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Lukas L, Nuding L, Schulte-Körne G, Platt B, Sfärlea A. Seeing oneself as an unattractive loser: Similar interpretation and memory biases in adolescents with anorexia nervosa and adolescents with depression or anxiety. EUROPEAN EATING DISORDERS REVIEW 2024; 32:855-868. [PMID: 38594822 DOI: 10.1002/erv.3095] [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: 11/29/2023] [Revised: 03/19/2024] [Accepted: 03/30/2024] [Indexed: 04/11/2024]
Abstract
OBJECTIVE Anorexia nervosa (AN) is characterised by dysfunctional cognitive biases but these have rarely been investigated in adolescents with AN. The present study systematically assessed cognitive biases in adolescents with AN and addressed the questions of content-specificity (i.e., do biases occur only for eating disorder-related information?) and disorder-specificity (i.e., are biases unique to individuals with AN?). METHODS Cognitive biases on three information processing levels (attention, interpretation, memory) and for two types of information content (eating disorder-related, non-eating disorder-related) were assessed within a single experimental paradigm based on the Scrambled Sentences Task. 12-18-year-old adolescents with AN (n = 40) were compared to a healthy (HC; n = 40) and a clinical (girls with depression and/or anxiety disorders; CC; n = 34) control group. RESULTS Both clinical groups (AN and CC) showed pronounced negative interpretation and memory biases compared to the HC group, for both disorder-related and non-disorder-related information. Attention biases could not be analysed. CONCLUSION The results support the hypothesis that adolescents with AN show negative cognitive biases but these were not limited to disorder-related information. Adolescents with depression and/or anxiety disorders showed similar biases, suggesting them to be transdiagnostic phenomena. Important implications for cognitive-behavioural theories of AN, subsequent cognitive bias modification studies in AN, as well as clinical practice are discussed.
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Affiliation(s)
- Linda Lukas
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Laura Nuding
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Gerd Schulte-Körne
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Belinda Platt
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Anca Sfärlea
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
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House T, Stephen ID, Brooks KR, Bould H, Attwood AS, Penton-Voak IS. The effect of an odd-one-out visual search task on attentional bias, body size adaptation, and body dissatisfaction. ROYAL SOCIETY OPEN SCIENCE 2024; 11:231817. [PMID: 39021772 PMCID: PMC11252673 DOI: 10.1098/rsos.231817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 05/20/2024] [Indexed: 07/20/2024]
Abstract
Body image disturbance is a both a risk factor for, and a symptom of, many eating disorders and refers to the misperception of and dissatisfaction with one's own body. Women with high body dissatisfaction have been shown to direct more attention to low body mass index (BMI) bodies, which results in the overestimation of body size via body size adaptation. Therefore, attention may have a causal role in body image disturbance. We conducted a novel training visual search task with 142 young adult women who we trained to attend to either high or low BMI bodies. We assessed the effects of this training on attention to bodies of different sizes, body size adaptation, and body dissatisfaction. Women trained to attend to low BMI bodies decreased their perceptions of a 'normal' body size via adaptation from pre- to post-training (p < 0.001); however, women trained to attend to high BMI bodies showed no change in their perception of a 'normal' body size. We found no lasting effects of the training on attention to body size or body dissatisfaction; however, our visual search task showed poor internal consistency as a measure of attention. These findings indicate that attention to low BMI bodies may exacerbate body image disturbance in women. However, more reliable measures of attentional are required to confirm this finding.
