The feeling is mutual: A randomised controlled trial testing the positive body image process of reciprocity among close friends.

This study investigated the positive body image process of reciprocity and tested whether promoting positive body image can improve one's own and the others' body image. To this end, 124 pairs of female friends (N = 248) were randomised to the experimental or control group. Within each pair, friends were randomised to be the "letter writer" or "letter receiver." Letter writers wrote a letter expressing appreciation for their friend's body functionality (experimental group) or for their shared memories (control group) and read their letter to their friend. Body appreciation, functionality appreciation, and self-objectification were measured at pretest, midtest (after letter writing), and posttest (after reading). Letter writers in the experimental group reported higher body appreciation and lower self-objectification at midtest and posttest, and higher functionality appreciation at posttest, compared to the control group. Further, both groups reported higher body appreciation and functionality appreciation from midtest to posttest. Similarly, letter receivers in both groups reported higher body appreciation and functionality appreciation from midtest to posttest, and letter receivers in the control group reported decreased self-objectification. The findings suggest that promoting positive body image can improve one's own and others' body image, but the effects of the control activity must be considered.

Orthorexia nervosa in dietitians and dietetics students-prevalence, risk factors, and interventions: a scoping review using a systematic approach.

CONTEXT: Orthorexia nervosa (ON) is characterized by compulsive behaviors and increased concerns about healthful eating. Dietitians appear to be especially vulnerable to ON, and it is still debatable whether the disordered eating behaviors motivate individuals to enroll in nutrition programs, or whether these behaviors result from an exaggerated preoccupation with healthy eating triggered during their nutrition studies. OBJECTIVE: The aim was to provide an overview of the present state of knowledge about the prevalence, risk factors, and interventions addressing ON among dietitians and dietetics students. More specifically, it was examined whether dietitians and dietetics students differ from students attending different education programs or other health professionals with regard to the severity and risk factors of ON, and whether the extent of ON changes during the progression in the nutrition education years of study. DATA SOURCES: MEDLINE (Ovid), PubMed, EMBASE (Ovid), PsycInfo (EBSCO), CINAHL (EBSCO), Cochrane, ProQuest Central, CABI, ProQuest Dissertations, Google Scholar, ScienceDirect, and SpringerLink were searched on May 8, 2021, and updated on November 12, 2022. DATA EXTRACTION: Records were screened for eligibility; study characteristics, methodology, and findings of included articles were extracted; and the methodological quality assessed using the AXIS tool. Each step was preceded by a calibration exercise and conducted independently and in duplicate by pairs of 2 reviewers. Any disagreements were resolved through discussions. DATA ANALYSIS: A narrative synthesis was performed, whereby the characteristics, methodologies, and results of included studies were compared. CONCLUSIONS: Results were inconclusive; yet, a general status of the relatively "high" prevalence of ON among dietitians and dietetics students was established, stressing the need for systematic research to understand and mitigate orthorexic tendencies in this group. It is still too early to answer questions pertaining to prevalence, risk factors, interventions, and differences between dietetics students and other majors when it comes to severity and progress of ON throughout the continuing years of study, or between dietitians and other professional groups. SYSTEMATIC REVIEW REGISTRATION: Open Science Framework Identifier: DOI 10.17605/OSF.IO/BY5KF.

Psychometric properties of a Dutch translation of the Functionality Appreciation Scale (FAS) among adults in the Netherlands.

The Functionality Appreciation Scale (FAS; Alleva et al., 2017) measures functionality appreciation, the extent to which people appreciate their body for what it is able to do. We translated the FAS to Dutch and evaluated its factor structure and psychometric properties among 471 native Dutch speakers in the Netherlands (255 cisgender women, 204 cisgender men, 8 nonbinary, 1 "other," 3 "rather not say") who were between 18 and 85 years old. Participants completed the Dutch translation of the FAS, followed by questionnaires to assess additional variables of interest (body appreciation, appearance satisfaction, self-esteem, and gratitude). Exploratory factor analysis showed that Dutch FAS scores demonstrated a unidimensional factor structure. Dutch FAS scores demonstrated acceptable internal consistency and construct validity via their positive associations with the additional variables of interest. Dutch FAS scores also demonstrated gender invariance, and women reported higher functionality appreciation than men. Dutch FAS scores evidenced incremental validity for gratitude (but not self-esteem), and were inversely correlated with age and body mass index. Last, 2-week test-retest reliability of the Dutch FAS scores was supported. Overall, these findings provide support that the Dutch FAS is a psychometrically sound instrument to assess functionality appreciation among Dutch speaking adults in the Netherlands.

