Reducing binge eating through behavioral-focused versus emotion-focused implementation intentions in patients with binge eating disorder or bulimia nervosa: An experimental approach.

Binge eating disorder (BED) and bulimia nervosa (BN) are characterized by recurrent binge eating, episodes of consuming large amounts of food in a discrete period of time associated with a loss of control. Implementation intentions are explicit if-then plans that engender goal-directed action, and rely less on cognitive control than standard treatment options. In a sample with BED and BN, we compared two implementation intention conditions to a control condition. In the behavior-focused condition, implementation intentions targeted binge eating behaviors. In the emotion-focused condition, implementation intentions targeted negative affect preceding binge eating. In the control condition, only goal intentions were set. Each condition comprised three sessions. Participants kept food diaries for four weeks. Compared to the control condition both implementation intention conditions showed significant and large reductions of binge eating that persisted for six months. Effects did not differ between the behavior-focused and emotion-focused implementation intention conditions. These results demonstrate that three sessions on implementation intention formation can lead to long-term reductions in binge eating in patients with BED or BN. Learning how to form implementation intentions seems a recommendable addition to the current standard treatment. Future research could investigate the added value of fully personalized implementation intentions. CLINICAL TRIAL REGISTRATION NUMBER: NL52600.068.15.

Is a dissonance-based group intervention targeting thin-ideal internalization a successful potential add-on for specialized eating disorder care? A randomized feasibility and acceptability pilot study.

BACKGROUND: Dissonance-based eating disorder programs have successfully targeted body dissatisfaction by challenging the thin beauty ideal in the preventive context and in groups of patients with a subthreshold and full threshold DSM-5 eating disorder. As there is a need for interventions specifically targeting thin-ideal internalization in (highly) specialized treatment centres, the present study adapted Stice's et al.'s Body Project for its use as an add-on treatment for severe eating disorders with the aims to identify whether it was feasible and acceptable in this treatment context, to determine any necessary modifications with regard to the treatment and study procedures, and to test preliminary effectiveness. METHODS: The study was a randomized controlled pilot/feasibility trial. Thirty patients started in the Body Project group and 25 in the Psycho-education group. Measurements took place pre- and post-intervention, and at three and six months follow-up. Patients and staff evaluated treatment and study procedures, and patients completed questionnaires on thin-ideal internalization, body dissatisfaction, self-objectification, negative affect and eating disorder pathology. RESULTS: The Body Project group and Psycho-education group both proved highly feasible and acceptable, as well as preliminarily effective, based on quantitative scores and qualitative feedback. Preliminary analyses showed that treatment effects did not differ between treatment groups. As both groups were an add-on to standard treatment, treatment effects cannot be disentangled from effects resulting from standard treatment. Qualitative feedback for the Body Project group included several recommendations for future implementation: increasing the number of treatment sessions, creating homogeneous therapy groups, and optimizing timing of the treatment. CONCLUSIONS: Future research should examine further modifications to the Body Project group for severe eating disorders, as well as for whom, and when in the course of treatment the intervention is most effective. The present study also showed the benefits of implementing a structured Psycho-education group. We tested the feasibility and acceptability of a group intervention targeting the thin beauty ideal (Body Project group) in patients with severe eating disorders and compared this intervention to a group intervention focusing on psycho-education about eating disorders (Psycho-education group). Both interventions were added to standard treatment. We adapted the protocol for patients with severe eating disorders. Both the Body Project group and the Psycho-education group were evaluated by patients as well as staff as highly feasible and acceptable, and effects were positive. Treatment effects did not differ between treatment groups. As both treatments were an add-on to standard treatment, treatment effects cannot be disentangled from effects resulting from standard treatment. The study suggested further modifications to the Body Project group. Future research should examine these modifications as well as for whom, and when in the course of treatment the intervention is most effective. The present study also showed the benefits of implementing a structured Psycho-education group.

Tracking of Nutritional Intake Using Artificial Intelligence.

In this short communication paper, we present the results we achieved for automated calorie intake measurement for patients with obesity or eating disorders. We demonstrate feasibility of applying deep learning based image analysis to a single picture of a food dish to recognize food types and make a volume estimation.

Effects of implementation intentions and mental imagery on subjective binge eating.

