Nothing Tastes as Good as Thin Feels: Low Positive Emotion Differentiation and Weight Loss Activities in Anorexia Nervosa

Risks and benefits of social media trends: The influence of "fitspiration", "body positivity", and text-based "body neutrality" on body dissatisfaction and affect in women with and without eating disorders

This online experimental study investigates the effects of the social media trends "fitspiration" (images of thin-muscular women promoting health and fitness), "body positivity" (images of larger female bodies motivating women to love their bodies), and "body neutrality" (illustrations encouraging women to appreciate the body's functions) on body dissatisfaction and affect in women with and without eating disorders (ED). Women with (n = 172) and women without ED (n = 210) were randomly assigned to the conditions "fitspiration", "body positivity", and text-based "body neutrality", each comprising the presentation of 30 Instagram posts. Before and after viewing the posts, participants answered state questionnaires on body dissatisfaction and affect. The results revealed that body dissatisfaction increased after viewing "fitspiration" images and decreased after viewing "body positivity" and text-based "body neutrality" posts. Positive affect decreased following exposure to "fitspiration" and text-based "body neutrality" but remained unchanged following "body positivity". Negative affect decreased following "body positivity" and text-based "body neutrality" content but did not change following exposure to "fitspiration". There was no differential effect on women with versus without ED. This study demonstrates harmful effects of "fitspiration" on body image and affect, indicating the need for prevention programs for both women with and without ED.

Associations between affect dynamics and eating regulation in daily life: a preliminary ecological momentary assessment study

Disordered eating behaviors consistently associated with emotion regulation difficulties. However, most studies have focused on affect intensity without considering dynamic affective patterns. We examined these patterns in relation to daily overeating, loss of control eating (LOCE), dietary restraint, and food craving in young adults using ecological momentary assessment (EMA).Adults (N = 24) completed a 10-day EMA protocol during which they reported momentary affect and eating patterns. Generalized linear mixed-models examined each index in relation to eating variable.Higher PA instability (within-person) was associated with higher ratings of binge-eating symptoms (B = 0.15, SE = 0.06, p = 0.007). Lower NA differentiation (within-person) was associated with higher levels of food craving (B = -10.11, SE = 4.74, p = 0.033).Our results support previous findings suggesting that acute fluctuations in PA may increase risk of binge-eating symptoms. Further, inability to differentiate between momentary states of NA was associated with cravings. This study highlights the importance of examining multiple facets of NA and PA in relation to eating regulation.Trial registration: ClinicalTrials.gov identifier: NCT02945475.

Effects of scaffolding emotion language use on emotion differentiation and psychological health: an experience-sampling study

Emotion differentiation (ED) - complexity in the mental representation and description of one's emotional experiences - is important for mental health. However, less is known whether ED can be enhanced in adults. We investigated if scaffolding emotion language use during affect labelling - initial provision of emotion word prompts (close-ended) followed by free response (open-ended) - impacts ED and psychological health. Utilising a crossover design, 92 college students completed questionnaires assessing psychological health at three time-points and ecological momentary assessment of emotions, affect valence and emotional self-efficacy for 14 days. Participants were randomised to the "scaffolding" group, where they reported emotions using the close-ended (7 days) followed by open-ended (7 days) approach, or the reverse sequence (control group). We extracted two ED indices: traditional intraclass correlation coefficient from close-ended reports and novel specificity index from open-ended reports. Primary analyses examined group differences across weeks while exploratory analyses examined moment-to-moment differences using multilevel modelling. Relative to controls, the scaffolding group demonstrated greater ED during open-ended emotion reporting of negative emotions and associated shifts in negative affect and emotional self-efficacy. There were no significant group differences in psychological symptoms. Results provide preliminary evidence that scaffolding may enhance ED and have implications for psychological intervention.

Changes in affect longitudinally mediate associations between emotion regulation strategy use and disordered eating

BACKGROUND

Trait-level emotion regulation (ER) difficulties are associated with eating disorders (EDs) transdiagnostically. However, little research has examined whether within-person fluctuations in ER longitudinally predict ED behaviors in daily life or the mechanisms of ER effects. Investigating daily ER could help us better understand why people experience ED behaviors at a given time. We examined whether day-to-day changes in adaptive (e.g., cognitive reappraisal) and maladaptive (e.g., rumination) ER longitudinally predicted core ED behaviors (binge eating, purging, dieting) and whether changes in affect mediated effects.

METHOD

Female participants (N = 688) ages 15-30 from the Michigan State University Twin Registry reported their adaptive and maladaptive ER use, negative affect (NA), positive affect (PA), binge eating, purging, and dieting on 49 consecutive days. Using structural equation modeling, we examined whether within-person fluctuations in ER predicted same- and next-day ED behaviors and whether changes in affect mediated longitudinal ER effects.

RESULTS

Greater maladaptive ER predicted increased likelihood of same-day binge eating and next-day binge eating and purging. The association between maladaptive ER and next-day binge eating and purging was mediated by increased next-day NA. In contrast, dieting was more closely related to changes in PA. Adaptive ER did not predict reduced likelihood of any ED behavior.

CONCLUSIONS

Maladaptive ER may longitudinally increase risk for binge eating and purging by amplifying NA. Interventions focused on decreasing maladaptive ER and subsequent NA might help disrupt binge eating-purging cycles. Conversely, results add to evidence that PA fluctuations may play a unique role in maintaining restrictive behaviors.

PUBLIC SIGNIFICANCE

Little is known about how daily changes in emotion regulation may impact disordered eating. We found that maladaptive emotion regulation (e.g., rumination) was associated with a higher likelihood of binge eating and purging on the next day because it predicted increased next-day negative affect. In contrast, dieting was more closely tied to fluctuations in positive affect. Targeting daily emotion regulation and affective processes may help disrupt cycles of disordered eating.

