To deliver or not to deliver cognitive behavioral therapy for eating disorders: Replication and extension of our understanding of why therapists fail to do what they should do.

OBJECTIVE: This study investigated the extent to which therapists fail to apply empirically supported treatments in a sample of clinicians in The Netherlands, delivering cognitive behavioral therapy for eating disorders (CBT-ED). It aimed to replicate previous findings, and to extend them by examining other potential intra-individual factors associated with the level of (non-)use of core CBT-ED techniques. METHOD: Participants were 139 clinicians (127 women; mean age 41.4 years, range = 24-64) who completed an online survey about the level of use of specific techniques, their beliefs (e.g., about the importance of the alliance and use of pretreatment motivational techniques), anxiety (Intolerance of Uncertainty Scale), and personality (Ten Item Personality Inventory). RESULTS: Despite some differences with Waller's (2012) findings, the present results continue to indicate that therapists are not reliably delivering the CBT-ED techniques that would be expected to provide the best treatment to their patients. This 'non-delivery' appears to be related to clinician anxiety, temporal factors, and clinicians' beliefs about the power of the therapeutic alliance in driving therapy outcomes. DISCUSSION: Improving treatment delivery will involve working with clinicians' levels of anxiety, clarifying the lack of benefit of pre-therapy motivational enhancement work, and reminding clinicians that the therapeutic alliance is enhanced by behavioral change in CBT-ED, rather than the other way around.

'Emotional' does not even start to cover it: Generalization of overeating in emotional eaters.

Based on recent studies indicating that emotional eating is not the clearly defined problem it is often thought to be, the present study investigated whether emotional eaters overeat merely in response to negative emotional cues, or to other cues as well. It was hypothesized that emotional eaters would overeat after a variety of food cues, not limited to negative emotions. Participants took part in four conditions (negative mood manipulation, positive mood manipulation, food exposure and a control condition) divided over two sessions. Each condition was followed by a bogus taste test, after which food intake was measured. Results showed strong correlations between food intake after all four conditions, indicating that increased intake after one type of cue is related to increased intake after other cues. Participants were identified as emotional or non-emotional eaters based on food intake in the negative mood condition, and based on self-reported emotional eating scores. Both measures of emotional eating were significantly related to food intake after all cues. Based on the current findings, we conclude that individuals who show increased food intake when in a negative emotional state also overeat when experiencing other food-signalling cues. This indicates that 'emotional eating' may not fully capture the eating behaviour of individuals currently identified as 'emotional eaters'.