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Binge eating and drinking in young women : personality correlates and psychophysiological indices of… Dominelli, Rachelle 2015

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BINGE EATING AND DRINKING IN YOUNG WOMEN:PERSONALITY CORRELATES AND PSYCHOPHYSIOLOGICAL INDICES OFEMOTION PROCESSINGbyRachelle DominelliM.A., The University of British Columbia, 2008DISSERTATION SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTSFOR THEDEGREE OFDOCTOR OF PHILOSOPHYinTHE FACULTY OF GRADUATE AND POSTDOCTORAL STUDIES(Psychology)THE UNIVERSITY OF BRITISH COLUMBIA(Vancouver)August 2015© Rachelle Dominelli, 2015iiAbstractThe disinhibited behaviours of binge eating and binge drinking are associated withsignificant negative consequences. Impulsivity and emotion dysregulation are commonly positedto underlie engagement in these behaviours. To advance our understanding of these behavioursin young women, the studies identified unique impulsive personality contributions and advancedemotion regulation theories of these behaviours through psychophysiological assessment. Studyone examined unique relationships between binge behaviours, traits derived from ReinforcementSensitivity Theory and those derived from the Urgency Premeditation Perseverance SensationSeeking-Positive Urgency (UPPS-P) Impulsive Behavior Scale. Reward Sensitivity wasassociated with both behaviours while Punishment Sensitivity had differential relationships withthe binge types. Negative Urgency was the greatest predictor of binge eating, Sensation Seekinghad the strongest relationship with binge drinking, and Lack of Perseverance was a commonpredictor for both types of bingeing. These findings support trait emotion regulationconceptualizations. In study two, emotion reactivity and emotion regulation ability wereexamined within the context of a picture viewing startle blink paradigm. While a broad deficit inthe ability to regulate emotional states across psychophysiological response systems was notsupported, subtle differences in response duration, regulation of valence versus arousal andresponse coherence warrant further investigation. Study three examined emotion responsecoherence between the psychophysiological measures, (i.e. startle blink, corrugator activity, latepositive potential), and subjective ratings of the emotion stimuli. Though stability ofrelationships was limited by small samples, results were suggestive of similar patterns ofcoherence amongst non-bingeing and binge drinking women with a possible alteration ofcoherence in binge eating women. Overall, the findings suggest that maladaptive affectiveiiiresponses that are evident on trait-based assessments may not translate into deficits in the abilityto regulate brief emotional states. Emotion dysregulation may be limited to interpersonally-relevant emotional states or specific emotion-evoking stimuli. Application of thesepsychophysiological methods in paradigms using these more binge-specific stimuli may provemore sensitive to potential deficits in emotion regulation ability. These studies highlight theimportance of a multi-component assessment of emotional processing in those with disinhibitedbingeing behaviours.ivPrefaceThis dissertation is based on research conducted in Dr. Colleen Brenner’s Clinical andCognitive Neuroscience Lab, UBC, Vancouver campus. Rachelle Dominelli designed the studiesdescribed in this dissertation, collected and analyzed the data and wrote this manuscript. Dr.Colleen Brenner provided guidance at each stage and edited this manuscript. Dr. Scott Carlsonassisted with development of the experimental task used in studies two and three. He assistedwith the conceptualization and analysis approach for studies one and two, which are included inchapters two and three, and provided editorial feedback on manuscript drafts derived from thosechapters. Brittany Speed and Lacey Grant assisted with data collection and participantdebriefings. Brittany Speed also assisted with development of the experimental task used instudies two and three. Jo-Anne Kirk, Program Manager for Community Mental Health andAddictions, Vancouver Coastal Health (VCH) was the VCH collaborator for this research; hercollaboration permitted us to advertise the research program at select VCH sites. The researchprogram was approved by the UBC Behavioural Research Ethics Board (Certificate # H10-02157).vTable of ContentsAbstract.......................................................................................................................................... iiPreface........................................................................................................................................... ivTable of Contents ...........................................................................................................................vList of Tables ................................................................................................................................ ixList of Figures.................................................................................................................................xList of Abbreviations ................................................................................................................... xiAcknowledgements ..................................................................................................................... xiiDedication ................................................................................................................................... xiiiChapter 1: Introduction ................................................................................................................11.1 Binge Eating Definition .................................................................................................. 21.2 Binge Drinking Definition .............................................................................................. 31.3 Personality Contributions to Binge Behaviour ............................................................... 41.3.1 Emotion-based dispositions to impulsive behaviour ..................................................... 41.3.2 Reinforcement Sensitivity Theory and binge behaviour ............................................... 81.3.3 Bringing together emotion-based dispositions to impulsive behaviour andReinforcement Sensitivity Theory ........................................................................................ 111.4 Study One Research Questions..................................................................................... 121.5 Emotion Reactivity and Regulation Definitions ........................................................... 131.6 Emotion Regulation Theories of Binge Eating............................................................. 141.7 Emotion Regulation Theories of Binge Drinking......................................................... 191.8 Psychophysiological Measures of Emotion Reactivity................................................. 22vi1.9 Psychophysiological Measures of Emotion Regulation ............................................... 241.10 Startle Blink & Corrugator Activity in Disordered Eating & Drinking Women.......... 251.11 Study Two Research Questions .................................................................................... 261.12 Emotion Response Coherence ...................................................................................... 281.13 Study Three Research Questions .................................................................................. 33Chapter 2: Study One..................................................................................................................342.1 Introduction................................................................................................................... 342.2 Methods......................................................................................................................... 382.2.1 Participants................................................................................................................ 382.2.2 Procedure .................................................................................................................. 392.2.3 Questionnaires........................................................................................................... 392.3 Results........................................................................................................................... 442.3.1 Psychometrics & data reduction ............................................................................... 442.3.2 Binge analyses .......................................................................................................... 462.4 Discussion ..................................................................................................................... 492.4.1 Limitations ................................................................................................................ 532.4.2 Conclusions............................................................................................................... 54Chapter 3: Study Two .................................................................................................................553.1 Introduction................................................................................................................... 553.2 Methods......................................................................................................................... 603.2.1 Power analysis .......................................................................................................... 603.2.2 Participants................................................................................................................ 613.2.3 Procedure .................................................................................................................. 62vii3.2.3.1 Emotion regulation task .................................................................................... 643.2.3.2 Electromyographic recording: startle blink and corrugator activity ................. 683.2.3.3 Data processing................................................................................................. 683.3 Results........................................................................................................................... 693.3.1 Demographics ........................................................................................................... 693.3.2 Emotion reactivity..................................................................................................... 723.3.3 Emotion regulation.................................................................................................... 743.3.4 Regulation strategies ................................................................................................. 753.3.5 Image ratings............................................................................................................. 763.4 Discussion ..................................................................................................................... 773.4.1 Limitations and future directions .............................................................................. 803.4.2 Conclusion ................................................................................................................ 83Chapter 4: Study Three...............................................................................................................844.1 Introduction................................................................................................................... 844.2 Methods......................................................................................................................... 904.2.1 Participants................................................................................................................ 904.2.2 Procedure .................................................................................................................. 914.2.2.1 Psychophysiological Recording........................................................................ 924.3 Results........................................................................................................................... 934.4 Discussion ..................................................................................................................... 974.4.1 Limitations and future directions .............................................................................. 994.4.2 Conclusion .............................................................................................................. 100Chapter 5: General Discussion .................................................................................................101viii5.1 Summary of Results .................................................................................................... 1015.2 Personality Contributions to Binge Behaviour ........................................................... 1035.3 Implications for Emotion Regulation Theories of Binge Eating ................................ 1075.4 Implications for Emotion Regulation Theories of Binge Drinking ............................ 1115.5 Clinical Implications................................................................................................... 1135.6 Limitations .................................................................................................................. 1145.7 Conclusions and Future Directions ............................................................................. 117Bibliography ...............................................................................................................................120Appendix A: Emotion Regulation Strategy Questionnaire....................................................163ixList of TablesTable 2.1 Reinforcement Sensitivity Measures PCA ................................................................... 44Table 2.2 Correlations between Personality Measures ................................................................. 45Table 2.3 Descriptive Statistics..................................................................................................... 47Table 2.4 Regression Summary .................................................................................................... 49Table 3.1 Binge Data .................................................................................................................... 70Table 3.2 Eating Disorder Examination-Questionnaire Scores .................................................... 70Table 3.3 DASS-21 Scores ........................................................................................................... 71Table 3.4 Eating and Drinking Motives........................................................................................ 72Table 3.5 Emotion Regulation Strategies ..................................................................................... 76Table 4.1 Correlation Summary: Negative Valence Images ........................................................ 96Table 4.2 Correlation Summary: Positive Valence Images .......................................................... 96xList of FiguresFigure 3.1 Participant Flowchart................................................................................................... 62Figure 3.2 a) Emotion Reactivity Assessment b) Emotion Regulation Assessment .................... 67Figure 3.3 a) Startle Blink b) Corrugator Activity........................................................................ 73Figure 3.4 Image Ratings.............................................................................................................. 77Figure 4.1 ERP Waveforms in the Healthy Control Group .......................................................... 94Figure 4.2 Late Positive Potential Pooled Across Cz, Pz, P3 & P4 Electrode Sites..................... 