ORCID Profile
0000-0003-4402-770X
Current Organisation
Flinders University
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Research Topics
In Research Link Australia (RLA), "Research Topics" refer to ANZSRC FOR and SEO codes. These topics are either sourced from ANZSRC FOR and SEO codes listed in researchers' related grants or generated by a large language model (LLM) based on their publications.
Top 5 Research Topics
ANZSRC Field of Research (FoR)
Teacher Education and Professional Development of Educators | Health, Clinical and Counselling Psychology | Health Promotion | Social and Cultural Anthropology | Anthropology | Specialist Studies in Education |
ANZSRC Socio-Economic Objective (SEO)
Cultural Understanding not elsewhere classified | Expanding Knowledge through Studies of Human Society | Health Education and Promotion | Expanding Knowledge in Education | Mental Health Services
Related Links
Publications
Ross D . C rosby: Scholar, teacher, mentor, and friend. Introducing a virtual issue honoring the contributions of R oss D . C rosby to the field of ea
Publisher: Wiley
Date: 13-09-2017
DOI: 10.1002/EAT.22769
The Anorexia Nervosa Genetics Initiative: Study description and sample characteristics of the Australian and New Zealand arm
Publisher: SAGE Publications
Date: 05-04-2017
Abstract: Anorexia nervosa is a severe psychiatric disorder with high mortality rates. While its aetiology is poorly understood, there is evidence of a significant genetic component. The Anorexia Nervosa Genetics Initiative is an international collaboration which aims to understand the genetic basis of the disorder. This paper describes the recruitment and characteristics of the Australasian Anorexia Nervosa Genetics Initiative s le, the largest s le of in iduals with anorexia nervosa ever assembled across Australia and New Zealand. Participants completed an online questionnaire based on the Structured Clinical Interview Diagnostic and Statistical Manual of Mental Disorders (4th ed. DSM-IV) eating disorders section. Participants who met specified case criteria for lifetime anorexia nervosa were requested to provide a DNA s le for genetic analysis. Overall, the study recruited 3414 Australians and 543 New Zealanders meeting the lifetime anorexia nervosa case criteria by using a variety of conventional and social media recruitment methods. At the time of questionnaire completion, 28% had a body mass index ⩽ 18.5 kg/m 2 . Fasting and exercise were the most commonly employed methods of weight control, and were associated with the youngest reported ages of onset. At the time of the study, 32% of participants meeting lifetime anorexia nervosa case criteria were under the care of a medical practitioner those with current body mass index 18.5 kg/m 2 were more likely to be currently receiving medical care (56%) than those with current body mass index ⩾ 18.5 kg/m 2 (23%). Professional treatment for eating disorders was most likely to have been received from general practitioners (45% of study participants), dietitians (42%) and outpatient programmes (42%). This study was effective in assembling the largest community s le of people with lifetime anorexia nervosa in Australia and New Zealand to date. The proportion of people with anorexia nervosa currently receiving medical care, and the most common sources of treatment accessed, indicates the importance of training for general practitioners and dietitians in treating anorexia nervosa.
Comparative efficacy and acceptability of psychological interventions for the treatment of adult outpatients with anorexia nervosa: a systematic review and network meta-analysis
Publisher: Elsevier BV
Date: 03-2021
Characterizing and predicting trajectories of disordered eating over adolescence.
Publisher: American Psychological Association (APA)
Date: 04-2016
DOI: 10.1037/ABN0000146
Abstract: This study sought to identify distinct trajectory classes of growth of disordered eating (DE), and their respective correlates and risk factors. Females ages 12-19 years (Australian Twin Registry) were interviewed by telephone with the Eating Disorder Examination on 3 occasions (Wave 1: N = 699 Wave 2: N = 669 Wave 3: N = 499). Each participant also completed self-report measures across all waves, and their parents at Waves 1 and 2. Growth mixture modeling determined the optimal classes representing DE growth trajectories over 3 data-points. The best fit was a 3-class solution constituting: (a) no growth in DE over time (90% low-static) where 10% reported a lifetime eating disorder (ED) (b) a high intercept but decreasing over time (7% 53% had a lifetime ED attenuating) (c) an increasing level of DE (3% 80% experiencing a lifetime ED escalating). The majority (64%) of EDs in the attenuating group were diagnosed at Wave 1, whereas 84% of EDs in the escalating group were diagnosed at subsequent waves. The low-static group had fewest significant correlates/risk factors for DE. A multivariable GEE identified that over adolescence, internalization of the thin ideal was 2.5 times more likely characterize an escalating rather than low-static DE symptom trajectory. These findings underscore the fundamental importance of concentrating efforts on reducing the potency of the thin ideal message, and strategies directed toward resolving life stressors by effective management of emotion and problem resolution, in order to prevent the development of DE.
Turning eating disorders screening in primary practice into treatment: A clinical practice approach
Publisher: Wiley
Date: 12-05-2022
DOI: 10.1002/EAT.23732
Abstract: The rate of screening for eating disorders (EDs) by general practitioners (GPs) in primary health care is low. We examined an approach to increase screening and the impact on referrals. Low cost assessment/treatment pathways were established in February 2019 for patients with an ED. Between October 2020 and June 2021 information was sent to GP practices about screening for EDs, along with provision of an online screening tool and training. Of the 44 GP practices invited to participate in the screening initiative, 42 (95.5%) agreed. Only 12 (27%) had referred patients before the initiative, 53 patients over 19 months (2.8/month). Over the 10‐month initiative 90 patients were referred and started treatment from 50% of the practices (8.2/month) 73 (81%) had an ED and six had disordered eating but not an ED. Qualitative feedback from GPs suggested they would not screen for a condition if there were no readily identifiable treatment pathway available. Results suggest that the three elements of the initiative (provision of assessment and treatment pathways, access to a screening tool, provision of information on screening) increased the likelihood that GPs would use a screening tool, leading to an almost three‐fold increase in referrals. An initiative used to translate screening for an eating disorder to treatment in primary health care had three components. First, provision of an easy referral process to assessment as well as treatment. Second, screening tools were made available on computer desktops. Third, information and training provided to GPs was used to support their clinical observation and increase confidence in initiating screening. Adoption of this initiative almost tripled referrals for assessment.
Beyond screening in primary practice settings: Time to stop fiddling while Rome is burning
Publisher: Wiley
Date: 28-05-2022
DOI: 10.1002/EAT.23735
Abstract: This forum presents the current state of research in the screening and identification of people with eating disorders in community and primary care, taking a longer‐term perspective that highlights the slow rate of progression in development of instruments, and impact on polices and practice. An historical overview is presented, followed by a critique of contemporary instruments and practice, and barriers to case detection and appropriate referral pathways. There are now many instruments but all lack high levels of positive predictive power. However, some do have high sensitivity. Barriers contributing to poor detection and the treatment gap include need for improved education and support for primary care professionals and lack of confidence of in iduals with eating disorders to initiate a discussion with health professionals. The best screening instrument would not overcome either of these barriers. We purport there is an urgent need to improve current screening instruments (not to develop more), particularly those with high sensitivity. These should be being employed alongside programs to both improve primary care professionals' skills in assessment and management of people with eating disorders, and to empower consumers to navigate care pathways. We argue that further screening instruments for eating disorders are not needed. Rather, it is more urgent to have a greater research focus on how to encourage primary care workers to ask about eating and body image and how to best translate that to more in iduals with eating disorders being offered treatment. This work needs to be linked with tools that empower consumers to navigate care pathways.
A genetic analysis of the eating and attitudes associated with bulimia nervosa: Dealing with the problem of ascertainment in twin studies
Publisher: Springer Science and Business Media LLC
Date: 1999
Abstract: Little is known about the etiology of bulimia nervosa and the attitudes associated with it. We have undertaken a study of selected (45 pairs) and unselected (106 pairs) female twins to elucidate the broad causes of in idual differences in these behaviours and attitudes. The selected s le was chosen on the basis of at least one of the twin pair having a lifetime incidence of bulimia nervosa. Biometrical model fitting, which corrected for the biased twin correlations of the ascertained group, was used to investigate the genetic and environmental risk factors contributing to the development of bulimia nervosa. The best-fitting model showed that in idual variation was best explained by additive genetic influences (62%) and nonshared environmental influences (38%). The proportion of genetic variance affecting in idual variation in the ascertained group and the random group was not found to be significantly different. In summary, it is suggested that it may not be necessary to supplement a randomly selected s le with an ascertained s le when investigating the liability to a low-prevalence psychiatric disorder if a continuous measure of that disorder is available.
Shared genetic risk between eating disorder‐ and substance‐use‐related phenotypes: Evidence from genome‐wide association studies
Publisher: Wiley
Date: 16-02-2020
DOI: 10.1111/ADB.12880
A systematic review: Solutions to problems caused by age transition between eating disorder services
Publisher: Wiley
Date: 11-08-2023
DOI: 10.1002/ERV.2945
Abstract: This systematic review examines age transition issues specific to young people with eating disorders, including the extent of, and reasons for, problematic transition. Suggested solutions are examined, with focus on age‐integrated services. PsycINFO, Medline and SCOPUS databases were searched on 4 April, 2022 using two inclusion criteria: (1) a peer‐reviewed journal article in English, (2) focus on service transition caused by moving from childhood to adulthood for people with eating disorders. A narrative integration of the content was used. Of the 17 non‐overlapping studies located in the review, 6 involved quantitative data. Problematic transition between age‐based services was indicated, where a substantial minority of young people who still require help lose contact with speciality services. A variety of reasons for this problematic transition were identified, including differing and sometimes adversarial cultures between age‐based services. While a variety of solutions have been suggested, the least explored was the development of age integrated services only 3 papers focussed primarily on this. The consideration of the advantages of integration and the similarities between age‐based services suggested that these potentially outweigh the barriers to integration. An implementation science research agenda is required to test this hypothesis.
Risk factors for clinically significant importance of shape and weight in adolescent girls
Publisher: American Psychological Association (APA)
Date: 02-2010
DOI: 10.1037/A0017779
Abstract: The objective of the current study was to conduct a longitudinal study of adolescent girls to determine how temperament, attitudes toward shape and weight, life events, and family factors might contribute to the growth of clinically significant importance of shape and weight, assessed using the Eating Disorder Examination (EDE). Time 1 data were available from 699 female twins (M age = 13.96 years) and 595 parents, and approximately 1.15 years later (Time 2) the twins completed the EDE again (M age = 15.10 years). Twins were treated as singletons in the analyses. Time 1 importance of shape and weight was a significant predictor of Time 2 lifetime disordered eating behaviors. Seven Time 1 variables were significant univariate predictors of Time 2 importance of shape and weight. In multivariate analyses, fathers' sensitivity to reward was the only significant predictor of growth of Time 2 importance of shape and weight. Some support was found for established risk factors of disordered eating risk, while the multivariate analyses highlight the importance of developing conceptualizations of eating disorder etiology beyond the in idual level.
Recent Research on Bulimia Nervosa
Publisher: Elsevier BV
Date: 03-2019
DOI: 10.1016/J.PSC.2018.10.002
Abstract: Estimates of lifetime bulimia nervosa (BN) range from 4% to 6.7% across studies. There has been a decrease in the presentation of BN in primary care but an increase in disordered eating not meeting full diagnostic criteria. Regardless of diagnostic status, disordered eating is associated with long-term significant impairment to both physical and mental quality of life, and BN is associated with a significantly higher likelihood of self-harm, suicide, and death. Assessment should adopt a motivationally enhancing stance given the high level of ambivalence associated with BN. Cognitive behavior therapy specific to eating disorders outperforms other active psychological comparisons.
Group skills training for parents of adolescents with anorexia nervosa: a pilot evaluation
Publisher: Informa UK Limited
Date: 18-05-2022
How perfectionism and ineffectiveness influence growth of eating disorder risk in young adolescent girls
Publisher: Elsevier BV
Date: 03-2015
DOI: 10.1016/J.BRAT.2015.01.007
Abstract: While perfectionism is widely considered to influence risk for eating disorders, results of longitudinal studies are mixed. The goal of the current study was to investigate a more complex model of how baseline perfectionism (both high personal standards and self-critical evaluative concerns) might influence change in risk status for eating disorders in young adolescent girls, through its influence on ineffectiveness. The study was conducted with 926 girls (mean age of 13 years), and involved three waves of data (baseline, 6- and 12-month follow-up). Latent growth curve modelling, incorporating the average rate at which risk changed over time, the intercept (initial status) of ineffectiveness, and baseline perfectionism, was used to explore longitudinal mediation. Personal standards was not supported as contributing to risk but results indicated that the higher mean scores on ineffectiveness over the three waves mediated the relationship between higher baseline self-critical evaluative concerns and both measures of eating disorder risk. The relationship between concern over mistakes and change in risk was small and negative. These results suggest the usefulness of interventions related to self-criticism and ineffectiveness for decreasing risk for developing an eating disorder in young adolescent girls.
Assessing the validity and responsiveness of a generic preference quality of life measure in the context of posttraumatic stress disorder
Publisher: Springer Science and Business Media LLC
Date: 14-05-2023
DOI: 10.1007/S11136-023-03432-Y
Abstract: There is limited research exploring the usefulness of generic preference-based quality of life (GPQoL) measures used to facilitate economic evaluation in the context of posttraumatic stress disorder (PTSD). The aim of the current study was to explore the validity and responsiveness of a common GPQoL measure (Assessment of Quality of Life 8 Dimension [AQoL-8D]) in relation to a PTSD condition-specific outcome measure (Posttraumatic Stress Disorder Checklist for the DSM-5 [PCL-5]). This aim was investigated in a s le of in iduals ( N = 147) who received trauma-focused cognitive-behavioural therapies for posttraumatic stress disorder. Convergent validity was investigated using spearman’s correlations, and the level of agreement was investigated using Bland–Altman plots. Responsiveness was investigated by exploring the standardised response means (SRM) from pre-post-treatment across the two measures, which allow the comparison of the magnitude of change between the measures over time. Correlations between the AQoL-8D (dimensions, utility and summary total scores) and the PCL-5 total score ranged from small to large and agreement between the measures was considered moderate to good. While SRMs were large for the AQoL-8D and PCL-5 total scores, the SRM for the PCL-5 was nearly double that of the AQoL-8D. Our findings demonstrate that the AQoL-8D has good construct validity but present preliminary evidence that economic evaluations using only GPQoL measures may not fully capture the effectiveness of PTSD treatments.
Structure of disordered eating in a twin community sample
Publisher: Wiley
Date: 1996
DOI: 10.1002/(SICI)1098-108X(199601)19:1<63::AID-EAT8>3.0.CO;2-U
Interactive programme to enhance protective factors for eating disorders in girls with type 1 diabetes
Publisher: Wiley
Date: 24-01-2013
DOI: 10.1111/EIP.12012
Abstract: This study evaluated the effectiveness of a pilot programme in enhancing protective factors for eating disorders in young girls with type 1 diabetes (T1D). Twenty girls with T1D (M age = 11.06 years) attended two 4-h group sessions. A 4-week baseline control period was compared against changes at post-programme and at 1-month follow-up on measures of eating disorder risk factors and indicators of glycaemic control. At post-intervention, significant improvements were found for self-efficacy related to diabetes management, self-esteem, body-esteem,thin-ideal internalization and perfectionism. These gains were maintained at 1-month follow-up. Participants were also rated by their parents as assuming more responsibility for specific diabetes-related tasks at follow-up. A brief interactive programme can favourably impact protective factors for disordered eating. The development of effective disordered eating prevention strategies for girls with T1D is an urgent priority and the current study is a first step in this direction.
Treating bulimia nervosa in the context of gender dysphoria using 10‐session cognitive behavior therapy
Publisher: Wiley
Date: 07-03-2019
DOI: 10.1002/EAT.23068
Abstract: This case report describes the psychological treatment for bulimia nervosa of a 16-year old with co-occurring gender dysphoria. He reported restricting his food intake and purging for approximately 1 year prior to therapy commencing. Ten sessions of cognitive behavioral therapy for eating disorders (CBT-T) were conducted with accommodations for gender-specific body dissatisfaction. The client eliminated binging and purging from the second treatment session and had maintained this at the 3-month follow-up. The quantity and variety of foods he was eating had increased and he no longer reported subjective binges. Improvements were also evident in his depression, anxiety and stress symptoms. This suggests that bulimia nervosa may be effectively treated with CBT-T in the context of gender dysphoria. Further research that investigates the generalizability of these outcomes would be beneficial.
Predictors of treatment outcome in individuals with eating disorders: A systematic review and meta‐analysis
Publisher: Wiley
Date: 14-07-2015
DOI: 10.1002/EAT.22411
Abstract: Understanding the factors that predict a favourable outcome following specialist treatment for an eating disorder may assist in improving treatment efficacy, and in developing novel interventions. This review and meta-analysis examined predictors of treatment outcome and drop-out. A literature search was conducted to identify research investigating predictors of outcome in in iduals treated for an eating disorder. We organized predictors first by statistical type (simple, meditational, and moderational), and then by category. Average weighted mean effect sizes (r) were calculated for each category of predictor. The most robust predictor of outcome at both end of treatment (EoT) and follow-up was the meditational mechanism of greater symptom change early during treatment. Simple baseline predictors associated with better outcomes at both EoT and follow-up included higher BMI, fewer binge urge behaviors, greater motivation to recover, lower depression, lower shape/weight concern, fewer comorbidities, better interpersonal functioning and fewer familial problems. Drop-out was predicted by more binge urge behaviors and lower motivation to recover. For most predictors, there was large interstudy variability in effect sizes, and outcomes were operationalized in different ways. There were generally insufficient studies to allow analysis of predictors by eating disorder subtype or treatment type. To ensure that this area continues to develop with robust and clinically relevant findings, future studies should adopt a consistent definition of outcome and continue to examine complex multivariate predictor models. Growth in this area will allow for stronger conclusions to be drawn about the prediction of outcome for specific diagnoses and treatment types.
The Relationship Between Irritable Bowel Syndrome and Panic Disorder: A Case Study
Publisher: Cambridge University Press (CUP)
Date: 12-1998
DOI: 10.1017/S0813483900004721
Abstract: Evidence suggests that cognitive behaviour therapy is the treatment of choice for both irritable bowel syndrome (IBS) and panic disorder (PD). The present study examines the treatment issues relating to a woman diagnosed with both IBS and PD (with agoraphobia), where therapy for PD was disrupted by IBS symptoms. Group therapy was then initiated for IBS, and this was associated with a large decrease in general anxiety and depression, and an increase in confidence concerning management of the pain caused by the IBS. This finding is discussed with respect to its possible implications for the treatment of people suffering both IBS and PD.
A longitudinal investigation of the impact of disordered eating on young women's quality of life.
Publisher: American Psychological Association (APA)
Date: 2012
DOI: 10.1037/A0025956
Abstract: The extent to which subclinical levels of disordered eating affect quality of life (QOL) was assessed. Four waves of self-report data from Survey 2 (S2) to 5 (S5) of a national longitudinal survey of young Australian women (N = 9,688) were used to assess the impact of any level of disordered eating at S2 on QOL over the following 9 years, and to evaluate any moderating effects of social support and of depression. At baseline, 23% of the women exhibited some level of disordered eating, and they scored significantly lower on both the physical and the mental component scores of the SF-36 at every survey differences in mental health were still clinically meaningful at S5. Social support and depressive symptoms each acted as a moderator of the mental component scores. Women with both disordered eating and low social support, or disordered eating and depression, had the worst initial scores although they improved the most over time, they still had the lowest scores at S5. Higher social support at baseline resulted in women with disordered eating being largely indistinguishable from women without disordered eating who had low social support. Lower levels of depression resulted in women with disordered eating having a significantly better QOL than women with high levels of depression, regardless of eating status. This is the first study to examine the long-term impact of subclinical levels of disordered eating on QOL, and it suggests that even apparently minor levels of symptomatology are associated with significant and far-reaching deficits in well-being.
Reliability of lifetime history of bulimia nervosa
Publisher: Royal College of Psychiatrists
Date: 07-2000
DOI: 10.1192/BJP.177.1.72
Abstract: Previous studies have found that the reliability of the lifetime prevalence of bulimia nervosa is low to moderate. However, the reasons for poor reliability remain unknown. We investigated the ability of a range of variables to predict reliability, sensitivity, and specificity of reporting of both bulimia nervosa and major depression. Two interviews, approximately 5 years apart, were completed with 2163 women from the Virginia Twin Registry. After accounting for different base rates, bulimia nervosa was shown to be as reliably reported as major depression. Consistent with previous studies of major depression, improved reliability of bulimia nervosa reporting is associated with more severe bulimic symptomatology. Frequent binge eating and the presence of salient behavioural markers such as vomiting and laxative misuse are associated with more reliable reporting of bulimia nervosa. In the absence of the use of fuller forms of assessment, brief interviews should utilise more than one prompt question, thus increasing the probability that memory of past disorders will be more successfully activated and accessed.
Which aspects of mindfulness are important to include in adolescent interventions?
Publisher: Wiley
Date: 05-10-2019
DOI: 10.1111/EIP.12490
Abstract: Despite widespread enthusiasm to adopt universal mindfulness-based interventions (MBIs) for youth, high-quality evidence is still lacking. It remains unknown how best to modify the successful adult curricula to render them accessible for young people but still effective. Specifically, it is unclear whether particular elements of mindfulness are key ingredients. The aim of this research was to identify the relation between aspects of baseline mindfulness and longitudinal trajectories related to well-being in adolescence. We examined associations between eight aspects of mindfulness at baseline and longitudinal trajectories of depression, anxiety, well-being, weight concern and shape concern over a 12-month period in early adolescents (N = 499 46% female M We found a transdiagnostic protective effect for those high in Accepting and Nonjudgmental Orientation, Decentering and Nonreactivity and Acting with Awareness, with effect sizes across the variables ranging from small to large (Cohen's d = .29-1.26) although this benefit reduced over time, especially for weight and shape concerns in girls. This natural but waning protective effect strengthens the case for MBIs in youth. The isolation of three key elements is an important preliminary step in identifying ways to improve the effectiveness of current adolescent curricula. Of the three, the current study suggests that teaching young adolescents to respond to their mistakes with kindness and non-judgement should be a prime focus.
Mindfulness-based prevention for eating disorders: A school-based cluster randomized controlled study
Publisher: Wiley
Date: 06-06-2015
DOI: 10.1002/EAT.22416
Abstract: Successful prevention of eating disorders represents an important goal due to damaging long-term impacts on health and well-being, modest treatment outcomes, and low treatment seeking among in iduals at risk. Mindfulness-based approaches have received early support in the treatment of eating disorders, but have not been evaluated as a prevention strategy. This study aimed to assess the feasibility, acceptability, and efficacy of a novel mindfulness-based intervention for reducing the risk of eating disorders among adolescent females, under both optimal (trained facilitator) and task-shifted (non-expert facilitator) conditions. A school-based cluster randomized controlled trial was conducted in which 19 classes of adolescent girls (N = 347) were allocated to a three-session mindfulness-based intervention, dissonance-based intervention, or classes as usual control. A subset of classes (N = 156) receiving expert facilitation were analyzed separately as a proxy for delivery under optimal conditions. Task-shifted facilitation showed no significant intervention effects across outcomes. Under optimal facilitation, students receiving mindfulness demonstrated significant reductions in weight and shape concern, dietary restraint, thin-ideal internalization, eating disorder symptoms, and psychosocial impairment relative to control by 6-month follow-up. Students receiving dissonance showed significant reductions in socio-cultural pressures. There were no statistically significant differences between the two interventions. Moderate intervention acceptability was reported by both students and teaching staff. Findings show promise for the application of mindfulness in the prevention of eating disorders however, further work is required to increase both impact and acceptability, and to enable successful outcomes when delivered by less expert providers.
Piloting a more intensive 8-week mindfulness programme in early- and mid-adolescent school students.
Publisher: Wiley
Date: 22-03-2019
DOI: 10.1111/EIP.12801
Abstract: It is unclear how adult mindfulness-based interventions (MBIs) should be modified for youth, and at what ages programmes should be implemented for optimal impact. Recent non-replication with a 9-week programme in early adolescence suggested abbreviated programme content might be insufficient and/or that this age group are less receptive. This controlled quasi-experimental design tested a more intensive 8-week MBI (longer meditation and session duration, plus inquiry) in Year 8 (M Within this format students rated the content as agreeable, and school staff deemed content developmentally appropriate, across both age bands. Efficacy was tested in a small subs le (N = 90) to provide an estimate of effect size. Linear mixed modelling demonstrated significant between-group differences in depression (Cohen's d = 0.61 95% CI = 0.19 to 1.03) and anxiety (d = 0.52 95% CI = 0.10 to 0.94) at 4-month follow-up, but not immediately post-intervention. An MBI more closely modelled on adult curricula was acceptable to students, although session duration was harder to timetable by schools. Promising effect sizes support further investigation in a larger s le.
Outcomes for adults with anorexia nervosa who do not respond early to outpatient treatment
Publisher: Wiley
Date: 24-03-2021
DOI: 10.1002/EAT.23508
Abstract: To better understand those patients with anorexia nervosa who do not show early response to treatment and are likely to have poorer outcome. From an existing data set of 187 patients with anorexia nervosa across 22 eating disorder outpatient services in the United Kingdom, participants who had started treatment and had at least one body mass index (BMI) observation in the first 6 weeks of treatment were eligible for these secondary analyses ( N = 65), a latent class analysis of BMI change over the first 6 weeks of treatment. Fifty‐six patients showed no early change in BMI. We used logistic regression to examine predictors of good outcome in the 40 participants who had 12‐month follow‐up data. Predictors included global EDE‐Q, negative affect (Depression, Anxiety, and Stress Scales) and functional impairment (Work and Social Adjustment Scale). Good outcome was achieved by 23% of patients and remission by 15%. Good outcome was predicted by less functional impairment at baseline. Further work that can identify sub‐groups of patients with anorexia nervosa who do not achieve good outcome after treatment will inform the development of targeted engagement approaches.
Comparison of cognitive style in bulimia nervosa and depression
Publisher: Elsevier BV
Date: 10-1997
DOI: 10.1016/S0005-7967(97)00056-9
Abstract: This study investigated the global and specific cognitive style associated with bulimia nervosa. Three groups of women (women with bulimia nervosa, women with major depression, and controls) completed measures of eating disorder severity, depression, dysfunctional cognitions and irrational beliefs. The control group was found to report significantly lower levels of cognitive distortions and irrational beliefs overall than both women with bulimia nervosa and women with depression. However, no difference was found between the latter two groups. Furthermore, the pattern of in idual cognitions and beliefs was exactly the same. When depression was statistically controlled, cognitive style no longer differentiated between the control group and two clinical groups. These results have implications for improving the effectiveness of cognitive behaviour therapy for bulimia nervosa.
Differences between treatment seekers in an obese population
Publisher: Springer Science and Business Media LLC
Date: 1997
Abstract: This study examined two groups of people who were pursuing treatment for obesity: either medical intervention (a hospital group N = 20) or support for dietary restriction (a community group N = 18). This study addressed four questions: (1) Were there differences between the two groups in terms of their psychological distress (as measured by the Symptom Checklist)? (2) Does binge eating moderate psychological distress? (3) Do feelings of ineffectiveness moderate psychological distress? and (4) Which variables best accounted for group membership (i.e., type of treatment sought)? Results suggested that the hospital group was significantly more distressed than the community group. However, there were no differences between the two groups with respect to binge eating or feelings of ineffectiveness. These findings suggest that it is the effects of morbid obesity that are most likely to moderate psychological distress.
Anorexia nervosa following gastric reduction surgery for morbid obesity
Publisher: Wiley
Date: 1998
DOI: 10.1002/(SICI)1098-108X(199801)23:1<111::AID-EAT16>3.0.CO;2-4
Abstract: Anorexia nervosa and morbid obesity are popularly considered to be opposite ends of the eating disorder spectrum. Research and clinical experience, however, suggest common psychological factors in a subgroup of obese people. This paper details case reports of two subjects who developed anorexia nervosa following gastric reduction surgery for morbid obesity. Clinical profiles, treatment, and outcome are reported. Psychological similarities between morbid obesity and anorexia nervosa in these subjects are explored. Implications for the selection of subjects for gastric reduction surgery and management after surgery are discussed.
