A synthesis of evidence for policy from behavioural science during COVID-19.

Scientific evidence regularly guides policy decisions1, with behavioural science increasingly part of this process2. In April 2020, an influential paper3 proposed 19 policy recommendations ('claims') detailing how evidence from behavioural science could contribute to efforts to reduce impacts and end the COVID-19 pandemic. Here we assess 747 pandemic-related research articles that empirically investigated those claims. We report the scale of evidence and whether evidence supports them to indicate applicability for policymaking. Two independent teams, involving 72 reviewers, found evidence for 18 of 19 claims, with both teams finding evidence supporting 16 (89%) of those 18 claims. The strongest evidence supported claims that anticipated culture, polarization and misinformation would be associated with policy effectiveness. Claims suggesting trusted leaders and positive social norms increased adherence to behavioural interventions also had strong empirical support, as did appealing to social consensus or bipartisan agreement. Targeted language in messaging yielded mixed effects and there were no effects for highlighting individual benefits or protecting others. No available evidence existed to assess any distinct differences in effects between using the terms 'physical distancing' and 'social distancing'. Analysis of 463 papers containing data showed generally large samples; 418 involved human participants with a mean of 16,848 (median of 1,699). That statistical power underscored improved suitability of behavioural science research for informing policy decisions. Furthermore, by implementing a standardized approach to evidence selection and synthesis, we amplify broader implications for advancing scientific evidence in policy formulation and prioritization.

Momentary appearance focused self-concept is associated with dietary restraint and binge eating in female university students: An experience sampling study.

OBJECTIVE: Appearance focused self-concept (i.e., overvaluing the importance of appearance for self-definition and self-worth) is theorized to predict dietary restraint and binge eating in the short-term (e.g., daily life). Yet, no research has examined whether appearance focused self-concept increases within-persons during a day and if such increases are linked to greater dietary restraint and binge eating for that day. We addressed this gap in knowledge. METHOD: Sixty-three female university students completed four items from the Beliefs About Appearance Scale as a measure of appearance focused self-concept six times per day (9 am, 11 am, 1 pm, 3 pm, 5 pm, and 7 pm) for 14 days. Daily at 9 pm, they completed measures of dietary restraint and binge eating for that day. RESULTS: Analyzing data from 555 days, latent growth curve analyses revealed a small-to-moderate linear increase in appearance focused self-concept from 9 am to 3 pm that plateaued from 3 to 7 pm. A more rapid linear increase in appearance focused self-concept from 9 am to 3 pm was associated with greater binge-eating frequency during that day, but not with dietary restraint. The findings were observed when adjusting for between-day appearance focused self-concept at 9 am, which was positively associated with dietary restraint and binge-eating frequency. DISCUSSION: Findings are discussed in relation to research on appearance focused self-concept as a risk factor for disordered eating. Findings are also discussed in relation to how sociocultural factors may increase appearance focused self-concept over time. Future research should delve into the within-day dynamic interplay between appearance focused self-concept and disordered eating. PUBLIC SIGNIFICANCE: Our study revealed a noteworthy increase in the importance women attach to their appearance over the course of a day, correlating with increased binge eating during that day. Additionally, heightened appearance importance at the onset of a day was associated with more dietary restraint and binge eating during that day. These findings suggest a shorter timescale for the connection between appearance importance and disordered eating than previously understood.

Trajectories of depression and anxiety symptoms over time in the transition to university: Their co-occurrence and the role of self-critical perfectionism.

Little is known about how mental health symptoms develop during the transition to university. Most anxiety and depression research fails to consider how symptom development differs over time across different individuals, and how symptom co-occurrence influences the severity of mental health problems. Students (N = 658) completed online surveys on mental health prior to starting university and every 2 months until April. To better understand mental health problems during this transitional period, latent class growth curve analyses were run to determine how anxiety and depressive symptoms co-develop over time, as well, if self-critical perfectionism was a transdiagnostic risk factor for more severe symptom trajectories in this transition. About 40% of students experienced depression and anxiety symptoms prior to entering/during the transition to university. There is substantial variation between students in terms of how they experience depression and anxiety symptoms, and research needs to take this heterogeneity into account to properly identify which students might benefit most from resources. Self-critical perfectionism was a transdiagnostic risk factor, such that students higher in this trait experienced more severe anxiety and depressive symptom trajectories during this transition. This research further implicates the importance of understanding and studying individual differences in symptom development.

