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Altered Cognitive and Psychophysiological Components of Psychological Flexibility in Individuals with Overweight/Obesity

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Altered Cognitive and Psychophysiological Components of Psychological Flexibility in Individuals with Overweight/Obesity ALTERED COGNITIVE AND PSYCHOPHYSIOLOGICAL COMPONENTS OF PSYCHOLOGICAL FLEXIBILITY IN INDIVIDUALS WITH OVERWEIGHT/OBESITY Tanya S. Watford A Dissertation Submitted to the Graduate College of Bowling Green State University in partial fulfillment of the requirements for the degree of DOCTOR OF PHILOSOPHY August 2020 Committee: Abby Braden, Advisor Amilcar Challu Graduate Faculty Representative Dara Musher-Eizenman William O'Brien ii ABSTRACT Abby Braden, Advisor The prevalence of overweight and obesity has continued to rise among adults. While biological factors contribute to overweight (Frayling et al., 2007), body weight regulation is influenced by behavior (Fuglestad, Jeffery, & Sherwood, 2012). Behavioral weight loss interventions often demonstrate only modest reductions in weight, possibly because the psychological factors that modulate obesity-related behaviors are rarely targeted in treatment. Thus, psychological flexibility may be of particular importance, given it describes the ability to perform goal-consistent behavior in the presence of contrary urges or environmental demands. To characterize the dynamic factors involved in psychological flexibility (Kashdan & Rottenberg, 2010), the present study examined between-group (overweight/obese: n=33, normal weight: n=47) differences in executive function, cognitive traits of awareness and acceptance, and heart rate variability (HRV). Individuals with overweight/obesity demonstrated poorer attention-shifting (Wisconsin Card Sorting Task, p = .009) and lower attention and awareness (Mindful Attention Awareness Scale, p = .01 and Difficulties in Emotion Regulation subscale emotional clarity, p = .006). Participants with overweight/obesity also demonstrated greater vagally-mediated HRV compared to normal weight with marginal significance (p = .07) and a 2 medium effect size (ηp = .042) across all HRV conditions (rest, stress, and recovery). No other significant differences were found regarding executive function (i.e., inhibition and working memory), cognitive features of acceptance and awareness (i.e. subscales of the Difficulties in Emotion Regulation scale), or HRV reactivity and recovery. Findings suggest some factors essential to psychological flexibility may be altered in individuals with overweight/obesity compared to normal-weight. iii This work is dedicated to my husband, Lee. I could not imagine navigating the challenges of this journey without his patience, faith, humor, and compassion. I am truly grateful to him for his unconditional support and for showing me what it means to be an amazing human. iv ACKNOWLEDGEMENTS This project would not have come into being without the influence and support of many wonderful people in my life. First, I would like to thank my advisor, Dr. Abby Braden, for her consistent feedback and compassionate guidance during the dissertation process. Your warmth and sincerity in conjunction with your excellent skills as a scholar and researcher created an environment that has fostered my growth and my well-being. I am thankful for the critical thinking and expertise of my committee members, Drs. William O’Brien, Dara Musher- Eizenman, and Amilcar Challu, whose feedback significantly strengthened this study. A special thanks to Dr. William O’Brien for offering me the opportunity to be a part of this BGSU family. I have learned so much! I am grateful for the support and friendship of the clinical faculty, administrative staff, and fellow students in the Psychology Department at Bowling Green State University. I must also thank Dr. Jane Stafford, whose ongoing support and mentorship have been essential elements throughout the successful pursuit of this doctoral degree. I would like to thank the wonderful research assistants that provided their time and energy to this project. A special thank you to Bret Williamson for his excellent work and amazing contribution to analyzing a mountain of psychophysiological data. Thank you for your commitment to completing this project. As a scientist-practitioner, I have been significantly impacted by my clinical supervisors during my graduate training. A special thanks to Drs. William O’Brien, Abby Braden, Joshua Grubbs, Marlys Reetz, Jane Stafford, Maureen Carrigan, and Anne Ellison for your excellent training. You are exceptional role models. Finally, I would like to thank my family and friends for their incredible support through this process. To my mother, your love, encouragement, and unconditional support have been invaluable. I am in awe when I reflect on the powerful impact of being part of my wonderful v clan, with special recognition of my brother and sister-in-law and my godmother. A special thanks to my husband. This project would not have been possible without your patience and support. Thank you for believing in me through every challenge. I am incredibly grateful to be surrounded by so many wonderful people. vi TABLE OF CONTENTS Page INTRODUCTION .................................................................................................................... 1 Psychological Flexibility .............................................................................................. 6 Executive Function (EF) ................................................................................... 7 Cognitive Traits of Acceptance and Awareness ............................................... 10 Heart Rate Variability (HRV) ........................................................................... 14 Present Study ................................................................................................................ 16 Hypotheses .................................................................................................................... 17 METHOD ................................................................................................................................. 19 Participants .................................................................................................................... 19 Measures ....................................................................................................................... 19 Demographics ................................................................................................... 19 Anthropometry .................................................................................................. 19 Heart Rate Variability (HRV) ........................................................................... 20 Attention-shifting .............................................................................................. 21 Working Memory.............................................................................................. 21 Inhibition ........................................................................................................... 22 Psychological Health and Treatment History ................................................... 22 Health Behaviors ............................................................................................... 22 Mindfulness....................................................................................................... 22 Mindful Emotion Regulation ............................................................................ 23 Positive and Negative Affect ............................................................................ 24 vii Stressor .......................................................................................................................... 24 Procedure ...................................................................................................................... 25 Data Analytic Plan ........................................................................................................ 25 Preliminary Analyses ........................................................................................ 26 Primary Analyses .............................................................................................. 26 RESULTS ................................................................................................................................. 29 DISCUSSION ........................................................................................................................... 33 Executive Function ....................................................................................................... 33 Cognitive Traits of Acceptance and Awareness ........................................................... 37 Heart Rate Variability ................................................................................................... 40 Limitations .................................................................................................................... 43 Conclusions ................................................................................................................... 44 REFERENCES ......................................................................................................................... 52 APPENDIX A. MINDFUL ATTENTION AWARENESS SCALE (MAAS) ......................... 78 APPENDIX B. DIFFICULTIES IN EMOTION REGULATION, SHORT FORM (DERS-SF) ................................................................................................................................ 79 APPENDIX C. POSITIVE AND NEGATIVE AFFECT SCHEDULE (PANAS) .................. 80 viii LIST OF FIGURES Figure Page 1 Components of Psychological Flexibility .................................................................. 48
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