Gender stereotypes in eating disorder recognition.

PURPOSE: Eating disorder (ED) awareness is low. We assessed if ED symptom recognition, perceived need for treatment, perceived distress, perceived acceptability, and perceived prevalence differed depending on the gender of the individual with the ED. METHODS: 276 community participants were randomly assigned to one of three gender conditions (female, male, and non-binary), read three vignettes describing three different individuals with ED symptoms [anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED)], and then answered a series of questions related to participants ED symptom recognition, perceived need for treatment, perceived distress associated with having ED symptoms, perceived acceptability (e.g., the extent to which it may not be too bad to have an ED), and perceived prevalence. Mixed ANOVAs and chi-square analyses were conducted to examine differences between groups. RESULTS: There were no significant main effects of gender condition across the outcome variables. There were main effects of ED type for problem recognition, perceived need for treatment, perceived level of distress, and perceived prevalence, with participants being more likely to recognize a problem in the AN and BN vignettes than the BED vignettes, refer for treatment and rate a higher perceived level of distress in then AN vignette than the BN and BED vignettes, and perceive a higher prevalence rate in the BN vignette than the AN vignette. There was a significant gender by condition interaction for perceived prevalence, with participants rating a higher prevalence of AN in women and non-binary individuals than men and a higher prevalence of BN in women than non-binary individuals and men. CONCLUSION: These results highlight the importance of education on EDs and awareness that EDs can occur in any individual, regardless of their gender identification. LEVEL OF EVIDENCE: Level I, experimental study with randomization.

Mindfulness and Interoceptive Awareness: A Network Analysis.

ABSTRACT: Higher trait mindfulness is correlated with higher interoceptive awareness. However, there is a gap in understanding which mindfulness dimensions connect to which interoceptive awareness dimensions. This study ( N = 1005) used network analysis to identify central and bridge nodes driving the linkage between mindfulness and interoceptive awareness. Central nodes included trusting body sensations, feeling a sense of calm when bringing awareness to the body, the ability to refocus one's attention from thinking to sensing the body, and the ability to accept all emotions. Bridge nodes included noticing how food and drink affect thoughts, bodily sensations, and emotions; staying alert to the sensations of the body when taking a shower; and noticing and letting go of distressing thoughts and feelings. Future research studies should explore whether mindfulness-based interventions may be more effective by targeting observations of sensations related to eating and the body as well as noticing and letting go of distressing thoughts and feelings.

A Pilot Open Trial of a Digital Mindfulness-Based Intervention for Anorexia Nervosa.

Anorexia nervosa (AN) is a chronic and debilitating psychiatric disorder. Unfortunately, current treatments are lacking, with only 30-50% of individuals with AN recovering after treatment. We developed a beta-version of a digital mindfulness-based intervention for AN called Mindful Courage-Beta, which includes: (a) one foundational multimedia module; (b) 10 daily meditation mini-modules; (c) emphasis on a core skill set called the BOAT (Breathe, Observe, Accept, Take a Moment); and (d) brief phone coaching for both technical and motivational support. In this open trial, we aimed to evaluate (1) acceptability and feasibility; (2) intervention skill use and its association with state mindfulness in daily life; and (3) pre-to-post changes in target mechanisms and outcomes. Eighteen individuals with past-year AN or past-year atypical AN completed Mindful Courage-Beta over 2 weeks. Participants completed measures of acceptability, trait mindfulness, emotion regulation, eating disorder symptoms, and body dissatisfaction. Participants also completed ecological momentary assessment of skill use and state mindfulness. Acceptability ratings were good (ease-of-use: 8.2/10, helpfulness: 7.6/10). Adherence was excellent (100% completion for foundational module and 96% for mini-modules). Use of the BOAT in daily life was high (1.8 times/day) and was significantly associated with higher state mindfulness at the within-person level. We also found significant, large improvements in the target mechanisms of trait mindfulness (d = .96) and emotion regulation (d = .76), as well as significant, small-medium to medium-large reductions in eating disorder symptoms (ds = .36-.67) and body dissatisfaction (d = .60). Changes in trait mindfulness and emotion regulation had medium-large size correlations with changes in global ED symptoms and body dissatisfaction (rs = .43 - .56). Mindful Courage-Beta appears to be promising and further research on a longer, refined version is warranted.

