Self-compassion and body image inflexibility as mediators of outcomes in a residential eating disorder sample.

Eating disorders are serious mental health conditions that are accompanied by negative health outcomes, high mortality rates, impaired functioning, and comorbid mental health conditions. Despite many empirically supported interventions for eating disorders, it remains one of the most challenging mental disorders to treat, as individuals often struggle to maintain treatment gains. One method of improving our understanding of effective eating disorder treatment is to identify important processes of change to target during therapy. The aim of the current study was to test two candidate mediators of disordered eating symptom change during residential treatment: self-compassion and body image inflexibility. In the present study, women and adolescent girls (N = 132) completed a battery of measures, including eating disorder severity, self-compassion, and body image inflexibility, at admission to and discharge from a residential eating disorder facility. Our results indicated that changes in body image inflexibility and self-compassion, specifically self-judgment, were both mediators between ED symptom severity from pre- to post-treatment. These results have potential treatment implications, pointing to the possible importance of targeting body image inflexibility, self-judgment, and self-compassion while treating eating disorders.

Examining a mediation model of body image-related cognitive fusion, intuitive eating, and eating disorder symptom severity in a clinical sample.

PURPOSE: This study sought to explore the associations between Intuitive Eating (IE), eating disorder (ED) symptom severity, and body image-related cognitive fusion within a clinical sample. IE was also examined as a possible mediator in the relationship between body image-related fusion and ED symptoms. METHODS: This study includes cross-sectional analyses with data from 100 adult females and 75 adolescent females seeking residential treatment for an ED. Self-reported demographic information, ED symptoms, IE behaviors, and body image-related cognitive fusion were collected from participants within the first week of treatment following admission to the same residential ED treatment facility. RESULTS: ED symptom severity was significantly negatively associated with three of the four domains of IE; unconditional permission to eat, reliance on hunger and satiety cues, and body-food choice congruence. A significant mediational effect of IE on the relationship between body image-related fusion and ED symptoms through IE behaviors was observed (ß = 11.3, SE = 0.003, p < 0.001). This effect was only observed for the unconditional permission to eat (ß = 0.13, p = 0.003) and reliance on hunger and satiety cues (ß = 0.10, p = 0.005) domains of IE when the domains were subsequently analyzed individually. CONCLUSION: Unconditional permission to eat and reliance on hunger and satiety cues appear to be particularly influential domains of IE in the relationship between body image-related fusion and ED symptom severity. It is possible that changes in these IE domains may be mechanisms through which body image-related fusion influences ED symptoms. Future longitudinal research is needed to better understand the relationship between body image-related cognitive fusion and IE and the potential for targeting these constructs specifically in the context of ED treatment. LEVEL OF EVIDENCE: Level V, cross-sectional analysis from descriptive study.

An exploratory component analysis of emotion regulation strategies for improving emotion regulation and emotional eating.

Emotion-focused treatments are generally efficacious for improving emotion regulation and consequently, improving clinical symptoms across numerous disorders. However, emotion-focused treatment approaches often contain numerous treatment components, limiting our ability to identify which are most efficacious. As such, the current pilot study sought to isolate three components common across a range of emotion-focused treatments (i.e. emotional awareness, emotion down-regulation, and distress tolerance) and test the impact of each component on (1) emotion regulation and (2) emotional eating behavior. Adults (N = 76) who reported four or more emotional eating episodes in the past month were assigned to attend a one-time, three-hour workshop focused on either awareness, down-regulation or tolerance of emotions, and were subsequently evaluated at one-week and two-weeks follow-up. All groups experienced equivalent improvements in emotional eating at two-weeks follow-up (F [1.47, 85.38 ] = 7.60, p < .01). However, groups showed differential patterns of change across facets of emotion regulation. Improvements in access to healthy emotion regulation strategies was moderately related to improvements in emotional eating in Down-Regulation and Distress Tolerance groups (r [18] = 0.40, r [20] = 0.63, respectively). In the Distress Tolerance group, improvements in emotional eating were moderately related to improvements in acceptance of emotions (r[20] = 0.33) and ability to refrain from impulses (r[20] = 0.41). In the Emotional Awareness group, improvements in emotional acceptance (r[20] = 0.30), awareness (r[20] = 0.38) and clarity (r[20] = 0.39) were moderately related to improvements in emotional eating. While several components of emotion-focused treatments may improve outcomes, each component may demonstrate a unique mechanism of action. Further study is needed to isolate these treatment components in fully powered clinical trials to better understand the mechanisms of action for emotion-focused treatments and ultimately develop more efficient and effective treatment approaches.

Mechanisms and moderators in mindfulness- and acceptance-based treatments for binge eating spectrum disorders: A systematic review.

