The Role of Email Guidance in Internet‐Based Cognitive‐Behavioural Self‐Care Treatment for Bulimia Nervosa

Email has been progressively used as a means for providing therapeutic guidance and support for cognitive behavioural treatment (CBT) self‐care programmes. Many aspects of the use of email in self‐care need to be explored such as the content of therapists' emails. Such information would optimise the delivery of self‐care treatments. To date no study has looked at the content of the therapists' emails. We analysed the content of emails (n = 712) sent by therapists to participants (n = 71) of a randomised controlled trial (RCT) of internet‐based CBT with email support for bulimic disorders. 14.7% of the emails therapists sent contained at least one CBT comment, while 95.4% had at least one supportive comment and 13.6% had at least one technical comment. The mean time spent on providing email support to each participant across the complete programme was 45 minutes. Emails sent by therapists were mainly supportive in content, with only a small amount of time being required by therapists to provide email support. Copyright © 2011 John Wiley & Sons, Ltd and Eating Disorders Association.     

Inpatient Treatment for Adolescents with Anorexia Nervosa: Clinical Significance and Predictors of Treatment Outcome

This study evaluated the clinical significance as well as predictors of outcome for adolescents with severe anorexia nervosa (AN) treated in an inpatient setting. Body mass index (BMI), eating disorder (ED) symptoms [Eating Disorder Inventory‐2 (EDI‐2)], general psychopathology and depression were assessed in 238 patients at admission and discharge. BMI increased from 14.8 + 1.2 to 17.3 + 1.4 kg/m². Almost a fourth (23.6%) of the patients showed reliable changes, and 44.7% showed clinically significant changes (EDI‐2). BMI change did not significantly differ between those with reliable or clinically significant change or no reliable change in EDI‐2. Length of stay, depression and body dissatisfaction were negative predictors of a clinically significant change. Inpatient treatment is effective in about two thirds of adolescents with AN and should be considered when outpatient treatment fails. About one third of patients showed significant weight gain, but did not improve regarding overall ED symptomatology. Future studies should focus on treatment strategies for non‐responders. Copyright © 2015 John Wiley & Sons, Ltd and Eating Disorders Association.     

Early Response as a Predictor of Success in Guided Self‐help Treatment for Bulimic Disorders

The aims of this study were to investigate the number of sessions and time required for a clinical meaningful symptomatic change with a guided self‐help treatment and to assess the predictive value of early response and other potential predictors of end‐of‐treatment clinical status. Participants were 42 patients with a diagnosis of bulimia nervosa or ED not otherwise specified. Survival analyses (Kaplan–Meier) were performed to estimate the median time required to attain a 51% reduction in bulimic symptoms. Logistic regression was used to assess predictors of symptom remission. Results showed that the median time to achieve a 51% reduction in binge and purge frequencies was 3.68 and 3.77, respectively. This change occurred at session 3 for 50% of the participants. Early response was the most significant predictor of binge eating remission. No pretreatment predictors of time to achieve early response were found. These results have implications for allocating treatment resources in a stepped‐care intervention model. Copyright © 2013 John Wiley & Sons, Ltd and Eating Disorders Association.     

Investigation of Oxytocin Secretion in Anorexia Nervosa and Bulimia Nervosa: Relationships to Temperament Personality Dimensions

Published studies suggested an implication of oxytocin in some temperament characteristics of personality. Therefore, we measured oxytocin secretion in 23 women with anorexia nervosa (AN), 27 with bulimia nervosa (BN) and 19 healthy controls and explored the relationships between circulating oxytocin and patients' personality traits. Plasma oxytocin levels were significantly reduced in AN women but not in BN ones. In healthy women, the attachment subscale scores of the reward dependence temperament and the harm avoidance (HA) scores explained 82% of the variability in circulating oxytocin. In BN patients, plasma oxytocin resulted to be negatively correlated with HA, whereas no significant correlations emerged in AN patients. These findings confirm a dysregulation of oxytocin production in AN but not in BN and show, for the first time, a disruption of the associations between hormone levels and patients' temperament traits, which may have a role in certain deranged behaviours of eating disorder patients. Copyright © 2015 John Wiley & Sons, Ltd and Eating Disorders Association.     

The Impact of Alexithymia on Emotion Dysregulation in Anorexia Nervosa and Bulimia Nervosa over Time

Research supports that anorexia nervosa‐restricting subtype (AN‐R) and bulimia nervosa (BN) are associated with emotion regulation difficulties and alexithymia. However, the impact of diagnosis on the relationship between these constructs is less well understood. The purpose of the present study was to examine whether eating disorder diagnosis moderated the association between admission alexithymia and emotion regulation through discharge. Adult patients with AN‐R (n = 54) and BN (n = 60) completed assessments at treatment admission and discharge from a partial hospital program. Eating disorder diagnosis moderated the association between admission alexithymia levels and change in global emotion dysregulation, impulse control difficulties and access to emotion regulation strategies. At higher levels of admission alexithymia, there were no differences between AN‐R and BN on emotion dysregulation, whereas at lower levels of alexithymia, AN‐R patients demonstrated lower levels of emotion dysregulation. Results imply that difficulties with alexithymia appear to have a greater impact on emotion dysregulation for AN‐R patients. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.     

