RESUMO
OBJECTIVE: Emerging research indicates that skills acquisition may be important to behavior change in cognitive behavior therapy (CBT) for eating disorders. This study investigated whether skills use assessed in real time during the initial 4 weeks of CBT-based day treatment was associated with momentary eating disorder behavior change and rapid response to treatment. METHODS: Participants with DSM-5 bulimia nervosa or purging disorder (N = 58) completed ecological momentary assessments (EMA) several times daily for the first 28 days of treatment. EMA assessed skills use, the occurrence of binge eating and/or purging, and state negative affect. Rapid response was defined as abstinence from binge eating and/or purging in the first 4 weeks of treatment. RESULTS: Greater real-time skills use overall, and use of "planning ahead," "distraction," "social support," and "mechanical eating" skills in particular, were associated with a lower likelihood of engaging in binge eating or purging during the same period. After controlling for baseline group differences in overall difficulties with emotion regulation, rapid and non-rapid responders did not differ in overall skills use, or skills use at times of higher negative affect, during the EMA period. DISCUSSION: Momentary use of skills appears to play an important role in preventing binge eating and purging, and certain skills appear to be particularly helpful. These findings contribute to the literature elucidating the processes by which CBT treatments for eating disorders work by providing empirical evidence that skills use helps to prevent binge eating and purging behaviors. PUBLIC SIGNIFICANCE: Individuals with eating disorders learn new skills during treatment to help them improve their symptoms. This study shows that for people with eating disorders, using skills helps prevent eating disorder behaviors in the moment. Certain skills may be particularly helpful, including planning ahead, distracting activities, support from others, and focusing on eating meals and snacks regardless of how one is feeling. These findings help us better understand how treatments work.
Assuntos
Transtorno da Compulsão Alimentar , Bulimia Nervosa , Terapia Cognitivo-Comportamental , Humanos , Transtorno da Compulsão Alimentar/diagnóstico , Transtorno da Compulsão Alimentar/terapia , Transtorno da Compulsão Alimentar/psicologia , Avaliação Momentânea Ecológica , Bulimia Nervosa/psicologia , EmoçõesRESUMO
INTRODUCTION: In an uncontrolled study, we previously demonstrated the feasibility and preliminary efficacy of our virtual diabetes-specific version (Diabetes Body Project) of the eating disorder (ED) prevention program the Body Project. The aim of the current study was to evaluate further this program for women with type 1 diabetes (T1D) by assessing within-subject changes in outcomes from pretest over 6-month follow-up. METHODS: Young women with T1D aged 16-35 years were invited to participate in Diabetes Body Project groups. A total of 35 participants were allocated to five Diabetes Body Project groups (six meetings over 6 weeks). Primary outcome measures included ED risk factors and symptoms, and secondary outcomes included three T1D-specific constructs previously found to be associated with ED pathology: glycemic control as measured by HbA1c level, diabetes distress, and illness perceptions. RESULTS: Within-subject reductions, with medium-to-large effect sizes, were observed for the primary (ED pathology, body dissatisfaction, thin-ideal internalization, and appearance ideals and pressures) and secondary outcomes (within-condition Cohen's ds ranged from .34 to 1.70). CONCLUSION: The virtual Diabetes Body Project appears to be a promising intervention worthy of more rigorous evaluation. A randomized controlled trial with at least a 1-year follow-up is warranted to determine its efficacy compared to a control condition.
RESUMO
Relapse is a substantial problem in eating disorders. Until recently, there have been few investigations into maintenance treatments aimed at helping patients maintain improvements made in treatment. This study compared the outcomes of group-based intensive outpatient versus individual cognitive behavioural therapy (CBT)-based maintenance treatments for eating disorders, following inpatient or day treatment. In this sequential cohort study, patients received the type of maintenance treatment (intensive outpatient group or individual CBT) available at the time. A total of 221 patients with eating disorders were included, and data were examined retrospectively. Cox regression was used to determine whether treatment type predicted rate of return to clinically significant symptoms over the 12 months following inpatient or day treatment. Intensive outpatient group versus individual CBT maintenance treatment did not predict differential rate or trajectory of return to clinically significant symptoms in diagnostic subgroups and the overall sample. Maintenance treatment type did not predict changes in weight/shape concerns between end-of-inpatient or day treatment) and 6- or 12-month follow-up (after controlling for diagnosis). Although the treatments appeared similarly effective in helping patients maintain gains made in intensive treatment, individual CBT may be a more time- and cost-efficient approach to delivering maintenance treatment.
