Differential caloric intake in overweight females with and without binge eating: effects of a laboratory-based emotion-regulation training.

Negative emotions are among the best predictors for the occurrence of binge eating attacks in binge eating disorder (BED). Evidence from self-report and experimental studies suggests that this link may be mediated by deficits in emotion regulation (ER). Therefore, the aim of the present study was to experimentally test the effects of a short laboratory-based ER training on caloric intake in BED. Thirty-nine women with BED and 42 overweight females without BED were randomly assigned to a laboratory-based ER training focusing on either expressive suppression or cognitive reappraisal. They were then given a negative mood induction with the instruction to adopt the learned ER strategy, which was followed by a bogus taste-test. Independent of group membership, caloric intake was significantly higher in the suppression compared to the reappraisal condition. Furthermore, the BED group displayed significantly higher habitual suppression and significantly lower habitual reappraisal scores than the overweight group. The data suggest that therapeutic interventions focusing on the mediation of more adaptive affect-regulation skills may be useful for the reduction of binge eating episodes.

The undue influence of shape and weight on self-evaluation in anorexia nervosa, bulimia nervosa and restrained eaters: a combined ERP and behavioral study.

BACKGROUND: Current theories and nosology assume that the self-evaluation (SE) of individuals with eating disorders (EDs) is unduly influenced by body shape and weight. However, experimental data supporting this link are scarce, and it is not specified which subdomains of SE might be affected. METHOD: We studied patients with anorexia nervosa (AN), bulimia nervosa (BN) and healthy controls (HC) with an affective priming (AP) procedure (Study 1) to unveil explicit and implicit associations between shape/weight and SE. We used weight/shape-related prime sentences, complemented by affectively congruent and incongruent target words from two SE domains. AP effects were assessed by event-related potentials (ERPs), reaction times (RTs) and subjective ratings. The ratings were also assessed (Study 2) in undergraduate restrained (RES) and unrestrained eaters (UNRES). RESULTS: Study 1 demonstrated stronger AP effects in both ED groups compared to HC on RTs and subjective ratings. ERPs showed AP effects only in the BN group. Restrained eaters showed similar, albeit less pronounced, priming effects on subjective ratings. CONCLUSIONS: ED patients associate shape/weight concerns with the non-appearance-related SE domains of interpersonal relationships and achievement/performance. These associations seem to be encoded deeper in BN patients relative to the other groups. Links between shape/weight and SE explain how body dissatisfaction impacts on self-esteem and mood in ED. The existence of similar associations in restrained eaters supports a continuum model according to which increasing associations between shape/weight and SE go along with increasing levels of ED symptoms.

Explicit memory bias for positively valenced body-related cues in women with binge eating disorder.

Overweight women with and without binge eating disorder (BED) are characterized by a marked body dissatisfaction, which may in part be due to the negative comments about their weight. Weight-related teasing and discrimination is reported both by healthy overweight women and women with BED, whereas body dissatisfaction is markedly increased among women with BED. Therefore, a memory bias for negatively valenced body-related cues is suspected to occur as a mediating factor in women with BED. In an experimental study, 18 women with BED were compared to 18 overweight healthy female controls (HC) on a free recall task containing four word categories: positively valenced with and without body-related content and negatively valenced with and without body-related content. While both groups showed a bias towards negatively valenced shape-/weight-related words, women with BED retrieved positively valenced shape-/weight-related words significantly less often compared to overweight HC. Findings suggest that it may be the reduced ability to attend to positively valenced shape-/weight-related information, rather than the activation of negative body schemata that differentiates overweight women with BED from overweight women without BED. Results are discussed in the context of cognitive biases in the maintenance of body dissatisfaction.

Personality, coping and sperm count.

