Improvements in Quality of Life and Readiness for Change After Participating in an Eating Disorder Psychoeducation Group: A Pilot Study

Figures & data

Table 1. Demographics and Baseline Characteristics of Study Sample

Characteristic	Total (N = 75)
Age, y, mean (SD)	29.3 (10.1)
Age at onset at disorder, y, mean (SD) (n = 68)	17.4 (5.6)
Gender, n (%) (n = 75)
Male	71 (94.7)
Female	2 (2.7)
Other	2 (2.7)
Ethnicity, n (%) (n = 75)
Caucasian	55 (73.3)
Caucasian and Asian*	8 (10.7)
Caucasian and Other*	5 (6.7)
Asian	5 (6.7)
Arab and West Asian*	2 (2.7)
Body mass index (kg/m2), mean, (SD) (n = 67)	21 (5.13)
Highest past weight (lb), mean, (SD) (n = 71)	154 (33.7)
Lowest adult weight (lb), mean, (SD) (n = 75)	108 (23.0)
Desired weight (lb), mean, (SD) (n = 70)	115 (16.9)
Self-reported primary eating disorder diagnosis, n (%) (n = 68):
Anorexia (includes atypical)	29 (42.6)
Bulimia	26 (38.2)
Other Specified Feeding and Eating Disorder	9 (13.2)
Binge Eating Disorder	2 (2.9)
Binge-Purge**	2 (2.9)
Past eating disorder treatment, n (%) (n = 75):
Yes	43 (57.3)
No	32 (42.7)
Substance use issues, n (%) (n = 74):
Yes	24 (32.4)
No	50 (67.6)

*Mixed heritage.

**Binge-Purge is not an official diagnosis in DSM-5.

Table 2. Fundamentals Group Weekly Outline

Week	Fundamentals Group Weekly Outline
1	How to make the most out of the group Icebreaker (done weekly at the beginning of the group) Discuss group guidelines and frequently asked questions Discuss “why groups” and “how to make the most out of the group” Toolbox: Describe concept of adding new coping skills to the “toolbox” Journal: Distribute blank journals Breathing/grounding exercise: Diaphragmatic breathing Charting (weekly self-report questionnaire to be completed and given to group leader at the end of the session)
2	Self-compassion and the “toolbox” of coping strategies Homework review (done weekly after icebreaker activity) Teaching: Introduce mind-body connection; recovery model; food, weight, and shape preoccupation as a symptom of other issues; self-compassion; health at every size concept Toolbox: Have participants think about helpful coping strategies and skills they learn throughout the sessions and write them down in their “toolbox” Breathing/grounding exercise: Grounding exercises Homework: Self-compassion break (Kristin Neff)
3	The recovery model and the “iceberg” metaphor (what is beneath food, weight, and shape preoccupation?) Teaching: Recovery journey (hope, self-responsibility, self-advocacy, support, meaning and purpose, awareness, personal vision); underlying issues that drive the ED (iceberg metaphor: What’s below the water line?) Discussion: What are you fighting for? Exercise: Brainstorm what might be above the water line (i.e., behaviors) and what might be below the water line (i.e., trauma, loss, unmet needs) Teaching: Ancel Keys’ Minnesota Starvation Experiment Breathing/grounding exercise: Square breathing Homework: Complete the Readiness Ruler (1–10 motivational rating) and journal on your motivation rating and on the connection between your ED behaviors and the issues “under the iceberg”
4	Stages of change and emotion avoidance Teaching: Recovery is a process; stages of change; emotional avoidance; “fat is not a feeling;” tuning into emotions Discussion: Thoughts and feelings about content presented Breathing/grounding exercise: Tactile grounding (hold an object and describe 3 details about it) Homework: When you “feel fat” or “feel out of control” ask yourself what might be going on. Journal.
5	The function of the eating disorder Teaching: Decisional balance grid Watch video about ambivalence and externalizing the ED and discuss Activity: Do decisional balance as a group (Benefits of the ED, cost of the ED, cost of recovery, benefit of recovery) Discussion: Review Recovery A–Z recovery story Breathing/grounding exercise: Using imagination to send your breath on a little journey around your body Homework: Journal about 2 components of recovery that you are willing to work on (based on Recovery A–Z)
6	How media influences our attitudes about body weight and shape Teaching: Myths the beauty industry wants people to believe; media; fad diets; how to combat the “fat talk” phenomenon Activity: Think of someone in your life that has positively impacted you and list 3 qualities about that person Breathing/grounding exercise: Mindful breathing Homework: Journal about 20 things you enjoy doing: for example, watching the sunset, playing with children, walking the dog, going for a drive, making soup
7	Triggers and automatic thoughts/thought distortions Teaching: CBT triangle (thoughts/behaviors/feelings) Exercise: Identifying individual triggers Watch video about automatic thoughts and thought distortions Discussion: How do we stop automatic thoughts/thought traps? Review automatic thoughts worksheet Breathing/grounding exercise: Breath counting Homework: Use your automatic thoughts worksheet and practice recording, rationalizing, and replacing.
8	Thought distortions and feelings Watch video on emotions and the brain Activity: Do an activity sheet on Feelings: True or False (i.e., Some emotions are wrong to feel). Discuss Teaching: What are feelings? Why do we have feelings? Breathing/grounding exercise: 54321 grounding exercise Homework: Draw a pie chart of your life, with each segment representing the degree to which you give attention. Draw another pie chart to show how you would like your life to look. What small step could you take to bring yourself closer to your ideal?
9	Feelings, urges, and behaviors Teaching: Primary emotions; feelings about feelings; urges and coping Activity: Review “Coping With Urges” activity sheet (which includes affirmations, delaying, distraction, self-care) Activity: Working on mandalas Breathing/grounding exercise: Pedaling with your feet Homework: Describe yourself at 80. Write a letter from you at 80 to you at your current age
10	Recovery Review content Review toolbox Discussion: Exploring your personal recovery hope Activity: Where are you in the recovery process and where would you like to be? Group exit evaluation

