- Email: [email protected]
Investigating the moderating role of emotional awareness in the association between urgency and binge eating
Eating Behaviors 17 (2015) 99–102
Contents lists available at ScienceDirect
Eating Behaviors
Investigating the moderating role of emotional awareness in the association between urgency and binge eating Eishita Manjrekar ⁎, Howard Berenbaum, Natasha Bhayani Department of Psychology, University of Illinois at Urbana-Champaign, 603 E. Daniel St., Champaign, IL 61820, USA
a r t i c l e
i n f o
Article history: Received 13 August 2014 Received in revised form 26 October 2014 Accepted 28 January 2015 Available online 4 February 2015 Keywords: Binge eating Urgency Emotional awareness Clarity of emotions Attention to emotions
a b s t r a c t Binge eating has been found to be associated with urgency (the tendency to act impulsively in response to negative affect) and emotional awareness (i.e., attention to emotions, clarity of emotions). The present study tested the hypothesis that the relation between binge eating and urgency would be moderated by emotional awareness, over and above negative affect. Participants were 249 female college students. Items from the Trait Meta Mood Scale (TMMS), the Urgency subscale of the UPPS Impulsive Behavior Scale, and the Bulimia (B) subscale of the Eating Disorders Inventory (EDI-3) were administered. As predicted, emotional awareness moderated the link between urgency and binge eating. Both Urgency × Attention to emotions and Urgency × Clarity of emotions significantly predicted binge eating scores, even after taking into account negative affect. Consistent with past research, higher levels of urgency were associated with higher levels of binge eating, even after taking negative affect into account. However, the associations were particularly strong among individuals with low levels of attention to emotions and low levels of clarity of emotions. The findings from this study have implications for future research examining binge eating. © 2015 Elsevier Ltd. All rights reserved.
1. Introduction Binge eating is characterized by the consumption of an unambiguously large quantity of food in a short period of time, as well as a lack of sense of control (Emery, King, Fischer, & Davis, 2013). It is a central feature of bulimia nervosa and binge eating disorder (American Psychiatric Association, 2013). Therefore, research exploring factors that influence binge eating is important given the potential implications for improving our understanding of its etiology and treatment. The association between one aspect of impulsivity—negative urgency, or urgency—and binge eating has been especially well documented in past studies (e.g., Emery et al., 2013; Fischer, Peterson, & McCarthy, 2013). Defined as the propensity to act in a rash manner in response to distressed feelings (Whiteside & Lynam, 2001), urgency has been found to predict binge eating over and above negative affect (NA; Racine et al., 2013). Similarly, it has been linked to a host of problematic outcomes such as non-suicidal self-injury and substance abuse (Selby, Anestis, & Joiner, 2008). Urgency has been conceptualized as a component of emotion dysregulation (Anestis, Bagge, Tull, & Joiner, 2011) that encourages behavioral dysregulation, including binge eating (Anestis, Selby, & Joiner, 2007). Specifically, it has been argued that urgency might promote the occurrences of maladaptive behavioral coping strategies such as binge eating, which serve to down regulate intense negative ⁎ Corresponding author. Tel.: +1 515 779 0402; fax: +1 217 244 5876. E-mail address: [email protected] (E. Manjrekar).
http://dx.doi.org/10.1016/j.eatbeh.2015.01.010 1471-0153/© 2015 Elsevier Ltd. All rights reserved.
emotions (Selby et al., 2008). In other words, in an attempt to feel better, individuals with high levels of urgency are more likely to react impulsively to negative affect by engaging in behaviors such as binge eating. However, urgency is not the only factor that influences binge eating. Factors that mobilize adaptive emotion regulation would be expected to counteract the effect of urgency on binge eating. Specifically, factors that promote adaptive emotion regulation strategies would protect against rash action (e.g., binge eating) in the face of negative affect, thereby moderating the association between urgency and binge eating. Emotional awareness is one factor that we expected to moderate the impact of urgency on binge eating. It can be divided into two distinguishable components (Coffey, Berenbaum, & Kerns, 2003; Gohm & Clore, 2002): (a) attention to emotions—the extent to which one attends to and values one's own emotions; and (b) clarity of emotions—the extent to which one can identify and describe one's own emotions. According to the “affect as information” hypothesis, both attention to emotion and clarity of emotion are thought to mobilize emotion regulation and influence behavioral outcomes (e.g., Gohm & Clore, 2002). Specifically, it has been argued that affect contributes to the effectiveness of individuals' judgments and actions by providing bodily and experiential information (Clore & Huntsinger, 2007). Therefore, paying more attention to and being clearer about affect-relevant information is likely to result in more successful emotional and behavioral outcomes (Gohm & Clore, 2002). Unsurprisingly, past research has found that greater levels of clarity of emotions and attention to emotions were associated with less binge eating, and less overeating (Moon & Berenbaum, 2009; Whiteside et al., 2007).
