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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.

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. K E Y W O R D S eating disorders, emotion perception, emotion recognition training, emotional theory of mind, social cognition, training of emotion recognition ability

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.

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.

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.

Background: The present pilot study investigated the relationship between temperament and the risk for exercise dependence (EXD). Sampling and Methods: A total of 32 female patients with eating disorders (potentially at risk for secondary EXD) and 29 female elite athletes without eating disturbances (potentially at risk for primary EXD) answered the Eating Disorder Examination-Questionnaire (EDE-Q), the Exercise Dependence Scale-German version (EDS-G), the Behavioral Inhibition System/Behavioral Activation System (BIS/BAS) scales, and the effortful control subscale of the Adult Temperament Questionnaire (ATQ-EC). Results: There were significant positive correlations of the EDS-G with the BIS in women with an eating disorder and with the BAS in elite athletes. No significant association was found between the EDS-G and effortful control. Conclusions: The results indicate that the risk for EXD is associated with avoidance tendencies in women with eating disorders and with approach tendencies in elite athletes. Implications for secondary and primary EXD are discussed.