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1.
Psychiatr Hung ; 34(4): 426-435, 2019.
Artigo em Húngaro | MEDLINE | ID: mdl-31767803

RESUMO

The authors summarize their experiences collected from psychotherapeutic treatment of anorectic and bulimic patients treated at the outpatient and inpatient clinics of the Department of Psychiatry and Psychotherapy, Semmelweis University in the period of 1984-2008. The introduction provides an overview of the literature, that represents a theoretical background to their therapeutic strategies. Afterwards, insights are given about the authors own treatment strategies, that varied, although only slightly in different time periods. Therapeutic outcomes are summarized separately for groups of restrictive and purging anorexia patients, bulimia patients and bulimia patients suffering from other impulse control problems. Results are evaluated on the basis of clinical assessments, symptomatic reductions of eating disorders after treatment, and based on two years follow-up data. Finally results are analysed critically, concerning the used methods and further opportunities for relapse prevention.


Assuntos
Transtornos da Alimentação e da Ingestão de Alimentos/história , Transtornos da Alimentação e da Ingestão de Alimentos/terapia , Psiquiatria/história , Universidades/história , Anorexia Nervosa/história , Anorexia Nervosa/terapia , Bulimia/história , Bulimia/terapia , História do Século XX , História do Século XXI , Humanos , Psicoterapia/história
2.
Psychiatr Clin North Am ; 42(2): 205-218, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31046923

RESUMO

Interpersonal psychotherapy (IPT) for the treatment of eating disorders is a brief treatment that addresses the social and interpersonal context in which the disorder begins and is maintained. IPT is classified as a strongly supported evidence-based treatment of bulimia nervosa and binge-eating disorder, and more research is needed to understand the effectiveness of IPT for anorexia nervosa and IPT for preventing excess weight gain. This article describes the core components and elements of IPT, the empirical evidence that supports its effectiveness, efforts to increase the dissemination and implementation of IPT, and future directions.


Assuntos
Transtorno da Compulsão Alimentar/terapia , Bulimia/terapia , Psicoterapia Interpessoal , Humanos
3.
BMJ Open ; 9(4): e025344, 2019 04 20.
Artigo em Inglês | MEDLINE | ID: mdl-31005919

RESUMO

OBJECTIVES: To study the expectations women with bulimia nervosa (BN) or binge eating disorder (BED) had to a new treatment programme based on guided physical exercise and dietary therapy. DESIGN AND PARTICIPANTS: Semistructured interviews were conducted with six women with BN and four women with BED following a group-based therapy programme. Transcribed interviews were analysed using a text-condensing analytic approach. RESULTS: The analysis resulted in three main categories, that is, expectations about (1) increased knowledge, (2) symptom changes and (3) therapeutic expertise. The women expected that learning more about nutrition and physical exercise would give them more energy, less fear of food, physical and mental symptoms and a negative body focus. They also expected therapists to be professional and competent, and able to take care of them. CONCLUSION: The overall high and positive treatment expectation can, to some extent, reflect enthusiasm about a new and innovative approach to treatment. However, the results also reflect generic and highly adequate outcome expectations, which for the purpose of effectiveness should be incorporated into all treatment efforts at least for patients with eating disorders. TRIAL REGISTRATION NUMBER: NCT02079935; Results.


Assuntos
Transtorno da Compulsão Alimentar/terapia , Bulimia/terapia , Dietoterapia/psicologia , Terapia por Exercício/psicologia , Satisfação do Paciente , Adulto , Transtorno da Compulsão Alimentar/psicologia , Bulimia/psicologia , Feminino , Humanos , Noruega , Relações Profissional-Paciente , Pesquisa Qualitativa , Ensaios Clínicos Controlados Aleatórios como Assunto
4.
Obes Surg ; 29(1): 252-261, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30229461

