Elsevier

Journal of Psychiatric Research

Volume 82, November 2016, Pages 119-125
Journal of Psychiatric Research

Effects of emotional acceptance and rumination on media-induced body dissatisfaction in anorexia and bulimia nervosa

https://doi.org/10.1016/j.jpsychires.2016.07.021Get rights and content

Abstract

Introduction

Body dissatisfaction is an important risk and maintaining factor for eating disorders. The aim of the present study was to experimentally test the effects of two emotion regulation strategies - acceptance and rumination - on media-induced body dissatisfaction in eating disorders.

Method

After watching pictures of thin models, women with anorexia nervosa (AN; n = 39) and bulimia nervosa (BN; n = 39) were encouraged to either use emotional acceptance or rumination to cope with their feelings. Body dissatisfaction and mood were repeatedly assessed.

Results

Acceptance significantly improved body dissatisfaction in women with BN. Rumination led to a significant increase of body dissatisfaction in both eating disorder groups. Results were independent from mood changes.

Discussion

Findings highlight the importance ruminative thinking may have in the aggravation of dissatisfaction with the own body in AN and BN. Results suggest that emotional acceptance is a useful strategy to regulate body dissatisfaction after exposure to thin-ideal media in BN.

Introduction

Beyond being a main diagnostic feature of anorexia nervosa (AN) and bulimia nervosa (BN), severe body image disturbances have been shown to play a decisive role in the onset and maintenance of eating disorders (ED; for a review see Stice and Shaw, 2002). Previous research also points to the positive association between a negative body image at the end of treatment and relapse rates in ED (Freeman et al., 1985, Keel et al., 2005). Thus, it is crucial to conduct research on factors that influence body image in ED as this may hold implications for the improvement of current prevention and treatment programs.

Results from an experimental study by Wade et al. (2009) provide compelling evidence that body dissatisfaction – defined as the affective component of body image disturbances – can be modulated by certain emotion regulation (ER) strategies. In this study, female college students were allocated to different ER techniques following a body dissatisfaction induction by the exposure to media images of thin women. Findings suggest that emotional acceptance is the most effective strategy to cope with media-induced appearance dissatisfaction, while emotional rumination has an attenuated effect on the recovery of body satisfaction.

To this date, only two studies experimentally assessed effects of ER on body image disturbance in patients with AN. In one study, women with AN reported significantly lower estimations of weight following an imaginary meal task when they were encouraged to engage in an experiential-mindful compared to an analytical-ruminative self-focus (Rawal et al., 2011). In another experimental approach (Cowdrey et al., 2013), females with AN were asked to listen to a mindfully breathing, rumination or distraction CD-guided exercise before their evening meal. In this study, no differences between the ER conditions were found regarding feelings of fatness after meal time. However, eating the meal might have blurred possible effects of ER on feelings of fatness. Notably, a substantial number of participants in these two studies (Cowdrey et al., 2013, Rawal et al., 2011) were partially remitted, and both studies focused on different body image aspects, with no information on body dissatisfaction.

Taken together, the mentioned experimental data suggest that ER strategies – in particular emotional acceptance and rumination – have an influence on the experience of body image problems. However, it must be stressed that these studies were either conducted in non-ED samples or partially recovered AN patients. Therefore, we do not know if these results are transferable to the severe body dissatisfaction found in full-syndrome ED.

In light of this, the goal of the present study was to examine the effects of emotional acceptance and rumination on body dissatisfaction in patients with AN and BN. In line with former studies (Svaldi and Naumann, 2014, Wade et al., 2009), participants were at first exposed to media images of thin models serving as a body-related stressor. Thereafter, participants were randomly allocated to either use acceptance or rumination to cope with their feelings. Participants repeatedly rated their current body dissatisfaction. General mood was additionally measured, because it is closely associated with body dissatisfaction (Paxton et al., 2006, Stice and Shaw, 2002), and because it can be affected by acceptance and rumination (Broderick, 2005, Singer and Dobson, 2009). It was predicted that acceptance would improve and rumination worsen media-induced body dissatisfaction and negative mood in patients with ED. Given the scant literature focusing on differences in effects of induced acceptance and rumination across ED diagnoses, no specific hypotheses for AN and BN were made. ED groups were analyzed separately for exploratory reasons.

