaviors. The Eating Disorder Examination was used to measured ED symptoms at post-treatment and 3-month follow-up. Latent growth mixture modeling of digital self-monitoring data identified latent growth classes. Kruskal-Wallis H tests examined effect of trajectory of change in ED symptoms on post-treatment to follow-up symptom change. RESULTS Multi-class models of change in binge eating, compensatory behaviors, and regular eating improved fit over one-class models. Individuals with high frequency-rapid response in binge eating (H(1) = 10.68, p =0 .001, η2 = 0.24) had greater recurrence of compensatory behaviors compared to individuals with low frequency-static response. Individuals with static change in regular eating exhibited greater recurrence of binge eating than individuals with moderate response (H(1) = 8.99, p = 0.003, η2 = 0.20). CONCLUSION Trajectories of change in ED symptoms predict post-treatment worsening of symptoms. Personalized treatment approaches should be evaluated among individuals at risk of poor long-term outcomes. LEVEL OF EVIDENCE IV, evidence obtained from multiple time series. TRIAL REGISTRATION ClinicalTrials.gov registration number NCT03673540, registration date: September 17, 2018.
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Affiliation(s)
- Emily K Presseller
- Center for Weight Eating and Lifestyle Science (WELL Center), Drexel University, Philadelphia, PA, USA. .,Department of Psychology, Drexel University, Philadelphia, PA, USA.
| | - Elizabeth W Lampe
- Center for Weight Eating and Lifestyle Science (WELL Center), Drexel University, Philadelphia, PA, USA.,Department of Psychology, Drexel University, Philadelphia, PA, USA
| | - Megan L Michael
- Center for Weight Eating and Lifestyle Science (WELL Center), Drexel University, Philadelphia, PA, USA.,Department of Psychology, Drexel University, Philadelphia, PA, USA
| | - Claire Trainor
- Center for Weight Eating and Lifestyle Science (WELL Center), Drexel University, Philadelphia, PA, USA.,Department of Psychology, Drexel University, Philadelphia, PA, USA
| | - Stephanie C Fan
- Department of Psychology, Drexel University, Philadelphia, PA, USA
| | - Adrienne S Juarascio
- Center for Weight Eating and Lifestyle Science (WELL Center), Drexel University, Philadelphia, PA, USA.,Department of Psychology, Drexel University, Philadelphia, PA, USA
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5
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Matherne CE, Watson H, Fassnacht DB, Ali K, Zerwas S, Peat C, Runfola C, Levine MD, Marcus MD, Zimmer B, Moessner M, Crosby R, Bulik CM. An exploratory investigation of predictors of outcome in face-to-face and online cognitive-behavioural therapy for bulimia nervosa. EUROPEAN EATING DISORDERS REVIEW 2022; 30:373-387. [PMID: 35474624 DOI: 10.1002/erv.2898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 03/08/2022] [Accepted: 03/17/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Cognitive-behavioural therapy (CBT) delivered face-to-face and via the internet reduces bulimia nervosa (BN) symptoms. However, our empirical understanding of factors affecting patient outcomes is limited. METHOD Using data from a randomised, controlled trial comparing internet-based (CBT4BN, n = 78) with face-to-face (CBTF2F, n = 71) group CBT (97% female, M = 28 years), we examined general treatment (across conditions) and modality-specific predictors of end-treatment and 1-year outcomes (abstinence, binge-eating frequency, purging frequency). RESULTS Improved eating disorder-related quality of life (EDQOL) during treatment and follow-up predicted abstinence at end-treatment and 1-year assessments. Improved EDQOL, disordered eating cognitions, and anxiety symptoms predicted less frequent binge eating and purging. Previous CBT and being employed predicted more frequent binge eating and purging at both assessments. Higher self-transcendence and self-directedness predicted less frequent binge eating. More severe binge eating and purging at baseline and end-treatment predicted more frequent binge eating and purging at subsequent assessments. Improved EDQOL was more strongly associated with positive outcome in CBT4BN; improved depressive symptoms and health-related QOL predicted positive outcome in CBT4BN but not CBTF2F. DISCUSSION Symptom improvement and certain character traits predicted positive outcome, whereas more severe presentation and prior CBT experience predicted poorer outcome. Consideration of intreatment symptom improvement may facilitate care recommendations, particularly for internet-based modalities.
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Affiliation(s)
- Camden E Matherne
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Hunna Watson
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,School of Psychology, Curtin University, Bentley, Western Australia, Australia.,Division of Paediatrics, The University of Western Australia, Crawley, Western Australia, Australia
| | - Daniel B Fassnacht
- College of Education, Psychology and Social Work, Flinders University, Adelaide, South Australia, Australia.,Research School of Psychology, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Kathina Ali
- College of Education, Psychology and Social Work, Flinders University, Adelaide, South Australia, Australia.,Research School of Psychology, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Stephanie Zerwas
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Christine Peat
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Cristin Runfola
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Michele D Levine
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Marsha D Marcus
- Department of Psychiatry, Western Psychiatric Hospital, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Benjamin Zimmer
- Center for Psychotherapy Research, University Hospital, Heidelberg, Germany
| | - Markus Moessner
- Center for Psychotherapy Research, University Hospital, Heidelberg, Germany
| | - Ross Crosby
- Sanford Center for Biobehavioral Research, Fargo, North Dakota, USA.,Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota, USA
| | - Cynthia M Bulik
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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6
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Levinson CA, Ralph-Nearman C, Brown ML, Gardner T, Cardi V, Treasure J, Purves K, Eley TC. A pilot randomized control trial of online exposure for eating disorders and mechanisms of change delivered after discharge from intensive eating disorder care: A registered report. Int J Eat Disord 2021; 54:2066-2074. [PMID: 34480773 PMCID: PMC9886130 DOI: 10.1002/eat.23603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 08/26/2021] [Accepted: 08/26/2021] [Indexed: 02/01/2023]
Abstract
More than 50% of individuals with an eating disorder (ED) will readmit to treatment within 6 months of treatment discharge and often due to persistent cognitive ED pathology. Interventions addressing unremitted cognitive ED pathology following discharge from intensive treatment are crucial to prevent readmission. Imaginal exposure therapy facilitates the approach of feared stimuli not accessible in everyday life (e.g., rapidly gaining weight). In the current pilot randomized control trial (RCT), participants will be randomly assigned to a five-session online imaginal exposure condition (n = 65) or a control online writing and thinking intervention (n = 65) within a month of discharge from intensive treatment. Exposure participants write about and imagine an ED fear and control participants will write about their ED generally. We will examine the feasibility and acceptability of the treatment conditions and whether imaginal exposure is more effective in preventing readmission than the control condition. We will test the efficacy of the imaginal exposure treatment in reducing ED symptoms and fears of food and weight gain, and whether fear learning is a mechanism of change related to ED pathology. Ultimately, this research will lead to the development of an easily deployable readmission prevention treatment based on fear conditioning targets.
