Changes in specific and nonspecific psychopathology network structure after intensive cognitive behavior therapy in patients with anorexia nervosa

Calugi, Simona; Dametti, Laura; Grave, Anna Dalle; Grave, Riccardo Dalle

doi:10.1002/eat.23755

Cited by 4 publications

(8 citation statements)

References 50 publications

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“…Among the 33 reviewed studies, six studies (18.2%) modeled cross‐sectional networks from data obtained at different time points (i.e., pre‐ and posttreatment) and compared them, therefore adopting a longitudinal study design (Brown et al, 2020; Calugi et al, 2022; Elliott et al, 2020; Mares et al, 2022; Monteleone et al, 2022; Smith et al, 2019). The remaining 27 studies (81.8%) applied a cross‐sectional study design (Calugi et al, 2020, 2021; Cascino et al, 2019; Chen et al, 2022; de Vos et al, 2021; DuBois et al, 2017; Forrest et al, 2018, 2019; Goldschmidt et al, 2018; Hagan et al, 2021; Hilbert et al, 2020; Kerr‐Gaffney et al, 2020; Levinson et al, 2017; Meier et al, 2020; Monteleone et al, 2019, 2020, 2021; Olatunji et al, 2018; Ralph‐Nearman et al, 2021; Schlegl et al, 2021; Smith et al, 2020; Solmi et al, 2018, 2019; Vanzhula et al, 2019; Vervaet et al, 2021; Wang et al, 2019; Wong et al, 2021).…”

Section: Resultsmentioning

confidence: 99%

“…The remaining 27 studies (81.8%) applied a cross‐sectional study design (Calugi et al, 2020, 2021; Cascino et al, 2019; Chen et al, 2022; de Vos et al, 2021; DuBois et al, 2017; Forrest et al, 2018, 2019; Goldschmidt et al, 2018; Hagan et al, 2021; Hilbert et al, 2020; Kerr‐Gaffney et al, 2020; Levinson et al, 2017; Meier et al, 2020; Monteleone et al, 2019, 2020, 2021; Olatunji et al, 2018; Ralph‐Nearman et al, 2021; Schlegl et al, 2021; Smith et al, 2020; Solmi et al, 2018, 2019; Vanzhula et al, 2019; Vervaet et al, 2021; Wang et al, 2019; Wong et al, 2021). Twenty‐five studies (75.7%) used network analysis as the primary data analysis procedure, involved treatment‐seeking patients and were uncontrolled (Brown et al, 2020; Calugi et al, 2020, 2021, 2022; Cascino et al, 2019; Chen et al, 2022; de Vos et al, 2021; DuBois et al, 2017; Forrest et al, 2018, 2019; Goldschmidt et al, 2018; Kerr‐Gaffney et al, 2020; Mares et al, 2022; Meier et al, 2020; Monteleone et al, 2019; Monteleone et al, 2020, 2021; Olatunji et al, 2018; Schlegl et al, 2021; Solmi et al, 2018, 2019; Vanzhula et al, 2019; Vervaet et al, 2021; Wang et al, 2019; Wong et al, 2021). Results from the remaining eight (24.3%) of the 33 studies included in this review are based on secondary analyses of data (Elliott et al, 2020; Hagan et al, 2021; Hilbert et...…”

Section: Resultsmentioning

confidence: 99%

“…The full text of the remaining 65 articles and 3 dissertations were assessed, leading to the exclusion of an additional 35 articles. The remaining 33 articles were thus included in the review (Brown et al, 2020;Calugi et al, 2020Calugi et al, , 2021Calugi et al, , 2022Cascino et al, 2019;Chen et al, 2022;de Vos et al, 2021;DuBois et al, 2017;Elliott et al, 2020;Forrest et al, 2018Forrest et al, , 2019Goldschmidt et al, 2018;Hagan et al, 2021;Hilbert et al, 2020;Kerr-Gaffney et al, 2020;Levinson et al, 2017;Mares et al, 2022;Meier et al, 2020;Monteleone et al, 2019Monteleone et al, , 2020Monteleone et al, , 2022Olatunji et al, 2018;Ralph-Nearman et al, 2021;Schlegl et al, 2021;Smith et al, 2019;Smith et al, 2020;Solmi et al, 2018Solmi et al, , 2019Vanzhula et al, 2019;Vervaet et al, 2021;Wang et al, 2019;Wong et al, 2021). See Figure 1 for the flowchart of the selection process, including reasons for exclusion at each step.…”