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E. Manjrekar et al. / Eating Behaviors 17 (2015) 99–102
To summarize, past research has found that: (a) urgency and binge eating are positively associated even after controlling for NA; and (b) both attention to emotions and clarity of emotions are positively associated with successful emotional and behavioral outcomes (including less binge eating and overeating). We expected to replicate these findings in the present study. Additionally, given that both clarity of emotions and attention to emotions can facilitate adaptive emotion regulation, we predicted that they would moderate the association between urgency and binge eating. Specifically, at high levels of attention to emotions and clarity of emotions—when adaptive emotion regulation was being facilitated—we predicted that the positive association between urgency and binge eating would be attenuated. In contrast, at low levels of attention to emotions and clarity of emotions—when adaptive emotion regulation was being inhibited—we predicted that the positive association between urgency and binge eating would be amplified. 2. Method 2.1. Participants Participants were 249 female undergraduates (mean age = 19.0; SD = 1.1). Participants provided voluntary informed consent, and this study was approved by the university's Institutional Review Board. The majority of participants (63.9%) was European American, while 16.9% were Asian/Asian American, 7.6% were Black/African American, 6.0% were Latina, 3.2% were Biracial, and 2.4% were from various other races or ethnicities. 2.2. Measures 2.2.1. Binge eating relevant thoughts and behaviors 1 The Bulimia (B) scale from the Eating Disorders Inventory (EDI-3; Garner, 2004) was used to measure the tendency to think about, and engage in, bouts of uncontrollable overeating (i.e., binge eating). Participants responded to each of 8 items (α = .81; e.g., “I stuff myself with food; I eat when I am upset”) 2 on a scale ranging from 1 (never) to 6 (always), and higher scores indicated higher levels of binge eating.3 The B scale has been shown to be stable over time and to predict the onset of eating problems (Garner, 2004). It has been found to be a reliable measure for those with Binge Eating Disorder/BED (Tasca, Illing, Lybanon-Daigle, Bissada, & Balfour, 2003), and to be sensitive to frequency and severity of binge eating symptoms (e.g., Deumens, Noorthoorn, & Verbraak, 2012). 2.2.2. Emotional awareness Two domains of emotional awareness—attention to emotion and clarity of emotion—were measured using subscales from the Trait Meta Mood Scale (TMMS; Salovey, Mayer, Goldman, Turvey, & Palfai, 1995). The attention subscale consists of 13 items and measures the degree to which participants notice or think about their feelings (α = .85; e.g., “I pay a lot of attention to how I feel”). The clarity subscale consists of 11 items and assesses how well participants identify, discriminate between, and understand their feelings (α = .84; e.g., “I am usually very clear about my feelings”). Participants responded to items on a scale ranging from 1 (strongly disagree) to 5 (strongly agree) and higher scores indicated higher levels of clarity or attention. Both the clarity and attention subscales have been found to have excellent psychometric properties and reasonable evidence of convergent and discriminant validity 1
For the sake of efficiency, the term “binge eating” will be used to signify “binge eating relevant thoughts and behaviors.” 2 All α reported are based on data from the present study. 3 Other than one item that refers to thoughts of vomiting, all items on the B scale refer to thoughts and behaviors associated with binge eating. Results presented include this item; the results did not change when the vomiting item was excluded from analyses.
(Salovey et al., 1995). The TMMS has been validated in a variety of clinical and nonclinical samples (Salovey et al., 1995). 2.2.3. Urgency The Urgency subscale from the UPPS Impulsive Behavior Scale (Whiteside & Lynam, 2001) was used to measure the degree to which individuals act rashly in the face of negative affect. Participants responded to each of 12 items (α = .87; e.g., “I often make matters worse because I act without thinking when I am upset”) on a scale ranging from 1 (not true of me) to 5 (very true of me), and higher scores indicated higher levels of urgency. The Urgency subscale has demonstrated good psychometric properties and has been used with patients who display impulsivity in a variety of settings (Whiteside & Lynam, 2001). 2.2.4. Trait negative affect We measured NA to enable us to rule out the possibility that the relation between binge eating, urgency and emotional awareness was merely an artifact of shared variance with NA. The NA scale from the Positive and Negative Affect Schedule (PANAS; Watson, Clark, & Tellegen, 1988) was used to measure trait NA. Participants indicated their experience of NA “on average” (α = .84; e.g., “distressed”) on a 5-point scale. The PANAS has good convergent and discriminant validity (Watson et al., 1988). It has demonstrated good test–retest reliabilities as well as internal consistencies in undergraduate samples (Watson et al., 1988). 3. Results Descriptive statistics for and correlations among all variables are depicted in Table 1. As expected, binge eating was positively associated with both urgency and NA. In contrast, binge eating was negatively associated with clarity of emotion and attention to emotion. We next explored whether clarity of emotion and attention to emotion would moderate the association between binge eating and urgency, after taking NA into account. To do so, we conducted hierarchical regression analyses. Specifically we built two regression models predicting binge eating scores, entering in the following order: (1) trait NA; (2) urgency and an emotional awareness variable (clarity of emotion or attention to emotion); and (3) the two-way interaction between the emotional awareness variable and urgency (e.g., clarity of emotion × urgency). Table 2 presents the results of these analyses. Both the clarity of emotion × urgency interaction and the attention to emotion × urgency interaction significantly improved the prediction of binge eating scores, over and above NA. Slope tests further revealed the nature of the interactions. Urgency and binge eating were positively associated at average levels of the emotional awareness components (clarity of emotion: ß = .30, p b .001; attention to emotion: ß = .32, p b .001). However, by comparison, as predicted, this positive association was weaker at high levels of emotional awareness (clarity of
Table 1 Descriptive statistics for and correlations between all study variables. Variables
1
2
1. Binge Eating (EDI-3 Bulimia Scale) 2. Urgency (UPPS) 3. Negative Affect (PANAS) 4. Clarity of Emotion (TMMS-Clarity) 5. Attention to Emotion (TMMS-Attention) M SD Min Max
–
.49⁎⁎ .32⁎⁎ −.31⁎⁎ −.14⁎ – .32⁎⁎ −.44⁎⁎ −.05 – −.33⁎⁎ −.15⁎ – .20⁎⁎
4.3 4.4 0.0 26.0
27.8 6.6 12.0 46.0
Note: N = 249. ⁎p b .05; ⁎⁎p b .01.
