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Reilly EE, Wierenga CE, Grange DL. Testing the role of associative learning in evidence-based treatments for anorexia nervosa. Int J Eat Disord 2024; 57:1088-1095. [PMID: 38323377 PMCID: PMC11093706 DOI: 10.1002/eat.24161] [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: 11/02/2023] [Revised: 01/25/2024] [Accepted: 01/26/2024] [Indexed: 02/08/2024]
Abstract
Treatments for anorexia nervosa (AN) remain ineffective for many patients. Processes that can account for differential treatment outcomes remain mostly unknown. We propose that the field test the role of associative learning in current psychological treatments. We hold that this line of research could yield actionable information for understanding non-response and improving long-term outcomes. To make this argument, we define associative learning and outline its proposed role in understanding psychiatric disorders and their treatment. We then briefly review data exploring associative learning in AN. We argue that associative learning processes are implicitly implicated in existing treatments; by this rationale, baseline differences in learning may interfere with treatment response. Finally, we outline future research to test our hypotheses. Altogether, future research aimed at better understanding how associative learning may contribute to AN symptom persistence has the potential to inform novel directions in intervention research. PUBLIC SIGNIFICANCE: There is a pressing need to improve outcomes in treatments for anorexia nervosa (AN). We propose that individual differences in associative learning-the ability to form and update associations between cues, contexts, behaviors, and outcomes-may account for differential response to existing treatments. Undertaking this research could provide an understanding of how current treatments work and inform new approaches for those who may be at risk of poor outcomes.
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Affiliation(s)
- Erin E. Reilly
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA
| | | | - Daniel Le Grange
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA
- Department of Psychiatry & Behavioral Neuroscience (Emeritus), The University of Chicago, Chicago, Illinois, USA
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2
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Altered Reinforcement Learning from Reward and Punishment in Anorexia Nervosa: Evidence from Computational Modeling. J Int Neuropsychol Soc 2022; 28:1003-1015. [PMID: 34839845 PMCID: PMC9148374 DOI: 10.1017/s1355617721001326] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Anorexia nervosa (AN) is associated with altered sensitivity to reward and punishment. Few studies have investigated whether this results in aberrant learning. The ability to learn from rewarding and aversive experiences is essential for flexibly adapting to changing environments, yet individuals with AN tend to demonstrate cognitive inflexibility, difficulty set-shifting and altered decision-making. Deficient reinforcement learning may contribute to repeated engagement in maladaptive behavior. METHODS This study investigated learning in AN using a probabilistic associative learning task that separated learning of stimuli via reward from learning via punishment. Forty-two individuals with Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 restricting-type AN were compared to 38 healthy controls (HCs). We applied computational models of reinforcement learning to assess group differences in learning, thought to be driven by violations in expectations, or prediction errors (PEs). Linear regression analyses examined whether learning parameters predicted BMI at discharge. RESULTS AN had lower learning rates than HC following both positive and negative PE (p < .02), and were less likely to exploit what they had learned. Negative PE on punishment trials predicted lower discharge BMI (p < .001), suggesting individuals with more negative expectancies about avoiding punishment had the poorest outcome. CONCLUSIONS This is the first study to show lower rates of learning in AN following both positive and negative outcomes, with worse punishment learning predicting less weight gain. An inability to modify expectations about avoiding punishment might explain persistence of restricted eating despite negative consequences, and suggests that treatments that modify negative expectancy might be effective in reducing food avoidance in AN.
