Abstract
Purpose
The present review explores emotion-focused treatments for anorexia nervosa (AN).
Methods
We conducted a systematic literature search across key databases (PsychINFO, PubMed/Medline, and Web of Science) prior to September 2015. Twenty studies were selected for systematic review.
Results
The present review found initial evidence supporting the acceptability and feasibility of emotion-focused treatments for AN. Although preliminary results are promising, further controlled studies are necessary to establish the efficacy of emotion-focused treatments for AN.
Conclusions
Future controlled trials should compare emotion-focused treatments against each other and against other AN treatments. Future studies should also examine the mechanisms of action for the emotion-focused treatments and treatment moderators.
Similar content being viewed by others
References
American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders, 5th edn. American Psychiatric Publishing, Washington, DC
Papadopoulos FC, Ekbom A, Brandt L, Ekselius L (2009) Excess mortality, causes of death and prognostic factors in anorexia nervosa. Br J Psychiatry 194(1):10–17. doi:10.1192/bjp.bp.108.054742
Sullivan PF (1995) Mortality in anorexia nervosa. Am J Psychiatry. 152(7):1073–1074. doi:10.1176/ajp.152.7.1073
Bulik CM, Brownley KA, Sedway JA, Lohr KN (2007) Anorexia nervosa treatment: a systematic review of randomized controlled trials. Int J Eat Disord. 40(4):310–320. doi:10.1002/eat.20367
Carter JC, McFarlane TL, Bewell C, Olmsted MP, Woodside DB, Kaplan AS et al (2009) Maintenance treatment for anorexia nervosa: a comparison of cognitive behavior therapy and treatment as usual. Int J Eat Disord 42(3):202–207. doi:10.1002/eat.20591
Pike KM, Walsh BT, Vitousek K, Wilson GT, Bauer J (2003) Cognitive behavior therapy in the posthospitalization treatment of anorexia nervosa. Am J Psychiatry 160(11):2046–2049. doi:10.1176/appi.ajp.160.11.2046
Lock J, Le Grange D, Agras WS, Moye A, Bryson SW, Jo B (2010) Randomized clinical trial comparing family-based treatment with adolescent-focused individual therapy for adolescents with anorexia nervosa. Arch Gen Psychiatry 67(10):1025–1032. doi:10.1001/archgenpsychiatry.2010.128
Juarascio A, Shaw J, Forman E, Timko CA, Herbert J, Butryn M et al (2013) Acceptance and commitment therapy as a novel treatment for eating disorders: an initial test of efficacy and mediation. Behav Modif 37(4):459–489. doi:10.1177/0145445513478633
Torres S, Guerra MP, Lencastre L, Roma-Torres A, Brandão I, Queirós C et al (2011) Cognitive processing of emotions in anorexia nervosa. Eur Eat Disord Rev. 19(2):100–111. doi:10.1002/erv.1046
Davies H, Schmidt U, Stahl D, Tchanturia K (2011) Evoked facial emotional expression and emotional experience in people with anorexia nervosa. Int J Eat Disord 44(6):531–539. doi:10.1002/eat.20852
Nowakowski ME, McFarlane T, Cassin S (2013) Alexithymia and eating disorders: a critical review of the literature. J Eat Disord. 1(21):10–1186. doi:10.1186/2050-2974-1-21
Haynos AF, Fruzzetti AE (2011) Anorexia nervosa as a disorder of emotion dysregulation: Evidence and treatment implications. Clin Psychol Sci Pract. 18(3):183–202. doi:10.1111/j.1468-2850.2011.01250.x
Oldershaw A, DeJong H, Hambrook D, Broadbent H, Tchanturia K, Treasure J et al (2012) Emotional processing following recovery from anorexia nervosa. Eur Eat Disord Rev. 20(6):502–509. doi:10.1002/erv.2153
Lavender JM, Wonderlich SA, Engel SG, Gordon KH, Kaye WH, Mitchell JE (2015) Dimensions of emotion dysregulation in anorexia nervosa and bulimia nervosa: a conceptual review of the empirical literature. Clin Psychol Rev 40:111–122. doi:10.1016/j.cpr.2015.05.010
Bruch H (1973) Eating disorders; obesity, anorexia nervosa, and the person within. Basic Books, New York
