RESEARCH ARTICLE Direct Experience and the Course of Eating Disorders in Patients on Partial Hospitalization: A Pilot Study Joaquim Soler 1,2 * , José Soriano 1 , Liliana Ferraz 2 , Eva Grasa 1,2 , Cristina Carmona 1 , Maria J. Portella 1,2 , Victoria Seto 1 , Enric Alvarez 1,2 & Víctor Pérez 1,2 1 Department of Psychiatry, Santa Creu i Sant Pau Hospital, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain 2 Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Institut d’Investigació Biomèdica-Sant Pau (IIB-SANT PAU), Institut de Recerca del Servicio de Psiquiatría Hospital de la Santa Creu i Sant Pau (Barcelona), Universitat Autònoma de Barcelona, Barcelona, Spain Abstract Awareness of sensory experience in the present moment is central to mindfulness practice. This type of information processing, in contrast to an analytical evaluative style of processing, could be more beneficial for the course of those psychiatric disorders characterized by ruminative and content-centred processing, such as eating disorders (EDs). We performed a pilot study to assess the relation between patients’ approach to information processing and the duration and severity of EDs. Fifty-seven patients with a diagnosed ED were included in the study and participated in a self-guided eating activity to asses the primary information processing mode based on mindfulness concepts of ‘Direct Experience’ and ‘Thinking About’. Additionally, dispositional mindfulness was assessed by the Five Factors Mindfulness Questionnaire, and anxiety during the experiment was determined by means of a 10-point visual analogue scale. We found that a higher level of self-reported Direct Experience was inversely associated with several severity variables and with anxiety levels. Direct Experience was predicted by a low anxiety level, less severe illness, and higher scores on one mindfulness facet (Observing). Our results suggest that a Direct Experience proces- sing approach is associated with better ED outcomes. Future studies should be carried out to clarify the repercussion of mindfulness training on EDs. Copyright © 2013 John Wiley & Sons, Ltd and Eating Disorders Association. Keywords Eating Disorders; Severity; Mindfulness; Direct Experience; Thinking About *Correspondence Joaquim Soler, Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, St. Antoni Mª Claret 167, 08025 Barcelona, Spain. Tel.: +34 93 553 78 40; Fax: +34 93 291 93 99. Email: jsolerri@santpau.cat Published online 12 February 2013 in Wiley Online Library (wileyonlinelibrary.com) DOI: 10.1002/erv.2224 Introduction Eating disorders (EDs) are common mental disorders character- ized by behavioural alterations caused by a driving desire to lose weight. Anorexia nervosa (AN), bulimia nervosa, and eating disorders not otherwise specified (EDNOS) are estimated to affect from 2% to 5% of the population (Hudson, Hiripi, Pope, & Kessler, 2007). EDs can negatively impact many aspects of a patient’s life, including psychological functioning, and the presence of EDs is commonly associated with depressive symptomatology and anxiety (Godart et al., 2007; Mischoulon et al., 2011). These illnesses most commonly affect young people, and the mortality risk for patients is among the highest of all psychiatric disorders (Arcelus, Mitchell, Wales, & Nielsen, 2011; Harris & Barraclough, 1998). Somatic problems are common and generally severe, with up to 10% of the most severe cases ending in death (American Psychiatric Association, 2000; Mitchell & Crow, 2006). Studies with long-term follow-up have shown that outcomes tend to be dichotomous over time: either recovery or severe chronicity or even mortality. Steinhausen (2002) reviewed 119 series of patients with AN and found that 46.9% of the patients recovered, 33.5% improved, and 20.8% were classified as chronic. Several psychological variables—including coping strategies and cognitions—have been associated with the duration and maintenance of EDs (Ball & Lee, 2002; Bloks, Van-Furth, Callewaert, & Hoek, 2004; Quiles & Terol, 2008). Active coping strategies are associated with less chronicity (Bloks et al., 2004), whereas inadequate coping strategies can maintain or worsen symptoms and impair recovery (Ball & Lee, 2002; Quiles & Terol, 2008). Cognitions also play a central role in the development and maintenance of the disorder. Numerous studies have found that thought contents of ED patients are mostly related to control of eating, weight, and shape (Cooper, Wells, & Todd, 2004; Fairburn, Peveler, Jones, Hope, & Doll, 1993; Fairburn, Shafran, & Cooper, 1999). Several authors have suggested that such thoughts are central to patients’ sense of self and are a core component of dysfunctional cognitive structures in patients with EDs. Moreover, these same authors argue that the presence of this type of cognition contributes both to the emergence and to the severity of ED symptomatology (Cooper & Hunt, 1998; Cooper, Rose, & Turner, 2005; Cooper & Turner, 2000). Despite the importance of cognitive processes in EDs, little empirical research has focused on identifying the specific proces- sing mode that predominates in this population. Williams (2008) 399 Eur. Eat. Disorders Rev. 21 (2013) 399–404 © 2013 John Wiley & Sons, Ltd and Eating Disorders Association.