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Meneguzzo P, Bonello E, Tenconi E, Todisco P. Enhancing emotional abilities in anorexia nervosa treatment: A rolling-group cognitive remediation and emotional skills training protocol. EUROPEAN EATING DISORDERS REVIEW 2024; 32:1026-1037. [PMID: 38837559 DOI: 10.1002/erv.3113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 04/07/2024] [Accepted: 05/29/2024] [Indexed: 06/07/2024]
Abstract
INTRODUCTION Anorexia nervosa (AN) is characterised by limited remission rates and emotional dimensions are often neglected. Cognitive remediation and emotional skills training (CREST) protocol aims to address cognitive and emotional factors. This study evaluates the feasibility and effectiveness of a modified rolling-group CREST protocol in an inpatient setting. METHODS Quasi-experimental design evaluated CREST protocol in a rehabilitation programme. A total of 116 females diagnosed with AN were included, of whom 63 were included in the CREST protocol and 53 in the standard rehabilitation treatment. Various standardized measures were employed to assess psychopathology. Data collection occurred longitudinally, before and after CREST implementation. RESULTS No significant differences emerged between groups regarding changes in specific eating psychopathology. CREST group exhibited significant improvements in emotion regulation (p = 0.002) and social skills (p = 0.014), besides a reduction in alexithymia (p < 0.001) and cognitive rigidity (p = 0.013). Empathic features remained stable. Participants reported positive perceptions of the CREST intervention. DISCUSSION The study highlights the potential benefits of integrating emotional training within multidisciplinary intensive treatment for AN. Results emphasise the importance of treatment protocol with more affective and hot-cognition-related interventions, beyond weight-related psychopathology. Implementing a rolling-group CREST protocol in an inpatient setting showed promise in enhancing the emotional abilities of AN patients.
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Affiliation(s)
- Paolo Meneguzzo
- Department of Neuroscience, University of Padova, Padova, Italy
- Padova Neuroscience Center, University of Padova, Padova, Italy
| | - Elisa Bonello
- Eating Disorders Unit, Casa di Cura "Villa Margherita" - Neomesia, Arcugnano (Vicenza), Italy
| | - Elena Tenconi
- Department of Neuroscience, University of Padova, Padova, Italy
- Padova Neuroscience Center, University of Padova, Padova, Italy
| | - Patrizia Todisco
- Eating Disorders Unit, Casa di Cura "Villa Margherita" - Neomesia, Arcugnano (Vicenza), Italy
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Guadagnoli L, Yadlapati R, Pandolfino J, Bedell A, Pandit AU, Dunbar KB, Fass R, Gevirtz R, Gyawali CP, Lupe SE, Petrik M, Riehl ME, Salwen-Deremer J, Simons M, Tomasino KN, Taft T. Behavioral Therapy for Functional Heartburn: Recommendation Statements. Clin Gastroenterol Hepatol 2024; 22:1709-1718.e3. [PMID: 38518891 PMCID: PMC11272445 DOI: 10.1016/j.cgh.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 02/09/2024] [Accepted: 03/05/2024] [Indexed: 03/24/2024]
Abstract
BACKGROUND & AIMS Brain-gut behavior therapies (BGBT) are increasingly recognized as effective therapeutic interventions for functional heartburn. However, recommendations regarding candidacy for treatment, initial treatment selection, and navigating treatment non-response have not been established for functional heartburn specifically. The aim of this study was to establish expert-based recommendations for behavioral treatment in patients with functional heartburn. METHODS The validated RAND/University of California, Los Angeles Appropriateness Method was applied to develop recommendations. A 15-member panel composed of 10 gastrointestinal psychologists and 5 esophageal specialists ranked the appropriateness of a series of statements on a 9-point interval scale over 2 ranking periods. Statements were within the following domains: pre-therapy evaluation, candidacy criteria for BGBT, selection of initial BGBT, role of additional therapy for initial non-response to BGBT, and role of pharmacologic neuromodulation. The primary outcome was appropriateness of each intervention based on the recommendation statements. RESULTS Recommendations for psychosocial assessment (eg, hypervigilance, symptom-specific anxiety, health-related quality of life), candidacy criteria (eg, motivated for BGBT, acknowledges the role of stress in symptoms), and treatment were established. Gut-directed hypnotherapy or cognitive behavioral therapy were considered appropriate BGBT for functional heartburn. Neuromodulation and/or additional BGBT were considered appropriate in the context of non-response. CONCLUSIONS Gut-directed hypnotherapy and/or cognitive behavioral therapy are recommended as appropriate behavioral interventions for heartburn symptoms, depending on clinical indication, specific gut-brain targets, and preferred treatment modality (pharmacologic vs non-pharmacologic). Pre-therapy evaluation of psychosocial processes and candidacy for BGBT are important to determine eligibility for referral to psychogastroenterology services.
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Affiliation(s)
- Livia Guadagnoli
- Laboratory for Brain-Gut Axis Studies (LaBGAS), Translational Research Center for Gastrointestinal Disorders (TARGID), Department of Chronic Diseases and Metabolism (CHROMETA), KU Leuven, Leuven, Belgium.
| | - Rena Yadlapati
- Center for Esophageal Diseases, Division of Gastroenterology & Hepatology, University of California San Diego, La Jolla, California
| | - John Pandolfino
- Kenneth C. Griffin Esophageal Center, Division of Gastroenterology & Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Alyse Bedell
- Departments of Psychiatry & Behavioral Neuroscience and Medicine (Section of Gastroenterology, Hepatology, and Nutrition), The University of Chicago, Chicago, Illinois
| | - Anjali U Pandit
- Division of Gastroenterology & Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Kerry B Dunbar
- Division of Digestive Diseases, University of Texas Southwestern Medical Center and VA North Texas Healthcare System, Dallas, Texas
| | - Ronnie Fass
- Division of Gastroenterology and Hepatology, Case Western Reserve University, Cleveland, Ohio
| | - Richard Gevirtz
- Clinical PhD Program, CSPP@Alliant International University, San Diego, California
| | - C Prakash Gyawali
- Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri
| | - Stephen E Lupe
- Department of Gastroenterology, Hepatology, and Nutrition, The Cleveland Clinic, Cleveland, Ohio
| | - Megan Petrik
- Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Megan E Riehl
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan
| | - Jessica Salwen-Deremer
- Departments of Psychiatry and Medicine (Section of Gastroenterology & Hepatology), Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
| | - Madison Simons
- Department of Gastroenterology, Hepatology, and Nutrition, The Cleveland Clinic, Cleveland, Ohio
| | - Kathryn N Tomasino
- Division of Gastroenterology & Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Tiffany Taft
- Division of Gastroenterology & Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Kuge R, Hasegawa A, Morino Y, Nakazato M. Group cognitive remediation therapy for adolescents with anorexia nervosa: Outcomes before, after, and during follow-up in a real-world setting in Japan. Clin Child Psychol Psychiatry 2024:13591045241259255. [PMID: 38849306 DOI: 10.1177/13591045241259255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/09/2024]
Abstract
Objective: Cognitive remediation therapy (CRT) can be used as an adjunct treatment for adolescents with severe and complex anorexia nervosa (AN) requiring inpatient treatment. However, there has been only one study on CRT for adolescents with AN in Japan. This study explored group CRT as an adjunct to inpatient treatment for Japanese adolescents with severe and complex AN requiring inpatient care. Methods: Thirty-one adolescents with AN underwent group CRT. Neuropsychological (set-shifting and central coherence) and psychological assessments (motivation, self-esteem, and depressive symptoms) were measured before and after the intervention. Weight and AN symptoms were measured before and after the intervention and at follow-up, and the adolescents completed post-intervention and follow-up questionnaires. Results: Set-shifting led to medium to large effect size improvements. Medium effect size improvements in central coherence and depressive symptoms were also observed. The feedback from the adolescents was mainly positive, and the treatment completion rate was high. The patients also reported that the skills learned through group CRT could be applied in daily life. Conclusion: Group CRT may be beneficial for adolescents with severe and complex AN who require inpatient care.
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Affiliation(s)
- Rie Kuge
- Mental Health Clinic for Children, Shinshu University Hospital, Japan
| | - Ayano Hasegawa
- Clinical Psychology Unit, Tokyo Metropolitan Matsuzawa Hospital, Japan
| | - Yuriko Morino
- Narimasu Kousei Hospital, Narimasu Centre for Child and Adolescent Mental Health, Japan
| | - Michiko Nakazato
- Department of Psychiatry, International University of Health and Welfare, Japan
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Robinson L, Flynn M, Cooper M. Individual differences in motivation to change in individuals with eating disorders: A systematic review. Int J Eat Disord 2024; 57:1069-1087. [PMID: 38436481 DOI: 10.1002/eat.24178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 02/14/2024] [Accepted: 02/14/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVE Motivation to change has been suggested to significantly impact treatment outcomes in eating disorders (EDs). This review will investigate factors associated with motivation to change in EDs with the aim of supporting clinicians to be aware and sensitive to factors that might obstruct recovery and to inform motivation-based interventions. METHOD Using PRISMA guidelines, this article identified 24 studies through database searches meeting eligibility criteria. Only correlates of motivation were identified, limiting the ability of this review to identify causal relationships. Factors that changed alongside changes in motivation were identified from longitudinal studies. RESULTS This review identified factors such as individual characteristics, co-morbid psychopathology, lack of treatment autonomy and relationships with others to be associated with motivation to change in individuals with EDs. In addition, motivation to change significantly increased alongside self-esteem and identity re-negotiation when measured longitudinally. DISCUSSION Motivational interviewing can typically focus on exploring ambivalence to treatment, identifying goals and values, and increasing self-efficacy. However, this review identifies individual and relational factors to be particularly significant and may obstruct recovery from an ED. As such, evidence-based targets have been identified to inform clinicians and motivation-based interventions. PUBLIC SIGNIFICANCE Knowledge of factors associated with motivation to change in EDs is important to understand those who may have poorer treatment outcomes. Motivation may be improved by supporting individuals' relationship with others and tailoring interventions according to temperament and personality traits. Utilizing an individual's social support as they enter ED treatment may be effective in maximizing motivation to recover.
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Affiliation(s)
- Lauren Robinson
- Oxford Institute of Clinical Psychology Training and Research, Oxford University, Oxford, UK
| | - Michaela Flynn
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Myra Cooper
- Oxford Institute of Clinical Psychology Training and Research, Oxford University, Oxford, UK
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Timko CA, Schnabel J, Orloff NC. The importance of improving cognitive flexibility in adolescents with anorexia nervosa: The case for cognitive remediation therapy. Int J Eat Disord 2024; 57:1109-1118. [PMID: 38333943 DOI: 10.1002/eat.24164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 01/29/2024] [Accepted: 01/29/2024] [Indexed: 02/10/2024]
Abstract
OBJECTIVE Inefficiencies in executive functioning (EF), more specifically cognitive flexibility and an overly detailed processing style, are frequently observed in individuals with Anorexia Nervosa (AN) and have been identified as potential targets in treatment. Cognitive Remediation Therapy (CRT) is an adjunctive treatment approach specifically designed to have a positive impact on EF. Mainly evaluated in adults, CRT has been criticized for its perceived ineffectiveness in promoting weight restoration or directly reducing eating disorder symptoms. METHOD We argue that we need to refocus our conceptual framework for using CRT as an adjunctive treatment and specifically explore its potential benefit in adolescents. RESULTS Adolescence is a critical window for EF development during which CRT has the potential to have the most impact. While it may not specifically ameliorate eating disorder symptoms and directly improve weight gain, CRT may mitigate the impact of malnutrition on adolescent brain development, reduce attrition rates in treatment, and improve cognitive flexibility and (indirectly) other maintaining factors, thereby improving global functioning. DISCUSSION More research needs to be done to understand the development of EF in adolescents with AN and how best to employ CRT as an adjunctive treatment to support development and target maintaining factors. The current article broadly reviews findings on executive functioning inefficiencies in adolescents with AN and discusses the purpose and role of CRT in treating AN. Finally, we highlight key critiques of using CRT and pose questions for future research. PUBLIC SIGNIFICANCE Treatments targeting executive functioning in adolescents with AN are limited. We need to better understand how CRT can benefit adolescents in treatment. Increasing treatment options, including adjunctive treatments, is necessary to reduce the long-term impact of AN.
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Affiliation(s)
- C Alix Timko
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jiana Schnabel
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Psychology and Neuroscience, Temple University, Philadelphia, Pennsylvania, USA
| | - Natalia C Orloff
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Equip Health, Carlsbad, California, USA
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Gibson D, Mehler PS. A new conceptual model for anorexia nervosa: A role for connective tissue? Int J Eat Disord 2024; 57:537-542. [PMID: 38372082 DOI: 10.1002/eat.24172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 02/06/2024] [Accepted: 02/07/2024] [Indexed: 02/20/2024]
Abstract
The etiology of anorexia nervosa (AN) remains to be fully elucidated, and current theories also fail to account for the direct effect of starvation on the health of the organs and tissues, specifically the connective tissue present in most organs of the body. Individuals with hereditary disorders of connective tissue manifest with clinical symptoms that overlap with AN, as the abnormal connective tissue also contributes to many of the other extra-articular manifestations of these hereditary disorders. This article hypothesizes that a similar pathophysiology may also contribute to the clinical presentation of AN. Therefore, a better understanding is needed to elucidate: (1) the relationship between abnormal connective tissue and AN, (2) the impact of starvation toward the development of abnormal connective tissue and how this manifests clinically, (3) the etiology of autonomic nervous system changes contributing to the dysautonomia in AN, and (4) how the sensory signals sent from potentially abnormal connective tissue to the central nervous system impact interoception in AN. A conceptual model incorporating abnormal connective tissue is provided. PUBLIC SIGNIFICANCE: The etiology of AN remains poorly understood and current theories fail to account for the direct impact of starvation on the health of the organs and tissues of the body. There is significant clinical overlap between AN and hereditary connective tissue disorders. This paper attempts to provide a new conceptual model for AN in which abnormal connective tissue contributes to the underlying pathogenesis.
