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Rizvi SL, Bitran AM, Oshin LA, Yin Q, Ruork AK. The State of the Science: Dialectical Behavior Therapy. Behav Ther 2024; 55:1233-1248. [PMID: 39443064 DOI: 10.1016/j.beth.2024.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 02/26/2024] [Accepted: 02/26/2024] [Indexed: 10/25/2024]
Abstract
The first randomized clinical trial of dialectical behavior therapy (DBT) for women with borderline personality disorder was published in 1991. Over the past 30 years, research on DBT has proliferated along with interest by clinicians and the public. In this State of the Science review, we provide a brief description of the treatment paradigm and its conceptual and theoretical underpinnings. We also briefly review the research conducted to date on DBT across populations and settings, the vast majority of which demonstrates that it is effective at treating the behaviors that it targets. We also argue that, although DBT has been established as a "gold-standard" treatment for certain populations and behaviors, there is much more research needed to answer critical questions and improve its efficacy.
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Pennesi JL, Johnson C, Radünz M, Wade TD. Acute Augmentations to Psychological Therapies in Eating Disorders: A Systematic Review and Meta-Analysis. Curr Psychiatry Rep 2024; 26:447-459. [PMID: 39093534 PMCID: PMC11344718 DOI: 10.1007/s11920-024-01519-y] [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] [Accepted: 06/22/2024] [Indexed: 08/04/2024]
Abstract
PURPOSE OF REVIEW The purpose of this systematic review and meta-analysis was to examine the use and efficacy of acute augmentation therapies in eating disorders. RECENT FINDINGS A meta-analysis addressing this topic across psychological disorders found augmentation significantly improved therapy outcome with strongest findings for augmentations targeting biological mechanisms; however, only one study examined eating disorders. Our systematic review identified 29 studies examining people with eating disorders (N = 1831 participants, 93.7% female), of which 17 RCTs (n = 1162 participants) were included in the meta-analysis. Small subgroups of acute augmentations were identified. Adding acute augmentations to an intervention was effective in 72.4% of studies, with a significant effect on eating disorder outcomes (Hedges' g = 0.14, 95% CI: [0.02, 0.26]). Acute augmentation looks to be a promising approach regardless of weight status or whether it is added to treatment as usual or a single therapy approach.
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Affiliation(s)
- Jamie-Lee Pennesi
- Flinders University Institute for Mental Health and Wellbeing and Blackbird Initiative, Flinders University, Adelaide, SA, Australia.
| | - Catherine Johnson
- Flinders University Institute for Mental Health and Wellbeing and Blackbird Initiative, Flinders University, Adelaide, SA, Australia
| | - Marcela Radünz
- Flinders University Institute for Mental Health and Wellbeing and Blackbird Initiative, Flinders University, Adelaide, SA, Australia
| | - Tracey D Wade
- Flinders University Institute for Mental Health and Wellbeing and Blackbird Initiative, Flinders University, Adelaide, SA, Australia
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Wilson K, Kagabo R. Bulimia nervosa and treatment-related disparities: a review. Front Psychol 2024; 15:1386347. [PMID: 39205982 PMCID: PMC11349707 DOI: 10.3389/fpsyg.2024.1386347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 07/25/2024] [Indexed: 09/04/2024] Open
Abstract
Introduction Bulimia nervosa (BN) is a type of eating disorder disease usually manifesting between adolescence and early adulthood with 12 as median age of onset. BN is characterized by individuals' episodes of excessive eating of food followed by engaging in unusual compensatory behaviors to control weight gain in BN. Approximately 94% of those with BN never seek or delay treatment. While there are available treatments, some populations do not have access. Left untreated, BN can become severe and lead to other serious comorbidities. This study is a review of randomized controlled trials to explore available treatments and related treatment disparities. The objective of this review was to identify differences among treatment modalities of BN and aide in the further treatment and research of bulimia nervosa. Methods This study followed narrative overview guidelines to review BN treatment studies published between 2010 and 2021. The authors used PubMed and PsychInfo databases to search for articles meeting the inclusion criteria. Search terms included phrases such as, BN treatment, BN and clinical trials, and BN and randomized clinical trials. Results Most of the reviewed studies had their sample sizes between 80 and 100% female with age range between 18 and 60 years old. Sample sizes were mostly between 80 and 100% white. Treatment practices included both pharmacological and psychosocial interventions, such as cognitive behavioral therapy (CBT) and limited motivational interviewing (MI). Most studies were in outpatient settings. Conclusion Reviewed research shows that certain populations face disparities in BN treatment. Generally, individuals older than 60, males and racial minorities are excluded from research. Researchers and practitioners need to include these vulnerable groups to improve BN treatment-related disparities.
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Croci MS, Brañas MJAA, Javaras KN, Dechant E, Jurist J, Steigerwald G, Choi-Kain LW. General Psychiatric Management for Adolescents With Borderline Personality Disorder and Eating Disorders. Am J Psychother 2024:appipsychotherapy20230045. [PMID: 39083007 DOI: 10.1176/appi.psychotherapy.20230045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2024]
Abstract
Borderline personality disorder and eating disorders frequently co-occur among youths. These disorders emerge in adolescence, during the critical developmental period of building an independent sense of self and the capacity to relate to one's community. Because of core differences in the development and psychopathology of borderline personality disorder and eating disorders, adjustments are required when treating these disorders when they co-occur. Few established treatment approaches can address these disorders simultaneously. Evidence-based psychotherapies for borderline personality disorder, such as dialectical behavior therapy and mentalization-based treatment, have been adapted to accommodate the shared vulnerabilities and features of the two disorders. However, these approaches are specialized, intensive, and lengthy and are therefore poorly suited to implementation in general psychiatric or primary health care, where most frontline mental health care is provided. Generalist approaches can fill this public health gap, guiding nonspecialists in structuring informed clinical management for these impairing and sometimes fatal disorders. In this overview, the authors describe the adjustment of good (or general) psychiatric management (GPM) for adolescents with borderline personality disorder to incorporate the prevailing best practices for eating disorder treatment. The adjusted treatment relies on interventions most clinicians already use (diagnostic disclosure, psychoeducation, focusing on life outside treatment, managing patients' self-destructive behaviors, and conservative psychopharmacology with active management of comorbid conditions). Limitations of the adjusted treatment, as well as guidelines for referring patients to specialized and general medical treatments and for returning them to primary generalist psychiatric care, are discussed.
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Affiliation(s)
- Marcos S Croci
- Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, and National Institute of Developmental Psychiatry for Children and Adolescents, São Paulo, Brazil (Croci, Brañas); Division of Women's Mental Health (Javaras), Klarman Eating Disorders Center (Dechant), and Gunderson Personality Disorders Institute (Jurist, Steigerwald, Choi-Kain), McLean Hospital, Belmont, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston (Javaras, Dechant, Choi-Kain); Department of Psychology, Harvard University, Cambridge, Massachusetts (Steigerwald)
| | - Marcelo J A A Brañas
- Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, and National Institute of Developmental Psychiatry for Children and Adolescents, São Paulo, Brazil (Croci, Brañas); Division of Women's Mental Health (Javaras), Klarman Eating Disorders Center (Dechant), and Gunderson Personality Disorders Institute (Jurist, Steigerwald, Choi-Kain), McLean Hospital, Belmont, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston (Javaras, Dechant, Choi-Kain); Department of Psychology, Harvard University, Cambridge, Massachusetts (Steigerwald)
| | - Kristin N Javaras
- Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, and National Institute of Developmental Psychiatry for Children and Adolescents, São Paulo, Brazil (Croci, Brañas); Division of Women's Mental Health (Javaras), Klarman Eating Disorders Center (Dechant), and Gunderson Personality Disorders Institute (Jurist, Steigerwald, Choi-Kain), McLean Hospital, Belmont, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston (Javaras, Dechant, Choi-Kain); Department of Psychology, Harvard University, Cambridge, Massachusetts (Steigerwald)
| | - Esther Dechant
- Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, and National Institute of Developmental Psychiatry for Children and Adolescents, São Paulo, Brazil (Croci, Brañas); Division of Women's Mental Health (Javaras), Klarman Eating Disorders Center (Dechant), and Gunderson Personality Disorders Institute (Jurist, Steigerwald, Choi-Kain), McLean Hospital, Belmont, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston (Javaras, Dechant, Choi-Kain); Department of Psychology, Harvard University, Cambridge, Massachusetts (Steigerwald)
| | - Julia Jurist
- Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, and National Institute of Developmental Psychiatry for Children and Adolescents, São Paulo, Brazil (Croci, Brañas); Division of Women's Mental Health (Javaras), Klarman Eating Disorders Center (Dechant), and Gunderson Personality Disorders Institute (Jurist, Steigerwald, Choi-Kain), McLean Hospital, Belmont, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston (Javaras, Dechant, Choi-Kain); Department of Psychology, Harvard University, Cambridge, Massachusetts (Steigerwald)
| | - Georgia Steigerwald
- Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, and National Institute of Developmental Psychiatry for Children and Adolescents, São Paulo, Brazil (Croci, Brañas); Division of Women's Mental Health (Javaras), Klarman Eating Disorders Center (Dechant), and Gunderson Personality Disorders Institute (Jurist, Steigerwald, Choi-Kain), McLean Hospital, Belmont, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston (Javaras, Dechant, Choi-Kain); Department of Psychology, Harvard University, Cambridge, Massachusetts (Steigerwald)
| | - Lois W Choi-Kain
- Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, and National Institute of Developmental Psychiatry for Children and Adolescents, São Paulo, Brazil (Croci, Brañas); Division of Women's Mental Health (Javaras), Klarman Eating Disorders Center (Dechant), and Gunderson Personality Disorders Institute (Jurist, Steigerwald, Choi-Kain), McLean Hospital, Belmont, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston (Javaras, Dechant, Choi-Kain); Department of Psychology, Harvard University, Cambridge, Massachusetts (Steigerwald)
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Anderson C, Fuller-Tyszkiewicz M, Messer M, Linardon J. Resilience eDBT: Development and Usability Evaluation of a Dialectical Behavior Therapy Skills Training App for Eating Disorders. Int J Eat Disord 2024. [PMID: 39007401 DOI: 10.1002/eat.24258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Revised: 06/23/2024] [Accepted: 06/24/2024] [Indexed: 07/16/2024]
Abstract
OBJECTIVE Dialectical behavior therapy (DBT) is an evidence-based treatment for disorders characterized by recurrent binge eating. Yet, access to specialized treatment like DBT remains limited. To increase the accessibility of DBT, we developed a DBT skills training app (Resilience: eDBT) for the management of eating disorder (ED) symptoms. This paper delineates the developmental process of Resilience and tests its usability. METHODS Descriptive information on the development and features of Resilience is provided, including its framework, content structure and delivery formats, functionality, data storage procedure, and privacy protocols. Usability was assessed via a mixed methods approach in 10 symptomatic individuals. Qualitative data were organized based on an existing framework, which included six themes: usability, visual design, user engagement, content, therapeutic persuasiveness, and therapeutic alliance. RESULTS Resilience demonstrated good usability via a Systems Usability Scale score of 85.5, which exceeded the recommended cutoff of 68. Positive aspects of the app, according to interview data, were the ease of use and the visual design, while the addition of peer support was suggested as an opportunity for improvement. DISCUSSION A novel DBT-based app may serve as an acceptable, low-intensity option or adjunct to traditional treatment for targeting ED symptoms that emerge in daily life. However, notable limitations include the small sample size and the single time point at which the usability assessment was conducted.
