Disorders - Eating Disorders
Summers, B. J., Cougle, J. R.
BACKGROUND: Previous research suggests that computerized interpretation bias modification (IBM) techniques may be useful for
modifying thoughts and behaviours relevant to eating pathology; however, little is known about the utility of IBM for decreasing specific eating
disorder (ED) symptoms (e.g. bulimia, drive for thinness). AIMS: The current study sought to further examine the utility of IBM for ED symptoms via
secondary analyses of an examination of IBM for individuals with elevated body dysmorphic disorder (BDD) symptoms (see Summers and Cougle, 2016), as
these disorders are both characterized by threat interpretation biases of ambiguous appearance-related information. METHOD(S): We recruited 41
participants for a randomized trial comparing four sessions of IBM aimed at modifying problematic social and appearance-related threat interpretation
biases with a placebo control training (PC). RESULT(S): At 1-week post-treatment, and relative to the PC, the IBM group reported greater reductions
in negative/threat interpretations of ambiguous information in favour of positive/benign biases. Furthermore, among individuals with high pre-
treatment bulimia symptoms, IBM yielded greater reductions in bulimia symptoms compared with PC at post-treatment. No treatment effects were observed
on drive for thinness symptoms. CONCLUSION(S): The current study suggests that cognitive interventions for individuals with primary BDD symptoms may
improve co-occurring ED symptoms such as bulimia.
Behavioural and cognitive psychotherapy, 46(6) : 676-
689
- Year: 2018
- Problem: Eating Disorders
(any), Bulimia Nervosa
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Attention/cognitive bias
modification, Technology, interventions delivered using technology (e.g. online, SMS)
Vasileva, S., Mesana, L., Pruce, D., Syed, I. A.
Objectives: Eating disorders affect 2-4% of young adults. Technology in healthcare is changing treatment
delivery. Previous meta-analysis of clinical trials have demonstrated promising, but inconclusive results of online and app-based interventions (e-
therapies), urging improved methods in future trials. Uncertainty also exists about effectiveness in real-world settings. Objectives of this review
are to identify and review recent comparative trials and real-world evidence (RWE) assessing efficacy/effectiveness of e-health technologies in
preventing and treating eating disorder. Method(s): A previous systematic literature review (SLR) of e-therapies in eating disorder captured relevant
trials published prior to July 2014. Additional searches were run on Medline, Embase and trial registries to identify trials since 2014 and all RWE
from database inception until June 2018. Studies assessing efficacy/effectiveness of e-therapies versus other or no therapy were included. We also
ran targeted searches to identify trials including therapist, which were excluded from previous SLR. Result(s): Eighteen additional trials were
included but no RWE was identified. Internet-based interventions were the most commonly evaluated therapies but the search identified little evidence
from single studies on smartphone applications, telemedicine, text messaging and video therapies. Most studies comparing internet-based therapies to
waiting lists showed reduction in eating disorder symptoms and improvement on eating disorder scales. Majority of the studies comparing internet-
based (mostly therapist-led interventions) or chat to face-to-face therapies reported similar efficacy. Limited evidence was identified comparing
therapist-involved therapies (i.e., video therapies, text messaging, email therapies, telemedicine) and non-therapist involved smartphone
applications with face-to-face or waiting lists. Conclusion(s): Similar to previous SLR, recent trials showed efficacy of internet-based
interventions versus waitlist, but similar efficacy to face-to-face therapy. Potential cost-savings with internet-based interventions versus face-
to-face therapies, given the similar efficacy, is yet to be determined. Further research is required to assess effectiveness of e-therapies in real-
life settings in treating and preventing eating disorders. Copyright © 2018
Value in Health, 21 (Supplement 3) : S277
- Year: 2018
- Problem: Eating Disorders
(any)
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Technology, interventions delivered using technology (e.g. online, SMS), Technology, comparing delivery mode (e.g. online vs. face-to-face)
Glashouwer, K. A., Neimeijer, R. A., de-Koning, M. L., Vestjens, M., Martijn, C.