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Affiliation(s)
- Dennis Gibson
- ACUTE Center for Eating Disorders and Severe Malnutrition at Denver Health, Denver, Colorado, USA
- Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Philip S Mehler
- ACUTE Center for Eating Disorders and Severe Malnutrition at Denver Health, Denver, Colorado, USA
- Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
- Eating Recovery Center, Denver, Colorado, USA
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Marchesi G, Cammisuli DM, Semonella M, Castelnuovo G, Pietrabissa G. The Efficacy of Cognitive Remediation Therapy for Anorexia Nervosa: A Systematic Review of Systematic Reviews. Brain Sci 2024; 14:118. [PMID: 38391693 PMCID: PMC10886621 DOI: 10.3390/brainsci14020118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/16/2024] [Accepted: 01/20/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Cognitive remediation therapy (CRT) for anorexia nervosa (AN) is an intervention specifically focused on addressing cognitive difficulties associated with the eating disorder. This systematic review of systematic reviews and meta-analysis aimed to provide a summary of the existing literature examining the efficacy of CRT in improving the neuropsychological, psychological, and clinical parameters of patients with AN. METHODS Systematic reviews and meta-analyses were sought in electronic databases, encompassing studies that explored the impact of CRT on AN. Three eligible reviews were identified based on the inclusion criteria. The Revised Assessment of Multiple SysTemAtic Reviews (R-AMSTAR) was employed to evaluate the methodological quality of the reviews, and all included reviews demonstrated satisfactory methodological quality with an R-AMSTAR score of ≥22. Relevant information was extracted from each review and qualitatively compiled. RESULTS Findings suggest that CRT can help people increase their awareness of cognitive styles and information processing and have a positive effect on patients' responses to treatment. CONCLUSIONS Further research is required to better understand its impact on other relevant outcomes, including psychological variables, to optimize the treatment's benefits.
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Affiliation(s)
- Gloria Marchesi
- Department of Psychology, Catholic University of Milan, 20123 Milan, Italy
| | | | | | - Gianluca Castelnuovo
- Department of Psychology, Catholic University of Milan, 20123 Milan, Italy
- Clinical Psychology Research Laboratory, I.R.C.C.S. Istituto Auxologico Italiano, 20149 Milan, Italy
| | - Giada Pietrabissa
- Department of Psychology, Catholic University of Milan, 20123 Milan, Italy
- Clinical Psychology Research Laboratory, I.R.C.C.S. Istituto Auxologico Italiano, 20149 Milan, Italy
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Cummings MP, Alexander RK, Boswell RG. "Ordinary days would be extraordinary": The lived experiences of severe and enduring anorexia nervosa. Int J Eat Disord 2023; 56:2273-2282. [PMID: 37732708 DOI: 10.1002/eat.24058] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 08/29/2023] [Accepted: 08/30/2023] [Indexed: 09/22/2023]
Abstract
OBJECTIVE Approximately 25% of individuals with anorexia nervosa (AN) experience a chronic form of the disorder, referred to as severe and enduring anorexia nervosa (SE-AN). Although the classification of SE-AN remains preliminary, there have been increasing calls for a harm reduction-based, collaborative treatment model for these patients. To provide such care for patients with SE-AN, it is critical to listen to and learn from their lived experiences. METHOD Patients (N = 17) admitted to an inpatient eating disorders program who met initial criteria for SE-AN completed semi-structured interviews about the course of their illness and prior treatment episodes. Interviews were audio recorded and transcribed. Data were analyzed using an inductive, reflexive approach to thematic analysis that examined common themes within and across interviews. RESULTS Three themes were identified focused on (1) the all-encompassing nature of SE-AN, (2) treatment experiences, and (3) living with chronic illness. Within these themes, there were subthemes. Overall, individuals noted clear insight about their condition, both negative and positive experiences with previous treatment, and hope for better quality of life despite their illness. DISCUSSION Individuals with SE-AN describe their illness as a chronic condition and hope for a harm reduction-based treatment. Future work, including the lived experiences of individuals with SE-AN, is important to build our understanding of the classification and clinical characteristics of SE-AN and to develop treatment approaches that may best serve these individuals. PUBLIC SIGNIFICANCE Many people with anorexia nervosa do not achieve a full recovery despite repeated treatment episodes throughout their lifespan. Understanding the lived experiences of individuals with SE-AN may help to inform future treatment development efforts that could improve eating disorder and quality of life outcomes for these patients.
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Affiliation(s)
- Melinda Parisi Cummings
- Graduate Counseling Psychology Department, Holy Family University, Philadelphia, Pennsylvania, USA
| | - Robbi K Alexander
- Princeton Center for Eating Disorders, Penn Medicine Princeton Medical Center, Plainsboro, New Jersey, USA
| | - Rebecca G Boswell
- Princeton Center for Eating Disorders, Penn Medicine Princeton Medical Center, Plainsboro, New Jersey, USA
- Department of Psychology, Princeton University, Princeton, New Jersey, USA
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Wong D, Pike K, Stolwyk R, Allott K, Ponsford J, McKay A, Longley W, Bosboom P, Hodge A, Kinsella G, Mowszowski L. Delivery of Neuropsychological Interventions for Adult and Older Adult Clinical Populations: An Australian Expert Working Group Clinical Guidance Paper. Neuropsychol Rev 2023:10.1007/s11065-023-09624-0. [PMID: 38032472 DOI: 10.1007/s11065-023-09624-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 10/16/2023] [Indexed: 12/01/2023]
Abstract
Delivery of neuropsychological interventions addressing the cognitive, psychological, and behavioural consequences of brain conditions is increasingly recognised as an important, if not essential, skill set for clinical neuropsychologists. It has the potential to add substantial value and impact to our role across clinical settings. However, there are numerous approaches to neuropsychological intervention, requiring different sets of skills, and with varying levels of supporting evidence across different diagnostic groups. This clinical guidance paper provides an overview of considerations and recommendations to help guide selection, delivery, and implementation of neuropsychological interventions for adults and older adults. We aimed to provide a useful source of information and guidance for clinicians, health service managers, policy-makers, educators, and researchers regarding the value and impact of such interventions. Considerations and recommendations were developed by an expert working group of neuropsychologists in Australia, based on relevant evidence and consensus opinion in consultation with members of a national clinical neuropsychology body. While the considerations and recommendations sit within the Australian context, many have international relevance. We include (i) principles important for neuropsychological intervention delivery (e.g. being based on biopsychosocial case formulation and person-centred goals); (ii) a description of clinical competencies important for effective intervention delivery; (iii) a summary of relevant evidence in three key cohorts: acquired brain injury, psychiatric disorders, and older adults, focusing on interventions with sound evidence for improving activity and participation outcomes; (iv) an overview of considerations for sustainable implementation of neuropsychological interventions as 'core business'; and finally, (v) a call to action.
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Affiliation(s)
- Dana Wong
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia.
| | - Kerryn Pike
- School of Psychology and Public Health & John Richards Centre for Rural Ageing Research, La Trobe University, Melbourne, Australia
- School of Applied Psychology, Griffith University, Gold Coast, Australia
| | - Rene Stolwyk
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
- Monash-Epworth Rehabilitation Research Centre, Melbourne, Australia
| | - Kelly Allott
- , Orygen, Parkville, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Jennie Ponsford
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
- Monash-Epworth Rehabilitation Research Centre, Melbourne, Australia
| | - Adam McKay
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
- MERRC, Rehabilitation and Mental Health Division, Epworth HealthCare, Richmond, Australia
| | - Wendy Longley
- Rehabilitation Studies Unit, Sydney Medical School, University of Sydney, Sydney, Australia
- The Uniting War Memorial Hospital, Waverley, Sydney, Australia
| | - Pascalle Bosboom
- MindLink Psychology, West Perth, Australia
- School of Psychological Science, University of Western Australia, Crawley, Australia
| | | | - Glynda Kinsella
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Loren Mowszowski
- Faculty of Science, School of Psychology & Brain and Mind Centre, The University of Sydney, Sydney, Australia
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Vintró-Alcaraz C, Mallorquí-Bagué N, Lozano-Madrid M, Testa G, Granero R, Sánchez I, Treasure J, Jiménez-Murcia S, Fernández-Aranda F. The usefulness of an intervention with a serious video game as a complementary approach to cognitive behavioural therapy in eating disorders: A pilot randomized clinical trial for impulsivity management. EUROPEAN EATING DISORDERS REVIEW 2023; 31:781-792. [PMID: 37381106 DOI: 10.1002/erv.3003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 06/04/2023] [Accepted: 06/12/2023] [Indexed: 06/30/2023]
Abstract
OBJECTIVE The aim of the present study was to test the usefulness of an add-on serious video game approach (i.e., Playmancer) to treatment as usual (TAU) on reducing impulsive behaviours and psychopathology in individuals diagnosed with an eating disorder (ED). METHOD Thirty-seven patients diagnosed with an ED according to the DSM-5 were included in the present randomized clinical trial (RCT; study record 35,405 in ClinicalTrials.gov) and were randomly assigned to either the TAU or TAU + Playmancer group. All participants completed a clinical interview. Impulsivity (UPPS-P self reported questionnaire and Stroop task) and general psychopathology (SCL-90-R) measures were assessed at: baseline, 4 weeks into treatment, at the end of TAU (after 16 weeks), and follow-up (2 years). In addition, patients in the experimental group underwent a total of nine sessions with Playmancer over the span of 3 weeks. RESULTS Patients in both treatment groups (TAU + Playmancer or TAU) improved on Stroop task performance and psychological distress. Additionally, patients in TAU-Playmancer improved on the impulsive trait domain of lack of perseverance. No statistical differences were found regarding treatment outcomes (i.e., treatment adherence and remission of eating symptomatology) when comparing the two treatment groups. CONCLUSION Our results suggest that the impulsivity associated with EDs should be addressed and could be modified, as some facets of trait impulsivity improved after Playmancer add-on treatment. Yet, there were no significant differences in treatment outcomes when comparing the two groups and further research needs to be conducted.
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Affiliation(s)
- Cristina Vintró-Alcaraz
- Clinical Psychology Unit, Bellvitge University Hospital, Hospitalet del Llobregat, Spain
- Psychoneurobiology of Eating and Addictive Behaviours Group, Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet del Llobregat, Spain
- CIBER de Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Barcelona, Spain
| | - Núria Mallorquí-Bagué
- Department of Psychiatry, Hospital de Mataró, Consorci Sanitari del Maresme, Mataró, Spain
- Departament of Psychology, University of Girona, Girona, Spain
| | - María Lozano-Madrid
- Clinical Psychology Unit, Bellvitge University Hospital, Hospitalet del Llobregat, Spain
- CIBER de Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Barcelona, Spain
| | - Giulia Testa
- Universidad Internacional de la Rioja, La Rioja, Spain
| | - Roser Granero
- Psychoneurobiology of Eating and Addictive Behaviours Group, Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet del Llobregat, Spain
- CIBER de Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Barcelona, Spain
- Departament de Psicobiologia i Metodologia, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Isabel Sánchez
- Clinical Psychology Unit, Bellvitge University Hospital, Hospitalet del Llobregat, Spain
- Psychoneurobiology of Eating and Addictive Behaviours Group, Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet del Llobregat, Spain
- CIBER de Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Barcelona, Spain
| | - Janet Treasure
- Department of Psychological Medicine, King's College London, Institute of Psychiatry and Neuroscience, Section of Eating Disorders, London, UK
| | - Susana Jiménez-Murcia
- Clinical Psychology Unit, Bellvitge University Hospital, Hospitalet del Llobregat, Spain
- Psychoneurobiology of Eating and Addictive Behaviours Group, Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet del Llobregat, Spain
- CIBER de Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Barcelona, Spain
- Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Fernando Fernández-Aranda
- Clinical Psychology Unit, Bellvitge University Hospital, Hospitalet del Llobregat, Spain
- Psychoneurobiology of Eating and Addictive Behaviours Group, Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet del Llobregat, Spain
- CIBER de Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Barcelona, Spain
- Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
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Colton E, Wilson KE, Chong TTJ, Verdejo-Garcia A. Dysfunctional decision-making in binge-eating disorder: A meta-analysis and systematic review. Neurosci Biobehav Rev 2023; 152:105250. [PMID: 37263530 DOI: 10.1016/j.neubiorev.2023.105250] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 05/26/2023] [Accepted: 05/28/2023] [Indexed: 06/03/2023]
Abstract
Binge-Eating Disorder (BED) involves anticipatory craving and urges, subjective loss-of-control during binge-eating episodes, and post-feeding psychological distress and guilt. Evidence indicates neurocognitive dysfunctions contribute to BED onset, maintenance, and treatment response. However, an integrated understanding of how cognitive processes underpin BED symptomology is lacking. We utilised a multi-stage decision-making model defining ten cognitive processes underpinning Preference Formation, Choice Implementation, Feedback Processing, and Flexibility/Shifting, to comprehensively review research published since 2013. We used preregistered PICOS criteria to assess 1966 articles identified from PubMed, PsycInfo, and Scopus database searches. This yielded 50 studies reporting behavioural cognitive tasks outcomes, comparing individuals with BED to controls with normal and higher weight. Meta-analyses revealed a unique profile of cognitive dysfunctions that spanned all decision-making stages. Significant deficits were evident in Uncertainty Evaluation, Attentional Inhibition, Choice Consistency, and Cognitive Flexibility/Set-shifting. We propose a novel model of dysfunctional decision-making processes in BED and describe their role in binge-eating behaviour. We further highlight the potential for cognitive interventions to target these processes and address the significant treatment gap in BED.
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Affiliation(s)
- Emily Colton
- Turner Institute of Brain and Mental Health, Monash University, Clayton, VIC 3800, Australia.
| | - Kira-Elise Wilson
- Turner Institute of Brain and Mental Health, Monash University, Clayton, VIC 3800, Australia
| | - Trevor T-J Chong
- Turner Institute of Brain and Mental Health, Monash University, Clayton, VIC 3800, Australia
| | - Antonio Verdejo-Garcia
- Turner Institute of Brain and Mental Health, Monash University, Clayton, VIC 3800, Australia
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12
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Abstract
INTRODUCTION Anorexia nervosa is a frequent eating disorder that affects predominantly young women and may take a severe and chronically worsening course of disease contributing to its high mortality rate. Although a multitude of treatment options exist, this disease still bears a high relapse rate. In light of these facts, an improvement of existing and development of new treatment targets and options is warranted. AREAS COVERED The present review article covers recent developments in psychotherapy associated with the respective neuropsychological and brain alterations as well as highlights current and future pharmacotherapeutic options. EXPERT OPINION Several encouraging developments in the field of psychotherapy such as interventions targeting neurocognitive profiles or addressing reward processing, brain stimulation as well as pharmacological modulation of hormones, namely leptin, oxytocin, ghrelin and nesfatin-1 signaling might be - most likely as part of a multimodal treatment approach - efficacious in order to improve treatment of patients with anorexia nervosa, especially those with a severe course of disease as well as comorbidities. As anorexia nervosa represents a complex and severe mental disorder, it seems most likely that a combination and integration of different evidence-based treatment approaches and settings will contribute to an improved prognosis of this eating disorder. This should be further explored in future studies.