Assuntos
Terapia Cognitivo-Comportamental , Transtornos da Alimentação e da Ingestão de Alimentos , Estudos de Coortes , Transtornos da Alimentação e da Ingestão de Alimentos/terapia , Humanos , Pacientes Internados , Pacientes Ambulatoriais , Estudos Retrospectivos , Resultado do TratamentoRESUMO
STUDY QUESTION: Does increased daily energy intake lead to menstrual recovery in exercising women with oligomenorrhoea (Oligo) or amenorrhoea (Amen)? SUMMARY ANSWER: A modest increase in daily energy intake (330 ± 65 kcal/day; 18 ± 4%) is sufficient to induce menstrual recovery in exercising women with Oligo/Amen. WHAT IS KNOWN ALREADY: Optimal energy availability is critical for normal reproductive function, but the magnitude of increased energy intake necessary for menstrual recovery in exercising women, along with the associated metabolic changes, is not known. STUDY DESIGN, SIZE, DURATION: The REFUEL study (trial # NCT00392873) is the first randomised controlled trial to assess the effectiveness of 12 months of increased energy intake on menstrual function in 76 exercising women with menstrual disturbances. Participants were randomised (block method) to increase energy intake 20-40% above baseline energy needs (Oligo/Amen + Cal, n = 40) or maintain energy intake (Oligo/Amen Control, n = 36). The study was performed from 2006 to 2014. PARTICIPANTS/MATERIALS, SETTING, METHODS: Participants were Amen and Oligo exercising women (age = 21.0 ± 0.3 years, BMI = 20.8 ± 0.2 kg/m2, body fat = 24.7 ± 0.6%) recruited from two universities. Detailed assessment of menstrual function was performed using logs and measures of daily urinary ovarian steroids. Body composition and metabolic outcomes were assessed every 3 months. MAIN RESULTS AND THE ROLE OF CHANCE: Using an intent-to-treat analysis, the Oligo/Amen + Cal group was more likely to experience menses during the intervention than the Oligo/Amen Control group (P = 0.002; hazard ratio [CI] = 1.91 [1.27, 2.89]). In the intent-to-treat analysis, the Oligo/Amen + Cal group demonstrated a greater increase in energy intake, body weight, percent body fat and total triiodothyronine (TT3) compared to the Oligo/Amen Control group (P < 0.05). In a subgroup analysis where n = 22 participants were excluded (ambiguous baseline menstrual cycle, insufficient time in intervention for menstrual recovery classification), 64% of the Oligo/Amen + Cal group exhibited improved menstrual function compared with 19% in the Oligo/Amen Control group (χ2, P = 0.001). LIMITATIONS, REASONS FOR CAUTION: While we had a greater than expected dropout rate for the 12-month intervention, it was comparable to other shorter interventions of 3-6 months in duration. Menstrual recovery defined herein does not account for quality of recovery. WIDER IMPLICATIONS OF THE FINDINGS: Expanding upon findings in shorter, non-randomised studies, a modest increase in daily energy intake (330 ± 65 kcal/day; 18 ± 4%) is sufficient to induce menstrual recovery in exercising women with Oligo/Amen. Improved metabolism, as demonstrated by a modest increase in body weight (4.9%), percent body fat (13%) and TT3 (16%), was associated with menstrual recovery. STUDY FUNDING/COMPETING INTEREST(S): This research was supported by the U.S. Department of Defense: U.S. Army Medical Research and Material Command (Grant PR054531). Additional research assistance provided by the Penn State Clinical Research Center was supported by the National Center for Advancing Translation Sciences, National Institutes of Health, through Grant UL1 TR002014. M.P.O. was supported in part by the Loretta Anne Rogers Chair in Eating Disorders at University of Toronto and University Health Network. All authors report no conflict of interest. TRIAL REGISTRATION NUMBER: NCT00392873. TRIAL REGISTRATION DATE: October 2006. DATE OF FIRST PATIENT'S ENROLMENT: September 2006.
