Incorporating dispositional traits into the treatment of anorexia nervosa

Our laboratory studies individuals who have difficulty detecting, interpreting, and/or using signals from their body to guide adaptive behavior towards themselves and their environment.  We explore how disruptions in these capacities contribute to psychosomatic disorders such as functional abdominal pain or anorexia nervosa and how the adaptive development of these capacities helps individuals to know themselves, trust themselves, and flourish.

Our primary populations of study are individuals struggling with eating disorders and feeding disorders of childhood: conditions that are sine quo non for dysregulation of basic motivational drives or conditions in which disruption in these processes may be more likely: such as the presence of pediatric pain. Several conditions are of particular focus due to the presence of profound deficits in interoception or/and integration of internal arousal: anorexia nervosa, a disorder notable for extreme, determined, rigid, and repetitive behaviors promoting malnourishment and the inability to use signals of interoception and proprioception in the service of goal-directed actions, Avoidant Restrictive Food Intake Disorder (ARFID), children with "sensory superpowers" who may be hypersensitive to somatic signals and external sensory features; and pediatric functional abdominal pain, children who may become afraid of their bodies' messages due to generalization of fear of pain to innocuous sensations. Study of children allows us to ask different questions about disorder etiology, maintenance, and course as we can minimize the impact of malnutrition on brain function and perhaps better characterize prior learning history. What we most passionate about is using this conceptualization to design and test novel treatments that enable individuals across the lifespan to feel safe in their bodies and to achieve this in a way that is fun.

Our parallel line of research examines how individuals’ sense others when they have difficulties sensing themselves. Increasing evidence suggests that we understand others via embodied enactments of our own experiences. These findings have profound implications for individuals who have dysfunction in the experience of their bodies as it suggests limited capacities to truly understand others’ experiences. By studying these processes in parallel, we hope to better understand how this interaction between sensing ourselves and others unfolds.

Dr. Moskovich is interested in the treatment of adolescent and adult eating disorders, anxiety disorders, and mood disorders using acceptance-based interventions, including Acceptance and Commitment Therapy.

Rhonda M. Merwin, PhD, is an Associate Professor in the Department of Psychiatry and Behavioral Sciences. Dr. Merwin completed her doctorate at the University of Mississippi and an NIH-sponsored postdoctoral fellowship in Behavioral Medicine at Duke University Medical Center before joining the Duke faculty in 2008. Dr. Merwin has expertise in eating disorders, Acceptance and Commitment Therapy (ACT), and psychological concerns in the management of Type 1 diabetes. She is 1 of 111 peer-reviewed ACT trainers worldwide and a Fellow and the President-Elect of the Association for Contextual Behavioral Science. Dr. Merwin is leading work to address eating disorders in type 1 diabetes, a dangerous comorbidity that disproportionately affects women. Her research is funded by the National Institutes of Health (e.g., NIDDK, NIMH) and the Juvenile Diabetes Research Foundation (JDRF), among others. She is the author of ACT for Anorexia: A Guide for Clinicians. Dr. Merwin directs the ACT in Context Laboratory, which focuses on the mechanisms and treatment of eating disorders, or more broadly, problems in living that arise from an adversarial relationship with the body or the body's cues, and/or difficulty reading and responding to internal cues to meet one's physical and emotional needs. Her treatment development work integrates digital and mobile technologies to increase treatment access, and for contextually sensitive assessment and intervention, with a focus on processes of change. Dr. Merwin directs the ACT at Duke program, a clinical, research and training program in ACT and process-based therapy, that includes a practicum for psychiatry residents, and psychology fellows and graduate students to receive in-depth training in ACT, as well as community consultation team for local providers and continuing education events. Dr. Merwin teaches a psychotherapy course for psychiatry residents in the School of Medicine. For more information about Dr. Merwin's research, educational and clinical activities, see ACTatDuke.org.