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Dol A, van Strien T, Velthuijsen H, van Gemert-Pijnen L, Bode C. Preferences for coaching strategies in a personalized virtual coach for emotional eaters: an explorative study. Front Psychol 2023; 14:1260229. [PMID: 38034311 PMCID: PMC10687361 DOI: 10.3389/fpsyg.2023.1260229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 11/01/2023] [Indexed: 12/02/2023] Open
Abstract
Objectives Emotional eating is recognized as a potential contributor to weight gain. Emotional eaters often hide their problems because of feelings of shame about their behavior, making it challenging to provide them with the necessary support. The introduction of a virtual coach might offer a potential solution in assisting them. To find out whether emotional eaters are receptive to online personalized coaching, we presented emotional eaters with two essential proto-typical problem situations for emotional eaters: "experiencing cravings" and "after giving in to cravings," and asked them whether they preferred one of the three coaching strategies presented: Validating, Focus-on-Change and Dialectical. Methods An experimental vignette study (2 × 3 design) was carried out. The vignettes featured two distinct personas, each representing one of the two common problem scenarios experienced by emotional eaters, along with three distinct coaching strategies for each scenario. To identify potential predictors for recognition of problem situations, questionnaires on emotional eating (DEBQ), personality traits (Big-5), well-being (PANAS), and BMI were administrated. Results A total of 62% of the respondents identified themselves with "after giving in to cravings" and 47% with "experiencing cravings." BMI, emotional eating and emotional stability appeared to be predictors in recognizing both the problem situations. In "experiencing cravings," the participating women preferred Dialectical and the Validation coaching strategies. In the "after giving in to cravings" condition, they revealed a preference for the Dialectical and the Focus-on-Change coaching strategies. Conclusion Using vignettes allowed a less threatening way of bringing up sensitive topics for emotional eaters. The personas representing the problem situations were reasonably well recognized. To further enhance this recognition, it is important for the design and content of the personas to be even more closely related to the typical problem scenarios of emotional eaters, rather than focusing on physical characteristics or social backgrounds. This way, users may be less distracted by these factors. With the knowledge gained about the predictors that may influence recognition of the problem situations, design for coaching can be more customized. The participants represented individuals with high emotional eating levels, enhancing external validity.
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Affiliation(s)
- Aranka Dol
- Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands
- Institute for Communication, Media & IT, Hanze University, Groningen, Netherlands
| | - Tatjana van Strien
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
| | - Hugo Velthuijsen
- Institute for Communication, Media & IT, Hanze University, Groningen, Netherlands
| | | | - Christina Bode
- Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands
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Barnhart WR, Kalantzis MA, Braden AL. Mindfulness facets differentially relate to self-reported negative and positive emotional eating types in treatment-seeking adults with overweight/obesity. Eat Weight Disord 2023; 28:54. [PMID: 37351755 DOI: 10.1007/s40519-023-01578-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 06/04/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND Mindfulness is a meaningful therapeutic target in the treatment of emotional eating in adults with overweight/obesity. Descriptive research mapping relations between mindfulness facets and emotional eating types in treatment-seeking adults with overweight/obesity is needed. METHODS Cross-sectional relations between mindfulness facets (i.e., acting with awareness, describe, non-judgment, non-reactive, and observe; Five Facet Mindfulness Questionnaire-Short Form) and emotional eating types (i.e., self-reported negative and positive emotional eating; Emotional Eating Scale-Revised, Emotional Appetite Questionnaire) were examined in a treatment-seeking sample of adults with overweight/obesity (N = 63). RESULTS Significant bivariate correlations revealed negative relations between mindfulness facets and emotional eating types. Multiple regressions revealed that higher describe (β = - 0.42, p = 0.004) mindfulness was associated with lower self-reported emotional eating-anger/anxiety; higher non-reactive (β = - 0.31, p = 0.01) and non-judgment (β = - 0.28, p = 0.02) mindfulness were associated with lower self-reported emotional eating-depression; and higher non-judgment (β = 0.26, p = 0.04) mindfulness was associated with higher self-reported emotional eating-positive. CONCLUSIONS Describe, non-judgment, and non-reactive mindfulness were uniquely and significantly associated with eating in response to negative and positive emotions. Results suggest the potential need for intervention programs to be sensitive to the multidimensional nature of mindfulness in the treatment of distinct types of emotional eating in adults with overweight/obesity. LEVEL OF EVIDENCE V, cross-sectional descriptive study.
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Affiliation(s)
- Wesley R Barnhart
- Department of Psychology, Bowling Green State University, Bowling Green, OH, 43403, USA.
| | - Maria A Kalantzis
- Department of Psychology, Bowling Green State University, Bowling Green, OH, 43403, USA
| | - Abby L Braden
- Department of Psychology, Bowling Green State University, Bowling Green, OH, 43403, USA
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Clément S, Tereno S. Attachment, Feeding Practices, Family Routines and Childhood Obesity: A Systematic Review of the Literature. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20085496. [PMID: 37107778 PMCID: PMC10138359 DOI: 10.3390/ijerph20085496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 03/26/2023] [Accepted: 04/07/2023] [Indexed: 05/11/2023]
Abstract
Childhood obesity is considered a major public health problem. To help prevention and intervention programs targeting families with obese children, this paper is aimed at synthesizing multifactorial and transactional data resulting from studies and reviews assessing relational factors between the child and his or her parents and the child's obesity risk, including the child's and CG's attachment quality, parental feeding practices, and family routines. It is also aimed at assessing the mediation of these links by specific self-regulatory capacities across different developmental periods (0-2, 2-8, and 8-18 years old). The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines were applied in the review methodology. Ten papers were analyzed, including seven empirical studies and three reviews proposing etiological models of childhood obesity. The quality of empirical studies was assessed, and a synthetical model of the results was proposed. This literature review showed that the caregiver's (CG) and the child's attachment quality, along with controlling or permissive feeding practices, and few family routines are mostly mediated by appetite dysregulation and emotional regulation strategies with the development of child obesity. New research topics are proposed to understand other facets of childhood obesity, as well as how to better prevent and treat it.
