A Review of Eating Disorders in Athletes

SUMMARY

The current review aims to evaluate the literature on eating disorders and athletes with the purpose of making recommendations for sport psychologists and other relevant personnel on how to proceed in identifying, managing, and preventing eating disorders in school settings. Whereas the intention of this review is to make recommendations for secondary educational settings, research on other populations such as collegiate and young adult athletes was also reviewed where helpful or where information on adolescent athletes was not available. Recommendations for prevention and intervention include ongoing education of athletes and coaches regarding nutrition, body composition, and performance, using appropriate screening to detect eating disorders, and use of a sport management team to aid in athlete recovery.     

焦虑障碍的虚拟现实暴露疗法研究述评

虚拟现实暴露疗法(VRET)是传统的行为疗法的一种转换形式, 也是经典的现实情境暴露疗法的替代性治疗形式。虚拟现实整合了即时计算机图形学、身体感觉传感、视觉成像技术, 给来访者提供近似真实的、可以沉浸(immersion)和交互作用的虚拟环境。研究者采用虚拟现实暴露疗法治疗幽闭恐怖症、恐高症、飞行恐怖症、创伤后应激障碍、惊恐障碍等焦虑障碍, 并且关注虚拟现实暴露疗法的认知机制以及心理生理机制。实验研究表明, 虚拟现实暴露疗法在治疗焦虑障碍时是有效的。被试经过治疗之后, 对情境的控制感和自我效能感提升, 消极自我评价降低, 对创伤事件的容忍力提高, 重新获得对情境的控制感。与心率指标相比, 皮肤电是预测虚拟现实暴露疗法治疗效果更好的指标。虚拟现实暴露疗法还处于实验验证阶段, 并没有应用到实际临床中, 需要更加规范的实验设计验证该疗法的认知机制以及心理生理机制。虚拟现实暴露疗法结合功能磁共振成像(FMRI)用于心理治疗, 会是未来发展的新方向。     

Toward Reducing Risk for Eating Disorders and Obesity in Latina College Women

The efficacy of 2 computer‐based programs was tested with Latina college women (N= 64). Compared with participants in the control group, intervention participants improved their motivation to eat fruits and vegetables (F&V; p= .042) and to participate in physical activity (p= .023) and significantly increased their F&V intake (pre‐ to posttest, p < .001; pre‐follow‐up, p= .002). Body dissatisfaction improved at a trend level (p= .055). Some modest effects of computer‐based programs were found.     

Mindfulness and Eating Disorders: A Network Analysis

Higher trait mindfulness may be protective against eating disorder (ED) pathology. However, little is understood about which specific mindfulness processes connect to specific ED symptoms. This study (N = 1,056 undergraduates) used network analysis at the symptom/process level to identify: (1) central nodes, or symptoms/processes with the greatest collective connection with all other symptoms/processes; and (2) bridge nodes, or symptoms/processes driving interconnection between mindfulness processes and ED symptoms. We conducted analyses both with and without food- and body-related mindfulness items. Central nodes included: describing how one feels in detail, expressing how one feels in words, and feeling guilty about eating due to shape/weight. Bridge nodes connecting higher mindfulness processes with lower ED symptoms included: the eating disorder symptom, being uncomfortable about others seeing one eat, and the mindfulness process, not criticizing oneself for having irrational/inappropriate emotions. Bridge nodes connecting higher mindfulness processes with higher ED symptoms included: noticing sensations of the body moving when walking and noticing how food/drinks affect thoughts, bodily sensations, and emotions. Findings suggest that future research should explore whether mindfulness-based interventions for EDs may be more effective by targeting mindfulness processes related to describing, expressing, and accepting emotions, accepting discomfort when eating with others, and reducing hyper-focus on and reactivity to food-and-body related sensations.     

Acceptance and Commitment Therapy for Eating Disorders: Rationale and Literature Review

Empirical studies using Acceptance and commitment therapy (ACT) and its components to treat eating disorders (EDs) were reviewed. Evidence suggests that emotional avoidance is a major component in the onset and maintenance of EDs. Acceptance and commitment therapy targets emotional avoidance and control strategies with six core processes. These core processes have been applied to EDs and demonstrated improvement in subjects’ functioning and reduction in disordered eating. There are several advantages of using ACT for treating EDs: ACT fundamentally equalizes the therapeutic relationship; experiential techniques in ACT may facilitate lasting treatment gains; ACT navigates the ego-syntonic nature of EDs; the ACT conceptualization based on experiential avoidance and cognitive rigidity in EDs is consistent with current literature. The six core processes of ACT can be further modified to fit the challenges of treating EDs. Specifically, concerns about client motivation for treatment can be addressed by emphasizing creative hopelessness and a values construction process earlier in treatment.     

