Early evaluation of a DBT-informed online intervention for people with eating disorders.

OBJECTIVES: Eating disorders (EDs) have a worldwide prevalence of 7.8%, with towering mortality rates and high healthcare costs. The current recommended treatment for EDs principally works by directly targeting ED thoughts and behaviours, but recovery rates are low. A multifaceted link between difficulties with emotions and EDs is now widely established, and newer third-wave therapies that aim to address these underlying emotion difficulties are promising. The current study piloted an online emotion self-help intervention which was co-developed with clinicians and people with lived experienced of EDs. The intervention aimed to specifically address difficulties with emotion identification and regulation, as well as unhelpful beliefs about emotions, which are believed to give rise to and maintain ED thoughts and behaviours. METHOD: We recruited 39 people with self-reported EDs to test this intervention over a one-week period. Our participants were asked to complete a series of questionnaires measuring emotion processes and psychopathology on Day 1 (T1) before being given access to the intervention. Participants were then asked to practice the newly acquired skills for seven days, before taking the same questionnaires on Day 9 (T2). We also asked participants to qualitatively report on their experience of the intervention. RESULTS: We found significant improvements in ED psychopathology (ED-15), depression (PHQ-9), and anxiety (GAD-7) pre- to post-intervention, with medium to large effect sizes. All our emotion variables namely alexithymia (TAS-20), difficulties regulating emotions (DERS-SF), and unhelpful beliefs about emotions (EBQ) also showed significant changes post-intervention with medium to large effect sizes. Most importantly, changes in emotion regulation processes were linked to improved eating psychopathology. The qualitative analysis corroborated this finding, highlighting how the intervention helped them form new beliefs about emotions, which helped them reduce ED behaviours. DISCUSSION: Significant improvements in emotion processing and regulations, as well as psychopathology, along with positive qualitative feedback, suggest that the intervention effectively met its aims of increasing awareness of the link between emotions and eating psychopathology, providing help to identify and regulate emotions, and normalising emotional experiences. While our results are promising, further research is required to assess its effectiveness longer term and in clinical settings.

About one person dies every hour as a direct result of an eating disorder (ED), in part because of poor treatment outcomes. Current recommended treatments have a limited focus around emotion difficulties, such as the ability to identify emotions and regulate them, which are linked to ED thoughts and behaviours. With the help of clinicians and people with lived experience of EDs, we developed an online intervention that works on these emotion difficulties. We recruited 39 people with EDs to test this intervention over a one-week period and evaluated our results using quantitative and qualitative analyses. Comparing scores before and after the intervention, we found that ED psychopathology, depression and anxiety were significantly lower post-intervention. Beliefs about emotions as well as the ability to identify, describe and regulate emotions were also significantly improved post-intervention. Qualitative analysis showed that our intervention helped people feel better equipped to deal with their feelings in a healthier way, which helped reduce ED behaviours. One person even described the intervention as "life-changing". While our results are promising, further research is required to assess our intervention in a clinical setting.

Conceptualisations of health in orthorexia nervosa: a mixed-methods study.

PURPOSE: Limited research has explored conceptualisations of health and healthy eating in orthorexia nervosa (ON). This mixed-methods study aimed to investigate how 'health' and 'healthy eating' are conceptualised by individuals at risk for ON. This study examined the potential relationships between health anxiety, beliefs about health controllability and orthorexic symptomatology in our broader sample. METHODS: A total of 362 participants took a survey on health anxiety (measured with the HAQ), beliefs about the controllability of one's own health (IMHLC) and ON symptomatology (E-DOS and EHQ). Participants 'at risk' for ON (n = 141), also completed an online qualitative survey about conceptualisations of health and healthy eating. Qualitative data were analysed using thematic analysis (part A). The PROCESS macro for SPSS was used for the quantitative analysis (part B). RESULTS: Conceptualisations of health and healthy eating were complex. Four themes were generated from our qualitative data: 'health is more than thin ideals', 'healthy food equals healthy mind', 'a body that works for you' and 'taking control of your body'. Our quantitative analysis revealed that health anxiety and beliefs in health controllability independently predicted ON symptomatology. CONCLUSION: A richer understanding of what health means in the context of ON is important, given the centrality of this concept to the proposed classification of this disordered eating style. Our findings highlight that both health anxiety and health controllability are important targets for future investigation, given their potential relevance to the aetiology and treatment of ON. LEVEL OF EVIDENCE: Level V, based on a descriptive study.

