Cognitive behavioral therapies for depression and anxiety in people with chronic disease: A systematic review and meta-analysis.

OBJECTIVE: Anxiety and depression in chronic disease are common and burdensome co-morbidities. There has been growing interest in cognitive and behavioral therapies (CBTs) for anxiety and depression in chronic disease, however their efficacy has not been well-established. This study examined the efficacy of CBTs for depression and/or anxiety symptoms within chronic disease and explored the moderating role of clinical and methodological characteristics. METHODS: Following prospective registration, electronic databases were searched up to 2023 for randomized controlled trials (RCTs) examining CBTs for depression and/or anxiety in any adult chronic disease population. RESULTS: We included 56 RCTs. The overall effect of CBTs was g = 0.61 (95% CI, 0.49, 0.72) for depression and g = 0.56 (95% CI, 0.42, 0.70) for anxiety. A range of methodological features significantly moderated the effect sizes obtained, including type of control group and the outcome measure used. Risk of Bias ratings indicated some concerns regarding RCT conduct and reporting. CONCLUSIONS: CBTs lead to moderate improvements in both depression and anxiety symptoms among people with chronic disease. However, the efficacy of CBT should be interpreted considering certain study and sample characteristics. It is recommended that future studies make improvements to study methodology and reporting.

Grazing Is Associated with ADHD Symptoms, Substance Use, and Impulsivity in a Representative Sample of a Large Metropolitan Area in Brazil.

Grazing is a clinically relevant eating behaviour, especially when it presents with a sense of loss of control (compulsive grazing). There is evidence that other disordered eating patterns are associated with problematic substance use and impulsivity-related conditions, such as attention-deficit/hyperactivity disorder (ADHD). This overlap contributes to higher psychopathology and treatment complications. Less is known about grazing, and most information originates in high-income countries. Hence, we sought to investigate relationships between grazing, tobacco and alcohol use, ADHD, and impulsivity in a large representative sample from Brazil. Data were collected by trained interviewers from adults (N = 2297) through an in-person household survey based on a stratified and clustered probability sample. We found significant associations between compulsive grazing and problematic alcohol use (OR = 3.02, 95% CI: 1.65, 5.53), ADHD (OR = 8.94, 95% CI: 5.11, 15.63), and smoking (OR = 1.67, 95% CI: 1.12, 2.47), with impulsivity contributing to the first two relationships. The substantial association with ADHD suggests that other executive functions may promote disordered eating, possibly expressed through difficulties in adhering to regular meals. Clinically, these findings highlight the importance of assessing problematic eating patterns, such as compulsive grazing, in those presenting with difficulties with substance use or impulsivity, and vice versa.

The impact of obesity and overweight on response to internet-delivered cognitive behavioural therapy for adults with chronic health conditions.

BACKGROUND: There is growing evidence that internet-delivered cognitive behavioural therapy (iCBT) can improve functioning and reduce psychological distress in people with chronic health conditions. Obesity frequently co-occurs with chronic health conditions, yet its impact on response to psychological interventions in this population is not known. The current study examined associations between BMI and clinical outcomes (depression, anxiety, disability, and satisfaction with life) following a transdiagnostic iCBT program targeting adjustment to chronic illness. METHODS: Participants from a large randomised controlled trial, who provided information on height and weight, were included (N = 234; mean age= 48.32, SD = 13.80; mean BMI = 30.43, SD = 8.30, range 16.18-67.52; 86.8% female). The influence of baseline BMI range on treatment outcomes at post-treatment and 3-month follow-up was examined using generalized estimating equations. We also examined changes in BMI and in participants' perceived impact of weight on their health. RESULTS: Improvement in all outcomes occurred across BMI ranges; additionally, persons with obesity or overweight generally experienced greater symptom reductions than those within a healthy weight range. A greater proportion of participants with obesity achieved clinically significant change on key outcomes (e.g., depression: 32% [95% CI: 25%, 39%]) than participants with a healthy weight (21% [95% CI: 15%, 26%]) or overweight (24% [95% CI: 18%, 29%], p = 0.016). There were no significant changes in BMI from pre-treatment to 3-month follow-up, however there were significant reductions on the self-rated impact of weight on health. CONCLUSIONS: Persons with chronic health conditions and with obesity or overweight benefit at least as much as those with a healthy BMI from iCBT programs targeting psychological adjustment to chronic illness, even without changes in BMI. iCBT programs may be an important component in the self-management of this population, and may address barriers implicated in health behaviour change.