Objective: The aim was to investigate whether a
computer-based evaluative conditioning intervention improves body image in adolescents with an eating disorder. Positive effects were found in
earlier studies in healthy female students in a laboratory and a field setting. This study is the first to test evaluative conditioning in a clinical
sample under less controlled circumstances. Method: Fifty-one adolescent girls with an eating disorder and a healthy weight were randomly assigned to
an experimental condition or a placebo-control condition. The computerized intervention consisted of six online training sessions of 5 min, in which
participants had to click on pictures of their own and other people's bodies. Their own pictures were systematically followed by portraits of
friendly smiling faces. In the control condition, participants were shown the same stimuli, but here, a stimulus was always followed by another
stimulus from the same category, so that own body was not paired with smiling faces. Before, directly after, three weeks after, and 11 weeks after
the intervention, self-report measures of body image and general self-esteem were administered. Automatic self-associations were also measured with
an Implicit Association Test. Results: In contrast to our hypotheses, we did not find an effect of the intervention on self-report questionnaires
measuring body satisfaction, weight and shape concern, and general self-esteem. In addition, the intervention did not show positive effects on
implicit associations regarding self-attractiveness. Conclusions: These findings do not support the use of evaluative conditioning in its present
form as an intervention for adolescents in clinical practice. (PsycINFO Database Record (c) 2018 APA, all rights reserved) Impact Statement What is
the public health significance of this article?-This study investigated a new intervention to improve body image in adolescents with eating
disorders. Outcomes do not support the use of evaluative conditioning in its present form as a body image treatment for adolescents. (PsycINFO
Database Record (c) 2018 APA, all rights reserved)
Journal of
Consulting and Clinical Psychology, 86(12) : 1046-1055
- Year: 2018
- Problem: Eating Disorders
(any)
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Other Psychological Interventions, Technology, interventions delivered using technology (e.g. online, SMS)
Grossman, S. L., Campagna, B., Brochu, H., Odermatt, M., Annunziato, R. A.
OBJECTIVE: To conduct a pilot test
to determine if the Body Project, an eating disorder prevention program, was able to reduce risky sexual behaviors. PARTICIPANTS: Twenty college-age
women ages 18-21 (in March, 2015) who endorsed both body image dissatisfaction and previous or current sexual activity. METHOD(S): Participants were
randomized to the Body Project or psychoeducational control group, and completed baseline, post-test, and 6-month follow-up measures assessing body
image concerns, eating behaviors, and sexual behaviors and attitudes. RESULT(S): An intervention manipulation check demonstrated that body image
variables were in expected directions, though were not significant by group. There was a significant interaction across group and time for
\"unanticipated sexual encounters,\" which decreased in the Body Project group. CONCLUSION(S): This pilot study supports the feasibility of using an
eating disorder prevention program to reduce other risky behaviors, specifically risky sexual behaviors.
Journal of American college health : J of
ACH, 66(8) : 826-830
- Year: 2018
- Problem: Eating Disorders
(any)
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Psychoeducation, Cognitive dissonance
therapy
Wade, T.
D., Wilksch, S. M.
Purpose of review Internet prevention of eating disorders is a relatively new field that is
expanding rapidly. We review randomized controlled trial designs examining the efficacy of Internet prevention in eating disorders that have emerged
from 2016. Recent findings Our literature search identified five studies that used randomized controlled trial designs to examine the efficacy of
Internet prevention in eating disorders. All of the studies represented indicated prevention, that is, young women who have body image concerns.
Three specific approaches were examined: media literacy, cognitive dissonance, and cognitive behavior therapy. All studies indicated significantly
more impact of the intervention than a control condition, with between group effect sizes at follow-up ranging from 0.24 to 0.42. Summary Although
Internet interventions for eating disorders may be less effective than face-to-face interventions, and attrition increases when populations are used
that reflect real-world usage, these interventions have an important role in a stepped-care approach. Future research should make direct comparisons
of different Internet programs with a view to helping us understand who will gain most benefit out of which approach, including who requires
moderated Internet approaches and who does not. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
Current Opinion in Psychiatry, 31(6) : 456-
461
- Year: 2018
- Problem: Eating Disorders
(any)
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Other Psychological Interventions, Cognitive dissonance
therapy, Technology, interventions delivered using technology (e.g. online, SMS), Technology, comparing delivery mode (e.g. online vs. face-to-face)
Wilksch, S. M., OShea, A., Taylor, C. B., Wilfley, D., Jacobi, C., Wade, T. D.