RESUMO

BACKGROUND: Bariatric surgery is the most effective treatment for morbid obesity, yet 20 to 30% of such patients regain weight approximately 2 years post-surgery. A psychological intervention adjunctive to bariatric surgery that addresses eating pathology often observed in bariatric populations may improve outcomes. In the present study, a brief, adapted DBT-ST group for bariatric surgical candidates was evaluated as an adjunctive intervention to bariatric surgery in the pre-surgical period to reduce eating pathology and clinical impairment. METHODS: Participants included 95 bariatric surgery candidates, with 50 candidates in the DBT-ST plus treatment as usual (TAU) group and 45 candidates in the TAU (i.e., comparison) group. Participants completed measures of eating pathology at three time points (i.e., T1 = pre-DBT-ST program; T2 = post-DBT-ST program; T3 = 4 months post-DBT-ST; comparable time points employed for TAU group). Average wait time for surgery following the pre-surgical program was approximately 2 to 4 months. RESULTS: A series of 2 (group: DBT-ST + TAU versus TAU) × 3 (assessment time: T1, T2, and T3) mixed-model ANOVAs were completed. Participants in the DBT-ST plus TAU group showed significant reductions in binge eating, emotional eating, global eating pathology, and clinical impairment related to eating difficulties over time in comparison to TAU. CONCLUSIONS: Findings demonstrated that a brief DBT-ST group integrated as an adjunctive intervention to TAU in a bariatric pre-surgical program could aid in addressing eating pathology. Bariatric participants in a DBT-ST plus TAU group may be on a better weight loss trajectory than those who only receive TAU.


Assuntos
Cirurgia Bariátrica , Terapia do Comportamento Dialético , Transtornos da Alimentação e da Ingestão de Alimentos/terapia , Obesidade Mórbida/terapia , Cuidados Pré-Operatórios/métodos , Adaptação Psicológica , Transtorno da Compulsão Alimentar/psicologia , Transtorno da Compulsão Alimentar/terapia , Bulimia/psicologia , Bulimia/terapia , Terapia Combinada , Comorbidade , Emoções , Transtornos da Alimentação e da Ingestão de Alimentos/complicações , Transtornos da Alimentação e da Ingestão de Alimentos/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/complicações , Obesidade Mórbida/psicologia , Obesidade Mórbida/cirurgia , Resultado do Tratamento , Perda de Peso/fisiologia
5.
Eat Weight Disord ; 24(6): 1099-1111, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29197947

RESUMO

PURPOSE: This pilot study aimed to analyze the effects of an adapted dialectical behavior therapy (DBT) skills training group on problematic and adaptive eating behaviors in Brazilian obese individuals. METHODS: Thirty-one obese individuals were randomly assigned to 10 sessions of adapted DBT skills training (n = 14) or two months of a waiting list comparison condition (n = 17). RESULTS: Attrition rates were similar to what's been found in comparable studies, with most dropouts happening at the beginning of the treatment. Results showed improvements in binge eating severity (d = 0.80) and depression (d = 0.82) compared to no treatment condition. After the intervention, adaptive eating and distress outcomes showed an improvement trend, reaching nonclinical levels for most participants in the intervention group. Large to moderate between-group effect sizes were observed, but none of those were statistically significant. Large within-group effect sizes were observed in the intervention group in binge eating severity (d = 1.34), intuitive eating (d = 1.33) and depression (d = 1.12). Medium effect sizes were observed in emotional eating (d = 0.73) and in emotion regulation (d = 0.72). Despite positive outcomes in other variables, mindful eating worsened after the intervention (d = 0.66). CONCLUSIONS: These results are preliminary and require further replications with larger samples, yet they suggest that the intervention may be useful to improve distress outcomes and adaptive eating among obese people. Implications for clinical practice and recommendations for future research are discussed. LEVEL OF EVIDENCE: Level I, randomized controlled trial.


Assuntos
Bulimia/terapia , Depressão/terapia , Terapia do Comportamento Dialético/métodos , Regulação Emocional , Comportamento Alimentar , Obesidade/terapia , Adulto , Brasil , Bulimia/psicologia , Depressão/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/psicologia , Projetos Piloto , Angústia Psicológica , Psicoterapia de Grupo/métodos
6.
BMC Res Notes ; 11(1): 748, 2018 Oct 22.
Artigo em Inglês | MEDLINE | ID: mdl-30348226

RESUMO

OBJECTIVE: This review looked at internet-delivered cognitive behavioural therapy (iCBT) as a possible treatment for patients with bulimic symptoms. CBT has been established as an effective treatment; however, waiting lists lead to delayed initiation of treatment. iCBT is a possible delivery method to combat this. Medline, EMBASE and PsycInfo were searched for controlled trials using iCBT as a treatment for patients with bulimia nervosa (BN), subthreshold BN or 'eating disorders not otherwise specified' with bulimic characteristics (EDNOS-BN). The literature search returned 482 papers. 5 met the review criteria and were compared in characteristics, methodological quality and outcomes. Outcomes were analysed by calculation of effect sizes; iCBT was evaluated on reduction in binge eating and purging post treatment and at follow-up. RESULTS: Participants were mostly female with an average age range of 23.7-31 years. 4 studies demonstrated good methodological quality. 1 did not report all of the outcome data, increasing the likelihood of bias. Only 1 study showed widespread benefit over waiting list controls. iCBT was shown to reduce behaviours but was not found to be superior to bibliotherapy or waiting list. Further large-scale studies are required to make conclusive recommendations.


