Association between engagement with appearance and eating related TikTok content and eating disorder symptoms via recommended content and appearance comparisons.

OBJECTIVE: It is well-established that the use of appearance-focused social media is associated with eating disorder (ED) symptoms, due to the presence of idealized imagery. Of concern, social media exposure is increasingly influenced by algorithms, which recommend content based on an analysis of the users' previous patterns of engagement. However, the relationships between users' engagement with social media content based upon its centering of appearance and eating, the presence of these themes in content suggested to them, and their ED symptoms remains unknown. The current study aimed to examine these relationships in the context of TikTok, a video- and algorithm-based platform. METHOD: Undergraduate students (N = 230; 78% female) completed self-report measures of ED symptoms, upwards social media appearance comparisons, as well as a novel measure of TikTok activity. RESULTS: Serial mediation analyses provided support for indirect relationships between engagement with appearance/eating-related content and ED symptoms via higher proportions of appearance/eating-related recommended content and higher levels of upwards social media appearance comparisons, respectively. There was no association between average screen time, nor general tendency to actively engage with content, and either ED symptoms or upwards social media appearance comparisons. DISCUSSION: Findings provide preliminary support for how engagement on TikTok is related to targeted exposure in ways that may contribute to perpetuating and exacerbating ED symptoms. PUBLIC SIGNIFICANCE: Social media use has been consistently associated with greater eating disorder symptoms. However, the ways in which users' engagement with social media content may be related to targeted social media exposure, and in turn eating disorder symptoms, remains unknown. This research provided preliminary evidence for associations between users' engagement with, and targeted exposure to, TikTok content related to appearance and eating, and their eating disorder symptoms.

Enhanced capacity to switch but not to maintain: The basis of attentional bias to high calorie foods in restrained eaters.

It has been argued that high restrained eaters (i.e., people who fluctuate between restrictive food intake and overeating) are characterised by a heightened attentional bias to high calorie foods. However, the validity of this hypothesis has not yet been convincingly established. The current study sought to empirically evaluate this hypothesis using two directional measures of attentional bias: the well-established dot probe bias assessment task and the more novel Chase the Food bias assessment task. The latter attentional assessment approach has the capacity to differentiate between attentional switching and attentional maintenance within a complex and dynamic food environment. Participants (61 high restrained eaters and 38 low restrained eaters) completed the dot probe task and the Chase the Food task. Findings obtained on the dot probe task did not reveal a group difference in terms of biased attentional responding towards high calorie vs. low calorie food. Conversely, the two groups were found to differ on one of the measures obtained on the Chase the Food task. Specifically, high restrained eaters, as compared to low restrained eaters, demonstrated speeded attentional switching to high calorie foods, rather than a greater ability to maintain attention on high calorie foods when required to do so. These novel findings imply that high restrained eaters are potentially characterised by facilitated attentional switching towards high calorie foods. Implications are discussed including the possibility of targeting biased attentional switching using training variants of the Chase the Food task in interventions designed to reduce maladaptive eating behaviours.

Healthiness matters: Approach motivation for healthy food in overweight and obese individuals.

It is well documented that approach tendencies for appetitive substances play a role in certain unhealthy patterns of consumption. However, it remains uncertain whether overweight individuals differ from healthy-weight individuals in terms of their tendency to approach unhealthy foods. Thus, the present study aimed to empirically test the hypothesis that overweight individuals are characterised by an elevated behavioural tendency to approach unhealthy food, rather than healthy food, as compared to healthy-weight individuals. Participants were forty-one overweight individuals (Mean BMI = 30.40 kg/m2) and forty-five healthy-weight individuals (Mean BMI = 22.17 kg/m2) aged between 17 and 47. They completed an Approach-Avoidance Task to assess behavioural approach-avoidance tendencies towards healthy and unhealthy food. Contrary to the hypothesis under test, results revealed a greater approach tendency towards healthy food in overweight individuals, as compared to healthy-weight individuals, whereas there were no group differences in behavioural approach-avoidance tendencies towards unhealthy food. These novel findings suggest that overweight individuals are characterised by an approach motivation for healthy food. We provide suggestions concerning how future researchers can build on these findings to test whether this approach tendency contributes to consumption behaviour in overweight individuals.