Advancing the Pathways Model: Financially Focused Self-concept and Erroneous Beliefs as Core Psychopathologies in Disordered Gambling.

In the Pathways Model, there are three distinct etiological subtypes of disordered gambling (Behaviourally Conditioned, Emotionally Vulnerable, and Anti-Social Impulsive Risk-Taker). The Pathways Model also posits that erroneous gambling beliefs are a maintenance factor of disordered gambling across the subtypes. Yet, etiological factors and erroneous beliefs have largely been examined separately when determining disordered gambling subtype. Moreover, there may be heretofore unexamined maintenance factors that span the disordered gambling subtypes. In the current research, we addressed this gap by using latent profile analyses to assess the role both erroneous beliefs and financially focused self-concept (a novel maintenance factor) play in the determination of disordered gambling subtype. In Study 1, community members with gambling problems (n = 215) completed the Gambling Pathways Questionnaire and Financially Focused Self-Concept Scale. In Study 2 (n = 290), participants also completed the Gambling Beliefs Questionnaire. Results from both studies revealed three profiles that coincide with the subtypes in the Pathways Model as providing the best fit to the data. The three profiles were largely distinguished by low, medium, or high scores on the etiological factors, which is consistent with the disordered gambling subtypes being on different parts of the same continuum of psychopathology severity. Financial focus (Studies 1 and 2) and erroneous gambling beliefs (Study 2) were elevated across the three profiles, and both were higher among profiles with more severe psychopathology. Findings support a dimensional understanding of gambling disorder psychopathology and suggest that a financially focused self-concept may be a maintenance factor of disordered gambling.

The association of perfectionism, health-focused self-concept, and erroneous beliefs with orthorexia nervosa symptoms: A moderated mediation model.

OBJECTIVE: Orthorexia nervosa (ON) is a putative eating disorder linked to perfectionism among people who eat healthily (or who want to eat healthily). However, little is known about the process by which perfectionism fosters ON symptoms. Like the Transdiagnostic Cognitive-Behavioral Theory of Eating Disorders, we hypothesized that perfectionism among people who eat healthily (or who want to eat healthily) fosters ON symptoms indirectly by cultivating a health-focused self-concept (i.e., placing overriding importance on health for self-definition and self-worth). We also hypothesized that a health-focused self-concept would be associated with ON symptoms among people who have erroneous beliefs about the safety and efficacy of maladaptive healthy eating strategies. METHOD: To test this moderated mediation model, a sample of people following a healthy eating diet plan and/or who believe they are leading a healthy eating lifestyle (N = 456) were recruited from Amazon's Mechanical Turk and completed measures that assessed perfectionism, health-focused self-concept, ON symptoms, and erroneous beliefs about the safety and efficacy of maladaptive healthy eating strategies. They also completed a measure of appearance-focused self-concept. RESULTS: Health-focused and appearance-focused self-concepts were empirically distinct. As expected, perfectionism was indirectly and positively associated with ON symptoms via a health-focused self-concept. Importantly, the indirect association was only observed among participants high, but not low, in erroneous beliefs. DISCUSSION: The findings support the role of perfectionism in ON. The findings also advance knowledge by identifying a health-focused self-concept and erroneous beliefs as potential factors in the etiology and maintenance of ON.

Explaining reinforcement and erroneous beliefs in pathological exercise: A commentary and expansion on Coniglio et al. (in press) using the pathways model of disordered gambling.

