Treating the overlooked majority: quantitative outcomes from an NHS adaptation of Interpersonal Group Psychotherapy for binge eating disorder

Purpose To evaluate the effectiveness of an adaptation of Interpersonal Group Psychotherapy (IPT-G), in facilitating short- and longer-term improvements in eating disorder symptomology, psychosocial impairment, anxiety, depression and attachment difficulties among adults living with overweight and diagnosed with binge eating disorder (BED). Design/methodology/approach In total, 24 participants completed measures at the start of IPT-G, mid-treatment, discharge and six-month follow-up. Quantitative outcomes were analysed utilising one-way repeated measures analysis of variance. Findings Treatment retention was 100%. Significant improvements in binge-eating frequency, psychosocial impairment and depression were achieved at mid-treatment and maintained at post-treatment and six-month follow-up, and with large effect sizes. Attachment anxiety had reduced significantly at post-treatment and was maintained at six-month review. Body mass index (BMI) had stabilised by mid-treatment and was maintained at post-treatment and six-month follow-up. All hypotheses were supported, with the exception that attachment avoidance did not improve significantly and following a post-treatment reduction, anxiety symptoms deteriorated slightly by six-month follow-up, such that they were no longer significantly different from pre-treatment levels. Practical implications Despite being the most prevalent of the eating disorders (compared to anorexia nervosa and bulimia nervosa), BED is under-recognised and under-treated in clinical settings. Results indicate the sustained effectiveness of IPT-G in improving eating disorder and comorbid symptomology associated with BED. Originality/value This is the first UK study to investigate the effectiveness of IPT-G at treating BED. Unlike previous studies in the field, this study did not exclude participants based on age, BMI or psychiatric comorbidity.

Download Full-text

Change in impulsivity is prospectively associated with treatment outcomes for binge-eating disorder

Psychological Medicine ◽

10.1017/s003329172100475x ◽

2021 ◽

pp. 1-9

Author(s):

Rebecca G. Boswell ◽

Ralitza Gueorguieva ◽

Carlos M. Grilo

Keyword(s):

Eating Disorder ◽

Binge Eating ◽

Treatment Outcomes ◽

Binge Eating Disorder ◽

Pharmacological Treatment ◽

Rapid Change ◽

Post Treatment ◽

Controlled Clinical Trial ◽

Eating Disorder Psychopathology

Abstract Background Impulsivity may be a process underlying binge-eating disorder (BED) psychopathology and its treatment. This study examined change in impulsivity during cognitive-behavioral therapy (CBT) and/or pharmacological treatment for BED and associations with treatment outcomes. Methods In total, 108 patients with BED (NFEMALE = 84) in a randomized placebo-controlled clinical trial evaluating the efficacy of CBT and/or fluoxetine were assessed before treatment, monthly throughout treatment, at post-treatment (16 weeks), and at 12-month follow-up after completing treatment. Patients completed established measures of impulsivity, eating-disorder psychopathology, and depression, and were measured for height and weight [to calculate body mass index (BMI)] during repeated assessments by trained/monitored doctoral research-clinicians. Mixed-effects models using all available data examined changes in impulsivity and the association of rapid and overall changes in impulsivity on treatment outcomes. Exploratory analyses examined whether baseline impulsivity predicted/moderated outcomes. Results Impulsivity declined significantly throughout treatment and follow-up across treatment groups. Rapid change in impulsivity and overall change in impulsivity during treatment were significantly associated with reductions in eating-disorder psychopathology, depression scores, and BMI during treatment and at post-treatment. Overall change in impulsivity during treatment was associated with subsequent reductions in depression scores at 12-month follow-up. Baseline impulsivity did not moderate/predict eating-disorder outcomes or BMI but did predict change in depression scores. Conclusions Rapid and overall reductions in impulsivity during treatment were associated with improvements in specific eating-disorder psychopathology and associated general outcomes. These effects were found for both CBT and pharmacological treatment for BED. Change in impulsivity may be an important process prospectively related to treatment outcome.

