Disorders - Eating Disorders
Ng, L. W. C., Ng, D. P., Wong, W. P.
Background: Anorexia nervosa is an eating disorder that is often preceded by excessive physical activity. As such, exercise is not often
prescribed in the clinical management of individuals with anorexia nervosa. Objective: To examine the effects of supervised exercise training in
patients with anorexia nervosa. Data sources: Five databases were searched from their inception to Week 14 of 2011 using the subject headings
'anorexia' and 'exercise' to identify relevant studies. Eligibility criteria: PRISMA guidelines were followed. Studies that investigated the
effects of inclusion of supervised exercise training in clinical management with usual management in patients diagnosed with anorexia nervosa were
included in this review. Case reports were excluded. Data extraction and synthesis: Two reviewers independently extracted data using a standardised
assessment form. Quality assessment was rated for the controlled trials and single-group studies using the PEDro scale and Downs and Black scale,
respectively. Fixed or random effect approaches were used to determine effect size, depending on the heterogeneity of the studies. Results: Pooled
randomised controlled trials and quasi-randomised studies showed no significant effect of supervised exercise training on selected anthropometric
measurements, while the single-group studies showed significant improvement in weight and body fat. Although Short Form-36 revealed no training
effect, distorted feelings about food and exercise were reduced. Cardiovascular fitness also improved with no decrease in weight. Limitations:
Heterogeneity of exercise training programmes, small sample size (. n(less-than or equal to). 20) for 67% of the trials, and inability to exclude
publication bias. Conclusions: Inclusion of supervised exercise training in the comprehensive management of patients with anorexia nervosa appears to
be safe, as no detrimental effect was observed in anthropometry. Strength and cardiovascular fitness were also shown to improve. (copyright) 2012
Chartered Society of Physiotherapy.
Physiotherapy, 99(1) : 1-11
- Year: 2013
- Problem: Eating Disorders
(any), Anorexia Nervosa
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Complementary & Alternative
Interventions (CAM), Physical activity, exercise
Palmer, R., Nascimento, L. N., Fonagy, P.
This article
reviews outcomes of psychodynamic psychotherapy (PP) for children and adolescents reported in articles identified by a comprehensive review of the
literature on treatment evaluations of psychological and medical interventions for mental disorders in pediatric populations. The review identified
48 reports based on 33 studies. While there is evidence of substantial clinical gains associated with PP, in almost all the studies, when contrasted
with family-based interventions, PP fares no better and appears to produce outcomes with some delay relative to family-based therapies. Further
rigorous evaluations are needed, but evidence to date suggests that the context in which PP is delivered should be extended from the traditional
context of individual therapy and parents should be included in the treatment of children. (copyright) 2013 Elsevier Inc.
Child & Adolescent Psychiatric Clinics of North America, 22(2) : 149-
214
- Year: 2013
- Problem: Anxiety Disorders (any), Depressive Disorders, Eating Disorders
(any), Suicide or self-harm behaviours (excluding non-suicidal self-harm)
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention), Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Psychodynamic/Psychoanalysis
Stein, K. F., Corte, C., Chen, D-
G. D., Nuliyalu, U., Wing, J.
Objective: Findings of a randomized trial of an identity intervention programme (IIP) designed to
build new positive self-schemas that are separate from other conceptions of the self in memory as the means to promote improved health in women
diagnosed with eating disorders are reported.; Method: After baseline data collection, women with anorexia nervosa or bulimia nervosa were randomly
assigned to IIP (n?=?34) or supportive psychotherapy (SPI) (n?=?35) and followed at 1, 6, and 12?months post-intervention.; Results: The IIP and
supportive psychotherapy were equally effective in reducing eating disorder symptoms at 1?month post-intervention, and changes were stable through
the 12-month follow-up period. The IIP tended to be more effective in fostering development of positive self-schemas, and the increase was stable
over time. Regardless of baseline level, an increase in the number of positive self-schemas between pre-intervention and 1-month post-intervention
predicted a decrease in desire for thinness and an increase in psychological well-being and functional health over the same period.; Discussion: A
cognitive behavioural intervention that focuses on increasing the number of positive self-schemas may be central to improving emotional health in
women with anorexia nervosa and bulimia nervosa.; Copyright © 2012 John Wiley & Sons, Ltd and Eating Disorders Association.
European Eating Disorders Review, 21(2) : 130-
142
- Year: 2013
- Problem: Eating Disorders
(any), Anorexia Nervosa, Bulimia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Supportive
therapy, Other Psychological Interventions
Sharpe, H., Schobe, I., Treasure, J., Schmidt, U.