3
20.7 6.1 10.0 41.0
4
37.7 7.3 14.0 55.0
5
– 51.8 7.3 22.0 65.0
E. Manjrekar et al. / Eating Behaviors 17 (2015) 99–102 Table 2 Summary of hierarchical regression analyses predicting binge eating. Criterion: Binge Eating (EDI-3 Bulimia Scale) Step 1 Negative affect Step 2 Clarity of emotion Urgency Step 3 Clarity of emotion × urgency Step 1 Negative affect Step 2 Attention to emotion Urgency Step 3 Attention to emotion × urgency
ΔR2
ß .31⁎⁎ −.09 .40⁎⁎ −.13⁎ .31⁎⁎
.10⁎⁎ .18⁎⁎
.02⁎ .10⁎⁎ .18⁎⁎
−.10 .44⁎⁎ .04⁎⁎ −.20⁎⁎
⁎p b .05; ⁎⁎p b .01.
emotion: ß = .21, p b .001; attention to emotion: ß = .19, p b .001), and stronger at low levels of emotional awareness (clarity of emotion: ß = .38, p b .001; attention to emotion: ß = .46, p b .001). 4. Discussion We found that higher levels of attention to emotions and clarity of emotions mitigated the association between urgency and binge eating, whereas lower levels of attention to emotions and clarity of emotions enhanced this association. Given the cross-sectional, correlational study design, we cannot ascertain the exact mechanisms responsible for the findings; however, theory and past research suggest possible explanations. The “affect as information” hypothesis (Clore & Huntsinger, 2007) posits that the degree of accuracy in perceiving and understanding emotions influences the quality of available information upon which judgments and behaviors are based. Therefore, higher levels of attention to emotions and clarity of emotions are expected to aid adaptive emotion regulation strategies by providing more accurate emotional data. Support for this explanation includes findings from a recent study by Subic-Wrana et al. (2014), which suggested that higher levels of emotional awareness were a precondition to using reappraisal—an adaptive emotion regulation strategy—effectively. With regard to the present study, it is possible that having higher levels of emotional awareness contributes to more adaptive emotion regulation, which counteracts the deleterious effect of urgency, and in turn leads to diminished binge eating outcomes. However, future research is needed to elucidate the mechanisms responsible for the moderation effects found in the present study. For instance, an experimental design that manipulates levels of emotional awareness in the context of urgency, while examining the effectiveness of various adaptive emotional regulation strategies and binge eating outcomes, could be beneficial. Our findings have implications for future research and practice regarding the prevention and treatment of binge eating. They suggest that increased emotional awareness competencies might act as protective factors against habitual binge eating, especially in the presence of high urgency. This concept could be further explored with existing therapeutic approaches such as mindfulness-based approaches, which are thought to increase emotional awareness (Hill & Updegraff, 2012). Specifically, future research might explore how increasing levels of clarity of emotions and attention to emotions, in the context of treating binge eating, influences binge eating outcomes. Increased emotional awareness competencies might also be discussed and promoted in educational/parental interventions addressing binge eating. As with all research, the present study had both strengths and limitations. One strength of the study was its use of a large sample. Additionally, testing the present hypotheses in a sample of undergraduate women is a particularly useful first step, given that young adult females
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are at the highest risk for eating disorder symptoms (Hudson, Hiripi, Pope, & Kessler, 2007). However, future research using community and clinical samples is necessary for understanding the role of urgency and emotional awareness in relation to more extreme eating-related problems. Finally, given that the number of men suffering from eating disorder symptoms is increasing (see Hudson et al., 2007), it will be beneficial to explore questions from the present study with male participants. Prior research conducted with male samples (e.g., Lavender & Anderson, 2010) has found that difficulty with emotion regulation contributes unique variance to disordered eating symptoms (over and above NA). This suggests that the present study's findings are likely relevant to males. Role of funding sources There was no external funding for this study.
