Biomedical subjects

G T Wilson

Publications and source records attributed to G T Wilson.

At least 19 recordsLinked to original sources

PubMed1998

Binge eating in an obese community sample.

OBJECTIVE: The present study sought to examine the validity and utility of diagnostic criteria for binge-eating disorder (BED) by replicating and extending a study reported by de Zwaan and colleagues (International Journal of Eating Disorders, 15, 43-52, 1994). METHOD: Four groups of obese individuals were selected from a large community-based sample of men and women: 33 women and 20 men with BED, 79 women and 40 men with subthreshold BED, 21 women and 39 men who reported recurrent overeating, and 80 female and 80 male normal controls. The groups were compared on measures of body image concern, dieting behavior, and associated psychological distress. RESULTS: Individuals with BED were distinguishable from overeaters and normal controls on a number of psychological and behavioral variables. Few differences were found between subthreshold and full-syndrome BED, raising questions about the diagnostic validity of the frequency threshold. Men with BED did not differ from women with BED above and beyond the gender-related differences observed across all four groups. DISCUSSION: Our findings support the view of BED as a distinct syndrome.

Adult↗

PubMed1998

Binge eating in bariatric surgery patients.

OBJECTIVE: Eating behavior, attitudes toward eating and body weight and shape, and depression were assessed in a sample of 64 morbidly obese gastric bypass surgery candidates. METHOD: The Beck Depression Inventory (BDI), the Three-Factor Eating Questionnaire (TFEQ), and the Eating Disorder Examination (EDE) were administered at the first preoperative visit. RESULTS: Twenty-five subjects (39%) reported at least one binge episode per week on average over the 3 months prior to seeking treatment. Binge eaters had significantly higher TFEQ Disinhibition and Hunger scores than nonbinge eaters. Binge eaters also differed from nonbinge eaters in terms of attitudes toward eating, shape, and weight. DISCUSSION: A significant number of gastric bypass surgery candidates report binge eating. The findings are consistent with other studies showing binge eaters to be a distinctive subgroup of the obese.

Adult↗

PubMed1998

The clinical utility of randomized controlled trials.

OBJECTIVE: Efficacy studies using randomized controlled trials (RCTs), on which empirically supported treatments are based, are often rejected as having little if any relevance to clinical practice. RCTs are faulted for allegedly excluding poor prognosis patients and therapists and treatments that are unrepresentative of clinical practice. METHODS: Evidence on the generalizability of findings from RCTs to diverse patient populations, different therapists, and varied clinical settings is critically evaluated. RESULTS: Existing research indicates that RCTs commonly include patients with multiple problems and levels of disturbance as severe as patients in clinical settings. DISCUSSION: The applicability of the findings of RCTs to clinical practice will be a changing function of the nature of the particular study and clinical setting to which the results are to be generalized. Future research should address the clinical utility of the findings of efficacy studies across different patient populations, therapists, and treatment methods.

Bulimia↗

PubMed1998

Enhancing motivation for change in treatment-resistant eating disorders.

Denial and resistance to change are prominent features in most patients with anorexia nervosa. The egosyntonic quality of symptoms can contribute to inaccuracy in self-report, avoidance of treatment, difficulties in establishing a therapeutic relationship, and high rates of attrition and relapse. Individuals with bulimia nervosa are typically more motivated to recover, but often ambivalent about forfeiting the ideal of slenderness and the protective functions of binge-purge behavior. Few attempts have been made to assess denial and resistance in the eating disorders, or to examine alternative strategies for enhancing motivation to change. Review of the clinical literature indicates a striking convergence of recommendations across conceptually distinct treatment approaches. Clinicians are encouraged to acquire a frame of reference that can help them understand the private experience of individuals with eating disorders, empathize with their distress at the prospect of weight gain, and acknowledge the difficulty of change. The Socratic method seems particularly well-suited to work with this population because of its emphasis on collaboration, openness, curiosity, patience, focused and systematic inquiry, and individual discovery. Four themes are crucial in engaging reluctant eating-disordered clients in therapy: the provision of psychoeducational material, an examination of the advantages and disadvantages of symptoms, the explicit use of experimental strategies, and an exploration of personal values.

Attitude of Health Personnel↗

PubMed1997

Selective processing of eating disorder relevant stimuli: does the Stroop Test provide an objective measure of bulimia nervosa?

OBJECTIVE: To evaluate the specificity of the modified Stroop test as an objective measure of bulimia nervosa. METHOD: A modified Stroop Test was administered to patients with bulimia nervosa and two non-clinical control groups of restrained and unrestrained eaters. RESULTS: The data failed to show any specificity in the Stroop effect. Nor did the test provide a useful measure of treatment response. DISCUSSION: Taken in conjunction with previous inconsistent findings, the results of this study call into question the utility of the modified Stroop effect as a specific measure of bulimia nervosa.

Adult↗

PubMed1997

Treatment manuals in clinical practice.

