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Liu J, Wang H, Wetherall L, Giannone A, Juarascio A. Patients' perceptions of post-treatment factors that influenced skill use after cognitive-behavioral therapy for bulimia nervosa spectrum disorders. Int J Eat Disord 2024; 57:1589-1598. [PMID: 38558432 PMCID: PMC11262978 DOI: 10.1002/eat.24206] [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: 12/08/2023] [Revised: 03/19/2024] [Accepted: 03/20/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVE Deterioration rate among patients with bulimia-spectrum eating disorders (BN-EDs) after receiving enhanced cognitive-behavioral therapy (CBT-E) remains high. Previous studies identified body image concerns, environmental triggers, lack of social support, lack of resources, comorbidity, and discontinued skill use as predictors of deterioration. However, no studies have qualitatively explored patients' perceptions of how these factors influenced their skill use and led to deterioration after receiving outpatient CBT. METHODS This study aimed to qualitatively explore (1) what post-treatment factors patients believe contributed to deterioration, and (2) whether patients continued to practice the CBT skills they learned from treatment and identify motivators and barriers to post-treatment skill use. Twelve participants who had previously completed 16 sessions of CBT for their BN-EDs and experienced at least modest treatment responses participated in the qualitative interviews. RESULTS Four themes were identified from the qualitative interviews. Post-treatment deterioration was primarily driven by decreased skill use due to a perceived sudden loss of accountability and continued body dissatisfaction after treatment ended. Discontinued practice of binge analysis led to decreased awareness of the relationship between poor skill use and ED behaviors. Difficulty accessing resources impeded participants from receiving external help to address challenges in skill practice, thus also contributing to deterioration. DISCUSSION Findings suggested that outpatient treatment for BN-EDs patients should emphasize more on body image concern, and deterioration prevention for outpatient CBT-E should focus on building self-accountability to keep practicing skills after treatment ends. PUBLIC SIGNIFICANCE This study was the first to qualitatively explore post-treatment factors influencing skill use and deterioration in patients with bulimia-spectrum eating disorders after they completed outpatient CBT. Findings indicated that decreased skill use was a primary driver of post-treatment deterioration, and that relapse prevention for outpatient CBT for BN-EDs should focus on enhancing patients' self-accountability to continue practicing therapeutic skills independently after treatment ended.
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Affiliation(s)
- Jianyi Liu
- Center for Weight, Eating and Lifestyle Science, Drexel University, Philadelphia, PA, USA
- Department of Psychological and Brain Sciences, Drexel University, Philadelphia, PA, USA
| | - Hailing Wang
- Center for Weight, Eating and Lifestyle Science, Drexel University, Philadelphia, PA, USA
- Graduate School of Education, University of Pennsylvania, Philadelphia, PA, USA
| | - Lucy Wetherall
- Center for Weight, Eating and Lifestyle Science, Drexel University, Philadelphia, PA, USA
- Department of Psychological and Brain Sciences, Drexel University, Philadelphia, PA, USA
| | - Alyssa Giannone
- Center for Weight, Eating and Lifestyle Science, Drexel University, Philadelphia, PA, USA
- Department of Psychological and Brain Sciences, Drexel University, Philadelphia, PA, USA
| | - Adrienne Juarascio
- Center for Weight, Eating and Lifestyle Science, Drexel University, Philadelphia, PA, USA
- Department of Psychological and Brain Sciences, Drexel University, Philadelphia, PA, USA
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Beard J, Cooper Z, Masson P, Mountford VA, Murphy R, Raykos B, Tatham M, Thomas JJ, Turner HM, Wade TD, Waller G. Assessing clinician competence in the delivery of cognitive-behavioural therapy for eating disorders: development of the Cognitive-Behavioural Therapy Scale for Eating Disorders (CBTS-ED). Cogn Behav Ther 2024; 53:29-47. [PMID: 37807843 DOI: 10.1080/16506073.2023.2263640] [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: 10/27/2022] [Accepted: 09/20/2023] [Indexed: 10/10/2023]
Abstract
Evidence-based cognitive-behaviour therapy for eating disorders (CBT-ED) differs from other forms of CBT for psychological disorders, making existing generic CBT measures of therapist competence inadequate for evaluating CBT-ED. This study developed and piloted the reliability of a novel measure of therapist competence in this domain-the Cognitive Behaviour Therapy Scale for Eating Disorders (CBTS-ED). Initially, a team of CBT-ED experts developed a 26-item measure, with general (i.e. present in every session) and specific (context- or case-dependent) items. To determine statistical properties of the measure, nine CBT-ED experts and eight non-experts independently observed six role-played mock CBT-ED therapy sessions, rating the therapists' performance using the CBTS-ED. The inter-item consistency (Cronbach's alpha and McDonald's omega) and inter-rater reliability (ICC) were assessed, as appropriate to the clustering of the items. The CBTS-ED demonstrated good internal consistency and moderate/good inter-rater reliability for the general items, at least comparable to existing generic CBT scales in other domains. An updated version is proposed, where five of the 16 "specific" items are reallocated to the general group. These preliminary results suggest that the CBTS-ED can be used effectively across both expert and non-expert raters, though less experienced raters might benefit from additional training in its use.
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Affiliation(s)
- Jessica Beard
- Department of Psychology, University of Sheffield, Sheffield, UK
| | - Zafra Cooper
- Department of Psychiatry, Yale University, New Haven, USA
| | - Philip Masson
- Department of Psychology, Western University, London, Canada
| | - Victoria A Mountford
- Sage Clinics, Dubai, UAE
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Rebecca Murphy
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Bronwyn Raykos
- Centre for Clinical Interventions, Northbridge, Western Australia
| | - Madeleine Tatham
- Department of Psychology, University of Sheffield, Sheffield, UK
| | - Jennifer J Thomas
- Department of Psychiatry, Harvard Medical School Massachusetts General Hospital, Boston, USA
| | - Hannah M Turner
- Eating Disorders Service, Southern Health NHS Foundation Trust, Southampton, UK
| | - Tracey D Wade
- College of Education, Psychology and Social Work, Flinders University, Bedford Park, South Australia
| | - Glenn Waller
- Department of Psychology, University of Sheffield, Sheffield, UK
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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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Tanis J, Martijn C, Vroling MS, Maas J, Keijsers GPJ. Reducing binge eating through behavioral-focused versus emotion-focused implementation intentions in patients with binge eating disorder or bulimia nervosa: An experimental approach. Behav Res Ther 2023; 169:104399. [PMID: 37672830 DOI: 10.1016/j.brat.2023.104399] [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: 03/09/2023] [Revised: 08/25/2023] [Accepted: 08/28/2023] [Indexed: 09/08/2023]
Abstract
Binge eating disorder (BED) and bulimia nervosa (BN) are characterized by recurrent binge eating, episodes of consuming large amounts of food in a discrete period of time associated with a loss of control. Implementation intentions are explicit if-then plans that engender goal-directed action, and rely less on cognitive control than standard treatment options. In a sample with BED and BN, we compared two implementation intention conditions to a control condition. In the behavior-focused condition, implementation intentions targeted binge eating behaviors. In the emotion-focused condition, implementation intentions targeted negative affect preceding binge eating. In the control condition, only goal intentions were set. Each condition comprised three sessions. Participants kept food diaries for four weeks. Compared to the control condition both implementation intention conditions showed significant and large reductions of binge eating that persisted for six months. Effects did not differ between the behavior-focused and emotion-focused implementation intention conditions. These results demonstrate that three sessions on implementation intention formation can lead to long-term reductions in binge eating in patients with BED or BN. Learning how to form implementation intentions seems a recommendable addition to the current standard treatment. Future research could investigate the added value of fully personalized implementation intentions. CLINICAL TRIAL REGISTRATION NUMBER: NL52600.068.15.
