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Kauczor-Rieck K, Allroggen M, Gradl-Dietsch G. [Sports and Physical Exercise Therapy in the Treatment of Mental Health Issues in Children and Adolescents]. ZEITSCHRIFT FUR KINDER- UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2024; 52:110-123. [PMID: 38224568 DOI: 10.1024/1422-4917/a000961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2024]
Abstract
Sports and Physical Exercise Therapy in the Treatment of Mental Health Issues in Children and Adolescents Abstract: Mental disorders are among the most common chronic diseases in childhood and adolescence in Germany and worldwide. The health benefits of a physically active lifestyle during adolescence are well documented. Furthermore, a growing body of evidence suggests a positive impact of physical activity on mental health and emotional well-being. Longitudinal studies also show an association between physical activity and reduced risk of developing a mental disorder. Therefore, therapeutic exercise plays an important role in child and adolescent psychiatry. High-quality randomized-controlled trials are needed to substantiate the described effects.
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Affiliation(s)
- Katja Kauczor-Rieck
- Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Klinik für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie, Homburg, Deutschland
| | - Marc Allroggen
- Universitätsklinik Ulm, Kinder- und Jugendpsychiatrie/Psychotherapie, Ulm, Deutschland
| | - Gertraud Gradl-Dietsch
- LVR-Klinikum Essen, Kliniken und Institut der Universität Duisburg-Essen, Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters, Essen, Deutschland
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2
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Harris A, Mannan H, Hay P, Aouad P, Arcelus J, Attia E, Crosby R, Madden S, Meyer C, Touyz S. Assessment and treatment of compulsive exercise in anorexia nervosa - A combined investigation of Compulsive Exercise Activity Therapy (LEAP) and Compulsive Exercise Test subscales. Eat Behav 2024; 52:101825. [PMID: 38006774 DOI: 10.1016/j.eatbeh.2023.101825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 11/05/2023] [Accepted: 11/10/2023] [Indexed: 11/27/2023]
Abstract
INTRODUCTION Compulsive exercise is a transdiagnostic feature of eating disorders which adversely affects aspects of recovery, such as length of hospitalisation, risk of a chronic outcome, and risk of relapse. CompuLsive Exercise Activity TheraPy (LEAP) aims to reduce compulsive exercise through a cognitive behavioural approach. This study aims to investigate the effect of LEAP on compulsive exercise behaviour using subscales of the Compulsive Exercise Test (CET), a measure of exercise in individuals with eating disorders. Predictive validity of the CET's subscales and its ability to predict eating psychopathology are investigated. METHOD This study used data from a randomized controlled trial of LEAP (1). Linear mixed modelling was used to investigate the effect of LEAP on compulsive exercise behaviour, and the predictive ability of CET subscales on various outcomes. The CET was compared to other exercise measures to assess its superiority in predicting eating psychopathology. RESULTS LEAP was superior in reducing the scores of the CET's Avoidance and Rule Driven Behaviour and Exercise Rigidity subscales. All subscales made a contribution to the respective models. The CET was superior to other measures in predicting eating pathology. CONCLUSION The results lend credibility to LEAP's ability to reduce core parts of compulsive exercise. The CET has been found to target important aspects of compulsive exercise behaviour, and has was superior to other exercise measures in predicting eating psychopathology.
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Affiliation(s)
| | - Haider Mannan
- Translational Health Research Institute, School of Medicine, Western Sydney University.
| | - Phillipa Hay
- Translational Health Research Institute, School of Medicine, Western Sydney University; Mental Health Services, SWSLHD, Campbellown, Australia.
| | - Phillip Aouad
- The University of Sydney, Australia; InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, University of Sydney and Sydney Local Health District.
| | - Jon Arcelus
- Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom.
| | - Evelyn Attia
- New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, USA; Weill Cornell Medical College, New York, USA.
| | - Ross Crosby
- Center for Biobehavioral Research, Sanford Research, Fargo, North Dakota, USA; Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota, USA.
| | - Sloane Madden
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
| | - Caroline Meyer
- International Digital Laboratory, The University of Warwick, Coventry CV4 7AL, UK.
| | - Stephen Touyz
- The University of Sydney, Australia; InsideOut Institute for Eating Disorders, Faculty of Medicine and Health, University of Sydney and Sydney Local Health District.
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Gorrell S, Rienecke RD, Duffy A, Huston E, Mehler PS, Johnson C, Manwaring J, McClanahan S, Blalock DV, Le Grange D. Understanding non-routine discharge: Factors that are associated with premature termination from higher levels of care in adults with anorexia nervosa. Eat Disord 2022; 30:686-699. [PMID: 35175902 PMCID: PMC9869711 DOI: 10.1080/10640266.2021.2011648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
This study sought to replicate and extend associations between clinical and demographic features at admission and types of premature treatment termination for adults diagnosed with anorexia nervosa (AN) in higher-level-of-care settings. Secondary data analyses examined a study population comprised of adults with AN (N = 565) who were admitted to one of two United States eating disorder treatment centers (April 2015-April 2020) for intensive outpatient, partial hospitalization, residential, or inpatient services. There were no significant differences in the type of non-routine discharge according to level of care. At admission, those with lower BMI were more likely to discharge against medical advice, and those with lower cognitive restraint and elevated binge eating were more likely to discharge against medical advice or by staff-initiated request, respectively. Discharge by parent/patient request was more likely among those who were older or who reported lower baseline desire for muscularity. Overall older age, elevated binge eating, and lower weight, desire for muscularity, and cognitive restraint may be associated with less tolerance/acceptability for AN treatment. Increased understanding of how to better support patients who admit to higher levels of care with these clinical features will contribute to better odds of completion of a full course of treatment.