95xiList of AbbreviationsAN = Anorexia NervosaBAS = Behavioural Approach SystemBC = Binge CombinedBD = Binge DrinkingBE = Binge EatingBED = Binge Eating DisorderBIS = Behavioural Inhibition SystemBN = Bulimia NervosaED = Eating DisorderEDDS = Eating Disorder Diagnostic ScaleEDE-Q = Eating Disorder Examination-QuestionnaireHC = Healthy ControlLP = Lack of PerseveranceLPM = Lack of PremeditationNU = Negative UrgencyPS = Punishment SensitivityPU = Positive UrgencyRS = Reward SensitivitySP = Sensitivity to PunishmentSPSRQ = Sensitivity to Punishment and Sensitivity to Reward QuestionnaireSR = Sensitivity to RewardSS = Sensation SeekingxiiAcknowledgementsI would like to thank my research supervisor, Dr. Colleen Brenner, for her mentorship andsupport. I am also appreciative of the thoughtful questions and feedback provided by mysupervisory committee members, Dr. Sheila Woody and Dr. Todd Handy. I am grateful to Dr.Scott Carlson for starting me on this research path and for his guidance at the beginning of thisjourney. Thank you to Brittany Speed for her dedication to this project and to Lacey Grant forher contributions. To my husband, parents and sister for their encouragement and words ofwisdom. I would like to express my gratitude to the Canadian Institutes of Health Research forproviding the funding, which supported this research. Most importantly, I would like toacknowledge the research participants without whom this project would not have been possible.xiiiDedicationTo my husband (Giulio Dominelli), parents (Ron and Sheila Smith) and sister (Jocelyn Smith).1Chapter 1: IntroductionThough the majority of the population encounters food and alcohol on a fairly regularbasis, a subset of the population develops problematic intake of these substances. One suchmaladaptive form of intake is that of bingeing behaviour wherein a large amount of a substanceis consumed in a short timeframe. The focus of this dissertation is on two forms of bingebehaviour, binge eating and binge drinking, in young women. Interest in studying thesebehaviours concurrently is driven by the frequent co-occurrence of binge eating and alcoholmisuse in the community and, to a greater extent, in clinical samples (Bulik et al., 2004;Holderness, Brooks-Gunn, & Warren, 1994; Luce, Engler, & Crowther, 2007; von Ranson,Iacono, & McGue, 2002; Wolfe & Maisto, 2000). For example, binge drinking is more likely tooccur in those who binge eat (Luce et al., 2007), and those who are at high risk for eatingdisorders tend to engage in high rates of binge drinking (Khaylis, Trockel, & Taylor, 2009).Recent research has identified common frameworks for understanding the risk andmaintenance factors underlying binge eating and binge drinking behaviours (Ferriter & Ray,2011). Two common factors frequently associated with binge behaviour are impulsivepersonality traits and emotion dysregulation (Cassin & von Ranson, 2005; Ferriter & Ray, 2011).This dissertation aimed to identify unique personality contributions to binge behaviour and toinform emotion regulation theories of binge behaviour through the application ofpsychophysiological methods. The phenomena of binge eating and drinking are described first.The research questions addressed by this dissertation are then outlined along with a review of therelevant literature. Hypotheses are outlined in more detail in the research chapters that follow theintroduction.21.1 Binge Eating DefinitionA food binge has been defined as eating a larger amount of food than normal in a shortperiod of time and experiencing a lack of control over eating during the episode (AmericanPsychiatric Association (APA), 2000). Binge eating may occur at subclinical levels and as part ofan eating disorder (ED); either as a stand-alone behaviour in Binge Eating Disorder (BED) or inassociation with compensatory behaviour in Anorexia Nervosa (AN) or Bulimia Nervosa (BN)(APA, 2000; APA, 2013). This dissertation focused on women with BN, BED or subclinicalbinge eating meaning that the binge eating occurs at a lower frequency or in the absence of othercriteria necessary for diagnosis; women with possible AN were excluded because of the potentialcognitive deficits associated with starvation (Zakzanis, Campbell, & Polsinelli, 2010).Prevalence data and typical age of onset indicate that young adulthood is an important periodduring which to study disordered eating behaviour in women. Amongst a community sample ofadolescent females, by age 20 the lifetime prevalence was 2.6% for BN, 4.4% for subthresholdBN, 3.0% for BED and 3.6% for subthreshold BED (Stice, Marti, & Rhode, 2013). The peak ageof onset of (sub)threshold BN was 16-20 years and 18-20 years for BED (Stice, et al.); however,retrospective reports indicate that peak onset extends into the early 20s (Kessler et al., 2013).Therefore, the dissertation samples were limited to young women between 18/19 to 30 years ofage who reported binge eating behaviours.The importance of developing a greater understanding of binge eating at subclinicallevels is supported by evidence of psychosocial impairment found in ED at subthreshold levelsand a high progression from subthreshold to threshold levels of binge eating over time (Stice etal., 2013). A number of negative consequences are associated with binge eating, includingperceived negative consequences in physical health, interpersonal relationships and life outlook3(Piran, Robinson, & Cormier, 2007), lower health-related quality of life (Mitchison, Mond,Stewa-Younan, & Hay, 2013), and high rates of co-morbid psychopathology (Agras, 2001). It isalso important to consider binge eating from a trans-diagnostic perspective as crossover betweendiagnostic categories (e.g. BN versus BED) is commonly observed amongst prospectiveadolescent samples (Allen, Byrne, Oddy, & Crosby, 2013; Stice, et al.). The dissertation studiesprimarily focused on women with subclinical levels of binge eating with possible BN and BEDdiagnoses identified by self-report questionnaire.1.2 Binge Drinking DefinitionThe standardized definition of an alcohol binge is a pattern of drinking which brings theblood alcohol concentration (BAC) to 0.08 gram percent or above; this corresponds to theconsumption of an equivalent of four alcoholic drinks for women and five drinks for men withina two hour period (National Institute on Alcohol Abuse and Alcoholism (NIAAA), 2004). Thisdefinition of binge drinking, also termed heavy episodic drinking, was first employed in theHarvard School of Public Health College Alcohol Study (CAS; Wechsler, Davenport, Dowdall,& Moeykens, 1994) and has since been adopted by major national and international healthorganizations such as the NIAAA, the World Health Organization (WHO, 2004) and HealthCanada (Statistics Canada Health Fact Sheet “Heavy drinking, 2013”).Canadian estimates of heavy drinking (four or more drinks on one occasion at least once amonth in the past year) in young women are high at 28.2% amongst women aged 18-19 yearsand 24.2% amongst women aged 20-34 years (Statistics Canada Health Fact Sheet “Heavydrinking, 2013”). Surveys of colleges in the United States reveal that binge drinking is alsoprevalent at American post-secondary institutions, with approximately 40% of female studentsendorsing recent binge drinking (Wechsler et al., 2002). Similar to binge eating, binge drinking4has been linked to poorer health-related quality of life (Okoro et al., 2004; Tsai, Ford, Li,Pearson, & Zhao, 2010), and a higher likelihood of negative consequences in interpersonal andacademic functioning even amongst occasional binge drinkers (i.e. once or twice in the past twoweeks) compared to a non-bingeing pattern of alcohol consumption (Wechsler et al., 1994;Wechsler, Lee, Kuo, & Lee, 2000; Wechsler & Nelson, 2006). While some young adults “matureout” of this pattern of use, for others it prospectively predicts increased risk of later developmentof alcohol use disorders (Gotham, Sher, & Wood, 1997; Jennison, 2004; Sher, Grekin, &Williams, 2005). Therefore, this dissertation focused on young women with recent and repetitivebinge drinking behaviour.1.3 Personality Contributions to Binge BehaviourTwo related personality frameworks emphasize the role of impulsive personality facets inboth binge eating and binge drinking behaviours: emotion-based dispositions to impulsivebehaviour and Reinforcement Sensitivity Theory (RST). Research guided by these frameworkssuggest that these two types of bingeing differ in their relationships with specific impulsivityfacets. Furthermore, these frameworks and their supporting bodies of research emerged inparallel; therefore, the extent to which the impulsivity facets provide unique prediction ofbingeing is currently unclear.1.3.1 Emotion-based dispositions to impulsive behaviourOne personality framework used to conceptualize risk for binge eating and drinkingbehaviour focuses on the role of emotion-based dispositions to behaviours with a high potentialfor negative consequences (Cyders & Smith, 2008). This line of research followed fromWhiteside and Lynam’s (2001) factor analysis of commonly used impulsivity measures and theFive Factor Model of personality (Costa & McCrae, 1992). Four impulsivity facets were5identified: Urgency, Lack of Premeditation (LPM: acting without forethought or consideration ofconsequences), Lack of Perseverance (LP: difficulty maintaining focus on boring/difficult tasks)and Sensation Seeking (SS: tendency to enjoy and pursue exciting activities and openness tonew, possibly dangerous, activities). The UPPS Impulsive Behaviour Scale was developed toassess these facets. The urgency facet of the original UPPS Impulsive Behavior Scale was laterre-conceptualized and evidence from cross-sectional and prospective studies now supports adistinction between two facets of urgency: Negative Urgency (NU) and Positive Urgency (PU)(Cyders & Smith, 2007; Cyders et al., 2007; Cyders & Smith, 2008; Cyders & Smith, 2010).Whereas Negative Urgency refers to the tendency to engage in impulsive behaviours when innegative mood states, Positive Urgency refers to the tendency to engage in such behaviours whenin positive mood states. These facets, Negative Urgency and Positive Urgency, areconceptualized as emotion-based dispositions to impulsive behaviour. Current evidence suggeststhat they have differential relationships with binge eating and drinking behaviour. WhileNegative Urgency is related to both types of bingeing behaviour, higher levels of PositiveUrgency appear unique to problematic alcohol use (Cyders et al., 2007; Cyders & Smith, 2008).Following Whiteside and Lynam’s (2001) publication, a central role for NegativeUrgency, which had previously been underrepresented in the impulsivity literature, began toemerge in relation to bulimic symptoms. As determined by meta-analysis, the largest effect sizeamongst Whiteside and Lynam’s impulsivity facets in relation to BN symptoms is NegativeUrgency (r=0.38) (Fischer, Smith, & Cyders, 2008). Consistent with this finding, there issubstantial evidence from college student samples using summary measures of bulimicsymptoms (Anestis, Selby, & Joiner, 2007; Fischer, Smith, & Anderson, 2003; Fischer, Smith,Anderson, & Flory, 2003) and from clinical samples (Anestis, Smith, Fink, & Joiner, 2009;6Claes, Vandereycken, & Vertommen, 2005) implicating Negative Urgency as the impulsivityfacet of greatest relevance for bulimic symptoms. Negative Urgency is positively correlated withbinge eating episodes (Fischer, Anderson, & Smith, 2004), accounts for unique variance in bingeeating beyond other UPPS facets in cross-sectional studies (Fischer & Smith, 2008; Smith et al.,2007) and prospectively predicts binge eating in college samples (Davis & Fischer, 2013; Emery,King, Fischer, & Davis, 2013; Fischer, Peterson, & McCarthy, 2013). Recent integrative modelsof bulimic symptoms posit a trait-based pathway to eating disorder symptoms; individuals highin Negative Urgency are thought to binge eat in part due to the negative reinforcement (i.e.emotion regulatory effect) of the behaviour in reducing/distracting from distress (Cyders &Smith, 2008; Fischer, Settles, Collins, Gunn, & Smith, 2012; Pearson, Riley, Davis, & Smith,2014).Similar to its relationship with binge eating, Negative Urgency denotes risk for variousalcohol outcomes (Cyders et al., 2007; Cyders, Flory, Rainer, & Smith, 2009; Shin, Hong, &Jeon, 2012). As such, Positive Urgency and Negative Urgency had the largest effect sizesamongst UPPS-P facets for endorsement of adolescent and adult problematic drinking in recentmeta-analytic reviews (r=0.34) (Coskunpinar, Dir, & Cyders, 2013; Stautz & Cooper, 2013).However, evidence pertaining to the relationship between Negative Urgency and binge drinkingspecifically is limited to a few studies (e.g. Adams, Kaiser, Lynam, Charnigo, & Milich, 2012;Fernie, Cole, Goudie, & Field, 2010; Phillips, Hine, & Marks, 2009; Shin et al., 2012); effectsizes, though smaller than for the broader construct of problematic alcohol use, remain positive(r=0.13) (Coskunpinar et al., 2013; Stautz & Cooper, 2013).Regarding Positive Urgency, women with eating disorders have comparable levels ofPositive Urgency to healthy controls whereas women with alcohol abuse have significantly7higher levels of Positive Urgency compared to both eating disordered women and healthycontrols (Cyders et al., 2007). Furthermore, Positive Urgency correlates with drinking quantity,frequency, alcohol-related problems, and highest alcohol use (Adams et al., 2012; Cyders et al.,2007) and prospectively predicts increased alcohol consumption per drinking session as well asnegative consequences of drinking (Cyders et al., 2009). Self-report findings are furthersupported by a laboratory study in which increased alcohol consumption in an alcohol taste testfollowing positive mood induction was positively predicted by Positive Urgency (Cyders et al.,2010). While these studies establish a link between Positive Urgency and general alcohol use,there is a relative paucity of research examining Positive Urgency and binge drinking as aspecific alcohol outcome (Coskunpinar et al., 2013; Stautz & Cooper, 2013).Of the other UPPS-P facets, binge drinking is further differentiated from binge eating inits association with high levels of Sensation Seeking. As such, the UPPS-P facet with the largesteffect size in relation to binge drinking is Sensation Seeking (r=0.36, Coskunpinar et al., 2013;r=0.26, Stautz & Cooper, 2013) whereas the effect size for measures of Sensation Seeking forbulimic symptoms is small (r=0.09) (Fischer et al., 2008). This is reflected in part by thecontexts in which these behaviours commonly occur (Birch, Stewart, & Brown, 2007).Individuals high in Sensation Seeking may tend to seek out social contexts in which bingedrinking is likely to occur (Cyders et al., 2009). In contrast, binge eating most often occurs whenthe individual is alone (Polivy & Herman, 1993).Altogether, current evidence suggests that trait impulsive emotion dysregulation in thepresence of negative affect (i.e. Negative Urgency) pertains to both binge eating and bingedrinking behaviour with a larger effect observed for binge eating. A tendency towards engagingin impulsive behaviours in a positive mood state (i.e. Positive Urgency) relates to problematic8alcohol use in general, although support for a specific relationship with binge drinking is limited.Sensation Seeking appears to further differentiate binge drinking from binge eating.1.3.2 Reinforcement Sensitivity Theory and binge behaviourThe second personality framework used to conceptualize binge behaviour emphasizesmotivational systems drawing on Gray’s Behavioural Approach and Inhibition Systems(Reinforcement Sensitivity Theory; Gray, 1970; Corr, 2004; see Bijttebier, Beck Claes, &Vandereycken, 2009 for review). Reward Sensitivity (RS) and Punishment Sensitivity (PS) areproposed to play a key role in approach and avoidance behaviours associated with disorderedconsumption (Loxton & Dawe, 2001; Gray, 1991).1 Individuals with higher Reward Sensitivityhave a more reactive Behavioural Approach System (BAS) and are considered to be more likelyto approach and experience higher levels of positive affect to signals of reward (Carver & White,1994). Punishment Sensitivity is associated with greater Behavioural Inhibition System(BIS)/Fight-Flight-Freeze System (FFFS) co-activation, which confers greater responsivenessand higher negative affect to signals of punishment. Reinforcement Sensitivity Theory has beenincorporated into models of disordered eating and alcohol use behaviours (e.g. Dawe, Gullo, &Loxton, 2004; Dawe & Loxton, 2004). Individuals at risk for disordered consumption are positedto have a heightened response to highly palatable (i.e. rewarding) substances and associated cues.1 Though revisions to Reinforcement Sensitivity Theory (Gray & McNaughton, 2000) have drawn furtherdistinctions between BIS and what is referred to as the Fight-Flight-Freeze system (FFFS), well-validated measuresof sensitivity to reward and sensitivity to punishment available at the time of study conception did not distinguishbetween these systems (e.g. Carver & White, 1994; Torrubia, Avila, Molto, & Caseras, 2001); rather, measures ofpunishment sensitivity were considered reflective of combined BIS/FFFS functioning (Corr, 2004). Therefore, thecurrent study refers to Reward and Punishment Sensitivity with the acknowledgment that Punishment Sensitivitypertains to activation of BIS/FFFS; an approach that has been taken by other recent work (e.g. Tull, Gratz, Latzman,Kimbrel, & Lejuez, 2010; Hundt, Kimbrel, Mitchell, & Nelson-Gray, 2008). Since study conception new measureshave been developed, e.g. Jackson-5 (Jackson, 2009), in an effort to better capture revised RST.9Two commonly used self-report measures whose development was guided by RST areCarver and White’s (1994) Behavioural Inhibition System/Behavioural Activation System Scale(BIS/BAS Scale) and the Sensitivity to Punishment and Sensitivity to Reward Questionnaire(SPSRQ; Torrubia et al., 2001). Both measures have a subscale designed to assess punishmentsensitivity with items reflective of anxiety in the presence of punishment cues (BIS andSensitivity to Punishment, respectively). In regards to reward sensitivity, the BAS has threesubscales (Drive, Reward Responsiveness and Fun-Seeking) with items reflective of responses togeneral rewarding events whereas the SPSRQ Sensitivity to Reward scale pertains toresponsiveness to specific rewarding stimuli.Although evidence regarding the relationship between Reward and PunishmentSensitivity and ED diagnosis is somewhat mixed (Harrison, O'Brien, Lopez, & Treasure, 2010),the majority of studies using the BIS/BAS Scale or the SPSRQ, have documented higher RewardSensitivity in individuals with ED characterized by binge eating behaviours (i.e. AN-Binge-Purge, BN, and BED) (e.g. Beck, Smits, Claes, Vandereycken, & Bijttebier, 2009; Davis et al.,2008; Kane, Loxton, Staiger, & Dawe, 2004; Schienle, Schäfer, Hermann, & Vaitl, 2009; but seeClaes, Nederkoorn, Vandereycken, Guerrieri, & Vertommen, 2006; Harrison, Treasure, &Smillie, 2011). Higher sensitivity to palatable and potentially rewarding stimuli amongst bingeeating individuals is also suggested by behavioural measures of reward responsiveness (Kane etal., 2004) and heightened response to food cues (e.g. Svaldi, Tuschen-Caffier, Peyk, & Blechert,2010). In contrast, findings are mixed in regards to Punishment Sensitivity as measured by theBIS/BAS in comparisons between BN/BED and healthy controls with both higher PunishmentSensitivity and lack of significant differences noted (Beck et al., 2009; Claes et al., 2006;Harrison, et al., 2011; Kane et al, 2004; Schienle et al., 2009).10In subclinical populations, higher scores on disordered eating measures inclusive ofstriving for thinness and bulimic symptoms, are also associated with higher Reward