A meta‐analysis of the relation between therapeutic alliance and treatment outcome in eating disorders
The therapeutic alliance has demonstrated an association with favorable psychotherapeutic outcomes in the treatment of eating disorders (EDs). However, questions remain about the inter‐relationships between early alliance, early symptom improvement, and treatment outcome. We conducted a meta‐analysi...
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| Veröffentlicht in: | The International journal of eating disorders 2017-04, Vol.50 (4), p.323-340 |
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| container_title | The International journal of eating disorders |
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| creator | Graves, Tiffany A. Tabri, Nassim Thompson‐Brenner, Heather Franko, Debra L. Eddy, Kamryn T. Bourion‐Bedes, Stephanie Brown, Amy Constantino, Michael J. Flückiger, Christoph Forsberg, Sarah Isserlin, Leanna Couturier, Jennifer Paulson Karlsson, Gunilla Mander, Johannes Teufel, Martin Mitchell, James E. Crosby, Ross D. Prestano, Claudia Satir, Dana A. Simpson, Susan Sly, Richard Lacey, J. Hubert Stiles‐Shields, Colleen Tasca, Giorgio A. Waller, Glenn Zaitsoff, Shannon L. Rienecke, Renee Le Grange, Daniel Thomas, Jennifer J. |
| description | The therapeutic alliance has demonstrated an association with favorable psychotherapeutic outcomes in the treatment of eating disorders (EDs). However, questions remain about the inter‐relationships between early alliance, early symptom improvement, and treatment outcome. We conducted a meta‐analysis on the relations among these constructs, and possible moderators of these relations, in psychosocial treatments for EDs. Twenty studies met inclusion criteria and supplied sufficient supplementary data. Results revealed small‐to‐moderate effect sizes, βs = 0.13 to 0.22 (p |
| doi_str_mv | 10.1002/eat.22672 |
| format | Article |
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Resumen: Objetivo: La alianza terapéutica entre paciente y terapeuta ha demostrado ser una relación con resultados psicoterapéuticos favorables en el tratamiento de los trastornos de la conducta alimentaria (TCA). Sin embargo, quedan preguntas acerca de la inter‐relación entre alianza temprana, mejoría temprana de síntomas y resultados del tratamiento. Hicimos un meta‐análisis de la relación entre estos constructos y los posibles moderadores de estas relaciones en los tratamientos psicosociales para TCA. Método: Veintiún estudios reunieron los criterios de inclusión y aportaron suficientes datos suplementarios. Resultados: los resultados revelaron un efecto de la talla pequeño a moderado, β = 0.13 a 0.22 (p < .05), encontrando que la mejoría temprana de los síntomas estuvo relacionada con la subsecuente calidad de la alianza y las calificaciones de la alianza también estuvieron relacionadas con la subsecuente reducción de los síntomas. La relación entre alianza temprana y resultados de tratamiento fue parcialmente explicada por la temprana mejoría de los síntomas. Con relación a los moderadores, la alianza temprana mostró débiles asociaciones con el resultado en terapias con un fuerte componente conductual relativo a terapias no conductuales. Sin embargo, la alianza mostró más fuerte relación con los resultados para pacientes más jóvenes (versus mayores), por encima y sobre la varianza compartida con la temprana mejoría de síntomas. Discusión: En resumen, la reducción temprana de los síntomas refuerza la alianza terapéutica y los resultados del tratamiento en TCA, pero la alianza temprana puede requerir atención específica para pacientes jóvenes y para aquellos que no reciben tratamientos basados en una orientación conductual.