Debra Safer - Academia.edu (original) (raw)

Papers by Debra Safer

Climate Change Management, 2020

Health impacts from extreme weather events have massive, deleterious effects on our communities. ... more Health impacts from extreme weather events have massive, deleterious effects on our communities. Plots from mankind’s long history of storytelling cannot help us prepare for the unprecedented environmental shifts we are experiencing. Dystopian plots focusing on a catastrophic future caused by climate change often immobilize rather than spur action. Despite over a half-century of evidence that science and health communication strategies, including entertainment-education, can effectively change human behavior, such strategies are rarely applied by our contemporary entertainment or media industries. Tools from social psychology, including social modeling and building self and collective efficacy, can help us to create a new model for current, culturally-relevant stories that can help communities prepare for extreme events. These “solution stories” are hopeful, funny stories that effectively teach climate change adaptation, mitigation, and resilience strategies. Solution stories are set in the present day and frame climate solutions to feel “easy, fun and popular.” Up-to-date research on adaptation, mitigation, and resilience strategies can be iteratively utilized in these stories to better equip communities to manage climate change disasters and lessen harmful physical and mental health impacts. An example of a potential climate communication solution story, “Rhythm and Glue,” is provided. In summary, solution stories are an innovative management strategy for substantially improving preparedness and, hence, health outcomes among communities facing extreme weather events caused by climate change.

Sickness as Story: An Approach to Philip Roth's Patrimony and Saul Be1low's More Die of H... more Sickness as Story: An Approach to Philip Roth's Patrimony and Saul Be1low's More Die of Heartbreak Copyright © 1992 by Debra Lynn Safer

Journal of Clinical Medicine, 2021

Binge-eating disorder (BED) and bulimia nervosa (BN) have adverse psychological and medical conse... more Binge-eating disorder (BED) and bulimia nervosa (BN) have adverse psychological and medical consequences. Innovative interventions, like the integration of virtual reality (VR) with cue-exposure therapy (VR-CET), enhance outcomes for refractory patients compared to cognitive behavior therapy (CBT). Little is known about the feasibility and acceptability of translating VR-CET into real-world settings. To investigate this question, adults previously treated for BED or BN with at least one objective or subjective binge episode/week were recruited from an outpatient university eating disorder clinic to receive up to eight weekly one-hour VR-CET sessions. Eleven of 16 (68.8%) eligible patients were enrolled; nine (82%) completed treatment; and 82% (9/11) provided follow-up data 7.1 (SD = 2.12) months post-treatment. Overall, participant and therapist acceptability of VR-CET was high. Intent-to-treat objective binge episodes (OBEs) decreased significantly from 3.3 to 0.9/week (p < 0.00...

Annals of Medicine and Surgery, 2021

This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

Journal of Medical Internet Research, 2020

Novel treatment options for eating disorders (EDs) are critically needed to enhance treatment out... more Novel treatment options for eating disorders (EDs) are critically needed to enhance treatment outcomes and reduce the rates of treatment dropouts. On average, only 50% of individuals receiving evidence-based care remit, whereas 24% drop out before treatment completion. One particularly promising direction involves integrating virtual reality (VR) with existing evidence-based treatments (EBTs) such as cue exposure therapy (CET). Across psychiatric disorders, VR-based interventions are demonstrating at least preliminary efficacy and noninferiority to traditional treatments. Furthermore, VR technology has become increasingly portable, resulting in improved acceptance, increased access, and reductions in cost. However, more efficient research processes may be needed to uncover the potential benefits of these rapid technological advances. This viewpoint paper reviews existing empirical support for integrating VR with EBTs (with a focus on its use with EDs) and proposes key next steps to ...

Eating Disorders, 2019

ABSTRACT Binge-eating disorder (BED) is a prevalent and serious public health issue. BED is chara... more ABSTRACT Binge-eating disorder (BED) is a prevalent and serious public health issue. BED is characterized by recurrent out-of-control binge eating episodes in the absence of extreme weight control behavior and is associated with significant psychosocial and physiological impairment. Dialectical Behavior Therapy (DBT), based on the affect regulation model of binge eating, is an evidence-based treatment (EBT) approach for BED. Unfortunately, access to EBTs is often limited due to geographical barriers (i.e., lack of local providers with specialized training in EBTs), lack of financial resources, and/or time constraints. Self-help approaches (via guided and unguided versions) to delivering DBT for BED offer a potentially effective means of more widely disseminating this treatment. Compared to traditional, higher intensity approaches, self-help DBT for BED is less time-consuming, less financially costly, and requires less need for specialized therapist-training. This paper will present how DBT for BED has been adapted for self-help delivery, review the limited but promising research on DBT self-help available to date, and provide directions for future research.

