The Need to Control Thoughts in Eating Disorder Outpatients: A Longitudinal Study on Its Modification and Association with Eating Disorder Symptom Improvement
Abstract
:1. Introduction
2. Materials and Methods
2.1. Participants
2.2. Measures
- (1)
- The Metacognitions Questionnaire [21] is a self-report questionnaire with 65 Likert scale items assessing five positive and negative evaluations of one’s cognitive processes: positive beliefs about worry, beliefs about the need to control thoughts, cognitive confidence, negative beliefs about the uncontrollability and danger of thoughts, and cognitive self-consciousness. The Italian translation (M. Brazzelli and G. Cocchini) of the MCQ-65 provided in Wells’ [22] treatment manual for anxiety disorders was used. In the current study, only the need-to-control-thoughts scale, composed of 16 items, was used. Cronbach’s alpha was 0.86 for beliefs about the need to control thoughts, in line with the validation of the original English version [1].
- (2)
- The General Health Questionnaire 30-item version [23] is an instrument used for evaluating depressive and anxiety symptoms, sleeping problems, social functioning, well-being, and coping abilities. A composite global score is used. Higher scores reflect a greater impairment of mental health. The GHQ global score was developed as a screening measure to detect cases that are likely to have or be at major risk of developing psychiatric disorders. Cronbach’s alpha coefficients for the GHQ-30 have been tested in various empirical studies in community samples, ranging from approximately 0.82 to 0.93. Test–retest reliability coefficients varied from 0.50 to 0.90, whereas validity correlations with outcome scores from psychiatric structured interviews ranged between 0.65 and 0.70. In this study, the Italian version was applied [24].
- (3)
- The Eating Attitudes Test-40 [25] is a 40-item Likert scale screening measure used to identify behaviors and cognitive patterns associated with EDs, where a greater total score indicates a higher ED severity. The measure yields a total score and three subscale scores: dieting, bulimia and food preoccupations, and oral control. The dieting subscale concerns a preoccupation with being thinner and a tendency to avoid high-calorie food. Bulimia and food preoccupations relate to the items that reflect thoughts about food, while the oral control subscale describes attempts to control eating, and the perceived social pressure to gain weight. The measure shows excellent psychometric properties [25]. In this study, we used the Italian version of the EAT-40, which has been validated [26] and exhibits good psychometric properties, with reported Cronbach alphas of 0.80 for the dieting subscale, 0.70 for the bulimia and food preoccupations subscale, and 0.83 for the oral control subscale.
- (4)
- Body mass index (BMI) and illness duration in months were identified from medical records. BMI in adolescents (age < 20 years) was checked against the normative weight percentiles for the Italian population [27], with correspondence between AN diagnosis and underweight status, between both BN and OSFED diagnoses, and against normal weight or over-weight status.
2.3. Treatment
2.4. Data Analysis
3. Results
3.1. Sample Characteristics
3.2. Paired t-Tests
3.3. Regression Analysis
4. Discussion
4.1. Implications
4.2. Limitations and Future Directions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- Wells, A. Metacognitive Therapy for Anxiety and Depression; Guilford Press: New York, NY, USA, 2009. [Google Scholar]
