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Ralph-Nearman C, Rae J, Levinson CA. Using clinician and patient input to assess utility, accuracy, efficiency, and therapeutic implementation of a new data-driven digital therapeutic for personalized clinical eating disorder treatment: Awaken digital guide. Psychother Res 2024:1-14. [PMID: 38917165 DOI: 10.1080/10503307.2024.2360445] [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: 07/20/2023] [Accepted: 05/18/2024] [Indexed: 06/27/2024] Open
Abstract
OBJECTIVE Eating disorders (EDs) take a life every 52 minutes and treatments are ineffective for ∼50% of individuals. Though EDs are heterogeneous illnesses, current evidence-based treatments take a "one-size-fits-all" approach. Network-Informed Personalized Treatment is a new promising treatment for EDs, but clinician-patient-friendly software tools are needed to integrate this guidance system into routine treatment. Adoption is key for impact, necessitating the inclusion of clinicians in the software development. The current pilot assessed a new data-driven clinician-guidance therapeutic. METHOD A two-part pilot was analyzed for quantitative (0-not at all to 10-extremely) and qualitative input on user perception through quantitative and open-ended prompted questions evaluating using personalizing ED treatment with the Awaken Digital Guide therapeutic. RESULTS Results demonstrated that clinicians in a focus group (N = 9) and clinician/patient dyads within implementation (N = 10) endorsed improved efficiency, effectiveness, self-awareness, and accuracy using Awaken Digital Guide compared to current treatment as suggested by quantitative and qualitative results. Both clinicians and patients rated the tool positively (6.8-9.6/5.8-8.6, respectively) with an average rating of good and excellent. CONCLUSION Findings suggest that ED-specialized clinicians desire data-driven guidance on personalizing ED treatment. Users perceive Awaken Digital Guide therapeutic with potential to increase collaboration, motivation, efficiency, and effectiveness of ED personalized treatment.
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Affiliation(s)
- Christina Ralph-Nearman
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, KY, USA
| | - Jesse Rae
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, KY, USA
| | - Cheri A Levinson
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, KY, USA
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Levinson CA, Osborn K, Hooper M, Vanzhula I, Ralph-Nearman C. Evidence-Based Assessments for Transdiagnostic Eating Disorder Symptoms: Guidelines for Current Use and Future Directions. Assessment 2024; 31:145-167. [PMID: 37997290 DOI: 10.1177/10731911231201150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2023]
Abstract
Eating disorders are severe and often chronic mental illnesses that are associated with high impairment and mortality rates. Recent estimates suggest that eating disorder prevalence rates are on the rise, indicating an increased need for accurate assessment and detection. The current review provides an overview of transdiagnostic eating disorder assessments, including interview, self-report, health and primary care screeners, and technology-based and objective assessments. We focused on assessments that are transdiagnostic in nature and exhibit high impact in the field. We provide recommendations for how these assessments should be used in research and clinical settings. We also discuss considerations that are crucial for assessment, including the use of a categorical versus dimensional diagnostic framework, assessment of eating disorders in related fields (i.e., anxiety and depression), and measurement-based care for eating disorders. Finally, we provide suggestions for future research, including the need for more research on short transdiagnostic screeners for use in health care settings, standardized assessments for ecological momentary assessment, development of state-based assessment of eating disorder symptoms, and consideration of assessment across multiple timescales.
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Affiliation(s)
| | - Kimberly Osborn
- University of Louisville, KY, USA
- Oklahoma State University, Stillwater, USA
| | - Madison Hooper
- University of Louisville, KY, USA
- Vanderbilt University, Nashville, TN, USA
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Shaw R, Cassidy T. Self-Compassion, Mindful Eating, Eating Attitudes and Wellbeing Among Emerging Adults. THE JOURNAL OF PSYCHOLOGY 2021; 156:33-47. [PMID: 34762553 DOI: 10.1080/00223980.2021.1992334] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Mindful eating behavior and self-compassion have been individually shown to contribute to healthy eating. Evidence suggests that they may interact and that interaction may increase our understanding of eating behavior. The aim of the current study was to explore the relationship between mindful eating behavior, self-compassion, healthy/unhealthy weight, eating disorder and wellbeing in a sample of university students. An online survey using questionnaire data collection in a sample of 349 students (105 males and 244 females). Variables measured included body mass index (BMI), mindful eating behavior, eating attitudes, self-compassion and mental wellbeing. Regression and path analysis show mindful eating behavior and self-compassion to individually and interaction predict eating attitudes and wellbeing. BMI was shown to have a curvilinear relationship with mindful eating behavior, self-compassion and wellbeing with both the underweight and obese reporting lower self-compassion, less Mindful eating behavior, lower wellbeing and more likely to exhibit disordered eating. These results indicate that self-compassion and mindful eating behavior might be usefully targeted in interventions to prevent both obesity and eating disorder.
