Effectiveness of the intensive group process-retreat model in the treatment of bulimia

The present study examined the effectiveness of a short-term, intensive, group process-retreat treatment model for bulimia. The multicomponent, two-day treatment and follow-up booster session focused primarily on the interpersonal deficits associated with the disorder. A sample of 24 subjects who met the DSM-III criteria for bulimia and who binged-purged at least one time per week participated in the study. Compared to a control group (N=12), the women who received the group treatment (N=12) evidenced significant improvements in self-esteem and severity of binge eating. The frequency of binge-purge episodes and dysfunctional eating attitudes were also significantly reduced. The results of this study suggest that the intensive group-process retreat model is an effective adjunct in the treatment of bulimia.     

The Bulimia Workshop: A Unique Integration of Group Treatment Approaches

The time constraints of weekly group therapy and the slow evolution of group cohesion attenuate the direct confrontation that is essential with bulimic patients. Consequently, a three-phase, multidimensional group program was devised to accelerate the treatment process. Treatment begins with an intensive weekend workshop during which members formulate contracts for interrupting the binge–purge cycle and changing symptomatic behavior. During a follow-up session problems in fulfilling the contracts are dealt with and successes are reinforced, in the final phase, group members convene without their therapists to provide peer support, reevaluate contracts, and share feelings regarding treatment progress. The unique implications for treatment process and therapist interventions prompted by this new format are discussed, and preliminary research findings are highlighted.     

An experimental test of the effect of weight-loss dieting on bulimic pathology: tipping the scales in a different direction

Although it is widely accepted that dieting increases the risk for bulimic pathology, this hypothesis has not been tested in a randomized experiment. Accordingly, the authors conducted an experimental test of the dietary restraint model by randomly assigning nonobese women (N = 82) to either a 6-week, low-calorie diet or a waitlist control condition. The diet intervention resulted in significant weight loss, confirming that dieting was successfully manipulated. Contrary to the restraint model, dieting resulted in significant decreases in bulimic symptoms relative to the control condition. Results converge with past findings from randomized obesity prevention and treatment trials and provide evidence that dieting does not promote bulimic pathology; rather, effective decreases in caloric intake appear to reduce bulimic symptoms.     

Anorexic and bulimic states of mind in the psycho-analytic treatment of anorexic/bulimic patients and psychotic patients

SUMMARY

This paper discusses the relationship of bulimic and anorexic states of mind, and their interchangeability as manifested in the transference. The anorexic making bulimic-like greedy demands upon his/her objects. The bulimic showing all the qualities manifestly presented by the anorexic, an appetiteless approach to possibilities and peculiar searches in a non-specific fashion for satisfaction. Clinical material for discussion is presented from the analysis of three patients — one of whom was psychotic.

The paper attempts to show how in the transference in the true anorexic and bulimic, attacks are directed towards the awareness of the meaningful and intended specificity and function of all objects, so that any specific function can be mis-directed or nullified by the patient. The paper shows how some of these characteristics can appear as well in the treatment of borderline cases and affect the countertransference of the therapist.     

The interaction of perfectionism, perceived weight status, and self-esteem to predict bulimic symptoms: the role of 'benign' perfectionism

The present study sought to replicate an interactive model of global perfectionism, perceived weight status, and self-esteem in predicting bulimic symptom development in a sample of young women [Bardone-Cone, et al. (2006). Predicting bulimic symptoms: An interactive model of self-efficacy, perfectionism, and perceived weight status. Behaviour Research and Therapy, 44, 27-42; Vohs, K. D., et al. (1999). Perfectionism, perceived weight status, and self-esteem interact to predict bulimic symptoms: A model of bulimic symptom development. Journal of Abnormal Psychology, 108, 695-700; Vohs, K. D., et al. (2001). Perfectionism, body dissatisfaction, and self-esteem: An interactive model of bulimic symptom development. Journal of Social and Clinical Psychology, 20, 476-497]. The aim was to investigate the role of 'problematic' and 'benign' perfectionism within this model, using data from 95 female university students over a 3-month period. Contrary to hypotheses, multivariate analyses revealed a significant three-way interaction only between 'benign' perfectionism, perceived weight status and self-esteem in predicting change in bulimic symptoms over a 3-month period. The predictive effect of the interaction between 'benign' perfectionism and perceived weight status on bulimic symptoms was strongest for women with high self-esteem, for whom feeling overweight and having perfectionistic attitudes preceded increased bulimic symptoms. These findings suggest that high self-esteem is insufficient to protect against the development of bulimic symptoms when both the perception of oneself as being overweight, and high levels of perfectionistic standards, are present. It would appear that the role of perfectionism within the context of disordered eating is complex.     

