Stephanie Manasse

Drexel University | DU · Center for Weight, Eating, and Lifestyle Sciences (WELL Center)

Behavioral weight loss (BWL) treatments result in suboptimal weight losses for many individuals. Impulsivity appears to be a maintenance factor of obesity, yet few studies have examined impulsivity as a predictor of outcomes from BWL. We examined specific facets of impulsivity (inhibitory control and delay discounting) as moderators of outcome in B...

Multiple dimensions of impulsivity (e.g., affect-driven impulsivity, impulsive inhibition – both general and food-specific, and impulsive decision-making) are associated with binge eating pathology cross-sectionally, yet the literature on whether impulsivity predicts treatment outcome is limited. The present pilot study explored impulsivity-related...

Poor inhibitory control may contribute to the maintenance of binge eating (BE) among overweight and obese individuals. However, it is unknown whether deficits are general or specific to food (versus other attractive non-food stimuli), or whether observed deficits are attributable to increased depressive symptoms in BE groups. In the current study,...

Objective Deficits in executive function (EF)—including inhibitory control, cognitive flexibility, decision-making, and working memory—may be risk or maintenance factors for binge eating disorder (BED). However, there is mixed evidence regarding EF deficits in individuals with BED. Significant methodological weaknesses (e.g., use of a single EF mea...

Purpose Fear of weight gain may play a central role in maintaining eating disorders (EDs), but research on the role of fear of weight gain during cognitive behavioral therapy (CBT-E) for binge-spectrum EDs is sparse. We examined changes in fear of weight gain during CBT-E for binge-spectrum EDs. We investigated whether fear of weight gain predicted...

Cognitive-behavioral therapy (CBT-E) is the most widely researched and effective treatment for bulimia nervosa (BN). CBT-E for BN emphasizes the importance of therapeutic skills utilization as consistent skill utilization is proposed to drive treatment outcomes. Despite its theoretical importance, there is limited research on skill use during BN tr...

Objective: Individuals with eating disorders (EDs) often engage in maladaptive exercise (e.g., feeling driven, or to "compensate" for eating) which maintains eating pathology. Maladaptive exercise has been theorized to help individuals with EDs regulate emotions by enhancing positive affect (PA) and reducing negative affect (NA) associated with bi...

Objective: Low reward response to conventionally rewarding stimuli and high reward response to food (i.e., reward imbalance), has been supported as a maintenance factor for eating disorders characterized by binge eating. The current study was a pilot randomized controlled trial testing a novel treatment approach for binge eating targeting reward i...

Objective: Despite evidence supporting the link between dietary restraint (i.e., attempts at dietary restriction) and loss of control (LOC) eating among individuals with binge-spectrum eating disorders (EDs), some research suggests that dietary restraint may not be linked to LOC eating in all contexts. It is currently unknown how often dietary res...

Objective: Momentary worsening (i.e., greater than one's average levels) of state body dissatisfaction (BD) has been implicated as a proximal risk factor for eating disorder (ED) behaviors in binge-spectrum EDs. Yet, research exploring the prospective association between noneating activities in daily life (e.g., chores, self-care/coping) and momen...

Recent studies have found increasing rates of overweight and obesity in bulimia nervosa (BN). However, the relationships between body mass index (BMI) and BN symptoms and other clinically relevant constructs are unknown. Participants (N = 152 adults with BN) were assigned to three groups by BMI: group with no overweight or obesity (NOW-BN; BMI <25;...

Background: Obesity prevalence among adolescent girls continues to rise. Acceptance-based therapy (ABT) is effective for weight loss in adults and feasible and acceptable for weight loss among adolescents. This pilot randomized controlled trial (RCT) assessed effectiveness of an adolescent-tailored ABT intervention on decreasing weight-related outc...

Anhedonia is theorized as being relevant to binge eating spectrum disorders (BESDs) by palatable foods substituting the pleasure typically obtained from day-to-day activities. The current study examined whether anhedonia is associated with eating pathology at baseline and whether it predicts cognitive behavioral therapy (CBT) outcomes alone and whe...

Over 70% of men are overweight, and most desire weight loss; however, men are profoundly underrepresented in weight loss programs. Gamification represents a novel approach to engaging men and may enhance efficacy through two means: (1) game-based elements (e.g., streaks, badges, team-based competition) to motivate weight control behaviors and (2) a...

Objectives: Elevated glucose variability may be one mechanism that increases risk for significant psychological and physiological health conditions among individuals with binge-spectrum eating disorders (B-EDs), given the impact of eating disorder (ED) behaviors on blood glucose levels. This study aimed to characterize glucose variability among in...