Grazing Prevalence and Associations with Eating and General Psychopathology, Body Mass Index, and Quality of Life in a Middle-Income Country.

Research from high-income countries has shown that grazing is a common but problematic eating pattern, particularly when associated with a sense of loss of control. However, it is unclear whether these patterns hold globally. Thus, the goal of this study was to extend previous research by examining the prevalence and clinical correlates of compulsive grazing (CG) and non-compulsive grazing (NCG) in a middle-income country. Participants (N = 2297) comprised adult residents from Rio de Janeiro, Brazil. Recruitment of this population-based household survey occurred from September 2019 to February 2020. The short inventory of grazing was used to operationalise grazing subtypes. Chi-square analyses, logistic regression, and univariate tests were conducted using the complex samples procedure. The point prevalence of regular CG was 10.2% (n = 239) and was consistent with high-income countries, while NCG was 29.8% (n = 679) and was less frequent than reported in high-income countries. Additionally, similar to high-income countries, CG was associated with a higher body mass index and higher odds of eating disorders, eating disorder symptomatology, depression, anxiety, and a lower physical and mental health-related quality of life, than no grazing and NCG. Overall, this study demonstrated that grazing patterns in high-income countries extend to middle-income countries.

The timing and magnitude of symptom improvements during an Internet-delivered transdiagnostic treatment program for anxiety and depression.

OBJECTIVE: In face-to-face treatments, mental health symptoms improve rapidly across the first few treatment sessions, and the pace of improvement slows with additional sessions. Some individuals also report clinically meaningful symptom improvements after only two or three treatment sessions. As the rate of symptom change has been given limited attention within digital treatments, the present study investigated the timing and magnitude of symptom change during an 8-week online treatment for anxiety and depression. METHOD: Three adult samples were derived from previous randomized controlled trials: generalized anxiety disorder (n = 165), major depression (n = 149), and mixed anxiety/depression (n = 262). Symptom scores were compared between consecutive weeks of treatment, and we examined the proportion of individuals who achieved a ≥ 25% or ≥ 50% improvement in symptoms each week. RESULTS: Across all three samples, symptoms improved more rapidly during the first half of treatment compared to the second half of treatment. Within the first 4 weeks, over half of the participants had experienced a ≥ 25% improvement in symptoms, and approximately a third of participants had experienced a ≥ 50% improvement in symptoms. This pattern of change was found irrespective of diagnostic status or outcome measure. CONCLUSIONS: A substantial number of people who receive internet-delivered treatments appear to experience rapid, large, and clinically significant symptom improvement early in treatment. These findings add to our theoretical understanding of symptom improvements during psychotherapy, and further research investigating the mechanisms of such change will inform the development of more effective treatments. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Sudden gains in therapist-guided versus self-guided online treatments for anxiety or depression.

OBJECTIVE: Sudden gains are large, rapid, and sustained symptom improvements, and are associated with improved treatment outcomes across a range of mental health problems. Current theories suggest that therapists are required for sudden gains to be sustained, and to result in improved treatment outcomes. We compared the prevalence and consequences of sudden gains in therapist-guided versus self-guided internet-delivered treatments for anxiety and depression. METHOD: Samples from four previous randomized controlled trials were analyzed: generalized anxiety disorder (n = 259), panic disorder (n = 109), social anxiety disorder (n = 175), and major depressive disorder (n = 209). The prevalence, timing, and reversal rates of sudden gains were compared across therapist-guided and self-guided groups. Generalized estimating equations were used to examine the impact of guidance level and sudden gain status on posttreatment outcomes. RESULTS: Sudden gains were similarly prevalent in therapist-guided and self-guided treatments. In all four diagnostic samples, sudden gains most frequently occurred between Weeks 2 and 3 of treatment, and the rate of reversals did not differ based on the presence of guidance. The association between sudden gains and treatment outcome varied by disorder, such that sudden gains were associated with improved outcomes (irrespective of guidance condition) for participants with social anxiety disorder and major depression, but not generalized anxiety disorder or panic disorder. CONCLUSIONS: Sudden gains can occur, and are maintained, during internet-delivered psychotherapy even in the absence of therapist guidance. Furthermore, sudden gains may be associated with different patterns of symptom improvement depending on diagnostic presentation. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

A meta-analytic review of randomized clinical trials of online treatments for anxiety: Inclusion/exclusion criteria, uptake, adherence, dropout, and clinical outcomes.

