Samantha Lloyd

Cognitive Remediation Therapy for Anorexia Nervosa: Current Evidence and Future Research Directions

The effective treatment of anorexia nervosa (AN) remains a significant challenge. This had prompted new research into ways of engaging and keeping patients in treatment, and ultimately achieving better outcomes, not only on a symptomatic level but also in broader aspects of life. 1 In an attempt to improve treatment outcomes for AN, there has been a move toward approaches that target the core maintaining factors of the disorder. Impaired cognition has been implicated in the maintenance of AN, contributing to individuals’ difficulties in processing and in engaging with psychological therapy. An established body of existing research (including both systematic reviews and large sample studies) currently highlights two main areas of difficulty—cognitive flexibility (particularly setshifting difficulties) and an extreme attention to detail (or weak central coherence). 2 Both inflexibility and an overly detail-focused way of thinking are prevalent in adults with AN, and appear to be exaggerated in the acute stage of the illness. 3

Can Psychological Interventions Reduce Perfectionism? A Systematic Review and Meta-analysis

BACKGROUND Perfectionism is implicated in a range of psychiatric disorders, impedes treatment and is associated with poorer treatment outcomes. AIMS The aim of this systematic review and meta-analysis was to summarize the existing evidence for psychological interventions targeting perfectionism in individuals with psychiatric disorders associated with perfectionism and/or elevated perfectionism. METHOD Eight studies were identified and were analysed in meta-analyses. Meta-analyses were carried out for the Personal Standards and Concern over Mistakes subscales of the Frost Multi-Dimensional Perfectionism Scale (FMPS) and the Self Orientated Perfectionism and Socially Prescribed Perfectionism subscales of the Hewitt and Flett MPS (HMPS) in order to investigate change between pre and postintervention. RESULTS Large pooled effect sizes were found for the Personal Standards and Concern over Mistakes subscales of the FMPS and the Self Orientated Perfectionism subscale of the HMPS, whilst a medium sized effect was found for change in Socially Prescribed Perfectionism. Medium pooled effect sizes were also found for symptoms of anxiety and depression. CONCLUSIONS There is some support that it is possible to significantly reduce perfectionism in individuals with clinical disorders associated with perfectionism and/or clinical levels of perfectionism. There is also some evidence that such interventions are associated with decreases in anxiety, depression, eating disorder and obsessive compulsive symptoms. Further research is needed in order to investigate the optimal dosage and format of such interventions as well as into specific disorders where there is a lack of evidence for their effectiveness.

Do Children and Adolescents with Anorexia Nervosa Display an Inefficient Cognitive Processing Style

Objective This study aimed to examine neuropsychological processing in children and adolescents with Anorexia Nervosa (AN). The relationship of clinical and demographic variables to neuropsychological functioning within the AN group was also explored. Method The performance of 41 children and adolescents with a diagnosis of AN were compared to 43 healthy control (HC) participants on a number of neuropsychological measures. Results There were no differences in IQ between AN and HC groups. However, children and adolescents with AN displayed significantly more perseverative errors on the Wisconsin Card Sorting Test, and lower Style and Central Coherence scores on the Rey Osterrieth Complex Figure Test relative to HCs. Conclusion Inefficient cognitive processing in the AN group was independent of clinical and demographic variables, suggesting it might represent an underlying trait for AN. The implications of these findings are discussed.

Perfectionism in Anorexia Nervosa: Novel Performance Based Evidence

Existing research into perfectionism in Anorexia Nervosa (AN) is limited by a reliance upon self-report measures. This study used novel performance based measures to investigate whether there is behavioural evidence for elevated perfectionism in AN. 153 participants took part in the study – 81 with a diagnosis of AN and 72 healthy controls (HCs). Participants completed two performance based tasks assessing perfectionism – a text replication task and a bead sorting task – along with self-report measures of perfectionism. Significant group differences were observed on both tasks. In the text replication task the AN group took significantly longer compared with healthy controls (p = 0.03, d = 0.36) and produced significantly higher quality copies (p = <0.01, d = 0.45). In the bead sorting task, there was a trend towards more participants in the AN group choosing to check their work compared with the HC group (p = 0.07, d = 0.30) and the AN group took significantly longer checking than those in the HC group (p = <0.01, d = 0.45). Only copy quality uniquely predicted scores on self report measures of perfectionism. This study provides empirically tested evidence of elevated performance based perfectionism in AN compared with a healthy control group.

