Reduction in depressive symptoms predicts improvement in eating disorder symptoms in interpersonal psychotherapy: results from a naturalistic study

Abstract

Background: Interpersonal psychotherapy (IPT) can be effective for both Bulimia Nervosa (BN) and co-occurring depression. While changes in symptoms of Eating disorder (ED) and depression have been found to correlate, it is unclear how they interact during treatment and in which order the symptoms decrease. Methods: Thirty-one patients with BN and depressive symptoms received IPT using the manual IPT-BNm in a naturalistic design. The outcome was measured with the Eating Disorder Examination Questionnaire (EDE-Q) and the Montgomery Åsberg Depression Rating Scale (MADRS-S). Symptom improvement at each session was measured with Repeated Evaluation of Eating Disorder Symptoms (REDS) and the Patient Health Questionnaire-9 (PHQ-9). Results: Significant improvements with large effect sizes were found on both ED symptoms and depression. The rates of change were linear for both BN and depression. A strong correlation between reduction of depressive symptoms and ED symptoms was found. Depressive symptom reduction at one session predicted improvement of ED symptoms at the next session. Conclusions: IPT-BNm had an effect on both BN and co-occurring depressive symptoms. The analyses indicated that reduction in depressive symptoms preceded reduction in bulimic symptoms.

2023 International Olympic Committee’s (IOC) consensus statement on Relative Energy Deficiency in Sport (REDs)

“…However, we must recognise that the picture is still unclear regarding the dynamics of mental health and DE behaviours according to sex and level of competition,83 as well as in athletes with physical disabilities 84. Furthermore, studies are required to (1) ascertain why many athletes experience few or no negative mental health consequences in the early stages of problematic LEA exposure20 72 85 and (2) to better understand the reciprocal function of the different psychological variables 86 87. As perceived stress appears to be common for many mental health concerns related to LEA and REDs, a heightened focus should be placed on developing psychologically safe environments surrounding athletes.…”

The integrated treatment of eating disorders, posttraumatic stress disorder, and psychiatric comorbidity: a commentary on the evolution of principles and guidelines

“…However, other trauma-focused therapies can be applied to ED + PTSD patients, including prolonged exposure (PE), eye movement desensitization reprocessing (EMDR), imaging rescripting (IR), written exposure therapy (WET), narrative exposure therapy (NET), compassionfocused therapy (CFT), and trauma-focused CBT (TFCBT) in children and adolescents (49,71,121,(124)(125)(126)(127)(128)(129)(130)(131)(132)(133)(134)(135)(136)(137)(138)(139)(140)(141)(142). Other adjunctive approaches, or elements of these approaches, can also be useful, including acceptance and commitment therapy (ACT), which identifies values and addresses experiential avoidance (143)(144)(145)(146), interpersonal psychotherapy (IPT), which has been reported to be effective in EDs, PTSD, and major depression (145,(147)(148)(149)(150)(151)(152), and 12-step facilitation, a manual based, therapist driven treatment based on 12-step principles found to be effective for alcohol use and stimulant use disorders (153)(154)(155). The unified treatment model has also been recommended for ED + PTSD (156).…”

Which came first? Bulimia and emotional symptoms: A cross-lagged panel analysis

“…In line with this finding, a meta-analysis of randomized controlled trails shows that the significant reduction in depressive symptoms through cognitive behavior therapy (CBT) can be associated with greater improvement in bulimia ( Linardon et al, 2017 ). Bäck and colleagues later found that the reduction in depressive symptoms also reduces eating problems through interpersonal psychotherapy ( Bäck et al, 2020 ). These findings also shed light on further clinical practice, in which health workers are encouraged to alleviate their patients’ negative feelings, as these emotional symptoms may hamper the therapeutic alliance, as well as the process with the eating problems and the maintenance of the co-occurring symptoms ( Fairburn et al, 2003 ).…”