Article

Mindfulness and its relationship with eating disorders symptomatology in women receiving residential treatment

January 2013
Eating Behaviors 14(1):13-6

DOI:10.1016/j.eatbeh.2012.10.005

Source
PubMed

Authors:

Meghan Butryn

Drexel University

Adrienne S Juarascio

Drexel University

Jena Shaw Tronieri

University of Pennsylvania

Stephanie G. Kerrigan

Drexel University

Show all 7 authorsHide

Yoga Practice in a College Sample: Associated Changes in Eating Disorder, Body Image, and Related Factors Over Time

Article

Full-text available

Dec 2019

Yoga practice is associated with improvements in eating disorder (ED) symptoms and body dissatisfaction. This study continued to evaluate this relationship while also assessing changes in variables negatively associated with ED symptoms (self-compassion, mindfulness, body appreciation, self-efficacy) that are emphasized throughout yoga. Men were also included in this study given studies have predominantly focused on women. Participants (N = 99, 77.8% women) were recruited from a university-implemented yoga course and completed assessments at the beginning (Time 1 (T1)) and end (Time 2 (T2)) of an eight-week yoga course meeting three times a week for fifty minutes. Body dissatisfaction (ps <.05) and ED pathology (p = .02) were lower at T2. Body appreciation (p < .001), self-compassion (p = .01), yoga self-efficacy (p = .004) were higher at T2. Some gender differences emerged. Men reported greater reductions in concern with being overweight, (Overweight Preoccupation) from T1 (M = 2.46, SD = 0.61) to T2 (M = 2.13, SD = 0.61) compared to women, T1 (M = 2.75, SD = 0.98) to T2 (M = 2.69, SD = 0.97) associated with yoga practice. Men also reported greater improvements in body satisfaction (Appearance Evaluation) from T1 (M = 3.60, SD = 0.49) to T2 (M = 3.90, SD = 0.34) compared with women, T1 (M = 3.48, SD = 0.58) to T2 (M = 3.39, SD = 0.52) associated with yoga practice. Results suggest yoga may be associated with concurrent changes in protective and risk factors for ED in a college population.

Less Binge Eating and Loss of Control over Eating Are Associated with Greater Levels of Mindfulness: Identifying Patterns in Postmenopausal Women with Obesity

Article

Full-text available

Apr 2019

Obesity is a public health concern resulting in widespread personal, social, and economic burden. Many individuals with obesity report feeling unable to stop eating or to control their food intake (i.e., a loss of control over eating) despite their best efforts. Experiencing loss of control over eating predicts further eating pathology and is a key feature of binge eating. Mindfulness (i.e., awareness and acceptance of current thoughts, feelings, sensations, and surrounding events) has emerged as a potential strategy to treat such eating disorder behaviors, but it is not known whether there is merit in investigating this strategy to address binge eating in postmenopausal women with obesity. Thus, this study aimed to examine the relationships between binge eating and mindfulness in postmenopausal women with obesity seeking weight loss treatment. Participants (n = 101) were assessed with the Eating Disorder Examination Questionnaire, the Loss of Control over Eating Scale, the Five-Facet Mindfulness Questionnaire, and the Langer Mindfulness Scale. Participants´ overall scores on both mindfulness scales were significantly and negatively correlated with binge eating frequency or the severity of loss of control over eating. Moreover, participants who reported fewer binge eating episodes were significantly more mindful than those who reported greater frequencies of binge eating episodes within the past 28 days. These findings suggest a merit in investigating the use of mindfulness-based therapies to treat binge eating in postmenopausal women with obesity.

Anorexia Nervosa: Pathophysiology, Treatment, and Genetic Considerations

Article

Full-text available

Dec 2018

A longitudinal study on the association between facets of mindfulness and eating disorder symptoms in individuals diagnosed with eating disorders

Article

Full-text available

Nov 2018

Mindfulness‐based treatments for eating disorders could be improved by understanding how facets of mindfulness predict eating disorder symptoms over time. We examined whether facets of mindfulness predict eating disorder symptoms over time and vice versa. Individuals with an eating disorder diagnosis (N = 124; 87.9% diagnosed with anorexia nervosa) and an undergraduate sample (N = 290) completed measures of mindfulness at baseline. The clinical sample also completed these measures 1 month later. Individuals in the clinical sample had lower acting with awareness and higher observing than individuals in the undergraduate sample (ps < 0.002). In the clinical sample, higher body dissatisfaction prospectively predicted lower acting with awareness (p = 0.02). Lower acting with awareness prospectively predicted higher drive for thinness (p < 0.01) and bulimic symptoms (p < 0.01). Acting with awareness shows potential as a process that can be altered to effect positive outcomes on drive for thinness and bulimic symptoms.

Body Image Flexibility

Chapter

Mar 2019

As part of a growing movement to emphasize the positive aspects of body image, an increasing amount of research has been devoted to the study of body image flexibility. By definition, this process-oriented construct encompasses the ability to embrace a present-moment experience of potentially distressing emotions and cognitions related to the body, particularly when doing so allows for pursuit of life values. This chapter briefly reviews the relevant literature pertaining to body image flexibility, including its conceptual roots, measurement, correlates, role in moderation and mediation analyses, and related intervention research. Despite limitations, the extant literature base suggests that this construct is both a unique and an important concept to consider; moreover, it holds promise for informing future efforts to better understand and improve this type of adaptive response to the body. Future directions for research, such as the development of more process-oriented assessment and examination utilizing experimental methods, are highlighted.

Validation of the Chinese Version of the Body Image Acceptance and Action Questionnaire and the Mediating Role of Body Image Flexibility in the Relationship Between Body Dissatisfaction and Psychological Distress

Article

Jul 2020
BEHAV THER

The psychometric properties of the Chinese version of the Body Image Acceptance and Action Questionnaire (C-BI-AAQ) and its short form (C-BI-AAQ-5) were examined with a sample of Chinese undergraduates (n = 1068, 52.6% female). The factor structure, measurement reliability, measurement invariance across gender, and latent gender mean difference of the two scales were explored. Confirmatory factor analysis was used to examine the factor structure of the C-BI-AAQ and the C-BI-AAQ-5. The original one-factor structure was replicated for both the C-BI-AAQ and the C-BI-AAQ-5. Both the C-BI-AAQ and C-BI-AAQ-5 showed good internal consistency, test–retest reliability, and convergent and discriminant validity (e.g., relationship patterns in the expected directions with theoretically similar psychological flexibility, and with theoretically dissimilar body dissatisfaction, and psychological distress). The C-BI-AAQ-5 was shown to be equivalent to the C-BI-AAQ. Furthermore, strict measurement invariance across gender was confirmed for both the C-BI-AAQ and C-BI-AAQ-5, and latent mean difference tests showed that men had higher levels of body image flexibility than women. Thus, both the C-BI-AAQ and C-BI-AAQ-5 appear to be psychometrically sound instruments for use in the Chinese young adult population. In addition, body image flexibility measured by both the C-BI-AAQ and the C-BI-AAQ-5 fully mediated the relationship between body dissatisfaction and psychological distress.

Validation of the 12-item Short Form of the Eating Disorder Examination Questionnaire in the Chinese context: confirmatory factor analysis and Rasch analysis

Article

Full-text available

Feb 2021
EAT WEIGHT DISORD-ST

Purpose As a 12-item Short Form of the Eating Disorder Examination Questionnaire (EDE-QS), the EDE-QS was developed based on Rasch modeling to address certain weaknesses of the EDE-Q, and it has been demonstrated to be a psychometrically sound measure. Thus, the current study aimed to obtain a Chinese version of the EDE-QS and validate its psychometric properties in the Chinese context. Methods According to standard procedures, the Chinese version of the EDE-QS (C-EDE-QS) was obtained. A total of 1068 Chinese college students finished the survey. The psychometric properties of the C-EDE-QS were examined under the frameworks of both classic test theory and Rasch modeling. Results The one-factor structure of the C-EDE-QS was confirmed in confirmatory factor analysis; the C-EDE-QS showed good reliability with a Cronbach’s α of 0.89; and the total scores of the C-EDE-QS were significantly correlated with eating disturbances and psychological distress in expected magnitudes and directions. Rasch analysis supported the unidimensional construct of the C-EDE-QS and the four-point rating scale structure. However, results revealed differential item functioning (DIF) across gender groups. Conclusions The findings suggest that the C-EDE-QS could be a useful tool to assess key attitudes and behavioral features of eating disorder psychopathologies in the Chinese context. Level of evidence V, descriptive (cross-sectional) study.

Mindfulness in persons with anorexia nervosa and the relationships between eating disorder symptomology, anxiety and pain

Article

Dec 2019

Mindfulness is useful for some psychiatric illnesses, but limited research exists among persons with anorexia nervosa (AN). This study aimed to determine the relationship between mindfulness, eating disorder symptomology and indicators of health in women with AN (n = 59) entering residential treatment. Participants completed a self-administered survey, including the Cognitive Affective Mindfulness Scale and other measures. Additional data from medical records were collected. Greater mindfulness was associated with less eating disorder symptoms (p = .049). This relationship was most profound in individuals with AN, including restrictive and binge-purge subtypes compared to individuals with atypical AN (interaction p-value = 0.044). Greater mindfulness was significantly associated with less shape (p = .023) and weight concern (p = .047). Expectedly, anxiety was inversely associated with eating disorder symptoms (p = .001). Greater pain was associated with less eating disorder symptoms (p = .024). Overall, mindfulness may be a protective factor against some eating disorder symptomology.