Assuntos
Distúrbios Menstruais , Menstruação , Adulto , Ingestão de Energia , Exercício Físico , Feminino , Humanos , Oligomenorreia , Estados Unidos , Adulto JovemRESUMO
OBJECTIVE: This study aimed to develop a virtual diabetes-specific version of the eating disorder (ED) prevention program the Body Project, and to assess feasibility and preliminary efficacy of this program for young females with type 1 diabetes. METHOD: Young females with type 1 diabetes aged 16-35 years were invited to participate in the study. A total of 35 participants were allocated to five Diabetes Body Project groups (six meetings over 6 weeks) and completed pretest assessments; 26 participants completed all sessions and posttest assessments (<7 days after last meeting). Primary measures included ED risk factors and symptoms, and secondary outcomes included diabetes-specific constructs previously found to be associated with ED psychopathology (e.g., diabetes distress and illness perceptions). RESULTS: The ease of recruitment, timely conduct of five groups, moderate drop-out rate and appreciation of the intervention by participants indicated that the Diabetes Body Project is feasible. Meaningful reductions occurred on the primary outcomes (i.e., ED psychopathology, body dissatisfaction, and thin ideal internalization) and on internalization of appearance ideals and appearance pressures at posttest (Cohen's d ranging from .63 to .83, which are medium to large effects). Small to medium effect sizes were found for diabetes illness perceptions and distress (.41 and .48, respectively). DISCUSSION: The virtual Diabetes Body Project is a promising and much-needed intervention, worthy of more rigorous evaluation. A randomized controlled trial is warranted to determine its effectiveness compared with a control condition.
Assuntos
Insatisfação Corporal , Diabetes Mellitus Tipo 1 , Transtornos da Alimentação e da Ingestão de Alimentos , Adolescente , Adulto , Imagem Corporal , Diabetes Mellitus Tipo 1/prevenção & controle , Estudos de Viabilidade , Transtornos da Alimentação e da Ingestão de Alimentos/prevenção & controle , Feminino , Humanos , Adulto JovemRESUMO
Care providers and individuals with severe and enduring anorexia nervosa (SE-AN) are weathering a perfect storm in which the sickest patients receive the least evidence-based treatment and iatrogenic factors play a significant role. Examining access to treatment from an ethical perspective is one strategy for developing more objective protocols related to the care of individuals with SE-AN.
Assuntos
Anorexia Nervosa , Humanos , Doença IatrogênicaRESUMO
OBJECTIVE: Rapid and substantial behavior change (RSBC) early in cognitive behavior therapy (CBT) for eating disorders is the strongest known predictor of treatment outcome. Rapid change in other clinically relevant variables may also be important. This study examined whether rapid change in emotion regulation predicted treatment outcomes, beyond the effects of RSBC. METHOD: Participants were diagnosed with bulimia nervosa or purging disorder (N = 104) and completed ≥6 weeks of CBT-based intensive treatment. Hierarchical regression models were used to test whether rapid change in emotion regulation variables predicted posttreatment outcomes, defined in three ways: (a) binge/purge abstinence; (b) cognitive eating disorder psychopathology; and (c) depression symptoms. Baseline psychopathology and emotion regulation difficulties and RSBC were controlled for. RESULTS: After controlling for baseline variables and RSBC, rapid improvement in access to emotion regulation strategies made significant unique contributions to the prediction of posttreatment binge/purge abstinence, cognitive psychopathology of eating disorders, and depression symptoms. DISCUSSION: Individuals with eating disorders who rapidly improve their belief that they can effectively modulate negative emotions are more likely to achieve a variety of good treatment outcomes. This supports the formal inclusion of emotion regulation skills early in CBT, and encouraging patient beliefs that these strategies are helpful.
