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Behavioural Medicine and Health

Margarita Slof-Op ‘t Landt, Alexandra Dingemans, Mayron Picolo, Melissa Atkinson, Orçun Yorulmaz, Francisco Esteves / Sandra Mulkens (Chair) Speaker

Chair: Sandra Mulkens, Maastricht University

10:30 Functional and dysfunctional impulsivity in relation to impulsivity measures in an
             eating disorder sample
            Margarita Slof-Op ‘t Landt, Eric F. van Furth, Rivierduinen Eating Disorders Ursula &
            Leiden University Medical Center

10:45 Executive functioning as predictor for treatment outcome in Binge Eating Disorder
           Alexandra Dingemans, C.B.Vanhaelen, Rivierduinen Eating Disorders Ursula, Leiden
           G.E.van Son, Rivierduinen Quality of Care, Leiden
           Eric F. van Furth, Rivierduinen Eating Disorders Ursula & Leiden University Medical Center

11:00 Interactions between reward and hunger: mood reactions to reward in anorexia 
             nervosa under starvation and satiety states
           Mayron Picolo,Chantal Martin-Sölch,University of Fribourg
           Gabriella Milos, Sena Bluemel, Sonja Schumacher, Christoph Müller-Pfeiffer, University
           Hospital Zurich
           Monique Ersnt, National Institutes of Mental Health, Bethesda

11:15 Acceptability and preliminary efficacy of an online mindfulness-based eating disorder 
            prevention programme: Results from a randomized controlled pilot study among
            young 
adult women
            Melissa Atkinson, University of Bath & University of the West of England
            Phillippa Diedrichs, University of the West of England
            Tracey Wade, Flinders University
            Nichola Rumsey,University of the West of England

11:30 Highlights of Cognitive Model on Body Dissatisfaction: Examination of Several Factors 
            in a Non-Western Culture
           Orçun Yorulmaz, Dokuz Eylül University
           Münire Kaytan, Uludağ University

11:45 Attention and eating disorders
           Francisco Esteves, Mid Sweden University & Instituto Universitário de Lisboa
          Isabel Santos, Instituto Universitário de Lisboa & Universidade Lusófona de Humanidades
           e Tecnologias, Lisboa
           Jens Bernhardsson, Billy Jansson,  Örjan Sundin,Mid Sweden University

 

Abstracts:

1) Functional and dysfunctional impulsivity in relation to impulsivity measures in an eating disorder sample

Margarita C.T. Slof-Op ‘t Landt, Eric F. van Furth, Rivierduinen Eating Disorders Ursula, Leiden, Netherlands & Department of Psychiatry, Leiden University Medical Center, Leiden, Netherlands

Impulsivity – the tendency to act with little or no forethought, reflection or consideration of the consequences – is a multidimensional construct. It can be split into an ‘unhealthy’, when consequences of the lack of deliberation are undesirable, and a ‘healthy’ variant, when consequences are positive. In the current study the relation between both impulsivity variants and three commonly used impulsivity measures was examined in a group of patients with eating disorders (EDs). 185 patients with EDs (55 restricted type, 130 binge eating/purging type) completed the Dickman Impulsivity Inventory to assess Functional (‘healthy’) and Dysfunctional (‘unhealthy’) Impulsivity. In addition the Go/No Go task, the Iowa Gambling Task and the Inhibit subscale of the BRIEF-A questionnaire were completed. In regression analyses the association between Dysfunctional/Functional Impulsivity and the scores on the separate impulsivity measures were tested. Finally, the difference between ED types (binge eating/purging type is generally characterized by high impulsivity) was examined. Higher levels of Dysfunctional Impulsivity were associated with making more commission errors in the Go/No Go task (β=0.18, [95% CI:0.07;0.52], p<0.05) and with a self-reported lower ability to resist impulses on the Inhibit subscale (β=0.57, [95% CI:1.68;2.55], p<0.01). For both associations the effect was present in the binge eating/purging type but not in the restricted type patients. Functional Impulsivity was not associated with any of the impulsivity measures. Patients who reported more ‘unhealthy’ impulsivity were also more likely to show impulsivity on the Go/No Go task and the Inhibit scale. ‘Healthy’ impulsivity was not related to these impulsivity tasks.

