Nassim Tabri

Recovery From Anorexia Nervosa and Bulimia Nervosa at 22-Year Follow-Up.

OBJECTIVE The course of eating disorders is often protracted, with fewer than half of adults achieving recovery from anorexia nervosa or bulimia nervosa. Some argue for palliative management when duration exceeds a decade, yet outcomes beyond 20 years are rarely described. This study investigates early and long-term recovery in the Massachusetts General Hospital Longitudinal Study of Anorexia and Bulimia Nervosa. METHODS Females with DSM-III-R/DSM-IV anorexia nervosa or bulimia nervosa were assessed at 9 and at 20 to 25 years of follow-up (mean [SD] = 22.10 [1.10] years; study initiated in 1987, last follow-up conducted in 2013) via structured clinical interview (Longitudinal Interval Follow-Up Evaluation of Eating Disorders [LIFE-EAT-II]). Seventy-seven percent of the original cohort was re-interviewed, and multiple imputation was used to include all surviving participants from the original cohort (N = 228). Kaplan-Meier curves estimated recovery by 9-year follow-up, and McNemar test examined concordance between recovery at 9-year and 22-year follow-up. RESULTS At 22-year follow-up, 62.8% of participants with anorexia nervosa and 68.2% of participants with bulimia nervosa recovered, compared to 31.4% of participants with anorexia nervosa and 68.2% of participants with bulimia nervosa by 9-year follow-up. Approximately half of those with anorexia nervosa who had not recovered by 9 years progressed to recovery at 22 years. Early recovery was associated with increased likelihood of long-term recovery in anorexia nervosa (odds ratio [OR] = 10.5; 95% CI, 3.77-29.28; McNemar χ²₁ = 31.39; P < .01) but not in bulimia nervosa (OR = 1.0; 95% CI, 0.49-2.05; McNemar χ²₁ = 0; P = 1.0). CONCLUSION At 22 years, approximately two-thirds of females with anorexia nervosa and bulimia nervosa were recovered. Recovery from bulimia nervosa happened earlier, but recovery from anorexia nervosa continued over the long term, arguing against the implementation of palliative care for most individuals with eating disorders.

Economic mobility moderates the effect of relative deprivation on financial gambling motives and disordered gambling

This study examined whether a positive association between personal relative deprivation and disordered gambling severity is mediated by the motivation to gamble for financial gain. We hypothesized that this would occur specifically among people who perceived a low personal capacity for upward economic mobility via conventional means of advancement. A sample of community gamblers (N = 196) completed measures of personal relative deprivation, perceptions about upward economic mobility, gambling motivations (financial, coping, enhancement and social) and disordered gambling severity. The predicted moderated mediation model was observed – among people who perceived a low capacity for upward economic mobility, relative deprivation predicted disordered gambling severity via the motivation to gamble for financial gain. This indirect effect did not hold among people who perceived a high capacity for upward mobility. These findings suggest the importance of addressing beliefs about upward economic mobility in gambling prevention and intervention strategies. Among gamblers who feel relatively deprived, it may be advantageous to highlight feasible avenues for upward economic mobility that do not involve gambling.

To dissent and protect: Stronger collective identification increases willingness to dissent when group norms evoke collective angst

Research has shown that collective angst (i.e., concern for a group’s future vitality) triggers ingroup protective responses. The current studies examined whether group members seek to protect their group by dissenting from collective angst-inducing group norms. We hypothesized that strong (vs. weak) identifiers holding non-normative opinions would be more willing to dissent, but only when the normative opinion elicited collective angst. In Study 1, as predicted, strongly (vs. weakly) identified Republicans who held non-normative opinions about Obamacare were more willing to dissent, but only when collective angst was high. In Study 2, we manipulated rather than measured collective angst and examined a different political issue: the deployment of American ground troops to fight terrorism overseas. We observed the same pattern of dissent detected in Study 1. This research contributes to current understandings of dissent in groups and the motivating power of collective angst.

The Dark Side of Self-Forgiveness: Forgiving the Self Can Impede Change for Ongoing, Harmful Behavior

Self-forgiveness is typically conceptualized as an abandonment of self-condemnation in the face of acknowledged, self-directed harm-doing that helps the harm-doer make a positive change in their life. In this chapter, we qualify the link between self-forgiveness and well-being by outlining theory and research that positions self-forgiveness for an ongoing, harmful behavior as a hindrance to positive behavioral change. We argue that self-forgiveness in this context de-motivates behavioral change by alleviating negative emotions (e.g., guilt) that are needed to initiate change. The net effect is a maintenance of the behavioral status quo. We conclude by outlining a conceptual model of self-forgiveness for ongoing harm-doing that situates this dark side of self-forgiveness within the broader self-forgiveness literature. In doing so, we point to potentially fruitful avenues for future research.