The inside out model of emotion recognition: how the shape of one's internal emotional landscape influences the recognition of others' emotions

Some people are exceptional at reading emotional expressions, while others struggle. Here we ask whether the way we experience emotion "on the inside" influences the way we expect emotions to be expressed in the "outside world" and subsequently our ability to read others' emotional expressions. Across multiple experiments, incorporating discovery and replication samples, we develop EmoMap (N = 20; N = 271) and ExpressionMap (N = 98; replication N = 193) to map adults' experiences of emotions and visual representations of others' emotions. Some individuals have modular maps, wherein emotional experiences and visual representations are consistent and distinct-anger looks and feels different from happiness, which looks and feels different from sadness. In contrast, others have experiences and representations that are variable and overlapping-anger, happiness, and sadness look and feel similar and are easily confused for one another. Here we illustrate an association between these maps: those with consistent and distinct experiences of emotion also have consistent and distinct visual representations of emotion. Finally (N = 193), we construct the Inside Out Model of Emotion Recognition, which explains 60.8% of the variance in emotion recognition and illuminates multiple pathways to emotion recognition difficulties. These findings have important implications for understanding the emotion recognition difficulties documented in numerous clinical populations.

Examining the Role of Emotion Differentiation on Emotion and Cardiovascular Physiological Activity During Acute Stress

Emotion differentiation (ED) - the tendency to experience one's emotions with specificity - is a well-established predictor of adaptive responses to daily life stress. Yet, there is little research testing the role of ED in self-reported and physiological responses to an acute stressor. In the current study, we investigate the effects of negative emotion differentiation (NED) and positive emotion differentiation (PED) on participants' self-reported emotions and cardiac-mediated sympathetic nervous system reactivity (i.e., pre-ejection period) in response to a stressful task. Healthy young adults enrolled in a two-session study. At an initial session, participants completed a modified experience sampling procedure (i.e., the Day Reconstruction Method). At session 2, 195 completed the Trier Social Stress Test while cardiac impedance was acquired throughout. Linear regressions demonstrated that higher NED, but not PED, was associated with experiencing less intense self-reported negative, high arousal emotions (e.g., irritated, panicky) during the stressor (β =  - .15, p < .05) although people with higher NED also exhibited greater sympathetic reactivity (β = .16, p < .05). In exploratory analyses, we tested whether the effect of NED on self-reported stress was mediated by the tendency to make internally focus (or self-focused) attributions about performance on the task but did not find a significant indirect effect (p = .085). These results both complement prior work and provide a more complex picture of the role of NED in adaptive responses to stressful life events, suggesting that people with higher NED may experience their emotions as more manageable regardless of their level of physiological arousal.

Supplementary Information

The online version contains supplementary material available at 10.1007/s42761-023-00189-y.

Emotion dysregulation, help-seeking attitudes, and posttraumatic stress disorder symptoms: A structural equation model

Objective: Most college students have experienced an adverse event in their lifetime, yet help-seeking rates remain low. This study seeks to understand psychological factors that might contribute to delays in treatment initiation among trauma-affected students. Participants: Our sample consisted of 531 undergraduate students of which 27% scored above the clinical cutoff for PTSD using the PTSD Checklist for DSM-5 (PCL-5). Methods: This cross-sectional study explored relationships among help-seeking attitudes, emotion dysregulation, and PTSD symptoms using structural equation modeling. Results: Findings demonstrated that individuals with more severe emotion dysregulation had more severe PTSD symptoms and held more negative attitudes toward seeking help. Conclusions: Individuals who are the most in need of treatment hold attitudes that may impede help-seeking. We discuss clinical implications and ways college counseling centers can maximize outreach and programming efforts to increase treatment initiation and engagement.

A machine learning investigation into the temporal dynamics of physical activity-mediated emotional regulation in adolescents with anorexia nervosa and healthy controls

OBJECTIVE

Anorexia nervosa (AN) is commonly experienced alongside difficulties of emotion regulation (ER). Previous works identified physical activity (PA) as a mechanism for AN sufferers to achieve desired affective states, with evidence towards mitigation of negative affect. However, temporal associations of PA with specific emotional state outcomes are unknown.

METHOD

Using lag-ensemble machine learning and feature importance analyses, 888 affect-based ecological momentary assessments across N = 75 adolescents with AN (N = 44) and healthy controls (N = 31) were analysed to explore significance of past PA, measured through passively collected wrist-worn actigraphy, with subsequent self-report momentary affect change across 9 affect constructs.

RESULTS

Among AN adolescents, later lags (≥2.5 h) were important in predicting change across negative emotions (hostility, sadness, fear, guilt). AN-specific model performance on held-out test data revealed the holistic "negative affect" construct as significantly predictable. Only joviality and self-assurance, both positively-valenced constructs, were significantly predictable among healthy-control-specific models.

DISCUSSION

Results recapitulated previous findings regarding the importance of PA in negative ER for AN individuals. Moreover, PA was found to play a uniquely prominent role in predicting negative affect 4.5-6 h later among AN adolescents. Future research into the PA-ER dynamic will benefit from targeting specific negative emotions across greater temporal scales.