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Affiliation(s)
- Andreas Stengel
- Department of Internal Medicine, Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
- Center for Excellence in Eating Disorders Tübingen (KOMET)
- Charité Center for Internal Medicine and Dermatology, Department of Psychosomatic Medicine, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany
| | - Katrin Giel
- Department of Internal Medicine, Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
- Center for Excellence in Eating Disorders Tübingen (KOMET)
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13
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Kim JH, Song DY, Han HS, Yoon NH, Cho HB, Lee HB, Choi KH, Chae PK, Bong G, Ahn S, Yoo HJ. Improving adaptive behaviors for autistic adults without intellectual disability through executive function training. Asian J Psychiatr 2023; 84:103579. [PMID: 37043906 DOI: 10.1016/j.ajp.2023.103579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 03/09/2023] [Accepted: 04/03/2023] [Indexed: 04/14/2023]
Abstract
Executive functioning (EF) is a cognitive process used to perform various daily activities throughout one's lifespan. Autistic adults without intellectual disabilities (ID) also experience difficulties with EF, which is closely associated with adaptive behaviors. For this reason, it is important to improve adaptive behaviors through enhanced use of EF for autistic adults to transition into adulthood successfully. This study aims to conduct a randomized controlled trial to evaluate the effectiveness of a newly developed and modified intervention program. Thirty autistic adults without ID were randomly assigned to the treatment or waitlist group. The participants and caregivers completed various assessments and self-report questionnaires to measure everyday EF and adaptive behaviors. We performed linear mixed-effect modeling to compare the two groups. Data collected at pre-, middle, post-, and follow-up based on participants who completed the program were used to explore changes across time. While there were significant differences in the EF utility-scale (F=5.46, p = .027) between the treatment and waitlist groups, no group x time interactions were detected in other measures. Everyday EF and adaptive behaviors improved when comparing measurements at different time points (p < .001). Our program is Korea's first evidence-based intervention to improve everyday EF and adaptive behaviors for autistic adults without ID.
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Affiliation(s)
- Joo Hyun Kim
- Department of Psychiatry, Seoul National University Bundang Hospital, South Korea
| | - Da-Yea Song
- Department of Psychiatry, Seoul National University College of Medicine, South Korea
| | - Hye Sun Han
- Department of Neurology, Samsung Medical Center, South Korea
| | - Nan-He Yoon
- Division of Social Welfare & Health Administration, Wonkwang University, South Korea
| | - Hwi Bin Cho
- Department of Psychiatry, Konkuk University Medical Center, South Korea
| | - Han Bit Lee
- Center for Campus Life & Culture, Seoul National University, South Korea
| | - Kyung Hee Choi
- Department of Psychiatry, Seoul National University Bundang Hospital, South Korea
| | | | - Guiyoung Bong
- Department of Psychiatry, Seoul National University Bundang Hospital, South Korea
| | - Soyeon Ahn
- Division of Statistics, Medical Research Collaborating Center, Seoul National Unversity Bundang Hospital, South Korea
| | - Hee Jeong Yoo
- Department of Psychiatry, Seoul National University Bundang Hospital, South Korea; Department of Psychiatry, Seoul National University College of Medicine, South Korea.
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14
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Tenconi E, Meregalli V, Buffa A, Collantoni E, Cavallaro R, Meneguzzo P, Favaro A. Belief Inflexibility and Cognitive Biases in Anorexia Nervosa-The Role of the Bias against Disconfirmatory Evidence and Its Clinical and Neuropsychological Correlates. J Clin Med 2023; 12:jcm12051746. [PMID: 36902532 PMCID: PMC10003469 DOI: 10.3390/jcm12051746] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 02/18/2023] [Accepted: 02/20/2023] [Indexed: 02/24/2023] Open
Abstract
The aim of this study was to explore, in a sample of patients with a diagnosis of AN, the ability to question their first impression and, in particular, the willingness to integrate their prior ideas and thoughts with additional progressive incoming information. A total of 45 healthy women and 103 patients with a diagnosis of AN, consecutively admitted to the Eating Disorder Padova Hospital-University Unit, underwent a broad clinical and neuropsychological assessment. All participants were administered the Bias Against Disconfirmatory Evidence (BADE) task, which specifically investigates belief integration cognitive bias. Acute AN patients showed a significantly greater bias toward disconfirming their previous judgment, in comparison to healthy women (BADE score, respectively, 2.5 ± 2.0 vs. 3.3 ± 1.6; Mann-Whitney test, p = 0.012). A binge-eating/purging subtype of AN individuals, compared to restrictive AN patients and controls, showed greater disconfirmatory bias and also a significant propensity to uncritically accept implausible interpretations (BADE score, respectively, 1.55 ± 1.6 and 2.70 ± 1.97 vs. 3.33 ± 1.63; Kruskal-Wallis test, p = 0.002 and liberal acceptance score, respectively, 1.32 ± 0.93 and 0.92 ± 1.21 vs. 0.98 ± 0.75; Kruskal-Wallis test p = 0.03). Abstract thinking skills and cognitive flexibility, as well as high central coherence, are neuropsychological aspects positively correlated with cognitive bias, in both patients and controls. Research into belief integration bias in AN population could enable us to shed light on hidden dimensional aspects, facilitating a better understanding of the psychopathology of a disorder that is so complex and difficult to treat.
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Affiliation(s)
- Elena Tenconi
- Department of Neuroscience, University of Padova, 35128 Padova, Italy
- Padova Neuroscience Center, University of Padova, 35129 Padova, Italy
- Correspondence: ; Tel.: +39-0498217771
| | - Valentina Meregalli
- Department of Neuroscience, University of Padova, 35128 Padova, Italy
- Padova Neuroscience Center, University of Padova, 35129 Padova, Italy
| | - Adriana Buffa
- Department of Neuroscience, University of Padova, 35128 Padova, Italy
| | - Enrico Collantoni
- Department of Neuroscience, University of Padova, 35128 Padova, Italy
| | - Roberto Cavallaro
- School of Medicine, Vita-Salute San Raffaele University, 20132 Milan, Italy
- IRCCS San Raffaele Turro, Scientific Institute Hospital, 20127 Milan, Italy
| | - Paolo Meneguzzo
- Department of Neuroscience, University of Padova, 35128 Padova, Italy
| | - Angela Favaro
- Department of Neuroscience, University of Padova, 35128 Padova, Italy
- Padova Neuroscience Center, University of Padova, 35129 Padova, Italy
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15
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Wayda-Zalewska M, Grzegorzewski P, Kot E, Skimina E, Santangelo PS, Kucharska K. Emotion Dynamics and Emotion Regulation in Anorexia Nervosa: A Systematic Review of Ecological Momentary Assessment Studies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13659. [PMID: 36294238 PMCID: PMC9603728 DOI: 10.3390/ijerph192013659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 10/18/2022] [Accepted: 10/19/2022] [Indexed: 06/16/2023]
Abstract
Altered emotion dynamics and emotion regulation (ER) have been indicated in theoretical descriptions of abnormal emotional functioning, which contributes to the development and maintenance of anorexia nervosa (AN). Ecological momentary assessment (EMA) has recently become popular in research on eating disorders. It is a source of new insights into the psychopathology of AN as it enables intensive long-term tracking of everyday experiences and behaviours of individuals through repeated self-reports. The following systematic review aims to synthesize research on the use of EMA when evaluating emotion dynamics and ER in AN. Specific studies were identified with the use of MEDLINE, PsycINFO, and Scopus databases. A supplemental search was performed in reference lists of the relevant publications. As a result, 27 publications were identified and included in the systematic review. The findings from the reviewed studies point to various disturbed components of emotion dynamics as well as to unique associations of maladaptive ER strategies with specific abnormalities in emotion dynamics in AN. Limitations of the studies were discussed as well. An outlook for further research in the field was provided in the last section of the paper.
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Affiliation(s)
| | - Piotr Grzegorzewski
- Institute of Psychology, Cardinal Stefan Wyszyński University in Warsaw, 01938 Warsaw, Poland
| | - Emilia Kot
- Faculty of Psychology, University of Warsaw, 00183 Warsaw, Poland
| | - Ewa Skimina
- Institute of Psychology, Cardinal Stefan Wyszyński University in Warsaw, 01938 Warsaw, Poland
| | | | - Katarzyna Kucharska
- Institute of Psychology, Cardinal Stefan Wyszyński University in Warsaw, 01938 Warsaw, Poland
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16
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Group cognitive remediation therapy for children and adolescents in intensive day-patient treatment for anorexia nervosa: a feasibility study. NEUROPSYCHIATRIE 2022; 36:125-135. [PMID: 35704173 PMCID: PMC9458577 DOI: 10.1007/s40211-022-00420-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 05/10/2022] [Indexed: 11/20/2022]
Abstract
Background Cognitive Remediation Therapy (CRT) is an adjunct treatment targeting set-shifting (SS) and weak central coherence (CC) thought to play a role in maintaining anorexia nervosa (AN). This study aimed to test the feasibility of brief group CRT for young people with AN in a day-patient setting using neuropsychological assessment of SS and CC. It also explored the benefit for young people with Autism Spectrum Disorder (ASD) features. Methods Twenty female day-patients (12–18 years) with AN or Atypical AN completed neuropsychological assessment of SS (using the Wisconsin Card Sorting Task and the Brixton Spatial Anticipation Test) and of CC (using the Rey Osterrieth Complex Figures Task) pre and post 4 sessions of group CRT. Baseline ASD features and weight change pre and post were measured. Feasibility was assessed regarding the recruitment process, intervention feedback, suitability of neuropsychological assessment measures, and effect sizes. Results Study uptake was 95%, intervention retention was 91%, and group CRT was rated as acceptable. Medium to large effect size improvements were found across measures of SS (dz = 0.44 to dz = 0.90) and medium size improvements found in CC (dz = 0.59). Young people with ASD features showed smaller to similar size improvements in SS and larger improvements in CC. There was a moderate (not significant) correlation with level of weight restoration. Conclusions Important study parameters have been estimated in order to plan a future definitive trial of brief group CRT in a day-patient setting using neuropsychological assessment. These findings also have implications for the use of brief group CRT in young people with ASD features.
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17
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Évaluer un programme de remédiation cognitive dans l’anorexie : nouveaux outils. Encephale 2022; 49:317-320. [DOI: 10.1016/j.encep.2022.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 01/17/2022] [Accepted: 01/18/2022] [Indexed: 11/15/2022]
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18
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Keegan E, Byrne S, Hay P, Touyz S, Treasure J, Schmidt U, McIntosh VVW, Wade TD. An exploratory examination of executive functioning as an outcome, moderator, and predictor in outpatient treatment for adults with anorexia nervosa. J Eat Disord 2022; 10:83. [PMID: 35715854 PMCID: PMC9206373 DOI: 10.1186/s40337-022-00602-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 05/30/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE People with anorexia nervosa often exhibit inefficiencies in executive functioning (central coherence and set shifting) that may negatively impact on treatment outcomes. It is unclear from previous research whether these inefficiencies can change over treatment. We aimed to (1) investigate whether executive functioning can improve over treatment, (2) determine whether baseline executive functioning moderates treatment outcome, and (3) examine whether baseline executive functioning predicts early change (i.e., increase in body mass index over the first 13 weeks of treatment) or remission. METHOD We conducted linear mixed model and logistic regression analyses on data from the Strong Without Anorexia Nervosa trial (Byrne et al. in Psychol Med 47:2823-2833, 2017). This study was a randomised controlled trial of three outpatient treatments for people with anorexia nervosa: Enhanced Cognitive Behavioural Therapy, Maudsley Model Anorexia Nervosa Treatment for Adults, and Specialist Supportive Clinical Management. RESULTS While set shifting clearly improved from baseline to end of treatment, the results for central coherence were less clear cut. People with low baseline central coherence had more rapid reductions in eating disorder psychopathology and clinical impairment than those with high baseline central coherence. Baseline executive functioning did not predict early change or remission. DISCUSSION The detail-focused thinking style commonly observed among people with anorexia nervosa may aid treatment outcomes. Future research that is more adequately powered should replicate this study and examine whether the same pattern of results is observed among people with non-underweight eating disorders.
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Affiliation(s)
- Ella Keegan
- Discipline of Psychology, Blackbird Initiative, Órama Research Institute, Flinders University, GPO Box 2100, Adelaide, South Australia, 5001, Australia.
| | - Susan Byrne
- SWAN Centre, Perth and School of Psychology, University of Western Australia, Perth, Australia
| | - Phillipa Hay
- Translational Health Research Institute, School of Medicine, Western Sydney University, Penrith, Australia
| | - Stephen Touyz
- InsideOut Institute, Sydney University, Sydney, Australia
| | - Janet Treasure
- Department of Psychological Medicine, Kings College London, London, UK
| | - Ulrike Schmidt
- Department of Psychological Medicine, Kings College London, London, UK
| | - Virginia V W McIntosh
- School of Psychology, Speech and Hearing, University of Canterbury Christchurch, Christchurch, New Zealand
| | - Tracey D Wade
- Discipline of Psychology, Blackbird Initiative, Órama Research Institute, Flinders University, GPO Box 2100, Adelaide, South Australia, 5001, Australia
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19
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Thomas KS, Birch RE, Jones CRG, Vanderwert RE. Neural Correlates of Executive Functioning in Anorexia Nervosa and Obsessive-Compulsive Disorder. Front Hum Neurosci 2022; 16:841633. [PMID: 35693540 PMCID: PMC9179647 DOI: 10.3389/fnhum.2022.841633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 05/09/2022] [Indexed: 11/13/2022] Open
Abstract
Anorexia nervosa (AN) and obsessive-compulsive disorder (OCD) are commonly reported to co-occur and present with overlapping symptomatology. Executive functioning difficulties have been implicated in both mental health conditions. However, studies directly comparing these functions in AN and OCD are extremely limited. This review provides a synthesis of behavioral and neuroimaging research examining executive functioning in AN and OCD to bridge this gap in knowledge. We outline the similarities and differences in behavioral and neuroimaging findings between AN and OCD, focusing on set shifting, working memory, response inhibition, and response monitoring. This review aims to facilitate understanding of transdiagnostic correlates of executive functioning and highlights important considerations for future research. We also discuss the importance of examining both behavioral and neural markers when studying transdiagnostic correlates of executive functions.
