Disorders - Eating Disorders
Swain, J., Hancock, K., Dixon, A., Bowman, J.
An emerging body of
research demonstrates the effectiveness of Acceptance and Commitment Therapy (ACT) in the treatment of adult psychopathology, with several reviews
and meta-analyses attesting to its effectiveness. While there are comparatively fewer empirical studies of child populations, the past few years has
seen burgeoning research interest in the utility of ACT for problems in childhood. A systematic review of the published and unpublished literature
was conducted to examine the evidence for ACT in the treatment of children and to provide support for clinical decision making in this area. Searches
of PsycInfo, PsycArticles, PsycExtra, Proquest and the Association for Contextual Behavioral Science databases were undertaken, as well as reference
lists and citation searches conducted, up to December 2014. Broad inclusion criteria were employed to maximise review breadth. Methodological quality
was assessed and a narrative synthesis approach adopted. Twenty-one studies covering a spectrum of presenting problems met inclusion criteria, with a
total of 707 participants. Studies were predominantly within-group designs, with a lesser proportion of case studies/series, between-group and
randomised controlled trials. The preponderance of evidence suggests ACT results in improvements in clinician, parent and self-reported measures of
symptoms, quality of life outcomes and/or psychological flexibility, with many studies demonstrating further gains at follow-up assessment. However,
several methodological weaknesses limit conclusions, including small samples, non-randomised designs, and few alternative treatment or control
comparisons. While larger scale, methodologically rigorous trials from a broader research teams are needed to consolidate these preliminary findings,
emerging evidence suggests ACT is effective in the treatment of children across a multitude of presenting problems. ACT may be a viable alternative
treatment option for clinicians working with young people.
Journal of Contextual
Behavioral Science, 4(2) : 73-85
- Year: 2015
- Problem: Anxiety Disorders (any), Depressive Disorders, Eating Disorders
(any)
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Acceptance & commitment therapy
(ACT)
Wilksch, S M.
Aim: This pilot study tested teacher-delivered Media
Smart, a school-based eating disorder prevention program that has achieved significant benefits when delivered by health professionals. Method: Two
Grade 7 classes (N = 51; M age = 12.43 years) participated, with one randomly allocated to Media Smart (n = 27; 67% girls) and the other to a control
condition of usual lessons (n = 24; 37% girls). Program feasibility was assessed by teacher self-report, whereas student self-report of shape and
weight concern (primary outcome variable) and seven additional risk factors were measured at baseline, post-program and 6-month follow up. Results:
Teacher ratings of program feasibility revealed that 25 of the 29 (86.2%) program activities were taught with 96% of activities rated as either
highly (19 activities) or moderately (5 activities) valuable for students. Mixed model analyses were conducted using a 2 (group: Media Smart,
control) x 2 (time: post-program, 6-month follow up) x 2 (gender: girls, boys) design, with baseline scores as a covariate. A not-significant trend
for group favouring Media Smart was observed for shape and weight concern (Cohen's d effect size [d] = 0.32), whereas significant effects were found
for feelings of ineffectiveness (d = 0.52) and weight-related peer teasing (d = 0.68). Conclusions: The program was feasible for teacher delivery and
showed some promising results, supporting a more substantial randomized-controlled effectiveness trial. (PsycINFO Database Record (c) 2015 APA, all
rights reserved) (journal abstract).
Early Intervention in Psychiatry, 9(1) : 21-
28
- Year: 2015
- Problem: Eating Disorders
(any)
- Type: Randomised controlled trials
-
Stage: Universal prevention
-
Treatment and intervention: Psychological Interventions
(any), Other Psychological Interventions
Wilksch, S., Paxton, S., Byrne, S., Austin, S., McLean, S., Thompson, K., Dorairaj, K., Wade, T.