Assuntos
Bulimia Nervosa/terapia , Bulimia/terapia , Terapia Cognitivo-Comportamental/métodos , Emoções , Psicoterapia/métodos , Adulto , Bulimia/psicologia , Bulimia Nervosa/psicologia , Feminino , Humanos , Masculino , Resultado do TratamentoRESUMO
This pilot study is the initial investigation of an integrated cognitive behavioral therapy (CBT) for co-occurring eating disorders (ED) and posttraumatic stress disorder (PTSD). Following a course of intensive hospital-based ED treatment focused on ED behavioral symptom interruption, 10 individuals with ED-PTSD received 16 sessions of CBT that focused on maintaining improvements in ED symptoms outside of the hospital environment and integrated cognitive processing therapy for PTSD. We hypothesized that the treatment would be associated with significant improvements in PTSD symptoms, depression, and anxiety, as well as sustained improvements in ED symptomatology. There were statistically significant improvements in clinician-rated PTSD symptoms (gav = 4.58), depression (gav = 1.37), and anxiety (gav = 1.00). As expected, there was no statistically significant change in ED cognitions (gav = .28). Reliable change analyses revealed that only 1 participant experienced deterioration in ED cognitions over the course of the integrated treatment. Of the 9 participants who were remitted from behavioral ED symptoms at the end of intensive treatment/beginning of the integrated treatment, 8 remained behaviorally remitted at poststudy treatment, which is encouraging given the high rate of rapid relapse following intensive ED treatment. Findings from this study provide preliminary support for the efficacy of an integrated CBT for ED-PTSD.
Assuntos
Terapia Cognitivo-Comportamental/métodos , Transtornos da Alimentação e da Ingestão de Alimentos/terapia , Transtornos de Estresse Pós-Traumáticos/terapia , Adolescente , Adulto , Ansiedade/terapia , Criança , Depressão/terapia , Transtornos da Alimentação e da Ingestão de Alimentos/complicações , Feminino , Humanos , Masculino , Projetos Piloto , Escalas de Graduação Psiquiátrica , Transtornos de Estresse Pós-Traumáticos/complicações , Resultado do Tratamento , Adulto JovemRESUMO
With this study, we sought to survey clinicians regarding their perspectives and use of concurrent or integrated psychotherapy for co-occurring eating disorders (EDs) and posttraumatic stress disorder. We conducted a quantitative survey of 184 frontline ED clinicians to investigate whether, and to what extent, they view concurrent EDs and trauma-focused therapy as clinically important. We also assessed clinicians' specific concerns regarding concurrent EDs and trauma-focused treatment, as well as barriers to implementation of an evidence-based concurrent treatment. On the whole, clinicians reported that addressing trauma-related symptoms in individuals with EDs is highly important and should be administered concurrently. Although clinicians reported anticipating many important benefits of concurrent treatment, they also reported anticipating several potential negative side effects, and they reported a number of perceived barriers to implementation. Clinicians working in hospital settings anticipated more complications, expected fewer benefits, and perceived more barriers to the administration of concurrent treatment.
Assuntos
Atitude do Pessoal de Saúde , Transtornos da Alimentação e da Ingestão de Alimentos/terapia , Pesquisas sobre Atenção à Saúde/métodos , Psicoterapia/métodos , Transtornos de Estresse Pós-Traumáticos/terapia , Comorbidade , Transtornos da Alimentação e da Ingestão de Alimentos/epidemiologia , Humanos , Transtornos de Estresse Pós-Traumáticos/epidemiologiaRESUMO
OBJECTIVE: Relapse remains a significant concern in bulimia nervosa, with some patients relapsing within months of treatment completion. The purpose of the study was to identify predictors of relapse within the first 6 months following treatment. METHOD: The 116 participants were bingeing and/or vomiting ≥ 8 times per month before day hospital (DH), and had ≤ 2 episodes per month in the last month of DH and the first month after DH. Rapid relapse was defined as ≥ 8 episodes per month for 3 months starting within 6 months. RESULTS: The rate of rapid relapse was 27.6%. Patients who relapsed soon after DH had higher frequencies of bingeing and vomiting before treatment, engaged in less body avoidance before treatment and were more likely to be slow responders to treatment. Weight and shape concerns and body checking were not significant predictors. DISCUSSION: More frequent bulimic symptoms accompanied by less body avoidance may indicate an entrenchment in the illness which in turn augurs a labored and transient response to DH treatment that is difficult to sustain after intensive treatment ends.