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Affiliation(s)
- Cheri A. Levinson
- Department of Psychological & Brain Sciences, University of Louisville, Louisville, Kentucky, USA
- Kings College London, Psychological Medicine, Academic Psychiatry and Social, Genetic and Developmental Psychiatry Centre, London, UK
| | - Christina Ralph-Nearman
- Department of Psychological & Brain Sciences, University of Louisville, Louisville, Kentucky, USA
- Kings College London, Psychological Medicine, Academic Psychiatry and Social, Genetic and Developmental Psychiatry Centre, London, UK
| | - Mackenzie L. Brown
- Department of Psychological & Brain Sciences, University of Louisville, Louisville, Kentucky, USA
- Kings College London, Psychological Medicine, Academic Psychiatry and Social, Genetic and Developmental Psychiatry Centre, London, UK
| | - Taylor Gardner
- Department of Psychological & Brain Sciences, University of Louisville, Louisville, Kentucky, USA
- Kings College London, Psychological Medicine, Academic Psychiatry and Social, Genetic and Developmental Psychiatry Centre, London, UK
| | - Valentina Cardi
- Department of Psychological & Brain Sciences, University of Louisville, Louisville, Kentucky, USA
- Kings College London, Psychological Medicine, Academic Psychiatry and Social, Genetic and Developmental Psychiatry Centre, London, UK
| | - Janet Treasure
- Department of Psychological & Brain Sciences, University of Louisville, Louisville, Kentucky, USA
- Kings College London, Psychological Medicine, Academic Psychiatry and Social, Genetic and Developmental Psychiatry Centre, London, UK
| | - Kirstin Purves
- Department of Psychological & Brain Sciences, University of Louisville, Louisville, Kentucky, USA
- Kings College London, Psychological Medicine, Academic Psychiatry and Social, Genetic and Developmental Psychiatry Centre, London, UK
| | - Thalia C. Eley
- Department of Psychological & Brain Sciences, University of Louisville, Louisville, Kentucky, USA
- Kings College London, Psychological Medicine, Academic Psychiatry and Social, Genetic and Developmental Psychiatry Centre, London, UK
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Rapid response is predictive of treatment outcomes in a transdiagnostic intensive outpatient eating disorder sample: a replication of prior research in a real-world setting. Eat Weight Disord 2021; 26:1345-1356. [PMID: 32507929 PMCID: PMC7903880 DOI: 10.1007/s40519-020-00939-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 05/25/2020] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE There is a growing call to identify specific outcome predictors in real-world eating disorder (ED) treatment settings. Studies have implicated several ED treatment outcome predictors [rapid response (RR), weight suppression, illness duration, ED diagnosis, and psychiatric comorbidity] in inpatient settings or randomized controlled trials of individual outpatient therapy. However, research has not yet examined outcome predictors in intensive outpatient programs (IOP). The current study aimed to replicate findings from randomized controlled research trials and inpatient samples, identifying treatment outcome predictors in a transdiagnostic ED IOP sample. METHOD The current sample comprised 210 consecutive unique IOP patient admissions who received evidence-based ED treatment, M(SD)Duration = 15.82 (13.38) weeks. Weekly patient measures of ED symptoms and global functioning were obtained from patients' medical charts. RESULTS In relative weight analysis, RR was the only significant predictor of ED symptoms post treatment, uniquely accounting for 45.6% of the predicted variance in ED symptoms. In contrast, baseline ED pathology was the strongest unique predictor of end-of-treatment global functioning, accounting for 15.89% of predicted variance. Baseline factors did not differentiate patients who made RR from those who did not. CONCLUSIONS Consistent with findings in more controlled treatment settings, RR remains a robust predictor of outcome for patients receiving IOP-level treatment for EDs. Future work should evaluate factors that mediate and moderate RR, incorporating these findings into ED treatment design and implementation. LEVEL OF EVIDENCE Level IV, uncontrolled intervention.
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Chang PGRY, Delgadillo J, Waller G. Early response to psychological treatment for eating disorders: A systematic review and meta-analysis. Clin Psychol Rev 2021; 86:102032. [PMID: 33915335 DOI: 10.1016/j.cpr.2021.102032] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 04/04/2021] [Accepted: 04/14/2021] [Indexed: 12/25/2022]
Abstract
Early response is a well-established predictor of positive outcomes at the end of psychological treatments for common mental disorders. There is some prior evidence that this conclusion also applies to eating disorders, including three meta-analyses, but no moderators of that relationship have been identified. However, a number of further papers have been published since, which might influence the size of the effect of early response or the potential role of moderating factors. This pre-registered systematic review presents a comprehensive examination of this literature. Three databases were searched (Scopus, PsycInfo, PubMed). In total, 33 eligible studies were included in a narrative synthesis, and 25 studies were included in random-effects meta-analysis. The majority (91%) of studies were rated as having low or moderate risk of bias. Approximately half of patients across clinical samples showed early response to psychological therapy, which was most often defined as reliable symptomatic improvement during the first four sessions. A significant and moderate association was found between early response and post-treatment outcomes (r = 0.41 [95% CI: 0.32-0.481], p < .0001). Significant evidence of heterogeneity (Q[28] = 136.42, p < .0001; I2 = 80.2%) was evident. The review was limited by the exclusion of grey literature and only 76% of studies provided sufficient statistical information for meta-analytic synthesis, although we found no significant evidence of publication bias, χ2(1) = 0.001, p = .97. Overall, evidence accumulated over twenty years establishes early response as the most robust predictor of treatment outcomes in the field of eating disorders. However, only half of patients show early change in this way. Further research is needed to determine whether there are patient or clinician characteristics that predict early response to psychological treatment for eating disorders.
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Affiliation(s)
- Peter G R Y Chang
- Clinical and Applied Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, UK
| | - Jaime Delgadillo
- Clinical and Applied Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, UK
| | - Glenn Waller
- Clinical and Applied Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, UK.
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9
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Brown TA, Murray SB, Anderson LK, Kaye WH. Early predictors of treatment outcome in a partial hospital program for adolescent anorexia nervosa. Int J Eat Disord 2020; 53:1550-1555. [PMID: 32662119 DOI: 10.1002/eat.23343] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 06/24/2020] [Accepted: 06/25/2020] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Previous research supports the relevance of early symptom change in eating disorder (ED) treatment; however, few studies have distinguished early weight change from early change in ED psychopathology, particularly in higher levels of care. Thus, the present study examined whether early change in weight and ED psychopathology predicted outcome for adolescents with anorexia nervosa (AN) in a partial hospitalization program. METHOD Adolescents with AN (n = 99) completed assessments at admission, 1-month after treatment admission, discharge, and 6-month follow-up. RESULTS Higher admission percent expected body weight (%EBW), greater early change in %EBW, longer duration of treatment, shorter length of illness, and earlier age of onset predicted greater change in %EBW at discharge, but not follow-up. Greater ED psychopathology at admission and greater early change in ED psychopathology predicted later change in ED symptoms at discharge, but not follow-up. Neither early change in %EBW nor ED psychopathology predicted likelihood of remission at discharge and follow-up. DISCUSSION Results support the importance of early change in predicting later change in the same ED outcome variables and suggest that early change in both %EBW and ED psychopathology in adolescents may be an important area for future research.