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Smith J, Ang XQ, Giles EL, Traviss-Turner G. Emotional Eating Interventions for Adults Living with Overweight or Obesity: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2722. [PMID: 36768088 PMCID: PMC9915727 DOI: 10.3390/ijerph20032722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 01/31/2023] [Accepted: 02/01/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Emotional eating (EE) may be defined as a tendency to eat in response to negative emotions and energy-dense and palatable foods, and is common amongst adults with overweight or obesity. There is limited evidence regarding the effectiveness of interventions that address EE. OBJECTIVES To synthesize evidence on the effectiveness of EE interventions for weight loss and EE in adults living with overweight or obesity. METHODS This is a systematic review and meta-analysis. Adhering to the PRISMA guidance, a comprehensive electronic search was completed up to February 2022. Random effects meta-analysis was carried out to determine the percentage change in weight and EE scores. RESULTS Thirty-four studies were included. The combined effect size for percentage weight change was -1.08% (95% CI: -1.66 to -0.49, I2 = 64.65%, n = 37), once adjusted for publication bias. Similarly, the combined effect size for percentage change in EE was -2.37%, (95% CI: -3.76 to -0.99, I2 = 87.77%, n = 46). Cognitive Behavioural Therapy showed the most promise for reducing weight and improving EE. CONCLUSIONS Interventions to address EE showed promise in reducing EE and promoted a small amount of weight loss in adults living with overweight or obesity.
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Affiliation(s)
- Jo Smith
- School of Health and Life Sciences, Teesside University, Middlesbrough TS1 3BX, UK
- Tees, Esk and Wear Valleys NHS Foundation Trust, Darlington DL2 2TS, UK
| | - Xiao Qi Ang
- School of Health and Life Sciences, Teesside University, Middlesbrough TS1 3BX, UK
| | - Emma L. Giles
- School of Health and Life Sciences, Teesside University, Middlesbrough TS1 3BX, UK
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Hadar-Shoval D, Alon-Tirosh M, Asraf K, Tannous-Haddad L, Tzischinsky O. Lifestyle Changes, Emotional Eating, Gender, and Stress during COVID-19 Lockdown. Nutrients 2022; 14:nu14183868. [PMID: 36145243 PMCID: PMC9501635 DOI: 10.3390/nu14183868] [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] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 09/08/2022] [Accepted: 09/14/2022] [Indexed: 11/16/2022] Open
Abstract
Emotional eating poses health risks. It is associated with adverse weight gain and a higher body mass index and is frequently triggered by stressful situations such as pandemics. The COVID-19 pandemic was found to cause stress as well as lifestyle changes of different magnitudes. This study examined the relationship between lifestyle changes and emotional eating by focusing on the moderating effect of gender and COVID-19-related stressors. A total of 1969 respondents completed online questionnaires during the first COVID-19 lockdown in Israel. The questionnaires assessed COVID-19-related lifestyle changes concerning eating habits, alcohol consumption, sleep quality, physical activity, and cigarette smoking, COVID-19-related stressors, and emotional eating (Dutch Eating Behavior Questionnaire). People with positive and negative COVID-19-related lifestyle changes demonstrated higher emotional eating compared to people with no lifestyle changes. The relationship between lifestyle changes and emotional eating was moderated by gender and COVID-19-related stressors. In conclusion, health officials should consider recommendations about lifestyle changes given to the public in times of unpredictable changes, with special attention to populations at risk of emotional eating. As emotional eating is related to poor emotional regulation skills, public nutrition recommendations should focus on improving these skills rather than adopting better diets.
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Affiliation(s)
- Dorit Hadar-Shoval
- Psychology Department, The Max Stern Yezreel Valley College, Yezreel Valley 1930600, Israel
- Correspondence:
| | - Michal Alon-Tirosh
- Behavioral Sciences Department, The Max Stern Yezreel Valley College, Yezreel Valley 1930600, Israel
| | - Kfir Asraf
- Psychology Department, The Max Stern Yezreel Valley College, Yezreel Valley 1930600, Israel
| | - Lubna Tannous-Haddad
- Behavioral Sciences Department, The Max Stern Yezreel Valley College, Yezreel Valley 1930600, Israel
| | - Orna Tzischinsky
- Educational Counseling Department, The Max Stern Yezreel Valley College, Yezreel Valley 1930600, Israel
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Dialectical Behaviour Therapy Improves Emotion Dysregulation Mainly in Binge Eating Disorder and Bulimia Nervosa: A Systematic Review and Meta-Analysis. J Pers Med 2021; 11:jpm11090931. [PMID: 34575707 PMCID: PMC8470932 DOI: 10.3390/jpm11090931] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 09/07/2021] [Accepted: 09/15/2021] [Indexed: 12/12/2022] Open
Abstract
Emotion dysregulation is a transdiagnostic phenomenon in Eating Disorders (ED), and Dialectical Behaviour Therapy (DBT) (which was developed for reducing dysregulated emotions in personality disorders) has been employed in patients with ED. This systematic review and meta-analysis investigated whether the effect of DBT was stronger on emotion dysregulation, general psychopathology, and Body Mass Index (BMI) in participants with ED, when compared to a control group (active therapy and waitlist). Eleven studies were identified in a systematic search in accordance with PRISMA guidelines. Most studies included participants with Binge Eating Disorder (BED) (n = 8), some with Bulimia Nervosa (BN) (n = 3), and only one with Anorexia Nervosa (AN). The pooled effect of DBT indicated a greater improvement in Emotion Regulation (ER) (g = −0.69, p = 0.01), depressive symptoms (g = −0.33, p < 0.00001), ED psychopathology (MD = −0.90, p = 0.005), Objective Binge Episodes (OBE) (MD = −0.27, p = 0.003), and BMI (MD = −1.93, p = 0.01) compared to the control group. No improvement was detected in eating ER following DBT (p = 0.41). DBT demonstrated greater efficacy compared with the control group in improving emotion dysregulation, ED psychopathology, and BMI in ED. The limitations included the small number of studies and high variability.
