4 - (IOP 35) Anticipatory and Consummatory Pleasure in a Partial Hospitalization Eating Disorder Sample

Mounting data from self-report and neuroimaging studies suggest altered reward processing across eating disorders (EDs). The Temporal Experience of Pleasure Scale (TEPS) isolates and assesses both anticipatory and consummatory experiences of pleasure thus capturing a more muti-dimensional perspective to dysfunction within the brain reward system. To date, only a few studies have utilized the TEPS to compare individuals with EDs to healthy controls. Our study is the first to elucidate whether these specific components of reward processing change over the course of treatment and impact response to treatment in a partial hospitalization program (PHP) for EDs. Our aims were to assess whether 1) anticipatory and consummatory pleasure change from admission to discharge, 2) anticipatory and consummatory pleasure at admission predict treatment outcomes at discharge, and 3) change in anticipatory or consummatory pleasure is associated with change in treatment outcomes from admission to discharge.

Our sample consisted of 154 adults and adolescents with anorexia nervosa restricting subtype (AN-R), anorexia nervosa binge-purge subtype, bulimia nervosa, avoidant/ restrictive food intake disorder, and other specified feeding or eating disorder. Participants were admitted into a PHP for EDs with a primary treatment modality of Dialectical Behavior Therapy. They completed the TEPS, Eating Disorder Examination Questionnaire (EDE-Q), and Clinical Impairment Assessment Questionnaire (CIA) at admission and discharge. The TEPS has four items assessing anticipatory pleasure related to food. Since eating or feeding disturbance is a primary clinical feature of EDs, we completed analyses both with and without food items.

Aim 1 results showed that only anticipatory pleasure with food items improved significantly from admission to discharge (t = -2.04, p = .04). Aim 2 results showed that lower anticipatory pleasure with food items at admission predicted better outcomes on the CIA (B = -6.34, t(149) = -3.21, p < .001), whereas lower anticipatory pleasure without food items at admission predicted worse outcomes on the CIA (B = 5.91, t(149) = 3.23, p < .001). Aim 3 results showed that only change in anticipatory pleasure with food items predicted better outcomes on the EDE-Q (B = -.54, t(150) = -2.11, p = .04) and CIA (B = -6.57, t(150) = -2.62, p = .01). Across aims, there were no significant differences between diagnoses.

Overall, these results indicate that consummatory pleasure did not change significantly over the course of treatment nor impact outcomes. Lower anticipatory pleasure at admission, which may suggest lower motivation or greater anxiety, was associated with poorer treatment outcomes. When including food items, anticipatory pleasure improved significantly during treatment and was associated with better outcomes. This suggests that while individuals with EDs experience broad deficits in reward processing, targeting and improving the reward they expect to receive from food may be impactful for treatment. Future research should seek to replicate these results using additional measures of reward and across broader symptomatology in EDs.