Disorders - Eating Disorders
Musiat, P., Conrod, P., Treasure, J., Tylee, A., Williams, C., Schmidt, U.
Background: A large proportion of university students show symptoms of common mental disorders, such as depression, anxiety, substance use
disorders and eating disorders. Novel interventions are required that target underlying factors of multiple disorders. Aims: To evaluate the efficacy
of a transdiagnostic trait-focused web-based intervention aimed at reducing symptoms of common mental disorders in university students. Method:
Students were recruited online (n = 1047, age: M= 21.8, SD = 4.2) and categorised into being at high or low risk for mental disorders based on their
personality traits. Participants were allocated to a cognitive-behavioural trait-focused (n = 519) or a control intervention (n = 528) using
computerised simple randomisation. Both interventions were fully automated and delivered online (trial registration: ISRCTN14342225). Participants
were blinded and outcomes were selfassessed at baseline, at 6 weeks and at 12 weeks after registration. Primary outcomes were current depression and
anxiety, assessed on the Patient Health Questionnaire (PHQ9) and Generalised Anxiety Disorder Scale (GAD7). Secondary outcome measures focused on
alcohol use, disordered eating, and other outcomes. Results: Students at high risk were successfully identified using personality indicators and
reported poorer mental health. A total of 520 students completed the 6-week follow-up and 401 students completed the 12-week follow-up. Attrition was
high across intervention groups, but comparable to other web-based interventions. Mixed effects analyses revealed that at 12-week follow up the
trait-focused intervention reduced depression scores by 3.58 (p,.001, 95%CI [5.19, 1.98]) and anxiety scores by 2.87 (p = .018, 95%CI [1.31, 4.43])
in students at high risk. In high-risk students, between group effect sizes were 0.58 (depression) and 0.42 (anxiety). In addition, self-esteem was
improved. No changes were observed regarding the use of alcohol or disordered eating. Conclusions: This study suggests that a transdiagnostic web-
based intervention for university students targeting underlying personality risk factors may be a promising way of preventing common mental disorders
with a low-intensity intervention. © 2014 Musiat et al.
PLoS ONE, 9(4) :
- Year: 2014
- Problem: Anxiety Disorders (any), Depressive Disorders, Eating Disorders
(any), Alcohol
Use
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Technology, interventions delivered using technology (e.g. online, SMS)
Kilpela, L. S., Hill, K., Kelly, M. C., Elmquist, J., Ottoson, P., Keith,
D., Hildebrandt, T., Becker, C. B.
Recent advances in
psychological intervention research have led to an increase in evidence-based interventions (EBIs), yet there remains a lag in dissemination and
implementation of EBIs. Task-shifting and the train-the-trainer (TTT) model offer two potential strategies for enhancing reach of EBIs. The Body
Project, an EBI found to prevent onset of eating disorders, served as the vehicle for this dissemination/implementation study. The primary aim of
this study was to determine if training of peer-leaders for the Body Project could be task-shifted to undergraduate students using a hybrid task-
shifting/TTT model. Our secondary aim was to determine if subgroups of participants evidenced different trajectories of change through 14-month
follow-up. Regarding the first aim, we found almost no evidence to suggest that a presence of a doctoral-level trainer yielded superior participant
outcomes compared to training by undergraduates alone. Regarding Aim 2, almost all classes for all variables evidenced improvement or a benign
response. Additionally, for three key risk factors (thin-ideal internalization, body dissatisfaction, and ED symptoms) virtually all trajectories
showed improvement. This study provides initial support for the use of a blended task-shifting/TTT approach to dissemination and implementation
within prevention generally, and further support for broad dissemination of the Body Project specifically.; Copyright © 2014 Elsevier Ltd. All rights
reserved.
Behaviour Research &
Therapy, 63 : 70-82
- Year: 2014
- Problem: Eating Disorders
(any)
- Type: Randomised controlled trials
-
Stage: Universal prevention
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Cognitive dissonance
therapy, Other service delivery and improvement
interventions
Langford, R., Bonell, CP., Jones, HE., Pouliou, T., Murphy, SM., Waters, E., Komro, KA., Gibbs LF., Magnus, D., Campbell, R.
