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Bijsterbosch JM, Hasenack B, van Rooijen B, Sternheim LC, Boelen PA, Dijkerman HC, Keizer A. Intolerable feelings of uncertainty within the body: Associations between interoceptive awareness, intolerance of uncertainty, and body dissatisfaction. J Adolesc 2023; 95:1678-1688. [PMID: 37655512 DOI: 10.1002/jad.12237] [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: 01/19/2023] [Revised: 08/15/2023] [Accepted: 08/17/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND Adolescence is a period marked by important physical and social changes, which often leads to an increase of body dissatisfaction. Recent studies have shown an association between interoception and body dissatisfaction in female adolescents. One variable that may contribute to the association between interoceptive awareness and body dissatisfaction is intolerance of uncertainty (IU). This study aims to investigate multiple facets of interoceptive awareness, IU, and their relations with body dissatisfaction in adolescent girls. METHODS In a cross-sectional study, a convenience sample of 307 adolescent girls (mean age = 17.73; SD = 1.02) was recruited in the Netherlands in 2022. Three questionnaires were completed measuring interoceptive awareness, IU, and body dissatisfaction. A moderation analyses using a multiple hierarchical regression was used to investigate associations between variables. RESULTS Correlation analyses indicated that several facets of lower interoceptive awareness (Not distracting, Not worrying and Trusting) were related to higher levels of body dissatisfaction. IU only marginally moderated the relationship between several domains of interoceptive awareness (Notice, Attention regulation and Emotional awareness) and body dissatisfaction. DISCUSSION Findings suggest that experiencing bodily signals as ambiguous and uncertain may result in more complex body image issues. Within certain domains of interoceptive awareness, IU may affect the process of appraising bodily signals. Furthermore, adolescent girls who do not feel safe in their body and who find it difficult to distract their thoughts when experiencing pain or discomfort in their body may be particularly at risk for developing more complex body image disturbances and may benefit from interventions improving both interoceptive awareness and IU. Moreover, future research should focus on interoceptive awareness and IU as potential underlying mechanisms for body image issues.
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Affiliation(s)
| | - Birgit Hasenack
- Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands
| | - Bregje van Rooijen
- Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands
| | - Lot C Sternheim
- Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands
| | - Paul A Boelen
- Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands
- ARQ National Psychotrauma Centre, Diemen, The Netherlands
- ARQ Centrum'45, Diemen, The Netherlands
| | - H Chris Dijkerman
- Department of Experimental Psychology, Utrecht University, Utrecht, The Netherlands
| | - Anouk Keizer
- Department of Experimental Psychology, Utrecht University, Utrecht, The Netherlands
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2
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Jacoby RJ, Szkutak A, Shin J, Lerner J, Wilhelm S. Feeling uncertain despite knowing the risk: Patients with OCD (but not controls) experience known and unknown probabilistic decisions as similarly distressing and uncertain. J Obsessive Compuls Relat Disord 2023; 39:100842. [PMID: 38249753 PMCID: PMC10795542 DOI: 10.1016/j.jocrd.2023.100842] [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] [Indexed: 01/23/2024]
Abstract
Patients with obsessive compulsive disorder (OCD) present as risk-averse and avoidant of feared stimuli, yet the literature examining risk aversion in OCD is conflicting. One possible explanation is that patients may exhibit aversion only on ambiguous tasks where the likelihood of possible outcomes is unknown. To test this idea, the current study assigned 30 patients with OCD versus 30 non-psychiatric controls (NPC) to conditions of known versus unknown risk (i.e., probabilities) on the Beads Task. Importantly, the task involved real financial stakes. We also examined self-reported intolerance of uncertainty (IU) as a mechanism. Results revealed a significant risk information x group interaction for certainty about the decision. Specifically, while NPCs felt significantly less certain on the unknown risk (versus known risk) task, the OCD group felt uncertain regardless of risk information. Results also revealed a significant main effect of group for distress after deciding, such that the OCD group was more distressed across all task versions compared to NPCs. Elevated trait IU was associated with higher task-related distress. Results indicate that even when patients with OCD are given information about likelihoods, they still feel uncertain and experience distress. Findings have clinical implications for addressing risk aversion and ambiguity/uncertainty in treatment.
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Affiliation(s)
- Ryan J. Jacoby
- Massachusetts General Hospital/Harvard Medical School, 185 Cambridge Street, Suite 2000, Boston, MA, 02114, USA
| | - Abigail Szkutak
- Teachers College, Columbia University, 422F Thompson Hall, 525 W 120th Street, New York, NY, 10027, USA
| | - Jin Shin
- Washington University in St. Louis, CB 1125, One Brookings Drive, St. Louis, MO, 63130-4899, USA
| | - Jennifer Lerner
- Harvard Kennedy School,, 79 John F. Kennedy Street, Cambridge, MA 02138, USA
| | - Sabine Wilhelm
- Massachusetts General Hospital/Harvard Medical School, 185 Cambridge Street, Suite 2000, Boston, MA, 02114, USA
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3
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Slanina‐Davies A, Robinson OJ, Pike AC. Eating disorder symptoms and control-seeking behavior. Brain Behav 2023; 13:e3105. [PMID: 37381651 PMCID: PMC10454257 DOI: 10.1002/brb3.3105] [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: 01/24/2022] [Revised: 04/22/2023] [Accepted: 05/18/2023] [Indexed: 06/30/2023] Open
Abstract
OBJECTIVE Eating disorders (EDs) are a heterogenous group of disorders characterized by disturbed eating patterns. Links have been made between ED symptoms and control-seeking behaviors, which may cause relief from distress. However, whether direct behavioral measures of control-seeking behavior correlate with ED symptoms has not been directly tested. Additionally, existing paradigms may conflate control-seeking behavior with uncertainty-reducing behavior. METHOD A general population sample of 183 participants completed part in an online behavioral task, in which participants rolled a die in order to obtain/avoid a set of numbers. Prior to each roll, participants could choose to change arbitrary features of the task (such as the color of their die) or view additional information (such as the current trial number). Selecting these Control Options could cost participants points or not (Cost/No-Cost conditions). Each participant completed all four conditions, each with 15 trials, followed by a series of questionnaires, including the Eating Attitudes Test-26 (EAT-26), the Intolerance of Uncertainty Scale, and the Obsessive-Compulsive Inventory-Revised (OCI-R). RESULTS A Spearman's rank test indicated no significant correlation between total EAT-26 score and total number of Control Options selected, with only elevated scores on a measure of obsessions and compulsivity (OCI-R) correlating with the total number of Control Options selected (rs = .155, p = .036). DISCUSSION In our novel paradigm, we find no relationship between EAT-26 score and control-seeking. However, we do find some evidence that this behavior may be present in other disorders that often coincide with ED diagnosis, which may indicate that transdiagnostic factors such as compulsivity are important to control-seeking.
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Affiliation(s)
- Ashley Slanina‐Davies
- Anxiety Lab, Neuroscience and Mental Health Group, Institute of Cognitive NeuroscienceUniversity College LondonLondonUK
| | - Oliver J. Robinson
- Anxiety Lab, Neuroscience and Mental Health Group, Institute of Cognitive NeuroscienceUniversity College LondonLondonUK
| | - Alexandra C. Pike
- Anxiety Lab, Neuroscience and Mental Health Group, Institute of Cognitive NeuroscienceUniversity College LondonLondonUK
- Department of Psychology and York Biomedical Research InstituteUniversity of YorkYorkUK
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Cuesta-Zamora C, Ricarte JJ, Ros L, Latorre JM, Plateau C. The role of intolerance of uncertainty and anxiety on compulsive exercise in adolescents. ANXIETY, STRESS, AND COPING 2023:1-12. [PMID: 36943399 DOI: 10.1080/10615806.2023.2188204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
BACKGROUND AND OBJECTIVES The role of anxiety as a risk factor for compulsive exercise elements among adolescents is unclear. Intolerance of uncertainty (IU), which is a risk feature for anxiety and eating disorders, may be an important, unexplored risk factor for compulsive exercise dimensions. This study aimed to examine the role of IU dimensions and anxiety on compulsive exercise elements. Given previous evidence indicating gender differences in compulsive exercise and IU levels, gender was included as a moderator. DESIGN/METHODS A total of 201 adolescent girls and 207 adolescent boys completed the following questionnaires: Eating Disorder Inventory-3, Intolerance of Uncertainty Scale-12 (IUS-12), a brief version of the State-Trait Anxiety Inventory and the Compulsive Exercise Test (CET). RESULTS The hierarchical regression analyses showed that the interaction between IUS-Prospective and gender emerged as a significant predictor of CET-Avoidance and CET-Weight control exercise beyond symptoms of eating disorders and anxiety. Post hoc analysis revealed that the IUS-Prospective was a significant predictor of CET-Avoidance and CET-Weight Control among boys, but not among girls. CONCLUSIONS These findings suggest that prospective IU may contribute towards obsessive-compulsive attitudes towards exercise among adolescent population, specifically among boys.
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Affiliation(s)
- Cristina Cuesta-Zamora
- Faculty of Education, Psychology Department, University of Castilla-La Mancha, Albacete, Spain
| | - Jorge Javier Ricarte
- Faculty of Education, Psychology Department, University of Castilla-La Mancha, Albacete, Spain
| | - Laura Ros
- Faculty of Medicine, Psychology Department, University of Castilla-La Mancha, Albacete, Spain
| | - José Miguel Latorre
- Faculty of Medicine, Psychology Department, University of Castilla-La Mancha, Albacete, Spain
| | - Carolyn Plateau
- School of Sport, Exercise and Health Sciences, National Centre for Sport and Exercise Medicine, Loughborough University, Leicestershire, UK
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5
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Tajadura-Jiménez A, Crucianelli L, Zheng R, Cheng C, Ley-Flores J, Borda-Más M, Bianchi-Berthouze N, Fotopoulou A. Body weight distortions in an auditory-driven body illusion in subclinical and clinical eating disorders. Sci Rep 2022; 12:20031. [PMID: 36414765 PMCID: PMC9681758 DOI: 10.1038/s41598-022-24452-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 11/15/2022] [Indexed: 11/23/2022] Open
Abstract
Previous studies suggest a stronger influence of visual signals on body image in individuals with eating disorders (EDs) than healthy controls; however, the influence of other exteroceptive sensory signals remains unclear. Here we used an illusion relying on auditory (exteroceptive) signals to manipulate body size/weight perceptions and investigated whether the mechanisms integrating sensory signals into body image are altered in subclinical and clinical EDs. Participants' footstep sounds were altered to seem produced by lighter or heavier bodies. Across two experiments, we tested healthy women assigned to three groups based on self-reported Symptomatology of EDs (SED), and women with Anorexia Nervosa (AN), and used self-report, body-visualization, and behavioural (gait) measures. As with visual bodily illusions, we predicted stronger influence of auditory signals, leading to an enhanced body-weight illusion, in people with High-SED and AN. Unexpectedly, High-SED and AN participants displayed a gait typical of heavier bodies and a widest/heaviest visualized body in the 'light' footsteps condition. In contrast, Low-SED participants showed these patterns in the 'heavy' footsteps condition. Self-reports did not show group differences. The results of this pilot study suggest disturbances in the sensory integration mechanisms, rather than purely visually-driven body distortions, in subclinical/clinical EDs, opening opportunities for the development of novel diagnostic/therapeutic tools.
