Early response in people with anorexia nervosa receiving cognitive-behavioural therapy for eating disorders (CBT-ED): a latent change study.

Objective: Early improvement predicts good outcome in psychotherapy for eating disorders. Prior studies have examined change in body mass index (BMI) or Eating Disorder Examination Questionnaire scores (EDE-Q) as indicators of early response, but not both simultaneously. Little research has examined early change among Anorexia Nervosa (AN) samples treated with eating disorder-focussed cognitive behavioural therapy (CBT-ED).

Eating-Specific Interpersonal Difficulties: Changes and Impacts on Outcomes During Ten-Session Cognitive Behavioral Therapy for Eating Disorders (CBT-T).

Objective: The relationship between self-reported interpersonal difficulties and eating disorder symptoms is well-established. The Interpersonal Relationships in Eating Disorders (IR-ED) is a new measure of eating-specific interpersonal difficulties (food-related isolation, avoidance of body evaluation, foot-related interpersonal tension). This study aims to (1) explore changes in IR-ED scores, eating disorder symptoms, and psychosocial impairment during ten-session cognitive behavioral therapy for eating disorders (CBT-T), (2) assess whether pre-treatment IR-ED scores moderate the trajectory of change in eating disorder symptoms and psychosocial impairment during CBT-T and (3) investigate the relationship between changes in the IR-ED and changes in eating disorder symptoms and psychosocial impairment.

Validation of the Interpersonal Relationships in Eating Disorders (IR-ED) Scale in an Eating Disorder Sample.

Objective: Interpersonal problems have been identified as a plausible mechanism underlying the onset and maintenance of eating disorders. The Interpersonal Relationships in Eating Disorders (IR-ED) scale is the first eating disorders-specific measure of interpersonal problems, which was developed in a nonclinical sample. The aims of the current study were to (a) confirm the factor structure of the IR-ED within a large clinical sample, (b) investigate measurement invariance of the IR-ED across nonclinical and clinical samples, (c) examine the convergent validity of the IR-ED using a generic measure of interpersonal problems, and (d) investigate the incremental clinical utility of the IR-ED in uniquely predicting eating disorder symptomatology.

The Contribution of Shame to Eating Disorder Treatment Outcomes in a Community Mental Health Clinic.

Objective: Shame is a powerful self-conscious emotion that is often experienced by individuals with eating disorders (EDs). While the association between EDs and shame is well-established, there is limited research investigating the contribution of pre-treatment shame to clinical outcomes.

Method: Participants (N = 273) received outpatient cognitive-behavioral therapy for eating disorders (CBT-ED).

Opportunities lost? Rates and predictors of attrition in an eating disorders outpatient service.

Objective: To examine rates and predictors of attrition from referral through to treatment completion in an outpatient public psychology service's eating disorder program in Perth, Western Australia.

Method: The proportion (number) of clients (N = 671; mean age = 23.8 years) transitioning between stages of pre-treatment and treatment was identified.

Examining co-occurring social anxiety in cognitive behavioral therapy for eating disorders: Does it change and does it moderate eating disorder outcomes?

Objective: Eating disorders (EDs) often co-occur with social anxiety disorder (SAD). However, little research has examined the influence of SAD symptoms on ED treatment outcomes in the context of individual outpatient cognitive-behavior therapy for eating disorders (CBT-ED). It is plausible that SAD symptom severity could improve as a result of ED treatment, given the high overlap between EDs and SAD.

What explains the failure to identify replicable moderators of symptom change in social anxiety disorder?

Trials of cognitive behaviour therapy (CBT) for social anxiety disorder (SAD) have struggled to identify replicable moderators of treatment outcome. This could be due to a genuine lack of effects, or a spurious finding caused by methodological factors such as inadequate testing of theory-driven moderators, use of small homogenous samples, failure to model non-linear relationships, and over-reliance on significance testing. We probed explanations for the field's failure to detect moderators by testing whether 15 theory-driven and atheoretical variables moderated treatment outcome in a large heterogeneous sample treated with group CBT for SAD.

Concurrent and prospective associations between negative social-evaluative beliefs, safety behaviours, and symptoms during and following cognitive behavioural group therapy for social anxiety disorder.

