A case series of group-based ketamine-assisted psychotherapy for patients in residential treatment for eating disorders with comorbid depression and anxiety disorders.

BACKGROUND: Depression and anxiety outcome measures, safety/tolerability, patient satisfaction, and ease of implementation of group-based ketamine-assisted psychotherapy (G-KAP) delivered to patients in intensive residential eating disorder (ED) treatment were assessed. CASE PRESENTATION: This study reports on five participants with a diagnosis of an ED and comorbid mood and anxiety disorders who received weekly intramuscular ketamine injections in a group setting over 4 weeks. Measures of anxiety (GAD-7) and depression (PHQ-9) were administered pre-dose, 4-h post-dose, and 24-h post dose. Four of the 5 participants experienced clinically significant improvements on the PHQ-9 score (i.e., change greater than 5) while 2 of the 5 participants experienced clinically significant improvements on the GAD-7 score (i.e., change greater than 4) from pre-dose to 24-h post-dose after the last ketamine session. Dosing sessions were well tolerated, and no serious adverse events were reported. Clinical observations and participant reports corroborated improvements in depression and anxiety symptoms, good tolerability of ketamine treatment, and practical implementation of the G-KAP protocol in a residential ED treatment center. CONCLUSIONS: This study suggests the potential utility of G-KAP as an adjunct to intensive, specialized ED treatment. Overall, this novel, cross-diagnostic intervention warrants future research to further explore its appropriateness in a treatment setting.

Treatment-engagement fears in family-oriented interventions: validation of the caregiver traps scale for eating disorders.

As more caregivers of children (of any age) struggling with an eating disorder are recruited as partners in care, it is important to identify potential barriers to such involvement. The Caregiver Traps Scale for Eating Disorders (CTS-ED) was developed as a measure of caregiver fears with respect to treatment-engagement. The purpose of this study was to evaluate its psychometric properties. One hundred and twenty four parents of children with ED participated in the validation of this instrument. Data were analyzed through exploratory factor analysis. The exploratory factor analysis revealed one factor, accounting for 39% of the variance, with a mean of 3.99 (scale from 1 to 7), indicating that caregivers endorsed clinically significant fears relating to their involvement in their child's treatment. The scale yielded high internal consistency (α = .89). As expected, the CTS-ED was significantly positively correlated with a measure of accommodating and enabling of ED symptoms, and negatively correlated with a measure of parental self-efficacy. This scale shows promise as a measure for clinicians and researchers to identify parental fears that could potentially fuel accommodating, enabling or treatment-interfering behaviors. Suggestions for its utility as a clinical and supervision tool are also provided.Clinical SignificanceDevelopment of an assessment tool to identify caregiver fears with respect to therapy engagement in the context of family-oriented interventions for eating disordersTool has the potential to increase the positive involvement of caregivers to support their child (of any age) with an eating disorderTool can be used clinically and to support self-reflective practices to improve compassionate clinician engagement of caregivers struggling to support their child.

The influence of carer fear and self-blame when supporting a loved one with an eating disorder.

Carers often feel disempowered and engage in behaviours that inadvertently enable their loved one's ED symptoms and yet little is known regarding these processes. This study examined the relationships among fear, self-blame, self-efficacy, and accommodating and enabling behaviours in 137 carers of adolescents and adults with ED. The results revealed that fear and self-blame predicted low carer self-efficacy in supporting their loved one's recovery as well as the extent to which carers reported engaging in recovery-interfering behaviours. The relevance of these findings are discussed in the context of family-oriented ED therapies and highlight the importance for clinicians to attend to and help to process strong emotions in carers, in order to improve their supportive efforts and, ultimately, ED outcomes.

'I know I can help you': parental self-efficacy predicts adolescent outcomes in family-based therapy for eating disorders.

Family-based therapy is regarded as best practice for the treatment of eating disorders in adolescents. In family-based therapy, parents play a vital role in bringing their child or adolescent to health; however, little is known about the parent-related mechanisms of change throughout treatment. The present study examines parent and adolescent outcomes of family-based therapy as well as the role of parental self-efficacy in relation to adolescent eating disorder, depressed mood and anxiety symptoms. Forty-nine adolescents and their parents completed a series of measures at assessment, at 3-month post-assessment and at 6-month follow-up. Results indicate that, throughout treatment, parents experienced an increase in self-efficacy and adolescents experienced a reduction in symptoms. Maternal and paternal self-efficacy scores also predicted adolescent outcomes throughout treatment. These results are consistent with the philosophy of the family-based therapy model and add to the literature on possible mechanisms of change in the context of family-based therapy.

Setting the bar: divergent sociocultural norms for women's and men's ideal appearance in real-world contexts.

Research suggests that exposure to sociocultural norms for idealized appearance can reduce both women's and men's body satisfaction. Despite comparable effects for both genders in the lab, in the "real-world" women's body satisfaction is chronically lower than men's. Real-world gender differences may arise from discrepancies in men's and women's everyday exposure to norms. Across eight studies using a variety of content analysis, survey, and experimental methods, we examine differences in sociocultural norms for ideal appearance pertaining to women and men in "daily life" contexts. We demonstrate that appearance norms encountered by women in daily life are more rigid, homogenous and pervasive than those for men, and that more messages implying the attainability of the ideal appearance are directed at women. Finally, experimental results show that homogeneous, rigid norms (like those typically encountered by women) are more harmful to body image than heterogeneous, flexible norms (like those typically encountered by men).

Victoria's dirty secret: how sociocultural norms influence adolescent girls and women.

The present studies tested whether the salience of sociocultural norms for ideal appearance leads women to base their self-worth more strongly on appearance, which in turn leads them to feel more concerned with others' perceptions and less satisfied with their bodies. Study 1 tested this model by manipulating the salience of the sociocultural norm among female university students. The model was supported. In Study 2 an intervention challenging the legitimacy of the sociocultural norm was delivered to female and male adolescents. Compared to controls, females who received this intervention were less accepting of the sociocultural norms for appearance, based their self-worth less strongly on appearance, and in turn were less concerned with others' perceptions and were more satisfied with their bodies. The implications for women are discussed.

Don't take another bite: how sociocultural norms for appearance affect women's eating behavior.

Four studies tested the impact of exposure to thin images on women's eating behavior. In Study 1, women who were exposed to commercials containing thin models ate less in a taste test than women exposed to neutral commercials. The next two studies revealed that the impact of the thin images could be reduced by challenging the sociocultural norms for appearance. In Study 2, including images of relatively heavier women who have been successful in life (an indirect challenge to the norm) attenuated the impact of the thin images on women's eating behavior. Study 3 demonstrated that convincing women that their peers do not endorse the sociocultural norms also reduced the impact of the thin images. In Study 4, we found that exposure to thin images led to activation of an association between heaviness and rejection and that the more this association was activated, the less participants ate.

Comparing to perfection: How cultural norms for appearance affect social comparisons and self-image.

Theory and research suggests that cultural norms for appearance present unrealistic standards of beauty which may contribute to women's body dissatisfaction. In Study 1, women described their appearance more negatively than men and made more upward social comparisons about their bodies, but not about other domains. Women also compared more than men with unrealistic targets (e.g., models). In Study 2, we explored the role of cultural norms for appearance in social comparisons with relevant (peer) or irrelevant (model) superior targets. When cultural norms were not salient, participants judged a peer to be more relevant, compared more with the peer, and were more negatively affected by the peer. However, when cultural norms were salient, participants judged a professional model to be equally relevant, compared more with the model and felt worse after exposure to the model. We discuss the powerful role of cultural norms in determining social comparison processes and self-appraisals.