Depression mediates cutaneous body image and facial appearance dissatisfaction in insomnia

This study examined the relationship between dissatisfaction with cutaneous body image and facial appearance with symptoms of insomnia whilst incorporating the mediating role of anxiety and/or depression after accounting for co-morbid sleep disorder symptoms. Participants (n = 241) completed online measures assessing insomnia symptoms, anxiety and depression symptoms, and satisfaction with cutaneous body image and facial appearance. Symptoms of insomnia were independently related to greater dissatisfaction with cutaneous body image and facial appearance in univariate analyses. However, linear regression analyses determined these relationships to be partially mediated by depression, but not anxiety. Expanding on prior research, these findings suggest that whilst increased symptoms of insomnia may influence dissatisfaction with cutaneous and facial features, these relationships may be partially attributed to the experience of depressive symptoms often co-morbid with both insomnia and dermatological complaints. Treatment approaches for individuals with insomnia may benefit from targeting and improving negatively appraised aspects of physical self-perception

The visual cues that drive the self-assessment of body size: Dissociation between fixation patterns and the key areas of the body for accurate judgement

A modified version of the bubbles masking paradigm was used in three experiments to determine the key areas of the body that are used in self-estimates of body size. In this paradigm, parts of the stimuli are revealed by several randomly allocated Gaussian “windows” forcing judgements to be made based on this partial information. Over multiple trials, all potential cues are sampled, and the effectiveness of each window at predicting the judgement is determined. The modified bubbles strategy emphasises the distinction between central versus edge cues and localises the visual features used in judging one’s own body size. In addition, eye-movements were measured in conjunction with the bubbles paradigm and the results mapped onto a common reference space. This shows that although observers fixate centrally on the torso, they are actually directing their visual attention to the edges of the torso to gauge body width as an index of body size. The central fixations are simply the most efficient way of positioning the eye to make this estimation. Inaccurate observers are less precise in their central fixations and do not evenly allocate their attention to both sides of the torso’s edge, illustrating the importance of efficiently sampling the key informatio

Examining the factor structure, reliability, and validity of the disturbing dreams and nightmare severity index (DDNSI) consequences sub-component

Background: The Disturbing Dreams and Nightmares Severity Index (DDNSI) is commonly used when assessing the experience of nightmares. It comprises two parts examining i) chronicity and ii) nightmare consequences. The primary aim of the present study was to explore the dimensional structure of the optional and currently unvalidated nightmare consequences component using exploratory factor analysis. Internal reliability and construct validity were also examined. A secondary aim explored the relationships between nightmare chronicity and perceived consequences with measures of anxiety, depression, stress, self-efficacy, and insomnia. Methods: A cross-sectional survey was conducted with complete data from N = 757 students from six UK-based universities. Participants completed the chronicity and consequences components of the DDNSI, alongside the Sleep Condition Indicator, Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, Perceived Stress Scale, and General Self-Efficacy Scale. Results: Two nightmare consequences factors emerged; ‘Sleep-Interference’ (four items; α =.848), and ‘Psychosocial Well-being’ (six items; α =.946). Significantly moderate correlations were observed between the two emerging factors and the nightmare chronicity component, as well as with insomnia, anxiety, depression, perceived stress, and self-efficacy. Perceived ‘Sleep-Interference’ (β =−.241) was the strongest predictor of insomnia, and ‘Psychosocial wellbeing’ was the strongest predictor of anxiety (β =.688) depression (β =.804) perceived stress and lower self-efficacy. Conclusions: The perceived nightmare consequences component of the DDSNI is a multidimensional construct comprising two internally consistent and distinct, but related dimensions. The potential importance of distinguishing between types of perceived nightmare consequences and the associations with mental health outcomes in a student population is highlighted

Distorted body image influences body schema in individuals with negative bodily attitudes

There is now a considerable body of evidence to suggest that internal representations of the body can be meaningfully separated into at least two general levels; body image as a perceptual construct and body schema as a motor metric. However, recent studies with eating disordered individuals have suggested that there may in fact be more interaction between these two representations than first thought. We aimed to investigate how body image might act to influence body schema within a typical, healthy population. 100 healthy adult women were asked to judge the smallest gap between a pair of sliding doors that they could just pass through. We then determined whether these estimates were sufficient to predict the size of the smallest gap that they could actually pass through, or whether perceptual and attitudinal body image information was required in order to make these predictions. It was found that perceptual body image did indeed mediate performance on the egocentric (but not allocentric) motor imagery affordance task, but only for those individuals with raised body image concerns and low self-esteem; body schema was influenced by both the perceptual and attitudinal components of body image in those with more negative bodily attitudes. Furthermore, disparities between perceived versus actual size were associated with body parts that had larger variations in adipose/muscle-dependent circumference. We therefore suggest that it may be the affective salience of a distorted body representation that mediates the degree to which it is incorporated into the current body state

