Meta-analysis of the effects of third-wave behavioural interventions on disordered eating and body image concerns: implications for eating disorder prevention

Addressing body dysmorphic disorder through mindfulness: A new therapeutic frontier

Body dysmorphic disorder presents in up to 2% of the general population, yet less than half seek psychological support. Some treatment barriers include poor illness insight, low body dysmorphic disorder awareness among mental health professionals and a lack of accessibility to body dysmorphic disorder-specific treatments. Currently available treatments for body dysmorphic disorder, including psychopharmacology and psychotherapy, show modest results in improving body dysmorphic disorder symptoms. With the reduced quality of life and increased risks of suicide among individuals with body dysmorphic disorder, there is a need for new and easily accessible therapeutic approaches specific to body dysmorphic disorder. Emerging research has suggested that mindfulness-based interventions show promise as an addition to available body dysmorphic disorder treatments. Clinical evidence of mindfulness-based interventions demonstrates efficacy in improving symptoms in eating disorders, social anxiety disorder and obsessive-compulsive disorder, conditions that have similar clinical presentations as body dysmorphic disorder. Mindfulness strategies, such as increasing interoceptive awareness, non-judgement and non-reactivity, are also suggested to reduce body image disturbances, anxiety and repetitive thoughts, and cognitive rigidity, clinical characteristics of body dysmorphic disorder. This perspective piece aims to provide evidences for integrating mindfulness into treatment protocols to support mental health professionals better address the challenges faced by individuals with body dysmorphic disorder.

Comparative efficacy and acceptability of interventions for universal, selective and indicated prevention of eating disorders: study protocol for a systematic review and network meta-analysis

BACKGROUND

Eating disorders (EDs) are severe psychiatric conditions, with prevalence rates ranging from 5.5 to 17.9% in women and 0.6 to 2.4% in men. EDs carry a high risk of chronicity and mortality, highlighting the need for effective prevention strategies. Primary prevention can target the entire population (universal), high-risk groups (selective), or individuals with early signs (indicated). Despite substantial research, prior reviews often show limitations, such as single-author data extraction, lack of quality assessment, reliance on endpoint data, exclusion of obesity prevention programs, or outdated findings. No review has yet evaluated the comparative effectiveness of multiple interventions across risk groups. This article outlines a systematic review and network meta-analysis (NMA) protocol to assess the comparative effectiveness of various ED preventive interventions across different prevention types and populations.

METHODS

Eligible studies will include (cluster) randomized controlled trials (RCTs) involving children, adolescents, and adults across a range of settings. Databases to be searched include MEDLINE, Embase, PsycINFO, and CENTRAL. All prevention types (universal, selective, indicated) will be included. Interventions will encompass psychological, educational, physical, and nutritional approaches aimed at preventing EDs, disordered eating, or negative body image and/or reducing risk factors. Coprimary outcomes will be ED diagnostic symptoms, overall ED pathology, ED onset, and intervention all-cause discontinuation (acceptability). A frequentist NMA framework will be used for data synthesis, with sensitivity and subgroup analyses to identify effect modifiers.

DISCUSSION

This first NMA on ED prevention aims to provide valuable insights for clinicians, researchers, policymakers and the public by identifying the most effective interventions and highlighting research gaps. The findings will inform intervention selection for specific populations and guide future prevention strategies to reduce the burden of EDs on affected individuals, their communities, and wider society.

CLINICAL TRIAL REGISTRATION NUMBER

CRD42024498102.

Navigating body image flexibility: Psy-Flex scale for body image and its utility in differentiating severity levels of disordered eating and body dysmorphia symptomatology

Body image flexibility concerns the willingness to tolerate undesirable body-related experiences, while remaining committed to valued goals and actions, and plays an important role in the development and maintenance of the body and eating-related disorders. However, the known limitations of current assessment measures represent a major barrier to the adequate study of this construct. Recently, a novel brief psychological flexibility measure was successfully developed (Psy-Flex). The present study aimed to adapt and validate the Psy-Flex for Body Image (Psy-Flex-BI) and to explore its psychometric properties. Additionally, we aimed to support this scale as an important tool in the fields of disordered eating and body dysmorphia, by testing its ability to differentiate the severity levels of these symptoms in the general population. The study comprised 1031 participants who completed online questionnaires. The Psy-Flex-BI (6 items) was successfully adapted, and the one-dimensional factorial structure of the scale was confirmed. The scale presented robust psychometric properties, including a Cronbach's alpha of 0.89, and was invariant across sex. It also correlated in expected directions and strengths with similar constructs and maladaptive psychological indicators. Finally, Psy-flex-BI scores successfully corresponded to distinctive disordered eating and body dysmorphia symptomatology severity levels, presenting two distinct patterns supported by the literature. This data supports the scale's screening potential. Indeed, the Psy-Flex-BI is a brief and sound measure of body image flexibility, encompassing the six core ACT dimensions, and can differentiate the severity of eating and body dysmorphia symptoms in the general population.

Toward Integrated Treatment for Co-Occurring Borderline Personality Disorder and Eating Disorders: A Clinician Perspective

OBJECTIVE

It is common practice in Australia for co-occurring borderline personality disorder (BPD) and eating disorders (ED) to be treated separately. The objective of this research was to review features these disorders share, evidence-based approaches used for treating these disorders in isolation, clinicians' experiences of delivering treatment for co-occurring BPD and ED, and finally to explore integrated approaches to treating this dual diagnosis.

METHOD

A qualitative approach was used to examine interview transcripts of 10 clinicians employed at specialist outpatient services for severe BPD or severe ED. Interview transcripts were analyzed using thematic analysis.

RESULTS

Nominated features shared by BPD and ED were emotion dysregulation, impulsivity, and interpersonal difficulties. Clinicians endorsed a range of therapeutic approaches for this dual diagnosis patient group, as well as an eclectic approach utilizing a combination of treatment features. Most clinicians proposed an ideal program duration of 6-12 months, with group and individually focused therapy complementing one another to address underlying behavioural drivers and confer lasting clinical benefits.

DISCUSSION

This study distills the importance of adopting integrated treatments for people with this dual diagnosis to optimize treatment outcomes. Future research could include soliciting client perspectives on using an integrated treatment approach for this dual diagnosis and trials of this approach to assess acceptability, feasibility, and longer-term outcomes.

PUBLIC SIGNIFICANCE STATEMENT

This study highlights the merit of concurrently addressing the complex interplay between EDs and BPD via an integrated treatment approach. Streamlining the therapeutic approach can address underlying features of these disorders, improve clinical formulation, and optimize patient outcomes.