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Affiliation(s)
- Ana Tajadura-Jiménez
- grid.7840.b0000 0001 2168 9183DEI Interactive Systems Group, Department of Computer Science and Engineering, Universidad Carlos III de, Av. de La Universidad, 30, 28911 Madrid, Leganés, Spain ,grid.83440.3b0000000121901201UCL Interaction Centre (UCLIC), University College London, London, UK
| | - Laura Crucianelli
- grid.4714.60000 0004 1937 0626Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden ,grid.83440.3b0000000121901201Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Rebecca Zheng
- grid.83440.3b0000000121901201UCL Interaction Centre (UCLIC), University College London, London, UK
| | - Chloe Cheng
- grid.83440.3b0000000121901201UCL Interaction Centre (UCLIC), University College London, London, UK
| | - Judith Ley-Flores
- grid.7840.b0000 0001 2168 9183DEI Interactive Systems Group, Department of Computer Science and Engineering, Universidad Carlos III de, Av. de La Universidad, 30, 28911 Madrid, Leganés, Spain
| | - Mercedes Borda-Más
- grid.9224.d0000 0001 2168 1229Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Universidad de Sevilla, Seville, Spain
| | - Nadia Bianchi-Berthouze
- grid.83440.3b0000000121901201UCL Interaction Centre (UCLIC), University College London, London, UK
| | - Aikaterini Fotopoulou
- grid.83440.3b0000000121901201Department of Clinical, Educational and Health Psychology, University College London, London, UK
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Parker SC, Ahrens AH. (Just Thinking of) Uncertainty Increases Intolerance of Uncertainty. JOURNAL OF INDIVIDUAL DIFFERENCES 2022. [DOI: 10.1027/1614-0001/a000376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Abstract. Intolerance of uncertainty is a far-reaching – yet not widely examined – construct with clinical and nonclinical associations. The current study implemented a brief reflection on uncertainty hypothesized to increase tolerance of uncertainty. The group who engaged in the reflection ( n = 50) was compared to an active control condition ( n = 50). Results demonstrated the opposite of the primary hypothesis: simply reflecting on uncertainty significantly increased intolerance of uncertainty (vs. tolerance of uncertainty). Results also demonstrated that those higher in mindfulness were higher in tolerance of uncertainty, with the “nonreactivity” factor of mindfulness contributing unique variance. These findings suggest multiple factors that might contribute to both tolerance and intolerance of uncertainty. This study indicates that investigations of interventions that include training in mindfulness and its component of nonreactivity might be particularly warranted.
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Affiliation(s)
- Suzanne C. Parker
- George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT, USA
- Department of Psychology, American University, Washington, DC, USA
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Engel MM, Ainley V, Tsakiris M, Chris Dijkerman H, Keizer A. Sense of agency during and following recovery from anorexia nervosa. Conscious Cogn 2022; 103:103369. [PMID: 35717717 DOI: 10.1016/j.concog.2022.103369] [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: 10/26/2021] [Revised: 06/07/2022] [Accepted: 06/08/2022] [Indexed: 11/03/2022]
Abstract
The need to feel in control is central to anorexia nervosa (AN). The sense of control in AN has only been studied through self-report. This study investigated whether implicit sense of control (sense of agency; SoA) differs across AN patients, recovered AN (RAN) patients and healthy controls (HC). Furthermore, we assessed whether state anxiety is influenced by negative emotional states. SoA was measured with the intentional binding task (IB) and state-anxiety levels through a questionnaire. We did not find any evidence of differences in SoA between groups. Furthermore, state anxiety was not a significant predictor of SoA. Further research into SoA in AN should focus on other features of the SoA that are not targeted by the IB task.
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Affiliation(s)
- Manja M Engel
- Department of Experimental Psychology, Faculty of Social and Behavioural Sciences, Utrecht University, The Netherlands.
| | - Vivien Ainley
- Department of Psychology, Royal Holloway, School of Advanced Study, University of London, United Kingdom
| | - Manos Tsakiris
- Department of Psychology, Royal Holloway, School of Advanced Study, University of London, United Kingdom
| | - H Chris Dijkerman
- Department of Experimental Psychology, Faculty of Social and Behavioural Sciences, Utrecht University, The Netherlands
| | - Anouk Keizer
- Department of Experimental Psychology, Faculty of Social and Behavioural Sciences, Utrecht University, The Netherlands
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Broad and Narrow Transdiagnostic Risk Factors in Eating Disorders: A Preliminary Study on an Italian Clinical Sample. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116886. [PMID: 35682468 PMCID: PMC9180279 DOI: 10.3390/ijerph19116886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 05/30/2022] [Accepted: 06/02/2022] [Indexed: 12/04/2022]
Abstract
Eating disorders are multifaceted psychopathologies and the transdiagnostic approach is currently considered a useful framework to understand their complexity. This preliminary study aimed to investigate both broad (i.e., intolerance of uncertainty and emotion dysregulation) and narrow (i.e., extreme body dissatisfaction) transdiagnostic risk factors underlying eating disorders. 50 Italian female patients seeking treatment for an eating disorder were involved (Mage = 31.6 years ± 12.8, 18–65). They completed self-report measures assessing emotion regulation difficulties, intolerance of uncertainty, extreme body dissatisfaction, general psychological distress, and eating disorder symptomatology. To explore whether the abovementioned transdiagnostic factors predicted patients’ psychological distress and eating disorder symptoms, two linear regressions were performed. Emotion dysregulation emerged as the only significant predictor of distress, while extreme body dissatisfaction was the only significant predictor of overall eating disorder symptomatology. Then, to analyze the differences between patients with anorexia nervosa and bulimia nervosa in intolerance of uncertainty and emotion regulation problems, t-tests were conducted. The two groups differed significantly in intolerance of uncertainty levels only, with higher scores obtained by patients with anorexia nervosa. Overall, our findings suggest that emotion dysregulation and extreme body dissatisfaction may be relevant constructs in eating disorders in general, while intolerance of uncertainty may be more involved in restrictive eating disorders. The clinical implications of such results are discussed.
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9
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Balzan RP, Gilder M, Nancarrow T, Mavrangelos T, Wade TD. Hasty decision-making in individuals at higher risk of developing an eating disorder. J Behav Ther Exp Psychiatry 2022; 75:101717. [PMID: 34929485 DOI: 10.1016/j.jbtep.2021.101717] [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: 12/21/2020] [Revised: 11/04/2021] [Accepted: 12/06/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND OBJECTIVES The Jumping to Conclusions (JTC) bias is the tendency to make hasty decisions based on limited evidence and may contribute to the formation of over-valued beliefs about the importance of weight, shape and eating. Previous research investigating the JTC bias in clinical eating disorder samples, as assessed by the beads task, is inconclusive. The current study investigated the JTC bias in a non-clinical sample of undergraduate students identified as being lower or higher risk of developing an eating disorder. The study used a more reliable 'distractor' beads task that also incentivised hastier decisions by elevating the pressure of the task. METHODS Female undergraduate students (N = 156, 48%, classified as higher risk) completed a pressure and non-pressure distractor beads task, along with measures of weight concern and body-image flexibility. RESULTS Higher risk participants displayed a hastier decision-making style than lower risk participants. Task pressure elicited a hastier decision-making style across the whole sample, however, was unable to distinguish between higher and lower eating disorder risk status. LIMITATIONS Interpretation of findings are limited to non-clinical samples and may not generalise to clinical eating disorder populations. CONCLUSIONS Findings suggest the need for replication in a clinical eating disorder sample using the distractor beads task. Future research should investigate whether eating disorder salient stimuli elicits a stronger bias.
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Affiliation(s)
- Ryan P Balzan
- College of Education, Psychology, and Social Work, Flinders University, Australia; Blackbird Initiative, Órama Institute for Mental Health and Wellbeing, Australia.
| | - Madeline Gilder
- College of Education, Psychology, and Social Work, Flinders University, Australia
| | - Tenille Nancarrow
- College of Education, Psychology, and Social Work, Flinders University, Australia
| | - Teri Mavrangelos
- College of Education, Psychology, and Social Work, Flinders University, Australia
| | - Tracey D Wade
- College of Education, Psychology, and Social Work, Flinders University, Australia; Blackbird Initiative, Órama Institute for Mental Health and Wellbeing, Australia
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Konstantellou A, Sternheim L, Hale L, Simic M, Eisler I. The experience of intolerance of uncertainty for parents of young people with a restrictive eating disorder. Eat Weight Disord 2022; 27:1339-1348. [PMID: 34292530 PMCID: PMC9079010 DOI: 10.1007/s40519-021-01256-8] [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: 11/11/2020] [Accepted: 02/18/2021] [Indexed: 11/30/2022] Open
Abstract
PURPOSE This study aimed to explore how parents of young people with a restrictive eating disorder (ED) experience and manage uncertainty. METHODS Seventeen parents of young people with a restrictive ED were recruited from multi-family therapy groups run within a specialised ED clinic. Five focus groups were conducted asking parents about their experience of uncertainty both prior and after the onset of their child's illness. RESULTS Data were analysed using interpretative phenomenological analysis which yielded seven superordinate themes. (1) Anorexia nervosa and uncertainty, (2) Positive and negative experiences of uncertainty (3), Helpful and unhelpful ways of coping with uncertainty, (4) Parent's self-efficacy and uncertainty (5), Needs of parents, (6) Parents' perceptions of intolerance of uncertainty in their children and (7) Impact of uncertainty on family life. CONCLUSION Parents caring for young people with a restrictive ED exhibit a strong intolerance of uncertainty, particularly in relation to their child's illness. This 'negative uncertainty' was thought to reduce their confidence as parents in how they managed their child's ED. Targeting high levels of intolerance of uncertainty in parents caring for young people with an ED could be beneficial for supporting parents when faced with their child's illness, increasing parental self-efficacy, decreasing accommodating behaviours and ultimately contributing to improved treatment outcomes. LEVEL OF EVIDENCE Level V: Opinions of authorities, based on descriptive studies, narrative reviews, clinical experience, or reports of expert committees.
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Affiliation(s)
- Anna Konstantellou
- Maudsley Centre for Child and Adolescent Eating Disorders, South London and Maudsley NHS Foundation Trust, London, UK
| | - Lot Sternheim
- Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands
| | - Lucy Hale
- Department of Psychology, University of Surrey, Guildford, UK
| | - Mima Simic
- Maudsley Centre for Child and Adolescent Eating Disorders, South London and Maudsley NHS Foundation Trust, London, UK
| | - Ivan Eisler
- Maudsley Centre for Child and Adolescent Eating Disorders, South London and Maudsley NHS Foundation Trust, London, UK.
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11
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Bijsterbosch JM, Keizer A, Boelen PA, van den Brink F, Danner UN, Sternheim LC. How deep is your thought? The relations between intolerance of uncertainty, worry and weight and shape concerns in adolescent girls with anorexia nervosa. J Eat Disord 2021; 9:164. [PMID: 34930469 PMCID: PMC8686596 DOI: 10.1186/s40337-021-00523-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 12/10/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Inherent to anorexia nervosa are repetitive thoughts about weight and shape. Growing research suggests the relevance of intolerance of uncertainty and worry in maintaining these types of repetitive thoughts. The relation between these cognitive processes and weight and shape concerns in adolescent girls with anorexia nervosa is understudied. This study investigated associations between prospective (desire for predictability) and inhibitory (uncertainty paralysis) intolerance of uncertainty, and weight and shape concerns and the mediating role of worry in these associations. METHODS In a cross-sectional study, 93 adolescent girls with anorexia nervosa completed questionnaires measuring the variables of interest. A mediation model with worry as a mediator between inhibitory and prospective intolerance of uncertainty and weight and shape concerns was tested. RESULTS A total and direct effect of inhibitory intolerance of uncertainty on weight and shape concerns was found. Worry did not mediate this relation. CONCLUSIONS These results confirm the importance of inhibitory intolerance of uncertainty in adolescent girls with anorexia nervosa, more specifically to weight and shape concerns. This group may benefit from intervention strategies targeting intolerance of uncertainty. General worry seems less relevant to weight and shape concerns in adolescent girls with anorexia nervosa. Adolescent girls with anorexia nervosa often experience repetitive thoughts about weight and shape. Growing research suggests the relevance of intolerance of uncertainty and worry in maintaining these types of repetitive thoughts. Intolerance of uncertainty is defined as the incapacity to tolerate uncertainty and is often divided into two components; prospective intolerance of uncertainty (desire for predictability) and inhibitory intolerance of uncertainty (uncertainty paralysis). The relation between intolerance of uncertainty, worry and weight and shape concerns in adolescent girls with anorexia nervosa is understudied. This study aims to investigate study relations between prospective and inhibitory intolerance of uncertainty, worry, and weight and shape concerns. A total of 93 adolescent girls with anorexia nervosa completed three questionnaires, measuring prospective and inhibitory intolerance of uncertainty worry, and weight and shape concerns, respectively. The results of this study confirmed the importance of inhibitory intolerance of uncertainty in adolescent girls with anorexia nervosa, more specifically to weight and shape concerns. This group may benefit from intervention strategies targeting intolerance of uncertainty. General worry seems less relevant to weight and shape concerns in adolescent girls.
