Stress-Induced Binge Eating: A Behavior Analytic Approach to Assessment and Intervention

Responses to acute or chronic stress may include behaviors, such as alcohol consumption, cigarette smoking, and altered eating patterns. In connection with the stress-eating relation, some researchers have suggested that certain stressors (e.g., psychological or emotional) may influence the direction (i.e., increase or decrease) of a person’s eating response. In a recent study, Connors and Morse (Int J Eat Disord 13:1–11, 2006) indicated that the physical and psychological stress associated with sexual trauma could result in an increase in food intake and nonstandard eating patterns. In consequence, this study describes a multifaceted intervention for a 24-year-old woman who experienced chronic stress and received a diagnosis of Binge Eating Disorder (American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders. DSM-IV. Washington, DC: APA) following a series of unwanted sexual experiences. The behavior analytic intervention emphasized self-control, self-regulation, and physical activity. The treatment package resulted in a 19% reduction in the participant’s body weight, a 96% reduction in binge eating, and long-term adherence to an exercise routine.     

Is dispositional optimism or dispositional pessimism predictive of ideal cardiovascular health? The Young Finns Study

Objective: We examined the independent association between dispositional optimism compared to dispositional pessimism and ideal cardiovascular health (defined by the American Heart Association).

Design: A prospective design with a study sample of 1113 participants aged 24–39 years from the longitudinal Young Finns Study.

Main outcome measures: Ideal cardiovascular health (comprised of seven ideal cardiovascular health metrics) was measured in 2001. The ideal cardiovascular health metrics were reassessed in 2007.

Results: Low pessimism rather than high optimism was a better predictor of ideal cardiovascular health in 2007. When examining the association between optimism and pessimism and the seven ideal cardiovascular health metrics in 2007 (BMI, diet, physical activity, smoking status, blood pressure, total cholesterol and plasma glucose), low pessimism predicted non-smoking status, ideal physical activity and eating a healthy diet, while high optimism was associated with eating a healthy diet.

Conclusion: Our findings suggest that low pessimism rather than high optimism is associated with ideal cardiovascular health, especially with health behaviours such as not smoking, being physically active and eating a healthy diet. Socio-economic status was the potential mediating or confounding factor. Future studies should examine the differential meaning of the optimism/pessimism concepts to further clarify their relation to health outcomes.     

Leisure time physical activity motives and smoking in adolescence

ObjectivesThe study aimed to gain a better understanding of the relationship between leisure time physical activity and smoking in adolescence by investigating adolescents' motives for participation in leisure time physical activity.MethodsThe study involved cross-sectional and longitudinal data from a postal survey involving 16–22-year old Danes. The hypothesized associations were examined using hierarchical logistic regression analyses.ResultsAn inverse association between participating in leisure time physical activity and smoking was found. Participation in leisure time physical activity for friendship or competition reasons were conditions that strengthened the inverse association between physical activity and smoking in males. In contrast, participation for the reason of losing weight or gaining self-esteem appeared to weaken the inverse association among females. In addition, the motives enjoyment, health and, in females, friendships and stress relief were associated with less smoking irrespective of participation level, while the motives self-esteem, losing weight and, in males, friendships were unrelated or even positively related to smoking.ConclusionsThe association between adolescents' leisure time physical activity and smoking behavior differs with the underlying motivation for the activity.     

Depressive symptoms, social support, and personal health behaviors in young men and women.

This study investigated the relationship of depressive symptoms, social support, and a range of personal health behaviors in 2,091 male and 3,438 female university students from 16 countries. Depressive symptoms and social support were measured using the short Beck Depression Inventory and the Social Support Questionnaire; 9 personal health behaviors were also assessed. After the authors took age, social support, and clustering by country into account, depressive symptoms were significantly associated with lack of physical activity, not eating breakfast, irregular sleep hours, and not using a seat belt in both men and women, and additionally with smoking, not eating fruit, and not using sunscreen among women. Low social support was independently associated with low alcohol consumption, lack of physical activity, irregular sleep hours, and not using a seat belt in men and women. Bidirectional causal pathways are likely to link health behaviors with depressed mood.     

