Margarita Sala

Examining the construct validity of affective judgments of physical activity measures.

Affective judgments of physical activity have emerged as important predictors of physical activity and interventions targeting affective judgments are a promising approach to improving regular physical activity. Currently, measures assessing a variety of potentially distinct constructs are treated as interchangeable assessments of affective judgments of physical activity. Moreover, little is known about the construct validity of the purported measures of this construct. We review several components of construct validity; highlighting their importance for health psychology research. Then, we examine the construct validity of a wide variety of affective judgment of physical activity measures in MTurk and student samples. Cronbachs alpha for the included measures was uniformly high; however, several scales contained excessively redundant items that ultimately lessen their construct validity. Moreover, dependability estimates for the majority of measures was poor, indicating high levels of transient measurement error. The included measures significantly predicted levels of physical activity; however, their relative predictive power was strongly associated with their dependability. In general, the affective judgment measures demonstrated poor convergent validity suggesting they are not interchangeable and best viewed as assessing distinct, albeit related, constructs. Another important limitation of these measures is that they exhibited poor discriminant validity from exercise self-efficacy, which represents an important theoretical and empirical issue for the field of health behavior research. Overall, the current findings indicate the available affective judgments of physical activity measures are suboptimal, have considerable construct validity limitations, and thereby prevent the further advancement of science, theory, and intervention development in this promising area of research. (PsycINFO Database Record

Emotion-focused treatments for anorexia nervosa: a systematic review of the literature.

PurposeThe present review explores emotion-focused treatments for anorexia nervosa (AN).MethodsWe conducted a systematic literature search across key databases (PsychINFO, PubMed/Medline, and Web of Science) prior to September 2015. Twenty studies were selected for systematic review.ResultsThe present review found initial evidence supporting the acceptability and feasibility of emotion-focused treatments for AN. Although preliminary results are promising, further controlled studies are necessary to establish the efficacy of emotion-focused treatments for AN.ConclusionsFuture controlled trials should compare emotion-focused treatments against each other and against other AN treatments. Future studies should also examine the mechanisms of action for the emotion-focused treatments and treatment moderators.

Predictors of Attrition Before and After Bariatric Surgery

Bariatric surgery is considered the most effective approach to treating morbid obesity [1]. Despite this, a considerable number of individuals who initiate the preoperative evaluation process do not undergo surgery. Moreover, of the individuals who do have surgery, many are non-compliant with follow-up appointments. Attrition makes it difficult for clinicians to assess post-surgery outcomes and compromises the post-surgery lifelong medical surveillance required for optimal patient health and well-being. The purpose of this study was to identify predictors of [1] surgery completion and [2] follow-up appointment attendance at 2-year post-surgery. On the basis of previously published studies, we hypothesized that [1] surgery completion would be related to higher baseline BMI, no current tobacco use, more medical co-morbidities, and fewer psychological comorbidities; and [2] attendance at the 2year follow-up appointment would be related to older age, male gender, non-minority race/ethnicity, undergoing gastric banding, fewer medical and psychological co-morbidities, attendance at the 1-, 3-, and 6-month follow-up appointments, and greater weight loss at 1-, 3-, and 6-month following surgery.

Meal and snack-time eating disorder cognitions predict eating disorder behaviors and vice versa in a treatment seeking sample: A mobile technology based ecological momentary assessment study

Individuals with eating disorders experience high anxiety when eating, which may contribute to the high relapse rates seen in the eating disorders. However, it is unknown if specific cognitions associated with such anxiety (e.g., fears of gaining weight) may lead to engagement in eating disorder behaviors (e.g., weighing oneself). Participants (N = 66) recently treated at a residential eating disorder facility and diagnosed with an eating disorder (primarily anorexia nervosa; n = 40; 60.6%) utilized a mobile application to answer questions about mealtime cognitions, anxiety, and eating disorder behaviors four times a day for one week. Hierarchical linear models using cross-lag analyses identified that there were quasi-causal (and sometimes reciprocal) within-person relationships between specific eating disorder cognitions and subsequent eating disorder behaviors. These cognitions predicted higher anxiety during the next meal and eating disorder pathology at one-month follow-up. Interventions personalized to target these specific cognitions in real time might reduce eating disorder relapse.

The longitudinal relationship between worry and disordered eating: Is worry a precursor or consequence of disordered eating?

Worry, the core component of generalized anxiety disorder, is associated with disordered eating. However, it is unclear whether worry is a precursor to disordered eating or whether worry is a consequence of disordered eating (or both). The current study tested if worry prospectively predicted disordered eating symptoms and vice-versa across six months. Young adult women (n=300) completed a measure of worry and disordered eating at Time 1, and two months and six months later. A prospective path model utilizing structural equation modeling investigated if worry predicted disordered eating (and vice-versa). Worry prospectively predicted drive for thinness across both two and six months while controlling for previous levels of worry. In the opposite direction, drive for thinness did not predict worry over time. There were no prospective relationships between worry and bulimia or body dissatisfaction. Therefore, interventions focusing on decreasing worry could be effective in preventing and treating excessive concerns about thinness and their associated impairment.

Post-meal affective states.