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Affiliation(s)
- Cleo Anderson
- School of Psychology, Deakin University, Geelong, Victoria, Australia
| | - Matthew Fuller-Tyszkiewicz
- School of Psychology, Deakin University, Geelong, Victoria, Australia
- Center for Social and Emotional Development, Deakin University, Burwood, Victoria, Australia
| | - Mariel Messer
- School of Psychology, Deakin University, Geelong, Victoria, Australia
| | - Jake Linardon
- School of Psychology, Deakin University, Geelong, Victoria, Australia
- Center for Social and Emotional Development, Deakin University, Burwood, Victoria, Australia
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Edney LC, Pellizzer ML. Adaptive design trials in eating disorder research: A scoping review. Int J Eat Disord 2024; 57:1278-1290. [PMID: 38619362 DOI: 10.1002/eat.24198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 03/01/2024] [Accepted: 03/01/2024] [Indexed: 04/16/2024]
Abstract
OBJECTIVE This scoping review sought to map the breadth of literature on the use of adaptive design trials in eating disorder research. METHOD A systematic literature search was conducted in Medline, Scopus, PsycInfo, Emcare, Econlit, CINAHL and ProQuest Dissertations and Theses. Articles were included if they reported on an intervention targeting any type of eating disorder (including anorexia nervosa, bulimia nervosa, binge-eating disorder, and other specified feeding or eating disorders), and employed the use of an adaptive design trial to evaluate the intervention. Two independent reviewers screened citations for inclusion, and data abstraction was performed by one reviewer and verified by a second. RESULTS We identified five adaptive design trials targeting anorexia nervosa, bulimia nervosa and binge-eating disorder conducted in the USA and Australia. All employed adaptive treatment arm switching based on early response to treatment and identified a priori stopping rules. None of the studies included value of information analysis to guide adaptive design decisions and none included lived experience perspectives. DISCUSSION The limited use of adaptive designs in eating disorder trials represents a missed opportunity to improve enrolment targets, attrition rates, treatment outcomes and trial efficiency. We outline the range of adaptive methodologies, how they could be applied to eating disorder research, and the specific operational and statistical considerations relevant to adaptive design trials. PUBLIC SIGNIFICANCE Adaptive design trials are increasingly employed as flexible, efficient alternatives to fixed trial designs, but they are not often used in eating disorder research. This first scoping review identified five adaptive design trials targeting anorexia nervosa, bulimia nervosa and binge-eating disorder that employed treatment arm switching adaptive methodology. We make recommendations on the use of adaptive design trials for future eating disorder trials.
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Affiliation(s)
- Laura C Edney
- Flinders University Institute for Mental Health and Wellbeing, Flinders University, Adelaide, South Australia, Australia
| | - Mia L Pellizzer
- Flinders University Institute for Mental Health and Wellbeing, Flinders University, Adelaide, South Australia, Australia
- Blackbird Initiative, Flinders University, Adelaide, Australia
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Wade TD, Shafran R, Cooper Z. Developing a protocol to address co-occurring mental health conditions in the treatment of eating disorders. Int J Eat Disord 2024; 57:1291-1299. [PMID: 37278186 DOI: 10.1002/eat.24008] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 05/25/2023] [Accepted: 05/27/2023] [Indexed: 06/07/2023]
Abstract
OBJECTIVE While co-occurring mental health conditions are the norm in eating disorders, no testable protocol addresses management of these in psychotherapy. METHOD The literature on managing mental health conditions that co-occur with eating disorders is outlined and reviewed. RESULTS In the absence of clear evidence to inform managing co-occurring mental health conditions, we advocate for use of an iterative, session-by-session measurement to guide practice and research. We identify three data-driven treatment approaches (focus solely on the eating disorder; multiple sequential interventions either before or after the eating disorder is addressed; integrated interventions), and the indications for their use. Where a co-occurring mental health condition/s impede effective treatment of the eating disorder, and an integrated intervention is required, we outline a four-step protocol for three broad intervention approaches (alternate, modular, transdiagnostic). A research program is suggested to test the usefulness of the protocol. DISCUSSION Guidelines that provide a starting point to improving outcomes for people with eating disorders that can be evaluated/researched are offered in the current paper. These guidelines require further elaboration with reference to: (1) whether any difference in approach is required where the co-occurring mental health condition is a comorbid symptom or condition; (2) the place of biological treatments within these guidelines; (3) precise guidelines for selecting among the three broad intervention approaches when adapting care for co-occurring conditions; (4) optimal approaches to involving consumer input into identifying the most relevant co-occurring conditions; (5) detailed specification on how to determine which adjuncts to add. PUBLIC SIGNIFICANCE Most people with an eating disorder also have another diagnosis or an underlying trait (e.g., perfectionism). Currently no clear guidelines exist to guide treatment in this situation, which often results in a drift away from evidence-based techniques. This paper outlines data-driven strategies for treating eating disorders and the accompanying comorbid conditions and a research program that can test the usefulness of the different approaches suggested.
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Affiliation(s)
- Tracey D Wade
- Blackbird Initiative, Flinders Institute for Mental Health and Wellbeing, Flinders University, Bedford Park, South Australia, Australia
| | - Roz Shafran
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Zafra Cooper
- Yale School of Medicine, New Haven, Connecticut, USA
- Department of Psychiatry, Oxford University, Oxford, UK
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Pellizzer ML, Thompson M, Edney LC. Lived experience perspectives on eating disorder research: The use of adaptive trials and research priorities. Int J Eat Disord 2024; 57:1390-1398. [PMID: 38366386 DOI: 10.1002/eat.24167] [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: 10/30/2023] [Revised: 01/25/2024] [Accepted: 01/30/2024] [Indexed: 02/18/2024]
Abstract
OBJECTIVE This novel study sought to understand lived experience and carer perspectives on the use of adaptive trials to evaluate interventions for eating disorders, in addition to understanding the factors and outcomes of most importance in eating disorder research and treatments from a lived experience perspective. METHOD A total of 73 people with either lived or carer experience consented, 70 started the questionnaire, and 36 (51%) completed all questions. Participants were asked Likert scale and open-ended questions to understand what factors and outcomes of eating disorder interventions were most important to them and understand their pre-existing knowledge of clinical trials. Two videos were then used to explain randomized controlled trials (RCTs) and adaptive trials and participants were asked their opinions, including perceived benefits and concerns, of each trial type. RESULTS The thematic analysis found two key themes regarding factors important in eating disorder treatment: Person-centred care and Evidence-based and effective treatment; and two key themes regarding outcomes of treatment: Sustained, full recovery and The bigger picture. Both RCTs and adaptive trials were viewed favorably, however, there was a slight preference for adaptive trials. Key themes for both demonstrated perceived benefits and ethical, practical, and scientific considerations unique to each. DISCUSSION Findings demonstrate the support of adaptive trials in eating disorder interventions from people with lived experience and their carers. It is recommended that researchers consider the use of adaptive designs and the incorporation of lived experience perspectives when designing future intervention trials. PUBLIC SIGNIFICANCE This novel study found that the use of adaptive trials in eating disorder intervention research is supported by people with lived experience and carers. Furthermore, the factors and outcomes of most importance to participants in this study are comparable to those previously identified in the emerging literature. The use of adaptive designs and the incorporation of lived experience are recommended in further clinical trials.
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Affiliation(s)
- Mia L Pellizzer
- Flinders University Institute of Mental Health and Wellbeing, Flinders University, Adelaide, South Australia, Australia
- Blackbird Initiative, Flinders University, Adelaide, South Australia, Australia
| | - Matthew Thompson
- Flinders University Institute of Mental Health and Wellbeing, Flinders University, Adelaide, South Australia, Australia
| | - Laura C Edney
- Flinders University Institute of Mental Health and Wellbeing, Flinders University, Adelaide, South Australia, Australia
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Anderson C, Fuller-Tyszkiewicz M, Messer M, Linardon J. Target-user preferences, motivations, and acceptance for a dialectical behaviour therapy smartphone application for eating disorders. Eat Weight Disord 2024; 29:17. [PMID: 38411711 PMCID: PMC10899409 DOI: 10.1007/s40519-024-01646-8] [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: 10/27/2023] [Accepted: 02/15/2024] [Indexed: 02/28/2024] Open
Abstract
PURPOSE Evidence shows that dialectical behavioural therapy (DBT) is efficacious for eating disorders (ED), yet few people have access to specialized treatments like DBT. Translating key DBT skills for delivery via a smartphone application may broaden the dissemination of evidence-based interventions. However, prior to developing a DBT-based app, it is crucial to gather information on target-user needs and preferences. Assessing overall acceptance and identifying predictors of acceptance, informed by the UTAUT framework, is also important. This process ensures not only a demand for such an app, but also that users receive content and features tailored to their needs. METHOD This study aimed to understand target-user preferences of DBT-based apps for EDs by assessing willingness to engage, overall acceptance levels, and preferred functionality/content delivery modes (n = 326 symptomatic participants). RESULTS Eighty-eight percent indicated they would be willing to use a DBT-based ED app if it were available. Acceptance levels of a DBT app were high (64%), which was uniquely predicted by performance expectancy (perceptions of how beneficial an intervention is) and facilitating conditions (expectations of technological infrastructure and support in interventions) in path analysis. Content perceived as important to contain were emotion regulation techniques, tailored intervention strategies, and psychoeducation. CONCLUSION Findings generate important information about target-user preferences of a DBT-based app for EDs, highlighting necessary design principles for apps of this kind. Level of evidence Level V, cross-sectional descriptive study.
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Affiliation(s)
- Cleo Anderson
- School of Psychology, Deakin University, 1 Gheringhap Street, Geelong, VIC, 3220, Australia.
| | | | - Mariel Messer
- School of Psychology, Deakin University, 1 Gheringhap Street, Geelong, VIC, 3220, Australia
| | - Jake Linardon
- Center for Social and Emotional Development, Deakin University, Burwood, VIC, 3125, Australia
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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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Tan MYL, McConnell B, Barlas J. Application of Dialectical Behaviour Therapy in treating common psychiatric disorders: study protocol for a scoping review. BMJ Open 2022; 12:e058565. [PMID: 36167385 PMCID: PMC9516170 DOI: 10.1136/bmjopen-2021-058565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Dialectical behaviour therapy (DBT) is a well-known intervention for treating borderline personality disorder, and has been increasingly adapted for other disorders. Standard DBT consists of four treatment modes, delivered over a year. Adaptations to DBT include changes to modes of delivery, treatment length, and skills modules taught to clients, or incorporating interventions from other evidence-based therapies. There is a need to synthesise existing evidence on DBT so that stakeholders-clinicians, researchers and policymakers-can understand how it has been provided for various psychiatric conditions, and whether it has been effective. METHODS AND ANALYSIS This study proposes a scoping review conducted according to Arksey and O'Malley's (2005) procedures, to map and summarise the literature on DBT interventions for treating a range of psychiatric concerns. Electronic databases (ie, the Cochrane Central Register of Controlled Trials, PubMed, PsycINFO, SCOPUS, EBSCOhost and ProQuest Dissertations and Theses), conference proceedings and the US National Institutes of Health Ongoing Trial Register will be searched for intervention studies that involve a control or comparison group, and that report quantitative data on pre/post-measures for psychiatric symptom severity. The initial search was conducted on 18 September 2020, and data charting has not commenced. An update will be performed in September 2022, pending this protocol's publication. Data charting will collect individual studies' characteristics, methodology and reported findings. Outcomes will be reported by following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for Scoping Reviews. ETHICS AND DISSEMINATION No ethical approval is required for this study. The goal of dissemination is to keep DBT stakeholders abreast on latest updates in clinical applications of DBT. Findings from this research are intended to inform a more specific topic of study (eg, a meta-analysis), to further aid in the development of DBT interventions for psychiatric populations. REGISTRATION DETAILS The study protocol was pre-registered with the Open Science Framework on 24 August 2021 (https://osf.io/vx6gw).