- Tajrishi, K.Z.; Mohammadkhani, S.; Jadidi, F. Metacognitive beliefs and negative emotions. Proc. Soc. 2011, 30, 530–533. [Google Scholar] [CrossRef] [Green Version]
- Heiden, C.V. Metacognitions in generalized anxiety disorder: Theoretical and practical perspectives. Expert Rev. Neurother. 2013, 13, 135–141. [Google Scholar] [CrossRef] [PubMed]
- Cucchi, M.; Bottelli, V.; Cavadini, D.; Ricci, L.; Conca, V.; Ronchi, P.; Smeraldi, E. An explorative study on metacognition in obsessive-compulsive disorder and panic disorder. Comp. Psychiatry 2012, 53, 546–553. [Google Scholar] [CrossRef] [PubMed]
- Jelinek, L.; Van Quaquebeke, N.; Moritz, S. Cognitive and metacognitive mechanisms of change in metacognitive training for depression. Sci. Rep. 2017, 7, 3449. [Google Scholar] [CrossRef] [PubMed]
- Roussis, P.; Wells, A. Post-traumatic stress symptoms: Tests of relationships with thought control strategies and beliefs as predicted by the metacognitive model. Personal. Individ. Differ. 2006, 40, 111–122. [Google Scholar] [CrossRef]
- Palmieri, S.; Mansueto, G.; Ruggiero, G.M.; Caselli, G.; Sassaroli, S.; Spada, M.M. Metacognitive beliefs across eating disorders and eating behaviours: A systematic review. Clin. Psychol. Psychother. 2021, 28, 1254–1265. [Google Scholar] [CrossRef] [PubMed]
- Olstad, S.; Solem, S.; Hjemdal, O.; Hagen, R. Metacognition in eating disorders: Comparison of women with eating disorders, self-reported history of eating disorders or psychiatric problems, and healthy controls. Eat. Behav. 2015, 16, 17–22. [Google Scholar] [CrossRef]
- Quattropani, M.C.; Lenzo, V.; Faraone, C.; Pistorino, G.; Di Bella, I.; Mucciardi, M. The role of metacognition in eating behavior: An exploratory study. Mediterr. J. Clin. Psychol. 2016, 4, 1–15. [Google Scholar] [CrossRef]
- Sun, X.; Zhu, C.; So, S.H.W. Dysfunctional metacognition across psychopathologies: A meta-analytic review. Eur. Psychiatry 2017, 45, 139–153. [Google Scholar] [CrossRef]
- Georgantopoulos, G.; Konstantakopoulos, G.; Michopoulos, I.; Dikeos, D.; Gonidakis, F. The relationship between metacognitive beliefs and symptoms in eating disorders. Psychiatriki 2020, 31, 225–235. [Google Scholar] [CrossRef]
- Davenport, E.; Rushford, N.; Soon, S.; McDermott, C. Dysfunctional metacognition and drive for thinness in typical and atypical anorexia nervosa. J. Eat. Disord. 2015, 3, 24. [Google Scholar] [CrossRef] [Green Version]
- Tecuta, L.; Gardini, V.; DiGiuseppe, R.; Tomba, E. Do metacognitions mediate the relationship between irrational beliefs, eating disorder symptoms and cognitive reappraisal? Psychother. Res. 2020, 31, 483–492. [Google Scholar] [CrossRef]
- Fairburn, C.G.; Cooper, Z.; Shafran, R. Cognitive behaviour therapy for eating disorders: A “transdiagnostic” theory and treatment. Behav. Res. Ther. 2003, 41, 509–528. [Google Scholar] [CrossRef]
- Fairburn, C.G.; Cooper, Z.; Doll, H.A.; O’Connor, M.E.; Palmer, R.L.; Dalle Grave, R. Enhanced cognitive behavioural therapy for adults with anorexia nervosa: A UK- Italy study. Behav. Res. Ther. 2012, 51, 2–8. [Google Scholar] [CrossRef] [Green Version]
- Atwood, M.E.; Friedman, A. A systematic review of enhanced cognitive behavioral therapy (CBT-E) for eating disorders. Int. J. Eat. Disord. 2020, 53, 311–330. [Google Scholar] [CrossRef]
