Abstract
Objectives
Eating disorders are associated with significant physical, psychological, and social impairment, but existing treatments are effective only half of the time and relapse rates are high. Mindfulness-based programs (MBPs) are growing in empirical support and present a promising area of research to fill a crucial treatment gap for eating disorders. Several studies on MBPs for eating disorders show promising results, but overall the research on the use of mindfulness in eating disorder treatment is still lacking.
Methods
The goal of this theoretical paper is to present a rationale for why and how mindfulness may be helpful in the treatment of eating disorders.
Results
Several potential mechanisms by which MBPs may produce change in the eating disorder symptoms are presented: reduction in repetitive negative thinking and improvements in self-compassion, decentering, psychological flexibility, emotion regulation, and interoceptive awareness of hunger and fullness cues.
Conclusions
Research gaps and future directions for the study of mechanisms involved in MBPs for eating disorders are discussed.
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References
Adams, C. E., McVay, M. A., Kinsaul, J., Benitez, L., Vinci, C., Stewart, D. W., & Copeland, A. L. (2012). Unique relationships between facets of mindfulness and eating pathology among female smokers. Eating Behaviors, 13(4), 390–393. https://doi.org/10.1016/j.eatbeh.2012.05.009.
Alberts, H. J. E. M., Thewissen, R., & Raes, L. (2012). Dealing with problematic eating behaviour. The effects of a mindfulness-based intervention on eating behaviour, food cravings, dichotomous thinking and body image concern. Appetite, 58(3), 847–851. https://doi.org/10.1016/j.appet.2012.01.009.
Albertson, E. R., Neff, K. D., & Dill-Shackleford, K. E. (2015). Self-compassion and body dissatisfaction in women: A randomized controlled trial of a brief meditation intervention. Mindfulness, 6(3), 444–454. https://doi.org/10.1007/s12671-014-0277-3.
Alsubaie, M., Abbott, R., Dunn, B., Dickens, C., Keil, T. F., Henley, W., & Kuyken, W. (2017). Mechanisms of action in mindfulness-based cognitive therapy (MBCT) and mindfulness-based stress reduction (MBSR) in people with physical and/or psychological conditions: A systematic review. Clinical Psychology Review, 55, 74–91. https://doi.org/10.1016/J.CPR.2017.04.008.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596.
Arcelus, J., Mitchell, A. J., Wales, J., & Nielsen, S. (2011). Mortality rates in patients with anorexia nervosa and other eating disorders. Archives of General Psychiatry, 68(7), 724–731. https://doi.org/10.1001/archgenpsychiatry.2011.74.
Arch, J. J., & Craske, M. G. (2006). Mechanisms of mindfulness: Emotion regulation following a focused breathing induction. Behaviour Research and Therapy, 44(12), 1849–1858. https://doi.org/10.1016/J.BRAT.2005.12.007.
Baer, R. A. (2006). Mindfulness training as a clinical intervention: A conceptual and empirical review. Clinical Psychology: Science and Practice, 10(2), 125–143. https://doi.org/10.1093/clipsy.bpg015.
Baer, R. A., Smith, G. T., & Allen, K. B. (2004). Assessment of mindfulness by self-report: The Kentucky inventory of mindfulness skills. Assessment, 11(3), 191–206. https://doi.org/10.1177/1073191104268029.
Baer, R. A., Fischer, S., & Huss, D. B. (2005). Mindfulness and acceptance in the treatment of disordered eating. Journal of Rational-Emotive & Cognitive-Behavior Therapy, 23(4), 281–300. https://doi.org/10.1007/s10942-005-0015-9.
Bankoff, S. M., Karpel, M. G., Forbes, H. E., & Pantalone, D. W. (2012). A systematic review of dialectical behavior therapy for the treatment of eating disorders. Eating Disorders, 20(3), 196–215. https://doi.org/10.1080/10640266.2012.668478.
Barney, J. L., Murray, H. B., Manasse, S. M., Dochat, C., & Juarascio, A. S. (2019). Mechanisms and moderators in mindfulness- and acceptance-based treatments for binge eating spectrum disorders: A systematic review. European Eating Disorders Review, 27(4), 352–380. https://doi.org/10.1002/erv.2673.
Batink, T., Peeters, F., Geschwind, N., van Os, J., & Wichers, M. (2013). How does MBCT for depression work? Studying cognitive and affective mediation pathways. PLoS One, 8(8), e72778. https://doi.org/10.1371/journal.pone.0072778.
Beck, J. S. (2011). Cognitive behavior therapy: Basics and beyond (2nd ed.). Guilford Press.
Beshara, M., Hutchinson, A. D., & Wilson, C. (2013). Does mindfulness matter? Everyday mindfulness, mindful eating and self-reported serving size of energy dense foods among a sample of South Australian adults. Appetite, 67, 25–29. https://doi.org/10.1016/J.APPET.2013.03.012.
Bishop, S. R., Lau, M., Shapiro, S., Carlson, L., Anderson, N. D., Carmody, J., Segal, Z. V., Abbey, S., Speca, M., Velting, D., & Devins, G. (2006). Mindfulness: A proposed operational definition. Clinical Psychology: Science and Practice, 11(3), 230–241. https://doi.org/10.1093/clipsy.bph077.