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3
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Miles S, Phillipou A, Sumner P, Nedeljkovic M. Cognitive flexibility and the risk of anorexia nervosa: An investigation using self-report and neurocognitive assessments. J Psychiatr Res 2022; 151:531-538. [PMID: 35636028 DOI: 10.1016/j.jpsychires.2022.05.043] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 02/28/2022] [Accepted: 05/20/2022] [Indexed: 10/18/2022]
Abstract
Impaired cognitive flexibility has been suggested as a risk factor for the development of anorexia nervosa (AN). The current study aimed to 1) investigate cognitive flexibility in people at various levels of risk of AN; and 2) compare people with a history of AN to people at different levels of risk of AN in cognitive flexibility. The sample comprised of 262 community participants (79% female) and 36 participants with a lifetime diagnosis of AN (97.2% female) aged between 18 and 64 years old. Participants completed self-report (the Depression Anxiety Stress Scale short-form version, the Eating Disorders Examination-Questionnaire, the Neuroticism Scale, and the Cognitive Flexibility Inventory) and neurocognitive (the Trail Making Test and the Wisconsin Card Sorting Test) assessments online to evaluate eating disorder symptoms, depression, neuroticism, and cognitive flexibility. Using a cluster analysis, participants were allocated into low-, medium-, and high-risk of AN groups (n = 88, 128, 46, and 36 respectively). Although high-risk participants self-reported significantly poorer cognitive flexibility than the other risk groups, performance on the neurocognitive tasks was similar across groups. Further, participants with lifetime AN reported significantly poorer cognitive flexibility than the low-risk group. People at high-risk of AN may perceive themselves to have poorer cognitive flexibility compared to those at a lower risk of AN. These results have implications for early identification of people at high-risk of AN.
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Affiliation(s)
- Stephanie Miles
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Victoria, Australia.
| | - Andrea Phillipou
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Victoria, Australia; Department of Mental Health, St Vincent's Hospital, Melbourne, Victoria, Australia; Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia; Department of Mental Health, Austin Health, Melbourne, Victoria, Australia
| | - Philip Sumner
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Maja Nedeljkovic
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Victoria, Australia
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4
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Sternheim LC, Wickham MI, Danner UN, Maddox TW, Filoteo VJ, Shott ME, Frank GKW. Understanding implicit and explicit learning in adolescents with and without anorexia nervosa. J Eat Disord 2021; 9:77. [PMID: 34187577 PMCID: PMC8243584 DOI: 10.1186/s40337-021-00431-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 06/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cognitive disturbances such as impairments in learning are thought to play a role in adult Anorexia Nervosa (AN). It is remains unclear to what extent these disturbances result from starvation of the brain, or relate to an abnormal premorbid cognitive profile. This study investigates learning processes in adolescents with AN, hypothesizing that implicit learning is intact, as found previously in explicit learning tasks. Secondly, we hypothesized that anxiety and depression symptoms, inherent to AN, are associated to learning processes in AN. METHODS In total 46 adolescents diagnosed with AN and 44 control participants were administered an implicit category learning task in which they were asked to categorize simple perceptual stimuli (Gabor patches) based on a linear integration (i.e., an implicit task) of orientation and spatial frequency of the stimulus. A subgroup of adolescents (n = 38) also completed a task assessing explicit learning. RESULTS Model-based analyses indicated that adolescents with AN performed significantly more accurately compared to their healthy peers regardless of whether they used the optimal strategy or not. Depression and anxiety did not relate to learning performance in the AN group. CONCLUSIONS Overall, our findings of augmented implicit and explicit learning in adolescents with AN corroborate recent studies that suggested higher stimulus-response learning during prediction error paradigms. Learning disturbances in adult AN may then be at least partly due to long-term malnourishment, highlighting the importance of early recognition and refeeding in treatments for AN.
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Affiliation(s)
- Lot C Sternheim
- Department of Clinical Psychology, Universiteit Utrecht, Heidelberglaan 1, 3508, TC, Utrecht, The Netherlands.
