Specific affect regulation impairments in major depression

Impairments in affect regulation as well as cognitive reactivity have been considered to play important roles in the development, maintenance, and recurrence of major depressive disorder (MDD). However, there is a lack of studies investigating, (a) whether certain difficulties in emotion regulation are specific for MDD, (b) whether certain meta-mood beliefs are associated with an increased risk for MDD, and (c) whether reduced abilities to engage in mood-incongruent information processing and to disengage from negative information are associated with depression vulnerability, and whether those specific mood regulation processes underlie the mechanism of cognitive reactivity. Therefore, Study 1 of this dissertation compared patients with MDD with a clinical and a healthy control group regarding a comprehensive set of central and clinically relevant emotion regulation difficulties. Study 2 investigated two specific kinds of meta-mood beliefs [i.e., generalized negative mood regulation (NMR) expectancies and a generalized motive to avoid emotional experience (EA)] in formerly-depressed and never-depressed subjects. Finally, Study 3 tested whether two specific mood regulation processes (i.e., mood-incongruent information processing and disengagement from negative information) differentially appear in vulnerable and non-vulnerable individuals, and whether they can account for differences in cognitive reactivity. Patients with MDD reported greater emotion regulation difficulties than healthy controls and did not differ from the clinical control group regarding difficulties with the experience and differentiation of emotions, however, patients with MDD reported greater difficulties than clinical controls regarding the attenuation and modulation of emotions (Study 1). As expected, vulnerable individuals reported lower NMR expectancies and stronger EA as compared to non-vulnerable individuals, and NMR expectancies were furthermore found to be inversely associated with EA (Study 2). In the second but not in the first phase of an autobiographical memory task, vulnerable subjects retrieved fewer mood-incongruent (positively toned) emotion words than non-vulnerable subjects (Study 3). Furthermore, vulnerable subjects with a high cognitive reactivity retrieved more negatively toned emotion words. For non-vulnerable subjects a different pattern occurred: Subjects with a high cognitive reactivity retrieved less positively toned emotion words. The findings of the three studies suggest that emotion regulation difficulties constitute transdiagnostic phenomena, and that MDD may be characterized by particularly broad and pronounced deficits in this domain. The results also suggest that maladaptive meta-mood beliefs are associated with depression vulnerability and that individuals with low confidence in their negative mood regulation abilities are concurrently characterized by a stronger avoidance of emotional experience. Furthermore, the results suggest that a reduced ability of mood-incongruent information processing is associated with depression vulnerability, and that two different memory processes of mood regulation may account for cognitive reactivity in individuals who are at high versus low risk for depression. The cross-sectional designs and the use of self-report measures as well as the relatively small sample sizes in two of the studies limit the interpretation of the obtained results. Notwithstanding, the findings of these three studies call for an implementation of specific elements that foster adaptive affect regulation (e.g., computer-assisted training of cognitive processes) into existing treatment packages for MDD

The ABBA study – approach bias modification in bulimia nervosa and binge eating disorder: study protocol for a randomised controlled trial

Background: The core symptoms of bulimia nervosa (BN) and binge eating disorder (BED) are recurrent episodes of binge eating. Despite negative psychological and physical consequences, BN/BED patients show uncontrollable approach tendencies towards food. This cognitive bias occurs at an early stage of information processing. Cognitive bias modification (CBM) directly targets such biases and has been shown to be effective in treating several mental disorders. In alcohol addiction, automatic action tendencies towards alcohol cues and relapse rates were successfully reduced by a specific form of CBM, termed approach bias modification. Based on these findings and data from a proof-of-concept study in people with high levels of food craving, CBM is considered a promising new treatment approach for BN/BED. Given the similarities between BN/BED and addictive disorders, the rationale for using approach bias modification appears to be particularly strong. The aim of the present study is to examine whether, compared to a sham training, computerised approach bias modification (10 sessions) can reduce binge-eating episodes in BN/BED patients from pre-treatment to follow-up. Additionally, we will investigate whether this CBM programme also reduces global eating disorder psychopathology, trait and cue-elicited food craving, food intake as well as approach and attentional bias towards visual food cues. Treatment acceptance will be determined by attrition rates and responses on a feedback form. Methods This is a double-blind, randomised, placebo-controlled, parallel-group superiority trial with two parallel arms. A total of 54 BN/BED patients will be recruited. Approach bias towards food will be retrained by a computer task adopting an implicit learning paradigm. Patients in the control condition (sham) will conduct a similar task but will not be trained to avoid food cues. Methods: against bias include public registration, randomisation by a central study office, standardisation of the treatments and blinding of assessors. Furthermore, the session number and duration will be equivalent in the two conditions. Discussion: This is the first registered randomised controlled trial of approach bias modification in a clinical BN/BED sample. Results from this study will provide an indication of the efficacy of approach bias modification training for BN/BED and the potential mechanisms of action underlying this treatment. Trial registration: DRKS00010231 (retrospectively registered on 24 March 2016; first version

