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Efstathiou M, Delicato LS, Sedda A. Emotional body representations: more pronounced effect of hands at a more explicit level of awareness. Exp Brain Res 2024; 242:1595-1608. [PMID: 38760470 DOI: 10.1007/s00221-024-06839-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 04/16/2024] [Indexed: 05/19/2024]
Abstract
To understand conditions such as body dysmorphic disorder, we need to understand healthy individuals' perceptual, conceptual, and emotional representations of their bodies. Not much is known about the differences in these representations across body districts, for example, hands, feet, and whole-body, despite their differences at sensory and functional levels. To understand this, we developed more implicit and explicit measures of body satisfaction for these body districts. Sixty-seven participants (age M = 30.66, SD = 11.19) completed a series of online Implicit Association Tests (IAT) and a Body Image Satisfaction Visual Analogue Scale (BISVAS; explicit) for each body district (hands/feet/whole body). The results show no differences in the more implicit level of awareness in hands, feet and whole body, while differences are apparent at a more explicit level of awareness, with higher scores for body image satisfaction for the hands than the whole body and marginally significant lower scores for feet than hands. Those findings suggest that visual attention, level of concern attributed to a body district, and disgust drivers are possible factors affecting the experience of attitudinal body image satisfaction.
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Affiliation(s)
- Myrto Efstathiou
- Centre for Applied Behavioural Sciences, Department of Psychology, School of Social Sciences, Heriot-Watt University, Edinburgh Campus, Edinburgh, UK.
| | - Louise S Delicato
- Centre for Applied Behavioural Sciences, Department of Psychology, School of Social Sciences, Heriot-Watt University, Edinburgh Campus, Edinburgh, UK
| | - Anna Sedda
- Centre for Applied Behavioural Sciences, Department of Psychology, School of Social Sciences, Heriot-Watt University, Edinburgh Campus, Edinburgh, UK
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2
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Pullmer R, Potter S, Laliberte M. Enhancing eating disorder recovery: Weight control beliefs predict body dissatisfaction in group cognitive behavioural therapy for body image. Eat Behav 2023; 50:101774. [PMID: 37336160 DOI: 10.1016/j.eatbeh.2023.101774] [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: 11/01/2022] [Revised: 06/12/2023] [Accepted: 06/13/2023] [Indexed: 06/21/2023]
Abstract
Body dissatisfaction is one of the strongest predictors of eating disorder relapse. Yet, a dearth of research exists on factors that facilitate change in body dissatisfaction following treatment focused on symptom interruption. Recent research points to the role of weight control beliefs in predicting outcomes in patients with eating disorders. The primary objective of this research was therefore twofold: 1) To investigate the impact of group cognitive behavioural therapy (GCBT) on weight control beliefs and body dissatisfaction and 2) to examine the influence of weight control beliefs on body dissatisfaction over time. Participants were 50 adults with a recent eating disorder diagnosis who completed 10 sessions of GCBT for body image following GCBT for eating disorders. All participants completed the Eating Disorder Inventory and Weight Control Beliefs Questionnaire at baseline and post-treatment. Body dissatisfaction and weight control beliefs improved from pre- to post-treatment. Hierarchical linear regression analyses revealed that increases in lifestyle control beliefs, a subtype of weight control beliefs, predicted decreases in body dissatisfaction. Results underscore the utility of fostering healthy weight control beliefs to cultivate a positive body image in patients navigating the eating disorder recovery process.
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Affiliation(s)
- Rachelle Pullmer
- St. Joseph's Healthcare Hamilton, Eating Disorders Program, Hamilton, Ontario, Canada; St. Paul's Hospital, Eating Disorders Program, Vancouver, British Columbia, Canada.
| | - Sarah Potter
- St. Joseph's Healthcare Hamilton, Eating Disorders Program, Hamilton, Ontario, Canada
| | - Michele Laliberte
- St. Joseph's Healthcare Hamilton, Eating Disorders Program, Hamilton, Ontario, Canada
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Naumann E, Werthmann J, Vocks S, Svaldi J, Hartmann AS. Die Spiegelkonfrontationstherapie zur Behandlung von Körperbildstörungen bei Essstörungen – Evidenz, Wirkmechanismen und Vorgehensweise. PSYCHOLOGISCHE RUNDSCHAU 2022. [DOI: 10.1026/0033-3042/a000558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Zusammenfassung. Körperbildprobleme sind ein Kernmerkmal von Essstörungen. Daher gilt eine Verbesserung des Körperbildes bei der Behandlung von Essstörungen als zentrales Therapieziel. Verschiedene empirische Befunde weisen auf die Spiegelkonfrontation als wirksame Methode zur Reduktion von Körperbildstörungen hin. Ziel dieses Übersichtsartikels ist es, den aktuellen Stand der wissenschaftlichen Literatur zum Thema Spiegelkonfrontationstherapie bei Essstörungen darzulegen. Insbesondere sollen die Wirksamkeitsstudien getrennt für nicht-klinische, körperunzufriedene Gruppen mit und ohne Übergewicht sowie die verschiedenen Essstörungsgruppen systematisiert und unterschiedliche Vorgehensweisen beschrieben werden. Der Übersichtsartikel liefert Hinweise dafür, dass die Spiegelkonfrontationstherapie bei Hochrisikogruppen mit erhöhter Körperunzufriedenheit sowie bei Essstörungen zu positiven Veränderungen hinsichtlich der kognitiv-affektiven und behavioralen Komponente des Körperbildes führt. Jedoch mangelt es insgesamt an randomisiert-kontrollierten Studien, die die Wirksamkeit der Spiegelkonfrontationstherapie mit ausreichend großen Stichproben gezielt untersuchen – vor allem bei der Anorexia nervosa. Der Übersichtsartikel schließt mit einer Diskussion über mögliche Wirkmechanismen, (Kontra–)Indikationen und einem Ausblick für zukünftige Forschung ab.
