Acceptance-based treatment and quality of life among patients with an eating disorder

Abstract

This study assessed the relationship between acceptance-based constructs and quality of life (QOL) among patients with an eating disorder, as well as whether an acceptance-based treatment group could improve QOL. Patients (n = 105) at a residential treatment center received treatment as usual (TAU) or TAU plus twice-weekly acceptance and commitment therapy groups (TAU+ACT), and completed assessments at admission and discharge. Higher scores on several acceptance-related constructs at admission were associated with better psychological QOL, and pre- to post-treatment improvements in the ability to defuse from distressing internal experiences were associated with improved QOL. However, no differences in pre- to post-treatment changes in QOL were observed between treatment conditions. These results suggest that while some acceptance-related variables (e.g. defusion, impulse control, access to emotion regulation skills) may contribute to QOL, ACT does not appear to incrementally improve these variables or QOL beyond standard treatment programs. Additional research is needed to evaluate whether ACT may confer greater benefit for improving QOL in an outpatient setting where patients have more opportunity to utilize ACT skills, or when a stronger dose of treatment is administered.

Mechanisms and moderators in mindfulness‐ and acceptance‐based treatments for binge eating spectrum disorders: A systematic review

“…Results of “proxy” mediation analyses indicated that improvements in global ED pathology (assessed by the Eating Disorder Examination or Eating Disorder Examination Questionnaire; Cooper & Fairburn, 1987; Luce & Crowther, 1999) were significantly related to increases in access to emotion regulation strategies following treatment (Juarascio et al, 2017; Juarascio, Schumacher, Shaw, Forman, & Herbert, 2015). Further, Juarascio et al (2015) found that increases in cognitive defusion abilities were significantly associated with increases in ED-related quality of life at end of treatment. Importantly, all improvements and significant associations were observed across all participants, regardless of treatment condition (when a control or comparison condition was used), suggesting that these improvements may not be specific to ACT-based processes.…”

“…PHP: partial hospitalization programme; ACGT: active comparison control group; PECB: psychoeducational cognitive behavioural treatment. & Fairburn, 1987;Luce & Crowther, 1999) were significantly related to increases in access to emotion regulation strategies following treatment (Juarascio et al, 2017;Juarascio, Schumacher, Shaw, Forman, & Herbert, 2015). Further, Juarascio et al (2015) found that increases in cognitive defusion abilities were significantly associated with increases in ED-related quality of life at end of treatment.…”

The Role of Emotion Regulation in Eating Disorders: A Network Meta-Analysis Approach

“…Additionally, a recent longitudinal study reported that a poor response to CBT-based ED treatment was associated with lack of change in the patients' self-reported ability to accept emotions and limited access to other effective emotion regulation strategies ( 146 ). Moreover, another interventional study found that irrespective of treatment condition, changes in acceptance of emotions were associated with greater improvements in ED-related quality of life post-intervention ( 27 ). These findings have led some authors to suggest that emotion regulation in general and acceptance of unwanted emotions in particular should be added to current standard ED treatments ( 146 , 147 ).…”

The role of emotion regulation in eating disorders: a network meta-analysis approach

“…Moreover, another interventional study found that irrespective of treatment condition, changes in acceptance of emotions were associated with greater improvements in ED-related quality of life post-intervention (Juarascio, Schumacher, Shaw, Forman, & Herbert, 2015). These findings have led some authors to suggest that emotion regulation in general and acceptance of unwanted emotions in particular should be added to current standard ED treatments (Juarascio, Manasse, Schumacher, Espel, & Forman, 2017;Mallorqui-Bague et al, 2018).…”

“…Another larger longitudinal treatment study found that ACT was more effective than treatment as usual in reducing residual ED symptoms and risk or relapse following standard ED treatment and the effects were maintained at a 2-year follow-up (Fogelkvist, Gustafsson, Kjellin, & Parling, 2020). However, another interventional study found that ACT did not lead to greater improvements in ED related quality of life than treatment as usual (Juarascio et al, 2015). Furthermore, a systematic review examining the use of ACT to treat body image disturbance and weight dissatisfaction reported that they could not determine the effectiveness of ACT due to the poor quality of current evidence (Griffiths, Williamson, Zucchelli, Paraskeva, & Moss, 2018).…”