Assuntos
Bulimia Nervosa/terapia , Bulimia/terapia , Terapia Cognitivo-Comportamental/métodos , Internet , Avaliação de Resultados em Cuidados de Saúde , Adulto , Feminino , Humanos , Masculino , Adulto Jovem
7.
Clin Obes ; 8(6): 383-390, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30222916

RESUMO

Anti-obesity medication may help people maintain diet-induced reductions in appetite. The present exploratory analysis assessed the effects of lorcaserin on changes at 24 weeks post-randomization in emotion- and stress-related eating, food cravings and other measures of appetite (i.e. binge eating, cognitive restraint, disinhibition, hunger, preoccupation with eating and fullness). The parent study investigated the efficacy of combined lorcaserin and behavioural treatment in facilitating weight loss maintenance (WLM) in 137 adults (mean age = 46.1 years, 86.1% female, 68.6% black) who had lost ≥5% of initial weight during a 14-week, low-calorie diet (LCD) run-in. Participants were randomly assigned to lorcaserin or placebo and were provided with group WLM counselling sessions. Emotion- and stress-related eating, food cravings and appetite were measured at the start of the LCD (week -14), randomization (0) and week 24. From randomization, lorcaserin-treated participants had significantly greater improvements in emotion- and stress-related eating compared to placebo-treated participants (P = 0.04). However, groups did not differ significantly after randomization in changes in the frequency of food cravings, binge eating or other measures of appetite (Ps > 0.05). Compared to placebo, lorcaserin may improve emotion- and stress-related eating.


Assuntos
Benzazepinas/uso terapêutico , Aconselhamento/métodos , Ingestão de Alimentos/psicologia , Estilo de Vida , Obesidade/terapia , Perda de Peso , Adulto , Apetite , Terapia Comportamental/métodos , Bulimia/terapia , Fissura , Emoções , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/psicologia , Placebos , Estresse Psicológico , Resultado do Tratamento
8.
Nutrients ; 10(9)2018 Sep 14.
Artigo em Inglês | MEDLINE | ID: mdl-30223500

RESUMO

Binge eating is a core diagnostic feature of bulimia nervosa, binge eating disorder, anorexia nervosa binge/purge type, and is a common feature of "other specified" and "unspecified" feeding and eating disorders. It has been suggested that specific metacognitive beliefs about food, eating, and binge eating may play a key role in the maintenance of binge eating behaviour. The Eating Beliefs Questionnaire (EBQ-18) provides a brief self-report assessment tool measuring three types of metacognitive beliefs: negative, positive, and permissive beliefs about food and eating. This study aimed to build on past research by validating the factor structure and psychometric properties of the EBQ-18 using both a clinical and non-clinical sample. A sample of 688 participants (n = 498 non-clinical participants, n = 161 participants seeking treatment for an eating disorder, and n = 29 participants seeking treatment for obesity) completed a battery of questionnaires, including the EBQ-18 and other measures of eating disorder symptoms and relevant constructs. A subset of 100 non-clinical participants completed the test battery again after an interval of two-weeks, and 38 clinical participants completed the EBQ-18 before and after receiving psychological treatment for their eating disorder. A confirmatory factor analysis (CFA) was conducted and psychometric properties of this measure were assessed. The results of this study provide support for the three-factor model of the EBQ-18. In addition, the EBQ-18 was found to be a valid and reliable measure, with excellent internal consistency, good test-retest reliability in the non-clinical sample, and also demonstrated evidence of sensitivity to treatment in clinical samples with binge eating pathology. Receiver operating characteristic (ROC) curve analyses were used to identify optimal cut-off scores for the EBQ-18. This study provides valuable information about the utility of the EBQ-18 as a measure for use in both clinical and research settings.


