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Mason TB, Lesser EL, Dolgon-Krutolow AR, Wonderlich SA, Smith KE. An updated transdiagnostic review of social cognition and eating disorder psychopathology. J Psychiatr Res 2021; 143:602-627. [PMID: 33190838 DOI: 10.1016/j.jpsychires.2020.11.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 09/22/2020] [Accepted: 11/05/2020] [Indexed: 01/10/2023]
Abstract
Existing data suggest that deficits in social cognitive functioning are transdiagnostic phenomena that are observed across various forms of psychopathology. The goal of the present review was to provide an updated systematic review of the literature on social cognitive functioning across eating disorders (EDs), including anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED). Studies that assessed six areas of social cognition were included: theory of mind, social perception, social knowledge, attributional bias, emotion perception, and emotion processing. A systematic search identified 71 studies, the majority of which examined adult women with AN. Research typically focused on alexithymia, theory of mind, empathy, social processing, emotion recognition, or emotion processing. Results suggested some deficits in social cognition in EDs. AN had the most studies with some evidence for deficiencies in social cognition but a fair amount of variability. Research on BN and BED was limited and inconsistent, though there appear to be some deficits in social cognition. Together, the limited coverage across EDs and heterogeneous methodology preclude firm conclusions regarding general or ED-specific deficits, as well as understanding the role of social cognition in ED etiology and maintenance. Therefore, several key questions and future directions are outlined for research moving forward.
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Affiliation(s)
- Tyler B Mason
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA
| | | | - Anna R Dolgon-Krutolow
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA
| | - Stephen A Wonderlich
- Sanford Center for Bio-behavioral Research, Sanford Health, Fargo, ND, USA; Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, ND, USA
| | - Kathryn E Smith
- Department of Psychiatry and Behavioral Sciences, University of Southern California, Los Angeles, CA, USA.
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2
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French MN, Chen EY. Emotion and Psychophysiological Responses During Emotion-Eliciting Film Clips in an Eating Disorders Sample. Front Psychol 2021; 12:630426. [PMID: 34366957 PMCID: PMC8336872 DOI: 10.3389/fpsyg.2021.630426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 01/22/2021] [Indexed: 11/21/2022] Open
Abstract
Background: Greater vulnerability to negative emotions appears associated with the development and maintenance of eating disorders (EDs). A systematic review of psychophysiological studies using emotion-eliciting film clips reveals that there are no studies examining the effect of standardized validated film clips on psychophysiological response across a range of EDs. Methods: Using standardized validated film clips without ED-specific content, the present study examined self-reported emotions and psychophysiological responses of women with Binge-Eating Disorder (BED; n = 57), Anorexia Nervosa (AN; n = 16), Bulimia Nervosa (BN; n = 34), and Healthy Controls (HCs; n = 26) at Baseline, during Neutral, Sad, Happy, and Fear-inducing film clips, and at Recovery. Results: Throughout the protocol, the ED groups reported significantly greater sadness and anxiety than HCs. Additionally, the AN group reported more fear, the BED group more frustration, and the BED and BN groups more tension than HCs. Compared to HCs, the BED group reported stronger urges to binge throughout the protocol, whereas BN group reported stronger urges to binge relative to the HC group only at Baseline and Recovery. The BN and BED groups experienced decreased urges to binge during all film clips compared to Baseline. Respiratory Sinus Arrhythmia levels were significantly lower in the BED group compared to HCs and the BN group throughout the protocol. Discussion: Standardized validated film clips can be used to elicit expected self-reported emotion and skin conductance responses in ED groups, although individuals with EDs compared HCs report greater negative emotions. Interestingly, film clips appeared to reduce urges to binge in binge-eating groups.
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Affiliation(s)
- Melanie N French
- Temple Eating Disorders Program, Department of Psychology, Temple University, Philadelphia, PA, United States
| | - Eunice Y Chen
- Temple Eating Disorders Program, Department of Psychology, Temple University, Philadelphia, PA, United States.,Department of Psychiatry and Behavioral Neurosciences, University of Chicago, Chicago, IL, United States
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3
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Bentz M, Westwood H, Jepsen JRM, Plessen KJ, Tchanturia K. The autism diagnostic observation schedule: Patterns in individuals with anorexia nervosa. EUROPEAN EATING DISORDERS REVIEW 2020; 28:571-579. [PMID: 32729156 DOI: 10.1002/erv.2757] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 05/04/2020] [Accepted: 06/05/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Studies have used the Autism Diagnostic Observation Schedule (the ADOS-2) in individuals with anorexia nervosa (AN), but the patterns of scores have not been assessed. We examined which subset of the ADOS-2 items best discriminate individuals with AN from healthy controls (HC), and assessed the potential clustering of AN participants based on different profiles of the ADOS-2 item scores. METHOD We combined datasets from two previous studies, and (a) compared mean ranks between young AN participants (N = 118) and HC (N = 42), (ii) replicated the item selection procedure of the existing ADOS-2 algorithm to assess sensitivity of items in the AN group, and (c) applied a two-step clustering analysis in the AN group (N = 149). RESULTS AN participants displayed significantly higher mean ranks than HC participants in five of 32 items. All five items are part of the existing ADOS-2 algorithm. We found two clusters of AN participants; one representing normal social behaviour, comprising 68% of the individuals with AN, and one representing less efficient social behaviour, comprising 32% of individuals with AN. CONCLUSIONS The items comprising the social affective cluster of the existing ADOS-2 algorithm are well suited to assess difficulties with social functioning in individuals with AN.
