Mapping the Path to Cognitive Balance: Applying the States of Mind Model and Network Analysis to Eating Disorder Patients

Background: In eating disorders (EDs), cognitive-behavioral therapy (CBT) represents one of the first-line treatment options albeit with sub-optimal results. The assessment of cognitive balance through an index measuring increased adaptive thinking and reduced maladaptive thinking, the desired outcomes, and the ultimate goal of CBT treatments warrants attention. The states of mind model (SOM) provides a framework through which a cognitive balance index can be defined. The current cross-sectional controlled study tested the clinical utility of the SOM model in a sample of ED outpatients. Methods: ED outpatients (n = 199) were assessed at baseline with the attitudes and beliefs scale-2 (ABS-2) for rational beliefs (RBs) and irrational beliefs (IBs), from which a SOM ratio score index (RBs/(RBs + IBs)) was calculated, the eating disorder inventory-3 (EDI-3) for ED symptoms and ED-related psychopathological features, the psychological well-being scales (PWB) for positive psychological functioning. A matched control sample (n = 95) was also assessed with the ABS-2. Results: ED patients exhibited significantly lower SOM and RB scores compared to controls. Network analysis results highlighted the centrality of the SOM-cognitive balance index, PWB-self-acceptance, and EDI-3-general psychological maladjustment, as well as the importance of the influence that cognitive balance and general psychological maladjustment exert on each other. Conclusions: The findings support the clinical utility of the SOM ratio applied to cognitions in EDs. This demonstrates its ability to differentiate such patients from controls and in capturing worse ED-related general psychopathology as well as compromised aspects of psychological well-being, in particular self-acceptance and environmental mastery. It thus might be considered in CBT treatment of EDs a potential cognitive clinimetric and clinical index of ED severity indicating key difficulties in counteracting maladaptive thinking with adaptive thinking.