Garrett A. Pollert

Blood alcohol concentrations rise rapidly and dramatically after Roux-en-Y gastric bypass

BACKGROUND This study provides new information on how rapidly and extensively alcohol is absorbed after Roux-en-Y gastric bypass (RYGB). Previous alcohol pharmacokinetic research in RYGB patients has not reported blood alcohol concentrations in this early time period after ingestion. The objective of this study was to examine the rate and extent of alcohol absorption, particularly in the first 10 minutes after a dose of alcohol. METHODS Five female participants who had undergone RYGB 3 to 4 years previously completed the study. Participants were given .3 g/kg of actual weight of ethanol. After the dose of alcohol, blood samples were collected through an indwelling intravenous catheter every minute for the first 5 minutes and at 7.5, 10, 20, and 60 minutes. RESULTS The observed mean Cmax was 138.4±28.6 mg/dL (range 98.0-170.0 mg/dL), and the observed mean Tmax was 5.4±3.1 minutes (range 2-10 minutes) after alcohol consumption. CONCLUSIONS Within minutes after consumption of a beverage containing a modest amount of alcohol, post-RYGB patients achieve disproportionately high blood alcohol concentrations. All 5 participants in this study reached blood alcohol concentrations>.08%, the legal driving limit in the United States, within 10 minutes after a dose of alcohol. Clinicians are encouraged to educate patients about the marked changes in alcohol pharmacokinetics that are they are likely to experience after RYGB and to guide patients in making modifications to alcohol intake after surgery accordingly.

The role of eating and emotion in binge eating disorder and loss of control eating.

OBJECTIVE Binge eating, defined as the consumption of large amounts of food during which a sense of loss of control (LOC) is experienced, is associated with negative affect. However, there are no data on the experience of LOC after accounting for the effects of negative affect and caloric intake. METHOD Nine adult patients with binge eating disorder (BED) and 13 obese nonbinge eating disorder (NBED) participants carried a palmtop computer for 7 days, rating momentary mood and sense of LOC multiple times each day. Electronic food logs were collected once daily. RESULTS After removing the effects of caloric intake and negative affect, a significant group difference was observed for ratings of LOC between BED and NBED participants. DISCUSSION These findings suggest the experience of LOC in adults with BED is a salient feature of binge episodes, beyond that explained by caloric intake and momentary affect.

Multidimensional assessment of beliefs about emotion: development and validation of the emotion and regulation beliefs scale.

Recent work has extended the idea of implicit self-theories to the realm of emotion to assess beliefs in the malleability of emotions. The current article expanded on prior measurement of emotion beliefs in a scale development project. Items were tested and revised over rounds of data collection with both students and nonstudent adult online participants. Exploratory and confirmatory factor analyses revealed a three-factor structure. The resulting scale, the Emotion and Regulation Beliefs Scale, assesses beliefs that emotions can hijack self-control, beliefs that emotion regulation is a worthwhile pursuit, and beliefs that emotions can constrain behavior. Preliminary findings suggest that the Emotion and Regulation Beliefs Scale has good internal consistency, is conceptually distinct from measures assessing individuals’ beliefs in their management of emotions and facets of emotional intelligence, and predicts clinically relevant outcomes even after controlling for an existing short measure of beliefs in emotion controllability.

Behavioral Assessment of the Negative Emotion Aspect of Distress Tolerance

The current behavioral tasks assessing distress tolerance measure tolerance to frustration and tolerance to physical discomfort, but do not explicitly assess tolerance to negative emotion. We closely evaluated the conceptual distinctions between current behavioral tasks and self-report tasks assessing distress tolerance, and then developed a new behavioral distress tolerance task called the Emotional Image Tolerance (EIT) task. The EIT task retains elements of existing behavioral tasks (e.g., indices of persistence) while augmenting the reliability and content sufficiency of existing measures by including multiple trials, including a variety of negative affect stimuli, and separating overall task persistence from task persistence after onset of distress. In a series of three studies, we found that the EIT correlated with extant behavioral measures of distress tolerance, the computerized mirror-tracing task and a physical cold pressor task. Across all of the studies, we also evaluated whether the EIT correlated with self-report measures of distress tolerance and measures of psychopathology (e.g., depression, anxiety, and binge eating). Implications for the refinement of the distress tolerance construct are discussed.

Symptoms of Psychopathology Within Groups of Eating-Disordered, Restrained Eating, and Unrestrained Eating Individuals

OBJECTIVE While eating-disordered individuals have shown high levels of comorbid psychopathology, there has not been an assessment of these symptoms across groups exhibiting different forms of problematic eating behavior. METHOD Using 1,122 participants recruited via Amazon Mechanical Turk, this study examined self-reported differences between controls, restrained eaters, and individuals meeting criteria for binge eating disorder and bulimia nervosa on several measures of psychopathology unrelated to eating. RESULTS On nearly all outcome measures, eating-disordered participants had greater symptoms of psychopathology compared to restrained eaters, who had greater levels compared to controls. Among the eating-disordered participants, bulimia nervosa participants had more symptoms of psychopathology than binge eating-disordered participants. CONCLUSION Treatment of the populations included in this study may be informed by an understanding of the different amounts of symptoms of comorbid psychopathology that confer additional distress and impairment above and beyond disordered eating behavior.