 

2) Executive functioning as predictor for treatment outcome in Binge Eating Disorder

Dingemans A.E., Rivierduinen Eating Disorders Ursula, Leiden, the Netherlands; van Son G.E., Rivierduinen Quality of Care, Leiden, the Netherlands; Vanhaelen C.B., Rivierduinen Eating Disorders Ursula, Leiden, the Netherlands; van Furth E.F., Rivierduinen Eating Disorders Ursula, Leiden, the Netherlands; Department of Psychiatry, Leiden University Medical Center, Leiden, the Netherlands

One of the key symptoms of Binge Eating Disorder (BED) is eating large amounts of food within a limited period of time while experiencing feelings of loss of control. Binge eating may serve as a means to escape from negative thoughts and worries, and to alleviate emotional distress. Executive functions play an important role in mediating self-control and self-regulation. It has been suggested that the inability to control eating in BED may indicate inefficiencies in executive functioning. This study investigated whether executive functioning predicted treatment outcome in patients with BED. Depressive symptoms and executive functioning (neuropsychological tests and a questionnaire) were assessed in 91 patients with BED. Eating disorder (ED-) symptoms (EDE-Q) were assessed every six months. Potential predictor variables were investigated using multivariate Cox regression models. Remission was defined by means of two different indicators based on the EDE-Q: 1. achieving abstinence of objective binge eating; and 2. showing a 50% reduction in baseline symptom ED severity and/or reaching the clinical significance cut-off. The results revealed no significant predictors for achieving abstinence of binge eating. . Severity of ED-psychopathology at baseline was the only significant predictor for 50% reduction ED-symptoms . An increase of 1 SD of the EDEQ global score was associated with a 42% decrease in the chance of a good outcome (HR=0.58 (95% CI: 0.37-0.93), p <0.01). No associations were found between executive functioning and treatment outcome. Inefficiencies in executive functioning at baseline do not seem to play a role in the maintenance of the BED.

 

3) Interactions between reward and hunger: mood reactions to reward in anorexia nervosa under starvation and satiety states

Picolo, Mayron, Unit of Clinical and Health Psychology, University of Fribourg, Fribourg, Switzerland;Milos, Gabriella, Clinic for Psychiatry and Psychotherapy, University Hospital Zurich, Zurich, Switzerland; Bluemel, Sena, Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland; Schumacher, Sonja; Müller-Pfeiffer, Christoph, Clinic for Psychiatry and Psychotherapy, University Hospital Zurich, Zurich, Switzerland; Ersnt, Monique, Section on Neurobiology of Fear and Anxiety, National Institutes of Mental Health, Bethesda, USA;  Martin-Sölch, Chantal, Unit of Clinical and Health Psychology, University of Fribourg, Fribourg, Switzerland

Introduction:
Previous studies reported altered reward processing in anorexia nervosa (AN), showing reduced striatal activation to natural and monetary rewards as well as reduced dopamine function. In addition, anhedonia states are frequently reported in AN, potentially due to the physiological stress produced by the permanent starvation. Here, we investigated the effect of hunger and satiety on reward responses and associated mood reactions to monetary rewards in AN patients and healthy controls.
Methods:
24 participants with current AN diagnosis (BMI 14.4 (11.9-15.5) kg/m2) and 17 age and gender matched healthy, normal weight subjects (BMI 21.8 (18.9-24.9) kg/m2) without psychiatric disorders performed a validated reward task (wheel of fortune), involving uncertainty (50/50 probability of winning high and low reward), safe and risky (30/70 and 10/90 probabilities) conditions, while fasting (session 1, before eating) and after ingestion of a standard meal (session 2, after eating). Subjects rated their mood through the positive and negative affective schedule (PANAS) questionnaire before and after the task in each session. Data analysis was done with linear mixed models.
Results:
While fasting, healthy women (HW) showed higher hunger ratings than AN participants while this difference disappeared after meal intake. Across groups and sessions, positive affect was rated higher after the reward task compared to before. In general, HW reported higher positive and lower negative affect ratings than those with AN. HW and AN reported very similar positive mood in response to reward, while negative mood after not winning was more prominent in HW than in AN, mostly involving risky conditions.
Discussion:
Mood reactivity to monetary reward is stronger under starvation compared to satiety for both HW and AN. However, the general mood refers mostly to winning a monetary reward, and this does not seem to be impaired in AN, while negative mood after not winning is stronger in HW compared to AN. Also, patients with AN report less hunger under starvation compared to healthy controls, and this could mean that hunger has less effect on mood in AN than in the general population. In addition, our results suggest that negative but not positive mood is less adaptive in AN.
Conclusion:
Our study shows that hunger does not have the same effect in AN compared to HW, and also that people with AN may not respond to not getting a monetary reward as does the healthy population. The awareness of this fact might lead to changes in clinical practice targeting this population.

 

4) Acceptability and preliminary efficacy of an online mindfulness-based eating disorder prevention programme: Results from a randomized controlled pilot study among young adult women

Melissa Atkinson, Department of Psychology, University of Bath, Bath, United Kingdom;  Centre for Appearance Research, University of the West of England, Bristol, United Kingdom; Phillippa Diedrichs, Centre for Appearance Research, University of the West of England, Bristol, United Kingdom;Tracey Wade, School of Psychology, Flinders University, Adelaide, South Australia; Nichola Rumsey, Centre for Appearance Research, University of the West of England, Bristol, United Kingdom.

