'I can't accept that feeling': Relationships between interoceptive awareness, mindfulness and eating disorder symptoms in females with, and at-risk of an eating disorder

A controlled trial assessing the acceptability and efficacy of a yoga-based eating disorder prevention program among division I athletes: Eat Breathe Thrive (EBT)

OBJECTIVE

This study evaluated the acceptability and effectiveness of the Eat Breathe Thrive (EBT) program as an eating disorder prevention intervention among women collegiate athletes.

METHOD

Change over time in eating disorder risk and competencies of positive embodiment were examined in 94 women (n = 48 EBT participants and n = 46 matched-controls) from one National Collegiate Athletic Association (NCAA) Division I-classified university in the United States. Eating disorder risk factors were measured using the Eating Disorder Examination Questionnaire (EDE-Q) and State Trait Anxiety Inventory (STAI). Aspects of positive embodiment were measured using the Multidimensional Assessment of Interoceptive Awareness (MAIA) and The Mindful Self-Care Scale (MSCS). Data were collected through participants' completion of online surveys across three time-points.

RESULTS

Repeated measures ANOVAS revealed EBT participants reported experiencing significantly less state anxiety and greater interoceptive body trusting over time relative to matched-controls. No other significant interactions were found. Respondents found the EBT program acceptable.

DISCUSSION

Acceptability and partial support for integrative, yoga-based, interventions targeting Division I student-athletes is indicated.

Eat Breathe Thrive: an interpretative phenomenological analysis of a yoga-based eating disorder intervention

A growing body of evidence suggests that yoga-based interventions might aid in the prevention and treatment of eating disorders. The current qualitative study used Interpretative Phenomenological Analysis (IPA) to analyze the nature and degree of impact of a yoga and mindfulness-based eating disorder prevention intervention Eat Breath Thrive (EBT). Data was collected via semi-structured interviews with 16 participants over the age of 18 who took part in the EBT program between 2018 and 2022. Using IPA methodology, and after several rounds of coding, emergent themes were interpreted and organized to develop a theoretical model explaining the mechanism of change experienced and described by EBT participants. The resulting model outlines an experiential progression from psychoeducation and skill development/practice to increased mindful awareness, and empowered state experiences which led to the following outcomes: independent positive action, self-initiated positive state experiences, and increased embodied well-being. Participants reported increased self-compassion and self-acceptance, with decreased emphasis on disordered eating behaviors. Qualitative data is necessary for understanding why yoga works, from an experiential perspective. This study adds to the new, and rapidly expanding body of research supporting the positive effects of yoga and mindfulness on the prevention and treatment of eating disorders.

Pain experience in eating disorders: The mediating role of depression, alexithymia and interoceptive awareness

OBJECTIVE

Evidence suggests reduced sensitivity to pain due to high pain threshold in anorexia and bulimia nervosa and a possible role of depression, alexithymia and interoceptive awareness on pain experience. This study examined whether self-report and real-time evoked pain experience were mediated by depression, alexithymia and interoceptive awareness in a comprehensive sample of patients with eating disorders (ED).

METHOD

145 participants (90 ED, 55 healthy controls (HC)) underwent a real-time evoked examination of pain and completed self-report questionnaires for pain (Pain Detect Questionnaire (PD-Q), PD-Q VAS, Leeds Assessment of Neuropathic Symptoms and Signs), depression (BDI-II), interoceptive awareness Multidimensional Assessment of Interoceptive Awareness (MAIA), and alexithymia (TAS-20). Three mediation models, with ED diagnosis as independent variable, and BDI, MAIA and TAS-20 as mediators, were tested.

RESULTS

Participants with ED and HC exhibited similar pain type and intensity (self-report and real-time). Eating disorders diagnosis was associated with lower self-report pain intensity and non-neuropathic like pain experience (model 1-2). Depressive symptoms partially (model 1-2) or fully (model 3) mediated the association between ED diagnosis and pain experience, alone (model 1) or via alexithymia (model 3). Interoceptive awareness did not influence pain symptomatology.