- , Utrecht, The Netherlands.
| | - Miriam I Wickham
- Department of Social Health and Organisation Psychology, Universiteit Utrecht, Heidelberglaan 1, 3508, TC, Utrecht, The Netherlands
| | - Unna N Danner
- Department of Clinical Psychology, Universiteit Utrecht, Heidelberglaan 1, 3508, TC, Utrecht, The Netherlands
- Altrecht Eating Disorders Rintveld, Wenshoek 4, 3705, WE, Zeist, The Netherlands
| | - Todd W Maddox
- Department of Psychology, University of Texas, Austin, USA
| | - Vincent J Filoteo
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Megan E Shott
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
- Eating Disorders Center for Treatment and Research, University of California San Diego, San Diego, CA, USA
| | - Guido K W Frank
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
- Eating Disorders Center for Treatment and Research, University of California San Diego, San Diego, CA, USA
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5
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Duriez P, Kaya Lefèvre H, Di Lodovico L, Viltart O, Gorwood P. Increased cognitive flexibility mediates the improvement of eating disorders symptoms, depressive symptoms and level of daily life functioning in patients with anorexia nervosa treated in specialised centres. EUROPEAN EATING DISORDERS REVIEW 2021; 29:600-610. [PMID: 33851482 DOI: 10.1002/erv.2829] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 02/15/2021] [Accepted: 02/23/2021] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Poor cognitive flexibility has been highlighted in patients with anorexia nervosa (AN), contributing to the development and maintenance of symptoms. The aim of the present study is to investigate how enhanced cognitive flexibility is involved in treatment outcomes in patients with AN. METHOD One hundred thirty female out-patients treated for AN have been assessed at baseline and after 4 months of treatment. Path analyses were used to investigate the mediating role of cognitive flexibility, measured through the Brixton test, on a wide range of outcomes: body mass index, eating disorder symptoms, daily life functioning, anxiety, depression, emotions, self-rated silhouette. RESULTS Cognitive flexibility was improved during treatment, and enhanced cognitive flexibility explains a significant part of level of the improvement in daily life functioning (26%), reduction of eating disorder symptoms (18%) and reduction of depressive symptoms (17%). Others outcomes were also improved, but these improvements were not mediated by cognitive flexibility. CONCLUSIONS Results suggest that enhancing cognitive flexibility could help reduce rigid cognitive and behavioural patterns involved in AN, thus improving everyday functioning and clinical severity. Further studies combining different types of cognitive flexibility evaluation as well as neuroimaging may be necessary to better establish which of its aspects are involved in patients' improvement.
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Affiliation(s)
- Philibert Duriez
- GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, CMME, Paris, France.,Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Université de Paris, Paris, France
| | - Héline Kaya Lefèvre
- GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, CMME, Paris, France.,Université de Paris, LPPS, Boulogne-Billancourt, France
| | - Laura Di Lodovico
- GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, CMME, Paris, France.,Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Université de Paris, Paris, France
| | - Odile Viltart
- Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Université de Paris, Paris, France.,Cité scientifique, SN4, Université de Lille, Villeneuve d'Ascq, France
| | - Philip Gorwood
- GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, CMME, Paris, France.,Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Université de Paris, Paris, France
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6
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Miles S, Gnatt I, Phillipou A, Nedeljkovic M. Cognitive flexibility in acute anorexia nervosa and after recovery: A systematic review. Clin Psychol Rev 2020; 81:101905. [PMID: 32891022 DOI: 10.1016/j.cpr.2020.101905] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 08/05/2020] [Accepted: 08/10/2020] [Indexed: 02/06/2023]
Abstract
Difficulties in cognitive flexibility-the ability to adapt effectively to changes in the environment and/or changing task demands-have been reported in anorexia nervosa (AN). However, findings are inconsistent across studies and it remains unclear which specific aspects of cognitive flexibility patients with AN may struggle with. This systematic review aimed to synthesise existing research on cognitive flexibility in AN and clarify differences between patients with acute AN, patients who are weight-restored and patients who are fully recovered from AN. Electronic databases were searched through to January 2020. 3,310 papers were screened and 70 papers were included in the final review. Although adults with acute AN performed worse in perceptual flexibility tasks and self-report measures compared to HCs, they did not exhibit deficits across all domains of cognitive flexibility. Adolescents with acute AN did not differ to HCs in performance on neurocognitive tasks despite self-reporting poorer cognitive flexibility. Overall, significant differences in cognitive flexibility between acute and recovered participants was not evident, though, the findings are limited by a modest number of studies. Recovered participants performed poorer than HCs in some neurocognitive measures, however, results were inconsistent across studies. These results have implications for the assessment of cognitive flexibility in AN and targeted treatment approaches.