Bluett, E. J., Lee, E. B., Simone, M., Lockhart, G., Twohig, M. P., Lensegrav-Benson, T., & Quakenbush-Roberts, B. (2016). The role of body image psychological flexibility on the treatment of eating disorders in a residential facility. Eating Behaviors, 23, 150–155. https://doi.org/10.1016/j.eatbeh.2016.10.002.
Bornemann, B., Herbert, B. M., Mehling, W. E., & Singer, T. (2015). Differential changes in self-reported aspects of interoceptive awareness through 3 months of contemplative training. Frontiers in Psychology, 5, 1504. https://doi.org/10.3389/fpsyg.2014.01504.
Boyd, J. E., Lanius, R. A., & McKinnon, M. C. (2018). Mindfulness-based treatments for posttraumatic stress disorder: A review of the treatment literature and neurobiological evidence. Journal of Psychiatry & Neuroscience, 43(1), 7–25. https://doi.org/10.1503/jpn.170021.
Brown, K. W., & Ryan, R. M. (2003). The benefits of being present: Mindfulness and its role in psychological well-being. Journal of Personality and Social Psychology, 84(4), 822–848. https://doi.org/10.1037/0022-3514.84.4.822.
Brown, K. W., Ryan, R. M., & Creswell, J. D. (2007). Mindfulness: Theoretical foundations and evidence for its salutary effects. Psychological Inquiry, 18(4), 211–237. https://doi.org/10.1080/10478400701598298.
Brown, T. A., Berner, L. A., Jones, M. D., Reilly, E. E., Cusack, A., Anderson, L. K., Kaye, W. H., & Wierenga, C. E. (2017). Psychometric evaluation and norms for the multidimensional assessment of interoceptive awareness (MAIA) in a clinical eating disorders sample. European Eating Disorders Review, 25(5), 411–416. https://doi.org/10.1002/erv.2532.
Butryn, M. L., Juarascio, A., Shaw, J., Kerrigan, S. G., Clark, V., O’Planick, A., & Forman, E. M. (2013). Mindfulness and its relationship with eating disorders symptomatology in women receiving residential treatment. Eating Behaviors, 14(1), 13–16. https://doi.org/10.1016/J.EATBEH.2012.10.005.
Carmody, J., Baer, R. A., Lykins, E., & Olendzki, N. (2009). An empirical study of the mechanisms of mindfulness in a mindfulness-based stress reduction program. Journal of Clinical Psychology, 65(6), 613–626. https://doi.org/10.1002/jclp.20579.
Carroll, H., & Lustyk, M. K. B. (2018). Mindfulness-based relapse prevention for substance use disorders: Effects on cardiac vagal control and craving under stress. Mindfulness, 9(2), 488–499. https://doi.org/10.1007/s12671-017-0791-1.
Chambers, R., Gullone, E., & Allen, N. B. (2009). Mindful emotion regulation: An integrative review. Clinical Psychology Review, 29(6), 560–572. https://doi.org/10.1016/J.CPR.2009.06.005.
Compare, A., Callus, E., & Grossi, E. (2012). Mindfulness trait, eating behaviours and body uneasiness: A case-control study of binge eating disorder. Eating and Weight Disorders, 17(4), e244–e251. https://doi.org/10.3275/8652.
Corstorphine, E. (2006). Cognitive-emotional-behavioural therapy for the eating disorders: Working with beliefs about emotions. European Eating Disorders Review, 14(6), 448–461. https://doi.org/10.1002/erv.747.
Courbasson, C. M., Nishikawa, Y., & Shapira, L. B. (2010). Mindfulness-action based cognitive behavioral therapy for concurrent binge eating disorder and substance use disorders. Eating Disorders, 19(1), 17–33. https://doi.org/10.1080/10640266.2011.533603.
Cowdrey, F. A., & Park, R. J. (2012). The role of experiential avoidance, rumination and mindfulness in eating disorders. Eating Behaviors, 13(2), 100–105. https://doi.org/10.1016/j.eatbeh.2012.01.001.
Cowdrey, N. D., & Waller, G. (2015). Are we really delivering evidence-based treatments for eating disorders? How eating-disordered patients describe their experience of cognitive behavioral therapy. Behaviour Research and Therapy, 75, 72–77. https://doi.org/10.1016/j.brat.2015.10.009.
Craig, P., Dieppe, P., Macintyre, S., Michie, S., Nazareth, I., Petticrew, M., & Medical Research Council Guidance. (2008). Developing and evaluating complex interventions: The new Medical Research Council guidance. BMJ, 337, a1655. https://doi.org/10.1136/BMJ.A1655.
Dar, K. A., & Iqbal, N. (2015). Worry and rumination in generalized anxiety disorder and obsessive compulsive disorder. The Journal of Psychology, 149(8), 866–880. https://doi.org/10.1080/00223980.2014.986430.
Duarte, J., & Pinto-Gouveia, J. (2017). Mindfulness, self-compassion and psychological inflexibility mediate the effects of a mindfulness-based intervention in a sample of oncology nurses. Journal of Contextual Behavioral Science, 6(2), 125–133. https://doi.org/10.1016/J.JCBS.2017.03.002.
Duarte, C., Pinto-Gouveia, J., & Stubbs, R. J. (2017). Compassionate attention and regulation of eating behaviour: A pilot study of a brief low-intensity intervention for binge eating. Clinical Psychology & Psychotherapy, 24(6), O1437–O1447. https://doi.org/10.1002/cpp.2094.
