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Dialectical behavior therapy (DBT) is commonly used in the treatment of eating disorders (ED), yet few studies have examined the utility of DBT skills groups as an adjunct to evidence-based therapy for ED. Thus, we sought to examine the preliminary efficacy of a DBT skills group as an adjunct to Family-Based Treatment (FBT) for adolescent restrictive ED. Our preliminary pilot study included 18 adolescent girls ages 13-18 (

Functional gastrointestinal disorders (FGIDs), including functional abdominal pain (FAP), account for a large portion of conditions seen by paediatric gastroenterologists. Despite the commonality of FGIDs, there remains significant stigma around these diagnoses among medical providers, patients and families. This is due to the absence of easily identifiable biological markers in FGIDs and the overlay with psychological and social factors contributing to symptom onset and maintenance. As such, the biopsychosocial model is essential in conceptualising, evaluating and treating FGIDs. The way in which medical providers explain FGIDs and the manner in which they collaborate with other specialists (eg, psychologists, dieticians, physical therapists, school nurses) is paramount to the patient and family acceptance of an FGID diagnosis and the success of subsequent treatment. The following review outlines paediatric FGIDs with a focus on FAP in adolescents, in particular within the context of the biopsychosocial approach to pathophysiology, diagnosis and treatment.

Purpose of review To highlight current evidence supporting the prescription of cognitive behavioral therapy (CBT) as part of first-line preventive treatment for children and adolescents with headache and discuss a research strategy aimed at: (1) understanding how and why CBT works, and (2) developing effective and efficient approaches for integrating CBT into headache specialty, neurology, and primary care settings. Recent findings Although preventive medications for pediatric headache and migraine are commonly prescribed, recent meta-analyses and an NIH-funded, multi-center clinical trial suggests that the effect of pill-taking therapies may be mostly due to a placebo effect. These findings have led to greater consideration of prescription of non-pharmacological therapies as first-line interventions (either alone or in combination with pill-based therapy). A literature that extends back to the 1980s and includes recent clinical trials and meta-analyses demonstrates that CBT decreases headache frequency and related disability in youth with headache and migraine and has a favorable benefit to risk profile with almost no negative side effects. Summary CBT has been repeatedly demonstrated as effective in treating pediatric headache and migraine. As such, it should be considered as part of first-line preventive treatment for pediatric headache (either alone or in combination with a pill-based therapy). We need to better understand how this therapy works and what makes it distinct (if anything) from the placebo effect. What we need to achieve is empirical support for efficient access to this evidence-based treatment and clarity on how to match the intensity of non-pharmacological intervention to the needs of our patients at the time they present for care.

OBJECTIVE: The goal of this study was to determine which cognitive behavioral therapy (CBT-HA) treatment components pediatric headache patient stakeholders would report to be most helpful and essential to reducing headache frequency and related disability in order to develop a streamlined, less burdensome treatment package that would be more accessible to patients and families. BACKGROUND: Pediatric migraine is a prevalent and disabling condition. CBT-HA has been shown to reduce headache frequency and related disability, but may not be readily available or accepted by many migraine sufferers due to treatment burden entailed. Research is needed to determine systematic ways of reducing barriers to CBT-HA. METHODS: Qualitative interviews were conducted with 10 patients and 9 of their parents who had undergone CBT-HA. Interviews were analyzed using an inductive thematic analysis approach based upon modified grounded theory. Patients were 13 to 17.5 years of age (M = 15.4, SD = 1.63) and had undergone CBT-HA approximately one to two years prior to participating in the study. RESULTS: Overall, patients and their parents reported that CBT-HA was helpful in reducing headache frequency and related disability. Although patients provided mixed reports on the effectiveness of different CBT-HA skills, the majority of patients indicated that the mind and body relaxation skills of CBT-HA (deep breathing, progressive muscle relaxation, and activity pacing in particular) were the most helpful and most frequently used skills. Patients and parents also generally reported that treatment was easy to learn, and noted at least some aspect of treatment was enjoyable. CONCLUSIONS: Results from these qualitative interviews indicate that mind and body CBT-HA relaxation skills emerged as popular and effective based on patient and parent report. Future research examining the effectiveness of streamlined pediatric migraine non-pharmacological interventions should include these patient-preferred skills.

