The role of positive self-compassion, distress tolerance, and social problem-solving in the relationship between perfectionism and disordered eating among racially and ethnically diverse college students.

Eating disorders (EDs) are associated with high levels of distress, functional impairment, and morbidity. Perfectionism has been consistently identified as an important factor in the etiology and maintenance of disordered eating, and as a promising target for treatment efforts. To address the detrimental effects of perfectionism on disordered eating, further research is needed to better understand what mechanisms may influence the relationship between these variables. In the present research, we examined three constructs related to self-regulation as potential mediators of the relationship between perfectionism and disordered eating: positive self-compassion, distress tolerance, and social problem-solving. We collected data from a sample of racially and ethnically diverse undergraduate students (N = 280) using an online questionnaire battery. Using structural equation modeling (SEM), we developed measurement and structural models to meet criteria for good fit and tested the hypothesized relationships. Distress tolerance emerged as a robust, statistically significant mediator of the relationship between perfectionism and disordered eating. Social problem-solving and self-compassion did not mediate this relationship. Distress tolerance may counterbalance the cognitive load associated with perfectionism; freeing up mental resources to focus on resisting urges for immediate relief through engagement in maladaptive disordered eating.

Enhancing employee wellness: Translating an effective community behavioral weight-loss treatment to the worksite.

BACKGROUND: As rates of obesity continue to rise in the USA, there is a need for effective treatments for excess adiposity. Behavioral weight-loss interventions can produce clinically meaningful weight reduction through life-style modifications. However, few studies have evaluated the effectiveness of high-intensity behavioral weight-loss interventions at worksites. AIM: The present research investigated the effectiveness of a previously validated behavioral weight-loss intervention in a Hawai'i worksite. METHODS: Thirty-six participants were recruited from the employee population of a local employer. Participants received six months of group behavioral weight-loss treatment from trained providers. Anthropomorphic, physiological, psychological, and behavioral assessments were collected pre and post treatment. Select physiological and behavioral assessments were collected every four sessions. RESULTS: Sixty-one percent of participants adhered to treatment, and 78% of participants completed treatment. From pre to post treatment, results found that participants achieved clinically significant improvements in weight, body mass index (BMI), and waist circumference, with accompanying physiological, psychological, and behavioral improvements (F(12, 2)=101.379, p=0.010, partial η2=0.998). Analyses revealed that participants also achieved significant changes in weight, BMI, and waist circumference across time points, as well as improvements in specific eating habits. CONCLUSIONS: The present study demonstrated the efficacy of a worksite behavioral weight-loss program. The present intervention produced clinically significant weight losses for a large proportion of participants, accompanied by significant improvements in physiological, behavioral, and psychological outcomes. This research is promising for the ongoing implementation of behavioral weight-loss approaches.

Psychometric Properties of the Eating Disorder Examination-Questionnaire (EDE-Q): A Confirmatory Factor Analysis and Assessment of Measurement Invariance by Sex.

The original, theoretically derived factor structure of the Eating Disorder Examination-Questionnaire (EDE-Q) has received limited empirical support and there is no consensus on an appropriate alternative. Moreover, there is a paucity of data on the factor structure of the EDE-Q across sexes. The goals of the current study were to evaluate models of the EDE-Q factor structure and to assess the best-fitting model for differences by sex. Twelve models were compared using confirmatory factor analysis in a sample of 940 undergraduates. Confirmatory factor analysis did not support the original factor structure. A four-factor model fit the data reasonably well with factors corresponding to themes of (a) dietary restraint, (b) preoccupation and restriction, (c) weight and shape concern, and (d) eating shame. The EDE-Q was found to be invariant by sex across all factors except Factor 3. The implications of these findings are discussed.

Body dissatisfaction, internalized weight bias and quality of life in young men and women.

PURPOSE: We examined the relative importance of body dissatisfaction (BD) and internalized weight bias (IWB) in accounting for variance in quality of life (QoL) impairment in an ethnically diverse sample of college students (n = 630) and potential moderation of these associations by sex. METHODS: Participants completed an online survey that included established measures of BD, IWB and QoL. Regression models were used to examine the relative contributions of BD and IWB in accounting for variance in physical and mental QoL impairment. RESULTS: BD and IWB were highly correlated with bivariate analysis in both women (r = .76) and men (r = .60). In multivariable analysis, IWB was found to be associated with both physical (b = - 1.33, 95% CI - 1.93, - 0.72) and mental (b = - 2.58, 95% CI - 3.45, - 1.72) QoL impairment, whilst BD was not associated with impairment in either physical (b = - 0.29, 95% CI - 0.68, 0.09) or mental (b = - 0.48, 95% CI - 1.03, 0.07) QoL. While levels of both BD and IWB were higher for women than for men, sex did not moderate the association between either BD or IWB and either physical or mental QoL. CONCLUSIONS: The findings support the view that IWB warrants greater attention in interventions seeking to reduce the adverse impact of BD in both women and men and both normal-weight and overweight individuals.