Coniglio, Cooper, and Selby proposed that behavioral reinforcement may be critical for understanding the etiology and maintenance of pathological exercise among people living with anorexia nervosa. They presented three competing hypotheses about why exercise can become problematic: (a) positive reinforcement via biological and behavioral rewards, (b) negative reinforcement via avoidance of aversive states, or (c) a synergistic interplay between positive and negative reinforcement. Herein, we extend Coniglio and colleagues' framework by drawing on theory and research from the field of disordered gambling-a behavior in which reinforcement is an etiological and maintaining mechanism. We applied the pathways model of disordered gambling to the study of pathological exercise and made the following two proposals. First, pathological exercise may be driven by positive reinforcement, negative reinforcement, or both (they are not mutually exclusive), depending on the presence or absence of specific co-occurring psychopathologies. Second, erroneous beliefs about the safety and efficacy of maladaptive exercise for weight control may help maintain pathological exercise regardless of the type of reinforcement. We conclude by calling for research that assesses Coniglio and colleagues' novel hypotheses and our supposition that the pathways model can help provide a framework for those hypotheses.

A p-curve analysis of the emotional Stroop effect among women with eating disorders.

OBJECTIVE: A recent meta-review of attentional bias research in eating disorders suggests that meta-analyses and systematic reviews include many low-quality and underpowered studies (Stott et al., 2021). As such, we examined whether published research examining the link between attentional bias, using the emotional Stroop task, and eating disorders among women with eating disorders has evidential value (ruling out selective reporting of a statistically significant effect) using a p-curve analysis. A p-curve analysis plots statisticall significant p-values onto a curve from .01 to .05 to examine its distribution. We hypothesized that the p-curve would be flat, indicating no true effect. METHOD: The hypothesis, database search strategy, and data analytic approach were pre-registered. The inclusion criteria were reports that compared control and eating disorder groups, reported inferential statistics, and that used body shape/weight or general threat target words. RESULTS: Fifty published reports were included in the p-curve analyses. Unexpectedly, the half and full p-curves were significantly right-skewed, indicating evidential value. However, the results were not robust to the exclusion of the seven lowest p-values and on average, reports were underpowered. There were also 18 reports with null results (they had a p-value greater than .05), which precluded their inclusion in the p-curve analyses. DISCUSSION: The findings suggest that most of the evidence from research examining attentional biases using the emotional Stroop task among women with an eating disorder or with elevated eating disorder symptoms is underpowered and so should be interpreted with considerable caution. PUBLIC SIGNIFICANCE: Concerns have been raised about the low quality of research examining attentional biases among women with eating disorders using the emotional Stroop task. In the current research, we observed that the evidential value of primary research reporting differences between women with and without eating disorders was equivocal and had low statistical power. These results can guide researchers towards conducting more rigorous research on attentional biases among people with eating disorders.

OBJETIVO: Una meta-revisión reciente de la investigación del sesgo atencional en los trastornos de la conducta alimentaria sugiere que los metaanálisis y las revisiones sistemáticas incluyen muchos estudios de baja calidad y con poco poder estadístico (Stott et al., 2021). Como tal, examinamos si la investigación publicada que examina el vínculo entre el sesgo atencional, el uso de la tarea de Stroop emocional y los trastornos de la conducta alimentaria entre mujeres con trastornos alimentarios tiene valor de evidencia (descartando el informe selectivo de un efecto estadísticamente significativo) mediante un análisis de curva-p. Un análisis de curva-p traza p valores significativos en una curva de .01 a .05 para examinar su distribución. Planteamos la hipótesis de que la curva-p sería plana, lo que indica que no hay un efecto verdadero. MÉTODO: La hipótesis, la estrategia de búsqueda en la base de datos y el enfoque analítico de datos fueron pre-registrados. Los criterios de inclusión fueron informes que compararon grupos control y de trastornos de la conducta alimentaria, informaron estadísticas inferenciales y que utilizaron palabras clave de figura/peso corporal o de amenaza general. RESULTADOS: Cincuenta estudios publicados fueron incluidos en los análisis de la curva-p. Inesperadamente, las curvas-p medias y completas estaban significativamente sesgadas a la derecha, lo que indica un valor de evidencia. Sin embargo, los resultados no fueron robustos para la exclusión de los siete p valores más bajos y, en promedio, los reportes tuvieron poca potencia. También hubo 18 reportes con resultados nulos (tenían un p valor mayor que .05), lo que impidió su inclusión en los análisis de la curva-p. DISCUSIÓN: Los hallazgos sugieren que la mayor parte de la evidencia de la investigación que examina los sesgos atencionales utilizando la tarea de Stroop emocional entre las mujeres con un trastorno de la conducta alimentaria o con síntomas elevados del trastorno alimentario tiene poco poder y, por lo tanto, debe interpretarse con mucha precaución.

