Evidence List

Zhou, Yuan, Wade, Tracey D.

Face-to-face imagery rescripting as a treatment adjunct for day patients with an eating disorder: A randomised controlled pilot study

Imagery rescripting (IR) has been widely used to treat various mental health problems, however, little is known about its usefulness in eating disorders. The primary aim of this pilot study was to evaluate the feasibility of using a face-to-face imagery rescripting as a treatment adjunct among day patients with an eating disorder. Our secondary aim was to investigate within-group effect size changes between groups in order to ensure the suitability of IR in this population. Twelve participants were recruited from the Statewide Eating Disorders Services and were randomly assigned to either treatment as usual (TAU) or treatment as usual plus imagery rescripting (TAU+IR). Participants in the TAU+IR group received a one-hour face-to-face imagery rescripting session with a postgraduate trainee therapist within their first week of treatment. Outcome measures, including psychological distress, eating disorder symptoms, self-compassion and dysfunctional attitudes, were measured at baseline and 4 weeks. Overall, feasibility was promising with all participants completing the protocol and assessment once randomised, but no one completed seven days of home practice. Recruitment was slow with less than 50% agreeing to be randomised. TAU demonstrated a quicker reduction in symptoms than the TAU+IR group. Possible explanations include the timing of the imagery rescripting session was not appropriate for this group of patients, IR has a longer term effect that cannot be observed in merely four weeks, or the current form of imagery rescripting is not appropriate to use with this group of patients. Future research is needed to clarify whether imagery rescripting is indeed appropriate to use for eating disorder patients, and if so, how it can best be delivered (e.g., time point, content, targeted population). (PsycInfo Database Record (c) 2021 APA, all rights reserved)

Journal of Behavioral and Cognitive Therapy, 31(1) : 37- 45

Year: 2021
Problem: Eating Disorders (any)
Type: Randomised controlled trials

Stage: Disorder established (diagnosed disorder)
Treatment and intervention: Psychological Interventions (any), Other Psychological Interventions

Wolter, V., Hammerle, F., Buerger, A., Ernst, V.

Prevention of eating disorders-Efficacy and cost-benefit of a school-based program (\"MaiStep\") in a randomized controlled trial (RCT)

Objective: Given the severity of eating disorders, effective and easily implementable prevention programs which reduce incidence rates and in addition have health-economic benefits are essential. The majority of research on prevention programs focuses on questionnaire-based efficacy or the reduction of eating disorder symptoms while neglecting the health-economic perspective. By contrast, the present study focuses on both an efficacy analysis considering diagnostic criteria (DSM-5) and on evaluating the cost-benefit of a universal prevention program for eating disorders (\"MaiStep\"). Method(s): A three-arm randomized controlled trial with baseline, posttreatment and 12-month follow-up was conducted with 1,654 adolescents (M = 13.35, SD = 0.76), comprising two intervention groups (MaiStep delivered by psychologists or teachers, IG-T) and an active control group (ACG). The primary outcome was DSM-5 eating disorder diagnosis measured with the SIAB-S. Furthermore, the costs of the prevention program and the savings in health care costs were calculated. Result(s): A significant difference in eating disorder diagnosis was found between the IG-T and the ACG for posttreatment (chi²(1= 7.352, p =.007), Relative Risk (RR) =.53 and 12-month follow- up (chi² (1= 5.203, p =.023), RR =.61. MaiStep proved to be cost-effective (tcbr = 6.75), saving about 560,000 (standardized per 1,000 students = 601,388.19 ). Discussion(s): Universal prevention can both reduce incidence rates of eating disorders and be cost-beneficial for health care systems. Future research should analyze prevention programs regarding efficacy and cost-benefit to enable comparability and derive guidelines for political decision-makers. Trial registration number: MaiStep is registered at the German Clinical Trials Register (DRKS00005050). Copyright © 2021 The Authors. International Journal of Eating Disorders published by Wiley Periodicals LLC.

International Journal of Eating Disorders, 54(10) : 1855-1864

Year: 2021
Problem: Eating Disorders (any)
Type: Randomised controlled trials

Stage: Universal prevention
Treatment and intervention: Psychological Interventions (any), Other Psychological Interventions

Wade, T. D., Ghan, C., Waller, G.

