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Patel TA, Zech JM, Cougle JR. Do appearance related safety behaviors contribute to distress intolerance? A Multi-method examination. Behav Res Ther 2024; 182:104617. [PMID: 39178529 DOI: 10.1016/j.brat.2024.104617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 07/19/2024] [Accepted: 08/17/2024] [Indexed: 08/26/2024]
Abstract
Individuals elevated in distress intolerance (DI) may engage in dysfunctional behavioral strategies to cope with their distress. One behavioral strategy that may be related to DI is appearance related safety behavior (ARSB; i.e., maladaptive behavior that seeks to mitigate the feared consequences of the negative evaluation of appearance). We examined the relationship between DI and ARSBs in two separate samples of women. In Study 1 (N = 91), we found in an unselected sample that ARSBs were robustly associated with DI cross-sectionally while accounting for symptoms of depression and body dysmorphia. Further, greater ARSBs predicted increases in DI longitudinally. In Study 2, among a clinical sample of women with elevated appearance concerns (N = 94), we examined the experimental effect of reducing ARSBs compared to a self-monitoring control. Relative to control, instructions to reduce ARSBs led to lower DI, but this effect was only found for individuals low in baseline DI. Overall, we found preliminary evidence that ARSBs may be a salient factor in contributing to and maintaining DI; and SB fading may be a helpful strategy for reducing DI. We discuss these findings in the context of existing literature and provide directions for future research.
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Huguenin FM, de Almeida VAR, Rodrigues MVF, Ferreira MEC, Morgado FFDR. Body image of university students: a systematic review of the characteristics of interventions. PSICOLOGIA-REFLEXAO E CRITICA 2024; 37:22. [PMID: 38913140 PMCID: PMC11196468 DOI: 10.1186/s41155-024-00307-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 05/31/2024] [Indexed: 06/25/2024] Open
Abstract
BACKGROUND Body image is the mental representation of the body and can be influenced by cognitive, biological, behavioral, sociocultural, and environmental factors. University students often encounter challenges related to it. OBJECTIVE This systematic review examined interventions aimed at holistically developing a positive body image within this population. METHODS The PRISMA 2020 guidelines and the PICO method were employed to identify, select, assess, and synthesize studies. The consulted databases included Scopus, Web of Science, and PsycINFO, with inclusion criteria targeting body image interventions for university students aged 18 to 39. Study quality was evaluated using the QATSDD tool. RESULTS Twenty-one relevant studies were identified, primarily from the United States, mostly employing quantitative methods, with a focus on female participants. Various intervention strategies were utilized, including cognitive-behavioral approaches, media literacy, and physical/resistance training, with a growing use of technology like mobile applications. The majority of studies reported effective outcomes, such as reduced body dissatisfaction and increased self-esteem following interventions. Nevertheless, literature gaps were identified, such as the scarcity of formative interventions and limited use of qualitative approaches. CONCLUSION While technology in interventions offers promising opportunities, careful assessments and judicious selection of evaluation instruments are fundamental for reliable results. Future research should focus on addressing identified gaps, such as exploring more formative interventions and incorporating qualitative methodologies to provide a more comprehensive understanding of the effectiveness of body image interventions among university students.
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Affiliation(s)
- Felipe Machado Huguenin
- Federal Rural University of Rio de Janeiro, BR-465 Road, Km 7, Seropédica, Rio de Janeiro, 23890-000, Brazil.
