Lisa M. Anderson

An idiographic analysis of change processes in the unified transdiagnostic treatment of depression.

UNLABELLED Idiographic research methods can provide rich information regarding the process of change in specific treatments. OBJECTIVE Adopting an idiographic, exploratory approach, this study examined (a) temporal patterns of 3 transdiagnostic change constructs (mindfulness, cognitive reappraisal, and emotion avoidance), (b) the relationships between these constructs and depression and anxiety symptom severity over time, and (c) changes in these constructs in relation to the introduction of specific transdiagnostic intervention strategies in a single case. METHOD The case was a 64-year-old, White, female patient with principal major depressive disorder and secondary generalized anxiety disorder being treated with the Unified Protocol (UP). Univariate and multivariate time series analyses were applied to symptom and change construct data. RESULTS (a) Clinically significant decreases in depression and anxiety from baseline to posttreatment were observed, as well as clinically significant increases in mindfulness and reappraisal; (b) changes in mindfulness were associated with changes in depression and anxiety, and changes in mindfulness temporally preceded changes in depression and anxiety; (c) changes in reappraisal were associated with changes in depression, and changes in reappraisal temporally preceded changes in depression; (d) the UP module designed to increase present-focused emotion awareness exerted the strongest influence on mindfulness ratings, although other modules had an impact; (e) reappraisal ratings were most strongly influenced by the emotion monitoring and functional analysis module, although subsequent modules continued to have a measureable impact. CONCLUSIONS Although specific to this case, these results begin to elucidate important processes of change in transdiagnostic cognitive-behavioral therapy for principal depression with comorbid anxiety.

Dietary restraint: what's the harm? A review of the relationship between dietary restraint, weight trajectory and the development of eating pathology

Dietary restraint has historically been implicated as a risk factor for the development of eating pathology. Despite existing findings, recent research suggests that many individuals are capable of practicing dietary restraint without negative effects. In order to successfully incorporate the positive aspects of dietary restraint into interventions for healthy weight management, a nuanced examination of the relationship between dietary restraint and resulting eating patterns is necessary. Accordingly, the current review seeks to clarify the existing literature with regard to dietary restraint. First, this review examines the construct of dietary restraint and differentiates dietary restraint from related constructs, such as weight loss dieting. Second, it identifies situations in which dietary restraint has been linked with positive outcomes, such as healthy weight management and prevention of eating pathology. Altogether, it appears that dietary restraint can prove a beneficial strategy for those attempting to control their weight, as it does not relate to increased levels of eating pathology when practiced as part of a well‐validated weight management programme.

Patterns of Compensatory Behaviors and Disordered Eating in College Students.

Abstract. Objective: The current study investigated rates of endorsement of eating-related compensatory behaviors within a college sample. Participants: This sample included male and female students (N = 1,158). Methods: Participants completed the Eating Disorder Examination Questionnaire (EDE-Q). The study defined 3 groups of students: those who did not endorse purging behaviors, those who endorsed only exercise, and those who endorsed laxative use or vomiting. Rates of related eating disorder risk variables were compared across the 3 groups. Results: Almost half of college students reported utilizing exercise as a compensatory strategy over the past 28 days. Those reporting compensatory exercise did not differ from other community and college samples on EDE-Q subscales. Conclusions: Findings suggest that college students report significant rates of compensatory exercise, and those who report exercise as their only compensatory behavior also report relatively low levels of eating disorder risk.

