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  • 1
    Article
    Article
    Language: English
    In: Psychoneuroendocrinology, September 2013, Vol.38(9), pp.1923-1927
    Description: Appetitive behaviors such as substance use and eating are under significant regulatory control by the hypothalamic-pituitary adrenal (HPA) and hypothalamic pituitary gonadal (HPG) axes. Recent research has begun to examine how these systems interact to cause and maintain poor regulation of these appetitive behaviors. A range of potential molecular, neuroendocrine, and hormonal mechanisms are involved in these interactions and may explain individual differences in both risk and resilience to a range of addictions. This manuscript provides a commentary on research presented during the International Society of Psychoneuroendocrinology's mini-conference on sex differences in eating and addiction with an emphasis on how HPG and HPA axis interactions affect appetitive behaviors in classic addictions and may be used to help inform the ongoing debate about the validity of food addiction.
    Keywords: Hypothalamic-Pituitary Gonadal Axis ; Hypothalamic Pituitary Adrenal Axis ; Food Addiction ; Substance Abuse ; Sex Differences ; Medicine ; Anatomy & Physiology
    ISSN: 0306-4530
    E-ISSN: 1873-3360
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  • 2
    Language: English
    In: International Journal of Eating Disorders, December 2011, Vol.44(8), pp.692-702
    Description: The primary aim was to examine the utility of DSM-IV criteria in predicting treatment outcome in a sample of adolescents with eating disorders. We (a) descriptively compared the baseline rates of anorexia nervosa (AN) and bulimia nervosa (BN) across multiple reference points for diagnostic criteria, (b) using ROC curve analyses, assessed the sensitivity and specificity of each diagnostic criterion in predicting clinical outcome, and (c) with logistic regression analyses, examined the incremental predictive value of each criterion. Results show a high degree of variability in the baseline diagnostic profiles as a function of the information used to inform each DSM-IV criterion. For AN, Criterion A yielded the best predictive validity, with Criteria B-D providing no significant incremental value. For BN, none of the measures had a significant AUC, and results from logistic regression analyses showed that none of the indicators were robust in predicting outcome. For AN, the existing Criterion A is appropriate for children and adolescents, and is sufficient to predict outcome in the context of active refusal to maintain a normal weight as well as multiple informants and behavioral indicators of the psychological aspects of AN. For BN, predictive validity could not be established.
    Keywords: Anorexia Nervosa ; Bulimia Nervosa ; Children ; Adolescents ; Diagnosis ; Predictive Validity
    ISSN: 0276-3478
    E-ISSN: 1098-108X
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  • 3
    In: International Journal of Eating Disorders, December 2015, Vol.48(8), pp.1122-1131
    Description: OBJECTIVE: Impediments limit dissemination and implementation of evidence-based interventions (EBIs), including lack of sufficient training. One strategy to increase implementation of EBIs is the train-the-trainer (TTT) model. The Body Project is a peer-led body image program that reduces eating disorder (ED) risk factors. This study examined the effectiveness of a TTT model at reducing risk factors in Body Project participants. Specifically, this study examined whether a master trainer could train a novice trainer to train undergraduate peer leaders to administer the Body Project such that individuals who received the Body Project (i.e., participants) would evidence comparable outcomes to previous trials. We hypothesized that participants would evidence reductions in ED risk factors, with effect sizes similar to previous trials.METHOD: Utilizing a TTT model, a master trainer trained a novice trainer to train undergraduate peer leaders to administer the Body Project to undergraduate women. Undergraduate women aged 18 years or older who received the Body Project intervention participated in the trial and completed measures at baseline, post-treatment, and five-month follow-up. Primary outcomes included body dissatisfaction, thin ideal internalization, negative affect, and ED pathology.RESULTS: Participants demonstrated significant reductions in thin ideal internalization, ED pathology and body dissatisfaction at post-treatment and 5-month follow-up. At 5 months, using three different strategies for managing missing data, effect sizes were larger or comparable to earlier trials for 3 out of 4 variables.DISCUSSION: Results support a TTT model for Body Project implementation and the importance of utilizing sensitivity analyses for longitudinal datasets with missing data.
