Associations between disordered eating, internalizing symptoms, and behavioral and neural correlates of response inhibition in preadolescence.

Response inhibition difficulties are reported in individuals with eating disorders (EDs), anxiety, and depression. Although ED symptoms and internalizing symptoms co-occur in preadolescence, there is limited research examining associations between these symptoms and response inhibition in this age group. This study is the first to investigate the associations between behavioral and neural markers of response inhibition, disordered eating (DE), and internalizing symptoms in a community sample of preadolescents. Forty-eight children (M age = 10.95 years, 56.3% male) completed a Go/NoGo task, whereas electroencephalography was recorded. Self-report measures of DE and internalizing symptoms were collected. Higher levels of anxiety and depression were associated with neural markers of suboptimal response inhibition (attenuated P3NoGo amplitudes) in preadolescence. In contrast, higher levels of depression were associated with greater response inhibition at a behavioral level. These findings suggest internalizing symptoms in preadolescence are associated with P3-indexed difficulties in evaluation and monitoring, but these are not sufficient to disrupt behavioral performance on a response inhibition task. This pattern may reflect engagement of compensatory processes to support task performance. DE was not significantly associated with response inhibition, suggesting that difficulties in response inhibition may only be reliably observed in more chronic and severe DE and ED presentations.

A Systematic Review of the Effectiveness of Safewards: Has Enthusiasm Exceeded Evidence?

Safewards is intended to be an evidence-based approach to reduce levels of conflict and containment in mental health inpatient settings. A systematic review was carried out to examine whether Safewards is effective in reducing conflict and containment events; and improving ward climate. Searches for articles evaluating the implementation of Safewards was conducted using PsycINFO, PubMed, Web of Science, Cochrane Library and CINAHL. Thirteen studies were included for review after applying inclusion and exclusion criteria. The Quality Assessment Tool for Studies with Diverse Designs (QATSDD) was used to assess study quality and the majority of studies (N = 7) were rated as "moderate" quality. Whilst there is evidence to suggest that Safewards is effective for reducing conflict and containment in general mental health services, there is insufficient high-quality empirical evidence to support its effectiveness in settings beyond this. Further research using robust methodological designs with larger, more representative samples is required in order for the effectiveness of Safewards to be established across the range of contexts in which it is currently being applied.

Attentional bias in eating disorders: A meta-review.

OBJECTIVE: This meta-review summarizes and synthesizes the most reliable findings regarding attentional bias in eating disorders across paradigms and stimulus types and considers implications for theory and future research. METHOD: Four databases were systematically searched, along with reference lists of included reviews, yielding 15 systematic reviews (four of which were also meta-analyses). The quality of each review was appraised using the AMSTAR-2. RESULTS: Key findings from systematic reviews are summarized, organized by paradigm and stimulus type. DISCUSSION: The authors synthesize evidence from the highest-quality studies. There is evidence for attentional avoidance and vigilance in eating disorders depending on stimulus properties (low vs. high-calorie food; high-body mass vs. low-body mass index photos of others) and attentional avoidance of food stimuli in those with anorexia nervosa. Sad mood induction may generate attentional bias for food in those with binge-eating disorder. There may also be attentional bias to general threat in eating disorder samples. This meta-review concludes that most systematic reviews in this field are low in quality and summarizes the main areas that could be improved upon in future reviews. Implications of this study's findings for theory and intervention research are also discussed.

OBJETIVO: Esta meta-revisión resume y sintetiza los hallazgos más confiables con respecto al sesgo de atención en los trastornos de la conducta alimentaria a través de paradigmas y tipos de estímulos y considera las implicaciones para la teoría y la investigación futura. MÉTODO: Se realizaron búsquedas sistemáticas en cuatro bases de datos, junto con listas de referencias de las revisiones incluidas, lo que arrojó 15 revisiones sistemáticas (cuatro de las cuales también fueron metanálisis). La calidad de cada revisión se evaluó mediante el AMSTAR-2. RESULTADOS: Se resumen los hallazgos clave de las revisiones sistemáticas, organizados por paradigma y tipo de estímulo. DISCUSIÓN: Los autores sintetizan evidencia de estudios de la más alta calidad. Existe evidencia de evitación atencional y vigilancia en los trastornos alimentarios dependiendo de las propiedades de los estímulos (alimentos bajos en caloróas frente a alimentos ricos en calorías; fotos de otros con índice de masa corporal alto o bajo) y la evitación atencional de los estímulos alimentarios en personas con anorexia nerviosa. La inducción del estado de ánimo triste puede generar un sesgo de atención hacia la comida en personas con trastorno por atracón. También puede haber un sesgo de atención a la amenaza general en las muestras de trastornos alimentarios. Esta meta-revisión concluye que la mayoría de las revisiones sistemáticas en este campo son de baja calidad y resume las áreas principales que podrían mejorarse en revisiones futuras. También se discuten las implicaciones de los hallazgos de este estudio para la investigación de la teoría y la intervención.