Reducing binge eating through behavioral-focused versus emotion-focused implementation intentions in patients with binge eating disorder or bulimia nervosa: An experimental approach.

Binge eating disorder (BED) and bulimia nervosa (BN) are characterized by recurrent binge eating, episodes of consuming large amounts of food in a discrete period of time associated with a loss of control. Implementation intentions are explicit if-then plans that engender goal-directed action, and rely less on cognitive control than standard treatment options. In a sample with BED and BN, we compared two implementation intention conditions to a control condition. In the behavior-focused condition, implementation intentions targeted binge eating behaviors. In the emotion-focused condition, implementation intentions targeted negative affect preceding binge eating. In the control condition, only goal intentions were set. Each condition comprised three sessions. Participants kept food diaries for four weeks. Compared to the control condition both implementation intention conditions showed significant and large reductions of binge eating that persisted for six months. Effects did not differ between the behavior-focused and emotion-focused implementation intention conditions. These results demonstrate that three sessions on implementation intention formation can lead to long-term reductions in binge eating in patients with BED or BN. Learning how to form implementation intentions seems a recommendable addition to the current standard treatment. Future research could investigate the added value of fully personalized implementation intentions. CLINICAL TRIAL REGISTRATION NUMBER: NL52600.068.15.

Effects of implementation intentions and mental imagery on subjective binge eating.

OBJECTIVE: Binge-eating disorder (BED) and bulimia nervosa (BN) are characterised by binge eating. Changing unwanted behaviour is difficult, as intentions do not automatically lead to action. Implementation intentions (IIs) may help bridging the gap between intentions and behaviour. IIs are 'if-then' plans promoting goal attainment. Effects are moderated by degree of plan formation. Using mental imagery (MI) to impress IIs may strengthen plan formation and goal attainment. METHOD: In a students' sample with subjective binge eating, we compared IIs without MI, IIs with MI, and a control condition regarding their ability to reduce binge eating. Participants received three II-sessions and kept food diaries for 4 weeks. RESULTS: Results showed a significant and medium to large reduction of binge eating in both II-conditions compared to the control condition, that was sustained for 6 months. No additional effects of MI were found. CONCLUSIONS: Applying IIs results in long-lasting reductions in subjective binge eating. The absence of additional effects of MI may be due to floor effects. Also, participants in the IIs without MI condition may have applied MI without being instructed to do so. In future research, ideally with a clinical sample, it is recommended to prevent or control for this.

"I'll never sacrifice my well-being again:" The journey from negative to positive body image among women who perceive their body to deviate from societal norms.

We conducted one-on-one interviews with 25 Canadian cisgender women who self-identified as having (a) a condition or characteristic causing their body to deviate from societal norms and (b) overcome a negative body image to develop a positive body image. Using coding reliability thematic analyses, we identified 12 themes (italicised) involving processes and experiences associated with shifts in body image. Women had moments that sparked and confirmed the importance of building positive body image (Enough is Enough). They experienced accepting Social Connections and Community and Accessed Critical Knowledge conducive to body positivity. They engaged in Joyful Movement, Adaptive Appearance Investment, and Joyful and Intuitive Eating. They identified how Changing Societal Norms, Becoming Older and Wiser, COVID-19 Pandemic, having Illnesses and Medical Conditions, Pregnancy and Motherhood, and Spirituality, Religion, and Nature affected their body image, values, and valued action. As women engaged in these processes and experiences, shifts occurred in their perceptions of their embodied selves in the world, represented by four "Bigger Lessons:" I Am More Than My Looks, I Am More Than My Body, I am More Than My Self, and I am Inherently Worthy of Love, Respect, and Joy. These findings can inform body image programmes and clinical interventions.

