Publications by authors named "Nicholas Troop"

31 Publications

Emotional disclosure in palliative care: A scoping review of intervention characteristics and implementation factors.

Palliat Med 2021 07 29;35(7):1323-1343. Epub 2021 May 29.

Division of Psychiatry, Marie Curie Palliative Care Research Department, UCL, London, UK.

Background: Emotional disclosure is the therapeutic expression of emotion. It holds potential as a means of providing psychological support. However, evidence of its efficacy in palliative settings is mixed. This may be due to variation in intervention characteristics.

Aim: To derive a greater understanding of the characteristics of potentially effective emotional disclosure-based interventions in palliative care by:(1) Developing a taxonomy of emotional disclosure-based interventions tested in people with advanced disease and(2) Mapping and linking objectives, outcomes, underlying mechanisms, and implementation factors.

Design: A scoping review drawing on Intervention Component Analysis to combine evidence from studies' methods, results, and discussion sections.

Data Sources: Six databases were searched to May 2020 including CINAHL, PsycINFO, and MEDLINE. Studies of emotional disclosure in adults with advanced disease were included. Study quality was appraised using an established tool.

Results: Seven thousand seven hundred ninety-two unique records were screened, of which 25 primary studies were included. Intervention characteristics were grouped into classes within three domains: topic of disclosure, format, and dose. Evidence was not available to determine which, if any, of the characteristics is most effective. Thematic synthesis of evidence from methods and discussion sections identified factors to consider in tailoring an emotional disclosure-based intervention to this setting, including: population characteristics (e.g. time since diagnosis), providing a safe environment, and flexibility in format.

Conclusions: This review approach facilitated a clearer understanding of factors that may be key in developing emotional disclosure-based interventions for palliative populations. Intervention Component Analysis has potential for application elsewhere to help develop evidence-based interventions.
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http://dx.doi.org/10.1177/02692163211013248DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8267079PMC
July 2021

Determinants of weekly sitting time: construct validation of an initial COM-B model and comparison of its predictive validity with the Theory of Planned Behaviour.

Psychol Health 2021 01 14;36(1):96-114. Epub 2020 May 14.

Department of Psychology and Sport Sciences, University of Hertfordshire, Herts, UK.

Objective: In relation to sitting behaviour, to investigate which theoretical domains best formed the Capability, Opportunity, and Motivation constructs of the COM-B, and compare the predictive validity to the Theory of Planned Behaviour (TPB), taking habit strength into consideration.

Design: Using a prospective design, 186 adults completed measures capturing domains from the Theoretical Domains Framework for the three COM-B constructs, and habit strength, which were examined using a formative measurement model. Predictive validity was then compared to the TPB.

Main Outcome Measures: Self-reported sitting behaviour.

Results: Self-monitoring (behavioural regulation domain) formed Capability; subjective norm (social influences domain) formed Opportunity; intention (intentions domain), positive affect (emotion domain), and perceived behavioural control (beliefs about capabilities domain), formed Motivation. The COM-B strongly predicted sitting behaviour (27% variance explained), with Capability, Opportunity, and habit strength as key drivers. The TPB explained a large amount of variance (23%) in sitting behaviour, with intention and habit strength as key drivers.

Conclusions: The behavioural regulation domain of Capability, the social influences domain of Opportunity, and habit strength were important drivers of sitting behaviour, with comparable variance predicted in the COM-B and TPB. Future research should consider this approach to conceptualise the COM-B for specific populations and behaviours.
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http://dx.doi.org/10.1080/08870446.2020.1763994DOI Listing
January 2021

Eating Disorder Examination Questionnaire (EDE-Q): Norms and psychometric properties in U.K. females and males.

Psychol Assess 2019 Jul 25;31(7):839-850. Epub 2019 Feb 25.

Department of Psychology, University of York.

The Eating Disorder Examination Questionnaire (EDE-Q) is a widely used assessment of eating disorder psychopathology; however, EDE-Q norms are yet to be provided within a nonclinical U.K. adult sample. Second, there is considerable disagreement regarding the psychometric properties of this measure. Several alternative factor structures have been previously proposed, but very few have subsequently validated their new structure in independent samples and many are often confined to specific subpopulations. Therefore, in the current study, we provide norms of the original four-factor EDE-Q structure, and subsequently assess the psychometric properties of the EDE-Q in females and males using a large nonclinical U.K. sample (total N = 2459). EDE-Q norms were consistently higher in females compared with males across all samples. Initial confirmatory factor analyses (CFA) did not support the original 4-factor structure for females or males (Phase 1). However, subsequent exploratory factor analyses (EFA) revealed a 3-factor structure as being the optimal fit for both females and males, using an 18-item and 16-item model, respectively (Phase 2). For females, the newly proposed 18-item structure was validated within an independent student sample and further validated in an additional nonstudent sample. The 16-item 3-factor male structure was also validated within an independent nonstudent sample, but was marginally below accepted fit indices within an independent student sample (Phase 3). Taken together, the above findings suggest that the EDE-Q factor structure may require further reassessment, with greater focus on the qualitative differences in interpretation of EDE-Q items between females and males. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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http://dx.doi.org/10.1037/pas0000703DOI Listing
July 2019

Web-based indicated prevention of common mental disorders in university students in four European countries - Study protocol for a randomised controlled trial.

Internet Interv 2019 Apr 15;16:35-42. Epub 2018 Mar 15.

