"I'm Not Only a Body": Change in Thoughts about the Body after Mirror Exposure Treatment in Women with Obesity-An Exploratory Study.

Nowadays, obesity (OB) is one of the most important health problems in population-wide health. In addition to its physical consequences, it is a risk factor for the development of psychological problems, including body dissatisfaction (BD). This is why the treatment of BD is essential for its prevention. However, this has mostly been studied from a quantitative perspective, without focusing on the discomfort experienced by the person and the accompanying thoughts and emotions. In this study, 26 women with obesity (BMI > 30 kg/m2) participated, of whom 16 had high BD and 10 had low BD, as measured by the BSQ questionnaire. The women with high BD underwent six sessions of exposure to their own body in front of a mirror, recording the discomfort experienced with this vision during the session. In addition, all participants recorded positive and negative thoughts towards their body before and after these sessions. After the exposure treatment sessions, a reduction in symptomatology (BD, discomfort when visualizing one's own body) was observed, as well as a change in the thoughts expressed by the participants, both in quantity (fewer negative thoughts) and in quality (a more positive self-perception and/or in more respectful terms used towards themselves). In conclusion, such treatments prove to be effective in reducing subjective discomfort and body-related thoughts in women with obesity.

Psychophysiological Changes during Pure vs Guided Mirror Exposure Therapies in Women with High Body Dissatisfaction: What Are They Learning about Their Bodies?

This study aimed to examine the psychophysiological changes resulting from two mirror exposure treatments that are effective at reducing body dissatisfaction. Thirty-five university women with body dissatisfaction and subclinical eating disorders were randomly assigned to one of two groups: pure (n = 17) or guided exposure (n = 18). The participants received six sessions of treatment. Their thoughts, feelings and avoidance behaviours were assessed after each session. Their subjective discomfort, heart rate and skin conductance were assessed within the sessions. Both groups showed improvement in cognitive-affective and avoidance behaviour symptoms. Nevertheless, the pure exposure group showed faster habituation of subjective discomfort and a greater physiological response than the guided exposure group. These findings suggest that both procedures are effective interventions for improving body image disturbances, although psychophysiological changes observed within session suggest that each technique would act through different processes. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.

Affective Pictures and the Open Library of Affective Foods (OLAF): Tools to Investigate Emotions toward Food in Adults.

Recently, several sets of standardized food pictures have been created, supplying both food images and their subjective evaluations. However, to date only the OLAF (Open Library of Affective Foods), a set of food images and ratings we developed in adolescents, has the specific purpose of studying emotions toward food. Moreover, some researchers have argued that food evaluations are not valid across individuals and groups, unless feelings toward food cues are compared with feelings toward intense experiences unrelated to food, that serve as benchmarks. Therefore the OLAF presented here, comprising a set of original food images and a group of standardized highly emotional pictures, is intended to provide valid between-group judgments in adults. Emotional images (erotica, mutilations, and neutrals from the International Affective Picture System/IAPS) additionally ensure that the affective ratings are consistent with emotion research. The OLAF depicts high-calorie sweet and savory foods and low-calorie fruits and vegetables, portraying foods within natural scenes matching the IAPS features. An adult sample evaluated both food and affective pictures in terms of pleasure, arousal, dominance, and food craving, following standardized affective rating procedures. The affective ratings for the emotional pictures corroborated previous findings, thus confirming the reliability of evaluations for the food images. Among the OLAF images, high-calorie sweet and savory foods elicited the greatest pleasure, although they elicited, as expected, less arousal than erotica. The observed patterns were consistent with research on emotions and confirmed the reliability of OLAF evaluations. The OLAF and affective pictures constitute a sound methodology to investigate emotions toward food within a wider motivational framework. The OLAF is freely accessible at digibug.ugr.es.

Testing the efficacy of pure versus guided mirror exposure in women with bulimia nervosa: A combination of neuroendocrine and psychological indices.

