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Rizzuto L, Hay P, Noetel M, Touyz S. Yoga as adjunctive therapy in the treatment of people with anorexia nervosa: a Delphi study. J Eat Disord 2021; 9:111. [PMID: 34496949 PMCID: PMC8425123 DOI: 10.1186/s40337-021-00467-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 08/24/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND There is preliminary evidence to suggest that yoga can be beneficial in reducing anxiety, depression and general eating disorder symptoms in people with Anorexia Nervosa (AN). It is unclear whether the therapeutic benefits of yoga are supported or utilised in the treatment of AN amongst clinical experts. The present study aimed to explore and synthesise expert opinion on the use of yoga as an adjunctive therapy in the management of anxiety, depression and over-exercise in individuals with AN. METHODS A Delphi methodology was employed, with clinicians considered experts in the treatment of AN recruited internationally to form the panel (n = 18). The first iteration of questionnaires comprised of four open-ended questions concerning the experts' understanding of the term yoga and opinions on its' use in therapy generally and more specifically in the treatment of AN. Using content analysis, statements were derived from this data and included as Likert-based items in two subsequent rounds where panellists rated their level of agreement on each item. Seventeen out of 18 respondents completed all three iterations. RESULTS Consensus (level of agreement defined at ≥ 85%) was achieved for 36.47% of the items included in the second and third rounds. The panel reached consensus on items defining yoga and pertaining to its' general benefits. The panel agreed that yoga is a adjunct therapy for various problems, consensus was not achieved on the specific use of yoga as an adjunct therapy in the treatment of comorbid anxiety, depression or trauma in patients with AN. Although the expert panel acknowledged a number of benefits for use of yoga in AN, they strongly endorsed that future research should evaluate the potential risks of using yoga as an embodied practice. CONCLUSIONS It is possible that yoga could be considered for inclusion in future guidelines if supported by empirical research. We conclude that there seems to be enough consensus that such further scientific investigation is warranted. This study aimed to explore expert opinion on the use of yoga as an adjunctive therapy in the management of anxiety, depression and over-exercise in individuals with Anorexia Nervosa (AN). Clinicians considered experts in the treatment of AN recruited internationally to form the panel (n = 18). Experts were asked about their understanding of the term yoga and their opinions on its' use in therapy. The panel reached consensus on items defining yoga and pertaining to its' general benefits. Although the panel agreed that yoga is a nice additional therapy for various problems, consensus was not achieved on the use of yoga as an additional therapy in the treatment of specific problems like anxiety, depression or trauma in people with AN. The expert panel acknowledged a number of benefits for use of yoga in AN. However the panel strongly considered that future research should evaluate the potential risks of using yoga as an embodied practice. The areas of collective agreement gained in the study can serve as preliminary guidelines for the use of yoga in AN whilst guiding future research directions.
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Affiliation(s)
- Laura Rizzuto
- School of Psychology, The University of Sydney, Sydney, Australia
| | - Phillipa Hay
- Translational Health Research Institute, School of Medicine, Western Sydney University, Greater Western Sydney, Australia.
| | | | - Stephen Touyz
- School of Psychology, The University of Sydney, Sydney, Australia
- InsideOut Institute University of Sydney, Sydney, Australia
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Ho D, Verdejo-Garcia A. Interactive influences of food, contexts and neurocognitive systems on addictive eating. Prog Neuropsychopharmacol Biol Psychiatry 2021; 110:110295. [PMID: 33657421 DOI: 10.1016/j.pnpbp.2021.110295] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 10/04/2020] [Accepted: 02/24/2021] [Indexed: 02/08/2023]
Abstract
Compulsive eating is a common symptom of different conditions, including obesity, binge eating disorder and bulimia. One hypothesis is that contemporary food products promote compulsive eating via addiction-like mechanisms. However, what is the addictive substance in food, and what is the phenotypic overlap between obesity / eating disorders and addictions are questions that remain unresolved. In this review, we applied a multilevel framework of addiction, which encompasses the 'drug' (certain foods), the person's mindset, and the context, to improve understanding of compulsive eating. Specifically, we reviewed evidence on the addictive properties of specific foods, the neurocognitive systems that control dietary choices, and their interaction with physical, emotional and social contexts. We focused on different target groups to illustrate distinct aspects of the proposed framework: the impact of food and contextual factors were examined across a continuum, with most studies conducted on healthy participants and subclinical populations, whereas the review of neurocognitive aspects focused on clinical groups in which the alterations linked to addictive and compulsive eating are particularly visible. The reviewed evidence suggest that macronutrient composition and level of processing are associated with the addictive properties of food; there are overlapping neuroadaptations in reward and decision-making circuits across compulsive eating conditions; and there are physical and social contexts that fuel compulsive eating by exploiting reward mechanisms and their interaction with emotions. We conclude that a biopsychosocial model that integrates food, neurobiology and context can provide a better understanding of compulsive eating manifestations in a transdiagnostic framework.