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Affiliation(s)
- Kai S. Thomas
- School of Psychology, Cardiff University, Cardiff, United Kingdom
- Cardiff University Centre for Human Developmental Science, School of Psychology, Cardiff University, Cardiff, United Kingdom
| | | | - Catherine R. G. Jones
- School of Psychology, Cardiff University, Cardiff, United Kingdom
- Cardiff University Centre for Human Developmental Science, School of Psychology, Cardiff University, Cardiff, United Kingdom
| | - Ross E. Vanderwert
- School of Psychology, Cardiff University, Cardiff, United Kingdom
- Cardiff University Centre for Human Developmental Science, School of Psychology, Cardiff University, Cardiff, United Kingdom
- Cardiff University Brain Research Imaging Centre, School of Psychology, Cardiff University, Cardiff, United Kingdom
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20
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Herbrich-Bowe L, Bentz LK, Correll CU, Kappel V, van Noort BM. Randomized controlled trial of cognitive remediation therapy in adolescent inpatients with anorexia nervosa: Neuropsychological outcomes. EUROPEAN EATING DISORDERS REVIEW 2022; 30:772-786. [PMID: 35607258 DOI: 10.1002/erv.2921] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 04/21/2022] [Accepted: 05/08/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Neuropsychological dysfunction exists in anorexia nervosa (AN). Cognitive Remediation Therapy (CRT), mainly evaluated in adults with AN, targets these impairments. METHODS Adolescent inpatients (age = 11-17 years) with AN were randomized to 5 weeks of either 10 sessions of individually delivered CRT or non-specific cognitive-training (NSCT). Co-primary outcomes included cognitive domain 'flexibility' [composite score of Wisconsin Card Sorting Test (WSCT) and Trail Making Test (TMT-4)] and 'central coherence' [composite score of Central Coherence Index (CCI) and Group Embedded Figures Test (GEFT)] at end of treatment (FU1). Secondary outcomes included individual test scores and self-reported everyday-life flexibility at FU1 and at 6-months post-treatment (FU2). Independent sample t-tests, Pearson chi-square-tests and mixed models for repeated measures (MMRM) analyses were conducted. RESULTS In 56 females (age = 15.1 ± 1.5 years), CRT was not superior to NSCT at FU1 regarding 'flexibility' (p = 0.768) or 'central coherence' (p = 0.354), nor at FU2 (p = 0.507; p = 0.624) (effect sizes = 0.02-0.26). Both groups improved over time in central coherence (CCI p = 0.001; GEFT p < 0.001), self-reported flexibility (p = 0.002) and WCST (p = 0.18), but not TMT-4 (p = 0.286). NSCT was superior to CRT regarding self-reported planning/organisation ability at FU1 (p < 0.001) and FU2 (p = 0.003). CONCLUSIONS CRT was not superior to NSCT in adolescent inpatients with AN. More randomized controlled studies are needed.
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Affiliation(s)
- Laura Herbrich-Bowe
- Department for Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Charité - Universitätsmedizin Berlin, Germany
| | - Lea K Bentz
- Department for Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Charité - Universitätsmedizin Berlin, Germany
| | - Christoph U Correll
- Department for Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Charité - Universitätsmedizin Berlin, Germany.,Department of Psychiatry, Northwell Health, Glen Oaks, New York, USA.,Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA.,Center for Psychiatric Neuroscience, The Feinstein Institute for Medical Research, Manhasset, New York, USA
| | - Viola Kappel
- Department for Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Charité - Universitätsmedizin Berlin, Germany
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21
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Ghiotto C, Silva C, Charvin I, Atzori P, Givaudan M, Da Fonseca D, Bat-Pitault F. Comparing executive functions profiles in anorexia nervosa and autism spectrum disorder in adolescence. EUROPEAN EATING DISORDERS REVIEW 2022; 30:474-485. [PMID: 35411575 PMCID: PMC9540333 DOI: 10.1002/erv.2904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 03/22/2022] [Accepted: 03/31/2022] [Indexed: 11/25/2022]
Abstract
Objective Executive functions (EFs) inefficiencies in anorexia nervosa (AN), especially in set‐shifting and central coherence, suggest a link between AN and autism spectrum disorders (ASDs). This study aimed at comparing EF profiles in AN and ASD, and investigating clinical variables associated with the identified EF difficulties. Method One hundred and sixty‐two adolescents with AN or ASD completed self‐report questionnaires assessing depression, anxiety and autism symptoms. Parents completed the behaviour rating of executive functions parent‐form (BRIEF‐P). Besides comparing EFs in AN and ASD, we also analysed clinical variables scoring below and above the mean age score across the all sample. We additionally examined the relationship between clinical variables and the BRIEF‐P indexes in AN. Results Participants with ASD had greater EF difficulties than participants with AN on all BRIEF‐P scales. In the whole sample, higher autistic features were related to poorer EF. In AN, lower body mass index and particularly higher autism‐spectrum quotient (BRI: Beta = 0.55; p < 0.001 and GEC: Beta = 0.50; p < 0.001) were most strongly associated with poorer EF. Conclusion Although participants with ASD showed greater difficulties, autistic traits were related to alter EFs in AN. Exploring further this dimension can undeniably allow better adaptive cognitive remediation programs. Participants with autism spectrum disorder (ASD) had greater executive function (EF) difficulties than participants with anorexia nervosa (AN) on all behaviour rating of executive functions parent‐form scales In AN, lower body mass index and particularly higher autism‐spectrum quotient were most strongly associated with poorer EF Our study highlights the importance of autistic features in the alteration of EF in AN
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Affiliation(s)
- Clément Ghiotto
- Child and Adolescent Psychiatry Unit, Salvator University Hospital, Public Assistance-Marseille Hospitals, Aix-Marseille University, Marseille, France
| | - Catarina Silva
- Child and Adolescent Psychiatry Unit, Salvator University Hospital, Public Assistance-Marseille Hospitals, Aix-Marseille University, Marseille, France.,Institute of Neuroscience Timone, CNRS, Aix-Marseille University, Marseille, France
| | - Isabelle Charvin
- Child and Adolescent Psychiatry Unit, Salvator University Hospital, Public Assistance-Marseille Hospitals, Aix-Marseille University, Marseille, France
| | - Paola Atzori
- Child and Adolescent Psychiatry Unit, Salvator University Hospital, Public Assistance-Marseille Hospitals, Aix-Marseille University, Marseille, France
| | - Marion Givaudan
- Child and Adolescent Psychiatry Unit, Salvator University Hospital, Public Assistance-Marseille Hospitals, Aix-Marseille University, Marseille, France
| | - David Da Fonseca
- Child and Adolescent Psychiatry Unit, Salvator University Hospital, Public Assistance-Marseille Hospitals, Aix-Marseille University, Marseille, France.,Institute of Neuroscience Timone, CNRS, Aix-Marseille University, Marseille, France
| | - Flora Bat-Pitault
- Child and Adolescent Psychiatry Unit, Salvator University Hospital, Public Assistance-Marseille Hospitals, Aix-Marseille University, Marseille, France.,Institute of Neuroscience Timone, CNRS, Aix-Marseille University, Marseille, France
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22
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Berthoz S, Maria AS, Ringuenet D, Bourdier L, Nicolas I, Blanchet C, Foulon C, Lavoisy G, Godart N, Barry C. Cognitive flexibility and attention to detail in adolescents and adults with severe forms of anorexia nervosa. EUROPEAN EATING DISORDERS REVIEW 2022; 30:289-297. [PMID: 35229408 DOI: 10.1002/erv.2883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 12/14/2021] [Accepted: 12/24/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To determine if adolescents and adults diagnosed with anorexia nervosa differ in their levels of cognitive flexibility and attention to detail independently of potential confounds. METHOD Sixty-two adolescents and 54 adults were assessed while receiving inpatient treatment and completed the following self-reports: Eating Disorders Examination Questionnaire, Maudsley Obsessive Compulsive Inventory and Hospital Anxiety and Depression scale. Performance-based evaluations included the Wisconsin Card Sorting Test Computerised Version, the Comprehensive Trail Making Test, the Brixton Spatial Anticipation Test, the Rey Complex Figure and the Group Embedded Figures Test. RESULTS Comparisons of the adolescents and adults with anorexia nervosa revealed no significant differences for any of the neuropsychological test scores even after adjusting for potential confounding factors. Neither cognitive flexibility nor attention to detail were associated with level of eating disorder symptomatology, depression, anxiety or obsessive-compulsive symptomatology. Unlike age, illness duration was found weakly associated with perseverative errors Wisconsin Card Sorting Test and with the central coherence index of the Rey Complex Figure recall condition. CONCLUSIONS Set-shifting and central coherence performance were independent of age, clinical symptoms severity and emotional status. Additional studies on the relationship between the duration of anorexia nervosa and neuropsychological difficulties are needed.
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Affiliation(s)
- Sylvie Berthoz
- Université Bordeaux, CNRS, EPHE, INCIA, UMR 5287, Bordeaux, France.,Department of Psychiatry for Adolescents and Young Adults, Institut Mutualiste Montsouris, Paris, France
| | | | - Damien Ringuenet
- APHP, Hôpital Paul Brousse, Département de Psychiatrie, Unité Troubles du Comportement Alimentaires, Villejuif, France
| | - Léna Bourdier
- Addictology Department, University Hospital of Bordeaux, Bordeaux, France
| | - Isabelle Nicolas
- Department of Psychiatry for Adolescents and Young Adults, Institut Mutualiste Montsouris, Paris, France
| | - Corinne Blanchet
- Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP, INSERM, Villejuif, France.,APHP, Hôpital Cochin, Maison des Adolescents-Maison de Solenn, Paris, France
| | | | | | - Nathalie Godart
- Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP, INSERM, Villejuif, France.,UFR Simone Veil, UVSQ, Univ. Paris-Saclay, Montigny-le-Bretonneux, France.,Fondation Santé des Etudiants de France, Paris, France
| | - Caroline Barry
- Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP, INSERM, Villejuif, France
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Brockmeyer T, Febry H, Leiteritz-Rausch A, Wünsch-Leiteritz W, Leiteritz A, Friederich HC. Cognitive flexibility, central coherence, and quality of life in anorexia nervosa. J Eat Disord 2022; 10:22. [PMID: 35168670 PMCID: PMC8845392 DOI: 10.1186/s40337-022-00547-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 02/01/2022] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Anorexia nervosa (AN) has consistently been found to be associated with poor cognitive flexibility and central coherence. These two cognitive functions have been considered important maintenance factors in AN and are addressed by specific treatment approaches such as cognitive remediation therapy. While there is clear empirical evidence that difficulties in such cognitive functions are related to impaired daily functioning in schizophrenia and bipolar disorder, this potential association has received only little attention in AN research so far. Therefore, the aim of this study was to examine potential relationships between weak cognitive flexibility, central coherence, and poor quality of life (QoL) in AN. METHODS Cognitive flexibility and central coherence were measured by both neuropsychological (i.e., performance based) and self-report measures alongside with self-reported QoL in a sample of 138 adult patients with AN. RESULTS Self-report but not performance based measures of cognitive flexibility and central coherence were associated with QoL. Weaker cognitive flexibility and central coherence were correlated with poorer QoL. These associations were independent of comorbid depression. The link between weak central coherence and poor QoL was particularly strong in patients with the restricting subtype of AN. The link between cognitive flexibility and QoL, however, was independent of AN subtype. CONCLUSIONS Weak cognitive flexibility and central coherence are associated with low QoL in AN, especially in patients with the restrictive subtype. However, this relationship is dependent on the method of measurement, where self-report measures seem to be more relevant than performance based measures.
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Affiliation(s)
- Timo Brockmeyer
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Goettingen, Gosslerstrasse 14, 37073, Goettingen, Germany. .,Department of General Internal Medicine and Psychosomatics, Center for Psychosocial Medicine, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
| | - Hagen Febry
- Klinik Lueneburger Heide, Am Klaubusch 21, 29549, Bad Bevensen, Germany
| | | | | | - Andreas Leiteritz
- Klinik Lueneburger Heide, Am Klaubusch 21, 29549, Bad Bevensen, Germany
| | - Hans-Christoph Friederich
- Department of General Internal Medicine and Psychosomatics, Center for Psychosocial Medicine, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
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24
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Hajri M, Abbes Z, Yahia HB, Jelili S, Halayem S, Mrabet A, Bouden A. Cognitive deficits in children with autism spectrum disorders: Toward an integrative approach combining social and non-social cognition. Front Psychiatry 2022; 13:917121. [PMID: 36003981 PMCID: PMC9393361 DOI: 10.3389/fpsyt.2022.917121] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 07/13/2022] [Indexed: 11/13/2022] Open
Abstract
Autism spectrum disorder (ASD) is associated with neurocognitive impairment, including executive dysfunctioning and social cognition (SC) deficits. Cognitive remediation (CR) is a behavioral training-based intervention aiming to improve cognitive processes. Its first use in psychiatry interested patients with schizophrenia, in whom promising results have been shown. Integrated CR programs targeting both social and non-social cognition have demonstrated to be effective in improving both cognitive domains and functional outcomes. CR studies in children and adolescents with ASD are still new, those regarding CR approaches combining social and executive functioning remediation are scares. One study examining the efficacy of cognitive enhancement therapy (CET) for improving cognitive abilities in ADS adults, showed significant differential increases in neurocognitive function and large social-cognitive improvements. Therefore, taking into account the overlap between ASD and schizophrenia, and considering the close link between executive functions (EF) and SC, we suggest that integrative approach in ASD could result in better outcomes. The present perspective aimed to highlight cognitive remediation (CR) programs contributions in ASD (especially in children and adolescents), and to discuss the value of combining social and non-social programs.
