Current Projects

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.

Cognitive Remediation Therapy (CRT) is an adjunctive treatment known to improve cognitive flexibility by teaching individuals to think about how they think. The Shifting Perspectives Study combines FBT 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. 

In the first phase of this study, we recruited adolescents ages 12-18 with anorexia and enrolled them into one of three treatment arms: FBT alone, FBT plus parent-focused CRT or FBT plus adolescent-focused CRT. We collected psychosocial, neurocognitive and behavioral measures throughout the study. The ultimate purpose of this project was to determine whether or not CRT improves cognitive flexibility in parents, adolescents or both. We found that CRT did, indeed, increase flexibility in youth with AN more rapidly than renourishment alone. 

The second phase of this study is almost complete. We will recruit 100 youth with AN and their families to receive either FBT or FBT+Adolescent focused CRT.  Please see our study page for more information. 

Anorexia Nervosa (AN) is a serious eating disorder characterized by restriction of food intake and reduction of body weight below what is healthy or expected for someone of the same age and height. AN has the highest mortality rate of all psychiatric disorders and is associated with significant morbidity. There has been a call to understand the underlying neurobiology of AN, and to use this to inform new treatment development and treatment refinement.  A number of new theories have focused on a disruption in the reward system and impaired set shifting abilities as important maintenance factors.

Focusing on adults with AN is informative, but also raises the question as to whether or not any disruption observed is a state-based phenomenon, a biological cause of the illness, a consequence of being ill for a prolonged period of time, or a risk factor for developing a chronic course of illness. Researchers will often include individuals recovered from AN as a control or comparison group in order to begin to address the question as to whether or not disruptions are state based or a risk factor for illness. Many women who are recovered demonstrate some degree of normalization of the reward system; however, in comparison to women who never had eating disorders there continue to be clear abnormalities after weight restoration and symptom remission. These findings are typically taken to mean that a disruption in reward systems may be a biomarker for AN and, therefore, play a causal role in its development. The error in this assumption stems from the population typically studied. Adult women with AN represent only ⅓ of all individuals ever diagnosed. Age of onset is typically in adolescence; 1/3 of adolescents typically recover and 1/3 continue to display subclinical symptoms of AN or begin to engage in symptoms typical of bulimia (a phenomenon known as diagnostic crossover). Thus, individuals who continue to present with clinical AN into adulthood represent a unique subset of all women ever diagnosed with AN; research findings from this sample may not be generalizable to all individuals diagnosed with AN.  In order to fully understand dysregulation in the reward system in AN, it is necessary to study it in an adolescent population

Study visits include a multi-modal assessment of eating disorder symptomatology, reward and inhibition, executive functioning, and intellectual capabilities. This includes questionnaires, neuropsychological assessment, and fMRI scan of structural and connectivity components.

The primary outcome is feasibility and acceptability of study procedures. The optional component of research will specifically assess the feasibility for neuroimaging.

Secondary outcomes include preliminary correlations between MRI data and scores on assessments and examination of any potential trend level differences between groups.

A number of our projects fall under the broad umbrella of understanding neurocognition in youth with eating disorders.  Ongoing projects include the following:

  • Neurocognition in adolescents with restrictive eating disorders pre- and post weight restoration.
  • Data Repository of Assessment of Neurocognition in Eating Disorders (DR.NED).
  • Relationship between maternal and child cognitive flexibility in the context of anorexia nervosa.
  • Latent profile analysis of risk factors for AN that include aspects of neurocognition 

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 employ best practices in RCR. We are currently conducting a number of RCRs to answer a variety of questions:

  • Examining testosterone levels in males hospitalized for medical stabilization of anorexia nervosa.
  • The presentation and treatment of ARFID subtypes.
  • Sex differences in the prescription of atypical antipsychotics.
  • The impact of COVID on the presentation of eating disorders.
  • Examining clinical characteristics of comorbid of autoimmune gastrointestinal diseases and eating disorders.

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. Systematic reviews provide an overview of a particular area of research and can be used to identify research gaps.

  • Scoping review of participant adherence to Ecological Momentary Assessment (EMA) research protocols.
  • Review of aversive affects of highly visual social media on adolescents and young adults.