The effectiveness of randomized controlled psychosocial interventions on body image among nonclinical women: A systematic review and meta-analysis

Women are vulnerable to body image disturbances, prompting numerous interventions to improve their body image. However, a systematic review and meta-analysis of such interventions is lacking. This study reviewed interventions designed to enhance body image among nonclinical women and quantified their effectiveness. Seven English databases were searched up to 6 September 2024. Studies included were psychosocial, randomized controlled, high-quality according to the Newcastle-Ottawa Quality Assessment Scale, and evaluating nonclinical women's body image as outcomes. Effect sizes on body image components were meta-analyzed; subgroup analyses and sensitivity tests were conducted to determine the sources of heterogeneity. Forty-eight high-quality studies with 7,182 participants (3,669 subjects and 3,513 controls) were included. Most interventions targeted body dissatisfaction (n = 36) and thin-ideal internalization (n = 34). Weight and shape concerns (n = 15), body satisfaction (n = 14), and behavioral avoidance (n = 10) were commonly measured. Interventions produced reductions in body dissatisfaction (d = -0.45), thin-ideal internalization (d = -0.59), weight and shape concerns (d = -1.08), and behavioral avoidance (d = -1.14), and improvements in body satisfaction (d = 0.42). The long-term effects were examined. High heterogeneity among studies was attributed to countries, scales, therapies, and delivery modes. Results supported that existing interventions effectively relieved body image disturbances in nonclinical women. Additionally, face-to-face interventions led by facilitators are needed to achieve greater improvements in body image.

Early Detection of Psychosis in Eating Disorders: Unnecessary or a Useful Addition?

AIM

The absence of consensus regarding the presence and interpretation of certain symptoms as indicative of either a psychosis spectrum disorder or an eating disorder (ED) can hinder cooperation amongst treatment programmes for the early detection of psychosis and an ED. This study trans-diagnostically assessed the prevalence and co-occurrence of at-risk mental states for a psychosis (ARMS) or the risk of having an ED (EDr), and it explored the characteristics of ARMS profiles of individuals with an EDr.

METHOD

This cross-sectional and observational-prevalence study used assessment outcomes from an ED screening instrument (SCOFF), a psychosis prodromal screening questionnaire (PQ16) and a CAARMS interview (to evaluate the possibility of ARMS) with newly admitted outpatients aged 16-35 who were referred for various kinds of non-psychotic disorders from a secondary Mental Health Care Centre in the Netherlands. Data analysis consisted of calculating prevalences, associations amongst variables and conditional probabilities.

RESULTS

Of the 736 individuals who were screened, an EDr was identified in 51.2% and 49.0% of the participants who scored high on the PQ16, half of whom also completed the CAARMS interview. The results indicated that 53.0% of the participants were classified as not having ARMS, 28.3% as having ARMS and 18.7% as having a psychosis. EDr patients presented with symptoms of a psychotic spectrum disorder, which included both ED-consistent and ED-inconsistent symptoms. There were relatively frequent endorsements of the two subscale items guilt/punishment and ideas of reference.

CONCLUSIONS

From a trans-diagnostical perspective, the results indicate that collaboration amongst ED programmes and psychosis prevention interventions should be strongly encouraged. Future researchers are encouraged to conduct studies that assess associations amongst and features of psychotic spectrum symptoms in EDs. The unexpectedly high proportion of EDr suggests that a co-morbid ED in other kinds of psychopathology is being overlooked.

The impact of yoga on body image in adults: A systematic review of quantitative studies

Evidence suggests that yoga can be used as an intervention to improve body image. This systematic review evaluates the evidence of the efficacy of yoga in improving body image among adults. Authors followed PRISMA guidelines, searching Pubmed, Ovid MEDLINE, Embase, Cochrane, CINHAL, PsycInfo, and grey literature up to December 2, 2023 and identifying 446 unique records. Eligibility criteria included English-language, peer-reviewed studies with quantitative data on adult populations. Twenty-nine studies were eligible for inclusion and were evaluated for methodological quality using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach. Interventions focused solely on yoga varied in length, frequency, and style. Our synthesis revealed that yoga is associated with improved body satisfaction and appreciation, as well as reduced body dissatisfaction, across diverse adult populations, including those with clinical or subclinical levels of body dissatisfaction. Most low- and moderate-quality studies reported significant improvements, and some suggested a dose-response relationship. However, the evidence is limited by methodological weaknesses, such as a lack of blinding and inadequate reporting. Despite these limitations, findings support yoga as a promising intervention for improving body image in adults. Future research should aim for methodologically rigorous studies that use validated outcome measures and more inclusive populations.

Acceptance and Commitment Therapy for Hypersexuality: A Pilot Study

Hypersexuality refers to the inability to control sexual desire. Despite it has shown serious consequences for physical, psychological and social health, the evidence of available psychological interventions is still insufficient. In this open-label pilot study, an Acceptance and Commitment Therapy (ACT) intervention was conducted with adults with clinically significant levels of hypersexuality aimed to examine its feasibility and usefulness. The intervention consisted of eight weekly online individual psychological intervention sessions. Outcome self-report measures were administered at baseline, after the intervention and a 3 months follow-up. Behavioral and subjective informed changes in sexual practices were weekly assessed through self-monitoring. Twelve participants (M age = 38.8 ± 11.5 years, 83.3% male, 66.7% homo or bisexual) completed the intervention. The feasibility was found to be good, with all the participants completing the training and high levels of satisfaction. Hypersexuality, psychological flexibility, cognitive fusion and mindfulness scores significantly improved after the ACT intervention, with large effect sizes. Clinically significant changes in hypersexuality were found for the vast majority of participants, besides reductions in the time dedicated to planning and practicing sex and the sexualized drug use. Results indicate that ACT-based interventions may be considered feasible and potentially effective therapeutic alternatives for hypersexuality.

Effectiveness of acceptance commitment therapy for head and neck cancer patients with body image distress in China: a study protocol for randomised controlled trial

INTRODUCTION

The head and neck comprise vital organs and are apparent human body parts. Tumours here impair physical and sensory functions as well as appearance and social interactions, leading to body image distress (BID) and threatening mental health and quality of life. Acceptance and commitment therapy has shown effectiveness in improving BID in groups such as breast cancer patients. This study aims to apply this therapy to intervene in head and neck cancer (HNC) patients, aiming to improve BID and promote better psychological well-being.

METHODS AND ANALYSIS

This study is a prospective, parallel-group, randomised controlled trial. A total of 64 HNC patients will be allocated to either an intervention group or a control group. The intervention group will engage in a 3 week, six-session group-based acceptance and commitment therapy programme, while the control group will receive standard treatment. The primary outcome is cancer-related BID, and secondary outcomes are HNC-related BID, psychological flexibility, coping style and psychological distress. These indicators will be measured at baseline, postintervention and 1 month following the intervention's completion.

ETHICS AND DISSEMINATION

The trial has received approval from the Institutional Review Board of Shanghai Proton and Heavy Ion Hospital (2308-67-02). The study results will be shared through peer-reviewed journals and conferences.

TRIAL REGISTRATION NUMBER

ChiCTR2300077863.

Exploring the moderating roles of dispositional mindfulness and body image flexibility in the association between body dissatisfaction and disordered eating in Chinese adolescents

OBJECTIVES

Previous research suggests potential moderating roles of dispositional mindfulness and body image flexibility in the association between body dissatisfaction and disordered eating. However, relevant research is mainly conducted on adult women from Western countries, and limited evidence exists for adolescent samples, especially from non-Western contexts (e.g., China). Thus, this study aimed to examine the moderating roles of dispositional mindfulness and body image flexibility in the relationship between body dissatisfaction and disordered eating in Chinese adolescents.

METHOD

We recruited 545 Chinese adolescents (53.9% boys, aged 12-16 years) who completed measures of body dissatisfaction, dispositional mindfulness, body image flexibility, and disordered eating. Moderation analyses were examined with PROCESS macro on SPSS.

