I recently got the opportunity to listen to Dr. Stephen Wonderlich, a Concordia graduate and distinguished clinical psychologist, speak on campus. He began his talk by explaining that his research is focused on the science of eating disorders, specifically bulimia nervosa (BN). BN is a disorder that includes recurrent episodes of binge eating, a subsequent purge episode that those suffering do to rid themselves of the binge they just did, a sense of lack of self-control, and typically a deficit in positive self image. Furthermore, he explained that BN affects predominately females, with about 90% of cases being female.
Dr. Wonderlich offered a couple personal stories of people who suffered from BN, discussing how they often experienced negative childhood events or extreme social pressures to lose weight or obtain a “thin” image. To further explain, he talked about the current excepted treatment theory for BN – Cognitive Behavioral Treatment (CBT). This model begins with focusing on the patient’s low self esteem, which in turn leads to extreme concerns about weight, strict dieting, and eventually binge eating. He then discussed the theory he and his colleagues have been developing – Integrative Cognitive Affective Theory (ICAT) – and its mechanisms of action. He explained how ICAT focuses on the emotions of the subjects by analyzing the subjective experience, physiological reaction, expressive component, and behavioral reaction of the subject. Furthermore, he mentioned that many published articles explain that negative emotions precipitate eating disorders. These aspects provide the groundwork of ICAT.
Dr. Wonderlich then explained the role of the brain in emotion generation and regulation, with the dorsal system of the brain being responsible for emotional generation, and the ventral system being responsible for regulating and managing emotion. The two emotional circuits work in accordance – and in people suffering from BN, these two systems may not work as effectively as they could. From 
extensive testing and research, it has been found that with increased negative emotion comes increased activation of the brain’s reward center in BN patient. Additionally, when bulimic people plan a future binge, their amygdala calms down. Therefore, the thought of food for bulimic people leads to a reward response. This phenomenon is what drives Dr. Wonderlich’s work in the connection between negative emotional states and the induction of a bulimic episode.
Lastly, Dr. Wonderlich talked about the treatments for BN and how he and his team have developed a manual using ICAT that is being disseminated around the world. He explained that the treatment first works to increase positive emotions and then to find a way for patients to tolerate the negative emotional states. The results of the study showed that integrating ICAT and CBT had profoundly positive outcomes, and that the the large majority of the subjects involved continued with the treatment. This, to me, is amazing – a novel treatment for a very serious disorder can now be implemented in order to improve the lives of those that suffer from BN.
Getting the chance to hear the leader of this potentially groundbreaking research was undoubtedly enjoyable, and I am very intrigued to learn of what the future holds for ICAT and Dr. Wonderlich’s team. I also really appreciated Dr. Wonderlich’s ability to integrate the effects a Concordia College education had on him and his future. For me, I feel even more thankful to be given the opportunity to go into the community and influence the affairs of the world. Luckily, I had the chance to talk with Dr. Wonderlich about his work and the road he took to get to where he is today. I found myself further interested in neuroscience and medicine, and I hope I can continue to integrate the two areas in my future career.
Integrative Cognitive Affective Therapy – The Future of Bulimia Nervosa Treatment