| | | | | | - Maria Elisa Caputo Ferreira
- Federal University of Juiz de Fora, José Lourenço Kelmer Street, São Pedro, Juiz de Fora, Minas Gerais, 36036-900, Brazil
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Titov N, Dear BF, Nielssen O, Barrett V, Kayrouz R, Staples LG. A pilot study examining whether restricting and resuming specific actions systematically changes symptoms of depression and anxiety. A series of N-of-1 trials. Behav Res Ther 2024; 177:104536. [PMID: 38598899 DOI: 10.1016/j.brat.2024.104536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 03/24/2024] [Accepted: 04/02/2024] [Indexed: 04/12/2024]
Abstract
Anxiety and depressive disorders are highly prevalent and a leading cause of disability. Understanding how symptoms develop could lead to new preventive and clinical interventions. This pilot study examined whether systematically restricting specific behaviours (target actions) associated with good psychological health would increase psychological symptoms in healthy participants, and whether resuming those actions would reduce symptoms to baseline levels. Twelve adults participated in a series of N-of-1 trials comprising baseline (A), restriction (B) and recovery (C) phases. Outcomes were assessed weekly using measures of depression (PHQ-9), anxiety (GAD-7), and a validated 15-item measure of target actions (Big 5). Symptoms of depression and anxiety increased significantly from Phase A to Phase B and returned to baseline by the end of Phase C. Increased symptoms during Phase B were only observed in participants who restricted actions by more than 25%. Symptom increases were evident within 2 weeks of restriction, but most participants appeared to take longer to recover to baseline levels. This study demonstrates that reducing the frequency of specific actions may increase symptoms of anxiety and depression, which is reversed when those actions are resumed. This contributes to our understanding of the aetiology, maintenance, and recovery from depression, anxiety, and possibly other disorders.
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Affiliation(s)
- Nickolai Titov
- School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Blake F Dear
- School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Olav Nielssen
- School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Victoria Barrett
- School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Rony Kayrouz
- School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Lauren G Staples
- School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia.
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Patel TA, Summers BJ, Wilver NL, Cougle JR. Reliability and Validity of the Self-Report Version of the Yale-Brown Obsessive-Compulsive Scale Modified for Body Dysmorphic Disorder. Assessment 2023; 30:1935-1946. [PMID: 36114713 DOI: 10.1177/10731911221124341] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
Despite its frequent use in research studies, the self-report version of the Yale-Brown Obsessive-Compulsive Scale modified for Body Dysmorphic Disorder (BDD-YBOCS-SR) is yet to be formally validated. The present investigation sought to examine the psychometric properties of the BDD-YBOCS-SR across three different samples. In Study 1 (N = 847), we sought to explore the factor structure of the BDD-YBOCS-SR. In addition, we evaluated the convergent and divergent validity with similar self-report measures. In Study 2 (N = 187), the convergence of the BDD-YBOCS-SR with reactivity to an in vivo appearance-related task was observed. In Study 3, we compared scores on the BDD-YBOCS-SR between a clinical sample of individuals with BDD (n = 50) and a "healthy" control sample (n = 51). We further observed the BDD-YBOCS-SR's sensitivity to treatment and convergence with the rater-administered version in the clinical sample. The BDD-YBOCS-SR demonstrated strong psychometric properties across all three studies. Scores on the BDD-YBOCS-SR were found to be strongly associated with appearance anxiety, reactivity to the appearance task, and the rater-administered BDD-YBOCS. The present investigation provides support for the BDD-YBOCS-SR's utility in measuring body dysmorphic symptom severity for use in research and clinical settings.
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Affiliation(s)
| | - Berta J Summers
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Patel TA, Wilver NL, Cougle JR. Appearance-related safety behaviors predict symptoms of body dysmorphic disorder following internet-based treatment. Body Image 2023; 46:84-90. [PMID: 37245382 DOI: 10.1016/j.bodyim.2023.05.004] [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: 01/06/2023] [Revised: 05/11/2023] [Accepted: 05/12/2023] [Indexed: 05/30/2023]
Abstract
Recent experimental evidence has found that appearance related safety behaviors (i.e., practices meant to avoid a perceived feared outcome) likely play a crucial role in maintaining symptoms of body dysmorphic disorder (BDD). The present study sought to determine if these behaviors predicted BDD symptom severity following treatment. Participants (N = 50) with BDD were randomized to either eight sessions of interpretation bias modification or progressive muscle relaxation. Both treatments led to reductions in BDD symptom severity and appearance-related safety behaviors, though moderate levels of safety behaviors persisted at both posttreatment and follow-up. Importantly, post-treatment appearance related safety behaviors significantly predicted BDD symptom severity at three-month follow-up. Taken together, the present findings suggest appearance related safety behaviors maintain BDD symptoms following effective computerized treatments and provide further evidence for their importance in the treatment of BDD.
