Giorgio A. Tasca

Olanzapine in the Treatment of Low Body Weight and Obsessive Thinking in Women With Anorexia Nervosa: A Randomized, Double-Blind, Placebo-Controlled Trial

OBJECTIVE Anorexia nervosa is associated with high mortality, morbidity, and treatment costs. Olanzapine, an atypical antipsychotic, is known to result in weight gain in other patient populations. The objective of this trial was to assess the efficacy of olanzapine in promoting weight gain and in reducing obsessive symptoms among adult women with anorexia nervosa. METHOD The study was a double-blind, placebo-controlled, 10-week flexible dose trial in which patients with anorexia nervosa (N=34) were randomly assigned to either olanzapine plus day hospital treatment or placebo plus day hospital treatment. RESULTS Compared with placebo, olanzapine resulted in a greater rate of increase in weight, earlier achievement of target body mass index, and a greater rate of decrease in obsessive symptoms. No differences in adverse effects were observed between the two treatment conditions. CONCLUSIONS These preliminary results suggest that olanzapine may be safely used in achieving more rapid weight gain and improvement in obsessive symptoms among women with anorexia nervosa. Replication, in the form of a large multicenter trial, is recommended.

An interpersonally based model of chronic pain: An application of attachment theory

Abstract The article examines the applicability of attachment theory to the development of and adaptation to chronic pain. We begin with an overview of traditional psychological models of chronic pain, including psychoanalysis, behaviorism, and cognitive—behavioral theory. It is noted that psychoanalytic writings on chronic pain are few. Those that exist are based on drive theory and place little emphasis on interpersonal factors. The behavioral tradition was more interpersonally based, with its emphasis on social reinforcement of pain behavior. The cognitive—behavioral perspective signalled a return to an emphasis on intrapsychic factors in the etiology and maintenance of chronic pain syndrome. The interpersonal dimensions of the pain experience suggested or implied by these theories is discussed further. This is followed by a review of Bowlbys (1969, 1975, 1981) attachment theory. The tenets of attachment theory are used as a foundation for furthering our understanding of the development of and adjustment to chronic pain, within an interpersonal framework. Bowlby (1988) suggests that pain and illness evoke attachment behaviors that are meant to preserve the organisms survival. The four attachment groups identified by Bartholomew and Horowitz (1991) are described. Descriptions are provided as to the manner in which members of each group are likely to react to onset of chronic pain. Emphasis is placed on accounting for etiology of chronic pain and implications of this model for the assessment process.

Attachment Predicts Treatment Completion in an Eating Disorders Partial Hospital Program Among Women With Anorexia Nervosa

The goal of this study was to examine if attachment theory can provide a framework for understanding treatment completion in an eating disorders partial hospital program among women with anorexia nervosa (AN). Attachment was measured using the Attachment Styles Questionnaire (Feeney, Noller, & Hanrahan, 1994). As hypothesized, self-reports of high avoidant attachment predicted noncompletion of treatment for those with AN binge-purge subtype (ANB). However, this relationship did not emerge for those with AN restricting subtype (ANR). Also as hypothesized, self-reports of high anxious attachment predicted completing treatment for those with ANB but not for those with ANR. For completers with ANB and ANR, the program was helpful in increasing body weight and lowering drive for thinness, body dissatisfaction, interpersonal problems, and depression. Attachment avoidance, characterized by devaluing ones need for relationships, may be a contraindication for group-based partial hospital treatment of ANB. Attachment anxiety, characterized by high preoccupation with relationships, may facilitate remaining in treatment for those with ANB.

Attachment and eating disorders: A review of current research

OBJECTIVE Attachment insecurity may confer risk for developing an eating disorder. We describe domains of attachment functioning that are relevant to eating disorders including: affect regulation, interpersonal style, coherence of mind, and reflective functioning. Research since 2000 on attachment and eating disorders related to these domains is reviewed. METHOD We searched MedLine/Pubmed and PsycINFO from January 2000 to February 2014 and kept articles that: were empirical, included adults with a diagnosed eating disorder, and used a standard attachment measure. We retained 50 relevant studies. RESULTS Compared to controls, those with eating disorders had higher levels of attachment insecurity and disorganized mental states. Lower reflective functioning was specifically associated with anorexia nervosa. Attachment anxiety was associated with eating disorder symptom severity, and this relationship may be mediated by perfectionism and affect regulation strategies. Type of attachment insecurity had specific negative impacts on psychotherapy processes and outcomes, such that higher attachment avoidance may lead to dropping out and higher attachment anxiety may lead to poorer treatment outcomes. DISCUSSION Research to date suggests a possible relationship between attachment insecurity and risk for an eating disorder. More research is needed that uses attachment interviews, and longitudinal and case control designs. Clinicians can assess attachment insecurity to help inform therapeutic stances and interventions.

Multilevel modeling of longitudinal data for psychotherapy researchers: I. The basics

Abstract Psychotherapy researchers are often interested in change or development over time (i.e., pre- to posttreatment to follow-up or the development of process variables across multiple sessions). Traditional methods of assessing change and development are often unsatisfactory because of violations of statistical assumptions and because they do not model individual change. Modern longitudinal data analysis methods, including multilevel models (MLMs), provide an opportunity to model dynamic fluctuations in individual data across time. The objective of this article is to focus on the fundamentals of MLMs for longitudinal data analysis in psychotherapy research. To do so, the authors illustrate basic equations of MLMs and a strategy for developing increasingly complex models. They also present data from a psychotherapy research as an example of the application of MLMs. Finally, they offer some caveats and advice for conducting and presenting MLMs.

Attachment insecurity predicts eating disorder symptoms and treatment outcomes in a clinical sample of women.