Ehring, T., & Watkins, E. R. (2008). Repetitive negative thinking as a transdiagnostic process. International Journal of Cognitive Therapy, 1(3), 192–205. https://doi.org/10.1521/ijct.2008.1.3.192.
Espel, H. M., Goldstein, S. P., Manasse, S. M., & Juarascio, A. S. (2016). Experiential acceptance, motivation for recovery, and treatment outcome in eating disorders. Eating and Weight Disorders, 21(2), 205–210. https://doi.org/10.1007/s40519-015-0235-7.
Fairburn, C. G., Cooper, Z., & Shafran, R. (2003). Cognitive behaviour therapy for eating disorders: A “transdiagnostic” theory and treatment. Behaviour Research and Therapy, 41(5), 509–528. https://doi.org/10.1016/S0005-7967(02)00088-8.
Fairburn, C. G., Cooper, Z., Doll, H. A., O’Connor, M. E., Bohn, K., Hawker, D. M., Wales, J. A., & Palmer, R. L. (2009). Transdiagnostic cognitive-behavioral therapy for patients with eating disorders: A two-site trial with 60-week follow-up. American Journal of Psychiatry, 166(3), 311–319. https://doi.org/10.1176/appi.ajp.2008.0804060.
Fairburn, C. G., Bailey-Straebler, S., Basden, S., Doll, H. A., Jones, R., Murphy, R., O'Connor, M. E., & Cooper, Z. (2015). A transdiagnostic comparison of enhanced cognitive behavior therapy (CBT-E) and interpersonal psychotherapy in the treatment of eating disorders. Behavior Research and Therapy, 70, 64–71. https://doi.org/10.1016/j.brat.2015.04.010.
Fassino, S., & Abbate-Daga, G. (2013). Resistance to treatment in eating disorders: A critical challenge. BMC Psychiatry, 13(1), 282. https://doi.org/10.1186/1471-244X-13-282.
Fassino, S., Pierò, A., Tomba, E., & Abbate-Daga, G. (2009). Factors associated with dropout from treatment for eating disorders: A comprehensive literature review. BMC Psychiatry, 9(1), 67. https://doi.org/10.1186/1471-244X-9-67.
Ferreira, C., Pinto-Gouveia, J., & Duarte, C. (2013). Self-compassion in the face of shame and body image dissatisfaction: Implications for eating disorders. Eating Behaviors, 14(2), 207–210. https://doi.org/10.1016/j.eatbeh.2013.01.005.
Fischer, D., Messner, M., & Pollatos, O. (2017). Improvement of interoceptive processes after an 8-week body scan intervention. Frontiers in Human Neuroscience, 11, 452. https://doi.org/10.3389/fnhum.2017.00452.
Fissler, M., Winnebeck, E., Schroeter, T., Gummersbach, M., Huntenburg, J. M., Gaertner, M., & Barnhofer, T. (2016). An investigation of the effects of brief mindfulness training on self-reported interoceptive awareness, the ability to decenter, and their role in the reduction of depressive symptoms. Mindfulness, 7(5), 1170–1181. https://doi.org/10.1007/s12671-016-0559-z.
Fresnics, A. A., Wang, S. B., & Borders, A. (2019). The unique associations between self-compassion and eating disorder psychopathology and the mediating role of rumination. Psychiatry Research, 274, 91–97. https://doi.org/10.1016/J.PSYCHRES.2019.02.019.
Galmiche, M., Déchelotte, P., Lambert, G., & Tavolacci, M. P. (2019). Prevalence of eating disorders over the 2000–2018 period: A systematic literature review. The American Journal of Clinical Nutrition, 109(5), 1402–1413. https://doi.org/10.1093/ajcn/nqy342.
Garland, E. L., Hanley, A. W., Goldin, P. R., & Gross, J. J. (2017). Testing the mindfulness-to-meaning theory: Evidence for mindful positive emotion regulation from a reanalysis of longitudinal data. PLoS One, 12(12), e0187727. https://doi.org/10.1371/journal.pone.0187727.
Germer, C. K., Siegel, R. D., & Fulton, P. R. (Eds.). (2005). Mindfulness and psychotherapy. Guilford Press.
Godfrey, K. M., Gallo, L. C., & Afari, N. (2015). Mindfulness-based interventions for binge eating: A systematic review and meta-analysis. Journal of Behavioral Medicine, 38(2), 348–362. https://doi.org/10.1007/s10865-014-9610-5.
Goldberg, S. B., Tucker, R. P., Greene, P. A., Davidson, R. J., Wampold, B. E., Kearney, D. J., & Simpson, T. L. (2018). Mindfulness-based interventions for psychiatric disorders: A systematic review and meta-analysis. Clinical Psychology Review, 59, 52–60. https://doi.org/10.1016/j.cpr.2017.10.011.
Goldberg, S. B., Tucker, R. P., Greene, P. A., Davidson, R. J., Kearney, D. J., & Simpson, T. L. (2019). Mindfulness-based cognitive therapy for the treatment of current depressive symptoms: A meta-analysis. Cognitive Behaviour Therapy, 48(6), 445–446. https://doi.org/10.1080/16506073.2018.1556330.
Goldin, P. R., & Gross, J. J. (2010). Effects of mindfulness-based stress reduction (MBSR) on emotion regulation in social anxiety disorder. Emotion, 10(1), 83–91. https://doi.org/10.1037/a0018441.