The effectiveness of touchscreen-based attentional bias modification to thin body stimuli on state rumination.

Ruminative thinking is considered a vulnerability factor for eating disorder symptomatology. Research suggests that attentional bias to body shape stimuli may serve to underpin this maladaptive form of emotion regulation. The current study aimed to determine the direct effect of attentional bias to thin-ideal bodies on state depressive rumination. Additionally, this study sought to evaluate the efficacy of attentional bias modification (ABM) utilising a touchscreen device. A well-established ABM protocol, the modified dot probe task, was used for both attentional assessment and training. Female undergraduate students (N = 110) completed an ABM session where attention was trained either towards, or away from, thin-ideal body images. Pre- and post-attentional training, participants completed the dot probe task, as well as a state measure of depressive rumination. Results revealed that the ABM training induced a greater attentional bias to thin-ideal bodies in the attend-thin training condition than in the avoid-thin training condition. Furthermore, induced attentional avoidance of thin-ideal bodies led to a significant reduction in state depressive rumination. The current findings suggest that touchscreen-based ABM is effective in modifying patterns of attentional bias and state depressive rumination.

The role of cognitive biases involving selective interrogation of taste-based information in sugar-sweetened beverage consumption.

BACKGROUND AND OBJECTIVES: Consumption of sugar-sweetened beverages (SSBs) is a global public health issue. Consequently, there is strong interest in advancing understanding of the cognitive mechanisms that underpin excessive SSB consumption. This work proposes that selective interrogation of taste-based characteristics (e.g., flavour), rather than health-based characteristics (e.g., sugar content), of beverages is associated with greater SSB choice and consumption. METHODS: To evaluate this novel hypothesis, undergraduate students (n = 210) were recruited to complete self-report measures of SSB consumption, motivation and success in reducing SSB consumption and unhealthy eating more broadly, as well as a novel selective interrogation assessment task. This task provided participants with the opportunity to selectively interrogate taste-based and health-based characteristics of various mystery beverages. RESULTS: Results supported the hypothesis that greater selective interrogation of taste-based characteristics, rather than health-based characteristics, of beverages is associated with greater SSB choice and consumption. Additionally, results revealed that greater selective interrogation of taste-based characteristics was associated with decreased motivation to reduce SSB consumption and decreased motivation and success to reduce unhealthy consumption more broadly. LIMITATIONS: The current study did not evaluate whether selective interrogation of taste-based characteristics of beverages predicted actual SSB consumption. CONCLUSION: These findings provide novel evidence for the potential role of selective interrogation of taste-based characteristics of beverages in SSB choice and consumption. An important implication of these findings is that in order for interventions focusing on front-of-package nutrition labels to be effective in reducing unhealthy consumption, it is necessary that individuals are selectively interrogating this 'health-based' information.

A preliminary investigation of the causal role of social media use in eating disorder symptoms.

BACKGROUND AND OBJECTIVES: Research has consistently shown that greater social media use is associated with elevated eating disorder (ED) symptoms. Importantly, however, the investigation of this relationship has largely relied upon the use of self-report measures of social media use in the context of correlational designs. Given that correlational studies do not permit inferences regarding causation, and recent findings questioning the validity of self-report social media use, it is critical to corroborate past findings using experimental designs and objective measures. The current study sought to experimentally determine the potential causal impact of social media use in ED symptoms. METHODS: Participants completed an initial testing session to assess objective smartphone social media use and ED symptoms, following which they were randomly assigned to either suspend social media use for one week or use social media as usual. One week later, participants completed a second testing session to again assess social media use and ED symptoms. RESULTS: Results revealed that the manipulation exerted an impact on ED symptoms, such that participants who successfully reduced social media use exhibited a significant reduction in ED symptoms, and these symptoms were significantly attenuated as compared to participants in the control condition. LIMITATIONS: The current study did not employ an active control condition and almost a quarter of participants were excluded due to dropout or non-compliance. CONCLUSION: Findings are consistent with the causal impact of social media use in ED symptoms and suggest that a brief social media 'holiday' may reduce ED symptoms in undergraduate students.

Attentional engagement with and disengagement from appearance ideals: Differential associations with body dissatisfaction frequency and duration?

