Disorders - Eating Disorders
Kwan, M. Y., Haynos, A. F., Blomquist, K. K., Roberto, C. A.
Objective: Fashion warning labels that caution readers about digitally altered images have been recommended and adopted by several countries to prevent body dissatisfaction and eating disorders. This study investigated the short- and longer-term influence of fashion warning labels on affect, body dissatisfaction, eating disorder symptoms, and snack consumption using a randomized-controlled experiment. Method(s): Female undergraduates (n = 118) were randomized to view and rate responses to fashion images either with or without a warning label. They then consumed snacks and completed questionnaires. Sixty-four participants (54%) completed follow-up online surveys asking them to view and rate new fashion images with or without warning labels once per week for 4 weeks. Primary outcomes were affect, body dissatisfaction, eating disorder symptoms, and kilocalories consumed. Result(s): Overall, fashion warning labels had no short-term effects on affect, body dissatisfaction, or kilocalories consumed in the lab. However, individuals who reported engaging in restrictive eating consumed fewer kilocalories when exposed to advertisements with warning labels (M = 170.33, SD = 120.78) versus no labels (M = 286.46, SD = 166.30), p =.008. Warning labels also had no protective effects after repeated exposure over 4 weeks on affect or eating disorder symptoms, and significantly increased appearance orientation (p =.001). Discussion(s): Warning labels on media images are unlikely to be an effective policy tool to prevent negative affect, body dissatisfaction, and eating disorder symptoms, and, in some cases, may exacerbate these concerns. Copyright © 2018 Wiley Periodicals, Inc.
International Journal of Eating Disorders, 51(10) : 1153-1161
- Year: 2018
- Problem: Eating Disorders (any)
- Type: Randomised controlled trials
-
Stage: Universal prevention
-
Treatment and intervention: Psychological Interventions (any)
, Other Psychological Interventions
Glashouwer, K. A., Neimeijer, R. A., de-Koning, M. L., Vestjens, M., Martijn, C.
Objective: The aim was to investigate whether a computer-based evaluative conditioning intervention improves body image in adolescents with an eating disorder. Positive effects were found in earlier studies in healthy female students in a laboratory and a field setting. This study is the first to test evaluative conditioning in a clinical sample under less controlled circumstances. Method: Fifty-one adolescent girls with an eating disorder and a healthy weight were randomly assigned to an experimental condition or a placebo-control condition. The computerized intervention consisted of six online training sessions of 5 min, in which participants had to click on pictures of their own and other people's bodies. Their own pictures were systematically followed by portraits of friendly smiling faces. In the control condition, participants were shown the same stimuli, but here, a stimulus was always followed by another stimulus from the same category, so that own body was not paired with smiling faces. Before, directly after, three weeks after, and 11 weeks after the intervention, self-report measures of body image and general self-esteem were administered. Automatic self-associations were also measured with an Implicit Association Test. Results: In contrast to our hypotheses, we did not find an effect of the intervention on self-report questionnaires measuring body satisfaction, weight and shape concern, and general self-esteem. In addition, the intervention did not show positive effects on implicit associations regarding self-attractiveness. Conclusions: These findings do not support the use of evaluative conditioning in its present form as an intervention for adolescents in clinical practice. (PsycINFO Database Record (c) 2018 APA, all rights reserved) Impact Statement What is the public health significance of this article?-This study investigated a new intervention to improve body image in adolescents with eating disorders. Outcomes do not support the use of evaluative conditioning in its present form as a body image treatment for adolescents. (PsycINFO Database Record (c) 2018 APA, all rights reserved)
Journal of Consulting and Clinical Psychology, 86(12) : 1046-1055
- Year: 2018
- Problem: Eating Disorders (any)
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
, Other Psychological Interventions, Technology, interventions delivered using technology (e.g. online, SMS)
Grossman, S. L., Campagna, B., Brochu, H., Odermatt, M., Annunziato, R. A.
OBJECTIVE: To conduct a pilot test to determine if the Body Project, an eating disorder prevention program, was able to reduce risky sexual behaviors. PARTICIPANTS: Twenty college-age women ages 18-21 (in March, 2015) who endorsed both body image dissatisfaction and previous or current sexual activity. METHOD(S): Participants were randomized to the Body Project or psychoeducational control group, and completed baseline, post-test, and 6-month follow-up measures assessing body image concerns, eating behaviors, and sexual behaviors and attitudes. RESULT(S): An intervention manipulation check demonstrated that body image variables were in expected directions, though were not significant by group. There was a significant interaction across group and time for "unanticipated sexual encounters," which decreased in the Body Project group. CONCLUSION(S): This pilot study supports the feasibility of using an eating disorder prevention program to reduce other risky behaviors, specifically risky sexual behaviors.
