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Efstathiou M, Delicato LS, Sedda A. Emotional body representations: more pronounced effect of hands at a more explicit level of awareness. Exp Brain Res 2024; 242:1595-1608. [PMID: 38760470 DOI: 10.1007/s00221-024-06839-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 04/16/2024] [Indexed: 05/19/2024]
Abstract
To understand conditions such as body dysmorphic disorder, we need to understand healthy individuals' perceptual, conceptual, and emotional representations of their bodies. Not much is known about the differences in these representations across body districts, for example, hands, feet, and whole-body, despite their differences at sensory and functional levels. To understand this, we developed more implicit and explicit measures of body satisfaction for these body districts. Sixty-seven participants (age M = 30.66, SD = 11.19) completed a series of online Implicit Association Tests (IAT) and a Body Image Satisfaction Visual Analogue Scale (BISVAS; explicit) for each body district (hands/feet/whole body). The results show no differences in the more implicit level of awareness in hands, feet and whole body, while differences are apparent at a more explicit level of awareness, with higher scores for body image satisfaction for the hands than the whole body and marginally significant lower scores for feet than hands. Those findings suggest that visual attention, level of concern attributed to a body district, and disgust drivers are possible factors affecting the experience of attitudinal body image satisfaction.
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Affiliation(s)
- Myrto Efstathiou
- Centre for Applied Behavioural Sciences, Department of Psychology, School of Social Sciences, Heriot-Watt University, Edinburgh Campus, Edinburgh, UK.
| | - Louise S Delicato
- Centre for Applied Behavioural Sciences, Department of Psychology, School of Social Sciences, Heriot-Watt University, Edinburgh Campus, Edinburgh, UK
| | - Anna Sedda
- Centre for Applied Behavioural Sciences, Department of Psychology, School of Social Sciences, Heriot-Watt University, Edinburgh Campus, Edinburgh, UK
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2
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Pelzer M, Werthmann J, Fleischhaker C, Svaldi J, Tuschen-Caffier B. Mirror Exposure Training for Adolescents With Anorexia Nervosa (MIRADAN): Cognitive Mechanisms of Body Disturbance - A Study Protocol. CLINICAL PSYCHOLOGY IN EUROPE 2023; 5:e11277. [PMID: 38357429 PMCID: PMC10863679 DOI: 10.32872/cpe.11277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 08/28/2023] [Indexed: 02/16/2024] Open
Abstract
Background Anorexia Nervosa (AN) is a severe mental illness, which typically develops in adolescence and, if left untreated, often becomes chronic. Body dissatisfaction is a core characteristic of AN. Mirror exposure (ME) is an effective therapeutic technique to tackle body dissatisfaction in adult patients with eating disorders, but there is limited evidence for the effects of ME in adolescence. One potential mechanism underlying effects of ME on body dissatisfaction is change in body-related attention bias. However, this mechanism remains to be empirically tested. Accordingly, the aim of the current study is twofold: primarily, we aim to test if ME can reduce body dissatisfaction and associated symptoms in adolescent patients with AN. Additionally, we aim to investigate whether change in biased body-related attention due to ME is a possible mechanism of action. Method Adolescent patients with AN are randomized to either 12 sessions of ME (3 ME-sessions/week) or wait-list within four weeks. Main outcomes include body dissatisfaction and associated symptoms of AN. Moreover, body-related attention bias is assessed at baseline and post-treatment by means of eye-tracking with two paradigms. Further, process variables are collected weekly. In addition, 12 weeks after end of the study, the acceptability of the ME is assessed. Discussion The main aim of the study is to evaluate high-frequency and high-intense ME for treating body dissatisfaction in adolescents with AN. In addition, we would like to clarify whether change in attentional bias for body stimuli is a mechanism underlying change in body dissatisfaction due to ME.
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Affiliation(s)
- Maarit Pelzer
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Freiburg, Freiburg, Germany
| | - Jessica Werthmann
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Freiburg, Freiburg, Germany
| | - Christian Fleischhaker
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, Freiburg University Hospital, Freiburg, Germany
| | - Jennifer Svaldi
- Faculty of Science, Clinical Psychology and Psychotherapy, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Brunna Tuschen-Caffier
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Freiburg, Freiburg, Germany
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3
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Baur J, Krohmer K, Naumann E, Svaldi J. Efficacy and mechanisms of change in exposure-based and cognitive stand-alone body image interventions in women with overweight and obesity. Behav Res Ther 2022; 159:104210. [PMID: 36435148 DOI: 10.1016/j.brat.2022.104210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 07/25/2022] [Accepted: 10/07/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Body dissatisfaction is highly prevalent in overweight and obesity, while evidence for the efficacy of body image interventions is still scarce. This interventional pilot study investigates the efficacy and mechanisms of change of two stand-alone body image interventions in women with overweight and obesity. METHODS Women with overweight and obesity (n = 76) were randomly assigned to five weekly sessions of either a mirror exposure (ME) or a cognitive restructuring intervention (CR) or to a wait-list control group (WCG). Primary outcome measures were self-reported body dissatisfaction and interview-based shape concerns; depression, self-esteem and emotional eating served as secondary outcome measures. Experimental paradigms were used prior to and after the interventions to analyze possible mechanisms of change: (a) Implicit Associations Tests to assess weight-related attitudes (b) eye-tracking experiments to assess visual processing of body pictures and (c) a thought-sampling procedure to assess body-related cognitions and arousal. RESULTS According to intent-to-treat analyses using linear mixed-models, both interventions lead to significant improvements in body image, while there were no changes in the WCG. Different mechanisms of change were identified. CONCLUSIONS Both types of interventions might be effective in the reduction of self-reported body dissatisfaction and interview-based shape concerns in overweight and obesity. However, as different mechanisms drive the effects, future research should clarify which individual might best benefit from which intervention.
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Affiliation(s)
- Julia Baur
- Department of Clinical Psychology and Psychotherapy, University of Tuebingen, Tuebingen, Germany.
| | - Kerstin Krohmer
- Department of Clinical Psychology and Psychotherapy, University of Tuebingen, Tuebingen, Germany
| | - Eva Naumann
- Department of Clinical Psychology and Psychotherapy, University of Tuebingen, Tuebingen, Germany
| | - Jennifer Svaldi
- Department of Clinical Psychology and Psychotherapy, University of Tuebingen, Tuebingen, Germany
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4
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Behrens SC, Streuber S, Keizer A, Giel KE. How immersive virtual reality can become a key tool to advance research and psychotherapy of eating and weight disorders. Front Psychiatry 2022; 13:1011620. [PMID: 36405894 PMCID: PMC9668851 DOI: 10.3389/fpsyt.2022.1011620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 10/07/2022] [Indexed: 11/06/2022] Open
Abstract
Immersive virtual reality technology (VR) still waits for its wide dissemination in research and psychotherapy of eating and weight disorders. Given the comparably high efforts in producing a VR setup, we outline that the technology's breakthrough needs tailored exploitation of specific features of VR and user-centered design of setups. In this paper, we introduce VR hardware and review the specific properties of immersive VR versus real-world setups providing examples how they improved existing setups. We then summarize current approaches to make VR a tool for psychotherapy of eating and weight disorders and introduce user-centered design of VR environments as a solution to support their further development. Overall, we argue that exploitation of the specific properties of VR can substantially improve existing approaches for research and therapy of eating and weight disorders. To produce more than pilot setups, iterative development of VR setups within a user-centered design approach is needed.