Stages of change for health-related behaviours in 18 year-old Australians

Abstract This study investigated the validity of a Stages of Change algorithm with respect to independent measures of physical activity and fitness. dietary intake and alcohol consumption in 18 year-old Ausmlian men (n = 301) and women (n = 282). Stage of Change categories were related to fat and fibre intakes in men and fibre intake in women as well as hit and vegetable intakes in men and women. Physical activity and fitness for men and women also showed significant linear associations with Stage of Change categories. Alcohol consumption was significantly associated with Stage of Change categories for men but not for women although recorded alcohol consumption was very variable for women. However, the algorithm was valid for both men and women when drinking alcohol consistent with national guidelines on safe drinking was used. In summary, with reference to actual health behaviours, the Stages of Change algorithm was valid for young men and women for diet. physical activity and alcohol drinking. Independent behavioural data were not available for smoking behaviours. Using the algorithm, there were significant associations in men between prccontemplation status for diet and drinking and diet and physical activity, in women between diet and smoking and in both men and women between drinking and smoking. Covariance between precontemplation status for different health behaviours therefore suggests the need for multimodal interventions.     

The association between dispositional self-control and longitudinal changes in eating behaviors,diet quality,and BMI

In a random sample from the general population (N = 2781, 46% males), a longitudinal survey was conducted. The association between dispositional self-control and changes in eating behaviours and diet quality was analysed between the first wave (2010) and the last wave (2014). Results show that the higher the dispositional self-control, the lower the increase in overeating behaviours (emotional eating, external eating, ambivalence towards palatable food and overeating), and BMI and the larger the improvement in healthy diet over time. Self-control was not associated with changes in dietary restraint. This is one of the first studies suggesting that dispositional self-control is associated with changes in eating behaviours and healthy food intake over time.     

Destroying God’s Temple? Physical Inactivity,Poor Diet,Obesity, and Other “Sin” Behaviors

On average, our participants (N = 112), who self-proclaimed to be Christians, believed that physically inactive lifestyles, unhealthy eating, overeating, and being obese destroy the body, God’s temple. However, these beliefs were less definitive, than those of other common “sin” behaviors, such as drug use, smoking, and excessive drinking of alcohol. In addition, destroying the body with physical inactivity or poor diet was not necessarily viewed as sinful. Subsequently, these beliefs did not relate to self-reported physical activity, dietary behavior, or body mass index. It is possible that inactivity, poor dietary habits, and obesity are not internalized into the spiritual perspective as destroying the body, God’s temple, in the same way as other “sin” behaviors.

     

The Partners for Life Program: A Couples Approach to Cardiac Risk Reduction

Morbidity and mortality are reliably lower for the married compared with the unmarried across a variety of illnesses. What is less well understood is how a couple uses their relationship for recommended lifestyle changes associated with decreased risk for illness. Partners for Life compared a patient and partner approach to behavior change with a patient only approach on such factors as exercise, nutrition, and medication adherence. Ninety‐three patients and their spouses/partners consented to participate (26% of those eligible) and were randomized into either the individual or couples condition. However, only 80 couples, distributed across conditions, contributed data to the analyses, due to missing data and missing data points. For exercise, there was a significant effect of couples treatment on the increase in activity and a significant effect of couples treatment on the acceleration of treatment over time. In addition, there was an interaction between marital satisfaction and treatment condition such that patients who reported higher levels of marital distress in the individuals condition did not maintain their physical activity gains by the end of treatment, while both distressed and nondistressed patients in the couples treatment exhibited accelerating gains throughout treatment. In terms of medication adherence, patients in the couples treatment exhibited virtually no change in medication adherence over time, while patients in the individuals treatment showed a 9% relative decrease across time. There were no condition or time effects for nutritional outcomes. Finally, there was an interaction between baseline marital satisfaction and treatment condition such that patients in the individuals condition who reported lower levels of initial marital satisfaction showed deterioration in marital satisfaction, while non satisfied patients in the couples treatment showed improvement over time.     