Locating the mechanisms of therapeutic agency in family-based treatment for adolescent anorexia nervosa: A pilot study of clinician/researcher perspectives.

The theoretical agnosticism of family-based treatment (FBT) has precluded a thorough understanding of treatment mechanisms. We examined clinician and researcher perspectives on the mechanisms of FBT. Thirty-eight clinicians/researchers who had recently published in the domain of anorexia nervosa (AN) indicated their opinions as to the mechanisms of FBT, and content analysis was performed to identify relevant themes. Parental input was deemed crucial for weight-based symptom remission, and weight restoration was deemed crucial for cognitive symptom relief. Participants reported that mechanisms of FBT may be nullified by psychiatric comorbidities (50%), inappropriate weight goals (37%), or a long illness duration (24%). Attributions of causality to parents (66%) or family system factors (37%) were noted in instances of nonsuccessful outcomes. These findings offer important insights into clinician/researcher perspectives on the mechanisms of FBT and highlight beliefs among clinicians and researchers that may not reflect emerging evidence, or the theoretical framework of FBT.

Development and validation of CF-Medication Beliefs Questionnaire: A mixed-methods approach.

BACKGROUND: Beliefs about medication have been associated with adherence in other diseases but there are no existing disease-specific medication beliefs questionnaires for CF. This mixed-methods validated the Cystic Fibrosis Medication Belief Questionnaire (CF-MBQ), based on social cognitive theory. METHODS: Based on previous research, items were developed for five domains: motivation, self-efficacy, perceived importance, and decisional balance to take or miss medications. Cognitive interviews were conducted with 15 adult patients with CF to refine item development. 128 patients with CF completed an online survey and objective medication adherence was measured using pharmacy refill data. RESULTS: The five subscales demonstrated strong psychometric properties, with adequate-to-good internal consistency scores. More importantly, each domain demonstrated construct validity with adherence. CONCLUSIONS: These theoretically-derived measures may be important for clinical purposes to provide guidance on appropriate interventions to improve adherence and for research to provide enhanced understanding on patient determinants of medication adherence.

Disease disclosure in individuals with cystic fibrosis: Association with psychosocial and health outcomes.

BACKGROUND: This study aimed to quantify cystic fibrosis (CF) disclosure and examine associations between disclosure and psychosocial and health outcomes. METHODS: Participants completed measures assessing disease disclosure and psychosocial outcomes. Data from chart reviews and pharmacy records were obtained. RESULTS: Participants (N=128; ages 16-63) were more likely to disclose to romantic partners (97%) and close friends (94%) than to casual friends (79%), bosses (71%), or co-workers (53%). Participants reported more comfort discussing CF with and doing treatments in front of romantic partners and close friends than other groups. Disclosure was associated with higher social support, social functioning, and medication adherence self-efficacy. Lower lung-function was associated with disclosure to bosses and co-workers. CONCLUSIONS: Clinicians should consider discussing disclosure with patients, as limited disclosure may have a negative impact on psychosocial outcomes.

Perceptions of barriers and facilitators: self-management decisions by older adolescents and adults with CF.

BACKGROUND: Adherence to CF treatments is poor, which can lead to negative health outcomes. The objective of our study was to qualitatively investigate the barriers and facilitators of self-management among older adolescents and adults with CF. METHODS: Individual semi-structured interviews were conducted, audio-taped, transcribed verbatim and coded to identify common themes. RESULTS: Twenty-five patients were interviewed. Four broad themes were identified: Barriers to Self-Management (e.g., treatment burden (identified by 64% of patients), accidental or purposeful forgetting (60%), no perceived benefit (56%)), Facilitators of Self-Management (e.g., CF clinic visits (76%), social support (68%), perceived benefit (68%)), Substitution of Alternative Approaches to Conventional Management (36%) and Planned Non-adherence (32%). CONCLUSIONS: Older adolescents and adults with CF identified many barriers and facilitators of adherence that may be amenable to self-management counseling strategies, particularly the use of health feedback.