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Denman E, Parker EK, Ashley MA, Harris DM, Halaki M, Flood V, Stefoska-Needham A. Understanding training needs in eating disorders of graduating and new graduate dietitians in Australia: an online survey. J Eat Disord 2021; 9:27. [PMID: 33602327 PMCID: PMC7891015 DOI: 10.1186/s40337-021-00380-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 02/09/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Following recent reforms by the Australian Government to the Medicare Benefits Schedule, people living with a diagnosed eating disorder (ED) in Australia have greater access to dietetic services. However, new graduate dietitians anecdotally lack confidence to provide appropriate interventions to support patients with an ED. Therefore, this cross-sectional study aims to explore the perceived confidence, and educational and professional development needs of student dietitians and new graduate dietitians in the area of EDs. METHODS An online survey with 17 questions was designed, consisting of a combination of discrete (yes/no) questions, free text, ordered scales and 5-point Likert scales. Student dietitians, and first- and second- year graduates (n = 1456) were approached via email as potential participants, from the professional organisation Dietitians Australia member list. Survey data was analysed using descriptive statistics and odds ratios. RESULTS In total, 150 surveys were completed, with a response rate of 10.3%. Respondents reported a lack of confidence in managing patients with an ED and implementing ED treatment approaches (81 and 95%, respectively). However, participants previously exposed to patients with an ED, such as anorexia nervosa, were 4.7 times (95% CI 1.72, 12.97) more likely to be confident compared to those not exposed to patients with an ED. The majority of respondents (37%) stated they would seek assistance from other dietitians, and develop their skills via online webinars (27%) and workshops (25%). CONCLUSIONS This survey identified that final year dietetics students and new graduate dietitians perceive lower levels of confidence to practice in the area of EDs. The desire for further ED-specific training and education was reported.
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Affiliation(s)
- Elyse Denman
- SMART Foods Centre, Illawarra Health and Medical Research Institute, School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, 2522, Australia
| | - Elizabeth Kumiko Parker
- Department of Dietetics & Nutrition, Westmead Hospital, Westmead, NSW, 2145, Australia. .,Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia.
| | - Mellisa Anne Ashley
- Department of Dietetics & Nutrition, Westmead Hospital, Westmead, NSW, 2145, Australia.,Adult Eating Disorder Service, Western Sydney Local Health District, Sydney, NSW, 2145, Australia
| | - Deanne Maree Harris
- Department of Dietetics & Nutrition, Tamworth Rural Referral Hospital, Tamworth, NSW, 2340, Australia
| | - Mark Halaki
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Victoria Flood
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia.,Western Sydney Local Health District, Sydney, NSW, 2145, Australia
| | - Anita Stefoska-Needham
- SMART Foods Centre, Illawarra Health and Medical Research Institute, School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, 2522, Australia
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Simonson AP, Davis KK, Barone Gibbs B, Venditti EM, Jakicic JM. Comparison of mindful and slow eating strategies on acute energy intake. Obes Sci Pract 2020; 6:668-676. [PMID: 33354345 PMCID: PMC7746965 DOI: 10.1002/osp4.441] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 06/23/2020] [Accepted: 07/05/2020] [Indexed: 11/23/2022] Open
Abstract
Mindfulness and slow eating techniques are commonly recommended to achieve weight loss within behavioural weight management programmes; yet the role of these eating strategies on acute energy intake (EI) and satiety are not clear. This study investigated the effects of mindful and slow eating strategies on acute EI and satiety. Twenty-four participants were randomized to one of three eating conditions (EAT, MIND, SLOW). For the EAT condition, participants were instructed to eat as they normally would for both test meal sessions. For the SLOW condition, participants were instructed to eat as they normally would for their first test meal session and to slow their eating for the second test meal session. For the MIND condition, participants were instructed to eat as they normally would during their first test meal session and were given brief instructions on mindful eating for their second test meal session. For each condition, participants were provided ad libitum access to a test meal, and EI was calculated based upon food consumed. Participants rated their level of satiety following each meal. There were no significant differences in EI between eating strategy conditions. There was a trend towards a decrease in energy intake in the MIND condition compared with the EAT condition and a prevention of increased intake in the SLOW condition. There were no significant differences in ratings of satiety between conditions. Although, neither mindful nor slow eating strategies significantly decreased acute EI or satiety; the results suggest that both strategies blunted the increase in EI observed in EAT that occurred across two eating episodes, which may suggest that these strategies can be important for modifying eating behaviour that may contribute to body weight regulation. Additional appropriately designed studies investigating these strategies appear warranted to confirm these findings.