BACKGROUND AND OBJECTIVES: Body exposure improves body image problems in women with eating disorders. However it has almost always been combined with other interventions. Thus, the efficacy of body exposure alone (i.e., pure exposure) remains largely unclear. We aimed to compare the efficacy of two body exposure techniques through psychological and neuroendocrine indices recorded within and between successive sessions. METHOD: Twenty-nine women with high body dissatisfaction and diagnosis of bulimia nervosa were randomly assigned to one of two treatment groups: Pure Exposure (n = 14) or Guided Exposure (n = 15). Participants received 6 exposure sessions. After each session, changes in thoughts (positive/negative) and body satisfaction were assessed. Also, we assessed the body discomfort experienced by participants within and between sessions. Finally, the changes in salivary cortisol levels within and between the initial and final treatment sessions were measured. RESULTS: Both groups showed a reduction in negative thoughts and a progressive increase in positive thoughts throughout the treatment. However, the increase in body satisfaction and the reduction in subjective discomfort within the sessions were greater in the pure exposure group. The cortisol levels during the initial and final treatment sessions decreased in both groups. LIMITATIONS: Methodological limitations are reported. CONCLUSIONS: These results suggest that pure and guided exposures are effective interventions for improving thoughts and neuroendocrine responses, although pure exposure increased more body satisfaction feelings in bulimic women. Subjective discomfort also showed different patterns of change within and along sessions for each treatment. Reasons for these results are discussed.

Weight loss and psychological-related states in high-level judo athletes.

PURPOSE: This study aimed at comparing weight loss methods (WLM) performed near competition by elite judo athletes from different age and gender groups and relating WLM with the prevalence of eating disorders. METHODS: 144 athletes (66 females and 78 males) from the Spanish judo teams participated in this observational descriptive study grouped into cadets, juniors, and seniors. Data were collected during previous training meetings to international tournaments. The used tools are a basic data questionnaire, State-Trait Anxiety Inventory (STAI-T), Food Craving Questionnaire-Trait (FCQ-T), Restraint Scale (RS), and Eating Attitude Test (EAT- 40). Two-way ANOVAs and chi-square tests were used to compare groups. RESULTS: Seniors presented higher use of WLM, especially one week before competition compared with juniors. Judoists were more involved in their diets and reduced more weight as they were older. Females were more concerned about their diets, presented higher anxiety, scored higher in the emotion scale, and more eating disorders symptoms, although weight loss was lower. Anxiety and eating disorders symptoms differences were more common in juniors and cadets, respectively, with higher scores in females. CONCLUSIONS AND IMPLICATIONS: Seniors seem to develop more effective strategies to cope with weight loss. Cadet and junior females are more likely to suffer from the psychological-related states associated to weight loss. IMPLICATIONS: (1) Educational programs might help competitors and coaches to adopt and promote healthier weight loss processes, (2) special attention should be paid to female young judoists to detect eating disorders in its early stages, and (3) judo organizations should consider implementing new rules to sanction harmful weight loss practices.

Meet OLAF, a good friend of the IAPS! The Open Library of Affective Foods: a tool to investigate the emotional impact of food in adolescents.

In the last decades, food pictures have been repeatedly employed to investigate the emotional impact of food on healthy participants as well as individuals who suffer from eating disorders and obesity. However, despite their widespread use, food pictures are typically selected according to each researcher's personal criteria, which make it difficult to reliably select food images and to compare results across different studies and laboratories. Therefore, to study affective reactions to food, it becomes pivotal to identify the emotional impact of specific food images based on wider samples of individuals. In the present paper we introduce the Open Library of Affective Foods (OLAF), which is a set of original food pictures created to reliably select food pictures based on the emotions they prompt, as indicated by affective ratings of valence, arousal, and dominance and by an additional food craving scale. OLAF images were designed to allow simultaneous use with affective images from the International Affective Picture System (IAPS), which is a well-known instrument to investigate emotional reactions in the laboratory. The ultimate goal of the OLAF is to contribute to understanding how food is emotionally processed in healthy individuals and in patients who suffer from eating and weight-related disorders. The present normative data, which was based on a large sample of an adolescent population, indicate that when viewing affective non-food IAPS images, valence, arousal, and dominance ratings were in line with expected patterns based on previous emotion research. Moreover, when viewing food pictures, affective and food craving ratings were consistent with research on food cue processing. As a whole, the data supported the methodological and theoretical reliability of the OLAF ratings, therefore providing researchers with a standardized tool to reliably investigate the emotional and motivational significance of food. The OLAF database is publicly available at zenodo.org.

