Simona Calugi

• Villa Garda Hospital

Objective This study investigates baseline predictors of treatment response in patients with anorexia nervosa (AN) who received an intensive 20‐week program of enhanced cognitive behavioral therapy (CBT‐E). The aim was to identify demographic, clinical, and psychosocial variables that predict treatment outcomes at the end of intensive treatment—inp...

Purpose To examine the psychometric characteristics of the Italian language versions of the child eating disorder examination (ChEDE) interview and child eating disorder examination questionnaire (ChEDE-Q). Methods ChEDE (from EDE 17th edition) and ChEDE-Q were first translated, and then administered to 147 patients with eating disorders under the...

Background/Objectives: Cognitive and psychological factors, such as eating disorder psychopathology, irrational food beliefs, and internalized weight stigma, have not been sufficiently explored in the context of obesity treatment. This study evaluated the role of these variables as predictors of weight loss in patients with severe obesity following...

Enhanced Cognitive Behaviour Therapy (CBT-E) has shown efficacy in treating adults with anorexia nervosa and bulimia nervosa and has been successfully adapted for use with adolescents with eating disorders. Multiple cohort studies involving adolescents aged between 12 and 19 years have evaluated the effectiveness of CBT-E in younger populations. Th...

Towards the end of Step Two, if the treatment is going well, the patient should experience a progressive reduction in the intensity of their concerns about eating control associated with the remission of binge-eating episodes and dysregulated eating and overeating. This is the point at which the Setbacks and Mindsets module should be introduced. Pa...

The remaining five sessions of Step One are principally focused on assessing the patient’s progress in not weighing between sessions, adopting an active lifestyle, and implementing regular eating. Another new procedure to address the patient’s eating style is introduced if it is contributing to dysregulated eating and overeating. Patients are advis...

Overvaluation of shape and weight (i.e., judging oneself predominantly or even exclusively in terms of shape and weight) is encountered in over 50% of patients with binge eating disorder (BED). It needs to be addressed by the treatment because it contributes to maintaining binge-eating episodes and predicts a negative treatment outcome in BED patie...

This module is indicated for patients in whom events and associated moods contribute to the maintenance of binge-eating episodes and other types of dysfunctional eating. This mechanism is recognizable because it leads to repeated deviations from regular eating associated with events or changes in mood. Predictable events influencing eating are addr...

The main priority of Session 1 of cognitive behaviour therapy (CBT) for binge-eating disorder (BED) is continuing to bolster patient engagement. The session starts by initiating collaborative weighing and providing personalized information about weight and weighing, including weight regulation and interpretation. The second major goal of Session 1...

Cognitive behaviour thearpy (CBT) for binge-eating disorder BED is an individual treatment. However, the significant others of adult patients (whether friends, partners, or parents) are involved in some joint sessions if they may facilitate treatment and the patient agrees to their assistance (generally in about one-third of adult cases). Three to...

This module is intended for patients with clinical obesity who are motivated to achieve reasonable and healthy weight loss, and for those with non-clinical obesity who want to improve their overall health and prevent the development of clinical obesity and other non-communicable diseases. The module is not indicated for patients who have not adopte...

Step Three of cognitive behaviour therapy (CBT) for binge-eating disorder (BED) lasts 48 weeks, with 12 sessions delivered at 4-week intervals in patients who addressed the Healthy Weight Loss module in Step Two of the tretment, that are reduced to 12 weeks, with 3 sessions every 4 weeks, in all the other patients. The focus of the sessions is on a...

Cognitive behaviour therapy (CBT) for binge-eating disorder (BED) integrates the strategies and procedures from both enanched CBT (CBT-E) for eating disorders and personalized CBT for obesity. Unlike treatments based on the “disease model”, which address the patient’s illness (e.g., BED), CBT for BED is based on the “psychological model”; it target...

Session 2 of cognitive behaviour therapy (CBT) for binge-eating disorder (BED) is mainly dedicated to reviewing and reinforcing real-time monitoring, and introducing regular eating. From Session 2 onwards, the former primarily focuses on the content of monitoring, which helps both the patient and therapist increase their understanding of the mainte...

The assessment and preparation of the patient about to start cognitive behavior therapy (CBT) for binge-eating disorder (BED) has three main goals. The first is to assess the nature and severity of the eating-disorder psychopathology using a data-driven approach. Information should be gathered on current status (i.e., current body weight, height, w...