Understanding Lower-Risk Cannabis Consumption from the Consumers' Perspective: A Rapid Evidence Assessment.

Background: In the current rapid evidence assessment, we summarize the existing research on lower-risk cannabis consumption as understood by those who consume cannabis. Methods: We identified 7111 unique articles published between 1900 and 2021 using search terms related to a) cannabis consumption, b) beliefs and behaviors, and c) positive outcomes. Results: Twelve articles met our inclusion criteria. Three themes emerged that reflect lower-risk cannabis beliefs and behaviors (informed self-regulation, protective behavioral strategies, and the normalization of cannabis consumption) and one theme reflected motivations that undermine lower-risk cannabis consumption (e.g., using cannabis to cope). Conclusions: Results suggest a need for targeted lower-risk cannabis consumption research-research focused on how those who consume cannabis do so in a positive, non-problematic manner. Such research would help to inform policy and practice and, ultimately, help promote lower-risk cannabis consumption strategies.

Connecting a health-focused self-concept with orthorexia nervosa symptoms via fear of losing control over eating unhealthy food and disgust for unhealthy food.

PURPOSE: Orthorexia nervosa (ON) involves a maladaptive preoccupation with healthy eating through strict dietary rules that negatively affect physical and mental health. Recent evidence suggests that ON symptoms may stem, in part, from having a health-focused self-concept (i.e., overvaluing the importance of health for self-definition and self-worth). Herein, fear of losing control over eating unhealthy foods and disgust for unhealthy foods were examined as potential mediators of the association between health-focused self-concept and ON symptoms. METHODS: The parallel mediation model was tested using a community sample of people who believe they are currently following a healthy eating diet plan and/or believe they are leading a healthy eating lifestyle (N = 442). Participants were recruited from Amazon's Mechanical Turk and completed a questionnaire battery that included the Health-Focused Self-Concept Scale, questionnaires assessing fear of losing control over eating unhealthy food and disgust with unhealthy food, and the Orthorexia Nervosa Inventory. RESULTS: As expected, a health-focused self-concept was indirectly and positively associated with ON symptoms via fear and disgust. CONCLUSION: The findings conceptually replicate and extend prior research on anorexia nervosa supporting the transdiagnostic utility of a focused self-concept, fear of losing control, and disgust across eating disorders. LEVEL OF EVIDENCE: Level V, cross-sectional descriptive study.

People who overvalue appearance selectively attend to descriptors of the attractiveness ideal: Findings from an emotional Stroop task.