Beyond Body Size: Focusing on Body Functionality to Improve Body Image Among Women Who Have Undergone Bariatric Surgery.

This study investigated a novel technique to improve body image among women who have undergone bariatric surgery-namely, by having them focus on their body functionality (everything the body can do, rather than how it looks). Participants were 103 women (Mage = 46.61) who had undergone bariatric surgery 5-7 months prior to the study. They were randomized to the 1-week online intervention, comprising three functionality-focused writing exercises (Expand Your Horizon; Alleva et al., 2015), or to a wait-list control group. Body appreciation, appearance and functionality satisfaction, body awareness, self-objectification, self-esteem, and self-kindness were assessed at pretest, posttest, and at 1-week and 3-month follow-up. Multilevel modeling analyses showed that, compared to the control, the intervention group experienced improved body appreciation at posttest, and these improvements persisted at both follow-ups. These findings were nonsignificant when intent-to-treat analyses were performed. Both available case and intent-to-treat analyses showed that all participants experienced improvements in facets of body image across time. Qualitative analyses of participants' responses to the intervention writing exercises provided more insight. Via coding reliability thematic analysis, we identified 11 themes that together provide evidence that intervention participants experienced facets of a more positive body image, while also facing challenges to their body image and well-being. Together, findings suggest that focusing on body functionality may contribute to improved body image among women who have undergone bariatric surgery, but effects may be nuanced compared to prior functionality research among general samples of women. The study was registered retrospectively (ClinicalTrials.gov; identifier NCT04883268).

A new science of mental disorders: Using personalised, transdiagnostic, dynamical systems to understand, model, diagnose and treat psychopathology.

The core ideas of a 10-year research program 'New Science of Mental Disorders' are outlined. This research program moves away from the disorder-based 'one-model-fits-all' approach to treating mental disorders, and adopts the network approach to psychopathology as its foundation of research. Its core assumption is that dynamically interacting symptoms constitute the disorder. Our goal is to further develop the network approach by studying (1) dynamic networks of symptoms and other variables (i.e., elements) in a large number of individuals with a wide range of mental disorders from a transdiagnostic perspective (network-based diagnosis; mapping), including both Ecological Momentary Assessment (EMA) and digital phenotyping, (2) the transdiagnostic mechanisms reflecting potential causal relations among elements of the networks by performing experimental (pre-)clinical studies (zooming), and (3) the effectiveness of personalised network-informed interventions (targeting). Challenges to overcome in this research program are discussed, which relate to data collection (e.g., selection of EMA variables) and data analyses (e.g., power considerations), the development and application of network-informed diagnoses and network-informed interventions (e.g., what characteristic(s) of the network to target in interventions), and the implementation in clinical practice (e.g., train therapists in the use of networks in therapy).

Effects of implementation intentions on subthreshold binge eating.

Binge eating disorder (BED) and bulimia nervosa (BN) are characterized by binge eating. Frequently related to negative affect, binge eating is considered unwanted eating behavior. It is often preceded by a shift away from the goal of a healthy eating pattern. Implementation intentions are 'if-then' plans that may prevent such shifts in goals. In a students' sample with subthreshold binge eating, two implementation intention conditions were compared to a control condition in which only goals were formed. In the behavior-focused condition, implementation intentions targeted binge eating; in the emotion-focused condition, implementation intentions targeted negative affect preceding binge eating. All participants received three sessions and kept food diaries for four weeks, followed by a post-test and a one-month, three-months, and six-months follow-up. Compared to the control condition, both implementation intention conditions showed significant and large reductions in binge eating lasting for six months. Effects did not differ between both implementation intention conditions. Three implementation intention sessions reduced subthreshold binge eating. This continued for six months after the final session. Contrary to expectations, behavior-focused and emotion-focused implementation intentions were equally effective, possibly due to other triggers than negative affect. Future research should address their usefulness in BED and BN.

The potential benefits of death reflection for improving women's body image.

