Cognitive and Behavioral Inflexibility as a Transdiagnostic Process Underpinning Exercise Dependence

Miller, McKenzie; Hormes, Julia M.

doi:10.1007/s11469-022-00802-4

Cited by 6 publications

(6 citation statements)

References 39 publications

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“…Substance use and Addiction disorders are a third example of which inflexible behavior is the hallmark (e.g. Miller & Hormes, 2022 ; Stalnaker et al, 2009 ); notably Garland et al (2022) have shown the role of aberrant self-referential processes in addiction.…”

Section: Rigidity/inflexibility As a Transdiagnostic Psychopathologic...mentioning

confidence: 99%

The (In)flexible self: Psychopathology, mindfulness, and neuroscience

Giommi

Bauer

Berkovich‐Ohana

et al. 2023

International Journal of Clinical and Health Psychology

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Section: Rigidity/inflexibility As a Transdiagnostic Psychopathologic...mentioning

confidence: 99%

The (In)flexible self: Psychopathology, mindfulness, and neuroscience

Giommi

Bauer

Berkovich‐Ohana

et al. 2023

International Journal of Clinical and Health Psychology

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“…Exercise is generally associated with positive physical and mental health outcomes; however, exercise can become maladaptive in nature. Exercise that is characterized as addictive (Cook et al, 2014; Miller & Hormes, 2023) or compulsive (Dittmer, Jacobi, et al, 2018; Meyer et al, 2011) is widely reported across community samples (Bircher et al, 2017; Scharmer et al, 2020; Taranis & Meyer, 2011), and is a transdiagnostic behavior in the context of psychopathology (Miller & Hormes, 2023), including among those diagnosed with eating disorders (EDs) (Dittmer, Jacobi, et al, 2018; Meyer et al, 2016). Particularly when coupled with eating pathology, maladaptive exercise is associated with elevated risk for suicide (Smith et al, 2013), poorer clinical outcome (Dalle Grave et al, 2008; Erskine et al, 2017), and lower quality‐of‐life (Cook et al, 2014).…”

Section: Introductionmentioning

confidence: 99%

Working out measurement overlap in the assessment of maladaptive exercise

Lampe,

Schaumberg,

Kolar

et al. 2024

Intl J Eating Disorders

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ObjectiveAlthough exercise is generally considered healthy, many individuals engage in maladaptive exercise (e.g., compulsive in nature). Several definitions of maladaptive exercise exist, leading to multiple, varied assessment tools; assuming homogeneity across these assessments contributes to low consensus in etiological models.MethodWe used a Jaccard Index to quantify content overlap among 15 commonly‐used self‐report instruments measuring maladaptive exercise, with 31 features identified across 224 items.ResultsThe most common features were exercise to control weight/shape and to avoid negative affect (both included in 9/15 instruments), or compensate for calories consumed (8/15 instruments). Overlap among instruments was low (.206) and no features were common across all instruments.ConclusionsFindings generally support theoretical models of exercise in eating pathology. However, instruments most commonly used to assess maladaptive exercise measure heterogenous content. Careful consideration should be taken when comparing findings derived from differing instruments, when synthesizing literature on maladaptive exercise, and when selecting instruments to measure specific maladaptive exercise features.Public SignificanceMany, varied, tools exist for the assessment of maladaptive exercise (e.g., compulsive or compensatory) in the context of eating disorders. Assuming homogeneity across tools contributes to low consensus in the field. We used a Jaccard Index to quantify content overlap among 15 self‐report instruments measuring maladaptive exercise. The most commonly used instruments measure heterogenous content. Careful consideration should be taken when synthesizing literature and selecting instruments to use in research.

