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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.
... Pearson et al. (2012), por exemplo, encontraram que mulheres com diversos níveis de insatisfação com a imagem corporal apresentaram redução significativa da ansiedade em relação ao corpo e aumento dos processos de aceitação e flexibilidade psicológica após uma intervenção com a Terapia de Aceitação e Compromisso (em inglês, ACT), um modelo comportamental contextual que utiliza intervenções de aceitação, desfusão, ação comprometida e mindfulness para reduzir a esquiva experiencial. Indo ao encontro dos achados de Person et al. (2012), uma recente metanálise de intervenções comportamentais contextuais indicou que psicoterapias com elementos de aceitação, mindfulness e compaixão foram moderadamente eficazes para a redução da insatisfação com o corpo e aumento da flexibilidade da imagem corporal (Linardon et al., 2019). ...
... A efetividade das intervenções comportamentais na flexibilidade da imagem corporal salienta a necessidade de mais estudos focados na efetividade e na aceitabilidade de intervenções com imagem corporal, sobretudo no contexto brasileiro e com públicos alvos diversos (Griffiths et al., 2018;Guest et al., 2019;Laus et al., 2014;Linardon et al., 2019). O presente estudo objetivou (a) sistematizar e avaliar os efeitos de uma intervenção intensiva que busca promover flexibilidade da imagem corporal, flexibilidade psicológica e habilidade de atenção plena (mindfulness). ...
... Esses dados são coerentes com resultados anteriores de intervenções efetivas para a melhora da imagem corporal (Alleva et al., 2015). Mais importante para o presente estudo, a intervenção incluiu componentes de aceitação, mindfulness e autocompaixão que foram efetivos mesmo em um formato breve, o que sugere algum nível de aproximação com tratamentos de longo prazo efetivos para a melhora da imagem corporal (Linardon et al., 2019). Os resultados aqui apresentados são também similares a outras intervenções breves com populações de mulheres que apresentam insatisfação com a imagem corporal. ...
Esse estudo objetivou sistematizar e avaliar os efeitos de uma intervenção breve (Conecta) focada na promoção de flexibilidade da imagem corporal e na redução da insatisfação com a imagem corporal e dos comportamentos de risco para transtorno alimentar (TA). Buscou-se também avaliar a aceitabilidade e viabilidade da intervenção. Trata-se de um estudo pré experimental, no qual participaram 19 estudantes universitárias, com idades entre 18 e 33 anos. A intervenção breve consistiu em três encontros presenciais semanais. Os resultados revelaram um aumento significativo nos níveis de flexibilidade da imagem corporal, mindfulness, abertura à experiência e percepção atual de saúde, além de uma redução significativa na insatisfação da imagem corporal e no risco para o desenvolvimento de TA. Esses resultados sugerem que uma oficina breve pode ser útil para estudantes universitárias que apresentem dificuldades relacionadas à imagem corporal.
... 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.
... 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.
... For example, programs that focus on mindful eating, distress tolerance skills, and coping skills can help youth improve relationships with food and contribute to improved psychosocial functioning generally (Beccia et al., 2018;Omiwole et al., 2019). Existing eating disorder prevention programs that show promise for preventing eating disorder onset focus on dissonance (e.g., challenging the thin ideal) lifestyle modification (e.g., understanding harmful weight control strategies and enforcing healthful habits; Stice et al., 2021) and third-wave behavioral strategies (e.g., mindfulness, acceptance of distress, values clarification; Linardon et al., 2019). These could potentially be tailored further to address these risk factors that have shown to be particularly relevant for adolescents. ...
... Future work can continue to focus on drivers of normative eating behavior and risk for disordered eating to further inform current models and preventive interventions (Linardon et al., 2019;Tanofsky-Kraff et al., 2020). Future studies with larger and more diverse samples, conducted longitudinally and designed to test ordinal effects, and in comparison to clinical samples will move research in this area forward. ...
Objective: Understanding specific drivers of dietary behavior in adolescents can inform preventive models for disordered eating and psychosocial and physical health concerns. The present study examined how eating motives (hedonic appetite, palatable eating motives, controlled dietary motivation), relate to impulsivity and emotional eating to predict binge eating and calorie intake in adolescents. Method: 43 adolescents (Mage = 15.1 years, 72.1% female) self-reported all variables of interest via survey during a study lab visit. Calorie intake was assessed via dietary recall. Models were run in SPSS and post hoc probing was conducted for significant interactions. Results: Significant associations emerged between hedonic appetite and binge eating, emotional eating and binge eating, palatable eating motives and binge eating, and controlled dietary motivation and binge eating. There was a significant interaction of controlled dietary motivation and emotional eating predicting binge eating (β = .23, p < .05) with higher levels of controlled motivation positively associated with binge eating when emotional eating was high. There was a marginally significant interaction (β = .22, p = .05) for hedonic appetite and emotional eating predicting binge eating, with higher levels of emotional eating predicting binge eating when hedonic appetite was high. Conclusions: The present study identified potential risk factors for binge eating in adolescents, highlighting hedonic appetite and emotional eating as important factors to assess to inform preventive intervention. Future studies with larger and more diverse samples, conducted longitudinally in comparison to clinical samples will progress the application of this research.
... In general, clinical research refers to the general term body image disorder as a cognitive-affective attitude towards one's own body, which encompasses various concepts related to negative body perceptions, such as body dissatisfaction, avoidance or, conversely, compulsive control of one's own body, detachment, and feelings of alienation towards it, and concerns about specific body parts, shapes, or functions (Linardon et al., 2019). All of these psychopathological dimensions seem to relate to an underlying feature that precedes the onset of behavioural symptoms, often persisting after treatment, and may be associated with a poorer prognosis and a higher likelihood of relapse after remission (Castellini et al., 2020). ...
... However, research by J. Linardon et al. (2019) supports the assumptions made in this study and suggests that individual-typological features and personality disorders may predict baseline symptom expression and treatment outcome in eating disorders, and that a better understanding of patient-related moderators and mediators of outcome should be developed to improve treatment effectiveness. The majority of eating disorder treatment guidelines (Ramos-Grille et al., 2013) share the view that individual differences in symptom severity, treatment history, and comorbid psychopathology should be explicitly acknowledged to guide the selection of appropriate psychosocial interventions within a stepwise therapeutic approach. ...