Background: Improving the delivery of cognitive-behavioural therapy (CBT) for social anxiety disorder (SAD) requires an in-depth understanding of which cognitive and behavioural mechanisms drive change in social anxiety symptoms (i.e., social interaction anxiety) during and after treatment.

Measurement Invariance of Disorder-Specific and Transdiagnostic Measures of Repetitive Negative Thinking.

Background: Repetitive negative thinking is conceptualized to be a transdiagnostic process linked to the development and maintenance of psychopathology. Prior research distinguishes between disorder-specific exemplars (worry, rumination) and transdiagnostic measures of repetitive negative thinking with differences across disorders reported. However, establishing the measurement invariance of these measures is necessary to support meaningful comparisons across clinical groups.

Positive outcomes from integrating telehealth into routine clinical practice for eating disorders during COVID-19.

Background: The coronavirus pandemic (COVID-19) has required telehealth to be integrated into the delivery of evidence-based treatments for eating disorders in many services, but the impact of this on patient outcomes is unknown.

Objective: The present study examined the impact of the first wave of COVID-19 and rapid transition to telehealth on eating disorder symptoms in a routine clinical setting.

Method: Participants were 25 patients with a confirmed eating disorder diagnosis who had commenced face-to-face treatment and rapidly switched to telehealth during the first wave of COVID-19 in Western Australia.

A longitudinal assessment of the bivalent fear of evaluation model with social interaction anxiety in social anxiety disorder.

Background: The Bivalent Fear of Evaluation Model proposes that the fears of positive and negative evaluation each uniquely contribute to social anxiety severity. However, the debate continues as to whether these are distinct constructs, and, if so, the degree of influence each has on social anxiety severity. This study used a longitudinal evaluation of these relationships in a clinical sample to identify whether the two fears differentially change over time and differentially relate to social anxiety severity.

Imagery-enhanced verbally-based group cognitive behavior therapy for social anxiety disorder: a randomized clinical trial.

Background: Cognitive behavior therapy (CBT) is effective for most patients with a social anxiety disorder (SAD) but a substantial proportion fails to remit. Experimental and clinical research suggests that enhancing CBT using imagery-based techniques could improve outcomes. It was hypothesized that imagery-enhanced CBT (IE-CBT) would be superior to verbally-based CBT (VB-CBT) on pre-registered outcomes.

Self-efficacy in bipolar disorder: Development and validation of a self-report scale.

Background: Successful management of bipolar disorder (BPD) typically involves individuals undertaking a complex array of self-management tasks (e.g., taking medication, monitoring symptoms, following a regular sleep routine).

A single session assessment and psychoeducational intervention for eating disorders: Impact on treatment waitlists and eating disorder symptoms.

Objective: Long waitlists are common in eating disorder services and can have a detrimental impact on patients. We examined the effect on waitlist length, attendance, and eating disorder symptoms, of a 75-90 min single session intervention (SSI), attended a median of 16 days after referral to a specialist eating disorders clinic.

Method: Sequential referrals (N = 448) to a public outpatient eating disorders program were tracked from referral until a decision was made on patients entering treatment.

Attenuated Psychophysiological Reactivity following Single-Session Group Imagery Rescripting versus Verbal Restructuring in Social Anxiety Disorder: Results from a Randomized Controlled Trial.

Background: The effectiveness of psychotherapies for social anxiety disorder (SAD) is typically evaluated using self- and clinician-reported symptom change, while biomarkers of treatment response are rarely measured. The current study aimed to compare biomarkers of response following two brief group interventions for SAD.

Methods: This randomized controlled trial evaluated the effectiveness of single-session group interventions for SAD (n = 58) - imagery rescripting (IR) and verbal restructuring (VR) versus waitlist control (WC).

Validation of the clinical perfectionism questionnaire in an eating disorder sample: A bifactor approach.

Objective: Clinical perfectionism is involved in the etiology and maintenance of eating disorders. Limited research has examined the factor structure of the Clinical Perfectionism Questionnaire (CPQ) in clinical eating disorder samples. The aim of this research was to examine the validity and reliability of the CPQ in a mixed eating disorder sample.