BACKGROUND: Disordered eating (DE) is a widespread, serious problem. Efficacious prevention programs that can
be delivered at-scale are needed. METHOD(S): A pragmatic randomized controlled trial of two online programs was conducted. Participants were young-
adult women from Australia and New Zealand seeking to improve their body image. Media Smart-Targeted (MS-T) and Student Bodies (SB) were both 9-
module interventions released weekly, whilst control participants received positive body image information. Primary [Eating Disorder Examination-
Questionnaire (EDE-Q) Global], secondary (DE risk factors) and tertiary (DE) outcome measures were completed at baseline, post-program, 6- and 12-
month follow-up. RESULT(S): Baseline was completed by 608 women (M age = 20.71 years); 33 were excluded leaving 575 randomized to: MS-T (N = 191); SB
(N = 190) or control (N = 194). Only 66% of those randomized to MS-T or SB accessed the intervention and were included in analyses with controls; 78%
of this sample completed measures subsequent to baseline. Primary intent-to-treat (ITT) analyses revealed no differences between groups, while
measure completer analyses found MS-T had significantly lower EDE-Q Global than controls at 12-month follow-up. Secondary ITT analyses found MS-T
participants reported significantly higher quality of life-mental relative to both SB and controls (6-month follow-up), while MS-T and controls had
lower clinical impairment relative to SB (post-program). Amongst measure completers, MS-T scored significantly lower than controls and SB on 5
variables. Of those with baseline DE, MS-T participants were significantly less likely than controls to have DE at 12-month follow-up. CONCLUSION(S):
Given both programs were not therapist-moderated, MS-T has potential to achieve reductions in DE risk at low implementation costs.
Psychological Medicine, 48(12) : 2034-2044
- Year: 2018
- Problem: Eating Disorders
(any)
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Other Psychological Interventions, Self-help, Technology, interventions delivered using technology (e.g. online, SMS)
Summers, B. J., Cougle, J. R.
BACKGROUND: Previous research suggests that computerized interpretation bias modification (IBM) techniques may be useful for
modifying thoughts and behaviours relevant to eating pathology; however, little is known about the utility of IBM for decreasing specific eating
disorder (ED) symptoms (e.g. bulimia, drive for thinness). AIMS: The current study sought to further examine the utility of IBM for ED symptoms via
secondary analyses of an examination of IBM for individuals with elevated body dysmorphic disorder (BDD) symptoms (see Summers and Cougle, 2016), as
these disorders are both characterized by threat interpretation biases of ambiguous appearance-related information. METHOD(S): We recruited 41
participants for a randomized trial comparing four sessions of IBM aimed at modifying problematic social and appearance-related threat interpretation
biases with a placebo control training (PC). RESULT(S): At 1-week post-treatment, and relative to the PC, the IBM group reported greater reductions
in negative/threat interpretations of ambiguous information in favour of positive/benign biases. Furthermore, among individuals with high pre-
treatment bulimia symptoms, IBM yielded greater reductions in bulimia symptoms compared with PC at post-treatment. No treatment effects were observed
on drive for thinness symptoms. CONCLUSION(S): The current study suggests that cognitive interventions for individuals with primary BDD symptoms may
improve co-occurring ED symptoms such as bulimia.
Behavioural and cognitive psychotherapy, 46(6) : 676-
689
- Year: 2018
- Problem: Eating Disorders
(any), Bulimia Nervosa
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Attention/cognitive bias
modification, Technology, interventions delivered using technology (e.g. online, SMS)
Vasileva, S., Mesana, L., Pruce, D., Syed, I. A.
