Katherine S Young1, Samantha J Rennalls2, Jenni Leppanen3, David Mataix-Cols4, Andrew Simmons2, Masashi Suda5, Iain C Campbell3, Owen O'Daly2, Valentina Cardi6. 1. Social, Genetic and Developmental Psychiatry Centre, King's College London's Institute of Psychiatry, Psychology and Neuroscience, UK. 2. Dept. of Neuroimaging, King's College London's, Institute of Psychiatry, Psychology and Neuroscience, UK. 3. Dept. of Psychological Medicine, Section of Eating Disorders, King's College London's Institute of Psychiatry, Psychology and Neuroscience, UK. 4. Centre for Psychiatric Research and Education, Dept. of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden. 5. Dept. of Psychiatry and Neuroscience, Gunma University, Japan. 6. Dept. of Psychological Medicine, Section of Eating Disorders, King's College London's Institute of Psychiatry, Psychology and Neuroscience, UK; fDepartment of General Psychology, University of Padova, Italy. Electronic address: valentina.cardi@kcl.ac.uk.
Abstract
BACKGROUND: Although the primary target of treatment for anorexia nervosa (AN) is weight gain, established psychological interventions focus on maintaining factors of AN, and do not specifically address eating behaviours. We have previously reported results of a case series investigating in-vivo food exposure in AN, demonstrating the feasibility and acceptability of this treatment together with evidence of significant clinical change (Cardi, Leppanen, Mataix-Cols, Campbell, & Treasure, 2019). The current study examined the neural circuitry of food-related anxiety. METHODS: We examined neural reactivity (fMRI) to food images pre- and post-food exposure therapy (n=16), and compared it to a group of healthy control participants (HC n=21) who were scanned on two occasions. RESULTS: Prior to treatment, the AN group (compared to HC) showed less reactivity in the anterior cingulate cortex (ACC). Following exposure treatment, patients (compared to HC), show increased activity in the dorsolateral prefrontal cortex, decreased activity in the superior parietal lobe and no differences in the ACC. The level of activation of the insula (pre-treatment) predicted the degree of post-treatment reduction in self-reported food anxiety in AN. Changes in food-related anxiety were also associated with changes in neural activation in a cluster located in the middle temporal gyrus/lateral parietal cortex. LIMITATIONS: The primary limitations of this work are the small sample size and lack of patient comparison group. CONCLUSIONS: Exposure to food in AN may be associated with changes in neural circuitries implicated in emotion regulation and attentional processes. However, these findings need replication in larger and controlled studies.
BACKGROUND: Although the primary target of treatment for anorexia nervosa (AN) is weight gain, established psychological interventions focus on maintaining factors of AN, and do not specifically address eating behaviours. We have previously reported results of a case series investigating in-vivo food exposure in AN, demonstrating the feasibility and acceptability of this treatment together with evidence of significant clinical change (Cardi, Leppanen, Mataix-Cols, Campbell, & Treasure, 2019). The current study examined the neural circuitry of food-related anxiety. METHODS: We examined neural reactivity (fMRI) to food images pre- and post-food exposure therapy (n=16), and compared it to a group of healthy control participants (HC n=21) who were scanned on two occasions. RESULTS: Prior to treatment, the AN group (compared to HC) showed less reactivity in the anterior cingulate cortex (ACC). Following exposure treatment, patients (compared to HC), show increased activity in the dorsolateral prefrontal cortex, decreased activity in the superior parietal lobe and no differences in the ACC. The level of activation of the insula (pre-treatment) predicted the degree of post-treatment reduction in self-reported food anxiety in AN. Changes in food-related anxiety were also associated with changes in neural activation in a cluster located in the middle temporal gyrus/lateral parietal cortex. LIMITATIONS: The primary limitations of this work are the small sample size and lack of patient comparison group. CONCLUSIONS: Exposure to food in AN may be associated with changes in neural circuitries implicated in emotion regulation and attentional processes. However, these findings need replication in larger and controlled studies.
Authors: Maria Seidel; Sophie Pauligk; Sophia Fürtjes; Joseph A King; Sophie-Maleen Schlief; Daniel Geisler; Henrik Walter; Thomas Goschke; Stefan Ehrlich Journal: Transl Psychiatry Date: 2022-01-24 Impact factor: 7.989