OBJECTIVE: Binge-eating disorder (BED) and bulimia nervosa (BN) are characterised by binge eating. Changing unwanted behaviour is difficult, as intentions do not automatically lead to action. Implementation intentions (IIs) may help bridging the gap between intentions and behaviour. IIs are 'if-then' plans promoting goal attainment. Effects are moderated by degree of plan formation. Using mental imagery (MI) to impress IIs may strengthen plan formation and goal attainment. METHOD: In a students' sample with subjective binge eating, we compared IIs without MI, IIs with MI, and a control condition regarding their ability to reduce binge eating. Participants received three II-sessions and kept food diaries for 4 weeks. RESULTS: Results showed a significant and medium to large reduction of binge eating in both II-conditions compared to the control condition, that was sustained for 6 months. No additional effects of MI were found. CONCLUSIONS: Applying IIs results in long-lasting reductions in subjective binge eating. The absence of additional effects of MI may be due to floor effects. Also, participants in the IIs without MI condition may have applied MI without being instructed to do so. In future research, ideally with a clinical sample, it is recommended to prevent or control for this.

Anorexia nervosa and COVID-19 infection: Clinical case report.

The true risk of COVID-19 infection in anorexia nervosa (AN) including the duration of viral RNA shedding and infectivity is still unclear. We report on a case of a patient with severe AN with a mild course of COVID-19 and prolonged viral RNA shedding for at least 39 days after symptom onset. A careful evaluation of long-term infectivity must include viral load, live virus isolation, and viral genome sequencing.

Effects of implementation intentions on subthreshold binge eating.

Binge eating disorder (BED) and bulimia nervosa (BN) are characterized by binge eating. Frequently related to negative affect, binge eating is considered unwanted eating behavior. It is often preceded by a shift away from the goal of a healthy eating pattern. Implementation intentions are 'if-then' plans that may prevent such shifts in goals. In a students' sample with subthreshold binge eating, two implementation intention conditions were compared to a control condition in which only goals were formed. In the behavior-focused condition, implementation intentions targeted binge eating; in the emotion-focused condition, implementation intentions targeted negative affect preceding binge eating. All participants received three sessions and kept food diaries for four weeks, followed by a post-test and a one-month, three-months, and six-months follow-up. Compared to the control condition, both implementation intention conditions showed significant and large reductions in binge eating lasting for six months. Effects did not differ between both implementation intention conditions. Three implementation intention sessions reduced subthreshold binge eating. This continued for six months after the final session. Contrary to expectations, behavior-focused and emotion-focused implementation intentions were equally effective, possibly due to other triggers than negative affect. Future research should address their usefulness in BED and BN.

Group autonomy enhancing treatment versus cognitive behavioral therapy for anxiety disorders: A cluster-randomized clinical trial.

BACKGROUND: Although cognitive behavioral therapy (CBT) is effective in the treatment of anxiety disorders, few evidence-based alternatives exist. Autonomy enhancing treatment (AET) aims to decrease the vulnerability for anxiety disorders by targeting underlying autonomy deficits and may therefore have similar effects on anxiety as CBT, but yield broader effects. METHODS: A multicenter cluster-randomized clinical trial was conducted including 129 patients with DSM-5 anxiety disorders, on average 33.66 years of age (SD = 12.57), 91 (70.5%) female, and most (92.2%) born in the Netherlands. Participants were randomized over 15-week groupwise AET or groupwise CBT and completed questionnaires on anxiety, general psychopathology, depression, quality of life, autonomy-connectedness and self-esteem, pre-, mid-, and posttreatment, and after 3, 6, and 12 months (six measurements). RESULTS: Contrary to the hypotheses, effects on the broader outcome measures did not differ between AET and CBT (d = .16 or smaller at post-test). Anxiety reduction was similar across conditions (d = .059 at post-test) and neither therapy was superior on long term. CONCLUSION: This was the first clinical randomized trial comparing AET to CBT. The added value of AET does not seem to lie in enhanced effectiveness on broader outcome measures or on long term compared to CBT. However, the study supports the effectiveness of AET and thereby contributes to extended treatment options for anxiety disorders.

COVID-19, anorexia nervosa and obese patients with an eating disorder - some considerations for practitioners and researchers.

Since COVID-19 is a global health emergency, there is an urgent need to share experiences on decision-making with regard to safety recommendations and for hypotheses that can inform a more focused prevention and treatment. Moreover, combining research into eating disorders and obesity with research into COVID-19 may provide a unique opportunity to shed light on the susceptibility to COVID-19.

The role of sex and gender in anxiety disorders: Being scared "like a girl"?