DISCUSSION

ED diagnosis is associated with non-neuropathic and lower pain experience. However, concurrent depression and alexithymia are associated with higher pain symptoms and neuropathic features. These results could inform clinicians about the influence of psychopathology on pain experience in ED.

Topography and relationship-specific social touching in individuals displaying body image disturbances

Interpersonal touch is intimately related to the emotional bond between the touch giver and the touch receiver. Which bodily regions we touch in those individuals in our social network is relationship specific. Perception of interpersonal touch is altered in psychiatric disorders characterised by body image disturbances (BIDs). Here, we examined whether the 'imagined' experience of social touch in individuals with BIDs is body topography- and relationship-specific. By using an interactive media mobile App, the Virtual Touch Toolkit, high versus low levels of BIDs participants completed heatmaps of full-body virtual avatars, to indicate the body regions they find soothing/unpleasant to be touched by a loved one versus an acquaintance. Self-reports of interoceptive awareness and dysmorphic concerns were also measured. Overall, imagined touch was rated as the most soothing when received from a loved one, and also when this was delivered to 'social' body regions. The importance of the social relationship for the imagined tactile interactions was particularly evident for the high levels of BIDs group, with greater problems with interoceptive awareness predicting higher soothing touch ratings when this was received by a loved one. Despite the evidence that imagined bodily contacts between meaningful people is the most pleasant for socially acceptable bodily regions, our findings may suggest a greater sensitivity to relation-specific bodily patterns of social touch particularly in the high level of BIDs group. Heightened interoceptive awareness may also play a key role in this experience of bodily affective contacts. Future research for body-oriented therapy for BIDs is encouraged to systematically probe the efficacy of imagined social touch interaction protocols which use more plausible, ecological, scenarios where touch is delivered by loved ones and to socially acceptable bodily regions.

Interoceptive deficits moderate the relationship between bulimia symptoms and suicide risk

Objective: Interoceptive deficits have been linked to suicidality and eating disorders. The relationship between disordered eating symptoms and suicidality may depend on the level of interoceptive deficits. It was expected that interoceptive deficits would moderate the relationship between disordered eating symptoms (oral control, dieting, and bulimia) and suicidality (suicide attempts, ideation, and communication) when interoceptive deficits were high. Methods: University students (N = 417, Mage = 19.75, 78.2% white, 72.4% female) completed self-report measures that assessed disordered eating, interoceptive deficits, and suicide history. Results: Interoceptive deficits emerged as a significant moderator only in the association between bulimia symptoms and suicidality, when interoceptive deficits were high. Conclusions: The results of this study indicate that bulimia symptoms may have a unique interaction with interoceptive deficits and suicidality. Future research should focus on targeting interoceptive deficits in treatment to help reduce disordered eating symptoms and suicide risk, particularly for students with bulimia symptoms.

Body image, interoceptive awareness, depression and eating disorder symptoms: Within-group variability among sexual minority women

This study investigates within-group differences in body image concerns among sexual minority women and their related association with eating disorders and depression. Cross-sectional data were collected in 2017 and analysed in 2020 from 201 sexual minority women in the United States. Latent profile analyses and post hoc comparison analyses were conducted to investigate within-group variability in body image concerns and to understand their impact on depressive and eating disorder symptoms. Results suggested that a 5-class solution best fit the data, with five distinct profiles emerging in patterns of interoceptive awareness, sociocultural attitudes toward appearance, body shame, body surveillance and appearance anxiety. Significant differences in mean scores of depressive and eating disorder symptomatology emerged among the profiles; groups that reported low interoceptive awareness and high body image concerns experienced greater levels of eating disorder and depressive symptoms, compared to groups with average or higher levels of interoceptive awareness and average or lower body image concerns. Results underscore the significant within-group variability that exists for sexual minority women with regard to the prevalence of body image concerns, depressive symptoms and eating disorder symptoms. Efforts that aim to increase interoceptive awareness (for example, mindfulness) alongside strategies aimed at addressing negative body image concerns may be particularly effective avenues for future depression and eating disorder prevention in this diverse group. Our reporting adheres to the STROBE research reporting checklist.

