Objective: Although mindfulness-based therapy has become a popular treatment, little is known abo... more Objective: Although mindfulness-based therapy has become a popular treatment, little is known about its efficacy. Therefore, our objective was to conduct an effect size analysis of this popular intervention for anxiety and mood symptoms in clinical samples. Method: We conducted a literature search using PubMed, PsycINFO, the Cochrane Library, and manual searches. Our meta-analysis was based on 39 studies totaling 1,140 participants receiving mindfulness-based therapy for a range of conditions, including cancer, generalized anxiety disorder, depression, and other psychiatric or medical conditions. Results: Effect size estimates suggest that mindfulness-based therapy was moderately effective for improving anxiety (Hedges's g 0.63) and mood symptoms (Hedges's g 0.59) from pre-to posttreatment in the overall sample. In patients with anxiety and mood disorders, this intervention was associated with effect sizes (Hedges's g) of 0.97 and 0.95 for improving anxiety and mood symptoms, respectively. These effect sizes were robust, were unrelated to publication year or number of treatment sessions, and were maintained over follow-up. Conclusions: These results suggest that mindfulness-based therapy is a promising intervention for treating anxiety and mood problems in clinical populations.
Journal of consulting and clinical psychology, 2014
Research on anorexia nervosa (AN) has emphasized the importance of low absolute body weight, but ... more Research on anorexia nervosa (AN) has emphasized the importance of low absolute body weight, but emerging research suggests the importance of also considering low body weight relative to an individual's highest premorbid weight (weight suppression; WS). We investigated whether body mass index and WS at lowest weight (BMI-LW and WS-LW) among adolescents with AN predicted BMI at 6-, 10-, or 18-year follow-up, duration of AN, or total eating disorder duration, including time during which criteria were met for bulimia nervosa or eating disorder not otherwise specified. Forty-seven cases of AN identified through community screening in Sweden were included. Weight and height data were collected from medical records, school nurse charts, and study follow-up assessments. Higher WS-LW was associated with higher BMI at 6-year and 10-year follow-up, and this effect was strongest among those with the lowest BMI-LW values. BMI-LW and WS-LW were positively associated with BMI at 18-year follo...
Hedonic hunger, the appetitive drive to eat to obtain pleasure in the absence of an energy defici... more Hedonic hunger, the appetitive drive to eat to obtain pleasure in the absence of an energy deficit, is associated with overeating and with loss of control over eating, but has not been investigated among individuals with eating disorders. (1) to compare participants with anorexia nervosa, restricting type (AN-R), anorexia nervosa, binge-purge type (AN-B/P), and bulimia nervosa (BN) on scores on the Power of Food Scale (PFS), a self-report measure of hedonic hunger; (2) to examine the relation between PFS scores and frequency of binge eating; and (3) to examine whether pre-treatment PFS scores predict weight change during treatment. The PFS and measures of eating disorder symptomatology were administered to female patients with AN (N = 119) and BN (N = 144) at admission to residential treatment. Participants with BN scored higher on the PFS compared to participants with AN-R or AN-B/P; there was a trend for those with AN-B/P to score higher than those with AN-R. PFS scores were positively associated with binge eating frequency among participants with BN; these associations remained significant when controlling for restraint and weight suppression. A similar pattern was found among participants with AN. PFS scores predicted weight change in AN but not BN. Results suggest that hedonic processes may be important in stimulating binge eating. Furthermore, hedonic appetite may facilitate weight restoration in AN. Further research should investigate whether pre-treatment PFS scores have prognostic significance with respect to eating disorder symptoms.
The cognitive behavioral model of bulimia nervosa (BN) suggests that dieting is central to the ma... more The cognitive behavioral model of bulimia nervosa (BN) suggests that dieting is central to the maintenance of binge eating. However, correlational and experimental studies suggest that additional clarification is needed about the nature of this relationship. Dieting, weight, eating disorder psychopathology, and depression were assessed at admission among 166 patients with BN presenting for residential treatment. As in past research, a significant fraction (43%) of patients with BN reported not currently dieting. A comparison of weight loss dieters and non-dieters found greater food restriction and eating disorder psychopathology among weight loss dieters. However, dieters reported less frequent binge eating. There were no significant group differences in depression. Results suggest that 1) while many individuals with BN are attempting to restrict their food intake, the goal of losing weight fundamentally alters the effect of such restriction on binge eating, and 2) treatment may benefit from helping patients to establish a healthier approach to achieving long-term weight stability.
