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The effects of avoidance coping and coping self-efficacy on eating disorder attitudes and behaviors: A stress-diathesis model
Eating Behaviors 13 (2012) 293–296
Contents lists available at SciVerse ScienceDirect
Eating Behaviors
The effects of avoidance coping and coping self-efficacy on eating disorder attitudes and behaviors: A stress-diathesis model Laura MacNeil ⁎, Christianne Esposito-Smythers, Robyn Mehlenbeck, Julie Weismoore George Mason University, Fairfax, VA, United States
a r t i c l e
i n f o
Article history: Received 23 August 2011 Received in revised form 29 May 2012 Accepted 20 June 2012 Available online 24 August 2012 Keywords: Eating disorder Stress-diathesis Coping
a b s t r a c t The present study employed a series of stress-diathesis models to examine whether avoidance coping and poor coping self-efficacy contribute to disordered eating attitudes and behaviors in a sample of college students. The sample included one hundred fifteen undergraduate students (28.7% male; 71.3% female). Participants completed self-report measures to assess daily stressors, coping style, coping self-efficacy, and eating disorder attitudes and behaviors. As predicted, among students with an avoidance coping style, those who reported more daily stressors exhibited higher eating disorder attitudes and behaviors than those with less daily hassles. Contrary to study hypothesis, number of daily hassles did not moderate the association between coping self-efficacy and eating disorder attitudes and behaviors. However, there was a significant main effect for coping self-efficacy, suggesting that students who lack confidence in their coping abilities are more likely to have problematic eating attitudes and behaviors, regardless of their level of daily stress. Clinically, results suggest that students who enter college with an avoidance coping style and poor coping self-efficacy may be at risk for disordered eating, particularly with the onset of associated stress. Teaching students active problem-focused coping skills to deal with daily hassles associated with college life, and providing opportunities for repeated practice to bolster self-efficacy, may help prevent and/or reduce disordered eating attitudes and behaviors. © 2012 Elsevier Ltd. All rights reserved.
1. Introduction The stress-diathesis model of psychopathology suggests that people have, to varying degrees, vulnerabilities or “diatheses” that predispose them toward developing mental health problems. When these vulnerabilities interact with stressful life events, they trigger the onset of mental health problems (Slavik & Croake, 2006). Consistent with this model, higher perceived stress from daily hassles has been associated with greater eating disorder attitudes and behaviors as well as binge eating (Ball & Lee, 2002; Crowther, Snaftner, Bonafazi, & Shepherd, 2001; Freeman & Gil, 2004; Smyth et al., 2007). Moreover, higher perfectionism (Ruggiero et al., 2008), pathological worries (Sassaroli & Ruggiero, 2005), and eating restraint (Tanofsky-Kraff, Wilfley, & Spurrell, 2000; Woods, Racine, & Klump, 2010), three sources of vulnerability, have been associated with higher eating disorder attitudes and behaviors among individuals who report greater stress from daily hassles. Not yet studied as a source of vulnerability in stress-diathesis models of eating pathology is coping behavior. The purpose of the present study was to examine
⁎ Corresponding author at: George Mason University, Psychology Department, 4400 University Drive, MS 3F5, Fairfax, VA 22030, United States. Tel.: +1 908 247 3419; fax: +1 703 993 1359. E-mail address: [email protected] (L. MacNeil). 1471-0153/$ – see front matter © 2012 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.eatbeh.2012.06.005
coping style and coping self-efficacy as potential vulnerability factors for eating pathology in the context of stress-diathesis models. Avoidance coping refers to coping with problems or negative affect through the avoidance of thoughts related to stressors, wishful thinking, emotional detachment or denial, and behavioral efforts to escape or avoid the problem (Christiano & Mizes, 1997). Avoidance strategies can interfere with the processing of stress-relevant information, attention to possible consequences, and planning actions, all of which are necessary for adaptive coping (Neckowitz & Morrison, 1991). Avoidance coping has been associated with eating disorder attitudes and behaviors among female undergraduates (Freeman & Gil, 2004; Koff & Sangani, 1997; Mayhew & Edelman, 1989; Sulkowski, Dempsey, & Dempsey, 2011) and individuals with an eating disorder (Ghaderi, 2000; Soukup, Beiler, & Terrell, 1990; Troop, Holbrey, Trowler, & Treasure, 1994). Relatedly, recovery from an eating disorder has been associated with a decrease in use of avoidance coping strategies (Bloks, van Furth, Callewart, & Hoek, 2004). Similar to coping style, a person's perceived capability to effectively manage life stressors, referred to as coping self-efficacy, may also be associated with eating related pathology. Only one study has examined the relationship between eating disorders and coping self-efficacy. Using a single item to assess coping self-efficacy, Lobera, Estebanez, Santiago Fernandez, Alvarez-Bautista, and Garrido (2009) found that individuals with an eating disorder reported lower levels of coping self-efficacy than those without this diagnosis in a college sample.
