Showing papers by "Tracey D. Wade published in 2015"

Predictors of treatment outcome in individuals with eating disorders: A systematic review and meta-analysis: PREDICTORS OF TREATMENT OUTCOME IN INDIVIDUALS WITH EATING DISORDERS

Abstract: OBJECTIVE Understanding the factors that predict a favourable outcome following specialist treatment for an eating disorder may assist in improving treatment efficacy, and in developing novel interventions. This review and meta-analysis examined predictors of treatment outcome and drop-out. METHOD A literature search was conducted to identify research investigating predictors of outcome in individuals treated for an eating disorder. We organized predictors first by statistical type (simple, meditational, and moderational), and then by category. Average weighted mean effect sizes (r) were calculated for each category of predictor. RESULTS The most robust predictor of outcome at both end of treatment (EoT) and follow-up was the meditational mechanism of greater symptom change early during treatment. Simple baseline predictors associated with better outcomes at both EoT and follow-up included higher BMI, fewer binge/purge behaviors, greater motivation to recover, lower depression, lower shape/weight concern, fewer comorbidities, better interpersonal functioning and fewer familial problems. Drop-out was predicted by more binge/purge behaviors and lower motivation to recover. For most predictors, there was large interstudy variability in effect sizes, and outcomes were operationalized in different ways. There were generally insufficient studies to allow analysis of predictors by eating disorder subtype or treatment type. DISCUSSION To ensure that this area continues to develop with robust and clinically relevant findings, future studies should adopt a consistent definition of outcome and continue to examine complex multivariate predictor models. Growth in this area will allow for stronger conclusions to be drawn about the prediction of outcome for specific diagnoses and treatment types.

Prevention Across the Spectrum: a randomized controlled trial of three programs to reduce risk factors for both eating disorders and obesity

Abstract: Background A randomized controlled trial of three school-based programs and a no-intervention control group was conducted to evaluate their efficacy in reducing eating disorder and obesity risk factors. Method A total of 1316 grade 7 and 8 girls and boys (mean age = 13.21 years) across three Australian states were randomly allocated to: Media Smart; Life Smart; the Helping, Encouraging, Listening and Protecting Peers (HELPP) initiative; or control (usual school class). Risk factors were measured at baseline, post-program (5 weeks later), and at the 6- and 12-month follow-ups. Results Media Smart girls had half the rate of onset of clinically significant concerns about shape and weight than control girls at the 12-month follow-up. Media Smart and HELPP girls reported significantly lower weight and shape concern than Life Smart girls at the 12-month follow-up. Media Smart and control girls scored significantly lower than HELPP girls on eating concerns and perceived pressure at the 6-month follow-up. Media Smart and HELPP boys experienced significant benefit on media internalization compared with control boys and these were sustained at the 12-month follow-up in Media Smart boys. A group × time effect found that Media Smart participants reported more physical activity than control and HELPP participants at the 6-month follow-up, while a main effect for group found Media Smart participants reported less screen time than controls. Conclusions Media Smart was the only program to show benefit on both disordered eating and obesity risk factors. Whilst further investigations are indicated, this study suggests that this program is a promising approach to reducing risk factors for both problems.

Mindfulness‐based prevention for eating disorders: A school‐based cluster randomized controlled study

Abstract: Objective Successful prevention of eating disorders represents an important goal due to damaging long-term impacts on health and well-being, modest treatment outcomes, and low treatment seeking among individuals at risk. Mindfulness-based approaches have received early support in the treatment of eating disorders, but have not been evaluated as a prevention strategy. This study aimed to assess the feasibility, acceptability, and efficacy of a novel mindfulness-based intervention for reducing the risk of eating disorders among adolescent females, under both optimal (trained facilitator) and task-shifted (non-expert facilitator) conditions. Method A school-based cluster randomized controlled trial was conducted in which 19 classes of adolescent girls (N = 347) were allocated to a three-session mindfulness-based intervention, dissonance-based intervention, or classes as usual control. A subset of classes (N = 156) receiving expert facilitation were analyzed separately as a proxy for delivery under optimal conditions. Results Task-shifted facilitation showed no significant intervention effects across outcomes. Under optimal facilitation, students receiving mindfulness demonstrated significant reductions in weight and shape concern, dietary restraint, thin-ideal internalization, eating disorder symptoms, and psychosocial impairment relative to control by 6-month follow-up. Students receiving dissonance showed significant reductions in socio-cultural pressures. There were no statistically significant differences between the two interventions. Moderate intervention acceptability was reported by both students and teaching staff. Discussion Findings show promise for the application of mindfulness in the prevention of eating disorders; however, further work is required to increase both impact and acceptability, and to enable successful outcomes when delivered by less expert providers. © 2015 Wiley Periodicals, Inc. (Int J Eat Disord 2015; 48:1024–1037).

