Authors
Sara Bertelli¹, Renata del Giudice¹, Cristina Civilotti^2,3, Enrica Gaetano¹, Anna Mottaran¹,Simona Anselmetti^1
1Department of Mental Health and Addiction, ASST Santi Paolo e Carlo, Milan, Italy.
²Department of Psychology, University of Turin, Via Verdi 10, 10124 Torino, Italy.
3 EMDR center for Eating Disorders, Via Pergolesi 14, 20124 Milano, Italy.

Background and aims
In recent years, clinicians and researchers have demonstrated a strong relationship between childhood trauma and the development of eating disorders
While EMDR has been shown to be effective in restoring affective regulation strategies in patients with PTSD, much less is known about its efficacy in improving emotion processing in patients with anorexia nervosa compared to the CBT protocol. The purpose of this study was to observe the course and outcomes of the specific EMDR protocol for eating disorders compared to a CBT treatment.

Methods
Patients with AN recruited at the Eating Disorders Clinic of San Paolo Hospital in Milan underwent sociodemographic and clinical assessment at the time of recruitment and then randomly assigned to EMDR or CBT treatment.
The same assessment was repeated after four month, and as a follow-up six months after the completion of treatments.

Results
The preliminary results suggest that the two therapeutic approaches are comparable in terms of their effectiveness. However, a careful evaluation suggests that the mechanisms underlying the changes are different, suggesting EMDR increasing compliance by reducing drop-out and acting-out episodes.

Conclusions
Because exposure to stressful life experiences is among the underlying causes of the onset, maintenance, and eventual relapse of anorexia nervosa, EMDR might be particularly effective in addressing the emotional and traumatic core of the disorder with important implications for patients compliance and therapeutic feasibility in a national public service for eating disorders.

Abstract topic
Anorexia nervosa and EMDR

3 Learning objectives
Participants will learn the preliminary clinical outcomes of the trial to better understand therapeutic pathways.

Authors
Eleonora Rossi¹, Emanuele Cassioli², Giulio D’Anna², Michela Martelli², Vivienne M. Hazzard³, Ross D. Crosby³, Stephen A. Wonderlich³, Valdo Ricca², Giovanni Castellini^2
1 Psychiatry Unit, Department of Health Sciences, University of Florence, Largo Giovanni Alessandro Brambilla, 3, 50134, Florence, Italy
²Psychiatry Unit, Department of Health Sciences, University of Florence, Largo Giovanni Alessandro Brambilla, 3, 50134, Florence, Italy
³Sanford Center for Biobehavioral Research, Fargo, North Dakota, USA

Background and aims
Treatment response of Anorexia Nervosa (AN) is unsatisfactory, particularly in presence of childhood trauma (CT). Emotion dysregulation in traumatized patients with AN is higher, therefore this study aimed at evaluating the role of emotion dysregulation as a mechanism trough which CT maintains greater eating disorder (ED) psychopathology after treatment.

Methods
In total, 152 female AN patients performed the baseline assessment (T0), and 118 were re-evaluated after 1 year (T1) of a multidisciplinary treatment including enhanced cognitive-behavior therapy. T0 assessment included Eating Disorders Examination Questionnaire (EDE-Q), Difficulties in Emotion Regulation Scale (DERS), and Childhood Trauma Questionnaire (CTQ). At T1, EDE-Q and DERS were readministered. The longitudinal coupling between EDE-Q and DERS and the role of CT as an outcome predictor were evaluated through a bivariate latent change score (LCS) analysis using structural equation modeling (SEM).

Results
After treatment, an overall amelioration was observed. LCS-SEM showed that higher baseline DERS predicted less EDE-Q improvements. EDE-Q variation was unidirectionally predicted by DERS variation. Higher CTQ scores predicted worse longitudinal trend of EDE-Q through the mediation of greater baseline DERS.

