Hany Bissada - Academia.edu (original) (raw)

Papers by Hany Bissada

Women's Health Issues, 2010

Depression is a most burdensome illness, with personal and societal costs surpassing those of any... more Depression is a most burdensome illness, with personal and societal costs surpassing those of any other illness. Furthermore, depression affects women at a much higher rate than men. The most prevalent eating disorder among adult women is binge eating disorder (BED). Depression and obesity are common in women with BED, most of whom seek treatment later in life. Depression, obesity, and age are associated with greater health care use and lower health-related quality of life (HRQOL). Hence, for women with BED estimating the effects of depression can be confounded by both age and body mass index (BMI). The current study examined the relationships between depression, HRQOL, and health care utilization among treatment seeking women with BED. Participants (n = 105) completed the Structured Clinical Interview for DSM-IV, a health care utilization and cost survey, the Personality Assessment Inventory depression scale, and the EQ-5D to measure HRQOL. On average, participants were severely obese with a mean BMI of 38.20 (SD = 6.80); 67.27% had a lifetime history of depression. Participants had higher health care costs and lower HRQOL than published age- and gender-matched norms. After controlling for age and BMI, depressive symptoms were significantly related to greater medication use (excluding antidepressants), and lower HRQOL. Results suggest that targeting depressive symptoms may reduce the economic and personal burden of BED for women.

Journal of Social and Clinical Psychology, 2010

... giorgio a. taSCa The Ottawa Hospital, University of Ottawa, Carleton University NiKKi KeNNeDy... more ... giorgio a. taSCa The Ottawa Hospital, University of Ottawa, Carleton University NiKKi KeNNeDy University of Ottawa ... Two PAI (Morey, 1991) sub-scales, cognitive depression (DEP-C) and identity problems (BOR-I), were the indicator variables for the self-concept latent factor. ...

Personality and Individual Differences, 2009

The study examined the role of affect regulation strategies in mediating the relationship between... more The study examined the role of affect regulation strategies in mediating the relationship between attachment dimensions and both depressive and eating disorder (ED) symptoms. Participants were 310 women seeking treatment for an ED. Structural equation modeling indicated that attachment anxiety contributed to both depressive symptoms and ED symptoms through emotional reactivity. In contrast, only the association between attachment avoidance and

Psychotherapy, 2014

An interpersonal model of Binge Eating Disorder (BED) posits that difficulties with social functi... more An interpersonal model of Binge Eating Disorder (BED) posits that difficulties with social functioning precipitate negative affect, which in turn causes binge eating as a means of coping. Thus, long-term decreases in attachment insecurity may be important for women with BED. No research has assessed if long-term change in attachment insecurity is associated with sustained change in other outcomes. In the current study, we hypothesized that changes in attachment anxiety and avoidance will decrease at posttreatment and will be maintained up to 12 months after Group Psychodynamic Interpersonal Psychotherapy (GPIP). We further hypothesized that long-term stability of these changes in attachment insecurity will be related to other long-term outcomes. Women with BED (N = 102) attended 16 sessions of GPIP. Measures were completed pretreatment, posttreatment, at 6 and 12 months follow-up. Attachment anxiety, attachment avoidance, and the other outcome variables decreased significantly at 12 months posttreatment. Reductions in attachment anxiety and avoidance were significantly related to decreases in interpersonal problems up to 12 months posttreatment, and reduction in attachment anxiety was significantly related to decreases in depressive symptoms 12 months posttreatment. Further, the significant relationship between reduced attachment avoidance and decreased interpersonal problems strengthened over the long term. This is the first study to show an association between change in attachment insecurity and change in other outcomes in the long term, and to show an adaptive spiral in which greater reduction in attachment avoidance is increasingly associated with ongoing improvement of interpersonal problems.

Psychotherapy, 2014

Attachment to groups is analogous to attachment to individuals, and may play an important role in... more Attachment to groups is analogous to attachment to individuals, and may play an important role in group functioning and in group psychotherapy outcomes. This study examined whether attachment to the therapy group can change during treatment, and whether such change predicts improvements in treatment outcomes, including individual attachment, up to 1 year posttreatment. Eighty-seven women with binge eating disorder (BED) attended Group Psychodynamic Interpersonal Psychotherapy (GPIP). Participants were assigned to one of two conditions in which groups were homogeneously composed of women with either higher or lower individual attachment anxiety. Outcomes were assessed pre, post, 6 months, and 1 year posttreatment. Attachment to the group was assessed at weeks 4, 8, 12, and 16 of GPIP. Group attachment insecurity decreased significantly during treatment. Reductions in group attachment avoidance predicted decreases in individual attachment insecurity at 1 year posttreatment. Study condition did not moderate these associations. These results indicate that women with BED who receive GPIP are able to generalize improvements in group attachment security to their individual attachment relationships outside of therapy up to 1 year post group treatment.

