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Wilkinson ML, Presseller EK, Lampe EW, Trainor C, Sinex R, Manasse SM, Juarascio AS. The relationship between non-purging compensatory behaviors, clinical severity, and treatment outcomes in adults with binge-spectrum eating disorders. Eat Disord 2024; 32:212-222. [PMID: 38186089 PMCID: PMC10922548 DOI: 10.1080/10640266.2023.2293504] [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] [Indexed: 01/09/2024]
Abstract
Non-purging compensatory behaviors (NPCB; e.g. driven exercise, fasting, other extreme behaviors) are a subcategory of compensatory behaviors typically characterized as infrequent and less severe. Limited prior research has studied NPCB despite their increasing prevalence among adults with binge-spectrum eating disorders (B-ED). More research is needed to understand the types of NPCB present among B-ED and the association between NPCB, clinical severity, and treatment outcomes. Secondary analyses were conducted among 155 adults with B-ED in cognitive-behavioral (CBT)-based clinical trials. At baseline and post-treatment, clinical interviews of eating pathology assessed binge eating frequency, purging compensatory behavior frequency, and global eating pathology. The following NPCB were also assessed: driven exercise, 24-h fasting, 8+ waking hours of compensatory fasting, chewing and spitting, and other extreme weight control behaviors. Participants engaging in NPCB reported higher global eating pathology than those not engaging in NPCB. Frequency of chewing and spitting and 24-h fasting significantly decreased over treatment. Engagement in NPCB at baseline did not predict CBT outcomes. The current study highlights the prevalence and clinical severity of NPCB in B-ED but offers promising results regarding the potential for CBT to improve these behaviors. More research is needed on other extreme weight control behaviors reported qualitatively in our sample and on the maintenance of improvements in non-purging behaviors after CBT.
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Affiliation(s)
- M L Wilkinson
- Center for Weight, Eating, and Lifestyle Science, Drexel University, Philadelphia, Pennsylvania, USA
- Department of Psychology and Brain Sciences, Drexel University, Philadelphia, Pennsylvania, USA
| | - E K Presseller
- Center for Weight, Eating, and Lifestyle Science, Drexel University, Philadelphia, Pennsylvania, USA
- Department of Psychology and Brain Sciences, Drexel University, Philadelphia, Pennsylvania, USA
| | - E W Lampe
- Center for Weight, Eating, and Lifestyle Science, Drexel University, Philadelphia, Pennsylvania, USA
- Department of Psychology and Brain Sciences, Drexel University, Philadelphia, Pennsylvania, USA
| | - C Trainor
- Center for Weight, Eating, and Lifestyle Science, Drexel University, Philadelphia, Pennsylvania, USA
- Department of Psychology and Brain Sciences, Drexel University, Philadelphia, Pennsylvania, USA
| | - R Sinex
- Center for Weight, Eating, and Lifestyle Science, Drexel University, Philadelphia, Pennsylvania, USA
| | - S M Manasse
- Center for Weight, Eating, and Lifestyle Science, Drexel University, Philadelphia, Pennsylvania, USA
| | - A S Juarascio
- Center for Weight, Eating, and Lifestyle Science, Drexel University, Philadelphia, Pennsylvania, USA
- Department of Psychology and Brain Sciences, Drexel University, Philadelphia, Pennsylvania, USA
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Tecuta L, Tomei G, DiGiuseppe R, Schumann R, Ballardini D, Tomba E. Mapping the Path to Cognitive Balance: Applying the States of Mind Model and Network Analysis to Eating Disorder Patients. J Clin Med 2023; 12:5790. [PMID: 37762731 PMCID: PMC10531813 DOI: 10.3390/jcm12185790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 08/29/2023] [Accepted: 08/31/2023] [Indexed: 09/29/2023] Open
Abstract
Background: In eating disorders (EDs), cognitive-behavioral therapy (CBT) represents one of the first-line treatment options albeit with sub-optimal results. The assessment of cognitive balance through an index measuring increased adaptive thinking and reduced maladaptive thinking, the desired outcomes, and the ultimate goal of CBT treatments warrants attention. The states of mind model (SOM) provides a framework through which a cognitive balance index can be defined. The current cross-sectional controlled study tested the clinical utility of the SOM model in a sample of ED outpatients. Methods: ED outpatients (n = 199) were assessed at baseline with the attitudes and beliefs scale-2 (ABS-2) for rational beliefs (RBs) and irrational beliefs (IBs), from which a SOM ratio score index (RBs/(RBs + IBs)) was calculated, the eating disorder inventory-3 (EDI-3) for ED symptoms and ED-related psychopathological features, the psychological well-being scales (PWB) for positive psychological functioning. A matched control sample (n = 95) was also assessed with the ABS-2. Results: ED patients exhibited significantly lower SOM and RB scores compared to controls. Network analysis results highlighted the centrality of the SOM-cognitive balance index, PWB-self-acceptance, and EDI-3-general psychological maladjustment, as well as the importance of the influence that cognitive balance and general psychological maladjustment exert on each other. Conclusions: The findings support the clinical utility of the SOM ratio applied to cognitions in EDs. This demonstrates its ability to differentiate such patients from controls and in capturing worse ED-related general psychopathology as well as compromised aspects of psychological well-being, in particular self-acceptance and environmental mastery. It thus might be considered in CBT treatment of EDs a potential cognitive clinimetric and clinical index of ED severity indicating key difficulties in counteracting maladaptive thinking with adaptive thinking.
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Affiliation(s)
- Lucia Tecuta
- Department of Psychology, University of Bologna, 40127 Bologna, Italy; (L.T.); (G.T.)
| | - Giuliano Tomei
- Department of Psychology, University of Bologna, 40127 Bologna, Italy; (L.T.); (G.T.)
| | - Raymond DiGiuseppe
- Department of Psychology, St. John’s University, New York, NY 11439, USA;
| | - Romana Schumann
- Eating Disorder Clinic “Centro Gruber”, 40125 Bologna, Italy; (R.S.); (D.B.)
| | | | - Elena Tomba
- Department of Psychology, University of Bologna, 40127 Bologna, Italy; (L.T.); (G.T.)