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Affiliation(s)
- Michelle Yan Ling Tan
- Psychology, Institute of Mental Health, Singapore
- Department of Psychology, James Cook University, Singapore
| | | | - Joanna Barlas
- Department of Psychology, James Cook University, Singapore
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Lammers MW, Vroling MS, Crosby RD, van Strien T. Dialectical behavior therapy compared to cognitive behavior therapy in binge-eating disorder: An effectiveness study with 6-month follow-up. Int J Eat Disord 2022; 55:902-913. [PMID: 35665526 PMCID: PMC9328197 DOI: 10.1002/eat.23750] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 04/29/2022] [Accepted: 04/30/2022] [Indexed: 12/03/2022]
Abstract
OBJECTIVE To evaluate whether the results of a quasi-randomized study, comparing dialectical behavior therapy for binge-eating disorder (DBT-BED) and an intensive, outpatient cognitive behavior therapy (CBT+) in individuals with BED, would be replicated in a nonrandomized study with patients who more closely resemble everyday clinical practice. METHOD Patients with (subthreshold) BED (N = 175) started one of two group treatments: DBT-BED (n = 42) or CBT+ (n = 133), at a community eating disorder service. Measures of eating disorder pathology, emotion regulation, and general psychopathology were examined at end of treatment (EOT) and at 6-month follow-up using generalized linear models with multiple imputation. RESULTS Both treatments lead to substantial decreases on primary and secondary measures. Statistically significant, medium-size differences between groups were limited to global eating disorder psychopathology (d = -.62; 95% CI = .231, .949) at EOT and depressive symptoms at follow-up (d = -.45; 95% CI = .149, 6.965), favoring CBT+. Dropout of treatment included 15.0% from CBT+ and 19.0% from DBT-BED (difference nonsignificant). DISCUSSION Decreases in global eating disorder psychopathology were achieved faster with CBT+. Overall, improvements in DBT-BED were comparable to those observed in CBT+. Findings of the original trial, favoring CBT+ on the number of OBE episodes, emotional dysregulation and self-esteem at EOT, and on eating disorder psychopathology and self-esteem at follow-up, were not replicated. With similar rates of treatment dropout and about half of the therapy time used in CBT+, DBT-BED can be considered a relevant treatment for BED in everyday clinical practice. PUBLIC SIGNIFICANCE In this effectiveness study, dialectical behavior therapy (DBT) resulted in clinically relevant improvements in individuals with binge eating disorder. Changes were broadly comparable to those of cognitive behavior therapy (CBT), the current treatment of choice. Although CBT resulted in decreases in eating disorder psychopathology faster, there was a trend toward relapse in CBT at 6-month follow-up. Therefore, the less costly DBT-program can be considered a relevant treatment in clinical practice.
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Affiliation(s)
- Mirjam W. Lammers
- Amarum, Expertise Centre for Eating DisordersGGNet Network for Mental Health CareGelderlandZutphen,Radboud University, Behavioural Science InstituteNijmegenGelderland
| | - Maartje S. Vroling
- Amarum, Expertise Centre for Eating DisordersGGNet Network for Mental Health CareGelderlandZutphen,Radboud University, Behavioural Science InstituteNijmegenGelderland
| | - Ross D. Crosby
- Sanford Center for Biobehavioral ResearchFargoNorth DakotaUSA,School of Medicine and Health SciencesUniversity of North DakotaFargoNorth DakotaUSA
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13
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Linardon J, Shatte A, Rosato J, Fuller-Tyszkiewicz M. Efficacy of a transdiagnostic cognitive-behavioral intervention for eating disorder psychopathology delivered through a smartphone app: a randomized controlled trial. Psychol Med 2022; 52:1679-1690. [PMID: 32972467 DOI: 10.1017/s0033291720003426] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Although effective treatments exist for diagnostic and subthreshold-level eating disorders (EDs), a significant proportion of affected individuals do not receive help. Interventions translated for delivery through smartphone apps may be one solution towards reducing this treatment gap. However, evidence for the efficacy of smartphones apps for EDs is lacking. We developed a smartphone app based on the principles and techniques of transdiagnostic cognitive-behavioral therapy for EDs and evaluated it through a pre-registered randomized controlled trial. METHODS Symptomatic individuals (those who reported the presence of binge eating) were randomly assigned to the app (n = 197) or waiting list (n = 195). Of the total sample, 42 and 31% exhibited diagnostic-level bulimia nervosa and binge-eating disorder symptoms, respectively. Assessments took place at baseline, 4 weeks, and 8 weeks post-randomization. Analyses were intention-to-treat. The primary outcome was global levels of ED psychopathology. Secondary outcomes were other ED symptoms, impairment, and distress. RESULTS Intervention participants reported greater reductions in global ED psychopathology than the control group at post-test (d = -0.80). Significant effects were also observed for secondary outcomes (d's = -0.30 to -0.74), except compensatory behavior frequency. Symptom levels remained stable at follow-up. Participants were largely satisfied with the app, although the overall post-test attrition rate was 35%. CONCLUSION Findings highlight the potential for this app to serve as a cost-effective and easily accessible intervention for those who cannot receive standard treatment. The capacity for apps to be flexibly integrated within current models of mental health care delivery may prove vital for addressing the unmet needs of people with EDs.
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Affiliation(s)
- Jake Linardon
- School of Psychology, Deakin University, 1 Gheringhap Street, Geelong, VIC 3220, Australia
| | - Adrian Shatte
- Federation University, School of Science, Engineering & Information Technology, Melbourne, Australia
| | - John Rosato
- School of Psychology, Deakin University, 1 Gheringhap Street, Geelong, VIC 3220, Australia
| | - Matthew Fuller-Tyszkiewicz
- School of Psychology, Deakin University, 1 Gheringhap Street, Geelong, VIC 3220, Australia
- Center for Social and Early Emotional Development, Deakin University, Burwood, Victoria 3125, Australia
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14
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Burnette CB, Luzier JL, Weisenmuller CM, Boutté RL. A systematic review of sociodemographic reporting and representation in eating disorder psychotherapy treatment trials in the United States. Int J Eat Disord 2022; 55:423-454. [PMID: 35288967 PMCID: PMC8988395 DOI: 10.1002/eat.23699] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 02/24/2022] [Accepted: 02/24/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Eating disorders (EDs) were once conceptualized as primarily affecting affluent, White women, a misconception that informed research and practice for many years. Abundant evidence now discredits this stereotype, but it is unclear if prevailing "evidence-based" treatments have been evaluated in samples representative of the diversity of individuals affected by EDs. Our goal was to evaluate the reporting, inclusion, and analysis of sociodemographic variables in ED psychotherapeutic treatment randomized controlled trials (RCTs) in the US through 2020. METHODS We conducted a systematic review of ED psychotherapeutic treatment RCTs in the US and examined the reporting and inclusion of gender identity, age, race/ethnicity, sexual orientation, and socioeconomic status (SES) of enrolled participants, as well as recruitment methods, power analyses, and discussion of limitations and generalizability. RESULTS Our search yielded 58 studies meeting inclusion criteria dating back to 1985. Reporting was at times incomplete, absent, or centered on the racial/gender majority group. No studies reported gender diverse participants, and men and people of color were underrepresented generally, with differences noted across diagnoses. A minority of papers considered sociodemographic variables in analyses or acknowledged limitations related to sample characteristics. Some progress was made across the decades, with studies increasingly providing full racial and ethnic data, and more men included over time. Although racial and ethnic diversity improved somewhat, progress appeared to stall in the last decade. DISCUSSION We summarize findings, consider context and challenges for RCT researchers, and offer suggestions for researchers, journal editors, and reviewers on improving representation, reporting, and analytic practices. PUBLIC SIGNIFICANCE Randomized controlled trials of eating disorder psychotherapeutic treatment in the US are increasingly reporting full race/ethnicity data, but information on SES is inconsistent and sexual orientation absent. White women still comprise the overwhelming majority of participants, with few men and people of color, and no gender-diverse individuals. Findings underscore the need to improve reporting and increase representation to ensure evidence-based treatments are effective across and within diverse groups.
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Affiliation(s)
- C. Blair Burnette
- Charleston Area Medical CenterCharlestonWest VirginiaUSA
- Division of Epidemiology and Community Health, School of Public HealthUniversity of MinnesotaMinneapolisMinnesotaUSA
| | - Jessica L. Luzier
- Department of Behavioral Medicine and PsychiatryWest Virginia University School of Medicine – Charleston DivisionCharlestonWest VirginiaUSA
- Charleston Area Medical CenterInstitute for Academic MedicineCharlestonWest VirginiaUSA
| | - Chantel M. Weisenmuller
- Department of Behavioral Medicine and PsychiatryWest Virginia University School of Medicine – Charleston DivisionCharlestonWest VirginiaUSA
- Charleston Area Medical CenterInstitute for Academic MedicineCharlestonWest VirginiaUSA
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15
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Pedrini L, Rossi R, Magni LR, Lanfredi M, Meloni S, Ferrari C, Macis A, Lopizzo N, Zonca V, Cattaneo A. Emotional Regulation in Teens and Improvement of Constructive Skills (EmoTIConS): study protocol for a randomized controlled trial. Trials 2021; 22:920. [PMID: 34906222 PMCID: PMC8670183 DOI: 10.1186/s13063-021-05886-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 11/26/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Emotional dysregulation (ED) constitutes a relevant factor involved in the onset and maintenance of many mental disorders. Targeting ED during adolescence could be a determinant both to identify high-risk individuals and to promote preventive interventions. This study will aim to evaluate the impact of a brief Dialectical Behavioral Therapy (DBT)-based intervention for adolescent students by measuring changes in emotional regulation skills and impulsive behaviors. Moreover, alterations in biological features related to stress response and inflammation will be assessed as potential biological variables associated with ED. METHODS This is a randomized trial. A total of 20 classes of adolescent students will be recruited among high schools in Brescia, a city in northern Italy. They will be randomized to the psychoeducational intervention (experimental group) or to a control condition (control group). The intervention will be based on DBT Skills Training for Emotional Problem Solving for Adolescents, and will consist of four monthly, 2-h sessions (for a total of 8 h) scheduled during regular school time. Participants will be assessed at baseline, post-intervention, and at 3 and 6 months of follow-up. The primary outcome measures will be represented by changes in the use of emotional regulation skills and by changes in the frequency of impulsive behaviors. Salivary samples will be collected at baseline and post-intervention to explore possible biological features underlying ED. DISCUSSION Data from the present project will offer the opportunity to better understand the complex phenomenon of ED. Repeated assessment will cover several domains (emotional, behavioral, social, biological) as potential factors associated with ED. Moreover, it will be possible to establish the effect of the proposed intervention, thus helping to improve knowledge on the impact of school-based universal preventive programs. Finally, the current trial will propose an integrated screening and intervention-based model. Ultimately, this could reduce barriers to youths' mental health care by fostering collaboration between schools and mental health services. TRIAL REGISTRATION ClinicalTrials.gov NCT04349709 . Registered on April 16, 2020.