Acculturation and eating disorders: a systematic review.

PURPOSE: Acculturation, or the dual process of cultural change that takes place due to the interaction between two or more cultural identities, may contribute to the susceptibility of developing an eating disorder (ED). We conducted a systematic review exploring the relationship between acculturation-related constructs and ED pathology. METHODS: We searched the PsychINFO and Pubmed/Medline databases up to December 2022. Inclusion criteria were: (1) having a measure of acculturation or related constructs; (2) having a measure of ED symptoms; and (3) experiencing cultural change to a different culture with Western ideals. 22 articles were included in the review. Outcome data were synthesized by narrative synthesis. RESULTS: There was variability in the definition and measure of acculturation in the literature. Overall, acculturation, culture change, acculturative stress, and intergenerational conflict were associated with ED behavioral and/or cognitive symptoms. However, the nature of the specific associations differed depending on the specific acculturation constructs and ED cognitions and behaviors measured. Furthermore, cultural factors (e.g., in-group vs. out-group preferences, generational status, ethnic group, gender) impacted the relationship between acculturation and ED pathology. DISCUSSION: Overall, this review highlights the need for more precise definitions of the different domains of acculturation and a more nuanced understanding of the specific relationship between various acculturation domains and specific ED cognitions and behaviors. Most of the studies were conducted in undergraduate women and in Hispanic/Latino samples, limiting generalizability of results. LEVEL OF EVIDENCE: Level V, Opinions of respected authorities, based on descriptive studies, narrative reviews, clinical experience, or reports of expert committees.

A Network Analysis of Cigarette Craving.

INTRODUCTION: Craving is considered a central process to addictive behavior including cigarette smoking, although the clinical utility of craving relies on how it is defined and measured. Network analysis enables examining the network structure of craving symptoms, identifying the most central symptoms of cigarette craving, and improving our understanding of craving and its measurement. AIMS AND METHODS: This study used network analysis to identify the central symptoms of self-reported cigarette craving as measured by the Craving Experience Questionnaire, which assesses both craving strength and craving frequency. Data were obtained from baseline of a randomized controlled trial of mindfulness training for smoking cessation. RESULTS: The most central symptoms in an overall cigarette craving network were the frequency of imagining its smell, imagining its taste, and intrusive thoughts. The most central symptoms of both craving frequency and craving strength sub-networks were imagining its taste, the urge to have it, and intrusive thoughts. CONCLUSIONS: The most central craving symptoms reported by individuals in treatment for cigarette smoking were from the frequency domain, demonstrating the value of assessing craving frequency along with craving strength. Central craving symptoms included multisensory imagery (taste, smell), intrusive thoughts, and urge, providing additional evidence that these symptoms may be important to consider in craving measurement and intervention. Findings provide insight into the symptoms that are central to craving, contributing to a better understanding of cigarette cravings, and suggesting potential targets for clinical interventions. IMPLICATIONS: This study used network analysis to identify central symptoms of cigarette craving. Both craving frequency and strength were assessed. The most central symptoms of cigarette craving were related to craving frequency. Central symptoms included multisensory imagery, intrusive thoughts, and urge. Central symptoms might be targeted by smoking cessation treatment.

Predictors of relapse in eating disorders: A meta-analysis.