International Journal of Eating Disorders, 2011

To characterize a tertiary care treatment-seeking sample and assess post-treatment remission and ... more To characterize a tertiary care treatment-seeking sample and assess post-treatment remission and completion rates for purging disorder (PD). Consecutively admitted women with PD (n = 122), anorexia nervosa (AN) restricting subtype (AN-R; n = 146), AN binge-purge subtype (AN-B; n = 154), and bulimia nervosa-purging subtype (BN-P; n = 415) were compared on general and eating disorder specific psychopathology. A subsample (n = 256) attended a day treatment program and were assessed for post-treatment remission and completion rates. PD occurred in 17.3% of eating disorders not otherwise specified and 6.7% of total eating disorder referrals. PD patients were similar to AN-B and BN-P, but had higher levels than AN-R, on general and eating disorder psychopathology. PD individuals did not have different post-treatment remission or completion rates compared to other eating disorders. The results add to a growing literature on the utility of PD as a diagnosis.

Psychotherapy, 2014

Yalom and Leszcz (2005) indicated that interpersonal learning is a key therapeutic factor in grou... more Yalom and Leszcz (2005) indicated that interpersonal learning is a key therapeutic factor in group psychotherapy. In this study, we conceptualized interpersonal learning as the convergence over time between an individual's and the group's perception of the individual's cohesion to the group. First, we developed parallel measures of: (a) an individual's self-rated cohesion to the group (Cohesion Questionnaire-Individual Version [CQ-I]), and (b) the group's rating of the individual's cohesion to the group (CQ-G) based on the original Cohesion Questionnaire (CQ; Piper, Marache, Lacroix, Richardsen, & Jones, 1983). Second, we used these parallel scales to assess differences between an individual's self-rating and the mean of the group's ratings of the individual's cohesion to the group. Women with binge eating disorder (N = 102) received Group Psychodynamic Interpersonal Psychotherapy. Participants were assigned to homogeneously composed groups of either high or low attachment anxiety. Outcomes were measured pre- and post-treatment, and the CQ-I and CQ-G were administered every fourth group session. We found significant convergence over time between the CQ-I and mean CQ-G scale scores in both attachment anxiety conditions. Participants with higher attachment anxiety had lower individual self-ratings of cohesion and had greater discrepancies between the CQ-I and CG-G compared with those with lower attachment anxiety. There was a significant relationship between greater convergence in cohesion ratings and improved self-esteem at post-treatment. More accurate self-perceptions through feedback from group members may be a key factor in facilitating increased self-esteem in group therapy. Group therapists may facilitate such interpersonal learning, especially for those higher in attachment anxiety, by noting discrepancies and then encouraging convergence between an individual and the group in their perceptions of cohesion to the group.

Psychotherapy: Theory, Research, Practice, Training, 2007

The study examined if the relationship between change in attachment insecurity and target symptom... more The study examined if the relationship between change in attachment insecurity and target symptom outcomes was moderated by treatment type. Women (N = 66) with binge eating disorder (BED) were randomly assigned to two treatment types: group cognitive-behavioral therapy (GCBT) or group psychodynamic-interpersonal psychotherapy (GPIP). Results indicated significant positive pre- to posttreatment changes in all attachment insecurity scales, but no difference between GCBT and GPIP on these changes. Change in attachment anxiety was related to improved depression for women completing GPIP, but not for women completing GCBT. This indicated a moderating effect of treatment type in explaining the relationship between change in attachment anxiety and improved depression. Changes in attachment anxiety may be important for symptom outcomes related to psychodynamic-interpersonal therapies. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

Psychotherapy, 2011

This mixed method systematic case study applied an interpersonal stage model of the therapeutic p... more This mixed method systematic case study applied an interpersonal stage model of the therapeutic process to examine interpersonal processes among a highly adherent Group Psychodynamic-Interpersonal Psychotherapy (GPIP) therapist and a highly adherent Group Cognitive Behavioral Therapy (GCBT) therapist and their groups of binge eating disordered (BED) patients. This is the first case study to apply the interpersonal stage model of psychotherapy to compare GCBT and GPIP methods and the first to apply the model to group therapy. Early-, middle-, and late-stage transcribed video recordings of sequential interactions among therapists and patients in each of these two time-limited group therapies were analyzed with the Structural Analysis of Social Behavior (SASB). We also provide qualitative presentations of the transcripts from each stage as context for the quantitative analyses. BED patients in both groups achieved positive outcomes for binge eating and depression. Consistent with their treatment model, the GPIP therapist was more autonomy-giving, whereas the GCBT therapist was more controlling/directive. The GPIP therapist and her group had high levels of interpersonal complementary interaction sequences in the early stage followed by lower complementarity in the middle stage. The GCBT therapist and her group showed a high-low-high pattern of complementarity across the three stage of therapy. However, overall the GPIP group had higher levels complementarity than the GCBT group. This mixed method case study of group processes based on an interpersonal stage model of psychotherapy suggested specific therapist behaviors in each modality to maximize positive therapeutic interactions at each stage of group therapy.

