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Quittkat HL, Voges MM, Kisker J, Schöne B, Düsing R, Vocks S. One body, two faces: How double standards influence body evaluation in women with binge-eating disorder compared to mentally healthy women with higher weight and average weight. Int J Eat Disord 2023; 56:1752-1763. [PMID: 37272205 DOI: 10.1002/eat.23998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 05/09/2023] [Accepted: 05/10/2023] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Research has found evidence that women with anorexia nervosa (AN) and bulimia nervosa (BN) apply different standards for themselves than for others when evaluating bodies, an aspect of a disturbed body image. This study investigates whether women with binge-eating disorder (BED) likewise show self-deprecating double standards (DS). METHODS Women with BED (n = 40), women with higher weight (n = 40) and women with average weight (n = 40) viewed a presentation of different builds, including their individual ideal body, which were presented once with participants' own and once with an unknown woman's face. After each presentation, participants rated their emotional response regarding arousal and valence, and evaluated the body's attractiveness, body fat and muscle mass. DS were defined as the difference in ratings of the same body with one's own and the unknown face. RESULTS Women with BED showed a higher degree of negative emotions in response to a thin and a high-weight build, rated lower levels of body attractiveness for an athletic build, and displayed more arousal for almost all builds presented with their own compared to with another face. While women with BED showed a higher burden on measures of eating pathology and body image than the other groups, DS were not more pronounced in women with BED. DISCUSSION The findings contradict DS as a characteristic feature of BED, but underline "normative" DS for higher-weight/high-weight builds, reflecting weight stigmatization. Psychoeducation on these DS might complement cognitive-behavioral therapy in BED in order to reduce negative emotions. PUBLIC SIGNIFICANCE A bias in body evaluation has been proven in women with anorexia and BN, but no research has examined this in women with BED. This study provides evidence of DS in body evaluation in women with BED, compares the extent of DS between women with BED, higher weight, and average weight, and investigates individual body ideals in women with BED and higher weight.
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Affiliation(s)
- Hannah L Quittkat
- Institute of Psychology, Department of Clinical Psychology and Psychotherapy, Osnabrück University, Osnabrück, Germany
| | - Mona M Voges
- Institute of Psychology, Department of Clinical Psychology and Psychotherapy, Osnabrück University, Osnabrück, Germany
| | - Joanna Kisker
- Institute of Psychology, Department of Experimental Psychology I, Osnabrück University, Osnabrück, Germany
| | - Benjamin Schöne
- Institute of Psychology, Department of Experimental Psychology I, Osnabrück University, Osnabrück, Germany
| | - Rainer Düsing
- Institute of Psychology, Department of Research Methodology, Diagnostics and Evaluation, Osnabrück University, Osnabrück, Germany
| | - Silja Vocks
- Institute of Psychology, Department of Clinical Psychology and Psychotherapy, Osnabrück University, Osnabrück, Germany
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2
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Opladen V, Tanck JA, Baur J, Hartmann AS, Svaldi J, Vocks S. Body exposure and vocal analysis: validation of fundamental frequency as a correlate of emotional arousal and valence. Front Psychiatry 2023; 14:1087548. [PMID: 37293400 PMCID: PMC10244733 DOI: 10.3389/fpsyt.2023.1087548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 04/04/2023] [Indexed: 06/10/2023] Open
Abstract
Introduction Vocal analysis of fundamental frequency (f0) represents a suitable index to assess emotional activation. However, although f0 has often been used as an indicator of emotional arousal and different affective states, its psychometric properties are unclear. Specifically, there is uncertainty regarding the validity of the indices of f0mean and f0variabilitymeasures (f0dispersion, f0range, and f0SD) and whether higher or lower f0 indices are associated with higher arousal in stressful situations. The present study therefore aimed to validate f0 as a marker of vocally encoded emotional arousal, valence, and body-related distress during body exposure as a psychological stressor. Methods N = 73 female participants first underwent a 3-min, non-activating neutral reference condition, followed by a 7-min activating body exposure condition. Participants completed questionnaires on affect (i.e., arousal, valence, body-related distress), and their voice data and heart rate (HR) were recorded continuously. Vocal analyses were performed using Praat, a program for extracting paralinguistic measures from spoken audio. Results The results revealed no effects for f0 and state body dissatisfaction or general affect. F0mean correlated positively with self-reported arousal and negatively with valence, but was not correlated with HRmean/maximum. No correlations with any measure were found for any f0variabililtymeasures. Discussion Given the promising findings regarding f0mean for arousal and valence and the inconclusive findings regarding f0 as a marker of general affect and body-related distress, it may be assumed that f0mean represents a valid global marker of emotional arousal and valence rather than of concrete body-related distress. In view of the present findings regarding the validity of f0, it may be suggested that f0mean, but not f0variabilitymeasures, can be used to assess emotional arousal and valence in addition to self-report measures, which is less intrusive than conventional psychophysiological measures.
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Affiliation(s)
- Vanessa Opladen
- Department of Clinical Psychology and Psychotherapy, Osnabrück University, Osnabrück, Germany
| | - Julia A. Tanck
- Department of Clinical Psychology and Psychotherapy, Osnabrück University, Osnabrück, Germany
| | - Julia Baur
- Department of Clinical Psychology and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Andrea S. Hartmann
- Department of Psychology, Experimental Clinical Psychology, University of Konstanz, Konstanz, Germany
| | - Jennifer Svaldi
- Department of Clinical Psychology and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Silja Vocks
- Department of Clinical Psychology and Psychotherapy, Osnabrück University, Osnabrück, Germany
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3
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Baur J, Krohmer K, Naumann E, Svaldi J. Efficacy and mechanisms of change in exposure-based and cognitive stand-alone body image interventions in women with overweight and obesity. Behav Res Ther 2022; 159:104210. [PMID: 36435148 DOI: 10.1016/j.brat.2022.104210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 07/25/2022] [Accepted: 10/07/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Body dissatisfaction is highly prevalent in overweight and obesity, while evidence for the efficacy of body image interventions is still scarce. This interventional pilot study investigates the efficacy and mechanisms of change of two stand-alone body image interventions in women with overweight and obesity. METHODS Women with overweight and obesity (n = 76) were randomly assigned to five weekly sessions of either a mirror exposure (ME) or a cognitive restructuring intervention (CR) or to a wait-list control group (WCG). Primary outcome measures were self-reported body dissatisfaction and interview-based shape concerns; depression, self-esteem and emotional eating served as secondary outcome measures. Experimental paradigms were used prior to and after the interventions to analyze possible mechanisms of change: (a) Implicit Associations Tests to assess weight-related attitudes (b) eye-tracking experiments to assess visual processing of body pictures and (c) a thought-sampling procedure to assess body-related cognitions and arousal. RESULTS According to intent-to-treat analyses using linear mixed-models, both interventions lead to significant improvements in body image, while there were no changes in the WCG. Different mechanisms of change were identified. CONCLUSIONS Both types of interventions might be effective in the reduction of self-reported body dissatisfaction and interview-based shape concerns in overweight and obesity. However, as different mechanisms drive the effects, future research should clarify which individual might best benefit from which intervention.
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Affiliation(s)
- Julia Baur
- Department of Clinical Psychology and Psychotherapy, University of Tuebingen, Tuebingen, Germany.
| | - Kerstin Krohmer
- Department of Clinical Psychology and Psychotherapy, University of Tuebingen, Tuebingen, Germany
| | - Eva Naumann
- Department of Clinical Psychology and Psychotherapy, University of Tuebingen, Tuebingen, Germany
| | - Jennifer Svaldi
- Department of Clinical Psychology and Psychotherapy, University of Tuebingen, Tuebingen, Germany
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Rekkers ME, Aardenburg L, Scheffers M, van Elburg AA, van Busschbach JT. Shifting the Focus: A Pilot Study on the Effects of Positive Body Exposure on Body Satisfaction, Body Attitude, Eating Pathology and Depressive Symptoms in Female Patients with Eating Disorders. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11794. [PMID: 36142068 PMCID: PMC9517204 DOI: 10.3390/ijerph191811794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 09/02/2022] [Accepted: 09/06/2022] [Indexed: 06/16/2023]
Abstract
One of the most commonly used techniques for the treatment of body image problems in eating disorders (ED) is body exposure (BE). However, evidence of its effectiveness in clinical populations is scarce. In the Positive Body Experience (PBE) protocol, the focus of positive BE is on aesthetic, functional and tactile aspects of the body. The current study evaluates the outcomes of positive BE with regard to changes in attitudinal body image and eating pathology, as well as the factors that influence these changes, in a sample of 84 adult female patients with different EDs who did not receive any other treatment for their EDs during the period in which BE treatment occurred. The results show significant positive changes in attitudinal body image, ED behaviors and depressive symptoms, with depressive symptoms at baseline mediating the changes in attitudinal body image. This study indicates that the PBE protocol is a suitable intervention for reducing negative attitudinal body image in anorexia and bulimia nervosa patients, as well as those with binge eating disorder. Furthermore, the results suggest that positive non-weight-related and functional body satisfaction are strong catalysts for change and that depressive symptoms play an important role in the ability to change. Additional RCTs are needed to gain more insight into the effects of PBE.
