Evaluating the Indirect Effect of Self-Compassion on Binge Eating Severity Through Cognitive–Affective Self-Regulatory Pathways

EATBEH-00644; No of Pages 5 Eating Behaviors xxx (2013) xxx–xxx

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Eating Behaviors

Evaluating the indirect effect of self-compassion on binge eating severity through cognitive–affective self-regulatory pathways

Jennifer B. Webb a,⁎, Mallory J. Forman b a University of North Carolina at Charlotte, Department of Psychology, Health Psychology Ph.D. Program, 9201 University City Blvd., Charlotte, NC 28223, USA b Appalachian State University, Department of Psychology, P. O. Box 32109, 222 Joyce Lawrence Lane, Boone, NC 28608, USA article info abstract

Article history: Current theory and evidence point to disruptions in self-concept and difficulties with emotion regulation as Received 29 June 2012 contributing to the severity of binge eating. Alternatively, contemporary perspectives on self-compassion Received in revised form 19 October 2012 suggest that individual differences in this adaptive approach to self-regulation may serve to counteract Accepted 4 December 2012 these cognitive–affective triggers presumably resulting in reductions in binge eating severity. Accordingly, the Available online xxxx present cross-sectional analysis examined an indirect effect model of positive dimensions of self-compassion on binge eating severity through both emotional tolerance and unconditional self-acceptance pathways. Two Keywords: fi College students hundred fteen undergraduate students (78% female) completed self-report measures of the variables of interest; Self-compassion BMI was calculated from self-reported heights and weights. Pearson'scorrelationsrevealed a positive linear associ- Binge eating severity ation between self-compassion and unconditional self-acceptance; negative links were observed between Emotional tolerance self-compassion and emotional intolerance along with the severity of binge eating symptoms. A subsequent multi- Unconditional self-acceptance ple mediator analysis utilizing both normal test theory and robust non-parametric bootstrap resampling procedures confirmed the presence of a significant total indirect effect of self-compassion on binge eating severity (−.15, pb0.001) through the combined mediators along with yielding specific indirect effects for both emotional tolerance (−.05, pb0.05) and unconditional self-acceptance (−.11, pb0.01) which were preserved in a model adjusted for BMI. Preliminary results underscore the need to further evaluate the tenability of this model in both prospective cohort and intervention-based research. Findings additionally invite considering the value of integrating self-compassion training into college health promotion efforts towards mitigating the appreciable levels of binge eating behavior prevalent in this at-risk population. © 2012 Elsevier Ltd. All rights reserved.

1. Introduction maintenance of binge eating (Allen, Byrne, La Puma, McLean, & Davis, 2008; Heatherton & Baumeister, 1991; Polivy & Herman, Remarkably, although clinically-elevated binge eating patterns in 1993). A compelling consensus has accrued in the scientiﬁc literature the form of binge eating disorder (BED) have been documented in a in support of construing an eating binge as a means of momentarily minority of university undergraduates (e.g., 1%–8.4%), subthreshold alleviating the experience of negative emotions and/or avoiding levels appear to affect a considerable number of students at this devel- conscious awareness of undesirable aspects of the self that often opmental juncture (ranging from 15% to 44%: Laska, Pasch, Lust, Story, & co-occurs with threats to self-esteem (e.g., negative self-evaluations, Ehlinger, 2011; Napolitano & Himes, 2011; Saules et al., 2009; Whiteside self-criticism). Indeed, research conﬁrms that stress and negative affect et al., 2007). Not only is binge eating a risk factor for weight gain frequently precipitate as well as result from episodes of dysregulated (Barnes, Blomquist, & Grilo, 2011) and concomitant cardiometabolic eating (Barker, Williams, & Galambos, 2006; Deaver, Miltenberger, morbidity, it is also linked to poorer psychosocial well-being. Notably, Smyth, Meidinger, & Crosby, 2003; Kenardy, Arnow, & Agras, 1996; college students who reported higher scores on measures of binge eating Napolitano & Himes, 2011); emotional eating was also correlated with were more inclined to endorse lower self-esteem along with greater binge eating in an overweight sample (Ricca et al., 2009). Authors dietary restraint, body dissatisfaction, fat self-perceptions, anxiety, and have further noted that individuals engaging in binge eating report depressive symptoms (Benjamin & Wufert, 2005; Mitchell & Mazzeo, being able to access fewer resources with which to regulate emotions 2004; Napolitano & Himes, 2011; Saules et al., 2009). more constructively (Czaja, Rief, & Hilbert, 2009; Whiteside et al., Leading experts have proffered a functional self-regulatory perspec- 2007). Alternatively, data also suggests that cultivating more positive tive as a prevailing explanatory model driving both the onset and cognitive coping strategies may mitigate the severity of binge eating symptoms (Kelly, Lydecker, & Mazzeo, 2012). ⁎ Corresponding author. Tel.: +1 704 687 1320; fax: +1 704 687 1317. Along these lines, the main objective of the current study was to test E-mail address: [email protected] (J.B. Webb). an indirect effect model of individual differences in self-compassion on

