Skip to main content
SpringerLink
Log in

Spontaneous Emotion Regulation in Anorexia and Bulimia Nervosa

  • Original Article
  • Published:
Cognitive Therapy and Research Aims and scope Submit manuscript

Abstract

The aim of the current study was to examine the usage of spontaneous emotion regulation in eating disorders (ED). After watching a sad film clip, women with anorexia nervosa (n = 42), bulimia nervosa (n = 40), and a non-ED control group (n = 41) indicated on visual analogue scales to what extent they had used emotional acceptance, reappraisal, rumination and suppression to cope with their emotions during the film clip. Results revealed no differences between the groups with regard to levels of reappraisal. However, both ED groups used rumination and suppression to a greater extent, and acceptance to a lesser extent, than the non-ED control group. ED severity was predicted by spontaneous rumination and suppression. Results suggest that—when not instructed—individuals with anorexia and bulimia nervosa have a greater tendency to engage in maladaptive emotion regulation. In particular, spontaneous rumination and suppression seem to be closely related to ED pathology.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Notes

  1. The majority of participants with AN were classified as restricting subtype (ANR; n = 29 vs. n = 13 binge/purge subtype [ANBP]).

  2. Only the diagnostic questions of the Eating Disorder Examination Interview were administered.

  3. Items were translated from German into English for this manuscript. If you are interested in the original set of items, please contact the corresponding author.

  4. As a further form of validation, a pre-test was conducted correlating self-developed state ER scales with well-established self-report measures of the same ER strategy. All correlations were significant, ps < 0.001. State emotional acceptance was correlated with the global scores of the Acceptance and Action Questionnaire II (Bond et al. 2011; German version: Gloster et al. 2011; r = 0.532). State reappraisal was correlated with the reappraisal scale (r = 0.465) and state suppression with the suppression scale (r = 0.482) of the Emotion Regulation Questionnaire (Gross and John 2003; German version: Abler and Kessler 2009). State rumination was correlated with the global score of the Perseverative Thinking Questionnaire (German version: Ehring et al. 2011; r = 0.619).

  5. It is noteworthy that also no group differences in spontaneous ER were found between AN subtypes: ANR and ANBP.

References

  • Abler, B., & Kessler, H. (2009). Emotion Regulation Questionnaire—A German version of Gross and John’s ERQ. Diagnostica, 55, 3144–3152.

    Article  Google Scholar 

  • Aldao, A., Nolen-Hoeksema, S., & Schweizer, S. (2010). Emotion-regulation strategies across psychopathology: A meta-analytic review. Clinical Psychology Review, 30, 217–237.

    Article  PubMed  Google Scholar 

  • American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders: DSM-IV-TR ®. American Psychiatric Pub.

  • Beck, A. T., Steer, R. A., Ball, R., & Ranieri, W. F. (1996). Comparison of Beck Depression Inventories-I and-II in psychiatric outpatients. Journal of Personality Assessment, 67, 588–597.

    Article  CAS  PubMed  Google Scholar 

  • Berg, K. C., Peterson, C. B., Frazier, P., & Crow, S. J. (2012). Psychometric evaluation of the eating disorder examination and eating disorder examination-questionnaire: A systematic review of the literature. International Journal of Eating Disorders, 45, 428–438.

    Article  PubMed  PubMed Central  Google Scholar 

  • Bond, F. W., Hayes, S. C., Baer, R. A., Carpenter, K. M., Guenole, N., Orcutt, H. K., et al. (2011). Preliminary psychometric properties of the Acceptance and Action Questionnaire-II: A revised measure of psychological inflexibility and experiential avoidance. Behavior Therapy, 42, 676–688.

    Article  PubMed  Google Scholar 

  • Campbell-Sills, L., Barlow, D. H., Brown, T. A., & Hofmann, S. G. (2006a). Acceptability and suppression of negative emotion in anxiety and mood disorders. Emotion, 6, 587–595.

    Article  PubMed  Google Scholar 

  • Campbell-Sills, L., Barlow, D. H., Brown, T. A., & Hofmann, S. G. (2006b). Effects of suppression and acceptance on emotional responses of individuals with anxiety and mood disorders. Behaviour Research and Therapy, 44, 1251–1263.

    Article  PubMed  Google Scholar 

  • Chua, J. L., Touyz, S., & Hill, A. J. (2004). Negative mood-induced overeating in obese binge eaters: An experimental study. International Journal of Obesity and Related Metabolic Disorders, 28, 606–610.

    Article  CAS  PubMed  Google Scholar 

  • Cohen, J. (1988). Statistical power analysis for the behavioural sciences. New York: Routledge.

