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Peschel SKV, Fürtjes S, Sigrist C, Voss C, Berwanger J, Ollmann TM, Kische H, Rückert F, Koenig J, Pieper L, Beesdo-Baum K. Tension and disordered eating behaviors in the daily lives of adolescents and young adults from the general population: Associations and moderating role of trait emotion regulation. Scand J Psychol 2024; 65:252-263. [PMID: 37850537 DOI: 10.1111/sjop.12971] [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: 03/02/2023] [Revised: 08/10/2023] [Accepted: 09/15/2023] [Indexed: 10/19/2023]
Abstract
Experiences of tension and difficulties in emotion regulation have been linked to eating pathology in clinical samples and are targeted in respective treatment approaches. The present study aimed to investigate the impact of tension on engagement in disordered eating behaviors (DEBs) and potential moderating effects of trait emotion regulation in young people from the general population. A subsample of 971 adolescents and young adults from an epidemiological cohort study reported on levels of tension and four different DEBs (skipping eating, restrained eating, eating large amounts of food, loss-of-control-eating) via ecological momentary assessment (EMA), as well as on trait emotion regulation via questionnaire. In multilevel models, momentary tension did not predict levels of subsequent DEBs. However, higher average levels of tension across the EMA period predicted higher levels of all DEBs. No interactions with emotion regulation emerged. Individuals experiencing overall higher levels of tension appear to be more prone to engaging in DEBs.
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Affiliation(s)
- Stephanie K V Peschel
- Behavioral Epidemiology, Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Sophia Fürtjes
- Behavioral Epidemiology, Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Christine Sigrist
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Catharina Voss
- Behavioral Epidemiology, Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Johanna Berwanger
- Behavioral Epidemiology, Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Theresa M Ollmann
- Behavioral Epidemiology, Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Hanna Kische
- Behavioral Epidemiology, Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Frank Rückert
- Behavioral Epidemiology, Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Julian Koenig
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Lars Pieper
- Behavioral Epidemiology, Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Katja Beesdo-Baum
- Behavioral Epidemiology, Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
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van Riel L, van den Berg E, Polak M, Geerts M, Peen J, Ingenhoven T, Dekker J. Exploring effectiveness of CBT in obese patients with binge eating disorder: personality functioning is associated with clinically significant change. BMC Psychiatry 2023; 23:136. [PMID: 36879204 PMCID: PMC9990274 DOI: 10.1186/s12888-023-04626-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 02/22/2023] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND Binge eating disorder (BED), as the most prevalent eating disorder, is strongly related to obesity and other somatic and psychiatric morbidity. Despite evidence-based treatments a considerable number of BED patients fail to recover. There is preliminary evidence for the association between psychodynamic personality functioning and personality traits on treatment outcome. However, research is limited and results are still contradictory. Identifying variables associated with treatment outcome could improve treatment programs. The aim of the study was to explore whether personality functioning or personality traits are associated with Cognitive Behavioral Therapy (CBT) outcome in obese female patients with BED or subthreshold BED. METHODS Eating disorder symptoms and clinical variables were assessed in 168 obese female patients with DSM-5 BED or subthreshold BED, referred to a 6-month outpatient CBT program in a pre-post measurement design. Personality functioning was assessed by the Developmental Profile Inventory (DPI), personality traits by the Temperament and Character Inventory (TCI). Treatment outcome was assessed by the Eating Disorder Examination-Questionnaire (EDE-Q) global score and self-reported binge eating frequency. According to the criteria of clinical significance, 140 treatment completers were categorized in four outcome groups (recovered, improved, unchanged, deteriorated). RESULTS EDE-Q global scores, self-reported binge eating frequency and BMI significantly decreased during CBT, where 44.3% of patients showed clinically significant change in EDE-Q global score. Treatment outcome groups showed significant overall differences on the DPI Resistance and Dependence scales and the aggregated 'neurotic' scale. Significant overall differences were found between groups on TCI Harm avoidance, although post hoc t-tests were non-significant. Furthermore, multiple logistic regression analysis, controlling for mild to moderate depressive disorder and TCI harm avoidance showed that 'neurotic' personality functioning was a significant negative predictor of clinically significant change. CONCLUSION Maladaptive ('neurotic') personality functioning is significantly associated with a less favorable outcome after CBT in patients with binge eating. Moreover, 'neurotic' personality functioning is a predictor of clinically significant change. Assessment of personality functioning and personality traits could support indication for more specified or augmented care, tailored towards the patients' individual strengths and vulnerabilities. TRIAL REGISTRATION This study protocol was retrospectively evaluated and approved on 16-06-2022 by the Medical Ethical Review Committee (METC) of the Amsterdam Medical Centre (AMC). Reference number W22_219#22.271.
