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Affect Labeling Reduces Emotional Eating Behaviors among Female Undergraduates with Bulimic Tendencies: Comparisons with Cognitive Reappraisal and Psychological Education

Abstract

Affect labeling refers to naming one’s emotional experiences, which has proven to be a helpful strategy in down-regulating negative emotion. This study aimed to examine the effects of affect labeling on reducing emotion-induced eating among individuals with bulimic symptoms. Forty-two female undergraduates with bulimic tendencies were randomly assigned to one of the following treatment groups: affect labeling (AL; n=14), cognitive reappraisal (CR; n=13), or psychological education (PE; n=15). Following treatment, an impromptu speech task was given in order to induce anxiety, and participants were instructed to use the previously learned strategy during the speech task. Subsequently, a bogus taste test was conducted with high-carbohydrate snacks, and snack intake (kcal) was calculated as a measure of anxiety-induced eating behaviors. Results showed that both the AL and CR groups reported lower speech anxiety and consumed less snacks, as compared to the PE group. Furthermore, the AL group consumed even less snacks than the CR group. These results suggest that, while both AL and CR are effective in reducing anxiety-induced eating behaviors, AL may be more effective than CR. The implications of these findings are discussed.

keywords
affect labeling, bulimia nervosa, emotional eating, speech anxiety, cognitive reappraisal, 정서명명, 신경성 폭식증, 정서적 섭식, 발표불안, 인지적 재해석

Reference

1.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

2.

An, D., & Lee, H. (2017). The effects of affect labeling on reducing speech anxiety among socially anxious undergraduates: A preliminary study. Cognitive Behavior Therapy in Korea, 17, 533-545.

3.

Arnow, B., Kenardy, J., & Agras, W. S. (1995). The Emotional Eating Scale: The development of a measure to assess coping with negative affect by eating. International Journal of Eating Disorders, 18, 79-90.

4.

Baer, R. A., Smith, G. T., Hopkins, J., Krietemeyer, J., & Toney, L.(2006). Using self-report assessment methods to explore facets of mindfulness. Assessment, 13, 27-45.

5.

Barlow, D. H., Farchione, T. J., Fairholme, C. P., Ellard, K. K., Boisseau, C. L., Allen, L. B., & Ehrenreich-May, J. (2011). Unified protocol for transdiagnostic treatment of emotional disorders: Therapist guide. New York, NY: Oxford University Press.

6.

Bartholome, L. T., Peterson, R. E., Raatz, S. K., & Raymond, N. C.(2013). A comparison of the accuracy of self-reported intake with measured intake of a laboratory overeating episode in overweight and obese women with and without binge eating disorder. European Journal of Nutrition, 52, 193-202.

7.

Baumeister, R. F., Bratslavsky, E., Muraven, M., & Tice, D. M.(1998). Ego depletion: Is the active self a limited resource? Journal of Personality and Social Psychology, 74, 1252-1265.

8.

Burton, A. L., Abbott, M. J., Psych, M. C., Modini, M., & Touyz, S.(2016). Psychometric evaluation of self-report measures of binge-eating symptoms and related psychopathology: A systematic review of the literature. International Journal of Eating Disorders, 49, 123-140.

9.

Cho, Y., Lee, M., & Park, S. (1999). A study on the reliability and validity of the Korean version of Speech Anxiety Scale. Korean Journal of Clinical Psychology, 18, 165-178.

10.

Choi, H., Lee, J., & Jang, J. (2011). The effect of emotional intensity and emotional awareness clarity on the binge eating behavior of high school girls: Mediating effect of avoidant emotion regulation style. Korean Journal of Counseling, 12, 1579-1597.

11.

Chon, K. K., Choi, S., & Yang, B. (2001). Integrated adaptation of CES-D in Korea. The Korean Journal of Health Psychology, 6, 59-76.

12.

Danner, U. N., Evers, C., Stok, F. M., van Elburg, A. A., & de Ridder, D. T. D. (2012). A double burden: Emotional eating and lack of cognitive reappraisal in eating disordered women. European Eating Disorders Review, 20, 490-495.

13.