- Cooper, M.; Todd, G.; Wells, A. Treating Bulimia Nervosa and Binge Eating: An Integrated Metacognitive and Cognitive Therapy Manual; Routledge: London, UK, 2009. [Google Scholar]
- Jones, C.J.; Leung, N.; Harris, G. Dysfunctional core beliefs in eating disorders: A review. J. Cogn. Psychother. 2007, 21, 156–171. [Google Scholar] [CrossRef]
- APA. Diagnostic and Statistical Manual of Mental Disorders, 5th ed.; American Psychiatric Association: Washington, DC, USA, 2013. [Google Scholar]
- First, M.B.; Williams, J.B.W.; Karg, R.S.; Spitzer, R.L. Structured Clinical Interview for DSM-5 Disorders, Clinician Version (SCID-5-CV); American Psychiatric Association: Arlington, VA, USA, 2015. [Google Scholar]
- Cartwright-Hatton, S.; Wells, A. Beliefs about worry and intrusions: The meta-cognitions questionnaire and its correlates. J. Anxiety Disord. 1997, 1, 279–296. [Google Scholar] [CrossRef]
- Wells, A. Appendix. In Cognitive Therapy of Anxiety Disorders; Brazzelli, M., Cocchini, G.T., Eds.; McGraw-Hill: New York, NY, USA, 1999. [Google Scholar]
- Goldberg, D. The Detection of Psychiatric Illness by Questionnaire: A Technique for the Identification and Assessment of Non-Psychotic Psychiatric Illness; Oxford University Press: London, UK, 1972. [Google Scholar]
- Bellantuono, C.; Fiorio, R.; Zanotelli, R.; Tansella, M. Psychiatric screening in general practice in Italy. A validity study of GHQ. Soc. Psychiatr. 1987, 22, 113–117. [Google Scholar] [CrossRef]
- Garner, D.M.; Garfinkel, P.E. The Eating Attitude Test: An index of the symptoms of anorexia nervosa. Psychol. Med. 1979, 9, 273–279. [Google Scholar] [CrossRef]
- Cuzzolaro, M.; Petrilli, A. Validazione della versione italiana dell’EAT-40. Psichiatr. Dell’infanzia E Dell’adolescenza 1988, 55, 209–217. [Google Scholar]
- Cacciari, E.; Milani, S.; Balsamo, A. Directive Councils of SIEDP/ISPED for 1996–97 and 2002–03. J. Endocrinol. Invest. 2006, 29, 581–593. [Google Scholar] [CrossRef] [PubMed]
- Fairburn, C.G. Cognitive Behavior Therapy and Eating Disorders; Guilford Press: New York, NY, USA, 2008. [Google Scholar]
- American Psychiatric Association. Practice Guideline for the Treatment of Patients with Eating Disorders, 3rd ed.; APA: Washington, DC, USA, 2006. [Google Scholar]
- Field, A. Discovering statistics. In IBM SPSS Statistics, 4th ed.; Sage Publications: London, UK, 2013. [Google Scholar]
- Sullivan, G.M.; Feinn, R. Using Effect Size—Or Why the p Value Is Not Enough. J. Grad. Med. Educ. 2012, 4, 279–282. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Cohen, J. Statistical Power Analysis for the Behavioral Sciences, 2nd ed.; Lawrence Erlbaum Associates: Hillsdale, NJ, USA, 1988. [Google Scholar]
- Nezu, C.M.; Nezu, A.M. The Oxford Handbook of Cognitive and Behavioral Therapies; Oxford University Press: New York, NY, USA, 2016. [Google Scholar]
- National Health Service. National Institute for Clinical Excellence (NICE) Clinical Guideline for Eating Disorders; National Institute for Clinical Excellence: London, UK, 2017.
- Vann, A.; Strodl, E.; Anderson, E. The transdiagnostic nature of metacognitions in women with eating disorders. Eat. Disord. 2014, 22, 306–320. [Google Scholar] [CrossRef] [PubMed]
- DiGiuseppe, R.; Doyle, K.A.; Dryden, W.; Backx, W. A Practitioners’ Guide to Rational Emotive Behavior Therapy, 3rd ed.; Oxford University Press: New York, NY, USA, 2014. [Google Scholar]