Objectives: Eating disorders affect 2-4% of young adults. Technology in healthcare is changing treatment
delivery. Previous meta-analysis of clinical trials have demonstrated promising, but inconclusive results of online and app-based interventions (e-
therapies), urging improved methods in future trials. Uncertainty also exists about effectiveness in real-world settings. Objectives of this review
are to identify and review recent comparative trials and real-world evidence (RWE) assessing efficacy/effectiveness of e-health technologies in
preventing and treating eating disorder. Method(s): A previous systematic literature review (SLR) of e-therapies in eating disorder captured relevant
trials published prior to July 2014. Additional searches were run on Medline, Embase and trial registries to identify trials since 2014 and all RWE
from database inception until June 2018. Studies assessing efficacy/effectiveness of e-therapies versus other or no therapy were included. We also
ran targeted searches to identify trials including therapist, which were excluded from previous SLR. Result(s): Eighteen additional trials were
included but no RWE was identified. Internet-based interventions were the most commonly evaluated therapies but the search identified little evidence
from single studies on smartphone applications, telemedicine, text messaging and video therapies. Most studies comparing internet-based therapies to
waiting lists showed reduction in eating disorder symptoms and improvement on eating disorder scales. Majority of the studies comparing internet-
based (mostly therapist-led interventions) or chat to face-to-face therapies reported similar efficacy. Limited evidence was identified comparing
therapist-involved therapies (i.e., video therapies, text messaging, email therapies, telemedicine) and non-therapist involved smartphone
applications with face-to-face or waiting lists. Conclusion(s): Similar to previous SLR, recent trials showed efficacy of internet-based
interventions versus waitlist, but similar efficacy to face-to-face therapy. Potential cost-savings with internet-based interventions versus face-
to-face therapies, given the similar efficacy, is yet to be determined. Further research is required to assess effectiveness of e-therapies in real-
life settings in treating and preventing eating disorders. Copyright © 2018
Value in Health, 21 (Supplement 3) : S277
- Year: 2018
- Problem: Eating Disorders
(any)
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Technology, interventions delivered using technology (e.g. online, SMS), Technology, comparing delivery mode (e.g. online vs. face-to-face)
Kwan, M. Y., Haynos, A. F., Blomquist, K. K., Roberto, C. A.
Objective: Fashion warning labels that
caution readers about digitally altered images have been recommended and adopted by several countries to prevent body dissatisfaction and eating
disorders. This study investigated the short- and longer-term influence of fashion warning labels on affect, body dissatisfaction, eating disorder
symptoms, and snack consumption using a randomized-controlled experiment. Method(s): Female undergraduates (n = 118) were randomized to view and rate
responses to fashion images either with or without a warning label. They then consumed snacks and completed questionnaires. Sixty-four participants
(54%) completed follow-up online surveys asking them to view and rate new fashion images with or without warning labels once per week for 4 weeks.
Primary outcomes were affect, body dissatisfaction, eating disorder symptoms, and kilocalories consumed. Result(s): Overall, fashion warning labels
had no short-term effects on affect, body dissatisfaction, or kilocalories consumed in the lab. However, individuals who reported engaging in
restrictive eating consumed fewer kilocalories when exposed to advertisements with warning labels (M = 170.33, SD = 120.78) versus no labels (M =
286.46, SD = 166.30), p =.008. Warning labels also had no protective effects after repeated exposure over 4 weeks on affect or eating disorder
symptoms, and significantly increased appearance orientation (p =.001). Discussion(s): Warning labels on media images are unlikely to be an effective
policy tool to prevent negative affect, body dissatisfaction, and eating disorder symptoms, and, in some cases, may exacerbate these concerns.
Copyright © 2018 Wiley Periodicals, Inc.
International Journal of Eating
Disorders, 51(10) : 1153-1161
- Year: 2018
- Problem: Eating Disorders
(any)
