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Behrend N, Webb JB, Warschburger P. Explaining the prospective paths from body appreciation to intuitive eating facets: Does body image flexibility serve as a mediator? Body Image 2024; 49:101710. [PMID: 38569448 DOI: 10.1016/j.bodyim.2024.101710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 03/22/2024] [Accepted: 03/22/2024] [Indexed: 04/05/2024]
Abstract
Initial evidence suggests that body appreciation prospectively predicts intuitive eating. However, the limited number of longitudinal studies focused solely on girls and women, with a lack of evaluation among men. Furthermore, the underlying mechanisms explaining this relationship remain poorly understood. The present study examined whether body appreciation prospectively predicted intuitive eating facets among women and men in Germany. We also tested whether adaptive affect regulation skills (i.e., body image flexibility) mediated these relationships. We analyzed data from 1436 women and 704 men across three time points: Baseline (T1), 6-month (T2), and 12-month (T3) follow-up, using latent variable path models to assess direct and indirect effects. Among women, T1 body appreciation directly predicted T3 body-food choice congruence. Additionally, body appreciation indirectly predicted unconditional permission to eat, eating for physical rather than emotional reasons, and reliance on hunger and satiety cues at T3 via its effect on T2 body image flexibility. Among men, T1 body appreciation indirectly predicted T3 eating for physical rather than emotional reasons via T2 body image flexibility. Our findings suggest that body image flexibility plays a pivotal role in explaining why individuals who appreciate their bodies are more likely to eat intuitively.
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Affiliation(s)
- Nicole Behrend
- University of Potsdam, Department of Psychology, Counseling Psychology, Potsdam, Germany
| | - Jennifer B Webb
- University of North Carolina at Charlotte, Department of Psychological Science, Health Psychology Ph.D. Program, Charlotte, NC, United States
| | - Petra Warschburger
- University of Potsdam, Department of Psychology, Counseling Psychology, Potsdam, Germany.
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2
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Chen G, Wang X, Barnhart WR, Fu Y, He J. Exploring the moderating roles of dispositional mindfulness and body image flexibility in the association between body dissatisfaction and disordered eating in Chinese adolescents. J Clin Psychol 2024. [PMID: 38781606 DOI: 10.1002/jclp.23706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 04/06/2024] [Accepted: 05/10/2024] [Indexed: 05/25/2024]
Abstract
OBJECTIVES Previous research suggests potential moderating roles of dispositional mindfulness and body image flexibility in the association between body dissatisfaction and disordered eating. However, relevant research is mainly conducted on adult women from Western countries, and limited evidence exists for adolescent samples, especially from non-Western contexts (e.g., China). Thus, this study aimed to examine the moderating roles of dispositional mindfulness and body image flexibility in the relationship between body dissatisfaction and disordered eating in Chinese adolescents. METHOD We recruited 545 Chinese adolescents (53.9% boys, aged 12-16 years) who completed measures of body dissatisfaction, dispositional mindfulness, body image flexibility, and disordered eating. Moderation analyses were examined with PROCESS macro on SPSS. RESULTS In separate models, both higher dispositional mindfulness and body image flexibility weakened relationships between body dissatisfaction and disordered eating. However, when both dispositional mindfulness and body image flexibility were entered into the same moderation model, only body image flexibility showed a significant moderating effect. DISCUSSION Both dispositional mindfulness and body image flexibility may weaken the association between body dissatisfaction and disordered eating in adolescents. However, body image flexibility might have a stronger effect than dispositional mindfulness. These findings suggest that interventions aimed at reducing body dissatisfaction to prevent disordered eating in adolescents may pay more attention to adolescents' body image flexibility.
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Affiliation(s)
- Gui Chen
- Department of Psychology, College of Educational Science, Hengyang Normal University, Hengyang, Hunan, China
| | - Xingchang Wang
- Department of Psychology, College of Educational Science, Hengyang Normal University, Hengyang, Hunan, China
| | - Wesley R Barnhart
- Department of Psychology, Bowling Green State University, Bowling Green, Ohio, USA
| | - Yuru Fu
- Division of Applied Psychology, School of Humanities and Social Science, The Chinese University of Hong Kong, Shenzhen, Guangdong, China
| | - Jinbo He
- Division of Applied Psychology, School of Humanities and Social Science, The Chinese University of Hong Kong, Shenzhen, Guangdong, China
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3
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Raque TL, Lamphere B, Motzny C, Kauffmann J, Ziemer K, Haywood S. Pathways by Which Self-Compassion Improves Positive Body Image: A Qualitative Analysis. Behav Sci (Basel) 2023; 13:939. [PMID: 37998685 PMCID: PMC10669661 DOI: 10.3390/bs13110939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 11/08/2023] [Accepted: 11/13/2023] [Indexed: 11/25/2023] Open
Abstract
The current study applied consensual qualitative research-modified to essays written by 51 college women completing an expressive writing intervention over three time points for a total of 153 essays to identify how increases in self-compassion improve body image. A qualitative coding team tracked changes in affect and cognition over three time points. The results demonstrated that college women consistently expressed body acceptance and psychological flexibility. Additionally, the participants expressed important increases in mindfulness as well as decreases in social influences, feelings of separation, negative health behaviors, and attention to media messages. Decreases were found in their expressions of body functionality, love and kindness toward their body, and internal locus of control. These findings suggest pathways through which self-compassion may improve women's body image by increasing mindfulness and decreasing the negative ways of relating to one's body, specifically in the areas of media, clothing, make-up, and negative social interactions.
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Affiliation(s)
- Trisha L. Raque
- Department of Counseling Psychology, University of Denver, Denver, CO 80210, USA; (B.L.); (C.M.); (J.K.); (S.H.)
| | - Brooke Lamphere
- Department of Counseling Psychology, University of Denver, Denver, CO 80210, USA; (B.L.); (C.M.); (J.K.); (S.H.)
| | - Christine Motzny
- Department of Counseling Psychology, University of Denver, Denver, CO 80210, USA; (B.L.); (C.M.); (J.K.); (S.H.)
| | - Julia Kauffmann
- Department of Counseling Psychology, University of Denver, Denver, CO 80210, USA; (B.L.); (C.M.); (J.K.); (S.H.)
| | - Kathryn Ziemer
- Old Town Psychology, 1221 King Street, Alexandria, VA 22314, USA;
| | - Shaakira Haywood
- Department of Counseling Psychology, University of Denver, Denver, CO 80210, USA; (B.L.); (C.M.); (J.K.); (S.H.)