King's College London, Institute of Psychiatry, Psychology and Neuroscience, Section of Eating Disorders, PO59, 16 De Crespigny Park, London SE5 8AF, United Kingdom.

Background: Mental disorders and their symptoms are highly prevalent in the university student population, and the transition from secondary to tertiary education is associated with a rise in mental health problems. Existing web-based interventions for the prevention of common mental disorders in student populations often focus on just one disorder and have not been designed specifically for students. There is thus a need for transdiagnostic, student-specific preventative interventions that can be widely disseminated. This two-arm, parallel group randomised controlled trial aims to evaluate the effectiveness and cost-effectiveness of a web-based transdiagnostic mental health problem prevention programme (PLUS) across several universities in four countries.

Method: Students ( = 5550) will be recruited through a variety of channels and asked to complete a personality assessment to determine whether they are at high risk for developing common mental disorders. Students at high risk will be randomly allocated to either PLUS or a control intervention, which provides practical support around issues commonly experienced at university. Students at low risk will be allocated to the control intervention. Both intervention groups will be assessed at baseline, 4 weeks, 3 months, 6 months and 12 months after randomisation. Depression and generalised anxiety, assessed using the Patient Health Questionnaire and the Generalised Anxiety Disorder scales, will form the primary outcomes in this study. Secondary outcome measures include alcohol and drug use, eating behaviour, self-esteem, and quality of life. The cost-effectiveness of the intervention will also be evaluated.

Conclusions: This study will contribute to understanding the role of transdiagnostic indicated web-based interventions for the prevention of common mental disorders in university students. It will also be one of the first studies to investigate the cost-effectiveness of such interventions.

Trial Registration: This trial was registered in the ISRCTN register (ISRCTN15570935) on 12th February 2016.
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http://dx.doi.org/10.1016/j.invent.2018.02.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6364328PMC
April 2019

The Factor Structure of the Forms of Self-Criticising/Attacking & Self-Reassuring Scale in Thirteen Distinct Populations.

J Psychopathol Behav Assess 2018 13;40(4):736-751. Epub 2018 Jun 13.

15Marie Curie Palliative Care Research Department, University College London, TottenhamCourt Road 149, London, W1T 7NF UK.

There is considerable evidence that self-criticism plays a major role in the vulnerability to and recovery from psychopathology. Methods to measure this process, and its change over time, are therefore important for research in psychopathology and well-being. This study examined the factor structure of a widely used measure, the Forms of Self-Criticising/Attacking & Self-Reassuring Scale in thirteen nonclinical samples ( = 7510) from twelve different countries: Australia ( = 319), Canada ( = 383), Switzerland ( = 230), Israel ( = 476), Italy ( = 389), Japan ( = 264), the Netherlands ( = 360), Portugal ( = 764), Slovakia ( = 1326), Taiwan ( = 417), the United Kingdom 1 ( = 1570), the United Kingdom 2 ( = 883), and USA ( = 331). This study used more advanced analyses than prior reports: a bifactor item-response theory model, a two-tier item-response theory model, and a non-parametric item-response theory (Mokken) scale analysis. Although the original three-factor solution for the FSCRS (distinguishing between Inadequate-Self, Hated-Self, and Reassured-Self) had an acceptable fit, two-tier models, with two general factors (Self-criticism and Self-reassurance) demonstrated the best fit across all samples. This study provides preliminary evidence suggesting that this two-factor structure can be used in a range of nonclinical contexts across countries and cultures. Inadequate-Self and Hated-Self might not by distinct factors in nonclinical samples. Future work may benefit from distinguishing between self-correction versus shame-based self-criticism.
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http://dx.doi.org/10.1007/s10862-018-9686-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6223807PMC
June 2018

Are physical activity interventions for healthy inactive adults effective in promoting behavior change and maintenance, and which behavior change techniques are effective? A systematic review and meta-analysis.

Transl Behav Med 2019 01;9(1):147-157

Department of Psychology and Sport Sciences, University of Hertfordshire, Herts AL, UK.

Physical inactivity and sedentary behavior relate to poor health outcomes independently. Healthy inactive adults are a key target population for prevention. This systematic review and meta-analysis aimed to evaluate the effectiveness of physical activity and/or sedentary behavior interventions, measured postintervention (behavior change) and at follow-up (behavior change maintenance), to identify behavior change techniques (BCT) within, and report on fidelity. Included studies were randomized controlled trials, targeting healthy inactive adults, aiming to change physical activity and/or sedentary behavior, with a minimum postintervention follow-up of 6 months, using 16 databases from 1990. Two reviewers independently coded risk of bias, the "Template for Intervention Description and Replication" (TIDieR) checklist, and BCTs. Twenty-six studies were included; 16 pooled for meta-analysis. Physical activity interventions were effective at changing behavior (d = 0.32, 95% confidence intervals = 0.16-0.48, n = 2,346) and maintaining behavior change after 6 months or more (d = 0.21, 95% confidence intervals = 0.12-0.30, n = 2,190). Sedentary behavior interventions (n = 2) were not effective. At postintervention, physical activity intervention effectiveness was associated with the BCTs "Biofeedback," "Demonstration of the behavior," "Behavior practice/rehearsal," and "Graded tasks." At follow-up, effectiveness was associated with using "Action planning," "Instruction on how to perform the behavior," "Prompts/cues," "Behavior practice/rehearsal," "Graded tasks," and "Self-reward." Fidelity was only documented in one study. Good evidence was found for behavior change maintenance effects in healthy inactive adults, and underlying BCTs. This review provides translational evidence to improve research, intervention design, and service delivery in physical activity interventions, while highlighting the lack of fidelity measurement.
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http://dx.doi.org/10.1093/tbm/iby010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6305562PMC
January 2019

A prospective study exploring the construct and predictive validity of the COM-B model for physical activity.