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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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Högdahl L, Birgegård A, Norring C, de Man Lapidoth J, Franko MA, Björck C. Internet-based cognitive behavioral therapy for bulimic eating disorders in a clinical setting: Results from a randomized trial with one-year follow-up. Internet Interv 2022; 31:100598. [PMID: 36588668 PMCID: PMC9801110 DOI: 10.1016/j.invent.2022.100598] [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: 10/12/2022] [Revised: 11/28/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Those who suffer from eating disorders often experience serious impairment in quality of life and the majority never receive treatment. Treatment availability may be increased by implementing methods that demand less resources and are more easy accessible such as internet-based treatments, but knowledge about their effects is still insufficient. The study evaluated effects of two types of internet-based cognitive behavioral therapy and a structured day patient program, the latter being a standard treatment at an eating disorder clinic at the time for the study. METHODS 150 participants with bulimic eating disorders randomized to two types of internet based treatments (one pure online treatment and one based on a self-help guide in book-format) or an intensive 16-week day patient program. The number of participants that started treatment was 120 of which 98 in internet treatment and 22 in the day program. Outcome assessments were carried out at baseline, post treatment, and at one-year follow-up. RESULTS All treatments were associated with significantly improved eating disorder pathology, self-image, and clinical impairment. Although the day program generally showed larger effects, only one significant difference found was in diagnostic remission post treatment; 51 % of the participant was in remission in internet treatment and 88 % in the day program. At one-year follow-up, participants in the internet treatments had continued to improve, whereas in the day patient program the effect sustained. Internet treatment had a 36 % drop out rate, there were no dropouts found in the day program. CONCLUSIONS All treatments were comparable in effect at follow-up, suggesting that internet treatment is a conceivable alternative to standard treatment. Internet treatment in a book-based format was also equally effective as a pure online format. Internet delivered cognitive behavioral treatment forms can make important contributions to achieve increased access to treatment for patients with bulimic eating disorders. Future research and clinical implications for internet delivered treatments in eating disorder services are discussed. CLINICAL TRIAL REGISTRATION ISRCTN registry https://www.isrctn.com/ISRCTN44999017. The study was registered retrospectively.
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Affiliation(s)
- Louise Högdahl
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden,Centre for Psychiatry Research, Stockholm Health Care Services, Stockholm, Sweden
| | - Andreas Birgegård
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden,Centre for Psychiatry Research, Stockholm Health Care Services, Stockholm, Sweden,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden,Corresponding author at: Centre for Eating Disorders Innovation, Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Nobels väg 12A, 171 77, Sweden.
| | - Claes Norring
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden,Centre for Psychiatry Research, Stockholm Health Care Services, Stockholm, Sweden
| | - Joakim de Man Lapidoth
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden,TioHundra AB, Department of Psychiatry, Norrtälje Hospital, Norrtälje, Sweden
| | - Mikael Andersson Franko
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Caroline Björck
- Department of Women's and Children's Health, Akademiska sjukhuset, Uppsala University, Uppsala, Sweden,Centre for Research and Development, Region Gävleborg, Gävle, Sweden
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Yokoyama H, Nozaki T, Nishihara T, Sawamoto R, Komaki G, Sudo N. Factors associated with the improvement of body image dissatisfaction of female patients with overweight and obesity during cognitive behavioral therapy. Front Psychiatry 2022; 13:1025946. [PMID: 36339837 PMCID: PMC9634420 DOI: 10.3389/fpsyt.2022.1025946] [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: 08/23/2022] [Accepted: 10/07/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Cognitive behavioral therapy (CBT) has become one of the most commonly used psychotherapeutic treatments for obesity. It stems from CBT for bulimia nervosa and binge eating disorder, which focuses on amelioration of the eating behavior and body image dissatisfaction (BID), but usually does not focus on weight loss. In contrast, CBT for obesity focuses on weight loss, as well as eating behavior and BID. It is at present unclear whether the improvement of BID during CBT for obesity is associated with improvement of factors other than weight loss. OBJECTIVE The purpose of this study was to determine whether improvement of BID during CBT for obesity was associated with improvement of factors other than weight loss. METHODS One hundred and sixty-five women (BMI 31.8 ± 5.2 kg/m2, age 49.3 ± 10.5 years) with overweight or obesity completed a 7-month CBT-based weight loss intervention. BID, depression, anxiety, binge eating, and perfectionism were assessed at both baseline and the end of the intervention through the use of psychological questionnaires. RESULTS Percent total weight loss, baseline BID, baseline binge eating disorder (BED), change in depression (Δdepression), Δstate anxiety, Δtrait anxiety, Δbinge eating, and Δperfectionism were significantly correlated with ΔBID. Multiple regression analysis showed that baseline BID, baseline BED, percent total weight loss, Δbinge eating, and Δdepression were independently associated with ΔBID. CONCLUSION Improvement of binge eating, and improvement of depression, as well as weight loss, were independently associated with amelioration of BID. CLINICAL TRIAL REGISTRATION [https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000008052], identifier [UMIN000006803] and [https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R0000 55850], identifier [UMIN000049041].