DSM-5 unspecified feeding and eating disorders in adolescents: what do they look like and are they clinically significant?

Abstract: This is the peer reviewed version of the following article: Wade, T. D. and O'Shea, A. (2015), DSM-5 unspecified feeding and eating disorders in adolescents: What do they look like and are they clinically significant?. International Journal of Eating Disorders, 48: 367–374. , which has been published in final form at DOI:10.1002/eat.22303. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving. This item is under embargo for a period of 12 months from the date of publication, in accordance with the publisher's policy.

Does shared genetic risk contribute to the co-occurrence of eating disorders and suicidality?

Abstract: Objective: There is a high level of cooccurrence of suicidality with eating disorders (EDs) but the reason for this is unknown. To test the hypothesis that suicidality and EDs share genetic risk contributing to the expression of both phenotypes. Method: Female twins (N 5 1,002) from the Australian Twin Registry, aged 28–40 years, were interviewed with diagnostic interviews. Lifetime diagnostic information relating to eating disorders [anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder, and purging disorder (PD)], suicidality (ranging transitory thoughts to suicide attempts), and major depression. Results: Any suicidal thoughts were reported by 24% of the sample, but prevalence of lifetime suicidality among female twins with EDs was much higher (43%), presence of an ED diagnosis more than doubling likelihood of suicidality (OR 5 2.32, 95% CI: 1.63–3.31). AN and BN conveyed greatest risk of suicidality (OR 5 2.03, 95% CI: 1.06–3.87; OR 5 3.97, 95% CI: 2.01–7.85, respectively). Twin phenotype correlations showed monozygotic twins had uniformly higher estimates than dizygotic counterparts. A trivariate Cholesky model indicated a common genetic influence on suicidality and ED phenotypes (but not depression), and no nonshared environmental source. Discussion: Both cross twin phenotypic correlations and genetic modeling infer a common genetic pathway for suicidality and EDs, but further investigation is needed to elucidate whether this may constitute emotional dysregulation or other temperament-linked factors. Study findings also indicate that ED clients must be routinely assessed for presence of suicidality, independent of depression

Changes in genetic and environmental influences on disordered eating between early and late adolescence: a longitudinal twin study.

Abstract: Author version under embargo for a period of 6 months from the date of publication, made available in accordance with the publisher's policy.

Trail making task performance in inpatients with anorexia nervosa and bulimia nervosa.

Abstract: Set-shifting inefficiencies have been consistently identified in adults with anorexia nervosa (AN). It is less clear to what degree similar inefficiencies are present in those with bulimia nervosa (BN). It is also unknown whether perfectionism is related to set-shifting performance. We employed a commonly used set-shifting measure, the Trail Making Test (TMT), to compare the performance of inpatients with AN and BN with a healthy control sample. We also investigated whether perfectionism predicted TMT scores. Only the BN sample showed significantly suboptimal performance, while the AN sample was indistinguishable from controls on all measures. There were no differences between the AN subtypes (restrictive or binge/purge), but group sizes were small. Higher personal standards perfectionism was associated with better TMT scores across groups. Higher concern over mistakes perfectionism predicted better accuracy in the BN sample. Further research into the set-shifting profile of individuals with BN or binge/purge behaviours is needed. Copyright © 2015 John Wiley & Sons, Ltd and Eating Disorders Association.