Deaver, C. M., Miltenberger, R. G., Smyth, J., Meidinger, A., & Crosby, R. (2003). An evaluation of affect and binge eating. Behavior Modification, 27, 578-599.

14.

Evers, C., Stok, F. M., & de Ridder, D. T. D. (2010). Feeding your feelings: Emotional regulation strategies and emotional eating. Personality and Social Psychology Bulletin, 36, 792-804.

15.

Feldman-Barrett, L., Gross, J., Conner-Christensen, T., & Benvenuto, M. (2001). Knowing what you’re feeling and knowing what to do about it: Mapping the relation between emotion differentiation and emotion regulation. Cognition and Emotion, 15, 713-724.

16.

Garner, D. M., Olmsted, M. P., Bohr, Y., & Garfinkel, P. E. (1982). The Eating Attitudes Test: Psychometric features and clinical correlates. Psychological Medicine, 12, 871-878.

17.

Glisenti, K., & Strodl, E. (2012). Cognitive behavior therapy and dialectical behavior therapy for treating obese emotional eaters. Clinical Case Studies, 11, 71-88.

18.

Gross, J. J. (2014). Emotion regulation: Conceptual and empirical foundations. In J. J. Gross (Ed.), Handbook of emotion regulation (pp. 3-20). New York, NY: Guilford Press.

19.

Gross, J. J., & Jazaieri, H. (2014). Emotion, emotion regulation, and psychopathology: An affective science perspective. Clinical Psychological Science, 2, 387-401.

20.

Gross, J. J., & John, O. P. (2003). Individual differences in two emotion regulation processes: Implications for affect, relationships, and well-being. Journal of Personality and Social Psychology, 85, 348-362.

21.

Hariri, A. R., Bookheimer, S. Y., & Mazziotta, J. C. (2000). Modulating emotional responses: Effects of a neocortical network on the limbic system. NeuroReport, 11, 43-48.

22.

Hay, P. (2013). A systematic review of evidence for psychological treatments in eating disorders: 2005-2012. International Journal of Eating Disorders, 46, 462-469.

23.

Hilbert, A., & Tuschen-Caffier, B. (2007). Maintenance of binge eating through negative mood: A naturalistic comparison of binge eating disorder and bulimia nervosa. International Journal of Eating Disorders, 40, 521-530.

24.

Hofmann, S. G., Heering, S., Sawyer, A. T., & Asnaani, A. (2009). How to handle anxiety: The effects of reappraisal, acceptance, and suppression strategies on anxious arousal. Behaviour Research and Therapy, 47, 389-394.

25.

Jeon, S., & Son, C. (2012). The effects of mindfulness-based cognitive therapy (MBCT) program on binge eating behavior, emotional eating, difficulties in emotional regulation, and alexithymia of the binge eating-prone university students. The Korean Journal of Health Psychology, 17, 841-859.

26.

Kang, J. S., & Shin, H. (2010). The effects of induced anxiety on selective attentional bias and binge-eating behavior in bulimia nervosa. Korean Journal of Clinical Psychology, 29, 927-944.

27.

Katterman, S. N., Kleinman, B. M., Hood, M. M., Nackers, L. M., & Corsica, J. A. (2014). Mindfulness meditation as an intervention for binge eating, emotional eating, and weight loss: A systematic review. Eating Behaviors, 15, 197-204.

28.

Keenan, N. K. (2013). Emotion regulation and health behavior: Effects of negative affect and emotion regulation strategies on eating and smoking. (Unpublished doctoral dissertation). University of Minnesota, Minnesota, US.

29.

Kelly, N. R., Lydecker, J. A., & Mazzeo, S. E. (2012). Positive cognitive coping strategies and binge eating in college women. Eating Behaviors, 13, 289-292.

30.

Keski-Rahkonen, A., Raevuori, A., Bulik, C. M., Hoek, H. W., Sihvola, E., Kaprio, J., & Rissanen, A. (2013). Depression and drive for thinness are associated with persistent bulimia nervosa in the community. European Eating Disorders Review, 21, 121-129.

31.