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Affiliation(s)
- Simone C. Behrens
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
- Max Planck Institute for Intelligent Systems, Tübingen, Germany
- Centre of Excellence for Eating Disorders (KOMET), Tübingen, Germany
| | - Stephan Streuber
- Department of Electrical Engineering and Computer Science, Coburg University of Applied Sciences and Arts, Coburg, Germany
| | - Anouk Keizer
- Department of Experimental Psychology, University of Utrecht, Utrecht, Netherlands
| | - Katrin E. Giel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
- Centre of Excellence for Eating Disorders (KOMET), Tübingen, Germany
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5
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Naumann E, Werthmann J, Vocks S, Svaldi J, Hartmann AS. Die Spiegelkonfrontationstherapie zur Behandlung von Körperbildstörungen bei Essstörungen – Evidenz, Wirkmechanismen und Vorgehensweise. PSYCHOLOGISCHE RUNDSCHAU 2022. [DOI: 10.1026/0033-3042/a000558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Zusammenfassung. Körperbildprobleme sind ein Kernmerkmal von Essstörungen. Daher gilt eine Verbesserung des Körperbildes bei der Behandlung von Essstörungen als zentrales Therapieziel. Verschiedene empirische Befunde weisen auf die Spiegelkonfrontation als wirksame Methode zur Reduktion von Körperbildstörungen hin. Ziel dieses Übersichtsartikels ist es, den aktuellen Stand der wissenschaftlichen Literatur zum Thema Spiegelkonfrontationstherapie bei Essstörungen darzulegen. Insbesondere sollen die Wirksamkeitsstudien getrennt für nicht-klinische, körperunzufriedene Gruppen mit und ohne Übergewicht sowie die verschiedenen Essstörungsgruppen systematisiert und unterschiedliche Vorgehensweisen beschrieben werden. Der Übersichtsartikel liefert Hinweise dafür, dass die Spiegelkonfrontationstherapie bei Hochrisikogruppen mit erhöhter Körperunzufriedenheit sowie bei Essstörungen zu positiven Veränderungen hinsichtlich der kognitiv-affektiven und behavioralen Komponente des Körperbildes führt. Jedoch mangelt es insgesamt an randomisiert-kontrollierten Studien, die die Wirksamkeit der Spiegelkonfrontationstherapie mit ausreichend großen Stichproben gezielt untersuchen – vor allem bei der Anorexia nervosa. Der Übersichtsartikel schließt mit einer Diskussion über mögliche Wirkmechanismen, (Kontra–)Indikationen und einem Ausblick für zukünftige Forschung ab.
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Affiliation(s)
- Eva Naumann
- Abteilung Klinische Psychologie und Psychologie, Institut für Psychologie, Eberhard Karls Universität Tübingen, Deutschland
| | - Jessica Werthmann
- Abteilung Klinische Psychologie und Psychologie, Institut für Psychologie, Albert-Ludwigs-Universität Freiburg, Deutschland
| | - Silja Vocks
- Fachgebiet Klinische Psychologie und Psychologie, Institut für Psychologie, Universität Osnabrück, Deutschland
| | - Jennifer Svaldi
- Abteilung Klinische Psychologie und Psychologie, Institut für Psychologie, Eberhard Karls Universität Tübingen, Deutschland
| | - Andrea S. Hartmann
- Fachgebiet Klinische Psychologie und Psychologie, Institut für Psychologie, Universität Osnabrück, Deutschland
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6
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Walker DC, Murray K. A Pilot Clinical Case Series of Functionality-Focused Mirror Exposure in Women With Clinically Elevated Body Dissatisfaction. COGNITIVE AND BEHAVIORAL PRACTICE 2022. [DOI: 10.1016/j.cbpra.2022.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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7
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Sánchez CG, Ferrer SD, Cuellar JAA, Martín JLM, Ruiz SR. I Look at my whole body and i feel better: attentional bias, emotional and psychophysiological response by pure exposure treatment in women with obesity. Psychother Res 2022; 32:748-762. [PMID: 34983319 DOI: 10.1080/10503307.2021.2021310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Obesity is one of the most important health problems nowadays. In addition to the direct physical consequences, it is also a risk factor in the development of psychological (Eating disorders, body dissatisfaction, depression, anxiety, etc.) and social problems. Among there, body dissatisfaction is key for development and maintenance of such problems. OBJECTIVE to deepen the effectiveness of the body exposure treatment, both in its pure form and guided modality in subjective, psychological and attentional levels in people with body dissatisfaction and obesity. METHODS Evaluations were carried out in a total of 16 women with obesity and body dissatisfaction at the beginning and end of 6 treatment sessions of pure exposure in front of the mirror. The changes experienced at the subjective level (questionnaires and subjective discomfort during the sessions) and psychophysiological (eye-tracking and heart rate) were analyzed. RESULTS Pure exposure treatment reduces negative thoughts and emotions towards the body itself, as well as the experienced discomfort towards the most conflictive parts. Selective attention to those parts of the body classified as uglier by the participants (especially the rear view of the body) show a decrease in physiological reactivity. CONCLUSIONS Pure exposure treatment seems to be effective in reducing subjective and psychological symptoms associated with body dissatisfaction in people with obesity, this technique could be considered a good choice for the treatment of body dissatisfaction. This step is essential to guarantee the long-term therapeutic success of any other treatment (nutritional or/and physical activity) in the future.