Gratz, K. L., & Roemer, L. (2004). Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the difficulties in emotion regulation scale. Journal of Psychopathology and Behavioral Assessment, 26(1), 41–54. https://doi.org/10.1023/B:JOBA.0000007455.08539.94.
Gratz, K. L., & Tull, M. T. (2010). Emotion regulation as a mechanism of change in acceptance- and mindfulness-based treatments. In R. A. Baer (Ed.), Assessing mindfulness and acceptance processes in clients: Illuminating the theory and practice of change (pp. 107–133). Context Press/New Harbinger Publications.
Gu, J., Strauss, C., Bond, R., & Cavanagh, K. (2015). How do mindfulness-based cognitive therapy and mindfulness-based stress reduction improve mental health and wellbeing? A systematic review and meta-analysis of mediation studies. Clinical Psychology Review, 37, 1–12. https://doi.org/10.1016/J.CPR.2015.01.006.
Gu, J., Cavanagh, K., & Strauss, C. (2017). Investigating the specific effects of an online mindfulness-based self-help intervention on stress and underlying mechanisms. Mindfulness, 9(4), 1245–1257. https://doi.org/10.1007/s12671-017-0867-y.
Guendelman, S., Medeiros, S., & Rampes, H. (2017). Mindfulness and emotion regulation: Insights from neurobiological, psychological, and clinical studies. Frontiers in Psychology, 8, 220. https://doi.org/10.3389/fpsyg.2017.00220.
Hargus, E., Crane, C., Barnhofer, T., & Williams, J. M. G. (2010). Effects of mindfulness on meta-awareness and specificity of describing prodromal symptoms in suicidal depression. Emotion, 10(1), 34–42. https://doi.org/10.1037/a0016825.
Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (1999). Acceptance and commitment therapy: An experiential approach to behavior change. Guilford Press.
Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006). Acceptance and commitment therapy: Model, processes and outcomes. Behaviour Research and Therapy, 44(1), 1–25. https://doi.org/10.1016/J.BRAT.2005.06.006.
Haynos, A. F., Hill, B., & Fruzzetti, A. E. (2016). Emotion regulation training to reduce problematic dietary restriction: An experimental analysis. Appetite, 103, 265–274. https://doi.org/10.1016/j.appet.2016.04.018.
Hepworth, N. S. (2010). A mindful eating group as an adjunct to individual treatment for eating disorders: A pilot study. Eating Disorders, 19(1), 6–16. https://doi.org/10.1080/10640266.2011.533601.
Hoge, E. A., Bui, E., Goetter, E., Robinaugh, D. J., Ojserkis, R. A., Fresco, D. M., & Simon, N. M. (2015). Change in decentering mediates improvement in anxiety in mindfulness-based stress reduction for generalized anxiety disorder. Cognitive Therapy and Research, 39(2), 228–235. https://doi.org/10.1007/s10608-014-9646-4.
Holm-Denoma, J. M., & Hankin, B. L. (2010). Perceived physical appearance mediates the rumination and bulimic symptom link in adolescent girls. Journal of Clinical Child and Adolescent Psychology, 39(4), 537–544. https://doi.org/10.1080/15374416.2010.486324.
Hölzel, B. K., Lazar, S. W., Gard, T., Schuman-Olivier, Z., Vago, D. R., & Ott, U. (2011). How does mindfulness meditation work? Proposing mechanisms of action from a conceptual and neural perspective. Perspectives on Psychological Science, 6(6), 537–559. https://doi.org/10.1177/1745691611419671.
Hong, P. Y., Lishner, D. A., & Han, K. H. (2014). Mindfulness and eating: An experiment examining the effect of mindful raisin eating on the enjoyment of sampled food. Mindfulness, 5(1), 80–87. https://doi.org/10.1007/s12671-012-0154-x.
Hudson, J. I., Hiripi, E., Pope, H. G., Kessler, R. C., & Kessler, R. C. (2007). The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biological Psychiatry, 61(3), 348–358. https://doi.org/10.1016/j.biopsych.2006.03.040.
Juarascio, A., Shaw, J., Forman, E., Timko, C. A., Herbert, J., Butryn, M., Bunnell, D., Matteucci, A., & Lowe, M. (2013). Acceptance and commitment therapy as a novel treatment for eating disorders. Behavior Modification, 37(4), 459–489. https://doi.org/10.1177/0145445513478633.
Kabat-Zinn, J. (1990). Full catastrophe living: Using the wisdom of your body and mind to face stress, pain, and illness. Delacorte Press.
Kabat-Zinn, J. (2013). Full catastrophe living: Using the wisdom of your body and mind to face stress, pain, and illness. Random House Publishing Group.
Kazdin, A. E. (2007). Mediators and mechanisms of change in psychotherapy research. Annual Review of Clinical Psychology, 3(1), 1–27. https://doi.org/10.1146/annurev.clinpsy.3.022806.091432.
Keel, P. K., Dorer, D. J., Franko, D. L., Jackson, S. C., & Herzog, D. B. (2005). Postremission predictors of relapse in women with eating disorders. American Journal of Psychiatry, 162(12), 2263–2268. https://doi.org/10.1176/appi.ajp.162.12.2263.