Purpose Maladaptive exercise (i.e., exercise that is either driven or compensatory) is thought to momentarily down-regulate elevated fear of weight gain (FOWG). However, little research has examined associations between FOWG and exercise, and no research has measured FOWG at a momentary level or considered exercise type (i.e., maladaptive vs. adapt...

Purpose Maladaptive exercise is common among individuals with binge-spectrum eating disorders. One mechanism that may drive engagement in exercise in this population is state body dissatisfaction. However, no studies to date have examined prospective, momentary relationships between state body dissatisfaction and exercise. Methods Adults with bing...

Introduction: Specific characteristics of sleep (e.g., duration, quality, and fatigue) are positively associated with (ED) behaviors, specifically binge eating (BE) potentially through decreased self-regulation and increased appetite. However, prior work has been largely cross-sectional and has not examined temporal relationships between sleep cha...

Inhibitory control, the ability to inhibit one’s automatic responses to desirable stimuli, may be inadequately targeted in interventions for loss-of-control eating. Promising evidence has identified inhibitory control trainings (ICTs) as an avenue to target inhibitory control directly; however, effects of ICTs on real-world behavior are limited. Co...

Purpose The co-morbidity of binge eating and heavy drinking (BE + HD) is a serious concern due to the high prevalence rates and associated elevated severity. Clarifying the momentary factors that increase risk for binge eating and heavy drinking among BE + HD is important for expanding theoretical models of BE + HD and informing treatment recommend...

Cognitive Behavior Therapy (CBT) for bulimia nervosa (BN) requires patient skill utilization (use of treatment skills) and skill acquisition (successful skill use) for symptom improvement. Treatment outcomes are unsatisfactory, possibly due to poor skill acquisition and utilization by post-treatment. Just-in-time adaptive interventions (JITAIs), mo...

Behavioral treatments for psychological disorders characterized by reward-driven maladaptive behaviors (e.g., substance use disorder, eating disorders, behavioral addictions) primarily seek to reduce hyper-reward response to disorder-specific stimuli. Suboptimal outcomes for these treatments highlight the need to also target hypo-reward response to...

Objective Prior work evaluating cognitive flexibility (i.e., the ability to alter behavior in response to environmental changes) in bulimia-spectrum eating disorders (BN-ED) has produced mixed findings, perhaps due to reliance on set-shifting paradigms that do not effectively isolate cognitive flexibility. Task-switching paradigms are more precise,...

Purpose – The co-morbidity of binge eating and heavy drinking (BE+HD) is a serious concern due to the high prevalence rates and associated elevated severity. Clarifying the momentary factors that increase risk for binge eating and heavy drinking among BE+HD is important for expanding theoretical models of BE+HD and informing treatment recommendatio...

Objective: Loss-of-control (LOC) eating is associated with eating disorders and obesity, and thus it is imperative to understand its momentary risk factors in order to improve intervention efforts. Negative affect has been proposed as a momentary risk factor for LOC eating, but the evidence for its effects in children and adolescents is mixed. Sho...

BACKGROUND Dietary restraint is a key factor that maintains engagement in binge eating among individuals with binge eating disorder (BED) and bulimia nervosa (BN). Reducing dietary restraint is a key mechanism of change in cognitive-behavioral therapy (CBT) for BN and BED. However, many individuals who undergo CBT fail to adequately reduce dietary...

Background Dietary restraint is a key factor for maintaining engagement in binge eating among individuals with binge eating disorder (BED) and bulimia nervosa (BN). Reducing dietary restraint is a mechanism of change in cognitive behavioral therapy (CBT) for individuals with BN and BED. However, many individuals who undergo CBT fail to adequately r...

Objective: Emotion regulation (ER) deficits are associated with illness severity in individuals with bulimia nervosa. We examined whether baseline ER abilities are associated with remission following enhanced cognitive behavioural therapy for eating disorders (CBT-E). Method: Participants (N = 50, 85.0% female) receiving CBT-E completed a measur...

Objective: Fear of weight gain (FOWG) is increasingly implicated in the maintenance of binge-spectrum eating disorders (EDs; e.g., bulimia nervosa [BN], binge-eating disorder [BED]) through the pathway of increased dietary restriction. However, particularly in binge-spectrum EDs, research is nascent and based on retrospective self-report. To impro...

PurposeLoss of control eating (LOCE) is supported as a maladaptive regulation strategy for high negative affect (NA) and low positive affect (PA). Yet, little is known about the day-to-day activities outside of eating that may precipitate such changes in affect and impact risk for LOCE. The current ecological momentary assessment study sought to ex...