INTRODUCTION: Eating disorders (EDs) have high rates of relapse. However, it is still not clear which factors are the strongest predictors of ED relapse, and the extent to which predictors of relapse may vary due to study and individual differences. OBJECTIVE: We conducted a meta-analysis to quantify and compare which factors predict relapse in EDs and evaluate various potential moderators of these relations (e.g., ED subtype, sample age, length of follow-up, timing of predictor assessment, relapse operationalization). METHODS: A total of 35 papers (effects = 315) were included. We used a multilevel random-effects model to estimate summary study-level effect sizes, and multilevel mixed-effects models to examine moderator effects. RESULTS: Higher level of care, having psychiatric comorbidity, and higher severity of ED psychopathology were associated with higher odds of relapse. Higher leptin, higher meal energy density/variety, higher motivation for change, higher body mass index/weight/body fat, better response to treatment, anorexia nervosa-restricting (vs. anorexia nervosa-binge purge) subtype diagnosis, and older age of ED onset were associated with lower odds of relapse. Several moderators were identified. DISCUSSION: A variety of variables can predict ED relapse. Furthermore, predictors of ED relapse vary among ED subtypes, sample ages, lengths of follow-up, timing of predictor assessments, and relapse operationalization. Future research should identify the mechanisms by which these variables may contribute to relapse.

Application of machine learning to discover interactions predictive of dietary lapses.

The purpose of this study it to build a machine learning model to predict dietary lapses with comparable accuracy, sensitivity, and specificity to previous literature while recovering predictor interactions. The sample for the current study consisted of merged data from two separate studies of individuals with obesity/overweight (total N = 87). Participants completed six ecological momentary assessment surveys per day where they were asked about 16 risk factors of lapse and if they had lapsed from their dietary prescriptions since the previous survey. Alcohol consumption and self-efficacy were the most prevalent in the top 10 stable interactions. Alcohol consumption decreased the protective effect of self-efficacy, motivation, and planning. Higher planning predicted higher risk for lapse only when consuming alcohol. Low motivation, hunger, cravings, and lack of healthy food availability increased the protective effect of self-efficacy. Higher self-efficacy increased risk effect of positive mood and having recently eaten a meal on lapse. For individuals with lower levels of self-efficacy, planning increased the risk of lapse. Alcohol intake and self-efficacy interact with several variables to predict dietary lapses, and these interactions should be targeted in just-in-time adaptive interventions that deliver interventions for lapses.

Eating disorder psychopathology and resilience in Iranian college students: A network analysis.

OBJECTIVE: Eating disorder (ED) psychopathology is common among Iranian college students. Resilience (i.e., the ability to bounce back and adapt in the face of adverse and stressful conditions) has been found to be a protective factor against ED psychopathology in the West. However, no research to date has examined resilience as a protective factor against ED psychopathology in Iran. The current study used network analysis to examine an ED and resilience network in an Iranian sample. METHOD: Participants were Iranian college students (N = 478) who completed the Farsi-Eating Disorder Examination-Questionnaire and Farsi-Brief Resilience Scale. We estimated a network of ED symptoms and resilience processes and identified central and bridge symptoms. RESULTS: Central ED and resilience nodes were discomfort in seeing one's own body, feeling guilty about eating due to shape/weight, and thinking about shape and weight making it difficult to concentrate. Having a hard time making it through stressful events bridged with binge eating and fear of losing control over eating. CONCLUSION: Processes related to managing stress and binge eating appear to maintain the association between ED symptoms and resilience processes.

A Network Investigation of Core Mindfulness Processes.

Objective: Mindfulness has been associated with improved psychological well-being and health, although outcomes from mindfulness-based interventions are mixed. One challenge is a limited understanding about which specific processes are core to mindfulness. Network analysis offers a method to characterize the core processes of mindfulness. Methods: This study used network analysis to identify which processes are central to mindfulness (have the strongest connectivity with other mindfulness processes) as measured by the Five Facets Mindfulness Questionnaire- Short Form, analyzed at the item-level. Data were obtained from baseline of a randomized clinical trial of smartphone app-based mindfulness training for smoking cessation. Results: The most central processes in the mindfulness network included, "I think some of my emotions are bad or inappropriate and I shouldn't feel them," an aspect of Nonjudgment/acceptance; as well as "I can easily put my beliefs, opinions, and expectations into words," and "It's hard for me to find the words to describe what I'm thinking," aspects of Describing. Conclusions: Findings help to clarify which processes are to mindfulness, contributing to a better understanding of the definition of mindfulness, and suggest factors that may be promising to target in mindfulness-based interventions. Future research should examine if mindfulness-based interventions may be improved by targeting these core mindfulness processes.