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Affiliation(s)
- Anna Peluso Simonson
- Department of Exercise Science and Sport StudiesJohn Carroll UniversityUniversity HeightsOhioUSA
| | | | - Bethany Barone Gibbs
- Department of Health and Human DevelopmentUniversity of PittsburghPittsburghPennsylvaniaUSA
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Sala M, Shankar Ram S, Vanzhula IA, Levinson CA. Mindfulness and eating disorder psychopathology: A meta-analysis. Int J Eat Disord 2020; 53:834-851. [PMID: 32100320 DOI: 10.1002/eat.23247] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 01/26/2020] [Accepted: 01/26/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Mindfulness is implicated in eating disorder (ED) psychopathology. However, this literature has not been synthesized to date. The current meta-analysis examined the associations between mindfulness and ED psychopathology. METHODS A total of 74 independent samples (effects = 576) were included. We used a multilevel random-effects model to estimate summary study-level effect sizes, and multilevel mixed-effects models to examine moderator effects. RESULTS Mindfulness was negatively associated with ED psychopathology (r = -.25, p < .001), both concurrently (r = -.25, p < .001) and prospectively (rs = -.22 to -.24, ps < .001). Associations were strongest for binge eating, emotional/external eating, and body dissatisfaction as well as the acting with awareness and nonjudging facets. DISCUSSION Mindfulness may be an important process in ED psychopathology. Future research should prospectively and experimentally examine the relation between mindfulness and ED psychopathology.
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Affiliation(s)
- Margarita Sala
- Department of Psychology, Southern Methodist University, Dallas, Texas
| | - Shruti Shankar Ram
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, Kentucky
| | - Irina A Vanzhula
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, Kentucky
| | - Cheri A Levinson
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, Kentucky
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Omiwole M, Richardson C, Huniewicz P, Dettmer E, Paslakis G. Review of Mindfulness-Related Interventions to Modify Eating Behaviors in Adolescents. Nutrients 2019; 11:nu11122917. [PMID: 31810307 PMCID: PMC6950168 DOI: 10.3390/nu11122917] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 11/22/2019] [Accepted: 11/26/2019] [Indexed: 11/20/2022] Open
Abstract
There are few well-established treatments for adolescent eating disorders, and for those that do exist, remission rates are reported to be between 30 and 40%. There is a need for the development and implementation of novel treatment approaches. Mindfulness approaches have shown improvements in eating disorder-related psychopathology in adults and have been suggested for adolescents. The present review identifies and summarizes studies that have used mindfulness approaches to modify eating behaviors and to treat eating disorders in adolescents. Focused searches were conducted in Embase, Medline, and PsycINFO, and identified articles were checked for relevance. A small number of studies (n = 15) were designated as appropriate for inclusion in the review. These studies were divided into those that focused on the promotion of healthy eating/the prevention of disordered eating (n = 5), those that concentrated on targeted prevention among high risk adolescents (n = 5), and those that focused on clinical eating disordered adolescents (n = 5). Thirteen of the 15 studies reviewed reported at least one positive association between mindfulness treatment techniques and reduced weight/shape concerns, dietary restraint, decreased body mass index (BMI), eating in the absence of hunger (EAH), binge eating, increased willingness to eat novel healthy foods, and reduced eating disorder psychopathology. In summary, incorporating mindfulness to modify eating behaviors in adolescent non-clinical and clinical samples is still in the early stages, with a lack of data showing clear evidence of acceptability and efficacy. Further studies and preferably controlled conditions are warranted.