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Affiliation(s)
- Mette Bentz
- Child and Adolescent Mental Health Centre, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark
| | - Heather Westwood
- Section of Eating Disorders, Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Jens Richardt Møllegaard Jepsen
- Child and Adolescent Mental Health Centre, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark
- Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS) and Center for Neuropsychiatric Schizophrenia Research (CNSR), Mental Health Centre Glostrup, University of Copenhagen, Copenhagen, Denmark
| | - Kerstin Jessica Plessen
- Child and Adolescent Mental Health Centre, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark
| | - Kate Tchanturia
- Section of Eating Disorders, Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Giombini L, Nesbitt S, Kusosa R, Fabian C, Easter A, Tchanturia K. Adapted emotion skills training group for young people with anorexia nervosa : A mixed-methods evaluation. NEUROPSYCHIATRIE : KLINIK, DIAGNOSTIK, THERAPIE UND REHABILITATION : ORGAN DER GESELLSCHAFT ÖSTERREICHISCHER NERVENÄRZTE UND PSYCHIATER 2020; 35:76-83. [PMID: 32350767 DOI: 10.1007/s40211-020-00347-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 03/25/2020] [Indexed: 01/13/2023]
Abstract
BACKGROUND Brief interventions focused on emotion processing are needed to support young people (YP) in inpatient treatment programmes to manage emotions. Cognitive Remediation and Emotion Skills Training (CREST) has been found beneficial in adult anorexia nervosa (AN) groups. An initial case series found that CREST is a feasible intervention for YP with AN. Further age-appropriate adaptations were needed to improve YP's engagement. Following qualitative feedback on the original CREST manual, a second case series was conducted in an inpatient unit with age-appropriate adaptations to evaluate its feasibility in a YP inpatient setting. METHODS A mixed-methods methodology was used to evaluate the intervention. A total of 30 YP were asked to write a feedback letter about their experience of the group and to complete the Emotion Skills Scale (ESS), an ad hoc 12-item self-report Likert scale assessing emotional functioning. The ESS was also completed by a member of the multidisciplinary team for an external assessment. RESULTS Quantitative results showed no statistically significant changes in YP's emotional functioning, while qualitative results showed that YP found it helpful to learn about emotion processes, acknowledging their need to be supported to express them and understand the link with AN symptoms. Four high-order themes were identified: Helpfulness of CREST Group for Young People (CREST-GYP), Perception of contents, Challenges of group therapy, Suggestions for improvement. CONCLUSIONS Pilot findings suggest that CREST-GYP is an acceptable intervention for YP with AN. Clinical and research studies are needed to clarify whether CREST-GYP can produce more beneficial treatment results than treatment as usual.
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Affiliation(s)
- Lucia Giombini
- Elysium Healthcare, Rhodes Wood Hospital, Sheperd's Way, Brookmans Park, Hatfield, AL96NN, London, UK.
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Sophie Nesbitt
- Elysium Healthcare, Rhodes Wood Hospital, Sheperd's Way, Brookmans Park, Hatfield, AL96NN, London, UK
| | - Rutendo Kusosa
- Elysium Healthcare, Rhodes Wood Hospital, Sheperd's Way, Brookmans Park, Hatfield, AL96NN, London, UK
| | - Cleo Fabian
- Elysium Healthcare, Rhodes Wood Hospital, Sheperd's Way, Brookmans Park, Hatfield, AL96NN, London, UK
| | - Abigail Easter
- Health Service Research and Population Department, Institute of Psychiatry, Psychology and Neuroscience Health Services, King's College London, London, UK
| | - Kate Tchanturia
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Department of Psychology, Illia University Tbilisi, Tbilisi, Georgia
- South London and Maudsley NHS Foundation Trust, London, UK
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5
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Giombini L, Nesbitt S, Leppanen J, Cox H, Foxall A, Easter A, Tchanturia K. Emotions in play: young people's and clinicians' experience of 'Thinking about Emotions' group. Eat Weight Disord 2019; 24:605-614. [PMID: 30737647 PMCID: PMC6647864 DOI: 10.1007/s40519-019-00646-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 01/18/2019] [Indexed: 12/29/2022] Open
Abstract
PURPOSE Emotional difficulties in young people (YP) with anorexia nervosa (AN) are well recognised. Improved strategies are needed to support inpatients to tolerate group therapy and to help them to better identify and manage their emotions. Cognitive Remediation and Emotion Skills Training (CREST) for AN adults, aimed at improving emotional processing skills, has been found beneficial in adult AN groups. A case series of CREST was conducted in an inpatient ward for YP (CREST-YP) to evaluate its suitability for a younger population. METHODS A mixed-methods assessment was used. Thirty-two YP and 3 facilitators took part in qualitative interviews. YP (n = 32) also completed pre- and post-self-report questionnaires assessing emotional functioning. RESULTS Preliminary qualitative results showed that YP found it helpful to learn about emotion processes. More support is needed to clarify the link between emotions and AN. Quantitative results showed no significant changes in YP's self-perceived emotional functioning. Although no statistically significant changes were observed, a small increase in YP's use of both reappraisal (standardised mean changes scores, SMCC 0.22) and suppression (SMCC - 0.22) as a means to regulate their emotions was found. CONCLUSIONS Pilot findings suggest that CREST-YP is a suitable intervention for YP with AN. Age-appropriate adaptations are needed to improve YP's engagement in group CREST. LEVEL OF EVIDENCE Level IV: Evidence obtained from multiple time series.