Kelly, A. C., & Carter, J. C. (2015). Self-compassion training for binge eating disorder: A pilot randomized controlled trial. Psychology and Psychotherapy: Theory, Research and Practice, 88(3), 285–303. https://doi.org/10.1111/papt.12044.
Kelly, A. C., Carter, J. C., & Borairi, S. (2014). Are improvements in shame and self-compassion early in eating disorders treatment associated with better patient outcomes? International Journal of Eating Disorders, 47(1), 54–64. https://doi.org/10.1002/eat.22196.
Keng, S. L., Smoski, M. J., Robins, C. J., Ekblad, A. G., & Brantley, J. G. (2012). Mechanisms of change in mindfulness-based stress reduction: Self-compassion and mindfulness as mediators of intervention outcomes. Journal of Cognitive Psychotherapy, 26(3), 270–280. https://doi.org/10.1891/0889-8391.26.3.270.
Khalsa, S. S., & Lapidus, R. C. (2016). Can interoception improve the pragmatic search for biomarkers in psychiatry? Frontiers in Psychiatry, 7, 121. https://doi.org/10.3389/fpsyt.2016.00121.
Khalsa, S. S., Craske, M. G., Li, W., Vangala, S., Strober, M., & Feusner, J. D. (2015). Altered interoceptive awareness in anorexia nervosa: Effects of meal anticipation, consumption and bodily arousal. International Journal of Eating Disorders, 48(7), 889–897. https://doi.org/10.1002/eat.22387.
Khoury, B., Lecomte, T., Fortin, G., Masse, M., Therien, P., Bouchard, V., Chapleau, M. A., Paquin, K., & Hofmann, S. G. (2013). Mindfulness-based therapy: A comprehensive meta-analysis. Clinical Psychology Review, 33(6), 763–771. https://doi.org/10.1016/j.cpr.2013.05.005.
Kiken, L. G., Garland, E. L., Bluth, K., Palsson, O. S., & Gaylord, S. A. (2015). From a state to a trait: Trajectories of state mindfulness in meditation during intervention predict changes in trait mindfulness. Personality and Individual Differences, 81, 41–46. https://doi.org/10.1016/j.paid.2014.12.044.
Kissileff, H. R., Wentzlaff, T. H., Guss, J. L., Walsh, B. T., Devlin, M. J., & Thornton, J. C. (1996). A direct measure of satiety disturbance in patients with bulimia nervosa. Physiology & Behavior, 60(4), 1077–1085 http://www.ncbi.nlm.nih.gov/pubmed/8884936.
Kral, T. R. A., Schuyler, B. S., Mumford, J. A., Rosenkranz, M. A., Lutz, A., & Davidson, R. J. (2018). Impact of short- and long-term mindfulness meditation training on amygdala reactivity to emotional stimuli. NeuroImage, 181, 301–313. https://doi.org/10.1016/J.NEUROIMAGE.2018.07.013.
Kristeller, J. L., & Hallett, C. B. (1999). An exploratory study of a meditation-based intervention for binge eating disorder. Journal of Health Psychology, 4(3), 357–363. https://doi.org/10.1177/135910539900400305.
Kristeller, J. L., & Wolever, R. Q. (2010). Mindfulness-based eating awareness training for treating binge eating disorder: The conceptual foundation. Eating Disorders, 19(1), 49–61. https://doi.org/10.1080/10640266.2011.533605.
Kristeller, J., Wolever, R. Q., & Sheets, V. (2014). Mindfulness-based eating awareness training (MB-EAT) for binge eating: A randomized clinical trial. Mindfulness, 5(3), 282–297. https://doi.org/10.1007/s12671-012-0179-1.
Kuyken, W., Watkins, E., Holden, E., White, K., Taylor, R. S., Byford, S., Evans, A., Radford, S., Teasdale, J. D., & Dalgleish, T. (2010). How does mindfulness-based cognitive therapy work? Behaviour Research and Therapy, 48(11), 1105–1112. https://doi.org/10.1016/j.brat.2010.08.003.
Kuyken, W., Warren, F. C., Taylor, R. S., Whalley, B., Crane, C., Bondolfi, G., Hayes, R., Huijbers, M., Ma, H., Schweizer, S., Segal, Z., Speckens, A., Teasdale, J. D., Van Heeringen, K., Williams, M., Byford, S., Byng, R., & Dalgleish, T. (2016). Efficacy of mindfulness-based cognitive therapy in prevention of depressive relapse. JAMA Psychiatry, 73(6), 565–574. https://doi.org/10.1001/jamapsychiatry.2016.0076.
Labelle, L. E., Campbell, T. S., & Carlson, L. E. (2010). Mindfulness-Based Stress Reduction in oncology: Evaluating mindfulness and rumination as mediators of change in depressive symptoms. Mindfulness, 1(1), 28–40. https://doi.org/10.1007/s12671-010-0005-6
Labelle, L. E., Campbell, T. S., Faris, P., & Carlson, L. E. (2015). Mediators of mindfulness-based stress reduction (MBSR): Assessing the timing and sequence of change in cancer patients. Journal of Clinical Psychology, 71(1), 21–40. https://doi.org/10.1002/jclp.22117.
Lampard, A. M., Byrne, S. M., McLean, N., & Fursland, A. (2011). Avoidance of affect in the eating disorders. Eating Behaviors, 12(1), 90–93. https://doi.org/10.1016/J.EATBEH.2010.11.004.