Situation Taxonomy and Behavioral Diagnosis Using Prospective Self-Monitoring Data: Application to Dietary Adherence in Patients with Type 1 Diabetes

The goals of this study were to create a taxonomy of problem situations for diet adherence in persons with insulin-dependent diabetes mellitus (Type 1 diabetes) and a behavioral diagnosis by grouping patients together who have similar adherence problems. In study one, 29 patients with Type 1 diabetes kept food diaries for 4 weeks. Adherence was assessed using eight behavioral measures: (1) compliance with a meal plan, (2) energy intake, (3) protein, (4) carbohydrates, (5) fat, (6) self-reported overeating, (7) self-reported undereating, and (8) ratings of impulsive eating. The occurrence of each behavior was quantified in a wide range of situational contexts including meal, social context, physical location, and mood. Cluster analysis of behaviors, situations, and behaviors-in-situations was used to create a hierarchical classification model consisting of five major categories of adherence problems: (1) compliance with meal plan, (2) undereating, (3) overeating, (4) impulsive eating, and (5) lifestyle differences. Within each category, situations were associated with everyday eating habits and special circumstances such as social events, and meals in restaurants. Grouping patients based on the similarity of their adherence problems resulted in five diagnostic groups: (1) emotional binge eaters, (2) restrained eaters, (3) unrestrained eaters, (4) undereaters, and (5) cyclical diet bingers. In study two, 28 subjects kept diaries during an intervention program designed to enhance dietary adherence. Study two results were similar to study one. Situation taxonomy and behavioral diagnosis are potentially useful ways to understand the intervention needs of those attempting maintaining dietary behavior changes.     

Stages of change for health-related behaviours in 18 year-old Australians

Abstract

This study investigated the validity of a Stages of Change algorithm with respect to independent measures of physical activity and fitness. dietary intake and alcohol consumption in 18 year-old Ausmlian men (n = 301) and women (n = 282). Stage of Change categories were related to fat and fibre intakes in men and fibre intake in women as well as hit and vegetable intakes in men and women. Physical activity and fitness for men and women also showed significant linear associations with Stage of Change categories. Alcohol consumption was significantly associated with Stage of Change categories for men but not for women although recorded alcohol consumption was very variable for women. However, the algorithm was valid for both men and women when drinking alcohol consistent with national guidelines on safe drinking was used. In summary, with reference to actual health behaviours, the Stages of Change algorithm was valid for young men and women for diet. physical activity and alcohol drinking. Independent behavioural data were not available for smoking behaviours. Using the algorithm, there were significant associations in men between prccontemplation status for diet and drinking and diet and physical activity, in women between diet and smoking and in both men and women between drinking and smoking. Covariance between precontemplation status for different health behaviours therefore suggests the need for multimodal interventions.     

Smoking patterns and dependence: contrasting chippers and heavy smokers

The authors used ecological momentary assessment to contrast smoking patterns among chippers (CHs; n = 26)--smokers who smoke despite an apparent absence of tobacco dependence--with those seen in heavy smokers (HSs; n = 28). Smoking and nonsmoking settings (activity, mood, etc.) were assessed by means of electronic diary. CHs were not social smokers; like HSs, they smoked half their cigarettes while alone. When smoking, CHs' urge levels equaled those of HSs; between cigarettes, CHs had few urges, whereas HSs reported moderate urges. CHs' smoking was particularly associated with indulgent activities: relaxation, socializing, eating, and drinking alcohol. Outside of these indulgent settings, CHs' (but not HSs') smoking was associated with negative affect. In idiographic analyses, CHs' smoking was under much stronger stimulus control than was that of HSs. The authors propose that the disappearance of stimulus control over use is a characteristic of dependence.     