Fairburn CG, Cooper Z, Shafran R (2003) Cognitive behaviour therapy for eating disorders: a “transdiagnostic” theory and treatment. Behav Res Ther 41(5):509–528. doi:10.1016/s0005-7967(02)00088-8
Schmidt U, Treasure J (2006) Anorexia nervosa: valued and visible. A cognitive-interpersonal maintenance model and its implications for research and practice. Br J Clin Psychol 45(3):343–366. doi:10.1348/014466505x53902
Wildes JE, Ringham RM, Marcus MD (2010) Emotion avoidance in patients with anorexia nervosa: initial test of a functional model. Int J Eat Disord 43(5):398–404. doi:10.1002/eat.20730
Harrison A, Sullivan S, Tchanturia K, Treasure J (2009) Emotion recognition and regulation in anorexia nervosa. Clin Psychol Psychother. 16(4):348–356. doi:10.1002/cpp.628
Oldershaw A, Hambrook D, Stahl D, Tchanturia K, Treasure J, Schmidt U (2010) The socio-emotional processing stream in anorexia nervosa. Neurosci Biobehav Rev 35(3):970–988. doi:10.1016/j.neubiorev.2010.11.001
Russell TA, Schmidt U, Doherty L, Young V, Tchanturia K (2009) Aspects of social cognition in anorexia nervosa: affective and cognitive theory of mind. Psychiatry Res. 168(3):181–185. doi:10.1016/j.psychres.2008.10.028
Wildes JE, Marcus MD (2011) Development of emotion acceptance behavior therapy for anorexia nervosa: a case series. Int J Eat Disord 44(5):421–427. doi:10.1002/eat.20826
Fitzpatrick KK, Moye A, Hoste R, Lock J, Le Grange D (2010) Adolescent focused psychotherapy for adolescents with anorexia nervosa. J Contemp Psychother 40(1):31–39. doi:10.1007/s10879-009-9123-7
Le Grange D, Lock J, Agras WS, Moye A, Bryson SW, Jo B et al (2012) Moderators and mediators of remission in family-based treatment and adolescent focused therapy for anorexia nervosa. Behav Res Ther 50(2):85–92. doi:10.1016/j.brat.2011.11.003
Davies H, Fox J, Naumann U, Treasure J, Schmidt U, Tchanturia K (2012) Cognitive remediation and emotion skills training for anorexia nervosa: an observational study using neuropsychological outcomes. Eur Eat Disord Rev. 20(3):211–217. doi:10.1002/erv.2170
Money C, Davies H, Tchanturia K (2011) A case study introducing cognitive remediation and emotion skills training for anorexia nervosa inpatient care. Clin Case Study. 10(2):110–121. doi:10.1177/1534650110396545
Money C, Genders R, Treasure J, Schmidt U, Tchanturia K (2011) A brief emotion focused intervention for inpatients with anorexia nervosa: a qualitative study. J Health Psychol. 16(6):947–958. doi:10.1177/1359105310396395
Tchanturia K, Doris E, Fleming C (2014) Effectiveness of cognitive remediation and emotion skills training (CREST) for anorexia nervosa in group format: a naturalistic pilot study. Eur Eat Disord Rev. 22(3):200–205. doi:10.1002/erv.2287
Tchanturia K, Doris E, Mountford V, Fleming C (2015) Cognitive remediation and emotion skills training (CREST) for anorexia nervosa in individual format: self-reported outcomes. BMC Psychiatry 15(1):1–6. doi:10.1186/s12888-015-0434-9
Ben-Porath DD, Federici A, Wisniewski L, Warren M (2014) Dialectical behavior therapy: does it bring about improvements in affect regulation in individuals with eating disorders? J Contemp Psychother 44(4):245–251. doi:10.1007/s10879-014-9271-2
Chen EY, Segal K, Weissman J, Zeffiro TA, Gallop R, Linehan MM et al (2015) Adapting dialectical behavior therapy for outpatient adult anorexia nervosa—a pilot study. Int J Eat Disord 48(1):123–132. doi:10.1002/eat.22360
Kröger C, Schweiger U, Sipos V, Kliem S, Arnold R, Schunert T et al (2010) Dialectical behaviour therapy and an added cognitive behavioural treatment module for eating disorders in women with borderline personality disorder and anorexia nervosa or bulimia nervosa who failed to respond to previous treatments. An open trial with a 15-month follow-up. J Behav Ther Exp Psychiatry 41(4):381–388. doi:10.1016/j.jbtep.2010.04.001
