Hostname: page-component-848d4c4894-nr4z6 Total loading time: 0 Render date: 2024-05-22T19:52:34.927Z Has data issue: false hasContentIssue false

Worry and Rumination in Anorexia Nervosa

Published online by Cambridge University Press:  29 October 2012

Helen Startup*
Affiliation:
King's College London, Institute of Psychiatry, UK
Anna Lavender
Affiliation:
King's College London, Institute of Psychiatry, UK
Anna Oldershaw
Affiliation:
King's College London, Institute of Psychiatry, UK
Richard Stott
Affiliation:
King's College London, Institute of Psychiatry, UK
Kate Tchanturia
Affiliation:
King's College London, Institute of Psychiatry, UK
Janet Treasure
Affiliation:
King's College London, Institute of Psychiatry, UK
Ulrike Schmidt
Affiliation:
King's College London, Institute of Psychiatry, UK
*
Reprint requests to Helen Startup, King's College London, Institute of Psychiatry, Division of Psychological Medicine, Section of Eating Disorders (P059), De Crespigny Park, London SE5 8AF, UK. E-mail: helen.startup@kcl.ac.uk

Abstract

Background: Difficulties with comprehending and managing emotions are core features of the pathology of anorexia nervosa (AN). Advancements in understanding aetiology and treatment have been made within other clinical domains by targeting worry and rumination. However, worry and rumination have been given minimal consideration in AN. Aims: This study is the largest to date of worry and rumination in AN. Method: Sixty-two outpatients with a diagnosis of AN took part. Measures of worry, rumination, core AN pathology and neuropsychological correlates were administered. Results: Findings suggest that worry and rumination are elevated in AN patients compared with both healthy controls and anxiety disorder comparison groups. Regression analyses indicated that worry and rumination were significant predictors of eating disorder symptomatology, over and above the effects of anxiety and depression. Worry and rumination were not associated with neuropsychological measures of set-shifting and focus on detail. Conclusions: The data suggest that worry and rumination are major concerns for this group and warrant further study.