Targeting Perfectionism in Anorexia Nervosa Using a Group-Based Cognitive Behavioural Approach: A Pilot Study

OBJECTIVE This study aimed to explore whether a six session cognitive behavioural group intervention targeting perfectionism is efficacious in reducing perfectionism in adults with anorexia nervosa in an inpatient setting. METHOD Adults with anorexia nervosa received a group perfectionism intervention in an inpatient setting. Self-report and patient satisfaction questionnaires were completed at the beginning of the first session and end of the last session. RESULTS Significant changes of moderate effect size were observed for overall perfectionism, concern over mistakes and personal standards dimensions of perfectionism following participation in the group. These changes were found to be independent of change in body mass index. CONCLUSIONS A group cognitive behavioural approach appears to be efficacious in reducing perfectionism in adults with anorexia nervosa.

Targeting perfectionism in anorexia nervosa using a group-based cognitive behavioural approach

OBJECTIVE This study aimed to explore whether a six session cognitive behavioural group intervention targeting perfectionism is efficacious in reducing perfectionism in adults with anorexia nervosa in an inpatient setting. METHOD Adults with anorexia nervosa received a group perfectionism intervention in an inpatient setting. Self-report and patient satisfaction questionnaires were completed at the beginning of the first session and end of the last session. RESULTS Significant changes of moderate effect size were observed for overall perfectionism, concern over mistakes and personal standards dimensions of perfectionism following participation in the group. These changes were found to be independent of change in body mass index. CONCLUSIONS A group cognitive behavioural approach appears to be efficacious in reducing perfectionism in adults with anorexia nervosa.

Telephone-based guided self-help for adolescents with chronic fatigue syndrome: A non-randomised cohort study

The aim of this study was to gain preliminary evidence about the efficacy of a new telephone-based guided self-help intervention, based on cognitive-behavioural principles, which aimed to reduce fatigue and improve school attendance in adolescents with chronic fatigue syndrome (CFS). A non-randomised cohort design was used, with a two-month baseline period. Sixty-three 11-18 year-old participants recruited from a specialist CFS unit received the intervention. Participants received six half-hour fortnightly telephone sessions and two follow-up sessions. Fatigue and school attendance were the main outcomes and the main time point for assessing outcome was 6 months post-treatment. Using multi-level modelling, a significant decrease in fatigue was found between pre-treatment and 6 month follow-up, treatment effect estimate = - 5.68 (-7.63, -3.72), a large effect size (Cohens d = 0.79). The decrease in fatigue between pre and post-treatment was significantly larger than between baseline and pre-treatment. A significant increase in school attendance was found between pre-treatment and 6 month follow-up, effect estimate = 1.38 (0.76, 2.00), a medium effect size (d = -0.48). univariate logistic regression found baseline perfectionism to be associated with better [corrected] school attendance at six-month follow-up. In conclusion, telephone-based guided self-help is an acceptable minimal intervention which is efficacious in reducing fatigue in adolescents with CFS.

Patients’ perspective of a group intervention for perfectionism in anorexia nervosa: A qualitative study

This study aimed to explore the experiences of adults with anorexia nervosa who took part in a perfectionism group intervention in an inpatient setting. Thematic analysis was used to explore patient feedback collected in focus groups. Patient feedback was generally positive and centred around three main themes: perceived benefits of the group, the content of the group and suggested improvements. The findings suggest that a brief perfectionism group intervention is an acceptable treatment with a range of perceived benefits for patients with severe anorexia nervosa. Understanding patients’ experiences of the intervention can provide further important information to maximise therapeutic impact of the group in inpatient settings.

Self-reported and performance based perfectionism in mothers of individuals with Anorexia Nervosa: a pilot study.