The construct of attempted eating restriction has been measured in a number of ways in recent yea... more The construct of attempted eating restriction has been measured in a number of ways in recent years. The Three-Factor Model of Dieting suggests that dieting can be subdivided into three types: (1) frequency of past dieting and overeating (i.e., history of dieting), (2) current dieting to lose weight, and (3) weight suppression, or the difference between an individual's current weight and his or her highest previous weight. The purpose of this paper is to (1) describe the Dieting and Weight History Questionnaire (DWHQ), a measure that we have used for many years to assess these three dimensions of dieting; (2) provide some recent examples of published research on each type of dieting; (3) discuss some of the nuances of assessing these dieting types; and (4) suggest directions for future research.
Weight suppression, the difference between highest past weight and current weight, is a robust pr... more Weight suppression, the difference between highest past weight and current weight, is a robust predictor of clinical characteristics of bulimia nervosa; however, the influence of weight suppression in anorexia nervosa (AN) has been little studied, and to our knowledge, no study to date has investigated the ways in which the relevance of weight suppression in AN may depend upon an individual's current body mass index (BMI). The present study investigated weight suppression, BMI, and their interaction as cross-sectional and prospective predictors of psychological symptoms and weight in AN. Women with AN completed depression (Beck Depression Inventory-II) and eating disorder symptomatology measures (Eating Disorder Examination Questionnaire and Eating Disorders Inventory-3) at residential treatment admission (N = 350) and discharge (N = 238). Weight suppression and BMI were weakly correlated (r = -.22). At admission, BMI was positively correlated with all symptom measures except Restraint and Depression scores. Weight suppression was also independently positively correlated with all measures except Weight Concern and Body Dissatisfaction subscale scores. In analyses examining discharge scores (including admission values as covariates), the admission weight suppression × BMI interaction consistently predicted posttreatment psychopathology. Controlling for weight gain in treatment and age, higher admission weight suppression predicted lower discharge scores (less symptom endorsement) among those with lower BMIs; among those with higher BMIs, higher weight suppression predicted higher discharge scores. These results are the first to our knowledge to demonstrate that absolute and relative weight status are joint indicators of AN severity and prognosis. These findings may have major implications for conceptualization and treatment of AN.
Objective: Although mindfulness-based therapy has become a popular treatment, little is known abo... more Objective: Although mindfulness-based therapy has become a popular treatment, little is known about its efficacy. Therefore, our objective was to conduct an effect size analysis of this popular intervention for anxiety and mood symptoms in clinical samples. Method: We conducted a literature search using PubMed, PsycINFO, the Cochrane Library, and manual searches. Our meta-analysis was based on 39 studies totaling 1,140 participants receiving mindfulness-based therapy for a range of conditions, including cancer, generalized anxiety disorder, depression, and other psychiatric or medical conditions. Results: Effect size estimates suggest that mindfulness-based therapy was moderately effective for improving anxiety (Hedges's g 0.63) and mood symptoms (Hedges's g 0.59) from pre-to posttreatment in the overall sample. In patients with anxiety and mood disorders, this intervention was associated with effect sizes (Hedges's g) of 0.97 and 0.95 for improving anxiety and mood symptoms, respectively. These effect sizes were robust, were unrelated to publication year or number of treatment sessions, and were maintained over follow-up. Conclusions: These results suggest that mindfulness-based therapy is a promising intervention for treating anxiety and mood problems in clinical populations.
Journal of consulting and clinical psychology, 2014
Research on anorexia nervosa (AN) has emphasized the importance of low absolute body weight, but ... more Research on anorexia nervosa (AN) has emphasized the importance of low absolute body weight, but emerging research suggests the importance of also considering low body weight relative to an individual's highest premorbid weight (weight suppression; WS). We investigated whether body mass index and WS at lowest weight (BMI-LW and WS-LW) among adolescents with AN predicted BMI at 6-, 10-, or 18-year follow-up, duration of AN, or total eating disorder duration, including time during which criteria were met for bulimia nervosa or eating disorder not otherwise specified. Forty-seven cases of AN identified through community screening in Sweden were included. Weight and height data were collected from medical records, school nurse charts, and study follow-up assessments. Higher WS-LW was associated with higher BMI at 6-year and 10-year follow-up, and this effect was strongest among those with the lowest BMI-LW values. BMI-LW and WS-LW were positively associated with BMI at 18-year follo...