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Affiliation(s)
- Eva Naumann
- Abteilung Klinische Psychologie und Psychologie, Institut für Psychologie, Eberhard Karls Universität Tübingen, Deutschland
| | - Jessica Werthmann
- Abteilung Klinische Psychologie und Psychologie, Institut für Psychologie, Albert-Ludwigs-Universität Freiburg, Deutschland
| | - Silja Vocks
- Fachgebiet Klinische Psychologie und Psychologie, Institut für Psychologie, Universität Osnabrück, Deutschland
| | - Jennifer Svaldi
- Abteilung Klinische Psychologie und Psychologie, Institut für Psychologie, Eberhard Karls Universität Tübingen, Deutschland
| | - Andrea S. Hartmann
- Fachgebiet Klinische Psychologie und Psychologie, Institut für Psychologie, Universität Osnabrück, Deutschland
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Tanck JA, Hartmann AS, Svaldi J, Hagena S, Osen B, Stierle C, Vocks S. What happens in the course of positive mirror exposure? Effects on eating pathology, body satisfaction, affect, and subjective physiological arousal in patients with anorexia and bulimia nervosa. EUROPEAN EATING DISORDERS REVIEW 2022; 30:797-814. [PMID: 35731138 DOI: 10.1002/erv.2929] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 04/12/2022] [Accepted: 05/18/2022] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Mirror exposure (ME) is a therapeutic technique to improve body image disturbance. However, evidence on the effectiveness of different forms of ME in clinical populations is lacking. The present study therefore analysed effects of ME on trait-like and state measures of body image in patients with anorexia nervosa (AN) and bulimia nervosa (BN). METHOD The present study therefore analysed effects of ME on trait-like and state measures of body image in patients with anorexia nervosa (AN) and bulimia nervosa (BN). In total, 47 inpatients underwent 3 ME sessions guided by a therapist, with instructions to exclusively verbalise positively about their whole body. Participants completed questionnaires on trait-like eating pathology and body image at the start and end of the study, and instruments on state affect and body satisfaction were administered directly before and after each ME session. Subjective physiological arousal and emotional valence relating to each body part were assessed within each session. RESULTS The results indicate significant improvements in eating pathology and body image regarding trait-like measures in patients with AN and BN. Concerning state measures, negative affect significantly decreased and body satisfaction increased during ME. Physiological arousal decreased and positively valenced emotions relating to the various body parts increased. CONCLUSIONS These findings suggest that positively verbalising about one's body during ME improves eating pathology, body image, affect, and subjective physiological arousal, and thus seems to be an effective form of ME.
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Affiliation(s)
- Julia A Tanck
- Institute of Psychology, Unit of Clinical Psychology and Psychotherapy, Osnabrück University, Osnabrück, Germany
| | - Andrea S Hartmann
- Department of Psychology, Unit of Experimental Clinical Psychology, University of Konstanz, Konstanz, Germany
| | - Jennifer Svaldi
- Institute of Psychology, Unit of Clinical Psychology and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Silka Hagena
- Asklepios Klinik Nord Ochsenzoll, Hamburg, Germany
| | | | | | - Silja Vocks
- Institute of Psychology, Unit of Clinical Psychology and Psychotherapy, Osnabrück University, Osnabrück, Germany
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5
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Walker DC, Murray K. A Pilot Clinical Case Series of Functionality-Focused Mirror Exposure in Women With Clinically Elevated Body Dissatisfaction. COGNITIVE AND BEHAVIORAL PRACTICE 2022. [DOI: 10.1016/j.cbpra.2022.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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6
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Sánchez CG, Ferrer SD, Cuellar JAA, Martín JLM, Ruiz SR. I Look at my whole body and i feel better: attentional bias, emotional and psychophysiological response by pure exposure treatment in women with obesity. Psychother Res 2022; 32:748-762. [PMID: 34983319 DOI: 10.1080/10503307.2021.2021310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Obesity is one of the most important health problems nowadays. In addition to the direct physical consequences, it is also a risk factor in the development of psychological (Eating disorders, body dissatisfaction, depression, anxiety, etc.) and social problems. Among there, body dissatisfaction is key for development and maintenance of such problems. OBJECTIVE to deepen the effectiveness of the body exposure treatment, both in its pure form and guided modality in subjective, psychological and attentional levels in people with body dissatisfaction and obesity. METHODS Evaluations were carried out in a total of 16 women with obesity and body dissatisfaction at the beginning and end of 6 treatment sessions of pure exposure in front of the mirror. The changes experienced at the subjective level (questionnaires and subjective discomfort during the sessions) and psychophysiological (eye-tracking and heart rate) were analyzed. RESULTS Pure exposure treatment reduces negative thoughts and emotions towards the body itself, as well as the experienced discomfort towards the most conflictive parts. Selective attention to those parts of the body classified as uglier by the participants (especially the rear view of the body) show a decrease in physiological reactivity. CONCLUSIONS Pure exposure treatment seems to be effective in reducing subjective and psychological symptoms associated with body dissatisfaction in people with obesity, this technique could be considered a good choice for the treatment of body dissatisfaction. This step is essential to guarantee the long-term therapeutic success of any other treatment (nutritional or/and physical activity) in the future.