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Affiliation(s)
- Cristina González Sánchez
- Faculty of Psychology, Department of Personality, Evaluation and Psychological Treatment, University of Granada, Granada, Spain
| | - Sandra Díaz Ferrer
- Faculty of Psychology, Department of Personality, Evaluation and Psychological Treatment, University of Granada, Granada, Spain
| | | | - José Luis Mata Martín
- Faculty of Psychology, Department of Personality, Evaluation and Psychological Treatment, University of Granada, Granada, Spain
| | - Sonia Rodríguez Ruiz
- Faculty of Psychology, Department of Personality, Evaluation and Psychological Treatment, University of Granada, Granada, Spain
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8
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Milton A, Hambleton A, Roberts A, Davenport T, Flego A, Burns J, Hickie I. Body Image Distress and Its Associations From an International Sample of Men and Women Across the Adult Life Span: Web-Based Survey Study. JMIR Form Res 2021; 5:e25329. [PMID: 34734831 PMCID: PMC8603168 DOI: 10.2196/25329] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 05/13/2021] [Accepted: 05/31/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Previous research on body image distress mainly relied on samples that were small, generally homogeneous in age or sex, often limited to one geographical region, and were characterized by a lack of comprehensive analysis of multiple psychosocial domains. The research presented in this paper extends the international literature using the results of the web-based Global Health and Wellbeing Survey 2015. The survey included a large sample of both men and women aged ≥16 years from Australia, Canada, New Zealand, the United Kingdom, or the United States. OBJECTIVE The main objectives of this study are to examine body image distress across the adult life span (≥16 years) and sex and assess the association between body image distress and various psychosocial risk and protective factors. METHODS Data were extracted from the Global Health and Wellbeing Survey 2015, a web-based international self-report survey with 10,765 respondents, and compared with previous web-based surveys conducted in 2009 and 2012. RESULTS The body image distress of young Australians (aged 16-25 years) significantly rose by 33% from 2009 to 2015. In 2015, 75.19% (961/1278) of 16- to 25-year-old adults reported body image distress worldwide, and a decline in body image distress was noted with increasing age. More women reported higher levels of body image distress than men (1953/3338, 58.51% vs 853/2175, 39.22%). Sex, age, current dieting status, perception of weight, psychological distress, alcohol and other substance misuse, and well-being significantly explained 24% of the variance in body image distress in a linear regression (F15,4966=105.8; P<.001). CONCLUSIONS This study demonstrates the significant interplay between body image distress and psychosocial factors across age and sex.
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Affiliation(s)
- Alyssa Milton
- Brain and Mind Centre, The University of Sydney, Sydney, Australia.,Sydney School of Medicine, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
| | - Ashlea Hambleton
- Project Synergy, InnoWell Pty Ltd, Sydney, Australia.,Inside Out Institute for Eating Disorders, Charles Perkins Centre, University of Sydney, Sydney, Australia
| | - Anna Roberts
- Brain and Mind Centre, The University of Sydney, Sydney, Australia.,Project Synergy, InnoWell Pty Ltd, Sydney, Australia
| | - Tracey Davenport
- Brain and Mind Centre, The University of Sydney, Sydney, Australia.,Project Synergy, InnoWell Pty Ltd, Sydney, Australia
| | - Anna Flego
- The Movember Foundation, Australia, East Melbourne, Australia
| | - Jane Burns
- Project Synergy, InnoWell Pty Ltd, Sydney, Australia
| | - Ian Hickie
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
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9
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Knejzlíková T, Světlák M, Malatincová T, Roman R, Chládek J, Najmanová J, Theiner P, Linhartová P, Kašpárek T. Electrodermal Response to Mirror Exposure in Relation to Subjective Emotional Responses, Emotional Competences and Affectivity in Adolescent Girls With Restrictive Anorexia and Healthy Controls. Front Psychol 2021; 12:673597. [PMID: 34566754 PMCID: PMC8461306 DOI: 10.3389/fpsyg.2021.673597] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 08/18/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: Body image disturbances and the attendant negative emotions are two of the major clinical symptoms of eating disorders. The objective of the present experimental study was to shed more light on the degree of association or dissociation between the physiological and emotional response to mirror exposure in patients with restrictive mental anorexia, and on the relationships between the physiological response and characteristics connected with emotional processing. Materials and Methods: Thirty adolescent girls with the restrictive type of anorexia and thirty matched healthy controls underwent bilateral measurement of skin conductance (SC) during rest, neutral stimulus exposure, and mirror exposure, and completed a set of measures focused on emotion regulation competencies, affectivity, and eating disorder pathology. Results: Compared to healthy controls, girls with restrictive anorexia rated mirror exposure as a subjectively more distressful experience. Differences in skin conductance response (SCR) were not significant; however, variance in SCR was substantially greater in the group of anorexia patients as compared to healthy controls. The overall skin conductance level (SCL) was lower in anorexia patients. Increase in SCR during mirror exposure, as opposed to exposure to neutral stimuli, was positively related to the tendency to experience negative emotions, interoceptive sensitivity, body dissatisfaction and suppression, but not to other symptoms of eating pathology or emotional awareness. A post hoc analysis suggested that physiological reactivity might be associated with interoceptive sensitivity to mirror exposure especially in anorectic patients. Conclusion: The study seems to demonstrate some degree of dissociation between psychophysiological reactivity and subjective response to body exposure in patients with restrictive anorexia. Factors affecting differences in psychophysiological responsiveness to body exposure in anorectic patients require further exploration.
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Affiliation(s)
- Terézia Knejzlíková
- Department of Psychiatry, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Miroslav Světlák
- Institute of Psychology and Psychosomatics, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Tatiana Malatincová
- Institute of Psychology and Psychosomatics, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Robert Roman
- Department of Psychiatry, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Jan Chládek
- Institute of Scientific Instruments of the CAS, Brno, Czechia
| | - Jana Najmanová
- Department of Psychiatry, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Pavel Theiner
- Department of Psychiatry, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Pavla Linhartová
- Department of Psychiatry, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Tomáš Kašpárek
- Department of Psychiatry, Faculty of Medicine, Masaryk University, Brno, Czechia
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10
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Exposure therapy for eating disorders: A systematic review. Clin Psychol Rev 2020; 78:101851. [DOI: 10.1016/j.cpr.2020.101851] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 03/07/2020] [Accepted: 03/10/2020] [Indexed: 12/25/2022]
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11
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Schmidt CK, Raque‐Bogdan TL, Hollern EA. Self‐Compassion, Affect, and Body Image in College Women. JOURNAL OF COLLEGE COUNSELING 2019. [DOI: 10.1002/jocc.12127] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
| | | | - Emily A. Hollern
- Psychology DepartmentTowson University
- Now at UNYQ in Charlotte North Carolina
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12
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Baur J, Krohmer K, Tuschen-Caffier B, Svaldi J. Cognitive-Emotional Involvement During Mirror Exposure Is Not Accompanied by Physiological Activation in Binge Eating Disorder. Front Psychiatry 2019; 10:745. [PMID: 31803074 PMCID: PMC6877718 DOI: 10.3389/fpsyt.2019.00745] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 09/17/2019] [Indexed: 12/29/2022] Open
Abstract
Body image interventions have been shown to reduce self-reported cognitive-emotional facets of body image disturbance in binge eating disorder (BED). However, more objective assessment methods are required to evaluate the effects of these interventions. Therefore, the present study aimed at investigating the usefulness of vocally encoded emotional arousal as physiological correlate of body dissatisfaction during mirror exposure in women with BED. Women with BED (n = 60) and weight-matched controls (CG; n = 60) participated in an experimental thought-sampling procedure including a mirror exposure and a control condition in a repeated-measures design. Fundamental frequency as a vocal correlate of emotional arousal as well as negative, neutral, and positive body-related cognitions during both conditions were analyzed. In line with our hypotheses, the BED group verbalized more negative, and less positive and neutral body-related cognitions during the mirror exposure condition compared to the CG. Contrary to our hypotheses, though, there was a stronger increase in physiological arousal between the control and the mirror exposure condition in the CG relative to the BED group. Furthermore, a significant negative correlation between fundamental frequency and the severity of cognitive-emotional body image disturbances emerged. The findings indicate a cognitive-emotional over-involvement with physical appearance during mirror exposure in women with BED compared to weight-matched controls in the absence of a corresponding physiological pattern. Results are discussed in terms of an impaired ability of women with BED to show adequate physiological responses to body-related stress. In addition, methodological recommendations for future research are presented.