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Affiliation(s)
- Stephanie Miles
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia.
| | - Inge Gnatt
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia
| | - Andrea Phillipou
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia; Department of Mental Health, St Vincent's Hospital, Melbourne, Australia; Department of Psychiatry, The University of Melbourne, Melbourne, Australia; Department of Mental Health, Austin Health, Melbourne, Australia
| | - Maja Nedeljkovic
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia
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7
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Saure E, Laasonen M, Lepistö-Paisley T, Mikkola K, Ålgars M, Raevuori A. Characteristics of autism spectrum disorders are associated with longer duration of anorexia nervosa: A systematic review and meta-analysis. Int J Eat Disord 2020; 53:1056-1079. [PMID: 32181530 DOI: 10.1002/eat.23259] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 02/14/2020] [Accepted: 02/14/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Anorexia nervosa (AN) is associated with neuropsychological characteristics such as impairments in central coherence, cognitive flexibility, and emotion recognition. The same features also manifest in autism spectrum disorders (ASD) and have been suggested to be associated with illness prolongation in AN. The purpose of this meta-analysis was to examine whether pronounced neuropsychological characteristics related to ASD are associated with illness duration in AN. METHOD Four databases (Medline, PsycINFO, Scopus, PubMed) were searched for eligible studies. Search terms were (a) "anorexia nervosa" and (b) "cognitive flexibility" or "set-shifting" or "central coherence" or "emotion recognition" or "theory of mind". The final sample consisted of 53 studies. Duration of AN was divided into three categories in order to investigate differences between the groups with varying illness duration. The meta-analysis was performed with Review Manager using a random-effects model. RESULTS Deficits in central coherence, cognitive flexibility, and emotion recognition were pronounced among individuals with prolonged AN compared to those with shorter illness duration. DISCUSSION A prolonged course of AN appears to be associated with underlying neuropsychological characteristics that are also distinctive to ASD. Neuropsychological impairments may lead to prolonged AN, and prolonged illness may contribute to the subsequent "neurological scar effect," further strengthening these impairments.
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Affiliation(s)
- Emma Saure
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Marja Laasonen
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Department of Psychology and Speech-Language Pathology, University of Turku, Turku, Finland.,Department of Otorhinolaryngology and Phoniatrics, Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | | | - Katri Mikkola
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Monica Ålgars
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Åbo Akademi University, Department of Psychology, Åbo Akademi Fakulteten för humaniora psykologi och teologi, Turku, Finland
| | - Anu Raevuori
- Clinicum, Department of Public Health, University of Helsinki, Helsinki, Finland.,Department of Adolescent Psychiatry, Helsinki University Hospital, Helsinki, Finland
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8
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Filoteo JV, Maddox WT, Ashby FG. Quantitative modeling of category learning deficits in various patient populations. Neuropsychology 2018; 31:862-876. [PMID: 29376668 DOI: 10.1037/neu0000422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE To provide a select review of our applications of quantitative modeling to highlight the utility of such approaches to better understand the neuropsychological deficits associated with various neurologic and psychiatric diseases. METHOD We review our work examining category learning in various patient populations, including individuals with basal ganglia disorders (Huntington's Disease and Parkinson's disease), amnesia and Eating Disorders. RESULTS Our review suggests that the use of quantitative models has enabled a better understanding of the learning deficits often observed in these conditions and has allowed us to form novel hypotheses about the neurobiological bases of their deficits. CONCLUSIONS We feel that the use of neurobiologically inspired quantitative modeling holds great promise in neuropsychological assessment and that future clinical measures should incorporate the use of such models as part of their standard scoring. Appropriate studies need to be completed, however, to determine whether such modeling techniques adhere to the rigorous psychometric properties necessary for a valid and reliable application in a clinical setting. (PsycINFO Database Record
