Abstract
Disordered eating and difficulties with emotion regulation have shown strong associations but there has been little attention paid to possible mediators that would explain this relationship. In depression and anxiety, negative memory and interpretation biases are implicated in the onset and maintenance of these disorders, however, little is known about whether these biases also exist in eating disorders, and if they are related to difficulties with emotion regulation. Females (n = 181) aged 17–26 years, completed self-report measures of disordered eating and behaviours, difficulties in emotion regulation, depression, anxiety, and memory and interpretation bias. While negative memory bias was related to objective binge episodes, it was not related to difficulties in emotion regulation. Negative interpretation biases were associated with higher levels of eating psychopathology and objective binge eating when controlling for depression and anxiety. Cross-sectional testing showed this bias to mediate the relationship between both measures of disordered eating and difficulties with emotion regulation. Findings support further research into the effectiveness of cognitive bias modification techniques with respect to disordered eating and the reduction of emotion regulation difficulties.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Aldao, A., & Nolen-Hoeksema, S. (2012). When are adaptive strategies most predictive of psychopathology? Journal of Abnormal Psychology, 121(1), 276–281. doi:10.1037/a0023598.
Aldao, A., Nolen-Hoeksema, S., & Schweizer, S. (2010). Emotion-regulation strategies across psychopathology: A meta-analytic review. Clinical Psychology Review, 30(2), 217–237. doi:10.1016/j.cpr.2009.11.004.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington: American Psychiatric Publishing.
Ashworth, F., Pringle, A., Norbury, R., Harmer, C. J., Cowen, P. J., & Cooper, M. (2011). Neural response to angry and disgusted facial expressions in bulimia nervosa. Psychological Medicine, 41(11), 2375–2384. doi:10.1016/S0006-3223(03)00168-9.
Beard, C., & Amir, N. (2010). Negative interpretation bias mediates the effect of social anxiety on state anxiety. Cognitive Therapy and Research, 34(3), 292–296. doi:10.1007/s10608-009-9258-6.
Berna, C., Lang, T. J., Goodwin, G. M., & Holmes, E. A. (2011). Developing a measure of interpretation bias for depressed mood: An ambiguous scenarios test. Personality and Individual Differences, 51(3), 349–354. doi:10.1016/j.paid.2011.04.005.
Braun, D. L., Sunday, S., & Halmi, K. (1994). Psychiatric comorbidity in patients with eating disorders. Psychological Medicine, 24(04), 859–867. doi:10.1017/S0033291700028956.
Brockmeyer, T., Holtforth, M. G., Bents, H., Kämmerer, A., Herzog, W., & Friederich, H. (2012). Starvation and emotion regulation in anorexia nervosa. Comprehensive Psychiatry, 53(5), 496–501. doi:10.1002/cpp.628.
Burt, D. B., Zembar, M. J., & Niederehe, G. (1995). Depression and memory impairment: A meta-analysis of the association, its pattern, and specificity. Psychological Bulletin, 117(2), 285. doi:10.1037//0033-2909.117.2.285.
Butler, G., & Mathews, A. (1983). Cognitive processes in anxiety. Advances in Behaviour Research and Therapy, 5(1), 51–62. doi:10.1016/0146-6402(83)90015-2.
Coles, M. E., & Heimberg, R. G. (2002). Memory biases in the anxiety disorders: Current status. Clinical Psychology Review, 22(4), 587–627. doi:10.1016/S0272-7358(01)00113-1.
Constans, J. I., Penn, D. L., Ihen, G. H., & Hope, D. A. (1999). Interpretive biases for ambiguous stimuli in social anxiety. Behaviour Research and Therapy, 37(7), 643–651. doi:10.1016/S0005-7967(98)00180-6.
Cooper, M. (1997). Bias in interpretation of ambiguous scenarios in eating disorders. Behaviour Research and Therapy, 35(7), 619–626. doi:10.1016/S0005-7967(97)00021-1.