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Affiliation(s)
- Julia Baur
- Department of Clinical Psychology and Psychotherapy, University of Tuebingen, Tuebingen, Germany
| | - Kerstin Krohmer
- Department of Clinical Psychology and Psychotherapy, University of Tuebingen, Tuebingen, Germany
| | - Brunna Tuschen-Caffier
- Department of Clinical Psychology and Psychotherapy, University of Freiburg, Freiburg, Germany
| | - Jennifer Svaldi
- Department of Clinical Psychology and Psychotherapy, University of Tuebingen, Tuebingen, Germany
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13
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Mirror exposure therapy for body image disturbances and eating disorders: A review. Clin Psychol Rev 2018; 65:163-174. [DOI: 10.1016/j.cpr.2018.08.006] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 08/25/2018] [Accepted: 08/27/2018] [Indexed: 12/21/2022]
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14
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Fendel U, Sandler H, Papachristou C, Voigt B, Rose M, Klapp BF. Bodily experiences of patients diagnosed with anorexia nervosa during treatment with the body monochord—A modified grounded theory approach. ARTS IN PSYCHOTHERAPY 2018. [DOI: 10.1016/j.aip.2018.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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15
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Miragall M, Etchemendy E, Cebolla A, Rodríguez V, Medrano C, Baños RM. Expand your body when you look at yourself: The role of the posture in a mirror exposure task. PLoS One 2018; 13:e0194686. [PMID: 29570729 PMCID: PMC5865731 DOI: 10.1371/journal.pone.0194686] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 03/07/2018] [Indexed: 11/28/2022] Open
Abstract
Mirror exposure (ME) is one of the main components of the treatment of patients with eating disorders symptomatology and it has shown its effectiveness in improving several outcomes (e.g., body dissatisfaction). However, the study as to what body posture should be adopted to maximize its effectiveness has been neglected. From embodied cognition and emotion theories, the adoption of an expansive (vs. contractive) body posture has been associated with positive changes in cognitive and emotional responses. The objective of this study was to analyze the effect of adopting an expansive (vs. contractive) posture before an ME task on body-related emotions and cognitions, as well as to analyze the possible moderator and mediator variables of these relationships. The sample was composed of 68 women (age: M = 21.74, SD = 3.12) with high scores on body dissatisfaction. Participants were randomly assigned to the expansive or contractive condition, where the openness of the arms/legs and the back position were manipulated. Posture was monitored by an electronic device and participants filled out several self-reported measures. ANCOVAs, moderation, mediation, and moderated mediated analyses were performed. Results showed that women in the expansive condition showed higher positive emotions after the ME. Moreover, exploratory analyses showed that adopting an expansive posture improved positive emotions, leading to improvements in negative emotions, body image satisfaction, and appraisal of the person’s own body. Psychological interventions should explore the value of holding an expansive posture before the ME in women with body dissatisfaction.
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Affiliation(s)
- Marta Miragall
- Department of Personality, Evaluation and Psychological Treatment, University of Valencia, Valencia, Spain
| | | | - Ausiàs Cebolla
- Department of Personality, Evaluation and Psychological Treatment, University of Valencia, Valencia, Spain.,CIBER Fisiopatología Obesidad y Nutrición (CIBEROBN), Instituto Carlos III, Madrid, Spain
| | | | - Carlos Medrano
- EduQTech, EUPT, University of Zaragoza, Teruel, Spain.,Aragon Institute for Health Research (IIS Aragón), University of Zaragoza, Zaragoza, Spain
| | - Rosa María Baños
- Department of Personality, Evaluation and Psychological Treatment, University of Valencia, Valencia, Spain.,CIBER Fisiopatología Obesidad y Nutrición (CIBEROBN), Instituto Carlos III, Madrid, Spain
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16
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Bauer A, Schneider S, Waldorf M, Cordes M, Huber TJ, Braks K, Vocks S. Visual processing of one's own body over the course of time: Evidence for the vigilance-avoidance theory in adolescents with anorexia nervosa? Int J Eat Disord 2017; 50:1205-1213. [PMID: 28851058 DOI: 10.1002/eat.22771] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Revised: 07/12/2017] [Accepted: 08/09/2017] [Indexed: 01/31/2023]
Abstract
OBJECTIVE The vigilance-avoidance theory postulates a specific threat-related pattern of attention deployment, characterized by initial orientation towards fear-evoking stimuli and subsequent directing of attention away from them. The current eye-tracking study was the first to examine the applicability of the theory for patients with eating disorders, who perceive their own body as a highly aversive, threat-evoking stimulus. METHOD N = 56 female adolescents with anorexia nervosa (AN) and n = 43 healthy controls (HC) aged 13-18 viewed own-body pictures while their eye movements were recorded. Relative fixation times on self-defined unattractive body areas were compared between the groups by sequencing the overall presentation time of 6,000 ms into six intervals à 1,000 ms. RESULTS Participants with AN showed a significantly stronger attentional bias for unattractive body areas than HC within the time intervals 1, 2, and 3. However, for intervals 4, 5, and 6, no significant group differences occurred. Within the AN group, the bias for unattractive body areas was significantly stronger in interval 1 compared to intervals 4, 5, and 6; whereas within the HC group, a stable pattern of attention deployment emerged. In AN, early attention deployment was positively correlated with the negative affect reported after photo presentation. DISCUSSION The early vigilance in AN and the subsequent decrease in attention to unattractive body parts is in line with our assumptions. However, no indication of attentional avoidance was found. The current findings partially support the vigilance-avoidance theory for the exposure to one's own body in adolescents with AN.