Introduction:
Mindfulness-based eating disorder (ED) prevention has received support when face-to-face, however dissemination is impeded by limited uptake and reliance on experts. This study therefore assessed online delivery for reducing ED risk factors.
Method:
Undergraduate women (N=174, Mage=20.34, SD=1.67; Mbmi =23.78, SD=4.97) were allocated to self-guided online mindfulness (3 x 30min weekly modules) or active control (body image tips). ED symptoms and risk factors were assessed at baseline, post-intervention and 3-months.
Results:
Of 87 allocated to mindfulness, 40% completed the first module and 25% completed all three. Moderate acceptability was indicated across understanding, effectiveness, enjoyment, ease of use, and likelihood of continued use (Ms=3.56-4.25). Qualitative feedback for non-completion included lack of time, being too busy or forgetting, too much written content and reading, and not being personally useful. Per-protocol analysis revealed a significant interaction for negative affect, with completers reporting lower negative affect than control at 3-months (Cohen’s d = 0.69). A similar pattern was observed for weight and shape concerns (d = 0.39), ED symptoms (d = 0.27), and body image inflexibility (d = 0.39), although not significant. Participants completing only the first module showed higher anxiety than control at post-intervention.
Discussion and conclusion:
Findings highlight sleeper effects of mindfulness practice, with potential initial discomfort likely contributing to drop-out. Despite promise for reducing ED risk factors, poor compliance resulted in lack of power to detect significant effects, and indicates limited feasibility of the intervention in this format. Future implementation will require adaptations to increase engagement and maximise impact.

 

5) Highlights of Cognitive Model on Body Dissatisfaction: Examination of Several Factors in a Non-Western Culture

Orçun Yorulmaz, Münire Kaytan, Department of Psychology, Faculty of Letters, Dokuz Eylul University, Izmir-Turkey; Department of Psychology, Faculty of Arts and Science, Uludag University, Bursa-Turket

According to the cognitive model (Veale & Neziroglu, 2010; Philips, 2009), attentional and cognitive biases, repetitive safety and/or avoidance behaviors as well as emotional states play critical roles in body dissatisfaction which is a core element in Body Dysmorphic Disorder. Although phenomenological consistency was reported throughout the world for this condition, few research have examined roles of these correlates in other than Western countries; yet, as the cultural characteristics and globalization are considered, this cognitive model and relevant factors needs to be verified. Accordingly, the present study aimed to investigate the main tenets of this model in a Turkish community sample with a cross-sectional design. After giving informed consent, 313 adults completed the self-report measures of body dissatisfaction, self-consciousness, basic emotions, social appearance anxiety and coping strategies of body image. Correlational analyses indicated that body dissatisfaction were positively associated with self-consciousness, social appearance anxiety and coping strategies of avoidance and appearance fixing as well as emotions of fear and disgust. Moreover, females also scored higher on those measures, except for disgust. Finally, hierarchical regression analysis confirmed the roles of gender, fear, fixing appearance, avoidance and appearance anxiety in whole sample, while it seems that these factors were highlighted more among females. In conclusion, the core factors of the cognitive model of the body dissatisfaction as well as gender difference was confirmed once more in a non-Western country; thus, it appears that these cognitive factors have important impacts, regardless of culture. In other words, people who were more self-conscious and who reported more fear and anxiety about their appearance with more use of problematic strategies are more prone to experience body dissatisfaction. Furthermore, the current findings suggest that prevention studies and psychoeducation programs for the BDD focusing on some emotions, cognitive biases and ways of coping toward body image are strongly needed.

 

6) Attention and eating disorders

Francisco Esteves, Mid Sweden University, Östersund, Sweden; Instituto Universitário de Lisboa (ISCTE-IUL), Portugal;Isabel Santos, Instituto Universitário de Lisboa (ISCTE-IUL), Portugal; Universidade Lusófona de Humanidades e Tecnologias, Lisboa, Portugal; Jens Bernhardsson, Mid Sweden University, Östersund, Sweden; Billy Jansson, Mid Sweden University, Östersund, Sweden; Örjan Sundin, Mid Sweden University, Östersund, Sweden;

In recent decades, there has been an increase in dysfunctional eating patterns related to eating disorders. Worries about heathier food, or attitudes related to ethical/environmental issues, or anxiety related to the way our own body corresponds to social desirability standards, might contribute to that behaviour. Furthermore, this problem is not limited to diagnosed eating disorders, but it affects many people who, although they do not meet the diagnostic criteria, show a very problematic way to cope with their food intake. A research strategy to increase the knowledge about possible psychological mechanisms involved is to study the perception we have of food stimuli and of our body. In a series of experimental studies, attentional patterns towards different types of food images (high or low calorie), and towards images of different body shapes (thinner or fatter), were studied. Gaze direction during free observation of several simultaneously presented stimuli was recorded by means of eye tracking. In general, the results showed that the participants with more symptoms of eating disorders had an attention bias towards high-calorie foods (i.e. looked longer to high calorie food pictures), and that women with higher body dissatisfaction looked more (longer) at the thin bodies than at the fatter ones. These results suggest interesting possibilities of using measures of ocular behaviour in the early detection of eating disorders, and maybe possibilities of improving clinical and preventive interventions.