Reducing Eating Disorder Onset in a Very High Risk Sample With Significant Comorbid Depression: A Randomized Controlled Trial

Objective: Eating disorders (EDs) are serious problems among college-age women and may be preventable. An indicated online eating disorder (ED) intervention, designed to reduce ED and comorbid pathology, was evaluated. Method: 206 women (M age = 20 +/- 1.8 years; 51% White/Caucasian, 11% African American, 10% Hispanic, 21% Asian/Asian American, 7% other) at very high risk for ED onset (i.e., with high weight/shape concerns plus a history of being teased, current or lifetime depression, and/or nonclinical levels of compensatory behaviors) were randomized to a 10-week, Internet-based, cognitive-behavioral intervention or waitlist control. Assessments included the Eating Disorder Examination (EDE, to assess ED onset), EDE-Questionnaire, Structured Clinical Interview for DSM Disorders, and Beck Depression Inventory-II. Results: ED attitudes and behaviors improved more in the intervention than control group (p = .02, d = 0.31); although ED onset rate was 27% lower, this difference was not significant (p = .28, NNT = 15). In the subgroup with highest shape concerns, ED onset rate was significantly lower in the intervention than control group (20% vs. 42%, p = .025, NNT = 5). For the 27 individuals with depression at baseline, depressive symptomatology improved more in the intervention than control group (p = .016, d = 0.96); although ED onset rate was lower in the intervention than control group, this difference was not significant (25% vs. 57%, NNT = 4). Conclusions: An inexpensive, easily disseminated intervention might reduce ED onset among those at highest risk. Low adoption rates need to be addressed in future research

Attentional biases for threat in at-risk daughters and mothers with lifetime panic disorder

Children of parents with panic disorder (PD) have high risk for developing anxiety disorders. However, the mechanisms involved in transmission of risk are uncertain. Cognitive models of anxiety propose that information-processing biases underlie anxiety vulnerability; in particular, attentional biases for threat. Consequently, this study examined attentional biases in mothers with lifetime PD and their daughters (aged 9 - 14 years). Sixty mother-daughter dyads (N = 120) were recruited to the study; half the mothers had lifetime PD (i.e., either a current or past history of PD); half had no psychiatric history. Attentional biases were assessed using a visual-probe task with pictorial and word stimuli related to physical-health threat. Stimulus duration was varied to examine the time-course of attentional biases (initial orienting and maintained attention). Results showed an attentional bias for threat in daughters of mothers with lifetime PD, compared with daughters of mothers with no PD history. Specifically, at-risk daughters had an attentional bias for physical-health threat cues (words and pictures) at the longer stimulus duration of 1250 ms (but not at 500 ms). In addition, attentional bias for threat in girls was associated with increased physical-health threat worries. Mothers with lifetime PD did not significantly differ from mothers with no PD history on the indices of attentional bias. The findings are discussed in terms of an attentional threat-monitoring strategy in at-risk girls, and argue against the view that there is simple transmission of an anxiety-related attentional processing style across generations