Validation of the Mindful Self-Care Scale (MSCS) and development of the Brief-MSCS among hospice and healthcare professionals: a confirmatory factor analysis approach to validation.

OBJECTIVE: In the emotionally intense field of healthcare, the ability to peacefully inhabit one's body, maintain good boundaries, and be fully present during care is essential. This study aimed to validate the recently developed Mindful Self-Care Scale (MSCS) among hospice and healthcare professionals and develop a brief version of the 33-item MSCS. METHOD: A sample of hospice and healthcare professionals from all 50 states (n = 858) was used. A confirmatory factor analysis was run using a rigorous methodology for validation and item reduction to develop a brief version of the 33-item MSCS. The brief MSCS (B-MSCS) was developed by identifying items for exclusion through examination of conceptual overlap, descriptive statistics by detecting sources of improvement model fit using confirmatory factor analysis. Model modifications were done sequentially and with regard to theoretical considerations. RESULT: The existing model, 33-item MSCS with six subscales, had good fit to the data with all indicators in acceptable ranges (chi-square/df = 3.08, df (480), p < 0.01, root mean square error of approximation = 0.059, comparative fit index = 0.915, Tucker and Lewis's index of fit = 0.907). Nine items were excluded on the basis of very low loadings and conceptual and empirical overlap with other items. SIGNIFICANCE OF RESULTS: The final 24-item, B-MSCS model was consistent with the original conceptual model and had a closer fit to the data (chi-square/df = 1.85, df (215), p < 0.01, root mean square error of approximation = 0.041, comparative fit index = 0.961, Tucker and Lewis's index of fit = 0.955). In addition, the reliability, construct, and concurrent validity of the MSCS and B-MSCS were in the acceptable and good ranges, respectively. Mean and standard deviation of the MSCS and B-MSCS scores were similar; B-MSCS mean scores well approximated the MSCS scores. Informal mindful self-care, in the process of everyday life, was practiced more regularly and associated with increased wellness and reduced burnout risk than formal mind-body practices.

Efficacy of Eat Breathe Thrive: A randomized controlled trial of a yoga-based program.

Evidence positions yoga as a promising intervention for enhancing positive embodiment and supporting the prevention of, and recovery from, eating disorders (EDs) by reducing ED symptomatology and building skills that facilitate an ongoing, embodied sense of wellbeing. However, yoga-based programs are few and rigorous literature on their efficacy is limited. This study examined the efficacy and feasibility of a yoga-based program called Eat Breathe Thrive (EBT) which aims to prevent EDs and support embodiment. Participants (N = 168, 93.5 % women) from a community sample in the United States and United Kingdom, ages 18-65, were randomly allocated to a 2-h, 7-week EBT program or waitlist-control condition. Compared to controls, EBT participants experienced significant decreases in ED behaviors, depression, and difficulties regulating emotions. They reported significantly greater use of mindfulness skills, such as interoceptive awareness, mindful self-care, and mindful eating. After a single session, participants reported immediate improvement in their sense of well-being, indicating increased state positive embodiment. Most effects were sustained at 6-month follow-up. The majority of individuals attended most sessions. Self-reported treatment integrity was excellent. Directions for future research are proposed. Results support the efficacy and feasibility of an integrated yoga intervention that fosters positive ways of inhabiting the body.

Demographic predictors of objectification theory and tripartite influence model constructs: The U.S. Body Project I.

We examined how demographic factors (gender, sexual orientation, racial group, age, body mass) were linked to measures of sociocultural appearance concerns derived from objectification theory and the tripartite influence model (McKinley & Hyde, 1996; Schaefer et al., 2015) among 11,620 adults. Men were less likely than women to report high body surveillance, thin-ideal internalization, appearance-related media pressures, and family pressures; did not differ in peer pressures; and reported greater muscle/athletic internalization. Both men and women expressed greater desire for their bodies to look "very lean" than to look "very thin". Compared to gay men, heterosexual men reported lower body surveillance, thin-ideal internalization, peer pressures, and media pressures. Black women reported lower thin-ideal internalization than White, Hispanic, and Asian women, whereas Asian women reported greater family pressures. Being younger and having higher BMIs were associated with greater sociocultural appearance concerns across most measures. The variation in prevalence of sociocultural appearance concerns across these demographic groups highlights the need for interventions.