Please cite this article as: Webb, J.B., & Forman, M.J., Evaluating the indirect effect of self-compassion on binge eating severity through cognitive– affective self-regulatory..., Eating Behaviors (2013), http://dx.doi.org/10.1016/j.eatbeh.2012.12.005 2 J.B. Webb, M.J. Forman / Eating Behaviors xxx (2013) xxx–xxx binge eating severity via both emotional tolerance and unconditional metropolitan area. Students were recruited through informational flyers self-acceptance pathways. Self-compassion as an outgrowth of ancient posted around campus as well as through the Psychology Department's Buddhist philosophy encourages treating oneself with kindness and subject pool. Seventy-eight percent of participants identified as female engaging mindful equanimity in the face of distress and life's difficulties and roughly 40% of the sample was comprised of college sophomores. comforted by the recognition that suffering is an essential part of the The ethnic representation of the sample (which reflects the more typical shared human condition (Neff, 2003). Closely aligned with Ellis' ethnic diversity of undergraduates matriculating in major universities (1962, 1995) influential epistemology promoting unconditional located in the southern region of the West coast: About USC: Facts self-acceptance, contemporary theory on adopting a self-compassionate and figures, n.d.; UCLA enrollment history, n.d.) was as follows: 45.2% stance further eschews placing emphasis on making global self- European American, 23.5% Latino American, 6.9% African American, 6% evaluations, antithetical to the conceptualization of self-esteem (Neff, Asian American, 12% South Asian American and 4.6% identifying as 2003). Though long-practiced in Eastern spiritual traditions, the scientific Other. The mean level of maternal education attained was 15.3 years construct of self-compassion has come under the scrutiny of Western (SD=3.85). The median reported annual household income range empiricism only within the last decade. Initial scale validation work was $75,000–$99,999. confirmed positive relationships between self-compassion and dimensions of well-being (e.g., social connectedness, life satisfaction) along 2.2. Measures with negative associations observed with reports of depression and anxiety (Neff, 2003). 2.2.1. Demographics and anthropometrics Surprisingly, the study of self-compassion in the context of disordered Participants completed a standard demographic questionnaire eating and related variables such as body image disturbance is highly un- requesting respondents' age, sex, year in school, maternal education derdeveloped in this emerging line of research. Nevertheless, limited ev- level, annual parental household income level, ethnic identification, and idence has shown higher levels of self-compassion to be linked to greater height and weight. The latter two parameters were used to calculate positive body image characteristics (Ferreira, Pinto-Gouveia, & Duarte, self-reported BMI. 2011; Wasylkiw, MacKinnon, & MacLellan, 2012) and reduced guilt over consuming forbidden or unhealthy foods (Adams & Leary, 2007; 2.2.2. Self-Compassion Scale (SCS) Wasylkiw et al., 2012). These relationships seem plausible in light of The SCS (Neff, 2003) is a 26-item self-report measure in which modern theoretical perspectives on mindfulness and acceptance- participants respond to each item (e.g., “I'm tolerant of my own flaws based approaches to self-regulation inclusive of self-compassion that and inadequacies”) on a 5-point scale (1 =almost never;5=almost foster cultivating greater non-judgmental awareness and a curiosity always), with higher scores indicating higher self-compassion. and openness to one's internal experience (i.e. thoughts, emotions, The scale yields six subscale scores, 3 of which correspond to the main physical