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Affiliation(s)
- Laura van Riel
- Centre for Eating Disorders and Obesity, Novarum, Arkin Institute of Mental Health, Amsterdam, The Netherlands. .,Centre for Personality Disorders, NPI, Arkin Institute of Mental Health, Amsterdam, The Netherlands.
| | - Elske van den Berg
- Centre for Eating Disorders and Obesity, Novarum, Arkin Institute of Mental Health, Amsterdam, The Netherlands
| | - Marike Polak
- Department of Psychology, Education & Child Studies (DPECS), Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Marjolein Geerts
- Centre for Eating Disorders and Obesity, Novarum, Arkin Institute of Mental Health, Amsterdam, The Netherlands
| | - Jaap Peen
- Department of Research, Arkin Institute of Mental Health, Amsterdam, The Netherlands
| | - Theo Ingenhoven
- Centre for Personality Disorders, NPI, Arkin Institute of Mental Health, Amsterdam, The Netherlands
| | - Jack Dekker
- Department of Research, Arkin Institute of Mental Health, Amsterdam, The Netherlands
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State-based measurement of emotion regulation: The Turkish versions of SERI and S-DERS. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-021-02582-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Krehbiel J, Halbeisen G, Kühn S, Erim Y, Paslakis G. Too hot to handle: Mood states moderate implicit approach vs. avoidance tendencies toward food cues in patients with obesity and active binge eating disorder. J Psychiatr Res 2021; 143:302-308. [PMID: 34530341 DOI: 10.1016/j.jpsychires.2021.09.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 08/20/2021] [Accepted: 09/08/2021] [Indexed: 11/27/2022]
Abstract
Patients with binge eating disorder (BED) display recurring episodes of eating large amounts of food in a short period of time, especially during negative mood states. However, the psychological processes linking negative mood to binge eating behavior have not been sufficiently explored. This study investigated the effects of experimentally inducing a negative (sad) mood state upon reaction times in a computerized Approach-Avoidance-Task (AAT) using images of foods and compared to a neutral control procedure in which negative mood was not induced. Differences in reaction times between "pulling" and "pushing away" food cues in the AAT were considered surrogates for fast, automatic (i.e., implicit) preferences ("bias") for either the approach or avoidance of foods. Obese patients with BED (n = 40), weight-matched (obese) individuals (n = 40), and norm-weight controls (n = 29) were asked to approach ("pull") or avoid ("push") images of high- and low-calorie foods following the induction of a negative mood state vs. the neutral control procedure. Sample size was within the common range of previous investigations of the kind. Similar to previous findings, obese patients with BED exhibited an avoidance bias (i.e., faster reaction times in "pushing" compared to "pulling") during the neutral control condition. However, a contrast analysis revealed that negative mood was associated with decreased avoidance bias in obese patients with BED, but not in obese and norm-weight controls. Mood status exerted no effect on BED patients' self-reported (i.e., explicit) ratings of the urge to consume foods. These findings may help to advance current understanding of how negative (sad) mood states may affect binge eating behaviors. Implications of these findings for developing novel treatment approaches are discussed.