The impact of meal consumption on emotion among individuals with eating disorders

PurposeThis pilot study sought to determine how meal consumption impacts affective states for treatment-seeking individuals with eating disorders (ED).MethodsParticipants with heterogeneous ED diagnoses completed the State-Trait Anxiety Inventory, Positive and Negative Affect Schedule, and Profile of Mood States measures before and immediately after meal consumption.ResultsMeal consumption was associated with significant decreases in negative affect and total mood disturbance for individuals with binge eating disorder (BED). Decreases in negative affect across meal time for individuals with BED were significantly different from increases in negative affect for participants with anorexia nervosa (AN) and bulimia nervosa (BN).ConclusionFindings indicate that individuals with BED have significantly different affective responses to eating non-binge meals than individuals with AN or BN. Data suggest changes in negative affect following meal consumption may be specific to certain ED diagnoses. Results provide preliminary evidence consistent with the idea that emotion states may function as maintenance mechanisms for psychopathology among ED diagnoses. Limitations and future directions pertaining to food–mood relationships for individuals with ED are discussed.

Gender-based differential item functioning in common measures of body dissatisfaction

Many widely used measures of body image were developed using all-female samples and thus may not adequately capture the male experience of body dissatisfaction. The current study examined differential item functioning (DIF) in three commonly-used measures of body image: The Body Shape Questionnaire (N=590, 39.7% male), the Body Dissatisfaction subscale of the Eating Disorders Inventory (N=529, 44.6% male), and the Shape and Weight Concern subscales of the Eating Disorders Examination Questionnaire (N=1116, 43.5% male). Participants completed a series of measures evaluating body image and eating pathology. Results evidenced statistically significant DIF in several of the items; one item met criteria for clinically significant DIF. While most items did not evidence clinically elevated levels of DIF, additional evaluation is necessary in order to determine overall quality of the measures in terms of capturing the experience of male body image concerns.

Running to win or to be thin? An evaluation of body dissatisfaction and eating disorder symptoms among adult runners.

The current study evaluated associations between sport-performance-related body dissatisfaction (BD), general-appearance-related BD, and their relation to EAT-26 scores among a sample of adult runners who participated in middle- and long-distance races in the northeastern United States (N=400, 46.5% male). Women reported elevated BD and eating disorder symptoms, as compared to men. Ridge regression was used to analyze correlations between appearance- and performance-related BD with EAT-26 scores. Results demonstrated that appearance- and performance-related BD positively correlated with EAT-26 scores in women (βs=0.18 and 0.13, respectively). Race length was a significant covariate for women, such that those who ran middle-distance race events were more likely to report higher EAT-26 scores (β=-3.12). These associations were not demonstrated in men. Results suggest that it is beneficial to address sport-specific body image concerns, in addition to more general appearance-related body image concerns in female runners.

Binge Eating Disorder

Despite the fact that Binge Eating Disorder was only recently introduced as a formal diagnosis in the Diagnostic and Statistical Manual for Mental Disorders (DSM-5), there has been a substantial amount of research over the past decade investigating the prevalence, etiology, and treatment of binge eating and loss of control eating behaviors in children and adolescents. The present chapter provides a summary of the current literature on binge eating, loss of control eating, and overeating behaviors in youth. In particular, we aim to (1) provide an overview of different terms and definitions used in the study of binge eating and loss of control eating, (2) outline available assessment tools for measuring binge eating within child and adolescent populations, (3) review existing research in the etiology and treatment of binge eating behaviors in youth, and (4) discuss important trends in symptom presentation and course within this population. Overall, we hope to provide an informative summary of current work regarding eating-disordered behaviors in children, with the larger intent of highlighting the areas in which future research can enhance our understanding and treatment of this debilitating condition.

Participation as a leader in immersion weight loss treatment: a 1-year follow-up study.

Non‐overweight individuals may follow aggressive weight management approaches alongside overweight/obese friends or family members; thus, research has begun to evaluate subsequent effects among non‐overweight populations. A prior study evaluated the short‐term effects of an immersion weight loss programme on healthy young adult staff leaders. Results indicated that participation seemed to benefit, not harm, the young adults. The current investigation examined 1‐year eating disorder and weight trajectories in this sample. The total sample (N = 244) consisted of staff leaders (44.3%) and demographically similar comparison participants who completed eating disorder and weight assessments across four time points: baseline, end of summer, 6‐week follow‐up and 1‐year follow‐up. Forty‐seven per cent of the original sample responded to all time points (staff leaders n = 60; comparison n = 55). Over the course of 1 year, risk trajectories did not differ between groups. Staff leaders did not report significant changes in body mass index, suggesting that they maintained healthy weight over the course of 1 year. Participation as an immersion weight loss programme leader appeared to be protective against weight gain, without increasing eating disorder risk, for healthy young adults. This provides further support for using weight management interventions across a wide range of individuals.

