Saramandi Alkistis, Crucianelli Laura, Koukoutsakis Athanasios, Nisticò Veronica, Mavromara Liza, Goeta Diana, Boido Giovanni, Gonidakis Fragiskos, Demartini Benedetta, Bertelli Sara, Gambini Orsola, Jenkinson Paul M, Fotopoulou Aikaterini
Department of Clinical, Educational and Health Psychology, University College London, UK.
Department of Biological and Experimental Psychology, Queen Mary University of London, London, UK.
Comput Psychiatr. 2024 Jun 26;8(1):92-118. doi: 10.5334/cpsy.109. eCollection 2024.
Patients with anorexia nervosa (AN) typically hold altered beliefs about their body that they struggle to update, including global, prospective beliefs about their ability to know and regulate their body and particularly their interoceptive states. While clinical questionnaire studies have provided ample evidence on the role of such beliefs in the onset, maintenance, and treatment of AN, psychophysical studies have typically focused on perceptual and 'local' beliefs. Across two experiments, we examined how women at the acute AN (N = 86) and post-acute AN state (N = 87), compared to matched healthy controls (N = 180) formed and updated their self-efficacy beliefs retrospectively (Experiment 1) and prospectively (Experiment 2) about their heartbeat counting abilities in an adapted heartbeat counting task. As preregistered, while AN patients did not differ from controls in interoceptive accuracy , they hold and maintain 'pessimistic' interoceptive, metacognitive self-efficacy beliefs after performance. Modelling using a simplified computational Bayesian learning framework showed that neither local evidence from performance, nor retrospective beliefs following that performance (that themselves were suboptimally updated) seem to be sufficient to counter and update pessimistic, self-efficacy beliefs in AN. AN patients showed lower learning rates than controls, revealing a tendency to base their posterior beliefs more on prior beliefs rather than prediction errors in both retrospective and prospective belief updating. Further explorations showed that while these differences in both explicit beliefs, and the latent mechanisms of belief updating, were not explained by general cognitive flexibility differences, they were explained by negative mood comorbidity, even after the acute stage of illness.
神经性厌食症（AN）患者通常对自己的身体持有改变了的信念，且难以更新这些信念，包括关于他们了解和调节自己身体尤其是内感受状态能力的整体、前瞻性信念。虽然临床问卷调查研究已经提供了大量证据证明此类信念在神经性厌食症的发病、维持和治疗中的作用，但心理物理学研究通常集中在感知和“局部”信念上。在两项实验中，我们研究了处于急性神经性厌食症状态（N = 86）和急性后神经性厌食症状态（N = 87）的女性，与匹配的健康对照组（N = 180）相比，如何在一项改编的心跳计数任务中回顾性地（实验1）和前瞻性地（实验2）形成和更新她们关于心跳计数能力的自我效能信念。正如预先注册的那样，虽然神经性厌食症患者在内感受准确性方面与对照组没有差异，但他们在表现后持有并维持“悲观的”内感受、元认知自我效能信念。使用简化的计算贝叶斯学习框架进行的建模表明，来自表现的局部证据，以及该表现后的回顾性信念（这些信念本身更新得并不理想）似乎都不足以反驳和更新神经性厌食症患者的悲观自我效能信念。神经性厌食症患者的学习率低于对照组，这表明在回顾性和前瞻性信念更新中，他们更倾向于根据先验信念而非预测误差来形成后验信念。进一步的探索表明，虽然这些在显性信念以及信念更新的潜在机制方面的差异，不能用一般认知灵活性差异来解释，但即使在疾病的急性期过后，它们也可以用负性情绪共病来解释。
