An Interview with Psychologist Ann Haynos
Ann Haynos, Ph.D. is a an assistant professor in clinical psychology at Virginia Commonwealth University. Her research specializes in destructive excess goal pursuit and restrictive eating disorders.
Ananya Udyaver: Hi! Thanks for joining us today for this installment of The Seattle Psychiatrist Interview series. I'm Ananya Udyaver, a research intern at Seattle Anxiety Specialists. I'd like to welcome Dr. Ann Haynos, an assistant professor in clinical psychology at Virginia Commonwealth University. She's an expert on the field of neuroscience and clinical science with an interest on the phenomenon of excess goal pursuit that leads to destructive health outcomes. Her research is primarily focused on restricted eating disorders and how they can become consuming and life-threatening. She's written several articles on the topic, including “Beyond Description and Deficits: How Computational Psychiatry Can Enhance an Understanding of Decision Making in Anorexia Nervosa” and “Moving Towards Specificity: A Systematic Review of Cue Features Associated with Reward and Punishment in Anorexia Nervosa.”
So before we get started, can you please tell us a little bit more about yourself and what made you interested in specifically studying restrictive eating disorders?
Ann Haynos: Sure, absolutely. So just briefly about myself, I guess. So I am new faculty member here at VCU. I just started last August, and before that, was on faculty at the University of Minnesota for several years. And so a lot of the research I'll be talking about was actually performed in Minnesota. I had gone there as part of my training and stayed on with my lovely colleagues to go into a faculty position there. So more generally about my background, I've been working in the field of eating disorders for a long time, since I was, I suppose an undergrad.
And along the way, have also become interested in some sort of intersecting fields like those pertaining to emotion regulation, reward, neuroscience, and have taken so those bits of training and integrated it into the work I'm doing. So as you mentioned, I do a lot related to the clinical neuroscience of eating disorders, but I also have a treatment arm of the research I do. And the hope is that our lab integrates both. So as far as how I got interested, I think the thing that really drew me to the eating disorders field was some early experiences. I grew up in sort of the DC metro area and went to a small all female school there. And when I was there, my graduating class was something like a class of a hundred, and we had a disproportionate amount of people affected by eating disorders in my class. I would say... Maybe the average estimates of how many people are affected by anorexia nervosa or something like 1%. And I would say, just based on my knowledge, something like 10% of my graduating class probably met criteria for anorexia nervosa.
Ananya Udyaver: Yeah. Wow. That's a lot...
Ann Haynos: And some of these people, I was quite close to and could see really upfront the devastating effects of these illnesses and would often get disheartened about how people would think about eating disorders in the lay public as sort of a disorder that might be something about wanting to look a certain way. And I could just tell people, based on firsthand experience, that it was so much more devastating to the people and the families affected by it. And then also as part of that experience, I saw some of the people I knew who were struggling with eating disorders got treatment and got better and seemed to recover without as much effort. And then some people really struggled to find the treatment that worked for them and continued struggle with their eating disorder for many years. It just really struck me that we needed more options for people, especially those who don't respond to initial treatments. So that's sort of what sparked my initial interest.
Ananya Udyaver: Yeah. That makes a lot of sense. Okay. Well, I read a little bit in your most recent article about excess goal pursuit and how that can affect psychiatric illnesses like anorexia nervosa. Can you please explain what this means and how it pertains to your study and understanding of anorexia nervosa?
Ann Haynos: Yeah. So sort of the background on thinking about anorexia as a disorder of excess goal pursuit is... A lot of studies in psychiatry and in psychology tend to look at places where people with psychological disorders or mental health problems have deficits in some sort of ability, right? For instance, the assumption would be all of us should have self-control and people might have problems with self-control, and that could lead to different sorts of problematic behaviors, like say drug use or something like that. Or maybe everybody should have the ability to manage their emotions effectively and people with psychological problems might have problems with doing that.
And one of the things I started to find when I was doing research on folks with anorexia nervosa, and I'm sure this is true of other clinical populations too, this is the area I worked in the most, is that I would find certainly some areas where there were deficits or problems and certain abilities, but I also found places where I was seeing actually distinct strengths in abilities that we usually think of as good, like the ability to inhibit impulses and work towards long-term goals. Society usually thinks that's a good thing. And so I would see the strengths. And the problem is a lot of times, those strengths get missed because people are so busy looking for the weaknesses that might lead to mental health problems.