Eating Disorder Treatment: a Systematic Review and Meta-analysis of the Efficacy of Mindfulness-Based Programs

Article

Full-text available

Nov 2019
Mindfulness

Objectives This systematic review and meta-analysis sought to evaluate the efficacy of mindfulness-based programs (MBPs) on eating disorder (ED) symptoms and related outcomes such as BMI, body dissatisfaction, emotion regulation, and negative affect. It also examined moderators that predicted larger intervention effects. Methods A search for studies evaluating such MBPs on participants with EDs was conducted in several online databases. In total, 23 articles were included in the systematic review and 22 in the meta-analysis (10 randomized controlled trials). Results Results showed a within-condition effect of MBPs on ED symptoms, emotional eating, negative affect, and body dissatisfaction, and on BMI in anorectic and bulimic participants relative to pre-assessment. A significant within-condition effect sizes ranged from d = .62 (negative affect) to d = 1.05 (ED symptoms). Meta-regression analyses showed that participants with BED and women benefit more of MBPs on mindfulness skills and emotion regulation skills than participants with anorexia nervosa, bulimia, and men. A high risk of bias was correlated with a larger effect of MBPs on mindfulness skills and emotion regulation skills but a smaller effect on restrained eating. Longer treatment was correlated with a larger effect of MBPs on emotion regulation skills. Conclusions Results indicated some positive correlations between MBPs and outcomes but a definitive conclusion cannot be drawn since these results are on within-condition effects and that half of the included studies did not have a control condition. Results identified moderators that may be useful to refine inclusion and exclusion criteria to target those most likely to benefit from MBPs. The field needs more rigorous studies with credible alternative interventions to confirm the efficacy of MBPs for ED patients.

Trait body image flexibility as a predictor of body image states in everyday life of young Australian women

Article

Sep 2019
BODY IMAGE

The present study evaluated whether individuals with varying levels of trait body image flexibility differ in the severity, variability, and correlates of state body dissatisfaction experienced in their daily lives. One hundred and forty-seven women completed a baseline measure of trait body image flexibility, followed by a 7-day ecological momentary assessment phase in which participants self-reported state body dissatisfaction, disordered eating behavior, drive for thinness, and appearance comparisons at 10 semi-random intervals daily. Higher trait body image flexibility predicted lower average scores, less frequent reporting of high state body dissatisfaction, and less variability in their state body dissatisfaction ratings. Individuals with higher trait body image flexibility were also less likely to engage in a range of behaviors and cognitions previously shown to produce body dissatisfaction, including upward appearance comparisons , drive for thinness, binge eating, and dieting. However, few of these state-based relationships involving body dissatisfaction and these related behaviors and cognitions were moderated by trait body image flexibility. Overall, this pattern of findings suggests that body image flexible individuals may have less negative body image because they are less inclined to engage in behaviors and cognitions in their daily lives that encourage negative body image.

Testing the Measurement Invariance of the Body Image Acceptance and Action Questionnaire Between Women With and Without Binge-Eating Disorder Symptomatology: Further Evidence for an Abbreviated Five-Item Version

Article

Full-text available

Jul 2019

The Body Image Acceptance and Action Questionnaire (BI-AAQ), a measure designed to assess body image flexibility, was originally developed for and psychometrically investigated with nonclinical populations, but it has been recently administered to people with binge-eating disorder (BED) symptomatology. Tests of measurement invariance are needed to understand whether the BI-AAQ operates in the same way for BED and non-BED populations, thereby ensuring meaningful comparison across these groups. We thus tested the measurement invariance of the BI-AAQ in participants with and without clinically significant BED symptomatology. Data were analyzed from 358 community-based participants. Participants were either classified as with (n = 179) or without (n = 179) "probable BED" based on self-reported symptom frequency. An unacceptable model fit was found across both groups, indicating that the unidimensional structure of the BI-AAQ was not replicated. We then sought to confirm the unidimensional structure of a recently proposed five-item version of the BI-AAQ. A unidimensional structure of this abbreviated version was replicated, and tests of measurement variance were upheld. Internal consistency, convergent validity, and incremental validity were documented for both the original and abbreviated BI-AAQ across individuals with and without BED symptomatology. Present findings provide further psychometric support for an abbreviated five-item BI-AAQ, although it is important for future research to replicate both the full and abbreviated BI-AAQ in more diverse samples. Overall, an abbreviated BI-AAQ may be an attractive alternative for researchers studying body image flexibility. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Mediators linking insecure attachment to eating symptoms: A systematic review and meta-analysis

Article

Full-text available

Mar 2019
PLOS ONE

In the last two decades, the number of studies focused on the mediators connecting insecure attachment with Eating Disorders (EDs), at both clinical and sub-clinical level, has considerably increased. However, there has not been a systematic synthesis of this literature to date. To fill this gap, the current meta-analytic review aimed at identifying and quantifying the extent to which mediators contribute to the explanation of this relationship. The present study was registered with PROSPERO (CRD42017076807). A comprehensive search process in seven different electronic databases retrieved 24 studies that examined how insecure attachment leads to ED symptoms through mediation analysis. Standardized regression coefficients of the indirect and total paths of 21 mediation models were pooled. Studies were coded and ranked for quality. We found evidence to show that maladaptive emotion regulation and depressive symptoms had the highest effect size for mediation (mediation ratio [PM] = 0.71). Further, body dissatisfaction, neuroticism, perfectionism, mindfulness and social comparison had significant, but moderate to low mediating effects (PM = 0.21–0.58). The methodological quality of these studies was mostly low to moderate and potential areas for development were highlighted. Our findings support the direct targeting of these psychological constructs in prevention programs and treatment of EDs. Future investigations addressing the time sequence between the variables will provide valuable clues to untangle the prospective contribution of each variable on the development and maintenance of eating pathology.

Predictors of outcome in cognitive behavioural therapy for eating disorders: An exploratory study

Article

Feb 2019
BEHAV RES THER

Objective: Early decrease in symptoms is a consistent predictor of good treatment outcome across all eating disorders. The current study explored the predictive value of novel early change variables in a transdiagnostic, non-underweight sample receiving 10-session cognitive behavioural therapy. Method: Participants who reported bingeing and/or purging in the week preceding baseline assessment (N = 62) were included in analyses. Early change variables were calculated for novel (body image flexibility, body image avoidance, body checking, and fear of compassion) and established predictors (behavioural symptoms and therapeutic alliance). Outcomes were global eating disorder psychopathology and clinical impairment at posttreatment and three-month follow-up. Intent-to-treat analyses were conducted using linear regression, adjusting for baseline values of the relevant outcome and early change in behavioural symptoms. Results: Early improvement in body image flexibility was the most consistent predictor of good outcome. Early change in body image avoidance and the fear of expressing and receiving compassion to/from others were significant predictors in some analyses. Discussion: Novel early change variables were significant predictors of eating disorder outcomes in this exploratory study. Model testing is required to understand the exact mechanisms by which these variables impact on outcomes, and whether there is potential benefit of modifying existing protocols. Anzctr trial number: ACTRN12615001098527.

Recommendations for a culturally-responsive mindfulness-based intervention for African Americans

Article

Nov 2018
Compl Ther Clin Pract

Background: African Americans are at increased risk for stress-related disparities. Mindfulness-based interventions are effective in reducing adverse outcomes; yet, racial/ethnic minorities are underrepresented in these interventions. Also, the development of culturally-responsive interventions has been mostly non-existent. Materials and methods: Focus group and interview data were acquired following a four-week mindfulness intervention with African American women. Results: Using Brigg's (2011) mental health utilization model to guide analysis, several recommended culturally-responsive modifications emerged. Recommended modifications internal to the intervention included using African American facilitators, incorporating cultural values, using culturally-familiar terminology, and providing cultural resources. Suggested modifications to the intervention's external factors included offering the intervention within culturally-familiar settings. Individual-level factors to address were religious concerns, perceived benefits, and holistic health goals. Conclusions: Themes were used to propose a model toward the creation of a culturally-responsive mindfulness-based interventions to guide culturally-relevant treatment modifications and improve underserved communities' engagement in these interventions.

Body image flexibility: A predictor and moderator of outcome in transdiagnostic outpatient eating disorder treatment

Article

Jan 2018

Objective: Predictors of attrition and predictors and moderators of outcome were explored in a transdiagnostic sample of patients who received ten-session cognitive behavioral therapy (CBT-T) for nonunderweight eating disorders. Body image flexibility, a protective positive body image construct, was hypothesized to be a significant moderator. Method: Data from two case series were combined to form a sample of 78 participants who received CBT-T. Baseline measures of body image, negative affect, personality, and motivation (readiness to change and self-efficacy) were included as potential predictors. Global eating disorder psychopathology at each assessment point (baseline, mid- and post-treatment, 1- and 3-month follow-up) was the outcome variable. Predictors of attrition were assessed using logistic regression, and multilevel modeling was applied for predictors and moderators of outcome. Results: Body image flexibility emerged as the strongest predictor and moderator of global eating disorder psychopathology, followed by body image avoidance. Body checking, negative affect, personality beliefs, and self-efficacy were significant predictors of global eating disorder psychopathology. Discussion: Higher body image flexibility predicted lower global eating disorder psychopathology at every assessment point. Further research is required to replicate findings and explore the benefit of focusing on positive body image in treatment.

Experiential Avoidance During Mealtimes Among Individuals With Eating Disorders

Article

Apr 2024
BEHAV THER

Insecure Attachment And Relationship Satisfaction: Testing the Buffering Roles of Mindfulness, Self-Compassion, and Cognitive Defusion

Thesis

Full-text available

Jul 2022

Nureda Taşkesen

This study aims to test a multiple-mediation model which examines mindfulness, relationship mindfulness, self-compassion, and cognitive defusion as possible mediators of the relationship between attachment insecurity and romantic relationship satisfaction. The sample consisted of 521 emerging adults in a romantic relationship for at least one month (70% female, 27% male, and 3% non-binary). Their ages ranged from 19 to 29 years old (M = 22.52, SD = 2.45). In data collection, Relationship Assessment Scale, Experiences in Close Relationships- Revised, Mindful Attention Awareness Scale, Relationship Mindfulness Measure, Self-Compassion Scale Short Form, Drexel Defusion Scale, and demographic information form developed by the researcher were used. To test the proposed model, structural equation modeling was used. Since the proposed model did not fit the data, insignificant paths and cognitive defusion variable were trimmed from the model. The trimmed model revealed a good model fit. Although self-compassion and trait mindfulness did not predict relationship satisfaction significantly, relationship mindfulness acted as a mediator in the relationship between attachment anxiety and relationship satisfaction. Discussions were made on the importance of context-specific relationship mindfulness measure as well as the distinct effects of attachment anxiety and avoidance in romantic relationships. Also, cognitive defusion was evaluated in the context of romantic relationships. Lastly, recommendations for future research and implications of the study were indicated.