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Affiliation(s)
- Lucia Giombini
- Rhodes Wood Hospital, Elysium Healthcare, Sheperd's way, Brookmans Park, Hatfield, London, AL96NN, UK.
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE58AF, UK.
| | - Sophie Nesbitt
- Rhodes Wood Hospital, Elysium Healthcare, Sheperd's way, Brookmans Park, Hatfield, London, AL96NN, UK
| | - Jenni Leppanen
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE58AF, UK
| | - Hannah Cox
- Rhodes Wood Hospital, Elysium Healthcare, Sheperd's way, Brookmans Park, Hatfield, London, AL96NN, UK
| | - Anna Foxall
- Rhodes Wood Hospital, Elysium Healthcare, Sheperd's way, Brookmans Park, Hatfield, London, AL96NN, UK
| | - Abigail Easter
- Research and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience Health Services, PO59 King's College London, London, UK
| | - Kate Tchanturia
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE58AF, UK
- Department of Psychology, Illia University, Tbilisi, Georgia
- South London and Maudsley NHS Foundation Trust, London, UK
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6
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Wieckowski AT, Swain DM, Abbott AL, White SW. Task Dependency When Evaluating Association Between Facial Emotion Recognition and Facial Emotion Expression in Children with ASD. J Autism Dev Disord 2019; 49:460-467. [PMID: 30173309 PMCID: PMC6365171 DOI: 10.1007/s10803-018-3712-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The impact of facial emotion recognition (FER) deficits on facial emotion expression (FEE) during interaction with a novel computerized system was investigated in children with ASD (n = 20), in comparison to typically developing (TD) peers (n = 20). Although there was not clear evidence of impaired FEE, children with ASD showed more atypical FEE. In children with ASD, better FER predicted better FEE when the participants were asked to express a labeled emotion (t(18) = - 2.75, p = .01, d = 1.24). The stronger relationship between FER and FEE in children with ASD, relative to controls, suggests that intervention targeting social communication deficits might have maximal effect when both processes are considered.
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Affiliation(s)
| | - Deanna M Swain
- Department of Psychology, Virginia Tech, Blacksburg, VA, 24061, USA
| | - A Lynn Abbott
- Bradley Department of Electrical and Computer Engineering, Virginia Tech, Blacksburg, VA, 24061, USA
| | - Susan W White
- Department of Psychology, The University of Alabama, Tuscaloosa, AL, 35401, USA
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7
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Gramaglia C, Gambaro E, Zeppegno P. Alexithymia and Treatment Outcome in Anorexia Nervosa: A Scoping Review of the Literature. Front Psychiatry 2019; 10:991. [PMID: 32116818 PMCID: PMC7033613 DOI: 10.3389/fpsyt.2019.00991] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 12/13/2019] [Indexed: 01/09/2023] Open
Abstract
Alexithymia is of great interest as an outcome predictor of recovery from anorexia nervosa, since it may interfere with both treatment compliance and patients' ability to benefit from the adopted interventions. For this reason, in the last years new treatment approaches targeting emotion identification, expression, and regulation have been applied and tested. Using the PRISMA methodology, we performed a scoping review of the literature about treatment outcome in anorexia nervosa, in terms of changes in alexithymia as assessed by its most commonly used self-report measure, the Toronto Alexithymia Scale (TAS). The Medline and Scopus databases were searched, and articles were included if matching the following criteria: dealing with patients affected by anorexia nervosa, without limits of age; involving the application of any kind of targeted therapy or treatment; assessing alexithymia and the effect of a treatment intervention on alexithymia, using the TAS. Ten studies were eventually included; overall, according to the selected studies, alexithymia levels often remain high even after specific treatment. Further research aimed at a deeper understanding of the actual impact of alexithymia on the outcome of anorexia, as well as exploring alternative treatment strategies for alexithymia in eating disorders (EDs), are warranted.
