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Smith KE, Goldschmidt AB. Treatment of Binge-Eating Disorder Across the Lifespan: An Updated Review of the Literature and Considerations for Future Research. Curr Obes Rep 2024; 13:195-202. [PMID: 38363468 PMCID: PMC11150297 DOI: 10.1007/s13679-024-00553-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/08/2024] [Indexed: 02/17/2024]
Abstract
PURPOSE OF REVIEW The present review describes the recent literature on treatment for binge-eating disorder (BED) in adults and youth, with a particular focus on research gaps, emerging treatments, and future research directions. RECENT FINDINGS Evidence supports the efficacy of several treatment modalities in adults, including self-help treatment, clinician-led psychotherapy, and pharmacotherapy; the largest effect sizes have been found for psychotherapies, most of which were cognitive-behavioral in orientation. Adapted psychotherapies for youth also show promise but lack a robust body of evidence. Predictors, moderators, and mediators of treatment outcome remain poorly understood; individuals with BED continue to experience significant barriers to treatment; and research is needed to address suboptimal treatment response. Recent work has highlighted the potential of adaptive interventions and investigation of novel mechanisms to address these gaps. Research on BED treatment continues to grow, though critical questions must be answered to improve treatment efficacy across the lifespan.
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Affiliation(s)
- Kathryn E Smith
- Department of Psychiatry and Behavioral Sciences, University of Southern California, 2250 Alcazar St #2200, Los Angeles, CA, 90033, USA.
| | - Andrea B Goldschmidt
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Bartholomay J, Schaefer LM, Forester G, Crosby RD, Peterson CB, Crow SJ, Engel SG, Wonderlich SA. Evaluating dietary restriction as a maintaining factor in binge-eating disorder. Int J Eat Disord 2024; 57:1172-1180. [PMID: 37974447 PMCID: PMC11093702 DOI: 10.1002/eat.24094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 11/02/2023] [Accepted: 11/02/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVE Prominent theories of binge-eating (BE) maintenance highlight dietary restriction as a key precipitant of BE episodes. Consequently, treatment approaches for eating disorders (including binge-eating disorder; BED) seek to reduce dietary restriction in order to improve BE symptoms. The present study tested the hypothesis that dietary restriction promotes BE among 112 individuals with BED. METHODS Participants completed a 7-day ecological momentary assessment (EMA) protocol before and after completing 17 weeks of either Integrative Cognitive-Affective Therapy or guided self-help cognitive behavioral therapy. Analyses examined whether dietary restriction on 1 day of the baseline EMA protocol predicted risk for BE later that same day, and on the following day. Changes in dietary restriction over the course of treatment were also evaluated as a predictor of change in BE from pre-treatment to post-treatment. Baseline dietary restraint was examined as a moderator of the above associations. RESULTS Dietary restriction did not predict BE later the same day, and changes in restriction were not related to changes in BE across treatment, regardless of baseline dietary restraint levels. Restriction on 1 day did predict increased BE risk on the following day for individuals with higher levels of dietary restraint, but not those with lower levels. DISCUSSION These findings challenge the assumption that dietary restriction maintains BE among all individuals with BED. Rather, results suggest that dietary restriction may be largely unrelated to BE maintenance in this population, and that reducing dietary restriction generally does not have the intended effect on BE frequency.
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Affiliation(s)
- Julia Bartholomay
- Center for Biobehavioral Research, Sanford Research, Fargo, North Dakota, USA
- Department of Psychology, North Dakota State University, Fargo, North Dakota, USA
| | - Lauren M Schaefer
- 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
| | - Glen Forester
- Center for Biobehavioral Research, Sanford Research, Fargo, North Dakota, USA
| | - Ross D 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
| | - Carol B Peterson
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Scott J Crow
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Scott G Engel
- 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
| | - Stephen A Wonderlich
- 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
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Wonderlich JA, Forester G, Crosby RD, Engel SG, Crow SJ, Peterson CB, Wonderlich SA. An examination of state and trait urgency in individuals with binge-eating disorder. EUROPEAN EATING DISORDERS REVIEW 2024. [PMID: 38602883 DOI: 10.1002/erv.3096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 03/30/2024] [Accepted: 04/02/2024] [Indexed: 04/13/2024]
Abstract
OBJECTIVE Negative urgency (i.e., acting rashly when experiencing negative affect; NU), is a theorised maintenance factor in binge-eating type eating disorders. This study examined the association between trait NU and eating disorder severity, momentary changes in state NU surrounding episodes of binge eating, and the momentary mechanistic link between affect, rash action, and binge-eating risk. METHODS Participants were 112 individuals with binge-eating disorder (BED). Baseline measures included the UPPS-P Impulsive Behaviour Scale to assess trait NU and the Eating Disorders Examination to assess binge-eating frequency and global eating disorder severity. Ecological momentary assessment captured real-time data on binge eating, negative affect, and state NU. RESULTS Multiple regression analysis revealed a strong association between trait NU and eating disorder severity. Generalised estimating equations showed that state NU increased before and decreased after binge-eating episodes, and that this pattern was not moderated by trait-level NU. Finally, a multilevel structural equation model indicated that increases in rash action mediated the momentary relationship between states of high negative affect and episodes of binge eating. CONCLUSION These findings underscore the importance of both trait and state NU in binge-eating type eating disorders, and suggest NU as a potential key target for intervention.
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Affiliation(s)
- Joseph A Wonderlich
- Sanford Research, Center for Biobehavioral Research, Fargo, North Dakota, USA
| | - Glen Forester
- Sanford Research, Center for Biobehavioral Research, Fargo, North Dakota, USA
| | - Ross D Crosby
- Sanford Research, Center for Biobehavioral 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
| | - Scott G Engel
- Sanford Research, Center for Biobehavioral Research, Fargo, North Dakota, USA
| | - Scott J Crow
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, Minnesota, USA
- Accanto Health, St. Paul, Minnesota, USA
| | - Carol B Peterson
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, Minnesota, USA
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Bottera AR, Dougherty EN, Forester G, Peterson CB, Crosby RD, Engel SG, Crow SJ, Wildes JE, Wonderlich SA. Changes in evening-shifted loss of control eating severity following treatment for binge-eating disorder. Psychol Med 2024:1-8. [PMID: 38414359 DOI: 10.1017/s003329172400028x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
BACKGROUND Loss of control eating is more likely to occur in the evening and is uniquely associated with distress. No studies have examined the effect of treatment on within-day timing of loss of control eating severity. We examined whether time of day differentially predicted loss of control eating severity at baseline (i.e. pretreatment), end-of-treatment, and 6-month follow-up for individuals with binge-eating disorder (BED), hypothesizing that loss of control eating severity would increase throughout the day pretreatment and that this pattern would be less pronounced following treatment. We explored differential treatment effects of cognitive-behavioral guided self-help (CBTgsh) and Integrative Cognitive-Affective Therapy (ICAT). METHODS Individuals with BED (N = 112) were randomized to receive CBTgsh or ICAT and completed a 1-week ecological momentary assessment protocol at baseline, end-of-treatment, and 6-month follow-up to assess loss of control eating severity. We used multilevel models to assess within-day slope trajectories of loss of control eating severity across assessment periods and treatment type. RESULTS Within-day increases in loss of control eating severity were reduced at end-of-treatment and 6-month follow-up relative to baseline. Evening acceleration of loss of control eating severity was greater at 6-month follow-up relative to end-of-treatment. Within-day increases in loss of control severity did not differ between treatments at end-of-treatment; however, evening loss of control severity intensified for individuals who received CBTgsh relative to those who received ICAT at 6-month follow-up. CONCLUSIONS Findings suggest that treatment reduces evening-shifted loss of control eating severity, and that this effect may be more durable following ICAT relative to CBTgsh.
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Affiliation(s)
| | - Elizabeth N Dougherty
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, IL, USA
| | - Glen Forester
- Center for Biobehavioral Research, Sanford Research, Fargo, ND, USA
| | - Carol B Peterson
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, USA
| | - Ross D Crosby
- Center for Biobehavioral Research, Sanford Research, Fargo, ND, USA
- Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, ND, USA
| | - Scott G Engel
- Center for Biobehavioral Research, Sanford Research, Fargo, ND, USA
| | - Scott J Crow
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, USA
- Department of Psychiatry, Accanto Health, St. Paul, MN, USA
| | - Jennifer E Wildes
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, IL, USA
| | - Stephen A Wonderlich
- Center for Biobehavioral Research, Sanford Research, Fargo, ND, USA
- Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, ND, USA
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Anderson LM, Lim KO, Kummerfeld E, Crosby RD, Crow SJ, Engel SG, Forrest L, Wonderlich SA, Peterson CB. Causal discovery analysis: A promising tool in advancing precision medicine for eating disorders. Int J Eat Disord 2023; 56:2012-2021. [PMID: 37548100 DOI: 10.1002/eat.24040] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 07/15/2023] [Accepted: 07/26/2023] [Indexed: 08/08/2023]
Abstract
OBJECTIVE Precision medicine (i.e., individually tailored treatments) represents an optimal goal for treating complex psychiatric disorders, including eating disorders. Within the eating disorders field, most treatment development efforts have been limited in their ability to identify individual-level models of eating disorder psychopathology and to develop and apply an individually tailored treatment for a given individual's personalized model of psychopathology. In addition, research is still needed to identify causal relationships within a given individual's model of eating disorder psychopathology. Addressing this limitation of the current state of precision medicine-related research in the field will allow us to progress toward advancing research and practice for eating disorders treatment. METHOD We present a novel set of analytic tools, causal discovery analysis (CDA) methods, which can facilitate increasingly fine-grained, person-specific models of causal relations among cognitive, behavioral, and affective symptoms. RESULTS CDA can advance the identification of an individual's causal model that maintains that individuals' eating disorder psychopathology. DISCUSSION In the current article, we (1) introduce CDA methods as a set of promising analytic tools for developing precision medicine methods for eating disorders including the potential strengths and weaknesses of CDA, (2) provide recommendations for future studies utilizing this approach, and (3) outline the potential clinical implications of using CDA to generate personalized models of eating disorder psychopathology. PUBLIC SIGNIFICANCE STATEMENT CDA provides a novel statistical approach for identifying causal relationships among variables of interest for a given individual. Person-specific causal models may offer a promising approach to individualized treatment planning and inform future personalized treatment development efforts for eating disorders.
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Affiliation(s)
- Lisa M Anderson
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Kelvin O Lim
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Erich Kummerfeld
- Institute for Health Informatics, University of Minnesota, Minneapolis, Minnesota, USA
| | - Ross D Crosby
- Center for Biobehavioral Research, Sanford Research, Fargo, North Dakota, USA
| | - Scott J Crow
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, Minnesota, USA
- Accanto Health, St Paul, Minnesota, USA
| | - Scott G Engel
- Center for Biobehavioral Research, Sanford Research, Fargo, North Dakota, USA
| | - Lauren Forrest
- Department of Psychiatry and Behavioral Health, Penn State Hershey Medical Center, Hershey, Pennsylvania, USA
| | | | - Carol B Peterson
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, Minnesota, USA
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Russell H, Aouad P, Le A, Marks P, Maloney D, Touyz S, Maguire S. Psychotherapies for eating disorders: findings from a rapid review. J Eat Disord 2023; 11:175. [PMID: 37794513 PMCID: PMC10548609 DOI: 10.1186/s40337-023-00886-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 09/11/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Psychotherapy is considered central to the effective treatment of eating disorders-focusing on behavioural, psychological, and social factors that contribute to the illness. Research indicates psychotherapeutic interventions out-perform placebo, waitlist, and/or other treatments; but, outcomes vary with room for major improvement. Thus, this review aims to (1) establish and consolidate knowledge on efficacious eating disorder psychotherapies; (2) highlight select emerging psychotherapeutic interventions; and (3) identify knowledge gaps to better inform future treatment research and development. METHODS The current review forms part of a series of Rapid Reviews published in a special issue in the Journal of Eating Disorders to inform the development of the Australian-government-funded National Eating Disorder Research and Translation Strategy 2021-2031. Three databases were searched for studies published between 2009 and 2023, published in English, and comprising high-level evidence studies (meta-analyses, systematic reviews, moderately sized randomised controlled studies, moderately sized controlled-cohort studies, and population studies). Data pertaining to psychotherapies for eating disorders were synthesised and outlined in the current paper. RESULTS 281 studies met inclusion criteria. Behavioural therapies were most commonly studied, with cognitive-behavioural and family-based therapies being the most researched; and thus, having the largest evidence-base for treating anorexia nervosa, bulimia nervosa, and binge eating disorder. Other therapies, such as interpersonal and dialectical behaviour therapies also demonstrated positive treatment outcomes. Emerging evidence supports specific use of Acceptance and Commitment; Integrative Cognitive Affective; Exposure; Mindfulness; and Emotionally-Focused therapies; however further research is needed to determine their efficacy. Similarly, growing support for self-help, group, and computer/internet-based therapeutic modalities was noted. Psychotherapies for avoidant/restrictive food intake disorder; other, and unspecified feeding and eating disorders were lacking evidence. CONCLUSIONS Currently, clinical practice is largely supported by research indicating that behavioural and cognitive-behavioural psychotherapies are most effective for the treatment of eating disorders. However, the efficacy of psychotherapeutic interventions varies across studies, highlighting the need for investment and expansion of research into enhanced variants and novel psychotherapies to improve illness outcomes. There is also a pressing need for investigation into the whole range of eating disorder presentations and populations, to determine the most effective interventions.
