Effects of emotional acceptance and rumination on media-induced body dissatisfaction in anorexia and bulimia nervosa

The effectiveness of psychological interventions for reducing poor body image in endometriosis, PCOS and other gynaecological conditions: a systematic review and meta-analysis

Gynaecological conditions (e.g., endometriosis, PCOS) result in bodily changes that negatively impact body image. Psychological interventions (e.g., CBT, psychoeducation) have shown promise in reviews with the general population for alleviating body image concerns. This systematic review and meta-analysis aims to provide asynthesis of the impact of psychological interventions for reducing body image concerns for individuals with gynaecological conditions. Electronic databases were searched for relevant psychological intervention studies with body image outcomes. Twenty-one eligible studies were included in the systematic review (ten were included in a random-effects meta-analysis). Studies included participants (N = 1483, M = 71.85, SD = 52.79) with a range of gynaecological conditions, ages (Mage = 35.08, SD = 12.17) and cultural backgrounds. Most included studies reported at least one positive effect with the meta-analysis indicating psychological interventions were moderately superior to control conditions for reducing body image concerns (SMD -.41, 95% CI [-0.20 -0.62]). However, there was a high risk of bias and moderate heterogeneity. Results suggest psychological interventions may hold promise for reducing body image concerns among individuals gynaecological conditions in the short term. Further, preliminary support was found for the use of theory-guided psychological interventions delivered in group settings in particular, with further research needed on optimal intervention length and particular psychotherapeutic approach.

Development of the Transdiagnostic Skills Scale (T2S)

INTRODUCTION

Psychotherapy has proved its efficacy for treating a wide range of psychological disorders. Most types of psychotherapy have been developed to treat specific disorders and validated through controlled-randomized trials. In recent years, researchers have developed a new way to conceptualize patients' difficulties, focusing on processes instead of diagnoses. However, there is no simple scale that evaluates transdiagnostic processes, and the development of such a tool is thus the aim of this study.

METHOD

We identified 12 processes that can be targeted in cognitive behavior therapy and created the Transdiagnostic Skills Scale (T2S) to evaluate them. We measured its internal consistency, factor structure and convergent validity in clinical and non-clinical samples.

RESULTS

We found a 6-factor structure composed of emotion regulation, behavioral activation/planning, emotional identification, assertiveness, problem solving and emotional confrontation. The T2S has high internal consistency (Cronbach's alpha = 0.95). We found negative associations between skills and symptoms of anxiety, depression and eating disorders. We found no association between these processes and symptoms of either alcohol or cannabis use disorder.

CONCLUSIONS

The T2S is a useful and valid tool to identify the skills that clinicians should work on with their patients. It offers a complementary way to understand patients' difficulties when categorical assessment is complicated.

The effects of exposure to social media images of thin and average size women on body satisfaction among young women: Emotion regulation and self-efficacy as modulating factors

Although appearance comparison has emerged as an important mechanism underlying the detrimental effects of exposure to idealized social media images on body image among young women, little is known regarding the role of the direction of these comparisons. In addition, to date, little attention has been paid to the role of self-regulation processes in these effects. A sample of 260 female students (M_age = 19.6) from a University in Paris completed an online survey where they were randomly assigned to view thin-ideal or average size social media images of women. Participants reported on state body satisfaction before and after exposure, as well as state appearance comparison and direction of appearance comparison, and trait emotion regulation difficulties and self-efficacy. Findings revealed no main effect of condition. However, among participants who engaged in upwards appearance comparison the thin-ideal condition was associated with greater decreases in body satisfaction. In addition, three-way interactions revealed that emotional regulation difficulties and self-efficacy both further moderated these effects. These findings suggest that self-regulation processes may be important to account for in the effects of exposure to social media images on body satisfaction among young women.

