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Meta-analysis of the effects of third-wave behavioural interventions on disordered eating and body image concerns: implications for eating disorder prevention
Abstract
Third-wave behavioural interventions are increasingly popular for treating and preventing mental health conditions. Recently, researchers have begun testing whether these interventions can effectively targeting eating disorder risk factors (disordered eating, body image concerns). This meta-analysis examined whether third-wave behavioural interventions (acceptance and commitment therapy; dialectical behaviour therapy; mindfulness-based interventions; compassion-focused therapy) show potential for being effective eating disorder prevention programs, by testing their effects on eating disorder risk factors in samples without an eating disorder. Twenty-four studies (13 randomized trials) were included. Most studies delivered selective prevention programs (i.e. participants who reported elevated risk factor). Third-wave interventions led to significant pre–post (g = 0.59; 95% CI = 0.43, 0.75) and follow-up (g = 0.83; 95% CI = 0.38, 1.28) improvements in disordered eating, and significant pre–post improvements in body image (g = 0.35; 95% CI = 0.13, 0.56). DBT-based interventions were associated with the largest effects. Third-wave interventions were also significantly more efficacious than wait-lists (g = 0.39; 95% CI = 0.09, 0.69) in reducing disordered eating, but did not differ to other interventions (g = 0.25; 95% CI = –0.06, 0.57). Preliminary evidence suggests that third-wave interventions may have a beneficial effect in ameliorating eating disorder risk.
... For example, a recent review of the meta-analytic evidence on ACT identified 20 meta-analyses that were based on 133 studies and 12,477 participants [22]. Results showed that ACT was efficacious across a broad range of intervention targets, including depression, [23][24][25][26][27][28][29][30] anxiety, [24][25][26][28][29][30][31][32] chronic pain, [27,29,33] substance use, [34][35][36] eating disorders [37], psychosis, [38] stress, [26,30] somatic complaints, [34] physical conditions, [23] and transdiagnostic combinations of conditions [23,31,33,39] with small to medium controlled effect sizes. Three meta-analyses also identified 17 unique RCTs that found ACT to be efficacious for smoking and other drug use [34][35][36] with preliminary evidence of efficacy for treatment of co-occurring substance use and affective disorders [18,[41][42][43][44][45]. ...
... While none of these studies were randomized trials, all provided preliminary evidence to suggest that ACT is a promising intervention for alcohol use and comorbid stress, anxiety, and/or trauma. Thekiso et al. (2015) conducted a pilot study of a group-based ACT intervention designed to enhance treatment as usual (TAU) for inpatients with AUD and either depression or bipolar disorder [37]. The ACT group received 4 weeks of daily (5 sessions/week) group ACT-based therapy, while TAU received 4 weeks of standard integrated inpatient treatment [37]. ...
... Thekiso et al. (2015) conducted a pilot study of a group-based ACT intervention designed to enhance treatment as usual (TAU) for inpatients with AUD and either depression or bipolar disorder [37]. The ACT group received 4 weeks of daily (5 sessions/week) group ACT-based therapy, while TAU received 4 weeks of standard integrated inpatient treatment [37]. Patients in the ACT group reported a significantly higher cumulative abstinence duration (i.e., percentage of total number of days abstinent from alcohol during the past 90 days) at 6-months post intervention, as well as significantly lower symptoms of anxiety and depression. ...
Alcohol use among people living with HIV (PWH) has been increasingly recognized as an important component of HIV care. Transdiagnostic treatments, such as Acceptance and Commitment Therapy (ACT), that target core processes common to multiple mental health and substance-related problems, may be ideal in HIV treatment settings where psychological and behavioral health comorbidities are high. In advance of a randomized clinical trial (RCT), the overall objective of this study was to systematically adapt an ACT-based intervention originally developed for smoking cessation, into an ACT intervention for PWH who drink at hazardous levels. Consistent with the ADAPT-ITT model, the adaptation progressed systematically in several phases, which included structured team meetings, three focus group discussions with PWH (N = 13), and in-depth interviews with HIV providers (N = 10), and development of standardized operating procedures for interventionist training, supervision, and eventual RCT implementation. The procedures described here offer a template for transparent reporting on early phase behavioral RCTs.
... These disorders are frequently associated with alteration in the way of seeing and living the body: with the term dysmorphophobia the DSM-5 refers to the more or less conscious concern for one or more defects or imperfections perceived in the physical appearance that are not observable, or only slightly, by others. The individual, in response to this concern that causes clinically signi icant discomfort, can carry out repetitive behaviors or mental actions that give rise to an obsessive search for change in body shapes [16,19]. ...
... An early detection of alterations in eating behavior is important in order to prevent the development of ED such as Anorexia and Bulimia Nervosa [7,19,41]. In fact, early diagnosis is associated with early intervention, not only from a psychological but also medical point of view [42,43]. ...
... Indeed, high levels of physical activity in athletes with ED can cause numerous health problems: chronic fatigue, weakened immune system, longer healing times, anemia, electrolyte imbalance, endocrine abnormalities, amenorrhea and reduced bone density [36,37]. Therefore, the scienti ic literature emphasizes the need to prevent these problems by acting on the promotion, education and information aimed at young athletes and their instructors [7,19,23,29,[44][45][46]. ...
Objective: This preliminary study focused on the description of some dysfunctional perceptions of the body image and eating habits in a sample of young. Methods: The results obtained by 55 amateur and professional volleyball players belonging to volleyball sports clubs located in the province of Reggio Emilia were examined. The age of the sample is in a range between 11 and 44 years. The participants completed the Pisa Survey for Eating Disorders (PSED), a questionnaire aimed at examining eating behavior and the perception of one’s body image. The athletes’ height and body weight were subsequently detected through direct measurement. Conclusion: The data collected through the self-evaluation questionnaire and the measurements carried out by the study made it possible to analyze the perception of the body image and the eating habits of the volleyball players belonging to the sample and to compare them with the data in the literature. The data, albeit preliminary, allow us to confirm the existence of the discrepancy between the real body image and the desired one, in a group of young athletes, who favors the adoption of non-adaptive coping strategies to control one’s own weight and body shapes typical of the vicious circle - strict diet, bingeing episodes, compensatory behaviors - which characterizes eating disorders (ED). It is therefore considered essential that body image assessment is a practice implemented in the assessment routine of these athletes, especially in consideration of the fact that body image disturbance is a very common feature in this category and is one of the main risk factors of EDs.
... Further, CBT is designed to help individuals modify negative thought patterns, such as ruminative negative thoughts [15,20]. ACT-, DBT-, or CBT-informed programs that primarily target body image, eating disorder prevention, or self-compassion have been found to improve body dissatisfaction or self-compassion [19,[21][22][23][24][25]. Studies of generalized programs (i.e., not specifically targeted for body image or self-compassion, but with some psychological component) have shown improvements in psychological well-being as well as body image [26,27]. ...
... This provided the unique opportunity to examine changes in body positivity and self-compassion in a setting that reflects real-world use of the program as much as possible (i.e., with individuals who self-voluntarily joined the program and minimal participation requirements). For this study's primary aim, based on past work on ACT, DBT, and CBT [19,[21][22][23][24][25], we hypothesized that body acceptance, body image flexibility, and self-compassion would significantly increase from baseline to end of the program and body-focused rumination (i.e., continuous negative thought patterns) would significantly decrease. We also hypothesized that these improvements would be independent of weight lost, with no significant associations between weight loss and body appreciation, body image flexibility, self-compassion, and body-focused rumination. ...
... Our results add to this literature by showing that body positivity and self-compassion significantly improved over time. Our findings are also consistent with studies showing improvements in body image from targeted CBT-, ACT-, or DBT-based programs, as well as programs specifically targeting self-compassion [21][22][23]47,48]. Our results also contribute new knowledge by showing that changes in body positivity and self-compassion can occur in individuals who voluntarily joined and used a digital publicly available program. ...
According to recent research, body positivity and self-compassion are key outcomes that are tied to better psychological and physical health. To date, it is unclear whether body positivity and self-compassion improve, stay constant, or deteriorate over the course of a weight management program, particularly one that addresses the psychological roots of behavior change. Additionally, beyond controlled settings, there are no studies on body positivity and self-compassion in individuals who choose to join a commercial weight management program. Therefore, this single-arm prospective study examined changes in body positivity and self-compassion from baseline to the 16 week milestone of Noom Weight, a commercial behavior change weight management program informed by acceptance and commitment therapy (ACT), dialectical behavior therapy (DBT), and cognitive behavioral therapy (CBT). We also examined how baseline and over-time changes in body positivity and self-compassion predicted engagement in program-measured relevant behaviors (e.g., exercises logged). Participants were a random subset of individuals who had recently self-enrolled in the program (n = 133). Body positivity and self-compassion were measured via survey at baseline and end of the core program (16 weeks). Self-reported weight and program-recorded engagement were extracted from the program database. Compared to baseline, body appreciation, body image flexibility, self-compassion, and body-focused rumination significantly improved at 16 weeks (all ps < 0.007). Participants lost a statistically significant amount of weight (3.9 kg; t(128)) = 10.64, p < 0.001) by 16 weeks, which was 4.4% body weight. Greater engagement, especially messaging a coach, reading articles, and logging meals, was associated with improvements over time in body appreciation (r = 0.17, p = 0.04), body image flexibility (r = −0.23, p = 0.007), and the brooding component of rumination (r = −0.23, p = 0.007). Greater engagement was also associated with baseline total self-compassion (r = 0.19, p = 0.03) and self-judgment (r = 0.24, p = 0.006). The results suggest that individuals experience improvements in body positivity and self-compassion while learning about ACT, DBT, and CBT through curriculum and coaching in this setting. The results also have important clinical implications, such as the possibility that psychologically-oriented (i.e., ACT, DBT, and CBT-based) weight management could be important to improve body positivity or that baseline self-compassion could be used to target individuals at risk for lower engagement. Future work should investigate these possibilities as well as delineate the causal relationships between body positivity, self-compassion, engagement, and weight loss.
... While clarification of emotional experience may be a crucial first step, this might be followed by attempts to increase accessibility of existing adaptive regulation strategies and develop new ones, including emotion acceptance, in response to distress. Dialectical Behaviour Therapy (DBT) for BED and BN was developed in response to patients who do not always benefit from Cognitive Behaviour Therapy (CBT)-focused treatments [62], but this and other third-wave interventions such as acceptance and commitment therapy (ACT), compassion-focused therapy (CFT) and mindfulness have wider potential in the treatment of people with EDs [63]. Their relevance in this context comes from the fact that in contrast to pure CBT which attempts to prevent strong negative emotions being activated, third wave interventions are response-focused [64]: centred around accepting, managing and finding adaptive ways to moderate the experience of strong emotions when they arise. ...
... Their relevance in this context comes from the fact that in contrast to pure CBT which attempts to prevent strong negative emotions being activated, third wave interventions are response-focused [64]: centred around accepting, managing and finding adaptive ways to moderate the experience of strong emotions when they arise. The existing evidence suggests that CBT may be more effective than third wave therapies [63][64][65], but these analyses all focus on a time prior to Covid-19. Whether third wave, response-focus therapies might be useful at a time when people have limited control over the antecedents of negative emotion is an intriguing query for future researchers. ...
Objective
The Covid-19 pandemic has wrought disruption to everyday life and services, and emerging evidence suggests that those with eating disorders (EDs) are likely to experience marked distress and exacerbation of their symptoms. However, little is known around the most relevant factors to symptom change; whether certain emotion regulation and coping strategies are linked to better outcomes; and how people with EDs are adjusting to psychological interventions moving online.
Method
In a mixed-method design, we collected qualitative and quantitative data from 207 (76 males) self-selected UK residents with self-reported ED, who described and ranked impacts of the pandemic on their symptoms. Regression analysis examined whether emotion regulation strategies were associated with self-reported symptom change, ED symptomatology, and negative emotional states. Thematic analysis explored participants’ experiences of the pandemic, particularly factors affecting their ED, coping strategies used, and experiences of psychological intervention.
Results
Most participants (83.1%) reported worsening of ED symptomatology, though factors affecting symptom change differed between specific EDs. Emotion regulation, such as having fewer strategies, poorer emotional clarity, and non-acceptance of emotions, explained nearly half of the variance in emotional distress during the pandemic. Qualitative findings indicated that difficult emotions (such as fear and uncertainty), changes to routine, and unhelpful social messages were triggering for participants during the pandemic. While some participants described employing positive coping strategies (such as limiting social media exposure), many reported using ED behaviours (among other maladaptive strategies, like alcohol use) to cope with the pandemic. Finally, loss of treatment support, feeling underserving of support and experiencing a ‘detached connection’ online were further exacerbating factors for these participants.
