Construct validity of the Levels of Emotional Awareness Scale among women high in eating disorder symptoms: a cross-sectional study.

PURPOSE: The Levels of Emotional Awareness Scale (LEAS), a measure of the ability to identify and describe one's own and others' emotions, may complement work with women with disordered eating symptoms. The study purpose was to (a) examine differences in hand (LEAS) versus computerized (e-LEAS) scoring methods and (b) examine the e-LEAS' psychometric properties, including convergent and discriminant validity, among women endorsing eating disorder symptoms. METHODS: Forty women (ages 18-21) scoring high on a self-report measure of disordered eating symptoms completed the LEAS and measures of convergent validity including a self-report measure of alexithymia (the perceived ability to identify and describe one's own emotions) and a measure of facial affect recognition as well as discriminant validity, including affect and facial memory. Inter-rater reliability was assessed via a two-way mixed effects model and correlations between the LEAS and the study constructs were examined. RESULTS: Computerized scoring (e-LEAS) offered benefits over hand scoring and correlations between LEAS and e-LEAS were statistically significant. Better total emotional awareness scores on the e-LEAS were significantly associated with more perceived difficulty identifying and describing emotions. Better total emotional awareness scores were also significantly associated with better facial memory and greater depression scores. The e-LEAS showed weak associations with facial affect recognition. CONCLUSION: The e-LEAS offers practical advantages over the LEAS in the assessment of emotional awareness among women endorsing eating disorder symptoms. Results suggest that the e-LEAS measures the ability to describe emotional experiences in oneself and others, but not facial affect recognition. LEVEL OF EVIDENCE: Level V: Evidence obtained from a cross-sectional descriptive study.

Professional Decision-Making in Research (PDR): The Validity of a New Measure.

In this paper, we report on the development and validity of the Professional Decision-Making in Research (PDR) measure, a vignette-based test that examines decision-making strategies used by investigators when confronted with challenging situations in the context of empirical research. The PDR was administered online with a battery of validity measures to a group of NIH-funded researchers and research trainees who were diverse in terms of age, years of experience, types of research, and race. The PDR demonstrated adequate reliability (alpha = .84) and parallel form correlation (r = .70). As hypothesized, the PDR was significantly negatively correlated with narcissism, cynicism, moral disengagement, and compliance disengagement; it was not correlated with socially desirable responding. In regression analysis, the strongest predictors of higher PDR scores were low compliance disengagement, speaking English as a native language, conducting clinical research with human subjects, and low levels of narcissism. Given that the PDR was written at an eighth grade reading level to be suitable for use with English as a second language participants and that only one-fourth of items focused on clinical research, further research into the possible roles of culture and research ethics training across specialties is warranted. This initial validity study demonstrates the potential usefulness of the PDR as an educational outcome assessment measure and a research instrument for studies on professionalism and integrity in research.

Education, progressive muscle relaxation therapy, and exercise for the treatment of night eating syndrome. A pilot study.

Night eating syndrome (NES) is a circadian rhythm disorder in which food intake is shifted toward the end of the day, interfering with sleep. According to the biobehavioral model of NES, the disorder is the result of a genetic predisposition that, coupled with stress, leads to enhanced reuptake of serotonin, thereby dysregulating circadian rhythms and decreasing satiety. Using the biobehavioral model as a guide, we developed a brief behavioral intervention using education, relaxation strategies, and exercise to address the core symptoms of NES. In this pilot randomized controlled clinical trial, 44 participants with NES were randomly assigned to an educational group (E; n = 14), E plus progressive muscle relaxation therapy (PMR; n = 15); or PMR plus exercise (PMR Plus, n = 15). Participants received a baseline intervention with 1- and 3-week follow-up sessions. Effectiveness analyses showed that participants in all three groups evidenced significant reductions on measures of NES symptoms (p < .001), depression (p < .05), anxiety (p < .01), and perceived stress (p < .05). However, the only significant between group change was for the percent of food eaten after the evening meal, with the PMR group showing the greatest reduction (-30.54%), followed by the PMR Plus group (-20.42%) and the E group (-9.5%); only the difference between the PMR and E groups was statistically significant (p = .012). Reductions in NES scores were significantly associated with reductions on measures of depression (r = .47; p < .01) and perceived stress (r = .37; p < .05), but not anxiety (r = .26, p = ns). Results support the role of education and relaxation in the behavioral treatment of NES.