OBJECTIVE: Attentional biases to stimuli related to stigmatized appearance are theorized to stem from appearance overvaluation, but little research has examined this link. As well, little research has examined whether appearance overvaluation is associated with biases toward stimuli that describe the attractiveness ideal. We addressed these gaps in the literature using the emotional Stroop task and tested whether appearance overvaluation is associated with an attentional bias for words that describe stigmatized appearance (e.g., fat, ugly, shabby), the attractiveness ideal (e.g., thin, beautiful, fashionable), or both. METHOD AND RESULTS: In Study 1, a community sample of people (N = 86) completed measures of appearance overvaluation, body dissatisfaction, and body mass index (BMI) followed by an emotional Stroop task. Appearance overvaluation was associated with an attentional bias for attractiveness ideal words-not stigmatized appearance words. Results remained significant when controlling for participants' body dissatisfaction, BMI, and gender. Study 2 (N = 316) replicated these findings. Finally, an integrative data analysis that pooled the data of Studies 1 and 2 (N = 402) provided additional support for our general hypothesis that people who overvalue appearance display an attentional bias to stimuli related to the attractiveness ideal. DISCUSSION: The results show a robust association between appearance overvaluation and selective attention for attractiveness ideal stimuli. Results are discussed in reference to theory and research on information processing in eating disorders. We also call for research to examine information processing of stimuli related to the attractiveness ideal among people with eating disorders and who place high importance on appearance for self-definition.

Behavioral inhibition moderates the association between overvaluation of shape and weight and noncompensatory purging in eating disorders.

OBJECTIVE: The cognitive-behavioral therapy (CBT) model of eating disorders suggests that compensatory purging behaviors (e.g., self-induced vomiting, inappropriate laxative use) are primarily driven by binge eating. However, many individuals endorse purging in the absence of binge eating (i.e., noncompensatory purging [NCP]). Research is needed to understand why some individuals purge in the absence of objective or subjective binge-eating episodes. METHOD: Given the importance of overvaluation of shape/weight in the CBT model, and the existing evidence linking temperamental characteristics like behavioral inhibition (i.e., the tendency to withdraw in response to threat cues) with purging in general, we tested whether behavioral inhibition moderated the relationship between overvaluation of shape/weight and NCP in a sample of individuals in a residential eating disorder treatment center (N = 143). RESULTS: Overvaluation was more strongly related to NCP in individuals with high (relative to low) levels of behavioral inhibition. Among individuals low in behavioral inhibition, overvaluation predicted engagement in NCP to a much weaker extent. DISCUSSION: For those high (relative to low) in behavioral inhibition, both emotional avoidance and overvaluation may be important targets in the treatment of NCP, particularly in the absence of binge eating.

Eating disorder recovery is associated with absence of major depressive disorder and substance use disorders at 22-year longitudinal follow-up.

BACKGROUND: Psychiatric comorbidity is common in eating disorders (EDs) and associated with poor outcomes, including increased risk for relapse and premature death. Yet little is known about comorbidity following ED recovery. METHODS: We examined two common comorbidities, major depressive disorder (MDD) and substance use disorder (SUD), in adult women with intake diagnoses of anorexia nervosa and bulimia nervosa who participated in a 22-year longitudinal study. One hundred and seventy-six of 228 surviving participants (77.2%) were interviewed 22 years after study entry using the Eating Disorders Longitudinal Interval Follow-up Evaluation to assess ED recovery status. Sixty-four percent (n = 113) were recovered from their ED. The Structured Clinical Interview for DSM-IV was used to assess MDD and SUD at 22 years. RESULTS: At 22-year follow-up, 28% (n = 49) met criteria for MDD, and 6% (n = 11) met criteria for SUD. Those who recovered from their ED were 2.17 times more likely not to have MDD at 22-year follow-up (95% CI [1.10, 4.26], p = .023) and 5.33 times more likely not to have a SUD at 22-year follow-up than those who had not recovered from their ED (95% CI [1.36, 20.90], p = .008). CONCLUSION: Compared to those who had not fully recovered from their ED, those who had recovered were twice as likely not to be diagnosed with MDD in the past year and five times as likely not to be diagnosed with SUDs in the past year. These findings provide evidence that long-term recovery from EDs is associated with recovery from or absence of these common major comorbidities. Because comorbidity in EDs can predict poor outcomes, including greater risk for relapse and premature death, our findings of reduced risk for psychiatric comorbidity following recovery at long-term follow-up is cause for optimism.

Will I get fat? 22-year weight trajectories of individuals with eating disorders.