Outcomes of intuitive eating interventions: a systematic review and meta-analysis

Intuitive eating (IE) is an approach to health promotion that fosters a positive relationship with food and the body. The objective of this review was to aggregate and analyse the literature on IE interventions, thereby offering an early investigation of methodological approaches to intervention. This review was conducted in accordance with the preferred reporting items for systematic review and meta-analysis protocols (PRISMA) guidelines. Searching was conducted in four electronic databases. Studies were eligible for inclusion if they delivered an IE intervention and used the Intuitive Eating Scale (IES). Nine studies were included in this review. Six were eligible for meta-analysis, though only outcomes on the IES were examined; all other measures were examined individually. All interventions led to improvements on measures of IE, with a large pooled effect size (1.50 [1.15, 1.85]) and positive changes on a variety of other outcomes relating to health. This pattern preliminarily suggests that IE interventions change psychological processes as intended and can be useful in promoting health behaviour. The present review offers a synthesis of existing approaches to IE interventions and an evaluation of which specific variants appear to be more effective. This paper provides a basis upon which future interventions can be developed to improve approaches to psychoeducation.Clinical ImplicationsInterventions contributed to improvements in measures of IE lasting up to 6 months.Interventions contributed to positive changes on outcomes such as quality of life, body image, and body appreciation.Self-management through IE-based interventions may be feasible and effective.

A snapshot of eating behaviors in undergraduate college students living in South Florida

Objective: To examine a) whether college students' eating behaviors are different by students' sex and/or body mass index (BMI) categories and b) the correlations between college students' eating behaviors and the degree to which they rely on internal bodily signals for food intake. Participants: Undergraduate college students 18-24 years old at a public university located in South Florida. Methods: Eligible students answered questionnaires to examine interoception, intuitive eating, and eating behaviors including emotional eating, restrained eating, cognitive restraint, external eating, and uncontrolled eating. Pearson correlation and independent t test were used (significance: p < 0.05). Results: Females reported lower interoception, intuitive eating, and higher emotional eating than males. Students with lower BMI had higher intuitive eating and lower restrained eating. Interoception was positively correlated with intuitive eating and negatively correlated with emotional, uncontrolled, restrained, and external eating. Conclusion: College students who have a better connection with their bodily signals have healthier eating behaviors and lower BMI.

Efficacy of Eat Breathe Thrive: A randomized controlled trial of a yoga-based program

Evidence positions yoga as a promising intervention for enhancing positive embodiment and supporting the prevention of, and recovery from, eating disorders (EDs) by reducing ED symptomatology and building skills that facilitate an ongoing, embodied sense of wellbeing. However, yoga-based programs are few and rigorous literature on their efficacy is limited. This study examined the efficacy and feasibility of a yoga-based program called Eat Breathe Thrive (EBT) which aims to prevent EDs and support embodiment. Participants (N = 168, 93.5 % women) from a community sample in the United States and United Kingdom, ages 18-65, were randomly allocated to a 2-h, 7-week EBT program or waitlist-control condition. Compared to controls, EBT participants experienced significant decreases in ED behaviors, depression, and difficulties regulating emotions. They reported significantly greater use of mindfulness skills, such as interoceptive awareness, mindful self-care, and mindful eating. After a single session, participants reported immediate improvement in their sense of well-being, indicating increased state positive embodiment. Most effects were sustained at 6-month follow-up. The majority of individuals attended most sessions. Self-reported treatment integrity was excellent. Directions for future research are proposed. Results support the efficacy and feasibility of an integrated yoga intervention that fosters positive ways of inhabiting the body.