Download Full-text

Managing Risk of Non-Communicable Diseases in Women with Bulimia Nervosa or Binge Eating Disorders: A Randomized Trial with 12 Months Follow-Up

Nutrients ◽

10.3390/nu10121887 ◽

2018 ◽

Vol 10 (12) ◽

pp. 1887 ◽

Cited By ~ 2

Author(s):

Therese Mathisen ◽

Jorunn Sundgot-Borgen ◽

Jan Rosenvinge ◽

Solfrid Bratland-Sanda

Keyword(s):

Eating Disorder ◽

Bulimia Nervosa ◽

Physical Fitness ◽

Binge Eating ◽

Binge Eating Disorder ◽

Communicable Diseases ◽

Post Treatment ◽

Dietary Therapy ◽

Non Communicable Diseases

Persons with bulimia nervosa (BN) or binge eating disorder (BED) have an elevated risk of non-communicable diseases (NCDs). However, lowering this risk is rarely addressed in standard cognitive-behavioral treatment (CBT). We aimed to compare CBT with an intervention combining physical exercise and dietary therapy (PED-t), and hypothesized that the PED-t would do better than CBT in lowering the risk of NCD both initially and longitudinally. In this study, 164 women with bulimia nervosa or binge eating disorder were randomly assigned to 16-weeks of outpatient group therapy with either PED-t or CBT. Body composition (BC) was measured by dual-energy X-ray absorptiometry. Measures of physical fitness (VO2peak and one repetition maximum (1RM) in squats, bench press, and seated row) were also recorded. All measurements were completed baseline, post-treatment, and at 6- and 12-month follow-ups, respectively. Our results showed that PED-t improved more than CBT on mean (99% CI) absolute Vo2peak; 57,2 (84.4, 198.8) mL (g = 0.22, p < 0.001) post-treatment. There were small to medium long-term differences in 1RM after PED-t compared to CBT. BC deteriorated in both groups during follow-up. Neither the PED-t nor the CBT lowered the risk for NCDs. Clearly, other approaches need to be considered to promote physical fitness and lower the risk of NCDs among individuals with BN and BED.

Download Full-text

Effectiveness of day treatment for eating disorders: are improvements maintained at 12-month follow-up?

Mental Health Review Journal ◽

10.1108/mhrj-09-2019-0032 ◽

2020 ◽

Vol 25 (3) ◽

pp. 255-268

Author(s):

Zoë Meropi Hepburn ◽

Emily Rose Rothwell

Keyword(s):

Eating Disorders ◽

Eating Disorder ◽

Repeated Measures ◽

Day Treatment ◽

Content Type ◽

Psychosocial Impairment ◽

Eating Disordered ◽

Eating Disorder Symptoms ◽

Repeated Measures Analysis

Purpose This study aimed to investigate the effectiveness of a specialist UK day treatment programme (DTP), in terms of whether improvements in eating disorder symptomology and psychosocial impairment achieved at discharge were maintained at 6-month and 12-month follow-ups. Design/methodology/approach A total of 69 patients (aged 16+) with eating disorders who had received treatment in the DTP were reviewed at 6-month and 12-month follow-ups, using demographic, physiological and psychological measures. Quantitative outcomes were analysed using one-way repeated measures analysis of variance. Findings Data analysis revealed that significant improvements in eating disordered attitudes, body mass index (among underweight participants), binge frequency (among participants with those symptoms) and psychosocial impairment achieved at discharge, were also maintained at 6-month and 12-month follow-ups, and with large effect sizes. All hypotheses were supported, with the exception that frequency of vomiting symptoms had deteriorated at the 12-month follow-up and was no longer significantly different from vomiting frequency on admission. Originality/value Results provide support for the sustained effectiveness of DTPs in improving eating disorder symptoms and psychosocial impairment associated with eating disorders. This is the first study to evaluate the effectiveness of a UK DTP for adults at maintaining improvements to eating disorder symptoms and attitudes at follow-up.