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Affiliation(s)
- Marlies E. Rekkers
- Faculty of Social Sciences, Utrecht University, Heidelberglaan 1, 3584 CS Utrecht, The Netherlands
- Department of Human Movement and Education, Windesheim University of Applied Sciences, Campus 2-6, 8017 CA Zwolle, The Netherlands
| | - Lisanne Aardenburg
- GGZ inGeest, Mental Health Institute, Laan van de Helende Meesters 433, 1186 DL Amstelveen, The Netherlands
| | - Mia Scheffers
- Department of Human Movement and Education, Windesheim University of Applied Sciences, Campus 2-6, 8017 CA Zwolle, The Netherlands
| | - Annemarie A. van Elburg
- Faculty of Social Sciences, Utrecht University, Heidelberglaan 1, 3584 CS Utrecht, The Netherlands
- Rintveld, Centre for Eating Disorders, Altrecht Mental Health Institute, 3705 WE Zeist, The Netherlands
| | - Jooske T. van Busschbach
- Department of Human Movement and Education, Windesheim University of Applied Sciences, Campus 2-6, 8017 CA Zwolle, The Netherlands
- University Center of Psychiatry, University Medical Center Groningen, University of Groningen, Rob Giel Onderzoekcentrum, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
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Naumann E, Werthmann J, Vocks S, Svaldi J, Hartmann AS. Die Spiegelkonfrontationstherapie zur Behandlung von Körperbildstörungen bei Essstörungen – Evidenz, Wirkmechanismen und Vorgehensweise. PSYCHOLOGISCHE RUNDSCHAU 2022. [DOI: 10.1026/0033-3042/a000558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Zusammenfassung. Körperbildprobleme sind ein Kernmerkmal von Essstörungen. Daher gilt eine Verbesserung des Körperbildes bei der Behandlung von Essstörungen als zentrales Therapieziel. Verschiedene empirische Befunde weisen auf die Spiegelkonfrontation als wirksame Methode zur Reduktion von Körperbildstörungen hin. Ziel dieses Übersichtsartikels ist es, den aktuellen Stand der wissenschaftlichen Literatur zum Thema Spiegelkonfrontationstherapie bei Essstörungen darzulegen. Insbesondere sollen die Wirksamkeitsstudien getrennt für nicht-klinische, körperunzufriedene Gruppen mit und ohne Übergewicht sowie die verschiedenen Essstörungsgruppen systematisiert und unterschiedliche Vorgehensweisen beschrieben werden. Der Übersichtsartikel liefert Hinweise dafür, dass die Spiegelkonfrontationstherapie bei Hochrisikogruppen mit erhöhter Körperunzufriedenheit sowie bei Essstörungen zu positiven Veränderungen hinsichtlich der kognitiv-affektiven und behavioralen Komponente des Körperbildes führt. Jedoch mangelt es insgesamt an randomisiert-kontrollierten Studien, die die Wirksamkeit der Spiegelkonfrontationstherapie mit ausreichend großen Stichproben gezielt untersuchen – vor allem bei der Anorexia nervosa. Der Übersichtsartikel schließt mit einer Diskussion über mögliche Wirkmechanismen, (Kontra–)Indikationen und einem Ausblick für zukünftige Forschung ab.
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Affiliation(s)
- Eva Naumann
- Abteilung Klinische Psychologie und Psychologie, Institut für Psychologie, Eberhard Karls Universität Tübingen, Deutschland
| | - Jessica Werthmann
- Abteilung Klinische Psychologie und Psychologie, Institut für Psychologie, Albert-Ludwigs-Universität Freiburg, Deutschland
| | - Silja Vocks
- Fachgebiet Klinische Psychologie und Psychologie, Institut für Psychologie, Universität Osnabrück, Deutschland
| | - Jennifer Svaldi
- Abteilung Klinische Psychologie und Psychologie, Institut für Psychologie, Eberhard Karls Universität Tübingen, Deutschland
| | - Andrea S. Hartmann
- Fachgebiet Klinische Psychologie und Psychologie, Institut für Psychologie, Universität Osnabrück, Deutschland
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Vicarious ratings of self vs. other-directed social touch in women with and recovered from Anorexia Nervosa. Sci Rep 2022; 12:13429. [PMID: 35927454 PMCID: PMC9352775 DOI: 10.1038/s41598-022-17523-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 07/26/2022] [Indexed: 11/09/2022] Open
Abstract
Anorexia Nervosa (AN) is an eating pathology characterized by restricted eating, body image distortions and impaired socio-cognitive abilities. Altered responses to affective touch—a pleasant interoceptive stimulus hypothesised to involve activation of the C-Tactile (CT) system, may contribute to the aetiology and maintenance of this disorder. Here, we investigated whether third-party social touch vicarious ratings of different body sites at CT-optimal vs. non-CT optimal velocities differed in women with and recovered from AN (RAN) and healthy controls (HCs). Thirty-five HCs, 27 AN and 29 RAN provided pleasantness ratings for two different tasks designed to probe expectations of how touch is perceived by self (self-directed touch) vs. others (other-directed touch). Findings revealed that both clinical groups, compared to HCs, did not differ in their pleasantness ratings to touch for another but when evaluating touch for self, both clinical groups rated CT-optimal touch as less pleasant than HCs. These findings suggest that AN and RAN women demonstrate an atypical vicarious pleasantness response to affective touch involving self, but not others. Novel therapeutic approaches that help anorexics to better interpret or improve tolerance of affective tactile experiences involving the self may be an important addition to current standard treatments.
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7
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Scott GG, Pinkosova Z, Jardine E, Hand CJ. “Thinstagram”: Image content and observer body satisfaction influence the when and where of eye movements during instagram image viewing. COMPUTERS IN HUMAN BEHAVIOR 2022. [DOI: 10.1016/j.chb.2022.107464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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8
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Walker DC, Murray K. A Pilot Clinical Case Series of Functionality-Focused Mirror Exposure in Women With Clinically Elevated Body Dissatisfaction. COGNITIVE AND BEHAVIORAL PRACTICE 2022. [DOI: 10.1016/j.cbpra.2022.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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9
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Mento C, Silvestri MC, Muscatello MRA, Rizzo A, Celebre L, Cedro C, Zoccali RA, Navarra G, Bruno A. The role of body image in obese identity changes post bariatric surgery. Eat Weight Disord 2022; 27:1269-1278. [PMID: 34283409 DOI: 10.1007/s40519-021-01270-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 07/07/2021] [Indexed: 01/03/2023] Open
Abstract
PURPOSE Body image is a multidimensional construct that encompasses perceptions about body size, emotions, and cognition about physical appearance. Obese identity is related to body image in the lifetime, and according to scientific literature body image dissatisfaction among obese patient persist after bariatric surgery. The objective of this review is to examine the body image changes in patients with obesity pre-and post-bariatric surgery. METHODS We have carried out a systematic review of literature on PubMed. Initially, 169 publications have been identified, but in total, in compliance with inclusion and exclusion criteria, 15 studies have been analyzed. RESULTS According to the examined literature, body image does not change after bariatric surgery. These patients will be difficult to adapt for a new body, because there is a persistent obese view of self. Furthermore, ex-obese patients are dissatisfied with the excessive skin after bariatric surgery. Excessive body weight, and negative self-image are replaced with dissatisfaction with excessive skin, and the factors associated with body image stability are still unknown. CONCLUSION Literature examination raises the issue of body image dissatisfaction, but does not explain why it varies so widely across bariatric patients. Obese identity is related to body image across the lifetime and is an important factor of post-surgical outcomes. Longitudinal studies based on ideal body image pre- and post- bariatric surgery and evidence-based controlled studies on psychotherapeutic treatment for body image dissatisfaction are strongly recommended. Psychotherapy could improve body image quality and wellbeing. LEVEL I Evidence obtained from: systematic reviews of experimental studies.