Eating disorder psychopathology and negative affect in Iranian college students: a network analysis.

BACKGROUND: ED psychopathology is becoming more prevalent in Iran. Negative affect has been found to be an important risk factor in eating disorder (ED) onset in research conducted in Western countries, and is also emerging as a potential vulnerability factor to ED psychopathology in Iran. Network theory offers a novel framework to understand the association between negative affect and ED psychopathology in Iran. The primary aim of the current study was to use network analysis to identify bridge symptoms (i.e., symptoms that activate or weaken symptoms in another cluster) across a negative affect and ED psychopathology network among Iranian college students. We also aimed to identify core symptoms (i.e., nodes that demonstrate the strongest connections to other nodes). METHOD: Participants were Iranian college students (n = 637; 60.3% women) who completed the Farsi-eating disorder examination-questionnaire and Farsi-negative affect. We estimated a network of ED symptoms and negative affective states and identified bridge and central symptoms. RESULTS: Hostility and shame emerged as central bridge symptoms across the negative affect and ED psychopathology clusters. The most central nodes were strong desire to lose weight, definite fear of losing control over eating, and binge eating episodes. CONCLUSION: The negative affective states of hostility and shame may increase vulnerability to ED psychopathology among Iranian college students. Findings have important implications for ED prevention programs that should be examined in future research.

ED psychopathology is common among Iranian college students, and negative affect may be a potential vulnerability factor to ED psychopathology in this population. However, it is unclear how specifically negative affective states may relate to ED psychopathology among Iranian college students. Therefore, we examined a network of negative affect and ED symptoms among Iranian college students (n = 637; 60.3% women). We found that the negative affective states of hostility and shame may link negative affect and ED psychopathology among Iranian college students. Findings have important implications for understanding the link between negative and ED psychopathology in Iran, and have potential implications for ED prevention programs in Iran that should be examined in further research.

Mindfulness and Eating Disorders: A Network Analysis.

Higher trait mindfulness may be protective against eating disorder (ED) pathology. However, little is understood about which specific mindfulness processes connect to specific ED symptoms. This study (N = 1,056 undergraduates) used network analysis at the symptom/process level to identify: (1) central nodes, or symptoms/processes with the greatest collective connection with all other symptoms/processes; and (2) bridge nodes, or symptoms/processes driving interconnection between mindfulness processes and ED symptoms. We conducted analyses both with and without food- and body-related mindfulness items. Central nodes included: describing how one feels in detail, expressing how one feels in words, and feeling guilty about eating due to shape/weight. Bridge nodes connecting higher mindfulness processes with lower ED symptoms included: the eating disorder symptom, being uncomfortable about others seeing one eat, and the mindfulness process, not criticizing oneself for having irrational/inappropriate emotions. Bridge nodes connecting higher mindfulness processes with higher ED symptoms included: noticing sensations of the body moving when walking and noticing how food/drinks affect thoughts, bodily sensations, and emotions. Findings suggest that future research should explore whether mindfulness-based interventions for EDs may be more effective by targeting mindfulness processes related to describing, expressing, and accepting emotions, accepting discomfort when eating with others, and reducing hyper-focus on and reactivity to food-and-body related sensations.

Momentary predictors of dietary lapse from a mobile health weight loss intervention.

Identifying factors that influence risk of dietary lapses (i.e., instances of dietary non-adherence) is important because lapses contribute to suboptimal weight loss outcomes. Existing research examining lapse risk factors has had methodological limitations, including retrospective recall biases, subjective operationalizations of lapse, and has investigated lapses among participants in gold-standard behavioral weight loss programs (which are not accessible to most Americans). The current study will address these limitations by being the first to prospectively assess several risk factors of lapse (objectively operationalized) in the context of a commercial mobile health (mHealth) intervention, a highly popular and accessible method of weight loss. N = 159 adults with overweight or obesity enrolled in an mHealth commercial weight loss program completed ecological momentary assessments (EMAs) of 15 risk factors and lapses (defined as exceeding a point target for a meal/snack) over a 2-week period. N = 9 participants were excluded due to low EMA compliance, resulting in a sample of N = 150. Dietary lapses were predicted by momentary increases in urges to deviate from one's eating plan (b = .55, p < .001), cravings (b = .55, p < .001), alcohol consumption (b = .51, p < .001), and tiredness (b = .19, p < .001), and decreases in confidence related to meeting dietary goals (b = -.21, p < .001) and planning food intake (b = -.15, p < .001). This study was among the first to identify prospective predictors of lapse in the context of a commercial mHealth weight loss program. Findings can inform mHealth weight loss programs, including just-in-time interventions that measure these risk factors, calculate when risk of lapse is high, and deliver momentary interventions to prevent lapses.