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Affiliation(s)
- Tapan A Patel
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | | | - Jesse R Cougle
- Department of Psychology, Florida State University, Tallahassee, FL, USA.
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Spix M, Melles H, Jansen A. From Bad to Worse: Safety Behaviors Exacerbate Eating Disorder Fears. Behav Sci (Basel) 2023; 13:574. [PMID: 37504021 PMCID: PMC10376478 DOI: 10.3390/bs13070574] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 07/02/2023] [Accepted: 07/05/2023] [Indexed: 07/29/2023] Open
Abstract
When evaluating ambiguous situations, humans sometimes use their behavior as a source of information (behavior-as-information effect) and interpret safety behaviors as evidence for danger. Accordingly, we hypothesized that eating disorder safety behaviors (restrictive eating, body checking, etc.) might aggravate fear and anxiety in individuals with an eating disorder. The present study tested to what extent eating disorder safety behaviors increase threat perception in individuals with and without an eating disorder. For this, 108 individuals with a self-reported eating disorder diagnosis and 82 healthy controls rated the dangerousness of several short situations. The situations systematically varied in the presence of eating disorder safety behaviors and danger information. As expected, all participants perceived situations in which the protagonist executed an eating disorder safety behavior as more threatening than situations without a safety behavior. This 'behavior-as-information' effect was equally strong in individuals with and without an eating disorder. Additionally, safety behaviors strengthened threat perception more in safe situations than in dangerous situations. To conclude, the presence of eating disorder safety behavior can increase threat perception regardless of whether individuals have an eating disorder or not. This makes eating disorder safety behaviors a potential risk factor for the development and maintenance of eating disorder fears.
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Affiliation(s)
- Michelle Spix
- Department of Clinical Psychological Science, Maastricht University, 6229 ER Maastricht, The Netherlands
| | - Hanna Melles
- Department of Clinical Psychological Science, Maastricht University, 6229 ER Maastricht, The Netherlands
| | - Anita Jansen
- Department of Clinical Psychological Science, Maastricht University, 6229 ER Maastricht, The Netherlands
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Patel TA, Summers BJ, Cougle JR. Development of a Forced Choice Assessment of Appearance Importance: The Appearance Preference Task (APT). COGNITIVE THERAPY AND RESEARCH 2023. [DOI: 10.1007/s10608-022-10341-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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A self-report assessment of appearance-related safety behaviours: Development and psychometric properties. Behav Cogn Psychother 2022; 50:604-619. [PMID: 36062459 DOI: 10.1017/s135246582200039x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Individuals with appearance concerns may engage in maladaptive appearance-related safety behaviours aimed at checking, hiding or fixing perceived flaws in their appearance. AIMS This investigation examined the psychometric properties of a newly developed measure of appearance-related safety behaviours across three different studies. METHOD The first two studies utilized exploratory and confirmatory factor analysis, respectively, to understand the factor structure of the measure. The final version of the Appearance-Related Safety Behavior Scale (ARSB) consisted of 13 items and two subscales related to behavioural avoidance and appearance maintenance. RESULTS Number of appearance-related safety behaviours was positively associated with body dysmorphic disorder symptomology and functional impairment, as well as social anxiety and eating disorder symptoms. The measure also demonstrated convergent validity with other appearance-related measures. Scores on the ARSB also predicted performance on an appearance-related behavioural task (time spent fixing appearance prior to having a picture taken). The third study found that scores on the ARSB were higher in a body dysmorphic disorder sample compared with healthy controls. Furthermore, change in scores on the ARSB was correlated with change in body dysmorphic disorder symptoms and impairment in a treatment study for body dysmorphic disorder. CONCLUSIONS Clinical implications and potential uses of the measure as a clinical and research tool are discussed.
