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Bethesda, Maryland | September 19-21, 2013
non-hunger related cues. Future studies are required to determine whether
the combination of high impulsivity and LOC eating confers greater risk for
exacerbated disordered eating or weight outcomes over time, beyond the
presence of either risk factor alone.
T66
Focused Vs. Broad Enhanced Cognitive Behavioral Therapy for
Bulimia Nervosa and Borderline Personality Disorder: A Randomized
Controlled Trial with Moderator Analyses
Heather Thompson-Brenner
1
,
Elizabeth M. Pratt
1
,
Dana A. Satir
2
,
Doug
Thompson
3
,
Rebecca M. Shingleton
1
,
Lauren K. Richards
1
1
Boston University, Boston, MA, USA,
2
Eating Disorders Recovery Center,
Denver, CO, USA,
3
Thompson Research Consulting, Milwaukee, WI, USA
Enhanced cognitive behavior therapy includes a focused version (CBT-Ef)
that addresses aspects of eating pathology and a broad version (CBT-Eb)
that also addresses mood and interpersonal problems (Fairburn, 2008).
CBT-Ef and CBT-Eb have demonstrated similar effects, with complex
patients showing favorable response to CBT-Eb (Fairburn et al., 2009).
This study examined CBT-Ef and CBT-Eb for patients with bulimia nervosa
(
BN) and borderline personality disorder (BPD). N=50 female patients
with BN and extensive co-morbidity were randomly assigned to CBT-Ef
or CBT-Eb. Assessments were conducted at baseline, termination, and
6-
month follow-up. Results indicated that overall treatment response
was comparable to prior trials. Focused treatment was associated with
better ED outcome. However, severe BPD mood and interpersonal
problems were associated with better response to broad treatment. Post-
hoc analyses investigated whether impulsivity could explain the effect of
CBT-Ef in this sample. In contrast to other BPD symptoms, impulsivity
was associated with drop-out and negative response to CBT-Eb. While
replicating positive outcomes for CBT-E for BN, this study is the first to
show specific benefit for CBT-Ef. Distinct BPD symptoms suggest different
therapy content and process. Patients with severe mood and interpersonal
problems benefit from multi-modal treatment including interpersonal
psychotherapy, while impulsive patients may benefit from a more
structured treatment approach.
T67
An Evaluation of the Representativeness Assumption for Twin
Studies of Eating Pathology and Internalizing Symptoms
Kristin M. von Ranson
1
,
Melissa A. Munn-Chernoff
2,3
,
Kristen M. Culbert
4
,
Christine L. Larson
5
,
S. Alexandra Burt
6
,
Kelly L. Klump
6
1
Department of Psychology, University of Calgary, Calgary, AB, Canada,
2
Department of Psychiatry, Washington University School of Medicine,
St. Louis, MO, USA,
3
Midwest Alcohol Research Center, Washington
University School of Medicine, St. Louis, MO, USA,
4
Department of
Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago,
IL, USA,
5
Department of Psychology, University of Wisconsin, Milwaukee,
WI, USA,
6
Department of Psychology, Michigan State University, East
Lansing, MI, USA
Introduction
:
Little research has tested whether the twin
representativeness assumption (i.e., results from twin research generalize
to singletons) holds for eating pathology and internalizing symptoms. This
study compared disordered eating, depression, and anxiety among young
adult female twins versus singletons.
Methods
:
Participants included
292
twins and three independent samples of singletons (overall n = 997).
Assessments included the Minnesota Eating Behavior Survey, Eating
Disorder Examination Questionnaire, Beck Depression Inventory, and
State-Trait Anxiety Inventory. After adjusting for age, body mass index,
and ethnicity, we examined mean and variance differences between
twins’ and singletons’ scores.
Results
:
Hierarchical linear modeling
results showed that twins had fewer eating and internalizing symptoms
than singletons, with small to moderate effect sizes. Levene’s tests
showed greater variance in some scores among singletons than twins.
Conclusions
:
Twins reported less disordered eating, depression, and
anxiety psychopathology than singletons, and singletons’ scores tended
to be more variable than twins’ scores. The differences observed were
statistically significant but generally small. Consistent with previous
evidence from extended twin studies suggesting similar shared
environments of twins and their non-twin siblings, the small differences
found in this study indicate that findings from twin samples in these
domains likely generalize to singletons.
T68
Clinician and Practice Characteristics Influencing Delivery and
Outcomes of the Early Part of Outpatient Cognitive Behavioural
Therapy for Anorexia Nervosa
Glenn Waller
1
,
Amy Brown
2
,
Victoria Mountford
3.4
1
University of Sheffield, Sheffield, United Kingdom,
2
Royal Holloway
University of London, London, United Kingdom,
3
King’s College London,
London, United Kingdom,
4
South London and Maudsley NHS Foundation
Trust, London, United Kingdom
Background:
Cognitive-behavioural therapy (CBT) can be effective
for anorexia nervosa. This study examined evidence that clinician
characteristics and practice can influence the effective implementation
of that approach.
Method:
The participants were 100 qualified clinicians
who routinely offered outpatient CBT to adults with anorexia nervosa.
They completed a survey of their demographic characteristics, level of
anxiety, clinical practice in CBT for anorexia nervosa, and beliefs about
the relationship between weight gain and therapeutic alliance in the early
part of such treatment.
Results:
Greater reported levels of weight gain
were associated with the use of manuals, early focus on weight gain as
a target, structured eating, and a belief that weight gain precedes a good
working alliance. Clinician anxiety and early focus on the therapeutic
alliance rather than structured eating were associated with poorer
outcomes.
Conclusions:
These conclusions need to be tested within
clinical and research settings. However, they suggest that clinicians should
be encouraged to use manual-based approaches when treating anorexia
nervosa using CBT, as focusing on techniques might result in the best
possible outcome in this early part of treatment.
T69
A Set of Food Pictures to Investigate the Emotional Significance of
Food in Eating Disorders and Obesity
Cortney S. Warren
1
,
Laura Miccoli
2
,
Rafael Delgado
2
,
Eduardo García
2
,
Sonia Rodríguez-Ruiz
2
,
M. Carmen Fernández-Santaella
2
1
University of Nevada, Las Vegas, NV, USA,
2
University of Granada,
Granada, Spain
1.
Introduction
It is increasingly common to investigate both eating
disorders and obesity by experimentally testing reactions to images of
foods. However, most laboratories use their own pictures, making it hard to
compare and replicate different investigations. In an attempt to overcome
this shortcoming, we created an initial set of 96 food pictures and asked
a non-clinical sample of Spanish adolescent to affectively evaluate each
photo.
2.
Methods
Food pictures, together with 36 affective pictures
taken from the International Affective Picture System, were presented in
4
different randomized orders to a total of 559 Spanish adolescents (285
females, age 12-17). Participants were asked to affectively evaluate each
picture, rating each photo as pleasant-unpleasant (valence dimension)
and as arousing-boring (arousal).
3.
Results
Participants perceived
high calorie foods as more pleasant than low calorie foods. Additionally,
participants found all foods as moderately arousing. However, contrary to
hypotheses, obese individuals rated high calorie foods as less arousing
compared to normal weight participants, indicating that as participants’
BMI increased, their arousal ratings tended to be lower.
4.
Conclusions
These data from a non-clinical sample of Spanish adolescents, highlight
the importance of controlling the motivational significance of food images,
which might in turn help understanding the emotional processing of food
stimuli in eating disorders and obesity.
POSTER SESSION 1 ABSTRACTS
