Abstract
This study investigated expectations of social rejection in adolescents with anorexia nervosa. Female adolescents (N = 24) admitted for hospital treatment completed both a positive interpretation bias training (experimental training) and a 50% positive and 50% negative interpretation bias training (control training), in a counterbalanced order, in two different testing sessions using a within-subjects design. The primary outcome for the training was the frequency of negative interpretations produced in the sentence completion task. At baseline, participants produced more negative than benign interpretations of ambiguous social scenarios (medium/large effect size). Following experimental training, participants produced fewer negative and more benign interpretations compared to control training (medium/large effect sizes). A trend for higher levels of self-esteem following virtual ostracism was found in the experimental condition compared to the control condition (small/medium effect size). Interpretation bias modification has the potential to improve resilience to rejection in adolescents with anorexia nervosa.
Highlights
Adolescence is a time of emerging independence and selfidentity that occurs in the context of heightened sensitivity towards social rejection (Sebastian et al 2011)
We provided evidence that attention and interpretation biases to social stimuli are amenable to change through computerised cognitive bias modification training in anorexia nervosa (Cardi et al 2015; Turton et al 2018), to what has been demonstrated in anxiety disorders
There was no significant correlation with EDE-Q total score. These findings indicate that adolescent patients have a negative interpretation bias towards ambiguous scenarios and that this bias correlates with anxiety, depression and expectation of rejection
Summary
Adolescence is a time of emerging independence and selfidentity that occurs in the context of heightened sensitivity towards social rejection (Sebastian et al 2011). Negative social experiences include episodes of bullying, criticism from others (especially in relation to weight and shape), exposure to the sudden death of a close relative and poor care and communication in the family, amongst others (Cardi et al 2018b) These experiences are broadly salient, because of their potential to threaten the universal need of social belonging and could be relevant to individuals with anorexia nervosa, who tend to demonstrate involuntary submissiveness, fear of negative evaluation from others and sensitivity to rejection (Cardi et al 2013a; Rieger et al 2010). This is in line with the proposal that one of the functions of abnormal eating behaviours might be to increase social acceptance, silence negative emotions due to interpersonal adversity or gain control in non-social areas (Arcelus et al 2011; Goss and Allan 2009; Rieger et al 2010)
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