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Lewandowska K, Klinkosz W, Styk W, Kowalczyk M. Diversity of Binge-Eating Disorder Symptoms Is Associated with Anxiety about Getting Fat Rather Than Body Image: A Clinical Study of Women in Poland. Nutrients 2023; 15:4572. [PMID: 37960225 PMCID: PMC10647494 DOI: 10.3390/nu15214572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 10/21/2023] [Accepted: 10/26/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Anxiety about gaining weight is strongly related to body image. Evidence indicates that body dissatisfaction is a strong predictor of eating disorder development. Although not included in DSM-V diagnostic criteria, body image dissatisfaction, and concern are clearly relevant also for individuals with binge-eating disorder (BED). Weight gain anxiety is associated with psychopathological behaviors, but existing research in this area is primarily focused on bulimia nervosa and anorexia nervosa. The goal of this present study was to investigate body image and body mass anxiety in people with BED. METHODS Women diagnosed with BED (n = 105) aged 18 to 66 were surveyed using the questionnaire developed by the authors evaluating the presence of BED symptoms based on DSM-V criteria, and two other instruments: the Body Esteem Scale (BES), and the Body Mass Anxiety Scale (BMAS-20). Statistical analyses were conducted to examine the correlations of BED with body image and body mass anxiety (Pearson's r), to test differences between groups with greater and lesser BED symptom diversity (Student's t-test or the Mann-Whitney U test), and to assess differences among mild-, moderate- and severe-BED groups (ANOVA with a post-hoc test). RESULTS A medium positive relationship was found between anxiety about getting fat (AGF) and the diversity of BED, measured as the number of BED symptoms. A larger number of BED symptoms was shown to be associated with a higher level of AGF. However, no significant differences in AGF levels were observed among BED-severity groups, specified with the frequency of binge eating episodes. No correlations were found between BED and body image. There were also no significant differences in body image between groups with a larger and a smaller number of BED symptoms. The only significant difference in body image observed among BED-severity groups was the level of weight concern. People with mild BED displayed a higher level of weight concern than those with severe BED. CONCLUSIONS Women who binge eat experience high levels of AGF. In the present study, AGF was primarily associated with the number of BED symptoms and not the rate of recurrence of binge-eating episodes. The frequency of BED episodes, however, was linked with weight concern. On the other hand, the hypothesized relationship between disturbed body image and BED was not confirmed. The findings indicate that anxiety about getting fat should be viewed as one of the psychological costs incurred by women experiencing BED symptoms, and it should be mentioned in the next DSM version.
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Affiliation(s)
- Karolina Lewandowska
- Institute of Psychology, The Cardinal Stefan Wyszyński University in Warsaw, 01-938 Warsaw, Poland; (K.L.); (W.K.)
| | - Waldemar Klinkosz
- Institute of Psychology, The Cardinal Stefan Wyszyński University in Warsaw, 01-938 Warsaw, Poland; (K.L.); (W.K.)
| | - Wojciech Styk
- Department of Psychology, Medical University in Lublin, 20-059 Lublin, Poland
| | - Magdalena Kowalczyk
- Mental Health Clinic, Complex of Provincial Specialty Clinics in Katowice, 40-038 Katowice, Poland;
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Baur J, Krohmer K, Naumann E, Svaldi J. Efficacy and mechanisms of change in exposure-based and cognitive stand-alone body image interventions in women with overweight and obesity. Behav Res Ther 2022; 159:104210. [PMID: 36435148 DOI: 10.1016/j.brat.2022.104210] [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: 12/30/2021] [Revised: 07/25/2022] [Accepted: 10/07/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Body dissatisfaction is highly prevalent in overweight and obesity, while evidence for the efficacy of body image interventions is still scarce. This interventional pilot study investigates the efficacy and mechanisms of change of two stand-alone body image interventions in women with overweight and obesity. METHODS Women with overweight and obesity (n = 76) were randomly assigned to five weekly sessions of either a mirror exposure (ME) or a cognitive restructuring intervention (CR) or to a wait-list control group (WCG). Primary outcome measures were self-reported body dissatisfaction and interview-based shape concerns; depression, self-esteem and emotional eating served as secondary outcome measures. Experimental paradigms were used prior to and after the interventions to analyze possible mechanisms of change: (a) Implicit Associations Tests to assess weight-related attitudes (b) eye-tracking experiments to assess visual processing of body pictures and (c) a thought-sampling procedure to assess body-related cognitions and arousal. RESULTS According to intent-to-treat analyses using linear mixed-models, both interventions lead to significant improvements in body image, while there were no changes in the WCG. Different mechanisms of change were identified. CONCLUSIONS Both types of interventions might be effective in the reduction of self-reported body dissatisfaction and interview-based shape concerns in overweight and obesity. However, as different mechanisms drive the effects, future research should clarify which individual might best benefit from which intervention.
