scholarly journals A mixed-methods approach to conceptualizing friendships in anorexia nervosa

PLoS ONE ◽  
2021 ◽  
Vol 16 (9) ◽  
pp. e0254110
Author(s):  
Nandini Datta ◽  
Molly Foukal ◽  
Savannah Erwin ◽  
Hannah Hopkins ◽  
Kate Tchanturia ◽  
...  
Keyword(s):  
Anorexia Nervosa ◽  
Mixed Methods ◽  
Attachment Styles ◽  
Negative Evaluation ◽  
Self Report ◽  
Healthy Controls ◽  
Care Seeking ◽  
Drive For Thinness ◽  
Attachment Figure ◽  
Mixed Methods Approach

Background Individuals with anorexia nervosa have reported feelings of loneliness, social anhedonia, and interpersonal difficulties. This study sought to clarify the nature of interpersonal relationships in adults with anorexia, which may help improve existing interventions while also facilitating the attainment of something that might compete with the drive for thinness: friendships. Methods The present study used a mixed-methods approach to investigate friendship experiences in three groups: anorexia (n = 27), participants with a history of anorexia who are weight restored (n = 20), and healthy controls (n = 24). Thematic analysis was used to isolate the most prevalent themes that emerged from an open-ended interview of experiencing friendships in a subset of participants. Three self-report questionnaires investigating friendship valuation and attachment styles were also administered. Results 11 unique themes emerged in the data: social comparison, reciprocity, trust, fear of negative evaluation, perceived skills deficit, logistical barriers, reliability, identity issue, low interest, similarity, and conflict avoidance. Only 17% of those with anorexia reported experiencing friendships as positive, relative to 82% of healthy controls and 52% of weight restored participants. Lastly, on self-report measures, participants with anorexia reported greater reliance on themselves versus others, greater use of care-seeking behaviors, and more fear/anger at the thought of losing an attachment figure (p < .05 in all cases). Conclusion Results suggest that individuals with anorexia have particular challenges which interfere with the formation and maintenance of friendships, such as viewing friendships negatively and struggling with social comparisons in friendships. Assessing and addressing barriers to intimacy may motivate those with anorexia to relinquish dangerous symptoms that maintain the illness.

scholarly journals Overcoming limitations of self-report: an assessment of fear of weight gain in anorexia nervosa and healthy controls using implicit association tests

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Tiana Borgers ◽  
Nathalie Krüger ◽  
Silja Vocks ◽  
Jennifer J. Thomas ◽  
Franziska Plessow ◽  
...  
Keyword(s):  
Anorexia Nervosa ◽  
Weight Gain ◽  
Normal Weight ◽  
Self Report ◽  
Healthy Controls ◽  
Drive For Thinness ◽  
Implicit Association ◽  
Association Tests ◽  
Implicit Assessment ◽  
Fear Of Weight Gain

Abstract Background Fear of weight gain is a characteristic feature of anorexia nervosa (AN), and reducing this fear is often a main target of treatment. However, research shows that 20% of individuals with AN do not report fear of weight gain. Studies are needed that evaluate the centrality of fear of weight gain for AN with a method less susceptible to deception than self-report. Methods We approximated implicit fear of weight gain by measuring implicit drive for thinness using implicit association tests (IATs). We asked 64 participants (35 AN, 29 healthy controls [HCs]) to categorize statements as pro-dieting vs. non-dieting and true vs. false in a questionnaire-based IAT, and pictures of underweight vs. normal-weight models and positive vs. negative words in a picture-based IAT using two response keys. We tested for associations between implicit drive for thinness and explicitly reported psychopathology within AN as well as group differences between AN and HC groups. Results Correlation analyses within the AN group showed that higher implicit drive for thinness was associated with more pronounced eating disorder-specific psychopathology. Furthermore, the AN group showed a stronger implicit drive for thinness than HCs in both IATs. Conclusion The results highlight the relevance of considering fear of weight gain as a continuous construct. Our implicit assessment captures various degrees of fear of weight gain in AN, which might allow for more individually tailored interventions in the future.