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Affiliation(s)
- Jojanneke M Bijsterbosch
- Department of Clinical Psychology, Utrecht University, PO Box 80140, 3508 TC, Utrecht, The Netherlands.
| | - Anouk Keizer
- Department of Experimental Psychology, Utrecht University, Utrecht, The Netherlands
| | - Paul A Boelen
- Department of Clinical Psychology, Utrecht University, PO Box 80140, 3508 TC, Utrecht, The Netherlands
- ARQ National Psychotrauma Centre, Diemen, The Netherlands
- ARQ Centrum'45, Diemen, The Netherlands
| | - Femke van den Brink
- Department of Clinical Psychology, Utrecht University, PO Box 80140, 3508 TC, Utrecht, The Netherlands
| | - Unna N Danner
- Department of Clinical Psychology, Utrecht University, PO Box 80140, 3508 TC, Utrecht, The Netherlands
- Rintveld Center for Eating Disorders, Altrecht, Zeist, The Netherlands
| | - Lot C Sternheim
- Department of Clinical Psychology, Utrecht University, PO Box 80140, 3508 TC, Utrecht, The Netherlands
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12
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Sadeh N, Bredemeier K. Engaging in Risky and Impulsive Behaviors to Alleviate Distress Mediates Associations Between Intolerance of Uncertainty and Externalizing Psychopathology. J Pers Disord 2021; 35:393-408. [PMID: 31682196 PMCID: PMC8314479 DOI: 10.1521/pedi_2019_33_456] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Despite increasing recognition that intolerance of uncertainty is a transdiagnostic dimension of psychopathology, very little research has investigated its relevance for externalizing psychopathology and related risky/impulsive behavior. Ninety-five unselected adults (ages 19-55, 53% men) recruited from the community completed a measure of intolerance of uncertainty, externalizing traits and problems, and risky/impulsive behavior. Higher levels of intolerance of uncertainty were associated with greater endorsement of externalizing symptoms (e.g., aggression, alcohol/marijuana use, problematic impulsivity) and last-month risky and impulsive behaviors. Relations between intolerance of uncertainty and externalizing symptoms/risky behaviors were mediated by a motivation to engage in these behaviors to avoid distress, but not by the motivation to experience pleasurable emotions. Findings suggest that difficulty tolerating uncertainty may confer risk for the externalizing spectrum of psychopathology by increasing the likelihood that an individual will engage in risky behaviors to alleviate distressing or unpleasant emotions.
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Affiliation(s)
- Naomi Sadeh
- University of Delaware, Department of Psychological & Brain Sciences, 105 The Green, Newark, DE 19716, USA
| | - Keith Bredemeier
- Center for the Treatment and Study of Anxiety, University of Pennsylvania, Department of Psychiatry, 3535 Market Street, Philadelphia, PA 19104, USA
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13
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Clarke E, Kiropoulos LA. Mediating the relationship between neuroticism and depressive, anxiety and eating disorder symptoms: The role of intolerance of uncertainty and cognitive flexibility. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2021. [DOI: 10.1016/j.jadr.2021.100101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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Pak H, Süsen Y, Denizci Nazlıgül M, Griffiths M. The Mediating Effects of Fear of COVID-19 and Depression on the Association Between Intolerance of Uncertainty and Emotional Eating During the COVID-19 Pandemic in Turkey. Int J Ment Health Addict 2021; 20:1882-1896. [PMID: 33564278 PMCID: PMC7860995 DOI: 10.1007/s11469-021-00489-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/07/2021] [Indexed: 01/22/2023] Open
Abstract
The COVID-19 pandemic has greatly affected the mental health of individuals due to severe changes in their normal life routines. These changes might give rise to stress-induced factors and result in developing maladaptive behaviors. Therefore, the present study tested an explorative sequential mediation model regarding the COVID-19 pandemic as a global natural experiment and hypothesized that fear and depression would be serial mediators of the relationship between intolerance of uncertainty and emotional eating. An online cross-sectional survey with convenience sampling was adopted. A total of 362 participants were recruited from Turkey, and each completed a battery of demographic questions and psychometric scales. The standardized instruments used to test the model’s constructs were the Intolerance of Uncertainty Scale, Fear of COVID-19 Scale, Hospital Anxiety and Depression Scale, and Three-Factor Eating Questionnaire-R21. The model was tested using a bootstrapping method utilizing IBM AMOS 24 software. Results showed that emotional eating was positively associated with intolerance of uncertainty, fear of COVID-19, and depression. Moreover, fear of COVID-19 had positive correlation with intolerance of uncertainty and depression. Significant negative association was also found between age and intolerance of uncertainty. In addition, females significantly reported higher levels of emotional eating and fear of COVID-19 than males. The study’s hypothesized sequential mediation model was further supported. It is concluded that depression most likely developed by fear was triggered by intolerance of uncertainty during the COVID-19 pandemic and leading to emotional eating. The study is significant because it advances theories of emotional eating with an investigation examining some of its underlying mechanisms. Also, it is one of a few research studies highlighting to what extent the COVID-19 pandemic-related cognitions and emotions are associated with maladaptive behaviors in the case of emotional eating.
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Affiliation(s)
- Halil Pak
- Vocational School, İzmir University of Economics, İzmir, Turkey
| | - Yankı Süsen
- Department of Psychology, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | - Merve Denizci Nazlıgül
- Department of Psychology, Yeditepe University, İnönü Mah. Kayışdağı Cad. 26 Ağustos Yerleşimi Atasehir, 34755 Istanbul, Turkey
| | - Mark Griffiths
- Department of Psychology, Nottingham Trent University, Nottingham, UK
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15
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Ioannidis K, Hook RW, Grant JE, Czabanowska K, Roman-Urrestarazu A, Chamberlain SR. Eating disorders with over-exercise: A cross-sectional analysis of the mediational role of problematic usage of the internet in young people. J Psychiatr Res 2021; 132:215-222. [PMID: 33189357 PMCID: PMC7614800 DOI: 10.1016/j.jpsychires.2020.11.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 09/16/2020] [Accepted: 11/01/2020] [Indexed: 02/07/2023]
Abstract
Eating disorders are widespread illnesses with significant global impact. There is growing concern about how young people overuse online resources leading to mental health sequelae. We gathered data from 639 individuals from a population cohort. Participants were all young adults at the point of contact and were grouped as having probable eating disorder with excessive exercise (n = 37) or controls (n = 602). We measured obsessionality, compulsivity, impulsivity, and problematic internet use. Group differences in these domains were evaluated; and structural equation modelling (SEM) was used to assess structural relationships between variables. Cases had higher scores of obsessional thoughts of threat (Cohen's d = 0.94, p < 0.001), intolerance towards uncertainty (Cohen's d = 0.72; p < 0.001), thoughts of importance and control (Cohen's d = 0.65, p < 0.01), compulsivity (Cohen's d = 0.72; p < 0.001), negative urgency (Cohen's d = 0.75, p < 0.001), and higher problematic usage of the internet (Cohen's d = 0.73; p-corrected <0.001). Our SEM showed significant partial mediation of problematic internet use on both the effect of obsessionality latent factor on cases (z-value = 2.52, p < 0.05), as well as of sensation seeking latent factor on cases (z-value = 2.09, p < 0.05). Youth with eating disorder and heightened exercise levels have increased obsessive thoughts of threat, compulsivity traits and sensation seeking impulsivity. The association between obsessive thoughts and eating disorders, as well as sensation seeking and eating disorders were partially mediated by problematic internet use. Problematic internet use may be playing a role in the development or maintenance of eating disorder symptoms in the background of obsessional thoughts and sensation seeking impulsive traits.
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Affiliation(s)
- Konstantinos Ioannidis
- Department of Psychiatry, University of Cambridge, UK; Cambridge and Peterborough NHS Foundation Trust, Cambridge, UK; Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands.
| | - Roxanne W Hook
- Cambridge and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Jon E Grant
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, USA
| | - Katarzyna Czabanowska
- Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands; Institute of Public Health, Faculty of Health Sciences, Jagiellonian University, Krakow, Poland
| | - Andres Roman-Urrestarazu
- Department of Psychiatry, University of Cambridge, UK; Cambridge and Peterborough NHS Foundation Trust, Cambridge, UK; Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Samuel R Chamberlain
- Department of Psychiatry, University of Cambridge, UK; Cambridge and Peterborough NHS Foundation Trust, Cambridge, UK; Department of Psychiatry, University of Southampton, UK, Southern Health NHS Foundation Trust, UK.
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16
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Williams BM, Levinson CA. Intolerance of uncertainty and maladaptive perfectionism as maintenance factors for eating disorders and obsessive-compulsive disorder symptoms. EUROPEAN EATING DISORDERS REVIEW 2020; 29:101-111. [PMID: 33220014 DOI: 10.1002/erv.2807] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 09/21/2020] [Accepted: 11/05/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Eating disorders (EDs) are highly comorbid with obsessive-compulsive disorder (OCD). In order to develop treatments which better address commonly comorbid ED and OCD symptoms, it is important to identify potential shared mechanisms. Two potential shared mechanisms are maladaptive perfectionism and intolerance of uncertainty (IU). We aimed to assess how maladaptive perfectionism and IU may contribute to the maintenance of ED and OCD symptoms in individuals with EDs. METHODS In the current study (N = 168 individuals with an ED), we analysed cross-sectional and prospective path models of maladaptive perfectionism and IU as maintenance factors of ED and OCD symptoms. RESULTS We found that IU was associated with both ED and OCD symptoms, and maladaptive perfectionism was associated with ED symptoms. We also found that maladaptive perfectionism and IU prospectively predicted OCD symptoms, but not ED symptoms. CONCLUSIONS Overall, these findings suggest that it may be beneficial to target both maladaptive perfectionism and IU in individuals with a current ED diagnosis in order to prevent the development of OCD symptoms.
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Affiliation(s)
- Brenna M Williams
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, Kentucky, USA
| | - Cheri A Levinson
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, Kentucky, USA
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17
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Understanding Relations Between Intolerance of Uncertainty, Social Anxiety, and Body Dissatisfaction in Women. J Nerv Ment Dis 2020; 208:833-835. [PMID: 33002940 DOI: 10.1097/nmd.0000000000001208] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Body dissatisfaction (BD) is highly prevalent among young females and is associated with negative mental health outcomes. Social anxiety (SA) has been identified as an important determinant of BD; however, potential factors underlying SA-related BD remain unstudied. Research indicates that intolerance of uncertainty (IU), the tendency to respond negatively to uncertainty, may be critical for developing and maintaining SA. The current study investigated whether IU is associated with SA and whether SA, in turn, is related to BD. In a cross-sectional study, 139 women completed an online survey measuring IU, SA, and BD. Correlation analyses showed that IU, SA, and BD were strongly positively associated. A mediation analysis revealed that higher levels of IU were indirectly related to more BD through higher levels of SA. A direct effect of IU on BD was also found. These findings suggest that individuals with SA-related BD may benefit from interventions targeting IU.