RESULTS

In separate models, both higher dispositional mindfulness and body image flexibility weakened relationships between body dissatisfaction and disordered eating. However, when both dispositional mindfulness and body image flexibility were entered into the same moderation model, only body image flexibility showed a significant moderating effect.

DISCUSSION

Both dispositional mindfulness and body image flexibility may weaken the association between body dissatisfaction and disordered eating in adolescents. However, body image flexibility might have a stronger effect than dispositional mindfulness. These findings suggest that interventions aimed at reducing body dissatisfaction to prevent disordered eating in adolescents may pay more attention to adolescents' body image flexibility.

Proof-of-concept testing of a brief virtual ACT workshop for emotional eating

BACKGROUND

Emotional eating, or eating in response to negative emotions, is a commonly reported short-term emotion regulation strategy but has been shown to be ineffective in the long term. Most emotional eating interventions based on Acceptance and Commitment Therapy (ACT) have been delivered in the context of weight loss trials, highlighting a need for ACT-based emotional eating interventions in weight-neutral contexts.

AIMS

This proof-of-concept study aimed to test the acceptability and efficacy potential of a brief virtual ACT workshop for emotional eating in a small sample of adults identifying as emotional eaters.

METHODS

Twenty-six adult emotional eaters completed an ACT workshop delivered in two 1.5-h sessions over two weeks. The workshop targeted awareness and acceptance of emotions and eating urges, and valued actions around eating.

RESULTS

The acceptability of the workshop was demonstrated by high participant satisfaction. Significant improvements on all outcome measures were found and maintained up to 3 months follow-up.

CONCLUSIONS

These proof-of-concept findings suggest that a brief virtual ACT workshop may improve emotional eating and associated ACT processes. Results from this study can inform a future randomized controlled trial to test the efficacy of the workshop and the role of theoretical processes of change.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT04457804.

LEVEL OF EVIDENCE

Level IV, evidence obtained from multiple time series with the intervention.

A controlled trial assessing the acceptability and efficacy of a yoga-based eating disorder prevention program among division I athletes: Eat Breathe Thrive (EBT)

OBJECTIVE

This study evaluated the acceptability and effectiveness of the Eat Breathe Thrive (EBT) program as an eating disorder prevention intervention among women collegiate athletes.

METHOD

Change over time in eating disorder risk and competencies of positive embodiment were examined in 94 women (n = 48 EBT participants and n = 46 matched-controls) from one National Collegiate Athletic Association (NCAA) Division I-classified university in the United States. Eating disorder risk factors were measured using the Eating Disorder Examination Questionnaire (EDE-Q) and State Trait Anxiety Inventory (STAI). Aspects of positive embodiment were measured using the Multidimensional Assessment of Interoceptive Awareness (MAIA) and The Mindful Self-Care Scale (MSCS). Data were collected through participants' completion of online surveys across three time-points.

RESULTS

Repeated measures ANOVAS revealed EBT participants reported experiencing significantly less state anxiety and greater interoceptive body trusting over time relative to matched-controls. No other significant interactions were found. Respondents found the EBT program acceptable.

DISCUSSION

Acceptability and partial support for integrative, yoga-based, interventions targeting Division I student-athletes is indicated.

Loneliness and Relationship Well-Being: Investigating the Mediating Roles of Relationship Awareness and Distraction among Romantic Partners

Loneliness arises when there is a discrepancy between one's desired and actual social connection with others. Studies examining the effects of loneliness in romantic relationships show that people who are lonely are less satisfied and committed to their romantic relationships. The present study explored the association between loneliness and romantic relationship well-being. Using a cross-sectional design, loneliness was correlated with relationship commitment, trust, and conflict. Relationship awareness, but not relationship distraction, statistically mediated the association between loneliness, relationship conflict, and relationship trust. The indirect effect of loneliness on relationship well-being was only present in people reporting low and medium levels of psychological inflexibility. Implications are discussed for acceptance- and mindfulness-based interventions for persons in romantic relationships.

Mindfulness-based interventions for body image dissatisfaction among clinical population: A systematic review and meta-analysis

PURPOSE

Mindfulness-based interventions (MBIs) are well-validated interventions to enhance the favourable body image of individuals. Despite their wide application, the efficacy of MBIs in reducing body image dissatisfaction (BID) among various clinical populations remains unclear. This study aims to expand the literature on MBIs for BID and identify effective types of MBIs for reducing BID in diverse clinical populations for future research and practice.

METHODS

A systematic search for studies published in English on the effectiveness of MBIs for BID among the clinical population was done on APA PsycNet, PubMed, Science Direct, Web of Science and Google Scholar databases in August 2023. Of the 1962 articles initially identified, 17 were found eligible and evaluated based on the JBI checklist.

RESULTS

Random effects meta-analyses on six MBIs revealed their effectiveness in reducing BID among the clinical population (SMD = -.59 and 95% CI = -1.03 to -.15, p = .009), with Acceptance and Commitment Therapy (ACT) (SMD = -1.29, 95% CI = -2.06 to -.52, p = .001) and My Changed Body (MyCB) (SMD = -.24, 95% CI = -.46 to -.01, p = .04) reporting significant effect sizes. Among the patients with breast cancer, MyCB (SMD = -.24, 95% CI = -.46 to -.01, p = .04) showed a significant effect size.

CONCLUSIONS

MBIs appear to be promising interventions in reducing BID among the clinical population. However, findings should be considered cautiously due to the possible publication bias, high heterogeneity and fewer available studies.

Novel insights into patient's thoughts about their body image in abdominal wall hernia

BACKGROUND

Abdominal wall hernias (AWH) are frequently large and deforming. Despite this, little is known about how AWH impact upon body image. This study is the first study to qualitatively examine patients' subjective lived experiences of how AWH affects their body image.

METHODS

Fifteen patients were interviewed from a purposive sample of AWH patients awaiting surgery until no new narrative themes emerged. Interviews explored patient thoughts and experiences of AWH and body image. Data were examined using interpretative phenomenological analysis (IPA).

RESULTS

Two key themes pertaining to body image were identified: "Changes to perceptions of self" and "Fears concerning other's perceptions of them". Both themes were often interrelated and displayed detrimental effects AWH had on patients' body image.

CONCLUSIONS

Our findings illustrate that AWH detrimentally affected patients' body image. This aspect of patient care can be treated and managed through better pre-operative information, including on body image as part of a holistic needs assessment (HNA), and ensuring the results are addressed in a patient care package. These development suggestions may positively affect the AWH patient's experience and outcomes in terms of Quality of Life (QoL) by preparing patients better for realistic results regarding what can be achieved in terms of form, function thus making a more holistic recovery from surgery.

Profiles of body image concerns and their associations with disordered eating behaviors

Although body image concerns (BIC) are recognized as a core driver in the development of disordered eating behaviors, the combined role of various types of BIC remains underexamined. This study relied on latent profile analysis to identify the main configurations of self-reported BIC (i.e., body checking and avoidance, perceived physical appearance, and fear of negative appearance evaluation) observed in a sample of 419 French-Canadian individuals (Mage = 26.59, SDage = 9.23). The role of body mass index, sex, and age on profile membership was also examined, as well as the relation between profile membership and disordered eating behaviors (i.e., dieting, bulimia and food preoccupation, and oral control). Six distinct BIC profiles differing in terms of shape and level were identified, with women being more likely to display a profile characterized by higher levels of BIC. In turn, profiles characterized by higher levels of BIC were associated with more disordered eating behaviors. The present study can broaden our understanding of the onset and maintenance of disordered eating behaviors and inspire the development of more tailored body-image interventions.

