Mood and Dysfunctional Cognitions Constitute Within-Subject Antecedents and Consequences of Exercise in Eating Disorders

Reichert, Markus; Schlegel, S.; Jagau, Friederike; Timm, Irina; Wieland, Lena M.; Ebner‐Priemer, Ulrich W.; Hartmann, Armin; Zeeck, Almut

doi:10.1159/000504061

Cited by 10 publications

(9 citation statements)

References 9 publications

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“…Several dysfunctional ED cognitions have been linked to DEx, such as thinness expectancies (i.e., belief that thinness will improve quality of life, Garner et al, 2014) or body dissatisfaction (Reichert et al, 2020), which are also associated with negative affect. However, it is unclear exactly how these cognitions might contribute to the affect‐regulating consequence of DEx.…”

Section: Our Idea Worth Researching: More Experimental Studies On Thementioning

confidence: 99%

A call to experimentally study acute affect‐regulation mechanisms specific to driven exercise in eating disorders

Kolar

Gorrell

2020

Intl J Eating Disorders

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Driven exercise (i.e., feeling compelled to exercise to control one's weight or shape, to obtain other positive consequences of exercising, or to avoid other negative consequences of not exercising) is a common phenomenon in individuals with eating disorders (EDs), typically associated with negative clinical outcomes. Current theoretical models of driven exercise highlight the short‐term affect‐regulating outcome of acute driven exercise, which is implicated to maintain this symptom either by positive or negative reinforcement. However, few studies have actually investigated cognitive, affective, and psychobiological mechanisms related to acute driven exercise. In particular, experimental studies that directly test mechanisms leading to the short‐term affective improvement after acute driven exercise are scarce. In this article, we therefore propose potential cognitive, affective, and psychobiological mechanisms that could explain the affect‐regulating function of driven exercise in individuals with EDs. In addition, we suggest examples of experimental studies that could directly test these mechanisms in individuals with EDs, as recent studies have demonstrated the safety of supervised exercise in EDs research. Our aim of stimulating research on the underlying causes and maintenance factors of driven exercise in EDs has the potential to critically inform treatment development for this high‐risk population.

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Section: Our Idea Worth Researching: More Experimental Studies On Thementioning

confidence: 99%

A call to experimentally study acute affect‐regulation mechanisms specific to driven exercise in eating disorders

Kolar

Gorrell

2020

Intl J Eating Disorders

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“…Since we have no data on physical parameters like body composition, it is not possible to say how many patients showed a level of physical activity that was a danger to their health. The average amount of exercise in our sample in terms of steps and moderate or vigorous physical activity at baseline was considerably high when compared to young, female, healthy controls (for a comparison group see supplement in [25]), but with a wide range of values. Some patients showed an amount of physical activity that was clearly beyond the level that can be considered healthy.…”

Section: Discussionmentioning

confidence: 78%

“…Difficulties with the regulation of negative affect as well as concerns about weight and shape are main aspects of psychopathology in patients with ED [23,24]. In a previous study using methods of ambulatory assessment in real life-situations, we could show that negative mood precedes exercise behavior in ED patients and that exercising was able to effectively influence mood as well as dysfunctional EDcognitions subsequently, such as a drive for thinness and body dissatisfaction [25]. This was a temporary, shortterm effect.…”

Section: Introductionmentioning

confidence: 83%

“…Finally, one further finding should be mentioned: If one considers possible changes in the attitudes towards exercise and exercise behavior as assessed with the CET (baseline to 6 months post intervention), one subscale showed no reduction at all: The subscale that measures exercising for mood improvement. It is a subscale that in another study showed at best minimal differences between patients with an eating disorder and a healthy control group (see [25]). This finding fits to research results showing that exercise in ED is often used to regulate difficult emotions [53].…”