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Affiliation(s)
- Michael Omiwole
- Toronto General Hospital, University Health Network, Toronto, ON M5G 2C4, Canada.
| | - Candice Richardson
- Toronto General Hospital, University Health Network, Toronto, ON M5G 2C4, Canada.
| | - Paulina Huniewicz
- Toronto General Hospital, University Health Network, Toronto, ON M5G 2C4, Canada.
| | - Elizabeth Dettmer
- Department of Psychology, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada.
- Department of Peadiatrics, University of Toronto, Toronto, ON M5T 1R8, Canada.
| | - Georgios Paslakis
- Toronto General Hospital, University Health Network, Toronto, ON M5G 2C4, Canada.
- Department of Psychiatry, University of Toronto, Toronto, ON M5T 1R8, Canada.
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Barney JL, Murray HB, Manasse SM, Dochat C, Juarascio AS. Mechanisms and moderators in mindfulness- and acceptance-based treatments for binge eating spectrum disorders: A systematic review. EUROPEAN EATING DISORDERS REVIEW 2019; 27:352-380. [PMID: 30887695 PMCID: PMC6570825 DOI: 10.1002/erv.2673] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 02/21/2019] [Accepted: 02/24/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Increasing evidence suggests that mindfulness- and acceptance-based psychotherapies (MABTs) for bulimia nervosa (BN) and binge eating disorder (BED) may be efficacious; however, little is known about their active treatment components or for whom they may be most effective. METHODS We systematically identified clinical trials testing MABTs for BN or BED through PsychINFO and Google Scholar. Publications were categorized according to analyses of mechanisms of action and moderators of treatment outcome. RESULTS Thirty-nine publications met inclusion criteria. Twenty-seven included analyses of therapeutic mechanisms, and five examined moderators of treatment outcome. Changes were largely consistent with hypothesized mechanisms of MABTs, but substandard mediation analyses, inconsistent measurement tools, and infrequent use of mid-treatment assessment points limited our ability to make strong inferences. DISCUSSION Analyses of mechanisms of action and moderators of outcome in MABTs for BN and BED appear promising, but the use of more sophisticated statistical analyses and adequate replication is necessary.
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Affiliation(s)
| | - Helen B Murray
- Department of Psychology, Drexel University, Philadelphia, Pennsylvania
| | | | - Cara Dochat
- San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, California
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Shared Concerns and Opportunity for Joint Action in Creating a Food Environment That Supports Health. Nutrients 2018; 11:nu11010041. [PMID: 30585215 PMCID: PMC6357161 DOI: 10.3390/nu11010041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 12/17/2018] [Accepted: 12/21/2018] [Indexed: 11/21/2022] Open
Abstract
The food industry is a for-profit industry with high relevance to universal eating disorders prevention. To date, policy which targets the food industry and food environment has been underutilized in efforts to decrease the incidence of eating disorders and associated risk factors. In contrast, food policy has been extensively leveraged with the aim of reducing the incidence of obesity. While philosophical misalignments with these later efforts may have constituted an obstacle to identifying the food environment as a key target for eating disorders prevention, food policy is an area where shared interests can be found. Specifically, a shared goal of obesity and eating disorders prevention efforts is creating a food environment that supports health, while minimizing the influence of the food industry that profits from the sale of highly palatable, processed foods and “diet” foods and from increasing portions of foods served and eaten.
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Sala M, Vanzhula IA, Levinson CA. A longitudinal study on the association between facets of mindfulness and eating disorder symptoms in individuals diagnosed with eating disorders. EUROPEAN EATING DISORDERS REVIEW 2018; 27:295-305. [DOI: 10.1002/erv.2657] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 10/07/2018] [Accepted: 11/01/2018] [Indexed: 11/05/2022]
Affiliation(s)
- Margarita Sala
- Department of PsychologySouthern Methodist University Dallas Texas USA
| | - Irina A. Vanzhula
- Department of Psychological and Brain SciencesUniversity of Louisville Louisville Kentucky USA
| | - Cheri A. Levinson
- Department of Psychological and Brain SciencesUniversity of Louisville Louisville Kentucky USA
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Abstract
BACKGROUND Anorexia nervosa is a serious psychiatric illness with limited evidenced-based treatment options. Mindfulness appears useful in many conditions, but few studies focus on its use in individuals with anorexia nervosa. OBJECTIVE To examine and summarize studies of mindfulness in individuals with anorexia nervosa and identify areas for future research. DESIGN An integrated review was conducted by searching health care computerized databases. RESULTS Results were mixed among the eight studies that met inclusion criteria. Multimodal mindfulness-based therapies appear effective, while brief interventions may be equally useful or result in greater anxiety compared to distraction. Qualitative data support that some participants feel mindfulness is challenging but beneficial. CONCLUSION Mindfulness as a concurrent part of therapy and/or when routinely practiced may be more clinically useful than single-episode mindful eating interventions. Due to the complexity of the concept of mindfulness and limited existing data, additional research is needed.