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Affiliation(s)
- T. House
- School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales 2109, Australia
- School of Psychological Science, University of Bristol, Bristol BS8 1QU, UK
| | - I. D. Stephen
- Department of Psychology, Bournemouth University, Bournemouth, UK
| | - K. R. Brooks
- School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales 2109, Australia
- Perception in Action Research Centre (PARC), Macquarie University, Sydney, New South Wales 2109, Australia
- Lifespan Health & Wellbeing Research Centre, Macquarie University, Sydney, New South Wales 2109, Australia
| | - H. Bould
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 1QU, UK
- Gloucestershire Health and Care NHS Foundation Trust, Centre for Academic Mental Health, University of Bristol, Bristol BS8 1QU, UK
- MRC Integrative Epidemiology Unit, Bristol Medical School, University of Bristol, Bristol BS8 1QU, UK
| | - A. S. Attwood
- School of Psychological Science, University of Bristol, Bristol BS8 1QU, UK
- MRC Integrative Epidemiology Unit, Bristol Medical School, University of Bristol, Bristol BS8 1QU, UK
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
| | - I. S. Penton-Voak
- School of Psychological Science, University of Bristol, Bristol BS8 1QU, UK
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
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Pedra Cruz Bettin B, Urquiza Nogueira L, Bertasso de Araujo PA, Antunes LC. Visual art- and music-based interventions as adjuvants in the treatment of eating disorders: a systematic review and a theoretical model. Arts Health 2024; 16:167-188. [PMID: 37259246 DOI: 10.1080/17533015.2023.2218408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 05/13/2023] [Indexed: 06/02/2023]
Abstract
AIM To assess the effect of visual art- and music-based interventions in the treatment of eating disorders. METHODS This study was registered in PROSPERO (CRD42020161503). Six databases (CINAHL, EMBASE, Lilacs, PsycINFO, PubMed and The Cochrane Library) were consulted. The searches were performed on 19 June 2019, and updated on 18 March 2022. No restriction on language, date, or publication status was applied. Methodological quality was assessed using Joanna Briggs Institute's instruments. All steps were performed by two independent reviewers and a third participated in the event of disagreement. RESULTS Eight studies were included. Few statistically significant results were found. Overall, both interventions might help to reduce negative emotional states. CONCLUSION Visual art- and music-based interventions present limited and inconclusive scientific evidence in patients with eating disorders and therefore their effectiveness is currently unknown. A theoretical model is proposed to guide future research. Further studies are needed to clarify their clinical relevance.
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Affiliation(s)
- Bibiana Pedra Cruz Bettin
- Multiprofessional Residency in Family Health, University of Santa Catarina State, Florianópolis, SC, Brazil
| | - Lauriana Urquiza Nogueira
- Multiprofessional Residency in Family Health, University of Santa Catarina State, Florianópolis, SC, Brazil
| | | | - Luciana C Antunes
- Health Sciences Center, Department of Nutrition, Clinical Nutrition Division, Federal University of Santa Catarina, SC, Brazil
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Levy S, Cohen N, Weinbach N. Negative and positive interpretations of emotionally neutral situations modulate the desire to eat personally craved foods. Appetite 2023; 191:107092. [PMID: 37852375 DOI: 10.1016/j.appet.2023.107092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 10/16/2023] [Accepted: 10/16/2023] [Indexed: 10/20/2023]
Abstract
Emotions play an important role in modulating food craving. Previous studies demonstrated that exposure to negative or positive stimuli can subsequently influence the desire to eat. However, in many daily situations, individuals self-generate their emotions, for example, by interpreting emotionally-neutral situations as positive or negative. So far, no studies have examined if and how positive and negative interpretations of emotionally-neutral situations modulate food craving. In this study, 65 healthy participants were asked to interpret emotionally-neutral images negatively or positively or observe the images naturally. Subsequently, participants rated their state negative/positive affect and their desire to eat their personally craved foods. The results demonstrate a lower desire to eat craved foods after negative interpretations and a higher desire to eat after positive interpretations, compared to an observe-naturally condition. Additionally, the impact of emotional interpretations on the desire to eat was mediated by participants' state negative/positive affect. These findings suggest that self-generated emotion as a result of negative/positive interpretations plays a significant role in modulating food craving. The results highlight the potential of modifying affective interpretations for the treatment of disorders that are characterized by both dysregulated food craving and emotion.
