Glenn Waller

The University of Sheffield | Sheffield · Department of Psychology (Faculty of Science)

Objective The relationship between self‐reported interpersonal difficulties and eating disorder symptoms is well‐established. The Interpersonal Relationships in Eating Disorders (IR‐ED) is a new measure of eating‐specific interpersonal difficulties (food‐related isolation, avoidance of body evaluation, foot‐related interpersonal tension). This stud...

Objective This experimental study investigated the weight loss parameters and resulting end weight that influence clinician confidence in diagnosing atypical anorexia nervosa (AAN). Methods Clinicians ( N = 67) read a series of vignettes where patient weight loss and end weight varied, then rated their confidence in an AAN diagnosis and alternativ...

Objective Interpersonal problems have been identified as a plausible mechanism underlying the onset and maintenance of eating disorders. The Interpersonal Relationships in Eating Disorders (IR‐ED) scale is the first eating disorders‐specific measure of interpersonal problems, which was developed in a nonclinical sample. The aims of the current stud...

People with eating disorders are often placed on lengthy waitlists for treatment. This is problematic, as increased time spent on waitlists has been shown to predict dropout. We examined whether providing brief interventions to people on a waitlist improved retention or outcomes in treatment. Participants (N = 85) were referred to a university trai...

Purpose of Review Eating disorders require more effective therapies than are currently available. While cognitive behavioural therapy for eating disorders (CBT-ED) has the most evidence to support its effectiveness, it requires substantial improvement in order to enhance its reach and outcomes, and to reduce relapse rates. Recent years have seen a...

Eating disorders are serious conditions that can be hard to treat; however, the chances of overcoming an eating disorder increase when exposure therapy is used as part of the overall treatment strategy. Exposure therapy involves confronting (rather than avoiding) challenging scenarios that evoke distress, and though this technique has typically bee...

Eating disorders are serious conditions that can be hard to treat; however, the chances of overcoming an eating disorder increase when exposure therapy is used as part of the overall treatment strategy. Exposure therapy involves confronting (rather than avoiding) challenging scenarios that evoke distress, and though this technique has typically bee...

Eating disorders are serious conditions that can be hard to treat; however, the chances of overcoming an eating disorder increase when exposure therapy is used as part of the overall treatment strategy. Exposure therapy involves confronting (rather than avoiding) challenging scenarios that evoke distress, and though this technique has typically bee...

Eating disorders are serious conditions that can be hard to treat; however, the chances of overcoming an eating disorder increase when exposure therapy is used as part of the overall treatment strategy. Exposure therapy involves confronting (rather than avoiding) challenging scenarios that evoke distress, and though this technique has typically bee...

Eating disorders are serious conditions that can be hard to treat; however, the chances of overcoming an eating disorder increase when exposure therapy is used as part of the overall treatment strategy. Exposure therapy involves confronting (rather than avoiding) challenging scenarios that evoke distress, and though this technique has typically bee...

Eating disorders are serious conditions that can be hard to treat; however, the chances of overcoming an eating disorder increase when exposure therapy is used as part of the overall treatment strategy. Exposure therapy involves confronting (rather than avoiding) challenging scenarios that evoke distress, and though this technique has typically bee...

Eating disorders are serious conditions that can be hard to treat; however, the chances of overcoming an eating disorder increase when exposure therapy is used as part of the overall treatment strategy. Exposure therapy involves confronting (rather than avoiding) challenging scenarios that evoke distress, and though this technique has typically bee...

Eating disorders are serious conditions that can be hard to treat; however, the chances of overcoming an eating disorder increase when exposure therapy is used as part of the overall treatment strategy. Exposure therapy involves confronting (rather than avoiding) challenging scenarios that evoke distress, and though this technique has typically bee...

Eating disorders are serious conditions that can be hard to treat; however, the chances of overcoming an eating disorder increase when exposure therapy is used as part of the overall treatment strategy. Exposure therapy involves confronting (rather than avoiding) challenging scenarios that evoke distress, and though this technique has typically bee...

Eating disorders are serious conditions that can be hard to treat; however, the chances of overcoming an eating disorder increase when exposure therapy is used as part of the overall treatment strategy. Exposure therapy involves confronting (rather than avoiding) challenging scenarios that evoke distress, and though this technique has typically bee...

