Disorders - Eating Disorders
Atkinson, M. J., Wade, T. D.
Objective Successful prevention of eating disorders represents an important goal due to damaging long-term impacts on health and well-being, modest treatment outcomes, and low treatment seeking among individuals at risk. Mindfulness-based approaches have received early support in the treatment of eating disorders, but have not been evaluated as a prevention strategy. This study aimed to assess the feasibility, acceptability, and efficacy of a novel mindfulness-based intervention for reducing the risk of eating disorders among adolescent females, under both optimal (trained facilitator) and task-shifted (non-expert facilitator) conditions. Method A school-based cluster randomized controlled trial was conducted in which 19 classes of adolescent girls (N-=-347) were allocated to a three-session mindfulness-based intervention, dissonance-based intervention, or classes as usual control. A subset of classes (N = 156) receiving expert facilitation were analyzed separately as a proxy for delivery under optimal conditions. Results Task-shifted facilitation showed no significant intervention effects across outcomes. Under optimal facilitation, students receiving mindfulness demonstrated significant reductions in weight and shape concern, dietary restraint, thin-ideal internalization, eating disorder symptoms, and psychosocial impairment relative to control by 6-month follow-up. Students receiving dissonance showed significant reductions in socio-cultural pressures. There were no statistically significant differences between the two interventions. Moderate intervention acceptability was reported by both students and teaching staff. Discussion Findings show promise for the application of mindfulness in the prevention of eating disorders; however, further work is required to increase both impact and acceptability, and to enable successful outcomes when delivered by less expert providers.
International Journal of Eating Disorders, 48(7) : 1024-1037
- Year: 2015
- Problem: Eating Disorders (any)
- Type: Randomised controlled trials
-
Stage: Universal prevention
-
Treatment and intervention: Psychological Interventions (any)
, Mindfulness based therapy, Cognitive dissonance therapy
Aspen, V., Martijn, C., Alleva, J. M., Nagel, J., Perret, C., Purvis, C., Saekow, J., Lock, J., Taylor, C.
Objective: Body dissatisfaction in females is common and a risk factor for the development of an eating disorder. This study tested whether body dissatisfaction could be improved using a brief conditioning intervention in which photographs of participants' bodies were selectively paired with positive social stimuli (smiling faces) and photographs of other bodies were paired with neutral or negative social stimuli (neutral and frowning faces). Method: 39 women (mean age=22.46; 64.1% Caucasian) with high body dissatisfaction were randomized to either the evaluative conditioning intervention (n=22) or to a delayed waitlist control condition (n=17). Body dissatisfaction (specifically, shape and weight concern), restraint, eating concern, and self-esteem were assessed at baseline, post treatment and again after four and 12 weeks. Results: Compared to women in the delayed waitlist control condition, women in the treatment condition demonstrated a significant decrease in shape and weight concern, and a significant increase in self-esteem. Similar trends were found for the control condition after they completed the intervention. Changes at post treatment related to body dissatisfaction were maintained at 12-week follow-up. Conclusions: Repeatedly pairing photographs of an individual's body with positive social feedback may lead to improved body image and self-esteem.
Behaviour Research & Therapy, 69 :
- Year: 2015
- Problem: Eating Disorders (any)
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions (any)
, Other Psychological Interventions
Ciao, A. C., Latner, J. D., Brown, K. E., Ebneter, D. S., Becker, C. B.
Objective: This pilot study investigated the feasibility, acceptability, and effectiveness of a peer-led dissonance-based eating disorders (ED) prevention/risk factor reduction program with high school girls. Method: Ninth grade girls (n = 50) received the peer-led program within the school curriculum. A quasi-experimental design was used to assess changes in ED risk factors pre intervention and post intervention compared with wait list control. Participants were followed through 3-month follow-up. Results: Peer-leader adherence to an intervention manual tailored for this age group was high. The intervention was rated as highly acceptable, with a large proportion of participants reporting that they enjoyed the program and learned and applied new information. Intervention participants exhibited significantly greater pre-post reductions in a majority of risk-factor outcomes compared to wait list controls. When groups were combined to assess program effects over time there were significant pre-post reductions in a majority of outcomes that were sustained through 3-month follow-up. Discussion: This pilot study provides tentative support for the effectiveness of using peer leaders to implement an empirically supported ED risk factor reduction program in a high school setting. Additional research is needed to replicate results in larger, better-controlled trials with longer follow-up. (PsycINFO Database Record (c) 2016 APA, all rights reserved) (journal abstract).
International Journal of Eating Disorders, 48(6) : 779-784
- Year: 2015
- Problem: Eating Disorders (any)
- Type: Randomised controlled trials
-
Stage: Universal prevention
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive dissonance therapy
Brown, T. A., Keel, P. K.