The cognitive behaviour theory of binge-eating disorder (BED) integrates established transdiagnostic mechanisms that maintain binge-eating episodes with the cognitive and behavioural factors that play a role in the perpetuation of clinical obesity. The model hypothesizes that events triggering mood changes, overvaluation of shape and weight, and dy...

Binge-eating disorder (BED) is characterized by recurrent binge-eating episodes not followed by the regular use of compensatory behaviours. For a diagnosis of BED, these episodes are to occur at least once a week over 3 months and be accompanied by significant distress. Recent data on BED indicates a lifetime prevalence of 0.42% in men and 1.25% in...

We call the first session of cognitive behaviour therapy (CBT) for binge-eating disorder (BED) Session 0 because it represents the baseline, or starting point. It includes five components, the first of which is engaging the patient in treatment and the process of change. To this end, the therapist needs to pay careful attention to their attitude to...

The module is indicated for patients with a persistent dysfunctional diet characterized by extreme and rigid dietary rules. This eating pattern causes profound harm and is one of the main mechanisms maintaining binge-eating episodes. To help them overcome dysfunctional dieting, patients are first helped to see it as a problem, then to identify and...

The final part of Step Two in cognitive behaviour therapy (CBT) for binge-eating disorder (BED) consists of three appointments, each separated by a 2-week interval. While the session structure remains constant, the focus gradually shifts towards future-oriented goals, of which there are three. The first is assessing progress made and the residual f...

A review session is scheduled for the end of Step One to review the treatment progress and to plan for Step Two. Progress should be reviewed jointly, and any emerging obstacles to change identified. The personal formulation should be reviewed and updated if necessary, and the next stage of the treatment planned, selecting specific modules to addres...

Internalized weight stigma arises when a person, applying negative societal weight stereotypes to themselves, develops negative beliefs about themselves and other reactions due to their higher weight. When internalized weight stigma coexists with binge-eating disorder (BED), it must be addressed as it hinders the change because the nature of patien...

Satisfaction with the amount of weight lost is one the most critical factors involved in long-term body-weight maintenance. Moreover, a decline in weight-loss satisfaction about 4 to 5 months after starting the treatment is associated with poor long-term weight-loss outcomes. To address these obstacles to weight maintenance, cognitive behavior ther...

CBT for BED is organized into three steps. Step One lasts 4 weeks, involves two sessions per week, and has the goals of increasing the patient’s understanding of the cognitive behavioural mechanisms that maintain BED, reducing weight concerns and the frequency of binge-eating episodes, and adopting an active lifestyle. A Review Session is planned a...

Enhanced cognitive behavior therapy (CBT-E) is a highly personalized and flexible psychological treatment designed to address eating disorder psychopathology operating in the patient rather than their eating disorder diagnosis. The treatment was initially intended for adult outpatients but was also adapted for adolescents and intensive care setting...

Eating disorders can significantly impact the psychosocial functioning and physical health of adolescents. Early and effective treatment is crucial to prevent long-lasting and potentially devastating adverse effects. The National Institute for Health and Care Excellence has recommended cognitive behaviour therapy (CBT) for eating disorders in adole...

The Department of Eating and Weight Disorders at Villa Garda Hospital holds the distinction of being the inaugural unit in Italy solely devoted to the intensive treatment of eating disorders. Established in 1984, the unit has been notable for its pioneering approach, seamlessly integrating clinical practice with research endeavours. This unique ble...

Objective: This study aimed to compare the effectiveness of an intensive treatment based on enhanced cognitive-behavioral therapy (CBT-E) in patients aged between 12 and 18 years with anorexia nervosa with a duration of illness <3 versus ≥3 years. Methods: One hundred and fifty-nine consecutively treated patients (n = 122 with illness duration <3 y...

We read the comments by Meule on our article with great interest, and we thank the author for his thoughtful suggestions [...]

Objective: The study aimed to evaluate the effectiveness of enhanced cogni-tive behaviour therapy (CBT-E) on patients with anorexia nervosa (AN) aged 14 to 25 treated in a real-world setting. Method: One hundred and fifteen patients with AN (n = 61, age <18 years) were recruited from consecutive referrals to a clinical eating disorder service offer...