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Affiliation(s)
- Hiroaki Yokoyama
- Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takehiro Nozaki
- Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Graduate School of Nutritional Sciences, Nakamura Gakuen University, Fukuoka, Japan
| | - Tomoe Nishihara
- Department of Psychosomatic Medicine, National Hospital Organization Fukuoka Higashi Medical Center, Koga, Japan
| | - Ryoko Sawamoto
- Department of Psychosomatic Medicine, Fukuoka Dental College, Fukuoka, Japan
| | - Gen Komaki
- Faculty of Medical Science, Fukuoka International University of Health and Welfare, Fukuoka, Japan
| | - Nobuyuki Sudo
- Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Levinson CA, Cash E, Welch K, Epskamp S, Hunt RA, Williams BM, Keshishian AC, Spoor SP. Personalized networks of eating disorder symptoms predicting eating disorder outcomes and remission. Int J Eat Disord 2020; 53:2086-2094. [PMID: 33179347 PMCID: PMC7864225 DOI: 10.1002/eat.23398] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 10/14/2020] [Accepted: 10/14/2020] [Indexed: 12/30/2022]
Abstract
Enhanced cognitive-behavioral therapy (CBT-E) is one of the primary evidence-based treatments for adults with eating disorders (EDs). However, up to 50% of individuals do not respond to CBT-E, likely because of the high heterogeneity present even within similar diagnoses. This high heterogeneity, especially in regard to presenting pathology, makes it difficult to develop a treatment based "on averages" and for clinicians to accurately pinpoint which symptoms should be targeted in treatment. As such, new models based at both the group, and individual level, are needed to more accurately refine targets for personalized evidence-based treatments that can lead to full remission. The current study (Expected N = 120 anorexia nervosa, atypical anorexia nervosa, and bulimia nervosa) will build both group and individual longitudinal models of ED behaviors, cognitions, affect, and physiology. We will collect data for 30 days utilizing a mobile application to assess behaviors, cognition, and affect and a sensor wristband that assesses physiology (heart rate, acceleration). We will also collect outcome data at 1- and 6-month follow-ups to assess ED outcomes and remission status. These data will allow for identification of "on average" and "individual" targets that maintain ED pathology and test if these targets predict outcomes, including ED remission.
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Affiliation(s)
- Cheri A. Levinson
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, Kentucky
| | - Elizabeth Cash
- School of Medicine, University of Louisville, Louisville, Kentucky
| | - Karla Welch
- Department of Engineering, University of Louisville, Louisville, Kentucky
| | - Sacha Epskamp
- Department of Psychological Methods and Psychometrics, University of Amsterdam, Amsterdam, The Netherlands
| | - Rowan A. Hunt
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, Kentucky
| | - Brenna M. Williams
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, Kentucky
| | - Ani C. Keshishian
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, Kentucky
| | - Samantha P. Spoor
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, Kentucky
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Levinson CA, Zerwas S, Calebs B, Forbush K, Kordy H, Watson H, Hofmeier S, Levine M, Crosby RD, Peat C, Runfola CD, Zimmer B, Moesner M, Marcus MD, Bulik CM. The core symptoms of bulimia nervosa, anxiety, and depression: A network analysis. JOURNAL OF ABNORMAL PSYCHOLOGY 2017; 126:340-354. [PMID: 28277735 DOI: 10.1037/abn0000254] [Citation(s) in RCA: 142] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Bulimia nervosa (BN) is characterized by symptoms of binge eating and compensatory behavior, and overevaluation of weight and shape, which often co-occur with symptoms of anxiety and depression. However, there is little research identifying which specific BN symptoms maintain BN psychopathology and how they are associated with symptoms of depression and anxiety. Network analyses represent an emerging method in psychopathology research to examine how symptoms interact and may become self-reinforcing. In the current study of adults with a Diagnostic and Statistical Manual for Mental Disorders-Fourth Edition (DSM-IV) diagnosis of BN (N = 196), we used network analysis to identify the central symptoms of BN, as well as symptoms that may bridge the association between BN symptoms and anxiety and depression symptoms. Results showed that fear of weight gain was central to BN psychopathology, whereas binge eating, purging, and restriction were less central in the symptom network. Symptoms related to sensitivity to physical sensations (e.g., changes in appetite, feeling dizzy, and wobbly) were identified as bridge symptoms between BN, and anxiety and depressive symptoms. We discuss our findings with respect to cognitive-behavioral treatment approaches for BN. These findings suggest that treatments for BN should focus on fear of weight gain, perhaps through exposure therapies. Further, interventions focusing on exposure to physical sensations may also address BN psychopathology, as well as co-occurring anxiety and depressive symptoms. (PsycINFO Database Record
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Affiliation(s)
| | - Stephanie Zerwas
- Department of Psychiatry, University of North Carolina at Chapel Hill
| | | | | | - Hans Kordy
- Center for Psychotherapy Research, University of Heidelberg
| | - Hunna Watson
- Department of Psychiatry, University of North Carolina at Chapel Hill
| | | | - Michele Levine
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center
| | | | - Christine Peat
- Department of Psychiatry and Neurosurgery, University of North Carolina at Chapel Hill
| | - Cristin D Runfola
- Department of Psychiatry, University of North Carolina at Chapel Hill
| | | | - Markus Moesner
- Center for Psychotherapy Research, University of Heidelberg
| | - Marsha D Marcus
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center
| | - Cynthia M Bulik
- Department of Psychiatry and Nutrition, University of North Carolina at Chapel Hill
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Silva TABD, Vasconcelos FMDND, Ximenes RCC, Sampaio TPDA, Sougey EB. As terapias cognitivo-comportamentais no tratamento da bulimia nervosa: uma revisão. JORNAL BRASILEIRO DE PSIQUIATRIA 2015. [DOI: 10.1590/0047-2085000000072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objetivo Realizar uma revisão na literatura sobre a utilização da terapia cognitivo-comportamental (TCC) no tratamento da bulimia nervosa entre 2009 e 2013. Métodos Três bases de dados eletrônicas foram pesquisadas, considerando artigos em língua inglesa, espanhola e portuguesa. Resultados Após as análises e exclusão dos artigos, seguindo o método PRISMA, foram selecionados 20 artigos. Os artigos selecionados foram produzidos ou na Europa ou nos Estados Unidos, em língua inglesa. Os diagnósticos da amostra variaram de exclusivamente bulimia nervosa (60%) aos que incluíram pessoas com transtorno de compulsão alimentar (35%), além de diagnósticos mistos (5%). Os estudos foram, em sua maioria, realizados em mulheres adultas. A TCC, em sua abordagem clássica no consultório, foi utilizada em todos os artigos, ora utilizada individualmente, ora comparada com outras intervenções (internet, CD-ROM e autoajuda). Encontrou-se como resultado que a TCC diminui os sintomas de compulsão alimentar e de purgação, além de oferecer ganhos secundários aos participantes, como melhora de sintomas depressivos, de ansiedade e até mudanças na personalidade. As outras intervenções pesquisadas obtiveram bons resultados na modificação dos sintomas, demonstrando que há um novo caminho a ser galgado com essas novas formas de tratamento. Conclusão O tratamento da bulimia nervosa possui evidências suficientes para que seja realizado com a terapia cognitivo-comportamental. Além dela, intervenções psicoterápicas inovadoras baseadas na TCC clássica apresentam bons indicativos de eficácia. Futuras pesquisas sobre essas diferentes intervenções são necessárias.