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“…Exercise is often adaptive, leading to improved physical and mental health; however, exercise can become dysfunctional or excessive, resulting in harmful physical and mental health outcomes and interference with social relationships and occupational functioning (Blaydon et al, 2004; Miller & Hormes, 2022; Trott et al, 2020). Exercise dependence (ExD) has been proposed as a diagnosis within the broader category of behavioral addictions to capture a maladaptive pattern of exercise that leads to clinically significant impairment (Hausenblas & Symons, 2002).…”

Section: Introductionmentioning

confidence: 99%

“…Evidence suggests that the high rates of comorbidity between AN and ExD are due to shared risk and maintaining mechanisms, with growing support for a prominent role of cognitive inflexibility (Miller & Hormes, 2022). Along with poor central coherence, cognitive inflexibility (reduced set‐shifting) is a key executive function inefficiency in AN (Bolton et al, 2014; Johnson, 2016; Klump et al, 2009; Pender et al, 2014; Snyder et al, 2015; Zastrow et al, 2009).…”

Section: Introductionmentioning

confidence: 99%

“…CRT does not directly target symptoms of AN, but is hypothesized to facilitate behavioral changes required for the successful treatment of AN, resulting in improved functional outcomes such as more approach behaviors and greater social engagement (Tchanturia et al, 2013; Zastrow et al, 2009). With growing evidence to suggest ExD and AN are maintained by shared underlying executive function inefficiencies (Miller & Hormes, 2022), resulting in exacerbated symptom severity, it is possible that adjunctive CRT will similarly foster flexibility around exercise behavior. Specifically, it reasons that CRT could effectively reduce the rigid cognitions and behaviors characteristic of ExD, resulting in improved functioning.…”

Section: Introductionmentioning

confidence: 99%

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Impact of virtual adjunctive cognitive remediation therapy on cognitive flexibility and treatment outcomes in comorbid anorexia nervosa and exercise dependence as quantified using novel biomarkers: A stage 1 registered report

Miller

Sanzari

Hormes

et al. 2023

Intl J Eating Disorders

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Objective: Anorexia nervosa (AN) is associated with significant individual mental and physical suffering and public health burden and fewer than half of patients recover fully with current treatments. Comorbid exercise dependence (ExD) is common in AN and associated with significantly worse symptom severity and treatment outcomes. Research points to cognitive inflexibility as a prominent executive function inefficiency and transdiagnostic etiologic and maintaining mechanism linking AN and ExD. This study will evaluate the initial efficacy of adjunctive Cognitive Remediation Therapy (CRT), which has been shown to produce cognitive improvements in adults with AN, in targeting cognitive inflexibility in individuals with comorbid AN and ExD. As an exploratory aim, this study also addresses the current lack of quick and costeffective assessments of cognitive flexibility by establishing the utility of two proposed biomarkers, heart rate variability and salivary oxytocin. Method: We will conduct a single-group, within-subjects trial of an established CRT protocol delivered remotely as an adjunct to inpatient or intensive outpatient treatment as usual (TAU) to adult patients (n = 42) with comorbid AN and ExD. Assessments, including self-report, neuropsychological, and biomarker measurements, will occur at three time points. Results: We expect CRT to increase cognitive flexibility transdiagnostically and consequently, along with TAU, positively impact AN and ExD compulsivity and symptom severity, including weight gain. Discussion: Findings will inform the development of more effective integrative interventions for AN and ExD targeting shared mechanisms and facilitate the routine assessment of cognitive flexibility as a transdiagnostic risk and maintaining factor across psychopathologies in clinical and research settings.Public Significance: Patients with anorexia nervosa often engage in excessive exercise, leading to harmful outcomes, including increased suicidal behavior. This study examines the preliminary efficacy of an intervention that fosters flexible and holistic thinking in patients with problematic eating and exercise to, along with routine treatment, decrease harmful exercise symptoms. This study also examines new biological

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Cognitive and Behavioral Inflexibility as a Transdiagnostic Process Underpinning Exercise Dependence

Cited by 6 publications

References 39 publications

The (In)flexible self: Psychopathology, mindfulness, and neuroscience

The (In)flexible self: Psychopathology, mindfulness, and neuroscience

Working out measurement overlap in the assessment of maladaptive exercise

Impact of virtual adjunctive cognitive remediation therapy on cognitive flexibility and treatment outcomes in comorbid anorexia nervosa and exercise dependence as quantified using novel biomarkers: A stage 1 registered report

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