Background: The World Health Organization's (WHO's)
Health Promoting Schools (HPS) framework is an holistic, settings-based approach to promoting health and educational attainment in school. The
effectiveness of this approach has not been previously rigorously reviewed.Objectives: To assess the effectiveness of the Health Promoting Schools
(HPS) framework in improving the health and well-being of students and their academic achievement.Search methods: We searched the following
electronic databases in January 2011 and again in March and April 2013: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE,
PsycINFO, CINAHL, Campbell Library, ASSIA, BiblioMap, CAB Abstracts, IBSS, Social Science Citation Index, Sociological Abstracts, TRoPHI, Global
Health Database, SIGLE, Australian Education Index, British Education Index, Education Resources Information Centre, Database of Education Research,
Dissertation Express, Index to Theses in Great Britain and Ireland, ClinicalTrials.gov, Current controlled trials, and WHO International Clinical
Trials Registry Platform. We also searched relevant websites, handsearched reference lists, and used citation tracking to identify other relevant
articles.Selection criteria: We included cluster-randomised controlled trials where randomisation took place at the level of school, district or
other geographical area. Participants were children and young people aged four to 18 years, attending schools or colleges. In this review, we define
HPS interventions as comprising the following three elements: input to the curriculum; changes to the school's ethos or environment or both; and
engagement with families or communities, or both. We compared this intervention against schools that implemented either no intervention or continued
with their usual practice, or any programme that included just one or two of the above mentioned HPS elements.Data collection and analysis: At least
two review authors identified relevant trials, extracted data, and assessed risk of bias in the trials. We grouped different types of interventions
according to the health topic targeted or the approach used, or both. Where data permitted, we performed random-effects meta-analyses to provide a
summary of results across studies.Main results: We included 67 eligible cluster trials, randomising 1443 schools or districts. This is made up of
1345 schools and 98 districts. The studies tackled a range of health issues: physical activity (4), nutrition (12), physical activity and nutrition
combined (18), bullying (7), tobacco (5), alcohol (2), sexual health (2), violence (2), mental health (2), hand-washing (2), multiple risk behaviours
(7), cycle-helmet use (1), eating disorders (1), sun protection (1), and oral health (1). The quality of evidence overall was low to moderate as
determined by the GRADE approach. 'Risk of bias' assessments identified methodological limitations, including heavy reliance on self-reported data
and high attrition rates for some studies. In addition, there was a lack of long-term follow-up data for most studies.We found positive effects for
some interventions for: body mass index (BMI), physical activity, physical fitness, fruit and vegetable intake, tobacco use, and being bullied.
Intervention effects were generally small but have the potential to produce public health benefits at the population level. We found little evidence
of effectiveness for standardised body mass index (zBMI) and no evidence of effectiveness for fat intake, alcohol use, drug use, mental health,
violence and bullying others; however, only a small number of studies focused on these latter outcomes. It was not possible to meta-analyse data on
other health outcomes due to lack of data. Few studies provided details on adverse events or outcomes related to the interventions. In addition, few
studies included any academic, attendance or school-related outcomes. We therefore cannot draw any clear conclusions as to the effectiveness of this
approach for improving academic achievement.Authors' conclusions: The resu ts of this review provide evidence for the effectiveness of some
interventions based on the HPS framework for improving certain health outcomes but not others. More well-designed research is required to establish
the effectiveness of this approach for other health topics and academic achievement.
Cochrane Database of Systematic
Reviews, (4) : CD008959
- Year: 2014
- Problem: Anxiety Disorders (any), Depressive Disorders, Eating Disorders
(any), Substance Use Disorders (any)
- Type: Systematic reviews
-
Stage: Universal prevention
-
Treatment and intervention: Service Delivery & Improvement
Lafont, J., Oberle, C. D.
This study investigated the effects of expressive writing on body image of women
varying in eating disorder symptomatology. Ninety-two female undergraduates were randomly assigned to the writing topic conditions: traumatic events,
body image, and room description. At three times (before, immediately after, and one month after the two-week intervention), participants selected
from among nine figures (a) the figure deemed closest to their current figure, (b) the figure deemed closest to the ideal figure, and (c) the figure
deemed closest to the figure that men prefer. The current figure ratings decreased after the writing intervention for the high-symptom group but not
the low-symptom group. The ideal and male-preferred figure ratings were not affected by the intervention and did not differ between the symptom level
groups. Based on the first finding, writing may improve body image perceptions in women with an already distorted body image. (PsycINFO Database
Record (c) 2014 APA, all rights reserved) (journal abstract)
Psychology, 5(American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders (4th ed.). Washington
DC: American Psychiatric Association.) : 431-440
- Year: 2014
- Problem: Eating Disorders
(any)
- Type: Randomised controlled trials
-
Stage: Universal prevention, At risk (indicated or selected prevention)
-
Treatment and intervention: Complementary & Alternative
Interventions (CAM), Creative expression: music, dance, drama, art
Martinsen, M., Bahr, R., Borresen, R., Holme, I., Pensgaard, A. M., Sundgot-Borgen, J.