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18
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Herbert BM. Interoception and Its Role for Eating, Obesity, and Eating Disorders. EUROPEAN JOURNAL OF HEALTH PSYCHOLOGY 2020. [DOI: 10.1027/2512-8442/a000062] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Abstract. The importance of the sense of ourselves from within for understanding adaptive behavior and psychopathology has been increasingly recognized during the last decades. Interoception builds the foundation of our embodied self and dysfunctional interoception lies at the core of many psychosomatic disorders. Eating is fundamental for survival with consequences for health and well-being. It is deeply grounded in homoeostatic and allostatic psychophysiological needs and is driven by interoceptive signals of the body. This narrative review summarizes a selection of empirical findings and draws conclusions on the role of interoception in eating behavior, body weight, and eating disorders. Beyond disordered eating behavior, eating disorders are characterized by impairment of the sense of self, with dysfunctional interoception at its core. Predictive coding accounts are addressed to integrate conclusions and to underline the relevance of interventions to modify interoception.
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Affiliation(s)
- Beate M. Herbert
- Clinical Psychology & Psychotherapy, Department of Psychology, Eberhard Karls University of Tübingen, Germany
- Psychology School, University of Applied Sciences Fresenius, Munich, Germany
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19
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Keep your interoceptive streams under control: An active inference perspective on anorexia nervosa. COGNITIVE AFFECTIVE & BEHAVIORAL NEUROSCIENCE 2020; 20:427-440. [DOI: 10.3758/s13415-020-00777-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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20
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Donthula D, Kortlever JTP, Ring D, Donovan E, Reichel LM, Vagner GA. Does Intolerance of Uncertainty Affect the Magnitude of Limitations or Pain Intensity? Clin Orthop Relat Res 2020; 478:381-388. [PMID: 31688214 PMCID: PMC7438119 DOI: 10.1097/corr.0000000000001042] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 10/21/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND Intolerance of uncertainty-the tendency to overestimate the chance of and be unwilling to accept potential, but unlikely, negative outcomes in uncertain situations-is a cognitive construct that has been shown to affect symptoms and limitations for patients with traumatic and nontraumatic upper-extremity conditions. Cognitive flexibility and tolerance of uncertainty can be trained and practiced, with the potential to increase musculoskeletal health. However, to our knowledge, the degree to which intolerance of uncertainty might be associated with symptom intensity and the magnitude of limitations in adults with upper-extremity problems has not been characterized. QUESTIONS/PURPOSES After accounting for personal and social factors, is intolerance of uncertainty independently associated with (1) the magnitude of physical limitations and (2) pain intensity? METHODS In this cross-sectional, observational study, 139 new and returning patients presenting to one of four orthopaedic offices in a large urban area completed the Intolerance of Uncertainty Scale (a validated measure of the level of comfort with uncertain situations), the Patient-reported Outcomes Measurement Information System-Physical Function Upper Extremity computer adaptive test (to measure the magnitude of limitations), and an 11-point ordinal measure of pain intensity. The mean age of the 139 participants was 51 years ± 16 years and 55% (76 of 139) were men. Participants presented to the clinics with a wide variety of upper-extremity conditions, such as trigger finger, distal radius fractures, lateral epicondylitis, or non-specific shoulder pain. We also assessed sex, race, marital status, education level, income, public versus private insurance, area deprivation index, and the participant's self-perception of their healthcare experience through a multiple-choice question (answer choices: none, some, a little, and a lot of experience). The following patient characteristics were more common in our study participants: white, employed, part of a married or unmarried couple, and private insurance coverage. We created two multivariable linear regression models to assess factors independently associated with the magnitude of limitations and pain intensity. RESULTS After controlling for potentially confounding variables including sex, insurance, area deprivation index, and type of visit, we found that fewer physical limitations were associated with a greater intolerance of uncertainty (regression coefficient [β] -0.30; 95% confidence interval, -0.50 to -0.10; p = 0.003; semi-partial r = 0.07; adjusted r for the full model = 0.16), as was being a man (β 3.2; 95% CI, 0.08-6.3; p = 0.045; semi-partial r = 0.03) and having private insurance coverage (β 5.2; 95% CI, 2.1-8.2; p = 0.001; semi-partial r = 0.08). After controlling for one important potentially confounding variable, the level of education, greater pain intensity was associated with a greater intolerance of uncertainty (β 0.08; 95% CI, 0.02-0.14; p = 0.009; semi-partial r = 0.05; adjusted r for the full model = 0.08). CONCLUSIONS Intolerance of uncertainty-a byproduct of cognitive bias and error, which are elements of the normal functioning of the human mind-increases limitations and pain intensity across diagnoses, independent of demographic and social factors. Future studies can address the effect of strategies that incorporate mindset training (for example, cognitive behavioral therapy and its derivatives) on musculoskeletal symptoms and limitations. LEVEL OF EVIDENCE Level II, prognostic study.
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Affiliation(s)
- Deepanjli Donthula
- D. Donthula, J. T. P. Kortlever, D. Ring, L. M. Reichel, G. A. Vagner,Department of Surgery and Perioperative Care, Dell Medical School, the University of Texas at Austin, Austin, TX, USA
| | - Joost T P Kortlever
- D. Donthula, J. T. P. Kortlever, D. Ring, L. M. Reichel, G. A. Vagner,Department of Surgery and Perioperative Care, Dell Medical School, the University of Texas at Austin, Austin, TX, USA
| | - David Ring
- D. Donthula, J. T. P. Kortlever, D. Ring, L. M. Reichel, G. A. Vagner,Department of Surgery and Perioperative Care, Dell Medical School, the University of Texas at Austin, Austin, TX, USA
| | - Erin Donovan
- E. Donovan, Department of Communication Studies, the University of Texas at Austin, Austin, TX, USA
- E. Donovan, UT Center for Health Communication, the University of Texas at Austin, Austin, TX, USA
| | - Lee M Reichel
- D. Donthula, J. T. P. Kortlever, D. Ring, L. M. Reichel, G. A. Vagner,Department of Surgery and Perioperative Care, Dell Medical School, the University of Texas at Austin, Austin, TX, USA
| | - Gregg A Vagner
- D. Donthula, J. T. P. Kortlever, D. Ring, L. M. Reichel, G. A. Vagner,Department of Surgery and Perioperative Care, Dell Medical School, the University of Texas at Austin, Austin, TX, USA
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21
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Morein-Zamir S, Shapher S, Gasull-Camos J, Fineberg NA, Robbins TW. Avoid jumping to conclusions under uncertainty in Obsessive Compulsive Disorder. PLoS One 2020; 15:e0225970. [PMID: 31940308 PMCID: PMC6961894 DOI: 10.1371/journal.pone.0225970] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 11/15/2019] [Indexed: 12/13/2022] Open
Abstract
High levels of intolerance of uncertainty (IU) could contribute to abnormal decision making in uncertain situations. Patients with Obsessive Compulsive Disorder (OCD) often report high IU, indecisiveness and the need to seek greater certainty before making decisions. The Beads task is a commonly used task assessing the degree of information gathering prior to making a decision and so would be predicted to show impairments in OCD patients. Results to date have found mixed support for this, possibility due to methodological issues. Here, a group of OCD patients (n = 50) with no comorbidities was compared with age, gender, and verbal-IQ matched controls (n = 50) on the most commonly used version of the Beads task. An independent sample of healthy volunteers with high versus low OC symptoms, and high versus low IU were also assessed (n = 125). There was no evidence that patients with OCD differed from control volunteers in the degree of information gathering prior to making a decision. Medication status and age did not appear to mediate performance. Similarly, there were no association in healthy volunteers between task performance and OC or IU characteristics. Additional measures examining the degree of certainty initially showed support for greater uncertainty in patients, but this was due to deviations from task instructions in a subset of patients. We conclude that despite the large sample size and good matching between groups, the Beads task in its most widely used form is not a useful measure of IU or of information gathering in OCD. The results argue against a robust behavioural difference in OCD when compared to controls. Recommendations for future studies employing the task are discussed.
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Affiliation(s)
- Sharon Morein-Zamir
- School of Psychology and Sports Science, Anglia Ruskin University, Cambridge, United Kingdom.,Behavioural and Clinical Neuroscience Institute; Department of Psychology, Cambridge University, Cambridge, United Kingdom
| | - Sonia Shapher
- Hertfordshire Partnership University NHS Foundation Trust, NHS; University of Hertfordshire, Hatfield, United Kingdom
| | - Julia Gasull-Camos
- Behavioural and Clinical Neuroscience Institute; Department of Psychology, Cambridge University, Cambridge, United Kingdom
| | - Naomi A Fineberg
- Hertfordshire Partnership University NHS Foundation Trust, NHS; University of Hertfordshire, Hatfield, United Kingdom
| | - Trevor W Robbins
- Behavioural and Clinical Neuroscience Institute; Department of Psychology, Cambridge University, Cambridge, United Kingdom
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22
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Intolerance of uncertainty and eating disorder behaviour: Piloting a consumption task in a non-clinical sample. J Behav Ther Exp Psychiatry 2019; 65:101492. [PMID: 31202086 DOI: 10.1016/j.jbtep.2019.101492] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 05/28/2019] [Accepted: 05/30/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND OBJECTIVES Intolerance of uncertainty (IU) is a transdiagnostic process contributing to the maintenance of anxiety disorders, and is a potential target for treatment. Recent literature has investigated IU as a cognitive process underpinning pathological fear and anxiety in Anorexia Nervosa (AN). The current study was designed to examine trait and state IU, and their relationship to restrictive eating disorder symptoms, anxiety, worry, cognitive rigidity and eating behaviour. METHODS A sample of undergraduate women (N = 85) completed measures of eating disorder symptoms, IU, cognitive rigidity and worry. Participants were randomised to complete an eating task under one of two conditions: the "certain" condition received a high-calorie meal and nutritional information, while the "uncertain" condition received the meal alone. During the meal, state IU and state anxiety were examined at three time-points (baseline, pre-eating, post-eating). RESULTS Trait IU was correlated with cognitive rigidity, worry, global eating disorder symptoms, and, in particular, dietary restraint. No differences emerged between conditions with respect to eating-related anxiety, or amount of food eaten. Controlling for condition and eating disorder symptoms, state IU predicted pre-eating anxiety. Beyond the contribution of condition, BMI and eating disorder symptoms, state IU predicted consumption, specifically greater dietary restriction. LIMITATIONS The study employed a non-clinical sample. CONCLUSIONS IU may be implicated in a rigid cognitive style, the anxiety response to energy-dense food, and restrictive eating behaviour. Should these findings be replicated in a clinical sample, then IU might emerge as an adjunctive treatment target for AN.
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23
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Piccolo M, Milos GF, Bluemel S, Schumacher S, Mueller-Pfeiffer C, Fried M, Ernst M, Martin-Soelch C. Behavioral Responses to Uncertainty in Weight-Restored Anorexia Nervosa - Preliminary Results. Front Psychol 2019; 10:2492. [PMID: 31749750 PMCID: PMC6848854 DOI: 10.3389/fpsyg.2019.02492] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 10/22/2019] [Indexed: 11/28/2022] Open
Abstract
Impaired decision-making under conditions of uncertainty seems to contribute to the expression and maintenance of anorexia nervosa (AN), but it is not clear whether this impairment is a disease state that would remit with treatment, or a persisting trait in patients with AN. To examine this question, a longitudinal study was conducted in 12 female inpatients with AN (age M = 22.2, SE = 1.36), before (Time-1) and after reaching a body mass index of >17.5 kg/m2 (Time-2). Intolerance of uncertainty (IU) was assessed via a decision-making task, the wheel of fortune (WOF). Weight gain at Time-2 was accompanied with significant changes in uncertainty-related performance compared to Time-1 [(Time × Uncertainty), p < 0.05]. At Time-1, reaction times (RTs) varied in function of uncertainty, while at Time-2, uncertainty did not modulate RTs. These findings support a change in decision-making under uncertainty with successful weight-rehabilitation in AN. While IU was present in underweight patients, it became non-significant after weight restoration.
