Reducing Disordered Eating Behaviors and Cognitions with Expressive Writing Interventions

By Christine Skubisz and Carly R. Pacanowski

Disordered eating includes both behaviors (e.g., skipping meals, self-induced vomiting, and chronic dieting) and cognitions (e.g., guilt after eating, shame, and intrusive thoughts) about controlling weight and shape. Disordered eating is not a medical diagnosis; rather, it is a term encompassing symptoms experienced by an individual. It can progress into a clinically diagnosable eating disorder, like Anorexia Nervosa, Bulimia Nervosa, or Binge Eating Disorder, comorbid with serious health outcomes including nutritional deficiencies, cardiac abnormalities, depression, anxiety, decreased quality of life, and possibly death.

Emerging adult women experience high rates of disordered eating, offering an opportunity for college-based prevention programs. In this study, an experiment was conducted to test 8 expressive writing interventions in the context of disordered eating. Writing task interventions offer a unique opportunity to influence emotional responses and cognitive revaluation about disordered eating. Examples of two writing task interventions are provided below:

How does feeling unhappy with your body image affect you? Make a list of the way it affects your physical health, social life, family life, and education.
Write a letter to “your body” expressing your need to have a better relationship with it.

Expressive writing interventions are easy to administer in a web-based primary prevention program and this format offers anonymity. Given the secretive nature of disordered eating behaviors and the shame that often accompanies them, this format has many benefits. A web-based primary prevention program could be used to identify those with risk factors for clinical eating disorders. Once identified, higher-risk women could then be offered a secondary prevention program or treatment.

Understanding which theory-based expressive writing intervention leads to a desired outcome is essential in the design of future interventions. Writing tasks for this study were drawn from existing theory-based prevention programs, including cognitive behavioral therapy, peer and media risk reduction, and cognitive dissonance theory. Dependent variables included discrete emotions, evaluation of the expressive writing interventions (e.g., engagement, clarity, ease, and interest), and re-evaluation of disordered eating behaviors and cognitions.

Overall, results indicate that expressive writing interventions are effective in eliciting emotions and a re-evaluation of harmful behaviors and cognitions in the context of disordered eating. Sadness was the most typical emotional response upon completion of the expressive writing tasks. As a discrete emotion, sadness is a reaction when an irrevocable loss has been sustained. Despite the negative cognitions associated with sadness, this outcome can be viewed as a positive one in terms of intervention success. Felt sadness has been shown to increase inward evaluation, which can lead to problem-solving behaviors intended to recover the loss. This action tendency is exactly the outcome that may be necessary for cognitive or behavioral change. Interventions that were based on the principles of cognitive behavioral therapy led to the most positive outcomes including engagement and re-evaluation of current disordered eating behaviors and cognitions.

Implications for Public Health

Results from this study can be used to develop a disordered eating prevention program for emerging adult women. Web-based interventions can provide anonymity to women who may be reluctant to seek help due to shame or embarrassment. Anonymity can make it easier for women to disclose personal information and allow them to feel safe exploring their emotions surrounding this sensitive topic. Some college students do not seek formal mental health services; thus, a web-based intervention offers assistance to those who may not utilize in-person options.

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Article Details
Testing Theory-Based Expressive Writing Interventions to Reduce Disordered Eating Behaviors and Cognitions
Christine Skubisz, Angelina N Seeney, and Carly R Pacanowski
First published online April 27, 2022
DOI: 10.1177/15598276221082604
American Journal of Lifestyle Medicine

About the Authors

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Christine Skubisz, PhD is an Assistant Professor of Psychology at Bentley University in Waltham, MA. She earned a BA from Purdue University, MA from Michigan State University, and a PhD from the University of Maryland in communication science. Dr. Skubisz completed her postdoctoral fellowship at the University of Pennsylvania in the Annenberg School for Communication. Her work focuses on the study of message design and effects in health contexts. She is the co-director of the DEDE (Disordered Eating Delaware) research group with Dr. Carly R. Pacanowski, her co-author on this project.

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Carly R Pacanowski PhD RD joined the Behavioral Health and Nutrition faculty in 2016. She earned a BS in Nutritional Sciences from the Pennsylvania State University, became a Registered Dietitian and earned her PhD in Human Nutrition from Cornell University. Dr. Pacanowski completed National Institutes of Health postdoctoral research fellowships in both obesity prevention (University of Minnesota) and eating disorders (Sanford Health in North Dakota). Dr. Pacanowski collaborates with interdisciplinary scholars to study quantifiable and intuitive approaches to health and well-being across the spectrum of body weights, both at the individual and population levels.