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Affiliation(s)
- Julia Baur
- Department of Clinical Psychology and Psychotherapy, University of Tuebingen, Tuebingen, Germany.
| | - Kerstin Krohmer
- Department of Clinical Psychology and Psychotherapy, University of Tuebingen, Tuebingen, Germany
| | - Eva Naumann
- Department of Clinical Psychology and Psychotherapy, University of Tuebingen, Tuebingen, Germany
| | - Jennifer Svaldi
- Department of Clinical Psychology and Psychotherapy, University of Tuebingen, Tuebingen, Germany
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Sebri V, Durosini I, Mazzoni D, Pravettoni G. The Body after Cancer: A Qualitative Study on Breast Cancer Survivors' Body Representation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191912515. [PMID: 36231811 PMCID: PMC9566341 DOI: 10.3390/ijerph191912515] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 09/27/2022] [Accepted: 09/28/2022] [Indexed: 05/16/2023]
Abstract
OBJECTIVE The relationship with the body is a relevant issue for breast cancer survivors. Oncological treatments damage their bodies due to scars, weight gain, and other side effects. Starting from the efficacy of psychological interventions for breast cancer survivors, a tailored psychological support program was provided to promote overall well-being after illness dealing with bodily signals and related emotions and thoughts. This study presents changes in the description of the relationship with their bodies as well as participants' emotions and thoughts before and after a psychological intervention. METHODS AND MEASURES Eighteen women answered questions related to their bodies before and after the psychological intervention. Results were analyzed in accordance with the procedure of the Word Association Analysis through the T-Lab software and the Qualitative Thematic Analysis. RESULTS Participants reported a great awareness of their bodies and the desire to take care of them daily. In particular, the body is now perceived as a helper to sustain breast cancer survivors in their everyday activities. CONCLUSION The words and the themes that characterized the participants' reports highlighted the impact of cancer diagnosis and oncological therapies on breast cancer survivors. The participation in the psychological intervention focused on self-compassion towards their body helps women to create an improved body perception.
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Affiliation(s)
- Valeria Sebri
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy
- Correspondence:
| | - Ilaria Durosini
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Davide Mazzoni
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
| | - Gabriella Pravettoni
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy
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Naumann E, Werthmann J, Vocks S, Svaldi J, Hartmann AS. Die Spiegelkonfrontationstherapie zur Behandlung von Körperbildstörungen bei Essstörungen – Evidenz, Wirkmechanismen und Vorgehensweise. PSYCHOLOGISCHE RUNDSCHAU 2022. [DOI: 10.1026/0033-3042/a000558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Zusammenfassung. Körperbildprobleme sind ein Kernmerkmal von Essstörungen. Daher gilt eine Verbesserung des Körperbildes bei der Behandlung von Essstörungen als zentrales Therapieziel. Verschiedene empirische Befunde weisen auf die Spiegelkonfrontation als wirksame Methode zur Reduktion von Körperbildstörungen hin. Ziel dieses Übersichtsartikels ist es, den aktuellen Stand der wissenschaftlichen Literatur zum Thema Spiegelkonfrontationstherapie bei Essstörungen darzulegen. Insbesondere sollen die Wirksamkeitsstudien getrennt für nicht-klinische, körperunzufriedene Gruppen mit und ohne Übergewicht sowie die verschiedenen Essstörungsgruppen systematisiert und unterschiedliche Vorgehensweisen beschrieben werden. Der Übersichtsartikel liefert Hinweise dafür, dass die Spiegelkonfrontationstherapie bei Hochrisikogruppen mit erhöhter Körperunzufriedenheit sowie bei Essstörungen zu positiven Veränderungen hinsichtlich der kognitiv-affektiven und behavioralen Komponente des Körperbildes führt. Jedoch mangelt es insgesamt an randomisiert-kontrollierten Studien, die die Wirksamkeit der Spiegelkonfrontationstherapie mit ausreichend großen Stichproben gezielt untersuchen – vor allem bei der Anorexia nervosa. Der Übersichtsartikel schließt mit einer Diskussion über mögliche Wirkmechanismen, (Kontra–)Indikationen und einem Ausblick für zukünftige Forschung ab.
