Reflections from ABCT 2017
By: Cheri A. Levinson, Ph.D.
The EAT lab (pictured to the right) just returned from ABCT 2017 in San Diego, California. To say that this conference was inspiring would be an understatement. I think the entire lab left the conference feeling renewed and excited about all of the immerging research both within the eating disorder field and in clinical psychology as a whole. Here are a few highlights from our trip.
Exposure in eating disorders. There was not one, but *two* symposiums focused on using exposure therapy to treat eating disorders. Given this area has been my passion for more than half of my career (which admittedly has not been that long yet), I am excited to see not only more work on the topic, but a growing interest and excitement within the eating disorder field. There were two talks that especially stood out to me on the impact they can bring to the field. First, Nick Farrell (from Rogers) presented work from his partial hospital program showing how exposure and response prevention can be integrated into a partial program. Second, Jamal Essayli (from Penn State Hershey) began to answer the question ‘Can we use exposure therapy during refeeding?’ The answer seems to be a resounding yes. Food exposure does not cause harm and in fact decreases anxiety around food during refeeding. Some research has proposed that we need to wait to use food expose with eating disorder patients until they are weight restored (e.g., instead of getting them to eat while distracting etc), since exposing them to food does in fact lead to their feared concern of weight gain. This research suggests that no, programs should go ahead and start using exposure even when patients are underweight.
Personalizing Treatment. I was lucky to be part of a fantastic symposium including Aaron Fisher (Berkley), Eiko Fried (U Amsterdam), Anne Roefs (Maastricht U), Sarah Jo David (Texas Tech), and Rich McNally (Harvard) that focused on using network analysis to personalize treatment. We got to hear about how network analysis is being used to lead to personalized treatment of anxiety, depression, eating disorders, and obesity. We also got to learn a bit about how we might use machine-learning to predict behaviors such as smoking. The main take away from this symposium, in my mind, is that technology is taking us to new places where we don’t have to rely on averages and can use data to make each treatment plan the best possible for each person.
Graduated Exposure versus Using a Hierarchy. Work from Ryan Jacoby at Mass General suggests that we don’t necessarily need to use an exposure hierarchy to treat OCD/anxiety. Instead, we can randomly choose exposures (regardless of difficulty level) and that this method may in fact maximize intolerance of uncertainty and produce better change (and surprisingly less drop out!).
Push for Open Science. One of the undertones of the conference was a push for Open Science. I have to give credit to Aaron Fisher for his plea during the personalized network symposium encouraging researchers to share their data. The message that I took away is that the more we collaborate and are open about our science, the more likely we are to really help people.
Overall, I felt inspired by the amount of collaboration and willingness of our colleagues to be open and work toward creating science that can have real impact. Thanks ABCT for another great conference- already looking forward to next year!
Eating Disorders Impact People of All Ages
by: Lisa Michelson, M.A.
Eating disorders happen at every age. From preteens to older adults, eating disorders do not discriminate. Previously, there was a long-held view that eating disorders are mental illnesses that mainly affect adolescents and young adults (e.g., Bruch, 1973). Subsequently, much of the eating disorder research has focused on these age groups (Rohde et al., 2015; Allen et al., 2014). However, as instances of eating disorders in older individuals increased, which may be attributed by an increase in awareness rather than an overall increase in eating disorders in older individuals, there became a need to treat this population as well. Unfortunately, eating disorders continue to be poorly understood in middle age and older populations. The comparison between how eating disorders manifest in older adults versus younger adults is even more elusive.
As we have begun to understand more about eating disorders, we have learned that fears and symptoms manifest in a variety of ages and also in a variety of ways. For example, at the onset of menopause, women may begin to alter how they view their body, which can lead to an increase in one’s body dissatisfaction (Gupta, 1990; Peat et al., 2008). In other words, as a woman’s body begins to change due to a decrease in hormonal production, she may become dissatisfied with how she experiences her body.
Conversely, we see body dissatisfaction in younger women may result from media portrayals of the “ideal” female body and femininity (Tiggemann & Stevens, 1999). Granted, older women are also affected by media portrayal of older women, but not to the same degree as younger women. In comparing the two ages, Rand and Wright (2000) found that older women have more realistic cognitive perceptions of their bodies. This literature may provide insight as to why older women are less affected by external factors (i.e. cultural factors) compared to younger women. Thus, it seems plausible that these cognitive, biological, and cultural differences may also manifest in different core fears in eating disorders in younger versus older individuals.
So why is this important? Why is identifying the differences between ages necessary? Therapy improves health outcomes for individuals of all ages in treatment for ED behaviors and fears. Furthermore, it is crucial to understand how etiological differences in various ages may contribute to diverse therapy outcomes. In other words, to treat a younger individual with AN in the same manner as an older individual with AN may lack efficacy. Yes, they both suffer from the same disorder; however, the reasons for engaging in such behaviors may be vastly different. It would be like a mechanic expecting to fix two cars in the same way.
Age may differentially influence how fears impact eating disorder symptoms. In a recent study, we analyzed if age moderated the relationship between the eating disorder symptoms and fear of food. Yes! We found that age moderated the relationship between fear of food and eating disorder symptoms (come see us present this work at ABCT!). Specifically, we found that fear of food is more related to eating disorder symptoms in younger versus older participants.
What does this mean? Older participants and younger participants differ in how food-related anxiety impacts eating disorder symptoms. This specific type of fear (food) may be most relevant in younger adults. This means we still need to figure out what types of eating-related fears are most relevant in older age! It is advantageous for the research community to continue to identify these differences as they may illuminate the most effective way to address eating disorder symptoms and fears between individuals of different ages.