Schulz Kurt P, Sysko Robyn, Fan Jin, Hildebrandt Thomas B
Icahn School of Medicine at Mount Sinai, New York, New York.
Icahn School of Medicine at Mount Sinai, New York, New York.
J Am Acad Child Adolesc Psychiatry. 2025 Feb 25. doi: 10.1016/j.jaac.2024.12.013.
This randomized controlled study tested the effect of interoceptive exposure on anterior insula function and connectivity for the extinction of palatable and rotten food-cue associations in adolescent girls with low weight eating disorders (LWED).
A food-related conditioning paradigm was performed by 39 adolescent girls with LWED and 19 matched controls during functional magnetic resonance imaging (fMRI). Adolescents with LWED were then randomized to 6 sessions of either interoceptive exposure (n = 18) or family-based (n = 21) treatment, followed by a second functional magnetic resonance imaging scan. Whole-brain activation and insula-driven connectivity for the extinction of palatable and rotten food-cue associations were compared between groups, and changes over treatment were compared between the 2 therapies.
Adolescents with LWED exhibited diminished bilateral anterior insula activation for the extinction of palatable food-cue associations compared with controls (t = 3.9-4.1, p < .001; Hedges g = 0.47-0.55). Brief interoceptive exposure treatment increased left anterior insula activation for the extinction of palatable food-cue associations (t = 5.10, p < .001; Hedges g = 1.59) and nonsignificantly improved palatability ratings for these associations during extinction compared with family-based treatment (β = -1.492, p = .087). There were no effects of group or therapy on connectivity or activation for rotten food-cue associations.
These results suggest that targeting food avoidance in adolescent girls with LWED using interoceptive exposure engages anterior insula regions that mediate the visceral sensation of disgust and may underlie the resistance to extinction. The findings present a window into possible pathophysiological mechanisms of anorexia nervosa and other LWED.
本随机对照研究测试了内感受暴露对低体重饮食失调（LWED）青春期女孩中美味和腐烂食物线索关联消退时前脑岛功能及连接性的影响。
39名患有LWED的青春期女孩和19名匹配的对照组在功能磁共振成像（fMRI）期间进行了与食物相关的条件反射范式实验。然后，将患有LWED的青少年随机分为接受6次内感受暴露治疗（n = 18）或家庭治疗（n = 21），随后进行第二次功能磁共振成像扫描。比较了两组之间美味和腐烂食物线索关联消退时的全脑激活及脑岛驱动的连接性，并比较了两种治疗方法在治疗过程中的变化。
与对照组相比，患有LWED的青少年在美味食物线索关联消退时双侧前脑岛激活减弱（t = 3.9 - 4.1，p <.001；Hedges g = 0.47 - 0.55）。简短的内感受暴露治疗增加了左侧前脑岛激活，以促进美味食物线索关联的消退（t = 5.10，p <.001；Hedges g = 1.59），并且与家庭治疗相比，在消退过程中对这些关联的美味评分有非显著改善（β = -1.492，p =.087）。对于腐烂食物线索关联，组间或治疗方法对连接性或激活均无影响。
这些结果表明，使用内感受暴露针对患有LWED的青春期女孩的食物回避行为，可激活前脑岛区域，该区域介导厌恶的内脏感觉，可能是消退抵抗的基础。这些发现为神经性厌食症和其他LWED的可能病理生理机制提供了一个窗口。