International Journal of Obesity, 2001

OBJECTIVE: To assess longitudinally the relationship between measures of adiposity in children ov... more OBJECTIVE: To assess longitudinally the relationship between measures of adiposity in children over the first 8 y of life with that of their parents and to explore the role of parental adiposity in the development of childhood adiposity. DESIGN: Longitudinal study of measures of adiposity in children. SUBJECTS: A community sample from three health service systems including 114 children followed annually from infancy to age 8 and their 228 biological parents. METHODS: Measurements were assessed at baseline for parents (6 months post-partum for mothers) and at regular intervals for children beginning at age 2 months. Measurements included weight, height, triceps skinfold, subscapular skinfold, midarm circumference, waist and hip. RESULTS: The major findings were: (1) significant correlations between parental body mass index (BMI), both maternal and paternal, and their biological offspring first emerged at age 7; (2) children with two overweight parents had consistently elevated BMI compared to children with either no overweight parents or one overweight parent. These differences became significant beginning at age 7. CONCLUSIONS: This study supports the hypothesis that familial factors (biological and=or environmental) affecting the development of adiposity emerge at specific ages and are related to the adiposity of both parents.

AACE Clinical Case Reports, 2016

Objective: With the intensified public awareness and media coverage of issues concerning gender i... more Objective: With the intensified public awareness and media coverage of issues concerning gender identity and gender incongruence, distinguishing true gender dysphoria or incongruence from the sexual obsessions of obsessive-compulsive disorder (OCD) is especially important. Although intrusive sexual obsessions are not uncommon in OCD, obsessions concerning sexual content are more difficult for clinicians to identify as OCD than other types of obsessions (e.g., obsessions concerning contamination). Making the correct diagnosis helps ensure that appropriate clinical treatment can be offered. Methods: We present a case report of a homosexual, single, young male with new-onset intrusive repetitive obsessive thoughts that he was transgender. The case report is accompanied by a review of the pertinent endocrine and psychiatric literature. Results: A Yale-Brown Obsessive Compulsive Scale indicated a significant negative impact of the patient's symptoms. Conclusion: To our knowledge, this is the first case report of an OCD patient whose symptoms include the unwanted, intrusive obsessive thought that he was transgender. The described case and associated review highlight the characteristics that distinguish the distress in patients with OCD who present with obsessions concerning being transgender relative to patients who are transgender or gender incongruent who present with gender dysphoria. The case illustrates the importance of considering OCD as a potential diagnosis in patients who present with newonset obsessions regarding gender identity and the importance of establishing the durability and pattern of gender identification and obsessions before embarking on treatment. (AACE Clinical Case Rep. 2016;2:e268-e271) Abbreviations: DSM = Diagnostic and Statistical Manual of Mental Disorders; OCD = obsessive-compulsive disorder; Y-BOCS = Yale-Brown Obsessive Compulsive Scale

Surgery for Obesity and Related Diseases, 2015

Eating Behaviors, 2015

To examine if implicit emotion regulation (occurring outside of awareness) is related to binge ea... more To examine if implicit emotion regulation (occurring outside of awareness) is related to binge eating disorder (BED) symptomatology and explicit emotion regulation (occurring within awareness), and can be altered via intervention. Methods: Implicit emotion regulation was assessed via the Emotion Conflict Task (ECT) among a group of adults with BED. Study 1 correlated BED symptomatology and explicit emotion regulation with ECT performance at baseline (BL) and after receiving BED treatment (PT). Study 2 generated effect sizes comparing ECT performance at BL and PT with healthy (non-eating disordered) controls (HC). Results: Study 1 yielded significant correlations (p b .05) between both BED symptomatology and explicit emotion regulation with ECT performance. Study 2 found that compared to BL ECT performance, PT shifted (d = −.27), closer to HC. Preliminary results suggest a) BED symptomatology and explicit emotion regulation are associated with ECT performance, and b) PT ECT performance normalized after BED treatment. Conclusions: Implicit emotion regulation may be a BED treatment mechanism because psychotherapy, directly or indirectly, decreased sensitivity to implicit emotional conflict. Further understanding implicit emotion regulation may refine conceptualizations and effective BED treatments.

