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Introduction: A complex and bidirectional relationship between eating and psychological symptoms in individuals with obesity has been proposed. This study aims to identify the specific processes playing a role in this association, using a data-driven approach. Methods: Two hundred ninety-four adults with obesity, including 106 (36 %) with binge-eating disorder, were consecutively admitted to a specialized public center. They completed self-report questionnaires to assess emotion regulation, interpersonal problems, self-esteem, binge-eating symptoms, and expectancies regarding eating behaviors. To assess the interplay among eating and psychological variables, a network analysis was used. The bridge function analysis was also performed to identify the bridge nodes among three communities (eating symptoms, interpersonal and emotional problems). Results: The network was stable. Limited access to emotion regulation strategies, eating helps manage negative affect, and non-assertiveness were the nodes with the highest strength centrality. Lack of emotional clarity, non-assertiveness, socially inhibition, and binge-eating were the nodes with the highest bridge strength. Limitations: The main limitation of the study is the cross-sectional nature of the findings which prevents to infer causality regarding the association between symptoms in the network. Discussion: An interplay between eating symptoms and affective and interpersonal factors characterizes individuals with obesity. Across the variety of psychological problems associated with obesity, the present study suggests specific psychological variables and their connections that could be addressed to improve treatment outcome. © 2022 Elsevier B.V.

Objective: The quality of working alliance (WA) is associated with treatment outcomes across several types of psychiatric disorders and psychological interventions. This study examined the role of WA with peer mentors (people with lived experience of illness) and student mentors (graduated psychology students) in a 6-week, digital, guided self-help (GSH) intervention for anorexia nervosa. Method: Ninety-nine patients rated weekly, for 6 weeks: (a) eating psychopathology using the short version of the Eating Disorder Examination Questionnaire (EDE-QS) and (b) WA with a student mentor (n= 14) or a peer mentor (n= 10). WA was assessed by asking patients the extent to which they felt comfortable working with their mentor and the extent to which they agreed with them on the goals for support. WA with mentors and the association with eating psychopathology change were measured on a session-by-session basis. The analysis involved a random intercepts cross-lagged panel model. Results: WA with peer mentors was slightly higher than WA with students (ES=0.3). Peer mentors' WA in the previous session was significantly associated with eating psychopathology ratings in the next session. No significant relationship was found between the previous session's EDE-QS scores and peer mentor alliance in the following session. In the student mentor group, there were no session-by-session associations between WA and eating psychopathology. However, greater WA with the student mentor across sessions was associated with less eating psychopathology. Discussion: These findings suggest that clinical outcomes are in part associated with the characteristics of the mentor delivering guidance in an online GSH for eating disorders.

Objective: To better understand those patients with anorexia nervosa who do not show early response to treatment and are likely to have poorer outcome. Method: From an existing data set of 187 patients with anorexia nervosa across 22 eating disorder outpatient services in the United Kingdom, participants who had started treatment and had at least one body mass index (BMI) observation in the first 6 weeks of treatment were eligible for these secondary analyses (N = 65), a latent class analysis of BMI change over the first 6 weeks of treatment. Fifty-six patients showed no early change in BMI. We used logistic regression to examine predictors of good outcome in the 40 participants who had 12-month follow-up data. Predictors included global EDE-Q, negative affect (Depression, Anxiety, and Stress Scales) and functional impairment (Work and Social Adjustment Scale). Results: Good outcome was achieved by 23% of patients and remission by 15%. Good outcome was predicted by less functional impairment at baseline. Discussion: Further work that can identify sub-groups of patients with anorexia nervosa who do not achieve good outcome after treatment will inform the development of targeted engagement approaches. © 2021 Wiley Periodicals LLC.