Kim, H., Lee, I., & Kim, J. (1996). A study of the reliability and validity of the Korean version of the Eating Behavior Questionnaire. Korean Journal of Clinical Psychology, 15, 141-150.

32.

Kim, K., & Kwon, S. (2015). The effects of acceptance and cognitive restructuring on the reduction of social anxiety. Korean Journal of Clinical Psychology, 34, 429-453.

33.

Kim, M., & Lee, J. (2014). Examination of dual-pathway model about binge eating: Mediating effects of interoceptive awareness and emotional eating and multi-group analysis upon BMI level. Korean Journal of Counseling, 15, 2165-2189.

34.

Kircanski, K., Lieberman, M. D., & Craske, M. G. (2012). Feelings into words: Contributions of language to exposure therapy. Psychological Science, 23, 1086-1091.

35.

Kristeller, J., Wolever, R. Q., & Sheets, V. (2014). Mindfulnessbased eating awareness training (MB-EAT) for binge eating: A randomized clinical trial. Mindfulness, 5, 282-297.

36.

Lavender, J. M., Utzinger, L. M., Cao, L., Wonderlich, S. A., Engel, S. G., Mitchell, J. E., & Crosby, R. D. (2016). Reciprocal associations between negative affect, binge eating, and purging in the natural environment in women with bulimia nervosa. Journal of Abnormal Psychology, 125, 381-386.

37.

Lavender, J. M., Wonderlich, S. A., Engel, S. G., Gordon, K. H., Kaye, W. H., & Mitchell, J. E. (2015). Dimensions of emotion dysregulation in anorexia nervosa and bulimia nervosa: A conceptual review of the empirical literature. Clinical Psychology Review, 40, 111-122.

38.

Lee, J. (2012). Emotion regulation coaching book: Be the master of your emotions. Seoul: SigmaPress.

39.

Lee, M., & Chae, K. (2012). The relationship between negative affect and binge eating behavior: Focusing on the mediating effect of difficulties with emotional regulation. Cognitive Behavior Therapy in Korea, 12, 129-144.

40.

Lee, Y. (2010). Identifying binge eating determinants. (Unpublished doctoral dissertation). Chung-Ang University, Seoul, Korea.

41.

Legenbauer, T., Vocks, S., & Rüddel, H. (2008). Emotion recognition, emotional awareness and cognitive bias in individuals with bulimia nervosa. Journal of Clinical Psychology, 64, 687-702.

42.

Lieberman, M. D., Eisenberger, N. I., Crockett, M. J., Tom, S. M., Pfeifer, J. H., & Way, B. M. (2007). Putting feelings into words:Affect labeling disrupts amygdala activity in response to affective stimuli. Psychological Science, 18, 421-428.

43.

Lieberman, M. D., Inagaki, T. K., Tabibnia, G., & Crockett, M. J.(2011). Subjective responses to emotional stimuli during labeling, reappraisal, and distraction. Emotion, 11, 468-480.

44.

Lindeman, M., & Stark, K. (2001). Emotional eating and eating disorder psychopathology. Eating Disorders, 9, 251-259.

45.

McKay, M., Wood, J. C., & Brantley, J. (2007). The dialectical behavior therapy skills workbook. Oakland, CA: New Harbinger Publications.

46.

Moyal, N., Henik, A., & Anholt, G. E. (2014). Cognitive strategies to regulate emotions: Current evidence and future directions. Frontiers in Psychology, 4, 1-4. doi: 10.3389/fpsyg.2013.01019

47.

National Health Insurance Service. (2015). Bulimia is 15 times higher in women than in men [Press release]. Retrieved from http://www.nhis.or.kr/bbs7/boards/B0039/13426

48.

Naumann, E., Tuschen-Caffier, B., Voderholzer, U., & Svaldi, J. (2016). Spontaneous emotion regulation in anorexia and bulimia nervosa. Cognitive Therapy and Research, 40, 304-313.

49.

Niles, A. N., Craske, M. G., Lieberman, M. D., & Hur, C. (2015). Affect labeling enhances exposure effectiveness for public speaking anxiety. Behaviour Research and Therapy, 68, 27-36.

50.