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Affiliation(s)
- Eva Naumann
- Abteilung Klinische Psychologie und Psychologie, Institut für Psychologie, Eberhard Karls Universität Tübingen, Deutschland
| | - Jessica Werthmann
- Abteilung Klinische Psychologie und Psychologie, Institut für Psychologie, Albert-Ludwigs-Universität Freiburg, Deutschland
| | - Silja Vocks
- Fachgebiet Klinische Psychologie und Psychologie, Institut für Psychologie, Universität Osnabrück, Deutschland
| | - Jennifer Svaldi
- Abteilung Klinische Psychologie und Psychologie, Institut für Psychologie, Eberhard Karls Universität Tübingen, Deutschland
| | - Andrea S. Hartmann
- Fachgebiet Klinische Psychologie und Psychologie, Institut für Psychologie, Universität Osnabrück, Deutschland
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Ralph AF, Brennan L, Byrne S, Caldwell B, Farmer J, Hart LM, Heruc GA, Maguire S, Piya MK, Quin J, Trobe SK, Wallis A, Williams-Tchen AJ, Hay P. Management of eating disorders for people with higher weight: clinical practice guideline. J Eat Disord 2022; 10:121. [PMID: 35978344 PMCID: PMC9386978 DOI: 10.1186/s40337-022-00622-w] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 06/24/2022] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION The prevalence of eating disorders is high in people with higher weight. However, despite this, eating disorders experienced by people with higher weight have been consistently under-recognised and under-treated, and there is little to guide clinicians in the management of eating disorders in this population. AIM The aim of this guideline is to synthesise the current best practice approaches to the management of eating disorders in people with higher weight and make evidence-based clinical practice recommendations. METHODS The National Eating Disorders Collaboration Steering Committee auspiced a Development Group for a Clinical Practice Guideline for the treatment of eating disorders for people with higher weight. The Development Group followed the 'Guidelines for Guidelines' process outlined by the National Health and Medical Research Council and aim to meet their Standards to be: 1. relevant and useful for decision making; 2. transparent; 3. overseen by a guideline development group; 4. identifying and managing conflicts of interest; 5. focused on health and related outcomes; 6. evidence informed; 7. making actionable recommendations; 8. up-to-date; and, 9. accessible. The development group included people with clinical and/or academic expertise and/or lived experience. The guideline has undergone extensive peer review and consultation over an 18-month period involving reviews by key stakeholders, including experts and organisations with clinical academic and/or lived experience. RECOMMENDATIONS Twenty-one clinical recommendations are made and graded according to the National Health and Medical Research Council evidence levels. Strong recommendations were supported for psychological treatment as a first-line treatment approach adults (with bulimia nervosa or binge-eating disorder), adolescents and children. Clinical considerations such as weight stigma, interprofessional collaborative practice and cultural considerations are also discussed. CONCLUSIONS This guideline will fill an important gap in the need to better understand and care for people experiencing eating disorders who also have higher weight. This guideline acknowledges deficits in knowledge and consequently the reliance on consensus and lower levels of evidence for many recommendations, and the need for research particularly evaluating weight-neutral and other more recent approaches in this field.
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Affiliation(s)
| | - Leah Brennan
- School of Psychology and Public Health, La Trobe University, Wodonga, Australia
| | - Sue Byrne
- Department of Psychology, University of Western Australia, Perth, Australia
| | | | - Jo Farmer
- Lived Experience Advocate, Melbourne, Australia
| | - Laura M. Hart
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Gabriella A. Heruc
- Eating Disorders and Nutrition Research Group (ENRG), School of Medicine, Western Sydney University, Sydney, Australia
| | - Sarah Maguire
- InsideOut Institute for Eating Disorders, The Boden Collaboration for Obesity, Nutrition, Exercise and Eating Disorders, The University of Sydney, Sydney, Australia
- Sydney Local Health District, NSW Health, Sydney, Australia
| | - Milan K. Piya
- School of Medicine, Western Sydney University, Macarthur Clinical School, Sydney, Australia
- Camden and Campbelltown Hospitals, Sydney, Australia
| | - Julia Quin
- Lived Experience Advocate, Melbourne, Australia
| | - Sarah K. Trobe
- National Eating Disorders Collaboration, Sydney, Australia
| | - Andrew Wallis
- Sydney Children’s Hospitals Network, The Children’s Hospital Westmead, Sydney, Australia
| | | | - Phillipa Hay
- Eating Disorders and Body Image (EDBI), Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, Australia
- South Western Sydney Local Health District, Sydney, Australia
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Giel KE, Bulik CM, Fernandez-Aranda F, Hay P, Keski-Rahkonen A, Schag K, Schmidt U, Zipfel S. Binge eating disorder. Nat Rev Dis Primers 2022; 8:16. [PMID: 35301358 PMCID: PMC9793802 DOI: 10.1038/s41572-022-00344-y] [Citation(s) in RCA: 59] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/28/2022] [Indexed: 12/30/2022]
Abstract
Binge eating disorder (BED) is characterized by regular binge eating episodes during which individuals ingest comparably large amounts of food and experience loss of control over their eating behaviour. The worldwide prevalence of BED for the years 2018-2020 is estimated to be 0.6-1.8% in adult women and 0.3-0.7% in adult men. BED is commonly associated with obesity and with somatic and mental health comorbidities. People with BED experience considerable burden and impairments in quality of life, and, at the same time, BED often goes undetected and untreated. The aetiology of BED is complex, including genetic and environmental factors as well as neuroendocrinological and neurobiological contributions. Neurobiological findings highlight impairments in reward processing, inhibitory control and emotion regulation in people with BED, and these neurobiological domains are targets for emerging treatment approaches. Psychotherapy is the first-line treatment for BED. Recognition and research on BED has increased since its inclusion into DSM-5; however, continuing efforts are needed to understand underlying mechanisms of BED and to improve prevention and treatment outcomes for this disorder. These efforts should also include screening, identification and implementation of evidence-based interventions in routine clinical practice settings such as primary care and mental health outpatient clinics.
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Affiliation(s)
- Katrin E Giel
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, Tübingen, Germany.