Reply to Sala: “Post-meal affective states”

Sala [1] expressed concerns that the findings from our study published last year in this journal [2] were biased due to limitations in our measures of affect and emotion. Responding to the points raised by Sala [1], we will first address concerns that the measures employed did not address all relevant emotions for individuals with eating disorders (EDs). We will then discuss considerations for future research, extending suggestions made by Sala [1]. First, we agree with Sala [1] that our measures (PANAS, POMS, STAI) may not capture all relevant emotion states for individuals with EDs. It is true that various emotions were not assessed by the PANAS, POMS, and STAI. However, assessing all theoretically-relevant emotions was not the original intent of this investigation. Instead, these measures were used for two primary reasons. First, instruments were selected for high reliability and validity in evaluating a range of affective states and emotions in the study sample, in addition to their apparent utility in other ED studies. Second, these measures assess emotional domains that we believed were most relevant given the prior literature. Nonetheless, we agree that research evaluating associations between additional emotions and EDs is needed; we hope this paper will help to spur such work. In particular, future investigations should evaluate distinctions between specific negative and positive emotions, and evaluate differential associations between ED risk and basic (i.e., fear, disgust) or complex (i.e., guilt, shame) emotions. We also concur that research should assess emotional change during mealtimes. Assessing change in the context of eating may provide valuable insight into emotional changes that treatment-seeking individuals experience during mealtimes in clinical settings. Although our study was not designed to assess change throughout mealtimes, we agree that such an investigation would contribute to the literature. Future work should also evaluate change in affect during other types of eating episodes (e.g., snacks, binge eating episodes) and in different surroundings (e.g., naturalistic environments). Overall, we agree that future research should investigate a wide range of emotions. However, the assertion that our results are biased due to lack of assessment of all relevant emotions is not necessarily warranted, considering the risk for Type I error, had we examined additional emotions given our sample size, and the fact that the measures used in our study were specifically selected a priori for theoretical relevance and empirical strength. For this reason, although certain emotions were omitted from our investigation, we do not believe that the results are biased, as much as potentially limited in generalizability to other emotional domains. Therefore, while assessing a broader range of relevant emotion states and emotional change is an admirable goal of future research, we believe that our investigation provided unbiased information about the nature L. M. Anderson (&) Department of Psychology, University at Albany, State University of New York, Social Sciences 137A, 1400 Washington Avenue, Albany, NY 12222, USA e-mail: lmanderson@albany.edu

Does short-term fasting promote pathological eating patterns?

Fasting, or going a significant amount of time without eating, has been identified as a risk factor for the development of pathological eating patterns. Findings from several studies examining the impact of fasting on subsequent eating behaviors have been mixed. The current study recruited college students to record food intake, episodes of binge eating, and use of compensatory behaviors before, throughout, and following a 24-hour fast. Participants attended an initial appointment in which they completed measures of dietary restraint and disinhibition and received instructions on self-monitoring and fasting. Participants (N=122) self-monitored their eating behaviors for 96 h, including a 24-hour fasting period. Participants did not demonstrate significant increases in disordered eating behaviors following the fast (e.g., objective binge episodes, self-defined excessive eating or compensatory behavior use). Baseline disinhibition predicted excessive eating as well as objective binge episodes both before and after fasting. Altogether, findings have implications for research seeking to further understand how fasting may contribute to the development of pathological eating patterns; specifically, it seems that the ED risk associated with fasting is derived from the behaviors interaction with other individual difference variables.