Social media, body image, and the question of causation: Meta-analyses of experimental and longitudinal evidence
Publisher: Elsevier BV
Date: 12-2021
DOI: 10.1016/J.BODYIM.2021.10.001
Abstract: This article presents four meta-analyses that can inform causality in the relationship between social media and body image 24 experimental s les comparing the effect of appearance-ideal social media images to non-appearance-related conditions (n = 3816) 21 experimental s les examining the effect of contextual features (e.g., comments and captions) accompanying appearance-ideal social media images (n = 3482) 14 experimental s les investigating the effect of appearance-ideal images versus other appearance images on social media (n = 2641) and 10 longitudinal s les on social media use and body image (n = 5177). Social media appearance-ideal images had a moderate negative effect on body image (Hedges' g = -0.61, p < .01), were more damaging in higher- than lower-risk contexts (Hedges' g = -0.12, p < .01), and were moderately more impactful than other social media appearance images (Hedges' g = -0.68, p = .05). These effects were smaller but significant with outliers removed. Social media use had a very small, negative correlation with body image longitudinally (Fisher's Z = -0.08, p < .001). No significant moderators emerged. Clinicians should consider approaches to managing social media use, particularly exposure to appearance-ideal imagery, in case conceptualisation and psychoeducation for clients at risk of, or experiencing, body image disturbance.
The role of perfectionism in body dissatisfaction
Publisher: Springer Science and Business Media LLC
Date: 22-01-2013
A clinician’s quick guide to evidence-based approaches: eating disorders (Version 2)
Publisher: Informa UK Limited
Date: 02-01-2023
A randomized controlled trial of Internet-Based Cognitive Behavior Therapy for perfectionism including an investigation of outcome predictors
Publisher: Elsevier BV
Date: 08-2017
DOI: 10.1016/J.BRAT.2017.05.015
Abstract: Being highly attentive to details can be a positive feature. However, for some in iduals, perfectionism can lead to distress and is associated with many psychiatric disorders. Cognitive behavior therapy has been shown to yield many benefits for those experiencing problems with perfectionism, but the access to evidence-based care is limited. The current study investigated the efficacy of guided Internet-based Cognitive Behavior Therapy (ICBT) and predictors of treatment outcome. In total, 156 in iduals were included and randomized to an eight-week treatment or wait-list control. Self-report measures of perfectionism, depression, anxiety, self-criticism, self-compassion, and quality of life were distributed during screening and at post-treatment. Intention-to-treat were used for all statistical analyses. Moderate to large between-group effect sizes were obtained for the primary outcome measures, Frost Multidimensional Perfectionism Scale, subscales Concerns over Mistakes and Personal Standards, Cohen's d = 0.68-1.00, 95% Confidence Interval (CI) [0.36-1.33], with 35 (44.9%) of the patients in treatment being improved. Predictors were also explored, but none were related to treatment outcome. In sum, guided ICBT can be helpful for addressing problems with clinical perfectionism, but research of its long-term benefits is warranted.
Prevention Across the Spectrum: A randomized controlled trial of three programs to reduce risk factors for both eating disorders and obesity
Publisher: Cambridge University Press (CUP)
Date: 19-12-2015
DOI: 10.1017/S003329171400289X
Abstract: A randomized controlled trial of three school-based programs and a no-intervention control group was conducted to evaluate their efficacy in reducing eating disorder and obesity risk factors. A total of 1316 grade 7 and 8 girls and boys (mean age = 13.21 years) across three Australian states were randomly allocated to: Media Smart Life Smart the Helping, Encouraging, Listening and Protecting Peers (HELPP) initiative or control (usual school class). Risk factors were measured at baseline, post-program (5 weeks later), and at the 6- and 12-month follow-ups. Media Smart girls had half the rate of onset of clinically significant concerns about shape and weight than control girls at the 12-month follow-up. Media Smart and HELPP girls reported significantly lower weight and shape concern than Life Smart girls at the 12-month follow-up. Media Smart and control girls scored significantly lower than HELPP girls on eating concerns and perceived pressure at the 6-month follow-up. Media Smart and HELPP boys experienced significant benefit on media internalization compared with control boys and these were sustained at the 12-month follow-up in Media Smart boys. A group × time effect found that Media Smart participants reported more physical activity than control and HELPP participants at the 6-month follow-up, while a main effect for group found Media Smart participants reported less screen time than controls. Media Smart was the only program to show benefit on both disordered eating and obesity risk factors. Whilst further investigations are indicated, this study suggests that this program is a promising approach to reducing risk factors for both problems.
Undue influence of weight and shape: Is it distinct from body dissatisfaction and concern about weight and shape?
Publisher: Cambridge University Press (CUP)
Date: 27-05-2011
DOI: 10.1017/S0033291710001066
Abstract: Three cognitive constructs are risk factors for eating disorders: undue influence of weight and shape, concern about weight and shape, and body dissatisfaction (BD). Undue influence, a diagnostic criterion for eating disorders, is postulated to be closely associated with self-esteem whereas BD is postulated to be closely associated with body mass index (BMI). We understand less about the relationships with concern about weight and shape. The aim of the current investigation was examine the degree of overlap across these five phenotypes in terms of latent genetic and environmental risk factors in order to draw some conclusions about the similarities and differences across the three cognitive variables. A s le of female Australian twins ( n =1056, including 348 complete pairs), mean age 35 years ( s.d .=2.11, range 28–40), completed a semi-structured interview about eating pathology and self-report questionnaires. An independent pathways model was used to investigate the overlap of genetic and environmental risk factors for the five phenotypes. In terms of variance that was not shared with other phenotypes, self-esteem emerged as being separate, with 100% of its variance unshared with the other phenotypes, followed by undue influence (51%) and then concern (34%), BD (28%) and BMI (32%). In terms of shared genetic risk, undue influence and concern were more closely related than BD, whereas BMI and BD were found to share common sources of risk. With respect to environmental risk factors, concern, BMI and BD were more closely related to each other than to undue influence.
Development of a new statewide eating disorder service: The role of evidence in a real world setting
Publisher: Wiley
Date: 25-01-2017
DOI: 10.1002/EAT.22664
Abstract: There are three aims of this report. First, to describe how research evidence informed a service development rationale for a new statewide eating disorder service (SEDS) for people aged 15 years and older. Second, to examine the profile of people accessing SEDS in the first 2 years of its operation with respect to the three broad dimensions: illness stage, illness severity, and previous history of treatment. Finally, to examine which patient characteristics resulted in the recommendation of ongoing treatment contact with SEDS. Over a 2-year period (July 2014 to July 2016) 292 people were referred to the service, 171 (59%) who consented to have their data used in research. Half of the referrals related to anorexia nervosa (AN 51.2%), with the remainder split between bulimia nervosa (25.3%) and other specified feeding and eating disorders (23.5%) 65.9% had previously received treatment for an eating disorder. The initial information about the service was typically provided by the general practitioner rimary care physician. Compared with any other eating disorder diagnosis, people with AN were three times more likely to be recommended to retain treatment contact with SEDS. Service development informed by research evidence, clinical expertise, and consideration of patients' characteristics, values, and circumstances, allows for a flexible but accountable development strategy.
Does shared genetic risk contribute to the co-occurrence of eating disorders and suicidality?
Publisher: Wiley
Date: 06-05-2015
DOI: 10.1002/EAT.22421
Abstract: There is a high level of co-occurrence of suicidality with eating disorders (EDs) but the reason for this is unknown. To test the hypothesis that suicidality and EDs share genetic risk contributing to the expression of both phenotypes. Female twins (N = 1,002) from the Australian Twin Registry, aged 28-40 years, were interviewed with diagnostic interviews. Lifetime diagnostic information relating to eating disorders [anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder, and purging disorder (PD)], suicidality (ranging transitory thoughts to suicide attempts), and major depression. Any suicidal thoughts were reported by 24% of the s le, but prevalence of lifetime suicidality among female twins with EDs was much higher (43%), presence of an ED diagnosis more than doubling likelihood of suicidality (OR = 2.32, 95% CI: 1.63-3.31). AN and BN conveyed greatest risk of suicidality (OR = 2.03, 95% CI: 1.06-3.87 OR = 3.97, 95% CI: 2.01-7.85, respectively). Twin phenotype correlations showed monozygotic twins had uniformly higher estimates than dizygotic counterparts. A trivariate Cholesky model indicated a common genetic influence on suicidality and ED phenotypes (but not depression), and no nonshared environmental source. Both cross twin phenotypic correlations and genetic modeling infer a common genetic pathway for suicidality and EDs, but further investigation is needed to elucidate whether this may constitute emotional dysregulation or other temperament-linked factors. Study findings also indicate that ED clients must be routinely assessed for presence of suicidality, independent of depression status.
Is the devil in the detail? A randomised controlled trial of guided internet-based CBT for perfectionism
Publisher: Elsevier BV
Date: 08-2017
DOI: 10.1016/J.BRAT.2017.05.014
Abstract: An internet guided self-help cognitive-behavioural treatment (ICBT) for perfectionism was recently found to be effective (see this issue). Such studies stand in need of replication. The aim of this study was to report the outcomes and predictors of change when the treatment is delivered in a UK setting. A total of 120 people (Mean = 28.9 years 79% female) were randomised to receive ICBT or wait-list control over 12 weeks (trial registration: NCT02756871). While there were strong similarities between the current study and its Swedish counterpart, there were also important differences in procedural details. There was a significant impact of the intervention on the primary outcome measure (Frost Multidimensional Perfectionism Scale, Concern over Mistakes subscale) and also on the Clinical Perfectionism Questionnaire (between group effect sizes d = 0.98 (95% CI: 0.60-1.36) and d = 1.04 (95% CI: 0.66-1.43) respectively using intent-to-treat analyses). Unlike the Swedish study, there was significant non-engagement and non-completion of modules with 71% of participants completing fewer than half the modules. The number of modules completed moderated the rate of change in clinical perfectionism over time. In conclusion, the study indicates the intervention is effective in a UK setting but highlighted the importance of procedural details to optimise retention.
Healthy Anorexia: rationalising contradictions
Publisher: Springer Science and Business Media LLC
Date: 11-2013
Rationale and development of a manualised dietetic intervention for adults undergoing psychological treatment for an eating disorder
Publisher: Springer Science and Business Media LLC
Date: 19-07-2020
The relationship between social media use and disordered eating in young adolescents
Publisher: Wiley
Date: 03-12-2020
DOI: 10.1002/EAT.23198
Abstract: The relationship between social media (SM) use and disordered eating (DE) has not been adequately explored in young adolescents. Data from 996 Grade 7 and 8 adolescents (n = 534 girls M age = 13.08) was investigated. DE cognitions (Eating Disorder Examination-Questionnaire [EDE-Q]), DE behaviors (Project Eating Among Teens), and SM use measures related to Facebook, Instagram, Snapchat, and Tumblr were completed. DE behaviors were reported by 51.7% of girls and 45.0% of boys, with strict exercise and meal skipping the most common. A total of 75.4% of girls and 69.9% of boys had at least one SM account where Instagram was the most common, used by 68.1% of girls and 61.7% of boys. Global EDE-Q scores were significantly higher for girls and boys with each type of SM account, except for Facebook and Instagram for girls. A greater number of SM accounts was associated with higher DE scores for both cognitions and behaviors. Girls with Snapchat and Tumblr accounts and boys with Snapchat, Facebook and Instagram were significantly more likely to have both DE behaviors and over-evaluation of shape and weight in the clinical range. Greater daily time spent using Instagram was associated with significantly higher Global EDE-Q scores and DE behaviors for girls, while this pattern was also found for Snapchat usage and DE behaviors for girls. A clear pattern of association was found between SM usage and DE cognitions and behaviors with this exploratory study confirming that these relationships occur at younger-age than previously investigated.
The role of body dissatisfaction and bingeing in the self-esteem of women with type II diabetes
Publisher: Springer Science and Business Media LLC
Date: 1999
Abstract: This study investigated the impact of body dissatisfaction and binge eating on self-esteem in women with Type II diabetes. The relationship of body dissatisfaction and bingeing to perceived blood glucose control was also assessed. Questionnaires were completed by a total of 215 women: 125 women with Type II diabetes and 90 comparison women, who were roughly matched for age, education, and ethnicity. When actual weight (BMI) was statistically controlled, there was no difference between the groups in body dissatisfaction or bingeing behavior. The women with diabetes, however, had significantly lower self-esteem. Further, bingeing made a significant contribution to their self-esteem, in contrast to the women without diabetes. For the women with diabetes, body dissatisfaction and bingeing were also related to perceived blood glucose control, although only bingeing remained significant when both variables were entered into the regression equation. It was concluded that diabetes broadens the domains of body dissatisfaction which are related to self-esteem.
Comparative efficacy of pharmacological and non-pharmacological interventions for the acute treatment of adult outpatients with anorexia nervosa: study protocol for the systematic review and network m
Publisher: Springer Science and Business Media LLC
Date: 02-08-2017
Trail Making Task Performance in Inpatients with Anorexia Nervosa and Bulimia Nervosa
Publisher: Wiley
Date: 13-05-2015
DOI: 10.1002/ERV.2364
Abstract: Set-shifting inefficiencies have been consistently identified in adults with anorexia nervosa (AN). It is less clear to what degree similar inefficiencies are present in those with bulimia nervosa (BN). It is also unknown whether perfectionism is related to set-shifting performance. We employed a commonly used set-shifting measure, the Trail Making Test (TMT), to compare the performance of inpatients with AN and BN with a healthy control s le. We also investigated whether perfectionism predicted TMT scores. Only the BN s le showed significantly suboptimal performance, while the AN s le was indistinguishable from controls on all measures. There were no differences between the AN subtypes (restrictive or binge urge), but group sizes were small. Higher personal standards perfectionism was associated with better TMT scores across groups. Higher concern over mistakes perfectionism predicted better accuracy in the BN s le. Further research into the set-shifting profile of in iduals with BN or binge urge behaviours is needed.
A randomized controlled feasibility trial of metacognitive training with adolescents receiving treatment for anorexia nervosa
Publisher: Wiley
Date: 09-06-2023
DOI: 10.1002/EAT.24009
Abstract: This pilot study investigated the feasibility and preliminary efficacy of the metacognitive training for eating disorders (MCT‐ED) program in adolescents with anorexia nervosa (AN). We report attrition and subjective evaluation as well as changes to cognitive flexibility, perfectionism and eating disorder pathology relative to waitlist controls. Female ( n = 35, aged 13–17 years) outpatients with a diagnosis of AN ( n = 20) or atypical AN ( n = 15) completed baseline measures of cognitive flexibility, perfectionism, and eating disorder pathology (May 2020–May 2022). Participants were randomly allocated to either treatment‐as‐usual (TAU) plus MCT‐ED or TAU waitlist condition. All participants completed post‐intervention and 3‐month follow‐up questionnaires. The MCT‐ED condition had a treatment attrition rate %. Participants provided positive evaluation of the program. There were large between groups differences favoring MCT‐ED at post‐intervention and 3‐month follow‐up for concern over mistakes perfectionism (respective d s = −1.25, 95% CI [−2.06, −.45] −.83, 95% CI [−1.60, .06]) with a significant group difference post‐intervention but not 3‐month follow‐up. Findings provide tentative support for the feasibility of MCT‐ED as an adjunct intervention for young people with AN, however replication is needed with a larger s le size to further explore its efficacy. Metacognitive training for eating disorders (MCT‐ED) is a feasible adjunct intervention for adolescents with anorexia nervosa. The intervention, which targets thinking styles and is delivered online by a therapist, received positive feedback, had high treatment retention, and led to reductions in perfectionism by the end of treatment compared to wait‐list controls. Although these gains were not sustained long‐term, the program is suitable adjunct intervention for young people with eating disorders.
Perfectionism and Eating Disorders
Publisher: Springer International Publishing
Date: 15-09-2015
Overcoming Perfectionism: Protocol of a Randomized Controlled Trial of an Internet-Based Guided Self-Help Cognitive Behavioral Therapy Intervention
Publisher: JMIR Publications Inc.
Date: 11-11-2016
DOI: 10.2196/RESPROT.6378
Impact of guidance on intervention adherence in computerised interventions for mental health problems: a meta-analysis
Publisher: Cambridge University Press (CUP)
Date: 22-11-2021
DOI: 10.1017/S0033291721004621
Abstract: Web-based interventions are increasingly used for the prevention, treatment and aftercare of mental disorders. A crucial factor to the efficacy of such online programmes is adherence to the intervention content and procedure. It has been frequently suggested that adherence in web-based interventions is low and little is known about which factors influence adherence. To increase intervention uptake and completion, studies increasingly include interventions with some form of guidance. Guided interventions have been shown to have higher efficacy, however, evidence for the impact on adherence is limited and mixed. This meta-analysis explored the impact of human guidance on intervention completion in web-based mental health interventions. A total of 22 studies were included with interventions primarily targeting symptoms of depression and anxiety disorders. Results showed that guidance significantly increases the average amount of intervention completion [ g = 0.29, 95% confidence interval (CI) 0.18–0.40] and the proportion of intervention completers [ log odds ratio (OR) = 0.50, 95% CI 0.34–0.66] with small effects. On average, full completion rates were 12% higher in guided intervention groups. This meta-analysis demonstrated that guidance in web-based mental health interventions does increase adherence, but more research is required to better understand the specific mechanisms between guidance, adherence and outcomes.
Developing a protocol to address co‐occurring mental health conditions in the treatment of eating disorders
Publisher: Wiley
Date: 06-06-2023
DOI: 10.1002/EAT.24008
Abstract: While co‐occurring mental health conditions are the norm in eating disorders, no testable protocol addresses management of these in psychotherapy. The literature on managing mental health conditions that co‐occur with eating disorders is outlined and reviewed. In the absence of clear evidence to inform managing co‐occurring mental health conditions, we advocate for use of an iterative, session‐by‐session measurement to guide practice and research. We identify three data‐driven treatment approaches (focus solely on the eating disorder multiple sequential interventions either before or after the eating disorder is addressed integrated interventions), and the indications for their use. Where a co‐occurring mental health condition/s impede effective treatment of the eating disorder, and an integrated intervention is required, we outline a four‐step protocol for three broad intervention approaches (alternate, modular, transdiagnostic). A research program is suggested to test the usefulness of the protocol. Guidelines that provide a starting point to improving outcomes for people with eating disorders that can be evaluated/researched are offered in the current paper. These guidelines require further elaboration with reference to: (1) whether any difference in approach is required where the co‐occurring mental health condition is a comorbid symptom or condition (2) the place of biological treatments within these guidelines (3) precise guidelines for selecting among the three broad intervention approaches when adapting care for co‐occurring conditions (4) optimal approaches to involving consumer input into identifying the most relevant co‐occurring conditions (5) detailed specification on how to determine which adjuncts to add. Most people with an eating disorder also have another diagnosis or an underlying trait (e.g., perfectionism). Currently no clear guidelines exist to guide treatment in this situation, which often results in a drift away from evidence‐based techniques. This paper outlines data‐driven strategies for treating eating disorders and the accompanying comorbid conditions and a research program that can test the usefulness of the different approaches suggested.
Disordered eating in girls with Type 1 diabetes: Examining directions for prevention
Publisher: Informa UK Limited
Date: 03-2010
Eating Disorder Day Programs
Publisher: MDPI AG
Date: 19-02-2022
DOI: 10.3390/NU14040879
Abstract: The use of a Day Program (DP) format (i.e., intensive daily treatment with no overnight admission) has been shown to be an effective treatment for eating disorders (EDs). The disadvantages, however, include higher cost than outpatient treatment (including costs of meals and staff), greater disruption to patients’ lives, and the use of a highly structured and strict schedule that may interrupt the development of patients’ autonomy in taking responsibility for their recovery. This study investigated whether reducing costs of a DP and the disruption to patients’ lives, and increasing opportunity to develop autonomy, impacted clinical outcomes. Three sequential DP formats were compared in the current study: Format 1 was the most expensive (provision of supported dinners three times/week and extended staff hours) Format 2 included only one dinner/week and provision of a take-home meal. Both formats gave greater support to patients who were not progressing well (i.e., extended admission and extensive support from staff when experiencing feelings of suicidality or self-harm). Format 3 did not provide this greater support but established pre-determined admission lengths and required the patient to step out of the program temporarily when feeling suicidal. Fifty-six patients were included in the analyses: 45% were underweight (body mass index (BMI) 18.5), 96.4% were female, 63% were given a primary diagnosis of anorexia nervosa (or atypical anorexia nervosa), and mean age was 25.57 years. Clinical outcomes were assessed using self-reported measures of disordered eating, psychosocial impairment, and negative mood, but BMI was recorded by staff. Over admission, 4- and 8-week post-admission, and discharge there were no significant differences between any of the clinical outcomes across the three formats. We can tentatively conclude that decreasing costs and increasing the opportunities for autonomy did not negatively impact patient outcomes, but future research should seek to replicate these results in other and larger populations that allow conclusions to be drawn for different eating disorder diagnostic groups.
Emotion regulation in broadly defined anorexia nervosa: Association with negative affective memory bias
Publisher: Elsevier BV
Date: 08-2013
DOI: 10.1016/J.BRAT.2013.04.005
Abstract: Theoretical models in anorexia nervosa (AN) implicate difficulties with emotion regulation as a maintaining factor. To date little is known about how different factors might maintain these difficulties. Forty eight women were recruited, 24 receiving treatment for AN (called broadly defined AN) and 24 healthy controls. Self-report measures of difficulties with emotion regulation and current depression were used in addition to computerized tasks which provided measures of social attentional bias and anger-threat bias, as well negative affective memory and recognition bias. Compared to controls, women with AN had significantly higher levels of difficulties with emotion regulation, depression, and negative affective memory bias, as well as lower bias for anger-threat. Simultaneous examination of the two variables that met pre-conditions for mediation of the relationship between group membership and difficulties with emotion regulation (anger-threat bias and negative affective memory) indicated negative affective memory bias to be a mediator, accounting for around one-third of the total effect a diagnosis of AN has on difficulties with emotion regulation. The association of these variables with AN may indicate shared risk factors with depression, and the variety of therapeutic approaches found to be effective with depression may be useful to further incorporate into treatments for AN.
Brief Cognitive Behavioural Therapy for Non-Underweight Patients
Publisher: Routledge
Date: 10-05-2019
Ascertaining an efficient eligibility cut-off for extended Medicare items for eating disorders
Publisher: SAGE Publications
Date: 15-07-2021
DOI: 10.1177/10398562211028632
Abstract: Currently eligibility for expanded Medicare items for eating disorders (excluding anorexia nervosa) require a score ⩾ 3 on the 22-item Eating Disorder Examination-Questionnaire (EDE-Q). We compared these EDE-Q “cases” with continuous scores on a validated 7-item version of the EDE-Q (EDE-Q7) to identify an EDE-Q7 cut-off commensurate to 3 on the EDE-Q. We utilised EDE-Q scores of female university students ( N = 337) at risk of developing an eating disorder. We used a receiver operating characteristic (ROC) curve to assess the relationship between the true-positive rate (sensitivity) and the false-positive rate (1-specificity) of cases ⩾ 3. The area under the curve showed outstanding discrimination of 0.94 (95% CI: .92–.97). We examined two specific cut-off points on the EDE-Q7, which included 100% and 87% of true cases, respectively. Given the EDE-Q cut-off for Medicare is used in conjunction with other criteria, we suggest using the more permissive EDE-Q7 cut-off (⩾2.5) to replace use of the EDE-Q cut-off (⩾3) in eligibility assessments.
Measuring perfectionism in children: a systematic review of the mental health literature
Publisher: Springer Science and Business Media LLC
Date: 02-11-2017
Cognitive‐behavioral therapy in the time of coronavirus: Clinician tips for working with eating disorders via telehealth when face‐to‐face meetings are not possible
Publisher: Wiley
Date: 08-05-2020
DOI: 10.1002/EAT.23289
Interventions for perinatal borderline personality disorder and complex trauma
Publisher: Springer Science and Business Media LLC
Date: 20-04-2023
DOI: 10.1007/S00737-023-01313-4
Abstract: Perinatal borderline personality disorder (BPD) and complex post-traumatic stress disorder (cPTSD) are associated with significant impairment to interpersonal functioning, and risk of intergenerational transmission of psychopathology. Evaluation of interventions, however, is scarce. To date, no systematic review has addressed interventions for perinatal BPD, cPTSD, and associated symptomatology. Given the modest evidence to support informed clinical guidelines, the objective of this systematic review is to synthesise the literature on interventions for perinatal BPD and cPTSD, and to generate future directions for research. A comprehensive literature search following PRISMA guidelines was conducted in PsycInfo, MEDLINE, Emcare, Scopus, and ProQuest Dissertations and Theses Global databases. Seven original studies were included, of which only two were randomised controlled trials, using less intensive comparison conditions. Results suggest an association between Dialectical Behavioural Therapy (DBT) group skills training, a multimodal therapeutic approach at a Mother-Baby Unit (MBU), and Child-Parent Psychotherapy with improved perinatal mental health outcomes and remission of symptoms. MBU admission and home-visiting programs were associated with healthy postpartum attachment relationships. Home-visiting programs and DBT group skills were additionally associated with improved maternal parenting capabilities. Conclusions to inform clinical guidelines are limited by a lack of credible comparison conditions, and low quantity and quality of evidence. The feasibility of implementing intensive interventions in real-world settings is dubious. Hence, it is suggested that future research considers utilising antenatal screening to identify at-risk mothers, and the implementation of early intervention, using robust designs that can inform robust conclusions.
Is guided self-help family-based treatment for parents of adolescents with anorexia nervosa on treatment waitlists feasible? A pilot trial.
Publisher: Wiley
Date: 26-04-2022
DOI: 10.1002/EAT.23720
Abstract: The aim of the study was to assess the feasibility (recruitment and retention) of an online 12-session guided self-help family-based treatment (GSH-FBT) for families on the waitlist for face-to-face FBT utilizing trainee psychologists to assist carers of children with anorexia nervosa (AN) or atypical AN. The primary outcomes were feasibility of GSH-FBT for families on the waitlist and secondary exploratory outcomes examined improvement of child and parental function. Of 187 eligible families on the waitlist, 24 (13%) expressed interest in the study 16 (67%) of these families completed baseline, 13 (54%) completed GSH-FBT over a 6-month recruitment period. Children (mean age = 13.92, SD = .86 mean body mass index [BMI] centile = 29.47, SD = 24.80) had an average weight gain of 6 kg (BMI centile effect size = 2.61, 95% CI: 1.77-3.44) and a decrease in eating disorder behaviors (effect size = 1.11, 95% CI: .27-1.95). Improvements also occurred for general mood and behaviors in the child, and the impact of eating disorder symptoms on their functioning. Parents reported improvements in knowledge, skills, and confidence in managing AN. Use of this low-cost intervention while families are on the waitlist for FBT is engaging and useful but strategies to improve initial recruitment are needed. Although most eligible families did not enroll in an online 12-session guided self-help family-based treatment for families on the waitlist for face-to-face FBT for anorexia nervosa, families who participated found it engaging. The children experienced improvements in BMI centile, eating and behavior. Parents reported increased confidence, knowledge, and skills. We need to examine how families can be encouraged to participate on online training when on waitlists for treatment.
Randomized controlled psychotherapy trials in eating disorders: Improving their conduct, interpretation and usefulness
Publisher: Wiley
Date: 25-04-2018
DOI: 10.1002/EAT.22872
Abstract: While randomized controlled trials (RCTs) inform the efficacy and effectiveness of treatments, we need to understand that even RCTs can be associated with sub-optimal execution. This is of special pertinence to eating disorders given the majority of treatment studies involving cognitive behaviour therapy are of poor quality with respect to managing risk of bias adequately. The current paper outlines the components of a good RCT for psychotherapy, and examines ways to improve the conduct, interpretation, and usefulness of RCTs. This includes managing reporting bias, recognizing the limits of randomization, applicability, and ethical considerations. We highlight a number of strategies for future research, including issues related to utilizing a variety of designs to examine treatment outcomes, integrity, openness and reproducibility.
