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Chester MA, Viranda T, Kaye WH, Berner LA. Evaluating the predictions of an interoceptive inference model of bulimia nervosa. J Eat Disord 2024; 12:57. [PMID: 38741168 DOI: 10.1186/s40337-024-01010-2] [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: 01/17/2024] [Accepted: 04/23/2024] [Indexed: 05/16/2024] Open
Abstract
OBJECTIVE Bulimia nervosa (BN) is associated with loss-of-control (LOC) eating episodes that frequently occur in response to negative emotions. According to recent neurocomputational models, this link could be explained by a failure to accurately update beliefs about the body in states of high arousal. Specifically, these interoceptive inference models suggest that under-relying on signals from one's body about sensory experience ("low sensory precision") and/or over-relying on previously held beliefs ("excessively precise priors") lead to inaccurate perception and maladaptive behaviors. We conducted an initial test of these core predictions of the interoceptive inference model in BN using self-report measures. METHODS We compared women with BN (n = 30) and age-, BMI-, and full-scale IQ-matched controls (n = 31) on trust in sensory information from the body and two types of beliefs about what can be done to regulate high negative affect. Within the BN group, we tested interrelations among these measures and explored their associations with LOC eating frequency. RESULTS Compared with healthy controls, the BN group reported lower levels of trust in sensory information and stronger beliefs that once upset, there is little one can do, apart from eating, to self-regulate. These beliefs were associated with each other and with lower body trust. Beliefs about the uncontrollability of emotion were associated with more frequent subjective binge-eating episodes. CONCLUSIONS Findings provide initial support for the core predictions of an interoceptive inference account of BN: low trust in sensory information ("sensory precision") may promote an overreliance on maladaptive "prior beliefs" about the effects of eating on negative emotions, ultimately interfering with accurate updating of beliefs about other strategies that could regulate emotions and maintain LOC eating. Low body trust, strong expectations about emotions, and their neurocomputational underpinnings could be promising combined treatment targets for BN.
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Affiliation(s)
- Maia A Chester
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Thalia Viranda
- Department of Information Science, Cornell Tech, New York, NY, USA
| | - Walter H Kaye
- Department of Psychiatry, University of California, San Diego, San Diego, CA, USA
| | - Laura A Berner
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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Labarta AC, Colvin KF, Emelianchik-Key K, Gill CS. Examining transdiagnostic factors among religious and spiritual individuals with comorbid eating disorders and post-traumatic stress disorders. Eat Disord 2024:1-17. [PMID: 38739157 DOI: 10.1080/10640266.2024.2352991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/14/2024]
Abstract
Eating disorders (EDs) have a harmful impact on the lives of millions of individuals in the United States. Research indicates that comorbid trauma could negatively impact treatment outcomes, reinforcing ED symptomology. Transdiagnostic approaches underscore experiential avoidance as a maintaining factor for EDs and other comorbid concerns, while mindfulness and adaptive coping help disrupt avoidance of emotional experiences. In addition to treatment approaches, clinicians must consider cultural identity factors, such as religion and spirituality (R/S), to engage in culturally responsive treatment. In the present study, we examined transdiagnostic factors in a clinical sample of 1153 individuals with comorbid EDs and post-traumatic stress disorder (99.6% of the sample), specifically considering differences between those who identified as religious, spiritual, or neither. Using a one-way analysis of variance, we found statistically significant differences in ED symptomology and adaptive coping scores across groups. Conversely, we found no statistically significant differences in mindfulness and experiential avoidance scores across groups. Despite the small effect sizes, these preliminary findings add to the existing body of research on R/S using a transdiagnostic framework, supporting the integration of spirituality into ED treatment to promote adaptive coping. Future research is needed to address the study's limitations, such as exploring adaptive coping styles that may further explain these relationships.
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Affiliation(s)
- Adriana C Labarta
- Department of Counselor Education, Florida Atlantic University, Boca Raton, USA
| | - Kimberly F Colvin
- Department of Educational & Counseling Psychology, University of Albany at SUNY, New York, USA
| | | | - Carman S Gill
- Department of Counselor Education, Florida Atlantic University, Boca Raton, USA
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Penwell TE, Smith M, Ortiz SN, Brooks G, Thompson-Brenner H. Traditional versus virtual partial hospital programme for eating disorders: Feasibility and preliminary comparison of effects. EUROPEAN EATING DISORDERS REVIEW 2024; 32:163-178. [PMID: 37677002 DOI: 10.1002/erv.3031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 08/07/2023] [Accepted: 08/21/2023] [Indexed: 09/09/2023]
Abstract
OBJECTIVE Minimal research has examined teletherapy for group or intensive eating disorder (ED) treatment, particularly partial hospital programme (PHP). This study compared treatment outcomes for individuals treated before and after a pandemic-driven implementation of virtual PHP. METHOD Patients received care at ED treatment centres using the Renfrew Unified Treatment for Eating Disorders and Comorbidity. Patients treated with virtual PHP were compared to patients treated with traditional PHP. Measures of ED symptomology and behaviours, depressive symptoms, anxiety severity, anxiety sensitivity, experiential avoidance, mindfulness, and body mass index (BMI; reported for anorexia nervosa [AN] patients only) were collected at intake and discharge. Multiple regression analyses were conducted to examine the effect of treatment group on outcomes, controlling for intake score, comorbidity, discharge status, AN diagnosis, and step-down status. RESULTS Differences in treatment type were only found for binge eating frequency, with those in virtual PHP reporting significantly lower binge eating episodes at discharge than those in traditional PHP. Body mass index showed significantly less improvement in virtual PHP than in traditional PHP. CONCLUSIONS Preliminary results suggest virtual PHP is feasible and effective, potentially increasing access to evidence-based, intensive ED treatment. However, additional research is needed to establish efficacious support for weight gain among individuals with AN in virtual programs.
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Affiliation(s)
| | | | - Shelby N Ortiz
- Department of Psychology, Miami University, Oxford, OH, USA
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Dikmeer N, Ersöz Alan B, Foto Özdemir D. The role of mindfulness on the psychological aspects of anorexia nervosa. Clin Child Psychol Psychiatry 2024; 29:15-29. [PMID: 37667411 PMCID: PMC10748460 DOI: 10.1177/13591045231190675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/06/2023]
Abstract
OBJECTIVE Emotion regulation, perfectionism, and rumination are perpetuating factors in anorexia nervosa (AN). Mindfulness can be protective and therapeutic. We aimed to understand the relationship between these factors and mindfulness in AN. METHODS 20 adolescent girls in the acute phase of the AN, 16 in remission, and 40 in the control group were evaluated. RESULTS Mindfulness was lowest in the acute AN group. The difference in the acute AN group regarding body dissatisfaction, emotion dysregulation, perfectionism, and mindfulness disappeared after controlling for the effects of depression and anxiety. The predictors of disordered eating in the entire study population were body dissatisfaction and depressive symptoms. Emotion regulation and perfectionism were the predictors of mindfulness in the acute AN group and the entire study population. When mindfulness decreased, concerns about body shape increased in both acute AN and remission groups, while dietary restriction and disordered eating behaviors increased only in the remission group. DISCUSSION Emotion regulation difficulties in acute AN could be related to depression and anxiety. Mindfulness interventions for emotion regulation could be used for depression during the acute phase while for perfectionism in remission. Early intervention for depression and body dissatisfaction seems protective, and mindfulness could be an appropriate intervention.
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Affiliation(s)
| | - Burcu Ersöz Alan
- Department of Child and Adolescent Psychiatry, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Dilşad Foto Özdemir
- Department of Child and Adolescent Psychiatry, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Chen DR, Lin LY, Hsiao SC. Role of peer support on the cycle of weight teasing, psychological distress and disordered eating in Taiwanese adolescents: A moderated mediation analysis. Eat Behav 2023; 51:101815. [PMID: 37748247 DOI: 10.1016/j.eatbeh.2023.101815] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 09/09/2023] [Accepted: 09/11/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND Several studies have reported the beneficial role of social support on adolescent health. However, few studies have explored the role of peer support on the cycle of weight teasing, psychological distress, and disordered eating. METHODS A total of 689 adolescents aged between 13 and 16 years recruited from 37 classes in three middle schools in New Taipei City from March to June 2019 were included for analysis. Path analysis was performed using Hayes' PROCESS module. RESULTS The study found that weight teasing is directly and indirectly associated with disordered eating through psychological distress. Peer support plays a role in moderating the relationship between weight teasing and psychological distress; however, it is not significantly associated with decreased risk of disordered eating among adolescents experiencing weight teasing. CONCLUSION While peer support can be used against the adverse effects of weight teasing, it is not the absolute solution, and additional interventions are warranted.
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Affiliation(s)
- Duan-Rung Chen
- Institute of Health Behaviors and Community Sciences, College of Public Health, National Taiwan University, Room 636, No. 17, Xu-Zhou Rd., Taipei 10055, Taiwan; Population Health Research Center, National Taiwan University, No. 17, Xu-Zhou Rd., Taipei 10055, Taiwan.
| | - Li-Yin Lin
- Department of Leisure Industry and Health Promotion, National Taipei University of Nursing and Health Sciences, 365 MingDe Road, Beitou District, Taipei 11219, Taiwan
| | - Shu-Chen Hsiao
- Institute of Health Behaviors and Community Sciences, College of Public Health, National Taiwan University, Room 636, No. 17, Xu-Zhou Rd., Taipei 10055, Taiwan
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de Boer K, Johnson C, Wade TD, Radunz M, Fernando AN, Babb J, Stafrace S, Sharp G. A systematic review and meta-analysis of intensive treatment options for adults with eating disorders. Clin Psychol Rev 2023; 106:102354. [PMID: 37926059 DOI: 10.1016/j.cpr.2023.102354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/22/2023] [Accepted: 10/25/2023] [Indexed: 11/07/2023]
Abstract
Eating disorders (EDs) are complex conditions with one of the highest mortality rates among psychiatric illnesses. While outpatient evidence-based treatments for EDs in adults exist, there is often utilisation of more intensive interventions as part of treatment. However, a comprehensive analysis of the impacts of intensive treatment (inpatient, residential and day program) on physical and psychosocial outcomes is lacking. Thus, the current systematic review and meta-analysis aimed to investigate the effectiveness of intensive treatments in adults with EDs for the outcomes of body mass index (BMI), disordered eating, depression, and quality of life, as well as a moderation analysis investigating a range of clinical characteristics. Overall, 62 studies were included in the meta-analysis. The results revealed that intensive treatment in adults yielded significant improvements in BMI (for underweight patients), disordered eating, depression, and quality of life. Treatment setting, length of stay and geographical region of the study all served as moderators for disordered eating and depression. Nevertheless, given the high heterogeneity in the meta- and moderation analyses, these results should be interpreted with caution. Future high-quality research is needed to determine the most beneficial elements of intensive treatment (compared to outpatient) in adults with EDs.
