MBSR has increased in popularity as treatment for patients with eating disorders, including anorexia nervosa and bulimia nervosa.

Mindfulness Based Stress Reduction for patients with eating disorders

DBT has shown effectiveness in treating anorexia nervosa, bulimia nervosa, and binge eating disorder. Studies have shown that using dialectical behavior therapy and mindfulness strategies as treatment for these patients is effective in curbing the negative behaviors associated with their respective disorders. Adapting DBT to emphasize the causal factors of these disorders has shown to be more effective than the use of standard DBT.


Usefulness of Dialectical Behavior Therapy in treating eating disorders

Mindfulness interventions have been shown to be beneficial for those suffering with eating disorders including anorexia nervosa, binge eating disorder, and bulimia nervosa.

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There are various populations that can benefit from the use of mindfulness-based interventions, and these populations can differ in age, gender, race, orientations, etc. 

- Children and youth
- Parents
- Those Suffering From Addiction
- Patients with anxiety or depression
- Patients with eating disorders
- Those suffering from minority stress
- Traumatic Brain Injury patients
- Healthcare workers
- Adult Survivors of Childhood Trauma 
- Athletes
- People Who Have Insomnia
- War veterans who suffer from PTSD
- Incarcerated Individuals

Populations that Benefit from Mindfulness Interventions

This list includes different types of methods for treating and/or managing different feeding and eating disorders. These include, but are not limited to the following:
-	Mindfulness for Patients with Eating Disorders
-	Cognitive-Behavioral Therapy vs. Behavioral Weight Loss (BWL) as Treatment for Binge-Eating Disorder
-	Mindfulness-Based Interventions for Binge Eating Disorders
-	Dialectical Behavior Therapy for treating Bulimia Nervosa
-	Dialectical Behavior Therapy for treating Anorexia Nervosa
-	Subjective Experiences of Eating Disorder Treatments
-	Pharmacological Treatment for Binge Eating Disorders
-	Enhanced Cognitive Behavioral Therapy (CBT-E) for Eating Disorders
-	Family-Based Treatment of Eating Disorders in Adolescents

Treatment & Management Methods for Feeding and Eating Disorders

Chen, E.Y., Segal, K., Weissman, J., Zeffiro, T.A., Gallop, R., Linehan, M.M., Bohus, M. and Lynch, T.R. (2015), Adapting dialectical behavior therapy for outpatient adult anorexia nervosa—A pilot study. Int. J. Eat. Disord., 48: 123-132. https://doi-org.ezproxy.bu.edu/10.1002/eat.22360

Adapting Dialectical Behavior Therapy For OutpatientAdult Anorexia Nervosa—A Pilot Study

Klein, A. S., Skinner, J. B., & Hawley, K. M. (2012). Adapted group-based dialectical behaviour therapy for binge eating in a practicing clinic: clinical outcomes and attrition. European eating disorders review : the journal of the Eating Disorders Association, 20(3), e148–e153. https://doi.org/10.1002/erv.2165

Adapted group-based dialectical behaviour therapy for binge eating in a practicing clinic: clinical outcomes and attrition

Safer, Debra L, Telch, Christy F, & Agras, W. Stewart. (2001). Dialectical Behavior Therapy for Bulimia Nervosa. The American Journal of Psychiatry, 158(4), 632–634. https://doi.org/10.1176/appi.ajp.158.4.632

Dialectical Behavior Therapy for Bulimia Nervosa

It is noted that there are possible benefits for children participating in different mindfulness-related activities, such as yoga and meditation. However, it should be noted that more in-depth research is needed to measure change over time.

Mindfulness in Children and Youth

Mindfulness has been studied for its usage in those suffering from addiction to substances. Mindfulness has been shown in some scenarios to be effective in decreasing addictive behaviors in people addicted to substances such as opioids, heroin, cocaine, drinking, and smoking. 

Mindfulness for those suffering from substance use disorder

Cognitive Behavioral Therapy (CBT) was one of the original treatments for mental disorders like depression and anxiety.  While CBT is still a very popular treatment, mindfulness-based interventions like Mindfulness-Based Stress Reduction (MBSR) and Mindfulness-Based Cognitive Therapy (MBCT) have been shown to be as effective as CBT, creating the "new" types of treatment.