Cooper, M. J., & Cowen, P. (2009). Negative self-beliefs in relation to eating disorder and depressive symptoms: Different themes are characteristic of the two sets of symptoms in those with eating disorders and/or depression. Journal of Cognitive Psychotherapy, 23(2), 147–159. doi:10.1891/0889-8391.23.2.147.
Cooper, J. L., O’Shea, A. E., Atkinson, M. J., & Wade, T. D. (2014). Examination of the difficulties in emotion regulation scale and its relation to disordered eating in a young female sample. International Journal of Eating Disorders, 47(6), 630–639. doi:10.1002/eat.22278.
Cooper, M. J., Wells, A., & Todd, G. (2004). A cognitive model of bulimia nervosa. British Journal of Clinical Psychology, 43(1), 1–16. doi:10.1348/014466504772812931.
Ellis, A. J., Beevers, C. G., & Wells, T. T. (2011). Attention allocation and incidental recognition of emotional information in dysphoria. Cognitive Therapy and Research, 35(5), 425–433. doi:10.1007/s10608-010-9305-3.
Fairburn, C. G., & Beglin, S. J. (1994). Assessment of eating disorders: Interview or self-report questionnaire? International Journal of Eating Disorders, 16(4), 363–370. doi:10.1002/1098-108X(199412)16:4<363:AID-EAT2260160405>3.0.CO;2-#.
Fairburn, C. G., Cooper, Z., & Shafran, R. (2003). Cognitive behaviour therapy for eating disorders: a “transdiagnostic” theory and treatment. Behaviour Research and Therapy, 41(5), 509–528. doi:10.1016/S0005-7967(02)00088-8.
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 and Behavioral Assessment, 26(1), 41–54. doi:10.1023/B:JOBA.0000007455.08539.94.
Harrison, A., Sullivan, S., Tchanturia, K., & Treasure, J. (2010a). Emotional functioning in eating disorders: Attentional bias, emotion recognition and emotion regulation. Psychological Medicine, 40(11), 1887–1897. doi:10.1017/S0033291710000036.
Harrison, A., Tchanturia, K., & Treasure, J. (2010b). Attentional bias, emotion recognition, and emotion regulation in anorexia: State or trait? Biological Psychiatry, 68(8), 755–761. doi:10.1016/j.biopsych.2010.04.037.
Henry, J. D., & Crawford, J. R. (2005). The short-form version of the Depression Anxiety Stress Scales (DASS-21): Construct validity and normative data in a large non-clinical sample. British Journal of Clinical Psychology, 44(2), 227–239. doi:10.1348/014466505x29657.
Hollon, S. D., DeRubeis, R. J., Shelton, R. C., et al. (2005). Prevention of relapse following cognitive therapy vs medications in moderate to severe depression. Archives of General Psychiatry, 62(4), 417–422. doi:10.1001/archpsyc.62.4.417.
Holmes, E. A., James, E. L., Kilford, E. J., & Deeprose, C. (2010). Key steps in developing a cognitive vaccine against traumatic flashbacks: Visuospatial tetris versus verbal pub quiz. PLoS ONE, 5(11), e13706. doi:10.1371/journal.pone.0013706.
Jacobi, C., & Fittig, E. (2010). Psychosocial risk factors for eating disorders The Oxford handbook of eating disorders (pp. 123–136). New York, NY: Oxford University Press.
Joormann, J., & Gotlib, I. H. (2009). Emotion regulation in depression: Relation to cognitive inhibition. Cognition and Emotion, 24(2), 281–298. doi:10.1080/02699930903407948.
Kaye, W. H., Bulik, C. M., Thornton, L., Barbarich, N., Masters, K., & Group, P. F. C. (2004). Comorbidity of anxiety disorders with anorexia and bulimia nervosa. American Journal of Psychiatry, 161(12), 2215–2221. doi:10.1176/appi.ajp.161.12.2215.