Pathways by Which Self-Compassion Improves Positive Body Image: A Qualitative Analysis

Article

Full-text available

Nov 2023

The current study applied consensual qualitative research–modified to essays written by 51 college women completing an expressive writing intervention over three time points for a total of 153 essays to identify how increases in self-compassion improve body image. A qualitative coding team tracked changes in affect and cognition over three time points. The results demonstrated that college women consistently expressed body acceptance and psychological flexibility. Additionally, the participants expressed important increases in mindfulness as well as decreases in social influences, feelings of separation, negative health behaviors, and attention to media messages. Decreases were found in their expressions of body functionality, love and kindness toward their body, and internal locus of control. These findings suggest pathways through which self-compassion may improve women’s body image by increasing mindfulness and decreasing the negative ways of relating to one’s body, specifically in the areas of media, clothing, make-up, and negative social interactions.

Effect of Integrative Psychotherapy on Body Image, Mindful Eating and Satisfaction of Therapy and Therapist in Obese women

Article

Nov 2019

Propriedades Psicométricas da Philadelphia Mindfulness Scale considerando fumadores e não fumadores portugueses

Article

Full-text available

Sep 2021

O mindfulness, enquanto processo psicológico, tem sido alvo de um interesse crescente por parte da investigação científica. O objetivo do presente estudo foi o de examinar a confiabilidade, validade fatorial e medição da invariância (fumadores e não fumadores) de uma versão portuguesa da Philadelphia Mindfulness Scale (PHLMS). Na pesquisa participaram 315 adultos portugueses entre os 18 e os 62 anos (M = 23.14; DP = 7.286), sendo 110 fumadores e 205 não fumadores. A confiabilidade para a dimensão consciência foi de .861 e de .868 para a subescala aceitação. A análise fatorial confirmatória apresentou um modelo ajustado a dois fatores sem necessidade de eliminação de itens. A análise multigrupos suportou a invariância do instrumento entre fumadores e não fumadores. Os resultados evidenciam boas propriedades psicométricas para a utilização da PHLMS no contexto de investigação em amostras de adultos portugueses.

Differences in the use of emotion regulation strategies between anorexia and bulimia nervosa: A systematic review and meta-analysis

Article

Full-text available

Jul 2021
COMPR PSYCHIAT

Objective Research has identified abnormal emotion regulation (ER) as an underlying mechanism in the onset and maintenance of eating disorders. Yet, it still remains unclear whether different forms of ER, adaptive and maladaptive strategies, are similar across categories of eating disorders. Method A systematic review and meta-analysis were carried out to look at ER differences between anorexia nervosa (AN) and bulimia nervosa (BN), two common eating disorder pathologies with different eating patterns. Results 41 studies were included in the meta-analysis. The results revealed no differences in the use of maladaptive ER strategies between individuals with AN and BN, however patients with AN tend to use less adaptive ER strategies as compared to patients with BN. Conclusions Making less use of adaptive strategies in AN might be due to low body weight and high levels of alexithymia which define AN. In order to improve treatment outcome in individuals suffering from AN, these findings suggest to focus more on improving the use of adaptive ER strategies.

Terapias Comportamentais de Terceira Geração: Disseminação a Falantes de Língua Portuguesa, Validade Transcultural e Aplicabilidade no Brasil

Thesis

Full-text available

Nov 2018

Paola Lucena-Santos

Aplicación de la Terapia de Aceptación y Compromiso en pacientes con un Trastorno de la Conducta Alimentaria: un estudio piloto.

Article

Full-text available

Jan 2018

The Association Between Mindfulness Facets and Body Checking in Individuals with High and Low Eating Disorder Pathology

Article

Full-text available

Sep 2020
Mindfulness

Objectives Higher trait mindfulness (i.e., bringing one’s attention to the present moment with an attitude of acceptance and non-judgment) is associated with lower eating disorder (ED) psychopathology. However, it is not yet clear how mindfulness results in lower ED psychopathology. One possibility is that mindfulness may decrease body checking, particularly in individuals who are high in ED psychopathology. The current study tests the relationships between mindfulness facets and body checking, and the extent to which these relationships are moderated by ED psychopathology.Methods College students (N = 805, 76.7% female, mean age = 20.0) completed the Five-Facet Mindfulness Questionnaire, the Body Checking Questionnaire, and the Eating Disorder Examination Questionnaire electronically.ResultsHigher acting with awareness, non-judging, and non-reactivity were uniquely associated with lower body checking, whereas higher observing was uniquely associated with higher body checking. The relation between non-judging and body checking was stronger for individuals who were higher in ED psychopathology.Conclusions All mindfulness facets, except describing, show potential as processes that can be altered to reduce body checking, particularly for individuals higher in ED psychopathology.

Emotion regulation strategies in bulimia nervosa: An experimental investigation of mindfulness, self-compassion, and cognitive restructuring

Article

Full-text available

Jul 2020

Background: While improving emotion regulation (ER) is a central goal in the therapy of bulimia nervosa (BN), there is no experimental evidence on the efficacy of different ER strategies. (1) We hypothesized that mindfulness as well as self-compassion as contextual strategies and cognitive restructuring as classical cognitive behavioral strategy would outperform waiting in improving emotional and eating disorder related outcomes after an unpleasant mood induction. Further, we explored (2) whether contextual strategies outperformed cognitive restructuring and (3) whether comorbid mental disorders and previous treatment for BN influenced the efficacy of contextual ER strategies compared to cognitive restructuring. Methods: Within their first 2 weeks of treatment, inpatients with BN were instructed to utilize mindfulness, self-compassion, and cognitive restructuring or to wait after a pre-induced sadness in a permuted repeated measures design. Patients further rated different emotional and cognitive outcomes on a visual analogue scale at baseline, and before and after each ER strategy. Multiple linear regression analyses were employed to compare (1) the active conditions to waiting, (2) the contextual strategies with cognitive restructuring, and (3) the latter analysis again, but separated according to comorbidity and previous treatment. Results: Forty-eight female inpatients with BN (mean age = 26.44 years, SD = 6.64) completed the study. (1) Contextual ER strategies were more efficacious than waiting for eating disorder symptoms. Cognitive restructuring did not differ from waiting for any outcome. (2) Contextual strategies were more efficacious than cognitive restructuring for emotional outcomes. (3) Self-compassion was more efficacious than cognitive restructuring in patients with comorbid mental disorders and previous treatment in increasing control over the present feeling. Conclusions: Contextual strategies, especially self-compassion, seem more efficacious than waiting and cognitive restructuring in improving short-term ER in patients with BN in an experimental setting.

Mindfulness in the Treatment of Eating Disorders: Theoretical Rationale and Hypothesized Mechanisms of Action

Article

Full-text available

May 2020
Mindfulness

Objectives Eating disorders are associated with significant physical, psychological, and social impairment, but existing treatments are effective only half of the time and relapse rates are high. Mindfulness-based programs (MBPs) are growing in empirical support and present a promising area of research to fill a crucial treatment gap for eating disorders. Several studies on MBPs for eating disorders show promising results, but overall the research on the use of mindfulness in eating disorder treatment is still lacking.Methods The goal of this theoretical paper is to present a rationale for why and how mindfulness may be helpful in the treatment of eating disorders.ResultsSeveral potential mechanisms by which MBPs may produce change in the eating disorder symptoms are presented: reduction in repetitive negative thinking and improvements in self-compassion, decentering, psychological flexibility, emotion regulation, and interoceptive awareness of hunger and fullness cues.Conclusions Research gaps and future directions for the study of mechanisms involved in MBPs for eating disorders are discussed.

Acceptance and commitment therapy for eating disorders: a pilot study with adolescent patients

Article

Full-text available

Jul 2018

La Terapia de Aceptación y Compromiso (ACT) se ha desarrollado como una alternativa conceptual conductista a los modelos cognitivo-conductuales y recientemente, se ha empezado a aplicar a los trastornos de la conducta alimentaria (TCA). El objetivo de este trabajo ha sido desarrollar, aplicar y evaluar un programa de intervención basado en la ACT en un grupo de pacientes con un TCA. Participaron 14 pacientes diagnosticadas de un TCA con una media de edad de 17.93 años (DT= 3.75). Se desarrolló yaplicó un programa de 12 sesiones basado en la ACT. Se evaluó la imagen corporal, calidad de vida, conciencia emocional, ansiedad y depresión, y aceptación, tanto antes como después de la intervención. Los análisis mostraron cambios en la apreciación corporal, calidad de vida así como en la atención plena. Estos resultados sugieren que disminuyeron las conductas evitativas, se redujo la insatisfacción corporal así como mejoró el conocimiento personal. En conclusión, los resultados apoyan la aplicación de la ACT en estas pacientes. Acceptance and Commitment Therapy (ACT) has recently been developed as a conceptual and behavioral alternative to cognitive-behavioral models. The aim of this work has been to develop, apply and assess an intervention program based on CFT in a group of patients with eating disorders. The sample consisted of 14 patients from the Center for Emotional and Food Recovery, CREA. The mean age was 17.93 years (SD = 3.75). Different instruments were applied for the empirical evaluation of the treatment, measures of body image, quality of life, emotional awareness, anxiety and depression, and acceptance related to the psychological flexibility. The results showed changes in body appreciation, quality of life as well as in mindfulness. These results suggested that avoidant behaviors decreased, body dissatisfaction decreased.