Real-time fluctuations in mindful awareness, willingness, and values clarity, and their associations with craving and dietary lapse among those seeking weight loss.

BACKGROUND: Mindful awareness, willingness and values clarity have been examined as protective factors across a wide range of problems, including overweight/obesity. However, these variables have almost exclusively been examined at the trait-level. It is possible that these variables also fluctuate within individuals in daily life, and that these intraindividual fluctuations may in turn be related to food craving and dietary lapse. The current study used ecological momentary assessment (EMA) to examine the extent to which momentary mindful awareness, willingness, and values clarity varied within-person, and were associated with craving and likelihood of dietary lapse among weight-loss seeking individuals with overweight/obesity prior to starting a weight loss program. We also examined the extent to which craving was associated with dietary lapse. METHODS: Adults with overweight/obesity (N = 126) completed one week of EMA prior to enrolling in a randomized controlled trial of behavioral weight loss treatments. They responded to EMA questions assessing dietary lapses, craving, mindful awareness, willingness, and values clarity six-times per day. RESULTS: Mindful awareness, willingness, and values clarity demonstrated substantial within-person variability, and higher within-person mindful awareness, willingness, and values clarity were concurrently (but not prospectively) associated with lower craving and likelihood of dietary lapse. Higher craving was concurrently (but not prospectively) associated with higher likelihood of dietary lapse. Between-person, higher mindful awareness, willingness, and values clarity were associated with lower craving and likelihood of dietary lapse, and higher craving was associated with greater frequency of dietary lapses. CONCLUSION: Mindful awareness, willingness, and values clarity vary substantially at the daily level, and may be important mechanisms to target to reduce craving and dietary lapses in the daily lives of individuals with overweight/obesity.

Awareness, affect, and craving during smoking cessation: An experience sampling study.

OBJECTIVE: Mindfulness has received attention in smoking cessation research, yet the mechanisms by which mindfulness may promote smoking cessation are not well understood. Mindfulness training may help individuals increase awareness and respond skillfully to processes that contribute to smoking, such as affective states and craving. This study used experience sampling (ES) to test how awareness was related to craving, positive and negative affect and smoking, in the moment, among smokers in treatment for smoking cessation. METHOD: Participants (N = 228) were part of a clinical trial evaluating Craving to Quit, a smartphone app for mindfulness training for smoking cessation, compared to an app delivering only ES. All participants were asked to complete 22 days of ES, with up to 6 ES surveys per day, measuring awareness, craving, positive and negative affect and smoking. Data were analyzed using multilevel linear modeling. RESULTS: Both at the within and between-person level, higher awareness was associated with higher positive affect, lower craving and lower negative affect. Lower within-person craving was associated with lower smoking. Within-person awareness, positive and negative affect were not significantly associated with smoking. At the between-person level, higher awareness and higher positive affect, and lower negative affect and lower craving were associated with lower smoking. CONCLUSIONS: Awareness of current experience was related to key psychological variables linked to behavior change in smoking cessation, namely positive and negative affect and craving, among smokers trying to quit. Future studies should test whether learning to increase awareness, such as through mindfulness training, may benefit smokers in treatment. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Mindfulness-based interventions for eating disorders: The potential to mobilize multiple associative-learning change mechanisms.