Body image and depression in endometriosis: Examining self-esteem and rumination as mediators

Endometriosis is a chronic systemic disease affecting 1 in 10 people assigned female at birth, that can result in appearance-based and functional bodily changes which can negatively impact body image. Empirical evidence supports the body dissatisfaction-driven hypothesis that negative body image leads to greater depressive symptoms; but potential underlying mechanisms are under-researched. This prospective study investigated the mediating role of two theoretically-derived intervening factors, self-esteem and rumination, in individuals living with endometriosis who typically report high rates of body image concerns and depressive symptoms. Initially, 996 participants completed the first online survey (T0) assessing demographic, medical and psychological factors. Of these, 451 completed surveys at 1-month (T1) and 2-months (T2) follow-up assessing self-esteem, rumination and depression. Bootstrapped analyses with full-information maximum likelihood estimation indicated that poor body image (T0) predicted greater depressive symptoms over time (T2). Self-esteem (T1), but not rumination (T1), mediated the body image-depression relationship. These results provide support for the body dissatisfaction-driven hypothesis and further identify that self-esteem is a key meditating factor. This highlights the importance of addressing self-esteem in body image focused interventions.

Expressive suppression a mediating variable between stress and procrastination in eating behavior disorder

Eating disorders (EDs) are psychiatric illnesses in which emotions play an important role in their development and maintenance. These disorders are associated with expressive suppression, stress, and procrastination. The purpose of this work was to explain eating disorders from stress and procrastination, with expressive suppression as a mediating variable. It was attended by 918 students from three universities in Ecuador. The information was collected through four instruments: inventory of eating disorders, perceived stress scale, Tuckman procrastination scale and emotional regulation questionnaire. The data was analyzed through a mediational analysis in the Jasp program, version 15. The independent variables were: procrastination and stress, the dependent variable was risk of experiencing bulimia (REB) and the mediating variable was expressive suppression. Procrastination and stress, mediated by expressive suppression, were found to have no statistically significant effect on EBR. Procrastination has a direct effect on REB, although stress does not, and the model between expressive suppression and REB explains a good percentage of the variance.

The role of rumination and positive beliefs about rumination in eating pathology

PURPOSE

General and eating disorder (ED)-specific ruminations have been identified as key factors that may contribute to eating pathology. Positive beliefs about rumination (e.g., "Ruminating helps me to prevent future mistakes") may impact this association. However, the effect of positive beliefs about rumination on the links between rumination and ED symptom severity has not been investigated. This study sought to clarify relations between rumination and ED symptom severity and to evaluate the potential moderating effect of positive beliefs about rumination on these associations.

METHODS

During a laboratory visit, undergraduate participants (N = 473, M_Age = 18.90 ± 2.27, M_BMI = 23.45 kg/m² ± 4.31, 54.8% female) completed an online battery of questionnaires assessing general and ED-specific ruminative processes (e.g., brooding, reflection), positive beliefs about rumination, and global ED symptoms. Hierarchical multiple regression analyses assessed the unique contributions of specific ruminative processes, and the moderating effect of positive beliefs on associations between ruminative processes and ED symptom severity.

RESULTS

Hierarchical multiple regression results suggest that, after controlling for gender and BMI, ED-specific brooding, b = 1.32, SE = 0.13, β = 0.46, p < 0.0001, and reflection, b = 1.44, SE = 0.33, β = 0.19, p < 0.0001, accounted for unique variance in ED symptom severity. Moderation model results indicate that, at low levels of general reflection, b = - 0.06, SE = 0.02, β = - 0.51, p = 0.003, and ED-specific reflection, b = - 0.15, SE = 0.03, β = - 0.59, p < 0.0001, increased positive beliefs about rumination were associated with greater ED symptom severity.

CONCLUSION

Findings suggest ED-specific rumination accounts for ED symptom severity above and beyond general rumination, and that rumination-related expectancies influence the association between reflection and ED symptom severity.

LEVEL OF EVIDENCE

Level III, evidence obtained from a well-designed cohort study.

