Reciprocal Influence of Distress and Group Therapeutic Factors in Day Treatment for Eating Disorders: A Progress and Process Monitoring Study

Eating disorders (EDs) are chronic mental illnesses with high levels of psychological, social, and health burden. Day treatment programs (DTP) are effective group-based partial hospital models that have been used to treat EDs for several decades. However, few studies have examined the factors associated with reduced distress in ED patients who participate in DTP groups. Related to this is whether change in distress is preceded by change in positive group processes, or vice versa. In this study we examine the reciprocal relationship between growth of group therapeutic factors and change in distress in an ED sample. Participants were patients with an ED (n=156) who took part in a 12-week DTP at a tertiary care hospital center. On a weekly basis, patients completed progress and process monitoring measures. We hypothesized: (a) positive changes in distress and in group therapeutic factors across weeks of DTP, and (b) a bidirectional relationship between change in distress and group therapeutic factors. We found a significant growth of group therapeutic factors and decline in distress over the 12 weeks of DTP. We also found evidence for a reciprocal relationship between change in group therapeutic factors and change in distress. Group therapists working in DTPs for patients with EDs can enhance the benefits of treatment by focusing on group therapeutic processes, which in turn reduces distress, which then acts to enhance the ability of an individual to benefit from group interactions

Correction: Characterization of IGF-II Isoforms in Binge Eating Disorder and Its Group Psychological Treatment

Binge eating disorder (BED) affects 3.5% of the population and is characterized by binge eating for at least 2 days a week for 6 months. Treatment options include cognitive behavioral therapy, interpersonal psychotherapy, and pharmacotherapy which are associated with varied success. Little is known about the biology of BED. Since there is evidence that the insulin like growth factor system is implicated in regulation of body weight, insulin sensitivity and feeding behavior, we speculated it may be involved in BED.A cross-sectional comparison was made between three groups of women: overweight with BED, overweight without BED and normal weight without BED. Women were assigned to Group Psychodynamic Interpersonal Psychotherapy. Blood was collected before therapy, at completion and at 6 months follow up for evaluation of IGF-II using Western blot.97 overweight women with BED contributed to the cross-sectional comparison. The two control groups comprised 53 overweight women without BED, and 50 age matched normal weight women without BED. Obese women had significantly lower Big IGF-II than normal weight women, p = .028; Overweight women with BED had higher Mature IGF-II than normal weight women, p<.05. Big IGF-II showed a significant decreasing slope from pre- to post- to six months post-group psychological treatment, unrelated to changes in BMI (p = .008).Levels of IGF-II isoforms differed significantly between overweight and normal weight women. Overweight women with BED display abnormal levels of circulating IGF-II isoforms. BED is characterized by elevated mature IGF-II, an isoform shown to carry significant bioactivity. This finding is not related to BMI or to changes in body weight. The results also provide preliminary evidence that BIG IGF-II is sensitive to change due to group psychological treatment. We suggest that abnormalities in IGF-II processing may be involved in the neurobiology of BED

Demographic data on the three samples.

<p>Note: BED = binge eating disorder. <i>SD</i> = standard deviation. Family income in Canadian dollars in which $1 Canadian =$0.99 US.</p

Means, standard deviations (<i>SD</i>), univariate p-values, and Tukey's post-hoc paired comparisons results for each IGF-II variable by group.

<p>BED = overweight binge eating disorder; OW = overweight group; NW = normal weight group.</p

Means and standard deviations (SD) of each IGF-II variable across three group psychological treatment assessment periods for women with binge eating disorder.

<p>Means and standard deviations (SD) of each IGF-II variable across three group psychological treatment assessment periods for women with binge eating disorder.</p

Testing a stepped care model for binge-eating disorder: a two-step randomized controlled trial

Background: A stepped care approach involves patients first receiving low-intensity treatment followed by higher intensity treatment. This two-step randomized controlled trial investigated the efficacy of a sequential stepped care approach for the psychological treatment of binge-eating disorder (BED). Methods: In the first step, all participants with BED (n = 135) received unguided self-help (USH) based on a cognitive-behavioral therapy model. In the second step, participants who remained in the trial were randomized either to 16 weeks of group psychodynamic-interpersonal psychotherapy (GPIP) (n = 39) or to a no-treatment control condition (n = 46). Outcomes were assessed for USH in step 1, and then for step 2 up to 6-months post-treatment using multilevel regression slope discontinuity models. Results: In the first step, USH resulted in large and statistically significant reductions in the frequency of binge eating. Statistically significant moderate to large reductions in eating disorder cognitions were also noted. In the second step, there was no difference in change in frequency of binge eating between GPIP and the control condition. Compared with controls, GPIP resulted in significant and large improvement in attachment avoidance and interpersonal problems. Conclusions: The findings indicated that a second step of a stepped care approach did not significantly reduce binge-eating symptoms beyond the effects of USH alone. The study provided some evidence for the second step potentially to reduce factors known to maintain binge eating in the long run, such as attachment avoidance and interpersonal problems