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Moreno-Lavaho SM, Mendoza-Muñoz M, Adsuar JC, Carlos-Vivas J, Rojo-Ramos J, Manzano-Redondo F, Pérez-Gómez J. Validation of a Physical Activity and Health Questionnaire Evaluating Knowledge of WHO Recommendations among Colombians. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:3526. [PMID: 33805338 PMCID: PMC8037879 DOI: 10.3390/ijerph18073526] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/18/2021] [Accepted: 03/25/2021] [Indexed: 11/20/2022]
Abstract
Knowledge of physical activity (PA) can be considered a predictor of public health for society. Thus, this study aims to show content validity of the "Knowledge Questionnaire on World Health Organization (WHO) Recommendations on PA and Health" (CUAFYS-A) and reference values on adults' knowledge of the WHO recommendations on PA. This is a quantitative, non-experimental, descriptive, and cross-sectional study, in which 579 adults completed an online questionnaire with demographic data. The questionnaire was made up of 9 items to measure PA related to knowledge. For the elaboration of the items of the questionnaire a disciplinary team formed it and for the analysis of results, a descriptive analysis of these was applied. Then an inferential analysis was performed, content validity, construct validity, and reliability were analyzed. The CUAFYS-A after its content analysis, obtained appropriate results in terms of pertinence and relevance; additionally, it showed Cronbach's alpha coefficient of 0.62. Thereby, it was concluded the CUAFYS-A questionnaire proved to be a valid and reliable instrument to show reference values and to evaluate the knowledge of adults of PA and health according to the WHO recommendations.
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Affiliation(s)
| | - María Mendoza-Muñoz
- Health, Economy, Motricity and Education Research Group (HEME), Faculty of Sport Sciences, University of Extremadura, 10003 Cáceres, Spain; (M.M.-M.); (J.C.A.); (J.C.-V.); (J.R.-R.); (J.P.-G.)
| | - José C. Adsuar
- Health, Economy, Motricity and Education Research Group (HEME), Faculty of Sport Sciences, University of Extremadura, 10003 Cáceres, Spain; (M.M.-M.); (J.C.A.); (J.C.-V.); (J.R.-R.); (J.P.-G.)
| | - Jorge Carlos-Vivas
- Health, Economy, Motricity and Education Research Group (HEME), Faculty of Sport Sciences, University of Extremadura, 10003 Cáceres, Spain; (M.M.-M.); (J.C.A.); (J.C.-V.); (J.R.-R.); (J.P.-G.)
| | - Jorge Rojo-Ramos
- Health, Economy, Motricity and Education Research Group (HEME), Faculty of Sport Sciences, University of Extremadura, 10003 Cáceres, Spain; (M.M.-M.); (J.C.A.); (J.C.-V.); (J.R.-R.); (J.P.-G.)
| | - Fernando Manzano-Redondo
- Health, Economy, Motricity and Education Research Group (HEME), Faculty of Sport Sciences, University of Extremadura, 10003 Cáceres, Spain; (M.M.-M.); (J.C.A.); (J.C.-V.); (J.R.-R.); (J.P.-G.)
| | - Jorge Pérez-Gómez
- Health, Economy, Motricity and Education Research Group (HEME), Faculty of Sport Sciences, University of Extremadura, 10003 Cáceres, Spain; (M.M.-M.); (J.C.A.); (J.C.-V.); (J.R.-R.); (J.P.-G.)
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Dol A, Bode C, Velthuijsen H, van Strien T, van Gemert-Pijnen L. Application of three different coaching strategies through a virtual coach for people with emotional eating: a vignette study. J Eat Disord 2021; 9:13. [PMID: 33446275 PMCID: PMC7809774 DOI: 10.1186/s40337-020-00367-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 12/29/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Around 13% of the world's population suffers from obesity. More than 40% of people with obesity display emotional eating behaviour (eating in response to negative emotions or distress). It is an alternate to more effective coping strategies for negative emotions. Our study explored the opportunities for helping adults with emotional overeating using a virtual coach, aiming to identify preferences for tailored coaching strategies applicable in a personal virtual coach environment. Three different coaching strategies were tested: a validating, a focus-on-change, and a dialectical one - the latter being a synthesis of the first two strategies. METHODS A qualitative study used vignettes reflecting the two most relevant situations for people with emotional eating: 1. experiencing negative emotions, with ensuing food cravings; and 2. after losing control to emotional eating, with ensuing feelings of low self-esteem. Applied design: 2 situations × 3 coaching strategies. PARTICIPANTS 71 adult women (Mage 44.4/years, range 19-70, SD = 12.86) with high scores on the DEBQ-emotional eating scale (Memo 3.65, range 1.69-4.92, SD = .69) with mean BMI 30.1 (range 18-46, SD = 6.53). They were recruited via dieticians' practices, were randomly assigned to the conditions and asked how they would face and react to the presented coaching strategies. Data were transcribed and a thematic analysis was conducted. RESULTS Qualitative results showed that participants valued both the validating coaching strategy and the focus-on-change strategy, but indicated that a combination of validation and focus-on-change provides both mental support and practical advice. Data showed that participants differed in their level of awareness of the role that emotions play in their overeating and the need for emotion-regulation skills. CONCLUSION The design of the virtual coach should be based on dialectical coaching strategies as preferred by participants with emotional eating behaviour. It should be tailored to the different stages of awareness of their emotions and individual emotion-regulation skills.
