Timko Research Group Research Overview

Shifting Perspectives Study

Because anorexia begins in adolescence, early intervention is key to prevent a chronic course of the disorder. To date, there is only one intervention with substantial evidence-based support for treating anorexia in adolescents: Family Based Treatment (FBT). Currently, approximately 50% of adolescents reach full remission after treatment.

Studies in adults and adolescents with anorexia indicate that they may have inefficiencies in cognitive flexibility (e.g., have a difficult time switching gears or topics) and may struggle with big picture thinking. In addition, they frequently exhibit reduced behavioral flexibility (e.g., extreme perfectionism, perseveration, difficulties in learning new behaviors) that researchers believe reflects this underlying neurocognitive inefficiency. Importantly, researchers hypothesize that cognitive inefficiencies are a generalized risk factor for the development of anorexia. Targeting these inefficiencies may increase the effectiveness of treatment.

Adding Cognitive Remediation Therapy (CRT) - a treatment known to improve cognitive flexibility by teaching individuals to think about how they think - may help improve outcomes for adolescents by mitigating the impact of malnutrition on the development of flexibility. This study combines FBT treatment with CRT to determine if we can improve long-term outcomes for more adolescents with anorexia.

We are recruiting adolescents ages 12-18 with anorexia and enrolled them into one of two treatment arms: FBT alone or FBT plus adolescent-focused CRT.

Shaping Parental Choices during the Re-nourishment of a Child with Restrictive Eating using an Interactive Open Science Online Grocery Store*

Open Science Open Grocery (OSOG) is a free and accessible mock online grocery store that can be modified to enhance nutritional education that is currently provided to parents during their child’s hospital stay. From the participants’ point of view, OSOG looks like any other online grocery store — it contains more than 10,000 products from American grocery stores including produce, meats, frozen items, and non-perishables. Each item has a price, description, and nutritional information, all of which are visible to participants.

On the research side, we are able to assess a user’s cart activity, interaction with nutritional labels, total shopping time and the macronutrient content of food “purchased.” In this feasibility and acceptability study, our team will modify OSOG to be used in the context of eating disorder treatment to help facilitate a rapid shift in parents’ decision-making around food, which we hope will lead to rapid weight gain in their child.

We asked Parent Research Partners (PRPs) who have had a child recover from anorexia to review OSOG with a study coordinator to share their impressions. Based on feedback from PRPs, we added multiple features to OSOG, including a caloric density scale for each product, pop-ups to suggest calorically dense pairings to products, and new food additions that have been found to be helpful during renourishment.

In the pilot phase of this study, we recruited parents who had a child with anorexia who was hospitalized at CHOP and on the Nutritional Rehabilitation Pathway. All parents were given the modified OSOG after nutritional teaching in the hospital. We followed parents for four weeks and collected psychosocial and behavioral measures, as well as the child’s height and weight to determine rate of weight gain.

*This study is now complete and we are currently preparing our findings for publication.

Reward and Punishment in Eating Disorders

There are documented disruptions in reward and punishment sensitivity in eating disorders. The Lab is examining this in a variety of studies. In addition to questionnaire-based research, we explored social reward and avoidance of punishment via an Incentive Delay Task (IDT). Adolescents completed the IDT while undergoing a functional MRI. Also, we are studying functional and structural connectivity in areas of the brain associated with executive functioning and reward. We have completed enrollment for this study and are in the final stages of data collection.

Retrospective Chart Reviews and Systematic Reviews

Retrospective chart review (RCR) is a research methodology using existing patient-centered data to answer specific research questions. RCRs allow researchers to leverage data to examine clinically relevant questions – results can be used to inform practice and subsequent prospective studies. A systematic review poses a research question, identifies inclusion and exclusion criteria, collects empirical evidence that fits the pre-specified eligibility criteria, all in order to answer the research question.

The Timko Research Group is currently undertaking two systematic reviews related to their research foci, a number of others are planned and are an excellent opportunity for research assistants to have in-depth exposure to a topic of interest.