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Affiliation(s)
- Shiran Levy
- School of Psychological Sciences, University of Haifa, Haifa, Israel
| | - Noga Cohen
- Department of Special Education, University of Haifa, Haifa, Israel; The Edmond J. Safra Brain Research Center for the Study of Learning Disabilities, University of Haifa, Haifa, Israel
| | - Noam Weinbach
- School of Psychological Sciences, University of Haifa, Haifa, Israel.
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Geerts JA, Pieterse ME, Laverman GD, Waanders F, Oosterom N, Slegten JT, Salemink E, Bode C. Cognitive Bias Modification Training Targeting Fatigue in Kidney Patients: Usability study (Preprint). JMIR Form Res 2022; 7:e43636. [DOI: 10.2196/43636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 01/12/2023] [Accepted: 01/13/2023] [Indexed: 01/15/2023] Open
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Dodd DR, Clerkin EM, Smith AR. A Randomized Test of Interpretation Bias Modification for Perfectionism Versus Guided Visualization Relaxation Among High Perfectionistic Undergraduate Students. Behav Ther 2022; 53:843-857. [PMID: 35987543 PMCID: PMC9395729 DOI: 10.1016/j.beth.2022.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 01/12/2022] [Accepted: 01/12/2022] [Indexed: 11/24/2022]
Abstract
Clinical perfectionism contributes to the onset and maintenance of multiple psychological concerns. We conducted a randomized, longitudinal test of the efficacy of a web-based intervention for perfectionism (specifically, cognitive bias modification, interpretation retraining; CBM-I), compared to an active treatment comparison condition (specifically, guided visualization relaxation training) for reducing perfectionism and related psychopathology. College students (N = 167) with elevated perfectionism were randomized to one of the two study conditions and were asked to complete their assigned intervention twice weekly for 4 weeks. Participants completed measures of perfectionism and psychological symptoms at baseline, 2 weeks (midway through the intervention period), 4 weeks (at the conclusion of the intervention period), and 8 weeks (1 month follow-up). CBM-I was rated as acceptable overall, though relaxation training was rated slightly more favorably. CBM-I outperformed relaxation training on improving perfectionism-relevant interpretation biases (i.e., increasing nonperfectionistic interpretations and decreasing perfectionistic interpretations), though with small effect sizes and inconsistency across study timepoints. Self-reported perfectionism showed small decreases across time in both intervention conditions. Support was found for a key hypothesized mechanism of CBM-I, such that randomization to CBM-I had a longitudinal, indirect effect on decreasing psychopathology symptom scores through improving perfectionism-relevant interpretation biases. However, in light of small effect sizes, the present study failed to provide compelling evidence that CBM-I for perfectionism contributes meaningfully to the treatment of perfectionism.
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Affiliation(s)
- Dorian R Dodd
- Sanford Center for Biobehavioral Research, Fargo; Miami University.
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7
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Klein KM, Fitzgerald EH, Forney KJ, Kennedy GA, Keel PK. Evaluating the role of negative affect and negative interpretation biases in emotional eating behavior. Int J Eat Disord 2022; 55:914-922. [PMID: 35652275 DOI: 10.1002/eat.23751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 05/15/2022] [Accepted: 05/15/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The study of emotional eating, or (over)eating in response to emotions, may inform transdiagnostic interventions for eating pathology. Prior work has focused on the role of negative affect in promoting emotional eating. The present study sought to extend this work through examining the role of cognitive biases. METHOD Women who self-reported (n = 50) and did not self-report (n = 40) emotional eating completed self-report questionnaires of negative affect and negative interpretation biases, an implicit measure of cognitive bias, and a behavioral assay of emotional eating involving an ad lib test meal following a stress induction task. RESULTS The emotional eating group endorsed elevated trait negative affect, explicit shame biases, and implicit negative biases compared to controls. In addition, state negative affect increased after the stress induction task, and the emotional eating group endorsed greater state negative affect before and after the task and consumed more food following the stress induction. Only explicit cognitive shame biases demonstrated significant indirect effects in the association between group and food consumption. Specifically, elevated explicit shame biases were positively associated with amount of food consumed for the emotional eating group. DISCUSSION Future research should examine whether interventions that target cognitive biases related to shame reduce emotional eating. PUBLIC SIGNIFICANCE Individuals with emotional eating consumed more food than controls following a stress induction. Explicit shame cognitive biases were positively associated with amount of food consumed for the emotional eating group. Shame cogntiive biases may be fruitful targets for reducing emotional eating.