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Affiliation(s)
- Mayron Piccolo
- Unit of Clinical and Health Psychology, University of Fribourg, Fribourg, Switzerland
| | - Gabriella Franca Milos
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Sena Bluemel
- Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
| | - Sonja Schumacher
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Christoph Mueller-Pfeiffer
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Michael Fried
- Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland.,Zurich Center for Integrative Human Physiology, Zurich, Switzerland
| | - Monique Ernst
- Section on Neurobiology of Fear and Anxiety, National Institute of Mental Health (NIMH), Bethesda, MD, United States
| | - Chantal Martin-Soelch
- Unit of Clinical and Health Psychology, University of Fribourg, Fribourg, Switzerland
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24
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The impact of methodological and measurement factors on transdiagnostic associations with intolerance of uncertainty: A meta-analysis. Clin Psychol Rev 2019; 73:101778. [PMID: 31678816 DOI: 10.1016/j.cpr.2019.101778] [Citation(s) in RCA: 87] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 08/04/2019] [Accepted: 08/20/2019] [Indexed: 01/12/2023]
Abstract
Intolerance of uncertainty is a dispositional trait associated with a range of psychological disorders, but the influence of methodological factors on theses associations remains unknown. The first aim of this meta-analysis was to quantify the strengths of the association between IU and symptoms of generalised anxiety disorder, social anxiety disorder, panic disorder, agoraphobia, obsessive compulsive disorder, depression, and eating disorders. The second aim was to assess the influence of methodological factors on these relationships, including clinical (vs. non-clinical) status, age group, sex, IU measure, and symptom measure. We extracted 181 studies (N participants = 52,402) reporting 335 independent effect sizes (Pearson's r). Overall, there was a moderate association between IU and symptoms (r = 0.51, 95% CI = 0.50-0.52), although heterogeneity was high (I2 = 83.50, p < .001). Some small but significant moderator effects emerged between and within disorders. Effect sizes were not impacted by sample size. The results indicate that IU has robust, moderate associations with a range of disorder symptoms, providing definitive evidence for the transdiagnostic nature of IU.
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25
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Oglesby ME, Stentz LA, Portero AK, King SL, Schmidt NB. Exaggerated interpretation bias for uncertain information as a predictor of anxiety-related symptoms: A new method of assessment for IU. J Behav Ther Exp Psychiatry 2019; 64:64-71. [PMID: 30852358 DOI: 10.1016/j.jbtep.2019.02.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 01/18/2019] [Accepted: 02/22/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND OBJECTIVES Intolerance of uncertainty (IU), or fear of the unknown, is as an important transdiagnostic risk factor across anxiety-related conditions, namely generalized anxiety disorder (GAD), obsessive compulsive disorder (OCD), and social anxiety disorder (SAD). IU is typically indexed using self-report measures. Given the importance of multi-method assessments and the shortcomings associated with existing behavioral indices of IU, additional methods of assessment are needed. Emerging literature supports the use of interpretation bias (IB) paradigms to index constructs such as IU. However, only one study to date has examined the association between an IU-focused IB paradigm (IU-IB) and self-report IU and no research has investigated whether an IU-IB paradigm would be related to increased anxiety-related symptoms. METHODS The current investigation examined the utility of an IU-IB paradigm across two separate samples wherein participants completed an interpretation bias task and self-report measures. Sample 1 included 86 participants (74.4% female; Mage = 19.14) and sample 2 included 138 participants (79.7% female; Mage = 18.88). RESULTS Findings from Study 1 indicated a significant association between an exaggerated IU-IB and symptoms of GAD and OCD, and this relationship held after covarying for negative affect. Study 2 results indicated a significant relationship between an exaggerated IU-IB and symptoms of GAD, OCD, and SAD, after covarying for negative affect. LIMITATIONS The current study had a variety of limitations, including the use of cross-sectional data and an undergraduate sample. CONCLUSIONS These findings provide an important replication and extension of previous work and highlight the transdiagnostic utility of this IU-IB task.
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Konstantellou A, Hale L, Sternheim L, Simic M, Eisler I. The experience of intolerance of uncertainty for young people with a restrictive eating disorder: a pilot study. Eat Weight Disord 2019; 24:533-540. [PMID: 30778868 DOI: 10.1007/s40519-019-00652-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 02/02/2019] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Research is consistently reporting elevated levels of intolerance of uncertainty (IU) in individuals with an eating disorder (ED). Less is known about the phenomenology of uncertainty for this clinical group. The present study aims to advance our understanding of the relationship between IU and restrictive EDs by providing insight into young people's subjective experiences of uncertainty. METHODS Thirteen young people with a restrictive ED were recruited from multi-family therapy groups run within the Maudsley Centre for Child and Adolescent Eating Disorders at the South London and Maudsley NHS Foundation Trust. Three focus groups were conducted asking young people to discuss their views, experiences and coping strategies when faced with uncertainty. RESULTS Data were analysed using interpretative phenomenological analysis which yielded five superordinate themes: (1) young people perceived uncertainty as something negative; (2) high levels of anxiety and stress were identified as primary responses to uncertainty; (3) ED behaviours were given a functional role in reducing uncertainty; (4) need to control various aspects of young peoples' lives was of high importance; (5) young people discussed how they struggled to find ways to cope with uncertainty and often used behaviours associated with the eating disorder psychopathology as coping strategies. CONCLUSION Young people's experiences of what uncertainty is like for them revealed a dynamic interplay between ED symptoms and fear of uncertainty. Findings support IU as a relevant concept for young people suffering from a restrictive ED and indicate that further exploration of IU from both theoretical and clinical perspectives could be fruitful. LEVEL OF EVIDENCE V.
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Affiliation(s)
- Anna Konstantellou
- Maudsley Centre for Child and Adolescent Eating Disorders, South London and Maudsley NHS Foundation Trust, London, UK.
| | | | - Lot Sternheim
- Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands
| | - Mima Simic
- Maudsley Centre for Child and Adolescent Eating Disorders, South London and Maudsley NHS Foundation Trust, London, UK
| | - Ivan Eisler
- Maudsley Centre for Child and Adolescent Eating Disorders, South London and Maudsley NHS Foundation Trust, London, UK
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27
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Bredemeier K, McCole K, Luther L, Beck AT, Grant PM. Reliability and Validity of a Brief Version of the Intolerance of Uncertainty Scale in Outpatients with Psychosis. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2018. [DOI: 10.1007/s10862-018-9714-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Food vs money? Effects of hunger on mood and behavioral reactivity to reward in anorexia nervosa. Appetite 2018; 134:26-33. [PMID: 30562563 DOI: 10.1016/j.appet.2018.12.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 12/10/2018] [Accepted: 12/13/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND Previous studies using neuroimaging and behavioral measures reported altered reward processing in anorexia nervosa (AN). In addition, anhedonia states are frequently reported in AN, potentially due to the physiological stress produced by the permanent starvation. We investigated the effect of fasting and satiety on mood and reaction times to monetary rewards in AN patients and healthy controls. METHODS Twenty-four participants with acute AN (BMI 14.4 (11.9-15.5) Kg/m2) and 17 age and gender matched healthy, normal weight subjects (HW) (BMI 21.8 (18.9-24.9) Kg/m2) performed a reward task (the wheel of fortune) involving uncertain (50/50 probability of winning high and low rewards), safe and risky (30/70 and 10/90 probabilities) categories in fasted (after an 8-h fasting period) and fed (after intake of a standardized meal) states. Data analysis was done with linear mixed models. RESULTS AN reacted slower than HW when maximum uncertainty (50/50) was involved. Positive mood in response to winning was higher when fasting especially for HW, while negative mood in response to not winning was higher in the fed state for both groups. Still, HW were more reactive than AN to not winning a highly predictable monetary reward (10/90 safe). CONCLUSION The data on the reaction times indicate an impaired motor response to uncertainty in AN. Mood reactivity to winning a monetary reward does not seem to be impaired in AN, however, our results suggest that negative mood in response to not winning is less adaptive in AN. Implications to clinical psychotherapy are discussed.
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Wilson S, Aardema F, O’Connor K. Possibility-Based Information Elicits Doubt in Bulimia Nervosa: A Study of Inductive Reasoning. Int J Cogn Ther 2018. [DOI: 10.1007/s41811-018-0032-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Elzakkers IFFM, Danner UN, Grisso T, Hoek HW, van Elburg AA. Assessment of mental capacity to consent to treatment in anorexia nervosa: A comparison of clinical judgment and MacCAT-T and consequences for clinical practice. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2018; 58:27-35. [PMID: 29853010 DOI: 10.1016/j.ijlp.2018.02.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 01/22/2018] [Accepted: 02/13/2018] [Indexed: 06/08/2023]
Abstract
Informed consent requires adequate mental capacity to consent to treatment. Mental capacity (MC) to consent to treatment refers to the ability to make medical decisions. MC is assessed in a general psychiatric interview, but this clinical assessment is known to overestimate mental capacity in patients and the inter rater reliability is low. The MacArthur Competence Assessment Tool for Treatment (MacCAT-T) has emerged as the gold standard to assess mental capacity to consent to treatment. The MacCAT-T is a semi-structured interview designed to aid clinicians in this assessment and has shown good inter rater reliability in patients with schizophrenia and other mental disorders, but has hardly been studied in patients with anorexia nervosa. Patients with anorexia nervosa (AN) regularly avoid treatment, even when severely ill and discussion includes assessing MC to consent to treatment. The aim of this study is to compare clinical judgment and the MacCAT-T in evaluating MC in patients with AN which in turn may influence use of the MacCAT-T in daily practice. In a sample of 70 consecutively referred severely ill patients with AN with a mean BMI of 15.5 kg/m2 and a mean duration of illness of 8.6 years, clinical assessment of MC by experienced psychiatrists and the outcome of the MacCAT-T interview were compared. Agreement (κ-value) was calculated. Agreement between clinical assessment and outcome of the MacCAT-T was questionable (κ 0.23). Unlike in other psychiatric populations, clinicians judged a high proportion of patients with AN as having diminished MC. The MacCAT-T can be useful in assessing MC in AN when used in addition to clinical judgment to aid clinicians in complex cases. Why clinicians judge a relatively high proportion of patients with AN as having diminished MC, in contrast to lower proportions in other psychiatric disorders, is an area in need of further research.
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Affiliation(s)
- Isis F F M Elzakkers
- Altrecht Eating Disorders Rintveld, Altrecht Mental Health Institute, The Netherlands
| | - Unna N Danner
- Altrecht Eating Disorders Rintveld, Altrecht Mental Health Institute, The Netherlands; Utrecht University, Department of Psychology, The Netherlands
| | - Thomas Grisso
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, USA
| | - Hans W Hoek
- Altrecht Eating Disorders Rintveld, Altrecht Mental Health Institute, The Netherlands; Parnassia Psychiatric Institute, The Hague, The Netherlands; Department of Psychiatry, University Medical Center Groningen, The Netherlands; Department of Epidemiology, Mailman School of Public Health, Columbia University New York, USA
| | - Annemarie A van Elburg
- Altrecht Eating Disorders Rintveld, Altrecht Mental Health Institute, The Netherlands; Utrecht University, Department of Psychology, The Netherlands.
