Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Jul;27(4):352-380.
doi: 10.1002/erv.2673. Epub 2019 Mar 19.

Mechanisms and moderators in mindfulness- and acceptance-based treatments for binge eating spectrum disorders: A systematic review

Jennifer L Barney  1 , Helen B Murray  2 , Stephanie M Manasse  2 , Cara Dochat  3 , Adrienne S Juarascio  2
Affiliations

Mechanisms and moderators in mindfulness- and acceptance-based treatments for binge eating spectrum disorders: A systematic review

Jennifer L Barney et al. Eur Eat Disord Rev. 2019 Jul.

Abstract

Objective: Increasing evidence suggests that mindfulness- and acceptance-based psychotherapies (MABTs) for bulimia nervosa (BN) and binge eating disorder (BED) may be efficacious; however, little is known about their active treatment components or for whom they may be most effective.

Methods: We systematically identified clinical trials testing MABTs for BN or BED through PsychINFO and Google Scholar. Publications were categorized according to analyses of mechanisms of action and moderators of treatment outcome.

Results: Thirty-nine publications met inclusion criteria. Twenty-seven included analyses of therapeutic mechanisms, and five examined moderators of treatment outcome. Changes were largely consistent with hypothesized mechanisms of MABTs, but substandard mediation analyses, inconsistent measurement tools, and infrequent use of mid-treatment assessment points limited our ability to make strong inferences.

Discussion: Analyses of mechanisms of action and moderators of outcome in MABTs for BN and BED appear promising, but the use of more sophisticated statistical analyses and adequate replication is necessary.

Keywords: acceptance-based therapies; binge eating disorder; bulimia nervosa; eating disorders; mindfulness.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
PRISMA 2009 Flow Diagram
Figure 2.
Figure 2.. Pre-Post Change
In pre-post change, changes in process measures and outcome measures from pre to post-treatment are examined in isolation. While improvements in process measures are in important first step, it is inappropriate to infer any relation with outcome.
Figure 3.
Figure 3.. “Proxy” Mediation
In “proxy” mediation, change in process measures from pre- to post-treatment were correlated with changes in outcome measures from pre-to post-treatment. As denoted by the grey dashed arrow, it is often assumed that change in the process variable change leads to change in the outcome variable, but this “proxy” mediation method leaves the possibility that change in the outcome is causing change in the process variable, or that both changes are being caused by an additional third variable.
Figure 4.
Figure 4.. Mediation (Formal)
In formal mediation, change in process measures from pre- to mid-treatment are used to predict change in the outcome variable from pre- to post treatment. As denoted by the grey arrow, this design still allows for the possibility that in fact early change in the outcome leads to early change in the process variable (which in turn may be related to pre-post change in the outcome variable).
Figure 5.
Figure 5.. Mediation (Ideal)
In ideal mediation, change in process measures from pre- to mid-treatment are used to predict subsequent change in the outcome variable from mid to post-treatment. This design allows for more confidence that change in a process variable produced a subsequent change in the outcome variable (true mediation).
See this image and copyright information in PMC

References

    1. Agüera Z, Sánchez I, Granero R, Riesco N, Steward T, Martín‐Romera V, … Segura‐García C (2017). Short‐term treatment outcomes and dropout risk in men and women with eating disorders. European Eating Disorders Review, 25(4), 293–301. - PubMed
    1. Arnow B, Kenardy J, & Agras WS (1995). The Emotional Eating Scale: The development of a measure to assess coping with negative affect by eating. International Journal of Eating Disorders, 18(1), 79–90. - PubMed
    1. Association AP (2013). Diagnostic and statistical manual of mental disorders (DSM-5®) (5th ed.): American Psychiatric Pub.
    1. Azari S, Fata L, & Poursharifi H (2013). The Effect of Short-Term Cognitive Behavioral Therapy and Mindfulness Based Cognitive Therapy in Patients with Binge Eating Disorder. Practice in Clinical Psychology, 1(2), 111–116.
    1. Baer RA, Fischer S, & Huss DB (2005). Mindfulness and acceptance in the treatment of disordered eating. Journal of rational-emotive and cognitive-behavior therapy, 23(4), 281–300.

Publication types