The role of food-cue exposure and negative affect in the experience of thought-shape fusion

Body-related cognitive distortions (thought-shape fusion body) associated with thin-ideal exposure in female students-An ecological momentary assessment study

Etiological models of eating disorders (EDs) describe body dissatisfaction (BD)as one of the major influences fostering dysfunctional body-related behaviour and disordered eating behaviour. BD is influenced by repeated exposure to thin ideals that evoke high self-ideal discrepancy and result in body-related cognitive distortions such as thought-shape fusion body (TSF-B). The aim of this study was to investigate the covariation of daily media exposure and the experience of TSF-B in a naturalistic setting. It was further analysed whether TSF-B is associated with self-ideal discrepancy, dysfunctional body-related behaviour, and disordered eating behaviour. Moreover, person-related predictors of TSF-B were explored. Altogether, 51healthy female students (mean age 21.06years, SD = 1.76) participated in an ecological momentary assessment study with four daily surveys during 10consecutive days. Exposure with thin ideals in contrast to exposure to unspecific media contents went along with the experience of TSF-B. TSF-B was associated with higher self-ideal discrepancy and dysfunctional body-related behaviour as well as more pronounced disordered eating behaviour, suggesting that TSF-B is a common phenomenon in young healthy females' everyday life. A main effect of trait measures (e.g., pre-existing BD) on TSF-B was observable but has no moderating effect. Thus, a specific vulnerability has not been detected.

Relevance of the Thought-Shape Fusion Trait Questionnaire for healthy women and women presenting symptoms of eating disorders and mixed mental disorders

Thought-shape fusion (TSF) describes the experience of marked concerns about body weight/shape, feelings of fatness, the perception of weight gain, and the impression of moral wrongdoing after thinking about eating fattening/forbidden foods. This study sets out to evaluate the short version of the TSF trait questionnaire (TSF). The sample consists of 315 healthy control women, 244 women with clinical and subthreshold eating disorders, and 113 women with mixed mental disorders (mixed). The factor structure of the TSF questionnaire was examined using exploratory and subsequent confirmatory factor analyses. The questionnaire distinguishes between a Concept scale and a Clinical Impact scale. However, a lack of measurement invariances refers to significant differences between groups in terms of factor loadings, thresholds, and residuals, which questions cross-group validity. Results indicate that the concept is understood differently in the 3 groups and refers to the suitability of the questionnaire primarily for individuals presenting with symptoms of eating disorders.

Cognitive Distortions Associated with Imagination of the Thin Ideal: Validation of the Thought-Shape Fusion Body Questionnaire (TSF-B)

Thought-shape fusion (TSF) describes the experience of body-related cognitive distortions associated with eating disorder (ED) pathology. In the laboratory TSF has been activated by thoughts about fattening/forbidden foods and thin ideals. This study aims at validating a questionnaire to assess the trait susceptibility to TSF (i.e., body-related cognitive distortions) associated with the imagination of thin ideals, and developing an adapted version of the original TSF trait questionnaire, the Thought-Shape Fusion Body Questionnaire (TSF-B). Healthy control women (HC, n = 317) and women diagnosed with subthreshold and clinical EDs (n = 243) completed an online-questionnaire. The factor structure of the TSF-B questionnaire was examined using exploratory (EFA) and subsequent confirmatory factor analysis (CFA). EFA pointed to a two-factor solution, confirmed by CFA. Subscale 1 was named Imagination of thin ideals, containing five items referring to the imagination of female thin ideals. Subscale 2 was named Striving for own thin ideal, with seven items about pursuing/abandoning attempts to reach one’s own thin ideal. The total scale and both subscales showed good convergent validity, excellent reliability, and good ability to discriminate between individuals with subthreshold/clinical EDs and HCs. Results indicate that cognitive distortions are also related to the imagination of thin ideals, and are associated with ED pathology. With two subscales, the TSF-B trait questionnaire appropriately measures this construct. Future studies should clarify whether TSF-B is predictive for the development and course of EDs. Assessing cognitive distortions with the TSF-B questionnaire could improve understanding of EDs and stimulate the development of cognitively oriented interventions. Clinical Trial Registration Number: DRKS-ID: DRKS00005709.