Finding My Way: protocol of a randomised controlled trial evaluating an internet self-help program for cancer-related distress

Abstract: Background: A cancer diagnosis elicits greater distress than any other medical diagnosis, and yet very few studies have evaluated the efficacy of structured online self-help therapeutic programs to alleviate this distress. This study aims to assess the efficacy over time of an internet Cognitive Behaviour Therapy (iCBT) intervention (‘Finding My Way’) in improving distress, coping and quality of life for individuals with a recent diagnosis of early stage cancer of any type. Methods/Design: The study is a multi-site Randomised Controlled Trial (RCT) seeking to enrol 188 participants who will be randomised to either the Finding My Way Intervention or an attention-control condition. Both conditions are delivered online; with 6 modules released once per week, and an additional booster module released one month after program-completion. Participants complete online questionnaires on 4 occasions: at baseline (immediately prior to accessing the modules); post-treatment (immediately after program-completion); then three and six months later. Primary outcomes are general distress and cancer-specific distress, with secondary outcomes including Health-Related Quality of Life (HRQoL), coping, health service utilisation, intervention adherence, and user satisfaction. A range of baseline measures will be assessed as potential moderators of outcomes. Eligible participants are individuals recently diagnosed with any type of cancer, being treated with curative intent, aged over 18 years with sufficient English language literacy, internet access and an active email account and phone number. Participants are blinded to treatment group allocation. Randomisation is computer generated and stratified by gender. Discussion: Compared to the few prior published studies, Finding My Way will be the first adequately powered trial to offer an iCBT intervention to curatively treated patients of heterogeneous cancer types in the immediate post-diagnosis/ treatment period. If found efficacious, Finding My Way will assist with overcoming common barriers to face-to-face therapy in a cost-effective and accessible way, thus helping to reduce distress after cancer diagnosis and consequently decrease the cancer burden for individuals and the health system.

A longitudinal study of midage women with indicators of disordered eating.

Abstract: This longitudinal study of midage women has two main aims: to examine the effect of disordered eating (DE) on quality of life (QoL) among women, including a comparison with a younger cohort and to investigate the mediating roles of both depressive symptoms and social support on the longitudinal relationship between DE and QoL as potential mechanisms of action. We used self-report data from six waves of the Australian Longitudinal Study on Women’s Health over 14 years. A total of 12,338 women participating in the midage cohort (aging from 45–50 to 59–64) provided self-report indications of DE at Surveys 1 and 2, and QoL (SF-36 component scales—mental [MCS] and physical [PCS]) at Surveys 2–6. DE was reported by 10.98% of the women; this group also reported significantly poorer mental and physical QoL than those without DE, and this effect was sustained over time. Comparison with a parallel analysis of a younger cohort of women showed that the effect on midage women’s physical QoL is greater than that of the younger women. The relationships between baseline DE and changes in QoL (both physical and mental) over time were mediated by levels of depressive symptoms and of social support over time. This study underscores the significant effect of DE on QoL in midage, an effect which is partially or fully mediated by depressive symptoms or social support. Well-being of midage women with indicators of DE needs to be supported by tailoring prevention and interventions activities specifically for this group. (PsycINFO Database Record (c) 2015 APA, all rights reserved)

Therapist adherence in the strong without anorexia nervosa (SWAN) study: A randomized controlled trial of three treatments for adults with anorexia nervosa

Abstract: Objective To develop a psychotherapy rating scale to measure therapist adherence in the Strong Without Anorexia Nervosa (SWAN) study, a multi-center randomized controlled trial comparing three different psychological treatments for adults with anorexia nervosa. The three treatments under investigation were Enhanced Cognitive Behavioural Therapy (CBT-E), the Maudsley Anorexia Nervosa Treatment for Adults (MANTRA), and Specialist Supportive Clinical Management (SSCM). Method The SWAN Psychotherapy Rating Scale (SWAN-PRS) was developed, after consultation with the developers of the treatments, and refined. Using the SWAN-PRS, two independent raters initially rated 48 audiotapes of treatment sessions to yield inter-rater reliability data. One rater proceeded to rate a total of 98 audiotapes from 64 trial participants. Results The SWAN-PRS demonstrated sound psychometric properties, and was considered a reliable measure of therapist adherence. The three treatments were highly distinguishable by independent raters, with therapists demonstrating significantly more behaviors consistent with the actual allocated treatment compared to the other two treatment modalities. There were no significant site differences in therapist adherence observed. Discussion The findings provide support for the internal validity of the SWAN study. The SWAN-PRS was deemed suitable for use in other trials involving CBT-E, MANTRA, or SSCM. © 2015 The Authors. International Journal of Eating Disorders Published by Wiley Periodicals, Inc. (Int J Eat Disord 2015; 48:1170–1175)

