Background: Functional neuroimaging is improving our understanding of a variety of mental disorders and contributing to the development of innovative interventions. However, with the complexity encountered in both understanding and treating Eating Disorders (ED), it is not surprising that there have been contradictory or inconclusive findings when the functional brain imaging data regarding ED is examined. In this workshop we will review the existing neuroimaging data on EDs and discuss the problems with the existing evidence. We will also present some new data obtained from individuals in a residential eating disorders program and discuss treatment applications across all levels of care.
Objectives: 1. List at least three published findings regarding brain functioning and eating disorders. 2. Describe two significant problems with the existing neuroimaging research to date. 3. Include applied neuroscience techniques in a comprehensive treatment plan for eating disorders.
1. Review the advent of neuroimaging technology and its importance for understanding neurophysiological correlates of mental disorders. In the mid-1980’s technological advances led to being able to image the brain in operation with enhanced structural identification. This led to a greater understanding of biological contributions to many cognitive, behavioral, and emotional difficulties
2. Introduce the role of arousal and its regulation for adaptive functioning. Various biological functions require different “mixtures” of arousal for adequate efficacy.
3. Discuss the promise of neuromodulation techniques in the treatment of mental disorders. Understanding the role of arousal in functioning can lead to the development of innovative and technology assisted treatment approaches.
B – Review neuroimaging research of eating disorders.
1. Neuroimaging research findings. Existing research on eating disorders has shown similarities and differences among the various eating disorders with findings implicating reward network circuitry, anxiety systems, bodily cuing networks, and sleep abnormalities.
2. Problems and limitations of existing research. With a lack of longitudinal research, it is difficult to differentiate potential pre-existing vulnerabilities from consequences of eating disorders.
C – Role of quantitative EEG in treating eating disorders.
1. Introduction to quantitative EEG (qEEG). The quantitative EEG offers an accessible approach for neuroimaging by examining cortical arousal patterns which can lead to more individualized treatment planning.
2. Quantitative EEG findings. Results from current qEEG studies on individuals with eating disorders are showing some recurring patterns of brain activation which can identify targets for intervention.
D – Neurotherapy in the treatment of eating disorders.
1. Use of neurofeedback in treating mental disorders. Neurofeedback has been used in the treatment of a variety of conditions ranging from epilepsy to post-traumatic stress disorder. It provides a noninvasive approach for neuromodulation.
2. Translating qEEG findings into neurofeedback protocols. Using qEEG results to identify targets for arousal training can inform locations and targets for training individuals with eating disorders.
Neuroimaging findings of individuals with eating disorders have revealed some of the important neurophysiological correlates associated with these all too common and life-threatening conditions. Studies have shown abnormal activity in the reward, anxiety, interoceptive, and self-system networks. Additional studies using EEG measures have shown sleep abnormalities in individuals with anorexia and frontal arousal asymmetries similar to people with clinical depression have also been observed. There are also indications of overarousal of the central nervous system and deficits of “idling” activity in the brain which can contribute to a lack of cognitive and behavioral flexibility. With conditions as complex as eating disorders, which can occur with a variety of presentations, there are often inconsistent findings and problems determining potentially predisposing abnormalities from consequences of the eating disorder symptoms. Also in question are which findings are resolved by refeeding and treatment and which remain as vulnerabilities.
While further research is warranted to help resolve unanswered questions, preliminary results indicate that neurotherapy has promise for use in treating eating disorders. EEG biofeedback is utilized in neurotherapy and training interventions can be targeted to an individual’s EEG pattern. This approach appears to be an important step toward further translating brain imaging findings into clinical practice.
Dr. Ed Hamlin is a neuropsychologist and the Clinical Director of the Institute for Applied Neuroscience. He currently holds (adjunct) faculty positions as Professor at Western Carolina University and associate professor in the Department of Psychiatry at the University of North Carolina Medical Center. In addition to clinical work, he conducts research and presents workshops regarding applied neuroscience and brain/mind relationships. His research projects involve examining the impact of early abuse and neglect on the developing brain and how to correct maladaptive patterns as well as a major collaborative research study examining dysfunctional brain patters in patients with eating disorders.
Dr. Don Hebert has been a therapist since 1975 following his education at Southern Methodist University. Don also earned a Doctorate of Theology in Counseling at the Iliff School of Theology, University of Denver. He is a Licensed Marriage and Family Therapist and BCIA certified in Biofeedback. Don began with Avalon Hills in 2006 and in 2010, Don attempted to retire. Fortunately, retirement was short-lived and he rejoined the Avalon Hills team in 2013. Don’s current role involves program development and strategic planning. He is currently coordinating the research and development of brain-based interventions for the treatment of eating disorders.