Emotion Dysregulation as a Mediator of the Relationship between Anxiety, Compulsive Exercise and Eating Disorder Symptoms in Adolescents

Anxiety has been suggested to be a key contributing factor for compulsive exercise, however, existing literature has demonstrated contradictory relationships between anxiety and compulsive exercise among adolescents. According to the Emotional Cascade Model (ECM), factors such as rumination and emotional suppression may mediate the association between affect and exercise. The current study therefore aimed to investigate whether rumination and emotional suppression mediate the relationship between anxiety and compulsive exercise in predicting ED symptoms in adolescents. Questionnaires assessing compulsive exercise, anxiety, depressive rumination, emotional suppression, and ED symptoms were completed by 212 adolescent males (Mage = 13.39, SD = 1.22) and 189 adolescent females (Mage = 13.64, SD = 1.29). The structural equation model showed indirect effects between anxiety and compulsive exercise through rumination and emotional suppression in males but not in females. Moreover, anxiety had an indirect effect on eating disorder symptoms through rumination, emotional suppression and compulsive exercise in both males and females. In line with ECM, the results suggest that rumination and emotional suppression may have a key role in the association between anxiety, compulsive exercise and eating disorder symptoms in adolescents. These findings suggest that compulsive exercise may be used as a dysfunctional coping mechanism to escape from a negative emotional cascade generated by the interaction of anxiety, rumination and emotional suppression. Future longitudinal studies to test the role of compulsive exercise as a dysfunctional behaviour in the ECM are needed.

Social determinants of health that permeate the mental suffering of children on the french-brazilian border

OBJECTIVES

to understand the determinants involved in the mental suffering of schoolchildren on the French-Brazilian border.

METHODS

a qualitative study was conducted with children from 6 to 12 years of age from four State schools in the municipality of Oiapoque, located on the French-Brazilian border. The data were obtained through interviews, analyzed by the IRAMUTEQ software, and interpreted in the light of the Dahlgren and Whitehead's social determinants of health model.

RESULTS

data indicate that the mental suffering experienced by children, especially characterized by anxious symptoms, such as concern of becoming fat and worries, were permeated by social situations that children went through daily, such as family abandonment, domestic violence, and bullying.

FINAL CONSIDERATIONS

social determinants can be predictors of mental suffering in children, especially in environments of extreme vulnerability, such as the border, in a context of financial difficulties, domestic violence, and absence of parenting.

Young women's body image following upwards comparison to Instagram models: The role of physical appearance perfectionism and cognitive emotion regulation

The present study examined whether trait physical appearance perfectionism moderates young women's body image following upwards appearance comparison to idealized body images on social media, and whether cognitive coping mediates the relationship between physical appearance perfectionism and resulting body image from social comparison processes. Female undergraduate students (N = 142) were randomly assigned to either 1) compare the size of their body parts to the body parts of attractive Instagram models, or 2) an appearance-neutral control condition. All participants completed measures of trait physical appearance perfectionism, pre and post measures of state body image, and state cognitive coping processes. Appearance comparison to the models resulted in lowered confidence and increased appearance and weight dissatisfaction. High trait physical appearance perfectionism predicted lower confidence and higher weight dissatisfaction and appearance dissatisfaction, and these relationships were mediated by engagement in rumination and catastrophizing. Clinical implications of the findings are discussed.

Effects of acceptance and reappraisal on body dissatisfaction: an experimental comparison of two adaptive emotion regulation strategies

BACKGROUND

In recent years, research has increasingly focused on body dissatisfaction, which is associated with numerous negative psychological and physical health consequences and, more importantly, with the development and maintenance of eating pathology.

OBJECTIVE

In the present study, we focused on the effect of two adaptive emotion regulation strategies (acceptance and reappraisal) on body dissatisfaction compared to a control group, and pre- and post-induction of body dissatisfaction.