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Affiliation(s)
- Melek Hajri
- Razi Hospital Child and Adolescent Psychiatry Department, Faculty of Medicine of Tunis, Tunis El Manar University, Manouba, Tunisia
| | - Zeineb Abbes
- Razi Hospital Child and Adolescent Psychiatry Department, Faculty of Medicine of Tunis, Tunis El Manar University, Manouba, Tunisia
| | - Houda Ben Yahia
- Razi Hospital Child and Adolescent Psychiatry Department, Manouba, Tunisia
| | - Selima Jelili
- Razi Hospital Child and Adolescent Psychiatry Department, Faculty of Medicine of Tunis, Tunis El Manar University, Manouba, Tunisia
| | - Soumeyya Halayem
- Razi Hospital Child and Adolescent Psychiatry Department, Faculty of Medicine of Tunis, Tunis El Manar University, Manouba, Tunisia
| | - Ali Mrabet
- Health Minsitery, General Directorate of Military Health, Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Asma Bouden
- Razi Hospital Child and Adolescent Psychiatry Department, Faculty of Medicine of Tunis, Tunis El Manar University, Manouba, Tunisia
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25
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Giombini L, Nesbitt S, Kusosa R, Fabian C, Sharia T, Easter A, Tchanturia K. Neuropsychological and clinical findings of Cognitive Remediation Therapy feasibility randomised controlled trial in young people with anorexia nervosa. EUROPEAN EATING DISORDERS REVIEW 2021; 30:50-60. [PMID: 34821431 DOI: 10.1002/erv.2874] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 10/19/2021] [Accepted: 11/03/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Randomised controlled trial (RCT) in adults with anorexia nervosa (AN) showed that Cognitive Remediation Therapy (CRT) enhances cognitive flexibility, abstract thinking and quality-of-life. Despite inconsistent findings, CRT has the potential as an adjunct treatment for young people (YP) with AN. A feasibility RCT was conducted in an inpatient setting. The study will also consider the effect of CRT in YP with AN and autistic symptoms. METHODS Participants were randomly allocated to the Immediate or Delayed condition to receive individual CRT sessions, in addition to standard treatment. A repeated measures design was conducted. RESULTS Eighty participants were recruited. The neuropsychological measures were feasible for evaluating individual CRT in YP. Significant improvements in set-shifting and central coherence were found, with no main effect between immediate and delayed condition. Significant interactions were found between the condition, and autism spectrum condition (ASC) and No-ASC subgroup, with significant positive impact of CRT on set-shifting in the No-ASC subgroup. There was some evidence that for the No-ASC subgroup, CRT was more effective if delivered at the start of the treatment; and for the ASC subgroup, that CRT was more effective if delivered at the later stage of treatment. CONCLUSIONS These findings suggest that the overall positive effect of CRT in set-shifting and central coherence alongside standard treatment. They also indicate the importance of screening for the presence of ASC which could require tailored CRT.
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Affiliation(s)
- Lucia Giombini
- Rhodes Wood Hospital, Elysium Healthcare, London, UK.,Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, PO59 King's College London, London, UK
| | | | | | - Cleo Fabian
- Rhodes Wood Hospital, Elysium Healthcare, London, UK
| | - Teo Sharia
- Department of Mathematics, Royal Holloway University of London, Egham, Surrey, UK
| | - Abigail Easter
- Department of Women and Children's Health, Faculty of Life Sciences & Medicine, School of Life Course Science, King's College London, London, UK
| | - Kate Tchanturia
- Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, PO59 King's College London, London, UK.,Department of Psychology, Illia University Tbilisi, Tbilisi, Georgia.,South London and Maudsley NHS Foundation Trust, Eating Disorders National Service, London, UK
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26
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Fichter MM, Quadflieg N. [Eating and feeding disorders : New developments]. DER NERVENARZT 2021; 92:1203-1213. [PMID: 34618173 DOI: 10.1007/s00115-021-01191-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/01/2021] [Indexed: 11/28/2022]
Abstract
An overview of eating and feeding disorders according to the future criteria of the International Classification of Diseases (ICD-11) is presented, including information on differential diagnosis, epidemiology, etiology, pathogenesis as well as therapy. Binge-eating disorder is new and the most frequent eating disorder. While anorexia nervosa and bulimia nervosa mostly affect women, the gender ratio in binge-eating disorder is more balanced. Concerning etiology, socio-cultural, biological and psychological factors are discussed. Cognitive behavioral psychotherapy is the best-validated treatment for all three eating disorders. According to the German guidelines for treatment (2019), focal psychodynamic psychotherapy is also a treatment option for anorexia nervosa. Evidence for the positive effect of psychopharmacologic drugs in the treatment of anorexia nervosa is still lacking. Fluoxetine has been shown to have a limited effect in the treatment of bulimia nervosa.
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Affiliation(s)
- Manfred M Fichter
- Schön Klinik Roseneck, Am Roseneck 6, 83209, Prien, Deutschland. .,Klinik und Poliklinik für Psychiatrie und Psychotherapie, LMU, München, Deutschland.
| | - Norbert Quadflieg
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, LMU, München, Deutschland
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27
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Cusack CE, Cooper M, Libbey N, Galupo MP. Rumination & eating psychopathology among trans and nonbinary individuals: A path analysis integrating minority stress. Eat Behav 2021; 42:101544. [PMID: 34358854 DOI: 10.1016/j.eatbeh.2021.101544] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 07/20/2021] [Accepted: 07/21/2021] [Indexed: 11/29/2022]
Abstract
UNLABELLED Ruminative thought patterns, defined as repetitive negative self-focused attention, are considered an avoidant coping strategy for managing stress. As trans and nonbinary (TNB) individuals commonly experience prejudice and discrimination in response to their gender identities (i.e. minority stressors), rumination over these stressors may contribute to heightened risk of psychopathology in these groups. Although rumination is a general risk factor for eating disorder (ED) psychopathology, no studies to date have examined whether eating- or gender-related ruminative patterns relate to maintenance of ED psychopathology for TNB individuals. This cross-sectional study investigated whether levels of rumination (both gender-related and ED-specific) mediated the relationship between minority stress and ED psychopathology. METHOD Participants were 242 TNB adults (Mage = 24.92, SD = 6.5, Range = 18-70) recruited online, who completed measures of minority stress, gender-related rumination, ED-specific rumination, and ED psychopathology. We used Preacher-Hayes' approach to examine the parallel mediation model, with gender-related and ED-specific rumination as potential mediators. RESULTS Gender-related rumination did not mediate the relation between gender minority stress and ED psychopathology, Indirect B = -0.00 [95% BCa CI: -0.01, 0.00]; however, ED-specific rumination was significant, indicating partial mediation, Indirect B = 0.01 [95% BCa CI: 0.00, 0.02]. CONCLUSION As gender minority stress and ED-specific rumination relate to ED psychopathology, it is essential that clinicians adopt an intersectional minority stress framework in understanding ED psychopathology among TNB individuals.
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Neuropsychological Learning Deficits as Predictors of Treatment Outcome in Patients with Eating Disorders. Nutrients 2021; 13:nu13072145. [PMID: 34201433 PMCID: PMC8308216 DOI: 10.3390/nu13072145] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 06/07/2021] [Accepted: 06/17/2021] [Indexed: 02/07/2023] Open
Abstract
Eating disorders (EDs) are severe psychiatric illnesses that require individualized treatments. Decision-making deficits have been associated with EDs. Decision-making learning deficits denote a lack of strategies to elaborate better decisions that can have an impact on recovery and response to treatment. This study used the Iowa Gambling Task (IGT) to investigate learning differences related to treatment outcome in EDs, comparing between patients with a good and bad treatment outcome and healthy controls. Likewise, the predictive role of impaired learning performance on therapy outcome was explored. Four hundred twenty-four participants (233 ED patients and 191 healthy controls) participated in this study. Decision making was assessed using the Iowa Gambling Task before any psychological treatment. All patients received psychological therapy, and treatment outcome was evaluated at discharge. Patients with bad outcome did not show progression in the decision-making task as opposed to those with good outcome and the healthy control sample. Additionally, learning performance in the decision-making task was predictive of their future outcome. The severity of learning deficits in decision making may serve as a predictor of the treatment. These results may provide a starting point of how decision-making learning deficits are operating as dispositional and motivational factors on responsiveness to treatment in EDs.
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Ozsivadjian A, Hollocks MJ, Magiati I, Happé F, Baird G, Absoud M. Is cognitive inflexibility a missing link? The role of cognitive inflexibility, alexithymia and intolerance of uncertainty in externalising and internalising behaviours in young people with autism spectrum disorder. J Child Psychol Psychiatry 2021; 62:715-724. [PMID: 32827150 DOI: 10.1111/jcpp.13295] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/12/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Internalising (anxiety and low mood) and externalising (aggressive or outburst behaviours, and irritability) difficulties are very common in autism spectrum disorder (ASD) across the life span, relatively stable over time and often associated with poorer quality of life. Understanding the cognitive mechanisms underlying internalising and externalising difficulties in ASD is essential for developing targeted supports and interventions. In the present study, we investigated established and less-researched cognitive factors hypothesised to contribute to internalising and/or externalising difficulties in ASD, namely cognitive inflexibility (CI), intolerance of uncertainty (IU) and alexithymia. Based on previous models and clinical experience, we hypothesised that IU would lead to internalising symptoms, with alexithymia contributing to this pathway, and that CI would have a direct effect on externalising behaviours and may indirectly contribute to internalising symptoms via increasing IU. METHODS Our sample consisted of 95 5- to 18-year-olds presenting to a specialist neurodevelopmental clinic and receiving a diagnosis of ASD. Parents/caregivers completed questionnaires assessing ASD symptomatology, internalising and externalising difficulties, CI, IU and alexithymia. Structural equation modelling was used to examine the hypothesised pathways and relationships between the main variables of interest. RESULTS Cognitive Inflexibility played a significant direct role in the pathway from ASD symptoms to externalising symptoms in ASD, and indirect role via IU in the pathway to internalising problems. Relationships between alexithymia and both internalising and externalising symptoms were weaker, with alexithymia predicting internalising difficulties via IU only. CONCLUSIONS The finding of a direct pathway from CI to externalising behaviours is novel, as is the indirect role of CI in internalising symptomatology. Of the three cognitive mechanisms examined, only CI significantly predicted externalising symptoms. Possible implications for interventions and supports targeting these cognitive processes in ASD are discussed.
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Affiliation(s)
- Ann Ozsivadjian
- Evelina London Children's Hospital, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Matthew J Hollocks
- Department of Child & Adolescent Psychiatry, Institute of Psychology, Psychiatry, and Neuroscience, King's College London, London, UK
| | - Iliana Magiati
- School of Psychological Science, University of Western Australia (UWA), Crawley, WA, Australia
| | - Francesca Happé
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychology, Psychiatry, and Neuroscience, King's College London, London, UK
| | - Gillian Baird
- Newcomen Centre, Evelina London Children's Hospital, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Michael Absoud
- Newcomen Centre, Evelina London Children's Hospital, Guy's & St Thomas' NHS Foundation Trust, London, UK.,Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
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30
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Lang K, Kerr-Gaffney J, Hodsoll J, Jassi A, Tchanturia K, Krebs G. Is poor global processing a transdiagnostic feature of Body Dysmorphic Disorder and Anorexia Nervosa? A meta-analysis. Body Image 2021; 37:94-105. [PMID: 33582531 DOI: 10.1016/j.bodyim.2021.01.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 01/26/2021] [Accepted: 01/26/2021] [Indexed: 11/27/2022]
Abstract
Body dysmorphic disorder (BDD) and anorexia nervosa (AN) are characterised by body image disturbance. It has been suggested that poor global integration in visual processing may underlie distorted body image, but empirical studies have yielded mixed results. The current study involved two meta-analyses aimed at examining the extent to which poor global processing is evident in BDD and AN. Studies were identified through a systematic literature search up to October 2020. The BDD search yielded 16 studies and the AN search yielded 18 studies. Random-effect models demonstrated a small pooled effect size for BDD (g = -0.44, 95 % CI -0.70, -0.17, p < 0.001) and a moderate pooled effect size for AN (g = -0.63, 95 % CI -0.77, -0.49, p < .001), with no evidence of significant publication bias for either. The results provide evidence that poor global processing is a transdiagnostic feature of both BDD and AN, although effects may be more pronounced in AN. Our findings highlight the possibility that interventions aimed at promoting global visual processing could prove beneficial in disorders characterised by distorted body image.
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Affiliation(s)
- Katie Lang
- King's College London (KCL), Psychology Department, Institute of Psychiatry, UK; National & Specialist OCD, BDD and Related Disorder Clinic, South London & Maudsley NHS Trust, UK.
| | - Jess Kerr-Gaffney
- King's College London (KCL), Psychological Medicine, Institute of Psychiatry, UK
| | - John Hodsoll
- King's College London (KCL), Department of Biostatistics, Institute of Psychiatry, UK
| | - Amita Jassi
- National & Specialist OCD, BDD and Related Disorder Clinic, South London & Maudsley NHS Trust, UK
| | - Kate Tchanturia
- King's College London (KCL), Psychological Medicine, Institute of Psychiatry, UK; National Eating Disorder Unit, South London & Maudsley NHS Trust, UK
| | - Georgina Krebs
- National & Specialist OCD, BDD and Related Disorder Clinic, South London & Maudsley NHS Trust, UK; King's College London (KCL), Social Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, UK
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31
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Conducting a Pilot Randomized Controlled Trial on a Medical Inpatient Unit Utilizing Cognitive Remediation Therapy for Adolescents with Restrictive Eating Disorders: Protocol Updates and Reflections on Feasibility. J Clin Psychol Med Settings 2021; 27:226-234. [PMID: 32052249 DOI: 10.1007/s10880-020-09704-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
We conducted a pilot randomized control trial (RCT) to simultaneously examine the feasibility of effectively implementing Cognitive Remediation Therapy (CRT) for adolescents with anorexia nervosa (AN) during medical hospitalization at a single-site hospital center. Employment of this protocol occurred on a general medical unit with diverse medical admitting diagnoses, not an eating disorder floor of a hospital and not part of a structured inpatient anorexia nervosa treatment program. This was the first time an RCT for a psychosocial intervention was implemented on this unit with patients with eating disorders. Here, we describe the process of piloting the study, including modifications that needed to be made to the original protocol. We also describe the feedback from major stakeholders regarding the process of conducting the pilot study. We summarize lessons learned and steps to take for smooth integration of an RCT of a therapeutic intervention on medical unit.Trial registration: ClinicalTrials.gov Identifier NCT02883413.