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Affiliation(s)
- Anika Bauer
- Department of Clinical Psychology and Psychotherapy, Osnabrück University, Osnabrück, Germany
| | - Silvia Schneider
- Department of Clinical Child and Adolescent Psychology, Ruhr-University Bochum, Bochum, Germany
| | - Manuel Waldorf
- Department of Clinical Psychology and Psychotherapy, Osnabrück University, Osnabrück, Germany
| | - Martin Cordes
- Department of Clinical Psychology and Psychotherapy, Osnabrück University, Osnabrück, Germany
| | | | | | - Silja Vocks
- Department of Clinical Psychology and Psychotherapy, Osnabrück University, Osnabrück, Germany
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17
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Díaz-Ferrer S, Rodríguez-Ruiz S, Ortega-Roldán B, Mata-Martín JL, Carmen Fernández-Santaella M. Psychophysiological Changes during Pure vs Guided Mirror Exposure Therapies in Women with High Body Dissatisfaction: What Are They Learning about Their Bodies? EUROPEAN EATING DISORDERS REVIEW 2017; 25:562-569. [PMID: 28944527 DOI: 10.1002/erv.2546] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 08/05/2017] [Accepted: 08/14/2017] [Indexed: 11/11/2022]
Abstract
This study aimed to examine the psychophysiological changes resulting from two mirror exposure treatments that are effective at reducing body dissatisfaction. Thirty-five university women with body dissatisfaction and subclinical eating disorders were randomly assigned to one of two groups: pure (n = 17) or guided exposure (n = 18). The participants received six sessions of treatment. Their thoughts, feelings and avoidance behaviours were assessed after each session. Their subjective discomfort, heart rate and skin conductance were assessed within the sessions. Both groups showed improvement in cognitive-affective and avoidance behaviour symptoms. Nevertheless, the pure exposure group showed faster habituation of subjective discomfort and a greater physiological response than the guided exposure group. These findings suggest that both procedures are effective interventions for improving body image disturbances, although psychophysiological changes observed within session suggest that each technique would act through different processes. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.
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Affiliation(s)
- Sandra Díaz-Ferrer
- Department of Personality, Assessment and Psychological Treatment, Faculty of Psychology, University of Granada, Spain
| | - Sonia Rodríguez-Ruiz
- Department of Personality, Assessment and Psychological Treatment, Faculty of Psychology, University of Granada, Spain
| | - Blanca Ortega-Roldán
- Department of Personality, Assessment and Psychological Treatment, Faculty of Psychology, University of Granada, Spain
| | - José Luis Mata-Martín
- Department of Personality, Assessment and Psychological Treatment, Faculty of Psychology, University of Granada, Spain
| | - M Carmen Fernández-Santaella
- Department of Personality, Assessment and Psychological Treatment, Faculty of Psychology, University of Granada, Spain
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18
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Steinfeld B, Bauer A, Waldorf M, Hartmann AS, Vocks S. Diagnostik der Körperbildstörung. PSYCHOTHERAPEUT 2017. [DOI: 10.1007/s00278-017-0188-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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19
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Caspi A, Amiaz R, Davidson N, Czerniak E, Gur E, Kiryati N, Harari D, Furst M, Stein D. Computerized assessment of body image in anorexia nervosa and bulimia nervosa: comparison with standardized body image assessment tool. Arch Womens Ment Health 2017; 20:139-147. [PMID: 27796596 DOI: 10.1007/s00737-016-0687-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 10/14/2016] [Indexed: 10/20/2022]
Abstract
UNLABELLED Body image disturbances are a prominent feature of eating disorders (EDs). Our aim was to test and evaluate a computerized assessment of body image (CABI), to compare the body image disturbances in different ED types, and to assess the factors affecting body image. The body image of 22 individuals undergoing inpatient treatment with restricting anorexia nervosa (AN-R), 22 with binge/purge AN (AN-B/P), 20 with bulimia nervosa (BN), and 41 healthy controls was assessed using the Contour Drawing Rating Scale (CDRS), the CABI, which simulated the participants' self-image in different levels of weight changes, and the Eating Disorder Inventory-2-Body Dissatisfaction (EDI-2-BD) scale. Severity of depression and anxiety was also assessed. Significant differences were found among the three scales assessing body image, although most of their dimensions differentiated between patients with EDs and controls. Our findings support the use of the CABI in the comparison of body image disturbances in patients with EDs vs. CONTROLS Moreover, the use of different assessment tools allows for a better understanding of the differences in body image disturbances in different ED types.
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Affiliation(s)
- Asaf Caspi
- Department of Psychiatry, The Chaim Sheba, Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Revital Amiaz
- Department of Psychiatry, The Chaim Sheba, Medical Center, Tel Hashomer, Israel. .,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Noa Davidson
- Department of Psychology, The Hebrew University at Jerusalem, Jerusalem, Israel
| | - Efrat Czerniak
- Department of Psychiatry, The Chaim Sheba, Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eitan Gur
- The Eating Disorders Department, The Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Nahum Kiryati
- Electrical Engineering-Systems Department, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel
| | - Daniel Harari
- Electrical Engineering-Systems Department, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel
| | - Miriam Furst
- Electrical Engineering-Systems Department, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel
| | - Daniel Stein
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,The Pediatric Psychosomatic Department, The Edmond and Lily Safra Children's Hospital, The Chaim Sheba Medical Center, Tel Hashomer, Israel
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20
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Trentowska M, Svaldi J, Blechert J, Tuschen-Caffier B. Does habituation really happen? Investigation of psycho-biological responses to body exposure in bulimia nervosa. Behav Res Ther 2016; 90:111-122. [PMID: 28027485 DOI: 10.1016/j.brat.2016.12.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 10/24/2016] [Accepted: 12/12/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Body exposure is a common and effective treatment for body image disturbance in bulimia nervosa (BN). However, little is known about treatment mechanisms. Based on models of emotional processing and neurovisceral integration, we expected to observe a) initial activation and b) habituation of cognitive-affective and autonomic responding within one and between two standardized body exposure sessions. METHODS A group of 13 women with BN and 13 healthy controls (HC) were repeatedly exposed to their bodies. Prior to and after treatment with three individualized mirror exposure sessions participants received a session of standardized exposure to videographic recordings of their body. Subjective ratings of body-related emotions and thoughts were assessed repeatedly throughout the standardized exposure sessions and autonomic responses were recorded continuously. RESULTS Subjective and sympathetic responses were activated initially in both groups. Cognitive-affective responses habituated within the standardized sessions in both groups, whereas between the standardized sessions habituation was only found in women with BN. Increasing sympathetic responses were found within the sessions in both groups. CONCLUSIONS The results support cognitive-affective habituation during body exposure in BN and to a lesser extent in HC. Autonomic responses however did not show a corresponding pattern and did not distinguish between groups. Implications for body exposure research and practice are discussed.