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Affiliation(s)
- Carla Gramaglia
- Institute of Psychiatry, Università degli Studi del Piemonte Orientale, Novara, Italy.,S.C. Psichiatria, Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy
| | - Eleonora Gambaro
- Institute of Psychiatry, Università degli Studi del Piemonte Orientale, Novara, Italy.,S.C. Psichiatria, Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy
| | - Patrizia Zeppegno
- Institute of Psychiatry, Università degli Studi del Piemonte Orientale, Novara, Italy.,S.C. Psichiatria, Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy
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8
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White SW, Abbott L, Wieckowski AT, Capriola-Hall NN, Aly S, Youssef A. Feasibility of Automated Training for Facial Emotion Expression and Recognition in Autism. Behav Ther 2018; 49:881-888. [PMID: 30316487 DOI: 10.1016/j.beth.2017.12.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 12/18/2017] [Accepted: 12/22/2017] [Indexed: 11/18/2022]
Abstract
Impairment in facial emotion recognition (FER) and facial emotion expression (FEE), often documented in autism spectrum disorder (ASD), are believed to contribute to the observed core social-communication disability that characterizes this disorder. Moreover, impaired FER and FEE are frequently seen in other disorders and problem behaviors. We describe the development of a novel system to detect and give real-time feedback on these processes, termed facial emotion expression training (FEET), an automated, gamelike system that is based on 3-dimensional sensing (Kinect) technology. A sample of 40 children (n = 20 ASD, n = 20 typically developing) interacted with our prototype system, which presented audiovisual stimuli and assessed responses of participants. Overall, consumer satisfaction ratings were high, and youth with ASD reported enjoying interacting with the system more than did the typical youth. Results suggest that new technology-based interventions are acceptable to consumers and viable for use in remediation of transdiagnostic processes, such as FER and FEE. Implications for future technology-based intervention to target transdiagnostic processes are discussed.
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9
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Geary DC. Evolution of Human Sex-Specific Cognitive Vulnerabilities. QUARTERLY REVIEW OF BIOLOGY 2017. [DOI: 10.1086/694934] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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10
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Leppanen J, Dapelo MM, Davies H, Lang K, Treasure J, Tchanturia K. Computerised analysis of facial emotion expression in eating disorders. PLoS One 2017; 12:e0178972. [PMID: 28575109 PMCID: PMC5456367 DOI: 10.1371/journal.pone.0178972] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 05/22/2017] [Indexed: 11/24/2022] Open
Abstract
Background Problems with social-emotional processing are known to be an important contributor to the development and maintenance of eating disorders (EDs). Diminished facial communication of emotion has been frequently reported in individuals with anorexia nervosa (AN). Less is known about facial expressivity in bulimia nervosa (BN) and in people who have recovered from AN (RecAN). This study aimed to pilot the use of computerised facial expression analysis software to investigate emotion expression across the ED spectrum and recovery in a large sample of participants. Method 297 participants with AN, BN, RecAN, and healthy controls were recruited. Participants watched film clips designed to elicit happy or sad emotions, and facial expressions were then analysed using FaceReader. Results The finding mirrored those from previous work showing that healthy control and RecAN participants expressed significantly more positive emotions during the positive clip compared to the AN group. There were no differences in emotion expression during the sad film clip. Discussion These findings support the use of computerised methods to analyse emotion expression in EDs. The findings also demonstrate that reduced positive emotion expression is likely to be associated with the acute stage of AN illness, with individuals with BN showing an intermediate profile.
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Affiliation(s)
- Jenni Leppanen
- Department of Psychological Medicine, Institute of Psychology, Psychiatry, and Neuroscience, King’s College London, London, United Kingdom
| | - Marcela Marin Dapelo
- Department of Psychological Medicine, Institute of Psychology, Psychiatry, and Neuroscience, King’s College London, London, United Kingdom
| | - Helen Davies
- Department of Psychological Medicine, Institute of Psychology, Psychiatry, and Neuroscience, King’s College London, London, United Kingdom
| | - Katie Lang
- Department of Psychological Medicine, Institute of Psychology, Psychiatry, and Neuroscience, King’s College London, London, United Kingdom
| | - Janet Treasure
- Department of Psychological Medicine, Institute of Psychology, Psychiatry, and Neuroscience, King’s College London, London, United Kingdom
| | - Kate Tchanturia
- Department of Psychological Medicine, Institute of Psychology, Psychiatry, and Neuroscience, King’s College London, London, United Kingdom
- Illia State University, Department of Psychology, Tbilisi, Georgia
- * E-mail:
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11
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Leppanen J, Cardi V, Ng KW, Paloyelis Y, Stein D, Tchanturia K, Treasure J. Effects of Intranasal Oxytocin on the Interpretation and Expression of Emotions in Anorexia Nervosa. J Neuroendocrinol 2017; 29. [PMID: 28140486 PMCID: PMC5363234 DOI: 10.1111/jne.12458] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 01/24/2017] [Accepted: 01/25/2017] [Indexed: 12/19/2022]
Abstract
Altered social-emotional functioning is considered to play an important role in the development and maintenance of anorexia nervosa (AN). Recently, there has been increasing interest in investigating the role of intranasal oxytocin in social-emotional processing. The present study aimed to investigate the effects of intranasal oxytocin on the interpretation and expression of emotions among people with AN. Thirty women with AN and 29 age-matched healthy women took part in the present study, which used a double-blind, placebo-controlled, cross-over design. The participants received a single dose of 40 IU of intranasal oxytocin in one session and a placebo spray in the other. Fifteen minutes after administration, the participants completed the Reading the Mind in the Eyes Test to assess the interpretation of complex emotions and mental states followed by a video task, which assessed expressions of facial affect when they were viewing humorous and sad film clips. The intranasal oxytocin did not significantly influence the expression or interpretation of emotions in the AN or healthy comparison groups. The AN group expressed significantly less positive emotion, spent more time looking away and reported experiencing a significantly more negative affect in response to the film clips. The finding that intranasal oxytocin had little to no effect on the interpretation or expression of emotions in either group supports the notion that the effects of oxytocin on social-emotional processing are not straightforward and may depend on individual and environmental differences, as well as the emotion being processed. Replication of these findings is necessary to explore the effect of timing on the effects of oxytocin before firm conclusions can be drawn. Nonetheless, these findings add to the steady accumulation of evidence that people with AN have reduced emotional expression and avoidance of emotionally provoking stimuli.
