Do reward and punishment sensitivity change after treatment for anorexia nervosa? Amy Harrison a, ⁎, Lot Sternheim b , Caitlin O'Hara c , Anna Oldershaw c , Ulrike Schmidt c a Regent's School of Psychotherapy & Psychology, Faculty of Humanities, Arts & Social Sciences, Regent's University London, Inner Circle, Regent's Park, London NW1 4NS, UK b Department of Clinical and Health Psychology, Utrecht University, The Netherlands c King's College London, Institute of Psychiatry, Psychology and Neauroscience, Section of Eating Disorders, Division of Psychological Medicine, De Crespigny Park, London SE5 8AF, UK abstract article info Article history: Received 8 December 2015 Received in revised form 19 February 2016 Accepted 20 February 2016 Available online xxxx An important question in eating disorders (EDs) is why people continue to pursue the perceived benefits of the illness in spite of devastating physical, psychological and social consequences. In investigating this, previous stud- ies have highlighted a profile of low reward and high punishment sensitivity in anorexia nervosa. Treatments have attempted to target this presentation in therapy although little is known about whether it is possible to do so, thus helping individuals to use more flexible, adaptive and less anxiety-driven responses to their own internal and external environments. In this longitudinal study, 77 outpatients receiving psychological treatment (mean age = 26.6; SD = 7.90) completed the Carver and White (1994) BIS/BAS Scales before and after treat- ment. There was a small-sized reduction in BIS anxiety (d = 0.33) after, compared to before treatment. There were no main effects of illness duration, nor treatment dosage (number of sessions attended) on reward and punishment sensitivity after, compared to before treatment. Future work could explore whether small reductions in anxiety may predict long-term recovery, given mood difficulties are a key maintaining factor in contemporary models of EDs. © 2016 Elsevier Ltd. All rights reserved. 1. Introduction 1.1. Background to reward and punishment sensitivity in eating disorders Eating disorders (EDs) can be severe and debilitating mental illnesses associated with serious physical health consequences with similar poor quality of life to those with schizophrenia (Arkell & Robinson, 2008). Several contemporary conceptualizations of EDs suggest that differences in the way people with EDs experience environ- mental stimuli and behavioral contingencies as rewarding or punishing compared to non-ED controls, might help to explain why people contin- ue to pursue the perceived benefits of the illness despite its disadvan- tages (e.g. Giel et al., 2013; Kaye, Fudge, & Paulus, 2009; Kaye, Wierenga, Bailer, Simmons, & Bischoff-Grethe, 2013; Klump et al., 2004; O'Hara, Campbell, & Schmidt, 2015). Empirical evidence further supports these ideas. A systematic review and meta-analysis of self- report measures (Carver and White's (1994) BIS/BAS Scales; the Tem- perament and Character Inventory (Cloninger, 1991) and the Tridimen- sional Personality Questionnaire (Cloninger, 1987)) found people with anorexia nervosa (AN) and bulimia nervosa (BN) reported higher pun- ishment sensitivity than non-ED controls. The AN restricting subtype was associated with lower reward sensitivity than the binge–purge sub- type (Harrison, O’Brien, Lopez, & Treasure, 2010). Recent data largely corroborate these findings regarding punishment sensitivity, and to some degree, reward sensitivity. Harrison, Treasure, and Smillie (2011), analysed using discriminant analysis, measured by the BIS/ BAS and Appetitive Motivation Scale (Jackson & Smillie, 2004) found non-ED controls (N = 91) were maximally separated from those with EDs (both AN restricting and binge–purge subtypes and BN) (N = 121) along a dimension reflecting high punishment sensitivity and low reward sensitivity. Jappe, Frank, Shott, Rollin, Pryor, Hagman, et al. (2011) using the Sensitivity to Punishment/Sensitivity to Reward Questionnaire (SPSRQ; Torrubia, Avila, Moltó, & Caseras, 2001) found women with AN (N = 31; restricting and binge–purge subtypes) re- ported higher punishment and reward sensitivity scores than non-ED controls (N = 33). A further study highlighted elevated punishment sensitivity in 48 ED outpatients compared with 19 non-ED controls, but did not observe differences in reward sensitivity (Monteleone, Scognamiglio, Monteleone, Perillo, & Maj, 2014). Glashouwer, Bloot, Veenstra, Franken, and de Jong (2014) reported 117 adolescents with restricting and 48 with binge–purge AN reported significantly higher Personality and Individual Differences 96 (2016) 40–46 ⁎ Corresponding author. E-mail address: harrisona@regents.ac.uk (A. Harrison). http://dx.doi.org/10.1016/j.paid.2016.02.051 0191-8869/© 2016 Elsevier Ltd. All rights reserved. Contents lists available at ScienceDirect Personality and Individual Differences journal homepage: www.elsevier.com/locate/paid