Type
Research Article
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorder IV (DSM-IV). Washington: American Psychiatric Association.Google Scholar
American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders. Washington, DC: APA.Google Scholar
Babyak, M. A. (2004). What you see may not be what you get: a brief, nontechnical introduction to overfitting in regression-type models. Psychosomatic Medicine, 66, 411421.Google Scholar
Barnard, P. J., Watkins, E. R., Mackintosh, B. and Nimmo–Smith, I. (2007). Getting Stuck in a Mental Rut: some process and experiential attributes. Paper presented at the BABCP Annual Conference, Brighton, 13–15 September.Google Scholar
Bjelland, I., Dahl, A. A., Haug, T. T. and Neckelmann, D. (2002). The validity of the Hospital and Depression Scale: an updated literature review. Journal of Psychosomatic Research, 52, 6977.CrossRefGoogle ScholarPubMed
Borkovec, T. D., Robinson, E., Pruzinsky, T. and Depree, J. A. (1983). Preliminary exploration of worry: some characteristics and processes. Behaviour Research and Therapy, 21, 916.CrossRefGoogle ScholarPubMed
Burgess, P. W. and Shallice, T. (1997). The Hayling and Brixton Tests. Thurston, UK: Thames Valley Test Company.Google Scholar
Cooper, Z., Cooper, P. J. and Fairburn, C. G. (1989). The validity of the eating disorder examination and its subscales. The British Journal of Psychiatry, 154, 807812.CrossRefGoogle ScholarPubMed
Cooper, M. J., Wells, A. and Todd, G. (2004). A cognitive model of bulimia nervosa. British Journal of Clinical Psychology, 43, 116.Google Scholar
Corstorphine, E., Mountford, V., Tomlinson, S., Waller, G. and Meyer, C. (2007). Distress tolerance in the eating disorders. Eating, 8, 9197.CrossRefGoogle ScholarPubMed
Douilliez, C., Philippot, P., Baeyens, C., Heeren, A., Watkins, E. and Barnard, P. (2009). Validation of the French version of the Cambridge Exeter Rumination Thinking Scale. Poster presented at the 37th Annual Conference of the British Association of Behavioural and Cognitive Therapy, 15th-18th July, Exeter, UKGoogle Scholar
Ehring, T. and Watkins, E. R. (2008). Repetitive negative thinking as a transdiagnostic process. International Journal of Cognitive Therapy, 1, 192205.CrossRefGoogle Scholar
Fairburn, C. G. and Cooper, Z. (1993). The Eating Disorder Examination (12th edn.). In Fairburn, C. G. and Wilson, G. T. (Eds.), Binge Eating: nature, assessment and treatment. New York: Guilford Press.Google Scholar
Field, A. (2005). Discovering Statistics Using SPSS (2nd edn). London: Sage.Google Scholar
Foster, C., Startup, H., Potts, L. and Freeman, D. (2010). A randomised controlled trial of a worry intervention for individuals with persistent persecutory delusions. Journal of Behavior Therapy and Experimental Psychiatry, 41, 4551.CrossRefGoogle ScholarPubMed
Hambrook, D., Oldershaw, A., Rimes, K., Schmidt, U., Tchanturia, K., Treasure, J., et al. (2011). Emotional expression, self-silencing, and distress tolerance in anorexia nervosa and chronic fatigue syndrome. British Journal of Clinical Psychology, 50, 310325.Google Scholar
Harrison, A., Tchanturia, K., Naumann, U. and Treasure, J. (2012). Social emotional functioning and cognitive styles in eating disorders. British Journal of Clinical Psychology, 51, 261279. doi: 10.1111/j.2044–8260.2011.02026.x. Epub 2011 Nov 25.Google Scholar
Harvey, A., Watkins, E., Mansell, W. and Shafran, R. (2004). Cognitive Behavioural Processes Across Psychological Disorders: a transdiagnostic approach to research and treatment. Oxford: Oxford University Press.Google Scholar
Kravariti, E., Morris, R. G., Rabe-Hesketh, D., Murray, R. M. and Frangou, S. (2003). The Maudsley early onset schizophrenia study: cognitive function in adolescents with recent onset schizophrenia. Schizophrenia Research, 61, 137148.Google Scholar
Lopez, C., Tchanturia, K., Stahl, D., Happe, F., Booth, R., Holliday, J., et al. (2008). An examination of central coherence in women with anorexia nervosa. International Journal of Eating Disorders, 41, 143152Google Scholar
Lopez, C., Tchanturia, K., Stahl, D. and Treasure, J. (2008). Central coherence in eating disorders: a systematic review. Psychological Medicine, 38, 13931404Google Scholar
Merwin, R. M., Timko, C. A., Moskovich, A. A., Ingle, K. K., Bulik, C. M. and Zucker, N. L. (2011). Psychological inflexibility and symptom expression in anorexia nervosa. Eating Disorders, 19, 6282.CrossRefGoogle ScholarPubMed
Meyer, T. J., Miller, M. L., Metzger, R. L. and Borkovec, T. D. (1990). Development and validation of the Penn State Worry Questionnaire. Behaviour Research and Therapy, 28, 487495.Google Scholar
Nolen-Hoeksema, S. and Morrow, J. (1991). A prospective study of depression and posttraumatic stress symptoms after a natural disaster: the Lorma Prieta earthquake. Journal of Personality and Social Psychology, 65, 115121.CrossRefGoogle Scholar
Oltman, P., Raskin, E. and Witkin, H. (2003). Group Embedded Figures Test. California, CA: Mind Garden Inc.Google Scholar
Papageorgiou, C. (2006). Worry and rumination: styles of persistent negative thinking in anxiety and depression. In Davey, G. C. L. and Wells, A. (Eds.), Worry and its Psychological Disorders (pp. 2140). Chichester: John Wiley.Google Scholar