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Affiliation(s)
- Daniel Ho
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Antonio Verdejo-Garcia
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia.
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Humbel N, Messerli-Bürgy N, Schuck K, Wyssen A, Garcia-Burgos D, Biedert E, Lennertz J, Meyer AH, Whinyates K, Isenschmid B, Milos G, Trier S, Adolph D, Cwik J, Margraf J, Assion HJ, Teismann T, Ueberberg B, Juckel G, Müller J, Klauke B, Schneider S, Munsch S. Self-reported emotion regulation difficulties are associated with mood but not with the biological stress response to thin ideal exposure. PLoS One 2018; 13:e0199769. [PMID: 29949642 PMCID: PMC6021103 DOI: 10.1371/journal.pone.0199769] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 06/13/2018] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Difficulties in emotion regulation have been related to psychological and physiological stress responses such as lower mood and lower parasympathetic activation (HF-HRV) under resting condition, but evidence on the potential link to the hypothalamic-pituitary-adrenal (HPA) axis functioning and to physiological stress responses during a stress task is still scarce. The aim of the study was to investigate stress responses in young women when confronted to a daily stressor such as exposure to thin ideals and to understand the role of correlates of self-reported trait-like emotion regulation difficulties (ERD). METHODS Heart rate variability (HRV) and salivary cortisol data were collected in a sample of 273 young women aged 18-35 with and without mental disorders during a vivid imagination of thin ideals (experimental condition) or landscapes (control condition). Changes in mood states were measured on a visual analogue scale (0-100). Correlates of trait-like ERD were self-reported using the Difficulties in Emotion Regulation Scale (DERS). RESULTS Participants with higher ERD showed a stronger decline in self-reported mood after vivid imagination of thin ideals compared to participants with lower ERD in the experimental condition but also a stronger increase of positive mood with increasing ERD in the control condition. ERD were not related to baseline HF-HRV or baseline salivary cortisol levels nor to any physiological response during and after the imagination of thin ideals. DISCUSSION AND CONCLUSION The results corroborate the role of ERD regarding the immediate psychological impact of daily stressors. Exposition to daily stressors in the laboratory results in discrepant psychological and physiological reactivity. Future studies should investigate under what conditions the complex interrelations between immediate and long-term ERD and biological activation are amenable to assessment in a laboratory setting. The additive effects of multiple exposition to stressors, such as thin ideals in daily life, also need to be addressed.