The Relationship Between Memory and Interpretation Biases, Difficulties with Emotion Regulation, and Disordered Eating in Young Women

Abstract: Disordered eating and difficulties with emotion regulation have shown strong associations but there has been little attention paid to possible mediators that would explain this relationship. In depression and anxiety, negative memory and interpretation biases are implicated in the onset and maintenance of these disorders, however, little is known about whether these biases also exist in eating disorders, and if they are related to difficulties with emotion regulation. Females (n = 181) aged 17–26 years, completed self-report measures of disordered eating and behaviours, difficulties in emotion regulation, depression, anxiety, and memory and interpretation bias. While negative memory bias was related to objective binge episodes, it was not related to difficulties in emotion regulation. Negative interpretation biases were associated with higher levels of eating psychopathology and objective binge eating when controlling for depression and anxiety. Cross-sectional testing showed this bias to mediate the relationship between both measures of disordered eating and difficulties with emotion regulation. Findings support further research into the effectiveness of cognitive bias modification techniques with respect to disordered eating and the reduction of emotion regulation difficulties.

Therapist adherence in the strong without anorexia nervosa (SWAN) study: A randomized controlled trial of three treatments for adults with anorexia nervosa: Therapist Adherence

Abstract: Objective To develop a psychotherapy rating scale to measure therapist adherence in the Strong Without Anorexia Nervosa (SWAN) study, a multi-center randomized controlled trial comparing three different psychological treatments for adults with anorexia nervosa. The three treatments under investigation were Enhanced Cognitive Behavioural Therapy (CBT-E), the Maudsley Anorexia Nervosa Treatment for Adults (MANTRA), and Specialist Supportive Clinical Management (SSCM). Method The SWAN Psychotherapy Rating Scale (SWAN-PRS) was developed, after consultation with the developers of the treatments, and refined. Using the SWAN-PRS, two independent raters initially rated 48 audiotapes of treatment sessions to yield inter-rater reliability data. One rater proceeded to rate a total of 98 audiotapes from 64 trial participants. Results The SWAN-PRS demonstrated sound psychometric properties, and was considered a reliable measure of therapist adherence. The three treatments were highly distinguishable by independent raters, with therapists demonstrating significantly more behaviors consistent with the actual allocated treatment compared to the other two treatment modalities. There were no significant site differences in therapist adherence observed. Discussion The findings provide support for the internal validity of the SWAN study. The SWAN-PRS was deemed suitable for use in other trials involving CBT-E, MANTRA, or SSCM. © 2015 The Authors. International Journal of Eating Disorders Published by Wiley Periodicals, Inc. (Int J Eat Disord 2015; 48:1170–1175)

The relationship between disordered eating and cigarette smoking among adult female twins

Abstract: Objective While previous studies have shown a link between cigarette smoking and disordered eating (DE), it is less clear whether this association can be explained by attempts to control weight and/or temperament. This study had two aims: to examine weight/shape and DE symptomatology associated with weight control-related smoking and disordered eating; second, to investigate whether temperament-based factors explain the association between compensatory smoking and weight and shape-related characteristics, and disordered eating symptoms. Method Female twins (N = 1,002) from the Australian Twin Registry, aged 28–39 years, were assessed by interview yielding lifetime diagnostic information of disordered eating and use of cigarette smoking for weight control. Self-report measures of temperament were available. Results Women who had never smoked (50.6%, n = 495) or had smoked for reasons other than weight and shape control (42.5%, n = 415) were generally not differentiated with respect to indicators of disordered eating. Women who smoked for reasons primarily associated with weight and shape control (6.9%, n = 67) had significantly higher levels of disordered eating than non-smokers identified as being higher levels of purging (OR = 4.55, 95% CI = 2.41–8.59) and fasting (OR = 9.32, 94% CI = 4.43–19.90) but not objective binge episodes (OR = 1.69, 95% CI = 0.71–3.99). Of those women diagnosed with lifetime eating disorders, weight-control smokers had higher levels of purging (OR = 4.22, 95% CI = 1.13–15.80) than those who did not. There were no differences in temperament. Discussion Results support co-occurrence of smoking for weight control and purging in both community and clinical groups, and indicate this association is related to weight control and not temperament. © 2014 Wiley Periodicals, Inc. (Int J Eat Disord 2015; 48:708–714)