Sensitivityand Punishment Sensitivity (Loxton & Dawe, 2001, 2006, 2007). While these findings do notallow for the attribution of a role for Reward Sensitivity or Punishment Sensitivity to a particulardisordered eating behaviour, some researchers have speculated that Punishment Sensitivity maybe more related to restricting behaviour with the goal towards avoiding weight gain whileReward Sensitivity may play a role in bingeing behaviour (e.g. Loxton & Dawe, 2001). GreaterPunishment Sensitivity associated with disordered eating may further contribute to the negativereinforcing effect of the binge episode (i.e. negative affect is experienced as more aversive or atgreater intensity thereby contributing to the urge to binge to relieve/distract from negativeaffect).Similar to findings for disordered eating, higher Reward Sensitivity has been consistentlyassociated with problematic alcohol use in college samples, and higher quantity and frequency ofuse in community samples (Franken & Muris, 2006; Gullo, Ward, Dawe, Powell, & Jackson,2011; Hundt et al., 2008; Jorm et al., 1999; Kambouropoulos & Staiger, 2007; Kimbrel, Nelson-Gray, & Mitchell, 2007; Lyvers, Czerczyk, Follent, & Lodge, 2009; O’Connor, Stewart, & Watt,2009). Of greatest relevance to the current study, Franken & Muris reported a positiverelationship between BAS-Fun Seeking and binge drinking. Cue reactivity research has alsodocumented increased responsiveness to alcohol cues in individuals who engage in heavydrinking (e.g. Field, Mogg, Zettler, & Bradley, 2004) again supportive of higher RewardSensitivity to potentially rewarding stimuli. Individuals with high Reward Sensitivity may bemore sensitive to the positive reinforcing effects of alcohol which in turn pertains to a heightened11risk of problematic use. However, the extent to which high Reward Sensitivity relates to bingedrinking specifically remains relatively understudied.In contrast to the positive findings for a role of Reward Sensitivity in problematic alcoholuse, it is unclear whether low Punishment Sensitivity is associated with problematic alcohol use.As such, the majority of the studies which examined problematic drinking (e.g. Jorm et al., 1999,Hundt et al., 2008; Kambouropoulos & Staiger, 2007; Lyvers et al., 2009) did not find asignificant relationship between low Punishment Sensitivity and problematic alcohol use.However, at least one study of problematic drinking (Kimbrel et al., 2007) and one study ofquantity and frequency (Pardo, Aguilar, Molinuevo, & Torrubia, 2007) reported an associationbetween low BIS and greater alcohol use. Of particular relevance to the current study, a negativeassociation between BIS and binge drinking frequency has been reported (Franken & Muris,2006). A recent prospective study provided preliminary evidence that the relationship betweennegative mood and negative drinking consequences decreases over time for individuals with highPunishment Sensitivity, suggesting that these individuals were more sensitive to the negativeconsequences associated with alcohol use as would be predicted by Reinforcement SensitivityTheory (Wardell, Read, & Colder, 2013). Individuals who refrain from binge drinking or whoengage in less bingeing over time may be more sensitive to the negative consequences associatedwith this pattern of use.1.3.3 Bringing together emotion-based dispositions to impulsive behaviour andReinforcement Sensitivity TheoryTaken together current evidence suggests a role for trait impulsive emotionaldysregulation (conceptualized as the urgency facets) and differential sensitivity of motivationalsystems (as represented by Reward and Punishment Sensitivity) in disordered eating and alcohol12use. The evidence outlined above with regards to Positive Urgency and Negative Urgency anddisordered eating and drinking behaviours suggests that the urgency facets are likely theconceptualizations of impulsive action most relevant for these disordered behaviours (Cyders &Smith, 2008). There appears to be considerable conceptual overlap between Negative Urgencyand Punishment Sensitivity and between Positive Urgency, Sensation Seeking and RewardSensitivity; therefore, clarification is required to determine whether all constructs providemeaningful contributions to binge behaviour (Gullo, Loxton, & Dawe, 2014). Given thesupposition that individuals high in Negative Urgency binge eat to relieve distress due tonegative and positive reinforcement pathways (Pearson et al., 2014) and that the urgency facetsand problematic drinking are linked via coping and enhancement motives (Coskunpinar &Cyders, 2012), it follows that Reward and Punishment Sensitivity may also play an importantrole in determining who is at risk for binge behaviour due to underlying individual differences inreinforcement sensitivity.1.4 Study One Research QuestionsStudy one aimed to bring together the parallel lines of research on emotion-baseddispositions to impulsive behaviour and Reinforcement Sensitivity Theory. This study addressedthe question of whether Reward Sensitivity and Punishment Sensitivity have unique associationswith binge eating and binge drinking beyond the associations of these behaviours withimpulsivity facets assessed by the UPPS-P Impulsive Behaviour Scale. Relationships betweenthe facets and binge behaviour were considered at the level of zero-order correlation and at thelevel of unique partial relationships while accounting for the other facets.131.5 Emotion Reactivity and Regulation DefinitionsThe emotion-based dispositions described in the preceding sections are indicative of arelationship between emotional states and binge behaviour. Several theories posit that emotionalstates and bingeing may be associated with one another because they both represent ways toregulate emotions (Ferriter & Ray, 2011). Prior to consideration of how emotion regulation maybe affected in women with binge behaviour, a definition of emotion regulation is required.General emotional responses may be divided into emotion reactivity and emotionregulation (Lewis, Zinbarg, & Durbin, 2010). Emotion reactivity refers to the initial intensity ofemotional activation in response to a stimulus, while emotion regulation refers to purposefulchanges in various aspects of the activated emotion such as the latency, rise-time, intensity andduration of the response in experiential, physiological and behavioural response systems (Gross& Thompson, 2007). Though different definitions of emotion regulation have been put forth,arguably the most influential definition is that provided by Gross (1998, p. 275) which states that“emotion regulation refers to the processes by which individuals influence which emotions theyhave, when they have them, and how they experience and express these emotions.”  According tothis definition, emotion regulation processes act to modulate responses across subjectiveexperiential, physiological and behavioural response systems. The coupling, also termedcoherence, between the various response systems may also be altered by psychopathology andemotion regulatory processes (Butler, Gross, & Barnard, 2014; Dan-Glauser & Gross, 2014;Eastabrook, Lanteigne, & Hollenstein, 2013; Gross, 1998). Therefore, a thorough investigationof emotion processing in relation to binge behaviours should include measurement of emotionreactivity, emotion regulation and coherence across response systems.141.6 Emotion Regulation Theories of Binge EatingEmotion regulation theories of binge eating purport that bingeing reduces or distractsfrom a negative emotional state considered intolerable by the individual (Wiser & Telch, 1999).Emotion regulation conceptualizations of binge eating are supported by motivational accounts(Jackson, Cooper, Mintz, & Albino, 2003), expectancy accounts (Hayaki, 2009), and functionalaccounts (Wedig & Nock, 2010) of binge eating. The frequent identification of negative affect asantecedent to binge eating in laboratory studies (Leehr et al., 2015), using ecological momentaryassessment (EMA: Haedt-Matt & Keel, 2011) and in retrospective investigations (Alpers &Tuschen-Caffier, 2001; Lynch, Everingham, Dubitzky, Hartman, & Kasser, 2000; Smyth et al.,2007; Wolff, Crosby, Roberts, & Wittrock, 2000) also support emotion regulation theories ofbinge eating. Across emotion regulation conceptualizations, there is general agreement that anegative emotional state precedes the binge episode and the behaviour provides some form ofrelief or at least the expectation of relief (Wiser & Telch, 1999). However, the mechanism ofemotion regulation is still unclear (Haedt-Matt & Keel, 2011; Polivy & Herman, 1993). Itremains undetermined whether binge eating is effective in reducing the overall level of negativeemotion during or after the binge episode, whether it acts to substitute different emotional states(e.g. anxiety versus depression) or whether it shifts the individual’s focus from other lifeproblems to concern regarding overeating. A recent investigation using EMA suggests thatchanges in the experience of guilt (encompassing feeling ashamed, dissatisfied with oneself, andangry at oneself) pre and post-binge eating may depend in part on diagnostic status andsubsequent engagement in vomiting (De Young et al., 2013). Greater declines in guilt wereobserved amongst women with BN compared to AN and in women who did not engage insubsequent vomiting.15Within the overarching umbrella of emotion regulation, a variety of emotion regulatorymechanisms and emotional triggers have been put forth. For example, Heatherton andBaumeister (1991) proposed that binge eating serves to narrow the focus of attention away fromaversive self-awareness. As reviewed by Polivy and Herman (1993), Johnson (1992) suggestedthat binge eating helps with “reorganization” when the individual feels overwhelmed, whereasHawkins and Clement (1984) considered binge eating a way to distract from life problems or toreduce anxiety/tension. Based on recent EMA findings, Goldschmidt and colleagues (2014)speculated that certain types of stressors (e.g. interpersonal) negatively impact self-evaluation orresult in an accumulation of distress leading to binge eating to cope with the associated negativeaffect. Emotion regulation theories of binge eating generally converge on the perspective thatbinge eating may be the result of a deficit in the ability to effectively regulate negative emotionalresponses through adaptive means (Birch et al., 2007; Wiser & Telch, 1999). It is thisperspective that is examined in the second study of this dissertation.Recent efforts to advance emotion regulation theories of binge eating have primarilyrelied on self-report measures to identify the specific aspects of emotion experience associatedwith binge eating behaviour. Reliance on self-report has some disadvantages; specifically, self-judgments about emotion regulation abilities may not map well onto actual abilities, and reportsmay be significantly influenced by high self-standards and negative mood states (Gardner,Quinton, & Qualter, 2014; Lundh, Johnsson, Sundqvist, & Olsson, 2002; Parling, Mortazavi, &Ghaderi, 2010). The self-report literature suggests that women who binge eat lack awareness of,and have low acceptance of, their emotional experiences (Gilboa-Schechtman, Avnon, Zubery,& Jeczmien, 2006; Gianini, White, & Masheb, 2013; Lafrance Robinson, Kosmerly, Mansfield-Green, & Lafrance, 2013; Legenbauer, Vocks, & Rüddel, 2008; Wheeler, Greiner, & Bolton,162005; Whiteside et al., 2007). Binge eating women may also tend to experience certain emotions,such as disgust, shame, contempt and guilt, more frequently than non-eating disordered women(Overton, Selway, Strongman, & Houston, 2005); however, these emotions may be a reaction tothe disordered eating rather than or in addition to acting as antecedents (Burney & Irwin, 2000).Self-reported emotional reactions to emotion-eliciting stimuli in the laboratory suggeststhat women who binge eat may experience greater negative emotion reactivity to idiographicstimuli (Hilbert, Vogele, Tuschen-Caffier, & Hartmann, 2011), but not to normative negativeemotional stimuli (Drobes et al., 2001; Mauler et al., 2006). However, self-report ratings ofemotional experience lack precision regarding the intensity and duration of the emotionalresponse and may be influenced by trait negative affect and demand characteristics (Lundh et al.,2002). Psychophysiological measures of general stress reactivity (e.g. cortisol, heart rate, skinconductance and blood pressure) help to address these shortcomings of self-report, but haveproduced mixed results (e.g. Ginty, Phillips, Heaney, & Carroll, 2012; Gluck, 2006; Hilbert etal., 2011; Messerli-Bürgy, Engesser, Lemmenmeier, Steptoe, & Laederach-Hofmann, 2010). Theuse of psychophysiological methods which are sensitive to emotional valence in addition toarousal, measure the time course of the emotional response, and tap multiple aspects of theresponse, such as experience and expression, may provide a richer picture of emotion reactivityin binge eating women. The startle eye-blink and corrugator muscle activity arepsychophysiological methods that fulfill these requirements and are described in greater detailbelow.In regards to emotion regulation, women who binge eat tend to either lack emotionregulation strategies or endorse strategies which are generally considered maladaptive (e.g.Danner, Evers, Stok, van Elburg, & de Ridder, 2012; Danner, Sternheim, & Evers, 2014; Gianini17et al., 2013; Lafrance et al., 2013; Svaldi, Griepenstroh, Tuschen-Caffier, & Ehring, 2012;Whiteside et al., 2007). They may rely on binge eating for immediate relief from distressingemotions in the absence of an ability to effectively regulate their emotional states through moreadaptive means. Two specific emotion regulation strategies, expressive suppression, defined asconcealment of facial emotional expressions, and cognitive reappraisal, defined as altering theinterpretation of the emotion evoking stimulus (Gross & John, 2003), have received the mostattention. Cognitive reappraisal is generally considered an adaptive strategy, whereas expressivesuppression is considered less adaptive as it often has the unintended effect of increasingemotional arousal (Gross, 1998).Amongst eating disordered women, the emotion regulation strategy of expressivesuppression is commonly endorsed in self-report trait-based measures, whereas cognitivereappraisal is less frequently endorsed (Danner et al., 2012; Danner et al., 2014; Svaldi, Caffier,& Tuschen-Caffier, 2010; Svaldi et al., 2012; Svaldi, Tuschen-Caffier, Trentowska, Caffier, &Naumann, 2014). However, the ED groups are often characterized by higher levels ofdepression; therefore, the differences in endorsed strategies may be attributable to highernegative affect rather than uniquely associated with eating disorder pathology (Svaldi et al.,2010; Svaldi et al., 2012; Svaldi et al., 2014). Furthermore, these self-report measures do notaddress the question of which emotion regulation strategies binge eating women choose toimplement when faced with an acute negative stimulus, nor do they identify whether the selectedstrategy is effective in reducing emotional arousal.Laboratory studies have examined the effect of these emotion regulation strategies onself-reported emotional state, desire to binge and actual food intake. The effect of instructions tosuppress emotional expressions during a sad film clip differed across three studies in women18with BED (Dingemans, Martijn, Jansen, & van Furth, 2009; Svaldi et al., 2010; Svaldi et al.,2014). Two of the studies found no difference in sadness between emotion regulation strategieswhereas the third study found that reappraisal was associated with reduced sadness compared tosuppression. Discrepant findings were also found regarding emotion regulation strategy and thedesire to binge or actual food intake in a subsequent taste test. These studies also do not addressthe question of which emotion regulation strategy women would implement if given the option tochoose their own strategy. As such, the ability to voluntarily regulate negative emotional statesarising from acute emotional triggers amongst binge eating women remains unclear. If womenwho binge eat are unable to effectively regulate their emotions when instructed to do so in astandardized laboratory setting, then this fits well with a broad deficit in emotion regulationability. If, however, they are able to effectively regulate their emotions in such a setting, then theinteresting question arises of what leads to binge eating for emotional relief in daily life.Dialectical Behaviour Therapy (DBT; Linehan, 1993), which addresses emotiondysregulation, has demonstrated efficacy in treating binge eating (Masson, von Ranson, Wallace,& Safer, 2013; Safer, Robinson, & Jo, 2010; Safer, Telch, & Agras, 2001; Telch, Agras, &Linehan, 2001; Wiser & Telch, 1999). Importantly, changes in emotion regulation predict bingeabstinence up to six months post-treatment (Wallace, Masson, Safer, & von Ranson, 2014).However, in this study emotion regulation was measured as the total score on a self-reportmeasure of emotion regulation. Therefore, it remains unclear whether reduced binge eating isattributable to a global change in emotion regulation or to change in a specific aspect such as anincreased ability to identify emotions, to tolerate emotions or to apply appropriate emotionregulation strategies.19Psychophysiological indices of emotion present with several advantages for studyingemotion processing in binge eating women. They can be used to help determine whether emotionreactivity and/or emotion regulation ability differ in women who binge eat. In regards to emotionreactivity, these measures allow for the assessment of intensity and duration of the emotionalresponse. Higher intensity or longer duration emotional responses could help to explain the lowtolerance for negative emotional states often endorsed by binge eating women.Psychophysiological measures can also be used to