Mindfulness Training to Facilitate Positive Body Image and Embodiment

Mindfulness – the non-judgemental awareness and acceptance of present moment experience – is cultivated through formal and informal experiential exercises, and has received support as an effective intervention approach across multiple disorders. The efficacy of mindfulness for body image and disordered eating is less well researched. This chapter outlines a theoretical framework for the application of mindfulness in this context, provides examples of intervention content, and reviews existing evidence related to the use of mindfulness training to enhance body image and prevent eating disorders in both clinical and non-clinical samples. Overall, research indicates mindfulness is a worthwhile approach, but should be carefully considered among those with clinical eating disorders due to the potential for negative impacts. Further research using rigorous methodology is required to establish stronger and broader support for intervention effects, and to explore mindfulness with regard to additional aspects of positive body image, embodiment and intuitive eating

Developing a protocol to address co-occurring mental health conditions in the treatment of eating disorders

OBJECTIVE: While co-occurring mental health conditions are the norm in eating disorders, no testable protocol addresses management of these in psychotherapy. METHOD: The literature on managing mental health conditions that co-occur with eating disorders is outlined and reviewed. RESULTS: In the absence of clear evidence to inform managing co-occurring mental health conditions, we advocate for use of an iterative, session-by-session measurement to guide practice and research. We identify three data-driven treatment approaches (focus solely on the eating disorder; multiple sequential interventions either before or after the eating disorder is addressed; integrated interventions), and the indications for their use. Where a co-occurring mental health condition/s impede effective treatment of the eating disorder, and an integrated intervention is required, we outline a four-step protocol for three broad intervention approaches (alternate, modular, transdiagnostic). A research program is suggested to test the usefulness of the protocol. DISCUSSION: Guidelines that provide a starting point to improving outcomes for people with eating disorders that can be evaluated/researched are offered in the current paper. These guidelines require further elaboration with reference to: (1) whether any difference in approach is required where the co-occurring mental health condition is a comorbid symptom or condition; (2) the place of biological treatments within these guidelines; (3) precise guidelines for selecting among the three broad intervention approaches when adapting care for co-occurring conditions; (4) optimal approaches to involving consumer input into identifying the most relevant co-occurring conditions; (5) detailed specification on how to determine which adjuncts to add. PUBLIC SIGNIFICANCE: Most people with an eating disorder also have another diagnosis or an underlying trait (e.g., perfectionism). Currently no clear guidelines exist to guide treatment in this situation, which often results in a drift away from evidence-based techniques. This paper outlines data-driven strategies for treating eating disorders and the accompanying comorbid conditions and a research program that can test the usefulness of the different approaches suggested

El proceso transdiagnóstico del perfeccionismo

The transdiagnostic approach to theory and treatment of psychological disorders is gainingincreasing interest. A transdiagnostic process is one that occurs across disorders and explainstheir onset or maintenance. The purpose of this review is to provide evidence that perfectionism isa transdiagnostic process that it is elevated in anxiety disorders, eating disorders, depression, obsessivecompulsive personality disorder and somatoform disorders. Data are also reviewed to showthat perfectionism can explain aetiology as it is a prospective predictor of depression and eatingdisorders. Perfectionism is also demonstrated to predict poorer outcome to treatment for anxietydisorders, eating disorders and depression, suggesting the need for specific treatment of perfectionism.Evidence is provided to demonstrate that perfectionism can be successfully treated with cognitivebehavioural therapy which results in reduction in psychopathologies. Clinical guidelines areoutlined to assist in treatment planning for individuals with elevated perfectionism.Abstract: The transdiagnostic approach to theory and treatment of psychological disorders is gainingincreasing interest. A transdiagnostic process is one that occurs across disorders and explainstheir onset or maintenance. The purpose of this review is to provide evidence that perfectionism isa transdiagnostic process that it is elevated in anxiety disorders, eating disorders, depression, obsessivecompulsive personality disorder and somatoform disorders. Data are also reviewed to showthat perfectionism can explain aetiology as it is a prospective predictor of depression and eatingdisorders. Perfectionism is also demonstrated to predict poorer outcome to treatment for anxietydisorders, eating disorders and depression, suggesting the need for specific treatment of perfectionism.Evidence is provided to demonstrate that perfectionism can be successfully treated with cognitivebehavioural therapy which results in reduction in psychopathologies. Clinical guidelines areoutlined to assist in treatment planning for individuals with elevated perfectionism.Resumen: El enfoque transdiagnóstico sobre la teoría y el tratamiento de los trastornos psicológicosestá generando un interés creciente en la literatura. Un proceso transdiagnóstico es aquel quese da a través de los trastornos y explica su inicio o mantenimiento. El objetivo de esta revisiónconsiste en aportar evidencia sobre el perfeccionismo como un proceso transdiagnóstico que seencuentra elevado en los trastornos de ansiedad, los trastornos alimentarios, la depresión, el trastornode personalidad obsesivo-compulsivo y los trastornos somatoformes. Revisamos la evidenciaempírica para mostrar que el perfeccionismo puede explicar la etiología como predictor prospectivode la depresión y los trastornos alimentarios. También se ha demostrado que el perfeccionismopredice un peor resultado terapéutico del tratamiento de los trastornos de ansiedad, los trastornosalimentarios y la depresión, sugiriendo la necesidad de un tratamiento específico del perfeccionismo.Proporcionamos evidencia para demostrar que el perfeccionismo puede ser tratado con éxitomediante terapia cognitivo conductual y que el tratamiento del perfeccionismo produce reduccionesen un rango amplio de psicopatologías. Se describen directrices clínicas para asistir en la planificacióndel tratamiento en individuos con elevados niveles de perfeccionismo

