Mediators and Moderators in a Brief Mobile Intervention for Disordered Eating Open Access

Abstract

Disordered eating is a significant and pervasive problem that is associated with substantial distress and increased risk for the later development of an eating disorder. Data support the efficacy of cognitive-behavioral interventions for disordered eating; however, the reach of existing interventions is limited. Mobile interventions have the potential to improve access to empirically-supported interventions. Before these interventions are widely disseminated, it is critical that we understand how and for whom these interventions are effective. To this end, the present study explores five potential mediators and one moderator of change within a brief, mobile mindful eating intervention targeting young adult women with disordered eating. Proposed mediators included: frequency of eating, change in mindful eating, change in self-compassion, change in emotion regulation, and change in trait mindfulness. Body mass index (BMI) was considered as a possible moderator. Participants were 189 female undergraduate and graduate students (ages 18-30) recruited for a study testing a 3-week mindful eating intervention delivered via an iPhone application (“app”). Analyses of mediation and conditional indirect effects (i.e., moderated mediation) were performed using the PROCESS macro for SPSS (Hayes, 2013), and bootstrapped confidence-intervals were utilized to facilitate statistical inference. Results demonstrated the effectiveness of the intervention in reducing symptoms of disordered eating, including binge eating, dysfunctional cognitions, and preoccupation with eating and weight. Mediation analyses indicated no mediation of the direct effects from pre- to post-intervention symptoms of disordered eating through the proposed mediators with one exception, pre- to post-intervention change in preoccupation eating/weight mediated by frequency of eating. Results indicated that improvement in self-reported mindful eating, and to a lesser extent improvement in self-compassion and emotion regulation, was associated with decreased symptoms of disordered eating whether assessed post-intervention or at a 3-week follow-up. There were interesting differences in the degree to which different variables predicted outcome across various measures of disordered eating. There was no support for the hypothesized moderated mediation of the indirect effects by BMI. Together, these results support the potential utility of brief mindfulness-based interventions, identify some predictors of therapeutic change to explore further, and highlight the importance of including multiple outcome measures in intervention research.  

Table of Contents

Introduction…………………………………………………………………………….…1

Methods………………………………………………………………………………….20

Results………………………………………………………………………………...…35

Discussion…………………………………………………………………………….....50

References……………………………………………………………………………….73

Table 1…………………………………………………………………………………...85

Table 2…………………………………………………………………………………...85

Table 3…………………………………………………………………………………...86

Table 4…………………………………………………………………………………...87

Table 5…………………………………………………………………………………...88

Table 6…………………………………………………………………………………...90

Figure 1…………………………………………………………………………………..91

Figure 2…………………………………………………………………………………..92

Figure 3…………………………………………………………………………………..93

Figure 4…………………………………………………………………………………..94

Figure 5…………………………………………………………………………………..95

Figure 6…………………………………………………………………………………..96

Figure 7…………………………………………………………………………………..97

About this Dissertation

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School	Laney Graduate School
Department	Psychology
Subfield / Discipline	Clinical Psychology
Degree	Ph.D.
Submission	Dissertation
Language	English
Research Field	Psychology, Clinical
Keyword	disordered eating mediators moderators mHealth mindful eating
Committee Chair / Thesis Advisor	Craighead, Linda, Emory University
Committee Members	Jones, Erin, Emory University Bliwise, Nancy, Emory University Craighead, W. Edward, Emory University Nygaard, Lynn, Emory University

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