Self-regulatory predictors of eating disorder symptoms: Understanding the contributions of action control and willpower beliefs

Action orientation, or the ability to regulate both positive and negative affect to perform goal-directed action, has been associated with eating behavior in previous research. Additionally, differences in beliefs about self-control have been shown to influence behavior, but it is unclear how these beliefs impact disordered eating behavior or how they may interact with other self-regulatory mechanisms to predict eating outcomes. In this study, 1128 participants were recruited online via Amazon Mechanical Turk to answer questions about self-regulation constructs and eating behavior. A three-way moderated regression analysis was used to assess relationships between two subtypes of action orientation (failure-related action orientation, or AOF, which describes an ability to up-regulate positive affect, and decision-related action orientation, or AOD, which describes an ability to down-regulate negative affect), willpower beliefs, and binge eating. Results revealed a significant three-way interaction between AOD, AOF, and willpower beliefs such that the interaction between AOF and willpower beliefs was only significant for those with low AOD. These findings suggest an ability to down-regulate negative affect (high AOF) is a protective factor against increased disordered eating, though this may not be the case for individuals with an inability to up-regulate positive affect (low AOD) and simultaneously ascribe to beliefs that willpower is a limited resource.

Quit interest influences smoking cue-reactivity

Interest in quitting smoking is important to model in cue-reactivity studies, because the craving elicited by cue exposure likely requires different self-regulation efforts for smokers who are interested in quitting compared to those without any quit interest. The objective of the current study was to evaluate the role of quit interest in how cigarette cue exposure influences self-control efforts. Smokers interested in quitting (n=37) and smokers with no interest in quitting (n=53) were randomly assigned to a cigarette or neutral cue exposure task. Following the cue exposure, all participants completed two self-control tasks, a measure of risky gambling (the Iowa Gambling Task) and a cold pressor tolerance task. Results indicated that smokers interested in quitting had worse performance on the gambling task when exposed to a cigarette cue compared to neutral cue exposure. We also found that people interested in quitting tolerated the cold pressor task for a shorter amount of time than people not interested in quitting. Finally, we found that for people interested in quitting, exposure to a cigarette cue was associated with increased motivation to take steps toward decreasing use. Overall these results suggest that including quit interest in studies of cue reactivity is valuable, as quit interest influenced smoking cue-reactivity responses.

The dynamics of persisting through distress: Development of a Momentary Distress Intolerance Scale using ecological momentary assessment.

Distress tolerance, or the ability to withstand uncomfortable states, is thought to be a transdiagnostic risk factor for psychopathology. Distress tolerance is typically measured using self-report questionnaires or behavioral tasks, both of which construe distress tolerance as a trait and downplay the potential variability in distress tolerance across time and situation. The aim of the current study was to provide a method for assessing momentary distress tolerance using ecological momentary assessment to capture both within- and between-individual information. Participants (n = 86) responded to random prompts on their cell phones seven times per day for one week, which included 10 momentary distress tolerance items as well as momentary emotion. After examining item distributions and interclass correlations, we conducted a multilevel exploratory factor analysis using both within-individual and between-individual data to arrive at a brief, 3-item measure we call the Momentary Distress Intolerance Scale. Model fit and reliability indices were good for both within- and between-individual approaches. We found that distress tolerance varied significantly over time, and that average momentary distress intolerance and instability in momentary distress intolerance were associated with trait distress tolerance, emotion dysregulation and tendencies to use experiential avoidance. Neither average momentary distress intolerance nor instability in momentary distress intolerance correlated with behavioral distress tolerance tasks. We discuss the importance of construing distress tolerance from a dynamic perspective and provide recommendations toward future research.

Attentional bias is more predictive of eating behavior after self-control exertion

There is experimental evidence to suggest that attentional bias to food stimuli may predict food intake. The process model of ego-depletion (Inzlicht & Schmeichel, 2012) proposes that after self-control exertion, attention shifts toward rewarding objects such as palatable food, which in turn should prompt greater food consumption as an indicator of lower self-control. In the current study, 84 female restrained and unrestrained eaters engaged in a self-control or neutral task, followed by a measure of attentional bias and an eating task. Results indicated there were no differences in attentional bias or amount eaten between self-control conditions and dietary restraint groups. However, a moderated regression showed that attentional bias toward food or self-control images predicted eating behavior only in participants who previously exerted self-control, while no effect was found for participants in the neutral condition. These results suggest that attentional bias may predict food intake, but only for individuals who have previously exerted self-control.