Behavioral assessment of the reinforcing effect of exercise in women with anorexia nervosa: Further paradigm development and data

Klein, David; Schebendach, Janet; Gershkovich, Marina; Bodell, Lindsay P.; Foltin, Richard W.; Walsh, B. Timothy

doi:10.1002/eat.20758

Cited by 41 publications

(43 citation statements)

References 29 publications

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“…Specifically, exercise is a highly reinforcing activity for some individuals and the strength of this reinforcing value may be what is leading to overuse or excessive patterns of exercise that are associated with ED severity (13,15,24,37). Consequently, emphasis should be placed on making appropriate exercise contingent on treatment compliance and success (41) rather than leaving exercise unmonitored and up to the ED individual to control.…”

Section: Discussionmentioning

confidence: 99%

Exercise in Eating Disorders Treatment

Cook

Wonderlich

Mitchell

et al. 2016

Medicine &Amp; Science in Sports &Amp; Exercise

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Introduction Although exercise is an effective intervention for many psychological health issues, it has often been overlooked as a potential adjunct to ED treatment. Thus, our objective was to summarize the literature by synthesizing themes identified in clinical studies and explicit guidelines or recommendations for the use or management of exercise in ED interventions into a proposed set of guidelines for the use of exercise in ED treatment. Method A literature search in exercise science, health psychology, and the ED literatures was conducted. The focus was to obtain articles that reported on therapeutic effects and/or guidelines for the therapeutic use of exercise in individuals with ED. Results Our review identified 11 core themes describing techniques that have been successful in using exercise therapeutically in ED treatment. These 11 guidelines are: employ a team of relevant experts, monitor medical status, screen for exercise related psychopathology, create a written contract of how therapeutic exercise will be used, include a psych-educational component, focus on positive reinforcement, create a graded exercise program, begin with mild intensity exercise, tailor the mode of exercise to the needs of the individual, include a nutritional component, and debrief after exercise sessions. Conclusion Our review identifies specific guidelines that may enhance ED treatment outcomes. It is the first to summarize divergent literatures and synthesizes previous successes that may guide the use of therapeutic exercise in some, but not all ED patients. This review provides a practical set of guidelines for the clinical management and therapeutic use of exercise in ED treatment by focusing on empowering individuals with exercise as a tool for healthy living.

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Section: Discussionmentioning

confidence: 99%

Exercise in Eating Disorders Treatment

Cook

Wonderlich

Mitchell

et al. 2016

Medicine &Amp; Science in Sports &Amp; Exercise

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show abstract

“…Estimates based on retrospective assessments suggest that up to 80% of individuals with anorexia nervosa have engaged in some form of excessive and/or strenuous physical activity during the course of their disorder; on cross-sectional assessment, 30-50% of patients endorsed recent “excessive” or “compulsive” engagement in exercise behavior, or symptoms of exercise “dependence” (for review, see [7]). Individuals hospitalized for anorexia nervosa will work at a progressive ratio task to gain access to exercise and this motivation is correlated with pre-admission levels of commitment to exercise [8]. Moreover, excessive exercise in anorexia nervosa has been associated with lower minimum BMI, younger age, higher scores on anxiety, perfectionism, and eating disorder symptom measures, more obsessions and compulsions, and greater persistence [9].…”

mentioning

confidence: 99%

Does Anorexia Nervosa Resemble an Addiction?

Barbarich-Marsteller¹,

Foltin²,

Walsh³

2011

CDAR

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Anorexia nervosa is a severe psychiatric disorder characterized by unrelenting self-starvation and life-threatening weight loss. The relentlessness with which individuals with anorexia nervosa pursue starvation and in some cases exercise despite the negative physical, emotional, and social consequences parallels features of addictive disorders. From a clinical perspective, individuals with anorexia nervosa behave similarly to individuals with substance abuse by narrowing their behavioral repertoire so that weight loss, restricting food intake, and excessive exercise interfere with other activities in much the same way that substance abuse does. However, fundamental differences exist between anorexia nervosa and substance abuse that suggest anorexia nervosa is not an addiction in and of itself.

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“…Our previous attempt to model sham feeding in a laboratory “sip and spit” paradigm using Kool Aid solutions sweetened with varying concentrations of aspartame (Klein, Schebendach, Gershkovich, Smith, et al, 2010) demonstrated feasibility of this novel paradigm, but there were no differences among AN and NC, and AN and BN participants (Klein et al, 2009). One notable difference between our modified sham feeding paradigm and the current study is that the latter allows patients to handle and administer their own Equal packets, versus presenting them with pre-prepared solutions.…”

Section: Discussionmentioning

confidence: 99%

Assessment of the motivation to use artificial sweetener among individuals with an eating disorder

et al. 2017

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Eating disorders are associated with a range of abnormalities in eating behavior. Some individuals consume large amounts of non-caloric artificial sweeteners, suggesting abnormalities in appetitive responding. The current study aimed to quantify hedonic and motivating effects of artificial sweetener in individuals with and without an eating disorder. Two laboratory studies were conducted. Hedonic preference was estimated using the number of artificial sweetener packets (0 to 10) added to unsweetened cherry flavored Kool-Aid (study 1). Motivation to obtain sweetener was assessed by a progressive ratio (PR) work task (study 2). Ninety-three participants (25 anorexia nervosa restricting type (AN-R), 23 AN binge/purge type (AN-B/P), 20 bulimia nervosa (BN), and 25 normal controls (NC)) completed the study. No significant difference in hedonic preference was found among participant groups. Work completed at the PR task ranged from 0 to 9500 key-board presses. The AN-B/P group had a significantly higher breakpoint and performed significantly more work for sweetener compared to the BN and NC groups. Among AN-B/P and AN-R participants, the preferred number of Equal packets was significantly correlated with the breakpoint and total work. The increased amount of work for sweetener among individuals with AN-B/P supports an enhanced reward value of sweet taste in this population, and suggests that the characteristic food avoidance in AN cannot be accounted for by decreased reward value of all taste-related stimuli. This study also supports the novel application of a PR ratio task to quantify the motivating effect of sweet taste among individuals with an eating disorder.

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Behavioral assessment of the reinforcing effect of exercise in women with anorexia nervosa: Further paradigm development and data

Cited by 41 publications

References 29 publications

Exercise in Eating Disorders Treatment

Exercise in Eating Disorders Treatment

Does Anorexia Nervosa Resemble an Addiction?

Assessment of the motivation to use artificial sweetener among individuals with an eating disorder

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