Operationalizing undifferentiated affect: Validity and utility in clinical samples

Emotion differentiation is conceptualized as the process of categorizing one's general affective experiences into discrete emotions. The experience of undifferentiated affect or the inability to distinguish the particular emotion or combination of emotions that one is experiencing is often considered a hallmark of emotion dysregulation. Some past research has attempted to operationalize the general tendency to experience undifferentiated affect at the trait level using explicit questionnaire measures. More recently, indirect measures using intraclass correlation coefficients (ICCs) to estimate the consistency between simultaneous measures of different in-the-moment emotional experiences have become the favored method of quantifying undifferentiated affect. While the ICC method constitutes an advancement in estimating undifferentiated affect, which is theorized to be a dynamic process that occurs at a very granular level, prior investigations have used aggregate ICC measures or momentary ICC derivations that ignore multiple sources of dynamic variability to make inferences about in-the-moment experiences. We introduce a new, flexible method of calculating ICC measures of undifferentiated affect at different levels of experience that takes full advantage of time-intensive data measurement and more closely maps onto the theorized process. This method provides more refined estimates of undifferentiated affect and its associations with various behavioral outcomes, as well as uncovers more nuanced associations regarding the temporal process of emotional differentiation. It also elucidates potential conceptual issues in mapping empirical estimates of emotion undifferentiation onto their underlying theoretical interpretations.

Emotion Dynamics and Emotion Regulation in Anorexia Nervosa: A Systematic Review of Ecological Momentary Assessment Studies

Altered emotion dynamics and emotion regulation (ER) have been indicated in theoretical descriptions of abnormal emotional functioning, which contributes to the development and maintenance of anorexia nervosa (AN). Ecological momentary assessment (EMA) has recently become popular in research on eating disorders. It is a source of new insights into the psychopathology of AN as it enables intensive long-term tracking of everyday experiences and behaviours of individuals through repeated self-reports. The following systematic review aims to synthesize research on the use of EMA when evaluating emotion dynamics and ER in AN. Specific studies were identified with the use of MEDLINE, PsycINFO, and Scopus databases. A supplemental search was performed in reference lists of the relevant publications. As a result, 27 publications were identified and included in the systematic review. The findings from the reviewed studies point to various disturbed components of emotion dynamics as well as to unique associations of maladaptive ER strategies with specific abnormalities in emotion dynamics in AN. Limitations of the studies were discussed as well. An outlook for further research in the field was provided in the last section of the paper.

The Association of Daily Stressors and Daily Emotions to Daily Optimism

Abstract. Daily life events often trigger and co-occur with various emotional reactions, which activate self-regulatory processes. One possible outcome of self-regulatory processes is optimism. Limited research has examined optimism in daily life and potential daily predictors, including stressors, negative emotions, and positive emotions. Emotion differentiation – the ability to identify and label discrete emotional states – has the potential to change the association between daily predictors and optimism. The current study contextualized optimism in the emotion-laden daily life and examined the association of daily stressors and daily negative and positive emotional states to daily optimism and the role of negative and positive emotion regulation on these relationships. The current study adopted a daily diary design and collected self-reported daily responses from a sample of 248 college students over a 7-day study period. The results included concurrent and lagged effects and showed that daily negative affect and positive affect predicted both concurrent daily optimism and the next day’s optimism. Greater negative emotion differentiation predicted higher daily optimism. A better ability to differentiate positive emotions predicted a stronger relation between positive affect and daily optimism. The findings underscored the importance of daily affect and emotion differentiation being important markers for optimism interventions and daily practices.

Emotional Nuance: Examining Positive Emotional Granularity and Well-Being

The focus of this review is on positive emotional granularity. Emotional granularity is the level of specificity that characterizes verbal representations of an affective experience. Although there has been research on negative emotional granularity, relatively less attention has been given to the study of positive emotional granularity. Positive emotions are theorized to motivate an individual to “broaden and build” one’s scope of cognition, attention, and behavior. Distinct positive emotion concepts may provide individuals with more informational value than that provided by global mood. Indeed, individuals who are higher in positive emotional granularity report being better at coping with stressful experiences. In this review, we discuss growing research on positive emotional granularity and well-being. Issues of measurement, interventions, and considerations for future lines of research are discussed.

Assessing Emotion Regulation Ability for Negative and Positive Emotions: Psychometrics of the Perth Emotion Regulation Competency Inventory in United States Adults

People regulate both negative and positive emotions, and their ability to do this successfully is a cornerstone of adaptive psychological functioning. However, few measures have been available to assess emotion regulation ability across both valence domains. The Perth Emotion Regulation Competency Inventory (PERCI) was recently developed for this purpose. Here we present the first psychometric study of the PERCI in the United States (N = 508). Confirmatory factor analyses supported the intended eight-factor structure, which was invariant across age, gender, and education. PERCI scores had high internal consistency, and were associated with measures of psychopathology, emotional reactivity, and emotion regulation strategies in expected ways. These observed relationships between the PERCI and various regulation strategies may serve to establish a profile of what strategy patterns characterize differences in emotion regulation ability. Overall, the PERCI had strong psychometrics. Its capacity to assess both valence domains should enable more comprehensive assessments of emotion regulation ability.

Mindfulness-based interventions for eating disorders: The potential to mobilize multiple associative-learning change mechanisms

Mindfulness is a two-component skill that includes mindful awareness (attentional monitoring of present moment experience) and mindful acceptance (adopting an attitude of acceptance toward this experience). Although mindfulness-based interventions (MBIs) are efficacious for many conditions, there is a lack of research on MBIs for eating disorders (EDs). We propose that MBIs may be promising for EDs given their potential to mobilize not one, but multiple associative-learning change mechanisms in EDs-defined as adaptive processes of change involving one of two forms of associative-learning: Pavlovian and operant learning. We hypothesize how MBIs-via increasing either mindful awareness or mindful acceptance-may mobilize up to eight associative-learning change mechanisms, two involving Pavlovian learning, and six involving operant learning. We also elaborate on similarities and differences between MBIs and CBT approaches for EDs, as well as opportunities for synergy. Finally, we present recommendations for future research related to the development and evaluation of novel MBI interventions for EDs and the testing of mechanisms and patient-treatment matching hypotheses.