</description><identifier>ISSN: 0276-3478</identifier><identifier>EISSN: 1098-108X</identifier><identifier>DOI: 10.1002/eat.22672</identifier><identifier>PMID: 28152196</identifier><identifier>CODEN: INDIDJ</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>Adult ; Cognitive Behavioral Therapy - methods ; Cooperative Behavior ; eating disorder ; Eating disorders ; Feeding and Eating Disorders - psychology ; Feeding and Eating Disorders - therapy ; Female ; Humans ; Male ; meta‐analysis ; Professional-Patient Relations ; Systematic review ; therapeutic alliance ; Treatment Outcome</subject><ispartof>The International journal of eating disorders, 2017-04, Vol.50 (4), p.323-340</ispartof><rights>2017 Wiley Periodicals, Inc.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c5272-879b568beaf9f03bd54067c7d8e8ed3ed7efb5cfb1a7f4c66a3401fcb4e495dd3</citedby><cites>FETCH-LOGICAL-c5272-879b568beaf9f03bd54067c7d8e8ed3ed7efb5cfb1a7f4c66a3401fcb4e495dd3</cites><orcidid>0000-0003-2601-581X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Feat.22672$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Feat.22672$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28152196$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Graves, Tiffany A.</creatorcontrib><creatorcontrib>Tabri, Nassim</creatorcontrib><creatorcontrib>Thompson‐Brenner, Heather</creatorcontrib><creatorcontrib>Franko, Debra L.</creatorcontrib><creatorcontrib>Eddy, Kamryn T.</creatorcontrib><creatorcontrib>Bourion‐Bedes, Stephanie</creatorcontrib><creatorcontrib>Brown, Amy</creatorcontrib><creatorcontrib>Constantino, Michael J.</creatorcontrib><creatorcontrib>Flückiger, Christoph</creatorcontrib><creatorcontrib>Forsberg, Sarah</creatorcontrib><creatorcontrib>Isserlin, Leanna</creatorcontrib><creatorcontrib>Couturier, Jennifer</creatorcontrib><creatorcontrib>Paulson Karlsson, Gunilla</creatorcontrib><creatorcontrib>Mander, Johannes</creatorcontrib><creatorcontrib>Teufel, Martin</creatorcontrib><creatorcontrib>Mitchell, James E.</creatorcontrib><creatorcontrib>Crosby, Ross D.</creatorcontrib><creatorcontrib>Prestano, Claudia</creatorcontrib><creatorcontrib>Satir, Dana A.</creatorcontrib><creatorcontrib>Simpson, Susan</creatorcontrib><creatorcontrib>Sly, Richard</creatorcontrib><creatorcontrib>Lacey, J. Hubert</creatorcontrib><creatorcontrib>Stiles‐Shields, Colleen</creatorcontrib><creatorcontrib>Tasca, Giorgio A.</creatorcontrib><creatorcontrib>Waller, Glenn</creatorcontrib><creatorcontrib>Zaitsoff, Shannon L.</creatorcontrib><creatorcontrib>Rienecke, Renee</creatorcontrib><creatorcontrib>Le Grange, Daniel</creatorcontrib><creatorcontrib>Thomas, Jennifer J.</creatorcontrib><title>A meta‐analysis of the relation between therapeutic alliance and treatment outcome in eating disorders</title><title>The International journal of eating disorders</title><addtitle>Int J Eat Disord</addtitle><description>The therapeutic alliance has demonstrated an association with favorable psychotherapeutic outcomes in the treatment of eating disorders (EDs). However, questions remain about the inter‐relationships between early alliance, early symptom improvement, and treatment outcome. We conducted a meta‐analysis on the relations among these constructs, and possible moderators of these relations, in psychosocial treatments for EDs. Twenty studies met inclusion criteria and supplied sufficient supplementary data. Results revealed small‐to‐moderate effect sizes, βs = 0.13 to 0.22 (p < .05), indicating that early symptom improvement was related to subsequent alliance quality and that alliance ratings also were related to subsequent symptom reduction. The relationship between early alliance and treatment outcome was partially accounted for by early symptom improvement. With regard to moderators, early alliance showed weaker associations with outcome in therapies with a strong behavioral component relative to nonbehavioral therapies. However, alliance showed stronger relations to outcome for younger (vs. older) patients, over and above the variance shared with early symptom improvement. In sum, early symptom reduction enhances therapeutic alliance and treatment outcome in EDs, but early alliance may require specific attention for younger patients and for those receiving nonbehaviorally oriented treatments.