J Health Psychol 2019 09 27;24(10):1378-1391. Epub 2017 Nov 27.

1 University of Hertfordshire, UK.

This study examined the constructs of capability, opportunity and motivation from the COM-B model and their influence on moderate-to-vigorous physical activity. Using a prospective survey design, 186 healthy adults completed measures representing the theoretical domains framework mapped to the COM-B, and moderate-to-vigorous physical activity 1 week later. The main indicators for the COM constructs were 'habits' (Capability), 'subjective norms' (Opportunity) and 'exercise self-identity' (Motivation). Motivation (77%) and moderate-to-vigorous physical activity (50%) were strongly predicted, with Capability and Motivation as key drivers of behaviour. Motivation was a strong mediator for Capability on behaviour. Future research should consider this approach for other populations and behaviours.
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http://dx.doi.org/10.1177/1359105317739098DOI Listing
September 2019

Health-Related Quality of Life after Coronary Revascularization: A systematic review with meta-analysis.

Hellenic J Cardiol 2016 Aug 23. Epub 2016 Aug 23.

Department of Psychology, Health & Human Sciences Research Institute, University of Hertfordshire, Hatfield, UK.

Objective: To conduct a systematic review and meta-analysis to summarize evidence and determine the impact of coronary revascularization (CR) on cardiac patients' Health-Related Quality of Life (HRQoL), highlighting factors that may affect this outcome in patients.

Methods: A systematic search of Medline (Pubmed), EMBASE, Cochrane Library, Sciverse (Science Direct and Scopus) and PsycInfo was conducted to identify studies published from January 2000 to December 2012. Data were analyzed using MIX 2.0 Pro and SPSS 20.

Results: Thirty-four longitudinal studies met the inclusion criteria; these studies included 15,992 patients, of whom 8,027 had undergone PCI, 6,348 had undergone CABG and 1,617 had received medication treatment. Moderate long-term effect sizes were revealed for both CR procedures. Both percutaneous coronary interventions (PCI) and coronary artery bypass graft surgery (CABG) had significantly greater effects on HRQoL than did medication; however, the CR procedures did not differ significantly from each other. Moderators included the type of instrument used to assess HRQoL and the study quality. Benefits related to physical functioning were greater than those related to psychosocial functioning in patients treated with CABG.

Conclusions: Empirical research highlights the positive effect of CR on patient HRQoL. Researchers should carefully select the instrument they use to measure HRQoL, as this may affect the results and thus conclusions. More RCTs and between-group studies employing pre-post designs should be conducted before clear conclusions can be drawn.
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http://dx.doi.org/10.1016/j.hjc.2016.05.003DOI Listing
August 2016

The effect of current and anticipated body pride and shame on dietary restraint and caloric intake.

Authors:
Nicholas A Troop

Appetite 2016 Jan 9;96:375-382. Epub 2015 Oct 9.

Department of Psychology, University of Hertfordshire, College Lane, Hatfield, Herts AL10 9AB, UK. Electronic address:

Studies have established a link between body shame and eating disorder symptoms and behaviours. However, few have differentiated current feelings of body shame from those anticipated with weight change and none has examined the effects of these on subsequent eating behaviour. In this paper, a measure of body pride and shame was developed (Study 1) for the purposes of using it in a subsequent longitudinal study (Study 2). Two hundred and forty two women were recruited from a university and the general population and participated in Study 1, completing the Body Pride and Shame (BPS) scale either online or offline, as well as a number of validating measures. In Study 2, 40 female students completed the BPS, as well as a measure of dietary restraint, and subsequently recorded their dietary intake everyday for the next seven days. Study 1 identified and validated subscales of current body pride/shame as well as pride/shame that is anticipated were the individual to gain weight or lose weight. In Study 2, over and above levels of dietary restraint, current feelings of body shame predicted eating more calories over the next 7 days while the anticipation of shame with weight gain predicted eating fewer calories. Although previous research has only measured current feelings of body shame, the present studies showed that anticipated shame also impacts on subsequent behaviour. Interventions that regulate anticipated as well as current emotions, and that do not merely challenge cognitions, may be important in changing eating behaviour.
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http://dx.doi.org/10.1016/j.appet.2015.09.039DOI Listing
January 2016

What are the most effective behaviour change techniques to promote physical activity and/or reduce sedentary behaviour in inactive adults? A systematic review protocol.

BMJ Open 2015 Aug 5;5(8):e008573. Epub 2015 Aug 5.

Research Department of Practice and Policy, Centre for Behavioural Medicine, UCL School of Pharmacy, University College London, London, UK.

Introduction: Large proportions of the population are not meeting recommended levels of physical activity and have increasingly sedentary lifestyles. Low levels of physical activity are predictive of poor health outcomes and time spent sedentary is related to a host of risk factors independently of physical activity levels. Building an evidence base of the best approaches to intervene in the lifestyles of inactive individuals is crucial in preventing long-term disease, disability and higher mortality rates.