Coming of age: A reflection of the first 21 years of cognitive behaviour therapy for perfectionism

It has been 21 years since the publication of the cognitive behavioural model of clinical perfectionism that underpins cognitive behaviour therapy (CBT) for perfectionism. The notion of clinical perfectionism and CBT for perfectionism has been controversial. Despite 15 randomised controlled trials which have demonstrated the efficacy of CBT for perfectionism in reducing perfectionism and symptoms of anxiety, depression and eating disorders, strong responses to this work continue to appear in the literature. In this article, we examine the evolution and controversy surrounding clinical perfectionism, the efficacy of CBT for perfectionism, and future directions for the concept of perfectionism and its treatment. Future research should aim to provide independent evaluations of treatment efficacy, compare CBT for perfectionism to active treatments, conduct dismantling trials to examine the effective components of treatment, and examine the causal processes involved in perfectionism. We provide recommendations for future pathways to support innovation in theory, understanding, and treatment of perfectionism with a view towards improving clinical outcomes

Online prevention of disordered eating in at-risk young-adult women: A two-country pragmatic randomized controlled trial

This article has been published in a revised form in Psychological Medicine. This version is free to view and download for private research and study only. Not for re-distribution, re-sale or use in derivative works. © Cambridge University Press 2017. This author accepted manuscript is made available following 6 month embargo from date of publication (Dec 2017) in accordance with the publisher’s copyright policyDisordered eating (DE) is a widespread, serious problem. Efficacious prevention programs that can be delivered at-scale are needed. A pragmatic randomized controlled trial of two online programs was conducted. Participants were young-adult women from Australia and New Zealand seeking to improve their body image. Media Smart-Targeted (MS-T) and Student Bodies (SB) were both 9-module interventions released weekly, whilst control participants received positive body image information. Primary [Eating Disorder Examination–Questionnaire (EDE-Q) Global], secondary (DE risk factors) and tertiary (DE) outcome measures were completed at baseline, post-program, 6- and 12-month follow-up. Baseline was completed by 608 women (M age = 20.71 years); 33 were excluded leaving 575 randomized to: MS-T (N = 191); SB (N = 190) or control (N = 194). Only 66% of those randomized to MS-T or SB accessed the intervention and were included in analyses with controls; 78% of this sample completed measures subsequent to baseline. Primary intent-to-treat (ITT) analyses revealed no differences between groups, while measure completer analyses found MS-T had significantly lower EDE-Q Global than controls at 12-month follow-up. Secondary ITT analyses found MS-T participants reported significantly higher quality of life–mental relative to both SB and controls (6-month follow-up), while MS-T and controls had lower clinical impairment relative to SB (post-program). Amongst measure completers, MS-T scored significantly lower than controls and SB on 5 variables. Of those with baseline DE, MS-T participants were significantly less likely than controls to have DE at 12-month follow-up. Given both programs were not therapist-moderated, MS-T has potential to achieve reductions in DE risk at low implementation costs

The development of co-designed parent-supported cognitive behaviour therapy for perfectionism in adolescents with eating disorders: initial feasibility and acceptability

BACKGROUND: Perfectionism is significantly associated with symptoms of eating disorders in adolescents. Studies to date have not examined parent-supported CBT for perfectionism in eating disorders (CBT-P-ED). We co-designed the treatment and conducted a feasibility trial. METHODS: Eight parents of adolescents with eating disorders (M age = 48.75 years, 100% female) engaged in three co-design workshops to create a parent-supported CBT-P-ED self-help intervention. A further 10 parents (M age 41.8 years, 50% female) and their adolescent offspring (n = 10, M age 15.4 years, 60% female, 50% with self-reported diagnosis of anorexia nervosa) participated in a feasibility trial and provided feedback on the intervention. RESULTS: The parents who engaged in the co-design workshops suggested several areas to optimise the perfectionism intervention, including using plain language, the impact of parental perfectionism, how to engage with their adolescent in treatment and the importance of increasing eating disorder specific material. Feedback from the feasibility trial suggested that the intervention was acceptable and feasible with 100% of parents and adolescents saying it was useful, and no attrition. CONCLUSIONS: Parent-supported CBT-P-ED appears to be feasible. Future research is now required in a randomised controlled trial