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Affiliation(s)
| | | | - F Gregory Ashby
- Department of Psychological & Brain Sciences, University of California Santa Barbara
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9
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Harper JA, Brodrick B, Van Enkevort E, McAdams CJ. Neuropsychological and Cognitive Correlates of Recovery in Anorexia Nervosa. EUROPEAN EATING DISORDERS REVIEW 2017; 25:491-500. [PMID: 28799287 DOI: 10.1002/erv.2539] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 07/10/2017] [Accepted: 07/11/2017] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To identify clinical or cognitive measures either predictive of illness trajectory or altered with sustained weight recovery in adult women with anorexia nervosa. METHODS Participants were recruited from prior studies of women with anorexia nervosa (AN-C) and in weight-recovery following anorexia nervosa (AN-WR). Participants completed a neuropsychological battery at baseline and clinical assessments at both baseline and follow-up. Groups based on clinical outcome (continued eating disorder, AN-CC; newly in recovery, AN-CR; sustained weight-recovery, AN-WR) were compared by using one-way ANOVAs with Bonferroni-corrected post hoc comparisons. RESULTS Women with continued eating disorder had poorer neuropsychological function and self-competence at baseline than AN-CR. AN-CR showed changes in depression and externalizing bias, a measure of self-related attributions. AN-WR differed from both AN-CC and AN-CR at baseline in externalizing bias, but only from AN-CC at outcome. DISCUSSION Neuropsychological function when recently ill may be a prognostic factor, while externalizing bias may provide a clinical target for recovery. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.
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Affiliation(s)
- Jessica A Harper
- Department of Psychiatry, University of Texas Southwestern Medical Center, TX, USA
| | - Brooks Brodrick
- Department of Internal Medicine, University of Texas Southwestern Medical Center, TX, USA
| | - Erin Van Enkevort
- Department of Psychiatry, University of Texas Southwestern Medical Center, TX, USA
| | - Carrie J McAdams
- Department of Psychiatry, University of Texas Southwestern Medical Center, TX, USA.,Department of Psychiatry, Children's Medical Center, TX, USA.,Department of Psychiatry, Texas Health Presbyterian Hospital of Dallas, TX, USA
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10
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Wierenga CE, Bischoff-Grethe A, Rasmusson G, Bailer UF, Berner LA, Liu TT, Kaye WH. Aberrant Cerebral Blood Flow in Response to Hunger and Satiety in Women Remitted from Anorexia Nervosa. Front Nutr 2017; 4:32. [PMID: 28770207 PMCID: PMC5515860 DOI: 10.3389/fnut.2017.00032] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 07/03/2017] [Indexed: 12/20/2022] Open
Abstract
The etiology of pathological eating in anorexia nervosa (AN) remains poorly understood. Cerebral blood flow (CBF) is an indirect marker of neuronal function. In healthy adults, fasting increases CBF, reflecting increased delivery of oxygen and glucose to support brain metabolism. This study investigated whether women remitted from restricting-type AN (RAN) have altered CBF in response to hunger that may indicate homeostatic dysregulation contributing to their ability to restrict food. We compared resting CBF measured with pulsed arterial spin labeling in 21 RAN and 16 healthy comparison women (CW) when hungry (after a 16-h fast) and after a meal. Only remitted subjects were examined to avoid the confounding effects of malnutrition on brain function. Compared to CW, RAN demonstrated a reduced difference in the Hungry − Fed CBF contrast in the right ventral striatum, right subgenual anterior cingulate cortex (pcorr < 0.05) and left posterior insula (punc < 0.05); RAN had decreased CBF when hungry versus fed, whereas CW had increased CBF when hungry versus fed. Moreover, decreased CBF when hungry in the left insula was associated with greater hunger ratings on the fasted day for RAN. This represents the first study to show that women remitted from AN have aberrant resting neurovascular function in homeostatic neural circuitry in response to hunger. Regions involved in homeostatic regulation showed group differences in the Hungry − Fed contrast, suggesting altered cellular energy metabolism in this circuitry that may reduce motivation to eat.