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Affiliation(s)
- Cristina González Sánchez
- Faculty of Psychology, Department of Personality, Evaluation and Psychological Treatment, University of Granada, Granada, Spain
| | - Sandra Díaz Ferrer
- Faculty of Psychology, Department of Personality, Evaluation and Psychological Treatment, University of Granada, Granada, Spain
| | | | - José Luis Mata Martín
- Faculty of Psychology, Department of Personality, Evaluation and Psychological Treatment, University of Granada, Granada, Spain
| | - Sonia Rodríguez Ruiz
- Faculty of Psychology, Department of Personality, Evaluation and Psychological Treatment, University of Granada, Granada, Spain
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7
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Klimek P, Wei B, Blashill AJ. Exploring moderators of mirror exposure on pre- to post changes in body image outcomes: Systematic review and meta-analysis. Eat Disord 2022; 30:77-98. [PMID: 33100189 DOI: 10.1080/10640266.2020.1791665] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE Mirror exposure (ME) is embedded within cognitive behavioral treatment of body image concern (BIC), and existing literature demonstrates its potential value as a BIC intervention. The purpose of the study is to provide a meta-analytic review of ME effects on attitudinal and behavioral BIC. METHODS Twelve studies met inclusion criteria, yielding six between-group and 18 within-group comparisons. RESULTS Random effects models demonstrated a medium effect of ME versus control conditions, on attitudinal BIC, from pre- to immediate posttreatment, small effect at follow-up (1 to 4 weeks posttreatment), and large effect on behavioral BIC pre- to immediate posttreatment. However, small sample sizes yielded nonsignificant findings and significant heterogeneity. Exploratory moderator analyses-ME type, ME dosage (session frequency, duration), and diagnosis-demonstrated that, among single group pre-post designs, higher ME dosage may be instrumental to pre-posttreatment improvements. Consistent with this finding, individual studies with high dosages of ME demonstrated the largest effect sizes. Conclusion: Results may suggest a strong ME effect on BIC at high dosages (>120 minutes). The current review highlights gaps in ME literature and the need for future clinical trials assessing ME, using a priori, high-quality research designs that further the understanding of ME's mechanisms of change.
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Affiliation(s)
- Patrycja Klimek
- San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, California, USA
| | - Boyu Wei
- Department of Psychology, San Diego State University, San Diego, California, USA
| | - Aaron J Blashill
- San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, California, USA.,Department of Psychology, San Diego State University, San Diego, California, USA
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Knejzlíková T, Světlák M, Malatincová T, Roman R, Chládek J, Najmanová J, Theiner P, Linhartová P, Kašpárek T. Electrodermal Response to Mirror Exposure in Relation to Subjective Emotional Responses, Emotional Competences and Affectivity in Adolescent Girls With Restrictive Anorexia and Healthy Controls. Front Psychol 2021; 12:673597. [PMID: 34566754 PMCID: PMC8461306 DOI: 10.3389/fpsyg.2021.673597] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 08/18/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: Body image disturbances and the attendant negative emotions are two of the major clinical symptoms of eating disorders. The objective of the present experimental study was to shed more light on the degree of association or dissociation between the physiological and emotional response to mirror exposure in patients with restrictive mental anorexia, and on the relationships between the physiological response and characteristics connected with emotional processing. Materials and Methods: Thirty adolescent girls with the restrictive type of anorexia and thirty matched healthy controls underwent bilateral measurement of skin conductance (SC) during rest, neutral stimulus exposure, and mirror exposure, and completed a set of measures focused on emotion regulation competencies, affectivity, and eating disorder pathology. Results: Compared to healthy controls, girls with restrictive anorexia rated mirror exposure as a subjectively more distressful experience. Differences in skin conductance response (SCR) were not significant; however, variance in SCR was substantially greater in the group of anorexia patients as compared to healthy controls. The overall skin conductance level (SCL) was lower in anorexia patients. Increase in SCR during mirror exposure, as opposed to exposure to neutral stimuli, was positively related to the tendency to experience negative emotions, interoceptive sensitivity, body dissatisfaction and suppression, but not to other symptoms of eating pathology or emotional awareness. A post hoc analysis suggested that physiological reactivity might be associated with interoceptive sensitivity to mirror exposure especially in anorectic patients. Conclusion: The study seems to demonstrate some degree of dissociation between psychophysiological reactivity and subjective response to body exposure in patients with restrictive anorexia. Factors affecting differences in psychophysiological responsiveness to body exposure in anorectic patients require further exploration.