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Affiliation(s)
- Julie Dunne
- 1 Julie Dunne, MSN, RN, PMHNP-BC, Boston College, Chestnut Hill, MA; The Cambridge Eating Disorder Center, Cambridge, MA, USA
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12
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Linardon J, Fairburn CG, Fitzsimmons-Craft EE, Wilfley DE, Brennan L. The empirical status of the third-wave behaviour therapies for the treatment of eating disorders: A systematic review. Clin Psychol Rev 2017; 58:125-140. [DOI: 10.1016/j.cpr.2017.10.005] [Citation(s) in RCA: 124] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 10/16/2017] [Accepted: 10/20/2017] [Indexed: 11/17/2022]
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Amaro H, Cortés DE, Garcia S, Duan L, Black DS. Video-Based Grocery Shopping Intervention Effect on Purchasing Behaviors Among Latina Shoppers. Am J Public Health 2017; 107:800-806. [PMID: 28323473 DOI: 10.2105/ajph.2017.303725] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To compare changes in food-purchasing knowledge, self-efficacy, and behavior after viewing nutrition education videos among Los Angeles, California Latinas responsible for household grocery shopping. METHODS From February to May 2015, a convenience sample of 113 Latinas watched 1 video (El Carrito Saludable) featuring MyPlate guidelines applied to grocery shopping (1-video intervention) and another convenience sample of 105 Latinas watched 2 videos (El Carrito Saludable and Ser Consciente), the latter featuring mindfulness to support attention and overcome distractions while grocery shopping (2-video intervention). We administered questionnaires before and after intervention. A preselected sample in each intervention condition (n = 72) completed questionnaires at 2-months after intervention and provided grocery receipts (before and 2-months after intervention). RESULTS Knowledge improved in both intervention groups (P < .001). The 2-video group improved more in self-efficacy and use of a shopping list (both P < .05) and purchased more healthy foods (d = 0.60; P < .05) at 2 months than did the 1-video group. CONCLUSIONS Culturally tailored videos that model food-purchasing behavior and mindfulness show promise for improving the quality of foods that Latinas bring into the home.
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Affiliation(s)
- Hortensia Amaro
- Hortensia Amaro is with the Office of the Provost, USC Suzanne Dworak-Peck School of Social Work and the Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles. Dharma E. Cortés is with the Cambridge Health Alliance, Department of Psychiatry, Harvard Medical School, Harvard University, Boston, MA. Samantha Garcia is with the Program in Public Health, University of California, Irvine. Lei Duan is with the USC Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles. David S. Black is with the Department of Preventive Medicine, Keck School of Medicine
| | - Dharma E Cortés
- Hortensia Amaro is with the Office of the Provost, USC Suzanne Dworak-Peck School of Social Work and the Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles. Dharma E. Cortés is with the Cambridge Health Alliance, Department of Psychiatry, Harvard Medical School, Harvard University, Boston, MA. Samantha Garcia is with the Program in Public Health, University of California, Irvine. Lei Duan is with the USC Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles. David S. Black is with the Department of Preventive Medicine, Keck School of Medicine
| | - Samantha Garcia
- Hortensia Amaro is with the Office of the Provost, USC Suzanne Dworak-Peck School of Social Work and the Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles. Dharma E. Cortés is with the Cambridge Health Alliance, Department of Psychiatry, Harvard Medical School, Harvard University, Boston, MA. Samantha Garcia is with the Program in Public Health, University of California, Irvine. Lei Duan is with the USC Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles. David S. Black is with the Department of Preventive Medicine, Keck School of Medicine
| | - Lei Duan
- Hortensia Amaro is with the Office of the Provost, USC Suzanne Dworak-Peck School of Social Work and the Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles. Dharma E. Cortés is with the Cambridge Health Alliance, Department of Psychiatry, Harvard Medical School, Harvard University, Boston, MA. Samantha Garcia is with the Program in Public Health, University of California, Irvine. Lei Duan is with the USC Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles. David S. Black is with the Department of Preventive Medicine, Keck School of Medicine
| | - David S Black