Body functionality has been identified as an important dimension of body image that has the potential to be useful in the prevention and treatment of negative body image and in the enhancement of positive body image. Specifically, cultivating appreciation of body functionality may offset appearance concerns. However, a scale assessing this construct has yet to be developed. Therefore, we developed the Functionality Appreciation Scale (FAS) and examined its psychometric properties among three online community samples totalling 1042 women and men (ns = 490 and 552, respectively). Exploratory factor analyses revealed a unidimensional structure with seven items. Confirmatory factor analysis upheld its unidimensionality and invariance across gender. The internal consistency, test-retest reliability, criterion-related, and construct (convergent, discriminant, incremental) validity of its scores were upheld. The FAS is a psychometrically sound measure that is unique from existing positive body image measures. Scholars will find the FAS applicable within research and clinical settings.

We compared headache frequency trajectories between clinical trial participants who received cognitive-behavioral therapy (CBT) and amitriptyline (CBT+A) or headache education (HE) and amitriptyline (HE+A) to determine if there was a differential time course of treatment response between the groups. One hundred thirty-five patients (age 10–17 years) diagnosed with chronic migraine participated, attending 8 one-hour one-on-one CBT or HE sessions with a trained psychologist for 8 weekly sessions, 2 sessions at weeks 12 and 16, and a post-treatment visit at week 20. Participants kept daily headache diaries and completed take-home assignments between visits. Data from daily headache diaries are presented for each day and according to 28-day periods. Trajectories of improvement indicate initial decrease in headache days began during the first month of treatment, for both groups, and continued to decrease throughout treatment. The CBT+A group had greater daily improvement than the HE+A group. A significantly greater proportion of the CBT+A group had a ≥50% reduction in headache days each month, and a significantly greater proportion of the CBT+A group had ≤4 headache days per month in months 3 through 5. Results indicate the trajectory of decrease in headache days is significantly better for patients receiving CBT+A versus HE+A. Perspective This article presents daily information about headache frequency over a 20-week clinical trial. Youth with chronic migraine who received CBT+A improved faster than those in the control group. Findings provide clinicians with evidence-based expectations for treatment response over time and ways of monitoring treatment success. Trial registration clinicaltrials.gov identifier NCT00389038 .

Cognitive behavioral therapy (CBT) is a psychological intervention that involves development of coping strategies to reduce the experience of pain. Although CBT is a promising intervention to reduce headache days in patients with migraine, it may not be effective for all patients. Thus, there is a need to identify markers that could predict which patients will respond to CBT. We aimed to determine whether baseline brain function and amygdalar connectivity, assessed by functional magnetic resonance imaging, or pain modulation capacities, assessed by the conditioned pain modulation (CPM) response, can predict a reduction in headache days after CBT in adolescents with migraine. Patients with migraine (n = 20; age range 10-17 years) completed 8 weekly CBT sessions. The CPM response was examined in the trapezius and the leg. Headache days significantly decreased after CBT (P < 0.001). Greater functional connectivity before CBT between the right amygdala and frontal gyrus, anterior cingulate cortex, and precentral gyrus was related to greater headache reduction after CBT. Greater reduction in headache days after CBT was related with less efficient CPM response before CBT at the trapezius (r = -0.492, P = 0.028) but not at the leg. This study found that headache reduction after CBT was related to right amygdala connectivity with frontal and sensorimotor regions at baseline as well as baseline pain modulation capacities. These findings suggest that individual differences in brain function and pain modulation can be associated with clinical improvements and help with determination of CBT responsiveness.