differentiate emotion reactivity fromeffortful emotion regulation. These measures do not depend on the individual’s ability to identifyand report on their own experience and are less influenced by demand characteristics (Jackson etal., 2000; Piper & Curtin, 2006). Inquiry into the strategies that were used during these effortfulemotion regulation attempts can also help determine whether binge eating women choose lessadaptive strategies, such as expressive suppression. With measurement of psychophysiologicalresponses, one can directly assess whether certain strategies are more or less effective inchanging the physiological response.1.7 Emotion Regulation Theories of Binge DrinkingSimilar to emotion regulation theories of binge eating, emotion regulation theories ofalcohol use posit that individuals engage in excessive consumption to reduce negative emotionalstates (Sher & Grekin, 2007). Such theories include those focused on the dampening effect ofalcohol on tension/stress (Conger, 1956; Sher, 1987; Khantzian & Galatner, 1990 as cited in Sher& Grekin) and coping motivations for use (Cooper, 1994; Cooper, Frone, Russell, & Mudar,1995; Cooper, Agocha, & Sheldon, 2000). However, these theories were not specificallyconceptualized to account for a binge drinking pattern of alcohol use amongst young women. Itis important to consider binge drinking amongst young women specifically, given prior findings20that peak time of heavy drinking in college and endorsed motivations for drinking may differbetween men and women (McCabe, 2002; Nolen-Hoeksema, 2012). Therefore, where possible,evidence specific to this population and this form of drinking are reviewed below. Similar tobinge eating, associations between negative emotional states and engagement in binge drinkinghave been examined to inform emotion regulation theories of alcohol use.Ecological momentary assessments (EMA) provide a strong test of emotion-alcohol useassociations as they are less influenced by recall biases (Simons, Gaher, Oliver, Bush, & Palmer,2005). Studies using this methodology provide a complex picture of the relationship betweennegative emotional states and alcohol consumption in young women. As such, daytime negativeemotional states have been directly linked to nighttime intoxication (Simons et al., 2005),indirectly linked via coping motives (Dvorak, Pearson, & Day, 2014), moderated by levels ofPositive/Negative Urgency (Simons, Dvorak, Batien, & Wray, 2010) or have been found todepend on the discrete negative emotion assessed (e.g. anxiety versus sadness) (Dvorak &Simons, 2014; Simons et al., 2010). Using time to drink analyses, Littlefield and colleagues(2012) found that women who endorsed greater coping drinking motives were less likely tobinge drink following periods of peak intensity negative emotional states than women endorsinglower levels of coping motivations. Taken together these findings suggest that the regulation ofnegative emotional states does not consistently underlie engagement in binge drinking behaviourin young women. However, moderation by coping motivations and the urgency facets, suggeststhat binge drinking may serve an emotion regulation function amongst a subset of young women.One such population is young women with binge eating behaviour who, as described in earliersections, tend to be high in Negative Urgency. Indeed, young women with probable BED or BNtend to report coping motives for drinking and engage in higher rates of binge drinking (Luce et21al., 2007). This suggests that young women who engage in binge eating to regulate negativeemotions in place of more adaptive strategies may engage in binge drinking for a similar purpose(Birch et al., 2007). However, the ability to voluntarily regulate emotional states amongst womenwith binge eating and binge drinking behaviour has yet to be assessed. This is important as suchan examination may help identify the specific aspect of emotional processing that is disrupted inwomen with these binge behaviours. If they are able to voluntarily regulate their emotional statesin the laboratory, then the question arises as to what undermines adaptive emotion regulation indaily life.The relationship between Positive Urgency and alcohol use reviewed previously suggeststhat binge drinking may also be associated with the regulation of positive emotional states(Cooper et al., 1995; Cooper et al., 2000). This is supported by reports of a positive associationbetween daytime positive emotions and nighttime drinking and intoxication amongst youngwomen in EMA studies (Dvorak & Simons, 2014; Simons et al., 2005; Simons et al., 2010; butsee Dvorak et al., 2014). This association may be explained by lowered perceptions of riskassociated with alcohol use when in a positive emotional state; an effect which is strongeramongst individuals who are higher in trait impulsivity (Haase & Silbereisen, 2011). Highunregulated positive emotional states may diminish the perceived risks of drinking and couldresult in excessive consumption in the form of binge drinking.Emotion regulation ability has not been directly assessed in binge drinking youngwomen. Based on the drinking motives, EMA and Positive Urgency literature, it is expected thatbinge drinking may be associated with difficulties regulating positive emotions. This couldmanifest as difficulty keeping positive emotions from reaching a high intensity that interfereswith decision making or inhibitory control. Alternatively, difficulty regulating positive emotion22may manifest in a limited ability to maintain or enhance positive emotional states as suggestedby enhancement drinking motives. The application of psychophysiological methods that aresensitive to the regulation of positive emotion would help to address whether there is a deficit inthe regulation of positive emotions amongst binge drinking young women and whether thispertains to difficulty maintaining or reducing these states.Similar to the binge eating literature, problematic alcohol use is also associated withdifficulty identifying feelings (Vine & Aldao, 2014). In regards to binge drinking specifically,however, findings are mixed. As binge drinking college women do not generally endorse greaterdifficulty identifying feelings compared to non-binge drinking women (Bauer & Ceballos, 2014),difficulty identifying feelings may be limited to a subset of binge drinking young women such asthose who are high in Positive or Negative Urgency (Shishido, Gaher, & Simons, 2013) or whoendorse drinking to cope with negative affect (Lyvers, Hasking, Albrecht, & Thorberg, 2012).Given the possibility of difficulty identifying feelings in binge drinking young women,psychophysiological methods which are not reliant on an ability to identify emotional states maybe important to further our understanding of emotion processes in this population.1.8 Psychophysiological Measures of Emotion ReactivityThe application of psychophysiological methods to assess emotion reactivity andregulation presents the opportunity to further advance our understanding of emotion processes inwomen with binge behaviour. To measure emotion reactivity and emotion regulation ability,study two utilized two psychophysiological measures which have been demonstrated todistinguish between emotion reactivity to negative and positive emotions and have also beenemployed as an index of instructed emotion regulation: the startle blink and corrugator muscleactivity. These methods help to overcome the inherent limitation of relying on subjective23experience reports amongst individuals who may have difficulty identifying and describing theiremotional experiences (Lundh et al., 2002). They offer more precise measurement of the timingand magnitude of responses, are less affected by demand characteristics and can helpdifferentiate whether regulation efforts alter valence or arousal dimensions of the response(Bernat, Cadwallader, Seo, Vizueta, & Patrick, 2011; Jackson, Malmstadt, Larson, & Davidson,2000). They also allow for the assessment of both negative and positive emotional states. This isimportant as reactivity and regulation of positive emotions is often neglected in the literature.The main advantage of using the startle blink paradigm in the study of emotion is that itallows for the distinction in emotional response between affectively positive and negative stimuli(Vrana, Spence, & Lang, 1988). In this paradigm, a blast of white noise is administered while theparticipant views images of differing valence. The startle magnitude in response to the noiseblast is measured by recording activity of the orbicularis oculi muscle which is located below theeye. The noise blast (i.e. the startle probe) evokes an aversive defensive response (the startleblink) and whether the startle blink that is evoked is small or large depends on the match ormismatch between the aversive quality of the reflex and the emotional context in which it occurs(Lang, Bradley, & Cuthbert, 1990; Lang, 1995). When the probe is presented in a negativeemotional context, there is a match between the aversive valence of the reflex and the aversivevalence of the context. This results in an augmented (i.e. larger) startle response as indicated bygreater activity in the orbicularis oculi muscle. Correspondingly, when the probe is presented in apositive emotional context, there is a mismatch between the valence of the reflex and theappetitive context and the startle response is inhibited (i.e. smaller). The startle response hasbeen consistently shown to be augmented during the viewing of negatively valenced images and24inhibited during the viewing of positively valenced images (Bradley, Cuthbert, & Lang, 1990;Lang et al., 1990).Corrugator muscle activity is another commonly used psychophysiological index ofemotion experience and expression. This muscle draws the eyebrows in and down and isassociated with expressions of distress (Lang, Greenwald, Bradley, & Hamm, 1993). Similar tothe startle blink, the activity in this muscle is greater during negative emotional states andreduced during positive emotional states (Lang et al., 1993).1.9 Psychophysiological Measures of Emotion RegulationIn addition to their use as indices of emotion reactivity, the startle blink and corrugatoractivity are also sensitive to instructed emotion regulation efforts. The examination of instructedemotion regulation efforts helps to strengthen the distinction between reactivity and regulationprocesses. Without the provision of an emotion regulation cue, the emotional response would bea combination of initial reactivity and automatic and effortful regulation attempts. By providing acue instructing participants to regulate their emotional response, the timing of regulation effortsis held constant across participants and helps ensure that all participants attempt to regulate theiremotional response. It removes the onus from the participants to decide when to regulate theirresponse, thereby, helping to remove this as a factor in the subsequent success of their efforts.Thus, measured differences in emotion regulation success can be attributed to difficultyemploying effective regulation strategies rather than to difficulty knowing when to apply thesestrategies. In terms of the startle paradigm, the startle magnitude evoked by the startle stimulusduring negative image viewing can be reduced or enhanced by instructions to decrease orenhance the negative emotions elicited by the image (Jackson et al., 2000; Piper & Curtin, 2006).Importantly, this pattern of larger startle magnitudes following “increase emotion” instructions25compared to “decrease emotion” instructions is also found for the regulation of positive emotions(Bernat et al., 2011; Dillon & LaBar, 2005; Driscoll, Tranel, & Anderson, 2009). There arepreliminary findings that corrugator muscle activity is sensitive to instructed regulation ofpositive emotion (Bernat et al., 2011) with more consistent evidence of regulation effects fornegative emotions (Jackson et al.; Lee, Shackman, Jackson, & Davidson, 2009). Emotionregulation of the startle response typically follows the arousal dimension (i.e. the pattern ofregulation efforts is the same for negative and positive emotions), while emotion regulation ofcorrugator muscle activity typically follows the valence dimension (i.e. “decrease” negativeemotion instructions results in less corrugator activity whereas “decrease” positive emotioninstructions results in greater corrugator activity) (Bernat et al., 2011).1.10 Startle Blink & Corrugator Activity in Disordered Eating & Drinking WomenIn regards to disordered eating and alcohol use, the majority of investigations haveexamined differences in reactivity to food or alcohol cues. Across startle and corrugator, foodcues tend to be associated with a negative emotional response in women who binge eat (Altman,Campbell, Nelson, Faust, & Shankman, 2013; Drobes et al., 2001; Mauler et al., 2006). Incontrast, self-reported valence of food images in binge eating women is more variable with bothpositive and negative valence classifications reported  (Altman et al.; Drobes et al.; Mauler etal.). Images of contamination that are associated with bulimic behaviours, e.g. a toilet, alsoevoked greater negative emotion reactivity as indexed by the startle probe in women with bingeeating (Altman et al.). When general negative and positive emotional stimuli (i.e. emotionalpictures that do not focus on food or alcohol) were included in these investigations, groupdifferences were not found (Drobes et al., 2001; Mauler et al., 2006).26In regards to reactivity to alcohol cues, an attenuated startle response and positive valenceratings have been demonstrated amongst heavy and light social drinkers (Drobes, Carter, &Goldman, 2009). However, this study failed to replicate the typical linear affective modulation ofthe startle response during viewing of general negative, neutral and positive images. Individualswith positive alcohol expectancies tended to rate unpleasant images as less unpleasant,suggesting a reduced sensitivity to negative emotional stimuli. Miranda and colleagues (2002)reported reduced startle potentiation during negative image viewing amongst individuals with afamily history of alcoholism. However, in a second study, reduced potentiation was not found inmen with alcoholism alone, rather, it was only found amongst men with co-morbid alcoholismand anti-social personality disorder (Miranda, Meyerson, Myers, & Lovallo, 2003). Thus, there ismixed evidence of a possible blunted emotional response to negative emotional stimuli inindividuals at risk for problematic alcohol use.These physiological methods have not been previously applied to study reactivity andvoluntary emotion regulation ability in binge eating and drinking young women. They offer theopportunity to examine whether women with either type of bingeing have differences inreactivity patterns, or whether they exhibit difficulty regulating positive and negative emotionalstates. These methods are not reliant on the individual’s ability to identify and describe theiremotional state, and may be more sensitive to subtle differences in the evoked emotionalresponse.1.11 Study Two Research QuestionsStudy two applied the psychophysiological methods described in the preceding sections(i.e. startle blink and corrugator muscle activity) to provide a comprehensive examination ofemotion processing in young women with binge behaviour. Such an approach has the advantage27of allowing us to identify acute changes in valence and arousal dimensions when an emotion isactivated and as it is altered by effortful regulation attempts. The recording of the emotionalresponse is less influenced by demand characteristics, emotional awareness, and trait negativeaffect (Jackson et al., 2000; Piper & Curtin, 2006). These methods will determine whetherdeficits in regulation ability, as suggested by the trait literature, are found when attempting toregulate a response to an acute negative emotional stimulus. This may inform whether therelationship between emotional states and bingeing behaviour is due, at least in part, to a deficitin the ability to voluntarily regulate the emotional state.Emotion processing of general negative and positive emotional stimuli was examined inthe context of a picture viewing paradigm. Emotion reactivity was investigated by comparison ofgroup means on self-report ratings and psychophysiological indices of emotional response(startle blink magnitude, corrugator activity) to general emotion invoking images. The questionof whether a broad deficit in emotion regulation ability is implicated in binge eating, bingedrinking or co-morbid bingeing behaviour was also assessed in study two. Such a deficit wouldbe evident as a lack of response differentiation between conditions where participants attemptedto maintain and decrease their emotional responses. This was assessed through examination of:1) Emotion reactivity in response to negative, neutral and positive images as measured bytwo psychophysiological indices (startle blink magnitude and corrugator activity) andself-report ratings of valence and arousal.2) The ability to regulate the emotional response evoked by negative, neutral and positiveimages as measured by two psychophysiological indices (startle blink magnitude andcorrugator activity).3) Self-reported emotion regulation strategies utilized during the experimental task.28The sample consisted of young women with recurrent binge eating, binge drinking orboth forms of behaviour and a non-bingeing comparison group. Motives for eating and drinkingwere examined in study two as a validation of group assignment. Replication of previouslydemonstrated differences in eating and drinking motives amongst eating disordered and heavydrinking women was anticipated.1.12 Emotion Response CoherenceThe measurement of startle blink and corrugator activity in addition to self-report ratingsof emotional stimuli allows for the assessment of coherence across subjective andpsychophysiological response systems, termed