Journal of American college health : J of ACH, 66(8) : 826-830
- Year: 2018
- Problem: Eating Disorders (any)
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions (any)
, Psychoeducation, Cognitive dissonance therapy
Wade, T. D., Wilksch, S. M.
Purpose of review Internet prevention of eating disorders is a relatively new field that is expanding rapidly. We review randomized controlled trial designs examining the efficacy of Internet prevention in eating disorders that have emerged from 2016. Recent findings Our literature search identified five studies that used randomized controlled trial designs to examine the efficacy of Internet prevention in eating disorders. All of the studies represented indicated prevention, that is, young women who have body image concerns. Three specific approaches were examined: media literacy, cognitive dissonance, and cognitive behavior therapy. All studies indicated significantly more impact of the intervention than a control condition, with between group effect sizes at follow-up ranging from 0.24 to 0.42. Summary Although Internet interventions for eating disorders may be less effective than face-to-face interventions, and attrition increases when populations are used that reflect real-world usage, these interventions have an important role in a stepped-care approach. Future research should make direct comparisons of different Internet programs with a view to helping us understand who will gain most benefit out of which approach, including who requires moderated Internet approaches and who does not. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
Current Opinion in Psychiatry, 31(6) : 456-461
- Year: 2018
- Problem: Eating Disorders (any)
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Other Psychological Interventions, Cognitive dissonance therapy, Technology, interventions delivered using technology (e.g. online, SMS), Technology, comparing delivery mode (e.g. online vs. face-to-face)
Wilksch, S. M., OShea, A., Taylor, C. B., Wilfley, D., Jacobi, C., Wade, T. D.
BACKGROUND: Disordered eating (DE) is a widespread, serious problem. Efficacious prevention programs that can be delivered at-scale are needed. METHOD(S): A pragmatic randomized controlled trial of two online programs was conducted. Participants were young-adult women from Australia and New Zealand seeking to improve their body image. Media Smart-Targeted (MS-T) and Student Bodies (SB) were both 9-module interventions released weekly, whilst control participants received positive body image information. Primary [Eating Disorder Examination-Questionnaire (EDE-Q) Global], secondary (DE risk factors) and tertiary (DE) outcome measures were completed at baseline, post-program, 6- and 12-month follow-up. RESULT(S): Baseline was completed by 608 women (M age = 20.71 years); 33 were excluded leaving 575 randomized to: MS-T (N = 191); SB (N = 190) or control (N = 194). Only 66% of those randomized to MS-T or SB accessed the intervention and were included in analyses with controls; 78% of this sample completed measures subsequent to baseline. Primary intent-to-treat (ITT) analyses revealed no differences between groups, while measure completer analyses found MS-T had significantly lower EDE-Q Global than controls at 12-month follow-up. Secondary ITT analyses found MS-T participants reported significantly higher quality of life-mental relative to both SB and controls (6-month follow-up), while MS-T and controls had lower clinical impairment relative to SB (post-program). Amongst measure completers, MS-T scored significantly lower than controls and SB on 5 variables. Of those with baseline DE, MS-T participants were significantly less likely than controls to have DE at 12-month follow-up. CONCLUSION(S): Given both programs were not therapist-moderated, MS-T has potential to achieve reductions in DE risk at low implementation costs.
Psychological Medicine, 48(12) : 2034-2044
- Year: 2018
- Problem: Eating Disorders (any)
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
, Other Psychological Interventions, Self-help
, Technology, interventions delivered using technology (e.g. online, SMS)
Agam-Bitton, R., Ahmad, W. A., Golan, M.