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Affiliation(s)
- Carmela Mento
- Clinical Psychology, Psychiatric Unit, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Policlinico Hospital Messina, University of Messina, Consolare Valeria str. 1, 98125, Messina, Italy.
| | | | | | - Amelia Rizzo
- Psychiatric Unit, Policlinico Hospital Messina, University of Messina, Messina, Italy
| | - Laura Celebre
- Psychiatric Unit, Policlinico Hospital Messina, University of Messina, Messina, Italy
| | | | - Rocco Antonio Zoccali
- Psychiatric Unit, BIOMORF Department, Policlinico Hospital in Messina, University of Messina, Messina, Italy
| | - Giuseppe Navarra
- General Surgery Unit, Department of Human Pathology of Adult and Evolutive Age, University Hospital of Messina, Via Consolare Valeria 1, 98125, Messina, ME, Italy
| | - Antonio Bruno
- Psychiatric Unit, BIOMORF Department, Policlinico Hospital in Messina, University of Messina, Messina, Italy
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Klimek P, Wei B, Blashill AJ. Exploring moderators of mirror exposure on pre- to post changes in body image outcomes: Systematic review and meta-analysis. Eat Disord 2022; 30:77-98. [PMID: 33100189 DOI: 10.1080/10640266.2020.1791665] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE Mirror exposure (ME) is embedded within cognitive behavioral treatment of body image concern (BIC), and existing literature demonstrates its potential value as a BIC intervention. The purpose of the study is to provide a meta-analytic review of ME effects on attitudinal and behavioral BIC. METHODS Twelve studies met inclusion criteria, yielding six between-group and 18 within-group comparisons. RESULTS Random effects models demonstrated a medium effect of ME versus control conditions, on attitudinal BIC, from pre- to immediate posttreatment, small effect at follow-up (1 to 4 weeks posttreatment), and large effect on behavioral BIC pre- to immediate posttreatment. However, small sample sizes yielded nonsignificant findings and significant heterogeneity. Exploratory moderator analyses-ME type, ME dosage (session frequency, duration), and diagnosis-demonstrated that, among single group pre-post designs, higher ME dosage may be instrumental to pre-posttreatment improvements. Consistent with this finding, individual studies with high dosages of ME demonstrated the largest effect sizes. Conclusion: Results may suggest a strong ME effect on BIC at high dosages (>120 minutes). The current review highlights gaps in ME literature and the need for future clinical trials assessing ME, using a priori, high-quality research designs that further the understanding of ME's mechanisms of change.
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Affiliation(s)
- Patrycja Klimek
- San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, California, USA
| | - Boyu Wei
- Department of Psychology, San Diego State University, San Diego, California, USA
| | - Aaron J Blashill
- San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, California, USA.,Department of Psychology, San Diego State University, San Diego, California, USA
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La Marra M, Ilardi CR, Villano I, Polito R, Sibillo MR, Franchetti M, Caggiano A, Strangio F, Messina G, Monda V, Di Maio G, Messina A. Higher general executive functions predicts lower body mass index by mitigating avoidance behaviors. Front Endocrinol (Lausanne) 2022; 13:1048363. [PMID: 36440204 PMCID: PMC9681800 DOI: 10.3389/fendo.2022.1048363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 10/20/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The present study examines the relationship between obesity, executive functions, and body image in a nonclinical population from southern Italy. METHODS General executive functioning (Frontal Assessment Battery-15), and body image disturbances (Body Uneasiness Test) were assessed in a sample including 255 participants (138 females, M age = 43.51 years, SD = 17.94, range = 18-86 years; M body mass index (BMI) = 26.21, SD = 4.32, range = 18.03-38.79). FINDINGS Multiple Linear Regression Analysis indicated that age, years of education, FAB15 score, body image concerns, and avoidance predicted the variance of BMI. A subsequent mediation analysis highlighted that the indirect effect of FAB15 on BMI through avoidance was statistically significant. INTERPRETATION Our results suggest that more performing executive functioning predicts a decrease in BMI that is partially due to the mitigation of avoidance behaviors.
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Affiliation(s)
- Marco La Marra
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Ciro Rosario Ilardi
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
- Department of Psychology, University of Campania “Luigi Vanvitelli”, Caserta, Italy
| | - Ines Villano
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
- *Correspondence: Ines Villano,
| | - Rita Polito
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Maria Raffella Sibillo
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Marina Franchetti
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Angela Caggiano
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Francesca Strangio
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Giovanni Messina
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Vincenzo Monda
- Department of Movement Sciences and Wellbeing, University of Naples “Parthenope”, Naples, Italy
| | - Girolamo Di Maio
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Antonietta Messina
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
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12
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Rekkers M, Scheffers M, van Elburg AA, van Busschbach JT. The protocol for positive body experience (PBE); introducing a psychomotor therapy intervention based on positive body exposure targeting negative body image in eating disorders. BODY MOVEMENT AND DANCE IN PSYCHOTHERAPY 2021. [DOI: 10.1080/17432979.2020.1863261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Marlies Rekkers
- Faculty of Social Sciences, Utrecht University, Utrecht, The Netherlands
- School of Human Movement and Education, Windesheim University of Applied Sciences, Zwolle, The Netherlands
| | - Mia Scheffers
- School of Human Movement and Education, Windesheim University of Applied Sciences, Zwolle, The Netherlands
| | - Annemarie A. van Elburg
- Faculty of Social Sciences, Utrecht University, Utrecht, The Netherlands
- Centre for Eating Disorders, Altrecht Mental Health Institute, Rintveld, Zeist, The Netherlands
| | - Jooske T. van Busschbach
- School of Human Movement and Education, Windesheim University of Applied Sciences, Zwolle, The Netherlands
- Rob Giel Research Center, University of Groningen, University Medical Center Groningen, University Center of Psychiatry, Groningen, The Netherlands
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Body exposure, its forms of delivery and potentially associated working mechanisms: How to move the field forward. CLINICAL PSYCHOLOGY IN EUROPE 2021; 3:e3813. [DOI: 10.32872/cpe.3813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 05/18/2021] [Indexed: 11/25/2022] Open
Abstract
Background
Body image disturbance (BID) is a hallmark feature of eating disorders (EDs) and has proven to be involved in their etiology and maintenance. Therefore, the targeting of BID in treatment is crucial, and has been incorporated in various treatment manuals. One of the most common techniques in the treatment of BID is body exposure (BE), the confrontation with one’s own body. BE has been found to be effective in individuals with EDs or high body dissatisfaction. However, BE is applied in a multitude of ways, most of which are based on one or a combination of the hypothesized underlying working mechanisms, with no differential effectiveness known so far.
Method
The aim of this paper is to selectively review the main hypothesized working mechanisms of BE and their translation into therapeutic approaches.
Results and Conclusion
Specifically, we underline that studies are needed to pinpoint the proposed mechanisms and to develop an empirically informed theoretical model of BE. We provide a framework for future studies in order to identify working mechanisms and increase effectiveness of BE.
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Visual perception and dissociation during Mirror Gazing Test in patients with anorexia nervosa: a preliminary study. Eat Weight Disord 2021; 26:1541-1551. [PMID: 32757140 PMCID: PMC8128841 DOI: 10.1007/s40519-020-00977-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 07/28/2020] [Indexed: 10/27/2022] Open
Abstract
PURPOSE It has been widely shown that dissociative features might play a fundamental role in producing body image distortions in patients affected by eating disorders. Here, we hypothesize that the Mirror Gazing Test (MGT), a task consisting in mirror exposure in a condition of sensory deprivation, would elicit dissociative symptoms in a group of patients with anorexia nervosa (AN). METHODS Fourteen patients with AN and fourteen healthy controls (HC) underwent a 10 min MGT and completed the Strange Face Questionnaire and a short version of the Clinician-Administered Dissociative States Scale, along with a psychological assessment for eating disorders psychopathology, anxiety and depression. RESULTS AN patients reported a higher number of strange-face apparitions and dissociative sensations than HC during the MGT. Dissociative identity (compartmentalization of two or more identities) and depersonalization (detachment of bodily-self) were much higher in patients with AN than in HC. These findings were correlated with body dissatisfaction and disruption in interoceptive awareness. CONCLUSION Dissociation and body image dysfunction are strongly connected in the pathophysiology of anorexia nervosa. Future research should investigate the same aspects in other psychiatric conditions characterized by body image distortions, such as Body Dysmorphic Disorder. LEVEL OF EVIDENCE I, Experimental studies.