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Affiliation(s)
- Laura Pedrini
- Psychiatry Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.
| | - Roberta Rossi
- Psychiatry Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Laura Rosa Magni
- Psychiatry Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Mariangela Lanfredi
- Psychiatry Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Serena Meloni
- Psychiatry Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Clarissa Ferrari
- Statistics Service, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Ambra Macis
- Statistics Service, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Nicola Lopizzo
- Biological Psychiatry Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.,Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
| | - Valentina Zonca
- Biological Psychiatry Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.,Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Annamaria Cattaneo
- Biological Psychiatry Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.,Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
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16
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Grohmann D, Laws KR. Two decades of mindfulness-based interventions for binge eating: A systematic review and meta-analysis. J Psychosom Res 2021; 149:110592. [PMID: 34399197 DOI: 10.1016/j.jpsychores.2021.110592] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 07/29/2021] [Accepted: 07/29/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Mindfulness-based interventions (MBIs) are being increasingly used as interventions for eating disorders including binge eating. This systematic review and meta-analysis aimed to assess two decades of research on the efficacy of MBIs in reducing binge eating severity. METHODS We searched PubMed, Scopus and Cochrane Library for trials assessing the use of MBIs to treat binge eating severity in both clinical and non-clinical samples. The systematic review and meta-analysis was pre-registered at PROSPERO (CRD42020182395). RESULTS Twenty studies involving 21 samples (11 RCT and 10 uncontrolled samples) met inclusion criteria. Random effects meta-analyses on the 11 RCT samples (n = 618: MBIs n = 335, controls n = 283) showed that MBIs significantly reduced binge eating severity (g = -0.39, 95% CI -0.68, -0.11) at end of trial, but was not maintained at follow-up (g = -0.06, 95% CI, -0.31, 0.20, k = 5). No evidence of publication bias was detected. On the Cochrane Risk of Bias Tool 2, trials were rarely rated at high risk of bias and drop-out rates did not differ between MBIs and control groups. MBIs also significantly reduced depression, and improved both emotion regulation and mindfulness ability. CONCLUSION MBIs reduce binge eating severity at the end of trials. Benefits were not maintained at follow-up; however, only five studies were assessed. Future well-powered trials should focus on assessing diversity better, including more men and people from ethnic minority backgrounds.
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Affiliation(s)
- Dominique Grohmann
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield AL10 9AB, UK
| | - Keith R Laws
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield AL10 9AB, UK.
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17
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Messer M, Linardon J. Trait-level differences in constructs that underpin the contextual behaviour therapies between binge-eating disorder with and without overvaluation of weight and shape. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2021. [DOI: 10.1016/j.jcbs.2021.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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18
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Wade T, Ambwani S, Cardi V, Albano G, Treasure J. Outcomes for adults with anorexia nervosa who do not respond early to outpatient treatment. Int J Eat Disord 2021; 54:1278-1282. [PMID: 33760307 DOI: 10.1002/eat.23508] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 03/14/2021] [Accepted: 03/15/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To better understand those patients with anorexia nervosa who do not show early response to treatment and are likely to have poorer outcome. METHOD From an existing data set of 187 patients with anorexia nervosa across 22 eating disorder outpatient services in the United Kingdom, participants who had started treatment and had at least one body mass index (BMI) observation in the first 6 weeks of treatment were eligible for these secondary analyses (N = 65), a latent class analysis of BMI change over the first 6 weeks of treatment. Fifty-six patients showed no early change in BMI. We used logistic regression to examine predictors of good outcome in the 40 participants who had 12-month follow-up data. Predictors included global EDE-Q, negative affect (Depression, Anxiety, and Stress Scales) and functional impairment (Work and Social Adjustment Scale). RESULTS Good outcome was achieved by 23% of patients and remission by 15%. Good outcome was predicted by less functional impairment at baseline. DISCUSSION Further work that can identify sub-groups of patients with anorexia nervosa who do not achieve good outcome after treatment will inform the development of targeted engagement approaches.
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Affiliation(s)
- Tracey Wade
- Blackbird Initiative, Órama Research Institute, Flinders University, South Australia, Australia
| | - Suman Ambwani
- Department of Psychology, Dickinson College, Carlisle, Pennsylvania, USA
| | - Valentina Cardi
- Department of Psychological Medicine, Kings College London, London, UK.,Department of General Psychology, University of Padova, Padova, Italy
| | - Gaia Albano
- Department of Psychological Medicine, Kings College London, London, UK.,Department of Psychology, Educational Sciences and Human Movement, University of Palermo, Palermo, Italy
| | - Janet Treasure
- Department of Psychological Medicine, Kings College London, London, UK
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19
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Mountford VA, Allen KL, Tchanturia K, Eilender C, Schmidt U. Implementing evidence-based individual psychotherapies for adults with eating disorders in a real world clinical setting. Int J Eat Disord 2021; 54:1238-1249. [PMID: 33719036 DOI: 10.1002/eat.23504] [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: 12/09/2020] [Revised: 03/03/2021] [Accepted: 03/03/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVE This study aimed to evaluate the effectiveness of evidenced-based psychological treatments (specifically, Cognitive-Behaviour Therapy for Eating Disorders [CBT-ED] and Maudsley Anorexia Nervosa Treatment for Adults [MANTRA]) for a transdiagnostic eating disorder population in a routine clinical setting. In particular, it aimed to determine the extent to which treatment was provided in line with current clinical guidelines (NICE, 2017) and how effective treatment was in improving eating disorder and general psychopathology. METHOD Three hundred and seventy-nine participants meeting criteria for DSM-5 anorexia nervosa, bulimia nervosa, binge-eating disorder or other specified feeding or eating disorder completed pre- and posttreatment measures of eating disorder pathology and general distress. Clinicians recorded weight and episodes of bingeing and purging. RESULTS Ninety seven percent of participants received treatment in line with evidence-based psychotherapies. Treatment was completed by 59.9% of the whole sample. Using stringent criteria and ITT analysis 21.4% met criteria for remission at end of treatment. In the underweight sample, there was a significant increase in BMI, averaging 1.38 kg/m2 over treatment, with similar outcomes for MANTRA and CBT-ED. DISCUSSION These findings, in a large transdiagnostic population, add to emerging literature on the translation of evidence-based psychotherapies to real-world clinical settings. Our results converge well with prior similar studies. Findings highlight the need for routine data collection in services and for the ongoing improvement of treatments for the eating disorders.
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Affiliation(s)
- Victoria A Mountford
- Eating Disorder Service, South London and Maudsley NHS Foundation Trust, Middle House, Maudsley Hospital, London, UK.,Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK.,Maudsley Health, Abu Dhabi, UAE
| | - Karina L Allen
- Eating Disorder Service, South London and Maudsley NHS Foundation Trust, Middle House, Maudsley Hospital, London, UK.,Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Kate Tchanturia
- Eating Disorder Service, South London and Maudsley NHS Foundation Trust, Middle House, Maudsley Hospital, London, UK.,Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Cara Eilender
- Eating Disorder Service, South London and Maudsley NHS Foundation Trust, Middle House, Maudsley Hospital, London, UK.,Department of Clinical Psychology, University College London, London, UK
| | - Ulrike Schmidt
- Eating Disorder Service, South London and Maudsley NHS Foundation Trust, Middle House, Maudsley Hospital, London, UK.,Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
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20
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Juarascio AS, Parker MN, Hunt R, Murray HB, Presseller EK, Manasse SM. Mindfulness and acceptance-based behavioral treatment for bulimia-spectrum disorders: A pilot feasibility randomized trial. Int J Eat Disord 2021; 54:1270-1277. [PMID: 33851734 PMCID: PMC8780759 DOI: 10.1002/eat.23512] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 03/19/2021] [Accepted: 03/19/2021] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Although existing research supports the efficacy of mindfulness- and acceptance-based treatments (MABTs) for eating disorders (EDs), few studies have directly compared outcomes from MABTs to standard CBT. METHOD Participants (N = 44), treatment-seeking adults with bulimia-spectrum EDs, were screened for eligibility, consented, and randomized to receive 20 sessions of outpatient, individual CBT or MABT treatment. Treatment outcomes (binge eating and compensatory behavior episodes, global ED severity, depressive symptoms, quality of life, emotional awareness/clarity, distress tolerance, values-based decision-making, and emotion modulation) were measured at pre-treatment, post-treatment, and 6-month follow up. Data on feasibility and acceptability are also presented. RESULTS Treatment and assessment retention rates were comparable between MABT and CBT (p range = .51-.73) and between-group differences on acceptability measures were very small (d range = 0.03-0.19). Both conditions produced notable and generally comparable changes in most treatment outcomes at post-treatment (within group d range = 0.06-1.77). DISCUSSION The MABT and CBT conditions demonstrated comparable degrees of feasibility, acceptability, and symptom improvement, suggesting that MABTs warrant further evaluation as ED treatments.
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Affiliation(s)
- Adrienne S. Juarascio
- Department of Psychology, Drexel University, Philadelphia, Pennsylvania,Center for Weight, Eating, and Lifestyle Science, Drexel University, Philadelphia, Pennsylvania
| | - Megan N. Parker
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USU), Bethesda, Maryland,Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), Division of Intramural Research, National Institutes of Health (NIH), Bethesda, Maryland
| | - Rowan Hunt
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, Kentucky
| | - Helen Burton Murray
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts,Harvard Medical School, Boston, Massachusetts
| | - Emily K. Presseller
- Department of Psychology, Drexel University, Philadelphia, Pennsylvania,Center for Weight, Eating, and Lifestyle Science, Drexel University, Philadelphia, Pennsylvania
| | - Stephanie M. Manasse
- Center for Weight, Eating, and Lifestyle Science, Drexel University, Philadelphia, Pennsylvania
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21
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Fumagalli G, Margola D. Is personality the key in cognitive-behavioural therapy for eating disorders? A review. Clin Psychol Psychother 2021; 29:164-177. [PMID: 34110647 DOI: 10.1002/cpp.2627] [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: 02/18/2021] [Revised: 05/13/2021] [Accepted: 06/03/2021] [Indexed: 11/08/2022]
Abstract
The efficacy of individual cognitive-behavioural therapy (CBT) for eating disorders can be assessed by investigating the potential predictors, mediators and moderators of treatment. The present review focused on personality since its crucial role has been emphasized both by research and practice. Sixteen studies were collected, and data were extracted through a highly operationalized coding system. Overall, personality disorders were the most investigated construct; however, their influence was somewhat contradictory. A more cogent result occurred for borderline personality disorder (BPD) when considered as a moderator (not a predictor nor a mediator). Patients with a more disturbed borderline personality benefited to a greater extent from treatments including booster modules on affects, interpersonal relationships and mood intolerance, rather than symptoms exclusively. Nine additional personality dimensions, beyond BPD, were investigated sparsely, and results regarding them were barely indicative in this review. However, some of these dimensions (e.g., affective lability and stimulus-seeking behaviours) could be traced back to BPD, thereby strengthening evidence of the role of borderline disorder as a moderator. Although research on the relationship between personality and eating disorders needs to be increased and methodologically improved, personality, taken as a whole, emerged as a promising variable for enhancing the efficacy of CBT.
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Affiliation(s)
| | - Davide Margola
- Faculty of Psychology, Catholic University of Milan, Milan, Italy
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22
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Abstract
Research findings strongly suggest that cognitive behavioral therapy for the eating disorders (CBT-ED) is more effective than other treatments for bulimia nervosa (BN) and for binge eating disorder (BED), although interpersonal psychotherapy appears to be equally effective for BED. Evidence for the effectiveness of CBT-ED for the persistent (adult) form of anorexia nervosa (AN) is insufficient at present and is essentially absent for AN in adolescents except for some evidence from uncontrolled trials. This article begins with an overview of the early studies in the development of CBT-ED that showed a similar effectiveness of other symptom-focused psychotherapies-a finding that was neglected at the time. Later developments are then considered, including comparisons of CBT-ED with other psychotherapies, efforts to develop Internet-based training and treatment, and electronic applications for treatment. Finally, implications of the findings for future short- and long-term research and for clinical practice are considered.
