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Marek R.J.,Kent State University | Ben-Porath D.D.,John Carroll University | Federici A.,Credit Valley Hospital | Wisniewski L.,Cleveland Center for Eating Disorders | Warren M.,Cleveland Center for Eating Disorders
International Journal of Eating Disorders | Year: 2013

Objective Studies have demonstrated that negative affect increases prior to food intake in individuals diagnosed with an eating disorder. Mindfulness has been supported empirically to treat experiential avoidance stemming from anxiety. Thus, the current objective in this study is to empirically compare mindfulness vs. thought suppression invention during a food exposure in both clinical and nonclinical samples. Method In a 2 (Group: clinical vs. nonclinical) × 2 (Intervention: mindfulness vs. distraction) counterbalanced within treatment design, the current investigation sought to determine the differential effectiveness of a brief mindfulness intervention vs. a brief distraction intervention in women diagnosed with AN and BN in a clinical and nonclinical sample during a food exposure. Results Results indicated that the eating disorder group reported a significant increase in negative affect after the mindfulness intervention as compared to the distraction intervention, whereas the nonclinical group reported a significant decrease in negative affect after the mindfulness intervention as compared to the distraction intervention. Discussion Preliminary findings suggest that clinicians may want to proceed cautiously when using mindful eating in those with severe eating disorders during the early stages of food exposure. Limitations and future directions are discussed. © 2013 Wiley Periodicals, Inc. (Int J Eat Disord 2013; 46:582-585) Copyright © 2013 Wiley Periodicals, Inc.


Middleman A.B.,Texas Childrens Hospital Center for Vaccine Awareness and Research | Middleman A.B.,Baylor College of Medicine | Short M.B.,University of Houston-Clear Lake | Doak J.S.,Cleveland Center for Eating Disorders
Human Vaccines and Immunotherapeutics | Year: 2012

School-located immunization programs (SLIP) will only be successful if parents consent to their children's participation. It is critical to understand parent perspectives regarding the factors that make them more or less likely to provide that consent. Organizations creating SLIPs will be able to capitalize on the aspects of SLIPs that parents appreciate, and address and correct issues that may give rise to parent concerns. This study involved five focus groups among the parents of school students in a large, urban school district. Findings highlight the broad range of concepts important to parents when considering participation in a SLIP. The safety and trust issues regarding vaccines in general that are so important to parents are also important to parents when considering participation in a SLIP. Effective communication strategies that include assurances regarding tracking of information and the competence and experience of immunizers will be helpful when addressing parents regarding SLIPs. In addition, parents were very cognizant of and positive regarding the public health benefits associated with SLIPs. Further study among larger populations of parents will further refine these ideas and aid in the development of successful influenza vaccine SLIPs that directly address and communicate with parents about the issues most important to them. © 2012 Landes Bioscience.


Middleman A.B.,Texas Childrens Hospital Center for Vaccine Awareness and Research | Middleman A.B.,Baylor College of Medicine | Short M.B.,University of Houston-Clear Lake | Doak J.S.,Cleveland Center for Eating Disorders
Vaccine | Year: 2012

Purpose: To describe both parent and student perspectives on the importance of various programmatic factors when deciding to participate in a school-located immunizations program (SLIP) for influenza vaccine. Methods: Questionnaires were distributed to middle- and high-school students and their parents; the document assessed demographic data, influenza vaccination history, and the importance of various factors in their decision to participate in a potential SLIP for influenza vaccine. Factor analysis created six primary factors of importance related to programming: (1) safety/trust; (2) outbreaks (representing imminent threat of disease, an environmental factor associated with program timing); (3) issues of site implementation; (4) public health benefits; (5) record-keeping; (6) medical/emotional support. Results: Participants included 621 students and 579 parents; 566 student/parent dyads were included. Most respondents were female, felt it is important to be immunized against the flu, and received the influenza vaccine in the past. Fewer than 50% had received the intranasal vaccine. More parents (67%) than students (46%) expressed a general willingness to consent to utilizing a SLIP. The programmatic factors associated with public health were second only to safety/trust factors as the most important to parents and students when considering participation in a SLIP. Demographic variables were found to be associated with the importance ratings of program factors associated with participation in a SLIP. Conclusions: When considering possible participation in SLIPs, parents and students consider programmatic factors associated with safety/trust and public health benefits to be of the greatest importance. Further study will be needed to develop effective and culturally sensitive messaging that targets and emphasizes these factors to potentially increase participation in SLIPS. © 2012 Elsevier Ltd.


