Prädiktoren des Behandlungserfolgs adipöser Patienten mit einer Binge Eating Disorder : eine mögliche differentielle Zuteilung zu einer störungsspezifischen kognitiv-verhaltenstherapeutischen Behandlung oder einem behavioralen Gewichtsreduktionsansatz?

Einleitung: Die Binge Eating Disorder (BED) wird als eine Essstörung definiert, die sich durch wiederkehrende Essanfälle ohne regelmässiges Kompensationsverhalten charakterisiert. Im DSM-IV wird die BED als eine neue Diagnose vorgeschlagen, die jedoch in weiteren Forschungsarbeiten noch zu überprüfen ist. Etwa 30% der Teilnehmer an Gewichtsreduktionsprogrammen erfüllen die Kriterien einer BED. In der Allgemeinbevölkerung liegt die Prävalenz bei 2%, wobei Frauen 1,5-mal häufiger betroffen sind als Männer. Verschiedene psychotherapeutische Therapieansätze zur Behandlung der BED mit unterschiedlichen inhaltlichen Schwerpunkten wurden bisher überprüft, woraus eine vergleichbare Effektivität hinsichtlich der essstörungsspezifischen Symptomatik resultierte. Aktuell liegen noch wenige Studienresultate aus der BED-Prädiktorenforschung vor, die eine differentielle Zuteilung zu einem spezifischen BED-Behandlungsansatz aufgrund individueller Patientencharakteristika erlauben und somit eine Steigerung der Therapieeffektivität ermöglichen würden. Fragestellung: Ausgehend von bisherigen Forschungsergebnissen zum Therapieerfolg der BED wurden mögliche differenzierende BED-Behandlungsprädiktoren erfasst und überprüft. Es wurde der prädiktive Wert spezifischer essstörungs- und gewichtsspezifischer anamnestischer Variablen und der Zustandsvariablen der Depression und Angst adipöser BED-Patienten auf den unmittelbaren Behandlungsausgang allgemein sowie zweier verschiedener Behandlungsansätze (störungsspezifische kognitiv-verhaltenstherapeutische Behandlung = KVT versus behaviorale Gewichtsreduktion = BGR) untersucht. Patienten und Methoden: Im Rahmen einer kontrollierten, randomisierten Therapiestudie wurden 38 adipöse BED-Patienten entweder mittels KVT oder BGR behandelt (KVT, n=18; BGR, n=20). Beide Therapieformen wurden im ambulanten Gruppensetting in 16 wöchentlichen Sitzungen durchgeführt. Die BED-Symptomatik und die dazugehörende essstörungsspezifische Psychopathologie sowie die Zustandsvariablen der Stimmung und der Angst wurden zu Beginn, im Verlauf und am Ende der jeweiligen Behandlung standardisiert erhoben. Als mögliche Prädiktoren für den Behandlungsausgang wurden anamnestische Variablen bezüglich der BED- und der Adipositaserkrankung, die Anzahl der Essanfälle bei Therapiebeginn sowie die Zustandsvariablen der Stimmung, Angst und des Gewichts erfasst und analysiert. Ergebnisse: Unabhängig vom Behandlungsansatz resultierte eine signifikante Reduktion der BED-Kernsypmptomatik. Für das Ausmass der Reduktion der Psychopathologie sowie deren individuelles Profil ergaben sich keine Unterschiede zwischen den beiden BEDBehandlungen, die KVT war im Vergleich zur BGR jedoch tendenziell effektiver hinsichtlich der Reduktion der Essanfälle. Das Ausmass der Stimmungsbeeinträchtigung sowie das Alter beim erstmaligen Diätieren erwiesen sich als generell den Behandlungserfolg beeinflussend. Die Variablen des Alters bei der BED-Erstmanifestation bzw. des ersten Essanfalls sowie des BMI bei Behandlungsbeginn resultierten als prädiktiv für den Therapieerfolg der unterschiedlichen Behandlungsansätze. Diskussion: Ein BED-Erstmanifestationsalter um das 30. Lebensjahr sowie eine BMI-Grenze um ca. 32 erwiesen sich als entscheidende Patientencharakteristika für die differentielle Zuteilung zur KVT oder BGR. Die therapeutische Bedeutung dieser Prädiktoren sowie Überlegungen zur Interpretation der Ergebnisse und weiterführenden Untersuchungen werden abschliessend diskutiert

Evaluation of a lifestyle change programme for the treatment of obesity in general practice