Purpose: To examine the effect of a 1-yr school-based intervention program to
prevent the development of new cases of eating disorders (ED) and symptoms associated with ED among adolescent female and male elite athletes.;
Methods: All 16 Norwegian Elite Sport High Schools were included (intervention group [n = 9] and control group [n = 7]). In total, 465 (93.8%)
first-year student athletes were followed during high school (2008-2011, three school years). The athletes completed the Eating Disorder Inventory 2
and questions related to ED before (pretest), immediately after (posttest 1), and 9 months after the intervention (posttest 2). Clinical interviews
(Eating Disorder Examination) were conducted after the pretest (all with symptoms [n = 115, 97%] and a random sample without symptoms [n = 116,
97%]), and at posttest 2, all athletes were interviewed (n = 463, 99.6%).; Results: Among females, there were no new cases of ED in the intervention
schools, while 13% at the control schools had developed and fulfilled the DSM-IV criteria for ED not otherwise specified (n = 7) or bulimia nervosa
(n = 1), P = 0.001. The risk of reporting symptoms was lower in the intervention than in the control schools at posttest 1 (odds ratio [OR] = 0.45,
95% confidence interval [CI] = 0.23-0.89). This effect was attenuated by posttest 2 (OR = 0.57, 95% CI = 0.29-1.09). The intervention showed a
relative risk reduction for current dieting (OR = 0.10, 95% CI = 0.02-0.54) and three or more weight loss attempts (OR = 0.47, 95% CI = 0.25-0.90).
Among males, there was one new case of ED at posttest 2 (control school) and no difference in the risk of reporting symptoms between groups at
posttest 1 or 2.; Conclusion: A 1-yr intervention program can prevent new cases of ED and symptoms associated with ED in adolescent female elite
athletes.;
Medicine & Science in Sports & Exercise, 46(3) : 435-
447
- Year: 2014
- Problem: Eating Disorders
(any)
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Complementary & Alternative
Interventions (CAM), Psychological Interventions
(any), Other Psychological Interventions, Dietary advice, dietary change
Ciao, Anna. C., Loth,
Katie., Neumark-Sztainer, Dianne.
Over the past two decades, the field of eating disorders has made
remarkable strides in identifying, evaluating, and disseminating successful prevention programs. The current review identifies and discusses nine
distinct eating disorders prevention programs that reduce existing eating disorder pathology or prevent the onset of future pathology. Each program
was evaluated in one or more controlled trial with a follow-up period of at least six months. We review the evidence base for these nine successful
programs and discuss their common and unique features. Based on authors' descriptions of their programs in published trials, we found that all
programs were theory-driven, targeted one or more eating disorder risk factor (e.g., body dissatisfaction), were delivered across multiple group
sessions, and included at least some interactive content. Most programs included content related to healthy eating/nutrition, media
literacy/sociocultural pressures, and body acceptance/body satisfaction. Notably, there was wide variation in some participant features (e.g.,
participant age, sex, risk status) and intervention features (e.g., setting and format, length and dose, providers), suggesting that a variety of
programs are beneficial in impacting eating disorder pathology. Implications and directions for future research are discussed, including an increased
focus on universal and indicated prevention programs, expanding programs to a wider age range and a broader spectrum of weight-related problems, and
rigorous evaluation of programs through efficacy, effectiveness, and implementation research.;
Current Psychiatry Reports, 16(7) : 453-
453
- Year: 2014
- Problem: Eating Disorders
(any)
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention), Universal prevention
-
Treatment and intervention: Psychological Interventions
(any)
Goldstein, Mandy., Peters, Lorna., Thornton, Christopher. E., Touyz, Stephen. W.
The aim of this pilot study was to investigate the impact of the direct treatment
of perfectionism on the outcome of perfectionism and eating disorder pathology. Sixty-one participants, attending day hospital treatment,
participated in a randomised controlled study, in which treatment as usual (TAU) was compared with TAU combined with a clinician-lead cognitive
behavioural treatment for perfectionism (TAU+P). Linear mixed model analysis revealed no significant interaction effects but significant main effects
for time on variables measuring eating pathology and perfectionism. Outcomes supported the effectiveness of overall treatment but suggested that
adding direct treatment of perfectionism did not enhance treatment. The results are discussed in relation to the existing literature on the treatment
of perfectionism.; Copyright © 2014 John Wiley & Sons, Ltd and Eating Disorders Association.