Eating disorders are serious conditions that can be hard to treat; however, the chances of overcoming an eating disorder increase when exposure therapy is used as part of the overall treatment strategy. Exposure therapy involves confronting (rather than avoiding) challenging scenarios that evoke distress, and though this technique has typically bee...

Eating disorders are serious conditions that can be hard to treat; however, the chances of overcoming an eating disorder increase when exposure therapy is used as part of the overall treatment strategy. Exposure therapy involves confronting (rather than avoiding) challenging scenarios that evoke distress, and though this technique has typically bee...

Eating disorders are serious conditions that can be hard to treat; however, the chances of overcoming an eating disorder increase when exposure therapy is used as part of the overall treatment strategy. Exposure therapy involves confronting (rather than avoiding) challenging scenarios that evoke distress, and though this technique has typically bee...

Eating disorders are serious conditions that can be hard to treat; however, the chances of overcoming an eating disorder increase when exposure therapy is used as part of the overall treatment strategy. Exposure therapy involves confronting (rather than avoiding) challenging scenarios that evoke distress, and though this technique has typically bee...

Eating disorders are serious conditions that can be hard to treat; however, the chances of overcoming an eating disorder increase when exposure therapy is used as part of the overall treatment strategy. Exposure therapy involves confronting (rather than avoiding) challenging scenarios that evoke distress, and though this technique has typically bee...

Eating disorders are serious conditions that can be hard to treat; however, the chances of overcoming an eating disorder increase when exposure therapy is used as part of the overall treatment strategy. Exposure therapy involves confronting (rather than avoiding) challenging scenarios that evoke distress, and though this technique has typically bee...

Eating disorders are serious conditions that can be hard to treat; however, the chances of overcoming an eating disorder increase when exposure therapy is used as part of the overall treatment strategy. Exposure therapy involves confronting (rather than avoiding) challenging scenarios that evoke distress, and though this technique has typically bee...

Eating disorders are serious conditions that can be hard to treat; however, the chances of overcoming an eating disorder increase when exposure therapy is used as part of the overall treatment strategy. Exposure therapy involves confronting (rather than avoiding) challenging scenarios that evoke distress, and though this technique has typically bee...

Eating disorders are serious conditions that can be hard to treat; however, the chances of overcoming an eating disorder increase when exposure therapy is used as part of the overall treatment strategy. Exposure therapy involves confronting (rather than avoiding) challenging scenarios that evoke distress, and though this technique has typically bee...

Eating disorders are serious conditions that can be hard to treat; however, the chances of overcoming an eating disorder increase when exposure therapy is used as part of the overall treatment strategy. Exposure therapy involves confronting (rather than avoiding) challenging scenarios that evoke distress, and though this technique has typically bee...

Eating disorders are serious conditions that can be hard to treat; however, the chances of overcoming an eating disorder increase when exposure therapy is used as part of the overall treatment strategy. Exposure therapy involves confronting (rather than avoiding) challenging scenarios that evoke distress, and though this technique has typically bee...

Background There is currently a limited understanding of the identification, nature, and treatment of Atypical Anorexia Nervosa (AAN). Recent systematic reviews have identified only small numbers of candidate papers, and some areas lack any meaningful review so far – particularly treatment outcomes. A key issue is the lack of clarity in the literat...

Objective Brief and accessible therapies for people with an eating disorder is an important health target. Ten‐session cognitive behavioural therapy (CBT‐T) is a brief treatment evaluated in people with a non‐underweight eating disorder. This study aimed to evaluate the feasibility and preliminary effectiveness of CBT‐T for young people in primary...

Eating disorders are serious conditions that can be hard to treat; however, the chances of overcoming an eating disorder increase when exposure therapy is used as part of the overall treatment strategy. Exposure therapy involves confronting (rather than avoiding) challenging scenarios that evoke distress, and though this technique has typically bee...

Evidence-based cognitive-behaviour therapy for eating disorders (CBT-ED) differs from other forms of CBT for psychological disorders, making existing generic CBT measures of therapist competence inadequate for evaluating CBT-ED. This study developed and piloted the reliability of a novel measure of therapist competence in this domain-the Cognitive...