Discussion
While our sample was self-selected and may not represent all people with EDs, our results suggest that people with EDs have been strongly affected by the pandemic. Some aspects of online treatment were found to be beneficial but our findings suggest it also needs some improvement. Our paper discusses implications for online treatment such as taking into account personal circumstances and, in a time where people have limited control over the antecedents of negative emotion, the need to develop skills to manage emotions when they arise.
... Mindfulness-based interventions have been increasingly adopted as treatments for a range of psychological conditions, including disordered eating behaviours (Linardon et al., 2019). There is preliminary evidence that trait mindfulness is a protective factor in the pathway between RST and adverse psychological outcomes, including disordered eating. ...
... If mindfulness is a protective factor in the pathway between RST and overconsumption, improving mindfulness may reduce maladaptive outcomes, rather than targeting stable RST systems themselves. Such an approach is supported by the efficacy of mindfulness-based interventions for disordered eating (Linardon et al., 2019). However, such interventions are not effective for all clients seeking treatment. ...
Research using the Revised Reinforcement Sensitivity Theory (RST) to investigate the individual differences in overconsumption of food has consistently found those who over-consume to be higher in conflict sensitivity (i.e., Behavioural Inhibition System (BIS)) and impulsivity than those who do not overconsume. However, the exact mechanisms through which these individual differences operate, and the identification of potential protective factors that may disrupt such pathways are not clear. The current study tested the moderating role of impulsivity and trait mindfulness in the pathway between BIS and two types of overconsumption; binge eating and grazing. Undergraduate students (n = 245, M = 22.48 years of age, SD = 8.95, 77% female) completed self-report measures of RST, trait mindfulness, binge eating symptoms, and grazing symptoms. Results showed that im-pulsivity moderated the pathway between BIS and both binge eating and grazing. With mindfulness included in the model, a two-way interaction was found for binge eating, and a three-way interaction was found for grazing. Results suggest the effect of trait mindfulness on the BIS/impulsivity pathway is unique for differing severities of overconsumption, and that RST systems, trait mindfulness and target behaviours may be worthy of consideration when selecting intervention modalities.
... While clari cation of emotional experience may be a crucial rst step, this might be followed by attempts to increase accessibility of existing adaptive regulation strategies and develop new ones, including emotion acceptance, in response to distress. Dialectical Behaviour Therapy (DBT) for BED and BN was developed in response to patients who do not always bene t from Cognitive Behaviour Therapy (CBT)focused treatments (78), but this and other third-wave interventions such as acceptance and commitment therapy (ACT), compassion-focused therapy (CFT) and mindfulness have wider potential in the treatment of people with EDs (79). Their relevance in this context comes from the fact that in contrast to pure CBT which attempts to prevent strong negative emotions being activated, third wave interventions are response-focused (80): centred around accepting, managing and nding adaptive ways to moderate the experience of strong emotions when they arise. ...
... Their relevance in this context comes from the fact that in contrast to pure CBT which attempts to prevent strong negative emotions being activated, third wave interventions are response-focused (80): centred around accepting, managing and nding adaptive ways to moderate the experience of strong emotions when they arise. The existing evidence suggests that CBT may be more effective than third wave therapies (79)(80)(81), but these analyses all focus on a time prior to Covid-19. ...
Objective: The Covid-19 pandemic has wrought disruption to everyday life and services, and emerging evidence suggests that those with eating disorders (EDs) are likely to experience marked distress and exacerbation of their symptoms. However, little is known around the most relevant factors to symptom change; whether certain emotion regulation and coping strategies are linked to better outcomes; and how people with EDs are adjusting to psychological interventions moving online.
Method: In a mixed-method design, we collected qualitative and quantitative data from 207 (76 males) UK residents with self-reported ED, who described and ranked impacts of the pandemic on their symptoms. Regression analysis examined whether emotion regulation strategies were associated with self-reported symptom change, ED symptomatology, and negative emotional states. Thematic analysis explored participants’ experiences of the pandemic, particularly factors affecting their ED, coping strategies used, and experiences of psychological intervention.
Results: Most participants (83.1%) reported worsening of ED symptomatology, though factors affecting symptom change differed between specific EDs. Emotion regulation, such as having fewer strategies, poorer emotional clarity, and non-acceptance of emotions, explained nearly half of the variance in emotional distress during the pandemic, and to a lesser extent also predicted ED symptomatology and symptom change. Qualitative findings indicated that difficult emotions (such as fear and uncertainty), changes to routine, confinement and unhelpful social messages were triggering for participants during the pandemic. While some participants described employing positive coping strategies (such as limiting social media exposure), many reported using ED behaviours (among other maladaptive strategies, like alcohol use) to cope with the pandemic. Finally, loss of treatment support, feeling underserving of support and experiencing a ‘detached connection’ online were further exacerbating factors for these participants.
Discussion: Our results show that people with EDs have been strongly affected by the pandemic, and that while beneficial for some, online treatment may need some improvement. Our paper discusses implications for online treatment such as taking into account personal circumstances and, in a time where people have limited control over the antecedents of negative emotion, the need to develop skills to manage emotions when they arise.
... Though EDs, disordered eating, and body image dissatisfaction may represent different latent constructs, they often present together, including in transgender individuals (Galupo et al., 2021;Romito et al., 2021). Importantly, rates of disordered eating are rising, and disordered eating and body image dissatisfaction are early indicators for EDs (Linardon et al., 2019;Mitchison et al., 2012). For cisgender women, a consistent risk factor and a defining feature of many EDs is body image dissatisfaction and overvaluation of weight and shape (Striegel-Moore & Bulik, 2007;Striegel-Moore & Cachelin, 2001). ...
... Conceptually, this may parallel EDs broadly. For instance, in treating EDs, health care providers may address weight and body image without focusing on the cognitive symptoms necessary for full recovery (Fairburn et al., 2003;Keski-Rahkonen et al., 2009;Linardon et al., 2019). If providers unduly attend to physical criteria, they may fail their clients by not addressing the emotional avoidance and cognitive processes underlying and maintaining EDs. ...
... Recent systematic reviews and meta-analyses have primarily focused on the effects of mindfulness-and acceptance-based treatments on weight-related outcomes, with a secondary focus on eating behaviours (Lawlor et al., 2020;Rogers, Ferrari, Mosely, Lang, & Brennan, 2017). Most have used combined measures of disordered eating behaviours and attitudes and/or combined measures of restricted and dysregulated forms of eating as well as body image concerns (Lawlor et al., 2020;Linardon, Gleeson, Yap, Murphy, & Brennan, 2019;Rogers et al., 2017). To date, systematic reviews and meta-analyses on ACT-based treatments for eating behaviour change have shown moderate-to-large effects on measures that combine restrained and dysregulated forms of eating (Godfrey, Gallo, & Afari, 2015;Lawlor et al., 2020;Linardon et al., 2019). ...
... Most have used combined measures of disordered eating behaviours and attitudes and/or combined measures of restricted and dysregulated forms of eating as well as body image concerns (Lawlor et al., 2020;Linardon, Gleeson, Yap, Murphy, & Brennan, 2019;Rogers et al., 2017). To date, systematic reviews and meta-analyses on ACT-based treatments for eating behaviour change have shown moderate-to-large effects on measures that combine restrained and dysregulated forms of eating (Godfrey, Gallo, & Afari, 2015;Lawlor et al., 2020;Linardon et al., 2019). While these findings are useful for understanding the effects of ACT-based treatments on general measures of eating pathology, little is known about their effects on dysregulated eating behaviours like binge eating and emotional eating. ...
Background
An increasing number of studies have investigated the efficacy of Acceptance and Commitment Therapy (ACT) for the reduction of dysregulated eating behaviours such as binge eating and emotional eating. However, little is known about their short- and long-term efficacy and underlying mechanisms of change.
Objectives
To conduct a systematic effect size analysis to estimate the efficacy of ACT-based treatments on measures of dysregulated eating and of psychological flexibility, a theorized ACT mechanism of change.
Methods
Literature searches were conducted in PsycInfo, Medline, Web of Science, and ProQuest Dissertations. Within-group and between-group standardized mean differences were computed using Comprehensive Meta-Analysis Version 3. Additional subgroup and meta-regression analyses by study characteristics were conducted.
Results
A total of 20 publications (22 samples, n = 1269) were included. Pre-post and pre-follow-up effects suggest that ACT-based treatments are moderately effective in reducing dysregulated eating behaviours and increasing psychological flexibility. These effects were comparable for binge-eating and emotional eating outcomes and for face-to-face interventions, Web-based interventions, and interventions that used a self-help book. Longer treatments were associated with larger outcome effect sizes, and changes in psychological flexibility were not associated with changes in dysregulated eating outcomes. Small significant effects were found in favour of ACT when compared to inactive control groups. The only three studies that included active control groups and did not show significant differences in outcomes between ACT and other treatments.
Conclusion
Future studies should aim to compare ACT-based treatments to active treatments and to provide empirical evidence for the theoretical mediating role of psychological flexibility in reported changes in eating behaviour.
... The preliminary conversational content and decision tree for KIT was developed by the authors, in collaboration with the helpline and communications teams at the Butterfly Foundation (a national charity based in Australia, which provides support for body image and eating disorders). The conversation content was based on evidence-based information/interventions for eating disorders, specifically, psychoeducation, cognitive behavioral therapy (CBT), acceptance commitment therapy (ACT), and mindfulness [25,26], and adapted for delivery by a chatbot. Owing to the short and simple style of conversations KIT was designed to deliver, we were highly selective in the therapeutic elements we chose from CBT (eg, education on cognitive distortions or unhelpful thinking styles), ACT (eg, practicing detaching from unhelpful thoughts via cognitive defusion exercises), and mindfulness (eg, mindful breathing) [17,25,26]. ...
... The conversation content was based on evidence-based information/interventions for eating disorders, specifically, psychoeducation, cognitive behavioral therapy (CBT), acceptance commitment therapy (ACT), and mindfulness [25,26], and adapted for delivery by a chatbot. Owing to the short and simple style of conversations KIT was designed to deliver, we were highly selective in the therapeutic elements we chose from CBT (eg, education on cognitive distortions or unhelpful thinking styles), ACT (eg, practicing detaching from unhelpful thoughts via cognitive defusion exercises), and mindfulness (eg, mindful breathing) [17,25,26]. ...
Background
Body image and eating disorders represent a significant public health concern; however, many affected individuals never access appropriate treatment. Conversational agents or chatbots reflect a unique opportunity to target those affected online by providing psychoeducation and coping skills, thus filling the gap in service provision.
Objective
A world-first body image chatbot called “KIT” was designed. The aim of this study was to assess preliminary acceptability and feasibility via the collection of qualitative feedback from young people and parents/carers regarding the content, structure, and design of the chatbot, in accordance with an agile methodology strategy. The chatbot was developed in collaboration with Australia’s national eating disorder support organization, the Butterfly Foundation.
Methods
A conversation decision tree was designed that offered psychoeducational information on body image and eating disorders, as well as evidence-based coping strategies. A version of KIT was built as a research prototype to deliver these conversations. Six focus groups were conducted using online semistructured interviews to seek feedback on the KIT prototype. This included four groups of people seeking help for themselves (n=17; age 13-18 years) and two groups of parents/carers (n=8; age 46-57 years). Participants provided feedback on the cartoon chatbot character design, as well as the content, structure, and design of the chatbot webchat.
Results
Thematic analyses identified the following three main themes from the six focus groups: (1) chatbot character and design, (2) content presentation, and (3) flow. Overall, the participants provided positive feedback regarding KIT, with both young people and parents/carers generally providing similar reflections. The participants approved of KIT’s character and engagement. Specific suggestions were made regarding the brevity and tone to increase KIT’s interactivity.
Conclusions
Focus groups provided overall positive qualitative feedback regarding the content, structure, and design of the body image chatbot. Incorporating the feedback of lived experience from both individuals and parents/carers allowed the refinement of KIT in the development phase as per an iterative agile methodology. Further research is required to evaluate KIT’s efficacy.
... Dialectical behavioral therapy (DBT) has been evaluated for addressing binge eating and focuses on improving emotion regulation. Meta-analyses of DBT and other third-wave psychotherapies (e.g., acceptance and commitment therapy, mindfulness-based interventions) have not found these treatments to be superior to active comparisons or CBT [95], but they may have promise for eating disorder prevention by reducing eating disorder risk factors like disordered eating [i.e., binge eating (e.g., of lower frequently than required for a clinical diagnosis), disinhibited/uncontrolled eating, or emotional eating behaviors] and body image concerns [96]. There also is growing interest in evaluating DBT using guided selfhelp versions for the treatment of BED [97,98]. ...