Mindfulness is a two-component skill that includes mindful awareness (attentional monitoring of present moment experience) and mindful acceptance (adopting an attitude of acceptance toward this experience). Although mindfulness-based interventions (MBIs) are efficacious for many conditions, there is a lack of research on MBIs for eating disorders (EDs). We propose that MBIs may be promising for EDs given their potential to mobilize not one, but multiple associative-learning change mechanisms in EDs-defined as adaptive processes of change involving one of two forms of associative-learning: Pavlovian and operant learning. We hypothesize how MBIs-via increasing either mindful awareness or mindful acceptance-may mobilize up to eight associative-learning change mechanisms, two involving Pavlovian learning, and six involving operant learning. We also elaborate on similarities and differences between MBIs and CBT approaches for EDs, as well as opportunities for synergy. Finally, we present recommendations for future research related to the development and evaluation of novel MBI interventions for EDs and the testing of mechanisms and patient-treatment matching hypotheses.

Associations between adverse childhood experiences and weight, weight control behaviors and quality of life in Veterans seeking weight management services.

INTRODUCTION: A neglected area of trauma research with Veterans is the study of Adverse Childhood Experiences (ACEs). The present study aimed to examine the prevalence of ACEs, and to explore relationships between ACEs and measures of weight, eating behaviors and quality of life in weight loss seeking Veterans. METHODS: Participants were 191 Veterans [mean age 58.9 (SD = 12.8), mean Body Mass Index (BMI) 35.4 (SD = 6.1), 86.9% male, 33.7% racial/ethnic minority] receiving care at VA Connecticut Healthcare System (VA CT) who attended an orientation session of VA's behavioral weight management program. Participants completed a measure of ACEs and measures related to weight, eating and health. RESULTS: Among completers, 68.6% endorsed at least one ACE. The average number of reported ACEs was 2.2 (SD = 2.5), with 48.7% of Veterans reporting more than one type of ACE. Women were more likely to report any ACE (88.0% vs. 65.6%, p = .025) and reported significantly more ACEs compared to males (4.2 vs. 1.9, p < .001). ACEs were associated with lower physical activity (p = .05), lower quality of life (p's < 0.05), and lower weight-related quality of life (p < .01), but not weight, weight control strategies, binge eating, or alcohol use. CONCLUSION: ACEs are common among weight loss seeking Veterans, particularly among female Veterans. Findings suggest that there is a high rate of ACEs in Veterans, which are associated with exercise and quality of life outcomes, but not diet and weight outcomes.

A Mindfulness-Based Physical Activity Intervention: A Randomized Pilot Study.

OBJECTIVE: Most US adults are insufficiently active. One strategy individuals could use to increase physical activity is to exercise mindfully (i.e., while paying attention to present-moment experiences with acceptance. A mindfulness-based intervention for exercise can be delivered via an audio recording, which is advantageous in regard to time demands, cost, and dissemination potential. The aims of this parallel two-arm pilot randomized controlled trial were to assess the feasibility and acceptability of an audio-recorded mindfulness-based intervention and to assess whether the intervention resulted in a clinically meaningful difference in physical activity compared with the control condition. METHODS: Physically underactive adults (N = 50) were randomized to a mindfulness intervention condition in which they were instructed to exercise while listening to an audio-recorded mindfulness-intervention or an active control group in which they were instructed to exercise while using a heart rate monitor. Participants completed a 30-minute moderate intensity treadmill exercise bout during a baseline in-laboratory session in the manner in which they were randomized (i.e., mindfulness recording versus using a heart rate monitor) and instructed to exercise in this manner for the next week. At follow-up, acceptability was measured by self-report, feasibility by frequency of intervention use, and physical activity using both self-reported physical activity recall and an accelerometer. RESULTS: The audio-recorded mindfulness-based physical activity intervention was rated as acceptable and feasible to use. Compared with the control group, the intervention also resulted in clinically meaningful differences in self-reported moderate-to-vigorous physical activity minutes (mean difference = 67.16 minutes) and accelerometer-measured minutes (mean difference = 35.48 minutes) during a 1-week follow-up. CONCLUSIONS: The audio-recorded mindfulness-based physical activity intervention is a promising approach to increasing physical activity with good dissemination potential.