Perelman School of Medicine at the University of Pennsylvania

Timko Research Group

Timko, CHOP

Current Projects

Shifting Perspectives Study

Because anorexia begins in adolescence, early intervention is key to prevent a chronic course of the disorder. To date, there is only one intervention with substantial evidence-based support for treating anorexia in adolescents: Family Based Treatment (FBT). However, currently, only 50% of adolescents reach full remission after treatment. 

Studies in adults and adolescents with anorexia indicate that they have inefficiencies in cognitive flexibility (e.g., have a difficult time switching gears or topics) and may struggle with big picture thinking. In addition, they frequently exhibit reduced behavioral flexibility (e.g. extreme perfectionism, perseveration, difficulties in learning new behaviors) that researchers believe reflects this underlying neurocognitive inefficiency. Importantly, researchers hypothesize that cognitive inefficiencies are a generalized risk factor for the development of anorexia. Targeting these inefficiencies may increase the effectiveness of treatment.

Using Cognitive Remediation Therapy (CRT) - a treatment known to improve cognitive flexibility by teaching individuals to think about how they think -  this study combines FBT treatment with CRT to determine if we can improve long-term outcomes for more adolescents with anorexia. Currently, there is little research on how best to combine CRT with FBT for adolescents. While the vast majority of research has focused on using CRT with adolescents, we propose that it may be more impactful to provide CRT to the parents of adolescents with anorexia as parents are the individuals carrying the burden of treatment and re-nourishment of their child. 

In this study, we are recruiting adolescents ages 12-18 with anorexia and enrolling them into one of three treatment arms: FBT alone, FBT plus parent-focused CRT or FBT plus adolescent-focused CRT. We will collect psychosocial, neurocognitive and behavioral measures throughout the study. The ultimate purpose of this project is to determine whether or not CRT improves cognitive flexibility in parents, adolescents or both. If successful, it will be the first step in determining how best to add CRT to FBT in order to improve outcomes.

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Understanding Social Rewards

There are documented disruptions in reward and punishment sensitivity in eating disorders. We are examining this via a variety of studies.  In addition to questionnaire-based research, we are examining social reward and avoidance of punishment via an Incentive Delay Task. Adolescents complete the IDT while undergoing a functional MRI.  Funded by the BIRCWH program through the NIH, the latter study also includes males in an attempt to understand sex differences in reward circuity in adolescents with anorexia. Participant recruitment and data entry is ongoing.

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CRT Study

Funded by the Hilda and Preston Davis Foundation, the goal of this study was to examine the feasibility of using Cognitive Remediation Therapy (CRT) as a pre-treatment intervention with adolescents with anorexia nervosa during an inpatient stay for medical stabilization. Adolescents received up to 8 sessions of CRT while hospitalized. We also included a parent involvement component. In one group (Teach the Parent), adolescents conducted up to 4 CRT sessions with a parent; in the other, adolescents conducted up to 4 sessions of Family Fun Time (positive interactions with parents that do not involve the eating disorder).  Finally, we included a control condition: treatment as usual. The study recruitment and follow-ups are complete. Data analysis and publications are ongoing. 

TRG continues to explore the best way to use CRT with adolescents who have eating disorders.

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Retrospective Chart Reviews

Retrospective chart review (RCR) is a research methodology that uses existing patient-centered data to answer specific research questions. RCRs allow researchers to leverage data to examine clinically relevant questions – results can be used to inform practice and subsequent prospective studies.  We are currently conducting a number of RCRs to answer questions about sex differences in eating disorders (funded by the BIRCWH), eating disorder severity specifiers, and other clinically relevant questions. We employ best practices in RCR.

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Systematic Reviews

A systematic review poses a research question, identifies inclusion and exclusion criteria, collects empirical evidence that fits the pre-specified eligibility criteria, all in order to answer the research question. We are currently undertaking two systematic reviews related to our research foci. A number of others are planned and are an excellent opportunity for research assistants to have in-depth exposure to a topic of interest.

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