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Affiliation(s)
- Christina E Wierenga
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States
| | - Amanda Bischoff-Grethe
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States
| | - Grace Rasmusson
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States
| | - Ursula F Bailer
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States.,Division of Biological Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Laura A Berner
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States
| | - Thomas T Liu
- Department of Radiology, University of California San Diego, La Jolla, CA, United States
| | - Walter H Kaye
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States
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11
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Brown GG, Thomas ML, Patt V. Parametric model measurement: reframing traditional measurement ideas in neuropsychological practice and research. Clin Neuropsychol 2017; 31:1047-1072. [PMID: 28617067 DOI: 10.1080/13854046.2017.1334829] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Neuropsychology is an applied measurement field with its psychometric work primarily built upon classical test theory (CTT). We describe a series of psychometric models to supplement the use of CTT in neuropsychological research and test development. METHOD We introduce increasingly complex psychometric models as measurement algebras, which include model parameters that represent abilities and item properties. Within this framework of parametric model measurement (PMM), neuropsychological assessment involves the estimation of model parameters with ability parameter values assuming the role of test 'scores'. Moreover, the traditional notion of measurement error is replaced by the notion of parameter estimation error, and the definition of reliability becomes linked to notions of item and test information. The more complex PMM approaches incorporate into the assessment of neuropsychological performance formal parametric models of behavior validated in the experimental psychology literature, along with item parameters. These PMM approaches endorse the use of experimental manipulations of model parameters to assess a test's construct representation. Strengths and weaknesses of these models are evaluated by their implications for measurement error conditional upon ability level, sensitivity to sample characteristics, computational challenges to parameter estimation, and construct validity. CONCLUSION A family of parametric psychometric models can be used to assess latent processes of interest to neuropsychologists. By modeling latent abilities at the item level, psychometric studies in neuropsychology can investigate construct validity and measurement precision within a single framework and contribute to a unification of statistical methods within the framework of generalized latent variable modeling.
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Affiliation(s)
- Gregory G Brown
- a Psychology Service (116B) , VA San Diego Healthcare System , San Diego , CA , USA
| | - Michael L Thomas
- b Department of Psychiatry , University of California , San Diego , CA , USA
| | - Virginie Patt
- c San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology , San Diego , CA , USA
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12
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Multiple stages of learning in perceptual categorization: evidence and neurocomputational theory. Psychon Bull Rev 2016; 22:1598-613. [PMID: 25917141 DOI: 10.3758/s13423-015-0827-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Virtually all current theories of category learning assume that humans learn new categories by gradually forming associations directly between stimuli and responses. In information-integration category-learning tasks, this purported process is thought to depend on procedural learning implemented via dopamine-dependent cortical-striatal synaptic plasticity. This article proposes a new, neurobiologically detailed model of procedural category learning that, unlike previous models, does not assume associations are made directly from stimulus to response. Rather, the traditional stimulus-response (S-R) models are replaced with a two-stage learning process. Multiple streams of evidence (behavioral, as well as anatomical and fMRI) are used as inspiration for the new model, which synthesizes evidence of multiple distinct cortical-striatal loops into a neurocomputational theory. An experiment is reported to test a priori predictions of the new model that: (1) recovery from a full reversal should be easier than learning new categories equated for difficulty, and (2) reversal learning in procedural tasks is mediated within the striatum via dopamine-dependent synaptic plasticity. The results confirm the predictions of the new two-stage model and are incompatible with existing S-R models.
