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Distress Tolerance, Experiential Avoidance, and Negative Affect: Implications for Understanding Eating Behavior and BMI University of Tennessee, Knoxville TRACE: Tennessee Research and Creative Exchange Doctoral Dissertations Graduate School 8-2011 Distress Tolerance, Experiential Avoidance, and Negative Affect: Implications for Understanding Eating Behavior and BMI Christen Nicole Mullane University of Tennessee - Knoxville, [email protected] Follow this and additional works at: https://trace.tennessee.edu/utk_graddiss Part of the Clinical Psychology Commons, Health Psychology Commons, and the Human and Clinical Nutrition Commons Recommended Citation Mullane, Christen Nicole, "Distress Tolerance, Experiential Avoidance, and Negative Affect: Implications for Understanding Eating Behavior and BMI. " PhD diss., University of Tennessee, 2011. https://trace.tennessee.edu/utk_graddiss/1103 This Dissertation is brought to you for free and open access by the Graduate School at TRACE: Tennessee Research and Creative Exchange. It has been accepted for inclusion in Doctoral Dissertations by an authorized administrator of TRACE: Tennessee Research and Creative Exchange. For more information, please contact [email protected]. To the Graduate Council: I am submitting herewith a dissertation written by Christen Nicole Mullane entitled "Distress Tolerance, Experiential Avoidance, and Negative Affect: Implications for Understanding Eating Behavior and BMI." I have examined the final electronic copy of this dissertation for form and content and recommend that it be accepted in partial fulfillment of the equirr ements for the degree of Doctor of Philosophy, with a major in Psychology. Derek R. Hopko, Major Professor We have read this dissertation and recommend its acceptance: Derek Hopko, Hollie Raynor, Greg Stuart, Betsy Haughton Accepted for the Council: Carolyn R. Hodges Vice Provost and Dean of the Graduate School (Original signatures are on file with official studentecor r ds.) To the Graduate Council: I am submitting herewith a dissertation written by Christen Mullane entitled “Distress Tolerance, Experiential Avoidance, and Negative Affect: Implications for Understanding Eating Behavior and BMI.” I have examined the final electronic copy of this dissertation for form and content and recommend that it be accepted in partial fulfillment of the requirements for the degree of Doctor of Philosophy, with a major in Psychology. Derek Hopko Major Professor We have read this dissertation and recommend its acceptance: Hollie Raynor Greg Stuart Betsy Haughton Accepted for the Council: Carolyn R. Hodges, Ph.D. Vice Provost and Dean of the Graduate School (Original signatures are on file with official student records.) Distress Tolerance, Experiential Avoidance, and Negative Affect: Implications for Understanding Eating Behavior and BMI A Dissertation Presented for the Doctor of Philosophy Degree The University of Tennessee, Knoxville Christen Nicole Mullane August 2011 ii Copyright © 2010 by Christen N. Mullane All rights reserved. iii Acknowledgements: Thank you to the University of Tennessee Clinical Psychology department for funding the current study. Thank you to Drs. Gregory Stuart and Betsy Haughton, whom I am honored to have on my committee. Thanks to my family and friends, who have been so supportive of my efforts, and who have given me much needed guidance along the way. Finally, special thanks to Drs. Hollie Raynor and Derek Hopko. Through your efforts, I have learned about the kind of professional and mentor that I will strive to be. iv ABSTRACT Distress tolerance and experiential avoidance are important aspects of the coping process. In the current study, both were examined in relation to Body Mass Index and self- reported disturbances in mood and eating behavior. Distress tolerance was measured behaviorally and via self-report to elucidate the manner in which a) the ability to tolerate emotional distress, and b) the ability to persist behaviorally in the presence of stress- inducing stimuli were related to self-reported levels of depression, anxiety, maladaptive eating habits, and bodily concerns. A sample of 73 undergraduate students participated, and height, weight, and waist circumference were measured. Increased experiential avoidance was associated with increased weight status; however, this was true only for the morbidly obese group (n = 1). Increased experiential avoidance and decreased self- efficacy were significantly associated with less rewarding eating experiences. Individuals with lower distress tolerance reported increased depression, anxiety, and experiential avoidance, and were more likely to indicate eating disturbances and concerns on self- report measures, although distress tolerance generally was unrelated to eating behaviors as indexed on food diaries. These results were not replicated utilizing a behavioral measure of distress tolerance. Future directions for research designed to examine these variables in overweight and obese populations are discussed. iii TABLE OF CONTENTS Introduction………………………………………………………………………… 1 Methods……………………………………………………………………………. 