The Role of Emotion Regulation in Eating Disorders: A Network Meta-Analysis Approach

Background

Previous theoretical models and reviews have documented a strong connection between emotion dysregulation eating disorder (ED) psychopathology among the general and clinical populations. The aim of this review was to build on this previous work by conducting a network meta-analysis to explore associations between adaptive and maladaptive emotion regulation strategies and ED psychopathology trans-diagnostically across the ED spectrum to identify areas of emotion dysregulation that have the strongest association with symptomatology.

Methodology

A total of 104 studies were included in the meta-analysis and correlation coefficient representing the associations between specific emotion regulation strategies and ED symptomatology were extracted. We ran a Bayesian random effects network meta-analysis and the initial network was well-connected with each emotion regulation strategy being linked to at least one other strategy. We also conducted a network meta-regression to explore whether between-study differences in body mass index (BMI), age, and whether the sample consisted of solely female participants explained any possible network inconsistency.

Results

The network meta-analysis revealed that ruminations and non-acceptance of emotions were most closely associated with ED psychopathology. There was no significant network inconsistency but two comparisons approached significance and thus meta-regressions were conducted. The meta-regressions revealed a significant effect of BMI such that the associations between different emotion regulation strategies and ED symptomatology were weaker among those with low BMI.

Discussion

The present findings build on previous work and highlight the role of rumination and difficulties with accepting emotions as key emotion regulation difficulties in EDs. Additionally, the finding that the associations were weaker among ED patients with low BMI may point toward a complex relationship between ED behaviors and emotion regulation. Taken together, our findings call for interventions that target emotion regulation, specifically rumination and difficulties accepting emotions, in the treatment of EDs.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021249996, PROSPERO, identifier: CRD42021249996.

Atypical interoception as a common risk factor for psychopathology: A review

The inadequacy of a categorial approach to mental health diagnosis is now well-recognised, with many authors, diagnostic manuals and funding bodies advocating a dimensional, trans-diagnostic approach to mental health research. Variance in interoception, the ability to perceive one's internal bodily state, is reported across diagnostic boundaries, and is associated with atypical functioning across symptom categories. Drawing on behavioural and neuroscientific evidence, we outline current research on the contribution of interoception to numerous cognitive and affective abilities (in both typical and clinical populations), and describe the interoceptive atypicalities seen in a range of psychiatric conditions. We discuss the role that interoception may play in the development and maintenance of psychopathology, as well as the ways in which interoception may differ across clinical presentations. A number of important areas for further research on the role of interoception in psychopathology are highlighted.

Mindfulness in persons with anorexia nervosa and the relationships between eating disorder symptomology, anxiety and pain

Mindfulness is useful for some psychiatric illnesses, but limited research exists among persons with anorexia nervosa (AN). This study aimed to determine the relationship between mindfulness, eating disorder symptomology and indicators of health in women with AN (n = 59) entering residential treatment. Participants completed a self-administered survey, including the Cognitive Affective Mindfulness Scale and other measures. Additional data from medical records were collected. Greater mindfulness was associated with less eating disorder symptoms (p = .049). This relationship was most profound in individuals with AN, including restrictive and binge-purge subtypes compared to individuals with atypical AN (interaction p-value = 0.044). Greater mindfulness was significantly associated with less shape (p = .023) and weight concern (p = .047). Expectedly, anxiety was inversely associated with eating disorder symptoms (p = .001). Greater pain was associated with less eating disorder symptoms (p = .024). Overall, mindfulness may be a protective factor against some eating disorder symptomology.