emotion response coherence or concordance(Hollenstein & Lanteigne 2014). This is defined as the extent of co-variation between subjectiveand psychophysiological response systems. The strength and direction of the association betweendifferent response systems may be impacted by psychopathology and emotion regulationprocesses (Butler et al., 2014; Dan-Glauser & Gross, 2014; Eastabrook et al., 2013; Gross,1998). Low coherence amongst physiology and experience is generally implicated inpsychopathology characterized by trait reports of low emotional awareness, such as alexithymia(Eastabrook et al., 2013), disordered eating (Hilbert et al., 2011; Tuschen-Caffier & Vogele,1999) and borderline personality disorder (Elices et al., 2012; Hazlett et al., 2007). In contrast,greater coherence amongst response systems is generally identified in psychopathologycharacterized by intense fear or anxiety (e.g. Hubert & DeJong Meyer, 1990; Schaefer, Larson,Davidson, & Coan, 2014). Response coherence may also depend on which response systems areassessed (Evers et al., 2014) and trait negative affect or trait tendencies to utilize specificemotion regulation strategies (Lanteigne, Flynn, Eastabrook, & Hollenstein, 2014).29Coherence between subjective experience and the psychophysiological measures utilizedin study two, namely startle blink magnitude and corrugator activity, and an additional measure(the late positive potential; LPP) has yet to be examined in young women with binge behaviour.Patterns of response coherence amongst bingeing and non-bingeing young women may help toexplain low emotional clarity and may reveal discrepancies between experience and expression.Expected relationships between each of the psychophysiological measures and their subjectiveexperience counterparts (i.e. rated valence or arousal) in non-bingeing young women arereviewed below. This is followed by consideration of how these relationships may be affected inwomen with binge behaviour.In regards to the valence dimension of the emotional response, corrugator muscle activityappears to be sensitive to variations in the level of displeasure evoked by the stimulus (Lee et al.,2009). Small to medium associations between corrugator muscle activity and self-reportedvalence have been documented for specific emotions such as sadness, anger, and fear and forgeneral negative and positive affect using a variety of emotion induction methods such asimages, film clips, mental imagery, negative feedback, sounds and words (Brown & Schwartz,1980; Jäncke, 1996; Johnson, Waugh, & Fredrickson, 2010; Lang et al., 1993; Larsen, Norris, &Cacioppo, 2003). A linear relationship between subjective valence ratings and corrugator activitywas found in 81% of Lang et al.’s sample (1993) suggesting that this relationship is often evidentwithin the context of a picture viewing paradigm. Corrugator activity tends to be greater fornegative valence images compared to positive valence images even during attempts tovoluntarily control these facial muscles (Dimberg, Thunberg, & Grunedal, 2002). As such,corrugator activity appears to reflect the degree of displeasure-pleasure evoked by the picturestimulus as well as facial emotional expression. Attenuated response coherence between valence30ratings and corrugator activity may, therefore, reflect a discrepancy between subjectiveexperience and emotional expression.Similar to corrugator activity, the magnitude of the startle blink reflex evoked by asudden, abrupt stimulus is modulated by the valence of the image in the picture viewingparadigm. According to emotional priming theory (Lang et al., 1990), the startle blink is adefensive reflex and is, therefore, augmented when the aversive motive system is active at thetime of startle probe presentation (i.e. during viewing of negative images) and inhibited when theappetitive motive system is active (i.e. during viewing of positive images). Beyond thisdistinction of augmentation and inhibition by valence, startle blink magnitude is also affected byarousal, which is considered indicative of the extent of activation in these motivational systems.Cuthbert, Bradley and Lang (1996) first demonstrated that startle blink modulation (potentiationfor negative, inhibition for positive valence) was greatest for highly arousing images as indexedby both subjective report and skin conductance response. Bradley, Codispoti, Cuthbert and Lang(2001) replicated this effect and demonstrated that picture contents of the highest motivationalrelevance (e.g. direct threat and mutilation) evoked the largest startle potentiation and were themost arousing based on self-report and skin conductance.Since both valence and arousal impact startle magnitude, some researchers havedeveloped a method to measure the combination of these affective components, which theytermed intensity (Bernat, Patrick, Benning, & Tellegen, 2006). Although intensity was found tocorrelate with startle blink magnitudes, the effect sizes were small and varied between imagecontents. In general, they were larger and more consistent within the negative valence conditioncompared to the positive valence condition. Taken together, these findings suggest that startlemodulation within negative and positive valence conditions correlates with rated arousal.31Attenuated coherence between startle magnitude and arousal ratings may reflect discordancebetween activation of basic motivational systems and subjective experience.The last index of coherence between physiological response and subjective experienceexamined in the third study is between an event-related potential (ERP) waveform termed thelate positive potential (LPP) and self-reported arousal. The LPP is a positive-going centro-parietal waveform beginning 300-400 ms post-picture onset and extending up to five secondsinto the picture viewing period (Cuthbert, Schupp, Bradley, Birbaumer, & Lang, 2000). The LPPis proposed to index motivational significance with greater activity observed for unpleasant andpleasant compared to neutral images; an effect which remains evident following repetitivepicture viewing (Cuthbert et al., 2000; Codispoti, Ferrari, & Bradley, 2007; Lang & Bradley,2009; Schupp et al., 2000). The LPP is larger for more arousing images as indexed by subjectivearousal reports and sympathetic arousal (Cuthbert et al; Leite et al., 2012; Schupp et al., 2004).The LPP has been used to index motivational significance of disorder specific cues, such as foodand alcohol images, in women with disordered eating and alcohol use (Blechert, Goltsche,Herbert, & Wilhelm, 2014; Svaldi et al., 2010).The magnitude of the LPP is diminished by emotion regulatory efforts such as attentionmanipulation (Dunning & Hajcak, 2009; Hajcak, Dunning, & Foti, 2009) and cognitivereappraisal (see Hajcak, MacNamara, & Olvet, 2010 for review). The LPP is also reduced inindividuals with Generalized Anxiety Disorder (GAD) in response to aversive stimuli; an effectwhich has been interpreted within the context of initial heightened vigilance followed by rapidavoidance (the vigilance-avoidance model; Mogg, Bradley, Miles, & Dixon, 2004; Weinberg &Hajcak, 2011). Results from functional magnetic resonance imaging investigations of the neuralstructures underlying the LPP have been interpreted to reflect elaborated processing in the extra-32striate visual cortex with re-entrant processing from the amygdala (see Lang & Bradley, 2010 forreview). Attenuated coherence between LPP magnitude and rated arousal may, therefore, reflectattentional disengagement and decreased perceptual processing of arousing stimuli.In regards to binge eating, greater self-reported negative affect in the absence ofphysiological response differences (cardiac reactivity and electrodermal activity) in interpersonalstressor tasks suggests a discrepancy between subjective and physiological response systems(e.g. Hilbert et al., 2011; Tuschen-Caffier & Vogele, 1999). However, emotion reactivity togeneral emotional stimuli indexed by startle blink, corrugator activity and self-report imageratings appears comparable between bingeing and non-bingeing women based on comparisons ofgroup means (Drobes et al., 2001; Mauler et al., 2006). A dimensional approach may be moresensitive to alterations in response coherence that are not apparent in prior group comparisons.The tendency of eating disordered women to suppress emotional expression also suggests thatcoherence between corrugator activity and valence ratings may be attenuated (Danner et al.,2014; Svaldi et al., 2012). There are no reports examining response coherence between LPP togeneral emotional stimuli and arousal in binge eating women. However, as anxiety is oftenassociated with disordered eating (Meng & D’Arcy, 2015), the association between LPP andarousal may be affected in this population given prior reports of decreased LPP amplitude inhigh anxiety groups (e.g. Weinberg & Hajcak, 2011).There is limited evidence to inform expected patterns of emotion response coherenceamongst young women with binge drinking behaviour. The two startle studies describedpreviously provided mixed evidence of a possible attenuation of the relationship between startleresponses and self-report (Miranda et al., 2002; 2003). Similar, to binge eating, there is a lack of33evidence to inform the expected coherence between LPP and arousal ratings in binge drinkingyoung women.1.13 Study Three Research QuestionsStudy three aimed to identify whether women with higher self-reported emotionreactivity to the picture stimuli also tended to show higher levels of activity in correspondingpsychophysiological indices. To address this issue, using data from study two, correlationsbetween the psychophysiological measures and subjective experience ratings outlined abovewere examined within non-bingeing women, binge eating women, binge drinking women andwomen with both binge eating and binge drinking behaviours.34Chapter 2: Study One2.1 IntroductionThe current study aimed to integrate two related frameworks, emotion-based dispositionsto impulsive behaviour and Reinforcement Sensitivity Theory (RST), to identify common andunique personality correlates of binge eating and binge drinking behaviours. Amongstimpulsivity facets, Negative Urgency (NU) or the tendency to experience strong impulses whenexperiencing negative affect (Whiteside & Lynam, 2001), is most highly correlated with bulimicsymptoms (Fischer et al., 2008). Negative Urgency predicts, and accounts for unique variance inbinge eating beyond other facets measured with the UPPS-P Impulsive Behavior Scale (Fischeret al., 2013; Fischer & Smith, 2008; Smith et al., 2007). Integrative models of bulimic symptomsposit that individuals high in Negative Urgency binge eat in part due to negative reinforcement(i.e. emotion regulatory effect) of the behaviour from distress relief (Pearson et al., 2014).Negative Urgency and a complementary facet called Positive Urgency (PU), or thetendency to engage in impulsive behaviours when in positive affective states (Cyders & Smith,2007), denote risk for various alcohol outcomes. Amongst the UPPS-P facets, the urgency facetshad the largest relationships with problematic drinking in meta-analyses (Coskunpinar et al.,2013; Stautz & Cooper, 2013). Whereas Negative Urgency is related to both types of bingeing,high Positive Urgency appears unique to problematic drinking. Positive Urgency is higher inwomen with alcohol abuse than in women with ED and healthy controls, positively correlateswith various alcohol outcomes and predicts alcohol consumption and negative drinkingconsequences (Cyders et al., 2007; Cyders et al., 2009). Evidence pertaining to the relationshipbetween urgency facets and binge drinking specifically, is limited. Correlations, though smaller35than for the broader construct of problematic drinking, remain positive (e.g. Adams et al., 2012;Shin et al., 2012).Of the other UPPS-P facets, binge drinking is further differentiated from binge eating inits association with high Sensation Seeking (SS). Amongst UPPS-P facets, Sensation Seeking,the tendency to enjoy and pursue new, exciting activities, has the largest relationship with bingedrinking (Coskunpinar et al., 2013; Stautz & Cooper, 2013) whereas the relationship withbulimic symptoms is small (Fischer et al., 2008). In summary, Negative Urgency appears relatedto both types of bingeing and may reflect a general risk for under-controlled consumption,whereas Positive Urgency and Sensation Seeking are more strongly related to binge drinking andmay differentiate this behaviour from binge eating.Reinforcement Sensitivity Theory draws on Gray’s motivational systems and providesanother framework from which to understand binge behaviour (Corr, 2004; Gray &McNaughton, 2000). Individuals with high Reward Sensitivity (RS) have a reactive BehaviouralApproach System and are more likely to approach and experience higher levels of positive affectto reinforcement and cues signaling probable reinforcement. Punishment Sensitivity (PS)pertains to co-activation of the Behavioural Inhibition System (BIS) and the Fight-Flight-FreezeSystem (FFFS). Individuals with high Punishment Sensitivity are more responsive andexperience higher negative affect to signals of punishment. RST has been incorporated intomodels of addiction (Dawe & Loxton, 2004) with the systems proposed to play a key role inapproach and avoidance behaviours associated with disordered consumption. Individuals at riskfor disordered consumption are posited to demonstrate increased responsiveness to highlypalatable (i.e. rewarding) substances and associated cues.36Higher self-reported and behavioral indicators of Reward Sensitivity have beendocumented in subclinical populations with dysfunctional eating (Loxton & Dawe, 2006, 2007)and in individuals with ED characterized by bingeing (e.g., Kane et al., 2004; Schienle et al.,2009). Whereas high Punishment Sensitivity has been consistently noted in subclinicalpopulations (Loxton & Dawe, 2006, 2007), results from comparisons between bulimia nervosa(BN)/binge eating disorder (BED) and healthy controls have been mixed (Claes, et al., 2006;Harrison et al., 2011; Kane et al, 2004; Schienle et al., 2009). Given the use of summarymeasures of ED symptoms in subclinical populations, current evidence does not allow for theattribution of a role for Reward Sensitivity or Punishment Sensitivity to a particular disorderedeating behaviour. Although some researchers have speculated that Punishment Sensitivitypertains to restricting behaviour with the goal towards avoiding weight gain while RewardSensitivity plays a role in bingeing (Loxton & Dawe, 2001), these behaviours frequently co-occur within the same individual. Greater Punishment Sensitivity associated with disorderedeating may also contribute to the negative reinforcing effect of the binge episode because ofrelief from more intense negative affect.Although high Reward Sensitivity has been consistently associated with problematicdrinking in college samples (Gullo et al., 2011; Hundt, at al., 2008), evidence of a relationshipwith binge drinking is limited (Franken & Muris, 2006). There is also limited evidence of anegative association between Punishment Sensitivity and binge drinking (Franken & Muris).Previous findings suggest that high Punishment Sensitivity individuals learn from the negativeconsequences of problematic drinking and over time engage in this behaviour less frequentlywhen experiencing negative affect (Wardell et al., 2013).37Altogether, trait impulsive emotional dysregulation (i.e. the urgency facets) anddifferential sensitivity of motivational systems (i.e. Reward Sensitivity and PunishmentSensitivity) are implicated in disordered eating and drinking. While unique prediction of RewardSensitivity beyond that provided by the UPPS-P facets has been reported for externalizingbehaviours, such as substance abuse, anti-social behaviour and aggression (Carlson, Pritchard, &Dominelli, 2013), there is a paucity of work examining unique contributions to binge eating anddrinking (Gullo et al., 2014). Given that individuals high in Negative Urgency may binge eat torelieve distress due to negative and positive reinforcement pathways (Pearson et al., 2014) andthat coping and enhancement motives link the urgency facets with problematic drinking(Coskunpinar & Cyders, 2012), it follows that individual differences in reinforcement sensitivitymay also be important in determining risk for binge behaviour.The current study aimed to evaluate the unique contribution of the urgency facets andreinforcement sensitivity to binge eating and drinking in young women. An all-female samplewas selected due to greater ED risk in women and gender differences in emotion-motivateddrinking (Jacobi, Hayward, de Zwaan, Kraemer, & Agras, 2004; Nolen-Hoeksema, 2012).Negative Urgency, Reward Sensitivity and Punishment Sensitivity were hypothesized to beuniquely associated with binge eating frequency. Binge drinking frequency was hypothesized tobe negatively related to Punishment Sensitivity and positively associated with Negative Urgency,Positive Urgency, Sensation Seeking and Reward Sensitivity.382.2 Methods2.2.1 ParticipantsThe survey was completed by 1763 females2, primarily university students, with a finalsample of 1001 participants (age M=20.63, SD=1.62) following removal of nonsensicalresponders (n=62, i.e. impossible values for height, weight or birthdate), patterned responses(n=9, i.e. same response or alternating between same response options on all questions),inconsistent or impossible responses on binge frequency questions (n=606), duplicateparticipants (n=44, i.e. participants who completed the survey multiple times) and ineligibleparticipants due to age <19 or >30 years (n = 29), neurological conditions (n=10) or possibleanorexia nervosa diagnosis (AN; n=2). Women with possible AN were excluded to allow forconsideration of findings alongside the results of the laboratory studies described in subsequentchapters, which excluded women with possible AN due to the potential detrimental effects ofstarvation on cognition (Zakzanis et al., 2010). Self-identified ethnicity was East Asian (52.7%),European (34.9%) and Indian-South Asian (9.2%); other categories were endorsed at <5% each.Forty-one participants endorsed current medication for depression/anxiety and 14 for attentiondeficit hyperactivity disorder. A minority of participants reported lifetime medicationmanagement of bipolar disorder (0.5%) or psychosis (0.3%). Based on the Eating DisorderDiagnostic Scale, 2.6% had BN and 4.0% had BED; however, diagnostic interviews were notconducted. Recruitment was via the University of British Columbia Psychology DepartmentHuman Subject Pool, a psychology study mailing list and posters in the university and2 The large sample size for study one resulted from extensive recruitment efforts for the laboratory studiesdescribed in studies two and three.39community. The majority of the sample consisted of university students (89.4 %) with a smallpercentage of participants from the community (10.6%).2.2.2 ProcedureThe UBC Behavioural Research Ethics Board approved study procedures and participantsprovided written informed consent. Participants completed questionnaires online and receivedPsychology course credit or remuneration.2.2.3 QuestionnairesUPPS-P. The UPPS-P (Lynam et al., 2006) is a 4-point Likert response format (“AgreeStrongly” to “Disagree Strongly”) questionnaire with scales assessing personality pathwaysleading to impulsive behaviour. Items on the Positive Urgency scale pertain to one’s own orothers’ perception of a tendency to engage in risky behaviours when feeling positively, e.g.