Background: A randomized controlled trial of three school-based programs and a no-intervention control group was
conducted to evaluate their efficacy in reducing eating disorder and obesity risk factors. Method: A total of 1316 grade 7 and 8 girls and boys (mean
age = 13.21 years) across three Australian states were randomly allocated to: Media Smart; Life Smart; the Helping, Encouraging, Listening and
Protecting Peers (HELPP) initiative; or control (usual school class). Risk factors were measured at baseline, post-program (5 weeks later), and at
the 6- and 12-month follow-ups. Results: Media Smart girls had half the rate of onset of clinically significant concerns about shape and weight than
control girls at the 12-month follow-up. Media Smart and HELPP girls reported significantly lower weight and shape concern than Life Smart girls at
the 12-month follow-up. Media Smart and control girls scored significantly lower than HELPP girls on eating concerns and perceived pressure at the 6
-month follow-up. Media Smart and HELPP boys experienced significant benefit on media internalization compared with control boys and these were
sustained at the 12-month follow-up in Media Smart boys. A group x time effect found that Media Smart participants reported more physical activity
than control and HELPP participants at the 6-month follow-up, while a main effect for group found Media Smart participants reported less screen time
than controls. Conclusions: Media Smart was the only program to show benefit on both disordered eating and obesity risk factors. Whilst further
investigations are indicated, this study suggests that this program is a promising approach to reducing risk factors for both problems. (PsycINFO
Database Record (c) 2015 APA, all rights reserved) (journal abstract).
Psychological Medicine, 45(9) : 1811-
1823
- Year: 2015
- Problem: Eating Disorders
(any)
- Type: Randomised controlled trials
-
Stage: Universal prevention
-
Treatment and intervention: Psychological Interventions
(any), Other Psychological Interventions
Stice, E.., Yokum, S., Waters, A.
Research supports the effectiveness of a dissonance-based eating disorder prevention program wherein high-
risk young women with body dissatisfaction critique the thin ideal, which reduces pursuit of this ideal, and the theory that dissonance induction
contributes to these effects. Based on evidence that dissonance produces attitudinal change by altering neural representation of valuation, we tested
whether completing the Body Project would reduce response of brain regions implicated in reward valuation to thin models. Young women with body
dissatisfaction were randomized to this intervention or an educational control condition, completing assessments and fMRI scans while viewing images
of thin versus averageweight female models at pre and post. Whole brain analyses indicated that, compared to controls, Body Project participants
showed greater reductions in caudate response to images of thin versus average-weight models, though participants in the two conditions showed
pretest differences in responsivity of other brain regions that might have contributed to this effect. Greater pre-post reductions in caudate and
putamen response to thin models correlated with greater reductions in body dissatisfaction. The finding that the Body Project reduces caudate
response to thin models provides novel preliminary evidence that this intervention reduces valuation of media images thought to contribute to body
dissatisfaction and eating disorders, providing support for the intervention theory by documenting that this intervention alters an objective
biological outcome.
PLoS
ONE, 10(12) :
- Year: 2015
- Problem: Eating Disorders
(any)
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive dissonance
therapy
Stice, E., Rohde, P., Butryn, M., Menke, K. S, Marti, C.
The authors conducted a pilot trial of a new dissonance-based group eating disorder treatment designed to be a cost-effective front-
line transdiagnostic treatment that could be more widely disseminated than extant individual or family treatments that are more expensive and
difficult to deliver. Young women with a DSM-5 eating disorder (N = 72) were randomized to an 8-week dissonance-based Counter Attitudinal Therapy
group treatment or a usual care control condition, completing diagnostic interviews and questionnaires at pre, post, and 2-month follow-up. Intent-
to-treat analyses revealed that intervention participants showed greater reductions in outcomes than usual care controls in a multivariate multilevel
model (chi2[6] = 34.1, p < .001), producing large effects for thin-ideal internalization (d = .79), body dissatisfaction (d = 1.14), and blinded
interview-assessed eating disorder symptoms (d = .95), and medium effects for dissonance regarding perpetuating the thin ideal (d = .65) and negative
affect (d = .55). Midway through this pilot we refined engagement procedures, which was associated with increased effect sizes (e.g., the d for
eating disorder symptoms increased from .51 to 2.30). This new group treatment produced large reductions in eating disorder symptoms, which is
encouraging because it requires about 1/20th the therapist time necessary for extant individual and family treatments, and has the potential to
provide a cost-effective and efficacious approach to reaching the majority of individuals with eating disorders who do not presently received
treatment. (PsycINFO Database Record (c) 2015 APA, all rights reserved) (journal abstract).