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Affiliation(s)
- W Stewart Agras
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California 94305, USA; ,
| | - Cara Bohon
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California 94305, USA; ,
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23
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Aloi M, Rania M, Carbone EA, Caroleo M, Calabrò G, Zaffino P, Nicolò G, Carcione A, Coco GL, Cosentino C, Segura-Garcia C. Metacognition and emotion regulation as treatment targets in binge eating disorder: a network analysis study. J Eat Disord 2021; 9:22. [PMID: 33588943 PMCID: PMC7885411 DOI: 10.1186/s40337-021-00376-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 02/03/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND This study aims to examine the underlying associations between eating, affective and metacognitive symptoms in patients with binge eating disorder (BED) through network analysis (NA) in order to identify key variables that may be considered the target for psychotherapeutic interventions. METHODS A total of 155 patients with BED completed measures of eating psychopathology, affective symptoms, emotion regulation and metacognition. A cross-sectional network was inferred by means of Gaussian Markov random field estimation using graphical LASSO and the extended Bayesian information criterion (EBIC-LASSO), and central symptoms of BED were identified by means of the strength centrality index. RESULTS Impaired self-monitoring metacognition and difficulties in impulse control emerged as the symptoms with the highest centrality. Conversely, eating and affective features were less central. The centrality stability coefficient of strength was above the recommended cut-off, thus indicating the stability of the network. CONCLUSIONS According to the present NA findings, impaired self-monitoring metacognition and difficulties in impulse control are the central nodes in the psychopathological network of BED whereas eating symptoms appear marginal. If further studies with larger samples replicate these results, metacognition and impulse control could represent new targets of psychotherapeutic interventions in the treatment of BED. In light of this, metacognitive interpersonal therapy could be a promising aid in clinical practice to develop an effective treatment for BED.
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Affiliation(s)
- Matteo Aloi
- Outpatient Unit for Clinical Research and Treatment of Eating Disorders, University Hospital "Mater Domini", Catanzaro, Italy.,Department of Health Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Marianna Rania
- Outpatient Unit for Clinical Research and Treatment of Eating Disorders, University Hospital "Mater Domini", Catanzaro, Italy.,Department of Health Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Elvira Anna Carbone
- Outpatient Unit for Clinical Research and Treatment of Eating Disorders, University Hospital "Mater Domini", Catanzaro, Italy.,Department of Health Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Mariarita Caroleo
- Outpatient Unit for Clinical Research and Treatment of Eating Disorders, University Hospital "Mater Domini", Catanzaro, Italy.,Department of Health Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Giuseppina Calabrò
- Outpatient Unit for Clinical Research and Treatment of Eating Disorders, University Hospital "Mater Domini", Catanzaro, Italy.,Department of Health Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Paolo Zaffino
- Department of Experimental and Clinical Medicine, School of Computer and Biomedical Engineering, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Giuseppe Nicolò
- Third Centre of Cognitive Psychotherapy - Italian School of Cognitive Psychotherapy (SICC), Rome, Italy
| | - Antonino Carcione
- Third Centre of Cognitive Psychotherapy - Italian School of Cognitive Psychotherapy (SICC), Rome, Italy
| | - Gianluca Lo Coco
- Department of Psychology, Educational Science and Human Movement, University of Palermo, Palermo, Italy
| | - Carlo Cosentino
- Department of Experimental and Clinical Medicine, School of Computer and Biomedical Engineering, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Cristina Segura-Garcia
- Outpatient Unit for Clinical Research and Treatment of Eating Disorders, University Hospital "Mater Domini", Catanzaro, Italy. .,Department of Medical and Surgical Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy.
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Heruc G, Hurst K, Casey A, Fleming K, Freeman J, Fursland A, Hart S, Jeffrey S, Knight R, Roberton M, Roberts M, Shelton B, Stiles G, Sutherland F, Thornton C, Wallis A, Wade T. ANZAED eating disorder treatment principles and general clinical practice and training standards. J Eat Disord 2020; 8:63. [PMID: 33292546 PMCID: PMC7653831 DOI: 10.1186/s40337-020-00341-0] [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: 08/05/2020] [Accepted: 10/21/2020] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Eating disorders are complex to manage, and there is limited guidance around the depth and breadth of knowledge, skills and experience required by treatment providers. The Australia & New Zealand Academy for Eating Disorders (ANZAED) convened an expert group of eating disorder researchers and clinicians to define the clinical practice and training standards recommended for mental health professionals and dietitians providing treatment for individuals with an eating disorder. General principles and clinical practice standards were first developed, after which separate mental health professional and dietitian standards were drafted and collated by the appropriate members of the expert group. The subsequent review process included four stages of consultation and document revision: (1) expert reviewers; (2) a face-to-face consultation workshop attended by approximately 100 health professionals working within the sector; (3) an extensive open access online consultation process; and (4) consultation with key professional and consumer/carer stakeholder organisations. RECOMMENDATIONS The resulting paper outlines and describes the following eight eating disorder treatment principles: (1) early intervention is essential; (2) co-ordination of services is fundamental to all service models; (3) services must be evidence-based; (4) involvement of significant others in service provision is highly desirable; (5) a personalised treatment approach is required for all patients; (6) education and/or psychoeducation is included in all interventions; (7) multidisciplinary care is required and (8) a skilled workforce is necessary. Seven general clinical practice standards are also discussed, including: (1) diagnosis and assessment; (2) the multidisciplinary care team; (3) a positive therapeutic alliance; (4) knowledge of evidence-based treatment; (5) knowledge of levels of care; (6) relapse prevention; and (7) professional responsibility. CONCLUSIONS These principles and standards provide guidance to professional training programs and service providers on the development of knowledge required as a foundation on which to build competent practice in the eating disorder field. Implementing these standards aims to bring treatment closer to best practice, and consequently improve treatment outcomes, reduce financial cost to patients and services and improve patient quality of life.
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Affiliation(s)
- Gabriella Heruc
- Australia & New Zealand Academy for Eating Disorders, Sydney, Australia.
- School of Medicine, Western Sydney University, Campbelltown, Australia.
- Eating Disorders Service, Northern Sydney Local Health District, St Leonards, Australia.
| | - Kim Hurst
- Australia & New Zealand Academy for Eating Disorders, Sydney, Australia
- School of Psychology, Griffith University, Gold Coast, Australia
- Eating Disorders Service, Robina Private Hospital, Robina, Australia
| | - Anjanette Casey
- Centre for Psychotherapy, Hunter New England Local Health District, Newcastle, Australia
| | | | - Jeremy Freeman
- Australia & New Zealand Academy for Eating Disorders, Sydney, Australia
| | | | - Susan Hart
- Nutrition and Dietetics, St Vincent's Hospital, Darlinghurst, Australia
- The Boden Collaboration of Obesity, Nutrition, Exercise and Eating Disorders, University of Sydney, Camperdown, Australia
| | - Shane Jeffrey
- Australia & New Zealand Academy for Eating Disorders, Sydney, Australia
- River Oak Health, Brisbane, Australia
- Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Rachel Knight
- Occupational Therapy, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Australia
- The Victorian Centre of Excellence in Eating Disorders, Melbourne, Australia
| | - Michelle Roberton
- The Victorian Centre of Excellence in Eating Disorders, Melbourne, Australia
| | - Marion Roberts
- Australia & New Zealand Academy for Eating Disorders, Sydney, Australia
- Department of General Practice and Primary Health Care, Faculty of Medical & Health Sciences, University of Auckland, Auckland, New Zealand
| | - Beth Shelton
- National Eating Disorders Collaboration, Sydney, Australia
| | - Garalynne Stiles
- School of Sport, Exercise and Nutrition, College of Health, Massey University, Palmerston North, New Zealand
| | - Fiona Sutherland
- Australia & New Zealand Academy for Eating Disorders, Sydney, Australia
- The Mindful Dietitian, Melbourne, Australia
| | | | - Andrew Wallis
- Eating Disorders Service, Sydney Children's Hospital Network, Sydney, Australia
| | - Tracey Wade
- Blackbird Initiative, Órama Institute, Flinders University, Bedford Park, Australia
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25
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Momentary changes in heart rate variability can detect risk for emotional eating episodes. Appetite 2020; 152:104698. [DOI: 10.1016/j.appet.2020.104698] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 04/01/2020] [Accepted: 04/04/2020] [Indexed: 12/22/2022]
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26
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Wade TD, Allen K, Crosby RD, Fursland A, Hay P, McIntosh V, Touyz S, Schmidt U, Treasure J, Byrne S. Outpatient therapy for adult anorexia nervosa: Early weight gain trajectories and outcome. EUROPEAN EATING DISORDERS REVIEW 2020; 29:472-481. [PMID: 32838476 DOI: 10.1002/erv.2775] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 05/10/2020] [Accepted: 06/22/2020] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The purpose of the study was to identify latent classes of trajectory of change in body mass index (BMI) between the initial and thirteenth session of outpatient treatment for adult anorexia nervosa and identify the association with outcome. METHOD Participants (n = 120) were randomised to one of three outpatient therapies. RESULTS Four latent classes were identified; two classes (higher, rapid and higher, moderate) had BMI > 17 kg/m2 at initial assessment, and both gained significantly more weight over the 13 sessions compared to the other two classes. The third and fourth classes (middle, stable and low, stable) had an initial BMI of 16.44 and 15.31, respectively, and neither gained weight over the first 13 sessions. Compared to the other three classes, the higher, rapid class (N = 19, 16%) showed a significantly greater BMI increase over the first 13 sessions of therapy and a significantly higher rate of remission at end of treatment and 12-month follow-up (18-22 months post-randomisation). CONCLUSIONS The group with the greatest early weight gain had significantly higher levels of remission. Higher BMI at baseline without substantial early weight gain was insufficient to produce higher levels of remission than those with lower weight at baseline.
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Affiliation(s)
- Tracey D Wade
- School of Psychology, Flinders University, Adelaide, South Australia, Australia
| | - Karina Allen
- Eating Disorders Service, South London and Maudsley NHS Foundation Trust; Department of Psychological Medicine, Kings College London, London, UK
| | - Ross D Crosby
- Sanford Center for Biobehavioral Research and the Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota, USA
| | - Anthea Fursland
- Centre for Clinical Interventions, Perth, Western Australia, Australia.,Western Australia Eating Disorders Outreach & Consultation Service, Perth, Western Australia, Australia
| | - Phillipa Hay
- School of Medicine & Centre for Health Research, Western Sydney University, Sydney, New South Wales, Australia
| | - Virginia McIntosh
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Stephen Touyz
- School of Psychology, Sydney University, Sydney, New South Wales, Australia
| | - Ulrike Schmidt
- Department of Psychological Medicine, Kings College London, London, UK
| | - Janet Treasure
- Department of Psychological Medicine, Kings College London, London, UK
| | - Susan Byrne
- Eating Disorders Service, South London and Maudsley NHS Foundation Trust; Department of Psychological Medicine, Kings College London, London, UK
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Soares EE, Thrall JN, Stephens TN, Rodriguez Biglieri R, Consoli AJ, Bunge EL. Publication Trends in Psychotherapy: Bibliometric Analysis of the Past 5 Decades. Am J Psychother 2020; 73:85-94. [PMID: 32506985 DOI: 10.1176/appi.psychotherapy.20190045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Bibliometric analyses are commonly used to document publication trends over time; however, this methodology has not been used to investigate possible trends concerning publishing about psychotherapy brands. In this study, the authors sought to identify the publication trends of peer-reviewed articles about 30 psychotherapy brands. METHODS Analyses were focused on the past 50 years and on each decade from 1970 to 2019. All searches were performed between October 2018 and January 2019 on the EbscoHost platform. Two databases were selected for the searches: PsycINFO and PubMed. RESULTS In the 28,594 articles reviewed, most published articles concerned cognitive-behavioral therapy (CBT), and five brands accounted for almost 78% of all publications: CBT, psychoanalysis, family systems therapy, behavioral therapy, and cognitive therapy. Three trends were identified across decades: five therapies consistently yielded the largest number of publications, the number of publications focused on therapies with less research support declined from the 1970s to the 1990s, and publications about therapies with more of a research basis increased in the 1990s through the 2010s. Publications on meditation and mindfulness presented the most salient growth area for all psychotherapies across the 5 decades. A few psychotherapy brands have dominated the publishing realm during the past 50 years and across each decade. CONCLUSIONS Possible explanations for these publication trends were considered, including the emergence of the evidence-based therapy movement and various sociohistorical changes. Potential psychotherapy publications trends in the future are discussed.