Hickling and Blanchard (1997) [Behavior Research and Therapy, 35, 191-203] summarize the results of treating PTSD patients with a highly structured treatment manual. Presenting a 'clinician's reaction' they argue for the added value of modifying treatment manuals based on the therapist's clinical experience and claim that manuals do not provide complete treatment of patients' multiple problems. In response, I reiterate that actuarial prediction is usually superior to clinical judgment, address the treatment of co-morbid psychopathology, underscore the importance of specific therapist skills in implementing manual-based treatment, and point out ways in which manual-based treatment can be more flexible and individualized than Hickling and Blanchard imply.

Accidents, Traffic↗

PubMed1997

Medication and psychotherapy in the treatment of bulimia nervosa.

OBJECTIVE: Two treatments for bulimia nervosa have emerged as having established efficacy: cognitive-behavioral therapy and antidepressant medication. This study sought to address 1) how the efficacy of a psychodynamically oriented supportive psychotherapy compared to that of cognitive-behavioral therapy; 2) whether a two-stage medication intervention, in which a second antidepressant (fluoxetine) was employed if the first (desipramine) was either ineffective or poorly tolerated, added to the benefit of psychological treatment; and 3) if the combination of medication and psychological treatment was superior to a course of medication alone. METHOD: A total of 120 women with bulimia nervosa participated in a randomized, placebo-controlled trial. RESULTS: Cognitive-behavioral therapy was superior to supportive psychotherapy in reducing behavioral symptoms of bulimia nervosa (binge eating and vomiting). Patients receiving medication in combination with psychological treatment experienced greater improvement in binge eating and depression than did patients receiving placebo and psychological treatment. In addition, cognitive-behavioral therapy plus medication was superior to medication alone, but supportive psychotherapy plus medication was not. CONCLUSIONS: At present, cognitive-behavioral therapy is the psychological treatment of choice for bulimia nervosa. A two-stage medication intervention using fluoxetine adds modestly to the benefit of psychological treatment.

Adolescent↗

PubMed1996

Assessment of eating disorders: interview versus questionnaire.

OBJECTIVE: This study assessed the validity of the Eating Disorder Examination--Questionnaire (EDE-Q) in identifying eating disorder symptoms in female substance abusers. METHOD: Subjects were assessed for the presence of eating disorder behaviors and attitudes using the Eating Disorder Examination (EDE), a semistructured interview, and the EDE-Q. The results of the two measures were then compared. RESULTS: Results showed that the EDE-Q does identify eating disorders in this population. It is more accurate in assessing purging than the more complex features of binge eating and dietary restraint. DISCUSSION: Eating disorders and substance abuse co-occur at a higher rate than expected by chance, and recent findings indicate that eating disorders often go undetected among patients with substance abuse. The EDE-Q appears to be an effective screening instrument for detecting the presence of eating disorder symptoms in this population.

Adolescent↗

PubMed1996

Treatment of bulimia nervosa: when CBT fails.

Controlled studies have established manual-based cognitive-behavioral therapy (CBT) is the first-line treatment of choice for bulimia nervosa. Nevertheless, its effectiveness is limited. On average, only 50% of patients cease being eating and purging. Of the remainder, some show partial improvement, whereas a small number derive no benefit at all. In treating nonresponders to CBT one option would be to use antidepressant medication. A second would be to adopt interpersonal psychotherapy (IPT), an alternative psychological therapy with empirical support. However, both options have failed to reduce binge eating following unsuccessful CBT. Treating nonresponders is hampered by the lack of treatment-specific predictor variables. Comorbid personality disorder is associated with a poorer response not only to CBT but also alternative therapies. There is no evidence that psychodynamic therapy is effective with complex cases with associated psychopathology. A third option is to use more expanded or intensive CBT. An example of the latter would be concentrated exposure within an inpatient setting. The relative merits of adhering to manual-based treatment versus allowing therapists free reign in individual case formulation are discussed.

Bulimia↗

PubMed1996

Manual-based treatments: the clinical application of research findings.

In addition to their now required use in controlled outcome studies, treatment manuals offer important advantages for clinical practice. Manual-based treatments are often empirically-validated, more focused, and more disseminable. They are useful in the training and supervision of therapists. Criticisms of manual-based treatments center on five main themes: they are conceptually at odds with fundamental principles of cognitive-behavioral therapy; they preclude idiographic case formulation; they undermine therapists' clinical artistry; they apply primarily to research samples which differ from the patients practitioners treat; and they promote particular 'schools' of psychological therapy. This paper emphasizes the inherent limitations of idiographic case formulation. It is argued that treatment manuals are consistent with an actuarial approach to assessment and therapy, which, on average, is superior to individual clinical judgment. Available data suggest that standardized treatment is no less effective than individualized therapy. Manual-based treatment demands therapist skill in its implementation. In suitably chosen therapists these skills are more a function of training than amount of clinical experience. Treatment manuals are likely to encourage a pragmatic approach to therapy and should not discourage clinical innovations.