Contributors H. Berenbaum and N. Bhayani designed the study and wrote the study protocol. N. Bhayani collected the study data. E. Manjrekar conducted statistical analyses and literature searches. H. Berenbaum and E. Manjrekar were responsible for portions of the first draft, and all authors contributed to the final version of the manuscript. All authors have approved the final manuscript.
Conflict of interest The authors have no conflicts of interest to disclose.
References American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (Fifth ed.). Arlington, VA: American Psychiatric Publishing. Anestis, M. D., Bagge, C. L., Tull, M. T., & Joiner, T. E. (2011). Clarifying the role of emotion dysregulation in the interpersonal–psychological theory of suicidal behavior in an undergraduate sample. Journal of Psychiatric Research, 45, 603–611. Anestis, M. D., Selby, E. A., & Joiner, T. E. (2007). The role of urgency in maladaptive behaviors. Behaviour Research and Therapy, 45, 3018–3029. Clore, G. L., & Huntsinger, J. R. (2007). How emotions inform judgment and regulate thought. Trends in Cognitive Sciences, 11, 393–399. Coffey, E., Berenbaum, H., & Kerns, J. G. (2003). The dimensions of emotional intelligence, alexithymia, and mood awareness: Associations with personality and performance on an emotional Stroop task. Cognition and Emotion, 17, 671–679. Deumens, R. A. E., Noorthoorn, E. O., & Verbraak, M. J. P. M. (2012). Predictors for treatment outcome of binge eating with obesity: A naturalistic study. Eating Disorders: The Journal of Treatment & Prevention, 20, 276–287. Emery, R. L., King, K. M., Fischer, S. F., & Davis, K. R. (2013). The moderating role of negative urgency on the prospective association between dietary restraint and binge eating. Appetite, 71, 113–119. Fischer, S., Peterson, C. M., & McCarthy, D. (2013). A prospective test of the influence of negative urgency and expectancies on binge eating and purging. Psychology of Addictive Behaviors, 27, 294–300. Garner, D. M. (2004). Eating Disorder Inventory-3: Professional manual. Lutz, FL: Psychological Assessment Resources, Inc. Gohm, C. L., & Clore, G. L. (2002). Four latent traits of emotional experience and their involvement in well-being, coping, and attributional style. Cognition and Emotion, 16, 495–518. Hill, C. L. M., & Updegraff, J. A. (2012). Mindfulness and its relationship to emotional regulation. Emotion, 12, 81–90. Hudson, J. I., Hiripi, E., Pope, H. G., & Kessler, R. C. (2007). The prevalence and correlates of eating disorders in the national comorbidity survey replication. Biological Psychiatry, 61, 348–358. Lavender, J. M., & Anderson, D. A. (2010). Contribution of emotion regulation difficulties to disordered eating and body dissatisfaction in college men. International Journal of Eating Disorders, 43, 352–357. Moon, A., & Berenbaum, H. (2009). Emotional awareness and emotional eating. Cognition and Emotion, 23, 417–429. Racine, S. E., Keel, P. K., Burt, S. A., Sisk, C. L., Neale, M., Boker, S., et al. (2013). Exploring the relationship between negative urgency and dysregulated eating: Etiologic associations and the role of negative affect. Journal of Abnormal Psychology, 122, 433–444. 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 MetaMood Scale. In J. W. Pennebaker (Ed.), Emotion, disclosure, & health (pp. 125–154). Washington, DC: American Psychological Association. Selby, E. A., Anestis, M. D., & Joiner, T. E. (2008). Understanding the relationship between emotional and behavioral dysregulation: Emotional cascades. Behaviour Research and Therapy, 46, 593–611. Subic-Wrana, C., Beutel, M. E., Brähler, E., Stöbel-Richter, Y., Knebel, A., Lane, R. D., et al. (2014). How is emotional awareness related to emotion regulation strategies and self-reported negative affect in the general population? PLoS ONE, 9. http://dx.doi. org/10.1371/journal.pone.0091846.
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Tasca, G. A., Illing, V., Lybanon-Daigle, V., Bissada, H., & Balfour, L. (2003). Psychometric properties of the eating disorders inventory-2 among women seeking treatment for binge eating disorder. Assessment, 10, 228–236. Watson, D., Clark, L. A., & Tellegen, A. (1988). Development and validation of brief measures of positive and negative affect: The PANAS scales. Journal of Personality and Social Psychology, 54, 1063–1070.
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. Whiteside, S. P., & Lynam, D. R. (2001). The five factor model and impulsivity: Using a structural model of personality to understand impulsivity. Personality and Individual Differences, 30, 669–689.