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Effects of safety behavior fading on social anxiety and emotional disclosure. Behav Res Ther 2022; 157:104165. [PMID: 36029642 DOI: 10.1016/j.brat.2022.104165] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 07/01/2022] [Accepted: 07/22/2022] [Indexed: 11/22/2022]
Abstract
Individuals with social anxiety disorder commonly engage in safety behaviors (SBs), which are behavioral and cognitive strategies employed in an effort to avoid or decrease the likelihood of a feared threat outcome and decrease anxiety in social situations. These behaviors are thought to be dysfunctional and play a key role in contemporary models of the disorder. The current experimental study sought to expand upon existing research by examining the role of SBs in social anxiety and self-disclosure. Participants with elevated social anxiety symptoms (N = 115) were randomized to either a two-week SB fading manipulation or a no-instruction control. Self-report measures were administered pre- and post-manipulation, and participants completed an in-vivo speech task at post. SB fading led to lower social anxiety symptoms at post relative to the control. SB fading also led to greater self-reported openness to general self-disclosure and emotional disclosure compared to the control, though these effects were modest. No condition effect on emotional reactivity to a speech task was observed. SB fading led to greater observer-rated disclosure on the speech task than control, though this was only found among those high in dispositional self-disclosure at baseline. The present study provides further evidence for the importance of SBs in social anxiety and suggests SB fading might lead to greater comfort with self-disclosure. Limitations and directions for future research are discussed.
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Stentz LA, Wilver NL, McDermott KA, Cougle JR. Effects of Safety Behavior Fading on Bulimic Symptoms and Drive for Thinness. COGNITIVE THERAPY AND RESEARCH 2022. [DOI: 10.1007/s10608-022-10311-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Jordan CD, Stewart RA, Brush CJ, Cougle JR, Hajcak G. Appearance Concerns are Uniquely Associated with LPP Amplitude to Pictures of Oneself. Soc Cogn Affect Neurosci 2021; 17:430-436. [PMID: 34673984 PMCID: PMC8972313 DOI: 10.1093/scan/nsab115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 09/09/2021] [Accepted: 10/20/2021] [Indexed: 11/13/2022] Open
Abstract
A number of psychiatric disorders, including body dysmorphic disorder (BDD), anorexia nervosa, bulimia nervosa, and social anxiety disorder, are characterized by heightened appearance concerns and increased cognitive and perceptual biases toward one’s own physical appearance. In the present study, we examined individual differences in self-reported appearance anxiety and symptoms of BDD in relation to the late positive potential (LPP)—an index of stimulus significance—in response to pictures of oneself, strangers and objects among 83 female college students. The results indicated that the LPP was larger for pictures of oneself compared to pictures of strangers and objects. Further, the Yale–Brown Obsessive-Compulsive Scale Modified for Body Dysmorphic Disorder and Appearance Anxiety Inventory scales both related to an increased LPP to pictures of oneself but not to strangers or objects. The findings suggest that the LPP elicited by pictures of oneself may function as a neural marker of appearance concerns, which could be leveraged to study the development and maintenance of a range of psychiatric disorders characterized by increased appearance concerns.