    Google Scholar 

  • Cohen, J. (1992). A power primer. Psychological Bulletin, 112, 115–159.

    Google Scholar 

  • Cohen, J., Cohen, P., West, S. G., & Aiken, L. S. (2003). Applied multiple regression/correlation analysis for the behavioral sciences. Mahwah, New Jersey: Lawrence Erlbaum Associates.

    Google Scholar 

  • Cooper, P. J., & Bowskill, R. (1986). Dysphoric mood and overeating. The British Journal of Clinical Psychology, 25, 155–156.

    Article  PubMed  Google Scholar 

  • Danner, U. N., Evers, C., Stok, F. M., Elburg, A. A., & Ridder, D. T. (2012). A double burden: Emotional eating and lack of cognitive reappraisal in eating disordered women. European Eating Disorders Review, 20, 490–495.

    Article  PubMed  Google Scholar 

  • Danner, U. N., Sternheim, L., & Evers, C. (2014). The importance of distinguishing between the different eating disorders (sub) types when assessing emotion regulation strategies. Psychiatry Research, 215, 727–732.

    Article  PubMed  Google Scholar 

  • Ehring, T., Tuschen-Caffier, B., Schnülle, J., Fischer, S., & Gross, J. J. (2010). Emotion regulation and vulnerability to depression: Spontaneous versus instructed use of emotion suppression and reappraisal. Emotion, 10, 563–572.

    Article  PubMed  Google Scholar 

  • Ehring, T., Zetsche, U., Weidacker, K., Wahl, K., Schönfeld, S., & Ehlers, A. (2011). The Perseverative Thinking Questionnaire (PTQ): Validation of a content-independent measure of repetitive negative thinking. Journal of Behavior Therapy and Experimental Psychiatry, 42, 225–232.

    Article  PubMed  PubMed Central  Google Scholar 

  • Ekman, P. (1992). Are there basic emotions? Psychological Review, 99, 550–553.

    Article  CAS  PubMed  Google Scholar 

  • Fairburn, C. G., & Beglin, S. (2008). Eating Disorder Examination Questionnaire (EDE-Q 6.0). In C. G. Fairburn (Ed.), Cognitive behavior therapy and eating disorders (pp. 30–360). New York: Guilford Press.

    Google Scholar 

  • Fairburn, C. G., Cooper, Z., Doll, H. A., Norman, P., & O’Connor, M. (2000). The natural course of bulimia nervosa and binge eating disorder in young women. Archives of General Psychiatry, 57, 659–665.

    Article  CAS  PubMed  Google Scholar 

  • Fairburn, C. G., Cooper, Z., & O’Connor, M. E. (2008). Eating Disorder Examination (edition 16.0D). In C. G. Fairburn (Ed.), Cognitive behavior therapy and eating disorders (pp. 265–308). New York: Guilford Press.

    Google Scholar 

  • Fairburn, C. G., Cooper, Z., & Shafran, R. (2003). Cognitive behaviour therapy for eating disorders: A “transdiagnostic” theory and treatment. Behaviour Research and Therapy, 41, 509–528.

    Article  PubMed  Google Scholar 

  • Fox, J. R., & Froom, K. (2009). Eating disorders: A basic emotion perspective. Clinical Psychology & Psychotherapy, 16, 328–335.

    Article  Google Scholar 

  • Frijda, N. H. (2007). The laws of emotion. Hillsdale: Lawrence Erlbaum Associates Publishers.

    Google Scholar 

  • Gilboa-Schechtman, E., Avnon, L., Zubery, E., & Jeczmien, P. (2006). Emotional processing in eating disorders: Specific impairment or general distress related deficiency? Depression and Anxiety, 23, 331–339.

    Article  PubMed  Google Scholar 

  • Gloster, A. T., Klotsche, J., Chaker, S., Hummel, K. V., & Hoyer, J. (2011). Assessing psychological flexibility: What does it add above and beyond existing constructs? Psychological Assessment, 23, 970–982.

    Article  PubMed  Google Scholar 

  • Gross, J. J. (2002). Emotion regulation: Affective, cognitive, and social consequences. Psychophysiology, 39, 281–291.

    Article  PubMed  Google Scholar 

  • Gross, J. J., & John, O. P. (2003). Individual differences in two emotion regulation processes: Implications for affect, relationships, and well-being. Journal of Personality and Social Psychology, 85, 348–362.

    Article  PubMed  Google Scholar 

  • Harrison, A., Sullivan, S., Tchanturia, K., & Treasure, J. (2010). Emotional functioning in eating disorders: Attentional bias, emotion recognition and emotion regulation. Psychological Medicine, 40, 1887–1897.

