A multifaceted study of interpersonal functioning and cognitive biases towards social stimuli in adolescents with eating disorders and healthy controls

Rowlands, Katie; Grafton, Ben; Cerea, Silvia; Simic, Mima; Hirsch, Colette R.; Cruwys, Tegan; Yellowlees, Robyn; Treasure, Janet; Cardi, Valentina

doi:10.1016/j.jad.2021.07.013

Cited by 16 publications

(22 citation statements)

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“…In the overall sample ( N = 67), participants reported high levels of interpersonal sensitivity, as indicated by the global score of the interpersonal sensitivity measure ( M = 112.80, SD = 12.54). In a previous study, adolescents with eating disorders scored significantly higher on this measure compared to healthy controls (Rowlands et al, 2021 ). Participants scored highly on the severity of eating disorder psychopathology, based on norms for adolescents with anorexia nervosa (Jennings & Phillips, 2017 ), and 40/67 (60%) scored in the clinical range for the EDE‐Q total, based on the widely used cut‐off score of 4 (Meule, 2021 ).…”

Section: Resultsmentioning

confidence: 70%

“…Post-intervention interpersonal sensitivity measure (M = 112.80, SD = 12.54). In a previous study, adolescents with eating disorders scored significantly higher on this measure compared to healthy controls (Rowlands et al, 2021). Participants scored highly on the severity of eating disorder psychopathology, based on norms for adolescents with anorexia nervosa (Jennings & Phillips, 2017) Baseline demographic and clinical characteristics for participants included in the main analyses are presented in Table 1.…”

Section: Baseline Demographic and Clinical Characteristicsmentioning

confidence: 99%

“…Adolescents with anorexia nervosa report submissive behaviors, unfavorable social comparison, sensitivity to rejection and poorer quality of social relationships to a greater extent than their healthy peers (Cardi et al, 2019 ; Kalaycı et al, 2019 ; Rowlands et al, 2021 ). Some of these problems, for example greater alienation perceived within family and peer relationships (Pelletier Brochu et al, 2018 ) and heightened interpersonal sensitivity (Rowlands et al, 2021 ), have been associated with a greater severity of self‐reported eating disorder psychopathology. In qualitative studies, adolescents with eating disorders have described a poor sense of group belonging, a heightened tendency to engage in self‐monitoring, and rejection sensitivity (Patel et al, 2016 ).…”

Section: Introductionmentioning

confidence: 99%

“…Another study demonstrated that adults with anorexia nervosa made more negative interpretations of ambiguous social scenarios that involved a risk of rejection compared to healthy controls, and that this bias was associated with fear of weight gain, body image disturbance and anxiety and depression symptoms (Cardi et al, 2017 ). Negative interpretation biases have also been found in adolescents with eating disorders and are associated with eating disorder psychopathology (Cardi et al, 2019 ; Rowlands et al, 2021 ).…”

Section: Introductionmentioning

confidence: 99%

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Cognitive bias modification training of attention and interpretation to reduce expectations of social rejection in adolescents with eating disorders: A small efficacy randomized controlled trial

Rowlands

Beaty

Simic

et al. 2022

Intl J Eating Disorders

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Objective This study aimed to investigate whether a computerized cognitive bias modification training delivered remotely would reduce expectations of rejection in adolescents with eating disorders. Method Sixty‐seven adolescents aged 12–18 (99.5% female) with an eating disorder diagnosis (94% anorexia nervosa) and receiving specialist treatment were recruited. Participants were randomized to an intervention condition (n = 37) which included treatment as usual (TAU) supplemented by nine sessions of online cognitive bias modification training for social stimuli (CBMT + TAU), or a control condition (n = 30), which included TAU only. Participants were invited to complete assessments at baseline and post‐intervention. Results In the intervention condition, 22/37 participants completed six or more training sessions and post‐intervention measures, the pre‐defined criteria to be considered “completers.” In the control condition, 28/30 participants completed the post‐intervention measures. Participants who completed the intervention displayed a significantly greater reduction in negative interpretations of ambiguous social scenarios, with a medium effect size (p = .048, ηp2 = .090), and eating disorder psychopathology, with a medium effect size (p = .027, ηp2 = .105), compared to participants in the control condition. No significant between‐group differences were found on emotional response to criticism, and anxiety and depression symptoms post‐intervention (ps > .05; small effect sizes). Discussion Enhancing treatment as usual with CBMT targeting expectations of social rejection might be feasible and effective to reduce expectations of social rejection and eating disorder psychopathology in adolescents with eating disorders. Training adaptations might be necessary to impact on emotional processing and comorbid psychological distress. Public Significance Adolescents with eating disorders who completed a brief (4‐week) online cognitive training intervention, alongside their usual treatment, reported greater reductions in expectations of social rejection and eating disorder psychopathology after the intervention, compared to a separate group of patients who received their usual treatment only. This brief and accessible intervention may be a helpful treatment adjunct for adolescents with eating disorders.