The Effect of Own Body Concerns on Judgments of Other Women’s Body Size

We investigated the relationships between healthy women’s estimates of their own body size, their body dissatisfaction, and how they subjectively judge the transition from normal to overweight in other women’s bodies (the “normal/overweight” boundary). We propose two complementary hypotheses. In the first, participants compare other women to an internalized Western “thin ideal,” whose size reflects the observer’s own body dissatisfaction. As dissatisfaction increases, so the size of their “thin ideal” reduces, predicting an inverse relationship between the “normal/overweight” boundary and participants’ body dissatisfaction. Alternatively, participants judge the size of other women relative to the body size they believe they have. For this implicit or explicit social comparison, the participant selects a “normal/overweight” boundary that minimizes the chance of her making an upward social comparison. So, the “normal/overweight” boundary matches or is larger than her own body size. In an online study of 129 healthy women, we found that both opposing factors explain where women place the “normal/overweight” boundary. Increasing body dissatisfaction leads to slimmer judgments for the position of the “normal/overweight” boundary in the body mass index (BMI) spectrum. Whereas, increasing overestimation by the observer of their own body size shifts the “normal/overweight” boundary toward higher BMIs

Homogeneity of cognitive and behavioural processes underlying the relationship between insomnia and body image disturbance

Specific cognitive behavioural mechanisms related to selective attention, situational avoidance and physical appearance are implicated in the development and maintenance of insomnia and negative reinforcement of body image disturbances. Therefore, we examined whether these processes potentially mediate the relationship between insomnia and body image perception. N = 728 participants completed self-reported measures of sleep-associated monitoring, insomnia symptoms, body image disturbance and coping with body image challenges. Symptoms of insomnia and sleep-associated monitoring behaviour were independently related to increased reports of body image disturbance, cognitive distortions of body image, appearance fixing (i.e. altering appearance by covering, camouflaging or correcting the perceived defect), avoidance (i.e. attempt to escape or avert stressful body image situations) and reduced levels of positive rationale acceptance (i.e. acceptance of the challenging event and positive self-care or rationale self-talk about one’s appearance). More crucially, sleep-related monitoring on awakening, cognitive distortion of body image and negative coping strategies related to body image (i.e. appearance fixing, avoidance, rationale acceptance) mediated the relationship between reports of body image disturbance and insomnia symptoms. The current findings expand upon previous research demonstrating consistent relationships between poor sleep and increased dissatisfaction with cutaneous features, by providing novel evidence that body image disturbances are associated with symptoms of insomnia. More crucially, we highlight the role of particular cognitive and behavioural mechanisms pertaining to sleep (i.e. selective attention for physical signs of poor sleep) and body image (i.e. avoidance and rationale acceptance) which may be targeted as part of cognitive behavioural treatments

The relationship between psychotic experiences, nightmares and emotion dysregulation: results from a student population

Sleep-disruption is commonly associated with psychotic experiences. Whilst sparse, the literature to date highlights nightmares and related distress as prominent risk factors for psychosis in students. We aimed to further explore the relationship between specific nightmare symptoms and psychotic experiences in university students whilst examining the mediating role of emotion dysregulation. Method: A sample(N=1273) of students respondents from UK Universities completed measures of psychotic experiences, nightmare disorder symptomology, and emotion dysregulation. Findings: Hierarchical linear regression analysis showed that psychotic experiences were significantly associated (Adjusted R 2 = 32.4%) with perceived nightmare intensity, consequences and resulting awakenings, and with emotion regulation difficulties. Furthermore, multiple mediation analysis showed that the association between psychotic experiences and nightmare factors was mediated by emotion regulation difficulties. Interpretation: Adaptive regulation of dream content during rapid eye-movement sleep has previously been demonstrated to attenuate surges in affective arousal by controlling the intensity and variability of emotional content. Deficits in emotion regulation may partially explain the experience of more intense and disruptive nightmares amongst individuals with psychotic experiences. Emotion regulation may represent an important control mechanism that safeguards dream content and sleep quality