Psychosocial correlates of bulimic symptomatology among male athletes

ObjectivesTo examine the relationship of four psychosocial constructs – body dissatisfaction, restrained eating, drive for muscularity, and negative affect – that have been identified as potential risk factors for bulimic symptoms in male athletes.DesignWe used a cross-sectional design and self-report questionnaires.MethodsParticipants were 203 male, NCAA Division I athletes who were drawn from three different U.S. universities and who competed in 17 different varsity sports. Athletes completed self-report measures of body satisfaction, dietary restraint, drive for muscularity (i.e., muscularity behaviors, muscular body image), negative affect (i.e., fear, hostility, guilt, sadness), and bulimic symptomatology.ResultsAfter controlling for the effects of body mass and social desirability, hierarchical regression analysis showed that the psychosocial variables explained an additional 21% of the variance in bulimic symptoms. In the full model, engaging in muscle building behaviors (β = .16), such as lifting weights, as well as restricting caloric intake (β = .33) were associated with higher levels of bulimic symptomatology; negative affect and body dissatisfaction were not.ConclusionsMale athletes' bulimic symptomatology is best explained by the extent to which they report engaging in behaviors to become leaner (i.e., less body fat) and more muscular.     

Mindfulness training modifies subsystems of attention

Mindfulness is defined as paying attention in the present moment. We investigate the hypothesis that mindfulness training may alter or enhance specific aspects of attention. We examined three functionally and neuroanatomically distinct but overlapping attentional subsystems: alerting, orienting, and conflict monitoring. Functioning of each subsystem was indexed by performance on the Attention Network Test (ANT; Fan, McCandliss, Sommer, Raz, & Posner, 2002). Two types of mindfulness training (MT) programs were examined, and behavioral testing was conducted on participants before (Time 1) and after (Time 2) training. One training group consisted of individuals naive to mindfulness techniques who participated in an 8-week mindfulness-based stress reduction (MBSR) course that emphasized the development of concentrative meditation skills. The other training group consisted of individuals experienced in concentrative meditation techniques who participated in a 1-month intensive mindfulness retreat. Performance of these groups was compared with that of control participants who were meditation naive and received no MT. At Time 1, the participants in the retreat group demonstrated improved conflict monitoring performance relative to those in the MBSR and control groups. At Time 2, the participants in the MBSR course demonstrated significantly improved orienting in comparison with the control and retreat participants. In contrast, the participants in the retreat group demonstrated altered performance on the alerting component, with improvements in exogenous stimulus detection in comparison with the control and MBSR participants. The groups did not differ in conflict monitoring performance at Time 2. These results suggest that mindfulness training may improve attention-related behavioral responses by enhancing functioning of specific subcomponents of attention. Whereas participation in the MBSR course improved the ability to endogenously orient attention, retreat participation appeared to allow for the development and emergence of receptive attentional skills, which improved exogenous alerting-related process.     

Resistance Revisited: Disillusionment,Hierarchies and the Brain

With the proliferation of new psychoanalytic theories and methods, some concepts, such as resistance and free association, have been cast aside. This paper looks at a pattern of forward motion and retreat that characterizes defense, but with a significant twist. The author maintains that there is an alternation between patients’ novel observations about themselves and their families and a logical sounding, authoritative dismissal of all they had just described. Considerations of left and right hemisphere functioning that echo this clinical pattern, the idea of powerful illusions being shed and the ubiquity of hierarchies are considered. A case for the importance of retaining the concept of resistance—that is, stopping the forward motion of treatment—is considered. Implications for the length of psychoanalytic treatment and the role of authority are discussed.

     

Addictive personality traits in bulimic patients

Forty-five female patients attending for treatment for bulimia nervosa completed the EPQ and an Impulsiveness Inventory (I₇). An Addiction score, derived from items on the EPQ, was obtained confirming that this group of bulimic patients score almost as high as drug addicts and certainly well above the normal range. On individual personality scales, the bulimic Ss scored higher than normals on N, P, Imp and Emp, but lower on E, Vent and Social Desirability.     