METHODS

A total of 105 women [mean age (M) = 22.07; standard deviation (SD) = 6.11] were randomly assigned to one of the two emotion regulation conditions: acceptance (n = 35) and reappraisal (n = 35) or to a control group (n = 35). Participants were instructed accordingly with the condition that was assigned (acceptance or reappraisal). Participants were then induced body dissatisfaction by exposure to images representing the female thin-ideal and were asked to respond to their body-related feelings according to the instructions. Outcomes assessed were body dissatisfaction, and positive and negative affect.

RESULTS

Results indicated a significant increase of body satisfaction in the acceptance and reappraisal conditions from pre- to post-induction of body dissatisfaction, compared to control group which suffered a significant decrease in body satisfaction. Moreover, in the control group, positive affect significantly decreased and negative affect increased from pre- to post-induction, and did not change significantly, neither in the acceptance nor in the reappraisal condition.

CONCLUSIONS

Our findings highlight the positive effects of acceptance and reappraisal as emotion regulation strategies on body dissatisfaction and on positive and negative affect.

LEVEL OF EVIDENCE

Experimental study, Level 1.

A systematic review on the effects of media disclaimers on young women's body image and mood

The purpose of this systematic review was to determine the effectiveness of media disclaimers in protecting women's body image and mood after exposure to thin ideal media. The keywords "warning*" OR "disclaimer*" AND "body image" OR "body dissatisfaction" were searched in the PsycINFO and MEDLINE/PubMed databases. Inclusion criteria included being a peer-reviewed, primary source article available in English, which had examined the impact of media disclaimers on women's body image. Articles published prior to February 22^nd, 2019 were included. In total, 15 experimental studies were included. Overall, disclaimers were ineffective at reducing women's body dissatisfaction and negative affect following exposure to thin ideal images, and in some cases were actually harmful to women's body image. For women high in trait body dissatisfaction and thin ideal internalization, warning labels increased body dissatisfaction after exposure to thin ideal images. For women high in trait social and appearance comparison specific disclaimers that outlined how the images had been altered resulted in increased body dissatisfaction after exposure to thin ideal images. Therefore, overall, disclaimers were ineffective at ameliorating the negative effects of exposure to thin ideal media. Future research should examine the impact of media disclaimers on the body image of adolescents and men.

The effectiveness of touchscreen-based attentional bias modification to thin body stimuli on state rumination

Ruminative thinking is considered a vulnerability factor for eating disorder symptomatology. Research suggests that attentional bias to body shape stimuli may serve to underpin this maladaptive form of emotion regulation. The current study aimed to determine the direct effect of attentional bias to thin-ideal bodies on state depressive rumination. Additionally, this study sought to evaluate the efficacy of attentional bias modification (ABM) utilising a touchscreen device. A well-established ABM protocol, the modified dot probe task, was used for both attentional assessment and training. Female undergraduate students (N = 110) completed an ABM session where attention was trained either towards, or away from, thin-ideal body images. Pre- and post-attentional training, participants completed the dot probe task, as well as a state measure of depressive rumination. Results revealed that the ABM training induced a greater attentional bias to thin-ideal bodies in the attend-thin training condition than in the avoid-thin training condition. Furthermore, induced attentional avoidance of thin-ideal bodies led to a significant reduction in state depressive rumination. The current findings suggest that touchscreen-based ABM is effective in modifying patterns of attentional bias and state depressive rumination.

Emotion regulation across eating pathology: A meta-analysis

The goal of this meta-analysis was to examine the associations between specific emotion regulation abilities (emotional awareness, emotional clarity) and strategies (acceptance of emotions, reappraisal, problem-solving, rumination, avoidance of emotions, and suppression), and eating pathology. A total of 96 studies and 239 effect sizes were included in the analysis. Relations between global and specific emotion regulation abilities and strategies and eating disorders and eating-related symptoms were examined. Results indicated medium-to-large effect sizes for the associations between adaptive emotion regulation and eating disorder and eating-related symptoms, and medium-to-large effect sizes for the associations between maladaptive emotion regulation and eating disorders and eating-related symptoms. In terms of specific emotion regulation strategies, large magnitude of associations were identified for the relations between lack of emotional awareness, clarity, acceptance, reappraisal, problem-solving, and eating disorders. Rumination, avoidance of emotions, and suppression also showed large associations with anorexia nervosa and bulimia nervosa. Overall, emotion regulation did not differ across eating disorders, a finding supporting the transdiagnostic character of emotion regulation problems in eating pathology. These findings have important theoretical and practical implications for prevention and intervention programs.

