Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
Showing 4 appraisals
Journal of medical Internet research
Training Clinicians in Private Practice in Family-Based Treatment for Anorexia Nervosa: Randomized Controlled Trial Comparing Two Online Approaches
BACKGROUND: There is a critical need to disseminate efficacious psychosocial treatments for mental disorders because there is a significant gap between evidence-based treatment (EBT) approaches and usual clinical practice. To address this gap, cost-effective, efficient, and scalable methods of training mental health clinicians in EBT are needed. One example of the need to improve dissemination and implementation of psychosocial treatments is for adolescents with anorexia nervosa (AN), a serious mental disorder with an incidence rate of about 1% that can become life-threatening. Based on outcomes from a series of randomized controlled trials (RCTs), an EBT for adolescents with AN is family-based treatment (FBT); however, few therapists are trained in the approach. Some studies suggest that online training is feasible for training clinicians treating eating disorders, including pilot data related to FBT specifically, but RCTs examining different training formats for FBT to improve fidelity and patient outcomes are needed. OBJECTIVE: This study compared 2 different formats for delivering online training in FBT to therapists treating adolescents with AN and planned to assess the feasibility of the 2 training formats, as well as to examine whether either approach was superior in improving fidelity to FBT or patient outcomes. METHODS: Participants were 123 mental health therapists licensed in the United States in private practice with no previous FBT training. Therapists were randomized to either (1) a webinar training lecture series or (2) an interactive e-training on-demand program (ET-FBT) with an additional focus on key FBT interventions. Both groups were offered up to 12 one-hour group-based clinical case consultation (CCC) sessions posttraining. We examined the feasibility and acceptability of the online training programs and posttraining outcomes in fidelity to key components of FBT, self-efficacy, and working alliance. We explored rates of patient early response (weight gain of 2.4 kg at session 4) in adolescent patients with AN treated after FBT training during CCC. RESULTS: Both online trainings had a high completion rate of 95% (117/123), with CCC completion at 38% (47/123). Both programs showed significant improvements within randomized groups in therapists' fidelity, self-efficacy, and working alliance. Working alliance improved significantly more in the ET-FBT group, but there were no other significant differences between training groups. Early response rates doubled posttraining and CCC (16%-34%), regardless of randomized training format, a rate that is similar to that achieved by therapists in RCTs examining FBT treatment outcomes. CONCLUSIONS: It is feasible to deliver online training in FBT to clinicians in private practice in 2 different formats, and both trainings led to significant improvements in fidelity, self-efficacy, working alliance, and patient outcomes. Future studies should address challenges in patient recruitment for posttraining CCC and refine CCC implementation to maximize training effects and efficiency.
26 May 2026
Read appraisal →Neuroscience
The effects of acute psychosocial stress on binge urges, inhibitory control, negative urgency and eating pathology in Binge Eating Disorder
Stress is frequently reported as a trigger for binge episodes, yet it remains unclear how subjective and physiological stress responses interact with cognitive and affective mechanisms to increase binge eating risk. The present study investigated the effects of acute psychosocial stress on binge urges, focusing on the role of state- and trait-level vulnerabilities. Twenty-eight individuals with BED were randomized to either a Stress condition (n = 14) or No-Stress condition (n = 14). Following an acute psychosocial stressor, participants completed the Stop-Signal Task to behaviourally assess inhibitory control. Self-reported mood, binge urge ratings and saliva samples for stress biomarker detection were collected at three timepoints throughout the experimental session. Results demonstrated that acute psychosocial stress elicited marked increases in total mood disturbance, without corresponding physiological stress responses and significantly impaired inhibitory control. Notably, only subjective stress responses were associated with greater binge urges, whereas physiological stress responses were not. This dissociation highlights subjective stress reactivity as a clinically meaningful mechanism of risk in BED, underscoring the potential value of interventions that target stress perception and regulation to reduce binge eating vulnerability.