Appearance-related teasing,body dissatisfaction,and disordered eating: A meta-analysis

A meta-analysis was conducted to determine the relationship between appearance and weight-based teasing and three outcome measures: body dissatisfaction, restrictive eating, and bulimic behaviors. Four meta-analyses were conducted. Fifty effect sizes (N = 10,618) resulted in a moderate effect size of .39 for the relationship between weight teasing and body dissatisfaction; 24 effect sizes (N = 7190) resulted in an effect size of .32 for the relationship between appearance teasing and body dissatisfaction; 20 effect sizes (N = 4792) resulted in an effect size of .35 for the relationship between weight teasing and dietary restraint; and 22 effect sizes (N = 5091) resulted in an effect size of .36 for the relationship between weight teasing and bulimic behaviors. Significant moderators that emerged were teasing measure type, publication type, study type, age group, and gender. The findings offer further support for the inclusion of strategies in body image and eating disorders’ prevention and intervention programs that focus on handling negative, appearance-related commentary.     

The Role of Attachment and Maladaptive Emotion Regulation Strategies in the Development of Bulimic Symptoms in Adolescents

Following the theoretical propositions of the Emotion Regulation model of attachment, the current study investigated whether attachment anxiety and attachment avoidance might play a differential contributing role in the development of bulimic symptoms, through assumed differences in adopting specific maladaptive emotion regulation strategies in a sample of adolescents. Developmentally appropriate self-report questionnaires were administered to a community sample of 397 adolescents (Mean age: 14.02; 62.7% female) and this at 2 time points with a 1-year time lag. Results provided longitudinal evidence for the Emotion Regulation model of attachment in confirming the differential contributing role of the attachment dimensions on the development of bulimic symptoms in a sample of adolescents. More specifically, attachment anxiety seemed to be related to bulimic symptoms through rumination, while attachment avoidance through emotional control. These results may have clinical implications for assessment and treatment of bulimic symptoms in adolescents.     

Bulimia nervosa: group behavior therapy with exposure plus response prevention

Exposure plus response prevention has been demonstrated to be effective in the treatment of bulimia nervosa. However, when done individually, it is labor intensive and cost-ineffective. In the present study exposure plus response prevention was used in the context of a 6-wk., 12-session behavioral group. In addition to the exposure plus response-prevention component, other techniques included self-monitoring, cognitive restructuring, eating-habit stabilization and problem-solving. Eight bulimic women, vomiting a minimum of five times per week for at least a year, participated in the group. At the end of treatment significant reductions in bingeing and vomiting behaviors were reported by all but one subject, substantiated by significantly lower depression scores (Beck Depression Inventory) and binge-eating scores (Binge Eating Scale). At 6 mo. and 1 yr. posttreatment, 6 of 8 subjects reported averaging less than one binge-purge episode per week, one subject continued unchanged, and one subject had relapsed. A group of wait-list control subjects reported essentially no change in binge-purge frequency over the treatment period. Exposure plus response prevention conducted in a behavioral group context appears to be a cost-effective alternative to individual treatment.     

Psychosocial factors as longitudinal predictors of bulimic symptomatology among female collegiate athletes

ObjectivesThis study examined the within-variable stability and prospective cross-lagged pathways between body satisfaction, negative affect, self-reported intentions to engage in dietary restraint, and bulimic symptomatology among female collegiate athletes in weight-sensitive sports.DesignThis study employed a cross-lagged longitudinal design.MethodFemale collegiate gymnasts, swimmers, and divers (n = 325) completed paper-pencil survey batteries at the beginning (Time 1) and end (Time 2) of their 5-month athletic season, including measures of body satisfaction, intentions to engage in dietary restraint, negative affect, and bulimic symptomatology.ResultsFrom Time 1 to Time 2, stability coefficients were highest for intentions to engage in dietary restraint and bulimic symptomatology. Significant cross-lagged relations revealed that Time 1 body satisfaction predicted a decrease in Time 2 negative affect, Time 1 bulimic symptomatology predicted a decrease in Time 2 body satisfaction, and Time 1 negative affect predicted a decrease in Time 2 intentions to engage in dietary restraint.ConclusionsThe relative stability of intentions to engage in dietary restraint and bulimic symptomatology suggests that certain disordered eating behaviors may become more resistant to change over the course of an athletic season and solidify while competing in college. The cross-lagged associations demonstrate the importance of targeting body satisfaction, negative affect, and bulimic behaviors when designing interventions for female collegiate athletes, and implementing such programs at the beginning of an athletic season. Risk factors for bulimic symptomatology should be examined over a time period longer than one athletic season and during transitional experiences (e.g., high school to college sports).     