Negative Emotion Differentiation Predicts Psychotherapy Outcome: Preliminary Findings

Emotion differentiation (ED), the extent to which same-valenced emotions are experienced as distinct, is considered a valuable ability in various contexts owing to the essential affect-related information it provides. This information can help individuals understand and regulate their emotional and motivational states. In this study, we sought to examine the extent to which ED can be beneficial in psychotherapy context and specifically for predicting treatment response. Thirty-two prospective patients with mood and anxiety disorders completed four daily assessments of negative and positive emotions for 30 days before receiving cognitive-behavioral treatment. Depression, stress, and anxiety symptoms severity were assessed pre- and post-treatment using self-reports and clinical interviews. We conducted a series of hierarchical regression models in which symptoms change scores were predicted by ED while adjusting for the mean and variability. We found that negative ED was associated with greater self-reported treatment response (except for anxiety) when negative emotional variability (EV) was included in the models. Probing negative ED and EV's interactive effects suggested that negative ED was associated with greater treatment response (except for anxiety) for individuals with lower EV levels. Results were obtained while controlling for mean negative affect. Our findings suggest that negative ED can benefit psychotherapy patients whose negative emotions are relatively less variable. We discuss the meaning of suppression and interactive effects between affect dynamics and consider possible clinical implications.

Emotional Granularity Increases With Intensive Ambulatory Assessment: Methodological and Individual Factors Influence How Much

Individuals differ in their ability to create instances of emotion that are precise and context-specific. This skill - referred to as emotional granularity or emotion differentiation - is associated with positive mental health outcomes. To date, however, little work has examined whether and how emotional granularity might be increased. Emotional granularity is typically measured using data from experience sampling studies, in which participants are prompted to report on their emotional experiences multiple times per day, across multiple days. This measurement approach allows researchers to examine patterns of responses over time using real-world events. Recent work suggests that experience sampling itself may facilitate increases in emotional granularity in depressed individuals, such that it may serve both empirical and interventional functions. We replicated and extended these findings in healthy adults, using data from an intensive ambulatory assessment study including experience sampling, peripheral physiological monitoring, and end-of-day diaries. We also identified factors that might distinguish individuals who showed larger increases over the course of experience sampling and examined the extent of the impact of these factors. We found that increases in emotional granularity over time were facilitated by methodological factors, such as number of experience sampling prompts responded to per day, as well as individual factors, such as resting respiratory sinus arrhythmia. These results provide support for the use of experience sampling methods to improve emotional granularity, raise questions about the boundary conditions of this effect, and have implications for the conceptualization of emotional granularity and its relationship with emotional health.

Network investigation of eating disorder symptoms and positive and negative affect in a clinical eating disorder sample

OBJECTIVE

Growing literature suggests that emotions influence the maintenance of eating disorder (ED) symptoms. However, most research has studied the relationship between ED symptoms and affect broadly (i.e., negative affect [NA], positive affect [PA]), rather than examining models comprised of multiple specific affective states (e.g., upset, proud).

METHOD

The current study (N = 196 individuals with EDs) used network analysis to examine the most interconnected (i.e., central) NA and PA states in EDs and test the complex associations between specific NA, PA, and ED symptoms. We estimated two networks: one with affective states only and another with affective states and ED symptoms.

RESULTS

Feeling distressed, afraid, attentive, and determined were the most central symptoms in the affect-only network. ED symptoms related to overvaluation of weight and shape, including affect-based ED symptoms (i.e., guilt about eating), were central in the network of affect and ED symptoms. Guilt about eating and shame were central bridge symptoms across affect and ED symptom clusters, meaning that they were each strongly connected across clusters, and may represent important pathways among affect and ED symptoms.

DISCUSSION

Limitations include the cross-sectional and between-person nature of these analyses, from which we cannot derive causal or within-persons processes. Clinical interventions that target central and bridge symptoms (e.g., fear, shame) may disrupt the reinforcing cycle of NA in EDs that may contribute to ED behaviors. Future research should examine relationships among affective states and ED symptoms in longitudinal and intraindividual network models to develop more effective treatments for EDs.

Measuring Negative Emotion Differentiation Via Coded Descriptions of Emotional Experience

Emotion differentiation (ED) has been defined in terms of two abilities: (a) making fine-grained distinctions between emotional experiences, and (b) describing individual emotional experiences with a high degree of nuance and specificity. Research to date has almost exclusively focused on the former, with little attention paid to the latter. The current study sought to address this discrepant focus by testing two novel measures of negative ED (i.e., based on negatively valenced emotions only) via coded open-ended descriptions of individual emotional experiences, both past and present. As part of a larger study, 307 participants completed written descriptions of two negative emotional experiences, as well as a measure of emotion regulation difficulties and indices of psychopathological symptom severity. Negative ED ability, as measured via consistency between emotional experiences, was found to be unrelated to negative ED ability exhibited via coding of language within experiences. Within-experience negative ED may offer an incrementally adaptive function to that of ED between emotional experiences. Implications for ED theory are discussed.

Investigating the relationship between emotional granularity and cardiorespiratory physiological activity in daily life

Emotional granularity describes the ability to create emotional experiences that are precise and context-specific. Despite growing evidence of a link between emotional granularity and mental health, the physiological correlates of granularity have been under-investigated. This study explored the relationship between granularity and cardiorespiratory physiological activity in everyday life, with particular reference to the role of respiratory sinus arrhythmia (RSA), an estimate of vagal influence on the heart often associated with positive mental and physical health outcomes. Participants completed a physiologically triggered experience-sampling protocol including ambulatory recording of electrocardiogram, impedance cardiogram, movement, and posture. At each prompt, participants generated emotion labels to describe their current experience. In an end-of-day survey, participants elaborated on each prompt by rating the intensity of their experience on a standard set of emotion adjectives. Consistent with our hypotheses, individuals with higher granularity exhibited a larger number of distinct patterns of physiological activity during seated rest, and more situationally precise patterns of activity during emotional events: granularity was positively correlated with the number of clusters of cardiorespiratory physiological activity discovered in seated rest data, as well as with the performance of classifiers trained on event-related changes in physiological activity. Granularity was also positively associated with RSA during seated rest periods, although this relationship did not reach significance in this sample. These findings are consistent with constructionist accounts of emotion that propose concepts as a key mechanism underlying individual differences in emotional experience, physiological regulation, and physical health.