Exploring the association between psychological distress and drunkorexia behaviors in non-clinical adolescents: the moderating role of emotional dysregulation

PURPOSE

Although drunkorexia seems to represent a new form of eating disorder, it shares several features with traditional eating disorders. However, very little is known about the association between drunkorexia and a widely studied correlate of eating disorders, such as psychological distress and about mechanisms underlying this association. The present study aimed to investigate the relation between symptoms of anxiety and depression and drunkorexia, and to explore the role of emotional dysregulation as moderator of this relationship.

METHODS

The sample was composed of 402 adolescents (222 females, 180 males; range 15-21) who completed self-reported measures: Drunkorexia Motives and Behaviors Scale, which assesses different behaviors and motivations associated with drunkorexia, Emotional dysregulation scale from the Eating Disorder Inventory-3, reflecting difficulties regulating emotions, and Anxiety and Depression scales from the Symptom CheckList-90 Revised, assessing general signs of anxious and depressive symptoms.

RESULTS

Anxious symptomatology resulted a significant statistical predictor of drunkorexia behaviors (β = .28, p = .001). Furthermore, emotional dysregulation moderated the relation between anxiety and drunkorexia; specifically, a positive relation was found both at medium levels (β = .22, p = .007) and at higher levels of emotional dysregulation (β = .38, p = .000), whereas at lower levels of emotional dysregulation, this association became nonsignificant.

CONCLUSIONS

Findings suggest that adolescents who experience both elevated anxiety and emotional dysregulation may be more likely to turn to drunkorexia to reduce their unregulated negative affect in the absence of more adaptive emotion regulation strategies. Implications for intervention and prevention programs are discussed.

LEVEL OF EVIDENCE

Level V, descriptive study.

Validation of the Intuitive Exercise Scale in Patients With Eating Disorders

Unhealthy cognitive–emotional relationships with exercise can hinder positive treatment outcomes when left unaddressed. However, clinicians lack validated tools to monitor this aspect of treatment. This study examined the 14-item Intuitive Exercise Scale with 165 patients in the United States (Mage = 26.48 years) who were receiving treatment for an eating disorder. The original factor structure was inadequate for the current sample, and exploratory factor analysis generated three factors—emotional exercise, body intuition, and exercise variety. The three-factor solution yielded strong internal consistency and partial support for the scale’s validity. Furthermore, patients scored lowest in body intuition, confirming low awareness of bodily cues common in patients with eating disorders. This study informs how clinicians may integrate and monitor patients’ cognitive–emotional relationship with exercise as part of holistic and intuitive eating disorder treatment approaches.

Women's Experiences with a Mindful Eating Program for Binge and Emotional Eating: A Qualitative Investigation into the Process of Change

Objectives: Mindfulness-based interventions (MBIs) have been shown to reduce engagement in disordered eating behaviors, although how these interventions engender change remains unclear. The objective of this exploratory qualitative study was to describe the experiences and perceived attitudinal and behavioral changes of women participating in a mindful eating program. Design: Focus group discussions were held with women participating in a community-based mindful eating program for binge and emotional eating. A semistructured interview guide was used to explore participants' conceptualizations of mindfulness-based attitudinal and behavior change, as related to food, eating, and body image. The focus group discussions were audio-recorded, transcribed, and analyzed using thematic analysis to identify salient concepts. Settings/Location: Focus group discussions were held at the Center for Mindfulness at the University of Massachusetts Medical School (UMMS) (United States). Participants: A sample of nine women who were enrolled in the mindful eating program at UMMS for problems with self-reported binge and/or emotional eating participated in this study. Results: Four themes were constructed that described a process of mindfulness-based behavior change, including (1) Learning Through Self-Awareness, (2) Self-Empowerment, (3) Mindful Choice-Making, and (4) Resilient Self-Care. An overarching description of the participants' perceived attitudinal and behavior changes was developed: "unforced freedom of choice, emerging from embodied awareness." Conclusions: These findings suggest that MBIs reduce may disordered eating behaviors through empowering women to make positive choices about food, eating, and coping, without focusing on weight control. Future research is needed to examine whether these findings replicate in larger and more diverse samples, and how they can be used to optimize and implement eating-specific MBIs in community-based settings.