OBJECTIVE: Increasing evidence suggests that mindfulness- and acceptance-based psychotherapies (MABTs) for bulimia nervosa (BN) and binge eating disorder (BED) may be efficacious; however, little is known about their active treatment components or for whom they may be most effective. METHODS: We systematically identified clinical trials testing MABTs for BN or BED through PsychINFO and Google Scholar. Publications were categorized according to analyses of mechanisms of action and moderators of treatment outcome. RESULTS: Thirty-nine publications met inclusion criteria. Twenty-seven included analyses of therapeutic mechanisms, and five examined moderators of treatment outcome. Changes were largely consistent with hypothesized mechanisms of MABTs, but substandard mediation analyses, inconsistent measurement tools, and infrequent use of mid-treatment assessment points limited our ability to make strong inferences. DISCUSSION: Analyses of mechanisms of action and moderators of outcome in MABTs for BN and BED appear promising, but the use of more sophisticated statistical analyses and adequate replication is necessary.

Confirmatory factor analysis and measurement invariance of the Cognitive Fusion Questionnaire-Body Image in a clinical eating disorder sample.

Individuals with eating disorders (EDs) may be particularly susceptible to body image related cognitive fusion (i.e., excessive entanglement with one's body image related thoughts such that they unduly influence on behavior). The Cognitive Fusion Questionnaire-Body Image (CFQ-BI) is the only existing measure of this construct, yet its psychometric properties have not been examined within a clinically diagnosed ED sample. The current study used confirmatory factor analysis and explored measurement invariance, construct validity, and incremental validity of the CFQ-BI when used with adolescent (n = 75) and adult (n = 100) females admitting to residential ED treatment. A modified version of the single-factor structure of the CFQ-BI best fit the data and configural, metric, and scalar invariance were supported across age groups (i.e., adolescents or adults) and ED behavioral presentations (i.e., restrictive behaviors or binge/purge behaviors). Adults' and individuals with binge/purge behavioral presentations reported significantly more body image related fusion compared to adolescents and adults, respectively. Body image related psychological flexibility and ED severity were both significantly correlated CFQ-BI scores in expected directions. These findings suggest the CFQ-BI is a valid measure for assessing body image related fusion among adolescent and adult females with varying ED behavioral presentations. Implications and future research directions are discussed.

Obsessive compulsive disorder and thought action fusion: Relationships with eating disorder outcomes.

Obsessive Compulsive Disorder (OCD) is among the most common psychiatric comorbidities with eating disorders (EDs) and most studies have only examined this relationship at a diagnostic level. More research is needed to determine whether specific symptom domains and cognitive patterns commonly observed in OCD are most salient among individuals with clinically significant EDs, and whether these symptoms appear to change and/or influence treatment outcomes. Thought Action Fusion (TAF) is one cognitive pattern that may underlie OCD-ED comorbidity. The current study assessed 112 adolescent and adult female patients at a residential ED treatment facility on levels of ED severity, OCD symptom severity, and TAF at pre- and post-treatment. All OCD symptom dimensions were positively correlated with ED severity at pretreatment, with Obsessing, Neutralizing and Ordering OCD symptoms being most elevated. TAF was also positively correlated with ED severity at pre-treatment, and higher levels of TAF at pretreatment significantly predicted greater ED severity at post-treatment after controlling for all other OCD symptoms. Improvements in TAF specific to thoughts about others also predicted improvements in ED severity after controlling for changes in OCD symptoms. Clinically, these results indicate that efforts targeting specific OCD symptom dimensions and TAF in addition to ED-focused treatment as usual may be beneficial for enhancing overall treatment outcomes.

Starting off on the right foot in acceptance and commitment therapy.

This article describes the initial phase of acceptance and commitment therapy (ACT). The article begins with a review of ACT's theoretical orientation. Basic empirical support for ACT and its model are covered. A case description follows that highlights the initial phases of ACT. The article concludes with practical recommendations for starting therapy using ACT. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Assessing the valuing process in Acceptance and Commitment Therapy: Experts' review of the current status and recommendations for future measure development.

Within Acceptance and Commitment Therapy (ACT), personal values provide the foundational framework of the therapeutic process and are considered necessary to facilitate targeted behavioral movement and a more vital, meaningful life. Considering the proposed nature of values as a core mechanism of change in this way, a thorough understanding of the therapeutic valuing process through which targeted changes occur is essential to evaluate the true efficacy of the ACT model empirically and implement it most effectively. However, to date, development of measurement tools for this purpose is limited and those that do exist are often inconsistent in their targeted constructs. The current study collected in-depth, descriptive data from ACT experts to critically examine how the valuing process in ACT is currently defined and measured and make recommendations for future measure development. 11 experts participated in semi-structured interviews and responded to topic guided questions. Thematic analyses of experts' responses were then conducted, and eight core themes were identified. Findings denoted that experts' definitions of the valuing process and its core components are largely consistent with theoretical conceptualization of ACT but that no measurement tool to date provides a complete and adequate assessment of this process. Experts expressed the need for measures capable of assessing essential contextual aspects of the valuing process and gaining a more proximal evaluation of values-consistent behaviors and experiential momentary awareness. The current study provides insight into critical areas for improvement and provides recommendations for future measure development for the empirical assessment of the valuing process in ACT which is crucial for evaluating the role of values work as a therapeutic mechanism of action.