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Affiliation(s)
- Aranka Dol
- Department of Psychology, Health and Technology, Faculty of Behavioural, Management and Social Sciences (BMS), University of Twente, De Zul 10, 7522 NJ Enschede, The Netherlands
| | - Christina Bode
- Department of Psychology, Health and Technology, Faculty of Behavioural, Management and Social Sciences (BMS), University of Twente, De Zul 10, 7522 NJ Enschede, The Netherlands
| | - Hugo Velthuijsen
- Institute for Communication, Media & IT, Hanze University, Groningen, The Netherlands
| | - Tatjana van Strien
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | - Lisette van Gemert-Pijnen
- Department of Psychology, Health and Technology, Faculty of Behavioural, Management and Social Sciences (BMS), University of Twente, De Zul 10, 7522 NJ Enschede, The Netherlands
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Lawlor ER, Islam N, Bates S, Griffin SJ, Hill AJ, Hughes CA, Sharp SJ, Ahern AL. Third-wave cognitive behaviour therapies for weight management: A systematic review and network meta-analysis. Obes Rev 2020; 21:e13013. [PMID: 32181957 PMCID: PMC7379202 DOI: 10.1111/obr.13013] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 01/28/2020] [Accepted: 02/06/2020] [Indexed: 12/30/2022]
Abstract
This systematic review and network meta-analysis synthesized evidence on the effects of third-wave cognitive behaviour therapies (3wCBT) on body weight, and psychological and physical health outcomes in adults with overweight or obesity. Studies that included a 3wCBT for the purposes of weight management and measured weight or body mass index (BMI) pre-intervention and ≥ 3 months post-baseline were identified through database searches (MEDLINE, CINAHL, Embase, Cochrane database [CENTRAL], PsycINFO, AMED, ASSIA, and Web of Science). Thirty-seven studies were eligible; 21 were randomized controlled trials (RCT) and included in the network meta-analyses. Risk of bias was assessed using RoB2, and evidence quality was assessed using GRADE. Random-effects pairwise meta-analysis found moderate- to high-quality evidence suggesting that 3wCBT had greater weight loss than standard behavioural treatment (SBT) at post-intervention (standardized mean difference [SMD]: -0.09, 95% confidence interval [CI]: -0.22, 0.04; N = 19; I2 = 32%), 12 months (SMD: -0.17, 95% CI: -0.36, 0.02; N = 5; I2 = 33%), and 24 months (SMD: -0.21, 95% CI: -0.42, 0.00; N = 2; I2 = 0%). Network meta-analysis compared the relative effectiveness of different types of 3wCBT that were not tested in head-to-head trials up to 18 months. Acceptance and commitment therapy (ACT)-based interventions had the most consistent evidence of effectiveness. Only ACT had RCT evidence of effectiveness beyond 18 months. Meta-regression did not identify any specific intervention characteristics (dose, duration, delivery) that were associated with greater weight loss. Evidence supports the use of 3wCBT for weight management, specifically ACT. Larger trials with long-term follow-up are needed to identify who these interventions work for, their most effective components, and the most cost-effective method of delivery.
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Affiliation(s)
| | - Nazrul Islam
- MRC Epidemiology UnitUniversity of CambridgeCambridgeUK
| | - Sarah Bates
- School of Health and Related Research, Faculty of Medicine, Dentistry and HealthUniversity of SheffieldSheffieldUK
| | - Simon J. Griffin
- MRC Epidemiology UnitUniversity of CambridgeCambridgeUK
- Primary Care Unit, Institute of Public HealthUniversity of CambridgeCambridgeUK
| | - Andrew J. Hill
- Division of Psychological and Social Medicine, School of MedicineUniversity of LeedsLeedsUK
| | - Carly A. Hughes
- Fakenham Medical PracticeNorfolkUK
- Norwich Medical SchoolUniversity of East AngliaNorwichUK
| | | | - Amy L. Ahern
- MRC Epidemiology UnitUniversity of CambridgeCambridgeUK
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Braden A, Ferrell E, Redondo R, Watford T. Dialectical Behavior Therapy Skills and Behavioral Weight Loss for Emotional Eating and Obesity: A Case Study. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2020. [DOI: 10.1007/s10879-020-09451-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Cancian ACM, de Souza LAS, Liboni RPA, Machado WDL, Oliveira MDS. Effects of a dialectical behavior therapy-based skills group intervention for obese individuals: a Brazilian pilot study. Eat Weight Disord 2019; 24:1099-1111. [PMID: 29197947 DOI: 10.1007/s40519-017-0461-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Accepted: 10/30/2017] [Indexed: 11/28/2022] Open
Abstract
PURPOSE This pilot study aimed to analyze the effects of an adapted dialectical behavior therapy (DBT) skills training group on problematic and adaptive eating behaviors in Brazilian obese individuals. METHODS Thirty-one obese individuals were randomly assigned to 10 sessions of adapted DBT skills training (n = 14) or two months of a waiting list comparison condition (n = 17). RESULTS Attrition rates were similar to what's been found in comparable studies, with most dropouts happening at the beginning of the treatment. Results showed improvements in binge eating severity (d = 0.80) and depression (d = 0.82) compared to no treatment condition. After the intervention, adaptive eating and distress outcomes showed an improvement trend, reaching nonclinical levels for most participants in the intervention group. Large to moderate between-group effect sizes were observed, but none of those were statistically significant. Large within-group effect sizes were observed in the intervention group in binge eating severity (d = 1.34), intuitive eating (d = 1.33) and depression (d = 1.12). Medium effect sizes were observed in emotional eating (d = 0.73) and in emotion regulation (d = 0.72). Despite positive outcomes in other variables, mindful eating worsened after the intervention (d = 0.66). CONCLUSIONS These results are preliminary and require further replications with larger samples, yet they suggest that the intervention may be useful to improve distress outcomes and adaptive eating among obese people. Implications for clinical practice and recommendations for future research are discussed. LEVEL OF EVIDENCE Level I, randomized controlled trial.
