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Saccaro LF, Giff A, De Rossi MM, Piguet C. Interventions targeting emotion regulation: A systematic umbrella review. J Psychiatr Res 2024; 174:263-274. [PMID: 38677089 DOI: 10.1016/j.jpsychires.2024.04.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 03/12/2024] [Accepted: 04/15/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND Emotion dysregulation (ED), the difficulty in modulating which emotions are felt, and when and how they are expressed or experienced, has been implicated in an array of psychological disorders. Despite potentially different manifestations depending on the disorder, this symptom is emerging as a transdiagnostic construct that can and should be targeted early, given the associations with various maladaptive behaviors as early as childhood and adolescence. As such, our goal was to investigate the psychotherapeutic interventions used to address ED and gauge their effectiveness, safety, and potential mechanisms across various populations. METHODS This umbrella systematic review, pre-registered under PROSPERO (registration: CRD42023411452), consolidates evidence from systematic reviews and meta-analyses on psychotherapeutic interventions targeting ED, in accordance with PRISMA guidelines. RESULTS Our synthesis of quantitative and qualitative evidence from 21 systematic reviews (including 11 meta-analyses) points-with moderate overall risk of bias-to the effectiveness of Dialectical Behavior Therapy and Cognitive Behavioral Therapy in reducing ED in a wide range of adult transdiagnostic psychiatric patients and healthy participants. Similar results have emerged in other less extensively researched methods as well. However, results on adolescents and children are sparse, highlighting the need for additional research to tailor these interventions to the unique challenges of ED in younger populations with diverse externalizing and internalizing disorders. CONCLUSIONS These demonstrated transdiagnostic advantages of psychotherapy for ED underscore the potential for specifically designed interventions that address this issue directly, particularly for high-risk individuals. In these individuals, early interventions targeting transdiagnostic core dimensions may mitigate the emergence of full-blown disorders. Future research on the mediating factors, the durability of intervention effects, and the exploration of understudied interventions and populations may enhance prevention and treatment efficiency, enhancing the quality of life for those affected by varied manifestations of ED.
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Affiliation(s)
- Luigi F Saccaro
- Psychiatry Department, Geneva University Hospital, Switzerland; Psychiatry Department, Faculty of Medicine, University of Geneva, Switzerland.
| | | | - Maurilio Menduni De Rossi
- Interdisciplinary Center for Health Sciences, Scuola Superiore Sant'Anna, Piazza Martiri della Libertà 33, Pisa 56127, Italy; Faculty of Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Camille Piguet
- Psychiatry Department, Geneva University Hospital, Switzerland; Psychiatry Department, Faculty of Medicine, University of Geneva, Switzerland
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Vuillier L, Greville-Harris M, Talbot CV, May L, Moseley RL. Early evaluation of a DBT-informed online intervention for people with eating disorders. J Eat Disord 2024; 12:9. [PMID: 38243262 PMCID: PMC10799469 DOI: 10.1186/s40337-024-00974-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 01/16/2024] [Indexed: 01/21/2024] Open
Abstract
OBJECTIVES Eating disorders (EDs) have a worldwide prevalence of 7.8%, with towering mortality rates and high healthcare costs. The current recommended treatment for EDs principally works by directly targeting ED thoughts and behaviours, but recovery rates are low. A multifaceted link between difficulties with emotions and EDs is now widely established, and newer third-wave therapies that aim to address these underlying emotion difficulties are promising. The current study piloted an online emotion self-help intervention which was co-developed with clinicians and people with lived experienced of EDs. The intervention aimed to specifically address difficulties with emotion identification and regulation, as well as unhelpful beliefs about emotions, which are believed to give rise to and maintain ED thoughts and behaviours. METHOD We recruited 39 people with self-reported EDs to test this intervention over a one-week period. Our participants were asked to complete a series of questionnaires measuring emotion processes and psychopathology on Day 1 (T1) before being given access to the intervention. Participants were then asked to practice the newly acquired skills for seven days, before taking the same questionnaires on Day 9 (T2). We also asked participants to qualitatively report on their experience of the intervention. RESULTS We found significant improvements in ED psychopathology (ED-15), depression (PHQ-9), and anxiety (GAD-7) pre- to post-intervention, with medium to large effect sizes. All our emotion variables namely alexithymia (TAS-20), difficulties regulating emotions (DERS-SF), and unhelpful beliefs about emotions (EBQ) also showed significant changes post-intervention with medium to large effect sizes. Most importantly, changes in emotion regulation processes were linked to improved eating psychopathology. The qualitative analysis corroborated this finding, highlighting how the intervention helped them form new beliefs about emotions, which helped them reduce ED behaviours. DISCUSSION Significant improvements in emotion processing and regulations, as well as psychopathology, along with positive qualitative feedback, suggest that the intervention effectively met its aims of increasing awareness of the link between emotions and eating psychopathology, providing help to identify and regulate emotions, and normalising emotional experiences. While our results are promising, further research is required to assess its effectiveness longer term and in clinical settings.