This study aimed to investigate the relationship between weight bias internalization and eating disorder psychopathology in treatment-seeking patients with severe obesity using a network approach. Two thousand one hundred and thirteen patients with obesity were consecutively admitted to a specialist clinical unit for obesity and were recruited from...

This study aimed to investigate the relationship between weight-bias internalization and eat-ing-disorder psychopathology in treatment-seeking patients with severe obesity using a network approach. Two thousand, one hundred and thirteen patients with obesity consecutively admitted to a specialist clinical unit for obesity were recruited from Januar...

The Irrational Food Beliefs Scale (IFBS) is a self-report questionnaire comprising 57 items, 41 of which in the irrational food beliefs subscale, assessing cognitive distortions and inappropriate attitudes and beliefs about food. This study aimed to propose the Italian version of the IFBS and examine its psychometric properties. The tool was transl...

The effectiveness of enhanced cognitive behaviour therapy (CBT-E) for adolescents with anorexia has been supported by several cohort studies and a non-randomi-zed effectiveness trial comparing this treatment with family-based treatment (FBT). However, although many patients achieve a good outcome, a significant proportion still has residual psychop...

The study aimed to establish the role of weight suppression in a cohort of adolescents with anorexia nervosa treated with intensive enhanced cognitive behavioral therapy (CBT-E). One hundred and twenty-eight adolescent patients with anorexia nervosa (128 females and 2 males), aged between 14 and 19 years, were recruited from consecutive referrals t...

Background Specific blends of essential amino acids (EAA) containing a high percentage of branched-chain amino acids preserves mitochondrial metabolism and higher physical resistance in elderly mice, increasing their survival and improving physical performance and cognitive functions in malnourished elderly patients. However, no study has been yet...

The network theory conceptualizes mental disorders as causally connected symptom systems rather than as effects of a superordinate and unknowable illness, otherwise called latent. Network analysis, a statistical technique designed to identify network structures among psychiatric symptoms from empirical data, has been widely used in eating disorders...

Background Specific blends of essential amino acids (EAA) containing a high percentage of branched-chain amino acids preserves mitochondrial metabolism and higher physical resistance in elderly mice, increasing their survival and improving physical performance and cognitive functions in malnourished elderly patients. However, no study has been yet...

This retrospective study aimed to assess the number, demographic and clinical characteristics of patients seeking treatment for eating disorders at a clinical service specialized in delivering enhanced cognitive behavior (CBT-E) before (the coronavirus (COVID-19) pandemic. A larger number of adults than adolescents sought treatment both before (121...

Background Problematic perfectionism has been traditionally conceptualized as a multidimensional construct, and specific instruments have been developed to capture its various dimensions. However, the Clinical Perfectionism Questionnaire (CPQ) was recently designed to measure a unidimensional construct called "clinical perfectionism", but the quest...

Abstract Background McArdle disease is an autosomal recessive genetic disorder caused by a deficiency of the glycogen phosphorylase (myophosphorylase) enzyme, which muscles need to break down glycogen into glucose for energy. Symptoms include exercise intolerance, with fatigue, muscle pain, and cramps being manifested during the first few minutes o...

Objective: This study aimed to assess the impact of the COVID-19 pandemic on the efficacy of an intensive treatment based on enhanced cognitive behavioral therapy (CBT-E) in patients with anorexia nervosa. Methods: This cohort study analyzed 57 patients with anorexia nervosa who experienced the COVID-19 pandemic during intensive CBT-E, comparing...

Objective: This study aimed to compare eating disorder-specific and nonspecific clinical features in patients with anorexia nervosa before and after intensive enhanced cognitive behavior therapy (CBT-E) via network analysis. Methods: All consecutive patients admitted to intensive CBT-E were eligible, and the sample comprised patients aged ≥16 ye...

Few tools to encourage therapists to implement evidence based psychological treatments as designed exist. Assessing therapist "competence" (implementing therapeutic procedures well) by evaluating the quality of their treatment sessions is problematic for multiple reasons. Therapist self-rated measures of "adherence" (using the correct therapeutic p...