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Affiliation(s)
- Ana Carolina Maciel Cancian
- Pontifícia Universidade Católica do Rio Grande do Sul, Av. Ipiranga, 6681 Partenon, Porto Alegre, Rio Grande Do Sul, 90619-900, Brazil.
| | - Lucas André Schuster de Souza
- Pontifícia Universidade Católica do Rio Grande do Sul, Av. Ipiranga, 6681 Partenon, Porto Alegre, Rio Grande Do Sul, 90619-900, Brazil
| | - Ronald Patrick Araujo Liboni
- Pontifícia Universidade Católica do Rio Grande do Sul, Av. Ipiranga, 6681 Partenon, Porto Alegre, Rio Grande Do Sul, 90619-900, Brazil
| | | | - Margareth da Silva Oliveira
- Pontifícia Universidade Católica do Rio Grande do Sul, Av. Ipiranga, 6681 Partenon, Porto Alegre, Rio Grande Do Sul, 90619-900, Brazil
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Beaulac J, Sandre D, Mercer D. Impact on mindfulness, emotion regulation, and emotional overeating of a DBT skills training group: a pilot study. Eat Weight Disord 2019; 24:373-377. [PMID: 30443799 DOI: 10.1007/s40519-018-0616-9] [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: 05/30/2018] [Accepted: 11/07/2018] [Indexed: 12/19/2022] Open
Abstract
PURPOSE The current study investigated the impact of a modified Dialectical Behavior Therapy skills (DBT) training group for patients at a hospital outpatient weight management clinic. Emotional eating is a problematic strategy for managing unpleasant feelings that can have a deleterious impact on weight management. DBT addresses emotional dysregulation via incorporation of skills aimed at coping with unpleasant affect. METHODS This study examines outcomes for 18 patients who participated in a 12-week DBT skills building group. A pre-post design with 3-month follow-up investigated the impact of the group on emotional eating, psychological distress, emotion regulation, and mindfulness. RESULTS Four repeated measures ANOVAs were run to assess for changes related to life difficulties and functioning, emotional overeating, emotion regulation, and mindfulness. Fisher's LSD tests assessed for linear and quadratic trends. Improvements in mindfulness, emotion regulation, and emotional overeating were found; these were maintained at follow-up. CONCLUSIONS This study demonstrated the utility of a group-based intervention aimed at improving emotion regulation and mindfulness skills among weight management patients. Further study is needed to determine whether improvements in the constructs studied in this research would translate to improved weight management outcomes and in determining the pathway for improvements. LEVEL OF EVIDENCE Level IV, multiple time series with intervention.
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Affiliation(s)
- Julie Beaulac
- Department of Psychology, The Ottawa Hospital, 501 Smyth Road, Room 7300 General Campus, Ottawa, ON, K1H 8L6, Canada. .,The Ottawa Hospital Research Institute, Ottawa, Canada.
| | - Daniella Sandre
- Department of Psychology, The Ottawa Hospital, 501 Smyth Road, Room 7300 General Campus, Ottawa, ON, K1H 8L6, Canada
| | - Deanna Mercer
- Department of Psychiatry, The Ottawa Hospital, Ottawa, Canada.,Department of Psychiatry, University of Ottawa, Ottawa, Canada
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Konttinen H, van Strien T, Männistö S, Jousilahti P, Haukkala A. Depression, emotional eating and long-term weight changes: a population-based prospective study. Int J Behav Nutr Phys Act 2019; 16:28. [PMID: 30894189 PMCID: PMC6427874 DOI: 10.1186/s12966-019-0791-8] [Citation(s) in RCA: 121] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 03/11/2019] [Indexed: 12/27/2022] Open
Abstract
Background Emotional eating (i.e. eating in response to negative emotions) has been suggested to be one mechanism linking depression and subsequent development of obesity. However, studies have rarely examined this mediation effect in a prospective setting and its dependence on other factors linked to stress and its management. We used a population-based prospective cohort of adults and aimed to examine 1) whether emotional eating mediated the associations between depression and 7-year change in body mass index (BMI) and waist circumference (WC), and 2) whether gender, age, night sleep duration or physical activity moderated these associations. Methods Participants were Finnish 25- to 74-year-olds who attended the DILGOM study at baseline in 2007 and follow-up in 2014. At baseline (n = 5024), height, weight and WC were measured in a health examination. At follow-up (n = 3735), height, weight and WC were based on measured or self-reported information. Depression (Center for Epidemiological Studies - Depression Scale), emotional eating (Three-Factor Eating Questionnaire-R18), physical activity and night sleep duration were self-reported. Age- and gender-adjusted structural equation models with full information maximum likelihood estimator were used in the analyses. Results Depression and emotional eating were positively associated and they both predicted higher 7-year increase in BMI (R2 = 0.048) and WC (R2 = 0.045). The effects of depression on change in BMI and WC were mediated by emotional eating. Night sleep duration moderated the associations of emotional eating, while age moderated the associations of depression. More specifically, emotional eating predicted higher BMI (P = 0.007 for the interaction) and WC (P = 0.026, respectively) gain in shorter sleepers (7 h or less), but not in longer sleepers (9 h or more). Depression predicted higher BMI (P < 0.001 for the interaction) and WC (P = 0.065, respectively) increase in younger participants, but not in older participants. Conclusions Our findings offer support for the hypothesis that emotional eating is one behavioural mechanism between depression and development of obesity and abdominal obesity. Moreover, adults with a combination of shorter night sleep duration and higher emotional eating may be particularly vulnerable to weight gain. Future research should examine the clinical significance of our observations by tailoring weight management programs according to these characteristics. Electronic supplementary material The online version of this article (10.1186/s12966-019-0791-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hanna Konttinen
- Department of Food and Nutrition, P.O. Box 66, 00014 University of Helsinki, Helsinki, Finland. .,Faculty of Social Sciences, P.O. Box 54, 00014 University of Helsinki, Helsinki, Finland.