A meta-ethnography of autistic people's experiences of social camouflaging and its relationship with mental health.

LAY ABSTRACT: Some autistic people describe trying to hide autistic behaviour and seem more neurotypical. Researchers called this 'social camouflaging' and have linked it with mental health difficulties. We used a step-by-step approach to identify research where autistic people talk about social camouflaging to explore the relationship between camouflaging and poor mental health. Thirteen studies were combined. The results describe how society negatively impacts autistic people's mental health, and camouflaging is a way to try and cope with this. Many autistic people find their camouflaging strategies have accidental negative consequences which also affect their mental health. Strategies which seemed 'successful' involved a lot of self-monitoring, were very mentally demanding or were very habitual and seemed to have more of an effect on mental health. This might be important for clinicians who support autistic people with mental health difficulties.

Climate distress and social identity: bringing theory to clinical practice.

Guidance for supporting individuals with climate distress often lacks a theoretical foundation to account for its social dimension. This paper argues for the value of the social identity approach (SIA) for understanding and supporting individuals with climate distress in clinic. Three aspects of climate distress are considered: social isolation, collective emotions, and climate action. It is posited that the SIA can guide interventions in a way that is tailored to the specific social dynamics entailed in each client's climate distress. The paper also considers how clinicians can weigh up the potential advantages and disadvantages of interventions that are commonly advised for these individuals, such as contact with nature and engaging in collective action. The author is a clinical psychologist and lecturer researching climate distress.

The relationship between shame, perfectionism and Anorexia Nervosa: A grounded theory study.

OBJECTIVES: The aim of this study was to explore the potential relationship between shame, perfectionism and Anorexia Nervosa (AN) and their impact on recovery from AN. METHOD: Semi-structured interviews were conducted with 11 people currently accessing services for AN. Interviews were transcribed and analysed using constructivist-grounded theory methodology. RESULTS: A model was developed which found a vicious cycle between shame and perfectionism. Participants tried to alleviate their feelings of shame by striving for perfectionism, however failing caused them more shame. Participants who disclosed childhood trauma believed their shame preceded their perfectionism. Participants who did not disclose trauma either believed their perfectionism preceded shame or they were unsure of which occurred first. Participants' responses suggested the following pathways from perfectionism to AN: needing goals; the need for a perfect life including a perfect body and AN being something they could be perfect at. The pathways identified between shame and AN entailed mechanisms via which AN could be used to escape shame, either by seeking pride through AN, seeking to numb shame through AN, seeking to escape body shame and punishing the self. AN was found to feed back into shame in two ways: when people had AN they felt ashamed when they broke their dietary rules, and also simultaneously people felt ashamed of their AN as they were not able to recover. Shame and perfectionism influenced one another in a cyclical pattern, in which shame drove perfectionism and not attaining high standards led to shame. Shame and perfectionism also impacted on recovery in several ways. AN functioned to numb participants' emotions, becoming part of their identity over time. AN also brought respite from a constant striving towards perfectionism. The need for a perfect recovery also influenced their motivation to engage in treatment, and fear of a return of strong emotions was another deterrent to recovery. CONCLUSION: The findings of this paper show perfectionism and shame to both be important in the aetiology and maintenance of AN and to have an impact on recovery from AN.

"Work WITH us": a Delphi study about improving eating disorder treatment for autistic women with anorexia nervosa.

BACKGROUND: There is an increased prevalence of anorexia nervosa (AN) in autistic women and this group has poorer treatment outcomes compared to non-autistic women with AN. However, there is little research into improving eating disorder treatment for autistic women. This study investigated how best to support autistic women with AN within eating disorder services. METHOD: A three-stage Delphi study was conducted with 49 participants with relevant expertise as a researcher, clinician, or expert by experience. RESULTS: A total of 70 statements were generated, with 56 reaching consensus after the final round. Statements reaching consensus made recommendations for adaptations to treatment, staff training, and service organisation. CONCLUSIONS: The results highlight the need to distinguish between autism- and AN-related difficulties, accommodate autistic traits such as sensory sensitivities and communication differences, and ensure the autistic voice is present in both the development and delivery of care. Future research should investigate the impact of these adaptations on outcomes. The applicability of these recommendations to autistic people with other eating disorders and of other genders needs to be investigated further.

