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Targeting habits in anorexia nervosa: a proof-of-concept randomized trial

Published online by Cambridge University Press:  19 February 2018

Joanna E. Steinglass ,
Deborah R. Glasofer ,
Emily Walsh ,
Gabby Guzman ,
Carol B. Peterson ,
B. Timothy Walsh ,
Evelyn Attia  and
Stephen A. Wonderlich
Joanna E. Steinglass*
Affiliation:
Department of Psychiatry, Center for Eating Disorders, New York State Psychiatric Institute, Columbia University Medical Center
Deborah R. Glasofer
Affiliation:
Department of Psychiatry, Center for Eating Disorders, New York State Psychiatric Institute, Columbia University Medical Center
Emily Walsh
Affiliation:
Department of Psychiatry, Center for Eating Disorders, New York State Psychiatric Institute, Columbia University Medical Center
Gabby Guzman
Affiliation:
Rutgers Graduate School of Applied and Professional Psychology
Carol B. Peterson
Affiliation:
Department of Psychiatry, University of Minnesota
B. Timothy Walsh
Affiliation:
Department of Psychiatry, Center for Eating Disorders, New York State Psychiatric Institute, Columbia University Medical Center
Evelyn Attia
Affiliation:
Department of Psychiatry, Center for Eating Disorders, New York State Psychiatric Institute, Columbia University Medical Center Department of Psychiatry, Weill Cornell Medical College
Stephen A. Wonderlich
Affiliation:
Neuropsychiatric Research Institute/Department of Psychiatry and Behavioral Science University of North Dakota School of Medicine and Health Sciences
*
Author for correspondence: Dr. Joanna Steinglass, E-mail: [email protected]
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Abstract

Background

Habits are behavioral routines that are automatic and frequent, relatively independent of any desired outcome, and have potent antecedent cues. Among individuals with anorexia nervosa (AN), behaviors that promote the starved state appear habitual, and this is the foundation of a recent neurobiological model of AN. In this proof-of-concept study, we tested the habit model of AN by examining the impact of an intervention focused on antecedent cues for eating disorder routines.

Methods

The primary intervention target was habit strength; we also measured clinical impact via eating disorder psychopathology and actual eating. Twenty-two hospitalized patients with AN were randomly assigned to 12 sessions of either Supportive Psychotherapy or a behavioral intervention aimed at cues for maladaptive behavioral routines, Regulating Emotions and Changing Habits (REaCH).

Results

Covarying for baseline, REaCH was associated with a significantly lower Self-Report Habit Index (SRHI) score and significantly lower Eating Disorder Examination-Questionnaire (EDE-Q) global score at the end-of-treatment. The end-of-treatment effect size for SRHI was d = 1.28, for EDE-Q was d = 0.81, and for caloric intake was d = 1.16.

Conclusions

REaCH changed habit strength of maladaptive routines more than an active control therapy, and targeting habit strength yielded improvement in clinically meaningful measures. These findings support a habit-based model of AN, and suggest habit strength as a mechanism-based target for intervention.

Keywords

Anorexia nervosaeating disorderhabithabit reversaloutcomessupportive psychotherapytreatment.
Type
Original Articles
Information
Psychological Medicine , Volume 48 , Issue 15 , November 2018 , pp. 2584 - 2591
Copyright
Copyright © Cambridge University Press 2018 

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Footnotes

*

These authors contributed equally to this work.

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