The mediating role of mentalizing between attachment and eating disorders

Article

Full-text available

Sep 2018
B MENNINGER CLIN

The objective of the study was to investigate whether mindfulness mediated the relationship between attachment and eating disorders in a sample of 323 female university students and 38 anorexic inpatients using structural equation modeling. All insecure attachment subscales were positively related to eating disorder symptoms and negatively to mindfulness. Furthermore, mindfulness scores were negatively associated with eating disorder symptoms. Mediation analyses showed that the relationship between all the insecure attachment subscales and eating disorders was partially mediated by the mindfulness effects. These results are in line with Bateman and Fonagy's (2004a, 2004b) theory that implies a mediating role of mindfulness used as a proxy for mentalizing between attachment and psychopathology. Further research is needed, however, to replicate these findings.

A systematic review of the roles of body image flexibility as correlate, moderator, mediator, and in intervention science (2011–2018)

Article

Aug 2018
BODY IMAGE

The emergence of body image flexibility into the positive body image nomenclature has innovatively expanded the conceptualization of how individuals may adaptively respond to body image threats. Given the notable growth of interest in researching this construct over nearly the past decade, the present analysis provides a systematic and critical review of evidence examining the roles of body image flexibility as correlate, mediator, moderator, and in intervention research. Results indicated that body image flexibility tended to demonstrate a pattern of relationships with correlates in directions predicted by its conceptualization and showed promise in functioning as both effect modifier and as an explanatory variable in the associations evaluated. Multiple studies demonstrated susceptibility to change following intervention. Although the current state of the literature is bound by notable limitations, the results of this review point to pertinent future steps in advancing the theory and application of body image flexibility scholarship.

BodiMojo: Efficacy of a Mobile-Based Intervention in Improving Body Image and Self-Compassion among Adolescents

Article

Full-text available

Jul 2018
J YOUTH ADOLESCENCE

Mobile interventions promoting positive body image are lacking. This study presents a randomized controlled evaluation of BodiMojo, a mobile application (app) intervention grounded in self-compassion to promote positive body image. A sample of 274 adolescents, mean (SD) age = 18.36 (1.34) years, 74% female, were allocated to a control group or used BodiMojo for 6 weeks. Appearance esteem, body image flexibility, appearance comparison, mood, and self-compassion were assessed at baseline, 6, and 12 weeks. Significant time by group interactions emerged for appearance esteem and self-compassion, with appearance esteem and self-compassion increasing in the intervention relative to the control group. These findings provide preliminary support for BodiMojo, a cost-effective mobile app for positive body image.

Direct experience while eating: Laboratory outcomes among individuals with eating disorders versus healthy controls

Article

Oct 2017

Objective: To compare individuals with eating disorders (EDs) to healthy controls (HCs) to assess for differences in direct engagement in the eating process. Method: Participants (n=58) were asked to eat an orange slice. To assess the degree of direct engagement with the eating process, participants were asked to write down 10 thoughts about the experience of eating the orange slice. Next, the participants were instructed to classify the main focus of each thought as either experiential ("direct experience") or analytical ("thinking about"). A direct experience index (DEI) was computed by dividing the number of times that participants classified an experience as a "direct experience" (the numerator) by the total number of all observations (i.e., direct experience+thinking about). Participants also completed the Five Facet Mindfulness Questionnaire (FFMQ) and the Experiences Questionnaire (EQ) to assess mindfulness facets and decentering, respectively. Results: Compared to controls, participants in the EDs group presented significantly lower levels of direct experience during the eating task (EDs group: mean=43.54, SD=29.64; HCs group: mean=66.17, SD=22.23, p=0.03). Participants in the EDs group also scored significantly lower on other mindfulness-related variables. Discussion: These findings suggest that engagement with the direct experience of eating is lower in individuals with EDs. Future research should investigate the role of mindfulness-based interventions to address direct experience while eating in individuals with EDs.

Explorando a relação entre medidas de imagem corporal e conexão socialExploring the relationship between body image measures and social connectednessExplorando la relación entre las medidas de la imagen corporal y la conexión social

Article

Full-text available

Sep 2024

: O presente estudo examinou os efeitos da flexibilidade da imagem corporal (aceitação de experiências de imagem corporal negativa) e da insatisfação com a imagem corporal na conexão social (CS). A amostra foi composta por 235 estudantes universitários. Um modelo de path analysis robusto revelou que a flexibilidade da imagem corporal predisse CS apenas quando mediada por autocompaixão e depressão, enquanto o sexo (e.g. feminino) teve um efeito direto na conexão social. A insatisfação com a imagem corporal não foi um preditor significativo de CS, mas previu o IMC. Este estudo contém informações relevantes sobre as associações entre imagem corporal e CS, uma vez que os resultados foram obtidos controlando as covariáveis relevantes. Os dados apresentados aqui sugerem que a flexibilidade da imagem corporal está relacionada à CS em mulheres com menos sintomas de depressão ou alta autocompaixão.

دور التعقل والتنظيم الانفعالي في التنبؤ بالكرب النفسي لدى المراهقات ذوات أعراض اضطرابات الأكل

Article

Jul 2023

د رغدة عيد مصطفي أ.د شعبان جاب الله

Prediction of binge-eating disorder based on symptoms of depression, emotion regulation, and psychological flexibility in women with type 2 diabetes

Article

Full-text available

Jun 2022

Introduction: Type 2 diabetes affects more than 90% of diabetic patients, which in addition to physical complications, is associated with psychological problems, such as binge-eating disorder. Diagnosing and treating binge-eating disorder can improve many comorbidities and type 2 diabetes. Therefore, this study aims to predict binge-eating disorder in women with type 2 diabetes based on symptoms of depression, emotion regulation, and psychological flexibility. Methods: The present descriptive-correlational study was conducted on 102 people with type 2 diabetes through the cooperation of centers related to diabetes and using social media in a targeted manner. Research tools included the Gormally et al. (1982) binge-eating, the Beck et al. (1996) depression, the Bond et al. (2011) acceptance and the practice, and Graz and Roemer (2004) difficulty in regulation of emotion questionnaires. The data were analyzed by SPSS software version 22 using Pearson correlation coefficient and multiple regression. Results: The results show that the symptoms of depression, emotion regulation, and psychological flexibility could significantly (p <0.001) predict binge-eating disorder. Among the predictor variables, depression symptoms with a prediction of 33% of the variance of binge-eating disorder, was the best predictor of the disorder in people with type 2 diabetes (p <0.001). Conclusion: It can be concluded that early detection and treatment of depression symptoms in people with type 2 diabetes, can reduce binge-eating disorder in these people.

The Role of Emotion Regulation in Eating Disorders: A Network Meta-Analysis Approach

Article

Full-text available

Feb 2022

Background Previous theoretical models and reviews have documented a strong connection between emotion dysregulation eating disorder (ED) psychopathology among the general and clinical populations. The aim of this review was to build on this previous work by conducting a network meta-analysis to explore associations between adaptive and maladaptive emotion regulation strategies and ED psychopathology trans-diagnostically across the ED spectrum to identify areas of emotion dysregulation that have the strongest association with symptomatology. Methodology A total of 104 studies were included in the meta-analysis and correlation coefficient representing the associations between specific emotion regulation strategies and ED symptomatology were extracted. We ran a Bayesian random effects network meta-analysis and the initial network was well-connected with each emotion regulation strategy being linked to at least one other strategy. We also conducted a network meta-regression to explore whether between-study differences in body mass index (BMI), age, and whether the sample consisted of solely female participants explained any possible network inconsistency. Results The network meta-analysis revealed that ruminations and non-acceptance of emotions were most closely associated with ED psychopathology. There was no significant network inconsistency but two comparisons approached significance and thus meta-regressions were conducted. The meta-regressions revealed a significant effect of BMI such that the associations between different emotion regulation strategies and ED symptomatology were weaker among those with low BMI. Discussion The present findings build on previous work and highlight the role of rumination and difficulties with accepting emotions as key emotion regulation difficulties in EDs. Additionally, the finding that the associations were weaker among ED patients with low BMI may point toward a complex relationship between ED behaviors and emotion regulation. Taken together, our findings call for interventions that target emotion regulation, specifically rumination and difficulties accepting emotions, in the treatment of EDs. Systematic Review Registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021249996, PROSPERO, identifier: CRD42021249996.

Mindfulness and Eating Disorders: A Network Analysis

Article

Aug 2021
BEHAV THER

Higher trait mindfulness may be protective against eating disorder (ED) pathology. However, little is understood about which specific mindfulness processes connect to specific ED symptoms. This study (N = 1,056 undergraduates) used network analysis at the symptom/process level to identify: (1) central nodes, or symptoms/processes with the greatest collective connection with all other symptoms/processes; and (2) bridge nodes, or symptoms/processes driving interconnection between mindfulness processes and ED symptoms. We conducted analyses both with and without food- and body-related mindfulness items. Central nodes included: describing how one feels in detail, expressing how one feels in words, and feeling guilty about eating due to shape/weight. Bridge nodes connecting higher mindfulness processes with lower ED symptoms included: the eating disorder symptom, being uncomfortable about others seeing one eat, and the mindfulness process, not criticizing oneself for having irrational/inappropriate emotions. Bridge nodes connecting higher mindfulness processes with higher ED symptoms included: noticing sensations of the body moving when walking and noticing how food/drinks affect thoughts, bodily sensations, and emotions. Findings suggest that future research should explore whether mindfulness-based interventions for EDs may be more effective by targeting mindfulness processes related to describing, expressing, and accepting emotions, accepting discomfort when eating with others, and reducing hyper-focus on and reactivity to food-and-body related sensations.

Original Paper A comparison between effectiveness of integrated group psychotherapy and cognitive-behavioral stress management on body image and mindful eating of obese women: A clinical trial study

Article

Full-text available

Nov 2020

Background and Objective: Obesity considered to be one of the major health problems and risk factors of a wide range of diseases including diabetes, cardiovascular diseases, blood pressure and various types of cancer. This study was performed to compare the effectiveness of integrated group psychotherapy and cognitive-behavioral stress management on body image and mindful eating of obese women.