Mediation of self‐regulation and mood in the relationship of changes in high emotional eating and nutritional behaviors: Moderating effects of physical activity

High emotional eating (EE) is prevalent in women with obesity. A previous study's subsample of obese women classified as high emotional eaters participated in either a physical activity‐focused experimental (n = 29) or an educationally focused comparison (n = 22) behavioral treatment and was assessed over phases of expected weight loss (baseline–month 6) and short‐ and long‐term regain (months 6–12 and 6–24, respectively). The study's aim was to assess theory‐based psychological and behavioral mediation and moderation of changes in nutritional behaviors via emotional eating change in order to inform behavioral weight‐loss treatments. During the weight‐loss phase, significant improvements in eating self‐regulation and mood significantly mediated the relationship of reduced EE and intake of both fruits and vegetables (FV) and sweets. Self‐regulation was a significant independent mediator. Physical activity significantly moderated the relationship between EE and self‐regulation changes. All variables demonstrated large positive effects and significant time × group interactions favoring the experimental group. During the short and long‐term phases of expected weight regain, there were no significant changes in FV intake, although consumption of sweets significantly increased during months 6–24. Change in FV and sweets significantly predicted weight change, which was significantly greater in the experimental vs. comparison group over both the initial 6 months (?6.1% vs. ?2.6%) and full 24 months of the study (?7.6% vs. ?1.3%). Findings suggest that behavioral treatments should address EE through improvements in self‐regulation and mood, and supported physical activity will aid in that process. The need for an improved understanding of weight‐loss maintenance remains.     

Consumer response to tobacco smoke in service settings

• Establishing smoking policies which accommodate customers' smoking preferences is a major problem for restaurants, bars, hotels, and other firms in the service industry. This study is based on the premise that tobacco smoke can be considered a component of both the physical and ambient retail service environment. Because of legal and ethical concerns, the presence or absence of environmental tobacco smoke (ETS) in two types of eating facilities (bar and fine dining restaurant) was operationalized by the presentation to respondents of photographs which pictured customers in a setting where smoking was either present or absent. The success of this method of manipulation of the treatment variable was assessed with a thought listing procedure. Thought listing responses indicate that both treatments (type of facility and smoking policy) were adequately conveyed by the photographs. Results indicate that cognitive, emotional, and behavioral responses were all negatively affected by the presence of tobacco smoke. The conclusion is that managers who permit smoking in their facilities risk losing non‐smoking patrons while smokers are little affected by either the presence or absence of smoke.
• The major contributions of this study include both the exploration of tobacco smoke as part of the retail service environment for eating establishments and the use of thought listings as a manipulation check for variables which were manipulated through use of photographs depicting the treatment conditions.

Copyright © 2010 John Wiley & Sons, Ltd.     

Longitudinal analysis of the relationship between changes in smoking and changes in drinking in a community sample: the Winnipeg Health and Drinking Survey.

Smoking cigarettes and drinking alcohol are positively correlated in cross-sectional studies of the general population. However, it is unclear whether changes in quantity of drinking over time are related to changes in amount of smoking over time. This investigation examined, with structural equation modeling, the relationship of changes in drinking to changes in smoking over 2 years among 344 adults who reported cigarette smoking and alcohol use at baseline in 1989-1990 or at follow-up in 1991-1992 or both. Surprisingly, no significant relationships were found between changes in smoking and changes in drinking. This lack of effect suggests that changes in the quantity or intensity of drinking and of smoking are not related in any important way in nonclinical populations.     

Gender role typing,the superwoman ideal,and the potential for eating disorders

The interactive effects of gender role typing and adherence to a superwoman ideal (desiring to excel in many diverse roles) on the potential for disordered eating were examined among a nonclinical sample of women. Results indicated that both masculine and feminine gender-typed women who strongly adhered to a superwoman ideal were at greater risk for eating disorders than androgynous superwomen. In contrast, androgynous superwomen had relatively low potential for disordered eating and appeared comparable to women who, regardless of gender typing, rejected the superwoman ideal. Women undifferentiated with regard to gender type, whether superwomen or not, also had reduced potential for disordered eating. Findings are discussed with regard to gender role socialization and expectations, and the implications for mediating the potential for eating disorders are considered.     

