Outcome From a Randomized Controlled Trial of Group Therapy for Binge Eating Disorder: Comparing Dialectical Behavior Therapy Adapted for Binge Eating to an Active Comparison Group Therapy

Dialectical Behavior Therapy for Binge Eating Disorder (DBT-BED) aims to reduce binge eating by improving adaptive emotion-regulation skills. Preliminary findings have been promising but have only compared DBT-BED to a wait-list. To control for the hypothesized specific effects of DBT-BED, the present study compared DBT-BED to an active comparison group therapy (ACGT). Men and women (n = 101) meeting DSM-IV BED research criteria were randomly assigned to 20 group sessions of DBT-BED (n = 50) or ACGT (n = 51). DBT-BED had a significantly lower dropout rate (4%) than ACGT (33.3%). Linear Mixed Models revealed that posttreatment binge abstinence and reductions in binge frequency were achieved more quickly for DBT-BED than for ACGT (posttreatment abstinence rate = 64% for DBT-BED vs. 36% for ACGT) though differences did not persist over the 3-, 6-, and 12-month follow-up assessments (e.g., 12-month follow-up abstinence rate = 64% for DBT-BED vs. 56% for ACGT). Secondary outcome measures revealed no sustained impact on emotion regulation. Although both DBT-BED and ACGT reduced binge eating, DBT-BED showed significantly fewer dropouts and greater initial efficacy (e.g., at posttreatment) than ACGT. The lack of differential findings over follow-up suggests that the hypothesized specific effects of DBT-BED do not show long-term impact beyond those attributable to nonspecific common therapeutic factors.     

Dialectical Behavior Therapy Modified for Adolescent Binge Eating Disorder: A Case Report

Given the lack of empirically supported treatments available for adolescents with eating disorders, it is important to investigate the clinical utility of extending treatments for adults with eating disorders to younger populations. Dialectical behavior therapy for binge eating disorder, based on the affect-regulation model, conceptualizes binge eating as a behavioral attempt to influence, change, or control painful emotional states. With promising research findings in adult women, it is of clinical interest whether the dialectical behavior therapy for binge eating disorder treatment manual could be usefully adapted for an adolescent population. This report describes adolescent-specific modifications (including the use of family sessions) to standard dialectical behavior therapy for binge eating disorder, with an illustrative case study. While more rigorous case studies are needed prior to establishing justification for a randomized trial, this pilot case provides preliminary support for a modified version of dialectical behavior therapy for binge eating disorder as a therapeutic option for adolescents with binge eating disorder.     

Stress-Induced Binge Eating: A Behavior Analytic Approach to Assessment and Intervention

Responses to acute or chronic stress may include behaviors, such as alcohol consumption, cigarette smoking, and altered eating patterns. In connection with the stress-eating relation, some researchers have suggested that certain stressors (e.g., psychological or emotional) may influence the direction (i.e., increase or decrease) of a person’s eating response. In a recent study, Connors and Morse (Int J Eat Disord 13:1–11, 2006) indicated that the physical and psychological stress associated with sexual trauma could result in an increase in food intake and nonstandard eating patterns. In consequence, this study describes a multifaceted intervention for a 24-year-old woman who experienced chronic stress and received a diagnosis of Binge Eating Disorder (American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders. DSM-IV. Washington, DC: APA) following a series of unwanted sexual experiences. The behavior analytic intervention emphasized self-control, self-regulation, and physical activity. The treatment package resulted in a 19% reduction in the participant’s body weight, a 96% reduction in binge eating, and long-term adherence to an exercise routine.     

Health-Related Quality of Life in Women with Eating Disorders: Association with Subjective and Objective Binge Eating

This study examined health-related quality of life (QOL) and its association with different forms of binge eating in 53 women with eating disorders. Participants had enrolled in treatment for anorexia nervosa, bulimia nervosa, binge eating disorder, or other eating disorders not otherwise specified and completed measures of QOL, eating-related psychopathology, and mood disturbance. Eating- and mood-related psychopathology, and to a lesser extent, mental-component QOL scores, were severely impaired in this sample relative to population norms. QOL was significantly and independently predicted by subjective bulimic episodes and compensatory behaviors, including food avoidance, laxative abuse, and self-induced vomiting, accounting for 32% of the variance. Subjective bulimic episodes and food avoidance also independently predicted the physical-component QOL, accounting for 27% of the variance. These findings suggest that subjective bulimic episodes may be independently associated with impairment in QOL and may require specific attention as targets of treatment.     