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AN-VR-BE. A Randomized Controlled Trial for Reducing Fear of Gaining Weight and Other Eating Disorder Symptoms in Anorexia Nervosa through Virtual Reality-Based Body Exposure. J Clin Med 2021; 10:jcm10040682. [PMID: 33578767 PMCID: PMC7916489 DOI: 10.3390/jcm10040682] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 02/03/2021] [Accepted: 02/07/2021] [Indexed: 12/18/2022] Open
Abstract
In vivo body exposure therapy is considered an effective and suitable intervention to help patients with anorexia nervosa (AN) reduce their body image disturbances (BIDs). However, these interventions have notable limitations and cannot effectively reproduce certain fears usually found in AN, such as the fear of gaining weight (FGW). The latest developments in virtual reality (VR) technology and embodiment-based procedures could overcome these limitations and allow AN patients to confront their FGW and BIDs. This study aimed to provide further evidence of the efficacy of an enhanced (by means of embodiment) VR-based body exposure therapy for the treatment of AN. Thirty-five AN patients (16 in the experimental group, 19 in the control group) participated in the study. FGW, BIDs, and other body-related and ED measures were assessed before and after the intervention and three months later. The experimental group received treatment as usual (TAU) and five additional sessions of VR-based body exposure therapy, while the control group received only TAU. After the intervention, ED symptoms were clearly reduced in both groups, with most of the changes being more noticeable in the experimental group. Specifically, after the intervention and at follow-up, significant group differences were found in the FGW and BIDs, with the experimental group showing significantly lower values than the control group. The current study provides new insights and encouraging findings in the field of exposure-based therapies in AN. VR technology might improve research and clinical practice in AN by providing new tools to help patients confront their core fears (i.e., food- or weight-related cues) and improve their emotional, cognitive, and behavioral responses to their body image.
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Exposure therapy for eating disorders: A systematic review. Clin Psychol Rev 2020; 78:101851. [DOI: 10.1016/j.cpr.2020.101851] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 03/07/2020] [Accepted: 03/10/2020] [Indexed: 12/25/2022]
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17
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How eating disordered and non-eating disordered women differ in their use (and effectiveness) of cognitive self-regulation strategies for managing negative experiences. Eat Weight Disord 2019; 24:897-904. [PMID: 29086389 DOI: 10.1007/s40519-017-0448-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 10/04/2017] [Indexed: 10/18/2022] Open
Abstract
PURPOSE The present study compared the use (and effectiveness) of cognitive self-regulation strategies in eating disordered (ED) and non-eating disordered women (non-ED), and whether ED subgroups differ in their use of avoidant/suppressive strategies and cognitive reappraisal. METHODS The participants consisted of 90 adult patients recruited from a specialist eating disorder service and 97 adults without an ED. Cognitive self-regulation strategies were examined on a baseline self-report measure and while looking in a mirror. RESULTS The results of this study showed that, relative to the non-ED group, ED participants engage in more worry and self-punishment and less distraction and social control strategies in general but not specifically during a body exposure task. Reappraisal strategies were equally likely to be used by clinical and non-clinical groups but participants with anorexia nervosa (AN) found them less effective during the task. Non-ED participants found distraction strategies more effective than the ED group for managing the body exposure experience. ED subgroups used avoidant/suppressive strategies and cognitive reappraisal strategies to a similar extent. CONCLUSION The use of maladaptive self-regulation strategies, and the use and effectiveness of some of the more adaptive self-regulation strategies sets eating disorders apart from those without an eating disorder, supporting previous research in the area. Contrary to what was predicted, the results were similar across ED subgroups. The findings highlight the importance of cognitive self-regulation strategies as a focus of research and clinical intervention. LEVEL OF EVIDENCE Level III: Case-control study.
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Baur J, Krohmer K, Tuschen-Caffier B, Svaldi J. Cognitive-Emotional Involvement During Mirror Exposure Is Not Accompanied by Physiological Activation in Binge Eating Disorder. Front Psychiatry 2019; 10:745. [PMID: 31803074 PMCID: PMC6877718 DOI: 10.3389/fpsyt.2019.00745] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 09/17/2019] [Indexed: 12/29/2022] Open
Abstract
Body image interventions have been shown to reduce self-reported cognitive-emotional facets of body image disturbance in binge eating disorder (BED). However, more objective assessment methods are required to evaluate the effects of these interventions. Therefore, the present study aimed at investigating the usefulness of vocally encoded emotional arousal as physiological correlate of body dissatisfaction during mirror exposure in women with BED. Women with BED (n = 60) and weight-matched controls (CG; n = 60) participated in an experimental thought-sampling procedure including a mirror exposure and a control condition in a repeated-measures design. Fundamental frequency as a vocal correlate of emotional arousal as well as negative, neutral, and positive body-related cognitions during both conditions were analyzed. In line with our hypotheses, the BED group verbalized more negative, and less positive and neutral body-related cognitions during the mirror exposure condition compared to the CG. Contrary to our hypotheses, though, there was a stronger increase in physiological arousal between the control and the mirror exposure condition in the CG relative to the BED group. Furthermore, a significant negative correlation between fundamental frequency and the severity of cognitive-emotional body image disturbances emerged. The findings indicate a cognitive-emotional over-involvement with physical appearance during mirror exposure in women with BED compared to weight-matched controls in the absence of a corresponding physiological pattern. Results are discussed in terms of an impaired ability of women with BED to show adequate physiological responses to body-related stress. In addition, methodological recommendations for future research are presented.
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Affiliation(s)
- Julia Baur
- Department of Clinical Psychology and Psychotherapy, University of Tuebingen, Tuebingen, Germany
| | - Kerstin Krohmer
- Department of Clinical Psychology and Psychotherapy, University of Tuebingen, Tuebingen, Germany
| | - Brunna Tuschen-Caffier
- Department of Clinical Psychology and Psychotherapy, University of Freiburg, Freiburg, Germany
| | - Jennifer Svaldi
- Department of Clinical Psychology and Psychotherapy, University of Tuebingen, Tuebingen, Germany
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Casas S, Portalés C, Vera L, Riera JV. Virtual and Augmented Reality Mirrors for Mental Health Treatment. ADVANCES IN PSYCHOLOGY, MENTAL HEALTH, AND BEHAVIORAL STUDIES 2019. [DOI: 10.4018/978-1-5225-7168-1.ch007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Virtual and Augmented Reality are technologies widely used in a variety of areas, including the medical sector. On the other hand, regular mirrors have been traditionally used as tools to aid in mental health treatment for a variety of diseases and disorders. Although it is possible to build Virtual and Augmented Reality experiences based on mirror metaphors, there are very few contributions of this kind in the medical sector. In this chapter, the great benefits that regular mirrors have brought for mental health treatment are addressed. In addition, a review on the state of the art in mirror-based Virtual and Augmented Reality applications is given, highlighting the potential benefits that these enhanced mirrors could bring for the mental health treatment.
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Mirror exposure therapy for body image disturbances and eating disorders: A review. Clin Psychol Rev 2018; 65:163-174. [DOI: 10.1016/j.cpr.2018.08.006] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 08/25/2018] [Accepted: 08/27/2018] [Indexed: 12/21/2022]
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Lewer M, Bauer A, Hartmann AS, Vocks S. Different Facets of Body Image Disturbance in Binge Eating Disorder: A Review. Nutrients 2017; 9:nu9121294. [PMID: 29182531 PMCID: PMC5748745 DOI: 10.3390/nu9121294] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Revised: 11/11/2017] [Accepted: 11/20/2017] [Indexed: 01/22/2023] Open
Abstract
The goal of the present review is to give an overview of the current findings on various facets of body image disturbance in Binge Eating Disorder such as body dissatisfaction, overconcern with weight and shape, body-related checking and avoidance behavior, misperception of body size, and body-related cognitive bias. In addition, treatments for a disturbed body image in BED and evidence of body image disturbance in youth with binge eating are reviewed. The results show that a disturbed body image in BED is present in the form of overconcern with weight and shape. Furthermore, there are hints that body dissatisfaction, as well as body-related checking and avoidance behavior, are also impaired. Research concerning misperception of body size in BED has been neglected so far, but first findings show that individuals with BED rate their own body shape rather accurately. Furthermore, there are first hints that body-related cognitive biases are present in individuals with BED. Moreover, in children and adolescents, there are first hints that body dissatisfaction, as well as shape and weight concerns, seem to be associated with loss of control and binge eating. Treatments aimed directly at the convertibility of a disturbed body image in BED have revealed encouraging outcomes. In conclusion, body image disturbance seems to occur in BED, and first studies show that it can be treated effectively.
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Affiliation(s)
- Merle Lewer
- Department of Clinical Psychology and Psychotherapy, Ruhr-Universität Bochum, Mental Health Research and Treatment Center, Massenbergstr, 9-13, D-44787 Bochum, Germany.
| | - Anika Bauer
- Department of Clinical Psychology and Psychotherapy, Universität Osnabrück, Knollstr. 52, D-49069 Osnabrück, Germany.
| | - Andrea S Hartmann
- Department of Clinical Psychology and Psychotherapy, Universität Osnabrück, Knollstr. 52, D-49069 Osnabrück, Germany.
| | - Silja Vocks
- Department of Clinical Psychology and Psychotherapy, Universität Osnabrück, Knollstr. 52, D-49069 Osnabrück, Germany.