How effective are psychosocial interventions at improving body image and reducing disordered eating in adult men? A systematic review

Disordered eating and body image concerns significantly impact a growing number of men. This systematic review assessed the evidence of the effectiveness of psychosocial interventions to improve body image and eating pathology in men. Searches were conducted in December 2022 in 13 databases (PsycINFO, MEDLINE, CINAHL Plus, AMED, PubMed, Scopus, Cochrane, EMBASE, ASSIA, British Nursing Index, Wiley and OpenGrey). Studies that quantitatively evaluated psychosocial interventions and reported pre-post body image or disordered eating outcomes in men aged 18 years and over were eligible. Articles including boys, uncontrolled designs, or not in English were excluded. Findings were narratively synthesised and presented according to intervention approach. Quality was assessed using EPHPP. Eight studies including six RCTs were reviewed. Five were assessed as being moderate quality and three as weak. Evidence from moderate quality studies suggested that dissonance-based interventions showed promising improvements in body image and disordered eating for up to six months post-intervention in men with and without body dissatisfaction. Evidence for media literacy and psychoeducational interventions was limited. Findings were limited by heterogeneity in outcome measures and homogeneity of participants preventing generalisability. Robust research with longer follow-ups is needed to confirm effectiveness.

A 12-month study of dialectical behavioral therapy for bοrderline patients suffering from eating disorders

PURPOSE

Individuals with eating disorders (ED) and comorbid borderline personality disorder (BPD) may benefit from therapies focusing on emotion regulation, such as dialectical behavioral therapy (DBT). The aim of the study was to evaluate the effectiveness of one-year standard DΒΤ enhanced with cognitive-behavioral therapy (CBT) strategies for patients suffering from ED and BPD.

METHODS

Seventy-two BPD and ED (anorexia and bulimia nervosa) participants were recruited from the eating disorders unit of the 1st Psychiatric Department of National and Kapodistrian University of Athens. All participants completed one year of standard DBT. ED-related behaviors were added to the treatment plan according to the DBT targeting hierarchy. Individual therapy and skills training group sessions were adapted to incorporate CBT strategies for nutritional and weight restoration. BPD and ED symptomatology were measured at the beginning and at the end of one year of treatment.

RESULTS

The major finding of the study was the significant improvement of patients in all the outcome measurements after one year of treatment. The study's second finding was that the severity of BPD symptomatology was significantly related to the severity of ED symptomatology. It was also shown that improvement of the patients coping skills was correlated with the reduction of ED and BPD symptomatology.

CONCLUSIONS

These results support previous studies on the effectiveness of DBT for comorbid BPD and EDs. Despite the promising results, randomized controlled trials are needed to establish the efficacy of DBT for BPD and ED patients.

LEVEL OF EVIDENCE

Level IV: Evidence obtained from multiple time series with or without the intervention, such as case studies. Dramatic results in uncontrolled trials might also be regarded as this type of evidence.

The Impact of Anorexia Nervosa and the Basis for Non-Pharmacological Interventions

Anorexia nervosa is a psychiatric disorder with an unknown etiology that is characterized by an individual's preoccupation with their weight and body structure while denying the severity of their low body weight. Due to the fact that anorexia nervosa is multifaceted and may indicate the coexistence of genetic, social, hormonal, and psychiatric disorders, a description of non-pharmacological interventions can be used to ameliorate or reduce the symptoms of this condition. Consequently, the purpose of the present narrative review is to describe the profile's context in the anorexic person as well as the support they would require from their family and environment. In addition, it is aimed at examining preventative and non-pharmacological interventions, such as nutritional interventions, physical activity interventions, psychological interventions, psychosocial interventions, and physical therapy interventions. To reach the narrative review aims, a critical review was conducted utilizing both primary sources, such as scientific publications, and secondary sources, such as bibliographic indexes, web pages, and databases. Nutritional interventions include nutritional education and an individualized treatment for each patient, physical activity interventions include allowing patients to perform controlled physical activity, psychological interventions include family therapy and evaluation of the existence of other psychological disorders, psychosocial interventions include management of the relationship between the patient and social media and physical therapy interventions include relaxation massages and exercises to relieve pain. All these non-pharmacological interventions need to be individualized based on each patient's needs.

Reciprocal association between session-by-session change in overvaluation of shape and weight and session-by-session change in bulimia nervosa symptoms during cognitive behavior therapies

Overvaluation of shape and weight (OSW) is supported as an important mechanism underlying improvement in bulimia nervosa (BN) during behavioral therapies (CBTs). It is not yet clear, however, whether changes in OSW temporally precede and prospectively predict changes in BN symptoms during CBTs, limiting the ability to establish causality. The present study is the first to examine whether session-by-session changes in OSW prospectively predict session-by-session changes in BN symptoms during CBTs and clinical outcomes at the end-of-treatment. Participants with BN (n = 44) who received 20 sessions of CBTs completed a brief survey at each session assessing OSW and BN symptom frequency during the past week. Results showed small but significant session-by-session reductions in OSW and BN symptoms during CBTs. Session-by-session improvements in OSW in any given week prospectively predicted reductions in restrictive eating, binge eating, and compulsive exercise in the following week but did not prospectively predict improvements in purging, while improvements in restrictive eating and compulsive exercise in any given week prospectively predicted reductions in OSW in the following week. Average session-by-session change in OSW during treatment was positively associated with remission status and improvements in eating pathology at the end-of-treatment. Changes in OSW temporally precede and prospectively predict changes in BN symptoms during CBTs, and vice versa. These findings may have critical implications for treatment planning and implementation.

Eating Disorders and Dietary Supplements: A Review of the Science

Disordered eating is a serious health concern globally. The etiology is complex and multidimensional and differs somewhat for each specific eating disorder. Several risk factors have been identified which include psychological, genetic, biochemical, environmental, and sociocultural factors. Poor body image, low self-esteem, teasing, family dynamics, and exposure to media images have also been identified as risk factors. While it is enticing to consider a single behavioral risk factor, doing so fails to consider the documented environmental, social, psychological, biological, and cultural factors that contribute to the development of an eating disorder in a multidimensional and complex integration that is undoubtedly unique to everyone. Focusing only on any one factor without taking the complex etiology into account is remiss. For example, it has been suggested that the use of dietary supplements may lead to eating disorders, despite a lack of evidence to support this conjecture. Therefore, the purpose of this review is to examine the evidence-based risk factors for eating disorders and discuss why connecting dietary supplements to eating disorder etiology is not supported by the scientific literature and may interfere with treatment. Established, effective prevention and treatment approaches for eating disorders should be the focus of public health initiatives in this domain.