Psychotherapy Research, 1999

... They found that low psychological mindedness (PM) as measured by the Psy-chological Mindednes... more ... They found that low psychological mindedness (PM) as measured by the Psy-chological Mindedness Assessment Procedure (PMAP) (McCallum & Piper, 19901, more severe psychiatric symptomatology as measured by the Symptom Checklist-90 (SCL-90) (Derogatis, 19771 ...

Psychotherapy Research, 2006

The development of group climate across 16 sessions of group psychodynamic–interpersonal psychoth... more The development of group climate across 16 sessions of group psychodynamic–interpersonal psychotherapy (GPIP) and group cognitive–behavioral therapy (GCBT) for 65 female treatment completers with binge-eating disorder (BED) was assessed. Engaged scale growth for GPIP patients varied across sessions and was best represented by a cubic growth curve. This suggested that GPIP progressed in definable phases that reflected a rupture and

Psychotherapy Research, 2013

We hypothesized that compared to therapy groups homogeneously composed of women with binge eating... more We hypothesized that compared to therapy groups homogeneously composed of women with binge eating disorder (BED) and low attachment anxiety, groups with high attachment anxiety would have better outcomes and a greater alliance-outcome relationship. We assigned 102 women with BED to therapy groups homogeneously composed of low attachment anxiety (n =52) or high attachment anxiety participants (n=50) who received Group Psychodynamic Interpersonal Psychotherapy (GPIP). GPIP resulted in improved outcomes with large effects. Attachment anxiety condition did not moderate outcomes. However, attachment anxiety condition did moderate the alliance-outcome relationship: i.e., group alliance growth was associated with improved binge eating only in the high attachment anxiety condition. Clinicians should be attentive to and encourage the growth of group therapy alliance especially for anxiously attached individuals.

Psychology and Psychotherapy: Theory, Research and Practice, 2014

Individuals with eating disorders are prone to depressive symptoms. This study examines whether d... more Individuals with eating disorders are prone to depressive symptoms. This study examines whether depressive symptoms can change in women who complete intensive day treatment for anorexia and bulimia nervosa (BN), and whether these changes are associated with pre-treatment attachment insecurity. Participants were 141 women with anorexia nervosa restricting type (n = 24), anorexia nervosa binge purge type (n = 30), and BN (n = 87) who completed a day hospital treatment programme for eating disorders. They completed a pre-treatment self-report measure of attachment, and a pre-treatment and post-treatment self-report measure of depressive symptoms. Participants experienced significant reductions in depressive symptoms at post-treatment. Eating disorder diagnosis was not related to these improvements. However, participants lower in attachment anxiety experienced significantly greater improvement in depressive symptoms than those who were higher in attachment anxiety. These results suggest that clinicians may tailor eating disorders treatments to patients' attachment patterns and focus on their pre-occupation with relationships and affect regulation to improve depressive symptoms. That depressive symptoms can decrease in women who complete day hospital treatment for anorexia and BN. That improvements in depressive symptoms do not vary according to eating disorder diagnosis in these women. That patients who complete treatment and who have higher attachment anxiety experience less improvements in depressive symptoms compared to those lower in attachment anxiety. That clinicians may attend to aspects of attachment anxiety, such as need for approval and up-regulation of emotions, to improve depressive symptoms in female patients with eating disorders.

Psychiatry: Interpersonal and Biological Processes, 2011

Adult attachment and group process research are emerging areas of research for treating eating di... more Adult attachment and group process research are emerging areas of research for treating eating disorders. In this study, we examined several aspects of group processes: the weekly growth of group therapy climate, the relationship between group climate growth and outcomes, and the impact of the group on individual experiences of group climate. Further, we assessed the relationship between adult attachment dimensions and these group processes. Women (n = 264) diagnosed with an eating disorder completed attachment scales pre-treatment, eating disorder symptom scales pre- and post-treatment, and group climate scales weekly during treatment. Treatment consisted of a specialized eating disorders group-based day hospital program with rolling admissions. Engaged group climate increased and Avoidance group climate decreased across weeks of treatment. Engaged group climate growth was associated with improved eating disorder symptoms post-treatment. Higher attachment avoidance at pre-treatment was related to lower Engaged group climate at week 1, and was related to a greater impact of the group on the individual's experience of group engagement. Clinicians might improve group processes and outcomes by tailoring interventions to individuals' attachment avoidance when treating women for eating disorders.

PLoS ONE, 2013

Intro: Binge eating disorder (BED) affects 3.5% of the population and is characterized by binge e... more Intro: Binge eating disorder (BED) affects 3.5% of the population and is characterized by binge eating for at least 2 days a week for 6 months. Treatment options include cognitive behavioral therapy, interpersonal psychotherapy, and pharmacotherapy which are associated with varied success. Little is known about the biology of BED. Since there is evidence that the insulin like growth factor system is implicated in regulation of body weight, insulin sensitivity and feeding behavior, we speculated it may be involved in BED.

