Mindfulness as therapy for disordered eating: a systematic review

Abstract

There is growing interest in mindfulness-based cognitive-behavioral therapies (CBTs), such as dialectical behavior therapy (DBT), mindfulness-based cognitive therapy (MBCT), mindfulness-based eating awareness training (MB-EAT), and acceptance and commitment therapy (ACT), as treatments for a range of disordered eating concerns. DBT modified for disordered eating is a standalone treatment for bulimia nervosa (BN), binge eating disorder (BED) and eating disorders comorbid with borderline personality disorder or substance use disorders. Evidence for MBCT is limited. Preliminary uncontrolled data suggest that MBCT alone may be a promising treatment for binge eating in patients diagnosed with BED. Early controlled studies suggest that MB-EAT is a useful intervention targeting binge eating and compulsive overeating. Evidence for ACT is limited for BN, BED and general disordered eating concerns. However, ACT alone seems to promote greater functioning and quality of life in patients with obesity, and an ACT-enhanced weight loss program promotes and maintains weight loss. Available evidence for mindfulness-based CBTs for disordered eating concerns varies in methodological rigor, and across interventions and types of disordered eating concerns. There is considerable overlap across different mindfulness-based CBTs and significant variation even within a single type of mindfulness-based CBT. As with other clinical interventions, evidence is extremely limited for mindfulness-based interventions as treatments for anorexia nervosa. Although mindfulness-based CBTs appear to be promising interventions, it remains unclear if these treatment modalities are comparable to the extant treatments of choice for disordered eating concerns. Additional research is needed in this area. Neuropsychiatry (2013) 3(4) future science group 434 Review Masuda & Hill SummaRy Recently there has been growing interest in mindfulness-based cognitive-behavioral therapies in the field of disordered eating treatment as an alternative or as an adjunct to extant treatment. The aims of this review are to comprehensively identify, summarize and critically evaluate the available outcome evidence of mindfulness-based cognitive-behavioral therapies as treatments for a range of disordered eating concerns. This review suggests that mindfulness-based interventions, especially modified dialectical behavior therapy, seem to be promising treatments for bulimia nervosa, binge eating disorder, and eating disorders with borderline personality disorders and substance use disorders. However, evidence is extremely limited on mindfulness-based interventions as treatments for anorexia nervosa. Limitations and future directions are also discussed in this review.

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

“…The results of this study suggest that low levels of acceptance-related variables upon admission to treatment may partially account for some of the impairments in QOL observed among ED patients, and that improvements in certain acceptance-related variables, especially defusion, may predict improvements in QOL in some domains. These results are consistent with models of eating pathology suggesting that psychological inflexibility is a particularly relevant factor for EDs (Manlick, Cochran & Koon 2013; Masuda & Hill, 2013).…”

“…By targeting psychological flexibility and its related constructs, acceptance-based therapies such as Acceptance and Commitment Therapy (ACT; Hayes, Strosahl, & Wilson, 2012) may be well-suited to improving QOL among ED patients. A growing number of case and pilot studies utilizing mindfulness and acceptance-based therapies to treat EDs have yielded promising results for symptom improvement, suggesting the potential utility of this treatment paradigm (Manlick, Cochran & Koon, 2013; Masuda & Hill, 2013). In addition, prior research with populations with other psychiatric and health conditions has shown that acceptance-based treatments can improve QOL (e.g., Lillis, Hayes, Bunting, & Masuda, 2009; Roemer, Orsillo, & Salters-Pedneault, 2008).…”

Reporting of Positive Results in Randomized Controlled Trials of Mindfulness-Based Mental Health Interventions

“…MBSR and MBCT have been reported to improve mental health outcomes among patients with psychiatric conditions (e.g., depression [ 1 , 10 ], anxiety [ 11 , 12 ], posttraumatic stress disorder [ 13 ], eating disorders [ 14 ], substance use disorders [ 15 ]), and other medical conditions (e.g., diabetes [ 16 ], hypertension [ 17 ], cancer [ 18 ], arthritis [ 19 ], obesity [ 20 ], heart disease [ 21 ], stroke [ 22 ]). In the United Kingdom, MBCT has been recommended by the National Institute for Health and Care Excellence to prevent depression relapse [ 23 ].…”

Addressing Weight Suppression to Improve Treatment Outcome for Bulimia Nervosa

“…These patients could benefit from the provision of distress tolerance techniques. Distress tolerance is a core construct of many third-wave behavioral treatments such as Dialectical Behavioral Therapy and Acceptance and Commitment Therapy, both of which have shown promise for the treatment of eating pathology (Hayes, Strosahl, & Wilson, 2011; Hill, Masuda, Melcher, Morgan, & Twohig, 2015; Juarascio et al, 2013; Juarascio, Manasse, Schumacher, Espel, & Forman, 2016; Linehan, 1993; Masuda & Hill, 2013; Safer & Jo, 2010). The integration of constructs from these treartment approaches into standard CBT for BN could be one option for augmenting treatment.…”