- Hortensia Amaro is with the Office of the Provost, USC Suzanne Dworak-Peck School of Social Work and the Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles. Dharma E. Cortés is with the Cambridge Health Alliance, Department of Psychiatry, Harvard Medical School, Harvard University, Boston, MA. Samantha Garcia is with the Program in Public Health, University of California, Irvine. Lei Duan is with the USC Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles. David S. Black is with the Department of Preventive Medicine, Keck School of Medicine
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14
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Fogelkvist M, Parling T, Kjellin L, Gustafsson SA. A qualitative analysis of participants' reflections on body image during participation in a randomized controlled trial of acceptance and commitment therapy. J Eat Disord 2016; 4:29. [PMID: 27999670 PMCID: PMC5151132 DOI: 10.1186/s40337-016-0120-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 10/09/2016] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Negative body image is a risk factor for development and relapse in eating disorders (ED). Many patients continue to be dissatisfied with their body shape or weight after treatment. This study presents a qualitative analysis of written reflections on body image from patients with an ED and a negative body image before and after an Acceptance and Commitment Therapy group treatment at a specialized ED-unit. METHOD Before and after the treatment participants (n = 47) answered a questionnaire with open ended questions on their thoughts on body image. Data were analyzed through conventional content analysis. RESULTS Body image meant different things for different participants. For some it had to do with how you evaluate your body, whereas others focused on whether their body image was realistic or not. Some emphasized their relationship with their body, while some described body image as strongly related to global self-esteem. These different views on the concept of body image affected the participants' descriptions of their own body image, and how they wanted it to change. Body image was considered a state that fluctuated from day to day. After treatment the participants described changes in their body image, for instance perceiving oneself as less judgmental towards one's body, and a shift in focus to the important things in life. CONCLUSIONS The participants had different views on body image and how they wished it to change. Thus treatment interventions targeting negative body image needs to address various aspects of this complex construct. TRIAL REGISTRATION This study is part of an RCT registered 02/06/2014 in Clinical Trials, registration number: NCT02058121.
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Affiliation(s)
- Maria Fogelkvist
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, S-huset, vån 2, Box 1613, 701 16 Örebro, Sweden
| | - Thomas Parling
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Lars Kjellin
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, S-huset, vån 2, Box 1613, 701 16 Örebro, Sweden
| | - Sanna Aila Gustafsson
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, S-huset, vån 2, Box 1613, 701 16 Örebro, Sweden
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Katterman SN, Kleinman BM, Hood MM, Nackers LM, Corsica JA. Mindfulness meditation as an intervention for binge eating, emotional eating, and weight loss: a systematic review. Eat Behav 2014; 15:197-204. [PMID: 24854804 DOI: 10.1016/j.eatbeh.2014.01.005] [Citation(s) in RCA: 334] [Impact Index Per Article: 33.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Revised: 11/23/2013] [Accepted: 01/22/2014] [Indexed: 12/18/2022]
Abstract
Mindfulness-based approaches are growing in popularity as interventions for disordered eating and weight loss. Initial research suggests that mindfulness meditation may be an effective intervention for binge eating; however, no systematic review has examined interventions where mindfulness meditation was the primary intervention and no review has examined its effect on subclinical disordered eating or weight. Using the PRISMA method for systematic reviews, we reviewed 14 studies that investigated mindfulness meditation as the primary intervention and assessed binge eating, emotional eating, and/or weight change. Results suggest that mindfulness meditation effectively decreases binge eating and emotional eating in populations engaging in this behavior; evidence for its effect on weight is mixed. Additional research is warranted to determine comparative effectiveness and long-term effects of mindfulness training.
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Affiliation(s)
- Shawn N Katterman
- Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL, United States
| | - Brighid M Kleinman
- Department of Behavioral Sciences, Bellarmine University, Louisville, KY, United States
| | - Megan M Hood
- Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL, United States
| | - Lisa M Nackers
- Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL, United States
| | - Joyce A Corsica
- Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL, United States.
