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Anorexia Nervosa: Emotion, Cognition, and Treatment
Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
2011 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Anorexia nervosa (AN) is a serious disorder with long-term consequences for those afflicted. No evidence-based care is available for adults with full or subthreshold AN. The thesis research investigated aspects of emotion and cognition relevant to the maintenance of AN that might inform psychological treatment. In addition, the effectiveness of a recent psychotherapy model of AN was investigated.

Study I investigated alexithymia and emotional awareness and their associations with depression, anxiety, and perfectionism among patients with AN compared with a control group. The AN group exhibited the same level of emotional awareness as did the control group and the same level of alexithymia when controlling for depression and anxiety. Alexithymia and emotional awareness were not associated, despite representing an overlapping construct. The results of the present study indicate that those with AN can trust their emotional awareness.

Study II explored implicit pro-thin and anti-fat attitudes (towards the self and others), striving for thinness (loosely corresponding to positive reinforcement), and avoidance of fatness (loosely corresponding to negative reinforcement). The AN and the control groups were found to have equally strong implicit pro-thin and striving for thinness attitudes. The AN group exhibited stronger implicit anti-fat and avoidance of fatness attitudes (loosely corresponding to negative reinforcement) than did the control group. There was no association between implicit and explicit measures. The results are in line with the over-evaluation of weight and shape as a core feature of eating disorders.

Study III compared the effectiveness of Acceptance and Commitment Therapy (ACT) and treatment as usual (TAU) for adults with AN after day-care. Follow-up measures indicated no difference in improvement or deterioration between the two groups. The level of perfectionism was reduced in the ACT group relative to the TAU group. The study was compromised by a lower inflow of patients than anticipated and by a high drop-out rate, and thus fails to provide evidence of a difference between the two groups.

The present thesis demonstrates that emotional awareness is intact in those with AN and that implicit attitudes concerning weight and shape reflect the explicit attitudes, although without association. The treatment study indicates that, when designing treatment, it is important to consider the ambivalence to treatment among those suffering from AN, which is reflected in the high drop-out rate in the present study.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis , 2011. , 84 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Social Sciences, ISSN 1652-9030 ; 69
Keyword [en]
Anorexia Nervosa, subthreshold Anorexia Nervosa, emotional awareness, implicit attitudes, Acceptance and Commitment Therapy, alexithymia, Relational Frame Theory
National Category
Psychology
Identifiers
URN: urn:nbn:se:uu:diva-156641ISBN: 978-91-554-8116-2 (print)OAI: oai:DiVA.org:uu-156641DiVA: diva2:432700
Public defence
2011-09-23, Gunnar Johansson, Blåsenhus, von Kraemers allé 1A, Uppsala, 09:15 (Swedish)
Opponent
Supervisors
Available from: 2011-08-26 Created: 2011-08-05 Last updated: 2011-12-19
List of papers
1. Alexithymia and emotional awareness in anorexia nervosa: time for a shift in the measurement of the concept?
Open this publication in new window or tab >>Alexithymia and emotional awareness in anorexia nervosa: time for a shift in the measurement of the concept?
2010 (English)In: Eating Behaviors, ISSN 1471-0153, E-ISSN 1873-7358, Vol. 11, no 4, 205-210 p.Article in journal (Refereed) Published
Abstract [en]

The present study compared 35 patients with anorexia nervosa (AN) with an age matched control group using the Toronto Alexithymia Scale (TAS-20; a self-report instrument) and the Levels of Emotional Awareness Scale (LEAS; a performance-based instrument). Depression and anxiety have been shown to account for elevated levels of alexithymia in AN, and an elevated level of perfectionism might affect self-reporting in general. The AN-group reported a higher level of alexithymia on the TAS-20 compared to the control group, a difference that disappeared after controlling for depression or anxiety (but not for perfectionism). The findings suggest that the AN-patients believe that they have difficulties in identifying and reporting emotions, but actually perform as well as the control group when confronted with the task of identifying and reporting their emotions according to LEAS. It might be time to rethink the measurement of alexithymia. Maybe, similar to assessment of personality disorders, it should not be assessed when patients are depressed, or it should be assessed through instruments and modalities that are not sensitive to the mood state of the patient.