This study investigated death reflection as a novel strategy to improve body image among women. Young adult women (N = 158; Mage = 21.35) completed a death reflection exercise, a death-related active control exercise (to ensure that effects were due to the manner in which women reflected on their death, rather than due to thoughts about death in general), or a non-death-related active control exercise. Participants completed measures of body image at posttest and 1-week follow-up. The women in the death reflection group, compared to the non-death-related control group, experienced higher body weight satisfaction at posttest. Among women higher in beauty orientation, those in the death reflection group experienced higher body shape satisfaction compared to women in the death-related control group. Effects were medium-to-large in magnitude. No group differences were observed for overall appearance satisfaction, appearance importance, broad conceptualisation of beauty, and endorsement of cultural appearance ideals. These findings provide preliminary support for death reflection as a technique to improve some facets of women's body image. Yet, future research is needed to test whether these effects are replicable and can be extended to other facets of body image.

What can my body do vs. how does it look?: A qualitative analysis of young women and men's descriptions of their body functionality or physical appearance.

The aim of this study was to explore the themes that emerge when individuals are asked to describe their body functionality, and those that emerge when individuals are asked to describe their physical appearance. Data were gathered from undergraduate women and men's (N = 75, Mage = 20.66) responses to a writing exercise (Alleva et al., 2014), wherein they were either asked to describe their body functionality or their physical appearance. Through thematic analysis, six themes were identified from participants' descriptions of their body functionality (ordered by frequency): (a) evaluating the functionality of the body, (b) positive body-self connection, (c) resilient body, (d) comparisons to the norm, (e) body behind the scenes, and (f) enjoyment of body functions. Five themes were identified from participants' descriptions of their physical appearance (ordered by frequency): (a) comparisons to the norm, (b) evaluating the appearance of the body - own evaluations, (c) evaluating the appearance of the body - other people's evaluations, (d) the body project, and (e) appearance appreciation. Overall, the findings suggest that the themes that emerge when people are asked to reflect on their body functionality tend to be more positive, as they can be linked to positive embodiment, gratitude, and less self-objectification.

Evaluative conditioning as a body image intervention for adolescents with eating disorders.

OBJECTIVE: The aim was to investigate whether a computer-based evaluative conditioning intervention improves body image in adolescents with an eating disorder. Positive effects were found in earlier studies in healthy female students in a laboratory and a field setting. This study is the first to test evaluative conditioning in a clinical sample under less controlled circumstances. METHOD: Fifty-one adolescent girls with an eating disorder and a healthy weight were randomly assigned to an experimental condition or a placebo-control condition. The computerized intervention consisted of six online training sessions of 5 min, in which participants had to click on pictures of their own and other people's bodies. Their own pictures were systematically followed by portraits of friendly smiling faces. In the control condition, participants were shown the same stimuli, but here, a stimulus was always followed by another stimulus from the same category, so that own body was not paired with smiling faces. Before, directly after, three weeks after, and 11 weeks after the intervention, self-report measures of body image and general self-esteem were administered. Automatic self-associations were also measured with an Implicit Association Test. RESULTS: In contrast to our hypotheses, we did not find an effect of the intervention on self-report questionnaires measuring body satisfaction, weight and shape concern, and general self-esteem. In addition, the intervention did not show positive effects on implicit associations regarding self-attractiveness. CONCLUSIONS: These findings do not support the use of evaluative conditioning in its present form as an intervention for adolescents in clinical practice. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

A randomised-controlled trial investigating potential underlying mechanisms of a functionality-based approach to improving women's body image.

Focusing on body functionality is a promising technique for improving women's body image. This study replicates prior research in a large novel sample, tests longer-term follow-up effects, and investigates underlying mechanisms of these effects (body complexity and body-self integration). British women (N = 261) aged 18-30 who wanted to improve their body image were randomised to Expand Your Horizon (three online body functionality writing exercises) or an active control. Trait body image was assessed at Pretest, Posttest, 1-week, and 1-month Follow-Up. To explore whether changes in body complexity and body-self integration 'buffer' the impact of negative body-related experiences, participants also completed beauty-ideal media exposure. Relative to the control, intervention participants experienced improved appearance satisfaction, functionality satisfaction, body appreciation, and body complexity at Posttest, and at both Follow-Ups. Neither body complexity nor body-self integration mediated intervention effects. Media exposure decreased state body satisfaction among intervention and control participants, but neither body complexity nor body-self integration moderated these effects. The findings underscore the value of focusing on body functionality for improving body image and show that effects persist one month post-intervention.