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Sternheim L, Harrison A. The acceptability, feasibility and possible benefits of a group-based intervention targeting intolerance of uncertainty in adolescent inpatients with anorexia nervosa. COGENT PSYCHOLOGY 2018. [DOI: 10.1080/23311908.2018.1441594] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Affiliation(s)
- L. Sternheim
- Faculty of Social Sciences, Clinical Psychology, Utrecht University, Heidelberglaan 1, Utrecht 3584 CS, The Netherlands
| | - A. Harrison
- Department of Psychology and Human Development, University College London, Institute of Education, 25 Woburn Square, London WC1H 0AA, UK
- Ellern Mede Service for Eating Disorders, The Ridgeway, Mill Hill, London NW5, UK
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Wilson S, Aardema F, O'Connor K. Doubt and fear of self in bulimia nervosa. Int J Eat Disord 2017; 50:1437-1441. [PMID: 29044579 DOI: 10.1002/eat.22789] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 08/29/2017] [Accepted: 09/25/2017] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Several overlapping cognitive processes have been identified in eating disorders (EDs) and obsessive compulsive disorder (OCD). Drawing from the OCD literature, the present study examined whether bulimia nervosa (BN) is associated with a maladaptive inductive reasoning style characterized by the over-investment in possibility-based (as opposed to reality-based) information. METHOD Women with BN (n = 25) and healthy controls (HC; n = 24) completed the Inference Processes Task (IPT), an ecological inductive reasoning task previously validated in OCD samples. Participants also completed the Fear of Self Questionnaire (FSQ) that evaluates investment in a feared possible identity. RESULTS Significant differences on the IPT indicate that the BN group was more influenced by possibility-based information throughout the task than the HC group (F[5.44, 255.78] = 6.94, p > .001). It was also found that the BN group scored significantly higher on the FSQ than the HC group (t[29.98] = 8.4, p > .001), replicating previous findings. Finally, scores on the IPT were significantly correlated with measures of symptom severity. DISCUSSION These findings suggest that BN may be associated with maladaptive inductive reasoning processes characterized by over-investment in possibility-based feared outcomes and identities.
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Affiliation(s)
- Samantha Wilson
- Research Center, Montreal Mental Health University Institute, Montreal, Quebec, H1N 3V2, Canada.,Department of Psychology, Université de Montréal, Montreal, Quebec, H2V 2S9, Canada
| | - Frederick Aardema
- Research Center, Montreal Mental Health University Institute, Montreal, Quebec, H1N 3V2, Canada.,Department of Psychiatry, Université de Montréal, Montreal, Quebec, H3T 1J4, Canada
| | - Kieron O'Connor
- Research Center, Montreal Mental Health University Institute, Montreal, Quebec, H1N 3V2, Canada.,Department of Psychiatry, Université de Montréal, Montreal, Quebec, H3T 1J4, Canada
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Garcia D, Granjard A, Lundblad S, Archer T. A dark past, a restrained present, and an apocalyptic future: time perspective, personality, and life satisfaction among anorexia nervosa patients. PeerJ 2017; 5:e3801. [PMID: 28929023 PMCID: PMC5600947 DOI: 10.7717/peerj.3801] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 08/22/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Despite reporting low levels of well-being, anorexia nervosa patients express temperament traits (e.g., extraversion and persistence) necessary for high levels of life satisfaction. Nevertheless, among individuals without eating disorders, a balanced organization of the flow of time, influences life satisfaction beyond temperamental dispositions. A balanced time perspective is defined as: high past positive, low past negative, high present hedonistic, low present fatalistic, and high future. We investigated differences in time perspective dimensions, personality traits, and life satisfaction between anorexia nervosa patients and matched controls. We also investigated if the personality traits and the outlook on time associated to positive levels of life satisfaction among controls also predicted anorexia patients' life satisfaction. Additionally, we investigated if time perspective dimensions predicted life satisfaction beyond personality traits among both patients and controls. METHOD A total of 88 anorexia nervosa patients from a clinic in the West of Sweden and 111 gender-age matched controls from a university in the West of Sweden participated in the Study. All participants responded to the Zimbardo Time Perspective Inventory, the Ten Item Personality Inventory, and the Temporal Satisfaction with Life Scale. RESULTS A t-test showed that patients scored higher in the past negative, the present fatalistic, and the future dimensions, lower in the past positive and the present hedonistic dimensions, higher in conscientiousness, extraversion, and agreeableness, and lower in life satisfaction. Regression analyses showed that life satisfaction was predicted by openness to experience and emotional stability for controls and by emotional stability among patients. When time dimensions were entered in the regression, emotional stability and the past negative and past positive time dimensions predicted life satisfaction among controls, but only the past positive and present hedonistic time dimensions predicted life satisfaction among patients. CONCLUSION Anorexia patients were less satisfied with life despite being more conscientious, social, and agreeable than controls. Moreover, compared to controls, patients had an unbalanced time perspective: a dark view of the past (i.e., high past negative), a restrained present (i.e., low present hedonistic) and an apocalyptic view of the future (i.e., high present fatalistic). It is plausible to suggest that, therapeutic interventions should focus on empowering patients to cultivate a sentimental and positive view of the past (i.e., high past positive) and the desire to experience pleasure without concern for future consequences (i.e., high present hedonistic) so that they can make self-directed and flexible choices for their own well-being. Such interventions might have effects on life satisfaction beyond the patients' temperamental disposition.
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Affiliation(s)
- Danilo Garcia
- Blekinge Centre of Competence, Blekinge County Council, Karlskrona, Sweden
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden
- Network for Empowerment and Well-Being, Sweden
- Department of Psychology, Lund University, Lund, Sweden
| | - Alexandre Granjard
- Blekinge Centre of Competence, Blekinge County Council, Karlskrona, Sweden
| | - Suzanna Lundblad
- Psychiatry Affective, Anorexia & Bulimia Clinic for Adults, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Trevor Archer
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden
- Network for Empowerment and Well-Being, Sweden
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Bartholdy S, Rennalls SJ, Jacques C, Danby H, Campbell IC, Schmidt U, O’Daly OG. Proactive and reactive inhibitory control in eating disorders. Psychiatry Res 2017; 255:432-440. [PMID: 28672226 PMCID: PMC5555256 DOI: 10.1016/j.psychres.2017.06.073] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 04/10/2017] [Accepted: 06/21/2017] [Indexed: 02/01/2023]
Abstract
Altered inhibitory control has been implicated in the development and maintenance of eating disorders (ED), however it is unclear how different types of inhibitory control are affected across the EDs. We explored whether individuals with bulimia nervosa (BN), binge eating disorder (BED) and anorexia nervosa (AN) differed from healthy individuals (HC) on two types of motor inhibitory control: proactive inhibition (related to the preparation/initiation of a response) and reactive inhibition (withholding a response in reaction to a signal). Ninety-four women (28 AN, 27 BN, 11 BED, 28 HC) completed two neuropsychological tasks (a cued reaction time task and a stop signal task), and questionnaires assessing clinical variables, mood, anxiety, and inhibitory control. Self-reported inhibitory control was poorer in women with BN compared to the HC and AN groups, but greater in women with AN compared to all other groups. However, no group differences in reactive inhibition were observed. Proactive inhibition was augmented in women with AN compared to HC, and this was related to self-reported intolerance of uncertainty. The findings suggest that proactive inhibition may be a relevant target for behavioural interventions for AN, and call for further research into the relationship between intolerance of uncertainty and proactive inhibition.
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Affiliation(s)
- Savani Bartholdy
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK.
| | - Samantha J. Rennalls
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Claire Jacques
- Department of Neuroscience, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Hollie Danby
- Department of Neuroscience, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Iain C. Campbell
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Ulrike Schmidt
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Owen G. O’Daly
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
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Sternheim LC, Fisher M, Harrison A, Watling R. Predicting intolerance of uncertainty in individuals with eating disorder symptoms. J Eat Disord 2017; 5:26. [PMID: 28883918 PMCID: PMC5580198 DOI: 10.1186/s40337-017-0152-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 05/10/2017] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Intolerance of Uncertainty (IU) is recognized for its contribution to various psychopathologies, in particular anxiety and depression. Studies highlight the relevance of IU for Eating Disorders (EDs) however, potential factors contributing to IU in EDs remain unstudied. METHODS Three hundred and forty-nine women with ED symptoms and 214 individuals without ED symptoms were recruited and compared on levels of IU, insecure (anxious and avoidant) attachment styles, extraversion and openness. Secondly, the contribution of these factors to IU were tested. RESULTS Compared to the non-ED group, the ED group scored higher on IU, insecure attachment, and lower on extraversion and openness. Regression analyses confirmed that higher insecure attachment, and lower extraversion predicted higher IU scores in the ED group, and that insecure attachment predicted higher IU scores in the non-ED group. CONCLUSIONS Results confirm the relevance of IU to ED, and demonstrate that personality traits and insecure attachment styles contribute to IU in ED. Findings add to the growing literature on IU in ED and suggest that people with EDs may benefit from clinical interventions targeting IU.