Identifying neuroanatomical signatures of anorexia nervosa: a multivariate machine learning approach

2015 ◽  
Vol 45 (13) ◽  
pp. 2805-2812 ◽  
Author(s):  
L. Lavagnino ◽  
F. Amianto ◽  
B. Mwangi ◽  
F. D'Agata ◽  
A. Spalatro ◽  
...  
Keyword(s):  
Machine Learning ◽  
Anorexia Nervosa ◽  
Predictive Accuracy ◽  
Third Ventricle ◽  
Healthy Controls ◽  
Drive For Thinness ◽  
Individual Subject ◽  
Machine Learning Approach ◽  
Scan Data ◽  
Selection Operator

BackgroundThere are currently no neuroanatomical biomarkers of anorexia nervosa (AN) available to make clinical inferences at an individual subject level. We present results of a multivariate machine learning (ML) approach utilizing structural neuroanatomical scan data to differentiate AN patients from matched healthy controls at an individual subject level.MethodStructural neuroimaging scans were acquired from 15 female patients with AN (age = 20, s.d. = 4 years) and 15 demographically matched female controls (age = 22, s.d. = 3 years). Neuroanatomical volumes were extracted using the FreeSurfer software and input into the Least Absolute Shrinkage and Selection Operator (LASSO) multivariate ML algorithm. LASSO was ‘trained’ to identify ‘novel’ individual subjects as either AN patients or healthy controls. Furthermore, the model estimated the probability that an individual subject belonged to the AN group based on an individual scan.ResultsThe model correctly predicted 25 out of 30 subjects, translating into 83.3% accuracy (sensitivity 86.7%, specificity 80.0%) (p < 0.001; χ2 test). Six neuroanatomical regions (cerebellum white matter, choroid plexus, putamen, accumbens, the diencephalon and the third ventricle) were found to be relevant in distinguishing individual AN patients from healthy controls. The predicted probabilities showed a linear relationship with drive for thinness clinical scores (r = 0.52, p < 0.005) and with body mass index (BMI) (r = −0.45, p = 0.01).ConclusionsThe model achieved a good predictive accuracy and drive for thinness showed a strong neuroanatomical signature. These results indicate that neuroimaging scans coupled with ML techniques have the potential to provide information at an individual subject level that might be relevant to clinical outcomes.

scholarly journals Increased plasticity of the bodily self in eating disorders

2011 ◽  
Vol 42 (4) ◽  
pp. 819-828 ◽  
Author(s):  
E. Eshkevari ◽  
E. Rieger ◽  
M. R. Longo ◽  
P. Haggard ◽  
J. Treasure
Keyword(s):  
Eating Disorders ◽  
Visual Processing ◽  
Subjective Experience ◽  
Emotional Dysregulation ◽  
The Body ◽  
Self Report ◽  
Healthy Controls ◽  
Drive For Thinness ◽  
Maintenance Factors ◽  
Self Objectification

BackgroundThe rubber hand illusion (RHI) has been widely used to investigate the bodily self in healthy individuals. The aim of the present study was to extend the use of the RHI to examine the bodily self in eating disorders (EDs).MethodThe RHI and self-report measures of ED psychopathology [the Eating Disorder Inventory – 3 (EDI-3) subscales of Drive for Thinness, Bulimia, Body Dissatisfaction, Interoceptive Deficits, and Emotional Dysregulation; the 21-item Depression, Anxiety and Stress Scale (DASS-21); and the Self-Objectification Questionnaire (SOQ)] were administered to 78 individuals with an ED and 61 healthy controls.ResultsIndividuals with an ED experienced the RHI significantly more strongly than healthy controls on both perceptual (i.e. proprioceptive drift) and subjective (i.e. self-report questionnaire) measures. Furthermore, both the subjective experience of the RHI and associated proprioceptive biases were correlated with ED psychopathology. Approximately 23% of the variance for embodiment of the fake hand was accounted for by ED psychopathology, with interoceptive deficits and self-objectification significant predictors of embodiment.ConclusionsThese results indicate that the bodily self is more plastic in people with an ED. These findings may shed light on both aetiological and maintenance factors involved in EDs, particularly visual processing of the body, interoceptive deficits, and self-objectification.

scholarly journals Implementing the Aseptic Non Touch Technique (ANTT®) clinical practice framework for aseptic technique: a pragmatic evaluation using a mixed methods approach in two London hospitals