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Affiliation(s)
- Kelly M Klein
- Department of Psychiatry, VA Boston Healthcare System, Brockton Division, Harvard University Medical School, Brockton, Massachusetts, USA
| | | | | | | | - Pamela K Keel
- Department of Psychology, Florida State University, Tallahassee, Florida, USA
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Berrisford-Thompson J, Sayers S, Bell J, Dondzilo L, Kennedy BL. Blinded by bodies: Elevated eating disorder symptomatology is associated with increased attentional priority for thin bodies. Body Image 2021; 39:237-247. [PMID: 34653925 DOI: 10.1016/j.bodyim.2021.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 09/18/2021] [Accepted: 09/23/2021] [Indexed: 11/17/2022]
Abstract
Selective processing of female thin-ideal body imagery is associated with greater body dissatisfaction, and eating disorder-specific rumination has been shown to mediate this relationship. Across two studies, we employed a modified rapid serial visual presentation task (similar to that used within the emotion-induced blindness literature), such that participants searched for a task-relevant target that was sometimes preceded by a thin body, non-thin body, or neutral task-irrelevant distractor. Our first experiment (N = 372) revealed a "body-induced blindness" in an unselected female sample, such that bodies in general distracted attention more than neutral images, and non-thin bodies distracted more than thin-ideal bodies. In our second experiment, female participants were selected based on eating disorder symptomatology (N = 114). Females that exhibited elevated eating disorder symptoms were distracted more by thin bodies compared to those low in symptomatology, greater distraction from thin bodies was associated with greater body dissatisfaction, and this relationship was mediated by eating disorder-specific rumination. Altogether, our findings illustrate the persistent nature of attentional distortions that occur early in cognitive processing and across time for those high in eating disorder symptomatology.
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Affiliation(s)
| | - Sarah Sayers
- School of Psychological Science, University of Western Australia, Perth, WA, Australia
| | - Jason Bell
- School of Psychological Science, University of Western Australia, Perth, WA, Australia
| | - Laura Dondzilo
- Elizabeth Rutherford Memorial Centre for the Advancement of Research on Emotion, School of Psychological Science, University of Western Australia, Perth, WA, Australia.
| | - Briana L Kennedy
- School of Psychological Science, University of Western Australia, Perth, WA, Australia
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9
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Sfärlea A, Lukas L, Schulte-Körne G, Platt B. The KOALA-study: study protocol for a comprehensive study of cognitive biases in adolescent anorexia nervosa patients compared to healthy and clinical controls. J Eat Disord 2021; 9:139. [PMID: 34715933 PMCID: PMC8555351 DOI: 10.1186/s40337-021-00494-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 10/08/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Anorexia nervosa (AN) is characterized by dysfunctional cognitions including cognitive biases at various levels of information processing. However, less is known about the specificity of these biases, i.e., if they occur for eating-disorder-related information alone or also for non-eating-disorder-related emotional information in AN patients (content-specificity) and if they are unique to individuals with AN or are also shown by individuals with other mental disorders (disorder-specificity). METHODS The present study systematically assesses cognitive biases in 12-18-year-old female adolescents with AN on three levels of information processing (attention, interpretation, and memory) and with regard to two types of information content (eating-disorder-related, i.e., stimuli related to body weight and shape, and non-eating-disorder-related). To address not only content- but also disorder-specificity, adolescents with AN will be compared not only to a healthy control group but also to a clinical control group (adolescents with major depression or particular anxiety disorders). Cognitive biases are assessed within a single experimental paradigm based on the Scrambled Sentences Task. During the task eye movements are recorded in order to assess attention biases while interpretation biases are derived from the behavioural outcome. An incidental free recall test afterwards assesses memory biases. We expect adolescents with AN to show more pronounced negative cognitive biases on all three levels of information processing and for both types of content compared to healthy adolescents. In addition, we expect the specificity of biases to translate into differential results for the two types of content: AN patients are expected to show stronger biases for disorder-related stimuli but similar or less pronounced biases for non-disorder-related stimuli compared to the clinical control group. DISCUSSION This is the first study to comprehensively assess cognitive biases in adolescents with AN. It will have essential implications not only for cognitive-behavioural models of AN but also for subsequent studies aiming to modify cognitive biases in this population, thereby addressing important maintaining factors already at an early stage of the disorder.