Recent work has served to dissociate two dimensions of trait body dissatisfaction: body dissatisfaction frequency and body dissatisfaction duration. The present study sought to evaluate whether body dissatisfaction frequency and body dissatisfaction duration are each associated with distinct patterns of appearance-related cognitive processing. It was hypothesized that speeded attentional engagement with idealized bodies is associated with higher frequency of body dissatisfaction episodes, while slowed attentional disengagement from such information may instead be associated with higher duration of body dissatisfaction episodes. Participants (238 women, 149 men) completed an attentional task capable of independently assessing attentional engagement with, and attentional disengagement from, idealized bodies. Participants also completed both trait and in vivo (i.e., ecological momentary assessment) measures of body dissatisfaction frequency and duration. Results showed that neither engagement nor disengagement bias index scores predicted variance in either body dissatisfaction frequency measures or body dissatisfaction duration measures. Findings suggest that either biased attentional engagement with, and disengagement from, idealized bodies do not associate with the frequency and duration of body dissatisfaction episodes, or there are other key moderating factors involved in the expression of body dissatisfaction-linked attentional bias.

Body dissatisfaction and selective attention to thin-ideal bodies: The moderating role of attentional control.

It has been widely hypothesised that elevated body dissatisfaction is characterised by a biased pattern of attentional selectivity that reflects increased attention to stimuli portraying the thin-ideal. Empirical evidence in support of this notion, however, has been inconsistent. The current study aimed to examine the potential moderating role of attentional control in the association between body dissatisfaction and selective attentional responding to thin-ideal bodies. Female undergraduate students (N = 232) completed a self-report measure of body dissatisfaction followed by performance-based measures of attentional control and selective attention. Results provided support for the moderating role of attentional control. Specifically, a positive association between body dissatisfaction and biased selective attention towards thin-ideal bodies was evident only amongst individuals with relatively low levels of attentional control. A general association between body dissatisfaction and selective attention was not observed. These findings may explain previous inconsistent findings and highlight the importance of considering the potential role of attentional control in the expression of body dissatisfaction-linked attentional responding to thin-ideal bodies.

Reliability and convergence of approach/avoidance bias assessment tasks in the food consumption domain.

Theories of motivation posit that people will more readily approach positive or appetitive stimuli, and there has been growing interest in the relationship between biases in approach and avoidance behaviours for food cues and food craving and consumption behaviour. Two paradigms commonly employed by research to investigate this relationship are the approach-avoidance task (AAT) and the stimulus-response compatibility task (SRCT). However, it is yet to be determined whether the measures yielded by these tasks reflect the same processes operating in the food craving and consumption domain. The present study examined the internal reliability and convergence of AAT and SRCT paradigms in their assessment of biased approach to unhealthy compared with healthy food stimuli, and whether the measures yielded by the AAT and SRCT paradigms demonstrated associations with individual differences in food craving and eating behaviour. One hundred twenty-one participants completed an SRCT, an AAT using an arm movement response mode, and an AAT using a key-press response mode. The measures yielded comparable and acceptable levels of internal consistency, but convergence between the different task bias scores was modest or absent, and only approach bias as measured with the AAT task using an arm movement response mode was associated with self-report measures of eating behaviour and trait food craving. Thus, tasks did not converge strongly enough to be considered equivalent measures of approach/avoidance biases, and the AAT task using an arm movement response seems uniquely suited to detect approach biases argued to characterise maladaptive eating behaviour and craving.

The independent roles of attentional engagement with, and disengagement from, negative information in intrusive re-experiencing of negative events.