Autistic women are more likely to have anorexia nervosa (AN) than non-autistic women. Autistic women can find eating disorder treatment unhelpful and need adaptations to treatment. This study asked a group of 49 researchers, staff, and people with personal experience of autism and eating disorders what they thought would help autistic women with AN. The study used a Delphi study method, which allows the calculation of how much participants agree without them needing to meet and make a decision. The study created 56 suggestions that the participants agreed on. The results give suggestions for changing treatment, training staff, and changing how services work to be better for autistic women. The suggestions highlight the importance of being able to tell the difference between autism- and AN- related behaviour, adjusting care to accommodate autistic traits, and involving autistic people in the development of care. Many of the suggestions recommend that changes are flexible to the individual autistic person. In the future, research should check if these changes are helpful for autistic women with AN, and if they would be helpful for autistic people who are not female or have other eating disorders.

Negative childhood events and the development of the anorexic voice: A grounded theory.

BACKGROUND: Many individuals diagnosed with anorexia nervosa (AN) describe their disorder as being represented by an internal 'anorexic voice' (AV). Previous studies have identified associations between eating psychopathology and multifarious forms of adverse life experiences. AIMS: This study explores the relationship between adverse experiences in childhood and the development of the AV. MATERIALS AND METHODS: Twelve women who had the experience of the AV in the context of a diagnosis of AN took part in semi-structured interviews. The interview data were analysed using a constructivist grounded theory methodology. RESULTS: Participants recalled feeling unsafe in a variety of relationships and a theory was constructed in which the AV provides a sense of conditional safety, becoming increasingly hostile and belittling when it is disobeyed, revealing similar characteristics to abusers and bullies in childhood. DISCUSSION: Findings are related to the broader literature on the link between trauma and eating disorders, and to existing theories of internal voices. CONCLUSIONS: The findings have implications for a trauma-focused approach when working with the AV.

Disordered eating and internalizing symptoms in preadolescence.

OBJECTIVES: Research has demonstrated links between disordered eating, anxiety, and depression in adults and adolescents but there is limited research investigating these associations in preadolescence. The current study examined the associations between disordered eating, anxiety, and depression during preadolescence, as well as the role of gender in moderating these associations. METHOD: Two hundred and thirteen children (M = 10.3 years; 51.2% male) reported levels of disordered eating (ChEAT) and anxiety and depression symptoms (RCADS-25). RESULTS: Regression analyses support an association between disordered eating and both anxiety and depression in preadolescence. Overall, there were no significant differences between boys and girls when the main effect was examined, which differs from research in adolescents. DISCUSSION: These findings highlight the importance of early detection for disordered eating behaviors and attitudes, as well as anxiety and depression in both boys and girls during preadolescence. Longitudinal research examining these associations is vital to help understand the trajectories of these problems, but also the gender differences in disordered eating that emerge during adolescence. Transdiagnostic interventions targeting several co-occurring problems, such as disordered eating, anxiety, and depression might be effective for preventing the development of eating disorders in the long term.

Verbal worry facilitates attention to threat in high-worriers.

BACKGROUND AND OBJECTIVES: Worry is predominantly a verbal-linguistic process with relatively little imagery. This study investigated whether the verbal nature of worry contributes to the maintenance of worry by enhancing attention to threat. It was hypothesised that verbal worry would lead to greater attentional bias to threat than imagery-based worry. METHODS: Fifty high-worriers were randomly assigned to one of two groups, one in which they were instructed to worry in a verbal way and one in which they worried in an imagery-based way, before completing a dot probe task as a measure of attention to threat-related words. RESULTS: Those who worried in verbal form demonstrated greater attentional bias to threat than did those who worried in imagery-based form. These findings could not be accounted for by group differences in personal relevance of or distress associated with worry topics, state mood following worry, levels of the relatedness of participants' worries to stimuli on the dot probe task, trait anxiety, general propensity to worry, nor adherence to the worry training. LIMITATIONS: The present study only included word stimuli in the dot probe task; inclusion of images would allow for firmly rejecting the hypothesis that the attention effects observed following verbal worry were merely a result of priming verbal threat representations. Also, future studies could include a further control group that does not engage in any form of worry to ascertain that verbal worry increased attentional bias rather than imagery decreasing pre-existing attentional bias. CONCLUSIONS: Possible mechanisms underlying this effect of verbal worry on attention to threat are discussed, together with clinical implications of the current findings.