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L. MacNeil et al. / Eating Behaviors 13 (2012) 293–296
Relatedly, low problem-solving confidence, a construct related to coping self-efficacy, has been associated with eating pathology in samples with (Etringer, Altmaier, & Bowers, 1989; Soukup et al., 1990) and without (VanBoven & Espelage, 2006) diagnosable eating disorders. As is evident, stress from daily hassles is associated with maladaptive eating attitudes, behaviors, and disorders. Further, an avoidance coping style and poor coping self-efficacy are associated with eating pathology. Consistent with the cognitive theory of stress and coping (Lazarus & Folkman, 1984), factors such as one's ability to employ adaptive coping methods, as well as ones belief in his/her ability to cope with stress, will affect an individual's appraisal about the potential negative impact of stressors. Therefore, when under stress, those who employ avoidance coping methods and perceive that they are unable to effectively cope with life stress may be at particularly high risk for eating pathology. The present study employed a series of stress-diathesis models to examine whether avoidance coping style and poor coping selfefficacy serve as vulnerability factors for eating disorder attitudes and behaviors. We hypothesized that individuals with an avoidance coping style and poor coping self-efficacy would report greater eating disorder attitudes and behaviors when experiencing more versus less stress from daily hassles. These hypotheses were tested in a large undergraduate sample.
2.3.4. Eating Attitudes Test (EAT-26; Garner, Olmstead, Bohr, & Garfinkel, 1982) The EAT-26 is a 26-item measure that assesses thoughts, feelings, and behaviors associated with eating disorders. In the present study, coefficient α was .84. 3. Results 3.1. Descriptive statistics Descriptive statistics for measures of eating disorder attitudes and behaviors, daily hassles, coping self-efficacy, and avoidance coping are presented in Table 1. 3.2. Preliminary bivariate analyses Because scores on the EAT were positively skewed (>2), a natural logarithmic (ln) transformation was conducted to decrease the skew to b 1. All analyses were conducted with the transformed version of the variable. All other variables were normally distributed. Correlation coefficients were computed to examine the bivariate relationships between study variables (see Table 1).
2. Methods 2.1. Participants Participants in this study included 82 (71.3%) female and 33 (28.7%) male undergraduate psychology students who received class credit for their participation. Participants ranged in age from 18 to 29 (Mean= 20.4). Inclusion criteria included fluency in spoken and written English, participant consent, and status as an undergraduate student. Racial composition of the sample was 50.4% (58) Caucasian, 14.8% (17) Black or African American, 21.7% (25) Asian, and 13.0% (15) reported they were another race. 2.2. Procedure Participants were recruited from the undergraduate psychology pool as part of a larger study that examined the association between stress, coping, and mental health problems. The study was advertised through an online university system that describes opportunities for students to participate in psychology research studies for class credit. All study participants provided informed consent and met with a trained research assistant to complete study assessments. This study received full approval from the Human Subjects Review Board. 2.3. Measures 2.3.1. Revised University Student Hassles Scale (RUSHS; Pett & Johnson, 2005) The RUSHS is a 57-item measures that assesses the count, frequency, and severity of everyday hassles experienced by college students in the past month. The count scale was used in the present study. In the present study coefficient α for the count score was .89. 2.3.2. Coping Self-Efficacy Scale (CSES; Chesney, Neilands, Chambers, Taylor, & Folkman, 2006) The CSES is a 13-item measure that assesses perceived selfefficacy for coping with life challenges. In the present study coefficient α for the total score was .91. 2.3.3. Coping Styles and Flexibility Inventory (CSFI; Williams, 2002) The CSFI assesses the use of four types of coping strategies (avoidance, action-oriented, social support, positive reappraisal). The avoidance subscale, which had a coefficient α of .93, was used in the present study.
3.3. Linear regression analyses Two separate linear regression analyses were used to examine how each hypothesized diathesis (avoidance coping and coping self-efficacy) interacts with number of daily hassles to predict eating disorder attitudes and behaviors. As gender was correlated with eating disorder attitudes and behaviors, it was controlled for in the first step of each analysis. The hypothesized diathesis and number of daily hassles were entered in the second step. Finally, the interaction between the diathesis variable and daily hassles was entered in the third step for each analysis. All predictor variables were mean centered prior to computing interaction terms. Simple slope analyses were conducted to probe significant interactions. 3.4. Avoidance coping as a diathesis The first linear regression analysis examined the relationship between avoidance coping, daily hassles, and eating disorder attitudes and behaviors (see Table 2). There was no main effect of avoidance coping (β = .04, p = .68) or daily hassles on eating disorder attitudes and behaviors (β = .13, p = .16). There was a significant interaction between avoidance coping and number of daily hassles (β = .21, p b .05). Simple slopes analysis indicated that individuals who were higher in avoidance coping and experienced more daily hassles reported greater levels of eating disorder attitudes and behaviors than those who were high in avoidance coping, but experienced fewer daily hassles.
