Pilot study of an online-delivered mindfulness meditation in Ehlers-Danlos syndrome (hEDS): effect on quality-of-life and participant lived experience.

PURPOSE: Ehlers-Danlos syndromes (EDS) are connective tissue disorders with multi-systemic symptoms. Management of chronic pain and other symptoms of EDS is a challenge for patients and clinicians. Mindfulness-based approaches for chronic pain produce improvement in pain symptoms. Mindfulness meditation could be an acceptable and readily accessible therapy for pain in EDS. This study evaluated the effect of daily practice of mindfulness meditation on pain experience and quality-of-life in EDS. MATERIALS AND METHODS: A pre-post design enabled assessment of change in quality-of-life (SF-36) after practicing internet-delivered mindful meditation for two weeks. Thematic analysis of interviews (n = 10) documented lived experience of meditation practice for pain symptoms. One hundred fifty-seven were recruited from UK EDS charities mailing lists. Seventy six completed the two-week intervention. RESULTS: There was a statistically significant improvement in the SF-36 mental component summary score of medium effect size; the change was clinically important. Thematic analysis revealed three key themes of lived experience relating to increased body awareness, reduction in pain intensity, and barriers to practicing meditation. CONCLUSIONS: This study provides novel evidence about the effect and experience of meditation for symptoms in people with EDS. The outcomes warrant further research with appropriate control groups to determine efficacy.Implications for rehabilitationMindfulness-based interventions are effective for chronic pain relief.Hypermobile Ehlers-Danlos syndrome (hEDS) patients experience chronic pain that affects quality-of-life.Online-delivered mindfulness meditation was clinically significant in reducing pain intensity and improving quality-of-life outcomes.hEDS patients found the online-delivered intervention acceptable and recommended development to make it flexible to meet their specific needs by varying types and duration of meditations offered.

Mindfulness-based emotional eating awareness training: taking the emotional out of eating.

PURPOSE: Emotional eating is important to study and address because it predicts poor outcome in weight loss interventions. Interventions have only touched the surface in terms of addressing emotional eating. Mindfulness approaches can address emotional eating by modification of emotion regulation and appetitive traits. The current study involved development of an emotional eating-specific mindfulness intervention and assessment of its effect on appetitive traits associated with emotional eating. METHODS: Participants (n = 14; age M = 29 years; 90% female) completed baseline and end-of-intervention self-report measures of emotional eating, food-cue reactivity, mindfulness, intuitive eating, emotional impulse regulation, stress, and a behavioural measure of inhibitory control. During the 6-week intervention, mindfulness meditation skills were taught weekly embedded in a psycho-educational curriculum about emotional eating. RESULTS: Paired t tests, controlled for type 1 error, revealed significant improvements in food-cue reactivity, intuitive eating, emotional impulse regulation, inhibitory control and stress (ps < 0.05; d: 0.58-1.54). Changes in emotional eating approached significance (p = 0.075, d = 0.66). CONCLUSION: The intervention purposefully did not focus on weight loss and recruited participants who had self-declared difficulties with emotional eating. The positive outcomes suggest that intervening with mindfulness training before weight loss is attempted has the potential to change psychological factors that underpin overeating and undermine weight loss efforts. The study provides proof of principle as a basis to design a randomized control trial to assess rigorously the effectiveness of the intervention as a precursor to a weight loss intervention. LEVEL OF EVIDENCE: Level IV, uncontrolled trial.

Exploring preferences for variable delays over fixed delays to high-value food rewards as a model of food-seeking behaviours in humans.

Foraging and operant models suggest that animals will tolerate uncertainty or risk to obtain food quickly. In modern food environments, sustained access to quick energy-dense foods can promote weight gain. Here, we used a discrete-choice procedure to examine peoples' decisions about when next to eat high-value, palatable food rewards, probabilistically delivered immediately or following longer delays. In Experiment 1, moderately hungry young females showed consistent preferences for a variable delay option that delivered food rewards immediately or following long delays over a fixed delay option that delivered the same rewards following intermediate delays. These preferences were stronger in females with higher BMIs compared with lower BMIs, suggesting that quick food can enhance the value of uncertain or 'risky' food-seeking strategies in individuals vulnerable to future weight gain. In Experiment 2, prior exposure to a subtle and not easily identifiable food aroma increased selections of the variable delay option following delayed food rewards in a mixed sample of male and female adults, providing preliminary evidence that food cues can sustain uncertain food-seeking strategies. These data highlight a working hypothesis that the rapid delivery and consumption of food rewards, and food cues, can increase risk-tolerance in the food-seeking behaviours of individuals who are vulnerable to weight gain. This article is part of the theme issue 'Risk taking and impulsive behaviour: fundamental discoveries, theoretical perspectives and clinical implications'.