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Affiliation(s)
- Johannes Krehbiel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Georg Halbeisen
- University Clinic of Psychosomatic Medicine and Psychotherapy, Ruhr-University Bochum, Campus East-Westphalia, Lübbecke, Germany
| | - Simone Kühn
- Lise Meiter Group for Environmental Neuroscience, Max Planck Institute for Human Development, Berlin, Germany; University Clinic Hamburg-Eppendorf, Clinic and Policlinic for Psychiatry and Psychotherapy, Hamburg, Germany
| | - Yesim Erim
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Georgios Paslakis
- University Clinic of Psychosomatic Medicine and Psychotherapy, Ruhr-University Bochum, Campus East-Westphalia, Lübbecke, Germany.
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Walenda A, Kostecka B, Santangelo PS, Kucharska K. Examining emotion regulation in binge-eating disorder. Borderline Personal Disord Emot Dysregul 2021; 8:25. [PMID: 34629115 PMCID: PMC8504023 DOI: 10.1186/s40479-021-00166-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 09/15/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Inefficient mechanisms of emotional regulation appear essential in understanding the development and maintenance of binge-eating disorder (BED). Previous research focused mainly on a very limited emotion regulation strategies in BED, such as rumination, suppression, and positive reappraisal. Therefore, the aim of the study was to assess a wider range of emotional regulation strategies (i.e. acceptance, refocusing on planning, positive refocusing, positive reappraisal, putting into perspective, self-blame, other-blame, rumination, and catastrophizing), as well as associations between those strategies and binge-eating-related beliefs (negative, positive, and permissive), and clinical variables (eating disorders symptoms, both anxiety, depressive symptoms, and alexithymia). METHODS Women diagnosed with BED (n = 35) according to the DSM-5 criteria and healthy women (n = 41) aged 22-60 years were assessed using: the Eating Attitudes Test-26, the Eating Beliefs Questionnaire-18, the Hospital Anxiety and Depression Scale, the Toronto Alexithymia Scale-20, the Cognitive Emotion Regulation Questionnaire, and the Difficulties in Emotion Regulation Scale. Statistical analyses included: Student t - tests or Mann-Whitney U tests for testing group differences between BED and HC group, and Pearson's r coefficient or Spearman's rho for exploring associations between the emotion regulation difficulties and strategies, and clinical variables and binge-eating-related beliefs in both groups. RESULTS The BED group presented with a significantly higher level of emotion regulation difficulties such as: nonacceptance of emotional responses, lack of emotional clarity, difficulties engaging in goal-directed behavior, impulse control difficulties, and limited access to emotion regulation strategies compared to the healthy controls. Moreover, patients with BED were significantly more likely to use maladaptive strategies (rumination and self-blame) and less likely to use adaptive strategies (positive refocusing and putting into perspective). In the clinical group, various difficulties in emotion regulation difficulties occurred to be positively correlated with the level of alexithymia, and anxiety and depressive symptoms. Regarding emotion regulation strategies, self-blame and catastrophizing were positively related to anxiety symptoms, but solely catastrophizing was related to the severity of eating disorder psychopathology. CONCLUSIONS Our results indicate an essential and still insufficiently understood role of emotional dysregulation in BED. An especially important construct in this context seems to be alexithymia, which was strongly related to the majority of emotion regulation difficulties. Therefore, it might be beneficial to pay special attention to this construct when planning therapeutic interventions, as well as to the maladaptive emotion regulation strategies self-blame and catastrophizing, which were significantly related to BED psychopathology.
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Affiliation(s)
- Anna Walenda
- The Institute of Psychology, Cardinal Stefan Wyszynski University, Warsaw, Poland
| | - Barbara Kostecka
- II Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland.