Objective: The therapeutic alliance has been studied in group interventions, but its relationship to patient outcome is still controversial. This study systematically reviewed the association of both the member-leader and member-group alliance with patient outcomes, and assessed the effects of several theoretically informed moderators. Method: A three-level meta-analysis was conducted on 57 studies to disentangle within- and between-study variability in the alliance-outcome association. Results: The overall effect size of the unconditional model was r = -.259 (95% CI: -.302, -.214; p < .001), whereas the correlation between alliance and outcome based on the three-level meta-analytic model was r = -.215 (95% CI: -.252, -.178; p < .001) indicating a medium effect. Meta-regressions of moderators showed that the alliance-outcome correlation was higher when patients reported on their alliance with the group/other members compared with when they rated the alliance with the leader. Outcome type, rating perspective, theoretical orientation, treatment length, and year of publication were significant moderators of the relationship between alliance and outcome. Conclusions: The current meta-analysis highlighted that the therapeutic alliance, especially with other group members, is a significant predictor of outcomes in group therapies even after controlling for several moderators and adopting more conservative statistical modeling.What is the public health significance of this article? Prior research has established that member-leader alliance is a predictor of outcome in group psychotherapy with a small effect. This meta-analysis provides a comprehensive analysis of the complex role of the alliance in group therapy, suggesting that the alliance with other group members or the group as a whole has a significantly larger association with outcome. This study provides support for the importance of the group context on the alliance-outcome relationship.

Background: It still remains unclear whether problematic social media use (PSMU) is a cause or a consequence of psychological distress. The present study aimed to investigate the temporal relationships between PSMU and psychological distress through a three-wave panel study (between April and July 2020, with an interval of 1 month between each period of time). Methods: 3,912 adult Italian participants were surveyed during the COVID-19 pandemic for psychological distress (Depression, Anxiety and Stress Scale) and PSMU (Bergen Social Media Addiction Scale). Random-Intercept Cross-Lagged Panel Models were applied to disaggregate between-person from within-person associations as regards PSMU and an individual’s distress. Results: On a between-person level we found that adults with higher PSMU also reported heightened levels of psychological distress across the three waves. However, on a within-person level, no cross-lagged associations were found between changes in distress and subsequent changes in PSMU and vice versa. The results were largely unchanged with the inclusion of participants’ gender and age or COVID-19-related fears as covariates, and when the three subscales of depression, anxiety and stress were examined in separate models. Conclusions: The current study suggests that the link between PSMU and psychological distress is mainly driven by trait-like differences and not by state-like individual changes over time.

The coronavirus disease 2019 (COVID-19) spread several months ago from China and it is now a global pandemic. The experience of lockdown has been an undesirable condition for people with mental health problems, including eating disorders. The present study has the aim of understanding the impact of the first wave of the COVID-19 pandemic on people with selfreported disordered eating behaviours. A linguistic analysis was carried out with regard to the online posts and comments published by 1971 individuals (86% women) in a Facebook online community focusing on EDs during the lockdown. A total of 244 posts and 3603 comments were collected during the 56 days of lockdown (from the 10th of March until the 4th of May 2020) in Italy and were analysed by Linguistic Inquiry and Word Count (LIWC) software. The results showed that words related to peer support decreased in posts over time, and that anxiety and anger increased in the published comments. Moreover, greater feelings of negativity and anxiety were found in posts and comments throughout the COVID-19 pandemic, as well as lesser use of words related to positive emotions. Thematic qualitative analysis revealed eight themes that described the main subjective components of ED symptomatology and distress during the first COVID-19 lockdown. The current findings can help in delivering tailored treatments to people with eating disorders during the COVID-19 pandemic.

The COVID-19 outbreak is having a profound impact on individuals' psychological and physical wellbeing. The aim of this study was to assess the extent of this impact and its mechanisms on a sample of adults living in Italy during the first lockdown (April–May 2020). Two hundred ninety-two individuals (67.1% females) were recruited from the community through social media. They completed baseline online questionnaires to collect demographic information, data on past and present general health and health behaviours, and to assess emotion regulation strategies. Participants completed a brief survey to assess mood and health behaviours three times a week, for three weeks. Individuals with lifetime psychiatric disorders (about 50%) reported greater negative mood and use of unhealthy behaviours over time, compared to those with no psychiatric vulnerability. The use of cognitive reappraisal to regulate emotions was associated with greater resilience (i.e., feelings of hope and resourcefulness, and ability to seek social support and enjoyable activities). Cognitive reappraisal is a skill that can be trained and could be utilised to buffer the effect of general stress (i.e. stress caused by the pandemic) on individuals’ wellbeing. © 2021