Methods And Analysis: Systematic searches will be conducted on all relevant databases (eg, PubMed, Scopus, CINAHL, PsycINFO). Studies will be included if they assess interventions aimed at changing physical activity or sedentary behaviour levels in adults (over 18) who are inactive and do not suffer from chronic conditions. Studies must also be randomised controlled trials (RCTs), have a primary outcome of physical activity or sedentary behaviour, and measure outcomes at least 6 months after intervention completion. Studies will be coded using the Behaviour Change Technique (BCT) taxonomy v1 and Template for Intervention Description and Replication (TIDieR) guidelines. 2 reviewers will independently screen full-text articles and extract data on study characteristics, participants, BCTs, intervention features and outcome measures. Study quality will also be assessed independently by 2 reviewers using the Cochrane risk of bias tool. A meta-analysis will be considered if there is sufficient homogeneity across outcomes. GRADE criteria will be used to assess quality of evidence.

Dissemination: This will be the first review to systematically appraise interventions aimed at changing the physical activity or sedentary behaviour of inactive individuals using RCT designs with a 6-month follow-up post-intervention. This review will better inform intervention designers targeting inactive populations and inform the design of a future complex intervention.

Review Registration Number: This protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) on 17 October 2014 (registration number: CRD42014014321).
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http://dx.doi.org/10.1136/bmjopen-2015-008573DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4538267PMC
August 2015

Social Rank, Rank-Related Life Events and Eating Pathology.

Authors:
Nicholas A Troop

Eur Eat Disord Rev 2016 Jan 2;24(1):75-7. Epub 2015 Jul 2.

Dr Nicholas Troop, School of Psychology, University of Hertfordshire, College Lane, Hatfield, Hertfordshire, AL10 9AB, UK.

Background: This study explored the role of meaning in the link between stress and disordered eating, in particular focusing on social rank.

Method: Two hundred and eleven women completed measures of eating pathology, depression, social comparison and life events where life events were assessed in terms of general loss, threat, shame and loss of social status.

Results: Events involving loss of social status were related to eating pathology but only in women reporting self-perceived low rank. Events that did not concern social status were unrelated to eating pathology.

Discussion: Women who perceive themselves to be low social status appear vulnerable to events that concern their social status.
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http://dx.doi.org/10.1002/erv.2386DOI Listing
January 2016

Expressive writing, self-criticism, and self-reassurance.

Psychol Psychother 2013 Dec 17;86(4):374-86. Epub 2012 Apr 17.

School of Psychology, University of Hertfordshire, Hatfield, UK.

Objectives: Self-criticism and reassurance are important mechanisms for regulating negative emotions but relatively little attention has been paid to interventions aimed at improving them.

Design: This study explored the use of an expressive writing task to increase self-reassurance and reduce self-criticism using a randomized controlled design.

Method: A total of 46 participants wrote either about life goals (the expressive writing task, n= 23) or a control topic (a review of a recent book or film, n= 23) for 15 min, three times within an hour. Measures of self-criticism/self-reassurance, stress, and positive affect were completed at baseline and at 2-week follow-up. The Linguistic Inquiry and Word Count (LIWC) was used to analyse the writing of participants in the 'life goals' condition to identify psychological processes that might differentiate those who improved and those who did not.

Results: While there were no significant changes in self-reported stress or positive affect, participants writing about life goals decreased in their levels of self-criticism at 2-week follow-up relative to participants writing about control topics. Text analysis showed that experimental participants using words that imply the possibility of doubt or failure, including use of the subjunctive tense (e.g., could, would, should), were least likely to decrease their self-criticism. CONCLUSION. Expressive writing shows promise as a means by which people may decrease in their self-criticism. Future research should determine whether such experimentally induced changes in self-criticism lead to the improvements in psychological health that is implied by previous cross-sectional research.
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http://dx.doi.org/10.1111/j.2044-8341.2012.02065.xDOI Listing
December 2013

Social defeat and PTSD symptoms following trauma.

Br J Clin Psychol 2013 Nov 25;52(4):365-79. Epub 2013 Jun 25.

School of Psychology, University of Hertfordshire, Hatfield, UK.

Objectives: Research indicates that constructs relevant to social rank predict a diagnosis of post-traumatic stress disorder (PTSD), including mental defeat, alienation, and shame. However, no studies have yet explored a social rank view explicitly.

Design: This was a community-based study carried out online. Analyses were both cross-sectional and longitudinal over 6 months.

Methods: Participants were recruited online for a cross-sectional study (Study 1, n = 194) and a 6-month longitudinal study (Study 2, n = 81). Measures included self-report measures of PTSD symptoms (the Post-Traumatic Diagnostic Scale) and social rank (including measures of unfavourable social comparison, social defeat, and internal/external entrapment).

Results: Cross-sectional analysis showed that social defeat, but not other aspects of social rank, was independently predictive of a diagnosis of PTSD. Longitudinal analysis showed that greater social defeat at baseline predicted less improvement in PTSD symptoms, whereas greater reduction in social defeat over the 6-month follow-up predicted greater improvement in PTSD symptoms.

Conclusions: In addition to the implications for understanding the role of social (rather than individual mental) defeat in the aetiology of PTSD, interventions could usefully incorporate methods that either increase social status or else minimize the impact of low status (e.g., through the use of compassion-focused approaches).
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http://dx.doi.org/10.1111/bjc.12022DOI Listing
November 2013

Social cognitive predictors of intention to test for variant Creutzfeldt-Jakob disease in those affected by haemophilia and other clotting disorders.