Objective: Binge planning (BP; i.e., preparatory thoughts and actions to facilitate future binge-eating episodes) is hypothesized to distract individuals from negative affect and increase the salience of food. Thus, individuals who engage in BP may report greater positive eating expectancies (i.e., beliefs about the outcomes of eating) and hedonic...

Background Mindful awareness, willingness and values clarity have been examined as protective factors across a wide range of problems, including overweight/obesity. However, these variables have almost exclusively been examined at the trait-level. It is possible that these variables also fluctuate within individuals in daily life, and that these in...

Objective The Food Craving Acceptance and Action Questionnaire (FAAQ) was developed to measure psychological flexibility around food-related internal experiences (e.g., thoughts, feelings, and urges) and has two subscales, acceptance and willingness. However, the FAAQ factor structure has not yet been systematically validated with a clinically rele...

Behavioral weight loss treatment (BT) for individuals with overweight and obesity is effective but leaves room for improvement. Mindfulness and acceptance-based treatments may bolster weight loss outcomes; yet, little is known about the efficacy of the individual components or the combinations of components that are most effective in producing weig...

Although 40–60% of individuals with eating disorders (EDs) report engaging in maladaptive exercise, self-reported reasons for engaging in exercise vary. Further, no studies have examined momentary reasons for exercise and whether reasons for exercising could be both adaptive and maladaptive for any episode. Examining reasons for exercise can inform...

[This corrects the article DOI: 10.2196/18261.].

UNSTRUCTURED Dear Dr. Eysenbach, In “A Clinician-Controlled Just-in-time Adaptive Intervention System (CBT+) Designed to Promote Acquisition and Utilization of Cognitive Behavioral Therapy Skills in Bulimia Nervosa: Development and Preliminary Evaluation Study” (JMIR Form Res 2021;5(5):e18261), an accidental error was made in the authorship order....

Binge eating (BE) often develops during adolescence and is associated with deleterious psychological and physical consequences. Current treatments for adolescents achieve suboptimal results, likely due to failure to adequately address fear of weight gain (FOWG) which maintains BE. Thus, exposure treatment (the most powerful intervention for fear) m...

Emotional eating (EE) has been proposed as a key weight loss barrier. However, most investigations of EE rely on retrospective self-reports, which may have poor construct validity. This study evaluated concordance between a common self-report EE measure and a novel method for assessing momentary EE using ecological momentary assessment (EMA). We fu...

Reduced exposure to social reward during the COVID‐19 pandemic may result in both reduced reward response to day‐to‐day life activities and elevated reward response to substances or naturally rewarding stimuli (e.g., food). The combined hypo‐ and hyper‐reward responses results in a reward imbalance, which has been noted as a relevant maintenance fa...

Objective Existing screening tools are inadequate in differentiating binge eating from normative overeating in treatment‐seeking individuals with overweight or obesity, as these individuals tend to overendorse loss‐of‐control (LOC; the hallmark characteristic of binge eating) on self‐report measures. In order for treatment centers to efficiently an...

Objective Although existing research supports the efficacy of mindfulness- and acceptance-based treatments (MABTs) for eating disorders (EDs), few studies have directly compared outcomes from MABTs to standard CBT. Method Participants (N = 44), treatment-seeking adults with bulimia-spectrum EDs, were screened for eligibility, consented, and random...

Objective Lesbian, Gay, and Bisexual (LGB) individuals generally experience eating disorders at higher rates than heterosexual individuals. While there is limited research examining why LGB individuals experience higher levels of eating pathology, emotion regulation (ER) deficits have been associated with higher rates of other forms of psychopathol...

Objective One reason for limited efficacy of treatments for binge eating disorder (BED) and bulimia nervosa (BN) is a failure to directly target deficits in inhibitory control (i.e., the ability to withhold a pre-potent response). Inhibitory control trainings (ICTs; computerized tasks meant to improve inhibitory control) have shown promise but appe...

There is ample evidence linking broad trait emotion regulation deficits and negative affect with loss-of-control (LOC)-eating among individuals with obesity and binge eating, however, few studies have examined emotion regulation at the state-level. Within and across day fluctuations in the ability to modulate emotion (or regulate emotional and beha...

PurposeEcological momentary assessment (EMA) studies preliminarily support the transactional model of emotion regulation in eating disorders, such that heightened stress appraisal (i.e., the cognitive evaluation of an event’s demands) results in increased negative affect (NA) and subsequent binge eating (BE). However, the temporal relationships bet...