European Eating Disorders Review, 22(3) : 217-
221
- Year: 2014
- Problem: Eating Disorders
(any)
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
Halliwell, E., Diedrichs,
P. C.
Objective: Body image and eating disorder interventions based on cognitive dissonance have been shown to be
effective among girls and women aged 14 and above. This article reports a preliminary examination of whether a dissonance intervention is also
effective when delivered in a school setting to 12- and 13-year-old girls in the United Kingdom Method: Girls (N =106, mean age =12.07 years, SD
=.27) were allocated to the intervention condition or a waitlist control. Results: In contrast to the control group, girls in the intervention
condition reported significant reductions in body dissatisfaction and internalization of a thin body ideal post-intervention. There was no
significant change in self-reported dietary restraint for either condition. In addition, compared with the control group, girls in the intervention
condition showed increased resilience to negative media effects 1-month post-intervention. Conclusions: Results suggests that dissonance based
programs can reduce body dissatisfaction, internalization and negative media effects among a younger group of girls than previously examined and in
an United Kingdom school setting. © 2013 American Psychological Association.
Health Psychology, 33(2) : 201-204
- Year: 2014
- Problem: Eating Disorders
(any)
- Type: Controlled clinical trials
-
Stage: Universal prevention
-
Treatment and intervention: Psychological Interventions
(any), Cognitive dissonance
therapy
Bailey, A. P., Parker, A. G., Colautti, L. A., Hart, L. M., Liu, P., Hetrick, S.
E.
Eating disorders often develop during adolescence and young adulthood, and are
associated with significant psychological and physical burden. Identifying evidence-based interventions is critical and there is need to take stock
of the extant literature, to inform clinical practice regarding well-researched interventions and to direct future research agendas by identifying
gaps in the evidence base.To investigate and quantify the nature and distribution of existing high-quality research on the prevention and treatment
of eating disorders in young people using evidence mapping methodology.A systematic search for prevention and treatment intervention studies in
adolescents and young adults (12-25 years) was conducted using EMBASE, PSYCINFO and MEDLINE. Studies were screened and mapped according to disorder,
intervention modality, stage of eating disorder and study design. Included studies were restricted to controlled trials and systematic reviews
published since 1980.The eating disorders evidence map included 197 trials and 22 systematic reviews. Prevention research was dominated by trials of
psychoeducation (PE). Bulimia nervosa (BN) received the most attention in the treatment literature, with cognitive behavioural therapy (CBT) and
antidepressants the most common interventions. For anorexia nervosa (AN), family based therapy (FBT) was the most studied. Lacking were trials
exploring treatments for binge eating disorder (BED) and eating disorder not otherwise specified (EDNOS). Relapse prevention strategies were notably
absent across the eating disorders.Despite substantial literature devoted to the prevention and treatment of eating disorders in young people, the
evidence base is not well established and significant gaps remain. For those identified as being at-risk, there is need for prevention research
exploring strategies other than passive PE. Treatment interventions targeting BED and EDNOS are required, as are systematic reviews synthesising BN
treatment trials (e.g., CBT, antidepressants). FBTs for AN require investigation against other validated psychological interventions, and the
development of relapse prevention strategies is urgently required. By systematically identifying existing interventions for young people with eating
disorders and exposing gaps in the current literature, the evidence map can inform researchers, funding bodies and policy makers as to the
opportunities for future research.
Journal of Eating
Disorders, 2(1) :
- Year: 2014
- Problem: Eating Disorders
(any)
- Type: Systematic reviews
-
Stage: Universal prevention, At risk (indicated or selected prevention), Disorder established (diagnosed disorder), Relapse prevention
-
Treatment and intervention: Biological Interventions
(any), Service Delivery & Improvement, Psychological Interventions
(any)
Kass, A. E., Trockel, M., Safer, D. L., Sinton, M. M., Cunning, D., Rizk, M. T., Genkin, B. H., Weisman, H. L., Bailey, J. O., Jacobi, C., Wilfley, D. E., Taylor, C. B.
