Associations between Mindfulness, Self-Compassion, Difficulties in Emotion Regulation, and Emotional Eating among Adolescents with Overweight/Obesity
Tóm tắt
This study explores whether the associations between mindfulness and self-compassion skills and emotional eating are mediated by difficulties in emotion regulation in adolescents with overweight/obesity, and whether the direct and indirect effects vary according to nutritional treatment and weight status. The sample included 245 adolescents (12–18 years old) with overweight (85th ≤ Body Mass Index (BMI) < 97th percentile) and obesity (BMI ≥ 97th percentile; WHO 2006) undergoing or not nutritional treatment. Participants completed self-reported measures of mindfulness, self-compassion, difficulties in emotion regulation and emotional eating. Regardless of undergoing or not nutritional treatment and of weight status, difficulties in emotion regulation mediated the associations between mindfulness and emotional eating, and between self-compassion and emotional eating. Specifically, higher levels of mindfulness and self-compassion skills were associated with less difficulties in emotion regulation, which, in turn, were associated with less emotional eating (mindfulness: point estimate = −0.14, SE = 0.06, 95%CI = −0.26/−0.05; self-compassion: point estimate = −1.76, SE = 0.67, 95%CI = −3.20/−0.58). Moreover, whereas mindfulness skills were directly associated with emotional eating, self-compassion was only indirectly associated with emotional eating, suggesting that self-compassion skills are related to emotional eating only because these skills enable more adaptive emotion regulation. Mindfulness and self-compassion may help adolescents with overweight/obesity develop more adaptive responses to emotional distress, which consequently may help them develop healthier eating behaviors. Future research should be developed on the adequacy of mindfulness and compassion-based approaches for adolescents with overweight/obesity.
Tài liệu tham khảo
Aparicio, E., Canals, J., Arija, V., De Henauw, S., & Michels, N. (2016). The role of emotion regulation in childhood obesity: Implications for prevention and treatment. Nutrition Research Reviews, 29(1), 17–29. https://doi.org/10.1017/S0954422415000153.
Barnes, V. A., Kristeller, J. L., & Johnson, M. H. (2016). Impact of mindfulness-based eating awareness on diet and exercise habits in adolescents. International Journal of Complementary & Alternative Medicine, 3(2), 1–7.
Bishop, S. R., Lau, M., Shapiro, S., Carlson, L., Anderson, N. D., Carmody, J., & Devins, G. (2004). Mindfulness: a proposed operational definition. Clinical Psychology, 11(3), 230–241. https://doi.org/10.1093/clipsy.bph077.
Black, D. S. (2015). Mindfulness training for children and adolescents: a state-of-the-science review. InK. W. Brown, R. M. Ryan & J. D. Creswell (Eds.), Handbook of Mindfulness: Theory and Research (pp. 283–310). New York, NY: Guilford Press.
Braet, C., Claus, L., Goossens, L., Moens, E., Van Vlierberghe, L., & Soetens, B. (2008). Differences in eating style between overweight and normal-weight youngsters. Journal of Health Psychology, 13(6), 733–743. https://doi.org/10.1177/1359105308093850.
Braet, C., & van Strien, T. (1997). Assessment of emotional, externally induced and restrained eating behaviour in nine to twelve-year-old obese and non-obese children. Behaviour Research and Therapy, 35(9), 863–873. https://doi.org/10.1016/S0005-7967(97)00045-4.
Brener, N. D., McManus, T., Galuska, D. A., Lowry, R., & Wechsler, H. (2003). Reliability and validity of self-reported height and weight among high school students. Journal of Adolescent Health, 32, 281–287. https://doi.org/10.1016/S1054-139X(02)00708-5.
Brown, K. W., Ryan, R. M., & Creswell, J. D. (2007). Mindfulness: theoretical foundations and evidence for its salutary effects. Psychological Inquiry, 18(4), 211–237. https://doi.org/10.1080/10478400701598298.
Buttitta, M., Iliescu, C., Rousseau, A., & Guerrien, A. (2014). Quality of life in overweight and obese children and adolescents: a literature review. Quality of Life Research, 23(4), 1117–1139. https://doi.org/10.1007/s11136-013-0568-5.