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Affiliation(s)
- Tiffany A Brown
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Stuart B Murray
- Department of Psychiatry & Behavioral Sciences, University of Southern California, Los Angeles, California, USA
| | - Leslie K Anderson
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Walter H Kaye
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
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10
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Matheson BE, Gorrell S, Bohon C, Agras WS, Le Grange D, Lock J. Investigating Early Response to Treatment in a Multi-Site Study for Adolescent Bulimia Nervosa. Front Psychiatry 2020; 11:92. [PMID: 32184746 PMCID: PMC7058584 DOI: 10.3389/fpsyt.2020.00092] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 02/04/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND This secondary data analysis seeks to replicate and extend findings that early response to treatment in adolescent bulimia nervosa (BN) predicts outcome, resulting in earlier identification of patients who might need a different treatment approach. METHODS Participants were 71 adolescents (M ± SD: 15.69 ± 1.55 years; 93% female; 75% non-Hispanic) with a Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) diagnosis of BN or partial BN enrolled in a two-site treatment study. Participants were randomized to cognitive behavioral therapy for adolescents (CBT-A), family-based treatment for BN (FBT-BN), or supportive psychotherapy (SPT). The Eating Disorder Examination was administered at baseline, end-of-treatment (EOT), 6-month, and 12-month follow-up. Binge eating and purge symptoms were self-reported at each session. Outcome was defined as abstinence of binge eating and compensatory behaviors (self-induced vomiting, laxative use, diet pills, diuretics, compensatory exercise, fasting) in the 28 days prior to assessment. Receiver operating characteristic (ROC) analyses were utilized to assess the viability of predicting treatment outcomes based on reduction of symptoms within the first 10 sessions of treatment. RESULTS ROC analyses suggest that reduction in purging at session 2 (AUC =.799, p < .001) and binge eating at session 4 (AUC =.750, p < .01) were independently related to abstinence of symptoms at EOT, regardless of treatment type. Symptom reduction later in treatment predicted outcome at follow-up, as change in binge eating at session 8 and purging at session 9 were the strongest predictors of abstinence at 6-month follow-up (AUCs =.726-.763, ps < .01). Change in binge eating, but not purging behaviors, was significantly related to abstinence at 12-month follow-up (AUC =.766, p < .01). Only slight differences emerged based on treatment group, such that reductions in symptoms most predictive of abstinence at EOT occurred one session sooner in FBT-BN than SPT. CONCLUSION Reductions in binge eating and purge symptoms early in adolescent BN treatment suggest better outcome, regardless of treatment modality. Additional research with larger samples is needed to better understand which treatments, if any, contribute to earlier change in BN symptoms and/or likelihood of improved patient response.
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Affiliation(s)
- Brittany E Matheson
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Sasha Gorrell
- Department of Psychiatry, University of California San Francisco School of Medicine, San Francisco, CA, United States
| | - Cara Bohon
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - W Stewart Agras
- Department of Psychiatry and Behavioral Sciences, Emeritus, Stanford University School of Medicine, Stanford, CA, United States
| | - Daniel Le Grange
- Department of Psychiatry, University of California San Francisco School of Medicine, San Francisco, CA, United States.,Department of Psychiatry and Behavioral Neuroscience, Emeritus, The University of Chicago, Chicago, IL, United States
| | - James Lock
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
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11
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Forbush KT, Crosby RD, Coniglio K, Haynos AF. Education, dissemination, and the science of eating disorders: Reflections on the 2019 International Conference on Eating Disorders: Editorial to accompany IJED Virtual Issue in honor of the 2019 International Conference on Eating Disorders. Int J Eat Disord 2019; 52:493-496. [PMID: 30788850 PMCID: PMC6499674 DOI: 10.1002/eat.23050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 02/03/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This virtual issue of the International Journal of Eating Disorders highlights recently published research that aligns with the broad themes of the 2019 International Conference on Eating Disorders (ICED), held in New York, NY, USA. METHODS AND RESULTS We selected articles that were published between 2017 and 2019 that complement the content of the keynote and plenary sessions. We also curated additional articles from early career scholars, given that an important component of the annual ICED is to foster the development and training of the next generation of eating-disorder clinicians and researchers. DISCUSSION We hope that this virtual issue will spark more in-depth discussion and reflection on the topics, questions, and critical advances in the field of eating disorders that were presented at the 2019 ICED.
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Affiliation(s)
| | - Ross D. Crosby
- Sanford Research, Neuropsychiatric Research Institute, Fargo, North Dakota
| | - Kathryn Coniglio
- Department of Psychology, Rutgers University, Piscataway, New Jersey
| | - Ann F. Haynos
- Department of Psychiatry, University of Minnesota, Minneapolis, Minnesota
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Svaldi J, Schmitz F, Baur J, Hartmann AS, Legenbauer T, Thaler C, von Wietersheim J, de Zwaan M, Tuschen-Caffier B. Efficacy of psychotherapies and pharmacotherapies for Bulimia nervosa. Psychol Med 2019; 49:898-910. [PMID: 30514412 DOI: 10.1017/s0033291718003525] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Bulimia nervosa (BN), a mental disorder that causes significant impairment, can be treated with psychological, pharmacological, nutrition-based and self-help interventions. We conducted a pre-registered meta-analysis of randomized-controlled trials (RCTs) to assess the efficacy of these interventions in up to 19 different interventions. METHODS Database search terms were combined for BN and RCTs from database inception to March 2017. Abstinence from binge eating episodes, compensatory behaviors, the absence of a BN diagnosis and reduction of symptom severity were considered as primary outcome variables, reduction of self-reported eating pathology and depression served as secondary outcome variables. Retrieved RCTs were meta-analyzed using fixed and random effects models. RESULTS RCT (79 trials; 5775 participants) effects post-treatment revealed moderate to large intervention effects for psychotherapy [mostly cognitive-behavioral therapy (CBT)] for primary outcome variables. Slightly reduced effects were obtained for self-help and moderate effects for pharmacotherapy. Similarly, psychotherapy yielded large to very large effects in regard to secondary outcome variables, while moderate to large effects were observed for self-help, Pharmacotherapy and combined therapies. Meta-analyses for the pre to post changes within group confirmed these findings. Additionally, follow-up analyses revealed the sustainability of psychotherapies in terms of large effects in primary outcome criteria, while these effects were moderate for self-help, pharmacotherapy, and combined therapies. CONCLUSIONS Most psychological and pharmacological interventions revealed to be effective in BN treatment. Taking effect size, sustainability of the intervention, as well as the consistency of findings and available evidence into consideration, CBT can be recommended as the best intervention for the initial treatment of BN.
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Affiliation(s)
- Jennifer Svaldi
- Department of Clinical Psychology and Psychotherapy,University of Tübingen,Schleichstrasse 4, 72076 Tuebingen,Germany
| | - Florian Schmitz
- Department of Individual Differences and Psychological Assessment,Ulm University,Albert-Einstein-Allee 47, 89081 Ulm,Germany
| | - Julia Baur
- Department of Clinical Psychology and Psychotherapy,University of Tübingen,Schleichstrasse 4, 72076 Tuebingen,Germany
| | - Andrea S Hartmann
- Department of Clinical Psychology and Psychotherapy,Osnabrück University,Knollstrasse 15, 49069 Osnabrück,Germany
| | - Tanja Legenbauer
- LWL University Hospital Hamm for Child and Adolescent Psychiatry, Psychotherapy and Psychosomatic, Ruhr University Bochum,Heithofer Allee 64, 59071 Hamm,Germany
| | - Charlotte Thaler
- Department of Clinical Psychology and Psychotherapy,University of Freiburg,Engelbergerstrasse 41, 79085 Freiburg,Germany
| | - Jörn von Wietersheim
- Department of Psychosomatic Medicine and Psychotherapy,Ulm Medical School,Albert-Einstein-Allee 23, 89070 Ulm,Germany
| | - Martina de Zwaan
- Department of Psychosomatic Medicine and Psychotherapy,Hannover Medical School,Carl-Neuberg-Strasse 1, 30625 Hannover,Germany
| | - Brunna Tuschen-Caffier
- Department of Clinical Psychology and Psychotherapy,University of Freiburg,Engelbergerstrasse 41, 79085 Freiburg,Germany
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Beintner I, Jacobi C. Are we overdosing treatment? Secondary findings from a study following women with bulimia nervosa after inpatient treatment. Int J Eat Disord 2018; 51:899-905. [PMID: 30070386 DOI: 10.1002/eat.22894] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 05/15/2018] [Accepted: 05/15/2018] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Provision of eating disorder (ED) treatment in practice is often guided by national health service structures rather than evidence-based treatment recommendations. Especially for more severely or chronically ill patients, clinicians seem to advocate a "the more the better" strategy of treatment provision. Exploring the dose-response relationship in ED treatment may shed light on both beneficial and detrimental effects of prolonged treatment provision. METHOD We utilized data from 64 women from the treatment-as-usual (TAU) group of a randomized controlled trial on Internet-based aftercare for women with bulimia nervosa who had received inpatient treatment. We examined the relationship between treatment duration and dose and (1) baseline patient characteristics and (2) treatment outcomes (abstinence from binge eating and compensatory behaviors, frequency of binge eating and vomiting, thin ideal internalization, and general psychopathology) at 18-month follow up. RESULTS On average, the women in our study were hospitalized for 9 weeks and most received high doses of subsequent outpatient psychotherapy (median: 45 sessions). The severity of symptoms that a patient experienced at hospital admission or discharge was largely unrelated to the amount of outpatient treatment she subsequently received. Longer inpatient treatments or higher doses of subsequent outpatient treatment did not result in more favorable outcomes. DISCUSSION Our findings suggest that, instead of providing costly long treatment without evidenced benefit to patients, there is a need for further exploration of and discussion about the risks and benefits of providing high doses of treatment for both individuals and the health care system.