Hot Yoga Leads to Greater Well-being: A Six-week Experience-sampling RCT in Healthy Adults

Practicing hot yoga may bring significant psychological benefits, but it is largely unstudied. We examined the effects of hot yoga on multifaceted well-being indicators with 290 healthy yoga-naïve volunteers partaking in a six-week randomized controlled trial. Participants completed questionnaires pre- and post-intervention, and reported their emotional experiences four times per day throughout an experience-sampling study. Results revealed that the hot yoga group (n = 137) improved their well-being from pre- to post-treatment, comparing to the wait-list control group (n = 153). These improvements included life satisfaction, general health, mindfulness, peace of mind, and eudaimonic well-being (ΔR2 ranging from .01 to .08)—but not flourishing, which describes major aspects of social-psychological functioning. Multilevel analyses demonstrated that momentary positive emotional experiences increased significantly throughout the trial in the yoga group only (conditional R2 = .68), particularly when attending a yoga class (conditional R2 = .50). Interestingly, this increase in momentary positive emotion explained the improvement in post-intervention mindfulness, peace of mind, and general health by 21%, 31%, and 11%, respectively. Finally, the benefits of hot yoga were more notable in individuals with lower levels of baseline eudaimonic well-being (conditional R2 = .45), flourishing (conditional R2 = .61), and mental well-being (conditional R2 = .65), even after ruling out any possible ceiling effects. To sum up, this study demonstrated multiple psychological benefits of hot yoga and its potential to be an effective positive psychology intervention. Future research—especially considering an active control group—is warranted. (AU)

La práctica del hot yoga puede aportar importantes ventajas psicológicas, aunque apenas se ha estudiado. Analizamos los efectos del hot yoga sobre una gran variedad de indicadores de bienestar en una muestra de 290 voluntarios sin experiencia en yoga que tomaron parte en un ensayo controlado aleatorio de seis semanas. Los participantes contestaron cuestionarios antes y después de la intervención, dando cuenta de sus experiencias emocionales cuatro veces al día a lo largo de un estudio de muestreo de experiencias. Los resultados mostraron que el bienestar del grupo de hot yoga (n = 137) aumentó del pretratamiento al postratamiento en comparación con el grupo de control de lista de espera (n = 153), mejorando la satisfacción en la vida, la salud en general, la atención plena, la paz mental y el bienestar eudaimónico (ΔR2 entre .01 y .08), aunque no en prosperidad psicosocial, que describe aspectos importantes del funcionamiento social psicológico. Los análisis multinivel desvelaron que se daba un gran aumento de las experiencias emocionales positivas momentáneas a lo largo de todo el ensayo únicamente en el grupo de yoga (R2 condicional = .68), sobre todo al asistir a clase de yoga (R2 condicional = .50). Es interesante ver que este aumento de la emoción positiva momentánea explicaba la mejora de la atención plena, la paz mental y la salud en general en un 21%, 31% y 11% respectivamente tras la intervención. Por último, los beneficios del hot yoga destacaban más en personas con menor bienestar eudaimónico base (R2 condicional = 45), prosperidad psicosocial (R2 condicional = .61) y bienestar mental (R2 condicional = .65), incluso tras descartar los posibles efectos techo. Resumiendo, este estudio ha demostrado los muchos efectos psicológicos del hot yoga y su potencial como eficaz intervención en psicología positiva. La investigación futura (en especial teniendo en cuenta un grupo de control activo) está justificada. (AU)

Hot Yoga Leads to Greater Well-being: A Six-week Experience-sampling RCT in Healthy Adults.