OBJECTIVES This basic mechanistic study examined the changes in brain activation and resting-state connectivity after 8 weeks of CBT in youth with migraine. BACKGROUND Cognitive behavioral therapy (CBT) is a psychological intervention that is effective in reducing pain in migraine patients. However, the neural mechanisms underlying CBT in adolescents with migraine are not yet known. METHODS Eighteen adolescents with migraine (15 females, age 15.1 ± 2.1 years [mean ± SD]) completed 8 weekly CBT sessions. Before the first and after the final CBT session, participants underwent structural and resting-state blood-oxygen-level-dependent contrast MRI scans. Arterial spin labeling was also used to examine brain activation during the resting state. For connectivity analyses, the right and left amygdala were chosen as seed regions. Relationships of the time courses within these seeds with voxels across the whole brain were evaluated. RESULTS Headache frequency decreased from 15 ± 7.4 headaches per month before CBT to 10 ± 7.4 after CBT (P

There is limited research on cognitive risk factors for eating disorders among young girls despite accumulating evidence that body dissatisfaction and thin-ideal internalization can begin to occur between 3 and 5 years of age. To improve upon the existing literature and significantly contribute to the prevention and intervention literature, the current study examined body dissatisfaction, thin-ideal internalization, and self-objectification in girls between 5 and 7 years of age. The sample consisted of 151 mother-daughter dyads with 63 five-year-olds, 39 six-year-olds, and 49 seven-year-olds. Girls were interviewed about their body dissatisfaction, thin-ideal, and self-objectification. In addition, all mothers and daughters participated in an individual and joint mirror experiment. Levels of body dissatisfaction were consistent across 5- to 7-year-olds. Thin-ideal internalization was higher among 5-year-olds than 6- and 7-year-olds. In contrast, self-objectification was higher among 6- and 7-year-olds than 5-year-old girls. Mother's body dissatisfaction significantly and positively predicted daughter's body dissatisfaction during the joint mirror experiment. Similarly, mother's body satisfaction significantly and positively predicted daughter's body satisfaction. Results from this study suggest that girls model their mothers' self-body talk. In addition, girls will change their positive or negative body responses after being exposed to their mothers' response.

Objective The purpose of this investigation was to examine treatment adherence to medication and lifestyle recommendations among pediatric migraine patients using electronic monitoring systems. Background Nonadherence to medical treatment is a significant public health concern, and can result in poorer treatment outcomes, decreased cost-effectiveness of medical care, and increased morbidity. No studies have systematically examined adherence to medication and lifestyle recommendations in adolescents with migraine outside of a clinical trial. Methods Participants included 56 adolescents ages 11-17 who were presenting for clinical care. All were diagnosed with migraine with or without aura or chronic migraine and had at least 4 headache days per month. Medication adherence was objectively measured using electronic monitoring systems (Medication Event Monitoring Systems technology) and daily, prospective self-report via personal electronic devices. Adherence to lifestyle recommendations of regular exercise, eating, and fluid intake were also assessed using daily self-report on personal electronic devices. Results Electronic monitoring indicates that adolescents adhere to their medication 75% of the time, which was significantly higher than self-reported rates of medication adherence (64%). Use of electronic monitoring of medication detected rates of adherence that were significantly higher for participants taking once daily medication (85%) versus participants taking twice daily medication (59%). Average reported adherence to lifestyle recommendations of consistent noncaffeinated fluid intake (M = 5 cups per day) was below recommended levels of a minimum of 8 cups per day. Participants on average also reported skipping 1 meal per week despite recommendations of consistently eating three meals per day. Conclusions Results suggest that intervention focused on adherence to preventive treatments (such as medication) and lifestyle recommendations may provide more optimal outcomes for children and adolescents with migraine and their families. Once daily dosing of medication may be preferred to twice daily medication for increased medication adherence among children and adolescents.

Migraine is a highly prevalent and disabling neurological disorder associated with a wide range of psychiatric comorbidities. In this manuscript, we provide an overview of the link between migraine and several comorbid psychiatric disorders, including depression, anxiety and post-traumatic stress disorder. We present data on psychiatric risk factors for migraine chronification. We discuss the evidence, theories and methods, such as brain functional imaging, to explain the pathophysiological links between migraine and psychiatric disorders. Finally, we provide an overview of the treatment considerations for treating migraine with psychiatric comorbidities. In conclusion, a review of the literature demonstrates the wide variety of psychiatric comorbidities with migraine. However, more research is needed to elucidate the neurocircuitry underlying the association between migraine and the comorbid psychiatric conditions and to determine the most effective treatment for migraine with psychiatric comorbidity.