SummaryBackgroundPerfectionism is implicated in the development and maintenance of Anorexia Nervosa and there is some evidence that perfectionism may be elevated in family members. However to date there are no studies investigating behavioural aspects of perfectionism in unaffected mothers.MethodsForty-one participants took part in this pilot study: 21 unaffected mothers of individuals with Anorexia Nervosa and 20 healthy control mothers. Participants completed two performance based tasks assessing perfectionism—a text replication task and a bead sorting task—along with self-report measures of perfectionism.ResultsNo group differences were found between unaffected AN mothers and HC mothers on performance measures of perfectionism.DiscussionThe findings are discussed in relation to existing studies and clinical implications explored.ZusammenfassungGrundlagenPerfektionismus wird mit der Entwicklung und Aufrechterhaltung von Anorexia Nervosa in Verbindung gebracht, und die Forschung deutet darauf hin, dass Perfektionismus auch bei Familienmitgliedern erhöht sein könnte. Dennoch wurden bisher keine Studien veröffentlicht, die verhaltensbezogene Aspekte von Perfektionismus bei nicht beeinträchtigten Müttern untersuchen.MethodikEs nahmen 41 Probandinnen an dieser Pilotstudie teil: 21 nicht beeinträchtigte Mütter von Personen mit Anorexia Nervosa und 20 gesunde Kontrollmütter. Die Probanden absolvierten zwei leistungsbasierte Tests zur Erhebung von Perfektionismus – eine Text-Reproduktions-Aufgabe und eine Perlen-Sortier-Aufgabe – und einen Selbstbericht zur Erhebung von Perfektionismus.ErgebnisseEs wurden keine Gruppenunterschiede zwischen nicht beeinträchtigten Müttern von Personen mit AN und Kontrollmüttern bezüglich des leistungsbezogenen Perfektionismus gefunden.DiskussionDie Ergebnisse werden in Bezug auf bereits vorhandene Studien und klinische Implikationen diskutiert.

Self-reported and performance based perfectionism in mothers of individuals with Anorexia Nervosa: a pilot study@@@Selbstberichteter und leistungsbasierter Perfektionismus bei Müttern von Personen mit Anorexia Nervosa: eine Pilotstudie

SummaryBackgroundPerfectionism is implicated in the development and maintenance of Anorexia Nervosa and there is some evidence that perfectionism may be elevated in family members. However to date there are no studies investigating behavioural aspects of perfectionism in unaffected mothers.MethodsForty-one participants took part in this pilot study: 21 unaffected mothers of individuals with Anorexia Nervosa and 20 healthy control mothers. Participants completed two performance based tasks assessing perfectionism—a text replication task and a bead sorting task—along with self-report measures of perfectionism.ResultsNo group differences were found between unaffected AN mothers and HC mothers on performance measures of perfectionism.DiscussionThe findings are discussed in relation to existing studies and clinical implications explored.ZusammenfassungGrundlagenPerfektionismus wird mit der Entwicklung und Aufrechterhaltung von Anorexia Nervosa in Verbindung gebracht, und die Forschung deutet darauf hin, dass Perfektionismus auch bei Familienmitgliedern erhöht sein könnte. Dennoch wurden bisher keine Studien veröffentlicht, die verhaltensbezogene Aspekte von Perfektionismus bei nicht beeinträchtigten Müttern untersuchen.MethodikEs nahmen 41 Probandinnen an dieser Pilotstudie teil: 21 nicht beeinträchtigte Mütter von Personen mit Anorexia Nervosa und 20 gesunde Kontrollmütter. Die Probanden absolvierten zwei leistungsbasierte Tests zur Erhebung von Perfektionismus – eine Text-Reproduktions-Aufgabe und eine Perlen-Sortier-Aufgabe – und einen Selbstbericht zur Erhebung von Perfektionismus.ErgebnisseEs wurden keine Gruppenunterschiede zwischen nicht beeinträchtigten Müttern von Personen mit AN und Kontrollmüttern bezüglich des leistungsbezogenen Perfektionismus gefunden.DiskussionDie Ergebnisse werden in Bezug auf bereits vorhandene Studien und klinische Implikationen diskutiert.