Roxanne Rockwell

Cognitive set-shifting in anorexia nervosa.

OBJECTIVE Adult anorexia nervosa (AN) is associated with inefficient cognitive flexibility and set-shifting. Whether such inefficiencies also characterize adolescent AN is an important area of research. METHOD Adolescents with AN and matched controls were administered a computerized task that required initial learning of an explicit rule using corrective feedback and learning of a new rule after a set number of trials. Adult patients with AN and controls were also examined. RESULTS Adolescents with AN did not differ from matched controls with respect to set-shifting cost (decrease in performance after rule change), whereas adults with AN had significantly greater set-shifting cost compared with controls. DISCUSSION This study suggests that set-shifting inefficiencies may not be a vulnerability factor for AN development in adolescents with AN, but might become an important aspect of the disorder at later age, and could point towards developmental neurobiologic brain changes that could affect AN at different ages.

Relationships Between Body Satisfaction and Psychological Functioning and Weight-Related Cognitions and Behaviors in Overweight Adolescents

PURPOSE To examine how differences in body satisfaction may influence weight control behaviors, eating, weight and shape concerns, and psychological well-being among overweight adolescents. METHODS A group of 103 overweight adolescents completed a survey assessing body satisfaction, weight control behaviors, eating-related thoughts and behaviors, importance placed on thinness, self-esteem, anger, and symptoms of depression and anxiety between 2004 and 2006. Logistic regression analyses compared overweight adolescents with high and low body satisfaction. RESULTS Higher body satisfaction was associated with a lower likelihood of engaging in unhealthy weight control behaviors, less frequent fears of losing control over eating, and less importance placed on thinness. Overweight adolescents with higher body satisfaction reported higher levels of self-esteem and were less likely to endorse symptoms of depression, anxiety, and anger than overweight adolescents with lower body satisfaction. CONCLUSIONS Adolescents with higher body satisfaction may be protected against the negative behavioral and psychological factors associated with overweight.

An Innovative Short‐term, Intensive, Family‐based Treatment for Adolescent Anorexia Nervosa: Case Series

OBJECTIVE In order to improve the dissemination of new expert-based treatments for adolescents with anorexia nervosa, we have developed an innovative 1-week intensive family-based evaluation and treatment programme. Ages of the adolescents in the programme ranged from 10 to 18 years (mean = 15.0, SD = 2.1). We report the outcomes of the first 19 cases. METHOD Data were obtained from a retrospective chart review and a follow-up of cases at 52 to 738 days (mean = 278.4, SD = 193.8) post-treatment. The primary outcome measure was ideal body weight (IBW) percentage. RESULTS At admission, the duration of illness ranged from less than 1 to 8 years (mean 2.1, SD = 1.7). Admission IBW ranged from 69.3 to 99.1% (mean = 84.3%, SD = 8.7). Follow-up IBW ranged from 84.4 to 134.6% (mean = 99.3%, SD = 11.8). All but one patient reported a sustained gain in weight post-treatment (mean = 15.0, SD = 14.5). DISCUSSION These data provide further support for the notion that short-term family-based therapy may be useful for weight restoration and maintenance in some adolescents with anorexia nervosa.

Short‐Term Intensive Family Therapy for Adolescent Eating Disorders: 30‐Month Outcome

Family therapy approaches have generated impressive empirical evidence in the treatment of adolescent eating disorders (EDs). However, the paucity of specialist treatment providers limits treatment uptake; therefore, our group developed the intensive family therapy (IFT)-a 5-day treatment based on the principles of family-based therapy for EDs. We retrospectively examined the long-term efficacy of IFT in both single-family (S-IFT) and multi-family (M-IFT) settings evaluating 74 eating disordered adolescents who underwent IFT at the University of California, San Diego, between 2006 and 2013. Full remission was defined as normal weight (≥ 95% of expected for sex, age, and height), Eating Disorder Examination Questionnaire (EDE-Q) global score within 1 SD of norms, and absence of binge-purging behaviours. Partial remission was defined as weight ≥ 85% of expected or ≥ 95% but with elevated EDE-Q global score and presence of binge-purging symptoms (<1/week). Over a mean follow-up period of 30 months, 87.8% of participants achieved either full (60.8%) or partial remission (27%), while 12.2% reported a poor outcome, with both S-IFT and M-IFT showing comparable outcomes. Short-term, intensive treatments may be cost-effective and clinically useful where access to regular specialist treatment is limited.

Simulating category learning and set shifting deficits in patients weight-restored from anorexia nervosa.