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Affiliation(s)
- Erin E Soares
- Department of Clinical Psychology, Palo Alto University, Palo Alto, California (Soares, Thrall, Stephens, Bunge); Instituto de Terapia Cognitiva Conductual, Buenos Aires, Argentina (Rodriguez Biglieri); Gevirtz Graduate School of Education, University of California, Santa Barbara (Consoli)
| | - Jillian N Thrall
- Department of Clinical Psychology, Palo Alto University, Palo Alto, California (Soares, Thrall, Stephens, Bunge); Instituto de Terapia Cognitiva Conductual, Buenos Aires, Argentina (Rodriguez Biglieri); Gevirtz Graduate School of Education, University of California, Santa Barbara (Consoli)
| | - Taylor N Stephens
- Department of Clinical Psychology, Palo Alto University, Palo Alto, California (Soares, Thrall, Stephens, Bunge); Instituto de Terapia Cognitiva Conductual, Buenos Aires, Argentina (Rodriguez Biglieri); Gevirtz Graduate School of Education, University of California, Santa Barbara (Consoli)
| | - Ricardo Rodriguez Biglieri
- Department of Clinical Psychology, Palo Alto University, Palo Alto, California (Soares, Thrall, Stephens, Bunge); Instituto de Terapia Cognitiva Conductual, Buenos Aires, Argentina (Rodriguez Biglieri); Gevirtz Graduate School of Education, University of California, Santa Barbara (Consoli)
| | - Andrés J Consoli
- Department of Clinical Psychology, Palo Alto University, Palo Alto, California (Soares, Thrall, Stephens, Bunge); Instituto de Terapia Cognitiva Conductual, Buenos Aires, Argentina (Rodriguez Biglieri); Gevirtz Graduate School of Education, University of California, Santa Barbara (Consoli)
| | - Eduardo L Bunge
- Department of Clinical Psychology, Palo Alto University, Palo Alto, California (Soares, Thrall, Stephens, Bunge); Instituto de Terapia Cognitiva Conductual, Buenos Aires, Argentina (Rodriguez Biglieri); Gevirtz Graduate School of Education, University of California, Santa Barbara (Consoli)
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Aloi M, Rania M, Carbone EA, Calabrò G, Caroleo M, Carcione A, Nicolò G, Semerari A, Segura-Garcia C. The role of self-monitoring metacognition sub-function and negative urgency related to binge severity. EUROPEAN EATING DISORDERS REVIEW 2020; 28:580-586. [PMID: 32419220 DOI: 10.1002/erv.2742] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 03/31/2020] [Accepted: 04/24/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE This study aims to test a model where low self-monitoring (a sub-function of first-person domain of metacognition) and high negative urgency lead to a worsening of binge severity through the mediation of emotional dysregulation in patients with binge eating disorder (BED). METHOD Forty non-BED-obese and 46 BED-obese patients completed a battery of tests assessing metacognition and psychopathology. To test our hypothesized model, a structural equation model (SEM) using maximum likelihood estimation was conducted. RESULTS BED-obese patients had significantly higher scores in BES, UPPS-P Negative urgency, and DERS total score, and lower MSAS self-monitoring than non-BED-obese, while no differences emerged in the MSAS others-monitoring subscale. The structural model demonstrated very good fit indexes (χ2 = 1.377, df = 2; p = .502, CMIN/DF = 0.688, CFI = 1.000, RMSEA = 0.000, TLI = 1.047) and all paths were significant in the predicted directions. CONCLUSIONS These preliminary findings show that, low self-monitoring and high negative urgency lead BED-obese patients to express the worsening of binge severity through the mediation of emotional dysregulation. This knowledge may be helpful in the clinical practice to develop a tailor-made treatment. Accordingly, an approach through Metacognitive Interpersonal Therapy could be attempted in BED-obese patients with these characteristics. Highlights Patients with BED exhibited low self-monitoring and high negative urgency. Binge severity was mediated by high level of emotional dysregulation. Metacognitive Interpersonal Therapy may be useful for BED patients.
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Affiliation(s)
- Matteo Aloi
- Outpatient Unit for Clinical Research and Treatment of Eating Disorders, University Hospital "Mater Domini", Catanzaro, Italy.,Department of Health Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Marianna Rania
- Outpatient Unit for Clinical Research and Treatment of Eating Disorders, University Hospital "Mater Domini", Catanzaro, Italy.,Department of Health Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Elvira A Carbone
- Outpatient Unit for Clinical Research and Treatment of Eating Disorders, University Hospital "Mater Domini", Catanzaro, Italy.,Department of Health Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Giuseppina Calabrò
- Outpatient Unit for Clinical Research and Treatment of Eating Disorders, University Hospital "Mater Domini", Catanzaro, Italy.,Department of Health Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Mariarita Caroleo
- Outpatient Unit for Clinical Research and Treatment of Eating Disorders, University Hospital "Mater Domini", Catanzaro, Italy.,Department of Health Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Antonino Carcione
- Third Centre of Cognitive Psychotherapy, Italian School of Cognitive Psychotherapy (SICC), Rome, Italy
| | - Giuseppe Nicolò
- Third Centre of Cognitive Psychotherapy, Italian School of Cognitive Psychotherapy (SICC), Rome, Italy
| | - Antonio Semerari
- Third Centre of Cognitive Psychotherapy, Italian School of Cognitive Psychotherapy (SICC), Rome, Italy
| | - Cristina Segura-Garcia
- Outpatient Unit for Clinical Research and Treatment of Eating Disorders, University Hospital "Mater Domini", Catanzaro, Italy.,Department of Medical and Surgical Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
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Brown TA, Cusack A, Berner LA, Anderson L, Nakamura T, Gomez L, Trim J, Chen JY, Kaye WH. Emotion Regulation Difficulties During and After Partial Hospitalization Treatment Across Eating Disorders. Behav Ther 2020; 51:401-412. [PMID: 32402256 PMCID: PMC7225176 DOI: 10.1016/j.beth.2019.07.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 07/01/2019] [Accepted: 07/03/2019] [Indexed: 01/19/2023]
Abstract
Emotion regulation deficits are associated with eating disorder (ED) symptoms, regardless of eating disorder diagnosis. Thus, recent treatment approaches for EDs, such as dialectical behavior therapy (DBT), have focused on teaching patients skills to better regulate emotions. The present study examined changes in emotion regulation among adult patients with EDs during DBT-oriented partial hospital treatment, and at follow-up (M[SD] = 309.58[144.59] days from discharge). Exploratory analyses examined associations between changes in emotion regulation and ED symptoms. Patients with anorexia nervosa, restricting (AN-R, n = 77), and binge-eating/purging subtype (AN-BP, n = 46), or bulimia nervosa (BN, n = 118) completed the Difficulties in Emotion Regulation Scale (DERS) at admission, discharge, and follow-up. Patients with BN demonstrated significant improvements across all facets of emotion dysregulation from admission to discharge and maintained improvements at follow-up. Although patients with AN-BP demonstrated statistically significant improvements on overall emotion regulation, impulsivity, and acceptance, awareness, and clarity of emotions, from admission to discharge, these improvements were not significant at follow-up. Patients with AN-R demonstrated statistically significant improvements on overall emotion dysregulation from treatment admission to discharge. Changes in emotion regulation were moderately correlated with changes in ED symptoms over time. Results support different trajectories of emotion regulation symptom change in DBT-oriented partial hospital treatment across ED diagnoses, with patients with BN demonstrating the most consistent significant improvements.
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Affiliation(s)
- Tiffany A. Brown
- Eating Disorder Center for Treatment and Research, UC San Diego Health; 4510 Executive Drive, Suite 315; San Diego, CA 92121
| | - Anne Cusack
- Eating Disorder Center for Treatment and Research, UC San Diego Health; 4510 Executive Drive, Suite 315; San Diego, CA 92121
| | - Laura A. Berner
- Eating Disorder Center for Treatment and Research, UC San Diego Health; 4510 Executive Drive, Suite 315; San Diego, CA 92121
| | - Leslie Anderson
- Eating Disorder Center for Treatment and Research, UC San Diego Health; 4510 Executive Drive, Suite 315; San Diego, CA 92121
| | - Tiffany Nakamura
- Eating Disorder Center for Treatment and Research, UC San Diego Health; 4510 Executive Drive, Suite 315; San Diego, CA 92121
| | - Lauren Gomez
- Eating Disorder Center for Treatment and Research, UC San Diego Health; 4510 Executive Drive, Suite 315; San Diego, CA 92121
| | - Julie Trim
- Eating Disorder Center for Treatment and Research, UC San Diego Health; 4510 Executive Drive, Suite 315; San Diego, CA 92121
| | - Joanna Y. Chen
- Department of Psychology, Drexel University; 3201 Chestnut St, Philadelphia, PA 19104
| | - Walter H. Kaye
- Eating Disorder Center for Treatment and Research, UC San Diego Health; 4510 Executive Drive, Suite 315; San Diego, CA 92121
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30
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Ben-Porath D, Duthu F, Luo T, Gonidakis F, Compte EJ, Wisniewski L. Dialectical behavioral therapy: an update and review of the existing treatment models adapted for adults with eating disorders. Eat Disord 2020; 28:101-121. [PMID: 32129724 DOI: 10.1080/10640266.2020.1723371] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Despite the effectiveness of CBT in reducing shape/weight concerns and dietary restraint, research suggests that patients considered recovered may still exhibit emotional difficulties related to eating disorders (EDs). Dialectical behavior therapy (DBT) has been adapted for a variety of mental disorders characterized by emotion dysregulation and, more recently, for EDs specifically. The current review found that the majority of the research studies employed one of the following three adaptations of DBT for EDs: The Stanford Model, Radically Open-DBT (RO-DBT), or Multidiagnostic ED-DBT (MED-DBT). Therefore, this review sought to review and update the empirical research on each adaptation and (2) offer preliminary recommendations for when and which adaptation of DBT to use when treating adults with EDs. Findings from the empirical literature on DBT and EDs indicate that the Stanford Model has the most rigorous and numerous studies demonstrating efficacy and effectiveness in those diagnosed with binge eating disorder. Fewer studies have been conducted using the Stanford Model with bulimia nervosa; therefore, less strong assertions can be made about DBT with those diagnosed with bulimia. The MED-DBT model has been evaluated in several open trials within higher levels of care with promising results, but the lack of randomized clinically-controlled trials prevents a definitive statement about its efficacy. Finally, research on applying the RO-DBT model to anorexia-nervosa, restricting subtype is in its infancy, prohibiting solid conclusions or recommendations regarding its efficacy or effectiveness.