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Affiliation(s)
- Laura Vuillier
- Department of Psychology, Bournemouth University, Poole, UK.
| | | | - C V Talbot
- Department of Psychology, Bournemouth University, Poole, UK
| | - L May
- Southern Health University NHS Foundation Trust, Southampton, UK
| | - R L Moseley
- Department of Psychology, Bournemouth University, Poole, UK
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Bohrer BK, Chen Y, Christensen KA, Forbush KT, Thomeczek ML, Richson BN, Chapa DAN, Jarmolowicz DP, Gould SR, Negi S, Perko VL, Morgan RW. A pilot multiple-baseline study of a mobile cognitive behavioral therapy for the treatment of eating disorders in university students. Int J Eat Disord 2023; 56:1623-1636. [PMID: 37213077 PMCID: PMC10765960 DOI: 10.1002/eat.23987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 04/26/2023] [Accepted: 04/26/2023] [Indexed: 05/23/2023]
Abstract
OBJECTIVE Eating disorders (EDs) are serious psychiatric disorders associated with substantial morbidity and mortality that are prevalent among university students. Because many students do not receive treatment due to lack of access on university campuses, mobile-health (mHealth) adaptations of evidence-based treatments represent an opportunity to increase treatment accessibility and engagement. The purpose of this study was to test the initial efficacy of Building Healthy Eating and Self-Esteem Together for University Students (BEST-U), which is a 10-week mHealth self-guided cognitive-behavioral therapy (CBT-gsh) app that is paired with a brief 25-30-min weekly telehealth coaching, for reducing ED psychopathology in university students. METHOD A non-concurrent multiple-baseline design (N = 8) was used to test the efficacy of BEST-U for reducing total ED psychopathology (primary outcome), ED-related behaviors and cognitions (secondary outcomes), and ED-related clinical impairment (secondary outcome). Data were examined using visual analysis and Tau-BC effect-size calculations. RESULTS BEST-U significantly reduced total ED psychopathology and binge eating, excessive exercise, and restriction (effect sizes ranged from -0.39 to -0.92). Although body dissatisfaction decreased, it was not significant. There were insufficient numbers of participants engaging in purging to evaluate purging outcomes. Clinical impairment significantly reduced from pre-to-post-treatment. DISCUSSION The current study provided initial evidence that BEST-U is a potentially efficacious treatment for reducing ED symptoms and ED-related clinical impairment. Although larger-scale randomized controlled trials are needed, BEST-U may represent an innovative, scalable tool that could reach greater numbers of underserved university students than traditional intervention-delivery models. PUBLIC SIGNIFICANCE Using a single-case experimental design, we found evidence for the initial efficacy of a mobile guided-self-help cognitive-behavioral therapy program for university students with non-low weight binge-spectrum eating disorders. Participants reported significant reductions in ED symptoms and impairment after completion of the 10-week program. Guided self-help programs show promise for filling an important need for treatment among university students with an ED.