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Affiliation(s)
- Terézia Knejzlíková
- Department of Psychiatry, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Miroslav Světlák
- Institute of Psychology and Psychosomatics, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Tatiana Malatincová
- Institute of Psychology and Psychosomatics, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Robert Roman
- Department of Psychiatry, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Jan Chládek
- Institute of Scientific Instruments of the CAS, Brno, Czechia
| | - Jana Najmanová
- Department of Psychiatry, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Pavel Theiner
- Department of Psychiatry, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Pavla Linhartová
- Department of Psychiatry, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Tomáš Kašpárek
- Department of Psychiatry, Faculty of Medicine, Masaryk University, Brno, Czechia
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9
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Tanck JA, Hartmann AS, Svaldi J, Vocks S. Effects of full-body mirror exposure on eating pathology, body image and emotional states: Comparison between positive and negative verbalization. PLoS One 2021; 16:e0257303. [PMID: 34516591 PMCID: PMC8437269 DOI: 10.1371/journal.pone.0257303] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 08/29/2021] [Indexed: 01/15/2023] Open
Abstract
Mirror exposure (ME) is an effective technique to improve body image. However, evidence on the underlying mechanisms and the optimal verbalization instruction during ME is lacking. Therefore, this experimental study analyzed mechanisms of ME and therapeutic outcomes by comparing positive (PV) and negative (NV) full-body verbalization. N = 73 healthy females were randomized to a PV or an NV condition. PV participants verbalized positively while NV participants verbalized negatively about their whole body. Each participant underwent three standardized ME sessions. Before and after each ME session, positive affect, negative affect and body satisfaction were assessed. Before the first and after the third ME, participants completed questionnaires on cognitive-affective and behavioral aspects of body image, eating pathology and self-esteem. Regarding within-ME changes, the results indicate that positive affect and body satisfaction decreased while negative affect increased in the NV group but not in the PV group. In contrast, regarding between-ME changes, decreased negative affect as well as positive affect and increased body satisfaction were observed in both groups. However, eating pathology remained stable, whereas body-checking behavior increased and the PV condition was followed by higher levels of self-esteem compared to the NV condition. These findings suggest that both PV and NV improve negative affect and body satisfaction between-ME, and thus seem to be effective ME instructions. Given that NV led to increased negative affect within-ME and did not influence self-esteem, PV might represent the favorable instruction during ME for body-satisfied women.
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Affiliation(s)
- Julia A. Tanck
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Osnabrück University, Osnabrück, Germany
- * E-mail:
| | - Andrea S. Hartmann
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Osnabrück University, Osnabrück, Germany
| | - Jennifer Svaldi
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Tübingen University, Tübingen, Germany
| | - Silja Vocks
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Osnabrück University, Osnabrück, Germany
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10
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Exposure therapy for eating disorders: A systematic review. Clin Psychol Rev 2020; 78:101851. [DOI: 10.1016/j.cpr.2020.101851] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 03/07/2020] [Accepted: 03/10/2020] [Indexed: 12/25/2022]
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11
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Irvine KR, Irvine AR, Maalin N, McCarty K, Cornelissen KK, Tovée MJ, Cornelissen PL. Using immersive virtual reality to modify body image. Body Image 2020; 33:232-243. [PMID: 32408166 DOI: 10.1016/j.bodyim.2020.03.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 03/27/2020] [Accepted: 03/27/2020] [Indexed: 12/11/2022]
Abstract
We tested the efficacy of a training programme, delivered in virtual reality (VR), to modify the perceptual boundary between what participants classify as a fat versus a thin body. Three cohorts of 20 female volunteers with high body image concerns were recruited to two intervention groups and one control group. All participants completed a 4-day training programme in VR where they categorised a series of 3D models as either thin or fat; one intervention group was presented with the stimuli briefly, while the other group had no time limits imposed. Both intervention groups were given inflationary feedback to shift their categorisations of the stimulus models towards higher BMIs. Our results show that, compared to controls, both intervention groups shifted their categorical boundaries between Day 1 and follow-up on Day 14. Unlimited stimulus presentation times were associated with a larger training effect. Furthermore, both intervention groups experienced statistically significant reductions in their concerns about their own body shape, weight and eating habits. However, only in the group with longer stimulus presentation times were these reductions consistent with a clinically meaningful effect. These findings suggest that manipulating categorical perception in VR might provide a complementary addition to existing treatments for eating disorders.
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Affiliation(s)
- Kamila R Irvine
- Department of Psychology, Faculty of health and Life Sciences, Northumbria University, Newcastle upon Tyne, NE1 8ST, UK.
| | - Andrew R Irvine
- Virtual Research Innovations Ltd., UK; School of Psychology, College of Social Science, University of Lincoln, Lincolnshire, LN6 7TS, UK
| | - Nadia Maalin
- School of Psychology, College of Social Science, University of Lincoln, Lincolnshire, LN6 7TS, UK
| | - Kristofor McCarty
- Department of Psychology, Faculty of health and Life Sciences, Northumbria University, Newcastle upon Tyne, NE1 8ST, UK
| | - Katri K Cornelissen
- Department of Psychology, Faculty of health and Life Sciences, Northumbria University, Newcastle upon Tyne, NE1 8ST, UK
| | - Martin J Tovée
- Department of Psychology, Faculty of health and Life Sciences, Northumbria University, Newcastle upon Tyne, NE1 8ST, UK
| | - Piers L Cornelissen
- Department of Psychology, Faculty of health and Life Sciences, Northumbria University, Newcastle upon Tyne, NE1 8ST, UK
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12
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Pinquart M, Pfeiffer JP. Longitudinal Associations of the Attainment of Developmental Tasks With Psychological Symptoms in Adolescence: A Meta-Analysis. JOURNAL OF RESEARCH ON ADOLESCENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR RESEARCH ON ADOLESCENCE 2020; 30 Suppl 1:4-14. [PMID: 30367691 DOI: 10.1111/jora.12462] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The present meta-analysis integrates results from 310 longitudinal studies on associations of the attainment of 10 developmental tasks with psychological symptoms (e.g., internalizing or externalizing symptoms, anxiety, and depression). Higher initial success with getting access to a peer group, building friendships, preparing for a future career, body acceptance, as well as developing a personal identity, a value system, and socially responsible behavior predicted lower levels of symptoms at follow-up and stronger declines of symptoms over time when controlling for initial symptom levels. Furthermore, higher initial symptom levels predicted lower attainment of these tasks at follow-up as well as lower progress in task attainment. In contrast, more initial romantic/sexual involvement predicted an increase in symptoms over time, while higher initial symptoms were related to an increase in romantic/sexual involvement. Associations with autonomy varied between different forms of autonomy, while acquisition of a gender role was not related with psychological symptoms.