A model of disturbed eating behavior in men: The role of body dissatisfaction, emotion dysregulation and cognitive distortions

Comprehensive models, targeting the development of eating disorders (EDs) in males, often employ a sociocultural perspective and empathize the importance of body dissatisfaction (BD). To further illuminate psychological factors contributing to the development of ED pathology, we propose a mediator model of disturbed eating and compensatory behavior (DECB) for men. This model suggests that emotion dysregulation and the susceptibility to body-related cognitive distortions (thought-shape fusion, TSF) mediate the relationship between BD and DECB. Based on data from a cross-sectional online-survey we tested our model in a non-clinical community sample of young men (N=123, 18-37 years). We found a significant positive association between BD and DECB, accounting for participant's body mass index (BMI), age and depressive symptoms. While TSF partially mediated the relationship between BD and DECB, we did not detect a corresponding effect for emotion dysregulation. Based on our findings, we concluded that TSF, which describes specific distorted cognitions with respect to one's own body triggered by fattening/ forbidden food, contributes to the pathological eating- and body-related behavior in men who are dissatisfied with their body. We suggest that TSF should be included in etiological models as a relevant aspect of cognitive information processing with emotional and behavioral consequences.

Thought-shape fusion in young healthy females appears after vivid imagination of thin ideals

BACKGROUND AND OBJECTIVES

It has been shown that exposure to female thin ideals in media has minimal to moderate direct effects on body image satisfaction (BIS), mood and dysfunctional eating in healthy young women. Evidence has been found for several intervening variables such as social comparison processes. Accordingly it is assumed, that cognitive processing (rather than mere media exposure) is crucial. Consequently, vivid imagination of thin ideals after exposure to a fashion magazine was induced in order to trigger cognitive processes. Changes in mood, BIS and resulting bodyrelated cognitive distortions (Thought-Shape Fusion Body, TSF-B) were assessed.

METHODS

A total of 91 healthy women (mean age 21.9 years, SD = 2.0) were exposed to either a fashion magazine (thin-ideal group) or a nature magazine (control group) in a waiting room design. Afterwards they were instructed to vividly imagine either the thin ideals or landscapes.

RESULTS

When exposed to thin ideals, a significant decrease in mood and BIS emerged after vivid imagination, but not after mere magazine exposure. Imagining thin ideals triggered body-related cognitive distortions (TSF-B). A higher degree of eating disorder (ED) symptomatology amplified this effect.

LIMITATIONS

These findings apply to young healthy females and cannot be generalized to samples with obesity, EDs or males. Internal validity is limited since the intensity of the exposure has not been systematically controlled.

CONCLUSIONS

Vivid imagination of thin ideals promoted by magazines results in impaired mood and BIS and moreover in body-related cognitive distortions (TSF-B) in healthy women, especially, for those with stronger ED symptomatology.

Susceptibility to cognitive distortions: the role of eating pathology

BACKGROUND

Thought-Shape Fusion (TSF) and Thought-Action Fusion (TAF) are cognitive distortions that are associated with eating and obsessional pathology respectively. Both involve the underlying belief that mere thoughts and mental images can lead to negative outcomes. TSF involves the belief that food-related thoughts lead to weight gain, body dissatisfaction, and perceptions of moral wrong-doing. TAF is more general, and involves the belief that merely thinking about a negative event (e.g., a loved one getting into a car accident) can make this event more likely to happen, and leads to perceptions of moral wrong-doing. However, the shared susceptibility across related cognitive distortions-TAF and TSF-has not yet been studied.

METHOD

The effects of TSF and TAF inductions in women with an eating disorder (n = 21) and a group of healthy control women with no history of an eating disorder (n = 23) were measured. A repeated-measures design was employed, with all participants exposed to a TSF, TAF and neutral induction during three separate experimental sessions. Participants' cognitive and behavioral responses were assessed.