Bigger is better: Full-length versions of the Social Interaction Anxiety Scale and Social Phobia Scale outperform short forms at assessing treatment outcome.

The Social Interaction Anxiety Scale (SIAS) and Social Phobia Scale (SPS) are 20-item companion measures of social anxiety symptoms frequently used to evaluate outcome in treatment trials. The SIAS-6, SPS-6, and Social Interaction Phobia Scale (SIPS) are promising short forms of the SIAS and SPS. The current study evaluated whether it is sound to use these short scales instead of the full-length instruments to measure outcome in social anxiety disorder (SAD) treatment studies, using data from a trial in which 255 adults with SAD were treated with traditional or imagery-enhanced group cognitive-behavioral therapy.

Severe and enduring anorexia nervosa? Illness severity and duration are unrelated to outcomes from cognitive behaviour therapy.

Objective: The present study aimed to examine whether Anorexia Nervosa (AN) illness severity or duration is associated with retention or treatment response in outpatient, enhanced cognitive-behavioral therapy (CBT-E).

Method: Patients with a confirmed AN diagnosis (N = 134) completed measures of eating disorder symptoms and quality of life, and had their BMI objectively measured before, during, and after treatment. We evaluated whether illness severity or duration predicted treatment outcomes, using longitudinal regression models.

Transportability of imagery-enhanced CBT for social anxiety disorder.

Pilot and open trials suggest that imagery-enhanced group cognitive behaviour therapy (CBT) is highly effective for social anxiety disorder (SAD). However, before being considered reliable and generalisable, the effects of the intervention need to be replicated by clinicians in a setting that is independent of the protocol developers. The current study compared outcomes from clients with a principal diagnosis of SAD at the Australian clinic where the protocol was developed (n = 123) to those from an independent Canadian clinic (n = 46) to investigate whether the large effects would generalise.

Evidence That the Clinical Impairment Assessment (CIA) Subscales Should Not Be Scored: Bifactor Modelling, Reliability, and Validity in Clinical and Community Samples.

The Clinical Impairment Assessment (CIA 3.0) is the most widely used instrument assessing psychosocial impairment secondary to eating disorder symptoms. However, there is conflicting advice regarding the dimensionality and optimal method of scoring the CIA.

Assessing the efficacy of imagery-enhanced cognitive behavioral group therapy for social anxiety disorder: Study protocol for a randomized controlled trial.

Cognitive behavior group therapy (CBGT) is effective for social anxiety disorder (SAD), but a substantial proportion of patients do not typically achieve normative functioning. Cognitive behavioral models of SAD emphasize negative self-imagery as an important maintaining factor, and evidence suggests that imagery is a powerful cognitive mode for facilitating affective change. This study will compare two group CBGT interventions, one that predominantly uses verbally-based strategies (VB-CBGT) and another that predominantly uses imagery-enhanced strategies (IE-CBGT), in terms of (a) efficacy, (b) mechanisms of change, and (c) cost-effectiveness.

The search for universal transdiagnostic and trans-therapy change processes: Evidence for intolerance of uncertainty.

The search for universal processes associated with symptom change across emotional disorders and different forms of psychotherapy offers hope of increased theoretical parsimony and treatment efficiencies. This study investigated whether intolerance of uncertainty (IU) is a universal process by examining whether changes in IU were associated with changes in symptoms across three different cognitive behavior therapy protocols for depression (n=106), social anxiety disorder (n=88), or generalized anxiety disorder (n=62) in a community mental health clinic. IU was associated with reductions in repetitive negative thinking in all treatments, which is consistent with IU being a transdiagnostic and 'trans-therapy' process of change.

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

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.

Mechanisms of change during group metacognitive therapy for repetitive negative thinking in primary and non-primary generalized anxiety disorder.

Repetitive negative thinking (RNT) is a transdiagnostic process that serves to maintain emotional disorders. Metacognitive theory suggests that positive and negative metacognitive beliefs guide the selection of RNT as a coping strategy which, in turn, increases psychological distress. The aim of this study was to test the indirect effect of metacognitive beliefs on psychological distress via RNT.