Section: Discussionmentioning

confidence: 98%

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The Freiburg sport therapy program for eating disorders: a randomized controlled trial

et al. 2020

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Background: Unhealthy attitudes towards sport and problematic exercise behavior in eating disorders (ED) are common and associated with poorer treatment outcome and higher relapse rates. There is a need to develop and empirically test interventions that could complement standard treatment. The study aimed to assess the efficacy of the Freiburg sport therapy program for eating disorders (FSTP). Methods: Outpatients with ED were randomized either to a 3 month sport therapy program (sport therapy group: STG) or a waiting list control group (CG). Patients were assessed when starting the program and at the end of the intervention. The intervention group (STG) was followed up after 6 month. Main outcome criterion was a reduction in unhealthy exercise (Commitment to Exercise Scale, CES). Secondary outcomes encompassed eating pathology (Eating Disorder Examination, EDE), different dimensions of unhealthy exercise (Compulsive Exercise Test, CET subscales) and exercise quantity (accelerometer). Results: Recruitment was challenging. Fifteen patients were randomized to the STG and 11 were randomized to the CG condition. There was no statistically significant difference between groups according to the main outcome criterion. However, the STG showed a significantly stronger reduction in avoidance and rule driven behavior (CET subscale) when compared to the CG. Improvements (STG) were maintained at follow up. Conclusions: There was no statistically significant difference in the reduction of unhealthy attitudes towards sport and problematic exercise behavior between the intervention and the group, as measured with the Commitment to Exercise Scale. Further findings may point to the effectiveness of the program, but have to be interpreted with caution and verified in further studies. A major limitation is the small sample size.

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“…The current perspective is that compulsive exercise is performed in people with EDs for a combination of two reasons: (a) to regulate affect and avoid negative emotions, such as guilt and anxiety (Meyer & Taranis, 2011) and (b) to increase caloric expenditure to assist with goal-directed pursuit of body shape goals, for example, extreme thinness in AN (Dalle Grave et al, 2008). In their recent article, Kolar and Gorrell (2021) identified several other factors involved in the development and maintenance of compulsive exercise in EDs, including attenuating high transitory levels of body dissatisfaction (Garner et al, 2014; Reichert et al, 2020), the rewarding or pleasurable nature of intense exercise for people with EDs (Davis & Woodside, 2002; Klein et al, 2010), and increased endocannabinoids (Dietrich & McDaniel, 2004).…”

Section: Clinical Similarities Between Eds and MDmentioning

confidence: 99%

Treatment of compulsive exercise in eating disorders and muscle dysmorphia: A systematic review and meta-analysis.

Martenstyn¹,

Aouad²,

Touyz³

et al. 2022

Clinical Psychology: Science and Practice

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A lack of consensus exists among the scientific and medical communities on how to treat compulsive exercise, a core feature of eating disorders (EDs) and muscle dysmorphia (MD). We systematically searched five electronic databases for treatment studies of compulsive exercise that sampled adolescents and/or adults with an ED or MD, assessed longitudinal changes in compulsive exercise and used a validated instrument to measure compulsive exercise or related constructs. We identified 777 papers, of which 18 met eligibility criteria. None of the included studies sampled people with MD and 15 of 18 evaluated multi-component interventions combining psychoeducation and/or psychotherapy and/or structured exercise. Results from meta-analyses indicated moderate-to-large prepost treatment changes in compulsive exercise (Cohen’s d = −.62), but small treatment effects between active and control treatments in randomized controlled trials (Cohen’s d = −.23). Multi-component interventions appear best suited to reduce compulsive exercise in people with EDs, but the optimal combination of treatment components is unknown. Further treatment research on MD is needed.

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Mood and Dysfunctional Cognitions Constitute Within-Subject Antecedents and Consequences of Exercise in Eating Disorders

Cited by 10 publications

References 9 publications

A call to experimentally study acute affect‐regulation mechanisms specific to driven exercise in eating disorders

A call to experimentally study acute affect‐regulation mechanisms specific to driven exercise in eating disorders

The Freiburg sport therapy program for eating disorders: a randomized controlled trial

Treatment of compulsive exercise in eating disorders and muscle dysmorphia: A systematic review and meta-analysis.

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