Dispositional mindfulness and reward motivated eating: The role of emotion regulation and mental habit.

Evidence regarding the effectiveness of mindfulness based interventions (MBIs) for eating disorders, weight management and food craving is emerging and further studies are required to understand the underlying mechanisms of MBIs in these domains. The current study was designed to establish the role of specific mechanisms underlying the putative relationship between mindfulness and reward motivated eating. We predicted that mindfulness would be negatively related to features of reward motivated eating and that this association would be mediated by emotion regulation and habitual negative self-thinking. A cross-sectional survey measuring uncontrolled and emotional eating, mindfulness, emotion regulation and habitual negative self-thinking was completed by female and male meditators and non-meditators (N = 632). Lower levels of dispositional mindfulness were associated with difficulties in emotion regulation, habitual negative self-thinking and both emotional and uncontrolled eating. Difficulties in emotion regulation significantly mediated the mindfulness-uncontrolled eating relationship. Habitual negative self-thinking significantly mediated the mindfulness-emotional eating relationship. Participants with meditation experience reported greater levels of dispositional mindfulness, fewer difficulties with emotion regulation and habitual negative self-thinking and reduced uncontrolled eating tendencies, compared to non-meditators. The findings suggest that MBIs designed to change reward motivated eating and weight control should focus on emotion regulation and mental habits as underlying mechanisms.

'I can't accept that feeling': Relationships between interoceptive awareness, mindfulness and eating disorder symptoms in females with, and at-risk of an eating disorder.

Mindfulness based therapies (MBTs) for eating disorders show potential benefit for outcomes yet evidence is scarce regarding the mechanisms by which they influence remission from symptoms. One way that mindfulness approaches create positive outcomes is through enhancement of emotion regulation skills. Maladaptive emotion regulation is a key psychological feature of all eating disorders. The aim of the current study was to identify facets of emotion regulation involved in the relationship between mindfulness and maladaptive eating behaviours. In three cross-sectional studies, clinical (n=39) and non-clinical (n=137 and 119) female participants completed: 1) the Eating Disorder Inventory (EDI) eating specific scales (drive-for-thinness and bulimia) and the EDI psychological symptom scales (emotion dysregulation and interoceptive deficits); and 2) mindfulness, impulsivity, and emotion regulation questionnaires. In all samples mindfulness was significantly and inversely associated with EDI eating and psychological symptom scales, and impulsivity. In non-clinical samples interoceptive deficits mediated the relationship between mindfulness and EDI eating specific scales. Non-acceptance of emotional experience, a facet of interoceptive awareness, mediated the relationship between mindfulness and eating specific EDI scores. Further investigations could verify relationships identified so that mindfulness based approaches can be optimised to enhance emotion regulation skills in sufferers, and those at-risk, of eating disorders.

Attention with a mindful attitude attenuates subjective appetitive reactions and food intake following food-cue exposure.

BACKGROUND: Excessive energy intake that contributes to overweight and obesity is arguably driven by pleasure associated with the rewarding properties of energy-dense palatable foods. It is important to address influences of external food cues in food-abundant societies where people make over 200 food related decisions each day. This study experimentally examines protective effects of a mindful attention induction on appetitive measures, state craving and food intake following exposure to energy-dense foods. METHOD: Forty females were randomly allocated to a standard food-cue exposure condition in which attention is brought to the hedonic properties of food or food-cue exposure following a mindful attention induction. Appetitive reactions were measured pre, post and 10 min after post-cue exposure, after which a plate of cookies was used as a surreptitious means of measuring food intake. RESULTS: Self-reported hunger remained unchanged and fullness significantly increased for the mindful attention group post-cue exposure whereas hunger significantly increased for the standard attention group and fullness remained unchanged. There was no significant between-group difference in state craving post-cue exposure and 10 min later. Significantly more cookies were eaten by the standard attention group 10 min post-cue exposure although no significant between-group differences in appetitive and craving measures were reported at that time. CONCLUSION: Our results point to a promising brief intervention strategy and highlights the importance of distinguishing mindful attention from attention. Results also demonstrate that mindful attention can influence food intake even when craving and hunger are experienced.