Previous research has suggested an association between personality traits and coping, as well as between coping and sperm concentration. In the present study, both domains of research were combined, leading to the formulation of specific hypotheses. A total of 54 healthy volunteers were given questionnaires twice to assess personality traits and coping behaviour. Participants also produced up to three semen specimens. As hypothesized, active coping was correlated negatively with neuroticism (r = -0.59) and positively with conscientiousness (r = 0.56), whereas sperm concentration was correlated negatively with both active coping (r = -0.28) and conscientiousness (r = -0.37). The relationship between conscientiousness and sperm concentration did not appear to be mediated by active coping. Although the correlations were small, evidence is mounting that psychological aspects and male sperm parameters are not independent. The present findings, however, should not lead to the conclusion that conscientiousness and active forms of coping are characteristics of infertile patients.

Is infertility a risk factor for impaired male fertility?

BACKGROUND: Previous research has suggested an interaction between distress and male fertility. The present longitudinal study sought to deliver evidence for a negative impact of distress due to infertility on sperm concentration. METHODS: The sample consisted of 120 patients who twice visited an andrological clinic on their own initiative for fertility work-ups. Baseline and follow-up examinations were at least 6 months apart. Prior to each fertility work-up, patients completed a questionnaire assessing distress due to infertility. RESULTS: Path analyses revealed that the level of infertility distress at follow-up has a negative impact on the change in sperm quality from baseline to follow-up assessment. Distress scores were highly stable. As a consequence, the level of distress at baseline assessment provided only little additional information for the changes in sperm concentration. Further analysis suggested that the fertility status had no impact on infertility distress. CONCLUSION: The present study delivers the strongest evidence to date that distress due to infertility is a significant risk factor for a decrease in sperm quality.

Psychological responses to body shape exposure in patients with bulimia nervosa.

One of the unresolved issues regarding research on bulimia nervosa concerns the question as to how patients diagnosed with bulimia nervosa respond to body image exposure. In addition, it remains unclear whether there are differential responses associated with different exposure techniques (e.g. in vivo exposure vs. exposure by visualization). The aim of the present study was to investigate psychological responses to body image exposure. Twenty participants diagnosed with bulimia nervosa (DSM IV) and twenty non-eating disordered individuals were exposed to their body image using a video recording (video confrontation). In addition, they were asked to imagine and describe the appearance of their body (imagery task). Results indicate that self-reported negative emotions increased in response to both, video confrontation and imagery task, in the clinical as well as in the control group. Furthermore, video confrontation led to more pronounced group differences than exposure by visualization (imagery task). Participants diagnosed with bulimia nervosa took less time to describe their waist, hips and bottom compared to non-eating disturbed controls. This last result could be interpreted in terms of avoidance behavior and other mechanisms during body image exposure.

Food exposure in patients with bulimia nervosa.

BACKGROUND: The aim of the study was to investigate psychological and physiological responses of bulimic patients to the repeated presentation of food cues. METHOD: On 2 subsequent days, 48 bulimic women (DSM-IV) were confronted with high- or low-caloric food for 20 min. A control group (n = 24) was exposed to high-caloric food once. Blood sugar levels were manipulated with a glucose load. RESULTS: High-caloric food only elicited increases in urge to binge, subjective and physiological stress in the first session. During the second session, reported urge to binge and subjective stress was significantly lower. Bulimic patients confronted with high-caloric food showed higher subjective and physiological stress in the first session compared to bulimic patients confronted with low-caloric food. In the second session, they reported more subjective stress and urge to binge, compared to the low-caloric group. Blood sugar levels did not affect psychological and physiological responses. DISCUSSION: The results are discussed in terms of the conditioning model of binge eating model, habituation models and implications for exposure therapy.

Evaluation of manual-based cognitive-behavioral therapy for bulimia nervosa in a service setting.

In the present study manual-based cognitive-behavioral therapy for bulimia nervosa was evaluated on an unselected sample of an out-patient service facility. A total of 73 female patients who asked for treatment received the primary diagnosis of bulimia nervosa. Of these, 67 took up treatment. Treatment was completed by 66 patients. Outcome variables were the number of binge episodes along with questionnaire scores for restraint eating, emotional eating, body dissatisfaction and depressiveness. At the end of treatment and 1 year after the end of treatment significant improvements were found in all outcome variables. Effect sizes for outcome variables were within the range of those of controlled research. Therefore, the present study delivered empirical evidence that manual-based cognitive-behavioral therapy is an effective treatment for bulimia nervosa not only within the restricted area of research.