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Affiliation(s)
- Sasha Gorrell
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA
| | - Renee D Rienecke
- Eating Recovery Center/Pathlight Mood & Anxiety Center, Denver, Colorado, USA
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, Illinois, USA
| | - Alan Duffy
- Eating Recovery Center/Pathlight Mood & Anxiety Center, Denver, Colorado, USA
| | - Emma Huston
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA
- Department of Psychology and Counseling, Palo Alto University, PGSP - Stanford PsyD Consortium, Palo Alto, California, USA
| | - Philip S Mehler
- Eating Recovery Center/Pathlight Mood & Anxiety Center, Denver, Colorado, USA
- Acute Center for Eating Disorders at Denver Health, Denver, Colorado, USA
- University of Colorado School of Medicine, Denver, Colorado, USA
| | - Craig Johnson
- Eating Recovery Center/Pathlight Mood & Anxiety Center, Denver, Colorado, USA
| | - Jamie Manwaring
- Eating Recovery Center/Pathlight Mood & Anxiety Center, Denver, Colorado, USA
| | - Susan McClanahan
- Eating Recovery Center/Pathlight Mood & Anxiety Center, Denver, Colorado, USA
| | - Dan V Blalock
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, Durham, North Carolina, USA
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, USA
| | - Daniel Le Grange
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA
- Department of Psychiatry & Behavioral Neuroscience, The University of Chicago (Emeritus), Chicago, Illinois, USA
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Staples C, Palermo M, Rancourt D. Intrinsic and extrinsic motivations as moderators of the association between exercise frequency and exercise behavior. Eat Weight Disord 2022; 27:2801-2809. [PMID: 35776380 DOI: 10.1007/s40519-022-01430-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 06/03/2022] [Indexed: 11/28/2022] Open
Abstract
PURPOSE Motivations underlying exercise may contribute to the extent to which exercise is maladaptive, independent of exercise frequency. Extrinsic and intrinsic exercise motivation may independently moderate associations between exercise frequency and 1) compulsive and 2) healthy exercise. It was expected that among individuals with high extrinsic motivation, greater exercise frequency would be associated with more compulsive exercise, whereas among individuals with high intrinsic motivation, greater exercise frequency would be associated with more healthy exercise. METHODS A total of 446 university students (50.9% female; 67.0% White) completed measures of intrinsic and extrinsic exercise motivations, exercise frequency, compulsive exercise, and healthy exercise. Intrinsic and extrinsic motivations for exercise were entered as simultaneous independent moderators of the associations between exercise frequency and 1) compulsive exercise and 2) healthy exercise in multiple linear regressions. RESULTS Moderation effects of exercise motivation were not supported for compulsive exercise. Only main effects of frequency (b = 0.04, p < 0.01) and extrinsic motivation (b = 0.27, p < 0.01) were observed. Intrinsic motivation moderated the association between frequency and healthy exercise (b = -0.02, p = 0.03). Among individuals with lower intrinsic motivation, greater frequency was related to more healthy exercise. This association was significantly weaker among individuals with high intrinsic motivation. CONCLUSION Consistent with theory and extant work, extrinsic motivation was associated with compulsive exercise, while intrinsic motivation was associated with healthy exercise. Clinically, assessing the extent to which exercise is intrinsically or extrinsically motivated may help identify whether individuals may be more likely to engage in compulsive versus healthy exercise. Results support the importance of exploring the exercise motivations as predictors of compulsive and healthy exercise. LEVEL OF EVIDENCE Level V, Descriptive Cross-Sectional Study.
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Affiliation(s)
- Cody Staples
- Department of Psychology, University of South Florida, Tampa, FL, USA.
| | - Madeline Palermo
- Department of Psychology, University of South Florida, Tampa, FL, USA
| | - Diana Rancourt
- Department of Psychology, University of South Florida, Tampa, FL, USA
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Ouellet M, Monthuy-Blanc J. Quand bouger n’est plus synonyme de santé : une recension des traitements de l’exercice physique pathologique en troubles des conduites alimentaires. ANNALES MEDICO-PSYCHOLOGIQUES 2022. [DOI: 10.1016/j.amp.2022.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Toutain M, Gauthier A, Leconte P. Exercise therapy in the treatment of anorexia nervosa: Its effects depending on the type of physical exercise-A systematic review. Front Psychiatry 2022; 13:939856. [PMID: 36339831 PMCID: PMC9627498 DOI: 10.3389/fpsyt.2022.939856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 09/12/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND AND PURPOSE Clinical research focusing on the effectiveness of exercise therapy (ET) in patients with anorexia nervosa (AN) shows increasing interest in the last decade. The aim of this systematic review was to provide an overview of quantitative studies that have examined the impact of ET in AN patients and to examine its specific effects on physical and mental health according to the type of physical exercise (PE) practiced. METHODS The review was carried out based on the PRISMA 2020. Electronic databases PubMed, Web of Science, Embase, and Wiley were searched from inception to December 2021. Quantitative studies assessing the effects of ET interventions on AN patients were included and study quality was assessed using the PEDro scale. RESULTS A total of 27 studies were selected, including 13 randomized controlled trials. Regarding outcomes measured, results showed that aerobic and resistance exercise improved muscle strength, that mind-body PE decreased main symptoms of AN and mental health, and that combined PE reduced dysfunctional exercise and improved weight gain. CONCLUSION The findings suggest that ET intervention can induce benefits and has no deleterious effects on patients. In addition, specific effects on anorexia symptoms and physical and mental health have been observed according to the type of PE. However, this review reported several methodological weaknesses, including a lack of control group or randomization and statistical misconduct. Finally, ET intervention parameters were heterogeneous, and ET intervention generally lacked details, making reproducibility and comparability difficult. All these limitations underscore the need for a more rigorous methodology for further research.
