Emotions in play: young people’s and clinicians’ experience of ‘Thinking about Emotions’ group

Abstract

Purpose Emotional difficulties in young people (YP) with anorexia nervosa (AN) are well recognised. Improved strategies are needed to support inpatients to tolerate group therapy and to help them to better identify and manage their emotions. Cognitive Remediation and Emotion Skills Training (CREST) for AN adults, aimed at improving emotional processing skills, has been found beneficial in adult AN groups. A case series of CREST was conducted in an inpatient ward for YP (CREST-YP) to evaluate its suitability for a younger population. Methods A mixed-methods assessment was used. Thirty-two YP and 3 facilitators took part in qualitative interviews. YP ( n = 32) also completed pre- and post-self-report questionnaires assessing emotional functioning. Results Preliminary qualitative results showed that YP found it helpful to learn about emotion processes. More support is needed to clarify the link between emotions and AN. Quantitative results showed no significant changes in YP’s self-perceived emotional functioning. Although no statistically significant changes were observed, a small increase in YP’s use of both reappraisal (standardised mean changes scores, SMCC 0.22) and suppression (SMCC − 0.22) as a means to regulate their emotions was found. Conclusions Pilot findings suggest that CREST-YP is a suitable intervention for YP with AN. Age-appropriate adaptations are needed to improve YP’s engagement in group CREST. Level of evidence Level IV: Evidence obtained from multiple time series.

Alexithymia and Treatment Outcome in Anorexia Nervosa: A Scoping Review of the Literature

“…Some studies clearly failed to find a positive impact of treatment on alexithymia as assessed with the TAS (32,45,46). On the other hand, others supported an improvement of alexithymia after treatment (2,15,44,47,48), which was represented by CREST (15), a mixed approach including different types of treatment (2,44), a 4-month day hospital treatment (48), and a psycho-pedagogic intervention (47), respectively (see Table 1 for more details).…”

“…As described in the PRISMA flow diagram (Figure 1) (43), the initial search identified 384 titles (17 from Medline, 367 from Scopus); after removing 13 duplicates, titles were screened first, and those clearly not in line with the purpose of the review were excluded (N = 276). Then abstracts were assessed, leading to the exclusion of 71 records, and last full texts were read, eventually leading to the inclusion of 10 papers (2,15,32,(44)(45)(46)(47)(48)(49)(50) in the qualitative synthesis.…”

“…The studies included in this review involved patients with an age range from 12 to 63 years old; two studies (32,45) were specifically focused on an adolescent population. Most studies included only female patients, while two (32,46) assessed both genders.…”

“…Moreover, alexithymia and emotion regulation difficulties have been shown to have an impact on the course and maintenance of anorexia (12,15,32,33), and on treatment outcome and recovery (34,35). Actually, the lack of insight and the externally-oriented thinking style typical of alexithymia may interfere with treatment compliance and with patients' ability to benefit from interventions, especially psychotherapy ones (36).…”

“…According to these clinical observations, in the last years the need to explore new treatment approaches targeting emotion identification, expression and regulation has emerged, with the aim of fostering the process of recovery, enhancing quality of life (27) and improving long-term outcomes in the ED population (32). Another issue which should not be overlooked is that, notwithstanding patients' primary psychiatric diagnosis, increasing evidence suggests that alexithymia may play a role as risk factor for suicide, often mediated by depressive symptoms (37,38).…”