Applying neurobiology to the treatment of adults with anorexia nervosa

Abstract

BackgroundAnorexia nervosa is a severe, biologically based brain disorder with significant medical complications. It is critical that new, effective treatments are developed to interrupt the persistent course of the illness due to the medical and psychological sequelae. Several psychosocial, behavioral and pharmacologic interventions have been investigated in adult anorexia nervosa; however, evidence shows that their impact is weak and treatment effects are generally small.MethodThis paper describes a new neurobiological anorexia nervosa model that shifts focus from solely external influences, such as social and family, to include internal influences that integrate genetic and neurobiological contributions, across the age span. The model serves as a theoretical structure for a new, five-day treatment, outlined in this paper, targeting anorexia nervosa temperament, which integrates neurobiological dimensions into evidence-based treatment interventions. The treatment is in two phases. Phase I is a five day, 40 hour treatment for anorexia nervosa adults. Phase II is the follow-up and is currently being developed.ResultsPreliminary qualitative acceptability data on 37 adults with anorexia nervosa and 60 supports (e.g., spouses, parents, aunts, friends, partners, children of anorexia nervosa adults) are promising from Phase I. Clients with anorexia nervosa and their supports report that learning neurobiological facts improved their understanding of the illness and helped equip them with better tools to manage anorexia nervosa traits and symptoms. In addition, nutritional knowledge changed significantly.ConclusionsThis is the first neurobiologically based, five-day treatment for adults with anorexia nervosa and their supports. It is a new model that outlines underlying genetic and neurobiological contributions to anorexia nervosa that serves as a foundation to treat both traits and symptoms. Preliminary qualitative findings are promising, with both clients and supports reporting that the neurobiological treatment approach helped them better understand the illness, while better conceptualizing how to respond to their traits and manage their symptoms. Data in Phase I shows promise as a neurobiologically based intervention for anorexia nervosa, and it serves as a foundation for the development of Phase II. Evidence of ongoing program efficacy will be described as data are reported on Phase II.Trial registrationNCT NCT02852538 Registered 1 August 2016.Electronic supplementary materialThe online version of this article (doi:10.1186/s40337-016-0119-x) contains supplementary material, which is available to authorized users.

The acceptability, feasibility, and possible benefits of a neurobiologically‐informed 5‐day multifamily treatment for adults with anorexia nervosa

“…We previously demonstrated clinical effects following a 1‐week intervention for adolescent AN (Marzola et al, ; Rockwell, Boutelle, Trunko, Jacobs, & Kaye, ). This intensive format was adapted for adults while incorporating different interventions specific to adult AN (Hill, ; Hill, Peck, Wierenga, & Kaye, ) (see Supporting Information). The 5‐day treatment leverages SU participation based on considerable data showing that AN‐focused family therapy (FT‐AN) is the most effective approach in treating adolescents with AN (Eisler, Grange, & Lock, ; Lock, ; NICE, 2017), with multifamily therapy showing improved efficacy over single‐family therapy (Eisler et al, ).…”

A Protocol for Integrating Neuroscience Into Studies of Family-Based Treatment for Anorexia Nervosa: An Approach to Research and Potential Benefits for Clinical Care

“…Studies of neural change over the course of treatment in anorexia nervosa, particularly early in treatment, have the potential to increase motivation for early refeeding behavior among parents of adolescents. A recently developed treatment incorporating neurobiological research findings into treatment was considered helpful in improving understanding of AN (76), suggesting that improving knowledge about neurobiological changes through treatment may be of interest to patients and families. Anecdotally, we often hear parents and clinicians express concern about not directly targeting eating disorder cognitions early in treatment.…”

Reclaiming the Lost Self in the Treatment of Bulimia Nervosa: A Neurobiological Approach to Recovery That Integrates Mind, Brain, and Body

“…Currently, conventional psychosocial, behavioral and pharmacological treatment interventions for adults with BN and AN have been shown to have limited efficacy [25]. Hilde Bruch, a pioneer in the field of ED treatment, contends that…”

“…"Greater attention to improving the efficacy of existing ED treatment methodologies is critical, given the increasing prevalence of ED, the high risk of relapse, the effects of concurrent psychopathology, the high cost of care, and the greatest mortality rate of all the mental health disorders, which is one in ten patients [25]. Treatment outcome studies for cognitive-behavioral therapy (CBT), currently considered 'best practice' for the treatment of BN, reveal that only 50% of BN subjects stop bingeing and purging even under the very best conditions" [25].…”

“…"Greater attention to improving the efficacy of existing ED treatment methodologies is critical, given the increasing prevalence of ED, the high risk of relapse, the effects of concurrent psychopathology, the high cost of care, and the greatest mortality rate of all the mental health disorders, which is one in ten patients [25]. Treatment outcome studies for cognitive-behavioral therapy (CBT), currently considered 'best practice' for the treatment of BN, reveal that only 50% of BN subjects stop bingeing and purging even under the very best conditions" [25]. Neurobiological solutions for the impairment of self-structure exist within the patient's learned capacity to sense self-experience, a process defined as "attunement to one's subjective felt experience… a 'felt sense,' being both psychic and bodily, beginning with the body and occurring in the zone between the conscious and the unconscious.…”