Unna N. Danner

Habit vs. intention in the prediction of future behaviour: The role of frequency, context stability and mental accessibility of past behaviour

This research examined the role of habit and intention in the prediction of future behaviour by analysing that past behaviour frequency moderates the intention-behaviour relationship to the extent that the context in which the behaviour was performed is stable. In two correlational studies, it was found that habit interacted with intention when context stability was taken into account and not when merely past behaviour frequency was considered: intentions guided future behaviour when habits were weak (low frequency or unstable context), while this was not the case when habits were strong (high frequency and stable context). A third exploratory study investigated and confirmed the idea that, if habitual goal-directed behaviour is directly activated by the context, mental accessibility of the behaviour (i.e. the ease of accessing the goal-directed behaviour in memory) moderates the intention-behaviour relation in a similar way. These findings are discussed against the background of current research on goal-directed habits and the cognitive processes underlying them.

Neuropsychological weaknesses in anorexia nervosa: Set-shifting, central coherence, and decision making in currently ill and recovered women

OBJECTIVE The purpose of this study is to examine set-shifting, central coherence, and decision making in women currently ill with anorexia nervosa (AN), women recovered from AN, and healthy control women. We aim to test whether these neuropsychological weaknesses persist after recovery, and explore relations between the impairments RESULTS Compared to control women, ill and recovered women showed poor set-shifting and decision making. There were strong correlations between set-shifting and central coherence in the ill and recovered women. Decision making did not correlate with the other measures. DISCUSSION The present findings suggest that impaired set-shifting and decision making are stable traits in women with AN. Because individual differences within these groups were large, a rigid thinking style is only present in a (sub)population of ill and recovered women. Decision-making performance is not related to a rigid thinking style, but further research in this area is warranted.

Decision-making impairments in women with binge eating disorder in comparison with obese and normal weight women.

OBJECTIVE The purpose of the current study was to examine decision making in female patients with binge eating disorder (BED) in comparison with obese and normal weight women. METHOD In the study, 20 patients with BED, 21 obese women without BED and 34 healthy women participated. Decision making was assessed using the Iowa Gambling Task (IGT). Several questionnaires were administered measuring binge eating severity, sensitivity for punishment and reward, and self-control. RESULTS The findings indicated that the BED and obese group performed poorly on the IGT. Participants who have BED and are obese did not improve their choice behaviour over time, whereas participants with normal weight showed a learning effect. An association between IGT performance and binge eating severity was found. CONCLUSION This study demonstrates that patients with BED display decision-making deficits on the IGT comparable with other forms of disordered eating. Future research should focus on unravelling the processes underlying the deficits.

Habit Formation and Multiple Means to Goal Attainment: Repeated Retrieval of Target Means Causes Inhibited Access to Competitors

Three studies examined the cognitive processes underlying the formation of goal-directed habits in a multiple means context. Repeated retrieval of target means upon goal activation was expected to result in inhibition of competing means for the same goal. In all studies, participants studied goal—means combinations and subsequently practiced the retrieval of certain means to attain the goals in a retrieval paradigm. Study 1 tested accessibility of the different means in a goal—means verification task and showed that competing means were not inhibited after a single retrieval but only upon repeated retrieval (three or nine times). Studies 2 and 3 extended these findings in a means—recognition task and demonstrated that inhibition occurred in the absence of explicit intent or instructions to suppress the competitors. These inhibitory effects of competing means are discussed against the background of current social cognition research on the processes underlying goal—means networks and the formation of habits.

The effectiveness of cognitive remediation therapy in patients with a severe or enduring eating disorder: a randomized controlled trial.

Background: Individuals with eating disorders show deficits in neuropsychological functioning which might preexist and underlie the etiology of the eating disorders and influence relapse. Deficits in cognitive flexibility, i.e. set-shifting and central coherence, might perpetuate the symptoms. Cognitive remediation therapy (CRT) was developed to improve cognitive flexibility, thereby increasing the likelihood of improved outcome. The focus of CRT is on how patients think, rather than on what patients think. The present study investigated the effectiveness of CRT for patients with a severe or enduring eating disorder by means of a randomized controlled trial comparing intensive treatment as usual (TAU) to CRT plus TAU. Methods: Eighty-two patients were randomly assigned to CRT plus TAU (n = 41) or TAU alone (n = 41). Outcome measures were set-shifting, central coherence, eating disorder and general psychopathology, motivation, quality of life and self-esteem. Assessments were performed at baseline (n = 82) and after 6 weeks (T1; n = 75) and 6 months (T2; n = 67). Data were analyzed by means of linear mixed model analyses. Results: Patients who received CRT in addition to TAU improved significantly more with regard to eating disorder-related quality of life at the end of treatment (T1) and eating disorder psychopathology at follow-up (T2), compared to those who received TAU only. Moreover, moderator analyses revealed that patients with poor baseline set-shifting abilities benefited more from CRT than patients with no deficits in set-shifting abilities at baseline; the quality of life of the former group was higher than that of the latter at follow-up. Conclusions: CRT seems to be promising in enhancing the effectiveness of concurrent treatment.