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Bhar SS, Kyrios M, Hordern C. Self-Ambivalence in the Cognitive-Behavioural Treatment of Obsessive-Compulsive Disorder. Psychopathology 2015; 48:349-56. [PMID: 26393363 DOI: 10.1159/000438676] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 07/13/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS Despite emerging interest in the role of self-concept in obsessive-compulsive disorder (OCD), current research has failed to consider the role of self-perceptions in the cognitive-behavioural treatment of OCD. This study examined the relationship between ambivalence about self-worth and treatment outcomes in patients diagnosed with OCD. METHODS Sixty-two volunteers (59.7% female, mean age = 36.05 years, standard deviation, SD = 11.58) with a primary diagnosis of OCD were assigned to 16 sessions of face-to-face cognitive-behavioural treatment delivered in an individual format. Symptom severity, self-ambivalence, depressive symptoms and anxiety were measured using self-report measures at 5 time points: prewaitlist, pretreatment, midtreatment, posttreatment and 6- month follow-up. RESULTS All variables improved significantly at the posttreatment compared to the earlier time points, inclusive of OCD severity and self-ambivalence, and improvements were maintained at follow-up. As revealed through a series of logistical and stepwise regression analyses, controlling for various pretreatment levels of symptom severity and/or changes in mood severity, pre-post changes in self-ambivalence were predictive of lower posttreatment OCD severity and recovery from OCD. Of particular note, participants who changed by 1 SD in self-ambivalence were 2.5-3.9 times more likely to be recovered in OCD symptoms at the posttreatment time point, depending on what factors were entered first in the regression analysis. CONCLUSION These results suggest that resolution of self-ambivalence predicts positive treatment outcomes in the cognitive-behavioural treatment of OCD. Assisting patients resolve self-ambivalence may be an important target in the psychological treatment of OCD.
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Högdahl L, Birgegård A, Björck C. How effective is bibliotherapy-based self-help cognitive behavioral therapy with Internet support in clinical settings? Results from a pilot study. Eat Weight Disord 2013; 18:37-44. [PMID: 23757249 DOI: 10.1007/s40519-013-0005-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Accepted: 05/23/2012] [Indexed: 10/27/2022] Open
Abstract
Cognitive behavioral therapy-based guided self-help (CBT-GSH) via the Internet has been shown to be effective in the treatment of bulimia nervosa (BN) and similar eating disorders (EDs), but it is rarely offered, and little is known about the effects, in clinical settings. The present study investigated the effects of a bibliotherapy-based CBT-GSH with Internet support in a clinical setting. Participants were 48 adult outpatients who were recruited without randomization from a specialized ED clinic, diagnosed with BN or similar eating disorder. Forty-eight patients in an intensive day patient program (DPP) were used as comparison group. The Eating Disorder Examination Questionnaire (EDE-Q) and the Eating Disorder Inventory 2 measured pre- and post treatment symptoms. Results showed that both groups attained significant improvements in core- as well as related ED symptoms in both instruments. As expected, treatment effects were larger in the more intensive DPP. Nonetheless, bibliotherapy CBT-GSH appears to be a cost-effective treatment that represents a new way to provide more CBT in clinical settings.
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Affiliation(s)
- Louise Högdahl
- Karolinska Institutet, KÄTS Z8:02, Karolinska Universitetssjukhuset Solna, 171 76, Stockholm, Sweden,
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11
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Konstantakopoulos G, Varsou E, Dikeos D, Ioannidi N, Gonidakis F, Papadimitriou G, Oulis P. Delusionality of body image beliefs in eating disorders. Psychiatry Res 2012; 200:482-8. [PMID: 22494704 DOI: 10.1016/j.psychres.2012.03.023] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2011] [Revised: 12/26/2011] [Accepted: 03/17/2012] [Indexed: 11/17/2022]
Abstract
Preoccupation with body shape and weight is characteristic of both anorexia nervosa and bulimia nervosa. Despite their diagnostic and clinical significance, evidence on the nature of the underlying beliefs is relatively scarce. We used the Brown Assessment of Beliefs Scale (BABS) to assess the degree of delusionality of body image beliefs in seventy-two participants: 39 with anorexia and 33 with bulimia nervosa. We also investigated the relationship between body image delusionality and other clinical characteristics in eating disorders. Only patients with anorexia nervosa (28.8%) had delusional body image beliefs, whereas overvalued ideas appeared to be frequent in both anorexia and bulimia nervosa. Body image delusionality in anorexia nervosa was associated with restrictive eating pathology, early onset of the disorder and body dissatisfaction, whereas in the bulimia group it was linked to shorter duration of the illness, more intense dieting behaviors and specific psychological factors: ineffectiveness and maturity fears. Results suggest that a delusional variant of anorexia nervosa represents the one end of a continuum of insight among patients with eating disorders. Categorization of patients with eating disorders based on the level of delusionality of body image beliefs could facilitate further research on the role of insight deficits in these disorders.
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Affiliation(s)
- George Konstantakopoulos
- Athens University Medical School, First Department of Psychiatry, Greece; King's College, London, Institute of Psychiatry, Section of Cognitive Neuropsychiatry, UK.