Section snippets

Participants

The study sample consisted of women with AN (n = 39) and BN (n = 39). The main recruitment source for the AN (n = 31) and BN (n = 25) group was an ED inpatient clinic. The other participants were recruited through advertisements in local newspapers. Differences in recruitment style between the two ED groups or ER conditions did not reach significance, χ2(1, N = 78) < 2.37, p < 0.131. In order to avoid potential confounding treatment effects, ED inpatients were only included if they were newly

Induction of body dissatisfaction

A Group (AN, BN) × Condition (acceptance, rumination) × Time (T0, T1) repeated measures ANCOVA conducted on state body dissatisfaction yielded a significant main effect of Time, F(1, 72) = 15.05, p < 0.001, ηp2 = 0.173, with significantly higher scores after the media image exposure than at baseline. No other main effect or interaction reached significance, F(1, 72) < 0.69, p > 0.793, ηp2 < 0.001. A Group × Condition × Time repeated measures ANCOVA conducted on mood yielded no significant

Discussion

As predicted, we found that the application of emotional acceptance significantly improved body dissatisfaction in response to thin-ideal media images in women with BN. Therefore, extending previous data in non-ED samples (Dijkstra and Barelds, 2011, Wade et al., 2009, Wood-Barcalow et al., 2010), our finding suggests that the mindful processing of emotions is a useful and effective strategy to cope with body dissatisfaction in BN.

In contrast to our hypothesis, we found that the usage of

Contributors

All authors have approved the final article. Eva Naumann developed the study design, was responsible for collection, analysis and interpretation of data, and wrote the paper. Brunna Tuschen-Caffier, Ulrich Voderholzer and Jennifer Svaldi contributed substantially to the study design and intellectual content of the paper. Johanna Schäfer contributed substantially to the data analysis.

Role of the funding source

We received a grant (2000 Euro) from the Scientific Society of Freiburg, which enabled us to pay participants a small honorarium. The corresponding authors received a state-funded doctoral scholarships from the International Graduate Academy Freiburg. The funding sources had no involvement in study design, in the collection, analysis and interpretation of data, in the writing of the report, and in the decision to submit the article for publication.

Acknowledgements

We want to thank the Scientific Society of Freiburg for their generous grant, which enabled us to pay participants a small honorarium. We gratefully acknowledge the excellent support of the master students who have been involved in this research and the staff of the Schoen Clinic Roseneck in Germany. We thank all the participants for their commitment and dedication.

References (49)

  • A.R. Singer et al.

    An experimental investigation of the cognitive vulnerability to depression

    Behav. Res. Ther.

    (2007)
  • E. Stice et al.

    Role of body dissatisfaction in the onset and maintenance of eating pathology: a synthesis of research findings

    J. Psychosom. Res.

    (2002)
  • J.K. Thompson

    The (mis)measurement of body image: ten strategies to improve assessment for applied and research purposes

    Body Image

    (2004)
  • G.J.P. Van Breukelen

    ANCOVA versus change from baseline had more power in randomized studies and more bias in nonrandomized studies

    J. Clin. Epidemiol.

    (2006)
  • N.L. Wood-Barcalow et al.

    “But I like my body”: positive body image characteristics and a holistic model for young-adult women

    Body Image

    (2010)
  • A. Wyssen et al.

    Thought-shape fusion in young healthy females appears after vivid imagination of thin ideals

    J. Behav. Ther. Exp. Psy.

    (2016)
  • M.J. Atkinson et al.

    Impact of metacognitive acceptance on body dissatisfaction and negative affect: engagement and efficacy

    J. Consult. Clin. Psych.

    (2012)
  • M.J. Atkinson et al.

    Mindfulness-based prevention for eating disorders: a school-based cluster randomized controlled study

    Int. J. Eat. Disord.

    (2015)
  • P.C. Broderick

    Mindfulness and coping with dysphoric mood: contrasts with rumination and distraction

    Cogn. Ther. Res.

    (2005)
  • T.F. Cash et al.

    Beyond body image as a trait: the development and validation of the body image states scale

    Eat. Disord.

    (2002)
  • J. Cohen

    Statistical Power Analysis for the Behavioural Sciences

    (1988)
  • F.A. Cowdrey et al.

    Rumination and modes of processing around meal times in women with anorexia nervosa: qualitative and quantitative results from a pilot study

    Eur. Eat. Disord. Rev.

    (2013)
  • S. Grabe et al.

    The role of the media in body image concerns among women: a meta-analysis of experimental and correlational studies

    Psychol. Bull.

    (2008)
  • M. Hautzinger et al.

    Beck Depressions-inventar (BDI-II)

    (2006)
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