Mediators of change in cognitive behavior therapy and interpersonal psychotherapy for eating disorders: a secondary analysis of a transdiagnostic randomized controlled trial
Open accessAbstract
OBJECTIVE: Understanding the mechanisms of action of psychological treatments is a key first step in refining and developing more effective treatments. The present study examined hypothesized mediators of change of enhanced cognitive behavior therapy (CBT-E) and interpersonal psychotherapy for eating disorders (IPT-ED). METHOD: A series of mediation studies were embedded in a randomized controlled trial (RCT) comparing 20 weeks of CBT-E and IPT-ED in a transdiagnostic, non-underweight sample of patients with eating disorders (N = 130) consecutively referred to the service. Three hypothesized mediators of change in CBT-E (regular eating, weighing frequency, and shape checking) and the key hypothesized mediator of IPT-ED (interpersonal problem severity) were studied. RESULTS: The data supported regular eating as being a mediator of the effect of CBT-E on binge-eating frequency. The findings were inconclusive regarding the role of the other putative mediators of the effects of CBT-E; and were similarly inconclusive for interpersonal problem severity as a mediator of the effect of IPT-ED. DISCUSSION: This research highlights the potential benefits of embedding mediation studies within RCTs to better understand how treatments work. The findings supported the role of regular eating in reducing patients' binge-eating frequency. Other key hypothesized mediators of CBT-E and IPT-ED were not supported, although the data were not inconsistent with them. Key methodological issues to address in future work include the need to capture both behavioral and cognitive processes of change in CBT-E, and identifying key time points for change in IPT-ED.
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The marked slowing in the rate of change at this juncture further supports the theory that behavioural techniques introduced in the preliminary sessions of CBT treatment (i.e., weekly weighing, self-monitoring of food intake, regular eating) may facilitate early and rapid symptom change.
“A marked slowing in the rate of change at this juncture further supports the theory that behavioural techniques introduced in the preliminary sessions of CBT treatment (i.e., weekly weighing, self-monitoring of food intake, regular eating) may facilitate early and rapid symptom change (34, 53, 54).”
From The acceptability, feasibility, and preliminary efficacy of a supported online self-help treatment program for binge-eating disorder (2023) · cites this paper as [53]
Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredThis is noteworthy given the sub-clinical level of dietary restraint in this sample but aligns with evidence suggesting regular eating may be the most potent mechanism behind reductions in OBEs in CBT-based interventions in transdiagnostic non-underweight ED samples.
“This is noteworthy given the sub-clinical level of dietary restraint in this sample but aligns with evidence suggesting regular eating may be the most potent mechanism behind reductions in OBEs in CBT-based interventions in transdiagnostic non-underweight ED samples (53, 55).”
From The acceptability, feasibility, and preliminary efficacy of a supported online self-help treatment program for binge-eating disorder (2023) · cites this paper as [53]
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- Authors
- Sivyer, K., Allen, E., Cooper, Z., Bailey‐Straebler, S., O'Connor, M. E., Fairburn, C. G., & Murphy, R.
- Affiliations
- University of Oxford (GB)
- London School of Hygiene & Tropical Medicine (GB)
- Corresponding author
- Sivyer, Katy
- ORCID
- Venue
- International Journal of Eating Disorders
- Publisher
- Wiley
- Published
- 2020-11-05
- Volume
- 53
- Issue
- 12
- Pages
- 1928-1940
- ISSN
- 0276-3478 (ISSN-L)
- 1098-108X
- PMC
- PMC7756462
- OpenAlex
- W3094481030
- Cited by
- 27
- References
- 41
- Citations by year
- 2026: 1 · 2025: 4 · 2024: 3 · 2023: 7 · 2022: 6 · 2021: 5 · 2020: 1
- FWCI
- 1.90
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- International Journal of Eating Disorders (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- ePrints Soton (University of Southampton) (acceptedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- Funders
- Wellcome Trust (046386)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
- Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- eating disorders, mediators of change, binge eating, transdiagnostic treatment
- MeSH terms
- Interpersonal Psychotherapy, Adult, Feeding and Eating Disorders, Humans, Cognitive Behavioral Therapy, Treatment Outcome
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