Training Rejection Interpretation in Eating disordeRs (TRIER): Preliminary Findings of a Feasibility Study in Adolescents with Anorexia Nervosa

Abstract

This study investigated expectations of social rejection in adolescents with anorexia nervosa. Female adolescents (N = 24) admitted for hospital treatment completed both a positive interpretation bias training (experimental training) and a 50% positive and 50% negative interpretation bias training (control training), in a counterbalanced order, in two different testing sessions using a within-subjects design. The primary outcome for the training was the frequency of negative interpretations produced in the sentence completion task. At baseline, participants produced more negative than benign interpretations of ambiguous social scenarios (medium/large effect size). Following experimental training, participants produced fewer negative and more benign interpretations compared to control training (medium/large effect sizes). A trend for higher levels of self-esteem following virtual ostracism was found in the experimental condition compared to the control condition (small/ medium effect size). Interpretation bias modification has the potential to improve resilience to rejection in adolescents with anorexia nervosa.

A network analysis of borderline personality disorder symptoms and disordered eating

“…Examples of such treatments are dialectical behavioral therapy (DBT; Linehan, 1987), interpersonal therapy (Rieger et al, 2010), and emotion regulation training programs (Berking, Ebert, Cuijpers, & Hofmann, 2013). Therapeutic interventions aimed at correcting cognitive bias towards negative social cues (Cardi et al, 2019), particularly sensitivity to rejection and possibly also fear of abandonment, may also prove helpful for individuals with EDs and/or BPD symptoms.…”

The predictive value of the early maladaptive schemas in social situations in anorexia nervosa

“…In the literature, the Cyberball paradigm was used to understand how being rejected can hurt healthy people, as well as people with neurodevelopmental disorders (e.g., ASD) or behavioural and mood disorders (e.g., borderline personality disorder; Mastena et al, ; Zhang et al, ). To our knowledge, only one study (Cardi et al, ) has used the Cyberball task in populations with an ED, even though there is robust literature addressing the role of interpersonal impairment, social comparison, fear of negative evaluation, and the presence of a specific bias in the interpretation of social scenarios in AN (Arcelus, Haslam, Farrow, & Meyer, ; Cardi et al, ; Krug et al, ; Patel, Tchanturia, & Harrison, ). The Cyberball paradigm helps to evaluate the effects of inclusion and ostracism overcoming the limitation of body weight/shape concerns that could be a triggering bias for emotion and interpersonal relationship evaluations in people with eating concerns (Rieger, Dolan, Thomas, & Bell, ; Smith & Elizabeth, ).…”

“…Korn, Dietel, and Hartmann () used the Cyberball task as a measure of the effect of an interpretation modification paradigm in people with ED, showing that cognitive bias modification can have an effect on social interaction and physical comparison in nonclinical samples. Moreover, Cardi et al () used the Cyberball paradigm to evaluate the effect of an interpretation bias training for social rejection; however, they did not evaluate the paradigm per se. However, at the moment, no study has evaluated how the Cyberball paradigm is interpreted by the ED population.…”

A Critical Review of Studies Assessing Interpretation Bias Towards Social Stimuli in People With Eating Disorders and the Development and Pilot Testing of Novel Stimuli for a Cognitive Bias Modification Training

“…Five studies included adults (N = 312) aged 18-65 and one study included adolescents (N = 24) aged 14-18. With the exception of Cardi et al (2019) that involved adolescents with lived experience of eating disorders in the process of adapting materials for an interpretation bias modification training, all five studies included stimuli adapted by the researchers that were originally designed for other populations. This presents missed opportunities to tap into concerns around social rejection that may be relevant to people with eating disorders in particular, such as fears around being rejected due to the physical or behavioral symptoms that are specific to anorexia nervosa, and to explore concerns that may be predominantly relevant to adolescents with these conditions.…”

“…Each group lasted for one hour. Ambiguous scenarios related to the risk of rejection from others were then generated with consideration of those previously adapted for adolescents with eating disorders (Cardi et al, 2019) and the data derived from the focus groups. Each scenario consisted of a hypothetical ambiguous social situation which was open to the young person for interpretation (e.g., "It is a classmate's birthday and your good friend brings in a cake.…”