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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. [ABSTRACT FROM AUTHOR]

Evidence-based cognitive-behaviour therapy for eating disorders (CBT-ED) differs from other forms of CBT for psychological disorders, making existing generic CBT measures of therapist competence inadequate for evaluating CBT-ED. This study developed and piloted the reliability of a novel measure of therapist competence in this domain—the Cognitive Behaviour Therapy Scale for Eating Disorders (CBTS-ED). Initially, a team of CBT-ED experts developed a 26-item measure, with general (i.e. present in every session) and specific (context- or case-dependent) items. To determine statistical properties of the measure, nine CBT-ED experts and eight non-experts independently observed six role-played mock CBT-ED therapy sessions, rating the therapists' performance using the CBTS-ED. The inter-item consistency (Cronbach's alpha and McDonald's omega) and inter-rater reliability (ICC) were assessed, as appropriate to the clustering of the items. The CBTS-ED demonstrated good internal consistency and moderate/good inter-rater reliability for the general items, at least comparable to existing generic CBT scales in other domains. An updated version is proposed, where five of the 16 "specific" items are reallocated to the general group. These preliminary results suggest that the CBTS-ED can be used effectively across both expert and non-expert raters, though less experienced raters might benefit from additional training in its use. [ABSTRACT FROM AUTHOR]

It is well recognized by the general public that breastfeeding expends calories. In our clinical practice, a number of postpartum women with a history of or a current eating disorder (ED) report using breastfeeding and/or pumping breast milk to influence their body shape and weight. This appears to be either a form of weight control behavior or, in some cases, a compensation for perceived overeating or binge eating. Breastfeeding and pumping have not generally been identified as maladaptive weight control behaviors, nor have they been a subject of research to date. We suggest that this practice should be investigated to determine how common it is, its potential role in maintaining EDs or contributing to relapse in the postpartum period, and to better understand other potential harms it may cause to both the mother and infant/child. Public significance: Breastfeeding and pumping may be used as maladaptive methods of weight control by women with EDs. This behavior is under‐recognized in clinical practice and has received little research attention. We argue that maladaptive breastfeeding and pumping warrant further investigation, as the behaviors may play an important role in maintaining an ED or in contributing to relapse during the postpartum period and may also indirectly harm the infant/child. [ABSTRACT FROM AUTHOR]

In recent years there has been widespread acceptance that cognitive behavior therapy (CBT) is the treatment of choice for bulimia nervosa. The cognitive behavioral treatment of bulimia nervosa (CBT-BN) was first described in 1981. Over the past decades the theory and treatment have evolved in response to a variety of challenges. The treatment has been adapted to make it suitable for all forms of eating disorder--thereby making it "transdiagnostic" in its scope--and treatment procedures have been refined to improve outcome. The new version of the treatment, termed "enhanced CBT" (CBT-E) also addresses psychopathological processes "external" to the eating disorder, which, in certain subgroups of patients, interact with the disorder itself. In this paper we discuss how the development of this broader theory and treatment arose from focusing on those patients who did not respond well to earlier versions of the treatment. (Contains 2 figures and 1 table.)

Objective: To map and examine the systematic review evidence base regarding the effects of cognitive‐behavioral therapy (CBT) for eating disorders (EDs), especially against active interventions. Method: This systematic review is an extension of an overview of CBT for all health conditions (CBT‐O). We identified ED‐related systematic reviews from the CBT‐O database and performed updated searches of EMBASE, MEDLINE, and PsychInfo in April 2021 and September 2022. Results: The 44 systematic reviews included (21 meta‐analyses) were of varying quality. They focused on "high intensity" CBT, delivered face‐to‐face by qualified clinicians, in BN, BED and mixed, not specifically low‐weight samples. ED‐specific outcomes were studied most, with little consensus on their operationalization. The, often insufficient, reporting of sample characteristics did not allow assessment of the generalizability of findings. The meta‐analytic syntheses show that high intensity one‐to‐one CBT produces better short‐term effects than a mix of active controls especially on ED‐specific measures for BED, BN, and transdiagnostic samples. There is little evidence favoring group CBT or low intensity CBT against other active interventions. Discussion: While this study found evidence consistent with current ED treatment recommendations, it highlighted notable gaps that need to be addressed. There were insufficient data to allow generalizations regarding sex and gender, age, culture and comorbidity and to support CBT in AN samples. The evidence for group CBT and low intensity CBT against active controls is limited, as it is for the longer‐term effects of CBT. Our findings identify areas for future innovation and research within CBT. Public Significance: This study provides a comprehensive mapping and quality assessment of the current large systematic review research base regarding the effects of cognitive behavioral therapy (CBT) for eating disorders (EDs), with a focus on comparisons to other active interventions. By transcending the more limited scope of individual systematic reviews, this overview highlights the gaps in the current evidence base, and thus provides guidance for future research and clinical innovation. [ABSTRACT FROM AUTHOR]

Perfectionism can be a problem in its own right and it can impede the progress of treatment of Axis I disorders. This study reports on a preliminary randomised controlled trial of cognitive- behaviour therapy (CBT) for 'clinical perfectionism'. Twenty participants were randomly assigned to either immediate treatment (IT) (n = 10) or a waitlist (NL) (n = 10). Treatment consisted often sessions of CBT over eight weeks. Two participants did not complete the follow-up assessments (10%). Fifteen of the original 20 participants (75%) were clinically significantly improved after treatment and the effect size was large (1.8). Treatment gains were maintained at 8-week and 16-week follow-up. [c] 2006 Elsevier Ltd. All rights reserved. Keywords: Cognitive-behaviour therapy; Clinical perfectionism; Randomised controlled trial

The relationship between the eating disorders and attentional biases is studied in two samples of female patients with clinical eating disorders and anxiety along with a control group of normal females. The negative eating biases were observed in women with eating disorders than in anxious and normal controls.

It is a consistent finding that, among obese patients, the weight lost as a result of the most widely available treatments for obesity is almost always regained. This relapse appears to be attributable to the individual's inability to persist with the behavioural strategies needed to maintain the new lower weight. Little research has investigated the psychological mechanisms that might account for this phenomenon. This study aimed to identify psychological factors that predict weight regain. Fifty-four women with obesity who had lost weight by attending community slimming clubs were interviewed immediately after losing 10% of their initial body weight, and then followed-up every 2 months for a period of 1 year by means of telephone interviews. The results identified two prospective predictors of weight regain: one cognitive factor (dichotomous thinking) and one historical variable (maximum lifetime weight). The finding that a specific cognitive style is a significant predictor of relapse has implications for the treatment of obesity. Keywords: Obesity: Weight maintenance; Weight regain; Psychological factors; Dichotomous thinking