Humans↗

PubMed1996

Eating pathology among women with alcoholism and/or anxiety disorders.

Two hundred one non-treatment seeking women with alcoholism, anxiety disorders, alcoholism and anxiety disorders, or neither alcoholism nor anxiety disorders were interviewed to assess core psychopathology associated with eating disorders using the Eating Disorders Examination and DSM-IIIR psychiatric diagnoses using the Schedule of Affective Disorders and Schizophrenia-Lifetime version. Alcoholic women had significantly higher mean scores on each of the Eating Disorders Examination subscales of Restraint, Overeating, Eating Concern, Shape Concern, and Weight Concern compared with nonalcoholic women. Women with anxiety disorders had significantly elevated scores on subscales of Overeating, Eating Concern, and Weight Concern compared with women without anxiety disorders. Women with both alcoholism and anxiety disorders had higher rates of bulimia nervosa and/or eating disorder NOS compared with women with either disorder alone. Implications of these findings are discussed in the context of the co-morbid association between alcoholism, eating disorders, and anxiety disorders.

Adolescent↗

PubMed1994

Assessment of diagnostic features of bulimia nervosa: interview versus self-report format.

In order to determine the clinical severity of bulimia nervosa and to measure symptomatic improvement during treatment, the behavioral and psychological features of the syndrome must be assessed. Focused semistructured interviews have recently been designed for this purpose, but such instruments can be time-consuming and costly. The present study compared the assessment of the key symptoms of bulimia nervosa using the Eating Disorder Examination with data obtained in self-report inventories and in patients' diaries of binge eating and purging. Results suggest that once the diagnosis has been established and patients have been instructed in the construct of a binge, the essential features of bulimia nervosa (frequency of binge eating and purging, and overconcern with body shape and weight) can be evaluated with self-report measures. These findings may be useful for the purposes of repeated assessment of progress and measurement of outcome in treatment studies.

Adult↗

PubMed1994

Behavioral treatment of childhood obesity: theoretical and practical implications.

The impressive 10-year success of behavioral treatment of childhood obesity stands in marked contrast to the disappointing long-term results obtained with obese adults. It may be easier to teach children healthy eating and activity habits. Parents also regulate access to food, thereby reducing the importance of self-control. Whether treatment of childhood obesity affects the later development of an eating disorder is a question that calls for future research.

Adult↗

PubMed1994

Cognitive therapy.

Explore the source record for details and available documents.

Anorexia Nervosa↗

PubMed1994

Parental history of alcohol abuse and the effects of alcohol and expectations of intoxication on social stress.

Male and female social drinkers, half of whom had a biological father who abused alcohol, were exposed to a social stressor (anticipation and delivery of a public speech) after consuming either a moderate dose of alcohol or tonic water. Half of each group were led to believe that they had consumed alcohol, the other half tonic water, yielding a 2 x 2 x 2 x 2 factorial design. Intoxication, but not beliefs about having consumed alcohol, significantly reduced subjective anxiety and negative self-evaluation in response to the stressor in both men and women. Parental history of alcohol abuse differentially affected alcohol's influence on mood, but not measures of subjective intoxication, subjective physiological responses to alcohol, beliefs about alcohol's effects on behavior, or reactivity to the stressor.

Adult↗

PubMed1993

Relation of dieting and voluntary weight loss to psychological functioning and binge eating.

Voluntary weight loss in obese patients consistently reduces negative emotions such as depression and anxiety in the short term. Dieting by persons of normal weight is associated with low self-esteem and depressive symptoms. Dieting is linked to the development and maintenance of eating disorders such as anorexia nervosa and bulimia nervosa, although the precise nature of this association is unclear. Dieting cannot be a sufficient causal condition and must combine with other still undetermined vulnerabilities to cause eating disorders. Identification of these risk factors must precede the development of effective programs to prevent eating disorders.

Diet, Reducing↗

PubMed1993

Assessment of binge eating in obese patients.

Obese patients entering a weight control program were classified as binge eaters if they reported uncontrolled consumption of what others would regard as an unusually large amount of food at least once a week for the previous month. Binge eaters differed significantly from nonbingers across a broad range of eating and weight-related characteristics assessed using a self-report version of the Eating Disorder Examination. Attitudinal differences were marked. The results provided no support for the view that obese binge eaters have a pattern of general "addictiveness" to psychoactive substances or other activities.

Adult↗

PubMed1993

Cognitive treatments for eating disorders.

Cognitive-behavioral therapy (CBT) is applicable to all eating disorders but has been most intensively studied in the treatment of bulimia nervosa (BN). CBT is designed to alter abnormal attitudes about body shape and weight, replace dysfunctional dieting with normal eating habits, and develop coping skills for resisting binge eating and purging. CBT is effective in reducing all core features of BN and shows good maintenance of therapeutic improvement. Although superior to therapy with antidepressant drugs, CBT has not been shown to be consistently superior to alternative psychological treatments. Different hypotheses about CBT's mechanisms of action are discussed.

Adaptation, Psychological↗