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Affiliation(s)
- Kathleen de Boer
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
| | - Catherine Johnson
- Flinders University, Blackbird Initiative, Flinders University Institute for Mental Health and Wellbeing, Adelaide, South Australia, Australia
| | - Tracey D Wade
- Flinders University, Blackbird Initiative, Flinders University Institute for Mental Health and Wellbeing, Adelaide, South Australia, Australia
| | - Marcela Radunz
- Flinders University, Blackbird Initiative, Flinders University Institute for Mental Health and Wellbeing, Adelaide, South Australia, Australia
| | | | - Jennifer Babb
- Alfred Mental and Addiction Health, Alfred Health, Melbourne, Victoria, Australia
| | - Simon Stafrace
- Alfred Mental and Addiction Health, Alfred Health, Melbourne, Victoria, Australia
| | - Gemma Sharp
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia; Alfred Mental and Addiction Health, Alfred Health, Melbourne, Victoria, Australia.
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Tomba E, Tecuta L. The sequential approach in eating disorders: A scoping systematic review. EUROPEAN EATING DISORDERS REVIEW 2023; 31:874-893. [PMID: 37469129 DOI: 10.1002/erv.3013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 07/07/2023] [Accepted: 07/09/2023] [Indexed: 07/21/2023]
Abstract
OBJECTIVE The sequential model has been defined as an intensive, two-stage approach that comprises administering two types of treatment consecutively to improve treatment outcomes in cases of non-optimal or absence of treatment response. A psychiatric population that would potentially benefit from the application of the sequential model is the eating disorders (EDs) population. The current scoping review aimed to explore the emerging literature on the application of sequential treatments in EDs. METHOD Using PRISMA and Population intervention comparison outcomes study guidelines, Pubmed and PsycINFO were systematically searched for studies which applied temporally sequential treatments in patients diagnosed with EDs from inception to April 2022 using a combination of keywords. Studies utilising combined or integrated approaches were excluded. RESULTS A total of 12 studies were selected and reviewed. Studies included Bulimia Nervosa, Binge Eating Disorder (BED), or mixed ED samples with a majority of female patients. No studies on AN samples were identified. The majority of studies contained a Cognitive-Behavioural Therapy module of treatment, were conducted on BED patients, were in outpatient settings, and included a group format in one or more treatment conditions. Studies varied in number of comparison groups and study design. Secondary and sequentially applied treatment modules were consistent with treatment recommendations of clinical guidelines. CONCLUSIONS The available data on sequential treatments in EDs is scarce and exhibits methodological limitations that should be addressed in future studies. Definition of sequential treatments in EDs should be further developed to guide robust clinical research and improve empirical support of sequential treatment for complex ED cases and for non-optimal ED treatment response.
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Affiliation(s)
- Elena Tomba
- Department of Psychology, University of Bologna, Bologna, Italy
| | - Lucia Tecuta
- Department of Psychology, University of Bologna, Bologna, Italy
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Smith IS, Bind MA, Weihs KL, Bei B, Wiley JF. Targeting emotional regulation using an Internet-delivered psychological intervention for cancer survivors: A randomized controlled trial. Br J Health Psychol 2023; 28:1185-1205. [PMID: 37437963 PMCID: PMC10710879 DOI: 10.1111/bjhp.12679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 06/09/2023] [Accepted: 06/22/2023] [Indexed: 07/14/2023]
Abstract
OBJECTIVES This trial assessed the efficacy of an emotion-focused, modular, Internet-delivered adaptation of the Unified Protocol (UP) in improving cancer survivors' emotion regulation strategies. DESIGN A two-arm randomized controlled trial (1:1) was used to compare the efficacy of two Internet-based interventions: UP-adapted CanCope Mind (CM) and lifestyle-focused active control CanCope Lifestyle (CL). METHODS N = 224 cancer survivors randomized to CM or CL were assessed at baseline, between-modules, at post-intervention and 3-month follow-up on emotion regulation outcomes targeted by each CM module (Module 1: beliefs about emotions; Module 2: mindfulness; Module 3: cognitive reappraisal skills, catastrophizing, refocus on planning; Module 4: experiential avoidance). Primary analyses were intention-to-treat linear regressions using Fisher randomization tests for p-values and intervals were used to compare groups with standardized mean difference (SMD) effect sizes. RESULTS CanCope Mind participants (n = 61 completers) experienced moderate-to-large improvements (SMDs from .44-.88) across all outcomes at post-intervention. CM's effects were larger than CL's (n = 75 completers) immediately post-intervention and at 3-month follow-up for beliefs about emotions, mindfulness, cognitive reappraisals and experiential avoidance (all p's < .05). CM experienced greater improvements in catastrophizing immediately post-intervention, with a trending effect at follow-up. However, we could not reject the null hypothesis of identical between-group effects for refocusing on planning both immediately post-intervention and at follow-up. Exploratory analyses revealed inconsistent between-module effects. CONCLUSIONS In its entirety, CM is a promising intervention for improving and maintaining cancer survivors' adaptive emotion regulation, especially for mindfulness and experiential avoidance. This may have important clinical implications for promoting cancer survivors' emotional functioning and general well-being.
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Affiliation(s)
- Isabelle S. Smith
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
| | - Marie-Abèle Bind
- Biostatistics Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Karen L. Weihs
- Department of Psychiatry, College of Medicine, University of Arizona, Tucson, Arizona, USA
- University of Arizona Cancer Center, Tucson, Arizona, USA
| | - Bei Bei
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
| | - Joshua F. Wiley
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
- Peter MacCallum Cancer Centre, Melbourne, Australia
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Zhang X, Bhatt RR, Todorov S, Gupta A. Brain-gut microbiome profile of neuroticism predicts food addiction in obesity: A transdiagnostic approach. Prog Neuropsychopharmacol Biol Psychiatry 2023; 125:110768. [PMID: 37061021 PMCID: PMC10731989 DOI: 10.1016/j.pnpbp.2023.110768] [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: 10/26/2022] [Revised: 03/29/2023] [Accepted: 04/09/2023] [Indexed: 04/17/2023]
Abstract
Neuroticism is one of the most robust risk factors for addictive behaviors including food addiction (a key contributor to obesity), although the associated mechanisms are not well understood. A transdiagnostic approach was used to identify the neuroticism-related neuropsychological and gut metabolomic patterns associated with food addiction. Predictive modeling of neuroticism was implemented using multimodal features (23 clinical, 13,531 resting-state functional connectivity (rsFC), 336 gut metabolites) in 114 high body mass index (BMI ≥25 kg/m2) (cross-sectional) participants. Gradient boosting machine and logistic regression models were used to evaluate classification performance for food addiction. Neuroticism was significantly associated with food addiction (P < 0.001). Neuroticism-related features predicted food addiction with high performance (89% accuracy). Multimodal models performed better than single-modal models in predicting food addiction. Transdiagnostic alterations corresponded to rsFC involved in the emotion regulation, reward, and cognitive control and self-monitoring networks, and the metabolite 3-(4-hydroxyphenyl) propionate, as well as anxiety symptoms. Neuroticism moderated the relationship between BMI and food addiction. Neuroticism drives neuropsychological and gut microbial signatures implicated in dopamine synthesis and inflammation, anxiety, and food addiction. Such transdiagnostic models are essential in identifying mechanisms underlying food addiction in obesity, as it can help develop multiprong interventions to improve symptoms.
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Affiliation(s)
- Xiaobei Zhang
- G. Oppenheimer Center for Neurobiology of Stress & Resilience, at UCLA, United States of America; UCLA Vatche and Tamar Manoukian Division of Digestive Diseases, United States of America; David Geffen School of Medicine at UCLA, United States of America; University of California, Los Angeles, United States of America
| | - Ravi R Bhatt
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, University of Southern California, United States of America
| | - Svetoslav Todorov
- G. Oppenheimer Center for Neurobiology of Stress & Resilience, at UCLA, United States of America
| | - Arpana Gupta
- G. Oppenheimer Center for Neurobiology of Stress & Resilience, at UCLA, United States of America; UCLA Vatche and Tamar Manoukian Division of Digestive Diseases, United States of America; David Geffen School of Medicine at UCLA, United States of America; Goodman-Luskin Microbiome Center at UCLA, United States of America; University of California, Los Angeles, United States of America.