Behaviour Research & Therapy, 65 : 67-
75
- Year: 2015
- Problem: Eating Disorders
(any)
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive dissonance
therapy
Stice, E., Rohde, P., Butryn, M. L., Shaw, H., Marti,
C.
Objective: An efficacy trial found
that a dissonance-based prevention program reduced risk factors, eating disorder symptoms, and future eating disorder onset, but smaller effects
emerged when high school clinicians recruited students and delivered the program under real-world conditions in an effectiveness trial. The current
report describes results at 2- and 3-year follow-up from an effectiveness trial that tested whether a new enhanced dissonance version of this program
produced larger effects when college clinicians recruit students and deliver the intervention using improved train and supervision procedures.
Method: Young women from eight universities (N = 408, M age = 21.6, SD = 5.64) were randomized to the prevention program or an educational brochure
control condition. Results: Dissonance participants showed greater decreases in risk factors, eating disorder symptoms, and psychosocial impairment
by 3-year follow-up than controls, but not healthcare utilization, BMI, or eating disorder onset. Conclusions: This novel multisite effectiveness
trial found that the enhanced dissonance intervention and improved training and supervision procedures produced an average effect size at 3-year
follow-up that was 290% and 160% larger than effects observed in the high school effectiveness trial and efficacy trial respectively. Yet, the lack
of eating disorder onset effects may imply that factors beyond pursuit of the thin ideal now contribute to eating disorder onset. (PsycINFO Database
Record (c) 2015 APA, all rights reserved) (journal abstract).
Behaviour
Research & Therapy, 71 : 20-26
- Year: 2015
- 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
Tanofsky-Kraff, M., Shomaker, L. B., Wilfley, D. E., Young, J. F., Sbrocco, T., Stephens, M., Ranzenhofer, L. M., Elliott, C., Brady,
S., Radin, R.
M., Vannucci, A., Bryant, E. J., Osborn, R., Berger, S. S., Olsen, C., Kozlosky, M., Reynolds, J. C., Yanovski, J. C.
Conclusions: The intervention with adolescent girls with loss-ofcontrol eating is associated with lower age-adjusted BMI and percentage of
adiposity as well as improved mood symptoms over 1 y. Interpersonal psychotherapy further reduced objective binge eating. Additional research is
needed to elucidate the mechanisms by which physical and psychological improvements were observed.\rResults: Participation in both conditions was
associated with decreases in expected BMI gain, age-adjusted BMI metrics, the percentage of fat by using dual-energy X-ray absorptiometry, symptoms
of depression and anxiety, and the frequency of lossof- control eating over 12 mo of follow-up (Ps < 0.001) with no group difference. In follow-up
analyses, interpersonal psychotherapy was more efficacious than health education at reducing objective binge eating at the 12-mo follow-up (P <
0.05).\rBackground: The high prevalence and incidence of obesity and eating disorders in US adolescent girls are serious health problems. Because of
the shared risk factors for obesity and eating disorders, a targeted prevention of both conditions is a priority.\rObjective: We determined whether
an adapted interpersonal psychotherapy prevention program is more efficacious for reducing excess weight gain and worsening disordered eating than
health education in adolescent girls at high risk of obesity and eating disorders.\rDesign: A parallel-group, randomized controlled trial was
conducted between September 2008 and January 2013 in a university-based laboratory and a federal research hospital. The study included 113 adolescent
(12-17-y-old) girls deemed at high risk of adult obesity and eating disorders because of a body mass index (BMI) between the 75th and 97th
percentiles and reports of episodes of a loss of control over their eating. Girls were randomly assigned to participate in an adapted interpersonal
psychotherapy or a health-education group program for 12 weekly 90-min group sessions. Follow-up assessments occurred immediately after group
programs and at 6 and 12 mo.