Reduced emotion recognition from nonverbal cues in anorexia nervosa

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. Keywords: eating disorder; emotion recognition; social cognition; socio-emotional processing; theory of mind

Patient and mentor language style matching as a predictor of working alliance, engagement with treatment as usual, and eating disorders symptoms over the course of an online guided self-help intervention for anorexia nervosa

Objective The aim of this study was to examine the processes involved in a guided self-help (GSH) pre-treatment intervention (RecoveryMANTRA) for patients with anorexia nervosa (AN), by measuring the levels of patient/mentor Language Style Matching (LSM). RecoveryMANTRA was supported by student mentors or peer mentors (recovered individuals) over six weekly chat-based sessions. We examined whether LSM during RecoveryMANTRA predicted patients'working alliance with the clinic therapist, motivation, eating disorder (ED) and general psychopathology. A further aim was to examine differences in LSM between student mentors and peer mentors. Method 87 AN adults received RecoveryMANTRA plus treatment as usual. The LSM algorithm was used to calculate verbal attunement between patient and mentor. Participants were assessed at baseline and at the end of the intervention. Results Both early (1(st) session) and late (6(th) session) LSM predicted higher working alliance with the clinic therapist. Moreover, late LSM predicted lower EDs symptoms at the end of the RecoveryMANTRA intervention. Patient/peer mentor dyads showed higher late verbal attunement than patient/student mentor dyads. Conclusions These findings suggests that in the early phase of treatment relational aspects can impact on engagement with treatment. Verbal attunement in a GSH for AN is associated with working alliance and better clinical outcome

Impaired Cross-Talk between Mesolimbic Food Reward Processing and Metabolic Signaling Predicts Body Mass Index

The anticipation of the pleasure derived from food intake drives the motivation to eat, and hence facilitate overconsumption of food which ultimately results in obesity. Brain imaging studies provide evidence that mesolimbic brain regions underlie both general as well as food related anticipatory reward processing. In light of this knowledge, the present study examined the neural responsiveness of the ventral striatum in participants with a broad BMI spectrum. The study differentiated between general (i.e. monetary) and food related anticipatory reward processing. We recruited a sample of volunteers with greatly varying body weights, ranging from a low BMI (below 20 kg/m²) over a normal (20 to 25 kg/m²) and overweight (25 to 30 kg/m²) BMI, to class I (30 to 35 kg/m² ) and class II (35 to 40 kg/m²) obesity. A total of 24 participants underwent functional magnetic resonance imaging whilst performing both a food and monetary incentive delay task, which allows to measure neural activation during the anticipation of rewards. After the presentation of a cue indicating the amount of food or money to be won, participants had to react correctly in order to earn snack points or money coins which could then be exchanged for real food or money, respectively, at the end of the experiment. During the anticipation of both types of rewards, participants displayed activity in the ventral striatum, a region that plays a pivotal role in the anticipation of rewards. Additionally, we observed that specifically anticipatory food reward processing predicted the individual BMI (current and maximum lifetime). This relation was found to be mediated by impaired hormonal satiety signaling, i.e. increased leptin levels and insulin resistance. These findings suggest that heightened food reward motivation contributes to obesity through impaired metabolic signaling

Time to make a change:A call for more experimental research on key mechanisms in anorexia nervosa

Anorexia nervosa (AN) is a life‐threatening eating disorder, characterised by persistent pathological weight loss behaviours and an intense fear of weight gain and food consumption. Although there is an abundance of scientific theories on the neurobiological, psychological and sociocultural factors thought to be involved in the maintenance of AN, there is little experimental research testing these ideas. The need for theory firmly grounded in empirical evidence becomes strikingly clear when we consider that current treatments for patients with AN are limited in their effectiveness, and relapse after treatment is common

Emotional Expression Predicts Treatment Outcome in Focal Psychodynamic and Cognitive Behavioural Therapy for Anorexia Nervosa: Findings from the ANTOP Study

Emotional Expression Predicts Treatment Outcome in Focal Psychodynamic and Cognitive Behavioural Therapy for Anorexia Nervosa: Findings from the ANTOP Stud

Utilizing multi-objective decision support tools for protected area selection

Establishing and maintaining protected areas (PAs) is a key action in delivering post-2020 biodiversity targets. PAs often need to meet multiple objectives, ranging from biodiversity protection to ecosystem service provision and climate change mitigation, but available land and conservation funding is limited. Therefore, optimizing resources by selecting the most beneficial PAs is vital. Here, we advocate for a flexible and transparent approach to selecting PAs based on multiple objectives, and illustrate this with a decision support tool on a global scale. The tool allows weighting and prioritization of different conservation objectives according to user-specified preferences as well as real-time comparison of the outcome. Applying the tool across 1,346 terrestrial PAs, we demonstrate that decision makers frequently face trade-offs among conflicting objectives, e.g., between species protection and ecosystem integrity. Nevertheless, we show that transparent decision support tools can reveal synergies and trade-offs associated with PA selection, thereby helping to illuminate and resolve land-use conflicts embedded in divergent societal and political demands and values.publishedVersio