Castilho, P., Pinto-Gouveia, J., & Duarte, J. (2015). Evaluating the multifactor structure of the long and short versions of the Self-Compassion Scale in a clinical sample. Journal of Clinical Psychology, 71(9), 856–870. https://doi.org/10.1002/jclp.22187.
Cohen, J. (1988). Statistical power analysis for the behavioral sciences. 2nd ed Hillsdale, NJ: Lawrence Erlbaum Associates.
Cunha, M., Galhardo, A., & Pinto-Gouveia, J. (2013). Child and adolescent mindfulness measure (CAMM): Study of the psychometric properties of the portuguese version. Psicologia Reflexão e Crítica, 26(3), 459–468. https://doi.org/10.1590/S0102-79722013000300005.
Cunha, M., Xavier, A., & Castilho, P. (2016). Understanding self-compassion in adolescents: validation study of the Self-Compassion Scale. Personality and Individual Differences, 93, 56–62. https://doi.org/10.1016/j.paid.2015.09.023.
D’Arrigo, T. (2007). Emotional eating. A sneak attack on weight loss. Diabetes Forecast, 60(8), 23.
Dalen, J., Smith, B. W., Shelley, B. M., Sloan, A. L., Leahigh, L., & Begay, D. (2010). Pilot study: Mindful Eating and Living (MEAL): weight, eating behavior, and psychological outcomes associated with a mindfulness-based intervention for people with obesity. Complementary Therapies in Medicine, 18(6), 260–264. https://doi.org/10.1016/j.ctim.2010.09.008.
Daly, P. (2013). Obese adolescent females and actual behavioral responses to a mindful eating intervention. (Unpublished doctoral dissertation). Tucson, USA: The University of Arizona. http://hdl.handle.net/10150/311457 Retrieved from.
Doyle, A. C., le Grange, D., Goldschmidt, A., & Wilfley, D. E. (2007). Psychosocial and physical impairment in overweight adolescents at high risk for eating disorders. Obesity, 15(1), 145–154. https://doi.org/10.1038/oby.2007.515.
Eichen, D. M., Chen, E., Boutelle, K. N., & McCloskey, M. S. (2017). Behavioral evidence of emotion dysregulation in binge eaters. Appetite, 111, 1–6. https://doi.org/10.1016/j.appet.2016.12.021.
Evers, C. F., Stok, M., & Ridder, D. T. D. (2010). Feeding your feelings: emotion regulation strategies and emotional eating. Personality and Social Psychology Bulletin, 36(6), 792–804. https://doi.org/10.1177/0146167210371383.
Fritz, M. S., & Mackinnon, D. P. (2007). Required sample size to detect the mediated effect. Psychological Science, 18(3), 233–239. https://doi.org/10.1111/j.1467-9280.2007.01882.x.
Gilbert, D., & Waltz, J. (2010). Mindfulness and health behaviors. Mindfulness, 1(4), 227–234. https://doi.org/10.1007/s12671-010-0032-3.
Gilbert, P., & Procter, S. (2006). Compassionate mind training for people with high shame and self-criticism: overview and pilot study of a group therapy approach. Clinical Psychology & psychotherapy, 13(6), 353–379. https://doi.org/10.1002/cpp.507.
Goodwin, R., Lucio, J., Vega-López, S., & Bruening, M. (2017). Exploring mindful eating and weight status among underserved youth and their parents living in public housing. Mindfulness, 8(4), 973–983. https://doi.org/10.1007/s12671-016-0674-x.
Gorlach, M. G., Kohlmann, S., Shedden-Mora, M., Rief, W., & Westermann, S. (2016). Expressive suppression of emotions and overeating in individuals with overweight and obesity. European Eating Disorders Review, 24(5), 377–382. https://doi.org/10.1002/erv.2452.
Gouveia, M. J., Frontini, R., Canavarro, M. C., & Moreira, H. (2014). Quality of life and psychological functioning in pediatric obesity: the role of body image dissatisfaction between girls and boys of different ages. Quality of Life Research, 23(9), 2629–2638. https://doi.org/10.1007/s11136-014-0711-y.