Download Full-text

The impact of attachment anxiety on interpersonal complementary interactions in group psychotherapy of women with binge eating disorder

10.22215/etd/2011-07378 ◽

2011 ◽

Author(s):

Hilary Maxwell

Keyword(s):

Eating Disorder ◽

Binge Eating ◽

Group Psychotherapy ◽

Binge Eating Disorder ◽

Attachment Anxiety ◽

Complementary Interactions ◽

The Impact

Download Full-text

Translating Virtual Reality Cue Exposure Therapy for Binge Eating into a Real-World Setting: An Uncontrolled Pilot Study

Journal of Clinical Medicine ◽

10.3390/jcm10071511 ◽

2021 ◽

Vol 10 (7) ◽

pp. 1511

Author(s):

Katherine Nameth ◽

Theresa Brown ◽

Kim Bullock ◽

Sarah Adler ◽

Giuseppe Riva ◽

...

Keyword(s):

Virtual Reality ◽

Eating Disorder ◽

Binge Eating ◽

Real World ◽

Exposure Therapy ◽

Post Treatment ◽

Cue Exposure ◽

Treatment Gains ◽

Intent To Treat

Binge-eating disorder (BED) and bulimia nervosa (BN) have adverse psychological and medical consequences. Innovative interventions, like the integration of virtual reality (VR) with cue-exposure therapy (VR-CET), enhance outcomes for refractory patients compared to cognitive behavior therapy (CBT). Little is known about the feasibility and acceptability of translating VR-CET into real-world settings. To investigate this question, adults previously treated for BED or BN with at least one objective or subjective binge episode/week were recruited from an outpatient university eating disorder clinic to receive up to eight weekly one-hour VR-CET sessions. Eleven of 16 (68.8%) eligible patients were enrolled; nine (82%) completed treatment; and 82% (9/11) provided follow-up data 7.1 (SD = 2.12) months post-treatment. Overall, participant and therapist acceptability of VR-CET was high. Intent-to-treat objective binge episodes (OBEs) decreased significantly from 3.3 to 0.9/week (p < 0.001). Post-treatment OBE 7-day abstinence rate for completers was 56%, with 22% abstinent for 28 days at follow-up. Among participants purging at baseline, episodes decreased from a mean of one to zero/week, with 100% abstinence maintained at follow-up. The adoption of VR-CET into real-world clinic settings appears feasible and acceptable, with a preliminary signal of effectiveness. Findings, including some loss of treatment gains during follow-up may inform future treatment development.

Download Full-text

Fluoxetine and Fluvoxamine Combined with Individual Cognitive-Behaviour Therapy in Binge Eating Disorder: A One-Year Follow-Up Study

Psychotherapy and Psychosomatics ◽

10.1159/000056270 ◽

2001 ◽

Vol 70 (6) ◽

pp. 298-306 ◽

Cited By ~ 68

Author(s):

Valdo Ricca ◽

Edoardo Mannucci ◽

Barbara Mezzani ◽

Sandra Moretti ◽

Milena Di Bernardo ◽

...

Keyword(s):

Eating Disorder ◽

Binge Eating ◽

Binge Eating Disorder ◽

Cognitive Behaviour Therapy ◽

Behaviour Therapy ◽

Follow Up Study ◽

Cognitive Behaviour ◽

One Year

Download Full-text

Micro-level de-coupling of negative affect and binge eating in relationship to macro-level outcomes in binge eating disorder treatment

Psychological Medicine ◽

10.1017/s0033291720001804 ◽

2020 ◽

pp. 1-9

Author(s):

Kathryn E. Smith ◽

Tyler B. Mason ◽

Lauren M. Schaefer ◽

Lisa M. Anderson ◽

Vivienne M. Hazzard ◽

...