Student
Bodies, an internet-based intervention, has successfully reduced weight/shape concerns and prevented eating disorders in a subset of college-age
women at highest risk for an eating disorder. Student Bodies includes an online, guided discussion group; however, the clinical utility of this
component is unclear. This study investigated whether the guided discussion group improves program efficacy in reducing weight/shape concerns in
women at high risk for an eating disorder. Exploratory analyses examined whether baseline variables predicted who benefitted most. Women with high
weight/shape concerns (N = 151) were randomized to Student Bodies with a guided discussion group (n = 74) or no discussion group (n = 77). Regression
analyses showed weight/shape concerns were reduced significantly more among guided discussion group than no discussion group participants (p = 0.002;
d = 0.52); guided discussion group participants had 67% lower odds of having high-risk weight/shape concerns post-intervention (p = 0.02). There were
no differences in binge eating at post-intervention between the two groups, and no moderators emerged as significant. Results suggest the guided
discussion group improves the efficacy of Student Bodies in reducing weight/shape concerns in college students at high risk for an eating disorder.
Copyright © 2014 Elsevier Ltd. All rights reserved.
Behaviour Research and Therapy, 63 : 90-98
- 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), Self-help, Technology, interventions delivered using technology (e.g. online, SMS)
Amianto, Federico., Bertorello, Antonella., Spalatro, Angela., Milazzo, Marina., Signa, Caterina., Cavarero, Silvia., Abbate-Daga., Giovanni, Fassino, Secondo.
Objective: Counseling interventions for parents with a
daughter affected by an eating disorder (ED) may represent a useful and cost-effective tool to improve patients' compliance to treatment and overall
outcome. The present study evaluates the outcome of Adlerian Parental Counseling (APC) on individuals affected by ED and their parents.; Methods: We
assessed 114 patients whose parents underwent APC and 44 individuals whose parents did not receive this intervention. All patients received
multimodal treatment and were assessed at intake and at a 6-month follow-up. Patients were assessed using: the first scale and the improvement scale
(GI) of the Clinical Global Impression (CGI) and the Family Assessment Device (FAD). Parents underwent APC and completed several psychometric tests:
Attachment Style Questionnaire, State-Trait Anger Expression Inventory, Symptom Questionnaire, and Family Assessment Device.; Results: The GI of the
ED group whose parents received APC significantly improved when compared with baseline. Moreover, the improvement was significantly greater for the
APC group with respect to the non-APC group if the initial CGI score was considered. After counseling, mothers displayed poorer FAD scores, but their
sense of inadequacy, their anxiety symptoms and their preoccupation with relationships improved. Fathers improved their social trust and reduced
introverted anger. APC reduced the differences as regards family functioning perception among family members.; Conclusion: Parents reported a
subjective improvement in psychopathology scales and a better fine-tuning of their perception of family dynamics with those of their daughters and
husband. The improvement in family dynamics along with the motivational effect of parents' participation in counseling may have positively
influenced the outcome of the multimodal treatment. Moreover, this intervention could also have been helpful for those with a severe ED.;
Eating & Weight Disorders, 19(3) : 303-
314
- Year: 2014
- Problem: Eating Disorders
(any)
- Type: Controlled clinical trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Psychoeducation, Other Psychological Interventions
Volker, U., Jacobi, C., Trockel, M. T., Taylor, C. B.
The
objective of this study was to investigate moderators and mediators of the effect of an indicated prevention program for eating disorders (ED) on
reduction of dysfunctional attitudes and specific ED symptoms. 126 women (M age = 22.3; range 18-33) reporting subthreshold ED symptoms were
randomized to the Student BodiesTM+ (SB+) intervention or an assessment-only control condition. Assessments took place at pre-intervention, mid-
intervention (mediators), post-intervention, and 6-month follow-up. Mixed effects modeling including all available data from all time points were
used for the data analysis. Intervention effects on the reduction of binge rate were weaker for participants with higher baseline BMI and for
participants with a lower baseline purge rate. Intervention effects on reduction of eating disorder pathology were weaker for participants with
higher baseline purge rate and with initial restrictive eating. No moderators of the intervention effect on restrictive eating were identified. An
increase in knowledge mediated the beneficial effect of SB+ on binge rate. The results suggest that different moderators should be considered for the
reduction of symptoms and change in attitudes of disturbed eating and that SB+ at least partially operates through psychoeducation. Copyright © 2014
Elsevier Ltd. All rights reserved.
Behaviour Research and
Therapy, 63 : 114-121
- 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 & behavioural therapies (CBT), Technology, interventions delivered using technology (e.g. online, SMS)