Journal of Obesity and Bariatrics, 2015

Background: Poor dietary adherence to post-bariatric eating guidelines and associated maladaptive... more Background: Poor dietary adherence to post-bariatric eating guidelines and associated maladaptive eating behaviors predict suboptimal post-bariatric weight loss outcomes. Psychometricallyevaluated measures that reliably detect such maladaptive behaviors are lacking. Objectives: To describe the Dietary-adherence Intake and Eating Test (DIET), a brief self-report measure to detect post-bariatric maladaptive eating behaviors that have been previously associated with suboptimal weight loss post-bariatric surgery. Methods: Preliminary psychometrics properties, including temporal stability, were examined in 109 patients within their first year postbariatric surgery. Results: The 13-item measure demonstrated good test-retest reliability (p<0.001), internal consistency (α=0.86), and factor analysis results suggested all items load onto a single component solution. Conclusion: The DIET is a brief, reliable, and internally consistent self-report measure with good psychometric properties that assesses the presence and frequency of a range of maladaptive post-bariatric eating behaviors. The DIET fills an important gap in the literature as it is, to our knowledge, the first psychometrically-valid questionnaire to assess the range of maladaptive eating behaviors shown by previous research to be associated with greater risks of suboptimal post-bariatric weight loss. The DIET, which can be easily administered post-bariatric surgery, possesses valuable clinical utility in that the maladaptive eating behaviors it captures can serve as the target of early, postsurgical intervention, thus potentially improving post-bariatric surgery weight loss outcomes.

Journal of eating disorders, 2014

Dialectical behavior therapy (DBT), which appears to be an effective treatment for binge eating d... more Dialectical behavior therapy (DBT), which appears to be an effective treatment for binge eating disorder (BED), focuses on teaching emotion regulation skills. However, the role of improved emotion regulation in predicting treatment outcome in BED is uncertain. This secondary analysis explored whether change in self-reported emotion regulation (as measured by the Difficulties in Emotion Regulation Scale) during treatment was associated with abstinence from binge eating at post-treatment and 4-, 5-, and 6-month follow-up in individuals who received a guided self-help adaptation of DBT for BED. Participants were 60 community-based men and women with BED who received a self-help manual and six 20-minute support phone calls. Greater improvement in self-reported emotion regulation between pre- and post-treatment predicted abstinence from binge eating at post-treatment, 4-, 5-, and 6-month follow-up. However, some follow-up results were no longer significant when imputed data was excluded,...

Innovations in clinical neuroscience, 2012

Duloxetine, a serotonin norepinephrine reuptake inhibitor (SNRI) indicated for the treatment of d... more Duloxetine, a serotonin norepinephrine reuptake inhibitor (SNRI) indicated for the treatment of depression, is used for off-label purposes such as treatment-resistant obsessive compulsive disorder, bulimia, and binge eating disorder. Although establishing a dose-response relationship for antidepressants in the treatment of depression is difficult, it is possible that for certain patterns of comorbidity, suprathreshold doses may be important to achieve remission. There is currently a paucity of literature regarding the use of suprathreshold doses of duloxetine in treatment refractory cases. This case report describes a clinical situation in which suprathreshold duloxetine was used to treat a patient with severe depression as well as co-morbid anorexia nervosa binge-purging type and obsessive compulsive disorder. One year after the initial increase to 180mg, the patient's mood remains improved. Our clinical account appears to be only the second case report describing the efficacy ...

The International journal of eating disorders, 2012

Investigate moderators of a randomized clinical trial of group Dialectical Behavior Therapy for B... more Investigate moderators of a randomized clinical trial of group Dialectical Behavior Therapy for Binge Eating Disorder (DBT-BED) compared to an active comparison group control (ACGT) on the post-treatment outcome of binge frequency after twenty 2-h weekly sessions. Moderation analyses. Participants were 101 adults with BED [mean (SD) age, 52.2 (10.6) years and BMI, 36.4 (8.6)]. Analyses identified two moderators of post-treatment outcome. Participants with (1) Avoidant Personality Disorder or (2) an earlier onset of overweight and dieting (<15 years old) evidenced significantly worsened outcome when treated with ACGT versus DBT-BED. Participants with certain indicators of higher baseline pathology respond better to DBT-BED than ACGT at post-treatment.

International Journal of Eating Disorders, 2013

Objective: To examine the predictive value of end of treatment (EOT) outcomes for longer term rec... more Objective: To examine the predictive value of end of treatment (EOT) outcomes for longer term recovery status. Method: We used signal detection analysis to identify the best predictors of recovery based on outcome at EOT using five different eating disorder samples from randomized clinical treatment trials. We utilized a transdiagnostic definition of recovery that included normalization of weight and eating related psychopathology. Results: Achieving a body weight of 95.2% of expected body weight by EOT is the best predictor of recovery for adolescents with anorexia nervosa (AN). For adults with AN, the most efficient predictor of weight recovery (BMI > 19) was weight gain to greater than 85.8% of ideal body weight. In addition, for adults with AN, the most efficient predictor of psychological recovery was achievement of an eating disorder examination (EDE) weight concerns score below 1.8. The best predictor of recovery for adults with Bulimia Nervosa (BN) was a frequency of compensatory behaviors less than two times a month. For adolescents with BN, abstinence from purging and reduction in the EDE restraint score of more than 3.4 from baseline to EOT were good predictors of recovery. For adults with binge eating disorder, reduction of the Global EDE score to within the normal range (<1.58) was the best predictor of recovery. Discussion: The relationship between EOT response and recovery remains understudied. Utilizing a transdiagnostic definition of recovery, no uniform predictors were identified across all eating disorder diagnostic groups. V