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Affiliation(s)
- Ina Beintner
- Technische Universität Dresden, Institute of Clinical Psychology and Psychotherapy, Chemnitzer Straße 46, 01187, Dresden, Germany
| | - Corinna Jacobi
- Technische Universität Dresden, Institute of Clinical Psychology and Psychotherapy, Chemnitzer Straße 46, 01187, Dresden, Germany
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Forbush KT, Chen PY, Hagan KE, Chapa DAN, Gould SR, Eaton NR, Krueger RF. A new approach to eating-disorder classification: Using empirical methods to delineate diagnostic dimensions and inform care. Int J Eat Disord 2018; 51:710-721. [PMID: 30132954 DOI: 10.1002/eat.22891] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 05/10/2018] [Accepted: 05/14/2018] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Despite changes to the diagnostic criteria for eating disorders (EDs) in the DSM-5, the current diagnostic system for EDs has limited ability to inform treatment planning and predict outcomes. Our objective was to test the clinical utility of a novel dimensional approach to understanding the structure of ED psychopathology. METHOD Participants (N = 243; 82.2% women) were community-recruited adults with a DSM-5 ED assessed at baseline, 6-month, and 1-year follow-up. Hierarchical factor analysis was used to identify a joint hierarchical-dimensional structure of eating, mood, and anxiety symptoms. Exploratory structural equation modeling was used to test the ability of the dimensional model to predict outcomes. RESULTS At the top of the hierarchy, we identified a broad Internalizing factor that reflected diffuse symptoms of eating, mood, and anxiety disorders. Internalizing branched into three subfactors: distress, fear-avoidance (fears of certain stimuli and behaviors to neutralize fears, including ED behaviors designed to reduce fear of weight gain), and body dissatisfaction, which was nested within distress. The lowest level of the hierarchy was characterized by 15 factors. The hierarchical model predicted 60.1% of the variance in outcomes at 6-month follow-up, whereas all DSM eating, mood, and anxiety disorders combined predicted 35.8% of the variance in outcomes. DISCUSSION A dimensional approach to understanding and diagnosing EDs improved the ability to prospectively predict clinical course above-and-beyond the traditional categorical (DSM-based) approach. Our findings have implications for endeavors to improve the prediction of ED prognosis and course, and to develop more effective trans-diagnostic treatments.
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Affiliation(s)
- Kelsie T Forbush
- Department of Psychology, University of Kansas, Lawrence, Kansas
| | - Po-Yi Chen
- Department of Psychology, University of Kansas, Lawrence, Kansas
| | - Kelsey E Hagan
- Department of Psychology, University of Kansas, Lawrence, Kansas
| | | | - Sara R Gould
- Division of Pediatrics, Children's Mercy-Kansas City Kansas City, Kansas
| | - Nicholas R Eaton
- Department of Psychology, Stony Brook University, Stony Brook, New York
| | - Robert F Krueger
- Department of Psychology, University of Minnesota, Minneapolis, Minnesota
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Yu JS, Szigethy E, Wallace M, Solano F, Oser M. Implementation of a Guided, Digital Cognitive Behavioral Program for Anxiety in Primary Care: Preliminary Findings of Engagement and Effectiveness. Telemed J E Health 2018; 24:870-878. [PMID: 29480752 DOI: 10.1089/tmj.2017.0280] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Implementation of digital behavioral health programs in primary care (PC) can improve access to care for patients in need. INTRODUCTION This study provides preliminary data on user engagement and anxiety symptom change among patients referred by their PC provider to a guided, mobile cognitive behavioral program, Lantern. MATERIALS AND METHODS Adults aged 20-65 years with at least mild anxiety (GAD-7 ≥ 5) during routine clinical screening in two PC practices were offered Lantern. The primary outcome was self-reported anxiety collected at baseline and 2 months. Linear mixed effects modeling was used to examine anxiety symptom reduction from baseline to 2 months. Post hoc analyses evaluated how number of units completed, number of techniques practiced, and days of usage impacted symptom change. RESULTS Sixty-three participants signed up for Lantern and had both baseline and 2- month GAD-7. A mixed effects model adjusted for age, gender, medical complexity score, and physical health found a significant effect of time on GAD-7 (β = -2.08, standard error = 0.77, t(62) = -2.71, p = 0.009). Post hoc analyses indicated that mean number of units, techniques, and usage days did not significantly impact GAD-7 change over 2 months. However, there was significantly greater improvement in anxiety in participants who completed at least three techniques. DISCUSSION Results benchmark to previous studies that have found statistically significant symptom change among participants after 4-9 weeks of face-to-face or Internet-based cognitive behavioral therapy (CBT). CONCLUSIONS This study suggests that use of Lantern is associated with anxiety reduction and provides proof-of-concept for the dissemination and implementation of guided, CBT-based mobile behavioral health interventions in PC settings.
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Affiliation(s)
| | - Eva Szigethy
- 2 Department of Psychiatry and Medicine, University of Pittsburgh Medical Center , Pittsburgh, Pennsylvania
| | - Meredith Wallace
- 2 Department of Psychiatry and Medicine, University of Pittsburgh Medical Center , Pittsburgh, Pennsylvania
| | - Francis Solano
- 3 Department of Internal Medicine, University of Pittsburgh Medical Center , Pittsburgh, Pennsylvania
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MacDonald DE, Trottier K, Olmsted MP. Rapid improvements in emotion regulation predict intensive treatment outcome for patients with bulimia nervosa and purging disorder. Int J Eat Disord 2017; 50:1152-1161. [PMID: 28833314 DOI: 10.1002/eat.22766] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 07/31/2017] [Accepted: 07/31/2017] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Rapid and substantial behavior change (RSBC) early in cognitive behavior therapy (CBT) for eating disorders is the strongest known predictor of treatment outcome. Rapid change in other clinically relevant variables may also be important. This study examined whether rapid change in emotion regulation predicted treatment outcomes, beyond the effects of RSBC. METHOD Participants were diagnosed with bulimia nervosa or purging disorder (N = 104) and completed ≥6 weeks of CBT-based intensive treatment. Hierarchical regression models were used to test whether rapid change in emotion regulation variables predicted posttreatment outcomes, defined in three ways: (a) binge/purge abstinence; (b) cognitive eating disorder psychopathology; and (c) depression symptoms. Baseline psychopathology and emotion regulation difficulties and RSBC were controlled for. RESULTS After controlling for baseline variables and RSBC, rapid improvement in access to emotion regulation strategies made significant unique contributions to the prediction of posttreatment binge/purge abstinence, cognitive psychopathology of eating disorders, and depression symptoms. DISCUSSION Individuals with eating disorders who rapidly improve their belief that they can effectively modulate negative emotions are more likely to achieve a variety of good treatment outcomes. This supports the formal inclusion of emotion regulation skills early in CBT, and encouraging patient beliefs that these strategies are helpful.