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32
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Timko CA, Bhattacharya A, Fitzpatrick KK, Howe H, Rodriguez D, Mears C, Heckert K, Ubel PA, Ehrenreich-May J, Peebles R. The shifting perspectives study protocol: Cognitive remediation therapy as an adjunctive treatment to family based treatment for adolescents with anorexia nervosa. Contemp Clin Trials 2021; 103:106313. [PMID: 33539993 PMCID: PMC8489286 DOI: 10.1016/j.cct.2021.106313] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 01/13/2021] [Accepted: 01/28/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Adolescents with anorexia nervosa have set-shifting inefficiencies that can be exacerbated by starvation and that may interfere with outcomes of treatment interventions. Cognitive Remediation Therapy (CRT), an adjunctive treatment focused on improving set-shifting, can target inefficiencies and may augment treatment effectiveness. The best way to add CRT to the standard of care (Family Based Treatment, FBT) for adolescents with anorexia remains understudied. METHODS/DESIGN This is a randomized controlled trial designed to determine if CRT is effective in increasing flexibility in adolescents with anorexia and/or their parents. Participants are adolescents 12-18 years old with anorexia and their parents. 54 family groups will be randomized into one of three groups: FBT only, FBT plus Parent-focused CRT, or FBT plus Adolescent-focused CRT. Psychosocial, neurocognitive, and behavioral measures will be collected throughout the study. DISCUSSION This is the first study of its kind to apply CRT to parents. All forms of CRT in the context of anorexia have targeted the individual with anorexia's thinking style. We propose that it may be impactful to target the parent of the adolescent with anorexia as parents carry the burden of treatment and re-nourishment of their child during FBT and may have similar thinking styles. CONCLUSION This study takes an experimental therapeutics approach to further our understanding of the mechanisms of treatment for adolescents with anorexia. It focuses on increasing cognitive flexibility in patients or their parents and determining the appropriate dose of CRT needed to achieve positive change. TRIAL REGISTRATION ClinicalTrails.gov Identifier NCT03928028.
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Affiliation(s)
- C Alix Timko
- Eating Disorder Assessment and Treatment Program, Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA, United States of America; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America.
| | - Anushua Bhattacharya
- Eating Disorder Assessment and Treatment Program, Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA, United States of America
| | | | - Holly Howe
- The Fuqua School of Business, Duke University, Durham, NC, United States of America
| | - Daniel Rodriguez
- School of Nursing and Health Sciences and Public Health, La Salle University, Philadelphia, PA, United States of America
| | - Connor Mears
- Eating Disorder Assessment and Treatment Program, Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA, United States of America
| | - Kerri Heckert
- Deptartment of Clinical Nutrition, Children's Hospital of Philadelphia, Philadelphia, PA, United States of America
| | - Peter A Ubel
- The Fuqua School of Business, Duke University, Durham, NC, United States of America; Sanford School of Policy, Duke University, Durham, NC, United States of America; School of Medicine, Duke University, Durham, NC, United States of America
| | - Jill Ehrenreich-May
- Psychology Department, University of Miami, Miami, FL, United States of America
| | - Rebecka Peebles
- Craig Dalsimer Division of Adolescent Medicine, Department of Pediatrics, Children's Hospital of Philadelphia, United States of America; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
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33
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Dann KM, Hay P, Touyz S. Are poor set-shifting and central coherence associated with everyday function in anorexia nervosa? A systematic review. J Eat Disord 2021; 9:40. [PMID: 33781337 PMCID: PMC8008586 DOI: 10.1186/s40337-021-00392-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 03/02/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND There is increasing interest in associations between cognitive impairments and clinical symptoms in Anorexia Nervosa (AN), however, the relationship with everyday function is unclear. The current review synthesizes existing data regarding associations between scores on tests of set-shifting and central coherence and functional outcome measures for individuals with AN. METHOD A systematic electronic database search yielded 13 studies which included participants with current or lifetime AN where scores on a neuropsychological test of set-shifting or central coherence were directly or indirectly compared to a functional outcome measure. RESULTS Associations between set-shifting and central coherence performance measures and functional outcomes were limited in number and noted only in adult or mixed-age cohorts. Associations were noted at subscale level, suggesting they are specific in nature. In younger cohorts, assessments of executive functioning in everyday life appear sensitive to cognitive-behavioral flexibility issues. CONCLUSIONS Associations between cognitive performance and functional outcome have not been as systematically assessed in AN as in other psychiatric disorders. Key factors to address in future research include: (a) the use of function measures which are sensitive to both the level of impairment, and specific rather than general impairments (b) the ecological validity of measures, (c) the task impurity problem, especially in regard to cognitive flexibility assessment, and (d) the need to measure both cognitive deficits and strengths, because tests of specific cognitive processes may underestimate the ability to function in daily life due to compensatory strategies.
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Affiliation(s)
- Kelly M Dann
- School of Psychology, University of Sydney, Sydney, Australia.
| | - Phillipa Hay
- School of Medicine, Western Sydney University, Sydney, Australia
| | - Stephen Touyz
- InsideOut Institute and School of Psychology, University of Sydney, Sydney, Australia
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34
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Han J, Liu Y, Song S, Wang Y, Zhang X, Chen H. Effects of food stimuli on event-related potentials of restrained eating subgroups during task switching. Neurosci Lett 2021; 754:135853. [PMID: 33781912 DOI: 10.1016/j.neulet.2021.135853] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 12/17/2020] [Accepted: 03/23/2021] [Indexed: 10/21/2022]
Abstract
Executive functions are thought to affect problematic eating behaviors in restrained eaters. While neurophysiological features of inhibitory control among restrained eaters in particular have been extensively investigated, considerably less is known about its influence on cognitive flexibility. The present study investigated the behavioral and neural correlates of food-related cognitive flexibility with event-related potentials (ERPs) associated in a task-switching paradigm among successful restrained eaters (SREs, n = 30) and unsuccessful restrained eaters (UREs, n = 32). Behavioral results revealed smaller switch reaction times among SREs than among UREs in both food-stimuli and neutral-stimuli tasks. ERP analyses indicated that neutral-switch trials, especially in UREs, displayed larger N2 amplitudes. In addition, SREs displayed larger P3 amplitudes in frontal, frontal-central, and central than UREs. P3 amplitude increased significantly during food-stimuli tasks compared to that during neutral-stimuli tasks. These results indicate that SREs possess better efficiency in enhanced cognitive transformation during the processing of target monitoring and conflict resolution. This is the first study to provide evidence for differences between SREs and UREs during task switching using ERP measures and reliance on different food-related processing strategies among SREs compared to UREs.
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Affiliation(s)
- Jinfeng Han
- Key Laboratory of Cognition and Personality (Ministry of Education), Southwest University, Beibei, Chongqing, 400715, China; School of Psychology, Southwest University, Chongqing, China
| | - Yong Liu
- Key Laboratory of Cognition and Personality (Ministry of Education), Southwest University, Beibei, Chongqing, 400715, China; School of Psychology, Southwest University, Chongqing, China
| | - Shiqing Song
- Key Laboratory of Cognition and Personality (Ministry of Education), Southwest University, Beibei, Chongqing, 400715, China; School of Psychology, Southwest University, Chongqing, China
| | - Yunuo Wang
- Key Laboratory of Cognition and Personality (Ministry of Education), Southwest University, Beibei, Chongqing, 400715, China; School of Psychology, Southwest University, Chongqing, China
| | - Xuemeng Zhang
- Key Laboratory of Cognition and Personality (Ministry of Education), Southwest University, Beibei, Chongqing, 400715, China; School of Psychology, Southwest University, Chongqing, China
| | - Hong Chen
- Key Laboratory of Cognition and Personality (Ministry of Education), Southwest University, Beibei, Chongqing, 400715, China; School of Psychology, Southwest University, Chongqing, China.
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35
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Dinkler L, Taylor MJ, Råstam M, Hadjikhani N, Bulik CM, Lichtenstein P, Gillberg C, Lundström S. Anorexia nervosa and autism: a prospective twin cohort study. J Child Psychol Psychiatry 2021; 62:316-326. [PMID: 32496594 DOI: 10.1111/jcpp.13265] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/27/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Anorexia nervosa (AN) and autism spectrum disorder (ASD) may be phenotypically and etiologically linked. However, due to the absence of prospective studies, it remains unclear whether the elevation of autistic traits in AN is evident in early childhood. Here, we prospectively investigated autistic traits before and after the first diagnosis of AN. METHODS In a population-based sample of 5,987 individuals (52.4% female) from the Child and Adolescent Twin Study in Sweden, parents reported autistic traits at ages 9 and 18. AN and ASD diagnoses were retrieved from the Swedish National Patient Register. In addition, AN diagnoses were ascertained by parent-reported treatment for AN. We compared whether individuals with and without AN differed in autistic traits before the first diagnosis of AN (age 9) and after the first diagnosis of AN (age 18). RESULTS We did not find evidence for elevated autistic traits in 9-year-old children later diagnosed with AN. At age 18, however, there was a marked elevation in restricted/repetitive behavior and interests, but only in the subgroup of individuals with acute AN. A less pronounced elevation was observed for social communication problems. CONCLUSIONS Coping strategies in individuals with ASD and the somewhat different female ASD phenotype may explain why we did not find elevated autistic traits in children who later developed AN. Alternatively, it is possible that elevated autistic traits were not present prior to the onset of AN, thus questioning the previously reported elevated prevalence of ASD in AN. Future studies should use tailored measurements in order to investigate whether autistic traits in individuals with AN are best conceptualized as an epiphenomenon of the acute AN phase or whether these symptoms indeed represent ASD as a clinically verifiable neurodevelopmental disorder.
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Affiliation(s)
- Lisa Dinkler
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Mark J Taylor
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Maria Råstam
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden.,Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Nouchine Hadjikhani
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden.,Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Cynthia M Bulik
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Christopher Gillberg
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Sebastian Lundström
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
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36
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Keegan E, Tchanturia K, Wade TD. Central coherence and set-shifting between nonunderweight eating disorders and anorexia nervosa: A systematic review and meta-analysis. Int J Eat Disord 2021; 54:229-243. [PMID: 33305366 DOI: 10.1002/eat.23430] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/20/2020] [Accepted: 11/22/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE This systematic review and meta-analysis compared previously documented inefficiencies in central coherence and set-shifting between people with nonunderweight eating disorders (bulimia nervosa and binge-eating disorder) and people with anorexia nervosa. METHOD We performed random-effects meta-analyses on 16 studies (1,112 participants) for central coherence and 38 studies (3,505 participants) for set-shifting. Random effects meta-regressions were used to test whether the effect sizes for people with nonunderweight eating disorders were significantly different from the effect sizes for people with anorexia nervosa. RESULTS People with anorexia nervosa (Hedge's g = -0.53, 95% CIs: -0.80, -0.27, p < .001) and bulimia nervosa (Hedge's g = -0.70, 95% CIs: -1.14, -0.25, p = .002), but not binge-eating disorder, had significantly poorer central coherence than healthy controls. Similarly, people with anorexia nervosa (Hedge's g = -0.38, 95% CIs: -0.50, -0.26, p < .001) and bulimia nervosa (Hedge's g = -0.55, 95% CIs: -0.81, -0.29, p < .001), but not binge-eating disorder, had significantly poorer set-shifting than healthy controls. The effect sizes for people with nonunderweight eating disorders did not significantly differ from those for people with anorexia nervosa. DISCUSSION Our meta-analysis was underpowered to make definitive judgments about people with binge-eating disorder. However, we found that people with bulimia nervosa clearly have central coherence and set-shifting inefficiencies which do not significantly differ from those observed in people with anorexia nervosa. Clinically, this suggests that people with bulimia nervosa might benefit from adjunctive approaches to address these inefficiencies, such as cognitive remediation therapy.
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Affiliation(s)
- Ella Keegan
- Blackbird Initiative, Órama Research Institute, Flinders University, Adelaide, Australia
| | | | - Tracey D Wade
- Blackbird Initiative, Órama Research Institute, Flinders University, Adelaide, Australia
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37
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Overlapping neurocognitive inefficiencies associated with higher disordered eating psychopathology in college women. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-020-01281-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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38
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Plemeniti Tololeski B, Suhodolčan Grabner A, Kumperscak HG. Adolescents With Autism Spectrum Disorder and Anorexia Nervosa Comorbidity: Common Features and Treatment Possibilities With Cognitive Remediation Therapy and Oxytocin. Front Psychiatry 2021; 12:686030. [PMID: 34413796 PMCID: PMC8369034 DOI: 10.3389/fpsyt.2021.686030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 07/01/2021] [Indexed: 12/16/2022] Open
Abstract
Autistic traits or autism spectrum disorder (ASD) can be found in 4% to 52% of anorexic patients, which makes the treatment of these patients very challenging. In this review, possible ways to treat ASD and anorexia nervosa (AN) comorbidity in children and adolescents are summarized. Over recent years, the focus has shifted from searching for the evidence of connections between these two disorders, which have started with Gillberg's study in 1983, to searching for more effective and holistic treatment of this comorbidity. The latter is known to contribute to more severe courses and worse prognosis, which is probably related to the obstacles in both diagnosing and treating. Since AN usually starts in early adolescence and high-functioning ASD children seem to begin struggling with increased pressure in adolescence, while various comorbidities can occur, it is important to improve the treatment of this comorbidity in young patients and to tailor it specifically in terms of diagnosing. In this paper, a literature review is conducted on common features and promising treatment possibilities. We describe cognitive remediation therapy and the promising pharmacotherapeutic candidate oxytocin with a special focus on adolescents.