Background: Body image dissatisfaction during
adolescence is common but not benign. School-based interventions have the potential for wide reach, but scalability of previous programmes is limited
by a reliance on external facilitators. Aims: To assess the acceptability, feasibility and efficacy of a teacher-delivered body image intervention.
Method: A pilot clustered randomised controlled trial in which 16 classes of adolescent girls were allocated to a 6-session body image programme (n =
261), or usual curriculum control (n = 187) (registration: ISRCTN42594993). Results: Students in the intervention group had significantly improved
body esteem and self-esteem and reduced thin-ideal internalisation. Effects for body esteem and thin-ideal internalisation were maintained for 3
months. There were no group differences for eating pathology, peer factors or depression. Acceptability, feasibility and efficacy varied between
schools. Conclusions: Teacher-delivered body image lessons have promise but further work is needed to increase efficacy and make interventions
suitable across a range of schools. (PsycINFO Database Record (c) 2014 APA, all rights reserved). (journal abstract)
British Journal of Psychiatry, 203(6) : 428-
435
- Year: 2013
- Problem: Eating Disorders
(any)
- Type: Randomised controlled trials
-
Stage: Universal prevention
-
Treatment and intervention: Psychological Interventions
(any), Other Psychological Interventions
Simon, W., Lambert, M. J., Busath, G., Vazquez, A., Berkeljon, A., Hyer, K., Granley, M., Berrett, M.
Research
on the effects of progress feedback and clinician problem-solving tools on patient outcome has been limited to a few clinical problems and settings
(Shimokawa, Lambert, & Smart, 2010). Although these interventions work well in outpatient settings their effects so far have not been investigated
with eating-disordered patients or in inpatient care. In this study, the effect of providing feedback interventions was investigated in a randomized
clinical trial involving 133 females diagnosed with anorexia nervosa, bulimia nervosa, or eating disorders not otherwise specified. Comparisons were
made between the outcomes of patients randomly assigned to either treatment-as-usual (TAU) or an experimental condition (Fb) within therapists (the
same therapists provided both treatments). Patients in the Fb condition more frequently experienced clinically significant change than those who had
TAU (52.95% vs. 28.6%). Similar trends were noted within diagnostic groups. In terms of pre to post change in mental health functioning, large effect
sizes favored Fb over TAU. Patients' BMI improved substantially in both TAU and the feedback condition. The effects of feedback were consistent with
past research on these approaches although the effect size was smaller in this study. Suggestions for further research are delineated.
Psychotherapy Research, 23(3) : 287-300
- Year: 2013
- Problem: Eating Disorders
(any)
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Other service delivery and improvement
interventions
Ruiz-Lazaro, P. M., Zapata, M. A., Calvo, A.
I.
Introduction:
The ZARIMA Prevention Group multi-disciplinary team which works on ED has developed a community action programme to promote mental health through
primary and secondary prevention (published in Directory of Projects in Europe, Mental Health Promotion of Adolescents and Young People M.H.E.
financed by the European Commission). Method: The intervention consisted of 5 weekly sessions of 120 min duration. It was integrated into the regular
school hours, with small group activities, involvement techniques in eating nutrition, body image, gender differences, sociocultural influences,
self-esteem/self concept and social skills. Work was effected with adolescents, parents and teachers with ZARIMA programme This combined teacher
assessment, parent training, and skills training. Different technical and methodological approaches were applied, included role-playing, discussion
within small groups, videotape, slides, drawing, performance. The interventions were designed to reach the students on cognitive, emotional and
behavioural levels. The interventions were conducted in a coeducational setting without a separate curriculum for male or female students.
Standardised psychological measure (EAT- 26, SCAN with DSM-IV, ICD-10 diagnosis) is used with the intervention and control group, pre- and post-
intervention. One year later a booster session on nutrition and body image, was given with a DVD video and a pamphlet, for pupils, and another for
parents. Guide has been published for the prevention of ED and is distributed free of charge. Results: The ZARIMA programme has proved to be
effective when evaluated scientifically (result in a decrease statistically significant in the incidence of eating disorders in intervention group)
at the 1 year follow-up using standardized methods. After 12-month follow-up the risk of ED in the intervention group was almost one-third that in
the control group (4.1 vs. 10.5 %), and the incidence of ED significant decrease in intervention group but not in control group (0.0 vs. 2.7 %).