Pathways from sociocultural and objectification constructs to body satisfaction among women: The U.S. Body Project I.

Objectification theory proposes that widespread sexualization causes women to engage in surveillance of their appearance. We integrated this concept into a model with constructs from the tripartite influence model, which proposes that body dissatisfaction is a result of internalizing cultural notions of thin ideal beauty that stem from family, peer, and media appearance-related pressures. We tested this model with an online sample of 6327 adult women. Specifically, we tested whether these pressures predicted increased thin-ideal and muscular-ideal internalization, leading to greater body surveillance, and in turn lower appearance evaluation and body image quality of life. Structural equation modeling supported many aspects of the model. Family, peer, and media pressures related to higher thin-ideal internalization, which related to higher body surveillance and lower appearance evaluation. Peer and media pressures related to higher muscular-ideal internalization, which related to lower appearance evaluation. However, muscular-ideal internalization was not related to body image quality of life. An indirect relationship emerged between thin-ideal internalization and body image outcomes via body surveillance. Body mass index (BMI) moderated several of these model paths. Findings highlight the value of this integrated sociocultural model, and of BMI as an important moderating factor when examining objectification and tripartite influence models.

Demographic and sociocultural predictors of sexuality-related body image and sexual frequency: The U.S. Body Project I.

Body image is a critical component of an individual's sexual experiences. This makes it critical to identify demographic and sociocultural correlates of sexuality-related body image: the subjective feelings, cognitions, and evaluations related to one's body in the context of sexual experience. We examined how sexuality-related body image differed by gender, sexual orientation, race, age, and BMI. Four items assessing sexuality-related body image were completed by 11,620 U.S. adults: self-perceived sex appeal of their body, nude appearance satisfaction, and the extent to which they believed that body image positively or negatively affected their sexual enjoyment and feelings of sexual acceptability as a partner. Men reported slightly less nude appearance dissatisfaction and fewer negative effects of body image on sexual enjoyment and sexual acceptability than women, but did not differ in reported sex appeal. Poorer sexuality-related body image was reported by people with higher BMIs, not in relationships, who had sex less frequently, among White compared to Black women and men, and among gay compared to heterosexual men. Data also revealed a subgroup of respondents who reported that their body image had a positive impact on their sex lives. The findings highlight a need for interventions addressing sexuality-related body image.

Pathways from sociocultural and objectification constructs to body satisfaction among men: The U.S. Body Project I.

According to the tripartite influence model, body dissatisfaction is shaped by internalizing cultural appearance ideals stemming from appearance-related family, peer, and media pressures. This model was developed for women, but emerging evidence points to its relevance for men's body image. This study advanced this budding research by (a) integrating muscular-ideal internalization alongside lean-ideal internalization and body surveillance into the model, (b) examining two positive dimensions of body image as outcomes (body image quality of life and appearance evaluation), and (c) testing this model in national online sample of 5293 men. Structural equation modeling supported the model. Family, peer, and media pressures related to higher lean-ideal internalization, which related to higher body surveillance and poorer body image outcomes. Peer and media pressures related to higher muscular-ideal internalization, which related to higher body surveillance but more adaptive body image outcomes. We further examined whether model variables and paths differed based on men's body mass index (BMI). Men with higher BMIs evidenced a stronger path between body surveillance and body image outcomes. These findings highlight the usefulness of sociocultural models for understanding men's body image experiences.

Sexual orientation differences in pathways from sociocultural and objectification constructs to body satisfaction: The U.S. Body Project I.

Objectification theory and the tripartite influence model provide useful frameworks for understanding the body image experiences of men and women. However, there is little systematic investigation of how sexual orientation moderates the links between these constructs and body image satisfaction. It has been hypothesized, for example, that the associations of surveillance (i.e., monitoring of one's appearance due to objectification by others) would be strongest for groups targeted by the male gaze (e.g., gay men, lesbian women, and bisexual men and women). Here we proposed an integrated sociocultural model and examined these pathways in multigroup structural equation models in a national sample of heterosexual, bisexual, and lesbian women (ns = 5395; 598; 213, respectively), and heterosexual, bisexual, and gay men (4869; 194; and 194, respectively) aged 18-65 years. Sexual orientation moderated some of these pathways. The most consistent pattern was that appearance pressures were internalized to a greater extent among bisexual participants. The pathways to poorer body image were generally similar among heterosexual and gay/lesbian men and women. These findings highlight the importance of examining sexual orientation-specific influences on body image across diverse groups, as well as the commonalities in the experiences of men and women across sexual orientations.

