Wednesday, September 16, 2026

Gastrointestinal Interoception and Relapse in Anorexia Nervosa

Verdonk C, Mink K, Choquette E, Moseman SE, Mayeli A, Stewart JL, Paulus MP, Smith R, Khalsa SS. JAMA Psychiatry. September 2026.

This crossover study at the Laureate Institute for Brain Research tested gut-signal detection in 62 weight-restored women with anorexia nervosa against 57 matched healthy comparators, using a swallowed vibrating capsule to deliver calibrated gut stimulation while researchers recorded behavioral accuracy, gastric-evoked EEG potentials, and computational models of interoceptive learning.

Compared with healthy comparators, participants with anorexia were substantially worse at detecting the gut stimulation and held stronger prior expectations that nothing was there to detect — a bias that computational modeling linked to rigid, asymmetric updating of those expectations even when the signal was clearly present. At six-month follow-up, the strength of those maladaptive priors, along with response bias and reported stomach discomfort, predicted which patients relapsed.

Full text   doi:10.1001/jamapsychiatry.2026.1301

Collaborative Working Models of Alliance Rupture Repair: A Theory-Building Case Study

Sell C, Eis JL, Volz M, Klug G, Muran JC, Huber D. Psychotherapy Research. July 2026.

Using video from 81 sessions of a single successful long-term psychodynamic treatment, this research team applied statistical process-control charting to identify phases of unusually high versus low success at repairing alliance ruptures, then analyzed those sessions using grounded theory coding.

High-repair phases were marked by what the authors call a collaborative working model — a tacit, jointly built, case-specific way the therapist and patient had learned to negotiate emotional intensity together. In the lower-repair phase, that shared framework broke down, coinciding with a shift in the treatment frame that altered the transference-countertransference dynamic. The authors argue that repair capacity isn't a fixed therapist skill applied uniformly, but an emergent property of the specific dyad that can be built, and can also be lost.

Full text   doi:10.1080/10503307.2026.2709435

Lithium's Thyroid Problem Doesn't Always Go Away When Lithium Does

Lithium blocks thyroid hormone release at multiple points — it inhibits iodine uptake, blocks coupling of iodotyrosines, and impairs thyroglobulin proteolysis, so TSH rises even when the gland itself is structurally normal. Clinically overt hypothyroidism develops in roughly 20% of patients over long-term treatment, more in women and in those already carrying antithyroid antibodies, because lithium appears to unmask or accelerate an underlying autoimmune thyroiditis rather than simply suppressing a healthy gland.

That distinction matters at discontinuation: if lithium were purely suppressing normal thyroid function, stopping it should restore normal levels — but when it has unmasked Hashimoto's disease, the hypothyroidism frequently persists after lithium is stopped and needs its own ongoing treatment. Check TSH before starting lithium, then at 6 months and annually thereafter — and check thyroid peroxidase antibodies at baseline in anyone with a personal or family history of thyroid disease, since a positive antibody result is what predicts who will need levothyroxine indefinitely rather than a temporary bridge.

TFP's Clarification-Confrontation-Interpretation Sequence Isn't Optional Order

In transference-focused psychotherapy, the three-step sequence exists because skipping ahead breaks the intervention. Clarification comes first: the therapist explores what the patient means, checking for confusion, vagueness, or dissociated gaps in the account — not yet challenging anything. Only once the picture is as clear as the patient can make it does confrontation enter: gently pointing to a contradiction or gap between what's being said and what's being enacted, without yet explaining it.

Interpretation — offering a hypothesis about the unconscious meaning behind the contradiction — comes last, and only once confrontation has been tolerated without fragmentation. Interpreting before confronting, or confronting before clarifying, tends to land as an accusation the patient can't use, because the shared factual ground hasn't been established yet.