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Affiliation(s)
- Jorg Tanis
- Department of Clinical Psychological Science, Maastricht University, Maastricht, the Netherlands.
| | - Carolien Martijn
- Department of Clinical Psychological Science, Maastricht University, Maastricht, the Netherlands
| | - Maartje S Vroling
- GGNet Amarum, Expert Centre for Eating Disorders, Nijmegen, the Netherlands; Behavioural Science Institute, Radboud University, Nijmegen, the Netherlands
| | - Joyce Maas
- GGZ Oost-Brabant, Center for Eating Disorders, Helmond, the Netherlands
| | - Ger P J Keijsers
- Department of Clinical Psychological Science, Maastricht University, Maastricht, the Netherlands; Behavioural Science Institute, Radboud University, Nijmegen, the Netherlands
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Fioravanti G, Nicolis M, MacBeth A, Dimaggio G, Popolo R. Metacognitive interpersonal therapy-eating disorders versus cognitive behavioral therapy for eating disorders for non-underweight adults with eating disorders: study protocol for a pilot pre-registered randomized controlled trial. RESEARCH IN PSYCHOTHERAPY (MILANO) 2023; 26:690. [PMID: 37667887 PMCID: PMC10519278 DOI: 10.4081/ripppo.2023.690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 08/09/2023] [Indexed: 09/06/2023]
Abstract
Eating disorders (ED) are serious disorders characterized by an alteration of eating habits and excessive concern about weight and body shapes (Fairburn, 2002), accompanied by significant impairment inequality of life, high mortality rates and serious organic consequences (Jenkins et al., 2011; Treasure et al., 2015; 2020). Although evidence-based psychological therapies for nonunderweight ED presentations such as cognitive behavioral therapy for eating disorders (CBT-ED) are widely available, there is substantial scope for improvements, particularly in terms of efficacy and adherence. One option is to develop interventions to address elements of pathology not fully addressed by existing empirical supported treatments, such as incorporating techniques aimed at addressing interpersonal problems and personality disorder features into existing treatment delivery. We adapted Metacognitive Interpersonal Therapy, a psychological intervention supported by evidence for treating personality disorders and integrated it with existing CBT techniques for eating disorders (MIT-ED). MIT-ED targets aspects of ED that are not included in the transdiagnostic CBT-E model such as poor metacognition, or maladaptive interpersonal schemas. This is a pre-registered (Protocol number: 0000781) pilot randomized clinical trial aimed at assessing acceptability and feasibility of MIT-ED and establishing preliminary evidence of effectiveness for future larger studies. Twenty patients (10 in each arm) will be randomized to 20 sessions of individual psychotherapy, either MIT-ED or CBTE. Repeated follow-ups will be collected up to 24 months. Participants are recruited at a private outpatient clinic for ED treatment. Acceptability will be assessed via session attendance, completion rates and preliminary outcomes. The primary outcome is ED pathology assessed with the Eating Disorder Examination Questionnaire-6. Other ED outcomes assessed will be eating disorder attitudes, clinical impairment and binge eating pathology. Secondary treatment outcomes are anxiety, depression, and global symptomatology. We will also assess emotional awareness, emotion regulation and therapeutic alliance. Based on previous studies of MIT for personality disorders we hypothesize that MIT-ED will be acceptable to patients, evidenced by high treatment adherence and retention. We hypothesize that MIT-ED will be associated with reductions in eating disorder pathology, at least equivalent to CBT-E. Results will be used to inform the study design, sampling, likely effect sizes and choice of outcome measures for future larger trials of MIT-ED in ED samples.
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Affiliation(s)
- Gloria Fioravanti
- Centro di Trattamento Integrato Disturbi Alimentari e Obesità di Gloria Fioravanti, Verona.
| | - Martina Nicolis
- 1Centro di Trattamento Integrato Disturbi Alimentari e Obesità di Gloria Fioravanti, Verona.
| | - Angus MacBeth
- Department of Clinical Psychology, School of Health in Social Science, The University of Edinburgh, Medical School (Doorway 6), Edinburgh.
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Dixon L, Bartel S, Brown V, Ali SI, Gamberg S, Murphy A, Brewer KL, McElroy SL, Kaplan A, Nunes A, Keshen AR. Secondary outcomes and qualitative findings of an open-label feasibility trial of lisdexamfetamine dimesylate for adults with bulimia nervosa. J Eat Disord 2023; 11:81. [PMID: 37218020 PMCID: PMC10204259 DOI: 10.1186/s40337-023-00796-x] [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: 01/05/2023] [Accepted: 04/21/2023] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND There is emerging evidence that stimulants warrant further investigation as a treatment for bulimia nervosa (BN) including a recent open-label feasibility trial examining the use of lisdexamfetamine dimestylate (LDX) for BN. The current report presents the secondary outcomes and qualitative interview results from that feasibility trial. These outcomes explore several purported mechanisms that may explain how stimulants affect symptoms of BN: appetite, impulsivity, obsessive and compulsive symptoms, eating disorder psychopathology/impairment and reward-based decision-making. METHODS Twenty-three participants with BN received LDX for eight weeks. Questionnaires assessing appetite, impulsivity, obsessive and compulsive symptoms, eating disorder psychopathology and impairment were administered at baseline and post-treatment. Participants also completed a two-step reinforcement learning task to assess their decision-making. Semi-structured interviews took place at baseline, week 5, and follow-up. RESULTS Reductions in hunger, food-related impulsivity, obsessive and compulsive features, eating disorder psychopathology and impairment were found. However, reward learning, as far as it is assessed by the task, did not seem to contribute to the effect of LDX on BN symptoms. Qualitative analysis suggested four themes: (1) reprieve from the eating disorder, (2) improvement in function and quality of life, (3) renewed hope for recovery, and (4) ability to normalize eating. CONCLUSIONS This report suggests several potential mechanisms by which LDX may reduce symptoms of binging and purging in those with BN. Importantly, due to the open-label design, we are unable to attribute findings to the medication. Instead, our results should be interpreted as hypothesis generating to inform future studies such as adequately powered randomized controlled trials. Trial registration NCT03397446.
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Affiliation(s)
- Laura Dixon
- Eating Disorder Program, Nova Scotia Health Authority, Halifax, NS, Canada
| | - Sara Bartel
- Eating Disorder Program, Nova Scotia Health Authority, Halifax, NS, Canada
| | - Victoria Brown
- Eating Disorder Program, Nova Scotia Health Authority, Halifax, NS, Canada
| | - Sarrah I Ali
- Eating Disorder Program, Nova Scotia Health Authority, Halifax, NS, Canada
| | - Susan Gamberg
- Eating Disorder Program, Nova Scotia Health Authority, Halifax, NS, Canada
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Andrea Murphy
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
- College of Pharmacy, Dalhousie University, Halifax, NS, Canada
| | | | - Susan L McElroy
- Lindner Center of HOPE, Mason, OH, USA
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Allan Kaplan
- Department of Psychiatry, Centre for Addiction and Mental Health, Institute of Medical Science, University of Toronto, ON, Toronto, Canada
| | - Abraham Nunes
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
- Faculty of Computer Science, Dalhousie University, Halifax, NS, Canada
| | - Aaron R Keshen
- Eating Disorder Program, Nova Scotia Health Authority, Halifax, NS, Canada.
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada.
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Eriksson E, Ramklint M, Wolf-Arehult M, Isaksson M. The relationship between self-control and symptoms of anxiety and depression in patients with eating disorders: a cross-sectional study including exploratory longitudinal data. J Eat Disord 2023; 11:21. [PMID: 36788558 PMCID: PMC9930220 DOI: 10.1186/s40337-023-00750-x] [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: 10/31/2022] [Accepted: 02/06/2023] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND Personality style can partly be described as the way an individual controls and regulates emotions and can be divided into over- and undercontrol. Studies have indicated that personality style may impact the onset, clinical presentation, and recovery from an eating disorder (ED). Furthermore, symptoms of anxiety and depression are common in patients with EDs. However, the association between self-control levels and anxiety/depression symptoms in patients with EDs remains unknown. The main aim of this study was to assess how levels of self-control relate to anxiety/depression symptoms in patients with EDs, with a secondary, exploratory aim to assess the stability of self-control during treatment. METHODS Patients were recruited from the outpatient ED clinic at the Uppsala University Hospital, between October 2014 and December 2019. In total, 227 patients (age: 25.4, SD: 7.1) were included at the start of their treatment, with 14 participants also completing post-treatment measurements. Self-control was assessed with the Ego Undercontrol scale (EUC-13), anxiety/depression symptoms with the Hopkins Symptoms Checklist (HSCL-25), and ED diagnosis and symptoms with the Eating Disorder Examination Interview (EDE-I) and Questionnaire (EDE-Q), respectively. RESULTS A quadratic regression (n = 227) showed that levels of self-control accounted for about four percent of the variance in degree of global anxiety/depressive symptoms. Anxiety/depression symptoms were better explained by ED symptoms (R2 = 0.24). Visualizations in boxplots revealed a tendency for extreme values of both over- and undercontrol to be associated with higher levels of depression, whereas symptoms of anxiety increased with increasing undercontrol. In the exploratory analyses (n = 14) levels of self-control remained more stable than symptoms of anxiety and depression, which decreased significantly during ED treatment. CONCLUSIONS Our results indicated that anxiety/depression symptoms, in patients with EDs, were not strongly correlated with levels of self-control, but rather with ED symptoms. However, extreme values of both over- and undercontrol showed a tendency to be associated with higher levels of depression symptoms, whereas anxiety symptoms increased with increasing levels of undercontrol. Future studies could benefit from considering both over- and undercontrol as potentially dysfunctional.