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Affiliation(s)
- Barbara Plemeniti Tololeski
- Centre for Mental Health, Unit for Adolescent Psychiatry, University Psychiatric Hospital Ljubljana, Ljubljana, Slovenia
| | | | - Hojka Gregoric Kumperscak
- Department for Child and Adolescent Psychiatry, University Medical Centre, Maribor, Slovenia.,Faculty for Medicine, University of Maribor, Maribor, Slovenia
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39
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Maria AS, Barry C, Ringuenet D, Falissard B, Group T, Berthoz S. Subjective cognitive rigidity and attention to detail: A cross-cultural validation of the Detail and Flexibility Questionnaire (DFlex) in a French clinical sample. J Clin Exp Neuropsychol 2020; 42:1059-1071. [PMID: 33274668 DOI: 10.1080/13803395.2020.1842333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Introduction: People diagnosed with Anorexia Nervosa (AN) are at risk for poor cognitive flexibility and excessive attention to detail. These difficulties are traditionally quantified using neuropsychological tests. These tests do not capture the subjective repercussions of these cognitive styles. The Detail and Flexibility Questionnaire (DFlex) has been specifically developed to measure these repercussions. The aim of this study was to evaluate the psychometric properties of the French version of this scale (F-DFlex) and to adapt it if needed. Methods: The instrument factor structure, internal consistency, convergent, and discriminant validity were assessed in a sample of 107 French women AN inpatients. For convergent validity, associations between F-DFlex scores, perceived levels of autistic traits (Autism Quotient questionnaire - AQ) and eating disorders symptomatology (Eating Disorder Examination Questionnaire - EDE-Q), as well as neuropsychological evaluations (Wisconsin Card Sorting Test - WCST, Rey Complex Figure - RCF) were tested. Discriminant validity was assessed by comparing F-DFlex scores of the patients with a chronic versus non-chronic illness. Results: The results of the exploratory factorial analysis led to the removal of four items. Internal consistency indices of this shortened version were good. Correlation coefficients directions and values between F-DFlex factors and relevant AQ Switching and Detail subscores were satisfactory, indicating good convergent validity. F-DFlex Rigidity scores were associated with the WCST percentage of perseverative errors, but the F-DFlex Attention to Detail scores were not associated with the RCF central coherence index. F-DFlex scores were associated with the severity of eating disorders symptomatology independently of BMI, illness duration, or anxiety, and depression. Conclusion: This study indicates good psychometric properties of this new version of the DFlex. The F-DFlex appears as a promising self-report screening tool of important cognitive dimensions for use in clinical management of people diagnosed with AN.
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Affiliation(s)
- Anne-Solène Maria
- Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP, INSERM , Villejuif, France
| | - Caroline Barry
- Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP, INSERM , Villejuif, France
| | - Damien Ringuenet
- Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP, INSERM , Villejuif, France.,Unité de Traitement des Troubles des Conduites Alimentaires, Département de Psychiatrie et d'Addictologie, Hôpital Paul Brousse , Villejuif, France
| | - Bruno Falissard
- Université Paris-Saclay, Université Paris-Sud, UVSQ, CESP, INSERM , Villejuif, France
| | | | - Sylvie Berthoz
- Département de Psychiatrie de l'Adolescent et du Jeune Adulte, Institut Mutualiste Montsouris , Paris, France.,Univ. Bordeaux, CNRS, EPHE, INCIA, UMR 5287 , Bordeaux, France
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40
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Schaumberg K, Reilly EE, Gorrell S, Levinson CA, Farrell NR, Brown TA, Smith KM, Schaefer LM, Essayli JH, Haynos AF, Anderson LM. Conceptualizing eating disorder psychopathology using an anxiety disorders framework: Evidence and implications for exposure-based clinical research. Clin Psychol Rev 2020; 83:101952. [PMID: 33221621 DOI: 10.1016/j.cpr.2020.101952] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 11/09/2020] [Accepted: 11/09/2020] [Indexed: 12/13/2022]
Abstract
Eating disorders (EDs) and anxiety disorders (ADs) evidence shared risk and significant comorbidity. Recent advances in understanding of anxiety-based disorders may have direct application to research and treatment efforts for EDs. The current review presents an up-to-date, behavioral conceptualization of the overlap between anxiety-based disorders and EDs. We identify ways in which anxiety presents in EDs, consider differences between EDs and ADs relevant to treatment adaptions, discuss how exposure-based strategies may be adapted for use in ED treatment, and outline directions for future mechanistic, translational, and clinical ED research from this perspective. Important research directions include: simultaneous examination of the extent to which EDs are characterized by aberrant avoidance-, reward-, and/or habit-based neurobiological and behavioral processes; improvement in understanding of how nutritional status interacts with neurobiological characteristics of EDs; incorporation of a growing knowledge of biobehavioral signatures in ED treatment planning; development of more comprehensive exposure-based treatment approaches for EDs; testing whether certain exposure interventions for AD are appropriate for EDs; and improvement in clinician self-efficacy and ability to use exposure therapy for EDs.
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Affiliation(s)
| | | | - Sasha Gorrell
- University of California, San Francisco, United States of America
| | - Cheri A Levinson
- University of Louisville, Department of Psychological & Brain Sciences, United States of America
| | | | - Tiffany A Brown
- University of California, San Diego, United States of America
| | - Kathryn M Smith
- Sanford Health, United States of America; University of Southern California, United States of America
| | | | | | - Ann F Haynos
- University of Minnesota, United States of America
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Flint Kids Cook: positive influence of a farmers' market cooking and nutrition programme on health-related quality of life of US children in a low-income, urban community. Public Health Nutr 2020; 24:1492-1500. [PMID: 33028450 DOI: 10.1017/s136898002000395x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To examine changes in health-related quality of life (HRQoL) among youth who participated in Flint Kids Cook, a 6-week healthy cooking programme for children, and assess whether changes in HRQoL were associated with changes in cooking self-efficacy, attitude towards cooking (ATC) and diet. DESIGN Pre-post survey (Pediatric Quality of Life Inventory, Block Kids Food Screener, 8-item cooking self-efficacy, 6-item ATC) using child self-report at baseline and programme exit. Analysis involved paired sample t-tests and Pearson's correlations. SETTING Farmers' market in Flint, Michigan, USA. PARTICIPANTS Children (n 186; 55·9 % female, 72·6 % African American) participated in Flint Kids Cook from October 2017 to February 2020 (mean age 10·55 ± 1·83 years; range 8-15). RESULTS Mean HRQoL summary score improved (P < 0·001) from baseline (77·22 ± 14·27) to programme exit (81·62 ± 14·43), as did mean psychosocial health summary score (74·68 ± 15·68 v. 79·04 ± 16·46, P = 0·001). Similarly, physical (P = 0·016), emotional (P = 0·002), social (P = 0·037), and school functioning (P = 0·002) improved. There was a correlation between change in HRQoL summary score and change in ATC (r = -0·194, P = 0·025) as well as change in cooking self-efficacy (r = -0·234, P = 0·008). Changes in HRQoL and psychosocial health summary scores were not correlated with dietary changes, which included decreased added sugar (P = 0·019) and fruit juice (P = 0·004) intake. CONCLUSIONS This study is the first to report modest yet significant improvements in HRQoL among children and adolescents who participated in a healthy cooking programme. Results suggest that cooking programmes for youth may provide important psychosocial health benefits that are unrelated to dietary changes.
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42
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Khalsa SS, Moseman SE, Yeh HW, Upshaw V, Persac B, Breese E, Lapidus RC, Chappelle S, Paulus MP, Feinstein JS. Reduced Environmental Stimulation in Anorexia Nervosa: An Early-Phase Clinical Trial. Front Psychol 2020; 11:567499. [PMID: 33123048 PMCID: PMC7573249 DOI: 10.3389/fpsyg.2020.567499] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 09/02/2020] [Indexed: 12/25/2022] Open
Abstract
Reduced Environmental Stimulation Therapy (REST) alters the balance of sensory input to the nervous system by systematically attenuating sensory signals from visual, auditory, thermal, tactile, vestibular, and proprioceptive channels. Previous research from our group has shown that REST via floatation acutely reduces anxiety and blood pressure (BP) while simultaneously heightening interoceptive awareness in clinically anxious populations. Anorexia nervosa (AN) is an eating disorder characterized by elevated anxiety, distorted body representation, and abnormal interoception, raising the question of whether REST might positively impact these symptoms. However, this approach has never been studied in eating disorders, and it is unknown whether exposure to floatation REST might worsen AN symptoms. To examine these possibilities, we conducted an open-label study to investigate the safety and tolerability of REST in AN. We also explored the acute impact of REST on BP, affective symptoms, body image disturbance, and interoception. Twenty-one partially weight-restored AN outpatients completed a protocol involving four sequential sessions of REST: reclining in a zero-gravity chair, floating in an open pool, and two sessions of floating in an enclosed pool. All sessions were 90 min, approximately 1 week apart. We measured orthostatic BP before and immediately after each session (primary outcome), in addition to collecting BP readings every 10 min during the session using a wireless waterproof system as a secondary outcome measure. Each participant's affective state, awareness of interoceptive sensations, and body image were assessed before and after every session (exploratory outcomes). There was no evidence of orthostatic hypotension following floating, and no adverse events (primary outcome). Secondary analyses revealed that REST induced statistically significant reductions in BP (p < 0.001; Cohen's d, 0.2-0.5), anxiety (p < 0.001; Cohen's d, >1) and negative affect (p < 0.01; Cohen's d, >0.5), heightened awareness of cardiorespiratory (p < 0.01; Cohen's d, 0.2-0.5) but not gastrointestinal sensations, and reduced body image dissatisfaction (p < 0.001; Cohen's d, >0.5). The findings from this initial trial suggest that individuals with AN can safely tolerate the physical effects of REST via floatation. Future randomized controlled trials will need to investigate whether these initial observations of improved anxiety, interoception, and body image disturbance occur in acutely ill AN populations. Clinical Trial Registration ClinicalTrials.gov; Identifier: NCT02801084 (April 01, 2016).
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Affiliation(s)
- Sahib S Khalsa
- Laureate Institute for Brain Research (LIBR), Tulsa, OK, United States.,Oxley College of Health Sciences, The University of Tulsa, Tulsa, OK, United States
| | | | - Hung-Wen Yeh
- Laureate Institute for Brain Research (LIBR), Tulsa, OK, United States.,Children's Mercy Health System, Kansas City, MO, United States
| | - Valerie Upshaw
- Laureate Institute for Brain Research (LIBR), Tulsa, OK, United States
| | - Beth Persac
- Laureate Eating Disorders Program, Tulsa, OK, United States
| | - Eric Breese
- Laureate Institute for Brain Research (LIBR), Tulsa, OK, United States
| | - Rachel C Lapidus
- Laureate Institute for Brain Research (LIBR), Tulsa, OK, United States.,Department of Psychology, The University of Tulsa, Tulsa, OK, United States
| | | | - Martin P Paulus
- Laureate Institute for Brain Research (LIBR), Tulsa, OK, United States.,Oxley College of Health Sciences, The University of Tulsa, Tulsa, OK, United States
| | - Justin S Feinstein
- Laureate Institute for Brain Research (LIBR), Tulsa, OK, United States.,Oxley College of Health Sciences, The University of Tulsa, Tulsa, OK, United States
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Marchiol F, Lionetti F, Luxardi GL, Cavallero C, Roberts M, Penolazzi B. Cognitive inflexibility and over‐attention to detail: The Italian validation of the
DFlex
Questionnaire in patients with eating disorders. EUROPEAN EATING DISORDERS REVIEW 2020; 28:671-686. [DOI: 10.1002/erv.2781] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 07/22/2020] [Accepted: 07/28/2020] [Indexed: 12/19/2022]
Affiliation(s)
| | - Francesca Lionetti
- Department of Neurosciences Imaging and Clinical Sciences University "G. D'Annunzio", Chieti‐Pescara, IT; Department of Biological and Experimental Psychology, Queen Mary University of London London UK
| | - Gian Luigi Luxardi
- Center for Eating Disorders, AAS n5 'Friuli Occidentale’ – Pordenone Pordenone Italy
| | | | - Marion Roberts
- Department of General Practice & Primary Health Care, Faculty of Medical & Health Sciences University of Auckland Auckland New Zealand
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Dandil Y, Smith K, Kinnaird E, Toloza C, Tchanturia K. Cognitive Remediation Interventions in Autism Spectrum Condition: A Systematic Review. Front Psychiatry 2020; 11:722. [PMID: 32793009 PMCID: PMC7393993 DOI: 10.3389/fpsyt.2020.00722] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 07/09/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Autism spectrum condition (ASC) is a lifelong neurodevelopmental condition characterized by difficulties in social cognition and heterogeneity of executive function which are suggested to be underpinned by neurobiological, prenatal and genetic factors. Cognitive remediation (CR) interventions are frequently used to address cognitive characteristics and improve cognitive and general functioning. However, the evidence is limited for ASC. This systematic review is the first to provide a narrative synthesis of all studies of CR interventions and ASC. The review aimed to delineate the development of research in this area in both adolescents and adults, with implications for clinical practice and future research. METHOD The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) statement. The literature was reviewed using the PubMed, PsycINFO, Web of Science, Scopus and Embase from inception to 1st April 2020. Out of 1,503 publications, a total of 13 papers were identified as being relevant for the review. RESULTS The 13 studies meeting the inclusion criteria were: four randomized control trials (RCTs); two non-randomized control trials, four case series, two feasibility studies and one case study. A narrative synthesis of the data suggested that CR interventions are potentially effective in improving social cognition and cognitive functioning in ASC. RCTs supported the efficacy of CR interventions in improving social cognition and executive functioning. Non-randomized control trials provided evidence for the effectiveness of social cognition remediation interventions in ASC. Case series and a case study have also supported the feasibility of CR interventions, including reflections on their adaptation for ASC populations and the positive feedback from participants. CONCLUSIONS CR interventions are potentially effective in improving social cognition and cognitive functioning in ASC. However, the generalizability of the included empirical studies was hampered by several methodological limitations. To further strengthen understandings of the effectiveness of CR interventions for ASC, future RCTs are needed with larger sample sizes in exploring the long-term effectiveness of CR interventions, using age-appropriate valid and reliable outcome measures. They should also consider the heterogeneity in neuropsychological functioning in ASC and the mediating and moderating mechanisms of the CR intervention for ASC.