Developing consensus on the definition of remission and recovery for research
Publisher: Wiley
Date: 30-08-2019
DOI: 10.1002/EAT.23165
Abstract: The current research investigated whether a consensus among professional eating disorder researchers existed for definitions of remission and recovery that could be used in research. Membership of the Eating Disorder Research Society and attendees at the 2018 annual meeting in Sydney were invited to participate in this investigation. Two surveys were conducted with 62 and 122 respondents, respectively. The first survey used a mix of forced choice yes/no or scaled responses. The second survey was a free response to the question "which definitions of recovery do you favor?" A majority consensus emerged about three issues. First, it was agreed that it was important to develop a standard definition of recovery for research purposes. Second, recovery needed to be evident over a 12-month period, with remission evident over a 3- to 12-month period. Third, recovery and remission required the absence of diagnostic criteria in addition to the presence of functional recovery. Consensus is apparent in the field. We suggest that future research seeks to: (a) validate the most commonly researched definition of remission and recovery across different eating disorders using a standardized battery of assessments, and (b) better understand differences in self-assessed and psychometrically assessed recovery.
The efficacy of cognitive-behavioral therapy for eating disorders: A systematic review and meta-analysis.
Publisher: American Psychological Association (APA)
Date: 11-2017
DOI: 10.1037/CCP0000245
Abstract: This meta-analysis examined the efficacy of cognitive-behavioral therapy (CBT) for eating disorders. Randomized controlled trials of CBT were searched. Seventy-nine trials were included. Therapist-led CBT was more efficacious than inactive (wait-lists) and active (any psychotherapy) comparisons in in iduals with bulimia nervosa and binge eating disorder. Therapist-led CBT was most efficacious when manualized CBT-BN or its enhanced version was delivered. No significant differences were observed between therapist-led CBT for bulimia nervosa and binge eating disorder and antidepressants at posttreatment. CBT was also directly compared to other specific psychological interventions, and therapist-led CBT resulted in greater reductions in behavioral and cognitive symptoms than interpersonal psychotherapy at posttreatment. At follow-up, CBT outperformed interpersonal psychotherapy only on cognitive symptoms. CBT for binge eating disorder also resulted in greater reductions in behavioral symptoms than behavioral weight loss interventions. There was no evidence that CBT was more efficacious than behavior therapy or nonspecific supportive therapies. CBT is efficacious for eating disorders. Although CBT was equally efficacious to certain psychological treatments, the fact that CBT outperformed all active psychological comparisons and interpersonal psychotherapy specifically, offers some support for the specificity of psychological treatments for eating disorders. Conclusions from this study are h ered by the fact that many trials were of poor quality. Higher quality RCTs are essential. (PsycINFO Database Record
The effectiveness of lived experience involvement in eating disorder treatment: A systematic review
Publisher: Wiley
Date: 13-11-2022
DOI: 10.1002/EAT.23847
Abstract: This systematic review sought to understand the effectiveness of lived experience mentoring, by people recovered from an eating disorder, with clinical s les currently receiving eating disorder treatment. The systematic review was conducted using PsycINFO, MEDLINE, Scopus, and ProQuest Dissertations and Theses Global and reviewing reference lists of included papers. Articles were included if they: (1) were intervention studies that included peer (recovered from an eating disorder) involvement, (2) delivered the intervention to clinical s les (or carers with direct involvement in treatment), (3) were in English, and (4) included quantitative results. Eleven studies were included across randomized control trials (RCTs), case series, and a case study there was variation in quality. Findings varied considerably with some concluding that lived experience mentoring led to significant improvements for mentees, while other studies found no significant differences. Mentor outcomes were often not evaluated. Of those that did assess mentors, there is preliminary evidence for some benefits to participation but also the potential for harm. There is a need for further research in this area using high‐quality RCTs that address the risk of bias. It is important that lived experience peer mentors are monitored on key outcomes, provided with adequate training and ongoing supervision, and are reimbursed for their involvement. This systematic review is the first review to focus on the use of peer mentors recovered from an eating disorder contributing to interventions for people receiving treatment for an eating disorder. All included studies present quantitative results. Given the emerging interest of lived experience mentoring, understanding its effectiveness for both mentees and impacts on mentors continues to be of critical importance.
Predictors of treatment outcome in individuals with eating disorders: A systematic review and meta‐analysis
Publisher: Wiley
Date: 04-2016
DOI: 10.1002/EAT.22518
Open science practices for eating disorders research
Publisher: Wiley
Date: 23-09-2021
DOI: 10.1002/EAT.23607
Abstract: This editorial seeks to encourage the increased application of three open science practices in eating disorders research: Preregistration, Registered Reports, and the sharing of materials, data, and code. For each of these practices, we introduce updated International Journal of Eating Disorders author and reviewer guidance. Updates include the introduction of open science badges specific instructions about how to improve transparency and the introduction of Registered Reports of systematic or meta‐analytical reviews. The editorial also seeks to encourage the study of open science practices. Open science practices pose considerable time and other resource burdens. Therefore, research is needed to help determine the value of these added burdens and to identify efficient strategies for implementing open science practices.
Internet-based cognitive behaviour therapy for perfectionism
Publisher: Informa UK Limited
Date: 11-2019
DOI: 10.1111/CP.12193
Training mental health nurses to provide motivational interviewing on an inpatient eating disorder unit
Publisher: Wiley
Date: 20-05-2014
DOI: 10.1111/JPM.12163
Abstract: This study examined whether: (1) brief training in motivational interviewing (MI) can prepare mental health nurses (MHNs) to provide MI to patients and (2) this MI impacts on patients with respect to premature discharge. Six MHNs on an inpatient eating disorder unit were trained in MI, and their treatment adherence and competence were evaluated at post-training and 2-month follow-up. Premature discharge was examined by comparing a 3-month period in 2009 before MI administration with 2010 when MI was being administered. MHNs significantly improved their MI adherence and competence. Satisfaction with the training was high as was patient satisfaction with MI. Premature discharge rates significantly decreased. Brief training in MI is sufficient to significantly increase competency and adherence in the practice of MI by MHNs, which may in turn be effective in improving patients' treatment adherence by reducing premature discharge rates. Future research will need to utilize a randomized controlled design in order to further investigate these findings.
Epidemiology of eating disorders: Creating opportunities to move the current classification paradigm forward
Publisher: Wiley
Date: 2007
DOI: 10.1002/EAT.20456
Pathways to improve early intervention for eating disorders: Findings from a systematic review and meta‐analysis
Publisher: Wiley
Date: 08-11-2022
DOI: 10.1002/EAT.23845
Abstract: Treatment‐seeking rates among eating disorder (ED) populations are relatively low, with only one in four in iduals seeking help. Previous research has identified many factors that might be associated with help‐seeking in EDs, but to date no review has investigated the quantitative association between these factors and actual help‐seeking behavior. The aim of the current review was to synthesize the relevant quantitative literature on factors (i.e., perceived barriers, characteristics associated with treatment seeking, demographic variables) associated with help‐seeking using meta‐analytic strategies, as well as provide recommendations on future early intervention research strategies to promote early help‐seeking. Overall, 19 studies were included, identifying 141 perceived barriers (e.g., stigma) or in idual characteristics (e.g., BMI, duration of illness) and 56 demographic variables (e.g., ethnicity), which were synthesized into 24 unique variables. Less help‐seeking was predicted by higher levels of denial and less perceived ability of others to provide help. Given the small number of studies these results should be considered preliminary. Future studies should consider barriers to help‐seeking when creating early intervention approaches. To improve help‐seeking rates we suggest the use of targeted psychoeducational materials and co‐design with people with lived experience when developing new strategies. The present study addresses a significant gap in the literature by synthesizing factors associated with help‐seeking, with the aim of informing early intervention strategies to promote early help‐seeking in eating disorder populations. Denial of illness and perceived inability of others to provide help were associated with lower help‐seeking. Future studies should consider barriers to help‐seeking and co‐design with people with lived experience when creating new early intervention strategies.
Enhancing dissemination in selective eating disorders prevention: An investigation of voluntary participation among female university students
Publisher: Elsevier BV
Date: 12-2013
DOI: 10.1016/J.BRAT.2013.09.012
Abstract: Maximising dissemination of efficacious psychological interventions is an important undertaking, particularly in prevention work where the target population may not be seeking help. Consequently, the current study investigated voluntary participation in a selective eating disorder prevention programme by examining predictors of, and evaluating a motivational enhancement approach to, increased participation. Female students studying first-year psychology (N = 124, M(age) = 19.30, SD = 1.55) completed baseline measures, were randomised to a motivational or control condition, then presented with a flyer for an eating disorders prevention trial and assessed regarding potential participation. Results showed that interest and likelihood of participation were low overall and lack of time the most commonly endorsed reason. Participants high on weight concerns were more likely to cite the group format of the intervention as a deterrent. A greater belief in the helpfulness of body image programmes and higher personal ineffectiveness were significant predictors of interest in participation. There was no significant difference between those who did and did not undergo the motivational enhancement with respect to interest and likelihood of participation. These findings suggest important avenues for consideration when designing eating disorder prevention efforts relying on voluntary participation, and highlight the importance of evaluating programmes cross-culturally.
Treatment of eating disorders: A systematic meta-review of meta-analyses and network meta-analyses
Publisher: Elsevier BV
Date: 11-2022
DOI: 10.1016/J.NEUBIOREV.2022.104857
Abstract: MONTELEONE, A.M., F. Pellegrino, G. Croatto, M. Carfagno, A. Hilbert, J. Treasure, T. Wade, C. Bulik, S. Zipfel, P. Hay, U. Schmidt, G. Castellini, A. Favaro, F. Fernandez-Aranda, J. Il Shin, U. Voderholzer, V. Ricca, D. Moretti, D. Busatta, G. Abbate-Daga, F. Ciullini, G. Cascino, F. Monaco, C.U. Correll and M. Solmi. Treatment of Eating Disorders: a systematic meta-review of meta-analyses and network meta-analyses. NEUROSCI BIOBEHAV REV 21(1) XXX-XXX, 2022.- Treatment efficacy for eating disorders (EDs) is modest and guidelines differ. We summarized findings/quality of (network) meta-analyses (N)MA of randomized controlled trials (RCTs) in EDs. Systematic meta-review ((N)MA of RCTs, ED, active/inactive control), using (anorexia or bulimia or eating disorder) AND (meta-analy*) in PubMed/PsycINFO/Cochrane database up to December 15th, 2020. Standardized mean difference, odds/risk ratio vs control were summarized at end of treatment and follow-up. Interventions involving family (family-based therapy, FBT) outperformed active control in adults/adolescents with anorexia nervosa (AN), and in adolescents with bulimia nervosa (BN). In adults with BN, in idual cognitive behavioural therapy (CBT)-ED had the broadest efficacy versus active control also, antidepressants outperformed active. In mixed age groups with binge-eating disorder (BED), psychotherapy, and lisdexamfetamine outperformed active control. Antidepressants, stimulants outperformed placebo, despite lower acceptability, as did CBT-ED versus waitlist/no treatment. Family-based therapy is effective in AN and BN (adolescents). CBT-ED has the largest efficacy in BN (adults), followed by antidepressants, as well as psychotherapy in BED (mixed). Medications have short-term efficacy in BED (adults).
A study of changes in genetic and environmental influences on weight and shape concern across adolescence.
Publisher: American Psychological Association (APA)
Date: 02-2013
DOI: 10.1037/A0030290
Abstract: The goal of the current study was to examine whether genetic and environmental influences on an important risk factor for disordered eating, weight and shape concern, remained stable over adolescence. This stability was assessed in 2 ways: whether new sources of latent variance were introduced over development and whether the magnitude of variance contributing to the risk factor changed. We examined an 8-item WSC subscale derived from the Eating Disorder Examination (EDE) using telephone interviews with female adolescents. From 3 waves of data collected from female-female same-sex twin pairs from the Australian Twin Registry, a subset of the data (which included 351 pairs at Wave 1) was used to examine 3 age cohorts: 12 to 13, 13 to 15, and 14 to 16 years. The best-fitting model contained genetic and environmental influences, both shared and nonshared. Biometric model fitting indicated that nonshared environmental influences were largely specific to each age cohort, and results suggested that latent shared environmental and genetic influences that were influential at 12 to 13 years continued to contribute to subsequent age cohorts, with independent sources of both emerging at ages 13 to 15. The magnitude of all 3 latent influences could be constrained to be the same across adolescence. Ages 13 to 15 were indicated as a time of risk for the development of high levels of WSC, given that most specific environmental risk factors were significant at this time (e.g., peer teasing about weight, adverse life events), and indications of the emergence of new sources of latent genetic and environmental variance over this period.
IJED support for eating disorders research in the time of COVID ‐19
Publisher: Wiley
Date: 09-05-2020
DOI: 10.1002/EAT.23293
Identifying research priorities in eating disorders: A Delphi study building consensus across clinicians, researchers, consumers, and carers in Australia
Publisher: Wiley
Date: 30-09-2019
DOI: 10.1002/EAT.23172
Abstract: Eating disorders are underrepresented among successful applications for medical research funding. Developing agreement on the top research priorities may assist in fostering collaborations, innovation, and meaningful consumer and carer involvement. This study aimed to develop consensus among Australian clinicians, researchers, consumers, carers, and interested members of affiliated industries, on the priorities for eating disorders research. The Delphi expert consensus method was used. Participants were 291 members of the Australia New Zealand Academy for Eating Disorders (ANZAED) or the National Eating Disorders Collaboration (NEDC). Three panels were formed based on participant expertise: "ED Specialists," Consumers/Carers, and Affiliates. A total of 32 potential research areas (29 in Survey 1, 3 in Survey 2) were rated on a 5-point scale of importance, with 80% agreement across all three panels required for endorsement as a priority. Participants also ranked 7 broad research domains in order of priority. Research areas describing early intervention and evidence-based treatments were the most highly rated, with more than 90% endorsement from each of the three panels. The research domains of accessible evidence-based treatments, early intervention and detection, and origins of eating disorders, were the most highly ranked. The ED specialists and Consumers/Carers panels had very similar patterns of responding, while the Affiliates panel showed small differences. Using the Delphi expert consensus method resulted in a collaborative consensus driven eating disorders research agenda for the Australian context and forms a model upon which other countries may also develop their funding priorities.
A Pilot Study of Associations Between Treatment for Anorexia Nervosa and Carers' Distress
Publisher: Wiley
Date: 30-03-2014
DOI: 10.1002/CPP.1895
Abstract: In order to investigate the degree to which symptom reduction in the treatment of adults with anorexia nervosa (AN) impacted on their carers' psychological distress, we examined 12 participants in an outpatient treatment trial and their nominated 'significant other'. Measures of eating psychopathology in the person being treated for AN were collected on six occasions: baseline, session 4, session 10, session 25 (end of treatment), and at three-month and 12-month follow-up. At these same time points, measures of psychological distress were collected from carers. Early significant reductions in eating psychopathology were found in the AN group at session 4, whereas significant reductions in carers' distress were found at three-month follow-up and maintained at 12-month follow-up. These reductions were moderated by baseline body mass index of the person with AN. Carers whose significant other had a lower BMI at baseline received most benefit in terms of symptom reduction at 12-month follow-up. Clinical implications include the need to provide more direct support to carers in order to achieve more clinically significant reductions in distress, and the need to discuss a carer's expectations of the recovery process. Only 61% of adults being treated for anorexia nervosa (AN) were willing to allow their carer to be contacted by researchers in order to ask them to complete questionnaires over the duration of treatment and follow-up. Significant reductions in eating psychopathology from those being treated for AN was followed by significant reductions in their carers' distress some 12 months later. Reductions of carers' distress was associated with only a small effect size and may indicate that more clinically significant reductions requires in idualised support for the carers. Carers whose significant other had a lower body mass index at baseline received most benefit in terms of symptom reduction at 12-month follow-up, which may indicate a need to clarify a carer's expectations of the recovery process.
Why people choose to not use complementary therapies during cancer treatment: A focus group study
Publisher: Hindawi Limited
Date: 18-08-2012
DOI: 10.1111/J.1365-2354.2011.01279.X
Abstract: While 50% of cancer patients use complementary therapies (CT) during treatment, few studies have examined why in iduals choose not to use CT. This study aimed to address this gap in knowledge using a focus group methodology, where 36 participants took part in one of eight groups participants were recruited until saturation of themes was achieved. Three categories of participants were investigated: patients/recent survivors (n= 14) volunteers/advocates (n= 16), the majority of whom were also long-term survivors and health professionals (n= 6). Focus groups were digitally audio-recorded, transcribed, and coded thematically using NVivo software. Reasons for non-use fell into four broad themes: (1) Resource barriers, particularly the cost and lack of time (2) fear and distrust, including the potential for drug interactions (3) lack of evidence, including the unproven nature of many CT practices and (4) satisfaction with conventional treatment. Two further themes related to the benefits of non-use and reasons for discontinuation. A sub-analysis indicated that reasons for non-use differed by CT category, with non-use being mentioned more frequently for biologically based and body-based therapies. Differences in understanding CT non-use emerged between patients, volunteers and health professionals. Findings have clinical implications regarding tailoring information for patients during and after cancer.
Setting a youth-focused research agenda for eating disorders during the COVID-19 pandemic
Publisher: SAGE Publications
Date: 26-10-2022
Psychotherapy for bulimia nervosa on symptoms of depression: A meta-analysis of randomized controlled trials
Publisher: Wiley
Date: 14-08-2017
DOI: 10.1002/EAT.22763
Abstract: Depressive symptoms are an important risk factor and consequence of binge eating and purging behavior in bulimia nervosa (BN). Although psychotherapy is effective in reducing symptoms of BN in the short- and long-term, it is unclear whether psychotherapy for BN is also effective in reducing depressive symptoms. This meta-analysis examined the efficacy of psychotherapy for BN on depressive symptoms in the short- and long-term. Randomized controlled trials (RCTs) on BN that assessed depressive symptoms as an outcome were identified. Twenty-six RCTs were included. Psychotherapy was more efficacious at reducing symptoms of depression at post-treatment (g = 0.47) than wait-lists. This effect was strongest when studies delivered therapist-led, rather than guided self-help, treatment. No significant differences were observed between psychotherapy and antidepressants. There was no significant post-treatment difference between CBT and other active psychological comparisons at reducing symptoms of depression. However, when only therapist-led CBT was analyzed, therapist-led CBT was significantly more efficacious (g = 0.25) than active comparisons at reducing depressive symptoms. The magnitude of the improvement in depressive symptoms was predicted by the magnitude of the improvement in BN symptoms. These findings suggest that psychotherapy is effective for reducing depressive symptoms in BN in the short-term. Whether these effects are sustained in the long-term is yet to be determined, as too few studies conducted follow-up assessments. Moreover, findings demonstrate that, in addition to being the front-running treatment for BN symptoms, CBT might also be the most effective psychotherapy for improving the symptoms of depression that commonly co-occur in BN.
Outcomes of three universal eating disorder risk reduction programs by participants with higher and lower baseline shape and weight concern
Publisher: Wiley
Date: 21-10-2017
DOI: 10.1002/EAT.22642
Abstract: To investigate if baseline shape and weight concern (SWC) moderated outcomes in Prevention Across the Spectrum, a randomized-controlled trial (RCT) of 3 school-based programs aimed at reducing eating disorder and obesity risk factors. N = 1,316 Grade 7 and 8 girls and boys (M age = 13.21 years) across three Australian states were randomly allocated to: Media Smart Life Smart Helping, Encouraging, Listening and Protecting Peers Initiative (HELPP) or control (usual school class). Moderation was explored by testing interaction effects for group (Media Smart Life Smart HELPP Control) × moderator (SWC: higher-SWC lower-SWC) × time (post-program 6-month follow-up 12-month follow-up), with baseline risk factor scores entered as covariates. Moderation effects were found for shape concern, weight concern, eating concern, regular eating (i.e., meal skipping), physical activity, body dissatisfaction, dieting, and perfectionism. Post-hoc testing found eating concern at post-program was the only variable where higher-SWC Media Smart participants experienced a reduction in risk relative to controls. Both higher-SWC Life Smart and HELPP participants reported an increase in eating concern relative to controls and both groups were skipping more meals than controls at 12-month follow-up. Amongst lower-SWC participants, Media Smart was the only group to experience a benefit relative to controls (physical activity). This study highlights the need for moderator analyses to become more routinely conducted in universal trials, to ensure that participants across baseline risk levels are benefiting and not harmed from program participation. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2017 50:66-75).
A Collaborative Approach to Eating Disorders
Publisher: Routledge
Date: 03-2013
The Relationship between Social Support and Major Depression
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2000
DOI: 10.1097/00005053-200005000-00001
Abstract: Although social support (SS) is associated with risk for major depression (MD), we are uncertain of the extent to which a) low SS increases risk for MD, b) MD lowers SS, or c) both variables reflect a common genetic liability. Using two waves of interview data on female twin pairs from a population-based registry, we examine the cross-sectional and longitudinal association of eight dimensions of perceived SS and MD. Risk for MD in the last year was inversely associated with supportive spouse and relative relationships, and directly associated with problems in these relationships (e.g., too many demands, criticism, tension, and disagreements). Significant cross-time associations were seen only for spousal variables. The history of MD in one twin significantly predicted low relative and spouse support, and relative and friend problems, in her co-twin (MZ > DZ pairs). The relationship between SS and MD in women is complex and due to at least the three separate mechanisms outlined above that operate to varying degrees in different dimensions of SS.
A Pragmatic Randomized Controlled Trial Targeting Perfectionism in Young Adolescents
Publisher: Springer Science and Business Media LLC
Date: 06-09-2022
DOI: 10.1007/S12310-022-09540-3
Abstract: Perfectionism has adverse impacts on mental health and academic outcomes. We evaluated a 5-lesson classroom intervention for young adolescents delivered by teachers for impact on perfectionism, well-being, self-compassion, academic motivation and negative affect, at post-intervention and 3-month follow-up. Classes ( N = 636 students, M age = 13.68, SD = 0.60) were randomized to intervention ( n = 343) or classes as usual ( n = 293). Data were analyzed using linear mixed models adjusted for baseline observation and clustering. At post-intervention no differences were found between the groups. At 3-month follow-up, anxiety showed a significant increase in the control group with no increase in the intervention group ( d = 0.23 95% CI: 0.05, 0.40) females in the control group had a significant decrease in well-being from post-intervention to 3 month follow-up compared to the intervention group ( d = 0.33 95% CI: 0.08, 0.58) students with high levels of perfectionistic concerns in the intervention had significantly lower perfectionistic strivings at 3 month follow-up than the control group (( d = 0.34, 95% CI: 0.19, 0.49). This intervention shows promising results when delivered by teachers. Australian New Zealand Clinical Trials Registry (ANZCTR) Trial Number: ACTRN12621000457842 (April 19, 2021).
A randomized controlled trial of unguided internet cognitive behaviour therapy for perfectionism in adolescents: Impact on risk for eating disorders
Publisher: Elsevier BV
Date: 09-2019
DOI: 10.1016/J.BRAT.2019.103429
Abstract: Perfectionism is a risk factor for the development and maintenance of eating disorders. The objective of this study was to examine the efficacy of unguided Internet cognitive behaviour therapy for perfectionism (ICBT-P) as a treatment and prevention for perfectionism and symptoms of eating disorders, anxiety, depression and self-esteem in female adolescents. Young women (N = 94, 14-19 years) who self-identified as having difficulties with perfectionism but did not have a clinical eating disorder diagnosis were recruited. Participants were randomly allocated into one of three groups: unguided ICBT-P, unguided ICBT for nonspecific stress management (ICBT-S), or waitlist control. All analyses were intent-to-treat. ICBT-P resulted in the most favorable outcomes at post-treatment and 3- and 6-months follow-up. ICBT-P was superior to control on all outcome measures at 3- and 6-months and superior to ICBT-S on all outcomes over most time points (ds = 0.13-0.94). Clinical significance analysis demonstrated that the treatment prevented symptom increases over 6-month follow-up, with ICBT-P superior to ICBT-S in prevention of clinical perfectionism and depressive symptoms, and ICBT-P superior to waitlist control in prevention of eating disorder symptoms. There was relatively high attrition, although there were no differences in attrition between the groups at 3- and 6-month follow-up and rates were commensurate with other Internet interventions. The findings support unguided ICBT-P as a useful target for preventing eating disorder and associated symptoms in female youth who self-identify as perfectionistic. ACTRN12615001098527.
A longitudinal study of midage women with indicators of disordered eating.
Publisher: American Psychological Association (APA)
Date: 2015
DOI: 10.1037/DEV0000011
Abstract: This longitudinal study of midage women has two main aims: to examine the effect of disordered eating (DE) on quality of life (QoL) among women, including a comparison with a younger cohort and to investigate the mediating roles of both depressive symptoms and social support on the longitudinal relationship between DE and QoL as potential mechanisms of action. We used self-report data from six waves of the Australian Longitudinal Study on Women's Health over 14 years. A total of 12,338 women participating in the midage cohort (aging from 45-50 to 59-64) provided self-report indications of DE at Surveys 1 and 2, and QoL (SF-36 component scales-mental [MCS] and physical [PCS]) at Surveys 2-6. DE was reported by 10.98% of the women this group also reported significantly poorer mental and physical QoL than those without DE, and this effect was sustained over time. Comparison with a parallel analysis of a younger cohort of women showed that the effect on midage women's physical QoL is greater than that of the younger women. The relationships between baseline DE and changes in QoL (both physical and mental) over time were mediated by levels of depressive symptoms and of social support over time. This study underscores the significant effect of DE on QoL in midage, an effect which is partially or fully mediated by depressive symptoms or social support. Well-being of midage women with indicators of DE needs to be supported by tailoring prevention and interventions activities specifically for this group.
A randomised controlled trial to evaluate the effects of a self-help workbook intervention on distress, coping and quality of life after breast cancer diagnosis
Publisher: AMPCo
Date: 09-2010
DOI: 10.5694/J.1326-5377.2010.TB03932.X
Abstract: To evaluate the efficacy of an interactive self-help workbook in reducing distress, and improving quality of life (QOL) and coping for women recently diagnosed with breast cancer. Randomised controlled trial comparing the use of the workbook and that of an information booklet. 49 women with Stage 0 to II breast cancer diagnosed in the previous month and recruited from 1 February 2007 to 1 February 2008, in two urban Australian public hospitals. The primary outcome measures were depression, anxiety, and posttraumatic stress. Secondary outcomes included QOL, body image, and the coping styles helplessness/hopelessness, cognitive avoidance and anxious preoccupation. After controlling for baseline levels, interactions at 3-month follow-up showed that participants in the workbook group had significantly lower levels of posttraumatic stress (F[1,89] = 7.01 P = 0.01), helplessness/hopelessness (F [1,89] = 4.75 P = 0.03), and cognitive avoidance (F [1,89] = 4.95 P = 0.03) than those in the control (information booklet) group. However, women in the workbook group had significantly poorer body image than those in the control group (F [1,89] = 6.43 P = 0.01). At 6 months, only the body image interaction remained significant (F [1,93] = 7.44 P = 0.01). These results suggest that a self-help workbook can be an effective, short-term intervention for improving posttraumatic stress, cognitive avoidance, and certain depressive symptoms in women recently diagnosed with breast cancer. However, issues related to body image need to be dealt with differently. Australian New Zealand Clinical Trials Registry
Do universal media literacy programs have an effect on weight and shape concern by influencing media internalization?
Publisher: Wiley
Date: 02-02-2017
DOI: 10.1002/EAT.22689
Abstract: The current study examined whether media internalization, found to mediate the relationship between selected prevention programs and outcomes, mediated the impact of two universal prevention programs that targeted risk factors for eating disorders and obesity, namely weight concern, and shape concern. Students randomized to a media literacy (Media Smart) program (N = 269, 65% females, mean age 12.97 years) and a healthy lifestyle (Life Smart) program (N = 347, 69% females, mean age 13.07 years) were included in the analyses. There were four waves of data (baseline, end of intervention, 6- and 12-month follow-up). Latent growth curve modeling was used to explore whether group assignment influenced levels of media internalization, and whether that in turn influenced change over time of our two outcome variables. Being randomly allocated to Media Smart as opposed to Life Smart resulted in less growth of both outcome variables through the influence on decreasing levels of media internalization. Findings provided support for the suggestion that media literacy programs exert an impact on outcomes related to eating disorder risk through changes to media internalization. Future research should examine whether these mechanisms of change differ between girls and boys.
