Date on Master's Thesis/Doctoral Dissertation

12-2022

Document Type

Doctoral Dissertation

Degree Name

Ph. D.

Department

Psychological and Brain Sciences

Degree Program

Clinical Psychology, PhD

Committee Chair

Levinson, Cheri

Committee Member

Bufferd, Sara

Committee Member

Depue, Brendan

Committee Member

Newton, Tamara

Committee Member

Haynos, Ann

Author's Keywords

anorexia nervosa; avoidance; approach; fear learning; remission; eating disorders

Abstract

Background. Anorexia nervosa (AN) is a serious psychiatric illness, with high mortality, chronicity, and societal costs. Many individuals with AN that are weight restored do not to fully remit from cognitive-affective symptoms (e.g., fear of weight gain) maintaining the disorder, contributing to the poor outcomes. This critical stage of AN is called partial remission. AN is characterized by high levels of fear and avoidance, which may prevent full remission; however, the role of fear-based mechanisms (i.e., fear approach; avoidance) in partially-remitted AN remains untested. Methods. In the current study (N = 55 partially-remitted AN), participants completed two behavioral paradigms measuring approach-avoidance biases and completed 21 days of ecological momentary assessment (EMA). Participants also completed self-report surveys at baseline and post-EMA. These data were used to test 1) whether neurocognitive measures of approach-avoidance bias were correlated with momentary approach, avoidance, and eating disorder (ED) symptoms, 2) how momentary fear approach, avoidance, and ED symptoms relate to each other within-and between-persons using vector autoregression, and 3) whether fear approach, avoidance, or ED symptoms changed in response to EMA. Results. Body-related implicit bias and explicit anxiety and avoidance ratings were associated with momentary avoidance, fear, and ED behavioral urges. Momentary fear, approach, and avoidance were correlated with ED symptoms contemporaneously and temporally between- and within-individuals. However, participants differed in central symptoms and strength of symptom connections. Lastly, there were no significant changes in fear approach, avoidance, or ED symptoms from baseline to post-EMA. Conclusions. These findings suggest lab-based, approach-avoidance paradigms using body-related stimuli may aid in understanding real-world approach, avoidance, or ED behaviors. Additionally, this study supports that ED-related fears and avoidance maintain AN across hours or days for individuals in partial remission. However, the way in which fear-based mechanisms impact AN may differ across individuals. It is important to use idiographic, data-driven models to inform personalized treatment across AN recovery to reduce the cost and chronicity of AN. Lastly, symptoms did not change from EMA self-monitoring; therapeutic interventions that target fear and avoidance across stages of AN are needed.

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