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Affiliation(s)
- Marc Toutain
- UNICAEN, INSERM, COMETE, GIP CYCERON, Normandie University, Caen, France
| | - Antoine Gauthier
- UNICAEN, INSERM, COMETE, GIP CYCERON, Normandie University, Caen, France
| | - Pascale Leconte
- UNICAEN, INSERM, COMETE, GIP CYCERON, Normandie University, Caen, France
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Beeler JA, Mourra D, Zanca RM, Kalmbach A, Gellman C, Klein BY, Ravenelle R, Serrano P, Moore H, Rayport S, Mingote S, Burghardt NS. Vulnerable and Resilient Phenotypes in a Mouse Model of Anorexia Nervosa. Biol Psychiatry 2021; 90:829-842. [PMID: 32950210 PMCID: PMC7855473 DOI: 10.1016/j.biopsych.2020.06.030] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 06/26/2020] [Accepted: 06/30/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Increased physical activity is a common feature of anorexia nervosa (AN). Although high activity levels are associated with greater risk of developing AN, particularly when combined with dieting, most individuals who diet and exercise maintain a healthy body weight. It is unclear why some individuals develop AN while most do not. A rodent model of resilience and vulnerability to AN would be valuable to research. Dopamine, which is believed to play a crucial role in AN, regulates both reward and activity and may modulate vulnerability. METHODS Adolescent and young adult female C57BL/6N mice were tested in the activity-based anorexia (ABA) model, with an extended period of food restriction in adult mice. ABA was also tested in dopamine transporter knockdown mice and wild-type littermates. Mice that adapted to conditions and maintained a stable body weight were characterized as resilient. RESULTS In adults, vulnerable and resilient phenotypes emerged in both the ABA and food-restricted mice without wheels. Vulnerable mice exhibited a pronounced increase in running throughout the light cycle, which dramatically peaked prior to requiring removal from the experiment. Resilient mice exhibited an adaptive decrease in total running, appropriate food anticipatory activity, and increased consumption, thereby achieving stable body weight. Hyperdopaminergia accelerated progression of the vulnerable phenotype. CONCLUSIONS Our demonstration of distinct resilient and vulnerable phenotypes in mouse ABA significantly advances the utility of the model for identifying genes and neural substrates mediating AN risk and resilience. Modulation of dopamine may play a central role in the underlying circuit.
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Affiliation(s)
- Jeff A. Beeler
- Dept. of Psychology, Queens College and The Graduate Center, CUNY, Flushing, NY, 11367 USA
| | - Devry Mourra
- Dept. of Psychology, Queens College and The Graduate Center, CUNY, Flushing, NY, 11367 USA
| | - Roseanna M. Zanca
- Dept. of Psychology, Hunter College and The Graduate Center, CUNY, New York, NY, 10065 USA
| | - Abigail Kalmbach
- Dept. of Psychiatry, Columbia University, New York, NY, 10032 USA
| | - Celia Gellman
- Dept. of Psychiatry, Columbia University, New York, NY, 10032 USA,Dept. of Molecular Therapeutics, NYS Psychiatric Institute, New York, NY 10032 USA
| | - Benjamin Y. Klein
- Dept. of Psychiatry, Columbia University, New York, NY, 10032 USA,Dept. of Developmental Neuroscience, NYS Psychiatric Institute, New York, NY 10031 USA,Dept. of Microbiology and Molecular Genetics, Hebrew University, Jerusalem, Israel
| | | | - Peter Serrano
- Dept. of Psychology, Hunter College and The Graduate Center, CUNY, New York, NY, 10065 USA
| | - Holly Moore
- Dept. of Psychiatry, Columbia University, New York, NY, 10032 USA,Dept. of Systems Neuroscience, NYS Psychiatric Institute, New York, NY 10032 USA,National Institute on Drug Abuse, Bethesda, MD
| | - Stephen Rayport
- Dept. of Psychiatry, Columbia University, New York, NY, 10032 USA,Dept. of Molecular Therapeutics, NYS Psychiatric Institute, New York, NY 10032 USA
| | - Susana Mingote
- Dept. of Psychiatry, Columbia University, New York, NY, 10032 USA,Dept. of Molecular Therapeutics, NYS Psychiatric Institute, New York, NY 10032 USA,Advanced Science Research Center, The Graduate Center, CUNY, New York, NY 10031 USA
| | - Nesha S. Burghardt
- Dept. of Psychology, Hunter College and The Graduate Center, CUNY, New York, NY, 10065 USA,Dept. of Psychiatry, Columbia University, New York, NY, 10032 USA
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Bergmeier HJ, Morris H, Mundell N, Skouteris H. What role can accredited exercise physiologists play in the treatment of eating disorders? A descriptive study. Eat Disord 2021; 29:561-579. [PMID: 31818224 DOI: 10.1080/10640266.2019.1701351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Including exercise alongside other therapeutic approaches may help to address dysfunctional exercise use and improve eating disorder treatment outcomes. However, traditional treatment teams often lack the expertise needed to safely prescribe exercise. The aims of this study were to explore the perceptions and experiences of Accredited Exercise Physiologists (AEPs) relating to working with clients diagnosed with eating disorders to identify the role they play in the treatment of eating disorders and identify future training needs. Individual semi-structured telephone interviews were conducted with 12 (n = 