American Journal of Clinical
Nutrition, 100(4) : 1010-1018
- Year: 2014
- Problem: Eating Disorders
(any)
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Interpersonal therapy (IPT), Psychoeducation
van-den-Heuvel, L. L., Jordaan, G. P.
In this review we synthesised current literature on the
psychopharmacological management of eating disorders (EDs) in children and adolescents (C&As). We focus specifically on anorexia nervosa (AN),
bulimia nervosa (BN) and binge eating disorder (BED). The treatment of EDs is determined by physical and psycho-social factors and needs.
Pharmacological management should therefore be viewed and incorporated as one component of a multi-disciplinary comprehensive treatment plan for
specific requirements of a patient depending on the stage of the disorder. As there is a dearth of studies evaluating the use of psychopharmacology
for EDs in C&As we first review the findings from studies performed in adults and then discuss specific studies performed in C&As. We include
information from reviews and treatment guidelines to assist the clinician with an approach to the use of psychopharmacological agents in the
treatment of EDs in C&As.;
Journal of Child & Adolescent Mental Health, 26(2) : 125-
137
- Year: 2014
- Problem: Eating Disorders
(any)
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any)
Rohde, P., Auslander, B. A., Shaw, H., Raineri, K. M., Gau, J. M., Stice,
E.
Objective: Although several eating disorder
prevention programs reduce eating disorder risk factors and symptoms for female high school and college students, few efficacious prevention programs
exist for female middle school students, despite the fact that body image and eating disturbances often emerge then. Two pilot trials evaluated a new
dissonance-based eating disorder prevention program for middle school girls with body image concerns.; Method: Female middle school students with
body dissatisfaction from two sites [Study 1: N = 81, M age = 12.1, standard deviation (SD) = 0.9; Study 2: N = 52, M age = 12.5, SD = 0.8] were
randomized to a dissonance intervention (MS Body Project) or educational brochure control; Study 2 included a 3-month follow-up.; Results:
Intervention participants showed significant post-test reductions in only one of the six variables with both Studies 1 and 2 (i.e., pressure to be
thin and negative affect, respectively), though post-test effect sizes suggested medium reductions in eating disorder risk factors and symptoms
(Study 1: M d = .40; Study 2: M d = .65); reductions at 3-month follow-up in Study 2 were not evident (M d = .19).; Conclusions: Results suggest that
this new middle school version of the Body Project is producing medium magnitude reductions in eating disorder risk factors at post-test but that
effects are showing limited persistence. Continued refinement and evaluation of this intervention appears warranted to develop more effective
prevention programs for this age group.; © 2014 Wiley Periodicals, Inc.
International Journal of Eating Disorders, 47(5) : 483-
494
- Year: 2014
- Problem: Eating Disorders
(any)
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive dissonance
therapy
Serdar, K., Kelly, N. R., Palmberg, A. A., Lydecker, J.
A., Thornton, L., Tully, C. E., Mazzeo, S. E.
Disordered eating behavior
is common in college women. Thus, it is important to develop programs to reduce eating disorder (ED) risk. Studies suggest that dissonance-based (DB)
prevention programs successfully reduce ED risk factors; however, face-to-face DB groups lack anonymity and convenience. One way to address these
barriers is to adapt DB programs for online use. Few studies have examined the feasibility of this delivery mode. This study compared the efficacy of
an online DB program with a face-to-face DB program and an assessment-only condition. Undergraduate women (N = 333) recruited from a participant pool
at a public university in the mid-Atlantic United States participated (n = 107 face-to-face DB, n = 112 online DB, n = 114 assessment-only). It was
hypothesized that: (a) participants in the face-to-face and online DB conditions would report greater decreases in thin-ideal internalization, body
dissatisfaction, and ED symptoms at post-testing relative to participants in the assessment-only control group, and (b) online and face-to-face
programs would yield comparable results. Modified intent-to-treat analyses indicated that participants in both conditions manifested less body
dissatisfaction at post-test compared with assessment-only participants; there were no significant differences in outcomes between the two modes of
program delivery. These findings indicate that DB ED prevention programs can be successfully adapted for online use. Future studies should continue
to refine online adaptations of such programs and examine their effects with samples that include older and younger women, and men. Copyright ©
Taylor & Francis Group, LLC.