Resumen: Objetivo: La alianza terapéutica entre paciente y terapeuta ha demostrado ser una relación con resultados psicoterapéuticos favorables en el tratamiento de los trastornos de la conducta alimentaria (TCA). Sin embargo, quedan preguntas acerca de la inter‐relación entre alianza temprana, mejoría temprana de síntomas y resultados del tratamiento. Hicimos un meta‐análisis de la relación entre estos constructos y los posibles moderadores de estas relaciones en los tratamientos psicosociales para TCA. Método: Veintiún estudios reunieron los criterios de inclusión y aportaron suficientes datos suplementarios. Resultados: los resultados revelaron un efecto de la talla pequeño a moderado, β = 0.13 a 0.22 (p < .05), encontrando que la mejoría temprana de los síntomas estuvo relacionada con la subsecuente calidad de la alianza y las calificaciones de la alianza también estuvieron relacionadas con la subsecuente reducción de los síntomas. La relación entre alianza temprana y resultados de tratamiento fue parcialmente explicada por la temprana mejoría de los síntomas. Con relación a los moderadores, la alianza temprana mostró débiles asociaciones con el resultado en terapias con un fuerte componente conductual relativo a terapias no conductuales. Sin embargo, la alianza mostró más fuerte relación con los resultados para pacientes más jóvenes (versus mayores), por encima y sobre la varianza compartida con la temprana mejoría de síntomas. Discusión: En resumen, la reducción temprana de los síntomas refuerza la alianza terapéutica y los resultados del tratamiento en TCA, pero la alianza temprana puede requerir atención específica para pacientes jóvenes y para aquellos que no reciben tratamientos basados en una orientación conductual.</description><subject>Adult</subject><subject>Cognitive Behavioral Therapy - methods</subject><subject>Cooperative Behavior</subject><subject>eating disorder</subject><subject>Eating disorders</subject><subject>Feeding and Eating Disorders - psychology</subject><subject>Feeding and Eating Disorders - therapy</subject><subject>Female</subject><subject>Humans</subject><subject>Male</subject><subject>meta‐analysis</subject><subject>Professional-Patient Relations</subject><subject>Systematic review</subject><subject>therapeutic alliance</subject><subject>Treatment Outcome</subject><issn>0276-3478</issn><issn>1098-108X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqN0c9KHTEUBvAgLfXWdtEXkEA3uhhNMpM_s7yIWkHoxkJ3QyY5qZGZ5JpkuNydj-Az-iTO7VUXQqGbHDj8-AjnQ-gbJSeUEHYKupwwJiTbQwtKWlVRon5_QAvCpKjqRqp99DnnO0KIqAn_hPaZopzRVizQ7RKPUPTTw6MOethkn3F0uNwCTjDo4mPAPZQ1QNguk17BVLzBehi8DgawDhaXNH9ghFBwnIqJI2Af8Lzy4Q-2PsdkIeUv6KPTQ4avL_MA_bo4vzn7UV3_vLw6W15XhjPJKiXbngvVg3atI3VveUOENNIqUGBrsBJcz43rqZauMULouiHUmb6BpuXW1gfoaJe7SvF-gly60WcDw6ADxCl3VLVUyUbW7X9Qwfn2YTP9_o7exSnNF9sqxQWvBW1mdbxTJsWcE7hulfyo06ajpNs21c1X6f42NdvDl8SpH8G-yddqZnC6A2s_wObfSd358mYX-QyGy58s</recordid><startdate>201704</startdate><enddate>201704</enddate><creator>Graves, Tiffany A.</creator><creator>Tabri, Nassim</creator><creator>Thompson‐Brenner, Heather</creator><creator>Franko, Debra L.</creator><creator>Eddy, Kamryn T.</creator><creator>Bourion‐Bedes, Stephanie</creator><creator>Brown, Amy</creator><creator>Constantino, Michael J.</creator><creator>Flückiger, Christoph</creator><creator>Forsberg, Sarah</creator><creator>Isserlin, Leanna</creator><creator>Couturier, Jennifer</creator><creator>Paulson Karlsson, Gunilla</creator><creator>Mander, Johannes</creator><creator>Teufel, Martin</creator><creator>Mitchell, James E.</creator><creator>Crosby, Ross D.</creator><creator>Prestano, Claudia</creator><creator>Satir, Dana A.</creator><creator>Simpson, Susan</creator><creator>Sly, Richard</creator><creator>Lacey, J. Hubert</creator><creator>Stiles‐Shields, Colleen</creator><creator>Tasca, Giorgio A.</creator><creator>Waller, Glenn</creator><creator>Zaitsoff, Shannon L.</creator><creator>Rienecke, Renee</creator><creator>Le Grange, Daniel</creator><creator>Thomas, Jennifer J.</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TS</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-2601-581X</orcidid></search><sort><creationdate>201704</creationdate><title>A meta‐analysis of the relation between therapeutic alliance and treatment outcome in eating disorders</title><author>Graves, Tiffany A. ; Tabri, Nassim ; Thompson‐Brenner, Heather ; Franko, Debra L. ; Eddy, Kamryn T. ; Bourion‐Bedes, Stephanie ; Brown, Amy ; Constantino, Michael J. ; Flückiger, Christoph ; Forsberg, Sarah ; Isserlin, Leanna ; Couturier, Jennifer ; Paulson Karlsson, Gunilla ; Mander, Johannes ; Teufel, Martin ; Mitchell, James E. ; Crosby, Ross D. ; Prestano, Claudia ; Satir, Dana A. ; Simpson, Susan ; Sly, Richard ; Lacey, J. Hubert ; Stiles‐Shields, Colleen ; Tasca, Giorgio A. ; Waller, Glenn ; Zaitsoff, Shannon L. ; Rienecke, Renee ; Le Grange, Daniel ; Thomas, Jennifer J.