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Affiliation(s)
- Lot C. Sternheim
- Department of Psychology, Utrecht University, Utrecht, The Netherlands
- Social, Health and Organisation Psychology, Faculty of Social Sciences, Utrecht University, Heidelberglaan 1, 3584 CS Utrecht, The Netherlands
| | - Martin Fisher
- School of Psychotherapy & Psychology, Regent’s University London, London, UK
| | - Amy Harrison
- School of Psychotherapy & Psychology, Regent’s University London, London, UK
- Ellern Mede Service for Eating Disorders, London, UK
| | - Rosamond Watling
- School of Psychotherapy & Psychology, Regent’s University London, London, UK
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Schmidt U, Sharpe H, Bartholdy S, Bonin EM, Davies H, Easter A, Goddard E, Hibbs R, House J, Keyes A, Knightsmith P, Koskina A, Magill N, McClelland J, Micali N, Raenker S, Renwick B, Rhind C, Simic M, Sternheim L, Woerwag-Mehta S, Beecham J, Campbell IC, Eisler I, Landau S, Ringwood S, Startup H, Tchanturia K, Treasure J. Treatment of anorexia nervosa: a multimethod investigation translating experimental neuroscience into clinical practice. PROGRAMME GRANTS FOR APPLIED RESEARCH 2017. [DOI: 10.3310/pgfar05160] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BackgroundAnorexia nervosa (AN) is a severe psychiatric condition and evidence on how to best treat it is limited.ObjectivesThis programme consists of seven integrated work packages (WPs) and aims to develop and test disseminable and cost-effective treatments to optimise management for people with AN across all stages of illness.MethodsWP1a used surveys, focus groups and a pre–post trial to develop and evaluate a training programme for school staff on eating disorders (EDs). WP1b used a randomised controlled trial (RCT) [International Standard Randomised Controlled Trial Number (ISRCTN) 42594993] to evaluate a prevention programme for EDs in schools. WP2a evaluated an inpatient treatment for AN using case reports, interviews and a quasi-experimental trial. WP2b used a RCT (ISRCTN67720902) to evaluate two outpatient psychological therapies for AN. WP3 used a RCT (ISRCTN06149665) to evaluate an intervention for carers of inpatients with AN. WP4 used actimetry, self-report and endocrine assessment to examine physical activity (PA) in AN. WP5 conducted a RCT (ISRCTN18274621) of an e-mail-guided relapse prevention programme for inpatients with AN. WP6 analysed cohort data to examine the effects of maternal EDs on fertility and their children’s diet and growth. WP7a examined clinical case notes to explore how access to specialist ED services affects care pathways and user experiences. Finally, WP7b used data from this programme and the British Cohort Study (1970) to identify the costs of services used by people with AN and to estimate annual costs of AN for England.ResultsWP1a: a brief training programme improved knowledge, attitudes and confidence of school staff in managing EDs in school. WP1b: a teacher-delivered intervention was feasible and improved risk factors for EDs in adolescent girls. WP2a: both psychological therapies improved outcomes in outpatients with AN similarly, but patients preferred one of the treatments. WP2b: the inpatient treatment (Cognitive Remediation and Emotional Skills Training) was acceptable with perceived benefits by patients, but showed no benefits compared with treatment as usual (TAU). WP3: compared with TAU, the carer intervention improved a range of patient and carer outcomes, including carer burden and patient ED symptomatology. WP4: drive to exercise is tied to ED pathology and a desire to improve mood in AN patients. PA was not increased in these patients. WP5: compared with TAU, the e-mail-guided relapse prevention programme resulted in higher body mass index and lower distress in patients at 12 months after discharge. WP6: women with an ED had impaired fertility and their children had altered dietary and growth patterns compared with the children of women without an ED. WP7a: direct access to specialist ED services was associated with higher referral rates, lower admission rates, greater consistency of care and user satisfaction. WP7b: the annual costs of AN in England are estimated at between £45M and £230M for 2011.ConclusionsThis programme has produced evidence to inform future intervention development and has developed interventions that can be disseminated to improve outcomes for individuals with AN. Directions for future research include RCTs with longer-term outcomes and sufficient power to examine mediators and moderators of change.Trial registrationCurrent Controlled Trials ISRCTN42594993, ISRCTN67720902, ISRCTN06149665 and ISRCTN18274621.FundingThis project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 5, No. 16. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Ulrike Schmidt
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Helen Sharpe
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Savani Bartholdy
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Eva-Maria Bonin
- Personal Social Services Research Unit, London School of Economics and Political Science, London, UK
| | - Helen Davies
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Abigail Easter
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- Institute of Child Health, University College London, London, UK
| | - Elizabeth Goddard
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Rebecca Hibbs
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Jennifer House
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Alexandra Keyes
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Pooky Knightsmith
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Antonia Koskina
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Nicholas Magill
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Jessica McClelland
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Nadia Micali
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- Institute of Child Health, University College London, London, UK
| | - Simone Raenker
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Bethany Renwick
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Charlotte Rhind
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Mima Simic
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Lot Sternheim
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Sabine Woerwag-Mehta
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Jennifer Beecham
- Personal Social Services Research Unit, London School of Economics and Political Science, London, UK
- Personal Social Services Research Unit, University of Kent, Canterbury, UK
| | - Iain C Campbell
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Ivan Eisler
- South London and Maudsley NHS Foundation Trust, London, UK
- Department of Child Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Sabine Landau
- Department of Biostatistics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | | | - Helen Startup
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Kate Tchanturia
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Janet Treasure
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
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Kesby A, Maguire S, Brownlow R, Grisham JR. Intolerance of Uncertainty in eating disorders: An update on the field. Clin Psychol Rev 2017; 56:94-105. [PMID: 28710918 DOI: 10.1016/j.cpr.2017.07.002] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Revised: 07/03/2017] [Accepted: 07/04/2017] [Indexed: 01/12/2023]
Abstract
Pathological fear and anxiety regarding food, eating, weight and body shape are at the core of eating disorder (ED) psychopathology. To manage anxiety, patients develop complicated repertoires of ritualistic and repetitive behaviours, which can lead to total functional impairment. Yet the cognitive processes underlying anxiety, fear, and anxiety-driven behaviours in EDs remain poorly understood. Intolerance of Uncertainty (IU) is defined as a tendency to react negatively on an emotional, cognitive, and behavioural level to uncertain situations and events. There is substantial evidence that IU is a transdiagnostic process that contributes to the maintenance of anxiety disorders; however, IU may also be relevant to the understanding and treatment of EDs. The current review summarises the growing literature examining IU in relation to ED symptoms, including restriction, bingeing, purging, ritualised behaviours, reassurance-seeking and body checking. Extending from the obsessive-compulsive disorder (OCD) and anxiety disorder literature, we propose that IU provides a novel theoretical and clinical framework from which to understand the anxiety, fixation with rules and rituals, and the cognitively rigid profile that is characteristic of ED presentations. We conclude with suggestions for future research, and discuss IU as a potential treatment target for core features of EDs and comorbid symptoms.
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Affiliation(s)
- Alice Kesby
- School of Psychology, UNSW Australia, Sydney, NSW, Australia.
| | - Sarah Maguire
- Boden Institute, University of Sydney, Sydney, NSW, Australia
| | - Rachel Brownlow
- Boden Institute, University of Sydney, Sydney, NSW, Australia
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Brown M, Robinson L, Campione GC, Wuensch K, Hildebrandt T, Micali N. Intolerance of Uncertainty in Eating Disorders: A Systematic Review and Meta-Analysis. EUROPEAN EATING DISORDERS REVIEW 2017; 25:329-343. [DOI: 10.1002/erv.2523] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 03/23/2017] [Accepted: 04/11/2017] [Indexed: 11/10/2022]
Affiliation(s)
- Melanie Brown
- Department of Psychiatry; Icahn School of Medicine at Mount Sinai; New York NY USA
| | - Lauren Robinson
- Department of Psychiatry; Icahn School of Medicine at Mount Sinai; New York NY USA
- Institute of Child Health; University College; London UK
| | - Giovanna Cristina Campione
- Department of Psychiatry; Icahn School of Medicine at Mount Sinai; New York NY USA
- Child Psychopathology Unit, Scientific Institute; IRCCS Eugenio Medea; Bosisio Parini Italy
| | - Kelsey Wuensch
- Department of Psychiatry; Icahn School of Medicine at Mount Sinai; New York NY USA
| | - Tom Hildebrandt
- Department of Psychiatry; Icahn School of Medicine at Mount Sinai; New York NY USA
| | - Nadia Micali
- Department of Psychiatry; Icahn School of Medicine at Mount Sinai; New York NY USA
- Institute of Child Health; University College; London UK
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Bartholdy S, Campbell IC, Schmidt U, O’Daly OG. Proactive inhibition: An element of inhibitory control in eating disorders. Neurosci Biobehav Rev 2016; 71:1-6. [DOI: 10.1016/j.neubiorev.2016.08.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 07/19/2016] [Accepted: 08/05/2016] [Indexed: 12/01/2022]
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Shihata S, McEvoy PM, Mullan BA, Carleton RN. Intolerance of uncertainty in emotional disorders: What uncertainties remain? J Anxiety Disord 2016; 41:115-24. [PMID: 27212227 DOI: 10.1016/j.janxdis.2016.05.001] [Citation(s) in RCA: 151] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 05/03/2016] [Accepted: 05/05/2016] [Indexed: 01/04/2023]
Abstract
The current paper presents a future research agenda for intolerance of uncertainty (IU), which is a transdiagnostic risk and maintaining factor for emotional disorders. In light of the accumulating interest and promising research on IU, it is timely to emphasize the theoretical and therapeutic significance of IU, as well as to highlight what remains unknown about IU across areas such as development, assessment, behavior, threat and risk, and relationships to cognitive vulnerability factors and emotional disorders. The present paper was designed to provide a synthesis of what is known and unknown about IU, and, in doing so, proposes broad and novel directions for future research to address the remaining uncertainties in the literature.
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Affiliation(s)
- Sarah Shihata
- School of Psychology and Speech Pathology, Curtin University, Perth, Australia
| | - Peter M McEvoy
- School of Psychology and Speech Pathology, Curtin University, Perth, Australia; Centre for Clinical Interventions, Perth, Australia.
| | - Barbara Ann Mullan
- School of Psychology and Speech Pathology, Curtin University, Perth, Australia
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41
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Carleton RN. Fear of the unknown: One fear to rule them all? J Anxiety Disord 2016; 41:5-21. [PMID: 27067453 DOI: 10.1016/j.janxdis.2016.03.011] [Citation(s) in RCA: 260] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 03/26/2016] [Accepted: 03/26/2016] [Indexed: 12/14/2022]
Abstract
The current review and synthesis was designed to provocatively develop and evaluate the proposition that "fear of the unknown may be a, or possibly the, fundamental fear" (Carleton, 2016) underlying anxiety and therein neuroticism. Identifying fundamental transdiagnostic elements is a priority for clinical theory and practice. Historical criteria for identifying fundamental components of anxiety are described and revised criteria are offered. The revised criteria are based on logical rhetorical arguments using a constituent reductionist postpositivist approach supported by the available empirical data. The revised criteria are then used to assess several fears posited as fundamental, including fear of the unknown. The review and synthesis concludes with brief recommendations for future theoretical discourse as well as clinical and non-clinical research.
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Affiliation(s)
- R Nicholas Carleton
- Anxiety and Illness Behaviours Laboratory, Department of Psychology, University of Regina, Regina, SK, Canada.
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42
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Stomaching uncertainty: Relationships among intolerance of uncertainty, eating disorder pathology, and comorbid emotional symptoms. J Anxiety Disord 2016; 41:88-95. [PMID: 27019977 DOI: 10.1016/j.janxdis.2016.03.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 02/23/2016] [Accepted: 03/17/2016] [Indexed: 11/22/2022]
Abstract
Intolerance of uncertainty (IU) is proposed to be a transdiagnostic vulnerability factor for various emotional disorders. There is robust evidence for the role of IU in anxiety and depressive disorders, but a paucity of evidence in eating disorders (ED). This study evaluated the factorial validity, internal consistency, and convergent validity of the Intolerance of Uncertainty Scale-Short Form (IUS-12; Carleton, Norton, & Asmundson, 2007), and examined whether IU is associated with ED pathology and comorbid emotional symptoms, in a clinical sample with EDs (N=134). A unitary factor solution provided the best fit. The IUS-12 showed excellent internal consistency, and good convergent validity. IU had an indirect effect on dietary restraint, purging, and emotional symptoms via overvaluation of eating, weight, and shape. The indirect effect was not significant for bingeing. Findings provide partial support for the notion that IU is a vulnerability factor for ED pathology and support the notion that IU is a transdiagnostic vulnerability factor for emotional symptoms. Limitations, research implications, and future directions for research are discussed.
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43
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Enhancing the ecological validity of the Beads Task as a behavioral measure of intolerance of uncertainty. J Anxiety Disord 2016; 41:43-9. [PMID: 26896872 DOI: 10.1016/j.janxdis.2016.02.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 01/28/2016] [Accepted: 02/02/2016] [Indexed: 11/23/2022]
Abstract
To broaden the measurement of intolerance of uncertainty (IU) beyond self-report methods, recent research has examined the Beads Task as a behavioral measure of IU. In the present study, we enhanced this task to increase its ecological validity by maximizing decisional uncertainty and the importance of a correct response. Undergraduate participants (n=102) completed the Beads Task with instructions that they would complete the Cold Pressor Task (CPT) if they answered incorrectly. As hypothesized, baseline CPT endurance time and self-reported pain level were weakly associated with later Beads Task distress during the decision-making process. Furthermore, in vivo Beads Task distress was associated with self-report inhibitory IU, which measures avoidance and paralysis in the face of uncertainty, but not with prospective IU, perfectionism, or general psychological distress after making statistical adjustments for multiple comparisons. Comparisons to previous work using the Beads Task, clinical implications, and avenues for future research are discussed.
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44
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Into the unknown: A review and synthesis of contemporary models involving uncertainty. J Anxiety Disord 2016; 39:30-43. [PMID: 26945765 DOI: 10.1016/j.janxdis.2016.02.007] [Citation(s) in RCA: 461] [Impact Index Per Article: 57.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 02/12/2016] [Accepted: 02/16/2016] [Indexed: 12/15/2022]
Abstract
The current review and synthesis serves to define and contextualize fear of the unknown relative to related constructs, such as intolerance of uncertainty, and contemporary models of emotion, attachment, and neuroticism. The contemporary models appear to share a common core in underscoring the importance of responses to unknowns. A recent surge in published research has explored the transdiagnostic impact of not knowing on anxiety and related pathologies; as such, there appears to be mounting evidence for fear of the unknown as an important core transdiagnostic construct. The result is a robust foundation for transdiagnostic theoretical and empirical explorations into fearing the unknown and intolerance of uncertainty.
