Emotion Regulation Training as an Add-on in the Treatment of Obesity in Young Adolescents: A Randomized Controlled Superiority Trial.

In an inpatient treatment center for pediatric obesity, the effectiveness of an emotion regulation (ER) training on top of the multidisciplinary obesity treatment (MOT) was tested by means of an RCT. The ER training was evaluated on primary outcomes: ER and emotional eating, and secondary outcomes: well-being and weight loss, taking into account pre, post, and follow-up measurements. Of the 115 10- to-14-year old adolescents with obesity (52.2% girls), 65 were allocated to the ER training. Physicians measured their height and weight objectively (4 times). Participants also filled out questionnaires on ER competencies (ER abilities and ER strategies), emotional eating and well-being (3 times). Significant pre-post interactions were found for "emotional awareness," "problem solving," and "evoking a positive mood." Moreover, the positive effects of the ER training on emotion regulation strategies were maintained at follow-up. Concerning well-being, no significant pre-post interaction effects were found but a significant interaction effect was found when comparing pre with follow-up. Analyses show a significant main effect of time on weight loss, but this was not qualified by a Time × Condition interaction effect. The current RCT study shows limited but promising effects of adding an ER training to the MOT. Further research should investigate whether the positive short-term effects will be maintained.

Treatment Effects on Psychophysiological Stress Responses in Youth With Obesity.

OBJECTIVE: Stress plays a central role in obesity development, but research on treatment options to tackle elevated stress levels in youth with obesity is scarce. The present study examined the impact of the Multidisciplinary Obesity Treatment (MOT; lifestyle intervention including physical exercise, healthy meals, and cognitive behavioral techniques) on physiological stress parameters in youth with obesity and assessed whether adding emotion regulation (ER) training on top of MOT is beneficial. METHODS: From an inpatient treatment center for obesity, 92 youngsters (mean [standard deviation] age = 12.50 [1.66] years, 43.5% boys) were randomly assigned to a control group (MOT) or experimental group (MOT + ER training). Before (T1) and after 12 weeks of treatment (T2), high-frequency heart rate variability (HF-HRV) and heart rate were measured at rest and during a stress induction (= psychophysiological reactivity). RESULTS: At T2, after MOT only, participants displayed a lower resting heart rate ( MT2/T1 = 74.7/78.6) and a reduced stress response (i.e., less decrease in HF-HRV [ MT2/T1 = -0.06/-0.01] and less increase in heart rate [ MT2/T1 = 0.03/0.06] after the stress induction). No further improvements were revealed after adding ER training. However, when considering the weight changes, the significant results in resting heart rate and HF-HRV and heart rate reactivity decreased in the control group, and additional improvements in psychophysiological parameters were discovered in the experimental group. CONCLUSIONS: The results suggest that MOT may effectively reduce physiological stress responses and also provide preliminary evidence for a potential additional effect of ER training. Further research in a larger sample with extended follow-up measurements is needed.

The cortisol stress response in youth with overweight and obesity: Influence of psychosocial variables.

BACKGROUND: Despite previous research pointing out a bifurcation in cortisol stress reactivity, it is not yet clear if all variables explaining inter-individual differences in stress responses are captured. OBJECTIVES: To explore which (psychosocial and demographic) variables predict the cortisol response after a standardized stress-and affective state (SAS)-induction in youth with overweight and obesity. METHODS: As part of a randomized control trial (SRCTN83822934) investigating the effects of emotion regulation (ER)-training on top of a 10-month inpatient multidisciplinary obesity treatment, 79 children and adolescents (9-15 years) with moderate obesity (M adjusted BMI = 154.35% overweight, SD = 24.57) completed a SAS-induction before leaving the clinic. RESULTS: Those whose cortisol levels decreased (N = 59.5%) from baseline to reactivity showed higher levels of alexithymia than increasers (p = 0.049). Attachment avoidance was a significant positive predictor of relative cortisol decrease after SAS-induction (p = 0.001). Age was significantly related to less cortisol decrease (p = 0.006). No significant effect of ER-intervention group on relative cortisol change was found. CONCLUSIONS: The current study provides evidence for a bifurcation in cortisol stress reactivity in youth with obesity. Our data further suggested that psychosocial variables (alexithymia and attachment avoidance) influence the cortisol stress response. Future research should further explore whether the attenuators are a more vulnerable group.