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Harris BA, Boswell JF, Hormes JM, Espel-Huynh H, Thompson-Brenner H. A baseline comparison of three diagnostic groups using the Progress Monitoring Tool for Eating Disorders. EUROPEAN EATING DISORDERS REVIEW 2023. [PMID: 37209255 DOI: 10.1002/erv.2992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 05/09/2023] [Accepted: 05/13/2023] [Indexed: 05/22/2023]
Abstract
Utilisation of intensive inpatient treatment for eating disorders (EDs) has climbed in the last decade, illuminating a need for better consensus on what constitutes effective treatment and context-appropriate progress/outcome monitoring during residential stays. The novel Progress Monitoring Tool for Eating Disorders (PMED) measure is specifically designed for inpatient settings. Previous research supports the factorial validity and internal consistency of the PMED; however, additional work is needed to determine its appropriateness for complex patient populations. This study used measurement invariance (MI) testing to determine if the PMED administered at programme admission measures the same items in similar ways across patients with anorexia nervosa restricting- and binge-purge subtypes (AN-R; AN-BP) and bulimia nervosa (BN, N = 1121; Mage = 24.33 years, SD = 10.20; 100% female). Progressively constrained models were used to determine the level of invariance upheld between the three groups. Results indicated that, while the PMED meets configural and metric MI, it does not display scalar invariance. Said otherwise, the PMED similarly assesses constructs and items across AN-R, AN-BP, and BN, however the same score overall may reflect different levels of psychopathology for patients in one diagnostic category versus another. Comparisons of severity between different EDs should be made with caution, however the PMED appears to be a sound tool for understanding the baseline functioning of patients with EDs in an inpatient setting.
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Affiliation(s)
- Bethany A Harris
- Department of Psychology, University at Albany, SUNY, Albany, New York, USA
| | - James F Boswell
- Department of Psychology, University at Albany, SUNY, Albany, New York, USA
| | - Julia M Hormes
- Department of Psychology, University at Albany, SUNY, Albany, New York, USA
| | - Hallie Espel-Huynh
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, Rhode Island, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island, USA
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Henrich D, Glombiewski JA, Scholten S. Systematic review of training in cognitive-behavioral therapy: Summarizing effects, costs and techniques. Clin Psychol Rev 2023; 101:102266. [PMID: 36963208 DOI: 10.1016/j.cpr.2023.102266] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 02/09/2023] [Accepted: 02/28/2023] [Indexed: 03/06/2023]
Abstract
With the steadily growing importance of psychotherapeutic care, there is also an increasing need for high-quality training. We analyze the literature published between 2009 and 2022 on the effectiveness of training in cognitive behavioral therapy. The review addresses current gaps in the literature by focusing on the description of specific training components and their associated costs, as well as examining therapist-level predictors of training effectiveness. Our findings confirm the effect of additional supervision on both therapist competence and patient outcomes. Instructor-led training and self-guided web-based training seem to moderately increase competence, especially when targeting specific and highly structured treatments or skills. The level of prior training and experience of a therapist appears to predict the strength of training-related gains in competence. Few studies analyzed the differential effect of certain elements of training (e.g., the amount of active learning strategies) and training costs were generally not reported. Future studies should replicate or expand the existing evidence on active ingredients and therapist-level predictors of training effectiveness. Costs should be systematically reported to enhance the comparability of different training strategies.
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Affiliation(s)
- Dominik Henrich
- Department of Clinical Psychology and Psychotherapy, RPTU Kaiserslautern-Landau, Germany.
| | - Julia A Glombiewski
- Department of Clinical Psychology and Psychotherapy, RPTU Kaiserslautern-Landau, Germany
| | - Saskia Scholten
- Department of Clinical Psychology and Psychotherapy, RPTU Kaiserslautern-Landau, Germany
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Labarta AC, Emelianchik-Key K. Exploring the Relationships Between Transdiagnostic Factors and Eating Disorder Symptomology in a Clinical Sample of Lesbian, Gay, Bisexual, Questioning, Queer, Asexual, and Pansexual Clients. JOURNAL OF LGBTQ ISSUES IN COUNSELING 2022. [DOI: 10.1080/26924951.2022.2057391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Adriana C. Labarta
- Department of Counselor Education, Florida Atlantic University, Boca Raton, FL, USA
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Scheer JR, Helminen EC, Felver JC, Coolhart D. Nonmedical Social Determinants, Syndemic Conditions, and Suicidal Thoughts and Behaviors in a Treatment-seeking Community Sample: A Latent Class Analysis. Arch Suicide Res 2022:1-20. [PMID: 35946421 PMCID: PMC9911562 DOI: 10.1080/13811118.2022.2108741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
OBJECTIVE Knowledge gaps remain regarding whether syndemic conditions identify treatment-seeking individuals most at risk for suicidal thoughts and behaviors (STB). We employed latent class analysis to: (1) model treatment-seeking individuals' syndemic conditions, (2) examine latent classes across nonmedical social determinants, and (3) assess associations between class membership and STB. METHOD Participants were 982 individuals presenting at a community mental health clinic between October 2014 and February 2020. The three-step latent class analytic approach was used. Regression analyses were employed to examine nonmedical social determinants and STB outcomes associated with class membership. RESULTS Participants were aged 18 to >72 (75.8% White; 76.7% heterosexual; 53.7% cisgender woman; 73.8% earned ≥$20,000 annually). Latent class analysis resulted in a three-class solution. Participants in Class 1 were characterized by low probabilities across syndemic conditions. Class 2 was characterized by high probabilities of anxiety and depression. Class 3 was characterized by high probabilities of eating disorders, anxiety, and depression. Participants of color, sexual minority participants, cisgender women, and those experiencing financial distress were more likely to be in classes characterized by syndemic conditions. Classes characterized by syndemic conditions, relative to no syndemic conditions, were associated with greater risk of STB. CONCLUSION Findings confirm the concentrated clustering of co-occurring syndemic conditions among marginalized groups and highlight differing risks for those considering suicide or who have attempted suicide vs. those engaging in self-harm. Results underscore the need for resource allocation and multilevel interventions targeting syndemic conditions and suicidality for minority populations and those experiencing financial distress.
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A model of self-criticism as a transdiagnostic mechanism of eating disorder comorbidity: A review. NEW IDEAS IN PSYCHOLOGY 2022. [DOI: 10.1016/j.newideapsych.2022.100949] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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15
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Family-Empowered Treatment in Higher Levels of Care for Adolescent Eating Disorders: The Role of the Dietitian. J Acad Nutr Diet 2022; 122:1825-1832. [PMID: 35738535 DOI: 10.1016/j.jand.2022.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 05/27/2022] [Accepted: 06/14/2022] [Indexed: 11/21/2022]
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Sánchez CG, Ferrer SD, Cuellar JAA, Martín JLM, Ruiz SR. I Look at my whole body and i feel better: attentional bias, emotional and psychophysiological response by pure exposure treatment in women with obesity. Psychother Res 2022; 32:748-762. [PMID: 34983319 DOI: 10.1080/10503307.2021.2021310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Obesity is one of the most important health problems nowadays. In addition to the direct physical consequences, it is also a risk factor in the development of psychological (Eating disorders, body dissatisfaction, depression, anxiety, etc.) and social problems. Among there, body dissatisfaction is key for development and maintenance of such problems. OBJECTIVE to deepen the effectiveness of the body exposure treatment, both in its pure form and guided modality in subjective, psychological and attentional levels in people with body dissatisfaction and obesity. METHODS Evaluations were carried out in a total of 16 women with obesity and body dissatisfaction at the beginning and end of 6 treatment sessions of pure exposure in front of the mirror. The changes experienced at the subjective level (questionnaires and subjective discomfort during the sessions) and psychophysiological (eye-tracking and heart rate) were analyzed. RESULTS Pure exposure treatment reduces negative thoughts and emotions towards the body itself, as well as the experienced discomfort towards the most conflictive parts. Selective attention to those parts of the body classified as uglier by the participants (especially the rear view of the body) show a decrease in physiological reactivity. CONCLUSIONS Pure exposure treatment seems to be effective in reducing subjective and psychological symptoms associated with body dissatisfaction in people with obesity, this technique could be considered a good choice for the treatment of body dissatisfaction. This step is essential to guarantee the long-term therapeutic success of any other treatment (nutritional or/and physical activity) in the future.
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Affiliation(s)
- Cristina González Sánchez
- Faculty of Psychology, Department of Personality, Evaluation and Psychological Treatment, University of Granada, Granada, Spain
| | - Sandra Díaz Ferrer
- Faculty of Psychology, Department of Personality, Evaluation and Psychological Treatment, University of Granada, Granada, Spain
| | | | - José Luis Mata Martín
- Faculty of Psychology, Department of Personality, Evaluation and Psychological Treatment, University of Granada, Granada, Spain
| | - Sonia Rodríguez Ruiz
- Faculty of Psychology, Department of Personality, Evaluation and Psychological Treatment, University of Granada, Granada, Spain
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17
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Cascino G, Marciello F, Abbate-Daga G, Balestrieri M, Bertelli S, Carpiniello B, Corrivetti G, Favaro A, Renna C, Ricca V, Salvo P, Segura-Garcia C, Todisco P, Volpe U, Zeppegno P, Monteleone P, Monteleone AM. How Is the History of Early Traumatic Exposure Associated With the Psychopathological Outcomes of COVID-19 Related Lockdown and Subsequent Re-opening in People With Eating Disorders? Front Psychiatry 2021; 12:789344. [PMID: 34955933 PMCID: PMC8692284 DOI: 10.3389/fpsyt.2021.789344] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 11/15/2021] [Indexed: 12/14/2022] Open
Abstract
The negative impact of COVID-19 pandemic on people with Eating Disorders (EDs) has been documented. The aim of this study was to evaluate whether a history of traumatic experiences during childhood or adolescence was associated with a higher degree of psychopathological worsening during COVID-19 related lockdown and in the following re-opening period in this group of people. People with EDs undergoing a specialist ED treatment in different Italian services before the spreading of COVID-19 pandemic (n = 312) filled in an online survey to retrospectively evaluate ED specific and general psychopathology changes after COVID-19 quarantine. Based on the presence of self-reported traumatic experiences, the participants were split into three groups: patients with EDs and no traumatic experiences, patients with EDs and childhood traumatic experiences, patients with EDs and adolescent traumatic experiences. Both people with or without early traumatic experiences reported retrospectively a worsening of general and ED-specific psychopathology during the COVID 19-induced lockdown and in the following re-opening period. Compared to ED participants without early traumatic experiences, those with a self-reported history of early traumatic experiences reported heightened anxious and post-traumatic stress symptoms, ineffectiveness, body dissatisfaction, and purging behaviors. These differences were seen before COVID-19 related restrictions as well as during the lockdown period and after the easing of COVID-19 related restrictions. In line with the "maltreated ecophenotype" theory, these results may suggest a clinical vulnerability of maltreated people with EDs leading to a greater severity in both general and ED-specific symptomatology experienced during the exposure to the COVID-19 pandemic.