The Journal of Nervous and Mental Disease, 2010

We examined the extent to which attachment insecurity was related to eating disorder (ED) symptom... more We examined the extent to which attachment insecurity was related to eating disorder (ED) symptoms, and predictive of treatment outcomes. Women diagnosed with anorexia nervosa (AN) restricting subtype (ANR), AN binge purge subtype (ANB), or bulimia nervosa (BN) completed an attachment scale pretreatment, and ED symptom scales pretreatment (N = 243) and post-treatment (N = 157). A comparison sample of 126 non-ED women completed attachment scales on 1 occasion. Those with EDs had significantly higher attachment insecurity than non-ED. ANB was associated with higher attachment avoidance compared with ANR and BN, and higher attachment anxiety compared with BN. Higher attachment anxiety was significantly related to greater ED symptom severity and poorer treatment outcome across all EDs even after controlling for ED diagnosis. Attachment dimensions substantially contribute to our understanding of ED symptoms and treatment outcome. Addressing attachment insecurity when treating those with EDs may improve treatment outcomes.

International Journal of Group Psychotherapy, 2012

We assessed whether an attachment-based treatment, Group Psychodynamic Interpersonal Psychotherap... more We assessed whether an attachment-based treatment, Group Psychodynamic Interpersonal Psychotherapy (GPIP) had a greater impact compared to Group Cognitive Behavioral Therapy (GCBT) on Cold/Distant and Intrusive/Needy interpersonal problems. Ninety-five individuals with Binge Eating Disorder (BED) were randomized to GPIP or GCBT and assessed at pre-, post-, and six months post-treatment. Both therapies resulted in a significant decrease in all eight interpersonal problem subscales except the Nonassertive subscale. GPIP resulted in a greater reduction in the Cold/Distant subscale compared to GCBT, but no differences were found for changes in the Intrusive/Needy subscale. GPIP may be most relevant for those with BED who have Cold/Distant interpersonal problems and attachment avoidance.

Group Dynamics: Theory, Research, and Practice, 2012

ABSTRACT Interpersonal complementarity during the early stage of therapy may be related to treatm... more ABSTRACT Interpersonal complementarity during the early stage of therapy may be related to treatment outcomes. The extent to which a patient experiences attachment anxiety may affect the amount of complementary interactions in which a patient engages with a therapist during group therapy, which in turn may be associated with outcomes. The current study is one of the first to assess complementarity in group psychotherapy with the Structural Analysis of Social Behavior. Women with Binge Eating Disorder (n = 60) who received group psychodynamic interpersonal psychotherapy were assessed for attachment anxiety based on the Attachment Style Questionnaire (Feeney, Noller, & Hanrahan, 1994) pretreatment. They were then assigned to one of two conditions in which groups were homogeneously composed of either high or low attachment anxiety patients. Outcomes included depressive symptoms and binge eating frequency from pre to posttreatment. Complementarity of sequential interactions was assessed among six therapists and their patients during the third session of the 12 therapy groups. The low attachment anxiety condition was associated with higher therapist–patient complementary interactions during the early session of treatment. Greater therapist–patient complementarity during the early session of group therapy was related to a decrease in binge eating frequency at posttreatment. Results suggest that group therapists might focus on promoting greater interpersonal complementary interactions within groups in the early stage of treatment to improve outcomes. (PsycINFO Database Record (c) 2014 APA, all rights reserved)

Group Dynamics: Theory, Research, and Practice, 2014

ABSTRACT Previous research suggests an association between increased group cohesion and: (a) impr... more ABSTRACT Previous research suggests an association between increased group cohesion and: (a) improved group process, and (b) improved treatment outcomes for those with binge eating disorder (BED) and depression (Castonguay, Pincus, Agras, & Hines, 1998; Crowe & Grenyer, 2008). Other research indicated that attachment anxiety may be associated with treatment outcomes for women with BED (Tasca, Ritchie et al., 2006). Our goals for this study were to examine the relationship between group cohesion, attachment anxiety, and change in clinical outcomes at posttreatment. Participants, 102 women with BED, were assigned to homogeneously composed psychotherapy groups based on their pretreatment level of attachment anxiety (i.e., high vs. low attachment anxiety). The group treatment was 16 weeks of Group Psychodynamic Interpersonal Psychotherapy (GPIP; Tasca, Mikail, & Hewitt, 2005). Outcomes were measured pre- and posttherapy, and cohesion was measured weekly. We found a significant increase in group cohesion over the course of treatment in both high and low attachment anxiety conditions. We also found that attachment anxiety at study baseline moderated the relationship between growth in group cohesion and change in binge eating. Increase in group cohesion was associated with improved binge eating, but only for those high in attachment anxiety. Our findings are consistent with an interpersonal model of BED, and suggest that group therapists should emphasize the growth of cohesion in therapy groups, especially for those with high attachment anxiety, so as to maximize interventions aimed at reducing binge eating and associated presenting problems. (PsycINFO Database Record (c) 2014 APA, all rights reserved)