Objective: Gay males have increased risk for eating disorders compared to heterosexual males, establishing a need to develop and empirically evaluate programs to reduce risk for this population. The present study investigated the acceptability and efficacy of a cognitive dissonance-based (DB) intervention (The PRIDE Body Project©) in reducing eating disorder risk factors among gay males in a university-based setting. Method: Eighty-seven gay males were randomized to either a 2-session DB intervention (n = 47) or a waitlist control condition (n = 40). Participants completed eating disorder risk factor assessments pre-intervention, post-intervention, and at 4-week follow-up, and those receiving the intervention completed post-treatment acceptability measures. Results: Acceptability ratings were highly favorable. Regarding efficacy, the DB condition was associated with significantly greater decreases in body dissatisfaction, drive for muscularity, self-objectification, partner-objectification, body-ideal internalization, dietary restraint, and bulimic symptoms compared to waitlist control from pre- to post-intervention. Improvements in the DB group were maintained at 4-week follow-up, with the exception of body-ideal internalization. Body-ideal internalization mediated treatment effects on bulimic symptoms. Conclusion: Results support the acceptability and efficacy of The PRIDE Body Project© and provide support for theoretical models of eating pathology in gay men. (PsycINFO Database Record (c) 2015 APA, all rights reserved) (journal abstract).
Behaviour Research & Therapy, 74 : 1-10
- Year: 2015
- Problem: Eating Disorders (any)
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive dissonance therapy
Fairburn, C. G., Bailey-Straebler, S., Basden, S., Doll, H. A., Jones, R., Murphy, R., O'Connor, M. E., Cooper, Z.
Eating disorders may be viewed from a transdiagnostic perspective and there is evidence supporting a transdiagnostic form of cognitive behaviour therapy (CBT-E). The aim of the present study was to compare CBT-E with interpersonal psychotherapy (IPT), a leading alternative treatment for adults with an eating disorder. One hundred and thirty patients with any form of eating disorder (body mass index >17.5 to <40.0) were randomized to either CBT-E or IPT. Both treatments involved 20 sessions over 20 weeks followed by a 60-week closed follow-up period. Outcome was measured by independent blinded assessors. Twenty-nine participants (22.3%) did not complete treatment or were withdrawn. At post-treatment 65.5% of the CBT-E participants met criteria for remission compared with 33.3% of the IPT participants (p < 0.001). Over follow-up the proportion of participants meeting criteria for remission increased, particularly in the IPT condition, but the CBT-E remission rate remained higher (CBT-E 69.4%, IPT 49.0%; p = 0.028). The response to CBT-E was very similar to that observed in an earlier study. The findings indicate that CBT-E is potent treatment for the majority of outpatients with an eating disorder. IPT remains an alternative to CBT-E, but the response is less pronounced and slower to be expressed. (PsycINFO Database Record (c) 2015 APA, all rights reserved) (journal abstract).
Behaviour Research & Therapy, 70 : 64-71
- Year: 2015
- Problem: Eating Disorders (any)
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Interpersonal therapy (IPT)
Diedrichs, P. C., Atkinson, M. J., Steer, R. J., Garbett, K. M., Rumsey, N., Halliwell, E.
This study evaluated a 90-min single session school-based body image intervention (Dove Confident Me: Single Session), and investigated if delivery could be task-shifted to teachers. British adolescents (N = 1707; 11-13 years; 50.83% girls) participated in a cluster randomised controlled trial [lessons as usual control; intervention teacher-led (TL); intervention researcher-led (RL)]. Body image, risk factors, and psychosocial and disordered eating outcomes were assessed 1-week pre-intervention, immediate post-intervention, and 4-9.5 weeks follow-up. Multilevel mixed-models showed post-intervention improvements for intervention students relative to control in body esteem (TL; girls only), negative affect (TL), dietary restraint (TL; girls only), eating disorder symptoms (TL), and life engagement (TL; RL). Awareness of sociocultural pressures increased at post-intervention (TL). Effects were small-medium in size (ds 0.19-0.76) and were not maintained at follow-up. There were no significant differences between conditions at post or follow-up on body satisfaction, appearance comparisons, teasing, appearance conversations and self-esteem. The intervention had short-term benefits for girls' body image and dietary restraint, and for eating disorder symptoms and some psychosocial outcomes among girls and boys. A multi-session version of the intervention is likely to be necessary for sustained improvements. Teachers can deliver this intervention effectively with minimal training, indicating broader scale dissemination is feasible. Trial registration: ISRCTN16782819.
Behaviour Research & Therapy, 74 : 94-104
- Year: 2015
- Problem: Eating Disorders (any)
- Type: Randomised controlled trials
-
Stage: Universal prevention
-
Treatment and intervention: Psychological Interventions (any)
, Psychoeducation, Other Psychological Interventions
Hart, L. M., Cornell, C., Damiano, S. R., Paxton, S. J.