虚拟与"虚拟实在"

"虚拟"是这个时代的热门词,也是当下文化的关键词.在三亿多的网民中,很多人见面时的问候语从"吃过没有"变为"魔兽了吗"抑或"摘菜了没有",网络虚拟生活已经成为国人乃至世人一种必不可少的生活方式.二十年前美国学者迈克海姆写过一本关于虚拟实在的书,大约十年前引入国内,引发了国内学者关于"虚拟实在"的研究和讨论.但由于当时国内的信息技术尚未普及,网民数量稀少,所以他的书和这场讨论未能引起社会轰动并深入持久下去.如今恰逢读网时代,我们重拾"虚拟实在",重新探讨它的形而上以及与"虚拟"的区别与联系,因为它是我们在谈及当下文化时绝不能回避和忽略的问题.     

The Use of the Term Virtual Reality in Post-Stroke Rehabilitation: A Scoping Review and Commentary

Virtual reality (VR) offers many opportunities for post-stroke rehabilitation. However, “VR” can refer to several types of computer-based rehabilitation systems. Since these systems may impact the feasibility and the efficacy of VR interventions, consistent terminology is important. In this study, we aimed to optimize the terminology for VR-based post-stroke rehabilitation by assessing whether and how review papers on this topic defined VR and what types of mixed reality systems were discussed. In addition, this review can inspire the use of consistent terminology for other researchers working with VR. We assessed the use of the term VR in review papers on post-stroke rehabilitation extracted from Scopus, Web of Science and PubMed. We also developed a taxonomy distinguishing 16 mixed reality systems based on three factors: immersive versus semi-immersive displays, the way in which real and virtual information is mixed, and the main input device. 64% of the included review papers (N = 121) explicitly defined VR and 33% of them described different subtypes of VR, with immersive and non-immersive VR as the most common distinction. The most frequently discussed input devices were motion-capture cameras and handheld devices, while regular 2D monitors were the most frequently mentioned output devices. Our analysis revealed that reviews on post-stroke VR rehabilitation did not or only broadly defined “VR” and did not focus on a specific system. Since the efficacy and feasibility of rehabilitation may depend on the specific system, we propose a new data-driven taxonomy to distinguish different systems, which is expected to facilitate communication amongst researchers and clinicians working with virtual reality.     

Eating Disorders in Men: Current Considerations

Over the past two decades, there has been a change in the way men think about their bodies. The media portrays images of men with muscular bodies and a six pack abdomen. These images can create body dissatisfaction in males. With the change in the way that the media and society in the United States look at men, so has the drive for men to achieve this ideal body image. Eating disorders, body dysmorphia, and strict exercise and diet regimens seem to plague young men as do the images in advertisements. Although eating disorders in men are similar to what women experience, men seem to strive for more body mass whereas women try to obtain thinness. Gay men and heterosexual men seem to experience eating disorders in the same way although there are differences between how they perceive their bodies. This paper outlines how the media contributes to body dissatisfaction in men. In addition to understanding how the media affects men, it is important to review and possibly revise out understanding of eating disorders and body dysmorphia symptoms to gain a solid understanding of how these symptoms appear in men today.     

Rehabilitation Treatments for Adults with Behavioral and Psychosocial Disorders Following Acquired Brain Injury: A Systematic Review

This review was aimed at systematically investigating the treatment efficacy and clinical effectiveness of neurobehavioral rehabilitation programs for adults with acquired brain injury and making evidence-based recommendations for the adoption of these rehabilitation trainings. Using a variety of search procedures, 63 studies were identified and reviewed using a set of questions about research methods, treatments, results and outcomes for the 1,094 participants. The 63 studies included treatments falling into three general categories: approaches based on applied behavior analysis, interventions based on cognitive-behavior therapy (CBT), and comprehensive-holistic rehabilitation programs (CHRPs). Considerable heterogeneity exists in the reviewed literature among treatment methods and within reported sample subjects. Despite the variety of methodological concerns, results indicate that the greatest overall improvement in psychosocial functioning is achieved by CHRP that can be considered a treatment standard for adults with behavioral and psychosocial disorders following acquired brain injury. Both approaches based on applied behavior analysis and CBT can be said to be evidence-based treatment options. However, findings raise questions about the role of uncontrolled factors in determining treatment effects and suggest the need for rigorous inclusion/exclusion criteria, with greater specification of theoretical basis, design, and contents of treatments for both interdisciplinary-comprehensive approaches and single-case methodologies.     

Eating Disorders: A Bond between Medicine,Culture and Psychoanalysis

Action in connection with the therapeutic process is often equated with acting out. The subtle behaviour that belongs to ?the complicated system of transmitting and receiving unconscious signals? (Sandler), with which the patient attempts to make the analyst behave as the object of transference or to fulfill an unconscious desire, is also described as acting out or micro-acting out (Treurniet). This fine-grained action, however, means nothing; it is not symbolic or communicative action. Its intention is, rather, to trigger effects and induce interactions. It occurs not only on the side of the analysand but also on that of the analyst, and is part of the unconscious communication in the therapeutic process. Presented here are some of the various interactive ways and means with which the analyst is prompted into unconscious action and certain, unnoticed, ways in that he turn ?treats? the patient. The analyst's action responses can bear the character of interpretations with which he may unintentionally reveal how he regards the behaviour of the patient.     