Mindfulness-based emotional eating awareness training: taking the emotional out of eating

PURPOSE

Emotional eating is important to study and address because it predicts poor outcome in weight loss interventions. Interventions have only touched the surface in terms of addressing emotional eating. Mindfulness approaches can address emotional eating by modification of emotion regulation and appetitive traits. The current study involved development of an emotional eating-specific mindfulness intervention and assessment of its effect on appetitive traits associated with emotional eating.

METHODS

Participants (n = 14; age M = 29 years; 90% female) completed baseline and end-of-intervention self-report measures of emotional eating, food-cue reactivity, mindfulness, intuitive eating, emotional impulse regulation, stress, and a behavioural measure of inhibitory control. During the 6-week intervention, mindfulness meditation skills were taught weekly embedded in a psycho-educational curriculum about emotional eating.

RESULTS

Paired t tests, controlled for type 1 error, revealed significant improvements in food-cue reactivity, intuitive eating, emotional impulse regulation, inhibitory control and stress (ps < 0.05; d: 0.58-1.54). Changes in emotional eating approached significance (p = 0.075, d = 0.66).

CONCLUSION

The intervention purposefully did not focus on weight loss and recruited participants who had self-declared difficulties with emotional eating. The positive outcomes suggest that intervening with mindfulness training before weight loss is attempted has the potential to change psychological factors that underpin overeating and undermine weight loss efforts. The study provides proof of principle as a basis to design a randomized control trial to assess rigorously the effectiveness of the intervention as a precursor to a weight loss intervention.

LEVEL OF EVIDENCE

Level IV, uncontrolled trial.

Mindfulness and eating disorder psychopathology: A meta-analysis

OBJECTIVE

Mindfulness is implicated in eating disorder (ED) psychopathology. However, this literature has not been synthesized to date. The current meta-analysis examined the associations between mindfulness and ED psychopathology.

METHODS

A total of 74 independent samples (effects = 576) were included. We used a multilevel random-effects model to estimate summary study-level effect sizes, and multilevel mixed-effects models to examine moderator effects.

RESULTS

Mindfulness was negatively associated with ED psychopathology (r = -.25, p < .001), both concurrently (r = -.25, p < .001) and prospectively (rs = -.22 to -.24, ps < .001). Associations were strongest for binge eating, emotional/external eating, and body dissatisfaction as well as the acting with awareness and nonjudging facets.

DISCUSSION

Mindfulness may be an important process in ED psychopathology. Future research should prospectively and experimentally examine the relation between mindfulness and ED psychopathology.

Body mistrust bridges interoceptive awareness and eating disorder symptoms

Interoceptive awareness (IA), or the awareness of internal body states, is known to be impaired in individuals with eating disorders (EDs); however, little is understood about how IA and ED symptoms are connected. Network analysis is a statistical approach useful for examining how symptoms interrelate and how comorbidities may be maintained. The present study used network analysis to (1) test central symptoms within an IA-ED network, (2) identify symptoms that may bridge the association between IA and ED symptoms, and (3) explore whether central and bridge symptoms predict ED remission at discharge from intensive treatment. A regularized partial correlation network was estimated in a sample of 428 adolescent (n = 187) and adult (n = 241) ED patients in a partial hospital program. IA was assessed using items from the Multidimensional Assessment of Interoceptive Awareness, and ED symptoms were assessed using items from the Eating Disorder Examination-Questionnaire. Central symptoms within the network were strong desire to lose weight, feeling guilty, and listening for information from the body about emotional state. The most central symptom bridging IA and ED symptoms was (not) feeling safe in one's body. Of the central symptoms, greater desire to lose weight predicted lower likelihood of remission at treatment discharge. Bridge symptoms did not significantly predict remission. Body mistrust may be a mechanism by which associations between IA and EDs are maintained. Findings suggest targeting central and bridge symptoms may be helpful to improve IA and ED symptoms. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Effects of mindfulness on psychological and psychophysiological responses during self-paced walking