Posttraumatic Growth Among HIV/AIDS Patients1

Correlates (n= 835 at Time 1) and predictors (n= 434 at Time 2) of posttraumatic growth (PTG; perceiving positive life changes stemming from diagnosis) over 1.6 years were examined among a diverse sample of HIV/AIDS patients. PTG was common–59% of participants reported to have experienced at least moderate positive changes since diagnosis. At Time 1, PTG had significant negative associations with age, alcohol use, depression, and pessimism; and positive associations with African American ethnicity (vs. White), female gender, eating a healthy diet, and optimism. At Time 2, religiosity was positively associated with PTG. The process of experiencing PTG over time was associated with lower levels of depression over time. Although the underlying process of PTG remains unclear, these results suggest that PTG is worthy of intervention focus.     

An analysis of fidgeting and associated individual differences

Fidgeting was defined as engaging in manipulations of one's own body parts or other objects, such actions being peripheral or nonessential to central ongoing events or tasks Two studies employed preliminary fidgeting questionnaires of 70 and 106 items, respectively, tapping a wide range of habitual behaviors Item selection and factor analyses led to the development of a final, 40-item, individual difference measure of fidgeting tendency which is balanced for response bias and has an alpha reliability coefficient of 89 Convergent and construct validity were supported by positive correlations between the fidgeting tendency measure and measures of tendencies to engage in extraneous activities (consuming alcoholic drinks, cigarette smoking, eating, daydreaming, restlessness, insomnia) while preoccupied with certain situations and tasks These findings implied that fidgeting is an activity overflow and that it is more probable when the organism's physical activity is constrained by the central or focal act Fidgeting tendency also correlated positively with binge eating and with physical activity In two additional studies, questionnaire fidgeting tendency scores correlated positively with direct observations of fidgeting by subjects and with peer predictions Personality correlates of fidgeting tendency were well defined More fidgety persons were more unpleasant and more arousable (i e, more anxious or hostile) Fidgeting tendency did not correlate significantly with subject sex or with arousal-seeking tendency     

Personality and Serum Lipids: Does Lifestyle Account for Their Concurrent and Long‐term Relationships

This study evaluates concurrent and over time associations of personality with measures of three serum lipids associated coronary heart disease morbidity, namely, high‐density lipoprotein cholesterol (HDL‐C), low‐density lipoprotein cholesterol and triglyceride (TRI). Participants were individuals who underwent a health examination at two points of time, T1 (N = 3835) and T2 (N = 2283), about 2.5 years apart. Personality was assessed by the Five‐Factor Model. Health, socioeconomic status and healthy lifestyle behaviours (smoking intensity, physical activity and body weight) were controlled. Regression analyses indicate that the personality factors of neuroticism, extraversion and conscientiousness are each significantly associated with HDL‐C and TRI, both concurrently and over time. However, most of these associations decreased to marginal significance when adjusted for body weight or physical activity as possible mediators. Both concurrent and over time associations of the openness personality trait with HDL‐C and TRI were significant and persisted after adjustment for measures of a healthy lifestyle. This study emphasizes the importance of collecting measures of a healthy lifestyle to better understand how personality might influence serum lipids. Copyright © 2013 European Association of Personality Psychology     

Loneliness,eating, and body mass index in parent–adolescent dyads from the Family Life,Activity, Sun,Health, and Eating study

Loneliness is a salient risk factor for obesity, emotional eating, and poor diet. Because adolescents and parents are embedded within a family unit, their experiences of loneliness may be associated with both their own and one another's behaviors. To examine the extent to which parent and child loneliness predict body mass index (BMI) and eating in parents and adolescents, an actor–partner interdependence model of loneliness, eating, and BMI in adolescent–parent dyads was analyzed. There were actor effects among adolescents such that greater loneliness was positively associated with emotional eating and BMI‐z, and there was an actor effect among parents such that higher loneliness was positively related to emotional eating. There was a partner effect among adolescents such that greater parental loneliness was positively associated with adolescent emotional eating, and there was a partner effect among parents such that higher adolescent loneliness was positively associated with parental emotional eating. There were several actor–partner effects for loneliness and junk food in dyads with boys. Findings highlight the importance of dyadic models of loneliness in adolescent–parent dyads.