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Affiliation(s)
- Monika Trentowska
- Department of Clinical Psychology and Psychotherapy, Albert-Ludwigs-University Freiburg, Germany
| | - Jennifer Svaldi
- Department of Clinical Psychology and Psychotherapy, Eberhard Karls University Tübingen, Germany.
| | - Jens Blechert
- Department for Psychology & Centre for Cognitive Neuroscience, University of Salzburg, Austria
| | - Brunna Tuschen-Caffier
- Department of Clinical Psychology and Psychotherapy, Albert-Ludwigs-University Freiburg, Germany
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21
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Fogelkvist M, Parling T, Kjellin L, Gustafsson SA. A qualitative analysis of participants' reflections on body image during participation in a randomized controlled trial of acceptance and commitment therapy. J Eat Disord 2016; 4:29. [PMID: 27999670 PMCID: PMC5151132 DOI: 10.1186/s40337-016-0120-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 10/09/2016] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Negative body image is a risk factor for development and relapse in eating disorders (ED). Many patients continue to be dissatisfied with their body shape or weight after treatment. This study presents a qualitative analysis of written reflections on body image from patients with an ED and a negative body image before and after an Acceptance and Commitment Therapy group treatment at a specialized ED-unit. METHOD Before and after the treatment participants (n = 47) answered a questionnaire with open ended questions on their thoughts on body image. Data were analyzed through conventional content analysis. RESULTS Body image meant different things for different participants. For some it had to do with how you evaluate your body, whereas others focused on whether their body image was realistic or not. Some emphasized their relationship with their body, while some described body image as strongly related to global self-esteem. These different views on the concept of body image affected the participants' descriptions of their own body image, and how they wanted it to change. Body image was considered a state that fluctuated from day to day. After treatment the participants described changes in their body image, for instance perceiving oneself as less judgmental towards one's body, and a shift in focus to the important things in life. CONCLUSIONS The participants had different views on body image and how they wished it to change. Thus treatment interventions targeting negative body image needs to address various aspects of this complex construct. TRIAL REGISTRATION This study is part of an RCT registered 02/06/2014 in Clinical Trials, registration number: NCT02058121.
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Affiliation(s)
- Maria Fogelkvist
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, S-huset, vån 2, Box 1613, 701 16 Örebro, Sweden
| | - Thomas Parling
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Lars Kjellin
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, S-huset, vån 2, Box 1613, 701 16 Örebro, Sweden
| | - Sanna Aila Gustafsson
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, S-huset, vån 2, Box 1613, 701 16 Örebro, Sweden
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22
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Tuschen-Caffier B, Bender C, Caffier D, Klenner K, Braks K, Svaldi J. Selective Visual Attention during Mirror Exposure in Anorexia and Bulimia Nervosa. PLoS One 2015; 10:e0145886. [PMID: 26714279 PMCID: PMC4700997 DOI: 10.1371/journal.pone.0145886] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 12/09/2015] [Indexed: 02/07/2023] Open
Abstract
Objective Cognitive theories suggest that body dissatisfaction results from the activation of maladaptive appearance schemata, which guide mental processes such as selective attention to shape and weight-related information. In line with this, the present study hypothesized that patients with anorexia nervosa (AN) and bulimia nervosa (BN) are characterized by increased visual attention for the most dissatisfying/ugly body part compared to their most satisfying/beautiful body part, while a more balanced viewing pattern was expected for controls without eating disorders (CG). Method Eye movements were recorded in a group of patients with AN (n = 16), BN (n = 16) and a CG (n = 16) in an ecologically valid setting, i.e., during a 3-min mirror exposure. Results Evidence was found that patients with AN and BN display longer and more frequent gazes towards the most dissatisfying relative to the most satisfying and towards their most ugly compared to their most beautiful body parts, whereas the CG showed a more balanced gaze pattern. Discussion The results converge with theoretical models that emphasize the role of information processing in the maintenance of body dissatisfaction. Given the etiological importance of body dissatisfaction in the development of eating disorders, future studies should focus on the modification of the reported patterns.
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Affiliation(s)
| | - Caroline Bender
- Department of Psychology, University of Freiburg, Freiburg, Germany
| | - Detlef Caffier
- Department of Psychology, University of Freiburg, Freiburg, Germany
| | | | | | - Jennifer Svaldi
- Department of Psychology, University of Tübingen, Tübingen, Germany
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23
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Martinez MA, Craighead LW. Toward Person(ality)-Centered Treatment: How Consideration of Personality and Individual Differences in Anorexia Nervosa May Improve Treatment Outcome. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2015. [DOI: 10.1111/cpsp.12111] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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24
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Díaz-Ferrer S, Rodríguez-Ruiz S, Ortega-Roldán B, Moreno-Domínguez S, Fernández-Santaella MC. Testing the efficacy of pure versus guided mirror exposure in women with bulimia nervosa: A combination of neuroendocrine and psychological indices. J Behav Ther Exp Psychiatry 2015; 48:1-8. [PMID: 25665513 DOI: 10.1016/j.jbtep.2015.01.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Revised: 12/01/2014] [Accepted: 01/14/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND OBJECTIVES Body exposure improves body image problems in women with eating disorders. However it has almost always been combined with other interventions. Thus, the efficacy of body exposure alone (i.e., pure exposure) remains largely unclear. We aimed to compare the efficacy of two body exposure techniques through psychological and neuroendocrine indices recorded within and between successive sessions. METHOD Twenty-nine women with high body dissatisfaction and diagnosis of bulimia nervosa were randomly assigned to one of two treatment groups: Pure Exposure (n = 14) or Guided Exposure (n = 15). Participants received 6 exposure sessions. After each session, changes in thoughts (positive/negative) and body satisfaction were assessed. Also, we assessed the body discomfort experienced by participants within and between sessions. Finally, the changes in salivary cortisol levels within and between the initial and final treatment sessions were measured. RESULTS Both groups showed a reduction in negative thoughts and a progressive increase in positive thoughts throughout the treatment. However, the increase in body satisfaction and the reduction in subjective discomfort within the sessions were greater in the pure exposure group. The cortisol levels during the initial and final treatment sessions decreased in both groups. LIMITATIONS Methodological limitations are reported. CONCLUSIONS These results suggest that pure and guided exposures are effective interventions for improving thoughts and neuroendocrine responses, although pure exposure increased more body satisfaction feelings in bulimic women. Subjective discomfort also showed different patterns of change within and along sessions for each treatment. Reasons for these results are discussed.
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Affiliation(s)
- Sandra Díaz-Ferrer
- Department of Personality, Assessment and Psychological Treatment, Faculty of Psychology, Campus la Cartuja s/n, 18071, University of Granada, Granada, Spain.
| | - Sonia Rodríguez-Ruiz
- Department of Personality, Assessment and Psychological Treatment, Faculty of Psychology, Campus la Cartuja s/n, 18071, University of Granada, Granada, Spain.
| | - Blanca Ortega-Roldán
- Department of Personality, Assessment and Psychological Treatment, Faculty of Psychology, Campus la Cartuja s/n, 18071, University of Granada, Granada, Spain.
| | - Silvia Moreno-Domínguez
- Department of Psychology, Faculty of Humanities and Educational Sciences, Campus las Lagunillas, s/n 2307, University of Jaén, Jaén, Spain.
| | - M Carmen Fernández-Santaella
- Department of Personality, Assessment and Psychological Treatment, Faculty of Psychology, Campus la Cartuja s/n, 18071, University of Granada, Granada, Spain.