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Affiliation(s)
- Anca Sfärlea
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, Ludwig-Maximilians-University Munich, Pettenkoferstr. 8a, 80336, Munich, Germany.
| | - Linda Lukas
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, Ludwig-Maximilians-University Munich, Pettenkoferstr. 8a, 80336, Munich, Germany
| | - Gerd Schulte-Körne
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, Ludwig-Maximilians-University Munich, Pettenkoferstr. 8a, 80336, Munich, Germany
| | - Belinda Platt
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, Ludwig-Maximilians-University Munich, Pettenkoferstr. 8a, 80336, Munich, Germany
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10
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Schmidt J, Martin A. Smartphone-Apps zur Verbesserung der Körperzufriedenheit? PSYCHOTHERAPEUT 2021. [DOI: 10.1007/s00278-021-00517-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Ren Z, Zhao Z, Yu X, Zhang L, Li X. Effects of cognitive bias modification for interpretation on hostile interpretation bias and self-reported aggression in juvenile delinquents. Int J Clin Health Psychol 2021; 21:100226. [PMID: 33680000 PMCID: PMC7893428 DOI: 10.1016/j.ijchp.2021.100226] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 01/04/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND/OBJECTIVE The social information processing model holds that aggressive behavior is closely related to the hostile interpretation of ambiguous social cues, suggesting the possibility that an intervention that reduces hostile interpretations could reduce aggression. This study in Mainland China evaluated the remediating effects of cognitive bias modification for interpretation (CBM-I) on the hostile interpretation bias and self-reported aggressive behaviors of male juvenile delinquents, taking into account initial hostile interpretation bias as a possible moderator of the intervention effect. METHOD Fifty-six male juvenile delinquents aged 16-18 were recruited and randomly assigned to the CBM-I group (n = 28) or the Waiting-List group (n = 28). Interpretation bias and self-reported aggressive behavior were assessed at pre-test and post-test. RESULTS The positive interpretations of participants in the CBM-I group were significantly increased compared with participants in the Waiting-List group. The intervention effect of CBM-I on self-reported physical aggression was significant only for juvenile delinquents with high pre-test hostile interpretation bias. CONCLUSIONS CBM-I can significantly improve the positive interpretation bias of juvenile delinquents, and reduce the self-reported physical aggression for some male juvenile delinquents. The results have implications for providing low-cost and high-efficiency intervention for juvenile delinquents' self-reported aggression behavior.