- Center of Excellence for Eating Disorders (KOMET), Tübingen, Germany.
| | - Cynthia M Bulik
- Department of Psychiatry, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Fernando Fernandez-Aranda
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain
- Ciber Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Madrid, Spain
- Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Phillipa Hay
- Translational Health Research Institute, Western Sydney University, Sydney, NSW, Australia
- Camden and Campbelltown Hospitals, SWSLHD, Campbelltown, NSW, Australia
| | | | - Kathrin Schag
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, Tübingen, Germany
- Center of Excellence for Eating Disorders (KOMET), Tübingen, Germany
| | - Ulrike Schmidt
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, Tübingen, Germany
- Center of Excellence for Eating Disorders (KOMET), Tübingen, Germany
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Body exposure, its forms of delivery and potentially associated working mechanisms: How to move the field forward. CLINICAL PSYCHOLOGY IN EUROPE 2021; 3:e3813. [DOI: 10.32872/cpe.3813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 05/18/2021] [Indexed: 11/25/2022] Open
Abstract
Background
Body image disturbance (BID) is a hallmark feature of eating disorders (EDs) and has proven to be involved in their etiology and maintenance. Therefore, the targeting of BID in treatment is crucial, and has been incorporated in various treatment manuals. One of the most common techniques in the treatment of BID is body exposure (BE), the confrontation with one’s own body. BE has been found to be effective in individuals with EDs or high body dissatisfaction. However, BE is applied in a multitude of ways, most of which are based on one or a combination of the hypothesized underlying working mechanisms, with no differential effectiveness known so far.
Method
The aim of this paper is to selectively review the main hypothesized working mechanisms of BE and their translation into therapeutic approaches.
Results and Conclusion
Specifically, we underline that studies are needed to pinpoint the proposed mechanisms and to develop an empirically informed theoretical model of BE. We provide a framework for future studies in order to identify working mechanisms and increase effectiveness of BE.
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Moghimi E, Davis C, Rotondi M. The Efficacy of eHealth Interventions for the Treatment of Adults Diagnosed With Full or Subthreshold Binge Eating Disorder: Systematic Review and Meta-analysis. J Med Internet Res 2021; 23:e17874. [PMID: 34283028 PMCID: PMC8335602 DOI: 10.2196/17874] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 12/18/2020] [Accepted: 05/13/2021] [Indexed: 02/06/2023] Open
Abstract
Background There has been a recent rise in the use of eHealth treatments for a variety of psychological disorders, including eating disorders. Objective This meta-analysis of randomized controlled trials is the first to evaluate the efficacy of eHealth interventions specifically for the treatment of binge eating disorder (characterized by compulsive overconsumption of food, in a relatively short period, and without compensatory behaviors such as purging or fasting). Methods A search on the electronic databases PubMed, Web of Science, Embase, MEDLINE, and CINAHL was conducted for randomized controlled trials that compared the efficacy of eHealth treatment interventions with waitlist controls. Results From the databases searched, 3 studies (298 participants in total) met the inclusion criteria. All interventions were forms of internet-based guided cognitive behavioral therapy. The results of the analysis demonstrated that when compared with waitlist controls, individuals enrolled in eHealth interventions experienced a reduction in objective binge episodes (standardized mean difference [SMD] −0.77, 95% CI −1.38 to −0.16) and eating disorder psychopathology (SMD −0.71, 95% CI −1.20 to −0.22), which included shape (SMD −0.61, 95% CI −1.01 to −0.22) and weight concerns (SMD −0.91, 95% CI −1.33 to −0.48). There was no significant difference in BMI between the eHealth interventions and controls (SMD −0.01, 95% CI −0.40 to 0.39). Conclusions These findings provide promising results for the use of internet-based cognitive behavioral therapy for binge eating disorder treatment and support the need for future research to explore the efficacy of these eHealth interventions.
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Affiliation(s)
- Elnaz Moghimi
- School of Kinesiology and Health Science, Faculty of Health, York University, Toronto, ON, Canada
| | - Caroline Davis
- School of Kinesiology and Health Science, Faculty of Health, York University, Toronto, ON, Canada
| | - Michael Rotondi
- School of Kinesiology and Health Science, Faculty of Health, York University, Toronto, ON, Canada
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Glisenti K, Strodl E, King R, Greenberg L. The feasibility of emotion-focused therapy for binge-eating disorder: a pilot randomised wait-list control trial. J Eat Disord 2021; 9:2. [PMID: 33407948 PMCID: PMC7789500 DOI: 10.1186/s40337-020-00358-5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 12/06/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Research into psychotherapy for binge-eating disorder (BED) has focused mainly on cognitive behavioural therapies, but efficacy, failure to abstain, and dropout rates continue to be problematic. The experience of negative emotions is among the most accurate predictors for the occurrence of binge eating episodes in BED, suggesting benefits to exploring psychological treatments with a more specific focus on the role of emotion. The present study aimed to explore the feasibility of individual emotion-focused therapy (EFT) as a treatment for BED by examining the outcomes of a pilot randomised wait-list controlled trial. METHODS Twenty-one participants were assessed using a variety of feasibility measures relating to recruitment, credibility and expectancy, therapy retention, objective binge episodes and days, and binge eating psychopathology outcomes. The treatment consisted of 12 weekly one-hour sessions of EFT for maladaptive emotions over 3 months. A mixed model approach was utilised with one between effect (group) using a one-way analysis of variance (ANOVA) to test the hypothesis that participants immediately receiving the EFT treatment would demonstrate a greater degree of improvement on outcomes relating to objective binge episodes and days, and binge eating psychopathology, compared to participants on the EFT wait-list; and one within effect (time) using a repeated-measures ANOVA to test the hypothesis that participation in the EFT intervention would result in significant improvements in outcome measures from pre to post-therapy and then maintained at follow-up. RESULTS Recruitment, credibility and expectancy, therapy retention outcomes indicated EFT is a feasible treatment for BED. Further, participants receiving EFT demonstrated a greater degree of improvement in objective binge episodes and days, and binge eating psychopathology compared to EFT wait-list control group participants. When participants in the EFT wait-list control group then received treatment and outcomes data were combined with participants who initially received the treatment, EFT demonstrated significant improvement in objective binge episodes and days, and binge eating psychopathology for the entire sample. CONCLUSIONS These findings provide further preliminary evidence for the feasibility of individual EFT for BED and support more extensive randomised control trials to assess efficacy. TRIAL REGISTRATION The study was retrospectively registered with the Australian New Zealand Clinical Trials Registry ( ACTRN12620000563965 ) on 14 May 2020.