2017 ◽  
Vol 19 (1) ◽  
pp. 6-15 ◽  
Author(s):  
Simon Clare ◽  
Stephen Rowley
Keyword(s):  
Clinical Practice ◽  
Mixed Methods ◽  
Infection Prevention ◽  
Self Report ◽  
Healthcare Associated Infection ◽  
Structured Interviews ◽  
Aseptic Technique ◽  
Mixed Methods Approach ◽  
Practice Framework ◽  
Mean Compliance

Background: Aseptic technique is an important infection prevention competency for protecting patients from healthcare-associated infection (HAI). Healthcare providers using the Aseptic Non Touch Technique (ANTT®) aseptic technique have demonstrated reduced variability and improved compliance with aseptic technique. Objectives: The primary aim of this study is to determine whether standardizing aseptic technique for invasive IV procedures, using the ANTT® - Clinical Practice Framework (CPF), increases staff compliance with the infection prevention actions designed to achieve a safe and effective aseptic technique, and whether this is sustainable over time. Methods: A pragmatic evaluation using a mixed-methods approach consisting of an observational audit of practice, a self-report survey and structured interviews with key stakeholders. Compliance with aseptic technique before and after the implementation of ANTT® was measured by observation of 49 registered healthcare professionals. Results: Mean compliance with competencies was 94%; each component of practice was improved over baseline: hand hygiene = 63% ( P ≤ 0.001); glove use = 14% ( P ≤ 0.037); Key-Part protection = 54% ( P ≤ 0.001); a non-touch technique = 45% ( P ≤ 0.001); Key-Part cleaning = 82% ( P ≤ 0.001); and aseptic field management = 80% ( P ≤ 0.001). Conclusions: Results show implementation of ANTT® improved compliance with the prerequisite steps for safe and effective aseptic technique as defined by the ANTT®-CPF. Improvements in compliance were sustained over four years.

scholarly journals Investigating the Interpersonal Dynamics Between Coaches and Athletes Based on Fundamental Principles of Attachment

2010 ◽  
Vol 4 (2) ◽  
pp. 112-132 ◽  
Author(s):  
Louise Davis ◽  
Sophia Jowett
Keyword(s):  
Relationship Satisfaction ◽  
Attachment Theory ◽  
Attachment Styles ◽  
Self Report ◽  
Secure Base ◽  
Interpersonal Dynamics ◽  
Attachment Figure ◽  
As Relationship ◽  
The Relationship ◽  
Associated Data

Grounded in Bowlby’s (1969/1982, 1988) attachment theory, this study aimed to explore (a) the pervasiveness of the three main functions of attachment within the context of the coach-athlete relationship, (b) the associations of athletes’ attachment styles with such important variables as satisfaction with the relationship and satisfaction with the sport, and (c) the process by which athletes’ attachment styles and satisfaction with sport are associated. Data were collected through self-report measures of attachment functions and styles as well as relationship satisfaction and sport satisfaction from 309 student athletes (males = 150, females = 159) whose age ranged from 18 to 28 years (Mage = 19.9, SD = 1.58 years). Athletes’ mean scores indicated that the coach was viewed as an attachment figure fulfilling all three functions of secure base, safe haven, and proximity maintenance. Bivariate correlations indicated that athletes’ avoidant and anxious styles of attachment with the coach were negatively correlated with both relationship satisfaction and sport satisfaction. Mediational regression analysis revealed that athletes’ satisfaction with the coach-athlete relationship may be a process that links athletes’ attachment styles with levels of satisfaction with sport. The findings from this study highlight the potential theoretical and practical utility of attachment theory in studying relationships within the sport context.