- DiGiuseppe, R.; David, D.; Venezia, R. Cognitive theories. In The Handbook of Clinical Psychology Volume II of V. Theory and Research; Norcross, J.C., VandenBos, G.R., Freedheim, D.F., Eds.; American Psychological Association: Washington, DC, USA, 2016; pp. 45–182. [Google Scholar]
- Ingram, R.E. Self-focused attention in clinical disorders: Review and a conceptual model. Psychol. Bull. 1990, 107, 156–176. [Google Scholar] [CrossRef] [PubMed]
- Ellis, A. Reason and Emotion in Psychotherapy; Birch Lane Press: New York, NY, USA, 1994. [Google Scholar]
- Fairburn, C.G.; Beglin, S.J. Eating Disorder Examination Questionnaire (EDE-Q 6.0). In Cognitive Behavior Therapy and Eating Disorders; Fairburn, C.G., Ed.; The Guilford Press: New York, NY, USA, 2008; pp. 309–314. [Google Scholar]
- Garner, D.M. EDI-3. Eating disorder Inventory-3. Professional Manual; Psychological Assessment Research Inc.: Lutz, FL, USA, 2008. [Google Scholar]
- Sassaroli, S.; Gallucci, M.; Ruggiero, G.M. Low perception of control as a cognitive factor of eating disorders: Its independent effects on measuring of eating disorders and its interactive effects with perfectionism and self-esteem. J. Behav. Ther. Exp. Psychiatry 2008, 39, 467–488. [Google Scholar] [CrossRef] [PubMed]
- Cooper, M. Cognitive theory of anorexia nervosa and bulimia nervosa: Progress, development and future directions. Clin. Psychol. Rev. 2005, 25, 511–531. [Google Scholar] [CrossRef] [PubMed]
- Laghi, F.; Bianchi, D.; Pompili, S.; Lonigro, A.; Baiocco, R. Metacognition, emotional functioning and binge eating in adolescence: The moderation role of need to control thoughts. Eat. Weight Disord. 2018, 23, 861–869. [Google Scholar] [CrossRef]
- Cowdrey, F.A.; Park, R.J. Assessing rumination in eating disorders: Principal component analysis of a minimally modified ruminative response scale. Eat. Behav. 2011, 12, 321–324. [Google Scholar] [CrossRef]
- Startup, H.; Lavender, A.; Oldershaw, A.; Stott, R.; Tchanturia, K.; Treasure, J.; Schmidt, U. Worry and rumination in anorexia nervosa. Behav. Cogn. Psychother. 2013, 41, 301–316. [Google Scholar] [CrossRef]
- Surgenor, L.J.; Horn, J.; Plumridge, E.W.; Hudson, S.M. Anorexia nervosa and psychological control: A reexamination of selected theoretical accounts. Eur. Eat. Disord. Rev. 2002, 10, 85–101. [Google Scholar] [CrossRef]
- Bruch, H. Eating Disorders: Obesity, Anorexia Nervosa and the Person Within; Basic Books: New York, NY, USA, 1973. [Google Scholar]
- Crisp, A.H. Anorexia Nervosa: Let Me Be; Academic Press: London, UK, 1980. [Google Scholar]
- Garfinkel, P.E.; Garner, D.M. Anorexia Nervosa: A Multidimensional Perspective; Brunner/Mazel Inc.: New York, NY, USA, 1982. [Google Scholar]
- Fairburn, C.G.; Shafran, R.; Cooper, Z.A. Cognitive behavioural theory of anorexia nervosa. Behav. Res. Ther. 1999, 37, 1–13. [Google Scholar] [CrossRef]
- Monteleone, A.M.; Cascino, G. A systematic review of network analysis studies in eating disorders: Is time to broaden the core psychopathology to non specific symptoms. Eur. Eat. Disord. Rev. 2021, 29, 531–547. [Google Scholar] [CrossRef]
- Robertson, S.; Strodl, E. Metacognitive therapy for binge eating disorder: A case series study. Clin. Psychol. 2020, 24, 143–154. [Google Scholar] [CrossRef]
T0 Mean ± SD | T1 Mean ± SD | T (df) | p | r(p) | d | |
---|---|---|---|---|---|---|
MCQ-Need to control thoughts | 27.84 ± 8.02 | 24.61 ± 6.67 | 3.510(69) | <0.001 | 0.464 (<0.001) | 0.438 |
EAT-Oral control | 7.94 ± 5.47 | 3.86 ± 4.86 | 6.631(69) | <0.001 | 0.507 (<0.001) | 0.788 |