Why do infertile males use psychological couple counselling?

The purpose of the present study was to identify characteristics of male patients that could be relevant for the uptake of psychological couple counselling for infertility. Therefore, 94 male patients who participated in psychological couple counselling were compared to 134 unselected infertility patients who attended an andrological clinic. Counselling users showed higher scores for depression and anxiety as well as a higher number of impaired sperm parameters. Multivariate analysis revealed that beyond the level of depression the number of impaired sperm parameters delivered additional information about the probability of a patient using counselling. For interpretation of these results the former research was broadly reviewed. It is suggested that an increased level of distress, the feeling of being responsible for infertility and few marital difficulties are relevant for the usage of couple counselling by male infertility patients. Practical consequences are discussed.

Negative feelings and the desire to eat in bulimia nervosa.

This study examines a broad range of negative feelings as possible antecedents of binge eating in bulimia nervosa (BN). Another goal is to explore the connection between negative feelings and the desire to eat as recorded continuously during two consecutive days. This is the first study comparing data from BN patients with a relevant clinical control group. Forty female BN patients, 40 female panic disorder (PD) patients, and 40 healthy women continuously recorded their feelings and the desire to eat while in their natural environment. Both patient groups reported more negative feelings than the healthy controls. BN patients had higher within-subject correlations between most negative feelings and the desire to eat than the two control groups. BN patients rated most feelings more negatively in the hour prior to binge eating than during the rest of the day. BN patients' general mood state worsened after binge eating but returned to prebinge levels after purging. The study provides additional evidence that unspecific negative feelings play an important role in the context of binge-eating behavior in BN.

Psychological and physiological reactivity to stress: an experimental study on bulimic patients, restrained eaters and controls.

BACKGROUND: Binge eating behavior in bulimic patients is thought to play a crucial role in the regulation of psychophysiological arousal in stressful situations. Previous results suggest that interpersonal stress and achievement challenge are perceived as particularly stressful by bulimic individuals. It is not clear, however, whether bulimic individuals respond to stress with an increased desire to binge, and whether this increase is accompanied by higher psychophysiological reactivity compared to healthy controls. METHODS: Twenty-seven patients with bulimia nervosa (DSM-IV), 27 restrained eaters, and 27 controls participated in two experimental sessions in which continuous measures of heart rate, blood pressure, respiration rat e, and ecectrodermal activity were monitored under conditions of achievement challenge (mental arithmetic, Stroop test) and interpersonal stress provoking feelings of loneliness and social rejection (film, imagery task). Ratings of desire to binge, negative mood, and hunger were obtained between experimental trials. Groups were matched for age and body mass index. RESULTS: There was a marked difference in subjective ratings during interpersonal stress. Bulimic patients responded to the imagery task with increases in both desire to binge and hunger, whereas restrained eaters and controls showed no change. There were no substantial group differences in psychophysiological reactivity. CONCLUSIONS: The dissociation between emotional responses and physiological activation may have important therapeutic implications.

Cognitive-behavioral therapy for idiopathic infertile couples.

BACKGROUND: The purpose of this pilot study was to evaluate the impact of a 6-month cognitive-behavioral therapy for infertile couples. METHODS: Seventeen idiopathic infertile couples participated in a therapy program comprised of modules to behaviorally optimize the chance of conception, improve sexual functioning and satisfaction, reduce thoughts of helplessness and, if necessary, improve marital communication skills. Pre- to posttreatment changes in the therapy group were compared to changes in two control groups. RESULTS: The therapy group showed an improvement in sperm concentration, a reduction in thoughts of helplessness and a decrease in marital distress. By the end of therapy participants practiced timed intercourse more reliably and reported unchanged sexual pleasure and satisfaction during the nonfertile period of the menstrual cycle. At the 6-month follow-up, problem-focused thoughts had decreased. The live birth rate was higher in the therapy group than in epidemiological samples. CONCLUSION: Preliminary data suggest that cognitive-behavioral treatment may be an effective approach for the treatment of infertility.