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Affiliation(s)
- Nadine Humbel
- Clinical Psychology and Psychotherapy, Department of Clinical Psychology, University of Fribourg, Fribourg, Switzerland
| | - Nadine Messerli-Bürgy
- Clinical Psychology and Psychotherapy, Department of Clinical Psychology, University of Fribourg, Fribourg, Switzerland
| | - Kathrin Schuck
- Faculty of Psychology, Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Bochum, Germany
| | - Andrea Wyssen
- Clinical Psychology and Psychotherapy, Department of Clinical Psychology, University of Fribourg, Fribourg, Switzerland
| | - David Garcia-Burgos
- Clinical Psychology and Psychotherapy, Department of Clinical Psychology, University of Fribourg, Fribourg, Switzerland
| | - Esther Biedert
- Clinical Psychology and Psychotherapy, Department of Clinical Psychology, University of Fribourg, Fribourg, Switzerland
| | - Julia Lennertz
- Faculty of Psychology, Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Bochum, Germany
| | - Andrea H. Meyer
- Clinical Psychology and Psychotherapy, Department of Clinical Psychology, University of Fribourg, Fribourg, Switzerland
- Department of Psychology, Division of Clinical Psychology and Epidemiology, University of Basel, Basel, Switzerland
| | | | - Bettina Isenschmid
- Kompetenzzentrum für Essstörungen und Adipositas (KEA), Spital Zofingen, Zofingen, Switzerland
| | - Gabriella Milos
- Klinik für Psychiatrie und Psychotherapie, Universitätsspital Zürich, Zürich, Switzerland
| | | | - Dirk Adolph
- Faculty of Psychology, Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Bochum, Germany
| | - Jan Cwik
- Faculty of Psychology, Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Bochum, Germany
| | - Jürgen Margraf
- Faculty of Psychology, Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Bochum, Germany
| | - Hans-Jörg Assion
- LWL-Klinik Dortmund, Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Dortmund, Germany
| | - Tobias Teismann
- Faculty of Psychology, Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Bochum, Germany
| | - Bianca Ueberberg
- LWL-Klinik Dortmund, Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Dortmund, Germany
| | - Georg Juckel
- Department of Psychiatry, Psychotherapy and Preventive Medicine, Ruhr University Bochum, LWL University Hospital, Bochum, Germany
| | - Judith Müller
- Christoph-Dornier-Clinic for Psychotherapy, Münster, Germany
| | - Benedikt Klauke
- Christoph-Dornier-Clinic for Psychotherapy, Münster, Germany
| | - Silvia Schneider
- Faculty of Psychology, Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Bochum, Germany
| | - Simone Munsch
- Clinical Psychology and Psychotherapy, Department of Clinical Psychology, University of Fribourg, Fribourg, Switzerland
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Emotion Regulation in Binge Eating Disorder: A Review. Nutrients 2017; 9:nu9111274. [PMID: 29165348 PMCID: PMC5707746 DOI: 10.3390/nu9111274] [Citation(s) in RCA: 163] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 11/10/2017] [Accepted: 11/18/2017] [Indexed: 01/19/2023] Open
Abstract
The purpose of the present review is to provide a summary of the research findings on emotion regulation in Binge Eating Disorder (BED). Negative emotions and maladaptive emotion regulation strategies play a role in the onset and maintenance of binge eating in BED. Anger and sadness, along with negative emotions related to interpersonal experiences (i.e., disappointment, being hurt or loneliness), seem to be particularly relevant. Individuals with BED have a tendency to suppress and ruminate on their unwanted emotions, which leads to increased psychopathological thoughts and symptoms. Compared to healthy controls, they use adaptive strategies, such as reappraisal, less frequently. Evidence concerning the causal relation between negative affect and binge eating is inconclusive and still very limited. While experimental studies in a laboratory setting lack ecological validity, ecological momentary assessment studies offer more promise at unraveling the causal relationship between emotions and binge eating. Increases in negative affect are found to be antecedents of binge eating in BED. However, there seems to be less support for the possibility that binge eating serves as a means to alleviate negative affect. Finally, BED seems to be related to other forms of maladaptive emotion regulation strategies, such as substance abuse and self-harm.