Salbach-Andrae H, Bohnekamp I, Pfeiffer E, Lehmkuhl U, Miller AL (2008) Dialectical behavior therapy of anorexia and bulimia nervosa among adolescents: a case series. Cogn Behav Pract. 15(4):415–425. doi:10.1016/j.cbpra.2008.04.001
Lynch TR, Gray KL, Hempel RJ, Titley M, Chen EY, O’Mahen HA (2013) Radically open-dialectical behavior therapy for adult anorexia nervosa: feasibility and outcomes from an inpatient program. BMC Psychiatry. 13(1):293. doi:10.1186/1471-244x-13-293
Berman MI, Boutelle KN, Crow SJ (2009) A case series investigating acceptance and commitment therapy as a treatment for previously treated, unremitted patients with anorexia nervosa. Eur Eat Disord Rev. 17(6):426–434. doi:10.1002/erv.962
Heffner M, Sperry J, Eifert GH, Detweiler M (2002) Acceptance and commitment therapy in the treatment of an adolescent female with anorexia nervosa: a case example. Cogn Behav Pract. 9(3):232–236. doi:10.1016/s1077-7229(02)80053-0
Wildes JE, Marcus MD, Cheng Y, McCabe EB, Gaskill JA (2014) Emotion acceptance behavior therapy for anorexia nervosa: a pilot study. Int J Eat Disord 47(8):870–873. doi:10.1002/eat.22241
Dolhanty J, Greenberg LS (2009) Emotion-focused therapy in a case of anorexia nervosa. Clin Psychol Psychother. 16(4):336–382. doi:10.1002/cpp.624
Robinson AL, Dolhanty J, Greenberg L (2015) Emotion-focused family therapy for eating disorders in children and adolescents. Clin Psychol Psychother. 22(1):75–82. doi:10.1002/cpp.1861
Robin AL, Siegel PT, Moye A, Giroy M, Dennis AB, Sikand A (1999) A controlled comparison of family versus individual therapy for adolescents with anorexia nervosa. J Am Acad Child Adolesc Psychiatry 38(12):1482–1489. doi:10.1097/00004583-199912000-00008
Robin AL, Siegel PT, Koepke T, Moye AW, Tice S (1994) Family therapy versus individual therapy for adolescent females with anorexia nervosa. J Dev Behav Pediatr 15(2):111–116. doi:10.1097/00004703-199404000-00008
Tchanturia K, Davies H, Lopez C, Schmidt U, Treasure J, Wykes T (2008) Neuropsychological task performance before and after cognitive remediation in anorexia nervosa: a pilot case-series. Psychol Med 38(9):1371–1373. doi:10.1017/s0033291708003796
APA Presidential Task Force on Evidence-Based Practice (2006) Evidence-based practice in psychology. Am Psychol 61:271–285. doi:10.1037/0003-066x.61.4.271
Hambrook D, Oldershaw A, Rimes K, Schmidt U, Tchanturia K, Treasure J et al (2011) Emotional expression, self-silencing, and distress tolerance in anorexia nervosa and chronic fatigue syndrome. Br J Clin Psychol 50(3):310–325. doi:10.1348/014466510x519215
Lopez C, Tchanturia K, Stahl D, Treasure J (2008) Central coherence in eating disorders: a systematic review. Psychol Med 38(10):1393–1404. doi:10.1017/s0033291708003486
Tchanturia K, Davies H, Harrison A, Fox JRE, Treasure J, Schmidt U (2012) Altered social hedonic processing in eating disorders. Int J Eat Disord 45(8):962–969. doi:10.1002/eat.22032
Tchanturia K, Davies H, Roberts M, Harrison A, Nakazato M, Schmidt U et al (2012) Poor cognitive flexibility in eating disorders: examining the evidence using the Wisconsin Card Sorting Task. PLoS One 7(1):e28331. doi:10.1371/journal.pone.0028331
Zucker NL, Losh M, Bulik CM, LaBar KS, Piven J, Pelphrey KA (2007) Anorexia nervosa and autism spectrum disorders: guided investigation of social cognitive endophenotypes. Psychol Bull 133(6):976–1006. doi:10.1037/0033-2909.133.6.976