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13
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Ralph-Nearman C, Achee M, Lapidus R, Stewart JL, Filik R. A systematic and methodological review of attentional biases in eating disorders: Food, body, and perfectionism. Brain Behav 2019; 9:e01458. [PMID: 31696674 PMCID: PMC6908865 DOI: 10.1002/brb3.1458] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Accepted: 10/05/2019] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE The current systematic and methodological review aimed to critically review existing literature utilizing implicit processing, or automatic approach- and/or avoidance-related attentional biases between eating disorder (ED) and nonclinical samples, which (a) highlights how psychophysiological methods advance knowledge of ED implicit bias; (b) explains how findings fit into transdiagnostic versus disorder-specific ED frameworks; and (c) suggests how research can address perfectionism-related ED biases. METHOD Three databases were systematically searched to identify studies: PubMed, Scopus, and PsychInfo electronic databases. Peer-reviewed studies of 18- to 39-year-olds with both clinical ED and healthy samples assessing visual attentional biases using pictorial and/or linguistic stimuli related to food, body, and/or perfectionism were included. RESULTS Forty-six studies were included. While behavioral results were often similar across ED diagnoses, studies incorporating psychophysiological measures often revealed disease-specific attentional biases. Specifically, women with bulimia nervosa (BN) tend to approach food and other body types, whereas women with anorexia nervosa (AN) tend to avoid food as well as overweight bodies. CONCLUSIONS Further integration of psychophysiological and behavioral methods may identify subtle processing variations in ED, which may guide prevention strategies and interventions, and provide important clinical implications. Few implicit bias studies include male participants, investigate binge-eating disorder, or evaluate perfectionism-relevant stimuli, despite the fact that perfectionism is implicated in models of ED.
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Affiliation(s)
- Christina Ralph-Nearman
- Laureate Institute for Brain Research, Tulsa, OK, USA.,School of Psychology, University of Nottingham, Nottingham, UK
| | - Margaret Achee
- Department of Psychology, University of Tulsa, Tulsa, OK, USA
| | | | - Jennifer L Stewart
- Laureate Institute for Brain Research, Tulsa, OK, USA.,Department of Community Medicine, University of Tulsa, Tulsa, OK, USA
| | - Ruth Filik
- School of Psychology, University of Nottingham, Nottingham, UK
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14
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Abstract
Body dissatisfaction is a risk factor for development of eating disorders and represents a core psychopathologic feature of eating disorders. Prevention and treatment interventions address established risk and maintaining factors for body dissatisfaction: appearance pressures, internalization of appearance ideals, upward appearance comparison, avoidance and checking, and body disparagement. It is essential to address body dissatisfaction within eating disorders treatment to improve outcomes and reduce risk of relapse. Future directions in research and treatment aim to reach populations increasingly recognized as in need, including children, men, and individuals at higher weights, with the ultimate goal of reducing the significant distress associated with body dissatisfaction.
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15
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Mirror exposure therapy for body image disturbances and eating disorders: A review. Clin Psychol Rev 2018; 65:163-174. [DOI: 10.1016/j.cpr.2018.08.006] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 08/25/2018] [Accepted: 08/27/2018] [Indexed: 12/21/2022]
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16
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Voges MM, Giabbiconi CM, Schöne B, Braks K, Huber TJ, Waldorf M, Hartmann AS, Vocks S. Double standards in body evaluation? How identifying with a body stimulus influences ratings in women with anorexia nervosa and bulimia nervosa. Int J Eat Disord 2018; 51:1223-1232. [PMID: 30480829 DOI: 10.1002/eat.22967] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 08/24/2018] [Accepted: 09/20/2018] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Women with eating disorders (ED) evaluate their own body more negatively than do women without ED. However, it is unclear whether this negative rating is due to objective bodily features or different standards for one's own body and others' bodies. Therefore, the purpose of this study was to examine whether women with ED apply double standards when rating bodies by disentangling the objective features of one's own body from the feelings of ownership. METHOD We presented n = 34 women with anorexia nervosa, n = 31 women with bulimia nervosa, and n = 114 healthy controls with pictures of thin, average-weight, overweight, athletic, and hypermuscular bodies. Identity was manipulated by showing each body once with the participant's own face and once with the face of another woman. Participants were instructed to report their emotional state according to valence and arousal and to rate body attractiveness, body fat, and muscle mass. RESULTS Women with anorexia nervosa and bulimia nervosa displayed greater self-deprecating double standards in body fat rating than did women without ED, as quantified by the difference between the ratings of the same body with one's own versus another woman's face. Double standards reflected in valence, arousal and attractiveness ratings were significantly more pronounced in women with anorexia nervosa than in women without ED. DISCUSSION The double standards found may be due to an activation of dysfunctional self-related body schemata, which distort body evaluation depending on identity. Double standards related to body fat were characteristic for women with ED, but not for women without ED.