OBJECTIVE: For some, fat phobia or fear of uncontrollable weight gain is diagnostic of eating disorders, often inhibiting treatment engagement and predicting symptom relapse. Prior research has reported weight changes at infrequent or long intervals, but rate, shape, and magnitude of long-term changes remain unknown. Our study examined 22-year longitudinal trajectories of body mass index (BMI) in women with anorexia nervosa (AN) and bulimia nervosa (BN). METHOD: Participants were followed over 10 years (N = 225) and at 22-year follow-up (N = 175). Using latent growth curves, we examined: (1) shape and rate of intra-individual BMI change over 10 years; (2) predictors of BMI change over 10 years, (3) 22-year BMI outcomes; and (4) BMI changes over 10 years as predictors of 22-year BMI. RESULTS: The best-fitting model captured overall intra-individual rates of BMI change in three intervals, showing moderate rate of BMI increase from intake to year 2, modest increase from year 2 to 5, and plateau from year 5 to 10. At 22 years, 14% were underweight, 69% were normal weight, and only 17% were overweight or obese. Greater increases from intake to year 2 predicted higher BMI at 22 years (ß = 0.43, p < 0.01) and were predicted by intake diagnosis of AN-restricting (ß = 0.31, p < 0.01) or AN-binge eating/purging (ß = 0.29, p < 0.01). DISCUSSION: BMI increased most rapidly during earlier years of the study for those with lower weight at study intake (i. e., AN) and plateaued over time, settling in the normal range for most. Psychoeducation about expected BMI trajectory may challenge patients' long-term fat phobic predictions.

Global/local processing style: Explaining the relationship between trait anxiety and binge eating.

OBJECTIVE: Anxiety is a risk factor for disordered eating, but the mechanisms by which anxiety promotes disordered eating are poorly understood. One possibility is local versus global cognitive processing style, defined as a relative tendency to attend to details at the expense of the "big picture." Anxiety may narrow attention, in turn, enhancing local and/or compromising global processing. We examined relationships between global/local processing style, anxiety, and disordered eating behaviors in a transdiagnostic outpatient clinical sample. We hypothesized that local (vs. global) processing bias would mediate the relationship between anxiety and disordered eating behaviors. METHOD: Ninety-three participants completed the eating disorder examination-questionnaire (EDE-Q), State-Trait Anxiety Inventory (STAI)-trait subscale, and the Navon task (a test of processing style in which large letters are composed of smaller letters both congruent and incongruent with the large letter). The sample was predominantly female (95%) with a mean age of 27.4 years (SD = 12.1 years). RESULTS: Binge eating, but not fasting, purging, or excessive exercise, was correlated with lower levels of global processing style. There was a significant indirect effect between anxiety and binge eating via reduced global level global/local processing. DISCUSSION: In individuals with disordered eating, being more generally anxious may encourage a detailed-oriented bias, preventing individuals from maintaining the bigger picture and making them more likely to engage in maladaptive behaviors (e.g., binge eating).

A meta-analysis of the relation between therapeutic alliance and treatment outcome in eating disorders.

The therapeutic alliance has demonstrated an association with favorable psychotherapeutic outcomes in the treatment of eating disorders (EDs). However, questions remain about the inter-relationships between early alliance, early symptom improvement, and treatment outcome. We conducted a meta-analysis on the relations among these constructs, and possible moderators of these relations, in psychosocial treatments for EDs. Twenty studies met inclusion criteria and supplied sufficient supplementary data. Results revealed small-to-moderate effect sizes, ßs = 0.13 to 0.22 (p < .05), indicating that early symptom improvement was related to subsequent alliance quality and that alliance ratings also were related to subsequent symptom reduction. The relationship between early alliance and treatment outcome was partially accounted for by early symptom improvement. With regard to moderators, early alliance showed weaker associations with outcome in therapies with a strong behavioral component relative to nonbehavioral therapies. However, alliance showed stronger relations to outcome for younger (vs. older) patients, over and above the variance shared with early symptom improvement. In sum, early symptom reduction enhances therapeutic alliance and treatment outcome in EDs, but early alliance may require specific attention for younger patients and for those receiving nonbehaviorally oriented treatments.