"Like putting on an old pair of gloves" or "realising i am actually over it": a qualitative study exploring the impact of the COVID-19 pandemic lockdown restrictions on eating disorder recovery in the UK

The COVID-19 pandemic lockdown restrictions posed unique challenges for people living with eating disorders (EDs), particularly relating to social isolation and changes in treatment access. However, less is known about the experience of lockdown for people 'in recovery' from EDs or disordered eating (DE) (i.e., with an ED/DE history). This study explored: (i) how people with a self-reported ED/DE history responded to and managed the experience of lockdown, specifically in relation to their recovery, and (ii) coping strategies for the management of recovery. Semi-structured interviews were conducted between June and August 2020 with 20 adults with a self-reported ED/DE history living in the UK. Data were analysed using inductive thematic analysis within a critical realist framework. Three overarching themes were identified: (1) Seeking safety and stability during a pandemic, (2) Lockdown prompting realisations about recovery, and (3) Exploring self-compassion as a more adaptive approach. While most participants experienced a resurgence in ED symptoms during lockdown, many reflected on the successful management of these as reinforcing their recovery. These findings have important implications for understanding ED recovery, in addition to informing interventions to better promote recovery during the COVID-19 pandemic and beyond.

Supplementary information

The online version contains supplementary material available at 10.1007/s12144-023-04353-2.

Bridging cognitive, phenomenological and psychodynamic approaches to eating disorders

Cognitive, psychodynamic, and phenomenological scholars converged their attention on abnormal bodily phenomena as the core psychopathological feature of eating disorders (EDs). While cognitive approaches focus their attention on a need for "objective" (i.e., observable, measurable) variables (including behaviours and distorted cognitions), the phenomenological exploration typically targets descriptions of persons' lived experience. According to a new emerging phenomenological perspective, the classic behavioural and cognitive symptoms of EDs should be considered as epiphenomena of a deeper core represented by a disorder of the embodiment. The cognitive-behavioural model is the most studied and, up till now, clinically efficacious treatment for EDs. However, as any coherent and scientifically grounded model, it presents some limitations in its application. Numerous patients report a chronic course, do not respond to treatment and develop a personality structure based on pathological eating behaviours, since "being anorexic" becomes a new identity for the person. Furthermore, the etiopathogenetic trajectory of EDs influences the treatment response: for example, patients reporting childhood abuse or maltreatment respond differently to cognitive-behavioural therapy. To obtain a deeper comprehension of these disorders, it seems important to shift attention from abnormal eating behaviours to more complex and subtle psycho(patho)logical features, especially experiential ones. This characterisation represents the unavoidable premise for the identification of new therapeutic targets and consequently for an improvement of the outcome of these severe disorders. Thus, the present review aims to provide an integrated view of cognitive, psychodynamic, and phenomenological perspectives on EDs, suggesting new therapeutic targets and intervention strategies based on this integrated model. Level of Evidence: Level V.Level of evidence Level V: Opinions of authorities, based on descriptive studies, narrative reviews, clinical experience, or reports of expert committees.

Experiencing eight psychotherapy approaches devoted to eating disorders in a single-day workshop increases insight and motivation to engage in care: a pilot study

PURPOSE

For patients with eating disorders (EDs), early engagement in care is usually considered a positive prognostic factor. The aim of the study was to investigate how a single-day intervention devoted to early, brief, experiential exposure to a variety of psychotherapy approaches might support commitment to change and the decision to engage in care in patients with EDs.

METHODS

One hundred and sixty-nine adult outpatients newly diagnosed with an ED took part in a single-day workshop for groups of up to ten patients, where they experienced eight psychotherapeutic approaches. Motivation to change care and level of insight were assessed at baseline and 10 days after the intervention.

RESULTS

Motivation and commitment to take active steps toward change (expressed by the "Committed Action" composite score) significantly improved after the intervention (p < 0.001), and a significant number of patients specifically moved from "contemplation" to "action" stage (p < 0.001). The improvement of motivation to change was significantly associated with an increase in insight capacity (p < 0.001), and this increase was observed for almost all related dimensions such as recognition of illness or awareness of need for psychological treatment.

CONCLUSION

A single-day session devoted to experiencing a range of group psychotherapies increased patients' insight and motivation to actively engage in care. To confirm potential longer-term benefits of this intervention, further studies are needed to explore the contribution of each approach and process specifically involved in patients' increased motivation for care, as well as the clinical characteristics of patients associated with better outcomes.

LEVEL OF EVIDENCE

V: Opinions of respected authorities, based on descriptive studies, narrative reviews, clinical experience, or reports of expert committees.

Examining a mediation model of body image-related cognitive fusion, intuitive eating, and eating disorder symptom severity in a clinical sample

PURPOSE

This study sought to explore the associations between Intuitive Eating (IE), eating disorder (ED) symptom severity, and body image-related cognitive fusion within a clinical sample. IE was also examined as a possible mediator in the relationship between body image-related fusion and ED symptoms.

METHODS

This study includes cross-sectional analyses with data from 100 adult females and 75 adolescent females seeking residential treatment for an ED. Self-reported demographic information, ED symptoms, IE behaviors, and body image-related cognitive fusion were collected from participants within the first week of treatment following admission to the same residential ED treatment facility.

RESULTS

ED symptom severity was significantly negatively associated with three of the four domains of IE; unconditional permission to eat, reliance on hunger and satiety cues, and body-food choice congruence. A significant mediational effect of IE on the relationship between body image-related fusion and ED symptoms through IE behaviors was observed (β = 11.3, SE = 0.003, p < 0.001). This effect was only observed for the unconditional permission to eat (β = 0.13, p = 0.003) and reliance on hunger and satiety cues (β = 0.10, p = 0.005) domains of IE when the domains were subsequently analyzed individually.

CONCLUSION

Unconditional permission to eat and reliance on hunger and satiety cues appear to be particularly influential domains of IE in the relationship between body image-related fusion and ED symptom severity. It is possible that changes in these IE domains may be mechanisms through which body image-related fusion influences ED symptoms. Future longitudinal research is needed to better understand the relationship between body image-related cognitive fusion and IE and the potential for targeting these constructs specifically in the context of ED treatment.

LEVEL OF EVIDENCE

Level V, cross-sectional analysis from descriptive study.

Randomized Clinical Trial Evaluating AcceptME-A Digital Gamified Acceptance and Commitment Early Intervention Program for Individuals at High Risk for Eating Disorders

Eating disorders (ED) constitute a serious public health issue affecting predominantly women and appearing typically in adolescence or early adulthood. EDs are extremely difficult to treat, as these disorders are ego-syntonic, and many patients do not seek treatment. It is vital to focus on the development of successful early-intervention programs for individuals presenting at risk and are on a trajectory towards developing EDs. This study is a randomized controlled trial evaluating an innovative digital gamified Acceptance and Commitment early-intervention program (AcceptME) for young females showing signs and symptoms of an ED and at high risk for an ED. Participants (n = 92; Mage = 15.30 years, SD = 2.15) received either AcceptME (n = 62) or a waitlist control (n = 30). Analyses indicated that the AcceptME program effectively reduced weight and shape concerns with large effects when compared to waitlist controls. Most participants scored below the at-risk cut-off (WCS score < 52) in the AcceptME at end-of-intervention (57.1%) compared to controls (7.1%), with odds of falling into the at-risk group being 14.5 times higher for participants in the control group. At follow-up, 72% of completers reported scores below the at-risk cut-off in the AcceptME group. The intervention also resulted in a decrease in ED symptomatology and increased body image flexibility. Overall, results suggest that the AcceptME program holds promise for early-intervention of young women at risk for developing an ED.

