Article

Mirror exposure in women with bulimic symptoms: How do thoughts and emotions change in body image treatment?

Department of Clinical Psychology and Psychotherapy, Albert-Ludwigs-University Freiburg, Engelbergerstrasse 41, 79106 Freiburg, Germany. Electronic address: .
Behaviour Research and Therapy (Impact Factor: 3.85). 09/2012; 51(1):1-6. DOI: 10.1016/j.brat.2012.03.012
Source: PubMed

ABSTRACT Mirror exposure is an efficient treatment for body image problems in eating disorders. Although habituation processes and cognitive changes are postulated to be underlying mechanisms, evidence is scarce, especially during repeated mirror exposure treatment. Fourteen participants with eating disorders not otherwise specified (EDNOS) and five with bulimia nervosa (BN) composed the bulimic group (BG), and 19 healthy women without any mental disorder composed the healthy controls group (HC). The participants were treated by four standardized mirror exposure sessions. Subjective distress was assessed five times during each session. Both negative and positive emotions and negative thoughts were assessed after each session. The patients in the BG reported significantly higher levels of negative emotions and cognitions than did those in the HC in all measures and across all sessions. In both groups, subjective distress increased significantly within each session and decreased toward the end of each session. Only in the subjects of the BG group did both distress and negative thoughts and emotions decrease significantly from session to session, whereas positive emotions increased. The patterns of change differed between the BG and the HC, suggesting that habituation between sessions occurred only in the BG. Our findings suggest that the additional underlying cognitive-affective processes merit further investigation.

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Available from: Monika Trentowska, Sep 01, 2015
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    • "The deficit in multisensory integration between the somatosensory and the visual networks emphasize the importance of body image in bulimia, and might account for the centrality of body image disturbance in resistance to treatment (Stice, 2002). Treatment strategies that include specific components addressing body image disturbance have been proven to be effective (Trentowska et al., 2013a,b); future studies assessing how these treatments affect the resting-state connectivity in brain regions that process body perception and how the changes might mediate treatment outcomes would greatly advance our knowledge on the disorder. "
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    ABSTRACT: Background: Alterations in the resting-state functional connectivity (rs-FC) of several brain networks have been demonstrated in eating disorders. However, very few studies are currently available on brain network dysfunctions in bulimia nervosa (BN). The somatosensory network is central in processing body-related stimuli and it may be altered in BN. The present study therefore aimed to investigate rs-FC in the somatosensory network in bulimic women. Methods: Sixteen medication-free women with BN (age = 23 ± 5 years) and 18 matched controls (age = 23 ± 3 years) underwent a functional magnetic resonance resting-state scan and assessment of eating disorder symptoms. Within-network and seed-based functional connectivity analyses were conducted to assess rs-FC within the somatosensory network and to other areas of the brain. Results: Bulimia nervosa patients showed a decreased rs-FC both within the somatosensory network (t = 9.0, df = 1, P = 0.005) and with posterior cingulate cortex and two visual areas (the right middle occipital gyrus and the right cuneus) (P = 0.05 corrected for multiple comparison). The rs-FC of the left paracentral lobule with the right middle occipital gyrus correlated with psychopathology measures like bulimia (r = −0.4; P = 0.02) and interoceptive awareness (r = −0.4; P = 0.01). Analyses were conducted using age, BMI (body mass index), and depressive symptoms as covariates. Conclusion: Our findings show a specific alteration of the rs-FC of the somatosensory cortex in BN patients, which correlates with eating disorder symptoms. The region in the right middle occipital gyrus is implicated in body processing and is known as extrastriate body area (EBA). The connectivity between the somatosensory cortex and the EBA might be related to dysfunctions in body image processing. The results should be considered preliminary due to the small sample size.
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