Attachment–style Differences in the Appraisal of the Attachment Figure

2011 ◽  
Vol 25 (3) ◽  
pp. 173-183 ◽  
Author(s):  
Marieke Dewitte ◽  
Jan De Houwer
Keyword(s):  
Attachment Style ◽  
Attachment Styles ◽  
Negative Evaluation ◽  
Affective Priming ◽  
Cognitive Inhibition ◽  
Secure Attachment ◽  
Anxious Attachment ◽  
Attachment Figure ◽  
Specific Attachment

The present study investigated the distinctive effects of global and specific attachment styles on the processing of attachment–figure cues, focusing specifically on the role of cognitive inhibition. We manipulated the temporal accessibility of specific attachment styles and measured automatic inhibitory processes using a negative affective priming (NAP) task presenting positive and negative words. We also measured one's explicit attitude towards the attachment figure. Results showed that specific, but not global, attachment styles influenced the processing of attachment–figure cues. We also found that participants primed with a secure attachment style showed a better inhibition of negative traits than those primed with an insecure style. At the explicit level, the anxious attachment types showed a more negative evaluation of their attachment figure than primed secures. Copyright © 2010 John Wiley & Sons, Ltd.

scholarly journals A Novel Mixed Methods Approach to Assess Children’s Sedentary Behaviors

2020 ◽  
Vol 3 (1) ◽  
pp. 78-86
Author(s):  
Liezel Hurter ◽  
Anna M. Cooper-Ryan ◽  
Zoe R. Knowles ◽  
Lorna A. Porcellato ◽  
Stuart J. Fairclough ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Data Collection ◽  
Sedentary Behavior ◽  
Screen Time ◽  
Contextual Information ◽  
Self Report ◽  
Complex Nature ◽  
Accelerometer Data ◽  
Sedentary Behaviors ◽  
Mixed Methods Approach

Purpose: Accurately measuring sedentary behavior (SB) in children is challenging by virtue of its complex nature. While self-report questionnaires are susceptible to recall errors, accelerometer data lacks contextual information. This study aimed to explore the efficacy of using accelerometry combined with the Digitising Children’s Data Collection (DCDC) for Health application (app), to capture SB comprehensively. Methods: 74 children (9–10 years old) wore ActiGraph GT9X accelerometers for 7 days. Each received a SAMSUNG Galaxy Tab4 (SM-T230) tablet, with the DCDC app installed and a specially designed sedentary behavior study downloaded. The app uses four data collection tools: 1) Questionnaire, 2) Take a photograph, 3) Draw a picture, and 4) Record my voice. Children self-reported their SB daily. Accelerometer data were analyzed using R-package GGIR. App data were downloaded and individual participant profiles created. SBs reported were grouped into categories and reported as frequencies. Results: Participants spent, on average, 629 min (i.e., 73% of their waking time) sedentary. App data revealed most of their out-of-school SB consisted of screen time (112 photos, 114 drawings, and screen time mentioned 135 times during voice recordings). Playing with toys, reading, arts and crafts, and homework were also reported across all four data capturing tools on the app. On an individual level, data from the app often explained irregular patterns in physical activity and SB observed in accelerometer data. Conclusion: This mixed methods approach to assessing SB adds context to accelerometer data, providing researchers with information needed for intervention design.

scholarly journals Care home residents’ quality of life and its association with CQC ratings and workforce issues: the MiCareHQ mixed-methods study

2021 ◽  
Vol 9 (19) ◽  
pp. 1-188
Author(s):  
Ann-Marie Towers ◽  
Nick Smith ◽  
Stephen Allan ◽  
Florin Vadean ◽  
Grace Collins ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Mixed Methods ◽  
Social Care ◽  
Care Home ◽  
Self Report ◽  
Care Homes ◽  
Mixed Methods Approach ◽  
Related Quality ◽  
The Relationship

