How do we get there? Effects of cognitive aging on route memory

Research into the effects of cognitive aging on route navigation usually focuses on differences in learning performance. In contrast, we investigated age-related differences in route knowledge after successful route learning. One young and two groups of older adults categorized using different cut-off scores on the Montreal Cognitive Assessment (MoCA), were trained until they could correctly recall short routes. During the test phase, they were asked to recall the sequence in which landmarks were encountered (Landmark Sequence Task), the sequence of turns (Direction Sequence Task), the direction of turn at each landmark (Landmark Direction Task), and to identify the learned routes from a map perspective (Perspective Taking Task). Comparing the young participant group with the older group that scored high on the MoCA, we found effects of typical aging in learning performance and in the Direction Sequence Task. Comparing the two older groups, we found effects of early signs of atypical aging in the Landmark Direction and the Perspective Taking Tasks. We found no differences between groups in the Landmark Sequence Task. Given that participants were able to recall routes after training, these results suggest that typical and early signs of atypical aging result in differential memory deficits for aspects of route knowledge.     

An evaluation of the enhanced cognitive-behavioural model of bulimia nervosa

The original cognitive-behavioural model of bulimia nervosa (BN) has been enhanced to include four additional maintaining mechanisms: low self esteem, clinical perfectionism, interpersonal problems, and mood intolerance. These models have been used to guide cognitive-behavioural treatment for BN, but the enhanced model has yet to be directly evaluated as a whole in a clinical sample. This study aimed to compare and evaluate the original and the enhanced cognitive-behavioural models of BN using structural equation modelling. The Eating Disorder Examination and self-report questionnaires were completed by 162 patients seeking treatment for BN (N = 129) or atypical BN (N = 33). Fit indices suggested that both the original and enhanced models provided a good fit to the data, but the enhanced model accounted for more variance in dietary restraint and binge eating. In the enhanced model, low self esteem was associated with greater overevaluation of weight and shape, which, in turn, was associated with increased dietary restraint. Interpersonal problems were also directly associated with dietary restraint, and binge eating was associated with increased purging. While the current study provides support for some aspects of the enhanced cognitive-behavioural model of BN, some key relationships in the model were not supported, including the important conceptual relationship between dietary restraint and binge eating.     

Bulimic symptomatology: the role of adaptive perfectionism, shape and weight concern, and self-esteem

An interactive model implicating high perfectionism, high weight and shape concern, and low self-esteem in the onset and maintenance of bulimic symptoms ( [Bardone et?al., 2000] and [Vohs et?al., 1999] ) has received mixed support. This study aimed to replicate the cross-sectional model in a clinical sample of women with eating disorders, and to investigate whether the model could predict changes in binge eating and purging at the end of treatment. Eating disorder outpatients (n = 353) completed measures of perfectionism, weight/shape concern, self-esteem, and bulimic symptoms at pre-treatment and discharge. Contrary to the hypotheses, the three-way interaction did not predict binge eating or purging cross-sectionally or prospectively as a moderator of psychotherapy outcome. It was concluded that the robustness of the interactive model seems questionable and may be impacted by an inadequate conceptualization of the perfectionism construct.     

The effectiveness of enhanced cognitive behavioural therapy for eating disorders: an open trial

The aim of this study was to examine the effectiveness of Enhanced Cognitive Behaviour Therapy (CBT-E) for eating disorders in an open trial for adults with the full range of eating disorders found in the community. The only previously published trial of CBT-E for eating disorders was a randomised controlled trial (RCT) conducted in the U.K. for patients with a BMI ≥ 17.5. The current study represents the first published trial of CBT-E to include patients with a BMI < 17.5. The study involved 125 patients referred to a public outpatient clinic in Perth, Western Australia. Patients attended, on average, 20–40 individual sessions with a clinical psychologist. Of those who entered the trial, 53% completed treatment. Longer waiting time for treatment was significantly associated with drop out. By the end of treatment full remission (cessation of all key eating disorder behaviours, BMI ≥ 18.5 kg/m², not meeting DSM-IV criteria for an eating disorder) or partial remission (meeting at least 2 these criteria) was achieved by two thirds of the patients who completed treatment and 40% of the total sample. The results compared favourably to those reported in the previous RCT of CBT-E, with one exception being the higher drop-out rate in the current study. Overall, the findings indicated that CBT-E results in significant improvements, in both eating and more general psychopathology, in patients with all eating disorders attending an outpatient clinic.     

Does enhanced cognitive behaviour therapy for eating disorders improve quality of life?

Quality of life (QOL) is the degree of enjoyment and satisfaction experienced in life, and embraces emotional well-being, physical health, economic and living circumstances, and work satisfaction. QOL recovery with eating disorder treatment has received sparse attention, and until now, no study has investigated QOL recovery with enhanced cognitive behaviour therapy (CBT-E). Patients (n?=?196) admitted to a specialist eating disorders outpatient programme and receiving CBT-E completed measures of QOL, eating disorder psychopathology, depression, anxiety and self-esteem, before and after treatment. QOL at intake was compared with community norms, and QOL below the norm was predicted from sociodemographic and clinical correlates with logistic regression. Baseline QOL below the norm was associated with depression and anxiety Axis I comorbidity, and severity of depressive symptoms. Predictors of post-treatment QOL were baseline QOL and level of depressive symptoms and self-esteem at post-treatment. CBT-E was associated with gains in QOL over the course of treatment, in addition to eating disorder symptom relief. Copyright ? 2012 John Wiley & Sons, Ltd and Eating Disorders Association.