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13
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Rose M, Reville MC, Iszatt A, Levinson S, Frampton I, Lask B. Deconstructing Planning Ability in Children and Adolescents with Anorexia Nervosa. APPLIED NEUROPSYCHOLOGY-CHILD 2016; 6:297-304. [DOI: 10.1080/21622965.2016.1172312] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Mark Rose
- The Huntercombe Group, Newmarket, UK
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Marie-Claire Reville
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- College of Life and Environmental Sciences, University of Exeter, Exeter, UK
| | - Amber Iszatt
- College of Life and Environmental Sciences, University of Exeter, Exeter, UK
| | | | - Ian Frampton
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- College of Life and Environmental Sciences, University of Exeter, Exeter, UK
- Regional Eating Disorders Service, Oslo University Hospital, Oslo, Norway
| | - Bryan Lask
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- College of Life and Environmental Sciences, University of Exeter, Exeter, UK
- Regional Eating Disorders Service, Oslo University Hospital, Oslo, Norway
- Care UK, Colchester, UK
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14
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Ely AV, Wierenga CE, Kaye WH. Anxiety Impacts Cognitive Inhibition in Remitted Anorexia Nervosa. EUROPEAN EATING DISORDERS REVIEW 2016; 24:347-51. [DOI: 10.1002/erv.2451] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 02/26/2016] [Accepted: 03/23/2016] [Indexed: 12/31/2022]
Affiliation(s)
- Alice V. Ely
- Department of Psychiatry; University of California San Diego; San Diego CA USA
| | | | - Walter H. Kaye
- Department of Psychiatry; University of California San Diego; San Diego CA USA
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15
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Abstract
Studies published between the beginning of 2013 and May 2015 on the neuropsychological functioning of patients with anorexia nervosa compared with healthy participants framed in the context of the Research Domain Criteria matrix identifies evidence for functional differences in three domains: Negative Valance Systems-negative attentional biases and lack of neural responsivity to hunger; Cognitive Systems-limited congruence between clinical and cognitive performance, poorer non-verbal than verbal performance, altered attentional styles to disorder related stimuli, perceptual processing impairment in discriminating body images, weaknesses in central coherence, set shifting weaknesses at low weight status, decision-making weaknesses, and greater neural resources required for working memory; Systems for Social Processes-patients appear to have a different attentional response to faces, and perception and understanding of self and others. Hence, there is evidence to suggest that patients with anorexia nervosa have a specific neuropsychological performance style across tasks in three domains of functioning. Some current controversies and areas for future development are identified.
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Affiliation(s)
- Marie-Claire Reville
- Feeding and Eating Disorders Service, Department of Child and Adolescent Mental Health, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, UK.
- College of Life and Environmental Sciences, University of Exeter, Exeter, UK.