Eating Disorders, 22(3) : 244-260
- Year: 2014
- Problem: Eating Disorders
(any)
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Cognitive dissonance
therapy, Technology, comparing delivery mode (e.g. online vs. face-to-face)
Stice, E., Durant, S., Rohde, P., Shaw, H.
Objective: A group-based eating disorder prevention program wherein young women explore the costs of pursuing the thin ideal reduces eating
disorder risk factors and symptoms. However, it can be challenging to identify school clinicians to effectively deliver the intervention. The present
study compares the effects of a new Internet-based version of this prevention program, which could facilitate dissemination, to the group-based
program and to educational video and educational brochure control conditions at 1- and 2-year follow-up.; Method: Female college students with body
dissatisfaction (n = 107; M age = 21.6, SD = 6.6) were randomized to these 4 conditions.; Results: Internet participants showed reductions in eating
disorder risk factors and symptoms relative to the 2 control conditions at 1- and 2-year follow-up (M -d = .34 and .17, respectively), but the
effects were smaller than parallel comparisons for the group participants (M -d = .48 and .43, respectively). Yet the Internet intervention produced
large weight gain prevention effects relative to the 2 control conditions at 1- and 2-year follow-up (M -d = .80 and .73, respectively), which were
larger than the parallel effects for the group intervention (M -d = .19 and .47, respectively).; Conclusions: Although the effects for the Internet
versus group intervention were similar at posttest, results suggest that the effects faded more quickly for the Internet intervention. However, the
Internet intervention produced large weight gain prevention effects, implying that it might be useful for simultaneously preventing eating disordered
behavior and unhealthy weight gain.;
Health Psychology, 33(12) : 1558-
1567
- Year: 2014
- Problem: Eating Disorders
(any)
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Cognitive dissonance
therapy, Technology, comparing delivery mode (e.g. online vs. face-to-face)
Stice, E., Marti, C. N., Cheng, Z. H.
Objective: As young women from certain ethnic minority groups have reported
less pursuit of the thin ideal and body dissatisfaction than European American young women we tested whether a dissonance-based prevention program
designed to reduce thin-ideal internalization among women with body dissatisfaction is less effective for the former relative to the later groups. We
also tested whether intervention effects are larger when participants from minority groups worked with a facilitator matched versus not matched on
ethnicity.; Method: In Study 1, 426 female undergraduates (M age=21.6, SD=5.6) were randomized to clinician-led Body Project groups or an educational
control group. In Study 2, 189 female undergraduates were randomized to peer-led Body Project groups or a waitlist control condition.; Results:
Although there was some variation in risk factor scores across ethnic groups, ethnic minority participants did not demonstrate consistently higher or
lower risk relative to European American participants. Intervention effects did not significantly differ for participants from minority groups versus
European American participants in either trial. There was no evidence that effects were significantly larger when minority participants and
facilitators were matched on ethnicity.; Conclusions: Results suggest that the Body Project is similarly effective for African American, Asian
American, European American, and Hispanic female college students, and when participants and facilitators are matched or not on minority ethnicity
status, implying that this prevention program can be broadly disseminated in this population.; Copyright © 2014 Elsevier Ltd. All rights
reserved.
Behaviour Research &
Therapy, 55 : 54-64
- Year: 2014
- Problem: Eating Disorders
(any)
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive dissonance
therapy