The effectiveness and cultural adaptations of psychological interventions for eating disorders in East Asia: A systematic scoping review

Abstract

ObjectiveThere has been no review on eating disorder‐focused psychological interventions in East Asia. The aims of this systematic scoping review were to summarize existing and forthcoming studies and to synthesize the cultural adaptations and effectiveness of the interventions identified.MethodFive databases (PubMed, Embase, Global Health, Medline, PsychInfo) and seven trial registries were searched. Studies examining eating disorder (ED)‐focused psychological interventions in East Asia were included. Narrative synthesis was used for the analysis.ResultsEighteen published studies and 14 ongoing/completed but unpublished studies were included. Most published studies were uncontrolled and five were feasibility studies. Among the ongoing studies, 71% are randomized controlled trials. Cognitive therapies were the main approach used, including individual cognitive behavioral therapy (CBT), internet CBT, group CBT, guided self‐help, and cognitive remediation therapy. Cultural adaptations were mostly related to language, communication style and tailoring the dietary requirements to local diets. Interventions were shortened to increase acceptability and reduce financial and time burden to patients. Overall, studies showed good acceptability, completion rates and positive effects on ED symptoms (indicated by moderate to large effect sizes or statistical significance).DiscussionStudies were underpowered and uncontrolled, thus precluding meaningful interpretations of effectiveness to be made. However, the psychological interventions were acceptable and showed promise in delivery. Digital and group interventions seemed to be the most feasible given barriers in the local health systems. More controlled studies, as well as studies on children and adolescents, are needed in future.Public significanceThis is the first systematic scoping review examining psychological interventions for eating disorders in East Asia. Research in eating disorders has largely focused on White people and in Western countries. This review will be helpful for clinicians and researchers to understand the current state of the field through a non‐Eurocentric lens, to identify gaps and plan future research.

The Cultural Formulation Interview as a clinical tool in the assessment of eating disorders: a pilot study

“…This mirrors what might be described as a lack of interest in the social and cultural aspects of food in much eating disorder research, where eating pathology is typically conceptualized as a maladaptive coping mechanism in response to affect dysregulation (43), similar to self-injurious behaviors or substance use, and where food as culture is merely a curiosity (44). An exception to this is the budding field of research on cultural adaptations of eating disorder treatment (45,46), which usually involve considerations regarding acculturation, family dynamics, and food as care. It may be noted that when participants were explicitly asked (in a separate, broader interview) about cultural aspects of food and eating in their family or their country of origin, almost all affirmed that this had played a role for them in the development and maintenance of eating pathology.…”