Developing an Acceptance-Based Behavioral Treatment for Binge Eating Disorder: Rationale and Challenges

Binge eating disorder (BED), characterized by recurrent eating episodes in which individuals eat an objectively large amount of food within a short time period accompanied by a sense of loss of control, is the most common eating disorder. While existing treatments, such as cognitive behavioral therapy (CBT), produce remission in a large percentage of individuals with BED, room for improvement in outcomes remains. Two reasons some patients may continue to experience binge eating after a course of treatment are: (a) Difficulty complying with the prescribed behavioral components of CBT due to the discomfort of implementing such strategies; and (b) a lack of focus in current treatments on strategies for coping with high levels of negative affect that often drive binge eating. To optimize treatment outcomes, it is therefore crucial to provide patients with strategies to overcome these issues. A small but growing body of research suggests that acceptance-based treatment approaches may be effective for the treatment of binge eating. The goal of the current paper is to describe the development of an acceptance-based group treatment for BED, discuss the structure of the manual and the rationale and challenges associated with integrating acceptance-based strategies into a CBT protocol, and to discuss clinical strategies for successfully implementing the intervention.     

The Association Between Childhood Gender Atypical Behavior and Adult Psychiatric Symptoms is Moderated by Parenting Style

The association between childhood gender atypical behavior (GAB) i.e. behavior traditionally considered more typical for children of the opposite sex, and adult psychiatric symptoms as well as cold or over-controlling parenting style as a moderator of the association were studied in a sample of 1767 Finnish participants aged 33 to 43 years (M?=?37.5). Participants completed the Gender Identity/Gender Role Questionnaire, the Brief Symptom Inventory 18, and the Measure of Parenting Style. Regression analyses showed that women recalled more GAB than men did, and that participants who recalled more GAB reported significantly more psychiatric symptoms. Negative parenting style was associated with psychiatric symptoms. Structural equation modeling showed that parenting style significantly moderated the association between childhood GAB and adult psychiatric symptoms with positive parenting reducing the association and negative parenting sustaining it.     

Early Onset Binge Eating and Purging Eating Disorders: Course and Outcome in a Population-Based Study of Adolescents

This study aimed to describe the course of early onset eating disorders in a population-based sample followed from 14 to 20 years; identify variables that could account for the persistence of eating disorders from 14 to 20 years; and describe outcome of early onset eating disorders with reference to general and psychological functioning at age 20. Participants (N?=?1,383; 49 % male) were drawn from the Western Australian Pregnancy Cohort (Raine) Study, which has followed children from pre-birth to young adulthood. Eating disorder symptoms were assessed using an adapted version of the Eating Disorder Examination-Questionnaire, at ages 14, 17 and 20. At age 14, 70 participants met DSM-IV criteria for a binge eating or purging eating disorder. Nearly half (44 %) of these adolescents ceased to meet criteria for an eating disorders at ages 17 and 20, whilst one-quarter still met criteria for an eating disorder at age 20 and one-fifth met criteria for an eating disorder at all three time points. Purging at age 17 and externalising behaviour problems at age 14 were the strongest predictors of eating disorder persistence to age 20. Participants who experienced a persistent eating disorder were less likely to complete high school than other participants, and reported pronounced depressive and anxiety symptoms at age 20. This study provides new data the course and outcome of early onset eating disorders at a population level. Behavioural difficulties in early adolescence and purging in middle adolescence may predict persistent eating pathology to young adulthood.     

The Empirical Status of Cue Exposure and Response Prevention Treatment for Binge Eating: A Systematic Review

Approximately 50% of individuals fail to obtain treatment benefits when undergoing cognitive-behavioral therapy (CBT) for binge-eating behaviors, making it necessary to evaluate additional approaches. Cue exposure and response prevention (CERP) is one such approach, although its effectiveness across studies has been inconsistent. This may be due to inconsistent implementation of theoretically based CERP strategies. This possibility has not yet been systematically investigated. To address this gap, this review investigated which CERP strategies have been incorporated into treatment protocols for binge eating, and if the use of certain strategies improves treatment effectiveness. Relevant studies were identified through reference lists, grey literature, and searches of electronic databases using multiple search terms related to CERP and binge eating, which resulted in 18 eligible studies. Most studies were underpowered, many were of low methodological quality, and none of the included studies utilized all of the strategies that have been recommended to optimize CERP. Despite these weaknesses, CERP appeared to reduce the frequency of binge eating in the short and long term. This review underscores the need for higher quality research that utilizes larger samples and uniform outcome measures that are more strongly grounded in theory. Such research would help improve treatment outcomes for binge eating.     

Cultural Adaptation of a Cognitive Behavior Therapy Guided Self‐Help Program for Mexican American Women With Binge Eating Disorders

Data on the compatibility of evidence‐based treatment in ethnic minority groups are limited. This study utilized focus group interviews to elicit Mexican American women's (N= 12) feedback on a cognitive behavior therapy guided self‐help program for binge eating disorders. Findings revealed 6 themes to be considered during the cultural adaptation process and highlighted the importance of balancing the fidelity and cultural relevance of evidence‐based treatment when disseminating it across diverse racial/ethnic groups.     