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Abstract
Ms. Z, a 35-year-old African-American single woman with a body mass index (BMI) of 37.8 kg/m2 (height 5 feet, 5.5 inches, weight 238 lb.), presents for an evaluation for bulimia nervosa. She was referred to the eating disorders program by her primary care physician who knew about her eating disorder, but was primarily concerned about her weight and blood pressure. Ms. Z has an advanced degree and is employed full time. She has struggled with her eating, weight, and body image since childhood and began binge eating regularly (1–2× week) at age 15. Fasting and self-induced vomiting began in her early twenties, when she achieved her lowest adult BMI of 21.6 kg (weight 130 lb. at age 23). She gained 100 pounds in the past 7 years and currently binges and purges 1–2 times a day. A typical binge consists of a box of cookies, a pint of ice cream, 7 oz. of cheese, two bowls of cereal with 2 cups of milk, and 4 pickles. Ms. Z has seen five therapists to address her eating behaviors and weight concerns and participated in numerous commercial weight loss programs. She states binge eating has always served a self-soothing purpose for her. Ms. Z has a demanding university-related job that absorbs most of her time. She has few friends and has not been in a romantic relationship for the past five years believing that no one would be interested in a woman of her size. She also claimed that food is more reliable than any man because “it’s always there when you need it and you don’t have to take care of it or stoke its ego.” She spends evenings at home working until she is completely exhausted, heads to the kitchen for an all-out binge, vomits everything up, and then cries herself to sleep. She has never smoked and does not drink alcohol. Current medications prescribed by her primary care physician include Fluoxetine (20 mg), Norvasc (5 mg), and Clonazepam (prn). What are Ms. Z’s treatment goals? What are her primary care physician’s? Is her medication for bulimia nervosa adequate? How well would cognitive-behavioral therapy for bulimia nervosa address her personal treatment goals? Her physician’s? What challenges might a therapist face having Ms. Z in group therapy for bulimia?
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13
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A review of the definitions of outcome used in the treatment of bulimia nervosa. Clin Psychol Rev 2012; 32:292-300. [DOI: 10.1016/j.cpr.2012.01.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2011] [Revised: 12/15/2011] [Accepted: 01/30/2012] [Indexed: 01/23/2023]
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Bulik CM, Marcus MD, Zerwas S, Levine MD, Hofmeier S, Trace SE, Hamer RM, Zimmer B, Moessner M, Kordy H. CBT4BN versus CBTF2F: comparison of online versus face-to-face treatment for bulimia nervosa. Contemp Clin Trials 2012; 33:1056-64. [PMID: 22659072 DOI: 10.1016/j.cct.2012.05.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Revised: 05/22/2012] [Accepted: 05/24/2012] [Indexed: 01/28/2023]
Abstract
Cognitive-behavioral therapy (CBT) is currently the "gold standard" for treatment of bulimia nervosa (BN), and is effective for approximately 40-60% of individuals receiving treatment; however, the majority of individuals in need of care do not have access to CBT. New strategies for service delivery of CBT and for maximizing maintenance of treatment benefits are critical for improving our ability to treat BN. This clinical trial is comparing an Internet-based version of CBT (CBT4BN) in which group intervention is conducted via therapeutic chat group with traditional group CBT (CBTF2F) for BN conducted via face-to-face therapy group. The purpose of the trial is to determine whether manualized CBT delivered via the Internet is not inferior to the gold standard of manualized group CBT. In this two-site randomized controlled trial, powered for non-inferiority analyses, 180 individuals with BN are being randomized to either CBT4BN or CBTF2F. We hypothesize that CBT4BN will not be inferior to CBTF2F and that participants will value the convenience of an online intervention. If not inferior, CBT4BN may be a cost-effective approach to service delivery for individuals requiring treatment for BN.
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Affiliation(s)
- Cynthia M Bulik
- Department of Psychiatry, University of North Carolina at Chapel Hill, CB 7160, Chapel Hill, NC 27599, USA.
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15
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Abstract
The extent to which cognitive-behavioral therapy (CBT) is helpful in treating individuals with bulimic symptoms who do not meet full criteria for bulimia nervosa is unclear. The purpose of this investigation was to examine the potential efficacy of CBT for eating disorder individuals with bulimic symptoms who do not meet full criteria for bulimia nervosa. Twelve participants with subthreshold bulimia nervosa were treated in a case series with 20 sessions of CBT. Ten of the 12 participants (83.3%) completed treatment. Intent-to-treat abstinent percentages were 75.0% for objectively large episodes of binge eating (OBEs), 33.3% for subjectively large episodes of binge eating (SBEs), and 50% for purging at end of treatment. At one year follow-up, 66.7% were abstinent for OBEs, 41.7% for SBEs, and 50.0% for purging. The majority also reported improvements in associated symptoms. This case series provides support for the use of CBT with individuals with subthreshold bulimia nervosa.
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Krug I, Root T, Bulik C, Granero R, Penelo E, Jiménez-Murcia S, Fernández-Aranda F. Redefining phenotypes in eating disorders based on personality: a latent profile analysis. Psychiatry Res 2011; 188:439-45. [PMID: 21664698 DOI: 10.1016/j.psychres.2011.05.026] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2010] [Revised: 04/14/2011] [Accepted: 05/22/2011] [Indexed: 11/19/2022]
Abstract
To conduct a latent profile analysis (LPA) in eating disorder (ED) patients using temperament and character (TCI-R) measures as indicators. 1312 ED patients including those with anorexia nervosa (AN), bulimia nervosa (BN) and EDNOS were assessed. The final LPA solution was validated using demographics, clinical variables, ED symptomatology (EDI-2) and impulsive behaviors. The best-fitting model consisted of a six-profile solution using the seven subscales of the TCI-R. These profiles were labeled: "self-focused", "inhibited", "average", "impulsive", "adaptive" and "maladaptive". Validation analyses indicated that the "inhibited" and "maladaptive" profiles generally presented with the highest values for ED symptomatology and impulsive behaviors. Whereas high levels of Harm Avoidance and low levels of Novelty Seeking and Persistence characterized the "inhibited" profile, the "maladaptive" profile presented with low levels of Reward Dependence, Self-Directedness and Cooperativeness. The most favorable results on the other hand were exhibited by the "adaptive" profile, characterized by high scores on Reward Dependence, Self-Directedness, Cooperativeness and low levels on Novelty Seeking. Finally, when our six-profile solution was compared with the DSM-IV ED diagnoses, significant differences among profiles and ED diagnoses were observed. Our study shows that ED patients can be meaningfully grouped according to temperament and character.