Development of a Telephone-Delivered Acceptance and Commitment Therapy Intervention for People Living with HIV who are Hazardous Drinkers

Alcohol use among people living with HIV (PWH) has been increasingly recognized as an important component of HIV care. Transdiagnostic treatments, such as Acceptance and Commitment Therapy (ACT), that target core processes common to multiple mental health and substance-related problems, may be ideal in HIV treatment settings where psychological and behavioral health comorbidities are high. In advance of a randomized clinical trial (RCT), the overall objective of this study was to systematically adapt an ACT-based intervention originally developed for smoking cessation, into an ACT intervention for PWH who drink at hazardous levels. Consistent with the ADAPT-ITT model, the adaptation progressed systematically in several phases, which included structured team meetings, three focus group discussions with PWH (N = 13), and in-depth interviews with HIV providers (N = 10), and development of standardized operating procedures for interventionist training, supervision, and eventual RCT implementation. The procedures described here offer a template for transparent reporting on early phase behavioral RCTs.

Efficacy of ACT-Based treatments for dysregulated eating behaviours: A systematic review and meta-analysis

BACKGROUND

An increasing number of studies have investigated the efficacy of Acceptance and Commitment Therapy (ACT) for the reduction of dysregulated eating behaviours such as binge eating and emotional eating. However, little is known about their short- and long-term efficacy and underlying mechanisms of change.

OBJECTIVES

To conduct a systematic effect size analysis to estimate the efficacy of ACT-based treatments on measures of dysregulated eating and of psychological flexibility, a theorized ACT mechanism of change.

METHODS

Literature searches were conducted in PsycInfo, Medline, Web of Science, and ProQuest Dissertations. Within-group and between-group standardized mean differences were computed using Comprehensive Meta-Analysis Version 3. Additional subgroup and meta-regression analyses by study characteristics were conducted.

RESULTS

A total of 20 publications (22 samples, n = 1269) were included. Pre-post and pre-follow-up effects suggest that ACT-based treatments are moderately effective in reducing dysregulated eating behaviours and increasing psychological flexibility. These effects were comparable for binge-eating and emotional eating outcomes and for face-to-face interventions, Web-based interventions, and interventions that used a self-help book. Longer treatments were associated with larger outcome effect sizes, and changes in psychological flexibility were not associated with changes in dysregulated eating outcomes. Small significant effects were found in favour of ACT when compared to inactive control groups. The only three studies that included active control groups and did not show significant differences in outcomes between ACT and other treatments.

CONCLUSION

Future studies should aim to compare ACT-based treatments to active treatments and to provide empirical evidence for the theoretical mediating role of psychological flexibility in reported changes in eating behaviour.

Micro-level de-coupling of negative affect and binge eating in relationship to macro-level outcomes in binge eating disorder treatment

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.

Self-compassion mediates the relationship between COVID-19-related stress and body image disturbance: Evidence from the United Kingdom under lockdown

The ongoing coronavirus (COVID-19) pandemic and attendant lockdown mandates may have detrimental effects on body image outcomes, which in turn highlights the importance of identifying protective factors. Here, we examined associations between COVID-19-related stress and body image disturbance, as well as the potential mediating and moderating role of self-compassion. During the third lockdown in the United Kingdom, we asked an online sample of adults (N = 600) to complete measures of COVID-19-related stress, body image disturbance, and self-compassion. Mediation analysis showed that higher COVID-19-related stress was significantly associated with greater body image disturbance, and that this relationship was mediated by self-compassion. In contrast, self-compassion did not significantly moderate the effects of stress on body image disturbance. These results suggest that promoting greater self-compassion may be a viable means of mitigating adverse outcomes from the COVID-19 pandemic on body image disturbance.

Body Positivity and Self-Compassion on a Publicly Available Behavior Change Weight Management Program

According to recent research, body positivity and self-compassion are key outcomes that are tied to better psychological and physical health. To date, it is unclear whether body positivity and self-compassion improve, stay constant, or deteriorate over the course of a weight management program, particularly one that addresses the psychological roots of behavior change. Additionally, beyond controlled settings, there are no studies on body positivity and self-compassion in individuals who choose to join a commercial weight management program. Therefore, this single-arm prospective study examined changes in body positivity and self-compassion from baseline to the 16 week milestone of Noom Weight, a commercial behavior change weight management program informed by acceptance and commitment therapy (ACT), dialectical behavior therapy (DBT), and cognitive behavioral therapy (CBT). We also examined how baseline and over-time changes in body positivity and self-compassion predicted engagement in program-measured relevant behaviors (e.g., exercises logged). Participants were a random subset of individuals who had recently self-enrolled in the program (n = 133). Body positivity and self-compassion were measured via survey at baseline and end of the core program (16 weeks). Self-reported weight and program-recorded engagement were extracted from the program database. Compared to baseline, body appreciation, body image flexibility, self-compassion, and body-focused rumination significantly improved at 16 weeks (all ps < 0.007). Participants lost a statistically significant amount of weight (3.9 kg; t(128)) = 10.64, p < 0.001) by 16 weeks, which was 4.4% body weight. Greater engagement, especially messaging a coach, reading articles, and logging meals, was associated with improvements over time in body appreciation (r = 0.17, p = 0.04), body image flexibility (r = −0.23, p = 0.007), and the brooding component of rumination (r = −0.23, p = 0.007). Greater engagement was also associated with baseline total self-compassion (r = 0.19, p = 0.03) and self-judgment (r = 0.24, p = 0.006). The results suggest that individuals experience improvements in body positivity and self-compassion while learning about ACT, DBT, and CBT through curriculum and coaching in this setting. The results also have important clinical implications, such as the possibility that psychologically-oriented (i.e., ACT, DBT, and CBT-based) weight management could be important to improve body positivity or that baseline self-compassion could be used to target individuals at risk for lower engagement. Future work should investigate these possibilities as well as delineate the causal relationships between body positivity, self-compassion, engagement, and weight loss.

Self-compassion in weight management: A systematic review

OBJECTIVE

Self-compassion - the tendency or ability to treat oneself kindly in times of failure or distress - may be a natural fit to support individuals who struggle with weight management. However, while self-compassion shows promise with improving health behaviours, the associations self-compassion has on weight management outcomes are unclear. The objective of this systematic review was three-fold: (1) to evaluate whether self-compassion interventions can increase individual self-compassion in the context of weight management, (2) to investigate if self-compassion interventions can improve weight management outcomes, defined as healthier eating, increased physical activity, or reduced weight and finally, (3) to explore whether these benefits can be sustained over the longer term.

METHODS

Following PRISMA guidelines, Scopus, PsycINFO, Medline, PubMed and Embase databases were searched. Studies including a measure of self-compassion and a self-compassion intervention reporting weight management outcomes were included. Studies in populations living with an eating disorder were excluded. The Quality Criteria Checklist from the American Dietetic Association was used to assess study quality. Prospero Registration #CRD42019146707.

RESULTS

Of the 9082 records screened, a total of 20 studies met inclusion criteria. Seventeen studies reported significant increases in self-compassion post-intervention. Improvements were also found for eating behaviours (15 of 18), physical activity behaviours (6 of 9), and weight loss (6 of 11). The majority of improvements were maintained at follow-up, except for physical activity behaviours (1 of 7).