- Type: Randomised controlled trials
-
Stage: Universal prevention
-
Treatment and intervention: Psychological Interventions
(any), Other Psychological Interventions
Glashouwer,
K. A., Neimeijer, R. A., de-Koning, M. L., Vestjens, M., Martijn, C.
Objective: The aim was to investigate whether a
computer-based evaluative conditioning intervention improves body image in adolescents with an eating disorder. Positive effects were found in
earlier studies in healthy female students in a laboratory and a field setting. This study is the first to test evaluative conditioning in a clinical
sample under less controlled circumstances. Method: Fifty-one adolescent girls with an eating disorder and a healthy weight were randomly assigned to
an experimental condition or a placebo-control condition. The computerized intervention consisted of six online training sessions of 5 min, in which
participants had to click on pictures of their own and other people's bodies. Their own pictures were systematically followed by portraits of
friendly smiling faces. In the control condition, participants were shown the same stimuli, but here, a stimulus was always followed by another
stimulus from the same category, so that own body was not paired with smiling faces. Before, directly after, three weeks after, and 11 weeks after
the intervention, self-report measures of body image and general self-esteem were administered. Automatic self-associations were also measured with
an Implicit Association Test. Results: In contrast to our hypotheses, we did not find an effect of the intervention on self-report questionnaires
measuring body satisfaction, weight and shape concern, and general self-esteem. In addition, the intervention did not show positive effects on
implicit associations regarding self-attractiveness. Conclusions: These findings do not support the use of evaluative conditioning in its present
form as an intervention for adolescents in clinical practice. (PsycINFO Database Record (c) 2018 APA, all rights reserved) Impact Statement What is
the public health significance of this article?-This study investigated a new intervention to improve body image in adolescents with eating
disorders. Outcomes do not support the use of evaluative conditioning in its present form as a body image treatment for adolescents. (PsycINFO
Database Record (c) 2018 APA, all rights reserved)
Journal of
Consulting and Clinical Psychology, 86(12) : 1046-1055
- Year: 2018
- Problem: Eating Disorders
(any)
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Other Psychological Interventions, Technology, interventions delivered using technology (e.g. online, SMS)
Grossman, S. L., Campagna, B., Brochu, H., Odermatt, M., Annunziato, R. A.
OBJECTIVE: To conduct a pilot test
to determine if the Body Project, an eating disorder prevention program, was able to reduce risky sexual behaviors. PARTICIPANTS: Twenty college-age
women ages 18-21 (in March, 2015) who endorsed both body image dissatisfaction and previous or current sexual activity. METHOD(S): Participants were
randomized to the Body Project or psychoeducational control group, and completed baseline, post-test, and 6-month follow-up measures assessing body
image concerns, eating behaviors, and sexual behaviors and attitudes. RESULT(S): An intervention manipulation check demonstrated that body image
variables were in expected directions, though were not significant by group. There was a significant interaction across group and time for
\"unanticipated sexual encounters,\" which decreased in the Body Project group. CONCLUSION(S): This pilot study supports the feasibility of using an
eating disorder prevention program to reduce other risky behaviors, specifically risky sexual behaviors.
Journal of American college health : J of
ACH, 66(8) : 826-830
- Year: 2018
- Problem: Eating Disorders
(any)
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Psychoeducation, Cognitive dissonance
therapy
Wade, T. D., Wilksch, S. M.
Purpose of review Internet prevention of eating disorders is a relatively new field that is
expanding rapidly. We review randomized controlled trial designs examining the efficacy of Internet prevention in eating disorders that have emerged
from 2016. Recent findings Our literature search identified five studies that used randomized controlled trial designs to examine the efficacy of
Internet prevention in eating disorders. All of the studies represented indicated prevention, that is, young women who have body image concerns.
Three specific approaches were examined: media literacy, cognitive dissonance, and cognitive behavior therapy. All studies indicated significantly
more impact of the intervention than a control condition, with between group effect sizes at follow-up ranging from 0.24 to 0.42. Summary Although
Internet interventions for eating disorders may be less effective than face-to-face interventions, and attrition increases when populations are used
that reflect real-world usage, these interventions have an important role in a stepped-care approach. Future research should make direct comparisons
of different Internet programs with a view to helping us understand who will gain most benefit out of which approach, including who requires
moderated Internet approaches and who does not. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
Current Opinion in Psychiatry, 31(6) : 456-
461
- Year: 2018
- Problem: Eating Disorders
(any)
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Other Psychological Interventions, Cognitive dissonance
therapy, Technology, interventions delivered using technology (e.g. online, SMS), Technology, comparing delivery mode (e.g. online vs. face-to-face)