Me, Myself, and Money II: Relative Deprivation Predicts Disordered Gambling Severity via Delay Discounting, Especially Among Gamblers Who Have a Financially Focused Self-Concept.

In the current research, we examined whether the known link between relative deprivation and disordered gambling (via delay discounting; i.e., preferences for immediate smaller rewards relative to delayed larger rewards) is moderated by the extent to which gamblers have a financially focused self-concept. Specifically, we hypothesized that delay discounting would be a strong predictor of disordered gambling among those who base their self-worth on their financial success. To test this moderated-mediation model, a community sample of gamblers (N = 239) completed measures that assessed relative deprivation, delay discounting, financially focused self-concept, and disordered gambling severity. As predicted, people who felt more relative deprivation reported more severe symptoms of disordered gambling and this association was mediated by delay discounting. Importantly, this mediated relationship was moderated by the extent to which participants' self-concept was focused on financial success. Among participants whose self-concept was high in financial focus, greater delay discounting (stemming from relative deprivation) was a strong predictor of disordered gambling. Among people whose self-concept was low in financial focus, delay discounting (stemming from relative deprivation) was a weak predictor of disordered gambling. Thus, the magnitude of the indirect effect of relative deprivation on disordered gambling severity was larger among people with a more financially focused self-concept-an effect mediated by delay discounting. These findings suggest that targeting gamblers' financial focus in prevention and treatment interventions may be instrumental in curtailing the development and maintenance of disordered gambling.

A 5-year longitudinal examination of the co-occurring patterns of gambling and other addictive behaviors.

OBJECTIVE: We examined the co-occurring patterns of problem gambling and substance/behavioral addiction severity over a five-year period and the predictors of the different co-occurring patterns of problem gambling and addiction severity. METHODS: We conducted a secondary analysis of the Quinte Longitudinal Study (QLS) data. The QLS is a 5-year prospective longitudinal study of gambling and problem gambling in the Quinte Region in Southern Ontario. The QLS consists of a total of 4,121 participants, including a sample of participants at risk of developing problem gambling. Severity of problem gambling, substance use, and behavioral addictions were used to examine their co-occurring patterns over time. Predictors of the co-occurring patterns included the presence of mental health disorders, personality, stress, happiness, lifesatisfaction, social support, family history, and demographics. RESULTS: Six co-occurring patterns of problem gambling and addiction severity were identified. The largest co-occurring pattern was characterized by concurrent decrease in gambling and other addictive behaviors. Several co-occurring patterns were characterized by moderate-to-severe problem gambling and other addiction severity that remained stable over time. No co-occurring pattern represented a decrease in gambling followed by increase in other addictive behaviors (e.g., addiction substitution). The presence of mental health disorders, stress, and lifesatisfaction significantly predicted the different co-occurring patterns. CONCLUSIONS: Taken together, the results suggest that in a non-clinical sample, gambling and other co-occurring addictive behaviors are likely to simultaneously decrease over time. Comorbidity of mental health disorders significantly influences co-occurring patterns of gambling and other addictive behaviors.

Co-occurring compulsive sexual behaviour in an inpatient substance use population: Clinical correlates and influence on treatment outcomes.

