Eating Disorder Treatment: a Systematic Review and Meta-analysis of the Efficacy of Mindfulness-Based Programs

Abstract

Objectives

This systematic review and meta-analysis sought to evaluate the efficacy of mindfulness-based programs (MBPs) on eating disorder (ED) symptoms and related outcomes such as BMI, body dissatisfaction, emotion regulation, and negative affect. It also examined moderators that predicted larger intervention effects.

Methods

A search for studies evaluating such MBPs on participants with EDs was conducted in several online databases. In total, 23 articles were included in the systematic review and 22 in the meta-analysis (10 randomized controlled trials).

Results

Results showed a within-condition effect of MBPs on ED symptoms, emotional eating, negative affect, and body dissatisfaction, and on BMI in anorectic and bulimic participants relative to pre-assessment. A significant within-condition effect sizes ranged from d = .62 (negative affect) to d = 1.05 (ED symptoms). Meta-regression analyses showed that participants with BED and women benefit more of MBPs on mindfulness skills and emotion regulation skills than participants with anorexia nervosa, bulimia, and men. A high risk of bias was correlated with a larger effect of MBPs on mindfulness skills and emotion regulation skills but a smaller effect on restrained eating. Longer treatment was correlated with a larger effect of MBPs on emotion regulation skills.

Conclusions

Results indicated some positive correlations between MBPs and outcomes but a definitive conclusion cannot be drawn since these results are on within-condition effects and that half of the included studies did not have a control condition. Results identified moderators that may be useful to refine inclusion and exclusion criteria to target those most likely to benefit from MBPs. The field needs more rigorous studies with credible alternative interventions to confirm the efficacy of MBPs for ED patients.

Correction to: Principles for a Responsible Integration of Mindfulness in Individual Therapy The article “Principles for a Responsible Integration of Mindfulness in Individual Therapy”.

Correction to: The Effect of Brief Mindfulness Training on Brain Reactivity to Food Cues During Nicotine Withdrawal: A Pilot Functional Imaging Study The original publication is missing the following funding statement.

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Evaluation of a Compassionate Mind Training Intervention with School Teachers and Support Staff Abstract Objectives Teacher retention is a key issue facing schools, with stress, student behavior, current competitive policies, and practices resulting in many leaving within the first 5 years of qualification. Consequently, recent in-school research initiatives have focused on resilience training, although the quality of such conducted studies is debated. Drawn from compassion-focused therapy (CFT), this study set out to explore a six-module compassionate mind training (CMT) program with school staff to improve well-being. Methods As part of their continued professional development, over 70 teachers and support staff took part in the CMT, with a mixed-measures AAB quantitative and qualitative design employed. This enabled us to explore both implementation effectiveness and outcome effectiveness in terms of parameters of well-being. Results The initiative was well received with the majority of staff reporting positively on their experiences of the curriculum and practices. Additionally, exercise practice was associated with significant increases in self-compassion (p < 0.01) and significant decreases in self-criticism (p < 0.05). Thematic analyses further revealed benefits of CMT for dealing with emotional difficulties. Conclusions As a feasibility study, our results demonstrate many benefits of CMT in educational settings. CMT may hold promise as a way of helping those in education counteract the current competition-based nature of education, especially that which contributes to negative changes in well-being. Given this, future research should employ a control group design, a larger sample size, and a range of well-being measures at follow-up, to fully evaluate the utility of CMT in educational settings.

Development and Validation of an Age-Appropriate Self-Compassionate Reactions Scale for Children (SCRS-C) Abstract Objectives Three studies were conducted to develop an age-appropriate scale to assess children’s self-compassionate reactions by using a vignette technique. Methods In Study 1, a scale employing vignette technique was developed first based on self-compassion theory and interview with children. Next, based on further item analysis with 161 children, two items were eliminated and three were modified to form the Self-Compassionate Reactions Scale for Children (SCRS-C), including 4 vignettes and 24 items. In Study 2, serial CFAs (N = 637) were conducted to investigate the structure, factorial invariance, and equivalence across gender of the SCRS-C. The reliability, convergent and discriminate validity, and concurrent validity were also examined. Study 3 explored the test-retest reliability of the scale over 6 weeks (N = 77). Results A two second-order factor model (compassionate and uncompassionate reaction) with six first-order factors (self-kindness, common humanity, mindfulness, self-judgment, isolation, and over-identification) was found to best fit the data. In addition, the factorial invariance of the second-order factor structure across gender was verified, and the internal consistency reliability was satisfactory. The scale showed satisfactory convergent, discriminate and concurrent validity and test-retest reliability. Conclusions The SCRS-C shows promise as a reliable and valid scale of self-compassion suited for children aged 9–12 for both boys and girls.

Compassion: Embodied and Embedded Abstract Objectives The aim of this paper is to review current conceptualizations, assessment measures, and operationalizations of compassion towards self and others in order to propose a new theoretically grounded, empirically driven, unified notion of compassion towards self and others. Methods A thorough qualitative review of theoretical and empirical papers and books regarding compassion towards self and others was conducted with a particular emphasis on neurological and neurophysiological evidence. Results Theoretical and empirical evidence suggest that compassion should be grounded in affective, cognitive, behavioral, and interpersonal processes. Moreover, based on available neurological and neurophysiological evidence, compassion can be considered as embodied and embedded in the interpersonal and social context. Conclusions The new notion of compassion has important implications in conceptualizing and measuring compassion and in devising and validating new compassion-based interventions. Therefore, this notion should be taken in consideration in conducting future research on compassion.