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4
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Kalika E, Hussain M, Egan H, Mantzios M. Exploring the moderating role of mindfulness, mindful eating, and self-compassion on the relationship between eating-disordered quality of life and orthorexia nervosa. Eat Weight Disord 2023; 28:18. [PMID: 36808014 PMCID: PMC9941235 DOI: 10.1007/s40519-023-01542-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 01/12/2023] [Indexed: 02/23/2023] Open
Abstract
Orthorexia nervosa (ON) is characterised by an obsessive focus on healthy eating, following restrictive dietary practices and dietary restrictions escalating over time. The aim of this study was to explore mindfulness, mindful eating, self-compassion and quality of life in a female population. Two hundred eighty-eight participants completed Orthorexia, Self-Compassion, Mindful eating, Mindfulness and Eating Disorder Quality of Life scales. The results indicated that there was a negative relationship between ON and mindfulness, self-compassion and mindful eating. Furthermore, the present study found a positive relationship between lower quality of life and ON, while findings indicated that self-compassion and the awareness facet of mindfulness moderated the relationship between ON and QOL. The present results contribute to a better understanding of orthorexic eating behaviours in a female population, and identify the moderating capacity of self-compassion and mindfulness. Further implications and future directions are discussed.Level of evidence Level V, cross-sectional descriptive study.
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Affiliation(s)
- Eliza Kalika
- Department of Psychology, Birmingham City University, Curzon Building, Office C325, Birmingham, B4 7DE, UK.
| | - Misba Hussain
- Department of Psychology, Birmingham City University, Curzon Building, Office C325, Birmingham, B4 7DE, UK
| | - Helen Egan
- Department of Psychology, Birmingham City University, Curzon Building, Office C325, Birmingham, B4 7DE, UK
| | - Michail Mantzios
- Department of Psychology, Birmingham City University, Curzon Building, Office C325, Birmingham, B4 7DE, UK
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Kalika E, Egan H, Mantzios M. Exploring the role of mindful eating and self-compassion on eating behaviours and orthorexia in people following a vegan diet. Eat Weight Disord 2022; 27:2641-2651. [PMID: 35553382 PMCID: PMC9556376 DOI: 10.1007/s40519-022-01407-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 04/11/2022] [Indexed: 11/01/2022] Open
Abstract
Orthorexia nervosa (ON) is a new concept that is more prevalent in vegan populations. ON is characterised by obsessive focus on healthy eating, following restrictive dietary practices and dietary restrictions escalating over time. The aim of this study was to explore problematic eating behaviours in a vegan population, and to explore whether mindful eating and self-compassion have an impact on ON. Two hundred and eighty-seven females and twenty-eight males who followed a vegan diet completed scales in Orthorexia, Self-Compassion, Mindful, Emotional, External and Restraint Eating. The results indicated that individuals with high levels of ON display low levels of self-compassion, and high levels of restrained eating. Moreover, the findings indicated that self-compassion, but not mindful eating, partially mediated the relationship between restrained eating and orthorexia nervosa. The present results contribute to a better understanding of orthorexic eating behaviours in a vegan population, and identifies the mediating capacity of self-compassion. Further implications and future directions are discussed.Level of evidence: Level V, cross-sectional descriptive study.
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Affiliation(s)
- Eliza Kalika
- Department of Psychology, Birmingham City University, Curzon Building, Office C325, Birmingham, B4 7DE, UK.
| | - Helen Egan
- Department of Psychology, Birmingham City University, Curzon Building, Office C325, Birmingham, B4 7DE, UK
| | - Michail Mantzios
- Department of Psychology, Birmingham City University, Curzon Building, Office C325, Birmingham, B4 7DE, UK
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6
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Jo D, Spencer SD, Masuda A. Mindfulness attenuates the positive association between disordered eating cognition and disordered eating behavior in a sample of college women. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-020-00969-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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7
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Zhan C, Heatherington L, Klingenberg B. Disordered eating- and exercise-related behaviors and cognitions during the first year college transition. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2022; 70:852-863. [PMID: 32730728 DOI: 10.1080/07448481.2020.1775608] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 05/05/2020] [Accepted: 05/22/2020] [Indexed: 06/11/2023]
Abstract
ObjectiveDuring the college transition, vulnerability to disordered eating and exercise behaviors and cognitions may increase. We studied how behaviors and cognitions change differentially over time, in the context of gender, athletic participation, and contingencies of self-worth. Participants: 229 diverse, first-year students at a competitive liberal arts college. Methods: Three-wave longitudinal study employing surveys before, during, and following the first semester, using linear mixed model analyses. Results: There were changes over time in one measure of disordered exercise-related cognitions and exercise frequency; disordered eating showed no significant changes over time. Athletic participation and basing a lower amount of self-worth on appearance were protective against subclinical disordered cognitions and behaviors; gender was not predictive. Conclusion: Health personnel should consider athletic participation and contingencies of self-worth when assessing students' risk for ED symptoms, in both genders. Early interventions may be useful, as changes were observed within the first three months of college.
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Affiliation(s)
- Chanel Zhan
- School of Medicine, Duke University, Durham, NC, USA
| | | | - Bernhard Klingenberg
- Department of Mathematics and Statistics, Williams College, Williamstown, MA, USA
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8
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Gwira R, DeBlaere C, shodiya-zeumault S, Davis DE. Perfectionism and disordered eating cognitions with women of color: The moderating role of self-compassion. PERSONALITY AND INDIVIDUAL DIFFERENCES 2021. [DOI: 10.1016/j.paid.2021.110923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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9
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Di Corrado D, Coco M, Guarnera M, Maldonato NM, Quartiroli A, Magnano P. The Influence of Self-Efficacy and Locus of Control on Body Image: A Path-Analysis in Aspiring Fashion Models, Athletes and Students. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18116128. [PMID: 34204114 PMCID: PMC8201046 DOI: 10.3390/ijerph18116128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 05/27/2021] [Accepted: 06/03/2021] [Indexed: 01/24/2023]
Abstract
It is widely documented that negative body image is a significant public health concern due to its association with symptoms of disordered eating and worse psychological well-being. The purpose of the study was to develop a path model of intrapersonal dimensions (self-efficacy and internal locus of control) as antecedents of perceived stress toward females’ body dissatisfaction and eating attitude disorders. A total of 300 females, including 100 aspiring fashion models, 100 athletes and 100 students (controls), between 15 and 24 years of age (M = 19.6, SD = 1.85) participated in the study. Measures included level of psychological stress, self-efficacy and locus of control dimensions, body dissatisfaction and eating attitude disorder indices. A path analysis confirmed our research hypothesis. Comparing the three subsamples, we found better fit indexes in the two subgroups with elevated investment on their body image with respect the control group. More specifically, the model in the group of aspiring fashion models showed the best fit index. These results indicated that aspiring fashion models have a strong desire to maintain their low body mass or to become thinner. For this reason, a suitable involvement of expert health workers in the nutritional and psychological field could be extremely essential in the fashion world to maintain a healthier well-being.