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Affiliation(s)
- Kevin Glisenti
- School of Psychology and Counselling, Queensland University of Technology, Faculty of Health, Brisbane, Queensland, Australia.
| | - Esben Strodl
- School of Psychology and Counselling, Queensland University of Technology, Faculty of Health, Brisbane, Queensland, Australia
| | - Robert King
- School of Psychology and Counselling, Queensland University of Technology, Faculty of Health, Brisbane, Queensland, Australia
| | - Leslie Greenberg
- Department of Psychology, York University, Faculty of Health, Toronto, Canada
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Eik-Nes TT, Vrabel K, Raman J, Clark MR, Berg KH. A Group Intervention for Individuals With Obesity and Comorbid Binge Eating Disorder: Results From a Feasibility Study. Front Endocrinol (Lausanne) 2021; 12:738856. [PMID: 34803910 PMCID: PMC8597950 DOI: 10.3389/fendo.2021.738856] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 09/30/2021] [Indexed: 11/13/2022] Open
Abstract
PURPOSE A common challenge among a subgroup of individuals with obesity is binge eating, that exists on a continuum from mild binge eating episodes to severe binge eating disorder (BED). BED is common among bariatric patients and the prevalence of disordered eating and ED in bariatric surgery populations is well known. Conventional treatments and assessment of obesity seldom address the underlying psychological mechanisms of binge eating and subsequent obesity. This study, titled PnP (People need People) is a psychoeducational group pilot intervention for individuals with BED and obesity including patients with previous bariatric surgery. Design, feasibility, and a broad description of the study population is reported. MATERIAL AND METHODS A total of 42 patients were from an obesity clinic referred to assessment and treatment with PnP in a psychoeducational group setting (3-hour weekly meetings for 10 weeks). Of these, 6 (14.3%) patients had a previous history of bariatric surgery. Feasibility was assessed by tracking attendance, potentially adverse effects and outcome measures including body mass index (BMI), eating disorder pathology, overvaluation of shape and weight, impairment, self-reported childhood difficulties, alexithymia, internalized shame as well as health related quality of life (HRQoL). RESULTS All 42 patients completed the intervention, with no adverse effects and a high attendance rate with a median attendance of 10 sessions, 95% CI (8.9,9.6) and 0% attrition. Extent of psychosocial impairment due to eating disorder pathology, body dissatisfaction and severity of ED symptoms were high among the patients at baseline. Additionally, self-reported childhood difficulties, alexithymia, and internalized shame were high among the patients and indicate a need to address underlying psychological mechanisms in individuals with BED and comorbid obesity. Improvement of HRQoL and reduction of binge eating between baseline and the end of the intervention was observed with a medium effect. CONCLUSION This feasibility study supports PnP as a potential group psychoeducational intervention for patients living with BED and comorbid obesity. Assessments of BED and delivery of this intervention may optimize selection of candidates and bariatric outcomes. These preliminary results warrant further investigation via a randomized control trial (RCT) to examine the efficacy and effectiveness of PnP.
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Affiliation(s)
- Trine T. Eik-Nes
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
- Stjørdal Community Mental Health Centre, Levanger Hospital, Levanger, Norway
- *Correspondence: Trine T. Eik-Nes,
| | | | - Jayanthi Raman
- Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Melinda Rose Clark
- Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Kjersti Hognes Berg
- Stjørdal Community Mental Health Centre, Levanger Hospital, Levanger, Norway
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11
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Baur J, Krohmer K, Naumann E, Tuschen-Caffier B, Svaldi J. Vocal arousal: a physiological correlate of body distress in women with overweight and obesity. Eat Weight Disord 2020; 25:1161-1169. [PMID: 31338792 DOI: 10.1007/s40519-019-00744-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 07/01/2019] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Numerous studies highlight the relevance of body image in the development and maintenance of overweight and obesity mostly using self-reported data. Given the importance of physiological assessment methods, the present study aimed at investigating vocally encoded emotional arousal as a correlate of body distress in women with overweight and obesity. METHODS Cognitions of women with overweight and obesity (OW; n = 22) as well as normal weight controls (NW; n = 22) were assessed by means of a thought-sampling procedure during a mirror exposure and a control condition. Fundamental frequency (f0) as a marker of vocally encoded emotional arousal as well as verbalized body-related cognitions were analyzed during this experimental task. RESULTS A stronger increase in f0 between the control and the mirror exposure condition was found in OW compared to NW. Furthermore, there were significant positive correlations between vocally encoded emotional arousal and various measures of body image. CONCLUSION The findings support the utility of vocally encoded emotional arousal as an objective physiological correlate of the evaluative dimension of body image in women with overweight and obesity. LEVEL OF EVIDENCE Level I, experimental study.