The aim of the present study was to investigate the effects of an audio-guided mindfulness (MF) single session on psychological and psychophysiological responses during an outdoor walking task. Twenty-four participants (12 females and 12 males; M_age  = 23.6, SD = 3.9 years) were required to walk 200 m at a pace of their choosing. Two experimental conditions (mindfulness meditation and mindlessness [ML] meditation) and a control condition (CO) were administered. Electrical activity in the brain was measured by the use of a portable electroencephalography (EEG) system during walking. Fast Fourier Transform was used to decompose the EEG samples into theta (5-7 Hz), alpha (8-14 Hz), and beta (15-29 Hz) frequencies. Brain connectivity analysis between frontal and temporo-parietal electrode sites was conducted to explore functional interactions through the use of spectral coherence. Affective and perceptual responses were measured by the use of single-item scales and questionnaires. The present findings indicate that MF was sufficiently potent to reallocate attention toward task-related thoughts, downregulate perceived activation, and enhance affective responses to a greater degree than the other two conditions. Conversely, ML was sufficient to increase the use of dissociative thoughts, make participants less aware of their physical sensations and emotions, induce a more negative affective state, and upregulate perceived activation to a greater extent than MF and CO. The brain mechanisms that underlie the effects of MF on exercise appear to be associated with the enhanced inter-hemispheric connectivity of high-frequency waves between right frontal and left temporo-parietal areas of the cortex.

Relationships Between Self-Esteem, Interoceptive Awareness, Impulse Regulation, and Binge Eating. Path Analysis in Bariatric Surgery Candidates

OBJECTIVE

The current study investigates the hypothesis that the effect of low self-esteem on binge eating in bariatric candidates was mediated by both difficulties in the perception of bodily signals and impulse regulation after accounting for gender, age, and body mass index.

METHOD

59 preoperative patients (both male and female) were screened by means of self-report measures of self-esteem, interoceptive deficits, impulse dysregulation, and severity of binge eating. Results: Results indicated that all direct effects were significant, except for the self-esteem on impulse dysregulation and the interoceptive deficits on binge eating. Self-esteem had a significant indirect effect on impulse dysregulation mediated by interoceptive deficits. Impulse dysregulation, in turn, mediates the effect of interoceptive deficits on binge eating. Moreover, the path starting from self-esteem, going first to interoceptive deficits, then going via impulse regulation difficulties to binge eating was significant.

RESULTS AND CONCLUSIONS

A potential underlying mechanism through which self-esteem is linked to binge eating has been suggested. Obese individuals who perceived themselves as inadequate may carry a stronger burden by the confusion and mistrust related to bodily functioning and, consequently, may act more impulsively, through binge eating.

Mindfulness-based interventions for adolescent health

PURPOSE OF REVIEW

Mindfulness, the practice of paying attention to the present moment, purposefully and nonjudgmentally, has been gaining popularity as adjunct treatment for adolescents with a range of physical and mental health problems. Research conducted in adults and emerging research conducted in adolescents has shown that mindfulness-based interventions can improve outcomes in several areas. The purpose of this review is to discuss recent research on the effects of mindfulness and suggest exercises that primary care clinicians can offer to their adolescent patients.

RECENT FINDINGS

Research has shown positive effects of mindfulness across several health conditions commonly encountered during adolescence. Mindfulness-based Interventions can reduce symptoms of anxiety and depression. The application of mindfulness can help with the prevention and treatment of binge eating, over-eating, and restrictive eating disorders. In the treatment of substance use disorders, mindfulness can improve emotion regulation and reduce symptoms of withdrawal and craving. Mindfulness can also lead to improvement in overall quality of life for patients suffering from chronic pain. Lastly, mindfulness can be useful for adolescents with ADHD, sleep problems, chronic illness, and stress related to performance sports.