See it, grab it, or STOP! Relationships between trait impulsivity, attentional bias for pictorial food cues and associated response inhibition following in-vivo food cue exposure.

Impulsivity is associated with appetitive behaviour such as heightened sensitivity to cues of reward. Impulsivity may thus confer a vulnerability to weight gain by virtue of over-responsiveness to rewarding appetitive cues. This vulnerability should be detectable as heightened cognitive and behavioural responsiveness to food cues, namely, an attentional bias to food-stimuli, subjective wanting, and loss of inhibitory control. We examined this proposition by measuring reactions to acute, in-vivo, food-cue exposure in low-impulsive and high-impulsive individuals. We expected that high-impulsive individuals would: (1) show a greater attentional bias towards pictorial food cues presented after in-vivo food cue exposure; (2) show a greater appetitive reaction to high-calorie snack foods; and (3) show poorer inhibitory control after in vivo exposure compared to control. Fifty female participants (25 yr ± 1.1; 24 kg/m2 ± 0.6) randomly allocated to either a high-calorie food-cue exposure or food-neutral control condition subsequently completed a food-cue visual probe reaction time task, subjective ratings of appetitive state and the Stop-Signal task. A significant Group-by-Duration interaction indicated that high-impulsives show slowed disengagement (longer RTs for 2000 ms duration) of pictorial food stimuli compared to their low-impulsive counterparts. Conversely, the low impulsive group show greater attentional bias than the high impulsive group (faster RTs) at the 500 ms duration, indicating speeded detection of pictorial food cues. High-impulsives showed poorer response inhibition compared to low-impulsives following in-vivo food-cue exposure. Impulsivity did not significantly moderate the effect of in-vivo cue-exposure on desire-to-eat ratings. The evidence we obtained regarding inhibitory control following in vivo food cue exposure suggests that high-impulsive individuals may be prone to overeat when their reward systems are activated, a hypothesis that requires further confirmation.

An interactional test of the reformulated helplessness theory of depression in women receiving clinical treatment for eating disorders.

The study tested the Reformulated Helplessness model that individuals who show combined internal locus of control, high stability and high globality attributions for negative life events are prone to depression. Thirty-six women (M=29 years-8 months of age) receiving clinical treatment for eating disorders completed: the Attribution Style Questionnaire, the Beck Depression Inventory, and the Stirling Eating Disorder Scales. An HRA yielded a three-way interaction among the attributional dimensions on depressive symptoms. Plotting of the slopes showed that the attribution of negative life events to the combination of internal locus of control, high stability, and a high globality, was associated with the optimal level of depressive symptoms. The findings supported the Reformulated Helplessness as a model of depression.

The relation between the lack of control attributional style for indulgent food consumption and bulimic symptoms.

OBJECTIVE: The study examined the potential link between the lack of control attributional style for indulgent food consumption and bulimic symptoms. METHOD: One hundred and 77 undergraduates (145 female; mean age=19 years-2 months) were administered the Eating Attributional Style Questionnaire and the Sterling Eating Disorder Scales across a five-month period. RESULTS: SEM analyses confirmed that: (1) uncontrollability attributions for indulgent food consumption were concurrently associated with bulimic symptoms, and (2) external locus of control and uncontrollability attributions for indulgent food consumption predicted changes in bulimic symptoms. CONCLUSIONS: The findings yielded support for the conclusion that the lack of control attributional style for indulgent food consumption is a probable cause of bulimic symptoms.

A cross-sectional investigation of trait disinhibition and its association with mindfulness and impulsivity.