Contents lists available at ScienceDirect
Eating Behaviors
Investigating the moderating role of emotional awareness in the association between urgency and binge eating Eishita Manjrekar ⁎, Howard Berenbaum, Natasha Bhayani Department of Psychology, University of Illinois at Urbana-Champaign, 603 E. Daniel St., Champaign, IL 61820, USA
a r t i c l e
i n f o
Article history: Received 13 August 2014 Received in revised form 26 October 2014 Accepted 28 January 2015 Available online 4 February 2015 Keywords: Binge eating Urgency Emotional awareness Clarity of emotions Attention to emotions
a b s t r a c t Binge eating has been found to be associated with urgency (the tendency to act impulsively in response to negative affect) and emotional awareness (i.e., attention to emotions, clarity of emotions). The present study tested the hypothesis that the relation between binge eating and urgency would be moderated by emotional awareness, over and above negative affect. Participants were 249 female college students. Items from the Trait Meta Mood Scale (TMMS), the Urgency subscale of the UPPS Impulsive Behavior Scale, and the Bulimia (B) subscale of the Eating Disorders Inventory (EDI-3) were administered. As predicted, emotional awareness moderated the link between urgency and binge eating. Both Urgency × Attention to emotions and Urgency × Clarity of emotions significantly predicted binge eating scores, even after taking into account negative affect. Consistent with past research, higher levels of urgency were associated with higher levels of binge eating, even after taking negative affect into account. However, the associations were particularly strong among individuals with low levels of attention to emotions and low levels of clarity of emotions. The findings from this study have implications for future research examining binge eating. © 2015 Elsevier Ltd. All rights reserved.
1. Introduction Binge eating is characterized by the consumption of an unambiguously large quantity of food in a short period of time, as well as a lack of sense of control (Emery, King, Fischer, & Davis, 2013). It is a central feature of bulimia nervosa and binge eating disorder (American Psychiatric Association, 2013). Therefore, research exploring factors that influence binge eating is important given the potential implications for improving our understanding of its etiology and treatment. The association between one aspect of impulsivity—negative urgency, or urgency—and binge eating has been especially well documented in past studies (e.g., Emery et al., 2013; Fischer, Peterson, & McCarthy, 2013). Defined as the propensity to act in a rash manner in response to distressed feelings (Whiteside & Lynam, 2001), urgency has been found to predict binge eating over and above negative affect (NA; Racine et al., 2013). Similarly, it has been linked to a host of problematic outcomes such as non-suicidal self-injury and substance abuse (Selby, Anestis, & Joiner, 2008). Urgency has been conceptualized as a component of emotion dysregulation (Anestis, Bagge, Tull, & Joiner, 2011) that encourages behavioral dysregulation, including binge eating (Anestis, Selby, & Joiner, 2007). Specifically, it has been argued that urgency might promote the occurrences of maladaptive behavioral coping strategies such as binge eating, which serve to down regulate intense negative ⁎ Corresponding author. Tel.: +1 515 779 0402; fax: +1 217 244 5876. E-mail address: [email protected] (E. Manjrekar).
http://dx.doi.org/10.1016/j.eatbeh.2015.01.010 1471-0153/© 2015 Elsevier Ltd. All rights reserved.
emotions (Selby et al., 2008). In other words, in an attempt to feel better, individuals with high levels of urgency are more likely to react impulsively to negative affect by engaging in behaviors such as binge eating. However, urgency is not the only factor that influences binge eating. Factors that mobilize adaptive emotion regulation would be expected to counteract the effect of urgency on binge eating. Specifically, factors that promote adaptive emotion regulation strategies would protect against rash action (e.g., binge eating) in the face of negative affect, thereby moderating the association between urgency and binge eating. Emotional awareness is one factor that we expected to moderate the impact of urgency on binge eating. It can be divided into two distinguishable components (Coffey, Berenbaum, & Kerns, 2003; Gohm & Clore, 2002): (a) attention to emotions—the extent to which one attends to and values one's own emotions; and (b) clarity of emotions—the extent to which one can identify and describe one's own emotions. According to the “affect as information” hypothesis, both attention to emotion and clarity of emotion are thought to mobilize emotion regulation and influence behavioral outcomes (e.g., Gohm & Clore, 2002). Specifically, it has been argued that affect contributes to the effectiveness of individuals' judgments and actions by providing bodily and experiential information (Clore & Huntsinger, 2007). Therefore, paying more attention to and being clearer about affect-relevant information is likely to result in more successful emotional and behavioral outcomes (Gohm & Clore, 2002). Unsurprisingly, past research has found that greater levels of clarity of emotions and attention to emotions were associated with less binge eating, and less overeating (Moon & Berenbaum, 2009; Whiteside et al., 2007).