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Affiliation(s)
- Julia Baur
- Department of Clinical Psychology and Psychotherapy, University of Tuebingen, Schleichstraße 4, 72076, Tübingen, Germany
| | - Kerstin Krohmer
- Department of Clinical Psychology and Psychotherapy, University of Tuebingen, Schleichstraße 4, 72076, Tübingen, Germany
| | - Eva Naumann
- Department of Clinical Psychology and Psychotherapy, University of Tuebingen, Schleichstraße 4, 72076, Tübingen, Germany
| | - Brunna Tuschen-Caffier
- Department of Clinical Psychology and Psychotherapy, University of Freiburg, Engelbergerstraße 41, 79106, Freiburg, Germany
| | - Jennifer Svaldi
- Department of Clinical Psychology and Psychotherapy, University of Tuebingen, Schleichstraße 4, 72076, Tübingen, Germany.
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12
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Hilbert A, Petroff D, Herpertz S, Pietrowsky R, Tuschen-Caffier B, Vocks S, Schmidt R. Meta-analysis on the long-term effectiveness of psychological and medical treatments for binge-eating disorder. Int J Eat Disord 2020; 53:1353-1376. [PMID: 32583527 DOI: 10.1002/eat.23297] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 03/17/2020] [Accepted: 03/19/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Long-term effectiveness is a critical aspect of the clinical utility of a treatment; however, a meta-analytic evaluation of psychological and medical treatments for binge-eating disorder (BED), including weight loss treatments, is outstanding. This meta-analysis sought to provide a comprehensive evaluation of the long-term effectiveness in diverse treatments for BED regarding a range of clinically relevant outcomes. METHOD Based on a systematic search up to February 2018, 114 published and unpublished randomized-controlled (RCTs), nonrandomized, and uncontrolled treatment studies, totaling 8,862 individuals with BED (DSM-IV, DSM-5), were identified and analyzed using within-group random-effect modeling. RESULTS Effectiveness (regarding binge-eating episodes and abstinence, eating disorder and general psychopathology) up to 12 months following treatment was demonstrated for psychotherapy, structured self-help treatment, and combined treatment, while the results regarding body weight reduction were inconsistent. These results were confirmed in sensitivity analyses with RCTs on the most common treatments-cognitive-behavioral therapy and self-help treatment based on this approach. Follow-up intervals longer than 12 months were rarely reported, mostly supporting the long-term effectiveness of psychotherapy. Few follow-up data were available for pharmacotherapy, and behavioral and self-help weight loss treatment, while follow-up data were lacking for pharmacological and surgical weight loss treatment. Study quality varied widely. DISCUSSION This comprehensive meta-analysis demonstrated the medium-term effectiveness of psychotherapy, structured self-help treatment, and combined treatment for patients with BED, and supported the long-term effectiveness of psychotherapy. The results were derived from uncontrolled comparisons over time. Further long-term high quality research on psychological and medical treatments for BED is required.
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Affiliation(s)
- Anja Hilbert
- Integrated Research and Treatment Center AdiposityDiseases, Behavioral Medicine Research Unit, Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany
| | - David Petroff
- Integrated Research and Treatment Center AdiposityDiseases, Clinical Trial Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Stephan Herpertz
- Integrated Research and Treatment Center AdiposityDiseases, Clinical Trial Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Reinhard Pietrowsky
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Clinic, Ruhr-University Bochum, Germany
| | - Brunna Tuschen-Caffier
- Department of Clinical Psychology, Institute of Experimental Psychology, University of Düsseldorf, Düsseldorf, Germany
| | - Silja Vocks
- Department of Psychology, University of Freiburg, Freiburg, Germany
| | - Ricarda Schmidt
- Integrated Research and Treatment Center AdiposityDiseases, Behavioral Medicine Research Unit, Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany
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13
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Exposure therapy for eating disorders: A systematic review. Clin Psychol Rev 2020; 78:101851. [DOI: 10.1016/j.cpr.2020.101851] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 03/07/2020] [Accepted: 03/10/2020] [Indexed: 12/25/2022]
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Abstract
PURPOSE OF REVIEW The purpose of this review was to examine different forms of disordered eating among individuals with excess weight, including their rates, correlates, and psychosocial treatments. RECENT FINDINGS Binge eating/binge eating disorder, loss of control eating, emotional eating, and food addiction are all fairly prevalent among individuals with excess weight. They appear to share many of the same correlates, including broader eating disorder psychopathology, body/shape/weight concerns, depression, anxiety, and low self-esteem. Behavioral, cognitive-behavioral, and third-wave (e.g., acceptance, mindfulness) therapies appear effective in improving binge eating, loss of control eating, emotional eating, associated features (e.g., weight and shape concerns), and psychological distress (e.g., depression). Certain forms of disordered eating are elevated among individuals with excess weight, and psychosocial interventions have been found effective in improving symptomatology. Empirical research examining the efficacy of treatments for food addiction is lacking, and greatly needed given both its rate and controversy.