Assuntos
Transtorno da Compulsão Alimentar/psicologia , Bulimia/psicologia , Comportamento Alimentar/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Obesidade/psicologia , Psicometria , Autorrelato , Adolescente , Adulto , Transtorno da Compulsão Alimentar/diagnóstico , Transtorno da Compulsão Alimentar/terapia , Bulimia/diagnóstico , Bulimia/terapia , Cultura , Feminino , Humanos , Masculino , Metacognição , Obesidade/diagnóstico , Obesidade/terapia , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Adulto Jovem
9.
Ann Epidemiol ; 28(9): 625-628.e1, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30033037

RESUMO

PURPOSE: In the context of Cochrane systematic reviews/meta-analyses of randomized clinical trials, risk of bias (RoB) is assessed using categorical indicators (low, unclear, or high RoB). This study sought to evaluate the indicators of the Cochrane RoB tool available for construct validity as applied to randomized clinical trials of psychological treatments for bulimia nervosa and binge eating. METHODS: Bayesian confirmatory factor analysis was used to test the construct validity of the measurement model underlying the set of five categorical items, and the reliability of these indicators to measure RoB. RESULTS: In 48 primary randomized clinical trials, the model showed good fit indices and factor loadings higher than 0.4. CONCLUSIONS: The results support the construct validity of the Cochrane RoB tool and the reliability of three of five items in this health intervention context.


Assuntos
Bulimia Nervosa/terapia , Bulimia/terapia , Psicoterapia , Ensaios Clínicos Controlados Aleatórios como Assunto , Viés , Bulimia/psicologia , Bulimia Nervosa/psicologia , Terapia Cognitivo-Comportamental , Análise Fatorial , Feminino , Humanos
10.
Eat Behav ; 29: 83-90, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29549863

RESUMO

INTRODUCTION: U.S. Black women have the highest rates of obesity and report frequent binge eating behaviors. To our knowledge, no intervention research has aimed to treat binge eating specifically among Black women. The purpose of this study was to investigate the feasibility and preliminary effect of Appetite Awareness Treatment (AAT), an 8-week cognitive-behavioral binge eating intervention, among Black women with obesity, and who report binge eating. METHODS: Participants (N = 31), had a mean (±SD) age of 48.8 ±â€¯12.8 years, a body mass index of 33.7 ±â€¯3.9 kg/m2, and reported at least one binge eating episode monthly over the last three months. Using a randomized controlled trial design, Black women were randomized to AAT or a wait-list control group (WAIT) group. We examined recruitment, attendance, retention, and adherence. Linear mixed models explored preliminary differences between the AAT and WAIT on the primary outcome variables of binge eating and eating self-efficacy measured at baseline and 8-weeks. RESULTS: Approximately one-third of screened participants were eligible and did enroll. Participants completed 55% of homework assignments, and attended 59% of intervention sessions. Retention to AAT was 87.5%. Compared to participants in the WAIT group, AAT participants had greater decreases in binge eating scores and greater improvements in eating self-efficacy scores at the end of Week 8. CONCLUSION: Results suggest that AAT is feasible among Black women with binge eating behaviors, with evidence of preliminary efficacy, providing a rationale for a trial of AAT in a larger sample of Black women.


Assuntos
Afro-Americanos/psicologia , Bulimia/etnologia , Bulimia/terapia , Terapia Cognitivo-Comportamental , Obesidade/etnologia , Adulto , Afro-Americanos/estatística & dados numéricos , Apetite , Conscientização , Índice de Massa Corporal , Estudos de Viabilidade , Feminino , Humanos , Pessoa de Meia-Idade , Obesidade/terapia , Resultado do Tratamento , Estados Unidos/epidemiologia
11.
Arch Dis Child Educ Pract Ed ; 103(3): 118-123, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29079591

RESUMO

Type 1 diabetes mellitus (T1DM) is a common chronic disease in children and young people. Living with diabetes can pose many challenges both medical and psychological. Disordered eating behaviours, intentional insulin omission and recognised eating disorders are common among young people with diabetes and are associated with increased risk of short-term and long-term complications and death. Recognition of these behaviours is important to ensure that relevant support is provided. Joint working between diabetes and mental health teams has challenges but is essential to ensure all needs are met during treatment and recovery.


