Hostname: page-component-586b7cd67f-tf8b9 Total loading time: 0 Render date: 2024-11-23T21:43:14.750Z Has data issue: false hasContentIssue false

Changes in neuronal correlates of body image processing by means of cognitive-behavioural body image therapy for eating disorders: a randomized controlled fMRI study

Published online by Cambridge University Press:  16 December 2010

S. Vocks*
Affiliation:
Department of Clinical Psychology and Psychotherapy, Ruhr-University, Bochum, Germany
D. Schulte
Affiliation:
Department of Clinical Psychology and Psychotherapy, Ruhr-University, Bochum, Germany
M. Busch
Affiliation:
Department of Radiology, University of Witten-Herdecke, Germany
D. Grönemeyer
Affiliation:
Department of Radiology, University of Witten-Herdecke, Germany
S. Herpertz
Affiliation:
Department of Psychosomatic Medicine and Psychotherapy, Ruhr-University, Bochum, Germany
B. Suchan
Affiliation:
Department of Cognitive Neuroscience, Ruhr-University, Bochum, Germany
*
*Address for correspondence: PD Dr S. Vocks, Ruhr-University Bochum, Department of Clinical Psychology and Psychotherapy, Universitätsstr. 150, D-44780 Bochum, Germany. (Email: [email protected])

Abstract

Background

Previous neuroimaging studies have demonstrated abnormalities in visual body image processing in anorexia and bulimia nervosa, possibly underlying body image disturbance in these disorders. Although cognitive behavioural interventions have been shown to be successful in improving body image disturbance in eating disorders, no randomized controlled study has yet analysed treatment-induced changes in neuronal correlates of visual body image processing.

Method

Altogether, 32 females with eating disorders were randomly assigned either to a manualized cognitive behavioural body image therapy consisting of 10 group sessions, or to a waiting list control condition. Using functional magnetic resonance imaging, brain responses to viewing photographs of one's own and another female's body taken from 16 standardized perspectives while participants were wearing a uniform bikini were acquired before and after the intervention and the waiting time, respectively.

Results

Data indicate a general blood oxygen level dependent signal enhancement in response to looking at photographs of one's own body from pre- to post-treatment, whereas exclusively in the control group activation decreases from pre- to post-waiting time were observed. Focused activation increases from pre- to post-treatment were found in the left middle temporal gyrus covering the coordinates of the extrastriate body area and in bilateral frontal structures including the middle frontal gyrus.

Conclusions

Results point to a more intense neuronal processing of one's own body after the cognitive behavioural body image therapy in cortical regions that are responsible for the visual processing of the human body and for self-awareness.

Type
Original Articles
Copyright
Copyright © Cambridge University Press 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