Objective: Eating disorders are associated with significant illness burden and costs, yet access to evidence-based care is limited. Greater use of programme-led and focused interventions that are less resource-intensive might be part of the solution to this demand-capacity mismatch. Method: In October 2022, a group of predominantly UK-based clin...

Mixed findings exist regarding whether athletes have different levels of body image concerns to non-athletes. Such body image concerns have not been reviewed recently, meaning that new findings need to be incorporated into our understanding of the adult sporting population. This systematic review and meta-analysis aimed first to characterise body i...

State body shame is a risk factor for eating disorders, and self-compassion is emerging as a potentially effective treatment option in such cases. This study tested the efficacy of a brief (15-minute) self-compassion intervention in reducing state body shame. Using dismantling trial methodology, participants were randomly allocated to an active com...

Objective: CBT-T is a brief (10-week) cognitive-behavioral therapy for non-underweight eating disorders. This report describes the findings from a single center, single group, feasibility trial of online CBT-T in the workplace as an alternative to health service settings. Method: This trial was approved by the Biomedical and Scientific Research...

The aims of this study were to determine the effectiveness of an adapted version of the Body Project for young Saudi women, and to determine the impact of compliance (i.e. adherence to homework and attendance) on outcomes. A randomized controlled trial was used, allocating Saudi undergraduate females (N = 92; mean age = 20.48 years; SD = 2.28) to e...

Exposure therapy is effective but widely underused. Numerous studies indicate therapist factors that might explain this pattern of underuse. This systematic review and meta-analysis synthesised those previous research findings, to identify which therapist factors are clearly associated with their intent to use exposure therapy. A systematic review...

Objective: Brief cognitive-behavioral therapy for non-underweight eating disorders (CBT-T) has been shown to be clinically useful in non-underweight samples, when delivered one-to-one. This pilot study assessed the acceptance, compliance and feasibility levels of a group version of CBT-T, which has the potential to enhance patient access. Method:...

Background and objectives Two experimental studies examined the impact that body comparison has on women's body satisfaction and self-esteem. The two studies differed in the use of a human comparator or an avatar (non-human) comparator. The independent variables were the type of body comparison (upward, downward and neutral) and the perceived perso...

Exposure therapy is a critical evidence-based treatment for eating disorders, addressing a range of symptoms. However, it is substantially underused and is not always well understood by clinicians. This chapter outlines ways in which exposure therapy needs to be adapted for eating disorders, allowing for risk management and nutritional recovery. It...

Objective: Treatment guidelines recommend that people with non-underweight eating disorders should receive up to 20 sessions of eating-disorder-focused cognitive behavioural therapy (CBT-ED). The present study reviewed ten studies of 10-session cognitive behavioural therapy for non-underweight patients (CBT-T). Method: We conducted a systematic rev...

Background and Objectives It has been suggested that body comparison is a safety behavior in eating disorders. This experimental study investigates the causal impact of upward and downward body comparison on body image, eating pathology, self-esteem, anxiety and mood. It also considers whether trait body comparison and eating pathology are associat...

Objective: CBT-T is a brief (10 sessions) version of cognitive behavioral therapy for non-underweight eating disorders. This report describes the protocol for a single center, single group, feasibility trial of online CBT-T in the workplace as an alternative to the health-service setting. By offering mental health services for eating disorders in...

This study assessed the feasibility and effectiveness of two brief online interventions for body shame for women with moderate to severe negative body image, to inform the design of a future randomized controlled trial. The primary feasibility outcomes were recruitment, measure completion rates, retention rates, and internet connection failure rate...

Background & Aims Dietetic involvement in eating disorder (ED) treatment is often initiated by other members of a patient’s treating team. This 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 decis...

PurposeThe main aim of this study was to test the feasibility of an adapted version of the Body Project for young Saudi women as their eating and body issues are comparable to western culture and linked to internalization of westernization. The study also aims to assess predictors of attrition and preliminary effectiveness.Method The intervention w...

Purpose This longitudinal study aims to determine what factors mediate the previously established link between self-compassion and eating pathology/body image concerns, over a 6-month period. Methods A community sample of 274 adult women (M = 29.50 years) completed standardised validated measures of self-compassion (Self-Compassion Scale), ruminat...