And one of the things that concerned me about this bias towards looking at these sort of deficits or relative weaknesses that might lead to mental health problems is that there is a possibility that certain things that we really encourage as a society, like self-control, like the ability to focus on a goal very narrowly and intently, if taken too far, could actually cause some problems. But we encourage those things as a society. And so one of the ways I've begun to conceptualize anorexia nervosa is this may be a disorder where people with this disorder are doing what society has told them to do. They are pursuing a goal. And specifically, they're pursuing what is often a socially sanctioned goal, which is weight loss. They just keep going and going past when most people would stop. But I think it can be very confusing if you're told, "This is the right thing to do and this is a thing that will be rewarded," and then at some point people say, "Oh, no, no, no, stop doing that thing." Right? And so that's how I started pursuing that area of research.
Ananya Udyaver: Okay. Makes a lot of sense. And it's really interesting, the idea of goal pursuit and how you also have to consider patients' strengths and not just their weaknesses when you're looking at disorders like this. So when you talk about computational psychiatry in your research, what does that entail, and how does it relate to treating anorexia?
Ann Haynos: Yeah, I'm smiling because it's such a complicated... It's an umbrella term, and it's very complicated. I think a lot of people who even work closely on areas related to computational psychiatry get a little confused about exactly what it means. So basically, the field of computational psychiatry developed mostly out of partnerships with neuroscience. So over time, mental health fields have been more and more drawing off of some of the tools and theories that neuroscientists have been using to look at things at a much more fine-grained level, like how brain circuits work. And one of the things that neuroscientists have learned is that there are different ways that our brain makes mental calculations to solve different problems. So you could have a problem in front of you, like there are different types of reward in front of me. Which should I pursue? And there are many different mental calculations that should go into how you make that choice.
So you could mentally calculate, what is the cost of pursuing option A over option B? You could calculate the relative reward of these different options. You can calculate, how much do I know about option A, option B? And all of us do this throughout the day in living our everyday lives. If you think about where you choose to get a sandwich for lunch or whatever, you're usually doing some sort of probably quick, but mental calculations, weighing out familiarity, effort to get someplace, how much things cost, et cetera. Now, the idea of computational psychiatry is that sometimes those mental calculations can be either over applied in certain situations, or applied insensitively, or otherwise just go awry, and that can lead to mental health problems. So again, taking the example of the mental calculations that go into getting your lunch sandwich, let's say you are always selecting the deli downstairs, except that costs a ton of money and you don't have a lot of money.
Well, suddenly that's a problematic way of making that mental decision because it's leading over time to bad outcomes. You just don't have enough money in the same ways we can make mental calculations that can over time lead to mental health problems. So some of the... One example from my work in anorexia is we're starting to see some evidence that people with anorexia nervosa make decisions... They form preferences very quickly and stick very rigidly to their preferences about things. So that can translate to, if you have decided that the thing you really care about pursuing is weight loss, maybe you may be quick to jump to that as a solution to certain problems, and it might be harder for you to stop and say, "No, I need to do a different thing at this moment."
Ananya Udyaver: That makes a lot of sense, and that was a really great analogy with the sandwich.
Ann Haynos: Maybe it's just cause of lunchtime and I'm hungry.
Ananya Udyaver: Yeah. Okay. So I guess you kind of answered this question in this sense of what is the difference between under responding and over responding and how an individual can recognize that type of response within themselves.
Ann Haynos: And so when you refer to under responding and over responding, are you talking about to rewards?
Ananya Udyaver: Yes, or to...
Ann Haynos: Okay.
Ananya Udyaver: Yeah.
Ann Haynos: Yeah. Okay. So as far as rewards go, all of us want to seek out things that are going to be pleasant or enjoyable or give us some payoff in life, right? And there are some problems that can arise with mental health where people over respond to rewards, generally speaking. So let's say, for instance, this is something that could lead to impulsivity. If you were just saying like, "Ooh, food, ooh, drugs, ooh, sex," whatever, all the rewards, that's going to lead to not making sensitive decisions about also the cost of those behaviors.
On the other hand, you could have a problem related to overall under-responsivity. So that might look like what you might see, for instance, in people with depression, where nothing really interests me, nothing's that rewarding. Not just like, oh, I don't care about the food, sex and drugs, but I also don't care about talking on the phone with friends or watching a movie. And that would be a really clear example of overall under responding. Your brain is just not gravitating towards any rewards, which is problematic because you need your brain to want to do some things in order to function in the world.