Federici A.,Cleveland Center for Eating Disorders | Summerfeldt L.J.,Trent University | Harrington J.L.,University of Ottawa | McCabe R.E.,McMaster University | And 3 more authors.
Journal of Anxiety Disorders | Year: 2010

Background: Preliminary efforts to demonstrate the utility of a self-rated version of the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) have been promising; however, earlier reports are based on small clinical samples. The objective of the present study was to evaluate the level of agreement between the clinician-administered Y-BOCS and a self-report version. Methods: Participants included 86 individuals with a principal diagnosis of obsessive-compulsive disorder (OCD). All participants were given the self-report version of the Y-BOCS to complete offsite and instructed to return it at a second assessment session (within a 2-week time frame), at which time a trained and experienced clinician administered the Y-BOCS interview. Results: The two versions were moderately correlated with the highest correlation observed for the Compulsions subscale. Comparison of scores for individual items revealed several inconsistencies between the two measures: level of agreement was low for resistance items, and the interview version generated higher compulsion severity ratings. Conclusions: The study provided moderate support for the convergence of the self-report and clinician-administered version of the Y-BOCS, however, important difference were detected between the two assessment methods. © 2010 Elsevier Ltd.


Walders-Abramson N.,University of Colorado at Denver | Nadeau K.J.,University of Colorado at Denver | Kelsey M.M.,University of Colorado at Denver | Schmiege S.J.,University of Colorado at Denver | And 4 more authors.
Childhood Obesity | Year: 2013

Background: An understanding of the relationships among obesity severity, medical co-morbidities, and psychological complications is important in the design of interventions to encourage overweight youth and families to accomplish healthy lifestyle changes. Methods: We evaluated associations among psychological status, diagnosed medical co-morbidities consistent with components of the metabolic syndrome, and BMI among 166 obese adolescents (11-18 years) referred for endocrinology consultation. We hypothesized that there would be higher levels of psychological distress among youth with more diagnosed components of the metabolic syndrome (i.e., more medical co-morbidities associated with obesity). Results: Contrary to expectation, we found that meeting criteria for extreme obesity alone was more predictive of psychological difficulties. Conclusions: The degree of obesity may be more relevant than the number of associated medical co-morbidities in impacting psychological health. It is important to recognize individual differences between patients in terms of identifying motivating goals for accomplishing weight management. © Copyright 2013, Mary Ann Liebert, Inc. 2013.


Federici A.,Cleveland Center for Eating Disorders | Wisniewski L.,Cleveland Center for Eating Disorders | Wisniewski L.,Case Western Reserve University
International Journal of Eating Disorders | Year: 2013

Objective: This study presents case-series data on a novel outpatient program that blends dialectical behavior therapy (DBT) with standard eating disorder (ED) interventions (i.e., food exposure, weight monitoring, cognitive modification, ED psychoeducation) for patients with complex and multidiagnostic ED presentations. Method: Quantitative and qualitative data was collected on a sample of seven consecutively admitted women who presented with a severe ED, a history of several failed treatment attempts, pervasive emotion dysregulation, and significant Axis I or II psychiatric comorbidity (e.g., PTSD, borderline personality disorder). Results: Treatment was associated with reductions in ED symptoms, suicidal and self-injurious behaviors, treatment interfering behaviors, psychiatric and medical hospitalizations, and clinican burnout. Discussion: Overall, the results suggest that this blended DBT/cognitive behavior therapy for ED treatment model is a promising intervention for this complex and "hard to treat" population. © 2013 by Wiley Periodicals, Inc. (Int J Eat Disord 2013) Copyright © 2013 Wiley Periodicals, Inc.


