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In their paper on "Realizing the Untapped Promise of Single‐Session Interventions for Eating Disorders" Schleider and colleagues suggest an innovative approach to addressing a much‐ discussed critical issue in the treatment of eating disorders—how we help more people quickly and with greater efficiency. While building on the feasibility and success of program‐led approaches, they make a potentially transformative proposal for the use of single‐session, "one‐at‐a‐time" interventions freely accessible to those in need. We suggest that not only does this proposal have the potential to narrow the treatment gap, but its ability to generate informative data at scale may also contribute to improving treatment outcomes overall. We also note the need for further independent support for the claim that single sessions produce meaningful benefit especially in the field of the prevention and treatment of eating disorders. While Schleider and colleagues' proposal is potentially transformative and has heuristic value, some caution needs to be exercised. In our view, single‐session interventions should not be regarded as displacing existing treatment provision. Rather they should be seen as complementary and a potential way of improving provision overall. [ABSTRACT FROM AUTHOR]

Background: While randomized controlled trials (RCTs) inform the efficacy and effectiveness of treatments, we need to understand that even RCTs can be associated with sub‐optimal execution. This is of special pertinence to eating disorders given the majority of treatment studies involving cognitive behaviour therapy are of poor quality with respect to managing risk of bias adequately. Methods: The current paper outlines the components of a good RCT for psychotherapy, and examines ways to improve the conduct, interpretation, and usefulness of RCTs. Results: This includes managing reporting bias, recognizing the limits of randomization, applicability, and ethical considerations. Conclusions: We highlight a number of strategies for future research, including issues related to utilizing a variety of designs to examine treatment outcomes, integrity, openness and reproducibility. [ABSTRACT FROM AUTHOR]

Objective: Eating disorders (EDs) are serious psychiatric disorders associated with substantial morbidity and mortality that are prevalent among university students. Because many students do not receive treatment due to lack of access on university campuses, mobile‐health (mHealth) adaptations of evidence‐based treatments represent an opportunity to increase treatment accessibility and engagement. The purpose of this study was to test the initial efficacy of Building Healthy Eating and Self‐Esteem Together for University Students (BEST‐U), which is a 10‐week mHealth self‐guided cognitive‐behavioral therapy (CBT‐gsh) app that is paired with a brief 25–30‐min weekly telehealth coaching, for reducing ED psychopathology in university students. Method: A non‐concurrent multiple‐baseline design (N = 8) was used to test the efficacy of BEST‐U for reducing total ED psychopathology (primary outcome), ED‐related behaviors and cognitions (secondary outcomes), and ED‐related clinical impairment (secondary outcome). Data were examined using visual analysis and Tau‐BC effect‐size calculations. Results: BEST‐U significantly reduced total ED psychopathology and binge eating, excessive exercise, and restriction (effect sizes ranged from −0.39 to −0.92). Although body dissatisfaction decreased, it was not significant. There were insufficient numbers of participants engaging in purging to evaluate purging outcomes. Clinical impairment significantly reduced from pre‐to‐post‐treatment. Discussion: The current study provided initial evidence that BEST‐U is a potentially efficacious treatment for reducing ED symptoms and ED‐related clinical impairment. Although larger‐scale randomized controlled trials are needed, BEST‐U may represent an innovative, scalable tool that could reach greater numbers of underserved university students than traditional intervention‐delivery models. Public Significance: Using a single‐case experimental design, we found evidence for the initial efficacy of a mobile guided‐self‐help cognitive‐behavioral therapy program for university students with non‐low weight binge‐spectrum eating disorders. Participants reported significant reductions in ED symptoms and impairment after completion of the 10‐week program. Guided self‐help programs show promise for filling an important need for treatment among university students with an ED. [ABSTRACT FROM AUTHOR]