J Health Psychol 2014 Jun 21;19(6):809-17. Epub 2013 Mar 21.

University of Hertfordshire, UK

Individuals with bleeding disorders are at increased risk of variant Creutzfeldt-Jakob disease. This study explored social cognitive predictors of screening intentions. Ninety men and women with bleeding disorders, recruited through the Haemophilia Society, completed an extended Theory of Planned Behaviour questionnaire to predict intention to screen for variant Creutzfeldt-Jakob disease. Extended Theory of Planned Behaviour variables accounted for 57 per cent of the variance in intention. Self-efficacy and anticipated affect predicted intention directly, while attitudes were mediated by anticipated affect. Simple interventions that already exist address relevant predictive components of intention to screen for variant Creutzfeldt-Jakob disease and could be used to aid decision-making.
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http://dx.doi.org/10.1177/1359105313481073DOI Listing
June 2014

A confirmatory factor analysis and validation of the forms of self-criticism/reassurance scale.

Br J Clin Psychol 2013 Mar 22;52(1):12-25. Epub 2012 Aug 22.

School of Psychology, University of Hertfordshire, UK.

Objective: Several studies have used the Forms of Self-Criticism/Reassurance Scale (FSCRS; Gilbert, Clarke, Hempel, Miles, & Irons, 2004) when exploring the role of emotion regulation in psychopathology. However, psychometric evaluation of the FSCRS is limited. The present study sought to confirm the factor structure of the FSCRS based on theoretical and empirical grounds in a large sample of the general population.

Method: The FSCRS was completed by a large sample of men and women (N= 1,570) as part of an online survey. The data were randomly split in order to perform both independent exploratory (EFA) and confirmatory factor analyses (CFA). One-, two- and three-factor solutions were examined.

Results: A three-factor model of reassured-self (RS) and the two types of self-criticism, inadequate-self (IS), and hated-self (HS), proved to be the best-fitting measurement model in this sample (χ(2) = 800.3, df= 148, p < .001; CFI [comparative fit index]= .966, TLI [Tucker Lewis index]= .961, RMSEA [root mean square error of the approximation]= .074). Although very similar to the original questionnaire, there were some differences in terms of the items that were retained. Validity was confirmed with the shortened FSCRS showing the same associations with mood and sex as the original version of the FSCRS.

Conclusion: A three-factor model (RS, IS and HS) provided the best-fitting structure and confirmed the separation of different types of self-criticism. Future research should explore the degree to which these separable aspects of self-criticism are theoretically and clinically meaningful and to identify the role of self-reassurance in ameliorating their effects.
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http://dx.doi.org/10.1111/j.2044-8260.2012.02042.xDOI Listing
March 2013

Social rank and symptom change in eating disorders: a 6-month longitudinal study.

Clin Psychol Psychother 2014 Mar-Apr;21(2):115-22. Epub 2013 Jan 8.

Department of Psychology, University of Hertfordshire, Herts, UK.

Background: Following previous cross-sectional research adopting an evolutionary approach to social rank and eating disorders, the present study explored the predictive value of social rank for changes in eating disorder symptoms in a 6-month longitudinal study.

Methods: Seventy-three women and men with a history of eating disorders were followed up over 6 months. A broad range of measures of social rank were used to determine whether social rank at baseline predicted residual changes in eating disorder symptoms.

Results: Low social rank (in terms of perceived external entrapment and submissive behaviour) predicted an increase in symptoms of anorexia but not symptoms of bulimia. The predictive value of low social rank was not mediated by changes in depressive symptoms.

Conclusion: Perceived low rank predicts an increase in anorexic symptoms. However, further research is required to determine the precise nature of how social rank exerts its influence on the development of eating disorder symptoms.

Key Practitioner Message: Self-perceived low social rank predicts an increase in anorexic symptoms but not bulimic symptoms. The effect of low social rank on changes in anorexic symptoms was not mediated by changes in depressive symptoms. Interventions for anorexia nervosa may need to incorporate techniques for increasing status and/or self-compassion.
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http://dx.doi.org/10.1002/cpp.1830DOI Listing
June 2014

Brief report: effect of dietary restraint on fruit and vegetable intake following implementation intentions.

Authors:
Nicholas A Troop

J Health Psychol 2013 Jul 6;18(7):861-5. Epub 2012 Sep 6.

Department of Psychology, University of Hertfordshire, UK.

This study explored whether the effects of implementation intentions on increasing fruit and vegetable intake were moderated by dietary restraint. In total, 208 participants were randomly allocated to control or implementation intention conditions where they were asked to write down when, where and how they would increase their fruit and vegetable intake. Implementation intentions increased fruit and vegetable intake but only in participants scoring low (not high) on rigid dietary restraint. Motives underlying fruit and vegetable consumption may be different for restrained and unrestrained eaters. Efforts to increase their intake may need to be tailored, for example, through motivational rather than situational cues.
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http://dx.doi.org/10.1177/1359105312456320DOI Listing
July 2013

A pilot study on the effects and feasibility of compassion-focused expressive writing in Day Hospice patients.

Palliat Support Care 2012 Jun;10(2):115-22

School of Psychology, University of Hertfordshire, Hertfordshire, United Kingdom.

Objective: Research has found that writing about stress can confer physical and psychological health benefits on participants and that adopting a self-compassionate stance may have additional benefits. This pilot study evaluated a self-compassionate expressive writing intervention in a Day Hospice setting.