College Atmosphere and Eating Disorders

The authors investigated whether different campus environment factors were related to eating disorder symptomatology at two distinctly different colleges. The first campus was conservative, placing an emphasis on appearance and dress, whereas the second campus was liberal, placing an emphasis on political activism and intellectual talent. As hypothesized, the two schools did not differ in regard to overall levels of eating disorders, yet different factors were associated with eating disorder symptomatology at each school. Implications for eating disorder interventions on college campuses are discussed.     

Psychological Treatments for Mental Disorders in Children and Adolescents: A Review of the Evidence of Leading International Organizations

In recent decades, the evidence on psychological treatments for children and adolescents has increased considerably. Several organizations have proposed different criteria to evaluate the evidence of psychological treatment in this age group. The aim of this study was to analyze evidence-based treatments drawn from RCTs, reviews, meta-analyses, guides and lists provided by four leading international organizations. The institutions reviewed were the National Institute for Health and Care Excellence, the Society of Clinical Child and Adolescent Psychology (Division 53) of the American Psychological Association, Cochrane Collaboration and the Australian Psychological Society in relation to mental disorders in children and adolescents. A total of 137 treatments were analyzed for 17 mental disorders and compared to determine the level of agreement among the organizations. The results indicate that, in most cases, there is little agreement among organizations and that there are several discrepancies within certain disorders. These results require reflection on the meaning attributed to evidence-based treatments with regard to psychological treatments in children and adolescents. The possible reasons for these differences could be explained by a combination of different issues: the procedures or committees may be biased, different studies were reviewed, different criteria are used by the organizations or the reviews of existing evidence were conducted in different time periods.     

Sublime Hunger: A Consideration of Eating Disorders Beyond Beauty

In this paper, I argue that one of the most intense ways women are encouraged to enjoy sublime experiences is via attempts to control their bodies through excessive dieting. If this is so, then the societal‐cultural contributions to the problem of eating disorders exceed the perpetuation of a certain beauty ideal to include the almost universal encouragement women receive to diet, coupled with the relative shortage of opportunities women are afforded to experience the sublime.     

Eating Disorders on Campus: A Procedure for Community Intervention

Concern for students with eating disorders and concern for the environment served as the catalyst for the development of a procedure for responding to eating disorders. The procedure, which relies heavily on residence hall staff, is presented here, with emphasis on training, prevention, and issues in implementation.     

Assessment and Diagnosis of Eating Disorders: A Guide for Professional Counselors

Despite the prevalence of and risk associated with disordered eating, there are few guidelines for counselors on how to conduct an eating disorder assessment. Given the importance of the clinical interview, the purpose of this article is to provide recommendations for the assessment and diagnosis of eating disorders that (a) specifically focus on assessment in the context of a clinical interview and (b) can be used by counselors whether or not they specialize in eating disorder treatment.     

Nutritional Intervention in Young Women with Eating Disorders: A Brief Report

Eating disorders in young women are often associated with a number of comorbid conditions, including mood disorders and cognitive problems. Although group therapy is often used as part of overall treatment for eating disorders in many types of settings, specific nutritional interventions used in such settings have rarely been evaluated. In this study, I evaluated the effects of a nutritional intervention used by 78 girls, aged 12–18 years, at a private school. My results showed that nutritional knowledge increased following intervention, but attitudes toward eating healthy did not change.     

Sexual Abuse and Eating Disorders: A Test of a Conceptual Model

To provide a better conceptual understanding and to stimulate further research, A. Kearney-Cooke and R. H. Striegel-Moore (1994) proposed several theoretical models concerning the relationship between sexual abuse and eating disorders. In this study, we tested the model that hypothesized an indirect relationship between sexual abuse and eating disorders, with the effects of sexual abuse being mediated through bodily shame and body disparagement. Three hundred thirty female undergraduates from a large southwestern public university participated. The women represented the social class of the university, which is predominantly middle to upper-middle class. Race/ethnicity of the participants was 69.8% Caucasian, 15.9% African American, 5.8% Latino/Mexican American, 4.9% Asian American, and 0.9% Native American; the remainder did not indicate their race/ethnicity. Of the total sample, 60% reported having been sexually abused at some point in their lives; 21% had experienced abuse prior to age 14. Almost 8% were categorized as having a diagnosable eating disorder, whereas another 72.7% were symptomatic. To test the hypothesized model, structural equation modeling with LISREL 8.3 (K. G. Joreskog & G. Sorbom, 1999) was used. Results indicated that the model fit the data well and the hypothesized relationships among the variables were in the expected directions. Sexual abuse predicted higher levels of bodily shame that, in turn, predicted increases in body disparagement. As expected, only body disparagement directly predicted eating disorder symptoms. Directions for future research are discussed.