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Affiliation(s)
- Donatella Di Corrado
- Department of Sport Sciences, Kore University, Cittadella Universitaria, 94100 Enna, Italy
- Correspondence:
| | - Marinella Coco
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95123 Catania, Italy;
| | - Maria Guarnera
- Faculty of Human and Social Sciences, Kore University, 94100 Enna, Italy; (M.G.); (P.M.)
| | - Nelson Mauro Maldonato
- Department of Neuroscience and Reproductive and Odontostomatological Sciences, University of Naples Federico II, 80138 Naples, Italy;
| | - Alessandro Quartiroli
- Department of Psychology, University of Wisconsin-La Crosse, La Crosse, WI 54601, USA;
- School of Sport, Health and Exercise Science, University of Portsmouth, Portsmouth PO1 2UP, UK
| | - Paola Magnano
- Faculty of Human and Social Sciences, Kore University, 94100 Enna, Italy; (M.G.); (P.M.)
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10
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Linardon J, Anderson C, Messer M, Rodgers RF, Fuller-Tyszkiewicz M. Body image flexibility and its correlates: A meta-analysis. Body Image 2021; 37:188-203. [PMID: 33684721 DOI: 10.1016/j.bodyim.2021.02.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 02/14/2021] [Accepted: 02/14/2021] [Indexed: 12/16/2022]
Abstract
Body image flexibility refers to the ability to openly experience thoughts or feelings about the body without acting on them or trying to change them. Accumulating evidence has demonstrated that body image flexibility is connected to numerous adaptive processes, and that it is sensitive to change during psychological interventions. However, a quantitative synthesis of empirical research on body image flexibility is lacking. We conducted the first meta-analysis on body image flexibility and its correlates. Sixty-two studies were included. Random effects meta-analyses were conducted on 19 psychological correlates, divided into three clusters: eating and body image disturbances, positive body-related and general psychological constructs, and general psychopathology. Meta-analyses showed inverse correlations between body image flexibility and each construct within the eating and body image disturbances cluster (rs= -.45 to -.67), and the general psychopathology cluster (rs= -.37 to -.58). Body image flexibility was positively associated with each positive psychology construct (rs = .23 - .58). Men reported higher levels of body image flexibility than women (d = 0.32). Psychological interventions were more effective than control groups at enhancing body image flexibility in randomized controlled trials (d = 0.42). Findings confirm that body image flexibility is consistently connected to indices of mental health, and that it can be enhanced during psychological interventions.
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Affiliation(s)
- Jake Linardon
- School of Psychology, Deakin University, 1 Gheringhap Street, Geelong, VIC, 3220, Australia.
| | - Cleo Anderson
- School of Psychology, Deakin University, 1 Gheringhap Street, Geelong, VIC, 3220, Australia
| | - Mariel Messer
- School of Psychology, Deakin University, 1 Gheringhap Street, Geelong, VIC, 3220, Australia
| | - Rachel F Rodgers
- Department of Applied Psychology, North Eastern University, 360 Huntington Ave, Boston, MA, 02115, USA; Department of Psychiatric Emergency & Acute Care, Lapeyronie Hospital, CHRU Montpellier, France
| | - Matthew Fuller-Tyszkiewicz
- School of Psychology, Deakin University, 1 Gheringhap Street, Geelong, VIC, 3220, Australia; Center for Social and Early Emotional Development, Deakin University, Burwood, VIC, 3125, Australia
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11
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Strahler J. Trait mindfulness differentiates the interest in healthy diet from orthorexia nervosa. Eat Weight Disord 2021; 26:993-998. [PMID: 32445115 PMCID: PMC8004484 DOI: 10.1007/s40519-020-00927-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 05/11/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Obsessive healthy eating and its extreme form orthorexia nervosa are epidemiologically significant problems. Mindfulness, the focused, non-judgmental attention to and awareness of present events, may be an important psychological contributor to (orthorexic) eating habits. METHODS In this cross-sectional survey-based study, 314 women and 75 men (mean agetotal sample = 27.17 years, SD = 10.64) provided data on mindfulness (Freiburg Mindfulness Inventory, presence and acceptance subscale) and orthorexic eating (Teruel Orthorexia Scale, healthy orthorexia and orthorexia nervosa subscale). RESULTS In this study, we found a positive relation between mindfulness and healthy orthorexia, the non-pathological interest in eating healthy. By contrast, orthorexia nervosa, the pathological obsession with healthy eating, was negatively associated with mindfulness. Gender differences appeared neglectable. CONCLUSION Taken together, these results confirm previous research showing that mindfulness encourages eating healthy and may protect against eating-related pathologies. Result also support the notion that orthorexia has two dimensions, healthy and nervosa, which are differently related to psychological factors, herein mindfulness. LEVEL OF EVIDENCE Level III, cohort study.
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Affiliation(s)
- J Strahler
- Psychotherapy and Systems Neuroscience, Justus-Liebig-University Giessen, Otto-Behaghel-Str. 10H, 35394, Giessen, Germany. .,Health Psychology and Applied Diagnostics, Bergische University Wuppertal, Wuppertal, Germany.
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12
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Cardoso A, Oliveira S, Ferreira C. Negative and positive affect and disordered eating: The adaptive role of intuitive eating and body image flexibility. CLIN PSYCHOL-UK 2021. [DOI: 10.1111/cp.12224] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Ana Cardoso
- CINEICC – Center for Research in Neuropsychology and Cognitive and Behavioral Intervention Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal,
| | - Sara Oliveira
- CINEICC – Center for Research in Neuropsychology and Cognitive and Behavioral Intervention Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal,
| | - Cláudia Ferreira
- CINEICC – Center for Research in Neuropsychology and Cognitive and Behavioral Intervention Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal,
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13
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Godfrey KM, Butryn ML, Forman EM, Martinez M, Roberts SR, Sherwood NE. Depressive symptoms, psychological flexibility, and binge eating in individuals seeking behavioral weight loss treatment. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2020; 14:50-54. [PMID: 32864324 DOI: 10.1016/j.jcbs.2019.09.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Depressive symptoms and binge eating are both prevalent in weight management populations and may be associated with reduced benefit from behavioral weight loss, including higher attrition, more perceived barriers, lower weight loss, and increased weight regain. These two potential risk factors for poor behavioral weight loss outcomes may also be associated with each other as depressive symptoms may trigger binge eating, and binge eating-related distress could increase depressive symptoms. The depressive symptom-binge eating link has not been well studied in weight management samples, and psychological processes involved in this relationship have not yet been elucidated. Psychological flexibility, an individual's ability to be connected with and conscious of the present moment and to engage in values-consistent behavior even in the presence of difficult internal experiences, may be one psychological process that changes the depressive symptom-binge eating relationship. High psychological flexibility may be a protective factor in the association of depressive symptoms with binge eating. This study examined the relationship between depressive symptom and binge eating and a potential interactive role of psychological flexibility. Participants (N = 468, 76% female) completed self-report questionnaires of binge eating, depressive symptoms, and psychological flexibility at baseline prior to initiating behavioral weight loss. Depressive symptoms were positively associated with binge eating (B = 1.00, p < 0.001). Psychological flexibility had an interactive role (B = -0.03, p = 0.005). Among participants with minimal to mild depressive symptoms, those with higher psychological flexibility had less severe binge eating. Findings suggest that psychological flexibility may be a protective factor in the association between depressive symptoms and binge eating in the majority of individuals initiating behavioral weight loss. Psychological flexibility is a psychological process to consider targeting for enhancing efficacy of weight loss treatment, especially among individuals with minimal to mild depressive symptoms and binge eating behavior.