Coming of age: A reflection of the first 21 years of cognitive behaviour therapy for perfectionism
Publisher: Elsevier BV
Date: 02-2023
Therapist written goodbye letters: evidence for therapeutic benefits in the treatment of anorexia nervosa
Publisher: Cambridge University Press (CUP)
Date: 17-03-2020
DOI: 10.1017/S1352465820000089
Abstract: Despite their use in clinical practice, there is little evidence to support the use of therapist written goodbye letters as therapeutic tools. However, preliminary evidence suggests that goodbye letters may have benefits in the treatment of anorexia nervosa (AN). This study aimed to examine whether therapist written goodbye letters were associated with improvements in body mass index (BMI) and eating disorder symptomology in patients with AN after treatment. Participants were adults with AN ( n = 41) who received The Maudsley Model of Anorexia Treatment for Adults (MANTRA) in a clinical trial evaluating two AN out-patient treatments. As part of MANTRA, therapists wrote goodbye letters to patients. A rating scheme was developed to rate letters for structure and quality. Linear regression analyses were used to examine associations between goodbye letter scores and outcomes after treatment. Higher quality letters and letters that adopted a more affirming stance were associated with greater improvements in BMI at 12 months. Neither the overall quality nor the style of goodbye letters were associated with improvements in BMI at 24 months or reductions in eating disorder symptomology at either 12 or 24 months. The results highlight the potential importance of paying attention to the overall quality of therapist written goodbye letters in the treatment of AN, and adopting an affirming stance.
Perfectionism as a transdiagnostic process: A clinical review
Publisher: Elsevier BV
Date: 03-2011
DOI: 10.1016/J.CPR.2010.04.009
Abstract: Perfectionism is a risk and maintaining factor for eating disorders, anxiety disorders and depression. The objective of this paper is to review the four bodies of evidence supporting the notion that perfectionism is a transdiagnostic process. First, a review of the literature was conducted that demonstrates the elevation of perfectionism across numerous anxiety disorders, depression, and eating disorders compared to healthy controls. Data is presented that shows perfectionism increases vulnerability for eating disorders, and that it maintains obsessive-compulsive disorder, social anxiety and depression as it predicts treatment outcome in these disorders. Second, evidence is examined showing that elevated perfectionism is associated with co-occurrence of psychopathology. Third, the different conceptualisations of perfectionism are reviewed, including a cognitive-behavioural conceptualisation of clinical perfectionism that can be utilised to understand this transdiagnostic process. Fourth, evidence that treatment of perfectionism results in reductions in anxiety, depression and eating pathology is reviewed. Finally, the importance of clinicians considering the routine assessment and treatment of perfectionism is outlined.
Genetic and environmental risk factors for the weight and shape concerns characteristic of bulimia nervosa
Publisher: Cambridge University Press (CUP)
Date: 07-1998
DOI: 10.1017/S0033291798006989
Abstract: Background. This study seeks to identify the genetic and environmental risk factors for the overvalued ideas that are characteristic of bulimia nervosa, using a biometrical model fitting approach with twin data. Methods. The Eating Disorder Examination (EDE), which can be used to gain continuous measures of dietary restraint, eating concern, weight concern and shape concern, was administered to 325 female twins, both monozygotic (MZ) and dizygotic (DZ). For each subscale, questions were asked concerning the month prior to interview and lifetime prevalence (‘ever’). Results. Model fitting indicated that there is a powerful role of the environment in shaping women's attitude towards weight, shape, eating and food, ranging from 38% to 100% of the variance. For all subscales, with the exception of weight concern, the best explanation for in idual variation was one that incorporated additive genetic and non-shared environmental influences. In contrast, model fitting indicated that non-shared and shared environmental influences best explained the variance of weight concern. Conclusions. With the exception of the Shape Concern subscale, environmental factors make a greater contribution than genetic factors to the development of the overvalued ideas that are seen to be one of the triggers for the development of bulimia nervosa. Given this substantial role of the environment influences, it seems likely that environmental manipulation can be effective in the prevention of bulimia nervosa.
The Psychology of Perfectionism
Publisher: Routledge
Date: 22-08-2017
Weight-related peer-teasing moderates genetic and environmental risk and disordered eating: Twin study
Publisher: Royal College of Psychiatrists
Date: 05-2017
DOI: 10.1192/BJP.BP.116.184648
Abstract: Weight-related peer-teasing is considered a potent prospective risk factor for development of disordered eating and clinical eating disorders. Currently, the interplay between genetic and environmental influences has yet to be elucidated. To determine whether peer-teasing moderates latent genetic and/or environmental risk for disordered eating among female adolescent twins. Full quantitative gene–environment interplay modelling of longitudinal trajectory of disordered eating in 685 female twins from the Australian Twin Registry. A model permitting moderation of disordered eating by peer-teasing involving genetic and non-shared environment effects fit these data best. As levels of peer-teasing increased, both genetic and environmental influences on disordered eating strengthened however, genetic sources increased proportionally more than environmental sources. Weight-related peer-teasing represents a particularly powerful trigger for disordered eating. Nevertheless, it is amenable to intervention revention activities spanning in idual to universal levels of endeavour.
A clinician's quick guide of evidence-based approaches number 1: Eating disorders
Publisher: Informa UK Limited
Date: 03-2013
DOI: 10.1111/CP.12004
ANGI — Anorexia Nervosa Genetics Initiative
Publisher: Cambridge University Press (CUP)
Date: 04-2020
DOI: 10.1017/THG.2020.24
Abstract: Identification of genetic variants associated with eating disorders is underway. The Anorexia Nervosa Genetics Initiative, an initiative of the Klarman Family Foundation, has contributed to advancing the field, yielding a large-scale genome-wide association study published in Nature Genetics . Eight genetic variants significantly associated with anorexia nervosa were identified, along with patterns of genetic correlations that suggest both psychiatric and metabolic origins of this serious and life-threatening illness. This article details the role of Professor Nick Martin in contributing to this important collaboration.
Assessing the relevance of the hopelessness theory of depression to women with disordered eating
Publisher: Wiley
Date: 2000
DOI: 10.1002/(SICI)1098-108X(200007)28:1<113::AID-EAT14>3.0.CO;2-K
Abstract: The aim of this study was to investigate the relevance of the hopelessness theory of depression to women with partial-syndrome eating disorders. Three groups of women, one meeting criteria for eating disorders not otherwise specified (EDNOS), one with major depression, and a control group, completed the Balanced Attributional Style Questionnaire, the Eating Disorders Examination Questionnaire, and the Beck Depression Inventory. Once levels of depression were controlled, all three groups differed significantly with respect to their attributional style for bad events, with the depressed group showing the greatest tendency to attribute the causes of negative life events to internal factors. However, with respect to the attributional style for good events, the depressed and control group displayed similar styles of attribution, whereas the EDNOS group showed a significantly more dysfunctional style, being more likely to attribute positive events to external factors. These findings are discussed in terms of their implications for specific therapeutic interventions with disordered eating.
Self-efficacy as a robust predictor of outcome in guided self-help treatment for broadly defined bulimia nervosa
Publisher: Wiley
Date: 18-08-2010
DOI: 10.1002/EAT.20830
Abstract: To examine predictors of guided self-help (GSH) treatment outcome in bulimia nervosa (BN). Data were included from 87 in iduals who participated in one of two randomized controlled trials evaluating GSH interventions for BN. Participants received eight sessions of GSH over a 6- to 8-week period and were assessed at baseline, pretreatment, posttreatment, and 6-month follow-up. Motivation (confidence in ability to change) proved to be the most robust predictor of outcome, across three of the four outcome measures. Baseline measures of concern over mistakes perfectionism also uniquely predicted outcome at posttreatment. Posttreatment measures of stress, eating disorder-related automatic thoughts, and frequency of binge episodes predicted outcome at 6-month follow-up. This study suggests that tackling motivation early in therapy, with a particular focus on confidence in succeeding in change, could be of benefit to outcome in BN treatment.
Reconsidering perfect: a qualitative study of the experiences of internet-based cognitive behaviour therapy for perfectionism
Publisher: Cambridge University Press (CUP)
Date: 10-03-2020
DOI: 10.1017/S1352465820000090
Abstract: Internet-based cognitive behaviour therapy (ICBT) is a promising format for treating different psychiatric disorders. In addition, several clinical trials have found positive results when using it to target transdiagnostic processes, such as perfectionism. However, few qualitative investigations have been conducted on the experiences of clients undergoing such treatments. In the current study, clients completing 12-week guided ICBT for perfectionism responded to open-ended questions at post-treatment. In total, 30 out of 62 (48.4%) described their impressions of its content and the support provided by their guide. The results were analysed qualitatively using thematic analysis. Five themes were found in the responses: Learning how to do things differently , Noticing the positives , Feeling safe to be honest , A comfortable treatment format and Barriers to treatment . The results suggest that many clients were able to achieve a change in perspective in relation to their perfectionism and started facing their fears. They were also able to report the benefits of doing things differently as part of treatment, such as an improvement in their interpersonal relationships. Most clients were also positive about the treatment format, enjoying its flexibility and the encouragement offered by their therapist. However, obstacles such as conflicting commitments, personal difficulties, time-consuming and comprehensive treatment modules, and a desire for more support were brought up by some, suggesting that there are aspects that could be considered in the future.
A randomised controlled trial of guided internet-based cognitive behavioural therapy for perfectionism: Effects on psychopathology and transdiagnostic processes
Publisher: Elsevier BV
Date: 09-2019
DOI: 10.1016/J.JBTEP.2019.03.007
Abstract: Perfectionism is a transdiagnostic process that has been associated with a range of psychopathology and also with other transdiagnostic processes. We have previously shown that guided internet-based cognitive behavioural therapy (ICBT) can reduce symptoms of dysfunctional perfectionism, however, no impact was observed on symptoms of depression and anxiety. Here we explore the impact of guided ICBT for perfectionism on symptoms of other associated psychopathology, specifically obsessive-compulsive disorder (OCD) and eating disorders, and also on other associated transdiagnostic processes (self-esteem, intolerance of uncertainty, and self-compassion). Participants who presented with clinical levels of perfectionism were randomised to an experimental group that received the intervention (n = 62), or a wait list control group (n = 58). Questionnaires assessing symptoms of OCD, eating disorders, self-esteem, intolerance of uncertainty, and fear of self-compassion were completed pre-intervention, post-intervention (12 weeks), and at follow-up (24 weeks). Between group effect sizes are reported. The intervention led to significant decreases in symptoms of OCD (d = -0.9 CI: -1.4, -0.4) and eating disorders (d = -0.6 CI: -1.0, -0.1), and had an impact on other transdiagnostic processes resulting in increased self-esteem (d = 0.7 CI: 0.2, 1.2), decreases in intolerance of uncertainty (d = -0.9 CI: -1.4, -0.4), and fear of self-compassion (d = -0.8 CI: -1.3, -0.3). At follow-up changes were maintained in symptoms of OCD (d = -1.3 CI: -1.8, -0.8), disordered eating (d = -0.7 CI: -1.2, -0.2), intolerance of uncertainty (d = -0.8 CI: -1.2, -0.3), and fear of self-compassion (d = -1.0 CI: -1.5, -0.5). Guided ICBT for perfectionism improves associated psychopathology and transdiagnostic processes. ClinicalTrials.gov registration no. NCT02756871.
Significant Locus and Metabolic Genetic Correlations Revealed in Genome-Wide Association Study of Anorexia Nervosa
Publisher: American Psychiatric Association Publishing
Date: 09-2017
Discrepancies Between Australian Eating Disorder Clinicians and Consumers Regarding Essential Components of Dietetic Treatment
Publisher: Elsevier BV
Date: 08-2022
DOI: 10.1016/J.JAND.2021.12.006
Abstract: A recent Delphi study indicated that, compared with eating disorder (ED) consumers and carers, ED specialists were less likely to endorse involvement of a dietitian as a standard component of treatment. In addition, there was disagreement between these groups regarding the inclusion of a number of components of dietetic treatment. This study aimed to further investigate these data to identify areas of disagreement among ED specialist dietitians, ED specialist non-dietetic clinicians, consumers, and carers with regard to outpatient dietetic treatment. The ED specialists panel from a previous Delphi study was recoded into 2 panels: ED specialist dietitians (n = 31) and ED specialist non-dietetic clinicians (n = 48) to compare responses of these panels with responses from consumers (n = 32) and carers (n = 23). Statements in 7 categories relating to referral to dietitian, essential components of outpatient dietetic treatment regarding 4 ED patient populations, strategies to promote multidisciplinary collaboration, and skills dietitians should possess if treating patients with an ED were rated on a 5-point Likert scale. One-way analysis of variance was conducted with post-hoc multiple comparisons to compare mean statement ratings. Thirty-seven statements (30%) showed statistically significant differences (P < .05) in responses between panels. Discrepancies were primarily observed for statements regarding how and when dietetics is included in treatment and essential components of dietetic treatment, particularly the use of behavioral tasks, such meal plans and self-monitoring. Results also highlighted deficits in participants' understanding of core responsibilities of dietitians in ED treatment and dietitians "drifting" from delivering evidence-based components of dietetic treatment. Results of this study show discrepancies among ED dietitians, clinicians, consumers, and carers regarding what dietetic treatment for people with EDs should encompass. It also indicates the need for further research into optimizing dietetic treatment for EDs that is conducted in collaboration with in iduals with lived experience.
A review of treatment manuals for adults with an eating disorder: nutrition content and consistency with current dietetic evidence.
Publisher: Springer Science and Business Media LLC
Date: 30-01-2021
DOI: 10.1007/S40519-020-00850-6
Abstract: This study aimed to summarise the nutrition and food-related content of treatment manuals for adults with eating disorders (EDs) and assess the degree to which this information conforms with current guidelines and literature. Treatment manuals for adults with an ED were identified by conducting an online search of Internet book dealer Amazon and University of Sydney library catalogue as per methods used in previous reviews of self-help patient resources. The nutrition and food-related content of these manuals was extracted and reviewed independently by two reviewers using a criteria based on current best evidence to date regarding dietetic treatment for EDs. Twenty-two manuals met inclusion criteria, 20 (91%) of which contained some degree of nutrition and food-related content. Two manuals (9%) included content written by a dietitian, six (27%) included citation of dietetic literature to support the recommendations made and eight (36%) recommended a dietitian be consulted as part of a multidisciplinary approach to treatment. Thirteen manuals (60%) contained nutrition and food-related information not substantiated by current evidence. It is common for treatment manuals for EDs to contain nutrition and food-related content. However, most of the authors of the 22 manuals identified did not appear to collaborate with a dietitian in writing this content or cite peer-reviewed literature to substantiate dietary advice given. Consistent with current clinical practice guidelines, greater collaboration between dietitians and clinicians is required to develop, evaluate and disseminate evidence-based approaches to dietetic management. Level V, narrative review.
Twin studies of eating disorders: A review
Publisher: Wiley
Date: 2000
DOI: 10.1002/(SICI)1098-108X(200001)27:1<1::AID-EAT1>3.0.CO;2-Q
Abstract: Twin methodology has been used to delineate etiological factors in many medical disorders and behavioral traits including eating disorders. Although twin studies are powerful tools, their methodology can be arcane and their implications easily misinterpreted. The goals of this study are to (a) review the theoretical rationale for twin studies (b) provide a framework for their interpretation and evaluation (c) review extant twin studies on eating disorders and (d) explore the implications for understanding etiological issues in eating disorders. On the basis of this review, it is not possible to draw firm conclusions regarding the precise contribution of genetic and environmental factors to anorexia nervosa. Twin studies confirm that bulimia nervosa is familial and reveal significant contributions of additive genetic effects and of unique environmental factors in liability to bulimia nervosa. The magnitude of the contribution of shared environment is less clear, but in the studies with the greatest statistical power, it appears to be less prominent than additive genetic factors.
Examination of a day programme for eating disorders: impact on 3-month follow-up by psychiatric comorbidity
Publisher: SAGE Publications
Date: 16-09-2020
Abstract: The two aims of this preliminary investigation were to use a case series design to examine outcomes of a day programme (DP) for eating disorders and to investigate whether the presence of baseline psychiatric comorbidities moderated outcomes 3 months after discharge. Linear mixed modelling was used to investigate changes over time in the 91 participants who had commenced the DP by April 2019 87 (96%) female, 61 (67%) with a DSM-5 diagnosis of anorexia nervosa. Six of our seven outcome variables (dietary restraint concern over weight, eating and shape clinical impairment and psychological distress) showed moderate to large effect size improvements from baseline to follow-up. Generally, improvement declined somewhat at follow-up from discharge, with a pattern of results suggesting this decline was less where there was comorbidity at baseline. These results suggest that a DP effectively reduces eating disorder psychopathology regardless of the presence of psychiatric comorbidity.
Body Mass Index and Breast Size in Women: Same or Different Genes?
Publisher: Cambridge University Press (CUP)
Date: 10-2010
Abstract: The objective of the current study was to investigate the heritability of breast size and the degree to which this heritability is shared with BMI. In a s le of 1010 females twins (mean age 35 years SD = 2.1 range 28–40), self-report data pertaining to bra cup size and body mass index (BMI) was collected in the context of self-report data and an interview relating to disordered eating respectively. In a s le of 348 complete twin pairs who completed data collection (226 MZ pairs and 122 DZ pairs and 360 incomplete pairs (170 MZ and 190 DZ)), we found that the heritability of bra cup size was 56%. Of this genetic variance, one third is in common with genes influencing body mass index, and two thirds (41% of total variance) is unique to breast size, with some directional evidence of non-additive genetic variation. The implications of these findings with respect to previous research linking breast size with reproductive potential are discussed.
A pragmatic effectiveness study of 10‐session cognitive behavioural therapy (CBT‐T) for eating disorders: Targeting barriers to treatment provision
Publisher: Wiley
Date: 27-05-2019
DOI: 10.1002/ERV.2684
Abstract: Ten-session cognitive behavioural therapy (CBT-T) for transdiagnostic eating disorders targets several barriers to treatment, including cost, therapist expertise, and lengthy wait lists. We used a case series design to investigate the effectiveness of CBT-T delivered by trainee psychologists in a postgraduate training clinic. Participants were randomly allocated to commence treatment either immediately or after a 4-week waitlist period. CBT-T was delivered to 52 patients, by six different trainees under supervision. Measures of eating disorder cognitions and behaviours, quality of life, and general psychopathology were examined in completer and intention-to-treat analyses using multilevel modelling. Last observation carried forward was applied for abstinence, remission, and good outcome analyses to aid comparison with prior studies. Significant improvements, associated with medium to large effect sizes, were found for eating disorder cognitions, behaviours quality of life, and negative affect from baseline to posttreatment, and at 1- and 3-month follow-up. Attrition (38.5%) was comparable with other treatment studies. Results provide evidence for the effectiveness of CBT-T delivered by trainee psychologists for transdiagnostic eating disorder patients, thus tackling some important barriers for treatment. Longer follow-up, randomised controlled trial designs, and moderator analyses will provide more robust evidence about which patients do best with a shorter therapy.
DSM‐5 unspecified feeding and eating disorders in adolescents: What do they look like and are they clinically significant?
Publisher: Wiley
Date: 22-05-2014
DOI: 10.1002/EAT.22303
Abstract: The recent DSM-5 categorization of eating disorders introduces a new category of eating disorders, Unspecified Feeding and Eating Disorders (UFED), where symptoms do not meet criteria for any other diagnostic category, but cause clinically significant distress or impairment. The aim of the current study was to explore what disorders in UFED might look like in an adolescent population. We examined a large cohort of adolescent female twins (N = 699) who were assessed on three occasions and who did not meet a DSM-5 eating disorder diagnosis but who reported threshold levels of either fasting and/or driven exercise (N = 33 4.7%). This group of girls was compared to girls who reported no eating disorder over the three waves, and girls who met a diagnosis of either anorexia nervosa (AN) or atypical AN. The UFED group was characterized as being in the overweight range while striving to lose weight, and placing a high degree of importance on weight and shape in their self-evaluation. This group was indistinguishable from the two eating disorder groups on measures of global eating disorder severity, and demonstrated significantly elevated impairment and distress compared to the no eating disorder group commensurate with the eating disorder groups. Further research of this group is necessary to ensure that these in iduals are not overlooked, and that treatment options are appropriate and available.
CORRESPONDENCE
Publisher: Cambridge University Press (CUP)
Date: 03-2000
Targeting the link between social media and eating disorder risk: A randomized controlled pilot study.
Publisher: Wiley
Date: 16-06-2022
DOI: 10.1002/EAT.23756
Abstract: Evaluate the feasibility, acceptability, and preliminary efficacy of a self-criticism intervention addressing the link between appearance-motivated social media use and eating disorder risk. Another condition, designed to help users curate their social media feed to reduce negative impacts on wellbeing, was also trialed as an active and credible comparison. University students aged 17-25 (N = 170) were screened and randomized (n = 130) to the self-criticism intervention, social media curation, or waitlist control group. The intervention comprised self-guided cognitive behavior therapy delivered in four modules over 1 week. Primary outcomes were feasibility and acceptability. Secondary outcomes were appearance motivations for social media use, appearance comparison, self-criticism, body image flexibility, and disordered eating (at baseline, one-week postrandomization, and two-weeks postrandomization). ACTRN12621000353897. Participants completed an average of 82% of the intervention modules and 77% of the homework exercises within the week allocated. The intervention was well-accepted participants reported a range of positive aspects, alongside suggested modifications to the intervention and study design to improve acceptability. Group by time interactions suggested groups changed at a different rate on three secondary outcomes between-groups effect sizes suggested this was due to greater improvements in the self-criticism group than waitlist control. This was the first study to evaluate an intervention for the link between appearance-related social media use and eating disorder risk for young adults. Positive findings relating to feasibility, acceptability, and preliminary efficacy suggest a larger randomized controlled trial, with modifications to the intervention and study design, is warranted. Appearance-related social media use has been linked to poorer body image and disordered eating, necessitating treatments that can disrupt this relationship. The self-criticism intervention evaluated in this study shows promise as a strategy to address this need. It is the first intervention focused on appearance-related social media use to be designed for and tested in young adults, who are at heightened risk of developing an eating disorder.
Online prevention of disordered eating in at-risk young-adult women: a two-country pragmatic randomized controlled trial
Publisher: Cambridge University Press (CUP)
Date: 13-12-2017
DOI: 10.1017/S0033291717003567
Abstract: Disordered eating (DE) is a widespread, serious problem. Efficacious prevention programs that can be delivered at-scale are needed. A pragmatic randomized controlled trial of two online programs was conducted. Participants were young-adult women from Australia and New Zealand seeking to improve their body image. Media Smart-Targeted ( MS-T ) and Student Bodies ( SB ) were both 9-module interventions released weekly, whilst control participants received positive body image information. Primary [Eating Disorder Examination–Questionnaire (EDE-Q) Global], secondary (DE risk factors) and tertiary (DE) outcome measures were completed at baseline, post-program, 6- and 12-month follow-up. Baseline was completed by 608 women ( M age = 20.71 years) 33 were excluded leaving 575 randomized to: MS-T ( N = 191) SB ( N = 190) or control ( N = 194). Only 66% of those randomized to MS-T or SB accessed the intervention and were included in analyses with controls 78% of this s le completed measures subsequent to baseline. Primary intent-to-treat (ITT) analyses revealed no differences between groups, while measure completer analyses found MS-T had significantly lower EDE-Q Global than controls at 12-month follow-up. Secondary ITT analyses found MS-T participants reported significantly higher quality of life–mental relative to both SB and controls (6-month follow-up), while MS-T and controls had lower clinical impairment relative to SB (post-program). Amongst measure completers, MS-T scored significantly lower than controls and SB on 5 variables. Of those with baseline DE, MS-T participants were significantly less likely than controls to have DE at 12-month follow-up. Given both programs were not therapist-moderated, MS-T has potential to achieve reductions in DE risk at low implementation costs.
Assessment of Eating Disorders
Publisher: Cambridge University Press
Date: 31-12-2019
Face-to-face imagery rescripting as a treatment adjunct for day patients with an eating disorder: A randomised controlled pilot study
Publisher: Elsevier BV
Date: 03-2021
Guided Web-Based Cognitive Behavior Therapy for Perfectionism: Results From Two Different Randomized Controlled Trials (Preprint)
Publisher: JMIR Publications Inc.
Date: 17-01-2018
Abstract: erfectionism can become a debilitating condition that may negatively affect functioning in multiple areas, including mental health. Prior research has indicated that internet-based cognitive behavioral therapy can be beneficial, but few studies have included follow-up data. he objective of this study was to explore the outcomes at follow-up of internet-based cognitive behavioral therapy with guided self-help, delivered as 2 separate randomized controlled trials conducted in Sweden and the United Kingdom. n total, 120 participants randomly assigned to internet-based cognitive behavioral therapy were included in both intention-to-treat and completer analyses: 78 in the Swedish trial and 62 in the UK trial. The primary outcome measure was the Frost Multidimensional Perfectionism Scale, Concern over Mistakes subscale (FMPS CM). Secondary outcome measures varied between the trials and consisted of the Clinical Perfectionism Questionnaire (CPQ both trials), the 9-item Patient Health Questionnaire (PHQ-9 Swedish trial), the 7-item Generalized Anxiety Disorder scale (GAD-7 Swedish trial), and the 21-item Depression Anxiety Stress Scale (DASS-21 UK trial). Follow-up occurred after 6 months for the UK trial and after 12 months for the Swedish trial. nalysis of covariance revealed a significant difference between pretreatment and follow-up in both studies. Intention-to-treat within-group Cohen d effect sizes were 1.21 (Swedish trial 95% CI 0.86-1.54) and 1.24 (UK trial 95% CI 0.85-1.62) for the FMPS CM. Furthermore, 29 (59% Swedish trial) and 15 (43% UK trial) of the participants met the criteria for recovery on the FMPS CM. Improvements were also significant for the CPQ, with effect sizes of 1.32 (Swedish trial 95% CI 0.97-1.66) and 1.49 (UK trial 95% CI 1.09-1.88) the PHQ-9, effect size 0.60 (95% CI 0.28-0.92) the GAD-7, effect size 0.67 (95% CI 0.34-0.99) and the DASS-21, effect size 0.50 (95% CI 0.13-0.85). he results are promising for the use of internet-based cognitive behavioral therapy as a way of targeting perfectionism, but the findings need to be replicated and include a comparison condition.
Unguided low intensity cognitive behaviour therapy for anxiety and depression during the COVID-19 pandemic: A randomised trial
Publisher: Elsevier BV
Date: 09-2021
Genetic Influences on Eating and the Eating Disorders
Publisher: Oxford University Press
Date: 06-07-2010
DOI: 10.1093/OXFORDHB/9780195373622.013.0007
Abstract: The current chapter reviews our progress in understanding how genes influence eating and eating disorders (EDs) by addressing the following areas: (1) how recognition of genetic influences on eating and EDs emerged (2) the complex nature of genetic action (3) what twin studies can tell us about genetic influences and (4) the current state of linkage and association studies. It is concluded that genes are an important part of the explanatory framework for the etiology of EDs, with an important contribution of the shared environment to the development of cognition and attitudes that may initiate disordered eating practices, and a critical contribution of the environment in providing a context within which genetic risk is more likely to be expressed. We currently have a limited understanding of the specific genes that are implicated, and the ways in which genes and the environment work together to increase risk for disordered eating.