Table 1 Descriptive statistics and intercorrelations between variables of interest. Variable 1. 2. 3. 4.
RUSHS — total number CSE CSFI — avoidance EAT — 26a
M
SD
Range
1
2
3
4
33.49 86.22 35.09 7.30
8.89 21.55 10.49 7.57
13–57 44–130 12–59 0–56
–
−.13 –
.16⁎ −.23⁎⁎
.21⁎⁎ −.21⁎⁎
–
.05 –
Note: RUSHS = Revised University Student Hassles Scale; CSE = Coping Self-Efficacy; CSFI = Coping Styles and Flexibility Inventory; EAT-26 = Eating Attitudes and Behaviors Test — 26. a Correlations for the EAT-26 computed using the natural log transformation. ⁎ p b .10. ⁎⁎ p b .05.
L. MacNeil et al. / Eating Behaviors 13 (2012) 293–296 Table 2 Summary of the linear regression analyses predicting eating disorder attitudes and behaviors. Predictor variables
B
SEB
β
R2
ΔR2
Avoidance coping Step 1 Gender Step 2 Avoidance coping Number of daily hassles Step 3 Avoidance coping × number of daily hassles
−.37 .00 .01 .00
.15 .01 .01 .00
−.23⁎ .04 .13 .21⁎
.06 .09
.06⁎⁎ .03
.13
.04⁎
Coping self-efficacy Step 1 Gender Step 2 Coping self-efficacy Number of daily hassles Step 3 Coping self-efficacy × number of daily hassles
−.37 −.01 .01 .00
.15 .00 .01 .00
−.23⁎ −.19⁎ .13 −.05
.06 .12
.06⁎⁎ .06⁎
.12
.00
⁎ ⁎⁎
p b .05. p b .01.
3.5. Coping self-efficacy as a diathesis The second linear regression analysis examined the relationship between coping self-efficacy, number of daily hassles, and eating disorder attitudes and behaviors (see Table 2). There was a main effect of coping self-efficacy on eating disorder attitudes and behaviors (β = − .19, p b .05). Specifically, individuals with lower levels of coping self-efficacy reported more eating disorder attitudes and behaviors. There was no main effect of daily hassles on eating disorder attitudes and behaviors (β = .13, p = .16) or an interaction between coping self-efficacy and number of daily hassles (β = − .05, p = .63). 4. Discussion This is the first study to examine whether avoidance coping and coping self-efficacy serve as vulnerabilities for eating disorder attitudes and behaviors in the context of stress-diathesis models. Also notable is that the present study included both males and females, whereas the large majority of research in this area only includes females. Consistent with our hypothesis, we found that an avoidance coping style was associated with greater eating disorder attitudes and behaviors among college students who reported higher versus lower daily stress. This finding adds uniquely to the growing body of literature that has found support for stress-diathesis models of eating pathology (Heatherton & Baumeister, 1991; Ruggiero, Levi, Ciuna, & Sassaroli, 2003, Ruggiero et al., 2008; Sassaroli & Ruggiero, 2005; Tanofsky-Kraff et al., 2000). When avoidance coping methods fail to effectively reduce daily stress, it is possible that individuals with an avoidance coping style engage in disordered eating as a means to distract themselves from their persistent difficulties and resultant negative affect (Heatherton & Baumeister, 1991) or to obtain a feeling of control in the face of a situation that appears irresolvable (Bruch, 1982). In contrast to study hypotheses, number of daily hassles was not found to moderate the association between coping self-efficacy and eating disorder attitudes and behaviors. However, those with poorer coping self-efficacy did report greater eating disorder attitudes and behaviors in the sample as a whole. These latter results are consistent with prior research (Lobera et al., 2009). It appears that college students who lack confidence in their ability to cope with stressors, regardless of their level of current stress, are more likely to report problematic eating attitudes and behaviors. Unlike avoidance coping behaviors, which are employed in the face of stress, coping selfefficacy is a belief about oneself that is present regardless of current stress level. For individuals who do not believe that they possess the ability to actively cope with stress in general, eating disorder behavior itself may serve as a coping strategy (Bruch, 1973; Heatherton &
295
