Mediators of change in cognitive behavior therapy and interpersonal psychotherapy for eating disorders: A secondary analysis of a transdiagnostic randomized controlled trial

Sivyer, Katy; Allen, Elizabeth; Cooper, Zafra; Bailey‐Straebler, Suzanne; O'Connor, Marianne; Fairburn, Christopher G.; Murphy, Rebecca

doi:10.1002/eat.23390

Cited by 20 publications

(18 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…More attention has been devoted towards understanding the role of smartphone apps as an adjunct to traditional facetoface services. In light of evidence demonstrating a robust relation ship between low skills utilization and poor treatment outcomes among individuals with eating disorders 170,171 , app technologies have been proposed to augment facetoface treatments by al lowing patients to more regularly practice essential homework tasks between sessions 172 .…”

Section: Eating Disordersmentioning

confidence: 99%

The growing field of digital psychiatry: current evidence and the future of apps, social media, chatbots, and virtual reality

et al. 2021

View full text Add to dashboard Cite

As the COVID-19 pandemic has largely increased the utilization of telehealth, mobile mental health technologies -such as smartphone apps, virtual reality, chatbots, and social media -have also gained attention. These digital health technologies offer the potential of accessible and scalable interventions that can augment traditional care. In this paper, we provide a comprehensive update on the overall field of digital psychiatry, covering three areas. First, we outline the relevance of recent technological advances to mental health research and care, by detailing how smartphones, social media, artificial intelligence and virtual reality present new opportunities for "digital phenotyping" and remote intervention. Second, we review the current evidence for the use of these new technological approaches across different mental health contexts, covering their emerging efficacy in self-management of psychological well-being and early intervention, along with more nascent research supporting their use in clinical management of long-term psychiatric conditions -including major depression; anxiety, bipolar and psychotic disorders; and eating and substance use disorders -as well as in child and adolescent mental health care. Third, we discuss the most pressing challenges and opportunities towards real-world implementation, using the Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework to explain how the innovations themselves, the recipients of these innovations, and the context surrounding innovations all must be considered to facilitate their adoption and use in mental health care systems. We conclude that the new technological capabilities of smartphones, artificial intelligence, social media and virtual reality are already changing mental health care in unforeseen and exciting ways, each accompanied by an early but promising evidence base. We point out that further efforts towards strengthening implementation are needed, and detail the key issues at the patient, provider and policy levels which must now be addressed for digital health technologies to truly improve mental health research and treatment in the future.

show abstract

Section: Eating Disordersmentioning

confidence: 99%

The growing field of digital psychiatry: current evidence and the future of apps, social media, chatbots, and virtual reality

et al. 2021

View full text Add to dashboard Cite

show abstract

“…Garcia & Brennan, 2017) mediated treatment outcome for binge-eating, as did regular eating (Sivyer et al, 2020) Future research should address these issues.…”

Section: Discussionmentioning

confidence: 97%

“…Early symptom change was found to consistently mediate better treatment outcomes in CBT (Linardon, de la Piedad Garcia & Brennan, 2017) and, in one study, also in DBT‐BED (Safer & Joyce, 2011). In CBT, reductions in weight concern (Dingemans et al, 2007) and dietary restraint (Linardon, de la Piedad Garcia & Brennan, 2017) mediated treatment outcome for binge‐eating, as did regular eating (Sivyer et al, 2020) in nonunderweight eating disorders. Integrating related elements of CBT (e.g.…”

Section: Discussionmentioning

confidence: 99%

Dialectical behavior therapy compared to cognitive behavior therapy in binge‐eating disorder: An effectiveness study with 6‐month follow‐up