APA (2000). Diagnostic and Statistic Manual of Psychiatric Disorders, 4th edn, text revision. American Psychiatric Association: Washington, DC.Google Scholar
Cash, TF (2004). Body image: past, present, and future. Body Image 1, 15.CrossRefGoogle ScholarPubMed
Cash, TF, Deagle, EA (1997). The nature and extent of body-image disturbances in anorexia nervosa and bulimia nervosa: a meta-analysis. International Journal of Eating Disorders 22, 107126.3.0.CO;2-J>CrossRefGoogle ScholarPubMed
Cash, TF, Hrabosky, JI (2004). Treatment of body image disturbances. In Handbook of Eating Disorders and Obesity (ed. Thompson, J. K.), pp. 515541. John Wiley, Sons: Hoboken, New Jersey.Google Scholar
Clower, DM, West, RA, Lynch, JC, Strick, PL (2001). The inferior parietal lobule is the target of output from the superior colliculus, hippocampus, and cerebellum. Journal of Neuroscience 21, 62836291.CrossRefGoogle ScholarPubMed
Cohen, J (1977). Statistical Power Analysis for the Behavioural Sciences. Academic Press: New York.Google Scholar
Cooper, MJ, Fairburn, CG (1992). Thoughts about eating, weight and shape in anorexia nervosa and bulimia nervosa. Behaviour Research and Therapy 30, 501511.CrossRefGoogle ScholarPubMed
Coull, JT, Nobre, AC (1999). Where and when to pay attention: the neural systems for directing attention to spatial locations and to time intervals as revealed by both PET and fMRI. Journal of Neuroscience 18, 74267435.CrossRefGoogle Scholar
Downing, PE, Jiang, Y, Shuman, M, Kanwisher, N (2001). A cortical area selective for visual processing of the human body. Science 293, 24702473.CrossRefGoogle ScholarPubMed
Fairburn, CG, Cooper, GT (1993). The Eating Disorder Examination. In Binge Eating: Nature, Assessment and Treatment (ed. Fairburn, C. F. and Wilson, G. T.), pp. 317332. Guilford: New York.Google Scholar
Fairburn, CG, Cooper, Z, Shafran, R (2003 a). Cognitive behavior therapy for eating disorders: a ‘transdiagnostic’ theory and treatment. Behaviour Research and Therapy 41, 509528.CrossRefGoogle ScholarPubMed
Fairburn, CG, Stice, E, Cooper, Z, Doll, HA, Norman, PA, O'Connor, ME (2003 b). Understanding persistence in bulimia nervosa: a 5-year naturalistic study. Journal of Consulting and Clinical Psychology 71, 103109.CrossRefGoogle ScholarPubMed
Farrell, C, Lee, M, Shafran, R (2005). Assessment of body size estimation: a review. European Eating Disorders Review 13, 7588.CrossRefGoogle Scholar
First, MB, Spitzer, RL, Gibbon, M, Williams, JBW (1996). Structured Clinical Interview for DSM-IV Axis I Disorders Clinician Version (SCID-CV). American Psychiatric Press Association: Washington DC.Google Scholar
Friederich, H-C, Uher, R, Brooks, S, Giampietro, V, Brammer, M, Williams, SCR, Herzog, W, Treasure, J, Campbell, IC (2007). I'm not as slim as that girl: neural bases of body shape self-comparison to media images. NeuroImage 37, 674681.CrossRefGoogle Scholar
Furmark, T, Tillfors, M, Marteinsdottir, I, Fischer, H, Pissiota, A, Langstrom, B, Fredrikson, M (2002). Common changes in cerebral blood flow in patients with social phobia treated with citalopram or cognitive-behavioral therapy. Archives of General Psychiatry 59, 425433.CrossRefGoogle ScholarPubMed
Garner, DM (1991). Eating Disorder Inventory – 2. Professional Manual. Psychological Assessment Resources: Odessa.Google Scholar
Grawe, K (2006). Neuropsychotherapy: How the Neurosciences Inform Effective Psychotherapy. Lawrence Erlbaum: London.Google Scholar
Heatherton, TF, Wyland, CL, Macrae, CN, Demos, KE, Denny, BT, Kelley, WM (2006). Medial prefrontal activity differentiates self from close others. Social Cognitive and Affective Neuroscience 1, 1825.CrossRefGoogle ScholarPubMed
Hilbert, A, Tuschen-Caffier, B, Karwautz, A, Niederhofer, N, Munsch, S (2007). Eating Disorder Examination Questionnaire: evaluation of the German translation [in German]. Diagnostica 53, 144154.CrossRefGoogle Scholar
Hodzic, A, Muckli, L, Singer, W, Stirn, A (2009). Cortical responses to self and others. Human Brain Mapping 30, 951962.CrossRefGoogle ScholarPubMed
Jacobi, C, Hayward, C, de Zwaan, M, Kraemer, HC, Agras, WS (2004). Coming to terms with risk factors for eating disorders: application of risk terminology and suggestions for a general taxonomy. Psychological Bulletin 130, 1965.CrossRefGoogle ScholarPubMed
Keel, PK, Dorer, DJ, Franko, DL, Jackson, SC, Herzog, DB (2005). Post remission predictors of relapse in women with eating disorders. American Journal of Psychiatry 162, 22632268.CrossRefGoogle Scholar
Linden, DEJ (2006). How psychotherapy changes the brain – the contribution of functional neuroimaging. Molecular Psychiatry 11, 528538.CrossRefGoogle ScholarPubMed
Modinos, G, Ormel, J, Aleman, A (2009). Activation of anterior insula during self-reflection. PLoS ONE 4, e4618.CrossRefGoogle ScholarPubMed
Paquette, V, Lévesque, J, Mensour, B, Leroux, J-M, Beaudoin, G, Bourgouin, P, Beauregard, M (2003). ‘Change the mind and you change the brain’: effects of cognitive-behavioral therapy on the neural correlates of spider phobia. NeuroImage 18, 401409.CrossRefGoogle ScholarPubMed
Paul, T, Thiel, A (2005). Eating Disorder Inventory Deutsche Version [Eating Disorder Inventory German version]. Hogrefe: Göttingen.Google Scholar
Peelen, MV, Downing, PE (2007). The neural basis of visual body perception. Nature Reviews Neuroscience 8, 636648.Google Scholar