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Affiliation(s)
- Emmi Eriksson
- Department of Medical Sciences, Child and Adolescent Psychiatry, Uppsala University, Entrance 10, Floor 3B, 751 85, Uppsala, Sweden
| | - Mia Ramklint
- Department of Medical Sciences, Child and Adolescent Psychiatry, Uppsala University, Entrance 10, Floor 3B, 751 85, Uppsala, Sweden
| | - Martina Wolf-Arehult
- Department of Medical Sciences, Child and Adolescent Psychiatry, Uppsala University, Entrance 10, Floor 3B, 751 85, Uppsala, Sweden.,Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet and Stockholm Health Care Services, Region Stockholm, Solna, Sweden
| | - Martina Isaksson
- Department of Medical Sciences, Child and Adolescent Psychiatry, Uppsala University, Entrance 10, Floor 3B, 751 85, Uppsala, Sweden.
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Pakhomova SA, Abrosimova JS, Barylnik JB, Batrakova PA. [Anxiety-depressive symptoms in the structure of eating disorders in adolescents]. Zh Nevrol Psikhiatr Im S S Korsakova 2023; 123:22-29. [PMID: 38127697 DOI: 10.17116/jnevro202312311222] [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] [Indexed: 12/23/2023]
Abstract
OBJECTIVE To identify the features of anxiety and depressive disorders in adolescents with eating disorders (ED) in a comprehensive approach to treatment. MATERIAL AND METHODS The study included 30 middle-aged (11-14 years) and older female adolescents (15-18 years) with ED. All patients underwent psychotherapy using a cognitive-behavioral approach 2 times a week, as well as psychopharmacotherapy using SSRI antidepressants (fluvoxamine, sertraline). A standardized assessment method was used using the Children's Depression Inventory, the multivariate assessment of childhood anxiety, the Lazarus Coping Strategy Questionnaire, and the Eating Behavior Rating Scale. RESULTS The clinical severity and severity of depression were significantly more often detected in girls of the older adolescent group (U=4.5, p<0.05). The highest scores in adolescents of middle and older groups were found on the scales «Decrease in mental activity due to anxiety» (1.52 and 1.64 points respectively), «Increased autonomic reactivity due to anxiety» (1.46 and 1.55 points respectively), «Anxiety related to the evaluation of others» (1.51 and 1.61 points respectively), as well as «Anxiety in relations with peers» (1.53 and 1.64 points respectively). A correlation was found between the severity of anxiety and depression and the choice of certain coping strategies (p<0.05). In both age groups, adolescents more often used maladaptive behavioral strategies. CONCLUSION The results suggest the importance of choosing an individual way to build a cognitive-behavioral therapy plan, taking into account personal responses and the emotional status of adolescents with ED.
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Affiliation(s)
- S A Pakhomova
- Razumovsky Saratov State Medical University, Saratov, Russia
| | - J S Abrosimova
- Razumovsky Saratov State Medical University, Saratov, Russia
| | - J B Barylnik
- Razumovsky Saratov State Medical University, Saratov, Russia
| | - P A Batrakova
- Razumovsky Saratov State Medical University, Saratov, Russia
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Kaa BS, Bünemann JMN, Clausen L. A benchmark study of a combined individual and group anorexia nervosa therapy program. Nord J Psychiatry 2022:1-8. [PMID: 36398931 DOI: 10.1080/08039488.2022.2143558] [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] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Anorexia nervosa (AN) is a treatment-resistant illness. Up to half of the patients show limited or no significant treatment response. First, we aimed to describe a new stepped-care outpatient treatment combining group and individual therapy (CIGAN) with a strong focus on normalizing eating and weight and in vivo meal support for adults with moderate to severe AN. Second, we aimed to compare CIGAN with specialized treatments of Specialized Supportive Clinical Management (SSCM) and the Maudsley model of AN (MANTRA). METHOD The study includes 137 adults with moderate to severe AN and the primary outcome (BMI) at six and twelve months was compared with the outcomes published for SSCM and MANTRA using the Chi-squared test and Student's t-test. The paired t-test and Cohen's d were used to compare the within-group follow-up data with the baseline data. RESULTS CIGAN patients changed significantly on all outcome measures at 6 and 12 months, with effect sizes on BMI of 1.37 and 1.51 and on the weight of 1.36 and 1.60, respectively. Except for the 12-month comparison with MANTRA, patients had a higher BMI and larger BMI increase at both 6 and 12 months than SSCM (BMI p = 0.002 and 0.023, BMI increase p < 0.001 and 0.003) and MANTRA (BMI p = 0.031 and 0.168, BMI increase p < 0.001 and 0.037). DISCUSSION CIGAN, including a stepped care approach, is a promising treatment, and further research on the effective elements is warranted.
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Affiliation(s)
- Bo Skytte Kaa
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Aarhus, Denmark
| | | | - Loa Clausen
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
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Ciążyńska J, Maciaszek J. Various Types of Virtual Reality-Based Therapy for Eating Disorders: A Systematic Review. J Clin Med 2022; 11:jcm11174956. [PMID: 36078886 PMCID: PMC9456485 DOI: 10.3390/jcm11174956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/21/2022] [Accepted: 08/22/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Background: Interactive VR (virtual reality) environments (i.e., using three-dimensional graphics presented with a head-mounted display) have recently become a popular professional tool for the treatment of patients with eating disorders (EDs). However, there are no published review reports that have analyzed the original papers between 2015 and 2021, which additionally focused only on HMD (head-mounted display) 3DVR (three-dimensional virtual reality) exposure and included only three therapeutic categories for ED patients. (2) Methods: The EbscoHost and Scopus databases were searched to identify relevant papers on VR research employing VR in the assessment and treatment of eating disorders. (3) Results: In addition to the known therapeutic divisions for ED, there are new forms of therapy based on 360 cameras, eye-tracking, and remote therapy. (4) Conclusions: The potential of VR in combination with different therapies may offer an alternative for future research. More rigorous testing, especially in terms of larger sample sizes, the inclusion of control groups or multisessions, and follow-up measures, is still needed. The current state of research highlights the importance of the nature and content of VR interventions for ED patients. Future research should look to incorporate more home-based and remote forms of VR tools.
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11
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Simpson S, Azam F, Brown S, Hronis A, Brockman R. The impact of personality disorders and personality traits on psychotherapy treatment outcome of eating disorders: A systematic review. Personal Ment Health 2022; 16:217-234. [PMID: 34866357 DOI: 10.1002/pmh.1533] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 09/15/2021] [Accepted: 11/05/2021] [Indexed: 11/10/2022]
Abstract
A significant proportion of those with eating disorders (EDs) do not respond to first-line treatments. This systematic review was conducted to identify whether personality disorders (PDs)/traits predict or moderate ED treatment outcomes and whether these outcomes were differentially influenced by ED or PD diagnostic subtypes, or treatment approach. A comprehensive systematic literature search was conducted using the PRISMA guidelines. A total of seven randomised controlled trials (RCTs) plus four follow-up studies were reviewed investigating the impact of PD and PD traits on treatment outcomes for EDs. The majority indicated that PD had some impact on treatment outcomes. Outcome measures and time-point measurements varied across studies. Included studies suggested that bulimia nervosa treatment outcomes were not hindered by co-morbidity of borderline PD; however, psychiatric impairment remained high at post-treatment and follow-up. Cluster C PDs were found to negatively impact treatment outcomes for binge ED and attrition rates for anorexia nervosa. Included studies suggested that interventions that addressed aspects of personality pathology showed greater main effects for ED treatment outcomes. There is an urgent need for future RCTs on ED treatments to include routine measures of core personality features to allow their impacts to be more thoroughly examined and for psychotherapies to be tailored accordingly.
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Affiliation(s)
- Susan Simpson
- Regional Eating Disorders Unit, NHS Lothian, Edinburgh, UK.,Department of Justice and Society, University of South Australia, Adelaide, South Australia, Australia
| | - Fatima Azam
- Graduate School of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - SiennaMarisa Brown
- School of Health in Social Science, University of Edinburgh, Edinburgh, UK
| | - Anastasia Hronis
- Graduate School of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Robert Brockman
- Graduate School of Health, University of Technology Sydney, Sydney, New South Wales, Australia.,Institute for Positive Psychology and Education, Australian Catholic University, Melbourne, Victoria, Australia
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12
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Kissileff HR. The Universal Eating Monitor (UEM): objective assessment of food intake behavior in the laboratory setting. Int J Obes (Lond) 2022; 46:1114-1121. [PMID: 35233038 PMCID: PMC9151389 DOI: 10.1038/s41366-022-01089-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 01/27/2022] [Accepted: 02/02/2022] [Indexed: 11/17/2022]
Abstract
The Universal Eating Monitor was a term used to describe a device used in a laboratory setting that enabled investigators to measure, with the same instrument, the rate of eating either solids or liquids, hence the term “universal”. It consisted of an electronic balance placed in a false panel under a table cloth on which could be placed a food reservoir that contained either solid or liquefied food. The device was created in order to determine whether rates of eating differed in pattern between solid and liquid foods. An acceptable mixture of foods of identical composition that could be served as either solid or blended as a liquid was used to test the hypothesis that eating rate and intake were affected by physical composition. A best-fitting mathematical function (intake was quadratic function of time, with coefficients varying among foods used and experimental conditions), quantified intake rates. The device was used to test a variety of mechanisms underlying food intake control. Eating rates were linear when solid foods were used, but negatively accelerated with liquids. Overall, intake did not differ between solid and liquefied food of identical composition. Satiation on a calorie for calorie basis was different among foods, but physical composition interacted with energy density. Hormones and gastric distension were strong influences on food intake and rate of eating. Individuals with bulimia nervosa and binge eating disorder ate more than individuals without these disturbances. Intake in social and individual contexts was identical, but the rate of eating was slower when two individuals dined together. The eating monitor has been a useful instrument for elucidating controls of food intake and describing eating pathology.