A test of an interactive model of bulimic symptomatology in adult women

An interactive model of bulimic symptom development, first suggested by Vohs et al. (1999), was tested in adult women (mean age = 45.19). The following hypothesis was examined in a longitudinal design over 2.5 years: Women high in perfectionism, low in self-esteem, and who perceive themselves as overweight would be the most likely to experience an increase in bulimic symptoms. Results supported the model with regard to maintenance and exacerbation, but not onset, of bulimic symptoms. Furthermore, the interactive model was tested to see if it showed specificity to bulimic, versus depressive or anxious, symptoms. Some support for the model's specificity to bulimic symptoms was observed; however, the increase of anxious symptoms was also observed. Clinical and theoretical implications are discussed.     

Guided Recovery: An Interpretative Phenomenological Analysis of Service Users’ Experiences of Guided Self-Help for Bulimic and Binge Eating Disorders

The efficacy of Cognitive Behavioral Therapy–based Guided Self-Help for mild to moderate bulimia and binge eating disorders has been well supported. However, limited research has explored in-depth individual experiences of this treatment approach. In-depth semi-structured interviews were conducted with 4 individuals who had completed Cognitive Behavioral Therapy–based Guided Self-Help (CBT-GSH) for bulimic or binge eating disorders. The interviews were transcribed verbatim and subsequently analyzed using Interpretative Phenomenological Analysis (IPA). Three superordinate themes emerged: Autonomy and volition; A dynamic relationship: the guided and the guide; and The unwanted friend. The reciprocal nature of the guide/guided relationship was identified as integral to the success of the therapeutic approach. However, participants expressed initial uncertainty towards the therapeutic process, and experienced an uncomfortable dissonance between a lack of volition in therapy seeking and the need to continually self-prescribe CBT-GSH. The findings affirm the central role of the guide in promoting motivation to engage with therapy and highlight the potential benefits of in-session weighing. However, it may be necessary to provide additional support on commencing CBT-GSH to address concerns about the therapeutic approach in this group.     

The happy face of mindfulness: Mindfulness meditation is associated with perceptions of happiness as rated by outside observers

The last decade has witnessed an enormous increase in research examining the effects of mindfulness meditation. One of the basic assumptions guiding this research is that meditation ultimately makes people happier. In this article, in two studies we tested whether meditators actually look happier. To address this question, outside raters judged the happiness of meditators and non-meditators based on a 15-s video clip of their behaviour. Study 1 demonstrated that novice meditators looked happier after an intensive 9-day meditation retreat (as compared to before the retreat), while Study 2 demonstrated that experienced mindfulness meditators looked happier as compared to controls. The interpersonal implications of these findings are discussed.     

Weight suppression as a predictor of weight gain and response to intensive behavioral treatment in patients with anorexia nervosa

Previous studies have documented that weight suppression (a person's highest adult weight minus current weight) predicts weight gain and disordered eating symptoms during treatment of bulimia spectrum disorders, but no research has examined weight suppression in individuals with anorexia nervosa (AN). Thus, this study sought to characterize weight suppression in a large sample of patients with AN (N = 185), and to evaluate whether weight suppression at admission for intensive behavioral treatment predicts weight gain and clinical outcomes at discharge. Weight suppression varied from 0 kg to 78 kg (M [SD] = 17.1 [10.8] kg) in AN patients. Higher levels of weight suppression predicted greater total weight gain, a faster rate of weight gain, and bulimic symptoms during intensive treatment even after controlling for body mass index on admission, length and type of intensive treatment received, restricting versus binge-eating/purging AN subtype, and other predictors of study outcomes. These findings converge with previous research documenting the clinical significance of weight suppression in the treatment of eating disorders. Future work is needed to replicate the current findings, and examine whether weight suppression predicts the course of AN following discharge from intensive treatment.     

Dietary restraint and negative affect as mediators of body dissatisfaction and bulimic behavior in adolescent girls and boys.

Stice's dual pathway model of dietary restraint and negative affect was examined in both adolescent girls and boys. Self-report measures assessing body dissatisfaction, dietary restraint, negative affect and bulimic behavior were administered to 267 girls and 199 boys aged between 12 and 16 years. The findings for the girls were consistent with Stice's model, in that they indicated that both dietary restraint and negative affect mediated the relationship between body dissatisfaction and bulimic behavior. For the boys who desired a thinner body size, only negative affect was found to mediate the relationship between body dissatisfaction and bulimic behavior. On the other hand, for boys who desired a larger body size, both body dissatisfaction and dietary restraint were found to exert an independent effect on bulimic behavior. As boys can aspire to two contrasting and seemingly opposite body size ideals, the findings highlight that the relationship between body dissatisfaction, dietary restraint, negative affect and bulimic behavior are more complex in males than in females. Further research using longitudinal designs is needed in order to test the directional and bidirectional nature of the observed interrelationships.