Over the last decade there has been rapid growth in the number of clinical trials examining internet-delivered interventions for anxiety. While there have been numerous analyses of treatment efficacy, few studies have examined treatment engagement. The current meta-analysis examined participant eligibility, uptake, adherence, and drop-out in clinical trials of internet-delivered treatments for anxiety. This meta-analysis used random effects models to obtain estimates of participant inclusion, uptake, adherence, drop-out, and within-group treatment effect size. Moderator analyses examined the effects of anxiety disorder type, treatment type, and level of clinician guidance. After screening, 140 trials with 199 treatment arms (N = 11,021) were included. An average of 46% (95% CI 42, 50) of interested people were included in the clinical trials. In the active treatment arms, 98% (95% CI 97, 99) of participants began treatment, 81% (95% CI 78, 85) of the assigned treatments were completed, 21% (95% CI 18, 23) of individuals dropped out at post-treatment based on questionnaire non-completion, and an overall within-group effect size of g = 1.03 (95% CI 0.94, 1.13) was obtained. Several moderators of interest were significant (e.g., clinical guidance, anxiety disorder type), and there was substantial heterogeneity in estimates. In conclusion, a large number of inclusion and exclusion criteria have been used in trials of internet-delivered treatments for anxiety. Once recruited into a trial, however, most people appear to begin, adhere, and complete internet-delivered treatment for anxiety. Further research exploring various eligibility criteria and their impact on engagement and efficacy is warranted.

Understanding the untreated course of anxiety disorders in treatment-seeking samples: A systematic review and meta-analysis.

BACKGROUND: Very little is known about the course of anxiety disorders when they go untreated, despite the significant theoretical and practical value of this information, such as for treatment planning and benchmarking purposes. This meta-analysis aimed to examine the course of anxiety disorders in treatment-seeking samples using the control groups of treatment studies for anxiety disorders. METHODS: Following pre-registration, we systematically searched the literature for RCTs of treatment for anxiety disorders. Studies were included if they randomised participants to a control arm, where treatment was not received (i.e. waitlist control or no-treatment control). Meta-analyses were conducted to determine the magnitude of symptom change over the control period (Hedges' g), and rate of response (pooled prevalence). Effects were compared between anxiety disorders, alongside other potential moderators. RESULTS: Following search and screening, 173 RCTs met criteria (n = 15,250) for data extraction. Overall, untreated participants demonstrated significant, but small improvements to anxiety symptoms (g = 0.17, 95% CI 0.14, 0.21). Significant differences were observed between anxiety disorders, and according to other methodological features of the included trials. CONCLUSIONS: Results suggest that anxiety disorders are unlikely to remit without treatment, with some disorders remitting to a lesser extent than others. While this review is limited to a treatment-seeking sample, results provide theoretical and practical value for researchers and treatment providers.

The Chronic Conditions Course: A Randomised Controlled Trial of an Internet-Delivered Transdiagnostic Psychological Intervention for People with Chronic Health Conditions.

INTRODUCTION: Psychological adjustment to chronic health conditions is important, as poor adjustment predicts a range of adverse medical and psychosocial outcomes. Psychological treatments demonstrate efficacy for people with chronic health conditions, but existing research takes a disorder-specific approach and they are predominately delivered in face-to-face contexts. The internet and remotely delivered treatments have the potential to overcome barriers to accessing traditional face-to-face treatment. OBJECTIVE: The current study examined the efficacy and acceptability of an internet-delivered transdiagnostic psychological intervention to promote adjustment to illness, based on cognitive behaviour therapy principles. METHODS: In a two-arm randomised controlled trial, participants (n = 676) were randomly allocated to the 8-week intervention or a waitlist control. Treatment included five core lessons, homework tasks, additional resources, and weekly contact with a psychologist. Primary outcomes included depression, anxiety, and disability, assessed at pre-treatment, post-treatment, 3-month follow-up, and 12-month follow-up. RESULTS: The treatment group reported significantly greater improvements in depression (between-groups d = 0.47), anxiety (d = 0.32), and disability (d = 0.17) at post-treatment (all ps <0.001). Improvements were sustained over the 3-month and 12-month follow-ups. High treatment completion rates (69%) and levels of satisfaction (86%) were reported by participants in treatment. The intervention required a mean clinician time of 56.70 min per participant. CONCLUSIONS: The findings provide preliminary and tentative support for the potential of internet-delivered transdiagnostic interventions to promote adjustment to chronic health conditions. Further research using robust control groups, and exploring the generalisability of findings, is needed before firm conclusions can be drawn.