Lattimore, P., Mead, B. R., Irwin, L., Grice, L., Carson, R., & Malinowski, P. (2017). ‘I can’t accept that feeling’: Relationships between interoceptive awareness, mindfulness and eating disorder symptoms in females with, and at-risk of an eating disorder. Psychiatry Research, 247, 163–171. https://doi.org/10.1016/j.psychres.2016.11.022.
Lavender, J. M., Wonderlich, S. A., Peterson, C. B., Crosby, R. D., Engel, S. G., Mitchell, J. E., Crow, S. J., Smith, T. L., Klein, M. H., Goldschmidt, A. B., & Berg, K. C. (2014). Dimensions of emotion dysregulation in bulimia nervosa. European Eating Disorders Review, 22(3), 212–216. https://doi.org/10.1002/erv.2288.
Leahey, T. M., Crowther, J. H., & Irwin, S. R. (2008). A cognitive-behavioral mindfulness group therapy intervention for the treatment of binge eating in bariatric surgery patients. Cognitive and Behavioral Practice, 15(4), 364–375. https://doi.org/10.1016/J.CBPRA.2008.01.004.
Linardon, J., Fairburn, C. G., Fitzsimmons-Craft, E. E., Wilfley, D. E., & Brennan, L. (2017). The empirical status of the third-wave behaviour therapies for the treatment of eating disorders: A systematic review. Clinical Psychology Review, 58, 125–140. https://doi.org/10.1016/J.CPR.2017.10.005.
Lowe, M. R. (1993). The effects of dieting on eating behavior: A three-factor model. Psychological Bulletin, 114(1), 100–121. https://doi.org/10.1037/0033-2909.114.1.100.
Machado, P. P. P., Machado, B. C., Gonçalves, S., & Hoek, H. W. (2007). The prevalence of eating disorders not otherwise specified. International Journal of Eating Disorders, 40(3), 212–217. https://doi.org/10.1002/eat.20358.
Mallorquí-Bagué, N., Vintró-Alcaraz, C., Sánchez, I., Riesco, N., Agüera, Z., Granero, R., Jiménez-Múrcia, S., Menchón, J. M., Treasure, J., & Fernández-Aranda, F. (2018). Emotion regulation as a transdiagnostic feature among eating disorders: Cross-sectional and longitudinal approach. European Eating Disorders Review, 26(1), 53–61. https://doi.org/10.1002/erv.2570.
Masuda, A., & Latzman, R. D. (2012). Psychological flexibility and self-concealment as predictors of disordered eating symptoms. Journal of Contextual Behavioral Science, 1(1–2), 49–54. https://doi.org/10.1016/j.jcbs.2012.09.002.
Mendes, A. L., Ferreira, C., & Marta-Simões, J. (2017). Experiential avoidance versus decentering abilities: The role of different emotional processes on disordered eating. Eating and Weight Disorders, 22(3), 467–474. https://doi.org/10.1007/s40519-016-0291-7.
Merwin, R. M. (2011). Anorexia nervosa as a disorder of emotion regulation: Theory, evidence, and treatment implications. Clinical Psychology: Science and Practice, 18(3), 208–214. https://doi.org/10.1111/j.1468-2850.2011.01252.x.
Michie, S., & Prestwich, A. (2010). Are interventions theory-based? Development of a theory coding scheme. Health Psychology, 29(1), 1–8. https://doi.org/10.1037/a0016939.
Naumann, E., Tuschen-Caffier, B., Voderholzer, U., Caffier, D., & Svaldi, J. (2015). Rumination but not distraction increases eating-related symptoms in anorexia and bulimia nervosa. Journal of Abnormal Psychology, 124(2), 412–420. https://doi.org/10.1037/abn0000046.
Neff, K. D. (2003). The development and validation of a scale to measure self-compassion. Self and Identity, 2(3), 223–250. https://doi.org/10.1080/15298860309027.
Nolen-Hoeksema, S. (2000). The role of rumination in depressive disorders and mixed anxiety/depressive symptoms. Journal of Abnormal Psychology, 109(3), 504–511. https://doi.org/10.1037//0021-843X.109.3.504.
Nolen-Hoeksema, S., Stice, E., Wade, E., & Bohon, C. (2007). Reciprocal relations between rumination and bulimic, substance abuse, and depressive symptoms in female adolescents. Journal of Abnormal Psychology, 116(1), 198–207. https://doi.org/10.1037/0021-843X.116.1.198.
Nolen-Hoeksema, S., Wisco, B. E., & Lyubomirsky, S. (2008). Rethinking rumination. Perspectives on Psychological Science, 3(5), 400–424. https://doi.org/10.1111/j.1745-6924.2008.00088.x.
Norton, A. R., Abbott, M. J., Norberg, M. M., & Hunt, C. (2015). A systematic review of mindfulness and acceptance-based treatments for social anxiety disorder. Journal of Clinical Psychology, 71(4), 283–301. https://doi.org/10.1002/jclp.22144.
Nowakowski, M. E., McFarlane, T., & Cassin, S. (2013). Alexithymia and eating disorders: A critical review of the literature. Journal of Eating Disorders, 1(1), 21. https://doi.org/10.1186/2050-2974-1-21.
