Cognitive flexibility, central coherence, and quality of life in anorexia nervosa.

BACKGROUND: Anorexia nervosa (AN) has consistently been found to be associated with poor cognitive flexibility and central coherence. These two cognitive functions have been considered important maintenance factors in AN and are addressed by specific treatment approaches such as cognitive remediation therapy. While there is clear empirical evidence that difficulties in such cognitive functions are related to impaired daily functioning in schizophrenia and bipolar disorder, this potential association has received only little attention in AN research so far. Therefore, the aim of this study was to examine potential relationships between weak cognitive flexibility, central coherence, and poor quality of life (QoL) in AN. METHODS: Cognitive flexibility and central coherence were measured by both neuropsychological (i.e., performance based) and self-report measures alongside with self-reported QoL in a sample of 138 adult patients with AN. RESULTS: Self-report but not performance based measures of cognitive flexibility and central coherence were associated with QoL. Weaker cognitive flexibility and central coherence were correlated with poorer QoL. These associations were independent of comorbid depression. The link between weak central coherence and poor QoL was particularly strong in patients with the restricting subtype of AN. The link between cognitive flexibility and QoL, however, was independent of AN subtype. CONCLUSIONS: Weak cognitive flexibility and central coherence are associated with low QoL in AN, especially in patients with the restrictive subtype. However, this relationship is dependent on the method of measurement, where self-report measures seem to be more relevant than performance based measures.

Cognitive remediation therapy in anorexia nervosa-A randomized clinical trial.

Objective: Especially for adult patients with anorexia nervosa (AN), treatment response is generally low to moderate. The present study aimed to evaluate the efficacy of cognitive remediation therapy (CRT) as adjunctive treatment for AN regarding clinical and cognitive outcomes. Method: In this randomized controlled superiority trial, 167 adult and adolescent (≥17 years) patients with AN were randomly allocated (1:1) to 10 weekly sessions of group therapy of either CRT (n = 82) or art therapy (ART; n = 85) as an adjunct to inpatient treatment-as-usual (TAU). Outcomes were assessed at baseline, end-of-treatment (10 weeks), and 6-month follow-up. Change in body mass index (BMI), eating disorder psychopathology, and health-related quality of life (QoL) from baseline to 6-month follow-up served as primary outcomes. Improvements in motivation to change and several indices of set-shifting and central coherence between baseline and end-of-treatment and between baseline and 6-month follow-up served as secondary outcomes. Analysis was by intention to treat. Results: Treatment groups did not differ regarding change in BMI, eating disorder psychopathology, and health-related QoL from baseline to 6-month follow-up. Likewise, groups neither differed regarding improvements in these outcomes between baseline and end-of-treatment nor in motivation to change, set-shifting, and central coherence at any time, except for greater short-term improvements in one measure of set-shifting in the CRT group. Conclusions: CRT as an adjunct to inpatient TAU for AN was not efficacious in improving clinical and cognitive outcomes. The results do not support routine employment of CRT in inpatient treatment for AN. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Reduced emotion recognition from nonverbal cues in anorexia nervosa.

OBJECTIVE: Recent models of anorexia nervosa (AN) emphasise the role of reduced emotion recognition ability (ERA) in the development and maintenance of the disorder. However, methodological limitations impede conclusions from prior research. The current study tries to overcome these limitations by examining ERA with an audio-visual measure that focuses strictly on multimodal nonverbal cues and allows to differentiate between ERA for different emotion categories. METHOD: Forty women with AN and 40 healthy women completed the Geneva Emotion Recognition Test. This test includes 83 video clips in which 10 actors express 14 different emotions while saying a pseudo-linguistic sentence without semantic meaning. All clips contain multimodal nonverbal cues (i.e., prosody, facial expression, gestures, and posture). RESULTS: Patients with AN showed poorer ERA than the healthy control group (d = 0.71), particularly regarding emotions of negative valence (d = 0.26). Furthermore, a lower body weight (r = 0.41) and longer illness duration (ρ = -0.32) were associated with poorer ERA in the AN group. CONCLUSIONS: Using an ecologically valid instrument, the findings of the study support illness models emphasising poor ERA in AN. Directly addressing ERA in the treatment of AN with targeted interventions may be promising.

No effect of very brief exposure to masked food pictures on fear of food in anorexia nervosa.

OBJECTIVE: Very brief exposure to masked images of spider stimuli can facilitate approach behaviour towards spiders in fearful subjects. We hypothesized that a similar effect might occur for fear of food in patients with anorexia nervosa (AN), possibly offering a new treatment approach, with advantages over other methods of food exposure. METHODS: Patients with AN (n = 60) were randomly assigned to one of three experimental conditions and received a single session of exposure to either masked and very briefly presented food images, clearly visible food images, or masked non-food images (i.e. household items). Effects of the three exposure conditions on fear of food and food avoidance were examined. RESULTS: Contrary to our expectations, very brief food cue exposure was not superior to the control conditions regarding fear of food and approach behaviour towards food immediately after the intervention and body mass index four weeks later. CONCLUSION: This finding suggests important differences between fear of food in AN and specific phobias such as fear of spiders. The absence of an effect reveals limitations of the very brief exposure method, which might be better suited for evolutionarily relevant threat stimuli.

Approach and avoidance bias for thin-ideal and normal-weight body shapes in anorexia nervosa.