Method: Thirteen patients with life-limiting illnesses wrote on two occasions about recent stressful experiences. Half also received a self-compassion instruction for their writing. Outcome measures were taken at baseline and one week after the second writing session, and text analysis was used to identify changes in the types of words used, reflecting changes in psychological processes.

Results: Patients given the self-compassion instruction increased in their self-soothing and self-esteem in contrast to patients in the stress-only condition. Happiness broadly increased in both groups although reported levels of stress generally increased in patients given the self-compassion instruction but decreased in patients in the stress-only condition. Those given the self-compassion instruction also increased in their use of causal reasoning words across the two writing sessions compared with those in the stress-only condition.

Significance Of Results: Expressive writing appears to be beneficial in patients at a hospice and was viewed as valuable by participants. The inclusion of a self-compassion instruction may have additional benefits and a discussion of the feasibility of implementing expressive writing sessions in a Day Hospice is offered.
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http://dx.doi.org/10.1017/S1478951512000181DOI Listing
June 2012

General shame and bodily shame in eating disorders: a 2.5-year longitudinal study.

Eur Eat Disord Rev 2012 Sep 8;20(5):373-8. Epub 2012 Feb 8.

School of Psychology, University of Hertfordshire, UK.

Objective: Studies have established a link between shame and eating disorder symptoms but have generally been cross-sectional or failed to differentiate between general shame and bodily shame. The present study addressed both these issues.

Design: This study used a longitudinal panel design.

Method: Fifty-five women with a past or current eating disorder participated. They completed measures of eating pathology, depression, general shame (internal and external) and bodily shame (current feelings of bodily shame as well as bodily shame that is anticipated were the individual to gain weight) and were followed up over 2.5 years.

Results: Bodily shame uniquely predicted an increase in anorexic (but not bulimic) symptoms. Current bodily shame predicted an increase in the degree of underweight and the misperception of body size. Anticipated bodily shame predicted an increase in fear of weight gain.

Discussion: Current versus anticipated bodily shame predicts different anorexic symptoms. Both therefore should be considered in developing interventions and aetiological models of anorexia nervosa.
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http://dx.doi.org/10.1002/erv.2160DOI Listing
September 2012

A randomized controlled two-stage trial in the treatment of bulimia nervosa, comparing CBT versus motivational enhancement in Phase 1 followed by group versus individual CBT in Phase 2.

Psychosom Med 2010 Sep 28;72(7):656-63. Epub 2010 Jul 28.

Department of Psychiatry, Weill Cornell Medical Center, New York, NY 10075, USA.

Objective: To conduct a randomized, controlled, two-stage trial in the treatment of bulimia nervosa, comparing cognitive-behavioral therapy (CBT) versus motivational enhancement in Phase 1 followed by group versus individual CBT in Phase 2.

Methods: A total of 225 patients with bulimia nervosa or eating disorder not otherwise specified (EDNOS) were recruited into a randomized controlled trial lasting 12 weeks with follow-ups at 1 year and 2.5 years.

Results: Patients improved significantly across all of the interventions with no differences in outcome or treatment adherence. Including motivational enhancement therapy rather than a CBT first phase of treatment did not affect outcome.

Conclusions: Outcome differences between individual and group CBT were minor, suggesting that group treatment prefaced by a short individual intervention may be a cost-effective alternative to purely individual treatment.
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http://dx.doi.org/10.1097/PSY.0b013e3181ec5373DOI Listing
September 2010

The specificity of social rank in eating disorder versus depressive symptoms.

Eat Disord 2008 Jul-Sep;16(4):331-41

School of Psychology, University of Hertfordshire, Hertfordshire, UK.

It has been proposed that an evolutionary approach to understanding rank and social status may contribute to our understanding of eating disorder symptoms. The present study sought to explore the degree to which rank might be related to eating pathology independently of its known association with depression. A non-clinical sample of 74 women completed rank-relevant measures of social defeat, entrapment, submissive behavior and social comparison as well as measures of depressive and eating disorder symptoms. Independently of depressive symptoms, submissive behavior and an unfavorable social comparison predicted eating pathology while social defeat and internal entrapment predicted depressive symptoms. There appears to be a specific role for social rank in relation to eating pathology. However, further research is required to determine precisely what this role is and the degree to which it relates to risk or recovery.
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http://dx.doi.org/10.1080/10640260802115993DOI Listing
August 2008

Shame in women with a history of eating disorders.

Eur Eat Disord Rev 2008 Nov;16(6):480-8

Department of Psychology, London Metropolitan University, London, UK.

Objective: Several studies have investigated shame in eating disorders but most have used non-clinical samples examined only one type of eating disorder or included only a limited range of shame measures. The current study explored shame from multiple perspectives in women who report a range of eating disorder diagnoses and who are at different stages of illness and recovery.

Method: In a postal questionnaire study, 224 women with a history of an eating disorder completed measures of anorexic and bulimic symptoms, depression and shame.

Results: After controlling for levels of depression, shame was associated with eating disorder symptoms. Specifically, shame as a measure of 'perceived involuntary subordination' (external shame) was uniquely associated with severity of anorexia nervosa symptoms, while shame as a measure of 'feelings' (internal shame) was uniquely associated with severity of bulimia nervosa symptoms.

Discussion: Different types of shame are related to different eating disorder symptoms and this may have implications for the aetiology and presentation of these disorders. These affective states may need to be addressed explicitly in therapy.
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http://dx.doi.org/10.1002/erv.858DOI Listing
November 2008

The effects of stress on body weight: biological and psychological predictors of change in BMI.