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Affiliation(s)
- Harry R Kissileff
- Mount Sinai Morningside Hospital and Department of Medicine Icahn School of Medicine, 1111 Amsterdam Ave., New York, NY, 10025, USA.
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13
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Hamatani S, Matsumoto K, Ishibashi T, Shibukawa R, Honda Y, Kosaka H, Mizuno Y, Andersson G. Development of a culturally adaptable internet-based cognitive behavioral therapy for Japanese women with bulimia nervosa. Front Psychiatry 2022; 13:942936. [PMID: 36081468 PMCID: PMC9446753 DOI: 10.3389/fpsyt.2022.942936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 07/20/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The process of cultural adaptation of internet-based cognitive behavioral therapy (ICBT) programs for bulimia nervosa (BN) have rarely been reported despite the potential influence of cultural adaptation of psychosocial interventions on therapeutic response. AIM This study aimed to illustrate development process of an ICBT program for Japanese women with bulimia nervosa (BN). METHODS A mixed methods approach was used to assess cultural adaptation of the prototype of an original ICBT program by using the Cultural Relevance Questionnaire (CRQ). Five women with BN and seven clinicians were interviewed using the CRQ. RESULTS Quantitative analyses were conducted to assess cultural adaptation of the prototype of the program and participants rated cultural adaptation as high. A qualitative analysis of the mixed method supported the culturally sensitive changes implemented. CONCLUSIONS The results of this study show that a series of processes can make ICBT programs more culturally adapted.
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Affiliation(s)
- Sayo Hamatani
- Research Center for Child Mental Development, University of Fukui, Fukui, Japan.,Division of Developmental Higher Brain Functions, United Graduate School of Child Development, University of Fukui, Fukui, Japan.,Department of Child and Adolescent Psychological Medicine, University of Fukui Hospital, Fukui, Japan.,Research Center for Child Mental Development, Chiba University, Chiba, Japan
| | - Kazuki Matsumoto
- Research Center for Child Mental Development, Chiba University, Chiba, Japan.,Division of Clinical Psychology, Kagoshima University Hospital, Kagoshima, Japan
| | | | | | - Yuki Honda
- Department of Neuropsychiatry, University of Fukui, Fukui, Japan
| | - Hirotaka Kosaka
- Research Center for Child Mental Development, University of Fukui, Fukui, Japan.,Division of Developmental Higher Brain Functions, United Graduate School of Child Development, University of Fukui, Fukui, Japan.,Department of Child and Adolescent Psychological Medicine, University of Fukui Hospital, Fukui, Japan.,Department of Neuropsychiatry, University of Fukui, Fukui, Japan
| | - Yoshifumi Mizuno
- Research Center for Child Mental Development, University of Fukui, Fukui, Japan.,Division of Developmental Higher Brain Functions, United Graduate School of Child Development, University of Fukui, Fukui, Japan.,Department of Child and Adolescent Psychological Medicine, University of Fukui Hospital, Fukui, Japan
| | - Gerhard Andersson
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.,Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
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14
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Mares SHW, Burger J, Lemmens LHJM, van Elburg AA, Vroling MS. Evaluation of the cognitive behavioural theory of eating disorders: A network analysis investigation. Eat Behav 2022; 44:101590. [PMID: 34896868 DOI: 10.1016/j.eatbeh.2021.101590] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 11/19/2021] [Accepted: 11/22/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVE One of the prevailing theories of eating disorders (ED) is the transdiagnostic cognitive behavioural theory of eating disorders, which suggests that certain ED symptoms, such as over-valuation of eating, shape, and weight, may be more central than others. In the present study, network analyses were used to evaluate these assumptions in a patient sample. METHODS Participants were 336 individuals receiving treatment at an expert center for ED in the Netherlands. Eating disorder symptoms were used to create transdiagnostic and diagnosis-specific networks and assess symptom centrality and density of the networks. RESULTS Networks for patients with bulimia nervosa and binge eating disorder confirmed that over-valuation of shape, weight, and eating is the most central symptom in the network. A transdiagnostic network of ED symptoms and separate networks for patients with anorexia nervosa and bulimia nervosa showed that strict dieting was an additional central ED symptom. An exploratory analysis revealed that, although eating disorder symptoms decreased, there were no differences in density of the eating disorder networks before and after treatment with cognitive behavioural therapy. DISCUSSION In conclusion, the current study confirmed that over-valuation of shape, weight, and eating is a central symptom across eating disorders, in agreement with the transdiagnostic cognitive behavioural model of eating disorders. Specifically targeting this symptom in treatment could lead to other symptoms improving as a result.
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Affiliation(s)
- Suzanne H W Mares
- Department of Eating Disorders (Amarum), GGNet Mental Health, Warnsveld, the Netherlands.
| | - Julian Burger
- University of Groningen, University Medical Center Groningen, University Center Psychiatry (UCP) Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), Groningen, the Netherlands
| | - Lotte H J M Lemmens
- Department of Clinical Psychological Science, Maastricht University, Maastricht, the Netherlands
| | - Annemarie A van Elburg
- Department of Eating Disorders (Amarum), GGNet Mental Health, Warnsveld, the Netherlands; Altrecht Eating Disorders Rintveld, Zeist, the Netherlands; Department of Clinical Psychology, Utrecht University, Utrecht, the Netherlands
| | - Maartje S Vroling
- Department of Eating Disorders (Amarum), GGNet Mental Health, Warnsveld, the Netherlands; Radboud University Nijmegen, Behavioural Science Institute, NijCa2re, the Netherlands
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15
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Langlet BS, Odegi D, Zandian M, Nolstam J, Södersten P, Bergh C. Virtual Reality App for Treating Eating Behavior in Eating Disorders: Development and Usability Study. JMIR Serious Games 2021; 9:e24998. [PMID: 33847593 PMCID: PMC8057519 DOI: 10.2196/24998] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 02/15/2021] [Accepted: 03/13/2021] [Indexed: 12/30/2022] Open
Abstract
Background Anorexia nervosa is one of the more severe eating disorders, which is characterized by reduced food intake, leading to emaciation and psychological maladjustment. Treatment outcomes are often discouraging, with most interventions displaying a recovery rate below 50%, a dropout rate from 20% to 50%, and a high risk of relapse. Patients with anorexia nervosa often display anxiety and aversive behaviors toward food. Virtual reality has been successful in treating vertigo, anxiety disorder, and posttraumatic stress syndrome, and could potentially be used as an aid in treating eating disorders. Objective The aim of this study was to evaluate the feasibility and usability of an immersive virtual reality technology administered through an app for use by patients with eating disorders. Methods Twenty-six participants, including 19 eating disorder clinic personnel and 5 information technology personnel, were recruited through emails and personal invitations. Participants handled virtual food and utensils on an app using immersive virtual reality technology comprising a headset and two hand controllers. In the app, the participants learned about the available actions through a tutorial and they were introduced to a food challenge. The challenge consisted of a meal type (meatballs, potatoes, sauce, and lingonberries) that is typically difficult for patients with anorexia nervosa to eat in real life. Participants were instructed, via visual feedback from the app, to eat at a healthy rate, which is also a challenge for patients. Participants rated the feasibility and usability of the app by responding to the mHealth Evidence Reporting and Assessment checklist, the 10-item System Usability Scale, and the 20-point heuristic evaluation questionnaire. A cognitive walkthrough was performed using video recordings of participant interactions in the virtual environment. Results The mean age of participants was 37.9 (SD 9.7) years. Half of the participants had previous experience with virtual reality. Answers to the mHealth Evidence Reporting and Assessment checklist suggested that implementation of the app would face minor infrastructural, technological, interoperability, financial, and adoption problems. There was some disagreement on intervention delivery, specifically regarding frequency of use; however, most of the participants agreed that the app should be used at least once per week. The app received a mean score of 73.4 (range 55-90), earning an overall “good” rating. The mean score of single items of the heuristic evaluation questionnaire was 3.6 out of 5. The lowest score (2.6) was given to the “accuracy” item. During the cognitive walkthrough, 32% of the participants displayed difficulty in understanding what to do at the initial selection screen. However, after passing the selection screen, all participants understood how to progress through the tasks. Conclusions Participants found the app to be usable and eating disorder personnel were positive regarding its fit with current treatment methods. Along with the food item challenges in the current app, participants considered that the app requires improvement to offer environmental and social (eg, crowded room vs eating alone) challenges.