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Affiliation(s)
- Kathryn M Godfrey
- Center for Weight, Eating, and Lifestyle Science (WELL Center), Drexel University, Philadelphia, PA, USA
| | - Meghan L Butryn
- Center for Weight, Eating, and Lifestyle Science (WELL Center), Drexel University, Philadelphia, PA, USA
| | - Evan M Forman
- Center for Weight, Eating, and Lifestyle Science (WELL Center), Drexel University, Philadelphia, PA, USA
| | - Monica Martinez
- Center for Weight, Eating, and Lifestyle Science (WELL Center), Drexel University, Philadelphia, PA, USA
| | - Savannah R Roberts
- Center for Weight, Eating, and Lifestyle Science (WELL Center), Drexel University, Philadelphia, PA, USA
| | - Nancy E Sherwood
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
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14
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Psychometric Properties of the Body Image Acceptance and Action Questionnaire in Patients with Somatic Symptom and Related Disorders in Kashan City. IRANIAN JOURNAL OF PSYCHIATRY AND BEHAVIORAL SCIENCES 2020. [DOI: 10.5812/ijpbs.69889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: The Body Image Acceptance and Action Questionnaire (BI-AAQ) assesses cognitive flexibility and acceptance of body image. Objectives: This study was done to assess the validity and reliability of the Persian version of BI-AAQ, as an instrument to measure body image flexibility, in patients with somatic symptom and related disorders. Methods: This descriptive psychometric study was done in 2017 on 357 patients with somatic symptom and related disorders selected through a convenient sampling method from Kashan University of Medical Sciences clinics. They responded to the BI-AAQ, Depression, Anxiety, and Stress Scale (DASS), Acceptance and Action Questionnaire-II (AAQ-II), and Freiburg Mindfulness Inventory (FMI). The reliability of the BI-AAQ was calculated using Cronbach’s alpha coefficient. To assess its validity, the exploratory and confirmatory factor analyses were used. The gathered data were analyzed via SPSS-22 and Amos-22 software. Results: This version retained a one-factor structure, similar to the original version of the questionnaire, which explained 42.55% of the variance. It had high internal consistency (0.84), split-half method (0.77), and correlates with AAQ (0.45), mindfulness (0.39) and correlates contrastingly with stress (0.11), anxiety (0.36) and depression (0.43). Conclusions: According to the results of the current research, the BI-AAQ is a reliable instrument with valid psychometric properties to measure the body image acceptance of individuals in Iranian patients with somatic symptom and related disorders.
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15
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Sala M, Shankar Ram S, Vanzhula IA, Levinson CA. Mindfulness and eating disorder psychopathology: A meta-analysis. Int J Eat Disord 2020; 53:834-851. [PMID: 32100320 DOI: 10.1002/eat.23247] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 01/26/2020] [Accepted: 01/26/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Mindfulness is implicated in eating disorder (ED) psychopathology. However, this literature has not been synthesized to date. The current meta-analysis examined the associations between mindfulness and ED psychopathology. METHODS A total of 74 independent samples (effects = 576) were included. We used a multilevel random-effects model to estimate summary study-level effect sizes, and multilevel mixed-effects models to examine moderator effects. RESULTS Mindfulness was negatively associated with ED psychopathology (r = -.25, p < .001), both concurrently (r = -.25, p < .001) and prospectively (rs = -.22 to -.24, ps < .001). Associations were strongest for binge eating, emotional/external eating, and body dissatisfaction as well as the acting with awareness and nonjudging facets. DISCUSSION Mindfulness may be an important process in ED psychopathology. Future research should prospectively and experimentally examine the relation between mindfulness and ED psychopathology.
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Affiliation(s)
- Margarita Sala
- Department of Psychology, Southern Methodist University, Dallas, Texas
| | - Shruti Shankar Ram
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, Kentucky
| | - Irina A Vanzhula
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, Kentucky
| | - Cheri A Levinson
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, Kentucky
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16
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Fogelkvist M, Gustafsson SA, Kjellin L, Parling T. Acceptance and commitment therapy to reduce eating disorder symptoms and body image problems in patients with residual eating disorder symptoms: A randomized controlled trial. Body Image 2020; 32:155-166. [PMID: 32000093 DOI: 10.1016/j.bodyim.2020.01.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 01/09/2020] [Accepted: 01/14/2020] [Indexed: 01/26/2023]
Abstract
Body image problems are central aspects of eating disorders (ED), and risk factors both for the development of and relapse into an ED. Acceptance and commitment therapy (ACT) aims at helping patients accept uncomfortable internal experiences while committing to behaviors in accordance with life values. The aim of the present study was to compare the effectiveness of a group intervention, consisting of 12 sessions, based on ACT to treatment as usual (TAU) for patients with residual ED symptoms and body image problems. The study was a randomized controlled superiority trial. Patients with residual ED symptoms and body image problems were recruited from a specialized ED clinic in Sweden. The final sample consisted of 99 women, randomized to ACT or TAU. At the two-year follow-up, patients who received ACT showed a significant greater reduction in ED symptoms and body image problems and received less specialized ED care than patients in TAU. In conclusion, ACT was superior in reducing ED symptoms and body image problems.
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Affiliation(s)
- Maria Fogelkvist
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, SE 701 82 Örebro, Sweden.
| | - Sanna Aila Gustafsson
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, SE 701 82 Örebro, Sweden.
| | - Lars Kjellin
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, SE 701 82 Örebro, Sweden.
| | - Thomas Parling
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Stockholm County Council, The Centre for Psychotherapy, Education & Research, Liljeholmstorget 7, SE-117 63 Stockholm, Sweden.
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17
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Tan W, Holt N, Krug I, Ling M, Klettke B, Linardon J, Baxter K, Hemmings S, Howard D, Hughes E, Rivelli-Rojas I, Fuller-Tyszkiewicz M. Trait body image flexibility as a predictor of body image states in everyday life of young Australian women. Body Image 2019; 30:212-220. [PMID: 31377478 DOI: 10.1016/j.bodyim.2019.07.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 07/17/2019] [Accepted: 07/17/2019] [Indexed: 10/26/2022]
Abstract
The present study evaluated whether individuals with varying levels of trait body image flexibility differ in the severity, variability, and correlates of state body dissatisfaction experienced in their daily lives. One hundred and forty-seven women completed a baseline measure of trait body image flexibility, followed by a 7-day ecological momentary assessment phase in which participants self-reported state body dissatisfaction, disordered eating behavior, drive for thinness, and appearance comparisons at 10 semi-random intervals daily. Higher trait body image flexibility predicted lower average scores, less frequent reporting of high state body dissatisfaction, and less variability in their state body dissatisfaction ratings. Individuals with higher trait body image flexibility were also less likely to engage in a range of behaviors and cognitions previously shown to produce body dissatisfaction, including upward appearance comparisons, drive for thinness, binge eating, and dieting. However, few of these state-based relationships involving body dissatisfaction and these related behaviors and cognitions were moderated by trait body image flexibility. Overall, this pattern of findings suggests that body image flexible individuals may have less negative body image because they are less inclined to engage in behaviors and cognitions in their daily lives that encourage negative body image.