Pike, K. M., Hilbert, A., Wilfley, D. E., Fairburn, C. G., Dohm, F. A., Walsh, B. T., et al. (2008). Toward an understanding of risk factors for anorexia nervosa: a case-control study. Psychological Medicine, 38, 14431453.CrossRefGoogle ScholarPubMed
Psychological Assessment Resources (2003). Computerised Wisconsin Card Sort Task (WCST). Florida, USA: Psychological Assessment Resources.Google Scholar
Rawal, A., Park, R. J. and Williams, M. G. (2010). Rumination, experiential avoidance, and dysfunctional thinking in eating disorders. Behaviour Research and Therapy, 48, 851859.Google Scholar
Roberts, M. E., Tchanturia, K., Stahl, D., Southgate, L. and Treasure, J. (2007). A systematic review and meta-analysis of set-shifting ability in eating disorders. Psychological Medicine, 37, 10751084.Google Scholar
Schmidt, U., Oldershaw, A., Jichi, F., Sternheim, L., Startup, H., McIntosh, V., et al. (in press). A randomized controlled trial of the Maudsley Model of Treatment for Adults with Anorexia Nervosa (MANTRA) compared to specialist supportive clinical management in outpatients with anorexia nervosa. British Journal of Psychiatry.Google Scholar
Schmidt, U. and Treasure, , , J. (2006). Anorexia nervosa: valued and visible. A cognitive-interpersonal maintenance model and its implications for research and practice. British Journal of Clinical Psychology, 45, 343366.Google Scholar
Sibrava, N. J. and Borkovec, , , T. D. (2006). The cognitive avoidance theory of worry. In Davey, G. C. L. and Wells, A. (Eds.), Worry and its Psychological Disorders (pp. 239258). Chichester: John Wiley.Google Scholar
Startup, H. M. and Davey, , , G. C. L. (2001). Mood as input and catastrophic worrying. Journal of Abnormal Psychology, 110, 8396.CrossRefGoogle ScholarPubMed
Startup, H. M. and Erickson, , , T. M. (2006). The Penn State Worry Questionnaire (PSWQ). In Davey, G. C. L. and Wells, A. (Eds.), Worry and its Psychological Disorders (pp. 101120). Chichester: John Wiley.Google Scholar
Startup, H. M., Freeman, D. and Garety, P. A. (2007). Persecutory delusions and catastrophic worry in psychosis: developing the understanding of delusion distress and persistence. Behaviour Research and Therapy, 45, 523537.CrossRefGoogle ScholarPubMed
Sternheim, L., Konstantello, A., Startup, H. and Schmidt, U. (2011). What does uncertainty mean to women with anorexia nervosa? An interpretative phenomenological analysis. European Eating Disorders Review, 19, 1224.CrossRefGoogle ScholarPubMed
Sternheim, L., Startup, H., Pretorius, N., Johnson-Sabine, E., Schmidt, U. and Channon, S. (2012). An experimental exploration of social problem solving and its underlying processes in anorexia nervosa. Psychiatry Research, Jul 16. doi:10.1016/j.psychres.2012.06.029Google Scholar
Sternheim, L., Startup, H., Saeidi, S., Morgan, J., Hugo, P., Russell, A., et al. (2012). Understanding catastrophic worry in eating disorders: process and content characteristics. Journal of Behavior Therapy and Experimental Psychiatry, 43, 10951103.Google Scholar
Sternheim, L., Startup, H. and Schmidt, U. (2011). An experimental exploration of behavioural and cognitive-emotional aspects of intolerance of uncertainty in eating disorder patients. Journal of Anxiety Disorders, 25, 806812.Google Scholar
Tchanturia, K., Davies, H., Harrison, A., Roberts, M., Nakazato, M., Schmidt, U., et al. (2012). Poor cognitive flexibility in eating disorders: examining the evidence using the Wisconsin Card Sorting Task. Plos one 7, e28331.CrossRefGoogle ScholarPubMed
Tchanturia, K., Harrison, A., Davies, H., Roberts, M., Oldershaw, A., Nakazato, M., et al. (2011) Cognitive flexibility and clinical severity in eating disorders. Plos one 6, e20462. doi:10.1371/journal.pone.0020462Google Scholar
Teasdale, J. D. (2004). Mindfulness-based cognitive therapy. In Yiend, J. (Ed.), Cognition, Emotion and Psychopathology: theoretical, empirical and clinical directions (pp. 270289). New York: Cambridge University Press.Google Scholar
Troop, N. A, Holbrey, A. and Treasure, J. (1998). Stress, coping, and crisis support in eating disorders. International Journal of Eating Disorders, 24, 157166.3.0.CO;2-D>CrossRefGoogle ScholarPubMed
Watkins, E. R. (2004). Appraisals and strategies associated with rumination and worry. Personality and Individual Differences, 37, 679694.Google Scholar
Watkins, E. R. (2008). Constructive and unconstructive repetitive thought. Psychological Bulletin, 134, 163206.Google Scholar
Watkins, E. and Baracaia, S. (2002) Rumination and social problem-solving in depression. Behaviour Research and. Therapy, 40, 11791189.CrossRefGoogle ScholarPubMed
Watkins, E., Moulds, M. and Mackintosh, B. (2005). Comparisons between rumination and worry in a non-clinical population. Behaviour Research and Therapy, 43, 15771585.CrossRefGoogle Scholar
Whitmer, A. J. and Banich, M. T. (2007). Inhibition vs. switching deficits in different forms of rumination. Psychological Science, 18, 546553.Google Scholar
Zigmund, A. S. and Snaith, R. D. (1983). The Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavia, 67, 361370.Google Scholar
Submit a response

Comments

No Comments have been published for this article.