Palmeira, L., Trindade, I. A., & Ferreira, C. (2014). Can the impact of body dissatisfaction on disordered eating be weakened by one’s decentering abilities? Eating Behaviors, 15(3), 392–396. https://doi.org/10.1016/j.eatbeh.2014.04.012.
Pinto-Gouveia, J., Carvalho, S. A., Palmeira, L., Castilho, P., Duarte, C., Ferreira, C., Duarte, J., Cunha, M., Matos, M., & Costa, J. (2016). Incorporating psychoeducation, mindfulness and self-compassion in a new programme for binge eating (BEfree): Exploring processes of change. Journal of Health Psychology, 24(4), 466–479. https://doi.org/10.1177/1359105316676628.
Pisetsky, E. M., Haynos, A. F., Lavender, J. M., Crow, S. J., & Peterson, C. B. (2017). Associations between emotion regulation difficulties, eating disorder symptoms, non-suicidal self-injury, and suicide attempts in a heterogeneous eating disorder sample. Comprehensive Psychiatry, 73, 143–150. https://doi.org/10.1016/j.comppsych.2016.11.012.
Rawal, A., Park, R. J., & Williams, J. M. G. (2010). Rumination, experiential avoidance, and dysfunctional thinking in eating disorders. Behaviour Research and Therapy, 48(9), 851–859. https://doi.org/10.1016/J.BRAT.2010.05.009.
Roemer, L., Williston, S. K., & Rollins, L. G. (2015). Mindfulness and emotion regulation. Current Opinion in Psychology, 3, 52–57. https://doi.org/10.1016/J.COPSYC.2015.02.006.
Safer, D. L., Telch, C. F., & Agras, W. S. (2001). Dialectical behavior therapy for bulimia nervosa. American Journal of Psychiatry, 158(4), 632–634. https://doi.org/10.1176/appi.ajp.158.4.632.
Safran, J. D., & Segal, Z. V. (1990). Interpersonal process in cognitive therapy. Jason Aronson.
Sala, M., & Levinson, C. A. (2016). The longitudinal relationship between worry and disordered eating: Is worry a precursor or consequence of disordered eating? Eating Behaviors, 23, 28–32. https://doi.org/10.1016/j.eatbeh.2016.07.012.
Sala, M., & Levinson, C. A. (2017). A longitudinal study on the association between facets of mindfulness and disinhibited eating. Mindfulness, 8(4), 893–902. https://doi.org/10.1007/s12671-016-0663-0.
Sala, M., Brosof, L. C., & Levinson, C. A. (2019a). Repetitive negative thinking predicts eating disorder behaviors: A pilot ecological momentary assessment study in a treatment seeking eating disorder sample. Behaviour Research and Therapy, 112, 12–17. https://doi.org/10.1016/J.BRAT.2018.11.005.
Sala, M., Vanzhula, I. A., & Levinson, C. A. (2019b). A longitudinal study on the association between facets of mindfulness and eating disorder symptoms in individuals diagnosed with eating disorders. European Eating Disorders Review, 27(3), 295–305. https://doi.org/10.1002/erv.2657.
Sandoz, E. K., Wilson, K. G., Merwin, R. M., & Kate Kellum, K. (2013). Assessment of body image flexibility: The body image-acceptance and action questionnaire. Journal of Contextual Behavioral Science, 2(1–2), 39–48. https://doi.org/10.1016/J.JCBS.2013.03.002.
Segal, Z. V., Williams, J. M. G., & Teasdale, J. T. (2013). Mindfulness-based cognitive therapy for depression: A new approach to preventing relapse. Guilford Press.
Seidel, M., Petermann, J., Diestel, S., Ritschel, F., Boehm, I., King, J. A., Geisler, D., Bernardoni, F., Roessner, V., Goschke, T., & Ehrlich, S. (2016). A naturalistic examination of negative affect and disorder-related rumination in anorexia nervosa. European Child & Adolescent Psychiatry, 25(11), 1207–1216. https://doi.org/10.1007/s00787-016-0844-3.
Shapiro, S. L., Carlson, L. E., Astin, J. A., & Freedman, B. (2006). Mechanisms of mindfulness. Journal of Clinical Psychology, 62(3), 373–386. https://doi.org/10.1002/jclp.20237.
Smith, B. W., Shelley, B. M., Leahigh, L., & Vanleit, B. (2006). A preliminary study of the effects of a modified mindfulness intervention on binge eating. Complementary Health Practice Review, 11(3), 133–143. https://doi.org/10.1177/1533210106297217.
Smith, B. W., Shelley, B. M., Dalen, J., Wiggins, K., Tooley, E., & Bernard, J. (2008). A pilot study comparing the effects of mindfulness-based and cognitive-behavioral stress reduction. The Journal of Alternative and Complementary Medicine, 14(3), 251–258. https://doi.org/10.1089/acm.2007.0641.
Smith, K. E., Mason, T. B., & Lavender, J. M. (2018). Rumination and eating disorder psychopathology: A meta-analysis. Clinical Psychology Review, 61, 9–23. https://doi.org/10.1016/J.CPR.2018.03.004.
Ștefan, C. A., Căpraru, C., & Szilágyi, M. (2018). Investigating effects and mechanisms of a mindfulness-based stress reduction intervention in a sample of college students at risk for social anxiety. Mindfulness, 9(5), 1509–1521. https://doi.org/10.1007/s12671-018-0899-y.
