Informing the Development of More Effective Prevention Interventions for Eating Disorders and Disordered Eating

Author: Jamie-Lee Pennesi

Pennesi, Jamie-Lee, 2018 Informing the Development of More Effective Prevention Interventions for Eating Disorders and Disordered Eating, Flinders University, School of Psychology

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Abstract

Eating disorders, including threshold and subthreshold disordered eating, are prevalent and are associated with elevated mortality rates, impairments across several health dimensions, and reduced quality of life. The development and implementation of effective prevention programs is imperative in order to reduce the burden of this serious mental health problem. Despite recent advances in the eating disorder prevention field, the vast majority of widely disseminated public health interventions are not informed by theory and lack empirical support. Thus there is a need to develop more effective interventions for eating disorders that integrate theory and intervention development. The first study was a systematic review of the current eating disorder literature, including an examination of the degree to which eating disorder models have informed interventions, and a summary of the variables commonly considered in the most promising models. While an extensive range of theoretical models were identified, few models led to the development of effective interventions. One exception was the dual-pathway model for bulimia nervosa which has informed the gold standard of prevention approaches for eating disorders in young women. Despite the model’s success, several critical limitations were identified. The second study therefore investigated whether this model could be improved, additional temperament factors (i.e., perfectionism, self-efficacy, self-compassion, and difficulties with emotion regulation) were investigated and the model was applied to the full range of disordered eating disturbances and a global measure of eating psychopathology. The model was examined cross-sectionally and longitudinally in a sample of women considered to be at risk of disordered eating (N = 167), and sociocultural influences, body dissatisfaction, and difficulties with emotion regulation were identified as potentially robust predictors. The final study was a randomised controlled trial which specifically targeted emotional regulation through the use of imagery rescripting and postulated increases in self-compassion. We compared two brief interventions, namely imagery rescripting and cognitive dissonance, to a control condition, in terms of reducing disordered eating and modifying risk and protective factors for eating disorders. Change in state variables was examined within the experimental session in a sample of women at risk of disordered eating (N = 201; Mage = 20.18 years), and support was found for both imagery rescripting and cognitive dissonance interventions compared to the control in increasing self-compassion. Change in trait variables was subsequently examined over the one-week follow-up for those women considered to be at risk of developing an eating disorder (N = 107; Mage = 20.27 years), and support was found for the imagery rescripting intervention in increasing body image acceptance and self-compassion and reducing disordered eating. Taken together, these findings identify a number of key variables of pertinence to the development and/or maintenance of disordered eating that ought to be considered in the revision of models that inform the development of future interventions, including those which appear to be most effective for change within prevention research.

Keywords: prevention, intervention, eating disorders, disordered eating
Subject: Psychology thesis

Thesis type: Doctor of Philosophy
Completed: 2018
School: School of Psychology
Supervisor: Professor Tracey Wade