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Affiliation(s)
- J. Leppanen
- Department of Psychological MedicineInstitute of Psychiatry, Psychology, and NeuroscienceKing's College LondonLondonUK
| | - V. Cardi
- Department of Psychological MedicineInstitute of Psychiatry, Psychology, and NeuroscienceKing's College LondonLondonUK
| | - K. W. Ng
- Singapore General HospitalSingaporeSingapore
| | - Y. Paloyelis
- Division of NeuroscienceDepartment of NeuroimagingThe Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
| | - D. Stein
- Chaim Sheba Medical CenterEdmond and Lily Safra Children's HospitalTel HashomerIsrael
| | - K. Tchanturia
- Department of Psychological MedicineInstitute of Psychiatry, Psychology, and NeuroscienceKing's College LondonLondonUK
- Department of PsychologyIlia State UniversityTbilisiGAUSA
| | - J. Treasure
- Department of Psychological MedicineInstitute of Psychiatry, Psychology, and NeuroscienceKing's College LondonLondonUK
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12
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Wieckowski AT, White SW. Application of technology to social communication impairment in childhood and adolescence. Neurosci Biobehav Rev 2017; 74:98-114. [PMID: 28093239 DOI: 10.1016/j.neubiorev.2016.12.030] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 12/13/2016] [Accepted: 12/26/2016] [Indexed: 10/20/2022]
Abstract
Social communication impairment has been implicated in various mental health disorders. The primary aim of this review paper is to summarize the extant research on the development and application of technologies to address social communication deficits, conceptualized according to the four constructs outlined by the NIMH's Research Domain Criteria (RDoC), transdiagnostically in children and adolescents. An exhaustive and systematic search yielded 69 peer-reviewed articles meeting all inclusion criteria (i.e., used technology, applied the technology to target impairment in at least one of four constructs of social communication, included a child or adolescent samples). We found limited use of technology for exploration of impairment in reception of non-facial communication, compared to the other social communication constructs. In addition, there has been an overwhelming focus on social communication impairment in children and adolescents with Autism Spectrum Disorder (ASD), with relatively few studies evaluating technology application in other clinical populations. Implications for future directions for technological interventions to treat social communication impairments transdiagnostically are discussed.
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Affiliation(s)
| | - Susan W White
- Department of Psychology, Virginia Polytechnic Institute and State University, United States
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13
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Sharpe E, Wallis DJ, Ridout N. The influence of variations in eating disorder-related symptoms on processing of emotional faces in a non-clinical female sample: An eye-tracking study. Psychiatry Res 2016; 240:321-327. [PMID: 27138825 DOI: 10.1016/j.psychres.2016.04.065] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 04/19/2016] [Accepted: 04/20/2016] [Indexed: 11/19/2022]
Abstract
This study aimed to: (i) determine if the attention bias towards angry faces reported in eating disorders generalises to a non-clinical sample varying in eating disorder-related symptoms; (ii) examine if the bias occurs during initial orientation or later strategic processing; and (iii) confirm previous findings of impaired facial emotion recognition in non-clinical disordered eating. Fifty-two females viewed a series of face-pairs (happy or angry paired with neutral) whilst their attentional deployment was continuously monitored using an eye-tracker. They subsequently identified the emotion portrayed in a separate series of faces. The highest (n=18) and lowest scorers (n=17) on the Eating Disorders Inventory (EDI) were compared on the attention and facial emotion recognition tasks. Those with relatively high scores exhibited impaired facial emotion recognition, confirming previous findings in similar non-clinical samples. They also displayed biased attention away from emotional faces during later strategic processing, which is consistent with previously observed impairments in clinical samples. These differences were related to drive-for-thinness. Although we found no evidence of a bias towards angry faces, it is plausible that the observed impairments in emotion recognition and avoidance of emotional faces could disrupt social functioning and act as a risk factor for the development of eating disorders.
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Affiliation(s)
- Emma Sharpe
- Loughborough University Centre for Eating Disorders, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough LE11 3TU, UK.
| | - Deborah J Wallis
- Loughborough University Centre for Eating Disorders, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough LE11 3TU, UK.
| | - Nathan Ridout
- Department of Psychology, School of Life and Health Sciences, Aston University, Birmingham B4 7ET, UK.