Conclusion: The number of subjects of this pilot study was small. It would therefore be inappropriate to generalize from its findings. Additional
research was needed on using a testing this program with a more divergent and larger sample with randomised controlled trial with measurements pre-
and post-intervention. A replication was required, a multicenter research project financed by F.I.S. PI 05/2533 (Spain Health Department). Our
previous study provides preliminary evidence that the primary prevention of ED in adolescents in school is possible. Our findings in replication
study suggest that school interventions for adolescents is useful in prevention of ED.
European Child & Adolescent Psychiatry, 22(2) : S310-
S311
- Year: 2013
- Problem: Eating Disorders
(any)
- Type: Controlled clinical trials
-
Stage: Universal prevention
-
Treatment and intervention: Psychological Interventions
(any), Other Psychological Interventions
Yager, Z., Diedrichs, P. C., Ricciardelli, L. A., Halliwell, E.
Governments, schools, and curriculum authorities are increasingly
recognizing that body image during adolescence is a public health issue that warrants attention in the school setting. After 30 years of eating
disorder prevention research, and given the current interest in this area, it seems timely to review the research on interventions to improve body
image in schools. We reviewed universal-selective, classroom-based programs that have been conducted since the year 2000, among adolescents, and
found 16 eligible intervention programs. Seven of these programs were effective in improving body image on at least one measure, from pre to post
test, though effect sizes were small (d = 0.22-0.48). These effective programs were conducted among younger adolescents 12.33-13.62 years, and
included activities focusing on media literacy, self esteem, and the influence of peers. Implications for school personnel and curriculum authorities
are discussed, and we provide recommendations for a strategic approach to future research in this area. (copyright) 2013 Elsevier Ltd.
Body
Image, 10(3) : 271-281
- Year: 2013
- Problem: Eating Disorders
(any)
- Type: Systematic reviews
-
Stage: Universal prevention
-
Treatment and intervention: Psychological Interventions
(any), Psychoeducation
Wagner, G., Penelo, E., Nobis, G., Mayerhofer, A., Schau, J., Spitzer, M., Imgart, H., Karwautz, A.
Summary: Objective: This study aims to evaluate
the long-term outcome of new technology assisted guided self-help in adolescents with bulimia nervosa (BN). Method: One hundred and twenty-six
patients with BN (29 adolescents and 97 adults) were randomly allocated to a cognitive behavioural therapy-based self-help program delivered by the
Internet or bibliotherapy, both accompanied by e-mail guidance. Outcomes were assessed at baseline, month 4, 7 and 18 including remission rates and
eating disorder associated psychopathology. Results: In all, 44 % of adolescents vs. 38.7 % of adults were in remission at month 7, and 55 % of
adolescents vs. 62.5 % of adults were in remission at follow-up. Objective binge eating and compensatory behaviour improved significantly over time
in both groups, with the highest decrease during the first 4 months. A significant decrease over time and no group differences have been found in
almost all EDI-2 subscales. Conclusions: E-mail guided self-help (delivered via the Internet or bibliotherapy) is equally effective for adolescents
as for adults with BN, and can be recommended as an initial step of treatment for this younger age group. (copyright) 2013 Springer-Verlag Wien.
Neuropsychiatrie, 27(2) : 66-73
- Year: 2013
- Problem: Eating Disorders
(any), Bulimia Nervosa
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Self-help, Technology, comparing delivery mode (e.g. online vs. face-to-face)
Stice, E., Rohde, P., Durant, S., Shaw, H., Wade, E.
Objective: The present preliminary trials tested whether undergraduate peer leaders can
effectively deliver a dissonance-based eating disorder prevention program, which could facilitate broad dissemination of this efficacious
intervention. Method: In Study 1, female undergraduates (N = 171) were randomized to peer-led groups, clinician-led groups, or an educational
brochure control condition. In Study 2, which improved a design limitation of Study 1 by using completely parallel outcome measures across
conditions, female undergraduates (N = 148) were randomized to either immediate peer-led groups or a waitlist control condition. Results: In Study 1,
participants in peer- and clinician-led groups showed significantly greater pre-post reductions in risk factors and eating disorder symptoms than
controls (M d = .64 and .98 respectively), though clinician- versus peer-led groups had higher attendance and competence ratings, and produced
stronger effects at posttest (M d = .32) and at 1-year follow-up (M d = .26). In Study 2, participants in peer-led groups showed greater pre-post
reductions in all outcomes than waitlist controls (M d = .75). Conclusions: Results provide novel evidence that dissonance-based eating disorder
prevention groups led by undergraduate peers are feasible and produce greater reductions in eating disorder risk factors and symptoms than minimal-
intervention control conditions, but indicate that effects are smaller for peer- versus clinician-led groups. (copyright) 2013 Elsevier Ltd.