A brief emotion regulation training in children and adolescents with obesity: A feasibility study.

BACKGROUND: Recent studies emphasize the role of emotion dysregulation as an underlying mechanism initiating and maintaining emotional eating in obesity. Since multidisciplinary obesity treatment (MOT) does not directly address emotion regulation (ER), the current study aimed to investigate the feasibility of an ER training in children and adolescents with obesity on top of MOT. Feasibility was evaluated multi-informant on relevant parameters e.g. practicability, satisfaction, change in affect and homework compliance. METHODS: Participants (N = 50, M_age = 12.26, 60.7 % girls) with obesity received a brief ER training and were assigned to one out of three conditions to learn one specific ER strategy (i.e., Cognitive reappraisal, Distraction or Acceptance). Afterwards the ER strategy was further trained by a homework assignment during 5 consecutive days. Children and adolescents, trainers and as well as the educators of the treatment center completed a feasibility questionnaire. RESULTS: The training was positively evaluated by different informants for 11 out of 19 feasibility criteria. Only one implementation barrier was reported regarding homework compliance. Furthermore, some important considerations could be taken into account e.g. session length and motivation. CONCLUSIONS: Reports suggest that, with some modifications, it is feasible to implement an ER training on top of MOT. In addition, future training protocols should focus on other essential components of ER (e.g., emotional awareness, emotional flexibility).

The Moderating Role of Emotion Regulation in the Association Between Stressors With Psychological and Biological Measures in Adolescence.

OBJECTIVE: This study explored the role of emotion regulation (ER) as a moderator in the stressor-adjustment outcome relationship while identifying the relevant stressors. METHODS: In 214 adolescents (10-18 years; 51.4% boys), stressors (parent and peer relations, negative events), psychological outcomes (adolescent perceived stress, psychopathology symptoms, negative affect), and biological measures related to the stress response (hair cortisol [HC], heart rate variability [HRV]) as well as ER strategies-maladaptive (MalER), adaptive (AdER), and their ratio (Mal/AdER)-were measured and analyzed via linear regression, adjusted for age, sex, and socioeconomic status. RESULTS: Parental rejection and bullying were the stressors with the strongest association with psychological outcomes (ß range = |0.217-0.352|, p < .05). In addition, parental rejection was associated with HC (ß = 0.242, p = .035), whereas none of the stressors were associated with HRV. MalER was linked to all, and AdER to most psychological outcomes (ß range = |0.21-0.49|, p < .05). MalER, but not AdER, was associated with HC (ß = 0.25, p = .009), whereas none of the ER strategy types were associated with HRV. Moreover, several associations between stressors and psychological outcomes were moderated by MalER and Mal/AdER, whereas AdER's role as a moderator was not confirmed. CONCLUSIONS: The study confirmed that adolescents' stressors are associated with both psychological and physiological outcomes and moderated by MalER or Mal/AdER. The lack of moderation by AdER directs toward the maladaptive shift theory. Investigations through a longitudinal, rather than a cross-sectional design, could further elucidate the current observations. Moreover, training in how to use ER effectively has a potential of increasing adolescents' stress resilience.

Emotion regulation training in the treatment of obesity in young adolescents: protocol for a randomized controlled trial.