Mindfulness, rumination, and coping skills in young women with Eating Disorders: A comparative study with healthy controls

Eating Disorders (ED) have been associated with dysfunctional coping strategies, such as rumination. Promoting alternative ways of experiencing mental events, based on a mindfulness approach, might be the clue for learning more effective coping and regulatory strategies among young women with ED. This study examined the comparison between patients with ED diagnosis and healthy subjects in mindfulness, rumination and effective coping. In addition, we analyzed the independent association of those with the presence of ED. The study sample was formed by two groups of young women ranged 13-21 years: Twenty-five with an ED diagnosis and 25 healthy subjects. They were assessed by using the Freiburg Mindfulness Inventory (FMI) and the Responses Styles Questionnaire (RSQ). Our findings show that ED patients have significantly lesser average scores in mindfulness and effective coping than the healthy sample (p < .05). Also, our data concludes that mindfulness and effective coping independently predict the presence or absence of ED in young women. The study results suggest that training mindfulness abilities may contribute to making effective coping strategies more likely to occur in ED patients, which is incompatible with some eating-related symptoms. Further studies are needed, trough prospective and experimental designs, to evaluate clinical outcomes of mindfulness training among young women with ED.

Maladaptive Rumination as a Transdiagnostic Mediator of Vulnerability and Outcome in Psychopathology

Background: Maladaptive rumination is a form of negative repetitive thinking which has attracted the interest of researchers, as it is considered a cognitive vulnerability to depression. Some of the original beliefs regarding rumination, in particular its exclusive link with depression, have been questioned in the light of research findings. At present, the very concept of rumination is still unclear, so research has been investigating this topic from different, and somewhat inconsistent, perspectives. Methods: A literature review was performed in order to outline some core characteristics of rumination, explain its determinants, and discuss its possible role as a transdiagnostic mediator of vulnerability and outcome in psychopathology. Results: Maladaptive rumination could be interpreted as a dysfunctional coping strategy strictly linked to emotion regulation and metacognition that may occur in several psychopathological conditions, such as psychosis, eating disorders, and alcohol dependence. Conclusion: Evidence allows the interpretation of maladaptive rumination as a transdiagnostic mediator of vulnerability and outcome in psychopathology. Therefore, investigating it from a dimensional perspective may represent a valid research strategy.

Rumination in anorexia nervosa: Cognitive-affective and neuroendocrinological aspects

Rumination about body weight/figure as well as food is common in patients with Anorexia Nervosa (AN) and may be a maintenance factor of the disorder. While rumination can generally be considered as a cognitive-affective process, food-related rumination may be driven primarily by a physiological response to undernutrition. In the current longitudinal study, we integrate ecological momentary assessment of rumination and affect and, as a biological marker of undernutrition, plasma leptin levels collected from 33 AN patients. At the very acute stage and again after short-term weight-restoration patients answered short questionnaires six times per day over two weeks. Analyses via hierarchical linear modelling confirmed that rumination is closely linked to affect in AN before and after weight-restoration. Rumination about food decreased during weight-restoration and was correlated with leptin levels. In contrast, rumination about body weight/figure was not linked to leptin, persisted after weight gain, and showed stronger connections with affect. This suggests that rumination about body weight/figure seems to be a cognitive-affective aspect of the disorder, but food-related rumination may need to be considered from a physiological perspective. It is possible that food-related ruminative thoughts reflect a physiological symptom induced by undernutrition, similar to well-described leptin-associated changes in physical activity.