Women's Health Issues, 2010

Depression is a most burdensome illness, with personal and societal costs surpassing those of any... more Depression is a most burdensome illness, with personal and societal costs surpassing those of any other illness. Furthermore, depression affects women at a much higher rate than men. The most prevalent eating disorder among adult women is binge eating disorder (BED). Depression and obesity are common in women with BED, most of whom seek treatment later in life. Depression, obesity, and age are associated with greater health care use and lower health-related quality of life (HRQOL). Hence, for women with BED estimating the effects of depression can be confounded by both age and body mass index (BMI). The current study examined the relationships between depression, HRQOL, and health care utilization among treatment seeking women with BED. Participants (n = 105) completed the Structured Clinical Interview for DSM-IV, a health care utilization and cost survey, the Personality Assessment Inventory depression scale, and the EQ-5D to measure HRQOL. On average, participants were severely obese with a mean BMI of 38.20 (SD = 6.80); 67.27% had a lifetime history of depression. Participants had higher health care costs and lower HRQOL than published age- and gender-matched norms. After controlling for age and BMI, depressive symptoms were significantly related to greater medication use (excluding antidepressants), and lower HRQOL. Results suggest that targeting depressive symptoms may reduce the economic and personal burden of BED for women.

Journal of Social and Clinical Psychology, 2010

... giorgio a. taSCa The Ottawa Hospital, University of Ottawa, Carleton University NiKKi KeNNeDy... more ... giorgio a. taSCa The Ottawa Hospital, University of Ottawa, Carleton University NiKKi KeNNeDy University of Ottawa ... Two PAI (Morey, 1991) sub-scales, cognitive depression (DEP-C) and identity problems (BOR-I), were the indicator variables for the self-concept latent factor. ...

Personality and Individual Differences, 2009

The study examined the role of affect regulation strategies in mediating the relationship between... more The study examined the role of affect regulation strategies in mediating the relationship between attachment dimensions and both depressive and eating disorder (ED) symptoms. Participants were 310 women seeking treatment for an ED. Structural equation modeling indicated that attachment anxiety contributed to both depressive symptoms and ED symptoms through emotional reactivity. In contrast, only the association between attachment avoidance and

Psychotherapy, 2014

An interpersonal model of Binge Eating Disorder (BED) posits that difficulties with social functi... more An interpersonal model of Binge Eating Disorder (BED) posits that difficulties with social functioning precipitate negative affect, which in turn causes binge eating as a means of coping. Thus, long-term decreases in attachment insecurity may be important for women with BED. No research has assessed if long-term change in attachment insecurity is associated with sustained change in other outcomes. In the current study, we hypothesized that changes in attachment anxiety and avoidance will decrease at posttreatment and will be maintained up to 12 months after Group Psychodynamic Interpersonal Psychotherapy (GPIP). We further hypothesized that long-term stability of these changes in attachment insecurity will be related to other long-term outcomes. Women with BED (N = 102) attended 16 sessions of GPIP. Measures were completed pretreatment, posttreatment, at 6 and 12 months follow-up. Attachment anxiety, attachment avoidance, and the other outcome variables decreased significantly at 12 months posttreatment. Reductions in attachment anxiety and avoidance were significantly related to decreases in interpersonal problems up to 12 months posttreatment, and reduction in attachment anxiety was significantly related to decreases in depressive symptoms 12 months posttreatment. Further, the significant relationship between reduced attachment avoidance and decreased interpersonal problems strengthened over the long term. This is the first study to show an association between change in attachment insecurity and change in other outcomes in the long term, and to show an adaptive spiral in which greater reduction in attachment avoidance is increasingly associated with ongoing improvement of interpersonal problems.

Psychotherapy, 2014

Attachment to groups is analogous to attachment to individuals, and may play an important role in... more Attachment to groups is analogous to attachment to individuals, and may play an important role in group functioning and in group psychotherapy outcomes. This study examined whether attachment to the therapy group can change during treatment, and whether such change predicts improvements in treatment outcomes, including individual attachment, up to 1 year posttreatment. Eighty-seven women with binge eating disorder (BED) attended Group Psychodynamic Interpersonal Psychotherapy (GPIP). Participants were assigned to one of two conditions in which groups were homogeneously composed of women with either higher or lower individual attachment anxiety. Outcomes were assessed pre, post, 6 months, and 1 year posttreatment. Attachment to the group was assessed at weeks 4, 8, 12, and 16 of GPIP. Group attachment insecurity decreased significantly during treatment. Reductions in group attachment avoidance predicted decreases in individual attachment insecurity at 1 year posttreatment. Study condition did not moderate these associations. These results indicate that women with BED who receive GPIP are able to generalize improvements in group attachment security to their individual attachment relationships outside of therapy up to 1 year post group treatment.