Affect and engagement in healthy and unhealthy weight control behaviors in college women: An ecological momentary assessment study

PURPOSE

The relationships between momentary affect and weight control behaviors have been extensively studied in samples of individuals with eating disorders, but we do not know that the established relationships translate to healthy college women. The current study examined the relationship between affect and weight control behaviors in healthy college women.

METHOD

Female college students (N = 67) completed measures of negative affect, positive affect, healthy weight control behaviors, and unhealthy weight control behaviors across fourteen days using ecological momentary assessment.

RESULTS

Average daily negative affect was inversely associated with daily engagement in unhealthy weight control behaviors, but was not associated with healthy weight control behaviors. Average daily positive affect was not associated with daily engagement in healthy or unhealthy weight control behaviors.

CONCLUSION

Negative affect was inversely associated with engagement in unhealthy weight control behaviors in this female undergraduate sample. Future studies should continue to elucidate the differences in the relationships in samples of individuals with ED psychopathology vs. healthy samples.

Development of a Novel Method of Emotion Differentiation That Uses Open-Ended Descriptions of Momentary Affective States

Emotion differentiation (ED) has been conceptualized as a trait that facilitates emotion regulation and increases well-being. Yet basic questions remain unanswered about how best to assess it and whether favorable outcomes can be observed only during times of stress. The goal of the present research was to develop a novel behavioral (specificity) index of ED. We conducted two daily diary studies (N = 111-190) in which we included different measures of ED, well-being, and emotion regulation. The different ED measures were largely unrelated to each other. In both studies, the specificity index of ED showed a positive association with daily well-being, but in Study 2, this association held only on days with a negative event. Results regarding ED and the use of emotion-regulation strategies were inconsistent across strategies and studies. Possible reasons for these mixed results (e.g., sample selection, context sensitivity of regulation strategies) are discussed.

Differences in Affective Dynamics Among Eating Disorder Diagnostic Groups

Emotion regulation theories suggest that affect intensity is crucial in the development and maintenance of eating disorders. However, other aspects of emotional experience, such as lability, differentiation, and inertia, are not as well understood. This study is the first to use ecological momentary assessment (EMA) to examine differences in several daily negative affect (NA) indicators among adults diagnosed with anorexia nervosa (AN), bulimia nervosa (BN), or binge eating disorder (BED). Using EMA data from three large studies, a series of linear mixed models showed that participants in the AN and BN groups experienced significantly greater NA intensity and better emotion differentiation than participants in the BED group. Alternatively, the BN group demonstrated significantly greater NA lability than the AN group and greater NA inertia than the BED group. These results suggest that several daily affective experiences differ among eating disorders diagnostic groups and have implications towards distinct conceptualizations and treatments.

Emotion differentiation and disordered eating behaviors: The role of appearance schemas

Emotion differentiation, or the ability to distinguish between discrete emotions in the moment, has been linked to maladaptive behaviors, including disordered eating. Appearance schemas may impact this relationship, as it has been suggested that individuals who are preoccupied with appearance-related information in their environment have limited attentional resources to devote to other internal processes. This study sought to expand existing research by examining: 1) the relationships between emotion differentiation and self-reported eating disorder symptomatology, and 2) strength of implicit appearance schemas as a moderator of these relationships. Participants were 118 female undergraduate students who completed a self-report disordered eating symptomatology questionnaire and a word stem completion task (measuring implicit appearance schemas) at baseline. Participants then reported their daily disordered eating behaviors and emotions through ecological momentary assessment for seven days. Emotion differentiation indices were calculated from negatively-valenced (NED) and positively-valenced (PED) daily affect ratings using intraclass correlation coefficients. Analyses demonstrated significant relationships between NED, severity of eating disorder symptomology, and frequency of compensatory behaviors; however, these relationships did not emerge with PED. Strength of appearance schemas was a moderator, suggesting that poor NED paired with stronger appearance schemas resulted in more severe eating disorder symptoms and more frequent engagement in compensatory behaviors. Multilevel models revealed that better NED predicted daily engagement in dietary restriction. By examining the relationship between emotion differentiation and disordered eating symptoms, this study contributes clinically significant information regarding a facet of emotional experience that may be important to our understanding of eating disorder symptomatology.

Low emotion differentiation: An affective correlate of binge eating?

BACKGROUND

Low emotion differentiation (the tendency to experience vague affective states rather than discrete emotions) is associated with psychopathology marked by emotion regulation deficits and impulsive/maladaptive behavior. However, research examining associations between emotion differentiation and dysregulated eating is nascent and has yet to incorporate measures of clinically significant binge eating. Different measures of emotion differentiation have also been used, impeding cross-study comparisons. We therefore examined associations between several emotion differentiation measures and binge eating-related phenotypes across a spectrum of severity.

METHODS

Women (N = 482) from the Michigan State University Twin Registry completed the Positive and Negative Affect Schedule (PANAS) daily for 45 consecutive days. Three measures of negative/positive emotion differentiation (NED/PED) were created using the intraclass correlation coefficient (ICC), average interitem correlation, and average daily variance between negative/positive emotion ratings on the PANAS. Associations between NED/PED measures and emotional eating (EE) and a history of binge eating episodes (BEs) were then examined, controlling for affect intensity and BMI.

