Treatment manuals: use in the treatment of bulimia nervosa

As psychology has moved toward emphasizing evidence-based practice, use of treatment manuals has extended from research trials into clinical practice. Minimal research has directly evaluated use of manuals in clinical practice. This survey of international eating disorder professionals examined use of manuals with 259 clinicians’ most recent client with bulimia nervosa. Although evidence-based manuals for bulimia nervosa exist, only 35.9% of clinicians reported using a manual. Clinicians were more likely to use a manual if they were younger; were treating an adult client; were clinical psychologists; were involved in research related to eating disorders; and endorsed a cognitive-behavioral orientation. Clinicians were less likely to use a manual if they provided eclectic psychotherapy that incorporated multiple psychotherapeutic approaches. We conclude that psychotherapy provided in clinical practice often does not align with the specific form validated in research trials, and “eclecticism” is at odds with efforts to disseminate manuals into clinical practice.     

Dietary restraint, body dissatisfaction, and psychological distress: a prospective analysis

This study uses prospective data from a survey of 1,177 adolescent girls to examine whether emotional eating, binge eating, abnormal attitudes to eating and weight, low self-esteem, stress, and depression are associated with dietary restraint or body dissatisfaction. In analyses that included both restraint and body dissatisfaction as independent predictors, restraint was associated only with more negative attitudes to eating, whereas body dissatisfaction was significantly associated with all the adverse outcomes. These results cast doubt on the proposition that restrained eating is a primary cause of bulimic symptoms, emotional eating, and psychological distress seen in individuals who are trying to control their weight, and rather suggest that body dissatisfaction is the key factor.     

Weight-based discrimination,body dissatisfaction and emotional eating: The role of perceived social consensus

Objective: Discrimination can have a negative impact on psychological well-being, attitudes and behaviour. This research evaluates the impact of experiences of weight-based discrimination upon emotional eating and body dissatisfaction, and also explores whether people's beliefs about an ingroup's social consensus concerning how favourably overweight people are regarded can moderate the relationship between experiences of discrimination and negative eating and weight-related cognitions and behaviours.

Research methods and procedures: 197 undergraduate students completed measures about their experiences of weight-based discrimination, emotional eating and body dissatisfaction. Participants also reported their beliefs concerning an ingroup's attitude towards overweight people.

Results: Recollections of weight-based discrimination significantly contributed to emotional eating and body dissatisfaction. However, the relationships between experiencing discrimination and body dissatisfaction and emotional eating were weakest amongst participants who believed that the ingroup held a positive attitude towards overweight people.

Discussion: Beliefs about ingroup social consensus concerning overweight people can influence the relationships between weight-based discrimination and emotional eating and body dissatisfaction. Changing group perceptions to perceive it to be unacceptable to discriminate against overweight people may help to protect victims of discrimination against the negative consequences of weight-based stigma.     

Just world beliefs, causal beliefs, and acquaintance: Associations with stigma toward eating disorders and obesity

The current study investigated the relationship between just world beliefs and stigmatizing attitudes toward eating disorders and obesity. Further, the associations between stigma and causal beliefs, and between stigma and acquaintance with these conditions, were examined. Participants (n = 447) read four vignettes describing an individual with anorexia nervosa, bulimia nervosa, binge eating disorder, or obesity. After each vignette, participants completed questionnaires assessing stigmatizing attitudes, just world beliefs, causal beliefs, and acquaintance with the condition depicted in the vignette. Stronger just world beliefs were associated with greater stigma toward all three eating disorders, as well as obesity (rs ranging from −.11 to −.18). More stigmatizing attitudes were associated with greater attribution of individual responsibility for the development of the disorder. However, participants with personal experience or who knew someone with the depicted problem did not have lower stigma scores than those who did not. The current study suggests that justification ideologies such as just world beliefs and controllability beliefs may underlie the stigmatization of eating disorders and obesity. These findings provide support for stigma reduction efforts aimed at targeting justification ideologies and altering causal beliefs.     