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Díaz-Ferrer S, Rodríguez-Ruiz S, Ortega-Roldán B, Mata-Martín JL, Carmen Fernández-Santaella M. Psychophysiological Changes during Pure vs Guided Mirror Exposure Therapies in Women with High Body Dissatisfaction: What Are They Learning about Their Bodies? EUROPEAN EATING DISORDERS REVIEW 2017; 25:562-569. [PMID: 28944527 DOI: 10.1002/erv.2546] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 08/05/2017] [Accepted: 08/14/2017] [Indexed: 11/11/2022]
Abstract
This study aimed to examine the psychophysiological changes resulting from two mirror exposure treatments that are effective at reducing body dissatisfaction. Thirty-five university women with body dissatisfaction and subclinical eating disorders were randomly assigned to one of two groups: pure (n = 17) or guided exposure (n = 18). The participants received six sessions of treatment. Their thoughts, feelings and avoidance behaviours were assessed after each session. Their subjective discomfort, heart rate and skin conductance were assessed within the sessions. Both groups showed improvement in cognitive-affective and avoidance behaviour symptoms. Nevertheless, the pure exposure group showed faster habituation of subjective discomfort and a greater physiological response than the guided exposure group. These findings suggest that both procedures are effective interventions for improving body image disturbances, although psychophysiological changes observed within session suggest that each technique would act through different processes. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.
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Affiliation(s)
- Sandra Díaz-Ferrer
- Department of Personality, Assessment and Psychological Treatment, Faculty of Psychology, University of Granada, Spain
| | - Sonia Rodríguez-Ruiz
- Department of Personality, Assessment and Psychological Treatment, Faculty of Psychology, University of Granada, Spain
| | - Blanca Ortega-Roldán
- Department of Personality, Assessment and Psychological Treatment, Faculty of Psychology, University of Granada, Spain
| | - José Luis Mata-Martín
- Department of Personality, Assessment and Psychological Treatment, Faculty of Psychology, University of Granada, Spain
| | - M Carmen Fernández-Santaella
- Department of Personality, Assessment and Psychological Treatment, Faculty of Psychology, University of Granada, Spain
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23
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Erratum zu: Diagnostik der Körperbildstörung. PSYCHOTHERAPEUT 2017. [DOI: 10.1007/s00278-017-0231-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Yiu A, Murray SM, Arlt JM, Eneva KT, Chen EY. The importance of body image concerns in overweight and normal weight individuals with binge eating disorder. Body Image 2017; 22:6-12. [PMID: 28535446 DOI: 10.1016/j.bodyim.2017.04.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 04/11/2017] [Accepted: 04/27/2017] [Indexed: 11/19/2022]
Abstract
Body image concerns in binge eating disorder (BED) have been examined almost exclusively in overweight individuals with BED. The current study extends past research by including overweight and normal weight BED and non-BED groups to assess the multifactorial construct of body image using subscales of the Eating Disorder Examination 16.0 (EDE-16.0) and a Body Comparison Task. Independent of weight status and when controlling for age and race, women with BED are distinguished from those without BED by significantly greater overvaluation of shape and weight on the EDE-16.0 and significantly reduced weight satisfaction after a Body Comparison Task. Both BED diagnosis and weight status were independently associated with Weight Concern and Shape Concern subscales on the EDE-16.0. Taken together, these data provide further support for the consideration of body image concerns in the diagnostic criteria for BED.
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Affiliation(s)
- Angelina Yiu
- Temple Eating Disorders Program, Department of Psychology, Temple University, 1701 North 13th Street, Philadelphia, PA 19122, USA
| | - Susan M Murray
- Temple Eating Disorders Program, Department of Psychology, Temple University, 1701 North 13th Street, Philadelphia, PA 19122, USA
| | - Jean M Arlt
- Temple Eating Disorders Program, Department of Psychology, Temple University, 1701 North 13th Street, Philadelphia, PA 19122, USA
| | - Kalina T Eneva
- Temple Eating Disorders Program, Department of Psychology, Temple University, 1701 North 13th Street, Philadelphia, PA 19122, USA
| | - Eunice Y Chen
- Temple Eating Disorders Program, Department of Psychology, Temple University, 1701 North 13th Street, Philadelphia, PA 19122, USA.
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Steinfeld B, Bauer A, Waldorf M, Hartmann AS, Vocks S. Diagnostik der Körperbildstörung. PSYCHOTHERAPEUT 2017. [DOI: 10.1007/s00278-017-0188-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Lewer M, Kosfelder J, Michalak J, Schroeder D, Nasrawi N, Vocks S. Effects of a cognitive-behavioral exposure-based body image therapy for overweight females with binge eating disorder: a pilot study. J Eat Disord 2017; 5:43. [PMID: 29296280 PMCID: PMC5738809 DOI: 10.1186/s40337-017-0174-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 09/15/2017] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Although not part of the diagnostic criteria of the DSM-5, body image disturbance seems to be a relevant feature of Binge Eating Disorder (BED) as well as of other eating disorders such as Anorexia Nervosa (AN) or Bulimia Nervosa (BN). Hence, the aim of the present pilot study was to assess the changeability of body image disturbance in a sample of overweight females with BED by a cognitive-behavioral treatment, directly addressing body image disturbance. METHOD Overweight females (N = 34) with BED were randomized to a manualized body image therapy or a waiting-list control group. The final sample consisted of n = 15 participants in the intervention group and n = 19 in the control group due to two drop-outs in the control condition. Before and after the intervention or the waiting period, respectively, participants filled out a questionnaire battery assessing several body image and eating disorder related features. To quantify the perceptual component of body image disturbance, a digital photo distortion technique based on a picture of each participant taken in a standardized suit was applied. RESULTS In a two-way ANOVA, significant Time × Group interactions were found for eating and shape concerns, drive for thinness, body dissatisfaction, depressiveness and low self-esteem. Follow-up t-tests indicated a significant symptom reduction of a generally high magnitude in the intervention group. No significant changes concerning body checking and the estimations of one's own "real", "felt" and "ideal" body dimensions were found. CONCLUSION The strong symptom reduction in the cognitive-affective component of body image disturbance indicates that an exposure-based cognitive-behavioral body image intervention is a promising treatment module for overweight females with BED, but future research with a larger sample size is needed to quantify possible changes in all components of body image.
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Affiliation(s)
- Merle Lewer
- Department of Clinical Psychology and Psychotherapy, Ruhr-Universität Bochum, Bochum, Germany
| | - Joachim Kosfelder
- Department of Social and Cultural Sciences, University of Applied Sciences, Duesseldorf, Germany
| | - Johannes Michalak
- Department of Psychology and Psychotherapy, Witten/Herdecke University, Witten, Germany
| | - Dorothea Schroeder
- Department of Clinical Psychology and Psychotherapy, Ruhr-Universität Bochum, Bochum, Germany
| | - Nadia Nasrawi
- Department of Clinical Psychology and Psychotherapy, Ruhr-Universität Bochum, Bochum, Germany
| | - Silja Vocks
- Department of Clinical Psychology and Psychotherapy, Osnabrueck University, Knollstrasse 15, D-49069 Onabrück, Germany
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Trentowska M, Svaldi J, Blechert J, Tuschen-Caffier B. Does habituation really happen? Investigation of psycho-biological responses to body exposure in bulimia nervosa. Behav Res Ther 2016; 90:111-122. [PMID: 28027485 DOI: 10.1016/j.brat.2016.12.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 10/24/2016] [Accepted: 12/12/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Body exposure is a common and effective treatment for body image disturbance in bulimia nervosa (BN). However, little is known about treatment mechanisms. Based on models of emotional processing and neurovisceral integration, we expected to observe a) initial activation and b) habituation of cognitive-affective and autonomic responding within one and between two standardized body exposure sessions. METHODS A group of 13 women with BN and 13 healthy controls (HC) were repeatedly exposed to their bodies. Prior to and after treatment with three individualized mirror exposure sessions participants received a session of standardized exposure to videographic recordings of their body. Subjective ratings of body-related emotions and thoughts were assessed repeatedly throughout the standardized exposure sessions and autonomic responses were recorded continuously. RESULTS Subjective and sympathetic responses were activated initially in both groups. Cognitive-affective responses habituated within the standardized sessions in both groups, whereas between the standardized sessions habituation was only found in women with BN. Increasing sympathetic responses were found within the sessions in both groups. CONCLUSIONS The results support cognitive-affective habituation during body exposure in BN and to a lesser extent in HC. Autonomic responses however did not show a corresponding pattern and did not distinguish between groups. Implications for body exposure research and practice are discussed.