Food-related advertisements and food intake among adult men and women.

Television viewing may contribute to obesity via promotion of sedentary behavior and exposure to food-related commercials. However, the mechanisms by which food-related commercials promote food intake are not well understood. Therefore, the purpose of the present study was to examine the impact of television advertisements on food intake according to sex and transportability, or the tendency to become engrossed in what one is viewing. Eighty-three undergraduate students, free of disordered eating symptoms, were stratified by sex and randomly assigned to one of three conditions (food-related advertisements, neutral advertisements, or no advertisements). They were then identified as high or low in transportability according to a median split. A significant interaction was found between advertisement condition and transportability such that those high in transportability ate more in the food than other advertisement conditions. A second interaction was found between sex and transportability with women high in transportability eating more food than women low in transportability irrespective of advertisement condition. No significant main effects of advertisement condition, sex, or transportability were found. Results suggest the importance of studying the impact of individual difference variables on the relationship between food-related advertising and food intake.

Escitalopram for treatment of night eating syndrome: a 12-week, randomized, placebo-controlled trial.

The primary objective of this study was to examine the short-term effects of escitalopram on symptoms of night eating syndrome (NES) in a randomized controlled clinical trial. A total of 40 patients with NES were randomly assigned to double-blind treatment with escitalopram 20 mg (n = 20) or placebo (n = 20) for 12 weeks. Escitalopram was started at 10 mg/d with a dosage increase to 20 mg/d after 4 weeks; placebo dosing was identical. The primary end point was a mean change in total score of the Night Eating Questionnaire (NEQ). At 12 weeks, mean (SE) change in NEQ total score was -13.0 (1.6) and -10.6 (2.2) in the escitalopram and placebo groups, respectively (F(1,37) = 2.5, P = 0.124). There was a marginal interaction effect between response to escitalopram and race (F(1,34) = 4.0, P = 0.052), with a favorable effect for white patients (F(1,20) = 6.0, P = 0.024) but not for black patients (F(1,13) = 0.6, P = 0.453). Seven patients in the escitalopram group, compared with 6 patients in the placebo group, showed a 50% NEQ score reduction (P = 0.736). Sixteen patients in the escitalopram group and 12 patients in the placebo group no longer met NES criteria (P = 0.168). Twelve patients in the escitalopram group were classified as responders according to the Clinical Global Impression Improvement scale compared with 7 patients in the placebo group (P = 0.113). No significant between-group differences were found for weight, mood ratings, or adverse events. We conclude that escitalopram treatment for 12 weeks was not superior to placebo in reducing NES symptoms as measured by the NEQ.

Measurement invariance and psychometric properties of three positive body image measures among cisgender sexual minority and heterosexual women.

Positive body image is a multidimensional construct consisting of various facets including body appreciation, body image flexibility, and functionality appreciation measured via the Body Appreciation Scale-2 (BAS-2), Body Image-Acceptance and Action Questionnaire-5 (BI-AAQ-5), and Functionality Appreciation Scale (FAS), respectively. Research has supported the unidimensional factor structure of these measures; however, invariance testing based on sexual identity has yet to be conducted. The study's primary aim was to assess the measurement invariance of the BAS-2, BI-AAQ-5, and FAS between sexual minority and heterosexual women. The secondary aim was to assess the psychometric properties of each positive body image measure among each sample. Participants were predominantly White, cisgender women who identified as a sexual minority (n = 310) or heterosexual (n = 360) and completed online questionnaires of positive body image, eating behaviors, and mental and physical health. Results supported invariance with no differences in BAS-2 or BI-AAQ-5 scores. A significant difference with a small effect size was found in FAS scores, with sexual minority women reporting lower FAS scores. Findings supported the BI-AAQ-5 and FAS's incremental validity on perceived mental health. Overall, results suggest that the BAS-2, BI-AAQ-5, and FAS scores can be compared among women of varying sexual identities.

Failure to confirm the factor structure of the CEBRACS: An assessment of food and alcohol disturbance.