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Affiliation(s)
- Danielle E MacDonald
- Centre for Mental Health, University Health Network, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Kathryn Trottier
- Centre for Mental Health, University Health Network, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Marion P Olmsted
- Centre for Mental Health, University Health Network, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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17
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Linardon J, Wade T, de la Piedad Garcia X, Brennan L. Psychotherapy for bulimia nervosa on symptoms of depression: A meta-analysis of randomized controlled trials. Int J Eat Disord 2017; 50:1124-1136. [PMID: 28804915 DOI: 10.1002/eat.22763] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 07/09/2017] [Accepted: 07/21/2017] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Depressive symptoms are an important risk factor and consequence of binge eating and purging behavior in bulimia nervosa (BN). Although psychotherapy is effective in reducing symptoms of BN in the short- and long-term, it is unclear whether psychotherapy for BN is also effective in reducing depressive symptoms. This meta-analysis examined the efficacy of psychotherapy for BN on depressive symptoms in the short- and long-term. METHOD Randomized controlled trials (RCTs) on BN that assessed depressive symptoms as an outcome were identified. Twenty-six RCTs were included. RESULTS Psychotherapy was more efficacious at reducing symptoms of depression at post-treatment (g = 0.47) than wait-lists. This effect was strongest when studies delivered therapist-led, rather than guided self-help, treatment. No significant differences were observed between psychotherapy and antidepressants. There was no significant post-treatment difference between CBT and other active psychological comparisons at reducing symptoms of depression. However, when only therapist-led CBT was analyzed, therapist-led CBT was significantly more efficacious (g = 0.25) than active comparisons at reducing depressive symptoms. The magnitude of the improvement in depressive symptoms was predicted by the magnitude of the improvement in BN symptoms. DISCUSSION These findings suggest that psychotherapy is effective for reducing depressive symptoms in BN in the short-term. Whether these effects are sustained in the long-term is yet to be determined, as too few studies conducted follow-up assessments. Moreover, findings demonstrate that, in addition to being the front-running treatment for BN symptoms, CBT might also be the most effective psychotherapy for improving the symptoms of depression that commonly co-occur in BN.
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Affiliation(s)
- Jake Linardon
- School of Psychology, Australian Catholic University, 115 Victoria Parade/Locked Bag 4115, Melbourne, Victoria, 3065, Australia
| | - Tracey Wade
- School of Psychology, Flinders University, GPO Box 2100, Adelaide, 5001, South Australia
| | - Xochitl de la Piedad Garcia
- School of Psychology, Australian Catholic University, 115 Victoria Parade/Locked Bag 4115, Melbourne, Victoria, 3065, Australia
| | - Leah Brennan
- School of Psychology, Australian Catholic University, 115 Victoria Parade/Locked Bag 4115, Melbourne, Victoria, 3065, Australia
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18
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Barakat S, Maguire S, Surgenor L, Donnelly B, Miceska B, Fromholtz K, Russell J, Hay P, Touyz S. The Role of Regular Eating and Self-Monitoring in the Treatment of Bulimia Nervosa: A Pilot Study of an Online Guided Self-Help CBT Program. Behav Sci (Basel) 2017; 7:E39. [PMID: 28672851 PMCID: PMC5618047 DOI: 10.3390/bs7030039] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 06/19/2017] [Accepted: 06/21/2017] [Indexed: 11/28/2022] Open
Abstract
Background: Despite cognitive behavioural therapy (CBT) being regarded as the first-line treatment option for bulimia nervosa (BN), barriers such as its time-consuming and expensive nature limit patient access. In order to broaden treatment availability and affordability, the efficacy and convenience of CBT could be improved through the use of online treatments and selective emphasis on its most 'potent' components of which behavioural techniques form the focus. Method: Twenty-six individuals with BN were enrolled in an online CBT-based self-help programme and 17 completed four weeks of regular eating and food-monitoring using the online Food Diary tool. Participants were contacted for a weekly check-in phone call and had their bulimic symptom severity assessed at five time points (baseline and weeks 1-4). Results: There was a significant decrease in the frequency of self-reported objective binge episodes, associated loss of control and objective binge days reported between pre- and post-treatment measures. Significant improvements were also observed in most subscales of the Eating Disorder Examination-Questionnaire. Conclusion: This study provides encouraging preliminary evidence of the potential of behavioural techniques of online CBT in the treatment of BN. Online therapy with this focus is potentially a viable and practical form of treatment delivery in this illness group. These preliminary findings support the need for larger studies using control groups.
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Affiliation(s)
- Sarah Barakat
- School of Psychology, University of Sydney, Sydney, NSW 2006, Australia.
| | - Sarah Maguire
- Centre for Eating and Dieting Disorders, Boden Institute, University of Sydney, Sydney, NSW 2006, Australia.
| | - Lois Surgenor
- Department of Psychological Medicine, University of Otago at Christchurch, Christchurch 8140, New Zealand.
| | | | - Blagica Miceska
- Centre for Eating and Dieting Disorders, Boden Institute, University of Sydney, Sydney, NSW 2006, Australia.
| | - Kirsty Fromholtz
- Centre for Eating and Dieting Disorders, Boden Institute, University of Sydney, Sydney, NSW 2006, Australia.
| | - Janice Russell
- School of Medicine, University of Sydney, Sydney, NSW 2006, Australia.
| | - Phillipa Hay
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, NSW 2751, Australia.
| | - Stephen Touyz
- School of Psychology, University of Sydney, Sydney, NSW 2006, Australia.
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Mathisen TF, Rosenvinge JH, Pettersen G, Friborg O, Vrabel K, Bratland-Sanda S, Svendsen M, Stensrud T, Bakland M, Wynn R, Sundgot-Borgen J. The PED-t trial protocol: The effect of physical exercise -and dietary therapy compared with cognitive behavior therapy in treatment of bulimia nervosa and binge eating disorder. BMC Psychiatry 2017; 17:180. [PMID: 28494809 PMCID: PMC5427572 DOI: 10.1186/s12888-017-1312-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Accepted: 04/13/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sufferers from bulimia nervosa (BN) and binge eating disorder (BED) underestimate the severity risk of their illness and, therefore, postpone seeking professional help for years. Moreover, less than one in five actually seek professional help and only 50% respond to current treatments, such as cognitive behavioral therapy (CBT). The impetus for the present trial is to explore a novel combination treatment approach adapted from physical exercise- and dietary therapy (PED-t). The therapeutic underpinnings of these separate treatment components are well-known, but their combination to treat BN and BED have never been previously tested. The purpose of this paper is to provide the rationale for this new treatment approach and to outline the specific methods and procedures. METHODS The PED-t trial uses a prospective randomized controlled design. It allocates women between 18 and 40 years (BMI range 17.5-35.0) to groups consisting of 5-8 members who receive either CBT or PED-t for 16 weeks. Excess participants are allocated to a waiting list control group condition. All participants are assessed at baseline, post-treatment, 6, 12 and 24 months' post-follow-up, respectively, and monitored for changes in biological, psychological and therapy process variables. The primary outcome relates to the ED symptom severity, while secondary outcomes relates to treatment effects on physical health, treatment satisfaction, therapeutic alliance, and cost-effectiveness. We aim to disseminate the results in high-impact journals, preferable open access, and at international conferences. DISCUSSION We expect that the new treatment will perform equal to CBT in terms of behavioral and psychological symptoms, but better in terms of reducing somatic symptoms and complications. We also expect that the new treatment will improve physical fitness and thereby, quality of life. Hence, the new treatment will add to the portfolio of evidence-based therapies and thereby provide a good treatment alternative for females with BN and BED. TRIAL REGISTRATION Prospectively registered in REC the 16th of December 2013 with the identifier number 2013/1871 , and in Clinical Trials the 17th of February 2014 with the identifier number NCT02079935 .
