• Detecting eating psychopathology in female athletes by asking about exercise: Use of the compulsive exercise test

      Arcelus, Jon (2017)
      The present study assessed the suitability of the Compulsive Exercise Test (athlete version; CET-A) for identifying female athletes with clinically significant features related to or comparable with eating psychopathology. Three hundred and sixty-one female athletes (including 12 with a clinically diagnosed eating disorder) completed the Eating Disorders Examination Questionnaire and the CET-A. Receiver operating curve analysis was employed to identify a cut-off value on the CET-A, which could indicate clinically significant features related to or comparable with eating psychopathology among female athletes. The analysis demonstrated that a CET-A score of 10 successfully discriminated female athletes with a current eating disorder. The results suggest that the CET-A may be a suitable tool for detecting eating psychopathology in female athletes. Additional longitudinal research is needed to evaluate the predictive value of the CET-A. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.
    • Dimensions of compulsive exercise across eating disorder diagnostic subtypes and the validation of the Spanish version of the Compulsive Exercise Test

      Arcelus, Jon (2016)
      Objectives: Compulsive exercise in eating disorders has been traditionally considered as a behavior that serves the purpose of weight/shape control. More recently, it has been postulated that there may be other factors that drive the compulsive need to exercise. This has led to the development of the Compulsive Exercise Test (CET); a self-reported questionnaire that aims to explore the cognitive-behavioral underpinnings of compulsive exercise from a multi-faceted perspective. The objectives of this study were threefold: (1) to validate the Spanish version of the CET; (2) to compare eating disorder diagnostic subtypes and a healthy control group in terms of the factors that drive compulsive exercise as defined by the CET; (3) to explore how the dimensions evaluated in the CET are associated with eating disorder symptoms and general psychopathology. Methods: The CET was administered to a total of 157 patients with an eating disorder [40 anorexia nervosa, 56 bulimia nervosa (BN), and 61 eating disorder not-otherwisespecified (EDNOS)] and 128 healthy weight/eating controls. Patients were assessed via a semi-structured interview to reach a DSM-IV-TR diagnosis. Additionally, all participants completed the Symptom Checklist-90-Revised (SCL-90R) and the Eating Disorders Inventory-2 (EDI-2). Results: Confirmatory factor analysis demonstrated adequate goodness-of-fit to the original five-factor model of the CET. BN and EDNOS patients scored higher in the avoidance and rule-driven behavior, weight control, and total CET scales in comparison to the healthy controls, and higher across all scales apart from the exercise rigidity scale compared to the anorexia nervosa patients. Mean scores of the anorexia nervosa patients did not differ to those of the control participants, except for the mood improvement scale where the anorexia nervosa patients obtained a lower mean score. Mean scores between the BN and EDNOS patients were equivalent. The CET scales avoidance and rule-driven behavior, weight of control and total CET scores were positively correlated with the clinical assessment measures of the SCL-90R and EDI-2. Conclusion: Compulsive exercise is a multidimensional construct and the factors driving compulsive exercise differ according to the eating disorder diagnostic subtype. This should be taken into account when addressing compulsive exercise during the treatment of eating disorders. (PsycINFO Database Record (c) 2017 APA, all rights reserved) (Source: journal abstract)
    • Eating disorders in athletes: Detection, diagnosis, and treatment

      Arcelus, Jon (2017)
      Sportsmen/women and dancers possess a distinct combination of physical and psychological attributes that can contribute toward their success within their sporting and dance context. This includes qualities such as physical and psychological resilience, an unyielding commitment to exercise, the continuous pursuit of excellence, and the ability to withstand intense physical exertion. However, because close attention to diet and weight control is very important in some sports and dance modalities, athletes are also at a significantly increased risk of developing an eating disorder. This chapter presents an overview of the current evidence on the presentation, prevalence, risk factors, and treatment strategies for eating disorders among athletes. (PsycINFO Database Record (c) 2017 APA, all rights reserved) (Source: chapter)
    • Evaluating a motivational and psycho-educational self-help intervention for athletes with mild eating disorder symptoms: A mixed methods feasibility study

      Arcelus, Jon (2022)
      OBJECTIVEThe primary aim was to assess the feasibility of undertaking a study evaluating the novel Motivational and Psycho-Educational Self-Help Programme for Athletes with Mild Eating Disorder Symptoms (MOPED-A). A mixed-methods approach was adopted to explore the feasibility of recruiting and retaining participants, and to evaluate the acceptability of measures, procedures and the intervention. A secondary aim was to explore the potential efficacy of MOPED-A in reducing athletes' eating disorder symptoms.METHODThirty-five athletes were recruited. Participation involved completing MOPED-A over a 6-week period and completing self-report measures at baseline (T1), post-intervention (T2) and 4-week follow-up (T3). A subsample (n = 15) completed an interview at T2.RESULTSRetention was good throughout the study (n = 28; 80%). Quantitative and qualitative feedback suggested the format, delivery, content and dosage of MOPED-A were acceptable. Athletes valued that the intervention was tailored to them, and this facilitated both participation and completion. Over a third of participants reported disclosing their eating difficulties and deciding to seek further support. Large reductions in eating disorder symptoms were detected at T2 and sustained at T3.CONCLUSIONSThe MOPED-A intervention can be feasibly implemented, is acceptable to participants, and demonstrates potential for reducing symptoms in athletes. A larger, controlled trial is warranted.
    • Female athlete experiences of seeking and receiving treatment for an eating disorder