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Affiliation(s)
- Haley Russell
- InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, Level 2, Charles Perkins Centre (D17), University of Sydney, Sydney, NSW, 2006, Australia
| | - Phillip Aouad
- InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, Level 2, Charles Perkins Centre (D17), University of Sydney, Sydney, NSW, 2006, Australia.
| | - Anvi Le
- Healthcare Management Advisors, Melbourne, Australia
| | - Peta Marks
- InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, Level 2, Charles Perkins Centre (D17), University of Sydney, Sydney, NSW, 2006, Australia
| | - Danielle Maloney
- InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, Level 2, Charles Perkins Centre (D17), University of Sydney, Sydney, NSW, 2006, Australia
- Sydney Local Health District, New South Wales Health, Sydney, Australia
| | - Stephen Touyz
- InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, Level 2, Charles Perkins Centre (D17), University of Sydney, Sydney, NSW, 2006, Australia
| | - Sarah Maguire
- InsideOut Institute, Central Clinical School, Faculty of Medicine and Health, Level 2, Charles Perkins Centre (D17), University of Sydney, Sydney, NSW, 2006, Australia
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Wronski ML, Hohnemann C, Bernardoni F, Bahnsen K, Doose A, Arold D, Borucki K, Holsen LM, Lawson EA, Plessow F, Weidner K, Roessner V, Diestel S, King JA, Seidel M, Ehrlich S. Explicating the role of amygdala substructure alterations in the link between hypoleptinemia and rumination in anorexia nervosa. Acta Psychiatr Scand 2023; 148:368-381. [PMID: 37688292 DOI: 10.1111/acps.13607] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 07/19/2023] [Accepted: 08/05/2023] [Indexed: 09/10/2023]
Abstract
OBJECTIVE The amygdaloid complex plays a pivotal role in emotion processing and has been associated with rumination transdiagnostically. In anorexia nervosa (AN), we previously observed differential reductions of amygdala nuclei volumes (rostral-medial cluster substantially affected) and, in another study, elevated food-/weight-related rumination. Both amygdala volumes and rumination frequency correlated with characteristically suppressed leptin levels in AN. Thus, we hypothesized that amygdala nuclei alterations might be associated with AN-related rumination and potentially mediate the leptin-rumination relationship in AN. METHODS Rumination (food-/weight-related) was assessed using ecological momentary assessment for a 14-day period. We employed frequentist and Bayesian linear mixed effects models in females with AN (n = 51, 12-29 years, majority admitted to inpatient treatment) and age-matched healthy females (n = 51) to investigate associations between rostral-medial amygdala nuclei volume alterations (accessory basal, cortical, medial nuclei, corticoamygdaloid transitions) and rumination. We analyzed mediation effects using multi-level structural equation models. RESULTS Reduced right accessory basal and cortical nuclei volumes predicted more frequent weight-related rumination in AN; both nuclei fully mediated the effect of leptin on weight-related rumination. In contrast, we found robust evidence for the absence of amygdala nuclei volume effects on rumination in healthy females. CONCLUSION This study provides first evidence for the relevance of specific amygdala substructure reductions regarding cognitive symptom severity in AN and points toward novel mechanistic insight into the relationship between hypoleptinemia and rumination, which might involve the amygdaloid complex. Our findings in AN may have important clinical value with respect to understanding the beneficial neuropsychiatric effects of leptin (treatment) in AN and potentially other psychiatric conditions such as depression.
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Affiliation(s)
- Marie-Louis Wronski
- Translational Developmental Neuroscience Section, Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
- Neuroendocrine Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Charlotte Hohnemann
- Schumpeter School of Business and Economics, Faculty of Economy, University of Wuppertal, Wuppertal, Germany
| | - Fabio Bernardoni
- Translational Developmental Neuroscience Section, Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Klaas Bahnsen
- Translational Developmental Neuroscience Section, Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Arne Doose
- Translational Developmental Neuroscience Section, Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Dominic Arold
- Translational Developmental Neuroscience Section, Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Katrin Borucki
- Department of Clinical Chemistry and Pathobiochemistry, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Laura M Holsen
- Division of Women's Health, Department of Medicine/Department of Psychiatry, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Elizabeth A Lawson
- Neuroendocrine Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Franziska Plessow
- Neuroendocrine Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Kerstin Weidner
- Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Veit Roessner
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Stefan Diestel
- Schumpeter School of Business and Economics, Faculty of Economy, University of Wuppertal, Wuppertal, Germany
| | - Joseph A King
- Translational Developmental Neuroscience Section, Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Maria Seidel
- Translational Developmental Neuroscience Section, Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Stefan Ehrlich
- Translational Developmental Neuroscience Section, Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
- Eating Disorder Treatment and Research Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
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Davey E, Allen K, Bennett SD, Bryant‐Waugh R, Clarke T, Cooper Z, Dixon‐Ward K, Dudley J, Eisler I, Griffiths J, Hill AJ, Micali N, Murphy R, Picek I, Rea R, Schmidt U, Simic M, Tchanturia K, Traviss‐Turner G, Treasure J, Turner H, Wade T, Waller G, Shafran R. Improving programme-led and focused interventions for eating disorders: An experts' consensus statement-A UK perspective. EUROPEAN EATING DISORDERS REVIEW 2023; 31:577-595. [PMID: 37218053 PMCID: PMC10947440 DOI: 10.1002/erv.2981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 03/29/2023] [Accepted: 04/24/2023] [Indexed: 05/24/2023]
Abstract
OBJECTIVE Eating disorders are associated with significant illness burden and costs, yet access to evidence-based care is limited. Greater use of programme-led and focused interventions that are less resource-intensive might be part of the solution to this demand-capacity mismatch. METHOD In October 2022, a group of predominantly UK-based clinical and academic researchers, charity representatives and people with lived experience convened to consider ways to improve access to, and efficacy of, programme-led and focused interventions for eating disorders in an attempt to bridge the demand-capacity gap. RESULTS Several key recommendations were made across areas of research, policy, and practice. Of particular importance is the view that programme-led and focused interventions are suitable for a range of different eating disorder presentations across all ages, providing medical and psychiatric risk are closely monitored. The terminology used for these interventions should be carefully considered, so as not to imply that the treatment is suboptimal. CONCLUSIONS Programme-led and focused interventions are a viable option to close the demand-capacity gap for eating disorder treatment and are particularly needed for children and young people. Work is urgently needed across sectors to evaluate and implement such interventions as a clinical and research priority.
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Affiliation(s)
- Emily Davey
- UCL Great Ormond Street Institute of Child HealthUniversity College LondonLondonUK
| | - Karina Allen
- Section of Eating DisordersDepartment of Psychological MedicineInstitute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
- South London and Maudsley NHS Foundation TrustLondonUK
| | - Sophie D. Bennett
- UCL Great Ormond Street Institute of Child HealthUniversity College LondonLondonUK
| | - Rachel Bryant‐Waugh
- Department of Child and Adolescent PsychiatryInstitute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
- Maudsley Centre for Child and Adolescent Eating DisordersSouth London and Maudsley NHS Foundation TrustLondonUK
| | - Tim Clarke
- Norwich Medical SchoolUniversity of East AngliaNorwichUK
- Norfolk and Suffolk NHS Foundation TrustNorwichUK
| | - Zafra Cooper
- Department of PsychiatryYale School of MedicineNew HavenConnecticutUSA
| | | | - Jake Dudley
- UCL Great Ormond Street Institute of Child HealthUniversity College LondonLondonUK
| | - Ivan Eisler
- Department of Child and Adolescent PsychiatryInstitute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
- Maudsley Centre for Child and Adolescent Eating DisordersSouth London and Maudsley NHS Foundation TrustLondonUK
| | - Jess Griffiths
- NHS England Adult Eating Disorders Co‐Chair Parliamentary Health Service Ombudsman's Delivery GroupRedditchUK
| | - Andrew J. Hill
- Leeds Institute of Health SciencesSchool of MedicineUniversity of LeedsLeedsUK
| | - Nadia Micali
- UCL Great Ormond Street Institute of Child HealthUniversity College LondonLondonUK
- Department of PsychiatryFaculty of MedicineUniversity of GenevaGenevaSwitzerland
- Mental Health Services of the Capital Region of DenmarkEating Disorders Research UnitBallerup Psychiatric CentreCopenhagenDenmark
| | | | - Ivana Picek
- Section of Eating DisordersDepartment of Psychological MedicineInstitute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
- South London and Maudsley NHS Foundation TrustLondonUK
| | | | - Ulrike Schmidt
- Section of Eating DisordersDepartment of Psychological MedicineInstitute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
- South London and Maudsley NHS Foundation TrustLondonUK
| | - Mima Simic
- Maudsley Centre for Child and Adolescent Eating DisordersSouth London and Maudsley NHS Foundation TrustLondonUK
| | - Kate Tchanturia
- Section of Eating DisordersDepartment of Psychological MedicineInstitute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
- South London and Maudsley NHS Foundation TrustLondonUK
| | | | - Janet Treasure
- Section of Eating DisordersDepartment of Psychological MedicineInstitute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
- South London and Maudsley NHS Foundation TrustLondonUK
| | - Hannah Turner
- Eating Disorders ServiceSouthern Health NHS Foundation TrustSouthamptonUK
| | - Tracey Wade
- Blackbird InitiativeFlinders Research Institute for Mental Health and WellbeingFlinders UniversityAdelaideSouth AustraliaAustralia
| | - Glenn Waller
- Clinical and Applied Psychology UnitDepartment of PsychologyUniversity of SheffieldSheffieldUK
| | - Roz Shafran
- UCL Great Ormond Street Institute of Child HealthUniversity College LondonLondonUK
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Grilo CM, Juarascio A. Binge-Eating Disorder Interventions: Review, Current Status, and Implications. Curr Obes Rep 2023; 12:406-416. [PMID: 37439970 PMCID: PMC10528223 DOI: 10.1007/s13679-023-00517-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/09/2023] [Indexed: 07/14/2023]
Abstract
PURPOSE OF REVIEW Binge-eating disorder (BED) is a serious psychiatric problem associated with substantial morbidity that, unfortunately, frequently goes unrecognized and untreated. This review summarizes the current status of behavioral, psychological, pharmacological, and combined treatments for BED in adults with a particular focus on recent findings and advances. RECENT FINDINGS Certain specific psychological treatments, notably CBT and IPT, and to some extent DBT, have demonstrated efficacy and are associated with durable benefits after treatment. Certain specific lower-cost scalable interventions, notably CBTgsh, have demonstrated efficacy and have potential for broader uptake. An important advance is the emerging RCT data indicating that BWL, a generalist and available behavioral lifestyle intervention, has effectiveness that approximates that of CBT for reducing binge eating and eating-disorder psychopathology but with the advantage of also producing modest weight loss. There exists only one pharmacological agent (LDX) with approval by the FDA for "moderate-to-severe" BED. Research with other "off label" medications has yielded modest and mixed outcomes with a few medications statistically superior to placebo over the short-term and almost no longer-term data. Nearly all research combining medications and psychological treatments has failed to enhance outcomes (combined appears superior to pharmacotherapy-only but not to psychotherapy-only). Many people with BED suffer in silence and shame, go untreated, and rarely receive evidence-based treatments. Patients and practitioners need to recognize that research has identified several effective interventions for BED, and these can work quickly for many patients. Future research should identify treatments for those who do not derive benefit from initial interventions, identify additional pharmacological options, test agents with relevant mechanisms of action, and utilize innovative adaptative "SMART" designs to identify treatments to enhance outcomes among initial responders and to test alternative treatments to assist initial non-responders.
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Affiliation(s)
- Carlos M Grilo
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.