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Affiliation(s)
- Zhihong Ren
- Key Laboratory of Adolescent Cyberpsychology and Behavior (CCNU), Ministry of Education, Key Laboratory of Human Development and Mental Health of Hubei Province, School of Psychology, Central China Normal University, China
| | - Ziyi Zhao
- Key Laboratory of Adolescent Cyberpsychology and Behavior (CCNU), Ministry of Education, Key Laboratory of Human Development and Mental Health of Hubei Province, School of Psychology, Central China Normal University, China
| | - Xianglian Yu
- Key Laboratory of Adolescent Cyberpsychology and Behavior (CCNU), Ministry of Education, Key Laboratory of Human Development and Mental Health of Hubei Province, School of Psychology, Central China Normal University, China
- Department of Education, Jianghan University, China
| | - Lin Zhang
- Key Laboratory of Adolescent Cyberpsychology and Behavior (CCNU), Ministry of Education, Key Laboratory of Human Development and Mental Health of Hubei Province, School of Psychology, Central China Normal University, China
| | - Xu Li
- Key Laboratory of Adolescent Cyberpsychology and Behavior (CCNU), Ministry of Education, Key Laboratory of Human Development and Mental Health of Hubei Province, School of Psychology, Central China Normal University, China
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Revisiting the relationship between body dissatisfaction and eating disorder symptoms in Chinese adolescents: the mediating roles of regulatory emotional self-efficacy and depression symptoms. Eat Weight Disord 2021; 26:239-247. [PMID: 31960348 DOI: 10.1007/s40519-020-00848-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 01/09/2020] [Indexed: 12/17/2022] Open
Abstract
PURPOSE Even though many studies have investigated the relationship between body dissatisfaction and eating disorder symptoms, the relationship is still far from being clear, especially about what factors that could potentially mediate such relationship. This study aimed to examine the direct pathway in the relationship between body dissatisfaction and eating disorder symptoms, and possible mediation pathways between the two via regulatory emotional self-efficacy and depression symptoms. METHODS A sample of 654 adolescents from central China completed questionnaires for a set of study variables. Modeling analysis was conducted that examined the direct pathway between body dissatisfaction and eating disorder symptoms, and the mediating roles of regulatory emotional self-efficacy and depression symptoms between these two constructs. Multi-group modeling analysis was conducted to assess model invariance across gender and age groups. RESULTS The results showed that, in addition to the direct pathway between body dissatisfaction and eating disturbances, regulatory emotional self-efficacy and depression symptoms partially mediated the relationship between these two constructs. Results of multi-group invariance analysis showed that the mediation model was consistent across gender and age groups. DISCUSSION These results indicated that management of regulatory emotional self-efficacy and appropriate intervention for depression could potentially buffer against the negative impact of body dissatisfaction on eating disorder symptoms. Finally, some potential clinical implications are discussed, and possible preventions for eating disorder symptoms are suggested. LEVEL OF EVIDENCE V, Cross-sectional descriptive study.
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Gober CD, Lazarov A, Bar-Haim Y. From cognitive targets to symptom reduction: overview of attention and interpretation bias modification research. EVIDENCE-BASED MENTAL HEALTH 2021; 24:42-46. [PMID: 33246935 PMCID: PMC10231632 DOI: 10.1136/ebmental-2020-300216] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 11/14/2020] [Accepted: 11/18/2020] [Indexed: 12/15/2022]
Abstract
Cognitive bias modification (CBM) is a class of mechanised psychological interventions designed to target specific aberrant cognitive processes considered key in the aetiology and/or maintenance of specific psychiatric disorders. In this review, we outline a multistage translational process that allows tracking progress in CBM research. This process involves four steps: (1) the identification of reliable cognitive targets and establishing their association with specific disorders; (2) clinical translations designed to rectify the identified cognitive targets; (3) verification of effective target engagement and (4) testing of clinical utility in randomised controlled trials. Through the prism of this multistage process, we review progress in clinical CBM research in two cognitive domains: attention and interpretation; in six psychiatric conditions: anxiety disorders, major depressive disorder, post-traumatic stress disorder, addictive disorders, eating disorders and obsessive-compulsive disorder. The review highlights achievement as well as shortcomings of the CBM approach en route to becoming a recognised evidence-supported therapy for these disorders.