“When I am very happy, I can’t seem to stop myself from doing things that can have badconsequences” and “Others would say I make bad choices when I am extremely happy aboutsomething.” One item may pertain directly to risk for binge behaviour “When I am very happy, Ifeel like it is ok to give in to cravings or overindulge.” All fourteen items on this scale refer to apositive mood state. In contrast, all twelve items on the Negative Urgency scale do not explicitlyrefer to a negative mood state. Some items are similar in format to the Positive Urgencystatements, e.g. “When I feel bad, I will often do things I later regret in order to make myself feelbetter now.” However, the Negative Urgency scale also includes items assessing generaldifficulty inhibiting impulses, e.g. “I have trouble controlling my impulses” or controllingemotions, e.g. “I always keep my feelings under control.” Items on this scale also relate tocraving and loss of control inherent in binge behaviour, e.g. “I have trouble resisting my cravings(for food, cigarettes, etc.)” and “Sometimes when I feel bad, I can’t seem to stop what I am doing40even though it is making me feel worse.” The ten items comprising the Perseverance scalepertain to one’s ability to concentrate on, think through and see a task to completion, e.g. “Ifinish what I start” and “I concentrate easily.” Premeditation includes eleven items focused on acautious, logical approach to thought and behaviour, e.g. “My thinking is usually careful andpurposeful” and “I like to stop and think things over before I do them.” Perseverance andPremeditation scales are scored to reflect a lack of these traits. Finally, the twelve items makingup the Sensation Seeking scale reflect enjoyment of risk taking, e.g. “I quite enjoy taking risks”and anticipated enjoyment of specific thrilling activities, e.g. “I would enjoy parachute jumping.”Internal consistency was good in the present sample (Cronbach’s α=0.83-0.94) and comparableto published values (Cronbach’s α=0.82-0.94; Cyders et al., 2007; Whiteside & Lynam, 2001).One strength of the UPPS-P is that development of four of the facets (Negative Urgency,Sensation Seeking, Lack of Premeditation and Lack of Perseverance) was guided by acomprehensive model of personality, the Five Factor Model (FFM). The factor structureunderlying the scales was replicated in questionnaire and interview response formats by Smith etal. (2007). Correlations between questionnaire and interview assessments were high (e.g. r=0.64between Negative Urgency interview versus questionnaire). However, a replication of the factorstructure of the original UPPS suggested that five of the items have poor factor loadings (Magid& Colder, 2007).When developing the Positive Urgency scale, it was differentiated from the other fourUPPS facets and from the BAS scale by factor analysis (Cyders et al., 2007). A limitation of theUPPS-P is inconsistent criterion validity for the Positive Urgency scale. Expected relationshipswith drinking measures have been primarily limited to research conducted by the group which41developed the Positive Urgency scale (e.g. Cyders et al., 2007; Cyders et al., 2009) whereasfindings from other groups have been inconsistent (e.g. Adams et al., 2012; Simons et al., 2010).BIS/BAS Scale. The BIS/BAS Scale (Carver & White, 1994) is a 4-point Likertresponse format (“Strongly Agree” to “Strongly Disagree”) questionnaire, which assessesdispositional sensitivities of the Behavioral Inhibition System and Behavioral Approach System.It is composed of one BIS subscale (Cronbach’s α=0.79 current sample; α=0.74 validationsample) and three BAS subscales (Cronbach’s α=0.77-0.80 current sample; α=0.66-0.76validation sample). The seven item BIS subscale reflects a tendency to experience fear, worry orfeel upset in the face of criticism, failure, or the possibility of negative events, e.g. “I feelworried when I think I have done poorly at something.” BAS-Drive consists of four itemsreflecting a persistent pursuit of goals, e.g. “When I want something, I usually go all-out to getit.” The four item BAS-Fun Seeking subscale reflects a desire for new rewards and acting on thespur of the moment to approach a potentially rewarding event, e.g. “I'm always willing to trysomething new if I think it will be fun.” The five items of the BAS-Reward Responsivenesssubscale assess positive responses to the occurrence or anticipation of reward, e.g. “When goodthings happen to me, it affects me strongly.”Initial validation studies provided evidence of convergent and discriminant validity; BIScorrelated positively with measures of negative affectivity/anxiety (e.g. r=0.42) while BASscales correlated positively with positive affectivity/extraversion (e.g. r=0.41). Correlations withexpected frequency of exposure to punishment and reward cues as well as between typicalnegative and positive affect were moderate suggesting that the scales assess related but distinctconstructs (Carver & White, 1994). Construct validity was provided by the finding that high BISscores were associated with greater nervousness to a laboratory punishment cue. Construct42validity for the BAS-Drive and BAS-Reward Responsiveness scales was evident in ratings ofgreater happiness to a laboratory reward in individuals with high scores on these scales. Onelimitation of the BIS/BAS scale is that on factor analysis, BAS-Fun Seeking crossloads withmeasures of rash impulsivity (i.e. acting without consideration of consequences) and withmeasures of reward sensitivity, leading some to argue that it is more related to rash impulsivitythan to reward sensitivity (see Loxton et al., 2004 for review).Sensitivity to Punishment and Sensitivity to Reward Questionnaire (SPSRQ). TheSPSRQ (Torrubia et al., 2001) is a yes-no response format questionnaire consisting of 48 itemswith items split evenly across two scales assessing functioning of the BIS and BAS: Sensitivityto Punishment (SP; Cronbach’s α=0.84 present sample; α=0.82 validation sample), e.g.“Comparing yourself to people you know, are you afraid of many things?”, “Do you often refrainfrom doing something because of your fear of being embarrassed?” and Sensitivity to Reward(SR; Cronbach’s α=0.76 present sample; α=0.75 validation sample), e.g. “Do you like tocompete and do everything you can to win?”, “Do you often do things to be praised?”Convergent and discriminant validity as provided in the initial validation studies indicate thatSensitivity to Punishment positively correlates with Neuroticism (r=0.62) and negativelycorrelates with Extraversion (r=-0.53) while Sensitivity to Reward correlates positively with bothNeuroticism (r=0.33) and Extraversion (r=0.41). Sensitivity to Punishment also correlates withtrait anxiety (r=0.59) while Sensitivity to Reward does not (r=0.10, p>0.05). A strength of theSPSRQ is its convergent validity with a behavioural measure of Punishment Sensitivity indisordered eating and alcohol use samples; however, convergent validity with a behaviouralmeasure of Reward Sensitivity was not supported (Loxton & Dawe, 2007). One limitation of thisscale is that its two-factor structure has been questioned with some items demonstrated to have43poor factor loadings (Cogswell, Alloy, van Dulmen, & Fresco, 2006; O’Connor, Colder, &Hawk, 2004).Eating Disorder Diagnostic Scale (EDDS). The EDDS (Stice, Telch, & Rizvi, 2000)was used as a self-report measure of ED diagnosis. This scale assesses the DSM-IV diagnosticcriteria for AN, BN, and BED. Initial validity and reliability data comes from a study of 367females between the ages of 13-65 (Stice et al.). The one-week test-retest reliability reported inStice and colleagues’ study was κ = 0.95 for AN, κ = 0.71 for BN, and κ = 0.75 for BED.Criterion validity was established by comparing the EDDS to diagnoses from the EatingDisorder Examination interview (Fairburn & Cooper, 1993). Agreement between the EDDS andEDE appeared to be adequate:  κ =0.93 (AN), κ = 0.81 (BN) and κ = 0.74 (BED). Sensitivity andspecificity were also adequate with values greater than 0.93 for AN, 0.81 for BN and 0.77 forBED. Evidence of convergent validity was provided by their finding that the identified eatingdisorder groups scored higher on several other well-established measures of eating pathologythan the non-eating disordered controls.Eating Disorder Examination Questionnaire (EDE-Q 6.0). The EDE-Q (Fairburn &Bèglin, 1994) is a self-report measure derived from the EDE interview (Fairburn & Cooper,1993). This scale provides frequency ratings for laxative misuse, self-induced vomiting andbinge eating in the past 28 days. In an undergraduate female sample, the two-week test-retestreliability has been reported as r = 0.68 for the frequency of binge eating (Luce & Crowther,1999). The EDE-Q item pertaining to the number of objective binge days in the past month wasused as the binge eating measure (“Over the past 28 days, on how many days have such episodesof overeating occurred, i.e., you have eaten an unusually large amount of food and have had asense of loss of control at the time?”).44Alcohol Binge Frequency. The NIAAA definition of a binge for females, which is theconsumption of four or more drinks within a two hour period, was used (NIAAA, 2004). A drinkwas defined as half an ounce (15 ml) of absolute alcohol (e.g. a 12 ounce/355 ml can or glass ofbeer or cooler, a 5 ounce/ 150 ml glass of wine, or a drink containing 1 shot of liquor).Participants provided an estimate of past month alcohol binge frequency.2.3 Results2.3.1 Psychometrics & data reductionA principal components analysis with direct oblimin rotation (delta=0) was completedusing the BIS/BAS Scale and the SPSRQ to derive a comprehensive measure of RewardSensitivity and Punishment Sensitivity for use in subsequent analyses. An oblimin rotation wasselected to account for the possible interdependence between the reward and punishmentsensitivity measures postulated by the joint-subsystems conceptualization of the BIS/BASsystems (Corr, 2001, 2002). A square-root transform was applied to BAS RewardResponsiveness to adjust for negative skew. A two-component solution explained 63.70% of thevariance with a correlation of -0.02 (Table 2.1).Table 2.1 Reinforcement Sensitivity Measures PCAComponent Loadings(n=1001)Subscales M (SD) Reward Sensitivity Punishment SensitivitySP SPSRQ 13.09 (5.31) -0.13 0.85BIS 22.29 (3.43) 0.13 0.87SR SPSRQ 10.36 (4.12) 0.68 0.13BAS Drive 10.91 (2.21) 0.75 -0.19BAS Fun-Seeking 11.35 (2.37) 0.74 -0.20BAS Reward Responsiveness 17.47 (2.17) 0.76 0.24eigenvalue 2.20 1.63% of variance 36.58 27.12Note: BAS = Behavioural Approach System; BIS = Behavioural Inhibition System scale from BIS/BAS Scale; SPSPSRQ = Sensitivity to Punishment scale from Sensitivity to Punishment and Sensitivity to Reward Questionnaire;45SR = Sensitivity to Reward scale from SPSRQ. Bolded items reflect the PCA component on which the scales hadprimary loadings.Means and standard deviations for the UPPS-P and correlations between the UPPS-P, theseparate Reinforcement Sensitivity Theory measures and PCA components are presented inTable 2.2. The BAS Fun-Seeking scale was moderately associated with Negative and PositiveUrgency and Lack of Premeditation and had a large association with the UPPS-P SensationSeeking scale in line with prior criticism of this scale tapping both rash impulsiveness andreward sensitivity. A large association between the Reward Sensitivity component and SensationSeeking as well as medium associations with Negative and Positive Urgency were also evidentand suggestive of construct overlap.Table 2.2 Correlations between Personality MeasuresPearson Correlation Coefficients(n=1001)Subscales M (SD) BIS BAS-FS BAS-D BAS-RRSPSPSRQSRSPSRQPS RSNU 2.27 (0.57) 0.15** 0.31** 0.18** 0.11** 0.25** 0.42** 0.21** 0.34**PU 1.78 (0.57) -0.10** 0.31** 0.20** 0.03 0.17** 0.42** 0.02 0.30**SS 2.55 (0.61) -0.25** 0.55** 0.33** 0.18** -0.32** 0.35** -0.34** 0.49**LPM 1.92 (0.42) -0.26** 0.34** 0.12** -0.09* -0.25** 0.18** -0.32** 0.18**LP 2.05 (0.47) 0.03 0.05 -0.20** -0.18** 0.28** 0.10* 0.16** -0.10**Note. NU = Negative Urgency; PU = Positive Urgency; SS = Sensation Seeking; LPM = Lack of Premeditation; LP= Lack of Perseverance; BIS = Behavioural Inhibition System scale from BIS/BAS Scale; BAS-FS = BehavioralApproach System Fun Seeking subscale; BAS-D = BAS Drive subscale; BAS-RR = BAS Reward Responsivenesssubscale; SP SPSRQ = Sensitivity to Punishment scale from Sensitivity to Punishment and Sensitivity to RewardQuestionnaire; SR = Sensitivity to Reward scale from SPSRQ; PS = Punishment Sensitivity Component; RS =Reward Sensitivity Component*p<0.05**p<0.001462.3.2 Binge analysesThe analysis approach involved the computation of Pearson correlation coefficients toidentify zero-order relationships between the personality facets and bingeing behaviours.Hierarchical multiple linear regression was then conducted with the personality facets entered aspredictors of the binge behaviours. This allowed us to determine partial relationships betweeneach personality facet and the binge behaviours while taking into account relationships with theother personality facets. The UPPS-P facets were entered in the first block (Model 1) with theRST components entered in the second block (Model 2). Analyses were first conducted acrossthe entire sample (i.e. all participants were included irrespective of endorsement of bingebehaviour). Given that the majority of the sample did not endorse any binge behaviour, thisanalysis primarily reflected differences between bingeing and non-bingeing women. Tocharacterize the relationship between the personality facets and frequency of binge behaviour,analyses were then run using data limited to participants who endorsed two or more food (bingeeating group; n=249) or alcohol (binge drinking group; n=249) binge days in the past 28 days. Athreshold of two or more binge days was selected to identify participants with recent, repetitivebingeing behaviour. This more focused analysis aimed to identify the contribution of eachpersonality facet to the frequency of engagement in the behaviour amongst those with recurrentepisodes. Ninety-three participants fell in both the binge eating and binge drinking groups,indicating they endorsed recent engagement in both behaviours. The entire sample analysisincluded women who binged in the past month, any time prior to the past month and those thathave never binged, whereas the current bingeing group analysis only included those women thatbinged in the past 28 days. Correlation and regression analyses were completed with natural logtransformed binge data given positive skew.47Descriptive statistics and correlations are presented in Table 2.3. Food binge frequency(range: zero to daily) was positively correlated with all personality facets with the largestassociation observed for Negative Urgency. In the current binge eating group, binge eatingfrequency had small to medium positive correlations with Negative Urgency, Sensation Seeking,Lack of Perseverance and Reward Sensitivity.Alcohol binge frequency (range: zero to 16) had the largest positive correlations withSensation Seeking and Reward Sensitivity and small to medium positive correlations with theremaining personality facets with the exception of Punishment Sensitivity with which it had asmall negative association. In the current binge drinking group, alcohol binge frequency hadsmall, positive associations with Negative Urgency, Positive Urgency, Lack of Premeditationand Lack of Perseverance.Table 2.3 Descriptive StatisticsBivariate Correlationsn M SD NU PU SS LPM LP PS RSFood BingesEntire Sample 1001 1.50 3.52 0.35** 0.24** 0.11** 0.12** 0.20** 0.16** 0.19**Current Binge 249 5.73 5.08 0.17* 0.003 0.14* 0.04 0.23** 0.07 0.16*Alcohol BingesEntire Sample 1001 1.17 2.20 0.23** 0.15** 0.29** 0.22** 0.14** -0.11* 0.26**Current Binge 249 4.22 2.60 0.16* 0.16* 0.03 0.22** 0.24** -0.03 0.07Note. Entire Sample=all participants; Current Binge=participants with two or more binges of the specified type inthe past 28 days; NU=Negative Urgency; PU=Positive Urgency; SS=Sensation Seeking; LPM=Lack ofPremeditation; LP=Lack of Perseverance; PS=Punishment Sensitivity Component; RS=Reward SensitivityComponent.