A randomized controlled trial of two 10-session cognitive behaviour therapies for eating disorders: An exploratory investigation of which approach works best for whom

Cognitive behaviour therapy for eating disorders (CBT-ED) outperforms other treatments for non-underweight eating disorders in adults, but we have limited ability to match CBT-ED to individual profiles. We examined if we could identify who benefits most from two forms of 10-session CBT-ED; one emphasizing early behaviour change with substantial content on improving body image (CBT-T), and the other including motivational work and no content on body image using chapters from self-help books (CBTm). Participants were 98 consecutive referrals to the Flinders University Services for Eating Disorders. Fourteen clinical psychology postgraduates delivered the treatment under expert supervision. Outcome measures were completed on five occasions: baseline, 4-, 10-, 14- and 22-weeks post-randomisation. Our primary outcome was global eating psychopathology. Moderators included motivation (readiness and confidence to change) and body avoidance and body checking. Intent-to-treat analyses showed no difference between the groups with a significant main effect of time associated with large effect size improvements, commensurate with longer forms of CBT-ED. Participants with lower readiness to change in CBTm had significantly greater decreases in disordered eating over follow-up compared to those with low motivation in CBT-T. People with lower readiness to change might benefit from the incorporation of motivational work in CBT-ED. Copyright © 2021 Elsevier Ltd

Behaviour Research and Therapy, 146 (no pagination) :

Year: 2021
Problem: Eating Disorders (any)
Type: Randomised controlled trials

Stage: Disorder established (diagnosed disorder)
Treatment and intervention: Psychological Interventions (any), Cognitive & behavioural therapies (CBT)

van-Doornik, Sanne F., Glashouwer, Klaske A., Ostafin, Brian D., de-Jong, Peter J.

The causal influence of life meaning on weight and shape concerns in women at risk for developing an eating disorder

Background: Although previous studies have shown an inverse relation between life meaning and eating disorder symptoms, the correlational nature of this evidence precludes causal inferences. Therefore, this study used an experimental approach to test the causal impact of life meaning on individuals' weight and shape concerns.

Frontiers in Psychology Vol 12 2021, ArtID 593393, :

Year: 2021
Problem: Eating Disorders (any)
Type: Randomised controlled trials

Stage: At risk (indicated or selected prevention)
Treatment and intervention:

Svantorp-Tveiten, Kethe Marie Engen, Torstveit, Monica Klungland, Rosenvinge, Jan H., Sundgot-Borgen, Christine, Friborg, Oddgeir, Bratland-Sanda, Solfrid, Pettersen, Gunn, Sundgot-Borgen, Jorunn

Effect of a healthy body image intervention on risk- and protective factors for eating disorders: A cluster randomized controlled trial

Objective: To investigate the immediate and 12-months effects of a school-based intervention aiming to reduce risk and enhance protective factors for eating disorder development in high school boys and girls.\rMethod: In total, 4,149 adolescents from 30 high schools were eligible for inclusion and 2,446 consented to participate and were randomly allocated to the Healthy Body Image (HBI) intervention or a control group (classes as usual). The HBI intervention is multicomponent consisting of three workshops targeting body image, social media usage and lifestyle. Linear mixed model and intention-to-treat analyses were applied to investigate the effects of group, time, and gender at posttest, 3-, and 12-months follow-up. The main outcome variable was eating disorder sympomatology, and secondary outcome variables were self-esteem, mental distress, body\rimage flexibility, thin internalization, muscular internalization, drive for leanness, perceived media pressure, protein- and creatine supplement use, and diet aid use.\rResults: The HBI intervention significantly reduced eating disorder risk factor scores related to eating disorder sympomatology, thin internalization and perceived pressure from media, which was particularly pronounced in girls. Positive intervention effects on body image flexibility were only observed at posttest for boys but grew increasingly larger for girls across the 12-month follow-up time span. Favorable intervention effects on protein and creatine supplement use were only present at 3-months follow-up in boys solely. A general favorable intervention effect was observed for self-esteem, mental distress, muscular internalization, and drive for leanness.\rConclusion: The HBI intervention produced consistent reductions in risk factors and enhancements in protective factors associated with eating disorder development in adolescents.

Mental Health and Prevention Vol 24 2021, ArtID 200225, 24 :

Year: 2021
Problem: Eating Disorders (any)
Type: Randomised controlled trials

Stage: Universal prevention
Treatment and intervention: Psychological Interventions (any), Other Psychological Interventions

Stice, E., Yokum, S., Rohde, P., Gau, J., Shaw, H.