Section: Selection Of Articles and Study Characteristicsmentioning

confidence: 99%

“…Thirty-one out of 33 (94%) studies reported applying network estimation functions which included glasso regularization (Friedman et al, 2008). Of these, 15 studies (45.4%) manually tuned the regularization/penalty applied to correlations (λ value) (Elliott et al, 2020;Forrest et al, 2018Forrest et al, , 2019Hagan et al, 2021;Hilbert et al, 2020;Kerr-Gaffney et al, 2020;Levinson et al, 2017;Olatunji et al, 2018;Ralph-Nearman et al, 2021;Schlegl et al, 2021;Smith et al, 2019Smith et al, , 2020Vanzhula et al, 2019;Vervaet et al, 2021;Wang et al, 2019;Wong et al, 2021), while the remaining 16 (48.5%) derived the λ value using the Extended Bayesian Information Criterion glasso (EBICglasso; Brown et al, 2020;Calugi et al, 2020Calugi et al, , 2021Calugi et al, , 2022Cascino et al, 2019;Chen et al, 2022;de Vos et al, 2021;DuBois et al, 2017;Goldschmidt et al, 2018;Meier et al, 2020;Monteleone et al, 2019Monteleone et al, , 2020Solmi et al, 2018Solmi et al, , 2019. None of the studies included provided the rationale for deciding whether to apply glasso or EBICglasso or why it was considered necessary to apply a regularization technique.…”

Section: Network Estimation Functionmentioning

confidence: 99%

“…Schlegl et al, 2021;Smith et al, 2020;Solmi et al, 2018Solmi et al, , 2019Vanzhula et al, 2019;Vervaet et al, 2021;Wang et al, 2019;Wong et al, 2021). Twenty-five studies (75.7%) used network analysis as the primary data analysis procedure, involved treatment-seeking patients and were uncontrolled(Brown et al, 2020;Calugi et al, 2020Calugi et al, , 2021Calugi et al, , 2022Cascino et al, 2019;Chen et al, 2022;de Vos et al, 2021;DuBois et al, 2017;Forrest et al, 2018Forrest et al, , 2019Goldschmidt et al, 2018;Kerr-Gaffney et al, 2020;Mares et al, 2022;Meier et al, 2020;Monteleone et al, 2019;Monteleone et al, 2020Olatunji et al, 2018;Schlegl et al, 2021;Solmi et al, 2018Solmi et al, , 2019Vanzhula et al, 2019;Vervaet et al, 2021;Wang et al, 2019;Wong et al, 2021). Results from the remaining eight (24.3%) of the 33 studies included in this review are based on secondary analyses of data(Elliott et al, 2020;Hagan et al, 2021;Hilbert et al, 2020;Levinson et al, 2017;Monteleone et al, 2022;Ralph-Nearman et al, 2021;Smith et al, 2019;…”

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Network analysis studies in patients with eating disorders: A systematic review and methodological quality assessment

Tomei

Pieroni

Tomba

2022

Intl J Eating Disorders

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Introduction Network psychometrics has been enthusiastically embraced by researchers studying eating disorders (ED), but a rigorous evaluation of the methodological quality of works is still missing. This systematic review aims to assess the methodological quality of cross‐sectional network analysis (NA) studies conducted on ED clinical populations. Methods PRISMA and PICOS criteria were used to retrieve NA studies on ED. Methodological quality was evaluated based on five criteria: variable‐selection procedure, network estimation method, stability checks, topological overlap checks, and handling of missing data. Results Thirty‐three cross‐sectional NA studies were included. Most studies focused on populations that were female, white and, with an anorexia nervosa (AN) diagnosis. Depending on how many criteria were satisfied, 27.3% of studies (n = 9) were strictly adherent, 30.3% (n = 10) moderately adherent, 33.3% (n = 11) sufficiently adherent, and 9.1% (n = 3) poorly adherent. Missing topological overlap checks and not reporting missing data represented most unreported criteria, lacking, respectively, in 63.6% and 48.5% of studies. Conclusions Almost all reviewed cross‐sectional NA studies on ED report those methodological procedures (variable‐selection procedure, network estimation method, stability checks) necessary for a network study to provide reliable results. Nonetheless these minimum reporting data require further improvement. Moreover, elements closely related to the validity of an NA study (controls for topological overlap and management of missing data) are lacking in most studies. Recommendations to overcome such methodological weaknesses in future NA studies on ED are discussed together with the need to conduct NA studies with longitudinal design, to address diversity issues in study samples and heterogeneity of assessment tools. Public Significance The present work aims to evaluate the quality of ED NA studies to support applications of this approach in ED research. Results show that most studies adopted basic procedures to produce reliable results; however, other important procedures linked to NA study validity were mostly neglected. Network methodology in ED is extremely promising, but future studies should consistently include topological overlap control procedures and provide information on missing data.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Selection Of Articles and Study Characteristicsmentioning

confidence: 99%

Section: Network Estimation Functionmentioning

confidence: 99%

mentioning

confidence: 99%

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Network analysis studies in patients with eating disorders: A systematic review and methodological quality assessment