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Kenny TE, Singleton C, Carter JC. Testing predictions of the emotion regulation model of binge-eating disorder. Int J Eat Disord 2017; 50:1297-1305. [PMID: 29052240 DOI: 10.1002/eat.22787] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 09/24/2017] [Accepted: 09/24/2017] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The emotion regulation (ER) model of binge eating posits that individuals with binge-eating disorder (BED) experience more intense emotions and greater difficulties in ER than individuals without BED, leading them to binge eat as a means of regulating emotions. According to this model, individuals with BED should report greater difficulties in ER than their non-BED counterparts, the severity of these difficulties should be positively associated with BED symptoms, and this association should be stronger when individuals experience persistent negative emotions (i.e., depression). Studies examining these hypotheses, however, have been limited. METHOD Data were collected from adults meeting the DSM 5 criteria for BED (n = 71; 93% female) and no history of an eating disorder (NED; n = 79; 83.5% female). Participants completed self-report measures of difficulties in ER, eating disorder (ED) psychopathology, and depression. RESULTS Individuals with BED reported greater difficulties in ER compared to those with NED. Moreover, difficulties in ER predicted unique variance in binge frequency and ED psychopathology in BED. Depression moderated the association between ER difficulties and binge frequency such that emotion dysregulation and binge frequency were positively associated in those reporting high, but not low, depression levels. DISCUSSION The association between difficulties in ER and ED pathology in BED suggests that treatments focusing on improving ER skills may be effective in treating this ED; however, the moderating effect of depression underscores the need for research on individual differences and treatment moderators. These findings suggest the importance of ER in understanding and treating BED.
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Affiliation(s)
- Therese E Kenny
- Department of Psychology, Memorial University of Newfoundland, St. John's, A1B 3X9, Canada
| | - Christopher Singleton
- Department of Psychology, Memorial University of Newfoundland, St. John's, A1B 3X9, Canada
| | - Jacqueline C Carter
- Department of Psychology, Memorial University of Newfoundland, St. John's, A1B 3X9, Canada
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Vannucci A, Nelson EE, Bongiorno DM, Pine DS, Yanovski JA, Tanofsky-Kraff M. Behavioral and neurodevelopmental precursors to binge-type eating disorders: support for the role of negative valence systems. Psychol Med 2015; 45:2921-2936. [PMID: 26040923 PMCID: PMC4589435 DOI: 10.1017/s003329171500104x] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Pediatric loss-of-control (LOC) eating is a robust behavioral precursor to binge-type eating disorders. Elucidating precursors to LOC eating and binge-type eating disorders may refine developmental risk models of eating disorders and inform interventions. METHOD We review evidence within constructs of the Negative Valence Systems (NVS) domain, as specified by the Research Domain Criteria framework. Based on published studies, we propose an integrated NVS model of binge-type eating-disorder risk. RESULTS Data implicate altered corticolimbic functioning, neuroendocrine dysregulation, and self-reported negative affect as possible risk factors. However, neuroimaging and physiological data in children and adolescents are sparse, and most prospective studies are limited to self-report measures. CONCLUSIONS We discuss a broad NVS framework for conceptualizing early risk for binge-type eating disorders. Future neural and behavioral research on the developmental trajectory of LOC and binge-type eating disorders is required.
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Affiliation(s)
- Anna Vannucci
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health (NIH), DHHS, Bethesda, MD
| | - Eric E. Nelson
- Section on Development and Affective Neuroscience of the National Institute of Mental Health, National Institutes of Health (NIH), DHHS, Bethesda, MD
| | - Diana M. Bongiorno
- Section on Development and Affective Neuroscience of the National Institute of Mental Health, National Institutes of Health (NIH), DHHS, Bethesda, MD
| | - Daniel S. Pine
- Section on Development and Affective Neuroscience of the National Institute of Mental Health, National Institutes of Health (NIH), DHHS, Bethesda, MD
| | - Jack A. Yanovski
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health (NIH), DHHS, Bethesda, MD
| | - Marian Tanofsky-Kraff
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health (NIH), DHHS, Bethesda, MD
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Abstract
OBJECTIVE Many patients with anorexia nervosa develop an intractable and debilitating illness course. Our aims were to (i) conduct a systematic review of randomised controlled trials (RCTs) of treatment for chronic anorexia nervosa participants, and (ii) identify research informing novel therapeutic approaches for this group. METHODS Systematic search (SCOPUS plus previous reviews date 2011) of literature for (i) RCTs of treatment that included anorexia nervosa participants with a mean duration of illness of at least 3 years, (ii) studies reporting new treatments addressing factors associated with chronicity. RESULTS Evidence of efficacy for treatment approaches in severe and enduring anorexia nervosa is limited. Only one unpublished RCT designed to test a specific psychological approach for these patients was identified. There is a probable advantage for specialist psychotherapy over treatment as usual, and a promising study of relapse prevention with cognitive behaviour therapy (CBT) for anorexia nervosa (CBT-AN). Open trials have, however, reported developments in psychological therapies that warrant further specific evaluation. These include forms of CBT modified for anorexia nervosa, cognitive remediation therapy with emotion skills training, the Maudsley Model for Treatment of Adults with Anorexia Nervosa, the Community Outreach Partnership Program, Specialist Supportive Clinical Management and the approach of Strober with its emphasis on therapeutic alliance and flexible goals. CONCLUSIONS Treatment trials need to move beyond targeting core eating disorder pathology (primarily weight restoration) and examine efficacy and effectiveness in minimising harm and reducing personal and social costs of chronic illness. There is also a need to develop better definitions of chronicity, with or without treatment 'resistance' specifiers.