The relevance of the study is due to statistical indicators demonstrating the increasing prevalence of eating disorders and insufficient consideration of individual psychological factors in building a strategy for helping to achieve and maintain remission. The purpose of the study is to investigate the individual psychological characteristics of individuals with different types of eating disorders and compare them. The empirical research methods used are observation, analysis of medical records, the Eating Behaviour Rating Scale, and the 16-factor personality questionnaire by R.B. Cattell. The article presents the differences and similarities in the individual psychological characteristics of patients with eating disorders. It has been found that patients with different eating disorders have inherent characteristics. The analysis showed that there are features that have similar indicators in two groups of respondents, but differ in the third and vice versa. It has been found that respondents with compulsive overeating have the most chaotic personality profile when compared with patients of other groups. The main individual psychological features by type of eating disorder are summarized. It has been found that patients with anorexia have high rates of self-control, requirements for their own body, distrust in interpersonal relationships and suspicion with a tendency to control their desires. Indecision, suspicion, and anxiety scores are also high. Patients with bulimia have a more pronounced softness score among all groups of respondents, with high levels of carelessness and anxiety, along with indicators of gullibility, indecision, and emotional instability. Patients with compulsive overeating are characterized by pronounced emotional instability among all groups of respondents. It was found that patients with anorexia and compulsive overeating are more open to communication than patients with bulimia. Patients with anorexia and compulsive overeating are expressive, dynamic, and active in relationships, in contrast to patients with bulimia who have pronounced anxiety, hypochondria, and pessimism. The respondents of all groups have impaired feelings of satiety and hunger. The results showed that patients with anorexia and patients with compulsive overeating have a higher level of perfectionism than patients with bulimia. Dissatisfaction with the body and the desire for thinness are common to the three groups. The practical value of the article lies in the possibility of using the research materials for an effective strategy of psychotherapeutic care for patients with different types of food addiction
... In treating AN, it is recommended that the client receives a combination of psychotherapy, nutritional rehabilitation, and medical monitoring (American Psychiatric Association, 2006;Linardon et al., 2019). For youth requiring more intensive medical services, the primary and initial focus will be on rehabilitation of the body (American Psychiatric Association, 2006). ...
... Third-wave behavioral interventions such as Dialectical Behavior Therapy (DBT) and Acceptance and Commitment Therapy (ACT) have yet to show the same effcacy as CBT for eating disorders. However, there is promise of their use in prevention programs (Linardon et al., 2019). Motivational interviewing can be a key part of therapy as well, as motivation is a key predictor of change for individuals with EDs (Wade et al., 2009). ...
... 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. ...
Conceptualizations of eating disorders (ED) have primarily been based on the experiences of cisgender women. Yet trans and nonbinary individuals (TNB) may be at greater risk than cisgender individuals to suffer from eating disorders, disordered eating, and body image concerns. The current study takes a phenomenological approach to explore how TNB individuals conceptualize eating and/or body image issues. Qualitative data were obtained from 82 TNB participants who self-reported eating and/or body image concerns. Primary analyses focused on participants’ responses to an open-ended prompt regarding how participants understand the relationships among gender identity, gender expression, and weight and shape control behaviors. Thematic analysis identified five themes: (a) gender dysphoria, (b) puberty, (c) emotion (dys)regulation, (d) gender expression, and (e) recovery/transition. Results indicate various factors salient to gender identity and expression and eating concerns. Findings extend beyond the traditional focus on gender dysphoria by highlighting other important factors for TNB individuals, such as the function ED psychopathology serves (e.g., gender avoidance and self-punishment). This broadens the ED field’s understanding of how gender dysphoria relates to ED psychopathology, rather than focusing solely on the physical body. Distress and associated behaviors related to both gender dysphoria and eating disorder psychopathology may be reciprocal and reinforcing and, as such, should be considered in tandem in treating TNB clients experiencing EDs and body image concerns. This work may better identify ED risk and maintenance within this population and thus optimize prevention and intervention.
... 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 intervention specifically aimed at promoting PF is Acceptance and Commitment Therapy (ACT). It is an innovative intervention that has been shown to be effective in well-being promotion (Howell & Passmore, 2019) and in the treatment, among other disorders, of anxiety, depression, eating disorders, substance use and chronic pain (French et al., 2017;Gloster et al., 2020;Graham et al., 2016;Hughes et al., 2017;Ii et al., 2019;Linardon et al., 2019;Tonarelli et al., 2016). ACT proposes a change in the focus of therapy. ...
Hypersexuality refers to the inability to control sexual desire. Despite it has shown serious consequences for physical, psychological and social health, the evidence of available psychological interventions is still insufficient. In this open-label pilot study, an Acceptance and Commitment Therapy (ACT) intervention was conducted with adults with clinically significant levels of hypersexuality aimed to examine its feasibility and usefulness. The intervention consisted of eight weekly online individual psychological intervention sessions. Outcome self-report measures were administered at baseline, after the intervention and a 3 months follow-up. Behavioral and subjective informed changes in sexual practices were weekly assessed through self-monitoring. Twelve participants (M age = 38.8 ± 11.5 years, 83.3% male, 66.7% homo or bisexual) completed the intervention. The feasibility was found to be good, with all the participants completing the training and high levels of satisfaction. Hypersexuality, psychological flexibility, cognitive fusion and mindfulness scores significantly improved after the ACT intervention, with large effect sizes. Clinically significant changes in hypersexuality were found for the vast majority of participants, besides reductions in the time dedicated to planning and practicing sex and the sexualized drug use. Results indicate that ACT-based interventions may be considered feasible and potentially effective therapeutic alternatives for hypersexuality.
... Acceptance and commitment therapy (ACT) is an experiential, mindfulness-based behavior therapy that has shown sizable promise in the treatment of a wide spectrum of psychological disorders Heffner et al., 2003;Orsillo & Batten, 2005;Strosahl & Robinson, 2015;Wicksell et al., 2005). In a recent meta-analysis of meta-analyses examining the efficacy of ACT, Gloster et al. (2020) reported that ACT outweighed control conditions, treatment as usual, across a broad range of mental health disorders and conditions including chronic pain (Veehof et al., 2011), anxiety and OCD spectrum disorders (Bluett et al., 2014), substance use disorders (Lee et al., 2015), mental health and well-being (Brown et al., 2016), psychosis (Tonarelli et al., 2016), disordered eating and body image concerns (Linardon et al., 2019), and burnout (Reeve et al., 2018). Although the practice of ACT has been introduced to couples therapy (Ghafoorian & Hasanabadi, 2016;Kavousian et al., 2017;Peterson et al., 2009), recent findings regarding the role of psychological inflexibility in romantic relationships (Daks & Rogge, 2020;Twiselton et al., 2020) underscore the potential of ACT as an effective intervention for addressing couples problems. ...