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45
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Hirot F, Lesage M, Pedron L, Meyer I, Thomas P, Cottencin O, Guardia D. Impaired processing of self-face recognition in anorexia nervosa. Eat Weight Disord 2016; 21:31-40. [PMID: 26420298 DOI: 10.1007/s40519-015-0223-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2015] [Accepted: 09/08/2015] [Indexed: 01/01/2023] Open
Abstract
Body image disturbances and massive weight loss are major clinical symptoms of anorexia nervosa (AN). The aim of the present study was to examine the influence of body changes and eating attitudes on self-face recognition ability in AN. Twenty-seven subjects suffering from AN and 27 control participants performed a self-face recognition task (SFRT). During the task, digital morphs between their own face and a gender-matched unfamiliar face were presented in a random sequence. Participants' self-face recognition failures, cognitive flexibility, body concern and eating habits were assessed with the Self-Face Recognition Questionnaire (SFRQ), Trail Making Test (TMT), Body Shape Questionnaire (BSQ) and Eating Disorder Inventory-2 (EDI-2), respectively. Subjects suffering from AN exhibited significantly greater difficulties than control participants in identifying their own face (p = 0.028). No significant difference was observed between the two groups for TMT (all p > 0.1, non-significant). Regarding predictors of self-face recognition skills, there was a negative correlation between SFRT and body mass index (p = 0.01) and a positive correlation between SFRQ and EDI-2 (p < 0.001) or BSQ (p < 0.001). Among factors involved, nutritional status and intensity of eating disorders could play a part in impaired self-face recognition.
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Affiliation(s)
- France Hirot
- SCALab, UMR CNRS 9193, 59653, Villeneuve d'Ascq, France
| | - Marine Lesage
- SCALab, UMR CNRS 9193, 59653, Villeneuve d'Ascq, France.,Lille Nord de France University, 59000, Lille, France.,Addiction Center, CHU Lille, 59000, Lille, France
| | - Lya Pedron
- SCALab, UMR CNRS 9193, 59653, Villeneuve d'Ascq, France.,Lille Nord de France University, 59000, Lille, France.,Addiction Center, CHU Lille, 59000, Lille, France
| | | | - Pierre Thomas
- SCALab, UMR CNRS 9193, 59653, Villeneuve d'Ascq, France.,Lille Nord de France University, 59000, Lille, France
| | - Olivier Cottencin
- SCALab, UMR CNRS 9193, 59653, Villeneuve d'Ascq, France.,Lille Nord de France University, 59000, Lille, France.,Addiction Center, CHU Lille, 59000, Lille, France
| | - Dewi Guardia
- SCALab, UMR CNRS 9193, 59653, Villeneuve d'Ascq, France. .,Lille Nord de France University, 59000, Lille, France. .,Adolescent Mental Health Center, Lautreamont Clinic, 59120, Loos, France.
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46
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Summers BJ, Matheny NL, Sarawgi S, Cougle JR. Intolerance of uncertainty in body dysmorphic disorder. Body Image 2016; 16:45-53. [PMID: 26688272 DOI: 10.1016/j.bodyim.2015.11.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 11/06/2015] [Accepted: 11/07/2015] [Indexed: 10/22/2022]
Abstract
Intolerance of uncertainty (IU) is a transdiagnostic construct associated with several anxiety and related disorders. Three studies were conducted to explore the potential relationship between IU and body dysmorphic disorder (BDD). Study 1 revealed a positive relationship between IU and BDD symptoms above symptoms of anxiety and depression in an unselected student sample (N=88). Study 2 demonstrated a similar relationship between IU and BDD symptoms above negative affectivity and intolerance of ambiguity in a community sample (N=116). Study 3 found that a clinical BDD sample (N=23) reported greater IU than healthy controls (N=20), though this relationship was accounted for by symptoms of anxiety and depression. Greater IU predicted functional impairment in the clinical sample above BDD symptoms and past-week anxiety and depression. The observed relationship between IU and BDD symptoms provides preliminary support for the relevance of IU to this population.
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Affiliation(s)
- Berta J Summers
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Natalie L Matheny
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Shivali Sarawgi
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Jesse R Cougle
- Department of Psychology, Florida State University, Tallahassee, FL, USA.
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Yang Z, Chen H, Zhang X, Wang R, Ding J. The Online Version of the Chinese Intolerance of Uncertainty Scale: Psychometric Properties. CYBERPSYCHOLOGY BEHAVIOR AND SOCIAL NETWORKING 2016; 19:217-22. [PMID: 26985782 DOI: 10.1089/cyber.2015.0149] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The Intolerance of Uncertainty Scale (IUS) is widely used to assess the implications of being uncertain, attempts to control the future, and emotional, cognitive, and behavioral reactions to ambiguous situations. Several language versions of the paper-and-pencil test have shown satisfactory psychometric properties. This study is intended to explore whether the IUS is suited to being administered on the Internet. We examined the factor structure, reliability, and validity of the online version of the Chinese IUS in a sample of college students (N = 905). The results showed a four-factor structure model, excellent internal consistency reliability (α = 0.91), re-tested reliability (r = 0.82), and convergent and divergent validity. We can conclude that the online version of the Chinese IUS is appropriate for measurement and its psychometric properties are similar to the paper-and-pencil version.
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Affiliation(s)
- Zhihui Yang
- 1 Department of Psychology, School of Humanities and Social Sciences, Beijing Forestry University , Beijing, P.R. China
| | - Hui Chen
- 1 Department of Psychology, School of Humanities and Social Sciences, Beijing Forestry University , Beijing, P.R. China
| | - Xiao Zhang
- 2 The Hong Kong Institute of Education , Hong Kong, P.R. China
| | - Ruimin Wang
- 3 School of Psychology, Beijing Normal University , Beijing, P.R. China
| | - Jiali Ding
- 1 Department of Psychology, School of Humanities and Social Sciences, Beijing Forestry University , Beijing, P.R. China
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48
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Brooks SJ. A debate on working memory and cognitive control: can we learn about the treatment of substance use disorders from the neural correlates of anorexia nervosa? BMC Psychiatry 2016; 16:10. [PMID: 26772802 PMCID: PMC4715338 DOI: 10.1186/s12888-016-0714-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 01/12/2016] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Anorexia Nervosa (AN) is a debilitating, sometimes fatal eating disorder (ED) whereby restraint of appetite and emotion is concomitant with an inflexible, attention-to-detail perfectionist cognitive style and obsessive-compulsive behaviour. Intriguingly, people with AN are less likely to engage in substance use, whereas those who suffer from an ED with a bingeing component are more vulnerable to substance use disorder (SUD). DISCUSSION This insight into a beneficial consequence of appetite control in those with AN, which is shrouded by the many other unhealthy, excessive and deficit symptoms, may provide some clues as to how the brain could be trained to exert better, sustained control over appetitive and impulsive processes. Structural and functional brain imaging studies implicate the executive control network (ECN) and the salience network (SN) in the neuropathology of AN and SUD. Additionally, excessive employment of working memory (WM), alongside more prominent cognitive deficits may be utilised to cope with the experience of negative emotions and may account for aberrant brain function. WM enables mental rehearsal of cognitive strategies while regulating, restricting or avoiding neural responses associated with the SN. Therefore, high versus low WM capacity may be one of the factors that unites common cognitive and behavioural symptoms in those suffering from AN and SUD respectively. Furthermore, emerging evidence suggests that by evoking neural plasticity in the ECN and SN with WM training, improvements in neurocognitive function and cognitive control can be achieved. Thus, considering the neurocognitive processes of excessive appetite control and how it links to WM in AN may aid the application of adjunctive treatment for SUD.
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Affiliation(s)
- Samantha J. Brooks
- UCT Department of Psychiatry and Mental Health, Groote Schuur Hospital, Anzio Road, Observatory Cape Town, South Africa
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49
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Abbate-Daga G, Quaranta M, Marzola E, Amianto F, Fassino S. The Relationship between Alexithymia and Intolerance of Uncertainty in Anorexia Nervosa. Psychopathology 2015; 48:202-8. [PMID: 25896407 DOI: 10.1159/000381587] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 03/08/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Alexithymia and intolerance of uncertainty (IU) are relevant factors in social and emotional processing abilities in anorexia nervosa (AN) eventually rendering emotional coping difficult. However, the link potentially existing in AN between IU and alexithymia has been so far understudied. SAMPLING AND METHODS Sixty-one patients affected by AN and 59 healthy controls (HC) were enrolled and assessed for study purposes. All participants completed the following self-report questionnaires: Intolerance of Uncertainty Scale, State Trait Anxiety Inventory (STAI), Beck Depression Inventory (BDI) and Toronto Alexithymia Scale. RESULTS IU and alexithymia were greater in patients with AN when compared to HC. Moreover, in both AN and HC groups, IU and alexithymia significantly correlated with each other as well as with anxiety (STAI score) and depression (BDI score). No correlations were found between alexithymia and age. Patients' duration of illness was negatively correlated with two alexithymia subscales. After adjusting for anxiety, depression, body mass index and duration of illness (for AN), the correlation between IU and alexithymia remained significant. CONCLUSIONS In addition to confirming previous findings on marked levels of IU and alexithymia in AN, this study showed for the first time a correlation between IU and alexithymia in both AN and HC. Moreover, this result remained significant after controlling for a number of clinical variables. Taken together, these findings may have useful clinical implications for the treatment of AN sufferers. © 2015 S. Karger AG, Basel.
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Affiliation(s)
- Giovanni Abbate-Daga
- Eating Disorders Center, Department of Neuroscience, University of Turin, Turin, Italy
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50
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Freeman D, Startup H, Dunn G, Černis E, Wingham G, Pugh K, Cordwell J, Mander H, Kingdon D. Understanding jumping to conclusions in patients with persecutory delusions: working memory and intolerance of uncertainty. Psychol Med 2014; 44:3017-3024. [PMID: 25066636 DOI: 10.1017/s0033291714000592] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Persecutory delusions are a key psychotic experience. A reasoning style known as 'jumping to conclusions' (JTC) - limited information gathering before reaching certainty in decision making - has been identified as a contributory factor in the occurrence of delusions. The cognitive processes that underpin JTC need to be determined in order to develop effective interventions for delusions. In the current study two alternative perspectives were tested: that JTC partially results from impairment in information-processing capabilities and that JTC is a motivated strategy to avoid uncertainty. METHOD A group of 123 patients with persistent persecutory delusions completed assessments of JTC (the 60:40 beads task), IQ, working memory, intolerance of uncertainty, and psychiatric symptoms. Patients showing JTC were compared with patients not showing JTC. RESULTS A total of 30 (24%) patients with delusions showed JTC. There were no differences between patients who did and did not jump to conclusions in overall psychopathology. Patients who jumped to conclusions had poorer working memory performance, lower IQ, lower intolerance of uncertainty and lower levels of worry. Working memory and worry independently predicted the presence of JTC. CONCLUSIONS Hasty decision making in patients with delusions may partly arise from difficulties in keeping information in mind. Interventions for JTC are likely to benefit from addressing working memory performance, while in vivo techniques for patients with delusions will benefit from limiting the demands on working memory. The study provides little evidence for a contribution to JTC from top-down motivational beliefs about uncertainty.
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Affiliation(s)
- D Freeman
- Department of Psychiatry,University of Oxford,Oxford,UK
| | - H Startup
- Department of Psychiatry,University of Oxford,Oxford,UK
| | - G Dunn
- Centre for Biostatistics, Institute of Population Health,University of Manchester,Manchester,UK
| | - E Černis
- Department of Psychiatry,University of Oxford,Oxford,UK
| | - G Wingham
- Academic Department of Psychiatry, Faculty of Medicine,University of Southampton,Southampton,UK
| | - K Pugh
- Department of Psychiatry,University of Oxford,Oxford,UK
| | - J Cordwell
- Academic Department of Psychiatry, Faculty of Medicine,University of Southampton,Southampton,UK
| | - H Mander
- Academic Department of Psychiatry, Faculty of Medicine,University of Southampton,Southampton,UK
| | - D Kingdon
- Academic Department of Psychiatry, Faculty of Medicine,University of Southampton,Southampton,UK
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