Objectives: Food and Alcohol Disturbance (FAD) is the phenomenon in which individuals exhibit co-occurring hazardous alcohol and eating behaviors to either negate caloric intake associated with alcohol and/or maximize intoxication. While the Compensatory Eating and Behaviors in Response to Alcohol Scale (CEBRACS) is the most widely used measure to assess FAD to date, its factor-structure has yet to be confirmed. Methods: The current study utilized confirmatory factor analysis (CFA) to examine the CEBRACS' four factor subscales as well as recently proposed alternative scoring structures. Participants: Participants (N = 582) were American college students from seven universities (18-24 years; 67% cisgender women; 70% non-Hispanic White). Results: The CFA failed to provide optimal fit for all models tested. Results of invariance testing found no measurement variance by sex, suggesting the failure of the four-factor solution was not due to noninvariance. Conclusions: Overall, findings do not support continued use of the original 21-item CEBRACS.

A survey of psychological assessment on interdisciplinary craniofacial teams.

OBJECTIVE: To explore the role of mental health professionals on craniofacial teams and determine how craniofacial teams assess for psychological concerns in their patient populations. DESIGN: Online and paper surveys. PARTICIPANTS: A total of 55 craniofacial team coordinators and 40 mental health professionals who are team members participated in this study. RESULTS: Results indicated that teams in 2007 generally viewed psychological services on their teams similarly to teams assessed in 1987. Most teams do not use formal measures in their assessment of psychological concerns, and they provide feedback via discussions with the families. Mental health professionals assess a wide variety of potential areas of concern and are generally satisfied with the referral sources available to their patients. CONCLUSIONS: Craniofacial teams appear to practice in a manner consistent with professional standards, and these teams seem to value the inclusion of mental health professionals as part of the interdisciplinary team. Implications and limitations including response rate are discussed.

Weight bias reduction among first-year medical students: A quasi-randomized, controlled trial.

Implicit and explicit weight bias is prevalent among healthcare professionals and results in negative outcomes, including weak physician-patient rapport, low patient trust in physicians, and avoidance of healthcare. This study aimed to decrease weight bias in medical students via a one-session, curriculum-based intervention founded on the elaboration likelihood model (ELM). First-year medical students (N = 101) were quasi-randomly assigned to a group-based experimental or education-based control intervention. Data collected included measures of implicit and explicit weight bias and empathy (pre-intervention and up to 2 days post-intervention), and thoughts regarding weight bias (collected at the end of the intervention). Social desirability was identified as an important covariate. After controlling for social desirability, the intervention group showed no greater reduction in multi-item explicit bias rating scales or a computerized implicit bias task than the control group. Both groups showed less discomfort when near individuals with obesity (p < 0.01). The intervention group wrote a greater number of statements about weight bias and obesity (p < 0.05) and a greater number of statements about the harms of weight bias (p < 0.001) than the control group on a thought-listing task. Results highlight use of the ELM and the importance of controlling for social desirability in weight bias interventions. A thought-listing task captured unique intervention effects, highlighting potential gaps in the assessment of weight bias.

Factor structure and psychometric properties of the clinical impairment assessment 3.0 (CIA) in a clinical eating disorder sample.

PURPOSE: The aim of this study was to investigate the psychometric properties and the factor structure of the Clinical Impairment Assessment 3.0 (CIA) utilizing a confirmatory factor analysis in a large clinical sample of ED patients. METHODS: A total of 260 patients between the ages of 18 and 45 who completed assessments in a partial hospitalization or residential treatment program at an ED treatment facility between December 2012 and December 2016 were included in the analyses. Assessment measures included the CIA, EDE-Q, BDI-II, WHODAS, and a demographic questionnaire. RESULTS: Results favored a bifactor model with a strong general factor and three unreliable subfactors. The CIA showed strong construct validity with other measures of ED pathology (EDE-Q) and health-related QoL (WHODAS). Furthermore, admission CIA scores were predictive of treatment outcomes. CONCLUSIONS: The CIA assesses general psychosocial impairment, supporting the use of a total, but not subscale scores, among symptomatic ED samples in the United States.

Neuropsychological predictors of health and safety abilities in dementia.

