Eating-disorder psychopathology and driven exercise change models: A latent change score analysis.

OBJECTIVE: Approximately 50% of people with eating disorders (EDs) engage in driven exercise to influence their weight or shape and/or to compensate for loss-of-control eating. When present, driven exercise is associated with a lower quality-of-life, longer hospital stays, and faster rates-of-relapse. Despite the seriousness of driven exercise, most treatments for EDs do not target maladaptive exercise behaviors directly. Given the large proportion of patients with an ED who engage in driven exercise and its effect on treatment outcomes, it is critical to understand what predicts change in driven exercise. The purpose of this study was to test whether ED symptoms prospectively predicted change in driven exercise and vice versa. METHOD: Participants were Recovery Record (RR) users (N = 4,568; 86.8% female) seeking treatment for an ED. Participants completed the Eating Pathology Symptoms Inventory (EPSI) monthly for 3 months. RESULTS: In the full sample, dynamic bivariate latent change score analyses indicated that high levels of dietary restraint and restricting prospectively predicted reductions in driven exercise. Among persons with anorexia nervosa (AN), high levels of binge eating predicted increased driven exercise. Among persons with bulimia nervosa (BN), high levels of body dissatisfaction predicted increased driven exercise. Among persons with binge-eating disorder (BED), high levels of binge eating, purging, and restricting predicted reductions in driven exercise. DISCUSSION: Results highlight changes that may predict increased or decreased driven exercise relative to other ED symptoms for AN, BN, and BED groups. These preliminary findings could inform future research on ED treatment efforts to manage driven exercise.

Permutation randomization methods for testing measurement equivalence and detecting differential item functioning in multiple-group confirmatory factor analysis.

In multigroup factor analysis, different levels of measurement invariance are accepted as tenable when researchers observe a nonsignificant (Δ)χ2 test after imposing certain equality constraints across groups. Large samples yield high power to detect negligible misspecifications, so many researchers prefer alternative fit indices (AFIs). Fixed cutoffs have been proposed for evaluating the effect of invariance constraints on change in AFIs (e.g., Chen, 2007; Cheung & Rensvold, 2002; Meade, Johnson, & Braddy, 2008). We demonstrate that all of these cutoffs have inconsistent Type I error rates. As a solution, we propose replacing χ2 and fixed AFI cutoffs with permutation tests. Randomly permuting group assignment results in average between-groups differences of zero, so iterative permutation yields an empirical distribution of any fit measure under the null hypothesis of invariance across groups. Our simulations show that the permutation test of configural invariance controls Type I error rates better than χ2 or AFIs when the model contains parsimony error (i.e., negligible misspecification) but the factor structure is equivalent across groups (i.e., the null hypothesis is true). For testing metric and scalar invariance, Δχ2 and permutation yield similar power and nominal Type I error rates, whereas ΔAFIs yield inflated errors in smaller samples. Permuting the maximum modification index among equality constraints control familywise Type I error rates when testing multiple indicators for lack of invariance, but provide similar power as using a Bonferroni adjustment. An applied example and syntax for software are provided. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Understanding eating disorders within internalizing psychopathology: A novel transdiagnostic, hierarchical-dimensional model.

BACKGROUND: Several problems with the classification and diagnosis of eating disorders (EDs) have been identified, including proliferation of 'other specified' diagnoses, within-disorder heterogeneity, and frequent diagnostic migration over time. Beyond problems within EDs, past research suggested that EDs fit better in a spectrum of internalizing psychopathology (characterized by mood and anxiety disorders) than in a separate diagnostic class. PURPOSE: To develop a transdiagnostic, hierarchical-dimensional model relevant to ED psychopathology that: 1) reduces diagnostic heterogeneity, 2) includes important dimensions of internalizing psychopathology that are often excluded from ED diagnostic models, and 3) predicts clinical impairment. PROCEDURES: Goldberg's (2006) method and exploratory structural equation modeling were used to identify a hierarchical model of internalizing in community-recruited adults with EDs (N=207). FINDINGS: The lowest level of the hierarchy was characterized by 15 factors that defined specific aspects of eating, mood, and anxiety disorders. At the two-factor level, Internalizing bifurcated into Distress (low well-being, body dissatisfaction, suicidality, dysphoria, ill temper, traumatic intrusions) and Fear-Avoidance (claustrophobia, social avoidance, panic symptoms, dietary restricting, excessive exercise, and compulsions). Results showed that the lowest level of the hierarchy predicted 67.7% of the variance in clinical impairment. In contrast, DSM eating, mood, and anxiety disorders combined predicted 10.6% of the variance in impairment secondary to an ED. CONCLUSIONS: The current classification model represents an improvement over traditional nosologies for predicting clinically relevant outcomes for EDs.

Protective behavioral strategy use and motivations for drinking: exploring Alternatives to Drinking strategies.

Protective behavioral strategy (PBS) use is associated with less alcohol consumption and fewer alcohol-related problems. Further, greater endorsement of social or enhancement drinking motives (i.e., positive motives) is associated with less frequent PBS use. Limited research has, however, explored coping or conformity motives (i.e., negative motives) in relation to PBS. Consequently, the present study aimed to (1) identify the types of PBS most strongly associated with negative and positive motives and (2) examine different types of PBS as mediators of the relationship between each drinking motive and alcohol outcomes. Participants were college students (n=303; 70% women) who completed measures of drinking motives, PBS, alcohol use, and alcohol-related problems. Results indicated that greater endorsement of positive drinking motives were more strongly associated with less frequent use of PBS while drinking whereas negative motives were more strongly related to less frequent Alternatives to Drinking strategy use. Further, strategies used while drinking were more relevant in a model of positive drinking motives and Alternatives to Drinking strategies were more relevant in a model of negative motives. These findings may suggest that whereas individuals with stronger positive motives have difficulty using strategies while drinking, individuals who drink to cope or conform have greater difficulty utilizing Alternatives to Drinking strategies. Based on our results demonstrating that different types of PBS are more relevant for various types of drinkers, it may be important for future interventions to discuss not only the participant's PBS use but also their motivations for consuming alcohol.