In order to evaluate the effectiveness of a cognitive behavioural group therapy programme for the treatment of obesity in clinical practice, 122 patients from 14 general practices (n = 70) were randomised into either a treatment or a control arm with a ratio of 3 to 2. The group treatment programme was also assessed in a clinical centre (n = 52; University Hospital Basel). Before therapy, a clinical interview and a mental disorder examination were carried out on all patients. The instructors of the programme (practitioners; clinic physicians) were trained during two afternoon meetings to supervise the group sessions. The treatment programme consisted of 16 group sessions of 90 min each, and contained psycho-educational elements concerning a balanced diet, instruction for the integration of more activity in everyday life (lifestyle activity), problemsolving strategies, and the cognitive restructuring of dysfunctional cognition regarding the own body. All the patients who were treated in the various settings demonstrated a benefit from therapy. Compared to the control groups which received usual medical care, they were able to reduce their starting weight by around 5% (p <0.001 for the group treated by practitioners) at the end of treatment and stabilise it until follow up after one year. In regard to psychological factors the treatment groups showed an increased sense of control over eating behaviour, and feelings of distractibility and hunger were reduced after treatment and at follow up (p <0.05). All treatment groups showed statistically relevant increases in feelings of attractiveness regarding their body and shape (p <0.05). These results support the effectiveness of the integrated cognitive behavioural treatment programme in clinical practice over a duration of 12 months

Self-reported emotion regulation difficulties are associated with mood but not with the biological stress response to thin ideal exposure

BACKGROUND:Difficulties in emotion regulation have been related to psychological and physiological stress responses such as lower mood and lower parasympathetic activation (HF-HRV) under resting condition, but evidence on the potential link to the hypothalamic-pituitary-adrenal (HPA) axis functioning and to physiological stress responses during a stress task is still scarce. The aim of the study was to investigate stress responses in young women when confronted to a daily stressor such as exposure to thin ideals and to understand the role of correlates of self-reported trait-like emotion regulation difficulties (ERD). METHODS:Heart rate variability (HRV) and salivary cortisol data were collected in a sample of 273 young women aged 18-35 with and without mental disorders during a vivid imagination of thin ideals (experimental condition) or landscapes (control condition). Changes in mood states were measured on a visual analogue scale (0-100). Correlates of trait-like ERD were self-reported using the Difficulties in Emotion Regulation Scale (DERS). RESULTS:Participants with higher ERD showed a stronger decline in self-reported mood after vivid imagination of thin ideals compared to participants with lower ERD in the experimental condition but also a stronger increase of positive mood with increasing ERD in the control condition. ERD were not related to baseline HF-HRV or baseline salivary cortisol levels nor to any physiological response during and after the imagination of thin ideals. DISCUSSION AND CONCLUSION:The results corroborate the role of ERD regarding the immediate psychological impact of daily stressors. Exposition to daily stressors in the laboratory results in discrepant psychological and physiological reactivity. Future studies should investigate under what conditions the complex interrelations between immediate and long-term ERD and biological activation are amenable to assessment in a laboratory setting. The additive effects of multiple exposition to stressors, such as thin ideals in daily life, also need to be addressed

Evaluation of a lifestyle change programme for the treatment of obesity in general practice

In order to evaluate the effectiveness of a cognitive behavioural group therapy programme for the treatment of obesity in clinical practice, 122 patients from 14 general practices (n = 70) were randomised into either a treatment or a control arm with a ratio of 3 to 2. The group treatment programme was also assessed in a clinical centre (n = 52; University Hospital Basel). Before therapy, a clinical interview and a mental disorder examination were carried out on all patients. The instructors of the programme (practitioners; clinic physicians) were trained during two afternoon meetings to supervise the group sessions. The treatment programme consisted of 16 group sessions of 90 min each, and contained psycho-educational elements concerning a balanced diet, instruction for the integration of more activity in everyday life (lifestyle activity), problemsolving strategies, and the cognitive restructuring of dysfunctional cognition regarding the own body. All the patients who were treated in the various settings demonstrated a benefit from therapy. Compared to the control groups which received usual medical care, they were able to reduce their starting weight by around 5% (p textless0.001 for the group treated by practitioners) at the end of treatment and stabilise it until follow up after one year. In regard to psychological factors the treatment groups showed an increased sense of control over eating behaviour, and feelings of distractibility and hunger were reduced after treatment and at follow up (p textless0.05). All treatment groups showed statistically relevant increases in feelings of attractiveness regarding their body and shape (p textless0.05). These results support the effectiveness of the integrated cognitive behavioural treatment programme in clinical practice over a duration of 12 months

Efficacy and predictors of long-term treatment success for cognitive-behavioral treatment and behavioral weight-loss-treatment in overweight individuals with binge eating disorder