      Arcelus, Jon (2017)
      Clinical eating disorders are common among athletes; however research has yet to explore the process of seeking and receiving treatment for an eating disorder in this population. Semi-structured interviews were conducted with 13 female athletes currently receiving treatment for an eating disorder. A total of three themes emerged: challenges to treatment seeking, feeling out of place, and coping with exercise transitions. Athletes reported low levels of eating disorder literacy and lacked motivation to engage with therapy due to a lack of perceived relevance. Athletes found it challenging to relinquish exercise behaviours in treatment and expressed concerns around managing a return to sport. It may be necessary to provide additional support to athletes when embarking on and leaving treatment programs, particularly with regards to managing expectations about exercise.
    • A randomized controlled trial of the compuLsive Exercise Activity TheraPy (LEAP): A new approach to compulsive exercise in anorexia nervosa

      Arcelus, Jon (2018)
      OBJECTIVE: To compare the efficacy of the compuLsive Exercise Activity theraPy (LEAP) programme integrated with manualized cognitive behavioral therapy for anorexia nervosa (CBT-AN) compared to CBT-AN alone. METHOD: Seventy-eight adults were randomized to CBT-AN, delivered with or without eight embedded sessions of LEAP, for a total of 34 individual outpatient sessions. Participants were assessed at baseline, the end of the first phase of CBT-AN (which included LEAP), mid-therapy, end of therapy, and at 3 and 6 months follow-up. Linear mixed effects modelling was used for comparing trajectories over time by group in primary outcomes of pathological exercise cognitions and secondary outcomes of exercise frequency, BMI, eating disorder (ED) symptoms, AN stage of change, anxiety/depression, and health related quality of life. RESULTS: There were significant improvements over time in all outcomes. There were no significant differences between treatment groups in primary outcome measures. Fidelity and end-of-treatment participant satisfaction were satisfactory across both conditions. DISCUSSION: CBT-AN and LEAP added to CBT-AN resulted in improved attitudes and beliefs toward exercise and general improvements in BMI and ED psychopathology in people with AN.
    • Relationships between compulsive exercise, quality of life, psychological distress and motivation to change in adults with anorexia nervosa

      Arcelus, Jon (2018)
      Background: For people with anorexia nervosa (AN), compulsive exercise is characterized by extreme concerns about the perceived negative consequences of stopping/reducing exercise, dysregulation of affect, and inflexible exercise routines. It is associated with increased eating disorder psychopathology and poor clinical outcome. However, its relationships with two important clinical issues, quality of life (QoL) and motivation to change, are currently unknown. This study aimed to assess the cross-sectional relationships between compulsive exercise, QoL, psychological distress (anxiety and depressive symptoms, and obsessive-compulsive traits) and motivation to change in patients with AN. Method: A total of 78 adults with AN participated in this study, which was nested within a randomized controlled trial of psychological treatments for AN. At baseline (pre-treatment), participants completed questionnaires assessing compulsive exercise, eating disorder (ED) psychopathology, QoL, psychological distress and motivation to change. Results: Baseline correlational analyses demonstrated a moderate positive relationship between compulsive exercise and ED psychopathology, and a weak positive relationship between compulsive exercise and psychological distress. There was a moderate negative relationship between compulsive exercise and eating disorder QoL. Conclusions: These results indicate compulsive exercise is moderately associated with poorer QoL and weakly associated with higher distress. Targeting compulsive exercise in the treatment of anorexia nervosa may help reduce the burden of illness and improve patients' engagement in treatment. © 2018 The Author(s).
    • Validity of exercise measures in adults with anorexia nervosa: The EDE, compulsive exercise test and other self-report scales

      Arcelus, Jon (2016)
      OBJECTIVE: Compulsive exercise is a prominent feature for the majority of patients with Anorexia Nervosa (AN), but there is a dearth of research evaluating assessment instruments. This study assessed the concurrent validity of the exercise items of the Eating Disorder Examination (EDE) and Eating Disorder Examination-Questionnaire (EDE-Q), with the Compulsive Exercise Test (CET) and other self-report exercise measures in patients with AN. We also aimed to perform validation of the CET in an adult clinical sample. METHODS: The sample consisted of 78 adults with AN, recruited for the randomized controlled trial "Taking a LEAP forward in the treatment of anorexia nervosa." At baseline, participants completed the EDE, EDE-Q, CET, Reasons for Exercise Inventory (REI), Commitment to Exercise Scale (CES) and Exercise Beliefs Questionnaire (EBQ). Correlational and regression analyses were performed. RESULTS: EDE exercise days and exercise time per day were positively correlated with each other and with all CET subscales (except Lack of exercise enjoyment), CES mean, EBQ total and REI total. Exercise time per day was associated with a higher EDE global score. The CET demonstrated good concurrent validity with the CES, the REI and the EBQ. Of the self-reports, the CET explained the greatest variance in eating disorder psychopathology and demonstrated good to excellent reliability in this sample. DISCUSSION: The EDE and EDE-Q demonstrated good concurrent validity with the CET. Further research is required to evaluate the CET's factor structure in a large clinical sample. However, the CET has demonstrated strong clinical utility in adult patients with AN. (c) 2016 Wiley Periodicals, Inc.(Int J Eat Disord 2016).