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Affiliation(s)
- Mona M Voges
- Department of Clinical Psychology and Psychotherapy, Osnabrück University, Osnabrück, Germany
| | - Claire-Marie Giabbiconi
- Department of Clinical Psychology and Psychotherapy, Osnabrück University, Osnabrück, Germany
| | - Benjamin Schöne
- Department of Experimental Psychology I, Osnabrück University, Osnabrück, Germany
| | | | | | - Manuel Waldorf
- Department of Clinical Psychology and Psychotherapy, Osnabrück University, Osnabrück, Germany
| | - Andrea S Hartmann
- Department of Clinical Psychology and Psychotherapy, Osnabrück University, Osnabrück, Germany
| | - Silja Vocks
- Department of Clinical Psychology and Psychotherapy, Osnabrück University, Osnabrück, Germany
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Miragall M, Etchemendy E, Cebolla A, Rodríguez V, Medrano C, Baños RM. Expand your body when you look at yourself: The role of the posture in a mirror exposure task. PLoS One 2018; 13:e0194686. [PMID: 29570729 PMCID: PMC5865731 DOI: 10.1371/journal.pone.0194686] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 03/07/2018] [Indexed: 11/28/2022] Open
Abstract
Mirror exposure (ME) is one of the main components of the treatment of patients with eating disorders symptomatology and it has shown its effectiveness in improving several outcomes (e.g., body dissatisfaction). However, the study as to what body posture should be adopted to maximize its effectiveness has been neglected. From embodied cognition and emotion theories, the adoption of an expansive (vs. contractive) body posture has been associated with positive changes in cognitive and emotional responses. The objective of this study was to analyze the effect of adopting an expansive (vs. contractive) posture before an ME task on body-related emotions and cognitions, as well as to analyze the possible moderator and mediator variables of these relationships. The sample was composed of 68 women (age: M = 21.74, SD = 3.12) with high scores on body dissatisfaction. Participants were randomly assigned to the expansive or contractive condition, where the openness of the arms/legs and the back position were manipulated. Posture was monitored by an electronic device and participants filled out several self-reported measures. ANCOVAs, moderation, mediation, and moderated mediated analyses were performed. Results showed that women in the expansive condition showed higher positive emotions after the ME. Moreover, exploratory analyses showed that adopting an expansive posture improved positive emotions, leading to improvements in negative emotions, body image satisfaction, and appraisal of the person’s own body. Psychological interventions should explore the value of holding an expansive posture before the ME in women with body dissatisfaction.
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Affiliation(s)
- Marta Miragall
- Department of Personality, Evaluation and Psychological Treatment, University of Valencia, Valencia, Spain
| | | | - Ausiàs Cebolla
- Department of Personality, Evaluation and Psychological Treatment, University of Valencia, Valencia, Spain.,CIBER Fisiopatología Obesidad y Nutrición (CIBEROBN), Instituto Carlos III, Madrid, Spain
| | | | - Carlos Medrano
- EduQTech, EUPT, University of Zaragoza, Teruel, Spain.,Aragon Institute for Health Research (IIS Aragón), University of Zaragoza, Zaragoza, Spain
| | - Rosa María Baños
- Department of Personality, Evaluation and Psychological Treatment, University of Valencia, Valencia, Spain.,CIBER Fisiopatología Obesidad y Nutrición (CIBEROBN), Instituto Carlos III, Madrid, Spain
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18
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Díaz-Ferrer S, Rodríguez-Ruiz S, Ortega-Roldán B, Mata-Martín JL, Carmen Fernández-Santaella M. Psychophysiological Changes during Pure vs Guided Mirror Exposure Therapies in Women with High Body Dissatisfaction: What Are They Learning about Their Bodies? EUROPEAN EATING DISORDERS REVIEW 2017; 25:562-569. [PMID: 28944527 DOI: 10.1002/erv.2546] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 08/05/2017] [Accepted: 08/14/2017] [Indexed: 11/11/2022]
Abstract
This study aimed to examine the psychophysiological changes resulting from two mirror exposure treatments that are effective at reducing body dissatisfaction. Thirty-five university women with body dissatisfaction and subclinical eating disorders were randomly assigned to one of two groups: pure (n = 17) or guided exposure (n = 18). The participants received six sessions of treatment. Their thoughts, feelings and avoidance behaviours were assessed after each session. Their subjective discomfort, heart rate and skin conductance were assessed within the sessions. Both groups showed improvement in cognitive-affective and avoidance behaviour symptoms. Nevertheless, the pure exposure group showed faster habituation of subjective discomfort and a greater physiological response than the guided exposure group. These findings suggest that both procedures are effective interventions for improving body image disturbances, although psychophysiological changes observed within session suggest that each technique would act through different processes. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.
