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Objective: The aim of this study was to examine the processes involved in a guided self-help (GSH) pre-treatment intervention (RecoveryMANTRA) for patients with anorexia nervosa (AN), by measuring the levels of patient/mentor Language Style Matching (LSM). RecoveryMANTRA was supported by student mentors or peer mentors (recovered individuals) over six weekly chat-based sessions. We examined whether LSM during RecoveryMANTRA predicted patients'working alliance with the clinic therapist, motivation, eating disorder (ED) and general psychopathology. A further aim was to examine differences in LSM between student mentors and peer mentors., Method: 87 AN adults received RecoveryMANTRA plus treatment as usual. The LSM algorithm was used to calculate verbal attunement between patient and mentor. Participants were assessed at baseline and at the end of the intervention., Results: Both early (1 st session) and late (6 th session) LSM predicted higher working alliance with the clinic therapist. Moreover, late LSM predicted lower EDs symptoms at the end of the RecoveryMANTRA intervention. Patient/peer mentor dyads showed higher late verbal attunement than patient/student mentor dyads., Conclusions: These findings suggests that in the early phase of treatment relational aspects can impact on engagement with treatment. Verbal attunement in a GSH for AN is associated with working alliance and better clinical outcome., (© 2022 The Authors. European Eating Disorders Review published by Eating Disorders Association and John Wiley & Sons Ltd.)

Objective: This systematic review and meta-analysis aimed to examine: the pooled prevalence of symptomatic behaviours and mental health deterioration amongst individuals with eating disorders (EDs) and obesity during the COVID-19 confinement. Moreover, we examined changes in EDs and distress before and during the confinement, and the association between psychosocial factors and EDs symptoms., Method: A systematic search was carried out in biomedical databases from January 2020 to January 2021. Both cross-sectional and longitudinal studies that used quantitative measures of ED symptoms and psychological distress during and after the COVID-19 confinement were included., Results: A total of 26 studies met inclusion criteria (n = 3399, 85.7% female). The pooled prevalence of symptomatic deterioration in EDs was 65% (95% CI[48,81], k = 10). The pooled prevalence of increased weight in obesity was 52% (95% CI[25,78], k = 4). More than half of the participants experienced depression and anxiety. Moreover, at least 75% of the individuals with EDs reported shape and eating concerns, and increased thinking about exercising. However, the pooled analyses of longitudinal studies showed no significant differences from pre-pandemic levels to the first lockdown phase in Body Mass Index and ED symptoms, whereas only few studies suggested increased distress, particularly among individuals with anorexia nervosa., Conclusions: The majority of individuals with EDs and obesity reported symptomatic worsening during the lockdown. However, further longitudinal studies are needed to identify vulnerable groups, as well as the long-term consequences of COVID-19., (© 2021 The Authors. European Eating Disorders Review published by Eating Disorders Association and John Wiley & Sons Ltd.)

Objective: The quality of working alliance (WA) is associated with treatment outcomes across several types of psychiatric disorders and psychological interventions. This study examined the role of WA with peer mentors (people with lived experience of illness) and student mentors (graduated psychology students) in a 6-week, digital, guided self-help (GSH) intervention for anorexia nervosa., Method: Ninety-nine patients rated weekly, for 6 weeks: (a) eating psychopathology using the short version of the Eating Disorder Examination Questionnaire (EDE-QS) and (b) WA with a student mentor (n = 14) or a peer mentor (n = 10). WA was assessed by asking patients the extent to which they felt comfortable working with their mentor and the extent to which they agreed with them on the goals for support. WA with mentors and the association with eating psychopathology change were measured on a session-by-session basis. The analysis involved a random intercepts cross-lagged panel model., Results: WA with peer mentors was slightly higher than WA with students (ES = 0.3). Peer mentors' WA in the previous session was significantly associated with eating psychopathology ratings in the next session. No significant relationship was found between the previous session's EDE-QS scores and peer mentor alliance in the following session. In the student mentor group, there were no session-by-session associations between WA and eating psychopathology. However, greater WA with the student mentor across sessions was associated with less eating psychopathology., Discussion: These findings suggest that clinical outcomes are in part associated with the characteristics of the mentor delivering guidance in an online GSH for eating disorders., (© 2021 The Authors. International Journal of Eating Disorders published by Wiley Periodicals LLC.)

