Beth Renwick

Review of attentional bias modification: a brain-directed treatment for eating disorders.

OBJECTIVE Psychological treatments for eating disorders (ED) rely on mastery of effortful attentional control to divert attention from anxiety provoking thoughts. This paper assesses the potential suitability of attentional bias modification treatment (ABMT) for EDs as a way to target early automatic attentional processes and implicitly retune threat perception that happens outside of conscious control. METHOD We review data on anxiety in EDs, the neurobiological and behavioural relationship between anxiety disorders and EDs, attentional biases (AB) in EDs and the use of ABMT. RESULTS Co-morbidities between EDs and anxiety disorders are common and negatively affect illness outcome. EDs and anxiety disorders share many underlying elements, including AB towards threatening and disorder-relevant stimuli. AB has been modified across a range of anxiety disorders using ABMT. It is possible to modify AB in EDs. CONCLUSION There is evidence to suggest that ABMT has potential as a targeted, rapid and convenient treatment option for EDs.

Review of Attentional Bias Modification

OBJECTIVE Psychological treatments for eating disorders (ED) rely on mastery of effortful attentional control to divert attention from anxiety provoking thoughts. This paper assesses the potential suitability of attentional bias modification treatment (ABMT) for EDs as a way to target early automatic attentional processes and implicitly retune threat perception that happens outside of conscious control. METHOD We review data on anxiety in EDs, the neurobiological and behavioural relationship between anxiety disorders and EDs, attentional biases (AB) in EDs and the use of ABMT. RESULTS Co-morbidities between EDs and anxiety disorders are common and negatively affect illness outcome. EDs and anxiety disorders share many underlying elements, including AB towards threatening and disorder-relevant stimuli. AB has been modified across a range of anxiety disorders using ABMT. It is possible to modify AB in EDs. CONCLUSION There is evidence to suggest that ABMT has potential as a targeted, rapid and convenient treatment option for EDs.

Process Evaluation of the MOSAIC Trial, Part I: Therapist Experiences of Delivering Two Psychological Therapies for Treatment of Anorexia Nervosa

OBJECTIVES Forming part of a process evaluation of a large randomised controlled trial (the Maudsley Outpatient Study of Treatments for Anorexia Nervosa and Related conditions, MOSAIC) comparing two outpatient therapies for Anorexia Nervosa (AN), the Maudsley Model for Treatment of Adults with Anorexia Nervosa (MANTRA) and Specialist Supportive Clinical Management (SSCM), this study adopted a qualitative approach to examine therapist experiences of treatment delivery. METHOD Twenty MOSAIC therapists completed semi-structured interviews. Interviews were recorded, transcribed and analysed thematically. RESULTS Themes of positive aspects, challenges and therapeutic fit emerged. MANTRA was seen as structured and flexible but could feel demanding on therapist time and skill. The slow pace and narrower focus of SSCM gave patients space to talk, but the lack of psychological tools and nutritional emphasis could create frustration. Views on the therapeutic relationship and patient-therapy fit differed across treatments. DISCUSSION Findings provide testable hypotheses about what works for whom, ideas for therapist training, treatment development and delivery.

Threat‐related attentional bias in anorexia nervosa

OBJECTIVE Attentional bias (AB) modification treatment targeting general or social anxiety has been recently highlighted as a potential novel approach for the treatment of anorexia nervosa (AN). The purpose of this study was to examine threat-related AB in patients with ANand healthy control participants (HC) and the relationship between AB and eating disorder and other psychopathology. METHOD Forty-nine female outpatients with AN or Eating Disorder Not Otherwise Specified, Anorexia Type (EDNOS-AN), and 44 female HC completed a dot-probe task with threat words and a range of self-report measures assessing eating disorder symptoms and other psychopathology. RESULTS There was no evidence for a differential threat-related AB in AN patients despite elevated anxiety in this group. The AB-index, a parameter of the magnitude of attention allocation when two competing stimuli are presented, did not correlate with any of the self-report measures. However, patients with AN responded significantly more slowly to the probe as compared to controls, regardless of the valence or position of the stimuli. DISCUSSION The results suggest that the AB in AN patients may be specific to eating disorder-relevant anxieties.