Assuntos
Bulimia/etiologia , Bulimia/terapia , Diabetes Mellitus Tipo 1/complicações , Transtornos da Alimentação e da Ingestão de Alimentos/etiologia , Transtornos da Alimentação e da Ingestão de Alimentos/terapia , Pediatria/normas , Adolescente , Comportamento do Adolescente , Criança , Saúde da Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Guias de Prática Clínica como Assunto , Resultado do Tratamento , Reino Unido
12.
Appetite ; 123: 269-279, 2018 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-29278718

RESUMO

OBJECTIVE: Research has indicated that individuals with obesity have neurocognitive deficits, especially in cognitive flexibility that may in turn impact on their weight loss and maintenance. Consequently, we examined the efficacy of a manualised face-to-face cognitive remediation therapy for obesity (CRT-O) within a randomised controlled trial, in terms of improving cognitive flexibility, reducing binge eating behaviour, improving quality of life and helping with weight loss. METHODS: 80 adults with obesity (body mass index >30 kg/m2), 70% binge eaters, received three weekly sessions of group Behavioural Weight Loss (BWL) and then were randomised to 8 sessions of individual CRT-O or to a no-treatment control group. RESULTS: Mixed-effects model analyses revealed that the CRT-O group had a significant improvement in their cognitive flexibility at post-treatment and 3-month follow-up compared to the control group (Cohen's d = 0.96 to 2.1). 68% of those in the CRT-O group achieved a weight loss of 5% or more at follow-up compared to only 15% of the controls (Cohen's d = 1.3). Changes in set-shifting predicted changes in weight (p < .05). Binge eating reduced in the CRT-O group compared to the control (Cohen's d = 0.80). DISCUSSION: This is the first study showing the efficacy of CRT-O for obesity. Future CRT-O studies with longer follow-ups and pairing it with longer BWL programs are needed. TRIALS REGISTRY (ANZCTR): 12613000537752. DATE OF ANZCTR REGISTRATION: 14 May 2013.


Assuntos
Remediação Cognitiva , Obesidade/terapia , Adolescente , Adulto , Austrália , Transtorno da Compulsão Alimentar/psicologia , Transtorno da Compulsão Alimentar/terapia , Índice de Massa Corporal , Bulimia/psicologia , Bulimia/terapia , Feminino , Seguimentos , Comportamentos Relacionados com a Saúde , Humanos , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Obesidade/psicologia , Qualidade de Vida , Inquéritos e Questionários , Resultado do Tratamento , Perda de Peso , Adulto Jovem
13.
Trials ; 18(1): 592, 2017 Dec 12.
Artigo em Inglês | MEDLINE | ID: mdl-29233169

RESUMO

BACKGROUND: Cognitive behavior therapy (CBT) is the first-line of treatment for overweight and obesity patients whose problems originate in maladaptive eating habits (e.g., emotional eating). However, in-person CBT is currently difficult to access by large segments of the population. The proposed SIGMA intervention (i.e., the Self-help, Integrated, and Gamified Mobile-phone Application) is a mHealth intervention based on CBT principles. It specifically targets overweight young adults with underlying maladaptive behaviors and cognitions regarding food. The SIGMA app was designed as a serious game and intended to work as a standalone app for weight maintenance or alongside a calorie-restrictive diet for weight loss. It uses a complex and novel scoring system that allows points earned within the game to be supplemented by points earned during outdoor activities with the help of an embedded pedometer. METHODS/DESIGN: The efficacy of the SIGMA mHealth intervention will be investigated within a randomized, placebo-controlled trial. The intervention will be set to last 2 months with a 3-month follow-up. Selected participants will be young overweight adults with non-clinical maladaptive eating habits embodied by food cravings, binge eating, and emotional eating. The primary outcomes will be represented by changes in (1) self-reported maladaptive thoughts related to eating and body weight, (2) self-reported maladaptive eating behaviors in the range of urgent food cravings, emotional eating or binge eating, (3) as well as biased attentional processing of food items as indexed by reaction times. Secondary outcomes will be represented by changes in weight, Body Mass Index, general mood, and physical activity as indexed by the number of steps per day. DISCUSSION: Through an evidence-based cognitive behavioral approach and a user-friendly game interface, the SIGMA intervention offers a significant contribution to the development of a cost-effective and preventive self-help tool for young overweight adults with maladaptive eating habits. TRIAL REGISTRATION: ISRCTN, ID: 70907354 . Registered on 6 February 2017. The ISRCTN registration is in line with the World Health Organization Trial Registration Data Set. The present paper represents the original version of the protocol. Any changes to the protocol will be communicated to ISRCTN.