Baumeister, 1991). Coping self-efficacy may also reflect an aspect of one's self esteem. Low self-esteem too has been associated with disordered eating attitudes and behaviors (Fryer, Waller, & Kroese, 1997). Results of this study hold several important clinical implications. Clinically, results suggest that students who enter college with an avoidance coping style and poor coping self-efficacy may be at risk for disordered eating, particularly with the onset of associated stress. Therefore, it may be useful to develop and implement an educational curriculum for college students that provides instruction in problem-solving and encourages the use of active, approach-oriented coping strategies to address college related stressors. This could be accomplished through general prevention programs offered during college orientations, or classes for high risk groups of students, who may experience more difficulty and stress in the transition (such as transfer or international students) to college. Such programs may help students increase self-efficacy and adaptive coping skills in the face of stress, thus decreasing the risk for disordered eating attitudes and behaviors. Moreover, when working with undergraduate students presenting for counseling, it is important to assess for deficits in coping abilities and work on strengthening coping skills as indicated to best prevent eating pathology. While study results are novel and informative, there are a few limitations that deserve mention. Study results may not generalize to non-college populations or samples with greater eating pathology. Further, our study was correlational and thus causality cannot be established. Future research in this area would benefit from the use of other community based and/or clinical samples with a wider range of eating pathology. Use of a longitudinal design and more sophisticated assessment methods (e.g., ecological momentary assessment) would enable prospective measurement of study constructs in real-time. Such research may further improve our understanding of the manner in which coping behaviors contribute to the development and maintenance of eating disorder behaviors and attitudes. Role of funding sources No funding was provided for this research. Contributors Laura MacNeil, Dr. Christy Esposito-Smythers, and Julie Weissmore designed the study and wrote the protocol. Laura MacNeil conducted literature searches and provided summaries of previous research studies. Laura MacNeil and Dr. Christy Esposito Smythers conducted the statistical analysis. Laura MacNeil and Dr. Christy Esposito-Smythers wrote the first draft of the manuscript and all authors contributed to and have approved the final manuscript. Conflict of interest All authors declare that they have no conflicts of interest.
References Ball, K., & Lee, C. (2002). Psychological symptoms, coping, and symptoms of disordered eating in a community sample of young Australian women. International Journal of Eating Disorders, 31, 71–81. Bloks, H., van Furth, E. F., Callewart, I., & Hoek, H. W. (2004). Coping strategies and recovery in patients with a severe eating disorder. Eating Disorders, 12, 157–169. Bruch, H. (1973). Eating disorders: Obesity and anorexia nervosa. Riverside, CA: Behavioral Science Book Service. Bruch, H. (1982). Anorexia nervosa: Therapy and theory. The American Journal of Psychiatry, 139, 1531–1538. Chesney, M., Neilands, T., Chambers, D., Taylor, J., & Folkman, S. (2006). A validity and reliability study of the Coping Self-Efficacy Scale. British Journal of Health Psychology, 11, 421–437. Christiano, B., & Mizes, S. (1997). Appraisal and coping deficits associated with eating disorders: Implications for treatment. Cognitive Behavioral Practice, 4, 263–290. Crowther, J. H., Snaftner, J., Bonafazi, D. Z., & Shepherd, K. L. (2001). The role of daily hassles in binge eating. International Journal of Eating Disorders, 29, 449–454. Etringer, B. D., Altmaier, E. M., & Bowers, W. (1989). An investigation into the cognitive functioning of bulimic women. Journal of Counseling and Development, 68, 216–219. Freeman, L. M., & Gil, G. M. (2004). Daily stress, coping, and dietary restraint in binge eating. International Journal of Eating Disorders, 36, 204–212. Fryer, S., Waller, G., & Kroese, B. S. (1997). Stress, coping and disturbed eating attitudes in teenage girls. International Journal of Eating Disorders, 22, 427–436. Garner, D. M., Olmstead, M. P., Bohr, Y., & Garfinkel, P. E. (1982). The Eating Attitudes Test: Psychometric features and clinical correlates. Psychological Medicine, 12 (871-871).