25 May 2026
Read appraisal →PloS one
A systematic review and narrative synthesis of the psychometric properties and biopsychosocial correlates of the English version of the Intuitive Eating Scale-2
Intuitive eating is an adaptive eating approach characterised by having unconditional permission to eat when you are hungry, eating for physical rather than emotional reasons, relying on internal hunger and satiety cues, and honouring your health and practising gentle nutrition. The Intuitive Eating Scale-2 (IES-2) is currently the most commonly-used intuitive eating measure but, to date, there has not been a systematic review of how it performs psychometrically outside of the student sample in which it was developed. This systematic review aimed to assess the psychometric properties of the IES-2, including its associations with other variables, across all studies that used it as a measure of intuitive eating and reported psychometric data. MEDLINE, PsycINFO, Scopus and Web of Science were searched in April 2022, May 2024 and June 2025, identifying 90 papers from diverse populations including college students, people from the general population/community, and people seeking treatment for eating disorders or weight management. Results were presented and synthesised narratively, and risk of bias was assessed using two domains from the COSMIN Risk of Bias checklist. Findings suggest that the IES-2 has good construct validity but underperforms psychometrically in other areas such as response distribution, subscale inter-correlations and dimensionality, particularly in relation to the 'Unconditional permission to eat' subscale. Alternative factor structures were reported on and a three-factor solution excluding the 'Unconditional permission to eat' subscale was found to have promising results. The review contributes a comprehensive account of the biopsychosocial correlates of the IES-2, as well as identifying that studies relating to weight or eating disorders often report mean scores that tend towards the extremes of the scale. Limitations include the exclusion of non-English translations of the IES-2, and future reviews would benefit from being conducted in other languages. PROSPERO registration: CRD42022299436. Funder: ESRC (ES/P000711/1).
22 May 2026
Read appraisal →BMC psychiatry
Olanzapine effectiveness on weight gain in anorexia nervosa patients: systematic review and meta-analysis
BACKGROUND: Anorexia nervosa (AN) is a complex psychiatric disorder marked by extreme caloric restriction, intense fear of weight gain, and distorted body image perception. Not only influence physical health, but it also creates serious psychological burdens. Treatment of AN is especially daunting due to its multi-dimensional nature. Recent research indicates that a pharmacological approach, such as the prescription of atypical antipsychotics like Olanzapine, may help treat both the nutritional deficiency and psychological distress related to the disorder. By allowing an individual gain weight and potentially reducing comorbid depression and anxiety, Olanzapine can be a valuable add-on to standard treatments. AIM: This study aims to investigate the effectiveness of Olanzapine in causing weight gain among anorexia nervosa patients. Based on comparisons of results in a number of clinical trials, the study aims at establishing the effect of Olanzapine on weight restoration and investigating any accompanying shift in the psychological state of the patients. METHOD: A comprehensive literature search was performed on Medline, ClinicalTrials.gov, Scopus, and the Cochrane Database of Systematic Reviews for all records from the earliest date available through to August 22, 2024. Randomized controlled trials of olanzapine treatment in anorexia nervosa were included. Studies were screened, and data were extracted. Risk of bias was assessed with the Cochrane risk-of-bias tool. Records for meta-analysis were combined in a random-effects model to calculate effect sizes, and heterogeneity was quantified with the I2 statistic. RESULT: 207 records were found, 159 of which were excluded after title and abstract screening. After full-text review, seven RCTs were found. These trials involving 152 patients assessed the impact of olanzapine on weight gain in anorexia nervosa. Meta-analysis of 4 studies (91 patients) showed a mean difference in BMI of 1.68 kg/m² (95% CI: 0.82, 4.18) in favor of olanzapine but not statistically significant (p = 0.19), with high heterogeneity (I² = 94%). Sensitivity analysis reduced the heterogeneity to 28% but not the effect size. CONCLUSION: Although olanzapine showed a numerically greater weight gain compared to control conditions, the pooled effect did not reach statistical significance and was associated with substantial heterogeneity. Therefore, current evidence remains inconclusive. Olanzapine may be considered in selected cases, particularly where psychological comorbidities are prominent, but larger and methodologically robust trials are needed before routine clinical use can be recommended. CLINICAL TRIAL NUMBER: Not Applicable.
21 May 2026
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