Purpose of Review
Binge eating disorder (BED) is characterized by recurrent binge eating episodes (i.e., eating an objectively large amount of food accompanied by a sense of loss of control while eating) in the absence of regular compensatory behavior. BED follows a chronic course marked by significant dysfunction and impairment. This review focuses on advances in the understanding of BED, including its diagnosis, correlates, risk factors, and treatment, with particular attention to the past 5 to 8 years.
Recent Findings
BED remains the most common eating disorder in the USA and globally. BED occurs across the lifespan and among diverse gender, racial, and ethnic groups. Risk for and maintenance of BED results from multiple psychological, biological, and sociocultural factors. First-line treatment for reducing binge eating is cognitive behavioral therapy, with efficacy for interpersonal psychotherapy as well. Lisdexamfetamine is an FDA-approved medication for moderate to severe cases of BED.
Summary
Even with advances in its diagnosis and treatment, better assessment and understanding of BED in diverse gender, racial, and ethnic populations is needed. Studies of shared risk factors underlying BED and comorbid disorders may lead to a greater understanding of mechanisms for intervention. Future research should prioritize evaluating the implementation of established treatments among populations in need, as well as establishing new interventions that can be scaled for delivery in real-world settings. Given overlap between BED and overweight/obesity, a continued focus on developing treatments that effectively address binge eating and weight management is warranted.
... with the magnitude of relationships being similar among people with and without an ED (Sala, Shankar Ram, Vanzhula, & Levinson, 2020). Moreover, interventions designed to cultivate mindful awareness have been shown to lead to modest reductions in ED psychopathology in those with or at risk of an ED (for reviews, see Linardon, Fairburn, Fitzsimmons-Craft, Wilfley, & Brennan, 2017;Linardon, Gleeson, Yap, Murphy, & Brennan, 2018), suggesting that enhancing mindful awareness may be necessary for addressing ED psychopathology. ...
This study aimed to (1) examine the unique role of mindfulness and self-compassion on eating disorder (ED) psychopathology and functional impairment, and (2) compare levels of mindfulness and self-compassion between health controls and individuals categorized with bulimia nervosa (BN), and binge-eating disorder (BED). Data were analyzed from 1101 community-based participants, of which 145 met criteria for BN, 150 for BED, and 286 for healthy controls. Results from a series of multiple regressions revealed that self-compassion accounted for substantially more variance in ED psychopathol-ogy and functional impairment than mindfulness in the total sample and across the three subgroups, at times explaining 20 times more variance than mindfulness. Results remained unchanged when excluding the mindfulness subscale from the Self-Compassion Scale. When comparing these variables across the three study groups, results showed that self-compassion and mindfulness levels were lowest in the BN group, followed by the BED group, and then the healthy control group. Findings overall suggest that non-judgmental awareness may be less important in explaining levels of ED psychopathology than the nature of one's interaction with emotionally charged, negative experiences. Findings also point to possible priority intervention targets in indicated prevention and treatment programs.
... In one study, ACT was superior to CBT at posttreatment but not significantly different at a 3-months follow-up timepoint (Avdagic, Morrissey, & Boschen, 2014) and in another, ACT was inferior at posttreatment but superior to CBT at 6-months follow-up (Lanza, García, Lamelas, & González-Menéndez, 2014). Furthermore, the quality of studies within the ACT literature varies greatly, a fact criticized in the literature (Linardon, Gleeson, Yap, Murphy, & Brennan, 2019;Ö st, 2014). Thus, there is a need to systematically examine the current literature and, further, to assess the methodological quality of this evidence. ...
The efficacy of Acceptance and Commitment Therapy (ACT) has been evaluated in many randomized controlled trials investigating a broad range of target conditions. This paper reviews the meta-analytic evidence on ACT. The 20 included meta-analyses reported 100 controlled effect sizes across n = 12,477 participants. Controlled effect sizes were grouped by target conditions and comparison group. Results showed that ACT is efficacious for all conditions examined, including anxiety, depression, substance use, pain, and transdiagnostic groups. Results also showed that ACT was generally superior to inactive controls (e.g. waitlist, placebo), treatment as usual, and most active intervention conditions (excluding CBT). Weaknesses and areas for future development are discussed.
... Thirdly, given the connection between anorexia and bullying, it is crucial to integrate blocks devoted to the principles of maintaining a healthy lifestyle, care for the body and a set of recommendations on how to critically evaluate messages about body-and beauty-related topics into prophylactic programs aiming to affect bullying victimization for students, parents, and school staff. As with bullying awareness programs the details on these programs could be found by school psychologists in metaanalytical reviews, to exemplify (Beccia et al., 2018;Leme et al., 2018;Linardon et al., 2019). ...
Eating disorders significantly impact the quality of life of the persons they affect, as well as their involvement in school bullying. People with bulimia and binge-eating disorders are known to be more likely to be victims of bullying; however, studies provide mixed evidence on the connection between bullying and anorexia. Therefore, in this paper, we suggest an explanation for the bullying victimization of people with anorexia. Our theoretical framework is based on psychoanalytical research on eating disorders, and we illustrate our arguments with the results of biographical interviews with 50 girls who have been diagnosed with anorexia. We show that a hostile family environment may influence the girls’ proneness to fall victim to school bullying. Therefore, school staff hoping to address the involvement of girls with anorexia in bullying should be aware of the role that family members play in bullying victimization and tailor interventions accordingly.
... More recently, research using ecological momentary assessment has shown trait-level body image flexibility to predict lower body dissatisfaction and eating disorder behaviors in daily life among Australian women (Tan et al., 2019). Finally, randomized controlled trials of interventions designed to cultivate body image flexibility have produced large reductions in body image concerns and eating disorder symptomatology in women with or at risk of an eating disorder (for reviews, see Linardon, Fairburn, Fitzsimmons-Craft, Wilfley, & Brennan, 2017;Linardon, Gleeson, Yap, Murphy, & Brennan, 2018). ...
... Selfcompassion has been inversely linked to body shame, weight/shape concerns, social physique anxiety, body image avoidance, binge eating, and ED symptomatology, and has been positively linked to intuitive eating, body appreciation, and body image flexibility in numerous cross-sectional studies (for review, see Braun, Park, & Gorin, 2016). Randomized controlled trials (RCT) of interventions designed to cultivate self-compassion have produced significant reductions in body image concerns and ED psychopathology in both clinical (Linardon, Fairburn, Fitzsimmons-Craft, Wilfley, & Brennan, 2017) and non-clinical samples (Linardon, Gleeson, Yap, Murphy, & Brennan, 2018). Self-compassion has also been shown to buffer the effects of various body image and ED risk factors, such as media thinness-related pressures relationship with both thin-ideal internalisation and disordered eating (Tylka, Russell, & Neal, 2015), and BMI, body dissatisfaction, and shameful memories relationships with ED symptomatology (Ferreira, Matos, Duarte, & Pinto-Gouveia, 2014;Kelly, Vimalakanthan, & Miller, 2014;Stutts & Blomquist, 2018). ...
... Yildiz (2020) realizó un metaanálisis de la eficacia de ACT en psicosis, encontrando 11 ensayos clínicos aleatorizados que han mostrado que ACT es un tratamiento eficaz en la reducción de sintomatología emocional, y en la frecuencia y credibilidad delas alucinaciones. Revisio-nes adicionales han mostrado que ACT es un tratamiento eficaz en el trastorno por consumo de sustancias (Ii et al., 2019), dolor crónico (Hughes, Clark, Colclough, Dale y McMillan, 2017), trastornos alimentarios (Linardon, Gleeson, Yap, Murphy y Brennan, 2018), enfermedades crónicas (Graham, Gouick, Krahe y Gillanders, 2016), etc. ...
... The interplay between theory, program development, evaluation, and dissemination is the subject of two recent reviews of ED prevention approaches at very different stages of development. Linardon, Gleeson, Yap, Murphy, and Brennan (2019) review the relatively new class of mindfulness-and meditationbased programs for females. Thus far, these selective-indicated interventions have proven more effective than passive control conditions in increasing body appreciation (medium effect size) and reducing body image concerns and negative affect (small effects) at the program's conclusion, but not at follow-up. ...
This article reviews 11 prevention-related publications in Eating Disorders: The Journal of Treatment & Prevention during 2019. Two models from the 2018 review continue to frame this analysis: (1) the Mental Health Intervention Spectrum from health promotion → types of prevention → case identification and referral → treatment; and (2) parsing phases of prevention into rationale, theory, and methodology → clarification of risk factors → implications for specific preventive interventions → design innovation and feasibility (pilot) research → efficacy and effectiveness research → program dissemination. These articles illustrate how the theoretical complexity and rigorous methodological demands of prevention science are manifest in the eating disorder field. A subset of articles also demonstrates the importance of working with researchers and community stakeholders to improve our understanding of how ethnicity, class, and gender intersect with planning for improvements in all phases of prevention. Other subsets show the need to expand the list of relevant risk factors, and how the traditional schema of masculinity creates both maladaptive biases in case identification and obstacles to an effective and compassionate understanding of EDs. Finally, implications of the absence of efficacy, effectiveness, and dissemination studies are discussed.
... The results showed that metacognitive beliefs could significantly discriminate between obese individuals and normalweight ones. Compared to those who do not, people with obesity who seek treatment for weight loss experience more psychological distress such as depression, anxiety, etc [22]. Research findings suggest that even mild depression is associated with a significant increase in negative metacognitive beliefs [20]. ...
Background and Aim Obesity with its various physical and mental problems threatens public health. This study aimed to investigate the discriminative role of metacognitive beliefs, the difficulty in emotion regulation, and codependency in women with obesity.
Methods and Materials In this causal-comparative research, 40 obese women (BMI ≥30 kg/m2) and 40 normal-weight subjects were selected by convenience sampling method. The samples were evaluated by metacognitive questionnaire, difficulties in emotion regulation scale, and the Farsi version of codependency measurement tool. We used discriminant function analysis to analyze the obtained data.
Ethical Considerations All study subjects signed the written consent form. The Research Ethics Committee of Kharazmi University approved this study (Code: IR.KHU.REC.1397.41).
Results The discriminant function could correctly classify 95% of obese people and 97.5% of normal-weight people with 3 variables of metacognitive beliefs, difficulty in emotion regulation, and codependency. In other words, 96.25% of all participants had been classified correctly.
Conclusion Distinguishing the two groups of obese and normal people, the variables of metacognitive beliefs, difficulty in emotion regulation, and codependency have a significant role. Therefore, these variables are supposedly influential psychological factors in obesity. So they can be used for its prevention and treatment.
... These interventions, grounded in principles of nonjudgmental awareness, acceptance, defusion, and self-compassion, aim to address an individual's relationship with, and response to, certain cognitive and affective processes, rather than directly trying to modify them or their content (Hayes, Villatte, Levin, & Hildebrandt, 2011;Hofmann & Asmundson, 2008). Importantly, several previous metaanalyses of randomized controlled trials (RCT) have documented the efficacy of acceptance-and mindfulness-based interventions delivered in either face-to-face or online formats for several mental health problems, including symptoms of depression (Hofmann, Sawyer, Witt, & Oh, 2010), anxiety (Vøllestad, Nielsen, & Nielsen, 2012), eating disorders (Linardon, Fairburn, Fitzsimmons-Craft, Wilfley, & Brennan, 2017;Linardon, Gleeson, Yap, Murphy, & Brennan, 2018), psychosis (Louise, Fitzpatrick, Strauss, Rossell, & Thomas, 2018), and general distress (Spijkerman, Pots, & Bohlmeijer, 2016). ...
The potential health benefits of acceptance, mindfulness, and self-compassion are well-documented. However, interventions that teach these principles typically rely on face-to-face delivery, which can limit their dissemination. Delivering these interventions through smartphone apps could overcome this. This meta-analysis examined whether principles of acceptance, mindfulness, and self-compassion can be learnt through smartphone apps. Twenty-seven randomized controlled trials were included. Smartphone apps that included acceptance and/or mindfulness components resulted in significantly higher levels of acceptance/mindfulness than comparison conditions (k = 33; g = 0.29; 95% CI = 0.17, 0.41). These effects were moderated by the type of comparison and whether reminders to engage were offered. Smartphone apps also resulted in significantly lower levels of psychological distress than comparisons (k = 22; g = -0.32; 95% CI = -0.48, -0.16). Meta-regression revealed a negative relationship between the effect sizes for mindfulness/acceptance and the effect sizes for distress. Smartphone apps produced significantly greater increases in self-compassion than comparisons (k = 9; g = 0.31; 95% CI = 0.07, 0.56), although the quality of RCTs in this analysis was poor. Findings suggest that principles of acceptance, mindfulness, and self-compassion may be learnt through cheap, easily accessible, and low intensity interventions delivered via smartphone apps. However, the quality of available evidence is poor, as low risk of bias was noted in few trials (18%) and the observed effects were likely explained by a digital placebo.