RESULTS

Individuals with eating disorders were more susceptible to TSF and TAF than were control participants, demonstrating more neutralization behavior after TSF and TAF inductions (i.e., actions to try to reduce the negative effects of the induction), and reporting higher levels of trait TAF and TSF than did controls.

CONCLUSIONS

Individuals with eating disorders are particularly susceptible to both TAF and TSF. Clinical implications of these findings will be discussed.

Study protocol: psychological and physiological consequences of exposure to mass media in young women - an experimental cross-sectional and longitudinal study and the role of moderators

BACKGROUND

Repeated exposure to thin beauty ideals is part of the daily routine. Exposure to thin ideals via mass media plays an important role in the development and maintenance of eating disorders (EDs), low self-esteem, depressive or anxious feelings in young females. It is important to elucidate the circumstances under which exposure to thin ideals develops its detrimental impact and to investigate whether these features are more pronounced in EDs than in other mental disorders also related to negative body image.

METHODS/DESIGN

We investigate the following key questions: (1) Does laboratory induced exposure to thin ideals (waiting room design) relate to impairments in terms of body image, affect and eating behavior and biological stress response (salivary alpha-amylase, salivary cortisol, heart rate and heart rate variability) in 18 to 35 year old female suffering from anorexia and bulimia nervosa (AN, BN) compared to female healthy controls and to a sample of females suffering from mixed mental disorders (depression, anxiety and somatic symptom disorder (SSD) disorders)? (2) How do moderators such as cognitive distortions ("Thought-Shape Fusion, TSF"), and correlates of emotion regulation (ER) moderate the influence of the exposure? (3) Are these characteristics amenable to change after treatment? Altogether 250 female participants including patients with AN, BN, depressive, anxiety and SSD disorders, and healthy women will be recruited in Switzerland and Germany.

DISCUSSION

The findings will provide knowledge about the role of moderators influencing the effects of exposure to thin ideals promoted by mass media in eating disorder (ED) patients, patients suffering from mixed mental disorders and healthy controls. Evaluating their differential susceptibility will contribute to a better understanding of the role of negative body image in the maintenance of not only symptoms of ED, but also of depression, anxiety and SSD. Additionally our results will shed light on the stability of effects in healthy controls as well as in the patient groups before and after treatment as usual. Findings foster the development of tailored interventions including a training in specific ER strategies as well as cognitive restructuring of distorted beliefs about the own body when confronted with thin ideals.

TRIAL REGISTRATION

German Clinical Trials Register: DRKS00005709. Date of registration: 6(th) of February, 2014.

Reactivity to thought-shape fusion in adolescents: the effects of obesity status

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT

Thought-shape fusion (TSF) is a cognitive distortion associated with eating pathology. TSF is a phenomenon associated with perceptions of weight gain, body dissatisfaction and moral wrongdoing after merely thinking about consumption of high-caloric foods. Women who are overweight are less susceptible to inductions of TSF than are women who are normal-weight.

WHAT THIS STUDY ADDS

Obese adolescents were less susceptible to a TSF induction than were lean adolescents (i.e., they reported lower state TSF in comparison with lean adolescents, and did not demonstrate an increase in state TSF relative to a neutral induction). Eating pathology, but not obesity status or gender, predicted trait TSF.

BACKGROUND

Previous research has demonstrated that imagining consumption of high-caloric foods can lead to feelings of guilt, and perception of weight gain and moral wrongdoing. This psychological response is known as thought-shape fusion (TSF).

OBJECTIVES

This study was conducted to assess the susceptibility of obese and lean adolescents to TSF.

METHODS

To investigate TSF susceptibility in adolescents, and predictors of this distortion, a total of 82 adolescents (44 obese and 38 lean) were randomly assigned to receive either a TSF or a neutral induction. Subsequent TSF reactivity was assessed (i.e., levels of state TSF after the induction), as was trait TSF, eating pathology and depression.