Objective The aim of the study was to assess the long-term efficacy of Cognitive-Behavioral Treatment (CBT) and Behavioral Weight-Loss-Treatment (BWLT) in patients with binge eating disorder (BED) and to identify potential predictors of long-term treatment success. Method In a sample of overweight to obese BED patients from a randomized comparative trial we evaluated the efficacy of four months of CBT or BWLT, followed by 12 months extended care, and a final follow-up assessment 6 years after the end of active treatment. Outcomes included binge eating, eating disorder pathology, depressive feelings, and body mass index. Results After a strong improvement during active treatment, outcomes worsened during follow-up, yet remained improved at 6-year follow-up relative to pretreatment values. Long-term effects between CBT and BWLT were comparable. Rapid response during the early treatment phase was the only characteristic that was predictive of favorable treatment outcome in the long term. Conclusions Both CBT and BWLT can be considered to be comparably efficacious in the long-term. Patients not responding strongly enough during the first four therapy sessions might be in need of tailored interventions early during the treatment phase

The public's probabilistic numeracy : how tasks, education and exposure to games of chance shape it

As we navigate a world full of uncertainties and risks, dominated by statistics, we need to be able to think statistically. Very few studies investigating people's ability to understand simple concepts and rules from probability theory have drawn representative samples from the public. For this reason we investigated a representative sample of 1000 Swiss citizens, using six probabilistic problems. Most reasoned appropriately in problems representing pure applications of probability theory, but failed to do so in approximations of real-world scenarios - a disparity we replicated in a sample of first-year psychology students. Additionally, education is associated with probabilistic numeracy in the former but not the latter type of problems. We discuss possible reasons for these task disparities and suggest that gaining a comprehensive picture of citizens' probabilistic competence and its determinants requires using both types of tasks

Cognitive distortions associated with imagination of the thin ideal: validation of the thought-shape fusion body questionnaire (TSF-B)

Thought-shape fusion (TSF) describes the experience of body-related cognitive distortions associated with eating disorder (ED) pathology. In the laboratory TSF has been activated by thoughts about fattening/forbidden foods and thin ideals. This study aims at validating a questionnaire to assess the trait susceptibility to TSF (i.e., body-related cognitive distortions) associated with the imagination of thin ideals, and developing an adapted version of the original TSF trait questionnaire, the Thought-Shape Fusion Body Questionnaire (TSF-B). Healthy control women (HC, n = 317) and women diagnosed with subthreshold and clinical EDs (n = 243) completed an online-questionnaire. The factor structure of the TSF-B questionnaire was examined using exploratory (EFA) and subsequent confirmatory factor analysis (CFA). EFA pointed to a two-factor solution, confirmed by CFA. Subscale 1 was named Imagination of thin ideals, containing five items referring to the imagination of female thin ideals. Subscale 2 was named Striving for own thin ideal, with seven items about pursuing/abandoning attempts to reach one’s own thin ideal. The total scale and both subscales showed good convergent validity, excellent reliability, and good ability to discriminate between individuals with subthreshold/clinical EDs and HCs. Results indicate that cognitive distortions are also related to the imagination of thin ideals, and are associated with ED pathology. With two subscales, the TSF-B trait questionnaire appropriately measures this construct. Future studies should clarify whether TSF-B is predictive for the development and course of EDs. Assessing cognitive distortions with the TSF-B questionnaire could improve understanding of EDs and stimulate the development of cognitively oriented interventions. Clinical Trial Registration Number: DRKS-ID: DRKS00005709

Cognitive Distortions Associated with Imagination of the Thin Ideal : Validation of the Thought-Shape Fusion Body Questionnaire (TSF-B)

Thought-shape fusion (TSF) describes the experience of body-related cognitive distortions associated with eating disorder (ED) pathology. In the laboratory TSF has been activated by thoughts about fattening/forbidden foods and thin ideals. This study aims at validating a questionnaire to assess the trait susceptibility to TSF (i.e., body-related cognitive distortions) associated with the imagination of thin ideals, and developing an adapted version of the original TSF trait questionnaire, the Thought-Shape Fusion Body Questionnaire (TSF-B). Healthy control women (HC, n = 317) and women diagnosed with subthreshold and clinical EDs (n = 243) completed an online-questionnaire. The factor structure of the TSF-B questionnaire was examined using exploratory (EFA) and subsequent confirmatory factor analysis (CFA). EFA pointed to a two-factor solution, confirmed by CFA. Subscale 1 was named Imagination of thin ideals, containing five items referring to the imagination of female thin ideals. Subscale 2 was named Striving for own thin ideal, with seven items about pursuing/abandoning attempts to reach one’s own thin ideal. The total scale and both subscales showed good convergent validity, excellent reliability, and good ability to discriminate between individuals with subthreshold/clinical EDs and HCs. Results indicate that cognitive distortions are also related to the imagination of thin ideals, and are associated with ED pathology. With two subscales, the TSF-B trait questionnaire appropriately measures this construct. Future studies should clarify whether TSF-B is predictive for the development and course of EDs. Assessing cognitive distortions with the TSF-B questionnaire could improve understanding of EDs and stimulate the development of cognitively oriented interventions. Clinical Trial Registration Number: DRKS-ID: DRKS00005709.publishe