Background and objectives Clinicians often fail to deliver the best psychological treatments available, especially if they perceive their patients as fragile or vulnerable. This fragility might be interpreted by clinicians through their internalised gender stereotypes (e.g. female patients are less resilient to a demanding treatment) or according t...

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 individual 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 con...

Purpose of review: This review summarizes recent developments in cognitive-behavioural therapy for eating disorders (CBT-ED). More specifically, the past five years were covered, with the latest UK and Dutch guidelines for eating disorders as a starting benchmark, and with special consideration of the past 18 months. Recent findings: The new res...

Purpose This study addressed the prevalence of eating disorders and levels of eating pathology, body image, and psychological comorbidities in undergraduate women in Saudi Arabia. It examined the role of the current internalization of western culture that is under way in that country, focusing on political and economic issues rather than on issues...

Chairwork refers to a collection of experiential interventions which utilise chairs, their positioning, movement, and dialogue to facilitate therapeutic change. Chair-based methods are used in several models of psychotherapy, including cognitive behavioural therapy (CBT). However, little is known about cognitive behavioural therapists’ use and atti...

Brief cognitive behavioural therapy (CBT) is effective in working with non-underweight eating disorder patients across transdiagnostic groups. However, it is not clear whether it will be as effective in the treatment of binge-eating disorder, where emotional eating is likely to play a larger role than starvation-driven eating. This case series test...

This study examined whether rumination, shame, self-criticism, and perfectionism mediate the previously established link between self-compassion and both eating and body image concerns. A cross-sectional online survey was completed by a community sample of non-clinical adult women (n = 369) and men (n = 201). Participants completed standardised mea...

Objective: Outcome measurement in youth with eating disorders relies heavily on self-report, which is problematic in a population that may deny or minimize symptoms. Caregiver-report measures are lacking. This study examined the psychometric and clinical properties of a newly-developed measure designed to assess short-term change in eating disorde...

Background The UK Government's implementation in 2008 of the Improving Access to Psychological Therapies (IAPT) initiative in England has hugely increased the availability of cognitive behavioural therapy (CBT) for the treatment of depression and anxiety in primary care. Counselling for depression—a form of person-centred experiential therapy (PCET...

Early response is a well-established predictor of positive outcomes at the end of psychological treatments for common mental disorders. There is some prior evidence that this conclusion also applies to eating disorders, including three meta-analyses, but no moderators of that relationship have been identified. However, a number of further papers ha...

Outpatient care (e.g., individual, group, or self‐help therapies) and day treatment programs (DTPs) are common and effective treatments for adults with eating disorders. Compared to outpatient care, DTPs have additional expenses and could have unintended iatrogenic effects (e.g., may create an overly protective environment that undermines self‐effi...

Alliance and adherence to therapeutic techniques are key elements of Cognitive Behavioural Therapy (CBT). Therapists’ beliefs about how important alliance and technique adherence are throughout CBT might impact how they deliver therapy. Furthermore, these beliefs might or might not be congruent with patients’ therapy-related beliefs. This research...

Clinicians often omit or underuse several techniques while delivering therapy. These omissions can be due to unconscious factors (e.g., clinician’s anxiety), or due to clinicians’ deliberate decisions (e.g., modifying therapy believing that such modifications are on the patients’ best interests). However, little is known about whether patients cons...

Objective While there is evidence to support the use of group dialectical behavior therapy (DBT) in the treatment of binge‐eating disorder (BED), treatment is relatively long compared with other evidence‐based treatments. This study explored the effectiveness of brief DBT groups for BED, delivered in a routine community setting. Method Eighty‐four...

The current literature extensively recommends making cultural adaptations to psychological therapies, in order to address the differences in values, beliefs and attitudes that patients from different ethnic groups might hold. Although this approach has shown positive outcomes in some settings, it is not well established yet whether such adaptations...

Objective Despite evidence supporting the use of measures to track ongoing progress and outcome in treatment, there is a relative absence of measures that are appropriate for this purpose in youth with eating disorders. This study examined the psychometric properties of the Eating Disorder‐15 for Youth (ED‐15‐Y) scale, including its ability to dete...