Objective: To systematically review the literature on interventions involving parents that aim to prevent body dissatisfaction or eating disorders in children, and provide directions for future research by highlighting current gaps. Method The literature was searched for articles using key concepts: parents, prevention and eating disorders or disordered eating or body dissatisfaction. All English language publications between 1992 and 2013 were searched across a range of academic databases. Studies were reviewed if they: (i) delivered an intervention designed to reduce eating disorders or body dissatisfaction or their risk factors, in children or adolescents; (ii) provided some intervention component for parents; and (iii) included some outcome measure of intervention effectiveness on disordered eating or body dissatisfaction. A scoring matrix based on the Critical Appraisal Skills Program (CASP) screening questions was used to assess each study's sample representativeness, relevance and data quality. Results From 647 novel records uncovered by the search, 20 separate studies met inclusion criteria. The CASP scoring matrix revealed eight studies provided no relevant data, four relevant and eight highly relevant data on the effects of involving parents in prevention programs. Two of four high-quality studies reported that parental involvement significantly improved child outcomes on measures of body dissatisfaction or disordered eating. Discussion Although a greater focus on engaging and retaining parents is needed, this review demonstrates that a small number of prevention studies with parents have led to significant reductions in risk of body image and eating problems, and future research is indicated.
International Journal of Eating Disorders, 48(2) : 157-169
- Year: 2015
- Problem: Eating Disorders (any)
- Type: Systematic reviews
-
Stage: Universal prevention
, At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions (any)
, Other Psychological Interventions
Horney, A. C., Stice, E., Rohde, P.
Numerous trials provide support for the Body Project, an eating disorder prevention program wherein young women with body image concerns critique the thin ideal. Despite medium to large effects, some participants subsequently develop an eating disorder, suggesting that intervention or recruitment procedures could be improved. This study investigated baseline and acute intervention predictors of DSM-5 eating disorder development during a 3-year follow-up among Body Project participants. Combined data from two trials compare participants who experienced eating disorder onset during follow-up (n = 20) to those who did not (n = 216). Participants who did versus did not develop an eating disorder started the intervention with higher eating disorder symptoms (η (2) = 0.08), negative affect (η (2) = 0.06), thin-ideal internalization (η (2) = 0.02), and body dissatisfaction (η (2) = 0.02); the same baseline predictors of eating disorder onset emerged in controls. Attenuated pre-post reductions in eating disorder symptoms (η (2) = 0.01) predicted eating disorder onset but not after controlling for baseline levels. Given that Body Project and control participants who later developed an eating disorder started with initial elevations in risk factors and eating disorder symptoms, it might be useful to develop a more intensive variant of this program for those exhibiting greater risk at baseline and to deliver the prevention program earlier to prevent initial escalation of risk. The fact that nonresponders also showed greater negative affect and eating disorder symptoms suggests that it might be useful to add activities to improve affect and increase dissonance about disordered eating.;
Prevention Science, 16(4) : 518-526
- Year: 2015
- Problem: Eating Disorders (any)
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions (any)
, Psychoeducation, Cognitive dissonance therapy
Kilpela, L., DeBoer, L. B., Alley, M. C., Presnell, K., McGinley, J. W., Becker, C. Black
Research regarding different learning schedules is equivocal. Learning theory suggests that distributed learning may better facilitate long-term maintenance of behaviour change [Bouton, M. (2000). A learning theory perspective on lapse, relapse, and the maintenance of behavior change. Health Psychology: Special Issue: Maintenance of Behavior Change in Cardiorespiratory Risk Reduction, 19, 57-63]. Alternatively, some research suggests that massed-intensive content delivery can be as beneficial as distributed delivery [e.g. Rogojanski, J., & Rego, S. A. (2013). Advances and controversies in the application of a modified version of cognitive behavior therapy for social anxiety disorder. Pragmatic Case Studies in Psychotherapy, 9(3), 337-346]. The present study compared two versions of a cognitive dissonance (CD)-based eating disorders (EDs) prevention programme. CD interventions target ED risk factors via an interactive format with content spread over multiple sessions, and have demonstrated both efficacy and effectiveness across numerous trials. We randomised female undergraduates (N = 73) to either four 1-hour sessions over four weeks (4SV), or two 2-hour sessions over two weeks (2SV). The versions were identical in content and total intervention time. Results indicated that both conditions showed similar rates of improvement in ED risk factors and symptoms through a 12-month follow-up, with the exception of thin-ideal internalisation, where results suggested a possible advantage of the 4SV for long-term, but not short-term, gain. Therefore, findings suggest that entities implementing CD are able to select the format that best fits their needs without significantly compromising the positive impact of the programme. Implications regarding the dissemination benefits of a flexible programme format that maintains effectiveness are discussed. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
Advances in Eating Disorders, 3(1) : 34-47
- Year: 2015
- Problem: Eating Disorders (any)
- Type: Randomised controlled trials
-
Stage: Universal prevention
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
, Cognitive dissonance therapy
Linville, D., Cobb, E.., Lenee-Bluhm, T., Lopez-Zeron, G., Gau, J. M., Stice, E.