Linehan MM (1993) Dialectical behavior therapy for treatment of borderline personality disorder: implications for the treatment of substance abuse. In: Onken LS, Blane JD, Boren JJ (eds) National Institute on Drug Abuse research monograph: behavioral treatments for drug abuse and dependence. U.S. Department of Health and Human Services, Rockville, MD, pp 201–216. doi:10.1037/e495912006-012
Hayes SC, Strosahl KD, Wilson KG (1999) Acceptance and commitment therapy: an experiential approach to behavior change. Guilford Press, New York. doi:10.1037/e323402004-001
Bach P, Hayes SC (2002) The use of acceptance and commitment therapy to prevent the rehospitalization of psychotic patients: a randomized controlled trial. J Consult Clin Psychol 70(5):1129–1139. doi:10.1037//0022-006x.70.5.1129
Dalrymple KL, Herbert JD (2007) Acceptance and commitment therapy for generalized social anxiety disorder: a pilot study. Behav Modif 31(5):543–568. doi:10.1177/0145445507302037
Twohig MP, Hayes SC, Masuda A (2006) Increasing willingness to experience obsessions: acceptance and commitment therapy as a treatment for obsessive-compulsive disorder. Behav Ther 37(1):3–13. doi:10.1016/j.beth.2005.02.001
Woods DW, Wetterneck CT, Flessner CA (2006) A controlled evaluation of acceptance and commitment therapy plus habit reversal for trichotillomania. Behav Res Ther 44(5):639–656. doi:10.1016/j.brat.2005.05.006
Cockell SJ, Geller J, Linden W (2002) The development of a decisional balance scale for anorexia nervosa. Eur Eat Disord Rev. 10(5):359–375. doi:10.1002/erv.463
Kaye W (2008) Neurobiology of anorexia and bulimia nervosa. Physiol Behav 94(1):121–135. doi:10.1016/j.physbeh.2007.11.037
Strober M (2004) Pathologic fear conditioning and anorexia nervosa: on the search for novel paradigms. Int J Eat Disord 35(4):504–508. doi:10.1002/eat.20029
Hayes SC, Wilson KG, Gifford EV, Follette VM, Strosahl K (1996) Experiential avoidance and behavioral disorders: a functional dimensional approach to diagnosis and treatment. J Consult Clin Psychol 64(6):1152–1168. doi:10.1037//0022-006x.64.6.1152
Moses EB, Barlow DH (2006) A new unified treatment approach for emotional disorders based on emotion science. Curr Dir Psychol Sci 15(3):146–150. doi:10.1111/j.0963-7214.2006.00425.x
Greenberg LS (2002) Emotion-focused therapy: coaching clients to work through their feelings. American Psychological Association, Washington, DC. doi:10.1037/10447-000
Dolhanty J, Greenberg LS (2007) Emotion-focused therapy in the treatment of eating disorders. Eur Psychother. 7(1):97–116
Tchanturia K, Dapelo MAM, Harrison A, Hambrook D (2015) Why study positive emotions in the context of eating disorders? Curr Psychiatry Rep 17(1):1–12. doi:10.1007/s11920-014-0537-x
Kraemer HC, Wilson GT, Fairburn CG, Agras WS (2002) Mediators and moderators of treatment effects in randomized clinical trials. Arch Gen Psychiatry 59(10):877–883. doi:10.1001/archpsyc.59.10.877
Fredrickson BL (2001) The role of positive emotions in positive psychology. Am Psychol 56(3):218–226. doi:10.1037/0003-066x.56.3.218
Tugade MM, Fredrickson BL (2004) Resilient individuals use positive emotions to bounce back from negative emotional experiences. J Pers Soc Psychol 86(2):320–333. doi:10.1037/0022-3514.86.2.320
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
On behalf of all authors, the corresponding author states that there are no conflicts of interest.
Ethical approval
This article does not contain any studies with human participants or animals performed by any of the author.
Informed consent
For this type of study, formal consent is not required.
Rights and permissions
About this article
Cite this article
Sala, M., Heard, A. & Black, E.A. Emotion-focused treatments for anorexia nervosa: a systematic review of the literature. Eat Weight Disord 21, 147–164 (2016). https://doi.org/10.1007/s40519-016-0257-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s40519-016-0257-9