| | - Tatjana van Strien
- Behavioural Science Institute, Radboud University Nijmegen, P.O. Box 9104, 6500 HE, Nijmegen, The Netherlands.,Department of Health Sciences, Faculty of Science, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, 1081 HV, Amsterdam, The Netherlands
| | - Satu Männistö
- Department of Public Health Solutions, National Institute for Health and Welfare, P.O. Box 30, 00271, Helsinki, Finland
| | - Pekka Jousilahti
- Department of Public Health Solutions, National Institute for Health and Welfare, P.O. Box 30, 00271, Helsinki, Finland
| | - Ari Haukkala
- Faculty of Social Sciences, P.O. Box 54, 00014 University of Helsinki, Helsinki, Finland
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de Souza LAS, Cancian ACM, de Castro TG, da Silva Oliveira M. Problematic and adaptive eating in people with obesity after a DBT-based skills training intervention: 3- and 8-month follow-up and mediation analysis. ACTA ACUST UNITED AC 2019; 32:1. [PMID: 32026132 PMCID: PMC6967300 DOI: 10.1186/s41155-019-0116-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 01/02/2019] [Indexed: 11/18/2022]
Abstract
Background Dialectical behavior therapy conceptualizes problematic behaviors as attempts to regulate emotions that occur when the individual lacks effective skills with which to manage his or her emotions and cope with distress. Problematic eating behaviors, e.g., binge and emotional eating, may serve to alleviate aversive emotional states, being highly associated with overweight and obesity. Dialectical behavior therapy skills training has been proven effective in reducing binge eating in several clinical studies. However, few studies reveal the effects of DBT on adaptive eating behaviors or the stability of outcomes. Objectives This study aimed to test the effect of a brief DBT-based skills training intervention, and the stability of outcomes at 3- and 8-month follow-ups. Methods Self-report measures of binge eating, emotional eating, intuitive eating, and mindful eating were taken on 5 timepoints before and after a 10-session DBT skills training intervention (2 baseline measures, 1 post-test, and 2 follow-ups). Data were analyzed using a mixed-model intention-to-treat approach and mediation analysis was conducted with path analysis. Results After the intervention, intuitive eating and mindful eating scores were significantly higher than before the intervention, while emotional eating and binge eating scores were lower. The results remained stable during the follow-up period, with minor fluctuations and small trends towards returning to baseline values for binge eating and emotional eating. Mindful eating partially mediated the improvements in all outcomes. Limitations Given that results are entirely based on self-report measures and that some instruments showed poor reliability, in addition to the high attrition rates, the results should be interpreted as preliminary. Conclusions The results provide evidence that a brief DBT intervention is effective not only in reducing problematic eating but also in increasing adaptive eating, achieving reasonably stable results. Also, the mediation analysis results support the hypothesis that mindful eating partially explains the effects of the intervention on binge and emotional eating. Future research should address the limitations of this study by investigating a more diverse sample, triangulating different measurement strategies, and including other putative mediators.
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Affiliation(s)
- Lucas André Schuster de Souza
- Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Avenida Ipiranga, 6681, Prédio 11, 9° Andar, Sala 927, Partenon, Porto Alegre, RS, 90619-900, Brazil.
| | - Ana Carolina Maciel Cancian
- Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Avenida Ipiranga, 6681, Prédio 11, 9° Andar, Sala 927, Partenon, Porto Alegre, RS, 90619-900, Brazil
| | - Thiago Gomes de Castro
- Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2600-Sala 123, Rio Branco, Porto Alegre, RS, 90035003, Brazil
| | - Margareth da Silva Oliveira
- Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Avenida Ipiranga, 6681, Prédio 11, 9° Andar, Sala 927, Partenon, Porto Alegre, RS, 90619-900, Brazil
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15
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Linardon J, Gleeson J, Yap K, Murphy K, Brennan L. Meta-analysis of the effects of third-wave behavioural interventions on disordered eating and body image concerns: implications for eating disorder prevention. Cogn Behav Ther 2018; 48:15-38. [DOI: 10.1080/16506073.2018.1517389] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Jake Linardon
- School of Psychology, Deakin University, Burwood, Australia
| | - John Gleeson
- School of Psychology, Faculty of Health Sciences, Australian Catholic University, Melbourne, Australia
| | - Keong Yap
- School of Psychology, Faculty of Health Sciences, Australian Catholic University, Melbourne, Australia
| | - Kylie Murphy
- Centre for Eating, Weight and Body Image, Melbourne, Australia
| | - Leah Brennan
- School of Psychology, Faculty of Health Sciences, Australian Catholic University, Melbourne, Australia
- Centre for Eating, Weight and Body Image, Melbourne, Australia
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16
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Soler J, Cebolla A, Elices M, Campos D, Llorca G, Martínez-Rubio D, Martínez-Brotóns C, Jorquera M, Allirot X, Carmona C, Guillen V, Botella C, Baños RM. Direct Experience While Eating in a Sample With Eating Disorders and Obesity. Front Psychol 2018; 9:1373. [PMID: 30245645 PMCID: PMC6137958 DOI: 10.3389/fpsyg.2018.01373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 07/16/2018] [Indexed: 12/03/2022] Open
Abstract
Background: Individuals with eating disorders might be characterized by lower levels of direct engagement with the eating experience. This study aims to explore similarities and differences in direct experience while eating in four different weight conditions and healthy controls (HCs): anorexia nervosa (AN), bulimia nervosa (BN), eating disorders not otherwise specified (EDNOS), and obesity (OB). Methods: A total sample of 143 women were recruited. Participants were asked to eat an orange slice and write down 10 things about the experience of eating, classifying the focus of these thoughts as either experiential (“direct experience”) or analytical (“thinking about”). A direct experience index (DEI) was calculated by dividing the number of times a participant classified an experience as a “direct experience” (the numerator) by the total number of observations. Participants completed the Five Facet Mindfulness Questionnaire (FFMQ) and rated their level of anxiety after the task. Results: Between-groups significant differences were found on the DEI, with individuals in the OB group scoring higher than AN and BN, and similar to HC. After the task, the AN group reported significantly higher anxiety levels than HC, and EDNOS reported more anxiety than HC and OB. Between-group significant differences were also found for all the FFMQ facets. Conclusion: AN and BN presented lower access to direct experience while eating. Individuals with OB did not respond in the same way as the other clinical groups, showing a similar performance to HC.