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Affiliation(s)
| | - Amit Lazarov
- School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Yair Bar-Haim
- School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
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Dietel FA, Zache C, Bürkner PC, Schulte J, Möbius M, Bischof A, Wilhelm S, Buhlmann U. Internet-based interpretation bias modification for body dissatisfaction: A three-armed randomized controlled trial. Int J Eat Disord 2020; 53:972-986. [PMID: 32432384 DOI: 10.1002/eat.23280] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 04/07/2020] [Accepted: 04/14/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Appearance-related interpretation bias is postulated to play a role in the maintenance of body dissatisfaction (BD), a risk factor for body dysmorphic disorder (BDD), and eating disorders (ED). Cognitive bias modification for interpretation (CBM-I) has been shown to reduce maladaptive interpretation bias and symptoms in various emotional disorders. This study investigated the acceptability and efficacy of an easily disseminable, web-based CBM-I program for BD. METHODS Individuals with high BD (N = 318) were randomized to a multi-session CBM-I (Sentence Word Association Paradigm [SWAP] with feedback) vs. control (SWAP without feedback) versus waitlist condition. Interpretation bias, BD and associated symptoms were assessed at baseline and post-intervention. Symptoms were monitored up to 1-week and 4-week follow-up. We further investigated transference effects to stress reactivity, as predicted by cognitive-behavioral models, at post-intervention. RESULTS Appearance-related CBM-I led to a differential pre-post increase in adaptive interpretation patterns, particularly for appearance-related and social situations (d = 0.65-1.18). Both CBM-I and control training reduced BD, BDD symptom severity, and depression. However, CBM-I (vs. control and waitlist) improved appearance-related quality of life (d = 0.51), self-esteem (d = 0.52), and maladaptive appearance-related beliefs (d = 0.47). State stress reactivity was overall reduced in the CBM-I condition (vs. waitlist). Intervention effects largely held stable up to follow-ups. Treatment satisfaction was comparable to other CBM-I studies, with low rates of adverse reactions. DISCUSSION These findings support assumptions of cognitive-behavioral models for BD, BDD, and ED, and suggest that web-based CBM-I is an efficacious and acceptable intervention option.
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Affiliation(s)
- Fanny Alexandra Dietel
- Clinical Psychology and Psychotherapy, Department of Psychology, Westfälische Wilhelms-Universität, Muenster, Germany
| | - Carina Zache
- Clinical Psychology and Psychotherapy, Department of Psychology, Westfälische Wilhelms-Universität, Muenster, Germany
| | | | - Johanna Schulte
- Clinical Psychology and Psychotherapy, Department of Psychology, Westfälische Wilhelms-Universität, Muenster, Germany
| | - Martin Möbius
- Behavioral Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Annika Bischof
- Clinical Psychology and Psychotherapy, Department of Psychology, Westfälische Wilhelms-Universität, Muenster, Germany
| | - Sabine Wilhelm
- Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Ulrike Buhlmann
- Clinical Psychology and Psychotherapy, Department of Psychology, Westfälische Wilhelms-Universität, Muenster, Germany
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Fuller-Tyszkiewicz M, Vuong H, Linardon J, Krug I, Broadbent J, Rodgers RF. Body image in and out of the lab: Correspondence between lab-based attentional bias data and body shape dissatisfaction experiences in daily life. Body Image 2020; 32:62-69. [PMID: 31778889 DOI: 10.1016/j.bodyim.2019.11.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 11/12/2019] [Accepted: 11/12/2019] [Indexed: 01/27/2023]
Abstract
Accumulating lab-based studies have identified attentional biases in processing of negative appearance-related information among individuals with elevated trait body shape and weight dissatisfaction (BD). How these biases translate into experiences of BD in daily life remains unclear and, hence, was the focus of the present study. Thirty-eight women aged between 18-40 years completed a baseline survey and modified dot-probe task with both fat and thin appearance-related stimuli in a laboratory setting. Participants also downloaded a smartphone app that prompted them 10 times per day for 7 days to rate current body dissatisfaction. Results revealed that heightened BD in daily life tended to be transitory, and followed by a substantially lower rating of BD by the next survey (∼1-2 h later). For individuals with elevated trait BD and facilitated attention towards thin body images, this reduction in state BD was more gradual. Surprisingly, delayed disengagement towards thin body images was associated with greater reduction in state BD. Consistent with the hypothesis, moderating effects were not observed when initial state BD level was low. Susceptibility for immediate, short-term attentional biases towards appearance-related information may be a vulnerability factor for the prolonged persistence of negative body image experiences in daily life.