| | - Lorna O'Connor
- College of Life and Environmental Sciences, University of Exeter, Exeter, UK
- Department of Psychology, University of Bath, Bath, UK
| | - Ian Frampton
- Feeding and Eating Disorders Service, Department of Child and Adolescent Mental Health, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, UK
- College of Life and Environmental Sciences, University of Exeter, Exeter, UK
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16
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Firk C, Mainz V, Schulte-Ruether M, Fink G, Herpertz-Dahlmann B, Konrad K. Implicit sequence learning in juvenile anorexia nervosa: neural mechanisms and the impact of starvation. J Child Psychol Psychiatry 2015; 56:1168-76. [PMID: 25623396 DOI: 10.1111/jcpp.12384] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/09/2014] [Indexed: 01/10/2023]
Abstract
BACKGROUND Previous studies have reported that cognitive deficits occur in patients with anorexia nervosa (AN) and that these deficits may represent a predisposition towards developing AN or perpetuate the disorder. Specifically, dysfunctional implicit learning may contribute to the development of highly resistant dieting behaviours that are fundamental to the persistence of the disorder. Thus, the aims of this study were (a) to investigate implicit sequence learning in adolescent patients with AN before and after weight recovery and (b) to elucidate the associated neural mechanisms in acute AN relative to healthy controls. METHODS In a behavioural study, implicit sequence learning was assessed using a serial reaction time task in 27 adolescents with AN before (T1) and after weight recovery (T2) compared with age-matched healthy controls (HC) who were assessed at similar time intervals. The neural correlates of implicit sequence learning were subsequently investigated in 19 AN patients shortly after they were admitted to the hospital and 20 HC using functional magnetic resonance imaging (fMRI). RESULTS At T1, AN patients showed reduced sequence learning compared with HC. However, no behavioural differences between HC and AN patients were found at T2. At the neural level, acute AN patients showed reduced thalamic activation during sequence learning compared with HC subjects. CONCLUSIONS Our data suggest that the impaired implicit learning observed in adolescent AN patients before weight gain is a state-related dysfunction that normalises with weight gain. Thus, implicit learning deficits do not appear to represent a predisposition towards developing AN; rather, these deficits should be considered when planning psychotherapeutic interventions for acute AN. Reduced thalamic activation during the acute stage of AN may indicate a starvation-induced dysfunction of the neural circuitry that is involved in behavioural flexibility.
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Affiliation(s)
- Christine Firk
- Department of Child and Adolescent Psychiatry, University Hospital RWTH Aachen, Aachen, Germany
| | - Verena Mainz
- Department of Child and Adolescent Psychiatry, University Hospital RWTH Aachen, Aachen, Germany
| | - Martin Schulte-Ruether
- Department of Child and Adolescent Psychiatry, University Hospital RWTH Aachen, Aachen, Germany.,Institute of Neuroscience and Medicine (INM-3), Research Centre Juelich, Juelich, Germany
| | - Gereon Fink
- Institute of Neuroscience and Medicine (INM-3), Research Centre Juelich, Juelich, Germany.,Department of Neurology, University Hospital Cologne, Cologne, Germany
| | - Beate Herpertz-Dahlmann
- Department of Child and Adolescent Psychiatry, University Hospital RWTH Aachen, Aachen, Germany
| | - Kerstin Konrad
- Department of Child and Adolescent Psychiatry, University Hospital RWTH Aachen, Aachen, Germany.,Institute of Neuroscience and Medicine (INM-3), Research Centre Juelich, Juelich, Germany
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17
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Wildes JE, Marcus MD. Application of the Research Domain Criteria (RDoC) framework to eating disorders: emerging concepts and research. Curr Psychiatry Rep 2015; 17:30. [PMID: 25773226 DOI: 10.1007/s11920-015-0572-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The Research Domain Criteria (RDoC) project was initiated by the National Institute of Mental Health as a heuristic for addressing the limitations of categorical, symptom-based psychiatric diagnoses. RDoC is conceptualized as a matrix, with the rows representing dimensional constructs or domains implicated in the expression of psychiatric symptoms and the columns representing units of analysis that can be used to assess dimensional constructs (i.e., genes, molecules, cells, circuits, physiology, behavior, and self-reports). Few studies in eating disorders have adopted an RDoC framework, but accumulating data provide support for the relevance of RDoC dimensions to eating disorder symptoms. Herein, we review findings from RDoC-informed studies across the five domains of functioning included in the RDoC matrix-negative valence systems, positive valence systems, cognitive systems, systems for social processes, and arousal and regulatory systems-and describe directions for future research utilizing RDoC to enhance study design and treatment development in eating disorders.
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Affiliation(s)
- Jennifer E Wildes
- Department of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic of UPMC, 3811 O'Hara Street, Pittsburgh, PA, 15213, USA,
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