RESULTS AND CONCLUSIONS

The results suggest that obese adolescents are less susceptible to TSF than are lean adolescents, as lean (but not obese) adolescents reported significantly higher state TSF relative to participants who received the neutral induction. Similarly, lean adolescents who were exposed to a TSF induction reported higher state TSF than did obese adolescents. Furthermore, obesity did not emerge as a predictor of trait TSF. Factors that may account for decreased TSF susceptibility in obese adolescents relative to lean adolescents will be discussed.

Thought-shape fusion in anorexia and bulimia nervosa: a comparative experimental study

'Thought-shape fusion' (TSF) is a cognitive distortion specific in patients with eating disorders and occurs when the thought about eating a forbidden food increases a person's estimate of her weight/shape, elicits a perception of moral wrongdoing and makes her feel fat. This study aimed to experimentally induce, study and compare TSF between patients with bulimia nervosa (BN) and patients with anorexia nervosa (AN). 31 patients diagnosed with a current eating disorder, of which 20 met DSM-IV-TR criteria for BN and 11 for AN, participated in a mixed-model experimental design with the aim of eliciting TSF and investigating the effects of corrective behaviors (checking and mental neutralizing). Verbal analogue scales constituted the main outcome measures. TSF was experimentally induced and expressed in a similar way in both clinical groups, apart from 'feeling fat' which was higher in BN patients. TSF induction triggered heightened levels of anxiety, guilt and urges to engage in corrective behaviors in both groups. Body dissatisfaction only increased in the BN patients. Mental neutralizing and to a lesser extent checking reduced most effects of the experimental procedure, but this effect was larger for BN patients. The nature of TSF seems to have similarities between BN and AN patients; however, the precise connection between TSF and different types of eating disorders remains to be explored in future clinical trials.

Assessment of thought-shape fusion: initial validation of a short version of the trait thought-shape fusion scale

OBJECTIVE

Thought-shape fusion (TSF) is a cognitive distortion that has been linked to eating pathology. Two studies were conducted to further explore this phenomenon and to establish the psychometric properties of a French short version of the TSF scale.

METHOD

In Study 1, students (n = 284) completed questionnaires assessing TSF and related psychopathology. In Study 2, the responses of women with eating disorders (n = 22) and women with no history of an eating disorder (n = 23) were compared.

RESULTS

The French short version of the TSF scale has a unifactorial structure, with convergent validity with measures of eating pathology, and good internal consistency. Depression, eating pathology, body dissatisfaction, and thought-action fusion emerged as predictors of TSF. Individuals with eating disorders have higher TSF, and more clinically relevant food-related thoughts than do women with no history of an eating disorder.

DISCUSSION

This research suggests that the shortened TSF scale can suitably measure this construct, and provides support for the notion that TSF is associated with eating pathology.

Thought-shape fusion and body image in eating disorders

Purpose

The aim of this study was to analyze the relationships among thought–shape fusion (TSF), specific instruments to assess body image disturbances, and body image quality of life in eating disorder patients in order to improve the understanding of the links between body image concerns and a specific bias consisting of beliefs about the consequences of thinking about forbidden foods.

Patients and methods

The final sample included 76 eating disorder patients (mean age 20.13 ± 2.28 years; 59 women and seven men). After having obtained informed consent, the following questionnaires were administered: Body Appreciation Scale (BAS), Body Image Quality of Life Inventory (BIQLI-SP), Body Shape Questionnaire (BSQ), Eating Disorders Inventory-2 (EDI-2), State-Trait Anxiety Inventory (STAI), Symptom Checklist-90-Revised (SCL-90-R) and Thought-Shape Fusion Questionnaire (TSF-Q).

Results

Significant correlations were found between TSF-Q and body image-related variables. Those with higher scores in TSF showed higher scores in the BSQ (P < 0.0001), Eating Disorder Inventory – Drive for Thinness (EDI-DT) (P < 0.0001), and Eating Disorder Inventory – Body Dissatisfaction (EDI-BD) (P < 0.0001). The same patients showed lower scores in the BAS (P < 0.0001). With respect to the psychopathological variables, patients with high TSF obtained higher scores in all SCL-90-R subscales as well as in the STAI.

Conclusion

The current study shows the interrelations among different body image-related variables, TSF, and body image quality of life.