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Schaefer JT, Magnuson AB. A review of interventions that promote eating by internal cues. J Acad Nutr Diet 2014; 114:734-60. [PMID: 24631111 DOI: 10.1016/j.jand.2013.12.024] [Citation(s) in RCA: 124] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Accepted: 12/22/2013] [Indexed: 11/28/2022]
Abstract
Traditional diet programs that encourage individuals to consciously restrict their dietary intake have not only been ineffective in terms of weight outcomes, but have also been counterproductive, promoting psychological distress and unhealthy eating behaviors. Nondiet approaches shift the focus away from weight outcomes to the improvement of health outcomes and psychological well-being. One such approach, intuitive eating, promotes dietary intake based on internal cues of hunger and fullness, body acceptance, and making behavior choices based on health as well as enjoyment. Several studies have implemented such ideas into intervention programs. The purpose of our review was to examine the physical and psychological effects of these programs. Twenty interventions were identified. Overall, studies had positive results, demonstrating improvements in eating habits, lifestyle, and body image as measured by dietary restraint, restrictive dieting, physical activity, body satisfaction, and drive for thinness. Participants also experienced improved psychological health as measured by depression, ineffectiveness, anxiety, self-esteem, negative affect, and quality of life. Several improvements were sustained through follow-up periods as long as 2 years. Completion rates were as high as 92% in nondieting groups. In addition, improvements in eating behaviors and maintaining a nondiet approach, increased self-esteem, and decreased body dissatisfaction were sustained long-term. Overall, studies that encourage individuals to eat intuitively help participants abandon unhealthy weight control behaviors, improve metabolic fitness, increase body satisfaction, and improve psychological distress. Results from our review favor the promotion of programs that emphasize a nonrestrictive pattern of eating, body acceptance, and health rather than weight loss.
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A mindful eating group intervention for obese women: a mixed methods feasibility study. Arch Psychiatr Nurs 2013; 27:211-8. [PMID: 24070988 DOI: 10.1016/j.apnu.2013.05.004] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Revised: 04/26/2013] [Accepted: 05/05/2013] [Indexed: 02/05/2023]
Abstract
The purpose of this mixed methods study was to: 1) describe the effect of an 8-week mindful eating intervention on mindful eating, weight loss self-efficacy, depression, and biomarkers of weight in urban, underserved, obese women; and 2) identify themes of the lived experience of mindful eating. A convenience sample of 12 obese women was recruited with data collected at baseline and 8 weeks followed by a focus group. Only self-efficacy for weight loss significantly increased over 8 weeks (t=-2.63, P=.04). Qualitative findings of mindful eating supported quantitative findings and extended understanding about the effect of the intervention.
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Masuda A, Hill ML. Mindfulness as therapy for disordered eating: a systematic review. ACTA ACUST UNITED AC 2013. [DOI: 10.2217/npy.13.36] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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The role of mindfulness based interventions in the treatment of obesity and eating disorders: An integrative review. Complement Ther Med 2013; 21:430-9. [DOI: 10.1016/j.ctim.2013.06.003] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Revised: 05/31/2013] [Accepted: 06/05/2013] [Indexed: 12/14/2022] Open
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Cowdrey FA, Stewart A, Roberts J, Park RJ. Rumination and modes of processing around meal times in women with anorexia nervosa: qualitative and quantitative results from a pilot study. EUROPEAN EATING DISORDERS REVIEW 2013; 21:411-9. [PMID: 23893378 DOI: 10.1002/erv.2236] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Revised: 03/18/2013] [Accepted: 04/15/2013] [Indexed: 01/15/2023]
Abstract
OBJECTIVE The primary aim of this exploratory study was to examine qualitatively and quantitatively the effects of rumination, mindful breathing, and distraction on processing styles and the meal time experience in women with a history of anorexia nervosa (AN). METHOD A quasi-experimental within-participant design was employed. Thirty-seven women with history of AN and all experiencing current eating disorder psychopathology listened to a single rumination, mindful breathing and distraction exercise before a meal time. Qualitative and quantitative analyses were employed. RESULTS Specific themes were extracted for each exercise including avoidance, being in the moment and rumination. The rumination exercise led to significantly greater analytical self-focus. Mindful breathing led to significantly greater experiential self-focus compared with distraction in partially weight-restored AN participants. CONCLUSIONS In AN, self-material is processed in a ruminative way and avoidance is valued. It is difficult to shift individuals with AN out of a rumination around meal times using brief mindful breathing. Future research should investigate at what stage of AN illness mindful-based and acceptance-based strategies are useful and how these strategies could be incorporated in treatment.