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Affiliation(s)
- Weixi Tan
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Naomi Holt
- School of Psychology, Deakin University, Geelong, Victoria, 3220, Australia
| | - Isabel Krug
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Mathew Ling
- School of Psychology, Deakin University, Geelong, Victoria, 3220, Australia
| | - Bianca Klettke
- School of Psychology, Deakin University, Geelong, Victoria, 3220, Australia
| | - Jake Linardon
- School of Psychology, Deakin University, Geelong, Victoria, 3220, Australia
| | - Kimberley Baxter
- School of Psychology, Deakin University, Geelong, Victoria, 3220, Australia
| | - Shelley Hemmings
- School of Psychology, Deakin University, Geelong, Victoria, 3220, Australia
| | - Dominika Howard
- School of Psychology, Deakin University, Geelong, Victoria, 3220, Australia
| | - Erin Hughes
- School of Psychology, Deakin University, Geelong, Victoria, 3220, Australia
| | | | - Matthew Fuller-Tyszkiewicz
- School of Psychology, Deakin University, Geelong, Victoria, 3220, Australia; Center for Social and Early Emotional Development, Deakin University, Burwood, Victoria, 3125, Australia.
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18
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A review of AAQ variants and other context-specific measures of psychological flexibility. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2019. [DOI: 10.1016/j.jcbs.2019.02.007] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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19
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Pellizzer ML, Waller G, Wade TD. Predictors of outcome in cognitive behavioural therapy for eating disorders: An exploratory study. Behav Res Ther 2019; 116:61-68. [PMID: 30798180 DOI: 10.1016/j.brat.2019.02.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 01/25/2019] [Accepted: 02/06/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Early decrease in symptoms is a consistent predictor of good treatment outcome across all eating disorders. The current study explored the predictive value of novel early change variables in a transdiagnostic, non-underweight sample receiving 10-session cognitive behavioural therapy. METHOD Participants who reported bingeing and/or purging in the week preceding baseline assessment (N = 62) were included in analyses. Early change variables were calculated for novel (body image flexibility, body image avoidance, body checking, and fear of compassion) and established predictors (behavioural symptoms and therapeutic alliance). Outcomes were global eating disorder psychopathology and clinical impairment at posttreatment and three-month follow-up. Intent-to-treat analyses were conducted using linear regression, adjusting for baseline values of the relevant outcome and early change in behavioural symptoms. RESULTS Early improvement in body image flexibility was the most consistent predictor of good outcome. Early change in body image avoidance and the fear of expressing and receiving compassion to/from others were significant predictors in some analyses. DISCUSSION Novel early change variables were significant predictors of eating disorder outcomes in this exploratory study. Model testing is required to understand the exact mechanisms by which these variables impact on outcomes, and whether there is potential benefit of modifying existing protocols. ANZCTR TRIAL NUMBER ACTRN12615001098527.
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Affiliation(s)
- Mia L Pellizzer
- College of Education Psychology & Social Work, Flinders University, Adelaide, South Australia, Australia.
| | - Glenn Waller
- Department of Psychology, University of Sheffield, United Kingdom
| | - Tracey D Wade
- College of Education Psychology & Social Work, Flinders University, Adelaide, South Australia, Australia
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20
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Black EB, Garratt M, Beccaria G, Mildred H, Kwan M. Body image as a predictor of nonsuicidal self-injury in women: A longitudinal study. Compr Psychiatry 2019; 88:83-89. [PMID: 30529911 DOI: 10.1016/j.comppsych.2018.11.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 10/19/2018] [Accepted: 11/21/2018] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVES To determine whether Body Image Dissatisfaction (BID) predicted NonSuicidal Self-Injury (NSSI) cross-sectionally and longitudinally, independent of comorbidity between NSSI and Disordered Eating (DE). Another aim was to determine whether BID could predict number of NSSI methods present. METHOD Adult females completed measures of NSSI and DE (n = 283); and a longitudinal sample (n = 106) completed these measures again one year later. RESULTS BID was a small yet significant predictor of NSSI both cross-sectionally and longitudinally. Poorer BID significantly explained a greater number of NSSI methods cross-sectionally and longitudinally. CONCLUSIONS BID explains unique variance in NSSI (including increased number of methods), and is not a function of comorbidity with DE. This has the potential to influence theory, as well as inform early intervention initiatives for BID in females. Further research is required to determine other variables implicated in this relationship, as well as whether these findings are applicable to other groups such as adolescents and males.
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Affiliation(s)
- Emma B Black
- The University of Queensland, Australia; Deakin University, Australia.
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21
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Rogers CB, Webb JB, Jafari N. A systematic review of the roles of body image flexibility as correlate, moderator, mediator, and in intervention science (2011-2018). Body Image 2018; 27:43-60. [PMID: 30144730 DOI: 10.1016/j.bodyim.2018.08.003] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 08/06/2018] [Accepted: 08/06/2018] [Indexed: 01/25/2023]
Abstract
The emergence of body image flexibility into the positive body image nomenclature has innovatively expanded the conceptualization of how individuals may adaptively respond to body image threats. Given the notable growth of interest in researching this construct over nearly the past decade, the present analysis provides a systematic and critical review of evidence examining the roles of body image flexibility as correlate, mediator, moderator, and in intervention research. Results indicated that body image flexibility tended to demonstrate a pattern of relationships with correlates in directions predicted by its conceptualization and showed promise in functioning as both effect modifier and as an explanatory variable in the associations evaluated. Multiple studies demonstrated susceptibility to change following intervention. Although the current state of the literature is bound by notable limitations, the results of this review point to pertinent future steps in advancing the theory and application of body image flexibility scholarship.