RESULTS

Lower PED was associated with greater odds of BEs across the ICC and average interitem correlation measures, and more EE on the daily variance measure. Findings involving NED were less consistent; lower NED was associated with greater EE and greater odds of BEs using the daily variance measure only.

CONCLUSION

Low PED is associated with clinically significant binge eating, and some aspects of NED may also be relevant for binge eating-related phenotypes. Further research examining the constructs captured by different emotion differentiation measures and their relevance to binge eating is needed.

Understanding and Taking Stock of Positive Emotion Disturbance

The prevailing view on positive emotions is that they correlate with and confer psychological health benefits for the individual, including improved social, physical and cognitive functioning. Yet an emerging wave of scientific work suggests that positive emotions are also related to a range of suboptimal psychological health outcomes, especially when the intensity, duration, or context do not optimize the individual's goals or meet current environmental demands. This paper provides an overview of the 'other side' of positive emotion, by describing and reviewing evidence supporting the emerging field of Positive Emotion Disturbance (PED). We review relevant emotion processes and key themes of PED and apply this framework to example emotional disorders, and discuss implications for psychological change and future research agendas.

A Systematic Review and Meta-Analysis of the Association Between Complexity of Emotion Experience and Behavioral Adaptation

This article systematically reviews studies investigating the effect of three operationalizations of complexity in emotion experience (i.e., differentiation, covariation, and variability) on situational behavioral adaptation (i.e., physiological, cognitive, and overt action responses), and quantifies the results with meta-analyses. Twenty-seven studies of emotion complexity were identified and divided into four categories: (a) trait and (b) state studies within clinical samples, and (c) trait and (d) state studies within nonclinical samples. Most studies investigated trait emotion differentiation, revealing negligible to small effects ( r range: .06 to .15). Only 4 studies in total assessed indicators of state emotion complexity. The theoretical assumptions behind the indicators of emotion complexity as well as the conceptualization of behavioral adaptiveness are critically discussed, and a number of future avenues for this type of research are proposed.

The posited effect of positive affect in anorexia nervosa: Advocating for a forgotten piece of a puzzling disease

Anorexia nervosa (AN) is a complex and life-threatening eating disorder. Current models of AN onset and maintenance have largely focused on the role of negative affect, while fewer models have described the role of positive affect (PA). Given that these theoretical models have informed current treatment approaches, and that treatment remains minimally effective for adults with AN, we advocate that targeting PA is one avenue for advancing maintenance models and by extension, treatment. We specifically propose that AN may arise and be chronically and pervasively maintained as a function of dysregulated PA in response to weight loss and weight loss behaviors (e.g., restriction, excessive exercise), to a degree that is not accounted for in existing models of AN. We present evidence from multiple domains, including biological, behavioral, and self-report, supporting the hypothesis that PA dysregulation in AN contributes to the maintenance of the disorder. We conclude with several specific avenues for treatment development research as well as a call for future work elucidating the biological correlates of PA.

Effect of self-monitoring through experience sampling on emotion differentiation in depression

BACKGROUND

Major depressive disorder has been linked to an inability to differentiate between negative emotions. The current study investigates whether emotion differentiation improves when individuals with major depressive disorder are required to report on specific emotions multiple times a day through the experience sampling method (ESM) - a structured self-report diary technique.

METHODS

Seventy-nine patients diagnosed with major depressive disorder participated in this study, of whom 55 used ESM for 6 weeks (3 days a week, 10 times a day). Changes from baseline to post assessment in positive and negative emotion differentiation were compared between the participants who did and those who did not use ESM.

RESULTS

Engaging in ESM related to an improvement in both positive and negative emotion differentiation, but only the latter reached statistical significance. The relationship between the number of ESM measurements (dose) and emotion differentiation change (response) was not significant.

LIMITATIONS

The sample size for the dose-response analysis was relatively small (N = 55). It is unknown whether emotion differentiation improvements generalize beyond the emotions (N = 12) we probed in this study. Other factors could also have contributed to the change (e.g., meetings with the researchers).

CONCLUSIONS

The present study suggests that patients with depression using ESM for 3 days a week for 6 weeks can improve their negative emotion differentiation. Future studies should assess after what period of ESM changes in emotion differentiation become apparent, and whether these changes are persistent and relate to actual improvement in depressive symptoms.

Affect, reward, and punishment in anorexia nervosa: a narrative overview

INTRODUCTION

Anorexia nervosa (AN) is a serious psychiatric disorder that is difficult to treat and often follows a protracted course. A number of theoretical models have been proposed for the etiology and maintenance of AN. Two domains that have received substantial attention in the literature on AN are affect and reward/punishment processes. However, despite an overlap in the nature and implications of these processes, studies of AN addressing these constructs have typically investigated them independently.

PURPOSE

The purpose of this narrative review is to integrate the literature on the role of affect, reward, and punishment in AN.

METHOD

We provide a focused narrative overview of the literature relating to the affect, reward, and punishment in AN via a synthesis of recent reviews and meta-analyses.

RESULTS

We first describe several prominent affect and reward/punishment-based conceptualizations of AN, followed by a brief overview of the existing empirical literature in these domains.

CONCLUSION

We provide a critical discussion of the disparate nature of these literatures in AN, including associated limitations. We then conclude with an extensive discussion of directions for future research that integrate the study of affect and reward/punishment processes in AN.

LEVEL OF EVIDENCE

Level V, narrative review.