Examining the psychometric properties of brief screening measures of depression and anxiety in chronic pain: The Patient Health Questionnaire 2-item and Generalized Anxiety Disorder 2-item.

OBJECTIVE: Individuals with chronic pain experience anxiety and depressive symptoms at rates higher than the general population. The Patient Health Questionnaire 2-item (PHQ-2) and Generalized Anxiety Disorder 2-item (GAD-2) are brief screening measures of depression and anxiety, respectively. These brief scales are well-suited for use in routine care due to their brevity and ease of administration, yet their psychometric properties have not been established in heterogeneous chronic pain samples when administered over the Internet. MATERIALS AND METHODS: Using existing data from randomized controlled trials of an established Internet-delivered pain management program (n = 1333), we assessed the reliability, validity, diagnostic accuracy, and responsiveness to treatment change in the PHQ-2 and GAD-2, as well as the long-form counterparts. Exploratory analyses were conducted to obtain cutoff scores using those participants with diagnostic data (n = 62). RESULTS: The PHQ-2 and GAD-2 demonstrated appropriate reliability (eg, Cronbach's α = 0.79-0.84), validity (eg, higher scores in individuals with a diagnosis; p < 0.001), and responsiveness to treatment change (eg, pre- to post-treatment scores, p < 0.001). The psychometric properties of the short forms compared well with the longer forms. Cutoff scores on the short forms were consistent with general population samples, while cutoff scores on the long forms were higher than previously observed using general population samples. All four scales favored specificity over sensitivity. CONCLUSIONS: The PHQ-2 and GAD-2 demonstrated acceptable psychometric properties in the current sample, as did the long forms. Based on our findings, the PHQ-2 and GAD-2 can be used as screening tools with chronic pain samples when administered over the Internet.

Internet-delivered cognitive and behavioural based interventions for adults with chronic pain: a systematic review and meta-analysis of randomized controlled trials.

ABSTRACT: This study examined the efficacy of internet-delivered cognitive and behavioural interventions for adults with chronic pain AND explored the role of clinical and study characteristics as moderators of treatment effects. PubMed, Embase, PsycINFO, CENTRAL and CINAHL were searched to identify randomized controlled trials published up to October 2021. A meta-analysis of 36 studies (5778 participants) was conducted, which found small effect sizes for interference/disability (Hedges' g = 0.28; 95% confidence interval [CI] 0.21-0.35), depression ( g = 0.43; 95% CI 0.33-0.54), anxiety ( g = 0.32; 95% CI 0.24-0.40), pain intensity ( g = 0.27; 95% CI 0.21-0.33), self-efficacy ( g = 0.39; 95% CI 0.27-0.52) and pain catastrophizing ( g = 0.31; 95% CI 0.22-0.39). Moderator analyses found that interventions which involved clinician guidance had significantly greater effect sizes for interference/disability ( g = 0.38), anxiety ( g = 0.39), and pain intensity ( g = 0.33) compared with those without ( g = 0.16, g = 0.18, and g = 0.20, respectively). Studies using an inactive control had greater effects for depression ( g = 0.46) compared with active control trials ( g = 0.22). No differences were found between treatments based on traditional cognitive behaviour therapy vs acceptance and commitment therapy. Sample size, study year, and overall risk of bias (Cochrane rating) did not consistently moderate treatment effects. Overall, the results support the use of internet-delivered cognitive and behavioural interventions as efficacious and suggest guided interventions are associated with greater clinical gains for several key pain management outcomes.

The Pain Course: a randomised controlled trial and economic evaluation of an internet-delivered pain management program.