BACKGROUND AND OBJECTIVES: Intrusive re-experiencing of negative events represents a key vulnerability factor for Post-Traumatic Stress Disorder. Thus, delineating attentional mechanisms that might contribute to key facets of intrusive re-experiencing would be highly advantageous. The present study sought to evaluate the novel hypothesis that biased attentional engagement and disengagement differentially contribute to two central facets of intrusive re-experiencing, frequency and controllability, respectively. METHODS: One hundred undergraduates were exposed to an acutely negative event, followed by completion of an attentional task that permitted the discrete assessment of biased attentional engagement with, and biased attentional disengagement from, negative vs. non-negative information. Intrusions concerning this negative event were assessed daily, for the subsequent seven days, by means of an electronic diary. RESULTS: Results revealed that enhanced attentional engagement with negative vs. non-negative information predicted unique variance in intrusion frequency, whereas impaired attentional disengagement from negative vs. non-negative information predicted unique variance in intrusion controllability. These intrusion-linked patterns of attentional selectivity were evident at shorter (500 ms) stimulus exposure durations only, and not at longer (1000 ms) stimulus exposure durations. LIMITATIONS: The current study did not assess attentional selectivity prior to the negative event. Additionally, a time-based approach, rather than an event-based approach, was employed in the assessment of intrusions. CONCLUSIONS: The current findings suggest that engagement bias and disengagement bias may underpin differing facets of intrusive re-experiencing, raising the possibility that therapeutically targeting each type of attentional bias may attenuate a distinctive aspect of intrusive re-experiencing.

Effect of manipulating facial attractiveness judgements on the experience of intrusive thoughts in high facial appearance concern individuals.

Elevated facial appearance concern is characterised by highly frequent and distressing intrusive thoughts about appearance. Recent evidence suggests that enhanced readiness to make attractive (rather than unattractive) judgements of one's own and others' faces is associated with reduced experiencing of intrusive thoughts in high facial appearance concern individuals. The current study sought to experimentally evaluate the causal nature of this relationship. Females with high facial appearance concern (N = 123) completed the novel Judgement Dimension Manipulation (JDM) under conditions that required making 'attractive' judgments (i.e., only attractive faces were judged in terms of their attractiveness) or 'unattractive' judgments (i.e., only unattractive faces were judged in terms of their attractiveness). Prior to, and following the manipulation, participants completed a measure of intrusion frequency. Results revealed that the JDM was effective in inducing differential facial attractiveness judgements across the two groups and that this, in turn, impacted on intrusion frequency. Specifically, participants that were instructed to make 'attractive' judgments exhibited reduced intrusion frequency. These findings suggest that making attractive judgements of one's own and others' faces causally impacts on the experience of appearance-related intrusive thoughts and implicate that targeting this process may have potential therapeutic value.

Body dissatisfaction frequency and duration: Dissociable dimensions of trait body dissatisfaction.

This work proposes that trait body dissatisfaction rests on two dissociable components: 1) frequency of body dissatisfaction episodes, and 2) duration of such episodes, with higher trait body dissatisfaction resulting from more frequent and/or prolonged episodes. The current research aimed to develop a measure of these two dimensions (i.e., the Body Dissatisfaction Frequency Duration Questionnaire; BDFDQ) and test this theoretical model by investigating whether body dissatisfaction frequency and duration 1) were structurally dissociable, 2) meaningfully dissociable, and 3) each associated with different aspects of disordered eating behavior. Study 1 (N = 300, 42% women) developed the BDFDQ and showed that frequency and duration are structurally dissociable. Study 2 (N = 400, 50% women) showed that the two-factor model was invariant across gender and both subscales showed good psychometric properties of reliability and validity. Results further supported that frequency and duration are meaningfully dissociable by revealing that each component accounted for unique variance in trait body dissatisfaction. Study 3 (N = 279, 77% women) replicated Study 2 findings and established that frequency and duration subscales each associated with different aspects of disordered eating behavior. Together, findings imply that body dissatisfaction frequency and duration represent two separable dimensions underlying trait body dissatisfaction.

Attentional engagement, appearance comparisons, and rumination as predictors of body dissatisfaction: Evaluation of a serial mediation model in men.

Elevated body dissatisfaction is underpinned by an attentional bias towards images portraying appearance ideals. However, very little is known about the specific attentional mechanisms and mediating factors involved in this relationship in the context of male body dissatisfaction. The present study sought to replicate and extend on previous research among women showing that the relationship between attentional engagement bias and body dissatisfaction is sequentially mediated by appearance comparisons and rumination. Seventy undergraduate males completed an attentional task capable of independently assessing biased attentional engagement with images of muscular and non-muscular bodies followed by self-report measures of appearance comparisons, eating disorder-specific rumination, and body dissatisfaction. Results revealed that a heightened tendency to engage in appearance comparisons was associated with increased attentional engagement with muscular bodies, relative to non-muscular bodies. Moreover, a serial mediation analysis revealed that increased attentional engagement with muscular bodies was associated with appearance comparisons, which in turn were associated with eating disorder-specific rumination and, consequently, body dissatisfaction. The current findings replicate among men the serial mediation model of body dissatisfaction previously described among women and implicate heightened attentional engagement with idealized images as a potential pathway to body dissatisfaction in men.