Emotion differentiation mediates the association between emotion regulation difficulties and caloric intake

Emotion differentiation is the ability to identify and label emotional experiences into discrete categories. The present study examined the influence of emotion regulation difficulties, emotion differentiation, and emotional state-specifically sad versus positive mood-on caloric intake in a laboratory setting. Undergraduate participants completed a series of questionnaires, including measures of emotion regulation difficulties and emotion differentiation, and then underwent a randomly assigned sad or positive mood induction. Afterwards, they participated in a taste test. Food was counted before and after the taste test to determine total caloric intake. Results showed that negative emotion differentiation was significantly inversely associated with overall caloric intake, such that low negative emotion differentiators ate more regardless of mood induction group. Positive emotion differentiation was not associated with caloric intake. Additional analysis found that negative emotion differentiation mediated the relation between emotion regulation difficulties and caloric intake. An alternative model found that emotion regulation difficulties did not mediate the relation between negative emotion differentiation and caloric intake. Our results suggest that reducing caloric intake among individuals with emotion regulation difficulties may involve incorporating strategies to specifically target the ability to differentiate between emotions.

Reconsidering Emotion Dysregulation

This article aims to review the concept of emotion dysregulation, focusing on issues related to its definition, meanings and role in psychiatric disorders. Articles on emotion dysregulation published until May 2016 were identified through electronic database searches. Although there is no agreement about the definition of emotion dysregulation, the following five overlapping, not mutually exclusive dimensions of emotion dysregulation were identified: decreased emotional awareness, inadequate emotional reactivity, intense experience and expression of emotions, emotional rigidity and cognitive reappraisal difficulty. These dimensions characterise a number of psychiatric disorders in various proportions, with borderline personality disorder and eating disorders seemingly more affected than other conditions. The present review contributes to the literature by identifying the key components of emotion dysregulation and by showing how these permeate various forms of psychopathology. It also makes suggestions for improving research endeavours. Better understanding of the various dimensions of emotion dysregulation will have implications for clinical practice. Future research needs to address emotion dysregulation in all its multifaceted complexity so that it becomes clearer what the concept encompasses.

Emotion differentiation and its relation with emotional well-being in adolescents

Emotion differentiation (ED) refers to the precision with which people can identify and distinguish their emotions and has been associated with well-being in adults. This study investigated ED and its relation with emotional well-being (i.e. depressive symptoms, positivity and negativity intensity and propensity, implicit theories of emotions) in adolescents. We used an experience sampling method with 72 participants (M_age = 14.00, 71% girls) to assess adolescents' positive and negative emotions at different time points over the course of two weekends and a baseline questionnaire to assess emotional well-being. Differentiating negative emotions was related to less negativity intensity and propensity, and to the belief that emotions are malleable. Differentiating positive emotions was not related to any of the assessed well-being variables. Together, these results suggest that a detailed awareness of one's negative emotional states is an important dimension of well-being, also in adolescence.

Emotional Granularity Effects on Event-Related Brain Potentials during Affective Picture Processing

There is debate about whether emotional granularity, the tendency to label emotions in a nuanced and specific manner, is merely a product of labeling abilities, or a systematic difference in the experience of emotion during emotionally evocative events. According to the Conceptual Act Theory of Emotion (CAT) (Barrett, 2006), emotional granularity is due to the latter and is a product of on-going temporal differences in how individuals categorize and thus make meaning of their affective states. To address this question, the present study investigated the effects of individual differences in emotional granularity on electroencephalography-based brain activity during the experience of emotion in response to affective images. Event-related potentials (ERP) and event-related desynchronization and synchronization (ERD/ERS) analysis techniques were used. We found that ERP responses during the very early (60-90 ms), middle (270-300 ms), and later (540-570 ms) moments of stimulus presentation were associated with individuals' level of granularity. We also observed that highly granular individuals, compared to lowly granular individuals, exhibited relatively stable desynchronization of alpha power (8-12 Hz) and synchronization of gamma power (30-50 Hz) during the 3 s of stimulus presentation. Overall, our results suggest that emotional granularity is related to differences in neural processing throughout emotional experiences and that high granularity could be associated with access to executive control resources and a more habitual processing of affective stimuli, or a kind of "emotional complexity." Implications for models of emotion are also discussed.

Perfectionism, emotion dysregulation, and affective disturbance in relation to clinical impairment in college-age women at high risk for or with eating disorders

Individuals with eating disorders (EDs) demonstrate impaired quality of life; however, less than one-third report severe clinical impairment. Thus, it is important to determine factors that may identify those who are most likely to report marked impairment. Perfectionism, emotion dysregulation, and aspects of affective disturbance, such as anxiety and depression, are independently associated with eating pathology and clinical impairment in eating and other disorders. However, little research has explored these three factors concurrently in relation to eating pathology. It is possible that the combined interaction effect of these constructs could be especially harmful. The current study examined the influence of these constructs and their interactions on clinical impairment in college-aged women at high risk for or with a DSM-5 clinical or subclinical ED. Although the three-way interaction of perfectionism, emotion dysregulation, and affective disturbance (i.e., anxiety or depression) was not significant, the two-way interaction between perfectionism and emotion dysregulation was significant such that those who were high in both perfectionism and emotion dysregulation reported the highest levels of clinical impairment. This suggests that the combination of perfectionism and emotion dysregulation may be especially problematic for those with or at high risk for EDs. Interestingly, perfectionism alone was not a predictor of clinical impairment when accounting for the other constructs, implying that perfectionism may have a greater impact when in conjunction with emotion dysregulation. Understanding the impact of combined perfectionistic tendencies and emotion dysregulation on clinical impairment may better inform treatment and more directly target contributors to impaired quality of life.

