A fMRI Pilot Study of the Effects of Meal-support in Eating Disorders.
Condition: Anorexia Nervosa
MeSH terms: Anorexia; Feeding and Eating Disorders; Anorexia Nervosa
Study type: Interventional

Summary: 
      This study involves people with eating disorders and healthy volunteers (people who have
      never experienced an eating disorder). Participants are interviewed about their psychological
      and physical health by the experimenter and they have a simulated scan session (about 1
      hour). Approximately 1 week after they attend the first study session. They are asked to
      complete questionnaires and computerized tasks (about 30 minutes) followed by the active scan
      (1 hour). During the brain scan they look at pictures and answer questions about the
      pictures. After the first study session, people with eating disorders receive an intensive
      meal-support intervention (in the following 3 months) aimed at reducing anxiety and fears
      related to food (10 sessions lasting about 60 min.). Three months after the first brain scan,
      participants with eating disorders and healthy controls receive a second assessment and brain
      scan. We hypothesized that the meal support intervention will be effective in: 1) targeting
      eating disorder symptoms (body mass index - BMI, primarily) and 2) producing functional
      changes in brain regions that underline food-related anxiety and avoidance.
    

Detailed description: 
      Anorexia nervosa (AN) is characterized by severe malnutrition. Patients report aversive
      experiences of re-feeding and frequently drop-out from treatment. This study will test the
      hypothesis that gradual and guided exposure to food is associated with increased body mass
      index (BMI) and reduced eating disorder psychopathology in patients with AN. It is also
      hypothesized that the intervention will lead to changes in brain activation in regions
      implicated in anticipatory anxiety and fear of food and emotion regulation (i.e. amygdala,
      insula, dorso-lateral prefrontal cortex [DLPFC]). Sixteen women with anorexia nervosa not
      receiving any interventions at the time of the study will be recruited from the community.
      Patients will complete a range of self-report measures and will undergo a functional magnetic
      resonance imaging (fMRI) scan before and after receiving 10 exposure therapy sessions over 3
      months. A matched healthy control group (n=20) will also have two brain scans 3 months apart.

      To be eligible for the study, participants will have to be female, proficient in English,
      right-handed, between 19 and 60 years. Participants in the clinical group will have to meet
      the DSM-IV-TR diagnostic criteria for anorexia nervosa. Participants in the healthy control
      group will be required to have a BMI between 18.5 and 25 kg/m² and no history of, or current,
      mood and anxiety disorders. Additional exclusion criteria will be: history of head trauma,
      hearing or visual impairment, neurological disease, claustrophobia, pregnancy, metal in the
      body which cannot be removed, history of (or current) drugs and/or alcohol abuse; acute
      suicidality, psychotropic medication (other than antidepressants in the patient group).

      Pre- and post-intervention changes in patients' BMI, anxiety, eating disorders symptoms, mood
      and motivation to change will be assessed. Changes in brain activations in selected regions
      of interest, including the DLPFC, amygdala and insula will be examined.
    

Intervention name(s): Gradual exposure to food stimuli
Intervention type(s): Behavioral
Intervention description(s): Patients with anorexia nervosa will be encouraged to confront their fears and avoidance in relation to food and will be gradually exposed to different food items during the sessions.
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Treatment