Objective: Certain treatments have demonstrated acute efficacy for binge‐eating disorder (BED) but many patients who receive "evidence‐based" interventions do not derive sufficient benefit. Given the dearth of controlled research examining treatments for patients who fail to respond to initial interventions, this study tested the efficacy of cognitive‐behavioral therapy (CBT) for patients with BED who do not respond to initial acute treatments. Methods: Prospective randomized double‐blind placebo‐controlled single‐site trial, conducted August 2017–December 2021, tested 16‐weeks of therapist‐led CBT for non‐responders to initial treatment (naltrexone/bupropion and/or behavioral therapy) for BED with obesity. Thirty‐one patients (mean age 46.3 years, 77.4% women, 80.6% White, mean BMI 38.99 kg/m2) who were non‐responders to initial acute treatments were randomized to CBT (N = 18) or no‐CBT (N = 13), in addition to continuing double‐blinded pharmacotherapy. Independent assessments were performed at baseline, throughout treatment, and posttreatment; 83.9% completed posttreatment assessments. Results: Intention‐to‐treat remission rates were significantly higher for CBT (61.1%; N = 11/18) than no‐CBT (7.7%; N = 1/13). Mixed models of binge‐eating frequency (assessed using complementary methods) converged revealing a significant interaction between CBT and time and a significant main effect of CBT. Binge‐eating frequency decreased significantly with CBT but did not change significantly with no‐CBT. Since only four patients received behavioral treatment during the acute treatments, we performed "sensitivity‐type" analyses restricted to the 27 patients who received pharmacotherapy during the acute treatment and found the same pattern of findings for CBT versus no‐CBT. Conclusions: Adult patients with BED who fail to respond to initial pharmacological treatments should be offered CBT. Public Significance: Even with leading evidence‐based treatments for binge‐eating disorder, many patients do not derive sufficient benefit. Almost no controlled research has examined treatments for patients who fail to respond to initial interventions. This study found that that cognitive‐behavioral therapy was effective for patients with binge‐eating disorder who did not respond to initial interventions, with 61% achieving abstinence. [ABSTRACT FROM AUTHOR]

Objective: Food anxiety and limited dietary variety often persist after intensive treatment for eating disorders (EDs) and may contribute to relapse. Prior studies demonstrate decreased meal‐related anxiety with residential or inpatient treatment, but less is known about changes in dietary variety and anxiety associated with specific foods. The current study assessed change in food anxiety and dietary variety in inpatients with EDs (anorexia nervosa and bulimia nervosa) in relation to discharge outcomes from meal‐based behavioral treatment. Method: Patients (N = 128) admitted to a specialized, hospital‐based behavioral treatment program completed measures of food anxiety, dietary variety, and ED symptoms at admission and discharge. Demographic and clinical data were abstracted from electronic medical records. A novel network community analysis identified three food anxiety groups: fruit‐veg, animal‐based, and carb‐based foods. Results: High‐energy density combination foods were most anxiety‐provoking and most avoided. Food anxiety decreased, and dietary variety increased from admission to discharge. Reduction in food anxiety was associated with lower ED symptom scores and higher normative eating self‐efficacy at discharge. For animal‐based foods, increased dietary variety was associated with lower food anxiety at discharge. Neither variety nor anxiety was associated with weight restoration. Discussion: Findings highlight the importance of broadening dietary variety and targeting food anxiety during the nutritional rehabilitation and weight restoration phase of ED treatment. Increasing dietary variety may contribute to reduced food anxiety, which, in turn, may increase normative eating self‐efficacy. These results may help inform nutritional guidelines for meal‐based treatment programs. Public significance: Consuming a greater variety of foods during meal‐based intensive treatment may help alleviate food anxiety in patients with eating disorders. [ABSTRACT FROM AUTHOR]

Although cognitive behavioral treatment is the treatment of choice in bulimia nervosa, patients' response is variable. A minority of patients do not respond at all and some never engage in treatment. This paper concerns the latter group. A case series of six such patients with whom treatment could not be initiated is compared with a group who received a full course of treatment. The group with whom treatment could not begin were found to have a longer history of disorder, to report excessive laxative abuse, to have more severe depressed mood and a greater dissatisfaction with their body weight. In addition, they were more likely to have abused psychoactive substances, engaged in episodes of self-harm, and have a lower self-esteem. They were also more likely to be diagnosed as having borderline personality disorder. Patients presenting with the wide range of difficulties characteristic of this group require a more intensive form of treatment than standard outpatient cognitive behavior therapy. [ABSTRACT FROM AUTHOR]