Background Investigation of the optimal setting for body image prevention programmes is important to maximize the outcomes of such programmes. Objectives We examined the preferred setting for a school-based wellness programme called "In Favour of Myself". Methods A total of 259 girls (mean 13.82+/-0.64 years) were divided into a girls-only intervention group, a mixed-gender intervention and a waiting list control group. The participants completed self-report questionnaires at baseline, post-intervention (2 months) and at follow-up (3 months) examining changes in self-esteem, media literacy, body image and risk factors for eating disorders. The intervention group participants also completed a satisfaction questionnaire. Results Both intervention groups demonstrated statistically significant improvements in identifying advertising strategies (p<0.01) compared with the controls, with the girls-only arm (p<0.001) showing better results. Compared with the girls-only arm and the control group, the mixed-gender group demonstrated statistically significantly greater improvements in the internalization of pressure for thinness (p<0.004), the body-esteem appearance subscale (p<0.025) and body-esteem body-weight subscale (p<0.012) as well as reductions in their perceived current body silhouettes and in the gap between their current and ideal body image (p<0.003). Body dissatisfaction was increased following the programme, although not in a statistically significant manner, with the worst negative effect observed in the girls-only arm. All other differences among the study arms did not show statistically significant differences. Mediation models revealed that body-esteem was directly mediated by group, with statistically significant mediation only in the mixed group. Current body image was mediated indirectly by group through media literacy (i.e., recognizing advertisement strategies and internalization of pressure for thinness), with statistical significance only in the mixed-gender arm compared with the girls-only arm. Higher programme satisfaction was reported in the mixed-gender group (91%) vs. the girls-only groups (79%). Conclusions These outcomes provide preliminary evidence indicating the superiority of a mixed-gender setting compared with a girls-only setting for delivering prevention programmes to 13- to 14-year-old adolescents to enhance their media literacy, positive self-esteem and body image. Copyright © 2018 Agam-Bitton et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
PLoS ONE, 13 (6) (no pagination)(e0198872) :
- Year: 2018
- Problem: Eating Disorders (any)
- Type: Randomised controlled trials
-
Stage: Universal prevention
-
Treatment and intervention: Psychological Interventions (any)
, Other Psychological Interventions
Dondzilo, L., Rieger, E., Palermo, R., Bell, J.
Background and Objectives: Attentional bias towards thin-ideal body images has been implicated as a vulnerability factor for eating disorder symptomatology. However, the nature and causal basis of its relationship with other cognitive vulnerability factors, namely, eating disorder-specific rumination and negative mood, remains unclear. Accordingly, the current study investigated the causal influence of attentional bias towards thin-ideal images on emotional and ruminative vulnerability, in response to a body image-related stressor. Methods: An established attentional bias modification (ABM) procedure, the modified dot probe task, was used for the assessment and manipulation of attentional bias. Female undergraduate students (N = 110) aged between 17 and 24 years were randomly assigned to either 'attend' towards or 'avoid' thin-ideal images. Pre- and post-attentional training, participants completed the dot probe task, as well as state measures of rumination and negative mood. Additionally, following post-ABM assessment of attentional bias, participants were given a body image-related stressor. Results: Results showed that participants trained to attend to thin bodies reported heightened negative mood, in response to the stressor, compared with participants trained to avoid thin bodies. On the other hand, groups did not demonstrate a differential increase in eating disorder-specific rumination in response to the stressor. Limitations: The current findings will require replication with clinical samples. Additionally, state rumination and negative mood were assessed via single items. Conclusions: These results provide the first causal evidence for the role of attentional bias towards thin-ideal images in negative emotional vulnerability. Importantly, these results suggest attentional bias may serve as a risk factor for mood reactivity and a potential target for strategies designed to enhance emotional resilience. Copyright © 2018 Elsevier Ltd
Journal of Behavior Therapy and Experimental Psychiatry, 61 : 128-133
- Year: 2018
- Problem: Eating Disorders (any)
- Type: Randomised controlled trials
-
Stage: Universal prevention
-
Treatment and intervention: Psychological Interventions (any)
, Attention/cognitive bias modification
Leme, A. C. B., Philippi, S. T., Thompson, D., Nicklas, T., Baranowski, T.