Objective Whilst there is evidence to support the use of group dialectical behavioral therapy (DBT) in the treatment of binge‐eating disorder (BED), few studies have reported on its effectiveness when delivered in routine clinical practice. This study addressed this gap by exploring the effectiveness of group DBT for BED when delivered in a communi...

Purpose This study reports on the development and validation of a brief and widely applicable measure of body comparison (the Comparison of Self-Scale—CoSS), which is a maintaining feature of eating disorders. Methods A sample of 412 adults completed the CoSS, an existing measure of aspects of body comparison, and eating pathology and associated s...

Objective Cognitive‐behavioural therapy (CBT) is an efficacious and effective treatment for eating disorders, and is particularly valuable in the treatment of non‐underweight cases (e.g., bulimia nervosa; binge eating‐disorders). However, its recommended length for such cases (up to 20 sessions) makes it a relatively costly therapy. It has been sug...

Despite evidence that exposure therapy is an effective way to treat anxiety, many clinicians fail to implement it appropriately. The current review investigated whether training can improve practicing clinicians’ beliefs about and implementation of exposure therapy. A systematic search of four databases (PsycINFO, Medline, Scopus, and ProQuest Diss...

This editorial reports on an anonymous survey question posed to eating disorders researchers about changes the International Journal of Eating Disorders (IJED) should implement to support the eating disorders research community affected by COVID‐19. The editorial accompanies an IJED article that details responses to the larger survey focusing more...

Objective The coronavirus pandemic has led to a dramatically different way of working for many therapists working with eating disorders, where telehealth has suddenly become the norm. However, many clinicians feel ill equipped to deliver therapy via telehealth, while adhering to evidence‐based interventions. This article draws together clinician ex...

Eating disorders are severe mental health conditions, with substantial consequences for health and quality of life. Such disorders are strongly associated with body image concerns. It is important to consider treatments that might enhance our ability to treat such cases. Recently, there has been a growing body of research on self-compassion in rela...

In addition to the institutional barriers to exposure that are often present in higher levels of care for eating disorders, there are also clinician-level barriers that need to be addressed across clinical settings. In particular, there is a well-documented tendency for clinicians to endorse concerns about the safety and tolerability of exposure th...

This chapter provides an overview of the current evidence supporting the use of exposure therapy for eating disorders. Although further research is needed (because the existing research base is relatively small compared to large exposure literature for anxiety disorders), exposure is an effective approach for addressing key transdiagnostic features...

Body image disturbances play a central role in the development and maintenance of eating disorders and are maintained, in part, by body avoidance. Exposure-based strategies are effective in reducing the cognitive, affective, and behavioral features of body image disturbances. Mirror exposure is a body-focused treatment intervention that has amassed...

Many patients who have experienced difficulties with binge eating continue to do so even after nutritional stabilization. This can happen because they experience learned cues that trigger strong food cravings. Cue exposure can be useful to address such binge eating. This technique involves confronting the cues that typically elicit heightened food...

Exposure therapy is a core component of evidence-based treatments for eating disorders (EDs), including cognitive-behavioral therapy and family-based treatment. Despite this, existing treatment guides give relatively limited attention to the clinical issues associated with good implementation of exposure. This book is designed to augment a wide var...

Clinicians should strive to change their patients’ responses to anxiety via exposure therapy so that key symptoms are reduced. When planning exposure therapy, clinicians should (a) consider their patients’ everyday lives and how anxiety is generating problems in eating, body image, etc.; (b) aim to teach patients, via exposure activities, that thei...

The aim of this chapter is to help clinicians think through some of the nuts and bolts of doing exposure. Exposure clinicians have many choices to make throughout the therapy process. This chapter considers questions related to the use of hierarchies in exposure, the speed at which patients progress through feared stimuli, the titration of anxiety,...

Regular, open weighing is a critical component of evidence-based treatments for eating disorders. Weight provides critical information for violating patients’ harm expectancies, and weighing offers a powerful learning opportunity for coping with anxiety. However, many clinicians collude with their patients in avoiding open weighing. The clinician’s...