    Keywords: Dissemination ; Prevention ; Train‐The‐Trainer
    ISSN: 0276-3478
    E-ISSN: 1098-108X
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  • 4
    Language: English
    In: Behaviour Research and Therapy, 2015, Vol.71, p.131(8)
    Description: To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.brat.2015.06.008 Byline: Tom Hildebrandt, Andrew Grotzinger, Marianne Reddan, Rebecca Greif, Ifat Levy, Wayne Goodman, Daniela Schiller Abstract: Anorexia nervosa is characterized by chronic food avoidance that is resistant to change. Disgust conditioning offers one potential unexplored mechanism for explaining this behavioral disturbance because of its specific role in facilitating food avoidance in adaptive situations. A food based reversal learning paradigm was used to study response flexibility in 14 adolescent females with restricting subtype anorexia nervosa (AN-R) and 15 healthy control (HC) participants. Expectancy ratings were coded as a behavioral measure of flexibility and electromyography recordings from the levator labii (disgust), zygomaticus major (pleasure), and corrugator (general negative affect) provided psychophysiological measures of emotion. Response inflexibility was higher for participants with AN-R, as evidenced by lower extinction and updated expectancy ratings during reversal. EMG responses to food stimuli were predictive of both extinction and new learning. Among AN-R patients, disgust specific responses to food were associated with impaired extinction, as were elevated pleasure responses to the cued absence of food. Disgust conditioning appears to influence food learning in acutely ill patients with AN-R and may be maintained by counter-regulatory acquisition of a pleasure response to food avoidance and an aversive response to food presence. Developing strategies to target disgust may improve existing interventions for patients with AN. Author Affiliation: (a) Departmant of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA (b) Department of Neuroscience, Yale University, New Haven, CT, USA (c) Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA Article History: Received 1 March 2015; Revised 10 June 2015; Accepted 18 June 2015
    Keywords: Anorexia Nervosa – Research ; Anorexia Nervosa – Analysis ; Youth – Analysis ; Neurosciences – Analysis
    ISSN: 0005-7967
    Source: Cengage Learning, Inc.
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  • 5
    Language: English
    In: Behaviour Research and Therapy, August 2015, Vol.71, pp.131-138
    Description: Anorexia nervosa is characterized by chronic food avoidance that is resistant to change. Disgust conditioning offers one potential unexplored mechanism for explaining this behavioral disturbance because of its specific role in facilitating food avoidance in adaptive situations. A food based reversal learning paradigm was used to study response flexibility in 14 adolescent females with restricting subtype anorexia nervosa (AN-R) and 15 healthy control (HC) participants. Expectancy ratings were coded as a behavioral measure of flexibility and electromyography recordings from the levator labii (disgust), zygomaticus major (pleasure), and corrugator (general negative affect) provided psychophysiological measures of emotion. Response inflexibility was higher for participants with AN-R, as evidenced by lower extinction and updated expectancy ratings during reversal. EMG responses to food stimuli were predictive of both extinction and new learning. Among AN-R patients, disgust specific responses to food were associated with impaired extinction, as were elevated pleasure responses to the cued absence of food. Disgust conditioning appears to influence food learning in acutely ill patients with AN-R and may be maintained by counter-regulatory acquisition of a pleasure response to food avoidance and an aversive response to food presence. Developing strategies to target disgust may improve existing interventions for patients with AN.
    Keywords: Anorexia Nervosa ; Reversal Learning ; Electromyography ; Emotion ; Food Learning ; Medicine ; Psychology
    ISSN: 0005-7967
    E-ISSN: 1873-622X
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  • 6
    In: International Journal of Eating Disorders, November 2017, Vol.50(11), pp.1313-1322
    Description: OBJECTIVE: Guided self-help treatments based on cognitive-behavior therapy (CBT-GSH) are efficacious for binge eating. With limited availability of CBT-GSH in the community, mobile technology offers a means to increase use of these interventions. The purpose of this study was to test the initial efficacy of Noom Monitor, a smartphone application designed to facilitate CBT-GSH (CBT-GSH + Noom), on study retention, adherence, and eating disorder symptoms compared to traditional CBT-GSH.METHOD: Sixty-six men and women with DSM-5 binge-eating disorder (BED) or bulimia nervosa (BN) were randomized to receive eight sessions of CBT-GSH + Noom (n = 33) or CBT-GSH (n = 33) over 12 weeks. Primary symptom outcomes were eating disorder examination objective bulimic episodes (OBEs), subjective bulimic episodes (SBEs), and compensatory behaviors. Assessments were collected at 0, 4, 8, 12, 24, and 36 weeks. Behavioral outcomes were modeled using zero-inflated negative-binomial latent growth curve models with intent-to-treat.RESULTS: There was a significant effect of treatment on change in OBEs (β = -0.84, 95% CI = -1.49, -0.19) favoring CBT-GSH + Noom. Remission rates were not statistically different between treatments for OBEs (βlogit  = -0.73, 95% CI = -1.86, 3.27; CBT-GSH-Noom = 17/27, 63.0% vs. CBT-GSH 11/27, 40.7%, NNT = 4.5), but CBT-GSH-Noom participants reported greater meal and snack adherence and regular meal adherence mediated treatment effects on OBEs. The treatments did not differ at the 6-month follow-up.DISCUSSION: Smartphone applications for the treatment binge eating appear to have advantages for adherence, a critical component of treatment dissemination.