Background Care home staff have a critical bearing on quality. The staff employed, the training they receive and how well they identify and manage residents’ needs are likely to influence outcomes. The Care Act 2014 (Great Britain. The Care Act 2014. London: The Stationery Office; 2014) requires services to improve ‘well-being’, but many residents cannot self-report and are at risk of exclusion from giving their views. The Adult Social Care Outcomes Toolkit enables social care-related quality of life to be measured using a mixed-methods approach. There is currently no equivalent way of measuring aspects of residents’ health-related quality of life. We developed new tools for measuring pain, anxiety and depression using a mixed-methods approach. We also explored the relationship between care home quality, residents’ outcomes, and the skill mix and employment conditions of the workforce who support them. Objectives The objectives were to develop and test measures of pain, anxiety and depression for residents unable to self-report; to assess the extent to which regulator quality ratings reflect residents’ care-related quality of life; and to assess the relationship between aspects of the staffing of care homes and the quality of care homes. Design This was a mixed-methods study. Setting The setting was care homes for older adults in England. Participants Care home residents participated. Results Three measures of pain, anxiety and low mood were developed and tested, using a mixed-methods approach, with 182 care home residents in 20 care homes (nursing and residential). Psychometric testing found that the measures had good construct validity. The mixed-methods approach was both feasible and necessary with this population, as the majority of residents could not self-report. Using a combined data set (n = 475 residents in 54 homes) from this study and the Measuring Outcomes in Care Homes study (Towers AM, Palmer S, Smith N, Collins G, Allan S. A cross-sectional study exploring the relationship between regulator quality ratings and care home residents’ quality of life in England. Health Qual Life Outcomes 2019;17:22) we found a significant positive association between residents’ social care-related quality of life and regulator (i.e. Care Quality Commission) quality ratings. Multivariate regression revealed that homes rated ‘good/outstanding’ are associated with a 12% improvement in mean current social care-related quality of life among residents who have higher levels of dependency. Secondary data analysis of a large, national sample of care homes over time assessed the impact of staffing and employment conditions on Care Quality Commission quality ratings. Higher wages and a higher prevalence of training in both dementia and dignity-/person-centred care were positively associated with care quality, whereas high staff turnover and job vacancy rates had a significant negative association. A 10% increase in the average care worker wage increased the likelihood of a ‘good/outstanding’ rating by 7%. Limitations No care homes rated as inadequate were recruited to the study. Conclusions The most dependent residents gain the most from homes rated ‘good/outstanding’. However, measuring the needs and outcomes of these residents is challenging, as many cannot self-report. A mixed-methods approach can reduce methodological exclusion and an over-reliance on proxies. Improving working conditions and reducing staff turnover may be associated with better outcomes for residents. Future work Further work is required to explore the relationship between pain, anxiety and low mood and other indicators of care homes quality and to examine the relationship between wages, training and social care outcomes. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 19. See the NIHR Journals Library website for further project information.

Determining Emotional Tone and Verbal Behavior in Patients With Tinnitus and Hyperacusis: An Exploratory Mixed-Methods Study

2019 ◽  
Vol 28 (3) ◽  
pp. 660-672
Author(s):  
Suzanne H. Kimball ◽  
Toby Hamilton ◽  
Erin Benear ◽  
Jonathan Baldwin
Keyword(s):  
Mixed Methods ◽  
Verbal Behavior ◽  
Coping Strategies ◽  
Mixed Methods Study ◽  
Self Report ◽  
Anxiety And Depression ◽  
Negative Consequences ◽  
Emotional Tone ◽  
Explanatory Mixed Methods ◽  
Quantitative Results

Purpose The purpose of this study was to evaluate the emotional tone and verbal behavior of social media users who self-identified as having tinnitus and/or hyperacusis that caused self-described negative consequences on daily life or health. Research Design and Method An explanatory mixed-methods design was utilized. Two hundred “initial” and 200 “reply” Facebook posts were collected from members of a tinnitus group and a hyperacusis group. Data were analyzed via the LIWC 2015 software program and compared to typical bloggers. As this was an explanatory mixed-methods study, we used qualitative thematic analyses to explain, interpret, and illustrate the quantitative results. Results Overall, quantitative results indicated lower overall emotional tone for all categories (tinnitus and hyperacusis, initial and reply), which was mostly influenced by higher negative emotion. Higher levels of authenticity or truth were found in the hyperacusis sample but not in the tinnitus sample. Lower levels of clout (social standing) were indicated in all groups, and a lower level of analytical thinking style (concepts and complex categories rather than narratives) was found in the hyperacusis sample. Additional analysis of the language indicated higher levels of sadness and anxiety in all groups and lower levels of anger, particularly for initial replies. These data support prior findings indicating higher levels of anxiety and depression in this patient population based on the actual words in blog posts and not from self-report questionnaires. Qualitative results identified 3 major themes from both the tinnitus and hyperacusis texts: suffering, negative emotional tone, and coping strategies. Conclusions Results from this study suggest support for the predominant clinical view that patients with tinnitus and hyperacusis have higher levels of anxiety and depression than the general population. The extent of the suffering described and patterns of coping strategies suggest clinical practice patterns and the need for research in implementing improved practice plans.

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