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Affiliation(s)
- Giammarco Cascino
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, Salerno, Italy
| | - Francesca Marciello
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, Salerno, Italy
| | - Giovanni Abbate-Daga
- Department of Neuroscience, Eating Disorders Center for Treatment and Research, University of Turin, Turin, Italy
| | | | - Sara Bertelli
- Department of Mental Health, ASST Santi Paolo e Carlo, Milan, Italy
| | - Bernardo Carpiniello
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | | | - Angela Favaro
- Department of Neuroscience, University of Padova, Padua, Italy
| | - Caterina Renna
- Mental Health Department, Center for the Treatment and Research on Eating Disorders, ASL Lecce, Lecce, Italy
| | - Valdo Ricca
- Psychiatry Unit, Department of Neurological and Psychiatric Sciences, University of Florence, Florence, Italy
| | - Pierandrea Salvo
- Eating Disorders Centre Portogruaro, AULSS 4 Veneto Orientale, San Donà di Piave, Italy
| | - Cristina Segura-Garcia
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Patrizia Todisco
- Eating Disorders Unit, Casa di Cura “Villa Margherita”, Arcugnano, Italy
| | - Umberto Volpe
- Section of Clinical Psychiatry, Department of Clinical Neurosciences/DIMSC, Università Politecnica delle Marche, Ancona, Italy
| | - Patrizia Zeppegno
- Department of Translational Medicine, Psychiatry Institute, Università del Piemonte Orientale, Novara, Italy
| | - Palmiero Monteleone
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, Salerno, Italy
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18
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Peris-Baquero Ó, Osma J, Gil-LaCruz M, Martínez-García L. Acceptability of and intention to use the Unified Protocol delivered in group format in the Spanish Public Health System. J Eval Clin Pract 2021; 27:1299-1309. [PMID: 33565231 DOI: 10.1111/jep.13546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 01/14/2021] [Accepted: 01/17/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The high prevalence of emotional disorders leads to a high demand for mental care which results in high costs and long waiting lists in public mental health settings. The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) is a recent emotion-regulation-based intervention that can be a cost-effective solution in public mental health settings due its transdiagnostic approach and the possibility to apply it in group format. However, the acceptability by mental healthcare professionals (MHCPs) delivering the UP in group format has not been explored. METHODS Thirty-three MHCPs, grouped into MHCPs without previous experience and MHCPs with experience in delivering the UP, were asked about aspects of acceptability and intention to use. Quantitative analysis was carried out to explore MHCPs acceptability. Furthermore, qualitative opinion about UP were collected through a SWOT (strengths, weaknesses, opportunities, threats) analysis to explore MHCPs opinion of delivering the UP intervention in a group format, within the Spanish Public Mental Health System. RESULTS The results showed high scores in all acceptability dimensions and intention to use in the future. SWOT analysis showed strengths and opportunities focusing on its transdiagnostic nature and the cost-effective benefits of group treatment, and weaknesses and threats related to the limited material and human resources. CONCLUSIONS Findings indicate high acceptability of the UP by MHCPs working within the Spanish Public Mental Health System and also identified areas for improvements. In order to enhance the dissemination and implementation of the UP, it is essential to consider MHCPs' perceptions and to be open to their suggestions.
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Affiliation(s)
- Óscar Peris-Baquero
- Departamento de Psicología y Sociología, Facultad de Ciencias Sociales y Humanas, Universidad de Zaragoza, Teruel, Spain.,Instituto de Investigación Sanitaria de Aragón, Zaragoza, Spain
| | - Jorge Osma
- Departamento de Psicología y Sociología, Facultad de Ciencias Sociales y Humanas, Universidad de Zaragoza, Teruel, Spain.,Instituto de Investigación Sanitaria de Aragón, Zaragoza, Spain
| | - Marta Gil-LaCruz
- Departamento de Psicología y Sociología, Facultad de Ciencias de la Salud, Zaragoza, Spain
| | - Laura Martínez-García
- Departamento de Psicología y Sociología, Facultad de Ciencias Sociales y Humanas, Universidad de Zaragoza, Teruel, Spain.,Instituto de Investigación Sanitaria de Aragón, Zaragoza, Spain
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19
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Using shape and weight overvaluation to empirically differentiate severity of other specified feeding or eating disorder. J Affect Disord 2021; 295:446-452. [PMID: 34507225 DOI: 10.1016/j.jad.2021.08.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 07/18/2021] [Accepted: 08/21/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Although no severity specifiers are noted in the Diagnostic and Statistical Manual of Mental Disorders - 5 for other specified feeding or eating disorder (OSFED), shape/weight overvaluation is a proposed eating disorder (ED) severity specifier. We used structural equation modeling (SEM) Trees to empirically determine values of shape/weight overvaluation that differentiate OSFED severity. We additionally tested whether the SEM Tree-defined thresholds or a clinical cutoff for shape/weight overvaluation differentiated severity more meaningfully. METHODS Participants were 690 females with OSFED presenting to residential ED treatment. SEM Tree analyses specified an outcome model of OSFED severity and then recursively partitioning the outcome model into severity groups. The SEM Tree-defined and clinical cutoff severity groups were compared on clinical characteristics. RESULTS SEM Trees identified one split that occurred at value 5.12 on our shape/weight overvaluation items from the Eating Disorder Examination Questionnaire. The subgroup with higher overvaluation had significantly greater intensity of ED and depressive symptoms and longer lengths of stay. The subgroups created from the shape/weight overvaluation clinical-cut off value of 4 differed on the same clinical characteristics as the SEM Tree-derived groups, with the exception of laxative use frequency. Effect sizes were larger for the clinical cutoff as compared to the SEM Tree severity specification scheme. LIMITATIONS These cross-sectional data were used from a predominately white and female residential treatment sample; this likely skewed the subgroups and may limit generalizability. CONCLUSIONS Shape/weight overvaluation can meaningfully differentiate OSFED severity. The clinical cutoff slightly outperformed the empirically determined thresholds for shape/weight overvaluation.
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20
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Ehrenreich-May J, Halliday ER, Karlovich AR, Gruen RL, Pino AC, Tonarely NA. Brief Transdiagnostic Intervention for Parents With Emotional Disorder Symptoms During the COVID-19 Pandemic: A Case Example. COGNITIVE AND BEHAVIORAL PRACTICE 2021; 28:690-700. [PMID: 34629841 PMCID: PMC8488185 DOI: 10.1016/j.cbpra.2021.01.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 01/12/2021] [Indexed: 12/28/2022]
Abstract
Concerns regarding parent mental health and well-being during the COVID-19 pandemic are justifiably on the rise. Although anxiety, depression, and traumatic stress levels have risen precipitously across all demographics during the pandemic, parents residing with their children are under particular and unique strain. Caregivers with children in the home are responsible not only for their own health, financial security, and safety during this time, but often full-time caregiving, household management and, in many cases, their children's schooling. In this case paper, we describe the development of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders for Caregivers (UP-Caregiver) and provide a case example of its implementation. This 4-session indicated prevention for caregivers is a modification of existing versions of the Unified Protocols for adults and children, modified to maximize its responsiveness to issues faced by parents and caregivers living with youth (ages 6-13) during the current pandemic. UP-Caregiver was offered as part of a randomized, controlled trial via telehealth in a small group format to any parent with a child in the specified age range with mild or greater anxiety, depression or traumatic stress symptoms during an initial screening. The case example provided is of a White, Hispanic mother with a range of self-reported emotional disorder concerns at an initial assessment. Declines in anxiety, depression and traumatic stress symptoms were all noted, as well as improvements in parenting self-efficacy and distress tolerance 6-weeks after initiating UP-Caregiver. An ongoing randomized, controlled trial of UP-Caregiver will further evaluate the utility and feasibility of this approach to alleviate parental distress during COVID-19.
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21
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Meneguzzo P, Garolla A, Bonello E, Todisco P. Alexithymia, dissociation and emotional regulation in eating disorders: Evidence of improvement through specialized inpatient treatment. Clin Psychol Psychother 2021; 29:718-724. [PMID: 34432335 PMCID: PMC9291290 DOI: 10.1002/cpp.2665] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 08/18/2021] [Indexed: 02/05/2023]
Abstract
The research into emotional regulation in eating disorders (EDs) has shown specific impairments and maladaptive coping strategies in patients, and there is an increasing interest in the role of the emotional domain in the treatment outcome. This study aims to evaluate the effect of a specialized inpatient treatment characterized by both an intensive and comprehensive standardized multidisciplinary programme based on cognitive–behavioural therapy and a flexible and personalized component implemented by third‐wave interventions. A cohort of 67 female ED patients (anorexia nervosa = 28, bulimia nervosa = 28 and binge eating disorder = 11) underwent an evaluation of emotional regulation difficulties, alexithymia and dissociative symptomatology at admission to a specialized ED ward. The psychological modifications were subsequently re‐evaluated upon discharge, after an inpatients treatment of 60 days, examining specific changes in the specific psychopathology. A significant improvement after specialized ED treatment was shown in alexithymia, emotional regulation difficulties and dissociation symptoms, with higher effect sizes in patients with higher alexithymia scores. As regards the specific effect of the psychological improvement, changes into alexithymia scores have shown specific correlations with ED psychopathology (p < 0.010) and with difficulties in emotional regulation (p < 0.010) in patients with higher alexithymia levels at admission. Emotional regulation and dissociation should therefore be evaluated in ED patients and may be improved with specific therapeutic approaches, while alexithymia remains a clinical trait, even with a significant reduction.