OBJECTIVE To examine set shifting in a group of women previously diagnosed with anorexia nervosa who are now weight-restored (AN-WR) and then apply a biologically based computational model (Competition between Verbal and Implicit Systems [COVIS]) to simulate the pattern of category learning and set shifting performances observed. METHOD Nineteen AN-WR women and 35 control women (CW) were administered an explicit category learning task that required rule acquisition and then a set shift following a rule change. COVIS was first fit to the behavioral results of the controls and then parameters of the model theoretically relevant to AN were altered to mimic the behavioral results. RESULTS Relative to CW, the AN-WR group displayed steeper learning curves (i.e., hyper learning) before the rule shift, but greater difficulty in learning the new categories after the rule shift (i.e., a deficit in set shifting). Hyper learning and set shifting deficits in the AN-WR group were not associated and differentially correlated with clinical measures. Hyper learning in the AN-WR group was simulated by increasing the model parameter that represents sensitivity to negative feedback (δ parameter), whereas the deficit in set shifting was simulated by altering the parameters that represent changes in rule selection and flexibility (λ and γ parameters, respectively). CONCLUSIONS These simulations suggest that multiple factors can impact category learning and set shifting in AN-WR individuals (e.g., alterations in sensitivity to negative feedback, rule selection deficits, and inflexibility) and provide an important starting point to further investigate this pervasive deficit in adult AN.

Adapting Family-Based Treatment for Adolescent Anorexia Nervosa Across Higher Levels of Patient Care

An increasing body of evidence supports the use of family-based treatment (FBT) in medically stable outpatient presentations of adolescent anorexia nervosa, although there is relatively less research on adapting evidence-based treatment approaches in more intensive levels of patient care. The integration of FBT, which centrally leverages parental involvement in more intensive levels of care which typically require greater clinical management, requires careful consideration. We provide an overview of several key practical and theoretical considerations when adjusting the delivery of FBT across more intensive levels of patient care, providing clinical guidelines for the delivery of FBT while ensuring fidelity to the core theoretical tenets. Implications for clinical practice and future research are discussed.

Management of Bulimia Nervosa

Bulimia nervosa is a disorder of complex etiology that tends to occur in young women. These individuals binge eat and purge by vomiting or other means, and often have depression, anxiety, substance abuse and extremes of impulse control. It is thought that binge eating and purging behaviors are, at least in part, a means of coping with dysphoric mood states and interpersonal stress. Bulimic symptoms are not likely to abate without development of new coping skills and behaviors. In the past 25 years, considerable progress has been made in developing specific psychotherapies and medication for the treatment of bulimia nervosa. Despite this progress, many individuals have partial responses to therapy and may remain chronically ill. This complex illness often requires a multidisciplinary team of professionals for effective management and, despite significant advances in treatment, bulimia nervosa continues to present major challenges for providers of care.

Integrating Family-Based Treatment and Dialectical Behavior Therapy for Adolescent Bulimia Nervosa: Preliminary Outcomes of an Open Pilot Trial

Adolescent bulimia nervosa (BN) remains relatively understudied, and the complex interaction between core eating psychopathology and emotional regulation difficulties provides ongoing challenges for full symptom remission. In an open pilot trial, we aimed to investigate the efficacy of a program integrating family-based treatment (FBT) and dialectical behavior therapy (DBT) in treating adolescent BN, without exclusion criteria. Participants were 35 adolescents who underwent partial hospital treatment for BN, and outcomes included measures of core BN pathology and emotional regulation difficulties, as well as parental measures of self-efficacy, completed at intake and discharge. Results indicate significant improvements in overall eating disorder pathology, t(68) = 4.52, p = .002, and in core BN symptoms, including objective binge episodes, t(68) = 2.01, p = .041, and self-induced vomiting, t(68) = 2.90, p = .005. Results also illustrated a significant increase in parental efficacy throughout the course of treatment, t(20) = .081, p = .001, although no global improvement in difficulties in emotion regulation was noted, t(68) = 1.12, p = .285. These preliminary findings support the utility of this integration of FBT and DBT, although raise interesting questions as to the mechanism of symptom remission.

The Integration of Family-Based Treatment and Dialectical Behavior Therapy for Adolescent Bulimia Nervosa: Philosophical and Practical Considerations

Dialectical behavior therapy (DBT) and family-based treatment (FBT) are two evidence-based interventions that have been applied in the treatment of bulimia nervosa (BN) in adolescents. While DBT focuses on providing skills for coping with emotion dysregulation that often co-occurs with BN, FBT targets the normalization of eating patterns. The purpose of the current article is to introduce an integration of both treatments to provide a more comprehensive approach that targets the full scope of the disorder. We provide a review of the conceptual similarities and differences between FBT-BN and DBT along with strategies to guide a blended treatment approach. Given the strengths and limitations of either independent treatment, DBT and FBT-BN complement one another and together can address the range of symptoms and behaviors typically seen in adolescent BN.

A Brief, Intensive Application of Multi-Family-Based Treatment for Eating Disorders.

There is a continued need to improve upon the efficacy and availability of treatments for anorexia nervosa. Family-based therapy for anorexia nervosa demonstrates strong empirical evidence; however, trained treatment providers are limited and a subsample of participants receiving the treatment fail to respond. The intensive family treatment program is a brief, time-limited, multi-family program that trains families of adolescents with eating disorders to oversee their adolescents’ recovery at home by providing psychoeducation, skills training, and immersive practice over the course of a 5-day period. This article provide a description of the program by summarizing underlying theoretical principles and key therapeutic components.