... 25 ACT has been shown to have significant results for BID due to weight, size, height, skin colour and other aspects of the body. 26 Recent studies have found that ACT-based group psychological interventions can significantly improve BID in postoperative breast cancer patients, 22 and are effective in enhancing psychological flexibility and reducing BID due to body image issues in patients with eating disorders. 23 To address the lack of effective treatment options for BID in HNC patients, we designed a single-site randomised clinical trial (RCT) to evaluate the acceptability of ACT and its preliminary efficacy relative to the usual care (UC) group condition, as well as refine the trial infrastructure in preparation for a multisite RCT. ...
Introduction
The head and neck comprise vital organs and are apparent human body parts. Tumours here impair physical and sensory functions as well as appearance and social interactions, leading to body image distress (BID) and threatening mental health and quality of life. Acceptance and commitment therapy has shown effectiveness in improving BID in groups such as breast cancer patients. This study aims to apply this therapy to intervene in head and neck cancer (HNC) patients, aiming to improve BID and promote better psychological well-being.
Methods and analysis
This study is a prospective, parallel-group, randomised controlled trial. A total of 64 HNC patients will be allocated to either an intervention group or a control group. The intervention group will engage in a 3 week, six-session group-based acceptance and commitment therapy programme, while the control group will receive standard treatment. The primary outcome is cancer-related BID, and secondary outcomes are HNC-related BID, psychological flexibility, coping style and psychological distress. These indicators will be measured at baseline, postintervention and 1 month following the intervention’s completion.
Ethics and dissemination
The trial has received approval from the Institutional Review Board of Shanghai Proton and Heavy Ion Hospital (2308-67-02). The study results will be shared through peer-reviewed journals and conferences.
Trial registration number
ChiCTR2300077863.
... The term mindfulness has been broadly defined as a behavioral process including (1) an acute awareness of thoughts and feelings as being separate from reality, (2) the ability to remain present with intrusive thoughts without avoidance, (3) a predisposition towards accepting negative internal experiences, and (4) letting go of aversive thoughts without becoming preoccupied with their content [52]. In practice, mindfulness is a purported mechanism of change among many third-wave psychotherapies, yielding moderate to large effect sizes in youth [53], older adults [54], people with depression and anxiety [55], disordered eating [56], and psychosis [57]. Mindfulness-based interventions foster therapeutic change by deemphasizing the content of subtle events and building skills in areas related to emotion regulation, psychological flexibility, and compassion. ...
Loneliness arises when there is a discrepancy between one’s desired and actual social connection with others. Studies examining the effects of loneliness in romantic relationships show that people who are lonely are less satisfied and committed to their romantic relationships. The present study explored the association between loneliness and romantic relationship well-being. Using a cross-sectional design, loneliness was correlated with relationship commitment, trust, and conflict. Relationship awareness, but not relationship distraction, statistically mediated the association between loneliness, relationship conflict, and relationship trust. The indirect effect of loneliness on relationship well-being was only present in people reporting low and medium levels of psychological inflexibility. Implications are discussed for acceptance- and mindfulness-based interventions for persons in romantic relationships.
... We hypothesized that in separate moderation models, the association between body dissatisfaction and disordered eating would be attenuated among those individuals with higher levels of dispositional mindfulness or body image flexibility. Importantly, since dispositional mindfulness and body image flexibility have been proposed as core constructs to target in third-wave behavioral therapies for body dissatisfaction and disordered eating (e.g., Bluett et al., 2016;Fogelkvist et al., 2020;Lee et al., 2018;Linardon et al., 2017Linardon et al., , 2019Merwin et al., 2023), it is also important to understand the relative importance of these two factors to further explain variability in the well-documented association between body dissatisfaction and disordered eating. Thus, in the present study, we also compared the relative importance of the moderating roles of dispositional mindfulness and body image flexibility by entering both moderators in the same regression model. ...
Objectives: Previous research suggests potential moderating roles of dispositional mindfulness and body image flexibility in the association between body dissatisfaction and disordered eating. However, relevant research is mainly conducted on adult women from Western countries, and limited evidence exists for adolescent samples, especially from non-Western contexts (e.g., China). Thus, this study aimed to examine the moderating roles of dispositional mindfulness and body image flexibility in the relationship between body dissatisfaction and disordered eating in Chinese adolescents. Method: We recruited 545 Chinese adolescents (53.9% boys, aged 12-16 years) who completed measures of body dissatisfaction, dispositional mindfulness, body image flexibility, and disordered eating. Moderation analyses were examined with PROCESS macro on SPSS. Results: In separate models, both higher dispositional mindfulness and body image flexibility weakened relationships between body dissatisfaction and disordered eating. However, when both dispositional mindfulness and body image flexibility were entered into the same moderation model, only body image flexibility showed a significant moderating effect. Discussion: Both dispositional mindfulness and body image flexibility may weaken the association between body dissatisfaction and disordered eating in adolescents. However, body image flexibility might have a stronger effect than dispositional mindfulness. These findings suggest that
interventions aimed at reducing body dissatisfaction to prevent disordered eating in adolescents may pay more attention to adolescents' body image flexibility.
... Psychological flexibility, broadly defined, is the ability to contact the present moment with an attitude of openness to inner experiences and to act in the service of values instead of in the service of avoidance (Hayes et al., 2016). There is increasing meta-analytic support for the effectiveness of ACT-based treatments for dysregulated eating behaviors like emotional and binge eating, and psychological flexibility (Di Sante, Akeson, Gossack, & Knauper, 2022;Linardon, Gleeson, Yap, Murphy, & Brennan, 2019). ...
... In considering the experienced challenges universities face in identifying student-athletes in need of support and treatment (Reardon, 2021;Schlimmer & Chin, 2018), researchers recommend addressing mental health concerns (i.e., anxiety, EDs) through preventative measures such as interventions with interactive multimodal approaches (Bar et al., 2016;de Bruin, 2017). The Eat Breathe Thrive TM (EBT) program was selected as a preventive intervention based on: (1) its integration of several empirically supported approaches (i.e., cognitive-behavioral, dissonance-based, and mindfulnessbased) that, separately, have been found to produce significant effects with athletes (Bar et al., 2016;Le et al., 2017;Linardon et al., 2019); (2) recommendations that future studies select programs expanding beyond targeting reduction in risk-factors and adopt strengths-based approaches targeting the development of protective factors towards positive embodiment (Beccia et al., 2018;Le et al., 2017); and (3) the inclusion of yoga in each session as part of the experiential process. ...
