MIRROR IMAGE EVALUATION

Mirror Image Evaluation

Abstract

The present study sought to investigate effects of body exposure in the treatment of binge-eating disorder (BED). Cognitive-behavioral therapy with a body exposure component (CBT-E) was compared with CBT with a cognitive restructuring component focused on body image (CBT-C). Twenty-eight patients diagnosed with BED were randomly assigned to CBT-E or CBT-C, both delivered in a group format. Negative automatic thoughts about one's body, dysfunctional assumptions about shape and weight, and body dissatisfaction were assessed using experimental thought-sampling techniques, a clinical interview (Eating Disorder Examination), and self-report questionnaires. At post treatment and at 4-month follow-up, CBT-E and CBT-C were equally effective in improving body image disturbance on all indicators assessed. Both CBT-E and CBT-C produced substantial and stable improvements in the specific and general eating disorder psychopathology. Results suggest that both treatment components are equally effective in the treatment of BED.

Table of contents

Abstract2

1.Introduction4

2. Method9

2.1. Participants9

2.2. Treatment10

2.2.1. Initial stage11

2.2.2. Treatment stage12

2.3. Assessments and procedures14

2.3.1. Eating disorder psychopathology15

2.3.2. Experimental cognitive assessment15

2.3.2.1. Experimental body exposure16

2.3.2.2. Test meal17

2.3.2.3. Data reduction18

2.3.3. Self-reported body image disturbance19

2.3.4. Depression19

2.3.5. Body mass index19

2.4. Statistical analyses20

3. Results21

3.1. Randomization and attrition21

3.2. Experimental check23

3.3. Treatment outcome24

3.3.1. Primary outcomes: body image disturbance24

3.3.2. Secondary outcomes and BMI25

3.3.3. Clinical significance25

Discussion and conclusion26

References35

Mirror Image Evaluation

Introduction

In contrast to the diagnostic criteria of the eating disorders bulimia nervosa (BN) and anorexia nervosa (AN), DSM-IV research criteria for binge-eating disorder (BED) do not include body image disturbance (i.e. undue influence of body shape and weight on self-evaluation; American Psychiatric Association, 1994). However, there is increasing empirical evidence supporting the notion that negative body image may also be important in BED. For example, compared to non-eating-disordered individuals with a similarly high body mass index (BMI), patients with BED are more concerned with body shape and weight, and over-evaluate their importance; furthermore, patients with BED reveal more body dissatisfaction and feelings of fatness, a stronger fear of gaining weight, and more discomfort with and avoidance of seeing one's body ( Spitzer, Yanovski, Wadden, Wing, Marcus, Stunkard, Devlin, Mitchell, Hasin and Horne, 1993; Wilson, Nonas and Rosenblum, 1993; Eldredge and Agras, 1996; Hay and Fairburn, 1998; Striegel-Moore, Wilson, Wilfley, Elder and Brownell, 1998; Telch and Stice, 1998 and Wilfley, Schwartz, Spurrell and Fairburn, 2000). Body image disturbance appears to result from eating disorder psychopathology rather than from obese body weight, since patients with BED present similarly on shape and weight concerns, irrespective of their degree of overweight ( Eldredge & Agras, 1996). Further, there is evidence that over-evaluation of shape and weight predicts less spontaneous recovery in BED over a 6-month follow-up period ( Cachelin et al., 1999). Using structural equation modeling, shape and weight concerns were identified as maintaining factors directly leading to binge eating in individuals with BED ( Pratt, Telch, Labouvie, Wilson, & Agras, 2001). Against the background of this research, treatment of body image disturbance in BED appears to be vital.

Within cognitive-behavioral therapy (CBT), considered the most well-established treatment for BED (Wilson & Fairburn, 2002), interventions targeted at body image disturbance frequently include information about shape ...