People with AN consume more of test meal in vodcast condition

There is uncertainty about the best form of treatment for anorexia nervosa (AN). A report that is published in the current issue of Psychotherapy and Psychosomatics introduces a new treatment modality. A group of English investigators developed a short video clip intervention which uses aural and visual components to target food avoidance and anxiety (vodcast). It can be played on an iPod/MP4 player, allowing it to be easily accessible outside of the clinical environment. Its conceptual underpinning is based upon the theoretical models which posit that imagery is a key component behind drives and emotional reactions.

Interventions employing visuospatial elements to interrupt the elaboration of imagery and emotional reactions have been shown to reduce food craving and emotional reactions. The impact of the vodcast as a means to support eating has been investigated in a small case series. The aim of this study was to replicate the previous findings in a larger sample. The vodcast was compared to a control music condition in two different populations: participants with AN and healthy controls (HCs). The hypothesis was that participants with AN would consume more of the test meal, and experience a lower level of anxiety and negative cognitions in the vodcast condition, whereas no changes in those variables would be observed in HCs. Subjects were females between 18 and 55 years old who were fluent in English. The Structured Clinical Interview for DSM-IV was used to confirm the diagnosis of AN or eating disorder not otherwise specified AN subtype (EDNOS-AN). All participants completed the Eating Disorder Examination Questionnaire (EDE-Q) and the Depression Anxiety Stress Scale (DASS). The vodcast was a 20-min video with eating-disorder-specific auditory and visual imagery. The music used in the control group was modern classical music with a playing time of 20 min. The final sample consisted of 19 HCs and 18 participants with AN (8 restrictive, 2 binge/purge and 8 EDNOS-AN), with a mean duration of illness of 11.4 years.

This study demonstrated that people with AN consumed significantly more of the test meal in the vodcast condition than in the music condition, replicating the results of the preliminary case series. Furthermore, this was accompanied by a significant reduction in intrusive thoughts, anxiety and an improvement in mood. The attentional bias towards food-related stimuli was also reduced in the vodcast condition, but this failed to reach significance due to low power. There was no difference between the two conditions in HCs, except for a non-significant reduction in attentional bias in the music condition. The pattern of response in the HC group differed from the AN group as there were no changes in the amount of the test meal consumed, anxiety, intrusive thought and mood. These findings supported the specific beneficial effect of the vodcast intervention for those with AN, and endorses its utility as a supportive measure in counteracting the negative emotions and thoughts elicited by food.

While the increase in test meal consumption is modest (14.6 ml), the cumulative effect over time could significantly impact on the clinical outcome of AN. Further research will help to clarify the mechanism of change involved in the vodcast as a meal support for people with an eating disorder.