Table 3. Cronbach’s Alpha Coefficients for Instruments Used

EDQLS	Cronbach’s alpha— Preintervention	Cronbach’s alpha— Postintervention
12 domains, 40 items	0.852	0.856
RMQ	Cronbach’s alpha - Preintervention	Cronbach’s alpha - Postintervention
Action	0.624	0.443
Confidence	0.578	0.556
Precontemplation	0.558	0.366
Internality	0.624	0.445

Table 4. Readiness and Motivation Scores Before and After Fundamentals

Total Readiness Scores	Before Fundamentals	After Fundamentals	P-value^†	Cohen’s D
Action	38.45 ± 19.7	47.64 ± 18.2	.001	0.316
Confidence	36.03 ± 17.4	43.78 ± 17.7	.003	0.395
Internality	60.31 ± 25.3	69.05 ± 21.6	.012	0.440
Precontemplation	70.69 ± 18.4	66.06 ± 17.5	.050	0.059
Symptom readiness score
Action
Binge	59.23 ± 40.0	66.32 ± 28.5	.011	0.189
Cognitive	38.27 ± 23.7	49.20 ± 26.0	.001	0.267
Compensatory	39.39 ± 24.0	47.06 ± 23.4	.071	0.261
Restriction	29.04 ± 29.3	34.52 ± 28.2	.047	0.043
Confidence
Binge	39.25 ± 28.5	43.95 ± 25.7	.395	0.152
Cognitive	22.71 ± 21.3	33.47 ± 21.3	.093	0.406
Compensatory	46.00 ± 23.6	52.35 ± 23.1	.358	0.278
Restriction	41.92 ± 28.2	45.00 ± 23.3	.268	0.120
Internality
Binge	76.5 ± 28.2	84.5 ± 22.9	.168	0.307
Cognitive	64.2 ± 28.9	71.7 ± 26.8	.444	0.231
Compensatory	59.4 ± 26.5	67.3 ± 28.6	.041	0.398
Restriction	45.9 ± 32.0	57.2 ± 30.7	.070	0.420
Precontemplation
Binge	61.50 ± 34.6	63.42 ± 32.1	.066	0.050
Cognitive	64.19 ± 29.0	58.27 ± 28.6	.111	0.115
Compensatory	71.53 ± 20.9	68.60 ± 20.1	.111	0.050
Restriction	80.77 ± 21.2	74.90 ± 23.3	.314	0.203

^†Paired t-test.

Figure 1. Exit Evaluation – Responses to Question #5: Components of the Fundamentals Group That Were Most Useful, Ranked in Order of Frequency.

Table

1	2	3	4	5
Dissatisfied				Extremely Satisfied

Table

1	2	3	4	5
Dissatisfied				Extremely Satisfied