Associations Between Attention-Deficit/Hyperactivity Disorder and Various Eating Disorders: A Swedish Nationwide Population Study Using Multiple Genetically Informative Approaches
Publisher: Elsevier BV
Date: 10-2019
‘Healthy anorexia’: the complexity of care in disordered eating
Publisher: Elsevier BV
Date: 08-2015
DOI: 10.1016/J.SOCSCIMED.2015.06.030
Abstract: This paper examines how contemporary understandings of 'health' and 'care' are engaged with and practiced by women with disordered eating. Based on findings from an Australian study investigating why people with disordered eating are reluctant to engage with treatment services (March 2012 to March 2015), we demonstrate how young women use elements of a 'health habitus' and 'care' to rationalise and justify their practices. Moving beyond Foucauldian theories of self-discipline and in idual responsibility we argue that Bourdieu's concept of habitus and ethnographic concepts of care provide a deeper understanding of the ways in which people with disordered eating embody health practices as a form of care and distinction. We demonstrate how eating and bodily practices that entail 'natural', medical and ethical concerns (in particular, the new food regime known as orthorexia) are successfully incorporated into participants' eating disorder repertoires and embodied as a logic of care. Understanding how categories of health and care are tinkered with and practiced by people with disordered eating has important implications for health professionals, family members and peers engaging with and identifying people at all stages of help-seeking.
Examination of the Sociocultural Attitudes Towards Appearance Questionnaire-3 in a mixed-gender young-adolescent sample.
Publisher: American Psychological Association (APA)
Date: 2012
DOI: 10.1037/A0025618
Abstract: Thin-ideal (or media) internalization is an important eating disorder risk factor that has become a central target of many prevention programs. However, evidence for its valid assessment in young, mixed-gender, adolescent s les is limited, and the current study is the first to explore the psychometric properties of the 30-item Sociocultural Attitudes Towards Appearance Questionnaire-3 (SATAQ-3 J. Thompson, P. van den Berg, M. Roehrig, A. S. Guarda, & L. J. Heinberg, 2004) in a nonadult community s le. Two s les of Grade 8 students (M age = 13.68 years), totaling 680 girls (N = 332) and boys (N = 348) completed the SATAQ-3 and other measures, whereas a smaller s le (N = 123) of Grade 10 girls (M age = 15.01 years) served as a comparison group for supplementary analyses. Principal component analyses (PCA) with data from S le 1 (N = 201) revealed 4 factors with eigenvalues > 1.0, similar to the original authors' structure but with some cross-loading occurring between the Pressures and Internalization-General scales. Confirmatory factor analyses (CFA) were conducted with data from S le 2 (N = 479) on the factor solution found in the PCA. The model did not fit well, leading to further revisions based on removal of cross-loading items and CFA modification indices, resulting in a 19-item, 4-factor solution with acceptable fit. Examinations of validity and reliability were generally acceptable. The overall findings suggest that an abbreviated version of the SATAQ-3 might be more appropriate than the original version with young-adolescent, mixed-gender audiences. Further examinations of the psychometric properties of the SATAQ-3 with this demographic are indicated.
Evaluating an implementation model of evidence-based therapy for eating disorders in non-specialist regional mental health settings
Publisher: Springer Science and Business Media LLC
Date: 17-11-2022
DOI: 10.1186/S40337-022-00695-7
Abstract: Many people with eating disorders (EDs) either do not access treatment, access it well after symptoms first start, or drop out of treatment. This study evaluated ways to improve early access to evidence-based interventions for those with EDs in a non-specialist community setting. In an Australian regional community, links were formed between general medical practitioners and treatment providers (psychologists, mental health social workers and dietitians), who received ongoing training, feedback and support. Service users had access to 20–40 subsidised treatment sessions. Data were collected from 143 patients over 18 months. Our outcomes are reported according to the RE-AIM implementation framework: Reach (we measured uptake and treatment completion) Effectiveness (impact on disordered eating cognitions, body mass index, remission, and moderators of effectiveness including illness duration, previous treatment, presence of comorbidities, presence of a normative level of disordered eating, presence of any ED behaviours, weighing in treatment, multidisciplinary case conferencing, number of dietetic sessions) Adoption (drop-out and predictors) Implementation (barriers encountered) Maintenance (subsequent activity designed to embed new practices). Treatment was completed by 71% significant large decreases in eating disorder cognitions were achieved remission was obtained by 37% (intent-to-treat). Treatment completion was predicted by lower baseline levels of disordered eating, uptake of ≥ 3 dietetic sessions, and ≥ 2 team case conferences. Greater improvement over time was predicted by regular case conferencing and in-session weighing. Implementation of this model in a regional community setting produced completion rates and outcomes comparable to those found in specialist clinical trials of ED treatments. Service providers identified care coordination as the most important factor to connect users to services and help navigate barriers to ongoing treatment. Trial Registration: This research was an invited evaluation of a project implemented by the Australian Department of Health. The project did not introduce any new clinical practice but sought to improve access to evidence-based multidisciplinary treatment for people with EDs by removing four known systemic barriers: securing an accurate diagnosis, availability of multidisciplinary treatment, cost of treatment, and intensity of treatment. As such, the project did not require trial registration. Notwithstanding, this evaluation obtained ethics approval (Bellberry Human Research Ethics Committee, Application No: 2018-09-728-FR-1).
The impact of COVID‐19 on body‐dissatisfied female university students
Publisher: Wiley
Date: 13-04-2021
DOI: 10.1002/EAT.23521
Abstract: This study investigated the impact of COVID‐19 on young women's disordered eating and their responses to online interventions to reduce disordered eating. University students at risk of developing an eating disorder ( N = 100) were randomly assigned to either receiving an online intervention to reduce disordered eating or not. Forty‐one participants entered the study from September 2019 to March 2020 (pre‐COVID) and 59 after physical distancing was introduced due to COVID pandemic (during COVID). Online assessments were conducted at baseline and 1‐week follow up. There was a significant increase in weight concerns, disordered eating, and negative affect among participants entering the trial during COVID compared to pre‐COVID. The increases in the first two variables remained when adjusting for baseline negative affect. No significant interactions between time, condition and COVID status were observed. Young women experienced increased levels of disordered eating after the onset of COVID. While no interactions with COVID were detected, changes to within‐group effect sizes for disordered eating more than doubled for both online interventions and assessment from pre‐COVID to during COVID, suggesting any attention to issues related to disordered eating in the context of reduced social contact may be beneficial.
The cost-effectiveness of cognitive behavioral therapy for bulimia nervosa in the Australian context
Publisher: Wiley
Date: 16-10-2017
DOI: 10.1002/EAT.22790
Abstract: This study was to model the cost-effectiveness of specialist-delivered cognitive behavioral therapy for bulimia nervosa (CBT-BN) compared to no intervention within the Australian context. An illness-death model was developed to estimate the cost per disability-adjusted life-year (DALY) averted of CBT-BN over 2 years from the healthcare perspective. Target population was adults aged 18-65 years with BN. Results are reported as incremental cost-effectiveness ratios (ICER) in 2013 Australian dollars per DALY averted. Uncertainty and sensitivity analyses were conducted to test the robustness of results. Primary analysis indicated that CBT-BN was associated with greater DALY averted (0.10 DALY per person) and higher costs ($1,435 per person) than no intervention, resulting the mean ICER of $14,451 per DALY averted (95% uncertainty interval [UI]: $8,762 to $35,650). Uncertainty analysis indicated CBT-BN is 99% likely to be cost-effective at a threshold of $50,000 per DALY averted. Including the patients' time and travel costs resulted in the mean ICER of $18,858 per DALY averted (95% UI: $11,235 to $46,026). Sensitivity analysis indicated the intervention was not cost-effective if over 80% people discontinued treatment. Other analyses including a reduced time horizon, increased remission rates, and 4-month effect size of CBT-BN increases the ICERs but these ICERs remained well below under a threshold of $50,000 per DALY averted. This study has demonstrated that CBT-BN for adults with BN is a cost-effective treatment intervention. Further research is required to investigate the practicability of CBT-ED and the cost-effectiveness of other formats of CBT-BN delivery.
Structure and validity of the Clinical Perfectionism Questionnaire in female adolescents
Publisher: Cambridge University Press (CUP)
Date: 12-12-2019
DOI: 10.1017/S1352465819000729
Abstract: Perfectionism is a transdiagnostic risk factor across psychopathology. The Clinical Perfectionism Questionnaire (CPQ) was developed to assess change in order to provide clinical utility, but currently the psychometric properties of the CPQ with adolescents is unknown. To assess the factor structure and construct validity of the CPQ in female adolescents. The CPQ was administered to 267 females aged 14–19 years of age. Confirmatory factor analysis (CFA) was used to examine the validity of the two-factor model and a second-order factor model. Pearson correlations were used to evaluate the relationships between the CPQ and a wide range of measures of perfectionism, psychopathology and personality traits. The study demonstrated internal consistency, construct validity and incremental validity of the CPQ in a s le of female adolescents. The CFA in the present study confirmed the two-factor model of the CPQ with Factor 1 relating to perfectionistic strivings and Factor 2 representing perfectionistic concerns. The second-order two factor model indicated no deterioration in fit. The two-factor model of the CPQ fits with the theoretical definition of clinical perfectionism where the over-dependence of self-worth on achievement and concern over mistakes are key elements. The CPQ is suitable for use with female adolescents in future research that seeks to better understand the role of perfectionism in the range of mental illnesses that impact youth.
The impact of a universal intervention targeting perfectionism in children
Publisher: Wiley
Date: 31-07-2017
DOI: 10.1111/BJC.12152
Abstract: Perfectionism is considered to be an underlying mechanism of relevance to a broad array of indicators of psychological distress. The current research examined the impact of a three-session intervention targeting perfectionism in children on perfectionism, self-criticism, and well-being. The design of the current study can be considered quasi-experimental as the intervention and control classes were not randomly allocated but decided by convenience factors at the school level. Students (aged 10.08-12.79 years) were allocated to the intervention (N = 107, 41 boys) or control condition (N = 105, 33 boys), completing self-report assessments on perfectionism, self-criticism, and well-being at baseline, post-intervention, and 3-month follow-up. At post-intervention, children in the intervention group had significantly lower perfectionism than the control group (d = 0.35, 95% confidence intervals [CI]: 0.07-0.62) and at 3-month follow-up had significantly higher levels of well-being (d = 0.33, 95% CI: 0.06-0.60). As predicted by theory, decreases in perfectionism mediated the relationship between condition and improved well-being. This exploratory study provides evidence for the usefulness of a brief universal prevention programme targeting perfectionism. Future research should use more robust designs, explore longer-term effects, and the impact on a wider range of variables, including scholastic achievement. Clinical implications Perfectionism linked with negative outcomes in children can be decreased in a classroom setting. Decreasing perfectionism leads to improved well-being in children. Limitations More rigorous designs along with better assessment of perfectionism are required in further evaluations. The impact of perfectionism on scholastic achievement in children requires further investigation.
ANZAED eating disorder treatment principles and general clinical practice and training standards
Publisher: Springer Science and Business Media LLC
Date: 10-11-2020
DOI: 10.1186/S40337-020-00341-0
Abstract: Eating disorders are complex to manage, and there is limited guidance around the depth and breadth of knowledge, skills and experience required by treatment providers. The Australia & New Zealand Academy for Eating Disorders (ANZAED) convened an expert group of eating disorder researchers and clinicians to define the clinical practice and training standards recommended for mental health professionals and dietitians providing treatment for in iduals with an eating disorder. General principles and clinical practice standards were first developed, after which separate mental health professional and dietitian standards were drafted and collated by the appropriate members of the expert group. The subsequent review process included four stages of consultation and document revision: (1) expert reviewers (2) a face-to-face consultation workshop attended by approximately 100 health professionals working within the sector (3) an extensive open access online consultation process and (4) consultation with key professional and consumer/carer stakeholder organisations. The resulting paper outlines and describes the following eight eating disorder treatment principles: (1) early intervention is essential (2) co-ordination of services is fundamental to all service models (3) services must be evidence-based (4) involvement of significant others in service provision is highly desirable (5) a personalised treatment approach is required for all patients (6) education and/or psychoeducation is included in all interventions (7) multidisciplinary care is required and (8) a skilled workforce is necessary. Seven general clinical practice standards are also discussed, including: (1) diagnosis and assessment (2) the multidisciplinary care team (3) a positive therapeutic alliance (4) knowledge of evidence-based treatment (5) knowledge of levels of care (6) relapse prevention and (7) professional responsibility. These principles and standards provide guidance to professional training programs and service providers on the development of knowledge required as a foundation on which to build competent practice in the eating disorder field. Implementing these standards aims to bring treatment closer to best practice, and consequently improve treatment outcomes, reduce financial cost to patients and services and improve patient quality of life.
Erratum: A genetic analysis of the eating and attitudes associated with bulimia nervosa: Dealing with the problem of ascertainment in twin studies (Behavior Genetics (1999) 29 (1-10))
Publisher: Springer Science and Business Media LLC
Date: 1999
A co‐designed consumer checklist to support people with eating disorders to locate evidence‐based treatment
Publisher: Wiley
Date: 29-04-2021
DOI: 10.1002/EAT.23529
Abstract: Identifying a therapist with expertise in treating eating disorders (EDs) can be a daunting process for a consumer, resulting in delayed access to evidence‐based treatment, prolonging unnecessary suffering. We developed a consumer checklist designed to empower consumers to locate evidence‐based treatment earlier. We co‐designed (researchers and people with lived experience of an ED) a 15‐item consumer checklist, for use in a meeting with a potential therapist. A survey about the checklist was sent out to people with lived experience and clinicians, seeking quantitative endorsement of each item's helpfulness in the checklist, and inviting qualitative feedback. Seventeen people with lived experience and 11 clinicians gave feedback. The items were rated as being helpful, with overlap between the two groups as to the most helpful items. Both groups rated the checklist as likely to help locate effective treatment earlier. The checklist forms a basis for a useful consumer tool in their treatment journey. Examination of its uptake and impact on outcomes for consumers seeking treatment is recommended.
The impact of internet-based cognitive behaviour therapy for perfectionism on different measures of perfectionism: a randomised controlled trial
Publisher: Informa UK Limited
Date: 13-07-2021
DOI: 10.1080/16506073.2021.1928276
Abstract: The current study investigated the impact of an 8-module internet-based cognitive behaviour therapy for perfectionism (ICBT-P) across a variety of perfectionism subscales. Undergraduate students who identified as having a problem with perfectionism were randomized to receive the intervention (n = 41), and were free to choose the number of treatment modules they completed over a 4-week period, while the control group (N = 48) received access to treatment 8 weeks post-randomisation. Secondary measures included depression, anxiety, stress, body image and self-compassion. Assessments occurred at baseline, 2-, 4- and 8-week time points. A mean of 3.12 (SD = 2.67) modules were completed 7 participants (17%) completed none and 6 (15%) completed all. Linear mixed modelling (with baseline observation included as a covariate) showed significant Bonferroni-adjusted post-hoc between-group differences for 5 of the 6 perfectionism measures, favouring the intervention group the most robust between group effect sizes were for the Concern over Mistakes (
The relation between risk factors for binge eating and bulimia nervosa: A population-based female twin study.
Publisher: American Psychological Association (APA)
Date: 2000
Predictors of outcome in cognitive behavioural therapy for eating disorders: An exploratory study
Publisher: Elsevier BV
Date: 05-2019
DOI: 10.1016/J.BRAT.2019.02.005
Abstract: Early decrease in symptoms is a consistent predictor of good treatment outcome across all eating disorders. The current study explored the predictive value of novel early change variables in a transdiagnostic, non-underweight s le receiving 10-session cognitive behavioural therapy. Participants who reported bingeing and/or purging in the week preceding baseline assessment (N = 62) were included in analyses. Early change variables were calculated for novel (body image flexibility, body image avoidance, body checking, and fear of compassion) and established predictors (behavioural symptoms and therapeutic alliance). Outcomes were global eating disorder psychopathology and clinical impairment at posttreatment and three-month follow-up. Intent-to-treat analyses were conducted using linear regression, adjusting for baseline values of the relevant outcome and early change in behavioural symptoms. Early improvement in body image flexibility was the most consistent predictor of good outcome. Early change in body image avoidance and the fear of expressing and receiving compassion to/from others were significant predictors in some analyses. Novel early change variables were significant predictors of eating disorder outcomes in this exploratory study. Model testing is required to understand the exact mechanisms by which these variables impact on outcomes, and whether there is potential benefit of modifying existing protocols. ACTRN12615001098527.
Perfectionism and its relation to overevaluation of weight and shape and depression in an eating disorder sample
Publisher: Wiley
Date: 18-08-2010
DOI: 10.1002/EAT.20817
Abstract: To examine the relative association between psychopathology (depression and overevaluation of weight and shape) and measures of perfectionism and self-criticism in an eating disorder s le. Participants (n = 39) completed measures of independent variables (perfectionism and self-criticism) and dependent variables (depression and overevaluation of weight and shape). Simultaneous multiple regression analyses suggest that clinical perfectionism has a unique association with depression. Self-criticism and clinical perfectionism had a stronger association with overevaluation of weight and shape than other measures of perfectionism. Clinical perfectionism and self-criticism may be of more relevance than existing measures of multidimensional perfectionism in terms of explaining maintenance of depression and overevaluation of weight and shape.
A systematic review and meta-analysis of cognitive processing deficits associated with body dysmorphic disorder
Publisher: Elsevier BV
Date: 08-2018
DOI: 10.1016/J.BRAT.2018.05.013
Abstract: This systematic review and meta-analysis examined the evidence supporting the association between body dysmorphic disorder (BDD) symptomology and four types of cognitive processing abnormalities: local processing, selective attention, interpretive biases, and memory deficits. Twenty-three studies met inclusion requirements that examined differences in performance on cognitive tasks between BDD and control groups across the four categories. Multilevel modelling was used to calculate an overall effect size for each cognitive category. BDD and control groups differed significantly on measures of selective attention (g = 0.60, 95% CI = 0.26: 0.93), interpretive biases (g = 0.30, 95% CI = . 07: 0.54), and memory deficits (g=.56, 95% CI = 0.26: 0.87). Differences between the BDD and control groups on measures of local processing did not reach significance. These findings support the hypothesis that people with BDD may selectively attend to perceived threats or to disorder-related stimuli, misinterpret ambiguous stimuli as threatening, overvalue the importance of attractiveness, and have inaccurate coding and recall for facial or bodily stimuli. Recommendations for future research of these specific cognitive deficits in BDD include introducing the use of Modified Dot Probe Paradigms and new treatment targets that can be used as adjuncts to current treatment modalities.
Assessing the Prevalence of Eating Disorders in an Australian Twin Population
Publisher: SAGE Publications
Date: 12-1996
DOI: 10.3109/00048679609065054
Abstract: Objective: This paper examines the prevalence of disordered eating in a female Australian twin population aged between 28 and 90 years in 1993. Method: In two waves of data collection, the eating behaviour of 3869 female twins was first assessed in 1988–1989 by self-report questionnaire and then in 1992-1993 with a telephone interview, using the Semi-Structured Assessment for the Genetics of Alcoholism interview. Results: It was found that about 0.4% of the women have a lifetime prevalence of anorexia nervosa and 1.8% of the group have suffered from bulimia nervosa. The incidence of bulimia nervosa but not anorexia nervosa was markedly higher for those women under 45 (2.3% bulimia nervosa) than for those women 45 years or older. Furthermore, one in three women have at some stage in their life used some extreme method of weight control. Conclusions: The levels of bulimia nervosa and anorexia nervosa found are commensurate with those found in smaller studies in Australia and other parts of the world. The finding of widespread use of extreme weight control methods is of concern as this behaviour is a well-recognised precursor to more serious eating disorders.
Assessing global and gene specific DNA methylation in anorexia nervosa: A pilot study
Publisher: Wiley
Date: 02-10-2013
DOI: 10.1002/EAT.22200
Abstract: At present there are no genome-wide methylation data available in anorexia nervosa (AN) and no studies have examined the potential dynamic nature of DNA methylation during treatment, so it is unclear whether epigenetic disruption established over long periods of malnourishment is reversible. The current study examined global levels of DNA methylation and methylation at a labile imprinted locus in women with AN. Buccal swabs were collected from 10 women who were admitted to hospital for treatment of AN and 10 age-matched healthy controls DNA methylation of LINE-1 repetitive elements and the H19 imprinting control region was measured using previously validated assays using the Sequenom Mass Array platform. No evidence for altered global or gene-specific DNA methylation was observed in association with AN. Larger, genome-wide studies of epigenetic modifications, encompassing both DNA methylation and other epigenetic marks, are required to determine the degree to which AN is associated with specific epigenetic changes, potentially modifiable through appropriate treatments that improve nutrition.
Reduction in the prospective incidence of adolescent psychopathology: A review of school-based prevention approaches
Publisher: Elsevier BV
Date: 12-2014
Written case formulations in the treatment of anorexia nervosa: Evidence for therapeutic benefits
Publisher: Wiley
Date: 03-06-2016
DOI: 10.1002/EAT.22561
Abstract: Case formulation is a core component of many psychotherapies and formulation letters may provide an opportunity to enhance the therapeutic alliance and improve treatment outcomes. This study aimed to determine if formulation letters predict treatment satisfaction, session attendance, and symptom reductions in anorexia nervosa (AN). It was hypothesized that higher quality formulation letters would predict greater treatment satisfaction, a greater number of attended sessions, and greater improvement in eating disorder symptoms. Patients were adult outpatients with AN (n = 46) who received Maudsley Anorexia Nervosa Treatment for Adults (MANTRA) in the context of a clinical trial. A Case Formulation Rating Scheme was used to rate letters for adherence to the MANTRA model and use of a collaborative, reflective, affirming stance. Analyses included linear regression and mixed models. Formulation letters that paid attention to the development of the AN predicted greater treatment acceptability ratings (p = 0.002). More reflective and respectful letters predicted greater reductions in Eating Disorder Examination scores (p = 0.003). Results highlight the potential significance of a particular style of written formulation as part of treatment for AN. Future research should examine applicability to other psychiatric disorders. © 2016 Wiley Periodicals, Inc.(Int J Eat Disord 2016 49:874-882).
Mental contamination: Relationship with psychopathology and transdiagnostic processes
Publisher: Elsevier BV
Date: 04-2018
Genome-wide association study identifies eight risk loci and implicates metabo-psychiatric origins for anorexia nervosa
Publisher: Springer Science and Business Media LLC
Date: 15-07-2019
The current status of cognitive behavioral therapy for eating disorders: Marking the 51st Annual Convention of the Association of Behavioral and Cognitive Therapies
Publisher: Wiley
Date: 12-2017
DOI: 10.1002/EAT.22809
Impact of metacognitive acceptance on body dissatisfaction and negative affect: Engagement and efficacy
Publisher: American Psychological Association (APA)
Date: 2012
DOI: 10.1037/A0028263
Abstract: To investigate engagement in metacognitive acceptance and subsequent efficacy with respect to decreasing 2 risk factors for disordered eating, body dissatisfaction (BD), and negative affect (NA). In a pilot experiment, 20 female undergraduates (Mage = 24.35, SD = 9.79) underwent a BD induction procedure, received acceptance training using brief written instructions, and were then assessed on engagement in the technique. In a second experiment in which acceptance training was enhanced through the use of video format and a guided experiential exercise, 80 female undergraduates (mean age = 23.59, SD = 8.98) were randomized to an acceptance or control group following the same BD induction. Outcome measures were taken at baseline, postinduction, and posttreatment and consisted of separate visual analogue scales for weight and appearance satisfaction and the NA subscale of the Positive and Negative Affect Scale. Baseline assessments included the Eating Disorder Inventory-BD, Difficulties in Emotion Regulation Scale, Ways of Coping Questionnaire, and the Five Facet Mindfulness Questionnaire. Enhanced training significantly increased engagement in acceptance. Nonengagement was associated with NA, emotion regulation difficulties, and avoidant coping. Acceptance training significantly increased weight and appearance satisfaction and reduced NA relative to control, with no significant differences between those who did and did not engage. Intervention effects were moderated by mindfulness, emotion regulation difficulty, and avoidant coping. Findings provide clarification regarding engagement and lend further support for the utility of acceptance, with particular benefit identified for those "at risk" for emotion regulation difficulty.
Psycho-education and group cognitive-behavioural therapy for clinical perfectionism: A case-series evaluation
Publisher: Cambridge University Press (CUP)
Date: 14-08-2013
DOI: 10.1017/S1352465812000628
Abstract: Background: Research indicates that psycho-education and cognitive behavioural interventions can reduce perfectionism but to date no group treatments have been examined. Aims: The current study utilized a case series design to compare psycho-education materials and subsequent eight-week group cognitive behaviour therapy (CBT) to a baseline waitlist in an outpatient community psychiatry s le ( n = 21). Method: Participants were assessed on five occasions: baseline, 4 weeks later (waitlist), 4 weeks after receiving psycho-education material, post-treatment (8 weeks after receiving the group intervention), and 3-month follow-up. Results: There was a main effect of time for perfectionism and negative affect from baseline to post-group (effect sizes ranging from 1.46 to 1.91) that were maintained at 3-month follow-up. Conclusions: These results suggested that group CBT for clinical perfectionism may be beneficial, but that psycho-education alone is not effective for reducing perfectionism or negative affect.
Mindfulness Training to Facilitate Positive Body Image and Embodiment
Publisher: Oxford University Press
Date: 03-2019
DOI: 10.1093/MED-PSYCH/9780190841874.003.0030
Abstract: Mindfulness—the nonjudgmental awareness and acceptance of present moment experience—is cultivated through formal and informal experiential exercises and has received support as an effective intervention approach across multiple disorders. The efficacy of mindfulness for body image and disordered eating is less well researched. This chapter outlines a theoretical framework for the application of mindfulness in this context, provides ex les of intervention content, and reviews existing evidence related to the use of mindfulness training to enhance body image and prevent eating disorders in both clinical and nonclinical s les. Overall, research indicates mindfulness is a worthwhile approach but should be carefully considered among those with clinical eating disorders due to the potential for negative impacts. Further research using rigorous methodology is required to establish stronger and broader support for intervention effects and to explore mindfulness with regard to additional aspects of positive body image, embodiment, and intuitive eating.
Changes in genetic and environmental influences on disordered eating between early and late adolescence: a longitudinal twin study
Publisher: Cambridge University Press (CUP)
Date: 02-07-2015
DOI: 10.1017/S0033291715001257
Abstract: We investigated the genetic and environmental contributions to disordered eating (DE) between early and late adolescence in order to determine whether different sources of heritability and environmental risk contributed to these peak times of emergence of eating disorders. Adolescent female twins from the Australian Twin Registry were interviewed over the telephone with the Eating Disorder Examination (EDE). Data were collected at 12–15 and 16–19 years (wave 1: N = 699, 351 pairs wave 3: N = 499, 247 pairs). Assessments also involved self-report measures related to negative life events and weight-related peer teasing. Unstandardized estimates from the bivariate Cholesky decomposition model showed both genetic influences and non-shared environmental influences increased over adolescence, but shared environmental influences decreased. While non-shared environmental sources active at ages 12–15 years continued to contribute at 16–19 years, new sources of both additive genetic and non-shared environmental risk were introduced at ages 16–19 years. Weight-related peer teasing in early-mid adolescence predicted increases of DE in later adolescence, while negative life events did not. Two-thirds of the heritable influence contributing to DE in late adolescence was unique to this age group. During late adolescence independent sources of genetic risk, as well as environmental influences are likely to be related in part to peer teasing, appear key antecedents in growth of DE.
A cross‐sectional analysis of the cognitive model of bulimia nervosa
Publisher: Wiley
Date: 09-03-2012
DOI: 10.1002/EAT.22012
Abstract: The present study aimed to directly test Cooper et al.'s cognitive model of the maintenance of bulimia nervosa. The major predictions of the model were tested cross-sectionally using multiple regression analyses and structural equation modeling in a mixed s le comprising nonclinical female university students (n = 298) and clinical eating disorder patients (n = 44). Consistent with model, negative self-beliefs was associated with negative emotion, negative emotion with positive and negative beliefs about eating, beliefs about eating with eating behavior, and binge eating with negative self-beliefs. However, contrary to hypotheses, results did not consistently support a direct link between compensatory behavior and negative self-beliefs. Furthermore, the role of permissive thoughts was found to be questionable. Of note, results suggested that components of the model may operate to maintain bulimic pathology in a slightly different way for purging and nonpurging behaviors. While the results of this research provide some preliminary evidence for the validity of the cognitive model as an explanation of the persistence of bulimic symptoms, further work is required to develop the model.
Genetic variants associated with disordered eating.