... Systematic reviews of eating disorder prevention and body image interventions (e.g., Linardon, Gleeson, Yap, Murphy, & Brennan, 2019;Watson et al., 2016) have highlighted DBT as an effective intervention approach for reducing body dissatisfaction (Mazzeo et al., 2016;Roosen, Safer, Adler, Cebolla, & Van Strien, 2012) and eating pathology (Mushquash & McMahan, 2015;Roosen et al., 2012;Telch, Agras, & Linehan, 2001) among adult women in pre-post analyses. However, all studies evaluated the DBT program among individuals presenting with eating disorder symptoms (e.g., binge eating disorder, emotional eating); thus, it is not known whether DBT-based interventions are effective among a universal population who are not presenting with eating pathology. ...
... 36 More specific approaches by psychologists and health care workers, for instance, could be taken to assure a low threshold for seeking help for those identified with problematic eating behaviors already causing PAF. Based on a meta-analyses by Melioli et al. 37 and Linardon et al., 38 Internet-based programs and third-wave behavioral interventions could provide here an effective way to help students of both traditional and nontraditional age groups. Taken together, due to the limited number of and partly conflicting findings concerning PAF and their associated factors, more research on the topic is warranted. ...
Objective:
To explore the role of body-esteem and self-esteem in the occurrence of academic functioning problems associated with eating disturbances. Participants: 330 university students (aged 16-53 years) in Finland in 2016. Method: Interference with academic functioning measured with the Eating and Body Image Academic Interference Scale. Multivariable logistic regression analyses were performed to describe the relationship of body-esteem, global self-esteem, and age with academic functioning problems associated with eating disturbances. Results: The level of academic functioning problems was low. High appearance-esteem (OR = 0.26; 95% CI [0.14-0.48]) and a five-year increase in age (OR = 0.68; 95% CI [0.52-0.89]) provided protection against academic functioning problems, whereas high evaluations attributed to others about one's body and appearance increased the odds of such problems (OR = 2.25; 95% CI [1.41-3.59]). Conclusion: Problems in academic functioning may relate to problems in eating behavior, body image, and feelings about appearance.
... The original DBT program consists of four group skills-training modules (mindfulness, interpersonal effectiveness, emotion regulation, and distress tolerance modules), individual therapy, telephone crisis coaching, and a therapist consultation team (Linehan, 2014). Recent meta-analyses have established the efficacy of DBT for a variety of mental health problems, including BPD (Cristea et al., 2017), and DBT has been adapted for use in other psychiatric conditions, such as eating disorders, including anorexia nervosa, bulimia nervosa (Safer, Telch, & Agras, 2001), or binge-eating disorders (Linardon, Fairburn, Fitzsimmons-Craft, Wilfley, & Brennan, 2017;Linardon, Gleeson, Yap, Murphy, & Brennan, 2019), and suicidal behaviors (DeCou, Comtois, & Landes, 2019), as well as other psychiatric conditions such as mood disorders (Burckhardt et al., 2018), posttraumatic stress disorder (Bohus et al., 2013), or comorbid disorders (Harned, Korslund, & Linehan, 2014). However, DBT interventions require high therapist specialization, which is sometimes not possible due to its high costs in terms of time and money. ...
Dialectical behavior therapy (DBT) and systems training for emotional predictability and problem solving (STEPPS) are two treatment protocols for people with borderline personality disorder (BPD) that have received important empirical support. However, their possible differential effectiveness has not yet been studied. The objective of this study is to explore the effectiveness of these two treatment programs. A nonrandomized clinical trial was carried out in which both treatments were applied for six months. The sample consisted of 72 patients diagnosed with BPD. The results indicate that both groups experienced a statistically significant reduction in BPD symptom, emotional regulation, impulsiveness, dissociative experiences, suicidal risk, depression, or anger. However, the DBT condition obtained statistically significant differences in BPD behavioral symptoms and fear of suicide. DBT and STEPPS treatment are effective treatments for participants with BPD, and DBT was more effective for the behavioral symptoms of BPD.
... The original manualized DBT program consists of four group skills training modules (mindfulness, interpersonal effectiveness, emotion regulation, and distress tolerance modules), individual counselling, telephone crisis coaching, and a therapist consultation team (Linehan, 2014). Recent meta-analyses of randomized controlled trials (RCTs) have established the efficacy of DBT for a variety of mental health problems, including BPD (Cristea et al., 2017), bingeeating disorders (Linardon, Fairburn, Fitzsimmons-Craft, Wilfley, & Brennan, 2017;Linardon, Gleeson, Yap, Murphy, & Brennan, 2019), and suicidal behaviours (DeCou, Comtois, & Landes, 2019). ...
Dropout is an important factor that may compromise the validity of findings from randomized controlled trials (RCTs) of dialectical behaviour therapy (DBT). We conducted a targeted meta-analytic review of dropout from RCTs of DBT, with the aims of (1) calculating average rates of dropout from DBT; (2) investigating factors that moderate dropout; (3) examining whether dropout rates from DBT differ to control interventions; (4) synthesising reasons for dropout. Forty RCTs of DBT met full inclusion criteria. The weighted mean dropout rate was 28.0% (95% CI = 23.6, 32.9). Dropout rates were not related to target disorder, dropout definition, delivery format, therapist experience, and therapist adherence. Unexpectedly, dropout rates were significantly higher in trials that offered telephone coaching and utilized a therapist consultation team. DBT dropout rates did not significantly differ to dropout rates from control interventions. Few trials reported reasons for dropout, and there was little consistency in the reported reasons. Findings suggest that over one in four patients drop out from DBT in RCTs. This review highlights the urgency for future trials to explicitly report detail pertaining to patient dropout, as this may assist in the development of strategies designed to prevent future dropouts in RCTs of DBT.
... Accumulating evidence suggests that ACT holds potential for the treatment and prevention of EDs [4,[10][11][12]. ACT has been shown to have efficacy for reducing ED symptoms relative to a waitlist control and treatment as usual (TAU) [13,14] and to have greater effects compared to cognitive therapy in one trial of ED symptoms secondary to anxiety or depression [15]. ...
Eating disorders (ED) constitute a serious public health issue affecting predominantly women and appearing typically in adolescence or early adulthood. EDs are extremely difficult to treat, as these disorders are ego-syntonic, and many patients do not seek treatment. It is vital to focus on the development of successful early-intervention programs for individuals presenting at risk and are on a trajectory towards developing EDs. This study is a randomized controlled trial evaluating an innovative digital gamified Acceptance and Commitment early-intervention program (AcceptME) for young females showing signs and symptoms of an ED and at high risk for an ED. Participants (n = 92; Mage = 15.30 years, SD = 2.15) received either AcceptME (n = 62) or a waitlist control (n = 30). Analyses indicated that the AcceptME program effectively reduced weight and shape concerns with large effects when compared to waitlist controls. Most participants scored below the at-risk cut-off (WCS score < 52) in the AcceptME at end-of-intervention (57.1%) compared to controls (7.1%), with odds of falling into the at-risk group being 14.5 times higher for participants in the control group. At follow-up, 72% of completers reported scores below the at-risk cut-off in the AcceptME group. The intervention also resulted in a decrease in ED symptomatology and increased body image flexibility. Overall, results suggest that the AcceptME program holds promise for early-intervention of young women at risk for developing an ED.
... Overall, clinical research referred to the generic term of body image disturbance as a cognitive-affective attitude toward one's own body that embraces various concepts related to negative body image, such as body dissatisfaction, avoidance, or, on the contrary, compulsive control of one's own body, detachment, and estrangement feelings towards it and worries about particular body parts, shapes or functions [44]. All these psychopathological dimensions seem to pertain to a core feature preceding the onset of behavioural symptoms [45], often persisting after treatments [46], and being associated with a worse prognosis [2,47] and with a higher likelihood of relapse after remission [48]. ...
Cognitive, psychodynamic, and phenomenological scholars converged their attention on abnormal bodily phenomena as the core psychopathological feature of eating disorders (EDs). While cognitive approaches focus their attention on a need for “objective” (i.e., observable, measurable) variables (including behaviours and distorted cognitions), the phenomenological exploration typically targets descriptions of persons’ lived experience. According to a new emerging phenomenological perspective, the classic behavioural and cognitive symptoms of EDs should be considered as epiphenomena of a deeper core represented by a disorder of the embodiment. The cognitive–behavioural model is the most studied and, up till now, clinically efficacious treatment for EDs. However, as any coherent and scientifically grounded model, it presents some limitations in its application. Numerous patients report a chronic course, do not respond to treatment and develop a personality structure based on pathological eating behaviours, since “being anorexic” becomes a new identity for the person. Furthermore, the etiopathogenetic trajectory of EDs influences the treatment response: for example, patients reporting childhood abuse or maltreatment respond differently to cognitive-behavioural therapy. To obtain a deeper comprehension of these disorders, it seems important to shift attention from abnormal eating behaviours to more complex and subtle psycho(patho)logical features, especially experiential ones. This characterisation represents the unavoidable premise for the identification of new therapeutic targets and consequently for an improvement of the outcome of these severe disorders. Thus, the present review aims to provide an integrated view of cognitive, psychodynamic, and phenomenological perspectives on EDs, suggesting new therapeutic targets and intervention strategies based on this integrated model. Level of Evidence: Level V.
Level of evidence Level V: Opinions of authorities, based on descriptive studies, narrative reviews, clinical experience, or reports of expert committees.
... gratitude, body appreciation, mindfulness, and self-compassion). There is now good evidence that leveraging aspects of these approaches can improve overall body appreciation and satisfaction [13,[34][35][36][37][38][39][40], and lead to overall improvements in mental health outcomes [41][42][43]. ...
Background
Motherhood is a time of intense physical, psychological, and identity transformation, and body dissatisfaction may emerge through the process of pregnancy, birth, and adaptation to parenting. We present a feasibility trial of the Body Confident Mums Challenge, a program developed by adapting existing, effective interventions that focus on self-compassion and appreciation of body functionality to be specific to mothers.
Methods
The program was delivered using the social learning function in a closed Facebook group. Qualitative evaluation of evidence of change was conducted by gathering individual written reflections posted during the challenge (n = 120). Feasibility and acceptability was determined using a feedback survey (n = 22).
Results
Participant’s reflective posts indicated that they were embracing self-compassion, and de-prioritising body image concerns during the challenge. Feedback indicated that the program was mostly feasible and acceptable for mothers, with recommendations from some participants relating to slowing the pace of content delivery and reducing the time commitment of the Challenge.
Conclusions
The social media environment may therefore be a useful setting in which to implement brief intervention programs to improve body image and wellbeing.
... While theoretically, this process is in line with those posited by ACT interventions, longitudinal replication of our analyses and research specifically examining cognitive defusion as a process mechanism in interventions for EDs is needed to support this notion. To date, there is a small but growing body of evidence suggesting that ACT is effective in decreasing ED symptom severity and body image concerns [6,50], and that among a sample of overweight/obese adults, led to significant improvements in the eating for physical rather than emotional reasons component of IE from pre-to post-intervention. However, to our knowledge, no studies have explicitly examined the use of ACT-based interventions targeting body image-related fusion within individuals with eating disorders, or examined this as a possible therapeutic mechanism of change that may promote adaptive eating behaviors, such as IE within these populations. ...
Purpose
This study sought to explore the associations between Intuitive Eating (IE), eating disorder (ED) symptom severity, and body image-related cognitive fusion within a clinical sample. IE was also examined as a possible mediator in the relationship between body image-related fusion and ED symptoms.
Methods
This study includes cross-sectional analyses with data from 100 adult females and 75 adolescent females seeking residential treatment for an ED. Self-reported demographic information, ED symptoms, IE behaviors, and body image-related cognitive fusion were collected from participants within the first week of treatment following admission to the same residential ED treatment facility.
Results
ED symptom severity was significantly negatively associated with three of the four domains of IE; unconditional permission to eat, reliance on hunger and satiety cues, and body-food choice congruence. A significant mediational effect of IE on the relationship between body image-related fusion and ED symptoms through IE behaviors was observed (β = 11.3, SE = 0.003, p < 0.001). This effect was only observed for the unconditional permission to eat (β = 0.13, p = 0.003) and reliance on hunger and satiety cues (β = 0.10, p = 0.005) domains of IE when the domains were subsequently analyzed individually.
Conclusion
Unconditional permission to eat and reliance on hunger and satiety cues appear to be particularly influential domains of IE in the relationship between body image-related fusion and ED symptom severity. It is possible that changes in these IE domains may be mechanisms through which body image-related fusion influences ED symptoms. Future longitudinal research is needed to better understand the relationship between body image-related cognitive fusion and IE and the potential for targeting these constructs specifically in the context of ED treatment.
Level of evidence
Level V, cross-sectional analysis from descriptive study.