Keyword
Alexithymia, Emotional awareness, Anorexia nervosa, Anxiety, Depression, Perfectionism
National Category
Psychology
Identifiers
urn:nbn:se:uu:diva-133742 (URN)10.1016/j.eatbeh.2010.04.001 (DOI)000283484700001 ()
Available from: 2010-11-16 Created: 2010-11-15 Last updated: 2017-12-12Bibliographically approved
2. Using the Implicit Relational Assessment Procedure to Compare Implicit Pro-Thin/Anti-Fat Attitudes of Patients with Anorexia Nervosa and Non-clinical Controls
Open this publication in new window or tab >>Using the Implicit Relational Assessment Procedure to Compare Implicit Pro-Thin/Anti-Fat Attitudes of Patients with Anorexia Nervosa and Non-clinical Controls
Show others...
2012 (English)In: Eating Disorders, ISSN 1064-0266, E-ISSN 1532-530X, Vol. 20, no 2, 127-143 p.Article in journal (Refereed) Published
Abstract [en]

Implicit pro-thin/anti-fat attitudes was investigated among a mixed group of patients with full and sub-threshold Anorexia Nervosa (n = 17), and a matched-age control group (n = 17). The Implicit Relational Assessment Procedure (IRAP) was employed to measure implicit pro-thin and anti-fat attitudes towards Self and Others in addition to ‘striving for thinness’ and ‘avoidance of fatness’. The clinical group showed an implicit pro-fat attitude towards Others and stronger anti-fat attitudes towards Self and avoidance of fatness compared with controls. The findings are discussed in relation to the over-evaluation of weight and shape in the clinical group.

Keyword
Anorexia Nervosa, Implicit attitudes, Relational Frame Theory, Anorexia Nervosa, Implicit attitudes, Relational Frame Theory, Anorexia Nervosa, Implicit attitudes, Relational Frame Theory, Anorexia Nervosa, Implicit attitudes, Relational Frame Theory
National Category
Psychology
Research subject
Psychology
Identifiers
urn:nbn:se:uu:diva-156524 (URN)10.1080/10640266.2012.654056 (DOI)000208962500004 ()22364344 (PubMedID)
Available from: 2011-07-29 Created: 2011-07-29 Last updated: 2017-12-08Bibliographically approved
3. A randomised trial of Acceptance and Commitment Therapy for Anorexia Nervosa after daycare treatment, including five-year follow-up
Open this publication in new window or tab >>A randomised trial of Acceptance and Commitment Therapy for Anorexia Nervosa after daycare treatment, including five-year follow-up
Show others...
2016 (English)In: BMC Psychiatry, ISSN 1471-244X, E-ISSN 1471-244X, Vol. 16, 272Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: No specific psychotherapy for adult anorexia nervosa (AN) has shown superior effect. Maintenance factors in AN (over-evaluation of control over eating, weight and shape) were addressed via Acceptance and Commitment Therapy (ACT). The study aimed to compare 19 sessions of ACT with treatment as usual (TAU), after 9 to 12weeks of daycare, regarding recovery and risk of relapse up to five years. METHODS: Patients with a full, sub-threshold or partial AN diagnosis from an adult eating disorder unit at a hospital were randomized to ACT (n=24) and TAU (n=19). The staff at the hospital, as well as the participants, were unaware of the allocation until the last week of daycare. Primary outcome measures were body mass index (BMI) and specific eating psychopathology. Analyses included mixed model repeated measures and odds ratios. RESULTS: Groups did not differ regarding recovery and relapse using a metric of BMI and the Eating Disorder Examination Questionnaire (EDE-Q). There were only significant time effects. However, odds ratio indicated that ACT participants were more likely to reach good outcome. The study was underpowered due to unexpected low inflow of patients and high attrition. CONCLUSION: Longer treatment, more focus on established perpetuating factors and weight restoration integrated with ACT might improve outcome. Potential pitfalls regarding future trials on AN are discussed. Trial registration number ISRCTN 12106530. Retrospectively registered 08/06/2016.

Keyword
Anorexia Nervosa, sub-threshold Anorexia Nervosa, Acceptance and Commitment Therapy, Eating Disorders
National Category
Psychology Psychiatry
Research subject
Psychology
Identifiers
urn:nbn:se:uu:diva-156526 (URN)10.1186/s12888-016-0975-6 (DOI)000382223600003 ()27473046 (PubMedID)
Funder
Swedish Research Council
Available from: 2011-07-29 Created: 2011-07-29 Last updated: 2017-12-08Bibliographically approved

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