    Keywords: Binge‐Eating Disorder ; Bulimia Nervosa ; Guided Self‐Help ; Smartphone ; Technology
    ISSN: 0276-3478
    E-ISSN: 1098-108X
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  • 7
    Language: English
    In: Journal of eating disorders, 2013, Vol.1, pp.10
    Description: Previous research has documented that self-objectification is associated with numerous negative outcomes including body shame, eating disorder (ED) pathology, and negative affect. This exploratory open study investigated whether or not an evidence-based body image improvement program that targets thin-ideal internalization in university women also reduces self-objectification. A second aim of the study was to determine if previous findings showing that body shame mediated the relationship between self-objectification and eating disorder pathology at a single time point (consistent with self-objectification theory) but did not mediate longitudinally (inconsistent with self-objectification theory) would be replicated in a new sample under novel conditions. Ninety-six university women completed a peer-led dissonance-based intervention, along with assessment measures at pre-, post-intervention, 8-week and 8-month follow-up. To address the open trial nature of this study, a planned manipulation check was included to make sure that peer-led dissonance decreased thin-ideal internalization, body dissatisfaction, eating disorder pathology, and negative affect with effect sizes being similar to past randomized controlled trials. We hypothesized that all three subscales of the Objectified Body Consciousness Scale (i.e., self-surveillance, body shame, and appearance control beliefs) would be reduced. In addition, we hypothesized that body shame would mediate the relationship between self-objectification (i.e., self-surveillance) and eating disorder pathology at a both at a single time point and longitudinally. The planned manipulation check supported the interpretation that peer-led dissonance in this study largely yielded comparable changes to past controlled trials. In terms of changes in dependent variables, results supported all hypotheses with the exception of body shame, which remained unchanged. With regards to the mediation analyses, our first (cross-sectional) hypothesis but not our second (longitudinal) was supported. Findings provide preliminary support for the use of dissonance interventions in reducing self-surveillance and body control beliefs. Results for body shame and the mediation analyses suggest that greater scrutiny of the body shame construct is warranted.
    Keywords: Body Shame ; Cognitive Dissonance-Based Interventions ; Eating Disorders ; Mediation ; Self-Objectification ; Sororities
    ISSN: 2050-2974
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  • 8
    Language: English
    In: Cognitive and Behavioral Practice, November 2014, Vol.21(4), pp.470-484
    Description: The overlap between anorexia nervosa (AN) and anxiety disorders has led to the development of anxiety-based etiological models of AN and anxiety-based interventions for AN, including exposure treatment. Family-based treatment (FBT) is an efficacious intervention for adolescents with AN; however, it has recently been proposed that FBT accomplishes parent-facilitated exposure and habituation to food and related triggers in the individual's natural environment. FBT was recently altered to include an explicit exposure component that targets the broad construct of anxiety, including fear, worry, and disgust. This case series examines the application of FBT with an exposure component (FBT-E) to a group of adolescents meeting diagnostic criteria for AN ( = 4) and eating disorder not otherwise specified–restricting type (SAN, = 6). Ten outpatients (ages 12–17, mean age: 15.28) participated in a course of FBT-E. Session-by-session weight was examined, along with BMI at pre- and posttreatment and responses to self-report measures of eating disorder symptoms (Eating Disorder Examination Questionnaire; EDE-Q), depression and anxiety. Parent reports of their adolescents' anxiety were also collected. The results of this study provide preliminary evidence that FBT-E may effectively target disordered eating and anxiety symptoms and may be a viable alternative to traditional FBT. Implications and future directions are discussed.
    Keywords: Anorexia Nervosa ; Family-Based Treatment ; Exposure Treatment ; Anxiety ; Adolescents
    ISSN: 1077-7229
    E-ISSN: 1878-187X
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  • 9
    Language: English
    In: Cognitive and Behavioral Practice, February 2012, Vol.19(1), pp.17-30
    Description: This paper describes the transdiagnostic theory and application of family-based treatment (FBT) for children and adolescents with eating disorders. We review the fundamentals of FBT, a transdiagnostic theoretical model of FBT and the literature supporting its clinical application, adaptations across developmental stages and the diagnostic spectrum of eating disorders, and the strengths and challenges of this approach, including its suitability for youth. Finally, we report a case study of an adolescent female with eating disorder not otherwise specified (EDNOS) for whom FBT was effective. We conclude that FBT is a promising outpatient treatment for anorexia nervosa, bulimia nervosa, and their EDNOS variants. The transdiagnostic model of FBT posits that while the etiology of an eating disorder is unknown, the pathology affects the family and home environment in ways that inadvertently allow for symptom maintenance and progression. FBT directly targets and resolves family level variables, including secrecy, blame, internalization of illness, and extreme active or passive parental responses to the eating disorder. Future research will test these mechanisms, which are currently theoretical.
    Keywords: Anorexia Nervosa -- Development And Progression ; Anorexia Nervosa -- Care And Treatment ; Teenage Girls;
    ISSN: 1077-7229
    E-ISSN: 1878-187X
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  • 10
    Language: English
    In: Journal of Clinical Child & Adolescent Psychology, 13 January 2009, Vol.38(1), pp.176-183
    Description: This article describes the successful application of family-based treatment (FBT) for a 17-year-old identical twin presenting with a 4-month history of clinically significant symptoms of anorexia nervosa (AN). FBT is a manualized treatment that has been studied in randomized controlled trials...
    Keywords: Social Welfare & Social Work ; Psychology
    ISSN: 1537-4416
    E-ISSN: 1537-4424
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