Addressing Weight Suppression to Improve Treatment Outcome for Bulimia Nervosa

Cognitive behavioral therapy (CBT) is regarded as the gold-standard treatment for bulimia nervosa (BN), yet despite impressive empirical support for its effectiveness, over 50% of patients fail to achieve abstinence from binge eating and purging by the end of treatment. One factor that may contribute to reduced efficacy rates in CBT is weight suppression (WS; the difference between a person's highest weight ever at their adult height and current weight). A growing body of research indicates that WS in patients with BN may have a clinically significant effect on symptomatology and prognosis. However, the current cognitive behavioral framework for BN does not explicitly acknowledge the role of WS in the onset or maintenance of BN symptoms and does not provide guidance for clinicians on how to address WS during treatment. The relationship between WS, biological pressure to regain lost weight, and the maintenance of BN symptoms suggest that current cognitive behavioral models of BN may be improved by considering the role of WS and exploring needed treatment modifications. Indeed, a reconceptualization of existing models may offer insight into potential strategies that can be used to reduce the susceptibility to treatment dropout, nonresponse, and relapse. It is therefore necessary to consider whether, and how, clinicians' consideration of WS during case conceptualization and treatment planning could serve to improve CBT outcomes. The current review explores ways in which high WS could contribute to poor CBT outcomes, provides preliminary clinical recommendations for incorporating WS into existing cognitive behavioral treatments based on extant data and clinical wisdom, and proposes suggestions for future research needed in this domain.     

Attitudinal Approaches to Health Behavior: Integrating Expectancy‐Value and Automaticity Accounts

Attitudes are a key construct in health psychology due to their central role in motivating and changing behavior. An expectancy‐value framework has been the dominant conceptual approach for exploring the impact of attitudes on health behavior, applications of which emphasize volition and rational decision making. More recently, attention has focused on automatic attitudes, which are believed to capture reflexive aspects of motivation. Dual‐process models such as the MODE generally treat expectancy‐value and automaticity accounts as representing separate processing pathways. However, both accounts depend on associative learning. Learning history pairs beliefs or features with evaluations; subsequent activation of beliefs or features activates associated evaluations and drives overall attitude. Therefore, a single information processing architecture may accommodate expectancy‐value and automaticity approaches within a unifying framework, and this is provided by neural network (connectionist) accounts. In this paper, we highlight how a greater emphasis on the information processing mechanics of associative learning can provide a more parsimonious model of attitudes, which may also extend to a wider array of memory‐related phenomena of relevance to health psychology.     

Patterns of cognitive ageing

Neuroanatomical evidence suggests that normal ageing affects some brain areas, and the “local” functions they support, earlier and more severely than others. Changes appear to be especially marked in the hippocampus, temporal association and prefrontal cortex. Evidence from classical neuropsychological studies suggests that these brain areas are associated with memory and “executive” functions, respectively. We may, therefore, expect that tests purported to measure these functions may be disproportionately affected in old age and that there may be evidence for some separation of these functions even within neurologically normal populations. What we also know, however, is that measures reflecting general fluid ability also decline with increasing age, so any hypothesis relating to specific “local” deficits must acknowledge and account for any “globar” changes in performance. Volunteers (n=162) aged between 60–80 years who had completed the Cattell and Cattell Culture Fair Intelligence Test (CCF) completed the Cambridge Automated Neuropsychological Test Battery (CANTAB). The CANTAB has been administered to several patient populations and tests from the battery have been shown to be sensitive to damage in both temporal and prefrontal areas (Owen et al., 1996). Results from the test battery showed that both the Paired Associate Learning and Spatial Recognition tests were the most sensitive to normal ageing even when CCF is accounted for. In contrast, this performance on the “executive” tests, shown to be sensitive to frontal lobe damage, was not related to age, and CCF scores predicted performance on these tests. These results are discussed in relation to theories of cognitive ageing and patterns of change and in relation to several important methodological and theoretical considerations for the study of executive function. Received: 31 March 1999 / Accepted: 23 July 1999     

Obstructive Sleep Apnea Syndrome in Prader-Willi Syndrome: An Unrecognized and Untreated Cause of Cognitive and Behavioral Deficits?