Gowey, M. A., Reiter-Purtill, J., Becnel, J., Peugh, J., Mitchell, J. E., & Zeller, M. H., TeenView Study, G. (2016). Weight-related correlates of psychological dysregulation in adolescent and young adult (AYA) females with severe obesity. Appetite, 99, 211–218. https://doi.org/10.1016/j.appet.2016.01.020.
Gratz, K. L., & Gunderson, J. G. (2006). Preliminary data on an acceptance-based emotion regulation group intervention for deliberate self-harm among women with borderline personality disorder. Behavior Therapy, 37(1), 25–35. https://doi.org/10.1016/j.beth.2005.03.002.
Gratz, K. L., & Roemer, L. (2004). Multidimensional assessment of emotion regulation and dysregulation: development, factor structure, and initial validation of the Difficulties in Emotion Regulation Scale. Journal of Psychopathology & Behavioral Assessment, 26(1), 41–54. https://doi.org/10.1007/s10862-008-9102-4.
Graziano, P. A., Calkins, S. D., & Keane, S. P. (2010). Toddler self-regulation skills predict risk for pediatric obesity. International Journal of Obesity, 34(4), 633–641. https://doi.org/10.1038/ijo.2009.288.
Greco, L. A., Baer, R. A., & Smith, G. (2011). Assessing mindfulness in children and adolescents: development and validation of the Child and Adolescent Mindfulness Measure (CAMM). Psychological Assessment, 23(3), 606–614. https://doi.org/10.1037/a0022819.
Gregorio, S., & Pinto-Gouveia, J. (2013). Mindful attention and awareness: Relationships with psychopathology and emotion regulation. Spanish Journal of Psychology, 16, E79 https://doi.org/10.1017/sjp.2013.79.
Harrist, A. W., Hubbs-Tait, L., Topham, G. L., Shriver, L. H., & Page, M. C. (2013). Emotion regulation is related to children’s emotional and external eating. Journal of Developmental and Behavioral Pediatrics, 34(8), 557–565. https://doi.org/10.1097/DBP.0b013e3182a5095f.
Hayes, A. F. (2013). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach. New York, NY: The Guilford Press.
Heatherton, T. F., & Baumeister, R. F. (1991). Binge eating as escape from self-awareness. Psychological Bulletin, 110, 86–108.
Hofmann, S. G., Sawyer, A. T., Fang, A., & Asnaani, A. (2012). Emotion dysregulation model of mood and anxiety disorders. Depression and Anxiety, 29, 409–416. https://doi.org/10.1002/da.21888.
Kaufman, E. A., Xia, M., Fosco, G., Yaptangco, M., Skidmore, C. R., & Crowell, S. E. (2015). The Difficulties in Emotion Regulation Scale Short Form (DERS-SF): validation and replication in adolescent and adult samples. Journal of Psychopathology & Behavioral Assessment, 38(3), 443–455. https://doi.org/10.1007/s10862-015-9529-3.
Kemp, E., Bui, M., & Grier, S. (2013). When food is more than nutrition: understanding emotional eating and overconsumption. Journal of Consumer Behaviour, 12(3), 204–213. https://doi.org/10.1002/cb.1413.
Klump, K. L. (2013). Puberty as a critical risk period for eating disorders: a review of human and animal studies. Hormones and Behavior, 64(2), 399–410. https://doi.org/10.1016/j.yhbeh.2013.02.019.
Leary, M. R., Adams, C. E., & Tate, E. B. (2006). Hypo-egoic self-regulation: exercising self-control by diminishing the influence of the self. Journal of Personality, 74(6), 1803–1831. https://doi.org/10.1111/j.1467-6494.2006.00429.x.
Luna, B., Garver, K. E., Urban, T. A., Lazar, N. A., & Sweeney, J. A. (2004). Maturation of cognitive processes from late childhood to adulthood. Child Development, 75(5), 1357–1372. https://doi.org/10.1111/j.1467-8624.2004.00745.x.
Maxwell, S. E., & Cole, D. A. (2007). Bias in cross-sectional analyses of longitudinal mediation. Psychological Methods, 12(1), 23–44. https://doi.org/10.1037/1082-989X.12.1.23.