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Affiliation(s)
| | - Jennifer B Webb
- UNC Charlotte, Health Psychology, United States; UNC Charlotte, Department of Psychological Science, United States
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22
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Masuda A, Latner JD, Barlie JP, Sargent K. Understanding self-concealment within a framework of eating disorder cognitions and body image flexibility: Conceptual and applied implications. Eat Behav 2018; 30:49-54. [PMID: 29777970 DOI: 10.1016/j.eatbeh.2018.05.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 05/05/2018] [Accepted: 05/09/2018] [Indexed: 10/16/2022]
Abstract
Although self-concealment has been long recognized in the context of body image disturbance and disordered eating concerns, empirical evidence remains limited. Following cognitive behavioral therapy (CBT) models of disordered eating and body image concerns, the present cross-sectional study examined whether the construct of self-concealment was related to disordered eating and body image concerns. More specifically, we investigated whether eating disorder cognitions and body image flexibility, two factors linked to the maintenance of disordered eating concerns, are uniquely associated with self-concealment, while controlling for key demographic and sociocultural variables. Three-hundred thirty-six undergraduate women completed a web-based survey that included measures of interest. Results revealed that eating disorder cognitions associated with the fear of weight gain and body image flexibility were uniquely related to self-concealment in expected directions.
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23
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Christensen SS, Bentz M, Clemmensen L, Strandberg‐Larsen K, Olsen EM. Disordered eating behaviours and autistic traits—Are there any associations in nonclinical populations? A systematic review. EUROPEAN EATING DISORDERS REVIEW 2018; 27:8-23. [DOI: 10.1002/erv.2627] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 06/14/2018] [Accepted: 07/01/2018] [Indexed: 11/08/2022]
Affiliation(s)
| | - Mette Bentz
- Child and Adolescent Mental Health CenterMental Health Services Copenhagen Denmark
| | - Lars Clemmensen
- Child and Adolescent Mental Health CenterMental Health Services Copenhagen Denmark
- Center for TelepsychiatryMental Health Services Region of Southern Denmark
| | | | - Else Marie Olsen
- Section of Social Medicine, Department of Public HealthUniversity of Copenhagen Copenhagen Denmark
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24
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Masuda A, Marshall RD, Latner JD. Mindfulness as a Moderator of the Association Between Eating Disorder Cognition and Eating Disorder Behavior Among a Non-clinical Sample of Female College Students: A Role of Ethnicity. Front Psychol 2018; 9:700. [PMID: 29988519 PMCID: PMC6026804 DOI: 10.3389/fpsyg.2018.00700] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 04/23/2018] [Indexed: 11/30/2022] Open
Abstract
The present cross-sectional study examined whether mindfulness moderated the association between eating disorder cognition and eating disorder behaviors among Asian American, Black American, and White American female college students in the United States. Participants (N = 463, age range = 18–25 years) completed self-report measures online. Results revealed that mindfulness moderated the association between eating disorder cognition and eating disorder behavior in the White American group, but not in Asian American or Black American samples. Future research should replicate these differential findings across ethnic groups and investigate the factors that may contribute to this group difference.
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Affiliation(s)
- Akihiko Masuda
- Department of Psychology, University of Hawai'i at Mānoa, Honolulu, HI, United States
| | - Rachel D Marshall
- Department of Psychology, University of Hawai'i at Mānoa, Honolulu, HI, United States
| | - Janet D Latner
- Department of Psychology, University of Hawai'i at Mānoa, Honolulu, HI, United States
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25
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Basarkod G, Sahdra B, Ciarrochi J. Body Image-Acceptance and Action Questionnaire-5: An Abbreviation Using Genetic Algorithms. Behav Ther 2018; 49:388-402. [PMID: 29704968 DOI: 10.1016/j.beth.2017.09.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 09/08/2017] [Accepted: 09/15/2017] [Indexed: 10/18/2022]
Abstract
Body image concerns are typically linked with negative outcomes such as disordered eating and diminished well-being, but some people can exhibit psychological flexibility and remain committed to their valued goals despite being dissatisfied about their bodies. Such flexibility is most frequently measured by the Body Image-Acceptance and Action Questionnaire (BI-AAQ). This study used a recently validated, fully automated method based on genetic algorithms (GAs) on data from an American community sample (N1=538, 71.5% female, Age: M = 40.87, SD = 13.5) to abbreviate the 12-item BI-AAQ to a 5-item short form, BI-AAQ-5. Validation tests were conducted on data from an independent community sample (N2= 762, 44.6% female, Age: M = 40.65, SD = 13.06). The short form performed comparably to the long form in terms of its factor structure and correlations with theoretically relevant constructs, including body image dissatisfaction, stigma, internalization of societal norms of appearance, self-compassion, and poor mental health. Further, preliminary analyses using structural equation modeling showed that body image flexibility, as measured by either the long or short form, was associated with almost all the criterion variables, even while controlling for a highly related construct of body image dissatisfaction. These results demonstrate the potential discriminant validity of both the long and short form of the BI-AAQ, and show that the BI-AAQ-5 is a suitable alternative to its long form. We discuss how psychological flexibility with respect to body image dissatisfaction can be conducive to positive functioning.
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Affiliation(s)
- Geetanjali Basarkod
- Institute for Positive Psychology and Education, Australian Catholic University.
| | - Baljinder Sahdra
- Institute for Positive Psychology and Education, Australian Catholic University
| | - Joseph Ciarrochi
- Institute for Positive Psychology and Education, Australian Catholic University
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26
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Lee EB, Ong CW, Twohig MP, Lensegrav-Benson T, Quakenbush-Roberts B. Increasing body image flexibility in a residential eating disorder facility: Correlates with symptom improvement. Eat Disord 2018; 26:185-199. [PMID: 28929944 DOI: 10.1080/10640266.2017.1366229] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The purpose of this study was to examine the effects of changes in body image psychological flexibility over the course of treatment on various outcome variables. METHOD Participants included 103 female, residential patients diagnosed with an eating disorder. Pretreatment and posttreatment data were collected that examined body image psychological flexibility, general psychological flexibility, symptom severity, and other outcome variables. RESULTS Changes in body image psychological flexibility significantly predicted changes in all outcome measures except for obsessive-compulsive symptoms after controlling for body mass index, depression, and anxiety. Additionally, these results were maintained after controlling for general psychological flexibility, contributing to the incremental validity of the BI-AAQ. DISCUSSION This study suggests that changes in body image psychological flexibility meaningfully predict changes in various treatment outcomes of interest, including eating disorder risk, quality of life, and general mental health. Findings indicate that body image psychological flexibility might be a viable target for eating disorder treatment.