Exposure therapy is an extremely powerful technique for reducing pathological anxiety. As demonstrated in this chapter, this very common-sense strategy can be adapted to address a wide range of anxiety-based disorders. Although the efficacy of exposure has been long recognized, researchers and clinicians continue to find new ways to adapt exposure...

Eating disorders are serious mental health disorders that are associated with significant morbidity and mortality. This chapter provides eating disorders clinicians with the necessary understanding of both the differences associated with specific ED diagnoses and the transdiagnostic features that commonly present across diagnoses. Many, if not all,...

Given that one of the main objectives of exposure therapy is to alter individuals’ cognitions related to feared stimuli, cognitive therapy can be effectively used as an adjunctive strategy to exposure. However, it is important to note that behavioral change methods show greater effectiveness in reducing eating disorder symptoms as compared to cogni...

This chapter provides the rationale for using exposure therapy for eating disorders. Exposure is a very intuitive, albeit anxiety-provoking, intervention. Over the years, a number of models have been proposed to explain how exposure works. Although no one knows for sure exactly how exposure works, the recent inhibitory learning model offers a numbe...

Although exposure-based treatments are most commonly implemented in an individual therapy format, involving families in exposure can boost the likelihood of a successful treatment outcome. Many families will need instruction and careful guidance from clinicians in sidestepping the common pitfalls of accommodating their loved one’s eating disorder s...

Three relatively novel approaches to the use of exposure for eating disorders are considered. Each is relatively experimental in treating eating disorders but is well established in treating anxiety-based disorders. Interoceptive exposure can be used to treat distress over bodily cues (e.g., fullness). Imaginal exposure can be used to elevate and t...

Eating disordered behaviors are often still present when starvation has been reduced because they are used to reduce emotional states and to block the impact of interpersonal triggers. Exposure can be used to address both the emotional and the related interpersonal triggers to eating disordered behaviors. The Newton’s cradle model is used to formul...

Patients with eating disorders experience substantial fear of food and eating. Clinicians can use exposure to address the anxiety that underpins that fear. Specific foods are addressed, based on the nature of the fear associated with them. Sometimes patients avoid foods to reduce the fear that they will binge on them, while in other cases those foo...

This chapter outlines a theoretically based rationale for using exposure consistently in the treatment of individuals with eating disorders. Due to the substantial overlap between eating disorders and anxiety disorders (both in symptom content and in comorbidity between the conditions), exposure therapy is a sound choice for therapeutic interventio...

Providing a rationale for exposure therapy to patients is a key element to successful exposure, especially when it has not been used previously or has been used inadequately. Patients who do not understand what is involved with exposure therapy are less likely to commit to what can seem like a scary departure from their normal patterns of avoidance...

It is important to be aware of how different treatment settings and institutional barriers can undermine the effectiveness of exposure. These barriers often manifest in the team dynamic (e.g., the team that treats the exposure therapist as a threat to the patient’s equanimity), in outpatient service provision issues, and particularly in more intens...

One shared feature between eating disorders and anxiety-based disorders is the functional relationship between fears and associated avoidance and safety behaviors. Patients with eating disorders are individuals; thus, they will experience different symptoms. The clinician’s task is to understand those symptoms and plan treatment accordingly. That u...

The objective of this summary chapter is to provide readers with a synopsis of the key points made about exposure-based therapy for eating disorders throughout the book. Readers are reminded of the theoretically derived rationale for applying exposure-based therapy to eating disorders and that a growing body of literature demonstrates the efficacy...

Residential treatment is a necessary element of treatment in some cases of anorexia nervosa, where it is used prior to transitioning to complete the treatment in a less intensive setting. This study tests how effective residential treatment is at helping adolescent and adult patients to reduce their eating pathology to levels that can be managed in...

Objective: Exposure therapy is a central part of cognitive behavior therapy (CBT) for eating disorders, but is underused in routine clinical practice, at least partly because clinicians often hold very negative views about this technique. Although uncontrolled cohort studies suggest that teaching clinicians to use exposure improves their attitudes...

Background: The combination of eating disorder (ED) and the experience of childhood trauma leads to significant impairment and suffering. To improve treatment, it is critically important to study treatment effects, and the mechanism of these effects. The overall aim of the current project is to; (1) build knowledge on how to best treat patients wit...