Risk perceptions,worry, and attitudes about genetic testing for breast cancer susceptibility

This study assessed the unique associations of risk perceptions and worry with attitudes about genetic testing for breast cancer susceptibility. Women (general practitioner clinic attenders, university students, and first-degree relatives of breast cancer survivors; N?=?303) read information about genetic testing and completed measures assessing perceived cancer risk, cancer worry, and genetic testing attitudes and beliefs. Worry was associated with greater interest in genetic testing, stronger beliefs that testing has detrimental emotional consequences, and positive beliefs about benefits of testing and risk-reducing surgeries. Perceived risk was unrelated to interest and associated with more skeptical beliefs about emotional consequences and benefits of testing and risk-reducing surgeries. At low worry levels, testing interest increased with more positive beliefs about testing benefits; at high worry levels, interest was high regardless of benefits beliefs. The findings support Leventhal's Common-Sense Model of self-regulation delineating interactive influences of risk-related cognitions and emotions on information processing and behavior.     

Risk perceptions, worry, and attitudes about genetic testing for breast cancer susceptibility

This study assessed the unique associations of risk perceptions and worry with attitudes about genetic testing for breast cancer susceptibility. Women (general practitioner clinic attenders, university students, and first-degree relatives of breast cancer survivors; N?=?303) read information about genetic testing and completed measures assessing perceived cancer risk, cancer worry, and genetic testing attitudes and beliefs. Worry was associated with greater interest in genetic testing, stronger beliefs that testing has detrimental emotional consequences, and positive beliefs about benefits of testing and risk-reducing surgeries. Perceived risk was unrelated to interest and associated with more skeptical beliefs about emotional consequences and benefits of testing and risk-reducing surgeries. At low worry levels, testing interest increased with more positive beliefs about testing benefits; at high worry levels, interest was high regardless of benefits beliefs. The findings support Leventhal's Common-Sense Model of self-regulation delineating interactive influences of risk-related cognitions and emotions on information processing and behavior.     

Emotional eating moderates the relationship between implicit measures of attitudes and chocolate consumption

Emotional eaters tend to eat more when emotionally aroused and their food‐related actions are associated with lack of control. Two studies tested the hypothesis that implicit measures of attitudes would be more strongly associated with the dietary behaviour of emotional eaters. In both Study 1 (N = 32) and Study 2 (N = 101), participants completed the DEBQ sub‐scale of emotional eating and implicit measures of attitude, explicit attitude and behaviour measures concerning chocolate consumption. In both studies, high emotional eaters were more likely than low emotional eaters to eat in line with their implicit measures of attitudes. The relationship between implicit measures of attitudes and food intake varies as a function of emotional eating style. Copyright © 2010 John Wiley & Sons, Ltd.     

The Relationship Between Perceived Parenting,Negative Core Beliefs,and Dysfunctional Attitudes Among Young Adults

Previous studies have found that perceived parenting is associated with dysfunctional attitudes that predict depression. However, few studies have empirically investigated processes by which perceived parenting is associated with dysfunctional attitudes. To fill this gap, this study tested the hypothesis that perceived low parental care would be associated with negative core beliefs, which, in turn, would be associated with dysfunctional attitudes. To strictly test the hypothesis, this study controlled for current depressive symptoms that could affect the relationships between study variables. The participants were 305 college students (141 females). The results differed by sex: for female students, the hypothesis was supported; for male students, negative core beliefs were associated with dysfunctional attitudes; however, perceived low care was not associated with negative core beliefs. The findings suggest that targeting low parental care and negative core beliefs for females and negative core beliefs for males may help prevent their dysfunctional attitudes and the resultant depression.     