Assuntos
Bulimia/terapia , Terapia Cognitivo-Comportamental/métodos , Medicina Baseada em Evidências , Exercício Físico , Comportamento Alimentar , Hábitos , Sobrepeso/terapia , Autocuidado/métodos , Telemedicina/métodos , Jogos de Vídeo , Adaptação Psicológica , Fatores Etários , Bulimia/diagnóstico , Bulimia/fisiopatologia , Bulimia/psicologia , Telefone Celular , Protocolos Clínicos , Cognição , Terapia Cognitivo-Comportamental/instrumentação , Fissura , Emoções , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Aplicativos Móveis , Sobrepeso/diagnóstico , Sobrepeso/fisiopatologia , Sobrepeso/psicologia , Projetos de Pesquisa , Romênia , Autocuidado/instrumentação , Telemedicina/instrumentação , Fatores de Tempo , Resultado do Tratamento , Perda de Peso
14.
Nutrients ; 9(11)2017 Nov 22.
Artigo em Inglês | MEDLINE | ID: mdl-29165348

RESUMO

The purpose of the present review is to provide a summary of the research findings on emotion regulation in Binge Eating Disorder (BED). Negative emotions and maladaptive emotion regulation strategies play a role in the onset and maintenance of binge eating in BED. Anger and sadness, along with negative emotions related to interpersonal experiences (i.e., disappointment, being hurt or loneliness), seem to be particularly relevant. Individuals with BED have a tendency to suppress and ruminate on their unwanted emotions, which leads to increased psychopathological thoughts and symptoms. Compared to healthy controls, they use adaptive strategies, such as reappraisal, less frequently. Evidence concerning the causal relation between negative affect and binge eating is inconclusive and still very limited. While experimental studies in a laboratory setting lack ecological validity, ecological momentary assessment studies offer more promise at unraveling the causal relationship between emotions and binge eating. Increases in negative affect are found to be antecedents of binge eating in BED. However, there seems to be less support for the possibility that binge eating serves as a means to alleviate negative affect. Finally, BED seems to be related to other forms of maladaptive emotion regulation strategies, such as substance abuse and self-harm.


Assuntos
Transtorno da Compulsão Alimentar/psicologia , Transtorno da Compulsão Alimentar/terapia , Bulimia/psicologia , Bulimia/terapia , Emoções , Pesquisa Empírica , Humanos , Metanálise como Assunto
15.
Int J Eat Disord ; 50(10): 1152-1161, 2017 10.
Artigo em Inglês | MEDLINE | ID: mdl-28833314

RESUMO

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 Tratamento
16.
Curr Obes Rep ; 6(2): 217-228, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28434108

RESUMO

PURPOSE OF REVIEW: The objective of this paper is to review the role that hedonic factors, emotions and self-regulation systems have over eating behaviours from animal models to humans. RECENT FINDINGS: Evidence has been found to suggest that for some high-risk individuals, obesity/binge eating may develop as an impulsive reaction to negative emotions that over time becomes a compulsive habit. Animal models highlight the neural mechanisms that might underlie this process and suggest similarities with substance use disorders. Emotional difficulties and neurobiological factors have a role in the aetiology of eating and weight disorders. Precise treatments targeted at these mechanisms may be of help for people who have difficulties with compulsive overeating.


Assuntos
Comportamento Animal , Transtorno da Compulsão Alimentar/psicologia , Bulimia/psicologia , Emoções , Comportamento Alimentar , Animais , Transtorno da Compulsão Alimentar/metabolismo , Transtorno da Compulsão Alimentar/fisiopatologia , Transtorno da Compulsão Alimentar/terapia , Encéfalo/metabolismo , Encéfalo/fisiopatologia , Bulimia/metabolismo , Bulimia/fisiopatologia , Bulimia/terapia , Modelos Animais de Doenças , Predisposição Genética para Doença , Humanos , Fatores de Risco , Autocontrole
17.
Obes Surg ; 27(7): 1872-1878, 2017 07.
Artigo em Inglês | MEDLINE | ID: mdl-28181141