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E. Manjrekar et al. / Eating Behaviors 17 (2015) 99–102
To summarize, past research has found that: (a) urgency and binge eating are positively associated even after controlling for NA; and (b) both attention to emotions and clarity of emotions are positively associated with successful emotional and behavioral outcomes (including less binge eating and overeating). We expected to replicate these findings in the present study. Additionally, given that both clarity of emotions and attention to emotions can facilitate adaptive emotion regulation, we predicted that they would moderate the association between urgency and binge eating. Specifically, at high levels of attention to emotions and clarity of emotions—when adaptive emotion regulation was being facilitated—we predicted that the positive association between urgency and binge eating would be attenuated. In contrast, at low levels of attention to emotions and clarity of emotions—when adaptive emotion regulation was being inhibited—we predicted that the positive association between urgency and binge eating would be amplified. 2. Method 2.1. Participants Participants were 249 female undergraduates (mean age = 19.0; SD = 1.1). Participants provided voluntary informed consent, and this study was approved by the university's Institutional Review Board. The majority of participants (63.9%) was European American, while 16.9% were Asian/Asian American, 7.6% were Black/African American, 6.0% were Latina, 3.2% were Biracial, and 2.4% were from various other races or ethnicities. 2.2. Measures 2.2.1. Binge eating relevant thoughts and behaviors 1 The Bulimia (B) scale from the Eating Disorders Inventory (EDI-3; Garner, 2004) was used to measure the tendency to think about, and engage in, bouts of uncontrollable overeating (i.e., binge eating). Participants responded to each of 8 items (α = .81; e.g., “I stuff myself with food; I eat when I am upset”) 2 on a scale ranging from 1 (never) to 6 (always), and higher scores indicated higher levels of binge eating.3 The B scale has been shown to be stable over time and to predict the onset of eating problems (Garner, 2004). It has been found to be a reliable measure for those with Binge Eating Disorder/BED (Tasca, Illing, Lybanon-Daigle, Bissada, & Balfour, 2003), and to be sensitive to frequency and severity of binge eating symptoms (e.g., Deumens, Noorthoorn, & Verbraak, 2012). 2.2.2. Emotional awareness Two domains of emotional awareness—attention to emotion and clarity of emotion—were measured using subscales from the Trait Meta Mood Scale (TMMS; Salovey, Mayer, Goldman, Turvey, & Palfai, 1995). The attention subscale consists of 13 items and measures the degree to which participants notice or think about their feelings (α = .85; e.g., “I pay a lot of attention to how I feel”). The clarity subscale consists of 11 items and assesses how well participants identify, discriminate between, and understand their feelings (α = .84; e.g., “I am usually very clear about my feelings”). Participants responded to items on a scale ranging from 1 (strongly disagree) to 5 (strongly agree) and higher scores indicated higher levels of clarity or attention. Both the clarity and attention subscales have been found to have excellent psychometric properties and reasonable evidence of convergent and discriminant validity 1
For the sake of efficiency, the term “binge eating” will be used to signify “binge eating relevant thoughts and behaviors.” 2 All α reported are based on data from the present study. 3 Other than one item that refers to thoughts of vomiting, all items on the B scale refer to thoughts and behaviors associated with binge eating. Results presented include this item; the results did not change when the vomiting item was excluded from analyses.
(Salovey et al., 1995). The TMMS has been validated in a variety of clinical and nonclinical samples (Salovey et al., 1995). 2.2.3. Urgency The Urgency subscale from the UPPS Impulsive Behavior Scale (Whiteside & Lynam, 2001) was used to measure the degree to which individuals act rashly in the face of negative affect. Participants responded to each of 12 items (α = .87; e.g., “I often make matters worse because I act without thinking when I am upset”) on a scale ranging from 1 (not true of me) to 5 (very true of me), and higher scores indicated higher levels of urgency. The Urgency subscale has demonstrated good psychometric properties and has been used with patients who display impulsivity in a variety of settings (Whiteside & Lynam, 2001). 2.2.4. Trait negative affect We measured NA to enable us to rule out the possibility that the relation between binge eating, urgency and emotional awareness was merely an artifact of shared variance with NA. The NA scale from the Positive and Negative Affect Schedule (PANAS; Watson, Clark, & Tellegen, 1988) was used to measure trait NA. Participants indicated their experience of NA “on average” (α = .84; e.g., “distressed”) on a 5-point scale. The PANAS has good convergent and discriminant validity (Watson et al., 1988). It has demonstrated good test–retest reliabilities as well as internal consistencies in undergraduate samples (Watson et al., 1988). 3. Results Descriptive statistics for and correlations among all variables are depicted in Table 1. As expected, binge eating was positively associated with both urgency and NA. In contrast, binge eating was negatively associated with clarity of emotion and attention to emotion. We next explored whether clarity of emotion and attention to emotion would moderate the association between binge eating and urgency, after taking NA into account. To do so, we conducted hierarchical regression analyses. Specifically we built two regression models predicting binge eating scores, entering in the following order: (1) trait NA; (2) urgency and an emotional awareness variable (clarity of emotion or attention to emotion); and (3) the two-way interaction between the emotional awareness variable and urgency (e.g., clarity of emotion × urgency). Table 2 presents the results of these analyses. Both the clarity of emotion × urgency interaction and the attention to emotion × urgency interaction significantly improved the prediction of binge eating scores, over and above NA. Slope tests further revealed the nature of the interactions. Urgency and binge eating were positively associated at average levels of the emotional awareness components (clarity of emotion: ß = .30, p b .001; attention to emotion: ß = .32, p b .001). However, by comparison, as predicted, this positive association was weaker at high levels of emotional awareness (clarity of
Table 1 Descriptive statistics for and correlations between all study variables. Variables
1
2
1. Binge Eating (EDI-3 Bulimia Scale) 2. Urgency (UPPS) 3. Negative Affect (PANAS) 4. Clarity of Emotion (TMMS-Clarity) 5. Attention to Emotion (TMMS-Attention) M SD Min Max
–
.49⁎⁎ .32⁎⁎ −.31⁎⁎ −.14⁎ – .32⁎⁎ −.44⁎⁎ −.05 – −.33⁎⁎ −.15⁎ – .20⁎⁎
4.3 4.4 0.0 26.0
27.8 6.6 12.0 46.0
Note: N = 249. ⁎p b .05; ⁎⁎p b .01.