Aim The aim of this study was to use the innovative technique of Network Intervention Analysis (NIA) to examine the trajectory of symptom change associated with the use of a digital guided self-help intervention (RecoveryMANTRA) to augment treatment as usual in adult anorexia nervosa. Methods Self-reported eating disorder symptoms and mood (stress, anxiety and depression), work and social adjustment, motivation and treatment (Treatment as usual + RecoveryMANTRAand Treatment as usual) were included as nodes in the network and examined using NIA. Networks were computed at baseline (n = 88, 99), at end of treatment (6 weeks, n = 71, 75) and at 6- (n = 58, 63) and 12-month (n = 52, 63) follow-up. Results RecoveryMANTRA was associated with a direct effect on anxiety, shape concern and restraint at the end of the intervention. This effect was not maintained at follow-up. There were no direct effects of RecoveryMANTRA on motivation, stress and depression. Conclusions These findings indicate that RecoveryMANTRA exerts a direct effect on eating disorder symptoms and anxiety. NIA is a promising method to evaluate trajectories of clinical change and direct and indirect effects of a therapeutic intervention compared to a control condition.

Background: We explored the utility of “staging” anorexia nervosa (AN) by duration of illness and psychological wellbeing. We also investigated 12-month symptom trajectories and service usage in a large cohort of patients with AN assessed for outpatient treatment. Method: We conducted secondary analyses on data from a multisite clinical trial of adults with AN (n = 187) recruited from 22 NHS England specialist eating disorder (ED) services into a digital treatment augmentation study. Clinical outcomes and service use were measured at postintervention (six weeks), 6 and 12 months. We grouped patients into two categories: “early stage” (illness duration

TRIANGLE is a multicentre trial investigating whether the addition of a novel intervention for patients and carers (ECHOMANTRA) to treatment as usual (TAU) improves outcomes for people with anorexia nervosa (AN). ECHOMANTRA is based on the cognitive interpersonal model of AN and includes assessments, workbooks, videos, online groups and joint Skype sessions for patients and carers. People receiving intensive hospital treatment (N= 380) will be randomised to TAU or TAU plus ECHOMANTRA. Participants will be assessed over an 18-month period following randomisation. The primary outcome is patient psychological well-being at 12 months postrandomisation. Secondary outcomes include (i) patient’s weight, eating disorder symptoms, motivation to change, quality of life and number of days in hospital at 12 months postrandomisation and (ii) carer’s psychological well-being, burden and skills at 12 months (some outcomes will be assessed at 18 months postrandomisation). The results from this trial will establish the effectiveness of ECHOMANTRA.

The eating disorder clinical and scientific community advocates for the use of a shared approach to healthcare that actively involves patients and carers. A systematic review of the literature on guided self-help or self-help in anorexia nervosa (targeting either the individual affected by the illness or their carers) and meta-analyses of studies using randomised controlled designs for the evaluation of the outcomes: (1) drop-out from end-of-treatment assessment, (2) body mass index (BMI), (3) anxiety, (4) depression and (5) quality of life, were undertaken. Guided self-help was directed to patients in 15 studies and to carers in seven studies. The interventions were based on a variety of theoretical models, used different formats (books and digital materials), and were delivered by individuals with a range of experiences and expertise (e.g. individuals with lived experience of the illness, graduate students, or clinically trained professionals). Guided self-help was associated with significantly lower drop-out from the completion of end-of-treatment assessments compared to a control condition. There was an improvement in carers’ wellbeing from skill-sharing interventions. Guided self-help may facilitate patients' treatment engagement and also improve carers' wellbeing.