- Yale Program for Obesity Weight and Eating Research (POWER), New Haven, CT, USA.
| | - Adrienne Juarascio
- Department of Psychological and Brain Sciences, Drexel University, Philadelphia, PA, USA
- Drexel University Center for Weight, Eating and Lifestyle Science (WELL), Philadelphia, PA, USA
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Forester G, Schaefer LM, Dodd DR, Burr EK, Bartholomay J, Berner L, Crosby RD, Peterson CB, Crow SJ, Engel SG, Wonderlich SA. Time-of-day and day-of-week patterns of binge eating and relevant psychological vulnerabilities in binge-eating disorder. Int J Eat Disord 2023; 56:1694-1702. [PMID: 37212510 PMCID: PMC10600945 DOI: 10.1002/eat.23995] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 05/08/2023] [Accepted: 05/09/2023] [Indexed: 05/23/2023]
Abstract
OBJECTIVE The present study sought to characterize the temporal patterns of binge eating and theorized maintenance factors among individuals with binge-eating disorder (BED). METHOD Ecological momentary assessment of 112 individuals and mixed-effects models were used to characterize the within- and between-day temporal patterns of eating behaviors (binge eating, loss of control only eating, and overeating only), positive and negative affect, emotion regulation difficulty, and food craving. RESULTS Risk for binge eating and overeating only was highest around 5:30 p.m., with additional binge-eating peaks around 12:30 and 11:00 p.m. In contrast, loss of control eating without overeating was more likely to occur before 2:00 p.m. Risk for binge eating, loss of control only eating, and overeating only did not vary across days in the week. There was no consistent pattern of change in negative affect throughout the day, but it decreased slightly on the weekend. Positive affect showed a decrease in the evenings and a smaller decrease on the weekend. The within-day patterns of food craving, and to some extent emotion regulation difficulty, resembled the pattern of binge eating, with peaks around meal times and at the end of the night. DISCUSSION Individuals with BED appear most susceptible to binge-eating around dinner time, with heightened risk also observed around lunch time and late evening, though the effects were generally small. These patterns appear to most strongly mimic fluctuations in craving and emotion dysregulation, although future research is needed to test the temporal relationships between these experiences directly. PUBLIC SIGNIFICANCE It is unknown which times of the day and days of the week individuals with binge-eating disorder are most at risk for binge eating. By assessing binge-eating behaviors in the natural environment across the week, we found that individuals are most likely to binge in the evening, which corresponds to the times when they experience the strongest food craving and difficulty with regulating emotions.
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Affiliation(s)
| | - Lauren M. Schaefer
- Center for Biobehavioral Research, Sanford Research
- Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences
| | | | - Emily K. Burr
- Center for Biobehavioral Research, Sanford Research
- Department of Psychology, University of Central Florida
| | | | - Laura Berner
- Icahn School of Medicine at Mount Sinai, New York, USA
| | - Ross D. Crosby
- Center for Biobehavioral Research, Sanford Research
- Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences
| | - Carol B. Peterson
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School
| | - Scott J. Crow
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School
| | - Scott G. Engel
- Center for Biobehavioral Research, Sanford Research
- Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences
| | - Stephen A. Wonderlich
- Center for Biobehavioral Research, Sanford Research
- Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences
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Nabian P. The effect of cognitive-behavioral group therapy on reducing depression and anxiety in patients with mood disorders: experimental research. Ann Med Surg (Lond) 2023; 85:3901-3905. [PMID: 37554883 PMCID: PMC10406055 DOI: 10.1097/ms9.0000000000000971] [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: 03/16/2023] [Accepted: 06/10/2023] [Indexed: 08/10/2023] Open
Abstract
UNLABELLED Mood disorders are one of the most common psychiatric disorders that manifest as a low mood in depressed people or a high mood in manic people. The cognitive-behavioral therapy group is one of the most effective forms of intervention available for patients with mood disorders. This research aimed to evaluate the effect of cognitive-behavioral group therapy in reducing depression and anxiety in patients with mood disorders. CASE PRESENTATION The study was a semi-experimental study with a pretest-post-test design with a control group. The research subjects were 60 patients hospitalized in the psychiatric department of Razi Hospital in Tehran, who were randomly divided into two experimental (N:30) and control (N:30) groups. Both groups took medicine as usual. Before the therapeutic intervention, both groups were evaluated with Beck's depression questionnaire and the Zung anxiety scale. In addition to drug therapy, the experimental group participated in ten sessions of the cognitive-behavioral therapy group, and in the control group, no psychological intervention was performed except for drug therapy. At the end of the nonpharmacological treatment intervention, both groups were evaluated again with the aforementioned tests. The obtained data were analyzed using independent and dependent t-tests. CLINICAL DISCUSSION The research findings showed that the cognitive-behavioral therapy group was significantly (P<0.05) effective in reducing the depression of hospitalized patients with mood disorders, but this method did not have much effect in reducing the anxiety of the patients. CONCLUSION Cognitive-behavioral group therapy can be effective in reducing depression in hospitalized patients with mood disorders.
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Affiliation(s)
- Pantea Nabian
- Departmenta of Psychology, Tehran University, Tehran, Iran
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12
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de Moraes CEF, Donnelly B, Appolinario JC, Hay P. Obtaining long-term recovery: advances in optimizing treatment outcomes in patients with binge-eating disorder. Expert Rev Neurother 2023; 23:1097-1111. [PMID: 37916419 DOI: 10.1080/14737175.2023.2273392] [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: 05/30/2023] [Accepted: 10/17/2023] [Indexed: 11/03/2023]
Abstract
INTRODUCTION Binge-eating disorder (BED) is a complex and disabling eating disorder (ED) associated with considerable burden and impairments in quality of life and physical/mental health. It has been recognized as a formal ED category since 2013, however BED is still underdetected and undertreated. AREAS COVERED This review summarizes the advances in the understanding of the pathophysiology of BED as well as the evidence on the efficacy of the existing treatments. The authors searched Scopus, PubMed, ClinicalTrials.Gov, and ANZCTR with terms including 'assessment' OR 'treatment' OR 'diagnosis' OR 'mechanisms' AND 'binge eating' OR 'binge-eating disorder' for manuscripts published between January 2013 and April 2023. EXPERT OPINION Most of the trials on treatments of BED have been in people of high weight with weight loss as an outcome. Nevertheless, less is known about the treatment of this condition in people with body mass index (BMI) within the normal range where weight stabilization may be a more appropriate goal. Moreover, there is a need for an enhanced appreciation of the role of combination treatment to improve overall outcomes. Also, there are important opportunities for future research in understanding the mechanisms of action and effectiveness of BED treatments.
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Affiliation(s)
- Carlos Eduardo Ferreira de Moraes
- Obesity and Eating Disorders Group (GOTA), Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, Australia
| | - Brooke Donnelly
- Clinical Psychology Unit, School of Psychology, University of Sydney, Camperdown, Australia
| | - Jose Carlos Appolinario
- Obesity and Eating Disorders Group (GOTA), Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Phillipa Hay
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, Australia
- Mental Health Services, South West Sydney Local Health District (SWSLHD), Campbelltown, Australia
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13
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Hilbert A. Psychological and Medical Treatments for Binge-Eating Disorder: A Research Update. Physiol Behav 2023:114267. [PMID: 37302642 DOI: 10.1016/j.physbeh.2023.114267] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 02/23/2023] [Accepted: 06/08/2023] [Indexed: 06/13/2023]
Abstract
Binge-eating disorder (BED), characterized by recurrent binge eating in the absence of regular weight-compensatory behaviors, is the most common eating disorder, associated with pronounced mental and physical sequelae. An increasing body of research documents the efficacy of diverse approaches to the treatment of this disorder, summarized in meta-analyses. This research update narratively reviewed randomized-controlled trials (RCTs) on the psychological and medical treatment of BED published between January 2018 to November 2022, identified through a systematic literature search. A total of 16 new RCTs and 3 studies on previous RCTs providing efficacy- and safety-related data were included. Regarding psychotherapy, confirmatory evidence supported the use of integrative-cognitive therapy and, with lower effects, brief emotion regulation skills training for binge eating and associated psychopathology. Behavioral weight loss treatment was revealed to be efficacious for binge eating, weight loss, and psychopathology, but its combination with naltrexone-bupropion did not augment efficacy. New treatment approaches were explored, including e-mental-health and brain-directed treatments, mostly targeting emotion and self-regulation. Additionally, different therapeutic approaches were evaluated in complex stepped-care models. In light of these advances, future research is necessary to further optimize effects of evidence-based treatments for BED, through improvement of existing or development of new treatments, based on mechanistic and/or interventional research, and/or tailoring treatments to personal characteristics in a precision medicine approach.
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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.
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Valdez-Aguilar M, Vazquez-Arevalo R, López-Aguilar X, Ruíz Martínez AO, Rosinska M, Mancilla-Díaz JM. Online multidisciplinary treatment of binge eating disorder in people with high weight: a case series study. J Eat Disord 2023; 11:86. [PMID: 37264431 DOI: 10.1186/s40337-023-00809-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 05/12/2023] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND Binge eating disorder (BED) is the most frequent eating behavior among the general population (Guerdjikova in Med Clin 103:669-680, 2019). Many studies on interventions and BED treatments have been carried out in the United States and Europe, few have been reported in Latin American populations. People with this disorder not only have physical consequences of it but also social and psychological ones, therefore a multidisciplinary treatment approach is a good option to treat this condition. OBJECTIVE To evaluate the feasibility of a multidisciplinary online intervention (i.e., psychological, nutritional, and physical activity) in patients with BED. METHOD The design was a case series study of two clinical treatment groups, with pre-test and post-test psychometric measures along with two follow-ups (at 2 and 6 months). Fifteen people diagnosed with BED (2 men and 13 women), with a mean age of 34.93 years (SD=11.91) and a mean initial BMI of 42, participated in this study. The treatment was carried out over the span of 28 sessions, each one being two hours per week consisting of 1 hour of group therapy and 1 hour of individual therapy. There were four evaluations: pre, post and two follow-ups. RESULTS Five patients did not complete the treatment (30%). The comparisons were made through the non-parametric Friedman test, finding a statistically significant decrease in binge eating symptoms (x2=15.57; p=.001), anxiety symptoms (x2=15.96; p=.001) and depression (x2=15.03; p=.002). There was an improvement in clarity (x2=11.60; p=.010) and emotional regulation (x2=7.75; p=.050), only in women. The patients reduced their body weight, and improved their eating and exercise habits by introducing fruits and vegetables and including 20-30 minutes of physical activity into their daily routine. Regarding the Objective Clinical Change Index, in terms of the objective clinical change, a positive change was observed in all the variables addressed. CONCLUSIONS The data presented allowed us to conclude that the online multidisciplinary intervention was effective in the treatment of BED. Trial registration Retrospectively registered.
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Affiliation(s)
- Mariana Valdez-Aguilar
- Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, Estado de México, México.
| | - Rosalia Vazquez-Arevalo
- Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, Estado de México, México
| | - Xóchitl López-Aguilar
- Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, Estado de México, México
| | | | | | - Juan Manuel Mancilla-Díaz
- Facultad de Estudios Superiores Iztacala, Universidad Nacional Autónoma de México, Estado de México, México
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15
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Davey E, Bennett SD, Bryant-Waugh R, Micali N, Takeda A, Alexandrou A, Shafran R. Low intensity psychological interventions for the treatment of feeding and eating disorders: a systematic review and meta-analysis. J Eat Disord 2023; 11:56. [PMID: 37016447 PMCID: PMC10072817 DOI: 10.1186/s40337-023-00775-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 03/19/2023] [Indexed: 04/06/2023] Open
Abstract
BACKGROUND Feeding and eating disorders are associated with significant illness burden and costs, yet access to evidence-based care is limited. Low intensity psychological interventions have the potential to increase such access. METHODS A systematic review and meta-analysis were conducted on the use of low intensity psychological interventions for the treatment of feeding and eating disorders. Studies comparing low intensity psychological interventions against high intensity therapies and non-eating disorder specific psychological interventions were included, as well as those with waiting list control arms. There were three primary outcomes: eating disorder psychopathology, diagnostic and statistical manual of mental disorders (DSM) severity specifier-related outcomes and rates of remission/recovery. RESULTS Thirty-three studies met the inclusion criteria, comprising 3665 participants, and 30 studies were included in the meta-analysis. Compared to high intensity therapies, low intensity psychological interventions were equivalent on reducing eating disorder psychopathology (g = - 0.13), more effective at improving DSM severity specifier-related outcomes (g = - 0.15), but less likely to achieve remission/recovery (risk ratio (RR) = 0.70). Low intensity psychological interventions were superior to non-eating disorder specific psychological interventions and waiting list controls across all three primary outcomes. CONCLUSION Overall, findings suggest that low intensity psychological interventions can successfully treat eating disorder symptoms. Few potential moderators had a statistically significant effect on outcome. The number of studies for many comparisons was low and the methodological quality of the studies was poor, therefore results should be interpreted with caution. More research is needed to establish the effectiveness of low intensity psychological interventions for children and young people, as well as for individuals with anorexia nervosa, avoidant/restrictive food intake disorder, pica and rumination disorder.