The other thing we tend to see in eating disorders specifically, and I'll talk about anorexia nervosa here, is that some disorders are associated with over responsivity to some rewards and under responsivity to others. So one of the things we found in anorexia nervosa is that... And not just us, a lot of research. This is summarizing a lot of researchers findings, but people with anorexia nervosa tend to show a lot of under responsivity to rewards that the average person would find enjoyable, like winning money, seeing pleasant videos, or having social interactions, but tend to respond to rewards related to their eating disorder, so things like exercise cues or weight loss cues, or engaging in eating disorder behaviors. And that imbalance is also a problem. Because if you only have these sort of problematic weight loss things that make you feel good and nothing else really makes you feel that positively, then you're just going to keep going for the same rewards over time, even when they're problematic.
Ananya Udyaver: Right. Yeah. That makes sense. Okay. My next question was actually about rewards and punishments, but I feel like that question was kind of answered by your last response. Yeah. So do you think it's important for individuals suffering from eating disorders to understand the psychiatric basis behind their thoughts and actions? And if so, why?
Ann Haynos: I find a lot of folks with eating disorders are very interested in understanding sort of the neurobiology and some of the psychological and psychiatric mechanisms that underlie their disorder. At this point, I've run a lot of people with eating disorders through research studies, and they're often very eager research participants, because A, they know how much they've suffered from their disorder and they want to help other people. But B, I think a lot of times people are confused about what's driving their behaviors. They know they're really stuck in their eating disorder behaviors, and they know that they try really hard at times to get out of those behaviors, and it's very difficult. And so I found that by describing some of the neurobiology and other research that has helped to understand how eating disorders function, a lot of times, that can be helpful for people to just understand themselves, and also, I think hopefully can relieve a layer of self-criticism and self-blame.
Ananya Udyaver: Right.
Ann Haynos: This is another reason why I've gravitated in my work to towards looking at things that could be strengths that also could be problematic. I think that allows me to say to people I work clinically with, "Look, this set of skills that you're using is great, and if applied in to the right things and in a judicious way. I don't want to get rid of your hardworking nature, your willing to use control and effort. All of those things are not bad in themselves. We just got to attach them to good outcomes, and also make sure you balance it out with the ability to be flexible and give yourself a break sometimes." So I tend to, when I work clinically with people, try to bring in as much of the research as possible.
Ananya Udyaver: Yeah, I think that's a really great way to motivate your patients to want to do better and get better. So that's really interesting. Okay. And then I read about in your research, the positive effect treatment and as a cognitive behavioral intervention. And I was wondering if you could please more explain this intervention.
Ann Haynos: Yeah. Absolutely.
Ananya Udyaver: Yeah.
Ann Haynos: Oh, sorry. Sorry, I had a little bit of a delay talking over you.
Ananya Udyaver: It's okay. Go ahead.
Ann Haynos: Do you mind just saying the second part of your question again?
Ananya Udyaver: Yeah. Just explaining the intervention and its potential benefits for patients.
Ann Haynos: Wonderful. So positive affect treatment, I'm really excited to talk about this right now because we're sort of in this pivotal stage with this research that I'll talk more about. But positive affect treatment, which is abbreviated. We call it PAT, but the person who developed it calls it PAT often. But it was originally developed by Michelle Craske at UCLA. She developed it as a alternative treatment for depression and anxiety. And the idea that motivated her developing this treatment is a lot of treatment for people with depression and anxiety is focused on reducing negative emotions.
And we know those work, but we also know that in addition to having high negative emotions, people with anxiety and depression often have low positive emotions, and decreasing the negative emotions does not always lead to increasing the positive emotions. So a good example of this is antidepressant medications often help people feel less anxious, less depressed, but also often have the side effect of making people feel kind of numb, less interested in things around them. So that's an example of decreasing negative, but also just not helping positive emotion at all. So she had really good initial findings from delivering this treatment in depression and anxiety, basically finding that this treatment could reduce depression and anxiety symptoms, as well as suicidality. So we learned about it, and we're really interested in translating it to anorexia nervosa. This is me and my colleagues at University of Minnesota. Dr. Carol Peterson is the main person I've worked on this work with.
And what appealed to us is this treatment is really designed to target the neuroscience of reduced positive affect. So what goes on in the brain, and how can we correct that behaviorally for people who are just under responding to the rewards in their environment like we described before? So what we wanted to do is take everything that works so well for that set of problems, and then we added on some additional components of the treatment that target the over responsivity to weight loss rewards that we might see in anorexia. So the way we talk about this treatment is we tell clients our goal is to grow your life and shrink your eating disorder so that your life is so good that you don't need to rely on your eating disorder to do whatever it was doing for you in the past. So we just finished writing up our initial manuscript of our pilot study for this treatment. And the treatment involves some sort of cognitive behavioral interventions, as well as some mindfulness and self-compassion interventions, all targeting increasing positive emotions outside of the eating disorder.