Evidence that a novel transdiagnostic eating disorder treatment reduces reward region response to the thin beauty ideal and high-calorie binge foods

BACKGROUND: Findings from brain imaging studies with small samples can show limited reproducibility. Thus, we tested whether the evidence that a transdiagnostic eating disorder treatment reduces responsivity of brain valuation regions to thin models and high-calorie binge foods, the intervention targets, from a smaller earlier trial emerged when we recruited additional participants. METHOD(S): Women with DSM-5 eating disorders (N = 138) were randomized to the dissonance-based body project treatment (BPT) or a waitlist control condition and completed functional magnetic resonance imaging (fMRI) scans assessing neural response to thin models and high- calorie foods at pretest and posttest. RESULT(S): BPT v. control participants showed significantly greater reductions in responsivity of regions implicated in reward valuation (caudate) and attentional motivation (precuneus) to thin v. average-weight models, echoing findings from the smaller sample. Data from this larger sample also provided novel evidence that BPT v. control participants showed greater reductions in responsivity of regions implicated in reward valuation (ventrolateral prefrontal cortex) and food craving (hippocampus) to high-calorie binge foods v. low-calorie foods, as well as significantly greater reductions in eating disorder symptoms, abstinence from binge eating and purging behaviors, palatability ratings for high calorie foods, monetary value for high-calorie binge foods, and significantly greater increases in attractiveness ratings of average weight models. CONCLUSION(S): Results from this larger sample provide evidence that BPT reduces valuation of the thin ideal and high-calorie binge foods, the intervention targets, per objective brain imaging data, and produces clinically meaningful reductions in eating pathology.

Psychological medicine, : 1- 11

Year: 2021
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., Gau, J. M., Butryn, M. L., Shaw, H., Cloud, K., Dadamo, L.

Enhancing Efficacy of a Dissonance-Based Obesity and Eating Disorder Prevention Program: Experimental Therapeutics

Objective: Test the hypothesis that the efficacy of a dissonance-based obesity/eating disorder prevention program, Project Health, could be enhanced by implementing it in single-sex groups and adding food response inhibition and attention training. Method(s): Using a 2 x 2 factorial design, young adults (N = 261; Mage = 19.3, 79% female; 64% White) were randomized to (a) single-sex or (b) mixed-sex groups that completed food response inhibition and attention training or (c) single-sex or (d) mixed-sex groups that completed generic response inhibition and attention training with nonfood images. Preregistered primary outcomes (body fat, Body Mass Index [BMI]), eating disorder symptoms and other outcomes were assessed at pretest and posttest. Result(s): For one preregistered primary outcome, body fat loss, there was a significant interaction between the two manipulated factors (d = -.28), as well as significant main effects for sex composition of groups (d = -.18) and food response inhibition and attention training (d = -0.17), with the largest body fat loss occurring for single-sex groups implemented with food response inhibition and attention training. Although the two manipulated factors did not significantly affect the other outcomes (including BMI, the other preregistered primary outcome), there was a significant reduction in eating disorder symptoms across the conditions (within participant d = -.78), converging with prior evidence that Project Health produced larger reductions in symptoms than educational control participants. Conclusion(s): Results suggest that implementing Project Health in single-sex groups with food response inhibition and attention training produced the largest body fat loss effects, as well as significant reductions in eating disorder symptoms, suggesting that efforts to disseminate this prevention program are warranted. Copyright © 2021 American Psychological Association

Journal of Consulting and Clinical Psychology, 89(10) : 793-804

Year: 2021
Problem: Eating Disorders (any)
Type: Randomised controlled trials

Stage: At risk (indicated or selected prevention)
Treatment and intervention: Psychological Interventions (any), Other Psychological Interventions, Cognitive dissonance therapy, Attention/cognitive bias modification

Stice, E., Onipede, Z. A., Marti, C. N.

A meta-analytic review of trials that tested whether eating disorder prevention programs prevent eating disorder onset

This report provides a review of randomized controlled trials that tested whether an eating disorder prevention program significantly reduced future onset of eating disorders, which is important because eating disorders are common and result in marked functional impairment. We identified 15 trials involving 5080 participants (mean ages ranging from 14.5 to 22.3) that reported 19 tests of whether selective eating disorder prevention programs significantly reduced future onset of eating disorders relative to some type of minimal control condition or a credible alternative intervention. Healthy lifestyle modification prevention programs, dissonance-based prevention programs, and a self-esteem/self-efficacy prevention program significantly reduced future onset of eating disorders, though the later was only evaluated in one trial. Psychoeducational, cognitive behavioral, behavioral weight gain, interpersonal, and family-therapy-based prevention programs did not significantly reduce future onset of eating disorders. The average prevention effect size was statistically significant (OR = 1.64, 95% CI = [1.09, 2.46], t = 2.54, p =.020) and there was heterogeneity in effect sizes (Q [18] = 35.96, p =.007). Prevention effects were significantly larger for trials that recruited participants with elevations on a single risk factor versus with elevations in multiple risk factors and for healthy lifestyle modification prevention programs versus cognitive behavioral prevention programs, though the remaining examined factors did not moderate intervention effect sizes (e.g., risk of bias). The fact that lifestyle modification and dissonance-based prevention programs significantly reduced future onset of eating disorders in multiple trials, producing a 54% to 77% reduction in future eating disorder onset implies that broadly implementing these prevention programs could reduce the population prevalence of eating disorders. Copyright © 2021

Clinical Psychology Review, 87 (no pagination) :

Year: 2021
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)

Robinson, K., Wade, T. D.