OBJECTIVE: The two studies aimed to examine implicit affective evaluations of thin-ideal and normal-weight body shapes in women with anorexia nervosa (AN), taking identification with body shapes into account. METHOD: In study 1, approach-avoidance bias for thin-ideal and normal-weight bodies was assessed in 40 women with AN and 40 healthy women by using an Approach-Avoidance Task and female avatar bodies with a standard face as stimuli. In study 2, 39 women with AN and 38 healthy women underwent a similar task but identification with bodies was manipulated by presenting bodies once with the participant's own face and once with another woman's face. RESULTS: In study 1, patients with AN did not differ from healthy participants in their automatic approach-avoidance tendencies towards thin-ideal and normal-weight bodies. In study 2, no definite approach bias for a thin self and no avoidance bias for thin other women or for a normal-weight self were found. However, as compared to healthy women, those with AN showed a less positive implicit evaluation of thin other women, and an implicit preference for thin bodies depicted as themselves over thin bodies depicted as another woman. CONCLUSIONS: The findings suggest that intra-sexual competition for being slim is increased in AN.

Improving emotion recognition in anorexia nervosa: An experimental proof-of-concept study.

OBJECTIVE: Previous research has found increasing evidence for difficulties in emotion recognition ability (ERA) and social cognition in anorexia nervosa (AN), and recent models consider these factors to contribute to the development and maintenance of the disorder. However, there is a lack of experimental studies testing this hypothesis. Therefore, the present proof-of-concept study examined whether ERA can be improved by a single session of a computerized training in AN, and whether this has short-term effects on eating disorder symptoms. METHOD: Forty inpatients (22.20 ± 7.15 years) with AN were randomly assigned to receive a single session of computerized training of ERA (TERA) or a sham training (training the recognition of different types of clouds). ERA, self-reported eating disorder symptoms, and body mass index (BMI) were assessed within 3 days before and after training. RESULTS: After training, both groups showed improved ERA, reduced self-reported eating disorder symptoms, and an increased BMI. As compared to patients in the control group, patients who received TERA showed greater improvements in ERA and self-reported eating disorder symptoms. DISCUSSION: ERA can be effectively trained in patients with AN. Moreover, short-term improvements in self-reported eating disorder symptoms provide tentative support for the hypothesis that difficulties in ERA contribute to the maintenance of AN, and that specific trainings of ERA hold promise as an additional component in AN treatment. Future studies are needed to replicate these findings in larger samples, and to investigate long-term effects and transfer into real-world settings.

Body image related negative interpretation bias in anorexia nervosa.

A distorted body image and pronounced body dissatisfaction are hallmarks of anorexia nervosa (AN) that typically result in dietary restraint and compensatory behaviours. Cognitive biases such as negative interpretation bias are considered key maintaining factors of these maladaptive cognitions and behaviours. However, little attention has been paid to empirical tests whether negative interpretation bias exists in AN and to what degree it is associated with symptom severity. Participants in the present study were 40 women with AN and 40 healthy women with no history of an eating disorder. Body-related negative interpretation bias (i.e., a tendency to interpret ambiguous information about the own body in a negative way) was measured by a Scrambled Sentences Task. Patients with AN showed a stronger body-related negative interpretation bias than healthy controls. Within both groups, negative interpretation bias correlated strongly and positively with AN symptom severity and these effects were not moderated by levels of depressive symptoms. The findings support the idea that biased interpretation of body-related information is associated with the specific psychopathology of AN. Targeted, computerised interventions (e.g. interpretation bias modification) may help to alter these dysfunctional cognitive schemas that lie at the heart of AN.

[What do Patients Experience between Group Sessions during Inpatient Psychotherapy? An Application of the Inter-Session-Questionnaire in Psychotherapeutic Hospitals]. / Was erleben Patienten in stationärer Psychotherapie zwischen den Gruppentherapie-Sitzungen? Eine Erprobung des Inter-Session-Fragebogens in der Klinik.

The study describes an application of the Inter-Session-Questionnaire (ISF) related to inpatient group psychotherapy. The instrument should be tested with the extension of differentiating intersession experiences related to the person of the therapist as well as the group. In a cross sectional study performed in 13 different hospitals, 702 patients were assessed. These patients were treated in rehab hospitals, acute hospitals as well as special hospitals providing treatment for eating disorders. The sample should be relatively representative for psychosomatic and psychotherapeutic hospitals in Germany. Besides the type of the hospital, we also analysed the influence of group characteristics (size of group, type of group and number of completed sessions) as well as the patients' sex. Surprisingly, there were almost no marked differences of inter-session-experiences related to the the therapist or the group. The profiles of the item judgements of the ISF were similar to those reported for outpatient and day treatment samples. Inter-session-experiences differed in part according to our expectation depending on the variables mentioned above which suggests to use the ISF in specific studies dealing with the process and outcome of inpatient group psychotherapy as well as the differentiation of relevant subgroups.

[Training background, everyday practice, and training needs of group therapists working in inpatient psychotherapy - Results of a survey]. / Ausbildungshintergrund, Alltagspraxis und Weiterbildungsbedarf von Gruppenpsychotherapeuten in der stationären Psychotherapie - Ergebnisse einer Umfrage.

OBJECTIVES: A survey serves to clarify whether psychotherapists working in inpatient and day treatment psychotherapeutic hospitals feel sufficiently trained as group therapists and what their specific training needs are. METHODS: The survey queried 175 therapists from different hospitals and professions who perform group psychotherapy in their hospital. The questionnaire focussed on training experiences, everyday group practice, and training needs. RESULTS: As expected, only some of the therapists had completed training as group therapist. The therapists are faced with a wide variety of group formats and patients in their everyday work and reveal a broad spectrum of training needs. CONCLUSIONS: The survey, although not entirely representative, indicates general and specific needs of group therapists within psychotherapeutic hospitals and underlines the role of training and therapist experience in reducing uneasiness toward group psychotherapy.