Valentina Cardi

Social reward and rejection sensitivity in eating disorders: An investigation of attentional bias and early experiences

Abstract Objectives. People with eating disorders (EDs) have difficulties with social functioning. One explanatory mechanism is a problem with over-sensitivity to rejection and/or low sensitivity to social reward. The aim of this study is to investigate attentional bias to facial stimuli in people with a lifetime diagnosis of EDs and healthy controls (HCs) and to test whether these attentional biases are linked to adverse early experiences. Methods. Forty-six participants with a current diagnosis of EDs (29 with anorexia nervosa (AN) and 17 with bulimia nervosa (BN)), 22 participants recovered from an eating disorder (13 with past AN and nine with past BN) and 50 HCs completed a dot-probe task with faces expressing rejection and acceptance. Participants reported on parental style and adverse early experiences. Results. People with a lifetime diagnosis of EDs show an attentional bias to rejecting faces and a difficulty disengaging attention from these stimuli. Also, they had a sustained attentional avoidance of accepting faces. HCs demonstrated the opposite attentional pattern. The attentional bias to rejection was correlated with adverse childhood experiences. Conclusions. People with an EDs show vigilance to rejection and avoidance of social reward. This may contribute to the causation or maintenance of the illness.

A Three‐phase Model of the Social Emotional Functioning in Eating Disorders

BACKGROUND Problems with social emotional functioning are an important part of eating disorder psychopathology. AIM This study aimed to propose a model of social emotional functioning before and during the illness and to explain the consequences for those involved. METHOD We propose a three-phase model of social and emotional processes as both causal and maintaining factors in anorexia nervosa. The predictions from this model are examined, and we consider the relevance for treatment. RESULTS The evidence base for the theoretical model is presented: Phase 1 describes causal predispositions and environments, Phase 2 notes the way in which the symptoms themselves impact on brain function and social cognition and Phase 3 explains the reactions of close others. CONCLUSIONS A three-phase model including interpersonal and socio-emotional elements can be used to shape and plan treatment interventions. Understanding causal chains and consequences can give a rationale for change and frame therapeutic interventions.

Video game therapy for emotional regulation and impulsivity control in a series of treated cases with bulimia nervosa.

Although standard psychological treatments have been successful in treating several core features in eating disorders (ED), other characteristics such as emotional regulation or impulsivity appear to be more resistant to change. There is a growing body of evidence to support the efficacy of cognitive remediation for cognitive and emotional difficulties in ED. Playmancer/ Islands is a video game (VG) designed to specifically treat mental disorders, characterized by problems in impulse control. The objective of the game is to increase self-control over emotions, decision making and behaviours. The aim of this study is to describe the results from a consecutive series of nine bulimia nervosa patients who were treated with the VG in addition to cognitive behaviour therapy (CBT). The outcomes included clinical and psychopathological questionnaires, and physiological measures were obtained during the VG. Emotional regulation improved, heart rate variability increased, and respiratory rate and impulsivity measures reduced after the treatment. These findings suggest that VG training may enhance treatment for ED.

Novel methods to help develop healthier eating habits for eating and weight disorders: A systematic review and meta-analysis

This paper systematically reviews novel interventions developed and tested in healthy controls that may be able to change the over or under controlled eating behaviours in eating and weight disorders. Electronic databases were searched for interventions targeting habits related to eating behaviours (implementation intentions; food-specific inhibition training and attention bias modification). These were assessed in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. In healthy controls the implementation intention approach produces a small increase in healthy food intake and reduction in unhealthy food intake post-intervention. The size of these effects decreases over time and no change in weight was found. Unhealthy food intake was moderately reduced by food-specific inhibition training and attention bias modification post-intervention. This work may have important implications for the treatment of populations with eating and weight disorders. However, these findings are preliminary as there is a moderate to high level of heterogeneity in implementation intention studies and to date there are few food-specific inhibition training and attention bias modification studies.

Intranasal oxytocin attenuates attentional bias for eating and fat shape stimuli in patients with anorexia nervosa

We examined the impact of oxytocin on attentional processes for eating, shape, and weight stimuli in patients with anorexia nervosa (AN). A double-blind, placebo-controlled within-subject crossover design was used. Intranasal oxytocin or placebo followed by a visual probe detection task with food, weight, and shape images was administered to 64 female subjects: 31 patients with AN and 33 control students. The AN group showed significant reductions in the attentional biases toward eating-related stimuli (p=0.030, d=0.516) and toward negative shape stimuli (p=0.015, d=0.498) under the influence of intranasal oxytocin. The effect of oxytocin was correlated with autistic spectrum traits in the AN group. Oxytocin had no effect on the amount of juice consumed in either group. The results of this study suggest that oxytocin attenuates the attentional vigilance to eating and fat shape stimuli in patients with AN. Further studies using oxytocin as a form of intervention for patients with AN are needed.

Rank perception and self-evaluation in eating disorders.