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Görlach MG, Kohlmann S, Shedden-Mora M, Rief W, Westermann S. Expressive Suppression of Emotions and Overeating in Individuals with Overweight and Obesity. EUROPEAN EATING DISORDERS REVIEW 2016; 24:377-82. [DOI: 10.1002/erv.2452] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 02/29/2016] [Accepted: 03/30/2016] [Indexed: 11/10/2022]
Affiliation(s)
- Mirja Gianna Görlach
- Department of Psychosomatic Medicine; University Medical Centre Hamburg-Eppendorf; Martinistraße 52 20246 Hamburg Germany
- Schön Clinic Hamburg - Eilbek; Dehnhaide 120 22081 Hamburg Germany
| | - Sebastian Kohlmann
- Department of Psychosomatic Medicine; University Medical Centre Hamburg-Eppendorf; Martinistraße 52 20246 Hamburg Germany
- Schön Clinic Hamburg - Eilbek; Dehnhaide 120 22081 Hamburg Germany
| | - Meike Shedden-Mora
- Department of Psychosomatic Medicine; University Medical Centre Hamburg-Eppendorf; Martinistraße 52 20246 Hamburg Germany
- Schön Clinic Hamburg - Eilbek; Dehnhaide 120 22081 Hamburg Germany
| | - Winfried Rief
- Department of Clinical Psychology and Psychotherapy; University of Marburg; Gutenbergstrasse 18 35032 Marburg Germany
| | - Stefan Westermann
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology; University of Bern; Fabrikstrasse 8 3012 Bern Switzerland
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15
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Lang K, Larsson EEC, Mavromara L, Simic M, Treasure J, Tchanturia K. Diminished facial emotion expression and associated clinical characteristics in Anorexia Nervosa. Psychiatry Res 2016; 236:165-172. [PMID: 26778369 DOI: 10.1016/j.psychres.2015.12.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 09/30/2015] [Accepted: 12/04/2015] [Indexed: 11/25/2022]
Abstract
This study aimed to investigate emotion expression in a large group of children, adolescents and adults with Anorexia Nervosa (AN), and investigate the associated clinical correlates. One hundred and forty-one participants (AN=66, HC= 75) were recruited and positive and negative film clips were used to elicit emotion expressions. The Facial Activation Coding system (FACES) was used to code emotion expression. Subjective ratings of emotion were collected. Individuals with AN displayed less positive emotions during the positive film clip compared to healthy controls (HC). There was no significant difference between the groups on the Positive and Negative Affect Scale (PANAS). The AN group displayed emotional incongruence (reporting a different emotion to what would be expected given the stimuli, with limited facial affect to signal the emotion experienced), whereby they reported feeling significantly higher rates of negative emotion during the positive clip. There were no differences in emotion expression between the groups during the negative film clip. Despite this individuals with AN reported feeling significantly higher levels of negative emotions during the negative clip. Diminished positive emotion expression was associated with more severe clinical symptoms, which could suggest that these individuals represent a group with serious social difficulties, which may require specific attention in treatment.
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Affiliation(s)
- Katie Lang
- King's College London (KCL), Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, UK
| | - Emma E C Larsson
- King's College London (KCL), Mental Health Studies Programme, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, UK
| | - Liza Mavromara
- King's College London (KCL), Mental Health Studies Programme, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, UK
| | - Mima Simic
- Child & Adolescent Eating Disorder Team, South London & Maudsley NHS Trust, UK
| | - Janet Treasure
- King's College London (KCL), Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, UK
| | - Kate Tchanturia
- King's College London (KCL), Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, UK; King's College London (KCL), Mental Health Studies Programme, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, UK; Illia University Tbilisi, Department of Psychology, Georgia.
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16
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Davies H, Wolz I, Leppanen J, Fernandez-Aranda F, Schmidt U, Tchanturia K. Facial expression to emotional stimuli in non-psychotic disorders: A systematic review and meta-analysis. Neurosci Biobehav Rev 2016; 64:252-71. [PMID: 26915928 DOI: 10.1016/j.neubiorev.2016.02.015] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 02/01/2016] [Accepted: 02/17/2016] [Indexed: 02/07/2023]
Abstract
Facial expression of emotion is crucial to social interaction and emotion regulation; therefore, altered facial expressivity can be a contributing factor in social isolation, difficulties with emotion regulation and a target for therapy. This article provides a systematic review and meta-analysis of the literature on automatic emotional facial expression in people with non-psychotic disorders compared to healthy comparison groups. Studies in the review used an emotionally salient visual induction method, and reported on automatic facial expression in response to congruent stimuli. A total of 39 studies show alterations in emotional facial expression across all included disorders, except anxiety disorders. In depression, decreases in facial expression are mainly evident for positive affect. In eating disorders, a meta-analysis showed decreased facial expressivity in response to positive and negative stimuli. Studies in autism partially support generally decreased facial expressivity in this group. The data included in this review point towards decreased facial emotional expressivity in individuals with different non-psychotic disorders. This is the first review to synthesise facial expression studies across clinical disorders.
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Affiliation(s)
- H Davies
- King's College London, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neurosciences, London SE5 8AF, UK
| | - I Wolz
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain; CIBER Fisiopatologia Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Barcelona, Spain
| | - J Leppanen
- King's College London, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neurosciences, London SE5 8AF, UK
| | - F Fernandez-Aranda
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain; CIBER Fisiopatologia Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Barcelona, Spain; Clinical Sciences Department, School of Medicine, University of Barcelona, Spain
| | - U Schmidt
- King's College London, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neurosciences, London SE5 8AF, UK
| | - K Tchanturia
- King's College London, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neurosciences, London SE5 8AF, UK; Illia University, Department of Psychology, Tbilisi, Georgia.
