Accumulating psychobiological data implicate reward disturbances in the persistence of anorexia nervosa (AN). Evidence suggests that individuals with AN demonstrate decision-making deficits similar to those with mood and anxiety disorders that cause them to under-respond to many conventionally rewarding experiences (e.g., eating, interacting socially). In contrast, unlike individuals with other psychiatric disorders, individuals with AN simultaneously over-respond to rewards associated with eating-disorder behaviors (e.g., restrictive eating, exercising). This pattern of reward processing likely perpetuates eating-disorder symptoms, as the rewards derived from eating-disorder behaviors provide temporary relief from the anhedonia associated with limited responsivity to other rewards. Positive Affect Treatment (PAT) is a cognitive-behavioral intervention designed to target reward deficits that contribute to anhedonia in mood and anxiety disorders, including problems with reward anticipation, experiencing, and learning. PAT has been found to promote reward responsivity and clinical improvement in mood and anxiety disorders. This manuscript will: (1) present empirical evidence supporting the promise of PAT as an intervention for AN; (2) highlight nuances in the maintaining processes of AN that necessitate adaptations of PAT for this population; and (3) suggest future directions in research on PAT and other reward-based treatments that aim to enhance clinical outcomes for AN.
Past research has shown that people with anorexia nervosa (AN) have trouble experiencing positive emotions in response to many common life events (e.g., socializing, winning money). This tendency to under-respond to positive events is similar to that found in people with mood and anxiety disorders. However, people with AN also appear to feel more positive emotions when they think about or engage in eating-disorder behaviors (e.g., cutting back on their eating, exercising, thinking about being very thin). For this reason, people with AN may continually turn to eating-disorder behaviors, rather than other actions, to feel good about themselves and their lives. In this paper, we describe a new treatment, Positive Affect Treatment (PAT), that we believe has the potential to help individuals with AN gain more happiness and fulfillment from their lives outside of their eating disorder. Our expectation is that such a change may result in individuals with AN no longer needing their eating disorder to feel good.
Keywords: Anorexia nervosa; Intervention; Neuroscience; Positive affect; Reward; Treatment.