Reevaluating Cue Exposure and Response Prevention in a Pilot Study: An Updated Treatment for Binge Eating Disorder

Approximately half of individuals with binge eating disorder (BED) fail to improve when treated with cognitive behavioral therapy; thus, better treatments are needed. Cue exposure and response prevention (CERP) may be one option, but its full potential for reducing binge eating remains unknown because prior applications for binge eating have not utilized the broad range of strategies believed to optimize exposure therapy. The current single-subject AB design investigated the acceptability and effectiveness of a comprehensive CERP treatment among 8 women who met DSM-5 criteria for binge eating disorder. Changes in the number of binges were measured from baseline to the end of treatment, and desire to eat, salivation, and idiographic expectancies of aversive outcomes to food-cue exposure (idiographic CS-US expectancies), including expectancies about ability to tolerate distress when exposed to food cues were measured across the course of treatment. Statistical analysis revealed a significant reduction in the number of binges from baseline to the end of treatment. Across the course of treatment, desire to eat and idiographic CS-US expectancies reduced, and distress tolerance expectancies increased. No participants dropped out and all reported being maximally satisfied with the treatment. Based on these findings, future randomized-control trials with larger samples should examine the efficacy of CERP and mechanisms underlying change with the aim of establishing a more effective treatment for binge eating disorder.     

Links Between Antisocial Behavior and Depressed Mood: The Role of Life Events and Attributional Style

Comorbidity between antisocial behavior and depression in adolescence is widely recognized. This paper examines whether links with depressed mood differ among three subtypes of antisocial behavior: oppositionality, physical aggression and delinquency. In addition we examine two possible contributors to these links: negative life events that are dependent upon the individual's actions and depressogenic attributional style. Data are drawn from the G1219 large-scale community twin and sibling sample, and include 2409 questionnaire responses from youths aged between 13 and 19 living in the United Kingdom. Depressed mood was independently associated with both oppositionality and delinquency, but not with physical aggression. Dependent negative life events were strongly implicated in the association between delinquency and depressed mood, whereas depressogenic attributional style was implicated in the associations of both oppositionality and delinquency with depressed mood. Oppositionality remained a significant predictor of depressed mood after accounting for attributional style and life events whereas delinquency did not. The pattern of associations was largely similar in boys and girls. We discuss these results in terms of developmental models of the links between antisocial behavior and depressed mood.     

Primary Care Provider Familiarity with Binge Eating Disorder and Implications for Obesity Management: A Preliminary Survey

Current guidelines for the evaluation and treatment of obesity recommend referring individuals with binge eating disorder (BED) to a mental health professional. However, it is unclear how familiar primary care providers are with BED. The purpose of this study was to assess providers' familiarity with BED diagnosis and treatment. Providers in two primary care clinics completed a questionnaire, which assessed perceived familiarity with BED and demonstrated familiarity with BED diagnosis and treatment. Results indicated that 61% of respondents demonstrated familiarity with the essential symptoms of BED, and 80% reported familiarity with the diagnosis of BED. However, 35% of respondents who perceived themselves as familiar with BED did not demonstrate familiarity with the most basic symptoms. These results demonstrate that while many providers in primary care are familiar with BED, steps to improve provider familiarity with the disorder and provide appropriate mechanisms to address BED are warranted.     

高一学生学校压力与教师领导行为模式的关系研究

1 前言随着心理健康教育的深入开展,学生的心理压力受到很多学者的关注。压力的概念也随着社会的变迁而变化,现代研究认为,压力实质上是个体对付那些自认为很难应付的情况时,所产生的情绪和身体上的异常反应,是人和环境相互作用的结果,它是机体的内部状态,是一种强烈的情绪和生理上的唤醒。     

The Relationship Between Gender Social Identity and Support for Feminism

This study is an application of social identity theory to feminist consciousness and activism. For women, strong gender identifications may enhance support for equality struggles, whereas for men, they may contribute to backlashes against feminism. University students (N = 276), primarily Euroamerican, completed a measure of gender self-esteem (GSE, that part of one's self-concept derived from one's gender), and two measures of feminism. High GSE in women and low GSE in men were related to support for feminism. Consistent with past research, women were more supportive of feminism than men, and in both genders, support for feminist ideas was greater than self-identification as a feminist.     

The Moderator Roles of Coping Style and Identity Disclosure in the Relationship Between Perceived Sexual Stigma and Psychological Distress

The current study examined whether the association between perceived sexual stigma and psychological distress is influenced by individuals' level of identity disclosure and their typical coping strategies. Regression analyses were conducted with data from a survey of 79 gay men and lesbians. Results revealed a 3‐way interaction between participants' perceived level of stigma, the extent of their identity disclosure, and their utilization of avoidant coping strategies in predicting their endorsement of depressive symptoms. Findings also revealed an interaction between participants' perceived level of stigma, the extent of their identity disclosure, and their utilization of problem‐solving coping strategies in predicting their endorsement of depressive symptoms. The implications are discussed with regard to various models of minority stress.