A study of changes in genetic and environmental influences on weight and shape concern across adolescence

The goal of the current study was to examine whether genetic and environmental influences on an important risk factor for disordered eating, weight and shape concern (WSC), remained stable over adolescence. This stability was assessed in two ways: whether new sources of latent variance were introduced over development, and whether the magnitude of variance contributing to the risk factor changed. We examined an 8-item WSC sub-scale derived from the Eating Disorder Examination using telephone interviews with female adolescents. From three waves of data collected from female-female same sex twin pairs from the Australian Twin Registry, a subset of the data (which included 351 pairs at Wave 1) was used to examine three age cohorts: 12-13, 13-15, and 14-16 years. The best fitting model contained genetic and environmental influences, both shared and non-shared. Biometric model fitting indicated that non-shared environmental influences were largely specific to each age cohort, and results suggested that latent shared environmental and genetic influences that were influential at 12-13 years continued to contribute to subsequent age cohorts, with independent sources of both emerging at ages 13-15. The magnitude of all three latent influences could be constrained to be the same across adolescence. Ages 13-15 was indicated as a time of risk for the development of high levels of WSC given that most specific environmental risk factors were significant at this time (e.g., peer teasing about weight, adverse life events), and indications of the emergence of new sources of latent genetic and environmental variance over this period.NHMRC Grants 324715 and 480420

Development of transdiagnostic clinical risk prediction models for 12-month onset and course of eating disorders among adolescents in the community

Objective: To develop and internally validate risk prediction models for adolescent onset and persistence of eating disorders. Methods: N = 963 Australian adolescents (11–19 years) in the EveryBODY Study cohort completed online surveys in 2018 and 2019. Models were built to predict 12-month risk of (1) onset, and (2) persistence of a DSM-5 eating disorder. Results: Onset Model. Of the n = 687 adolescents without an eating disorder at baseline, 16.9% were identified with an eating disorder after 12 months. The prediction model was based on evidence-based risk factors for eating disorder onset available within the dataset (sex, body mass index percentile, strict weight loss dieting, history of bullying, psychological distress, weight/shape concerns). This model showed fair discriminative performance (mean AUC =.75). The most important factors were psychological distress, weight and shape concerns, and female sex. Diagnostic Persistence Model. Of the n = 276 adolescents with an eating disorder at baseline, 74.6% were identified as continuing to meet criteria for an eating disorder after 12 months. The prediction model for diagnostic persistence was based on available evidence-based risk factors for eating disorder persistence (purging, distress, social impairment). This model showed poor discriminative performance (mean AUC =.65). The most important factors were psychological distress and self-induced vomiting for weight control. Discussion: We found preliminary evidence for the utility of a parsimonious model for 12-month onset of an eating disorder among adolescents in the community. Future research should include additional evidence-based risk factors and validate models beyond the original sample. Public Significance: This study demonstrated the feasibility of developing parsimonious and accurate models for the prediction of future onset of an eating disorder among adolescents. The most important predictors in this model included psychological distress and weight and shape concerns. This study has laid the ground work for future research to build and test more accurate prediction models in diverse samples, prior to translation into a clinical tool for use in real world settings to aid decisions about referral to early intervention

Evaluation of Handheld Assays for the Detection of Ricin and Staphylococcal Enterotoxin B in Disinfected Waters

Development of a rapid field test is needed capable of determining if field supplies of water are safe to drink by the warfighter during a military operation. The present study sought to assess the effectiveness of handheld assays (HHAs) in detecting ricin and Staphylococcal Enterotoxin B (SEB) in water. Performance of HHAs was evaluated in formulated tap water with and without chlorine, reverse osmosis water (RO) with chlorine, and RO with bromine. Each matrix was prepared, spiked with ricin or SEB at multiple concentrations, and then loaded onto HHAs. HHAs were allowed to develop and then read visually. Limits of detection (LOD) were determined for all HHAs in each water type. Both ricin and SEB were detected by HHAs in formulated tap water at or below the suggested health effect levels of 455 ng/mL and 4.55 ng/mL, respectively. However, in brominated or chlorinated waters, LODs for SEB increased to approximately 2,500 ng/mL. LODs for ricin increased in chlorinated water, but still remained below the suggested health effect level. In brominated water, the LOD for ricin increased to approximately 2,500 ng/mL. In conclusion, the HHAs tested were less effective at detecting ricin and SEB in disinfected water, as currently configured