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17
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Dapelo MM, Bodas S, Morris R, Tchanturia K. Deliberately generated and imitated facial expressions of emotions in people with eating disorders. J Affect Disord 2016; 191:1-7. [PMID: 26599363 DOI: 10.1016/j.jad.2015.10.044] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 10/25/2015] [Accepted: 10/27/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND People with eating disorders have difficulties in socio emotional functioning that could contribute to maintaining the functional consequences of the disorder. This study aimed to explore the ability to deliberately generate (i.e., pose) and imitate facial expressions of emotions in women with anorexia (AN) and bulimia nervosa (BN), compared to healthy controls (HC). METHODS One hundred and three participants (36 AN, 25 BN, and 42 HC) were asked to pose and imitate facial expressions of anger, disgust, fear, happiness, and sadness. Their facial expressions were recorded and coded. RESULTS Participants with eating disorders (both AN and BN) were less accurate than HC when posing facial expressions of emotions. Participants with AN were less accurate compared to HC imitating facial expressions, whilst BN participants had a middle range performance. All results remained significant after controlling for anxiety, depression and autistic features. LIMITATIONS The relatively small number of BN participants recruited for this study. CONCLUSIONS The study findings suggest that people with eating disorders, particularly those with AN, have difficulties posing and imitating facial expressions of emotions. These difficulties could have an impact in social communication and social functioning. This is the first study to investigate the ability to pose and imitate facial expressions of emotions in people with eating disorders, and the findings suggest this area should be further explored in future studies.
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Affiliation(s)
- Marcela Marin Dapelo
- King's College London, Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, UK
| | - Sergio Bodas
- Consorci Sanitari de Terrassa, Department of Mental Health, Terrassa, Spain
| | - Robin Morris
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, UK
| | - Kate Tchanturia
- King's College London, Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, UK; Ilia State University, Tbilisi, Georgia.
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18
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Facial expression of positive emotions in individuals with eating disorders. Psychiatry Res 2015; 230:70-7. [PMID: 26323166 DOI: 10.1016/j.psychres.2015.08.019] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 07/02/2015] [Accepted: 08/12/2015] [Indexed: 11/20/2022]
Abstract
A large body of research has associated Eating Disorders with difficulties in socio-emotional functioning and it has been argued that they may serve to maintain the illness. This study aimed to explore facial expressions of positive emotions in individuals with Anorexia Nervosa (AN) and Bulimia Nervosa (BN) compared to healthy controls (HC), through an examination of the Duchenne smile (DS), which has been associated with feelings of enjoyment, amusement and happiness (Ekman et al., 1990). Sixty participants (AN=20; BN=20; HC=20) were videotaped while watching a humorous film clip. The duration and intensity of DS were subsequently analyzed using the facial action coding system (FACS) (Ekman and Friesen, 2003). Participants with AN displayed DS for shorter durations than BN and HC participants, and their DS had lower intensity. In the clinical groups, lower duration and intensity of DS were associated with lower BMI, and use of psychotropic medication. The study is the first to explore DS in people with eating disorders, providing further evidence of difficulties in the socio-emotional domain in people with AN.
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19
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Emotional reactivity to social stimuli in patients with eating disorders. Psychiatry Res 2015; 229:887-94. [PMID: 26257086 DOI: 10.1016/j.psychres.2015.07.049] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Revised: 05/31/2015] [Accepted: 07/17/2015] [Indexed: 11/23/2022]
Abstract
Patients with eating disorders often display a wide range of difficulties in psychosocial functioning. Most of the studies on this subject have focused on theory of mind; however, little is known about the subjective emotional reactivity of patients to social situations. The aim of this study was to evaluate the patients' perceptions of their own emotions when viewing pictures with social content. Emotional reactivity was assessed in 85 women (29 with anorexia nervosa, 28 with bulimia nervosa, and 28 healthy controls) by using 30 images from the International Affective Picture System. Images were divided into categories based on its social content and its emotional valence. The emotional response was evaluated through the Self-Assessment Manikin. Patients with bulimia nervosa presented higher arousal and lower control when viewing images with social content of pleasant, unpleasant, and neutral valence. Patients with anorexia nervosa reported higher arousal and lower control only for social images with neutral valence. There were no differences between groups for the control images. The finding of specific differences in emotional reactivity to pictures with social content contributes to a more accurate understanding of the difficulties of patients in social situations.
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20
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Cardi V, Corfield F, Leppanen J, Rhind C, Deriziotis S, Hadjimichalis A, Hibbs R, Micali N, Treasure J. Emotional Processing, Recognition, Empathy and Evoked Facial Expression in Eating Disorders: An Experimental Study to Map Deficits in Social Cognition. PLoS One 2015; 10:e0133827. [PMID: 26252220 PMCID: PMC4529105 DOI: 10.1371/journal.pone.0133827] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 07/02/2015] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Difficulties in social cognition have been identified in eating disorders (EDs), but the exact profile of these abnormalities is unclear. The aim of this study is to examine distinct processes of social-cognition in this patient group, including attentional processing and recognition, empathic reaction and evoked facial expression in response to discrete vignettes of others displaying positive (i.e. happiness) or negative (i.e. sadness and anger) emotions. METHOD One hundred and thirty-eight female participants were included in the study: 73 healthy controls (HCs) and 65 individuals with an ED (49 with Anorexia Nervosa and 16 with Bulimia Nervosa). Self-report and behavioural measures were used. RESULTS Participants with EDs did not display specific abnormalities in emotional processing, recognition and empathic response to others' basic discrete emotions. However, they had poorer facial expressivity and a tendency to turn away from emotional displays. CONCLUSION Treatments focusing on the development of non-verbal emotional communication skills might be of benefit for patients with EDs.