EAT-Bulimia and food preoccupations | 7.87 ± 4.45 | 3.79 ± 4.10 | 7.443(69) | <0.001 | 0.426 (<0.001) | 0.954 |
EAT-Dieting | 18.39 ± 10.47 | 9.76 ± 9.60 | 6.611(69) | <0.001 | 0.425(<0.001) | 0.859 |
Model | B | 95% CI for B | β | t(p) | F(p) | R | R2 | ΔR2 |
---|---|---|---|---|---|---|---|---|
Model Outcome: Δ EAT-40 Oral control | ||||||||
Constant | −3.007 | (−8.539, 2.526) | −1.087 (0.281) | 5.141 (<0.0001) | 0.609 | 0.371 | 0.242 | |
Age | −0.071 | (−0.251, 0.109) | −0.121 | −0.791 (0.432) | ||||
Baseline BMI | 0.102 | (−0.211, 0.416) | 0.091 | 0.651 (0.517) | ||||
Illness duration | −0.023 | (−0.271, 0.225) | −0.028 | −0.186 (0.853) | ||||
Baseline GHQ total score | −0.083 | (−0.205, 0.040) | −0.142 | −1.346 (0.183) | ||||
AN vs. BN | −1.865 | (−1.088, 4.818) | −0.180 | −1.263 (0.211) | ||||
AN vs. OSFED | −2.469 | (−1.295, 6.233) | −0.146 | −1.312 (0.194) | ||||
BN vs. OSFED | −0.604 | (−4.419, 3.210) | −0.058 | −3.17 (0.752) | ||||
Δ MCQ- Need to control | 0.341 | (0.200, 0.482) | 0.514 | 4.866(<0.0001) | ||||
Model Outcome: Δ EAT-40 Bulimia and food preoccupations | ||||||||
Constant | 0.113 | (−5.319, 5.544) | 0.041 (0.967) | 2.936 (0.010) | 0.502 | 0.252 | 0.122 | |
Age | −0.045 | (−0.222, 0.132) | −0.085 | −0.512 (0.610) | ||||
Baseline BMI | −0.088 | (−0.396, 0.219) | −0.087 | −0.574 (0.568) | ||||
Illness duration | −0.038 | (−0.281, 0.206) | −0.052 | −0.311 (0.757) | ||||
Baseline GHQ total score | −0.010 | (−0.130, 0.111) | −0.019 | −0.161 (0.873) | ||||
AN vs. BN | 1.442 | (−1.457, 4.341) | 0.154 | 0.995 (0.324) | ||||
AN vs. OSFED | −2.286 | (−5.981, 1.409) | −0.249 | −1.237 (0.221) | ||||
BN vs. OSFED | −3.728 | (−7.473, 0.017) | −0.399 | −1.991 (0.051) | ||||
Δ MCQ- Need to control | 0.218 | (0.073, 0.353) | 0.365 | 3.153 (0.002) | ||||
Model Outcome: Δ EAT-40 Dieting | ||||||||
Constant | −9.723 | (−22.046, 2.600) | −1.578 (0.120) | 3.537 (0.003) | 0.537 | 0.289 | 0.189 | |
Age | −0.053 | (−0.454, 0.348) | −0.043 | −0.265 (0.792) | ||||
Baseline BMI | 0.378 | (−0.321, 1.076) | 0.160 | 1.081 (0.284) | ||||
Illness duration | −0.144 | (−0.697, 0.408) | −0.085 | −0.523 (0.603) | ||||
Baseline GHQ total score | −0.125 | (−0.398, 0.148) | −0.103 | −0.915 (0.364) | ||||
AN vs. BN | 2.025 | (−8.601, 4.552) | 0.093 | 0.616 (0.540) | ||||
AN vs. OSFED | −6.715 | (−1.669, 15.099) | −0.190 | −1.602 (0.114) | ||||
BN vs. OSFED | −7.063 | (−16.106, 1.980) | −3.26 | −1.562 (0.123) | ||||
Δ MCQ- Need to control | 0.632 | (0.318, 0.945) | 0.455 | 4.031 (0.023) |
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. |
© 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Tecuta, L.; Schumann, R.; Ballardini, D.; Tomba, E. The Need to Control Thoughts in Eating Disorder Outpatients: A Longitudinal Study on Its Modification and Association with Eating Disorder Symptom Improvement. J. Clin. Med. 2022, 11, 2205. https://doi.org/10.3390/jcm11082205
Tecuta L, Schumann R, Ballardini D, Tomba E. The Need to Control Thoughts in Eating Disorder Outpatients: A Longitudinal Study on Its Modification and Association with Eating Disorder Symptom Improvement. Journal of Clinical Medicine. 2022; 11(8):2205. https://doi.org/10.3390/jcm11082205
Chicago/Turabian StyleTecuta, Lucia, Romana Schumann, Donatella Ballardini, and Elena Tomba. 2022. "The Need to Control Thoughts in Eating Disorder Outpatients: A Longitudinal Study on Its Modification and Association with Eating Disorder Symptom Improvement" Journal of Clinical Medicine 11, no. 8: 2205. https://doi.org/10.3390/jcm11082205