Me, myself and money: having a financially focused self-concept and its consequences for disordered gambling

Abstract The article describes a test of the hypothesis that some people’s self-concept is overly focused on financial success and that this focus contributes to disordered gambling. Study 1 reported on the development and validation of the Financially Focused Scale (FFS) with a sample of community gamblers (N = 197). As predicted, participants whose self-concept was financially focused attached greater importance to the money they possess as a domain of self-worth. They also indicated that the money they possess is a more important domain of self-worth relative to other life domains. Importantly, greater financial focus was a positive predictor of disordered gambling severity and did so over and above other known predictors of disordered gambling severity (i.e. personal income, Big-Five personality domains, global self-esteem, personal relative deprivation and materialism). Study 2 (N = 220) replicated and extended the findings of Study 1 by examining the motivational mechanisms that may link being financially focused with disordered gambling severity. As hypothesized, monetary gambling motives mediated the relationship between participants’ FFS scores and disordered gambling severity. Having a financially focused self-concept may play a critical role in the development and maintenance of disordered gambling. Addressing this self-concept in treatment may help alleviate gambling disorder.

Predictors of long-term recovery in anorexia nervosa and bulimia nervosa: Data from a 22-year longitudinal study

OBJECTIVE The objective of this study was to investigate predictors of long-term recovery from eating disorders 22 years after entry into a longitudinal study. METHOD One hundred and seventy-six of the 228 surviving participants (77.2%) were re-interviewed 20-25 years after study entry using the Longitudinal Interval Follow-up Evaluation to assess ED recovery. The sample consisted of 100 women diagnosed with anorexia nervosa (AN) and 76 with bulimia nervosa (BN) at study entry. RESULTS A comorbid diagnosis of major depression at the start of the study strongly predicted having a diagnosis of AN-Restricting type at the 22-year assessment. A higher body mass index (BMI) at study intake decreased the odds of being diagnosed with AN-Binge Purge type, relative to being recovered, 22 years later. The only predictor that increased the likelihood of having a diagnosis of BN at the 22-year assessment was the length of time during the study when the diagnostic criteria for BN were met. CONCLUSIONS Together, these results indicate that the presence and persistence of binge eating and purging behaviors were poor prognostic indicators and that comorbidity with depression is particularly pernicious in AN. Treatment providers might pay particular attention to these issues in an effort to positively influence recovery over the long-term.

Measuring responsible gambling amongst players: Development of the positive play scale

The modern gambling industry has, by-in-large, assumed a duty of care to minimize the risks associated with gambling, which has manifested in responsible gambling (RG) programming (e.g., educating players about the odds of success). The current study fills a void in gambling operators, regulators, and researchers ability to measure RG beliefs and behavior in their player-base, with the development and validation of the Positive Play Scale (PPS). In Study 1, we reviewed the literature and consulted 30 players as well as 10 RG experts to help generate a definition of RG beliefs and behavior that helped guide item generation. In Study 2, regular players (N = 1,551) of a Canadian provincial gambling operator completed a positive play survey. Four components from a principal components analysis (PCA) were extracted: Honesty and Control, Pre-commitment, Personal Responsibility, and Gambling Literacy. The PPS subscales were either not associated with gambling frequency or had small-to-moderate negative relationships with frequency of play for games most often associated with disordered gambling (e.g., electronic games). In Study 3 (N = 413), the factor structure of the PPS was confirmed and refined in a new sample of players. Moreover, a 1-month follow-up session demonstrated that the PPS has high test-retest reliability. The PPS is the first validated scale that reliably assesses the extent to which a consumer base has positive beliefs about gambling and gambles in a positive manner. The PPS can be used by the gambling industry to objectively assess the efficacy of their RG strategy, pinpoint specific areas for future focus, as well as examine the utility of new RG initiatives that aim to promote healthy patterns of gambling consumption. Furthermore, by examining the PPS scores for different player segments (e.g., sex, age, games played) it becomes possible to tailor RG strategy to the needs of specific players. In this way, RG strategy can be optimized by focusing resources where they will be most effective.