Practicing hot yoga may bring significant psychological benefits, but it is largely unstudied. We examined the effects of hot yoga on multifaceted well-being indicators with 290 healthy yoga-naïve volunteers partaking in a six-week randomized controlled trial. Participants completed questionnaires pre- and post-intervention, and reported their emotional experiences four times per day throughout an experience-sampling study. Results revealed that the hot yoga group (n = 137) improved their well-being from pre- to post-treatment, comparing to the wait-list control group (n = 153). These improvements included life satisfaction, general health, mindfulness, peace of mind, and eudaimonic well-being (ΔR2 ranging from .01 to .08)-but not flourishing, which describes major aspects of social-psychological functioning. Multilevel analyses demonstrated that momentary positive emotional experiences increased significantly throughout the trial in the yoga group only (conditional R2 = .68), particularly when attending a yoga class (conditional R2 = .50). Interestingly, this increase in momentary positive emotion explained the improvement in post-intervention mindfulness, peace of mind, and general health by 21%, 31%, and 11%, respectively. Finally, the benefits of hot yoga were more notable in individuals with lower levels of baseline eudaimonic well-being (conditional R2 = .45), flourishing (conditional R2 = .61), and mental well-being (conditional R2 = .65), even after ruling out any possible ceiling effects. To sum up, this study demonstrated multiple psychological benefits of hot yoga and its potential to be an effective positive psychology intervention. Future research-especially considering an active control group-is warranted.

La práctica del hot yoga puede aportar importantes ventajas psicológicas, aunque apenas se ha estudiado. Analizamos los efectos del hot yoga sobre una gran variedad de indicadores de bienestar en una muestra de 290 voluntarios sin experiencia en yoga que tomaron parte en un ensayo controlado aleatorio de seis semanas. Los participantes contestaron cuestionarios antes y después de la intervención, dando cuenta de sus experiencias emocionales cuatro veces al día a lo largo de un estudio de muestreo de experiencias. Los resultados mostraron que el bienestar del grupo de hot yoga (n = 137) aumentó del pretratamiento al postratamiento en comparación con el grupo de control de lista de espera (n = 153), mejorando la satisfacción en la vida, la salud en general, la atención plena, la paz mental y el bienestar eudaimónico (ΔR2 entre .01 y .08), aunque no en prosperidad psicosocial, que describe aspectos importantes del funcionamiento social psicológico. Los análisis multinivel desvelaron que se daba un gran aumento de las experiencias emocionales positivas momentáneas a lo largo de todo el ensayo únicamente en el grupo de yoga (R2 condicional = .68), sobre todo al asistir a clase de yoga (R2 condicional = .50). Es interesante ver que este aumento de la emoción positiva momentánea explicaba la mejora de la atención plena, la paz mental y la salud en general en un 21%, 31% y 11% respectivamente tras la intervención. Por último, los beneficios del hot yoga destacaban más en personas con menor bienestar eudaimónico base (R2 condicional = 45), prosperidad psicosocial (R2 condicional = .61) y bienestar mental (R2 condicional = .65), incluso tras descartar los posibles efectos techo. Resumiendo, este estudio ha demostrado los muchos efectos psicológicos del hot yoga y su potencial como eficaz intervención en psicología positiva. La investigación futura (en especial teniendo en cuenta un grupo de control activo) está justificada.

Believing emotions are uncontrollable is linked to eating disorder psychopathology via suppression and reappraisal.

OBJECTIVE: Research suggests that beliefs about emotional controllability influence the use of emotion regulation strategies, which in turn impact psychological health and illness. However, no research has yet investigated whether emotional controllability is linked to eating psychopathology. The current study investigates whether these concepts are related, as individuals with eating disorders have problems with emotion regulation. METHOD: We collected self-report data from 718 participants from a community sample using validated questionnaires, and ran mediational analyses to assess the relationship between emotional controllability and eating psychopathology, via reappraisal and suppression, two emotion regulation strategies. RESULTS: Our mediational analyses suggest that believing emotions to be uncontrollable relates to high levels of suppression (ß = -.08), low levels of reappraisal (ß = .19) and poorer eating disorder psychopathology (ß = -.11). Reappraisal and suppression were found to partially mediate the relationship between emotional controllability and eating psychopathology. DISCUSSION: The current study has demonstrated relationships that support investigations relating emotional controllability, emotion regulation and psychological health. This research has potential implications for developing interventions to target beliefs about emotions in order to help improve emotion regulation skills and eating psychopathology.

Oxytocin increases emotional theory of mind, but only for low socioeconomic status individuals.