We examined the extent to which attachment insecurity was related to eating disorder (ED) symptoms, and predictive of treatment outcomes. Women diagnosed with anorexia nervosa (AN) restricting subtype (ANR), AN binge purge subtype (ANB), or bulimia nervosa (BN) completed an attachment scale pretreatment, and ED symptom scales pretreatment (N = 243) and post-treatment (N = 157). A comparison sample of 126 non-ED women completed attachment scales on 1 occasion. Those with EDs had significantly higher attachment insecurity than non-ED. ANB was associated with higher attachment avoidance compared with ANR and BN, and higher attachment anxiety compared with BN. Higher attachment anxiety was significantly related to greater ED symptom severity and poorer treatment outcome across all EDs even after controlling for ED diagnosis. Attachment dimensions substantially contribute to our understanding of ED symptoms and treatment outcome. Addressing attachment insecurity when treating those with EDs may improve treatment outcomes.

A randomized controlled psycho-education intervention trial: Improving psychological readiness for successful HIV medication adherence and reducing depression before initiating HAART

Abstract The purpose of this study was to evaluate a novel psycho-educational intervention intended to increase patients’ medication preparedness and treatment adherence skills before initiating highly active antiretroviral therapy (HAART). Sixty-three HIV-positive patients not currently on antiretroviral therapy participated in a randomized controlled trial of a standardized, four-session psycho-educational intervention (Supportive Therapy for Adherence to Antiretroviral Treatment; STAART). Session topics included learning techniques to increase medication adherence and learning effective strategies to cope with stress and depression. Patients completed psychological questionnaires assessing psychological readiness to initiate HAART and depressed mood. They completed both measures at study baseline and at four-weeks post-baseline. After controlling for baseline medication readiness scores, intervention patients (n=30) reported significantly higher mean medication readiness following the STAART intervention (four-weeks post-baseline) (27.3±6.9) compared to controls (n=33; 24.6±9.9; p<0.05). Among depressed patients (n=27), those receiving the intervention (n=15) reported significantly lower mean depression scores at four-weeks post-baseline (22.5±12.9) compared to controls (n=12; 27±9.9; p<0.05). The STAART intervention enhanced HIV treatment readiness by better preparing patients prior to initiating HAART. It was also beneficial for reducing depressive symptoms in depressed, HIV-positive patients.

Cognitive effects of chemotherapy in breast cancer patients: a dose–response study†

The purpose of this study was to determine if cognition progressively worsens with cumulative chemotherapy exposure. We reasoned that the demonstration of such a ‘dose–response’ relationship would help to establish whether cognitive changes are caused by neurotoxic effects of chemotherapy or whether they are due to other confounding factors such as mood and pre‐treatment differences in cognition.

Reciprocal Influence of Alliance to the Group and Outcome in Day Treatment for Eating Disorders.

The nature of the alliance-outcome relationship is still emerging. This study examined the reciprocal influence of change in alliance to the group and change in urge to restrict in eating-disordered individuals attending a group-based day treatment. Participants (N = 238) were a transdiagnostic or mixed diagnostic sample of eating-disordered individuals consecutively admitted to a day treatment program. On a weekly basis, participants completed a measure of alliance to the group of patients with whom they attended multiple group therapies each week. After each meal, they rated the intensity of their urge to restrict food intake, and the intensity ratings were averaged per week. Latent change score analysis was used to assess the reciprocal relationship between prior change in alliance to the group with subsequent change in urge to restrict, and prior change in urge to restrict with subsequent change in alliance to the group across each participants first 9 weeks in the program. A reciprocal causal model was a good fit to the data. Prior growth in alliance to the group was significantly associated with subsequent reduction in urge to restrict, and concurrently, prior reduction in urge to restrict was significantly associated with subsequent growth in alliance to the group. Alliance to the group and individual outcomes are dynamically related and changing constructs represented by a reciprocal causal model. Clinicians may improve group treatment by assessing alliance to the group and outcomes repeatedly, being aware of their interplay, and structuring interventions based on the mutual causal effects of change in each.

The Role of Psychological and Behavioral Variables in Quality of Life and the Experience of Bodily Pain Among Persons Living with HIV

With increased life expectancy of individuals living with HIV, quality of life (QOL) has become a focus of treatment. More research is needed to address pain-related QOL and modifiable variables, such as health behaviors, depressive symptoms, and coping styles, which could be included in treatment protocols to improve QOL among individuals with HIV. Objectives of this study were to (1) examine relationships among health behaviors, psychological variables, and QOL, particularly pain-specific QOL, (2) examine the relationships among coping, depressive symptoms, and QOL, and (3) compare QOL scores of individuals with HIV and population-based normative data. HIV positive men and women not currently on highly active antiretroviral therapy were recruited during regular visits to an HIV outpatient clinic. They completed the Medical Outcome Study Health Survey SF-36 scale, which includes a physical components scale, a mental components scale, and a bodily pain subscale. They also completed questionnaires assessing health behaviors, depressive symptoms, and coping styles. Participants (n=97) scored significantly lower on most aspects of QOL than age-matched Canadian and U.S. norms. Hierarchical multiple regressions revealed that physical activity and CD4 cell count were independently related to lower physical components scale scores; smoking and depressive symptoms were independently associated with lower mental components scale scores; and education, physical activity, and depressive symptoms were independently associated with lower pain-related QOL. Depressive symptoms mediated the relationship between coping styles and the mental components scale and pain-related QOL. Results suggest that targeting depressive symptoms, physical activity, and coping strategies as part of comprehensive treatment protocols could help improve pain-specific QOL and overall QOL among individuals with HIV.