Background and Aims: Many individuals with substance use disorders (SUDs) present with co-occurring mental health disorders and other addictions, including behavioral addictions (BAs). Though several studies have investigated the relationship between SUDs and BAs, less research has focused specifically on compulsive sexual behaviour (CSB). Given that poly-addiction can hinder treatment outcomes, it is necessary to better understand the impact of co-occurring CSB and SUD. Therefore, the current study aimed to 1) determine the rate of CSB in a sample seeking treatment for SUDs, 2) identify demographic and clinical correlates of co-occurring CSB, and 3) to determine if co-occurring CSB impacts treatment outcomes for SUD. Methods: Participants were 793 adults (71.1% men) ranging in age from 18-77 (M = 38.73) at an inpatient treatment facility for SUDs who were assessed for CSB upon admission into treatment. Participants completed a battery of questionnaires upon admission and at discharge to assess psychological and addiction symptoms. Results: Rates of CSB were 24%. Younger age and being single were associated with greater CSB. Mental distress and addiction symptoms were higher in participants with CSB. Predictors of CSB severity included greater symptoms of traumatic stress and interpersonal dysfunction. Rates of treatment completion were similar between participants with and without CSB. Discussion and Conclusions: These results highlight several clinical and demographic correlates of CSB amongst individuals in treatment for SUD. However, CSB was not associated with poorer treatment outcomes. Further identifying characteristics associated with CSB can help clinicians identify individuals who may be at higher risk.

Avoidant/restrictive food intake disorder differs from anorexia nervosa in delay discounting.

BACKGROUND: Avoidant/restrictive food intake disorder (ARFID) and anorexia nervosa (AN) are the two primary restrictive eating disorders; however, they are driven by differing motives for inadequate dietary intake. Despite overlap in restrictive eating behaviors and subsequent malnutrition, it remains unknown if ARFID and AN also share commonalities in their cognitive profiles, with cognitive alterations being a key identifier of AN. Discounting the present value of future outcomes with increasing delay to their expected receipt represents a core cognitive process guiding human decision-making. A hallmark cognitive characteristic of individuals with AN (vs. healthy controls [HC]) is reduced discounting of future outcomes, resulting in reduced impulsivity and higher likelihood of favoring delayed gratification. Whether individuals with ARFID display a similar reduction in delay discounting as those with AN (vs. an opposing bias towards increased delay discounting or no bias) is important in informing transdiagnostic versus disorder-specific cognitive characteristics and optimizing future intervention strategies. METHOD: To address this research question, 104 participants (ARFID: n = 57, AN: n = 28, HC: n = 19) completed a computerized Delay Discounting Task. Groups were compared by their delay discounting parameter (ln)k. RESULTS: Individuals with ARFID displayed a larger delay discounting parameter than those with AN, indicating steeper delay discounting (M ± SD = -6.10 ± 2.00 vs. -7.26 ± 1.73, p = 0.026 [age-adjusted], Hedges' g = 0.59), with no difference from HC (p = 0.514, Hedges' g = -0.35). CONCLUSION: Our findings provide a first indication of distinct cognitive profiles among the two primary restrictive eating disorders. The present results, together with future research spanning additional cognitive domains and including larger and more diverse samples of individuals with ARFID (vs. AN), will contribute to identifying maintenance mechanisms that are unique to each disorder as well as contribute to the optimization and tailoring of treatment strategies across the spectrum of restrictive eating disorders.

Avoidant/restrictive food intake disorder (ARFID) and anorexia nervosa (AN) are both restrictive eating disorders. However, the reasons for restricting food intake differ between the two diagnoses. A key question in further understanding similarities and differences between ARFID and AN is to understand whether individuals with these disorders process information and make decisions in similar or distinct ways. When humans decide between two different outcomes (e.g., a smaller immediate or a larger delayed reward), outcomes decrease in their value the farther in the future we expect to receive them (delay discounting). Individuals with AN exhibit a reduced discounting of future outcomes, which makes them more likely to forego immediate gratification for later rewards. However, whether this holds true for individuals with ARFID too (or whether they show the opposite or no bias) is unknown. Our investigation is the first to compare delay discounting between individuals with ARFID, AN, and healthy controls (HC). Our results show that individuals with ARFID show more delay discounting than those with AN, with no difference from HC. Knowing how rewards are being chosen and decisions made (and knowing differences between diagnoses) will be helpful in further optimizing and tailoring treatments for restrictive eating disorders.