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Affiliation(s)
- Brittany K. Bohrer
- Department of Psychiatry, University of California San Diego Health Eating Disorders Center for Treatment and Research, San Diego, California, USA
| | - Yiyang Chen
- Department of Psychology, University of Kansas, Lawrence, Kansas, USA
| | - Kara A. Christensen
- Department of Psychology, University of Nevada, Las Vegas, Las Vegas, Nevada, USA
| | - Kelsie T. Forbush
- Department of Psychology, University of Kansas, Lawrence, Kansas, USA
| | | | | | | | | | - Sara R. Gould
- Children’s Mercy Hospital, Kansas City, Missouri, USA
| | - Sonakshi Negi
- Department of Psychology, University of Kansas, Lawrence, Kansas, USA
| | - Victoria L. Perko
- University of New Mexico Health Science Center, Albuquerque, New Mexico, USA
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Rohde J, Obbarius A, Voigt B, Sarrar L, Biesenthal-Matthes S, Kind CS, Rose M, Hofmann T. Differences and similarities in personality functioning across different types of eating disorders. Front Psychiatry 2023; 14:1155725. [PMID: 37324816 PMCID: PMC10267354 DOI: 10.3389/fpsyt.2023.1155725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 05/12/2023] [Indexed: 06/17/2023] Open
Abstract
Objective The classification of anorexia nervosa (AN) into subtypes is relevant due to their different symptomatology. However, subtypes (restricting type: AN-R; purging type: AN-P) differ also in terms of their personality functioning. Knowledge about these differences would allow for better treatment stratification. A pilot study indicated differences in structural abilities that can be assessed by the operationalized psychodynamic diagnosis (OPD) system. The aim of this study was therefore to systematically explore differences in personality functioning and personality between the two AN subtypes and bulimia nervosa (BN) using three personality (functioning) constructs. Methods A total of N = 110 inpatients with AN-R (n = 28), AN-P (n = 40), or BN (n = 42) were recruited in three clinics for psychosomatic medicine. Assignment to the three groups was performed using a comprehensive questionnaire validated for diagnostic purposes (Munich-ED-Quest). Personality functioning was examined using OPD Structure Questionnaire (OPD-SQ), personality by using the Personality Inventory for DSM-5-Brief Form and Big Five Inventory-10. (M)ANOVAs were used to examine differences across eating disorder groups. In addition, correlation and regression analyses were conducted. Results We observed differences on several sub- and main scales of the OPD-SQ. Whereas patients with BN showed the lowest levels, AN-R patients displayed the highest levels of personality functioning. On some sub- and main scales, such as "affect tolerance," the subtypes of AN differed from BN, whereas on the scale "affect differentiation," AN-R, differed from the other two groups. The total eating disorder pathology score of the Munich-ED-Quest best predicted overall personality structure [stand. β = 0.650; t(104) = 6.666; p < 0.001] and self-regulation [stand. β = 0.449; t(104) = 3.628; p < 0.001]. Discussion Our findings confirm most of the results of the pilot study. These findings can facilitate the development of stratified treatment approaches for eating disorders.
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Affiliation(s)
- Jens Rohde
- Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Alexander Obbarius
- Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Dornsife Center for Self-Report Science, University of Southern California, Los Angeles, CA, United States
| | - Barbara Voigt
- Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Lea Sarrar
- Department of Psychology, Faculty of Sciences, Medical School Berlin, Berlin, Germany
| | - Silke Biesenthal-Matthes
- Department of Psychosomatic Medicine and Psychotherapy, Gemeinschaftskrankenhaus Havelhöhe, Berlin, Germany
| | - Clara-Sophia Kind
- Department of Psychosomatic Medicine and Psychotherapy, Kliniken im Theodor-Wenzel-Werk, Berlin, Germany
| | - Matthias Rose
- Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Quantitative Health Sciences, Outcomes Measurement Science, University of Massachusetts Medical School, Worcester, MA, United States
| | - Tobias Hofmann
- Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Psychosomatic Medicine and Psychotherapy, DRK Kliniken Berlin Wiegmann Klinik, Berlin, Germany
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Salles BM, Maturana de Souza W, Dos Santos VA, Mograbi DC. Effects of DBT-based interventions on alexithymia: a systematic review. Cogn Behav Ther 2023; 52:110-131. [PMID: 36426727 DOI: 10.1080/16506073.2022.2117734] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
While dialectical behavior therapy (DBT) appears effective for some psychiatric conditions commonly associated with alexithymia, it is unclear whether DBT improves difficulties experienced by alexithymic individuals. This review investigated the current evidence on the effectiveness of DBT-based interventions in improving alexithymia. A qualitative synthesis of studies that investigated the efficacy of DBT on self-reported alexithymia was performed, identifying eligible studies using EBSCO/Essentials, Google Scholar, PubMed, Web of Science, and PsychINFO databases. Eight studies were identified. Overall, the results were inconclusive due to the heterogeneity of the studies but suggest that DBT-based interventions may be associated with self-reported decreases in alexithymia and increases in the ability to identify emotional states. The literature is limited by significant methodological problems, such as the low number of controlled trials, small samples, and high variability between DBT programs, which increases the risk of bias across study outcomes. More research is needed to reach conclusions regarding the effectiveness of DBT in improving alexithymia. Future studies should conduct randomized controlled trial designs (primarily with active treatment control conditions), greater standardization of DBT-based interventions, and a more in-depth examination of the level of participant involvement in long-term DBT-based interventions may help to understand whether DBT improves alexithymia difficulties.