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Affiliation(s)
| | - Jan H. Rosenvinge
- 0000000122595234grid.10919.30Department of Psychology, UiT -The Arctic University of Norway, Faculty of Health Sciences, 9037 Tromsø, Norway
| | - Gunn Pettersen
- 0000000122595234grid.10919.30Department of Health and Caring Sciences, UiT -The Arctic University of Norway, Faculty of Health Sciences, 9073 Tromsø, Norway
| | - Oddgeir Friborg
- 0000000122595234grid.10919.30Department of Psychology, UiT -The Arctic University of Norway, Faculty of Health Sciences, 9037 Tromsø, Norway
| | - KariAnne Vrabel
- Research Institute of Modum Bad, Badeveien 287, 3370 Vikersund, Norway
| | - Solfrid Bratland-Sanda
- grid.463530.7University College of Southeast Norway, Bø Postboks 235, 3603 Kongsberg, Norway
| | - Mette Svendsen
- 0000 0004 0389 8485grid.55325.34Department of Preventive Medicine, Oslo University Hospital, Kirkeveien 166, 0407 Oslo, Norway
| | - Trine Stensrud
- 0000 0000 8567 2092grid.412285.8Department of Sports Medicine, Norwegian School of Sport Sciences, Sognsvegen 220, 0806 Oslo, Norway
| | - Maria Bakland
- 0000000122595234grid.10919.30Department of Health and Caring Sciences, UiT -The Arctic University of Norway, Faculty of Health Sciences, 9073 Tromsø, Norway
| | - Rolf Wynn
- 0000000122595234grid.10919.30Department of Clinical Medicine, UiT -The Arctic University of Norway, Faculty of Health Sciences, 9037 Tromsø, Norway
| | - Jorunn Sundgot-Borgen
- 0000 0000 8567 2092grid.412285.8Department of Sports Medicine, Norwegian School of Sport Sciences, Sognsvegen 220, 0806 Oslo, Norway
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Graves TA, Tabri N, Thompson-Brenner H, Franko DL, Eddy KT, Bourion-Bedes S, Brown A, Constantino MJ, Flückiger C, Forsberg S, Isserlin L, Couturier J, Paulson Karlsson G, Mander J, Teufel M, Mitchell JE, Crosby RD, Prestano C, Satir DA, Simpson S, Sly R, Lacey JH, Stiles-Shields C, Tasca GA, Waller G, Zaitsoff SL, Rienecke R, Le Grange D, Thomas JJ. A meta-analysis of the relation between therapeutic alliance and treatment outcome in eating disorders. Int J Eat Disord 2017; 50:323-340. [PMID: 28152196 DOI: 10.1002/eat.22672] [Citation(s) in RCA: 101] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 12/12/2016] [Accepted: 12/12/2016] [Indexed: 12/11/2022]
Abstract
The therapeutic alliance has demonstrated an association with favorable psychotherapeutic outcomes in the treatment of eating disorders (EDs). However, questions remain about the inter-relationships between early alliance, early symptom improvement, and treatment outcome. We conducted a meta-analysis on the relations among these constructs, and possible moderators of these relations, in psychosocial treatments for EDs. Twenty studies met inclusion criteria and supplied sufficient supplementary data. Results revealed small-to-moderate effect sizes, βs = 0.13 to 0.22 (p < .05), indicating that early symptom improvement was related to subsequent alliance quality and that alliance ratings also were related to subsequent symptom reduction. The relationship between early alliance and treatment outcome was partially accounted for by early symptom improvement. With regard to moderators, early alliance showed weaker associations with outcome in therapies with a strong behavioral component relative to nonbehavioral therapies. However, alliance showed stronger relations to outcome for younger (vs. older) patients, over and above the variance shared with early symptom improvement. In sum, early symptom reduction enhances therapeutic alliance and treatment outcome in EDs, but early alliance may require specific attention for younger patients and for those receiving nonbehaviorally oriented treatments.
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Affiliation(s)
- Tiffany A Graves
- Eating Disorders Clinical and Research Program (EDCRP), Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States
| | - Nassim Tabri
- Eating Disorders Clinical and Research Program (EDCRP), Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States
| | - Heather Thompson-Brenner
- Eating Disorders Clinical and Research Program (EDCRP), Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States
| | - Debra L Franko
- Eating Disorders Clinical and Research Program (EDCRP), Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States
| | - Kamryn T Eddy
- Eating Disorders Clinical and Research Program (EDCRP), Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States
| | | | - Amy Brown
- Eating Disorder Service, South London and Maudsley NHS Foundation Trust, London, England, United Kingdom
| | - Michael J Constantino
- Department of Psychological and Brain Sciences, University of Massachusetts-Amherst, Amherst, Massachusetts, United States
| | - Christoph Flückiger
- Department of Psychology, University of Wisconsin-Madison, Madison, Wisconsin, United States and Institute fur Psychologie, University of Bern, Bern, Switzerland
| | - Sarah Forsberg
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, California, United States
| | - Leanna Isserlin
- Division of Child & Adolescent Psychiatry, University of Ottawa, Ottawa, Ontario, Canada
| | - Jennifer Couturier
- Pediatric Eating Disorders Program, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | | | - Johannes Mander
- ZZP Center for Psychological Psychotherapy, University of Heidelberg, Heidelberg, Germany
| | - Martin Teufel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany and Clinic for Psychosomatic Medicine and Psychotherapy, University of Duisburg-Essen, Essen, Germany
| | - James E Mitchell
- Neuropsychiatric Research Institute, Fargo, North Dakota, United States and University of North Dakota School of Medicine and Health Sciences, Grand Forks, North Dakota, United States
| | - Ross D Crosby
- Neuropsychiatric Research Institute, Fargo, North Dakota, United States and University of North Dakota School of Medicine and Health Sciences, Grand Forks, North Dakota, United States
| | | | - Dana A Satir
- Department of Psychiatry, University of Colorado Denver, Denver, Colorado, United States
| | - Susan Simpson
- School of Psychology, Social Work, and Social Policy, University of South Australia, South Australia, Australia
| | - Richard Sly
- School of Nursing Science, University of East Anglia, Norwich, Norfolk, United Kingdom
| | - J Hubert Lacey
- Department of Health and Social Care Sciences, St. George's, University of London, London, England, United Kingdom
| | - Colleen Stiles-Shields
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine and The School of Social Service Administration, University of Chicago, Chicago, Illinois, United States
| | - Giorgio A Tasca
- Brain and Mind Research Institute, University of Ottawa and the Ottawa Hospital, Ottawa, Ontario, Canada
| | - Glenn Waller
- Department of Psychology, University of Sheffield, Sheffield, United Kingdom
| | - Shannon L Zaitsoff
- Department of Psychology, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Renee Rienecke
- The University of Michigan Comprehensive Eating Disorders Program, Ann Arbor, Michigan, United States
| | - Daniel Le Grange
- Department of Psychiatry, University of California, San Francisco, California, United States
| | - Jennifer J Thomas
- Eating Disorders Clinical and Research Program (EDCRP), Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States
