Adrienne S. Juarascio

Acceptance and Commitment Therapy versus Cognitive Therapy for the Treatment of Comorbid Eating Pathology.

Previous research has indicated that although eating pathology is prevalent in college populations, both CBT and non-CBT-based therapies achieve only limited effectiveness. The current study examined several questions related to the treatment of eating pathology within the context of a larger randomized controlled trial that compared standard CBT (i.e., Beck’s cognitive therapy; CT) with acceptance and commitment therapy (ACT; Hayes, 2004).The results indicated that the two treatments were differentially effective at reducing eating pathology. Specifically, CT produced modest decreases in eating pathology whereas ACT produced large decreases. In addition, a weaker suggestion emerged that ACT was more effective than CT at increasing clinician-rated global functioning among those with eating pathology. These findings suggest that ACT is a useful treatment for disordered eating and potentially, for eating disorders per se.

Pro-Eating Disorder Communities on Social Networking Sites: A Content Analysis

The purpose of this study was to assess the number of pro-ana groups on social networking sites and to analyze their content. A general inductive approach was used to analyze the content. Two main themes emerged from the content analysis: social support and eating disorder specific content. Themes were similar across all groups; however, a linguistic analysis indicated differences between groups on the two different networking sites. There was an absence of content typically found on Internet sites. Pro-ana groups on social networking sites are focused on social interactions, and lack eating disorder specific content found on Internet sites.

Comparison of acceptance-based and standard cognitive-based coping strategies for craving sweets in overweight and obese women

Existing strategies for coping with food cravings are of unknown efficacy and rely on principles that have been shown to have paradoxical effects. The present study evaluated novel, acceptance-based strategies for coping with craving by randomly assigning 48 overweight women to either an experimental psychological acceptance-oriented intervention or a standard cognitive reappraisal/distraction intervention. Participants were required to carry a box of sweets on their person for 72 h while abstaining from any consumption of sweets. Results suggested that the acceptance-based coping strategies resulted in lower cravings and reduced consumption, particularly for those who demonstrate greater susceptibility to the presence of food and report a tendency to engage in emotional eating.

Acceptance and Commitment Therapy as a Novel Treatment for Eating Disorders: An Initial Test of Efficacy and Mediation.

Eating disorders are among the most challenging disorders to treat, with even state-of-the-art cognitive-behavioral treatments achieving only modest success. One possible reason for the high rate of treatment failure for eating disorders is that existing treatments do not attend sufficiently to critical aspects of the disorder such as high experiential avoidance, poor experiential awareness, and lack of motivation. These variables are explicit targets of Acceptance and Commitment Therapy (ACT). The current study examined the efficacy of an ACT-based group treatment for eating disorders by examining whether the addition of ACT groups to treatment-as-usual (TAU) at a residential treatment facility for eating disorders would improve treatment outcomes. TAU patients received an intensive residential treatment, while ACT patients received these services but additionally attended, depending on diagnosis, either ACT for anorexia nervosa groups or ACT for bulimia nervosa groups. Although individuals in both treatment conditions demonstrated large decreases in eating pathology, there were trends toward larger decreases among those receiving ACT. ACT patients also showed lower rates of rehospitalization during the 6 months after discharge. Overall, results suggest that ACT is a viable treatment option for individuals with eating pathology and further outcome research is warranted.

Review of Smartphone Applications for the Treatment of Eating Disorders

mHealth tools may be a feasible modality for delivering evidence-based treatments and principles (EBPs), and may enhance treatment for eating disorders (EDs). However, research on the efficacy of mHealth tools for EDs and the extent to which they include EBPs is lacking. The current study sought to (i) review existing apps for EDs, (ii) determine the extent to which available treatment apps utilize EBPs, and (iii) assess the degree to which existing smartphone apps utilize recent advances in smartphone technology. Overall, existing ED intervention apps contained minimal EBPs and failed to incorporate smartphone capabilities. For smartphone apps to be a feasible and effective ED treatment modality, it may be useful for creators to begin taking utilizing the abilities that set smartphones apart from in-person treatment while incorporating EBPs. Before mHealth tools are incorporated into treatments for EDs, it is necessary that the feasibility, acceptability, and efficacy be evaluated.

Acceptance based behavior therapy for social anxiety disorder through videoconferencing

Most individuals with social anxiety disorder (SAD) do not receive any type of treatment. Reasons include logistical barriers (e.g., geographic location, travel time), fear of stigmatization, and fear of the social interactions associated with seeking treatment. Videoconferencing technology holds great promise in the widespread delivery of evidence-based treatments to those who would otherwise not receive treatment. This pilot study assessed the feasibility, acceptability, and initial efficacy of an acceptance-based behavioral intervention using Skype videoconferencing to treat adults with generalized SAD. Twenty-four participants received 12 sessions of weekly therapy and were assessed at pre-treatment, mid-treatment, post-treatment, and 3-month follow-up. Participants and therapists rated the intervention as acceptable and feasible. Analyses revealed significant pre-treatment to follow-up improvements in social anxiety, depression, disability, quality of life, and experiential avoidance, with effect sizes comparable to or larger than previously published results of studies delivering in-person CBT for SAD. Implications and future directions are discussed.