International Journal of Eating Disorders, 2011

To characterize a tertiary care treatment-seeking sample and assess post-treatment remission and ... more To characterize a tertiary care treatment-seeking sample and assess post-treatment remission and completion rates for purging disorder (PD). Consecutively admitted women with PD (n = 122), anorexia nervosa (AN) restricting subtype (AN-R; n = 146), AN binge-purge subtype (AN-B; n = 154), and bulimia nervosa-purging subtype (BN-P; n = 415) were compared on general and eating disorder specific psychopathology. A subsample (n = 256) attended a day treatment program and were assessed for post-treatment remission and completion rates. PD occurred in 17.3% of eating disorders not otherwise specified and 6.7% of total eating disorder referrals. PD patients were similar to AN-B and BN-P, but had higher levels than AN-R, on general and eating disorder psychopathology. PD individuals did not have different post-treatment remission or completion rates compared to other eating disorders. The results add to a growing literature on the utility of PD as a diagnosis.

Psychotherapy, 2014

Yalom and Leszcz (2005) indicated that interpersonal learning is a key therapeutic factor in grou... more Yalom and Leszcz (2005) indicated that interpersonal learning is a key therapeutic factor in group psychotherapy. In this study, we conceptualized interpersonal learning as the convergence over time between an individual's and the group's perception of the individual's cohesion to the group. First, we developed parallel measures of: (a) an individual's self-rated cohesion to the group (Cohesion Questionnaire-Individual Version [CQ-I]), and (b) the group's rating of the individual's cohesion to the group (CQ-G) based on the original Cohesion Questionnaire (CQ; Piper, Marache, Lacroix, Richardsen, & Jones, 1983). Second, we used these parallel scales to assess differences between an individual's self-rating and the mean of the group's ratings of the individual's cohesion to the group. Women with binge eating disorder (N = 102) received Group Psychodynamic Interpersonal Psychotherapy. Participants were assigned to homogeneously composed groups of either high or low attachment anxiety. Outcomes were measured pre- and post-treatment, and the CQ-I and CQ-G were administered every fourth group session. We found significant convergence over time between the CQ-I and mean CQ-G scale scores in both attachment anxiety conditions. Participants with higher attachment anxiety had lower individual self-ratings of cohesion and had greater discrepancies between the CQ-I and CG-G compared with those with lower attachment anxiety. There was a significant relationship between greater convergence in cohesion ratings and improved self-esteem at post-treatment. More accurate self-perceptions through feedback from group members may be a key factor in facilitating increased self-esteem in group therapy. Group therapists may facilitate such interpersonal learning, especially for those higher in attachment anxiety, by noting discrepancies and then encouraging convergence between an individual and the group in their perceptions of cohesion to the group.

Psychotherapy: Theory, Research, Practice, Training, 2007

The study examined if the relationship between change in attachment insecurity and target symptom... more The study examined if the relationship between change in attachment insecurity and target symptom outcomes was moderated by treatment type. Women (N = 66) with binge eating disorder (BED) were randomly assigned to two treatment types: group cognitive-behavioral therapy (GCBT) or group psychodynamic-interpersonal psychotherapy (GPIP). Results indicated significant positive pre- to posttreatment changes in all attachment insecurity scales, but no difference between GCBT and GPIP on these changes. Change in attachment anxiety was related to improved depression for women completing GPIP, but not for women completing GCBT. This indicated a moderating effect of treatment type in explaining the relationship between change in attachment anxiety and improved depression. Changes in attachment anxiety may be important for symptom outcomes related to psychodynamic-interpersonal therapies. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

Psychotherapy, 2011

This mixed method systematic case study applied an interpersonal stage model of the therapeutic p... more This mixed method systematic case study applied an interpersonal stage model of the therapeutic process to examine interpersonal processes among a highly adherent Group Psychodynamic-Interpersonal Psychotherapy (GPIP) therapist and a highly adherent Group Cognitive Behavioral Therapy (GCBT) therapist and their groups of binge eating disordered (BED) patients. This is the first case study to apply the interpersonal stage model of psychotherapy to compare GCBT and GPIP methods and the first to apply the model to group therapy. Early-, middle-, and late-stage transcribed video recordings of sequential interactions among therapists and patients in each of these two time-limited group therapies were analyzed with the Structural Analysis of Social Behavior (SASB). We also provide qualitative presentations of the transcripts from each stage as context for the quantitative analyses. BED patients in both groups achieved positive outcomes for binge eating and depression. Consistent with their treatment model, the GPIP therapist was more autonomy-giving, whereas the GCBT therapist was more controlling/directive. The GPIP therapist and her group had high levels of interpersonal complementary interaction sequences in the early stage followed by lower complementarity in the middle stage. The GCBT therapist and her group showed a high-low-high pattern of complementarity across the three stage of therapy. However, overall the GPIP group had higher levels complementarity than the GCBT group. This mixed method case study of group processes based on an interpersonal stage model of psychotherapy suggested specific therapist behaviors in each modality to maximize positive therapeutic interactions at each stage of group therapy.