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Affiliation(s)
- Denise Ben-Porath
- Department of Psychology, John Carroll University, University Heights, Ohio, USA
| | - Florencia Duthu
- DBT-Eating Disorders Team, Fundación Foro, Buenos Aires, Argentina
| | - Tana Luo
- Eating Disorders Center for Treatment and Research, University of California, San Diego, California, USA
| | - Fragiskos Gonidakis
- Department of Psychiatry, National and Kapodistrian University of Athens, Athens, Greece
| | - Emilio J Compte
- DBT-Eating Disorders Team, Fundación Foro, Buenos Aires, Argentina.,School of Human and Behavioral Sciences, Favaloro University, Buenos Aires, Argentina.,Research Department, Comenzar De Nuevo Treatment Center, Monterrey, México
| | - Lucene Wisniewski
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, Ohio, USA.,Center for Evidence Based Treatment Ohio, Shaker Heights, Ohio, USA
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31
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Brown TA, Wisniewski L, Anderson LK. Dialectical Behavior Therapy for Eating Disorders: State of the Research and New Directions. Eat Disord 2020; 28:97-100. [PMID: 32301685 DOI: 10.1080/10640266.2020.1728204] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Tiffany A Brown
- Eating Disorder Center for Treatment and Research, Department of Psychiatry, University of California, San Diego, California, USA
| | | | - Leslie K Anderson
- Eating Disorder Center for Treatment and Research, Department of Psychiatry, University of California, San Diego, California, USA
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32
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Marino J, Hardin R, Gasbarro A, Dansereau VA, Fischer S. Outpatient treatment for adults with complex eating disorders and co-morbid conditions: a decision making model and case example. Eat Disord 2020; 28:171-183. [PMID: 32129726 DOI: 10.1080/10640266.2020.1723372] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Although Cognitive Behavioral Therapy (CBT-E) for eating disorders has the most empirical support for the outpatient treatment of adult eating disorders (EDs), this model does not include a focus on intense emotion dysregulation, suicidality, and non-suicidal self-injury (NSSI). Furthermore, a subset of patients do not achieve sustained remission with CBT-E. Given that Dialectical Behavior Therapy (DBT) was designed for treatment refractory, complex patients, clinicians must be able to use assessment information to determine which type of treatment to use. The aims of this manuscript are to 1) describe a DBT-based and research-informed conceptual model for treatment decision making for an outpatient non-academic setting, 2) present a case example of a client with significant ED symptoms and complex medical and psychiatric comorbidities, using this decision making model and 3) present descriptive data from a private practice setting in which patients are referred to DBT vs. CBT-E according to this decision making model.
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Affiliation(s)
- Joanna Marino
- Private practice, Potomac Behavioral Solutions, Arlington, VA, USA
| | - Rebecca Hardin
- Private practice, Potomac Behavioral Solutions, Arlington, VA, USA
| | | | | | - Sarah Fischer
- Department of Psychology, George Mason University, Fairfax, Virginia, USA
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Abstract
Binge-eating disorder (BED) is a prevalent and serious public health issue. BED is characterized by recurrent out-of-control binge eating episodes in the absence of extreme weight control behavior and is associated with significant psychosocial and physiological impairment. Dialectical Behavior Therapy (DBT), based on the affect regulation model of binge eating, is an evidence-based treatment (EBT) approach for BED. Unfortunately, access to EBTs is often limited due to geographical barriers (i.e., lack of local providers with specialized training in EBTs), lack of financial resources, and/or time constraints. Self-help approaches (via guided and unguided versions) to delivering DBT for BED offer a potentially effective means of more widely disseminating this treatment. Compared to traditional, higher intensity approaches, self-help DBT for BED is less time-consuming, less financially costly, and requires less need for specialized therapist-training. This paper will present how DBT for BED has been adapted for self-help delivery, review the limited but promising research on DBT self-help available to date, and provide directions for future research.
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Affiliation(s)
- Therese E Kenny
- Department of Psychology, University of Guelph, Guelph, ON, Canada
| | - Jacqueline C Carter
- Department of Psychology, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Debra L Safer
- Department of Psychiatry and Behavioural Sciences, Stanford University, Stanford, California, USA
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Grilo CM, White MA, Masheb RM, Ivezaj V, Morgan PT, Gueorguieva R. Randomized controlled trial testing the effectiveness of adaptive "SMART" stepped-care treatment for adults with binge-eating disorder comorbid with obesity. AMERICAN PSYCHOLOGIST 2020; 75:204-218. [PMID: 32052995 PMCID: PMC7027689 DOI: 10.1037/amp0000534] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
This randomized controlled trial (RCT) tested effectiveness of adaptive SMART stepped-care treatment to "standard" behavioral weight loss (BWL [standard]) for patients with binge-eating disorder (BED) and obesity. One hundred ninety-one patients were randomly assigned to 6 months of BWL (standard; n = 39) or stepped care (n = 152). Within stepped care, patients started with BWL for 1 month; treatment responders continued BWL, whereas nonresponders switched to cognitive-behavioral therapy (CBT), and patients receiving stepped care were additionally randomized to weight-loss medication or placebo (double-blind) for the remaining 5 months. Independent assessments were performed reliably at baseline, throughout treatment, and posttreatment. Intent-to-treat (ITT) analyses of remission rates (zero binges/month) revealed that BWL (standard) and stepped care did not differ (74.4% vs. 66.5%); within stepped care, remission rates ranged 40.0% to 83.3%, with medication significantly superior to placebo (overall) and among nonresponders switched to CBT. Mixed-models analyses of binge-eating frequency revealed significant time effects, but BWL (standard) and stepped care did not differ; within stepped care, medication was significantly superior to placebo and among nonresponders switched to CBT. Mixed models revealed significant weight loss, but BWL (standard; 5.1% weight-loss) and stepped care (5.8% weight-loss) did not differ; within stepped care (range = 0.4% to 8.8% weight-loss), medication was significantly superior to placebo and among both responders continued on BWL and nonresponders switched to CBT. In summary, BWL (standard) and adaptive stepped-care treatments produced robust improvements in binge eating and weight loss in patients with BED/obesity. Within adaptive stepped care, weight-loss medication enhanced outcomes for BED/obesity. Implications for clinical practice and future adaptive designs are offered. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Carlos M Grilo
- Department of Psychiatry, Yale University School of Medicine
| | - Marney A White
- Department of Social and Behavioral Sciences, Yale University School of Public Health
| | - Robin M Masheb
- Department of Psychiatry, Yale University School of Medicine
| | | | - Peter T Morgan
- Department of Psychiatry, Yale University School of Medicine
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35
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Lammers MW, Vroling MS, Crosby RD, van Strien T. Dialectical behavior therapy adapted for binge eating compared to cognitive behavior therapy in obese adults with binge eating disorder: a controlled study. J Eat Disord 2020; 8:27. [PMID: 32528681 PMCID: PMC7285554 DOI: 10.1186/s40337-020-00299-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 05/18/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Current guidelines recommend cognitive behavior therapy (CBT) as the treatment of choice for binge eating disorder (BED). Although CBT is quite effective, a substantial number of patients do not reach abstinence from binge eating. To tackle this problem, various theoretical conceptualizations and treatment models have been proposed. Dialectical behavior therapy (DBT), focusing on emotion regulation, is one such model. Preliminary evidence comparing DBT adapted for BED (DBT-BED) to CBT is promising but the available data do not favor one treatment over the other. The aim of this study is to evaluate outcome of DBT-BED, compared to a more intensive eating disorders-focused form of cognitive behavior therapy (CBT+), in individuals with BED who are overweight and engage in emotional eating. METHODS Seventy-four obese patients with BED who reported above average levels of emotional eating were quasi-randomly allocated to one of two manualized 20-session group treatments: DBT-BED (n = 41) or CBT+ (n = 33). Intention-to-treat outcome was examined at post-treatment and at 6-month follow-up using general or generalized linear models with multiple imputation. RESULTS Overall, greater improvements were observed in CBT+. Differences in number of objective binge eating episodes at end of treatment, and eating disorder psychopathology (EDE-Q Global score) and self-esteem (EDI-3 Low Self-Esteem) at follow-up reached statistical significance with medium effect sizes (Cohen's d between .46 and .59). Of the patients in the DBT group, 69.9% reached clinically significant change at end of the treatment vs 65.0% at follow-up. Although higher, this was not significantly different from the patients in the CBT+ group (52.9% vs 45.8%). CONCLUSIONS The results of this study show that CBT+ produces better outcomes than the less intensive DBT-BED on several measures. Yet, regardless of the dose-difference, the data suggest that DBT-BED and CBT+ lead to comparable levels of clinically meaningful change in global eating disorder psychopathology. Future recommendations include the need for dose-matched comparisons in a sufficiently powered randomized controlled trial, and the need to determine mediators and moderators of treatment outcome. TRIAL REGISTRATION Nederlands Trial Register: NL3982 (NTR4154). Date of registration: 2013 August 28, retrospectively registered.
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Affiliation(s)
- Mirjam W Lammers
- Amarum, Expertise Centre for Eating Disorders, GGNet Network for Mental Health Care, Den Elterweg 75, 7207 AE Zutphen, The Netherlands.,Radboud University, Behavioural Science Institute, Montessorilaan 3, 6525 HR Nijmegen, The Netherlands
| | - Maartje S Vroling
- Amarum, Expertise Centre for Eating Disorders, GGNet Network for Mental Health Care, Den Elterweg 75, 7207 AE Zutphen, The Netherlands.,Radboud University, Behavioural Science Institute, Montessorilaan 3, 6525 HR Nijmegen, The Netherlands
| | - Ross D Crosby
- Sanford Center for Biobehavioral Research, Fargo, North Dakota USA.,University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota USA
| | - Tatjana van Strien
- Radboud University, Behavioural Science Institute, Montessorilaan 3, 6525 HR Nijmegen, The Netherlands
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Aloi M, Rania M, Caroleo M, Carbone EA, Fazia G, Calabrò G, Segura-Garcia C. How are early maladaptive schemas and DSM-5 personality traits associated with the severity of binge eating? J Clin Psychol 2019; 76:539-548. [PMID: 31733127 DOI: 10.1002/jclp.22900] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The present study aimed to (a) assess and compare personological traits and early maladaptive schemas (EMSs) of obese women with and without binge eating disorder (BED) and (b) identify the variables associated with the binge severity. METHOD One hundred women (55 BED-obese and 45 non-BED-obese) completed psychopathological and personological self-report questionnaires. A forward stepwise linear regression analysis was performed to assess variables associated with binge eating severity. RESULTS Not only psychopathological but also personological differences were evident between BED and non-BED-obese women. BED severity was significantly associated with depressivity, emotional deprivation, and defectiveness. CONCLUSIONS Our preliminary findings suggest that BED patients exhibit some EMSs that could be linked to the construct of emotional neglect and specific personological traits closely related to depressive dimensions, emotional lability, and impulsivity. In particular, binge severity is associated with the pervasiveness of depressogenic cognitive schemas, as well as those of emotional deprivation and defectiveness.