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Affiliation(s)
- Eric B Lee
- a Psychology Department , Utah State University , Logan , Utah , USA
| | - Clarissa W Ong
- a Psychology Department , Utah State University , Logan , Utah , USA
| | - Michael P Twohig
- a Psychology Department , Utah State University , Logan , Utah , USA
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27
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Lucena-Santos P, Carvalho SA, Oliveira MDS, Pinto-Gouveia J. Body-Image Acceptance and Action Questionnaire: Its deleterious influence on binge eating and psychometric validation. Int J Clin Health Psychol 2017; 17:151-160. [PMID: 30487890 PMCID: PMC6220905 DOI: 10.1016/j.ijchp.2017.03.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 03/06/2017] [Indexed: 11/24/2022] Open
Abstract
Background/Objectives: This study aimed to explore the psychometric properties of BI-AAQ (Body-Image Acceptance and Action Questionnaire) and the body image psychological flexibility role as a mediator in a pervasive path towards binge eating in Brazilian samples. Method: This cross-sectional study was conducted in clinical (overweight or obese women currently in treatment for weight loss; n= 330) and non-clinical (general population; n= 682) groups of women. Results: BI-AAQ has one-factor structure, excellent internal consistency, ability to detect differences between groups and measurement invariance across samples. It was also negatively associated with self-compassion and positively associated with binge eating severity, drive for thinness and self-criticism. Conclusions: This study provides data confirming the robust psychometric properties of BI-AAQ in qualitatively different samples. Furthermore, an additional study conducted in a clinical sample of women with overweight or obesity revealed that body image psychological inflexibility has emerged as a partial and significant mediator of the effect of self-criticism and drive for thinness on binge eating severity.
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Affiliation(s)
- Paola Lucena-Santos
- Cognitive-Behavioral Research Centre (CINEICC), University of Coimbra, Portugal
| | - Sérgio A Carvalho
- Cognitive-Behavioral Research Centre (CINEICC), University of Coimbra, Portugal
| | - Margareth da Silva Oliveira
- Evaluation and Treatment in Cognitive-Behavioral Therapies - Research Group (GAAPCC), Pontifical Catholic University of Rio Grande do Sul, Brazil
| | - José Pinto-Gouveia
- Cognitive-Behavioral Research Centre (CINEICC), University of Coimbra, Portugal
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28
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Pinto-Gouveia J, Carvalho SA, Palmeira L, Castilho P, Duarte C, Ferreira C, Duarte J, Cunha M, Matos M, Costa J. BEfree: A new psychological program for binge eating that integrates psychoeducation, mindfulness, and compassion. Clin Psychol Psychother 2017; 24:1090-1098. [PMID: 28124451 PMCID: PMC6686162 DOI: 10.1002/cpp.2072] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 10/26/2016] [Accepted: 12/22/2016] [Indexed: 11/11/2022]
Abstract
Binge eating disorder (BED) is associated with several psychological and medical problems, such as obesity. Approximately 30% of individuals seeking weight loss treatments present binge eating symptomatology. Moreover, current treatments for BED lack efficacy at follow‐up assessments. Developing mindfulness and self‐compassion seem to be beneficial in treating BED, although there is still room for improvement, which may include integrating these different but complimentary approaches. BEfree is the first program integrating psychoeducation‐, mindfulness‐, and compassion‐based components for treating women with binge eating and obesity. Objective To test the acceptability and efficacy up to 6‐month postintervention of a psychological program based on psychoeducation, mindfulness, and self‐compassion for obese or overweight women with BED. Design A controlled longitudinal design was followed in order to compare results between BEfree (n = 19) and waiting list group (WL; n = 17) from preintervention to postintervention. Results from BEfree were compared from preintervention to 3‐ and 6‐month follow‐up. Results BEfree was effective in eliminating BED; in diminishing eating psychopathology, depression, shame and self‐criticism, body‐image psychological inflexibility, and body‐image cognitive fusion; and in improving obesity‐related quality of life and self‐compassion when compared to a WL control group. Results were maintained at 3‐ and 6‐month follow‐up. Finally, participants rated BEfree helpful for dealing with impulses and negative internal experiences. Conclusions These results seem to suggest the efficacy of BEfree and the benefit of integrating different components such as psychoeducation, mindfulness, and self‐compassion when treating BED in obese or overweight women. Key Practitioner Message The current study provides evidence of the acceptability of a psychoeducation, mindfulness, and compassion program for binge eating in obesity (BEfree); Developing mindfulness and self‐compassionate skills is an effective way of diminishing binge eating, eating psychopathology and depression, and increasing quality of life in women with obesity; Integrating psychoeducation, mindfulness, and compassion seem to be effective in diminishing binge eating, with results maintained up to 6‐month postintervention.
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Affiliation(s)
- José Pinto-Gouveia
- CINEICC, Cognitive and Behavioural Centre for Research and Intervention, University of Coimbra, Coimbra, Portugal
| | - Sérgio A Carvalho
- CINEICC, Cognitive and Behavioural Centre for Research and Intervention, University of Coimbra, Coimbra, Portugal
| | - Lara Palmeira
- CINEICC, Cognitive and Behavioural Centre for Research and Intervention, University of Coimbra, Coimbra, Portugal
| | - Paula Castilho
- CINEICC, Cognitive and Behavioural Centre for Research and Intervention, University of Coimbra, Coimbra, Portugal
| | - Cristiana Duarte
- CINEICC, Cognitive and Behavioural Centre for Research and Intervention, University of Coimbra, Coimbra, Portugal
| | - Cláudia Ferreira
- CINEICC, Cognitive and Behavioural Centre for Research and Intervention, University of Coimbra, Coimbra, Portugal
| | - Joana Duarte
- CINEICC, Cognitive and Behavioural Centre for Research and Intervention, University of Coimbra, Coimbra, Portugal
| | - Marina Cunha
- CINEICC, Cognitive and Behavioural Centre for Research and Intervention, University of Coimbra, Coimbra, Portugal.,ISMT, Instituto Superior Miguel Torga, Coimbra, Portugal
| | - Marcela Matos
- CINEICC, Cognitive and Behavioural Centre for Research and Intervention, University of Coimbra, Coimbra, Portugal
| | - Joana Costa
- CINEICC, Cognitive and Behavioural Centre for Research and Intervention, University of Coimbra, Coimbra, Portugal
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Duarte C, Pinto-Gouveia J. Body image flexibility mediates the effect of body image-related victimization experiences and shame on binge eating and weight. Eat Behav 2016; 23:13-18. [PMID: 27442702 DOI: 10.1016/j.eatbeh.2016.07.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 06/29/2016] [Accepted: 07/13/2016] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The current study examined a path model testing the indirect effect of negative body-image related memories of being teased and bullied in childhood and adolescence on binge eating severity symptoms, via its effect on current body image shame and body image flexibility. METHODS Participants were 853 Portuguese women from the general community who completed a set of self-report measures of body image-related bullying and teasing experiences in childhood and adolescence, current body image shame, body image flexibility, binge eating symptoms, body mass index (BMI) and depressive symptoms. RESULTS The path model accounted for 40% of the variance of binge eating symptoms and 14% of the variance of BMI, and revealed a very good fit. Findings corroborated the plausibility of the hypothesized associations suggesting that negative body image-related memories and emotional experiences are significantly associated with binge eating symptoms and BMI, and that body image flexibility is a significant mediator of these associations. The examined relationships were preserved after controlling for the effect of depressive symptoms. CONCLUSIONS The current study's findings contribute to clarify the role that body image-related memories and emotional experiences may play on individuals' difficulties in regulating eating behaviour and weight, and provides preliminary support for the potential effect of body image flexibility as a self-regulatory process that operates in these associations.