    Article  CAS  PubMed  Google Scholar 

  • Hautzinger, M., Keller, F., & Kuehner, C. (2006). Beck Depressions-Inventar (2 Revision). Frankfurt am Main: Harcourt Test Services.

    Google Scholar 

  • Haynos, A. F., & Fruzzetti, A. E. (2011). Anorexia nervosa as a disorder of emotion dysregulation: Evidence and treatment implications. Clinical Psychology: Science and Practice, 18, 183–202.

    Google Scholar 

  • Herpertz-Dahlmann, B., Schwarte, R., Krei, M., Egberts, K., Warnke, A., Wewetzer, C., & Dempfle, A. (2014). Day-patient treatment after short inpatient care versus continued inpatient treatment in adolescents with anorexia nervosa (ANDI): A multicentre, randomised, open-label, non-inferiority trial. Lancet, 383, 1222–1229.

    Article  PubMed  Google Scholar 

  • Hilbert, A., & Tuschen-Caffier, B. (2006). Eating Disorder Examination: Deutschsprachige Übersetzung (Vol. 01). Münster: Verlag für Psychotherapie.

    Google Scholar 

  • Hilbert, A., Tuschen-Caffier, B., & Ohms, M. (2004). Eating Disorder Examination: Deutschsprachige Version des strukturierten Essstörungsinterviews. Diagnostica, 50, 98–106.

    Article  Google Scholar 

  • Jones, N., & Rogers, P. J. (2003). Preoccupation, food, and failure: An investigation of cognitive performance deficits in dieters. International Journal of Eating Disorders, 33, 185–192.

    Article  PubMed  Google Scholar 

  • Keel, P. K., & Brown, T. A. (2010). Update on course and outcome in eating disorders. The International Journal of Eating Disorders, 43, 195–204.

    Article  PubMed  Google Scholar 

  • Keller, M. B., Herzog, D. B., Lavori, P. W., Bradburn, I. S., & Mahoney, E. S. (1992). The naturalistic history of bulimia nervosa: Extraordinarily high rates of chronicity, relapse, recurrence, and psychosocial morbidity. International Journal of Eating Disorders, 12, 1–9.

    Article  Google Scholar 

  • Masuda, A., & Hill, M. L. (2013). Mindfulness as therapy for disordered eating: a systematic review. Neuropsychiatry, 3, 433–447.

    Article  Google Scholar 

  • Milos, G., Spindler, A., Schnyder, U., & Fairburn, C. G. (2005). Instability of eating disorder diagnoses: Prospective study. The British Journal of Psychiatry, 187, 573–578.

    Article  PubMed  PubMed Central  Google Scholar 

  • Mond, J. M., Hay, P. J., Rodgers, B., Owen, C., & Beumont, P. J. V. (2005). Assessing quality of life in eating disorder patients. Quality of Life Research, 14, 171–178.

    Article  CAS  PubMed  Google Scholar 

  • Naumann, E., Tuschen-Caffier, B., Voderholzer, U., Caffier, D., & Svaldi, J. (2015). Rumination but not distraction increases eating-related symptoms in anorexia and bulimia nervosa. Journal of Abnormal Psychology, 124, 412–420.

    Article  PubMed  Google Scholar 

  • Naumann, E., Tuschen-Caffier, B., Voderholzer, U., & Svaldi, J. (2014). On the role of sadness in the psychopathology of anorexia nervosa. Psychiatry Research, 215, 711–717.

    Article  PubMed  Google Scholar 

  • Nolen-Hoeksema, S., Stice, E., Wade, E., & Bohon, C. (2007). Reciprocal relations between rumination and bulimic, substance abuse, and depressive symptoms in female adolescents. Journal of Abnormal Psychology, 116, 198–207.

    Article  PubMed  Google Scholar 

  • Nolen-Hoeksema, S., & Watkins, E. R. (2011). A heuristic for developing transdiagnostic models of psychopathology explaining multifinality and divergent trajectories. Perspectives on Psychological Science, 6, 589–609.

    Article  PubMed  Google Scholar 

  • Nolen-Hoeksema, S., Wisco, B. E., & Lyubomirsky, S. (2008). Rethinking rumination. Perspectives on Psychological Science, 3, 400–424.

    Article  PubMed  Google Scholar 

  • Park, R. J., Dunn, B. D., & Barnard, P. J. (2011). Schematic models and modes of mind in anorexia nervosa I: A novel process account. International Journal of Cognitive Therapy, 4, 415–437.