Live with your body – participants’ reflections on an acceptance and commitment therapy group intervention for patients with residual eating disorder symptoms

Article

Apr 2021

Acceptance and commitment therapy (ACT) is a transdiagnostic approach to human suffering that has been trialed in a range of different contexts. This study aimed to examine participants´ view of helpful and hindering aspects of an in person ACT group intervention targeting body image in patients with residual eating disorder (ED) symptoms. Thirteen women who completed the intervention were interviewed, and transcripts were analyzed through thematic analysis. Nine themes were identified and sorted into three main themes. The first main theme, Taking the plunge”, pointed to the importance of participants own effort, and included subthemes of self-efficacy, self as description, and self-exploration. The second main theme, “A push towards valued ends”, indicated that content of the intervention was helpful, and included subthemes of commitment and behavioral change processes, mindfulness and acceptance processes, and assignments in and between sessions. The third main theme, “The context matters”, described the importance of the contexts of the intervention and life outside of treatment, and included subthemes of the group format, the context outside of treatment, and the timing of the intervention. Through the description of specific content, we conclude that ACT seems to help women with residual ED symptoms and body image issues by fostering motivation to engage in avoided situations and behaviors while striving to live a more valued life.

Body image flexibility and its correlates: A meta-analysis

Article

Jun 2021
BODY IMAGE

Body image flexibility refers to the ability to openly experience thoughts or feelings about the body without acting on them or trying to change them. Accumulating evidence has demonstrated that body image flexibility is connected to numerous adaptive processes, and that it is sensitive to change during psychological interventions. However, a quantitative synthesis of empirical research on body image flexibility is lacking. We conducted the first meta-analysis on body image flexibility and its correlates. Sixty-two studies were included. Random effects meta-analyses were conducted on 19 psychological correlates, divided into three clusters: eating and body image disturbances, positive body-related and general psychological constructs, and general psychopathology. Meta-analyses showed inverse correlations between body image flexibility and each construct within the eating and body image disturbances cluster (rs= −.45 to −.67), and the general psychopathology cluster (rs= −.37 to −.58). Body image flexibility was positively associated with each positive psychology construct (rs = .23 – .58). Men reported higher levels of body image flexibility than women (d = 0.32). Psychological interventions were more effective than control groups at enhancing body image flexibility in randomized controlled trials (d = 0.42). Findings confirm that body image flexibility is consistently connected to indices of mental health, and that it can be enhanced during psychological interventions.

Post‐traumatic stress disorder as a moderator of transdiagnostic, residential eating disorder treatment outcome trajectory

Article

Full-text available

Jan 2021
J CLIN PSYCHOL

Objective Residential treatment for severe eating disorders (EDs) is associated with primarily positive outcomes. However, less is known about the moderators of treatment response. Comorbid post‐traumatic stress disorder (PTSD) diagnosis is associated with increased ED symptom severity. This study investigated whether PTSD moderated outcomes of transdiagnostic, residential ED treatment based upon the Unified Protocol. Method Female patients (N = 1055) in residential ED treatment completed a clinical interview to assess PTSD diagnosis and self‐reported ED, depression, and anxiety symptoms, anxiety sensitivity, experiential avoidance, and mindfulness. We tested whether PTSD moderated trajectories of symptom change from treatment admission to discharge and 6‐month follow‐up using multilevel models. Results PTSD moderated change in ED symptoms, depression severity, and experiential avoidance. Patients with PTSD showed steeper symptom improvements from admission to discharge. However, PTSD was associated with greater symptom recurrence after residential treatment. Conclusions Patients with comorbid PTSD demonstrated more improvement during residential treatment, but experienced steeper posttreatment symptom recurrence.

Maternal Mindfulness Is Associated With Lower Child Body Mass Index Z Score

Article

Jun 2020

Background Parental mindfulness may be a novel intervention target for child obesity prevention. Objective To examine associations between maternal mindfulness and child body mass index z-score (BMIz). Methods In a secondary data analysis of pre-intervention data from a randomized controlled trial, we assessed survey and anthropometric data from English-speaking mother/child dyads enrolled in Head Start in south central Michigan (n=105). Surveys included demographic information, child dietary intake, family meal frequency, and the Philadelphia Mindfulness Questionnaire. Multivariable linear regression examined associations between maternal mindfulness and child BMIz, child intake of fruits and vegetables, and frequency of family meals. Results Children were M=53.7 (SD 7.5) months old, and mothers were M=31.6 (SD 8.3) years old. The sample of children was 39% white, 26% black, 14% Hispanic, and 35% of children were overweight or obese. Mean maternal BMI was 32.0 (SD 8.3). Greater mindfulness was associated with child BMIz (β=-0.02 (SE 0.01), p=.027) adjusting for child race/ethnicity, household food security, maternal education, maternal age, and maternal BMI. Mindfulness was not associated with child fruit intake, child vegetable intake or frequency of family meals. The results were consistent with alternative outcomes of BMI percentile (p=.016) and BMI at the trend level (p=.0595) at the trend level. Conclusions Greater maternal mindfulness was associated with lower child BMIz. Future work should consider mechanisms of association. Pediatric providers might consider supporting maternal mindfulness as one element of multicomponent strategies for child obesity prevention.

Mindfulness and eating disorder psychopathology: A meta‐analysis

Article

Full-text available

Feb 2020
INT J EAT DISORDER

Objective Mindfulness is implicated in eating disorder (ED) psychopathology. However, this literature has not been synthesized to date. The current meta‐analysis examined the associations between mindfulness and ED psychopathology. Methods A total of 74 independent samples (effects = 576) were included. We used a multilevel random‐effects model to estimate summary study‐level effect sizes, and multilevel mixed‐effects models to examine moderator effects. Results Mindfulness was negatively associated with ED psychopathology (r = −.25, p < .001), both concurrently (r = −.25, p < .001) and prospectively (rs = −.22 to −.24, ps < .001). Associations were strongest for binge eating, emotional/external eating, and body dissatisfaction as well as the acting with awareness and nonjudging facets. Discussion Mindfulness may be an important process in ED psychopathology. Future research should prospectively and experimentally examine the relation between mindfulness and ED psychopathology.

Depressive symptoms, psychological flexibility, and binge eating in individuals seeking behavioral weight loss treatment

Article

Sep 2019

Depressive symptoms and binge eating are both prevalent in weight management populations and may be associated with reduced benefit from behavioral weight loss, including higher attrition, more perceived barriers, lower weight loss, and increased weight regain. These two potential risk factors for poor behavioral weight loss outcomes may also be associated with each other as depressive symptoms may trigger binge eating, and binge eating-related distress could increase depressive symptoms. The depressive symptom-binge eating link has not been well studied in weight management samples, and psychological processes involved in this relationship have not yet been elucidated. Psychological flexibility, an individual's ability to be connected with and conscious of the present moment and to engage in values-consistent behavior even in the presence of difficult internal experiences, may be one psychological process that changes the depressive symptom-binge eating relationship. High psychological flexibility may be a protective factor in the association of depressive symptoms with binge eating. This study examined the relationship between depressive symptom and binge eating and a potential interactive role of psychological flexibility. Participants (N = 468, 76% female) completed self-report questionnaires of binge eating, depressive symptoms, and psychological flexibility at baseline prior to initiating behavioral weight loss. Depressive symptoms were positively associated with binge eating (B = 1.00, p < 0.001). Psychological flexibility had an interactive role (B = −0.03, p = 0.005). Among participants with minimal to mild depressive symptoms, those with higher psychological flexibility had less severe binge eating. Findings suggest that psychological flexibility may be a protective factor in the association between depressive symptoms and binge eating in the majority of individuals initiating behavioral weight loss. Psychological flexibility is a psychological process to consider targeting for enhancing efficacy of weight loss treatment, especially among individuals with minimal to mild depressive symptoms and binge eating behavior.

Emotion regulation across eating pathology: A meta-analysis

Article

Aug 2019

The goal of this meta-analysis was to examine the associations between specific emotion regulation abilities (emotional awareness, emotional clarity) and strategies (acceptance of emotions, reappraisal, problem-solving, rumination, avoidance of emotions, and suppression), and eating pathology. A total of 96 studies and 239 effect sizes were included in the analysis. Relations between global and specific emotion regulation abilities and strategies and eating disorders and eating-related symptoms were examined. Results indicated medium-to-large effect sizes for the associations between adaptive emotion regulation and eating disorder and eating-related symptoms, and medium-to-large effect sizes for the associations between maladaptive emotion regulation and eating disorders and eating-related symptoms. In terms of specific emotion regulation strategies, large magnitude of associations were identified for the relations between lack of emotional awareness, clarity, acceptance, reappraisal, problem-solving, and eating disorders. Rumination, avoidance of emotions, and suppression also showed large associations with anorexia nervosa and bulimia nervosa. Overall, emotion regulation did not differ across eating disorders, a finding supporting the transdiagnostic character of emotion regulation problems in eating pathology. These findings have important theoretical and practical implications for prevention and intervention programs.

Mediating role of experiential avoidance in the relationship between anxiety sensitivity and eating disorder psychopathology: A clinical replication

Article

Jul 2019
Eat Behav

Objective: This study sought to examine whether anxiety sensitivity was associated with eating disorder (ED) symptom severity among patients with severe EDs, and to determine whether this relationship was mediated by experiential avoidance. Method: Adolescent and adult females (N = 625) seeking residential ED treatment completed self-report measures of anxiety sensitivity, experiential avoidance, and ED psychopathology. Linear regression evaluated the cross-sectional association between ED symptom severity and three dimensions of anxiety sensitivity (social, physical, and cognitive). Regression-based mediation analysis with bootstrapping tested the associations among the three dimensions of anxiety sensitivity and ED symptom severity through experiential avoidance. Results: The social dimension of anxiety sensitivity was positively associated with severity of ED psychopathology. Experiential avoidance mediated this association. Discussion: ED symptoms in this sample were more severe among patients who endorsed greater concern about appearing nervous or anxious to others. The current results indicate that this relationship was driven by a tendency to avoid experiences that evoke emotional discomfort. If replicated, these findings suggest that targeting both social anxiety sensitivity and experiential avoidance may improve ED treatment outcomes. Further study of the mechanistic relationships among social anxiety sensitivity, experiential avoidance, and ED psychopathology, is warranted.