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Affiliation(s)
- Bruno M Salles
- Department of Psychology, Pontifical Catholic University of Rio de Janeiro (PUC-Rio), Rio de Janeiro, Brazil
| | - Wayson Maturana de Souza
- Department of Psychology, Pontifical Catholic University of Rio de Janeiro (PUC-Rio), Rio de Janeiro, Brazil
| | - Veruska Andrea Dos Santos
- Department of Psychology, Pontifical Catholic University of Rio de Janeiro (PUC-Rio), Rio de Janeiro, Brazil
| | - Daniel C Mograbi
- Department of Psychology, Pontifical Catholic University of Rio de Janeiro (PUC-Rio), Rio de Janeiro, Brazil.,Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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Berking M, Eichler E, Naumann E, Svaldi J. The efficacy of a transdiagnostic emotion regulation skills training in the treatment of binge-eating disorder-Results from a randomized controlled trial. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2022; 61:998-1018. [PMID: 35567309 DOI: 10.1111/bjc.12371] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 03/29/2022] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Deficits in emotion regulation (ER) have been shown to be associated with binge-eating disorder (BED). To further clarify the causal nature of this association, we tested whether systematically enhancing ER skills would reduce symptoms of BED. METHODS We randomly allocated N = 101 individuals meeting the criteria for BED to a transdiagnostic ER skills training or to a waitlist control condition (WLC). Primary outcome was the reduction in binges during the treatment-vs.-waiting period as assessed with the Eating Disorder Examination (EDE) interview. RESULTS Mixed-model ANOVAs indicated that the average pre-to-post decrease in binges assessed with the EDE was significantly greater in the ER skills training condition than in the WLC (d = 0.66). These effects were stable over the 6-month follow-up period (d = 0.72). Remission rates at post/follow-up were 34.4/45.0% in the skills training and 7.5/20.0% in the WLC. Additionally, we found a greater reduction in general eating disorder psychopathology, of food consumption in a bogus taste test and of depression in the ER skills training condition. Moreover, the greater reduction in binge-eating episodes in the training condition was (partially) mediated by a greater increase in ER skills. CONCLUSIONS The findings provide further support for the assumed importance of deficits in ER as a maintaining factor and, hence, as a target in the treatment of BED. As ER skills trainings have been shown to also reduce other kinds of psychopathology, they might be considered a promising transdiagnostic add-on component to disorder-specific interventions.
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Affiliation(s)
| | - Eva Eichler
- University of Erlangen-Nuremberg, Erlangen, Germany
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Moore R, Gillanders D, Stuart S. The Impact of Group Emotion Regulation Interventions on Emotion Regulation Ability: A Systematic Review. J Clin Med 2022; 11:jcm11092519. [PMID: 35566645 PMCID: PMC9105582 DOI: 10.3390/jcm11092519] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 04/21/2022] [Accepted: 04/24/2022] [Indexed: 02/04/2023] Open
Abstract
Emotional regulation (ER) as a concept is not clearly defined, and there is a lack of clarity about how individuals can improve their ability to regulate emotions. Nevertheless, there is increasing evidence of the importance of ER as a transdiagnostic treatment target across mental health problems. This review examines the impact of ER group interventions on ER ability compared with no intervention, other comparable group interventions, or control conditions. A systematic review was conducted, in which 15 studies were included. Although types of ER intervention were mixed, the interventions had a considerable overlap in skills taught and how ER was measured. In all but one study, the ER intervention improved ER ability. ER interventions were superior to waitlist or treatment as usual, but there was limited evidence to suggest they were superior to other active treatments. Data from some studies suggest that improved ER was sustained at follow-up. Across the studies, there was generally poor linking of theory to practice, which hampers understanding of how interventions were constructed and why different skills were included. Although the results need to be interpreted with caution due to issues with methodological quality with the included papers, there is promising evidence that ER group interventions significantly improve ER ability.