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Affiliation(s)
- Paolo Meneguzzo
- Eating Disorders Unit, Casa di Cura "Villa Margherita", Arcugnano, Italy.,Department of Neuroscience, University of Padova, Padova, Italy
| | - Alice Garolla
- Eating Disorders Unit, Casa di Cura "Villa Margherita", Arcugnano, Italy
| | - Elisa Bonello
- Eating Disorders Unit, Casa di Cura "Villa Margherita", Arcugnano, Italy
| | - Patrizia Todisco
- Eating Disorders Unit, Casa di Cura "Villa Margherita", Arcugnano, Italy
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22
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Puttevils L, Vanderhasselt MA, Horczak P, Vervaet M. Differences in the use of emotion regulation strategies between anorexia and bulimia nervosa: A systematic review and meta-analysis. Compr Psychiatry 2021; 109:152262. [PMID: 34265598 DOI: 10.1016/j.comppsych.2021.152262] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 06/08/2021] [Accepted: 07/05/2021] [Indexed: 02/09/2023] Open
Abstract
OBJECTIVE Research has identified abnormal emotion regulation (ER) as an underlying mechanism in the onset and maintenance of eating disorders. Yet, it still remains unclear whether different forms of ER, adaptive and maladaptive strategies, are similar across categories of eating disorders. METHOD A systematic review and meta-analysis were carried out to look at ER differences between anorexia nervosa (AN) and bulimia nervosa (BN), two common eating disorder pathologies with different eating patterns. RESULTS 41 studies were included in the meta-analysis. The results revealed no differences in the use of maladaptive ER strategies between individuals with AN and BN, however patients with AN tend to use less adaptive ER strategies as compared to patients with BN. CONCLUSIONS Making less use of adaptive strategies in AN might be due to low body weight and high levels of alexithymia which define AN. In order to improve treatment outcome in individuals suffering from AN, these findings suggest to focus more on improving the use of adaptive ER strategies.
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Affiliation(s)
- Louise Puttevils
- Department of Head and Skin, Ghent University, Belgium; Ghent Experimental Psychiatry (GHEP) lab, Belgium.
| | - Marie-Anne Vanderhasselt
- Department of Head and Skin, Ghent University, Belgium; Ghent Experimental Psychiatry (GHEP) lab, Belgium; Department of Experimental-Clinical and Health Psychology, Ghent University, Belgium
| | - Paula Horczak
- Department of Head and Skin, Ghent University, Belgium; Ghent Experimental Psychiatry (GHEP) lab, Belgium
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23
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Espel-Huynh H, Zhang F, Thomas JG, Boswell JF, Thompson-Brenner H, Juarascio AS, Lowe MR. Prediction of eating disorder treatment response trajectories via machine learning does not improve performance versus a simpler regression approach. Int J Eat Disord 2021; 54:1250-1259. [PMID: 33811362 PMCID: PMC8273095 DOI: 10.1002/eat.23510] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 03/19/2021] [Accepted: 03/20/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Patterns of response to eating disorder (ED) treatment are heterogeneous. Advance knowledge of a patient's expected course may inform precision medicine for ED treatment. This study explored the feasibility of applying machine learning to generate personalized predictions of symptom trajectories among patients receiving treatment for EDs, and compared model performance to a simpler logistic regression prediction model. METHOD Participants were adolescent girls and adult women (N = 333) presenting for residential ED treatment. Self-report progress assessments were completed at admission, discharge, and weekly throughout treatment. Latent growth mixture modeling previously identified three latent treatment response trajectories (Rapid Response, Gradual Response, and Low-Symptom Static Response) and assigned a trajectory type to each patient. Machine learning models (support vector, k-nearest neighbors) and logistic regression were applied to these data to predict a patient's response trajectory using data from the first 2 weeks of treatment. RESULTS The best-performing machine learning model (evaluated via area under the receiver operating characteristics curve [AUC]) was the radial-kernel support vector machine (AUCRADIAL = 0.94). However, the more computationally-intensive machine learning models did not improve predictive power beyond that achieved by logistic regression (AUCLOGIT = 0.93). Logistic regression significantly improved upon chance prediction (MAUC[NULL] = 0.50, SD = .01; p <.001). DISCUSSION Prediction of ED treatment response trajectories is feasible and achieves excellent performance, however, machine learning added little benefit. We discuss the need to explore how advance knowledge of expected trajectories may be used to plan treatment and deliver individualized interventions to maximize treatment effects.
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Affiliation(s)
- Hallie Espel-Huynh
- Drexel University, Philadelphia, Pennsylvania
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, Rhode Island
- Alpert Medical School of Brown University, Providence, Rhode Island
| | | | - J. Graham Thomas
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, Rhode Island
- Alpert Medical School of Brown University, Providence, Rhode Island
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24
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Mitchell KS, Singh S, Hardin S, Thompson-Brenner H. The impact of comorbid posttraumatic stress disorder on eating disorder treatment outcomes: Investigating the unified treatment model. Int J Eat Disord 2021; 54:1260-1269. [PMID: 33876442 DOI: 10.1002/eat.23515] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 03/24/2021] [Accepted: 03/24/2021] [Indexed: 12/16/2022]
Abstract
PURPOSE Many women with eating disorders (EDs) have comorbid posttraumatic stress disorder (PTSD). However, there have been few studies on how comorbid PTSD may impact ED treatment outcomes. METHOD Participants were 2,809 patients from residential ED treatment facilities who were treated using the Unified Treatment Model (UTM). We investigated whether PTSD diagnosis at admission was associated with changes in Eating Disorder Examination-Questionnaire (EDE-Q) scores, binge eating, self-induced vomiting, and restriction, across three time points, as well as clinically significant improvement and treatment drop-out. RESULTS Using latent growth models, with time modeled as a second-order polynomial, we found that EDE-Q scores and behavioral symptoms decreased from admission to discharge, but increased from discharge to 6-month follow-up. PTSD diagnosis was associated with higher baseline EDE-Q scores and restriction, and lower binge-eating frequency. PTSD diagnosis was not associated with symptom change over time, treatment dropout, or clinically significant change. DISCUSSION Although PTSD diagnoses were associated with higher ED symptom levels at admission, PTSD was not associated with worse treatment outcomes, suggesting the UTM is a promising treatment for patients with and without PTSD. Future studies should investigate the impact of ED treatment on PTSD symptoms in order to determine the need for integrated treatments for these comorbid conditions.
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Affiliation(s)
- Karen S Mitchell
- Women's Health Sciences Division, National Center for PTSD at VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Simar Singh
- Department of Psychology, Drexel University, Philadelphia, Pennsylvania, USA
| | - Sabrina Hardin
- Women's Health Sciences Division, National Center for PTSD at VA Boston Healthcare System, Boston, Massachusetts, USA
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25
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Osma J, Peris-Baquero O, Suso-Ribera C, Farchione TJ, Barlow DH. Effectiveness of the Unified Protocol for transdiagnostic treatment of emotional disorders in group format in Spain: Results from a randomized controlled trial with 6-months follow-up. Psychother Res 2021; 32:329-342. [PMID: 34132170 DOI: 10.1080/10503307.2021.1939190] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND The present study aims to investigate the effectiveness of the Unified Protocol (UP), a transdiagnostic treatment of emotional disorders (EDs), when applied in a group format in the public mental health system in Spain. METHODS 488 participants with a primary diagnosis of ED were randomized to the UP group or to the treatment as usual (TAU; individual, disorder-specific cognitive behavioral therapy). Personality, depression and anxiety symptoms, affect, and quality of life were assessed at pre-treatment, 3 months after treatment onset (coinciding with the end of the UP treatment), and 6 and 9 months after treatment onset (follow-ups). The moderating effect of the treatment condition and the number of sessions received in the evolution of study outcomes was investigated with a linear mixed model analysis. RESULTS A significant improvement in outcomes occurred in both conditions, except for extraversion in the TAU. Improvements in depression, anxiety and quality of life were larger in the UP condition. After the treatment, improvements were maintained at follow-ups in all study outcomes. An interaction between Time*Condition*Sessions was found for depression. CONCLUSION The results add to the existing evidence on the effectiveness of the UP and may be important for implementation purposes in the Spanish or other similar public mental health systems. Trial registration number NCT03064477 (March 10, 2017).
