A naturalistic examination of negative affect and disorder-related rumination in anorexia nervosa
- 854 Downloads
In anorexia nervosa (AN), volitional inhibition of rewarding behaviors, such as eating, involves a conflict between the desire to suppress appetite and the inherent motive to consume. This conflict is thought to have costs that carry over into daily life, e.g., triggering negative affect and/or recurring ruminations, which may ultimately impact long term outcome. Hence, increasing research effort is being dedicated to understand the link between emotional and ruminative processes in the etiology and maintenance of AN. We investigated whether affective states influence disorder-related rumination in AN applying “ecological momentary assessment”, a method which allows the experimenter to gain insight into psychological processes in the natural environment and assess data in real time. Participants (AN = 37, healthy controls = 33) were given a smartphone for 14 days. A ringtone signaled at six random time-points each day to fill in a questionnaire, which gauged disorder-typical thoughts about food and weight as well as affective state. Analyses, applying hierarchical linear models confirmed that AN patients spend more time thinking about food, body shape and weight than controls (p < 0.001). Additionally, the results support the hypothesis that momentary negative affect (but not baseline depression (p = 0.56) or anxiety symptoms (p = 0.60) are positively associated with a higher amount of disorder-related rumination in patients (p < 0.001). Our findings are in line with theories which claim that ruminative thinking induces a vulnerability to negative stimuli which, in turn, fosters heightened negative affect. Thus, therapeutic interventions could be improved by implementing modules that specifically target disorder-related rumination.
KeywordsAnorexia nervosa Ecological momentary assessment Rumination Negative affect
This work was supported by the Deutsche Forschungsgemeinschaft (EH 367/5-1; SFB 940/1), and Swiss Anorexia Nervosa Foundation.
Complaince with ethical standards
Conflict of interest
Dr. Roessner has received payment for consulting and writing activities from Lilly, Novartis, and Shire Pharmaceuticals, lecture honoraria from Lilly, Novartis, Shire Pharmaceuticals, and Medice Pharma, and support for research from Shire and Novartis. He has carried out (and is currently carrying out) clinical trials in cooperation with the Novartis, Shire, and Otsuka companies. All other authors reported no biomedical financial interests or potential conflicts of interest.
- 15.Papageorgiou C, Wells A (2002) Depressive rumination. In: Papageorgiou A (ed) Nature, theory, and treatment, 3rd edn. Wiley, New York, pp 261–273Google Scholar
- 18.Martin LL, Tesser A (1996) Some ruminative thoughts. Adv Soc Cogn 9:1–47Google Scholar
- 28.Treasure J, Schmidt U (2013) The cognitive-interpersonal maintenance model of anorexia nervosa revisited: a summary of the evidence for cognitive, socio-emotional and interpersonal predisposing and perpetuating factors. J Eat Disord 1:13. doi: 10.1186/2050-2974-1-13 CrossRefPubMedPubMedCentralGoogle Scholar
- 36.Stone AA, Shiffman S (1994) Ecological momentary assessment (EMA) in behavorial medicine. Ann Behav Med 16:199–202Google Scholar
- 41.Thiel A, Jacobi C, Horstmann S et al (1997) Eine deutschsprachige Version des Eating Disorder Inventory EDI-2. [German translation of the Eating Disorder Inventory EDI-2.]. PPmP Psychother Psychosom Med Psychol 47:365–376Google Scholar
- 42.Hautzinger M, Keller F, Kühner C (2009) Beck Depressions Inventar. Huber Bern 38:615–628Google Scholar
- 44.Spielberger CD (2010) State-Trait Anxiety Inventory. Corsini Encycl PsycholGoogle Scholar
- 45.Steyer R, Schwenkmezger P, Notz P, Eid M (1997) Der mehrdimensionale Befindlichkeitsfragebogen (MDBF). Handanweisung [The multidimensional affect rating scale (MDBF). Manual]. Göttingen, HogrefeGoogle Scholar
- 47.Hox JJ (2000) Multilevel analysis of grouped and longitudinal data. Model Longitud Multilevel Data Pract Issues Appl Approach Specif 45:15–32Google Scholar
- 48.Raudenbush SW, Bryk AS, Cheong YF, Congdon RT, du Toit M (2011) Hierarchical linear & nonlinear modeling. Scientific Software International, Inc. LIncolnwood, ILGoogle Scholar
- 76.Hayes SC, Strosahl KD, Wilson KG (1999) Acceptance and commitment therapy: An experiential approach to behavior change. Guilford Press, New YorkGoogle Scholar
- 80.Musch J, Klauer KC (2003) The psychology of evaluation: affective processes in cognition and emotion. Psychology Press, New YorkGoogle Scholar