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Chen EY, Cacioppo J, Fettich K, Gallop R, McCloskey MS, Olino T, Zeffiro TA. An adaptive randomized trial of dialectical behavior therapy and cognitive behavior therapy for binge-eating. Psychol Med 2017; 47:703-717. [PMID: 27852348 PMCID: PMC7418949 DOI: 10.1017/s0033291716002543] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Early weak treatment response is one of the few trans-diagnostic, treatment-agnostic predictors of poor outcome following a full treatment course. We sought to improve the outcome of clients with weak initial response to guided self-help cognitive behavior therapy (GSH). METHOD One hundred and nine women with binge-eating disorder (BED) or bulimia nervosa (BN) (DSM-IV-TR) received 4 weeks of GSH. Based on their response, they were grouped into: (1) early strong responders who continued GSH (cGSH), and early weak responders randomized to (2) dialectical behavior therapy (DBT), or (3) individual and additional group cognitive behavior therapy (CBT+). RESULTS Baseline objective binge-eating-day (OBD) frequency was similar between DBT, CBT+ and cGSH. During treatment, OBD frequency reduction was significantly slower in DBT and CBT+ relative to cGSH. Relative to cGSH, OBD frequency was significantly greater at the end of DBT (d = 0.27) and CBT+ (d = 0.31) although these effects were small and within-treatment effects from baseline were large (d = 1.41, 0.95, 1.11, respectively). OBD improvements significantly diminished in all groups during 12 months follow-up but were significantly better sustained in DBT relative to cGSH (d = -0.43). At 6- and 12-month follow-up assessments, DBT, CBT and cGSH did not differ in OBD. CONCLUSIONS Early weak response to GSH may be overcome by additional intensive treatment. Evidence was insufficient to support superiority of either DBT or CBT+ for early weak responders relative to early strong responders in cGSH; both were helpful. Future studies using adaptive designs are needed to assess the use of early response to efficiently deliver care to large heterogeneous client groups.
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Affiliation(s)
- E. Y. Chen
- Department of Psychology, Temple University, Philadelphia, PA, USA
| | - J. Cacioppo
- Department of Psychology, The University of Chicago, Chicago, IL, USA
| | - K. Fettich
- Department of Psychology, Temple University, Philadelphia, PA, USA
| | - R. Gallop
- Department of Mathematics, West Chester University, West Chester, PA, USA
- Department of Psychiatry, Center for Psychotherapy Research, Perelman School of Medicine, University of Pennsylvania, USA
| | - M. S. McCloskey
- Department of Psychology, Temple University, Philadelphia, PA, USA
| | - T. Olino
- Department of Psychology, Temple University, Philadelphia, PA, USA
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22
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Nazar BP, Gregor LK, Albano G, Marchica A, Coco GL, Cardi V, Treasure J. Early Response to treatment in Eating Disorders: A Systematic Review and a Diagnostic Test Accuracy Meta-Analysis. EUROPEAN EATING DISORDERS REVIEW 2016; 25:67-79. [PMID: 27928853 DOI: 10.1002/erv.2495] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 10/21/2016] [Accepted: 11/10/2016] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Early response to eating disorders treatment is thought to predict a later favourable outcome. A systematic review of the literature and meta-analyses examined the robustness of this concept. METHOD The criteria used across studies to define early response were summarised following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Diagnostic Test Accuracy methodology was used to estimate the size of the effect. RESULTS Findings from 24 studies were synthesized and data from 14 studies were included in the meta-analysis. In Anorexia Nervosa, the odds ratio of early response predicting remission was 4.85(95%CI: 2.94-8.01) and the summary Area Under the Curve (AUC) = .77. In Bulimia Nervosa, the odds ratio was 2.75(95%CI:1.24-6.09) and AUC = .67. For Binge Eating Disorder, the odds ratio was 5.01(95%CI: 3.38-7.42) and AUC = .71. CONCLUSION Early behaviour change accurately predicts later symptom remission for Anorexia Nervosa and Binge Eating Disorder but there is less predictive accuracy for Bulimia Nervosa. Copyright © 2016 John Wiley & Sons, Ltd and Eating Disorders Association.
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Affiliation(s)
- Bruno Palazzo Nazar
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), London, UK.,Federal University of Rio de Janeiro, Institute of Psychiatry (IPUB-UFRJ), Brazil
| | - Louise Kathrine Gregor
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), London, UK
| | - Gaia Albano
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), London, UK.,University of Palermo, Department of Psychology and Educational Sciences, Palermo, Italy
| | - Angelo Marchica
- University of Palermo, Department of Psychology and Educational Sciences, Palermo, Italy
| | - Gianluca Lo Coco
- University of Palermo, Department of Psychology and Educational Sciences, Palermo, Italy
| | | | - Janet Treasure
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), London, UK
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Linardon J, de la Piedad Garcia X, Brennan L. Predictors, Moderators, and Mediators of Treatment Outcome Following Manualised Cognitive-Behavioural Therapy for Eating Disorders: A Systematic Review. EUROPEAN EATING DISORDERS REVIEW 2016; 25:3-12. [DOI: 10.1002/erv.2492] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 10/11/2016] [Accepted: 10/15/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Jake Linardon
- School of Psychology; Australian Catholic University; Melbourne Victoria Australia
| | | | - Leah Brennan
- School of Psychology; Australian Catholic University; Melbourne Victoria Australia
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24
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Linardon J, Brennan L, de la Piedad Garcia X. Rapid response to eating disorder treatment: A systematic review and meta-analysis. Int J Eat Disord 2016; 49:905-919. [PMID: 27528478 DOI: 10.1002/eat.22595] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/05/2016] [Indexed: 11/11/2022]
Abstract
OBJECTIVE This review aimed to (a) examine the effects of rapid response on behavioral, cognitive, and weight-gain outcomes across the eating disorders, (b) determine whether diagnosis, treatment modality, the type of rapid response (changes in disordered eating cognitions or behaviors), or the type of behavioral outcome moderated this effect, and (c) identify factors that predict a rapid response. METHOD Thirty-four articles met inclusion criteria from six databases. End of treatment and follow-up outcomes were divided into three categories: Behavioral (binge eating/purging), cognitive (EDE global scores), and weight gain. Average weighted effect sizes(r) were calculated. RESULTS Rapid response strongly predicted better end of treatment and follow-up cognitive and behavioral outcomes. Moderator analyses showed that the effect size for rapid response on behavioral outcomes was larger when studies included both binge eating and purging (as opposed to just binge eating) as a behavioral outcome. Diagnosis, treatment modality, and the type of rapid response experienced did not moderate the relationship between early response and outcome. The evidence for weight gain was mixed. None of the baseline variables analyzed (eating disorder psychopathology, demographics, BMI, and depression scores) predicted a rapid response. DISCUSSION As there is a solid evidence base supporting the prognostic importance of rapid response, the focus should shift toward identifying the within-treatment mechanisms that predict a rapid response so that the effectiveness of eating disorder treatment can be improved. There is a need for future research to use theories of eating disorders as a guide to assess within-treatment predictors of rapid response. © 2016 Wiley Periodicals, Inc. Int J Eat Disord 2016; 49:905-919.