Psychotherapy Research, 1999

... They found that low psychological mindedness (PM) as measured by the Psy-chological Mindednes... more ... They found that low psychological mindedness (PM) as measured by the Psy-chological Mindedness Assessment Procedure (PMAP) (McCallum & Piper, 19901, more severe psychiatric symptomatology as measured by the Symptom Checklist-90 (SCL-90) (Derogatis, 19771 ...

Psychotherapy Research, 2006

The development of group climate across 16 sessions of group psychodynamic–interpersonal psychoth... more The development of group climate across 16 sessions of group psychodynamic–interpersonal psychotherapy (GPIP) and group cognitive–behavioral therapy (GCBT) for 65 female treatment completers with binge-eating disorder (BED) was assessed. Engaged scale growth for GPIP patients varied across sessions and was best represented by a cubic growth curve. This suggested that GPIP progressed in definable phases that reflected a rupture and

Psychotherapy Research, 2013

We hypothesized that compared to therapy groups homogeneously composed of women with binge eating... more We hypothesized that compared to therapy groups homogeneously composed of women with binge eating disorder (BED) and low attachment anxiety, groups with high attachment anxiety would have better outcomes and a greater alliance-outcome relationship. We assigned 102 women with BED to therapy groups homogeneously composed of low attachment anxiety (n =52) or high attachment anxiety participants (n=50) who received Group Psychodynamic Interpersonal Psychotherapy (GPIP). GPIP resulted in improved outcomes with large effects. Attachment anxiety condition did not moderate outcomes. However, attachment anxiety condition did moderate the alliance-outcome relationship: i.e., group alliance growth was associated with improved binge eating only in the high attachment anxiety condition. Clinicians should be attentive to and encourage the growth of group therapy alliance especially for anxiously attached individuals.

Psychology and Psychotherapy: Theory, Research and Practice, 2014

Individuals with eating disorders are prone to depressive symptoms. This study examines whether d... more Individuals with eating disorders are prone to depressive symptoms. This study examines whether depressive symptoms can change in women who complete intensive day treatment for anorexia and bulimia nervosa (BN), and whether these changes are associated with pre-treatment attachment insecurity. Participants were 141 women with anorexia nervosa restricting type (n = 24), anorexia nervosa binge purge type (n = 30), and BN (n = 87) who completed a day hospital treatment programme for eating disorders. They completed a pre-treatment self-report measure of attachment, and a pre-treatment and post-treatment self-report measure of depressive symptoms. Participants experienced significant reductions in depressive symptoms at post-treatment. Eating disorder diagnosis was not related to these improvements. However, participants lower in attachment anxiety experienced significantly greater improvement in depressive symptoms than those who were higher in attachment anxiety. These results suggest that clinicians may tailor eating disorders treatments to patients' attachment patterns and focus on their pre-occupation with relationships and affect regulation to improve depressive symptoms. That depressive symptoms can decrease in women who complete day hospital treatment for anorexia and BN. That improvements in depressive symptoms do not vary according to eating disorder diagnosis in these women. That patients who complete treatment and who have higher attachment anxiety experience less improvements in depressive symptoms compared to those lower in attachment anxiety. That clinicians may attend to aspects of attachment anxiety, such as need for approval and up-regulation of emotions, to improve depressive symptoms in female patients with eating disorders.

Psychiatry: Interpersonal and Biological Processes, 2011

Adult attachment and group process research are emerging areas of research for treating eating di... more Adult attachment and group process research are emerging areas of research for treating eating disorders. In this study, we examined several aspects of group processes: the weekly growth of group therapy climate, the relationship between group climate growth and outcomes, and the impact of the group on individual experiences of group climate. Further, we assessed the relationship between adult attachment dimensions and these group processes. Women (n = 264) diagnosed with an eating disorder completed attachment scales pre-treatment, eating disorder symptom scales pre- and post-treatment, and group climate scales weekly during treatment. Treatment consisted of a specialized eating disorders group-based day hospital program with rolling admissions. Engaged group climate increased and Avoidance group climate decreased across weeks of treatment. Engaged group climate growth was associated with improved eating disorder symptoms post-treatment. Higher attachment avoidance at pre-treatment was related to lower Engaged group climate at week 1, and was related to a greater impact of the group on the individual's experience of group engagement. Clinicians might improve group processes and outcomes by tailoring interventions to individuals' attachment avoidance when treating women for eating disorders.

PLoS ONE, 2013

Intro: Binge eating disorder (BED) affects 3.5% of the population and is characterized by binge e... more Intro: Binge eating disorder (BED) affects 3.5% of the population and is characterized by binge eating for at least 2 days a week for 6 months. Treatment options include cognitive behavioral therapy, interpersonal psychotherapy, and pharmacotherapy which are associated with varied success. Little is known about the biology of BED. Since there is evidence that the insulin like growth factor system is implicated in regulation of body weight, insulin sensitivity and feeding behavior, we speculated it may be involved in BED.