Ecological Momentary Assessment in Eating Disorder and Obesity Research: a Review of the Recent Literature

Our current understanding of the etiology and maintenance of eating disorders and obesity continues to be far from complete. Similarly, our understanding of determinants of both successful and unsuccessful weight loss surgery is also quite limited. While a number of research methodologies have been applied to these areas, one methodology that has recently seen a rise in popularity is the use of ecological momentary assessment (EMA). EMA allows one to study a variety of variables of interest in the natural environment. The study of eating disorders, obesity, and bariatric surgery has all been conducted using EMA recently. The current study is a review of these areas and summarizes the recent literature (past 3 years) in eating disorders, obesity, and bariatric surgery using EMA methodology.

Decoupling as a Mechanism of Change in Mindfulness and Acceptance

A growing body of research within the acceptance and mindfulness-based therapies suggests that these treatments may function in part by reducing or eliminating (i.e., decoupling) the normative relationships between internal experiences and other internal/overt behavior. Examples of decoupling effects found in this review include reduced relationships between urges to smoke and smoking behavior, between dysphoric mood and depressive cognitions, and between pain intensity and persistence in a painful task. A literature review identified 44 studies on acceptance and mindfulness that demonstrated decoupling effects. Overall, preliminary evidence for decoupling effects were found across a broad range of problem areas, including substance abuse, depression, eating disorders, overeating, chronic pain, anxiety, relationships, anger, avoidance behavior, and self-harm, with the strongest evidence currently available in the area of substance abuse. However, the review also notes a general lack of replication studies on decoupling effects and the need for more well-powered and controlled research testing specific decoupling hypotheses.

A perfect storm: examining the synergistic effects of negative and positive emotional instability on promoting weight loss activities in anorexia nervosa

Growing evidence indicates that both positive and negative emotion potentially influence the development and maintenance of anorexia nervosa, through both positive and negative reinforcement of weight loss activities. Such reactive emotional experience may be characterized by frequent and intense fluctuations in emotion, a construct known as "emotional instability." The purpose of this study was to investigate the association between positive emotional instability and weight loss activities in anorexia nervosa, and to investigate the synergistic effects of positive and negative emotional instability on promoting weight loss activities. Using ecological momentary assessment methods, 118 participants with anorexia nervosa reported their emotional experiences and behaviors at least six times daily over 2 weeks using a portable digital device. Using generalized linear modeling, results indicated that high levels of both positive and negative emotional instability, and the interaction between the two, were associated with more frequent weight-loss activities, beyond anorexia subtype and mean levels of emotional intensity. These findings indicate that when women with anorexia exhibit both high levels of both positive and negative emotional instability they are more prone to a variety of weight loss activities. The importance of addressing the role of both positive and negative emotion in anorexia treatment is discussed.

The joint influence of acquired capability for suicide and stoicism on over-exercise among women

We investigated longitudinal relationships among eating disorder behaviors, stoicism, and the acquired capability for suicide (ACS), which is a construct comprised of pain tolerance and fearlessness about death. University students (n=150) completed assessments measuring stoicism, ACS, and eating disorder behaviors at two time points approximately 30days apart. Among women, there was a quadratic relationship between ACS and over-exercise behaviors, such that as ACS increased the positive association between ACS and over-exercise became more pronounced. Further, among women, ACS moderated the relationship between stoicism and over-exercise, such that high levels of ACS in combination with stoicism predicted increases in over-exercise. Results suggest that ACS in combination with stoicism may lead women to engage in more eating disordered behaviors, like over-exercise.

Relating specific emotions to intrinsic motivation: on the moderating role of positive and negative emotion differentiation

Despite the fact that studies on self-determination theory have traditionally disregarded the explicit role of emotions in the motivation eliciting process, research attention for the affective antecedents of motivation is growing. We add to this emerging research field by testing the moderating role of emotion differentiation -individual differences in the extent to which people can differentiate between specific emotions- on the relationship between twelve specific emotions and intrinsic motivation. To this end, we conducted a daily diary study (N = 72) and an experience sampling study (N = 34). Results showed that the relationship between enthusiasm, cheerfulness, optimism, contentedness, gloominess, miserableness, uneasiness (in both studies 1 and 2), calmness, relaxation, tenseness, depression, worry (only in Study 1) on one hand and intrinsic motivation on the other hand was moderated by positive emotion differentiation for the positive emotions and by negative emotion differentiation for the negative emotions. Altogether, these findings suggest that for people who are unable to distinguish between different specific positive emotions the relationship between those specific positive emotions and intrinsic motivation is stronger, whereas the relationship between specific negative emotions and intrinsic motivation is weaker for people who are able to distinguish between the different specific negative emotions. Theoretical and practical implications are discussed.

Compulsivity in anorexia nervosa: a transdiagnostic concept

The compulsive nature of weight loss behaviors central to anorexia nervosa (AN), such as relentless self-starvation and over-exercise, has led to the suggestion of parallels between AN and other compulsive disorders such as obsessive-compulsive disorder (OCD) and addictions. There is a huge unmet need for effective treatments in AN, which has high rates of morbidity and the highest mortality rate of any psychiatric disorder, yet a grave paucity of effective treatments. Viewing compulsivity as a transdiagnostic concept, seen in various manifestations across disorders, may help delineate the mechanisms responsible for the persistence of AN, and aid treatment development. We explore models of compulsivity that suggest dysfunction in cortico-striatal circuitry underpins compulsive behavior, and consider evidence of aberrancies in this circuitry across disorders. Excessive habit formation is considered as a mechanism by which initially rewarding weight loss behavior in AN may become compulsive over time, and the complex balance between positive and negative reinforcement in this process is considered. The physiological effects of starvation in promoting compulsivity, positive reinforcement, and habit formation are also discussed. Further research in AN may benefit from a focus on processes potentially underlying the development of compulsivity, such as aberrant reward processing and habit formation. We discuss the implications of a transdiagnostic perspective on compulsivity, and how it may contribute to the development of novel treatments for AN.