Koster, E. H., Fox, E., & MacLeod, C. (2009). Introduction to the special section on cognitive bias modification in emotional disorders. Journal of Abnormal Psychology, 118(1), 1. doi:10.1037/a0014379.
Lavender, J. M., Wonderlich, S. A., Peterson, C. B., Crosby, R. D., Engel, S. G., Mitchell, J. E., et al. (2014). Dimensions of emotion dysregulation in bulimia nervosa. European Eating Disorders Review, 22(3), 212–216. doi:10.1002/erv.2288.
Lee, M., & Shafran, R. (2004). Information processing biases in eating disorders. Clinical Psychology Review, 24(2), 215–238. doi:10.1016/j.cpr.2003.10.004.
MacLeod, C. (2012). Cognitive bias modification procedures in the management of mental disorders. Current Opinion in Psychiatry, 25(2), 114–120. doi:10.1097/YCO.0b013e32834fda4a.
MacLeod, C., & Cohen, I. L. (1993). Anxiety and the interpretation of ambiguity: A text comprehension study. Journal of Abnormal Psychology, 102(2), 238. doi:10.1037/0021-843X.102.2.238.
MacLeod, C., & Mathews, A. (2004). Selective memory effects in anxiety disorders: An overview of research findings and their implications. In D. R. P. Hertel (Ed.), Memory and emotion (pp. 155–185). New York, NY: Oxford University Press.
Manuel, A., & Wade, T. D. (2013). Emotion regulation in broadly defined anorexia nervosa: Association with negative affective memory bias. Behaviour Research and Therapy, 51(8), 417–424. doi:10.1016/j.brat.2013.04.005.
Martijn, C., Vanderlinden, M., Roefs, A., Huijding, J., & Jansen, A. (2010). Increasing body satisfaction of body concerned women through evaluative conditioning using social stimuli. Health Psychology, 29(5), 514. doi:10.1037/a0020770.
Mathews, A., & MacLeod, C. (2005). Cognitive vulnerability to emotional disorders. Annual Review of Clinical Psychology, 1(1), 167–195. doi:10.1146/annurev.clinpsy.1.102803.143916.
Matt, G. E., Vázquez, C., & Campbell, W. K. (1992). Mood-congruent recall of affectively toned stimuli: A meta-analytic review. Clinical Psychology Review, 12(2), 227–255. doi:10.1016/0272-7358(92)90116-P.
Mogg, K., Bradbury, K. E., & Bradley, B. P. (2006). Interpretation of ambiguous information in clinical depression. Behaviour Research and Therapy, 44(10), 1411–1419. doi:10.1016/j.brat.2005.10.008.
Neshat-Doost, H. T., Moradi, A. R., Taghavi, M. R., Yule, W., & Dalgleish, T. (1999). The development of a corpus of emotional words produced by children and adolescents. Personality and Individual Differences, 27(3), 433–451. doi:10.1016/S0191-8869(98)00253-0.
Peñas-Lledó, E., Vaz Leal, F. J., & Waller, G. (2002). Excessive exercise in anorexia nervosa and bulimia nervosa: Relation to eating characteristics and general psychopathology. International Journal of Eating Disorders, 31(4), 370–375. doi:10.1002/eat.10042.
Preacher, K. J., & Hayes, A. F. (2008). Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behavior Research Methods, 40(3), 879–891. doi:10.3758/BRM.40.3.879.
Pringle, A., Harmer, C., & Cooper, M. (2010). Investigating vulnerability to eating disorders: biases in emotional processing. Psychological Medicine, 40(04), 645–655. doi:10.1017/S0033291709990778.
Rude, S. S., Wenzlaff, R. M., Gibbs, B., Vane, J., & Whitney, T. (2002). Negative processing biases predict subsequent depressive symptoms. Cognition and Emotion, 16(3), 423–440. doi:10.1080/02699930143000554.