Eating disorder treatment in routine clinical care: A descriptive study examining treatment characteristics and short-term treatment outcomes among patients with anorexia nervosa and bulimia nervosa in Germany and Switzerland.

This descriptive study examined patient characteristics, treatment characteristics, and short-term outcomes among patients with Anorexia Nervosa (AN) and Bulimia Nervosa (BN) in routine clinical care. Results for patients receiving full-time treatment were contrasted with results for patients receiving ambulatory treatment. Data of a clinical trial including 116 female patients (18-35 years) diagnosed with AN or BN were subjected to secondary analyses. Patients were voluntarily admitted to one of nine treatment facilities in Germany and Switzerland. Patients received cognitive-behavioral interventions in accordance with the national clinical practice guidelines for the treatment of EDs under routine clinical care conditions, either as full-time treatment or ambulatory treatment. Assessments were conducted after admission and three months later. Assessments included a clinician-administered diagnostic interview (DIPS), body-mass-index (BMI), ED pathology (EDE-Q), depressive symptoms (BDI-II), symptoms of anxiety (BAI), and somatic symptoms (SOMS). Findings showed that treatment intensity differed largely by setting and site, partly due to national health insurance policies. Patients with AN in full-time treatment received on average 65 psychotherapeutic sessions and patients with BN in full-time treatment received on average 38 sessions within three months. In comparison, patients with AN or BN in ambulatory treatment received 8-9 sessions within the same time. Full-time treatment was associated with substantial improvements on all measured variables for both women with AN (d = .48-.83) and BN (d = .48-.81). Despite the relatively small amount of psychotherapeutic sessions, ambulatory treatment was associated with small increases in BMI (d = .37) among women with AN and small improvements on all measured variables among women with BN (d = .27-.43). For women with AN, reduction in ED pathology were positively related to the number of psychotherapeutic sessions received. Regardless of diagnosis and treatment setting, full recovery of symptoms was rarely achieved within three months (recovery rates ranged between 0 and 4.4%). The present study shows that a considerable amount of patients with EDs improved after CBT-based ED treatment in routine clinical care within three months after admission. Intensive full-time treatment may be particularly effective in quickly improving ED-related pathology, although full remission of symptoms is typically not achieved. A small amount of ambulatory sessions may already produce considerable improvements in BN pathology and weight gain among women with AN. As patient characteristics and treatment intensity differed largely between settings, results should not be interpreted as superiority of one treatment setting over another. Furthermore, this study shows that treatment intensity is quite heterogeneous, indicating the possibility for increasing effectiveness in the treatment of EDs in routine clinical care

Consequences of exposure to the thin ideal in mass media depend on moderators in young women: An experimental study

This study examined the consequences of media exposure to thin ideals compared to pictures of landscapes in healthy young women and women with eating and mixed mental disorders and investigated whether appearance-related cognitive factors and cognitive distortions moderate the effects. Two hundred seventy-five women in a multisite laboratory trial (174 in- or outpatients and 101 healthy women; Mage 22.87 years, SD = 3.94) were exposed to either thin ideals or to landscape pictures and guided through a vivid imagery of these pictures thereafter. Changes in body image dissatisfaction, mood, eating behavior, and physiological markers were assessed. After thin ideal exposure and even more after guided imagery, women’s body image dissatisfaction increased and mood declined. The effect on mood was most pronounced in women with eating disorders, less in women with mixed disorders, and smallest in healthy controls. No effects were found on physiological measures. Higher values of appearance-related cognitive factors moderated the effect of thin ideal exposure and guided imagery on all psychological outcomes. Cognitive distortions moderated the effect of thin ideal exposure and guided imagery on mood. Findings indicate an overall susceptibility to viewing thin ideal pictures in magazines in young and especially in women with eating disorders. Though exposure in the laboratory resulted in psychological effects, it did not lead to a physiological stress response. The impact of thin ideal exposure on mood is in line with affect-regulation models in eating disorders, with appearance-related cognitive factors and cognitive distortions potentially accelerating such effects. (PsycInfo Database Record (c) 2022 APA, all rights reserved