ABSTRACT: There is interest in the potential of Internet-delivered programs to cost-effectively increase access to pain management for people with chronic pain. However, few large-scale clinical and economic evaluations have been undertaken. Using a randomised controlled trial design, the current study (n = 659) examined the clinical efficacy, cost-effectiveness, and cost utility of an Internet-delivered pain management program for people with mixed chronic pain conditions when delivered with optional clinician support. The treatment group reported significant improvements in disability, depression, anxiety, average pain intensity, and quality-adjusted life years (QALYs), compared with control, and exhibited relatively high levels of treatment engagement and satisfaction. Each additional clinical improvement (defined as ≥ 30% improvement) produced by the intervention, over control, was associated with a cost of $48, $27, $38, and $83 for disability, depression, anxiety, and average pain intensity, respectively. Gaining one QALY was associated with a cost of $152 or $11,910 per QALY when an 80% probability criterion for cost utility was applied. The program itself was associated a relatively small, fixed, cost per patient but was not cost saving over the brief intervention period. The findings support the clinical efficacy and cost-effectiveness of Internet-delivered programs with "on demand" clinician support as a way to increase access to pain management. Key limitations of the current study include the use of a waitlist-control group, a short follow-up period, and the focus on governmental healthcare costs. Further evaluation of these programs is necessary if they are scaled up and offered as routine care.

Disability and life satisfaction in neurological disorders: The role of depression and perceived cognitive difficulties.

BACKGROUND: This study assessed factors associated with disability and life satisfaction in a large cohort of 2246 Australian adults with neurological disorders who completed an online survey of mental health and wellbeing. It was hypothesised that depressive symptoms and perceived cognitive difficulties would be significantly associated with both outcomes, even after controlling for significant demographic/medical covariates (e.g., age, marital-status, employment, multi-morbidity, medication). Differences in profiles of four neurological subgroups (i.e., multiple sclerosis; n = 738, epilepsy; n = 672, Parkinson's disease; n = 263, and Acquired Bran Injury; n = 278) were explored. METHODS: Multiple hierarchical linear regressions were run using cross-sectional data. RESULTS: Depressive symptoms made a significant and large unique contribution to higher levels of disability (ß = 0.333, p < .001), and poorer life satisfaction (ß = -0.434, p < .001), in the overall sample and across all four neurological subgroups (ß = 0.349 to 0.513, p < .001) Greater perceived cognitive difficulties were associated with disability in the overall sample (ß = 0.318, p < .001) and across all neurological subgroups (ß = 0.231 to 0.354, p < .001), but only life satisfaction in epilepsy (ß = -0.107, p = 006). CONCLUSIONS: The findings underscore the importance of managing psychological/neuropsychiatric comorbidities in neurological disorders.

The economic cost of bulimia nervosa and binge eating disorder: a population-based study.

BACKGROUND: The most common eating disorders (EDs) are bulimia nervosa (BN) and binge eating disorder (BED), serious psychiatric illnesses that have devastating effects on the physical and psychological wellbeing of sufferers. EDs range in complexity and severity but can be life-threatening without appropriate treatment. Although it is well-known that quality of life impacts is high for ED sufferers, research regarding fiscal and related costs is severely limited. The aim of this study was to understand economic and other costs of EDs at the community level. METHOD: Data were derived from 2017 household community representative structured interview of 2977 people aged ⩾ 15 years in South Australia. ED diagnoses, health systems, productivity, transaction, out-of-pocket expenses and other related costs of BN and BED were used to estimate the economic burden of EDs in South Australia. RESULTS: The annual total economic cost of EDs in 2018 was estimated at $84 billion for South Australia. This included $81 billion from the burden of disease as the result of years lived with disability (YLD) ($62 billion) and years of life lost ($19 billion). The health system costs, productivity and tax revenue loss to the Australian economy were estimated at $1 billion, $1.6 billion and $0.6 billion, respectively. CONCLUSIONS: The YLD average cost in 2018 in South Australia was $296 649 per person. This is two-thirds of the costs borne by individuals and the wider economy. Prevention and management initiatives for EDs need to take into account these costs when assessing their potential benefits.

A cross-sectional examination of executive function and its associations with grazing in persons with obesity with and without eating disorder features compared to a healthy control group.