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c5272-879b568beaf9f03bd54067c7d8e8ed3ed7efb5cfb1a7f4c66a3401fcb4e495dd3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Adult</topic><topic>Cognitive Behavioral Therapy - methods</topic><topic>Cooperative Behavior</topic><topic>eating disorder</topic><topic>Eating disorders</topic><topic>Feeding and Eating Disorders - psychology</topic><topic>Feeding and Eating Disorders - therapy</topic><topic>Female</topic><topic>Humans</topic><topic>Male</topic><topic>meta‐analysis</topic><topic>Professional-Patient Relations</topic><topic>Systematic review</topic><topic>therapeutic alliance</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Graves, Tiffany A.</creatorcontrib><creatorcontrib>Tabri, Nassim</creatorcontrib><creatorcontrib>Thompson‐Brenner, Heather</creatorcontrib><creatorcontrib>Franko, Debra L.</creatorcontrib><creatorcontrib>Eddy, Kamryn T.</creatorcontrib><creatorcontrib>Bourion‐Bedes, Stephanie</creatorcontrib><creatorcontrib>Brown, Amy</creatorcontrib><creatorcontrib>Constantino, Michael J.</creatorcontrib><creatorcontrib>Flückiger, Christoph</creatorcontrib><creatorcontrib>Forsberg, Sarah</creatorcontrib><creatorcontrib>Isserlin, Leanna</creatorcontrib><creatorcontrib>Couturier, Jennifer</creatorcontrib><creatorcontrib>Paulson Karlsson, Gunilla</creatorcontrib><creatorcontrib>Mander, Johannes</creatorcontrib><creatorcontrib>Teufel, Martin</creatorcontrib><creatorcontrib>Mitchell, James E.</creatorcontrib><creatorcontrib>Crosby, Ross D.</creatorcontrib><creatorcontrib>Prestano, Claudia</creatorcontrib><creatorcontrib>Satir, Dana A.</creatorcontrib><creatorcontrib>Simpson, Susan</creatorcontrib><creatorcontrib>Sly, Richard</creatorcontrib><creatorcontrib>Lacey, J. Hubert</creatorcontrib><creatorcontrib>Stiles‐Shields, Colleen</creatorcontrib><creatorcontrib>Tasca, Giorgio A.</creatorcontrib><creatorcontrib>Waller, Glenn</creatorcontrib><creatorcontrib>Zaitsoff, Shannon L.</creatorcontrib><creatorcontrib>Rienecke, Renee</creatorcontrib><creatorcontrib>Le Grange, Daniel</creatorcontrib><creatorcontrib>Thomas, Jennifer J.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Physical Education Index</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>The International journal of eating disorders</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Graves, Tiffany A.</au><au>Tabri, Nassim</au><au>Thompson‐Brenner, Heather</au><au>Franko, Debra L.</au><au>Eddy, Kamryn T.</au><au>Bourion‐Bedes, Stephanie</au><au>Brown, Amy</au><au>Constantino, Michael J.</au><au>Flückiger, Christoph</au><au>Forsberg, Sarah</au><au>Isserlin, Leanna</au><au>Couturier, Jennifer</au><au>Paulson Karlsson, Gunilla</au><au>Mander, Johannes</au><au>Teufel, Martin</au><au>Mitchell, James E.</au><au>Crosby, Ross D.</au><au>Prestano, Claudia</au><au>Satir, Dana A.</au><au>Simpson, Susan</au><au>Sly, Richard</au><au>Lacey, J. Hubert</au><au>Stiles‐Shields, Colleen</au><au>Tasca, Giorgio A.</au><au>Waller, Glenn</au><au>Zaitsoff, Shannon L.</au><au>Rienecke, Renee</au><au>Le Grange, Daniel</au><au>Thomas, Jennifer J.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A meta‐analysis of the relation between therapeutic alliance and treatment outcome in eating disorders</atitle><jtitle>The International journal of eating disorders</jtitle><addtitle>Int J Eat Disord</addtitle><date>2017-04</date><risdate>2017</risdate><volume>50</volume><issue>4</issue><spage>323</spage><epage>340</epage><pages>323-340</pages><issn>0276-3478</issn><eissn>1098-108X</eissn><coden>INDIDJ</coden><abstract>The therapeutic alliance has demonstrated an association with favorable psychotherapeutic outcomes in the treatment of eating disorders (EDs). However, questions remain about the inter‐relationships between early alliance, early symptom improvement, and treatment outcome. We conducted a meta‐analysis on the relations among these constructs, and possible moderators of these relations, in psychosocial treatments for EDs. Twenty studies met inclusion criteria and supplied sufficient supplementary data. Results revealed small‐to‐moderate effect sizes, βs = 0.13 to 0.22 (p < .05), indicating that early symptom improvement was related to subsequent alliance quality and that alliance ratings also were related to subsequent symptom reduction. The relationship between early alliance and treatment outcome was partially accounted for by early symptom improvement. With regard to moderators, early alliance showed weaker associations with outcome in therapies with a strong behavioral component relative to nonbehavioral therapies. However, alliance showed stronger relations to outcome for younger (vs. older) patients, over and above the variance shared with early symptom improvement. In sum, early symptom reduction enhances therapeutic alliance and treatment outcome in EDs, but early alliance may require specific attention for younger patients and for those receiving nonbehaviorally oriented treatments.