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Affiliation(s)
- Sandra Díaz-Ferrer
- Department of Personality, Assessment and Psychological Treatment, Faculty of Psychology, University of Granada, Spain
| | - Sonia Rodríguez-Ruiz
- Department of Personality, Assessment and Psychological Treatment, Faculty of Psychology, University of Granada, Spain
| | - Blanca Ortega-Roldán
- Department of Personality, Assessment and Psychological Treatment, Faculty of Psychology, University of Granada, Spain
| | - José Luis Mata-Martín
- Department of Personality, Assessment and Psychological Treatment, Faculty of Psychology, University of Granada, Spain
| | - M Carmen Fernández-Santaella
- Department of Personality, Assessment and Psychological Treatment, Faculty of Psychology, University of Granada, Spain
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19
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Steinfeld B, Bauer A, Waldorf M, Hartmann AS, Vocks S. Diagnostik der Körperbildstörung. PSYCHOTHERAPEUT 2017. [DOI: 10.1007/s00278-017-0188-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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20
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Trentowska M, Svaldi J, Blechert J, Tuschen-Caffier B. Does habituation really happen? Investigation of psycho-biological responses to body exposure in bulimia nervosa. Behav Res Ther 2016; 90:111-122. [PMID: 28027485 DOI: 10.1016/j.brat.2016.12.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 10/24/2016] [Accepted: 12/12/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Body exposure is a common and effective treatment for body image disturbance in bulimia nervosa (BN). However, little is known about treatment mechanisms. Based on models of emotional processing and neurovisceral integration, we expected to observe a) initial activation and b) habituation of cognitive-affective and autonomic responding within one and between two standardized body exposure sessions. METHODS A group of 13 women with BN and 13 healthy controls (HC) were repeatedly exposed to their bodies. Prior to and after treatment with three individualized mirror exposure sessions participants received a session of standardized exposure to videographic recordings of their body. Subjective ratings of body-related emotions and thoughts were assessed repeatedly throughout the standardized exposure sessions and autonomic responses were recorded continuously. RESULTS Subjective and sympathetic responses were activated initially in both groups. Cognitive-affective responses habituated within the standardized sessions in both groups, whereas between the standardized sessions habituation was only found in women with BN. Increasing sympathetic responses were found within the sessions in both groups. CONCLUSIONS The results support cognitive-affective habituation during body exposure in BN and to a lesser extent in HC. Autonomic responses however did not show a corresponding pattern and did not distinguish between groups. Implications for body exposure research and practice are discussed.
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Affiliation(s)
- Monika Trentowska
- Department of Clinical Psychology and Psychotherapy, Albert-Ludwigs-University Freiburg, Germany
| | - Jennifer Svaldi
- Department of Clinical Psychology and Psychotherapy, Eberhard Karls University Tübingen, Germany.
| | - Jens Blechert
- Department for Psychology & Centre for Cognitive Neuroscience, University of Salzburg, Austria
| | - Brunna Tuschen-Caffier
- Department of Clinical Psychology and Psychotherapy, Albert-Ludwigs-University Freiburg, Germany
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21
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Glashouwer KA, Jonker NC, Thomassen K, de Jong PJ. Take a look at the bright side: Effects of positive body exposure on selective visual attention in women with high body dissatisfaction. Behav Res Ther 2016; 83:19-25. [PMID: 27236075 DOI: 10.1016/j.brat.2016.05.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 03/18/2016] [Accepted: 05/17/2016] [Indexed: 10/21/2022]
Abstract
Women with high body dissatisfaction look less at their 'beautiful' body parts than their 'ugly' body parts. This study tested the robustness of this selective viewing pattern and examined the influence of positive body exposure on body-dissatisfied women's attention for 'ugly' and 'beautiful' body parts. In women with high body dissatisfaction (N = 28) and women with low body dissatisfaction (N = 14) eye-tracking was used to assess visual attention towards pictures of their own and other women's bodies. Participants with high body dissatisfaction were randomly assigned to 5 weeks positive body exposure (n = 15) or a no-treatment condition (n = 13). Attention bias was assessed again after 5 weeks. Body-dissatisfied women looked longer at 'ugly' than 'beautiful' body parts of themselves and others, while participants with low body dissatisfaction attended equally long to own/others' 'beautiful' and 'ugly' body parts. Although positive body exposure was very effective in improving participants' body satisfaction, it did not systematically change participants' viewing pattern. The tendency to preferentially allocate attention towards one's 'ugly' body parts seems a robust phenomenon in women with body dissatisfaction. Yet, modifying this selective viewing pattern seems not a prerequisite for successfully improving body satisfaction via positive body exposure.
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Affiliation(s)
- Klaske A Glashouwer
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, The Netherlands; Center for Eating Disorders, Accare, Child and Adolescent Psychiatry, The Netherlands.
| | - Nienke C Jonker
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, The Netherlands
| | - Karen Thomassen
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, The Netherlands
| | - Peter J de Jong
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, The Netherlands
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22
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Jansen A, Voorwinde V, Hoebink Y, Rekkers M, Martijn C, Mulkens S. Mirror exposure to increase body satisfaction: Should we guide the focus of attention towards positively or negatively evaluated body parts? J Behav Ther Exp Psychiatry 2016; 50:90-6. [PMID: 26117584 DOI: 10.1016/j.jbtep.2015.06.002] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Revised: 06/09/2015] [Accepted: 06/13/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND OBJECTIVES Though there is some evidence that body exposure increases body satisfaction, it is still unclear why exposure works and how attention should be guided during exposure. This pilot study manipulates the focus of attention during body exposure. METHODS Female participants high in body dissatisfaction were randomly assigned to an exposure intervention that exclusively focused on self-defined attractive (n = 11) or self-defined unattractive (n = 11) body parts. Both interventions consisted of five exposure sessions and homework. Outcome and process of change were studied. RESULTS Both types of exposure were equally effective and led to significant improvements in body satisfaction, body checking, body concerns, body avoidance and mood at post-test. Improvements for body satisfaction and mood were maintained at follow-up while body shape concerns and body checking still improved between post-test and follow-up. Body avoidance improvements were maintained for the positive exposure while the negative exposure tended to further decrease long-term body avoidance at follow-up.. The 'positive' exposure induced positive feelings during all exposure sessions while the 'negative' exposure initially induced a worsening of feelings but feelings started to improve after some sessions. The most unattractive body part was rated increasingly attractive in both conditions though this increase was significantly larger in the negative compared to the positive exposure condition. LIMITATIONS The sample size was small and non-clinical. CONCLUSIONS Both types of exposure might be effective and clinically useful. Negative exposure is emotionally hard but might be significantly more effective in increasing the perceived attractiveness of loathed body parts and in decreasing avoidance behavior.