A Pilot Study of Associations Between Treatment for Anorexia Nervosa and Carers' Distress

Abstract: In order to investigate the degree to which symptom reduction in the treatment of adults with anorexia nervosa (AN) impacted on their carers’ psychological distress, we examined 12 participants in an outpatient treatment trial and their nominated ‘significant other’ Measures of eating psychopathology in the person being treated for AN were collected on six occasions: baseline, session 4, session 10, session 25 (end of treatment), and at three-month and 12-month follow-up At these same time points, measures of psychological distress were collected from carers Early significant reductions in eating psychopathology were found in the AN group at session 4, whereas significant reductions in carers’ distress were found at three-month follow-up and maintained at 12-month follow-up These reductions were moderated by baseline body mass index of the person with AN Carers whose significant other had a lower BMI at baseline received most benefit in terms of symptom reduction at 12-month follow-up Clinical implications include the need to provide more direct support to carers in order to achieve more clinically significant reductions in distress, and the need to discuss a carer’s expectations of the recovery process Copyright © 2014 John Wiley & Sons, Ltd Key Practitioner Message:  Only 61% of adults being treated for anorexia nervosa (AN) were willing to allow their carer to be contacted byresearchers in order to ask themto complete questionnaires over the duration of treatment and follow-up  Significant reductions in eating psychopathology from those being treated for AN was followed by significant reductions in their carers’ distress some 12 months later  Reductions of carers’ distress was associated with only a small effect size and may indicate that more clinically significant reductions requires individualised support for the carers  Carers whose significant other had a lower body mass index at baseline received most benefit in terms of symptom reduction at 12-month follow-up, which may indicate a need to clarify a carer’s expectations of the recovery process

Disordered Eating and Choice in Postfeminist Spaces

Abstract: IntroductionThis paper explores the rise of eating disorders in a postfeminist world. The prevalence of eating disorders in the general Australian population is increasing (The Butterfly Foundation, 2012; NEDC, 2012) and it is estimated that 90% of people with anorexia and bulimia in Australia are female (The Butterfly Foundation, 2012, p. 20). While the National Eating Disorder Collaboration (NEDC) reports that lifetime prevalence of eating disorders for males and females of all ages is 9%, there are higher estimates of 1 in 5 for students and women said to be suffering from eating disorders (NEDC, 2012, p. 6). In data taken from a large national sample of young women from the Australian Longitudinal Study of Women's Health (ALSWH) it was found that '23% of respondents in this sample were categorized as having disordered eating', while 'body image was ranked of highest personal concern by 40.3% of 20-24 year-olds', suggesting that 'disordered eating is potentially a major public mental health issue which continues to be underestimated in many countries' (Wade & Wilsch, 2012, p. 356). Due to the severe and chronic nature of disordered eating, the long term course of the full spectrum of eating and body problems that exists in the community, and the difficulties with treatment, it is vital that we understand why the prevalence is increasing and the cultural parameters that support disordered eating (Wade et al., 2006; Hay, et al., 2008).Drawing upon interviews and ethnographic fieldwork with women with disordered eating in Adelaide, South Australia, we examine how postfeminist positions of 'choice' and 'individual responsibility' were embodied. We argue that postfeminism, neoliberalism and healthism represent a constellation of contemporary forces which have created an environment for disordered eating to flourish. Within this setting of lifestyle choice, postfeminist sensibilities support and disguise women's endeavours in their disordered eating practices.The paper begins by tracing the work of 1980s and 90s feminist scholars (Orbach, 1986; Bartky, 1988; Bordo, 1988; 1992) who introduced cultural and gendered analysis into eating disorder studies. They critiqued pathological causes of disordered eating, pointing to the oppressive relationship between patriarchy and the gendered nature of eating and body issues. While these analyses were (and remain) foundational in bringing Foucauldian and post-structuralist analysis to explain key relationships between particular constructions of feminine beauty and bodily discipline, new developments in feminism have led to new theoretical debates concerning femininity and gender relations. As the previous scholars highlighted, constructions of femininity do not occur in vacuums, and shifts within feminist research and theory reflect dominant historical and socio-political changes. Hence the postfeminist era of personal choice, individualism and the commodification of 'girl power' (Bail, 1996; McRobbie, 2009) is deeply entangled with the rise of neoliberalism.Using Rosalind Gill's (2007) concept of postfeminist sensibility as an analytic lens we investigate how the ideology of choice positions women as a source of subjective empowerment and agency. We argue that this renewed interest in personal choice in popular feminism (or what Hirshman (2006) originally referred to as 'choice feminism') has been problematically embraced by women with disordered eating, in that choice and responsibility for one's limited food consumption has become a legitimate 'lifestyle choice'. Considering that denial of eating disorders is common (Wade, 2007; Vandereycken & Van Humbeeck, 2008), it is important to understand the politics of choice and the role it may play in why young women might resist and reshape psychiatric explanations to maintain their practices.Following a description of the study and research methods, the paper describes how participants frequently used the language of choice and empowerment to present their everyday eating and activity practices as part of their health and fitness routines. …