Obesity (Silver Spring) 2007 Dec;15(12):3045-55

Kings College London, Institute of Psychiatry, London SE5 8AF, United Kingdom.

Objective: To investigate individual differences in the effects of stress on BMI.

Research Methods And Procedures: Participants were 71 healthy women volunteers enrolled in a university-based nurse practitioner program. Predictors of change in BMI were hypothesized to be cortisol secretion, dietary restraint, binging, mastery, mood, and eating attitudes. Measures were made at the beginning of the academic semester and 12 weeks later during the participants' examination period.

Results: The women were of normal weight (BMI 25.2 +/- 4.3) for their age [43; standard deviation (SD), 7]. By the examination period, 40 had gained weight (mean, 5.5 pounds; SD, 2.2), 19 lost weight (mean, 2.5 pounds; SD, 1.5), and 12 had stable weight. BMI, salivary cortisol secretion, binging behavior, depression, and anxiety increased significantly, whereas scores on dietary restraint, weight, shape, and eating concerns, and mastery decreased significantly. Regression analysis showed that change in daily cortisol secretion significantly predicted change in BMI and that mastery significantly moderated this relationship. However, a reduction in dietary restraint was a perfect mediator of this relationship. Change in cortisol secretion also significantly predicted change in dietary restraint, and this was moderated by dietary restraint at the beginning of the academic semester. Reduction in dietary restraint was also predicted by a reduction in mastery and weight concern.

Discussion: We identified individual differences that confer vulnerability to weight gain during stressful life events (dietary restraint and mastery). Given that women are exposed to daily stressors and use cognitive strategies to restrain their dietary intake, increasing awareness of the role of stress on eating behavior and weight is an important goal.
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http://dx.doi.org/10.1038/oby.2007.363DOI Listing
December 2007

The pros and cons of change in individuals with eating disorders: a broader perspective.

Int J Eat Disord 2006 Jul;39(5):394-403

Eating Disorders Unit, Department of Psychological Medicine, Institute of Psychiatry, London, United Kingdom.

Objective: The goals of the current study were to develop a questionnaire measuring the pros and cons of eating disorder symptoms and to explore the themes endorsed by different eating disorder groups.

Method: Participants recruited from an eating disorder volunteer register and an outpatient clinic completed the Pros and Cons of Eating Disorders scale (P-CED). Principal components analyses (PCA) were performed to validate the factorial structure of the original items and to explore the factorial structure of the new items. Planned comparisons were used to compare P-CED scores between diagnostic groups.

Results: PCA indicated a 10-factor solution for the original Pros and Cons of Anorexia Nervosa scale (P-CAN) items and a 4-factor solution for the new items. Participants with anorexia nervosa (AN) scored significantly higher than participants with bulimia nervosa (BN) on five of the P-CED subscales but there were no significant differences between the two AN subtypes.

Conclusion: The P-CED is a useful tool for identifying the positive and negative aspects of eating disorders that can be targeted in treatment or used as an outcome measure in research.
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http://dx.doi.org/10.1002/eat.20250DOI Listing
July 2006

The development of the P-CAN, a measure to operationalize the pros and cons of anorexia nervosa.

Int J Eat Disord 2004 Dec;36(4):416-33

Department of Mental Health, St. Georges Hospital Medical School, London, UK.

Objective: Research has suggested that a fundamental aspect of anorexia nervosa (AN) is its egosyntonic nature, the fact that it is often valued by individuals with the disorder. The current study describes the development of the P-CAN, a quantitative measure of both positive (valued) and negative aspects of AN.

Method: Items were derived from a previous qualitative study (Serpell, Treasure, Teasdale, & Sullivan. 1999. International Journal of Eating Disorders, 25, 177-186). Data from 233 women with AN were subjected to a principal components analysis.

Results: Ten subscales were identified, six describing the pros of AN and four describing the cons of the illness.

Discussion: The P-CAN shows good psychometric properties and should prove a useful tool for the measurement of attitudes towards AN, as well as offer insights into the maintenance of the disorder.
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http://dx.doi.org/10.1002/eat.20040DOI Listing
December 2004

Developing a stage of change measure for assessing recovery from anorexia nervosa.

Eat Behav 2003 Jan;3(4):365-85

Cancer Prevention Research Center, University of Rhode Island, 2 Chafee Road, Kingston, RI 02881, USA.

The purpose of this study was to advance understanding of the self-change process in recovery from anorexia nervosa (AN). This included the development of a measure for assessing readiness to change behaviors and/or cognitions associated with recovery from AN across five stages of change, based on the transtheoretical model of behavior change. Two-hundred and seventy-eight anorexics, predominantly female, completed questionnaires that measured all constructs of the TTM, as well as the EAT-26, demographic items, and other self-reported recovery measures. Based on a quantitative and qualitative comparison of five staging definitions in this relatively large sample of anorexics, it was concluded that the most meaningful staging measure was one that measured progress through the stages by readiness to stop restricting/bingeing/purging behaviors. The development of an algorithm to measure stages of change for recovery from AN has the potential to accelerate clinical research and to augment available treatments in this area.
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http://dx.doi.org/10.1016/s1471-0153(02)00087-9DOI Listing
January 2003

Social comparison and submissive behaviour in eating disorder patients.