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Affiliation(s)
- Billy Sundström Langlet
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Dorothy Odegi
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Modjtaba Zandian
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | | | - Per Södersten
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Cecilia Bergh
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Mandometer Clinic, Stockholm, Sweden
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16
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Nivière P, Da Fonseca D, Deruelle C, Bat-Pitault F. [Use of virtual reality in eating disorders]. Encephale 2021; 47:263-269. [PMID: 33814164 DOI: 10.1016/j.encep.2020.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 11/07/2020] [Accepted: 11/17/2020] [Indexed: 10/21/2022]
Abstract
Virtual reality is a new technology that can be used to model an environment with which an individual can interact using all five senses. It is notably used in psychiatry for anxiety disorders and addictions, and its use in eating disorders has been growing in recent years. Indeed, virtual reality offers interesting advantages, such as its ability to personalize any environment, which is also more secure and controllable. Recent studies show promising results in the understanding, evaluation, and therapeutic management of eating disorders. The use of avatars in anorexia nervosa allows for a correct assessment of the perceptual (body image distortion) and cognitive-affective (body dissatisfaction) components of the body image disorder in a similar way to conventional methods, but also for a better understanding of them. Moreover, avatars allow the development of innovative therapeutic protocols and are thus used in the context of exposure therapy. The new body swapping protocol, based on a multisensory illusion, offers particularly promising results in the reduction of body image disorder. For bulimia nervosa and binge eating disorder, virtual reality has made it possible to better characterize the triggering mechanisms of binge eating episodes through studies that have observed different responses to food-related environments and stimuli. At the therapeutic level, virtual reality cue exposure therapy has the most empirical support. Its aim is to reduce or eliminate the anxiety and craving felt by a patient in response to exposure to food or other food-related cues by preventing the patient from consuming food, and results show clear reductions in anxiety, craving and binge eating episodes. While all these results seem to indicate a bright future for virtual reality in eating disorders, further studies are needed to validate the positive impact of its use, but also its limitations. Notably, cyber sickness could alter the smooth running of virtual reality therapy sessions by causing nausea and disorientation. Moreover, it is important to verify that a therapeutic protocol does not lose its effectiveness when it is transposed into virtual reality. However, virtual reality seems to be a therapeutic tool that is better accepted by patients, and even better by adolescents, which is very interesting for eating disorders since adolescents are the most affected. Virtual reality could therefore help motivate patients to pursue treatment and reduce the dropout rate while offering good therapeutic results. Thus, studies conducted in recent years have shown that virtual reality is a promising tool in the understanding, assessment and treatment of eating disorders, and future research should confirm this, particularly in the adolescent population.
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Affiliation(s)
- P Nivière
- Institut de Neurosciences de la Timone, CNRS, Aix-Marseille Université, 27 boulevard Jean Moulin, 13005 Marseille, France.
| | - D Da Fonseca
- Institut de Neurosciences de la Timone, CNRS, Aix-Marseille Université, 27 boulevard Jean Moulin, 13005 Marseille, France; Service de Pédopsychiatrie, Hôpital Salvator, Assistance Publique Hôpitaux de Marseille, Aix-Marseille Université, Marseille, France
| | - C Deruelle
- Institut de Neurosciences de la Timone, CNRS, Aix-Marseille Université, 27 boulevard Jean Moulin, 13005 Marseille, France
| | - F Bat-Pitault
- Institut de Neurosciences de la Timone, CNRS, Aix-Marseille Université, 27 boulevard Jean Moulin, 13005 Marseille, France; Service de Pédopsychiatrie, Hôpital Salvator, Assistance Publique Hôpitaux de Marseille, Aix-Marseille Université, Marseille, France
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17
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Magson NR, Handford CM, Norberg MM. The Empirical Status of Cue Exposure and Response Prevention Treatment for Binge Eating: A Systematic Review. Behav Ther 2021; 52:442-454. [PMID: 33622512 DOI: 10.1016/j.beth.2020.06.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 05/27/2020] [Accepted: 06/08/2020] [Indexed: 12/30/2022]
Abstract
Approximately 50% of individuals fail to obtain treatment benefits when undergoing cognitive-behavioral therapy (CBT) for binge-eating behaviors, making it necessary to evaluate additional approaches. Cue exposure and response prevention (CERP) is one such approach, although its effectiveness across studies has been inconsistent. This may be due to inconsistent implementation of theoretically based CERP strategies. This possibility has not yet been systematically investigated. To address this gap, this review investigated which CERP strategies have been incorporated into treatment protocols for binge eating, and if the use of certain strategies improves treatment effectiveness. Relevant studies were identified through reference lists, grey literature, and searches of electronic databases using multiple search terms related to CERP and binge eating, which resulted in 18 eligible studies. Most studies were underpowered, many were of low methodological quality, and none of the included studies utilized all of the strategies that have been recommended to optimize CERP. Despite these weaknesses, CERP appeared to reduce the frequency of binge eating in the short and long term. This review underscores the need for higher quality research that utilizes larger samples and uniform outcome measures that are more strongly grounded in theory. Such research would help improve treatment outcomes for binge eating.
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18
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Troscianko ET, Leon M. Treating Eating: A Dynamical Systems Model of Eating Disorders. Front Psychol 2020; 11:1801. [PMID: 32793079 PMCID: PMC7394184 DOI: 10.3389/fpsyg.2020.01801] [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: 03/24/2020] [Accepted: 06/30/2020] [Indexed: 12/12/2022] Open
Abstract
Mainstream forms of psychiatric talk therapy and cognitive behavioral therapy (CBT) do not reliably generate lasting recovery for eating disorders. We discuss widespread assumptions regarding the nature of eating disorders as fundamentally psychological disorders and highlight the problems that underlie these notions, as well as related practical problems in the implementation of mainstream treatments. We then offer a theoretical and practical alternative: a dynamical systems model of eating disorders in which behavioral interventions are foregrounded as powerful mediators between psychological and physical states. We go on to present empirical evidence for behavioral modification specifically of eating speed in the treatment of eating disorders, and a hypothesis accounting for the etiology and progression, as well as the effective treatment, of the full spectrum of eating problems. A dynamical systems approach mandates that in any dietary and lifestyle change as profound as recovery from an eating disorder, acknowledgment must be made of the full range of pragmatic (psychological, cultural, social, etc.) factors involved. However, normalizing eating speed may be necessary if not sufficient for the development of a reliable treatment for the full spectrum of eating disorders, in its role as a mediator in the complex feedback loops that connect the biology and the psychology with the behaviors of eating.
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Affiliation(s)
- Emily T Troscianko
- The Oxford Research Centre in the Humanities (TORCH), University of Oxford, Oxford, United Kingdom
| | - Michael Leon
- Department of Neurobiology and Behavior, University of California, Irvine, Irvine, CA, United States
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19
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Habersaat KB, Betsch C, Danchin M, Sunstein CR, Böhm R, Falk A, Brewer NT, Omer SB, Scherzer M, Sah S, Fischer EF, Scheel AE, Fancourt D, Kitayama S, Dubé E, Leask J, Dutta M, MacDonald NE, Temkina A, Lieberoth A, Jackson M, Lewandowsky S, Seale H, Fietje N, Schmid P, Gelfand M, Korn L, Eitze S, Felgendreff L, Sprengholz P, Salvi C, Butler R. Ten considerations for effectively managing the COVID-19 transition. Nat Hum Behav 2020; 4:677-687. [PMID: 32581299 DOI: 10.1038/s41562-020-0906-x] [Citation(s) in RCA: 154] [Impact Index Per Article: 38.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 06/02/2020] [Indexed: 12/11/2022]
Abstract
Governments around the world have implemented measures to manage the transmission of coronavirus disease 2019 (COVID-19). While the majority of these measures are proving effective, they have a high social and economic cost, and response strategies are being adjusted. The World Health Organization (WHO) recommends that communities should have a voice, be informed and engaged, and participate in this transition phase. We propose ten considerations to support this principle: (1) implement a phased approach to a 'new normal'; (2) balance individual rights with the social good; (3) prioritise people at highest risk of negative consequences; (4) provide special support for healthcare workers and care staff; (5) build, strengthen and maintain trust; (6) enlist existing social norms and foster healthy new norms; (7) increase resilience and self-efficacy; (8) use clear and positive language; (9) anticipate and manage misinformation; and (10) engage with media outlets. The transition phase should also be informed by real-time data according to which governmental responses should be updated.