Acceptance and present-moment awareness in psychiatric disorders: Is mindfulness mood dependent?

Article

Mar 2019
PSYCHIAT RES

The aim of the present study was to determine 1) whether deficits in two mindfulness dimensions (present-centered awareness and acceptance) were present in individuals with different psychiatric conditions and 2) whether co-existing depressive symptoms affected the mindfulness-related capacities in these groups. A total of 246 individuals, both clinical and non-clinical participants, were included in this study. The clinical sample consisted of 162 individuals; of these, 43 had a diagnosis of cocaine dependence while the remaining 119met clinical criteria for eating disorders (n = 43), major depressive disorder in remission (n = 39), and borderline personality disorder (n = 45). A non-clinical (NC) community sample consisting of 76 individuals was included as a control group. All participants completed self-report instruments to assess present-centered awareness, acceptance, and depressive symptoms. Present-centered awareness scores were significantly associated with depressive symptoms but not with the diagnostic group. By contrast, a significant effect of depressive symptoms and diagnostic group was associated with acceptance scores, with all clinical groups presenting significantly lower scores than the NC sample. These findings suggest that the association between psychopathology, mindfulness, and depressive symptoms varies depending on the specific aspect of mindfulness aspect (i.e., awareness or acceptance) evaluated.

Mindfulness-based eating disorder prevention programs: A systematic review and meta-analysis

Article

Nov 2017

The goal of this systematic review and meta-analysis was to evaluate the efficacy of mindfulness-based eating disorder prevention programs. Twenty articles met all inclusion and exclusion criteria, including 15 randomized studies (2173 participants) that were included in the meta-analysis. Compared to wait-list controls, mindfulness-based programs were found to significantly reduce participants’ body image concerns and negative affect and improve body appreciation at post-intervention. Compared to cognitive-dissonance programs, mindfulness-based programs were found to significantly improve participants’ self-esteem at post-intervention. There were no significant differences between groups on any other outcome, and no significant differences on any outcome at long-term follow-up. Selective prevention programs and programs that incorporated meditation as the primary intervention type had the largest effect sizes. While the conclusions that can be drawn are limited by both the quantity and quality of available research, results of this review suggest that mindfulness-based eating disorder prevention programs may reduce eating disorder risk factors and increase protective factors.

Increasing body image flexibility in a residential eating disorder facility: Correlates with symptom improvement

Article

Sep 2017

Objective: The purpose of this study was to examine the effects of changes in body image psychological flexibility over the course of treatment on various outcome variables. Method: Participants included 103 female, residential patients diagnosed with an eating disorder. Pretreatment and posttreatment data were collected that examined body image psychological flexibility, general psychological flexibility, symptom severity, and other outcome variables. Results: Changes in body image psychological flexibility significantly predicted changes in all outcome measures except for obsessive-compulsive symptoms after controlling for body mass index, depression, and anxiety. Additionally, these results were maintained after controlling for general psychological flexibility, contributing to the incremental validity of the BI-AAQ. Discussion: This study suggests that changes in body image psychological flexibility meaningfully predict changes in various treatment outcomes of interest, including eating disorder risk, quality of life, and general mental health. Findings indicate that body image psychological flexibility might be a viable target for eating disorder treatment.

Experiential Avoidance and Bulimic Symptoms among Men in Residential Treatment for Substance Use Disorders: A Preliminary Examination

Article

Sep 2017

There has been a growing focus on identifying factors that underlie and maintain bulimic symptoms and substance use disorders (SUDs), as both are associated with high mortality and poor clinical outcomes. Experiential avoidance has been an area of interest within both the eating disorder and SUD fields, as it is a robust risk factor for both disorders. No known research has examined the relationship between experiential avoidance and bulimic symptoms in a SUD treatment-seeking sample. Moreover, the extant literature has focused exclusively on female samples. The purpose of this exploratory study was to examine the relationship between bulimic symptoms and experiential avoidance within an understudied population: men in treatment for a SUD. Three separate hierarchical regression analyses were conducted to examine the following relationships: (1) experiential avoidance and bulimic symptoms; (2) experiential avoidance and alcohol use and problems; and (3) experiential avoidance and drug use and problems. Results demonstrated that, controlling for alcohol and drug use and problems, experiential avoidance was significantly associated with bulimic symptoms. Experiential avoidance was also significantly associated with alcohol use and problems and drug use and problems. These findings are preliminary and future research is needed to further examine this relationship.

Dispositional mindfulness and reward motivated eating: The role of emotion regulation and mental habit

Article

Jul 2017
APPETITE

Evidence regarding the effectiveness of mindfulness based interventions (MBIs) for eating disorders, weight management and food craving is emerging and further studies are required to understand the underlying mechanisms of MBIs in these domains. The current study was designed to establish the role of specific mechanisms underlying the putative relationship between mindfulness and reward motivated eating. We predicted that mindfulness would be negatively related to features of reward motivated eating and that this association would be mediated by emotion regulation and habitual negative self-thinking. A cross-sectional survey measuring uncontrolled and emotional eating, mindfulness, emotion regulation and habitual negative self-thinking was completed by female and male meditators and non-meditators (N = 632). Lower levels of dispositional mindfulness were associated with difficulties in emotion regulation, habitual negative self-thinking and both emotional and uncontrolled eating. Difficulties in emotion regulation significantly mediated the mindfulness-uncontrolled eating relationship. Habitual negative self-thinking significantly mediated the mindfulness-emotional eating relationship. Participants with meditation experience reported greater levels of dispositional mindfulness, fewer difficulties with emotion regulation and habitual negative self-thinking and reduced uncontrolled eating tendencies, compared to non-meditators. The findings suggest that MBIs designed to change reward motivated eating and weight control should focus on emotion regulation and mental habits as underlying mechanisms.

The Validation of the Body Image Acceptance and Action Questionnaire: Exploring the Moderator Effect of Acceptance on Disordered Eating

Article

Full-text available

Oct 2011

AbstrAct The Body Image-Acceptance and Action Questionnaire measures cognitive flexibility and acceptance relatively to body image. This paper presents the factorial structure and psychometric properties of the Portuguese version of the Questionnaire in a sample from the general population (n= 679). This version maintains a one-factor structure, similar to the original version of the instrument, which accounts for 63.36% of the variance. It presents high internal consistency (.95), test-retest reliability, and correlates (contrastingly) with self-compassion, body image dissatisfaction, eating disorders symptomatology, social comparison, and depression, anxiety, and stress. The Questionnaire discriminates between a clinical sample with a diagnosed eating disorder (n= 46) and a comparable general population sample (n= 51). Results show that body image acceptance is a significant predictor of eating pathology, and it seems able to lessen the impact of body image dissatisfaction on the engagement on pathological restrictive behaviours and thinness seeking.

Dialectical behavior therapy for binge eating and bulimia

Book

Full-text available

Jan 2009

The Eating Disorder Inventory: A measure of cognitive-behavioral dimensions of anorexia nervosa and bulimia.

Chapter

Full-text available

Jan 1983

The development and validation of a new measure, the Eating Disorder Inventory (EDI) is described. The EDI is a 64 item, self-report, multiscale measure designed for the assessment of psychological and behavioral traits common in anorexia nervosa (AN) and bulimia. The EDI consists of eight sub-scales measuring: 1) Drive for Thinness, 2) Bulimia, 3) Body Dissatisfaction, 4) Ineffectiveness, 5) Perfectionism, 6) Interpersonal Distrust, 7) Interoceptive Awareness and 8) Maturity Fears. Reliability (internal consistency) is established for all subscales and several indices of validity are presented. First, AN patients (N = 113) are differentiated from female comparison (FC) subjects (N = 577) using a cross-validation procedure. Secondly, patient self-report subscale scores agree with clinician ratings of subscale traits. Thirdly, clinically recovered AN patients score similarly to FCs on all subscales. Finally, convergent and discriminate validity are established for subscales. The EDI was also administered to groups of normal weight bulimic women, obese, and normal weight but formerly obese women, as well as a male comparison group. Group differences are reported and the potential utility of the EDI is discussed.

Eating Disorder Inventory2: Professional manual

Book

Full-text available

Jun 1991

David M. Garner

The EDI-2 manual is currently out of print but the attached file provides the table of contents for the EDI-3 which includes all of the EDI-2 items as well as the updated scale structure and scoring system for the EDI-3

Eating Disorder Examination (16.0D)

Article

Full-text available

Jan 2008

Development and validation of a multidimensional eating disorder inventory of anorexia nervosa and bulimia

Article

Full-text available

Jan 1983
INT J EAT DISORDER

Interoceptive awareness in eating disorders: Distinguishing lack of clarity from non-acceptance of internal experience

Article

Full-text available

Aug 2010
COGNITION EMOTION

Poor interoceptive awareness is often cited as a key feature of eating disorders, yet the precise nature of the deficits and their relationship to eating pathology remains unclear. Interoceptive awareness includes both acceptance of affective experience and clarity regarding emotional responses. The aim of the current study was to parse these components and examine the association between these deficits and two representative eating disorder symptoms: dietary restraint and binge eating. Participants were 50 eating disorder patients who completed a medical examination, clinical interview and symptom self-report measures. Results of regression analyses controlling for BMI and illness duration indicated that non-acceptance, not lack of clarity, was significantly associated with dietary restraint. Neither predicted binge eating. Findings suggest that negative reactions to emotional responses may contribute to the development or maintenance of dietary restraint. Results highlight the need to investigate the experience of emotional arousal in individuals with eating disorders using experimental methods that deconstruct the components of interoceptive awareness, and the potential utility of treatments that increase comfort with affective experience for individuals with more restrictive patterns.