Perfectionism interventions targeting disordered eating: A systematic review and meta-analysis

Objective: Perfectionism is a risk factor for depression, anxiety, and eating disorders, and perfectionism interventions show evidence of the impact on the development and maintenance of these disorders. A systematic review and meta-analysis were conducted of studies using perfectionism interventions that included measures of disordered eating/body image concerns. The primary aim was to investigate the impact on perfectionism and disordered eating/body image concerns, with a secondary aim of examining the impact on depression and anxiety. Method(s): The systematic review was conducted using Medline, PsycINFO, and Scopus. Grey literature was sought via ProQuest Dissertations and Theses Global. Effect size estimates for the meta-analysis were calculated using between- and within-group comparisons. Result(s): Eight studies were included in the between-group analysis and nine studies for the within-group analysis. Perfectionism interventions were effective in reducing perfectionism and disordered eating with large effect sizes, and in reducing depression and anxiety with moderate effect sizes. Studies included both clinical and non-clinical populations. Substantial heterogeneity was present across most analyses. Discussion(s): Eating disorder treatments may benefit more from the inclusion of perfectionism interventions than depression and anxiety treatments. Possible reasoning for these variations between symptom reduction is discussed. This report provides important early evidence for the efficacy of perfectionism interventions, however, the limited number of publications in this area, the presence of heterogeneity, and lack of diversity in participant populations limits the generalizability of these findings. Future research is needed to determine whether eating disorder treatments may benefit from the routine inclusion of a perfectionism component. Copyright © 2021 Wiley Periodicals LLC.

International Journal of Eating Disorders, 54(4) : 473- 487

Year: 2021
Problem: Eating Disorders (any)
Type: Systematic reviews

Stage: At risk (indicated or selected prevention), Disorder established (diagnosed disorder)
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any), Technology, interventions delivered using technology (e.g. online, SMS)

Resende, T. R. O., Almeida, M., dos-Santos-Alvarenga, M., Brown, T. A., de-Carvalho, P. H. B.

Dissonance-based eating disorder prevention improves intuitive eating: a randomized controlled trial for Brazilian women with body dissatisfaction

Purpose: Investigate the efficacy of a dissonance-based (DB) intervention (i.e., the Body Project), during which some examples of intuitive eating were provided by peer leaders, in improving intuitive eating and targeting risk and protective factors for eating disorders (ED) among Brazilian women with body dissatisfaction. Method(s): Participants were randomized to a four-session DB intervention (n = 38) or assessment-only control (AOC) (n = 36), and completed validated measures assessing intuitive eating, body appreciation, self-esteem, body-ideal internalization, body dissatisfaction, negative affect, and disordered eating pre-intervention, post-intervention, and at 4- and 24-week follow-ups. Result(s): The DB condition demonstrated significantly greater increases in intuitive eating, body appreciation and self-esteem scores compared to AOC from pre-intervention to post- intervention (between-condition Cohen's d = 0.73-0.98), 4-week (between-condition Cohen's d = 1.25-1.87) and 24-week follow-up (between-condition Cohen's d = 0.82-1.38). Also, the DB condition showed significantly greater decreases in body-ideal internalization, body dissatisfaction and disordered eating scores from pre-intervention to post-intervention (between-condition Cohen's d = 0.76-1.04), 4-week (between-condition Cohen's d = 1.27-1.71) and 24-week follow-up (between-condition Cohen's d = 1.04-1.19). Regarding negative affect, DB condition showed significantly greater reduction only at 24-week follow-up (between-condition Cohen's d = 0.60). Conclusion(s): Results reinforce the efficacy of DB interventions in reducing ED risk factors for young women and support the preliminary efficacy of these programs in improving intuitive eating, body appreciation, and self-esteem. Level of Evidence: Level I, randomized controlled trial. ReBEC (Brazilian Registry of Clinical Trials; available at http://www.ensaiosclinicos.gov.br/) number of registration: RBR-2f57cs. Date of registration: June 1, 2020. Copyright © 2021, The Author(s), under exclusive licence to Springer Nature Switzerland AG.