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Affiliation(s)
| | - Cornelia Betsch
- Center for Empirical Research in Economics and Behavioral Sciences, Media and Communication Science, University of Erfurt, Erfurt, Germany
| | - Margie Danchin
- The University of Melbourne and Murdoch Children's Research Institute, Royal Children's Hospital, Victoria, Australia
| | | | - Robert Böhm
- Department of Psychology, Department of Economics, and Copenhagen Center for Social Data Science (SODAS), University of Copenhagen, Copenhagen, Denmark
| | - Armin Falk
- University of Bonn and Institute on Behavior and Inequality (BRIQ), Bonn, Germany
| | - Noel T Brewer
- Department of Health Behavior, Gillings School of Global Public Health, and Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Saad B Omer
- Yale Institute for Global Health, Department of Internal Medicine (Infectious Diseases), Yale School of Medicine, Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale School of Nursing, New Haven, CT, USA
| | - Martha Scherzer
- WHO Regional Office for Europe, Insights Unit, Copenhagen, Denmark
| | - Sunita Sah
- Cambridge Judge Business School, Cambridge University, Cambridge, UK
| | - Edward F Fischer
- Department of Anthropology, Vanderbilt University, Nashville, TN, USA
| | - Andrea E Scheel
- WHO Regional Office for Europe, Insights Unit, Copenhagen, Denmark
| | - Daisy Fancourt
- Department of Behavioural Science and Health, University College London, London, UK
| | - Shinobu Kitayama
- Department of Psychology, University of Michigan, Ann Arbor, MI, USA
| | - Eve Dubé
- Département d'Anthropologie, Université Laval, Québec City, Québec, Canada
| | - Julie Leask
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Mohan Dutta
- Center for Culture-Centered Approach to Research and Evaluation (CARE), Massey University, Aotearoa, New Zealand
| | - Noni E MacDonald
- Department of Paediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Anna Temkina
- Department of Sociology, European University of St. Petersburg, St, Petersburg, Russia
| | - Andreas Lieberoth
- Danish School of Education, Interacting Minds Center, Aarhus University, Aarhus, Denmark
| | - Mark Jackson
- Wellcome Centre for Cultures and Environments of Health and WHO Collaborating Centre on Culture and Health, University of Exeter, Exeter, UK
| | - Stephan Lewandowsky
- School of Psychological Science, University of Bristol, Bristol, UK
- University of Western Australia, Perth, Western Australia, Australia
| | - Holly Seale
- School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Nils Fietje
- WHO Regional Office for Europe, Insights Unit, Copenhagen, Denmark
| | - Philipp Schmid
- Department of Psychology, University of Erfurt, Erfurt, Germany
| | - Michele Gelfand
- Department of Psychology, University of Maryland, College Park, MD, USA
| | - Lars Korn
- Center for Empirical Research in Economics and Behavioral Sciences, Media and Communication Science, University of Erfurt, Erfurt, Germany
| | - Sarah Eitze
- Center for Empirical Research in Economics and Behavioral Sciences, Media and Communication Science, University of Erfurt, Erfurt, Germany
| | - Lisa Felgendreff
- Center for Empirical Research in Economics and Behavioral Sciences, Media and Communication Science, University of Erfurt, Erfurt, Germany
| | - Philipp Sprengholz
- Center for Empirical Research in Economics and Behavioral Sciences, Media and Communication Science, University of Erfurt, Erfurt, Germany
| | - Cristiana Salvi
- WHO Regional Office for Europe, Insights Unit, Copenhagen, Denmark
| | - Robb Butler
- WHO Regional Office for Europe, Insights Unit, Copenhagen, Denmark
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20
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Turk F, Waller G. Is self-compassion relevant to the pathology and treatment of eating and body image concerns? A systematic review and meta-analysis. Clin Psychol Rev 2020; 79:101856. [PMID: 32438284 DOI: 10.1016/j.cpr.2020.101856] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 04/06/2020] [Accepted: 04/23/2020] [Indexed: 01/09/2023]
Abstract
Eating disorders are severe mental health conditions, with substantial consequences for health and quality of life. Such disorders are strongly associated with body image concerns. It is important to consider treatments that might enhance our ability to treat such cases. Recently, there has been a growing body of research on self-compassion in relation to such problems. However, we are not yet clear about the extent of such effects, given the range of studies and methodologies used. Therefore, a systematic literature review was carried out using four key databases. Meta-analysis was used to reach conclusions about the size of the effects and moderators. Random-effects meta-analyses were conducted with 59 studies. Higher self-compassion was associated with lower eating pathology, reduced body image concerns, and greater positive body image, with medium to strong effect sizes (respectively, r = -0.34, r = -0.45, r = 0.52). Furthermore, self-compassion interventions for eating pathology and body image were effective, and superior to control groups (respectively, g = 0.58, g = 0.39). These findings support the role of self-compassion in understanding and addressing eating and body image concerns. Self-compassion appears to be an adaptive emotion regulation strategy in eating disorders and body image.
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Affiliation(s)
- Fidan Turk
- Department of Psychology, University of Sheffield, Sheffield, UK.
| | - Glenn Waller
- Department of Psychology, University of Sheffield, Sheffield, UK
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21
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Brown T, Nauman Vogel E, Adler S, Bohon C, Bullock K, Nameth K, Riva G, Safer DL, Runfola CD. Bringing Virtual Reality From Clinical Trials to Clinical Practice for the Treatment of Eating Disorders: An Example Using Virtual Reality Cue Exposure Therapy. J Med Internet Res 2020; 22:e16386. [PMID: 32324145 PMCID: PMC7206518 DOI: 10.2196/16386] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 12/07/2019] [Accepted: 12/15/2019] [Indexed: 12/11/2022] Open
Abstract
Novel treatment options for eating disorders (EDs) are critically needed to enhance treatment outcomes and reduce the rates of treatment dropouts. On average, only 50% of individuals receiving evidence-based care remit, whereas 24% drop out before treatment completion. One particularly promising direction involves integrating virtual reality (VR) with existing evidence-based treatments (EBTs) such as cue exposure therapy (CET). Across psychiatric disorders, VR-based interventions are demonstrating at least preliminary efficacy and noninferiority to traditional treatments. Furthermore, VR technology has become increasingly portable, resulting in improved acceptance, increased access, and reductions in cost. However, more efficient research processes may be needed to uncover the potential benefits of these rapid technological advances. This viewpoint paper reviews existing empirical support for integrating VR with EBTs (with a focus on its use with EDs) and proposes key next steps to more rapidly bring this innovative technology-based intervention into real-world clinic settings, as warranted. VR-CET for EDs is used to illustrate a suggested process for developing such treatment enhancements. We recommend following a deployment-focused model of intervention development and testing to enable rapid implementation of robust, practice-ready treatments. In addition, our review highlights the need for a comprehensive clinical protocol that supports clinicians and researchers in the implementation and testing of VR-CET and identifies key missing protocol components with rationale for their inclusion. Ultimately, this work may lead to a more complete understanding of the full potential of the applications and integrations of VR into mental health care globally.
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Affiliation(s)
- Theresa Brown
- PGSP-Stanford PsyD Consortium, Palo Alto, CA, United States
| | | | - Sarah Adler
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, United States
| | - Cara Bohon
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, United States
| | - Kim Bullock
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, United States
| | - Katherine Nameth
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, United States
| | - Giuseppe Riva
- Applied Technology for Neuro-Psychology Lab, Istituto Auxologico Italiano, Milan, Italy.,Centro Studi e Ricerche di Psicologia della Comunicazione, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Debra L Safer
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, United States
| | - Cristin D Runfola
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, United States
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22
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Mathisen TF, Rosenvinge JH, Friborg O, Vrabel K, Bratland‐Sanda S, Pettersen G, Sundgot‐Borgen J. Is physical exercise and dietary therapy a feasible alternative to cognitive behavior therapy in treatment of eating disorders? A randomized controlled trial of two group therapies. Int J Eat Disord 2020; 53:574-585. [PMID: 31944339 PMCID: PMC7187559 DOI: 10.1002/eat.23228] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 01/06/2020] [Accepted: 01/06/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To compare effects of physical exercise and dietary therapy (PED-t) to cognitive behavioral therapy (CBT) in treatment of bulimia nervosa (BN) and binge-eating disorder (BED). METHOD The active sample (18-40 years of age) consisted of 76 women in the PED-t condition and 73 in the CBT condition. Participants who chose not to initiate treatment immediately (n = 23) were put on a waiting list. Outcome measures were the eating disorder examination questionnaire (EDE-Q), Clinical Impairment Assessment (CIA), Satisfaction with Life Scale (SWLS), Beck Depression Inventory (BDI), and numbers in remission at posttreatment, and at 6-, 12-, and 24-months follow-up. RESULTS Both treatment conditions produced medium to strong significant improvements on all outcomes with long-term effect. The PED-t produced a faster improvement in EDE-Q and CIA, but these differences vanished at follow-ups. Only PED-t provided improvements in BDI, still with no between-group difference. Totally, 30-50% of participants responded favorable to treatments, with no statistical between-group difference. DISCUSSION Both treatments shared a focus on normalizing eating patterns, correcting basic self-regulatory processes and reducing idealized aesthetic evaluations of self-worth. The results point to the PED-t as an alternative to CBT for BN and BED, although results are limited due to compliance and dropout rates. Replications are needed by independent research groups as well as in more clinical settings.