| | | | - Katarzyna Kucharska
- The Institute of Psychology, Cardinal Stefan Wyszynski University, Warsaw, Poland
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Takgbajouah M, Buscemi J. Applying the developmental model of use disorders to hedonic hunger: a narrative review. J Addict Dis 2021; 40:47-55. [PMID: 34002675 DOI: 10.1080/10550887.2021.1926881] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND OBJECTIVES Hedonic hunger (HH) occurs when individuals are driven to consume highly palatable food for pleasure, rather than to satisfy a caloric need. Currently, the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) does not recognize HH as a use disorder. Previous research has noted physiological, neurobiological, and treatment similarities between HH, binge eating behavior and substance use, leading to the speculation of the existence of food addiction (FA). The purpose of the current review was to explore the literature on the developmental similarities between substance use, HH, binge eating behavior, and other use disorders to provide more evidence for the recognition of FA as an official use disorder, to add to the evidence in favor of a developmental model of use disorders, and to inform the development of interventions that target modifiable symptoms associated with use disorders. METHODS We provide a narrative review of the literature on developmental factors associated with both HH and substance use. RESULTS & DISCUSSION Adverse childhood experiences and attachment have been previously linked to both substance use and maladaptive eating behaviors. Adverse childhood experiences are linked with insecure attachment and emotion dysregulation, which is linked with compulsive behaviors and substance use. Clinical and research implications are discussed in terms of a developmental model of use disorders and the formal recognition of FA in the next edition of the DSM.
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Wooldridge JS, Herbert MS, Dochat C, Afari N. Understanding relationships between posttraumatic stress disorder symptoms, binge-eating symptoms, and obesity-related quality of life: the role of experiential avoidance. Eat Disord 2021; 29:260-275. [PMID: 33459212 PMCID: PMC8285449 DOI: 10.1080/10640266.2020.1868062] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Obesity, binge-eating symptoms, and PTSD symptoms commonly co-occur. Avoidance, a key feature of PTSD and proposed mechanism of binge-eating, is one potential mechanism for explaining this clinical overlap. The purpose of the current study was to: 1) examine the associations between PTSD symptoms (PTSD Checklist-Civilian; PCL-C) and measures of bingeeating symptoms (Binge Eating Scale; BES) and obesity-related quality of life (Obesity Related Well-Being Questionnaire-97; ORWELL-97) in a sample of veterans with overweight or obesity (N = 89), and 2) determine whether experiential avoidance (The Acceptance and Action Questionnaire-II; AAQ-II) explains the relationship between PTSD symptoms and binge-eating symptoms, and PTSD symptoms and obesity-related quality of life, respectively. Scores on the PCL-C, BES, ORWELL-97, and AAQ-II were all significantly correlated. Linear regression analyses indicated that higher PCL-C scores were related to higher scores on the BES and ORWELL-97 after controlling for potentially confounding factors (BMI and race). Effect sizes were in the medium-large range. Further, AAQ-II mediated the relationship between PCL-C and ORWELL-97, but did not mediate the relationship between PCL-C and BES. These findings suggest that experiential avoidance should be considered in interventions addressing co-occurring PTSD, binge-eating, and poor obesity-related well-being. Longitudinal research is needed to better understand directionality of these relationships and changes over time.
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Affiliation(s)
- Jennalee S Wooldridge
- VA San Diego Healthcare System, San Diego, California, USA.,Department of Psychiatry, University of California, San Diego, California, USA.,Center of Excellence for Stress and Mental Health (CESAMH), San Diego, California, USA
| | - Matthew S Herbert
- VA San Diego Healthcare System, San Diego, California, USA.,Department of Psychiatry, University of California, San Diego, California, USA.,Center of Excellence for Stress and Mental Health (CESAMH), San Diego, California, USA
| | - Cara Dochat
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, California, San Diego, USA
| | - Niloofar Afari
- VA San Diego Healthcare System, San Diego, California, USA.,Department of Psychiatry, University of California, San Diego, California, USA.,Center of Excellence for Stress and Mental Health (CESAMH), San Diego, California, USA
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Parker MN, Michael M, Murray HB, Juarascio AS, Manasse SM. State emotion modulation and loss-of-control eating in individuals with obesity: A preliminary ecological momentary assessment study. Eat Behav 2021; 41:101478. [PMID: 33610877 PMCID: PMC8131227 DOI: 10.1016/j.eatbeh.2021.101478] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 01/31/2021] [Accepted: 02/01/2021] [Indexed: 11/29/2022]