9 females) AEPs working in the eating disorders field. Thematic analysis was conducted to extract major themes from the interview transcripts. Five major themes were identified: (1) The role of AEPs in the treatment of individuals with eating disorders is comprehensive; (2) Treatment is more effective when all components are addressed; (3) The absence of therapeutic exercise within standard treatment protocols reflects limitations of traditional scope of practice and knowledge about the role of AEPs; (4) Methods of acquiring further knowledge are insufficient for those in current practice; and (5) Accredited comprehensive training is currently unavailable but needed. This qualitative study showed that AEPs believe they can play a major role in the treatment of eating disorders and that treatment outcomes for individuals are likely to be greatly enhanced when dysfunctional exercise is addressed. Multidisciplinary training is needed.
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Affiliation(s)
- Heidi J Bergmeier
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Australia
| | - Heather Morris
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Australia
| | - Niamh Mundell
- Institute for Physical Activity and Nutrition, Deakin University, Burwood, Australia
| | - Helen Skouteris
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Australia
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Puttevils L, Vanderhasselt MA, Horczak P, Vervaet M. Differences in the use of emotion regulation strategies between anorexia and bulimia nervosa: A systematic review and meta-analysis. Compr Psychiatry 2021; 109:152262. [PMID: 34265598 DOI: 10.1016/j.comppsych.2021.152262] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 06/08/2021] [Accepted: 07/05/2021] [Indexed: 02/09/2023] Open
Abstract
OBJECTIVE Research has identified abnormal emotion regulation (ER) as an underlying mechanism in the onset and maintenance of eating disorders. Yet, it still remains unclear whether different forms of ER, adaptive and maladaptive strategies, are similar across categories of eating disorders. METHOD A systematic review and meta-analysis were carried out to look at ER differences between anorexia nervosa (AN) and bulimia nervosa (BN), two common eating disorder pathologies with different eating patterns. RESULTS 41 studies were included in the meta-analysis. The results revealed no differences in the use of maladaptive ER strategies between individuals with AN and BN, however patients with AN tend to use less adaptive ER strategies as compared to patients with BN. CONCLUSIONS Making less use of adaptive strategies in AN might be due to low body weight and high levels of alexithymia which define AN. In order to improve treatment outcome in individuals suffering from AN, these findings suggest to focus more on improving the use of adaptive ER strategies.
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Affiliation(s)
- Louise Puttevils
- Department of Head and Skin, Ghent University, Belgium; Ghent Experimental Psychiatry (GHEP) lab, Belgium.
| | - Marie-Anne Vanderhasselt
- Department of Head and Skin, Ghent University, Belgium; Ghent Experimental Psychiatry (GHEP) lab, Belgium; Department of Experimental-Clinical and Health Psychology, Ghent University, Belgium
| | - Paula Horczak
- Department of Head and Skin, Ghent University, Belgium; Ghent Experimental Psychiatry (GHEP) lab, Belgium
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10
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Examining the impact of weight bias on the association between exercise identity and maladaptive exercise behaviors. Eat Behav 2021; 41:101503. [PMID: 33836341 DOI: 10.1016/j.eatbeh.2021.101503] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 03/09/2021] [Accepted: 03/25/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Though exercise behaviors are typically viewed as health-promoting, certain forms of exercise (i.e., excessive exercise, unhealthy muscle-building behaviors) are considered maladaptive and are associated with negative physical and psychological outcomes. Psychosocial factors may put people at greater risk for engaging in maladaptive exercise. Based on deviance regulation theory, weight bias was examined as a potential moderator of the association between exercise identity and both excessive exercise and muscle-building behaviors. DESIGN The current study is a secondary analysis of a larger data set investigating associations between athletic identity, exercise behaviors, and disordered eating behaviors. Hypotheses were examined using moderation testing in multiple linear regression. MAIN OUTCOME MEASURES Participants (N = 225, 50.2% female) completed the Eating Pathology Symptoms Inventory as a measure of maladaptive exercise. RESULTS Controlling for sex, age, athlete status, and body mass index, weight bias moderated the association between exercise identity and both excessive exercise and muscle-building behaviors. Among individuals with high exercise identity, higher weight bias was associated with increased maladaptive exercise behaviors. CONCLUSION Individuals with higher exercise identity and higher weight bias may be at greatest risk of engaging in maladaptive exercise. Preventive interventions for maladaptive exercise behaviors may consider targeting exercise identity and weight bias.
