Anorexia Nervosa and emotion

SECTION A
Anorexia nervosa can be maintained by difficulties expressing and regulating emotion. This systematic review aimed to identify whether four therapies recommended for anorexia target and successfully impact emotion regulation. Ten studies met eligibility criteria and were assessed against appropriate risk of bias tools. Studies at low risk of bias indicated that midtherapy negative emotional expression predicted improved outcomes for CBT-ED/FP,and emotional avoidance predicted poorer outcomes for MANTRA/SSCM. MANTRA was described as improving emotional connection and acceptance. Tentative evidence indicated that CBT-ED reduced impulsivity but did not improve distress tolerance, however quality was mixed and higher-quality studies are needed. Implications and limitations are discussed.

SECTION B
Sequences of emotion change (from secondary to primary, and maladaptive to adaptive) have been associated with improved outcomes. Emotional expression across phases of an emotion-focused therapy for adults with anorexia nervosa was qualitatively coded for eight participants: four who had recovered and four who had not fully recovered. Findings were
then quantitively analysed. Sequential patterns of change were observed, from secondary to primary adaptive emotions. Recovery was associated with fear of abandonment reducing over therapy and greater primary adaptive emotion expressed, including hurt/grief and acceptance. Not fully recovering was associated with greater need expression over time and self-soothing. Limitations, as well as implications for future research and clinical practice are explored.