20 Results……………………………………………………………………………… 30 Discussion………………………………………………………………………….. 37 References………………………………………………………………………….. 46 Tables………………………………………………………………………………. 69 Appendices…………………………………………………………………………. 94 Vita…………………………………………………………………………………. 105 iv LIST OF TABLES Table 1. Descriptive Statistics for all Measures…………………………………………… 68 Table 2. Correlations: Anthropomorphic Measures, Distress Tolerance, & Experiential Avoidance ……………………………………………………………………………………………... 69 Table 3. Correlations Between Anthropomorphic Measures and Mood Measures……….. 70 Table 4. Correlations Between Distress Tolerance, Experiential Avoidance, and TFEQ Subscales …………………………………………………………………………………………….. 71 Table 5. Correlations Between Distress Tolerance, Experiential Avoidance, and EDE-Q Scales ……………………………………………………………………………………………... 72 Table 6. Correlations Between Anthropomorphic Measures & Food Record Variables….. 73 Table 7. BMI and WC Group Status Predicting Average Eating Episode Duration………. 74 Table 8. BMI and WC Group Status Predicting Total Eating Episodes…………………… 75 Table 9. BMI and WC Group Status Predicting Total Three-Day Caloric Intake………… 76 Table 10. BMI and WC Group Status Predicting Average Mood Change………………… 77 Table 11. BMI and WC Group Status Predicting Average Reward Ratings per Eating Episode ………………………………………………………………………………………..……. 78 Table 12. BMI and WC Group Status Predicting Average Perceived Control…………….. 79 Table 13. Distress Tolerance (DTS) as a Function of BMI and WC Group Status……….. 80 Table 14. Distress Tolerance (PASAT-C) as a Function of BMI and WC Group Status….. 81 Table 15. Experiential Avoidance as a Function of BMI and WC Group Status …………. 82 Table 16. BMI as a Function of Distress Tolerance and Experiential Avoidance…………. 83 Table 17. WC as a Function of Distress Tolerance and Experiential Avoidance………….. 84 Table 18. Total Caloric Intake & Average Reward per Eating Episode as a Function of Average Mood Change……………….……………………………………………………... 85 Table 19. Total Caloric Intake & Average Reward per Eating Episode as a Function of Depression and Anxiety…………………………………………………………... 86 Table 20. Mediation of the Effect of Total Caloric Intake over the course of Three Days on Body Mass Index Through Behavioral Distress Tolerance and Experiential Avoidance ……………………………………………………………………………………. 87 Table 21. Mediation of the Effect of Total Caloric Intake over the course of Three Days on Body Mass Index Through Self-Reported Distress Tolerance and Experiential Avoidance ……………………………………………………………………………….…… 88 Table 22. Mediation of the Effect of Total Caloric Intake over the course of Three Days on Waist Circumference Through Behavioral Distress Tolerance and Experiential Avoidance …………………………………………………………………………………….. 89 Table 23. Mediation of the Effect of Total Caloric Intake over the course of Three Days on Waist Circumference Through Self-Reported Distress Tolerance and Experiential Avoidance …………………………………………………………………………………… 90 Table 24. Summary of Hierarchical Regression Analysis for Variables Predicting Average Reward Ratings per Eating Episode……………………………………………… 91 1 Distress Tolerance, Experiential Avoidance, and Negative Affect: Implications for Understanding Eating Behavior and BMI The incidence of obesity, defined as a BMI [Body Mass Index] of over 30, has increased by 50% in the past 20 years (Carlson, 2004). According to the National Health and Nutrition Examination Survey (NHANES; Hedley et al., 2004), among American adults aged 20 years and over, 65% are overweight or obese. Of these individuals, approximately 30% are considered obese and 5% are considered extremely obese (overweight BMI: 25.0-29.9 kg/m², class I obesity BMI: 30.0 - 34.9 kg/m², class II obesity BMI: 35.0 - 39.9 kg/m², and class III or extreme obesity BMI: ≥ 40.0 kg/m²). Research consistently has shown that overweight and obese persons are vulnerable to increased physical and mental health problems. For example, obesity is significantly associated with cardiovascular disease, diabetes, high blood pressure, hypercholesterolemia, asthma, arthritis, and poor general health (Mokdad et al., 2003). Obese individuals also are more likely to suffer from gout, gallbladder disease, certain cancers, and post-surgical complications (Straub, 2002; U.S. Department of Health and Human Services: Obesity Action Coalition, 2010). Indeed, a BMI greater than 40 has been associated with a two-fold increase in mortality rates (Straub, 2002). In addition to affecting physical health, weight plays a substantial role in psychological
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