Feeling bad posing as a model: an objective manner of study upward own-body comparisons in body-dissatisfied women.

Emotional effects of upward body comparisons are suggested to occur automatically. A startle reflex paradigm was used to objectively examine the emotions elicited by viewing a picture of one's own body adopting a model pose or a neutral pose, in 30 women with high body dissatisfaction (HBD) and 33 women with low body dissatisfaction (LBD). In-task emotional responses in perceived valence, arousal and control were assessed. Additionally, post-task positive/negative and body-related beauty feelings were recorded. The results revealed that HBD women, compared with LBD women, showed (i) less pleasure, higher activation and less control whilst viewing their own bodies and (ii) less pleasure, more negative/ugliness feelings and an increased startle response when viewing themselves posing as models. The data showed that their own bodies provoked an immediate negative emotional state in HBD women. However, greater aversive psychophysiological mechanisms were automatically activated only when these women posed as models, suggesting that they made upward own-body comparisons.

The emotional and attentional impact of exposure to one's own body in bulimia nervosa: a physiological view.

BACKGROUND: Body dissatisfaction is the most relevant body image disturbance in bulimia nervosa (BN). Research has shown that viewing one's own body evokes negative thoughts and emotions in individuals with BN. However, the psychophysiological mechanisms involved in this negative reaction have not yet been clearly established. Our aim was to examine the emotional and attentional processes that are activated when patients with BN view their own bodies. METHOD: We examined the effects of viewing a video of one's own body on the physiological (eye-blink startle, cardiac defense, and skin conductance) and subjective (pleasure, arousal, and control ratings) responses elicited by a burst of 110 dB white noise of 500 ms duration. The participants were 30 women with BN and 30 healthy control women. The experimental task consisted of two consecutive and counterbalanced presentations of the auditory stimulus preceded, alternatively, by a video of the participant's own body versus no such video. RESULTS: The results showed that, when viewing their own bodies, women with BN experienced (a) greater inhibition of the startle reflex, (b) greater cardiac acceleration in the first component of the defense reaction, (c) greater skin conductance response, and (d) less subjective pleasure and control combined with greater arousal, compared with the control participants. CONCLUSION: Our findings suggest that, for women with BN, peripheral-physiological responses to self-images are dominated by attentional processes, which provoke an immobility reaction caused by a dysfunctional negative response to their own body.

Impact of fasting on food craving, mood and consumption in bulimia nervosa and healthy women participants.

Researchers have found that dietary restraint increases food cravings and may contribute to loss of control over eating. Negative mood states often precede food cravings and binge eating. In the present study, we tested the influence of a prolonged food deprivation period over emotional states and food cravings. Twenty-one bulimia nervosa participants and 20 healthy women participants were asked to refrain from any eating for 20 hours and reported, at baseline, after 6 hours and at the end of the fasting period, their mood and craving states. Food consumption was also measured. Fasting increased food cravings in both groups but increased negative mood in healthy women only. Bulimia nervosa participants reported improved mood following food deprivation. Whereas Bulimia nervosa and healthy women participants ate moderate and similar amounts of food following the 20-hour fasting period, food cravings were significantly associated with the number of calories ingested. These findings are congruent with self-regulation theories that predict that prolonged fasting may reduce negative emotions in women with bulimia nervosa.

Pure versus guided mirror exposure to reduce body dissatisfaction: a preliminary study with university women.

While effectiveness of mirror exposure to reduce body dissatisfaction has been demonstrated, the exposure was almost always combined with other interventions. The aim of the study was to evaluate the effectiveness of a pure mirror exposure intervention compared with a guided mirror exposure (participants are guided to describe their body shape in a non-evaluative manner) and an imagery exposure intervention (participants are guided to describe their body through mental representation). Thirty-one women with high body dissatisfaction received five sessions of treatment under one of the three conditions. All interventions reduced body dissatisfaction, but only the mirror exposures successfully reduced the frequency of negative thoughts and feelings of ugliness. Pure mirror exposure was more effective than guided exposure for reducing body discomfort within and between sessions. Pure mirror exposure, based on the traditional extinction paradigm, led to strong emotional activation followed by a fast decrease in emotional reactivity.