Assuntos
Bulimia Nervosa/terapia , Adulto , Análise de Variância , Transtorno da Compulsão Alimentar/psicologia , Transtorno da Compulsão Alimentar/terapia , Imagem Corporal , Peso Corporal , Bulimia Nervosa/psicologia , Feminino , Humanos , Recidiva , Vômito/psicologiaRESUMO
OBJECTIVE: Graded body image exposure is a key component of CBT for eating disorders (EDs). However, despite being a highly anxiety-provoking intervention, its specific effectiveness is unknown. The aims of this initial study were to investigate the feasibility and preliminary effectiveness of individualized graded body image exposure to a range of feared/avoided body image-related situations in a sample of partially remitted ED patients. METHOD: Forty-five female adult participants were randomly assigned to maintenance treatment as usual (MTAU) only or MTAU plus five sessions of graded body image exposure. RESULTS: The graded body image exposure intervention led to large improvements in body avoidance as measured by two different methods. In addition, there was evidence of a significant impact of body image exposure on the overvaluation of shape, but not weight, 5 months after treatment. DISCUSSION: Taken together, the current results provide evidence of the feasibility of adjunctive individualized graded body image exposure within a clinical treatment program and suggest that graded body image exposure reduces body avoidance behaviors in partially remitted ED patients. Our findings suggest that individualized graded body image exposure shows promise as an intervention targeting the overvaluation of shape in EDs.
Assuntos
Imagem Corporal/psicologia , Terapia Cognitivo-Comportamental/métodos , Transtornos da Alimentação e da Ingestão de Alimentos/terapia , Adolescente , Adulto , Peso Corporal , Transtornos da Alimentação e da Ingestão de Alimentos/psicologia , Feminino , Humanos , Masculino , Resultado do Tratamento , Adulto JovemRESUMO
The traditional group format of day hospital treatment for eating disorders restricts individual tailoring of treatment, which is challenging when complex cases are referred. In 2007 we introduced a new program that included individual sessions. Patients referred to this program were older, had longer illness duration, and more pre-treatment symptoms than the original group program. These clients also had more psychopathology, and were more likely to have a diagnosis of anorexia nervosa binge/purge subtype. Weight gain and abstinence from symptoms were less likely for patients in this new program. However, premature discharge, rapid response, symptom frequencies, and relapse rates did not differ.
Assuntos
Anorexia Nervosa/terapia , Hospital Dia/métodos , Adulto , Anorexia Nervosa/psicologia , Imagem Corporal , Feminino , Humanos , Masculino , Cooperação do Paciente , Aumento de Peso , Adulto JovemRESUMO
BACKGROUND: Depression and disturbed eating behavior (DEB) are more common in girls with type 1 diabetes (T1D) than in the general population, and may negatively affect metabolic control. OBJECTIVE: To examine the relationship among depression, DEB, and metabolic control in teenage girls with T1D. METHODS: Metabolic control, body mass index and interview-ascertained symptoms of depression, and DEB were assessed twice in 98 girls with T1D, 9-14 y at baseline and 5 yr later at 14-18 yr. RESULTS: At year 5, 12.2% of girls reported current depressive symptoms, 49.0% reported current DEB, and 13.3% had a full or subthreshold eating disorder (ED). Eating Disorder Examination score was higher in girls with depression (1.4 ± 1.3 vs. 0.5 ± 0.7; p = 0.03), and 75.0% of girls with depression also endorsed DEB vs. 45.3% of girls without depression (p = 0.05). Girls with an ED were at high risk for depressive symptoms; 69.2% reported depressive symptoms vs. 22.0% of girls with no DEB (p = 0.004). Metabolic control was not significantly associated with either depression or DEB in this cohort. A regression model using baseline and year 5 depression and DEB to predict year 5 hemoglobin A1c was not significant overall. CONCLUSIONS: Depression and DEB were common and frequently concurrent in this cohort. It was encouraging that poor metabolic control was not yet strongly associated with either depression or DEB. Early detection and treatment may help to prevent the development of entrenched difficulties in this triad of mood, eating behavior, and metabolic control in a vulnerable population.