sensations: Baer, 2010; Germer, 2009; Kabat-Zinn, 1990). components of self-compassion—mindfulness, common humanity, Self-compassion purports to further extend these processes and self-kindness—while the remaining 3 subscales represent the through the intentional offering of kindness and care to oneself partic- opposite of these constructs: over-identification, isolation, and ularly during times of emotional suffering (Baer, 2010; Germer, 2009; self-judgment. The measure has demonstrated excellent internal Neff, 2003). Thus, self-compassion provides a unique way of relating consistency in college student samples (α=0.92: Neff, 2003; α=0.93: to oneself when the tendency to engage in negative self-evaluation Wasylkiw et al., 2012). Self-compassion evidenced negative correlations and the corresponding desire to avoid the experience of negative emo- with self-reported anxiety, depression, self-criticism, rumination, and tions are particularly salient (Germer, 2009; Neff, 2003). Accordingly, thought suppression (Neff, 2003). For the purposes of our analysis, the self-compassion may disrupt these common cognitive–affective precip- 3 adaptive components (i.e., mindfulness, common humanity, and itants of binge eating specifically through engaging adaptive emotion self-kindness) of self-compassion were combined to create a composite regulation skills (e.g., tolerating aversive emotions) and accepting score entitled “Positive Self-Compassion” (PSC) Our composite measure (versus attempting to suppress or escape) unwanted aspects of the demonstrated good internal consistency (α=0.88). Neff (2003) found self unconditionally (Neff, 2003; Wolever & Best, 2009). Thus, greater thatmeantotalSCSscoresalongwithmeanscoresonthe3positivecom- self-compassion would be associated with less binge eating severity ponents of self-compassion were significantly higher among Buddhist through these more adaptive self-regulatory pathways. Indeed, higher Vipassana meditation practitioners versus an undergraduate student reports of self-compassion were indicative of greater emotional intelli- sample. gence (i.e. attention, clarity, and negative mood repair abilities) and emotional approach coping in conjunction with less self-criticism and 2.2.3. Emotional Tolerance Scale (ETS) thought suppression among undergraduate students (Neff, 2003). The ETS (Kenardy et al., 1996) is a 25-item scale derived from the In view of emerging self-compassion theory and prior evidence, Emotional Eating Scale (EES; Arnow, Kenardy, & Agras, 1995), which we hypothesized observing negative associations between self- was designed to assess the aversiveness of a range of negative emotions compassion, impairments in the ability to withstand specific aversive associated with overeating. Subscales include specific negative mood emotional states, and attitudes reflecting more problematic binge states such as anger/frustration, depression and anxiety. Items are eating behavior. Conversely, we anticipated finding a positive link rated on a 5-point scale (1=“not at all scared”;5=“terrified”), with between a self-compassionate self-regulatory style and unconditional higher scores indicative of lower emotional tolerance. The scale de- self-acceptance. Finally, based on this proposed pattern of bivariate velopers report good internal consistency for the full-scale score of relationships we surmised that both emotional tolerance and uncon- the parent measure (α=0.81; Arnow et al., 1995). Higher ETS scores ditional self-acceptance would mediate the association between were observed in obese binge eaters versus non-binge eating controls self-compassion and binge eating severity with effects expected to (Kenardy et al., 1996). Internal consistency for the total score in the persist in a model adjusted for BMI. current study was excellent (α=0.94).

