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.     

Effects of social anxiety and depressive symptoms on the frequency and quality of sexual activity: a daily process approach

Diminished positive experiences and events might be part of the phenomenology of social anxiety; however, much of this research is cross-sectional by design, limiting our understanding of the everyday lives of socially anxious people. Sexuality is a primary source of positive experiences. We theorized that people with elevated social anxiety would have relatively less satisfying sexual experiences compared to those who were not anxious. For 21 days, 150 college students described their daily sexual episodes. Social anxiety was negatively related to the pleasure and feelings of connectedness experienced when sexually intimate. The relationship between social anxiety and the amount of sexual contact differed between men and women—it was negative for women and negligible for men. Being in a close, intimate relationship enhanced the feelings of connectedness during sexual episodes for only individuals low in social anxiety. Depressive symptoms were negatively related to the amount of sexual contact, and the pleasure and feelings of connectedness experienced when sexually intimate. Controlling for depressive symptoms did not meaningfully change the social anxiety effects on daily sexuality. Our findings suggest that fulfilling sexual activity is often compromised by social anxiety.     

Priming insight in groups: Facilitating and inhibiting solving an ambiguously worded insight problem

We extend research on the priming of insight by studying group problem solving. Groups of 2–4 participants tried to solve an ambiguously worded problem in the presence of a prime that reinforced the dominant but incorrect interpretation of the problem, a prime that reinforced the uncommon but correct interpretation, or no prime. The paradigm involved participants asking questions of the experimenter that could only be answered “yes” or “no.” In Experiment 1, the prime was present throughout the solving period; in Experiment 2, it was removed prior to the solving period. In both experiments, the primes had their predicted effects. Patterns in the time taken to solve the problem supported the idea that groups stuck at the impasse were more or less able to restructure the problem, depending on the environmental context. Data from the questions asked and questionnaires converged with time taken to solve the problem, consistent with the view that restructuring a problem is an automatic process that produces insight. A comparison of the group data in Experiment 1 with individually tested participants’ data revealed that the insight of the groups benefited from their being able to recognize lines of questions to follow, to listen to answers to questions asked, and to evaluate and reject errors or assumptions.     

Effects of Sensory Deficit on Phalanx Force Deviation During Power Grip Post Stroke

The effect of sensory deficits on power grip force from individual phalanges was examined. The authors found that stroke survivors with sensory deficits (determined by the Semmes-Weinstein monofilament test) gripped with phalanx force directed more tangential to the object surface, than those without, although both groups had similar motor deficits (Chedoke-McMaster and Fugl-Meyer), grip strength, and skin friction. Altered grip force direction elevates risk of finger slippage against the object thus grip loss/object dropping, hindering activities of daily living. Altered grip force direction was associated with altered muscle activation patterns. In summary, the motor impairment level alone may not describe hand motor control in detail. Information about sensory deficits helps elucidate patients' hand motor control with functional relevance.     

The individual and “the general situation”: The tension barometer and the race problem at the University of Chicago, 1947–1954

This article explains how social theories that posited white attitudes as the root of racial injustice gained traction in postwar social thought. Examining the production of a “tension barometer,” an attitude survey that scholars from the University of Chicago's Committee on Education, Training, and Research in Race Relations created to predict interracial violence, I chart vigorous debate over the nature and causes of racial oppression in the critical postwar decades. Available—and unavailable—social scientific frameworks, activists” interests, and emerging anticommunism, the Committee's history shows, created an environment where individualistic conceptions of the race problem won out, despite critique. © 2010 Wiley Periodicals, Inc.     