Objective: This study evaluated the acceptability and effectiveness
of the Eat Breathe ThriveTM (EBT) program as an eating
disorder prevention intervention among women collegiate
athletes.
Method: Change over time in eating disorder risk and competencies
of positive embodiment were examined in 94 women (n = 48
EBT participants and n = 46 matched-controls) from one National
Collegiate Athletic Association (NCAA) Division I-classified university
in the United States. Eating disorder risk factors were
measured using the Eating Disorder Examination Questionnaire
(EDE-Q) and State Trait Anxiety Inventory (STAI). Aspects of positive
embodiment were measured using the Multidimensional
Assessment of Interoceptive Awareness (MAIA) and The Mindful
Self-Care Scale (MSCS). Data were collected through participants’
completion of online surveys across three time-points.
Results: Repeated measures ANOVAS revealed EBT participants
reported experiencing significantly less state anxiety and
greater interoceptive body trusting over time relative to
matched-controls. No other significant interactions were
found. Respondents found the EBT program acceptable.
Discussion: Acceptability and partial support for integrative,
yoga-based, interventions targeting Division I student-athletes
is indicated.
... Step 3: Formal intervention-patients also scoring poorly on psychometric measures could be referred for assessment by a trained mental health clinician either within the Hospital Trust or via their local NHS Talking Therapies for Anxiety and Depression Service (formerly known as IAPT). Here, specialist psychological interventions such as cognitive behavioural therapy and compassion focused therapy, which have been shown to be effective in the treatment of body image disturbance can be provided [33]. ...
Background
Abdominal wall hernias (AWH) are frequently large and deforming. Despite this, little is known about how AWH impact upon body image. This study is the first study to qualitatively examine patients’ subjective lived experiences of how AWH affects their body image.
Methods
Fifteen patients were interviewed from a purposive sample of AWH patients awaiting surgery until no new narrative themes emerged. Interviews explored patient thoughts and experiences of AWH and body image. Data were examined using interpretative phenomenological analysis (IPA).
Results
Two key themes pertaining to body image were identified: “Changes to perceptions of self” and “Fears concerning other’s perceptions of them”. Both themes were often interrelated and displayed detrimental effects AWH had on patients’ body image.
Conclusions
Our findings illustrate that AWH detrimentally affected patients’ body image. This aspect of patient care can be treated and managed through better pre-operative information, including on body image as part of a holistic needs assessment (HNA), and ensuring the results are addressed in a patient care package. These development suggestions may positively affect the AWH patient’s experience and outcomes in terms of Quality of Life (QoL) by preparing patients better for realistic results regarding what can be achieved in terms of form, function thus making a more holistic recovery from surgery.
... In addition to contributing to research on the association between BIC and disordered eating behaviors, this study should also have clinical implications for the treatment of disordered eating behaviors and more severe eating disorders. Indeed, new approaches to the treatment of these conditions have started to focus on teaching patients how to reduce emotional distress caused by their BIC (Linardon et al., 2019b). Documenting how BIC are distributed among different profiles of participants, the present study should help refine these interventions in a more targeted manner by directly focusing efforts on the unique configuration of BIC present in each of these profiles. ...
... However, comparing the two interventions did not result in significant differences over the follow-up years, suggesting that a new program such as DBT may be as effective as a well-established program such as TAU-CBT [29]. A recent meta-analysis, reported that DBT was found to produce the largest effects in reducing disordered eating behaviors among other third-wave interventions [30]. ...
Purpose
Individuals with eating disorders (ED) and comorbid borderline personality disorder (BPD) may benefit from therapies focusing on emotion regulation, such as dialectical behavioral therapy (DBT). The aim of the study was to evaluate the effectiveness of one-year standard DΒΤ enhanced with cognitive-behavioral therapy (CBT) strategies for patients suffering from ED and BPD.
Methods
Seventy-two BPD and ED (anorexia and bulimia nervosa) participants were recruited from the eating disorders unit of the 1st Psychiatric Department of National and Kapodistrian University of Athens. All participants completed one year of standard DBT. ED-related behaviors were added to the treatment plan according to the DBT targeting hierarchy. Individual therapy and skills training group sessions were adapted to incorporate CBT strategies for nutritional and weight restoration. BPD and ED symptomatology were measured at the beginning and at the end of one year of treatment.
Results
The major finding of the study was the significant improvement of patients in all the outcome measurements after one year of treatment. The study's second finding was that the severity of BPD symptomatology was significantly related to the severity of ED symptomatology. It was also shown that improvement of the patients coping skills was correlated with the reduction of ED and BPD symptomatology.
Conclusions
These results support previous studies on the effectiveness of DBT for comorbid BPD and EDs. Despite the promising results, randomized controlled trials are needed to establish the efficacy of DBT for BPD and ED patients.
Level of evidence
Level IV: Evidence obtained from multiple time series with or without the intervention, such as case studies. Dramatic results in uncontrolled trials might also be regarded as this type of evidence.
... While usually considered as part of the CBT application, these interventions apply newer principles and techniques to target and improve the function or awareness of cognitive and emotional processes (Hayes, 2004). A meta-analysis of 24 studies (most studies were selective prevention programs) concluded that there is preliminary evidence supporting the benefits of third-wave behavioral interventions in reducing the risk of EDs (Linardon et al., 2019). Significant pre-post improvements were observed in disordered eating (g ¼ 0.59, 95% CI: 0.43-0.75) ...
... We know that these factors are essential for the appearance of the core symptoms of eating disorders, and among the most important, the following should be noted as determinants: the existence of some type of abuse during childhood, family presence of eating disorders or obesity, family presence of personality, mood or other mental disorders, rigid nutritional habits, body dysmorphia or dissatisfaction with selfimage, the presence of excessive physical activity routines, low self-esteem. A systematic review by showed that the identification of these elements is essential for a correct multidisciplinary intervention [230]. ...