PURPOSE: The current study aimed to investigate associations between grazing and different facets of executive functioning in persons with obesity with and without significant eating disorder psychopathology, compared to a healthy-weight control group. METHODS: Eighty-nine participants (of which 20 had obesity and marked eating disorder symptomatology, 25 had obesity but without marked eating disorder symptoms, and 44 were healthy-weight age- and sex-matched participants; N = 89; 66.3% female, age = 28.59 (8.62); 18.18-58.34 years) completed a battery of neuropsychological tests and demographic and eating disorder-related questionnaires. Poisson, Negative Binomial, and Ordinary Least Squares regressions were performed to examine group differences and the associations of grazing with executive functioning within the three groups. RESULTS: Significantly lower inhibitory control and phonemic fluency were observed for the obesity group without ED features compared to healthy-weight controls. Increasing grazing severity was associated with improved performance in inhibitory control in both groups with obesity, and with phonemic fluency in the obesity group with marked eating disorder features. CONCLUSION: Although there is mounting evidence that specific cognitive domains, especially inhibition, are affected in obesity, evidence of further detrimental effects of eating disorder psychopathology remains mixed; additionally, for persons with obesity, there may be a weak but positive link between executive functioning and grazing behaviour. LEVEL OF EVIDENCE: III, comparative cross-sectional observational study with a concurrent control group.

A Cost-effectiveness Analysis of an Internet-delivered Pain Management Program Delivered With Different Levels of Clinician Support: Results From a Randomised Controlled Trial.

There is growing interest in the potential of internet-delivered pain management programs (PMPs) to increase access to care for people with chronic pain. However, very few economic evaluations of these interventions have been reported. Using existing data, the current study examined the cost-effectiveness of an internet-delivered PMP for a mixed group chronic pain patients (n = 490) provided with different levels of clinician support. The findings indicated that each additional clinical outcome (defined as a ≥ 30% reduction in disability, depression, anxiety, and pain) was associated with cost-savings when the intervention was provided in a self-guided format (ICER range: -$404--$808 AUD) or an optional-guided format (ICER range: -$314--$541 AUD), and a relatively small fixed cost when provided in the clinician-guided format (ICER range: $88-$225 AUD). The results were driven by a reduction in service use costs among the treatment groups, which offset the costs of providing the internet-delivered PMP in the self-guided and optional-guided formats. The same general pattern of results was found when more stringent clinical outcomes (defined as a ≥ 50% reduction) were employed. These findings suggest that carefully developed and administered internet-delivered PMPs, provided with different levels of clinician support, can be highly cost effective for patients with a broad range of pain conditions. PERSPECTIVE: This study examines the cost-effectiveness of an internet-delivered PMP provided to adults with a broad range of chronic pain conditions. Evidence of cost-effectiveness was found across a broad range of clinical outcomes and with different levels of clinician support.

Relating goal-directed behaviour to grazing in persons with obesity with and without eating disorder features.

BACKGROUND: Both obesity and eating disorders (ED) have been associated with reductions in purposeful, flexible goal-directed behaviour, and with an overreliance on more rigid habitual behaviour. It is currently unknown whether grazing, an eating style which is common in both conditions, is related to goal-directed behaviour. The current study therefore aimed to relate grazing to goal-directed behaviour in a group of participants with obesity with and without ED features, compared to a healthy-weight control group. METHODS: Participants (N = 87; 67.8% women, mean age 28.57 years), of whom 19 had obesity and significant eating disorder features, 25 had obesity but without marked eating disorder features, and 43 were age- and sex-matched healthy-weight controls, completed two instrumental learning tasks assessing action-outcome contingency sensitivity and devaluation sensitivity, as well as demographic and eating disorder-related questionnaires. Gamma and Ordinary Least Squares regressions were performed to examine the effect of group and grazing on goal-directed behaviour. RESULTS: Lower action-outcome contingency sensitivity was found in the group with obesity and with eating disorder features than in the group with obesity but without eating disorder features or in healthy controls. No group differences in devaluation sensitivity were found. A small but significant relationship was found between grazing severity and contingency sensitivity in the group with obesity and eating disorder features, such that increasing grazing severity was associated with less diminished contingency sensitivity. CONCLUSIONS: There is some indication that in persons with obesity and eating disorder features instrumental behaviour is less flexible and adaptive; furthermore, within this group grazing may represent a goal-directed behaviour, despite unhelpful long-term implications of grazing.

Grazing behaviour and associations with obesity, eating disorders, and health-related quality of life in the Australian population.

