Edgar Luis Lima De Oliveira1, Emilie Lacroix2, Andrea Lorena Costa Stravogiannis1, Maria De Fátima Vasques1, Cristiane Ruiz Durante1, Érica Panzani Duran1, Daniela Pereira1, Janice Rico Cabral1, Hermano Tavares1
1 Department of Psychiatry, Psychiatry Institute, University of São Paulo (USP), SP, Brazil.
2 Department of Psychology, University of Calgary, AB, Canada.
Institution where the study was conducted: Instituto de Psiquiatria do Hospital de Clínicas da UNIVERSIDade de São Paulo, São Paulo, SP, Brasil.
Received: 27/08/2019 – Accepted: 18/04/2020
There has been an increase in the number of publications using the term food addiction (FA), with many animal and humans neuroimaging studies demonstrating similarities between food and drugs of abuse1,2. FA is most often assessed with the Yale Food Addiction Scale (YFAS), a questionnaire which directly applies DSM- IV-TR substance dependence criteria to food and eating2. Although FA is not an official diagnosis, YFAS scores are associated with eating disorders, depression, emotion dysregulation and lower self-esteem3, suggesting a need to target these symptoms in treatment.
There is a scarcity of research investigating treatments designed specifically for FA. Schema therapy (ST) is an approach which emphasizes the therapeutic relationship, the emotional and life experiences. Group ST treatments have demonstrated efficacy in treating both eating disorders and substance abuse3.
The aim of the present pilot study was to examine the feasability and efficacy of a group treatment program for FA which included components of nutritional orientation, motivational interviewing (MI) and ST. Participants were referred, in 2016, through the outpatient impulse control disorders unit at the Institute of Psychiatry of the University of São Paulo. The program comprised 21 weekly sessions divided into two phases, presented in Table 1. Patients completed self-report questionnaires pre- and post-treatment to assess eating behaviour, maladaptive schemas, depression and anxiety symptoms. Weight and height were measured to assess BMI. We administered the portuguese versions of the YFAS2, Bulimic Investigatory Test of Edinburgh (BITE), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), and the Young Schemas Questionnaire (YSQ-S35), a measure of early maladaptive schemas (EMS).
One male and eight females with FA participated, and seven participants completed treatment. The mean age was 39.7 (SD = 5.4) years, 44.4% were married, 77.8% white, and 66.6% had completed college. The sample had an epidemiological profile similar to previous studies6.
Paired samples t-tests compared questionnaire scores before and after treatment. The most prevalent EMS was “insufficient self- control/self-discipline” (57,1%). From pre- to post-treatment, there was a significant reduction in the number of FA symptoms (from 6,14 to 2,4), t(6) = 3.79, p = .009. There was no significant decrease in BITE severity (from 4,83 to 5,67) or symptom count (from 17,67 to 17,83), depressive symptoms (BDI) (from 20 to 17,17), anxiety symptoms (BAI) (from 15,14 to 14,42), EMS (from 3,71 to 0,29) or BMI (from 40,22 to 38,65). At post-treatment, six of seven patients (85.71%) no longer met YFAS diagnostic criteria for FA.
Our reductions in symptom count and proportion meeting FA criteria exceed those found by Hilker et al.8. Taken together, our findings suggest that the proposed model of ST, accompanied by behavioural nutrition and MI, may represent a promising avenue for the treatment of FA. Additional research is needed to investigate the efficacy of this treatment in larger samples, employing control groups and randomization. Furthermore, continued investigation of the validity of the FA construct is needed.
No funding was received for support of this research work.
HT receives research support from Conselho Nacional de Desenvolvimento Científico e Tecnológico – CNPq – (National Council for Scientific and Technological Development), grants #465550/2014-2 and #425716/2018-0, and from Fundação de Amparo a Pesquisa do Estado de São Paulo – FAPESP – (São Paulo Research Foundation), grant #2014/ 50917-0. The other authors declare no conflict of interest.
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