Measuring exercise in eating disorder patients : a Delphi study to aggregate clinical and research knowledge

Background: Exercise is a prominent feature of most eating disorders, and has been shown to have a number of detrimental effects on treatment outcome. There is some disagreement in the literature regarding the construct of compulsive exercise, and assessment and treatment varies significantly. This study therefore aimed to aggregate expert clinicians’ and researchers’ views on how to define and measure compulsive exercise in eating disorder patients. The expert panel was also asked about questionnaire design, and possible problems when measuring compulsive exercise. Method: This study used the Delphi method to establish consensus amongst an expert panel. Three successive rounds of questionnaires were distributed to the panel over a period of six months. The first round consisted of four open-ended questions regarding the definition and measurement of compulsive exercise in eating disorder patients. For Round 2, 70 statements were derived from the answers, and panelists were asked to rate each item on a Likert-based scale. An 85% consensus level was chosen. In Round 3, 44 statements were re-rated by the panel. Results: Seventeen of 24 participants completed all three rounds of the study. Consensus was achieved for 63% of the items, while 18.5% reached near consensus, and 18.5% did not reach consensus after Round 3. The panel agreed on a number of important aspects of compulsive exercise. Several suggestions regarding the format of a questionnaire assessing this behavior were also endorsed. The panel further identified common difficulties when assessing compulsive exercise in eating disorder patients, notably a lack of consensus still apparent in the literature. Conclusion: The current findings constitute a further step towards a unified definition of compulsive exercise, and contribute important suggestions to the measurement of this behavior

Compulsive Exercise in Adolescents with Anorexia Nervosa

The current thesis aimed to contribute to the understanding of the role and overall management of compulsive exercise in adolescents. The first aim was to systematically review the existing research that has studied the prevalence and psychopathological correlates of compulsive exercise in adolescents with eating disorders, which highlighted the limited research within this area. To contribute to the developmental of a clinical profile of compulsive exercise in adolescents with Anorexia Nervosa (AN), a second study was conducted to explore associations between compulsive exercise and both eating and general psychopathology in 60 adolescent inpatients with AN. Results revealed that the avoidance aspect of compulsive exercise was associated with elevated scores on measures of eating disorder and general psychopathology, whereas the mood improvement value of exercise did not reflect such trends. In aim of furthering our understanding of the mood regulatory role of exercise and moving towards examining possible means of managing compulsive exercise, an observational study was then conducted with the same clinical sample. This third study aimed to explore whether supervised exercise produced acute psychological benefits for adolescent inpatients receiving treatment for AN. Promising acute psychological benefits were found from participation in the supervised exercise program. Taken together, such research emphasized the need for the development of treatment guidelines that target the complexities of compulsive exercise in adolescents with AN. In the absence of empirical evidence, a final study was conducted that used the Delphi methodology to explore and establish expert clinical consensus on how to manage compulsive exercise in this vulnerable population. These findings serve as preliminary clinical practice guidelines, and the research project as a whole highlights the complex nature of compulsive exercise in AN that requires continued research and clinical efforts

Establishing consensus for labeling and defining the later stage of anorexia nervosa : a Delphi study

Objective: Varied perspectives on the later stage of anorexia nervosa (AN) have left the field of eating disorders without a consistent label or definition for this subpopulation. As a result, diverse criteria when recruiting participants have led to incomparable results across research studies and a lack of guidance when assessing and treating patients in the clinical context. The aim of the current study was to develop consensus-based guidelines on the labeling and defining of the later stage of AN. Method: Utilizing the Delphi methodology, a professional panel of experts (N = 21) participated in three rounds of questionnaires. Five open-ended questions (Round 1) were analyzed using content analysis to form statements relating to a classification system for labeling and defining the later stage of AN. A total of 80 statements were rated in terms of panelists' level of agreement (Rounds 2 and 3). Results: Consensus was achieved for 28.8% of statements and a further 16.3% of statements reached near consensus in the second and third round of questionnaires. Two labels were identified with five defining features achieving consensus. Discussion: Findings from the study suggest an alternative approach to labeling be adopted with consensus-based guidelines established for defining the later stage of AN. Implications that may occur from a unified classification system are explored with longitudinal research required to assess the impact on patients experiencing the later stage of AN