Outcomes from cognitive behavioral therapy for binge‐eating spectrum disorders are suboptimal, possibly due in part to deficits in self‐regulation (i.e., the ability to control behavior in pursuit of long‐term goals despite internal challenges). Mindfulness and acceptance‐based treatments (MABTs) integrate behavioral treatment with psychological st...

Caregivers and healthcare professionals (HPs) are increasingly concerned about childhood obesity. A critical consideration of caregivers and HPs is discussing weight status without provoking disordered eating. Given the complexity of these interacting concerns, major health advocacy groups have independently published guidelines for having conversa...

A major contributor to the obesity epidemic is the overconsumption of high-calorie foods, which is partly governed by inhibitory control, that is, the ability to override pre-prepotent impulses and drives. Computerized inhibitory control trainings (ICTs) have demonstrated qualified success at affecting real-world health behaviors, and at improving...

Purpose: Obese, behavioral weight-loss (BWL) seeking individuals may be prone to over-reporting binge-eating (BE). However, many studies rely on self-reported measures of BE in this population, which may be inaccurate. As such, this is the first-ever study to examine the concordance rates among one self-reported and one clinician- administered mea...

Objective: Examine COVID-19 impact on current research participants' mental health outcomes, ability to adhere to behavioral intervention recommendations, and desire to participate in research. Methods: Quantitative/qualitative cross-sectional survey among adults currently enrolled in health-related research (n=250; 85% women; >50% currently enr...

Maladaptive avoidance/intolerance of negative emotional states has been widely shown to contribute to negative outcomes. Growing interest in this construct has led to the use of multiple terms (e.g., emotion dysregulation, distress intolerance, experiential avoidance, anxiety sensitivity, negative urgency) to describe such individual differences, e...

Outcomes from cognitive behavioral therapy (CBT) for bulimia nervosa (BN) and binge‐eating disorder (BED) are suboptimal. One potential explanation is that CBT fails to adequately target inhibitory control (i.e., the ability to withhold an automatic response), which is a key maintenance factor for binge eating. Computerized inhibitory control train...

BACKGROUND Cognitive behavioral therapy (CBT) for bulimia nervosa (BN) is most effective when patients demonstrate adequate skill utilization (i.e., the frequency with which a patient practices or uses therapeutic skills) and skill acquisition (i.e., the ability to successfully perform a skill learned in treatment). However, rates of utilization an...

Background Cognitive behavioral therapy (CBT) for bulimia nervosa (BN) is most effective when patients demonstrate adequate skill utilization (ie, the frequency with which a patient practices or uses therapeutic skills) and skill acquisition (ie, the ability to successfully perform a skill learned in treatment). However, rates of utilization and ac...

Emotion-focused treatments are generally efficacious for improving emotion regulation and consequently, improving clinical symptoms across numerous disorders. However, emotion-focused treatment approaches often contain numerous treatment components, limiting our ability to identify which are most efficacious. As such, the current pilot study sought...

Objective: Dietary lapses drive weight loss failure, and specific factors influence risk of lapse. Physical activity (PA) may be one such risk factor, though whether PA increases or decreases appetite, and thus risk of lapse, is unclear. In fact, most studies examining the relation between PA and energy intake are limited by use of laboratory-base...

The present manuscript describes the multiphase optimization strategy (MOST) and its potential applications to treatments for eating disorders (EDs). The manuscript describes the three phases of MOST, discusses a hypothetical case example of how MOST could be applied to developing a disseminable ED treatment, and reviews the pros and cons of the MO...

Nearly 70% of Americans are overweight, in large part because of overconsumption of high-calorie foods such as sweets. Reducing sweets is difficult because powerful drives toward reward overwhelm inhibitory control (i.e., the ability to withhold a prepotent response) capacities. Computerized inhibitory control trainings (ICTs) have shown positive o...

Eating disorders (EDs) are associated with significant psychological and physical comorbidities, and adolescence is a particularly high-risk time for the development of EDs. Impulsivity (i.e., acting with little conscious judgment or forethought) and affect reactivity (i.e., changes in negative affect in response to a stressor) are hypothesized to...

Objective Although binge eating is associated with impulsivity, clinical reports suggest that some individuals with bulimia nervosa (BN) and binge eating disorder (BED) plan binge episodes in advance. This study is the first to examine: (1) the frequency of binge planning (BP; defined as both advanced knowledge that a binge episode will occur and t...

The study explored whether baseline individual differences in executive function (EF) affect the relation between elevations in internal states and subsequent likelihood of lapsing from a dietary prescription. Participants were 189 adults with overweight/obesity in a behavioral weight loss treatment who completed a neuropsychological EF task at int...