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Mateos Rodríguez I, Cowdrey FA, Park RJ. Is there a place for mindfulness in the treatment of anorexia nervosa? ACTA ACUST UNITED AC 2013. [DOI: 10.1080/21662630.2013.795755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Woolhouse H, Knowles A, Crafti N. Adding mindfulness to CBT programs for binge eating: a mixed-methods evaluation. Eat Disord 2012; 20:321-39. [PMID: 22703573 DOI: 10.1080/10640266.2012.691791] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The current study investigated the effectiveness of a combined mindfulness-CBT group therapy program for women with binge eating problems. Questionnaires were completed by group participants pre-program (n = 30), post-program (n = 30) and 3 month follow-up (n = 28). Significant reductions between pre- and post-program scores were found on standardised measures assessing binge eating, dieting, and body image dissatisfaction, with all reductions maintained at follow-up. Qualitative interviews with 16 women following completion of the program revealed the value of mindfulness in improving eating behaviour through increased self-awareness. This exploratory study supports the value of adding mindfulness to the more commonly utilised CBT-based programs for binge eating.
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Affiliation(s)
- Hannah Woolhouse
- Healthy Mothers Healthy Families Research Group, Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Victoria, Australia.
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Daubenmier J, Kristeller J, Hecht FM, Maninger N, Kuwata M, Jhaveri K, Lustig RH, Kemeny M, Karan L, Epel E. Mindfulness Intervention for Stress Eating to Reduce Cortisol and Abdominal Fat among Overweight and Obese Women: An Exploratory Randomized Controlled Study. J Obes 2011; 2011:651936. [PMID: 21977314 PMCID: PMC3184496 DOI: 10.1155/2011/651936] [Citation(s) in RCA: 175] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2011] [Accepted: 06/01/2011] [Indexed: 11/18/2022] Open
Abstract
Psychological distress and elevated cortisol secretion promote abdominal fat, a feature of the Metabolic Syndrome. Effects of stress reduction interventions on abdominal fat are unknown. Forty-seven overweight/obese women (mean BMI = 31.2) were randomly assigned to a 4-month intervention or waitlist group to explore effects of a mindfulness program for stress eating. We assessed mindfulness, psychological distress, eating behavior, weight, cortisol awakening response (CAR), and abdominal fat (by dual-energy X-ray absorptiometry) pre- and posttreatment. Treatment participants improved in mindfulness, anxiety, and external-based eating compared to control participants. Groups did not differ on average CAR, weight, or abdominal fat over time. However, obese treatment participants showed significant reductions in CAR and maintained body weight, while obese control participants had stable CAR and gained weight. Improvements in mindfulness, chronic stress, and CAR were associated with reductions in abdominal fat. This proof of concept study suggests that mindfulness training shows promise for improving eating patterns and the CAR, which may reduce abdominal fat over time.
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Affiliation(s)
- Jennifer Daubenmier
- Osher Center for Integrative Medicine, Department of Medicine, University of California, San Francisco, CA 94115, USA
- *Jennifer Daubenmier: and
| | - Jean Kristeller
- Department of Psychology, Indiana State University, Terre Haute, IN 47809, USA
| | - Frederick M. Hecht
- Osher Center for Integrative Medicine, Department of Medicine, University of California, San Francisco, CA 94115, USA
| | - Nicole Maninger
- California National Primate Research Center, University of California, Davis, CA 95616, USA
| | - Margaret Kuwata
- Osher Center for Integrative Medicine, Department of Medicine, University of California, San Francisco, CA 94115, USA
| | - Kinnari Jhaveri
- Osher Center for Integrative Medicine, Department of Medicine, University of California, San Francisco, CA 94115, USA
| | - Robert H. Lustig
- Department of Pediatrics, University of California, San Francisco, CA 94143, USA
| | - Margaret Kemeny
- Department of Psychiatry, University of California, San Francisco, CA 94143, USA
| | - Lori Karan
- Department of Medicine, University of California, San Francisco, CA 94143, USA
| | - Elissa Epel
- Department of Psychiatry, University of California, San Francisco, CA 94143, USA
- *Elissa Epel:
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