Eating and Weight Disorders., :

Year: 2021
Problem: Eating Disorders (any)
Type: Randomised controlled trials

Stage: At risk (indicated or selected prevention)
Treatment and intervention: Psychological Interventions (any), Cognitive dissonance therapy

Pursey, K. M., Burrows, T. L., Barker, D., Hart, M., Paxton, S. J.

Disordered eating, body image concerns, and weight control behaviors in primary school aged children: A systematic review and meta-analysis of universal-selective prevention interventions

Objective: Body image concerns and extreme weight control behaviors frequently develop in childhood indicating an important age group for the implementation of universal-selective prevention approaches. This systematic review aimed to evaluate the effect of universal-selective prevention interventions addressing disordered eating, body image concerns, and/or extreme weight control behaviors in children aged 6-12 years. Method(s): Nine databases were searched up to April 2021. Studies were included if they delivered a universal-selective prevention intervention to children aged 6-12 years and reported outcomes relating to body image, disordered eating, or weight control behaviors. The review was conducted in line with the PRISMA Guidelines. Result(s): A total of 42 articles describing 39 studies included in the review, with most (n = 24; 57%) classified as neutral quality. Thirty studies implemented an eating disorder specific universal-selective program and nine implemented lifestyle interventions plus content to address disordered eating risk factors. Meta-analysis (n = 16 studies) revealed an improvement in body image-related outcomes across all studies (standardized mean difference [SMD] 0.26 [95%CI 0.01, 0.51]); with a high level of heterogeneity (I2 = 89.9%; p <.01). Meta-analysis according to gender revealed a general improvement in body image-related outcomes for girls (SMD 0.40 [95%CI 0.07, 0.73]), but not boys (SMD 0.23 [95%CI -0.24, 0.70]). Discussion(s): By investigating child, parental and teaching interventions and including outcomes such as weight control and disordered eating behaviors, a trend toward a reduction in eating disorder risk factors was observed, particularly body image-related outomes in girls. Future directions include embedded disordered eating prevention materials within existing lifestyle interventions and inclusion of more diverse samples. Copyright © 2021 Wiley Periodicals LLC.

International Journal of Eating Disorders, 54(10) : 1730-1765

Year: 2021
Problem: Eating Disorders (any)
Type: Systematic reviews

Stage: Universal prevention, At risk (indicated or selected prevention)
Treatment and intervention: Complementary & Alternative Interventions (CAM), Psychological Interventions (any)

Parker, Elizabeth Kumiko, Flood, Victoria, Halaki, Mark, Wearne, Christine, Anderson, Gail, Gomes, Linette, Clarke, Simon, Wilson, Frances, Russell, Janice, Frig, Elizabeth, Kohn, Michael

A standard enteral formula versus an iso-caloric lower carbohydrate/high fat enteral formula in the hospital management of adolescent and young adults admitted with anorexia nervosa: A randomised controlled trial

Background: The nutritional rehabilitation of malnourished patients hospitalised with anorexia nervosa is essential. The provision of adequate nutrition must occur, while simultaneously, minimising the risk of refeeding complications, such as electrolyte, metabolic, and organ dysfunction. The aim of this study was to compare the efficacy and safety of an iso-caloric lower carbohydrate/high fat enteral formula (28% carbohydrate, 56% fat) against a standard enteral formula (54% carbohydrate, 29% fat). Impact Statement Patients hospitalised with anorexia nervosa require nutrition support as part of their treatment, whilst refeeding complications are prevented. Of particular concern, is the reintroduction of carbohydrate to malnourished patients, which has been proposed to cause a surge in insulin levels and disturbance in electrolytes, particularly a decrease in blood phosphate levels. This double-blinded randomised controlled trial measured the occurrence of low phosphate blood levels and other refeeding complications, in adolescent and young adult patients hospitalised with anorexia nervosa. These patients were provided either a lower carbohydrate/high fat feed (28% carbohydrate, 56% fat) or a standard enteral feed (54% carbohydrate, 29% fat). Fewer patients in the lower carbohydrate/high fat feed group (5/14) than standard feed group (9/10) developed a low phosphate level. There was no significant difference in weight gain, number of days to reach medical stability, occurrence of hypoglycaemia, or hospital length of stay. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Journal of Eating Disorders Vol 9 2021, ArtID 160, 9 :

Year: 2021
Problem: Eating Disorders (any), Anorexia Nervosa
Type: Randomised controlled trials

Stage: Disorder established (diagnosed disorder)
Treatment and intervention: Complementary & Alternative Interventions (CAM), Dietary advice, dietary change

Training

Disorders - Eating Disorders