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Affiliation(s)
- Isabel Krug
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain and CIBER, Fisiopatología de la Obesidad y Nutricion (CIBERObn), Instituto Carlos III, Spain
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17
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Bardone-Cone AM, Schaefer LM, Maldonado CR, Fitzsimmons EE, Harney MB, Lawson MA, Robinson DP, Tosh A, Smith R. Aspects of Self-Concept and Eating Disorder Recovery: What Does the Sense of Self Look Like When an Individual Recovers from an Eating Disorder? JOURNAL OF SOCIAL AND CLINICAL PSYCHOLOGY 2010. [DOI: 10.1521/jscp.2010.29.7.821] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Shapiro JR, Bauer S, Andrews E, Pisetsky E, Bulik-Sullivan B, Hamer RM, Bulik CM. Mobile therapy: Use of text-messaging in the treatment of bulimia nervosa. Int J Eat Disord 2010; 43:513-9. [PMID: 19718672 DOI: 10.1002/eat.20744] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To examine a text-messaging program for self-monitoring symptoms of bulimia nervosa (BN) within the context of cognitive-behavioral therapy (CBT). METHOD Thirty-one women participated in 12 weekly group CBT sessions and a 12 week follow-up. Participants submitted a text message nightly indicating the number of binge eating and purging episodes and rating their urges to binge and purge. Automatic feedback messages were tailored to their self-reported symptoms. RESULTS Fully 87% of participants adhered to self-monitoring and reported good acceptability. The number of binge eating and purging episodes as well as symptoms of depression (BDI), eating disorder (EDI), and night eating (NES) decreased significantly from baseline to both post-treatment and follow-up. DISCUSSION Given the frequent use of mobile phones and text-messaging globally, this proof-of-principle study suggests their use may enhance self-monitoring and treatment for BN leading to improved attendance, adherence, engagement in treatment, and remission from the disorder.
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Affiliation(s)
- Jennifer R Shapiro
- Department of Psychiatry, University of North Carolina at Chapel Hill, North Carolina 27599, USA.
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19
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Reese JB, Keefe FJ, Somers TJ, Abernethy AP. Coping with sexual concerns after cancer: the use of flexible coping. Support Care Cancer 2010; 18:785-800. [PMID: 20165890 DOI: 10.1007/s00520-010-0819-8] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2009] [Accepted: 01/11/2010] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Although cancer treatment commonly has a negative impact on sexual functioning, sexual concerns are still largely undertreated in routine cancer care. The medical model that guides current approaches to sexual care in cancer does not adequately address key patient needs. METHODS In this paper, we describe a broader approach to understanding and treating sexual concerns in cancer that focuses on the construct of flexibility in behavioral and cognitive coping strategies. We previously presented this model in the context of general medical conditions. We now adapt this model to the context of cancer, focusing on issues related to the benefits of flexible coping, interventions that shift perspectives following cancer, and on coping as a couple. RESULTS We argue that coping flexibly with sexual concerns is likely to lead to improvements in mood and sexual and relationship satisfaction. We present clinical applications of the flexible coping model, including suggestions for assessment and sexual concerns and methods of introducing flexible coping into both the content and process of clinical interactions with patients. DISCUSSION Finally, we discuss areas for future research, including the development of a validated instrument, the use of electronic methods of assessment, and intervention trials directly addressing flexibility in coping.
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Affiliation(s)
- Jennifer Barsky Reese
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD 21224, USA.
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20
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21
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Bosch A, Miltenberger RG, Gross A, Knudson P, Breitwieser CB. Evaluation of extinction as a functional treatment for binge eating. Behav Modif 2008; 32:556-76. [PMID: 18310603 DOI: 10.1177/0145445507313271] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Binge eating is a serious behavior problem exhibited by individuals diagnosed with binge eating disorder and bulimia nervosa. Binge eating is thought to be maintained by automatic negative reinforcement in the form of relief from negative emotional responding. Current treatments produce only moderate abstinence, perhaps because they do not attempt to alter the functional consequences of the behavior. Although extinction has been thought impossible with behaviors maintained by automatic negative reinforcement, this study evaluated the application of extinction with binge eating. Four women who reported engaging in binge eating at least twice per week participated. Participants listened to an audio tape recording of the covert verbal behavior associated with their negative emotional responding during the binge to prevent alleviation of the negative emotional responding, thus eliminating the reinforcer in an attempt to reduce the behavior. The procedure effectively reduced frequency of the binges when correctly implemented. Implications and suggestions for future research are discussed.
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22
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Ghaderi A. Logical functional analysis in the assessment and treatment of eating disorders. CLIN PSYCHOL-UK 2007. [DOI: 10.1080/13284200600957324] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Ata Ghaderi
- Department of Psychology, Uppsala University , Uppsala, Sweden
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23
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Anderson DA, Simmons AM, Milnes SM, Earleywine M. Effect of response format on endorsement of eating disordered attitudes and behaviors. Int J Eat Disord 2007; 40:90-3. [PMID: 17245846 DOI: 10.1002/eat.20342] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The present study was designed to compare response rates on a standard self-report questionnaire that was nominally anonymous to an unmatched count questionnaire that allowed for true anonymity in responding. METHOD Four hundred and fifty-four college students were asked about several topics, including attitudes towards weight and shape, dieting, and eating disordered behavior using one of two response formats; either a standard questionnaire in true-false format or an unmatched count questionnaire that did not require participants to directly answer sensitive questions. RESULTS Both males and females had significantly different rates of endorsement between the two methods of assessment on the majority of the eating-related questions. CONCLUSION Response format and degree of anonymity affect endorsement of eating-related thoughts and behaviors. Understanding response bias is critical to determining accurate rates of eating disordered thoughts and behaviors.
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Affiliation(s)
- Drew A Anderson
- Department of Psychology, University at Albany, State University of New York, Albany, New York, USA.
