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Meneguzzo P, Baron E, Marchesin S, Andretta AM, Nalesso L, Stella S, Todisco P. Tuning in to recovery: influence of music on emotional well-being during mealtime in inpatient facilities for eating disorders. J Eat Disord 2024; 12:7. [PMID: 38225626 PMCID: PMC10789025 DOI: 10.1186/s40337-024-00970-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 01/11/2024] [Indexed: 01/17/2024] Open
Abstract
BACKGROUND In rehabilitating eating disorders (ED), mealtimes are critical but often induce stress, both for restrictive and binge-purge disorders. Although preliminary data indicate a positive effect of music during mealtime, few studies employ an experimental approach. This study examines the influence of background music during mealtime in an inpatient ward setting, offering a real-world perspective. METHODS Fifty-one women diagnosed with ED participated in this within-subjects study. Over two weeks, during lunch and dinner, they were exposed to three randomized music conditions: no music, focus piano music, and pop music. The self-report questionnaires captured affective states, noise levels, and hunger, while trained dietitians recorded food consumption and eating rituals. RESULTS The absence of music led to an increase in uneaten food (p = 0.001) and the presence of eating rituals (p = 0.012) during mealtimes. Significantly, only silence during mealtime reduced positive emotional states, while background music maintained positive emotions (p < 0.001). No specific differences emerged between the two types of music (focus piano and pop). CONCLUSIONS These findings affirm the positive impact of background music during mealtime in real-world settings, enhancing the potential of inpatient eating rehabilitation programs for individuals with ED. More studies are needed to validate and extend these results, particularly in outpatient settings.
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Affiliation(s)
- Paolo Meneguzzo
- Department of Neuroscience, University of Padova, 35128, Padua, Italy.
- Padova Neuroscience Center, University of Padova, Padua, Italy.
| | - Elisa Baron
- Eating Disorders Unit, Villa Margherita - Neomesia, Arcugnano, Vicenza, Italy
| | - Silvia Marchesin
- Eating Disorders Unit, Villa Margherita - Neomesia, Arcugnano, Vicenza, Italy
| | - Anna Maria Andretta
- Eating Disorders Unit, Villa Margherita - Neomesia, Arcugnano, Vicenza, Italy
| | - Lisa Nalesso
- Eating Disorders Unit, Villa Margherita - Neomesia, Arcugnano, Vicenza, Italy
| | - Sonia Stella
- Eating Disorders Unit, Villa Margherita - Neomesia, Arcugnano, Vicenza, Italy
| | - Patrizia Todisco
- Eating Disorders Unit, Villa Margherita - Neomesia, Arcugnano, Vicenza, Italy
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Murray SB, Zbozinek TD, Craske M, Tadayonnejad R, Strober M, Bari AA, O'Doherty JP, Feusner JD. Neural, physiological, and psychological markers of appetitive conditioning in anorexia nervosa: a study protocol. J Eat Disord 2022; 10:68. [PMID: 35538507 PMCID: PMC9092702 DOI: 10.1186/s40337-022-00546-5] [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: 09/28/2021] [Accepted: 01/31/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Anorexia nervosa (AN) is a chronic and disabling psychiatric condition characterized by low hedonic drive towards food, and is thought to be inclusive of altered dimensions of reward processing. Whether there exists a fundamental aberrancy in the capacity to acquire and maintain de novo hedonic associations-a critical component of hedonic responding-has never been studied in AN. METHODS This multi-modal study will employ a 2-day Pavlovian appetitive conditioning paradigm to interrogate the (1) acquisition, (2) extinction, (3) spontaneous recovery and (4) reinstatement of appetitive learning in adolescents and young adults with AN. Participants will be 30 currently ill, underweight individuals with AN; 30 weight-restored individuals with AN; and 30 age-matched healthy controls, all aged 12-22 years. All subjects will undergo clinical assessment, followed by the 2-day appetitive conditioning task during which fMRI, pupillometry, heart rate deceleration, and subjective ratings will be acquired. DISCUSSION This study will be the first to interrogate appetitive conditioning in AN-a disorder characterized by altered hedonic responding to food. Results will help establish objective biomarkers of appetitive conditioning in AN and lay the groundwork for developing novel lines of treatment for AN and other psychiatric disorders involving diminished ability to experience pleasure and reward. TRIAL REGISTRATION Pending. INTENDED REGISTRY Clinicaltrials.gov.
