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ABSTRACT Objective Method Results Discussion Shame is a powerful self‐conscious emotion that is often experienced by individuals with eating disorders (EDs). While the association between EDs and shame is well‐established, there is limited research investigating the contribution of pre‐treatment shame to clinical outcomes.Participants (N = 273) received outpatient cognitive‐behavioral therapy for eating disorders (CBT‐ED). We investigated pre‐treatment shame as a predictor of dropout and as a moderator of change in ED psychopathology and clinical impairment from pre‐treatment to post‐treatment. We also explored the potentially moderating roles of body mass index, ED diagnostic category, and co‐occurring anxiety and depression diagnoses.Shame improved substantially (d = 1.28) despite not being explicitly targeted in treatment. Pre‐treatment shame did not predict treatment dropout. Individuals high in shame started and ended treatment with higher ED symptoms and impairment than those with low shame. The contribution of pre‐treatment shame on the degree of change in symptoms/impairment depended critically on whether analyses controlled for pre‐treatment symptoms/impairment. When those were controlled, high pre‐treatment shame was associated with substantially less improvement in ED symptoms and impairment. There was some evidence that ED diagnosis and co‐occurring depressive diagnoses may moderate the relationship between shame and treatment outcome. Changes in shame were positively associated with changes in ED symptoms and clinical impairment.A high level of shame at pre‐treatment is not a contraindication for CBT‐ED as good therapeutic outcomes can be achieved. However, outcomes may be enhanced among individuals high in shame by offering adjunctive interventions that explicitly target shame. [ABSTRACT FROM AUTHOR]

Although treatment dropout is common among patients with eating disorders, very few studies have examined predictors of non‐completion in day treatment. We investigated various potential predictors of dropout from adult day treatment. Participants were 295 adult patients with a diagnosis of Anorexia Nervosa (restricting or binge‐eating/purging subtype), Bulimia Nervosa (BN), Other Specified Feeding or Eating Disorder, or Avoidant Restrictive Food Intake Disorder. Predictors included eating‐disorder characteristics, motivation at the commencement of treatment, Body Mass Index (BMI), time spent in treatment and personality dimensions. Logistic regression analyses showed that for patients with a BMI of less than 20 at the start of treatment, low BMI was a significant predictor of staff‐initiated termination due to not meeting weight gain goals. Furthermore, completing less than 6 weeks of treatment was associated with staff‐initiated termination. For the whole sample, those with higher changes in weight over the course of treatment were less likely to terminate prematurely. None of the other predictor variables yielded significant results. Results of the current study highlight characteristics of patients who are more likely not to complete day treatment and can help identify patients who may be at risk for not succeeding in multi‐diagnostic day treatment programs. Highlights: For patients attending day treatment, low BMI at the start of treatment was a significant predictor of staff‐initiated discharge in participants who entered the program with a BMI < 20For all patients, larger changes in BMI over the course of treatment predicted higher likelihood of completing treatmentResults can help identify which patients may be at risk for not succeeding in multi‐diagnostic day treatment programs and address this risk in the transition to a higher level of care from lower levels [ABSTRACT FROM AUTHOR]

Sleep disruption and deprivation are highly prevalent among parents of an infant. However, most postpartum sleep studies focus solely on mothers, and few studies have investigated whether sleep differs between first‐time and experienced parents. The present study aimed to determine whether self‐reported sleep duration and quality differ between first‐time and experienced mothers and fathers during the postpartum period. A total of 111 parents (54 couples and three single mothers) of 6‐month‐old infants completed a 2‐week sleep diary to evaluate measures of sleep duration, sleep continuity, and sleep quality. An analysis of covariance model was used to compare the sleep variables of first‐time to experienced parents. Breastfeeding frequency, infant sleep location, depression, education, and work status were used as co‐variables. First‐time mothers reported a longer consecutive nocturnal sleep duration (mean [SEM] 297.34 [17.15] versus 246.01 [14.79] min, p <.05), fewer nocturnal awakenings (mean [SEM] 1.57 [0.20] versus 2.12 [0.17], p <.05), and rated their sleep quality higher (mean [SEM] score 7.07 [0.36] versus 5.97 [0.30], p <.05) than experienced mothers, while total nocturnal sleep duration did not differ. There were no differences in subjective sleep measures between first‐time and experienced fathers. The present study indicates that experienced mothers reported more fragmented sleep and perceived having worse sleep quality than first‐time mothers, but that paternal sleep did not differ as a function of parental experience. These findings have clinical implications for healthcare professionals working with families of various configurations and sizes. [ABSTRACT FROM AUTHOR]

Question: This review compares mindfulness-based stress reduction (MBSR) to cognitive-behavioural therapy (CBT) in its ability to improve physical functioning and reduce pain intensity and distress in patients with chronic pain (CP), when evaluated against control conditions., Study Selection and Analysis: Ovid MEDLINE, EmbaseClassic+Embase, PsycINFO and the Cochrane Library were searched to identify randomised controlled trials. The primary outcome measure was physical functioning. Secondary outcomes were pain intensity and depression symptoms. We used random and fixed effects (RE and FE) network meta-analyses (NMA) to compare MBSR, CBT and control interventions on the standardised mean difference scale., Findings: Twenty-one studies were included: 13 CBT vs control (n=1095), 7 MBSR vs control (n=545) and 1 MBSR vs CBT vs control (n=341). Of the 21 articles, 12 were determined to be of fair or good quality. Findings from RE NMA for change in physical functioning, pain intensity and depression revealed clinically important advantages relative to control for MBSR and CBT, but no evidence of an important difference between MBSR and CBT was found., Conclusions: This review suggests that MBSR offers another potentially helpful intervention for CP management. Additional research using consistent measures is required to guide decisions about providing CBT or MBSR., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.)