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Affiliation(s)
- Anita Jansen
- Clinical Psychological Science, Maastricht University, The Netherlands.
| | - Vera Voorwinde
- Health & Social Psychology Master, Maastricht University, The Netherlands
| | - Yvette Hoebink
- Health & Social Psychology Master, Maastricht University, The Netherlands
| | | | - Carolien Martijn
- Clinical Psychological Science, Maastricht University, The Netherlands
| | - Sandra Mulkens
- Clinical Psychological Science, Maastricht University, The Netherlands; Virenze Riagg Maastricht, The Netherlands
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Dyer AS, Spechea R, Beckmann-Schumacher B, Kolbenschlag C, Alpers GW. Körperbildstörungen im ambulanten Setting. PSYCHOTHERAPEUT 2015. [DOI: 10.1007/s00278-015-0064-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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24
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Boswell JF, Anderson LM, Anderson DA. Integration of interoceptive exposure in eating disorder treatment. ACTA ACUST UNITED AC 2015. [DOI: 10.1111/cpsp.12103] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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25
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Lavagnino L, Amianto F, D'Agata F, Huang Z, Mortara P, Abbate-Daga G, Marzola E, Spalatro A, Fassino S, Northoff G. Reduced resting-state functional connectivity of the somatosensory cortex predicts psychopathological symptoms in women with bulimia nervosa. Front Behav Neurosci 2014; 8:270. [PMID: 25136302 PMCID: PMC4120855 DOI: 10.3389/fnbeh.2014.00270] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 07/21/2014] [Indexed: 12/03/2022] Open
Abstract
Background: Alterations in the resting-state functional connectivity (rs-FC) of several brain networks have been demonstrated in eating disorders. However, very few studies are currently available on brain network dysfunctions in bulimia nervosa (BN). The somatosensory network is central in processing body-related stimuli and it may be altered in BN. The present study therefore aimed to investigate rs-FC in the somatosensory network in bulimic women. Methods: Sixteen medication-free women with BN (age = 23 ± 5 years) and 18 matched controls (age = 23 ± 3 years) underwent a functional magnetic resonance resting-state scan and assessment of eating disorder symptoms. Within-network and seed-based functional connectivity analyses were conducted to assess rs-FC within the somatosensory network and to other areas of the brain. Results: Bulimia nervosa patients showed a decreased rs-FC both within the somatosensory network (t = 9.0, df = 1, P = 0.005) and with posterior cingulate cortex and two visual areas (the right middle occipital gyrus and the right cuneus) (P = 0.05 corrected for multiple comparison). The rs-FC of the left paracentral lobule with the right middle occipital gyrus correlated with psychopathology measures like bulimia (r = −0.4; P = 0.02) and interoceptive awareness (r = −0.4; P = 0.01). Analyses were conducted using age, BMI (body mass index), and depressive symptoms as covariates. Conclusion: Our findings show a specific alteration of the rs-FC of the somatosensory cortex in BN patients, which correlates with eating disorder symptoms. The region in the right middle occipital gyrus is implicated in body processing and is known as extrastriate body area (EBA). The connectivity between the somatosensory cortex and the EBA might be related to dysfunctions in body image processing. The results should be considered preliminary due to the small sample size.
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Affiliation(s)
- Luca Lavagnino
- Department of Neuroscience, AOU San Giovanni Battista , Turin , Italy ; Institute of Mental Health Research, University of Ottawa, Royal Ottawa Healthcare Group , Ottawa, ON , Canada
| | - Federico Amianto
- Department of Neuroscience, AOU San Giovanni Battista , Turin , Italy
| | - Federico D'Agata
- Department of Neuroscience, AOU San Giovanni Battista , Turin , Italy
| | - Zirui Huang
- Institute of Mental Health Research, University of Ottawa, Royal Ottawa Healthcare Group , Ottawa, ON , Canada
| | - Paolo Mortara
- Department of Neuroscience, AOU San Giovanni Battista , Turin , Italy
| | | | - Enrica Marzola
- Department of Neuroscience, AOU San Giovanni Battista , Turin , Italy
| | - Angela Spalatro
- Department of Neuroscience, AOU San Giovanni Battista , Turin , Italy
| | - Secondo Fassino
- Department of Neuroscience, AOU San Giovanni Battista , Turin , Italy
| | - Georg Northoff
- Institute of Mental Health Research, University of Ottawa, Royal Ottawa Healthcare Group , Ottawa, ON , Canada ; Graduate Institute of Humanities in Medicine, Taipei Medical University , Taipei , Taiwan ; Brain and Consciousness Research Center, Taipei Medical University-Shuang Ho Hospital , New Taipei City , Taiwan ; Research Center for Mind, Brain and Learning, National Chengchi University , Taipei , Taiwan ; Department of Psychology, National Chengchi University , Taipei , Taiwan ; Centre for Cognition and Brain Disorders (CCBD), Normal University Hangzhou , Hangzhou , China
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