Assuntos
Depressão/etiologia , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 1/metabolismo , Transtornos da Alimentação e da Ingestão de Alimentos/complicações , Adolescente , Criança , Diabetes Mellitus Tipo 1/terapia , Feminino , Hemoglobinas Glicadas/metabolismo , Humanos , Estudos Longitudinais , Análise de RegressãoRESUMO
OBJECTIVE: Speed of response to eating disorder treatment is a reliable predictor of relapse, with rapid response predicting improved outcomes. This study investigated whether rapid, slow, and nonresponders could be differentiated on clinically relevant variables, and possibly identified prior to treatment. METHOD: Female patients (N = 181) were classified as rapid, slow, or nonresponders based on the speed and magnitude with which they interrupted their bingeing and/or vomiting symptoms, and were compared on eating disorder behaviors and psychopathology and general psychopathology. RESULTS: The rapid response group was marginally older and had a slightly shorter course of treatment than the slow response group. The rapid response group also had significantly fewer pretreatment binge episodes, and a longer course of treatment than the nonresponse group. However, the three response groups were not significantly different on any other examined variables. DISCUSSION: The only pretreatment variable that differentiated response groups was symptom frequency, in that rapid responders had fewer binge episodes than nonresponders. No pre-existing variables differentiated rapid and slow response. Given that few individual pre-existing differences that might account for speed of response were identified, the clinical importance of facilitating a rapid response to treatment for all patients is discussed.
Assuntos
Bulimia Nervosa/terapia , Adolescente , Adulto , Fatores Etários , Imagem Corporal , Bulimia Nervosa/classificação , Bulimia Nervosa/psicologia , Comportamento Alimentar , Feminino , Humanos , Pessoa de Meia-Idade , Prognóstico , Fatores de Tempo , Adulto JovemRESUMO
The purpose of the study was to compare the effectiveness of 4-day versus 5-day day hospital (DH) treatment and to document effectiveness based on a large sample size. Participants were 801 patients, diagnosed with an eating disorder, who participated in DH treatment from 1985 to 2009. The study followed a sequential cohort ABA design. Higher intensity DH was associated with higher rates of abstinence from bingeing and vomiting and larger improvements in depression and body dissatisfaction. Higher intensity DH provided no consistent advantage in rates of weight restoration or improvement on other indices of psychological functioning. These findings suggest that the optimal intensity of treatment may vary depending on treatment goals, but 5-day DH is recommended for eating disorders.