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Dittmer N, Voderholzer U, Mönch C, Cuntz U, Jacobi C, Schlegl S. Efficacy of a Specialized Group Intervention for Compulsive Exercise in Inpatients with Anorexia Nervosa: A Randomized Controlled Trial. PSYCHOTHERAPY AND PSYCHOSOMATICS 2021; 89:161-173. [PMID: 32036375 DOI: 10.1159/000504583] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 11/05/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Treatment of compulsive exercise is recognized as a key unmet challenge in the treatment of anorexia nervosa (AN). To address this challenge, we developed the manualized group intervention "healthy exercise behavior" (HEB). This study evaluates the efficacy of HEB for the reduction of compulsive exercise as add-on to routine inpatient treatment (treatment as usual [TAU]) in a randomized controlled trial. METHODS Two hundred and seven adolescent and adult female inpatients with (atypical) AN were randomly allocated to TAU or to additional participation in HEB (TAU + HEB). HEB integrates elements of exercise-based therapy into a cognitive-behavioral approach. Assessments took place at admission, pre-intervention, post-intervention, discharge, and 6 months follow-up. Primary outcome was the severity of compulsive exercise assessed by the Commitment to Exercise Scale between pre- and post-intervention; secondary outcomes were additional aspects of compulsive exercise, assessed by the Compulsive Exercise Test, weight gain, eating disorder and general psychopathology, and emotion regulation. RESULTS In intention-to-treat analysis for the primary outcome, the TAU + HEB group showed significantly stronger reductions in the severity of compulsive exercise compared to the TAU group (z = -2.81; p = 0.005; effect size [ES] = -0.3). We also found significantly stronger reductions from admission to discharge (z= 2.62; p = 0.009; ES = -0.43), and from admission to follow-up (z = 2.1; p = 0.035; ES = -0.39). Regarding secondary outcomes, we found significant group differences between pre- and post-intervention in additional aspects of compulsive exercise (z = -2.55; p = 0.011; ES = -0.27). We did not find significant differences regarding weight gain, eating disorder and general psychopathology, and emotion regulation. CONCLUSIONS Our intervention proved efficacious in reducing compulsive exercise in inpatients with (atypical) AN.
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Affiliation(s)
- Nina Dittmer
- Schoen Clinic Roseneck, Prien am Chiemsee, Germany, .,Department of Clinical Psychology and E-Mental-Health, Technische Universität Dresden, Dresden, Germany,
| | - Ulrich Voderholzer
- Schoen Clinic Roseneck, Prien am Chiemsee, Germany.,Department of Psychiatry and Psychotherapy, University Hospital of Freiburg, Freiburg, Germany.,Department of Psychiatry and Psychotherapy, University Hospital of Munich (LMU), Munich, Germany
| | | | - Ulrich Cuntz
- Schoen Clinic Roseneck, Prien am Chiemsee, Germany.,Paracelsus Medical University, Salzburg, Austria
| | - Corinna Jacobi
- Department of Clinical Psychology and E-Mental-Health, Technische Universität Dresden, Dresden, Germany
| | - Sandra Schlegl
- Department of Psychiatry and Psychotherapy, University Hospital of Munich (LMU), Munich, Germany
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Mang L, Garghan A, Grant J, Lacey H, Matthews R. An evaluation of efficacy and acceptability of a novel manualised JuniorLEAP group programme for compulsive exercise, for children and adolescents with anorexia nervosa, within an inpatient setting. Eat Weight Disord 2021; 26:591-597. [PMID: 32232776 DOI: 10.1007/s40519-020-00884-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 02/26/2020] [Indexed: 01/15/2023] Open
Abstract
PURPOSE Compulsive exercise is a symptom and a maintenance factor of eating disorders, which increases the risk of relapse. It has been considered a target for treatment, particularly for anorexia nervosa (AN). This audit aims to review the efficacy and acceptability of a new seven-week JuniorLEAP group therapy programme, for children and adolescents with anorexia nervosa. JuniorLEAP was adapted by the authors and based on the Loughborough Eating Disorder Activity Programme (LEAP) for adults. METHODS 32 children and adolescents with anorexia nervosa were allocated to the group in an in-patient setting using entry criteria. All children and adolescents completed seven weekly sessions of the JuniorLEAP programme, as well as pre- and post-treatment questionnaires, including the Eating Disorder Examination Questionnaire (EDE-Q) and the Compulsive Exercise Test (CET). The children and adolescents were also asked to provide qualitative responses about the acceptability of the group. A paired t test was conducted to review the efficacy of the JuniorLEAP programme. RESULTS Significant changes in eating disorder psychopathology was observed, as measured by the EDE-Q, with total mean scores reducing from 3.53 to 2.77 (p = 0.001). Compulsive exercise attitudes were also observed to reduce, as measured by the CET, with total mean scores reducing from 15.39 to 10.90 (p ≤ 0.001). Furthermore, there was a significant reduction in all five subscales of the CET following completion of the group. Qualitative results also demonstrate the group to be acceptable to the patients. CONCLUSION This study finds that a new manualised JuniorLEAP group therapy, specifically adapted for adolescents and children with AN, when used as an adjuvant with other therapies in a residential setting, significantly reduces their compulsive exercise, as measured by CET. The patients reported that the treatment was acceptable. Further research testing the new treatment in a randomised controlled trial is now needed, particularly to disentangle the impact of other aspects of standard treatment in reducing compulsive exercise. LEVEL OF EVIDENCE II.