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Affiliation(s)
| | - Jan H. Rosenvinge
- UiT—The Arctic University of Norway, Department of PsychologyFaculty of Health SciencesTromsøNorway
| | - Oddgeir Friborg
- UiT—The Arctic University of Norway, Department of PsychologyFaculty of Health SciencesTromsøNorway
| | | | - Solfrid Bratland‐Sanda
- Department of Outdoor Studies, Sports and Physical EducationUniversity College of Southeast NorwayBøNorway
| | - Gunn Pettersen
- Department of Health and Caring Sciences, Faculty of Health SciencesUiT—The Arctic University of NorwayTromsøNorway
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23
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Fraga A, Carreira MC, Gonzalez-Izquierdo A, Diéguez C, López M, Gutiérrez E. Temperature but not leptin prevents semi-starvation induced hyperactivity in rats: implications for anorexia nervosa treatment. Sci Rep 2020; 10:5300. [PMID: 32210308 PMCID: PMC7093431 DOI: 10.1038/s41598-020-62147-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 03/03/2020] [Indexed: 02/06/2023] Open
Abstract
The hypothesis linking hyperactivity with weight loss associated hypoleptinemia in anorexia nervosa gained momentum after a study showing that leptin suppressed semi-starvation induced hyperactivity in rats. Alternatively, ambient temperature is a key modulating factor of activity in semi-starved rats. The aim of the study is to compare the efficacy of leptin with increased ambient temperature in the prevention of hyperactivity in semi-starved rats. 74 Sprague-Dawley male rats were employed in two experiments with the difference residing in the length of baseline. After an extended (28 days), or shorter (14 days) baseline with free access to food and the running wheel, housed at 21 °C, animals were either ad-lib feed or food restricted (60% of food ingested during previous week) and infused with same amount of leptin at 21 °C, 25 °C, or vehicle at 21 °C, 25 °C and 32 °C for a week. Animals housed at 32 °C significantly reduced wheel running and weight loss during food restriction while animals given leptin did not yield no differences in activity or weight loss. Moreover, unlike animals housed at 32 °C, body temperature of leptin infused animals housed at 21 °C was significantly reduced during food restriction. Furthermore, leptin treated rats without a preceding stable pattern of activity displayed a severe dysregulation of circadian rhythm in activity and a collapse of body temperature. Housing temperature plays a more critical role than leptin in the regulation of semi-starvation induced hyperactivity in rats, which may be of relevance for the management of hyperactivity in anorexia nervosa.
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Affiliation(s)
- Angela Fraga
- Department Psicología Clínica y Psicobiología, Facultad de Psicología, Universidad de Santiago, Campus Vida, 15782, Santiago de Compostela, Spain
| | - Marcos C Carreira
- Lab de Endocrinología Molecular, Instituto de Investigaciones Sanitarias de Santiago de Compostela (IDIS), Complej o Hospitalario de Santiago (CHUS), A Coruña, Spain.,CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain
| | - Andrea Gonzalez-Izquierdo
- Lab de Endocrinología Molecular, Instituto de Investigaciones Sanitarias de Santiago de Compostela (IDIS), Complej o Hospitalario de Santiago (CHUS), A Coruña, Spain.,CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain
| | - Carlos Diéguez
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain.,Department Fisioloxía and Centro de Investigación en Medicina Molecular (CIMUS), Universidade de Santiago de Compostela, Instituto de Investigaciones Sanitarias de Santiago de Compostela (IDIS), Santiago de Compostela, 15782, Spain
| | - Miguel López
- CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain.,Department Fisioloxía and Centro de Investigación en Medicina Molecular (CIMUS), Universidade de Santiago de Compostela, Instituto de Investigaciones Sanitarias de Santiago de Compostela (IDIS), Santiago de Compostela, 15782, Spain
| | - Emilio Gutiérrez
- Department Psicología Clínica y Psicobiología, Facultad de Psicología, Universidad de Santiago, Campus Vida, 15782, Santiago de Compostela, Spain. .,Unidad Venres Clínicos, Facultad de Psicología, Campus Vida, Universidad de Santiago, 15782, Santiago de Compostela, Spain.
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24
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Södersten P, Brodin U, Zandian M, Bergh CEK. Verifying Feighner's Hypothesis; Anorexia Nervosa Is Not a Psychiatric Disorder. Front Psychol 2019; 10:2110. [PMID: 31607977 PMCID: PMC6756277 DOI: 10.3389/fpsyg.2019.02110] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Accepted: 08/30/2019] [Indexed: 12/17/2022] Open
Abstract
Mental causation takes explanatory priority over evolutionary biology in most accounts of eating disorders. The evolutionary threat of starvation has produced a brain that assists us in the search for food and mental change emerges as a consequence. The major mental causation hypothesis: anxiety causes eating disorders, has been extensively tested and falsified. The subsidiary hypothesis: anxiety and eating disorders are caused by the same genotype, generates inconsistent results because the phenotypes are not traits, but vary along dimensions. Challenging the mental causation hypothesis in Feighner et al. (1972) noted that anorexic patients are physically hyperactive, hoarding for food, and they are rewarded for maintaining a low body weight. In 1996, Feighner's hypothesis was formalized, relating the patients' behavioral phenotype to the brain mechanisms of reward and attention (Bergh and Södersten, 1996), and in 2002, the hypothesis was clinically verified by training patients how to eat normally, thus improving outcomes (Bergh et al., 2002). Seventeen years later we provide evidence supporting Feighner's hypothesis by demonstrating that in 2012, 20 out of 37 patients who were referred by a psychiatrist, had a psychiatric diagnosis that differed from the diagnosis indicated by the SCID-I. Out of the 174 patients who were admitted in 2012, most through self-referral, there was significant disagreement between the outcomes of the SCID-I interview and the patient's subjective experience of a psychiatric problem in 110 of the cases. In addition, 358 anorexic patients treated to remission scored high on the Comprehensive Psychopathological Rating Scale, but an item response analysis indicated one (unknown) underlying dimension, rather than the three dimensions the scale can dissociate in patients with psychiatric disorders. These results indicate that psychiatric diagnoses, which are reliable and valid in patients with psychiatric disorders, are less well suited for patients with anorexia. The results are in accord with the hypothesis of the present Research Topic, that eating disorders are not always caused by disturbed psychological processes, and support the alternative, clinically relevant hypothesis that the behavioral phenotype of the patients should be addressed directly.
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Affiliation(s)
- Per Södersten
- Karolinska Institutet, Mandometer Clinics, Huddinge, Sweden
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25
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Barney JL, Murray HB, Manasse SM, Dochat C, Juarascio AS. Mechanisms and moderators in mindfulness- and acceptance-based treatments for binge eating spectrum disorders: A systematic review. EUROPEAN EATING DISORDERS REVIEW 2019; 27:352-380. [PMID: 30887695 PMCID: PMC6570825 DOI: 10.1002/erv.2673] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 02/21/2019] [Accepted: 02/24/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Increasing evidence suggests that mindfulness- and acceptance-based psychotherapies (MABTs) for bulimia nervosa (BN) and binge eating disorder (BED) may be efficacious; however, little is known about their active treatment components or for whom they may be most effective. METHODS We systematically identified clinical trials testing MABTs for BN or BED through PsychINFO and Google Scholar. Publications were categorized according to analyses of mechanisms of action and moderators of treatment outcome. RESULTS Thirty-nine publications met inclusion criteria. Twenty-seven included analyses of therapeutic mechanisms, and five examined moderators of treatment outcome. Changes were largely consistent with hypothesized mechanisms of MABTs, but substandard mediation analyses, inconsistent measurement tools, and infrequent use of mid-treatment assessment points limited our ability to make strong inferences. DISCUSSION Analyses of mechanisms of action and moderators of outcome in MABTs for BN and BED appear promising, but the use of more sophisticated statistical analyses and adequate replication is necessary.