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Affiliation(s)
- Rebekah Moore
- NHS Greater Glasgow and Clyde, Glasgow Psychological Trauma Service, Festival Business Centre, 150 Brand Street, Glasgow G51 1DH, UK
- Correspondence:
| | - David Gillanders
- School of Health in Social Science, Elsie Inglis Quad, Teviot Place, University of Edinburgh, Edinburgh EH8 9AG, UK;
| | - Simon Stuart
- NHS Lanarkshire, Hunter Health Centre, Andrew Street, East Kilbride G74 1AD, UK;
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Yılmaz MN, Dundar C. The relationship between orthorexia nervosa, anxiety, and self-esteem: a cross-sectional study in Turkish faculty members. BMC Psychol 2022; 10:82. [PMID: 35361269 PMCID: PMC8974066 DOI: 10.1186/s40359-022-00796-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 03/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Orthorexia nervosa (ON) may be a disorder on the spectrum of obsessive-compulsive disorders, maybe a separate eating disorder, or it may be an eating disorder on the spectrum of other eating disorders. We aimed to explore how anxiety and self-esteem affect the orthorectic tendency among higher-educated groups. METHODS This cross-sectional study was conducted on 248 faculty members selected by stratified sampling method from Ondokuz Mayis University in Samsun, Turkey. Data were collected by face-to-face interview method using Ortho-15, Rosenberg self-esteem, and Beck Anxiety scales. RESULTS The study group consisted of 144 (58.1%) males and 104 (41.9%) females, and the mean age was 42.5 ± 6.3 years. We found a tendency for orthorexia nervosa in 47 (19%) participants. The mean scores were 41.0 ± 2.6 for the Ortho-15 scale, 0.7 ± 1.2 for the Self-esteem scale, and 5.9 ± 5.8 for the Beck Anxiety Scale. Self-esteem scores were low, and anxiety scores were high in participants who tended to orthorexia (p < 0.001). Logistic regression analysis showed that the high self-esteem scores decrease the orthorectic tendency, while high anxiety scores increase the tendency. CONCLUSIONS We found a significant relationship between anxiety, low self-esteem and orthorexia nervosa. This result can be considered as a preliminary finding leading to further research. Further clinical and longitudinal studies are needed to determine the characteristics of individuals with orthorexia nervosa and identify the cause and effect relationship with psychiatric comorbidities.
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Affiliation(s)
- Maide Nur Yılmaz
- Department of Public Health, Faculty of Medicine, Ondokuz Mayis University, 55139, Atakum, Samsun, Turkey
| | - Cihad Dundar
- Department of Public Health, Faculty of Medicine, Ondokuz Mayis University, 55139, Atakum, Samsun, Turkey.
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Emotion regulation and healthy behaviors of the body energy balance in adults: A review of evidence. ACTA COLOMBIANA DE PSICOLOGIA 2020. [DOI: 10.14718/acp.2020.23.2.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
There is no document that analyzes the state of the art of scientific research published between 2013 and 2018 in relation to possible interdependence links between emotional regulation [ER] and healthy behaviors associated with Body Energy Balance [BEB] (physical activity, balanced diet and sleep hygiene). To achieve this purpose, an exploratory systematic review was conducted, whose search criteria were “emotion regulation”, “emotion dysregulation” connected with the Boolean operator “AND” to the keywords “sleep hygiene”, “eating behavior” and “physical activity”. Terms like “alexithymia”, “depression”, “stress”, “negative emotions”, and “rumination” were omitted. The methodological quality of the evidence was assessed with a patented rubric. After applying the analysis criteria, 35 articles were obtained, reporting theexistence of reciprocal associations and interactions between ER and at least one of the three behaviors associated with BEB were analyzed. It is concluded that, despite the importance of these behaviors in the vital maintenance of people and the clear impact that emotional regulation has on them, their research has not been sufficient, and more empirical studies in this regard in Latin America are needed.
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