Lammers

Vroling

Crosby

et al. 2022

Intl J Eating Disorders

View full text Add to dashboard Cite

Objective: To evaluate whether the results of a quasi-randomized study, comparing dialectical behavior therapy for binge-eating disorder (DBT-BED) and an intensive, outpatient cognitive behavior therapy (CBT+) in individuals with BED, would be replicated in a nonrandomized study with patients who more closely resemble everyday clinical practice. Method: Patients with (subthreshold) BED (N = 175) started one of two group treatments: DBT-BED (n = 42) or CBT+ (n = 133), at a community eating disorder service. Measures of eating disorder pathology, emotion regulation, and general psychopathology were examined at end of treatment (EOT) and at 6-month followup using generalized linear models with multiple imputation. Results: Both treatments lead to substantial decreases on primary and secondary measures. Statistically significant, medium-size differences between groups were limited to global eating disorder psychopathology (d = À.62; 95% CI = .231, .949) at EOT and depressive symptoms at follow-up (d = À.45; 95% CI = .149, 6.965), favoring CBT+. Dropout of treatment included 15.0% from CBT+ and 19.0% from DBT-BED (difference nonsignificant). Discussion: Decreases in global eating disorder psychopathology were achieved faster with CBT+. Overall, improvements in DBT-BED were comparable to those observed in CBT+. Findings of the original trial, favoring CBT+ on the number of OBE episodes, emotional dysregulation and self-esteem at EOT, and on eating disorder psychopathology and self-esteem at follow-up, were not replicated. With similar rates of treatment dropout and about half of the therapy time used in CBT+, DBT-BED can be considered a relevant treatment for BED in everyday clinical practice. Public Significance: In this effectiveness study, dialectical behavior therapy (DBT) resulted in clinically relevant improvements in individuals with binge eating disorder.Changes were broadly comparable to those of cognitive behavior therapy (CBT), the current treatment of choice. Although CBT resulted in decreases in eating disorder

show abstract

“…Finally, computational modeling of person‐specific psychological processes may identify specific targets for psychological intervention in EDs (Foerde et al, 2021; Voon et al, 2015). Incorporating such information into randomized trials as additional mediator and moderator studies could improve our understanding of the mechanisms by which psychotherapies improve ED outcomes (Sivyer et al, 2020).…”

Section: Call To Action: Our Idea Worth Researchingmentioning

confidence: 99%

The costs and benefits of intensive day treatment programs and outpatient treatments for eating disorders: An idea worth researching

Ali

Bodnar

Gamberg

et al. 2021

Intl J Eating Disorders

View full text Add to dashboard Cite

Outpatient care (e.g., individual, group, or self‐help therapies) and day treatment programs (DTPs) are common and effective treatments for adults with eating disorders. Compared to outpatient care, DTPs have additional expenses and could have unintended iatrogenic effects (e.g., may create an overly protective environment that undermines self‐efficacy). However, these potential downsides may be offset if DTPs are shown to have advantages over outpatient care. To explore this question, our team conducted a scoping review that aimed to synthesize the existing body of adult eating disorder literature (a) comparing outcomes for DTPs to outpatient care, and (b) examining the use of DTPs as a higher level of care in a stepped care model. Only four studies met the predefined search criteria. The limited results suggest that the treatments have similar effects and that outpatient care is more cost‐effective. Furthermore, no studies explored the use of DTPs as a higher level of care in a stepped care model (despite international guidelines recommending this approach). Given the clear dearth of literature on this clinically relevant topic, we have provided specific avenues for further research.

show abstract

Mediators of change in cognitive behavior therapy and interpersonal psychotherapy for eating disorders: A secondary analysis of a transdiagnostic randomized controlled trial

Cited by 20 publications

References 34 publications

The growing field of digital psychiatry: current evidence and the future of apps, social media, chatbots, and virtual reality

The growing field of digital psychiatry: current evidence and the future of apps, social media, chatbots, and virtual reality

Dialectical behavior therapy compared to cognitive behavior therapy in binge‐eating disorder: An effectiveness study with 6‐month follow‐up

The costs and benefits of intensive day treatment programs and outpatient treatments for eating disorders: An idea worth researching

Contact Info

Product

Resources

About