Diminishing covariation bias in women with a negative body evaluation and the potential roles of outcome aversiveness and interpretation of social feedback.

Women with a more negative body evaluation perceive that their body is associated with more negative social feedback. This covariation bias could reinforce negative body evaluation. We investigated whether covariation bias could be diminished and explored the potential roles of outcome aversiveness and interpretation of negative social feedback associated with one's body. Ninety-seven undergraduate women completed a computer task wherein photos of their body, a control woman's body, and a neutral object were followed by negative social feedback or nothing. When the relation between each category and the negative feedback was random, women with a more negative body evaluation perceived more negative feedback following their body. They also experienced negative feedback following their body and the control woman's body as more aversive. After a manipulation block, women with a more negative body evaluation no longer perceived more negative feedback for their body. These effects coincided with improvements in state body evaluation.

The (non-)replicability of regulatory resource depletion: A field report employing non-invasive brain stimulation.

Cognitive effort and self-control are exhausting. Although evidence is ambiguous, behavioural studies have repeatedly suggested that control-demanding tasks seem to deplete a limited cache of self-regulatory resources leading to performance degradations and fatigue. While resource depletion has indirectly been associated with a decline in right prefrontal cortex capacity, its precise neural underpinnings have not yet been revealed. This study consisted of two independent experiments, which set out to investigate the causal role of the right dorsolateral prefrontal cortex (DLPFC) in a classic dual phase depletion paradigm employing non-invasive brain stimulation. In Experiment 1 we demonstrated a general depletion effect, which was significantly eliminated by anodal transcranial Direct Current Stimulation to the right DLPFC. In Experiment 2, however, we failed to replicate the basic psychological depletion effect within a second independent sample. The dissimilar results are discussed in the context of the current 'replication crisis' and suggestions for future studies are offered. While our current results do not allow us to firmly argue for or against the existence of resource depletion, we outline why it is crucial to further clarify which specific external and internal circumstances lead to limited replicability of the described effect. We showcase and discuss the current inter-lab replication problem based on two independent samples tested within one research group (intra-lab).

A Dutch translation and validation of the Body Appreciation Scale-2: An investigation with female university students in the Netherlands.

This paper describes a Dutch translation and validation of the Body Appreciation Scale-2 (BAS-2; Tylka & Wood-Barcalow, 2015a), an instrument for assessing key components of positive body image. Dutch-speaking female university students (N=310, Mage=21.31, SD=3.04) completed the Dutch BAS-2. To assess its construct validity, participants also completed measures of appearance satisfaction, functionality satisfaction, self-objectification, self-esteem, and optimistic life orientation. Exploratory factor analysis revealed a one-dimensional factor structure of the Dutch BAS-2, substantiating the BAS-2 factor structure found in samples of U.S., Chinese, and Iranian university students and community adults. Dutch BAS-2 scores also demonstrated good internal consistency (α=.90), convergent validity, and incremental validity. In addition, lower body mass indices were associated with higher Dutch BAS-2 scores. The present findings support the cross-cultural equivalence of the BAS-2 and thus its promise in enabling research on positive body image in diverse cultural contexts.

A Multilab Preregistered Replication of the Ego-Depletion Effect.