    Article  Google Scholar 

  • Park, R. J., Dunn, B. D., & Barnard, P. J. (2012). Schematic models and modes of mind in anorexia nervosa II: Implications for treatment and course. International Journal of Cognitive Therapy, 5, 86–98.

    Article  Google Scholar 

  • Rawal, A., Williams, J. M. G., & Park, R. J. (2011). Effects of analytical and experiential self-focus on stress-induced cognitive reactivity in eating disorder psychopathology. Behaviour Research and Therapy, 49, 635–645.

    Article  PubMed  PubMed Central  Google Scholar 

  • Rottenberg, J., Ray, R. D., & Gross, J. J. (2007). Emotion elicitation using films. In J. A. Coan & J. J. B. Allen (Eds.), The handbook of emotion elicitation and assessment (pp. 9–24). New York: Oxford University Press.

    Google Scholar 

  • Sato, H., & Kawahara, J. I. (2011). Selective bias in retrospective self-reports of negative mood states. Anxiety, Stress & Coping, 24, 359–367.

    Article  Google Scholar 

  • Selby, E. A., Anestis, M. D., & Joiner, T. E. (2008). Understanding the relationship between emotional and behavioral dysregulation: Emotional cascades. Behaviour Research and Therapy, 46, 593–611.

    Article  PubMed  Google Scholar 

  • Selby, E. A., Wonderlich, S. A., Crosby, R. D., Engel, S. G., Panza, E., Mitchell, J. E., et al. (2014). Nothing tastes as good as thin feels low positive emotion differentiation and weight-loss activities in anorexia nervosa. Clinical Psychological Science, 2, 514–531.

    Article  Google Scholar 

  • Suokas, J. T., Suvisaari, J. M., Grainger, M., Raevuori, A., Gissler, M., & Haukka, J. (2014). Suicide attempts and mortality in eating disorders: a follow-up study of eating disorder patients. General Hospital Psychiatry, 36, 355–357.

    Article  PubMed  Google Scholar 

  • Svaldi, J., Caffier, D., & Tuschen-Caffier, B. (2010). Emotion suppression but not reappraisal increases desire to binge in women with binge eating disorder. Psychotherapy and Psychosomatics, 79, 188–190.

    Article  PubMed  Google Scholar 

  • Svaldi, J., Griepenstroh, J., Tuschen-Caffier, B., & Ehring, T. (2012). Emotion regulation deficits in eating disorders: A marker of eating pathology or general psychopathology? Psychiatry Research, 197, 103–111.

    Article  PubMed  Google Scholar 

  • Svaldi, J., Tuschen-Caffier, B., Trentowska, M., Caffier, D., & Naumann, E. (2014). Differential caloric intake in overweight females with and without binge eating: Effects of a laboratory-based emotion-regulation training. Behaviour Research and Therapy, 56, 39–46.

    Article  CAS  PubMed  Google Scholar 

  • Tabachnick, B. G., & Fidell, L. S. (2007). Using multivariate statistics. Boston, M.A.: Pearson Education.

    Google Scholar 

  • Troop, N. A., Holbrey, A., & Treasure, J. L. (1998). Stress, coping, and crisis support in eating disorders. The International Journal of Eating Disorders, 24, 157–166.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Clinical Psychology and Psychotherapy, University of Freiburg, Engelbergerstrasse 41, 79106, Freiburg, Germany

    Eva Naumann & Brunna Tuschen-Caffier

  2. Schoen Clinic Roseneck, Am Roseneck 6, 83209, Prien, Germany

    Ulrich Voderholzer

  3. Department of Clinical Psychology and Psychotherapy, University of Tübingen, Schleichstrasse 4, 72076, Tübingen, Germany

    Jennifer Svaldi

Authors
  1. Eva Naumann
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Brunna Tuschen-Caffier
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ulrich Voderholzer
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jennifer Svaldi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Eva Naumann.

Ethics declarations

Conflict of Interest

Eva Naumann, Brunna Tuschen-Caffier, Ulrich Voderholzer and Jennifer Svaldi declare that they have no conflict of interest.

Informed Consent

All procedures performed in this study were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments. Informed consent was obtained from all individual participants included in the study.

Animal Rights

No animal studies were carried out by the authors for this article.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Naumann, E., Tuschen-Caffier, B., Voderholzer, U. et al. Spontaneous Emotion Regulation in Anorexia and Bulimia Nervosa. Cogn Ther Res 40, 304–313 (2016). https://doi.org/10.1007/s10608-015-9723-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10608-015-9723-3

Keywords

Search

Navigation