Anorexia nervosa is a psychiatric disorder with an unknown etiology that is characterized by an individual’s preoccupation with their weight and body structure while denying the severity of their low body weight. Due to the fact that anorexia nervosa is multifaceted and may indicate the coexistence of genetic, social, hormonal, and psychiatric disorders, a description of non-pharmacological interventions can be used to ameliorate or reduce the symptoms of this condition. Consequently, the purpose of the present narrative review is to describe the profile’s context in the anorexic person as well as the support they would require from their family and environment. In addition, it is aimed at examining preventative and non-pharmacological interventions, such as nutritional interventions, physical activity interventions, psychological interventions, psychosocial interventions, and physical therapy interventions. To reach the narrative review aims, a critical review was conducted utilizing both primary sources, such as scientific publications, and secondary sources, such as bibliographic indexes, web pages, and databases. Nutritional interventions include nutritional education and an individualized treatment for each patient, physical activity interventions include allowing patients to perform controlled physical activity, psychological interventions include family therapy and evaluation of the existence of other psychological disorders, psychosocial interventions include management of the relationship between the patient and social media and physical therapy interventions include relaxation massages and exercises to relieve pain. All these non-pharmacological interventions need to be individualized based on each patient’s needs.
... The results included 24 studies and indicated that third-wave behavioral interventions show potential as effective eating disorder prevention programs. These interventions led to modest improvements in eating disorder risk factors [51]. ...
Disordered eating is a serious health concern globally. The etiology is complex and multidimensional and differs somewhat for each specific eating disorder. Several risk factors have been identified which include psychological, genetic, biochemical, environmental, and sociocultural factors. Poor body image, low self-esteem, teasing, family dynamics, and exposure to media images have also been identified as risk factors. While it is enticing to consider a single behavioral risk factor, doing so fails to consider the documented environmental, social, psychological, biological, and cultural factors that contribute to the development of an eating disorder in a multidimensional and complex integration that is undoubtedly unique to everyone. Focusing only on any one factor without taking the complex etiology into account is remiss. For example, it has been suggested that the use of dietary supplements may lead to eating disorders, despite a lack of evidence to support this conjecture. Therefore, the purpose of this review is to examine the evidence-based risk factors for eating disorders and discuss why connecting dietary supplements to eating disorder etiology is not supported by the scientific literature and may interfere with treatment. Established, effective prevention and treatment approaches for eating disorders should be the focus of public health initiatives in this domain.
... Twenty-four studies were included, and the results indicated that third-wave behavioral interventions show potential as effective eating disorder prevention programs. These interventions produced modest improvements in established eating disorder risk factors [48]. ...
Disordered eating is a serious health concern globally. The etiology is complex and multidimensional and differs somewhat for each specific eating disorder. Several risk factors have been identified which include psychological, genetic, biochemical, environmental, and sociocultural factors. Poor body image, low self-esteem, teasing, family dynamics, and exposure to media images have also been identified as risk factors. While it is enticing to consider a single behavioral risk factor, doing so fails to consider the documented environmental, social, psychological, biological, and cultural factors that contribute to the development of an eating disorder in a multidimensional and complex integration that is undoubtedly unique to everyone. Focusing only on any one factor without taking the complex etiology into account is remiss. For example, it has been suggested that the use of dietary supplements may lead to eating disorders, despite a lack of evidence to support this conjecture. Therefore, the purpose of this review is to examine the evidence-based risk factors for eating disorders and discuss why connecting dietary supplements to eating disorder etiology is not supported by the scientific literature and may interfere with treatment. Established, effective prevention and treatment approaches for eating disorders should be the focus of public health initiatives in this domain.
... Weight is the force that is "experienced" by an object due to gravity. Hence, body image may be considered both "relative" and "subjective," as it may also be dynamic and seen as "amenable to change" [112]. However, human body image seems to be a more complex concept than only a mental picture of dimensions, but rather a multifaceted construct made of neurological, psychological, and sociocultural elements [113]. ...
Eating disorder, “a persistent disturbance in eating and its related behaviors” affects both “food consumption and its absorption”, and the overall physical and mental wellbeing of affected individuals. ED is reported worldwide, across gender, ethnical, racial, and socioeconomic strata. Societal emphasis on gender based body-ideals puts extra pressure on adolescents to achieve or maintain unattainable weigh or body shapes, at the cost of them becoming unwell. ED has a complex etiology where an interplay between genetics and environment brings about the onset of symptoms as early as prepubertal years. With their fluctuating and chronic nature, ED may affect perception, emotions, cognition, and behavior. The interface between ED, overeating and obesity, as well as the recent surge in reported cases of ED during Corona pandemic, has focused much attention on eating pathology amongst adolescents. Many adolescents (particularly boys) specially in a prodromal phases of ED, do not yet meet diagnostic thresholds for ED and hence do not receive timely or appropriate professional help. In the current chapter, we aim to 1- address the issues surrounding early recognition of ED symptoms in adolescents under a general umbrella term, “Disordered Eating”, and 2- highlight the importance of societal influence on vulnerable individuals.
... According to the prominent transdiagnostic CBT theory on which most CBTs including both CBT-E and MABTs are based, OSW contributes to restrictive eating and other weight-control behaviors (e.g., purging, compulsive exercise) that maintain BN symptoms. Reductions in weight/shape concerns on the Eating Disorder Examination (EDE; Cooper & Fairburn, 1987) have been associated with improvements in BN symptoms at post-treatment and follow-up (Dahlenburg et al., 2019;Linardon et al., 2019), suggesting that reductions in OSW may be a key mechanism underlying improvements in BN (Linardon et al., 2016;Vall & Wade, 2015). ...
Overvaluation of shape and weight (OSW) is supported as an important mechanism underlying improvement in bulimia nervosa (BN) during behavioral therapies (CBTs). It is not yet clear, however, whether changes in OSW temporally precede and prospectively predict changes in BN symptoms during CBTs, limiting the ability to establish causality. The present study is the first to examine whether session-by-session changes in OSW prospectively predict session-by-session changes in BN symptoms during CBTs and clinical outcomes at the end-of-treatment. Participants with BN (n = 44) who received 20 sessions of CBTs completed a brief survey at each session assessing OSW and BN symptom frequency during the past week. Results showed small but significant session-by-session reductions in OSW and BN symptoms during CBTs. Session-by-session improvements in OSW in any given week prospectively predicted reductions in restrictive eating, binge eating, and compulsive exercise in the following week but did not prospectively predict improvements in purging, while improvements in restrictive eating and compulsive exercise in any given week prospectively predicted reductions in OSW in the following week. Average session-by-session change in OSW during treatment was positively associated with remission status and improvements in eating pathology at the end-of-treatment. Changes in OSW temporally precede and prospectively predict changes in BN symptoms during CBTs, and vice versa. These findings may have critical implications for treatment planning and implementation.
... 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.
... 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.
... 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 evalu-ating 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%) com-pared 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 symp-tomatology 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.
... 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.