Publisher: Wiley
Date: 09-04-2013
DOI: 10.1002/EAT.22133
DSM‐5 eating disorders and other specified eating and feeding disorders: Is there a meaningful differentiation?
Publisher: Wiley
Date: 25-02-2014
DOI: 10.1002/EAT.22257
Abstract: In the DSM-5 diagnostic criteria for eating disorders, two main groups appear, threshold eating disorders (TED anorexia nervosa, bulimia nervosa, and binge eating disorder), and other specified feeding and eating disorders (OSFED). In addition to calculating prevalence of these two groups, we examined the degree to which they could be differentiated in terms of impairment and risk factors. Adolescent female twins (N = 699) were interviewed with the Eating Disorder Examination on three occasions spanning 12.70-19.84 years of age. Assessments also included self-report measures related to impairment and risk. Prevalence of DSM-5 ED in this adolescent population was 10.4% 5.4% for TED and 5% for OSFED. Impairment levels did not distinguish TED and OSFED groups at any wave. Examination of latent risk factors showed TED and OSFED groups to share a common genetic basis however, largely nonoverlapping unique environmental influences contributed to the two groups. Specific risk factors commonly differentiated the no ED and TED groups, but not OSFED. The findings suggest that TED and OSFED groups cannot be discriminated by prevalence or impairment or genetic risk factors. It is anticipated that OSFED will possess limited clinical utility for adolescents. Future research should examine clinical cases of these two groups in terms of meaningful differences, and a research focus should be maintained on both groups. Further examination of specific environmental risk factors that may attenuate the level of symptoms between the two groups may provide useful information for prevention efforts.
Developing a definition of body neutrality and strategies for an intervention
Publisher: Elsevier BV
Date: 09-2023
Outpatient therapy for adult anorexia nervosa: Early weight gain trajectories and outcome
Publisher: Wiley
Date: 24-08-2020
DOI: 10.1002/ERV.2775
Abstract: The purpose of the study was to identify latent classes of trajectory of change in body mass index (BMI) between the initial and thirteenth session of outpatient treatment for adult anorexia nervosa and identify the association with outcome. Participants (n = 120) were randomised to one of three outpatient therapies. Four latent classes were identified two classes (higher, rapid and higher, moderate) had BMI > 17 kg/m The group with the greatest early weight gain had significantly higher levels of remission. Higher BMI at baseline without substantial early weight gain was insufficient to produce higher levels of remission than those with lower weight at baseline.
Depression as a moderator of benefit from Media Smart: A school-based eating disorder prevention program
Publisher: Elsevier BV
Date: 2014
DOI: 10.1016/J.BRAT.2013.11.004
Abstract: To investigate if baseline depression moderated response to Media Smart, an 8-lesson school-based program previously found to achieve a long-term risk reduction effect in young adolescents. 540 Grade 8 students (M age = 13.62 years, SD = .37) from 4 schools participated with 11 classes receiving the Media Smart program (126 girls 107 boys) and 13 comparison classes receiving their normal lessons (147 girls 160 boys). Shape and weight concern, media internalization, body dissatisfaction, dieting, ineffectiveness, and perceived pressure were the outcome variables. Moderation was indicated by significant interaction effects for group (Media Smart Control) × moderator (high depression low depression) × time (post-program 6-month follow-up 2.5-year follow-up), with baseline entered as a covariate. Such effects were found for shape and weight concern, media internalization, body dissatisfaction, ineffectiveness and perceived pressure. Post-hoc testing found high depression Media Smart participants scored significantly lower than their control counterparts at post-program on shape and weight concern, media internalization and dieting, whereas low depression Media Smart participants scored significantly lower on shape and weight concern at 2.5-year follow-up. Media Smart achieved a reduction in eating disorder risk factors for high-depression participants and a reduced rate of growth in risk factor scores for low-depression participants. Trial registry name: Australian New Zealand Clinical Trials Registry. URL: www.anzctr.org.au. Registration identification number: ACTRN12608000545369.
A randomised pilot of a self-help workbook intervention for breast cancer survivors
Publisher: Springer Science and Business Media LLC
Date: 29-07-2010
DOI: 10.1007/S00520-010-0962-2
Abstract: The aim of this study is to evaluate the efficacy of a self-help workbook for improving adjustment for breast cancer survivors. An RCT compared the workbook (n = 20) with no-workbook controls (n = 20). Coping, traumatic stress and quality of life were measured at baseline, then 3 and 6 months later. No interactions were found. A significant group main effect was found for venting coping controls used less venting coping than workbook participants (p = 0.034). A significant time main effect was obtained for cognitive functioning (p = 0.003). Reliable change indices showed a trend towards a protective effect across all coping measures for workbook participants compared to controls. Qualitative feedback suggested that participants felt well supported by the intervention, but would have preferred receiving it during treatment. While trends showed some promise for improving coping, endorsement for the workbook was not obtained. The difficulties encountered in recruiting survivors and the resulting implications regarding the feasibility of offering self-help resources to this population are discussed.
A new cognitive bias modification technique to influence risk factors for eating disorders
Publisher: Wiley
Date: 08-2018
DOI: 10.1002/EAT.22938
Abstract: Eating disorder psychopathology is associated with a propensity to interpret ambiguous stimuli to be negatively related to one's appearance and self-worth. The relative impact of modifying interpretation bias for these respective stimuli is unknown. Hence the main aim of the current study was to compare two cognitive bias modification protocols targeting interpretation bias (CBM-I), one focused on appearance and the other on self-worth, in terms of impacting interpretation bias, body dissatisfaction and negative affect. The appearance-based CBM-I protocol was developed for the current study. Female university students (N = 123) were randomized into one of three CBM-I conditions: appearance, self-worth or control. Immediately following a negative induction that significantly increased body dissatisfaction and negative affect, participants underwent their respective CBM-I training. The CBM-I for appearance produced significant changes in the targeted bias, as well as significant improvements (moderate effect sizes) in appearance satisfaction, relative to the CBM-I for self-worth and control conditions. The results support the usefulness of the CBM-I for appearance protocol, and suggests that this technique warrants further investigation with respect to modifying interpretation bias and risk factors associated with eating disorder psychopathology. Null effects of CBM-I for self-worth should be interpreted in light of study limitations, including the potential unsuitability of training material for young women. CBM-I for both types of interpretation bias should be evaluated in future research.
Guided Web-Based Cognitive Behavior Therapy for Perfectionism: Results From Two Different Randomized Controlled Trials
Publisher: JMIR Publications Inc.
Date: 26-04-2018
DOI: 10.2196/JMIR.9823
Associations between adolescent risk for restrictive disordered eating and long‐term outcomes related to somatic symptoms, body mass index, and poor well‐being
Publisher: Wiley
Date: 18-02-2018
DOI: 10.1111/BJHP.12301
Abstract: To date, no longitudinal, community-based studies have examined the association between disordered eating emerging in adolescence and long-term physical well-being. This study sought to explore the longitudinal associations between risk for restrictive disordered eating (DE-R those not presenting with binge-purge symptoms) in adolescence and trajectories of functional somatic symptoms (FSS) and body mass index (BMI), and several indicators of poor physical well-being across early- to mid-adulthood, including medication, number of doctor visits, and sick leave. Data were obtained from the Northern Swedish Cohort Study (N = 1,001), a prospective longitudinal study including four time points from age 16 to 42 years. A cumulative measure of DE-R risk was computed. Latent class growth analysis was used to identify subpopulation trajectories of FSS and BMI. The three-step method for auxiliary variables and logistic regressions were used to assess associations between DE-R and the trajectory classes as well as indicators of poor physical well-being. Three trajectories were identified for FSS. A gender by BMI interaction led to a classification of four BMI trajectories in men, but three in women. The presence of DE-R risk in adolescence increased odds of unfavourable FSS development, increasing BMI in women, and continually low BMI in men. Indicators of poor physical well-being at ages 21, 30, and 42 years were associated with DE-R risk in adolescence. Data spanning nearly three decades suggest that physical well-being impairment is related to DE-R risk measured earlier in life, underscoring the urgency for targeted, gender-sensitive preventive interventions for teenagers. Statement of contribution What is already known on this subject? Disordered eating is linked to poor physical and mental well-being and quality of life. No longitudinal studies have examined long-term physical well-being consequences of adolescent disordered eating risk. What does this study add? Non-purging disordered eating symptoms in adolescence predict adverse physical well-being outcomes in middle-aged men and women. Targeted interventions and preventative work during adolescence are needed.
The Anorexia Nervosa Genetics Initiative (ANGI): Overview and methods
Publisher: Elsevier BV
Date: 11-2018
An RCT of three programs aimed at reducing risk factors for both eating disorders and obesity: Outcomes from the Prevention Across the Spectrum study
Publisher: Springer Science and Business Media LLC
Date: 24-11-2014
The genetic epidemiology of parental discipline
Publisher: Cambridge University Press (CUP)
Date: 11-2000
DOI: 10.1017/S0033291799003013
Abstract: Background. Previous studies of parental discipline have identified little influence of heritability on parental control, and some influence of gene–environment correlations, shared environment and child temperament. Method. Using interview data from 2003 female twins from a population-based twin registry and 1472 of their parents, we examined reports of parental discipline from four perspectives: (1) father and mother reporting separately on the type of discipline they provided for their offspring (2) each twin reporting on the type of discipline they received from their parents (3) each parent reporting on the discipline provided by their spouse and, (4) each twin reporting on the discipline they provided for their own offspring. Using factor analysis and univariate structural equation modelling, we examined the structure of parental discipline, and the genetic and environmental influences thereon. Results. The seven discipline items yielded two factors, physical discipline and limit setting, which were moderately positively correlated. Parents perceived discipline as largely a common environmental experience for the twins, whereas the twins indicated that discipline was influenced by unique environmental factors and the genotype of the child. Twins as parents indicated no influence of shared environment on discipline, with the majority of influence accounted for by non- shared environment and parental genotype. Conclusions. Parents recall providing similar discipline to their children, whereas children emphasize the differences in parental discipline. Sources of in idual variation in parental discipline vary according to which family member report is examined. In total, parental discipline is partially influenced by the genotype of both the parent and child, and by environmental factors shared by the twins and unique to the in idual.
Evaluation of a web‐based skills intervention for carers of people with anorexia nervosa: A randomized controlled trial
Publisher: Wiley
Date: 25-05-2013
DOI: 10.1002/EAT.22144
Abstract: To investigate the feasibility and usefulness of an online information and skills development intervention for carers of in iduals with anorexia nervosa (AN) and in iduals with AN. Thirty-seven carers and seventeen in iduals with AN were recruited carers completed the intervention Overcoming Anorexia Online (OAO), with random allocation to receiving additional clinician guidance (OAO-G) or no guidance (OAO-NoG). Level of expressed emotion, distress, depressive symptoms, experience of caregiving, and impact of eating disorder symptoms were assessed in carers and perceptions of changes in their carers' expressed emotion were assessed in in iduals with AN. Participants completed questionnaires at pre-intervention, post-intervention and 3-month follow-up. Significant reductions were found for carer intrusiveness, negative experiences of caregiving, and the impact of starvation and guilt. Within group effect sizes suggested mixed findings with respect to whether greater benefits were conferred for carers receiving clinician guidance. Decreases in perceived intrusiveness of the carer by the in idual with AN were associated with a large effect size. Results demonstrate the feasibility and usefulness of an online intervention for carers. Further examination of the efficacy of the intervention for both carers and in iduals with AN is warranted.
Psychometric properties of the eating disorder belief questionnaire
Publisher: Wiley
Date: 27-02-2014
DOI: 10.1002/EAT.22267
Abstract: The purpose of this investigation was to examine the psychometric properties of the eating disorder belief questionnaire (EDBQ). The EDBQ was administered to clinical patients with bulimia nervosa (n = 44) and nonclinical female university students (n = 298). Six types of psychometric testing were conducted: internal consistency, test-retest reliability, convergent validity, ability to discriminate between clinical and nonclinical groups, exploratory factor analysis, and confirmatory factor analysis. Psychometric testing generally supported the utility of the EDBQ with good internal consistency, 4- to 6-week test-retest reliability, convergent validity, and ability to discriminate between groups. The a priori structure of the EDBQ was shown to provide a good fit to the observed data. The results suggest that the EDBQ is a reliable and valid measure that may assist researchers and clinicians aiming to assess eating disorder cognitions in populations with bulimic symptoms.
A meta-synthesis of qualitative studies of the link between anxiety, depression and perfectionism: Implications for treatment
Publisher: Cambridge University Press (CUP)
Date: 08-09-2022
DOI: 10.1017/S1352465821000357
Abstract: Meta-analyses show an association between perfectionism and depression and anxiety (negative affect), and that therapy for perfectionism impacts positively on negative affect. No systematic reviews have focused on qualitative studies of perfectionism. Our aim was to perform a systematic, meta-synthesis of qualitative literature to (i) help inform our understanding of how perfectionism is associated with negative affect, so that we can (ii) inform future development of treatment for perfectionism in young people and to make it more effective. Included in the meta-synthesis were 37 qualitative studies. Six themes related to perfectionism were found: (1) the association with negative affect, (2) self-worth dependent on achievement, (3) cognitive and behavioural maintaining factors, (4) the expectations of others, (5) effective elements of interventions, and (6) barriers to treatment. The qualitative literature supports the notion of perfectionism as an important construct to consider in reducing negative affect. While cognitive behavioural therapy for perfectionism holds promise as a treatment to target negative affect, there was a paucity of qualitative research, particularly related to young people. A greater understanding of the views of young people are required to help tailor more effective interventions for perfectionism that can impact negative affect in this group.
Evaluating evidence‐based interventions in low socio‐economic‐status populations
Publisher: Wiley
Date: 18-08-2021
DOI: 10.1002/EAT.23594
Abstract: Socio‐economic‐status (SES) has rarely been reported or investigated in eating disorders (EDs) research. This Research Forum considers, from various perspectives, how SES may impact on evaluating evidence‐based treatments for EDs. We first reviewed previous literature that informs how SES impacts prevalence of EDs, help‐seeking, and treatment outcome. We then present findings from a case series effectiveness study of an early intervention program in low SES areas for EDs and discuss implications about the impact of SES on the effectiveness of evidence‐based interventions. Finally, we examine barriers to conducting rigorous evaluations in this population and discuss directions for future treatment outcome research. Evidence suggests a higher level of disordered eating but less help seeking in lower SES groups. In our case series, 96 participants started treatment and completed a mean of 13.85 sessions, 84 (87.5%) completed a mean of 6.40 sessional measures on ED cognitions and behaviors, but only 31% completed more extensive pre‐treatment and post‐treatment measures. The completer effect size decrease for the global Eating Disorder Examination‐Questionnaire score was 2.05 (95% CI: 1.43, 2.68) commensurate with other effectiveness studies in mixed SES groups. The high rates of missing data related to more extensive assessment present a barrier to evaluating evidence‐based treatments in this population. Evidence from the present study revealed in iduals from low SES can achieve similar treatment outcomes to other populations when receiving evidence‐based ED treatment. Future studies should investigate a range of approaches to maximizing data collection, including use of shorter sessional measures.
Encyclopedia of Feeding and Eating Disorders
Publisher: Springer Singapore
Date: 2017
Does perfectionism or pursuit of excellence contribute to successful learning? A meta-analytic review.
Publisher: American Psychological Association (APA)
Date: 10-2020
DOI: 10.1037/PAS0000942
The Maudsley Model of Anorexia Nervosa Treatment for Adults (MANTRA): Development, Key Features, and Preliminary Evidence
Publisher: Springer Publishing Company
Date: 2014
DOI: 10.1891/0889-8391.28.1.48
Abstract: Anorexia nervosa (AN) is a severe mental disorder that affects mainly young females. In adults with a well-established form of the illness, it is hard to treat. In 2006, we proposed a maintenance model of AN, combining intra- and interpersonal factors and we have recently refined this model. The model encompasses four main maintaining factors (a thinking style characterized by rigidity, detail focus, and a fear of making mistakes an avoidant emotion processing and relational style positive beliefs about the use of anorexia for the person [pro-anorexia beliefs] and a response of close others to the illness characterized by high expressed emotion and enabling of and accommodation to the illness). In this article, we describe how the model has been translated into a novel treatment for AN and the preliminary evidence supporting this. Implications for clinical practice and research are discussed.
Evaluating the impact of cancer on complementary and alternative medicine use, distress and health related QoL among Australian women: A prospective longitudinal investigation
Publisher: Elsevier BV
Date: 02-2012
DOI: 10.1016/J.CTIM.2011.09.008
Abstract: While several cross-sectional studies have examined psychological correlates of complementary and alternative medicine (CAM) use and cancer, few prospective longitudinal investigations have been reported. This study examined whether CAM use moderated distress and quality of life (HRQoL) from pre- to post-cancer. A prospective longitudinal national cohort design. Participants were 718 mid-aged women from the Australian longitudinal study on women's health who did not have cancer at survey 1, but who subsequently developed cancer. For each participant, three waves of data were extracted: the wave prior to diagnosis ('pre'), at diagnosis ('cancer'), and after cancer ('post'). CAM use was measured by the question 'in the past 12 months have you consulted an alternative health practitioner'. Distress was measured by perceived stress (PSS) and depression (CES-D 10), HRQoL was measured by physical and mental health functioning (SF-36). CAM use significantly moderated the change over time in stress [F(561)=3.09, p=0.04], depression [F(494)=3.14, p=0.04], but not HRQoL. CAM-users were significantly more stressed than non-users pre-cancer (p<0.05), but there were no significant differences at subsequent surveys. CAM-users were significantly less depressed post-cancer compared to non-users (p<0.05). Findings indicated that CAM users may be more psychologically vulnerable than non-users with respect to stress, with CAM acting as an effective psychological, but not HRQoL, intervention.
The Relationship Between Memory and Interpretation Biases, Difficulties with Emotion Regulation, and Disordered Eating in Young Women
Publisher: Springer Science and Business Media LLC
Date: 29-07-2015
A randomised controlled trial of three psychological treatments for anorexia nervosa
Publisher: Cambridge University Press (CUP)
Date: 29-05-2017
DOI: 10.1017/S0033291717001349
Abstract: There is a lack of evidence pointing to the efficacy of any specific psychotherapy for adults with anorexia nervosa (AN). The aim of this study was to compare three psychological treatments for AN: Specialist Supportive Clinical Management, Maudsley Model Anorexia Nervosa Treatment for Adults and Enhanced Cognitive Behavioural Therapy. A multi-centre randomised controlled trial was conducted with outcomes assessed at pre-, mid- and post-treatment, and 6- and 12-month follow-up by researchers blind to treatment allocation. All analyses were intention-to-treat. One hundred and twenty in iduals meeting diagnostic criteria for AN were recruited from outpatient treatment settings in three Australian cities and offered 25–40 sessions over a 10-month period. Primary outcomes were body mass index (BMI) and eating disorder psychopathology. Secondary outcomes included depression, anxiety, stress and psychosocial impairment. Treatment was completed by 60% of participants and 52.5% of the total s le completed 12-month follow-up. Completion rates did not differ between treatments. There were no significant differences between treatments on continuous outcomes all resulted in clinically significant improvements in BMI, eating disorder psychopathology, general psychopathology and psychosocial impairment that were maintained over follow-up. There were no significant differences between treatments with regard to the achievement of a healthy weight (mean = 50%) or remission (mean = 28.3%) at 12-month follow-up. The findings add to the evidence base for these three psychological treatments for adults with AN, but the results underscore the need for continued efforts to improve outpatient treatments for this disorder. Australian New Zealand Clinical Trials Registry (ACTRN 12611000725965) www.anzctr.org.au/
Absence of interactions between social support and stressful life events in the prediction of major depression and depressive symptomatology in women
Publisher: Cambridge University Press (CUP)
Date: 07-2000
DOI: 10.1017/S0033291799002251
Abstract: While high levels of social support (SS) are associated with a decreased risk for major depression (MD) or less depressive symptomatology, and stressful life events (SLEs) have a substantial causal relationship with MD, uncertainty remains as to whether a main-effect or a buffering model best explains the nature of the relationship among SS, MD and SLEs. Using two waves of interview data on 2,163 female twin pairs from a population-based twin registry, and discrete time survival analysis with both logistic and linear regression models, we examine the ability of interactions between eight dimensions of SS and 16 categories of stressful life events to predict MD onset and levels of depressive symptomatology. In the presence of a significant effect of a SLE on MD (beta > or = 100), we found evidence for seven interactions out of a possible 93, of which none involved buffering effects. Similarly, examination of depressive symptomatology detected a total of two interactions (both buffering) out of possible 28. We found no evidence, beyond what would be expected by chance, for the existence of buffering effects where either MD or depressive symptomatology was used as the dependent variable. There is little evidence to suggest the presence of the buffering effect of social support in the face of adverse life events for women. We suggest that it is important to use alternative models (multiplicative and additive) to examine data, to investigate the match between stressors and social resources, and to investigate fully whether detected interactions actually represent a buffering effect.
Perfectionism and selective attention predict dysmorphic concern in an Australian university population
Publisher: Informa UK Limited
Date: 04-2019
DOI: 10.1111/AP.12423
Response to Treasure and Schmidt
Publisher: SAGE Publications
Date: 12-12-2022
EPQ-R personality correlates of bulimia nervosa in an Australian twin population
Publisher: Elsevier BV
Date: 02-1995
Driving better intervention outcomes in eating disorders
Publisher: Wiley
Date: 24-07-2021
DOI: 10.1002/ERV.2759
Abstract: Setting specific research priorities and involving consumers in this process is one pathway to driving better intervention outcomes in eating disorders (EDs). We reviewed research priority setting in the field and the involvement of consumers in this priority setting. A systematic review following the PRSIMA statement was conducted and eight studies were identified for inclusion four included substantial input from consumers, and four were researcher led. Similarities and differences across the types of studies were examined. Research priorities informed by consumers were primarily concerned with producing better interventions and outcomes. A large degree of overlap with researcher-led priorities was present. The former studies had a greater focus on early intervention, bridging the research-practice gap, and recovery, while the latter were more likely to address diagnosis, genetic factors, brain circuitry, and pharmacotherapy. Priorities endorsed across more than one consumer-informed study included: the role of self-harm, working with health care professionals to increase early detection, supporting transition between services, and six issues about improved treatments. The ED field needs to engage in more meaningful involvement of co-design across consumers, clinicians and researchers along the entire research journey, not just research priority setting. An integrated research strategy incorporating a co-design perspective has the potential to drive better outcomes.
Time to make a change: A call for more experimental research on key mechanisms in anorexia nervosa
Publisher: Wiley
Date: 21-06-2020
DOI: 10.1002/ERV.2754
A comparison of the Eating Disorder Examination and a general psychiatric schedule
Publisher: SAGE Publications
Date: 12-1997
DOI: 10.3109/00048679709065511
Abstract: Objective: The aim of this study is to investigate the adequacy of a general interview schedule for the purpose of assessing bulimia net vosa. Method: In two waves of data collection 18–24 months apart, 250 women were assessed for disordered eating. The first interview was typical of that included in many psychiatric interview schedules and was used to screen women for selection in a subsequent interview. This latter interview, using the Eating Disorder Examination, represents the ‘gold standard’ for the assessment of disordered eating. Results: While the psychiatric interview satisfactorily assessed disturbed eating in general, it seemed less capable of accurately assessing cases of bulimia nervosa in particular, the major weakness being the overestimation of binge-eating. Conclusions: Structured psychiatric interviews are suitable for screening purposes to identify women with disordered eating, but identification of bulimia nervosa requires further assessment with a suitable instrument.
Towards an understanding of help‐seeking behaviour for disordered eating: Refinement of a barriers to help‐seeking measure
Publisher: Wiley
Date: 17-01-2023
DOI: 10.1111/EIP.13394
Abstract: Early intervention in eating disorders (EDs) is h ered by a lack of validated measures of barriers to treatment seeking. The present study examined the factor structure of the Perceived Barriers to Psychological Treatment scale (PBPT) and a combination of PBPT and Barriers to Seeking Help for ED items (BATSH‐ED) with respect to treatment‐seeking for an ED. Participants were 456 female university students aged 17–25 reporting a wide range of disordered eating severity. Confirmatory factor analyses were conducted with the whole s le followed by correlational and regression analyses with a high‐risk s le to assess validity of the selected questionnaire items. Four models were tested. First, we replicated the original PBPT 8‐factor structure in our s le with comparable fit indices. Second, the addition of six ED items comprising a Denial and Ambivalence subscale improved model fit. Third and fourth, when only significant subscales predicting treatment seeking were retained, with removal of items with weak loadings, a 15‐item six‐factor solution provided a best fit. A range of psychosocial measures had relationships in the expected directions with the questionnaire subscales. In addition to disordered eating, the denial subscale was uniquely associated with treatment seeking. While the present study contributes to refining the assessment of barriers to help‐seeking, future studies should consider co‐design with lived experience to further improve the model fit of the questionnaire and improve predictiveness of help‐seeking.
Impairments among DSM-5 eating disorders: A systematic review and multilevel meta-analysis
Publisher: Elsevier BV
Date: 04-2023
An exploratory examination of executive functioning as an outcome, moderator, and predictor in outpatient treatment for adults with anorexia nervosa
Publisher: Springer Science and Business Media LLC
Date: 17-06-2022
DOI: 10.1186/S40337-022-00602-0
Abstract: People with anorexia nervosa often exhibit inefficiencies in executive functioning (central coherence and set shifting) that may negatively impact on treatment outcomes. It is unclear from previous research whether these inefficiencies can change over treatment. We aimed to (1) investigate whether executive functioning can improve over treatment, (2) determine whether baseline executive functioning moderates treatment outcome, and (3) examine whether baseline executive functioning predicts early change (i.e., increase in body mass index over the first 13 weeks of treatment) or remission. We conducted linear mixed model and logistic regression analyses on data from the Strong Without Anorexia Nervosa trial (Byrne et al. in Psychol Med 47:2823–2833, 2017). This study was a randomised controlled trial of three outpatient treatments for people with anorexia nervosa: Enhanced Cognitive Behavioural Therapy, Maudsley Model Anorexia Nervosa Treatment for Adults, and Specialist Supportive Clinical Management. While set shifting clearly improved from baseline to end of treatment, the results for central coherence were less clear cut. People with low baseline central coherence had more rapid reductions in eating disorder psychopathology and clinical impairment than those with high baseline central coherence. Baseline executive functioning did not predict early change or remission. The detail-focused thinking style commonly observed among people with anorexia nervosa may aid treatment outcomes. Future research that is more adequately powered should replicate this study and examine whether the same pattern of results is observed among people with non-underweight eating disorders.
Internet-delivered cognitive behavioural therapy for perfectionism: Targeting dysmorphic concern
Publisher: Elsevier BV
Date: 09-2019
DOI: 10.1016/J.BODYIM.2019.05.002
Abstract: Perfectionism is an important transdiagnostic risk factor for several psychopathologies. As such, treatments targeting perfectionism have gained increased attention over recent years. While perfectionism is postulated to be an important underlying mechanism for dysmorphic concern, no research has explored the benefits of targeting perfectionism to reduce dysmorphic concern. The current study evaluated the use of Internet-delivered cognitive behavioural therapy for perfectionism (ICBT-P) with 31 participants (28 women) with high levels of dysmorphic concern to examine the impact on perfectionism, dysmorphic concern, body image disturbance, negative affect, and selective attention towards appearance-based stimuli. Using a case series design, observations were collected at baseline, at the end of a 4-week pre-treatment phase, after the 8-week ICBT-P, and 1-month post-treatment. Intent-to-treat analyses showed significant improvement from baseline to end-of-treatment and follow-up on most of the variables, with a large effect size decrease in dysmorphic concern, and decreased selective attention to BDD-body, BDD-positive, and BDD-negative words. The results of this study support the use of ICBT-P as an efficacious treatment worthy of further examination in populations who experience high levels of dysmorphic concern.