RESUMO

BACKGROUND: Borderline personality disorder (BPD) and eating disorders may affect the outcomes of bariatric surgery. This study was aimed to evaluate the influence of a post-operative dialectical behavioral therapy (DBT) intervention on weight loss and comorbidities in a sample of comorbid obese Italian patients with BPD traits and bulimia tendencies who underwent laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic adjustable gastric banding (LAGB). METHODS: One hundred fifty-four LRYGB or LAGB patients showing BPD and bulimia traits and type II diabetes, hypertension, and/or sleep apnea (OSAS) voluntarily adhered to DBT (n = 72) or treatment as usual (n = 82) for 12 months after surgery. Total weight loss (%TWL) and remission/improvement of comorbidities were considered as outcomes. Differences between treatment groups and between LRYGB and LAGB subgroups were evaluated through Student's t test for TWL and chi-square test for comorbidities. RESULTS: DBT was more effective than treatment as usual (TAU) in reducing weight loss (p < .001). Reduction of comorbidities was higher in patients treated with DBT, as for diabetes (p = .68), hypertension (p = .02), and OSAS (p = .03). LRYGB outcomes seem to be significantly better than those of LAGB, mainly in TAU group. CONCLUSION: Our findings confirm the effectiveness of DBT in enhancing post-bariatric weight loss and reduction of comorbidities in patients showing BPD traits and bulimia tendencies. Further in-depth investigations and a longer follow-up are needed to strengthen these results.


Assuntos
Cirurgia Bariátrica/psicologia , Terapia Comportamental/métodos , Transtorno da Personalidade Borderline/terapia , Bulimia/terapia , Obesidade/psicologia , Adolescente , Adulto , Transtorno da Personalidade Borderline/psicologia , Bulimia/psicologia , Comorbidade , Diabetes Mellitus Tipo 2/psicologia , Diabetes Mellitus Tipo 2/terapia , Feminino , Derivação Gástrica/psicologia , Gastroplastia/psicologia , Humanos , Hipertensão/psicologia , Hipertensão/terapia , Laparoscopia , Masculino , Pessoa de Meia-Idade , Obesidade/cirurgia , Cuidados Pós-Operatórios , Estudos Prospectivos , Apneia Obstrutiva do Sono/psicologia , Apneia Obstrutiva do Sono/terapia , Resultado do Tratamento , Perda de Peso , Adulto Jovem
18.
Trials ; 18(1): 42, 2017 01 26.
Artigo em Inglês | MEDLINE | ID: mdl-28126015

RESUMO

BACKGROUND: Current research indicates that obese individuals have cognitive deficits in executive function, leading to difficulties with planning, impulse control and decision-making. High levels of inflammation have been proposed to contribute to executive function deficits in individuals with obesity. METHODS/DESIGN: One hundred and seventy-six obese participants will be randomly assigned to one of two groups: (1) behavioural weight loss alone (BWL) group = 8 sessions of individual BWL sessions plus 12 group BWL sessions or (2) Cognitive Remediation Therapy for Obesity (CRT-O) plus BWL group (CRT-O + BWL) = 8 sessions of individual CRT-O plus 12 group BWL sessions. The study is double blind - participants will only be told that two weight-loss treatments are being compared and research assistants conducting outcome assessments will not know participants' group allocation. Blood tests will be conducted to measure inflammatory markers. Measurement points will be at baseline, post treatment and 1-year follow-up. The primary outcomes will be differences between treatment groups in percentage weight loss, executive function, binge eating and an examination of whether changes in executive function predict changes in weight and binge eating. Secondary outcome measures will examine changes on inflammation, quality of life, and grazing behaviour and whether these predict changes in executive function and weight. DISCUSSION: If CRT-O + BWL is more effective in assisting people to lose weight long term than BWL alone it should significantly improve treatment outcomes. This study expands upon our recent trial which showed that CRT-O enhanced executive function and weight loss in obese adults. The current study is strengthened by several factors: it is double-blind, it uses an active control, has a larger sample size, and measures inflammation to examine the mechanisms. TRIAL REGISTRATION: The RCT is registered with the Australian New Zealand Registry of Clinical Trial, trial identifier: ACTRN12616000658415 . Registered on 20 May 2016.


Assuntos
Bulimia/terapia , Remediação Cognitiva , Comportamento Alimentar , Comportamentos Relacionados com a Saúde , Obesidade/terapia , Perda de Peso , Adolescente , Adulto , Regulação do Apetite , Biomarcadores/sangue , Bulimia/sangue , Bulimia/fisiopatologia , Bulimia/psicologia , Protocolos Clínicos , Método Duplo-Cego , Função Executiva , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Mediadores da Inflamação/sangue , Masculino , Pessoa de Meia-Idade , New South Wales , Obesidade/sangue , Obesidade/fisiopatologia , Obesidade/psicologia , Qualidade de Vida , Projetos de Pesquisa , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
19.
Commun Med ; 14(2): 135-149, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29958355