Mindfulness Interventions in Patients with Depression and Anxiety

- Hypothesis which states that internalized stigma contributes to existing mental health disparities in marginalized communities

Minority Stress Hypothesis

Mindfulness has been shown to be effective in reducing depression and anxiety symptoms in adults who had  (ACE) adverse childhood experiences that led to trauma.

Mindfulness in Adult Survivors of Childhood Trauma 

There are possible benefits for people who suffering from addiction from mindfulness-related activities.

Those Suffering From Addiction

Mindfulness for patients with eating disorders

It has been proven that mindfulness-based interventions have been successful in reducing anxiety, symptoms of stress, improving well-being, and cognitive ability in athletes. Mindfulness-based interventions allow athletes to separate themselves from their feelings, thoughts, and perceptions by taking on a role as an "external observer."

Mindfulness-Based Interventions for Athletes

In general, Mindfulness Based Interventions have the strongest effects on self-reported sleep quality and on decreasing total wake time in people with insomnia. Additionally, it has been shown to positively affect the severity of insomnia as well. These benefits are achieved because through the the targeting of arousal in mindfulness practices, a mindful stance can be achieved, thus decreasing sleep arousal and allowing for normal sleep patterns to emerge. 

Mindfulness and Effects on Insomnia

It has been supported by mutliple studies that MBI's such as Mindfulness Meditations and Vipassana Meditation help those involved in the justice system reduce stress, anger, substance use and improve emotional regulations.

Mindfulness-Based Interventions for Incarcerated Individuals

Through mindfulness practices, parents are able to not only improve their own health and deal with the stress of being a parent but also improve their relationship with their children.  With their parents learning mindfulness practices, children are able to form more secure attachment styles and improve their own behavior.

Mindfulness in Parents

 Mindfulness-based therapies combines the use of mindfulness principles and practices with behavioral strategies for insomnia. Mindfulness-based therapies can provide an alternative treatment to Cognitive Behavioral Therapy (CBT) by addressing hyper-arousal symptoms of insomnia. With the development of a conscious awareness through mindfulness meditation, there is a reduction in cognitive and physiological hyper-arousal, which targets chronic insomnia.

Mindfulness and Behavior Therapy for Insomnia

A disorder that results from experiencing or witnessing something that makes one feel afraid, terrified, or powerless and makes them think that their life, bodily integrity, or safety are in danger. It manifests as painful and intrusive memories of the stressful event, jitteriness, ongoing negative emotional states, social distancing, violent outbursts, and avoiding reminders of the incident.

Post-Traumatic Stress Disorder (PTSD)

- Dialectic Behavior Therapy
- Mindfulness-Based Eating Awareness Training

Mindfulness-Based Interventions for Binge Eating Disorder

Though cognitive behavior therapy is generally considered the treatment of choice for bulimia nervosa, dialectical behavior therapy (DBT) may be particularly effective in treating bulimia nervosa due to its targeting of emotional dysregulation problems, which often underlie the eating disorder. One study has shown a significant decrease in binge/purging behaviors in patients with bulimia nervosa who underwent DBT with a focus on emotional regulation, though more research into this area is necessary.

Dialectical Behavior Therapy for treating Bulimia Nervosa

Dialectical behavior therapy (DBT) has been shown to be effective in treating anorexia nervosa (AN), as patients with the disorder who underwent DBT saw low dropout rates and increased BMIs which were sustained 6 months later. While standard DBT has been shown to be effective, a DBT program that was augmented to focus on overcontrolled emotions and behaviors which contribute to AN was more helpful in encouraging long term results.

Dialectical Behavior Therapy as Treatment for Anorexia Nervosa

One study examined the current literature on the experiences and perspectives of those across healthcare interfaces for eating disorders, to include individuals with eating disorders, people close to or caring for those with eating disorders such as family and friends, and health professionals.

Subjective Experiences of Eating Disorder Treatments 

One study explored the different pharmacological treatments for BED. The study found that antidepressants, appetite suppressants, and anticonvulsants, specifically, desipramine, fluvoxamine, fluoxetine, sertraline, citalopram, dexfenfluramine, sibutramine, and topiramate can aid in BED treatment. 