Written case formulations in the treatment of anorexia nervosa: Evidence for therapeutic benefits

OBJECTIVE Case formulation is a core component of many psychotherapies and formulation letters may provide an opportunity to enhance the therapeutic alliance and improve treatment outcomes. This study aimed to determine if formulation letters predict treatment satisfaction, session attendance, and symptom reductions in anorexia nervosa (AN). It was hypothesized that higher quality formulation letters would predict greater treatment satisfaction, a greater number of attended sessions, and greater improvement in eating disorder symptoms. METHOD Patients were adult outpatients with AN (n = 46) who received Maudsley Anorexia Nervosa Treatment for Adults (MANTRA) in the context of a clinical trial. A Case Formulation Rating Scheme was used to rate letters for adherence to the MANTRA model and use of a collaborative, reflective, affirming stance. Analyses included linear regression and mixed models. RESULTS Formulation letters that paid attention to the development of the AN predicted greater treatment acceptability ratings (p = 0.002). More reflective and respectful letters predicted greater reductions in Eating Disorder Examination scores (p = 0.003). DISCUSSION Results highlight the potential significance of a particular style of written formulation as part of treatment for AN. Future research should examine applicability to other psychiatric disorders.

Process Evaluation of the MOSAIC Trial, Part I: Therapist Experiences of Delivering Two Psychological Therapies for Treatment of Anorexia Nervosa: Process Evaluation of the MOSAIC trial: Part I

OBJECTIVES Forming part of a process evaluation of a large randomised controlled trial (the Maudsley Outpatient Study of Treatments for Anorexia Nervosa and Related conditions, MOSAIC) comparing two outpatient therapies for Anorexia Nervosa (AN), the Maudsley Model for Treatment of Adults with Anorexia Nervosa (MANTRA) and Specialist Supportive Clinical Management (SSCM), this study adopted a qualitative approach to examine therapist experiences of treatment delivery. METHOD Twenty MOSAIC therapists completed semi-structured interviews. Interviews were recorded, transcribed and analysed thematically. RESULTS Themes of positive aspects, challenges and therapeutic fit emerged. MANTRA was seen as structured and flexible but could feel demanding on therapist time and skill. The slow pace and narrower focus of SSCM gave patients space to talk, but the lack of psychological tools and nutritional emphasis could create frustration. Views on the therapeutic relationship and patient-therapy fit differed across treatments. DISCUSSION Findings provide testable hypotheses about what works for whom, ideas for therapist training, treatment development and delivery.

Process Evaluation of the MOSAIC Trial, Part 1

OBJECTIVES Forming part of a process evaluation of a large randomised controlled trial (the Maudsley Outpatient Study of Treatments for Anorexia Nervosa and Related conditions, MOSAIC) comparing two outpatient therapies for Anorexia Nervosa (AN), the Maudsley Model for Treatment of Adults with Anorexia Nervosa (MANTRA) and Specialist Supportive Clinical Management (SSCM), this study adopted a qualitative approach to examine therapist experiences of treatment delivery. METHOD Twenty MOSAIC therapists completed semi-structured interviews. Interviews were recorded, transcribed and analysed thematically. RESULTS Themes of positive aspects, challenges and therapeutic fit emerged. MANTRA was seen as structured and flexible but could feel demanding on therapist time and skill. The slow pace and narrower focus of SSCM gave patients space to talk, but the lack of psychological tools and nutritional emphasis could create frustration. Views on the therapeutic relationship and patient-therapy fit differed across treatments. DISCUSSION Findings provide testable hypotheses about what works for whom, ideas for therapist training, treatment development and delivery.