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Affiliation(s)
- Matthew Fuller-Tyszkiewicz
- School of Psychology, Deakin University, Geelong, Victoria, 3220, Australia; Center for Social and Early Emotional Development, Deakin University, Burwood, Victoria, 3125, Australia.
| | - Hao Vuong
- School of Psychology, Deakin University, Geelong, Victoria, 3220, Australia
| | - Jake Linardon
- School of Psychology, Deakin University, Geelong, Victoria, 3220, Australia
| | - Isabel Krug
- School of Psychological Sciences, The University of Melbourne, Victoria, 3010, Australia
| | - Jaclyn Broadbent
- School of Psychology, Deakin University, Geelong, Victoria, 3220, Australia
| | - Rachel F Rodgers
- APPEAR, Department of Applied Psychology, Northeastern University, Boston, USA; Department of Psychiatric Emergency & Acute Care, Lapeyronie Hospital, Montpellier, France
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Interpretation bias modification to reduce body dissatisfaction - a randomized controlled pilot study in women with elevated weight and shape concerns. J Eat Disord 2020; 8:34. [PMID: 32637101 PMCID: PMC7331132 DOI: 10.1186/s40337-020-00305-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 05/21/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Recent research has identified several cognitive biases in patients with eating disorders, such as a tendency to interpret ambiguous information about one's own body in a negative way. The so-called "negative interpretation bias" is considered to be a key factor in maintaining maladaptive cognitions and behaviors in eating disorders. Studies on modification of the negative interpretation bias in eating disorders have yielded mixed results. This randomized controlled pilot study examined whether a specially adapted, computerized version of the Scrambled Sentences Task modifies negative interpretation bias in women with elevated body dissatisfaction. METHODS The sample consisted of 40 normal-weight women with elevated body dissatisfaction, randomly assigned either to an intervention or a no-intervention control group (each n = 20). The intervention group received six sessions (within two weeks) of a newly-developed interpretation bias modification training that involved unscrambling positively valenced, body image-related sentences. The control group received no intervention. In both groups, body image-related negative interpretation bias (main outcome), trait body dissatisfaction and thin-ideal cue reactivity were assessed at baseline and two weeks later. Additionally, in the intervention condition, the trajectory of expected reductions in the thin-ideal internalization was measured during each training session. RESULTS In both conditions, body image-related negative interpretation bias and trait body dissatisfaction decreased significantly from pre- to post-assessment; however, a specific effect imparted by the interpretation bias modification training was not found. Groups did not differ in thin-ideal cue reactivity. In the intervention group, thin-ideal internalization decreased significantly over the training sessions. CONCLUSIONS The findings do not support use of body image-related interpretation bias modification in its current form in the treatment of body dissatisfaction. Further research involving different versions of the training and clinical samples is warranted.
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Abstract
The majority of cognitive bias research has been conducted in Western cultures. We examined cross-cultural differences in cognitive biases, comparing Westerners' and East Asians' performance and acculturation following migration to the opposite culture. Two local (UK, Hong Kong) and four migrant (short-term and long-term migrants to each culture) samples completed culturally validated tasks measuring attentional and interpretation bias. Hong Kong residents were more positively biased than people living in the UK on several measures, consistent with the lower prevalence of psychological disorders in East Asia. Migrants to the UK had reduced positive biases on some tasks, while migrants to Hong Kong were more positive, compared to their respective home counterparts, consistent with acculturation in attention and interpretation biases. These data illustrate the importance of cultural validation of findings and, if replicated, would have implications for the mental health and well-being of migrants.
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