Behaviour Research & Therapy, 51(4-5) : 197-
206
- Year: 2013
- 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
Stice, E., Rohde, P., Shaw, H., Marti, C. N.
Objective: Evaluate the effects of a prevention
program targeting both eating disorders and obesity at 1-and 2-year follow-ups. Method: Female college students at risk for these outcomes because of
body image concerns (N = 398) were randomized to the Healthy Weight 2 group-based 4-hr prevention program, which promotes lasting healthy
improvements to dietary intake and physical activity and nutrition science health behavior change principles, or an educational brochure control
condition. Results: Intervention participants showed significantly less body dissatisfaction and eating disorder symptoms and lower eating disorder
onset through 2-year follow-up versus controls, but the former 2 effects were small. There were no main effects for body mass index (BMI), depressive
symptoms, dieting, caloric intake, physical activity, or obesity onset. Moderator analyses revealed stronger eating disorder symptom effects for
youths with initially elevated symptoms and lower pressure to be thin, stronger BMI effects for youths with initially elevated symptoms and BMI
scores, and weaker eating disorder symptom effects for youths with initially elevated pressure to be thin. Conclusions: The 60% reduction in eating
disorder onset over the 2-year follow-up was clinically significant and a novel effect for a prevention program, but the main effects on continuous
outcomes were small, suggesting that adding nutrition science principles weakened the intervention efficacy. Effects on both eating disorder symptoms
and BMI were greater for those with elevated eating disorder symptoms and BMI at pretest, implying that it might be useful to target these
individuals in future trials. (copyright) 2012 American Psychological Association.
Journal of Consulting & Clinical Psychology, 81(1) : 183-
189
- Year: 2013
- 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), Psychoeducation, Dietary advice, dietary change
Stice, Eric, Rohde, Paul, Shaw, Heather, Marti, C. Nathan
Objective: Evaluate a selective prevention program targeting both eating disorder symptoms and unhealthy
weight gain in young women.; Method: Female college students at high-risk for these outcomes by virtue of body image concerns (N = 398; M age = 18.4
years, SD = 0.6) were randomized to the Healthy Weight group-based 4-hr prevention program, which promotes gradual lasting healthy improvements to
dietary intake and physical activity, or an educational brochure control condition.; Results: Compared to controls, intervention participants showed
significantly greater reductions in body dissatisfaction and eating disorder symptoms, and greater increases in physical activity, at posttest and
significantly greater reductions in body mass index (BMI) and self-reported dieting at 6-month follow-up. Moderator analyses revealed significantly
greater reductions in eating disorder symptoms for those with initially elevated symptoms and pressure to be thin and significantly greater
reductions in BMI for those with initially elevated eating disorder symptoms.; Conclusions: Results indicate that this intervention reduced both
eating disorder symptoms and unhealthy weight gain, but suggest it should be improved to produce stronger and more persistent effects, and that it
may be useful to target young women with both body image and eating disturbances.; (PsycINFO Database Record (c) 2012 APA, all rights reserved).
Journal of
Consulting & Clinical Psychology, 80(1) : 164-170
- Year: 2012
- 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), Psychoeducation, Dietary advice, dietary change
Stice, Eric, Rohde, Paul, Durant, Shelley, Shaw, Heather
Objective: A group dissonance-
based eating disorder prevention program, in which young women critique the thin ideal, reduces eating disorder risk factors and symptoms, but it can
be difficult to identify school clinicians with the time and expertise to deliver the intervention. Thus, we developed a prototype Internet version
of this program and evaluated it in a preliminary trial.; Method: Female college students with body dissatisfaction (N = 107; M age = 21.6 years, SD
= 6.6) were randomized to the Internet intervention, group intervention, educational video condition, or educational brochure condition.; Results:
Internet and group participants showed greater pre-post reductions in eating disorder risk factors and symptoms than video controls (M ds = 0.47 and
0.54, respectively) and brochure controls (M ds = 0.75 and 0.72, respectively), with many effects reaching significance. Effects did not differ
significantly for Internet versus group participants (M ds = -0.13) or for video versus brochure controls (M d = 0.25). Effect sizes for the Internet
intervention were similar to those previously observed for group versions of this intervention.; Conclusions: Results suggest that this prototype
Internet intervention is as efficacious as the group intervention, implying that there would be merit in completing this intervention and evaluating
it in a fully powered trial.; (PsycINFO Database Record (c) 2012 APA, all rights reserved).
Journal of Consulting & Clinical Psychology, 80(5) : 907-
916
- Year: 2012
- 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)