Purpose: To evaluate the immediate post-intervention and 6-month post-intervention effects of a Brazilian school-based randomized controlled trial for girls targeting shared risk factors for obesity and disordered eating. Methods: Total of 253 girls, mean of 15.6 (0.05) years from 1st to 3rd grades of high school participated in this 6-month school-based cluster randomized controlled trial. "Healthy Habits, Healthy Girls-Brazil (H3G-Brazil)", originally developed in Australia, emphasized 10 key nutrition and physical activity (PA) messages delivered over 6 months. Disordered eating prevention procedures, i.e., prevention of weight-teasing, body satisfaction, and unhealthy weight control behavior, were added to the intervention. Body dissatisfaction, unhealthy weight control behaviors and social cognitive-related diet, and physical activity variables were assessed at baseline, immediate post-intervention, and 6-month post-intervention. Intervention effects were determined by one-way analysis of covariance or logistic regression, after checking for the clustering effects of school. The control group did not receive intervention prior to follow-up assessment. A conservative significance level was set at p < 0.01. Results: Beneficial effects were detected for PA social support (F = 6.005, p = 0.01), and healthy eating strategies (F = 6.08, p = 0.01) immediate post-intervention; and healthy eating social support (F = 14.731, p = 0.00) and healthy eating strategies (F = 5.812, p = 0.01) at 6-month post-intervention. Intervention group was more likely to report unhealthy weight control behaviors (OR = 1.92, 95% CI 1.15-3.21, p = 0.01) at 6-month post-intervention. No other significant immediate or 6-month post effects were detected. Conclusion: H3G-Brazil demonstrated positive 6-month effects on some social cognitive variables but an adverse effect on unhealthy weight control behaviors. Thus, this study was not able to achieve synergy by combining obesity and disordered eating prevention procedures in an intervention among low-income girls in Brazil. Trial registration: Level I: cluster randomized controlled trial Copyright © 2018 Springer International Publishing AG, part of Springer Nature
Eating and Weight Disorders, : 1-13
- Year: 2018
- Problem: Eating Disorders (any)
- Type: Randomised controlled trials
-
Stage: Universal prevention
-
Treatment and intervention: Complementary & Alternative Interventions (CAM)
, Psychological Interventions (any)
, Other Psychological Interventions, Dietary advice, dietary change, Physical activity, exercise
Matheson, E., Wade, T. D., Yiend, J.
Objective: Eating disorder psychopathology is associated with a propensity to interpret ambiguous stimuli to be negatively related to one's appearance and self-worth. The relative impact of modifying interpretation bias for these respective stimuli is unknown. Hence the main aim of the current study was to compare two cognitive bias modification protocols targeting interpretation bias (CBM-I), one focused on appearance and the other on self-worth, in terms of impacting interpretation bias, body dissatisfaction and negative affect. The appearance-based CBM-I protocol was developed for the current study. Method: Female university students (N = 123) were randomized into one of three CBM-I conditions: appearance, self-worth or control. Immediately following a negative induction that significantly increased body dissatisfaction and negative affect, participants underwent their respective CBM-I training. Results: The CBM-I for appearance produced significant changes in the targeted bias, as well as significant improvements (moderate effect sizes) in appearance satisfaction, relative to the CBM-I for self-worth and control conditions. Discussion: The results support the usefulness of the CBM-I for appearance protocol, and suggests that this technique warrants further investigation with respect to modifying interpretation bias and risk factors associated with eating disorder psychopathology. Null effects of CBM-I for self-worth should be interpreted in light of study limitations, including the potential unsuitability of training material for young women. CBM-I for both types of interpretation bias should be evaluated in future research. Copyright © 2018 Wiley Periodicals, Inc.
International Journal of Eating Disorders, :
- Year: 2018
- Problem: Eating Disorders (any)
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions (any)
, Attention/cognitive bias modification
Pennesi, J. L., Wade, T. D.
Objective: This pilot study compared two brief online interventions, imagery rescripting and cognitive dissonance, to an assessment-only control condition in a sample of body-dissatisfied young women at risk of developing an eating disorder. We examined the degree to which each intervention reduced disordered eating and modified risk and protective factors for eating disorders. Method: Female university students (N = 107, 17-28 years of age) completed a screening questionnaire, followed by random allocation to one of the three conditions, followed by a baseline assessment, body dissatisfaction induction, and brief online intervention. Participants in the active conditions then completed online daily home practice and a postintervention questionnaire. Results: Findings provide qualified support for the imagery rescripting intervention, with participants reporting higher body image acceptance (Cohen's d = 0.49) than the cognitive dissonance condition, and higher self-compassion (d = 0.59) and lower levels of disordered eating (d = 0.59) than the control condition, at postintervention. There was no significant impact of cognitive dissonance on any factors. Change in body image acceptance and self-compassion mediated the relationship between allocated condition and change in disordered eating at postintervention. Discussion: These findings provide preliminary support for the use of online-adapted imagery-based techniques (e.g., imagery rescripting) to reduce risk for the development of an eating disorder by strengthening protective factors (i.e., body image acceptance and self-compassion) and reducing disordered eating. Further exploration of the use of imagery strategies in the prevention of disordered eating is required, including prospective tests of the mechanisms of action. Copyright © 2018 Wiley Periodicals, Inc.
International Journal of Eating Disorders, 51(5) : 439-448
- Year: 2018
- 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
Plessow, F., Singhal, V., Toth, A., Baskaran, C., Eddy, K. T., Misra, M.