Sternheim, L., Startup, H., Saeidi, S., Morgan, J., Hugo, P., Russell, A., & Schmidt, U. (2012). Understanding catastrophic worry in eating disorders: Process and content characteristics. Journal of Behavior Therapy and Experimental Psychiatry, 43(4), 1095–1103. https://doi.org/10.1016/J.JBTEP.2012.05.006.
Stockton, D., Kellett, S., Berrios, R., Sirois, F., Wilkinson, N., & Miles, G. (2019). Identifying the underlying mechanisms of change during acceptance and commitment therapy (ACT): A systematic review of contemporary mediation studies. Behavioural and Cognitive Psychotherapy, 47(3), 332–362. https://doi.org/10.1017/S1352465818000553.
Stutts, L. A., & Blomquist, K. K. (2018). The moderating role of self-compassion on weight and shape concerns and eating pathology: A longitudinal study. International Journal of Eating Disorders, 51(8), 879–889. https://doi.org/10.1002/eat.22880.
Svaldi, J., & Naumann, E. (2014). Effects of rumination and acceptance on body dissatisfaction in binge eating disorder. European Eating Disorders Review, 22(5), 338–345. https://doi.org/10.1002/erv.2312.
Svaldi, J., Griepenstroh, J., Tuschen-Caffier, B., & Ehring, T. (2012). Emotion regulation deficits in eating disorders: A marker of eating pathology or general psychopathology? Psychiatry Research, 197(1–2), 103–111. https://doi.org/10.1016/j.psychres.2011.11.009.
Takahashi, T., Sugiyama, F., Kikai, T., Kawashima, I., Guan, S., Oguchi, M., Uchida, T., & Kumano, H. (2019). Changes in depression and anxiety through mindfulness group therapy in Japan: The role of mindfulness and self-compassion as possible mediators. BioPsychoSocial Medicine, 13(1), 4. https://doi.org/10.1186/s13030-019-0145-4.
Teasdale, J. D. (2004) Mindfulness-based cognitive therapy. In J. Yield. Cognition, emotion and psychopathology: Theoretical, empirical and clinical directions (270-289). Cambridge University press.
Teasdale, J. D., Moore, R. G., Hayhurst, H., Pope, M., Williams, S., & Segal, Z. V. (2002). Metacognitive awareness and prevention of relapse in depression: Empirical evidence. Journal of Consulting and Clinical Psychology, 70(2), 275–287. https://doi.org/10.1037/0022-006X.70.2.275.
van Aalderen, J. R., Donders, A. R. T., Giommi, F., Spinhoven, P., Barendregt, H. P., & Speckens, A. E. M. (2012). The efficacy of mindfulness-based cognitive therapy in recurrent depressed patients with and without a current depressive episode: A randomized controlled trial. Psychological Medicine, 42(05), 989–1001. https://doi.org/10.1017/S0033291711002054.
van der Velden, A. M., Kuyken, W., Wattar, U., Crane, C., Pallesen, K. J., Dahlgaard, J., Fjorback, L. O., & Piet, J. (2015). A systematic review of mechanisms of change in mindfulness-based cognitive therapy in the treatment of recurrent major depressive disorder. Clinical Psychology Review, 37, 26–39. https://doi.org/10.1016/J.CPR.2015.02.001.
Wang, S. B., Lydecker, J. A., & Grilo, C. M. (2017). Rumination in patients with binge-eating disorder and obesity: Associations with eating-disorder psychopathology and weight-bias internalization. European Eating Disorders Review, 25(2), 98–103. https://doi.org/10.1002/erv.2499.
Warren, J. M., Smith, N., & Ashwell, M. (2017). A structured literature review on the role of mindfulness, mindful eating and intuitive eating in changing eating behaviours: Effectiveness and associated potential mechanisms. Nutrition Research Reviews, 30(02), 272–283. https://doi.org/10.1017/S0954422417000154.
Watson, H. J., & Bulik, C. M. (2014). Evidence-based psychotherapy for eating disorders. FOCUS, 12(4), 379–387. https://doi.org/10.1176/appi.focus.120403.
Westmoreland, P., Krantz, M. J., & Mehler, P. S. (2016). Medical complications of anorexia nervosa and bulimia. The American Journal of Medicine, 129(1), 30–37. https://doi.org/10.1016/j.amjmed.2015.06.031.
Wierenga, C. E., Bischoff-Grethe, A., Melrose, A. J., Irvine, Z., Torres, L., Bailer, U. F., Simmons, A., Fudge, J. L., McClure, S. M., Ely, A., & Kaye, W. H. (2015). Hunger does not motivate reward in women remitted from anorexia nervosa. Biological Psychiatry, 77(7), 642–652. https://doi.org/10.1016/j.biopsych.2014.09.024.
Woolhouse, H., Knowles, A., & Crafti, N. (2012). Adding mindfulness to CBT programs for binge eating: A mixed-methods evaluation. Eating Disorders, 20(4), 321–339. https://doi.org/10.1080/10640266.2012.691791.
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Vanzhula, I.A., Levinson, C.A. Mindfulness in the Treatment of Eating Disorders: Theoretical Rationale and Hypothesized Mechanisms of Action. Mindfulness 11, 1090–1104 (2020). https://doi.org/10.1007/s12671-020-01343-4
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DOI: https://doi.org/10.1007/s12671-020-01343-4