Tomei

Pieroni

Tomba

2022

Intl J Eating Disorders

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10‐session Cognitive Behavioural Therapy (CBT-T) for Eating Disorders: A Systematic Review and Narrative Synthesis

Paphiti,

Newman

2023

J Cogn Ther

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To review the literature examining the effectiveness and efficacy of a cognitive behavioural therapy (CBT) for eating disorders delivered in ten sessions for those who are not underweight (CBT-T). A systematic search of the literature (MEDLINE, EMBASE, PsycINFO, Scopus and ProQuest) was conducted to identify relevant publications to date at the time of March 2022 (re-run in May 2023). Intervention studies of any study design that investigated CBT-T offering outcome data at least pre- to post- intervention for eating disorder and related outcomes were included. Results were reported for treatment attrition, abstinence, remission, eating disorder psychopathology, disordered eating behaviours, psychosocial impairment, depression and anxiety and synthesised using a narrative synthesis framework. The Effective Public Health Practice Project (EPHPP) quality assessment tool (Thomas et al., 2004) was used to assess the quality of included studies. Outcomes for 555 people who received CBT-T across eight studies (one randomised control trial and seven non-randomised studies) were synthesised. Support was found for the effectiveness and efficacy of CBT-T for a range of non-underweight eating disorders, with respect to eating disorder psychopathology, disordered eating behaviours, psychosocial impairment, abstinence and remission. CBT-T also led to improvements for depression and anxiety symptoms. CBT-T appears to improve eating disorder and co-morbid outcomes for people with non-underweight eating disorders within ten sessions, with comparable results to standard-length CBT for eating disorders (CBT-ED). Although results for CBT-T are promising, there were concerns with the quality of the studies. Future research is required to strengthen the evidence base with larger, higher-quality studies which compare CBT-T directly with recommended psychological treatments, such as standard-length CBT-ED.

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The network analysis in patients with anorexia nervosa treated with intensive enhanced cognitive behavior therapy: reflections on the research data

Calugi¹,

Grave²

2023

Ijedo

Self Cite

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The network theory conceptualizes mental disorders as causally connected symptom systems rather than as effects of a superordinate and unknowable illness, otherwise called latent. Network analysis, a statistical technique designed to identify network structures among psychiatric symptoms from empirical data, has been widely used in eating disorders. Three of these studies have been conducted on patients with anorexia nervosa treated with intensive enhanced cognitive behavior therapy (CBT-E). The first study found that the network structures in adult and adolescent patients with anorexia nervosa are similar and share overvaluation of shape and weight as the core feature of anorexia nervosa psychopathology, supporting the cognitive behavioral theory. The second study found that intensive CBT-E reduces the psychopathology network connectivity over time in patients with anorexia nervosa, confirming the effectiveness of CBT-E in improving eating-disorder psychopathology. In contrast, the third study, including in the networks not only the clinical features of the eating disorder psychopathology but also those of the general psychopathology, found that the structure of the network of patients with anorexia nervosa remains unchanged mainly after intensive CBT-E. These findings stimulate a rethinking of the current viewing of the eating-disorder psychopathology and the potential reasons for the partial efficacy of actual therapeutic interventions for patients with anorexia nervosa, which seem not effective enough to break the bonds between specific and nonspecific eating disorder features.

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Changes in specific and nonspecific psychopathology network structure after intensive cognitive behavior therapy in patients with anorexia nervosa

Cited by 4 publications

References 50 publications

Network analysis studies in patients with eating disorders: A systematic review and methodological quality assessment

Network analysis studies in patients with eating disorders: A systematic review and methodological quality assessment

10‐session Cognitive Behavioural Therapy (CBT-T) for Eating Disorders: A Systematic Review and Narrative Synthesis

The network analysis in patients with anorexia nervosa treated with intensive enhanced cognitive behavior therapy: reflections on the research data

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