Racial identity differences in pathways from sociocultural and objectification constructs to body satisfaction: The U.S. Body Project I.

Racial minority men and women face a wide variety of appearance-related pressures, including ones connected to their cultural backgrounds and phenotypic features associated with their identity. These body image concerns exist within a larger context, wherein racial minorities face pressures from multiple cultures or subcultures simultaneously to achieve unrealistic appearance ideals. However, limited research has investigated racial differences in the relationships between theorized sociocultural risk factors and body image in large samples. This study tests pathways from an integrated sociocultural model drawing on objectification theory and the tripartite influence model to three key body image outcomes: appearance evaluation, body image quality of life, and face image satisfaction. These pathways were tested using multigroup structural equation modeling in a national sample of White, Black, Hispanic, and Asian men and women (ns = 205-4797 per group). Although many hypothesized associations were similar in strength across groups, race moderated some of the pathways between sociocultural pressures (media, peer, family), internalization of appearance ideals (thin-ideal, muscular/athletic), appearance surveillance, and body image outcomes. Findings support the likely role of both shared and specific risk factors for body image outcomes, suggesting avenues for tailoring adapted interventions in order to target culturally-salient risk factors.

Demographic predictors of body image satisfaction: The U.S. Body Project I.

We examined how gender, body mass, race, age, and sexual orientation were linked to appearance evaluation, overweight preoccupation, and body image-related quality of life among 11,620 adults recruited via Mechanical Turk. Men were less likely than women to report low appearance evaluation, high overweight preoccupation, negative effects of body image on their quality of life, being on a weight-loss diet, and trying to lose weight with crash diets/fasting. Racial differences were generally small, but greater appearance evaluation was reported by Black men versus other groups and Black women versus White women. Across all measures, gay and bisexual men reported poorer body image than heterosexual men, with only small effect sizes observed for sexual orientation differences among women. Body mass, but not age, was strongly associated with body image. The prevalence of poor body image highlights the need for interventions. On the positive side, half of men and women reported high appearance evaluation. Examination of this group could identify factors promoting positive body image.

The Africa Yoga Project and Well-Being: A Concept Map of Students' Perceptions.

BACKGROUND: Concept mapping methodology was used to explore the perceived impact of practicing yoga with the Africa Yoga Project (AYP)-an organisation created to increase health and well-being by providing community-based yoga classes throughout Kenya. AYP's mission fit with theoretical models of well-being is discussed. Anecdotal evidence and initial qualitative research suggested the AYP meaningfully impacted adult students. METHODS: Of the hundreds of AYP's adult students, 56 and 82 students participated in Phases I and II, respectively. Phase I brainstorming resulted in 94 student-generated statements about their perceived change. Phase II participants sorted and rated statements in terms of importance. Multidimensional scaling and hierarchical cluster analysis of sort data was utilised to map and group statements into clusters. RESULTS: Based on statistical and interpretive criteria, a five-cluster solution with the following concepts was identified as the best model of students' change: Personal Growth; Interpersonal Effectiveness (lowest importance); Physical and Social Benefits; Emotional Resiliency; and Improved Self-Concept (highest importance). CONCLUSIONS: Overall, students reported positive perceptions of the AYP. Additional research is needed to quantify students' change, and to compare the AYP outcomes to those of other programs aimed at poverty-related stress reduction and well-being.

Incorporating positive body image into the treatment of eating disorders: A model for attunement and mindful self-care.

This article provides a model for understanding the role positive body image can play in the treatment of eating disorders and methods for guiding patients away from symptoms and toward flourishing. The Attuned Representational Model of Self (Cook-Cottone, 2006) and a conceptual model detailing flourishing in the context of body image and eating behavior (Cook-Cottone et al., 2013) are discussed. The flourishing inherent in positive body image comes hand-in-hand with two critical ways of being: (a) having healthy, embodied awareness of the internal and external aspects of self (i.e., attunement) and (b) engaging in mindful self-care. Attunement and mindful self-care thus are considered as potential targets of actionable therapeutic work in the cultivation of positive body image among those with disordered eating. For context, best-practices in eating disorder treatment are also reviewed. Limitations in current research are detailed and directions for future research are explicated.