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Affiliation(s)
- Monika Trentowska
- Department of Clinical Psychology and Psychotherapy, Albert-Ludwigs-University Freiburg, Germany
| | - Jennifer Svaldi
- Department of Clinical Psychology and Psychotherapy, Eberhard Karls University Tübingen, Germany.
| | - Jens Blechert
- Department for Psychology & Centre for Cognitive Neuroscience, University of Salzburg, Austria
| | - Brunna Tuschen-Caffier
- Department of Clinical Psychology and Psychotherapy, Albert-Ludwigs-University Freiburg, Germany
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28
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Glashouwer KA, Jonker NC, Thomassen K, de Jong PJ. Take a look at the bright side: Effects of positive body exposure on selective visual attention in women with high body dissatisfaction. Behav Res Ther 2016; 83:19-25. [PMID: 27236075 DOI: 10.1016/j.brat.2016.05.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 03/18/2016] [Accepted: 05/17/2016] [Indexed: 10/21/2022]
Abstract
Women with high body dissatisfaction look less at their 'beautiful' body parts than their 'ugly' body parts. This study tested the robustness of this selective viewing pattern and examined the influence of positive body exposure on body-dissatisfied women's attention for 'ugly' and 'beautiful' body parts. In women with high body dissatisfaction (N = 28) and women with low body dissatisfaction (N = 14) eye-tracking was used to assess visual attention towards pictures of their own and other women's bodies. Participants with high body dissatisfaction were randomly assigned to 5 weeks positive body exposure (n = 15) or a no-treatment condition (n = 13). Attention bias was assessed again after 5 weeks. Body-dissatisfied women looked longer at 'ugly' than 'beautiful' body parts of themselves and others, while participants with low body dissatisfaction attended equally long to own/others' 'beautiful' and 'ugly' body parts. Although positive body exposure was very effective in improving participants' body satisfaction, it did not systematically change participants' viewing pattern. The tendency to preferentially allocate attention towards one's 'ugly' body parts seems a robust phenomenon in women with body dissatisfaction. Yet, modifying this selective viewing pattern seems not a prerequisite for successfully improving body satisfaction via positive body exposure.
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Affiliation(s)
- Klaske A Glashouwer
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, The Netherlands; Center for Eating Disorders, Accare, Child and Adolescent Psychiatry, The Netherlands.
| | - Nienke C Jonker
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, The Netherlands
| | - Karen Thomassen
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, The Netherlands
| | - Peter J de Jong
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, The Netherlands
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Jansen A, Voorwinde V, Hoebink Y, Rekkers M, Martijn C, Mulkens S. Mirror exposure to increase body satisfaction: Should we guide the focus of attention towards positively or negatively evaluated body parts? J Behav Ther Exp Psychiatry 2016; 50:90-6. [PMID: 26117584 DOI: 10.1016/j.jbtep.2015.06.002] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Revised: 06/09/2015] [Accepted: 06/13/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND OBJECTIVES Though there is some evidence that body exposure increases body satisfaction, it is still unclear why exposure works and how attention should be guided during exposure. This pilot study manipulates the focus of attention during body exposure. METHODS Female participants high in body dissatisfaction were randomly assigned to an exposure intervention that exclusively focused on self-defined attractive (n = 11) or self-defined unattractive (n = 11) body parts. Both interventions consisted of five exposure sessions and homework. Outcome and process of change were studied. RESULTS Both types of exposure were equally effective and led to significant improvements in body satisfaction, body checking, body concerns, body avoidance and mood at post-test. Improvements for body satisfaction and mood were maintained at follow-up while body shape concerns and body checking still improved between post-test and follow-up. Body avoidance improvements were maintained for the positive exposure while the negative exposure tended to further decrease long-term body avoidance at follow-up.. The 'positive' exposure induced positive feelings during all exposure sessions while the 'negative' exposure initially induced a worsening of feelings but feelings started to improve after some sessions. The most unattractive body part was rated increasingly attractive in both conditions though this increase was significantly larger in the negative compared to the positive exposure condition. LIMITATIONS The sample size was small and non-clinical. CONCLUSIONS Both types of exposure might be effective and clinically useful. Negative exposure is emotionally hard but might be significantly more effective in increasing the perceived attractiveness of loathed body parts and in decreasing avoidance behavior.
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Affiliation(s)
- Anita Jansen
- Clinical Psychological Science, Maastricht University, The Netherlands.
| | - Vera Voorwinde
- Health & Social Psychology Master, Maastricht University, The Netherlands
| | - Yvette Hoebink
- Health & Social Psychology Master, Maastricht University, The Netherlands
| | | | - Carolien Martijn
- Clinical Psychological Science, Maastricht University, The Netherlands
| | - Sandra Mulkens
- Clinical Psychological Science, Maastricht University, The Netherlands; Virenze Riagg Maastricht, The Netherlands
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Annunziato RA, Grossman SL. Integrating intervention targets offered by homeostatic theory. Health Psychol Open 2016; 3:2055102916634361. [PMID: 28070390 PMCID: PMC5193279 DOI: 10.1177/2055102916634361] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Marks presents "homeostatic theory" which proposes that weight gain is fostered by a "Circle of Discontent" consisting of body dissatisfaction, negative affect, and overconsumption. This innovative framework offers potential intervention approaches, including victim-blaming, stigma, and discrimination, as well as devalorizing the thin-ideal. Our article discusses possible ways that clinical health psychologists based in university settings may be uniquely positioned to consider and implement large-scale programs that have shown great promise for addressing these core issues.
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Tuschen-Caffier B, Bender C, Caffier D, Klenner K, Braks K, Svaldi J. Selective Visual Attention during Mirror Exposure in Anorexia and Bulimia Nervosa. PLoS One 2015; 10:e0145886. [PMID: 26714279 PMCID: PMC4700997 DOI: 10.1371/journal.pone.0145886] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 12/09/2015] [Indexed: 02/07/2023] Open
Abstract
Objective Cognitive theories suggest that body dissatisfaction results from the activation of maladaptive appearance schemata, which guide mental processes such as selective attention to shape and weight-related information. In line with this, the present study hypothesized that patients with anorexia nervosa (AN) and bulimia nervosa (BN) are characterized by increased visual attention for the most dissatisfying/ugly body part compared to their most satisfying/beautiful body part, while a more balanced viewing pattern was expected for controls without eating disorders (CG). Method Eye movements were recorded in a group of patients with AN (n = 16), BN (n = 16) and a CG (n = 16) in an ecologically valid setting, i.e., during a 3-min mirror exposure. Results Evidence was found that patients with AN and BN display longer and more frequent gazes towards the most dissatisfying relative to the most satisfying and towards their most ugly compared to their most beautiful body parts, whereas the CG showed a more balanced gaze pattern. Discussion The results converge with theoretical models that emphasize the role of information processing in the maintenance of body dissatisfaction. Given the etiological importance of body dissatisfaction in the development of eating disorders, future studies should focus on the modification of the reported patterns.
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Affiliation(s)
| | - Caroline Bender
- Department of Psychology, University of Freiburg, Freiburg, Germany
| | - Detlef Caffier
- Department of Psychology, University of Freiburg, Freiburg, Germany
| | | | | | - Jennifer Svaldi
- Department of Psychology, University of Tübingen, Tübingen, Germany
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Warschburger P, Calvano C, Richter EM, Engbert R. Analysis of Attentional Bias towards Attractive and Unattractive Body Regions among Overweight Males and Females: An Eye-Movement Study. PLoS One 2015; 10:e0140813. [PMID: 26479500 PMCID: PMC4610678 DOI: 10.1371/journal.pone.0140813] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2015] [Accepted: 09/29/2015] [Indexed: 11/18/2022] Open
Abstract
Background Body image distortion is highly prevalent among overweight individuals. Whilst there is evidence that body-dissatisfied women and those suffering from disordered eating show a negative attentional bias towards their own unattractive body parts and others’ attractive body parts, little is known about visual attention patterns in the area of obesity and with respect to males. Since eating disorders and obesity share common features in terms of distorted body image and body dissatisfaction, the aim of this study was to examine whether overweight men and women show a similar attentional bias. Methods/Design We analyzed eye movements in 30 overweight individuals (18 females) and 28 normal-weight individuals (16 females) with respect to the participants’ own pictures as well as gender- and BMI-matched control pictures (front and back view). Additionally, we assessed body image and disordered eating using validated questionnaires. Discussion The overweight sample rated their own body as less attractive and showed a more disturbed body image. Contrary to our assumptions, they focused significantly longer on attractive compared to unattractive regions of both their own and the control body. For one’s own body, this was more pronounced for women. A higher weight status and more frequent body checking predicted attentional bias towards attractive body parts. We found that overweight adults exhibit an unexpected and stable pattern of selective attention, with a distinctive focus on their own attractive body regions despite higher levels of body dissatisfaction. This positive attentional bias may either be an indicator of a more pronounced pattern of attentional avoidance or a self-enhancing strategy. Further research is warranted to clarify these results.