The relationship between disordered eating and cigarette smoking among adult female twins
Publisher: Wiley
Date: 03-11-2014
DOI: 10.1002/EAT.22363
Abstract: While previous studies have shown a link between cigarette smoking and disordered eating (DE), it is less clear whether this association can be explained by attempts to control weight and/or temperament. This study had two aims: to examine weight/shape and DE symptomatology associated with weight control-related smoking and disordered eating second, to investigate whether temperament-based factors explain the association between compensatory smoking and weight and shape-related characteristics, and disordered eating symptoms. Female twins (N = 1,002) from the Australian Twin Registry, aged 28-39 years, were assessed by interview yielding lifetime diagnostic information of disordered eating and use of cigarette smoking for weight control. Self-report measures of temperament were available. Women who had never smoked (50.6%, n = 495) or had smoked for reasons other than weight and shape control (42.5%, n = 415) were generally not differentiated with respect to indicators of disordered eating. Women who smoked for reasons primarily associated with weight and shape control (6.9%, n = 67) had significantly higher levels of disordered eating than non-smokers identified as being higher levels of purging (OR = 4.55, 95% CI = 2.41-8.59) and fasting (OR = 9.32, 94% CI = 4.43-19.90) but not objective binge episodes (OR = 1.69, 95% CI = 0.71-3.99). Of those women diagnosed with lifetime eating disorders, weight-control smokers had higher levels of purging (OR = 4.22, 95% CI = 1.13-15.80) than those who did not. There were no differences in temperament. Results support co-occurrence of smoking for weight control and purging in both community and clinical groups, and indicate this association is related to weight control and not temperament.
A realist synthesis of websites containing content on perfectionism: Are the descriptions and advice empirically supported?
Publisher: Springer Science and Business Media LLC
Date: 25-08-2021
DOI: 10.1186/S40359-021-00620-8
Abstract: Perfectionism is a risk factor for depression and anxiety and is increasing in young people. It is important to understand the information that youth are exposed to about perfectionism on the internet and what may be required to make this more helpful in terms of accessing empirically supported descriptions and advice. This research used novel methodology to investigate content about perfectionism on websites by conducting a realist synthesis of the definitions of perfectionism, and the degree to which websites contain empirically supported strategies and recognise the advantages and disadvantages of perfectionism. The results were presented to people aged 18 to 24 (N = 18) with a lived experience of anxiety/depression for feedback. The search yielded 992 websites, 266 of which were included in the synthesis only one met the criteria for excellent quality with most (56%) judged as moderate. The feelings, thoughts, and behaviours that accompany perfectionism were commonly described, and strategies included identifying cognitions and developing alternatives, moving from self-criticism to self-compassion, normalising mistakes, adjusting goals, receiving practical support, and strategies for procrastination. The young people wanted further emphasis on depression and anxiety as consequences of perfectionism that contributed to a vicious cycle. They identified interventions were difficult, with greater levels of support needed. While most websites contained empirically supported information, the quality needs to improve, and further information needs to be provided on the links with anxiety and depression. Interventions for perfectionism need to have more focus on helping young people develop support networks.
Development of consensus‐based guidelines for outpatient dietetic treatment of eating disorders: A Delphi study
Publisher: Wiley
Date: 14-07-2020
DOI: 10.1002/EAT.23330
Improving programme‐led and focused interventions for eating disorders: An experts' consensus statement—A UK perspective
Publisher: Wiley
Date: 22-05-2023
DOI: 10.1002/ERV.2981
Abstract: 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. 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. 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. 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.
Body image flexibility: A predictor and moderator of outcome in transdiagnostic outpatient eating disorder treatment
Publisher: Wiley
Date: 19-02-2018
DOI: 10.1002/EAT.22842
Abstract: Predictors of attrition and predictors and moderators of outcome were explored in a transdiagnostic s le of patients who received ten-session cognitive behavioral therapy (CBT-T) for nonunderweight eating disorders. Body image flexibility, a protective positive body image construct, was hypothesized to be a significant moderator. Data from two case series were combined to form a s le of 78 participants who received CBT-T. Baseline measures of body image, negative affect, personality, and motivation (readiness to change and self-efficacy) were included as potential predictors. Global eating disorder psychopathology at each assessment point (baseline, mid- and post-treatment, 1- and 3-month follow-up) was the outcome variable. Predictors of attrition were assessed using logistic regression, and multilevel modeling was applied for predictors and moderators of outcome. Body image flexibility emerged as the strongest predictor and moderator of global eating disorder psychopathology, followed by body image avoidance. Body checking, negative affect, personality beliefs, and self-efficacy were significant predictors of global eating disorder psychopathology. Higher body image flexibility predicted lower global eating disorder psychopathology at every assessment point. Further research is required to replicate findings and explore the benefit of focusing on positive body image in treatment.
Developing the “single‐session mindset” in eating disorder research: Commentary on Schleider et al., 2023 “Realizing the untapped promise of single‐session interventions for eating disorders”
Publisher: Wiley
Date: 09-03-2023
DOI: 10.1002/EAT.23930
Abstract: Schleider and colleagues' paper on the application of single‐session interventions (SSIs) to eating disorders is timely given the broader focus in mental health on flexible approaches to delivering support at the time the person needs it most. The eating disorder field needs to embrace these innovations including developing a “single‐session mindset” with greater attention paid to testing the relevance of SSI for eating disorders. The use of well‐powered trials of brief, focused and rapidly scalable interventions is an ideal vehicle for generation and evaluation of new and longer interventions. Our future research agenda needs to carefully consider our target audience, the primary outcome variable of most relevance, and the SSI topic that would be most likely to effect change. Research in prevention might focus on weight concern and evaluation of SSIs that focus on self‐compassion or cognitive dissonance related to appearance ideals in the media. Work in early intervention could target denial and disordered eating using SSIs on growth mindset, behavioral activation, and imagery rescripting. Treatment waitlists provide another suitable opportunity, evaluating SSIs that aim to increase hope for change, treatment retention, and kick start early change in therapy, a robust predictor of better treatment outcome.
A randomized controlled trial of two 10-session cognitive behaviour therapies for eating disorders: An exploratory investigation of which approach works best for whom
Publisher: Elsevier BV
Date: 11-2021
DOI: 10.1016/J.BRAT.2021.103962
Abstract: Cognitive behaviour therapy for eating disorders (CBT-ED) outperforms other treatments for non-underweight eating disorders in adults, but we have limited ability to match CBT-ED to in idual profiles. We examined if we could identify who benefits most from two forms of 10-session CBT-ED one emphasizing early behaviour change with substantial content on improving body image (CBT-T), and the other including motivational work and no content on body image using chapters from self-help books (CBTm). Participants were 98 consecutive referrals to the Flinders University Services for Eating Disorders. Fourteen clinical psychology postgraduates delivered the treatment under expert supervision. Outcome measures were completed on five occasions: baseline, 4-, 10-, 14- and 22-weeks post-randomisation. Our primary outcome was global eating psychopathology. Moderators included motivation (readiness and confidence to change) and body avoidance and body checking. Intent-to-treat analyses showed no difference between the groups with a significant main effect of time associated with large effect size improvements, commensurate with longer forms of CBT-ED. Participants with lower readiness to change in CBTm had significantly greater decreases in disordered eating over follow-up compared to those with low motivation in CBT-T. People with lower readiness to change might benefit from the incorporation of motivational work in CBT-ED.
Imagery rescripting and cognitive dissonance: A randomized controlled trial of two brief online interventions for women at risk of developing an eating disorder.
Publisher: Wiley
Date: 02-03-2018
DOI: 10.1002/EAT.22849
Abstract: This pilot study compared two brief online interventions, imagery rescripting and cognitive dissonance, to an assessment-only control condition in a s le of body-dissatisfied young women at risk of developing an eating disorder. We examined the degree to which each intervention reduced disordered eating and modified risk and protective factors for eating disorders. Female university students (N = 107, 17-28 years of age) completed a screening questionnaire, followed by random allocation to one of the three conditions, followed by a baseline assessment, body dissatisfaction induction, and brief online intervention. Participants in the active conditions then completed online daily home practice and a postintervention questionnaire. Findings provide qualified support for the imagery rescripting intervention, with participants reporting higher body image acceptance (Cohen's d = 0.49) than the cognitive dissonance condition, and higher self-compassion (d = 0.59) and lower levels of disordered eating (d = 0.59) than the control condition, at postintervention. There was no significant impact of cognitive dissonance on any factors. Change in body image acceptance and self-compassion mediated the relationship between allocated condition and change in disordered eating at postintervention. These findings provide preliminary support for the use of online-adapted imagery-based techniques (e.g., imagery rescripting) to reduce risk for the development of an eating disorder by strengthening protective factors (i.e., body image acceptance and self-compassion) and reducing disordered eating. Further exploration of the use of imagery strategies in the prevention of disordered eating is required, including prospective tests of the mechanisms of action.
A systematic review and meta-analysis of a 10-session cognitive behavioural therapy for non-underweight eating disorders
Publisher: Informa UK Limited
Date: 15-06-2022
Tertiary eating disorder services
Publisher: SAGE Publications
Date: 16-05-2021
DOI: 10.1177/10398562211010802
Abstract: Australian tertiary eating disorder services (EDS) have a ided model of care, where child and adolescent mental health services (CAMHS) support patients until the age of 18 years, and thereafter, adult mental health services (AMHS) provide care. Consumers and carers have criticised this ided model because the age boundary occurs during the peak period of onset and acuity for eating disorders. Most CAMHS patients are lost to specialty follow-up around age 18, increasing the risks of relapse and premature mortality from eating disorders, since young women (aged 15–24) have the highest hospitalisation rates from anorexia nervosa. The current article is a commentary on the transition gap and possible service designs. Eating disorders require access to specialty treatment across the life span. The Australian Federal Government has expanded all-age care through the 2019 Medicare Benefit Schedule (MBS) eating disorder plans. Some new MBS patients require a rapid step-up in care intensity to a tertiary EDS, thereby increasing demand on the public sector. State/Territory Governments should strengthen EDS using the ‘youth reach-down’ model, where AMHS extend EDS to age 12. Vertical service integration from 12 to 64+ facilitates continuity of care for the duration of an eating disorder.
A randomised controlled trial of face to face versus pure online self-help cognitive behavioural treatment for perfectionism
Publisher: Elsevier BV
Date: 12-2014
DOI: 10.1016/J.BRAT.2014.09.009
Abstract: Previous research has shown cognitive-behavioural treatment (CBT) to be effective in reducing perfectionism. The present study investigated the efficacy of two formats of CBT for perfectionism (CBT-P), face-to-face and pure online self-help, in reducing perfectionism and associated psychological symptoms. Participants were randomly allocated to face-to-face CBT-P (n = 18), pure online self-help CBT-P (n = 16), or a waitlist control period (n = 18). There was no significant change for the waitlist group on any of the outcome measures at the end of treatment. Both the face-to-face and pure online self-help groups reported significant reductions at the end of treatment for the perfectionism variables which were maintained at the 6-month follow-up. The face-to-face group also reported significant reductions over this time in depression, anxiety, and stress, and a significant pre-post increase in self-esteem, all of which were maintained at the 6-month follow-up. In contrast, the pure online self-help group showed no significant changes on these outcomes. The face-to-face group was statistically superior to the pure online self-help group at follow-up on the perfectionism measures, concern over mistakes and personal standards. The results show promising evidence for CBT for perfectionism, especially when offered face to face, where sustained benefit across a broad range of outcomes can be expected.
Impact of patient characteristics on clinicians' decisions to involve dietitians in eating disorder treatment.
Publisher: Wiley
Date: 10-02-2022
DOI: 10.1111/JHN.12980
Abstract: Dietetic involvement in eating disorder (ED) treatment is often initiated by other members of a patient's treating team. The present study aimed to examine the impact of patient characteristics on clinicians' decisions to involve a dietitian in a patient's ED treatment, as well as the influence of clinician characteristics on their decision-making. ED clinicians were recruited to complete an online survey, which used case vignettes to assess their likelihood of referring patients to a dietitian or consulting with a dietitian for guidance. Questions were also included that measured clinician anxiety, beliefs about the therapy they deliver, beliefs about dietitians and views on evidence-based practice to determine whether these were related to their responses to case vignettes. Fifty-seven clinicians completed the survey, with the largest group being clinical psychologists (n = 22, 39%). ED diagnosis, weight status, medical co-morbidities and progress in treatment were all shown to be influential on whether clinicians involved dietitians in ED treatment. Clinician characteristics and their beliefs about dietitians were generally not correlated with the likelihood of seeking dietetic input. The present study indicates that clinicians' decisions to involve dietitians in ED treatment are systematic rather than random decisions influenced by in idual clinician characteristics. Clinicians require further education on the potential for malnutrition regardless of patients' ED diagnosis or weight status, and the dietitian's role in addressing this.
Patients with bulimia nervosa who fail to engage in cognitive behavior therapy
Publisher: Wiley
Date: 1993
DOI: 10.1002/1098-108X(199301)13:1<35::AID-EAT2260130105>3.0.CO;2-N
Abstract: Although cognitive behavioral treatment is the treatment of choice in bulimia nervosa, patients' response is variable. A minority of patients do not respond at all and some never engage in treatment. This paper concerns the latter group. A case series of six such patients with whom treatment could not be initiated is compared with a group who received a full course of treatment. The group with whom treatment could not begin were found to have a longer history of disorder, to report excessive laxative abuse, to have more severe depressed mood and a greater dissatisfaction with their body weight. In addition, they were more likely to have abused psychoactive substances, engaged in episodes of self-harm, and have a lower self-esteem. They were also more likely to be diagnosed as having borderline personality disorder. Patients presenting with the wide range of difficulties characteristic of this group require a more intensive form of treatment than standard outpatient cognitive behavior therapy.
Anorexia nervosa
Publisher: Springer Science and Business Media LLC
Date: 26-11-2015
DOI: 10.1038/NRDP.2015.74
Abstract: Anorexia nervosa (AN) is a psychiatric condition characterized by severe weight loss and secondary problems associated with malnutrition. AN predominantly develops in adolescence in the peripubertal period. Without early effective treatment, the course is protracted with physical, psychological and social morbidity and high mortality. Despite these effects, patients are noted to value the beliefs and behaviours that contribute to their illness rather than regarding them as problematic, which interferes with screening, prevention and early intervention. Involving the family to support interventions early in the course of the illness can produce sustained changes however, those with a severe and/or protracted illness might require inpatient nursing support and/or outpatient psychotherapy. Prevention programmes aim to moderate the overvaluation of 'thinness' and body dissatisfaction as one of the proximal risk factors. The low prevalence of AN limits the ability to identify risk factors and to study the timing and sex distribution of the condition. However, genetic profiles, premorbid features, and brain structures and functions of patients with AN show similarities with other psychiatric disorders and contrast with obesity and metabolic disorders. Such studies are informing approaches to address the neuroadaptation to starvation and the other various physical and psychosocial deficits associated with AN. This Primer describes the epidemiology, diagnosis, screening and prevention, aetiology, treatment and quality of life of patients with AN.
Acceptability and Effectiveness of an 8-week Mindfulness Program in Early- and Mid-adolescent School Students: a Randomised Controlled Trial
Publisher: Springer Science and Business Media LLC
Date: 04-08-2021
Hasty decision-making in individuals at higher risk of developing an eating disorder
Publisher: Elsevier BV
Date: 06-2022
DOI: 10.1016/J.JBTEP.2021.101717
Abstract: The Jumping to Conclusions (JTC) bias is the tendency to make hasty decisions based on limited evidence and may contribute to the formation of over-valued beliefs about the importance of weight, shape and eating. Previous research investigating the JTC bias in clinical eating disorder s les, as assessed by the beads task, is inconclusive. The current study investigated the JTC bias in a non-clinical s le of undergraduate students identified as being lower or higher risk of developing an eating disorder. The study used a more reliable 'distractor' beads task that also incentivised hastier decisions by elevating the pressure of the task. Female undergraduate students (N = 156, 48%, classified as higher risk) completed a pressure and non-pressure distractor beads task, along with measures of weight concern and body-image flexibility. Higher risk participants displayed a hastier decision-making style than lower risk participants. Task pressure elicited a hastier decision-making style across the whole s le, however, was unable to distinguish between higher and lower eating disorder risk status. Interpretation of findings are limited to non-clinical s les and may not generalise to clinical eating disorder populations. Findings suggest the need for replication in a clinical eating disorder s le using the distractor beads task. Future research should investigate whether eating disorder salient stimuli elicits a stronger bias.
A clinician’s quick guide to evidence-based approaches: perfectionism
Publisher: Informa UK Limited
Date: 08-08-2022
The development of co-designed parent-supported cognitive behaviour therapy for perfectionism in adolescents with eating disorders: initial feasibility and acceptability
Publisher: Springer Science and Business Media LLC
Date: 17-08-2023
DOI: 10.1186/S40337-023-00860-6
Abstract: Perfectionism is significantly associated with symptoms of eating disorders in adolescents. Studies to date have not examined parent-supported CBT for perfectionism in eating disorders (CBT-P-ED). We co-designed the treatment and conducted a feasibility trial. Eight parents of adolescents with eating disorders ( M age = 48.75 years, 100% female) engaged in three co-design workshops to create a parent-supported CBT-P-ED self-help intervention. A further 10 parents ( M age 41.8 years, 50% female) and their adolescent offspring ( n = 10, M age 15.4 years, 60% female, 50% with self-reported diagnosis of anorexia nervosa) participated in a feasibility trial and provided feedback on the intervention. The parents who engaged in the co-design workshops suggested several areas to optimise the perfectionism intervention, including using plain language, the impact of parental perfectionism, how to engage with their adolescent in treatment and the importance of increasing eating disorder specific material. Feedback from the feasibility trial suggested that the intervention was acceptable and feasible with 100% of parents and adolescents saying it was useful, and no attrition. Parent-supported CBT-P-ED appears to be feasible. Future research is now required in a randomised controlled trial.
A systematic review of the existing models of disordered eating: Do they inform the development of effective interventions?
Publisher: Elsevier BV
Date: 02-2016
DOI: 10.1016/J.CPR.2015.12.004
Abstract: Despite significant advances in the development of prevention and treatment interventions for eating disorders and disordered eating over the last decade, there still remains a pressing need to develop more effective interventions. In line with the 2008 Medical Research Council (MRC) evaluation framework from the United Kingdom for the development and evaluation of complex interventions to improve health, the development of sound theory is a necessary precursor to the development of effective interventions. The aim of the current review was to identify the existing models for disordered eating and to identify those models which have helped inform the development of interventions for disordered eating. In addition, we examine the variables that most commonly appear across these models, in terms of future implications for the development of interventions for disordered eating. While an extensive range of theoretical models for the development of disordered eating were identified (N=54), only ten (18.5%) had progressed beyond mere description and to the development of interventions that have been evaluated. It is recommended that future work examines whether interventions in eating disorders increase in efficacy when developed in line with theoretical considerations, that initiation of new models gives way to further development of existing models, and that there be greater utilisation of intervention studies to inform the development of theory.
Piloting a perfectionism intervention for pre-adolescent children
Publisher: Elsevier BV
Date: 10-2015
DOI: 10.1016/J.BRAT.2015.07.004
Abstract: The aim of this pilot study was to evaluate a school-based intervention program focussing on reducing perfectionism in pre-adolescent children. A 2-lesson intervention or the control condition was implemented across three schools (N = 125 M age = 11.60 years 47.2% girls). Students completed assessments at baseline, post-intervention and 4-week follow-up. Significant between group differences for self-oriented perfectionism-striving were identified post-intervention and were maintained at 4-week follow-up (d = 0.47 and 0.40 respectively). Significant interactions between group and time favouring the intervention group were identified for the hyperactivity and emotional problems. Findings from this study provide preliminary support for the effectiveness of a perfectionism intervention at an earlier age than has been targeted to date. While these findings appear promising, the justification of such approaches with this age group will require follow-up investigations with expanded intervention content, longer follow-up assessments, larger s les, and evidence of impact on other variables such as well-being. ACTRN12614001262695.
Is the transtheoretical model and motivational interviewing approach applicable to the treatment of eating disorders? A review
Publisher: Elsevier BV
Date: 08-2012
DOI: 10.1016/J.CPR.2012.06.005
Abstract: Research in eating disorders is reviewed examining the (1) utility of the Transtheoretical Model in predicting outcome, and (2) efficacy of Motivational Interviewing (MI). There were promising results showing significant relationships between initial stage of change and treatment outcome related to eating pathology (not including purging), body mass index, and some aspects of psychopathology. Of those treatment studies utilising a control group, there was little indication that using MI conferred significant treatment benefit, with the exception of improving motivation and binge eating for people with binge eating disorder and bulimia nervosa. Overall the content of the studies varied greatly with relation to: stage of change and outcome measures, format of MI, diagnostic groupings, age of participants, utilisation of other adjunctive treatments, s le size, presence of follow-up assessments, and study design. Few of the 9 studies examining the efficacy of MI could be considered to have robust methodology. It is recommended that future research using the Transtheoretical Model to predict outcome adopt more uniform methodology so that we can more specifically determine its applicability, and that well-designed treatment studies in eating disorder populations be conducted so that we develop a stronger evidence base from which to decide whether MI confers benefit.
Internet eating disorder prevention
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2018
Characteristics of monozygotic twins discordant for bulimia nervosa
Publisher: Wiley
Date: 2000
DOI: 10.1002/1098-108X(200101)29:1<1::AID-EAT1>3.0.CO;2-J
Abstract: We studied monozygotic (MZ) twins who were discordant for bulimia nervosa in order to identify environmental factors that could have contributed to the expression of bulimia nervosa in only one member of these genetically identical twin pairs. Female twin pairs from the Virginia Twin Registry were identified. One twin met DSM-III-R criteria for bulimia nervosa (excluding the frequency and duration criterion) and the co-twin either reported some symptoms of bulimia nervosa but never met full diagnostic criteria (n = 20 pairs) or reported no symptoms of bulimia nervosa (n = 10). We compared the twins on demographic, developmental, personality, and psychiatric dimensions using self- and maternal report. Affected twins were more likely to report lifetime generalized anxiety disorder and were described by their mothers as more anxious and fearful as children. They also had significantly lower mastery, optimism, and self-esteem, and significantly greater obsessive and compulsive symptoms than their unaffected co-twins. Affected twins recalled greater discord in their families but viewed their parents as more warm toward them than toward their unaffected co-twin. Given that MZ twins are genetically identical and share a common family background, differences between them must be attributable to unique environmental factors. Although it is difficult to disentangle predisposing risk factors from sequelae of psychiatric illness in a retrospective co-twin control design, the affected twins were perceived to have been more anxious as children by their mothers-possibly reflecting a predisposing trait. More extensive interviews are required to determine the nature of environmental events that contribute to the expression of the observed personality, behavioral, anxious, and eating-related traits in the affected twins.
Assessing clinician competence in the delivery of cognitive-behavioural therapy for eating disorders: development of the Cognitive-Behavioural Therapy Scale for Eating Disorders (CBTS-ED)
Publisher: Informa UK Limited
Date: 09-10-2023
Predictors and moderators of outcomes and readmission for adolescent inpatients with anorexia nervosa: A pilot study
Publisher: Informa UK Limited
Date: 07-2017
DOI: 10.1111/CP.12091
Variables associated with disturbed eating habits and overvalued ideas about the personal implications of body shape and weight in a female adolescent population
Publisher: Wiley
Date: 14-05-2002
DOI: 10.1002/EAT.10054
Abstract: Few studies exist that examine risk factors for the overvalued ideas about the personal implications of body shape and weight that are viewed as the central cognitive substrate of eating disorders. In a female adolescent population (mean age = 14 years, SD = 0.7), we examine variables previously identified in the literature as risk factors for eating disorders, namely, self-esteem, comments from others about eating/weight/shape, perfectionism, childhood and parental weight/shape, and parental conflict. These variables were all correlated significantly with current (past 4 weeks) levels of overvalued ideas and disturbed eating patterns in the predicted directions. Self-esteem was found to mediate partially the relationship between the overvalued ideas and comments about weight and perfectionism. Self-esteem fully mediated the relationship between the overvalued ideas and parental conflict. A family index of body size had an independent influence on the overvalued ideas, that is, the bigger the size, the greater the overvalued ideas. Finally, the overvalued ideas fully accounted for the relationship between self-esteem and disturbed eating patterns. The cognitive model of bulimia nervosa is supported by the results of this study. Self-esteem represents an important gateway to the overvalued ideas that contribute substantially to disturbed eating patterns.
A qualitative examination of low-intensity cognitive behaviour therapy to reduce anxiety and depression during the COVID-19 pandemic
Publisher: Informa UK Limited
Date: 14-02-2022
Genetic and environmental risk factors shared between disordered eating, psychological and family variables
Publisher: Elsevier BV
Date: 04-2000
Genetic Influences on Eating Disorders
Publisher: Oxford University Press
Date: 06-09-2017
DOI: 10.1093/OXFORDHB/9780190620998.013.5
Abstract: The current chapter reviews our progress in understanding how genes influence eating disorders by addressing the following areas: (1) how recognition of genetic influences on eating disorders emerged (2) the complexities of gene environment interplay (3) what twin studies can tell us about gene environment interplay, and (4) the current state of molecular genetic studies. It is concluded that both genes and nonshared environment play a critical role in the explanatory framework for the etiology of eating disorders. Shared environment is likely to contribute to the development of cognition and attitudes that may initiate disordered eating practices. Researchers are on the cusp of identifying specific genes that are implicated, and explication of the manner in which genes and the environment work together to increase risk for eating disorders hinges on the collection of larger s les.
Development of transdiagnostic clinical risk prediction models for 12‐month onset and course of eating disorders among adolescents in the community
Publisher: Wiley
Date: 13-04-2023
DOI: 10.1002/EAT.23951
Abstract: To develop and internally validate risk prediction models for adolescent onset and persistence of eating disorders. N = 963 Australian adolescents (11–19 years) in the EveryBODY Study cohort completed online surveys in 2018 and 2019. Models were built to predict 12‐month risk of (1) onset, and (2) persistence of a DSM‐5 eating disorder. Onset Model. Of the n = 687 adolescents without an eating disorder at baseline, 16.9% were identified with an eating disorder after 12 months. The prediction model was based on evidence‐based risk factors for eating disorder onset available within the dataset (sex, body mass index percentile, strict weight loss dieting, history of bullying, psychological distress, weight/shape concerns). This model showed fair discriminative performance (mean AUC = .75). The most important factors were psychological distress, weight and shape concerns, and female sex. Diagnostic Persistence Model. Of the n = 276 adolescents with an eating disorder at baseline, 74.6% were identified as continuing to meet criteria for an eating disorder after 12 months. The prediction model for diagnostic persistence was based on available evidence‐based risk factors for eating disorder persistence (purging, distress, social impairment). This model showed poor discriminative performance (mean AUC = .65). The most important factors were psychological distress and self‐induced vomiting for weight control. We found preliminary evidence for the utility of a parsimonious model for 12‐month onset of an eating disorder among adolescents in the community. Future research should include additional evidence‐based risk factors and validate models beyond the original s le. This study demonstrated the feasibility of developing parsimonious and accurate models for the prediction of future onset of an eating disorder among adolescents. The most important predictors in this model included psychological distress and weight and shape concerns. This study has laid the ground work for future research to build and test more accurate prediction models in erse s les, prior to translation into a clinical tool for use in real world settings to aid decisions about referral to early intervention.
Life Smart: A Pilot Study of a School-Based Program to Reduce the Risk of Both Eating Disorders and Obesity in Young Adolescent Girls and Boys
Publisher: Oxford University Press (OUP)
Date: 22-05-2013
Abstract: To develop and pilot Life Smart, an eight-lesson program aimed at reducing risk factors for both eating disorders and obesity. Grade 7 girls and boys (N = 115) from one independent school were randomly allocated to the Life Smart (two classes N = 51) or control (three usual classes N = 64) conditions. Risk factors were measured at baseline and post-program (5 weeks later). Life Smart was rated as moderately enjoyable and valuable by participants. ANCOVAs with baseline as a covariate revealed a significant main effect for group favoring Life Smart for shape and weight concern (Effect Size [ES] = .54), with post-hoc testing finding girls particularly benefited on this variable (ES = .78). Feedback was generally favorable, with some suggestions for even more interactive content. The program showed more promise with girls. Informed by these findings, the program underwent revisions and is now being evaluated in a randomized controlled trial.