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Affiliation(s)
- Stuart B Murray
- Department of Psychiatry and Behavioral Sciences, University of Southern California, 2250 Alcazar Street, Los Angeles, CA, 90033, USA.
| | - Tomislav D Zbozinek
- Division of Humanities and Social Sciences, California Institute of Technology, Pasadena, CA, USA
| | - Michelle Craske
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Reza Tadayonnejad
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA.,Computation and Neural Systems Program, California Institute of Technology, Pasadena, CA, USA
| | - Michael Strober
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
| | - Ausaf A Bari
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA, USA
| | - John P O'Doherty
- Division of Humanities and Social Sciences, California Institute of Technology, Pasadena, CA, USA.,Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
| | - Jamie D Feusner
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA.,Centre for Addiction and Mental Health, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
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3
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Haynos AF, Anderson LM, Askew AJ, Craske MG, Peterson CB. Adapting a neuroscience-informed intervention to alter reward mechanisms of anorexia nervosa: a novel direction for future research. J Eat Disord 2021; 9:63. [PMID: 34039415 PMCID: PMC8152047 DOI: 10.1186/s40337-021-00417-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 05/04/2021] [Indexed: 01/16/2023] Open
Abstract
Accumulating psychobiological data implicate reward disturbances in the persistence of anorexia nervosa (AN). Evidence suggests that individuals with AN demonstrate decision-making deficits similar to those with mood and anxiety disorders that cause them to under-respond to many conventionally rewarding experiences (e.g., eating, interacting socially). In contrast, unlike individuals with other psychiatric disorders, individuals with AN simultaneously over-respond to rewards associated with eating-disorder behaviors (e.g., restrictive eating, exercising). This pattern of reward processing likely perpetuates eating-disorder symptoms, as the rewards derived from eating-disorder behaviors provide temporary relief from the anhedonia associated with limited responsivity to other rewards. Positive Affect Treatment (PAT) is a cognitive-behavioral intervention designed to target reward deficits that contribute to anhedonia in mood and anxiety disorders, including problems with reward anticipation, experiencing, and learning. PAT has been found to promote reward responsivity and clinical improvement in mood and anxiety disorders. This manuscript will: (1) present empirical evidence supporting the promise of PAT as an intervention for AN; (2) highlight nuances in the maintaining processes of AN that necessitate adaptations of PAT for this population; and (3) suggest future directions in research on PAT and other reward-based treatments that aim to enhance clinical outcomes for AN.
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Affiliation(s)
- Ann F Haynos
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, 2450 Riverside Ave., Minneapolis, MN, 55454, USA.
| | - Lisa M Anderson
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, 2450 Riverside Ave., Minneapolis, MN, 55454, USA
| | - Autumn J Askew
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, 2450 Riverside Ave., Minneapolis, MN, 55454, USA
| | - Michelle G Craske
- Department of Psychology and Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
| | - Carol B Peterson
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, 2450 Riverside Ave., Minneapolis, MN, 55454, USA
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Haynos AF, Lavender JM, Nelson J, Crow SJ, Peterson CB. Moving towards specificity: A systematic review of cue features associated with reward and punishment in anorexia nervosa. Clin Psychol Rev 2020; 79:101872. [PMID: 32521390 DOI: 10.1016/j.cpr.2020.101872] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 03/16/2020] [Accepted: 05/24/2020] [Indexed: 12/13/2022]
Abstract
Models of anorexia nervosa (AN) posit that symptoms are maintained through deficient reward and enhanced punishment processing. However, theoretical and empirical inconsistencies highlight the need for a more nuanced conceptualization of this literature. Our goal was to comprehensively review the research on reward and punishment responding in AN from a cue-specific lens to determine which stimuli evoke or discourage reward and punishment responses in this population, and, ultimately, what properties these rewarding and punishing cues might share. A systematic review interrogating reward and punishment responses to specific cues yielded articles (n = 92) that examined responses to disorder relevant (e.g., food) and irrelevant (e.g., money) stimuli across self-report, behavioral, and biological indices. Overall, in most studies individuals with AN exhibited aversive responses to cues signaling higher body weights, social contexts, and monetary losses, and appetitive responses to cues for weight loss behaviors and thinness. Findings were more mixed on responses to palatable food and monetary gains. Results highlight that reward and punishment responding in AN are context specific and may be affected by varied stimulus qualities (e.g., predictability, controllability, delay, effort). Increasing specificity in future research on reward and punishment mechanisms in AN will better inform development of precisely-targeted interventions.
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Affiliation(s)
- Ann F Haynos
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, United States of America.