OBJECTIVES Heightened sensitivity to social comparison and negative self-evaluation have been implicated in the development and maintenance of eating disorders (EDs). This study used behavioral tasks, as well as self-report measures, to examine processing of social rank-related cues and implicit self-concept in participants with EDs. METHOD Fifty healthy participants (HCs), 46 people with an ED, and 22 people recovered from an ED (REC) undertook an attentional bias task using social rank-related cues and an implicit self-evaluation task. In addition, they completed self-report measures of social comparison, submissive behavior, and shame. RESULTS People with EDs showed vigilance toward social rank-related stimuli and lower implicit positive self-evaluation than HCs. Self-report data confirmed the behavioral findings and showed that people with EDs had higher levels of unfavorable social comparison, submissive behaviors, and external and internal shame than HCs. People who had recovered from an ED showed an intermediate profile between the two groups. DISCUSSION People with EDs have heightened sensitivity to social rank-related cues and impaired self-evaluation at an automatic level of processing. Some of these biases remain in people who have recovered. Interventions which aim to remediate social threat sensitivity and negative bias about self and others might be of benefit in EDs.

Eating in eating disorders

The aim of this paper is to bring eating back into the centre of the eating disorder discourse. The ability to interrogate and understand the central processes of appetite has increased considerably since the discovery of leptin and the ability to observe brain function with scanning methodologies. This has led to substantial progress in understanding the biological causative and maintaining factors in eating disorders, opening up the possibility of translating the latest findings into new forms of treatment. The biological mechanisms underpinning symptoms evolution and course of illness will first be described, follows by a discussion on integrating the research evidence in fear and feeding into patient care.

New treatment approaches for severe and enduring eating disorders

OBJECTIVE The aim of this paper is to map the possibility of new treatment approaches for eating disorders. BACKGROUND Eating disorders have a protracted trajectory with over 50% of cases developing a severe and enduring stage of illness. Although a good response to family-based interventions occurs in the early phase, once the illness has become severe and enduring there is less of a response to any form of treatment. Neuroprogressive changes brought about by poor nutrition and abnormal eating patterns contribute to this loss of treatment responsivity. METHOD We have summarised the profile of symptoms at the various stages of illness and considered new treatments that might be applied. RESULTS In the enduring stage of illness in addition to problems with body image, food and eating, there are additional problems of low mood, high anxiety and compulsivity and problems in social functioning. This suggests that there are dysfunctions in circuits subsuming reward, punishment, decision-making and social processes. New approaches have been developed targeting these areas. CONCLUSION New interventions targeting both the primary and secondary symptoms seen in the enduring stage of eating disorders may improve the response to treatment.

Mealtime Support in Anorexia Nervosa: A Within-Subject Comparison Study of a Novel Vodcast Intervention

Methods  Participants recruited from the volunteer database.  Inclusion criteria: o Females o 18 – 55 years old o fluent in English  Structured Clinical Interview for DSMIV was used to: o screen HCs for a past/current mental health disorder (s) o confirm diagnosis of AN  Participants were randomised to either vodcast/music condition first. The paradigm was repeated a week later with exposure to the alterative condition.  Measures: o Eating Disorder Examination Questionnaire o Depression Anxiety Stress Scale o Dot-probe task for attentional bias towards food images o Visual Analogue Scales (-5 to +5) assessing subjective feeling of:  anxiety  unpleasant body sensations  preparedness to eat  fullness  hunger  levels of intrusive thoughts  positive mood o Test meal:  chose from 3 different flavoured smoothies (250ml) for consumption whilst listening to the vodcast/music. The experimental paradigm is summarised in the diagram below.

A preliminary investigation of a novel training to target cognitive biases towards negative social stimuli in Anorexia Nervosa

BACKGROUND Patients with Anorexia Nervosa (AN) experience high levels of social difficulties and anxiety. These problems might be underpinned by negatively biased processing of social stimuli. The aim of this study was to examine the feasibility of using a novel Cognitive Bias Modification (CBM) training to target information processing biases in patients with AN. METHODS Twenty-eight patients with AN completed a baseline and end of intervention assessment of mood and social appraisals. The CBM training consisted of 5 sessions and included an attentional probe task to train attention towards positive social stimuli and an ambiguous scenarios task to train benign or neutral interpretations of ambiguous social scenarios. RESULTS At baseline patients displayed an attention and interpretation bias towards negative social stimuli. At the end of intervention there was a medium sized increase in attention to positive faces and fewer negative interpretations of ambiguous social stimuli. There were also lower levels of anxiety and higher levels of self-compassion in response to a judgemental video clip. LIMITATIONS The lack of a control group is the main limitation to this preliminary study as the changes obtained may have resulted from non-specific aspects of the inpatient treatment. CONCLUSIONS A novel CBM training is associated with more positive processing of social information in AN. It would be of interest to test the hypothesis that reducing cognitive biases towards social stimuli impacts on wider features of an eating disorder.