Subtyping bulimic women along dietary restraint and negative affect dimensions.

Etiologic models of bulimia center on dieting and negative affect, yet no research has subtyped bulimic individuals according to whether they fit dietary versus negative affect profiles. This study subtyped 265 bulimic women along dieting and depressive dimensions and tested whether subtypes showed differences in eating pathology, clinical correlates, and treatment response. Cluster analysis revealed a pure dietary subtype (62%) and a mixed dietary–depressive subtype (38%). Whereas dietary and dietary–depressive bulimic women showed similar levels of bulimic behaviors, the latter reported more eating and weight obsessions; social maladjustment; higher rates of mood, anxiety, eating, impulse control, and personality disorders; and poorer treatment response. Results suggest dieting is a central feature of bulimia, but depressive affect occurs in only a subset of cases. However, the combination of dieting and depressive affect seems to signal a more severe variant of bulimia. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Weight suppression is a robust predictor of outcome in the cognitive-behavioral treatment of bulimia nervosa.

This study examined weight suppression (difference between highest premorbid weight and pretreatment weight) as a predictor of outcome in 188 outpatients with bulimia nervosa enrolled in a cognitive- behavioral therapy intervention. Participants who dropped out of treatment had significantly higher levels of weight suppression than treatment completers. Of participants who completed treatment, those who continued to engage in binge eating or purging had significantly higher levels of weight suppression than those who were abstinent from bingeing and purging. Results did not change when body mass index, dietary restraint, weight and shape concerns, or other relevant variables were controlled. Relinquishing bulimic behaviors and adopting normal eating patterns may be most feasible for patients who are closest to their highest premorbid weights. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A prospective test of the dual-pathway model of bulimic pathology: Mediating effects of dieting and negative affect.

Because there have been few longitudinal investigations of integrative etiological theories of bulimia nervosa, this study prospectively tested the dual-pathway model using random regression growth curve models and data from a 3-wave community sample of adolescent girls (N?=?231). Initial pressure to be thin and thin-ideal internalization predicted subsequent growth in body dissatisfaction, initial body dissatisfaction predicted growth in dieting and negative affect, and initial dieting and negative affect predicted growth in bulimic symptoms. There was prospective evidence for most of the hypothesized mediational effects. Results are consistent with the assertion that pressure to be thin, thin-ideal internalization, body dissatisfaction, dieting, and negative affect are risk factors for bulimic pathology and provide support for the dual-pathway model. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Revisiting the affect regulation model of binge eating: A meta-analysis of studies using ecological momentary assessment.

The affect regulation model of binge eating, which posits that patients binge eat to reduce negative affect (NA), has received support from cross-sectional and laboratory-based studies. Ecological momentary assessment (EMA) involves momentary ratings and repeated assessments over time and is ideally suited to identify temporal antecedents and consequences of binge eating. This meta-analytic review includes EMA studies of affect and binge eating. Electronic database and manual searches produced 36 EMA studies with N = 968 participants (89% Caucasian women). Meta-analyses examined changes in affect before and after binge eating using within-subjects standardized mean gain effect sizes (ESs). Results supported greater NA preceding binge eating relative to average affect (ES = 0.63) and affect before regular eating (ES = 0.68). However, NA increased further following binge episodes (ES = 0.50). Preliminary findings suggested that NA decreased following purging in bulimia nervosa (ES = –0.46). Moderators included diagnosis (with significantly greater elevations of NA prior to bingeing in binge eating disorder compared to bulimia nervosa) and binge definition (with significantly smaller elevations of NA before binge vs. regular eating episodes for the Diagnostic and Statistical Manual of Mental Disorders definition compared to lay definitions of binge eating). Overall, results fail to support the affect regulation model of binge eating and challenge reductions in NA as a maintenance factor for binge eating. However, limitations of this literature include unidimensional analyses of NA and inadequate examination of affect during binge eating, as binge eating may regulate only specific facets of affect or may reduce NA only during the episode. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Affect regulation and food intake in bulimia nervosa: Emotional responding to food cues after deprivation and subsequent eating.

Emotional responding to salient food cues and effects of food deprivation and consumption were investigated in 32 women with bulimia and 32 control women. One half of each group was food deprived before viewing unpleasant, neutral, pleasant, and food-related pictures. Then participants could eat from a buffet before viewing a parallel picture set. Women with bulimia showed a substantial potentiation of startle responses during viewing of food cues relative to control women. This startle potentiation was attenuated by food deprivation and augmented by increased food consumption. These data support the affective regulation model suggesting that food cues prompt negative affective states in women with bulimia, who are overwhelmed by fasting. The resulting deprivation increases the incentive value of food cues and may thus trigger binge eating. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive-behavioral therapy for bulimia nervosa: Time course and mechanisms of change.