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Affiliation(s)
- J Osma
- Universidad de Zaragoza, Zaragoza, Spain.,Instituto de Investigación Sanitaria de Aragón, Zaragoza, Spain
| | - O Peris-Baquero
- Universidad de Zaragoza, Zaragoza, Spain.,Instituto de Investigación Sanitaria de Aragón, Zaragoza, Spain
| | | | - T J Farchione
- Center for Anxiety and Related Disorders, Boston University (EEUU), Boston, MA, USA
| | - D H Barlow
- Center for Anxiety and Related Disorders, Boston University (EEUU), Boston, MA, USA
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26
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Grau Touriño A, Feixas G, Medina JC, Paz C, Evans C. Effectiveness of integrated treatment for eating disorders in Spain: protocol for a multicentre, naturalistic, observational study. BMJ Open 2021; 11:e043152. [PMID: 34006027 PMCID: PMC7942235 DOI: 10.1136/bmjopen-2020-043152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Eating disorders (EDs) are complex pathologies which require equally complex treatment strategies. These strategies should be multidisciplinary, personalised interventions, performed in appropriate settings along a healthcare continuum from inpatient to community care. Personalisation, and the complexity of levels of care and interventions make evaluation of treatments difficult. The present study aims to measure the effectiveness of a complex treatment programme for EDs which includes hospitalisation, day hospital and outpatient settings. Our purpose is to assess the complete therapeutic process of each patient through all these levels of care, capturing the multiplicity of trajectories that a programme of these characteristics involves. METHODS AND ANALYSIS This protocol describes a multicentre, naturalistic, observational study. All patients starting between November 2017 and October 2020 in a healthcare network for EDs in Spain are being invited to participate. The first phase of intensive change monitoring to November 2020 is followed by lower intensity follow-up until October 2025. In the first phase progress of all participants is assessed every 3 weeks using specific measures for ED and the Clinical Outcomes Routine Evaluation system, a family of instruments specifically designed to measure change in psychotherapy. In the second phase data collection will happen quarterly. Both cross-sectional and longitudinal analyses will be conducted, with a special focus on patterns and predictors of change studied through multilevel linear models. ETHICS AND DISSEMINATION The study has been approved by the Research Bioethics Committee of the University of Barcelona (no. IRB00003099) and the ethical committee of ITA Mental Health, the organisation to which all participating centres belong. Dissemination will be in papers for peer-reviewed research journals and to clinicians working with ED. TRIAL REGISTRATION NUMBER NCT04127214.
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Affiliation(s)
| | - Guillem Feixas
- Department of Clinical Psychology and Psychobiology, Section of Personality, Evaluation and Psychological Treatment, Psychology Faculty, Universitat de Barcelona, Barcelona, Spain
- The Institute of Neurosciences, Universitat de Barcelona, Barcelona, Spain
| | - Joan Carles Medina
- Department of Clinical Psychology and Psychobiology, Universitat de Barcelona, Barcelona, Spain
- Faculty of Psychology and Education Sciences, Universitat Oberta de Catalunya, Barcelona, Spain
| | - Clara Paz
- School of Psychology, Universidad de Las Americas, Quito, Ecuador
| | - Chris Evans
- Department of Psychology, The University of Sheffield, Sheffield, UK
- Department of Psychology, University of Roehampton, London, UK
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27
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Thompson-Brenner H, Singh S, Gardner T, Brooks GE, Smith MT, Lowe MR, Boswell JF. The Renfrew Unified Treatment for Eating Disorders and Comorbidity: Long-Term Effects of an Evidence-Based Practice Implementation in Residential Treatment. Front Psychiatry 2021; 12:641601. [PMID: 33746797 PMCID: PMC7973044 DOI: 10.3389/fpsyt.2021.641601] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 02/08/2021] [Indexed: 12/20/2022] Open
Abstract
Background: The Renfrew Unified Treatment for Eating Disorders and Comorbidity (UT) is a transdiagnostic, emotion-focused treatment adapted for use in residential group treatment. This study examined the effect of UT implementation across five years of treatment delivery. Methods: Data were collected by questionnaire at admission, discharge (DC), and 6-month follow-up (6MFU). Patient outcomes were measured by the Eating Disorder Examination-Questionnaire, Center for Epidemiologic Studies-Depression Scale, Brief Experiential Avoidance Questionnaire (BEAQ), Anxiety Sensitivity Index, and Southampton Mindfulness Scale. Data were analyzed for N = 345 patients treated with treatment-as-usual (TAU), and N = 2,763 treated with the UT in subsequent years. Results: Results from multilevel models demonstrated a significant interaction between implementation status (TAU vs. UT) and time, both linear and quadratic, for the depression, experiential avoidance, anxiety sensitivity, and mindfulness variables. Patients treated with the UT showed more improvement in these variables on average, as well as more rebound between DC and 6MFU. Results from multilevel models examining eating disorder outcome showed no significant difference between the TAU and UT for the full sample, but a significant three-way interaction indicated that the UT produced more improvement in the EDE-Q relative to the TAU particularly for patients who entered treatment with high levels of experiential avoidance (BEAQ score). Conclusion: This long-term study of a transdiagnostic, evidence-based treatment in residential care for eating disorders and comorbidity suggests implementation was associated with beneficial effects on depression and emotion function outcomes, as well as eating disorder severity for patients with high levels of baseline emotion regulation problems. These effects did not appear to diminish in the 5 years following initial implementation.
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Affiliation(s)
| | - Simar Singh
- Department of Psychology, Drexel University, Philadelphia, PA, United States
| | | | | | | | - Michael R. Lowe
- Department of Psychology, Drexel University, Philadelphia, PA, United States
| | - James F. Boswell
- Department of Psychology, University at Albany, Albany, NY, United States
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Ametaj AA, Wilner Tirpak J, Cassiello-Robbins C, Snow R, Rassaby MM, Beer K, Sauer-Zavala S. A Preliminary Investigation of Provider Attitudes Toward a Transdiagnostic Treatment: Outcomes from Training Workshops with the Unified Protocol. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 48:668-682. [PMID: 33538945 DOI: 10.1007/s10488-020-01101-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2020] [Indexed: 10/22/2022]
Abstract
Evidence-based psychological treatments (EBPTs) for common mental health conditions are efficacious but remain underutilized in clinical service settings. Novel transdiagnostic and modular approaches that treat several disorders simultaneously promise to address common barriers to the dissemination and implementation of traditional EBPTs. Despite the promise that transdiagnostic treatments hold, the claims that these interventions can be more easily disseminated and implemented have not been widely tested. The present study examined whether a transdiagnostic treatment, the Unified Protocol (UP), addresses some barriers to dissemination and implementation for clinicians. Exploratory aims of the current study were to examine the effects of a UP introductory training workshop on clinician attitudes and behaviors by: (1) evaluating UP knowledge and treatment delivery, (2) determining relationships between clinician characteristics and their knowledge acquisition, satisfaction with UP, and UP penetration, and (3) exploring clinicians' perceptions of the UP's characteristics utilizing mixed methods. Workshop participants showed a good understanding of UP treatment concepts following training, and over a third of survey respondents reported use of the intervention 6-months after training. Positive attitudes toward EBPTs and fewer years of clinical practice were associated with greater satisfaction with the UP. Clinicians held positive views of the UP's flexibility and relative advantage over standard EBPTs but held negative views toward the manual's design and packaging. Overall, our findings suggest that clinicians may view transdiagnostic treatments such as the UP favorably and may consider them appealing over standard EBPTs. However, barriers associated with traditional EBPTs may extend to transdiagnostic treatments like the UP.
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Affiliation(s)
- Amantia A Ametaj
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA. .,Department of Epidemiology, Harvard T. H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02215, USA.
| | | | - Clair Cassiello-Robbins
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA.,Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
| | - Rachel Snow
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Madeleine M Rassaby
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Kelsey Beer
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
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Scharff A, Ortiz SN, Forrest LN, Smith AR, Boswell JF. Post‐traumatic stress disorder as a moderator of transdiagnostic, residential eating disorder treatment outcome trajectory. J Clin Psychol 2021; 77:986-1003. [DOI: 10.1002/jclp.23106] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 11/09/2020] [Accepted: 12/24/2020] [Indexed: 12/15/2022]
Affiliation(s)
- Adela Scharff
- Department of Psychology University at Albany—State University of New York Albany New York USA
| | | | | | - April R. Smith
- Department of Psychology Miami University Oxford Ohio USA
| | - James F. Boswell
- Department of Psychology University at Albany—State University of New York Albany New York USA
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30
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Scharff A, Ortiz SN, Forrest LN, Smith AR. Comparing the clinical presentation of eating disorder patients with and without trauma history and/or comorbid PTSD. Eat Disord 2021; 29:88-102. [PMID: 31348724 DOI: 10.1080/10640266.2019.1642035] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This study examined whether clinical characteristics among patients presenting to residential eating disorder (ED) treatment differed according to patients' trauma history and current PTSD diagnostic status. Participants (699 girls and women) completed surveys at treatment onset. One-way analysis of covariance (ANCOVA) tests assessed cross-sectional differences between three groups of patients: those reporting no trauma history (No Trauma, n = 185), those with trauma history but without PTSD (Trauma, n = 263), and those with current PTSD (PTSD, n = 251). Relative to the No Trauma group, the combined Trauma and PTSD groups reported greater ED symptoms, anxiety and depressive symptoms, experiential avoidance, anxiety sensitivity, and lower mindfulness. The PTSD group reported greater ED, anxiety, and depressive symptoms, greater anxiety sensitivity, and lower mindfulness, relative to the Trauma group. In sum, ED patients with any history of trauma experienced more symptoms and other psychopathology relative to patients who did not report trauma history. Among patients reporting trauma, those with current PTSD experienced even greater symptom severity. Interventions focused on improving emotional functioning could be especially beneficial for ED patients with trauma histories.