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Affiliation(s)
- Joaquim Soler
- Department of Psychiatry, Research Institute of the Sant Pau Hospital, Autonomous University of Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain
| | - Ausiàs Cebolla
- Department of Personality, Assessment and Psychological Treatments, University of Valencia, Valencia, Spain.,CIBERObn Ciber Physiopathology of Obesity and Nutrition, Madrid, Spain
| | - Matilde Elices
- Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain.,Mental Health Research Group, Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - Daniel Campos
- Department of Basic Psychology, Psychobiology and Clinical Psychology, Universitat Jaume I, Castellón de la Plana, Spain.,Instituto de Investigación Sanitaria Aragón, Zaragoza, Spain
| | - Ginés Llorca
- Department of Basic Psychology, Psychobiology and Clinical Psychology, Universitat Jaume I, Castellón de la Plana, Spain.,Consorci Hospitalari Provincial de Castelló, Castellón de la Plana, Spain
| | | | | | | | | | - Cristina Carmona
- Department of Psychiatry, Research Institute of the Sant Pau Hospital, Autonomous University of Barcelona, Barcelona, Spain
| | - Verónica Guillen
- Department of Personality, Assessment and Psychological Treatments, University of Valencia, Valencia, Spain.,CIBERObn Ciber Physiopathology of Obesity and Nutrition, Madrid, Spain
| | - Cristina Botella
- Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain.,Department of Basic Psychology, Psychobiology and Clinical Psychology, Universitat Jaume I, Castellón de la Plana, Spain
| | - Rosa M Baños
- Department of Personality, Assessment and Psychological Treatments, University of Valencia, Valencia, Spain.,CIBERObn Ciber Physiopathology of Obesity and Nutrition, Madrid, Spain
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17
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Abstract
PURPOSE OF THE REVIEW Eating in response to negative emotions (EE) may be an explanatory factor of the weight regain of many dieters. This narrative review presents evidence on possible causes of EE and the association of EE with depression and obesity and discusses implications of these findings for the treatment of obesity. RECENT FINDINGS Possible causes of EE are high dietary restraint, poor interoceptive awareness, alexithymia, emotion dysregulation and a reversed hypothalamic pituitary adrenal (HPA) stress axis. EE may be the outcome of inadequate parenting or depressive feelings in interaction with genetic susceptibility. There is also robust evidence that EE is a mediator between depression and obesity. The association of EE with depression and poor emotion regulation skills suggests that the treatment of obese people with high EE should not focus on calorie-restricted diets but on emotion regulation skills. The DEBQ (Dutch Eating Behavior Questionnaire) enables such a matched treatment of obesity.
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Affiliation(s)
- Tatjana van Strien
- Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands.
- Department of Health Sciences, Faculty of Science, Amsterdam Public Health research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
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18
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Kockler TD, Tschacher W, Santangelo PS, Limberger MF, Ebner-Priemer UW. Specificity of emotion sequences in borderline personality disorder compared to posttraumatic stress disorder, bulimia nervosa, and healthy controls: an e-diary study. Borderline Personal Disord Emot Dysregul 2017; 4:26. [PMID: 29276606 PMCID: PMC5738798 DOI: 10.1186/s40479-017-0077-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 12/13/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients with borderline personality disorder (BPD) exhibit dysregulated emotion sequences in daily life compared to healthy controls (HC). Empirical evidence regarding the specificity of these findings is currently lacking. METHODS To replicate dysregulated emotion sequences in patients with BPD and to investigate the specificity of the sequences, we used e-diaries of 43 female patients with BPD, 28 patients with posttraumatic stress disorder (PTSD), 20 patients with bulimia nervosa (BN), and 28 HC. To capture the rapid dynamics of emotions, we prompted participants every 15 min over a 24-h period to assess their current perceived emotions. We analyzed group differences in terms of activation, persistence, switches, and down-regulation of emotion sequences. RESULTS By comparing patients with BPD to HC, we replicated five of the seven previously reported dysregulated emotion sequences, as well as 111 out of 113 unaltered sequences. However, none of the previously reported dysregulated emotion sequences exhibited specificity, i.e., none revealed higher frequencies compared to the PTSD group or the BN group. Beyond these findings, we revealed a specific finding for patients with BN, as they most frequently switched from anger to disgust. CONCLUSIONS Replicating previously found dysregulated and unaltered emotional sequences strengthens the significance of emotion sequences. However, the lack of specificity points to emotion sequences as transdiagnostic features.
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Affiliation(s)
- Tobias D Kockler
- Karlsruhe Institute of Technology, Mental mHealth Lab, Karlsruhe, Germany
| | - Wolfgang Tschacher
- University of Bern, University Hospital of Psychiatry, Bern, Switzerland
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19
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Santangelo PS, Limberger MF, Stiglmayr C, Houben M, Coosemans J, Verleysen G, Kuppens P, Tuerlinckx F, Vanpaemel W, Ebner-Priemer UW. Analyzing subcomponents of affective dysregulation in borderline personality disorder in comparison to other clinical groups using multiple e-diary datasets. Borderline Personal Disord Emot Dysregul 2016; 3:5. [PMID: 27386138 PMCID: PMC4934004 DOI: 10.1186/s40479-016-0039-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 06/15/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Affective dysregulation is widely regarded as being the core problem in patients with borderline personality disorder (BPD). Moreover, BPD is the disorder mainly associated with affective dysregulation. However, the empirical confirmation of the specificity of affective dysregulation for BPD is still pending. We used a validated approach from basic affective science that allows for simultaneously analyzing three interdependent components of affective dysregulation that are disturbed in patients with BPD: homebase, variability, and attractor strength (return to baseline). METHODS We applied two types of multilevel models on two e-diary datasets to investigate group differences regarding three subcomponents between BPD patients (n = 43; n = 51) and patients with posttraumatic stress disorder (PTSD; n = 28) and those with bulimia nervosa (BN; n = 20) as clinical control groups in dataset 1, and patients with panic disorder (PD; n = 26) and those with major depression (MD; n = 25) as clinical control groups in dataset 2. In addition, healthy controls (n = 28; n = 40) were included in the analyses. In both studies, e-diaries were used to repeatedly collect data about affective experiences during participants' daily lives. In study 1 a high-frequency sampling strategy with assessments in 15 min-intervals over 24 h was applied, whereas the assessments occurred every waking hour over 48 h in study 2. The local ethics committees approved both studies, and all participants provided written informed consent. RESULTS In contradiction to our hypotheses, BPD patients did not consistently show altered affective dysregulation compared to the clinical patient groups. The only differences in affective dynamics in BPD patients emerged with regard to one of three subcomponents, affective homebase. However, these results were not even consistent. Conversely, comparing the patients to healthy controls revealed a pattern of more negative affective homebases, higher levels of affective variability, and (partially) reduced returns to baseline in the patient groups. CONCLUSIONS Our results indicate that affective dysregulation constitutes a transdiagnostic mechanism that manifests in similar ways in several different mental disorders. We point out promising prospects that might help to elucidate the common and distinctive mechanisms that underlie several different disorders and that should be addressed in future studies.