International Journal of Eating Disorders, 2011

Objective: This treatment development study investigated the acceptability and efficacy of a modi... more Objective: This treatment development study investigated the acceptability and efficacy of a modified version of dialectical behavior therapy (DBT) for bulimia nervosa (BN), entitled appetite focused DBT (DBT-AF). Method: Thirty-two women with binge/ purge episodes at least one time per week were randomly assigned to 12 weekly sessions of DBT-AF (n 5 18) or to a 6-week delayed treatment control (n 5 14). Participants completed the EDE interview and self-report measures at baseline, 6 weeks, and posttreatment. Results: Treatment attrition was low, and DBT-AF was rated highly acceptable. At 6 weeks, participants who were receiving DBT-AF reported significantly fewer BN symptoms than controls. At posttest, 26.9% of the 26 individuals who entered treatment (18 initially assigned and 8 from the delayed treatment control) were abstinent from binge/purge episodes for the past month; 61.5% no longer met full or subthreshold criteria for BN. Participants demonstrated a rapid rate of response to treatment and achieved clinically significant change. Discussion: Results suggest that DBT-AF warrants further investigation as an alternative to DBT or cognitive behavior therapy for BN. V V

International Journal of Eating Disorders, 2004

Objective: To examine changes in dietary restraint patterns revealed by the Eating Disorders Exam... more Objective: To examine changes in dietary restraint patterns revealed by the Eating Disorders Examination Restraint subscale (EDE-R) and the Three-Factor Eating Questionnaire Cognitive Restraint scale (TFEQ-CR) in a large sample of women with bulimia nervosa (BN) who completed 18 weeks of cognitive-behavioral therapy (CBT). Method: Data from 134 subjects were obtained from a larger study and analyzed using repeated-measures analysis of variance (ANOVA). Results: The EDE-R showed statistically and clinically significant decreases post-CBT, whereas the TFEQ-CR did not change significantly. Discussion: This is the first study to directly compare the EDE-R and TFEQ-CR before and after CBT in the same population. The contrasting results suggest the two measures tap different aspects of the dietary restraint construct. The EDE-R may primarily reflect dieting to lose weight whereas the TFEQ-CR may reflect dieting to avoid weight gain. In assessing changes in dietary restraint targeted by CBT for BN, the TFEQ-CR appears less useful.

International Journal of Eating Disorders, 2007

Objective: Recent research has raised important questions about the relationships between weight ... more Objective: Recent research has raised important questions about the relationships between weight suppression (WS) (discrepancy between highest-ever and current weight), dietary restraint, and binge eating in bulimia nervosa (BN). Method: In the current study, these variables were studied cross-sectionally through secondary analyses of baseline data collected in a multi-site treatment study. Participants (N 5 182) were treatment-seeking women diagnosed with BN. Dietary restraint and binge eating were measured via the Eating Disorders Examination. Results: WS was directly and dietary restraint was inversely related to frequency of binge eating. The inverse relationship between dietary restraint and binge eating may be explained in part by the fact that the most restrained patients with BN had the greatest desire to lose weight. Conclusion: Implications of these findings for future research on the perpetuation and treatment of BN are discussed. V

Behaviour Research and Therapy, 2014

Student Bodies, an internet-based intervention, has successfully reduced weight/shape concerns an... more Student Bodies, an internet-based intervention, has successfully reduced weight/shape concerns and prevented eating disorders in a subset of college-age women at highest risk for an eating disorder. Student Bodies includes an online, guided discussion group; however, the clinical utility of this component is unclear. This study investigated whether the guided discussion group improves program efficacy in reducing weight/shape concerns in women at high risk for an eating disorder. Exploratory analyses examined whether baseline variables predicted who benefitted most. Women with high weight/shape concerns (N ¼ 151) were randomized to Student Bodies with a guided discussion group (n ¼ 74) or no discussion group (n ¼ 77). Regression analyses showed weight/shape concerns were reduced significantly more among guided discussion group than no discussion group participants (p ¼ 0.002; d ¼ 0.52); guided discussion group participants had 67% lower odds of having high-risk weight/shape concerns post-intervention (p ¼ 0.02). There were no differences in binge eating at post-intervention between the two groups, and no moderators emerged as significant. Results suggest the guided discussion group improves the efficacy of Student Bodies in reducing weight/shape concerns in college students at high risk for an eating disorder.