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Ghaderi, A. (2000). Coping in dieting and eating disorders: A population-based study. The Journal of Nervous and Mental Disease, 188, 273–279. Heatherton, T. F., & Baumeister, R. F. (1991). Binge eating as escape from selfawareness. Psychological Bulletin, 110, 86–108. Koff, E., & Sangani, P. (1997). Effects of coping style and negative body image on eating disturbance. International Journal of Eating Disorders, 22, 51–56. Lazarus, R. S., & Folkman, S. (1984). Stress, appraisal and coping. New York: Springer. Lobera, I. J., Estebanez, S., Santiago Fernandez, M. J., Alvarez-Bautista, E., & Garrido, O. (2009). Coping strategies in eating disorders. European Eating Disorders Review, 17, 220–226. Mayhew, R., & Edelman, R. J. (1989). Self-esteem, irrational beliefs and coping strategies in relation to eating problems in a non-clinical population. Personality and Individual Differences, 10, 581–584. Neckowitz, P., & Morrison, T. L. (1991). Interactional coping strategies of normal weight bulimic women in intimate and non-intimate stressful situations. Psychological Reports, 69, 1167–1175. Pett, M. A., & Johnson, J. M. (2005). Development and psychometric evaluation of the Revised University Student Hassles Scale. Educational and Psychological Measurement, 65, 984–1010. Ruggiero, G. M., Levi, D., Ciuna, A., & Sassaroli, S. (2003). Stress situation reveals an association between perfectionism and drive for thinness. International Journal of Eating Disorders, 34, 220–226. Ruggiero, G. M., Bertelli, S., Boccalari, L., Centorame, F., Ditucci, A., La Mela, C., et al. (2008). The influence of stress on the relationship between cognitive variables and measures of eating disorders (in healthy female university students): A quasi experimental study. Eating and Weight Disorders, 13, 142–148. Sassaroli, S., & Ruggiero, G. M. (2005). The role of stress in the association between low self-esteem, perfectionism, and worry, and eating disorders. International Journal of Eating Disorders, 37, 135–141.
Slavik, S., & Croake, J. (2006). The individual psychology conception of depression as a stress-diathesis model. Journal of Individual Psychology, 62, 417–428. Smyth, J. M., Wonderlich, S. A., Heron, K. E., Sliwinski, M. J., Crosby, R. D., Mitchell, J. E., et al. (2007). Daily and momentary mood and stress are associated with binge eating and vomiting in bulimia nervosa patients in their natural environment. Journal of Consulting and Clinical Psychology, 75, 629–638. Soukup, V. M., Beiler, M. E., & Terrell, F. (1990). Stress, coping style, and problem solving ability among eating-disordered inpatients. Journal of Clinical Psychology, 46, 592–601. Sulkowski, M. L., Dempsey, J., & Dempsey, A. G. (2011). Effects of stress and coping on binge eating in female college students. Eating Behaviors, 12, 188–191. Tanofsky-Kraff, M., Wilfley, D. E., & Spurrell, E. (2000). Impact of interpersonal and ego-related stress on restrained eaters. International Journal of Eating Disorders, 27, 411–418. Troop, N. A., Holbrey, A., Trowler, R., & Treasure, J. L. (1994). Ways of coping in women with eating disorders. The Journal of Nervous and Mental Disease, 182, 535–540. VanBoven, A. M., & Espelage, D. L. (2006). Depressive symptoms, coping strategies and disordered eating among college women. Journal of Counseling and Development, 84, 341–348. Williams, N. L. (2002). The cognitive interactional model of appraisal and coping: Implications for anxiety and depression. Fairfax, VA: Dissertation. George Mason University. Woods, A. M., Racine, S. E., & Klump, K. L. (2010). Examining the relationship between dietary restraint and binge eating: Differential effects of major and minor stressors. Eating Behaviors, 11, 276–280.
Contents lists available at SciVerse ScienceDirect
Eating Behaviors
The effects of avoidance coping and coping self-efficacy on eating disorder attitudes and behaviors: A stress-diathesis model Laura MacNeil ⁎, Christianne Esposito-Smythers, Robyn Mehlenbeck, Julie Weismoore George Mason University, Fairfax, VA, United States
a r t i c l e
i n f o
Article history: Received 23 August 2011 Received in revised form 29 May 2012 Accepted 20 June 2012 Available online 24 August 2012 Keywords: Eating disorder Stress-diathesis Coping
a b s t r a c t The present study employed a series of stress-diathesis models to examine whether avoidance coping and poor coping self-efficacy contribute to disordered eating attitudes and behaviors in a sample of college students. The sample included one hundred fifteen undergraduate students (28.7% male; 71.3% female). Participants completed self-report measures to assess daily stressors, coping style, coping self-efficacy, and eating disorder attitudes and behaviors. As predicted, among students with an avoidance coping style, those who reported more daily stressors exhibited higher eating disorder attitudes and behaviors than those with less daily hassles. Contrary to study hypothesis, number of daily hassles did not moderate the association between coping self-efficacy and eating disorder attitudes and behaviors. However, there was a significant main effect for coping self-efficacy, suggesting that students who lack confidence in their coping abilities are more likely to have problematic eating attitudes and behaviors, regardless of their level of daily stress. Clinically, results suggest that students who enter college with an avoidance coping style and poor coping self-efficacy may be at risk for disordered eating, particularly with the onset of associated stress. Teaching students active problem-focused coping skills to deal with daily hassles associated with college life, and providing opportunities for repeated practice to bolster self-efficacy, may help prevent and/or reduce disordered eating attitudes and behaviors. © 2012 Elsevier Ltd. All rights reserved.