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Affiliation(s)
| | | | - C. Stiglmayr
- />Consortium for Scientific Psychotherapy Berlin (AWP-Berlin), Berlin, Germany
| | - M. Houben
- />KU Leuven – University of Leuven, Leuven, Belgium
| | - J. Coosemans
- />KU Leuven – University of Leuven, Leuven, Belgium
| | - G. Verleysen
- />KU Leuven – University of Leuven, Leuven, Belgium
| | - P. Kuppens
- />KU Leuven – University of Leuven, Leuven, Belgium
| | | | - W. Vanpaemel
- />KU Leuven – University of Leuven, Leuven, Belgium
| | - U. W. Ebner-Priemer
- />Karlsruhe Institute of Technology, Karlsruhe, Germany
- />Central Institute of Mental Health, Mannheim, Germany
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20
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Braden A, Flatt SW, Boutelle KN, Strong D, Sherwood NE, Rock CL. Emotional eating is associated with weight loss success among adults enrolled in a weight loss program. J Behav Med 2016; 39:727-32. [PMID: 26931635 DOI: 10.1007/s10865-016-9728-8] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 02/19/2016] [Indexed: 10/22/2022]
Abstract
To examine associations between decreased emotional eating and weight loss success; and whether participation in a behavioral weight loss intervention was associated with a greater reduction in emotional eating over time compared to usual care. Secondary data analysis of a randomized controlled trial conducted at two university medical centers with 227 overweight adults with diabetes. Logistic and standard regression analyses examined associations between emotional eating change and weight loss success (i.e., weight loss of ≥7 % of body weight and decrease in BMI). After 6 months of intervention, decreased emotional eating was associated with greater odds of weight loss success (p = .05). The odds of weight loss success for subjects with decreased emotional eating at 12 months were 1.70 times higher than for subjects with increased emotional eating. No differences in change in emotional eating were found between subjects in the behavioral weight loss intervention and usual care. Strategies to reduce emotional eating may be useful to promote greater weight loss among overweight adults with diabetes.
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Affiliation(s)
- Abby Braden
- Department of Psychology, Bowling Green State University, Bowling Green, OH, 43403, USA.
| | - Shirley W Flatt
- Department of Family Medicine and Public Health, University of California, San Diego, San Diego, CA, USA
| | - Kerri N Boutelle
- Department of Pediatrics, University of California, San Diego, San Diego, CA, USA.,Department of Psychiatry, University of California, San Diego, San Diego, CA, USA
| | - David Strong
- Department of Family Medicine and Public Health, University of California, San Diego, San Diego, CA, USA
| | | | - Cheryl L Rock
- Department of Family Medicine and Public Health, University of California, San Diego, San Diego, CA, USA
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21
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Santangelo P, Reinhard I, Mussgay L, Steil R, Sawitzki G, Klein C, Trull TJ, Bohus M, Ebner-Priemer UW. Specificity of affective instability in patients with borderline personality disorder compared to posttraumatic stress disorder, bulimia nervosa, and healthy controls. JOURNAL OF ABNORMAL PSYCHOLOGY 2015; 123:258-72. [PMID: 24661176 DOI: 10.1037/a0035619] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Affective instability is a core feature of borderline personality disorder (BPD). The use of advanced assessment methodologies and appropriate statistical analyses has led to consistent findings that indicate a heightened instability in patients with BPD compared with healthy controls. However, few studies have investigated the specificity of affective instability among patients with BPD with regard to relevant clinical control groups. In this study, 43 patients with BPD, 28 patients with posttraumatic stress disorder (PTSD), 20 patients with bulimia nervosa (BN), and 28 healthy controls carried e-diaries for 24 hours and were prompted to rate their momentary affective states approximately every 15 minutes while awake. To quantify instability, we used 3 state-of-the-art indices: multilevel models for squared successive differences (SSDs), multilevel models for probability of acute changes (PACs), and aggregated point-by-point changes (APPCs). Patients with BPD displayed heightened affective instability for emotional valence and distress compared with healthy controls, regardless of the specific instability indices. These results directly replicate earlier studies. However, affective instability did not seem to be specific to patients with BPD. With regard to SSDs, PACs, and APPCs, patients with PTSD or BN showed a similar heightened instability of affect (emotional valence and distress) to that of patients with BPD. Our results give raise to the discussion if affective instability is a transdiagnostic or a disorder-specific mechanism. Current evidence cannot answer this question, but investigating psychopathological mechanisms in everyday life across disorders is a promising approach to enhance validity and specificity of mental health diagnoses.
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Affiliation(s)
- Philip Santangelo
- Department of Sport and Sport Science, Karlsruhe Institute of Technology
| | - Iris Reinhard
- Department of Biostatistics, Central Institute of Mental Health Mannheim
| | | | - Regina Steil
- Department of Psychology and Sports Sciences, Johann Wolfgang Goethe University
| | - Günther Sawitzki
- Statlab, Institute for Applied Mathematics, University of Heidelberg
| | - Christoph Klein
- Klein, Department of Child and Adolescent Psychiatry and Psychotherapy, Freiburg University
| | - Timothy J Trull
- Department of Psychological Sciences, University of Missouri-Columbia
| | - Martin Bohus
- Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University
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