Looking at Body Image: The Organization of Self-Knowledge About Physical Appearance and Its Relation to Disordered Eating

This study examined the organization of self-knowledge, with special attention to beliefs about physical appearance, in three groups of college-aged women: high body dissatisfaction with symptoms of disordered eating; high body dissatisfaction with no symptoms of disorder; and low body dissatisfaction. In the nondisordered, dissatisfied group, negative beliefs about physical appearance were organized in the self-structure in a way that isolated those beliefs and might minimize their impact and importance. This group also displayed adaptive types of self-concept organization (evaluative integration for those with important negative self-beliefs and compartmentalization for those with important positive beliefs) and effective coping strategies. Features of self-structure that characterize the nondisordered,dissatisfied group may provide a useful model for helping individuals with disordered eating cope with their negative physical appearance beliefs.     

A Retrospective Examination of the Similarity Between Clinical Practice and Manualized Treatment for Childhood Anxiety Disorders

The objective of this study was to facilitate the bidirectional communication between researchers and clinicians about the treatment of childhood anxiety disorders, including obsessive-compulsive disorder. Forty-four children were assessed before and after cognitive behavioral treatment with the parent versions of the Spence Child Anxiety Scale and Child Sheehan Disability Scale. In this retrospective study, treatment sessions were coded for the presence of exposures, relaxation, anxiety management, and behavior management. Results showed improved functioning within the clinical sample and suggested that treatment could be shorter, with exposure exercises implemented earlier in the course of treatment than described in manuals. Moreover, improvements in functioning were positively related to the use of exposures, and negatively related to the use of other anxiety management strategies. These results are discussed in the context of efforts to increase the availability of evidence-based treatments and are interpreted as supporting the development of more flexible treatment manuals.     

Eating Disorders—The Regulation of Positive as well as Negative Emotion Experience

Disordered eating behaviors are often conceptualized as maladaptive emotion regulation strategies. The present study investigated links between emotional experience, schematic belief systems, and psychological themes associated with eating disorders. In contrast to the majority of studies, which focus on just one or two emotions and use nonclinical samples, this study compared the full range of emotional experience in women with eating disorders to a control group. Measures used include the Differential Emotional Scale-IV, Youngs Early Maladaptive Schema Questionnaire, and Eating Disorder Inventory-2. The study provides the first empirical evidence that women diagnosed with eating disorders report experiencing pleasant as well as unpleasant emotions more frequently than do controls. A surprising finding was that pleasant emotions (joy, interest, surprise) correlated with eating disorder themes (EDI-2 subscales) more consistently than unpleasant emotions in the eating disorder group, while the reverse was true of the control group. Also of note, eating-disordered women reported significantly less anger and similar levels of fear vs. controls. While eating-disordered women scored more highly than do controls on all maladaptive schema (suggesting high levels of distress in women with eating disorders), the pattern of correlations between schema and emotion experience was distinctly different for each group and counterintuitive for the eating disorder group. In particular, pleasant emotion was highly correlated with maladaptive schema in the eating-disordered group but not in the control group. These marked group differences in the pattern of relationships between emotion experience, eating disorder themes, and belief systems suggest that it is not valid to draw conclusions about eating disorders from research that employs only nonclinical samples. The authors discuss these findings, and suggest that women with eating disorders are proficient at using disordered eating behaviors to manipulate their experience of both positive and negative emotional states, and that this dynamic should be recognized as an important maintenance factor.     

Open or close the door to the outgroup? Diversity beliefs moderate the impact of group boundary permeability on attitudes toward the outgroup

The present research investigated the moderating role of diversity beliefs with the aim of reconciling inconsistent findings regarding the impact of group boundary permeability on attitudes toward outgroup. In Study 1, all variables were measured with self‐report scales completed by Chinese participants. In Study 2, diversity beliefs were manipulated by randomly assigning Chinese participants to a high or low diversity belief condition. In Study 3, we replicated the moderating model with American participants. Results of all three studies indicated that diversity beliefs moderated the relationship between group boundary permeability and attitudes toward outgroup. Individuals with high diversity beliefs held more positive attitudes toward the outgroup when the group boundary was permeable (vs. impermeable). Conversely, individuals with low diversity beliefs held more negative attitudes toward the outgroup when the group boundary was permeable (vs. impermeable). These findings suggest that when the inflow of the outgroup members is inevitable, attitudes toward the outgroup may be effectively improved by increasing diversity beliefs.     