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25
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Trottier K, Carter JC, MacDonald DE, McFarlane T, Olmsted MP. Adjunctive graded body image exposure for eating disorders: A randomized controlled initial trial in clinical practice. Int J Eat Disord 2015; 48:494-504. [PMID: 25139056 DOI: 10.1002/eat.22341] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/16/2015] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Graded body image exposure is a key component of CBT for eating disorders (EDs). However, despite being a highly anxiety-provoking intervention, its specific effectiveness is unknown. The aims of this initial study were to investigate the feasibility and preliminary effectiveness of individualized graded body image exposure to a range of feared/avoided body image-related situations in a sample of partially remitted ED patients. METHOD Forty-five female adult participants were randomly assigned to maintenance treatment as usual (MTAU) only or MTAU plus five sessions of graded body image exposure. RESULTS The graded body image exposure intervention led to large improvements in body avoidance as measured by two different methods. In addition, there was evidence of a significant impact of body image exposure on the overvaluation of shape, but not weight, 5 months after treatment. DISCUSSION Taken together, the current results provide evidence of the feasibility of adjunctive individualized graded body image exposure within a clinical treatment program and suggest that graded body image exposure reduces body avoidance behaviors in partially remitted ED patients. Our findings suggest that individualized graded body image exposure shows promise as an intervention targeting the overvaluation of shape in EDs.
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Affiliation(s)
- Kathryn Trottier
- Department of Psychiatry, University Health Network, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
| | | | - Danielle E MacDonald
- Department of Psychiatry, University Health Network, Toronto, Canada.,Department of Psychology, Ryerson University, Toronto, Canada
| | - Traci McFarlane
- Department of Psychiatry, University Health Network, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada.,Department of Psychology, Ryerson University, Toronto, Canada
| | - Marion P Olmsted
- Department of Psychiatry, University Health Network, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
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26
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Servián-Franco F, Moreno-Domínguez S, del Paso GAR. Body dissatisfaction and mirror exposure: evidence for a dissociation between self-report and physiological responses in highly body-dissatisfied women. PLoS One 2015; 10:e0122737. [PMID: 25830861 PMCID: PMC4382336 DOI: 10.1371/journal.pone.0122737] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 02/12/2015] [Indexed: 11/19/2022] Open
Abstract
Background Weight and shape concerns are widespread in the general population. Mirror exposure has been used to reduce body dissatisfaction but little is known about the mechanisms which underlie this therapeutic technique. The present study examined emotional, cognitive, and psychophysiological responses, in women with high and low levels of body dissatisfaction, exposed to their own bodies in a mirror. Method Forty-two university-attending women (21 high body-dissatisfied (HBD) and 21 low body-dissatisfied (LBD)), were confronted with their own body during four 5-min trials in which participants were instructed to focus their attention on different parts of their body under standardized conditions. Emotional and cognitive measures were taken after each exposure trial. Heart rate (HR) and skin conductance (SC) were recorded continuously. Results HBD women experienced more negative emotions and cognitions following body exposure compared to LBD women but, conversely, showed a reduced physiological reaction in terms of HR and SC. In both groups greater physiological responses were observed looking at the thighs, buttocks, and abdomen. Extent of negative emotions and cognitions were positively associated with HR and/or SC in LBD women but no associations were observed in HBD women. Conclusion The dissociation between self-report and psychophysiological measures in HBD women supports the existence of a passive-behavioral inhibited coping style in HBD women and suggests deficiencies in the generation of physiological correlates of emotion related to body dissatisfaction.
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27
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Ortega-Roldán B, Rodríguez-Ruiz S, Díaz-Ferrer S, Fernández-Santaella MC, Vila J. Feeling bad posing as a model: an objective manner of study upward own-body comparisons in body-dissatisfied women. EUROPEAN EATING DISORDERS REVIEW 2014; 22:470-8. [PMID: 25257215 DOI: 10.1002/erv.2323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 07/15/2014] [Accepted: 09/03/2014] [Indexed: 11/12/2022]
Abstract
Emotional effects of upward body comparisons are suggested to occur automatically. A startle reflex paradigm was used to objectively examine the emotions elicited by viewing a picture of one's own body adopting a model pose or a neutral pose, in 30 women with high body dissatisfaction (HBD) and 33 women with low body dissatisfaction (LBD). In-task emotional responses in perceived valence, arousal and control were assessed. Additionally, post-task positive/negative and body-related beauty feelings were recorded. The results revealed that HBD women, compared with LBD women, showed (i) less pleasure, higher activation and less control whilst viewing their own bodies and (ii) less pleasure, more negative/ugliness feelings and an increased startle response when viewing themselves posing as models. The data showed that their own bodies provoked an immediate negative emotional state in HBD women. However, greater aversive psychophysiological mechanisms were automatically activated only when these women posed as models, suggesting that they made upward own-body comparisons.
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Affiliation(s)
- Blanca Ortega-Roldán
- Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Facultad de Psicología, University of Granada, Granada, Spain
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28
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An examination of body tracing among women with high body dissatisfaction. Body Image 2014; 11:346-9. [PMID: 24973477 DOI: 10.1016/j.bodyim.2014.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Revised: 05/09/2014] [Accepted: 05/21/2014] [Indexed: 11/24/2022]
Abstract
Within eating disorder treatment programs, a body tracing activity is often used to address body dissatisfaction and overestimation of body size; however, the effects of this activity have never been empirically evaluated. This research examined the effects of body tracing on body dissatisfaction and mood among 56 female participants assigned to either a body tracing or control group. Scores were collected on trait body dissatisfaction and a series of Visual Analogue Scales (VAS). Results showed that trait body dissatisfaction moderated the relationship between group and levels of state appearance dissatisfaction and anxiety. These results suggest that individuals experiencing higher levels of trait body dissatisfaction demonstrated greater state body dissatisfaction following participation in the body tracing activity. Individuals with lower trait body dissatisfaction experienced greater anxiety after drawing a human body. These findings have potential implications for the use of this strategy in the treatment of eating disorder patients.
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29
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Lavagnino L, Amianto F, D'Agata F, Huang Z, Mortara P, Abbate-Daga G, Marzola E, Spalatro A, Fassino S, Northoff G. Reduced resting-state functional connectivity of the somatosensory cortex predicts psychopathological symptoms in women with bulimia nervosa. Front Behav Neurosci 2014; 8:270. [PMID: 25136302 PMCID: PMC4120855 DOI: 10.3389/fnbeh.2014.00270] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 07/21/2014] [Indexed: 12/03/2022] Open
Abstract
Background: Alterations in the resting-state functional connectivity (rs-FC) of several brain networks have been demonstrated in eating disorders. However, very few studies are currently available on brain network dysfunctions in bulimia nervosa (BN). The somatosensory network is central in processing body-related stimuli and it may be altered in BN. The present study therefore aimed to investigate rs-FC in the somatosensory network in bulimic women. Methods: Sixteen medication-free women with BN (age = 23 ± 5 years) and 18 matched controls (age = 23 ± 3 years) underwent a functional magnetic resonance resting-state scan and assessment of eating disorder symptoms. Within-network and seed-based functional connectivity analyses were conducted to assess rs-FC within the somatosensory network and to other areas of the brain. Results: Bulimia nervosa patients showed a decreased rs-FC both within the somatosensory network (t = 9.0, df = 1, P = 0.005) and with posterior cingulate cortex and two visual areas (the right middle occipital gyrus and the right cuneus) (P = 0.05 corrected for multiple comparison). The rs-FC of the left paracentral lobule with the right middle occipital gyrus correlated with psychopathology measures like bulimia (r = −0.4; P = 0.02) and interoceptive awareness (r = −0.4; P = 0.01). Analyses were conducted using age, BMI (body mass index), and depressive symptoms as covariates. Conclusion: Our findings show a specific alteration of the rs-FC of the somatosensory cortex in BN patients, which correlates with eating disorder symptoms. The region in the right middle occipital gyrus is implicated in body processing and is known as extrastriate body area (EBA). The connectivity between the somatosensory cortex and the EBA might be related to dysfunctions in body image processing. The results should be considered preliminary due to the small sample size.