Experimental effects of chocolate deprivation on cravings, mood, and consumption in high and low chocolate-cravers.

This study examined how deprivation of chocolate affects state-level chocolate cravings, mood, and chocolate consumption in high and low trait-level chocolate-cravers. After identifying high and low chocolate cravers (N=58), half of the participants were instructed not to eat any chocolate for 2weeks. This created four experimental groups: deprived high-cravers (n=14), deprived low-cravers (n=14), non-deprived high-cravers (n=15), and non-deprived low-cravers (n=15). Following 2-week deprivation, state-level food cravings, mood, and chocolate intake were measured in a laboratory setting and compared across groups. Analyses revealed that anxiety increased over time for high-cravers (both deprived and non-deprived); state-level chocolate- and food-craving increased over time for both deprived groups and non-deprived high-cravers; non-deprived high-cravers ate the most chocolate; and, high-cravers were more joyful and guilty than low-cravers after eating chocolate in the laboratory. Theoretically, these results suggest that chocolate consumption may be better explained by trait-level of chocolate craving than by deprivation and highlighted significant differences in mood, state-level cravings, and chocolate intake between cravers and non-cravers following deprivation.

Habituation and sensitization of protective reflexes: dissociation between cardiac defense and eye-blink startle.

We examined the habituation and recovery of two protective reflexes, cardiac defense and eye-blink startle, simultaneously elicited by a white noise of 500ms as a function of the time interval between stimulus presentations. Participants were 90 volunteers (54 women) randomly distributed into 6 inter-trial interval (ITI) conditions. They all received three presentations of the stimulus with a time interval of 30min between the first and third noise. The timing of the second noise was manipulated in six steps, using a between-group design, in order to increase the ITI between Trials 1 and 2 and symmetrically decrease the ITI between Trials 2 and 3. Cardiac defense showed fast habituation at the shortest ITI (2.5min), but reduced habituation and increased recovery at the longest ITI (27.5min). In contrast, eye-blink startle showed sensitization irrespective of the ITI. This pattern of findings highlights dissociations between protective reflexes when simultaneously examined. The results are discussed in the context of the cascade model of defense reactions.

Cross-cultural assessment of eating disorders: psychometric properties of a Spanish version of the Bulimia Test-Revised.

The purpose of this study was to examine the psychometric properties of a Spanish version of the Bulimia Test-Revised (BULIT-R). The goal was to test the factor-structure equivalence of the BULIT-R across two samples of college students from two different cultures, Spain and the US. Researchers using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) have reported different model solutions for the factor-structure of the BULIT-R: a one-factor model, a four-factor model, a five-factor model and a six-factor model. For the two samples, CFA did not support any of the models previously reported in the literature. EFA supported a six- and a four-factor models for the US and Spanish samples, respectively.

Ethnicity as a protective factor against internalization of a thin ideal and body dissatisfaction.

OBJECTIVE: We examined the potential for ethnicity to moderate the relationships between awareness and internalization of sociocultural ideals of appearance and between internalization and body dissatisfaction. METHOD: Spanish (n = 100), Mexican American (n = 100), and European American (n = 100) female participants completed measures of sociocultural attitudes and body dissatisfaction. Path analysis using maximum likelihood with robust standard errors tested the relationships across and within ethnic groups. RESULTS: There was evidence for the mediational effect of internalization on the relationship between awareness and body dissatisfaction. Furthermore, both relationships were significantly stronger for European American women than for Mexican American or Spanish women (the predicted moderator effect). DISCUSSION: Results demonstrate how ethnicity may protect against the development of eating disorder symptoms and suggest that eating disorder prevention should involve denouncing the thin ideal, minimizing appearance as an indicator of value, and emphasizing traits other than appearance as determinants of worth.