A clinical profile of compulsive exercise in adolescent inpatients with anorexia nervosa

Background: The aim of the current study was to contribute to the development of a clinical profile of compulsive exercise in adolescents with Anorexia Nervosa (AN), by examining associations between compulsive exercise and eating and general psychopathology. Method: A sample of 60 female adolescent inpatients with AN completed a self-report measure of compulsive exercise and a series of standardized self-report questionnaires assessing eating and general psychopathology. Results: Higher levels of compulsive exercise were associated with increased levels of eating disorder psychopathology and anxiety. Specifically, the avoidance aspect (negatively reinforced) of compulsive exercise was associated with elevated scores on measures of eating disorder, anxiety, depression, and obsessive compulsiveness psychopathology, as well as lower self-esteem scores. The mood improvement value (positively reinforced) of compulsive exercise, however, did not reflect such trends. Conclusions: Compulsive exercise driven by avoidance of negative affect is associated with more severe psychological features in adolescent inpatients with AN. The current findings emphasize the need for research and clinical efforts in the development of treatments addressing avoidance of negative affect and compulsive exercise in adolescents with AN

Exercise for the compulsive exercisers? : an exploratory study in adolescent inpatients with anorexia nervosa

Objective: This study aimed to explore whether exercise produced acute psychological benefits for adolescent inpatients receiving treatment for anorexia nervosa (AN). Specifically, the study examined whether a supervised inpatient exercise programme resulted in negative or positive affective changes over time, and if the participant’s reported level of compulsive exercise influenced such changes. Method: Forty-seven adolescent female inpatients with a DSM-5 diagnosis of AN completed a measure of compulsive exercise at admission to an eating-disorder inpatient programme. Participants routinely attended physiotherapy sessions (exercise condition) and school lessons (school condition) throughout their admission, and completed visual analogue scales assessing anxious, depressed, and positive affect immediately prior to and after both conditions. Results: Participants reported a significant decrease in anxious and depressed affect, and an increase in positive affect after the exercise condition compared to the school condition. Participants with higher levels of compulsive exercise features reported significantly greater decreases in anxious affect following exercise. Discussion: The current study provides promising results in terms of the acute psychological benefits supervised exercise can offer adolescent inpatients with AN. Research and clinical efforts are required to develop standardised treatment guidelines for exercise programmes and the management of compulsive exercise in this population during active treatment

A Systematic Review of Machine Learning for Assessment and Feedback of Treatment Fidelity

Many psychological treatments have been shown to be cost-effective and efficacious, as long as they are implemented faithfully. Assessing fidelity and providing feedback is expensive and time-consuming. Machine learning has been used to assess treatment fidelity, but the reliability and generalisability is unclear. We collated and critiqued all implementations of machine learning to assess the verbal behaviour of all helping professionals, with particular emphasis on treatment fidelity for therapists. We conducted searches using nine electronic databases for automated approaches of coding verbal behaviour in therapy and similar contexts. We completed screening, extraction, and quality assessment in duplicate. Fifty-two studies met our inclusion criteria (65.3% in psychotherapy). Automated coding methods performed better than chance, and some methods showed near human-level performance; performance tended to be better with larger data sets, a smaller number of codes, conceptually simple codes, and when predicting session-level ratings than utterance-level ones. Few studies adhered to best-practice machine learning guidelines. Machine learning demonstrated promising results, particularly where there are large, annotated datasets and a modest number of concrete features to code. These methods are novel, cost-effective, scalable ways of assessing fidelity and providing therapists with individualised, prompt, and objective feedback