اکتشاف تجربی حل مسئله اجتماعی و فرآیندهای مرتبط با آن در بی اشتهایی عصبی
|کد مقاله||سال انتشار||مقاله انگلیسی||ترجمه فارسی||تعداد کلمات|
|33783||2012||6 صفحه PDF||سفارش دهید||5408 کلمه|
Publisher : Elsevier - Science Direct (الزویر - ساینس دایرکت)
Journal : Psychiatry Research, Volume 200, Issues 2–3, 30 December 2012, Pages 524–529
People with Anorexia Nervosa (AN) have well-documented socio-emotional and neurocognitive impairments. As yet, little is known about their ability to solve problems in social situations, although a link with cognitive avoidance has been suggested. This study explored social problem-solving (SPS), using an experimental task. Secondly, the role of cognitive avoidance in SPS was investigated. Individuals with AN (n=31) and healthy controls (HC; n=39) completed the Social Problem Resolution Task which consists of problem scenarios involving awkward everyday social situations. Participants were asked to generate both the optimal solution and their personal solution. Solutions were rated in terms of how socially sensitive and practically effective they were. AN patients produced relatively poorer personal solutions compared to optimal solutions than HC participants and had higher scores on a measure of cognitive avoidance than the HC group. In AN patients, cognitive avoidance was partially associated with poor SPS. These findings suggest that whilst people with AN have no difficulty in generating socially sensitive and effective solutions to problems, but may have difficulty applying this knowledge to themselves.
Anorexia nervosa (AN) is a serious psychiatric illness which is characterised by self-starvation, hyperactivity and being physically underweight, alongside extreme concerns about weight, shape, or eating (American Psychiatric Association, 2000). AN has the highest mortality rate of all psychiatric disorders (Hoek, 2006). Only 50–75% of those diagnosed with AN make a full recovery and around 20% become chronically ill (Steinhausen, 2009 and Keel and Brown, 2010). Patients report feeling isolated and problems in the interpersonal domain are now thought central to the development and maintenance of AN (e.g. Schmidt and Treasure, 2006 and Rieger et al., 2010). Social problem solving is the process by which a person attempts to identify effective or adaptive ways of coping with everyday life problems and is an important aspect of social competence (D'Zurilla and Chang, 1995). Social problem solving is underpinned by cognitive/executive processes, such as the ability to access and manipulate prior knowledge relevant to the problem situation in working memory, the generation of appropriate strategies, inhibition of inappropriate responses and monitoring and judging the effectiveness of solutions. It is also underpinned by social/emotional skills such as empathising, taking others' perspectives and responding to feedback during decision-making (Channon, 2004). All in all, effective social problem solving requires an intricate interplay of cognitive, emotional and behavioural skills (D'Zurilla and Nezu, 1982). Recent research suggests that people with AN have characteristic neurocognitive impairments with poor cognitive flexibility, difficulties with global processing and integrating information into context and impaired decision making (Roberts et al., 2007 and Lopez et al., 2008). They also have difficulties in the social cognitive domain, including impaired emotion recognition, impaired theory of mind (which refers to one's ability to make inferences about another person's beliefs, desires and intentions) and poor regulation of emotions (e.g. Oldershaw et al., 2010). Furthermore, a recent systematic review shows preliminary evidence for the persistence of a number of these social-cognitive impairments following recovery, such as attentional biases (towards or avoiding) threatening (social) stimuli and difficulty in facial emotion recognition (Oldershaw et al., 2011a). Taken together these findings suggest that impairments in social problem solving should be a likely consequence of these neurocognitive and socio-emotional impairments in AN sufferers. Indeed, there is preliminary evidence from self-report studies suggesting that people with AN are impaired in social problem solving (Paterson et al., 2007, Paterson et al., 2010 and SwansonPlease provide all the authors names in Ref. (Swanson et al., 2010) et al., 2010). However, these studies explore social problem-solving processes, rather than outcomes and as yet no experimental paradigms have been employed to explore the latter. One other factor that will be further explored in the current study is cognitive avoidance, which refers to cognitive strategies employed to avoid negative experiences and emotions. High cognitive avoidance is thought to play a role in the development and maintenance of AN (Troop and Treasure, 1997 and Schmidt and Treasure, 2006). People with AN have been shown to find the experience of having negative thoughts and feelings aversive, are fearful of revealing these to others and try to avoid distressing thoughts and feelings. Higher levels of maladaptive beliefs about the experience and expression of thoughts and feelings are associated with a greater degree of eating disorder symptomatology in AN (Hambrook et al., 2011). Moreover, high cognitive avoidance has previously been found to relate to poor social problem-solving processes in Eating Disorders (ED) (Troop et al., 1994, Troop et al., 2003, Ghaderi and Scott, 2000, Bloks et al., 2004, Paterson et al., 2010 and SwansonPlease provide all the authors names in Ref. (Swanson et al., 2010) et al., 2010). Channon and Crawford (1999) developed an experimental task investigating social problem solving in which participants are asked to generate effective solutions to real-life, socially awkward scenarios (Social Problem Resolution Task, SPRT; Channon and Crawford, 1999, Channon and Crawford, 2010 and Channon et al., 2001). The SPRT consists of a series of short scenarios of social everyday situations for which participants have to generate a course of action for the main character in the story (optimal solution), as well as identify their intended course of action (personal solution). The SPRT has demonstrated impaired social problem solving in people with acquired brain injury and neurodevelopmental disorders, such as Asperger's and Tourette's Syndrome (Channon and Crawford, 1999, Channon et al., 2001 and Channon, 2004). 1.1. Aims The aims of the present study were firstly to explore social problem solving in people with AN compared to that of healthy people using the SPRT, and secondly, to study the relationship between social problem solving and cognitive avoidance. 1.2. Hypotheses Our main hypothesis was that individuals with AN would generate both less effective optimal and less effective personal solutions than healthy controls (HC) as measured with the SPRT. Our subsidiary hypotheses were that individuals with AN would have higher levels of cognitive avoidance compared to HCs and that cognitive avoidance would correlate with poor social problem-solving ability in the AN group.