Anxiety disorders are among the most prevalent mental disorders, and women are at much higher risk to develop an(y) anxiety disorder. Women seem to experience more severe and long-lasting symptoms than men. Sex differences regarding etiology can be best understood from a vulnerability-stress perspective. A different exposure to psychosocial stressors and an increased biologic and/or psychologic vulnerability toward anxiety in women may contribute to the sex differences in anxiety disorders. Evidently, these findings have implications for both the diagnosis and treatment of patients with anxiety disorders. Therapists should be aware of gender bias during the diagnostic process and be sensitive for self-reporting bias (i.e., the reluctance to report "female-like" symptoms by men). Research on sex differences with respect to treatment is lacking and gender-related knowledge has rarely been integrated into clinical interventions. Interventions aimed at transdiagnostic factors that have been shown to relate to sex differences in anxiety seem rather promising and have the potential to enhance the care for both men and women with anxiety disorders.

Enhancing Autonomy-Connectedness in Patients With Anxiety Disorders: A Pilot Randomized Controlled Trial.

Autonomy-enhancing treatment (AET) is a person-centered, gender-sensitive treatment, targeting transdiagnostic personal autonomy deficits. The current study was set up as a first pilot randomized controlled trial (RCT) to investigate the preliminary efficacy of AET. Earlier small non-controlled plots showed AET to be feasible and acceptable. In the current study (Trial Code 3513), patients receiving 15-session group-based AET (N = 43) were compared with those in a waitlist control condition (N = 40). Both the intention-to-treat and completers analyses suggested a larger decrease in agoraphobic symptoms in the experimental treatment than in the waitlist condition. In both analyses, effect sizes were small. The completers analyses showed additional beneficial effects in two of three autonomy-connectedness components, as well as psychoneuroticism, anxiety, and depression, which disappeared after correcting for multiple testing. AET may alleviate agoraphobic symptoms in a patient sample with severe anxiety. Future research, including more stringent inclusion criteria and follow-up assessment, is needed to further evaluate whether AET may serve as a promising alternative or addition to existing approaches. Clinical Trial Registration: www.trialregister.nl, identifier NTR3513.

Associations Between Secret-Keeping and Quality of Life in Older Adults.

This study examined the effects of secrecy on quality of life in a sample consisting of older adults (>50 years; N = 301). Three key components of secrecy were examined with the Tilburg Secrecy Scale-25 (TSS25; possession of a secret, self-concealment, and cognitive preoccupation). The TSS25 distinguishes between the tendency to conceal personal information (self-concealment) and the tendency to worry or ruminate about the secret (cognitive preoccupation), thereby enabling investigation of the effects of secrecy on quality of life in detail. Confirming previous findings in younger samples, we found a positive effect of possession of a secret on quality of life, after controlling for both TSS25's self-concealment and cognitive preoccupation. This suggests that keeping secrets may have a positive association with quality of life in older adults as well, as long as they do not have the tendency to self-conceal and are not cognitively preoccupied with their secret.

The role of autonomy-connectedness in the relation between childhood stressful life events, current posttraumatic symptoms, and internalizing psychopathology in adulthood.

OBJECTIVE: Autonomy-connectedness (AC), the adult capacity for self-governance while being connected to others, reflects the healthy capacity of adults for self-steering. The present study's main aim was to investigate whether childhood stressful life events were associated with psychopathological symptoms in adulthood, but only in people with AC deficits. METHOD: We estimated path models based on data from several assessment waves, concerning childhood stressful life events, AC, and internalizing psychopathological symptoms (including posttraumatic symptoms) completed by panel members from the Longitudinal Internet Studies for the Social Sciences panel (community sample). RESULTS: We found positive associations between AC deficits and childhood stressful life events, on one hand, and psychopathological symptoms in adulthood, on the other hand, as well as between childhood stressful life events and the AC component Sensitivity to Others. Importantly, we found that the association between childhood stressful life events and trauma-related hyperarousal symptoms was strongest in individuals with low levels of the AC components Self-Awareness and Capacity for Managing New Situations (moderation). Childhood stressful life events also interacted with Self-Awareness in predicting general mental health symptoms. All effect sizes were small. CONCLUSIONS: Deficits in AC, particularly regarding Self-Awareness and Capacity for Managing New Situations, may represent a vulnerability factor for developing trauma-related psychopathology. Enhancing AC may be a beneficial treatment approach for trauma-related psychopathology. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Anorexia nervosa and uric acid beyond gout: An idea worth researching.