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Section: Resultsmentioning

confidence: 70%

Section: Baseline Demographic and Clinical Characteristicsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Cognitive bias modification training of attention and interpretation to reduce expectations of social rejection in adolescents with eating disorders: A small efficacy randomized controlled trial

Rowlands

Beaty

Simic

et al. 2022

Intl J Eating Disorders

Self Cite

View full text Add to dashboard Cite

show abstract

“…This association underlined the possible role of insufficient social support or social abilities in the face of complex events [35]; these factors have already been cited as core elements in the development and maintenance of eating psychopathology [42][43][44], and should be explored in more detail in patients' sisters in future studies. Laboratory tasks have explored and reported specific negative effects of social interaction in individuals with EDs, indicating the presence of interpretation bias, fear for negative evaluations, and less physiological arousal in social interactions [43,[45][46][47]. Conversely, depressive symptoms have been confirmed as related to posttraumatic symptomatology in community samples during the COVID-19 pandemic [48], with differences in patients which could be explained by the presence of higher scores in women with EDs for both depressive and posttraumatic symptomatology.…”

Section: Discussionmentioning

confidence: 99%

One year of COVID-19 pandemic on patients with eating disorders, healthy sisters, and community women: evidence of psychological vulnerabilities

et al. 2022

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Purpose The COVID-19 pandemic has been a psychological burden worldwide, especially for individuals with eating disorders (EDs). In addition, the healthy sisters of patients with EDs are known to present specific psychological vulnerabilities. This study evaluates differences between the general population, patients with EDs, and their healthy sisters. Method A group of 233 participants (91 patients with EDs, 57 of their healthy sisters and 85 community women) was enrolled in an online survey on general and specific psychopathology 1 year after the beginning of the COVID-19 pandemic. The survey examined associations between posttraumatic symptoms and depression, anxiety, obsessive–compulsiveness, interpersonal sensitivity, and eating-related concerns. Results Clinically relevant scores for posttraumatic disorders were found in patients with EDs. Healthy sisters scored similarly to patients for avoidance. Regression analysis showed specific associations between interpersonal sensitivity and posttraumatic symptomatology in patients and healthy sisters, but not in community women. Conclusion The psychological burden in patients with EDs is clinically relevant and linked to interpersonal sensitivity, obsessive–compulsiveness, and global symptom severity. Differences between patients, healthy sisters, and community women are discussed regarding vulnerability factors for EDs. Level of evidence Level III: evidence obtained from well-designed cohort or case–control analytic studies.

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Effect of modifying negative interpretation bias toward ambiguous social stimuli across eating and personality disorders

Kwag

Mirihae

et al. 2023

Intl J Eating Disorders

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Objective Heightened sensitivity toward social rejection has been implicated in eating disorders (ED) and personality disorder (PD). This study examined the effect of a cognitive bias modification training (CBM‐I) targeting the interpretation of ambiguous social situations in individuals with comorbid ED and PD. Method A total of 128 participants [33 with ED and PD, 22 with ED‐only, 22 with PD‐only, and 51 healthy controls (HC)] were recruited from a hospital and university settings, and included in the final analyses. The participants were randomly assigned to a CBM‐I task with benign resolutions or a control task with neutral resolutions in a counterbalanced order in two sessions using a within‐subject design. Interpretation bias toward social stimuli was measured using the ambiguous sentence completion task before and after completing the assigned task. Results The CBM‐I task increased benign and decreased negative interpretations with large effect sizes in the diagnostic groups, and with a moderate effect size in the HC group. Participants' anxiety levels were also reduced after the task. The size of the change in negative interpretation was positively associated with baseline negative affect, and negatively associated with baseline positive affect. Discussion The results suggest that modifying interpretation bias has the potential as a transdiagnostic target of treatment for ED and PD, and a fully powered clinical trial with consecutive sessions would be warranted. Public Significance Participants with eating disorders and/or personality disorder, and healthy controls completed a single session of a cognitive training intervention targeting rejection sensitivity. The training produced a large decrease in negative interpretation in the diagnostic groups, and a moderate effect in healthy controls. The findings indicate that training for positive processing of social information may be of value to augment treatment in conditions such as eating disorders and personality disorder, in which there are high levels of rejection sensitivity.

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A multifaceted study of interpersonal functioning and cognitive biases towards social stimuli in adolescents with eating disorders and healthy controls

Cited by 16 publications

References 68 publications

Cognitive bias modification training of attention and interpretation to reduce expectations of social rejection in adolescents with eating disorders: A small efficacy randomized controlled trial

Cognitive bias modification training of attention and interpretation to reduce expectations of social rejection in adolescents with eating disorders: A small efficacy randomized controlled trial

One year of COVID-19 pandemic on patients with eating disorders, healthy sisters, and community women: evidence of psychological vulnerabilities

Effect of modifying negative interpretation bias toward ambiguous social stimuli across eating and personality disorders

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