The role of biases in the judgement processing of (un)attractive faces in body dysmorphic symptomatology.

The current study tested the novel hypothesis that elevated facial appearance concern reflects a heightened tendency to judge facial appearance in terms of attractiveness, rather than in terms of attractiveness-irrelevant dimensions. Seventy-three females, reporting either high or low facial appearance concerns, were exposed to an individualised stimulus development protocol which involved a photoshoot and the subsequent selection of photographs perceived to be most and least attractive. Participants were then required to judge photographs in terms of either attractiveness or the eye gaze direction of the individual in the photograph. Results revealed that when judging attractiveness, low facial concern participants were faster to classify photographs as belonging to the attractive category rather than the unattractive category. We termed this potentially protective bias the General Attractiveness Recognition Advantage. Moreover, regardless of judgement required, high facial concern participants were faster to make responses to unattractive relative to attractive photographs of themselves. We termed this potential vulnerability bias the Efficient Processing of Unattractive Self. Further analyses revealed that the former bias associated with broader body dysmorphic symptomatology. The current findings, although inconsistent with the hypothesis under test, were novel in revealing two distinct mechanisms which distinguished high and low facial appearance concern individuals.

Blinded by bodies: Elevated eating disorder symptomatology is associated with increased attentional priority for thin bodies.

Selective processing of female thin-ideal body imagery is associated with greater body dissatisfaction, and eating disorder-specific rumination has been shown to mediate this relationship. Across two studies, we employed a modified rapid serial visual presentation task (similar to that used within the emotion-induced blindness literature), such that participants searched for a task-relevant target that was sometimes preceded by a thin body, non-thin body, or neutral task-irrelevant distractor. Our first experiment (N = 372) revealed a "body-induced blindness" in an unselected female sample, such that bodies in general distracted attention more than neutral images, and non-thin bodies distracted more than thin-ideal bodies. In our second experiment, female participants were selected based on eating disorder symptomatology (N = 114). Females that exhibited elevated eating disorder symptoms were distracted more by thin bodies compared to those low in symptomatology, greater distraction from thin bodies was associated with greater body dissatisfaction, and this relationship was mediated by eating disorder-specific rumination. Altogether, our findings illustrate the persistent nature of attentional distortions that occur early in cognitive processing and across time for those high in eating disorder symptomatology.

Assessment of approach-avoidance tendencies in body image using a novel touchscreen paradigm.

BACKGROUND AND OBJECTIVES: Approaching the thin-ideal and avoiding the stigma of fatness are motivational tendencies resulting from the internalisation of sociocultural appearance norms. Individual differences in subclinical levels of eating disorder symptomatology may be related to variation in motivational tendencies regarding thin vs. non-thin bodies. METHODS: To empirically investigate this hypothesis, the current study employed a novel touchscreen approach-avoidance task with the capacity to effectively simulate compatible approach-avoidance movements. Eighty-four undergraduate females pulled closer or pushed away images depicting either bodies or objects, in response to weight category (underweight bodies vs. overweight bodies) and object category (kitchen items vs. office tools), by means of arm movements. RESULTS: Unexpectedly, results revealed relatively faster approach of overweight bodies and relatively faster avoidance of underweight bodies. Moreover, speeded approach towards overweight bodies, relative to underweight bodies, correlated positively with elevated eating disorder symptomatology. LIMITATIONS: The current sample was restricted to undergraduate women. CONCLUSIONS: The current study provides initial evidence for the utility of a touchscreen-based measure of approach-avoidance tendencies in body image, albeit comparison with other bias assessments would be necessary. Moreover, our findings suggest that a greater tendency to approach overweight bodies is associated with elevated eating disorder symptomatology. Future extensions of the current work are necessary to clarify the function of motivational tendencies in the body image context.