Fallon P.,University of Washington | Wisniewski L.,Cleveland Center for Eating Disorders | Wisniewski L.,Case Western Reserve University
International Journal of Eating Disorders | Year: 2013

Although evidence-based treatments (EBTs) exist for both bulimia nervosa and binge eating disorder, there is far less evidence underpinning the treatment of anorexia nervosa (AN). Furthermore, there is no clearly defined standardized approach to patients who have not responded to treatment over an extended period of time. Chronic eating disorder patients in particular might need long-term engagement with treatment providers offering a wide range of interventions. This case study highlights how an experienced private practitioner systematically employed a variety of EBT techniques for a patient with a severe, long-term eating disorder and its comorbidities, within a model of attachment and collaboration. The practice of utilizing a wide variety of EBT techniques in a systematic manner guided by clinical expertise and supported by a therapy relationship of collaboration and attachment may prove to be a fruitful avenue for future research. Copyright © 2013 Wiley Periodicals, Inc.


Ben-Porath D.D.,John Carroll University | Federici A.,Cleveland Center for Eating Disorders | Wisniewski L.,Cleveland Center for Eating Disorders | Warren M.,Cleveland Center for Eating Disorders
Journal of Contemporary Psychotherapy | Year: 2014

The current investigation sought to determine whether a standard outpatient dose of dialectical behavior therapy (DBT) skills training (2 h per week) coupled with standard CBT treatment would be sufficient to produce changes in affect regulation over the course of day hospitalization treatment. In an uncontrolled pre-post treatment design, 65 women diagnosed with anorexia nervosa or bulimia nervosa were assessed at the beginning of treatment and at the end of treatment on affect regulation. Findings indicated that participants demonstrated a significant improvement in their ability to regulate affect, suggesting that weekly DBT treatment may play an important role in producing changes in affect regulation. Secondary analyses on eating disorder outcomes revealed a significant increase in weight gain as well as a significant reduction in restriction, bingeing, purging and eating disordered cognitions. Findings are discussed in the context of clinical and treatment implications for those with severe eating disorders. © 2014, Springer Science+Business Media New York.


Ben-Porath D.D.,John Carroll University | Wisniewski L.,Cleveland Center for Eating Disorders | Warren M.,Cleveland Center for Eating Disorders
Journal of Contemporary Psychotherapy | Year: 2010

The present study was designed to evaluate the outcomes of a day treatment program for 55 eating disordered (ED) patients using clinical and statistical significance testing. Results indicated a statistically significant reduction on all eating disordered outcomes. With respect to clinical significance testing, analysis of these data indicated that the majority of the individuals in the day treatment program made clinically significant and reliable change by the termination of treatment on all eating disorder measures. However, considerably less patients improved to such a point that they were asymptomatic. The importance of combining clinical significance testing with traditional significance testing is discussed. © Springer Science+Business Media, LLC 2009.


Taylor S.A.,Baylor College of Medicine | Garland B.H.,Baylor College of Medicine | Sanchez-Fournier B.E.,Baylor College of Medicine | Allen K.F.,Georgetown University | And 2 more authors.
Pediatrics | Year: 2013

OBJECTIVE: In an effort to develop more effective weight-loss interventions, this study examined the daily experiences and personal struggles of Mexican-American adolescent females with morbid obesity. METHODS: Twenty self-identified, morbidly obese Mexican-American adolescent females and their families were interviewed about their food choices, personal and family barriers to weight loss, sources of support, previous weight-loss experience, and weight-related beliefs. Qualitative responses were coded by using framework analysis. RESULTS: Four themes emerged from the adolescent and family responses: the impact of normal adolescent development, multiple sources of excess calories, the physical and emotional burden of excess weight for the adolescent, and the magnitude of the family's personal struggle with weight management. Multiple subthemes were also identified. CONCLUSIONS: Responses by the adolescents and their families highlighted the intersection of adolescence and Mexican-American culture and the daily challenges of obesity. Recommendations for providers include incorporating knowledge of adolescent development and culturally sensitive care into treatment recommendations.

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