Resumen: Objetivo: La alianza terapéutica entre paciente y terapeuta ha demostrado ser una relación con resultados psicoterapéuticos favorables en el tratamiento de los trastornos de la conducta alimentaria (TCA). Sin embargo, quedan preguntas acerca de la inter‐relación entre alianza temprana, mejoría temprana de síntomas y resultados del tratamiento. Hicimos un meta‐análisis de la relación entre estos constructos y los posibles moderadores de estas relaciones en los tratamientos psicosociales para TCA. Método: Veintiún estudios reunieron los criterios de inclusión y aportaron suficientes datos suplementarios. Resultados: los resultados revelaron un efecto de la talla pequeño a moderado, β = 0.13 a 0.22 (p < .05), encontrando que la mejoría temprana de los síntomas estuvo relacionada con la subsecuente calidad de la alianza y las calificaciones de la alianza también estuvieron relacionadas con la subsecuente reducción de los síntomas. La relación entre alianza temprana y resultados de tratamiento fue parcialmente explicada por la temprana mejoría de los síntomas. Con relación a los moderadores, la alianza temprana mostró débiles asociaciones con el resultado en terapias con un fuerte componente conductual relativo a terapias no conductuales. Sin embargo, la alianza mostró más fuerte relación con los resultados para pacientes más jóvenes (versus mayores), por encima y sobre la varianza compartida con la temprana mejoría de síntomas. Discusión: En resumen, la reducción temprana de los síntomas refuerza la alianza terapéutica y los resultados del tratamiento en TCA, pero la alianza temprana puede requerir atención específica para pacientes jóvenes y para aquellos que no reciben tratamientos basados en una orientación conductual.</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>28152196</pmid><doi>10.1002/eat.22672</doi><tpages>18</tpages><orcidid>https://orcid.org/0000-0003-2601-581X</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0276-3478 |
| ispartof | The International journal of eating disorders, 2017-04, Vol.50 (4), p.323-340 |
| issn | 0276-3478 1098-108X |
| language | eng |
| recordid | cdi_proquest_miscellaneous_1891874739 |
| source | MEDLINE; Wiley Online Library Journals Frontfile Complete |
| subjects | Adult Cognitive Behavioral Therapy - methods Cooperative Behavior eating disorder Eating disorders Feeding and Eating Disorders - psychology Feeding and Eating Disorders - therapy Female Humans Male meta‐analysis Professional-Patient Relations Systematic review therapeutic alliance Treatment Outcome |
| title | A meta‐analysis of the relation between therapeutic alliance and treatment outcome in eating disorders |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-07T13%3A38%3A22IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=A%20meta%E2%80%90analysis%20of%20the%20relation%20between%20therapeutic%20alliance%20and%20treatment%20outcome%20in%20eating%20disorders&rft.jtitle=The%20International%20journal%20of%20eating%20disorders&rft.au=Graves,%20Tiffany%20A.&rft.date=2017-04&rft.volume=50&rft.issue=4&rft.spage=323&rft.epage=340&rft.pages=323-340&rft.issn=0276-3478&rft.eissn=1098-108X&rft.coden=INDIDJ&rft_id=info:doi/10.1002/eat.22672&rft_dat=%3Cproquest_cross%3E1865518652%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1885653614&rft_id=info:pmid/28152196&rfr_iscdi=true |