BACKGROUND: The prevalence rates of childhood obesity are increasing. The current multidisciplinary treatments for (childhood) obesity are effective but only moderately and in the short term. A possible explanation for the onset and maintenance of childhood obesity is that it reflects a maladaptive mechanism for regulating high levels of stress and emotions. Therefore, the current RCT study aims to test the effectiveness of adding an emotion regulation training to care as usual (multidisciplinary obesity treatment) in young inpatients (10-14) involved in an obesity treatment program compared to care as usual alone. The research model for this RCT study states that when high levels of stress are regulated in a maladaptive way, this can contribute to the development of obesity. METHODS: The current study will recruit 140 youngsters (10-14 years) who are involved in an inpatient multidisciplinary obesity treatment (MOT) program. After giving consent to participate in the study, youngsters will be randomly assigned, during consecutive waves, to one of two conditions: care as usual (receiving MOT) or intervention (receiving MOT in addition to emotion regulation training). The training itself consists of 12 weekly sessions, followed by a booster session after 3 and 5 months. The participants will be tested pretraining, post-training, and at 6 months' follow-up. We hypothesize that, compared to the control condition, youngsters in the intervention condition will (1) use more adaptive emotion regulation strategies and (2) report less emotional eating, both primary outcome measures. Moreover, on the level of secondary outcome measures, we hypothesize that youngsters in the intervention condition, compared with the control condition, will (3) report better sleep quality, (4) undergo improved weight loss and weight loss maintenance, and (5) experience better long-term (6-months) psychological well-being. DISCUSSION: This study will add to both the scientific and clinical literature on the role of emotion regulation in the development and maintenance of different psychopathologies, as emotion regulation is a transdiagnostic factor. TRIAL REGISTRATION: The RCT study protocol is registered at ISRCTN Registry, with study ID "ISRCTN 83822934." Registered on 13 December 2017.

Stress and Eating Behavior: A Daily Diary Study in Youngsters.

Background: Overweight and obesity are growing problems, with more attention recently, to the role of stress in the starting and maintaining process of these clinical problems. However, the mechanisms are not yet known and well-understood; and ecological momentary analyses like the daily variations between stress and eating are far less studied. Emotional eating is highly prevalent and is assumed to be an important mechanism, as a maladaptive emotion regulation (ER) strategy, in starting and maintaining the vicious cycle of (pediatric) obesity. Objectives: The present study aims to investigate in youngsters (10 - 17 years) the daily relationship between stress and the trajectories of self-reported eating behavior (desire to eat motives; hunger eating motives and snacking) throughout 1 week; as well as the moderating role of emotion regulation and emotional eating in an average weight population. Methods: Participants were 109 average weighted youngsters between the age of 10 and 17 years (M age = 13.49; SD = 1.64). The youngsters filled in a trait-questionnaire on emotion regulation and emotional eating at home before starting the study, and answered an online diary after school time, during seven consecutive days. Desire to eat motives, hunger eating motives and snacking were assessed daily for seven consecutive days. Results: Using multilevel analyses results revealed that daily stress is significantly associated with trajectories of desire to eat motives and hunger eating motives. No evidence was found for the moderating role of maladaptive ER in these relationships; marginally significant evidence was found for the moderating role of emotional eating in the trajectories of desire to eat and snacking. Discussion: These results stress the importance of looking into the daily relationship between stress and eating behavior parameters, as both are related with change over and within days. More research is needed to draw firm conclusion on the moderating role of ER strategies and emotional eating.

The Daily Relation between Parental Rejection and Emotional Eating in Youngsters: A Diary Study.

KEY POINTS  Cross-sectional survey studies have demonstrated significant associations between parental rejection and peer rejection on the one hand and disturbed eating in youngsters, like emotional eating, on the other hand. In this study, we wanted to expand our knowledge on these relationships by investigating the daily fluctuations in these variables. Youngsters completed a 7-day diary to assess daily parental rejection, peer rejection and emotional eating. Using multilevel analyses, our results showed that daily variations in parental rejection were related to daily variations in emotional eating of the youngsters. This highlights the importance of addressing the parent-child relationship in interventions for emotional eating in youngsters. Background: This study investigated the daily relation between parental rejection and peer rejection on the one hand and emotional eating in youngsters on the other hand. Methods: Participants (N = 55) between the ages of 11 and 15 years completed a 7-day diary. A multilevel design was used to examine day-to-day within-person relationships between parental and peer rejection (measured by CHS) and emotional eating (measured by DEBQ-C) of youngsters. Results: The results showed that daily variations in parental rejection were related to daily variations in emotional eating of the youngsters. Daily peer rejection was only marginally significantly related to the emotional eating of the youngsters. Conclusions: These results indicate that especially parental rejection, and to a lesser extent peer rejection, are associated with the emotional eating of youngsters. The findings highlight the importance of addressing the parent-child relationship in interventions for emotional eating in youngsters.