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Affiliation(s)
- Petra Warschburger
- Department of Psychology, Division of Counseling Psychology, University of Potsdam, Potsdam, Germany
- * E-mail:
| | - Claudia Calvano
- Department of Psychology, Division of Counseling Psychology, University of Potsdam, Potsdam, Germany
| | - Eike M. Richter
- Department of Psychology, Division of Experimental and Biological Psychology, University of Potsdam, Potsdam, Germany
| | - Ralf Engbert
- Department of Psychology, Division of Experimental and Biological Psychology, University of Potsdam, Potsdam, Germany
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Díaz-Ferrer S, Rodríguez-Ruiz S, Ortega-Roldán B, Moreno-Domínguez S, Fernández-Santaella MC. Testing the efficacy of pure versus guided mirror exposure in women with bulimia nervosa: A combination of neuroendocrine and psychological indices. J Behav Ther Exp Psychiatry 2015; 48:1-8. [PMID: 25665513 DOI: 10.1016/j.jbtep.2015.01.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Revised: 12/01/2014] [Accepted: 01/14/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND OBJECTIVES Body exposure improves body image problems in women with eating disorders. However it has almost always been combined with other interventions. Thus, the efficacy of body exposure alone (i.e., pure exposure) remains largely unclear. We aimed to compare the efficacy of two body exposure techniques through psychological and neuroendocrine indices recorded within and between successive sessions. METHOD Twenty-nine women with high body dissatisfaction and diagnosis of bulimia nervosa were randomly assigned to one of two treatment groups: Pure Exposure (n = 14) or Guided Exposure (n = 15). Participants received 6 exposure sessions. After each session, changes in thoughts (positive/negative) and body satisfaction were assessed. Also, we assessed the body discomfort experienced by participants within and between sessions. Finally, the changes in salivary cortisol levels within and between the initial and final treatment sessions were measured. RESULTS Both groups showed a reduction in negative thoughts and a progressive increase in positive thoughts throughout the treatment. However, the increase in body satisfaction and the reduction in subjective discomfort within the sessions were greater in the pure exposure group. The cortisol levels during the initial and final treatment sessions decreased in both groups. LIMITATIONS Methodological limitations are reported. CONCLUSIONS These results suggest that pure and guided exposures are effective interventions for improving thoughts and neuroendocrine responses, although pure exposure increased more body satisfaction feelings in bulimic women. Subjective discomfort also showed different patterns of change within and along sessions for each treatment. Reasons for these results are discussed.
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Affiliation(s)
- Sandra Díaz-Ferrer
- Department of Personality, Assessment and Psychological Treatment, Faculty of Psychology, Campus la Cartuja s/n, 18071, University of Granada, Granada, Spain.
| | - Sonia Rodríguez-Ruiz
- Department of Personality, Assessment and Psychological Treatment, Faculty of Psychology, Campus la Cartuja s/n, 18071, University of Granada, Granada, Spain.
| | - Blanca Ortega-Roldán
- Department of Personality, Assessment and Psychological Treatment, Faculty of Psychology, Campus la Cartuja s/n, 18071, University of Granada, Granada, Spain.
| | - Silvia Moreno-Domínguez
- Department of Psychology, Faculty of Humanities and Educational Sciences, Campus las Lagunillas, s/n 2307, University of Jaén, Jaén, Spain.
| | - M Carmen Fernández-Santaella
- Department of Personality, Assessment and Psychological Treatment, Faculty of Psychology, Campus la Cartuja s/n, 18071, University of Granada, Granada, Spain.
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Kraus N, Lindenberg J, Zeeck A, Kosfelder J, Vocks S. Immediate Effects of Body Checking Behaviour on Negative and Positive Emotions in Women with Eating Disorders: An Ecological Momentary Assessment Approach. EUROPEAN EATING DISORDERS REVIEW 2015; 23:399-407. [DOI: 10.1002/erv.2380] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Revised: 04/24/2015] [Accepted: 05/24/2015] [Indexed: 11/05/2022]
Affiliation(s)
- Nicole Kraus
- Department of Clinical Psychology and Psychotherapy; University of Osnabrück; Germany
| | - Julia Lindenberg
- Department of Psychiatry and Psychotherapy; University Medical Center Freiburg; Germany
| | - Almut Zeeck
- Department of Psychiatry and Psychotherapy; University Medical Center Freiburg; Germany
| | - Joachim Kosfelder
- Department of Social and Cultural Sciences; University of Applied Sciences Düsseldorf; Germany
| | - Silja Vocks
- Department of Clinical Psychology and Psychotherapy; University of Osnabrück; Germany
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Vossbeck-Elsebusch AN, Waldorf M, Legenbauer T, Bauer A, Cordes M, Vocks S. Overestimation of body size in eating disorders and its association to body-related avoidance behavior. Eat Weight Disord 2015; 20:173-8. [PMID: 25138433 DOI: 10.1007/s40519-014-0144-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 07/18/2014] [Indexed: 10/24/2022] Open
Abstract
Body-related avoidance behavior, e.g., not looking in the mirror, is a common feature of eating disorders. It is assumed that it leads to insufficient feedback concerning one's own real body form and might thus contribute to distorted mental representation of one's own body. However, this assumption still lacks empirical foundation. Therefore, the aim of the present study was to examine the relationship between misperception of one's own body and body-related avoidance behavior in N = 78 female patients with Bulimia nervosa and eating disorder not otherwise specified. Body-size misperception was assessed using a digital photo distortion technique based on an individual picture of each participant which was taken in a standardized suit. In a regression analysis with body-related avoidance behavior, body mass index and weight and shape concerns as predictors, only body-related avoidance behavior significantly contributed to the explanation of body-size overestimation. This result supports the theoretical assumption that body-related avoidance behavior makes body-size overestimation more likely.
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36
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Boswell JF, Anderson LM, Anderson DA. Integration of interoceptive exposure in eating disorder treatment. ACTA ACUST UNITED AC 2015. [DOI: 10.1111/cpsp.12103] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
Feelings of body dissatisfaction are common in Western society, especially in women and girls. More than innocent discontent, body dissatisfaction can have serious consequences such as depression and eating disorders. The current article discusses the nature of body dissatisfaction, how it develops and how it is currently being treated. We also discuss novel strategies to increase body satisfaction that work on the automatic system (e.g., by retraining attentional and conditioning processes), since recent research suggests that appearance-related information is processed automatically. We suggest that extant methods should be combined with these novel strategies, in order to optimally improve body dissatisfaction and to prevent its detrimental consequences.
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Affiliation(s)
- Carolien Martijn
- Department of Clinical Psychological Science, Maastricht University, The Netherlands
| | - Jessica M. Alleva
- Department of Clinical Psychological Science, Maastricht University, The Netherlands
| | - Anita Jansen
- Department of Clinical Psychological Science, Maastricht University, The Netherlands
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38
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An examination of body tracing among women with high body dissatisfaction. Body Image 2014; 11:346-9. [PMID: 24973477 DOI: 10.1016/j.bodyim.2014.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Revised: 05/09/2014] [Accepted: 05/21/2014] [Indexed: 11/24/2022]
Abstract
Within eating disorder treatment programs, a body tracing activity is often used to address body dissatisfaction and overestimation of body size; however, the effects of this activity have never been empirically evaluated. This research examined the effects of body tracing on body dissatisfaction and mood among 56 female participants assigned to either a body tracing or control group. Scores were collected on trait body dissatisfaction and a series of Visual Analogue Scales (VAS). Results showed that trait body dissatisfaction moderated the relationship between group and levels of state appearance dissatisfaction and anxiety. These results suggest that individuals experiencing higher levels of trait body dissatisfaction demonstrated greater state body dissatisfaction following participation in the body tracing activity. Individuals with lower trait body dissatisfaction experienced greater anxiety after drawing a human body. These findings have potential implications for the use of this strategy in the treatment of eating disorder patients.