The importance of motivational orientation towards the muscular ideal versus the stigmatised burdensome body in male body dissatisfaction.

Internalisation of the muscular ideal is a vulnerability factor for body dissatisfaction in males. It is unclear, however, whether body dissatisfaction results from approach towards the muscular ideal versus fear of the stigmatised burdensome body. The current study sought to address this gap by assessing both approach and avoidance motivation regarding muscular and non-muscular bodies, respectively, and evaluating the unique associations between approach-avoidance tendencies and body dissatisfaction. Eighty-three male undergraduate students completed an implicit measure of approach-avoidance tendencies, the Stimulus Response Compatibility task, and a self-report measure of trait body dissatisfaction. Results revealed that participants were quicker to approach than to avoid muscular bodies; however, there were no differences in approach vs. avoidance tendencies regarding non-muscular bodies. Furthermore, in a multiple regression model comprising motivational bias scores regarding muscular and non-muscular bodies, only an approach bias towards muscular bodies predicted unique variance in body dissatisfaction. These findings are novel in showing an implicit approach motivation towards the muscular ideal in male undergraduates. Furthermore, in this population, motivational orientation towards the muscular ideal, versus the stigmatised burdensome body, seems to be more tightly associated with body dissatisfaction.

The causal role of selective attention for thin-ideal images on negative affect and rumination.

BACKGROUND AND OBJECTIVES: Attentional bias towards thin-ideal body images has been implicated as a vulnerability factor for eating disorder symptomatology. However, the nature and causal basis of its relationship with other cognitive vulnerability factors, namely, eating disorder-specific rumination and negative mood, remains unclear. Accordingly, the current study investigated the causal influence of attentional bias towards thin-ideal images on emotional and ruminative vulnerability, in response to a body image-related stressor. METHODS: An established attentional bias modification (ABM) procedure, the modified dot probe task, was used for the assessment and manipulation of attentional bias. Female undergraduate students (N = 110) aged between 17 and 24 years were randomly assigned to either 'attend' towards or 'avoid' thin-ideal images. Pre- and post-attentional training, participants completed the dot probe task, as well as state measures of rumination and negative mood. Additionally, following post-ABM assessment of attentional bias, participants were given a body image-related stressor. RESULTS: Results showed that participants trained to attend to thin bodies reported heightened negative mood, in response to the stressor, compared with participants trained to avoid thin bodies. On the other hand, groups did not demonstrate a differential increase in eating disorder-specific rumination in response to the stressor. LIMITATIONS: The current findings will require replication with clinical samples. Additionally, state rumination and negative mood were assessed via single items. CONCLUSIONS: These results provide the first causal evidence for the role of attentional bias towards thin-ideal images in negative emotional vulnerability. Importantly, these results suggest attentional bias may serve as a risk factor for mood reactivity and a potential target for strategies designed to enhance emotional resilience.

Correction: The mediating role of rumination in the relation between attentional bias towards thin female bodies and eating disorder symptomatology.

[This corrects the article DOI: 10.1371/journal.pone.0177870.].

The mediating role of rumination in the relation between attentional bias towards thin female bodies and eating disorder symptomatology.

The present study sought to investigate the association between selective attentional processing of body images, rumination, and eating disorder symptoms in young women. Seventy-three undergraduate female students (ages 17-24) completed a modified dot-probe task to assess whether young women showed a differential attentional bias pattern towards thin and non-thin female bodies. Participants also completed self-report measures of eating disorder pathology. It was found that increased reports of dietary restraint and body dissatisfaction were associated with both greater attentional bias towards thin bodies and avoidance of non-thin bodies (as compared to neutral images), although the former relationship was stronger than the latter. The results suggest attentional vigilance to thin-ideal images plays a greater role in the potential development and/or maintenance of eating disorder symptoms, at least in a university sample of young women. Results also revealed that eating disorder-specific rumination mediated the relationship between attentional bias to thin ideal images and eating disorder symptoms. These findings build on existing research and theories, for example the impaired disengagement model of rumination, and have potential clinical applications such as specifically targeting ruminative and/or attentional processes in the prevention and/or treatment of eating disorder symptoms.