Assuntos
Hospital Dia/métodos , Transtornos da Alimentação e da Ingestão de Alimentos/terapia , Psicoterapia de Grupo/métodos , Adolescente , Adulto , Estudos de Coortes , Hospital Dia/economia , Hospital Dia/normas , Transtornos da Alimentação e da Ingestão de Alimentos/psicologia , Feminino , Humanos , Pessoa de Meia-Idade , Psicoterapia de Grupo/economia , Psicoterapia de Grupo/normas , Fatores de Tempo , Resultado do Tratamento , Adulto JovemRESUMO
OBJECTIVE: The aim of this study was to compare two maintenance treatment conditions for weight-restored anorexia nervosa (AN): individual cognitive behavior therapy (CBT) and maintenance treatment as usual (MTAU). METHOD: This study was a nonrandomized clinical trial. The participants were 88 patients with AN who had achieved a minimum body mass index (BMI) of 19.5 and control of binge eating and purging symptoms after completing a specialized hospital-based program. Forty-six patients received 1 year of manualized individual CBT and 42 were in an assessment-only control condition (i.e., MTAU) for 1 year. This condition was intended to mirror follow-up care as usual. Participants in both the conditions were assessed at 3-month intervals during the 1-year study. The main outcome variable was time to relapse. RESULTS: When relapse was defined as a BMI Assuntos
Anorexia Nervosa/prevenção & controle
, Anorexia Nervosa/terapia
, Índice de Massa Corporal
, Terapia Cognitivo-Comportamental/métodos
, Peso Corporal/fisiologia
, Bulimia/prevenção & controle
, Bulimia/terapia
, Feminino
, Seguimentos
, Humanos
, Recidiva
, Resultado do Tratamento
, Adulto Jovem
RESUMO
OBJECTIVE: To identify factors that predict relapse in eating disorders to direct the development of effective relapse prevention interventions. METHOD: Fifty-eight participants who had partially remitted from their eating disorder after intensive treatment were prospectively followed for up to 24 months. A transdiagnostic sample was included based on current recommendations. RESULTS: The 12-month survival rate was 0.59, indicating that 41% of the sample had relapsed at this time, and four factors emerged as significant predictors of relapse. These factors included more severe pretreatment caloric restriction, higher residual symptoms at discharge, slower response to treatment, and higher weight-related self-evaluation. CONCLUSION: Clinical recommendations based on these data include encouraging clients to adopt the recommended behavioral changes immediately at the beginning of treatment, and to make complete symptom control a priority. In addition, addressing weight-related self-evaluation and teaching clients to detach from this schema that connects weight/shape with self-esteem may be an effective and feasible step toward relapse prevention.
Assuntos
Transtornos da Alimentação e da Ingestão de Alimentos/reabilitação , Adulto , Imagem Corporal , Peso Corporal , Transtornos da Alimentação e da Ingestão de Alimentos/diagnóstico , Transtornos da Alimentação e da Ingestão de Alimentos/prevenção & controle , Feminino , Humanos , Modelos Psicológicos , Ontário , Modelos de Riscos Proporcionais , Fatores de Risco , Prevenção Secundária , Autoimagem , Análise de Sobrevida , Terminologia como Assunto , Fatores de TempoRESUMO
OBJECTIVE: Rapid response to cognitive behavior therapy (CBT) for eating disorders (i.e., rapid and substantial change to key eating disorder behaviors in the initial weeks of treatment) robustly predicts good outcome at end-of-treatment and in follow up. The objective of this study was to determine whether rapid response to day hospital (DH) eating disorder treatment could be facilitated using a brief adjunctive CBT intervention focused on early change. METHOD: 44 women (average age 27.3 [8.4]; 75% White, 6.3% Black, 6.9% Asian) were randomly assigned to 1 of 2 4-session adjunctive interventions: CBT focused on early change, or motivational interviewing (MI). DH was administered as usual. Outcomes included binge/purge frequency, Eating Disorder Examination-Questionnaire and Difficulties in Emotion Regulation Scale. Intent-to-treat analyses were used. RESULTS: The CBT group had a higher rate of rapid response (95.7%) compared to MI (71.4%; p = .04, V = .33). Those who received CBT also had fewer binge/purge episodes (p = .02) in the first 4 weeks of DH. By end-of-DH, CBT participants made greater improvements on overvaluation of weight and shape (p = .008), and emotion regulation (ps < .008). Across conditions, there were no significant baseline differences between rapid and nonrapid responders (ps > .05). CONCLUSIONS: The results of this study demonstrate that rapid response can be clinically facilitated using a CBT intervention that explicitly encourages early change. This provides the foundation for future research investigating whether enhancing rates of rapid response using such an intervention results in improved longer term outcomes. (PsycINFO Database Record