Treating Disturbances in the Relationship Between Mothers With Bulimic Eating Disorders and Their Infants: A Randomized, Controlled Trial of Video Feedback

Department of Psychiatry, University of Oxford, Oxford, England, United Kingdom
American Journal of Psychiatry (Impact Factor: 12.3). 06/2006; 163(5):899-906. DOI: 10.1176/appi.ajp.163.5.899
Source: PubMed


Maternal eating disorders interfere with parenting, adversely affecting mother-infant interaction and infant outcome. This trial tested whether video-feedback treatment specifically targeting mother-child interaction would be superior to counseling in improving mother-child interaction, especially mealtime conflict, and infant weight and autonomy.
The participants were 80 mothers with bulimia nervosa or similar eating disorder who were attending routine baby clinics and whose infants were 4-6 months old. They were randomly assigned to video-feedback interactional treatment or supportive counseling. Both groups also received guided cognitive behavior self-help for their eating disorder. Each group received 13 sessions. The primary outcome measure was mealtime conflict; secondary outcome measures were infant weight, aspects of mother-infant interaction, and infant autonomy.
Seventy-seven mothers were followed up when their infants were 13 months old. The video-feedback group exhibited significantly less mealtime conflict than the control subjects. Nine of 38 (23.7%) in the video-feedback group showed episodes of marked or severe conflict, compared with 21 of 39 (53.8%) control subjects (odds ratio=0.27, 95% confidence interval=0.10 to 0.73). Video feedback produced significant improvements in several other interaction measures and greater infant autonomy. Both groups maintained good infant weight, with no differences between groups. Maternal eating psychopathology was reduced across both groups.
Video-feedback treatment focusing on mother-infant interaction produced improvements in interaction and infant autonomy, and both groups maintained adequate infant weight. To the authors' knowledge, this is the first controlled trial to show key improvements in interaction between mothers with postnatal psychiatric disorders and their infants.

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    • "VIPP incorporates both attachment and social learning perspectives, and specifically targets parenting capacities that are implicated in the aetiology of a range of childhood problems, including behavioural problems. It has been thoroughly evaluated in five randomised controlled trials with mothers and infants (Juffer, Bakermans-Kranenburg, & van IJzendoorn, 2005; Kalinauskiene et al., 2009; Klein Velderman, Bakermans-Kranenburg, Juffer, & van IJzendoorn, 2006; Stein et al., 2006; van Zeijl et al., 2006). It is a brief (four to six session), home-based intervention (both features that are likely to enhance the participation and engagement of fathers). "
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    • "Sensitive discipline includes childoriented discipline methods, such as induction (Hoffman, 1984), empathy for the child when frustrated or angry (Lieberman, 2004), and avoidance of coercive cycles (Patterson, 1982). Studies using the VIPP approach documented positive effects on parental sensitivity or attachment security in nonclinical groups, for example, in adoptive families (Juffer, Bakermans-Kranenburg , & Van IJzendoorn, 2005), and in at risk and clinical groups, such as mothers with an insecure representation of attachment (Klein Velderman , Bakermans-Kranenburg, Juffer, & Van IJzendoorn, 2006), mothers screened for low sensitive responsiveness (Kalinauskiene, Cekuoliene, VanIJzendoorn, Bakermans-Kranenburg, & Juffer , 2007), and mothers with eating disorders and their infants (Stein et al., 2006). In a previous report on the current sample, Van Zeijl, Mesman, Van IJzendoorn, et al. (2006) showed that VIPP- SD was effective in promoting maternal sensitive discipline in the intervention group compared to the control group. "
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    • "2 This task was also used as the basis to test feasibility of a video-feedback session with the mother in the subsequent session. The video-feedback session was adapted from Stein et al. (2006) to be relevant to parents of children of this age group. Specifically, the video-recording was used to help the mother identify and challenge key maternal cognitions and behaviours that may have influenced the child's performance during the task. "
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