TRIANGLE

The rate of admission and readmission for inpatient treatment for anorexia nervosa has been rapidly increasing over the last ten years, leading to severe disruption during a critical stage in the lives of these young adults. Through pilot studies, we have found that involving carers and patients in treatment that prepares for transition from hospital to home can be of benefit. TRIANGLE is a multi-centre randomised controlled trial which recruits patients and their families admitted for inpatient care and follows their progress for 18 months after admission. Using an online platform which hosts moderated chat sessions, training material, workbooks, and video clips, TRIANGLE aims to examine whether the transition from hospital treatment to home can be improved. https://triangle.slam.nhs.uk/research_team

FREED

The First Episode and Rapid Early Intervention for Eating Disorders (FREED) project is an innovative early intervention service for young people who have developed an eating disorder within the last three years. The service, which is embedded in larger NHS specialist eating disorder services, involves a rapid screening and assessment protocol, evidence-based interventions for patients and carers, and an implementation toolkit for staff. The intervention aims to reduce the duration of untreated eating disorder and improve outcomes for patients and carers. In 2014/15 the Section for Eating Disorders at King’s College London (KCL) and the South London and Maudsley NHS Foundation Trust (SLaM) received funding from the Health Foundation to pilot the FREED service model, and the results were promising. FREED patients waited almost 40% less time for assessment and treatment, and overall clinical improvement was rapid and sustained. Since this pilot study Professor Schmidt and her team have re-engaged the support of the Health Foundation to upscale the FREED initiative. FREED-Upscaled (FREED-Up) aims to demonstrate the scalability of the FREED approach by implementing it across four specialist eating disorder services in Greater London and Yorkshire. The main objectives are to reduce waiting times for treatment and the duration of untreated eating disorders, improve treatment engagement and clinical outcomes, and demonstrate and cost effectiveness. The FREED project has been presented at a number of conferences nationally and internationally and had significant impact. Notably, the FREED team were honoured to receive the British Medical Journal (BMJ) Award for Mental Health Team of the Year 2017.

The First Episode and Rapid Early Intervention for Eating Disorders (FREED) project

FLARe in AN: Fear Learning in Anorexia Nervosa

There is a growing interest in examining the basic mechanisms that are trans-diagnostic across psychiatric disorders. Research has found that anxiety disorders are associated with exaggerated fear and threat appraisals. The hypothesis that anomalies in fear conditioning may be a trans-diagnostic feature across all anxiety disorders was first proposed in 2004 by M. Strober. It is possible that anomalies in fear conditioning could apply to the eating disorders population. However, very little work has examined this hypothetical framework. FLARe in AN aims to examine the process of fear conditioning (fear acquisition/ generalisation/ extinction/ renewal) in individuals with anorexia nervosa, and those now recovered from the disorder.

BONE Project: Bone Health & Eating Disorders (Online study)

Bone health is closely linked to eating and exercise. People with eating disorders, especially anorexia nervosa, have a higher risk for osteoporosis and fractures than healthy controls due to low-weight and irregularity of menstrual periods. Therefore, we want to investigate how bone health is related to clinical characteristics in individuals with a diagnosis of anorexia nervosa such as illness duration, eating disorder symptom severity, reproductive function, severity of comorbid disorders (e.g. depression.) and frequency and severity of exercising. In this study we will access through online questionnaires a range of factors that we know are associated with bone health, such as physical activity and diet, and see how these are related to fracture occurrence and bone health and we hope that we will be able to make specific recommendations for behavioural change for people who are trying to protect or improve their bone health. We are recruiting young women who have been battling with eating and body concerns for 3 years or less. Participation involves completing an online questionnaire now (30-40 minutes) and another online questionnaire in 3 months time (30-40 minutes) about eating habits, physical activity, mood, sun exposure, reproductive life and fractures. Participants will be reimbursed £20 for completing the online questionnaires (£10 each). The participant requirements for this study as follows:  Females (female gender assigned at birth)  Age between 18 and 65  No acute or chronic inflammatory condition  Have anorexia nervosa for 3 years or less or • Think you might have symptoms for the diagnostic of anorexia nervosa for 3 years or less (including low weight, eating and body concerns). If you are interested, please write to boneproject@kcl.ac.uk for more information.

DAISIES

Clinical Effectiveness, Acceptability and Cost-Effectiveness of a ‘Stepping into Day Treatment’ Approach versus Inpatient Treatment as Usual for Anorexia Nervosa in Adult Specialist Eating Disorder Services. Anorexia nervosa is a serious mental illness. We understand that there are multiple causes, but due to the challenges individuals with the condition and their families face, about 20-30% of people experiencing anorexia nervosa will need intensive treatment (either day patient or inpatient treatment). We do not know if these two intensive treatment approaches have advantages or disadvantages for the patient, families, the NHS and wider society. DAISIES is a multi-centre randomised controlled trial which recruits patients with severe anorexia nervosa who are in need of intensive treatment from Eating Disorder Services across the UK. DAISIES aims to compare the effectiveness of two different intensive treatments for severe anorexia nervosa, Inpatient Treatment as Usual and a Stepped Care Day Treatment, by following patients’ progress for 12-months. Clinicians at collaborating Eating Disorder Services will invite their patients to participate in the trial if they think that intensive treatment would be appropriate and helpful for them. DAISIES is recruiting people (age 17 or over) with severe anorexia nervosa or a similar related disorder (e.g., avoidant restrictive food intake disorder) with a body mass index [BMI] lower than 16kg/m2, who need intensive treatment. This need may be due to illness severity, medical risk or lack of response to outpatient psychological therapy. If patients are too acutely unwell to give informed consent or have a severe medical or psychiatric illness (e.g. psychosis, substance dependence) that currently needs treatment in its own right, they will not be able to participate in DAISIES. Patients will also need to live within travelling distance to day patient treatment and be fluent in English. Please contact daisies@kcl.ac.uk for more information.