Attitudes of clinical psychologists towards clients with personality disorders

Previous studies have found that a variety of mental health professionals hold negative attitudes towards clients diagnosed with a personality disorder. These negative attitudes may lead to clients receiving a lower quality of service. Specialist training has been found to improve attitudes towards personality disorders but no empirical studies in Australia have examined this among clinical psychologists. In this study, the attitudes of 81 clinical psychologists towards clients with personality disorders were examined. We were specifically interested in investigating the relationship between recency of specialist training and clinician's attitudes as well as the influence of percentage of personality disorder clients on the clinician's caseload. Results demonstrated that both recency of specialist training and percentage of clients seen were associated with more positive attitudes; however, a higher caseload of clients with personality disorders was the most important predictor of positive attitudes. The implication is that recent participation in specialist training for personality disorders appears to be valuable in improving clinician's attitudes but that more positive attitudes are associated with seeing a greater number of individuals with personality disorders.     

The Role of Teachers' Social-Emotional Competence in Their Beliefs About Peer Victimization

One hundred fifty preservice teachers and 25 in-service teachers were surveyed to examine whether mental representations of relationships, confidence about managing bullying, empathy toward victims, and emotional expressiveness were associated with their peer victimization-related beliefs. Teachers' confidence about managing bullying was positively associated with their prosocial peer beliefs. In addition, the belief that the distress that children experience as a result of being victimized should be dismissed was negatively related to teachers' positive representations. Teachers' reports of positive emotional expressiveness were negatively related to normative, assertive, avoidance, and dismissive victimization-related beliefs and positively related to prosocial peer beliefs. In contrast, teachers' reports of negative emotional expressiveness were negatively related to prosocial peer beliefs and avoidance victimization-related beliefs. In-service teachers reported slightly higher positive expressiveness than preservice teachers did. Minority teachers reported higher scores for positive expressiveness, empathy, and lower negative classroom expressiveness than nonminority teachers did. Implications of these findings for practice are discussed.     

Eating Disorders in an Israeli Women’s Prison: Correlates of the Risk

Extensive rates of child abuse and neglect (CAN), substance abuse disorders (SUDs), and mental health problems have been reported among incarcerated women. The link between CAN, SUDs, and eating disorders is well-documented, but little is known about the eating-disorder behaviors of incarcerated women. The purpose of this study was (a) to explore eating-disorder behaviors among incarcerated women in Israel; (b) to examine whether certain types of CAN are associated with eating disorders; and (c) to study the link between CAN, SUDs, mental health problems, and eating disorders. This cross-sectional study investigated eating-disorder behaviors in a sample of 62 incarcerated women in Israel. The findings indicated a high prevalence of eating disorders among incarcerated women; almost 70% exhibited the drive for thinness, which is considered a central feature of eating disorders. In addition, the findings revealed a high prevalence of CAN (84.2%), especially emotional abuse (57.9%) and emotional neglect (73.7%). I also found a high rate of co-occurrence of CAN, SUDs, mental health problems, and eating disorders. Bulimia nervosa, ineffectiveness, and low impulse regulation were found to be associated with SUDs and mental health problems (p?=?0.006, p?=?0.032, and p?<?0.001, respectively). The findings highlight the intersection of trauma with self-destructive behaviors, including co-occurrences of SUDs, eating disorders, and severe mental health problems as a result of negative childhood experiences, suggesting a need for simultaneous treatment interventions.     