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Affiliation(s)
| | | | | | - Hubert Lacey
- Newbridge House, Birmingham, UK. .,St. George's, University of London, London, UK.
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Chubbs-Payne A, Lee J, Isserlin L, Norris ML, Spettigue W, Spence K, Longmuir PE. Attitudes toward physical activity as a treatment component for adolescents with anorexia nervosa: An exploratory qualitative study of patient perceptions. Int J Eat Disord 2021; 54:336-345. [PMID: 33185901 DOI: 10.1002/eat.23411] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 10/15/2020] [Accepted: 10/31/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Anorexia nervosa (AN) with compulsive exercise is associated with poor treatment outcomes. This study sought to understand the attitudes of adolescents with AN from various stages of treatment, toward physical activity research practices and physical activity as a component of treatment. METHOD Seventeen adolescents 12-18 years old (15 female) with AN (10 with acknowledged history of compulsive exercise) were recruited from a Canadian Tertiary Care Hospital's Eating Disorder Program. Six inpatients, 5-day program patients, and six outpatients treated by either the inpatient and/or day treatment program in the past 2 years completed individual, semi-structured interviews that were audio-recorded and transcribed. Results were analyzed deductively using qualitative techniques. RESULTS Participants recognized both benefits (psychological, sociological, and physiological) and risks (trigger negative thoughts, increase competitive behavior) of implementing physical activity into acute AN treatment. Patient characteristics, such as stage of treatment and exercise history, had an impact on participants' perceptions toward physical activity in AN. Participants suggested that the ideal physical activity program would be focused on fun, individualized and progressively integrated, group-based, and directly supported by staff. Although the majority of participants stated that they would wear an activity monitor for research purposes, concerns were voiced regarding compliance and the potential impact on eating disorder symptomatology. DISCUSSION Participants overwhelmingly supported the careful implementation of structured physical activity and physical activity psychoeducation into the acute treatment of adolescents with AN. This study allows for the inclusion of patient voices in the conversation surrounding the role of physical activity in AN treatment.
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Affiliation(s)
- Adam Chubbs-Payne
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.,Department of Paediatrics, University of Ottawa's Faculty of Medicine, Ottawa, Ontario, Canada
| | - Jacqueline Lee
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Leanna Isserlin
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.,Department of Psychiatry, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.,Children's Hospital of Eastern Ontario Regional Eating Disorders Program, Ottawa, Ontario, Canada
| | - Mark L Norris
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.,Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.,Children's Hospital of Eastern Ontario Regional Eating Disorders Program, Ottawa, Ontario, Canada
| | - Wendy Spettigue
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.,Department of Psychiatry, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.,Children's Hospital of Eastern Ontario Regional Eating Disorders Program, Ottawa, Ontario, Canada
| | - Kelly Spence
- Children's Hospital of Eastern Ontario Regional Eating Disorders Program, Ottawa, Ontario, Canada
| | - Patricia E Longmuir
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.,Department of Paediatrics, University of Ottawa's Faculty of Medicine, Ottawa, Ontario, Canada
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Schaumberg K, Reilly EE, Gorrell S, Levinson CA, Farrell NR, Brown TA, Smith KM, Schaefer LM, Essayli JH, Haynos AF, Anderson LM. Conceptualizing eating disorder psychopathology using an anxiety disorders framework: Evidence and implications for exposure-based clinical research. Clin Psychol Rev 2020; 83:101952. [PMID: 33221621 DOI: 10.1016/j.cpr.2020.101952] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 11/09/2020] [Accepted: 11/09/2020] [Indexed: 12/13/2022]
Abstract
Eating disorders (EDs) and anxiety disorders (ADs) evidence shared risk and significant comorbidity. Recent advances in understanding of anxiety-based disorders may have direct application to research and treatment efforts for EDs. The current review presents an up-to-date, behavioral conceptualization of the overlap between anxiety-based disorders and EDs. We identify ways in which anxiety presents in EDs, consider differences between EDs and ADs relevant to treatment adaptions, discuss how exposure-based strategies may be adapted for use in ED treatment, and outline directions for future mechanistic, translational, and clinical ED research from this perspective. Important research directions include: simultaneous examination of the extent to which EDs are characterized by aberrant avoidance-, reward-, and/or habit-based neurobiological and behavioral processes; improvement in understanding of how nutritional status interacts with neurobiological characteristics of EDs; incorporation of a growing knowledge of biobehavioral signatures in ED treatment planning; development of more comprehensive exposure-based treatment approaches for EDs; testing whether certain exposure interventions for AD are appropriate for EDs; and improvement in clinician self-efficacy and ability to use exposure therapy for EDs.