Review of the Eating Disorder Inventory–3

Article

Full-text available

Aug 2006

Edward J Cumella

Binge Eating: Nature, Assessment, and Treatment

Article

Full-text available

Jan 1993

The cardinal feature of bulimia nervosa as well as an important feature in some cases of anorexia nervosa, binge eating is central to the proposed Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) scheme for classifying eating disorders. Despite its prevalence, no one volume has been devoted to synthesizing all that is known about binge eating and its treatment. Bridging a gap in the literature, this . . . text brings together significant, original contributions from leading experts from a wide variety of fields. A valuable resource for all clinicians and researchers interested in eating problems and their treatment, "Binge Eating" also serves as a text for advanced courses on eating disorders, or as supplementary reading for students of psychopathology. (PsycINFO Database Record (c) 2012 APA, all rights reserved)

Mindfulness and Acceptance in the Treatment of Disordered Eating

Article

Full-text available

Dec 2005

Mindfulness and acceptance-based approaches to the treatment of clinical problems are accruing substantial empirical support. This article examines the application of these approaches to disordered eating. Theoretical bases for the importance of mindfulness and acceptance in the treatment of eating problems are reviewed, and interventions for eating problems that incorporate mindfulness and acceptance skills are briefly described. Empirical data are presented from a pilot study of mindfulness-based cognitive therapy adapted for treatment of binge eating.

Acceptance and Commitment Therapy Versus Cognitive Therapy for the Treatment of Comorbid Eating Pathology

Article

Full-text available

Mar 2010

Previous research has indicated that although eating pathology is prevalent in college populations, both CBT and non-CBT-based therapies achieve only limited effectiveness. The current study examined several questions related to the treatment of eating pathology within the context of a larger randomized controlled trial that compared standard CBT (i.e., Beck's cognitive therapy; CT) with acceptance and commitment therapy (ACT; Hayes, 2004).The results indicated that the two treatments were differentially effective at reducing eating pathology. Specifically, CT produced modest decreases in eating pathology whereas ACT produced large decreases. In addition, a weaker suggestion emerged that ACT was more effective than CT at increasing clinician-rated global functioning among those with eating pathology. These findings suggest that ACT is a useful treatment for disordered eating and potentially, for eating disorders per se.

The Assessment of Present-Moment Awareness and Acceptance

Article

Full-text available

Jun 2008
ASSESSMENT

The purpose of this project was to develop a bidimensional measure of mindfulness to assess its two key components: present-moment awareness and acceptance. The development and psychometric validation of the Philadelphia Mindfulness Scale is described, and data are reported from expert raters, two nonclinical samples (n = 204 and 559), and three clinical samples including mixed psychiatric outpatients (n = 52), eating disorder inpatients (n = 30), and student counseling center outpatients (n = 78). Exploratory and confirmatory factor analyses support a two-factor solution, corresponding to the two constituent components of the construct. Good internal consistency was demonstrated, and relationships with other constructs were largely as expected. As predicted, significant differences were found between the nonclinical and clinical samples in levels of awareness and acceptance. The awareness and acceptance subscales were not correlated, suggesting that these two constructs can be examined independently. Potential theoretical and applied uses of the measure are discussed.

The reliability of the eating disorder examination?Self-report questionnaire version (EDE-Q)

Article

Apr 1999

The Eating Disorder Examination

Article

Jan 1993

Development and validation of a multidimensional eating disorder inventory for anorexia nervosa and bulimia

Article

Jan 1982

The development and validation of a new measure, the Eating Disorder Inventory (EDI) is described. The EDI is a 64 item, self-report, multiscale measure designed for the assessment of psychological and behavioral traits common in anorexia nervosa (AN) and bulimia. The EDI consists of eight subscales measuring: Drive for Thinness, Bilimia, Body Dissatisfaction, Ineffectiveness, Perfectionism, Interpersonal Distrust, Interoceptive Awareness and Maturity Fears. Reliability (internal consistency) is established for all subscales and several indices of validity are presented. First, AN patients (N=113) are differentiated from femal comparison (FC) subjects (N=577) using a cross-validation procedure. Secondly, patient self-report subscale scores agree with clinician ratings of subscale traits. Thirdly, clinically recovered AN patients score similarly to FCs on all subscales. Finally, convergent and discriminant validity are established for subscales. The EDI was also administered to groups of normal weight bulimic women, obese, and normal weight but formerly obese women, as well as a male comparison group. Group differences are reported and the potential utility of the EDI is discussed.

Understanding and treating eating disorders: An ACT perspective

Chapter

Jan 2009

Mindfulness-Based Approaches to Eating Disorders

Article

Jan 2006

This chapter discusses the treatment for eating disorders. The Diagnostic and Statistical Manual of Mental Disorders recognizes two primary eating disorders: anorexia nervosa (AN) and bulimia nervosa (BN). It also includes binge eating disorder (BED), sub threshold versions of AN and BN, and other disordered eating patterns. The most widely researched treatments for eating disorders are based on cognitive-behavioral procedures and have focused on BN and BED. Acceptance-based methods for treating eating disorders deserve increased attention, and several interventions that incorporate mindfulness training and acceptance-related procedures. Some of these are adaptations of previously developed interventions. For example, dialectical behavior therapy (DBT) has been adapted for BED and BN; mindfulness-based cognitive therapy (MBCT) has been adapted for BED; and acceptance and commitment therapy (ACT) has been applied to AN. In addition, mindfulness-based eating awareness training (MB-EAT) is developed specifically for BED. MB-EAT is developed by integrating elements from MBSR and CBT with guided eating meditations. The program draws on traditional mindfulness meditation techniques, as well as guided meditation, to address specific issues pertaining to shape, weight, and eating-related self regulatory processes such as appetite and both gastric and taste-specific satiety.

Assessment of body image flexibility: The Body Image-Acceptance and Action Questionnaire

Article

Apr 2013

Acceptance and mindfulness components are increasingly incorporated into treatment for eating disorders with promising results. The development of measures of proposed change processes would facilitate ongoing scientific progress. The current series of studies evaluated one such instrument, the Body Image-Acceptance and Action Questionnaire (BI-AAQ), which was designed to measure body image flexibility. Study one focused on the generation and reduction of items for the BI-AAQ and a demonstration of construct validity. Body image flexibility was associated with increased psychological flexibility, decreased body image dissatisfaction, and less disordered eating. Study two demonstrated adequate internal consistency and test–retest reliability of BI-AAQ. Study three extended findings related to structural and construct validity, and demonstrated an indirect effect of body image dissatisfaction on disordered eating via body image flexibility. Research and clinical utility of the BI-AAQ are discussed. The BI-AAQ is proposed as a measure of body image flexibility, a potential change process in acceptance-oriented treatments of eating disorders.

Mindfulness-Based Treatment Approaches: Clinician's Guide to Evidence Base and Applications

Book

Jan 2006

Ruth Baer

This edited volume provides chapters on the leading evidence-based mindfulness interventions as of 2006: mindfulness-based stress reduction, mindfulness-based cognitive therapy, dialectical behavior therapy, and acceptance and commitment therapy. Applications for clinical, medical, and nonclinical but stressed populations, as well as children, adolescents, and older adults, are described. Each chapter includes a detailed case study illustrating how the intervention is implemented, conceptual background, empirical support, and a discussion of practical issues that clinicians wishing to use these treatments must consider. A second edition (2014) focusing on MBSR, MBCT, and related treatment programs is also available.

An Innovative Adaptation of Dialectical Behavior Therapy for Binge Eating and Bulimia

Article

Jan 2010

Sara J. Steinberg

Reviews the book, Dialectical behavior therapy for binge eating and bulimia by Debra L. Safer, Christy F. Telch, and Eunice Y. Chen (see record 2009-10250-000 ). In this book, the authors describe a comprehensive treatment program that adapts Dialectical Behavior Therapy (DBT) to treat binge-eating disorder (BED) and symptoms of bulimia nervosa (BN). One of the strengths of this program is that it is the only DBT treatment program for eating disorders that has been tested and shown to be efficacious in a number of randomized controlled trials. This book is well written and easy to read, and is a useful resource for practitioners, researchers, and students. In particular, this book will be helpful for those who have experience with DBT but have little knowledge of eating disorders, in addition to those who are seasoned in treating eating disorders but are not trained in DBT. Furthermore, the step-by-step guidelines, discussion points, and case examples are refreshing and informative. The authors should be congratulated for staying adherent to DBT while also adapting the skills discussed and the handouts to be used, targeting them for individuals with BED or BN. (PsycINFO Database Record (c) 2012 APA, all rights reserved)

Acceptance and Commitment Therapy in the Treatment of an Adolescent Female with Anorexia Nervosa: A Case Example

Article

Jun 2002
COGN BEHAV PRACT

Acceptance and Commitment Therapy (ACT) is a cognitive-behavioral treatment that targets ineffective control strategies and experiential avoidance—the unwillingness to accept negative thoughts, feelings, and emotions. Although ACT has been suggested as an effective treatment for panic, substance use, pain, and mood disorders, there are no published reports on the use of ACT for treating adolescent disorders such as anorexia nervosa. This case summarizes the successful adoption of ACT techniques in the treatment of a 15-year-old female with anorexia nervosa. It also shows how ACT techniques can be successfully combined with, and set the stage for, more standard cognitive-behavioral interventions.

A Pilot Study of a Functional Contextual Treatment for Bulimia Nervosa

Article

May 2008
COGN BEHAV PRACT

This paper describes the initial development of a treatment for bulimia nervosa using a functional contextual treatment approach. Seven women (6 with a diagnosis of bulimia nervosa and 1 with a diagnosis of eating disorder not otherwise specified) completed 12 sessions of functional contextual treatment. Participants were assessed with the Eating Disorders Examination at baseline and following treatment. The intervention produced significant reductions in binge eating, purgative behavior, dietary restraint, and eating concerns. A functional contextual treatment holds promise for the treatment of bulimia nervosa. However, the treatment needs to be refined further and will need to be tested in controlled clinical trials with long-term follow-up.