Anderson and collaborators [1] investigated how meal consumption impacts the affective states of individuals with eating disorders. They administered the State-Trait Anxiety Inventory (STAI-S), the Positive and Negative Affect Schedule (PANAS), and the Profile of Mood States (POMS) to assess affective states preand post-meal. Individuals with binge eating disorder (BED) experienced decreases in negative affect after meal consumption, whereas individuals with anorexia nervosa (AN) and bulimia nervosa (BN) experienced no changes in affect after meal consumption. However, Anderson and collaborators’ [1] findings may have been biased due to the affective measures that they used. The use of the PANAS, POMS, and STAI for measuring affect has been criticized on the basis that it may not capture all relevant affective states [2], and it may be useful to examine the limitations of relying solely on these instruments to measure post-meal affective states in the eating disorders field. Some states which are not captured by the PANAS may be relevant to the post-meal experiences of individuals with eating disorders (e.g. satisfaction, sadness). The POMS captures only six distinct mood states, and there are some mood states not captured by the POMS that may be influenced by the consumption of a meal (e.g. cheerfulness, regret). The STAI would not capture positively valenced increases in activation or negatively valenced decreases in activation post-meal consumption [3]. Although these measures are well validated and widely used, it is unclear whether these are the best measures to use in the context of eating disorders. Thus, it is possible that meal consumption influences affective states not tapped by the POMS, PANAS, or STAI. Additional research evaluating the association of affective states not covered by these measures with eating pathology is needed. Future research should also examine basic affect [2]. It is unclear which post-meal affective states would be most clearly relevant to individuals with eating disorders, and focusing on only some selected affective states could result in failing to measure a significant affective state [2].

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

IntroductionAnorexia 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.PurposeThe purpose of this narrative review is to integrate the literature on the role of affect, reward, and punishment in AN.MethodWe 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.ResultsWe 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.ConclusionWe 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 evidenceLevel V, narrative review.

Improving prediction of eating-related behavioral outcomes with zero-sensitive regression models

Objective Outcome variables gauging the frequency of specific disordered eating behaviors (e.g., binge eating, vomiting) are common in the study of eating and health behaviors. The nature of such data presents several analytical challenges, which may be best addressed through the application of underutilized statistical approaches. The current study examined several approaches to predicting count-based behaviors, including zero-sensitive (i.e., zero-inflated and hurdle) regression models. Method Exploration of alternative models to predict eating-related behaviors occurred in two parts. In Part 1, participants (N = 524; 54% female) completed the Eating Disorder Examination-Questionnaire and Daily Stress Inventory. We considered the theoretical basis and practical utility of several alternative approaches for predicting the frequency of binge eating and compensatory behaviors, including ordinary least squares (OLS), logistic, Poisson, negative binomial, and zero-sensitive models. In Part 2, we completed Monte Carlo simulations comparing negative binomial, zero-inflated negative binomial, and negative binomial hurdle models to further explore when these models are most useful. Results Traditional OLS regression models were generally a poor fit for the data structure. Zero-sensitive models, which are not limited to traditional distribution assumptions, were preferable for predicting count-based outcomes. In the data presented, zero-sensitive models were useful in modeling behaviors that were relatively rare (laxative use and vomiting, 9.7% endorsed) along with those that were somewhat common (binge eating, 33.4% endorsed; driven exercise, 40.7% endorsed). Simulations indicated missing data, sample size, and the number of zeros may impact model fit. Discussion Zero-sensitive approaches hold promise for answering key questions about the presence and frequency of common eating-related behaviors and improving the specificity of relevant statistical models. Hurdle models may also be appropriate when theoretically justified.

Eating Disorders, Addictions, and Substance Use Disorders: Research, Clinical, and Treatment Perspectives, edited by Timothy D. Brewerton and Amy Baker Dennis

Eating Disorders, Addictions, and Substance Use Disorders: Research, Clinical, and Treatment Perspectives is the first manual to focus on the co-occurrence of eating disorders (ED) and substance use disorders (SUD). The text is edited by Drs. Timothy D. Brewerton and Amy Baker Dennis, who are leading eating disorder treatment experts. Dr. Brewerton is also a longstanding member of the Eating Disorders editorial board. Drs. Brewerton and Dennis brought together other experts in the eating disorder and substance abuse fields to author this text. The book is divided into three parts: “Part One—Research Perspectives”; “Part Two—Clinical Perspectives”; and “Part Three—Treatment Perspectives.” Part One provides a comprehensive scientific review of ED, SUD, and addictions. Chapters 1–5 describe animal, neurotransmitter, neuroimaging, and genetic research that has informed our understanding of ED and SUD. The first five chapters of Part 1 are able to cover complex concepts in an easily digestible manner. Chapter 6 examines personality disorders and their relation to ED and SUD, as well as specific personality traits often seen in individuals with ED and/or SUD. The chapter ends with treatment implications and future directions. Chapter 7 examines problematic exercise. It distinguishes between exercise addiction, exercise dependence, and exercise compulsion; describes different assessment measures for problematic exercise; and explores the co-occurrence of problematic exercise with ED, SUD, and other behavioral addictions (BA). Chapter 8 discusses the nutritional aspects of ED and SUD with a particular emphasis on nutritional deficits that are commonly seen in patients with ED and/or SUD. Chapter 9 explores the emergence of SUD, disordered eating, and other addictive behaviors after bariatric surgery. Chapter 10 reviews effective prevention models that have been used in the ED and SUD fields. The chapter reviews Dr. Eric Stice’s dissonance-based eating disorder prevention and the ATLAS and ATHENA prevention programs, and concludes with proposed guidelines for the development of a prevention program that could address both ED and SUD.