Two online surveys were conducted to assess the relationship between trait disinhibition, impulsivity, mindfulness and adverse psychological symptoms. In study 1 adult females (n=196; mean age=21 yrs) completed the Three-Factor Eating Questionnaire (TEFQ-R21), the Hospital Anxiety and Depression Scale and a measure of dispositional mindfulness. In study 2 adult females (n=190; mean age=26 yrs) completed the same measures as in study 1 with the addition of the Barratt Impulsivity Scale. In both studies it was predicted that mindfulness would be negatively related to trait disinhibition controlling for adverse psychological symptoms. The second study addressed the additional hypothesis that the relationship between mindfulness and trait disinhibition would be mediated by impulsivity. Regression analyses indicated that mindfulness was negatively related to and explained 11% of variation in trait disinhibition (study 1). This relationship was replicated and extended in study 2 whereby impulsivity mediated the relationship between mindfulness and trait disinhibition. The findings warrant experimental and in vivo investigations of the potential causal relationships between mindfulness, impulsivity and eating behaviours.

Regular consumption of a cereal breakfast. Effects on mood and body image satisfaction in adult non-obese women.

Breakfast has psychological and nutritional benefits due to physiological mechanisms and expectations about health impact. Beliefs people hold about calories in food can adversely affect mood and body-image satisfaction and such adverse reactions can be predicted by body mass index. The objectives were to test the effect of consuming isocaloric breakfasts, appearing different in calorie content, on appetite, mood and body-image satisfaction, and to assess impact on daily nutrient intake. One-hundred-and-twenty-three women were randomly assigned to eat a cereal or muffin breakfast which "appeared" different in calorie content while unaware they were isocaloric. Participants estimated calories of breakfast, appetite, mood, and body-image satisfaction on a daily basis for seven-days. The cereal breakfast was perceived to be lower in calories, made participants fuller, happier, relaxed, and more satisfied about weight and body compared to the muffin breakfast. Differences in estimated daily fibre and micronutrient intake were compatible with the design. Breakfasts were isocaloric yet the cereal breakfast was rated lower in calories and produced more positive psychological reactions. This evidence indicates the power of perceptions of foods to influence important attributes of health and well-being which could be valuable in dietary interventions where mood and body image satisfaction affect outcome.

Perceived calorie intake and state body-image satisfaction in women attempting weight loss: a preliminary investigation.

State body-image satisfaction levels (BIS) can be predicted by appearance concerns, eating attitudes and body mass index (BMI). Determinants of state BIS and its variability were examined in women attempting weight loss. Little is known about contextual cues that influence state BIS; therefore the effect of eating on BIS was examined. Forty-six females attending a commercial weight loss group completed measures of shape and weight concerns, appearance beliefs and dietary restraint, followed by completion of a diary that assessed state BIS, mood and perceived calorie intake immediately following evening meals. Regression analysis indicated that after controlling for mood, state BIS was associated with higher BMI and dietary restraint. Greater variability in state BIS was associated with greater variability in perceived calorie intake. This relationship was fully mediated by greater variability in mood. The findings imply that state BIS warrants investigation as a process that may influence weight loss management.

Food cue exposure and body image satisfaction: the moderating role of BMI and dietary restraint.

Effects of cue exposure to high and low-caloric food on body image satisfaction and the moderating role of body mass index (BMI) and restraint were investigated in 77 lean unrestrained, lean restrained and overweight restrained females. Body (BS) and weight satisfaction (WS) were assessed before and after the cue exposure. Lean restrained participants were significantly less satisfied with their weight after cue exposure to high-caloric foods in comparison to cue exposure to low-caloric foods, whereas no such effect was present in overweight restrained and lean unrestrained participants. Low-caloric food cues did not influence WS. Food cues had a nonsignificant trend effect on BS. Yet, only lean unrestrained participants experienced significantly more BS in response to food cue exposure.

Dietary restraint moderates the effects of food exposure on women's body and weight satisfaction.

The influence of dietary restraint and food exposure on body satisfaction was tested. Body and weight satisfaction were measured before and after exposure to either high- or low-caloric food, without actual eating. Independent of caloric condition, higher dietary restraint was associated with a decrease in body satisfaction after food exposure. With regard to weight satisfaction, however, the association between higher dietary restraint and decreased weight satisfaction was specific for the high-caloric condition. Thus, the actual eating of food is not necessary for decreased body and weight satisfaction to occur, suggesting an exposure-induced activation of dysfunctional cognitions in restrained eaters.

Effects of priming thoughts about control on anxiety and food intake as moderated by dietary restraint.