BACKGROUND: Grazing, including a compulsive subtype, represents an eating behaviour of recent interest in obesity and eating disorders (ED), however, there is little information regarding its prevalence and correlates in the general population. The current study aimed to report on the distribution of compulsive grazing (CG) and non-compulsive grazing (NCG) in the Australian population, and to assess associations with obesity, ED, and health-related functioning. METHODS: A representative sample of 3047 individuals aged ≥15 years (50.8% female) completed a cross-sectional survey in 2016 assessing grazing, quality of life, BMI, and ED symptoms. Prevalence data were obtained, and logistic regressions and multivariate analyses were conducted to examine relationships between grazing and obesity, ED, and health-related quality of life. RESULTS: The point prevalence of regular NCG was 38.04% (95% CI [36.33, 39.78]; n = 1159) and CG was 10.24% (95% CI [9.21, 11.37]; n = 312). Persons with regular CG had almost twice the odds of a BMI ≥ 30 than of a BMI in the "healthy" range compared to those with no grazing. CG presented stronger associations with ED features and binge-type ED diagnostic groups than NCG, with high rates found in BED-Broad and BN, although some associations with ED features were also present for NCG. Those with both ED and obesity had an 11-fold increase in the odds of engaging in CG than in no grazing, compared to those without. Mental health-related quality of life was lower in those who engaged in CG in the population, as well as in those with obesity. CONCLUSIONS: Grazing, especially when associated with a more severe sense of loss of control, is a problematic eating behaviour in the general population, as well as in persons with high BMI, a binge-type ED, or both.

The short inventory of grazing (SIG): development and validation of a new brief measure of a common eating behaviour with a compulsive dimension.

BACKGROUND: Grazing, the repetitious and unplanned eating of small amounts of food with or without a sense of loss of control (LOC), is an eating pattern of recent interest which is highly prevalent in eating disorders and obesity. The current study aimed to (1) assess psychometric properties of a short inventory of grazing (SIG), consisting of a "grazing in general" item and a "compulsive/LOC grazing" item and (2) examine associations between compulsive and non-compulsive grazing and body mass index (BMI), eating disorder psychopathology, distress and health-related quality of life. METHODS: Participants recruited from a university and the community (n = 227; 75.3% female; age = 25.00 (9.88; 17.58-57.17) years; BMI = 23.24 (4.91, 14.20-46.06) kg/m2) completed an online test battery including the SIG. Parametric and non-parametric statistics were computed to assess internal consistency, test-retest reliability and construct validity, to test associations between the SIG and the other study variables, and to examine between-group differences. RESULTS: The SIG demonstrated appropriate psychometric properties. Results indicated that both grazing in general and low-frequency LOC grazing are common; however, LOC grazing of moderate-severe frequency and/or associated with marked distress is unusual. Frequency of LOC grazing, but not grazing in general, was significantly associated with higher BMI, psychological distress, compensatory behaviours and lower mental health-related quality of life. The presence of compulsive grazing was also associated with eating disorder caseness and binge-type eating disorder diagnostic groups. CONCLUSIONS: Results support the positioning of "compulsive" LOC grazing on a continuum of problematic eating. The SIG is a parsimonious measure of this eating pattern of emergent interest.

A randomized controlled trial of the compuLsive Exercise Activity TheraPy (LEAP): A new approach to compulsive exercise in anorexia nervosa.

OBJECTIVE: To compare the efficacy of the compuLsive Exercise Activity theraPy (LEAP) programme integrated with manualized cognitive behavioral therapy for anorexia nervosa (CBT-AN) compared to CBT-AN alone. METHOD: Seventy-eight adults were randomized to CBT-AN, delivered with or without eight embedded sessions of LEAP, for a total of 34 individual outpatient sessions. Participants were assessed at baseline, the end of the first phase of CBT-AN (which included LEAP), mid-therapy, end of therapy, and at 3 and 6 months follow-up. Linear mixed effects modelling was used for comparing trajectories over time by group in primary outcomes of pathological exercise cognitions and secondary outcomes of exercise frequency, BMI, eating disorder (ED) symptoms, AN stage of change, anxiety/depression, and health related quality of life. RESULTS: There were significant improvements over time in all outcomes. There were no significant differences between treatment groups in primary outcome measures. Fidelity and end-of-treatment participant satisfaction were satisfactory across both conditions. DISCUSSION: CBT-AN and LEAP added to CBT-AN resulted in improved attitudes and beliefs toward exercise and general improvements in BMI and ED psychopathology in people with AN.