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Affiliation(s)
| | - Helen B Murray
- Department of Psychology, Drexel University, Philadelphia, Pennsylvania
| | | | - Cara Dochat
- San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, California
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26
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Södersten P, Brodin U, Zandian M, Bergh C. Eating Behavior and the Evolutionary Perspective on Anorexia Nervosa. Front Neurosci 2019; 13:596. [PMID: 31249503 PMCID: PMC6584107 DOI: 10.3389/fnins.2019.00596] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 05/24/2019] [Indexed: 01/04/2023] Open
Abstract
On the standard perspective, anorexia nervosa and other eating disorders are caused by genetically determined, neurochemically mediated mental illnesses. Standard treatment, cognitive behavioral therapy (CBT), targets cognitive processes thought to maintain the disorders. Effective neurochemically based treatments are not available and the rate of remission is ≤25% 1 year after CBT, with unknown outcomes in the long-term. With starvation as the major threat in biological history, the evolutionary perspective focuses on foraging for food and eating behavior. A neural network, including hypothalamic arcuate peptide-neurons, brainstem serotonin- and dopamine-neurons and their prefrontal cortical projections, mediates (rather than controls) the behavioral adaptations to variations in food availability; activation of the network is associated with opposing behavioral outcomes depending upon external variations. In the clinic, the control of eating behavior is therefore outsourced to a machine that provides feedback on how to eat. Hundreds of eating disorders patients have recovered by practicing eating; the rate of remission is 75% in on average 1 year of treatment, the rate of relapse is 10% over 5 years of follow-up and no patient has died. A two-parameter asymptotic exponential growth curve modeled the eating behavior of 17 healthy women but not that of 17 women with anorexia nervosa. When in remission, the eating behavior of the anorexic women approached that of the healthy women. It is suggested that the treatment of eating disorders should focus on eating behavior.
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Affiliation(s)
- P. Södersten
- Karolinska Institutet, Mandometer Clinic, Huddinge, Sweden
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27
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Vittengl JR, Clark LA, Thase ME, Jarrett RB. Estimating outcome probabilities from early symptom changes in cognitive therapy for recurrent depression. J Consult Clin Psychol 2019; 87:510-520. [PMID: 31008632 PMCID: PMC6853186 DOI: 10.1037/ccp0000409] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Acute-phase cognitive therapy (CT) is an efficacious treatment for major depressive disorder (MDD) producing benefits comparable to pharmacotherapy, but not all patients respond or remit. The purpose of the current analyses was to estimate CT patients' probability of nonresponse and remission from symptom improvement early in treatment. METHOD Data from 2 clinical trials of acute-phase CT for recurrent depression were pooled for analysis (N = 679). Adult outpatients received 16- or 20-session CT protocols. Symptoms were measured repeatedly with the clinician-report Hamilton Rating Scale for Depression (HRSD) and Inventory of Depressive Symptomatology-Self-Report (IDS-SR). Outcomes at exit from CT were nonresponse (<50% reduction in HRSD scores) and remission (no MDD and HRSD score ≤6). RESULTS The nonresponse rate was 45.7%, and the remission rate was 33.4%. In logistic regression models, improvements on the HRSD or IDS-SR from intake to CT Sessions 3, 5, 7, 9, or 11 significantly predicted both outcomes, with prediction gaining in accuracy in later sessions. Clinician and self-report assessments yielded similar results. Prediction of outcomes replicated across data sets. Patients with no symptom improvement by CT Session 9 (Week 5) had ≤10% probability of remission and >75% probability of nonresponse. CONCLUSIONS Outcomes of CT for depression are predictable from early symptom changes. Clinicians may find nonresponse and remission probability estimates useful in the informed consent process and in choosing whether to continue, augment, or switch treatments for CT patients with recurrent MDD. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
| | | | - Michael E Thase
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania
| | - Robin B Jarrett
- Department of Psychiatry, The University of Texas Southwestern Medical Center
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28
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Södersten P, Brodin U, Sjöberg J, Zandian M, Bergh C. Treatment outcomes for eating disorders in Sweden: data from the national quality registry. BMJ Open 2019; 9:e024179. [PMID: 30647041 PMCID: PMC6340438 DOI: 10.1136/bmjopen-2018-024179] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To report the outcomes of eating disorders treatment in Sweden in 2012-2016. DESIGN The number of patients treated and the number of patients not fulfilling an eating disorders diagnosis (remission) at 1 year of follow-up at the clinics listed in the National Quality Registry for Eating Disorders Treatment were analysed. The published outcomes at three clinics, which used survival analysis to estimate outcomes, were compared with their outcomes in the registry. Outcomes at the three biggest clinics were compared. SETTING All eating disorders clinics. PARTICIPANTS All patients treated at eating disorders clinics. INTERVENTION Cognitive-behavioural therapy at most clinics and normalisation of eating behaviour at the three clinics with published outcomes. OUTCOME MEASURE Proportion of patients in remission. RESULTS About 2600 patients were treated annually, fewer than half were followed up and remission rates decreased from 21% in 2014 to 14% in 2016. Outcomes, which differed among clinics and within clinics over time, have been publicly overestimated by excluding patients lost to follow-up. The published estimated rate of remission at three clinics that treated 1200 patients in 1993-2011 was 27%, 28% and 40% at 1 year of follow-up. The average rate of remission over the three last years at the biggest of these clinics was 36% but decreased from 29% and 30% to 16 and 14% at the two other of the biggest clinics. CONCLUSIONS With more than half the patients lost to follow-up and no data on relapse in the National Quality Registry, it is difficult to estimate the effects of eating disorders treatment in Sweden. Analysis of time to clinically significant events, including an extended period of follow-up, has improved the quality of the estimates at three clinics. Overestimation of remission rates has misled healthcare policies. The effect of eating disorders treatment has also been overestimated internationally.
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Affiliation(s)
- Per Södersten
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Mandometer Clinic, Huddinge, Sweden
| | - Ulf Brodin
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Mandometer Clinic, Huddinge, Sweden
| | | | - Modjtaba Zandian
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Mandometer Clinic, Huddinge, Sweden
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29
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Esfandiari M, Papapanagiotou V, Diou C, Zandian M, Nolstam J, Södersten P, Bergh C. Control of Eating Behavior Using a Novel Feedback System. J Vis Exp 2018:57432. [PMID: 29806832 PMCID: PMC6101162 DOI: 10.3791/57432] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Subjects eat food from a plate that sits on a scale connected to a computer that records the weight loss of the plate during the meal and makes up a curve of food intake, meal duration and rate of eating modeled by a quadratic equation. The purpose of the method is to change eating behavior by providing visual feedback on the computer screen that the subject can adapt to because her/his own rate of eating appears on the screen during the meal. The data generated by the method is automatically analyzed and fitted to the quadratic equation using a custom made algorithm. The method has the advantage of recording eating behavior objectively and offers the possibility of changing eating behavior both in experiments and in clinical practice. A limitation may be that experimental subjects are affected by the method. The same limitation may be an advantage in clinical practice, as eating behavior is more easily stabilized by the method. A treatment that uses this method has normalized body weight and restored the health of several hundred patients with anorexia nervosa and other eating disorders and has reduced the weight and improved the health of severely overweight patients.
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Affiliation(s)
| | | | - Christos Diou
- Department of Electrical and Computer Engineering, Aristotle University of Thessaloniki
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30
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Papapanagiotou V, Diou C, Ioakimidis I, Sodersten P, Delopoulos A. Automatic Analysis of Food Intake and Meal Microstructure Based on Continuous Weight Measurements. IEEE J Biomed Health Inform 2018; 23:893-902. [PMID: 29993620 DOI: 10.1109/jbhi.2018.2812243] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The structure of the cumulative food intake (CFI) curve has been associated with obesity and eating disorders. Scales that record the weight loss of a plate from which a subject eats food are used for capturing this curve; however, their measurements are contaminated by additive noise and are distorted by certain types of artifacts. This paper presents an algorithm for automatically processing continuous in-meal weight measurements in order to extract the clean CFI curve and in-meal eating indicators, such as total food intake and food intake rate. The algorithm relies on the representation of the weight-time series by a string of symbols that correspond to events such as bites or food additions. A context-free grammar is next used to model a meal as a sequence of such events. The selection of the most likely parse tree is finally used to determine the predicted eating sequence. The algorithm is evaluated on a dataset of 113 meals collected using the Mandometer, a scale that continuously samples plate weight during eating. We evaluate the effectiveness for seven indicators and for bite-instance detection. We compare our approach with three state-of-the-art algorithms, and achieve the lowest error rates for most indicators (24 g for total meal weight). The proposed algorithm extracts the parameters of the CFI curve automatically, eliminating the need for manual data processing, and thus facilitating large-scale studies of eating behavior.
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