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Affiliation(s)
- Valentina Cardi
- Section of Eating Disorders, Psychological Medicine, King’s College London, Institute of Psychiatry, London, United Kingdom
| | - Freya Corfield
- Section of Eating Disorders, Psychological Medicine, King’s College London, Institute of Psychiatry, London, United Kingdom
| | - Jenni Leppanen
- Section of Eating Disorders, Psychological Medicine, King’s College London, Institute of Psychiatry, London, United Kingdom
| | - Charlotte Rhind
- Section of Eating Disorders, Psychological Medicine, King’s College London, Institute of Psychiatry, London, United Kingdom
| | - Stephanie Deriziotis
- Section of Eating Disorders, Psychological Medicine, King’s College London, Institute of Psychiatry, London, United Kingdom
| | - Alexandra Hadjimichalis
- Section of Eating Disorders, Psychological Medicine, King’s College London, Institute of Psychiatry, London, United Kingdom
| | - Rebecca Hibbs
- Section of Eating Disorders, Psychological Medicine, King’s College London, Institute of Psychiatry, London, United Kingdom
| | - Nadia Micali
- Behavioural and Brain Sciences Unit, Institute of Child Health, University College London, London, United Kingdom
| | - Janet Treasure
- Section of Eating Disorders, Psychological Medicine, King’s College London, Institute of Psychiatry, London, United Kingdom
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21
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Lang K, Dapelo MM, Khondoker M, Morris R, Surguladze S, Treasure J, Tchanturia K. Exploring Emotion Recognition in Adults and Adolescents with Anorexia Nervosa Using a Body Motion Paradigm. EUROPEAN EATING DISORDERS REVIEW 2015; 23:262-8. [DOI: 10.1002/erv.2358] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 02/14/2015] [Accepted: 02/24/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Katie Lang
- King's College London (KCL); Psychological Medicine, IoPPN; UK
| | | | | | - Robin Morris
- King's College London (KCL); Department of Psychology, IoPPN; UK
| | | | - Janet Treasure
- King's College London (KCL); Psychological Medicine, IoPPN; UK
| | - Kate Tchanturia
- King's College London (KCL); Psychological Medicine, IoPPN; UK
- Ilia State University Tbilisi; Georgia
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22
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Tchanturia K, Doris E, Mountford V, Fleming C. Cognitive Remediation and Emotion Skills Training (CREST) for anorexia nervosa in individual format: self-reported outcomes. BMC Psychiatry 2015; 15:53. [PMID: 25884480 PMCID: PMC4377046 DOI: 10.1186/s12888-015-0434-9] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 03/09/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To evaluate self-reported outcomes after a brief course of skills-based individual therapy for inpatients with anorexia nervosa (AN). METHODS In this case series study 37 adults with AN participated in cognitive remediation and emotion skills training (CREST) sessions, and completed social anhedonia, alexithymia and motivational measures before and after the intervention. RESULTS The CREST primary outcome measures were total scores on the Revised Social Anhedonia Scale (RSAS), which decreased significantly (p = 0.03) with an effect size of 0.31, and the Toronto Alexithymia Scale (TAS), which also decreased significantly (p = 0.05) with an effect size of 0.35. The secondary outcome measures focused on motivation: perceived 'importance to change' and 'ability to change'; the second of which increased significantly (p < 0.001) with a medium effect size (d = 0.71). CONCLUSIONS The individual format of CREST led to a decrease in patients' self-reported social anhedonia, an improvement in the ability to label their emotions, and increased confidence in their ability to change. Considering the limited number of individual sessions, this is a promising preliminary finding which warrants further research.
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Affiliation(s)
- Kate Tchanturia
- King's College London, Division of Psychological Medicine, Institute of Psychiatry, SE5 8AF, London, UK. .,Eating Disorders Unit, South London and Maudsley NHS Foundation Trust, London, UK. .,Illia State University, Tbilisi, Georgia.
| | - Eli Doris
- King's College London, Division of Psychological Medicine, Institute of Psychiatry, SE5 8AF, London, UK. .,Eating Disorders Unit, South London and Maudsley NHS Foundation Trust, London, UK.
| | - Vicki Mountford
- Eating Disorders Unit, South London and Maudsley NHS Foundation Trust, London, UK.
| | - Caroline Fleming
- Eating Disorders Unit, South London and Maudsley NHS Foundation Trust, London, UK.
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23
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Abstract
Experimental research, supported by systematic reviews, establishes that people with eating disorders have emotional difficulties in terms of recognising, regulating and expressing their emotions. These emotional difficulties contribute to poor social functioning and problems with relationships. The existing literature includes a broad range of studies, many of which have utilised self-report measures, but experimental studies of emotions in eating disorders are still limited. The primary aim of this paper is to highlight gaps in the clinical research on emotions in eating disorders, focusing on experimental investigations from our lab and highlighting potentially useful future directions for further basic research and its translation into new developments in treatment and prevention. Recent findings using experimental paradigms to study the expression of emotions along with neuroimaging research exploring differences in facial emotion processing are discussed, and clinical implications are presented.
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