Can distraction reduce negative symptoms around meals?
Reprinted from Eating Disorders Review
May/June Volume 27, Number 3
Assigning verbal, visuospatial, and somatic activities after meals may help counter the anxiety and depression mealtimes can produce among those with eating disorders, according to the results of a small study in London (J Eat Disord. 2016. 4:9).
Dr. Emily Griffiths and her colleagues at the University College London and the Eating Disorders Service, North East London NHS Foundation Trust, London, reported that post-meal symptoms may be increased in inpatients, who are often supervised and their activities restricted after meals. This post-meal distress is still not fully understood, but patients report “feeling fat,” and having negative body image and negative beliefs. The sensation of feeling fat may be a result of misinterpreting emotions such as depression and guilt and bodily sensations of feeling full and bloated after eating, and also fearing rapid weight gain.
Four post-meal tasks
In their study, the authors asked 25 eating disorders patients to use laptop computers to perform one of three tasks for 15 minutes right after 12 meals of their own choosing (breakfast, lunch, or dinner) within a 2-week period (inpatients) or over 1 month (day treatment patients). The participants were randomly assigned one of four conditions: playing an online computer game (Tetris®), completing a general knowledge quiz, using the fingertips to translate a random list of Braille letters into letters of the English alphabet, and/ or a control task of sitting quietly for 15 minutes. More than two-thirds (69%) of those approached agreed to take part; 11 of 36 who took part completed less than 75% of the post-meal sessions and were subsequently dropped from the study.
After they performed the task, all participants were asked two questions: (1) “To what extent did you experience intrusive body- and fatness-related thoughts during the activity?” and (2) “To what extent did you experience intrusive body and fatness-related images during the activity?” The participants then responded on a Likert-like scale of 1 (very slightly if at all) to 5 (extremely). In addition, the Positive and Negative Affect Scale (PANAS; J Pers Soc Psychol. 1988; 54:1063) was administered at three points: at the beginning of the task, before the specific task was known to the patient, and again after the task.
Post-meal activity produced positive effects
The study results showed that engaging in an activity after meals diminished post-meal distress. All three active tasks increased positive affect, and decreased negative affect, and intrusive thoughts and images.
(Note: These are thought-provoking results. Distress at meals is a prominent component of, and likely a major impediment to, eating disorders treatment. If one understands exposure as a goal of therapeutic meals, post-meal distraction would be unwanted. Perhaps it is helpful to diminish distress in the early phases of treatment and enhance exposure as treatment proceeds.)