Ouwens, M. A., van Strien, T., van Leeuwe, J. F. J., & van der Staak, C. P. F. (2009). The dual pathway model of overeating. Replication and extension with actual food consumption. Appetite, 52, 234-237.

51.

Park, S. (2006). The effect of an acceptance-based treatment on speech anxiety reduction in college students. (Unpublished master’s thesis). Hallym University, Chuncheon, Korea.

52.

Park, S. (2016). Effect of satisfaction with self-standard and social comparison on eating behavior. (Unpublished master’s thesis). Daejeon University, Daejeon, Korea.

53.

Paul, G. L. (1966). Insight vs. desensitization psychotherapy: An experiment in anxiety reduction. Stanford, CA: Stanford University Press.

54.

Payer, D. E., Baicy, K., Lieberman, M. D., & London, E. D. (2012). Overlapping neural substrates between intentional and incidental down-regulation of negative emotions. Emotion, 12, 229-235.

55.

Radloff, L. S. (1977). The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1, 385-401.

56.

Rhee, M., Go, Y., Lee, H., Whang, E., & Lee, Y. (2001). A validation of the Korean version of Eating Attitude Test-26. Korean Journal of Psychosomatic Medicine, 9, 153-163.

57.

Ricca, V., Castellini, G., Fioravanti, G., Sauro, C. L., Rotella, F., Ravaldi, C., . . . Faravelli, C. (2012). Emotional eating in anorexia nervosa and bulimia nervosa. Comprehensive Psychiatry, 53, 245-251.

58.

Robinson, E., Haynes, A., Hardman, C. A., Kemps, E., Higgs, S., & Jones, A. (2017). The bogus taste test: Validity as a measure of laboratory food intake. Appetite, 116, 223-231.

59.

Rosen, J. C., Leitenberg, H., Fisher, C., & Khazam, C. (1986). Binge-eating episodes in bulimia nervosa: The amount and type of food consumed. International Journal of Eating Disorders, 5, 255-267.

60.

Salovey, P., Mayer, J. D., Goldman, S. L., Turvey, C., & Palfai, T. P.(1995). Emotional attention, clarity, and repair: Exploring emotional intelligence using the Trait Meta-Mood Scale. In J. W. Pennebaker (Ed.), Emotion, disclosure, and health (pp. 125-154). Washington, DC: American Psychological Association.

61.

Schneider, K. L., Appelhans, B. M., Whited, M. C., Oleski, J., & Pagoto, S. L. (2010). Trait anxiety, but not trait anger, predisposes obese individuals to emotional eating. Appetite, 55, 701-706.

62.

Sheppes, G., & Gross, J. J. (2011). Is timing everything? Temporal considerations in emotion regulation. Personality and Social Psychology Review, 15, 319-331.

63.

Shon, J. (2005). Individual differences in two regulation strategies:Cognitive reappraiser vs. emotion suppressor. (Unpublished master’s thesis). Seoul National University, Seoul, Korea.

64.

Sim, L., & Zeman, J. (2004). Emotion awareness and identification skills in adolescent girls with bulimia nervosa. Journal of Clinical Child and Adolescent Psychology, 33, 760-771.

65.

Smith, B. W., Shelley, B. M., Dalen, J., Wiggins, K., Tooley, E., & Bernard, J. (2008). A pilot study comparing the effects of mindfulness-based and cognitive-behavioral stress reduction. The Journal of Alternative and Complementary Medicine, 14, 251-258.

66.

Smith, M. C., & Thelen, M. H. (1984). Development and validation of a test for bulimia. Journal of Consulting and Clinical Psychology, 52, 863-872.

67.

Smyth, J. M., Wonderlich, S. A., Heron, K. E., Sliwinski, M. J., Crosby, R. D., Mitchell, J. E., & Engel, S. G. (2007). Daily and momentary mood and stress are associated with binge eating and vomiting in bulimia nervosa patients in the natural environment. Journal of Consulting and Clinical Psychology, 75, 629-638.

68.

So, W. (2009). The effects of negative emotions on binge eating among bulimics: Comparisons among anger, anxiety, and depression. The Korean Journal of Health Psychology, 14, 419-432.