Good self-control has been linked to adaptive outcomes such as better health, cohesive personal relationships, success in the workplace and at school, and less susceptibility to crime and addictions. In contrast, self-control failure is linked to maladaptive outcomes. Understanding the mechanisms by which self-control predicts behavior may assist in promoting better regulation and outcomes. A popular approach to understanding self-control is the strength or resource depletion model. Self-control is conceptualized as a limited resource that becomes depleted after a period of exertion resulting in self-control failure. The model has typically been tested using a sequential-task experimental paradigm, in which people completing an initial self-control task have reduced self-control capacity and poorer performance on a subsequent task, a state known as ego depletion Although a meta-analysis of ego-depletion experiments found a medium-sized effect, subsequent meta-analyses have questioned the size and existence of the effect and identified instances of possible bias. The analyses served as a catalyst for the current Registered Replication Report of the ego-depletion effect. Multiple laboratories (k = 23, total N = 2,141) conducted replications of a standardized ego-depletion protocol based on a sequential-task paradigm by Sripada et al. Meta-analysis of the studies revealed that the size of the ego-depletion effect was small with 95% confidence intervals (CIs) that encompassed zero (d = 0.04, 95% CI [-0.07, 0.15]. We discuss implications of the findings for the ego-depletion effect and the resource depletion model of self-control.

A pilot study investigating whether focusing on body functionality can protect women from the potential negative effects of viewing thin-ideal media images.

This pilot study explored whether focusing on body functionality (i.e., everything the body can do) can protect women from potential harmful effects of exposure to thin-ideal images. Seventy women (Mage=20.61) completed an assignment wherein they either described the functionality of their body or the routes that they often travel (control). Afterward, participants were exposed to a series of thin-ideal images. Appearance and functionality satisfaction were measured before the assignment; appearance and functionality satisfaction, self-objectification, and body appreciation were measured after exposure. Results showed that participants who focused on body functionality experienced greater functionality satisfaction and body appreciation compared to control participants. Therefore, focusing on body functionality could be a beneficial individual-level technique that women can use to protect and promote a positive body image in the face of thin-ideal images. Research including a condition wherein participants are exposed to (product-only) control images is necessary to draw firmer conclusions.

Sweet Christmas: Do overweight and obese children associate special events more frequently with food than normal weight children?

This study examined children's spontaneous associations of special events with food. Children in primary education (N = 111, age between 10 and 13 years) at a school in Germany wrote down their first five associations with five special or festive events (Christmas, holidays, weekend, carnival and birthday). After completing the free-word association test, they were offered a choice between a candy and a toy. Finally, their body mass index (BMI) was measured. The first prediction was that overweight and obese children would associate special events more often with food than normal weight and leaner children. The second prediction was that choice for a candy would be predicted by a higher number of food-related associations. The first hypothesis was not supported: BMI was negatively related to number of food-related associations (the lower the BMI, the more food-related associations). The second hypothesis was also not supported: There was no relation between number of food-related associations and choice for a candy or toy. A possible explanation for the finding that leaner children reported more food-related associations is that for them specific sweets and snack food are more exclusively connected to special occasions than for overweight children. Speculatively, this may be the result of differences in food parenting styles between parents of heavier and leaner children. Parents of leaner children often have a more restrictive style, i.e., reserving specific foods for specific, relatively rare occasions whereas parents of overweight children adopt more liberal food rules.

Covariation bias in women with a negative body evaluation: How is it expressed and can it be diminished?

BACKGROUND AND OBJECTIVES: Women with a negative body evaluation display covariation bias: They overestimate the relation between their own body and negative social feedback. This study aimed to develop a more fine-grained understanding of this covariation bias and to determine whether it could be diminished. METHODS: Seventy women completed a computer task wherein three categories of stimuli--pictures of their own body, a control woman's body, and a neutral object--were followed by (nonverbal) negative social feedback or nothing. Participants' estimates of the relation between each stimulus category and negative social feedback were assessed throughout the task. RESULTS: Before starting the task, women with a more negative state body evaluation expected their body to be followed by more negative social feedback (demonstrating a priori covariation bias). During the task, when the relation between stimulus category and negative social feedback was random, women with a more negative trait and state body evaluation perceived at the present moment (online covariation bias) and retrospectively (a posteriori covariation bias) that their body was followed by more negative social feedback. When contingencies were manipulated so that women's own body was rarely followed by negative social feedback, covariation bias was temporarily diminished; this coincided with improvements in state body evaluation. LIMITATIONS: The task did not incorporate neutral or positive social feedback and focused only on undergraduate women. CONCLUSIONS: Covariation bias exists preexperimentally and occurs when situational information is ambiguous. It is possible to (temporarily) diminish covariation bias. This might be a technique for improving body evaluation.