Psychol Psychother 2003 Sep;76(Pt 3):237-49

Department of Psychology, London Metropolitan University, London, UK.

Animal analogues of anorexia nervosa suggest that submissive behaviour and social defeat may be implicated in the onset of wasting diseases. Data from human sufferers of anorexia nervosa and bulimia nervosa are also consistent with the presence of submissive behaviours and perceived low social rank (e.g. low self-esteem, helplessness, and feelings of shame). A total of 101 patients with eating disorders completed the Submissive Behaviour Scale and the Social Comparison Rating Scale, and their responses were compared with 101 age- and sex-matched student controls. Patients with eating disorders reported significantly higher levels of submissive behaviour and a more unfavourable social comparison than did student controls. Furthermore, levels of submissive behaviour and unfavourable social comparison were significantly related to severity of eating disorder symptoms, even after taking account of depressive symptoms and other psychopathology. These preliminary results suggest that ranking theory may have some application to eating disorders. Further research is required to determine whether rank plays a specific role in eating disorders (beyond the increased rates of depression which also occur in eating disorders) and, if so, what is its precise role.
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http://dx.doi.org/10.1348/147608303322362479DOI Listing
September 2003

Personality disorders and personality dimensions in anorexia nervosa.

J Pers Disord 2003 Feb;17(1):73-85

Eating Disorders Unit, Institute of Psychiatry, London, UK.

Information on the relationship between anorexia nervosa (AN) and personality disorders (PDs) and dimensions of temperament and character (measured by the Temperament and Character Inventory [TCI; Cloninger, Przybeck Svrakic, & Wetzel, 1994]) is limited. This study examines the predictive validity of the TCI for PD diagnoses assessed by the International Personality Disorder Examination-ICD-10 (IPDE-ICD-10; Loranger, Janca, & Sartorius, 1997) interviews of 46 women with DSM-IV-defined AN. Patients with a PD reported higher levels of harm-avoidance and lower levels of self-directedness than those without a PD. Scores on the TCI were predictive of the number of PD features present, particularly for those PDs in the anankastic, anxious, and dependent groups accounting for 40% to 51% of the variance. Cluster analysis based on scores on the TCI identified a subgroup of patients characterized by low levels of novelty seeking, self-directedness, and cooperativeness and high levels of harm avoidance. This cluster included the majority of those with avoidant, anxious, or dependent PDs. Assessment of particular personality dimensions was able to predict PDs in an anorexic sample. Since normal personality dimensions have greater validity than the categorical PDs, a consideration of normal temperament and character may assist in clinical decisionmaking and considerations concerning treatment.
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http://dx.doi.org/10.1521/pedi.17.1.73.24057DOI Listing
February 2003

An exploration of eating disorders in a Georgian sample.

Int J Soc Psychiatry 2002 Sep;48(3):220-30

Eating Disorder Unit, Institute of Psychiatry, London, UK.

Background: There is debate as to whether eating disorders may be culture-bound. However, accumulating evidence suggests that eating disorders may be found outside of the West, although the precise form of the eating disorder may differ.

Aims: There were two aims of this study: (1) to translate and establish the psychometric properties of standard questionnaires to measure eating pathology in a Georgian sample; (2) to use these measures to determine whether cases of eating disorders exist in Georgia.

Methods: We held focus groups of various health professionals to establish how eating disorders present in Georgia and to identify groups perceived to be at high risk of having an eating disorder. We obtained translated versions of a number of standardized questionnaires (measuring eating and general psychopathology) from 245 women from these identified high risk groups and a subsample were given a structured clinical interview.

Results: We estimated from the responses to the questionnaires, that as many as 5% may have clinically significant bulimia nervosa, 7% fell in the weight range for anorexia nervosa with a further 7% in the weight range for obesity. We interviewed a sample of the high scoring group which confirmed the presence of clinically significant eating pathology in the majority of those identified as possible cases.

Conclusions: The results of this study suggest there may be women in Georgia with significant eating problems.
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http://dx.doi.org/10.1177/002076402128783262DOI Listing
September 2002

Fear, disgust, and abnormal eating attitudes: a preliminary study.

Int J Eat Disord 2002 Sep;32(2):213-8

Department of Psychology, University of Essex, Essex, United Kingdom.

Objective: Clinical descriptions of eating disorders emphasize the role of fear (e.g., fear of weight gain, weight phobia, morbid dread of fatness). The present study explored whether disgust, an emotion that is linked intimately with food, may also be an important emotional response to eating and weight-related issues in women with abnormal eating attitudes.

Method: Forty nonclinical female participants were presented with a series of food, drink, body shape, and emotion-related stimuli. They were asked to rate each on a number of responses associated with fear and disgust. In addition, participants completed standard questionnaire measures of eating attitudes, phobias, and disgust sensitivity.

Results: Ratings of fear and disgust were higher in women with abnormal eating attitudes than in those without for high-calorie foods and for overweight body shapes, but not for drinks and slim body shapes. In response to fear and disgust relevant images, women with abnormal eating attitudes also rated emotional responses higher, but this was restricted to the appropriate emotion (i.e., higher levels of fear in response to fear stimuli and higher levels of disgust in response to disgust stimuli).

Conclusion: In women with abnormal eating attitudes, both disgust and fear responses to food and body shape issues are equally salient. Thus, an emphasis on fear in eating disorders, to the exclusion of disgust, may be unwarranted.
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http://dx.doi.org/10.1002/eat.10069DOI Listing
September 2002
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