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Affiliation(s)
- Bethany A Nightingale
- Department of Psychology, Ryerson University, 350 Victoria St., Toronto, ON, M5B 2K3, Canada.
| | - Stephanie E Cassin
- Department of Psychology, Ryerson University, 350 Victoria St., Toronto, ON, M5B 2K3, Canada.
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
- Centre for Mental Health, University Health Network, Toronto, ON, Canada.
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15
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Baur J, Krohmer K, Tuschen-Caffier B, Svaldi J. Cognitive-Emotional Involvement During Mirror Exposure Is Not Accompanied by Physiological Activation in Binge Eating Disorder. Front Psychiatry 2019; 10:745. [PMID: 31803074 PMCID: PMC6877718 DOI: 10.3389/fpsyt.2019.00745] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 09/17/2019] [Indexed: 12/29/2022] Open
Abstract
Body image interventions have been shown to reduce self-reported cognitive-emotional facets of body image disturbance in binge eating disorder (BED). However, more objective assessment methods are required to evaluate the effects of these interventions. Therefore, the present study aimed at investigating the usefulness of vocally encoded emotional arousal as physiological correlate of body dissatisfaction during mirror exposure in women with BED. Women with BED (n = 60) and weight-matched controls (CG; n = 60) participated in an experimental thought-sampling procedure including a mirror exposure and a control condition in a repeated-measures design. Fundamental frequency as a vocal correlate of emotional arousal as well as negative, neutral, and positive body-related cognitions during both conditions were analyzed. In line with our hypotheses, the BED group verbalized more negative, and less positive and neutral body-related cognitions during the mirror exposure condition compared to the CG. Contrary to our hypotheses, though, there was a stronger increase in physiological arousal between the control and the mirror exposure condition in the CG relative to the BED group. Furthermore, a significant negative correlation between fundamental frequency and the severity of cognitive-emotional body image disturbances emerged. The findings indicate a cognitive-emotional over-involvement with physical appearance during mirror exposure in women with BED compared to weight-matched controls in the absence of a corresponding physiological pattern. Results are discussed in terms of an impaired ability of women with BED to show adequate physiological responses to body-related stress. In addition, methodological recommendations for future research are presented.
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Affiliation(s)
- Julia Baur
- Department of Clinical Psychology and Psychotherapy, University of Tuebingen, Tuebingen, Germany
| | - Kerstin Krohmer
- Department of Clinical Psychology and Psychotherapy, University of Tuebingen, Tuebingen, Germany
| | - Brunna Tuschen-Caffier
- Department of Clinical Psychology and Psychotherapy, University of Freiburg, Freiburg, Germany
| | - Jennifer Svaldi
- Department of Clinical Psychology and Psychotherapy, University of Tuebingen, Tuebingen, Germany
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16
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Albertsen MN, Natvik E, Råheim M. Patients' experiences from basic body awareness therapy in the treatment of binge eating disorder -movement toward health: a phenomenological study. J Eat Disord 2019; 7:36. [PMID: 31641506 PMCID: PMC6802330 DOI: 10.1186/s40337-019-0264-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 09/30/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Binge Eating Disorder (BED) is the most common eating disorder. Patients with BED are often not diagnosed, nor offered adequate specific treatment. A great number of those who receive recommended treatment do not recover over time. More knowledge about central aspects of BED, and treatments that specifically target such aspects is needed. Previous research has linked body experience to the development and maintenance of eating disorders, as well as influencing treatment results and the risk of relapse. The aim of this study was to explore how patients with BED experience Basic Body Awareness Therapy (BBAT), which is a psychomotor physiotherapy treatment addressing body experience. METHOD In this phenomenological study, we interviewed two patients with BED in depth during and after treatment. Video observations of treatment sessions and logs written by the patients were used as supporting data. The analysis was guided by Van Manen's hermeneutic phenomenology. RESULTS A meaning structure was identified: "On the way from the body as a problem to the body as a possibility." The two participants that besides BED also had a history of childhood trauma, perceived BBAT as a process of getting to know their own bodies in new ways, and described that the way they related to their own body changed as did aspects of their way of being. These changes were prominent when the participants described emotions, movement, pain, calmness, and self-experience, and interwoven with relational aspects as well as practices in everyday life. CONCLUSION The present results indicate that BBAT stimulated body experience in a way that opened new possibilities for two participants with BED, and hence that BBAT can improve the health status of BED patients also suffering from childhood trauma.
