Effect of Aggression Regulation on Eating Disorder Pathology: RCT of a Brief Body and Movement Oriented Intervention

Abstract

Objective: The objective of the study is to evaluate the effect of a brief body and movement oriented intervention on aggression regulation and eating disorder pathology for individuals with eating disorders. Method: In a first randomized controlled trial, 40 women were allocated to either the aggression regulation intervention plus supportive contact or a control condition of supportive contact only. The intervention was delivered by a psychomotor therapist. Participants completed questionnaires on anger coping and eating disorder pathology. Independent samples t-tests were performed on the difference between pre-treatment and post-treatment scores. Results: Twenty-nine participants completed questionnaires at pre-intervention and post-intervention. The intervention resulted in a significantly greater improvement of anger coping, as well as of eating disorder pathology. Discussion: Results indicate that body and movement-oriented aggression regulation may be a viable add-on for treating eating disorders. It tackles a difficult to treat emotion which may have a role in blocking the entire process of treating eating disorders. Anger and aggressiveness are associated with several eating disorder (ED) subtypes, severity of ED symptoms and poorer treatment outcome (Krug et al., 2008). In ED, aggressiveness is mostly directed at the self in an attempt to control the body and regulate emotions, and as a means to confirm one's own fragile identity (Truglia et al., 2006). ED behaviours can be seen as self-destructive behaviours related to a great extent to inhibited anger expression (Truglia et al., 2006). Research findings indicate that anger is a significant underlying emotion contributing to disordered eating (Engel et al., 2007;Fox & Power, 2009;Harrison, Sullivan, Tchanturia, & Treasure, 2010;Ioannou & Fox, 2009;Quinton & Wagner, 2005). Patients with bulimia often feel anger and may impulsively direct it toward others or toward objects (Truglia et al., 2006). Patients suffering from anorexia nervosa can feel anger as a terrifying emotion that needs to be avoided (by concentration on food, body and weight), needs to be suppressed, for example by physical activity, and released by anorectic self-control or self-harm (Espeset, Gulliksen, Nordbø, Skårderud, & Holte, 2012). They tend to show less facial anger expression than they feel, which may lead to problems in social communication (Claes et al., 2012;Joos et al., 2012). It is suggested that treatment of non-suicidal self-injury in ED should focus on stabilizing affective states rather than on reducing affects like anger (Vansteelandt et al., 2013). Despite such findings, there is a lack of research on how to approach anger and aggression in the treatment of ED (Fassino, Daga, Piero, & Rovera, 2002;Krug et al., 2008;Miotto et al., 2003;Truglia et al., 2006).A specific evidence-based intervention protocol targeted at aggression is missing. In this respect, psychomotor therapy (PMT) -a body and movement oriented therapy frequently used in mental health care i...

Force production parameters as behavioural measures for anger expression and control: The Method of Stamp Strike Shout

“…In mental health care it can be recognized that many women still learn to silence their anger, deny it entirely, or vent it in another way. We found excessive anger internalization in women with eating disorders [ 20 , 21 ]. Although this may explain the gender differences also found in our present study, it does not account for the high incidence of anger internalization in our female student sample.…”

“…PMT for eating disorders targets on persistent anger issues by enabling patients to practice body expression including force production exercises such as used in the MSSS. Voice and movement exercises in PMT were found to be effective in the treatment of excessive anger inhibition in patients with eating disorders [ 20 , 21 ]. The MSSS is meant for diagnostic as well as therapeutic purposes.…”

Psychomotor therapy targeting anger and aggressive behaviour in individuals with mild or borderline intellectual disabilities: A systematic review

“…PMT is consistent with previous research suggesting that efforts to reduce aggression in individuals with MBID should aim to teach people self-management skills, functional skills, emotional regulation skills and problem-solving skills (Didden et al, 2016). Future research could aim to evaluate the effect of PMT in individuals with MBID as complementary therapy compared to treatment as usual, similar to the study on aggression regulation in patients with eating disorder (Boerhout, Swart, van Busschbach, & Hoek, 2016) and the study in chronic pain revalidation in individuals without MBID (van der Maas et al, 2015).…”

Aggression Regulation in Day Treatment of Eating Disorders: Two‐Centre RCT of a Brief Body and Movement‐Oriented Intervention

“…Moreover, ED symptoms only reduced significantly in the experimental group. During the intervention period, patients of both groups received supportive contact once every 1 or 2 weeks, including prescription of medication, psycho‐education, reassurance, advice and diet management, with both groups receiving the same total amount of treatment contacts (Boerhout et al, ). These results support the idea that body and movement‐oriented therapy may reduce anger suppression and hence may affect ED pathology.…”

“…The intervention under study has been evaluated in another randomized controlled trial (RCT) ( n = 40) conducted in an outpatient setting for ED treatment, showing a large decrease in anger internalization in the experimental group when compared with the control group (Boerhout, Swart, Van Busschbach, & Hoek, ). Moreover, ED symptoms only reduced significantly in the experimental group.…”