Prader-Willi Syndrome (PWS) is a rare genetic disorder characterized by a range of physical, psychological, and physiological abnormalities. It is also distinguished by the high prevalence of obstructive sleep apnea syndrome (OSAS), i.e., repetitive upper airway collapse during sleep resulting in hypoxia and sleep fragmentation. In non-PWS populations, OSAS is associated with a range of neurocognitive and psychosocial deficits. Importantly, these deficits are at least partly reversible following treatment. Given the findings in non-PWS populations, it is possible that OSAS may contribute to neurocognitive and psychosocial deficits in PWS. The present review examines this possibility. While acknowledging a primary contribution from the primary genetic abnormality to central neural dysfunction in PWS, we conclude that OSAS may be an important secondary contributing factor to reduced neurocognitive and psychosocial performance. Treatment of OSAS may have potential benefits in improving neurocognitive performance and behavior in PWS, but this awaits confirmatory investigation.     

Sociotropy-autonomy and situation-specific anxiety

Sociotropy and autonomy are conceptualized as two personality dimensions that relate to individuals' vulnerability to anxiety and depression. Sociotropy is characterized as an excessive investment in interpersonal relationships, and autonomy is characterized as an excessive concern with independence as well as a lack of concern for others. The present study investigated the relationships between sociotropy-autonomy and trait anxiety associated with four types of situations, i.e., Social Evaluation, Physical Danger, Ambiguous Situation, and Daily Routine. 255 undergraduate students completed the Sociotropy-Autonomy Scale, the Endler Multidimensional Anxiety Scale, and the Beck Depression Inventory. Analyses indicated that scores on Sociotropy were positively correlated with rated trait anxiety in situations of Social Evaluation, Physical Danger, and Ambiguous Situations, whereas scores on Autonomy were positively correlated with rated trait anxiety in Daily Routines. These findings are discussed in the context of the diathesis-stress model of anxiety and depression.     

The natural appearance of unnatural incline speed

In three experiments, college students provided judgments about a marble's speed along a nonlinear incline. Each experiment revealed widespread support for the slope-speed belief, a mistaken belief holding that an object's speed at any point depends on the slope at that point. In truth, an object's incline speed varies with its elevation. In Experiment 1, participants relied solely on a diagram. In Experiments 2 and 3, participants observed computer animations depicting the descent of a marble at speeds conforming to either the slope-speed belief or Newtonian theory, and they rated the slope-speed version as more "natural" than the correct version. The task in Experiment 1 gauged participants' consciously available knowledge, but the perceptual realism of the slope-speed animations suggests that the slope-speed belief is also held outside awareness. By contrast, virtually all previously identified false beliefs about motion appear unnatural once animated.     

Multiple-interval timing in rats: Performance on two-valued mixed fixed-interval schedules

Three experiments studied timing in rats on 2-valued mixed-fixed-interval schedules, with equally probable components, Fixed-Interval S and Fixed-Interval L (FI S and FI L, respectively). When the L:S ratio was greater than 4, 2 distinct response peaks appeared close to FI S and FI L, and data could be well fitted by the sum of 2 Gaussian curves. When the L:S ratio was less than 4, only 1 response peak was usually visible, but nonlinear regression often identified separate sources of behavioral control, by FI S and FI L, although control by FI L dominated. Data were used to test ideas derived from scalar expectancy theory, the behavioral theory of timing, and learning to time.     

Concurrent task effects on memory retrieval

Previous studies combining continuous free recall with a concurrent task have generally shown that concurrent tasks impose fairly negligible effects on memory retrieval. By contrast, dual-task studies employing either cued recall or semantic retrieval reveal gross memory impairment and suggest that retrieval is delayed by the centrally demanding phase of the concurrent tasks (i.e., response selection). To explore this conflict, subjects performed continuous free recall while carrying out a serial-choice#x2014; response time (RT) task, as in the previous free recall studies. Unlike these previous studies, however, the choice#x2014;RT task utilized arbitrary stimulus#x2014;response mappings in order to increase the proportion of time devoted to the centrally demanding response selection phase. Recall total was reduced significantly, and recall latency was slowed substantially.     

Pleasure, guilt and secretory immunoglobulin A

Before producing saliva samples for Immunoglobulin A assay, 30 subjects listed their pleasurable activities and rated them in terms of pleasure and guilt. Levels of Immunoglobulin A were higher in those subjects with high ratios of pleasure-guilt scores.