Cognitive-behavioral therapy (CBT) is an effective treatment of bulimia nervosa, but its mechanisms of action have not been established. In this study the authors analyzed the results of a randomized control trial comparing CBT with Interpersonal Psychotherapy (IPT) to identify possible mediators of change of CBT for BN and its time course of action. Reduction in dietary restraint as early as Week 4 mediated posttreatment improvement in both binge eating and vomiting. Measures of self-efficacy concerning eating behavior, negative affect, and body shape and weight at midtreatment were also significantly associated with posttreatment outcome at 20 wks. No evidence was found that the therapeutic alliance mediated treatment outcome. CBT had a significantly more rapid treatment effect than IPT, with 62% of posttreatment improvement evident by Week 6. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The nonconscious cessation of goal pursuit: When goals and negative affect are coactivated.

Extending on the recent investigation into the implicit affective processes underlying motivation and decision making, 5 studies examined the role of negative affect in moderating goal priming effects. Specifically, experimental effects on measures that typify motivational qualities of goal systems, such as keeping a goal at a heightened level of mental accessibility and exerting effort to work for a goal and experiencing desire to attain the goal, showed that the motivation and resultant operation of social goals cease when these goals are primed in temporal proximity of negatively valenced information. These goal cessation effects resulting from the mere coactivation of a goal and negative affect are discussed against the background of present research on nonconscious goal pursuit and the role of accessibility and desirability in the regulation of automatic goal-directed behavior. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Dietary and Dietary-Depressive Subtypes of Bulimia Nervosa Show Differential Symptom Presentation, Social Impairment, Comorbidity, and Course of Illness.

Research suggests that women with bulimia nervosa can be classified into dietary and dietary-depressive subtypes and that the latter show greater eating pathology, social impairment, comorbidity, and treatment nonresponse. The authors sought to replicate this subtyping scheme with an independent sample and to generate further evidence for the validity of this distinction. Analysis revealed dietary and dietary-depressive subtypes and indicated that the latter reported more current eating pathology, social impairment, and treatment seeking as well as greater psychiatric comorbidity and bulimic symptom persistence over a 5-year follow-up. This subtyping scheme had stronger concurrent and predictive validity than the purging-nonpurging distinction. Results provide further evidence for the reliability and validity of this subtyping scheme and suggest it has important clinical implications. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Eating Disorder Diagnostic Scale: Additional Evidence of Reliability and Validity.

The authors conducted 4 studies investigating the reliability and validity of the Eating Disorder Diagnostic Scale (HDDS; E. Stice, C. F. Telch, & S. L. Rizvi, 2000), a brief self-report measure for diagnosing anorexia nervosa, bulimia nervosa, and binge eating disorder. Study 1 found that the HDDS showed criterion validity with interview-based diagnoses, convergent validity with risk factors for eating pathology, and internal consistency. Studies 2 and 3 found that the EDDS was sufficiently sensitive to detect the effects of eating disorder prevention programs. Regarding predictive validity, Studies 3 and 4 found that the EDDS predicted response to a prevention program and future onset of eating pathology and depression. Results provide additional evidence of the reliability and validity of this scale and suggest it may be useful in clinical and research applications. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive reappraisal of negative affect: Converging evidence from EMG and self-report.

Prior psychophysiological studies of cognitive reappraisal have generally focused on the down-regulation of negative affect, and have demonstrated either changes in self-reports of affective experience, or changes in facial electromyography, but not both. Unfortunately, when taken separately, these measures are vulnerable to different sources of bias, and alternative explanations might account for changes in these indicators of negative affect. What is needed is a study that (a) obtains measures of self-reported affect together with facial electromyography, and (b) examines the use of reappraisal to regulate externally and internally generated affective responses. In the present study, participants up- or down-regulated negative affect in the context of both negative and neutral pictures. Up-regulation led to greater self reports of negative affect, as well as greater corrugator and startle responses to both negative and neutral stimuli. Down-regulation led to lesser reports of negative affect, and lesser corrugator responses to negative and neutral stimuli. These results extend prior research by (a) showing simultaneous effects on multiple measures of affect, and (b) demonstrating that cognitive reappraisal may be used both to regulate responses to negative stimuli and to manufacture a negative response to neutral stimuli. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Fibromyalgia: The role of sleep in affect and in negative event reactivity and recovery.