Hedonic hunger, the appetitive drive to eat to obtain pleasure in the absence of an energy defici... more Hedonic hunger, the appetitive drive to eat to obtain pleasure in the absence of an energy deficit, is associated with overeating and with loss of control over eating, but has not been investigated among individuals with eating disorders. (1) to compare participants with anorexia nervosa, restricting type (AN-R), anorexia nervosa, binge-purge type (AN-B/P), and bulimia nervosa (BN) on scores on the Power of Food Scale (PFS), a self-report measure of hedonic hunger; (2) to examine the relation between PFS scores and frequency of binge eating; and (3) to examine whether pre-treatment PFS scores predict weight change during treatment. The PFS and measures of eating disorder symptomatology were administered to female patients with AN (N = 119) and BN (N = 144) at admission to residential treatment. Participants with BN scored higher on the PFS compared to participants with AN-R or AN-B/P; there was a trend for those with AN-B/P to score higher than those with AN-R. PFS scores were positively associated with binge eating frequency among participants with BN; these associations remained significant when controlling for restraint and weight suppression. A similar pattern was found among participants with AN. PFS scores predicted weight change in AN but not BN. Results suggest that hedonic processes may be important in stimulating binge eating. Furthermore, hedonic appetite may facilitate weight restoration in AN. Further research should investigate whether pre-treatment PFS scores have prognostic significance with respect to eating disorder symptoms.
The cognitive behavioral model of bulimia nervosa (BN) suggests that dieting is central to the ma... more The cognitive behavioral model of bulimia nervosa (BN) suggests that dieting is central to the maintenance of binge eating. However, correlational and experimental studies suggest that additional clarification is needed about the nature of this relationship. Dieting, weight, eating disorder psychopathology, and depression were assessed at admission among 166 patients with BN presenting for residential treatment. As in past research, a significant fraction (43%) of patients with BN reported not currently dieting. A comparison of weight loss dieters and non-dieters found greater food restriction and eating disorder psychopathology among weight loss dieters. However, dieters reported less frequent binge eating. There were no significant group differences in depression. Results suggest that 1) while many individuals with BN are attempting to restrict their food intake, the goal of losing weight fundamentally alters the effect of such restriction on binge eating, and 2) treatment may benefit from helping patients to establish a healthier approach to achieving long-term weight stability.
The construct of attempted eating restriction has been measured in a number of ways in recent yea... more The construct of attempted eating restriction has been measured in a number of ways in recent years. The Three-Factor Model of Dieting suggests that dieting can be subdivided into three types: (1) frequency of past dieting and overeating (i.e., history of dieting), (2) current dieting to lose weight, and (3) weight suppression, or the difference between an individual's current weight and his or her highest previous weight. The purpose of this paper is to (1) describe the Dieting and Weight History Questionnaire (DWHQ), a measure that we have used for many years to assess these three dimensions of dieting; (2) provide some recent examples of published research on each type of dieting; (3) discuss some of the nuances of assessing these dieting types; and (4) suggest directions for future research.
Weight suppression, the difference between highest past weight and current weight, is a robust pr... more Weight suppression, the difference between highest past weight and current weight, is a robust predictor of clinical characteristics of bulimia nervosa; however, the influence of weight suppression in anorexia nervosa (AN) has been little studied, and to our knowledge, no study to date has investigated the ways in which the relevance of weight suppression in AN may depend upon an individual's current body mass index (BMI). The present study investigated weight suppression, BMI, and their interaction as cross-sectional and prospective predictors of psychological symptoms and weight in AN. Women with AN completed depression (Beck Depression Inventory-II) and eating disorder symptomatology measures (Eating Disorder Examination Questionnaire and Eating Disorders Inventory-3) at residential treatment admission (N = 350) and discharge (N = 238). Weight suppression and BMI were weakly correlated (r = -.22). At admission, BMI was positively correlated with all symptom measures except Restraint and Depression scores. Weight suppression was also independently positively correlated with all measures except Weight Concern and Body Dissatisfaction subscale scores. In analyses examining discharge scores (including admission values as covariates), the admission weight suppression × BMI interaction consistently predicted posttreatment psychopathology. Controlling for weight gain in treatment and age, higher admission weight suppression predicted lower discharge scores (less symptom endorsement) among those with lower BMIs; among those with higher BMIs, higher weight suppression predicted higher discharge scores. These results are the first to our knowledge to demonstrate that absolute and relative weight status are joint indicators of AN severity and prognosis. These findings may have major implications for conceptualization and treatment of AN.
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