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Affiliation(s)
| | | | - Sasha Gorrell
- University of California, San Francisco, United States of America
| | - Cheri A Levinson
- University of Louisville, Department of Psychological & Brain Sciences, United States of America
| | | | - Tiffany A Brown
- University of California, San Diego, United States of America
| | - Kathryn M Smith
- Sanford Health, United States of America; University of Southern California, United States of America
| | | | | | - Ann F Haynos
- University of Minnesota, United States of America
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15
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Zeeck A, Schlegel S, Jagau F, Lahmann C, Hartmann A. The Freiburg sport therapy program for eating disorders: a randomized controlled trial. J Eat Disord 2020; 8:31. [PMID: 32647573 PMCID: PMC7339379 DOI: 10.1186/s40337-020-00309-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 06/09/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Unhealthy attitudes towards sport and problematic exercise behavior in eating disorders (ED) are common and associated with poorer treatment outcome and higher relapse rates. There is a need to develop and empirically test interventions that could complement standard treatment. The study aimed to assess the efficacy of the Freiburg sport therapy program for eating disorders (FSTP). METHODS Outpatients with ED were randomized either to a 3 month sport therapy program (sport therapy group: STG) or a waiting list control group (CG). Patients were assessed when starting the program and at the end of the intervention. The intervention group (STG) was followed up after 6 month. Main outcome criterion was a reduction in unhealthy exercise (Commitment to Exercise Scale, CES). Secondary outcomes encompassed eating pathology (Eating Disorder Examination, EDE), different dimensions of unhealthy exercise (Compulsive Exercise Test, CET subscales) and exercise quantity (accelerometer). RESULTS Recruitment was challenging. Fifteen patients were randomized to the STG and 11 were randomized to the CG condition. There was no statistically significant difference between groups according to the main outcome criterion. However, the STG showed a significantly stronger reduction in avoidance and rule driven behavior (CET subscale) when compared to the CG. Improvements (STG) were maintained at follow up. CONCLUSIONS There was no statistically significant difference in the reduction of unhealthy attitudes towards sport and problematic exercise behavior between the intervention and the group, as measured with the Commitment to Exercise Scale. Further findings may point to the effectiveness of the program, but have to be interpreted with caution and verified in further studies. A major limitation is the small sample size. TRIAL REGISTRATION Study register: ISRCTN 14776348 (registered 26 January, 2015.
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Affiliation(s)
- Almut Zeeck
- Department of Psychosomatic Medicine und Psychotherapy, Center for Mental Health, Faculty of Medicine, University of Freiburg, Hauptstraße 8, D-79104 Freiburg, Germany
| | - Sabine Schlegel
- Department of Psychosomatic Medicine und Psychotherapy, Center for Mental Health, Faculty of Medicine, University of Freiburg, Hauptstraße 8, D-79104 Freiburg, Germany
| | - Friederike Jagau
- Department of Psychosomatic Medicine und Psychotherapy, Center for Mental Health, Faculty of Medicine, University of Freiburg, Hauptstraße 8, D-79104 Freiburg, Germany
| | - Claas Lahmann
- Department of Psychosomatic Medicine und Psychotherapy, Center for Mental Health, Faculty of Medicine, University of Freiburg, Hauptstraße 8, D-79104 Freiburg, Germany
| | - Armin Hartmann
- Department of Psychosomatic Medicine und Psychotherapy, Center for Mental Health, Faculty of Medicine, University of Freiburg, Hauptstraße 8, D-79104 Freiburg, Germany
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16
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Yun JY, Chung H, Sim JA, Yun YH. Prevalence and associated factors of depression among Korean adolescents. PLoS One 2019; 14:e0223176. [PMID: 31618232 PMCID: PMC6795486 DOI: 10.1371/journal.pone.0223176] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 09/16/2019] [Indexed: 02/06/2023] Open
Abstract
This study aimed to identify factors significantly associated with recent depressive mood with respect to health-related behavioral patterns at the individual level, perceived safety in the school environment, and willingness to share concerns with family and social networks. Self-reported responses to questions regarding recent feelings of depression, health-related behaviors in physical, psychological, and spiritual subdomains, school refusal and perceived safety at school, and perceived social support were obtained from 1,991 in-school adolescents (mean [SD] age = 15.3 [1.7] years; male/female = 936/1055). Multivariate logistic regression analyses were used to identify explanatory factors significantly associated with recent depression, defined as feelings of sadness or hopelessness for more than 2 weeks (during the last 12 months) that interfered with everyday functioning. Of the 1,991 students, 271 (13.6%) reported recent depression. Multivariate logistic regression analyses revealed higher odds of recent depression in adolescents with frequent thoughts of school refusal (odds ratio [95% confidence interval] = 3.25 [2.44-4.32]) and those who engaged in regular physical exercise (1.57 [1.19-2.07]), whereas a positive mindset (0.65 [0.49-0.86]), perceived safety at school (0.62 [0.47-0.82]), and perceived social support from one's mother (0.54 [0.40-0.72]) were associated with lower odds of recent depression. Taken together, our findings suggest that parents and teachers should talk regularly with adolescents about recent life (dis)satisfaction and stressors, particularly when they report frequent thoughts of school refusal. Perceived social support would increase perceived safety on school grounds and make it easier for teenagers to share their concerns with parents, thereby reducing the risk for depressive symptoms. School-based programs that promote a positive mindset would be helpful in preparing students for the challenges of adulthood.