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Affiliation(s)
- Cristiana Duarte
- University of Coimbra, CINEICC - Cognitive and Behavioural Centre for Research and Intervention, Portugal.
| | - José Pinto-Gouveia
- University of Coimbra, CINEICC - Cognitive and Behavioural Centre for Research and Intervention, Portugal
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30
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Duarte C, Ferreira C, Trindade IA, Pinto-Gouveia J. Normative body dissatisfaction and eating psychopathology in teenage girls: the impact of inflexible eating rules. Eat Weight Disord 2016; 21:41-8. [PMID: 26296435 DOI: 10.1007/s40519-015-0212-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 08/03/2015] [Indexed: 12/11/2022] Open
Abstract
PURPOSE Adolescence has been considered a critical time for the development of body image-related difficulties and disordered eating behaviours, especially in females. Although adherence to eating rules has been linked to disordered eating, literature has not yet explored how the inflexible subscription to those rules impacts on eating psychopathology. Therefore, the aim of the current study was to explore whether inflexible eating impacts on the relationships between weight and body image-related variables, and disordered eating. METHODS Participated in this study are 497 female adolescents from the community, aged between 14 and 18 years old, who completed self-report measures. RESULTS Results revealed that the majority of the participants were dissatisfied with their weight and body shape. Moreover, 6.64 % of the participants demonstrated severe eating psychopathology. A path analysis revealed that BMI, body dissatisfaction and social comparisons based on physical appearance impact on disordered eating behaviours, through the mechanism of inflexible adherence to eating rules. This model explained 52 % of eating psychopathology's variance. CONCLUSIONS Findings highlight the relevance of body image-related difficulties in adolescence and additionally they emphasise the importance of promoting more flexible attitudes towards eating in prevention and intervention programmes with female adolescents.
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Affiliation(s)
- Cristiana Duarte
- Cognitive and Behavioural Centre for Research and Intervention (CINEICC), Faculdade de Psicologia e Ciências da Educação, Universidade de Coimbra, Rua do Colégio Novo, Apartado 6153, 3001-802, Coimbra, Portugal.
| | - Cláudia Ferreira
- Cognitive and Behavioural Centre for Research and Intervention (CINEICC), Faculdade de Psicologia e Ciências da Educação, Universidade de Coimbra, Rua do Colégio Novo, Apartado 6153, 3001-802, Coimbra, Portugal
| | - Inês A Trindade
- Cognitive and Behavioural Centre for Research and Intervention (CINEICC), Faculdade de Psicologia e Ciências da Educação, Universidade de Coimbra, Rua do Colégio Novo, Apartado 6153, 3001-802, Coimbra, Portugal
| | - José Pinto-Gouveia
- Cognitive and Behavioural Centre for Research and Intervention (CINEICC), Faculdade de Psicologia e Ciências da Educação, Universidade de Coimbra, Rua do Colégio Novo, Apartado 6153, 3001-802, Coimbra, Portugal
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31
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Explaining rigid dieting in normal-weight women: the key role of body image inflexibility. Eat Weight Disord 2016; 21:49-56. [PMID: 25753131 DOI: 10.1007/s40519-015-0188-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Accepted: 02/27/2015] [Indexed: 01/03/2023] Open
Abstract
Restrictive dieting is an increasing behavior presented by women in modern societies, independently of their weight. There are several known factors that motivate diet, namely a sense of dissatisfaction with one's body and unfavorable social comparisons based on physical appearance. However, dieting seems to have a paradoxical effect and has been considered a risk factor for weight gain and obesity in women and for maladaptive eating. Nevertheless, the study of the emotional regulation processes that explain the adoption of inflexible and rigid eating behaviors still remains little explored. In this line, the present study aims to explore why normal-weight women engage in highly rigid and inflexible diets. We hypothesize that body and weight dissatisfaction and unfavorable social comparisons based on physical appearance explain the adoption of inflexible eating rules, through the mechanisms of body image inflexibility. The current study comprised 508 normal-weight female college students. Path analyses were conducted to explore the study's hypotheses. Results revealed that the model explained 43 % of inflexible eating and revealed excellent fit indices. Furthermore, the unwillingness to experience unwanted events related to body image (body image inflexibility) mediated the impact of body dissatisfaction and unfavorable social comparisons on the adoption of inflexible eating rules. This study highlights the relevance of body image inflexibility to explain rigid eating attitudes, and it seems to be an important avenue for the development of interventions focusing on the promotion of adaptive attitudes towards body image and eating in young women.
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Mensinger JL, Calogero RM, Tylka TL. Internalized weight stigma moderates eating behavior outcomes in women with high BMI participating in a healthy living program. Appetite 2016; 102:32-43. [PMID: 26829370 DOI: 10.1016/j.appet.2016.01.033] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 01/15/2016] [Accepted: 01/26/2016] [Indexed: 10/25/2022]
Abstract
Weight stigma is a significant socio-structural barrier to reducing health disparities and improving quality of life for higher weight individuals. The aim of this study was to examine the impact of internalized weight stigma on eating behaviors after participating in a randomized controlled trial comparing the health benefits of a weight-neutral program to a conventional weight-management program for 80 community women with high body mass index (BMI > 30, age range: 30-45). Programs involved 6 months of facilitator-guided weekly group meetings using structured manuals. Assessments occurred at baseline, post-intervention (6 months), and 24-months post-randomization. Eating behavior outcome measurements included the Eating Disorder Examination-Questionnaire and the Intuitive Eating Scale. Intention-to-treat linear mixed models were used to test for higher-order interactions between internalized weight stigma, group, and time. Findings revealed significant 3-way and 2-way interactions between internalized weight stigma, group, and time for disordered and adaptive eating behaviors, respectively. Only weight-neutral program participants with low internalized weight stigma improved global disordered eating scores. Participants from both programs with low internalized weight stigma improved adaptive eating at 6 months, but only weight-neutral program participants maintained changes at follow-up. Participants with high internalized weight stigma demonstrated no changes in disordered and adaptive eating, regardless of program. In order to enhance the overall benefit from weight-neutral approaches, these findings underscore the need to incorporate more innovative and direct methods to reduce internalized weight stigma for women with high BMI.
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Affiliation(s)
- Janell L Mensinger
- Reading Health System, Sixth Avenue and Spruce Street, West Reading, PA 19611, USA; Drexel University, College of Nursing and Health Professions 1601 Cherry Street, 3 Parkway Building, 9th Floor, MS 9503, Philadelphia, PA 19102, USA.
| | - Rachel M Calogero
- University of Kent School of Psychology, Keynes College Canterbury CT2 7NZ, UK.
| | - Tracy L Tylka
- The Ohio State University, Department of Psychology 225 Psychology Building, Columbus, OH 43210, USA.
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The role of disordered eating cognition and body image flexibility in disordered eating behavior in college men. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2015. [DOI: 10.1016/j.jcbs.2015.01.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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