Differential Impairments Underlying Decision Making in Anorexia Nervosa and Bulimia Nervosa: A Cognitive Modeling Analysis

OBJECTIVE This study examined the underlying processes of decision-making impairments in individuals with anorexia nervosa (AN) and bulimia nervosa (BN). We deconstructed their performance on the widely used decision task, the Iowa Gambling Task (IGT) into cognitive, motivational, and response processes using cognitive modeling analysis. We hypothesized that IGT performance would be characterized by impaired memory functions and heightened punishment sensitivity in AN, and by elevated sensitivity to reward as opposed to punishment in BN. METHOD We analyzed trial-by-trial data of IGT obtained from 224 individuals: 94 individuals with AN, 63 with BN, and 67 healthy comparison individuals (HC). The prospect valence learning model was used to assess cognitive, motivational, and response processes underlying IGT performance. RESULTS Individuals with AN showed marginally impaired IGT performance compared to HC. Their performance was characterized by impairments in memory functions. Individuals with BN showed significantly impaired IGT performance compared to HC. They showed greater relative sensitivity to gains as opposed to losses than HC. Memory functions in AN were positively correlated with body mass index. DISCUSSION This study identified differential impairments underlying IGT performance in AN and BN. Findings suggest that impaired decision making in AN might involve impaired memory functions. Impaired decision making in BN might involve altered reward and punishment sensitivity.

The importance of distinguishing between the different eating disorders (sub)types when assessing emotion regulation strategies

People with eating disorders (ED) have difficulties regulating their emotions adaptively. Little is known about differences and similarities between different types of ED and how these regulation difficulties relate to other emotional problems. The present study examines maladaptive (suppression) and adaptive (cognitive reappraisal) emotion regulation strategies in women with different ED and relationships with anxiety and depression levels. In 32 women with AN restrictive subtype (ANR), 32 with AN binge-purge subtype (ANBP), 30 with bulimia nervosa (BN), 29 with binge eating disorder (BED), and 64 healthy women, the ERQ (emotion regulation) as well as STAI-T (anxiety), BDI-SF (depression), and EDDS (eating pathology) were administered. Women across different ED subtypes were inclined to suppress emotions and lacked the capacity to reappraise emotions (except women with ANBP). Correlational relations of suppression and reappraisal with anxiety and depression levels differed across ED groups. Emotion regulation problems were found across ED subtypes. However, the types of emotion regulation problems, and the effect of coexisting other emotional problems such as anxiety and depression may differ across ED subtypes. These findings illustrate the importance to of considering ED subtypes in emotion regulation research rather than consider ED as a whole.

Psychometric Properties of the Dutch Version of the Eating Disorder Inventory–3

The psychometric properties of the Dutch version of the Eating Disorder Inventory–3 (EDI-3) were tested in eating disordered patients (N = 514) using confirmatory factor analyses, variance decomposition, reliabilities, and receiver operating characteristic (ROC) curve analyses. Factorial validity results supported the 12 subscales, but model fit was impaired by correlated item errors, misallocated items, and redundant subscales. At the composite level, the Bulimia subscale was identified as a largely specific source of information that did not contribute much to its overarching composite. Reliabilities for subscales and composites ranged from .6 to .9. ROC curve analysis indicated good to excellent discriminative ability of the EDI-3 identifying clinical subjects against a reference group. In conclusion, further revisions of the EDI-3 might target the item allocation and (over-)differentiation of subscales and composites to further clarify its structure. For the clinical practice, we advise the careful use of the EDI-3, although it might serve as a good screening tool.

Hyperactivity in Anorexia Nervosa: Warming Up Not Just Burning-Off Calories

Excessive physical activity is a common feature in Anorexia Nervosa (AN) that interferes with the recovery process. Animal models have demonstrated that ambient temperature modulates physical activity in semi-starved animals. The aim of the present study was to assess the effect of ambient temperature on physical activity in AN patients in the acute phase of the illness. Thirty-seven patients with AN wore an accelerometer to measure physical activity within the first week of contacting a specialized eating disorder center. Standardized measures of anxiety, depression and eating disorder psychopathology were assessed. Corresponding daily values for ambient temperature were obtained from local meteorological stations. Ambient temperature was negatively correlated with physical activity (p = −.405) and was the only variable that accounted for a significant portion of the variance in physical activity (p = .034). Consistent with recent research with an analogous animal model of the disorder, our findings suggest that ambient temperature is a critical factor contributing to the expression of excessive physical activity levels in AN. Keeping patients warm may prove to be a beneficial treatment option for this symptom.

The Eating Disorder Diagnostic Scale: Psychometric Features Within a Clinical Population and a Cut-off Point to Differentiate Clinical Patients from Healthy Controls

The Eating Disorder Diagnostic Scale (EDDS) is a brief self-report measure for diagnosing anorexia nervosa, bulimia nervosa and binge eating disorder. Research has provided evidence of the reliability and validity of this scale in non-clinical populations. Our study is the first to examine the psychometric features of the EDDS in a clinical population of eating disordered patients. We identified a cut-off point that differentiates clinical patients from healthy controls. A clinical group of 59 Dutch female eating disordered patients and a control group of 45 Dutch students completed the EDDS, the Eating Disorder Examination Interview, the Body Attitude Test and the Beck Depression Inventory--II. The EDDS showed good test-retest reliability, internal consistency, criterion validity and convergent validity with other scales assessing eating and general pathology. An overall symptom composite cut-off score of 16.5 accurately distinguished clinical patients from healthy controls. The EDDS may be a useful instrument in clinical settings and in aetiologic, prevention and treatment research.