The assessment of protective behavioral strategies: comparing the absolute frequency and contingent frequency response scales.

The purpose of the present studies was to examine the effects of response scale on the observed relationships between protective behavioral strategies (PBS) measures and alcohol-related outcomes. We reasoned that an "absolute frequency" scale (stem: "how many times …"; response scale: 0 times to 11+ times) conflates the frequency of using PBS with the frequency of consuming alcohol; thus, we hypothesized that the use of an absolute frequency response scale would result in positive relationships between types of PBS and alcohol-related outcomes. Alternatively, a "contingent frequency" scale (stem: "When drinking … how often …"; response scale: never to always) does not conflate frequency of alcohol use with use of PBS; therefore, we hypothesized that use of a contingent frequency scale would result in negative relationships between use of PBS and alcohol-related outcomes. Two published measures of PBS were used across studies: the Protective Behavioral Strategies Survey (PBSS) and the Strategy Questionnaire (SQ). Across three studies, we demonstrate that when measured using a contingent frequency response scale, PBS measures relate negatively to alcohol-related outcomes in a theoretically consistent manner; however, when PBS measures were measured on an absolute frequency response scale, they were nonsignificantly or positively related to alcohol-related outcomes. We discuss the implications of these findings for the assessment of PBS.

Predictive effects of good self-control and poor regulation on alcohol-related outcomes: do protective behavioral strategies mediate?

In the present study, we examined whether use of protective behavioral strategies mediated the relationship between self-control constructs and alcohol-related outcomes. According to the two-mode model of self-control, good self-control (planfulness; measured with Future Time Perspective, Problem Solving, and Self-Reinforcement) and poor regulation (impulsivity; measured with Present Time Perspective, Poor Delay of Gratification, Distractibility) are theorized to be relatively independent constructs rather than opposite ends of a single continuum. The analytic sample consisted of 278 college student drinkers (68% women) who responded to a battery of surveys at a single time point. Using a structural equation model based on the two-mode model of self-control, we found that good self-control predicted increased use of three types of protective behavioral strategies (Manner of Drinking, Limiting/Stopping Drinking, and Serious Harm Reduction). Poor regulation was unrelated to use of protective behavioral strategies, but had direct effects on alcohol use and alcohol problems. Further, protective behavioral strategies mediated the relationship between good self-control and alcohol use. The clinical implications of these findings are discussed.

The assessment of protective behavioral strategies: comparing prediction and factor structures across measures.

Protective behavioral strategies (PBS), or drinking control strategies, are specific behaviors one can utilize to minimize the harmful consequences of alcohol consumption. As there is not currently a standard measure of PBS, the goal of the present study was to examine the factor structure and concurrent validity of three scales designed to assess PBS: Protective Behavioral Strategies Scale (PBSS; Martens, M. P., Ferrier, A. G., Sheehy, M. J., Corbett, K., Anderson, D. A., & Simmons, A., 2005 Development of the Protective Behavioral Strategies Survey. Journal of Studies on Alcohol, 66, 698-705), Protective Behavioral Strategies Measure (Novik, M. G., & Boekeloo, B. O., 2011, Dimensionality and psychometric analysis of an alcohol protective behavioral strategies scale. Journal of Drug Education, 41, 65-78. doi:10.2190/DE.41.1.d), and the Strategy Questionnaire (SQ); (Sugarman, D. E., & Carey, K. B., 2007), The relationship between drinking control strategies and college student alcohol use. Psychology of Addictive Behaviors, 21, 338-345. doi:10.1037/0893-164X.21.3.338). In a sample of college students (n=291), we used confirmatory factor analysis to examine the proposed factor structures of each scale. Although the theorized three-factor structure fit the data moderately well for the PBSS, the theorized factor structures for the Protective Behavioral Strategies Measure and SQ did not fit the data well. Further, the composite scores from the PBSS were all significantly negatively correlated with alcohol-related problems, whereas the composites of the SQ were not significantly correlated with alcohol-related problems. Although we have evidence in favor of 1 PBS measure over others, we discuss broader issues related to assessment of PBS. We consider the different instructions, response scales, and time intervals for various PBS measures in terms of how they relate to the advancement of PBS research.

Unique direct and indirect effects of impulsivity-like traits on alcohol-related outcomes via protective behavioral strategies.

In the present study, we examined whether the use of protective behavioral strategies (PBS) mediates the effects of impulsivity-like traits on alcohol-related problems using a sample of 278 college students. Validating the 5-factor model of impulsivity, we showed that each impulsivity-like trait had a distinct pattern of relationships with PBS and/or alcohol outcomes. Further validating the 3-factor model of PBS (Limiting/Stopping Drinking, Manner of Drinking, and Serious Harm Reduction), we found that each type of PBS had unique antecedents (i.e., predicted by different impulsivity-like traits) and unique prediction (i.e., predicted alcohol use/problems differently). We discuss the implications of findings for the study of etiology of alcohol misuse as well as for intervention development.