Background Although there have been extensive studies that make group comparisons on child eating and feeding practices, few studies have examined measurement equivalence to ensure that measures used to make such group comparisons are equivalent across important group characteristics related to childhood obesity. Methods Using a sample of 243 caregivers with children between the ages of 4 to 6 years, we conducted a measurement equivalence analysis across gender, ethnicity (Latino versus non-Latino White), and household food security. The subscales of the Child Feeding Questionnaire (CFQ) and the Child Eating Behaviour Questionnaire (CEBQ) were examined separately using a one factor multi-group confirmatory factor analysis. Results For the CFQ, Concern about Child Weight and Parental Responsibility subscales were consistent across all groups examined. In contrast, Pressure to Eat, Restriction, and Perceived Parent Weight subscales varied or fit poorly across the groups. For the CEBQ, Emotional Overeating, Enjoyment of Food, and Satiety Responsiveness performed consistently across the groups. On the other hand, Food Fussiness, Desire to Drink, Slowness in Eating, and Emotional Undereating subscales varied or fit poorly across the groups. Conclusions Findings from this study suggest both of these measures need continued psychometric work, and group comparisons using some subscales should be interpreted cautiously. Some subscales such as Food Responsiveness and Parental Restriction may be assessing behaviors that occur in food secure households and are less applicable to food insecure environments.

This review presents findings from investigations of migraine in children and adults. Similarities and differences in the presentation, related consequences, and treatments between children and adults are reviewed. Significant similarities exist in the presentation, disability, and treatments for migraine between children and adults. Despite such similarities, many adult migraine treatments adapted for use in children are not rigorously tested prior to becoming a part of routine care in youth. Existing research suggests that not all approaches are equally effective across age groups. Specifically, psychological treatments are shown to be somewhat less effective in adults than in children. Pharmacological interventions found to be statistically significant relative to placebo in adults may not be as effective in children and have the potential to present more risk than benefit when used in youth. The placebo effect in both children and adults is robust and is need of further study. Better understanding of treatment mechanisms for all interventions across the age spectrum is needed. Although migraine treatments determined to be effective for adults are frequently adapted for use in children with little evaluation prior to implementation, existing research suggests that this approach may not be the best practice. Adaptation of adult pharmacological treatment for use in youth may present a particular risk in comparison to benefits gained. Because of the known efficacy of psychological treatments, such as cognitive behavioral therapy, more universal use of these interventions should be considered, either as first-line treatment or in combination with pill-based therapies.

Objectives To examine treatment adherence among children and adolescents with chronic migraine who volunteered to be in a clinical trial using 3 measures: treatment session attendance, therapy homework completion, and preventive medication use by daily diary. Materials and methods Analyses are secondary from a trial of 135 youth aged 10 to 17 years diagnosed with chronic migraine and with a Pediatric Migraine Disability Score over 20. Participants were randomly assigned to cognitive-behavioral therapy plus amitriptyline (CBT+A, N=64) or headache education plus amitriptyline (HE+A, N=71). Therapists recorded session attendance. Completion of homework/practice between sessions was reported to therapists by patients. Patients reported preventive medication adherence using a daily headache diary. Results Mean session attendance adherence out of 10 treatment sessions was 95% for CBT+A and 99% for HE+A. CBT+A participants reported completing a mean of 90% of home practice of CBT skills between the 10 sessions. Participants reported taking amitriptyline daily at a mean level of 90% when missing diaries were excluded and 79% when missing diaries were considered as missed doses of medication. Discussion Our findings demonstrate that youth with chronic migraine who agree to be a part of a clinical trial do quite well at attending therapy sessions, and report that they are adherent to completing home/practice between sessions and taking medication. These results lend further support to consideration of CBT+A as a first-line treatment for youth with chronic migraine and suggest that measurement of adherence when this treatment is provided in practice will be important.