RESUMO

One of the goals of psychotherapy with bulimia patients is identification of the functions of the eating disorder in their lives. Thus, as in any psychotherapeutic approach, the therapist should facilitate the patient's disclosure of his or her experience of living with bulimia. Talking about one's dysphoric experiences and, particularly in the case of bulimia, symptoms and experiences that commonly deprive people with bulimia of dignity, constitutes an emotional challenge for the patient and an equally challenging interactional task for the therapist. Using the example of one therapy session with a female bulimia patient, we examine how the therapist and the patient interactionally engage in co-constructing the patient's expertise - involving epistemics of experience as well as epistemics of expertise - concerning the illness in the interactional here-and-now. Applying tools and insights from discourse and conversation analysis, we examine the sequences in which the patient shifts the topical focus from a general observation concerning bulimia to her personal experience, to be further pursued interactionally by the therapist. We also discuss how the therapist downgrades her epistemic position and (concurrently) foregrounds and bolsters the patient's voice as expert to accomplish the session's therapeutic goals.


Assuntos
Bulimia/terapia , Relações Médico-Paciente , Psicoterapia/métodos , Bulimia/psicologia , Feminino , Humanos , Imaginação
20.
Rev. psicanal ; 24(1): 53-80, 2017.
Artigo em Português | LILACS | ID: biblio-913314

RESUMO

O comportamento alimentar, originário e essencial desde o nascimento, remete o sujeito à complexidade da sua relação com o próprio corpo, marca indelével dos efeitos da alteridade. A clínica psicanalítica da anorexia e da bulimia, por sua vez, nos confronta de saída com a questão do corpo, assim como nos coloca diante da especificidade dos processos da adolescência. Tal especificidade evoca as vicissitudes da relação precoce com a mãe no que diz respeito ao gerenciamento pulsional e sua relação com a identificação primária e, consequentemente, com os ideais, a diferenciação, a autonomia, o tempo e a morte. Este artigo traz para a discussão algumas hipóteses, elaboradas a partir da metapsicologia, com o objetivo de contribuir para uma melhor compreensão do processo de construção da imagem corporal. Destaca que o investimento materno, através da escuta e interpretação das sensações corporais realizadas pela mãe, vai construindo para o bebê a imagem de seu corpo e assim sua identidade. Para concluir, enfatiza os possíveis desdobramentos dessa construção teórica na escuta do analista diante das particularidades do manejo transferencial desses casos(AU)


The eating behavior, originating and essential since birth, makes the individual aware of the complex relationship with his own body, an indelible mark of the effects of alterity. On the other hand, the psychoanalytical practice related to anorexia and bulimia immediately confront us with the issue of the body, as well as with the specific processes of adolescence. Such specificities evoke the vicissitudes of the early relationship with the mother regarding the management of the drives and the relationship with primary identification and consequently with ideals, differentiation, autonomy, time and death. This paper discusses some hypotheses based on metapsychology, with the aim of providing a better understanding of the process of constructing the body image. It stresses that the maternal investment, by listening and interpreting the bodily sensations, builds the baby's image of his own body and, therefore, his identity. Finally, it emphasizes the possible repercussions of that theoretical construction in the analyst's listening, given the peculiarities of the transference management in such cases(AU)


El comportamiento alimentario, originario y esencial desde el nacimiento, remite al sujeto a su relación con el propio cuerpo, marca indeleble de los efectos de la alteridad. La clínica psicoanalítica de la anorexia y de la bulimia, a su vez, nos enfrenta de inmediato a la cuestión del cuerpo y a la especificidad de los procesos de la adolescencia. Esa especificidad evoca las vicisitudes de la relación precoz con la madre en lo que dice respecto al manejo pulsional y a su relación con la identificación primaria y, en consecuencia, con los ideales, la diferenciación, la autonomía, el tiempo y la muerte. En este artículo se ponen sobre el tapete algunas hipótesis, elaboradas a partir de la metapsicología, con el objetivo de contribuir a una mejor comprensión del proceso de construcción de la imagen corporal. Se resalta que la investidura materna, por medio de la escucha e interpretación de las sensaciones corporales realizadas por la madre, va construyendo para el bebé la imagen de su cuerpo y, así, su identidad. Para concluir, se enfatizan las posibles repercusiones de dicha construcción teórica en la escucha del analista ante las particularidades del manejo transferencial de esos casos(AU)


Assuntos
Anorexia Nervosa/terapia , Bulimia/terapia , Terapia Psicanalítica , Imagem Corporal/psicologia , Transferência Psicológica
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