Moderators of the Relationship Between Body Image Dissatisfaction and Disordered Eating

Various affective and personality variables may impact the relationship between body dissatisfaction and disordered eating symptomatology. The current study was a post-hoc analysis examining potential moderators (depression, anxiety, and impulsivity) of this relationship in college women. Four-hundred and seventy-two (472) enrolled college women between the ages of 18 and 55 participated in this study. Moderation analyses indicated that anxiety, depression, and dieting significantly moderated the relationship between body dissatisfaction and disordered eating, whereas impulsivity did not. Findings can be used to generate hypotheses for education and prevention programs on college campuses.

Implicit internalization of the thin ideal as a predictor of increases in weight, body dissatisfaction, and disordered eating

The freshman year of college has been identified as a time when some students experience large changes in their eating behaviors, body image, and weight. One factor that is predictive of changes in these variables is internalization of the thin ideal (i.e., the degree to which an individual has accepted societal values of thinness and applies these values to herself). However, given the limitation of self-report and previous research demonstrating the additional predictive validity implicit measurement provides, it may be important to develop an implicit paradigm for assessing internalization of the thin ideal. The Implicit Association Test is the most common implicit measurement technique. However this test is associational in nature, which reflects only one aspect of human cognition. The current study evaluates a newly-created implicit measure of internalization of the thin ideal that utilizes the Implicit Relational Assessment Procedure (IRAP). In particular, the study investigates concurrent and prospective associations between internalization of the thin ideal and disordered eating, body image dissatisfaction, and weight in a group of women at the beginning and end of their freshman year in college. Results of the study indicate that weight, disordered eating and body image dissatisfaction increased during the freshman year, and that these were predicted by implicit internalization of the thin ideal at the beginning of the year. Moreover, the new implicit measure was predictive above and beyond any predictive ability of the explicit measure. Results indicate that the thin ideal IRAP can successfully predict changes in many variables of interest at the freshman year of college, and suggest it may be a beneficial screening tool to assess at-risk freshman. This study also highlights the need for additional implicit measures in the realm of body image and disordered eating.

Mindfulness and its relationship with eating disorders symptomatology in women receiving residential treatment

OBJECTIVE Mindfulness and its related constructs (e.g., awareness and acceptance) are increasingly being recognized as relevant to understanding eating disorders and improving treatment. The purpose of this study was to (1) examine the relationship between mindfulness and ED symptomatology at baseline and (2) examine how changes in mindfulness relate to change in ED symptomatology. METHOD Measures of mindfulness and ED symptomatology were administered to 88 patients upon admission to residential ED treatment and at discharge. RESULTS Baseline ED symptomatology was associated with lower awareness, acceptance, and cognitive defusion, and higher emotional avoidance. Improvements in these variables were related to improvement in ED symptomatology. DISCUSSION Interventions targeting mindfulness could be beneficial for patients with EDs.

The development and validation of the food craving acceptance and action questionnaire (FAAQ)

Research has suggested that mindfulness and acceptance may be important factors in the development, maintenance and treatment of both obesity and eating disorders. However, very few scales exist that apply constructs of acceptance and mindfulness to eating behavior. A measure of acceptance about food related thoughts would be especially beneficial in investigating links between acceptance and problematic eating, and in better understanding mechanisms of action of effective treatments for obesity and eating disorders. The Food Acceptance and Awareness Questionnaire (FAAQ) was developed to measure acceptance of urges and cravings to eat or the extent to which individuals might try to control or change these thoughts. The FAAQ is a self-report questionnaire made up of ten items each rated on a seven-point Likert scale (1=very seldom true to 6=always true). Higher scores indicate greater acceptance of motivations to eat. The FAAQ was given to a sample of 463 undergraduate students along with several other measures of eating behavior and other psychological variables. Concurrent associations with variables theorized to be closely linked (Eating Attitudes Test, EAT; the Dutch Eating Behavior Questionnaire, DEBQ; body mass index, BMI) and not very closely linked (the Depression Anxiety Stress Scale, DASS) were evaluated in order to indicate the new scales convergent and divergent validity. These results demonstrated highly significant correlations with these measures in the expected direction, with stronger correlations for the theoretically-consistent variables than the theoretically-inconsistent variables. Exploratory factor analyses confirmed a structural two-factor model. Factor 1 seems to measure ones ability to regulate eating despite urges and cravings, and Factor 2 seems to measure desire to maintain internal control over eating thoughts. The FAAQ was also administered to a separate sample of 29 overweight or obese women enrolled in a weight loss program, and found to be predictive of weight loss. Taken together, results suggest that the FAAQ is a psychometrically sound instrument which might be a valuable tool for assessing acceptance of food related thoughts and urges.