Abstract
There is ample evidence linking broad trait emotion regulation deficits and negative affect with loss-of-control (LOC)-eating among individuals with obesity and binge eating, however, few studies have examined emotion regulation at the state-level. Within and across day fluctuations in the ability to modulate emotion (or regulate emotional and behavioral responses), one facet of state emotion regulation, may be a more robust momentary predictor of LOC-eating than momentary negative affect and trait emotion regulation ability. As such, the current study tested if daily emotion modulation, and daily variability in emotion modulation differed on days with and without LOC-eating episodes, and if momentary emotion modulation was associated with subsequent LOC-eating episodes. For two weeks individuals (N = 14) with obesity and binge eating completed surveys as part of an ecological momentary assessment study. Participants reported on current ability to modulate emotion, LOC-eating, and current negative affect. On LOC-eating days compared to non-LOC-eating days, ability to modulate emotion was poorer (β =0.10, p < .001) and average variability in ability to modulation emotions was greater (β = 0.56, p = .008), even when controlling for negative affect. Greater momentary difficulty modulating emotion was associated with a 40% increase in subsequent risk for LOC-eating (ß = 0.34, p = .071, OR = 1.40). Findings from this pilot study suggest that individuals with obesity report poorer ability to modulate emotion and greater variability in ability to modulate emotion on LOC-eating days, even when controlling for negative affect. Future research should replicate findings and further elucidate the relationships between state emotion regulation, negative affect, and LOC-eating.
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Affiliation(s)
- Megan N. Parker
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), 4301 Jones Bridge Road, Bethesda, MD, 20814, USA,Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), Division of Intramural Research, National Institutes of Health (NIH), 10 Center Drive, Bethesda, MD, 20892, USA,Department of Psychology, Drexel University, Stratton Hall, 3141 Chestnut Street Philadelphia, PA 19104
| | - Megan Michael
- Center for Weight, Eating and Lifestyle Science (WELL Center), Drexel University, Stratton Hall, 3141 Chestnut Street, Philadelphia, PA 19104
| | - Helen Burton Murray
- Department of Psychology, Drexel University, Stratton Hall, 3141 Chestnut Street Philadelphia, PA 19104
| | - Adrienne S. Juarascio
- Department of Psychology, Drexel University, Stratton Hall, 3141 Chestnut Street Philadelphia, PA 19104,Center for Weight, Eating and Lifestyle Science (WELL Center), Drexel University, Stratton Hall, 3141 Chestnut Street, Philadelphia, PA 19104
| | - Stephanie M. Manasse
- Center for Weight, Eating and Lifestyle Science (WELL Center), Drexel University, Stratton Hall, 3141 Chestnut Street, Philadelphia, PA 19104
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Emotional eating in healthy individuals and patients with an eating disorder: evidence from psychometric, experimental and naturalistic studies. Proc Nutr Soc 2020; 79:290-299. [PMID: 32398186 PMCID: PMC7663318 DOI: 10.1017/s0029665120007004] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Emotional eating has traditionally been defined as (over)eating in response to negative emotions. Such overeating can impact general health because of excess energy intake and mental health, due to the risks of developing binge eating. Yet, there is still significant controversy on the validity of the emotional eating concept and several theories compete in explaining its mechanisms. The present paper examines the emotional eating construct by reviewing and integrating recent evidence from psychometric, experimental and naturalistic research. Several psychometric questionnaires are available and some suggest that emotions differ fundamentally in how they affect eating (i.e. overeating, undereating). However, the general validity of such questionnaires in predicting actual food intake in experimental studies is questioned and other eating styles such as restrained eating seem to be better predictors of increased food intake under negative emotions. Also, naturalistic studies, involving the repeated assessment of momentary emotions and eating behaviour in daily life, are split between studies supporting and studies contradicting emotional eating in healthy individuals. Individuals with clinical forms of overeating (i.e. binge eating) consistently show positive relationships between negative emotions and eating in daily life. We will conclude with a summary of the controversies around the emotional eating construct and provide recommendations for future research and treatment development.