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Affiliation(s)
- Adela Scharff
- Department of Psychology, University at Albany - State University of New York , Albany, USA
| | - Shelby N Ortiz
- Department of Psychology, Miami University , Oxford, OH, USA
| | | | - April R Smith
- Department of Psychology, Miami University , Oxford, OH, USA
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31
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Evaluating empirically valid and clinically meaningful change in intensive residential treatment for severe eating disorders at discharge and at a 6-month follow-up. Eat Weight Disord 2020; 25:1609-1620. [PMID: 31673985 DOI: 10.1007/s40519-019-00798-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 10/14/2019] [Indexed: 10/25/2022] Open
Abstract
PURPOSE The present study evaluated the statistical and clinical significance of symptomatic change at discharge and after 6 months of an intensive residential treatment for patients with eating disorders (ED), and explored the individual factors that may affect therapeutic outcomes. METHODS A sample of 118 female ED patients were assessed at intake and discharge on the following dimensions: BMI, ED-specific symptoms, depressive features, and overall symptomatic distress. A subsample of 59 patients filled out the same questionnaires at a 6-month follow-up after discharge. RESULTS Findings evidenced statistically significant changes in all outcome measures at both discharge and follow-up. Between 30.1 and 38.6% of patients at discharge and 35.2-54.2% at the 6-month follow-up showed clinically significant symptomatic change; additionally, 19.8-29.1% of patients at discharge and 22.9-38.3% at follow-up improved reliably. However, 34.9-39.8% remained unchanged and 2-4.8% worsened. At the 6-month follow-up, 21.3-25.9% showed no symptomatic change and 0-3.7% had deteriorated. Unchanged and deteriorated patients had an earlier age of ED onset and were more likely to suffer a comorbid personality pathology and to be following concurrent pharmacological treatment. CONCLUSIONS Results suggested that intensive and multimodal residential treatment may be effective for the majority of ED patients, and that therapeutic outcomes tend to improve over time. Prevention strategies should focus on early onset subjects and those with concurrent personality pathology. LEVEL OF EVIDENCE Level III, evidence obtained from a longitudinal cohort study.
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32
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Schaumberg K, Reilly EE, Gorrell S, Levinson CA, Farrell NR, Brown TA, Smith KM, Schaefer LM, Essayli JH, Haynos AF, Anderson LM. Conceptualizing eating disorder psychopathology using an anxiety disorders framework: Evidence and implications for exposure-based clinical research. Clin Psychol Rev 2020; 83:101952. [PMID: 33221621 DOI: 10.1016/j.cpr.2020.101952] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 11/09/2020] [Accepted: 11/09/2020] [Indexed: 12/13/2022]
Abstract
Eating disorders (EDs) and anxiety disorders (ADs) evidence shared risk and significant comorbidity. Recent advances in understanding of anxiety-based disorders may have direct application to research and treatment efforts for EDs. The current review presents an up-to-date, behavioral conceptualization of the overlap between anxiety-based disorders and EDs. We identify ways in which anxiety presents in EDs, consider differences between EDs and ADs relevant to treatment adaptions, discuss how exposure-based strategies may be adapted for use in ED treatment, and outline directions for future mechanistic, translational, and clinical ED research from this perspective. Important research directions include: simultaneous examination of the extent to which EDs are characterized by aberrant avoidance-, reward-, and/or habit-based neurobiological and behavioral processes; improvement in understanding of how nutritional status interacts with neurobiological characteristics of EDs; incorporation of a growing knowledge of biobehavioral signatures in ED treatment planning; development of more comprehensive exposure-based treatment approaches for EDs; testing whether certain exposure interventions for AD are appropriate for EDs; and improvement in clinician self-efficacy and ability to use exposure therapy for EDs.
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Affiliation(s)
| | | | - Sasha Gorrell
- University of California, San Francisco, United States of America
| | - Cheri A Levinson
- University of Louisville, Department of Psychological & Brain Sciences, United States of America
| | | | - Tiffany A Brown
- University of California, San Diego, United States of America
| | - Kathryn M Smith
- Sanford Health, United States of America; University of Southern California, United States of America
| | | | | | - Ann F Haynos
- University of Minnesota, United States of America
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33
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Espel-Huynh H, Zhang F, Boswell JF, Thomas JG, Thompson-Brenner H, Juarascio AS, Lowe MR. Latent trajectories of eating disorder treatment response among female patients in residential care. Int J Eat Disord 2020; 53:1647-1656. [PMID: 32864806 PMCID: PMC7722162 DOI: 10.1002/eat.23369] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 08/06/2020] [Accepted: 08/06/2020] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Eating disorder (ED) treatment outcomes are highly variable from beginning to end of treatment; however, little is known about differential trajectories during the course of treatment. This study sought to characterize heterogeneous patterns of ED treatment response during residential care. METHOD Participants were adolescent girls and adult women (N = 360) receiving residential ED treatment for anorexia nervosa, bulimia nervosa, binge-eating disorder, other specified feeding or eating disorder, unspecified feeding or eating disorder, or avoidant/restrictive food intake disorder. Self-report symptom assessments were completed at admission, discharge, and approximately weekly throughout the residential stay to assess curvilinear patterns of change. Latent growth mixture modeling was applied to identify subgroups of patients with similar treatment response trajectories. RESULTS Three latent groups emerged, including gradual response (58.3%; steady improvements from admission to discharge), rapid response (23.9%; steep early improvements that were maintained through discharge), and low-symptom static response (17.8%; nearly nonclinical self-reported symptoms at admission that remained static through discharge). Groups differed on important clinical characteristics, such as body mass index, endorsement of compensatory behaviors, severity of global ED psychopathology at admission, and degree of symptom improvement by end of treatment. DISCUSSION Patients follow heterogeneous response patterns in residential ED treatment, and these patterns are associated with differential treatment outcome. Future work should explore whether these trajectories are associated with differential outcomes at follow-up and whether tailoring clinical intervention to a patient's trajectory type can improve treatment response.
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Affiliation(s)
- Hallie Espel-Huynh
- Drexel University, Philadelphia, PA;,Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI;,Alpert Medical School of Brown University, Providence RI
| | | | | | - J. Graham Thomas
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI;,Alpert Medical School of Brown University, Providence RI
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34
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Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Children and Adolescents. ACTA ACUST UNITED AC 2020. [DOI: 10.1007/978-1-0716-0700-8_13] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
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35
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Brown TA, Vanzhula IA, Reilly EE, Levinson CA, Berner LA, Krueger A, Lavender JM, Kaye WH, Wierenga CE. Body mistrust bridges interoceptive awareness and eating disorder symptoms. JOURNAL OF ABNORMAL PSYCHOLOGY 2020; 129:445-456. [PMID: 32202809 DOI: 10.1037/abn0000516] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Interoceptive awareness (IA), or the awareness of internal body states, is known to be impaired in individuals with eating disorders (EDs); however, little is understood about how IA and ED symptoms are connected. Network analysis is a statistical approach useful for examining how symptoms interrelate and how comorbidities may be maintained. The present study used network analysis to (1) test central symptoms within an IA-ED network, (2) identify symptoms that may bridge the association between IA and ED symptoms, and (3) explore whether central and bridge symptoms predict ED remission at discharge from intensive treatment. A regularized partial correlation network was estimated in a sample of 428 adolescent (n = 187) and adult (n = 241) ED patients in a partial hospital program. IA was assessed using items from the Multidimensional Assessment of Interoceptive Awareness, and ED symptoms were assessed using items from the Eating Disorder Examination-Questionnaire. Central symptoms within the network were strong desire to lose weight, feeling guilty, and listening for information from the body about emotional state. The most central symptom bridging IA and ED symptoms was (not) feeling safe in one's body. Of the central symptoms, greater desire to lose weight predicted lower likelihood of remission at treatment discharge. Bridge symptoms did not significantly predict remission. Body mistrust may be a mechanism by which associations between IA and EDs are maintained. Findings suggest targeting central and bridge symptoms may be helpful to improve IA and ED symptoms. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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36
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Peckmezian T, Paxton SJ. A systematic review of outcomes following residential treatment for eating disorders. EUROPEAN EATING DISORDERS REVIEW 2020; 28:246-259. [PMID: 32196843 PMCID: PMC7216912 DOI: 10.1002/erv.2733] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 02/05/2020] [Accepted: 03/05/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Residential centres for the treatment of eating disorders are becoming increasingly common, yet data following residential care are scarce. We reviewed outcomes of residential treatment for eating disorders across all diagnoses, age groups and genders. A secondary goal was to identify treatment elements and patient characteristics that predicted a greater response to treatment. METHOD Peer-reviewed studies published in the last 20 years were identified through a systematic search of the electronic databases PubMed and Cochrane Library. RESULTS Nineteen open-label studies reporting changes between admission and discharge were included in this review. Most took an eclectic approach to treatment, integrating elements from several different techniques without a unifying theoretical framework. All studies reported improvements in most outcomes at discharge, including changes in eating disorders psychopathology, weight, depression, anxiety and quality of life. Eight studies reported outcomes at some interval after discharge, with largely positive outcomes. CONCLUSIONS While residential care was associated with consistently positive outcomes, the variability in program characteristics and poor quality of research designs prevent firm conclusions from being drawn about their efficacy. Future research should include controlled studies that evaluate specific theoretical approaches and program elements, include long-term follow-up, and compare residential care to other treatment settings.
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Affiliation(s)
| | - Susan J Paxton
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
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37
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Espel-Huynh H, Thompson-Brenner H, Boswell JF, Zhang F, Juarascio AS, Lowe MR. Development and validation of a progress monitoring tool tailored for use in intensive eating disorder treatment. EUROPEAN EATING DISORDERS REVIEW 2020; 28:223-236. [PMID: 31994259 PMCID: PMC7086406 DOI: 10.1002/erv.2718] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 12/16/2019] [Accepted: 12/23/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Despite calls for routine use of progress and outcome monitoring in private and intensive treatment centres for eating disorders (EDs), existing measures have limited relevance to these supervised treatment settings. This study sought to develop and validate the progress monitoring tool for eating disorders, a multidimensional measure for progress monitoring in the context of intensive ED treatment. METHOD Thirty-seven items were generated by a team of content experts, clinicians, and administrative staff from the target treatment setting. Adolescent and adult females (N = 531) seeking residential ED treatment completed the items at admission as part of the clinic's routine assessment battery; 83% were retained for repeat assessment at discharge. Exploratory factor analysis was conducted for preliminary measure development. RESULTS Results yielded a five-factor, 26-item structure explaining 50% of total variance. Final construct domains included weight and shape concern, ED behaviours and urges, emotion avoidance, adaptive coping, and relational connection. The measure demonstrated adequate internal consistency, sensitivity to change during treatment, and convergence with validated assessment measures. CONCLUSIONS Preliminary data support the progress monitoring tool for eating disorders as a novel and valid multidimensional measure of treatment-relevant constructs. This measure may have utility in measuring treatment progress for patients receiving intensive treatment for EDs.