Randomised controlled trial of a guided self-help treatment on the Internet for binge eating disorder

Binge eating disorder (BED) is a common and under-treated condition with major health implications. Cognitive behavioural therapy (CBT) self-help manuals have proved to be efficient in BED treatment. Increasing evidence also support the use of new technology to improve treatment access and dissemination. This is the first randomised controlled study to evaluate the efficacy of an Internet guided self-help treatment programme, based on CBT, for adults with threshold and subthreshold BED. Seventy-four women were randomised into two groups. The first group received the six-month online programme with a six-month follow-up. The second group was placed in a six-month waiting list before participating in the six-month intervention. Guidance consisted of a regular e-mail contact with a coach during the whole intervention. Binge eating behaviour, drive for thinness, body dissatisfaction and interoceptive awareness significantly improved after the Internet self-help treatment intervention. The number of objective binge episodes, overall eating disorder symptoms score and perceived hunger also decreased. Improvements were maintained at six-month follow-up. Dropouts exhibited more shape concern and a higher drive for thinness. Overall, a transfer of CBT-based self-help techniques to the Internet was well accepted by patients, and showed positive results for eating disorders psychopathology.     

That’s not funny: Instrument validation of the concern for political correctness scale

The transformation of common language toward inclusion of all people is the mechanism by which many aim to alter attitudes and beliefs that stand in the way of more meaningful social change. The term for this motivated concern for language is “political correctness” or “PC.” The current project seeks to introduce a new tool for investigations into this phenomenon, the concern for political correctness (CPC) scale. CPC assesses individual differences in concern for politically correct speech. Exploratory and confirmatory structural equation modeling showed consistent factor structure of the two subscales; an emotion subscale measuring negative emotional response to hearing politically incorrect language, and an activism subscale measuring a willingness to correct others who use politically incorrect language. Correlational analyses suggested that concern for political correctness is associated with more liberal beliefs and ideologies and less right-wing authoritarianism. The emotion subscale was also found to be associated with lower emotional well-being and the activism subscale with more frequent arguments. Laboratory-based criterion validation studies indicated that the two subscales predicted negative reactions to politically incorrect humor.     

Effects of psychosocial and situational variables on substance abuse among homeless adults

Finding direct and indirect influences of salient psychosocial and situational variables on problem substance use among homeless people is important in designing evidence-based, effective, and relevant interventions for this special population. A stress-coping paradigm in conjunction with situational items specialized for homeless people was used to explore predictive relationships in a sample of homeless adults (N = 664) among (a) psychosocial variables of self-esteem, social support, positive and negative coping, and emotional distress, (b) situational variables of homelessness history and quality of recent housing, and (c) outcomes of alcohol use, injection drug use (IDU), and non-IDU. Lower self-esteem predicted greater emotional distress, lower positive coping, greater negative coping, and more alcohol use. Social support predicted less emotional distress and more positive coping. Chronic homelessness predicted more emotional distress, less positive coping, greater alcohol use, and IDU. Poor housing was associated with more alcohol use and IDU. Substance abuse interventions among the homeless should have a dual focus that includes attention to psychological issues and negative coping patterns while also addressing situational, environmental factors, including encouraging provision of permanent supportive housing.     

The Relationship Between Experience and Attitudes Concerning Epilepsy1

Research indicates that epilepsy is a misunderstood and stigmatizing disorder. The present study examined whether various levels and types of experience with epilepsy are related to attitudes about the disorder. It was hypothesized that certain types of direct experience with epilepsy (e.g., knowing people with epilepsy) are related to positive attitudes about the disorder, whereas other types of direct experience (e.g., witnessing seizures) are related to negative beliefs. As predicted, data from telephone interviews with 271 subjects indicate that individuals knowing someone with epilepsy held significantly more accepting attitudes than respondents who had never known an epileptic. The findings also suggest that witnessing epileptic seizures is an emotionally charged event, and, in the absence of other types of experience, this emotional impact might have a negative effect on attitudes toward people with epilepsy. The findings from this study have implications for the development of educational programs aimed at the general public, medical personnel, and people with epilepsy.