1. Introduction The stress-diathesis model of psychopathology suggests that people have, to varying degrees, vulnerabilities or “diatheses” that predispose them toward developing mental health problems. When these vulnerabilities interact with stressful life events, they trigger the onset of mental health problems (Slavik & Croake, 2006). Consistent with this model, higher perceived stress from daily hassles has been associated with greater eating disorder attitudes and behaviors as well as binge eating (Ball & Lee, 2002; Crowther, Snaftner, Bonafazi, & Shepherd, 2001; Freeman & Gil, 2004; Smyth et al., 2007). Moreover, higher perfectionism (Ruggiero et al., 2008), pathological worries (Sassaroli & Ruggiero, 2005), and eating restraint (Tanofsky-Kraff, Wilfley, & Spurrell, 2000; Woods, Racine, & Klump, 2010), three sources of vulnerability, have been associated with higher eating disorder attitudes and behaviors among individuals who report greater stress from daily hassles. Not yet studied as a source of vulnerability in stress-diathesis models of eating pathology is coping behavior. The purpose of the present study was to examine
⁎ Corresponding author at: George Mason University, Psychology Department, 4400 University Drive, MS 3F5, Fairfax, VA 22030, United States. Tel.: +1 908 247 3419; fax: +1 703 993 1359. E-mail address: [email protected] (L. MacNeil). 1471-0153/$ – see front matter © 2012 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.eatbeh.2012.06.005
coping style and coping self-efficacy as potential vulnerability factors for eating pathology in the context of stress-diathesis models. Avoidance coping refers to coping with problems or negative affect through the avoidance of thoughts related to stressors, wishful thinking, emotional detachment or denial, and behavioral efforts to escape or avoid the problem (Christiano & Mizes, 1997). Avoidance strategies can interfere with the processing of stress-relevant information, attention to possible consequences, and planning actions, all of which are necessary for adaptive coping (Neckowitz & Morrison, 1991). Avoidance coping has been associated with eating disorder attitudes and behaviors among female undergraduates (Freeman & Gil, 2004; Koff & Sangani, 1997; Mayhew & Edelman, 1989; Sulkowski, Dempsey, & Dempsey, 2011) and individuals with an eating disorder (Ghaderi, 2000; Soukup, Beiler, & Terrell, 1990; Troop, Holbrey, Trowler, & Treasure, 1994). Relatedly, recovery from an eating disorder has been associated with a decrease in use of avoidance coping strategies (Bloks, van Furth, Callewart, & Hoek, 2004). Similar to coping style, a person's perceived capability to effectively manage life stressors, referred to as coping self-efficacy, may also be associated with eating related pathology. Only one study has examined the relationship between eating disorders and coping self-efficacy. Using a single item to assess coping self-efficacy, Lobera, Estebanez, Santiago Fernandez, Alvarez-Bautista, and Garrido (2009) found that individuals with an eating disorder reported lower levels of coping self-efficacy than those without this diagnosis in a college sample.
294
L. MacNeil et al. / Eating Behaviors 13 (2012) 293–296
Relatedly, low problem-solving confidence, a construct related to coping self-efficacy, has been associated with eating pathology in samples with (Etringer, Altmaier, & Bowers, 1989; Soukup et al., 1990) and without (VanBoven & Espelage, 2006) diagnosable eating disorders. As is evident, stress from daily hassles is associated with maladaptive eating attitudes, behaviors, and disorders. Further, an avoidance coping style and poor coping self-efficacy are associated with eating pathology. Consistent with the cognitive theory of stress and coping (Lazarus & Folkman, 1984), factors such as one's ability to employ adaptive coping methods, as well as ones belief in his/her ability to cope with stress, will affect an individual's appraisal about the potential negative impact of stressors. Therefore, when under stress, those who employ avoidance coping methods and perceive that they are unable to effectively cope with life stress may be at particularly high risk for eating pathology. The present study employed a series of stress-diathesis models to examine whether avoidance coping style and poor coping selfefficacy serve as vulnerability factors for eating disorder attitudes and behaviors. We hypothesized that individuals with an avoidance coping style and poor coping self-efficacy would report greater eating disorder attitudes and behaviors when experiencing more versus less stress from daily hassles. These hypotheses were tested in a large undergraduate sample.
2.3.4. Eating Attitudes Test (EAT-26; Garner, Olmstead, Bohr, & Garfinkel, 1982) The EAT-26 is a 26-item measure that assesses thoughts, feelings, and behaviors associated with eating disorders. In the present study, coefficient α was .84. 3. Results 3.1. Descriptive statistics Descriptive statistics for measures of eating disorder attitudes and behaviors, daily hassles, coping self-efficacy, and avoidance coping are presented in Table 1. 3.2. Preliminary bivariate analyses Because scores on the EAT were positively skewed (>2), a natural logarithmic (ln) transformation was conducted to decrease the skew to b 1. All analyses were conducted with the transformed version of the variable. All other variables were normally distributed. Correlation coefficients were computed to examine the bivariate relationships between study variables (see Table 1).