Aim
The absence of consensus regarding the presence and interpretation of certain symptoms as indicative of either a psychosis spectrum disorder or an eating disorder (ED) can hinder cooperation amongst treatment programmes for the early detection of psychosis and an ED. This study trans‐diagnostically assessed the prevalence and co‐occurrence of at‐risk mental states for a psychosis (ARMS) or the risk of having an ED (EDr), and it explored the characteristics of ARMS profiles of individuals with an EDr.
Method
This cross‐sectional and observational‐prevalence study used assessment outcomes from an ED screening instrument (SCOFF), a psychosis prodromal screening questionnaire (PQ16) and a CAARMS interview (to evaluate the possibility of ARMS) with newly admitted outpatients aged 16–35 who were referred for various kinds of non‐psychotic disorders from a secondary Mental Health Care Centre in the Netherlands. Data analysis consisted of calculating prevalences, associations amongst variables and conditional probabilities.
Results
Of the 736 individuals who were screened, an EDr was identified in 51.2% and 49.0% of the participants who scored high on the PQ16, half of whom also completed the CAARMS interview. The results indicated that 53.0% of the participants were classified as not having ARMS, 28.3% as having ARMS and 18.7% as having a psychosis. EDr patients presented with symptoms of a psychotic spectrum disorder, which included both ED‐consistent and ED‐inconsistent symptoms. There were relatively frequent endorsements of the two subscale items guilt/punishment and ideas of reference.
Conclusions
From a trans‐diagnostical perspective, the results indicate that collaboration amongst ED programmes and psychosis prevention interventions should be strongly encouraged. Future researchers are encouraged to conduct studies that assess associations amongst and features of psychotic spectrum symptoms in EDs. The unexpectedly high proportion of EDr suggests that a co‐morbid ED in other kinds of psychopathology is being overlooked.
Emerging adulthood is a transitional period from adolescence to adulthood characterized by instability in roles and relationships as individuals navigate the demands of higher education, employment, intimate relationships, and self-identity formation. This transition often triggers various negative emotions, such as anxiety, distress, and self-doubt, particularly in women, making them more susceptible to engaging in emotional eating as a means of seeking temporary comfort or distraction. Emotional eating is a mechanism for temporary emotional relief, but feelings of regret or guilt often follow it. Emotion regulation skills are crucial when experiencing negative emotions. This study aims to demonstrate the effectiveness of Dialectical Behavior Therapy (DBT), an intervention designed to enhance emotion regulation skills, in reducing the occurrence of emotional eating among emerging adult women. The study employed a single case experiment design with two 21-year-old female participants experiencing emotional eating. The Emotional Eating Scale (EES) and emotional eating self-recording were used as measurement tools. Each participant received DBT over 7 sessions, each lasting 60-90 minutes. The results indicated that DBT reduced the frequency of emotional eating in both participants, with the effect persisting up to 14 days post-intervention. These findings suggest that DBT is an effective intervention for reducing emotional eating in emerging adult women.
Evidence suggests that yoga can be used as an intervention to improve body image. This systematic review evaluates the evidence of the efficacy of yoga in improving body image among adults. Authors followed PRISMA guidelines, searching Pubmed, Ovid MEDLINE, Embase, Cochrane, CINHAL, PsycInfo, and grey literature up to December 2, 2023 and identifying 446 unique records. Eligibility criteria included English-language, peer-reviewed studies with quantitative data on adult populations. Twenty-nine studies were eligible for inclusion and were evaluated for methodological quality using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach. Interventions focused solely on yoga varied in length, frequency, and style. Our synthesis revealed that yoga is associated with improved body satisfaction and appreciation, as well as reduced body dissatisfaction, across diverse adult populations, including those with clinical or subclinical levels of body dissatisfaction. Most low- and moderate-quality studies reported significant improvements, and some suggested a dose-response relationship. However, the evidence is limited by methodological weaknesses, such as a lack of blinding and inadequate reporting. Despite these limitations, findings support yoga as a promising intervention for improving body image in adults. Future research should aim for methodologically rigorous studies that use validated outcome measures and more inclusive populations.
We are in the midst of a youth mental health crisis. Yet, many children and adolescents who need services do not have access to high-quality mental health care. This is especially true for low-income and economically marginalized families and youth of color. Schools offer an ideal setting in which children and adolescents can access services; however, limited resources (e.g., time and training) are frequently cited barriers to providing school-based mental health care. Single-session interventions (SSI; i.e., one-time psychologically and therapeutically based interventions designed to quickly address mental health issues) have the potential to increase access to high-quality school-based mental health services for children and adolescents. Therefore, the purpose of this literature review was to explore the evidence base of single-session interventions for youth to identify brief, empirically supported, and accessible mental health interventions that school psychologists could deliver in schools. Specifically, this review examines the evidence base for several single-session interventions designed for use with various clinical and nonclinical youth populations and concludes with a brief discussion of future directions for SSI research and practice in school psychology, including the use of SSIs in school settings to increase access to high-quality mental health care for children and adolescents that may otherwise not receive care.
Introduction
Difficulties in emotion regulation (ER) are transdiagnostic in eating disorders (EDs). Self-compassion impacts ED-related outcomes by either preventing their initial establishment or interrupting/modifying their ongoing detrimental impact. Studies conducted in mixed samples found significantly lower levels of self-compassion in ED clinical samples. The main goal in this study was to explore the clinical profile presentation (in terms of transdiagnostic psychological processes) of participants within a continuum of eating psychopathology levels, through a two-step cluster analysis.
Methods
The ED clinical sample comprised 94 women aged between 18 and 60 years old (M = 29.5, SD = 10.2). The college sample included 274 female students aged between 18 and 56 years old (M = 21.2, SD = 4.7).
Results
Self-compassion facets significantly predicted overall difficulties in ER in both samples (clinical, F(6, 81) = 20.57, p < 0.001; R2 = 0.60; college, F(6, 267) = 22.64, p < 0.001; R2 = 0.34). The two-step cluster analysis resulted in an optimal solution of three clusters: low profile – C1; intermediate profile – C2; and severe profile – C3. Self-criticism and self-compassion were the strongest predictor variables, contributing 100% and 98%, respectively, to clustering membership. Self-compassion was a significant moderator on the relationship between difficulties in ER and eating psychopathology (b = −0.02, t(357) = 3.38, p < 0.001; R2 = 0.43).
Discussion
Fostering self-compassionate skills and addressing self-criticism and experiential avoidance (including experiential therapeutic components) as they become prominent during the therapeutic process, may be influential to successfully implement specific ER skills and enhance therapeutic gains.
