Dietary restriction (DR), or inadequate caloric and nutrient consumption, is a shockingly common practice associated with serious medical and psychological consequences. DR predicts development of both overweight and eating disorders. At its extreme, DR can develop into anorexia nervosa (AN), a serious and chronic disorder associated with considerable morbidity and lifetime mortality up to 20%. Despite the negative effects of DR, the psychological processes driving this behavior have received little attention and remain poorly understood. While certain psychological processes (e.g., excessive self-control;emotion dysregulation) have been hypothesized to be involved in DR, the models proposing the importance of these processes have not been adequately tested. As a result, treatments of DR are inadequate. No efficacious treatments have been identified for adults with AN and, DR interferes with treatment for other eating disorders, and the guidelines for addressing DR in treatment of other related disorders (e.g., depression) are unspecified. Research design issues hinder progress in understanding and treating DR. Traditionally, randomized, controlled trials (RCTs) have been used to investigate treatment for DR, yet this is often an impractical first step for investigating treatment targets. Further, self-report measures f eating behavior, which are unreliable, have been over-utilized. The current study proposes to address these problems by examining the effects of 2 brief interventions targeting different psychological processes (self-control, emotion dysregulation) hypothesized to affect DR, compared to an active control, on a behavioral measure of the amount of effort restrictive eaters exert to reduce caloric intake at a test meal. Individuals identified as engaging in frequent DR will be told they will be expected to consume a self-selected quantity of a high-calorie milkshake and participate in an intervention that may help them tolerate this experience. Subjects will then be randomized to receive 1 of 3 brief computer- guided interventions: 1) cognitive restructuring (targeting self-control), 2) emotion regulation skills (targeting emotion dysregulation), or 3) nutrition information (control). Following the intervention, subjects will be given the option to work (by pressing the space bar on a computer task) to either: 1) decrease the number of calories they will be expected to consume, or 2) increase monetary compensation. The primary dependent variable will be number of button presses (i.e., effort) subjects employ toward reducing intake. This study is innovative due to utilization of: 1) Brief interventions targeting psychological processes, as opposed to RCTs, representing a time- and cost- effective means of evaluating promising psychological targets for DR;2) A behavioral measure of a DR-related outcome, as opposed to self-report methods, presenting a more methodological precision. Results of this study will provide information regarding the psychological processes involved in DR, informing treatment development for DR. This has potential to make a substantial impact, as currently no efficacious treatments exist for DR, despite its commonality and potential for severe outcomes.
The investigation of the psychological processes involved in dietary restriction (DR) has the potential to have a large impact on both individuals struggling with DR, which includes individuals across a variety of eating disorder diagnoses, and society as a whole. DR is a common practice in the U.S. that is associated with high levels of associated psychological and physical morbidity and, in extreme forms, death, yet treatments for DR are alarmingly lacking. Identification of the psychological processes involved in DR can aid more effective treatment development for DR, which can both substantially impact the health of affected individuals and have a broader impact on public health by reducing the notable financial burden on the health care system resulting from problems associated with DR.
|Dickens, Yani L; Haynos, Ann F; Nunnemaker, Shannon et al. (2015) Multidisciplinary residential treatment of type 1 diabetes mellitus and co-occurring eating disorders. Eat Disord 23:134-43|
|Haynos, Ann F; Roberto, Christina A; Martinez, Margaret A et al. (2014) Emotion regulation difficulties in anorexia nervosa before and after inpatient weight restoration. Int J Eat Disord 47:888-91|