Micanti, F., Iasevoli, F., Cucciniello, C., Costabile, R., Loiarro, G., Pecoraro, G., & Galletta, D. (2017). The relationship between emotional regulation and eating behaviour: a multidimensional analysis of obesity psychopathology. Eating and Weight Disorders, 22(1), 105–115. https://doi.org/10.1007/s40519-016-0275-7.
Moreira, H., & Canavarro, M. C. (2016). A bifactor analysis of the Difficulties in Emotion Regulation Scale - Short Form in a sample of portuguese adolescents and adults. Unpublished manuscript.
Moreira, H., & Canavarro, M. C. (2017). Is body shame a significant mediator of the relationship between mindfulness skills and the quality of life of treatment-seeking children and adolescents with overweight and obesity? Body Image, 20, 49–57. https://doi.org/10.1016/j.bodyim.2016.11.004.
Muris, P., Meesters, C., Pierik, A., & de Kock, B. (2016). Good for the self: Self-compassion and other self-related constructs in relation to symptoms of anxiety and depression in non-clinical youths. Journal of Child and family Studies, 25, 607–617. https://doi.org/10.1007/s10826-015-0235-2.
Neff, K. D. (2003). The development and validation of a scale to measure self-compassion. Self and Identity, 2, 223–250. https://doi.org/10.1080/15298860390209035.
Neff, K. D. (2009). The role of self-compassion in development: a healthier way to relate to oneself. Human Development, 52(4), 211–214. doi:000215071.
Neff, K. D. (2012). The science of self-compassion. In C. Germer & R. Siegel (Eds.), Compassion and wisdom in psychotherapy (pp. 79–92). New York: The Guilford Press.
Neumann, A., van Lier, P. A. C., Gratz, K. L., & Koot, H. M. (2010). Multidimensional assessment of emotion regulation difficulties in adolescents using the Difficulties in Emotion Regulation Scale. Assessment, 17(1), 138–149. https://doi.org/10.1177/1073191109349579.
O’Reilly, G. A., & Black, D. S. (2015). Considering mindfulness training for obesity-related eating behaviors in children and adolescents: a conceptual review. Journal of Child and Adolescent Behaviour, 3(3), 1–7. https://doi.org/10.4172/2375-4494.1000207.
O’Reilly, G. A., Cook, L., Spruijt-Metz, D., & Black, D. S. (2014). Mindfulness-based interventions for obesity-related eating behaviours: a literature review. Obesity Reviews, 15(6), 453–461. https://doi.org/10.1111/obr.12156.
Oliver, G., Wardle, J., & Gibson, E. L. (2000). Stress and food choice: a laboratory study. Psychosomatic Medicine, 62(6), 853–865. 0033-3174/00/6206-0853.
Pearson, C. M., Combs, J. L., Zapolski, T. C., & Smith, G. T. (2012). A longitudinal transactional risk model for early eating disorder onset. Journal of Abnormal Psychology, 121(3), 707–718. https://doi.org/10.1037/a0027567.
Raes, F., Pommier, E., Neff, K. D., & Van Gucht, D. (2011). Construction and factorial validation of a short form of the Self-Compassion Scale. Clinical Psychology and Psychotherapy, 18(3), 250–255. https://doi.org/10.1002/cpp.702.
Shin, H. S., Black, D. S., Shonkoff, E. T., Riggs, N. R., & Pentz, M. A. (2016). Associations among dispositional mindfulness, self-compassion, and executive function proficiency in early adolescents. Mindfulness, 7(6), 1377–1384. https://doi.org/10.1007/s12671-016-0579-8.
Sperry, S., Knox, B., Edwards, D., Friedman, A., Rodriguez, M., Kaly, P., & Shaffer-Hudkins, E. (2014). Cultivating healthy eating, exercise, and relaxation (CHEER): a case study of a family-centered and mindfulness-based cognitive-behavioral intervention for obese adolescents at risk for diabetes and cardiovascular disease. Clinical Case Studies, 13(3), 218–230. https://doi.org/10.1177/1534650113507743.
Tabachnick, B. G., & Fidell, L. S. (2013). Using multivariate statistics. 6th ed. Boston, MA: Pearson.
Tokmakidis, S. P., Christodoulos, A. D., & Mantzouranis, N. I. (2007). Validity of self-reported anthropometric values used to assess body mass index and estimate obesity in Greek school children. Journal of Adolescent Health, 40, 305–310. https://doi.org/10.1016/j.jadohealth.2006.10.001.
