Esther Biedert

Randomized controlled comparison of two cognitive behavioral therapies for obese children : mother versus mother-child cognitive behavioral therapy

Background: Parent-child treatments have been shown to be superior to child-focused treatments of childhood obesity. Yet until now, the comparative effectiveness of parent-only and parent-child approaches has been little studied. Method: Fifty-six obese children and their families were randomly assigned to a 16-session cognitive behavioral therapy (CBT) for the parents only or for a combined treatment of parents and children. Children’s percent overweight, the body mass index of their mothers, and behavioral and psychological problems of children and mothers were assessed. Results: Both treatments reduced children’s percent overweight significantly and equally by 6-month follow-up. Also both treatments provided similar results in reducing general behavior problems (externalizing and internalizing behavior problems), global and social anxiety, and depression. Conclusions: Our results point to a comparable efficacy of the two treatments. Further, psychological well-being of both mothers and children can be improved in a CBT for obese children and their parents. Future studies should focus on finding ways to improve the adherence of families to long-term treatment of obesity in childhood.

Increasing the motivation for physical activity in obese patients

OBJECTIVE In this randomized controlled study, a standardized motivation intervention was compared with a relaxation intervention with regard to its effectiveness in decreasing dropout rates and increasing physical activity in a sample of obese patients. METHOD Thirty-eight obese participants were randomly assigned to a one-session motivation or relaxation intervention. Thereafter, both groups participated in an 8-week aerobic program. Adherence, physical activity, motivational stage of change, and body mass index (BMI) were assessed during intervention and at 3- and 6-month follow-ups. RESULTS During the aerobic program, the motivation group showed significantly fewer dropouts but comparable adherence if only completers were considered. Moreover, their weekly minutes of physical activity increased over time before leveling off, whereas steady decreases were observed in the relaxation group. For motivational stage of change and BMI, no significant group differences were observed. DISCUSSION The importance and efficacy of motivational interventions in enhancing the high dropout rates in obesity treatment is underlined.

Efficacy and predictors of long-term treatment success for cognitive-behavioral treatment and behavioral weight-loss-treatment in overweight individuals with binge eating disorder

OBJECTIVE The aim of the study was to assess the long-term efficacy of Cognitive-Behavioral Treatment (CBT) and Behavioral Weight-Loss-Treatment (BWLT) in patients with binge eating disorder (BED) and to identify potential predictors of long-term treatment success. METHOD In a sample of overweight to obese BED patients from a randomized comparative trial we evaluated the efficacy of four months of CBT or BWLT, followed by 12 months extended care, and a final follow-up assessment 6 years after the end of active treatment. Outcomes included binge eating, eating disorder pathology, depressive feelings, and body mass index. RESULTS After a strong improvement during active treatment, outcomes worsened during follow-up, yet remained improved at 6-year follow-up relative to pretreatment values. Long-term effects between CBT and BWLT were comparable. Rapid response during the early treatment phase was the only characteristic that was predictive of favorable treatment outcome in the long term. CONCLUSIONS Both CBT and BWLT can be considered to be comparably efficacious in the long-term. Patients not responding strongly enough during the first four therapy sessions might be in need of tailored interventions early during the treatment phase.

Negative mood induction and unbalanced nutrition style as possible triggers of binges in binge eating disorder (BED)

OBJECTVE: To investigate whether negative mood and unbalanced nutrition style (fat rich/carbohydrate low) synergistically trigger binge eating in overweight and obese binge eating disorder (BED) patients. METHODS: Subsequently to following an unbalanced or a balanced nutrition plan for three days, participants’ food intake in a taste test was measured. During the taste test, participants were either in a negative or a neutral mood that was induced through a guided imagery task. PARTICIPANTS: Sixty-nine overweight and obese women with BED (mean age: 36.7 years, mean body mass index: 32.8 kg/m2). MEASUREMENTS: Eating behavior was assessed by measuring the amount of eaten food during the taste test. Visual analog scales were used to assess negative affect, tension, urge to eat, and hunger before and after the mood induction and after the taste test. RESULTS: Negative mood and unbalanced nutrition had neither a combined synergistic effect nor separate additive effects on the amount of food intake. Negative affect and tension decreased after the taste test in the negative mood group. CONCLUSIONS: Negative mood does not invariably enhance the risk of binge-eating behavior. Fat-rich, carbohydrate-low nutrition style did not influence food intake during a taste test. This finding questions the role of this specific nutrition style as a crucial factor in promoting binge eating. If replicated, these findings are important, since they could guide development of treatment protocols.