The Independent Living Scales Health and Safety (ILS HS) scale is commonly used by neuropsychologists when evaluating older adults' instrumental activities of daily living (IADLs). However, there is a minimal amount of research on its use in dementia populations and, specifically, its relationship to other neuropsychological measures. The present study investigated relationships between the ILS HS scale and measures of cognition and depression. The study utilized archival data from a sample (N = 142) of older adults (mean age = 77.85) diagnosed with dementia, who were evaluated at Saint Louis University Medical Center and administered the ILS HS scale as part of a larger clinical neuropsychological evaluation. Multiple regression analyses demonstrated that up to 37% of the variance in ILS HS performance was accounted for by demographic variables, premorbid intelligence, and cognitive functioning (e.g., global cognition, delayed verbal recall, and executive functioning), and regression models demonstrated medium to large effect sizes. Depression and self- or informant-reported IADLs were unrelated to the ILS HS scale. Results suggest that older adults' ability to function in health and safety-related situations requires a range of cognitive abilities. Performance on these measures may help guide clinical decision making regarding independent living and treatment planning.

The role of body image dissatisfaction and depression on HAART adherence in HIV positive men: tests of mediation models.

The current study examined the role of body image dissatisfaction and depression on HAART adherence in a sample of HIV positive men. Participants were 124 HIV positive gay and bisexual men, who responded to an online survey. Results from moderated mediation models revealed that depression mediated the relationship between body dissatisfaction and HAART non-adherence for men who possessed elevated levels of body dissatisfaction, but not for those men who reported moderate or low levels. Additionally, depression was found to mediate the relationship between body dissatisfaction and HAART non-adherence for men with a self-reported AIDS diagnosis. Results suggest the importance of addressing both body dissatisfaction and depression in men who are living with HIV/AIDS.

Examining health-related quality of life, adaptive skills, and psychological functioning in children and adolescents with epilepsy presenting for a neuropsychological evaluation.

The purpose of this study was to characterize 132 children and adolescents (mean age = 10 years, 11 months) with epilepsy in terms of psychosocial functioning and to determine the extent to which adaptive skills and psychological functioning predict health-related quality of life (HRQOL), above and beyond demographic and epilepsy-specific characteristics. A chart review was conducted to obtain demographic and epilepsy-specific information as well as caregiver responses on the Behavior Assessment System for Children, Second Edition (BASC-2) Parent Report and the Quality of Life in Childhood Epilepsy Questionnaire (QOLCE). In addition to Full Scale IQ and age at seizure onset, the BASC-2 Clinical and Adaptive Skills subscales also predicted HRQOL, indicating that this measure may be particularly helpful in predicting HRQOL above and beyond information routinely collected in a medical setting. It is imperative to evaluate children with epilepsy for psychosocial difficulties and diminished HRQOL to ensure the provision of comprehensive quality care and intervention services.

Differences in alexithymia, emotional awareness, and facial emotion recognition under conditions of self-focused attention among women with high and low eating disorder symptoms: a 2 x 2 experimental study.

BACKGROUND: Women with eating disorders generally perform more poorly on measures of alexithymia, defined as difficulty identifying and describing emotions, and theory of mind, or the ability to infer what others are thinking and feeling. The extent to which these abilities may be influenced by variables such as self-focused attention, or directing attention toward internally generated information, has yet to be investigated. Thus, the purpose of the present study was to examine differences between women high and low in disordered eating symptoms on measures of emotional awareness and facial affect recognition under conditions of high and low self-focused attention. METHODS: University women scoring high or low on a measure of disordered eating (n = 79) were randomly assigned to a condition of high or low self-focused attention. Outcomes included alexithymia (self-rated ability to identify and describe emotions), emotional awareness (ability to describe the emotions of oneself and others), and facial affect recognition. Scores on a measure of negative affect were statistically controlled. RESULTS: Women with high disordered eating symptom scores rated themselves as having more difficulties identifying, but not describing emotions after controlling for negative affect, but demonstrated greater difficulties describing their own and others' emotions on a measure of emotional awareness. In the self-focused attention condition, women scored lower on self emotional awareness and were quicker to identify expressions of negative facial affect regardless of eating disorder symptom status than women in the non-self-focused attention condition. There were no significant interactions between eating disorder status and self-focused attention. CONCLUSIONS: Further examination of different types of emotion recognition and description in oneself and others as well as processes that may influence these abilities is warranted.

The relationship between religion and religious coping: religious coping as a moderator between religion and adjustment.