Behavioral weight loss (WL) trials show that, on average, participants regain lost weight unless provided long-term, intensive—and thus costly—intervention. Optimization solutions have shown mixed success. The artificial intelligence principle of “reinforcement learning” (RL) offers a new and more sophisticated form of optimization in which the int...

Objective Increasing evidence suggests that mindfulness‐ and acceptance‐based psychotherapies (MABTs) for bulimia nervosa (BN) and binge eating disorder (BED) may be efficacious; however, little is known about their active treatment components or for whom they may be most effective. Methods We systematically identified clinical trials testing MABT...

Introduction Many individuals engaged in behavioral weight loss make suboptimal increases in moderate-to-vigorous physical activity (MVPA). Theoretically, reductions in negative affect could reinforce MVPA. However, little work has been done investigating the association between facets of negative affect (e.g., average levels of negative affect, va...

Objective In the Mind Your Health Trial, acceptance‐based behavioral treatment (ABT) for obesity outperformed standard behavioral treatment (SBT) at posttreatment. This trial compared effects over 2 years of follow‐up. Methods Participants with overweight or obesity (n = 190) were randomized to 25 sessions of SBT or ABT over 1 year and assessed at...

Background Executive functioning, which is fundamental for carrying out goal-directed behaviors, may be an underappreciated predictor of outcomes in lifestyle modification programs for adults with obesity. Purpose This study tested the hypotheses that higher levels of baseline executive functioning would predict greater weight loss and physical ac...

Autonomic nervous system functioning, measured with heart rate variability (HRV), is associated with emotion regulation and likely contributes to binge eating. This study examined the link between HRV and binge eating severity and analyzed changes in HRV as a marker of emotion regulation in individuals with binge eating. Participants (n = 28) with...

Frequency of lapsing from a diet predicts weight loss failure, however previous studies have only utilized one definition of dietary lapse. No study has examined different types of lapse behaviors among individuals with overweight/obesity. The current study uses ecological momentary assessment (EMA) to examine predictors of three lapse types-eating...

Suboptimal outcomes from behavioral weight loss (BWL) treatments are partially attributable to accumulated instances of non-adherence to dietary prescriptions (i.e., dietary lapses). Results identifying negative internal triggers for dietary lapses are inconsistent, potentially due to individual differences that impact how individuals respond to cu...

Given that the overarching goal of weight loss programs is to remain adherent to a dietary prescription, specific moments of nonadherence known as “dietary lapses” can threaten weight control via the excess energy intake they represent and by provoking future lapses. Just-in-time adaptive interventions could be particularly useful in preventing die...

Objective: Individuals with overweight/obesity and loss-of-control eating (LOC) may experience poorer outcomes from behavioural weight loss due to reactivity to internal (e.g., affective and physical) states that impact treatment adherence (e.g., dietary lapses). This study examined (a) whether the presence of LOC increased risk for dietary lapses...

Objective: To examine whether self-attitudes and self-efficacy after dietary lapses relate to lapse frequency or predict risk for lapsing again on the same day. Method: Adults with overweight/obesity (n = 91) completed ecological momentary assessment for 14 days at the start of a lifestyle modification program. At each survey, participants repor...

One potential reason for the suboptimal outcomes of treatments targeting appetitive behavior, such as eating and alcohol consumption, is that they do not target the implicit cognitive processes that may be driving these behaviors. Two groups of related neurocognitive processes that are robustly associated with dysregulated eating and drinking are a...

Background Adherence to dietary prescriptions is critical for successful weight loss and weight loss maintenance. However, research on specific instances of inadherence (lapses) is limited, and findings regarding the frequency, nature, and causes of lapses are mixed. Additionally, no studies have examined lapses over the course of a weight loss pro...

While existing treatments produce remission in a relatively large percentage of individuals with binge eating disorder (BED), room for improvement remains. Interventions designed to increase emotion regulation skills and clarify one's chosen values may be well-suited to address factors known to maintain BED. The current study examined the prelimina...

Purpose: Lapses are strong indicators of later relapse among individuals with addictive disorders, and thus are an important intervention target. However, lapse behavior has proven resistant to change due to the complex interplay of lapse triggers that are present in everyday life. It could be possible to prevent lapses before they occur by using...

Obesity is a significant public health issue, and is associated with poor diet. Evidence suggests that eating behavior is related to individual differences in executive functioning. Poor executive functioning is associated with poorer diet (few fruits and vegetables and high saturated fat) in normal weight samples; however, the relationship between...