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Affiliation(s)
- Yasemin Dandil
- Department of Psychological Medicine, Institute of Psychology, Psychiatry and Neuroscience, King’s College London, London, United Kingdom
| | - Katherine Smith
- Department of Psychological Medicine, Institute of Psychology, Psychiatry and Neuroscience, King’s College London, London, United Kingdom
| | - Emma Kinnaird
- Department of Psychological Medicine, Institute of Psychology, Psychiatry and Neuroscience, King’s College London, London, United Kingdom
| | - Cindy Toloza
- Department of Psychology, National Eating Disorder Service, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Kate Tchanturia
- Department of Psychological Medicine, Institute of Psychology, Psychiatry and Neuroscience, King’s College London, London, United Kingdom
- Department of Psychology, National Eating Disorder Service, South London and Maudsley NHS Foundation Trust, London, United Kingdom
- Department of Psychology, Illia State University, Tbilisi, Georgia
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Hemmingsen SD, Lichtenstein MB, Hussain AA, Sjögren JM, Støving RK. Case report: cognitive performance in an extreme case of anorexia nervosa with a body mass index of 7.7. BMC Psychiatry 2020; 20:284. [PMID: 32503476 PMCID: PMC7275539 DOI: 10.1186/s12888-020-02701-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 05/28/2020] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Studies show that adult patients with anorexia nervosa display cognitive impairments. These impairments may be caused by illness-related circumstances such as low weight. However, the question is whether there is a cognitive adaptation to enduring undernutrition in anorexia nervosa. To our knowledge, cognitive performance has not been assessed previously in a patient with anorexia nervosa with a body mass index as low as 7.7 kg/m2. CASE PRESENTATION We present the cognitive profile of a 35-year-old woman with severe and enduring anorexia nervosa who was diagnosed at the age of 10 years. She was assessed with a broad neuropsychological test battery three times during a year. Her body mass index was 8.4, 9.3, and 7.7 kg/m2, respectively. Her general memory performance was above the normal range and she performed well on verbal and design fluency tasks. Her working memory and processing speed were within the normal range. However, her results on cognitive flexibility tasks (set-shifting) were below the normal range. CONCLUSIONS The case study suggests that it is possible to perform normally cognitively despite extreme and chronic malnutrition though set-shifting ability may be affected. This opens for discussion whether patients with anorexia nervosa can maintain neuropsychological performance in spite of extreme underweight and starvation. TRIAL REGISTRATION ClinicalTrials.gov, NCT02502617. Registered 20 July 2015.
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Affiliation(s)
- Simone Daugaard Hemmingsen
- Centre for Eating Disorder, Odense University Hospital, Odense, Denmark. .,Research Unit for Medical Endocrinology, Odense University Hospital, Odense, Denmark. .,Department of Clinical Research, University of Southern Denmark, Odense, Denmark. .,Open Patient data Explorative Network (OPEN), Odense, Denmark. .,The Research Unit, Child and Adolescent Psychiatry, Mental Health Services in the Region of Southern Denmark, Odense, Denmark.
| | - Mia Beck Lichtenstein
- Centre for Telepsychiatry, Mental Health Services in the Region of Southern Denmark, Odense, Denmark ,grid.10825.3e0000 0001 0728 0170Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Alia Arif Hussain
- grid.466916.a0000 0004 0631 4836Eating Disorder Unit, Mental Health Centre Ballerup, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark ,grid.5254.60000 0001 0674 042XDepartment of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jan Magnus Sjögren
- grid.466916.a0000 0004 0631 4836Eating Disorder Unit, Mental Health Centre Ballerup, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark ,grid.5254.60000 0001 0674 042XDepartment of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - René Klinkby Støving
- grid.7143.10000 0004 0512 5013Centre for Eating Disorder, Odense University Hospital, Odense, Denmark ,grid.7143.10000 0004 0512 5013Research Unit for Medical Endocrinology, Odense University Hospital, Odense, Denmark ,grid.10825.3e0000 0001 0728 0170Department of Clinical Research, University of Southern Denmark, Odense, Denmark ,Open Patient data Explorative Network (OPEN), Odense, Denmark ,The Research Unit, Child and Adolescent Psychiatry, Mental Health Services in the Region of Southern Denmark, Odense, Denmark
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46
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Giombini L, Nesbitt S, Kusosa R, Fabian C, Easter A, Tchanturia K. Adapted emotion skills training group for young people with anorexia nervosa : A mixed-methods evaluation. NEUROPSYCHIATRIE : KLINIK, DIAGNOSTIK, THERAPIE UND REHABILITATION : ORGAN DER GESELLSCHAFT ÖSTERREICHISCHER NERVENÄRZTE UND PSYCHIATER 2020; 35:76-83. [PMID: 32350767 DOI: 10.1007/s40211-020-00347-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 03/25/2020] [Indexed: 01/13/2023]
Abstract
BACKGROUND Brief interventions focused on emotion processing are needed to support young people (YP) in inpatient treatment programmes to manage emotions. Cognitive Remediation and Emotion Skills Training (CREST) has been found beneficial in adult anorexia nervosa (AN) groups. An initial case series found that CREST is a feasible intervention for YP with AN. Further age-appropriate adaptations were needed to improve YP's engagement. Following qualitative feedback on the original CREST manual, a second case series was conducted in an inpatient unit with age-appropriate adaptations to evaluate its feasibility in a YP inpatient setting. METHODS A mixed-methods methodology was used to evaluate the intervention. A total of 30 YP were asked to write a feedback letter about their experience of the group and to complete the Emotion Skills Scale (ESS), an ad hoc 12-item self-report Likert scale assessing emotional functioning. The ESS was also completed by a member of the multidisciplinary team for an external assessment. RESULTS Quantitative results showed no statistically significant changes in YP's emotional functioning, while qualitative results showed that YP found it helpful to learn about emotion processes, acknowledging their need to be supported to express them and understand the link with AN symptoms. Four high-order themes were identified: Helpfulness of CREST Group for Young People (CREST-GYP), Perception of contents, Challenges of group therapy, Suggestions for improvement. CONCLUSIONS Pilot findings suggest that CREST-GYP is an acceptable intervention for YP with AN. Clinical and research studies are needed to clarify whether CREST-GYP can produce more beneficial treatment results than treatment as usual.
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Affiliation(s)
- Lucia Giombini
- Elysium Healthcare, Rhodes Wood Hospital, Sheperd's Way, Brookmans Park, Hatfield, AL96NN, London, UK.
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Sophie Nesbitt
- Elysium Healthcare, Rhodes Wood Hospital, Sheperd's Way, Brookmans Park, Hatfield, AL96NN, London, UK
| | - Rutendo Kusosa
- Elysium Healthcare, Rhodes Wood Hospital, Sheperd's Way, Brookmans Park, Hatfield, AL96NN, London, UK
| | - Cleo Fabian
- Elysium Healthcare, Rhodes Wood Hospital, Sheperd's Way, Brookmans Park, Hatfield, AL96NN, London, UK
| | - Abigail Easter
- Health Service Research and Population Department, Institute of Psychiatry, Psychology and Neuroscience Health Services, King's College London, London, UK
| | - Kate Tchanturia
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Department of Psychology, Illia University Tbilisi, Tbilisi, Georgia
- South London and Maudsley NHS Foundation Trust, London, UK
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Contribution of executive functions to eating behaviours in obesity and eating disorders. Behav Cogn Psychother 2020; 48:725-733. [PMID: 32329428 DOI: 10.1017/s1352465820000260] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Patients with eating disorders (ED) or obesity show difficulties in tasks assessing decision-making, set-shifting abilities and central coherence. AIMS The aim of this study was to explore executive functions in eating and weight-related problems, ranging from restricting types of ED to obesity. METHOD Two hundred and eighty-eight female participants (75 with obesity; 149 with ED: 76 with restrictive eating, 73 with bingeing-purging symptoms; and 64 healthy controls) were administered the Wisconsin Card Sorting Test, the Iowa Gambling Task, and the Group Embedded Figures Test to assess set-shifting, decision-making and central coherence, respectively. RESULTS Participants with either obesity or ED performed poorly on tests measuring executive functioning compared with healthy controls, even after controlling for age and intelligence. Both participants with obesity and participants with ED showed a preference for global information processing. CONCLUSIONS The findings suggest that treatments for obesity and ED would benefit from addressing difficulties in cognitive functioning, in addition to the more evident clinical symptoms related to eating, body weight and shape.
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A preliminary systematic review and meta-analysis of randomized-controlled trials of cognitive remediation therapy for anorexia nervosa. Eat Behav 2020; 37:101391. [PMID: 32408265 PMCID: PMC10044473 DOI: 10.1016/j.eatbeh.2020.101391] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 04/28/2020] [Accepted: 04/28/2020] [Indexed: 12/15/2022]
Abstract
Cognitive remediation therapy (CRT) for anorexia nervosa (AN) was developed as an adjuvant treatment to target set-shifting and central coherence inefficiencies important in AN and to ultimately improve clinical outcomes of those with AN. The primary aim of this preliminary systematic review and meta-analysis was to determine the effect of CRT for AN relative to control treatments in randomized-controlled trials (RCTs) on neuropsychological inefficiencies at end-of-treatment. Secondary aims were to assess the effect of CRT for AN on dropout, eating-disorder-related, and other psychological outcomes at end-of-treatment. Systematic review and meta-analytic procedures were conducted in accordance with PRISMA Guidelines. RCTs evaluating CRT for AN compared to a control treatment were identified via ProQuest, PsycINFO, PubMed, and SCOPUS. Seven RCTs and one quasi-RCT of CRT for AN were included. RCT quality ratings ranged from fair (n = 3) to good (n = 4). Random-effects meta-analysis was conducted using Hedge's g. Study heterogeneity was assessed using I2 and publication bias was assessed with Begg's adjusted-rank correlation and the trim-and-fill method. CRT was not associated with improvement in central coherence compared to control treatments at end-of-treatment (g = 0.25, 95% CI = -0.35, 0.85, k = 3). Set-shifting outcomes were mixed due to heterogeneity of set-shifting measures across studies. CRT may prevent dropout; yet, more studies are needed to draw conclusions. CRT did not confer advantage over control treatments for eating-disorder-related and other psychological outcomes at end-of-treatment. Future RCTs of CRT for AN should use precise measures to assess constructs (particularly for set shifting), increase sample size, and implement longitudinal follow-up. (Word Count: 247 words).
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Dandil Y, Smith K, Adamson J, Tchanturia K. Individual cognitive remediation therapy benefits for patients with anorexia nervosa and high autistic features. EUROPEAN EATING DISORDERS REVIEW 2019; 28:87-91. [PMID: 31713309 PMCID: PMC6972597 DOI: 10.1002/erv.2707] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 10/03/2019] [Accepted: 10/05/2019] [Indexed: 11/17/2022]
Abstract
Cognitive remediation therapy (CRT) is an increasingly implemented intervention in psychiatric conditions. The majority of randomized treatment trials in psychiatry reports cognitive improvements resulting in better functional outcomes in CRT groups. This brief report from the national inpatient treatment programme for eating disorders demonstrates cognitive performance task–based improvements in patients with high and low autistic characteristics. This preliminary study shows feasibility and benefits of individual CRT in patients who have autism spectrum disorder features.
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Affiliation(s)
- Yasemin Dandil
- Department of Psychological Medicine, Institute of Psychiatry, Psychology Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, Eating Disorders National Service, London, UK
| | - Katherine Smith
- Department of Psychological Medicine, Institute of Psychiatry, Psychology Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, Eating Disorders National Service, London, UK
| | - James Adamson
- Department of Psychological Medicine, Institute of Psychiatry, Psychology Neuroscience, King's College London, London, UK
| | - Kate Tchanturia
- Department of Psychological Medicine, Institute of Psychiatry, Psychology Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, Eating Disorders National Service, London, UK.,Department of Psychology, Illia State University, Tbilisi, Georgia
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Sproch LE, Anderson KP, Sherman MF, Crawford SF, Brandt HA. A randomized controlled trial of group cognitive remediation therapy for anorexia nervosa: Effects on set-shifting tasks for inpatient adults and adolescents. Int J Eat Disord 2019; 52:1004-1014. [PMID: 31373405 DOI: 10.1002/eat.23143] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 06/13/2019] [Accepted: 07/04/2019] [Indexed: 01/26/2023]
Abstract
OBJECTIVE The aim of this randomized controlled trial with a parallel design was to evaluate the effect of brief, cognitive remediation therapy (CRT) for anorexia nervosa (AN) on set-shifting. METHOD Two hundred seventy-five inpatient adults and adolescents with AN (mean age = 23.1; SD = 12.7) were randomly assigned (using simple randomization procedures) to either a CRT or control condition. All participants received treatment as usual; however, the CRT condition completed five CRT group sessions in lieu of other group therapies provided on the unit. Set-shifting abilities were evaluated by: (a) neuropsychological measures and (b) experimental cognitive behavior therapy thought records. Blinding of group assignment occurred during baseline assessment and ended following group commencement. RESULTS Data from 135 CRT and 140 control condition participants were analyzed. On all neuropsychological measures, results revealed no between group condition effects, but did show statistically significant time effects, with medium to large effect sizes. Thought record analysis revealed a significant condition by age interaction effect where adults in the CRT condition generated significantly more alternative thoughts and had stronger believability of alternative thoughts than children, a trend that was not found in the control condition. This yielded moderate to large effect sizes of.0.56 and 0.72, respectively. DISCUSSION Based on traditional neuropsychological measures, these findings do not suggest a differential effect of CRT for AN in the format applied. However, results suggest that CRT may have some increased beneficial cognitive effect for adults, as compared to children, based on thought record analysis.
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Affiliation(s)
- Laura E Sproch
- Department of Psychology, The Center for Eating Disorders at Sheppard Pratt, Baltimore, Maryland
| | - Kimberly P Anderson
- Department of Psychology, The Center for Eating Disorders at Sheppard Pratt, Baltimore, Maryland
| | - Martin F Sherman
- Department of Psychology, Loyola University Maryland, Baltimore, Maryland
| | - Steven F Crawford
- Department of Psychiatry, The Center for Eating Disorders at Sheppard Pratt, Baltimore, Maryland
| | - Harry A Brandt
- Department of Psychiatry, The Center for Eating Disorders at Sheppard Pratt, Baltimore, Maryland
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