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Affiliation(s)
- Emily Davey
- UCL Great Ormond Street Institute of Child Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK.
| | - Sophie D Bennett
- UCL Great Ormond Street Institute of Child Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK
| | - Rachel Bryant-Waugh
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Maudsley Centre for Child and Adolescent Eating Disorders, South London and Maudsley NHS Foundation Trust, London, UK
| | - Nadia Micali
- UCL Great Ormond Street Institute of Child Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK
- Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Mental Health Services of the Capital Region of Denmark, Eating Disorders Research Unit, Ballerup Psychiatric Centre, Copenhagen, Denmark
| | | | | | - Roz Shafran
- UCL Great Ormond Street Institute of Child Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK
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Wattick RA, Olfert MD, Hagedorn-Hatfield RL, Barr ML, Claydon E, Brode C. Diet quality and eating behaviors of college-attending young adults with food addiction. Eat Behav 2023. [PMID: 36863205 DOI: 10.1016/j.eatbeh.2023.101710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
BACKGROUND College students are heavily influenced by their food environment and are an important population in which to study food addiction. This mixed-methods study aimed to examine diet quality and eating behaviors of college students with food addiction. METHODS Students attending a large university in November 2021 were invited to complete an online survey that measured food addiction, eating styles, eating disorder symptoms, diet quality, and anticipated feelings after eating. Kruskal-Wallis H determined differences between those with and without food addiction in mean scores of quantitative variables. Participants who met the symptom threshold for the presence of food addiction were invited to participate in an interview that elicited more information. Quantitative data was analyzed using JMP Pro Version 16.0 and qualitative data was thematically analyzed using NVIVO Pro Software Version 12.0. RESULTS Respondents (n = 1645) had a 21.9 % prevalence of food addiction. Individuals with mild food addiction had the highest scores in cognitive restraint. Those with severe food addiction had the highest scores in uncontrolled eating, emotional eating, and eating disorder symptoms. Individuals with food addiction showed significantly higher negative expectancies for healthy and junk food, lower intake of vegetables, higher intakes of added sugars and saturated fat. Interview participants had problems with sweets and carbohydrates most often and described eating until physically ill, eating in response to negative emotions, dissociation while eating, and strong negative feelings after eating. CONCLUSION Findings contribute to the understanding of the behaviors, emotions, and perceptions surrounding food by this population, providing potential behaviors and cognitions to target for treatment.
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Affiliation(s)
- Rachel A Wattick
- West Virginia University, Davis College of Agriculture, Natural Resources, and Design, Division of Animal and Nutritional Sciences; 4100 Agricultural Sciences Building, PO Box 6108, Morgantown, WV 26505-6108, United States of America.
| | - Melissa D Olfert
- West Virginia University, Davis College of Agriculture, Natural Resources, and Design, Division of Animal and Nutritional Sciences; 4100 Agricultural Sciences Building, PO Box 6108, Morgantown, WV 26505-6108, United States of America.
| | - Rebecca L Hagedorn-Hatfield
- Meredith College, School of Education Health & Human Sciences, Department of Nutrition, Health and Human Performance; 3800 Hillsborough Street, Raleigh, NC 27607-5298, United States of America.
| | - Makenzie L Barr
- University of Kentucky, Department of Dietetics and Human Nutrition, 212 Funkhouser Building, Lexington, KY 40514, United States of America.
| | - Elizabeth Claydon
- West Virginia University, School of Public Health, Department of Social & Behavioral Sciences, 64 Medical Center Dr., Morgantown, WV 26505-9190, United States of America.
| | - Cassie Brode
- West Virginia University School of Medicine, Department of Behavioral Medicine and Psychiatry, United States of America.
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McClure Z, Messer M, Anderson C, Liu C, Linardon J. Which dimensions of emotion dysregulation predict the onset and persistence of eating disorder behaviours? A prospective study. J Affect Disord 2022; 310:123-128. [PMID: 35545154 DOI: 10.1016/j.jad.2022.05.041] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 03/23/2022] [Accepted: 05/05/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Theoretical models highlight the importance of emotion dysregulation as a key risk and maintaining factor for eating disorders. However, most studies testing these theories are cross-sectional. It remains unclear which dimensions of emotion dysregulation account for the onset and persistence of eating disorder behaviours over time. METHODS To address these gaps, data were analyzed from 1321 adult women who completed study measures at baseline and eight-month follow-up. The dimensions of emotion dysregulation assessed were five subscales from the abbreviated 16-item Difficulties in Emotion Regulation Scale. Outcomes included the onset (versus asymptomatic) and persistence (versus remission) of binge eating and compensatory behaviours. RESULTS Univariate logistic regressions showed that, among initially asymptomatic women, higher baseline levels of each emotion dysregulation dimension (except the "goals" subscale) predicted the onset of binge eating and compensatory behaviours at follow-up. Each dimension also predicted the persistence of compensatory behaviours at follow-up among women endorsing these behaviours at baseline, while the "impulse", "strategies", and "non-acceptance" dimensions predicted the persistence of binge eating. In multivariate analyses, only the "strategies" dimension predicted the onset and persistence of binge eating, while the "non-acceptance" dimension predicted the onset and persistence of compensatory behaviours. LIMITATIONS Only a limited number of emotion dysregulation dimensions were tested. CONCLUSION Findings demonstrate the importance of emotion dysregulation dimensions in accounting for the onset and maintenance of eating disorder behaviours. The delivery of specific intervention strategies designed to address emotion dysregulation may depend on the risk and symptom profile of an individual.
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Affiliation(s)
- Zoe McClure
- School of Psychology, Deakin University, 1 Gheringhap Street, Geelong, VIC 3220, Australia
| | - Mariel Messer
- School of Psychology, Deakin University, 1 Gheringhap Street, Geelong, VIC 3220, Australia
| | - Cleo Anderson
- School of Psychology, Deakin University, 1 Gheringhap Street, Geelong, VIC 3220, Australia
| | - Claudia Liu
- School of Psychology, Deakin University, 1 Gheringhap Street, Geelong, VIC 3220, Australia
| | - Jake Linardon
- School of Psychology, Deakin University, 1 Gheringhap Street, Geelong, VIC 3220, Australia; Center for Social and Early Emotional Development, Deakin University, Burwood, Victoria 3125, Australia.
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Miller AE, Trolio V, Halicki-Asakawa A, Racine SE. Eating disorders and the nine symptoms of borderline personality disorder: A systematic review and series of meta-analyses. Int J Eat Disord 2022; 55:993-1011. [PMID: 35579043 DOI: 10.1002/eat.23731] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 04/11/2022] [Accepted: 04/27/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Eating disorders and borderline personality disorder have high rates of comorbidity. However, the extent to which individual BPD symptoms are elevated in patients with EDs is largely unknown. Meta-analyses examined: (1) which of the nine BPD symptoms are especially elevated in individuals with versus without EDs, (2) whether particular ED subtypes have elevated levels of certain BPD symptoms, and (3) which BPD symptoms remain unstudied/understudied in relation to EDs. METHODS We performed nine separate meta-analyses (one for each BPD symptom) to compare levels of symptoms in patients with EDs versus healthy controls. A total of 122 studies (range = 4-34 studies across symptoms) were included. RESULTS Affective instability was the BPD symptom most elevated, while anger was the BPD symptom least elevated, in patients with EDs compared to controls. When comparing effect sizes across ED subtypes, anorexia nervosa binge-eating/purging subtype had the largest effect sizes for the greatest number of BPD symptoms, while effect sizes for AN restrictive subtype were not significantly larger than those of other EDs for any BPD symptom. The least studied BPD symptoms were identity disturbance and interpersonal difficulties. DISCUSSION These meta-analyses suggest that certain symptoms of BPD play a more prominent role in the comorbidity between BPD and EDs than others. Targeting affective instability when treating cases of comorbid ED and BPD may be especially likely to ameliorate the negative outcomes related to this comorbidity. Future research should further investigate identity disturbance and interpersonal difficulties in the context of EDs. PUBLIC SIGNIFICANCE Having an eating disorder and borderline personality disorder is a common comorbidity associated with a severe clinical presentation. BPD is characterized by nine distinct symptoms. This research examined levels of individual BPD symptoms in patients with versus without EDs. Findings can guide researchers and clinicians towards studying and treating symptoms that may be most relevant for BPD-ED comorbidity and in turn, improve outcomes for these patients.
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Affiliation(s)
- Alexia E Miller
- Department of Psychology, McGill University, Montreal, Quebec, Canada
| | - Vittoria Trolio
- Department of Psychology, McGill University, Montreal, Quebec, Canada
| | - Amané Halicki-Asakawa
- Department of Psychology, University of British Columbia Okanagan, Kelowna, British Columbia, Canada
| | - Sarah E Racine
- Department of Psychology, McGill University, Montreal, Quebec, Canada
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Lammers MW, Vroling MS, Crosby RD, van Strien T. Dialectical behavior therapy compared to cognitive behavior therapy in binge-eating disorder: An effectiveness study with 6-month follow-up. Int J Eat Disord 2022; 55:902-913. [PMID: 35665526 PMCID: PMC9328197 DOI: 10.1002/eat.23750] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 04/29/2022] [Accepted: 04/30/2022] [Indexed: 12/03/2022]
Abstract
OBJECTIVE To evaluate whether the results of a quasi-randomized study, comparing dialectical behavior therapy for binge-eating disorder (DBT-BED) and an intensive, outpatient cognitive behavior therapy (CBT+) in individuals with BED, would be replicated in a nonrandomized study with patients who more closely resemble everyday clinical practice. METHOD Patients with (subthreshold) BED (N = 175) started one of two group treatments: DBT-BED (n = 42) or CBT+ (n = 133), at a community eating disorder service. Measures of eating disorder pathology, emotion regulation, and general psychopathology were examined at end of treatment (EOT) and at 6-month follow-up using generalized linear models with multiple imputation. RESULTS Both treatments lead to substantial decreases on primary and secondary measures. Statistically significant, medium-size differences between groups were limited to global eating disorder psychopathology (d = -.62; 95% CI = .231, .949) at EOT and depressive symptoms at follow-up (d = -.45; 95% CI = .149, 6.965), favoring CBT+. Dropout of treatment included 15.0% from CBT+ and 19.0% from DBT-BED (difference nonsignificant). DISCUSSION Decreases in global eating disorder psychopathology were achieved faster with CBT+. Overall, improvements in DBT-BED were comparable to those observed in CBT+. Findings of the original trial, favoring CBT+ on the number of OBE episodes, emotional dysregulation and self-esteem at EOT, and on eating disorder psychopathology and self-esteem at follow-up, were not replicated. With similar rates of treatment dropout and about half of the therapy time used in CBT+, DBT-BED can be considered a relevant treatment for BED in everyday clinical practice. PUBLIC SIGNIFICANCE In this effectiveness study, dialectical behavior therapy (DBT) resulted in clinically relevant improvements in individuals with binge eating disorder. Changes were broadly comparable to those of cognitive behavior therapy (CBT), the current treatment of choice. Although CBT resulted in decreases in eating disorder psychopathology faster, there was a trend toward relapse in CBT at 6-month follow-up. Therefore, the less costly DBT-program can be considered a relevant treatment in clinical practice.
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Affiliation(s)
- Mirjam W. Lammers
- Amarum, Expertise Centre for Eating DisordersGGNet Network for Mental Health CareGelderlandZutphen,Radboud University, Behavioural Science InstituteNijmegenGelderland
| | - Maartje S. Vroling
- Amarum, Expertise Centre for Eating DisordersGGNet Network for Mental Health CareGelderlandZutphen,Radboud University, Behavioural Science InstituteNijmegenGelderland
| | - Ross D. Crosby
- Sanford Center for Biobehavioral ResearchFargoNorth DakotaUSA,School of Medicine and Health SciencesUniversity of North DakotaFargoNorth DakotaUSA
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20
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Zarate D, Stavropoulos V, Ball M, de Sena Collier G, Jacobson NC. Exploring the digital footprint of depression: a PRISMA systematic literature review of the empirical evidence. BMC Psychiatry 2022; 22:421. [PMID: 35733121 PMCID: PMC9214685 DOI: 10.1186/s12888-022-04013-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 05/17/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND This PRISMA systematic literature review examined the use of digital data collection methods (including ecological momentary assessment [EMA], experience sampling method [ESM], digital biomarkers, passive sensing, mobile sensing, ambulatory assessment, and time-series analysis), emphasizing on digital phenotyping (DP) to study depression. DP is defined as the use of digital data to profile health information objectively. AIMS Four distinct yet interrelated goals underpin this study: (a) to identify empirical research examining the use of DP to study depression; (b) to describe the different methods and technology employed; (c) to integrate the evidence regarding the efficacy of digital data in the examination, diagnosis, and monitoring of depression and (d) to clarify DP definitions and digital mental health records terminology. RESULTS Overall, 118 studies were assessed as eligible. Considering the terms employed, "EMA", "ESM", and "DP" were the most predominant. A variety of DP data sources were reported, including voice, language, keyboard typing kinematics, mobile phone calls and texts, geocoded activity, actigraphy sensor-related recordings (i.e., steps, sleep, circadian rhythm), and self-reported apps' information. Reviewed studies employed subjectively and objectively recorded digital data in combination with interviews and psychometric scales. CONCLUSIONS Findings suggest links between a person's digital records and depression. Future research recommendations include (a) deriving consensus regarding the DP definition and (b) expanding the literature to consider a person's broader contextual and developmental circumstances in relation to their digital data/records.