A Randomised Controlled Comparison of Second‐Level Treatment Approaches for Treatment‐Resistant Adults with Bulimia Nervosa and Binge Eating Disorder: Assessing the Benefits of Virtual Reality Cue Exposure Therapy

A question that arises from the literature on therapy is whether second‐level treatment is effective for patients with recurrent binge eating who fail first‐level treatment. It has been shown that subjects who do not stop binge eating after an initial structured cognitive‐behavioural treatment (CBT) programme benefit from additional CBT (A‐CBT) sessions; however, it has been suggested that these resistant patients would benefit even more from cue exposure therapy (CET) targeting features associated with poor response (e.g. urge to binge in response to a cue and anxiety experienced in the presence of binge‐related cues). We assessed the effectiveness of virtual reality‐CET as a second‐level treatment strategy for 64 patients with bulimia nervosa and binge eating disorder who had been treated with limited results after using a structured CBT programme, in comparison with A‐CBT. The significant differences observed between the two groups at post‐treatment in dimensional (behavioural and attitudinal features, anxiety, food craving) and categorical (abstinence rates) outcomes highlighted the superiority of virtual reality‐CET over A‐CBT. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.     

Temperament‐based Treatment for Anorexia Nervosa

Anorexia nervosa (AN) tends to be a chronic and deadly disorder with no proven treatments that reverse core symptoms in adults. New insight into neurobiological mechanisms that contribute to symptoms may support development of more effective interventions. We describe the development of a temperament‐based treatment for AN on the basis of empirically supported models. It uses a systemized approach and takes into consideration an understanding of how neurobiological mechanisms are expressed through behaviour and personality and contribute to specific AN symptomatology. This model integrates the development of AN‐focused constructive coping strategies with carer‐focused strategies to manage temperament traits that contribute to AN symptomatology. This intervention is consistent with the recent Novel Interventions for Mental Disorders initiative mandating that treatment trials follow an experimental medicine approach by identifying underlying mechanisms that are directly targeted by the intervention to influence symptoms. Copyright © 2014 John Wiley & Sons, Ltd and Eating Disorders Association.     

Subjective and Objective Binge Eating in Relation to Eating Disorder Symptomatology,Depressive Symptoms,and Self‐Esteem among Treatment‐Seeking Adolescents with Bulimia Nervosa

This study investigated the importance of the distinction between objective (OBE) and subjective binge eating (SBE) among 80 treatment‐seeking adolescents with bulimia nervosa. We explored relationships among OBEs, SBEs, eating disorder (ED) symptomatology, depression, and self‐esteem using two approaches. Group comparisons showed that OBE and SBE groups did not differ on ED symptoms or self‐esteem; however, the SBE group had significantly greater depression. Examining continuous variables, OBEs (not SBEs) accounted for significant unique variance in global ED pathology, vomiting, and self‐esteem. SBEs (not OBEs) accounted for significant unique variance in restraint and depression. Both OBEs and SBEs accounted for significant unique variance in eating concern; neither accounted for unique variance in weight/shape concern, laxative use, diuretic use, or driven exercise. Loss of control, rather than amount of food, may be most important in defining binge eating. Additionally, OBEs may indicate broader ED pathology, while SBEs may indicate restrictive/depressive symptomatology. Copyright © 2014 John Wiley & Sons, Ltd and Eating Disorders Association.     

Day Hospital Treatment for Anorexia Nervosa: A 12‐Month Follow‐up Study

Day hospitals (DHs) represent a treatment option for anorexia nervosa (AN), a mental disorder that is difficult to treat and has no evidence‐based treatments available. We aimed to determine the effectiveness of a DH treatment that was specifically focused on the emotions of severe AN patients. Body mass index and eating psychopathology were the primary outcome measures. Fifty‐six adult patients with AN were assessed upon admission, at the end of treatment (EOT) and at a 12‐month follow‐up evaluation (T18) using Eating Disorders Inventory‐2, Beck Depression Inventory, Hamilton Rating Scale for Anxiety and Brief Social Phobia Scale. All participants received a multidisciplinary treatment programme that focused on psychodynamic psychotherapy. Seventy‐eight per cent of participants reported positive outcomes at EOT and 68% at T18. Moreover, 82.1% and 65.4% of long‐standing patients showed positive outcomes at EOT and T18, respectively. All measures of psychopathology were significantly improved at EOT and were maintained at follow‐up. Our DH was effective at treating severe AN patients; however, further investigations of the processes of change are warranted. Copyright © 2015 John Wiley & Sons, Ltd and Eating Disorders Association.