Objective: Fibromyalgia (FM) syndrome is a chronic pain condition characterized by diffuse muscle pain, increased negative mood, and sleep disturbance. Until recently, sleep disturbance in persons with FM has been modeled as the result of the disease process or its associated pain. The current study examined sleep disturbance (i.e., sleep duration and sleep quality) as a predictor of daily affect, stress reactivity, and stress recovery. Design and Measures: A hybrid of daily diary and ecological momentary assessment methodology was used to evaluate the psychosocial functioning of 89 women with FM. Participants recorded numeric ratings of pain, fatigue, and positive and negative affect 3 times throughout the day for 30 consecutive days. At the end of each day, participants completed daily diary records of positive and negative life events. In addition, participants reported on their sleep duration and sleep quality each morning. Results: After accounting for the effects of positive events, negative events, and pain on daily affect scores, it was found that sleep duration and quality were prospectively related to affect and fatigue. Furthermore, the effects of inadequate sleep on negative affect were cumulative. In addition, an inadequate amount of sleep prevented affective recovery from days with a high number of negative events. Conclusions: These results lend support to the hypothesis that sleep is a component of allostatic load and has an upstream role in daily functioning. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Patterns of hemispheric perceptual asymmetries: Left hemispatial biases predict changes in anxiety and positive affect in undergraduate women.

Consistent with the tripartite model of anxiety and depression, hemispheric asymmetries may be differentially associated with depressive and anxious symptoms. Indeed, research has demonstrated that asymmetries do exist when examining hernispatial biases in both anxious and depressed individuals; however, the magnitude and direction of these asymmetries has been variable. The Chimeric Faces Task was used here to measure these asymmetries, along with measures for current and future levels of anxiety and depression. Results indicated that (a) increased left hemispatial biases at Time 1 predict increased anxiety (i,e., physiological hyperarousal) at Time 2 among 63 female undergraduate students (aged 18-47 yrs) and (b) decreased left hernispatial biases at Time 1 predict decreased positive affectivity at Time 2 among the same participants. The possibility that hemispatial biases represent a vulnerability to future anxiety and depression is discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Increasing attendance for psychotherapy: Implementation intentions and the self-regulation of attendance-related negative affect.

The present study evaluated an implementation intention intervention that aimed to increase attendance at scheduled, initial appointments for psychotherapy by helping clients to manage negative feelings about attendance. Participants received a postal questionnaire that measured their views about attending psychotherapy. One half of the sample was randomly assigned to an implementation intention induction that was embedded in the questionnaire. Intention-to-treat analysis (N=390) indicated that participants who formed implementation intentions were more likely to attend compared to controls (75% vs. 63%), and this effect was even stronger among participants who returned the questionnaire (83% vs. 57%). Whereas anticipated affective costs (e.g., shame) had a negative impact on attendance for most participants, this effect was attenuated when participants formed implementation intentions and perceived that attendance would be beneficial. Thus, implementation intention formation can help clients to deal effectively with negative feelings that might otherwise prevent them attending their first psychotherapy appointment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Smoking, stress, and negative affect: Correlation, causation, and context across stages of smoking.

This transdisciplinary review of the literature addresses the questions, Do stress and negative affect (NA) promote smoking? and Does smoking genuinely relieve stress and NA? Drawing on both human and animal literatures, the authors examine these questions across three developmental stages of smoking--initiation, maintenance, and relapse. Methodological and conceptual distinctions relating to within- and between-subjects levels of analyses are emphasized throughout the review. Potential mechanisms underlying links between stress and NA and smoking are also reviewed. Relative to direct-effect explanations, the authors argue that contextual mediator-moderator approaches hold greater potential for elucidating complex associations between NA and stress and smoking. The authors conclude with recommendations for research initiatives that draw on more sophisticated theories and methodologies. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Age differences in psychosocial predictors of positive and negative affect: A longitudinal investigation of young, midlife, and older adults.

[Correction Notice: An erratum for this article was reported in Vol 26(2) of Psychology and Aging (see record 2011-11703-002). Contains an error in Figure 3, on page 649. The correction discusses where to find the correct data.] Research has consistently shown that despite aging-related losses, older adults have high levels of emotional well-being relative to those in young and midlife adults. We aimed to contribute to knowledge around the factors that predict emotional well-being over the life course by examining age group differences in associations of positive and negative social exchanges and mastery beliefs with positive and negative affect in a sample of 7,472 young, midlife, and older adults assessed on 2 measurement occasions, 4 years apart. Results from structural equation models indicated lower levels of negative affect with advancing age. Mastery was consistently related to higher well-being, with the strongest associations evident for young adults. Older adults reported the most frequent positive and least frequent negative social exchanges; however, associations of social relations with affect tended to be stronger among young and midlife adults relative to older adults. Results are discussed in the context of life course perspectives on goal orientations and self-regulatory processes. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Fear of reinjury, negative affect, and catastrophizing predicting return to sport in recreational athletes with anterior cruciate ligament injuries at 1 year postsurgery.

Objective: To examine fear of reinjury, negative affect, and pain catastrophizing as determinants of athletes' confidence in their ability to take part in sport activity and their reported return to sport 1 year after undergoing anterior cruciate ligament (ACL) reconstruction. Participants: 49 recreational-level athletes (27 men and 22 women; Mage=29.15 years, SD=11.57). Results: Negative affect was inversely associated with sport confidence, and fear of reinjury was inversely associated with reported return to sport. Regression models showed that negative affect was the lone significant predictor (β=-.32, p