Pharmacologic Treatment for Binge Eating Disorder

Enhanced cognitive behavior therapy (CBT-E) is a transdiagnostic approach that is designed to treat multiple clinical conditions, including the complete list of eating disorders identified in DSM-V, such as anorexia nervosa, bulimia nervosa, binge eating disorder (BED), among others. It is different from typical CBT in that it aims to treat the underlying pathological factors contributing to several disorders, rather than any one condition. 

CBT-E is comprised of four stages, yet the details of each stage differ based on the individual patient and their clinical circumstances.

The overarching goal of CBT-E is to assist the patient in first acknowledging their harmful eating patterns and body-image concerns so that they can eventually begin actively participating in therapeutic sessions targeted at addressing the emotions, beliefs/thoughts, and behaviors (e.g., body-image concerns, low self-esteem stressful life events, interpersonal relationship conflicts, etc.)  sustaining their condition. 

After the patient has begun to heal, CBT-E treatment provides them with coping mechanisms to manage challenges to their recovery so that they can maintain their progress.

Enhanced Cognitive Behavioral Therapy (CBT-E) for Eating Disorders 

The family-based treatment (FBT) method for eating disorders entails a clinician working with the adolescent patient and their family to establish a comprehensive care plan that extensively engages the patient's home/family life.

Comprised of three phases, FBT is characterized by granting the patient's family responsibility to monitor and oversee their child's eating behaviors in order to support the patient's sustainable adoption of healthy eating habits. As the patient progresses in their recovery, they are incrementally granted more autonomy over their dietary decisions and eating preferences.

Family-based Treatment of Eating Disorders in Adolescents

Research unfortunately indicates that anorexia nervosa treatment outcomes are not always ideal. Although oftentimes significant weight is restored by the end of treatment, psychological symptoms frequently go largely unaddressed, indicating a gap in current treatment procedures that may leave patients more vulnerable to relapse.

Anorexia Nervosa Treatment Outcomes

Depending on the severity of the case of bulimia nervosa, treatment methods may vary, but often include the following: 

- Purging cessation
- Nutritional support
- Monitoring 
- Medical treatment for complications
- Psychotherapy
- Psychiatric medication

Bulimia Nervosa Treatment

CBT is known as an effective treatment for binge-eating disorder (BED) in that it helps people to stop binge-eating, but it does not actually help people to lose weight (which is important because BED puts people at high risk for obesity and the health problems associated with that).  Because of this shortcoming, perhaps another treatment option is necessary to help people with BED to lose weight.

Cognitive-Behavioral Therapy vs. Behavioral Weight Loss (BWL) as Treatment for Binge-Eating Disorder

Multiple forms of treatment exist for binge eating disorder, each with different levels of efficacy in terms of prompting remission of binge-eating episodes, lessening psychological symptoms, and reducing body weight:

- Psychotherapy
- Structured self-help treatment
- Combined treatment
- Pharmacotherapy
- Behavioral weight loss treatment
- Self-help weight loss treatment
- Inpatient treatment 

Binge Eating Disorder Treatment Outcomes

In general, treatments for ARFID can be divided into two major groups: 

- Psychological treatment
- Adjunctive pharmacological treatment

Avoidant/Restrictive Food Intake Disorder (ARFID) Treatment

Several models exist to include family members in anorexia nervosa treatment. These models strive to put theory-based strategies into action, either by addressing intra- and inter-personal factors that maintain the disorder, by addressing behaviors of the illness, or by focusing on improving the well-being of the family as a whole: 

- CBT-oriented family module
- Systemic family therapy
- Maudsley model of family-based therapy (FBT)
- New Maudsley Model for Collaborative Care (NMCC)

Family Inclusion in Anorexia Nervosa Treatment

Neuromodulatory techniques are also being studied to directly affect the brain to regulate food intake and reduce AN’s psychological symptoms. Multiple forms on neuromodulation have been studied or are being studied currently, including the following:
- Transcranial direct-current stimulation (tDCS) 
- High-frequency repetitive transcranial magnetic stimulation (rTMS) 
- Deep brain stimulation (DBS)

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