Ananya Udyaver: Right.
Ann Haynos: And what we found is that this treatment was associated with people who went through the treatment, decreased their eating disorder symptoms and increased their body weight, which is what we want for people with anorexia nervosa. And also, unlike other treatments for eating disorders, we saw that anxiety and depression also really decreased...
Ananya Udyaver: Wow.
Ann Haynos: ... during this treatment. Yeah, which we were really excited about because a lot of times people will say, "My eating disorder is better, but I'm still miserable." Right? So we're about to publish... Well, we're about to submit that for publication. But the other really exciting thing is we're going to start a new study piloting this treatment for people stepping down from higher level of care after they've had an acute episode of care for anorexia nervosa in residential or partial hospitalization or intensive outpatient treatment. And we're going to be doing PAT and comparing it to more standard eating disorder treatments during that sort of pivotal step down period. And the treatment's virtual, so anybody across the country could participate in it. So if anybody's hearing this and this sounds like an interesting option for them or their clients, hopefully while this is up, we'll be running the study.
Ananya Udyaver: Yeah, definitely a lot of people that are interested in getting help will be reading and watching these interviews, and this is a really great study that you're doing because I'm sure people will definitely want to join. And that was actually one of my questions, which was, do you have any potential treatment options or a study going on that could help people watching these interviews and seeking help? So that's a really great thing that you're doing.
Ann Haynos: Absolutely. And I'll just put in one extra pitch, which is, one thing, you could do this treatment study while also doing other treatments. So it can be the only treatment people are doing, but it could not be as well. The other thing is it's completely free. And in fact, people get paid to participate in the research side of things. So this is a good option for folks who might not be able to financially access other eating disorder treatment during their step down period. So if anybody out there is listening and interested, please reach out to our group. We'd be happy to see if you'd be eligible. (email: haynosa@vcu.edu)
Ananya Udyaver: Definitely. And we'll make sure to put all your information on the website so that they can contact you.
Ann Haynos: Wonderful.
Ananya Udyaver: And then just to wrap things up, since we are coming to the end of our interview, as a professor in the field of clinical psychology and a researcher, do you have any other advice or recommendations for our listeners who may be seeking treatment or suffering from a psychiatric illness?
Ann Haynos: I think first, for anybody who's acutely struggling with an eating disorder or any other psychiatric illness, I guess I would say as a first thing, that I recognize how difficult that is, and it can feel at times near impossible to get the right type of treatment or the right type of resources to help alleviate your symptoms. So I guess the first thing is, I know it's hard. And I guess I also want to instill some hope. We do know that there are... Taking disorders as an example, even among people who have been struggling with their eating disorder for very many years, the evidence overwhelmingly suggests that most people do recover, even if it takes a while to do so. I think we are trying to get better as a field about understanding how to help people with the right treatments at the right time. But I would just always say to keep that glimmer of hope.
I've worked with so many clients who, at the moment when I've been working with them, have been just severely struggling, very uncertain about the directions to go in, not certain if they can overcome their psychological problems, whether that be eating disorder, anxiety, depression. And then I'm lucky enough to have people keep in touch with me sometimes and tell me where they are several years later. And a lot of times, they've built these beautiful lives. I think the other thing I'd recommend is just, to the extent you can, do the research about what are the evidence-based treatments for you. There's a lot of non-evidence based treatments for eating disorders and other disorders out there. And I think a lot of people get stuck in a place of getting treatment that actually is not going to benefit them for too long. And so that would be the other piece of advice. And get a support system to the extent you can, because it's hard to go through dealing with mental illness on your own. And having more supports, even if that's just your therapist, anything can be really helpful.
Ananya Udyaver: I think that's amazing advice and definitely very motivational to anyone who is seeking help.
Ann Haynos: I hope so.
Ananya Udyaver: Yeah, thank you so much for that. But anyway, thank you so much for your time and for your willingness to participate in our interview series. It's been a pleasure speaking with you, and we wish you the best on your future research and hope that you find more interesting things that can help people out there.
Ann Haynos: Wonderful. Well, thank you so much for having me.
Ananya Udyaver: Of course. Thank you.
Please note: The views expressed by the interviewee are for educational and informational purposes only, are not meant to diagnose or treat any condition, and do not necessarily reflect the views of Seattle Anxiety Specialists, PLLC.
Editor: Jennifer (Ghahari) Smith, Ph.D.