CONCLUSION

Self-compassion interventions tailored to weight management outcomes demonstrate efficacy with increasing self-compassion post-intervention. Methodological weaknesses and questions about the maintenance of any improvements in weight management outcomes limit our ability to make strong conclusions. However, there is promise and clear relevance for including self-compassion interventions to enhance weight management outcomes; directions for improved intervention and study design are given.

Psychosocial etiology of maladaptive exercise and its role in eating disorders: A systematic review

OBJECTIVE

Although maladaptive exercise (ME) is widely recognized as a clinical feature in transdiagnostic eating disorders, less is known about psychosocial factors that give rise to and perpetuate this behavior. This systematic review aimed to examine the empirical status of this association.

METHOD

We reviewed 46 full text articles examining longitudinal associations between psychosocial variables and ME.

RESULTS

Eighteen studies met full inclusion criteria. Based on our qualitative synthesis, evidence suggests reasonably consistent associations between early concern with weight and shape, and negative affect on later development of ME.

DISCUSSION

Inconsistent and insufficient assessment of ME across a majority of studies underscores caution in interpretation of results, but guides important discussion for future clinical and research efforts.

Randomized Controlled Trials of Mindfulness and Acceptance-Based Interventions Over the Past Two Decades: A Bibliometric Analysis

Introduction: The past several years have witnessed a significant increase in interest among the public in mindfulness with an unmistakable growth in the scientific literature investigating mindfulness-based therapies. A myriad of therapeutic uses of mindfulness have been studied. Given this burgeoning interest, the authors' objective was to conduct a broad-sweeping bibliometric analysis over the past two decades to describe overarching trends in the publications of randomized controlled trials (RCTs) investigating mindfulness to broadly identify both strengths and gaps in this field and inform a strategic plan for further advancing this research area. Materials and Methods: The authors retrieved mindfulness-focused RCTs available on PubMed in the past two decades (2000-2019). They synthesized the literature with respect to publication numbers, countries of publication, journal type, areas of research focus, characteristics of study designs, sample size, and trends in remote intervention delivery. Results: The resulting 1389 publications represent a near exponential growth trend over the past 20 years. Publications from the top three countries (the United States, the United Kingdom, and the Netherlands) with the highest productivity accounted for 60% of total number of publications. The most published modalities include acceptance-based therapy (n = 260), mindfulness-based stress reduction (n = 238), mindfulness-based cognitive therapy (n = 174), and dialectical behavior therapy (n = 82). Stress, depression, anxiety, pain, cancer, diet/healthy eating, and sleep were the most common major areas of focus. Studies included active (46%) or inactive controls (44%), and increasingly more studies with both types of controls (10%). The top 10 journals that published the most mindfulness RCTs were from behavioral sciences and psychiatry or psychology. There were 187 RCTs utilizing remote delivery, with 146 (87.1%) in the most recent 5 years. Conclusion: Publications of mindfulness-focused RCTs show a continuous increasing trend. Mindfulness research from non-Western countries and studies published in biomedical journals were less prevalent and potentially represent future opportunities. Trends of studies with both inactive and active controls support an overall advancement in research methodology. There has been a significant expansion of studies of remotely delivered mindfulness interventions. Future research might consider evaluation of a broader range of modalities and further examine optimal delivery formats.

Development of a Positive Body Image Chatbot (KIT) With Young People and Parents/Carers: Qualitative Focus Group Study

BACKGROUND

Body image and eating disorders represent a significant public health concern; however, many affected individuals never access appropriate treatment. Conversational agents or chatbots reflect a unique opportunity to target those affected online by providing psychoeducation and coping skills, thus filling the gap in service provision.

OBJECTIVE

A world-first body image chatbot called "KIT" was designed. The aim of this study was to assess preliminary acceptability and feasibility via the collection of qualitative feedback from young people and parents/carers regarding the content, structure, and design of the chatbot, in accordance with an agile methodology strategy. The chatbot was developed in collaboration with Australia's national eating disorder support organization, the Butterfly Foundation.

METHODS

A conversation decision tree was designed that offered psychoeducational information on body image and eating disorders, as well as evidence-based coping strategies. A version of KIT was built as a research prototype to deliver these conversations. Six focus groups were conducted using online semistructured interviews to seek feedback on the KIT prototype. This included four groups of people seeking help for themselves (n=17; age 13-18 years) and two groups of parents/carers (n=8; age 46-57 years). Participants provided feedback on the cartoon chatbot character design, as well as the content, structure, and design of the chatbot webchat.

RESULTS

Thematic analyses identified the following three main themes from the six focus groups: (1) chatbot character and design, (2) content presentation, and (3) flow. Overall, the participants provided positive feedback regarding KIT, with both young people and parents/carers generally providing similar reflections. The participants approved of KIT's character and engagement. Specific suggestions were made regarding the brevity and tone to increase KIT's interactivity.

CONCLUSIONS

Focus groups provided overall positive qualitative feedback regarding the content, structure, and design of the body image chatbot. Incorporating the feedback of lived experience from both individuals and parents/carers allowed the refinement of KIT in the development phase as per an iterative agile methodology. Further research is required to evaluate KIT's efficacy.

The Body Confident Mums challenge: a feasibility trial and qualitative evaluation of a body acceptance program delivered to mothers using Facebook

Background

Motherhood is a time of intense physical, psychological, and identity transformation, and body dissatisfaction may emerge through the process of pregnancy, birth, and adaptation to parenting. We present a feasibility trial of the Body Confident Mums Challenge, a program developed by adapting existing, effective interventions that focus on self-compassion and appreciation of body functionality to be specific to mothers.

Methods

The program was delivered using the social learning function in a closed Facebook group. Qualitative evaluation of evidence of change was conducted by gathering individual written reflections posted during the challenge (n = 120). Feasibility and acceptability was determined using a feedback survey (n = 22).

Results

Participant’s reflective posts indicated that they were embracing self-compassion, and de-prioritising body image concerns during the challenge. Feedback indicated that the program was mostly feasible and acceptable for mothers, with recommendations from some participants relating to slowing the pace of content delivery and reducing the time commitment of the Challenge.

Conclusions

The social media environment may therefore be a useful setting in which to implement brief intervention programs to improve body image and wellbeing.

Body image flexibility and its correlates: A meta-analysis

Body image flexibility refers to the ability to openly experience thoughts or feelings about the body without acting on them or trying to change them. Accumulating evidence has demonstrated that body image flexibility is connected to numerous adaptive processes, and that it is sensitive to change during psychological interventions. However, a quantitative synthesis of empirical research on body image flexibility is lacking. We conducted the first meta-analysis on body image flexibility and its correlates. Sixty-two studies were included. Random effects meta-analyses were conducted on 19 psychological correlates, divided into three clusters: eating and body image disturbances, positive body-related and general psychological constructs, and general psychopathology. Meta-analyses showed inverse correlations between body image flexibility and each construct within the eating and body image disturbances cluster (rs= -.45 to -.67), and the general psychopathology cluster (rs= -.37 to -.58). Body image flexibility was positively associated with each positive psychology construct (rs = .23 - .58). Men reported higher levels of body image flexibility than women (d = 0.32). Psychological interventions were more effective than control groups at enhancing body image flexibility in randomized controlled trials (d = 0.42). Findings confirm that body image flexibility is consistently connected to indices of mental health, and that it can be enhanced during psychological interventions.