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Affiliation(s)
- Jake Linardon
- School of Psychology, Australian Catholic University, Melbourne, Victoria, 3065, Australia.
| | - Leah Brennan
- School of Psychology, Australian Catholic University, Melbourne, Victoria, 3065, Australia
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25
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De Young KP, Anderson DA. An Interactive, Graphical Tool for Retrospectively Assessing Symptom Frequency and Severity: An Illustration With Eating Disorder Behaviors, Body Weight, and Stress. Assessment 2016; 24:835-852. [PMID: 27637739 DOI: 10.1177/1073191116668629] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
There are few assessments that gather valid, highly detailed data on short-term (i.e., weekly) symptom frequency/severity retrospectively. In particular, methodologies that provide valid data for research investigating symptom changes are typically prospective, expensive, and burdensome. The purpose of this study was to evaluate a new interactive and graphical assessment tool for gathering detailed information about eating-related symptom frequency/severity retrospectively over a 3-month period. A mixed eating disorder sample ( N = 113) recruited from the community provided symptom data once weekly for 12 weeks and completed the Interactive, Graphical Assessment Tool (IGAT) assessing eating disorder symptoms on three occasions to determine the test-retest and concurrent validity of the IGAT. The IGAT performed marginally better than other measures for retrospective symptom frequency assessment in the eating disorders and did so at a greater level of detail than other available tools. Future research should evaluate the IGAT with other behaviors of interest.
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Affiliation(s)
- Kyle P De Young
- 1 University of North Dakota, Grand Forks, ND, USA.,2 University of Wyoming, Laramie, WY, USA
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26
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Vall E, Wade TD. Predictors of treatment outcome in individuals with eating disorders: A systematic review and meta-analysis. Int J Eat Disord 2015; 48:946-71. [PMID: 26171853 DOI: 10.1002/eat.22411] [Citation(s) in RCA: 325] [Impact Index Per Article: 36.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/13/2015] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Understanding the factors that predict a favourable outcome following specialist treatment for an eating disorder may assist in improving treatment efficacy, and in developing novel interventions. This review and meta-analysis examined predictors of treatment outcome and drop-out. METHOD A literature search was conducted to identify research investigating predictors of outcome in individuals treated for an eating disorder. We organized predictors first by statistical type (simple, meditational, and moderational), and then by category. Average weighted mean effect sizes (r) were calculated for each category of predictor. RESULTS The most robust predictor of outcome at both end of treatment (EoT) and follow-up was the meditational mechanism of greater symptom change early during treatment. Simple baseline predictors associated with better outcomes at both EoT and follow-up included higher BMI, fewer binge/purge behaviors, greater motivation to recover, lower depression, lower shape/weight concern, fewer comorbidities, better interpersonal functioning and fewer familial problems. Drop-out was predicted by more binge/purge behaviors and lower motivation to recover. For most predictors, there was large interstudy variability in effect sizes, and outcomes were operationalized in different ways. There were generally insufficient studies to allow analysis of predictors by eating disorder subtype or treatment type. DISCUSSION To ensure that this area continues to develop with robust and clinically relevant findings, future studies should adopt a consistent definition of outcome and continue to examine complex multivariate predictor models. Growth in this area will allow for stronger conclusions to be drawn about the prediction of outcome for specific diagnoses and treatment types.
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Affiliation(s)
- Eva Vall
- School of Psychology, Flinders University, Adelaide, South Australia, Australia
| | - Tracey D Wade
- School of Psychology, Flinders University, Adelaide, South Australia, Australia
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27
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Abstract
Eating disorders are complex and serious psychiatric illnesses whose etiology includes psychological, biological, and social factors. Treatment of eating disorders is challenging as there are few evidence-based treatments and limited understanding of the mechanisms that result in sustained recovery. In the last 20 years, we have begun to identify neural pathways that are altered in eating disorders. Consideration of how these pathways may contribute to an eating disorder can provide an understanding of expected responses to treatments. Eating disorder behaviors include restrictive eating, compulsive overeating, and purging behaviors after eating. Eating disorders are associated with changes in many neural systems. In this targeted review, we focus on three cognitive processes associated with neurocircuitry differences in subjects with eating disorders such as reward, decision-making, and social behavior. We briefly examine how each of these systems function in healthy people, using Neurosynth meta-analysis to identify key regions commonly implicated in these circuits. We review the evidence for disruptions of these regions and systems in eating disorders. Finally, we describe psychiatric and psychological treatments that are likely to function by impacting these regions.
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Affiliation(s)
- Carrie J McAdams
- University of Texas at Southwestern Medical Center, Dallas, TX, USA; Department of Psychiatry, Texas Health Presbyterian Hospital of Dallas, Dallas, TX, USA
| | - Whitney Smith
- University of Texas at Southwestern Medical Center, Dallas, TX, USA
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28
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Elmquist J, Shorey RC, Anderson S, Stuart GL. Eating Disorder Symptoms and Length of Stay in Residential Treatment for Substance Use: A Brief Report. J Dual Diagn 2015; 11:233-7. [PMID: 26457661 PMCID: PMC4724169 DOI: 10.1080/15504263.2015.1104480] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Treatment dropout is common both among people in treatment for eating disorders and for substance use disorders. Because of the high rates of co-occurrence and mortality associated with these disorders, the purpose of the current study was to examine the relationship among eating disorder symptoms, length of stay, and decisions to leave against medical advice among individuals in substance use treatment. METHODS We analyzed de-identified medical record data for 122 adult women enrolled in residential treatment for substance use disorders over a 12-month period. Routine treatment intake included standardized assessments of eating disorders, depression, and substance use. RESULTS Participants averaged 43.1 years of age (SD = 10.7) and were primarily non-Hispanic Caucasian (n = 118, 96.7%). Approximately 8 (6.6%) patients met criteria for a probable eating disorder and 79 (64.8%) for a probable alcohol use disorder. Mean length of stay was 28.1 days (SD = 6.6) and 21 (17%) patients left against medical advice. Logistic regression analysis showed that eating disorder symptoms were significantly associated with decisions to leave treatment against medical advice after controlling for age, years of education, depression symptoms, alcohol problems, and drug problems: χ(2) = 14.88, df = 6, p =.02. This model accounted for 19.1% (Nagelkerke R(2)) of the variance in discharge type. Eating disorder symptoms were not associated with length of treatment. CONCLUSIONS Our findings suggest the importance of assessing and monitoring eating disorder symptoms among individuals in treatment for substance use disorders.
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Affiliation(s)
- JoAnna Elmquist
- a University of Tennessee-Knoxville , Knoxville , Tennessee , USA
| | - Ryan C Shorey
- b Department of Psychology , Ohio University , Athens , Ohio , USA
| | - Scott Anderson
- c Cornerstone of Recovery , Louisville , Tennessee , USA
| | - Gregory L Stuart
- a University of Tennessee-Knoxville , Knoxville , Tennessee , USA
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29
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Legenbauer TM, Meule A. Challenges in the Treatment of Adolescent Anorexia Nervosa - Is Enhanced Cognitive Behavior Therapy The Answer? Front Psychiatry 2015; 6:148. [PMID: 26528192 PMCID: PMC4604253 DOI: 10.3389/fpsyt.2015.00148] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 10/02/2015] [Indexed: 11/27/2022] Open
Affiliation(s)
- Tanja M Legenbauer
- Hospital for Child and Adolescent Psychiatry, LWL University Hospital of the Ruhr-University Bochum , Hamm , Germany
| | - Adrian Meule
- Department of Psychology, Center for Cognitive Neuroscience, University of Salzburg , Salzburg , Austria
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