This paper outlines the development of diagnostic criteria, therapeutic procedures, and preliminary findings concerning anorexia nervosa in Czechoslovakia. The therapeutic significance of a specialized care unit for anorexia nervosa with a specific daily regimen comprising behavior therapy, dietary measures, psychotherapy, pharmacotherapy, and family therapy is evaluated. A better therapeutic effect was achieved in this unit than with previous therapeutic methods. [ABSTRACT FROM AUTHOR]

Background: Loss‐of‐control (LOC)‐eating postoperatively predicts suboptimal longer‐term outcomes following bariatric surgery. This study examined longer‐term effects through 24‐month follow‐ups after completing treatments in a randomized controlled trial testing guided‐self‐help treatments (cognitive‐behavioral therapy [gshCBT] and behavioral weight‐loss [gshBWL]) and control (CON) delivered postoperatively for LOC‐eating. Methods: 140 patients with LOC‐eating 6 months after bariatric surgery were randomized (5:5:2 ratio) to 3‐months of gshCBT (n = 56), gshBWL (n = 60), or CON (n = 24) delivered by trained allied‐health clinicians. Independent assessments were performed throughout/after treatments and at 6‐, 12‐, 18‐, and 24‐month follow‐ups; 83% of patients were assessed at 24‐month follow‐up. Results: Intention‐to‐treat analyses comparing the three groups (gshCBT vs. gshBWL vs. CON) in LOC‐eating abstinence at posttreatment (30%, 27%, 38%), 12‐month follow‐up (34%, 32%, 42%), and 24‐month follow‐up (45%, 32%, 38%) revealed no significant differences. Mixed‐models revealed significantly reduced LOC‐eating frequency through posttreatment, no significant changes in LOC‐eating frequency during follow‐up, and no differences between the three groups. Weight reduced significantly, albeit modestly, through posttreatment but increased significantly and substantially during follow‐ups, with no differences between groups. Conclusions: Overall, the 12‐week scalable guided‐self‐help treatments did not differ from each other or control, were associated with significantly reduced frequency of LOC‐eating and modest weight loss at posttreatment but were followed by significant weight gain during the 24‐month follow‐up. Weight gain was substantial and nearly universal whereas the frequency of LOC‐eating did not change over time (i.e., LOC‐eating reductions and abstinence rates were well maintained through 24‐moth follow‐ups). Patients with postoperative LOC‐eating require more intensive adjunctive treatments. Public significance: Loss‐of‐control (LOC) eating postoperatively predicts poorer bariatric surgery outcomes and the longer‐term effects of postoperative adjunctive postoperative interventions for LOC eating are unknown. In this 24‐month follow‐up of a controlled study of scalable guided‐self‐help treatments and a control condition, improvements in LOC‐eating frequency, eating‐disorder psychopathology, and depression during treatment were maintained well, with no differences between the three groups. Proportion of patients achieving abstinence from LOC‐eating at the 24‐month follow‐up ranged from 38% to 45% across the three groups. In contrast, weight increased significantly during the 24‐month follow‐ups, with no differences between the three groups. Findings suggest LOC‐eating following bariatric surgery might represent a "marker" for a subgroup of patients that are at risk for substantial weight gains over time. LOC eating following bariatric surgery is challenging to treat with low‐intensity scalable treatments and may require more intensive specialist treatments. [ABSTRACT FROM AUTHOR]