CCK, ghrelin, and PYY responses in individuals with binge eating disorder before and after a cognitive behavioral treatment (CBT).

BACKGROUND Several abnormalities of peripheral neuropeptide release in obese and obese patients with binge eating disorder (BED) compared to controls have been reported: lower baseline, meal-induced, and post-meal ghrelin concentrations, decreased baseline PYY, and a blunted PYY response to meals. In contrast, obese BED individuals show comparable CCK releases. We aimed at clarifying the role of peripheral hormones in BED, to assess the impact of a cognitive behavioral treatment (CBT) for BED on neuropeptides and to investigate the predictive value of neuropeptide concentrations on binge eating status after treatment. METHODS Blood samples of 14 female and 4 male overweight to obese participants with BED were collected repeatedly for CCK, PYY, and ghrelin analysis in the morning after an 8-h fasting period. BED participants and 19 controls matched for age and body mass index (BMI) were served a standardized breakfast. The release of neuropeptides was compared to corresponding measures of controls. RESULTS Fasting baseline values of all three peptides were comparable between BED participants and controls. BED participants revealed a higher meal-induced increase in CCK and PYY compared to controls, whereas ghrelin was not affected. Following a short-term CBT the neuropeptide concentration of the BED participants was comparable to before CBT. The hormone release prior to treatment had no predictive value on binge eating status after the treatment. CONCLUSIONS With respect to CCK and PYY our results point to a combined conditioned response from the central nervous system and the gut to initiate the release of satiety hormones in order to prevent further bingeing after initial food intake. The release of neuropeptides does not predict short-term treatment outcome. Future prospective studies should investigate whether neuropeptide secretion influences the course of BED in the long term.

Ambulante Behandlung der Adipositas im Kindes- und Jugendalter

Zusammenfassung: Fragestellung: Adipositas im Kindesalter ist ein zunehmendes Problem in Industrie- und immer mehr auch in Entwicklungslandern. Die Pravalenzraten steigen bis zu 15% in den USA und bis zu 10% in Europa. Der vorliegende Artikel gibt einen Uberblick uber die aktuelle Forschungslage sowie uber medizinische und psychosoziale Probleme, die mit kindlicher Adipositas verbunden sind. Es folgt eine umfassende Zusammenstellung und Beurteilung verschiedener Behandlungsmoglichkeiten, wobei detailliert auf die Behandlungsmerkmale und die Wirksamkeit von ambulanten Behandlungsansatzen bei kindlicher Adipositas eingegangen wird. Methode: Medline- und PsycINFO-Suche von 1966 bis 2003. Schlussfolgerungen: Die Aussagekraft und Generalisierbarkeit der Untersuchungsergebnisse wird insbesondere durch die begrenzte Vergleichbarkeit der Studien eingeschrankt. Implikationen zur Behandlung kindlicher und jugendlicher Adipositas und weiterer Forschung werden diskutiert.

Self-reported emotion regulation difficulties are associated with mood but not with the biological stress response to thin ideal exposure

Background Difficulties in emotion regulation have been related to psychological and physiological stress responses such as lower mood and lower parasympathetic activation (HF-HRV) under resting condition, but evidence on the potential link to the hypothalamic-pituitary-adrenal (HPA) axis functioning and to physiological stress responses during a stress task is still scarce. The aim of the study was to investigate stress responses in young women when confronted to a daily stressor such as exposure to thin ideals and to understand the role of correlates of self-reported trait-like emotion regulation difficulties (ERD). Methods Heart rate variability (HRV) and salivary cortisol data were collected in a sample of 273 young women aged 18–35 with and without mental disorders during a vivid imagination of thin ideals (experimental condition) or landscapes (control condition). Changes in mood states were measured on a visual analogue scale (0–100). Correlates of trait-like ERD were self-reported using the Difficulties in Emotion Regulation Scale (DERS). Results Participants with higher ERD showed a stronger decline in self-reported mood after vivid imagination of thin ideals compared to participants with lower ERD in the experimental condition but also a stronger increase of positive mood with increasing ERD in the control condition. ERD were not related to baseline HF-HRV or baseline salivary cortisol levels nor to any physiological response during and after the imagination of thin ideals. Discussion and conclusion The results corroborate the role of ERD regarding the immediate psychological impact of daily stressors. Exposition to daily stressors in the laboratory results in discrepant psychological and physiological reactivity. Future studies should investigate under what conditions the complex interrelations between immediate and long-term ERD and biological activation are amenable to assessment in a laboratory setting. The additive effects of multiple exposition to stressors, such as thin ideals in daily life, also need to be addressed.