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Affiliation(s)
- Daniel Zarate
- Institute for Health and Sport, Victoria University, Melbourne, Australia.
| | - Vasileios Stavropoulos
- grid.1019.90000 0001 0396 9544Institute for Health and Sport, Victoria University, Melbourne, Australia ,grid.5216.00000 0001 2155 0800Department of Psychology, University of Athens, Athens, Greece
| | - Michelle Ball
- grid.1019.90000 0001 0396 9544Institute for Health and Sport, Victoria University, Melbourne, Australia
| | - Gabriel de Sena Collier
- grid.1019.90000 0001 0396 9544Institute for Health and Sport, Victoria University, Melbourne, Australia
| | - Nicholas C. Jacobson
- grid.254880.30000 0001 2179 2404Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Hanover, USA ,grid.254880.30000 0001 2179 2404Department of Biomedical Data Science, Geisel School of Medicine, Dartmouth College, Hanover, USA ,grid.254880.30000 0001 2179 2404Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Hanover, USA ,grid.254880.30000 0001 2179 2404Quantitative Biomedical Sciences Program, Dartmouth College, Hanover, USA
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21
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Berking M, Eichler E, Naumann E, Svaldi J. The efficacy of a transdiagnostic emotion regulation skills training in the treatment of binge-eating disorder-Results from a randomized controlled trial. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2022; 61:998-1018. [PMID: 35567309 DOI: 10.1111/bjc.12371] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 03/29/2022] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Deficits in emotion regulation (ER) have been shown to be associated with binge-eating disorder (BED). To further clarify the causal nature of this association, we tested whether systematically enhancing ER skills would reduce symptoms of BED. METHODS We randomly allocated N = 101 individuals meeting the criteria for BED to a transdiagnostic ER skills training or to a waitlist control condition (WLC). Primary outcome was the reduction in binges during the treatment-vs.-waiting period as assessed with the Eating Disorder Examination (EDE) interview. RESULTS Mixed-model ANOVAs indicated that the average pre-to-post decrease in binges assessed with the EDE was significantly greater in the ER skills training condition than in the WLC (d = 0.66). These effects were stable over the 6-month follow-up period (d = 0.72). Remission rates at post/follow-up were 34.4/45.0% in the skills training and 7.5/20.0% in the WLC. Additionally, we found a greater reduction in general eating disorder psychopathology, of food consumption in a bogus taste test and of depression in the ER skills training condition. Moreover, the greater reduction in binge-eating episodes in the training condition was (partially) mediated by a greater increase in ER skills. CONCLUSIONS The findings provide further support for the assumed importance of deficits in ER as a maintaining factor and, hence, as a target in the treatment of BED. As ER skills trainings have been shown to also reduce other kinds of psychopathology, they might be considered a promising transdiagnostic add-on component to disorder-specific interventions.
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Affiliation(s)
| | - Eva Eichler
- University of Erlangen-Nuremberg, Erlangen, Germany
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22
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Rodrigues TF, Ramos R, Vaz AR, Brandão IM, Fernandez-Aranda F, Machado PPP. The mediating role of self-criticism, experiential avoidance and negative urgency on the relationship between ED-related symptoms and difficulties in emotion regulation. EUROPEAN EATING DISORDERS REVIEW 2022; 30:760-771. [PMID: 35501947 DOI: 10.1002/erv.2914] [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: 10/15/2021] [Revised: 04/09/2022] [Accepted: 04/16/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Difficulties in emotion regulation are thought to play a transdiagnostic role across eating disorders (ED). In the current study, we explored with a path analysis the mediating role of self-criticism, experiential avoidance and negative urgency on the relationship between ED-related symptoms and dimensions of difficulties in emotion regulation. METHOD Participants were 103 female outpatients recruited at a Portuguese ED hospital unit, diagnosed with an ED, aged 14-60 years old (M = 28.0, SD = 10.5), body mass index (BMI) ranging from 11.72 to 39.44 (M = 20.1, SD = 5.4). RESULTS The path analysis resulted in a model with an adequate fit to the data (SRMR = 0.05; RMSEA = 0.07 [0.00, 0.12], PCLOSE = 0.269; TLI = 0.97; IFI = 0.99; GFI = 0.95). A final model in which the relationship between ED-related symptoms and dimensions of difficulties in emotion regulation was mediated by self-criticism, experiential avoidance and negative urgency, accounted for a variance of 71% for strategies, 57% for non-acceptance, 62% for impulses, 56% for goals and 20% for clarity. CONCLUSION Results suggest that self-criticism, experiential avoidance and negative urgency, combined, are relevant in the relationship between ED-related symptoms and difficulties in emotion regulation. ED treatment and emotion regulation skills may be enhanced through the inclusion of specific components that target self-criticism, experiential avoidance and negative urgency, as they become prominent during the therapeutic process.
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Affiliation(s)
- Tânia F Rodrigues
- Psychotherapy and Psychopathology Research Lab, Psychology Research Centre (CIPsi), School of Psychology, University of Minho, Braga, Portugal
| | - Rita Ramos
- Psychotherapy and Psychopathology Research Lab, Psychology Research Centre (CIPsi), School of Psychology, University of Minho, Braga, Portugal
| | - Ana Rita Vaz
- Psychotherapy and Psychopathology Research Lab, Psychology Research Centre (CIPsi), School of Psychology, University of Minho, Braga, Portugal
| | - Isabel Marques Brandão
- Psychiatry Department, Faculty of Medicine, Hospital of S. João, University of Porto, Porto, Portugal
| | - Fernando Fernandez-Aranda
- Department of Psychiatry, University Hospital of Bellvitge, Barcelona, Spain.,CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.,Psychoneurobiology of Eating and Addictive Behaviours Group, Neurosciences Programme, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain.,Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Paulo P P Machado
- Psychotherapy and Psychopathology Research Lab, Psychology Research Centre (CIPsi), School of Psychology, University of Minho, Braga, Portugal
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23
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Burnette CB, Luzier JL, Weisenmuller CM, Boutté RL. A systematic review of sociodemographic reporting and representation in eating disorder psychotherapy treatment trials in the United States. Int J Eat Disord 2022; 55:423-454. [PMID: 35288967 PMCID: PMC8988395 DOI: 10.1002/eat.23699] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 02/24/2022] [Accepted: 02/24/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Eating disorders (EDs) were once conceptualized as primarily affecting affluent, White women, a misconception that informed research and practice for many years. Abundant evidence now discredits this stereotype, but it is unclear if prevailing "evidence-based" treatments have been evaluated in samples representative of the diversity of individuals affected by EDs. Our goal was to evaluate the reporting, inclusion, and analysis of sociodemographic variables in ED psychotherapeutic treatment randomized controlled trials (RCTs) in the US through 2020. METHODS We conducted a systematic review of ED psychotherapeutic treatment RCTs in the US and examined the reporting and inclusion of gender identity, age, race/ethnicity, sexual orientation, and socioeconomic status (SES) of enrolled participants, as well as recruitment methods, power analyses, and discussion of limitations and generalizability. RESULTS Our search yielded 58 studies meeting inclusion criteria dating back to 1985. Reporting was at times incomplete, absent, or centered on the racial/gender majority group. No studies reported gender diverse participants, and men and people of color were underrepresented generally, with differences noted across diagnoses. A minority of papers considered sociodemographic variables in analyses or acknowledged limitations related to sample characteristics. Some progress was made across the decades, with studies increasingly providing full racial and ethnic data, and more men included over time. Although racial and ethnic diversity improved somewhat, progress appeared to stall in the last decade. DISCUSSION We summarize findings, consider context and challenges for RCT researchers, and offer suggestions for researchers, journal editors, and reviewers on improving representation, reporting, and analytic practices. PUBLIC SIGNIFICANCE Randomized controlled trials of eating disorder psychotherapeutic treatment in the US are increasingly reporting full race/ethnicity data, but information on SES is inconsistent and sexual orientation absent. White women still comprise the overwhelming majority of participants, with few men and people of color, and no gender-diverse individuals. Findings underscore the need to improve reporting and increase representation to ensure evidence-based treatments are effective across and within diverse groups.
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Affiliation(s)
- C. Blair Burnette
- Charleston Area Medical CenterCharlestonWest VirginiaUSA,Division of Epidemiology and Community Health, School of Public HealthUniversity of MinnesotaMinneapolisMinnesotaUSA
| | - Jessica L. Luzier
- Department of Behavioral Medicine and PsychiatryWest Virginia University School of Medicine – Charleston DivisionCharlestonWest VirginiaUSA,Charleston Area Medical CenterInstitute for Academic MedicineCharlestonWest VirginiaUSA
| | - Chantel M. Weisenmuller
- Department of Behavioral Medicine and PsychiatryWest Virginia University School of Medicine – Charleston DivisionCharlestonWest VirginiaUSA,Charleston Area Medical CenterInstitute for Academic MedicineCharlestonWest VirginiaUSA
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24
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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: 48] [Impact Index Per Article: 24.0] [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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25
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Wonderlich JA, Crosby RD, Engel SG, Crow SJ, Peterson CB, Le Grange D, Wonderlich SA, Fischer S. Negative affect and binge eating: Assessing the unique trajectories of negative affect before and after binge-eating episodes across eating disorder diagnostic classifications. Int J Eat Disord 2022; 55:223-230. [PMID: 34877679 PMCID: PMC8861898 DOI: 10.1002/eat.23648] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 11/17/2021] [Accepted: 11/18/2021] [Indexed: 01/26/2023]
Abstract
OBJECTIVE Ecological momentary assessment (EMA) studies suggest that among individuals who binge eat, emotional states and binge eating are functionally related. However, it is unclear whether the trajectory of negative affect (NA) is the same across diagnostic groups or if specific changes in affect are unique to each diagnostic category. This study examined the moderating effect of diagnosis on the trajectory of negative affect before and after binge eating. METHOD Adults with eating disorder diagnoses (anorexia nervosa [AN] = 118, bulimia nervosa [BN] = 133, binge-eating disorder [BED] = 112) completed an EMA where they reported binge eating and negative affect throughout the day. Generalized estimating equation analyses were used to model the trajectories of NA before and after binge eating. RESULTS For all individuals, the linear trajectory of NA significantly increased before (B = 0.044, p < .001) and decreased following the binge-eating episode (B = -0.054, p < .001). However, diagnosis moderated this trajectory. Specifically, individuals with BN had a greater change in linear trajectories of NA before (B = 2.305, p < .001) and after (B = -4.149, p < .001) binge eating compared to those with BED, but not those with AN. There were no differences in the trajectory of NA between individuals with BED or AN. DISCUSSION These findings suggest that binge-eating episodes in BN may be more strongly associated with NA than in BED, but similar to binge-eating episodes in AN.