PEACE Pathway: Pathway for Eating disorders and Autism developed from Clinical Experience (PEACE)

Research suggests that more than 30% of people with an eating disorder may have autism spectrum condition (ASC), or present with high levels of autistic symptoms. Comorbid ASC has been shown to have worst outcomes and impede treatment processes, due to ASC features such as cognitive inflexibility, sensory sensitivities and resistance to change. There are currently no guidelines or treatment recommendations for women with both conditions. We hope that this tailored care pathway will improve clinical outcomes and address the gap in treatment provision. Translating research evidence into clinical work, we have developed the following treatment adaptations as part of the PEACE Pathway: • Clinician training: a regular training program for clinicians was introduced, starting with the tools of assessment of autism (ADOS-2 and ADI-R), adaptations in various therapeutic modalities (CBT, DBT, formulation-based approach, Cognitive Remediation Therapy (CRT), and Cognitive Remediation and Social Skills (CREST) training), and later focusing on specific environmental and sensory adaptations for patients. • Clinician support: weekly team huddles were introduced to provide support, keep continuity and assess additional needs for the treatment team. • Patient identification: The AQ-10 (Autism Quotient-10, shortened version of the AQ-50) is used as a screener to flag up potential patients with autistic traits who are suitable for the PEACE Pathway. If eligible, a follow up ADOS-2 assessment is conducted. • Addressing sensory sensitivities: a sensory screening tool was developed and implemented to explore sensory sensitivities in the domains of smell, touch, taste, sight, and sound. We also developed a specialized PEACE menu and introduced a sensory box to our ward environments. • Carers’ support: we deliver monthly Carers' Workshops which include information on the comorbidity, to raise awareness and understanding of the carers who attend. As well as this, clinicians detail any particular adaptations that have been helpful to this patient and their carer/s, including adaptations in seating positions, lighting, regular appointment times, written information and debriefs, and communication passports. If you are interested, please visit https://www.peacepathway.org/ for more information and resources. Follow us on Tweeter @PEACE_Pathway PI of the project Professor Kate Tchanturia Project is managed by PhD student: Jo Li zhuo.li@kcl.ac.uk

Virtual Exposure to Defeat fOod fears (VEDO) in people with anorexia nervosa

It is common for people with anorexia nervosa to experience lots of negative emotions around food, such as fear. We have launched a study to learn more about this from people with personal experience. This study uses virtual reality technology to investigate which psychological techniques may help to reduce food-related fears, in people with anorexia nervosa. The study involves completing an online survey (30 minutes) and a visit to our research lab (one hour maximum) to complete a short virtual reality experience. We are looking for participants aged 16-60, with a diagnosis of anorexia nervosa. Participants receive £20 Amazon vouchers plus reimbursement for travel expenses. For more information please contact katie.rowlands@kcl.ac.uk

Understanding comorbidity and social functioning in women with anorexia nervosa and autism

Research has suggested that individuals with anorexia nervosa (AN) show differences in thinking styles, social understanding, and emotion processing, which may contribute to the development and maintenance of the disorder. Specifically, people with AN show rigid and detail-focussed thinking styles and difficulties in understanding nonverbal communication (such as facial expressions) in others. This can make social situations difficult, leading to further isolation. Interestingly, these characteristics are also seen in individuals with autism spectrum disorder (ASD), a neurodevelopmental disorder characterised by difficulties in social communication. In fact, recent research suggests that around one third of adults with AN show high levels of autistic symptoms. Importantly, the presence of autistic symptoms in individuals with AN is associated with poorer treatment outcomes and the need for more intensive treatments. In order to better understand the overlap between AN and ASD, studies directly comparing symptoms across disorders are required. This will help differentiate whether high autistic traits in AN are symptoms of starvation, or whether they may represent true ASD comorbidity. The current study, which uses data collected through existing projects, will compare autistic symptoms and social functioning in women in both the acute and recovered stages of AN, and women with a diagnosis of ASD. This study is being carried out, in collaboration with the EU-AIMS Longitudinal European Autism Project (LEAP). For more details of the project: jess.kerr-gaffney@kcl.ac.uk

BEACON: Brain Imaging of Emotion and Cognition of Adolescents with Anorexia Nervosa

People with the eating disorder anorexia nervosa (AN) exhibit a range of emotional and social problems, however we have little idea of the neural processes underlying these difficulties. We also know that individuals with AN exhibit elevated autistic spectrum condition (ASC) characteristics, however little work has been done on how ASC characteristics affect neural processing in response to social-emotional cognitive tasks. Using structural and functional magnetic resonance imaging we have scanned a 191 individuals aged between 12-27 with and without the eating disorder AN to see how the brain processes emotions and social situations as well as examining brain structure. We have found that people with AN do not neurally process certain social situations differently to people without AN (the study can be read here for free at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7511528/ ). We are currently in the process of analysing the data examining emotional processing in individuals with AN and how ASC characteristics affects processing in people with eating disorders. If you want to find out more then please get in touch daniel.j.halls@kcl.ac.uk