Conclusions
This study demonstrated that emotion dysregulation mediated the effect of CT in worsening treatment response in patients with AN. Trauma-focused interventions, such as Eye Movement Desensitization and Reprocessing (EMDR) could be pivotal to improving outcomes.

Abstract topic
Childhood trauma and anorexia nervosa

3 Learning objectives
To highlight that CT worsens AN prognosis through the mediation of greater emotion dysregulation and, therefore, trauma-focused interventions, such as EMDR, could be fundamental.

*** Background and aims ***
Many studies documented high rates of trauma in patients with eating disorders (ED).Trauma could lead to worse treatment outcomes, such as uncomplete remissions or relapses. For these reasons, international guidelines recommend to be alert to signs of prior trauma during assessment and treatment. Specific treatments of trauma could improve patients’ outcomes. However, no RCT targeting traumatic events have been conducted in patients with ED so far.

*** Methods ***
The aim of the study is to evaluate the effectiveness of EMDR plus CBT-Eb versus CBT-Eb alone in patients with ED. The primary outcome is the change of the EDE score. For this purpose, we are recruiting patients from Centre for ED in Verona Hospital. Patients are randomly assigned to one of the two treatments: CBT-Eb plus EMDR or CBT-Eb alone. Randomization is stratified according to BMI (≤17.5 vs >17.5 kg/m2) and presence of trauma (yes vs no). All patients are assessed at the baseline, at the end of treatment and after 6 months of follow-up.

*** Results ***
Eighty patients were prospectively enrolled. We expect that EMDR plus CBT-Eb will reduce the severity of the ED as compared to CBT-Eb alone, in particular in patients with trauma history. In addition, we expect that a combination of CBT-Eb and EMDR would enhance also the remission rates.

*** Conclusions ***
This study may serve as a basis for a larger RCT with stronger outcomes. This approach may be particularly promising for those patients resistant to treatment partly due to the presence of traumatic experiences.

*** Abstract topic ***


*** 3 Learning objectives ***

Authors
Marina Balbo¹, Stefania Picollo^1,2, Matteo Panero¹, Camilla Scalco¹, Giovanni Abbate Daga^2
1EMDR Italian Association, Via Umberto I, 65 - 20814 Varedo (MB).
²Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Via Cherasco 11, 10126 Turin, Italy

Background
Eating Disorders (ED) are serious diseases with significant morbidity and mortality. The approach to treatment is multidisciplinary and psychotherapy is crucial in ED treatments. The aim of the study is to evaluate early stages (first three sessions) of a psychotherapeutic treatment, confronting EMDR with psychodynamic psychotherapy.

Materials and methods
Twenty-five individuals with ED were recruited in the ED Center in Turin, and randomly assigned to EMDR or Psychodynamic psychotherapy. Subjects completed the following tests: EDE-Q; IIP-32; BDI I e II; STAI; CTQ; DERS; DES. Therapists completed the psychodynamic functioning scale (PFS).

Results
The sample of 25 patients with ED consists of: 8 AN-R (32%), 6 AN-BP (24%), 7 BN (28%), 4 atypical AN (16%). In our sample there were no statistically significant correlations between the presence of childhood traumatic events and the severity of eating symptoms. A positive correlation between restriction and dissociation emerges as an indirect measure of the presence of trauma. Therapist evaluation of psychological functioning does not correlate with psychopathology or with the presence of trauma. Unlike T0 tests, in clinical interviews currently underway, therapists are progressively detecting the presence of traumas that patients report not having declared in the initial test.

Discussion
The early stages of psychotherapy in ED are a complex and crucial moment in the treatment pathway. Our study highlighted that therapists may encounter some bias in evaluating the psychological functioning of individuals with ED in the early stage of psychotherapeutic treatments, and the presence of past trauma may not be easily detected in this phase but emerge via indirect characteristics such as dissociation. In the light of the progress of trauma focused psychotherapies we expect the emergence of a greater focus on the traumatic aspects on the part of the patient in the next T1 tests, more in line with the solid literature that correlates ED and trauma