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Douglas TD, Stephens JW, Barry J, Lee MD, Wilkinson LL. The influence of attachment orientation on weight loss, eating behaviour and other health outcomes among patients undergoing bariatric surgery: A scoping review. Appetite 2019; 147:104504. [PMID: 31689448 DOI: 10.1016/j.appet.2019.104504] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 10/29/2019] [Accepted: 10/29/2019] [Indexed: 12/19/2022]
Abstract
Attachment orientation is a psychological factor concerning our expectations of ourselves and others in interpersonal relationships. An emerging literature has suggested that attachment orientation may influence a range of outcomes associated with bariatric surgery. The purpose of this scoping review was to map the literature and examine the role of attachment orientation in the context of bariatric surgery. Studies conducted with patients who are undergoing or have undergone bariatric surgery, with a measure of attachment orientation and published by 21st July 2019, were located through electronic searches including Scopus, PubMed and Web of Science. 21180 studies were identified, of which 18 were retained for narrative synthesis. The major outcome themes reported were (1) post-surgery weight-loss/body mass index (k = 10), (2) eating behaviour (k = 9), (3) attachment orientation differences in bariatric surgery patients compared with control groups (k = 4) and 4) other mental and physical health outcomes (k = 12). Overall, the results showed that there was little evidence to suggest that poor attachment orientation is predictor of weight-loss following surgery. There was evidence to suggest that poorer attachment orientation relates to poorer eating behaviours both before and after surgery, that patients undergoing bariatric surgery are more likely to have a poorer attachment orientation and attachment orientation is related to mental health outcomes but not physical health outcomes for patients. However, where relationships were identified, there were considerable inconsistencies regarding the dimension of attachment orientation that drove the relationship. Future studies should consider appropriate sample sizes for studies, replication of key findings and longer durations for longitudinal studies.
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Affiliation(s)
| | | | - Jonathan Barry
- Welsh Institute of Metabolic and Obesity Surgery (WIMOS), Abertawe Bro Morgannwg University Health Board, UK
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Smith KE, Juarascio A. From Ecological Momentary Assessment (EMA) to Ecological Momentary Intervention (EMI): Past and Future Directions for Ambulatory Assessment and Interventions in Eating Disorders. Curr Psychiatry Rep 2019; 21:53. [PMID: 31161276 DOI: 10.1007/s11920-019-1046-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE OF REVIEW Ambulatory assessment methods, including ecological momentary assessment (EMA), have often been used in eating disorders (EDs) to assess the type, frequency, and temporal sequencing of ED symptoms occurring in naturalistic environments. Relatedly, growing research in EDs has explored the utility of ecological momentary interventions (EMIs) to target ED symptoms. The aims of the present review were to (1) synthesize recent literature pertaining to ambulatory assessment/EMA and EMI in EDs, and (2) identify relevant limitations and future directions in these domains. RECENT FINDINGS With respect to ambulatory assessment and EMA, there has been substantial growth in the expansion of constructs assessed with EMA, the exploration of state- vs. trait-level processes, integration of objective and passive assessment approaches, and consideration of methodological issues. The EMI literature in EDs also continues to grow, though most of the recent research focuses on mobile health (mHealth) technologies with relatively minimal EMI components that adapt to momentary contextual information. Despite these encouraging advances, there remain several promising areas of ambulatory assessment research and clinical applications in EDs going forward. These include integration of passive data collection, use of EMA in treatment evaluation and design, evaluation of dynamic system processes, inclusion of diverse samples, and development and evaluation of adaptive, tailored EMIs such as just-in-time adaptive interventions. While much remains to be learned in each of these domains, the continual growth in mobile technology has potential to facilitate and refine our understanding of the nature of ED psychopathology and ultimately improve intervention approaches.
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Affiliation(s)
- Kathryn E Smith
- Center for Bio-behavioral Research, Sanford Research, Fargo, ND, USA. .,Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, ND, USA.
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