The Journal of Nervous and Mental Disease, 2010

We examined the extent to which attachment insecurity was related to eating disorder (ED) symptom... more We examined the extent to which attachment insecurity was related to eating disorder (ED) symptoms, and predictive of treatment outcomes. Women diagnosed with anorexia nervosa (AN) restricting subtype (ANR), AN binge purge subtype (ANB), or bulimia nervosa (BN) completed an attachment scale pretreatment, and ED symptom scales pretreatment (N = 243) and post-treatment (N = 157). A comparison sample of 126 non-ED women completed attachment scales on 1 occasion. Those with EDs had significantly higher attachment insecurity than non-ED. ANB was associated with higher attachment avoidance compared with ANR and BN, and higher attachment anxiety compared with BN. Higher attachment anxiety was significantly related to greater ED symptom severity and poorer treatment outcome across all EDs even after controlling for ED diagnosis. Attachment dimensions substantially contribute to our understanding of ED symptoms and treatment outcome. Addressing attachment insecurity when treating those with EDs may improve treatment outcomes.

International Journal of Group Psychotherapy, 2012

We assessed whether an attachment-based treatment, Group Psychodynamic Interpersonal Psychotherap... more We assessed whether an attachment-based treatment, Group Psychodynamic Interpersonal Psychotherapy (GPIP) had a greater impact compared to Group Cognitive Behavioral Therapy (GCBT) on Cold/Distant and Intrusive/Needy interpersonal problems. Ninety-five individuals with Binge Eating Disorder (BED) were randomized to GPIP or GCBT and assessed at pre-, post-, and six months post-treatment. Both therapies resulted in a significant decrease in all eight interpersonal problem subscales except the Nonassertive subscale. GPIP resulted in a greater reduction in the Cold/Distant subscale compared to GCBT, but no differences were found for changes in the Intrusive/Needy subscale. GPIP may be most relevant for those with BED who have Cold/Distant interpersonal problems and attachment avoidance.

Group Dynamics: Theory, Research, and Practice, 2012

ABSTRACT Interpersonal complementarity during the early stage of therapy may be related to treatm... more ABSTRACT Interpersonal complementarity during the early stage of therapy may be related to treatment outcomes. The extent to which a patient experiences attachment anxiety may affect the amount of complementary interactions in which a patient engages with a therapist during group therapy, which in turn may be associated with outcomes. The current study is one of the first to assess complementarity in group psychotherapy with the Structural Analysis of Social Behavior. Women with Binge Eating Disorder (n = 60) who received group psychodynamic interpersonal psychotherapy were assessed for attachment anxiety based on the Attachment Style Questionnaire (Feeney, Noller, & Hanrahan, 1994) pretreatment. They were then assigned to one of two conditions in which groups were homogeneously composed of either high or low attachment anxiety patients. Outcomes included depressive symptoms and binge eating frequency from pre to posttreatment. Complementarity of sequential interactions was assessed among six therapists and their patients during the third session of the 12 therapy groups. The low attachment anxiety condition was associated with higher therapist–patient complementary interactions during the early session of treatment. Greater therapist–patient complementarity during the early session of group therapy was related to a decrease in binge eating frequency at posttreatment. Results suggest that group therapists might focus on promoting greater interpersonal complementary interactions within groups in the early stage of treatment to improve outcomes. (PsycINFO Database Record (c) 2014 APA, all rights reserved)

Group Dynamics: Theory, Research, and Practice, 2014

ABSTRACT Previous research suggests an association between increased group cohesion and: (a) impr... more ABSTRACT Previous research suggests an association between increased group cohesion and: (a) improved group process, and (b) improved treatment outcomes for those with binge eating disorder (BED) and depression (Castonguay, Pincus, Agras, & Hines, 1998; Crowe & Grenyer, 2008). Other research indicated that attachment anxiety may be associated with treatment outcomes for women with BED (Tasca, Ritchie et al., 2006). Our goals for this study were to examine the relationship between group cohesion, attachment anxiety, and change in clinical outcomes at posttreatment. Participants, 102 women with BED, were assigned to homogeneously composed psychotherapy groups based on their pretreatment level of attachment anxiety (i.e., high vs. low attachment anxiety). The group treatment was 16 weeks of Group Psychodynamic Interpersonal Psychotherapy (GPIP; Tasca, Mikail, & Hewitt, 2005). Outcomes were measured pre- and posttherapy, and cohesion was measured weekly. We found a significant increase in group cohesion over the course of treatment in both high and low attachment anxiety conditions. We also found that attachment anxiety at study baseline moderated the relationship between growth in group cohesion and change in binge eating. Increase in group cohesion was associated with improved binge eating, but only for those high in attachment anxiety. Our findings are consistent with an interpersonal model of BED, and suggest that group therapists should emphasize the growth of cohesion in therapy groups, especially for those with high attachment anxiety, so as to maximize interventions aimed at reducing binge eating and associated presenting problems. (PsycINFO Database Record (c) 2014 APA, all rights reserved)