2. Methods 2.2.4. Unconditional Self-Acceptance Questionnaire (USAQ) The USAQ (Chamberlain & Haaga, 2001a) is a 20-item self-report 2.1. Participants measure designed to reﬂect major components of unconditional self-acceptance as distilled from rational-emotive behavior therapy Participants were 215 undergraduates aged 18–28 years (M=19.81, (e.g., Ellis, 1962, 1995). Participants responded to each item on a scale SD=1.48) from a large, private university in the Los Angeles, California of 1 (almost always untrue)to7(almost always true), with higher scores

Table 1 presents the means, standard deviations, and intercorrelations for the primary study variables. As predicted, as individuals en- dorsed higher self-compassion they tended to report higher levels of A unconditional self-acceptance. Self-compassion scores were negatively associated with both binge eating severity and emotional intolerance. -.20* Interestingly, the linear relationship between self-compassion and Binge Eating Positive ﬁ − Severity BMI approached statistical signi cance (r= .12, p=0.08). Self-Compassion The Preacher and Hayes (2008) INDIRECT script for SPSS was used to test for possible indirect effects of individual differences in positive components of self-compassion on binge eating severity scores B through both emotional tolerance and unconditional self-acceptance in a single multiple mediator model. This analytic approach was Emotional deemed the most parsimonious way to discern the total indirect effect Tolerance combining both possible mediators along with permitting the evaluation of the existence of the separate indirect effect for each variable -.24** .20* while controlling for the other. Taking this more conservative approach

(versus testing the proposed mediators in separate models) also -.05 seemed warranted in light of the moderate correlation found between Positive Binge Eating emotional tolerance and unconditional self-acceptance in this sample. Self-Compassion Severity

Table 1 Descriptive statistics and intercorrelations for the primary study variables. .49**Unconditional -.22* 1 2345 Self-Acceptance

1. BMI – 2. Positive self-compassion −.12 – Fig. 1. Relationship between positive dimensions of self-compassion and binge eating 3. Emotional tolerance .06 −.24⁎⁎ – severity as mediated by both emotional tolerance and unconditional self-acceptance. 4. Unconditional self-acceptance −.10 .47⁎⁎ −.36⁎⁎ – Panel A presents the total (i.e. simple) effect (c) of positive self-compassion on binge 5. Binge Eating Scale .25⁎⁎ −.21⁎⁎ .29⁎⁎ −.32⁎⁎ – eating severity. Panel B presents the direct effect (c′) of positive self-compassion on M 22.72 3.00 40.72 82.19 30.76 binge eating severity accounting for its indirect effects via emotional tolerance (−.05, SD 4.55 0.69 19.69 13.88 8.31 pb0.05) and unconditional self-acceptance (−.11, pb0.01). The values presented are ⁎⁎ Correlation is signiﬁcant at the .01 level. standardized Beta coefﬁcients. *pb0.01; **p≤0.001.

4. Discussion Role of funding sources This research was supported by a University of Southern California Kellerman Fund Research Grant to the first author. The Kellerman Fund had no role in the study design, Elucidating the role of self-compassion in the context of disordered collection, analysis or interpretation of the data, writing the manuscript, or the decision to eating, body image disturbance, and weight loss is a cutting edge area submit the paper for publication. of clinical health psychology research and practice (Adams & Leary, 2007; Fain, 2011; Ferreira et al., 2011; Goss, 2011; Loring, 2010; Contributors Wasylkiw et al., 2012). The present study uniquely contributes to the Jennifer Webb designed the study, wrote the protocol, conducted the mediational existing literature by examining the relationship between positive analyses, and led the process of data interpretation and manuscript preparation. self-compassion and binge eating severity in an at-risk college student Mallory Forman conducted the descriptive and correlational analyses, drafted the methods section, and aided in the presentation of the results. Both authors contributed sample. We additionally tested a proposed indirect effect model in- to and have approved the final version of the manuscript. cluding two candidate mediators to further clarify this association. Results were well-aligned with initial predictions in that self- Conflict of interest compassion was shown to positively covary with unconditional The authors declare no conflict of interest. self-acceptance and to negatively correlate with deficits in the ability to tolerate specific negative emotional states along with attitudes in- Acknowledgments dicative of the severity of binge eating. In the bivariate instance a nota- The first author wishes to thank her former graduate advisor Dr. Gerald C. ble trend also emerged demonstrating a negative association between Davison for his generous and unwavering support of this research project. The authors the inclination to intentionally enact a self-compassionate stance would also like to thank Ms. Shanique J. Lee for her invaluable assistance with conducting when faced with emotional pain/threats to self-concept and BMI. 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