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Affiliation(s)
- Carson D Jordan
- Department of Psychology, Florida State University, Tallahassee, FL, USA.,Department of Biomedical Sciences, Florida State University, Tallahassee, FL, USA
| | - Rochelle A Stewart
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - C J Brush
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Jesse R Cougle
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Greg Hajcak
- Department of Psychology, Florida State University, Tallahassee, FL, USA.,Department of Biomedical Sciences, Florida State University, Tallahassee, FL, USA
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Saint SA, Moscovitch DA. Effects of mask-wearing on social anxiety: an exploratory review. ANXIETY STRESS AND COPING 2021; 34:487-502. [PMID: 34074171 DOI: 10.1080/10615806.2021.1929936] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND A unique feature of the global coronavirus pandemic has been the widespread adoption of mask-wearing as a public health measure to minimize the risk of contagion. Little is known about the effects of increased mask-wearing on social interactions, social anxiety, or overall mental health. OBJECTIVES Explore the potential effects of mask-wearing on social anxiety. DESIGN We review existing literatures to highlight three preselected sets of factors that may be important in shaping the effects of mask-wearing on social anxiety. These are: (a) people's perceptions of the social norms associated with wearing masks; (b) people's experiences of the degree to which masks prevent accurate interpretation of social and emotional cues; and (c) people's use of masks as a type of safety behavior that enables self-concealment. METHODS APA PsycNet and PubMed were searched principally between September and November 2020 for articles describing the relationship between social anxiety, intolerance of uncertainty, ambiguous feedback, and safety behavior use and for research on the relationship between mask-wearing and social norms and social interactions. Information identified as relevant from articles of interest was extracted and included in our review. RESULTS & CONCLUSIONS The effects of mask-wearing on social anxiety are likely to be substantial and clinically relevant.
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Affiliation(s)
- Sidney A Saint
- Department of Psychology, Centre for Mental Health Research and Treatment, University of Waterloo, Waterloo, Canada
| | - David A Moscovitch
- Department of Psychology, Centre for Mental Health Research and Treatment, University of Waterloo, Waterloo, Canada
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Opladen V, Vivell MB, Vocks S, Hartmann AS. Revisiting the Postulates of Etiological Models of Eating Disorders: Questioning Body Checking as a Longer-Term Maintaining Factor. Front Psychiatry 2021; 12:795189. [PMID: 35095608 PMCID: PMC8792988 DOI: 10.3389/fpsyt.2021.795189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 12/10/2021] [Indexed: 11/29/2022] Open
Abstract
Body checking (BC) is not only inherent to the maintenance of eating disorders but is also widespread among healthy females. According to etiological models, while BC serves as an affect-regulating behavior in the short term, in the longer term it is assumed to be disorder-maintaining and also produces more negative affect. The present study therefore aimed to empirically examine the proposed longer-term consequences of increased BC. In an online study, N = 167 women tracked their daily amount of BC over a total of 7 days: Following a 1-day baseline assessment of typical BC, participants were asked to check their bodies in an typical manner for 3 days and with a 3-fold increased frequency for 3-days. Before and after each BC episode, the impact of BC on affect, eating disorder symptoms, general pathology and endorsement of different functions of BC was assessed. Participants showed longer-term consequences of increased BC in terms of increased negative affect and general pathology, while eating disorder symptoms remained unaffected. In the case of typical BC, participants showed decreased general pathology and anxiety. Furthermore, the endorsement of a higher number of BC functions led to increased negative affect and an increased amount of typical BC. The findings support the theoretically assumed role of maladaptive BC in maintaining negative emotion in the longer term. However, though requiring replication, our finding of positive effects of typical BC calls into question the overall dysfunctionality of BC among non-clinical women who are not at risk of developing an eating disorder.
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Affiliation(s)
- Vanessa Opladen
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Osnabrück University, Osnabrück, Germany
| | - Maj-Britt Vivell
- Department of Psychology, Experimental Clinical Psychology, University of Konstanz, Konstanz, Germany
| | - Silja Vocks
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Osnabrück University, Osnabrück, Germany
| | - Andrea S Hartmann
- Department of Psychology, Experimental Clinical Psychology, University of Konstanz, Konstanz, Germany
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Experimental Psychopathology at the Crossroads: Reflections on Past, Present, and Future Contributions to Cognitive Behavioural Therapy. Int J Cogn Ther 2020. [DOI: 10.1007/s41811-020-00093-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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