Several clinical services offer eclectic multidisciplinary treatments with no evidence of efficacy and effectiveness for adolescents with eating disorders. These treatments are usually based on the 'disease model' of eating disorders. The model postulates that eating disorders are the result of a specific disease (i.e., anorexia nervosa, bulimia ne...

Background The aim of this quality-assessment study was to determine the outcome of patients with severe and extreme anorexia nervosa (AN) in a real-world outpatient setting. Methods Twenty-one adults with AN and a body mass index (BMI) of < 16 were recruited from consecutive referrals to an outpatient clinic at a public hospital in Western Norway...

The aim of our study was designed to evaluate the potential impact of lockdown on weight management, eating behaviors, and lifestyle in patients with severe obesity treated with intensive residential cognitive behavior therapy for obesity (CBT‐OB) and reassessed after 6 months of follow‐up encompassing the COVID‐19 lockdown period, as compared to t...

Objective: To assess outcomes in adult patients with eating disorders administered enhanced cognitive behavioral therapy (CBT-E) in a day-hospital setting. Method: Forty-three consecutive patients with eating disorders (86% females; mean age 28.8 [SD = 11.8]) were admitted to a 13-week day-hospital CBT-E program. Twenty-five (58.1%) patients wer...

This book fills two major gaps. For clinicians, it provides a detailed guide to the treatment of any form of eating disorder seen in adolescents. For researchers, it specifies for the first time how this empirically supported treatment, “enhanced cognitive behavior therapy” (CBT-E), should be implemented with young patients.

Although metabolomics studies are recently spreading and have allowed the characterization of putative biomarkers in many diseases, they are relatively scanty in anorexia nervosa (AN). In this explorative study we analyzed the fecal metabolomics profiles of women with AN in the underweight phase (n = 24) and after short-term weight restoration (n =...

Background: The COVID-19 lockdown may have negatively impacted the treatment of obesity. This study aimed to assess the effect of COVID-19 lockdown in patients with obesity treated with intensive residential cognitive behavioral therapy (CBT-OB). Methods: This retrospective case-control study analyzed 129 patients with severe obesity who experie...

Alterations in the gut microbiome and fecal metabolites have been detected in anorexia nervosa (AN), but differences in those profiles between restricting AN (ANR) and binge-purging AN (ANBP) type have not been explored. We made a secondary analysis of our previous data concerning microbiome and metabolomics profiles of 17 ANR women, six ANBP women...

This systematic review analysed published data on the effectiveness of enhanced cognitive behaviour therapy (CBT-E) for adolescents with eating disorders. Of the 28 papers retrieved, eight (6 case series, 1 prospective cohort study, and 1 non-randomized effectiveness trial) met the inclusion criteria and revealed the following five findings. First,...

Unfortunately, the sixth author name was incorrectly spelled as "S. Fassio" instead of "A. Fassio" in the original publication.

Purpose: The aim of the current study was to assess the psychometric proprieties of the Italian version of the latest edition of the Questionnaire of Eating and Weight Patterns (QEWP-5), evaluating its accuracy in screening patients with binge-eating disorder (BED). Methods: The Italian translation of the tool was administered to 604 Italian-spe...

Objective The study aimed to assess outcomes in patients with severe and extreme anorexia nervosa managed with enhanced cognitive behavior therapy (CBT‐E) in a real‐world outpatient setting. Method Thirty patients with anorexia nervosa and body mass index (BMI) <16 aged ≥17 years were recruited from consecutive referrals to an eating disorder serv...

Findings Although several individual psychotherapies for adults with eating disorders are empirically supported, with family-based treatment (FBT) being the leading recommended empiric treatment in adolescents, patients with eating disorders are still difficult to treat, and outcomes are often poor. In some countries, the clinical services for adol...

Binge-eating disorder (BED) is characterized by the presence of recurrent binge-eating episodes not followed by the recurrent use of compensatory behaviors, occurring at least once a week for three months, and associated with marked distress. According to the most recent data, BED has a lifetime prevalence of 0.85% (men 0.42% and women 1.25%). The...

Objective This study aimed to compare the effectiveness of an intensive treatment based on enhanced cognitive behavioral therapy (CBT‐E) in adolescent and adult patients with anorexia nervosa. Methods A total of 150 consecutive patients (74 adolescents and 81 adults) were admitted to a 20‐week intensive CBT‐E program (13 weeks of inpatient followe...