... La TCC tiene como objetivo normalizar la alimentación, reducir los intentos de dieta y modificar el contenido de las cogniciones sobre la evaluación del peso y el aspecto corporal. Para lograr estos objetivos se usan la psicoeducación y técnicas cognitivo-conductuales, que incluyen la prescripción de comer y pesarse regularmente, el autocontrol de la ingesta de alimentos y la reducción del control y evitación del cuerpo (Linardon, 2018). En cambio, los enfoques contextuales tienen como objetivo modificar la manera como las personas se relacionan con sus pensamientos sobre el peso, su aspecto físico y la alimentación. ...
Eating disorders (ED) are defined as specific and severe alterations in food intake, observed in people who present distorted patterns in the act of eating and are characterized by either overeating or stopping do it. Contextual or third generation therapies are being used to treat eating disorders, their objective is to modify the way in which people relate to their thoughts about weight, their physical appearance and eating, to favor the processes of acceptance and cognitive flexibility. The objective of this study is to review the current panorama of contextual or third generation therapies as therapeutic intervention in eating disorders, selecting for their development of adaptations and specific processes in eating disorders, Dialectical Behavioral Therapy (DBT) and Dialectical Behavioral Therapy (DBT), Acceptance and Commitment (ACT) and also including in the review, the Mindfulness-based Conscious Eating Program (MB EAT).
We consider that DBT has shown greater affective stabilization, improvement in levels of depression and anxiety, reduction of binge eating and greater adherence to treatment. ACT has been shown to be effective in binge-eating behavior and body dissatisfaction caused by cognitive inflexibility. MB EAT has achieved utility by creating greater acceptance and flexibility in the act of eating, recognizing signs of hunger and satiety, in addition to demonstrating reduction of compulsive eating and mindfulness in eating. More studies are necessary, especially with ACT and MB-EAT, to achieve a higher level of evidence.
... Psychological therapy is therefore changing in ways that positively address the current increase of body image-related difficulties and associated negative outcomes (e.g. emotional distress; Linardon, Gleeson, et al., 2019;Linardon, Kothe, et al., 2019;Williams et al., 2004;Zilcha-Mano & Ramseyer, 2020). ...
Positive body image is a contemporary construct, having only received research attention within the past two decades in an effort to elicit a more holistic, comprehensive account of the concept of body image. Nevertheless, emerging literature has suggested its direct and indirect association with improved outcomes, including indicators of well-being (e.g. self-compassion) and feelings towards the self (e.g. self-esteem). Positive body image has therefore been suggested as both a potential technique and a target of actionable therapeutic work for cultivating both physical and psychological well-being. First, through insights from quantitative and qualitative seminal works, this paper demonstrates that positive body image is: (i) a multidimensional construct, distinct from negative body image; (ii) a confluence of theoretical disciplines and influences; (iii) protective, with therapeutic capacities; (iv) a positive outcome; (v) young, yet flourishing; and (vi) socially and politically relevant. Thus, complementing what positive body image is, this paper further situates therapeutic practice within the field of positive body image by delineating and contextualising their reciprocal capacities and relevant techniques.
... Formal and informal self-compassion practices can easily be added to complement broader behaviour change interventions. For example, 'third-wave' cognitive behavioural therapy interventions include practices and techniques such as mindfulness and self-acceptance to improve psychological functioning (e.g., Acceptance and Commitment Therapy [42]). ...
Objective:
Self-compassion - the tendency or ability to treat oneself kindly in times of failure or distress - may be a natural fit to support individuals who struggle with weight management. However, while self-compassion shows promise with improving health behaviours, the associations self-compassion has on weight management outcomes are unclear. The objective of this systematic review was three-fold: (1) to evaluate whether self-compassion interventions can increase individual self-compassion in the context of weight management, (2) to investigate if self-compassion interventions can improve weight management outcomes, defined as healthier eating, increased physical activity, or reduced weight and finally, (3) to explore whether these benefits can be sustained over the longer term.
Methods:
Following PRISMA guidelines, Scopus, PsycINFO, Medline, PubMed and Embase databases were searched. Studies including a measure of self-compassion and a self-compassion intervention reporting weight management outcomes were included. Studies in populations living with an eating disorder were excluded. The Quality Criteria Checklist from the American Dietetic Association was used to assess study quality. Prospero Registration #CRD42019146707.
Results:
Of the 9082 records screened, a total of 20 studies met inclusion criteria. Seventeen studies reported significant increases in self-compassion post-intervention. Improvements were also found for eating behaviours (15 of 18), physical activity behaviours (6 of 9), and weight loss (6 of 11). The majority of improvements were maintained at follow-up, except for physical activity behaviours (1 of 7).
Conclusion:
Self-compassion interventions tailored to weight management outcomes demonstrate efficacy with increasing self-compassion post-intervention. Methodological weaknesses and questions about the maintenance of any improvements in weight management outcomes limit our ability to make strong conclusions. However, there is promise and clear relevance for including self-compassion interventions to enhance weight management outcomes; directions for improved intervention and study design are given.
Accumulating evidence suggests that the presence of shape/weight overvaluation in binge-eating disorder (BED) is associated with more severe psychopathology and impairment. To further inform the role of the overvaluation construct in BED, we examined whether those with and without shape/weight overvaluation differ on four core processes that underpin the contextual behaviour therapies: distress tolerance, self-compassion, mindfulness, and experiential avoidance. These four processes were investigated as each are considered important change mechanisms in contextual behavioural therapies and are either compatible or incompatible with the emotion dysregulation known to precipitate binge eating. Participants were categorized into one of four study groups: probable BED with overvaluation (n = 60); probable BED without overvaluation (n = 108); obese control (n = 59); healthy control (n = 123). Analyses of covariance showed that the probable BED with overvaluation group reported lower levels of self-compassion and distress tolerance, and higher levels of experiential avoidance than the three other groups. The probable BED without overvaluation group did not differ to control groups on these processes, except experiential avoidance levels. Findings highlight potentially important intervention targets and constructs among a subgroup of individuals with BED.
The Body Image Acceptance and Action Questionnaire (BI-AAQ), a measure designed to assess body image flexibility, was originally developed for and psychometrically investigated with nonclinical populations, but it has been recently administered to people with binge-eating disorder (BED) symptomatology. Tests of measurement invariance are needed to understand whether the BI-AAQ operates in the same way for BED and non-BED populations, thereby ensuring meaningful comparison across these groups. We thus tested the measurement invariance of the BI-AAQ in participants with and without clinically significant BED symptomatology. Data were analyzed from 358 community-based participants. Participants were either classified as with (n = 179) or without (n = 179) "probable BED" based on self-reported symptom frequency. An unacceptable model fit was found across both groups, indicating that the unidimensional structure of the BI-AAQ was not replicated. We then sought to confirm the unidimensional structure of a recently proposed five-item version of the BI-AAQ. A unidimensional structure of this abbreviated version was replicated, and tests of measurement variance were upheld. Internal consistency, convergent validity, and incremental validity were documented for both the original and abbreviated BI-AAQ across individuals with and without BED symptomatology. Present findings provide further psychometric support for an abbreviated five-item BI-AAQ, although it is important for future research to replicate both the full and abbreviated BI-AAQ in more diverse samples. Overall, an abbreviated BI-AAQ may be an attractive alternative for researchers studying body image flexibility. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
Purpose: For patients with eating disorders (EDs), early engagement in care is usually considered a positive prognostic factor. The aim of the study was to investigate how a single-day intervention devoted to early, brief, experiential exposure to a variety of psychotherapy approaches might support commitment to change and the decision to engage in care in patients with EDs.
Methods: One hundred and sixty-nine adult outpatients newly diagnosed with an ED took part in a single-day workshop for groups of up to ten patients, where they experienced eight psychotherapeutic approaches. Motivation to change care and level of insight were assessed at baseline and 10 days after the intervention.
Results: Motivation and commitment to take active steps toward change (expressed by the “Committed Action” composite score) signifcantly improved after the intervention (p<0.001), and a signifcant number of patients specifcally moved from “contemplation” to “action” stage (p<0.001). The improvement of motivation to change was signifcantly associated with an increase in insight capacity (p<0.001), and this increase was observed for almost all related dimensions such as recognition
of illness or awareness of need for psychological treatment.
Conclusion: A single-day session devoted to experiencing a range of group psychotherapies increased patients’ insight and motivation to actively engage in care. To confrm potential longer-term benefts of this intervention, further studies are needed to explore the contribution of each approach and process specifcally involved in patients' increased motivation for care, as well as the clinical characteristics of patients associated with better outcomes.
Adult women report significant body dissatisfaction yet are often overlooked in body image promotion programs. Although few venues afford opportune settings for intervening with adult women, the church serves as a regular meeting place for many in the South of the United States. This study tested a dissonance-based body image program, Reclaiming Beauty (RB), adapted for adult women in church settings. Six groups (n = 30) were led by two trained church leaders (peer-led) and three groups (n = 21) were led by a trained peer leader and a researcher (researcher-co-led). RB participants, aged 30–77 years (M = 53.1 ± 12.7), completed assessments pre-intervention, immediately post-intervention, and 6 months post-intervention. Waitlist-controls (n = 31) completed assessments at time intervals consistent with intervention participants. RB participants reported significantly decreased thin-ideal internalization, body surveillance, and eating psychopathology at post-intervention and at 6 months post-intervention relative to controls. RB participants also reported significantly increased body satisfaction immediately post-intervention relative to controls, but this was not significant at 6 months post-intervention. Peer-led groups outperformed researcher-co-led groups on body surveillance at 6 months, but RB conditions did not otherwise differ. Our findings provide preliminary support for the dissemination of a culturally-modified dissonance-based body image program to adult women in church settings.
Background: While negative affect reliably predicts binge eating, it is unknown how this association may decrease or ‘de-couple’ during treatment for binge eating disorder (BED), whether such change is greater in treatments targeting emotion regulation, or how such change predicts outcome. This study utilized multi-wave ecological momentary assessment (EMA) to assess changes in the momentary association between negative affect and subsequent binge-eating symptoms during Integrative Cognitive Affective Therapy (ICAT-BED) and Cognitive Behavior Therapy Guided Self-Help (CBTgsh). It was predicted that there would be stronger de-coupling effects in ICAT-BED compared to CBTgsh given the focus on emotion regulation skills in ICAT-BED and that greater de-coupling would predict outcomes. Methods: Adults with BED were randomized to ICAT-BED or CBTgsh and completed 1-week EMA protocols and the Eating Disorder Examination (EDE) at pre-treatment, end-of-treatment, and 6-month follow-up (final N = 78). De-coupling was operationalized as a change in momentary associations between negative affect and binge-eating symptoms from pre-treatment to end-of-treatment. Results: There was a significant de-coupling effect at follow-up but not end-of-treatment, and de-coupling did not differ between ICAT-BED and CBTgsh. Less de-coupling was associated with higher end-of-treatment EDE global scores at end-of-treatment and higher binge frequency at follow-up.
Conclusions: Both ICAT-BED and CBTgsh were associated with de-coupling of momentary negative affect and binge-eating symptoms, which in turn relate to cognitive and behavioral treatment outcomes. Future research is warranted to identify differential mechanisms of change across ICAT-BED and CBTgsh. Results also highlight the importance of developing momentary interventions to more effectively de-couple negative affect and binge eating.
The ongoing coronavirus (COVID-19) pandemic and attendant lockdown mandates may have detrimental effects on body image outcomes, which in turn highlights the importance of identifying protective factors. Here, we examined associations between COVID-19-related stress and body image disturbance, as well as the potential mediating and moderating role of self-compassion. During the third lockdown in the United Kingdom, we asked an online sample of adults (N = 600) to complete measures of COVID-19-related stress, body image disturbance, and self-compassion. Mediation analysis showed that higher COVID-19-related stress was significantly associated with greater body image disturbance, and that this relationship was mediated by self-compassion. In contrast, self-compassion did not significantly moderate the effects of stress on body image disturbance. These results suggest that promoting greater self-compassion may be a viable means of mitigating adverse outcomes from the COVID-19 pandemic on body image disturbance.