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Caglar-Nazali HP, Corfield F, Cardi V, Ambwani S, Leppanen J, Olabintan O, Deriziotis S, Hadjimichalis A, Scognamiglio P, Eshkevari E, Micali N, Treasure J. A systematic review and meta-analysis of ‘Systems for Social Processes’ in eating disorders. Neurosci Biobehav Rev 2014; 42:55-92. [PMID: 24333650 DOI: 10.1016/j.neubiorev.2013.12.002] [Citation(s) in RCA: 190] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Revised: 11/08/2013] [Accepted: 12/02/2013] [Indexed: 11/28/2022]
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40
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Trentowska M, Svaldi J, Tuschen-Caffier B. Efficacy of body exposure as treatment component for patients with eating disorders. J Behav Ther Exp Psychiatry 2014; 45:178-85. [PMID: 24172146 DOI: 10.1016/j.jbtep.2013.09.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Revised: 09/11/2013] [Accepted: 09/18/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND OBJECTIVES Body exposure and cognitive restructuring are well known interventions in cognitive-behavioral therapies for patients with eating disorders. Though promising, little is known about the impact of body exposure on body dissatisfaction, overvaluation of weight and shape and other aspects of eating disorder psychopathology. Thus, the aim of the two studies presented here is to evaluate the efficacy of mirror exposure and video exposure on body dissatisfaction, weight and shape concerns and other aspects of eating disorder psychopathology. METHOD STUDY 1: Fourteen women diagnosed with Eating Disorders Not Otherwise Specified (EDNOS; DSM-IV-TR) were treated in repeated mirror exposure sessions. Assessments were carried out before (baseline) and after body exposure. RESULTS STUDY 1 Measures of body dissatisfaction, shape concerns and eating disorder psychopathology were significantly improved at the post treatment assessment. METHOD STUDY 2: Thirteen women with Bulimia Nervosa (BN; DSM-IV-TR) received repeated mirror and video exposure sessions. Measures were assessed before (baseline) and after body exposure. RESULTS STUDY 2: Body image dissatisfaction was significantly improved at post treatment assessment. LIMITATIONS These preliminary results are based on subjective data from two small clinical samples. Comparisons between the studies are limited by design variations. CONCLUSIONS The studies provide evidence that body exposure is a promising technique for treatment of body dissatisfaction in EDNOS and BN. Moreover, in EDNOS shape concern and aspects of eating disorder psychopathology were improved after body exposure. Reasons for the lack of change in shape and weight concern as well as in eating disorder psychopathology in BN are discussed.
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Affiliation(s)
- Monika Trentowska
- Department of Clinical Psychology and Psychotherapy, Albert-Ludwigs-University, Freiburg, Germany.
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41
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Probst M, Majeweski M, Albertsen M, Catalan-Matamoros D, Danielsen M, De Herdt A, Duskova Zakova H, Fabricius S, Joern C, Kjölstad G, Patovirta M, Philip-Rafferty S, Tyyskä E, Vancampfort D. Physiotherapy for patients with anorexia nervosa. ACTA ACUST UNITED AC 2013. [DOI: 10.1080/21662630.2013.798562] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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42
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Get your own mirror. Investigating how strict eating disordered women are in judging the bodies of other eating disordered women. Appetite 2013; 68:98-104. [DOI: 10.1016/j.appet.2013.04.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Revised: 03/21/2013] [Accepted: 04/17/2013] [Indexed: 11/18/2022]
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43
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Megalakaki O, Mouveaux M, Hubin-Gayte M, Wypych L. Body image and cognitive restraint are risk factors for obesity in French adolescents. Eat Weight Disord 2013; 18:289-95. [PMID: 23807773 DOI: 10.1007/s40519-013-0027-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Accepted: 11/20/2012] [Indexed: 11/28/2022] Open
Abstract
The present study explored the links between cognitive restraint and body image in obese adolescents when compared with normal-weight adolescents according to sex. Body image was measured on the Body Esteem Scale and cognitive restraint by means of the Three-Factor Eating Questionnaire Revised 18-item version (TFEQ-R18). Although the results did not reveal any significant correlation between overall scores on these two measures, subscale scores showed that the obese adolescents used cognitive restraint more than the normal-weight adolescents did as a strategy for regulating their diet and were less satisfied with their body image. The normal-weight adolescents' use of cognitive restraint was correlated with body-weight dissatisfaction. Despite these differences, the two populations shared several characteristics. All the adolescents were dissatisfied with the way they thought that others saw them. The loss of control was one of their major concerns, although in the obese adolescents, it went hand in hand with major emotional investment. The results suggest that these are the variables responsible for adolescents' eating habits, regardless of their weight. The most discriminating variable when crossed with weight was sex, with girls being less satisfied with their body image, especially when they were obese.
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Affiliation(s)
- Olga Megalakaki
- Université de Picardie, UFR Sciences Humaines, sociales et philosophie, Chemin du Thil, 80025, Amiens Cedex 1, France,
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Naumann E, Trentowska M, Svaldi J. Increased salivation to mirror exposure in women with binge eating disorder. Appetite 2013; 65:103-10. [DOI: 10.1016/j.appet.2013.01.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Revised: 12/12/2012] [Accepted: 01/21/2013] [Indexed: 12/25/2022]
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45
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46
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Herbert C, Kübler A, Vögele C. Risk for eating disorders modulates startle-responses to body words. PLoS One 2013; 8:e53667. [PMID: 23341969 PMCID: PMC3547051 DOI: 10.1371/journal.pone.0053667] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2012] [Accepted: 12/03/2012] [Indexed: 12/17/2022] Open
Abstract
Body image disturbances are core symptoms of eating disorders (EDs). Recent evidence suggests that changes in body image may occur prior to ED onset and are not restricted to in-vivo exposure (e.g. mirror image), but also evident during presentation of abstract cues such as body shape and weight-related words. In the present study startle modulation, heart rate and subjective evaluations were examined during reading of body words and neutral words in 41 student female volunteers screened for risk of EDs. The aim was to determine if responses to body words are attributable to a general negativity bias regardless of ED risk or if activated, ED relevant negative body schemas facilitate priming of defensive responses. Heart rate and word ratings differed between body words and neutral words in the whole female sample, supporting a general processing bias for body weight and shape-related concepts in young women regardless of ED risk. Startle modulation was specifically related to eating disorder symptoms, as was indicated by significant positive correlations with self-reported body dissatisfaction. These results emphasize the relevance of examining body schema representations as a function of ED risk across different levels of responding. Peripheral-physiological measures such as the startle reflex could possibly be used as predictors of females' risk for developing EDs in the future.
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Affiliation(s)
- Cornelia Herbert
- Department of Psychology I, University of Würzburg, Würzburg, Germany.
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47
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Mirror exposure in women with bulimic symptoms: How do thoughts and emotions change in body image treatment? Behav Res Ther 2013; 51:1-6. [DOI: 10.1016/j.brat.2012.03.012] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2011] [Revised: 03/14/2012] [Accepted: 03/19/2012] [Indexed: 11/20/2022]
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48
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Adjunctive mirror exposure for eating disorders: A randomized controlled pilot study. Behav Res Ther 2012; 50:797-804. [DOI: 10.1016/j.brat.2012.09.004] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Revised: 09/03/2012] [Accepted: 09/15/2012] [Indexed: 11/20/2022]
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49
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Évolution du traitement attentionnel de l’information émotionnelle de joueurs pathologiques anxieux et non anxieux : une étude préliminaire. PSYCHOLOGIE FRANCAISE 2012. [DOI: 10.1016/j.psfr.2011.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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50
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Moreno-Domínguez S, Rodríguez-Ruiz S, Fernández-Santaella MC, Jansen A, Tuschen-Caffier B. Pure versus guided mirror exposure to reduce body dissatisfaction: a preliminary study with university women. Body Image 2012; 9:285-8. [PMID: 22244836 DOI: 10.1016/j.bodyim.2011.12.001] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2011] [Revised: 12/04/2011] [Accepted: 12/05/2011] [Indexed: 10/14/2022]
Abstract
While effectiveness of mirror exposure to reduce body dissatisfaction has been demonstrated, the exposure was almost always combined with other interventions. The aim of the study was to evaluate the effectiveness of a pure mirror exposure intervention compared with a guided mirror exposure (participants are guided to describe their body shape in a non-evaluative manner) and an imagery exposure intervention (participants are guided to describe their body through mental representation). Thirty-one women with high body dissatisfaction received five sessions of treatment under one of the three conditions. All interventions reduced body dissatisfaction, but only the mirror exposures successfully reduced the frequency of negative thoughts and feelings of ugliness. Pure mirror exposure was more effective than guided exposure for reducing body discomfort within and between sessions. Pure mirror exposure, based on the traditional extinction paradigm, led to strong emotional activation followed by a fast decrease in emotional reactivity.
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Affiliation(s)
- Silvia Moreno-Domínguez
- Dept. of Psychology, Faculty of Humanities and Educational Sciences, Campus Las Lagunillas, University of Jaén, 23071 Jaén, Spain.
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