Objective: To conduct a pilot effectiveness trial of a brief dissonance-based eating disorder preventative program, the Body Project, when implemented at primary care medical clinics. Method: Sixty-six female adolescents between the ages of 13 and 17 who reported at least some body image dissatisfaction were recruited at two primary care clinics and randomized to Body Project groups or an educational video control condition; eating disorder risk factors and symptoms were measured at pretest, posttest, and 3-month follow-up. Results: Body Project versus educational video control participants showed significantly greater reductions in thin-ideal internalization, pressure to be thin, dieting, and eating disorder symptoms at posttest, which were medium to large effect sizes. Body Project participants also showed greater decreases in body dissatisfaction and negative affect at posttest, though these moderate sized effects were not significant. Effects persisted through 3-month follow-up. Conclusion: Average pre-post effect sizes (d = 0.58) compare favorably to those observed in past Body Project efficacy (average d = 0.59) and effectiveness trials (average ds of 0.43 and 0.69), suggesting that primary care clinics may represent a novel venue for offering and extending the reach of this eating disorder prevention program.
Behaviour Research & Therapy, 75 : 32-39
- Year: 2015
- Problem: Eating Disorders (any)
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions (any)
, Psychoeducation, Cognitive dissonance therapy
Mora, M., Penelo, E., Gutierrez, T., Espinoza, P., Gonzalez, M. L., Raich, R. M.
Aims. To evaluate the long-term effects of two school-based prevention programs administered to a universal mixed-sex sample of school-going adolescents on disturbed eating attitudes, aesthetic ideal internalization, and other eating disorder risk factors, when compared to a control group. Methods. Participants were 200 adolescents aged 12-15 selected by means of incidental sampling from second-year compulsory secondary education at schools. An interactive multimedia media literacy program (ML + NUT, Media Literacy and Nutrition) and a program focused on the same topics using dramatic arts (Theatre Alive) were applied and compared with a control group. Pretest, posttest (1 month later), and 5- and 13-month follow-up measurements were taken. Analyses were conducted with two-way mixed 3 × 3 ANCOVA (group × phase) adjusted by baseline levels, body mass index, and sex. Results. Participants in both experimental groups showed significantly higher self-esteem scores than the control group over time. The ML + NUT group also presented lower aesthetic ideal internalization scores than the control group. Discussion. Both programs can benefit students' self-esteem. Moreover, ML + NUT program was useful in reducing thin-ideal internalization. However, differences in body dissatisfaction and disordered eating attitudes were not found. The programs may be protective on the core psychological variables, which are essential to adaptive adolescent development.
Scientific World Journal, 2015 :
- Year: 2015
- 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
Nehmy, T. J., Wade, T. D.
Objective: The aim of the current study was to evaluate a prevention program targeting unhelpful perfectionism and self-compassion, designed to prevent growth of negative affect (NA). Method: Four schools participated in the research, where grade levels were allocated to either the intervention (". Healthy Minds") or the control condition (N=688 individuals; mean age 14.90 years), and assessments occurred at baseline, post-intervention, and 6- and 12-month follow-up. Results: There were no significant between group differences at post-intervention but at 6-month follow-up the intervention group had significantly lower unhelpful perfectionism, self-criticism and NA than the controls. Only significant between-group differences in unhelpful perfectionism were retained at 12-month follow-up (Cohen's d=.24). Examination of the sub-group lower in NA at baseline showed the intervention group was significantly less likely to have elevated NA at 6-month follow-up than controls, indicating a prevention effect. Discussion: The effects obtained in the current study provide support for the utility of a perfectionism intervention for reducing transdiagnostic outcomes, including unhelpful perfectionism, self-judgment, and NA, and preventing the growth of NA. Ways of producing longer terms effects for NA need to be further investigated, as does the impact of the intervention on different types of psychopathology. Trial registration: ACTRN12614000650695.
Behaviour Research & Therapy, 67 : 55-63
- Year: 2015
- Problem: Anxiety Disorders (any), Depressive Disorders, Eating Disorders (any)
- Type: Controlled clinical trials
-
Stage: Universal prevention
-
Treatment and intervention: Psychological Interventions (any)
, Psychoeducation, Other Psychological Interventions