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Affiliation(s)
- Matteo Aloi
- Department of Health Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Marianna Rania
- Department of Health Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Mariarita Caroleo
- Department of Health Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Elvira A Carbone
- Department of Health Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Gilda Fazia
- Department of Health Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Giusy Calabrò
- Department of Health Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Cristina Segura-Garcia
- Department of Medical and Surgical Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy.,Outpatient Unit for Clinical Research and Treatment of Eating Disorders, Psychiatric Unit, University Hospital Mater Domini, Catanzaro, Italy
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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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Dixon LJ, Linardon J. A systematic review and meta-analysis of dropout rates from dialectical behaviour therapy in randomized controlled trials. Cogn Behav Ther 2019; 49:181-196. [PMID: 31204902 DOI: 10.1080/16506073.2019.1620324] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Dropout is an important factor that may compromise the validity of findings from randomized controlled trials (RCTs) of dialectical behaviour therapy (DBT). We conducted a targeted meta-analytic review of dropout from RCTs of DBT, with the aims of (1) calculating average rates of dropout from DBT; (2) investigating factors that moderate dropout; (3) examining whether dropout rates from DBT differ to control interventions; (4) synthesising reasons for dropout. Forty RCTs of DBT met full inclusion criteria. The weighted mean dropout rate was 28.0% (95% CI = 23.6, 32.9). Dropout rates were not related to target disorder, dropout definition, delivery format, therapist experience, and therapist adherence. Unexpectedly, dropout rates were significantly higher in trials that offered telephone coaching and utilized a therapist consultation team. DBT dropout rates did not significantly differ to dropout rates from control interventions. Few trials reported reasons for dropout, and there was little consistency in the reported reasons. Findings suggest that over one in four patients drop out from DBT in RCTs. This review highlights the urgency for future trials to explicitly report detail pertaining to patient dropout, as this may assist in the development of strategies designed to prevent future dropouts in RCTs of DBT.
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Kamody RC, Thurston IB, Pluhar EI, Han JC, Burton ET. Implementing a condensed dialectical behavior therapy skills group for binge-eating behaviors in adolescents. Eat Weight Disord 2019; 24:367-372. [PMID: 30242784 DOI: 10.1007/s40519-018-0580-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Accepted: 09/11/2018] [Indexed: 10/28/2022] Open
Abstract
PURPOSE Subthreshold binge-eating disorder (BED) symptoms can lead to additive physical and psychological health challenges and may put youth at risk for developing BED during the early adulthood. We examined the implementation of a condensed dialectical behavior therapy (DBT) skills intervention for subthreshold binge-eating behaviors in adolescents. METHODS Fifteen 14-18 years old participated in a 10-week DBT skills group, which experientially introduced mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness skills in the context of emotionally driven overeating behaviors. Adolescents and caregivers completed measures of emotional eating and binge-eating behaviors at baseline and post-intervention, including the Eating Disorder Examination Questionnaire and Emotional Eating Scale for Children and Adolescents. Eleven participants were retained at 3-month follow-up. RESULTS Descriptive statistics were compared at all three time points. Results suggested a reduction in emotional eating and binge-eating behaviors based on youth self-report and caregiver report. Acceptability ratings of the treatment were high among participants completing the intervention. CONCLUSIONS Using DBT skills to target emotionally driven overeating behaviors in youth may be useful in the treatment of subthreshold BED behaviors and potentially deter future development of full-criteria BED. LEVEL OF EVIDENCE Level IV, uncontrolled pilot trial.
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Affiliation(s)
- Rebecca C Kamody
- Department of Psychology, The University of Memphis, 202 Psychology Building, Memphis, TN, 38152, USA. .,Yale University Child Study Center, 230 South Frontage Road, New Haven, CT, 06520, USA.
| | - Idia B Thurston
- Department of Psychology, The University of Memphis, 202 Psychology Building, Memphis, TN, 38152, USA.,Department of Pediatrics, University of Tennessee Health Science Center, 50 N. Dunlap Street, Memphis, TN, 38103, USA.,Children's Foundation Research Institute, Le Bonheur Children's Hospital, 50 N. Dunlap Street, Memphis, TN, 38103, USA
| | - Emily I Pluhar
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, 333 Longwood Avenue, Boston, MA, 02115, USA.,Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA
| | - Joan C Han
- Department of Pediatrics, University of Tennessee Health Science Center, 50 N. Dunlap Street, Memphis, TN, 38103, USA.,Children's Foundation Research Institute, Le Bonheur Children's Hospital, 50 N. Dunlap Street, Memphis, TN, 38103, USA.,Department of Physiology, University of Tennessee Health Science Center, 71 S. Manassas Street, Memphis, TN, 38163, USA
| | - E Thomaseo Burton
- Department of Pediatrics, University of Tennessee Health Science Center, 50 N. Dunlap Street, Memphis, TN, 38103, USA.,Children's Foundation Research Institute, Le Bonheur Children's Hospital, 50 N. Dunlap Street, Memphis, TN, 38103, USA
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Abstract
Estimates of lifetime bulimia nervosa (BN) range from 4% to 6.7% across studies. There has been a decrease in the presentation of BN in primary care but an increase in disordered eating not meeting full diagnostic criteria. Regardless of diagnostic status, disordered eating is associated with long-term significant impairment to both physical and mental quality of life, and BN is associated with a significantly higher likelihood of self-harm, suicide, and death. Assessment should adopt a motivationally enhancing stance given the high level of ambivalence associated with BN. Cognitive behavior therapy specific to eating disorders outperforms other active psychological comparisons.
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Affiliation(s)
- Tracey D Wade
- School of Psychology, Flinders University, GPO Box 2100, Adelaide, South Australia 5001, Australia.
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Pellizzer ML, Waller G, Wade TD. Predictors of outcome in cognitive behavioural therapy for eating disorders: An exploratory study. Behav Res Ther 2019; 116:61-68. [PMID: 30798180 DOI: 10.1016/j.brat.2019.02.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 01/25/2019] [Accepted: 02/06/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Early decrease in symptoms is a consistent predictor of good treatment outcome across all eating disorders. The current study explored the predictive value of novel early change variables in a transdiagnostic, non-underweight sample receiving 10-session cognitive behavioural therapy. METHOD Participants who reported bingeing and/or purging in the week preceding baseline assessment (N = 62) were included in analyses. Early change variables were calculated for novel (body image flexibility, body image avoidance, body checking, and fear of compassion) and established predictors (behavioural symptoms and therapeutic alliance). Outcomes were global eating disorder psychopathology and clinical impairment at posttreatment and three-month follow-up. Intent-to-treat analyses were conducted using linear regression, adjusting for baseline values of the relevant outcome and early change in behavioural symptoms. RESULTS Early improvement in body image flexibility was the most consistent predictor of good outcome. Early change in body image avoidance and the fear of expressing and receiving compassion to/from others were significant predictors in some analyses. DISCUSSION Novel early change variables were significant predictors of eating disorder outcomes in this exploratory study. Model testing is required to understand the exact mechanisms by which these variables impact on outcomes, and whether there is potential benefit of modifying existing protocols. ANZCTR TRIAL NUMBER ACTRN12615001098527.
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Affiliation(s)
- Mia L Pellizzer
- College of Education Psychology & Social Work, Flinders University, Adelaide, South Australia, Australia.
| | - Glenn Waller
- Department of Psychology, University of Sheffield, United Kingdom
| | - Tracey D Wade
- College of Education Psychology & Social Work, Flinders University, Adelaide, South Australia, Australia
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Early Versus Later Improvements in Dialectical Behavior Therapy Skills Use and Treatment Outcome in Eating Disorders. COGNITIVE THERAPY AND RESEARCH 2019. [DOI: 10.1007/s10608-019-10006-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Keating L, Mills JS, Rawana JS. Momentary predictors of binge eating: An attachment perspective. Eat Behav 2019; 32:44-52. [PMID: 30594107 DOI: 10.1016/j.eatbeh.2018.12.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 12/10/2018] [Accepted: 12/17/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION According to attachment theory, individuals who are preoccupied with the possibility of rejection are prone to emotion dysregulation, which research has found to be related to disordered eating. The current study examined naturalistic momentary relationships between binge eating, depressive symptoms, emotion dysregulation, and attachment anxiety. METHOD Participants were 55 undergraduate women who owned a mobile phone and who had binge eaten at least once during the past 28 days. All participants were screened to confirm the presence of binge eating and then completed trait measures of attachment anxiety. Participants then received seven text messages per day for 14 days. Texts contained links to state measures of depressive symptoms, state emotion dysregulation, and recent binge eating. RESULTS Momentary depressive symptoms predicted subsequent binge eating. Aspects of emotion dysregulation (i.e., nonacceptance of emotional responses and difficulty modulating one's emotions) mediated the relationship between attachment anxiety and binge eating. DISCUSSION Depressed mood often triggers binge eating. Additionally, attachment anxiety seems to predict binge eating through emotion dysregulation. Interventions for binge eating should address both attachment anxiety and emotion dysregulation in order to maximize therapeutic benefit.
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Affiliation(s)
- Leah Keating
- Department of Psychology, Faculty of Health, York University, 4700 Keele St., Toronto, ON, M3J 1P3, Canada.
| | - Jennifer S Mills
- Department of Psychology, Faculty of Health, York University, 4700 Keele St., Toronto, ON, M3J 1P3, Canada.
| | - Jennine S Rawana
- Department of Psychology, Faculty of Health, York University, 4700 Keele St., Toronto, ON, M3J 1P3, Canada.
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Wade TD, Johnson C, Byrne SM. Randomized controlled psychotherapy trials in eating disorders: Improving their conduct, interpretation and usefulness. Int J Eat Disord 2018; 51:629-636. [PMID: 29693749 DOI: 10.1002/eat.22872] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 04/05/2018] [Accepted: 04/05/2018] [Indexed: 01/16/2023]
Abstract
BACKGROUND While randomized controlled trials (RCTs) inform the efficacy and effectiveness of treatments, we need to understand that even RCTs can be associated with sub-optimal execution. This is of special pertinence to eating disorders given the majority of treatment studies involving cognitive behaviour therapy are of poor quality with respect to managing risk of bias adequately. METHODS The current paper outlines the components of a good RCT for psychotherapy, and examines ways to improve the conduct, interpretation, and usefulness of RCTs. RESULTS This includes managing reporting bias, recognizing the limits of randomization, applicability, and ethical considerations. CONCLUSIONS We highlight a number of strategies for future research, including issues related to utilizing a variety of designs to examine treatment outcomes, integrity, openness and reproducibility.
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Affiliation(s)
- Tracey D Wade
- School of Psychology, Flinders University, South Australia, Australia
| | - Catherine Johnson
- School of Psychology, Flinders University, South Australia, Australia
| | - Susan M Byrne
- School of Psychology, University of Western Australia, Western Australia, Australia
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Brown TA, Cusack A, Anderson LK, Trim J, Nakamura T, Trunko ME, Kaye WH. Efficacy of a partial hospital programme for adults with eating disorders. EUROPEAN EATING DISORDERS REVIEW 2018. [DOI: 10.1002/erv.2589] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Tiffany A. Brown
- Department of Psychiatry; University of California San Diego; San Diego CA USA
| | - Anne Cusack
- Department of Psychiatry; University of California San Diego; San Diego CA USA
| | - Leslie K. Anderson
- Department of Psychiatry; University of California San Diego; San Diego CA USA
| | - Julie Trim
- Department of Psychiatry; University of California San Diego; San Diego CA USA
| | - Tiffany Nakamura
- Department of Psychiatry; University of California San Diego; San Diego CA USA
| | - Mary Ellen Trunko
- Department of Psychiatry; University of California San Diego; San Diego CA USA
| | - Walter H. Kaye
- Department of Psychiatry; University of California San Diego; San Diego CA USA
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Caldwell K, Fields S, Lench HC, Lazerus T. Prompts to regulate emotions improve the impact of health messages on eating intentions and behavior. MOTIVATION AND EMOTION 2018. [DOI: 10.1007/s11031-018-9666-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Linardon J, Fairburn CG, Fitzsimmons-Craft EE, Wilfley DE, Brennan L. The empirical status of the third-wave behaviour therapies for the treatment of eating disorders: A systematic review. Clin Psychol Rev 2017; 58:125-140. [DOI: 10.1016/j.cpr.2017.10.005] [Citation(s) in RCA: 124] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 10/16/2017] [Accepted: 10/20/2017] [Indexed: 11/17/2022]
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