Prevalence and psychiatric correlates of suicidal ideation in UK university students

Evidence highlights increased susceptibility to thoughts and behaviors related to suicide (i.e. suicidal ideation) in the student population, often in co-occurrence with mental health difficulties. Typically, studies focus on specific symptoms, with few providing comprehensive examination of risk factors. In this study we examined the prevalence of suicidal ideation among UK university students and assessed the association with multiple psychiatric risk factors. Methods: A total of N=1273 students completed online measures of suicidal ideation, anxiety, depression, insomnia, mania, psychosis, and perceived stress. Results: 37.3% students were classified as high-risk for suicidal behaviour. Moreover, 42.2% of students contemplated suicide at least once within the past twelve months, and 25.1% reported telling someone about these thoughts at least once. Logistic regression analysis showed that suicidal ideation was significantly associated with symptoms of depression, mania, psychosis, and stress. Limitations: The cross-sectional nature of ours study does not allow us to infer causality in the observed associations. Conclusions: Our results indicate the prevalence of suicidal ideation in a large sample of university students in the UK, and highlight associated mental health risk factors associated with it. Our findings have implications for mental health practitioners working with University students

Body image; representation and constraints on measurement in real and virtual worlds

Body image is a multidimensional construct that embraces a person’s conscious perception of their physical self, including the thoughts and feelings that result from that perception. Disturbed body image can lead to dramatic attempts by the individual to alter their appearance, for example through self-starvation in eating disorders such as anorexia nervosa. Body image comprises two independent modalities: i) a perceptual component that has to do with the accuracy with which a person can judge the dimensions of their own physical appearance, and ii) an attitudinal component which captures the feelings that a person has about their body size and shape. This thesis explores perceptual body image, with a focus on body size estimation, in samples of non-eating disordered women from three points of view. Firstly, individuals who have eating disorders are known to experience a diverse range of disturbances in body representation. In study one, we sought to investigate how attitudinal and perceptual body image may normally be expected to interact with motoric representations in the body scheme. To this end we tested a moderated mediation model which showed that perceptual body image only mediated performance on an egocentric motor imagery task in women with raised body image concerns and low self-esteem. We concluded that the affective salience of a distorted body representation mediates the degree to which it is incorporated into the current body state. Secondly, in studies 2-4 we used a modified version of the Bubbles masking technique, in combination with eye movement recording, to discover the visual cues that women use to make perceptual body image judgements. We found that although observers fixate centrally on the torso when making body size judgements, nevertheless they direct their visual attention to the edges of the torso, to gauge width as an index of body size. Based on this dissociation, we conclude that central fixations are simply the most efficient way of positioning the eye to make size judgements. Next, in studies 5 and 6, we investigated the feasibility of body size estimation using 3D stimuli in immersive virtual reality (VR). In a sequence of experiments, we show: i) how a bespoke avatar can be created from 2D photographs; and validated ii) that participants can identify the presence of their own avatar amongst others, despite anonymization by facial masking; iii) that participants are more accurate at estimating their body size with a bespoke avatar than a standard 3D model in VR. Lastly, in study 7 we replicated and extended an existing body image intervention, known to work in 2D on a flat panel monitor screen, by testing it in VR. We successfully raised individuals’ perceptual boundary for thin versus fat body sizes. This perceptual retraining led to reductions in psychological concerns about body shape, weight and eating; effects that persisted for up to two weeks post-training, some of which were more potent in VR than 2D

Using immersive virtual reality to modify body image

We tested the efficacy of a training programme, delivered in virtual reality (VR), to modify the perceptual boundary between what participants classify as a fat versus a thin body. Three cohorts of 20 female volunteers with high body image concerns were recruited to two intervention groups and one control group. All participants completed a 4-day training programme in VR where they categorised a series of 3D models as either thin or fat; one intervention group was presented with the stimuli briefly, while the other group had no time limits imposed. Both intervention groups were given inflationary feedback to shift their categorisations of the stimulus models towards higher BMIs. Our results show that, compared to controls, both intervention groups shifted their categorical boundaries between Day 1 and follow-up on Day 14. Unlimited stimulus presentation times were associated with a larger training effect. Furthermore, both intervention groups experienced statistically significant reductions in their concerns about their own body shape, weight and eating habits. However, only in the group with longer stimulus presentation times were these reductions consistent with a clinically meaningful effect. These findings suggest that manipulating categorical perception in VR might provide a complementary addition to existing treatments for eating disorders