*p<0.05**p<0.001Hierarchical multiple linear regression analyses with UPPS-P facets entered in the firstblock (Model 1) and RST components entered in the second block (Model 2) identified unique48contributions to food and alcohol binge behaviours. Results of regression analyses with 4000bootstrap samplings, VIF <2.5 and tolerance >0.10 are presented in Table 2.4. Across thesample, the addition of Reward Sensitivity/Punishment Sensitivity accounted for significantlymore variance in binge eating beyond that accounted for by the UPPS-P facets. Significantpositive predictors in the entire sample were Negative Urgency, Lack of Perseverance, RewardSensitivity and Punishment Sensitivity. In the current binge eating group, the addition of RewardSensitivity/Punishment Sensitivity to the model approached significance (p=0.072); NegativeUrgency became non-significant whereas Positive Urgency emerged as a significant negativepredictor with the addition of Reward Sensitivity/Punishment Sensitivity to the model.In the entire sample, Reward Sensitivity and Punishment Sensitivity accounted foradditional variance in alcohol binge frequency beyond the UPPS-P facets. Negative Urgency,Lack of Perseverance, Sensation Seeking and Reward Sensitivity were significant positivepredictors. Punishment Sensitivity was a negative predictor and counter to expectation, PositiveUrgency also emerged as a negative predictor. Amongst the current binge drinking group, Model2, with the addition of Reward Sensitivity/Punishment Sensitivity did not account forsignificantly more variance than Model 1. Lack of Perseverance and Lack of Premeditation werethe only significant predictors in Model 1.49Table 2.4 Regression SummaryFood Binge FrequencyEntire Sample2(n=1001)Current Binge2(n=249)BCa 95% CI BCa 95% CIPredictors B SE LL UL AdjR2 ∆R2 B SE LL UL AdjR2 ∆R2NU 0.35** 0.06 0.23 0.48 0.14** 0.02** 0.15 0.08 -0.02 0.31 0.11** 0.02PU -0.01 0.06 -0.14 0.12 -0.17* 0.08 -0.33 -0.02LPM 0.00 0.07 -0.14 0.14 -0.16 0.10 -0.36 0.06LP 0.17* 0.07 0.04 0.31 0.37** 0.10 0.18 0.56SS 0.03 0.05 -0.06 0.13 0.13 0.08 -0.03 0.28RS 0.08* 0.03 0.03 0.14 0.10* 0.04 0.01 0.18PS 0.08* 0.03 0.02 0.13 0.01 0.04 -0.08 0.10Alcohol Binge FrequencyPredictorsEntire Sample2(n=1001)Current Binge1(n=249)NU 0.19* 0.06 0.08 0.30 0.14** 0.02** 0.04 0.06 -0.08 0.14 0.07**PU -0.14* 0.06 -0.24 -0.03 0.02 0.05 -0.09 0.11LPM 0.11 0.07 -0.03 0.24 0.14* 0.07 0.00 0.26LP 0.18* 0.06 0.07 0.29 0.15* 0.06 0.04 0.27SS 0.18** 0.04 0.11 0.26 -0.02 0.05 -0.10 0.07RS 0.11** 0.03 0.06 0.16PS -0.05* 0.02 -0.10 -0.01Note. 1Model 1=UPPS-P facets; 2Model 2=UPPS-P facets + RS/PS components; ∆R2=change in variance accountedfor with the addition of RS and PS to the regression model; Adj=Adjusted; B=Unstandardized b value; SE=standarderror; BCa CI=bias corrected and accelerated confidence interval; LL=lower limit; UL=upper limit; EntireSample=all participants; Current Binge=participants with two or more binges of the specified type in the past 28days; NU=Negative Urgency; PU=Positive Urgency; SS=Sensation Seeking; LPM=Lack of Premeditation;LP=Lack of Perseverance; RS=Reward Sensitivity; PS=Punishment Sensitivity.*p<0.05**p<0.0012.4 DiscussionIn line with our hypotheses and past work, Negative Urgency significantly correlatedwith and remained a significant predictor of bingeing when the other UPPS-P facets wereconsidered concurrently. Relationships with Positive Urgency were more complex. PositiveUrgency had significant zero-order correlations with bingeing in the entire sample; however, anegative partial relationship with binge drinking unexpectedly emerged. The negative50relationship may be attributable to the loss of meaningful variance due to dispersion of positiveaffect across facets with stronger binge drinking correlations (i.e. Sensation Seeking and RewardSensitivity). However, prior evidence of a negative relationship between Positive Urgency andintoxication amongst moderate to heavy drinkers suggests that the relationship between PositiveUrgency and drinking requires further consideration (Simons et al., 2010). Interestingly in thecurrent binge eating group, Positive Urgency emerged as a negative predictor and NegativeUrgency and Punishment Sensitivity became non-significant predictors of binge eating. This isconsistent with recent findings of Negative Urgency prospectively predicting classification into abinge eating group but failing to predict increases in binge frequency amongst binge eaters(Fischer et al., 2013). Individuals with high Negative Urgency may binge eat in an attempt toregulate negative affect (Cyders & Smith, 2008; Pearson et al., 2014), while another factor maybetter account for the frequency of this behaviour. Positive Urgency may function as a proxy foranother factor such as low positive affect; this correlate may more directly confer risk forbingeing rather than low Positive Urgency. As the Positive Urgency findings were unexpected,replication will be required to further elucidate the unique role of Positive Urgency in bingeing.Lack of Perseverance was a significant predictor of binge eating and drinking across thebroader sample and amongst individuals with current bingeing. Susceptibility to boredom anddistraction is associated with binge risk and severity. Lack of Perseverance and Lack ofPremeditation, which has been previously linked to bulimic symptoms (Fischer et al., 2004;Smith et al., 2007), load together on a higher order factor reflective of lack of conscientiousness(Cyders & Smith, 2007; Smith et al., 2007). Thus, a broader deficit in conscientiousness maycontribute to bingeing. Low conscientiousness may reflect, in part, poor executive controlresulting in disinhibited behaviour, especially in the presence of reinforcers like food or alcohol,51or it may reflect the use of food or alcohol as reinforcers in place of those requiring sustainedfocus (e.g., academic or occupational pursuits) (Magid & Colder, 2007). Lack of Perseverancemay also be indicative of boredom intolerance due to its perception as a negative emotional state.There appears to be an association between bulimic symptoms and low distress tolerance(Anestis, Selby, Fink, & Joiner, 2007). Further work is needed to clarify the association betweenLack of Perseverance/Lack of Premeditation and bingeing.As expected, Reward Sensitivity and Punishment Sensitivity accounted for additionalvariance in bingeing, indicating that motivational sensitivities also play an important role beyondthat of the UPPS-P facets. Negative Urgency and Positive Urgency had moderate correlationswith Reward Sensitivity in line with the involvement of Reward Sensitivity in both activeavoidance and approach. BAS Fun Seeking and Sensation Seeking were also highly correlated(r=0.55); thus, the inclusion of BAS Fun Seeking in the composite measure of RewardSensitivity may have attenuated the amount of variance attributable to Reward Sensitivity in theregression model. While the variance attributable to the RST-derived traits was small, it wasevident even in the presence of the moderate correlations between UPPS-P facets and theReinforcement Sensitivity components, suggesting that there is meaningful variance that is notfully captured by the UPPS-P. Reward Sensitivity predicted binge eating across the broadersample and in the current binge eating group, suggesting that increased sensitivity to highlypalatable substances may further contribute to the likelihood that individuals will rely on bingeeating to regulate affect. The binge types differed in their relationships with PunishmentSensitivity. High Punishment Sensitivity predicted binge eating whereas low PunishmentSensitivity predicted binge drinking.52As anticipated, binge drinking, but not binge eating, was predicted by Sensation Seekingin the entire sample. Higher Reward Sensitivity predicted binge drinking beyond the positiveprediction of the highly-related trait of Sensation Seeking, suggesting the seeking out of excitingexperiences represents something more than the rewarding aspects of a stimulus (Carlson et al.,2013). Individuals high in Sensation Seeking may tend to seek out social contexts in whichdrinking occurs and heightened Reward Sensitivity may connote risk for higher levels ofconsumption in those contexts. Previous reports of partial mediation between high SensationSeeking and problematic drinking by reinforcing efficacy (Kiselica & Borders, 2013) andbehavioural reward response bias (Castellanos-Ryan, Rubia, & Conrod, 2011) reflect the currentfindings of a role for both Sensation Seeking and Reward Sensitivity in binge drinking.The results from the entire sample were considered in light of emotion regulationconceptualizations of binge behaviour as this analysis was thought to reflect more stableindividual differences in bingeing versus non-bingeing individuals. Whereas the frequency ofbingeing behaviour amongst bingeing individuals captured by the current bingeing analysis maybe more susceptible to fluctuations in binge frequency over time. Overall, the results from theentire sample support emotion regulation conceptualizations of binge behaviour. Increasedsensitivity to rewarding stimuli may contribute to binge eating due to positive reinforcement (i.e.a desire for high caloric binge foods) and negative reinforcement (i.e. distraction from negativeaffect) effects. Punishment Sensitivity and Negative Urgency may be generally elevated acrossbinge eaters as suggested by the decrease in variance accounted for amongst the binge eatingsample compared to the entire sample. Individuals with heightened Punishment Sensitivity maybe prone to higher or more frequent negative affect when faced with aversive cues (i.e. weightgain, criticism, rejection) (Loxton & Dawe, 2001). High Negative Urgency may contribute to53loss of control over intake during negative affective states regardless of the person’s level ofPunishment Sensitivity resulting in rapid overconsumption (Cyders & Smith, 2008) whennegative affect is experienced even in the absence of elevated Punishment Sensitivity. Thus,individuals with more reactive motivational systems or higher Negative Urgency may learn apattern of repetitive bingeing to alleviate distress (Fischer et al., 2004).Findings also support emotion regulatory models of binge drinking with implications forthe regulation of negative and positive affect (Cooper et al., 1995; 2000). Higher NegativeUrgency may confer risk to engage in hasty attempts to decrease negative affect through alcoholuse (Cyders & Smith, 2008). Our results, together with prior findings of partial mediation of therelationship between Sensation Seeking and drinking outcomes by enhancement motives,suggest that Sensation Seeking may be relevant to positive emotion regulatory efforts while theinvolvement of Positive Urgency is less clear (Adams et al., 2012). Heightened sensitivity to therewarding and negative reinforcement effects of alcohol may predispose individuals to learn toutilize alcohol for positive mood enhancement and coping motives, respectively. LowerPunishment Sensitivity may further contribute to this risk due to diminished motivation to avoidnegative consequences associated with this pattern of drinking.2.4.1 LimitationsCausal relationships cannot be determined from our cross-sectional data. However, riskfor disordered consumption conferred by Negative Urgency, Reward Sensitivity and PunishmentSensitivity is suggested by prior work in samples of young girls (Fischer et al., 2012; Loxton &Dawe, 2001). Research that includes measures of typical affect is needed to further inform theextent to which Negative Urgency and Positive Urgency are distinct facets beyond a sensitizationof reward pathways by negative affect (Gullo et al., 2014). A small proportion of variance was54accounted for in the current binge drinking group suggesting that other variables such as drinkingcontexts or peer group may be of greater relevance in predicting binge drinking severity amongstuniversity-age women. Our sample was limited to females due to higher rates of binge eating andan emerging emphasis on binge drinking in this demographic. Replication and extension inmixed gender samples will be required.2.4.2 ConclusionsThis is the first study using a large sample to examine unique and common influences ofemotion-based impulsivity and Reinforcement Sensitivity Theory-derived traits on bingeing. Thesample focused on a demographic at risk for developing eating and alcohol use disorders, asubset of whom endorsed binge behaviours suggesting these findings may have potential clinicalrelevance. Negative Urgency, Lack of Perseverance and Reward Sensitivity were commonpredictors of both binge eating and drinking. Punishment Sensitivity and Sensation Seekingdifferentiated between bingeing types with Punishment Sensitivity higher amongst binge eatingwomen and Sensation Seeking higher amongst binge drinking women compared to non-bingeingwomen. The relationship between Positive Urgency and bingeing was complex and warrantsfurther study. The study provides a significant contribution through examination of uniquepartial relationships and the use of discrete behavioural outcomes. Comprehensive models ofbingeing should incorporate UPPS-P facets and reinforcement sensitivity.55Chapter 3: Study Two3.1 IntroductionBinge eating and binge drinking frequently co-occur and represent significant healthconcerns amongst young women (Khaylis et al., 2009; Luce et al., 2007). Emotion dysregulationis commonly purported to underlie these maladaptive behaviours (see Ferriter & Ray, 2011 forreview). The course of an emotional response can be differentiated into emotion reactivity,which refers to the initial intensity of emotional activation and emotion regulation, which refersto purposeful changes in the activated emotion (Gross & Thompson, 2007). These processesoccur across subjective, behavioural and physiological response systems. As such, acomprehensive conceptualization of emotion processing in women with binge behaviour shouldinclude reactivity and regulation across response systems. Currently, support for emotionregulation theories of binge behaviour is mainly limited to the behavioural and experientialcomponents of the emotional response. The current study examined psychophysiologicalemotion reactivity to normative emotional stimuli and conscious emotion regulatory abilityamongst women who endorse binge behaviour.Two main lines of evidence support emotion regulation theories of binge behaviour:emotions as antecedents of binge episodes and self-reported emotion regulation skill. In regardsto binge eating, negative emotional states commonly precede binge episodes in daily life (seeHaedt-Matt & Keel, 2011 for review) and experimentally-induced negative emotional states areassociated with the desire to binge eat, increased food consumption and loss of control overeating in the laboratory (see Leehr et al., 2015 for review). In accordance with motivationalaccounts of alcohol use (Cooper et al., 1995), evidence suggests that both positive and negativeemotional states may act as triggers for heavy alcohol consumption (Dvorak & Simons, 2014;56Simons et al., 2005). Amongst young people, positive emotion enhancement tends to play agreater role in heavy drinking as opposed to attempts to reduce negative emotions (Kuntsche,Knibbe, Gmel, & Engels, 2005). In support of the primacy of drinking to increase positiveemotion in this age group, heavy drinking frequently occurs in celebratory contexts (e.g. Klein,1992; Kairouz, Gliksman, Demers, & Adlaf, 2002) and enhancement motives are a strongpredictor of hazardous drinking (Lyvers, Hasking, Hani, Rhodes, & Trew, 2010) whereasevidence of a link between heavy episodic drinking and coping motives is mixed (e.g. Rutledge& Sher, 2001; McCabe, 2002). Positive emotions may also contribute to binge drinking risk dueto the interference of high unregulated positive affect on inhibitory control mechanisms ordecreased perception of risks from heavy drinking, resulting in rapid, disinhibited consumptionof alcohol (Haase & Silbereisen, 2011).Research on competence to effectively regulate emotions also supports emotionregulation theories of binge behaviour. Based on self-report, women who binge eat tend to lackadaptive emotion regulation strategies, such as cognitive reappraisal (Svaldi et al., 2012;Whiteside et al., 2007) and may rely on maladaptive strategies such as the suppression ofemotional expression (termed expressive suppression; Danner et al., 2014; Svaldi et al., 2012).This strategy may result in increased physiological arousal rather than the intended effect ofdecreasing arousal (Gross, 1998). There is also preliminary evidence that expressive suppressionis associated with higher caloric intake; participants trained to use expressive suppression duringan experimentally induced sad mood consumed more calories in a subsequent food tasting taskthan participants who were trained to use cognitive reappraisal (Svaldi et al., 2014).The ability to accurately identify feelings and describe emotional experiences helps withthe selection of appropriate regulation strategies; difficulties in these aspects of emotion57regulation predict binge eating in women with eating disorders and in non-clinical samples withbulimic symptoms (Vine & Aldao, 2014; Wheeler et al., 2005; Whiteside et al., 2007).Moreover, treatments targeting emotion regulation skills, such as dialectical behaviour therapy(DBT) for binge eating disorder (BED), are associated with improvement in self-reportedemotion regulation skill and abstinence from binge eating (Wallace et al., 2014).Similar to the findings for binge eating, self-reported lack of emotional clarity alsopredicts problematic alcohol use (Vine & Aldao, 2014) and, in combination with a lack ofadaptive emotion regulation strategies, mediates the relationship between higher self-reportednegative emotional intensity and coping drinking motives (Veilleux, Skinner, Reese, & Shaver,2014). Given these findings of difficulties self-identifying emotional experiences,psychophysiological measures of emotion processes are particularly important to furtherunderstand the