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Affiliation(s)
- Marit Nilsen Albertsen
- 1Department of Global Health and Primary Care, University of Bergen, Bergen, Norway.,Present address: Department of Eating Disorders, Division of Psychiatry, Haukeland University Hospital, Institute of Psychological Counselling , Bergen, Norway
| | - Eli Natvik
- 3Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Førde, Norway
| | - Målfrid Råheim
- 4Department of Global Health and Primary Care, University of Bergen, Bergen, Norway
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17
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Imperatori C, Mancini M, Della Marca G, Valenti EM, Farina B. Feedback-Based Treatments for Eating Disorders and Related Symptoms: A Systematic Review of the Literature. Nutrients 2018; 10:E1806. [PMID: 30463330 PMCID: PMC6265864 DOI: 10.3390/nu10111806] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 11/15/2018] [Accepted: 11/16/2018] [Indexed: 01/27/2023] Open
Abstract
The effectiveness of biofeedback and neurofeedback has been investigated in a range of psychiatric disorders. However, to date, there are few studies on the clinical usefulness of feedback-based techniques for eating disorders (EDs) and EDs-related symptoms (e.g., food craving). A systematic search of PubMed, Scopus and PsychINFO identified 162 articles. Among these, thirteen studies exploring the therapeutic use of biofeedback and neurofeedback in EDs or EDs-related symptoms were included. Biofeedback and neurofeedback were implemented respectively in five and eight of all reviewed articles. No studies incorporated different feedback modalities or both biofeedback and neurofeedback. The considered studies provide preliminary data of the usefulness of feedback-based techniques in the treatment of several dysfunctional eating behaviors (e.g., food craving, rumination). Although no significant effect has been reported for other important EDs-related symptoms (i.e., body image disturbance), feedback-based techniques are also associated with significant modifications of both sympathetic reaction to food-related stimuli and brain activity in several regions of the reward system (e.g., insula). Taken together the results of the present review suggest that feedback-based treatments may be useful in the treatment of several dysfunctional eating behaviors operating both on top-down and bottom-up individual coping strategies. Methodological and clinical issues are also discussed.
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Affiliation(s)
- Claudio Imperatori
- Department of Human Sciences, European University of Rome, Via degli Aldobrandeschi 190, 00163 Roma, Italy.
| | - Miranda Mancini
- Department of Human Sciences, European University of Rome, Via degli Aldobrandeschi 190, 00163 Roma, Italy.
| | - Giacomo Della Marca
- Sleep Disorders Unit, Institute of Neurology, Catholic University, 00153 Rome, Italy.
| | - Enrico Maria Valenti
- Department of Human Sciences, European University of Rome, Via degli Aldobrandeschi 190, 00163 Roma, Italy.
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, 00185 Rome, Italy.
| | - Benedetto Farina
- Department of Human Sciences, European University of Rome, Via degli Aldobrandeschi 190, 00163 Roma, Italy.
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Imperatori C, Innamorati M, Lamis DA, Farina B, Fabbricatore M, Contardi A. Body uneasiness is associated with food addiction symptoms: A cross-sectional study. EUROPEAN EATING DISORDERS REVIEW 2018; 26:638-644. [DOI: 10.1002/erv.2640] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 06/19/2018] [Accepted: 08/22/2018] [Indexed: 12/15/2022]
Affiliation(s)
| | - Marco Innamorati
- Department of Human Sciences; European University of Rome; Rome Italy
| | - Dorian A. Lamis
- Department of Psychiatry and Behavioral Sciences; Emory University School of Medicine; Atlanta Georgia
| | - Benedetto Farina
- Department of Human Sciences; European University of Rome; Rome Italy
| | | | - Anna Contardi
- Department of Human Sciences; European University of Rome; Rome Italy
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19
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Lewer M, Bauer A, Hartmann AS, Vocks S. Different Facets of Body Image Disturbance in Binge Eating Disorder: A Review. Nutrients 2017; 9:nu9121294. [PMID: 29182531 PMCID: PMC5748745 DOI: 10.3390/nu9121294] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Revised: 11/11/2017] [Accepted: 11/20/2017] [Indexed: 01/22/2023] Open
Abstract
The goal of the present review is to give an overview of the current findings on various facets of body image disturbance in Binge Eating Disorder such as body dissatisfaction, overconcern with weight and shape, body-related checking and avoidance behavior, misperception of body size, and body-related cognitive bias. In addition, treatments for a disturbed body image in BED and evidence of body image disturbance in youth with binge eating are reviewed. The results show that a disturbed body image in BED is present in the form of overconcern with weight and shape. Furthermore, there are hints that body dissatisfaction, as well as body-related checking and avoidance behavior, are also impaired. Research concerning misperception of body size in BED has been neglected so far, but first findings show that individuals with BED rate their own body shape rather accurately. Furthermore, there are first hints that body-related cognitive biases are present in individuals with BED. Moreover, in children and adolescents, there are first hints that body dissatisfaction, as well as shape and weight concerns, seem to be associated with loss of control and binge eating. Treatments aimed directly at the convertibility of a disturbed body image in BED have revealed encouraging outcomes. In conclusion, body image disturbance seems to occur in BED, and first studies show that it can be treated effectively.
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Affiliation(s)
- Merle Lewer
- Department of Clinical Psychology and Psychotherapy, Ruhr-Universität Bochum, Mental Health Research and Treatment Center, Massenbergstr, 9-13, D-44787 Bochum, Germany.
| | - Anika Bauer
- Department of Clinical Psychology and Psychotherapy, Universität Osnabrück, Knollstr. 52, D-49069 Osnabrück, Germany.
| | - Andrea S Hartmann
- Department of Clinical Psychology and Psychotherapy, Universität Osnabrück, Knollstr. 52, D-49069 Osnabrück, Germany.
| | - Silja Vocks
- Department of Clinical Psychology and Psychotherapy, Universität Osnabrück, Knollstr. 52, D-49069 Osnabrück, Germany.
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