Smith, E., & Rieger, E. (2006). The effect of attentional bias toward shape- and weight-related information on body dissatisfaction. International Journal of Eating Disorders, 39(6), 509–515. doi:10.1002/eat.20291.
Smyth, J. M., Wonderlich, S. A., Heron, K. E., Sliwinski, M. J., Crosby, R. D., Mitchell, J. E., & Engel, S. G. (2007). Daily and momentary mood and stress are associated with binge eating and vomiting in bulimia nervosa patients in the natural environment. Journal of Consulting and Clinical Psychology, 75(4), 629–638. doi:10.1037/0022-006X.75.4.629.
Stanton, K., & Watson, D. (2014). Positive and negative affective dysfunction in psychopathology. Social and Personality Psychology Compass, 8(9), 555–567. doi:10.1111/spc3.12132.
Tabachnick, B. G., & Fidell, L. S. (2007). Using multivariate statistics (5th ed.). Boston, MA: Pearson/Allyn & Bacon.
Teasdale, J. D. (1985). Psychological treatments for depression: How do they work? Behaviour Research and Therapy, 23(2), 157–165. doi:10.1016/0005-7967(85)90024-5.
Wade, T. D., Bulik, C. M., Neale, M., & Kendler, K. S. (2000). Anorexia nervosa and major depression: shared genetic and environmental risk factors. American Journal of Psychiatry, 157(3), 469–471. doi:10.1176/appi.ajp.157.3.469.
Watson, D., & Clark, L. A. (1984). Negative affectivity: The disposition to experience aversive emotional states. Psychological Bulletin, 96(3), 465–490. doi:10.1037/0033-2909.96.3.465.
Werthmann, J., Roefs, A., Nederkoorn, C., Mogg, K., Bradley, B., & Jansen, A. (2012). Can(not) take my eyes off food. Attention bias, craving and overeating. Appetite, 59(2), 637. doi:10.1016/j.appet.2012.05.107.
Williamson, D. A., Muller, S. L., Reas, D. L., & Thaw, J. M. (1999). Cognitive bias in eating disorders: Implications for theory and treatment. Behavior Modification, 23(4), 556–577. doi:10.1177/0145445599234003.
Williamson, D. A., White, M. A., York-Crowe, E., & Stewart, T. M. (2004). Cognitive–behavioral theories of eating disorders. Behavior Modification, 28(6), 711–738. doi:10.1177/0145445503259853.
Wisco, B. E., & Nolen-Hoeksema, S. (2010). Interpretation bias and depressive symptoms: The role of self-relevance. Behaviour Research and Therapy, 48(11), 1113–1122. doi:10.1016/j.brat.2010.08.004.
Woud, M. L., & Becker, E. S. (2014). Editorial for the special issue on cognitive bias modification techniques: An introduction to a time traveller’s tale. Cognitive Therapy and Research, 38(2), 83–88. doi:10.1007/s10608-014-9605-0.
Yiend, J., Parnes, C., Shepherd, K., Roche, M., & Cooper, M. (2014). Negative self-beliefs in eating disorders a cognitive-bias-modification study. Clinical Psychological Science,. doi:10.1177/2167702614528163.
Acknowledgments
Funding for this research was provided by the Flinders University Faculty of Social and Behavioural Sciences. Details of this research have not been presented elsewhere.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
Jane L. Cooper and Tracey D. Wade declare that they have no conflict of interest.
Informed Consent
Informed consent was obtained from all individual participants included in the study. This study received approval from the Flinders University Social and Behavioural Research Ethics Committee and all procedures followed were in accordance with the ethical standards of the committee.
Animal Rights
No animal studies were carried out by the authors for this article.
Rights and permissions
About this article
Cite this article
Cooper, J.L., Wade, T.D. The Relationship Between Memory and Interpretation Biases, Difficulties with Emotion Regulation, and Disordered Eating in Young Women. Cogn Ther Res 39, 853–862 (2015). https://doi.org/10.1007/s10608-015-9709-1
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10608-015-9709-1