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      Cognitive Remediation and Emotion Skills Training (CREST) for anorexia nervosa in individual format: self-reported outcomes

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          Abstract

          Background

          To evaluate self-reported outcomes after a brief course of skills-based individual therapy for inpatients with anorexia nervosa (AN).

          Methods

          In this case series study 37 adults with AN participated in cognitive remediation and emotion skills training (CREST) sessions, and completed social anhedonia, alexithymia and motivational measures before and after the intervention.

          Results

          The CREST primary outcome measures were total scores on the Revised Social Anhedonia Scale (RSAS), which decreased significantly (p = 0.03) with an effect size of 0.31, and the Toronto Alexithymia Scale (TAS), which also decreased significantly (p = 0.05) with an effect size of 0.35. The secondary outcome measures focused on motivation: perceived ‘importance to change’ and ‘ability to change’; the second of which increased significantly (p < 0.001) with a medium effect size (d = 0.71).

          Conclusions

          The individual format of CREST led to a decrease in patients’ self-reported social anhedonia, an improvement in the ability to label their emotions, and increased confidence in their ability to change. Considering the limited number of individual sessions, this is a promising preliminary finding which warrants further research.

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          Most cited references26

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          Eating disorders.

          This Seminar adds to the previous Lancet Seminar about eating disorders, published in 2003, with an emphasis on the biological contributions to illness onset and maintenance. The diagnostic criteria are in the process of review, and the probable four new categories are: anorexia nervosa, bulimia nervosa, binge eating disorder, and eating disorder not otherwise specified. These categories will also be broader than they were previously, which will affect the population prevalence; the present lifetime prevalence of all eating disorders is about 5%. Eating disorders can be associated with profound and protracted physical and psychosocial morbidity. The causal factors underpinning eating disorders have been clarified by understanding about the central control of appetite. Cultural, social, and interpersonal elements can trigger onset, and changes in neural networks can sustain the illness. Overall, apart from studies reporting pharmacological treatments for binge eating disorder, advances in treatment for adults have been scarce, other than interest in new forms of treatment delivery. Copyright 2010 Elsevier Ltd. All rights reserved.
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            Emotional functioning in eating disorders: attentional bias, emotion recognition and emotion regulation.

            Interpersonal processes, anxiety and emotion regulation difficulties form a key part of conceptual models of eating disorders (EDs), such as anorexia nervosa (AN) and bulimia nervosa (BN), but the experimental findings to support this are limited. The Reading the Mind in the Eyes task, the Difficulties in Emotion Regulation Scale (DERS) and a computerized pictorial (angry and neutral faces) Stroop task were administered to 190 women [50 with AN, 50 with BN and 90 healthy controls (HCs)]. Those with an ED showed attentional biases to faces in general (medium effect), but specifically to angry faces over neutral faces (large effect) compared to HCs. The ED group also reported significantly higher emotion regulation difficulties (large effect) than HCs. There was a small difference between the ED and HC groups for the emotion recognition task (small-medium effect), particularly in the restricting AN (RAN) group. Depression and attentional bias to faces significantly predicted emotion regulation difficulties in a regression model. The data provide support for conceptualizations of EDs that emphasize the role of emotional functioning in the development and maintenance of EDs. Further research will concentrate on exploring whether these findings are state or trait features of EDs.
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              The socio-emotional processing stream in Anorexia Nervosa.

              The significance of socio-emotional factors in development and maintenance of Anorexia Nervosa (AN) has been noted, but the literature is poorly integrated without clear models guiding research or treatment. This systematic review retrieved experimental studies of social-cognitive or affective processing in AN and categorised them using Ochsner's "Social-Emotional Processing Stream." Ochsner's "Processing Stream", based on healthy data, comprises five constructs: (1) acquisition of and (2) recognition and response to social-affective stimuli, (3) low-level and (4) high-level mental state inference and (5) context-sensitive emotion regulation. Thirty-seven experimental studies in Anorexia Nervosa were identified, mapping on to four of the five constructs (not Construct 3). A meta-analysis of nine affect recognition studies was conducted. AN patients demonstrated impairments in each of the four domains with preliminary reports that some difficulties are trait-like, and others ameliorate following recovery. Socio-emotional data was integrated with previous reports of neural abnormalities to generate an AN specific model of socio-emotional processing. Additional research is required for further definition and to translate experimental findings into clinical practice. Copyright © 2010 Elsevier Ltd. All rights reserved.
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                Author and article information

                Contributors
                Kate.Tchanturia@kcl.ac.uk
                eli.doris@kcl.ac.uk
                vicki.mountford@slam.nhs.uk
                caroline.fleming@slam.nhs.uk
                Journal
                BMC Psychiatry
                BMC Psychiatry
                BMC Psychiatry
                BioMed Central (London )
                1471-244X
                20 March 2015
                20 March 2015
                2015
                : 15
                : 53
                Affiliations
                [ ]King’s College London, Division of Psychological Medicine, Institute of Psychiatry, SE5 8AF London, UK
                [ ]Eating Disorders Unit, South London and Maudsley NHS Foundation Trust, London, UK
                [ ]Illia State University, Tbilisi, Georgia
                Article
                434
                10.1186/s12888-015-0434-9
                4377046
                25884480
                7e496a00-e004-427e-94ea-340fab296fa5
                © Tchanturia et al.; licensee BioMed Central. 2015

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 4 December 2014
                : 9 March 2015
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2015

                Clinical Psychology & Psychiatry
                anorexia,flexibility,social interaction,social cognition,emotion skills,anhedonia,alexithymia

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