Uric acid is best known for its role in gout-the most prevalent inflammatory arthritis in humans-that is also described as an unusual complication of anorexia nervosa (AN). However, beyond gout, uric acid could also be involved in the pathophysiology and psychopathology of AN, as it has many biological functions serving as a pro- and antioxidant, neuroprotector, neurostimulant, and activator of the immune response. Further, recent research suggests that uric acid could be a biomarker of mood dysfunction, personality traits, and behavioral patterns. This article discusses the hypothesis that uric acid in AN may not be a mere innocent bystander determined solely by AN behavior and its medical complications. In contrast, the relation between uric acid and AN may have evolutionary origin and may be reciprocal, where uric acid regulates some features and pathophysiological processes of AN, including weight and metabolism regulation, oxidative stress, immunity, mood, cognition, and (hyper)activity.

Autonomy and self-esteem of women who donate to an oocyte cryopreservation bank in the Netherlands.

Worldwide, oocyte donors donate voluntarily or receive varying amounts of money for donation. This raises ethical questions regarding the appropriateness of financial compensation, and the possibility of undue inducement and exploitation of oocyte donors. Are these donors capable of making an independent, well-considered decision? Regarding this matter, it is important to examine aspects such as autonomy-connectedness and self-esteem. In this cross-sectional study, demographic characteristics and donation motivations were assessed in 92 women who attended the University Medical Center (UMC) Utrecht as potential oocyte donors between June 2012 and July 2016. Demographic characteristics were assessed. Motivations were recorded in semi-structured interviews (response rate 59%). The Rosenberg Self-Esteem Scale was used to assess level of self-esteem. The Autonomy-Connectedness Scale was used to measure the level of autonomy-connectedness. The typical oocyte donor at the UMC Utrecht is a well-educated, employed, 31-year-old woman living with her partner in a completed family with two children, and donating on altruistic grounds. The donors showed higher autonomy-connectedness scores than the average female Dutch population and do not lack self-esteem (questionnaire response rate 66%). Concerns regarding exploitation and attraction of women with lower socioeconomic status, with shortcomings in autonomy-connectedness and self-esteem, could not be confirmed in this group.

Implicit stigmatization-related biases in individuals with skin conditions and their significant others.

OBJECTIVE: Stigmatization is common in people with chronic skin conditions and may also affect their significant others (SOs). The fast and implicit processing of stigmatization-related stimuli has received little attention in these populations; however, such knowledge may offer indications for new treatment methods. This study aimed to investigate implicit processing of stigmatization-related stimuli in people with skin conditions and their SOs. METHOD: A modified Stroop task and 2 approach-avoidance tasks were administered to participants with chronic skin conditions (alopecia: n = 50 and psoriasis: n = 50); their significant others (alopecia SOs: n = 47 and psoriasis SOs: n = 50); and controls (n = 50). The aim was to examine attentional and behavioral biases toward disease-related and social threat-related stigmatization stimuli. RESULTS: An attentional bias to disease-related stimuli was found in participants with alopecia and their SOs, compared with controls (p < .001). This effect was not found for participants with psoriasis and their SOs. Increased behavioral avoidance of disgusted faces was found in participants with psoriasis and their SOs, compared with controls (p = .047). This effect was not found in participants with alopecia and their SOs. CONCLUSIONS: These results provide support for the idea that individuals with skin conditions and their SOs are characterized by a stigmatization-related stimulus bias regarding implicit cognitive and behavioral reactions, in comparison to healthy individuals. Furthermore, preliminary results suggest that these processes may differ across skin conditions, with people with psoriasis being more affected by social reactions (i.e., disgusted faces) and people with alopecia by disease-related cues possibly related to internalized self-stigma. (PsycINFO Database Record

Addressing Self-Control Cognitions in the Treatment of Trichotillomania: A Randomized Controlled Trial Comparing Cognitive Therapy to Behaviour Therapy.

People with trichotillomania often have persistent negative beliefs about giving into one's habit. Central in the present study was the hypothesis that the follow-up effects of cognitive therapy (CT), in which these negative beliefs are directly addressed, are better compared to the follow-up effects of behaviour therapy (BT). Fifty-six trichotillomania patients were randomly assigned to either six sessions CT or BT. Forty-eight completed their treatment. Follow-up measurements took place after a 3 months treatment-free period, and at 12 and 24 months. CT and BT both resulted in clear reductions of trichotillomania symptoms (severity, urge, inability to resist, and negative beliefs) immediately after treatment. There were no differences between the groups. Following the treatment-free period, there was a reoccurrence of symptoms. In contrast to our expectation, we failed to show that CT compared to BT resulted in lower relapse rates after the treatment-free period.