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Affiliation(s)
- Phillipa J Hay
- School of Medicine, University of Western Sydney, Penrith, Australia.
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Loxton NJ, Dawe S, Cahill A. Does negative mood drive the urge to eat? The contribution of negative mood, exposure to food cues and eating style. Appetite 2011; 56:368-74. [DOI: 10.1016/j.appet.2011.01.011] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2010] [Revised: 12/24/2010] [Accepted: 01/07/2011] [Indexed: 10/18/2022]
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Affiliation(s)
| | - Leah Graves
- Laureate Eating Disorders Program, Tulsa, Oklahoma
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Turner SA, Luszczynska A, Warner L, Schwarzer R. Emotional and uncontrolled eating styles and chocolate chip cookie consumption. A controlled trial of the effects of positive mood enhancement. Appetite 2010; 54:143-9. [DOI: 10.1016/j.appet.2009.09.020] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2009] [Revised: 08/27/2009] [Accepted: 09/30/2009] [Indexed: 10/20/2022]
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Expectations, mood, and eating behavior in binge eating disorder. Beware of the bright side. Appetite 2009; 53:166-73. [DOI: 10.1016/j.appet.2009.06.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2009] [Revised: 05/13/2009] [Accepted: 06/01/2009] [Indexed: 11/20/2022]
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Laessle RG, Schulz S. Stress-induced laboratory eating behavior in obese women with binge eating disorder. Int J Eat Disord 2009; 42:505-10. [PMID: 19172596 DOI: 10.1002/eat.20648] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To compare the microstructural eating behavior of obese patients with and without binge eating disorder (BED) after stress induction in laboratory. METHOD Forty-eight obese women were investigated. Seventeen were assigned to the group of BED. Group (BED vs. non-BED) by condition (stress vs. no stress) interaction effect on feeding variables, measured by a universal eating monitor, was tested. Stress was induced by the trier social stress test (TSST) and chocolate pudding served as laboratory food. RESULTS From the nonstress to the stress condition, patients with BED, when compared with non-BED had a greater increase in average eating rate (p < .01) and a corresponding greater increase in the frequency of spoonfuls (p < .02). The BED group also showed a different change in acceleration/deceleration from the nonstress to the stress condition compared to the non-BED group (p < .04). DISCUSSION Obese individuals with BED appear to exhibit a different response to stress than obese non-BED individuals and individuals with bulimia nervosa.
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Affiliation(s)
- Reinhold G Laessle
- Department of Clinical and Theoretical Psychobiology, University of Trier, Trier 54286, Germany.
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Body-related film clip triggers desire to binge in women with binge eating disorder. Behav Res Ther 2009; 47:790-6. [DOI: 10.1016/j.brat.2009.06.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2009] [Revised: 06/10/2009] [Accepted: 06/10/2009] [Indexed: 12/28/2022]
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Dingemans AE, Martijn C, Jansen AT, van Furth EF. The effect of suppressing negative emotions on eating behavior in binge eating disorder. Appetite 2009; 52:51-7. [DOI: 10.1016/j.appet.2008.08.004] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2008] [Revised: 07/07/2008] [Accepted: 08/01/2008] [Indexed: 11/29/2022]
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