3
20.7 6.1 10.0 41.0
4
37.7 7.3 14.0 55.0
5
– 51.8 7.3 22.0 65.0
E. Manjrekar et al. / Eating Behaviors 17 (2015) 99–102 Table 2 Summary of hierarchical regression analyses predicting binge eating. Criterion: Binge Eating (EDI-3 Bulimia Scale) Step 1 Negative affect Step 2 Clarity of emotion Urgency Step 3 Clarity of emotion × urgency Step 1 Negative affect Step 2 Attention to emotion Urgency Step 3 Attention to emotion × urgency
ΔR2
ß .31⁎⁎ −.09 .40⁎⁎ −.13⁎ .31⁎⁎
.10⁎⁎ .18⁎⁎
.02⁎ .10⁎⁎ .18⁎⁎
−.10 .44⁎⁎ .04⁎⁎ −.20⁎⁎
⁎p b .05; ⁎⁎p b .01.
emotion: ß = .21, p b .001; attention to emotion: ß = .19, p b .001), and stronger at low levels of emotional awareness (clarity of emotion: ß = .38, p b .001; attention to emotion: ß = .46, p b .001). 4. Discussion We found that higher levels of attention to emotions and clarity of emotions mitigated the association between urgency and binge eating, whereas lower levels of attention to emotions and clarity of emotions enhanced this association. Given the cross-sectional, correlational study design, we cannot ascertain the exact mechanisms responsible for the findings; however, theory and past research suggest possible explanations. The “affect as information” hypothesis (Clore & Huntsinger, 2007) posits that the degree of accuracy in perceiving and understanding emotions influences the quality of available information upon which judgments and behaviors are based. Therefore, higher levels of attention to emotions and clarity of emotions are expected to aid adaptive emotion regulation strategies by providing more accurate emotional data. Support for this explanation includes findings from a recent study by Subic-Wrana et al. (2014), which suggested that higher levels of emotional awareness were a precondition to using reappraisal—an adaptive emotion regulation strategy—effectively. With regard to the present study, it is possible that having higher levels of emotional awareness contributes to more adaptive emotion regulation, which counteracts the deleterious effect of urgency, and in turn leads to diminished binge eating outcomes. However, future research is needed to elucidate the mechanisms responsible for the moderation effects found in the present study. For instance, an experimental design that manipulates levels of emotional awareness in the context of urgency, while examining the effectiveness of various adaptive emotional regulation strategies and binge eating outcomes, could be beneficial. Our findings have implications for future research and practice regarding the prevention and treatment of binge eating. They suggest that increased emotional awareness competencies might act as protective factors against habitual binge eating, especially in the presence of high urgency. This concept could be further explored with existing therapeutic approaches such as mindfulness-based approaches, which are thought to increase emotional awareness (Hill & Updegraff, 2012). Specifically, future research might explore how increasing levels of clarity of emotions and attention to emotions, in the context of treating binge eating, influences binge eating outcomes. Increased emotional awareness competencies might also be discussed and promoted in educational/parental interventions addressing binge eating. As with all research, the present study had both strengths and limitations. One strength of the study was its use of a large sample. Additionally, testing the present hypotheses in a sample of undergraduate women is a particularly useful first step, given that young adult females
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are at the highest risk for eating disorder symptoms (Hudson, Hiripi, Pope, & Kessler, 2007). However, future research using community and clinical samples is necessary for understanding the role of urgency and emotional awareness in relation to more extreme eating-related problems. Finally, given that the number of men suffering from eating disorder symptoms is increasing (see Hudson et al., 2007), it will be beneficial to explore questions from the present study with male participants. Prior research conducted with male samples (e.g., Lavender & Anderson, 2010) has found that difficulty with emotion regulation contributes unique variance to disordered eating symptoms (over and above NA). This suggests that the present study's findings are likely relevant to males. Role of funding sources There was no external funding for this study.