Anorexia Nervosa and Major Depression: Shared Genetic and Environmental Risk Factors
Publisher: American Psychiatric Association Publishing
Date: 03-2000
DOI: 10.1176/APPI.AJP.157.3.469
Abstract: The authors sought to derive heritability estimates for anorexia nervosa and to explore the etiology of the comorbid relationship between anorexia nervosa and major depression. They applied bivariate structural equation modeling to a broad definition of anorexia nervosa and lifetime major depression as assessed in a population-based s le of 2,163 female twins. Anorexia nervosa was estimated to have a heritability of 58% (95% confidence interval=33%-84%). The authors were unable to completely rule out a contribution of shared environment. The comorbidity between anorexia nervosa and major depression is likely due to genetic factors that influence the risk for both disorders. Although the study was limited by the small number of affected twins, the results suggest that genetic factors significantly influence the risk for anorexia nervosa and substantially contribute to the observed comorbidity between anorexia nervosa and major depression.
Common genetic architecture and environmental risk factors underpin the anxiety‐disordered eating relationship: Findings from an adolescent twin cohort
Publisher: Wiley
Date: 20-08-2019
DOI: 10.1002/EAT.23155
Abstract: Despite established comorbidity between anxiety and disordered eating (DE), and a plethora of research using various methodologies to examine this overlap, use of twin modeling to expose whether a shared genetic liability underpins these conditions remains rare. Data from a longitudinal s le of female twins were selected: measures of risk for DE from Wave 1 (N = 699, 351 pairs, aged 12-15 years), and the Eating Disorder Examination (EDE) and Children's Anxiety Sensitivity Index (CASI) from Wave 2 (N = 669, 338 pairs, aged 16-19 years). At this time, they also completed Children's Anxiety Sensitivity Index (CASI). Bivariate Cholesky decomposition models adjusting for age and body mass index centile investigated the covariance structure between the CASI and EDE. Modeling both genetic and nonshared environmental influences parsimoniously fit these data. All paths were significant. Additive genetic influences were notable for CASI and EDE phenotypes 14% of the heritable variance was contributed by CASI to the expression of EDE. There was also a smaller but significant contribution of nonshared environmental influences. A multinomial logistic regression indicated body dissatisfaction (RRR = 1.53 95% CI = 1.07-2.18) differentiated groups with highest EDE scores from the highest CASI scores. Shared genetic and environmental influences appear to underpin the relationship, and potentially the observed comorbidity, between anxiety sensitivity and DE. The age of onset is typically earlier for anxiety than DE, suggesting a significant opportunity for early intervention work to reduce the likelihood of subsequent development of DE.
Does mindfulness have potential in eating disorders prevention? A preliminary controlled trial with young adult women
Publisher: Wiley
Date: 04-06-2016
DOI: 10.1111/EIP.12160
Abstract: This preliminary randomized controlled trial assessed the feasibility of a pilot mindfulness-based intervention with respect to reducing the risk of eating disorders in young women. Forty-four young adult women with body image concerns (Mage = 20.57, SD = 3.22) were randomly allocated to a mindfulness-based or a dissonance-based intervention (3 × 1 h weekly sessions), or to assessment-only control. Self-report measures of eating disorder risk factors, symptoms and related psychosocial impairment were compared at baseline, post-intervention, and at 1- and 6-month follow up. At post-intervention, acceptability ratings for both interventions were high. Mindfulness participants demonstrated statistically significant improvements relative to control at post-intervention for weight and shape concern, dietary restraint, thin ideal internalization, eating disorder symptoms and related psychosocial impairment however, these gains were largely lost over follow up. Dissonance participants did not show statistically significant improvements relative to control on any outcomes, despite small to moderate effect sizes. These preliminary findings demonstrate the acceptability and short-term efficacy of a mindfulness-based approach to reducing the risk of disordered eating in young women. This provides support for the continued evaluation of mindfulness in the prevention and early intervention of eating disorders, with increased efforts to produce maintenance of intervention gains.
The structure of genetic and environmental risk factors for three measures of disordered eating
Publisher: Cambridge University Press (CUP)
Date: 07-1999
DOI: 10.1017/S0033291799008740
Abstract: Background. The study explored the genetic and environmental risk factors for both the behaviours and attitudes characteristic of disordered eating. Methods. In three waves of data collection, information was collected from female twins regarding their eating and attitudes towards eating, weight and shape. The first assessment consisted of a self-report questionnaire (1988–9) with 1682 women. The second assessment consisted of a semi-structured psychiatric interview schedule (1992–3), completed by 1852 women, many of whom had completed Wave 1 assessment. The third assessment, with 325 women chosen from Waves 1 and 2 (1995–6), consisted of a semi-structured interview (the Eating Disorder Examination). Results. As only one twin pair was concordant for lifetime bulimia nervosa at Wave 3 assessment, ordinal measures of all assessments were used in a multivariate genetic analysis. Results indicated that additive genetic and non-shared environmental influences best explained variance in liability to disordered eating, with about 60% (95% CI 50–68) of the variance explained by genetic factors. Comparison with a model allowing for the effects of shared environment indicated genetic factors accounted for a similar degree of variance (59%, 95% CI 36–68). Conclusion. Liability to the development of the behaviours and attitudes characteristic of eating disorders is best explained by both environmental and genetic factors, with covariation between the three measures best explained by a single latent phenotype of disordered eating which has a heritability of 60%.
Celebrating research contributions from Australia
Publisher: Wiley
Date: 09-2018
DOI: 10.1002/EAT.22944
Abstract: This Virtual Issue of the International Journal of Eating Disorders (IJED) is released to mark the XXIVth Eating Disorder Research Society (EDRS) meeting in Sydney, Australia. This is the second EDRS meeting in Australia, reflecting the strong contribution of Australian researchers to eating disorder research internationally. Attendees at the Sydney EDRS meeting will be able to access the top 10 cited papers from IJED by Australian authors in 2016-2017, cited an average of 10.2 times each. It is pleasing to note the strong representation of early career researchers and the range of topics addressed.
A case series evaluation of the Maudsley Model for treatment of adults with anorexia nervosa
Publisher: Wiley
Date: 2011
DOI: 10.1002/ERV.1078
Abstract: Outpatient psychotherapy has been largely unsuccessful in assisting adults with anorexia nervosa (AN) to achieve weight restoration. The aim of the current study was to evaluate change and attainment of good and moderate outcome at 12-month follow-up using the Maudsley Model for Treatment of Adults with AN (MANTRA). Of 33 people assessed, 28 people commenced therapy, and 23 completed it (82%). At post-treatment, seven people (30%) met the criteria for good outcome and one person met the criteria for moderate outcome. At 12-month follow-up, six people (26%) achieved good outcome, a further five achieved a moderate outcome, and there were significant improvements in body mass index, eating psychopathology and motivation, with large intention to treat effect sizes (ES) of 0.85, 1.19 and 1.57, respectively. Those people who dropped out of therapy were significantly more likely to binge or purge, and this behaviour was also associated with a moderate effect size (0.71) when examining differences between people who obtained good/moderate outcome versus poor outcome. Also predicting poor outcome status was lower baseline self-esteem and ineffectiveness. Further evaluation of the use of MANTRA as an outpatient therapy for AN appears justified. Improvements to this therapy could include an early focus on binge and purge behaviour, as well as modules addressing low self-esteem and ineffectiveness.
Media Smart‐Targeted: Diagnostic outcomes from a two‐country pragmatic online eating disorder risk reduction trial for young adults
Publisher: Wiley
Date: 29-01-2018
DOI: 10.1002/EAT.22825
Abstract: Diagnostic outcomes in eating disorder (ED) risk reduction trials are important but rarely reported. An online pragmatic randomized-controlled trial was conducted with young-adult women in Australia and New Zealand seeking to improve their body image. Media Smart-Targeted (MS-T) was a 9-module program released weekly while control participants received tips for positive body image. Eating Disorder Examination-Questionnaire (EDE-Q) scores from baseline and 12-month follow-up were used to investigate two outcomes: ED onset in those who were asymptomatic at baseline (prevention effects) and, ED remission in those who met diagnosis at baseline (treatment effects). MS-T participants were 66% less likely than controls to develop an ED by 12-month follow-up (nonsignificant). MS-T participants who met ED criteria at baseline were 75% less likely than controls to still meet diagnostic criteria at follow-up. This effect was significant and remained so for both those who did and who did not access external face-to-face ED treatment during the trial. While further investigations are necessary, MS-T has fully automated procedures, low implementation costs, the potential to be delivered at-scale to assist those assist those where face-to-face services are limited or not available (e.g., remote areas).
ANZAED practice and training standards for mental health professionals providing eating disorder treatment
Publisher: Springer Science and Business Media LLC
Date: 02-11-2020
DOI: 10.1186/S40337-020-00333-0
Abstract: The Australia & New Zealand Academy for Eating Disorders (ANZAED) recently developed general principles and clinical practice standards recommended for mental health clinicians and dietitians providing treatment for people with eating disorders. Separate mental health practice and training standards were then devised as a foundation for strengthening the workforce and providing guidance to professional training programs and service providers on the minimal standards required for practice in the eating disorder field. The present recommendations for mental health professionals providing eating disorder treatment describe the following practice and training standards: eating disorder treatment foundations (including co-ordination of services, establishing a positive therapeutic alliance, professional responsibility and knowledge of levels of care), assessment, diagnosis, intervention (including evidence-based intervention, managing psychiatric risk and managing co-morbid mental health problems), and monitoring and evaluation. Further work is required to disseminate these standards to clinicians providing services across Australia to people with eating disorders, and to support adherence in the clinic room where they can translate to improved outcomes for clients. Pathways to supporting adherence include expert supervision of practice, incorporation in training and supervised practice in university settings, and support with checklists that can be used by consumers and referring professionals.
Using the experiences of COVID to reposition services for children and adolescents with anorexia nervosa
Publisher: SAGE Publications
Date: 10-05-2023
Utilising cognitive bias modification to remedy appearance and self-worth biases in eating disorder psychopathology: A systematic review
Publisher: Elsevier BV
Date: 12-2019
DOI: 10.1016/J.JBTEP.2019.101482
Abstract: This study systematically reviewed the impact of Cognitive Bias Modification (CBM) on biases related to attention (CBM-A) and interpretation (CBM-I) for appearance and self-worth stimuli and the subsequent impact on eating disorder (ED) psychopathology. The current review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), with 12 studies meeting inclusion criteria (CBM-A n = 5 CBM-I n = 7). The literature provides preliminary support for CBM-A and CBM-I efficacy in eliciting bias change in varying degrees of psychopathology (Cohen's d ranging between -1.67 and 1.34 9 studies reflected improved bias, and 3 reflected no change or did not assess), while highlighting the less robust effects associated with improving ED psychopathology (d ranging between -1.30 and 0.61 5 studies reflected symptom improvement, and 7 reflected no change or did not assess). The review only considered peer reviewed research and did not report on the findings of unpublished data thus, the current findings may not provide an accurate representation of CBM in EDs. The current findings highlight the potential of CBM as an adjunct intervention for EDs however the limited number of investigations and high degree of heterogeneity across the included studies impedes on the generalisability of the findings.
The transdiagnostic process of perfectionism
Publisher: UNED - Universidad Nacional de Educacion a Distancia
Date: 06-02-2012
The role of readiness and confidence to change in the treatment of atypical anorexia nervosa and bulimia nervosa
Publisher: Wiley
Date: 24-02-2023
DOI: 10.1002/EAT.23918
Abstract: Atypical anorexia nervosa (AN) is a serious eating disorder that is more common in the population than AN. Despite this, people with atypical AN are less likely to be referred or admitted for eating disorder treatment and there is evidence that they are less likely to complete or benefit from existing interventions. This study examined whether baseline readiness and/or confidence moderated outcomes from 10‐session cognitive behavioral therapy among people with atypical AN and bulimia nervosa (BN), and whether the impact of these variables differed between diagnoses. Participants ( n = 67 33 with atypical AN) were a subset from an outpatient treatment study. Linear mixed model analyses were conducted to examine whether baseline readiness and/or confidence moderated outcomes. People with BN who had higher levels of readiness or confidence at baseline had steeper decreases in eating disorder psychopathology over time. There was no evidence that readiness or confidence moderated outcomes for people with atypical AN. This study suggests that the moderators that have been identified for other eating disorders may not apply for people with atypical AN and highlights a need for future work to routinely investigate whether theoretically or empirically driven variables moderate outcomes in this little‐understood population. People with bulimia nervosa with higher readiness and confidence experienced greater decreases in eating disorder symptoms than people with lower readiness and confidence when treated with cognitive behavioral therapy. These findings did not apply to people with atypical anorexia nervosa. Results demonstrate that future work is urgently required to identify helpful treatments for people with atypical anorexia nervosa as well as the variables that have a positive impact on outcomes in treatment for these in iduals.
Unresolved Issues Regarding Homework Assignments in Cognitive and Behavioural Therapies: An Expert Panel Discussion at AACBT
Publisher: Cambridge University Press (CUP)
Date: 09-2010
Abstract: This article presents a panel discussion on the integration of homework assignments into cognitive behaviour therapy sessions. The panel comprised experts in research and practice who had been invited as keynote presenters for the 32nd National Conference for the Australian Association of Cognitive and Behaviour Therapy. Experts responded to questions about the definition of homework, the mechanism by which homework produces its effects, and the relative importance of homework adherence for effective therapy. Interwoven through the discussion was an emphasis on a collaborative approach to homework, as well as specific recommendations for the integration of homework into sessions. Selected case illustrations were also discussed.
Characteristics of interview refusers: Women who decline to participate in interviews relating to eating
Publisher: Wiley
Date: 07-1997
DOI: 10.1002/(SICI)1098-108X(199707)22:1<95::AID-EAT13>3.0.CO;2-H
Abstract: The aim of this study was to compare the eating habits and weight ranges of 27 women who refused to participate in a semistructured interview on eating with 25 women who agreed to participate, to determine if there were any systematic differences between the two groups. The women had previously completed a general psychiatric interview that also included a lifetime DSM-III-R diagnosis of eating disorders. About 2 years after this interview, the women were asked to participate in an interview that would specifically examine eating behaviors. In contrast to the results of previous studies, this study found that there was no difference between women who refused or agreed to participate in an interview about eating, in terms of their eating problems or weight ranges. It seems that eating or weight problems need not be overrepresented in groups who refuse to participate in surveys about eating, thereby undermining the accuracy of prevalence rates in the general population. Suggestions for achieving this representation are discussed.
Health psychology in action: Psycho-oncology
Publisher: Informa UK Limited
Date: 11-2005
Depressive symptoms, alcohol and other drug use, and suicide risk: Prevention and treatment effects from a two‐country online eating disorder risk reduction trial
Publisher: Wiley
Date: 23-12-2018
DOI: 10.1002/EAT.23005
Abstract: Eating disorders are known to have high comorbidity, and the current report outlines the impact of an online eating disorder risk reduction program on brief, self-report measures of depressive symptoms, alcohol and other drug use, and suicidality. An online pragmatic, randomized-controlled trial was conducted with N = 316 young-women (M age = 20.80 years) across Australia and New Zealand. Media Smart-Targeted (MS-T) was a 9-module program released weekly while control participants received positive body image tips. Prevention effects (asymptomatic at baseline) and treatment effects (symptomatic at baseline) were investigated. MS-T participants were 94% and 91% less likely than controls to develop Moderate or higher depressive symptoms at 6-month (MS-T = 3.3% controls = 35.4%) and 12-month follow-up (MS-T = 3.4% controls = 29.4%), respectively. MS-T participants did not commence using recreational drugs at any assessment point, compared to 18.2% of controls at a least one assessment point. Regarding treatment effects, MS-T participants were 84% more likely to no longer be using recreational drugs at 12-month follow-up (MS-T = 60% controls = 21.1%). Mutitvariate logistic regressions revealed group, depressive symptoms and alcohol use to be significant predictors of elevated suicide risk, where being an MS-T participant, without depressive symptoms and not drinking alcohol, significantly lowered likelihood of developing elevated suicide risk. Disordered eating at post-program mediated the relationship between group and depressive symptoms across post-program to 12-mnoth follow-up. MS-T shows promise as a program with important mental health benefits in addition to previous reports of lowered eating disorder diagnosis, risk and impairment.
Age differences in genetic and environmental influences on weight and shape concerns
Publisher: Wiley
Date: 10-11-2010
DOI: 10.1002/EAT.20772
Examination of the difficulties in emotion regulation scale and its relation to disordered eating in a young female sample
Publisher: Wiley
Date: 23-03-2014
DOI: 10.1002/EAT.22278
Abstract: Difficulties with emotion regulation is considered an important maintaining factor of disordered eating. One of the most commonly used measures of this construct is the Difficulties in Emotion Regulation Scale (DERS). The aim of this study was to explore the factor structure of this measure in young females and to examine its reliability and validity with respect to disordered eating. Females aged 17-25 years (M age = 19.6 years, N = 486) were examined in the analyses. Confirmatory factor analyses were conducted followed by regression analyses examining the DERS subscales as predictors of eating disorder severity and disordered eating behaviors. The original 6-factor 36-item model did not fit well and analyses indicated a 6-factor 30-item solution was a more suitable fit for our population. Validity and reliability of the 30-item solution were found to be acceptable. Regression analyses also indicated the 36- and 30-item models were able to adequately predict eating disorder severity and disordered eating behaviors with the "Awareness" and "Goals" subscales being predictors of the former, and the "Impulsivity" subscale being a significant predictor of the latter. The overall findings suggest that an abbreviated version of the DERS might be more appropriate than the original version with young females and that this measure exhibits stronger relationships with eating disorder severity and disordered eating behaviors than the longer version. Further examinations of the psychometric properties of the DERS with clinical populations are indicated.
A systematic review and meta-analysis of intensive treatment options for adults with eating disorders
Publisher: Elsevier BV
Date: 10-2023
Measures of body image: Confirmatory factor analysis and association with disordered eating.
Publisher: American Psychological Association (APA)
Date: 02-2018
DOI: 10.1037/PAS0000461
Abstract: The current study aimed to examine the factor structure, reliability, and validity of 3 measures of body image disturbance (body image flexibility, body avoidance, and body checking) considered to be relevant to eating disorder psychopathology, with the aim of determining the optimal structure of each for use in treatment planning and outcome monitoring. Additionally, the study aimed to identify which factors had the strongest association with disordered eating. Participants were 328 female undergraduate university students aged 17-25 years. Confirmatory factor analyses were conducted followed by correlational, regression, and
Epidemiology of Eating Disorders
Publisher: Wiley
Date: 14-04-2011
Perfectionism interventions targeting disordered eating: A systematic review and meta‐analysis
Publisher: Wiley
Date: 17-02-2021
DOI: 10.1002/EAT.23483
A Twin Study of Alcohol Dependence, Binge Eating, and Compensatory Behaviors
Publisher: Alcohol Research Documentation, Inc.
Date: 09-2013
Treatment of co-occurring food avoidance and alcohol use disorder in an adult: Possible avoidant restrictive food intake disorder?
Publisher: Wiley
Date: 02-02-2018
DOI: 10.1002/EAT.22832
Abstract: This case report details the presentation and treatment of a 42-year-old male self-presenting for treatment who reported having been a restrictive eater since childhood since adolescence he had failed to meet appropriate nutritional intake with one meal at night followed by around 10-20 standard alcoholic drinks. Ten sessions of cognitive behavioral therapy were offered emphasizing the need to adhere to regular eating patterns in conjunction with significant reduction of binge drinking. At the end of treatment, and 1-month follow-up, improvements in nutritional intake and alcohol intake were observed, accompanied by improvements in depression, anxiety, and stress. However, excessive alcohol intake had reoccurred at 3-month follow-up, accompanied by increases in negative affect and impairment due to eating, indicating that longer-term therapy may be required for this group of people.
A framework for conceptualising early intervention for eating disorders
Publisher: Wiley
Date: 25-11-2022
DOI: 10.1002/ERV.2959
Abstract: This paper outlines the evidence base for early intervention for eating disorders provides a global overview of how early intervention for eating disorders is provided in different regions and settings and proposes policy, service, clinician and research recommendations to progress early intervention for eating disorders. Currently, access to eating disorder treatment often takes many years or does not occur at all. This is despite neurobiological, clinical and socioeconomic evidence showing that early intervention may improve outcomes and facilitate full sustained recovery from an eating disorder. There is also considerable variation worldwide in how eating disorder care is provided, with marked inequalities in treatment provision. Despite these barriers, there are existing evidence‐based approaches to early intervention for eating disorders and progress is being made in scaling these. We propose action steps for the field that will transform eating disorder service provision and facilitate early detection, treatment and recovery for everyone affected by eating disorders, regardless of age, socioeconomic status and personal characteristics.
Reducing the onset of negative affect in adolescents: Evaluation of a perfectionism program in a universal prevention setting
Publisher: Elsevier BV
Date: 04-2015
DOI: 10.1016/J.BRAT.2015.02.007
Abstract: The aim of the current study was to evaluate a prevention program targeting unhelpful perfectionism and self-compassion, designed to prevent growth of negative affect (NA). Four schools participated in the research, where grade levels were allocated to either the intervention ("Healthy Minds") or the control condition (N = 688 in iduals mean age 14.90 years), and assessments occurred at baseline, post-intervention, and 6- and 12-month follow-up. There were no significant between group differences at post-intervention but at 6-month follow-up the intervention group had significantly lower unhelpful perfectionism, self-criticism and NA than the controls. Only significant between-group differences in unhelpful perfectionism were retained at 12-month follow-up (Cohen's d = .24). Examination of the sub-group lower in NA at baseline showed the intervention group was significantly less likely to have elevated NA at 6-month follow-up than controls, indicating a prevention effect. The effects obtained in the current study provide support for the utility of a perfectionism intervention for reducing transdiagnostic outcomes, including unhelpful perfectionism, self-judgment, and NA, and preventing the growth of NA. Ways of producing longer terms effects for NA need to be further investigated, as does the impact of the intervention on different types of psychopathology. ACTRN12614000650695.
How many individuals achieve symptom abstinence following psychological treatments for bulimia nervosa? A meta‐analytic review
Publisher: Wiley
Date: 08-02-2018
DOI: 10.1002/EAT.22838
Abstract: It is unclear how many patients with bulimia nervosa (BN) completely abstain from the core behavioral symptoms after receiving psychological treatment. The present meta-analysis of randomized controlled trials (RCTs) aimed to (a) estimate the prevalence of patients who abstain from binge eating and/or purging following all psychological treatments for BN, and (b) test whether these abstinence estimates are moderated by the type of treatment modality delivered, the definition of abstinence applied, and trial quality. Forty-five RCTs were included, with 78 psychotherapy conditions. Pooled event rates were calculated using random effects models. At post-treatment, the total weighted percentage of treatment-completers who achieved abstinence was 35.4% (95% CI = 29.6, 41.7), while the total weighted percentage of abstinence for all randomized patients (intention-to-treat) was 29.9% (95% CI = 25.7, 33.2). Abstinence estimates were highest in trials that used behavioral-based treatments (e.g., cognitive-behavioral therapy, behavior therapy). There was also evidence that guided self-help interventions produced the lowest post-treatment abstinence rates, but with no difference at follow-up from clinician-led treatments, and studies that used a shorter timeframe for defining abstinence (i.e., 14 days symptom-free compared to 28-days symptom-free) produced the highest abstinence rates. Abstinence estimates at follow-up for both the completer (34.6% 95% CI = 29.3, 40.2) and intention-to-treat (28.6% 95% CI = 25.1, 32.3) analyses were essentially the same as the post-treatment estimates. Over 60% of patients fail to fully abstain from core BN symptoms even after receiving our most empirically-supported treatments. The present findings highlight the urgency toward improving the effectiveness of psychological treatments for BN.
Bulimic symptomatology: The role of adaptive perfectionism, shape and weight concern, and self-esteem
Publisher: Elsevier BV
Date: 09-2011
DOI: 10.1016/J.BRAT.2011.04.002
Abstract: An interactive model implicating high perfectionism, high weight and shape concern, and low self-esteem in the onset and maintenance of bulimic symptoms (Bardone, Vohs, Abramson, Heatherton, & Joiner, 2000 Vohs, Bardone, Joiner, Abramson, & Heatherton, 1999) has received mixed support. This study aimed to replicate the cross-sectional model in a clinical s le of women with eating disorders, and to investigate whether the model could predict changes in binge eating and purging at the end of treatment. Eating disorder outpatients (n=353) completed measures of perfectionism, weight/shape concern, self-esteem, and bulimic symptoms at pre-treatment and discharge. Contrary to the hypotheses, the three-way interaction did not predict binge eating or purging cross-sectionally or prospectively as a moderator of psychotherapy outcome. It was concluded that the robustness of the interactive model seems questionable and may be impacted by an inadequate conceptualization of the perfectionism construct.
Online imagery rescripting among young women at risk of developing an eating disorder: A randomized controlled trial
Publisher: Wiley
Date: 31-08-2020
DOI: 10.1002/EAT.23370
Evaluating the efficacy of a self-guided Web-based CBT intervention for reducing cancer-distress
Publisher: Springer Science and Business Media LLC
Date: 07-08-2016
DOI: 10.1007/S00520-015-2867-6
Abstract: This study evaluated the efficacy of a self-guided Web-based cognitive behaviour therapy (CBT) intervention compared to an attention control in improving cancer-related distress, health-related quality of life (HRQOL), and maladaptive coping, among people recently diagnosed with cancer. Sixty in iduals with cancer diagnosed in the previous 6 months and receiving treatment with curative intent were randomised to receive either the 6-week intervention Cancer Coping Online (CCO: n = 30) or the 6-week Web-based attention control (n = 30). Outcome measures, including cancer distress (the Posttraumatic Stress Scale - Self-Report), general distress (Depression Anxiety Stress Scale), quality of life (EORTC QLQ-C30), and coping (mini-MAC), were administered at baseline, immediately post-intervention, and at 3 and 6 months post-intervention. Significant main effects for time were found for cancer distress, global QOL, physical function, role function, social function, and anxious preoccupation. Post hoc between-group comparisons showed CCO participants had statistically significantly higher physical functioning compared to controls at 3 months of follow-up (d = -0.52, p = 0.02). Furthermore, compared to controls, post hoc comparisons found moderate between-group effect sizes favouring CCO post-intervention for cancer distress (d = 0.43) and anxious preoccupation (d = 0.38), and at 6 months of follow-up for global QOL (d = -0.43). These results provide preliminary support for the potential efficacy of a self-guided Web-based CBT programme in improving aspects of HRQOL, cancer-related distress, and anxious preoccupation after cancer diagnosis. This paper provides justification for, and will help inform the development of, subsequent larger multi-site studies.
Finding My Way
Publisher: Springer Science and Business Media LLC
Date: 30-04-2015
Relationship between eating disorder duration and treatment outcome: Systematic review and meta‐analysis
Publisher: Wiley
Date: 28-08-2020
DOI: 10.1002/EAT.23373
Developing shared understandings of recovery and care: a qualitative study of women with eating disorders who resist therapeutic care
Publisher: Springer Science and Business Media LLC
Date: 12-2016
A review of the definitions of outcome used in the treatment of bulimia nervosa
Publisher: Elsevier BV
Date: 06-2012
DOI: 10.1016/J.CPR.2012.01.006
Abstract: There are many terms used to describe treatment outcome for bulimia nervosa. However, the way such terms are conceptualised across various studies differs dramatically, making comparison of outcomes difficult. A consensus working definition of pivotal terms such as remission and recovery is important if treatments are to be adequately evaluated and clinical meaning derived for in iduals with bulimia nervosa (BN). The central aim of the current review was to identify different definitions of remission and recovery and their utility in terms of client outcome after treatment for BN. Seventy one unique published treatment studies were identified that used 82 different outcome measures, of which 63 (77%) used behavioural outcomes only, with the most commonly used outcome (n=7 studies) being an abstinence of bingeing and vomiting for a 4 week period. The problems with the definitions of outcomes used to date are explored, and the implications of research in anorexia nervosa for forming consensus definitions of remission and recovery for BN will be examined. In addition, the review highlights the importance of considering the relationship between quality of life and outcome in assessing the "goodness of fit" of a definition of outcome.
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Start Date: 11-2011
End Date: 06-2016
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