2. Methods 2.1. Participants Participants in this study included 82 (71.3%) female and 33 (28.7%) male undergraduate psychology students who received class credit for their participation. Participants ranged in age from 18 to 29 (Mean= 20.4). Inclusion criteria included fluency in spoken and written English, participant consent, and status as an undergraduate student. Racial composition of the sample was 50.4% (58) Caucasian, 14.8% (17) Black or African American, 21.7% (25) Asian, and 13.0% (15) reported they were another race. 2.2. Procedure Participants were recruited from the undergraduate psychology pool as part of a larger study that examined the association between stress, coping, and mental health problems. The study was advertised through an online university system that describes opportunities for students to participate in psychology research studies for class credit. All study participants provided informed consent and met with a trained research assistant to complete study assessments. This study received full approval from the Human Subjects Review Board. 2.3. Measures 2.3.1. Revised University Student Hassles Scale (RUSHS; Pett & Johnson, 2005) The RUSHS is a 57-item measures that assesses the count, frequency, and severity of everyday hassles experienced by college students in the past month. The count scale was used in the present study. In the present study coefficient α for the count score was .89. 2.3.2. Coping Self-Efficacy Scale (CSES; Chesney, Neilands, Chambers, Taylor, & Folkman, 2006) The CSES is a 13-item measure that assesses perceived selfefficacy for coping with life challenges. In the present study coefficient α for the total score was .91. 2.3.3. Coping Styles and Flexibility Inventory (CSFI; Williams, 2002) The CSFI assesses the use of four types of coping strategies (avoidance, action-oriented, social support, positive reappraisal). The avoidance subscale, which had a coefficient α of .93, was used in the present study.
3.3. Linear regression analyses Two separate linear regression analyses were used to examine how each hypothesized diathesis (avoidance coping and coping self-efficacy) interacts with number of daily hassles to predict eating disorder attitudes and behaviors. As gender was correlated with eating disorder attitudes and behaviors, it was controlled for in the first step of each analysis. The hypothesized diathesis and number of daily hassles were entered in the second step. Finally, the interaction between the diathesis variable and daily hassles was entered in the third step for each analysis. All predictor variables were mean centered prior to computing interaction terms. Simple slope analyses were conducted to probe significant interactions. 3.4. Avoidance coping as a diathesis The first linear regression analysis examined the relationship between avoidance coping, daily hassles, and eating disorder attitudes and behaviors (see Table 2). There was no main effect of avoidance coping (β = .04, p = .68) or daily hassles on eating disorder attitudes and behaviors (β = .13, p = .16). There was a significant interaction between avoidance coping and number of daily hassles (β = .21, p b .05). Simple slopes analysis indicated that individuals who were higher in avoidance coping and experienced more daily hassles reported greater levels of eating disorder attitudes and behaviors than those who were high in avoidance coping, but experienced fewer daily hassles.
Table 1 Descriptive statistics and intercorrelations between variables of interest. Variable 1. 2. 3. 4.
RUSHS — total number CSE CSFI — avoidance EAT — 26a
M
SD
Range
1
2
3
4
33.49 86.22 35.09 7.30
8.89 21.55 10.49 7.57
13–57 44–130 12–59 0–56
–
−.13 –
.16⁎ −.23⁎⁎
.21⁎⁎ −.21⁎⁎
–
.05 –
Note: RUSHS = Revised University Student Hassles Scale; CSE = Coping Self-Efficacy; CSFI = Coping Styles and Flexibility Inventory; EAT-26 = Eating Attitudes and Behaviors Test — 26. a Correlations for the EAT-26 computed using the natural log transformation. ⁎ p b .10. ⁎⁎ p b .05.
L. MacNeil et al. / Eating Behaviors 13 (2012) 293–296 Table 2 Summary of the linear regression analyses predicting eating disorder attitudes and behaviors. Predictor variables
B
SEB
β
R2
ΔR2
Avoidance coping Step 1 Gender Step 2 Avoidance coping Number of daily hassles Step 3 Avoidance coping × number of daily hassles
−.37 .00 .01 .00
.15 .01 .01 .00
−.23⁎ .04 .13 .21⁎
.06 .09
.06⁎⁎ .03
.13
.04⁎
Coping self-efficacy Step 1 Gender Step 2 Coping self-efficacy Number of daily hassles Step 3 Coping self-efficacy × number of daily hassles
−.37 −.01 .01 .00
.15 .00 .01 .00
−.23⁎ −.19⁎ .13 −.05
.06 .12
.06⁎⁎ .06⁎
.12
.00
⁎ ⁎⁎
p b .05. p b .01.