Is the widely used two-factor structure of the Ruminative Responses Scale invariant across different samples of women?

OBJECTIVES

Although the Ruminative Responses Scale is one of the most widely used measures of rumination, its two-factor structure remains controversial. Taking this into account, we aimed to test the RRS-10 two-factor invariance (Brazilian version) between different samples of women and to study its internal consistency and convergent validity.

METHODS

A sample of 321 women (general population, n = 106; college students, n = 115; and medical population of patients with overweight and obesity, n = 100) participated in the study. The two-factor structure of RRS-10 was assessed by CFA and multigroup analysis using Mplus software. Internal consistency was assessed by Cronbach's alpha and the convergent validity by Pearson correlations.

RESULTS

The two-factor structure of RRS-10 showed a good fit, factorial invariance across three samples, good internal consistency, and adequate convergent validity. Brooding and Reflection subscales were both positively correlated with psychological inflexibility, cognitive fusion, anxiety, depression, and stress symptoms, although Brooding presented significantly stronger associations with these variables than Reflection.

CONCLUSIONS

This study provides further discussion and evidence regarding the RRS-10 two-factor structure, as well as a valid version of RRS-10 to use in Brazil in order to reliably assess rumination in medical and research settings.

PRACTITIONER POINTS

This is the first study to test and confirm the RRS two-factor structure invariance across groups. RRS-10 two-dimensionality was confirmed in medical and non-medical samples of women. Brooding subscale showed significantly stronger relationships with psychopathology and experiential avoidance than Reflection. The study provides evidence that RRS can be used as a valid and sound measure to accurately assess the clinically relevant dimensions of rumination simultaneously across distinct groups.

Rumination and eating disorder psychopathology: A meta-analysis

Rumination is a cognitive process involving repetitive thoughts about negative experiences and emotions and is associated with psychopathology. Rumination has been implicated in mood and anxiety disorders, and there is a growing body of research on rumination in relation to eating disorder (ED) psychopathology. The current meta-analytic review focused on the literature addressing rumination and ED psychopathology. A comprehensive search process identified 38 studies, which primarily used cross-sectional designs with non-clinical samples. Results demonstrated that rumination was concurrently (r = 0.33) and prospectively (r = 0.22-0.23) associated with ED psychopathology, and that groups with ED psychopathology evidenced higher levels of rumination compared to non-ED control groups (g = 0.95), though no significant differences in rumination were observed when comparing anorexia nervosa to bulimia nervosa groups (g = 0.09). In addition, a narrative review of five experimental studies suggested that rumination in response to ED-related stimuli was related to increased negative affect and negative body-related cognitions across clinical and non-clinical samples. The type of rumination and sample population emerged as moderators of effect sizes, such that larger effects were observed among samples using ED-specific measures of rumination and heterogeneous samples compared to only non-clinical samples. Taken together, this literature demonstrates that rumination is a salient process in ED psychopathology, though the literature is characterized by methodological limitations and the need for more fully elaborated theories on the role of rumination in EDs. Findings are discussed in the context of existing models of rumination and ED psychopathology, with suggestions for future research in this area.

Anorexia Nervosa, Theory and Treatment: Where Are We 35 Years on from Hilde Bruch's Foundation Lecture?

Hilde Bruch's foundation lecture in 1982 is a milestone from which to survey current theory and treatment for anorexia nervosa. Bruch described problems in body perception, emotion processing and interpersonal relationships as core theoretical aspects of the illness and built her theory of psychopathology on these aspects, as well as on animal studies on attachment. She also noted that many psychological problems result as consequence of starvation. In the first part of this paper, we parse Bruch's clinical descriptions into elements of psychopathology (disturbances in body perception, attachment, emotion expression, perception and regulation, social comparison, interpersonal, and family and therapeutic relationships), in order to assemble and update the theoretical evidence for a model of the illness. In the second part, we describe and extend her description of three core targets of treatment: family relationships, patient's inner confusion and nutritional restoration. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.