BackgroundOutpatient interventions for adult anorexia nervosa typically have a modest impact on weight and eating disorder symptomatology. This study examined whether adding a brief online intervention focused on enhancing motivation to change and the development of a recovery identity (RecoveryMANTRA) would improve outcomes in adults with anorexia nervosa.MethodsParticipants with anorexia nervosa (n= 187) were recruited from 22 eating disorder outpatient services throughout the UK. They were randomised to receiving RecoveryMANTRA in addition to treatment as usual (TAU) (n= 99; experimental group) or TAU only (n= 88; control group). Outcomes were measured at end-of-intervention (6 weeks), 6 and 12 months.ResultsAdherence rates to RecoveryMANTRA were 83% for the online guidance sessions and 77% for the use of self-help materials (workbook and/or short video clips). Group differences in body mass index at 6 weeks (primary outcome) were not significant. Group differences in eating disorder symptoms, psychological wellbeing and work and social adjustment (at 6 weeks and at follow-up) were not significant, except for a trend-level greater reduction in anxiety at 6 weeks in the RecoveryMANTRA group (p= 0.06). However, the RecoveryMANTRA group had significantly higher levels of confidence in own ability to change (p= 0.02) and alliance with the therapist at the outpatient service (p= 0.005) compared to the control group at 6 weeks.ConclusionsAugmenting outpatient treatment for adult anorexia nervosa with a focus on recovery and motivation produced short-term reductions in anxiety and increased confidence to change and therapeutic alliance.

Objective Early response to eating disorders treatment is thought to predict a later favourable outcome. A systematic review of the literature and meta-analyses examined the robustness of this concept. Method The criteria used across studies to define early response were summarised following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Diagnostic Test Accuracy methodology was used to estimate the size of the effect. Results Findings from 24 studies were synthesized and data from 14 studies were included in the meta-analysis. In Anorexia Nervosa, the odds ratio of early response predicting remission was 4.85(95%CI: 2.94–8.01) and the summary Area Under the Curve (AUC) = .77. In Bulimia Nervosa, the odds ratio was 2.75(95%CI:1.24–6.09) and AUC = .67. For Binge Eating Disorder, the odds ratio was 5.01(95%CI: 3.38–7.42) and AUC = .71. Conclusion Early behaviour change accurately predicts later symptom remission for Anorexia Nervosa and Binge Eating Disorder but there is less predictive accuracy for Bulimia Nervosa. Copyright © 2016 John Wiley & Sons, Ltd and Eating Disorders Association.

Anorexia nervosa (AN) is a serious psychiatric disorder characterized by severe restriction of energy intake and dangerously low body weight. Other domains of functioning are affected, including social functioning. Although difficulties within this domain have started to be acknowledged by the literature, some important gaps remain to be filled. Do social difficulties predate the onset of the illness? What difficulties in particular are relevant for the development and maintenance of the illness? The aim of this study is to combine the use of quantitative and qualitative methods to answer these questions. Ninety participants with lifetime AN (88 women and 2 men) completed an online survey assessing memories of involuntary submissiveness within the family, fear of negative evaluation from others, perceived lack of social competence, feelings of social belonging, eating disorder symptoms, and work and social adjustment. Participants also answered three open questions regarding their experience of social relationships before and after the illness onset. The findings provided support for the hypothesized relationships between the study variables. Involuntary submissiveness and fear of negative evaluation predicted eating disorder symptoms and these associations were partially mediated by perceived lack of social competence. Two-thirds of the sample recalled early social difficulties before illness onset and recognized that these had played a role in the development of the illness. A larger proportion of participants stated that the eating disorder had affected their social relationships in a negative way. This study sheds some light on patients' perspective on the predisposing and maintaining role that social difficulties play in AN and identifies key psychological variables that could be targeted in treatment.

Objective: Early response to eating disorders treatment is thought to predict a later favourable outcome. A systematic review of the literature and meta-analyses examined the robustness of this concept. Method: The criteria used across studies to define early response were summarised following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Diagnostic Test Accuracy methodology was used to estimate the size of the effect. Results: Findings from 24 studies were synthesized and data from 14 studies were included in the meta-analysis. In Anorexia Nervosa, the odds ratio of early response predicting remission was 4.85(95%CI: 2.94–8.01) and the summary Area Under the Curve (AUC) =.77. In Bulimia Nervosa, the odds ratio was 2.75(95%CI:1.24–6.09) and AUC =.67. For Binge Eating Disorder, the odds ratio was 5.01(95%CI: 3.38–7.42) and AUC =.71. Conclusion: Early behaviour change accurately predicts later symptom remission for Anorexia Nervosa and Binge Eating Disorder but there is less predictive accuracy for Bulimia Nervosa. Copyright © 2016 John Wiley & Sons, Ltd and Eating Disorders Association.