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Affiliation(s)
- Joseph A. Wonderlich
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
| | - Ross D. Crosby
- Sanford Research Center for Biobehavioral 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
| | - Scott G. Engel
- Sanford Research Center for Biobehavioral Research, Fargo, North Dakota, USA
| | - Scott J. Crow
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, Minnesota, USA
- The Emily Program, Minneapolis, Minnesota, USA
| | - Carol B. Peterson
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, Minnesota, USA
| | - Daniel Le Grange
- Department of Psychiatry and Behavioral Science, University of California San Francisco, San Francisco, California, USA
- Department of Psychiatry and Behavioral Neurosciences, The University of Chicago, Chicago, Illinois, USA
| | - Stephen A. Wonderlich
- Sanford Research Center for Biobehavioral 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
| | - Sarah Fischer
- Department of Psychology, George Mason University, Fairfax, Virginia, USA
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26
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Smith KE, Mason TB, Schaefer LM, Anderson LM, Hazzard VM, Crosby RD, Engel SG, Crow SJ, Wonderlich SA, Peterson CB. Micro-level de-coupling of negative affect and binge eating in relationship to macro-level outcomes in binge eating disorder treatment. Psychol Med 2022; 52:140-148. [PMID: 32597737 PMCID: PMC7770007 DOI: 10.1017/s0033291720001804] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND While negative affect reliably predicts binge eating, it is unknown how this association may decrease or 'de-couple' during treatment for binge eating disorder (BED), whether such change is greater in treatments targeting emotion regulation, or how such change predicts outcome. This study utilized multi-wave ecological momentary assessment (EMA) to assess changes in the momentary association between negative affect and subsequent binge-eating symptoms during Integrative Cognitive Affective Therapy (ICAT-BED) and Cognitive Behavior Therapy Guided Self-Help (CBTgsh). It was predicted that there would be stronger de-coupling effects in ICAT-BED compared to CBTgsh given the focus on emotion regulation skills in ICAT-BED and that greater de-coupling would predict outcomes. METHODS Adults with BED were randomized to ICAT-BED or CBTgsh and completed 1-week EMA protocols and the Eating Disorder Examination (EDE) at pre-treatment, end-of-treatment, and 6-month follow-up (final N = 78). De-coupling was operationalized as a change in momentary associations between negative affect and binge-eating symptoms from pre-treatment to end-of-treatment. RESULTS There was a significant de-coupling effect at follow-up but not end-of-treatment, and de-coupling did not differ between ICAT-BED and CBTgsh. Less de-coupling was associated with higher end-of-treatment EDE global scores at end-of-treatment and higher binge frequency at follow-up. CONCLUSIONS Both ICAT-BED and CBTgsh were associated with de-coupling of momentary negative affect and binge-eating symptoms, which in turn relate to cognitive and behavioral treatment outcomes. Future research is warranted to identify differential mechanisms of change across ICAT-BED and CBTgsh. Results also highlight the importance of developing momentary interventions to more effectively de-couple negative affect and binge eating.
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Affiliation(s)
- Kathryn E. Smith
- Department of Psychiatry and Behavioral Sciences, University of Southern California, Los Angeles, California, US
| | - Tyler B. Mason
- Department of Preventive Medicine, University of Southern California, Los Angeles, California, USA
| | - Lauren M. Schaefer
- Center for Bio-behavioral Research, Sanford Research, Fargo, North Dakota, USA
| | - Lisa M. Anderson
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, Minnesota, USA
| | - Vivienne M. Hazzard
- Center for Bio-behavioral Research, Sanford Research, Fargo, North Dakota, USA
| | - Ross D. Crosby
- Center for Bio-behavioral 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
| | - Scott G. Engel
- Center for Bio-behavioral 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
| | - Scott J. Crow
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, Minnesota, USA
- The Emily Program, Saint Paul, Minnesota, USA
| | - Stephen A. Wonderlich
- Center for Bio-behavioral 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
| | - Carol B. Peterson
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, Minnesota, USA
- The Emily Program, Saint Paul, Minnesota, USA
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27
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Bicaker E, Racine SE. Protection versus risk? The relative roles of compassionate and uncompassionate self-responding for eating disorder behaviors. Eat Behav 2022; 44:101592. [PMID: 34920209 DOI: 10.1016/j.eatbeh.2021.101592] [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: 06/23/2021] [Revised: 11/14/2021] [Accepted: 11/30/2021] [Indexed: 12/14/2022]
Abstract
Research demonstrates the protective role of self-compassion for eating disorder symptoms. However, studies investigating self-compassion most often use the Self-Compassion Scale, which aggregates the distinct but related constructs of compassionate and uncompassionate self-responding. This study examined differential associations of compassionate and uncompassionate self-responding with positive and negative affect and with a range of eating disorder behaviors (i.e., binge eating, purging, dietary restriction, and excessive exercise). Participants were 547 undergraduate students (59% women, Mage = 20.49, SDage = 1.83) who completed measures of self-compassion, trait affect, and eating disorder behaviors. Compassionate and uncompassionate self-responding were moderately negatively correlated (rs = -0.41 and -0.33, among women and men, respectively). Compassionate self-responding was more strongly related to positive affect, and uncompassionate self-responding was more strongly related to negative affect. Among women, uncompassionate self-responding was related to all eating disorder behaviors controlling for compassionate self-responding, whereas compassionate self-responding was not uniquely related to any eating disorder behavior. Among men, a similar pattern emerged, except that only compassionate self-responding related uniquely to excessive exercise. Results are consistent with studies showing that the presence of uncompassionate self-responding might outweigh the absence of compassionate self-responding in explaining psychopathology. Findings highlight the potential importance of primarily targeting uncompassionate self-responding in eating disorder interventions.
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Affiliation(s)
- Ege Bicaker
- Department of Psychology, McGill University, Montreal, Canada
| | - Sarah E Racine
- Department of Psychology, McGill University, Montreal, Canada.
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28
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Talbot HK, Martin ET, Gaglani M, Middleton DB, Ghamande S, Silveira FP, Murthy K, Zimmerman RK, Trabue CH, Olson SM, Petrie JG, Ferdinands JM, Patel MM, Monto AS. Coronavirus disease 2019 (COVID-19) Versus Influenza in Hospitalized Adult Patients in the United States: Differences in Demographic and Severity Indicators. Clin Infect Dis 2021; 73:2240-2247. [PMID: 34050659 PMCID: PMC8195096 DOI: 10.1093/cid/ciab123] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Novel coronavirus disease 2019 (COVID-19) is frequently compared with influenza. The Hospitalized Adult Influenza Vaccine Effectiveness Network (HAIVEN) conducts studies on the etiology and characteristics of U.S. hospitalized adults with influenza. It began enrolling patients with COVID-19 hospitalizations in March 2020. Patients with influenza were compared with those with COVID-19 in the first months of the U.S. epidemic. METHODS Adults aged ≥ 18 years admitted to hospitals in 4 sites with acute respiratory illness were tested by real-time reverse transcription polymerase chain reaction for influenza and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus causing COVID-19. Demographic and illness characteristics were collected for influenza illnesses during 3 seasons 2016-2019. Similar data were collected on COVID-19 cases admitted before June 19, 2020. RESULTS Age groups hospitalized with COVID-19 (n = 914) were similar to those admitted with influenza (n = 1937); 80% of patients with influenza and 75% of patients with COVID-19 were aged ≥50 years. Deaths from COVID-19 that occurred in younger patients were less often related to underlying conditions. White non-Hispanic persons were overrepresented in influenza (64%) compared with COVID-19 hospitalizations (37%). Greater severity and complications occurred with COVID-19 including more ICU admissions (AOR = 15.3 [95% CI: 11.6, 20.3]), ventilator use (AOR = 15.6 [95% CI: 10.7, 22.8]), 7 additional days of hospital stay in those discharged alive, and death during hospitalization (AOR = 19.8 [95% CI: 12.0, 32.7]). CONCLUSIONS While COVID-19 can cause a respiratory illness like influenza, it is associated with significantly greater severity of illness, longer hospital stays, and higher in-hospital deaths.
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Affiliation(s)
- H Keipp Talbot
- Department of Medicine and Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Emily T Martin
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Manjusha Gaglani
- Baylor Scott & White Health, Texas A&M University College of Medicine, Temple, Texas, USA
- Department of Medical Education at Texas A&M University COM, Texas, USA
| | - Donald B Middleton
- Department of Medicine, Division of Infectious Diseases, University of Pittsburgh and University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Shekhar Ghamande
- Baylor Scott & White Health, Texas A&M University College of Medicine, Temple, Texas, USA
- Department of Medical Education at Texas A&M University COM, Texas, USA
| | - Fernanda P Silveira
- Department of Medicine, Division of Infectious Diseases, University of Pittsburgh and University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Kempapura Murthy
- Baylor Scott & White Health, Texas A&M University College of Medicine, Temple, Texas, USA
| | - Richard K Zimmerman
- Department of Medicine, Division of Infectious Diseases, University of Pittsburgh and University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Christopher H Trabue
- Department of Medicine, University of Tennessee Health Science Center, Saint Thomas Health, Nashville, Tennessee, USA
| | - Samantha M Olson
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Joshua G Petrie
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Jill M Ferdinands
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Manish M Patel
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Arnold S Monto
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
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29
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Mason TB, Smith KE, Crosby RD, Dvorak R, Engel SG, Crow S, Wonderlich SA, Peterson CB. Self-discrepancy as a Predictor of Eating Disorder Symptoms: Findings from Two Ecological Momentary Assessment Studies of Adults with Binge Eating. COGNITIVE THERAPY AND RESEARCH 2021. [DOI: 10.1007/s10608-021-10279-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Wyssen A, Meyer AH, Messerli-Bürgy N, Forrer F, Vanhulst P, Lalanne D, Munsch S. BED-online: Acceptance and efficacy of an internet-based treatment for binge-eating disorder: A randomized clinical trial including waitlist conditions. EUROPEAN EATING DISORDERS REVIEW 2021; 29:937-954. [PMID: 34418221 PMCID: PMC9292199 DOI: 10.1002/erv.2856] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 07/04/2021] [Accepted: 07/31/2021] [Indexed: 01/21/2023]
Abstract
Objective Internet‐based guided self‐help (GSH) programs increase accessibility and utilization of evidence‐based treatments in binge‐eating disorder (BED). We evaluated acceptance and short as well as long‐term efficacy of our 8‐session internet‐based GSH program in a randomized clinical trial with an immediate treatment group, and two waitlist control groups, which differed with respect to whether patients received positive expectation induction during waiting or not. Method Sixty‐three patients (87% female, mean age 37.2 years) followed the eight‐session guided cognitive‐behavioural internet‐based program and three booster sessions in a randomized clinical trial design including an immediate treatment and two waitlist control conditions. Outcomes were treatment acceptance, number of weekly binge‐eating episodes, eating disorder pathology, depressiveness, and level of psychosocial functioning. Results Treatment satisfaction was high, even though 27% of all patients dropped out during the active treatment and 9.5% during the follow‐up period of 6 months. The treatment, in contrast to the waiting conditions, led to a significant reduction of weekly binge‐eating episodes from 3.4 to 1.7 with no apparent rebound effect during follow‐up. All other outcomes improved as well during active treatment. Email‐based positive expectation induction during waiting period prior to the treatment did not have an additional beneficial effect on the temporal course and thus treatment success, of binge episodes in this study. Conclusion This short internet‐based program was clearly accepted and highly effective regarding core features of BED. Dropout rates were higher in the active and lower in the follow‐up period. Positive expectations did not have an impact on treatment effects. The present internet‐based guided self‐help program adds to the existing research regarding online treatment of binge‐eating disorder and is currently one of the two existing validated programs available in German language. It is based on an established cognitive‐behavioural treatment approach, shows high acceptance by patients and high efficacy after eight guided online sessions, thereby representing the shortest duration of currently evaluated treatments During the internet‐based therapy, the number of weekly binge‐eating episodes, depressive symptoms, eating disorder pathology as well as impairments in psychosocial functioning all significantly decreased. These positive effects were maintained during follow‐up (6 months). Abstainer rate (no binge‐eating during last month) continued to increase during follow‐up with booster sessions An email‐based pre‐treatment positive expectation induction did not alter the temporal course and thus treatment success, of binge episodes
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Affiliation(s)
- Andrea Wyssen
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Fribourg, Fribourg, Switzerland.,University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Andrea H Meyer
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Fribourg, Fribourg, Switzerland.,Institute of Psychology, Clinical Psychology and Epidemiology, University of Basel, Basel, Switzerland
| | - Nadine Messerli-Bürgy
- Department of Psychology, Clinical Child Psychology & Biological Psychology, University of Fribourg, Fribourg, Switzerland
| | - Felicitas Forrer
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Fribourg, Fribourg, Switzerland
| | - Pierre Vanhulst
- Department of Informatics, Human-IST Institute, University of Fribourg, Fribourg, Switzerland
| | - Denis Lalanne
- Department of Informatics, Human-IST Institute, University of Fribourg, Fribourg, Switzerland
| | - Simone Munsch
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Fribourg, Fribourg, Switzerland
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Smith KE, Mason TB, Schaefer LM, Anderson LM, Critchley K, Crosby RD, Engel SG, Crow SJ, Wonderlich SA, Peterson CB. Dynamic Stress Responses and Real-Time Symptoms in Binge-Eating Disorder. Ann Behav Med 2021; 55:758-768. [PMID: 32856687 DOI: 10.1093/abm/kaaa061] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Stress is a dynamic construct that predicts a range of health behaviors and conditions, including binge eating and excess weight. Thus far, there have been limited and inconsistent findings regarding stress responses in binge-eating disorder (BED) and insufficient consideration of temporal patterns of stress responses across the weight spectrum. PURPOSE The present study used ecological momentary assessment (EMA) to examine stress reactivity (i.e., the magnitude of the initial stress response), recovery (i.e., how long the stress response lasts before returning to baseline), and pileup (i.e., accumulation of repeated experiences of stressors and responses over time) as predictors of binge-eating symptoms (BES) and food craving in BED. METHODS Adults with BED (N = 115) completed a 7 day EMA protocol assessing stressful events, perceived stress, binge eating, and food craving prior to being randomized to a behavioral intervention. RESULTS Generalized estimating equations indicated that moments of greater stress pileup predicted greater subsequent BES (within-person effect). Participants with higher perceived stress and pileup reported greater overall BES and craving, and those with better recovery reported higher overall craving (between-person effects). CONCLUSIONS Findings highlight the importance of considering the dynamic nature of stress responses and, particularly, that the accumulation of stress over the day is an important trigger for BES.
