Melles Hanna, Jansen Anita
Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
J Eat Disord. 2024 Sep 13;12(1):141. doi: 10.1186/s40337-024-01094-w.
Anxiety is a core characteristic of anorexia nervosa and a potential target of exposure therapy, which requires a profound understanding of the patients' fears in order to be successful. The knowledge about fears in anorexia nervosa that should be targeted during exposure therapy can be enriched by laboratory research to the precise emotional and behavioral responses of anorexia nervosa patients when they are exposed to disorder relevant fear stimuli.
In the laboratory, patients with anorexia nervosa (n = 15) and healthy controls (n = 51) were exposed to 1. their own body weight and a 10% higher body weight on the scale, 2. a standardized lab breakfast, and 3. five virtual bodies with different BMIs ranging from extreme underweight to lower healthy weight. The participants emotional (anxiety, disgust, satisfaction, acceptance) and behavioral responses (calorie consumption) were assessed. Patients with anorexia nervosa but not the healthy controls then received an intensive exposure treatment (~ 30 individual exposure sessions) targeting their individual fears, next to standard care. After the exposure treatment, it was investigated whether the patients' responses to the laboratory tasks changed.
Across all tasks, the patients reported more anxiety than healthy controls. The patients also consumed less calories during the breakfast and accepted the different body weights on the scale less than healthy controls. During the virtual body exposure, the patients' emotional responses did not differ per avatar but they reacted more negatively towards avatars with healthier weights than did healthy controls. After the exposure treatment, the patients reported less fears and they consumed more calories while their BMIs had increased. They were also more accepting of healthier weights.
Exposure to food-, body- and weight-related stimuli in the laboratory induces emotional reactions in patients with anorexia nervosa that are informative for the identification of exposure therapy treatment targets. In addition, exposure therapy targeting individual fears in patients with anorexia nervosa led to symptom reduction and is a promising intervention for the treatment of anorectic fears, though more research is needed to optimize its efficacy.
焦虑是神经性厌食症的核心特征，也是暴露疗法的潜在目标，而暴露疗法要取得成功就需要深入了解患者的恐惧。通过实验室研究，了解神经性厌食症患者在接触与疾病相关的恐惧刺激时精确的情绪和行为反应，可丰富有关暴露疗法中应针对的神经性厌食症恐惧的知识。
在实验室中，让神经性厌食症患者（n = 15）和健康对照组（n = 51）接触：1. 他们自己的体重以及体重秤上比其高10%的体重；2. 一份标准化的实验室早餐；3. 五个不同体重指数（BMI）的虚拟身体，范围从极度体重过轻到较低的健康体重。评估参与者的情绪（焦虑、厌恶、满足、接受）和行为反应（卡路里摄入量）。然后，除标准护理外，对神经性厌食症患者而非健康对照组进行针对其个人恐惧的强化暴露治疗（约30次个体暴露疗程）。暴露治疗后，调查患者对实验室任务的反应是否发生了变化。
在所有任务中，患者报告的焦虑程度均高于健康对照组。患者在早餐期间摄入的卡路里也较少，并且在体重秤上接受不同体重的程度低于健康对照组。在虚拟身体暴露期间，患者对每个虚拟形象的情绪反应没有差异，但与健康对照组相比，他们对体重更健康的虚拟形象反应更消极。暴露治疗后，患者报告的恐惧减少，卡路里摄入量增加，同时体重指数有所上升。他们对更健康的体重也更能接受。
在实验室中接触与食物、身体和体重相关的刺激会在神经性厌食症患者中引发情绪反应，这有助于确定暴露疗法的治疗目标。此外，针对神经性厌食症患者个人恐惧的暴露疗法可减轻症状，是治疗厌食相关恐惧的一种有前景的干预措施，不过还需要更多研究来优化其疗效。