ACT as Treatment of a Disorder of Excessive Control: Anorexia

Article

Jun 2002
COGN BEHAV PRACT

Acceptance and Commitment Therapy (ACT) is a conceptually driven approach to treatment that is directed at undermining the experiential avoidance and cognitive fusion that are assumed to produce restrictive and damaging behavioral patterns. ACT has recently been applied to the treatment of a number of behavioral problems. The current paper explores how an ACT perspective might guide the treatment of disordered eating based on the presentation of an adolescent female. Particularly, methods focused on addressing the treatment-resistant nature of anorexia, working with the complex control issues related to both eating and private events, facilitating the differentiation of the patient's sense of self from her private events and physical being, and assisting the client in refocusing on her valued directions are described. An ACT approach to treating anorexia seems strongly indicated, and further research is needed to assess the efficacy of ACT for this difficult problem.

Experiential avoidance, cognitive fusion, and an ACT approach to anorexia nervosa

Article

Jun 2002
COGN BEHAV PRACT

Case conceptualization and treatment planning for individuals with eating disorders seem to follow logically from within the framework of Acceptance and Commitment Therapy (ACT), which focuses on maladaptive control strategies directed toward emotional avoidance, cognitive fusion, and failure to act in accord with chosen values. The use of ACT in this case is discussed with recommendations for further ACT intervention strategies, why an ACT conceptualization makes sense with this population, and anticipated issues to consider.

Emotion Recognition and Regulation in Anorexia Nervosa

Article

Jul 2009
CLIN PSYCHOL PSYCHOT

It is recognized that emotional problems lie at the core of eating disorders (EDs) but scant attention has been paid to specific aspects such as emotional recognition, regulation and expression. This study aimed to investigate emotion recognition using the Reading the Mind in the Eyes (RME) task and emotion regulation using the Difficulties in Emotion Regulation Scale (DERS) in 20 women with anorexia nervosa (AN) and 20 female healthy controls (HCs). Women with AN had significantly lower scores on RME and reported significantly more difficulties with emotion regulation than HCs. There was a significant negative correlation between total DERS score and correct answers from the RME. These results suggest that women with AN have difficulties with emotional recognition and regulation. It is uncertain whether these deficits result from starvation and to what extent they might be reversed by weight gain alone. These deficits may need to be targeted in treatment. Copyright © 2009 John Wiley & Sons, Ltd. Key Practitioner Message: Clinicians can work to foster new skills in emotion functioning. This research shows that the acceptability of emotions and recognition of emotions are important factors, so specifically practising emotion recognition and examining the function of emotions might be useful treatment targets. Building skills in emotion functioning may enable to client to feel more confident about social interaction and reduce isolation. It might also be useful to involve the family to build a shared understanding of emotional functioning.

Fairburn CG, Beglin SJ. Assessment of eating disorders: interview or self-report questionnaire? Int J Eat Disord 16: 363-370

Article

Jan 1995

A detailed comparison was made of two methods for assessing the features of eating disorders. An investigator-based interview was compared with a self-report questionnaire based directly on that interview. A number of important discrepancies emerged. Although the two measures performed similarly with respect to the assessment of unambiguous behavioral features such as self-induced vomiting and dieting, the self-report questionnaire generated higher scores than the interview when assessing more complex features such as binge eating and concerns about shape. Both methods underestimated body weight.

Avoidance coping, binge eating, and depression: an examination of the Escape Theory of Binge Eating

Article

Aug 1997

The relationship between binge eating, avoidance coping, and depression was investigated with reference to the escape theory of binge eating which predicts binge eaters will exhibit elevated avoidance coping. Undergraduate females were selected into one of three groups: control (nonrestrained/nonbinge eating) (n = 73), restrained (restrained/ nonbinge eating) (n = 61), and binge eating (restrained/binge eating) (n = 15). The groups did not differ on use of avoidance coping. Binge eating scores were significantly correlated with avoidance coping and depression, but hierarchical regression analyses indicated avoidance coping did not significantly add to the prediction of binge eating above the contribution of depression. It is proposed therefore, that it is not appropriate to use findings of elevated avoidance coping in individuals with eating disorder in support of the escape theory.

The reliability of the Eating Disorder Examination-Self-Report Questionnaire Version (EDE-Q)

Article

May 1999

This research investigated the internal consistency and test-retest reliability of the Eating Disorder Examination-Self-Report Questionnaire Version (EDE-Q), a 41-item measure adapted from the Eating Disorder Examination (EDE). The EDE is a structured clinical interview assessing the key behavioral features and associated psychopathology of eating disorders. Results indicated excellent internal consistency and 2-week test-retest reliability for the four subscales of the EDE-Q: Restraint, Weight Concern, Shape Concern, and Eating Concern. There was somewhat less stability in the items measuring the occurrence and frequency of the key behavioral features of eating disorders. Overall, results support the psychometric adequacy of the EDE-Q.

Emotion Awareness and Identification Skills in Adolescent Girls With Bulimia Nervosa

Article

Jan 2005

This study examined emotion-identification skills in 19 adolescent girls (M age=16 years, 8 months) diagnosed with a Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM-IV], American Psychiatric Association, 1994) diagnosis of bulimia nervosa or eating disorder not otherwise specified in the bulimic spectrum, 19 age-matched girls with a DSM-IV diagnosis of unipolar depression, and 19 age-matched girls without a mental health history. Findings revealed that girls with bulimia nervosa compared to girls in the depressed and community control groups endorsed significantly greater reluctance to express emotions and inferior interoceptive awareness. Moreover, they exhibited significantly longer latencies to retrieve information regarding their emotional state in self-generated situations. When provided with a list of emotion labels, girls with bulimia endorsed significantly more labels to describe their responses to typical adolescent situations than girls in the control groups.

Is Avoidant Personality Disorder More Than Just Social Avoidance?

Article

Jan 2005
J PERS DISORD

Although social avoidance is a defining feature of avoidant personality disorder (APD), some theorists posit that APD is characterized by a broader pattern of avoidance that extends beyond social situations. This paper describes a series of four studies that examined the different types of nonsocial avoidance hypothesized to characterize APD in three undergraduate student samples and a clinical sample of adults with APD. Overall, the findings revealed low to moderate associations between APD and emotional and novelty avoidance, as well as avoidance of various nonsocial events. The results provide support for contemporary models of APD.

Anorexia Nervosa: Valued and Visible. A Cognitive-Interpersonal Maintenance Model and its Implications for Research and Practice

Article

Oct 2006

Anorexia nervosa (AN) is highly valued by people with the disorder. It is also a highly visible disorder, evoking intense emotional responses from others, particularly those closest to the person. A maintenance model of restricting anorexia nervosa, combining intra- and interpersonal factors is proposed. Four main maintaining factors (perfectionism/cognitive rigidity, experiential avoidance, pro-anorectic beliefs, response of close others) are suggested and the evidence supporting these is examined. These factors need to be integrated with what is known about starvation-related maintenance factors. This model departs from other models of AN in that it does not emphasize the role of weight and shape-related factors in the maintenance of AN; that is, it is culture-free. Implications for clinical practice and research are discussed.

Distress tolerance in the eating disorders

Article

Feb 2007
Eat Behav

It is commonly noted that patients with eating disorders have difficulties in regulating emotional states. This construct is similar to the concept of distress tolerance, which has been identified as a problem in patients with impulsive disorders. However, the elements that make up distress tolerance are not clearly delineated, making it difficult to target treatment in relevant cases. This study aimed to develop a measure of distress tolerance, and to validate it clinically with the eating disorders. The sample consisted of 72 women with DSM-IV eating disorder diagnoses, and 62 women with no history of eating disorders. Each completed a newly developed measure of distress tolerance (the Distress Tolerance Scale; DTS) and the Eating Disorders Inventory. The DTS was made up of three scales, each with acceptable psychometric properties. Two of those scales differentiated the groups--the clinical women showed higher levels of 'Avoidance of affect', while the non-clinical women had higher scores in the 'Accept and manage' scale. Avoidance of affect was positively associated with unhealthy eating attitudes. It is important to examine both maladaptive and adaptive means of coping with affect in the eating disorders. Treatment strategies for modification of distress tolerance should address both the reduction of avoidance and the development of emotional management skills. Further research is needed to determine whether these findings are relevant to the presence of other impulsive behaviours in the eating disorders.

Psychometric properties of the Eating Disorder Examination-Questionnaire: Factor structure and internal consistency

Article

May 2007

The purpose of this investigation was to evaluate the factor structure and the internal consistency of the Eating Disorder Examination-Questionnaire (EDE-Q). The EDE-Q was administered to 203 women with bulimic symptoms, who were recruited from five Midwestern communities. Acceptable levels of internal consistency were observed for the EDE-Q total score (alpha = .90) and subscales: Restraint (alpha = .70), Eating Concern (alpha = 0.73), Shape Concern (alpha = 0.83) and Weight Concern (alpha = 0.72). Exploratory factor loadings using Principal Axis Analysis supported the Eating Concern and Restraint subscales. Most of the Shape Concern and Weight Concern items loaded on one factor, with the exception of the items focusing on the importance of weight and shape in self-evaluation and preoccupation with shape and weight. The results of this study provide support for the internal consistency of the EDE-Q and indicate a need for further examination of the factor structure of this instrument.

DSM-IV: Diagnostic and statistical manual of mental disorders

Jan 1994

American Psychiatric Association (1994). DSM-IV: Diagnostic and statistical manual of mental disorders. Arlington, VA: American Psychiatric Association.

Assessment of body image flexibility: An evaluation the body imageacceptance and action questionnaire. (unpublished doctoral dissertation)

Jan 2010

E K Sandoz

Sandoz, E. K. (2010). Assessment of body image flexibility: An evaluation the body imageacceptance and action questionnaire. (unpublished doctoral dissertation). University of Mississippi.

Eating attitudes thoughts and defusion scale

J Shaw
M L Butryn
A J Juarascio
S G Kerrigan
A J Matteucci

Shaw, J., Butryn, M. L., Juarascio, A. J., Kerrigan, S. G., & Matteucci, A. J. (unpublished). Eating attitudes thoughts and defusion scale.

Mindfulness and its relationship with eating disorders symptomatology in women receiving residential treatment

No full-text available

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