ET4AN

New technologies to support eating in Anorexia Nervosa: a neuroimaging study

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 Obiettivo del progetto (Objective)

'Problems associated with abnormal eating behaviour cause a significant burden on individuals, society and health services. This project focuses on anorexia nervosa (AN), an illness which is characterised by low weight, body dissatisfaction and restriction of food intake. The aims of the project are: a) to develop the candidate as independent researcher; b) to conduct a proof of concept study that will test an intervention aimed at reducing food associated fear, anxiety and avoidance in people with AN; and c) to investigate clinical, psychological and neural biomarkers associated with acute AN and with treatment outcomes. The study will be centred around a randomised controlled trial that will compare an intervention that uses self-help mobile technologies and guided virtual exposure to food with treatment as usual (TAU). A multimodal assessment that will employ clinical, cognitive and functional magnetic resonance (fMRI) measures will be conducted pre- and post-intervention. It is hoped that the results obtained from this study will allow the development of an evidence-based, feasible and cost-effective treatment for AN, which is part self-directed, deliverable through the use of new technologies. In addition the project will hopefully contribute to the understanding of the aetiology of AN. Achievement of the aims of the proposed fellowship will be facilitated by the fact that the candidate is well qualified; the project is being conducted within a large and established eating disorders group in King’s College London and lastly, because it will done in conjunction with a multidisciplinary and international team.'

Introduzione (Teaser)

EU-funded researchers at King's College London have developed a new programme to reduce food-related anxiety in patients with severe and enduring anorexia nervosa (AN).

Descrizione progetto (Article)

AN has the highest rate of mortality amongst psychiatric disorders. About 25 % of patients develop a severe and enduring form of the illness, which becomes resistant to treatment due to the neuroprogressive changes associated with prolonged starvation.

The ET4AN (New technologies to support eating in anorexia nervosa: A neuroimaging study) project recruited 16 patients and 21 healthy controls and developed and delivered 12 sessions of gradual and guided exposure-based therapy over a 3-month period.

Programme effects were established measuring body mass index (BMI) and using self-reports to assess eating disorder symptoms, mood symptoms, rituals and disturbing thoughts around food. A brain scan measured brain activations in response to the visual presentation of images of food before and after the intervention.

After the intervention, patients had higher BMI and reported significantly lower levels of eating-related concern and preoccupations. Lower levels of anxiety and increased confidence to change were also found.

Interestingly, the patients' neural signatures indicated plastic changes associated with the intervention. Compared to controls, they showed a pronounced reduction of activity in the precuneus, a region associated with processing of personal phobic stimuli. In parallel, there was a significant increase in neural activity in the prefrontal cortex where planning of complex actions takes place. A previous study looking at recovered AN patients indicated increased activity in the same area of the brain.

Findings from the ET4AN project indicate there is hope of reducing high levels of anxiety induced by exposure to food stimuli and inducing clinical changes in associated brain activity. The research group is currently investigating ways of disseminating details of this intervention globally to train health professionals and carers as well as peer mentors. The results will be used in the future to plan a larger randomised controlled study testing this therapeutic programme.