| | - Jason M Lavender
- Military Cardiovascular Outcomes Research (MiCOR) Program, Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, United States of America; The Metis Foundation, San Antonio, TX, United States of America
| | - Jillian Nelson
- Department of Psychology, George Mason University, Fairfax, VA, United States of America
| | - Scott J Crow
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, United States of America; The Emily Program, St. Paul, MN, United States of America
| | - Carol B Peterson
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, United States of America; The Emily Program, St. Paul, MN, United States of America
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Trudel-Guy C, Bédard A, Corneau L, Bélanger-Gravel A, Desroches S, Bégin C, Provencher V, Lemieux S. Impact of pleasure-oriented messages on food choices: is it more effective than traditional health-oriented messages to promote healthy eating? Appetite 2019; 143:104392. [DOI: 10.1016/j.appet.2019.104392] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 07/05/2019] [Accepted: 07/31/2019] [Indexed: 01/08/2023]
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6
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Khalsa SS, Hassanpour MS, Strober M, Craske MG, Arevian AC, Feusner JD. Interoceptive Anxiety and Body Representation in Anorexia Nervosa. Front Psychiatry 2018; 9:444. [PMID: 30298026 PMCID: PMC6160545 DOI: 10.3389/fpsyt.2018.00444] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 08/28/2018] [Indexed: 12/31/2022] Open
Abstract
Individuals with anorexia nervosa (AN) typically display anxious traits prior to the onset of food avoidance and weight loss that characterize the disorder. Meal associated anxiety is an especially common clinical feature in these patients, and heightened sensitivity to sympathetically mediated interoceptive sensations has also been observed. However, it remains unclear how heightened interoceptive sensitivity relates to experiences of anxiety before and after meals. To investigate this relationship, we experimentally induced anxiety and panic symptoms with isoproterenol, a peripheral sympathetic agonist similar to adrenaline, across several different conditions: during panic provocation, during anticipation of a 1,000 Calorie meal, and after meal consumption. Fifteen AN and 15 age- and sex-matched healthy comparisons received bolus infusions of isoproterenol and saline in a double-blinded, randomized design. Participants rated anxiety symptoms after each infusion, completed panic rating scales, and traced the location of perceived palpitations on a manikin to index interoceptive "body map" representation. The AN group reported significantly elevated anxiety relative to healthy comparisons during infusions before and after the meal, but surprisingly, not during panic provocation. These symptoms were accompanied by geographical differences in patterns of perceived heartbeat sensations across each condition. In particular, the AN group localized heartbeat sensations disproportionately to the chest during meal related saline infusions, when no cardiorespiratory modulation actually occurred. The AN group also showed a trend toward higher panic attack rates during the meal anticipation period. Correcting for anxiety levels reported during saline infusions abolished group differences in anxiety change across all conditions, suggesting a significant contribution of anxious traits in AN. The observation of meal related "visceral illusions" provides further evidence that AN is associated with abnormal interoceptive representation of the heartbeat and suggests that meal consumption, particularly when anticipated, preferentially alters the processing of interoception related signals in AN.
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Affiliation(s)
- Sahib S. Khalsa
- Laureate Institute for Brain Research, Tulsa, OK, United States
- Oxley College of Health Sciences, University of Tulsa, Tulsa, OK, United States
| | | | - Michael Strober
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Michelle G. Craske
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Armen C. Arevian
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Jamie D. Feusner
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
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Abstract
On inpatient eating disorder units, resolving under-nutrition and reestablishing normal eating behavior are key treatment aims. Consequently, the provision of support at mealtimes is a core work task for patients with severe eating disorders. The purpose of this study was to explore staff deliberations and actions, as observed during staff-patient interactions at mealtimes on an inpatient eating disorder unit (EDU). We specifically aimed to characterize how and why staff members intervene during staff-patient interactions in which a refeeding script is activated. This exploratory qualitative study combined non-participant observation and in-depth interviews. Content analysis was used to categorize and abstract the data material. Through the described analysis, we identified two main types of patterns which were categorized as rule adherence and rule bending, describing how staff chose how to intervene in situations where refeeding scripts were activated. The current findings may contribute to enhanced insight and awareness regarding staff behavior and deliberations when providing meal support, and thus help staff members to better understand how meal time support is practiced on inpatient EDUs.