Cognitive Distortions Associated with Imagination of the Thin Ideal: Validation of the Thought-Shape Fusion Body Questionnaire (TSF-B)

Thought-shape fusion (TSF) describes the experience of body-related cognitive distortions associated with eating disorder (ED) pathology. In the laboratory TSF has been activated by thoughts about fattening/forbidden foods and thin ideals. This study aims at validating a questionnaire to assess the trait susceptibility to TSF (i.e., body-related cognitive distortions) associated with the imagination of thin ideals, and developing an adapted version of the original TSF trait questionnaire, the Thought-Shape Fusion Body Questionnaire (TSF-B). Healthy control women (HC, n = 317) and women diagnosed with subthreshold and clinical EDs (n = 243) completed an online-questionnaire. The factor structure of the TSF-B questionnaire was examined using exploratory (EFA) and subsequent confirmatory factor analysis (CFA). EFA pointed to a two-factor solution, confirmed by CFA. Subscale 1 was named Imagination of thin ideals, containing five items referring to the imagination of female thin ideals. Subscale 2 was named Striving for own thin ideal, with seven items about pursuing/abandoning attempts to reach one’s own thin ideal. The total scale and both subscales showed good convergent validity, excellent reliability, and good ability to discriminate between individuals with subthreshold/clinical EDs and HCs. Results indicate that cognitive distortions are also related to the imagination of thin ideals, and are associated with ED pathology. With two subscales, the TSF-B trait questionnaire appropriately measures this construct. Future studies should clarify whether TSF-B is predictive for the development and course of EDs. Assessing cognitive distortions with the TSF-B questionnaire could improve understanding of EDs and stimulate the development of cognitively oriented interventions. Clinical Trial Registration Number: DRKS-ID: DRKS00005709.

The Role of Cognitive Factors in the Development and Maintenance of Eating Disorders – the Concept of Thought Shape Fusion

TSF, like thought-action fusion, occurs when individuals assume that mere thoughts increase the probability of feared events, and are morally equal to real behavior. TSF occurs specifically when thinking about eating high-caloric foods. People who experience TSF report believing that they have gained weight after they merely imagine eating high-caloric or ‘fattening’ foods, report feeling fatter after thinking about eating these foods, and also report feeling as though How did theories about the role of cognitive factors in ED develop since the 2 factors theory of Connors [1996]?

Stationäre kognitiv-verhaltenstherapeutische Behandlung einer Patientin mit einer Anorexia nervosa vom Binge-Eating-/Purging-Typus

Die vorliegende Kasuistik beschreibt die stationäre Behandlung einer Patientin mit einer Anorexia nervosa vom Binge-Eating/Purging-Typus und einer komorbiden depressiven Störung. Das Oszillieren zwischen restriktivem Essverhalten, impulsiven Kontrolldurchbrüchen mit Essanfällen und Rumination sowie das deutliche Untergewicht und dessen psychologische und somatische Folgen stellen eine ausgeprägte Belastung für die Patientin dar. Spezifische Behandlungsanleitungen für die Anorexia nervosa vom Binge-Eating-/Purging-Typus, die auf evidenzbasierten Leitlinien beruhen, gibt es bislang nicht. Die Behandlungsinhalte für diesen Subtyp der Anorexia nervosa lassen sich jedoch aus bestehenden Behandlungsmanualen ableiten. Die Kasuistik beschreibt vor dem Hintergrund der individuellen Ätiologie der Störung sowie der belegten Therapieinterventionen bei Anorexia und Bulimia nervosa exemplarisch die Behandlung dieser Essstörung. Der Therapieverlauf wird mittels Messdaten zu 7 Zeitpunkten dargestellt.