3.5. Coping self-efficacy as a diathesis The second linear regression analysis examined the relationship between coping self-efficacy, number of daily hassles, and eating disorder attitudes and behaviors (see Table 2). There was a main effect of coping self-efficacy on eating disorder attitudes and behaviors (β = − .19, p b .05). Specifically, individuals with lower levels of coping self-efficacy reported more eating disorder attitudes and behaviors. There was no main effect of daily hassles on eating disorder attitudes and behaviors (β = .13, p = .16) or an interaction between coping self-efficacy and number of daily hassles (β = − .05, p = .63). 4. Discussion This is the first study to examine whether avoidance coping and coping self-efficacy serve as vulnerabilities for eating disorder attitudes and behaviors in the context of stress-diathesis models. Also notable is that the present study included both males and females, whereas the large majority of research in this area only includes females. Consistent with our hypothesis, we found that an avoidance coping style was associated with greater eating disorder attitudes and behaviors among college students who reported higher versus lower daily stress. This finding adds uniquely to the growing body of literature that has found support for stress-diathesis models of eating pathology (Heatherton & Baumeister, 1991; Ruggiero, Levi, Ciuna, & Sassaroli, 2003, Ruggiero et al., 2008; Sassaroli & Ruggiero, 2005; Tanofsky-Kraff et al., 2000). When avoidance coping methods fail to effectively reduce daily stress, it is possible that individuals with an avoidance coping style engage in disordered eating as a means to distract themselves from their persistent difficulties and resultant negative affect (Heatherton & Baumeister, 1991) or to obtain a feeling of control in the face of a situation that appears irresolvable (Bruch, 1982). In contrast to study hypotheses, number of daily hassles was not found to moderate the association between coping self-efficacy and eating disorder attitudes and behaviors. However, those with poorer coping self-efficacy did report greater eating disorder attitudes and behaviors in the sample as a whole. These latter results are consistent with prior research (Lobera et al., 2009). It appears that college students who lack confidence in their ability to cope with stressors, regardless of their level of current stress, are more likely to report problematic eating attitudes and behaviors. Unlike avoidance coping behaviors, which are employed in the face of stress, coping selfefficacy is a belief about oneself that is present regardless of current stress level. For individuals who do not believe that they possess the ability to actively cope with stress in general, eating disorder behavior itself may serve as a coping strategy (Bruch, 1973; Heatherton &
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Baumeister, 1991). Coping self-efficacy may also reflect an aspect of one's self esteem. Low self-esteem too has been associated with disordered eating attitudes and behaviors (Fryer, Waller, & Kroese, 1997). Results of this study hold several important clinical implications. Clinically, results suggest that students who enter college with an avoidance coping style and poor coping self-efficacy may be at risk for disordered eating, particularly with the onset of associated stress. Therefore, it may be useful to develop and implement an educational curriculum for college students that provides instruction in problem-solving and encourages the use of active, approach-oriented coping strategies to address college related stressors. This could be accomplished through general prevention programs offered during college orientations, or classes for high risk groups of students, who may experience more difficulty and stress in the transition (such as transfer or international students) to college. Such programs may help students increase self-efficacy and adaptive coping skills in the face of stress, thus decreasing the risk for disordered eating attitudes and behaviors. Moreover, when working with undergraduate students presenting for counseling, it is important to assess for deficits in coping abilities and work on strengthening coping skills as indicated to best prevent eating pathology. While study results are novel and informative, there are a few limitations that deserve mention. Study results may not generalize to non-college populations or samples with greater eating pathology. Further, our study was correlational and thus causality cannot be established. Future research in this area would benefit from the use of other community based and/or clinical samples with a wider range of eating pathology. Use of a longitudinal design and more sophisticated assessment methods (e.g., ecological momentary assessment) would enable prospective measurement of study constructs in real-time. Such research may further improve our understanding of the manner in which coping behaviors contribute to the development and maintenance of eating disorder behaviors and attitudes. Role of funding sources No funding was provided for this research. Contributors Laura MacNeil, Dr. Christy Esposito-Smythers, and Julie Weissmore designed the study and wrote the protocol. Laura MacNeil conducted literature searches and provided summaries of previous research studies. Laura MacNeil and Dr. Christy Esposito Smythers conducted the statistical analysis. Laura MacNeil and Dr. Christy Esposito-Smythers wrote the first draft of the manuscript and all authors contributed to and have approved the final manuscript. Conflict of interest All authors declare that they have no conflicts of interest.
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