Objective: Self-esteem is a core aspect of eating disorder symptomatology. This study aims to examine whether method effects associated with negatively worded items of the Rosenberg Self-Esteem Scale (RSES) may interact the negative self-evaluations experienced by patients with obesity and binge eating disorder (BED). We also examined whether negatively worded items were associated with psychological distress and eating symptoms., Method: Five hundred thirty three female outpatients (mean age: 42.59) with BED (n = 160) or obesity without BED (n = 373) completed the RSES and measures of interpersonal problems, psychological distress, and eating symptoms., Results: Patients with BED responded more strongly to the negatively worded items of the RSES than those with obesity. The RSES negatively worded item factor was negatively associated with higher interpersonal problems, psychological distress, and binge eating., Conclusions: Patients with BED may be more responsive to negatively phrased items on the RSES consistent with their negative self-evaluations and self-perceptions., (© 2020 Wiley Periodicals LLC.)

The interpersonal model has been validated for binge eating disorder (BED), but it is not yet known if the model applies to individuals who are obese but who do not binge eat. The goal of this study was to compare the validity of the interpersonal model in those with BED versus those with obesity, and normal weight samples. Data from a sample of 93 treatment-seeking women diagnosed with BED, 186 women who were obese without BED, and 100 controls who were normal weight were examined for indirect effects of interpersonal problems on binge eating psychopathology mediated through negative affect. Findings demonstrated the mediating role of negative affect for those with BED and those who were obese without BED. Testing a reverse model suggested that the interpersonal model is specific for BED but that this model may not be specific for those without BED. This is the first study to find support for the interpersonal model in a sample of women with obesity but who do not binge. However, negative affect likely plays a more complex role in determining overeating in those with obesity but who do not binge. Copyright © 2016 John Wiley & Sons, Ltd and Eating Disorders Association., (Copyright © 2016 John Wiley & Sons, Ltd and Eating Disorders Association.)

Objective: The study aimed to examine caregiving burden and levels of distress, accommodating behaviours, expressed emotion (EE) and carers' skills, in parents of adolescents with anorexia nervosa., Method: A semi-structured interview assessed the objective burden (time spent across caregiving tasks) in parents (n = 196) of adolescents (n = 144) receiving outpatient treatment for anorexia nervosa. Subjective burden (carers' distress), accommodating behaviours, EE and carers' skills were measured by self-report., Results: Mothers, on average, spent 2.5 h/day of care, mainly providing food and emotional support, compared with 1 h/day by fathers. The level of distress and accommodating behaviour was significantly lower in fathers than in mothers. Accommodating behaviours mediated the relationship between objective burden and subjective burden in mothers, whereas EE and carers' skills did not mediate this relationship for either parent., Discussion: The objective burden for most mothers is high. In order to reduce subjective burden, it may be helpful to target accommodating behaviours., Trial Registration: ISRCTN83003225 - Expert Carers Helping Others (ECHO). Copyright © 2016 John Wiley & Sons, Ltd and Eating Disorders Association., (Copyright © 2016 John Wiley & Sons, Ltd and Eating Disorders Association.)

Objective: The aim of this study was to develop and validate a new questionnaire designed to measure caregiver skills that, in line with the interpersonal component of the cognitive interpersonal maintenance model (Schmidt and Treasure, J Br J Clin Psychol, 45, 343-366, 2006), may be helpful in the support of people with anorexia nervosa (AN). A further aim is to assess whether this scale is sensitive to change following skills-based caregiver interventions., Method: The Caregiver Skills (CASK) scale was developed by a group of clinicians and caregivers. Preliminary versions of the scale devised for both caregivers and parents were given at baseline and at follow-up after two studies of caregiver interventions (a clinical trial of the effectiveness of guided self-help and training workshops). Exploratory and confirmatory factor analyses (CFA) were used to test the factorial structure of the CASK scale. Cronbach's alpha was used to measure internal consistency of the CASK scales., Results: Exploratory Factor Analysis suggested a six component solution (Bigger Picture, Self-Care, Biting-Your-Tongue, Insight and Acceptance, Emotional Intelligence and Frustration Tolerance) and this model was confirmed with CFA. Significant clinically relevant correlations were found between the CASK scales and other standardised measures of caregivers' attitudes and behaviours. Furthermore, greater improvements on abilities measured by the CASK scale were found in caregivers who received skills-training than caregivers assigned to a 'treatment as usual' condition., Discussion: The CASK scale is a measure of the fidelity of interventions based on the cognitive interpersonal maintenance model and is sensitive to the intensity of the intervention provided., (© 2014 Wiley Periodicals, Inc.)