This study examined the relationship between and among religion, religious coping, and positive/negative psychological adjustment and investigated whether the four religious coping styles of Self-Directing, Deferring, Collaborative, and Turning to Religion would significantly moderate the relationship between religion and psychological adjustment. Each of the four religious coping measures were significant moderators between religion and positive and negative adjustment. However, the high self-directing and high religion group showed opposite results from the other three coping styles, in that they were the most maladjusted and least satisfied with life compared to the other three integration and religious coping groups. The participants high on religion and high deferring, high collaborative, and high turning to religion groups were less maladjusted and more satisfied than the other three groups in each of these religious coping styles.

Validation of the Body Appreciation Scale-2 and relationships to eating behaviors and health among sexual minorities.

Although the study of positive body image continues to expand, researchers have predominantly focused the study of this newer construct among presumed heterosexual participants. The purpose of the present study was to examine the factor structure of a measure of positive body image, the Body Appreciation Scale-2 (BAS-2), among sexual minority participants. The present study also sought to psychometrically validate the BAS-2 among sexual minorities by assessing its relationship with other facets of positive body image, including functionality appreciation and body image flexibility, as well as other related constructs, such as body dissatisfaction, disordered eating behaviors, intuitive eating behaviors, and physical and mental health. Results from a confirmatory factor analysis of 223 sexual minority adults (Mage = 32.45, SD = 10.07) indicated that the BAS-2 displayed strong factorial validity with a unitary factor structure. Furthermore, the BAS-2's construct validity was supported based on correlations with other measures of positive body image, body dissatisfaction, and disordered eating behavior. Results from this cross-sectional study supported a relationship between body appreciation and intuitive eating behaviors, as well as physical and mental health among sexual minority participants. These findings provide an initial understanding of body appreciation and other related constructs among sexual minority individuals.

The sociocultural model of eating disorder development: application to a Guatemalan sample.

Exposure to Western ideals of appearance along with rapid societal change appears to be salient risk factors for eating disorder development. According to the sociocultural model, internalization of the thin ideal leads to body dissatisfaction and subsequent negative affect and dieting behaviors which increase the risk for eating disorder development. An expanded version of the sociocultural model was examined among an economically stratified sample of 347 girls in grades 5 and 6 from Guatemala City. Questionnaires used to measure disturbed eating attitudes and behaviors, body dissatisfaction, social sensitivity, and internalization of the thin ideal were administered and BMI was calculated following measurement of height and weight. Path analyses showed that the expanded sociocultural model was an excellent fit to the data. Both elevated adiposity and social sensitivity led to increased body dissatisfaction and thin ideal internalization. Thin ideal internalization led to body dissatisfaction and to disturbed eating attitudes and behaviors. Results suggest that developing countries are not immune to the influence of sociocultural risk factors for eating disorders.

Effect of impaired cognition on hypertension outcomes in older urban African Americans.

The Fuld Object Memory Evaluation and MacNeill Lichtenberg Decision Tree are useful screening tools to detect cognitive impairments that may be associated with difficulty in hypertension-related self-care and blood pressure outcomes. The results of a pilot study exploring the effect of cognition on hypertension-related self-care and blood pressure outcomes among African-American elders are described.

RBANS factor structure in older adults with suspected cognitive impairment: Evidence for a 5-factor structure.

Previous research has yielded minimal empirical support for the theoretically formulated five-factor structure of the RBANS, a brief, yet comprehensive standardized neuropsychological test battery used to assess cognitive impairment. The present study tested the theoretically formulated five-factor structure, as well as three alternative factor solutions, using a combination of exploratory and confirmatory factor analytic approaches. The present study utilized archival data from a clinical sample of 150 older adults who were evaluated at an outpatient neuropsychological service. A total of four RBANS models were specified using confirmatory factor analysis. Results of the five-factor model demonstrated good to excellent fit following modifications to the model. Results of chi-square difference tests demonstrated that the five-factor model was statistically superior to the two- and three-factor models (p < .001). In summary, results provide support for the theoretically derived five-factor structure of the RBANS in a clinical sample of older adults. Cautious interpretation of the RBANS index scores as five distinct cognitive domains may be warranted, particularly when there is minimal discrepancy across performance on the tests that comprise each index.