Contributors H. Berenbaum and N. Bhayani designed the study and wrote the study protocol. N. Bhayani collected the study data. E. Manjrekar conducted statistical analyses and literature searches. H. Berenbaum and E. Manjrekar were responsible for portions of the first draft, and all authors contributed to the final version of the manuscript. All authors have approved the final manuscript.
Conflict of interest The authors have no conflicts of interest to disclose.
References American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (Fifth ed.). Arlington, VA: American Psychiatric Publishing. Anestis, M. D., Bagge, C. L., Tull, M. T., & Joiner, T. E. (2011). Clarifying the role of emotion dysregulation in the interpersonal–psychological theory of suicidal behavior in an undergraduate sample. Journal of Psychiatric Research, 45, 603–611. Anestis, M. D., Selby, E. A., & Joiner, T. E. (2007). The role of urgency in maladaptive behaviors. Behaviour Research and Therapy, 45, 3018–3029. Clore, G. L., & Huntsinger, J. R. (2007). How emotions inform judgment and regulate thought. Trends in Cognitive Sciences, 11, 393–399. Coffey, E., Berenbaum, H., & Kerns, J. G. (2003). The dimensions of emotional intelligence, alexithymia, and mood awareness: Associations with personality and performance on an emotional Stroop task. Cognition and Emotion, 17, 671–679. Deumens, R. A. E., Noorthoorn, E. O., & Verbraak, M. J. P. M. (2012). Predictors for treatment outcome of binge eating with obesity: A naturalistic study. Eating Disorders: The Journal of Treatment & Prevention, 20, 276–287. Emery, R. L., King, K. M., Fischer, S. F., & Davis, K. R. (2013). The moderating role of negative urgency on the prospective association between dietary restraint and binge eating. Appetite, 71, 113–119. Fischer, S., Peterson, C. M., & McCarthy, D. (2013). A prospective test of the influence of negative urgency and expectancies on binge eating and purging. Psychology of Addictive Behaviors, 27, 294–300. Garner, D. M. (2004). Eating Disorder Inventory-3: Professional manual. Lutz, FL: Psychological Assessment Resources, Inc. Gohm, C. L., & Clore, G. L. (2002). Four latent traits of emotional experience and their involvement in well-being, coping, and attributional style. Cognition and Emotion, 16, 495–518. Hill, C. L. M., & Updegraff, J. A. (2012). Mindfulness and its relationship to emotional regulation. Emotion, 12, 81–90. Hudson, J. I., Hiripi, E., Pope, H. G., & Kessler, R. C. (2007). The prevalence and correlates of eating disorders in the national comorbidity survey replication. Biological Psychiatry, 61, 348–358. Lavender, J. M., & Anderson, D. A. (2010). Contribution of emotion regulation difficulties to disordered eating and body dissatisfaction in college men. International Journal of Eating Disorders, 43, 352–357. Moon, A., & Berenbaum, H. (2009). Emotional awareness and emotional eating. Cognition and Emotion, 23, 417–429. Racine, S. E., Keel, P. K., Burt, S. A., Sisk, C. L., Neale, M., Boker, S., et al. (2013). Exploring the relationship between negative urgency and dysregulated eating: Etiologic associations and the role of negative affect. Journal of Abnormal Psychology, 122, 433–444. 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 MetaMood Scale. In J. W. Pennebaker (Ed.), Emotion, disclosure, & health (pp. 125–154). Washington, DC: American Psychological Association. Selby, E. A., Anestis, M. D., & Joiner, T. E. (2008). Understanding the relationship between emotional and behavioral dysregulation: Emotional cascades. Behaviour Research and Therapy, 46, 593–611. Subic-Wrana, C., Beutel, M. E., Brähler, E., Stöbel-Richter, Y., Knebel, A., Lane, R. D., et al. (2014). How is emotional awareness related to emotion regulation strategies and self-reported negative affect in the general population? PLoS ONE, 9. http://dx.doi. org/10.1371/journal.pone.0091846.
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Tasca, G. A., Illing, V., Lybanon-Daigle, V., Bissada, H., & Balfour, L. (2003). Psychometric properties of the eating disorders inventory-2 among women seeking treatment for binge eating disorder. Assessment, 10, 228–236. Watson, D., Clark, L. A., & Tellegen, A. (1988). Development and validation of brief measures of positive and negative affect: The PANAS scales. Journal of Personality and Social Psychology, 54, 1063–1070.
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. Whiteside, S. P., & Lynam, D. R. (2001). The five factor model and impulsivity: Using a structural model of personality to understand impulsivity. Personality and Individual Differences, 30, 669–689.