Objective: A substantial proportion of patients with binge‐eating disorder (BED) do not derive sufficient benefits from available evidence‐based psychological interventions. We examined depression scores as predictors and moderators of response to cognitive‐behavioral therapy (CBT) and behavioral weight‐loss (BWL) for BED. We explored associations between changes in depression scores and changes in treatment outcomes. Method: Ninety adults with BED with obesity were randomized to CBT or BWL (6 months) and were evaluated independently throughout treatment, at posttreatment, and 12‐month follow‐up after treatments (18 months post‐randomization). Pre‐treatment depression scores, early changes in depression, and changes in depression from pre‐ to post‐treatment were tested as predictors/moderators of outcomes (binge‐eating frequency and eating‐disorder psychopathology). Results: Baseline depression scores did not predict nor moderate outcomes at post‐treatment or 12‐month follow‐up. Changes in depression scores (both early and throughout treatment) were not associated significantly with changes in binge‐eating frequency or eating‐disorder psychopathology at post‐treatment or 12‐month follow‐up. Discussion: Findings suggest depression scores do not predict nor moderate acute‐ or longer‐term outcomes in patients with BED receiving CBT or BWL. Findings reinforce need to improve treatments for BED overall, although they provide confidence that patients with elevated depression scores derive benefits from existing CBT and BWL interventions. [ABSTRACT FROM AUTHOR]

Outcomes from cognitive behavioral therapy for binge‐eating spectrum disorders are suboptimal, possibly due in part to deficits in self‐regulation (i.e., the ability to control behavior in pursuit of long‐term goals despite internal challenges). Mindfulness and acceptance‐based treatments (MABTs) integrate behavioral treatment with psychological strategies designed to enhance self‐regulation, yet little is known about how and for whom they are effective. The present study will utilize the multiphase optimization strategy to identify which of four MABT components (mindful awareness, distress tolerance, emotion modulation, values‐based decision making) to include in a fully powered clinical trial. Participants (n = 256) will be randomized to 16 sessions in one of 16 conditions, each a different combination of MABT components being included or excluded from a base behavioral treatment. Our primary aim is to evaluate each component's independent efficacy on disordered eating symptoms. Our secondary aims are to confirm each component's target engagement (i.e., whether each component improves the targeted variable and outcomes), and test that each component's efficacy is moderated by baseline weaknesses in the same component (e.g., that participants with poor distress tolerance at baseline benefit most from the distress tolerance component). Our exploratory aim is to quantify the component interaction effects. [ABSTRACT FROM AUTHOR]

Several objectives underlie the current article. First, to review historical diagnostic issues and clinical strategies for treating SE‐AN. Second, to provide an overview of recent evidence informed strategies and clinical innovations for the treatment of SE‐AN. Third, based on the authors' collective clinical and research experience, we offer eight observations that we believe capture the current clinical experience of patients with SE‐AN. Some of these observations represent empirically testable hypotheses, but all are designed to generate a meaningful discussion about the treatment of this group of individuals with eating disorders. Finally, we hope to call clinicians, scientists, professional organizations, advocates, and policy makers to action to attend to critical issues related to the care of individuals with SE‐AN. We believe that an international discussion could clarify areas of need for these patients and identify opportunities for clinical innovation that would enhance the lives of individuals with SE‐AN and their families. [ABSTRACT FROM AUTHOR]

Objective: The coronavirus pandemic has led to a dramatically different way of working for many therapists working with eating disorders, where telehealth has suddenly become the norm. However, many clinicians feel ill equipped to deliver therapy via telehealth, while adhering to evidence‐based interventions. This article draws together clinician experiences of the issues that should be attended to, and how to address them within a telehealth framework. Method: Seventy clinical colleagues of the authors were emailed and invited to share their concerns online about how to deliver cognitive‐behavioral therapy for eating disorders (CBT‐ED) via telehealth, and how to adapt clinical practice to deal with the problems that they and others had encountered. After 96 hr, all the suggestions that had been shared by 22 clinicians were collated to provide timely advice for other clinicians. Results: A range of themes emerged from the online discussion. A large proportion were general clinical and practical domains (patient and therapist concerns about telehealth; technical issues in implementing telehealth; changes in the environment), but there were also specific considerations and clinical recommendations about the delivery of CBT‐ED methods. Discussion: Through interaction and sharing of ideas, clinicians across the world produced a substantial number of recommendations about how to use telehealth to work with people with eating disorders while remaining on track with evidence‐based practice. These are shared to assist clinicians over the period of changed practice. [ABSTRACT FROM AUTHOR]