Shame and binge eating pathology: A systematic review

OBJECTIVE

Shame is broadly implicated in the development and maintenance of eating pathology. However, the relationship between shame and binge eating symptoms specifically is less clear. This review aimed to clarify what types of shame are associated with binge eating symptoms and the antecedents and maintenance factors in these relationships.

METHOD

A systematic search for quantitative and qualitative empirical studies was conducted to identify evidence of the relationship between shame and binge eating symptoms. Altogether, 270 articles were identified and screened for eligibility in the review.

RESULTS

Results of the relevant empirical studies (n = 31) identified several types of shame associated with binge eating pathology: (i) internal shame, (ii) external shame, (iii) body shame and (iv) binge eating-related shame, as well as several mechanisms and pathways through which shame was associated with binge eating symptoms.

DISCUSSION

Drawing from the research findings, this review presents an original, integrated model of the cyclical shame-binge eating relationship. Clinical interventions that might break this cycle are discussed, as well as methodological weaknesses which limit causal inferences and important areas of future research.

Exploring the Effectiveness of Dialectical Behavior Therapy Versus Systems Training for Emotional Predictability and Problem Solving in a Sample of Patients With Borderline Personality Disorder

Dialectical behavior therapy (DBT) and systems training for emotional predictability and problem solving (STEPPS) are two treatment protocols for people with borderline personality disorder (BPD) that have received important empirical support. However, their possible differential effectiveness has not yet been studied. The objective of this study is to explore the effectiveness of these two treatment programs. A nonrandomized clinical trial was carried out in which both treatments were applied for six months. The sample consisted of 72 patients diagnosed with BPD. The results indicate that both groups experienced a statistically significant reduction in BPD symptom, emotional regulation, impulsiveness, dissociative experiences, suicidal risk, depression, or anger. However, the DBT condition obtained statistically significant differences in BPD behavioral symptoms and fear of suicide. DBT and STEPPS treatment are effective treatments for participants with BPD, and DBT was more effective for the behavioral symptoms of BPD.

Self-compassion explains substantially more variance in eating disorder psychopathology and associated impairment than mindfulness

This study aimed to (1) examine the unique role of mindfulness and self-compassion on eating disorder (ED) psychopathology and functional impairment, and (2) compare levels of mindfulness and self-compassion between health controls and individuals categorized with bulimia nervosa (BN), and binge-eating disorder (BED). Data were analyzed from 1101 community-based participants, of which 145 met criteria for BN, 150 for BED, and 286 for healthy controls. Results from a series of multiple regressions revealed that self-compassion accounted for substantially more variance in ED psychopathology and functional impairment than mindfulness in the total sample and across the three subgroups, at times explaining 20 times more variance than mindfulness. Results remained unchanged when excluding the mindfulness subscale from the Self-Compassion Scale. When comparing these variables across the three study groups, results showed that self-compassion and mindfulness levels were lowest in the BN group, followed by the BED group, and then the healthy control group. Findings overall suggest that non-judgmental awareness may be less important in explaining levels of ED psychopathology than the nature of one's interaction with emotionally charged, negative experiences. Findings also point to possible priority intervention targets in indicated prevention and treatment programs.

Dissemination of a dissonance-based body image promotion program in church settings: A preliminary controlled pilot study with adult women

Adult women report significant body dissatisfaction yet are often overlooked in body image promotion programs. Although few venues afford opportune settings for intervening with adult women, the church serves as a regular meeting place for many in the South of the United States. This study tested a dissonance-based body image program, Reclaiming Beauty (RB), adapted for adult women in church settings. Six groups (n = 30) were led by two trained church leaders (peer-led) and three groups (n = 21) were led by a trained peer leader and a researcher (researcher-co-led). RB participants, aged 30-77 years (M = 53.1 ± 12.7), completed assessments pre-intervention, immediately post-intervention, and 6 months post-intervention. Waitlist-controls (n = 31) completed assessments at time intervals consistent with intervention participants. RB participants reported significantly decreased thin-ideal internalization, body surveillance, and eating psychopathology at post-intervention and at 6 months post-intervention relative to controls. RB participants also reported significantly increased body satisfaction immediately post-intervention relative to controls, but this was not significant at 6 months post-intervention. Peer-led groups outperformed researcher-co-led groups on body surveillance at 6 months, but RB conditions did not otherwise differ. Our findings provide preliminary support for the dissemination of a culturally-modified dissonance-based body image program to adult women in church settings.

The impact of the COVID-19 pandemic on individuals with eating disorders: the role of emotion regulation and exploration of online treatment experiences

OBJECTIVE

The Covid-19 pandemic has wrought disruption to everyday life and services, and emerging evidence suggests that those with eating disorders (EDs) are likely to experience marked distress and exacerbation of their symptoms. However, little is known around the most relevant factors to symptom change; whether certain emotion regulation and coping strategies are linked to better outcomes; and how people with EDs are adjusting to psychological interventions moving online.

METHOD

In a mixed-method design, we collected qualitative and quantitative data from 207 (76 males) self-selected UK residents with self-reported ED, who described and ranked impacts of the pandemic on their symptoms. Regression analysis examined whether emotion regulation strategies were associated with self-reported symptom change, ED symptomatology, and negative emotional states. Thematic analysis explored participants' experiences of the pandemic, particularly factors affecting their ED, coping strategies used, and experiences of psychological intervention.

RESULTS

Most participants (83.1%) reported worsening of ED symptomatology, though factors affecting symptom change differed between specific EDs. Emotion regulation, such as having fewer strategies, poorer emotional clarity, and non-acceptance of emotions, explained nearly half of the variance in emotional distress during the pandemic. Qualitative findings indicated that difficult emotions (such as fear and uncertainty), changes to routine, and unhelpful social messages were triggering for participants during the pandemic. While some participants described employing positive coping strategies (such as limiting social media exposure), many reported using ED behaviours (among other maladaptive strategies, like alcohol use) to cope with the pandemic. Finally, loss of treatment support, feeling underserving of support and experiencing a 'detached connection' online were further exacerbating factors for these participants.

DISCUSSION

While our sample was self-selected and may not represent all people with EDs, our results suggest that people with EDs have been strongly affected by the pandemic. Some aspects of online treatment were found to be beneficial but our findings suggest it also needs some improvement. Our paper discusses implications for online treatment such as taking into account personal circumstances and, in a time where people have limited control over the antecedents of negative emotion, the need to develop skills to manage emotions when they arise.

The role of body-esteem in academic functioning problems associated with eating disturbances

To explore the role of body-esteem and self-esteem in the occurrence of academic functioning problems associated with eating disturbances. Participants: 330 university students (aged 16-53 years) in Finland in 2016. Method: Interference with academic functioning measured with the Eating and Body Image Academic Interference Scale. Multivariable logistic regression analyses were performed to describe the relationship of body-esteem, global self-esteem, and age with academic functioning problems associated with eating disturbances. Results: The level of academic functioning problems was low. High appearance-esteem (OR = 0.26; 95% CI [0.14-0.48]) and a five-year increase in age (OR = 0.68; 95% CI [0.52-0.89]) provided protection against academic functioning problems, whereas high evaluations attributed to others about one's body and appearance increased the odds of such problems (OR = 2.25; 95% CI [1.41-3.59]). Conclusion: Problems in academic functioning may relate to problems in eating behavior, body image, and feelings about appearance.