Factors predictive of a fetal alcohol spectrum disorder diagnosis: Parent and teacher ratings

Diagnostic assessment in Fetal Alcohol Spectrum Disorder (FASD) is informed by multidisciplinary assessment incorporating objective (i.e., test measures) and subjective means, such as parent and teacher behavior ratings. The purpose of this study was to extend our previous neuropsychological test findings by identifying parent and teacher ratings of academic achievement, attention, executive functioning, and adaptive functioning as predictors of an FASD diagnosis. The charts of 315 children and adolescents with prenatal alcohol exposure (PAE) who underwent assessment for FASD were retrospectively reviewed. Direct logistic regressions analyzed the contribution of different ratings on the likelihood of an FASD diagnosis. The results suggest that a number of rating measures do contribute toward accurately differentiating those with FASD from within a PAE population, including teacher ratings of learning problems, inattention, and adaptive skills. The classification accuracy for each regression was clinically significant (59.1–70.8%). Children with worse ratings on these variables are approximately 1.5 to 2 times more likely to receive an FASD diagnosis. Only teacher ratings (not parent) significantly contributed to whether a diagnosis was made, suggesting that teacher observational rating scales are a critical component of an FASD assessment. Together with our previous research examining neuropsychological evaluation and FASD diagnostic assessment, this study helps to further guide decisions to streamline care in multidisciplinary assessment and intervention planning.     

Reengagement With Education: A Multidisciplinary Home-School-Clinic Approach Developed in Australia for School-Refusing Youth

School refusal (SR) can result in decreased academic achievement, impaired social connections, and family stress. Current interventions for SR include behavioral and cognitive-behavioral treatments that are not always effective. Incorporating multidisciplinary work that includes therapeutic and educational interventions may enhance outcomes for youth displaying SR. The In2School program fosters a working partnership between mental health clinicians and teachers. It was designed to meet the needs of young people missing more than 50% of school in the previous 6 weeks due to mental health disorders, including anxiety or depression. This paper reports on an action research study in which the In2School program was piloted. Over a 14-week period, therapeutic and educational interventions were integrated into the learning environment via a transitional classroom to support youths’ return to school. Outcomes of this program are reported for the first cohort of 7 youth. Of these youth, 6 returned to mainstream schooling with attendance levels being maintained for 6 months after completing the intervention. Progress was observed in mental health recovery, quality of life reports, increased social interactions with peers, and positive experiences at school. The preliminary results presented in this paper suggest that a multidisciplinary, home-school-clinic intervention holds promise for helping school-refusing youth to return to school.     

Meta-analysis of the effects of third-wave behavioural interventions on disordered eating and body image concerns: implications for eating disorder prevention

Third-wave behavioural interventions are increasingly popular for treating and preventing mental health conditions. Recently, researchers have begun testing whether these interventions can effectively targeting eating disorder risk factors (disordered eating, body image concerns). This meta-analysis examined whether third-wave behavioural interventions (acceptance and commitment therapy; dialectical behaviour therapy; mindfulness-based interventions; compassion-focused therapy) show potential for being effective eating disorder prevention programs, by testing their effects on eating disorder risk factors in samples without an eating disorder. Twenty-four studies (13 randomized trials) were included. Most studies delivered selective prevention programs (i.e. participants who reported elevated risk factor). Third-wave interventions led to significant pre–post (g = 0.59; 95% CI = 0.43, 0.75) and follow-up (g = 0.83; 95% CI = 0.38, 1.28) improvements in disordered eating, and significant pre–post improvements in body image (g = 0.35; 95% CI = 0.13, 0.56). DBT-based interventions were associated with the largest effects. Third-wave interventions were also significantly more efficacious than wait-lists (g = 0.39; 95% CI = 0.09, 0.69) in reducing disordered eating, but did not differ to other interventions (g = 0.25; 95% CI = –0.06, 0.57). Preliminary evidence suggests that third-wave interventions may have a beneficial effect in ameliorating eating disorder risk.     

In Search of Meaning: A Preliminary Typology of Gay Male Spiritual Identity Development

Reconciliation of the conflict between religious identity and sexual orientation has been related to a number of psychological challenges (Lease, Horne, & Noffsinger‐Frazier, 2005; Schuck & Liddle, 2001), and little is known about the convergence of spiritual identity, distinctly defined as separate from religious identity, and sexual orientation identity. This qualitative inquiry investigated the process by which 7 Caucasian gay men from a variety of religious backgrounds constructed spiritual identities outside the realm of institutionalized religion. From the findings, the authors hypothesize a typology of spiritual development influenced by religions of origin. Limitations of the study, implications, and future directions in research are also addressed.