Objective: The current multicentre randomized controlled trial assessed the clinical efficacy of a combined mHealth intervention for eating disorders (EDs) based on cognitive behavioral therapy (CBT). Method: A total of 106 ED patients from eight different public and private mental health services in Spain were randomly assigned to two parallel groups. Patients of the experimental group (N = 53) received standard face‐to‐face CBT plus a mobile intervention through an application called "TCApp," which provides self‐monitoring and an online chat with the therapist. The control group (N = 53) received standard face‐to‐face CBT only. Patients completed self‐report questionnaires on ED symptomatology, anxiety, depression, and quality of life, before and after treatment. Results: Significant reductions in primary and secondary outcomes were observed for participants of both groups, with no differences between groups. Results also suggested that the frequency with which patients attended their referral mental health institution after the intervention was lower for patients in the experimental group than for those in the control group. Discussion The current study showed that CBT can help to reduce symptoms relating to ED, regardless of whether its delivery includes online components in addition to traditional face‐to‐face treatment. Besides, the additional component offered by the TCApp does not appear to be promising from a purely therapeutic perspective but perhaps as a cost‐effective tool, reducing thus the costs and time burden associated with weekly visits to health professionals. [ABSTRACT FROM AUTHOR]

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The unprecedented COVID‐19 crisis presents an imperative for mental health care systems to make digital mental health interventions a routine part of care. Already because of COVID‐19, many therapists have rapidly moved to using telehealth in place of in‐person contact. In response to this shift, Waller and colleagues compiled a series of expert recommendations to help clinicians pivot to delivering teletherapy to address eating disorders during COVID‐19. However, numerous barriers still impede widespread adoption and implementation of digital interventions. In this commentary, we aim to extend the recommendations for clinicians offered by Waller and colleagues by presenting a roadmap of the systems‐ and policy‐level requirements that are needed. We advocate for addressing barriers associated with training, licensing, safety, privacy, payment, and evaluation, as these factors have greatly limited use of these promising interventions. We also indicate that longer‐term goals should include introducing truly innovative digital mental health practices, such as stepped‐care models and simultaneously providing preventive and self‐management services in addition to clinical services, into the health care system. Now is the time to catalyze change and comprehensively address the barriers that have prevented widespread delivery of these efficacious digital services to the millions of people who would benefit. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Research in individuals with bulimia nervosa has highlighted the clinical significance of weight suppression (WS), defined as the difference between one's highest and current weight. More recently, studies have suggested that WS also may play a role in symptom maintenance and weight gain during treatment in anorexia nervosa (AN) and that the influence of WS on AN outcomes may depend on an individual's body mass index (BMI). However, no study has investigated whether WS or the interaction between WS and BMI is associated with the longer-term course of eating pathology following treatment discharge in patients with AN. Method The current study examined a sample of females with AN ( N = 180) who completed interviews and self-report questionnaires at discharge from intensive treatment and at 3, 6, and 12-months after discharge. Latent growth curve models tested whether WS, BMI, or the WS by BMI interaction significantly predicted the trajectory of eating disorder symptoms (i.e., Eating Disorder Examination global score, BMI, frequency of loss of control eating, frequency of purging) over the year following discharge. Results WS at discharge predicted change in BMI, and the interaction between WS and BMI predicted growth in eating disorder severity and purging frequency over time. Neither WS nor its interaction with BMI predicted growth in loss of control eating frequency. Discussion Results provide further support for the clinical significance of WS in AN symptom maintenance, but suggest that the influence of WS likely depends on an individual's BMI as well as the outcome being measured. © 2016 Wiley Periodicals, Inc.(Int J Eat Disord 2016; 49:753-763) [ABSTRACT FROM AUTHOR]

Objective: To describe obstacles in the implementation of a controlled treatment trial of adolescent anorexia nervosa (AN). Method: The original aim was to enter 240 participants with AN to one of four cells: Behavioral family therapy (BFT) plus fluoxetine; BFT plus placebo; systems family therapy (SFT) plus fluoxetine; SFT plus placebo. Results: Recruitment was delayed pending a satisfactory resolution concerning participant safety. After 6 months of recruitment it became clear that the medication was associated with poor recruitment leading to a study redesign resulting in a comparison of two types of family therapy with a projected sample size of 160. One site was unable to recruit and was replaced. Discussion: Problems with the delineation of safety procedures, recruitment, re-design of the study, and replacement of a site, were the main elements resulting in a 1-year delay. Suggestions are made for overcoming such problems in future AN trials. © 2011 by Wiley Periodicals, Inc. (Int J Eat Disord 2012) [ABSTRACT FROM AUTHOR]