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Affiliation(s)
| | | | | | | | | | - Michael R. Lowe
- Drexel University, Philadelphia, PA, USA
- The Renfrew Center, Philadelphia, PA, USA
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38
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Bermudez MB, Costanzi M, Macedo MJA, Tatton-Ramos T, Xavier ACM, Ferrão YA, Bentley KH, Manfro GG, Dreher CB. Improved quality of life and reduced depressive symptoms in medical students after a single-session intervention. ACTA ACUST UNITED AC 2019; 42:145-152. [PMID: 31859792 PMCID: PMC7115440 DOI: 10.1590/1516-4446-2019-0526] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 08/08/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Anxiety and depression are prevalent among medical students. Brazilian medical students have higher levels of depression and lower quality of life than their U.S. counterparts, and no preventive intervention exists for this risk group in Brazil. The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP), a cognitive-behavioral treatment protocol for neuroticism, was recently adapted into a single-session, preventive intervention. This study tested the impact of this protocol on psychiatric symptoms and quality of life in Brazilian medical students. METHODS In this open trial, the intervention protocol was translated and adapted to Brazilian Portuguese. Medical students over 18 years of age without psychotic symptoms, severe depressive episodes, or acute psychiatric risk were included, undergoing a psychiatric clinical interview (Mini-International Neuropsychiatric Interview [MINI]) and evaluation at baseline and at 7 and 30 days after a single-session UP that included experimental avoidance, quality of life, self-esteem, empathy, and anxiety symptom scales. A new evaluation was performed 90 days after the intervention. RESULTS Sixty-two students participated. Ninety days after the intervention, there were significant reductions in the number of students who met the criteria for social anxiety disorder (p = 0.013) or panic disorder (p = 0.001). There were also significant improvements in depressive symptoms (Beck Depression Inventory, p < 0.001) and quality of life (Quality of Life Enjoyment and Satisfaction Questionnaire, p < 0.001). CONCLUSION UP improved anxiety and depressive symptoms in medical students. The single-session group format could reduce costs and facilitate application. Future placebo-controlled studies are necessary to confirm these findings.
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Affiliation(s)
| | - Monise Costanzi
- Universidade Federal de Ciências da Saúde de Porto Alegre, RS, Brazil
| | | | | | - Alice C M Xavier
- Universidade Federal de Ciências da Saúde de Porto Alegre, RS, Brazil
| | - Ygor A Ferrão
- Universidade Federal de Ciências da Saúde de Porto Alegre, RS, Brazil
| | - Kate H Bentley
- Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Gisele G Manfro
- Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Carolina B Dreher
- Universidade Federal de Ciências da Saúde de Porto Alegre, RS, Brazil
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Khakpoor S, Mohammadi Bytamar J, Saed O. Reductions in transdiagnostic factors as the potential mechanisms of change in treatment outcomes in the Unified Protocol: a randomized clinical trial. RESEARCH IN PSYCHOTHERAPY (MILANO) 2019; 22:379. [PMID: 32913807 PMCID: PMC7451383 DOI: 10.4081/ripppo.2019.379] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 06/21/2019] [Indexed: 11/22/2022]
Abstract
Transdiagnostic approaches emphasize on the share underlying features of emotional disorders. In their view, these transdiagnostic factors play an important role in the etiology, maintenance, and treatment of emotional disorders. This study aimed to investigate the transdiagnostic factors as the potential mechanisms of change in the Unified Protocol (UP) for the transdiagnostic treatment of emotional disorders outcomes. The present study is a randomized clinical trial. Twenty-six individuals were selected based on the Beck anxiety inventory and Beck depression inventory and randomly assigned into two groups of control and treatment (n=13). The treatment group received 20 one-hour individual UP sessions. Beck Depression Inventory, Beck Anxiety Inventory, Difficulty in emotion regulation scale, Intolerance of Uncertainty scale and Acceptance and Action questionnaire were carried out in all three phases. UP enhances the difficulty in emotion regulation (large effect size, SEsg=1.81), intolerance of uncertainty (SEsg=1.91), and experiential avoidance (SEsg=1.78). In addition, the results of linear regression show the association between changes in anxiety and depression with changes in transdiagnostic factors. The difficulty in emotion regulation, intolerance of uncertainty and experiential avoidance can be considered as the potential mechanism of change in improving UP outcomes.
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Affiliation(s)
- Sahel Khakpoor
- Master of Clinical Psychology, Education and Treatment Center of Beheshti Hospital, Zanjan University of Medical Sciences, Zanjan
| | - Jahangir Mohammadi Bytamar
- Master of Clinical Psychology, Education and Treatment Center of Valiasr Hospital, Zanjan University of Medical Sciences, Zanjan
| | - Omid Saed
- Department of Clinical Psychology, Faculty of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
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40
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Central Sensitization in Chronic Pain and Eating Disorders: A Potential Shared Pathogenesis. J Clin Psychol Med Settings 2019; 28:40-52. [DOI: 10.1007/s10880-019-09685-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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41
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Sakiris N, Berle D. A systematic review and meta-analysis of the Unified Protocol as a transdiagnostic emotion regulation based intervention. Clin Psychol Rev 2019; 72:101751. [DOI: 10.1016/j.cpr.2019.101751] [Citation(s) in RCA: 116] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 06/18/2019] [Accepted: 06/23/2019] [Indexed: 01/19/2023]
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42
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Forrest LN, Sarfan LD, Ortiz SN, Brown TA, Smith AR. Bridging eating disorder symptoms and trait anxiety in patients with eating disorders: A network approach. Int J Eat Disord 2019; 52:701-711. [PMID: 30900758 DOI: 10.1002/eat.23070] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 02/28/2019] [Accepted: 02/28/2019] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Anxiety is thought to influence the development and maintenance of eating disorders (EDs). However, little is known about how, specifically, anxiety influences ED symptoms and vice versa. Network analysis identifies how symptoms within and across disorders are interconnected. In a network, central nodes (i.e., symptoms) have the strongest relations to other nodes and are thought to maintain psychopathology. Bridge nodes are symptoms in one diagnostic cluster that are strongly connected to symptoms in another diagnostic cluster and are thought to explain comorbidity. We identified central and bridge nodes in a network of ED symptoms and trait anxiety features. METHOD We estimated a regularized partial correlation network in patients with mixed EDs (N = 296). ED symptoms were assessed with the Eating Disorder Examination-Questionnaire. Trait anxiety was assessed with the Trait subscale of the State-Trait Anxiety Inventory. Items to include in the network were selected with a statistical algorithm to ensure that all nodes represented unique constructs. Central and bridge nodes were identified with empirical calculations. RESULTS Central ED nodes were dietary restraint, as well as overvaluation of and dissatisfaction with shape and weight. The central trait anxiety node was low feelings of satisfaction. The strongest ED bridge node was avoidance of social eating. The strongest trait anxiety bridge node was low self-confidence. DISCUSSION Avoidance of social eating and low self-esteem may be routes through which EDs and trait anxiety are linked.
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Affiliation(s)
| | | | - Shelby N Ortiz
- Department of Psychology, Miami University, Oxford, Ohio
| | - Tiffany A Brown
- Department of Psychiatry, University of California San Diego, San Diego, California
| | - April R Smith
- Department of Psychology, Miami University, Oxford, Ohio
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43
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Christensen KA. Emotional feeding as interpersonal emotion regulation: A developmental risk factor for binge-eating behaviors. Int J Eat Disord 2019; 52:515-519. [PMID: 30770584 DOI: 10.1002/eat.23044] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Revised: 01/29/2019] [Accepted: 01/30/2019] [Indexed: 01/17/2023]
Abstract
Emotional feeding is an interpersonal emotion regulation strategy wherein people provide food to others as a means of influencing the recipient's emotional response. Parental emotional feeding has been linked to higher levels of emotional eating in children and adolescents using cross-sectional, retrospective, and prospective designs; however, there is little research on emotional feeding as a developmental risk factor for emotional eating and binge-eating behaviors in adolescence and adulthood. This Idea Worth Researching article explores the rationale for studying emotional feeding as a lifespan construct and its potential implications for understanding eating disorder pathology. Specifically, it offers suggestions for examining emotional feeding as a predictor of emotional eating and binge-eating behavior across the lifespan, assessing potential intergenerational transmission pathways, and researching similarities in feeding styles and emotional eating across a variety of relationships beyond the parent-child dyad.
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Affiliation(s)
- Kara A Christensen
- Department of Psychology, The Ohio State University, Columbus, Ohio.,Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina
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44
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An ARFID case report combining family-based treatment with the unified protocol for Transdiagnostic treatment of emotional disorders in children. J Eat Disord 2019; 7:34. [PMID: 31666952 PMCID: PMC6813117 DOI: 10.1186/s40337-019-0267-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 10/02/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND This case report discusses the presentation and treatment of a nine-year-old female with a history of significant weight loss and food refusal using a combined approach of Family-Based Treatment (FBT) and the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Children (UP-C). CASE PRESENTATION The patient was diagnosed with avoidant/restrictive food intake disorder (ARFID), separation anxiety disorder, and a specific phobia of choking, and subsequently treated with a modified version of FBT, in conjunction with the UP-C. At the end of treatment, improvements were seen in the patient's weight and willingness to eat a full range of foods. Decreases in anxiety regarding eating/choking, fears of food being contaminated with gluten, and fears of eating while being away from parents were also observed. CONCLUSIONS These findings highlight promising results from this combined treatment approach, referred to as FBT + UP for ARFID. Further research is needed to evaluate the use of this treatment in patients presenting with a variety of ARFID symptoms.
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