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Affiliation(s)
- Kathryn E Smith
- Department of Psychiatry and Behavioral Sciences, University of Southern California, Los Angeles, CA, USA
| | - Tyler B Mason
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA
| | - Lauren M Schaefer
- Center for Bio-behavioral Research, Sanford Research, Fargo, ND, USA
| | - Lisa M Anderson
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, USA
| | - Kobe Critchley
- Center for Bio-behavioral Research, Sanford Research, Fargo, ND, USA
| | - Ross D Crosby
- Center for Bio-behavioral Research, Sanford Research, Fargo, ND, USA.,Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, ND, USA
| | - Scott G Engel
- Center for Bio-behavioral Research, Sanford Research, Fargo, ND, USA.,Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, ND, USA
| | - Scott J Crow
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, USA.,The Emily Program, Saint Paul, MN, USA
| | - Stephen A Wonderlich
- Center for Bio-behavioral Research, Sanford Research, Fargo, ND, USA.,Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, ND, USA
| | - Carol B Peterson
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, USA.,The Emily Program, Saint Paul, MN, USA
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Mason TB, Smith KE, Anderson LM, Schaefer LM, Engel SG, Crow SJ, Crosby RD, Peterson CB, Wonderlich SA. Affective response to binge eating as a predictor of binge eating disorder treatment outcome. Clin Psychol Sci 2021; 9:752-760. [PMID: 34765322 DOI: 10.1177/2167702620985198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This report examined baseline affective response to binge eating as a predictor of binge-eating disorder (BED) treatment outcome. Baseline affective response was defined as: (1) each individual's average net change (i.e., area under the curve [AUC]) of positive affect (PA) or negative affect (NA) before and after binge-eating episodes and (2) post-binge eating slope of PA or NA across seven-days of ecological momentary assessment (EMA). Adults with BED completed Integrative Cognitive-Affective Therapy (ICAT-BED) or cognitive behavioral therapy guided self-help (CBTgsh). Individuals with greater net increases in PA (AUC) following binge eating at baseline exhibited better treatment response in ICAT-BED at end-of-treatment and follow-up. NA affective response was only significant at end-of-treatment; individuals with less rapid post-binge improvements in NA (slope) did better in ICAT-BED, while individuals with lower net improvements in NA (AUC) did better in CBTgsh. Affective response to binge eating may be a marker of BED treatment response.
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Affiliation(s)
- Tyler B Mason
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA
| | - Kathryn E Smith
- Department of Biobehavioral Research, Sanford Health, Fargo, ND.,Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, ND
| | - Lisa M Anderson
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN
| | | | - Scott G Engel
- Department of Biobehavioral Research, Sanford Health, Fargo, ND
| | - Scott J Crow
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN
| | - Ross D Crosby
- Department of Biobehavioral Research, Sanford Health, Fargo, ND.,Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, ND
| | - Carol B Peterson
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN
| | - Stephen A Wonderlich
- Department of Biobehavioral Research, Sanford Health, Fargo, ND.,Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, ND
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Juarascio AS, Parker MN, Hunt R, Murray HB, Presseller EK, Manasse SM. Mindfulness and acceptance-based behavioral treatment for bulimia-spectrum disorders: A pilot feasibility randomized trial. Int J Eat Disord 2021; 54:1270-1277. [PMID: 33851734 PMCID: PMC8780759 DOI: 10.1002/eat.23512] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 03/19/2021] [Accepted: 03/19/2021] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Although existing research supports the efficacy of mindfulness- and acceptance-based treatments (MABTs) for eating disorders (EDs), few studies have directly compared outcomes from MABTs to standard CBT. METHOD Participants (N = 44), treatment-seeking adults with bulimia-spectrum EDs, were screened for eligibility, consented, and randomized to receive 20 sessions of outpatient, individual CBT or MABT treatment. Treatment outcomes (binge eating and compensatory behavior episodes, global ED severity, depressive symptoms, quality of life, emotional awareness/clarity, distress tolerance, values-based decision-making, and emotion modulation) were measured at pre-treatment, post-treatment, and 6-month follow up. Data on feasibility and acceptability are also presented. RESULTS Treatment and assessment retention rates were comparable between MABT and CBT (p range = .51-.73) and between-group differences on acceptability measures were very small (d range = 0.03-0.19). Both conditions produced notable and generally comparable changes in most treatment outcomes at post-treatment (within group d range = 0.06-1.77). DISCUSSION The MABT and CBT conditions demonstrated comparable degrees of feasibility, acceptability, and symptom improvement, suggesting that MABTs warrant further evaluation as ED treatments.
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Affiliation(s)
- Adrienne S. Juarascio
- Department of Psychology, Drexel University, Philadelphia, Pennsylvania,Center for Weight, Eating, and Lifestyle Science, Drexel University, Philadelphia, Pennsylvania
| | - Megan N. Parker
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USU), Bethesda, Maryland,Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), Division of Intramural Research, National Institutes of Health (NIH), Bethesda, Maryland
| | - Rowan Hunt
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, Kentucky
| | - Helen Burton Murray
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts,Harvard Medical School, Boston, Massachusetts
| | - Emily K. Presseller
- Department of Psychology, Drexel University, Philadelphia, Pennsylvania,Center for Weight, Eating, and Lifestyle Science, Drexel University, Philadelphia, Pennsylvania
| | - Stephanie M. Manasse
- Center for Weight, Eating, and Lifestyle Science, Drexel University, Philadelphia, Pennsylvania
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Haynos AF, Anderson LM, Askew AJ, Craske MG, Peterson CB. Adapting a neuroscience-informed intervention to alter reward mechanisms of anorexia nervosa: a novel direction for future research. J Eat Disord 2021; 9:63. [PMID: 34039415 PMCID: PMC8152047 DOI: 10.1186/s40337-021-00417-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 05/04/2021] [Indexed: 01/16/2023] Open
Abstract
Accumulating psychobiological data implicate reward disturbances in the persistence of anorexia nervosa (AN). Evidence suggests that individuals with AN demonstrate decision-making deficits similar to those with mood and anxiety disorders that cause them to under-respond to many conventionally rewarding experiences (e.g., eating, interacting socially). In contrast, unlike individuals with other psychiatric disorders, individuals with AN simultaneously over-respond to rewards associated with eating-disorder behaviors (e.g., restrictive eating, exercising). This pattern of reward processing likely perpetuates eating-disorder symptoms, as the rewards derived from eating-disorder behaviors provide temporary relief from the anhedonia associated with limited responsivity to other rewards. Positive Affect Treatment (PAT) is a cognitive-behavioral intervention designed to target reward deficits that contribute to anhedonia in mood and anxiety disorders, including problems with reward anticipation, experiencing, and learning. PAT has been found to promote reward responsivity and clinical improvement in mood and anxiety disorders. This manuscript will: (1) present empirical evidence supporting the promise of PAT as an intervention for AN; (2) highlight nuances in the maintaining processes of AN that necessitate adaptations of PAT for this population; and (3) suggest future directions in research on PAT and other reward-based treatments that aim to enhance clinical outcomes for AN.
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Affiliation(s)
- Ann F Haynos
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, 2450 Riverside Ave., Minneapolis, MN, 55454, USA.
| | - Lisa M Anderson
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, 2450 Riverside Ave., Minneapolis, MN, 55454, USA
| | - Autumn J Askew
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, 2450 Riverside Ave., Minneapolis, MN, 55454, USA
| | - Michelle G Craske
- Department of Psychology and Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
| | - Carol B Peterson
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, 2450 Riverside Ave., Minneapolis, MN, 55454, USA
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Descriptives and baseline ecological momentary assessed predictors of weight change over the course of psychological treatments for binge eating disorder. J Psychosom Res 2021; 143:110373. [PMID: 33567390 PMCID: PMC8857897 DOI: 10.1016/j.jpsychores.2021.110373] [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: 09/03/2020] [Revised: 01/12/2021] [Accepted: 01/24/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The objectives were to examine individual variability in weight change across psychological treatments for binge-eating disorder (BED) and to examine baseline predictors (i.e., BED symptoms, affect, and appetite) of weight change using ecological momentary assessment (EMA). METHOD Adults with BED (N = 110) enrolled in a randomized clinical trial in which they received one of two psychological treatments for BED. At baseline, participants completed a 7-day EMA protocol measuring BED symptoms, affect, and appetite. Height and weight were measured at baseline, mid-treatment, end-of-treatment, and follow-up, and body mass index (BMI) was calculated. RESULTS On average, participants evidenced a 2% increase in BMI at end-of-treatment and a 1% increase between end-of-treatment and 6-month follow-up assessments. Although results showed that BMI increased over time, the quadratic term reflected a deceleration in this effect. There were interactions between positive affect and the linear trajectory across time predicting BMI, indicating that individuals reporting higher positive affect at baseline evidenced a flatter trajectory of weight gain. There was a main effect of overeating as assessed by EMA and interactions between overeating and linear and quadratic trajectories across time predicting BMI. Individuals who reported greater overeating at baseline had higher BMI across time. However, the BMI of individuals with lower overeating increased linearly, and increases in BMI among those with average or high rates of overeating appeared to stabilize over time. CONCLUSION Despite the variability in weight change, baseline positive affect and overeating may be ecological targets for improving weight outcomes in psychological treatments for BED.
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36
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Williams-Kerver GA, Schaefer LM, Hazzard VM, Cao L, Engel SG, Peterson CB, Wonderlich SA, Crosby RD. Baseline and momentary predictors of ecological momentary assessment adherence in a sample of adults with binge-eating disorder. Eat Behav 2021; 41:101509. [PMID: 33905971 PMCID: PMC8453583 DOI: 10.1016/j.eatbeh.2021.101509] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 04/05/2021] [Accepted: 04/06/2021] [Indexed: 10/21/2022]
Abstract
Ecological Momentary Assessment (EMA) is a widely used methodology to examine psychological and behavioral phenomena among individuals with eating disorders (EDs). While EMA overcomes limitations associated with traditional retrospective self-report, it remains subject to potential methodological limitations, including poor adherence to the EMA protocol, which may bias findings. Little is known about baseline and momentary predictors of missing EMA data in ED research; however, such work may help clarify the correlates of missingness and illuminate steps to address potential bias. The purpose of this study was to investigate predictors of EMA adherence in a sample of adults with binge-eating disorder (BED) enrolled in a randomized treatment trial. Prior to treatment, 110 patients completed self-report questionnaires assessing demographics, psychopathology, and transdiagnostic risk/maintenance factors. Participants then responded to EMA questions regarding their eating behavior and internal states six times a day for seven days. A series of generalized-linear and mixed-effect models were conducted to examine baseline and momentary predictors of EMA adherence. No significant baseline predictors were identified, suggesting that participants' overall level of missing data was not related to person-level characteristics (e.g., gender, level of ED pathology). However, lower positive affect, lower hunger, signals later in the day, later days in the EMA protocol, and missed prior signals predicted greater odds of signal non-response, suggesting certain contextual factors may impact the likelihood that a participant with BED will respond to the subsequent EMA signal. Ultimately, these findings have implications for future eating disorder EMA research.