Background: Disordered eating behavior is common in conditions with functional hypothalamic amenorrhea, such as anorexia nervosa (AN) and exercise-induced amenorrhea, which are also associated with anxiety and depression. In hypoestrogenic rodents, estrogen replacement reduces anxiety-related behavior. Similarly, we have shown that estrogen replacement in adolescent girls with AN reduces anxiety and prevents the increased body dissatisfaction observed with increasing weight. However, the impact of estrogen administration on disordered eating behavior and psychopathology in normal-weight young women with exercise-induced amenorrhea is unknown. We hypothesized that (1) normal-weight oligo- and psychopathology compared to eumenorrheic athletes (EA) and nonathletes (NA), and (2) 12 months of estrogen replacement would improve those symptoms. Methods: Cross-sectional study (CSS): 109 OA 50 EA, and 39 NA 14-25 years old and of normal weight, completed the Eating Disorder Inventory-2 (EDI-2) and Three-Factor Eating Questionnaire (TFEQ) as self-report assessments of disordered eating behavior and psychopathology. Randomized controlled trial (RCT): OA were then randomized to receive either the 100-mcg transdermal 17beta-estradiol patch with cyclic progesterone (Patch), a combined oral contraceptive pill with 30 mcg ethinyl estradiol and 0.15 mg desogestrel (Pill), or no estrogen (E-) for 12 months. None of the participants had a baseline diagnosis of an active eating disorder. Twenty-five 19 and 26 young women in the Patch, Pill, and E- groups completed the EDI-2 and 19 16 and 21 respectively completed the TFEQ at both baseline and 12-month follow-up. Data were analyzed for E+ (Patch+Pill) versus E- groups and for routes of administration separately, controlling for age and weight change. Results: CSS: OA showed higher EDI-2 Drive for Thinness (DT) and TFEQ Cognitive Restraint of Eating scores than EA and NA (p=0.008 and 0.02 and p=0.006 and 0.02 respectively) and higher EDI-2 Body Dissatisfaction (BD) scores than EA (p=0.04). RCT: Over 12 months, the E+ group, compared to E-, showed improved trajectories for the EDI-2 DT (-0.60+/-0.52 vs. 1.25+/-0.68 p=0.04), EDI-2 BD (-0.81+/-0.54 vs. 2.18+/-0.71 p=0.002), and TFEQ Uncontrolled Eating (UE) scores (-4.03+/-2.29 vs. 4.07+/-3.31 p=0.046). In 3-group comparisons (Patch, Pill, and E-), the Patch group outperformed the E- group and showed significant decreases in EDI-2 BD and TFEQ UE scores (p=0.01 and 0.02 respectively), while only numerical differences were observed between the Pill and Egroups. Conclusions: In young OA 12-month replacement of physiologic doses of estrogen improves trajectories of disordered eating behavior and psychopathology, emphasizing the importance of normalizing estrogen levels in this population.
Endocrine Reviews. Conference: 100th Annual Meeting of the Endocrine Society, ENDO, 39(2 Supplement 1) :
- Year: 2018
- Problem: Eating Disorders (any)
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Biological Interventions (any)
, Other biological interventions
Rohde, P., Desjardins, C. D., Arigo, D., Shaw, H., Stice, E.
The present study tested hypothesized mechanisms underlying the effects of two selective prevention interventions targeting both obesity and eating disorders (Healthy Weight and the newly developed Project Health), relative to video control. Tests examined mediation for the significant weight gain prevention and eating disorder symptom prevention effects previously reported. College students (N = 364; 72% women) with weight concerns were randomized to condition and assessed for 2-years post-intervention. Project Health participants had significant improvements in 2 of the 7 proposed mediators relative to comparisons (i.e., cognitive dissonance, the unhealthy Western dietary pattern) but change in these variables did not mediate its effect on long-term BMI change. Two variables emerged as full mediators of the eating disorder prevention effects for both experimental interventions: body dissatisfaction and negative affect. Analyses failed to support the exploratory hypothesis that change in eating disorder symptoms mediated the effects of condition on BMI gain. This report is the among the first to examine mediation for programs aimed at preventing both weight gain and eating disorders, particularly in mixed-gender groups. Mediational analyses are essential in identifying the mechanism of intervention action, which can inform improvements to prevention programs. Copyright © 2018 Elsevier Ltd
Behaviour Research and Therapy, 106 : 8-17
- Year: 2018
- 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, Dietary advice, dietary change, Physical activity, exercise