Introduction: The past several years have witnessed a significant increase in interest among the public in mindfulness with an unmistakable growth in the scientific literature investigating mindfulness-based therapies. A myriad of therapeutic uses of mindfulness have been studied. Given this burgeoning interest, the authors' objective was to conduct a broad-sweeping bibliometric analysis over the past two decades to describe overarching trends in the publications of randomized controlled trials (RCTs) investigating mindfulness to broadly identify both strengths and gaps in this field and inform a strategic plan for further advancing this research area. Materials and Methods: The authors retrieved mindfulness-focused RCTs available on PubMed in the past two decades (2000-2019). They synthesized the literature with respect to publication numbers, countries of publication, journal type, areas of research focus, characteristics of study designs, sample size, and trends in remote intervention delivery. Results: The resulting 1389 publications represent a near exponential growth trend over the past 20 years. Publications from the top three countries (the United States, the United Kingdom, and the Netherlands) with the highest productivity accounted for 60% of total number of publications. The most published modalities include acceptance-based therapy (n = 260), mindfulness-based stress reduction (n = 238), mindfulness-based cognitive therapy (n = 174), and dialectical behavior therapy (n = 82). Stress, depression, anxiety, pain, cancer, diet/healthy eating, and sleep were the most common major areas of focus. Studies included active (46%) or inactive controls (44%), and increasingly more studies with both types of controls (10%). The top 10 journals that published the most mindfulness RCTs were from behavioral sciences and psychiatry or psychology. There were 187 RCTs utilizing remote delivery, with 146 (87.1%) in the most recent 5 years. Conclusion: Publications of mindfulness-focused RCTs show a continuous increasing trend. Mindfulness research from non-Western countries and studies published in biomedical journals were less prevalent and potentially represent future opportunities. Trends of studies with both inactive and active controls support an overall advancement in research methodology. There has been a significant expansion of studies of remotely delivered mindfulness interventions. Future research might consider evaluation of a broader range of modalities and further examine optimal delivery formats.
Objective
Shame is broadly implicated in the development and maintenance of eating pathology. However, the relationship between shame and binge eating symptoms specifically is less clear. This review aimed to clarify what types of shame are associated with binge eating symptoms, and the antecedents and maintenance factors in these relationships.
Method
A systematic search for quantitative and qualitative empirical studies was conducted to identify evidence of the relationship between shame and binge eating symptoms. Altogether, 270 articles were identified and screened for eligibility in the review.
Results
Results of the relevant empirical studies (n = 31) identified several types of shame associated with binge eating pathology: (i) internal shame, (ii) external shame, (iii) body shame, and (iv) binge eating-related shame, as well as several mechanisms and pathways through which shame was associated with binge eating symptoms.
Discussion
Drawing from the research findings, this review presents an original, integrated model of the cyclical shame-binge eating relationship. Clinical interventions that might break this cycle are discussed, as well as methodological weaknesses which limit causal inferences and important areas of future research.
Objective:
Although maladaptive exercise (ME) is widely recognized as a clinical feature in transdiagnostic eating disorders, less is known about psychosocial factors that give rise to and perpetuate this behavior. This systematic review aimed to examine the empirical status of this association.
Method:
We reviewed 46 full text articles examining longitudinal associations between psychosocial variables and ME.
Results:
Eighteen studies met full inclusion criteria. Based on our qualitative synthesis, evidence suggests reasonably consistent associations between early concern with weight and shape, and negative affect on later development of ME.
Discussion:
Inconsistent and insufficient assessment of ME across a majority of studies underscores caution in interpretation of results, but guides important discussion for future clinical and research efforts.
Body image flexibility refers to the ability to openly experience thoughts or feelings about the body without acting on them or trying to change them. Accumulating evidence has demonstrated that body image flexibility is connected to numerous adaptive processes, and that it is sensitive to change during psychological interventions. However, a quantitative synthesis of empirical research on body image flexibility is lacking. We conducted the first meta-analysis on body image flexibility and its correlates. Sixty-two studies were included. Random effects meta-analyses were conducted on 19 psychological correlates, divided into three clusters: eating and body image disturbances, positive body-related and general psychological constructs, and general psychopathology. Meta-analyses showed inverse correlations between body image flexibility and each construct within the eating and body image disturbances cluster (rs= −.45 to −.67), and the general psychopathology cluster (rs= −.37 to −.58). Body image flexibility was positively associated with each positive psychology construct (rs = .23 – .58). Men reported higher levels of body image flexibility than women (d = 0.32). Psychological interventions were more effective than control groups at enhancing body image flexibility in randomized controlled trials (d = 0.42). Findings confirm that body image flexibility is consistently connected to indices of mental health, and that it can be enhanced during psychological interventions.
In response to questions regarding the scientific basis for mindfulness-based interventions (MBIs), we evaluated their empirical status by systematically reviewing meta-analyses of randomized controlled trials (RCTs). We searched six databases for effect sizes based on four or more trials that did not combine passive and active controls. Heterogeneity, moderators, tests of publication bias, risk of bias, and adverse effects were also extracted. Representative effect sizes based on the largest number of studies were identified across a wide range of populations, problems, interventions, comparisons, and outcomes (PICOS). A total of 160 effect sizes were reported in 44 meta-analyses (k = 336 RCTs, N = 30,483 participants). MBIs showed superiority to passive controls across most PICOS (ds = 0.10–0.89). Effects were typically smaller and less often statistically significant compared with active controls. MBIs were similar or superior to specific active controls and evidence-based treatments. Heterogeneity was typically moderate. Few consistent moderators were found. Results were generally robust to publication bias, although other important sources of bias were identified. Reporting of adverse effects was inconsistent. Statistical power may be lacking in meta-analyses, particularly for comparisons with active controls. Because MBIs show promise across some PICOS, future RCTs and meta-analyses should build on identified strengths and limitations of this literature.
We evaluated the effects of mindfulness-based eating awareness training (MB-EAT) as a treatment for weight maintenance and psychological symptoms post-bariatric surgery. MB-EAT is an evidence-based group intervention originally developed for individuals who binge eat. It consisted of eight weekly 2-h sessions and was an adjunct to treatment as usual for post-bariatric surgery care. Participants’ body mass index (BMI) was calculated, and they completed self-report measures of depression, anxiety, binge eating, emotional eating, emotion regulation, and mindfulness before and immediately after MB-EAT and at 4 months follow-up. Participants rated the helpfulness of each session and recorded the amount of time spent practicing mindfulness between sessions. Twenty-eight participants were recruited (100% female, mean age = 54.30), 22 completed the intervention, and comparable data was available for between 13 and 17 participants depending on the measure. Depression significantly decreased from pre to post MB-EAT (p = 0.04, Cohen’s d = 0.39), and at 4 months follow-up, emotion regulation was significantly improved (p = 0.04, Cohen’s d = 0.12). Trends toward improvement were observed in binge eating and emotional eating from pre- to post-MB-EAT and in emotional eating from pre to 4 months follow-up. Time spent practicing mindfulness between sessions was associated with statistically significant improvements in emotional eating in response to anger from pre- to post-MB-EAT (p = 0.05). The positive results from this pilot study highlight the feasibility of MB-EAT for addressing eating problems and mental health symptoms in bariatric surgery patients.
This study examined the effects of a mindful eating intervention on health-related outcomes. Thirty-six obese, post-menopausal women were randomized to a 6-week mindful eating and living (MEAL) intervention or an active control group (CONT), consisting of nutritional counseling, goal setting, and group support. Additionally, there were ten monthly refreshers. Weight, body mass index (BMI), waist-hip ratio (WHR), binge eating, interleukin-6 (IL-6), and C-reactive protein (CRP) were assessed at baseline and four follow-up periods up to 1 year. Multilevel analyses showed that the MEAL group had reductions in weight, BMI, WHR, binge eating, IL-6, and CRP, and the CONT group had reductions in weight, BMI, and binge eating. The reductions in IL-6 and CRP were greater for the MEAL as compared with the CONT group. This study suggests that a mindfulness-based eating intervention may have various health benefits in post-menopausal women who are obese.
Weight self-stigma is a promising target for innovative interventions seeking to improve outcomes among overweight/obese individuals. Preliminary research suggests acceptance and commitment therapy (ACT) may be an effective approach for reducing weight self-stigma, but a guided self-help version of this intervention may improve broad dissemination. This pilot open trial sought to evaluate the potential acceptability and efficacy of a guided self-help ACT intervention, included coaching and a self-help book, with a sample of 13 overweight/obese individuals high in weight self-stigma. Results indicated a high degree of program engagement (77% completed the intervention) and satisfaction. Participants improved on outcomes over time including weight self-stigma, emotional eating, weight management behaviors, health-related quality of life, and depression. Although not a directly targeted outcome, participants improved on objectively measured weight, with an average of 4.18 pounds lost over 7 weeks, but did not improve on self-reported weight at 3-month follow-up. Processes of change improved over time, including psychological inflexibility, valued action and reasons to lose weight. Coaching effects indicated greater retention and improvements over time with one coach vs. the other, suggesting characteristics of coaching can affect outcomes. Overall, these results provide preliminary support for the acceptability and efficacy of a guided self-help ACT program for weight self-stigma. Implications of these results and how to address clinical challenges with guided self-help are discussed.
Background
Middle-aged women are at risk of weight gain and associated comorbidities. Deliberate restriction of food intake (dieting) produces short-term weight loss but is largely unsuccessful for long-term weight management. Two promising approaches for the prevention of weight gain are intuitive eating (ie, eating in accordance with hunger and satiety signals) and the development of greater psychological flexibility (ie, the aim of acceptance and commitment therapy [ACT]).
Objectives
This pilot study investigated the usage, acceptability, and feasibility of “Mind, Body, Food,” a Web-based weight gain prevention intervention prototype that teaches intuitive eating and psychological flexibility skills.
Methods
Participants were 40 overweight women (mean age 44.8 [standard deviation, SD, 3.06] years, mean body mass index [BMI] 32.9 [SD 6.01] kg/m², mean Intuitive Eating Scale [IES-1] total score 53.4 [SD 7.46], classified as below average) who were recruited from the general population in Dunedin, New Zealand. Module completion and study site metrics were assessed using Google Analytics. Use of an online self-monitoring tool was determined by entries saved to a secure online database. Intervention acceptability was assessed postintervention. BMI, intuitive eating, binge eating, psychological flexibility, and general mental and physical health were assessed pre- and postintervention and 3-months postintervention.
Results
Of the 40 women enrolled in the study, 12 (30%) completed all 12 modules (median 7.5 [interquartile range, IQR, 2-12] modules) and 4 (10%) used the self-monitoring tool for all 14 weeks of the intervention period (median 3 [IQR 1-9] weeks). Among 26 women who completed postintervention assessments, most women rated “Mind, Body, Food” as useful (20/26, 77%), easy to use (17/25, 68%) and liked the intervention (22/25, 88%). From pre- to postintervention, there were statistically significant within-group increases in intuitive eating (IES-2 total score P<.001; all IES-2 subscale scores: P ≤.01), psychological flexibility (P=.01), and general mental health (P<.001) as well as significant decreases in binge eating (P=.01). At the 3-month follow-up, IES-2 improvements were maintained, and there were further improvements in binge eating (P<.001) and general mental health (P=.03), and a marginal yet nonsignificant tendency for further improvement in psychological flexibility (P=.06). There were no significant within-group changes in BMI from pre- to postintervention and postintervention to 3-month follow-up (P=.46 and P=.93, respectively).
Conclusions
The “Mind, Body, Food” prototype Web-based intervention is appealing to middle-aged women and may be a useful tool to help women learn intuitive eating and ACT skills, reduce binge eating, and maintain weight over 3 months. Further work to improve the user experience and engagement is required before testing the online intervention in a randomized controlled trial.
Background
Chronic pain patients increasingly seek treatment through mindfulness meditation. PurposeThis study aims to synthesize evidence on efficacy and safety of mindfulness meditation interventions for the treatment of chronic pain in adults. Method
We conducted a systematic review on randomized controlled trials (RCTs) with meta-analyses using the Hartung-Knapp-Sidik-Jonkman method for random-effects models. Quality of evidence was assessed using the GRADE approach. Outcomes included pain, depression, quality of life, and analgesic use. ResultsThirty-eight RCTs met inclusion criteria; seven reported on safety. We found low-quality evidence that mindfulness meditation is associated with a small decrease in pain compared with all types of controls in 30 RCTs. Statistically significant effects were also found for depression symptoms and quality of life. Conclusions
While mindfulness meditation improves pain and depression symptoms and quality of life, additional well-designed, rigorous, and large-scale RCTs are needed to decisively provide estimates of the efficacy of mindfulness meditation for chronic pain.
Introduction: Schizophrenia and psychotic disorders are chronic conditions. Although antipsychotic medicationsare the first line of treatment, many patients continued to have symptoms. Acceptance and Commitment Therapy(ACT) is a therapy that applies mindfulness to teach patients accepting the existence of symptoms rather than avoidthem. A meta-analysis was conducted to measure the efficacy of ACT in treatment of psychosis.Methods: A systematic review search was conducted using the following keywords: "acceptance andcommitment therapy", "randomized", "clinical trials", "psychosis"," schizophrenia", and "major depressive disorderAND psychosis". All studies were read by two authors and checked for eligibility. Studies were included if randomlyallocate to ACT or usual treatment (TAU), and psychosis as diagnosis. Mantel and Haenszel approach was used todetermine the heterogeneity in the study. For quantitative outcomes, standardized mean difference between ACTand TAU was used to summarize effect size, while relative risk was used for categorical outcomes along with 95%confidence interval.Results: 217 studies were identified. 92 studies were selected for review after removing the duplications. Atotal of 4 studies were included in quantitative-synthesis. The mean age for the participants was 38 years of age.Regarding treatment outcomes, there was a significant difference between the two arms in the degree of change ofnegative symptoms (p=0.008), but the difference was not significant for positive symptoms. There was a reduction ofre-hospitalization rate at 4 months in ACT compared to TAU in participants with psychosis.Conclusions: ACT is a promising adjunctive therapy for patient with psychosis.
