Emotion generation and regulation in anorexia nervosa: A systematic review and meta-analysis of self-report data

Oldershaw, Anna; Lavender, Tony; Sallis, Hannah M; Ståhl, Daniel; Schmidt, Ulrike

doi:10.1016/j.cpr.2015.04.005

Cited by 188 publications

(194 citation statements)

References 141 publications

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“…Clinically, these findings point to the importance of targeting the ability to enhance positive affect, in addition to decrease negative affect, in treatments for AN. Further, these findings map on well with results from a recent meta-analysis of questionnaire studies, which suggested that patients with AN endorse less habitual use of adaptive emotion regulation strategies (e.g., cognitive reappraisal) than controls (Oldershaw et al, 2015). Future research should examine whether less habitual use of strategies such as cognitive reappraisal and attentional deployment is associated with increased difficulty employing these strategies in experimental contexts, such as during the EMSP.…”

Section: Discussionsupporting

confidence: 82%

“…Emotion regulation can be defined as the process of intensifying, weakening, altering, or maintaining emotions (both positive and negative) according to one’s goals (Gross, 2007). AN is associated with broad impairments in emotion regulation (Lavender et al, 2015, Oldershaw et al, 2015), and emotion dysregulation prospectively predicts the maintenance of AN symptoms (Racine and Wildes, 2015). However, almost all studies in this area assess emotion regulation using self-report questionnaires.…”

Section: Introductionmentioning

confidence: 99%

“…However, almost all studies in this area assess emotion regulation using self-report questionnaires. This is potentially problematic because data suggest that individuals with AN have problems with emotion recognition, awareness, and avoidance (Oldershaw et al, 2011, Oldershaw et al, 2015, Wildes et al, 2010). Moreover, several studies have found discrepancies between self-reported emotional and physiologic reactivity to emotional events (Nandrino et al, 2012, Zonnevylle-Bender et al, 2005).…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Voluntary emotion regulation in anorexia nervosa: A preliminary emotion-modulated startle investigation

Racine

Forbush

Wildes

et al. 2016

Journal of Psychiatric Research

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Emotion regulation difficulties are implicated in the development and maintenance of anorexia nervosa (AN). However, research has been limited by an almost exclusive reliance on self-report. This study is the first to use the emotion-modulated startle paradigm (EMSP) to investigate emotional reactivity and voluntary emotion regulation in individuals with AN. Twenty women with AN viewed negative, positive, neutral, and food images and were asked to enhance, suppress, or maintain their emotional responses mid-way through picture presentation. Startle eyeblink magnitudes in response to startle probes administered prior, and subsequent, to regulation instructions indexed emotional reactivity and regulation, respectively. On emotional reactivity trials, startle magnitudes were greater for negative, positive, and food images, compared to neutral images. Participants had difficulty suppressing startle responses to negative and food images, as indicated by non-significant suppress-maintain comparisons. In contrast, startle responses to enhance and suppress cues during presentation of pleasant images were comparable and significantly lower than maintain cues. Findings converge with self-report data to suggest that patients with AN have difficulties with voluntary emotion regulation. The EMSP may be a promising trans-diagnostic method for examining emotion regulation difficulties that underlie risk for eating disorders and other psychiatric conditions.

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Section: Discussionsupporting

confidence: 82%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Voluntary emotion regulation in anorexia nervosa: A preliminary emotion-modulated startle investigation

Racine

Forbush

Wildes

et al. 2016

Journal of Psychiatric Research

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“…Attenuating negative facial expression or looking away may be explained as a way of regulating threatening or indeed any social interaction (Oltmanns and Gibbs, 1995). For example, studies have shown that people with AN report that they perceive the expression of negative emotion as unacceptable and believe that it should not be expressed for fear of being criticized and/or rejected Oldershaw et al, 2015). This is supported by an fMRI study reporting that AN patients may react over-sensitively to social rejection (Via et al, 2015).…”

Section: Discussionmentioning

confidence: 50%

Facial expression to emotional stimuli in non-psychotic disorders: A systematic review and meta-analysis

Davies

Wolz

Leppänen

et al. 2016

Neuroscience & Biobehavioral Reviews

109

104

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“…Several studies have found higher levels of alexithymia in patients with anorexia nervosa (AN) compared to healthy controls (HC) (Gilboa-Schechtman et al, 2006; Montebarocci et al, 2006; Nowakowski et al, 2013). Additionally, studies have identified deficits in emotional awareness (being attentive to one’s emotions in general) and emotional clarity (knowing exactly how one is feeling) among individuals with AN compared to HC (Brockmeyer et al, 2014; Lavender et al, 2015; Oldershaw et al, 2015; Svaldi et al, 2012). However, in some studies the effect of increased levels of alexithymia in patients with AN compared to other psychiatric disorders and HC disappeared when controlling for anxiety and depression (Eizaguirre et al, 2004; Gilboa-Schechtman et al, 2006; Montebarocci et al, 2006; Parling et al, 2010).…”

Section: Introductionmentioning

confidence: 99%

Momentary emotion identification in female adolescents with and without anorexia nervosa

Kolar

Huß

Preuss

et al. 2017

Psychiatry Research

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Individuals with anorexia nervosa (AN) often report difficulties in identifying emotions, which have been mostly studied as an alexithymia trait. In a controlled two-day ecological momentary assessment, we studied the influence of time of day and aversive tension on self-reported momentary emotion identification. Analysis on an aggregated level revealed a significant lower mean emotion identification in the AN group. In a mixed model analysis, the AN group showed lower emotion identification than the control group (HC). Both a general and a group effect of time of day were found, indicating that emotion identification improved during the day in HC, whereas a negligible decrease of the emotion identification over time was observed in the AN group. Age was associated positively with emotion identification in general, but no specific effect on a group level was found. No effect of aversive tension was found. Our results indicate that an improvement during the day might be a natural process of emotion identification, which is hindered in AN. Future research should focus on temporal relations between emotion identification and disordered eating behavior to further evaluate the clinical relevance of emotion identification difficulties in AN.

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Emotion generation and regulation in anorexia nervosa: A systematic review and meta-analysis of self-report data

Cited by 188 publications

References 141 publications

Voluntary emotion regulation in anorexia nervosa: A preliminary emotion-modulated startle investigation

Voluntary emotion regulation in anorexia nervosa: A preliminary emotion-modulated startle investigation

Facial expression to emotional stimuli in non-psychotic disorders: A systematic review and meta-analysis

Momentary emotion identification in female adolescents with and without anorexia nervosa

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