Studies have linked oxytocin to emotional theory of mind (eToM) - the ability to recognise and understand others' emotions. However, multiple replications have so far failed to reach a consistent result. Growing evidence suggests that oxytocin's positive effects on social-emotional tasks such as eToM are highly dependent on trait-level individual differences. In the present study, we theorised that socioeconomic status (SES) could influence oxytocin's impact on emotional mentalising processes. We tested our hypothesis in a double-blind between-subjects oxytocin nasal spray study on 147 Caucasian white male participants in the United Kingdom. In accordance with our hypothesis, we found that oxytocin (as compared to placebo) did boost emotional theory of mind, but only in people from low subjective SES backgrounds. Our results expand existing theory on how individual differences moderate oxytocin's role on social behaviours.

The role of oxytocin in the facial mimicry of affiliative vs. non-affiliative emotions.

The present paper builds upon a growing body of work documenting oxytocin's role in social functioning, to test whether this hormone facilitates spontaneous mimicry of others' emotional expressions. In a double-blind, randomized trial, adult Caucasian males (n = 145) received a nasal spray of either oxytocin or placebo before completing a facial mimicry task. Facial expressions were coded using automated face analysis. Oxytocin increased mimicry of facial features of sadness (lips and chin, but not areas around the eyes), an affiliative reaction that facilitates social bonding. Oxytocin also increased mimicry of happiness, but only for individuals who expressed low levels of happiness in response to neutral faces. Overall, participants did not reliably mimic expressions of fear and anger, echoing recent theoretical accounts of emotional mimicry as dependent on the social context. In sum, our findings suggest that oxytocin facilitates emotional mimicry in ways that are conducive to affiliation, pointing to a possible pathway through which oxytocin promotes social bonding.

Caring helps: Trait empathy is related to better coping strategies and differs in the poor versus the rich.

Coping has been extensively studied in health psychology; however, factors influencing the usage of different coping strategies have received limited attention. In five studies (N = 3702), we explored the relationship between trait empathy and coping strategies, and how subjective socioeconomic status (SES) moderates this relationship. In Studies 1-4, we found that people with higher level of empathic concern use more adaptive coping strategies, seek more social support, and use fewer maladaptive coping strategies. Moreover, higher trait empathy related to more adaptive coping strategies among the poor, and fewer maladaptive coping strategies among the rich. In Study 5, we tested the potential biological basis of the relationship between trait empathy and coping by examining the effect of the oxytocin receptor gene (OXTR) rs53576 polymorphism on coping. We found that individuals with the GG phenotype-who in previous research have been found to be more empathic-were more likely to seek social support than AG or AA individuals. Furthermore, in line with findings in Studies 1-4, amongst people with low SES, individuals with GG genotype used more adaptive coping strategies than AG or AA individuals. Our results highlight the selective role trait empathy plays in influencing coping strategy deployment, depending on the SES of individuals.

The Maturation of Interference Suppression and Response Inhibition: ERP Analysis of a Cued Go/Nogo Task.

Inhibitory control is a core function that allows us to resist interference from our surroundings and to stop an ongoing action. To date, it is not clear whether inhibitory control is a single process or whether it is composed of different processes. Further, whether these processes are separate or clustered in childhood is under debate. In this study, we investigated the existence and development of two hypothesized component processes of inhibitory control-interference suppression and response inhibition-using a single task and event related potential components. Twenty 8-year-old children and seventeen adults performed a spatially cued Go/Nogo task while their brain activity was recorded using electroencephalography. Mean N2 amplitudes confirmed the expected pattern for response inhibition with both the children and the adults showing more negative N2 for Nogo vs. Go trials. The interference suppression N2 effect was only present in adults and appeared as a more negative N2 in response to Go trials with a congruent cue than Go trials with an incongruent cue. Contrary to previous findings, there was no evidence that the interference suppression N2 effect was later occurring than the response inhibition N2 effect. Overall, response inhibition was present in both the children and the adults whereas interference suppression was only present in the adults. These results provide evidence of distinct maturational processes for both component processes of inhibitory control, with interference suppression probably continuing to develop into late childhood.

Social provocation modulates decision making and feedback processing: Examining the trajectory of development in adolescent participants.