Introduction:
Binge and loss of control (LOC) eating are significant concerns among many adolescents and are associated with poor physical, social, and psychological functioning. Black girls appear to be particularly vulnerable to binge and LOC eating. Yet, empirically validated, culturally sensitive treatments for these disordered eating behaviors are not well established. This investigation examined satisfaction, feasibility, and preliminary outcomes of a binge eating intervention for ethnically diverse adolescent girls.
Methods:
Participants were 45 girls (age 13-17years; 44.4% white, 42.2% black) randomized into a dialectical behavior therapy (DBT)-based intervention (Linking Individuals Being Emotionally Real, LIBER8) or a weight management group (2BFit). Following each meeting, participants completed satisfaction measures, and therapists assessed intervention feasibility. Participants also completed assessments of eating behavior and related psychological constructs at baseline, immediately following the intervention, and at 3-month follow-up.
Results:
Descriptive statistics indicated that LIBER8 was feasible, and participants were highly satisfied with this intervention. Significant reductions in eating disorder cognitions, dietary restraint, and eating in response to negative affect were observed for participants in both groups, with no differences between LIBER8 and 2BFit.
Discussion:
The acceptability and feasibility of LIBER8 and associated reductions in emotional eating show promise in ameliorating binge eating and provide insight into multiple options for treating this challenging eating concern.
Assessment in clinical psychology typically relies on global retrospective self-reports collected at research or clinic visits, which are limited by recall bias and are not well suited to address how behavior changes over time and across contexts. Ecological momentary assessment (EMA) involves repeated sampling of subjects' current behaviors and experiences in real time, in subjects' natural environments. EMA aims to minimize recall bias, maximize ecological validity, and allow study of microprocesses that influence behavior in real-world contexts. EMA studies assess particular events in subjects' lives or assess subjects at periodic intervals, often by random time sampling, using technologies ranging from written diaries and telephones to electronic diaries and physiological sensors. We discuss the rationale for EMA, EMA designs, methodological and practical issues, and comparisons of EMA and recall data. EMA holds unique promise to advance the science and practice of clinical psychology by shedding light on the dynamics of behavior in real-world settings.
Binge eating involves rapidly and uncontrollably eating a large amount of food in a short time period. Research suggests that binge eating is common among people seeking bariatric 1 (weight-management) services with prevalence rates upwards of 50 %. Binge eating is associated with poorer weight loss and weight regain after bariatric services or alternative attempts at weight loss [1, 2]. Given the high rates of binge eating among people seeking bariatric services and its negative impact on weight-loss outcomes [1-3], targeting binge eating in patients seeking bariatric services may be useful to enable optimal treatment response. However, programs aimed at targeting binge eating are not routinely offered in bariatric programs. This manuscript describes the implementation and evaluation of a targeted intervention for binge eating among a group of patients accessing bariatric services. The intervention used in the present study was adapted from Linehan's [4] manualized dialectical behavior therapy (DBT) and Safer, Telch, and Chen's [5] manualized dialectical behavior therapy for binge eating (DBT-BE). The theory underlying this treatment is based upon the affect regulation model that suggests binge eating is used in an attempt to manage painful or unpleasant emotional states [6, 7]. Available evidence suggests that DBT-BE is effective in reducing binge eating among community-dwelling, adults with eating disorders [8]. However, to date, no research has tested whether DBT-BE is effective in reducing binge eating among patients seeking bariatric services. The present study addresses this gap by testing the impact that a 10-week DBT-BE skills group has on binge eating and associated psychosocial functioning among patients seeking bariatric services. We hypothesized binge eating and associated psychosocial functioning would improve following participation in the DBT-BE skills group.
Mindfulness-based interventions are increasingly used to treat binge eating. The effects of these interventions have not been reviewed comprehensively. This systematic review and meta-analysis sought to summarize the literature on mindfulness-based interventions and determine their impact on binge eating behavior. PubMED, Web of Science, and PsycINFO were searched using keywords binge eating, overeating, objective bulimic episodes, acceptance and commitment therapy, dialectical behavior therapy, mindfulness, meditation, mindful eating. Of 151 records screened, 19 studies met inclusion criteria. Most studies showed effects of large magnitude. Results of random effects meta-analyses supported large or medium-large effects of these interventions on binge eating (within-group random effects mean Hedge’s g = −1.12, 95 % CI −1.67, −0.80, k = 18; between-group mean Hedge’s g = −0.70, 95 % CI −1.16, −0.24, k = 7). However, there was high statistical heterogeneity among the studies (within-group I
2 = 93 %; between-group I
2 = 90 %). Limitations and future research directions are discussed.
Background: The current study presents the results of a meta-analysis of 39 randomized controlled trials on the efficacy of ACT, including 1,821 patients with mental disorders or somatic health problems.
Methods: We searched PsycINFO, MEDLINE, and the Cochrane Central Register of Controlled Trials. Information provided by the Association of Contextual Behavioral Science (ACBS) community was also included. Statistical calculations were conducted using Comprehensive Meta-Analysis software. Study quality was rated using a methodology rating form.
Results: ACT outperformed control conditions (Hedges’s g = 0.57) at post-treatment and follow-up, in completer and intent-to-treat analyses for primary outcomes. ACT was superior to waitlist (Hedges’s g = 0.82), to psychological placebo (Hedges’s g = 0.51) and to TAU (Hedges’ g = 0.64). ACT was also superior on secondary outcomes (Hedges’s g = 0.30), life satisfaction/quality measures (Hedges’s g = 0.37) and process measures (Hedges’s g = 0. 56) when compared to control conditions. The comparison between ACT and established treatments (i.e., CBT) did not reveal any significant differences between these treatments (p = .140).
Conclusions: Our findings indicate that ACT is more effective than treatment as usual or placebo and that ACT may be as effective in treating anxiety disorders, depression, addiction, and somatic health problems as established psychological interventions. More research that focuses on quality of life and processes of change is needed to understand the added value of ACT and its trans diagnostic nature.
Dialectical Behavior Therapy (DBT) has been shown to effectively target binge eating disorder (BED). This study pilots the effectiveness of group DBT for obese "emotional eaters" to reduce eating psychopathology and achieve weight maintenance. Thirty-five obese male and female emotional eaters receiving 20 group psychotherapy sessions of DBT adapted for emotional eating were assessed at end-of-treatment and 6 month follow-up for reductions in eating psychopathology and weight maintenance. DBT resulted in significant reductions in emotional eating and other markers of eating psychopathology at the end-of-treatment that were maintained at follow-up. The drop-out rate was very low, with only 1 participant dropping from treatment. Thirty-three (94%) of the sample provided data at every assessment point. Of these, 80% achieved either weight reduction or weight maintenance after treatment and throughout the follow-up period. The effect size for weight reduction was small. This pilot study demonstrates group DBT targeting emotional eating in the obese to be a highly acceptable and effective intervention for reducing eating related psychopathology at both at end-of-treatment and during follow-up. The ability of DBT to limit the upward trajectory of weight gain in obese patients with high degrees of emotional eating suggests that DBT may also help limit the increase or even prevent onset of obesity related morbidity in these patients.
Objective
To examine temporal trends in the burden of eating disorder (ED) features, as estimated by the composite of their prevalence and impact upon quality of life (QoL) over a period of 10 years.
Methodology
Representative samples of 3010 participants in 1998 and 3034 participants in 2008 from the South Australian adult population were assessed for endorsement of ED features (objective binge eating, extreme dieting, and purging were assessed in both years; subjective binge eating and extreme weight/shape concerns were also assessed in 2008) and QoL using the Medical Outcomes Study Short Form (SF-36).
Principal Findings
From 1998 to 2008 significant increases in the prevalence of objective binge eating (2.7% to 4.9%, p<0.01) and extreme dieting (1.5% to 3.3%, p<0.01), but not purging, were observed. Lower scores on the SF-36 were significantly associated with endorsement of any of these behaviors in both 1998 and 2008 (all p<0.001). No significant difference was observed in the effect of the endorsement of these ED behaviors on QoL between 1998 and 2008 (all p>0.05). Multiple linear regressions found that in 1998 only objective binge eating significantly predicted scores on the mental health summary scale of the SF-36; however, in 2008 extreme weight/shape concerns, extreme dieting, and subjective binge eating were also significant predictors. Objective binge eating and extreme dieting were significant predictors of scores on the physical health summary scale of the SF-36 in both 1998 and 2008.
Conclusions and Significance
The prevalence of ED behaviors increased between 1998 and 2008, while their impact on QoL remained stable. This suggests an overall increase in the burden of disordered eating from 1998 to 2008. Given that binge eating and extreme dieting predict impairment in QoL, the necessity of interventions to prevent both under- and over-eating is reinforced.
Mindfulness and acceptance-based approaches to the treatment of clinical problems are accruing substantial empirical support. This article examines the application of these approaches to disordered eating. Theoretical bases for the importance of mindfulness and acceptance in the treatment of eating problems are reviewed, and interventions for eating problems that incorporate mindfulness and acceptance skills are briefly described. Empirical data are presented from a pilot study of mindfulness-based cognitive therapy adapted for treatment of binge eating.
Although third-wave behaviour therapies are being increasingly used for the treatment of eating disorders, their efficacy is largely unknown. This systematic review and meta-analysis aimed to examine the empirical status of these therapies. Twenty-seven studies met full inclusion criteria. Only 13 randomized controlled trials (RCT) were identified, most on binge eating disorder (BED). Pooled within- (pre-post change) and between-groups effect sizes were calculated for the meta-analysis. Large pre-post symptom improvements were observed for all third-wave treatments, including dialectical behaviour therapy (DBT), schema therapy (ST), acceptance and commitment therapy (ACT), mindfulness-based interventions (MBI), and compassion-focused therapy (CFT). Third-wave therapies were not superior to active comparisons generally, or to cognitive-behaviour therapy (CBT) in RCTs. Based on our qualitative synthesis, none of the third-wave therapies meet established criteria for an empirically supported treatment for particular eating disorder subgroups. Until further RCTs demonstrate the efficacy of third-wave therapies for particular eating disorder subgroups, the available data suggest that CBT should retain its status as the recommended treatment approach for bulimia nervosa (BN) and BED, and the front running treatment for anorexia nervosa (AN) in adults, with interpersonal psychotherapy (IPT) considered a strong empirically-supported alternative.
Objective:
Mindfulness is being promoted in schools as a prevention program despite a current small evidence base. The aim of this research was to conduct a rigorous evaluation of the .b ("Dot be") mindfulness curriculum, with or without parental involvement, compared to a control condition.
Method:
In a randomized controlled design, students (Mage 13.44, SD 0.33; 45.4% female) across a broad range of socioeconomic indicators received the nine lesson curriculum delivered by an external facilitator with (N = 191) or without (N = 186) parental involvement, or were allocated to a usual curriculum control group (N = 178). Self-report outcome measures were anxiety, depression, weight/shape concerns, wellbeing and mindfulness.
Results:
There were no differences in outcomes between any of the three groups at post-intervention, six or twelve month follow-up. Between-group effect sizes (Cohen's d) across the variables ranged from 0.002 to 0.37. A wide range of moderators were examined but none impacted outcome.
Conclusions:
Further research is required to identify the optimal age, content and length of mindfulness programs for adolescents in universal prevention settings.
Trial registration:
ACTRN12615001052527.
Objective:
Scientific research into compassion has burgeoned over the past 20 years and interventions aiming to cultivate compassion towards self and others have been developed. This meta-analysis examined the effects of compassion-based interventions on a range of outcome measures.
Method:
Twenty-one randomized controlled trials (RCTs) from the last 12 years were included in the meta-analysis, with data from 1,285 participants analyzed. Effect sizes were standardized mean differences calculated using the difference in pre-post change in the treatment group and control group means, divided by the pooled pre-intervention standard deviation.