The study was designed to examine: (a) if activating thoughts about control affects anxiety and food intake and (b) if those effects are moderated by dietary restraint. Eighty female undergraduates were administered the Dietary Restraint questionnaire and were primed for cognitions of control or of lack of control. The participants' perceptions of control over food consumption, their state anxiety, and their food intake as part of an alleged taste-test, were assessed. As evidence for the effectiveness of priming, participants reported less control over food consumption after being primed for lack of control than for control cognitions. As expected, Restraint score was negatively correlated with perceived control over food consumption. Consistent with hypothesis, participants high in dietary restraint experienced greater anxiety after being primed for control than after priming for lack of control, whereas participants low in dietary restraint displayed the opposite pattern. These findings were consistent with the cognitive dissonance principle that individuals experience greater anxiety when cognitions are inconsistent with personal beliefs than when they are consistent. As expected, priming thoughts of lack of control resulted in greater food intake than did priming thoughts of control, supporting the hypothesis of a nonconscious, automatic link between cognitions and food intake.

Cognitive load, stress, and disinhibited eating.

The impact of cognitive distraction on eating behaviour was examined in restrained and unrestrained eaters. It was predicted that restrained eaters would eat more than unrestrained eaters following high cognitive load when it involves processing of ego-threat information independent of self-reported anxiety. There were 119 female participants randomly allocated to one of four experimental conditions whereby cognitive load and ego threat were manipulated using modified colour-naming Stroop (CNS) tasks. Anxiety ratings were made prior to and following experimental tasks. After performing Stroop tasks, participants consumed snack foods ad libitum. Restrained eaters consumed significantly more food when high cognitive load was ego threatening than when it involved processing and memorisation of colour nouns and consumed significantly more than unrestrained eaters in a high cognitive load ego-threat condition. Posttask anxiety was greater than baseline across all conditions. Task difficulty was greater under high cognitive load than low cognitive load as indicated by Stroop response times. These results indicated that the escape theory of disinhibited eating is conceptually subsumed by a more generalisable limited cognitive capacity model.

Differential effects of active and passive stress on food intake in restrained and unrestrained eaters.

This study examined the effects of active (AC) and passive coping (PC) stress tasks on food intake in female restrained (n = 20) and unrestrained eaters (n = 20) Participants completed a reaction time task (AC), a cold-pressor test (PC), and a relaxation control condition separated by 1-week intervals. Food intake was assessed after each task. Self-reported anxiety, heart rate and blood pressure (BP) were measured before and after each task. Restraint was measured using the Dutch Eating Behaviour Questionnaire. Significant increases in BP were evident in the AC task only. Stress tasks produced significant increases in self-rated anxiety. Restrained eaters consumed more than unrestrained following the reaction time task, while the opposite was observed following relaxation. The findings of this study show that disinhibited eating of restrained eaters can be triggered by the distracting effects of a cognitively demanding task and may be independent of anxiety experienced.

Adolescence and the diet-dieting disparity: healthy food choice or risky health behaviour?

OBJECTIVES: Food choice in schoolchildren was examined in relation to dieting and measures of eating psychopathology. It was predicted that dieters would make healthier food choices compared to non-dieters and that measures of eating psychopathology would be associated with food choice. DESIGN: A cross-sectional questionnaire design incorporating an established adapted recall method was used to assess patterns of food consumption. METHODS: Questionnaires were administered in 13 state secondary schools. Measures included a food frequency questionnaire, the Children's Eating Attitudes Test (CHEAT), body satisfaction ratings, dietary restraint, and questions about dieting status. The sample consisted of 574 females and 445 males aged 11-16 years. RESULTS: Females made significantly more healthy food choices compared to males. Females reported dieting more than males (35% vs. 18%, respectively), and female dieters made more healthy food choices than female non-dieters. Almost a fifth (19%) of the entire sample reported skipping breakfast, with female dieters being three times more likely to do so than non-dieters. There were small but significant associations between reported food consumption and measures of eating attitudes, body dissatisfaction and restraint. For females who scored in the at-risk range on the CHEAT (8.7%), these associations were more substantial. CONCLUSIONS: Female dieters appear to make more healthy food choices than non-dieters and so may be tuning into healthy eating messages more effectively. Vulnerable females may use 'healthy eating' to hide risky weight reduction behaviours. Further studies are required to examine the nutritional impact of moderate and extreme dieting in this age group.