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Affiliation(s)
- Je-Yeon Yun
- Seoul National University Hospital, Seoul, Republic of Korea
- Yeongeon Student Support Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Halin Chung
- Department of Biomedical Science, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jin-ah Sim
- Department of Biomedical Science, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Young Ho Yun
- Department of Biomedical Science, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Family Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Biomedical Informatics, Seoul National University College of Medicine, Seoul, Republic of Korea
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Naab S, Fumi M, Schlegl S, Voderholzer U. Stationäre Behandlung von Kindern und Jugendlichen mit Anorexia nervosa und Bulimia nervosa. KINDHEIT UND ENTWICKLUNG 2019. [DOI: 10.1026/0942-5403/a000294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Zusammenfassung. Anorexia nervosa und Bulimia nervosa betreffen vor allem Jugendliche sowie junge Erwachsene, wobei das Ersterkrankungsalter sinkt, und bei Anorexia nervosa bereits 8-Jährige betroffen sein können. Häufig ist der Verlauf chronisch und kann sowohl schwere körperliche als auch psychische Komorbiditäten nach sich ziehen. Schlimmstenfalls enden Essstörungen tödlich (je nach Schweregrad der Erkrankung Mortalitätsraten bis zu 15 % bei Anorexia nervosa). Ein frühzeitiger Therapiebeginn geht mit einer verbesserten Prognose einher, weshalb die rasche Diagnosestellung von großer Bedeutung ist. Wesentlich hierfür ist die sichere Kenntnis der Diagnosekriterien sowie der essstörungstypischen Folgen. Es werden Aspekte der Symptomatik, Diagnostik, Differentialdiagnostik, Epidemiologie, Pathogenese, Funktionalität, sowie Therapiemöglichkeiten und eigene sowie internationale Studienergebnisse mit Schwerpunkt auf der stationären Therapie von Jugendlichen mit Anorexia nervosa und Bulimia nervosa ausgeführt.
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Affiliation(s)
| | | | - Sandra Schlegl
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Ludwig-Maximilians-Universität München
| | - Ulrich Voderholzer
- Schön Klinik Roseneck, Prien
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Ludwig-Maximilians-Universität München
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Albert-Ludwigs-Universität Freiburg
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18
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Fumi M, Naab S, Voderholzer U. [Eating disorders]. MMW Fortschr Med 2018; 160:62-70. [PMID: 29582314 DOI: 10.1007/s15006-018-0011-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Markus Fumi
- Schön Klinik Roseneck, Am Roseneck 6, D-83209, Prien am Chiemsee, Deutschland
| | - Silke Naab
- Schön Klinik Roseneck, Am Roseneck 6, D-83209, Prien am Chiemsee, Deutschland
| | - Ulrich Voderholzer
- Schön Klinik Roseneck, Am Roseneck 6, D-83209, Prien am Chiemsee, Deutschland.
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19
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Dittmer N, Jacobi C, Voderholzer U. Compulsive exercise in eating disorders: proposal for a definition and a clinical assessment. J Eat Disord 2018; 6:42. [PMID: 30505444 PMCID: PMC6260729 DOI: 10.1186/s40337-018-0219-x] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Accepted: 09/11/2018] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Compulsive exercise has been recognized as a highly prevalent symptom in eating disorders (ED) for over 100 years and is associated with poor short-term and long-term treatment outcome. Progress in understanding and treatment of compulsive exercise will remain limited as long as no consensus framework for definition and assessment of compulsive exercise exists, as results cannot be compared across clinical studies.Based on existing literature, it was our aim to propose a transdiagnostic definition and a clinical assessment for compulsive exercise, that can be applied to adolescent and adult patients with ED. METHOD During a series of meetings of experienced clinicians at a highly specialized hospital for eating disorders, we elaborated a transdiagnostic definition of compulsive exercise in ED. Additionally, we derived a clinical interview for the assessment of compulsive exercise and its different subtypes. RESULTS The core criterion when defining and assessing compulsive exercise is a pathologically increased exercise pattern characterized by 1) excessive exercise that a patient feels driven to perform in response to an obsession or according to rules that must be applied rigidly, and 2) exercise that is aimed at preventing or reducing distress or at preventing some dreaded consequence. A second necessary criterion is the physical or psychological burden caused by compulsive exercise, i.e., that it is time-consuming, significantly interferes with the patient's daily routine, occupational functioning or social relationships or is continued despite medical injury, illness, or lack of enjoyment. Insight that compulsive exercise is excessive or unreasonable was added as an optional criterion.Compulsive exercise manifests itself in three different subtypes: 1) vigorous exercise, 2) marked increase in daily movement, or 3) motor restlessness.The above criteria must be met during the past 6 months, together with one of the three subtypes of compulsive exercise. CONCLUSIONS The proposed criteria aim to foster the discussion around definition and assessment of compulsive exercise with the goal of reaching an international consensus in the near future.Providing a consistent framework for researchers and clinicians would considerably advance understanding and treatment of compulsive exercise in ED patients.
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Affiliation(s)
- Nina Dittmer
- Schoen Clinic Roseneck, Am Roseneck 6, Prien am Chiemsee, Germany.,2Department of Clinical Psychology and E-Mental-Health, Technische Universität Dresden, Dresden, Germany
| | - Corinna Jacobi
- 2Department of Clinical Psychology and E-Mental-Health, Technische Universität Dresden, Dresden, Germany
| | - Ulrich Voderholzer
- Schoen Clinic Roseneck, Am Roseneck 6, Prien am Chiemsee, Germany.,3Department of Psychiatry and Psychotherapy, University of Freiburg, Freiburg, Germany.,4Department of Psychiatry and Psychotherapy, University of Munich (LMU), Munich, Germany
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