Results:
Significant between-group differences in change scores were found on self-report measures of compassion (d = 0.55, k = 4, 95% CI [0.33-0.78]), self-compassion (d = 0.70, k = 13, 95% CI [0.59-0.87]), mindfulness (d = 0.54, k = 6, 95% CI [0.38-0.71]), depression (d = 0.64, k = 9, 95% CI [0.45-0.82]), anxiety (d = 0.49, k = 9, 95% CI [0.30-0.68]), psychological distress (d = 0.47, k = 14, 95% CI [0.19-0.56]), and well-being (d = 0.51, k = 8, 95% CI [0.30-0.63]). These results remained when including active control comparisons. Evaluations of risk of bias across studies pointed towards a relative lack of publication bias and robustness of findings. However, the evidence base underpinning compassion interventions relies predominantly on small sample sizes.
Conclusions:
Future directions are provided for compassion research, including the need for improved methodological rigor, larger scale RCTs, increased specificity on the targets of compassion, and examination of compassion across the lifespan. Although further research is warranted, the current state of evidence highlights the potential benefits of compassion-based interventions on a range of outcomes.
Every effect size has its place: a commentary on the avoidance of pre–post effect sizes - Volume 26 Issue 4 - M. Kösters
Objective:
To systematically review and quantify the effectiveness of Eating Disorder (ED) prevention interventions.
Methods:
Electronic databases (including the Cochrane Controlled Trial Register, MEDLINE, PsychInfo, EMBASE, and Scopus) were searched for published randomized controlled trials of ED prevention interventions from 2009 to 2015. Trials prior to 2009 were retrieved from prior reviews.
Results:
One hundred and twelve articles were included. Fifty-eight percent of trials had high risk of bias. Findings indicated small to moderate effect sizes on reduction of ED risk factors or symptoms which occurred up to three-year post-intervention. For universal prevention, media literacy (ML) interventions significantly reduced shape and weight concerns for both females (-0.69, confidence interval (CI): -1.17 to -0.22) and males (-0.32, 95% CI -0.57 to -0.07). For selective prevention, cognitive dissonance (CD) interventions were superior to control interventions in reducing ED symptoms (-0.32, 95% CI -0.52 to -0.13). Cognitive behavioural therapy (CBT) interventions had the largest effect size (-0.40, 95% CI -0.55 to -0.26) on dieting outcome at 9-month follow-up while the healthy weight intervention reduced ED risk factors and body mass index. No indicated prevention interventions were found to be effective in reducing ED risk factors.
Conclusions:
There are a number of promising preventive interventions for ED risk factors including CD, CBT and ML. Whether these actually lower ED incidence is, however, uncertain. Combined ED and obesity prevention interventions require further research.
This randomized-controlled trial aims to test the efficacy of a group intervention (Kg-Free) for women with overweight or obesity based on mindfulness, ACT and compassion approaches. The intervention aimed to reduce weight self-stigma and unhealthy eating patterns and increase quality-of-life (QoL). Seventy-three women, aged between 18 and 55 years old, with BMI ≥25 without binge-eating seeking weight loss treatment were randomly assigned to intervention or control groups. Kg-Free comprises 10 weekly group sessions plus 2 booster fortnightly sessions, of 2h30 h each. The control group maintained Treatment as Usual (TAU). Data was collected at baseline and at the end of the Kg-Free intervention. Overall, participants enrolled in Kg-Free found the intervention to be very important and helpful when dealing with their weight-related unwanted internal experiences. Moreover, when compared with TAU, the Kg-Free group revealed a significant increased health-related QoL and physical exercise and a reduction of weight self-stigma, unhealthy eating behaviors, BMI, self-criticism, weight-related experiential avoidance and psychopathological symptoms at post-treatment. Results for self-compassion showed a trend towards significance, whereas no significant between-groups differences were found for mindfulness. Taken together, evidence was found for Kg-Free efficacy in reducing weight-related negative experiences and promoting healthy behaviors, psychological functioning, and QoL.
This study examined the effectiveness of Kg-Free: an acceptance-, mindfulness- and compassion-based group intervention for women with overweight and obesity at post-treatment and 3-month follow-up and explored the psychological processes that underlie changes in quality of life, weight self-stigma, body mass index and emotional eating at post-treatment. Overall, 53 women completed Kg-Free. At post-treatment and 3-month follow-up, participants reported increased quality of life, mindfulness and self-compassion abilities and decreased weight self-stigma, emotional eating, shame, weight-related experiential avoidance, self-criticism and body mass index. Shame and self-criticism reductions were important mediators of changes in health-related outcomes, whereas weight-related experiential avoidance, mindfulness and self-compassion mediated changes in weight and eating-related outcomes.
Emotional eating is an important predictor of weight loss and weight regain after weight loss. This two part study's primary aim was to explore changes in emotional eating in a general population of individuals taking the Mindfulness Based Stress Reduction (MBSR) program, with a secondary aim to explore whether changes in mindfulness predicted changes in emotional eating. Self-reported survey data exploring these questions were collected before and after the intervention for two sequential studies (Study 1 and Study 2). While there were no control groups for either study, in both studies emotional eating scores following the MBSR were significantly lower than scores prior to taking the MBSR (p < 0.001; p < 0.001) In Study 2, changes in mindfulness were correlated with changes in emotional eating (r = 0.317, p = 0.004). These results suggest that MBSR may be an effective intervention for emotional eating, and that further research is warranted to examine effects on weight loss and maintenance.
Aims
The standardised mean difference (SMD) is one of the most used effect sizes to indicate the effects of treatments. It indicates the difference between a treatment and comparison group after treatment has ended, in terms of standard deviations. Some meta-analyses, including several highly cited and influential ones, use the pre-post SMD, indicating the difference between baseline and post-test within one (treatment group).
Methods
In this paper, we argue that these pre-post SMDs should be avoided in meta-analyses and we describe the arguments why pre-post SMDs can result in biased outcomes.
Results
One important reason why pre-post SMDs should be avoided is that the scores on baseline and post-test are not independent of each other. The value for the correlation should be used in the calculation of the SMD, while this value is typically not known. We used data from an ‘individual patient data’ meta-analysis of trials comparing cognitive behaviour therapy and anti-depressive medication, to show that this problem can lead to considerable errors in the estimation of the SMDs. Another even more important reason why pre-post SMDs should be avoided in meta-analyses is that they are influenced by natural processes and characteristics of the patients and settings, and these cannot be discerned from the effects of the intervention. Between-group SMDs are much better because they control for such variables and these variables only affect the between group SMD when they are related to the effects of the intervention.
Conclusions
We conclude that pre-post SMDs should be avoided in meta-analyses as using them probably results in biased outcomes.
Objective:
This systematic review evaluated the efficacy of universal, selective, and indicated eating disorder prevention.
Method:
A systematic literature search was conducted in Medline, PsycINFO, Embase, Scopus, and the Cochrane Collaboration Library databases to January 2016. Studies were included if they were randomized, controlled trials (RCT) and tested an eating disorder prevention program. We retrieved 13 RCTs of universal prevention (N = 3,989 participants, 55% female, M age = 13.0 years), 85 RCTs of selective prevention (N = 11,949 participants, 99% female, M age = 17.6 years), and 8 RCTs of indicated prevention (N = 510 participants, 100% female, M age = 20.1 years). Meta-analysis was performed with selective prevention trials. As there were a limited number of universal and indicated trials, narrative synthesis was conducted.
Results:
Media literacy had the most support for universal prevention. Most universal approaches showed significant modest effects on risk factors. Dissonance-based was the best supported approach for selective prevention. Cognitive-behavior therapy (CBT), a healthy weight program, media literacy, and psychoeducation, were also effective for selective prevention and effects were maintained at follow-up. CBT was supported for indicated prevention and effects were maintained at follow-up.
Discussion:
The modest effects for universal prevention were likely due to floor effects. The evidence for selective prevention suggests that empirically supported approaches should be disseminated on a wider basis. Our findings suggest CBT should be offered for indicated populations. Overall, results suggest efficacy of several prevention programs for reducing risk for eating disorders, and that wider dissemination is required. © 2016 Wiley Periodicals, Inc.
Binge eating disorder (BED), characterized by recurrent eating episodes in which individuals eat an objectively large amount of food within a short time period accompanied by a sense of loss of control, is the most common eating disorder. While existing treatments, such as cognitive behavioral therapy (CBT), produce remission in a large percentage of individuals with BED, room for improvement in outcomes remains. Two reasons some patients may continue to experience binge eating after a course of treatment are: (a) Difficulty complying with the prescribed behavioral components of CBT due to the discomfort of implementing such strategies; and (b) a lack of focus in current treatments on strategies for coping with high levels of negative affect that often drive binge eating. To optimize treatment outcomes, it is therefore crucial to provide patients with strategies to overcome these issues. A small but growing body of research suggests that acceptance-based treatment approaches may be effective for the treatment of binge eating. The goal of the current paper is to describe the development of an acceptance-based group treatment for BED, discuss the structure of the manual and the rationale and challenges associated with integrating acceptance-based strategies into a CBT protocol, and to discuss clinical strategies for successfully implementing the intervention.
This article examines the growing body of research that provides support for the many anecdotally reported health benefits resulting from the human-animal bond, including the prevention and treatment of cardiovascular diseases, cancer and chronic pain; benefits for paediatric and elderly patients and for early detection of medical conditions. The risk of zoonotic infections are also discussed.
Objective
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 individuals 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.
Method
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.
Results
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.
Discussion
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. © 2015 Wiley Periodicals, Inc. (Int J Eat Disord 2015).
Objective: 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 individuals 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. Method: A school-based cluster randomised controlled trial was conducted in which 19 classes of adolescent girls (N = 347) were allocated to a 3-session mindfulness-based intervention, dissonance-based intervention, or classes as usual control. A subset of classes (N = 156) receiving expert facilitation were analysed separately as a proxy for delivery under optimal conditions. Results: 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 internalisation, eating disorder symptoms and psychosocial impairment relative to control by 6-month follow-up. Students receiving dissonance showed significant reductions in sociocultural pressures. There were no statistically significant differences between the two interventions. Moderate intervention acceptability was reported by both students and teaching staff. Discussion: 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.
The first wave of behavior therapy countered the excesses and scientific weakness of existing nonempirical clinical traditions through empirically studied first-order change efforts linked to behavioral principles targeting directly relevant clinical targets. The second wave was characterized by similar direct change efforts guided by social learning and cognitive principles that included cognitive in addition to behav-ioral and emotive targets. Various factors seem to have set the stage for a third wave, including anomalies in the current literature and philosophical changes. Acceptance and Commitment Therapy (ACT) is one of a number of new interventions from both behavioral and cognitive wings that seem to be moving the field in a different direction. ACT is explicitly contextualistic and is based on a basic experimental analysis of human language and cognition, Relational Frame Theory (RFT). RFT explains why cognitive fusion and experiential avoidance are both ubiquitous and harmful. ACT targets these processes and is producing supportive data both at the process and outcome level. The third-wave treatments are characterized by openness to older clinical traditions, a focus on second order and contextual change, an emphasis of function over form, and the construction of flexible and effective repertoires, among other features. They build on the first-and second-wave treatments, but seem to be carrying the behavior therapy tradition forward into new territory. Over the last several years quite a number of behavior therapies have emerged that do not fit easily into traditional categories within the field.
Although sociocultural pressures are thought to contribute to bulimia nervosa, little research has examined the mechanisms by which these factors might actually produce eating pathology. The present study tested an integrative model of bulimia that centers around dietary restraint and affect regulation pathways. It also incorporates perceived sociocultural pressure, body-mass, ideal-body internalization, and body dissatisfaction. Using data from 257 female undergraduates, structural equation modeling revealed that the model accounted for 71% of the variance in bulimic symptomatology. The relation between perceived sociocultural pressure and bulimic symptoms was mediated by ideal-body internalization, body dissatisfaction, dietary restraint, and negative affect. The results support the dual pathway model of bulimia and suggest variables that might be targeted in prevention efforts.
IntroductionIndividual studiesThe summary effectHeterogeneity of effect sizesSummary points
Stress-related eating is increasingly cited as a difficulty in managing healthy eating behaviors and weight. However few interventions have been designed to specifically target stress-related eating. In addition, the optimal target of such an intervention is unclear, as the target might be conceptualized as overall stress reduction or changing emotional eating-related thoughts and behaviors. This pilot study compared the effects of three interventions targeting those components individually and in combination on stress-related eating, perceived stress, and weight loss to determine whether the two intervention components are effective alone or are more effective when combined. Fifty-three overweight participants (98% female) who reported elevated levels of stress and stress-eating and were at risk for obesity were randomly assigned to one of three six- week interventions: A modified mindfulness-based stress reduction (MBSR) intervention, a cognitive behavioral stress-eating intervention (SEI), and a combined intervention that included all MBSR and SEI components. All three interventions significantly reduced perceived stress and stress-eating, but the combination intervention resulted in greater reductions and also produced a moderate effect on short term weight loss. Benefits persisted at six week follow-up. The pattern of results preliminarily suggests that the combination intervention (MBSR + SEI) may yield promise in the treatment of stress-related eating.