Factorial integrity and validation of the Eating Pathology Symptoms Inventory (EPSI)

The Eating Pathology Symptoms Inventory (EPSI) is a 45-item self-report measure of eating pathology designed to be sensitive in assessing symptoms among diverse populations of individuals with disordered eating. The current study represents the first external validation of the EPSI as well as the first to examine the factor structure in an outpatient eating disorder clinic sample. We conducted an exploratory factor analysis in three separate samples: an outpatient clinic sample (n = 284), a college sample (n = 296), and a community sample (n = 341) and compared the observed factor structures to the original 8-factor solution proposed by Forbush et al. (2013). We also investigated whether the subscales correlated with the Eating Disorder Examination Questionnaire (EDE-Q) and a clinical impairment measure among the outpatient clinic sample. Results suggested between 7 and 8 factors for each of the three samples. Our findings largely replicated those of the original EPSI development study, excepting some deviations in the Muscle Building, Cognitive Restraint, and Excessive Exercise subscales. However, confirmatory factor analysis and exploratory structural equation modeling produced poor model fit, which may be related to the item heterogeneity within many of the subscales. Finally, eating disorder attitudes and behaviors assessed by the EPSI were significantly correlated with the EDE-Q and with clinical impairment. Overall, our results highlight both strengths and limitations of the EPSI. Findings provide preliminary support for the use of the EPSI among research with diverse populations, and present several avenues for future research for enhancing clinical utility.

The Rocky Road to Reconciliation: Regulating Emotions in an Intergroup Context

Emotion regulation—the shaping of when, how, or whether a particular emotion is experienced—has been a focus of many fields of study in psychology (see Gross, 2014). As noted by Cehaji c-Clancy, Goldenberg, Gross, and Halperin (this issue), however, researchers who study conflict resolution have been slow to the party. Most of the extant emotional regulation research has focused on individuals or dyads. For example, people who regulate their emotions have better interpersonal functioning and well-being (Gross & John, 2003). Yet many of the insights from this literature can (and should) be directed toward conflict resolution. This is because emotions lay at the heart of intergroup conflict (see Bar-Tal, 2007) and, as such, are more conducive to predicting and adjusting intergroup behaviors than general out-group evaluations (Halperin, 2015). Indeed, the passion with which group members engage in conflict is highly suggestive of an emotional root. If those roots are trimmed (or regulated as the case may be) the trajectory of intergroup relations may be shifted in a prosocial direction. According to intergroup emotion theory (Smith, 1993, 1999), when social identity is salient (as is the case during intergroup conflict and its resolution), group members appraise social events in terms of their implications for the in-group. These appraisals produce emotions felt on behalf of their ingroup and targeted at out-groups. The consequence is collective action tendencies. For example, Mackie, Devos, and Smith (2000) found that group-based anger resulted in a tendency to act against an adversarial out-group, whereas in-group members who experienced group-based fear had an inclination to move away from the out-group. In this light, group-based emotions play a functional role in intergroup relations—they are the process through which appraisals lead to intergroup behavior. The important contribution offered by Cehaji c-Clancy and colleagues (this issue) is that the resolution of intergroup conflict is not necessarily at the mercy of this group-based emotional process. Instead, they argue that with proper attention, group-based emotions can be regulated (or manipulated) to facilitate prosocial intergroup relations. To this end, Cehaji c-Clancy and colleagues (this issue) reviewed research that is suggestive of their proposition that downregulating emotions known to impede conflict resolution (anger, hate) and upregulating emotions necessary for the resolution of intergroup conflict (guilt, hope) help promote positive intergroup relations following intergroup harmdoing. In doing so, they broaden the theoretical vibrancy of the study of conflict resolution and provide practical means to bring (former) adversary groups toward a common ground. Unfortunately, we believe an overly rosy picture may have been painted. Herein, we argue that the road to reconciliation is a rocky one. Although strategies can be applied to regulate emotions (e.g., reappraisal) that allow a broader or balanced appreciation of events at the interpersonal level (Gross, 2002; Ray, Wilhelm, & Gross, 2008), these effects may be rather transient at the intergroup level. In-group members have a tendency to make sinister attributions about the out-group’s intentions during negotiation (Kramer, 1994). Any progress toward the down regulation of reconciliation-hindering emotions and upregulation of reconciliation-facilitating emotions may thus be met by eventual regression to the group-based emotional baseline. In this light, and in response to Cehaji cClancy and colleagues (this issue), we discuss theory and research that suggests group-based, reconciliation enhancing emotions are rather fickle and group-based, reconciliation hindering emotions easily come to the fore even when a path to peace is salient.