Incorporating dispositional traits into the treatment of anorexia nervosa
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2011-12-01
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We provide a general framework to guide the development of interventions that aim to address persistent features in eating disorders that may preclude effective treatment. Using perfectionism as an exemplar, we draw from research in cognitive neuroscience regarding attention and reinforcement learning, from learning theory and social psychology regarding vicarious learning and implications for the role modeling of significant others, and from clinical psychology on the importance of verbal narratives as barriers that may influence expectations and shape reinforcement schedules. © Springer-Verlag Berlin Heidelberg 2010.
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Zucker, Nancy L, David Herzog, Ashley Moskovich, Rhonda Merwin and Tammy Lin (2011). Incorporating dispositional traits into the treatment of anorexia nervosa. Current Topics in Behavioral Neurosciences, 6(1). pp. 1–26. 10.1007/7854_2010_92 Retrieved from https://hdl.handle.net/10161/10959.
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Nancy Lee Zucker
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.
Ashley Ann Moskovich
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
Rhonda M. Merwin, PhD, is an Associate Professor in the Department of Psychiatry and Behavioral Sciences. Dr. Merwin has expertise in eating disorders, Acceptance and Commitment Therapy (ACT), and psychological concerns in the management of Type 1 diabetes. She a Fellow and the current President of the Association for Contextual Behavioral Science, and 1 of 116 peer-reviewed ACT trainers worldwide. Dr. Merwin is leading work to address eating disorders in type 1 diabetes, a dangerous comorbidity that disproportionately affects women, and studies on the mechanisms of eating disorder development, maintenance and processes of change, and digital early interventions. Her research is funded by the National Institutes of Health (e.g., NIDDK, NIMH) and Breakthrough T1D (formerly the Juvenile Diabetes Research Foundation, JDRF), among other sponsors. Dr. Merwin is the author of ACT for Anorexia: A Guide for Clinicians. Her lab focuses on problematic eating and weight control, or more broadly, problems 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 momentary assessment and intervention. Dr. Merwin directs the ACT Clinic at Duke which provides clinical services in ACT and in-depth training in ACT for psychiatry residents, clinical psychology graduate students, interns and fellows. She also teaches a psychotherapy course for psychiatry residents in the School of Medicine and conducts continuing education events/workshops locally, nationally and internationally. For more information about Dr. Merwin's research, education and clinical activities, see ACTatDuke.org.
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