In the last decade, research findings on the treatment of eating disorders have increased significantly. The clinical effectiveness of various psychotherapeutic methods has been examined in several meta-analyses. The results show that cognitive behavioral therapy (CBT) continues to be the treatment of choice for eating disorders in adulthood; in addition to its successful use in treating bulimia nervosa (BN) and binge eating disorder (BED), studies also show success in treating anorexia nervosa (AN). Furthermore, there is increasing evidence that CBT can also be successfully used to treat adolescents with eating disorders. These empirical findings form the basis of guideline recommendations for the treatment of eating disorders.
O conceito de Imagem Corporal (IC) vem sendo tratado por diferentes campos de conhecimento. Fenômeno multifatorial, envolve componentes perceptivos, cognitivos, afetivos, comportamentais e sociais. Este estudo propõe uma operacionalização do conceito de IC, a partir de um viés analítico-comportamental e contextual. Para tanto, realizou-se um levantamento sobre as principais propostas de IC na psicologia baseada em evidências, bem como nas propostas behavioristas. Então, partiu-se para um estudo teórico em busca da operacionalização da IC e suas contingências de instalação e manutenção, articulando os conceitos de self, identidade, seleção por consequências, comportamento simbólico. Apresenta-se IC como uma unidade funcional, produto das interações operantes e respondentes (públicos e privados), que envolvem, principalmente, tatos sobre si e sobre a aparência corporal e discriminação destas características a partir de modelos socialmente estabelecidos. Configura-se como um processo identitário ao ser um conjunto estável (embora flexível) de descrições de si a partir da IC e sua influência em outros repertórios comportamentais. A partir da análise de práticas culturais sobre corpo, beleza e atratividade e da Teoria das Molduras Relacionais, propõe-se o enfoque selecionista das práticas culturais e em como estas modificam as relações verbais que estabelecemos com o próprio corpo e, consequentemente, na maneira que se simboliza e age diante da própria imagem. Conclui-se que a IC se situa no campo das relações verbais e simbólicas estabelecidas nas aprendizagens (emocionais, operantes verbais e não verbais) selecionadas na relação do sujeito com as práticas culturais relacionadas ao corpo.
Purpose
Mindfulness‐based interventions (MBIs) are well‐validated interventions to enhance the favourable body image of individuals. Despite their wide application, the efficacy of MBIs in reducing body image dissatisfaction (BID) among various clinical populations remains unclear. This study aims to expand the literature on MBIs for BID and identify effective types of MBIs for reducing BID in diverse clinical populations for future research and practice.
Methods
A systematic search for studies published in English on the effectiveness of MBIs for BID among the clinical population was done on APA PsycNet, PubMed, Science Direct, Web of Science and Google Scholar databases in August 2023. Of the 1962 articles initially identified, 17 were found eligible and evaluated based on the JBI checklist.
Results
Random effects meta‐analyses on six MBIs revealed their effectiveness in reducing BID among the clinical population (SMD = −.59 and 95% CI = −1.03 to −.15, p = .009), with Acceptance and Commitment Therapy (ACT) (SMD = −1.29, 95% CI = −2.06 to −.52, p = .001) and My Changed Body (MyCB) (SMD = −.24, 95% CI = −.46 to −.01, p = .04) reporting significant effect sizes. Among the patients with breast cancer, MyCB (SMD = −.24, 95% CI = −.46 to −.01, p = .04) showed a significant effect size.
Conclusions
MBIs appear to be promising interventions in reducing BID among the clinical population. However, findings should be considered cautiously due to the possible publication bias, high heterogeneity and fewer available studies.
Disordered eating and body image concerns significantly impact a growing number of men. This systematic review assessed the evidence of the effectiveness of psychosocial interventions to improve body image and eating pathology in men. Searches were conducted in December 2022 in 13 databases (PsycINFO, MEDLINE, CINAHL Plus, AMED, PubMed, Scopus, Cochrane, EMBASE, ASSIA, British Nursing Index, Wiley and OpenGrey). Studies that quantitatively evaluated psychosocial interventions and reported pre-post body image or disordered eating outcomes in men aged 18 years and over were eligible. Articles including boys, uncontrolled designs, or not in English were excluded. Findings were narratively synthesised and presented according to intervention approach. Quality was assessed using EPHPP. Eight studies including six RCTs were reviewed. Five were assessed as being moderate quality and three as weak. Evidence from moderate quality studies suggested that dissonance-based interventions showed promising improvements in body image and disordered eating for up to six months post-intervention in men with and without body dissatisfaction. Evidence for media literacy and psychoeducational interventions was limited. Findings were limited by heterogeneity in outcome measures and homogeneity of participants preventing generalisability. Robust research with longer follow-ups is needed to confirm effectiveness.
Dialectical behavior therapy (DBT) is an evidence-based intervention that aims to reduce maladaptive behavior by facilitating development of emotion regulation, with support for use with diagnostically diverse adolescents. We conducted a meta-analysis evaluating change in externalizing symptoms among adolescents in DBT-based interventions across 17 studies (with 25 data points). Results indicate that interventions have a small-to-medium effect in reducing externalizing symptoms (Hedge’s g = −0.499, 95% CI [−0.683, −0.315], p < .001). Greater intervention duration was associated with greater decrease in symptoms (slope = −0.014, Z = −2.312, SE = 0.006, p = .021), though this finding was no longer significant following removal of an outlier. No other moderators were significant (ps range: .182–.862). Findings provide meaningful information about the utility of DBT-based interventions for externalizing problems as currently delivered among adolescents.
Objective:
Breast cancer patients often suffer from body image disturbance due to impairment of their body/appearance resulting from surgeries, other cancer treatments, and/or their complications. Cognitive-based interventions (CBIs) have recently been adopted for patients having breast cancer but their effects on improving body image are uncertain. This systematic review aimed to examine the effects of CBIs on body image in these patients, identify the optimal dose, characteristics, and/or component(s) of an effective intervention for these patients to inform future research and practice.
Methods:
According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework, ten online databases and five search engines were used to search for eligible studies. Quality appraisal of included studies and meta-analysis results were conducted using Rob 2 and Grading of Recommendations Assessment, Development and Evaluation profiler Guideline Development Tool, respectively. RevMan and comprehensive meta-analysis software were used to perform data analysis and synthesis.