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Affiliation(s)
- Luca Lavagnino
- Department of Neuroscience, AOU San Giovanni Battista , Turin , Italy ; Institute of Mental Health Research, University of Ottawa, Royal Ottawa Healthcare Group , Ottawa, ON , Canada
| | - Federico Amianto
- Department of Neuroscience, AOU San Giovanni Battista , Turin , Italy
| | - Federico D'Agata
- Department of Neuroscience, AOU San Giovanni Battista , Turin , Italy
| | - Zirui Huang
- Institute of Mental Health Research, University of Ottawa, Royal Ottawa Healthcare Group , Ottawa, ON , Canada
| | - Paolo Mortara
- Department of Neuroscience, AOU San Giovanni Battista , Turin , Italy
| | | | - Enrica Marzola
- Department of Neuroscience, AOU San Giovanni Battista , Turin , Italy
| | - Angela Spalatro
- Department of Neuroscience, AOU San Giovanni Battista , Turin , Italy
| | - Secondo Fassino
- Department of Neuroscience, AOU San Giovanni Battista , Turin , Italy
| | - Georg Northoff
- Institute of Mental Health Research, University of Ottawa, Royal Ottawa Healthcare Group , Ottawa, ON , Canada ; Graduate Institute of Humanities in Medicine, Taipei Medical University , Taipei , Taiwan ; Brain and Consciousness Research Center, Taipei Medical University-Shuang Ho Hospital , New Taipei City , Taiwan ; Research Center for Mind, Brain and Learning, National Chengchi University , Taipei , Taiwan ; Department of Psychology, National Chengchi University , Taipei , Taiwan ; Centre for Cognition and Brain Disorders (CCBD), Normal University Hangzhou , Hangzhou , China
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Ortega-Roldán B, Rodríguez-Ruiz S, Perakakis P, Fernández-Santaella MC, Vila J. The emotional and attentional impact of exposure to one's own body in bulimia nervosa: a physiological view. PLoS One 2014; 9:e102595. [PMID: 25036222 PMCID: PMC4103750 DOI: 10.1371/journal.pone.0102595] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Accepted: 06/20/2014] [Indexed: 11/25/2022] Open
Abstract
Background Body dissatisfaction is the most relevant body image disturbance in bulimia nervosa (BN). Research has shown that viewing one's own body evokes negative thoughts and emotions in individuals with BN. However, the psychophysiological mechanisms involved in this negative reaction have not yet been clearly established. Our aim was to examine the emotional and attentional processes that are activated when patients with BN view their own bodies. Method We examined the effects of viewing a video of one's own body on the physiological (eye-blink startle, cardiac defense, and skin conductance) and subjective (pleasure, arousal, and control ratings) responses elicited by a burst of 110 dB white noise of 500 ms duration. The participants were 30 women with BN and 30 healthy control women. The experimental task consisted of two consecutive and counterbalanced presentations of the auditory stimulus preceded, alternatively, by a video of the participant's own body versus no such video. Results The results showed that, when viewing their own bodies, women with BN experienced (a) greater inhibition of the startle reflex, (b) greater cardiac acceleration in the first component of the defense reaction, (c) greater skin conductance response, and (d) less subjective pleasure and control combined with greater arousal, compared with the control participants. Conclusion Our findings suggest that, for women with BN, peripheral-physiological responses to self-images are dominated by attentional processes, which provoke an immobility reaction caused by a dysfunctional negative response to their own body.
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Affiliation(s)
- Blanca Ortega-Roldán
- Department of Personality, Evaluation and Psychological Treatment, University of Granada, Granada, Spain
- * E-mail:
| | - Sonia Rodríguez-Ruiz
- Department of Personality, Evaluation and Psychological Treatment, University of Granada, Granada, Spain
| | - Pandelis Perakakis
- Department of Personality, Evaluation and Psychological Treatment, University of Granada, Granada, Spain
- Laboratory of Experimental Economics, Department of Economics, University Jaume I, Castellón, Spain
| | | | - Jaime Vila
- Department of Personality, Evaluation and Psychological Treatment, University of Granada, Granada, Spain
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Trentowska M, Svaldi J, Tuschen-Caffier B. Efficacy of body exposure as treatment component for patients with eating disorders. J Behav Ther Exp Psychiatry 2014; 45:178-85. [PMID: 24172146 DOI: 10.1016/j.jbtep.2013.09.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Revised: 09/11/2013] [Accepted: 09/18/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND OBJECTIVES Body exposure and cognitive restructuring are well known interventions in cognitive-behavioral therapies for patients with eating disorders. Though promising, little is known about the impact of body exposure on body dissatisfaction, overvaluation of weight and shape and other aspects of eating disorder psychopathology. Thus, the aim of the two studies presented here is to evaluate the efficacy of mirror exposure and video exposure on body dissatisfaction, weight and shape concerns and other aspects of eating disorder psychopathology. METHOD STUDY 1: Fourteen women diagnosed with Eating Disorders Not Otherwise Specified (EDNOS; DSM-IV-TR) were treated in repeated mirror exposure sessions. Assessments were carried out before (baseline) and after body exposure. RESULTS STUDY 1 Measures of body dissatisfaction, shape concerns and eating disorder psychopathology were significantly improved at the post treatment assessment. METHOD STUDY 2: Thirteen women with Bulimia Nervosa (BN; DSM-IV-TR) received repeated mirror and video exposure sessions. Measures were assessed before (baseline) and after body exposure. RESULTS STUDY 2: Body image dissatisfaction was significantly improved at post treatment assessment. LIMITATIONS These preliminary results are based on subjective data from two small clinical samples. Comparisons between the studies are limited by design variations. CONCLUSIONS The studies provide evidence that body exposure is a promising technique for treatment of body dissatisfaction in EDNOS and BN. Moreover, in EDNOS shape concern and aspects of eating disorder psychopathology were improved after body exposure. Reasons for the lack of change in shape and weight concern as well as in eating disorder psychopathology in BN are discussed.
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Affiliation(s)
- Monika Trentowska
- Department of Clinical Psychology and Psychotherapy, Albert-Ludwigs-University, Freiburg, Germany.
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