Objectives: The study examined whether clients who continued longer in brief therapy reported stronger associations of real relationship and working alliance with therapy outcome than clients who received very brief treatment. It also examined whether real relationship and working alliance assessed early in treatment predicted outcome differently from that assessed later in therapy., Method: Fifty clients (32 women; M(age) = 22.3 years) were recruited from a university counseling center. Thirty-two clients (very brief therapy) completed the post-third session assessment of real relationship and working alliance, and 18 (brief therapy) had both the third and eighth assessment., Results: The real relationship scores (both client and therapist rating) were significantly correlated with outcome in the 18 brief therapy clients, but not in the 32 very brief therapy clients. We found significant correlations between outcome and Bond element of the working alliance in the 18 brief therapy clients, and between outcome and working alliance-Task in the 32 very brief therapy clients., Conclusions: These findings suggested that the strength of the early real relationship, as well as later real relationship, are highly associated with outcome for clients who continue brief therapy past its earliest stages., (© 2012 Wiley Periodicals, Inc.)

Objective: Several studies carried out over the last years show that patients' adjustment is very important to the past experiences of people with cancer. In our study of 96 subjects with cancer, we examined whether patient's working model of attachment anxiety/avoidance and perceptions of social support predicts adjustment to cancer., Methods: All participants filled in a demographic questionnaire, the Relationship Scale Questionnaire (RSQ), the Multidimensional Scale of Perceived Social Support (MSPSS), and the Mental Adjustment to Cancer (MAC)., Results: Anxious attachment predicted psychological adjustment: patients with high levels of anxious attachment showed high levels of helplessness/hopelessness and anxious preoccupation (p<0.01, and p<0.05, respectively). With regard to the function of perceived social support, the patient's perception of social support from friends was predictive of both fighting spirit and stoic acceptance (p=0.01, and p<0.001, respectively). Conversely, the patient's perception of support from family members was not predictive of adjustment to cancer. Patients in the advanced stages of the illness showed higher levels of helplessness/hopelessness (p<0.05)., Conclusions: Anxious attachment and perceived social support predicted different domains of psychological adjustment to cancer. Perceived support from friends may predict the patient's tendency to consider cancer as a challenge and to take an active role in therapy and recovery, whereas social support from family was not predictive of various states of adjustment to cancer.

Objectives: There is a lack of empirical data on the effectiveness and process of group-analytic therapy in eating disorders. This single-group study aimed to explore the effectiveness of such treatment for anorexic and bulimic individuals., Method: Eight patients (three anorexic and five bulimic women) entered group-analytic treatment, meeting weekly for 2 years. Eating behaviours, overall psychological distress and group process variables were regularly assessed using quantitative and qualitative measures, with comparisons made at the beginning and end of the therapy., Results: Treatment was discontinued in two cases. When outcome was classified on the basis of reliable change and clinical significance for the remaining patients at the end of treatment, four were recovered in terms of overall psychological distress, while one was unchanged and one had deteriorated. In terms of eating disorder symptoms, three patients were recovered, two were unchanged and one had deteriorated. Patients experienced an overall positive group climate and a positive group alliance. Perception of being understood by the therapist appeared to play an important role in the therapeutic process., Conclusions: These preliminary results suggest that group-analytic therapy may be effective in helping patients with eating disorders. However, more work is needed before firm conclusions can be drawn. Implications for clinical practice and future research are discussed., (Copyright 2008 John Wiley & Sons, Ltd and Eating Disorders Association.)