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24
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Ghaderi A. Does individualization matter? A randomized trial of standardized (focused) versus individualized (broad) cognitive behavior therapy for bulimia nervosa. Behav Res Ther 2006; 44:273-88. [PMID: 16389065 DOI: 10.1016/j.brat.2005.02.004] [Citation(s) in RCA: 125] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2004] [Revised: 01/19/2005] [Accepted: 02/03/2005] [Indexed: 11/19/2022]
Abstract
Does higher level of individualization increase treatment efficacy? Fifty patients with bulimia nervosa were randomized into either manual-based (focused) or more individualized (broader) cognitive behavioral therapy guided by logical functional analysis. Eating disorders Examination and a series of self-report questionnaires were used for assessment at pre-, and post-treatment as well as at follow-up. Both conditions improved significantly at post-treatment, and the results were maintained at the 6 months follow-up. There were no statistically and clinically significant differences between the two conditions at post-treatment with the exception of abstinence from objective bulimic episodes, eating concerns, and body shape dissatisfaction, all favoring the individualized, broader condition. Both groups improved concerning self-esteem, perceived social support from friends, and depression. The improvements were maintained at follow-up. Ten patients (20%) did not respond to the treatment. Notably, a majority of non-responders (80%) were in the manual-based condition. Non-responders showed extreme dominance of rule-governed behavior, and lack of contact with actual contingencies compared to responders. The study provided preliminary support for the superiority of higher level of individualization (i.e. broader CBT) in terms of the response to treatment, and relapses. However, the magnitude of effects was moderate, and independent replications, with blind assessment procedures, and a larger sample sized are needed before more clear cut conclusions can be drawn.
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Affiliation(s)
- Ata Ghaderi
- Department of Psychology, Uppsala University, Box 1225, SE-751 42 Uppsala, Sweden.
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25
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Simpson S, Bell L, Britton P, Mitchell D, Morrow E, Johnston AL, Brebner J. Does video therapy work? A single case series of bulimic disorders. EUROPEAN EATING DISORDERS REVIEW 2006. [DOI: 10.1002/erv.686] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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26
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Viken RJ, Treat TA, Bloom SL, McFall RM. Illusory correlation for body type and happiness: covariation bias and its relationship to eating disorder symptoms. Int J Eat Disord 2005; 38:65-72. [PMID: 15971243 DOI: 10.1002/eat.20149] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The current study investigates covariation bias (illusory correlation) in the perceived association between happiness and body type, as well as the association between covariation bias and eating disorder symptoms. METHOD Undergraduate women (n = 186) rated pictures of women on a variety of attributes, including happiness, degree of overweight, and attractiveness. Later, they were asked to judge the level of covariation between these attributes that was present in the stimuli that they had rated. Participants also completed the Eating Disorder Examination-Self-Report Questionnaire (EDE-Q). RESULTS Participants reported that there was a negative association between weight and happiness in the stimuli that they had rated, even though the true correlation in the data was zero. This covariation bias was stronger among participants with higher levels of eating disorder symptoms. DISCUSSION The results suggest a cognitive bias that may play a role in maintaining and enhancing concerns about shape and weight in symptomatic women.
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Affiliation(s)
- Richard J Viken
- Department of Psychology, Indiana University, Bloomington, Indiana 47405, USA.
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27
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Cooper MJ. Cognitive theory in anorexia nervosa and bulimia nervosa: Progress, development and future directions. Clin Psychol Rev 2005; 25:511-31. [PMID: 15914267 DOI: 10.1016/j.cpr.2005.01.003] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2004] [Revised: 11/18/2004] [Accepted: 01/03/2005] [Indexed: 02/03/2023]
Abstract
Important developments have taken place in cognitive theory of eating disorders (EDs) (and also in other disorders) since the review paper published by M.J. Cooper in 1997. The relevant empirical database has also expanded. Nevertheless, cognitive therapy for anorexia nervosa and bulimia nervosa, although helpful to many patients, leaves much to be desired. The current paper reviews the relevant empirical evidence collected, and the theoretical revisions that have been made to cognitive models of eating disorders, since 1997. The status and limitations of these developments are considered, including whether or not they meet the criteria for "good" theory. New theoretical developments relevant to cognitive explanations of eating disorders (second generation theories) are then presented, and the preliminary evidence that supports these is briefly reviewed. The lack of integration between cognitive theories of EDs and risk (vulnerability) factor research is noted, and a potential model that unites the two is noted. The implications of the review for future research and the development of cognitive theory in eating disorders are then discussed. These include the need for study of cognitive constructs not yet fully integrated (or indeed not yet applied clinically) into current theories and the need for cognitive theories of eating disorders to continue to evolve (as they have indeed done since 1997) in order to fully integrate such constructs. Treatment studies incorporating these new developments also urgently need to be undertaken.
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Affiliation(s)
- Myra J Cooper
- Isis Education Centre, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK.
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28
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Rybakowski F, Slopien A, Komorowska R, Antkowiak R, Ciesielski R, Rajewski A. Temperament and character inventory and pharmacotherapeutic outcome in bulimia nervosa. Eat Weight Disord 2005; 10:e33-7. [PMID: 16682854 DOI: 10.1007/bf03327538] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVE To assess the relationship between the personality dimensions measured by the temperament and character inventory (TCI) and pharmacotherapeutic outcome in bulimia nervosa (BN). METHODS Thirty female BN patients aged 19.5+/-2.9 years were enrolled to receive 12 weeks' treatment with fluoxetine or buspirone and assessed using the Polish version of the TCI. The personality dimensions of the patients with good and poor treatment responses were compared. RESULTS The subjects with a good outcome had a higher self-directedness and lower harm avoidance score; this difference was more pronounced in the fluoxetine-treated subjects. At multiple regression analysis, only self-directedness predicted a good outcome. DISCUSSION The results indicate that self-directedness is associated with a good pharmacotherapeutic outcome in BN. This seems to confirm the results of previous studies of the pharmacotherapy of depression and cognitive-behavioural therapy (CBT) in BN.
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Affiliation(s)
- F Rybakowski
- Department of Child and Adolescent Psychiatry, University of Medical Sciences, Poznan, Poland.