Within objectification theory research, sexual objectification is typically operationalized as interpersonal sexual objectification—being targets of body evaluation and unwanted sexual advances. We argue that women’s male partners’ pornography use could be integrated within objectification theory as another form of sexual objectification and negatively linked to women’s well-being. College women ( N = 171) rated how often their current and previous male partners viewed pornography and whether pornography use bothered them. They also completed measures of objectification theory constructs, internalization of cultural beauty standards, relationship attachment, self-esteem, body appreciation, and negative affect. The extent to which women were bothered by partner pornography use was controlled in all analyses. Path analysis revealed that previous partners’ pornography use (a) directly predicted interpersonal sexual objectification, internalization, and eating disorder symptomatology and (b) indirectly predicted body surveillance and body shame through internalization. In hierarchical regressions, previous partners’ pornography use inversely predicted self-esteem and body appreciation and positively predicted relationship anxiety and negative affect. Current partners’ pornography use was not linked to any criterion. Researchers should more comprehensively examine partners’ pornography use in relation to women’s distress. Practitioners may consider exploring male partners’ pornography use in female clients’ relationship histories and its potential associations with their well-being when relevant to them. Additional online materials for this article are available to PWQ subscribers on PWQ's website at http://pwq.sagepub.com/supplemental .

The purpose of the current study was to expand upon the literature examining the relationship between acculturative stress and eating disorder symptoms among different ethnic groups. Specifically, acculturative stress was explored as a moderator of the relationship between body dissatisfaction and eating disorder symptoms among ethnic minority women. Additionally, the distinction between acculturative stress and general life stress in predicting eating disorder symptoms was assessed. Participants consisted of 247 undergraduate women, all of whom were members of an ethnic minority group including African Americans, Asian Americans, and Latinas. Acculturative stress was found to moderate the relationship between body dissatisfaction and eating disorder symptoms, but only among African American women. Acculturative stress was also found to significantly predict bulimic symptoms above and beyond general life stress among African American, Asian American, and Latina women.

Analyses of thin-ideal internalization and self-objectification were conducted within the context of a cognitive dissonance based eating disorder prevention program implemented in an undergraduate sorority. Participants completed self-report assessments at baseline (n=177), post-intervention (n=169), 5-month (n=159), and 1-year follow-up (n=105). Cross-sectional path analysis indicated that thin-ideal internalization and self-objectification predict each other and both predict body dissatisfaction, which in turn, predicts eating disorder symptoms. A longitudinal examination conducted using hierarchical linear modeling indicated that participants showed significant reductions in thin-ideal internalization, self-objectification, body dissatisfaction, and eating disorder symptoms after participating in the prevention program. Reductions of symptoms were maintained 1-year post-intervention, with the exception of self-objectification, which was significantly reduced up to 5-months post-intervention. Collectively, results suggest that targeting both thin-ideal internalization and self-objectification simultaneously within eating disorder prevention programs could increase the reduction of eating disorder symptoms.

Researchers have started to explore the detrimental impact of maladaptive maternal eating behaviors on child feeding practices. However, identifying which adaptive maternal eating behaviors contribute to lower use of negative and higher use of positive child feeding practices remains unexamined. The present study explored this link with 180 mothers of 2- to 5-year-old children. Hierarchical regression analyses (controlling for recruitment venue and maternal demographic characteristics, i.e., age, education, ethnicity, and body mass index) examined mothers' intuitive eating and eating competence as predictors of four feeding practices (restriction, monitoring, pressure to eat, and dividing feeding responsibilities with their child). Mothers who gave themselves unconditional permission to eat were less likely to restrict their child's food intake. Mothers who ate for physical (rather than emotional) reasons and had eating-related contextual skills (e.g., mindfulness when eating, planning regular and nutritious eating opportunities for themselves) were more likely to monitor their child's food intake. Mothers who had eating-related contextual skills were more likely to divide feeding responsibilities with their child. No maternal eating behavior predicted pressure to eat. Interventions to help mothers develop their eating-related contextual skills and eat intuitively, in particular, may translate into a more positive feeding environment for their young children.