Keyword(s):

Emotion Regulation ◽

Eating Disorder ◽

Negative Affect ◽

Binge Eating ◽

Binge Eating Disorder ◽

Behavioral Treatment ◽

Future Research ◽

End Of Treatment ◽

Pre Treatment

Abstract Background While negative affect reliably predicts binge eating, it is unknown how this association may decrease or ‘de-couple’ during treatment for binge eating disorder (BED), whether such change is greater in treatments targeting emotion regulation, or how such change predicts outcome. This study utilized multi-wave ecological momentary assessment (EMA) to assess changes in the momentary association between negative affect and subsequent binge-eating symptoms during Integrative Cognitive Affective Therapy (ICAT-BED) and Cognitive Behavior Therapy Guided Self-Help (CBTgsh). It was predicted that there would be stronger de-coupling effects in ICAT-BED compared to CBTgsh given the focus on emotion regulation skills in ICAT-BED and that greater de-coupling would predict outcomes. Methods Adults with BED were randomized to ICAT-BED or CBTgsh and completed 1-week EMA protocols and the Eating Disorder Examination (EDE) at pre-treatment, end-of-treatment, and 6-month follow-up (final N = 78). De-coupling was operationalized as a change in momentary associations between negative affect and binge-eating symptoms from pre-treatment to end-of-treatment. Results There was a significant de-coupling effect at follow-up but not end-of-treatment, and de-coupling did not differ between ICAT-BED and CBTgsh. Less de-coupling was associated with higher end-of-treatment EDE global scores at end-of-treatment and higher binge frequency at follow-up. Conclusions Both ICAT-BED and CBTgsh were associated with de-coupling of momentary negative affect and binge-eating symptoms, which in turn relate to cognitive and behavioral treatment outcomes. Future research is warranted to identify differential mechanisms of change across ICAT-BED and CBTgsh. Results also highlight the importance of developing momentary interventions to more effectively de-couple negative affect and binge eating.

Download Full-text

Targeting binge eating in bulimia nervosa and binge eating disorder using inhibitory control training and implementation intentions: a feasibility trial

Psychological Medicine ◽

10.1017/s0033291720002494 ◽

2020 ◽

pp. 1-10

Author(s):

Rayane Chami ◽

Valentina Cardi ◽

Natalia Lawrence ◽

Pamela MacDonald ◽

Katie Rowlands ◽

...

Keyword(s):

Eating Disorder ◽

Bulimia Nervosa ◽

Binge Eating ◽

Binge Eating Disorder ◽

Implementation Intentions ◽

Effect Sizes ◽

Post Intervention ◽

Eating Frequency ◽

Eating Disorder Psychopathology

Abstract Background This trial examined the feasibility, acceptability, and effect sizes of clinical outcomes of an intervention that combines inhibitory control training (ICT) and implementation intentions (if-then planning) to target binge eating and eating disorder psychopathology. Methods Seventy-eight adult participants with bulimia nervosa or binge eating disorder were randomly allocated to receive food-specific, or general, ICT and if-then planning for 4 weeks. Results Recruitment and retention rates at 4 weeks (97.5% and 79.5%, respectively) met the pre-set cut-offs. The pre-set adherence to the intervention was met for the ICT sessions (84.6%), but not for if-then planning (53.4%). Binge eating frequency and eating disorder psychopathology decreased in both intervention groups at post-intervention (4 weeks) and follow-up (8 weeks), with moderate to large effect sizes. There was a tendency for greater reductions in binge eating frequency and eating disorders psychopathology (i.e. larger effect sizes) in the food-specific intervention group. Across both groups, ICT and if-then planning were associated with small-to-moderate reductions in high energy-dense food valuation (post-intervention), food approach (post-intervention and follow-up), anxiety (follow-up), and depression (follow-up). Participants indicated that both interventions were acceptable. Conclusions The study findings reveal that combined ICT and if-then planning is associated with reductions in binge eating frequency and eating disorder psychopathology and that the feasibility of ICT is promising, while improvements to if-then planning condition may be needed.

Download Full-text