Platek, SM, Wathne, K, Tierney, NG, Thomson, JW (2008). Neural correlates of self-face recognition: an effect–location meta-analysis. Brain Research 1232, 173184.CrossRefGoogle ScholarPubMed
Ricciardelli, LA, Tate, D, Williams, RJ (1997). Body dissatisfaction as a mediator of the relationship between dietary restraint and bulimic eating patterns. Appetite 29, 4354.CrossRefGoogle ScholarPubMed
Rushford, N, Ostermeyer, A (1997). Body image disturbances and their change with videofeedback in anorexia nervosa. Behaviour Research and Therapy 35, 389398.CrossRefGoogle ScholarPubMed
Sachdev, P, Mondraty, N, Wen, W, Gulliford, K (2008). Brains of anorexia nervosa patients process self-images differently from non-self-images: an fMRI study. Neuropsychologia 46, 21612168.CrossRefGoogle ScholarPubMed
Schienle, A, Schäfer, A, Hermann, A, Rohrmann, S, Vaitl, D (2007). Symptom provocation and reduction in patients suffering from spider phobia: an fMRI study on exposure therapy. European Archives of Psychiatry and Clinical Neuroscience 257, 486493.CrossRefGoogle Scholar
Seeger, G, Braus, DF, Ruf, M, Goldberger, U, Schmidt, MH (2002). Body image distortion reveals amygdala activation in patients with anorexia nervosa – a functional magnetic resonance imaging study. Neuroscience Letters 326, 2528.CrossRefGoogle ScholarPubMed
Straube, T, Glauer, M, Dilger, S, Mentzel, HJ, Miltner, WH (2006). Effects of cognitive-behavioral therapy on brain activation in specific phobia. NeuroImage 29, 125135.CrossRefGoogle ScholarPubMed
Suchan, B, Busch, M, Schulte, D, Grönemeyer, D, Herpertz, S, Vocks, S (2010). Reduction of grey matter density in the extrastriate body area in women with anorexia nervosa. Behavioral Brain Research 206, 6367.CrossRefGoogle ScholarPubMed
Talairach, J, Tournoux, J (1988). Co-planar Stereotaxic Atlas of the Human Brain: 3-Dimensional Proportional System – An Approach to Cerebral Imaging. Thieme: New York.Google Scholar
Thompson, JK (2004). The (mis)measurement of body image: ten strategies to improve assessment for applied and research purposes. Body Image 1, 714.CrossRefGoogle ScholarPubMed
Treat, TA, Gaskill, JA, McCabe, EB, Ghinassi, FA, Luczak, AD, Marcus, MD (2005). Short-term outcome of psychiatric inpatients with anorexia nervosa in the current care environment. International Journal of Eating Disorders 38, 123133.CrossRefGoogle ScholarPubMed
Troop, NA, Allan, S, Treasure, JL, Katzman, M (2003). Social comparison and submissive behaviour in eating disorder patients. Psychology and Psychotherapy: Theory Research and Practice 76, 237249.CrossRefGoogle ScholarPubMed
Tuschen-Caffier, B, Vögele, C, Bracht, S, Hilbert, A (2003). Psychological responses to body shape exposure in patients with bulimia nervosa. Behaviour Research and Therapy 41, 573586.CrossRefGoogle ScholarPubMed
Uher, R, Murphy, T, Friederich, H-C, Dalgleish, T, Brammer, MJ, Giampietro, V, Phillips, ML, Andrew, CM, Ng, VW, Williams, SCR, Campbell, IC, Treasure, J (2005). Functional neuroanatomy of body shape perception in healthy and eating-disordered women. Biological Psychiatry 58, 990997.CrossRefGoogle ScholarPubMed
Vocks, S, Busch, M, Grönemeyer, D, Schulte, D, Herpertz, S, Suchan, B (2010 a). Neural correlates of viewing photographs of one's own and another female's body in anorexia and bulimia nervosa: an fMRI study. Journal of Psychiatry and Neuroscience 35, 163176.CrossRefGoogle ScholarPubMed
Vocks, S, Busch, M, Schulte, D, Grönemeyer, D, Herpertz, S, Suchan, B (2010 b). Cognitive-behavioral body image therapy enhances extrastriate body area activation among patients with anorexia nervosa: an fMRI study. Psychiatry Research: Neuroimaging 183, 114118.Google Scholar
Vocks, S, Legenbauer, T (2005). Körperbildtherapie bei Anorexia und Bulimia Nervosa. Ein kognitiv-verhaltenstherapeutisches Behandlungsprogramm [Body image therapy in anorexia and bulimia nervosa. A cognitive-behavioural treatment programme]. Hogrefe: Göttingen.Google Scholar
Vocks, S, Legenbauer, T, Rüddel, H, Troje, NF (2007 a). Static and dynamic body image in bulimia nervosa: mental representation of body dimensions and biological motion patterns. International Journal of Eating Disorders 40, 5966.CrossRefGoogle ScholarPubMed
Vocks, S, Legenbauer, T, Troje, NF, Schulte, D (2006). Body image therapy in eating disorders: influencing the perceptive, cognitive-affective, and behavioral component of body image [in German]. Zeitschrift für Klinische Psychologie und Psychotherapie 35, 286295.CrossRefGoogle Scholar
Vocks, S, Legenbauer, T, Wächter, A, Wucherer, M, Kosfelder, J (2007 b). What happens in the course of body exposure? Emotional, cognitive, and physiological reactions to mirror confrontation in eating disorders. Journal of Psychosomatic Research 62, 231239.CrossRefGoogle ScholarPubMed
Vocks, S, Wächter, A, Wucherer, M, Kosfelder, J (2008). Look at yourself: can body image therapy affect the cognitive and emotional response to seeing oneself in the mirror in eating disorders? European Eating Disorders Review 16, 147154.Google Scholar
Wagner, A, Ruf, M, Braus, DF, Schmidt, MH (2003). Neuronal activity changes and body image distortion in anorexia nervosa. Neuroreport 14, 21932197.CrossRefGoogle ScholarPubMed
Wittchen, H-U., Zaudig, M, Fydrich, T (1997). SKID. Strukturiertes Klinisches Interview für DSM-IV [SCID. Structured Clinical Interview for DSM-IV]. Hogrefe: Göttingen.Google Scholar