APNA 30th Annual Conference Session 2047: October 20, 2016 Does a - PDF document

APNA 30th Annual Conference Session 2047: October 20, 2016 Does a Mindful Eating Intervention Decrease Binge Eating ? Presented by S haron Beck DNP , PMHNP-BC, LCS W Co-presenter, Dr Ruth Milstein DNP , PMHNP-BC LMHC Brandman University Learning Obj ectives Participants will: 1) Increase their understanding of difficulties individuals can experience keeping weight normal while taking many of the psychotropic medications prescribed to treat psychiatric conditions 2) Become educated on the use of mindful eating to teach patients new ways to manage eating patterns and cravings for food 3) Have the opportunity to experience mindful eating during the presentation The presenters have no relationships to disclose, and images were purchased from Adobe S tock Photos. Purpose • The purpose of this proj ect was to fill a gap in the literature around use of a mindful eating intervention for binge eating. Mindful eating has been shown in numerous studies to decrease binge eating in both frequency and intensity, as well as decrease depression and anxiety in binge eaters. It is currently unclear in the literature whether mindful eating practices will decrease binge eating in people who are concurrently taking psychotropic medication. Beck 1

APNA 30th Annual Conference Session 2047: October 20, 2016 Problem • For the first time in recorded history, if something does not change, the current generation of children may have shorter lifespans than their parents, due to the sequelae of obesity (Olshansky, Passaro, Hershow, Layden, Carnes, Brody, Hayflick et al, 2005). • Obesity has been linked with numerous diseases, including coronary artery disease, high blood pressure, stroke, cancer, gallbladder disease, osteoarthritis, diabetes, depression and anxiety as well as metabolic syndrome (Must, S padano, Coakley, Field, Colditz, Dietz, 1999). • Binge eating is strongly associated with obesity; in clinical samples of obese people, 23-46% report binge eating (Bulik, S ullivan & Kendler, 2009). Obese people who binge have greater psychiatric and co-occurring medical issues than those who do not binge (Rieger, Wilfley, S tein, Mariano, & Crow, 2005). • Many psychotropic dugs cause weight gain. (Dent, Blackmore, Peterson, Habib, Kay, Gervais, et al., 2012 PICOT Question • P In a population of self-identified binge eating women taking psychotropic medication who are between the ages of eighteen and sixty-four • I does a mindful eating intervention • C compared to treatment as usual • O cause a greater decrease in binges • T over a period of nine weeks? Literature Review • Two-site RCT comparing a mindful eating program based on MBS R called Mindfulness-Based Eating Awareness Training (MB- EAT) to a psychological cognitive-behavioral intervention (PECB). By the 4 month follow up, 95% of the MB-EAT participants had ceased to meet criteria for binge eating disorder, compared to 76% of the PECB group (Kristeller, Wolever, & S heets, 2013). • Non-RCT study done in 2006 adding eating exercises to a standard Mindfulness-Based S tress Reduction, showed decreased binges (S mith, S helley, LeaHigh, & Van Leit, 2006). • S ystematic review of mindfulness meditation as an intervention for binge eating, emotional eating, and weight loss showed decreased binges (Katterman, Kleinman, Hood, Nackers, & Corsica, 2014 Beck 2

APNA 30th Annual Conference Session 2047: October 20, 2016 Literature Review (cont.) • Jan Chozen Bays’ book on principles of mindful eating and her course at the Great Vow Monastery in Clataskie Oregon through UCSD (Bays, 2006). MBS R and CBT together • MBS R modified for eating using primarily mindful interventions but including some cognitive-behavioral therapy, Non-RCT (Dalen, S mith, S helley, LeaHigh, Begay 2010). • Doctoral study using MBS R and CBT , significant reduction in binge eating, increase in self esteem, decrease in negative mood symptoms. Qualitative portion to the study (Woolhouse, 2011). Intervention Methodology, Design and Procedures • Mi xed method, quantitative and qualitative design • Quantitative- pretest consisting of the Binge Eating S cale, Beck Anxiety Inventory and Beck Depression Inventory, intervention consisting of 9 week mindful eating course, then posttest including the Binge Eating S cale, Beck Anxiety Inventory, and Beck Depression Inventory • Qualitative- following the last meeting of the group, an independent psychiatric nurse from a local hospital called each participant and asked a set of questions privately regarding the intervention, and the participant’s satisfaction Intervention (cont.) Participants • Thirteen women between the ages of 18 and 64 • Volunteer, convenience sample • Willing to try meditation and exercise and attend weekly classes of 1 ½ hours a week • S elf-identify as binge eaters • Participants are not bulimic, hypothyroid, pregnant, have cognitive impairments, do speak English, are not currently on a weight loss drug, or have polycystic ovarian disease Beck 3

APNA 30th Annual Conference Session 2047: October 20, 2016 Results • The primary quantitative results of the intervention were derived by comparison of the BES scores. Prior to the intervention, the average BES score was 27. Post intervention, the BES score was 18.5. This meant the probability (p-value) was less than 0.05. • The secondary quantitative result of the research was determined by the results of the Beck depression inventory. Prior to the intervention, the average score on the Beck inventory was 21.4; following the intervention it was 11.4. • The level of anxiety remained unchanged, perhaps as the initial scores on the BAI were quite low. • The participant satisfaction studies showed high satisfaction with the intervention. Discussion and Clinical S ignificance • These findings are clinically significant as results were strongly positive and it applies the principles of mindful eating to a population that has not been studied in the literature previously (women on psychotropic drugs) for non-pharmacological interventions. • The results were also strongly positive in decreasing depressive symptoms in a group of women who were all chronically mentally ill, and have tried numerous ways to manage chronic depression. • The proj ect did mirror results of the previous literature, that mindfulness techniques can be applied to eating, and can decrease binge eating. Implications for Practice • It is hugely important to consider side effects of increased appetite, binge eating and weight gain when prescribing medications for psychiatric treatment. • In the site where the research was conducted, a practice change is underway; scales have been put in all prescribers’ offices, so weighing patients when they are started on psychotropic drugs can happen easily, and again patients can be weighed at follow up. • Non-pharmacological interventions for binge eating may be a cost effective way to impact this problem, and also to decrease depression in this population. Beck 4