Objective: To examine whether drive for thinness, body dissatisfaction, and restrictive/binge eating-purging subtype at admission moderates the weight curves of patients with Anorexia Nervosa (AN) over the course of inpatient treatment. Method: The nature of weight curves, individual differences herein and moderating factors are examined in 92 AN patients by means of multilevel modeling. Results: The average weight curve of AN patients is characterized by a linear weight increase during treatment that levels off near the end of treatment. Substantial individual differences exist in the shape of patients' weight curves. Patients with stronger body dissatisfaction at admission display a slower linear rate of weight gain over the course of treatment. Neither drive for thinness nor restrictive/binge eating-purging subtype predicted patients' weight curve over the course of treatment. Discussion: Body dissatisfaction moderates patients' weight curves over the course of inpatient treatment but more research on factors determining weight curves is needed. [ABSTRACT FROM AUTHOR]

Objective: This study presents the results of a receiver operating characteristics (ROC) analysis to evaluate response to cognitive behavioral treatment (CBT) for patients with bulimia nervosa (BN), delivered via telemedicine (TV-CBT) or face-to-face (FTF-CBT). Method: Data were gathered on 116 adults treated with CBT for BN. Response to treatment (i.e., percent reduction in binge eating and purging behavior) were examined at weeks two, four, six, and eight. ROC analysis was completed to predict abstinence at end of treatment (EOT) as well as 3-month and 1-year follow-up for the entire sample and by treatment group (TV-CBT versus FTF-CBT). Results: ROC analyses revealed that abstinence at EOT and 1-year follow-up was predicted by percent reduction in binge eating behavior whereas abstinence at 3-month follow-up was predicted by percent reduction in purging behavior. Results showed differences in predictors of treatment response when ROC analyses were completed for the entire sample and by treatment group. Discussion: Results suggest that evaluating percent reduction in binge eating and purging at weeks two, four, six, and eight of treatment is a clinically useful tool for predicting treatment response at EOT, 3-month, and 1-year follow-up. © 2008 by Wiley Periodicals, Inc. Int J Eat Disord 2009 [ABSTRACT FROM AUTHOR]

A restrictive thinking style in the eating disorders, often referred to as “anorexic thinking,” is often resistant to cognitive-behavioral interventions, even when apparent motivation is relatively high. It is argued that this difficulty is due in part to the ingrained nature of such thinking patterns, regardless of diagnosis. Those patterns reflect the ego-syntonic element of the eating disorders, and manifest as difficulty for the patient in identifying and challenging negative automatic thoughts and maladaptive core beliefs. There is a need to develop cognitive techniques that allow the individual to identify maladaptive cognitions as reflecting their restrictive schema mode, rather than being the only way of thinking and seeing the world. This study describes the use of imagery to enable patients to distinguish the restrictive thoughts from other cognitive perspectives. The restrictive “mode” is presented as part of the individual's personality structure (drawing on cognitive-behavioral models of personality), rather than being an external entity. This technique is designed to facilitate conventional cognitive-behavioral therapy, freeing the patient to challenge her cognitions and to engage in behavioral experiments. We present case material to illustrate this technique and its use in conjunction with other cognitive-behavioral techniques. Future directions and potential limitations are also discussed. © 2006 by Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Deals with a study which described and evaluated a full dialectical behavior therapy program for people with comorbid eating disorder and borderline personality disorder. Methods; Results; Discussion.

Provides information on a study which compared the clinical effectiveness of group and individual cognitive-behavioral therapy for bulimia nervosa. Methods; Results; Discussion.

Examines the characteristics of individuals who show a rapid and sustained response to cognitive-behavioral therapy for bulimia nervosa. Methodology; Results and discussion.