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29
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Fassino S, Abbate Daga G, Delsedime N, Busso F, Pierò A, Rovera GG. Baseline personality characteristics of responders to 6-month psychotherapy in eating disorders: preliminary data. Eat Weight Disord 2005; 10:40-50. [PMID: 15943171 DOI: 10.1007/bf03353418] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE The Karolinska Psychodynamic Profile (KAPP) was used for the assessment of the six-month outcome of Brief Adlerian Psychodynamic Psychotherapy (B-APP). METHOD Fifty-seven eating disordered women (28 with anorexia nervosa, 29 with bulimia nervosa), were included in the study. The sample was evaluated at baseline (time 0) and after six months (T6) with a clinical assessment and with Temperament and Character Inventory (TCI), Eating Disorder Inventory (EDI-2), State-Trait Anger Expression Inventory (STAXI), and KAPP. RESULTS Based on symptomatologic improvement, two sub-groups were obtained: responders (66.6%) and non-responders (33.3%). Significantly higher baseline scores emerged in the responders group on Ineffectiveness and Impulsivity (EDI-2) and on Harm Avoidance (TCI). Several KAPP items and areas improved in both groups at T6. CONCLUSION Multimodal treatment centered on B-APP lead to both a global clinical improvement and an improvement in several psychological and psychopathological features as assessed by EDI-2, STAXI and KAPP. The results suggest interesting clinical implications, though outcome predictors are quite weak.
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Affiliation(s)
- S Fassino
- Department of Neurosciences, Section of Psychiatry, University of Turin, Italy.
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30
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Tailoring Cognitive Behavioral Therapy for Individuals Diagnosed with Bulimia Nervosa. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2005. [DOI: 10.1007/s10879-005-6695-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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31
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Openshaw C, Waller G, Sperlinger D. Group cognitive-behavior therapy for bulimia nervosa: statistical versus clinical significance of changes in symptoms across treatment. Int J Eat Disord 2004; 36:363-75. [PMID: 15558655 DOI: 10.1002/eat.20042] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Cognitive-behavior therapy (CBT) is the most effective treatment to date for bulimia nervosa. The current study investigated the effects of group CBT treatment (including some interpersonal elements) for bulimic clients. METHOD Twenty-nine patients completed the Stirling Eating Disorder Scales, the Beck Depression Inventory, and the Beck Anxiety Inventory at assessment, pretreatment, end of treatment, and at 6 months follow-up. Symptom change was explored in two ways. Statistically significant change was determined using repeated-measures analyses of variance and clinically significant change was determined using criteria proposed by Jacobson & Truax (1991, Journal of Consulting and Clinical Psychology, 59, 12-19). RESULTS There was an overall improvement in dimensional measures of bulimic and restrictive attitudes and behaviors (maintained at the 6-month follow-up), which was most closely matched by clinically significant changes in bulimic behaviors. Depression (but not anxiety) was also targeted effectively. Statistically significant improvements in psychological functioning were evident only for assertiveness, but the analysis of clinical significance showed improvement for some participants in self-evaluation (self-directed hostility). DISCUSSION Group CBT (including interpersonal elements) is broadly effective when treating bulimia nervosa, but it does not work in all cases (and may lead to enhancement of restrictive characteristics in some cases). Tests of statistical and clinical significance provide different information, which can inform practice and aid in the development of treatments for patients who respond less well to current best practice.
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Affiliation(s)
- Christine Openshaw
- West Kent NHS and Social Care Trust Eating Disorders Service, The Red House, Oakapple Lane, Maidstone, Kent ME16 9NW, UK.
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32
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Jarry JL, Berardi K. Characteristics and effectiveness of stand-alone body image treatments: a review of the empirical literature. Body Image 2004; 1:319-33. [PMID: 18089164 DOI: 10.1016/j.bodyim.2004.10.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2004] [Revised: 10/20/2004] [Accepted: 10/22/2004] [Indexed: 01/08/2023]
Abstract
This literature review examined the characteristics and effectiveness of treatments dedicated exclusively to body image. A total of 18 studies met selection criteria. All but one involved at least one cognitive-behavioural therapy (CBT) condition and only three compared CBT to another treatment approach. Twelve studies were conducted with non-clinical, body dissatisfied, participants and only one focussed on eating disordered women. Overall, the interventions were highly effective in improving body image and psychological variables and, to a lesser extent, eating attitude and behaviour. Changes were generally maintained at follow-up. Given their efficacy, more controlled trials of stand-alone body image treatments in clinical populations are needed. Investigating approaches other than CBT may open fruitful avenues of body image treatment.
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Affiliation(s)
- Josée L Jarry
- Department of Psychology, University of Windsor, 401 Sunset Avenue, Windsor, Ont., Canada N9B 3P4
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Anderson DA, Lundgren JD, Shapiro JR, Paulosky CA. Assessment of eating disorders: review and recommendations for clinical use. Behav Modif 2004; 28:763-82. [PMID: 15383685 DOI: 10.1177/0145445503259851] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Practitioners have come under increasing pressure to provide objective data on assessment and treatment outcome of clients. This article provides a brief summary of assessment of eating disorders for the practicing clinician, with an emphasis on well-validated assessment instruments. The critical domains that should be covered in a thorough assessment of eating disorders are reviewed, as are some shortcomings in the current assessment literature, and also discussed is which assessment instruments for the eating disorders are most useful in a clinical context. Using well-validated, standardized assessment instruments in all phases of the treatment process is a critical part of justifying a treatment plan and providing objective data on client progress and outcome.
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Affiliation(s)
- Drew A Anderson
- University at Albany-State University of New York, Albany, NY, USA
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34
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Lundgren JD, Danoff-Burg S, Anderson DA. Cognitive-behavioral therapy for bulimia nervosa: an empirical analysis of clinical significance. Int J Eat Disord 2004; 35:262-74. [PMID: 15048942 DOI: 10.1002/eat.10254] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The purpose of this review was to assess the clinical significance of cognitive-behavioral therapy for bulimia nervosa using the reliable change index and normative comparison analyses. METHOD Fifteen treatment outcome studies using either individual or group cognitive-behavioral therapy for bulimia nervosa were selected for inclusion. RESULTS Results suggest that cognitive-behavioral therapy for bulimia nervosa produces clinically significant change for many treatment outcome measures when using the reliable change index. However, posttreatment symptomatology is rarely within a normative range when examined with normative comparison analyses. DISCUSSION This review provides a first step in examining the clinical significance of treatment for bulimia nervosa. Future studies should further this work by comparing the clinical significance of different types of treatment for bulimia nervosa using additional assessment measures.
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Affiliation(s)
- Jennifer D Lundgren
- Department of Psychology, University at Albany, The State University of New York, Albany, New York 12222, USA.
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