Shape and weight concern as a moderator of program outcomes from the Prevention Across the Spectrum RCT

Abstract: Results Moderation was indicated by significant interaction effects for group (Media Smart; Life Smart; HELPP; Control) X moderator (high shape and weight concern; low shape and weight concern) X time (post-program; 6-month followup; 12-month follow-up), with baseline entered as a covariate. Such effects were found for shape concern, weight concern, eating concern, regular eating, body dissatisfaction, and physical activity. Post-hoc testing found Media Smart participants with high baseline shape and weight concern experienced a reduction in risk at 12-month follow-up for 4 of the 6 variables. Discussion This study shows it is possible for a school-based program to reduce eating disorder risk factors in participants with high baseline risk of an eating disorder.

Orthorexia and deprivation as ‘care’: how people with disordered eating understand care

Abstract: This paper examines how contemporary understandings of health and care are engaged with by women with disordered eating. Based on findings from an Australian Research Council grant study, we explore the ways in which people align themselves with ‘healthy eating’ principles to legitimize their practices. Rather than always seeing their practices as a problem in need of intervention, many participants actively pursued and ‘tinkered with’ (Mol et al., 2010) their disordered eating as a form of self-care. We investigate how participants use the new food regime of orthorexia, as well as food choices and intolerances, as a normalised cover for restrictive diets. We argue that orthorexic practices entailing natural, medical and ethical concerns were successfully incorporated into participants' eating disorder repertoires. Participant's commentary on orthorexia reveals the vulnerability of people with disordered eating to the panoply of health and fitness advice circulating in contemporary society in which the pursuit of health and healthy lifestyles are at the centre of moral virtue, personhood and citizenship (Crawford, 1980). We demonstrate how these eating and body practices relate to an ethics of care that promotes moral virtues of hard work, purity and deprivation – all of which can ultimately lead to dangerous restrictive practices. Understanding how categories of health and care are understood and transformed by people with disordered eating has important implications for identifying people at all stages of help seeking.

The Anorexia Nervosa: Genetics Initiative (ANGI): Australia and New Zealand join forces.

Abstract: Anorexia nervosa (AN) is familial and heritable and the next logical step is to identify genes that influence risk. In the genome-wide association study (GWAS) era, for the study of complex traits such as eating disorders, large sample sizes are essential and necessitate global cooperation. The Anorexia Nervosa Genetics Initiative (ANGI) is a collaboration of researchers and clinicians from the United States, Sweden, Demark, and Australia and New Zealand who are collecting clinical information and DNA from 13,000 individuals with AN and controls. ANGI will unite with other global efforts to a goal of 25,000 participants with AN.