Tsiros, M. D., Olds, T., Buckley, J. D., Grimshaw, P., Brennan, L., Walkley, J., & Coates, A. M. (2009). Health-related quality of life in obese children and adolescents. International Journal of Obesity, 33(4), 387–400. https://doi.org/10.1038/ijo.2009.42.
Turner, T., & Hingle, M. (2017). Evaluation of a mindfulness-based mobile app aimed at promoting awareness of weight-related behaviors in adolescents: a pilot study. JMIR Research Protocols, 6(4), e67 https://doi.org/10.2196/resprot.6695.
van Strien, T., Frijters, J. E. R., Bergers, G. P. A., & Defares, P. B. (1986). The Dutch Eating Behavior Questionnaire (DEBQ) for assessment of restrained, emotional, and external eating behavior. International Journal of Eating Disorders, 5(2), 295–315. https://doi.org/10.1002/1098-108X(198602)5:2<295::AID-EAT2260050209>3.0.CO;2-T.
van Strien, T., & Oosterveld, P. (2008). The children’s DEBQ for assessment of restrained, emotional, and external eating in 7- to 12-year-old children. International Journal of Eating Disorders, 41(1), 72–81. https://doi.org/10.1002/eat.20424.
Viana, V., & Sinde, S. (2003). Estilo alimentar: Adaptação e validação do Questionário Holandês do Comportamento Alimentar. Psicologia Teoria Investigação e Prática, 8, 59–71.
Viveiro, C., Brito, S., & Moleiro, P. (2016). Sobrepeso e obesidade pediátrica: a realidade portuguesa. Revista portuguesa Délelőtt saúde pública, 34(1), 30–37. https://doi.org/10.1016/j.rpsp.2015.07.004.
Vivier, P., & Tompkins, C. (2008). Health consequences of obesity in children and adolescents. In E. J. R. Steele (Ed.), Handbook of childhood and adolescent obesity (pp. 11–24). New York: Springer.
Wardle, J., Marsland, L., Sheikh, Y., Quinn, M., Fedoroff, I., & Ogden, J. (1992). Eating style and eating behaviour in adolescents. Appetite, 18(3), 167–183. https://doi.org/10.1016/0195-6663(92)90195-C.
Wedig, M. M., & Nock, M. K. (2010). The functional assessment of maladaptive behaviors: a preliminary evaluation of binge eating and purging among women. Psychiatry Research, 178(3), 518–524. https://doi.org/10.1016/j.psychres.2009.05.010.
WHO. (2006). WHO Multicenter growth reference study group: WHO child growth standards: Length/height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age: Methods and development. Geneva, Switzerland: World Health Organization.
WHO. (2010). WHO Anthro for personal computers, version 3.1, 2010: Software for assessing growth and development of the world’s children. Geneva, Switzerland: World Health Organization.
WHO. (2017). Adolescent obesity and related behaviours: Trends and inequalities in the WHO European region, 2002–2014. Copenhagen, Denmark: World Health Organization.
Wildes, J. E., Marcus, M. D., Kalarchian, M. A., Levine, M. D., Houck, P. R., & Cheng, Y. (2010). Self-reported binge eating in severe pediatric obesity: impact on weight change in a randomized controlled trial of family-based treatment. International Journal of Obesity, 34(7), 1143–1148. https://doi.org/10.1038/ijo.2010.35.
Williams, J., Wake, M., Hesketh, K., Maher, E., & Waters, E. (2005). Health-related quality of life of overweight and obese children. Journal of the American Medical Association, 293(1), 70–76. https://doi.org/10.1001/jama.293.1.70.
Zeller, M. H., & Modi, A. C. (2008). Psychosocial factors related to obesity in children and adolescents. In R. S. E. Jelalian (Ed.), Handbook of childhood and adolescent obesity (pp. 25–42). New York: Springer.
Zeman, J., Cassano, M., Perry-Parrish, C., & Stegall, S. (2006). Emotion regulation in children and adolescents. Journal of Developmental & Behavioral Pediatrics, 27(2), 155–168. https://doi.org/10.1097/00004703-200604000-00014.