Comorbidity and quality of life in adults with hair pulling disorder.

Hair pulling disorder (HPD; trichotillomania) is thought to be associated with significant psychiatric comorbidity and functional impairment. However, few methodologically rigorous studies of HPD have been conducted, rendering such conclusions tenuous. The following study examined comorbidity and psychosocial functioning in a well-characterized sample of adults with HPD (N=85) who met DSM-IV criteria, had at least moderate hair pulling severity, and participated in a clinical trial. Results revealed that 38.8% of individuals with HPD had another current psychiatric diagnosis and 78.8% had another lifetime (present and/or past) psychiatric diagnosis. Specifically, HPD showed substantial overlap with depressive, anxiety, addictive, and other body-focused repetitive behavior disorders. The relationships between certain comorbidity patterns, hair pulling severity, current mood and anxiety symptoms, and quality of life were also examined. Results showed that current depressive symptoms were the only predictor of quality of life deficits. Implications of these findings for the conceptualization and treatment of HPD are discussed.

Assessment of Tobacco-Related Approach and Attentional Biases in Smokers, Cravers, Ex-Smokers, and Non-Smokers.

According to theories of addictive behaviors, approach and attentional biases toward smoking-related cues play a crucial role in tobacco dependence. Several studies have investigated these biases by using various paradigms in different sample types. However, this heterogeneity makes it difficult to compare and evaluate the results. The present study aimed to address this problem, via (i) a structural comparison of different measures of approach-avoidance and a measure of smoking-related attentional biases, and (ii) using within one study different representative samples in the context of tobacco dependence. Three measures of approach-avoidance were employed: an Approach Avoidance Task (AAT), a Stimulus Response Compatibility Task (SRC), and a Single Target Implicit Association Test (ST-IAT). To assess attentional biases, a modified Stroop task including smoking-related words was administered. The study included four groups: n = 58 smokers, n = 57 non-smokers, n = 52 cravers, and n = 54 ex-smokers. We expected to find strong tobacco-related approach biases and attentional biases in smokers and cravers. However, the general pattern of results did not confirm these expectations. Approach responses assessed during the AAT and SRC did not differ between groups. Moreover, the Stroop did not show the expected interference effect. For the ST-IAT, cravers had stronger approach associations toward smoking-related cues, whereas non-smokers showed stronger avoidance associations. However, no such differences in approach-avoidance associations were found in smokers and ex-smokers. To conclude, these data do not provide evidence for a strong role of implicit approach and attentional biases toward smoking-related cues in tobacco dependency.

Changing automatic behavior through self-monitoring: does overt change also imply implicit change?

BACKGROUND AND OBJECTIVES: Self-monitoring of unwanted behavior is a common component of effective cognitive-behavioral therapy. Self-monitoring has often shown to lead to decreases in undesirable behavior. To investigate the underlying mechanisms of these 'reactive effects', we investigated whether behavioral changes as a result of self-monitoring were accompanied by changes in explicit and implicit evaluation. For this purpose, monitoring of snack-eating was compared to monitoring of alcohol-drinking, since reactive effects are found absent in alcohol-drinking. METHODS: Implicit evaluations (Affective Priming Task), estimated frequency and satisfaction of consumption (Snacks and Drinks Questionnaire) were assessed before and after a 15-day self-monitoring period. Consumption was measured using self-monitoring forms. Participants were randomly assigned to a group that either monitored snack-eating behavior (experimental group) or to a group that monitored alcohol-drinking behavior (control group). RESULTS: After self-monitoring, consumption only decreased in the experimental group, although both groups estimated their snack-eating frequency to be higher after self-monitoring. Explicit satisfaction of the habit remained the same but self-monitoring did result in a slightly more implicit negative evaluation of the monitored substance in both groups. In both groups, participants were less satisfied with their snack-eating behavior than with their alcohol-drinking behavior. CONCLUSIONS: Self-monitoring reduced snack-eating but not alcohol-drinking. In both groups, self-monitoring appeared to be accompanied by small implicit, but not explicit changes in evaluation. Changes in evaluation apparently do not lead to actual behavioral change on their own. Other factors are expected to be involved as well, such as dissatisfaction at the start of monitoring.