69.

Stice, E. (2001). A prospective test of the dual-pathway model of bulimic pathology: Mediating effects of dieting and negative affect. Journal of Abnormal Psychology, 110, 124-135.

70.

Stice, E., Presnell, K., & Spangler, D. (2002). Risk factors for binge eating onset in adolescent girls: A 2-year prospective investigation. Health Psychology, 21, 131-138.

71.

Svaldi, J., Griepenstroh, J., Tuschen-Caffier, B., & Ehring, T. (2012). Emotion regulation deficits in eating disorders: A marker of eating pathology or general psychopathology? Psychiatry Research, 197, 103-111.

72.

Svaldi, J., Tuschen-Caffier, B., Trentowska, M., Caffier, D., & Naumann, E. (2014). Differential caloric intake in overweight females with and without binge eating: Effects of a laboratory-based emotion-regulation training. Behaviour Research and Therapy, 56, 39-46.

73.

Swinkles, A., & Giuliano, T. A. (1995). The measurement and conceptualization of mood awareness: Monitoring and labeling one’s mood states. Personality and Social Psychology Bulletin, 21, 934-949.

74.

Taut, D., Renner, B., & Baban, A. (2012). Reappraise the situation but express your emotions: Impact of emotion regulation strategies on ad libitum food intake. Frontiers in Psychology, 3, 1-7. doi: 10.3389/fpsyg.2012.00359

75.

Thelen, M. H., Farmer, J., Wonderlich, S., & Smith, M. (1991). A revision of the Bulimia Test: The BULIT-R. Psychological Assessment:A Journal of Consulting and Clinical Psychology, 3, 119-124.

76.

van Strien, T., Frijters, J. E. R., Bergers, G. P. A., & Defares, P. B.(1986). The Dutch Eating Behavior Questionnaire (DEBQ) for assessment of restrained, emotional, and external eating behavior. International Journal of Eating Disorders, 5, 295-315.

77.

van Strien, T., & Ouwens, M. A. (2007). Effects of distress, alexithymia and impulsivity on eating. Eating Behaviors, 8, 251-257.

78.

von Dawans, B., Kirschbaum, C., & Heinrichs, M. (2011). The Trier Social Stress Test for Groups (TSST-G): A new research tool for controlled simultaneous social stress exposure in a group format. Psychoneuroendocrinology, 36, 514-522.

79.

Wansink, B., Cheney, M. M., & Chan, N. (2003). Exploring comfort food preferences across age and gender. Physiology & Behavior, 79, 739-747.

80.

Welch, G., Thompson, L., & Hall, A. (1993). The BULIT-R: Its reliability and clinical validity as a screening tool for DSM-III-R bulimia nervosa in a female tertiary education population. International Journal of Eating Disorders, 14, 95-105.

81.

Westwood, H., Kerr-Gaffney, J., Stahl, D., & Tchanturia, K. (2017). Alexithymia in eating disorders: Systematic review and metaanalyses of studies using the Toronto Alexithymia Scale. Journal of Psychosomatic Research, 99, 66-81.

82.

Whiteside, U., Chen, E., Neighbors, C., Hunter, D., Lo, T., & Larimer, M. (2007). Difficulties regulating emotions: Do binge eaters have fewer strategies to modulate and tolerate negative affect? Eating Behaviors, 8, 162-169.

83.

Won, D., & Kim, K. (2006). Validation of the Korean version of Five-Factor Mindfulness Questionnaire. The Korean Journal of Health Psychology, 11, 871-886.

84.

Wonderlich, S. A., Peterson, C. B., Crosby, R. D., Smith, T. L., Klein, M. H., Mitchell, J. E., & Crow, S. J. (2014). A randomized controlled comparison of integrative cognitive-affective therapy and cognitive-behavioral therapy-enhanced for bulimia nervosa. Psychological Medicine, 44, 543-553.

85.

Yoon, H. (1996). The relationships among binge eating behavior, depressive symptoms, and attributional style. (Unpublished master’s thesis). The Catholic University of Korea, Seoul, Korea.

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