SUMMARY

Although research in adolescents remains limited, mindfulness holds promise in the treatment of a range of health conditions in adolescents.

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.

A randomised, double-blind, placebo-controlled parallel trial of closed-loop infraslow brain training in food addiction

The posterior cingulate cortex (PCC) is involved in food craving in obese food addicted individuals. This randomised, double-blind, placebo-controlled parallel study explored the potential therapeutic effects of infraslow neurofeedback (ISF-NF) on food craving targeting the PCC in obese women with symptoms of food addiction. Participants received six sessions of either ISF-NF (n = 11) or placebo (n = 10) over a three-week period. There were no reported adverse effects. Electrophysiologically, there were significant increases in infraslow activity (p = 0.0002) and infraslow/beta nesting (p < 0.001) in the PCC in the ISF-NF group (mean r = 0.004 ± 0.002) compared to placebo (mean r = 0.02 ± 0.002) two days after the last intervention. Also, there was a significant decrease in different dimensions of state food craving compared to baseline and to placebo. Findings suggest that source localized IFS-NF results in electrophysiological changes and may be associated with reduced food craving. This trial is registered at www.anzctr.org.au , identifier, ACTRN12617000601336. This study was funded by the Otago Medical Research Grant: CT375.

Self-reported interoceptive deficits in eating disorders: A meta-analysis of studies using the eating disorder inventory

OBJECTIVE

An impairment of the ability to sense the physiological condition of the body - interoception - has long been proposed as central to the onset and maintenance of eating disorders. More recent attention to this topic has generally indicated the presence of interoceptive deficits in individuals with an eating disorder diagnosis; however, possible links with specific diagnosis, BMI, age, illness duration, depression, and alexithymia remain unclear from individual studies. This meta-analysis aimed to provide a necessary quantitative overview of self-reported interoceptive deficits in eating disorder populations, and the relationship between these deficits and the previously mentioned factors.

METHODS

Using a random effects model, our meta-analysis assessed the magnitude of differences in interoceptive abilities as measured using the Eating Disorder Inventory in 41 samples comparing people with eating disorders (n = 4308) and healthy controls (n = 3459). Follow-up and moderator analysis was conducted, using group comparisons and meta-regressions.

RESULTS

We report a large pooled effect size of 1.62 for eating disorders with some variation between diagnostic groups. Further moderator analysis showed that BMI, age and alexithymia were significant predictors of overall effect size.

CONCLUSION

This meta-analysis is the first to confirm that large interoceptive deficits occur in a variety of eating disorders and crucially, in those who have recovered. These deficits may be useful in identifying and distinguishing eating disorders. Future research needs to consider both objective and subjective measures of interoception across different types of eating disorders and may fruitfully examine interoception as a possible endophenotype and target for treatment.

Mindfulness-based and acceptance-based interventions in sport and performance contexts

Since mindfulness-based and acceptance-based practice models were first conceptualized and applied in sport in an attempt to enhance performance and overall well-being of athletes and performers, these state-of-the-art theoretical and practice models have substantially broadened our knowledge base and have been successfully incorporated into sport and performance practice domains worldwide. Evolving from a sound empirical foundation, mindfulness-based and acceptance-based models in sport psychology have accumulated a strong basic and applied empirical foundation. In the nearly 20 years since their incorporation in the context of sport, empirical findings have demonstrated efficacious outcomes associated with performance and personal well-being, as well as supported their theorized mechanisms of change. Particularly as sport and performance environments increasingly call upon practitioners to provide more comprehensive care to clientele, including a range of care from performance enhancement and maintenance, to general personal well-being, to subclinical and clinical issues, mindfulness-based and acceptance-based practitioners have the tools to offer robust, empirically informed interventions that can enhance skills and quality of life, and/or ameliorate personal struggles.