We describe a 14-week individual cognitive behavioral treatments program that incorporated various techniques such as self-monitoring, development of alternative coping skills, cognitive restructuring, and exposure and response prevention. The background and rationale for the program are described. A case illustration of the treatment is presented and the findings are briefly discussed. [ABSTRACT FROM AUTHOR]

The study describe the outcome results of the first 53 patients with an eating disorder referred to a day hospital program, an innovative group treatment for patients requiring hospital treatment. Among the program’s completers, 19 fulfilled criteria for anorexia nervosa (AN), and 35 fulfilled criteria for bulimia nervosa (BN). There was a significant weight gain for the AN patients; 73.6% gained over 1 lb/week during the average 12 weeks of stay in the program. There was a significant decrease in the average number of binges per week in the BN group; a reduction of 75% in binges was present in 88% of patients within the study period, 9 AN and 12 BN patients completed a detailed assessment 1,3, and 6 months postdischarge; for these patients clinical gains were maintained. Factors related to dropout and outcome, as well as clinical implications, are discussed. [ABSTRACT FROM AUTHOR]

A day group treatment program is detailed which could offer effective treatment to many patients with anorexia and bulimia nervosa who would otherwise require inpatient treatment. The day hospital program can offer important clinical and financial advantages over inpatient program. A major difference between the day program and an inpatient setting is the degree of containment offered to the patient and control over the patient’s behavior. This necessitates important innovations. The day hospital treatment program includes psychological, social, and biological interventions. Most psychological treatment is done in groups. Staff use a multidisciplinary team approach. Potential pitfalls in the program include countertransference reactions and pathologiocal group processes. [ABSTRACT FROM AUTHOR]

Evaluation of some of the physical variables recorded during an intake of patients into the Macquarie University Weight Control Program is reported. Measures from 43 females aged between 19 and 66 years were taken prior to therapy and 15 weeks later. All subjects lost weight, the range being from 1 to 19 kg, and significant reductions on 14 anthropometric recordings were found. Factor analysis on the reductions suggested that five factors accounted for the variance. These were called general weight loss, torso, limbs, skinfold, and thigh factors. Suggestions are made to reduce the amount of anthropometry in future sessions in the interests of economy of time. [ABSTRACT FROM AUTHOR]

The Three-Factor Eating Questionnaire was administer to 88 men and women following behavioral treatment for obesity and to a comparison group of 16 obese and 60 normal weight persons. Treated subjects showed higher scores on Factor I (cognitive restraint of eating) of the Questionnaire than did untreated obese and normal weight subjects. Furthermore, the correlation between Factor I scores and weight loss increased over lime it] treatment. Factor II (disinhibition) and factor III (hunger) scores were significantly higher in obese groups than in the normal weight group but were not correlated with weight change. These findings suggest that cognitive control of eating discriminates obese from nonobese persons and increases during behavioral treatment for obesity. [ABSTRACT FROM AUTHOR]

The article focuses on iatrogenesis, in Anorexia Nervosa and Bulimia Nervosa, adverse effects arising from inability to provide adequate care by a physician or healthcare professional. It highlights several diagnostic challenges, including delay in the identification and overidentification of the illness; as well as inability to distinguish psychopathology from the starvation symptoms. Suggestions to prevent and manage misguided assumptions regarding these conditions are also offered.

The published literature on behavioral treatments of rumination is reviewed, and new case material on two recently reported procedures is presented. Rumination, a medical condition of infancy involving repeated regurgitation of previously ingested food, has historically been heated from a psychodynamic approach involving extended in-patient treatment by mother surrogates. This procedure is both time-consuming and very costly. The initial behavioral approach involved electric shock. Single-case studies reflect the utility of this procedure, but widespread resistance to this form of punishment makes this a difficult procedure to utilize. More recent behavioral procedures reported in single-case studies have included delivering aversive taste stimuli as consequences for ruminating. This procedure has met with mixed success, and has the added drawback of being difficult to implement technically and because of staff resistance. A combination of punishment by scolding, time-out, and reinforcement of retaining the food constitutes a useful alternative. This procedure has the added advantage of being more acceptable to staff and implementable at home. The possibility of individual differences among ruminators that might predict success is also raised. [ABSTRACT FROM AUTHOR]