The 21-item Intuitive Eating Scale (IES; Tylka, 2006) measures individuals' tendency to follow their physical hunger and satiety cues when determining when, what, and how much to eat. While its scores have demonstrated reliability and validity with college women, the IES-2 was developed to improve upon the original version. Specifically, we added 17 positively scored items to the original IES items (which were predominantly negatively scored), integrated an additional component of intuitive eating (Body-Food Choice Congruence), and evaluated its psychometric properties with 1,405 women and 1,195 men across three studies. After we deleted 15 items (due to low item-factor loadings, high cross-loadings, and redundant content), the results supported the psychometric properties of the IES-2 with women and men. The final 23-item IES-2 contained 11 original items and 12 added items. Exploratory and second-order confirmatory factor analyses upheld its hypothesized 4-factor structure (its original 3 factors, plus Body-Food Choice Congruence) and a higher order factor. The IES-2 was largely invariant across sex, although negligible differences on 1 factor loading and 2 item intercepts were detected. Demonstrating validity, the IES-2 total scores and most IES-2 subscale scores were (a) positively related to body appreciation, self-esteem, and satisfaction with life; (b) inversely related to eating disorder symptomatology, poor interoceptive awareness, body surveillance, body shame, body mass index, and internalization of media appearance ideals; and (c) negligibly related to social desirability. IES-2 scores also garnered incremental validity by predicting psychological well-being above and beyond eating disorder symptomatology. The IES-2's applications for empirical research and clinical work are discussed.

Nearly 10% of young women experience clinical eating disorders (Lewinsohn et al., 2000), and an even greater amount of women experience subclinical eating disorders and risk factors association with eating disorders, such as body dissatisfaction. Eating disorders are associated with a number of negative physical and psychological consequences, increased risk of mortality, and are often severe and debilitating (Thompson & Stice 2001). Of the individuals who experience eating disorder symptoms and their negative consequences, less than 25% will receive treatment (Hudson et al., 2007; Johnson et al., 2002). For those that do receive treatment, treatment effects are limited with only 30% experiencing long-lasting symptom remission (Agras et al., 2000; Fairburn, 2002; Fairburn et al., 2009; Wilson et al., 2003), and approximately 20% drop out (Fairburn 2002). Treatment for eating disorders is also relatively expensive, and most insurance companies will not fund inpatient treatment for individuals with severe eating disorders (Shaw et al., 2009). Therefore, more efforts have been devoted to the development of effective programs for the prevention of eating disorders.

Background: There is a current and pressing need for recovery resources for individuals suffering from eating disorders. Mentoring programs have been useful with other psychiatric disorders such as addictions, and may be useful for individuals recovering from an eating disorder. The present study sought to examine a mentoring program for individuals working towards recovery from an eating disorder. Methods: The study included mentors (i.e., individuals who have recovered from an eating disorder for an extended period of time), and mentees (i.e., individuals who were in the process of recovering from an eating disorder and wanting additional support aside from their treatment team). Participants included 141 participants, consisting of 34 mentors, 58 mentees who matched with a mentor, and 49 mentees searching for a mentor. Participants completed questions assessing eating disorder symptoms, quality of life, motivation towards recovery, and treatment compliance. Results: Matched mentees reported higher levels of quality of life on 7 out of 12 domains, and missed fewer appointments with treatment providers when compared to unmatched mentees. There were no differences between matched and unmatched mentees on motivation, energy or confidence towards recovery. Conclusions: Findings suggest a mentor model is beneficial for individuals engaged in the process of recovering from an eating disorder in the areas of quality of life and treatment compliance. Specifically, mentees in a mentoring relationship reported better family and close relationships, future outlook, and psychological, emotional, and physical well-being than unmatched mentees. Mentors reported being positively impacted by the mentoring relationship by strengthening the skills they learned while in recovery, and reminding them of how far they had come in their own recovery. The findings in this study suggest that mentor programs warrant further investigation as ancillary support services for individuals recovering from an eating disorder.