Results:
Eleven eligible randomized controlled trials (RCTs) examining the effects of cognitive behavioral, acceptance and commitment, mindfulness, and self-compassion therapies were reviewed. Results of the meta-analysis showed that CBIs significantly reduced negative body image perception (Standardised Mean Difference, SMD = -0.49, 95% confidence interval [CI], [-0.87, -0.11], I 2 = 81%, 6 RCTs, 758 participants), when compared to the control groups (mainly usual care) at immediately post-intervention; in which, CBT-based (SMD = -0.37, 95% CI (-0.60, -0.13), I 2 = 0%) and group-based (SMD = -0.38, 95% CI (-0.62, -0.13), I 2 = 0%) programs had more consistent and significant effects.
Conclusions:
In view of the highly heterogeneous and limited RCTs identified, high-quality controlled trials of CBIs for improving the body image of patients having breast cancer are suggested.
Systematic review registration:
PROSPERO, CRD42021259173.
Unlabelled:
The COVID-19 pandemic lockdown restrictions posed unique challenges for people living with eating disorders (EDs), particularly relating to social isolation and changes in treatment access. However, less is known about the experience of lockdown for people 'in recovery' from EDs or disordered eating (DE) (i.e., with an ED/DE history). This study explored: (i) how people with a self-reported ED/DE history responded to and managed the experience of lockdown, specifically in relation to their recovery, and (ii) coping strategies for the management of recovery. Semi-structured interviews were conducted between June and August 2020 with 20 adults with a self-reported ED/DE history living in the UK. Data were analysed using inductive thematic analysis within a critical realist framework. Three overarching themes were identified: (1) Seeking safety and stability during a pandemic, (2) Lockdown prompting realisations about recovery, and (3) Exploring self-compassion as a more adaptive approach. While most participants experienced a resurgence in ED symptoms during lockdown, many reflected on the successful management of these as reinforcing their recovery. These findings have important implications for understanding ED recovery, in addition to informing interventions to better promote recovery during the COVID-19 pandemic and beyond.
Supplementary information:
The online version contains supplementary material available at 10.1007/s12144-023-04353-2.
Recent studies have found increasing rates of overweight and obesity in bulimia nervosa (BN). However, the relationships between body mass index (BMI) and BN symptoms and other clinically relevant constructs are unknown. Participants (N = 152 adults with BN) were assigned to three groups by BMI: group with no overweight or obesity (NOW-BN; BMI <25; N = 32), group with overweight (OW-BN; BMI ≥25 and <30; N = 66), and group with obesity (O-BN; BMI ≥30; N = 54). We compared the groups on demographics, diet and weight histories, body esteem, BN symptoms, and depression using chi square, analysis of variance, analysis of covariance, and Poisson regression models. The O-BN group was older (d = 0.57) and OW-BN and O-BN groups had greater proportions of race/ethnic minorities than NOW-BN group. The O-BN group was significantly younger at first diet (d = 0.41) and demonstrated significantly higher cognitive dietary restraint (d = 0.31). Compared to NOW-BN, O-BN participants had lower incidence of objective binge eating (incidence rate ratio [IRR] = 4.86) and driven exercise (IRR = 7.13), and greater incidence of vomiting (IRR = 9.30), laxative misuse (IRR = 4.01), and diuretic misuse (d = 2.08). O-BN participants also experienced higher shape (d = 0.41) and weight (d = 0.42) concerns than NOW-BN and OW-BN, although NOW-BN experienced higher shape (d = 0.44) and weight (d = 0.39) concerns than OW-BN. Groups did not differ on depression scores. These results were replicated when examining BMI as a continuous predictor across the full sample, with the exception of objective binge eating and driven exercise, which were not significantly associated with BMI. Individuals with BN and comorbid obesity have distinct clinical characteristics. Existing interventions may need to be adapted to meet clinical needs of these individuals.
Im letzten Jahrzehnt hat sich die Datenlage zur Behandlung von Essstörungen deutlich verbessert. In verschiedenen Meta-Analysen wurde die klinische Effektivität für die unterschiedlichen psychotherapeutischen Verfahren geprüft. Die Ergebnisse zeigen, dass nach wie vor die kognitive Verhaltenstherapie (KVT) als Behandlung der Wahl bei Essstörungen im Erwachsenenalter gilt; neben dem erfolgreichen Einsatz bei der Bulimia nervosa (BN) und der Binge-Eating-Störung (BES) zeigen Studien auch Erfolge bei der Behandlung der Anorexia nervosa (AN). Zudem mehren sich Hinweise, dass die KVT auch zur Behandlung Jugendlicher mit Essstörungen erfolgreich eingesetzt werden kann. Diese empirischen Nachweise sind Grundlage der Leitlinienempfehlungen zur Behandlung von Essstörungen.
Acceptance and Commitment Therapy (ACT) is increasingly used to treat eating disorders (EDs); however, the evidence for ACT with EDs has not been the subject of a systematic review. The current study reviews the evidence of ACT for EDs through January of 2022. PubMed and PsycInfo were searched for treatment studies using three or more ACT processes with adolescents or adults with anorexia nervosa, bulimia nervosa, binge eating disorder and purging disorder spectrum diagnoses. Studies focusing primarily on obesity, weight loss or body image were excluded. Twenty-two intervention studies were identified with a combined total of 674 participants. Five were randomized controlled trials. While the majority of studies focused on anorexia nervosa, these tended to be smaller studies of fewer participants. Results indicated that ACT may show reasonable efficacy for improvements in ED symptoms. However, most studies lacked sufficient methodological rigor and were weak on two or more components of the Effective Public Health Practice Project (EPHPP) Quality Assessment Tool for Quantitative Studies. Future directions and limitations of using the EPHPP for quality assessment of psychological interventions are discussed, as well as strengths and weaknesses of the evidence base in light of the recent ACBS Task Force Report on the Strategies and Tactics of Contextual Behavioral Science Research.
Dialectical behavioural therapy (DBT) has become the gold standard in the treatment of patients with borderline personality disorder. This therapy includes the combination of stance and techniques, which are characterized by the dialectic of acceptance and change. In the meantime, this method has also been successfully applied to other psychiatric disorders. In the case of anorexia nervosa - a disorder with a tendency to chronification and a considerably increased mortality risk - the work on treatment motivation increases. Traditional concepts in clinics are increasingly being questioned and tested for their suitability for everyday use. Here, DBT offers a set of tools with which positive experiences of effectiveness have already been made in some clinics. Evidence based on randomized controlled trials is still lacking. In this article, the basic principles of DBT treatment for adolescent patients with anorexia nervosa are explained and experiences with the treatment concept are reported.
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.
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.