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Affiliation(s)
- Trine Wiig Hage
- a Division of Mental Health and Addiction, Regional Department for Eating Disorders , Oslo University Hospital , Oslo , Norway.,b Institute of Health and Society , University of Oslo , Oslo , Norway
| | - Øyvind Rø
- a Division of Mental Health and Addiction, Regional Department for Eating Disorders , Oslo University Hospital , Oslo , Norway.,c Institute of Clinical Medicine , University of Oslo , Oslo , Norway
| | - Anne Moen
- b Institute of Health and Society , University of Oslo , Oslo , Norway
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8
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Haynos AF, Berg KC, Cao L, Crosby RD, Lavender JM, Utzinger LM, Wonderlich SA, Engel SG, Mitchell JE, Le Grange D, Peterson CB, Crow SJ. Trajectories of higher- and lower-order dimensions of negative and positive affect relative to restrictive eating in anorexia nervosa. JOURNAL OF ABNORMAL PSYCHOLOGY 2016; 126:495-505. [PMID: 27893231 DOI: 10.1037/abn0000202] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Despite robust support for the role of affect in the maintenance of binge eating and purging, the relationship between affect and restrictive eating remains poorly understood. To investigate the relationship between restrictive eating and affect, ecological momentary assessment data from 118 women with anorexia nervosa (AN) were used to examine trajectories of higher-order dimensions of negative affect (NA) and positive affect (PA), as well as lower-order dimensions of NA (Fear, Guilt) and PA (Joviality, Self-Assurance) relative to restrictive eating. Affect trajectories were modeled before and after restrictive eating episodes and AN subtype was examined as a moderator of these trajectories. Across the sample, Guilt significantly increased before and decreased after restrictive eating episodes. Global NA, Global PA, Fear, Joviality, and Self-Assurance did not vary relative to restrictive eating episodes across the sample. However, significant subtype by trajectory interactions were detected for PA indices. Among individuals with AN restricting subtype, Global PA, Joviality, and Self-Assurance decreased prior to and Self-Assurance increased following restrictive eating episodes. In contrast, Global PA and Self-Assurance increased prior to, but did not change following, restrictive eating episodes among individuals with AN binge eating/purging subtype. Results suggest that dietary restriction may function to mitigate guilt across AN subtypes and to enhance self-assurance among individuals with AN restricting subtype. (PsycINFO Database Record
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Affiliation(s)
- Ann F Haynos
- Department of Psychiatry, University of Minnesota Medical Center
| | - Kelly C Berg
- Department of Psychiatry, University of Minnesota Medical Center
| | - Li Cao
- Neuropsychiatric Research Institute
| | | | | | - Linsey M Utzinger
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine
| | | | | | | | - Daniel Le Grange
- Department of Psychiatry, University of California, San Francisco
| | - Carol B Peterson
- Department of Psychiatry, University of Minnesota Medical Center
| | - Scott J Crow
- Department of Psychiatry, University of Minnesota Medical Center
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Kolar DR, Hammerle F, Jenetzky E, Huss M, Bürger A. Aversive tension in female adolescents with Anorexia Nervosa: a controlled ecological momentary assessment using smartphones. BMC Psychiatry 2016; 16:97. [PMID: 27068217 PMCID: PMC4828844 DOI: 10.1186/s12888-016-0807-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 04/06/2016] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Current models of Anorexia Nervosa (AN) emphasize the role of emotion regulation. Aversive tension, described as a state of intense arousal and negative valence, is considered to be a link between emotional events and disordered eating. Recent research focused only on adult patients, and mainly general emotion regulation traits were studied. However, the momentary occurrence of aversive tension, particularly in adolescents with AN, has not been previously studied. METHOD 20 female adolescents with AN in outpatient treatment and 20 healthy adolescents aged 12 to 19 years participated in an ecological momentary assessment using their smartphones. Current states of aversive tension and events were assessed hourly for two consecutive weekdays. Mean and maximum values of aversive tension were compared. Multilevel analyses were computed to test the influence of time and reported events on aversive tension. The effect of reported events on subsequent changes of aversive tension in patients with AN were additionally tested in a multilevel model. RESULTS AN patients showed higher mean and maximum levels of aversive tension. In a multilevel model, reported food intake was associated with higher levels of aversive tension in the AN group, whereas reported school or sport-related events were not linked to specific states of aversive tension. After food intake, subsequent increases of aversive tension were diminished and decreases of aversive tension were induced in adolescents with AN. CONCLUSIONS Aversive tension may play a substantial role in the psychopathology of AN, particular in relation with food intake. Therefore, treatment should consider aversive tension as a possible intervening variable during refeeding. Our findings encourage further research on aversive tension and its link to disordered eating. TRIAL REGISTRATION German register of clinical trials (DRKS): DRKS00005228 (Date of registration: September 2, 2013).
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Affiliation(s)
- David R. Kolar
- Department for Child and Adolescent Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Florian Hammerle
- Department for Child and Adolescent Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Ekkehart Jenetzky
- Department for Child and Adolescent Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg University, Mainz, Germany ,Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | - Michael Huss
- Department for Child and Adolescent Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Arne Bürger
- Department for Child and Adolescent Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg University, Mainz, Germany ,Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Würzburg, Würzburg, Germany
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Treasure J, Cardi V, Leppanen J, Turton R. New treatment approaches for severe and enduring eating disorders. Physiol Behav 2015; 152:456-65. [DOI: 10.1016/j.physbeh.2015.06.007] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Revised: 05/22/2015] [Accepted: 06/04/2015] [Indexed: 10/23/2022]
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Affiliation(s)
- Margarita Sala
- Department of Psychology, Southern Methodist University, 6116 N. Central Expressway, Suite 1300, Dallas, TX, 75206, USA,
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12
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Reply to Sala: "Post-meal affective states". Eat Weight Disord 2015; 20:279-80. [PMID: 25726161 DOI: 10.1007/s40519-015-0187-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 02/20/2015] [Indexed: 10/23/2022] Open
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