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Affiliation(s)
- Gail A. Williams-Kerver
- Sanford Center for Bio-behavioral Research; Fargo, ND,Department of Psychiatry, University of North Dakota School of Medicine and Health Sciences; Fargo, ND
| | - Lauren M. Schaefer
- Sanford Center for Bio-behavioral Research; Fargo, ND,Department of Psychiatry, University of North Dakota School of Medicine and Health Sciences; Fargo, ND
| | | | - Li Cao
- Sanford Center for Bio-behavioral Research; Fargo, ND
| | - Scott G. Engel
- Sanford Center for Bio-behavioral Research; Fargo, ND,Department of Psychiatry, University of North Dakota School of Medicine and Health Sciences; Fargo, ND
| | - Carol B. Peterson
- Department of Psychiatry and Behavioral Sciences, University of Minnesota; Minneapolis, MN
| | - Stephen A. Wonderlich
- Sanford Center for Bio-behavioral Research; Fargo, ND,Department of Psychiatry, University of North Dakota School of Medicine and Health Sciences; Fargo, ND
| | - Ross D. Crosby
- Sanford Center for Bio-behavioral Research; Fargo, ND,Department of Psychiatry, University of North Dakota School of Medicine and Health Sciences; Fargo, ND
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Hazzard VM, Crosby RD, Crow SJ, Engel SG, Schaefer LM, Brewerton TD, Castellini G, Trottier K, Peterson CB, Wonderlich SA. Treatment outcomes of psychotherapy for binge-eating disorder in a randomized controlled trial: Examining the roles of childhood abuse and post-traumatic stress disorder. EUROPEAN EATING DISORDERS REVIEW 2021; 29:611-621. [PMID: 33660906 DOI: 10.1002/erv.2823] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 12/22/2020] [Accepted: 01/17/2021] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To examine childhood abuse and post-traumatic stress disorder (PTSD) as predictors and moderators of binge-eating disorder (BED) treatment outcomes in a randomized controlled trial comparing Integrative Cognitive-Affective Therapy with cognitive-behavioural therapy administered using guided self-help. METHOD In 112 adults with BED, childhood abuse was defined as any moderate/severe abuse as assessed by the Childhood Trauma Questionnaire, lifetime PTSD was assessed via the Structured Clinical Interview for DSM-IV, and outcomes were assessed via the Eating Disorder Examination (EDE). Covariate-adjusted regression models predicting binge-eating frequency and EDE global scores at end of treatment and 6-month follow-up were conducted. RESULTS Lifetime PTSD predicted greater binge-eating frequency at end of treatment (B = 1.32, p = 0.009) and childhood abuse predicted greater binge-eating frequency at follow-up (B = 1.00, p = 0.001). Lifetime PTSD moderated the association between childhood abuse and binge-eating frequency at follow-up (B = 2.98, p = 0.009), such that childhood abuse predicted greater binge-eating frequency among participants with a history of PTSD (B = 3.30, p = 0.001) but not among those without a PTSD history (B = 0.31, p = 0.42). No associations with EDE global scores or interactions with treatment group were observed. CONCLUSIONS Results suggest that a traumatic event history may hinder treatment success and that PTSD may be more influential than the trauma exposure itself.
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Affiliation(s)
| | - Ross D Crosby
- Sanford Center for Biobehavioral 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
| | - Scott J Crow
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, Minnesota, USA.,The Emily Program, St. Paul, Minnesota, USA
| | - Scott G Engel
- Sanford Center for Biobehavioral Research, Fargo, North Dakota, USA
| | | | - Timothy D Brewerton
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Giovanni Castellini
- Department of Health Sciences, Psychiatry Unit, University of Florence, Florence, Italy
| | - Kathryn Trottier
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Carol B Peterson
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Stephen A Wonderlich
- Sanford Center for Biobehavioral 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
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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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Hazzard VM, Peterson CB, Crosby RD, Schaefer LM, Smith KE, Engel SG, Crow SJ, Wonderlich SA. Predictors of treatment response durability in psychotherapy for binge-eating disorder: Examining the roles of self-discrepancy, self-directed style, and emotion dysregulation. Int J Eat Disord 2020; 53:1918-1927. [PMID: 33118638 PMCID: PMC7718374 DOI: 10.1002/eat.23389] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 10/01/2020] [Accepted: 10/01/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To examine changes in hypothesized maintenance mechanisms during treatment as predictors of treatment response durability in binge-eating disorder (BED) treatment, using data from a randomized clinical trial comparing the efficacy of Integrative Cognitive-Affective Therapy for BED with cognitive-behavioral therapy delivered using guided self-help. METHOD Adults with BED (N = 112) received 17 weeks of treatment. Regression models were conducted to examine the extent to which changes in hypothesized maintenance mechanisms from baseline to end of treatment predicted treatment outcomes at 6-month follow-up, adjusting for demographics, study site, and baseline level of treatment outcome. RESULTS During-treatment reductions in negative self-directed style and emotion dysregulation predicted reductions in the primary treatment outcome (i.e., binge-eating episode frequency) at follow-up. During-treatment reductions in emotion dysregulation also predicted improvements at follow-up across all three secondary treatment outcomes examined (i.e., global eating disorder [ED] psychopathology, depressive symptoms, and anxiety symptoms), as did during-treatment reductions in actual-ideal self-discrepancy and actual-ought self-discrepancy. Increases in positive self-directed style (e.g., self-affirmation) and reductions in negative self-directed style (e.g., self-blame) during treatment each predicted improvements in anxiety symptoms at follow-up. When predictors were examined simultaneously, the most salient predictors of treatment response durability identified were negative self-directed style for binge-eating episode frequency, actual-ought self-discrepancy and emotion dysregulation for depressive symptoms, and emotion dysregulation for anxiety symptoms. No predictors emerged as most salient for global ED psychopathology. DISCUSSION Results indicate that negative self-directed style and emotion dysregulation are particularly important treatment targets in relation to behavioral treatment outcomes in BED.
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Affiliation(s)
| | - Carol B. Peterson
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, Minnesota USA
| | - Ross D. Crosby
- Sanford Center for Biobehavioral Research, Fargo, North Dakota USA
| | | | - Kathryn E. Smith
- Department of Psychiatry and Behavioral Sciences, University of Southern California, Los Angeles, California USA
| | - Scott G. Engel
- Sanford Center for Biobehavioral Research, Fargo, North Dakota USA
| | - Scott J. Crow
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, Minnesota USA,The Emily Program, St. Paul, Minnesota USA
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41
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Juarascio AS, Hunt RA, Lantz Lesser E, Engel SG, Pisetsky EM, Peterson CB, Wonderlich SA. Enhancing Integrative Cognitive-Affective Therapy with ecological momentary interventions: A pilot trial. EUROPEAN EATING DISORDERS REVIEW 2020; 29:152-158. [PMID: 33104279 DOI: 10.1002/erv.2800] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 08/14/2020] [Accepted: 10/10/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Although current treatments are effective for some patients with eating disorders, a large number of patients remain partially or fully symptomatic post-treatment. This may be related to poor utilization of treatment skills outside of the therapy office. Smartphone applications that can detect and intervene during moments of need could facilitate such skill use between sessions. METHOD Individuals (N = 16) participated in a small pilot open trial where they received 21 sessions of in-person Integrative Cognitive-Affective Therapy (ICAT) therapy an app (iCAT+) that delivers ecological momentary interventions (EMI) in response to user-entered data. Data were collected on the feasibility and acceptability of this treatment approach and on preliminary indicators of treatment outcomes. RESULTS Participants found iCAT+ as a treatment augmentation acceptable and indicated it had clinical utility as an adjunct to in-person therapy, although analyses indicated poor compliance with data entry needed to trigger EMI delivery. This suggests that long-term use of EMI requiring ongoing data entry is infeasible. CONCLUSIONS We describe lessons learned from our initial pilot trial and future directions for the development of impactful EMI systems that can be used to augment in-person therapies.
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Affiliation(s)
- Adrienne S Juarascio
- Center for Weight, Eating, and Lifestyle Sciences (WELL Center), Drexel University, Philadelphia, Pennsylvania, USA.,Department of Psychology, Drexel University, Philadelphia, Pennsylvania, USA
| | - Rowan A Hunt
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, Kentucky, USA
| | - Elin Lantz Lesser
- Sanford Health/Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota, USA
| | - Scott G Engel
- Sanford Health/Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota, USA
| | - Emily M Pisetsky
- Department of Psychiatry, University of Minnesota, Minneapolis, Minnesota, USA
| | - Carol B Peterson
- Department of Psychiatry, University of Minnesota, Minneapolis, Minnesota, USA
| | - Stephen A Wonderlich
- Sanford Health/Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota, USA
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Williams-Kerver GA, Wonderlich SA, Crosby RD, Cao L, Smith KE, Engel SG, Crow SJ, Peterson CB, Mitchell JE, Le Grange D. Differences in Affective Dynamics Among Eating Disorder Diagnostic Groups. Clin Psychol Sci 2020; 8:857-871. [PMID: 33758687 PMCID: PMC7983702 DOI: 10.1177/2167702620917196] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 01/29/2020] [Indexed: 12/25/2022]
Abstract
Emotion regulation theories suggest that affect intensity is crucial in the development and maintenance of eating disorders. However, other aspects of emotional experience, such as lability, differentiation, and inertia, are not as well understood. This study is the first to use ecological momentary assessment (EMA) to examine differences in several daily negative affect (NA) indicators among adults diagnosed with anorexia nervosa (AN), bulimia nervosa (BN), or binge eating disorder (BED). Using EMA data from three large studies, a series of linear mixed models showed that participants in the AN and BN groups experienced significantly greater NA intensity and better emotion differentiation than participants in the BED group. Alternatively, the BN group demonstrated significantly greater NA lability than the AN group and greater NA inertia than the BED group. These results suggest that several daily affective experiences differ among eating disorders diagnostic groups and have implications towards distinct conceptualizations and treatments.
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Affiliation(s)
| | - Stephen A. Wonderlich
- Sanford Center for Bio-behavioral Research, Fargo, North Dakota
- Department of Psychiatry, University of North Dakota School of Medicine and Health Sciences
| | - Ross D. Crosby
- Sanford Center for Bio-behavioral Research, Fargo, North Dakota
- Department of Psychiatry, University of North Dakota School of Medicine and Health Sciences
| | - Li Cao
- Sanford Center for Bio-behavioral Research, Fargo, North Dakota
| | - Kathryn E. Smith
- Sanford Center for Bio-behavioral Research, Fargo, North Dakota
- Department of Psychiatry, University of North Dakota School of Medicine and Health Sciences
| | - Scott G. Engel
- Sanford Center for Bio-behavioral Research, Fargo, North Dakota
| | - Scott J. Crow
- Department of Psychiatry, University of Minnesota
- The Emily Program, St. Paul, Minnesota
| | - Carol B. Peterson
- Department of Psychiatry, University of Minnesota
- The Emily Program, St. Paul, Minnesota
| | - James E. Mitchell
- Sanford Center for Bio-behavioral Research, Fargo, North Dakota
- Department of Psychiatry, University of North Dakota School of Medicine and Health Sciences
| | - Daniel Le Grange
- Department of Psychiatry, University of California, San Francisco
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago
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Anderson LM, Smith KM, Schaefer LM, Crosby RD, Cao L, Engel SG, Crow SJ, Wonderlich SA, Peterson CB. Predictors and moderators of treatment outcome in a randomized clinical trial for binge-eating disorder. J Consult Clin Psychol 2020; 88:631-642. [PMID: 32338932 DOI: 10.1037/ccp0000503] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The current study examined predictors and moderators of two interventions for binge-eating disorder (BED). METHOD Participants were 112 adults with BED (Mage = 39.7 ± 13.4 years; MBMI = 35.1 ± 13.4 kg/m²; 82% female; 91% Caucasian) randomly assigned to integrative cognitive-affective therapy for BED (ICAT-BED) or guided self-help cognitive-behavioral therapy (CBTgsh). Generalized linear models examined predictors and moderators of objective binge-eating episode (OBE) frequency and OBE abstinence at end-of-treatment (EOT) and 6-month follow-up (FU). RESULTS Lower levels of baseline dietary restraint and emotion regulation difficulties predicted greater reductions in OBE frequency at EOT and FU, respectively. At EOT, greater pretreatment self-control predicted greater reductions in OBE frequency in ICAT-BED than CBTgsh (ps < .05). In addition, low shape/weight overvaluation predicted greater reductions in OBE frequency in ICAT-BED than CBTgsh, whereas high shape/weight overvaluation predicted comparable reductions in OBE frequency across treatments at EOT (ps < .02). At EOT and FU, greater baseline actual-ideal self-discrepancy predicted significantly greater reductions in OBE frequency in ICAT-BED, than CBTgsh (ps < .02). No significant predictor or moderator effects were observed for models examining OBE abstinence. CONCLUSION This study identified two general predictors and four moderators of BED treatment response. However, only one predictor (actual-ideal self-discrepancy) interacted with treatment type to differentially predict OBE frequencies at both EOT and FU. Altogether, findings suggest that ICAT-BED may confer specific and durable improvements in OBE frequencies among individuals with high actual-ideal self-discrepancy. Therefore, patients demonstrating these characteristics may be more likely to benefit from ICAT-BED. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Lisa M Anderson
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School
| | - Kathryn M Smith
- Department of Psychiatry and The Behavioral Sciences, University of Southern California
| | | | | | - Li Cao
- Sanford Center for Biobehavioral Research
| | | | - Scott J Crow
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School
| | | | - Carol B Peterson
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School
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