Increasingly, research is turning to the ways in which social context impacts decision making and feedback processing in adolescents. The current study recorded electroencephalography to examine the trajectory of development across adolescence, with a focus on how social context impacts cognition and behaviour. To that end, younger (10-12 years) and older (14-16 years) adolescents played a modified Taylor Aggression Paradigm against two virtual opponents: a low-provoker and a high-provoker. During the task's decision phase (where participants select punishment for their opponent), we examined two event-related potentials: the N2 and the late positive potential (LPP). During the outcome phase (where participants experience win or loss feedback), we measured the feedback related negativity (FRN). Although N2 amplitudes did not vary with provocation, LPP amplitudes were enhanced under high provocation for the younger group, suggesting that emotional reactivity during the decision phase was heightened for early adolescents. During the outcome phase, the FRN was reduced following win outcomes under high provocation for both groups, suggesting that a highly provocative social opponent may influence the reward response. Collectively, the data argue that social context is an important factor modulating neural responses in adolescent behavioural and brain development.

Emotional processing, p50 sensory gating, and social functioning in bipolar disorder.

Emotional processing has been reported to effect sensory gating as measured by the event-related potential known as P50. Because both P50 and emotional processing are dysfunctional in bipolar disorder (BD), we sought to investigate the impact that concurrent emotional processing has on sensory gating in this psychiatric population. P50 was recorded using a paired-click paradigm. Peak-to-peak amplitudes for stimulus 1 (S1) and stimulus 2 (S2) were acquired during the presentation of disgust and neutral faces to young adults with BD (n = 19) and controls (n = 20). Social functioning and quality-of-life self-reported measures were also obtained. The BD group had significantly larger P50 amplitudes elicited by the S2-disgust response compared with controls, but no significant difference in overall P50 sensory gating was found between the groups. There were also no differences between groups in S1-disgust or in either of the neutral P50 amplitudes. The BD group showed significant associations between sensory gating to disgust and measures of social functioning. Importantly, BD showed impaired filtering of auditory information when paired with an emotionally salient image. Thus, it appears that patients with the greatest impairment in sensory gating also have the most difficulty engaging in social situations.

Modulation of haloperidol-induced patterns of the transcription factor Nur77 and Nor-1 expression by serotonergic and adrenergic drugs in the mouse brain.

Different patterns of expression of the transcription factors of Nur77 and Nor-1 are induced following acute administration of typical and atypical antipsychotic drugs. The pharmacological profile of atypical antipsychotics suggests that serotonergic and/or adrenergic receptors might contribute to these reported differences. In order to test this possibility, we examined the abilities of serotonin 5-HT(1A) and 5-HT(2A/2C), and α1- and α2-adrenergic receptor drugs to modify the pattern of Nur77 (NR4A1) and Nor-1 (NR4A3) mRNA expression induced by haloperidol. Various groups of mice were treated with either saline, DOI, a 5-HT(2A/2C) agonist, MDL11939, a 5-HT(2A) antagonist, 8-OH-DPAT, a 5-HT(1A) agonist, prazosin, an α1-adrenergic antagonist and idazoxan, an α2-adrenergic antagonist, alone or in combination with haloperidol. The 5-HT(2A/2C) agonist DOI alone significantly increased Nur77 expression in the medial striatum and nucleus accumbens. DOI reduced Nor-1 expression, while MDL11939 increased the expression of this transcript in the cortex. Prazosin reduced Nur77 expression in the dorsal striatum and nucleus accumbens. Interestingly, 8-OH-DPAT and MDL11939 partially prevented haloperidol-induced Nur77 up-regulation, while MDL11939 completely abolished Nor-1 expression in the striatum. In addition, MDL11939 decreased haloperidol-induced Nur77 and Nor-1 mRNA levels in the ventral tegmental area. On the contrary, idazoxan (α2 antagonist) consistently potentiated haloperidol-induced Nur77, but not Nor-1 mRNA levels in the striatum, whereas prazosin (α1 antagonist) remained without effect. Taken together, these results show the ability of a 5-HT(1A) agonist or a 5-HT(2A) antagonist to reduce haloperidol-induced Nur77 and Nor-1 striatal expression, suggesting that these serotonin receptor subtypes participate in the differential pattern of gene expression induced by typical and atypical antipsychotic drugs.