emotional experience and ability to regulate emotional intensity in women whobinge eat or drink.The current study aimed to test the hypothesis that women engage in binge behaviour inan attempt to regulate their emotional intensity due to deficits in regulatory ability. This wasevaluated using two psychophysiological measures, the startle blink and corrugator muscleactivity, that allow for the assessment of reactivity to emotional stimuli and regulation ofnegative and positive emotional states. In the startle blink paradigm, the size of a defensive blinkreflex elicited by an abrupt stimulus (i.e. an aversive sound blast) is augmented when an aversiveemotional state is active and decreased in magnitude when an appetitive emotional state is active(Lang, et al., 1990; Lang, 1995; Vrana, et al., 1988). This paradigm has been used to study thevoluntary regulation of positive and negative emotions with measurable changes in startlemagnitude associated with explicit instructions to alter the intensity of the emotional response in58non-clinical samples (e.g. Bernat et al., 2011; Dillon & LaBar, 2005; Driscoll et al., 2009;Jackson et al., 2000), in dependent smokers (Piper & Curtin, 2006) and based on type of emotionregulation strategy (Asnaani, Sawyer, Aderka, & Hofman, 2013). The resulting pattern of blinkmagnitudes indicates that the response is altered along the arousal rather than the valencedimension (i.e. larger blink magnitudes are observed when enhancing and smaller blinkmagnitudes are observed when decreasing emotional intensity of both negative and positivevalence).Similar to startle blink magnitude, corrugator supercilii muscle activity varies withintensity of negative and positive affect (Lang et al., 1993). Corrugator muscle activity occurswith facial expressions of distress, that is the drawing in and down of the eyebrows associatedwith frowning, and is sensitive to subtle emotional expressions that are not observable (Lang etal., 1993). Activity is greatest with negative emotional states and lowest with positive emotionalstates. In contrast to the startle blink, voluntary attempts to regulate emotion are associated withchanges in corrugator activity along the valence dimension (i.e. corrugator activity is greaterwith attempts to enhance negative emotion and activity is lower with attempts to enhancepositive emotion; Baur, Conzelmann, Wieser, & Pauli, 2015; Bernat et al., 2011).Startle blink and corrugator activity have been used previously to study emotionreactivity to disorder specific and general emotional stimuli in bingeing populations. Thesestudies reported normative responses to general affective images and negative responses to foodimages in women with bulimic symptoms (Altman et al., 2013; Drobes et al., 2001; Mauler et al.,2006). Positive responses to alcohol images were demonstrated in college age drinkers (Drobeset al., 2009). The effect of alcohol on emotion reactivity has also been examined using the startleprobe. At high levels of alcohol intoxication, the startle response is reduced during viewing of59negative images with no effect on response during positive image viewing (Donohue, Curtin,Patrick, & Lang, 2007). A reduction in negative emotional reactivity as indexed by startlemagnitude and/or corrugator has also been found at more moderate levels of intoxication underconditions of anxiety (Hefner et al., 2013) and under conditions of threat with competingcognitive demands (Curtin, Lang, Patrick, & Stritzke, 1998; Curtin, Patrick, Lang, Cacioppo, &Birbaumer, 2001). Interestingly, the effect of dampening anxiety was lower in binge drinkingindividuals. These studies provide support for emotion regulation theories of alcohol use bydemonstrating the ability of alcohol to alter evoked emotional responses. However, to ourknowledge no prior studies have applied these psychophysiological methods to consciousemotion regulatory attempts in women who engage in either binge eating or binge drinking.In the current study, emotion reactivity and regulation to normative emotional stimuliwas examined in four groups of young women: binge eating, binge drinking, binge-combined(endorsement of binge eating and binge drinking) and non-bingeing control women. No groupdifferences were hypothesized in emotion reactivity based on prior work using similarmethodology. Emotion regulation ability was hypothesized to differ between groups as follows:1) Women who endorsed binge eating would demonstrate difficulty decreasing negativeemotions relative to non-bingeing women.2) Women who endorsed binge drinking would demonstrate difficulty regulatingpositive emotion compared to non-bingeing women. This would be evident asdifficulty either maintaining or decreasing positive emotion.3) Women who endorsed both binge eating and binge drinking would have greateremotional dysregulation than all other groups with difficulty decreasing both negativeand positive emotion.60Emotion regulation strategies were also assessed and it was hypothesized that the Binge Eatingand Binge-Combined groups would rely more on expressive suppression strategies. Eating anddrinking motives were evaluated to characterize the motivations behind the different groups’eating and drinking habits. In accordance with the negative emotion regulatory deficitshypothesized for Binge Eating and Binge-Combined groups, these groups were predicted toendorse higher coping motives for eating. In accordance with the difficulties regulating positiveemotions hypothesized for the Binge Drinking and Binge-Combined groups, these groups werepredicted to endorse higher enhancement motives for drinking.3.2 Methods3.2.1 Power analysisBased on an examination of the literature, a medium effect size of f=.25 was selected forthe power analysis to determine the required number of participants to have power of .80 with analpha of .05. As such, a study by Drobes and colleagues (2001) which compared the startlemagnitude to food and affective pictures between binge eaters, deprived, restrained and controlparticipants reported a medium effect size of d = .55 for the difference between binge anddeprived compared to restrained and control participants in their startle magnitude to foodpictures. Mauler et al. (2006) reported significantly larger startle responses elicited to food cuesin those with bulimia than for control participants with an eta of .52. The effect size for thedifference between suppress and maintain negative emotion conditions at a 7 second probe timewas d = .57 (Jackson et al., 2000). The effect size for affective modulation at a 3 second probetime (unpleasant versus neutral) was d =1.17.Since emotion regulatory ability is hypothesized to differ between groups depending onthe image valence, the sample size to obtain an effect size of f =.25 at power of .80 and alpha of61.05 for a repeated measures ANOVA between-within interaction (Group x Regulation Condition)was calculated using G*Power 3 (Faul, Erdfelder, Lang, & Buchner, 2007) for four groups(binge eating, binge drinking, combined bingeing and non-bingeing) with two measurements(decrease and maintain emotion), giving a total sample size of 72 (18 women per group). A studywhich used a similar design to examine emotion regulation in smokers in withdrawal had 24participants per group (Piper & Curtin, 2006). Their post-hoc power analysis revealed that thisgave them power of .98 to detect a medium effect size.3.2.2 ParticipantsFemale participants were recruited from the University of British Columbia PsychologyDepartment Human Subject Pool, a psychology study list-serve and through posters on campusand in the community. An all-female sample was selected due to greater eating disorder risk inwomen and gender differences in emotion-motivated drinking (Jacobi, et al., 2004; Nolen-Hoeksema, 2012). Participants were invited to participate based on their responses to online ortelephone screening questions pertaining to binge eating and drinking frequency in the pastmonth and past year and contraindicators for EEG recording (i.e. head injury, neurological orcardiac conditions, bipolar disorder or psychotic illness, anti-psychotic or mood stabilizer use).Exclusion criteria included age <18 or >30 years, endorsement of EEG contraindications, or apossible anorexia nervosa diagnosis based on the Eating Disorder Diagnostic Scale (BMI cut-offof less than 17.5 as per EDDS; Stice et al., 2000) due to the potential detrimental effects ofstarvation on cognition (Zakzanis et al., 2010).One-hundred nineteen university-age females met group inclusion criteria in thelaboratory (See Figure 3.1 for participant selection flowchart). Participants received course credit62or remuneration for their participation. A list of community resources was provided toparticipants if requested.Figure 3.1 Participant FlowchartNote: Phone screen initially assessed for general eligibility criteria. Binge frequency questions were subsequentlyadded to improve the efficiency of recruitment.3.2.3 ProcedureParticipants provided informed consent and study procedures were approved by theUniversity of British Columbia Behavioural Research Ethics Board. Participants were screenedusing a brief telephone questionnaire if they were recruited from the community or several onlinequestionnaires if they were student participants. Responses were used to invite those whopotentially fell within our pre-defined groups for further testing with group assignmentconfirmed in the laboratory. The online battery was completed by all participants and alsoincluded assessment of eating (Eating Motives Questionnaires, EMQ; Jackson et al., 2003) anddrinking motives (Drinking Motives Questionnaire, DMQ; Cooper, 1994). Participants wereinstructed to eat a minimum of two hours prior to the testing session and to abstain from alcoholAttended Laboratory following OnlineQuestionnairesN=45Attended Laboratory following PhoneScreen & Online QuestionnairesN=148Met GroupCriteria in Labn=27 + n=92Did Not Meet GroupCriteria in Labn=17Did Not Meet GroupCriteria in Labn=53Withdrewfrom Studyn=1Withdrewfrom Studyn=3Binge CombinedGroupn=32Binge DrinkingGroupn=25Binge EatingGroupn=25Healthy ControlGroupn=3763and illicit substances for 24 hours prior to the study. Participants who endorsed alcohol use in thepast 24 hours were invited to participate on an alternate day. During set-up for EMG and EEGrecording, participants completed the Depression Anxiety Stress Scale (DASS-21; Lovibond &Lovibond, 1995).Participants were provided with written examples of different eating scenarios to helpthem identify binge eating episodes (Goldfein, Devlin, & Kamenetz, 2005), which were definedas eating what other people would regard as an unusually large amount of food given thecircumstances while feeling a loss of control (feeling that they could not stop eating or controlwhat they were eating) at the time they were eating. Participants were also given examples tohelp them identify binge drinking episodes (four or more drinks within a 2-hour period; NIAAA,2004), i.e. drinking the equivalent of at least 4 12-ounce/355 ml cans or bottles of beer, 4 fiveounce/150 ml glasses of wine, or 4 drinks each containing one shot of liquor or spirits. Separatequestionnaires assessed binge eating and drinking in the past 28 days (open-ended response), thepast three and six months (weekly averages), and the past year (response options: “0 times in thepast year”, “1 to 2 times in the past year”, “3 to 11 times in the past year”, “once a month”, “2 to3 times a month”, “once a week”, “twice a week”, “3-4 times a week”, “5-6 times a week” and“Everyday”). The questions pertaining to frequency of objective binge eating episodes weredrawn from the Eating Disorder Examination-Questionnaire (EDE-Q 6.0; Fairburn & Bèglin,1994) and Eating Disorder Diagnostic Scale (EDDS; Stice et al., 2000) and the binge drinkingquestions were administered in a similar format. Participant responses were clarified as required.Group assignment to one of four groups was determined based on the binge behaviourquestionnaires completed in the laboratory. Participants in the Binge Eating and Binge Drinkinggroups were permitted up to two binges of the other type within the past year and none in the64past month. Given the high rate of binge drinking in the student population (Wechsler et al.,2002), two binge drinking episodes in the past year were permitted in the Healthy Control groupso as not to overly restrict recruitment. Multiple time frames were assessed to select participantswith both recent and recurrent binge behaviour. Group criteria were as follows: Binge Eating (BE): a pattern of repetitive food binges over the past year as indicated byone or more food binge episodes in the past month and a minimum of weekly episodes inthe past 3 or 6 months, or monthly food binge episodes in the past year.3 Binge Drinking (BD): a pattern of repetitive alcohol binges as indicated by one or morealcohol binges in the past month and a minimum of weekly binges in the past 3 or 6months, or monthly alcohol binge episodes in the past year. Binge-Combined (BC): fulfilled both the BE and BD criteria (i.e. endorsement one ormore episodes of both types in the past month and a minimum of weekly episodes of bothtypes in the past 3 or 6 months, or monthly episodes in the past year). Healthy Control (HC): no current bingeing behavior and two or less binges in the pastyear.The binge drinking frequency criteria align with those used by the Canadian Community HealthSurvey (Statistics Canada Health Fact Sheet “Heavy Drinking, 2013”) to assess prevalence ofheavy drinking. The binge eating frequency criteria are similar to those used in a prospectiveexamination of binge eating and depressive symptoms (Skinner, Haines, Austin, & Field, 2012). Emotion regulation taskNine practice trials preceded the start of the task to allow for initial habituation to thestartle probe. The startle probe consisted of a 50 ms burst of 95 db white noise with near3 The criteria for BE were expanded to include: Two participants with only one past month alcohol binge and arepetitive pattern of binge eating in the past year, three participants with three to four alcohol binges in the pastyear (none in the past month) and a pattern of repetitive binge eating in the past year and one participant with nopast month food binges, but weekly food binges in the past 3, 6 and 12 months.65instantaneous rise-time generated using Audacity 1.3 Beta (Unicode) software. The startle probewas presented binaurally through ear insert head phones.Ninety-six images (32 of each valence: positive, neutral and negative) from theInternational Affective Picture System (IAPS; Center for the study of emotion and attention[CSEA-NIMH], 1999) were presented in pseudo-random order separated into two blocks of 48pictures4. Normative valence ratings significantly differed between valence categories (PositiveM=7.56, SD=0.61; Neutral M=5.00, SD=0.23; Negative M=2.16, SD=0.61). The block orderwas counterbalanced across participants with a short break between blocks. The negative andpositive valence conditions were matched for arousal within each block (Block 1 t(30)=1.74,p=0.092; Block 2 t(30)=1.71, p=0.097). The three picture valences (negative, neutral, positive)were crossed with two regulation instructions (decrease and maintain) and three probe conditions(no probe, 3 s and 7 s). The 3 s probe time assessed emotion reactivity and the 7 s probe timeassessed emotion regulation. Figure 3.2 depicts the timeline of a typical trial, including thetiming of emotion reactivity and regulation assessment. Each trial consisted of picturepresentation (8 s duration) with a 100 ms visual regulation cue appearing at 4 s post-image onset,which consisted of a solid black box with a central red minus sign (decrease emotion) or a whiteequal sign (maintain emotion). Each picture presentation was followed by a blank screen (4 sduration; a startle probe occurred during four of these screens to increase startle4 Block 1: 7100M,1120D, 7235D, 1280M, 3030M, 4538D, 9910M, 7053M, 2071M, 8200D, 9561M, 1525D, 7037D, 5910D,5621M, 9600M, 2383D, 1205D, 8186M, 7170D, 5629M. 3068M, 3301D, 7041M, 4680D, 7040M, 6821D, 6300M, 4626M,4695M, 7031D, 7705M, 7175D, 6313D, 7500D, 7034M, 2191M, 7502D, 6230M, 8185D, 3150D, 8502D, 2102M, 2215D,4645M, 2040M, 4572D, 9050D; Block 2: 7059D, 9250M, 7056M, 4689M, 2345D, 8030M, 9181D, 2100M, 6150M, 1300M,4677M, 8540M, 8210D, 2575D, 1270D, 2305M, 6550D, 3100M, 8370D, 1710D, 7020M, 7547M, 3000D, 7010D, 6571D,4542M, 2190M, 1463D, 8490D, 1220M, 3101M, 7036D, 3160D, 1930D, 7550M, 7030D, 7050M, 2070M, 7052D, 9611M,4608D, 1440M, 7025D, 4533M, 9435D, 6260M, 4660D, 7140D; M=Maintain Emotion; D=Decrease Emotion;66unpredictability), a screen with the word “RELAX” (4 s duration) and a screen promptingparticipants to push a button to view the next picture. There were four of each type of trial perblock (e.g., four negative images, decrease emotion cue, 7 s probe time per block) for a total ofeight trials of each type across the experiment. The number of trials per condition, duration ofpicture presentation and timing of startle probes were selected to reflect prior investigations,which reported significant emotion reactivity and regulation effects amongst healthy controlsusing these parameters (Jackson et al., 2000; Piper & Curtin, 2006). At the start of the task, theemotion regulation instructions were displayed on the computer screen and read aloud by theexperimenter. Participants were free to choose their own regulation strategy with the exceptionthat they were asked not to think of a different emotion or of something unrelated to the picture.67Figure 3.2 a) Emotion Reactivity Assessment b) Emotion Regulation AssessmentNo subjective ratings of the images were recorded during the startle task; after the startletask was completed, participants viewed the images a second time and provided ratings for eachimage using a nine-point visual analogue scale with figures depicting displeasure to pleasure(valence rating) and calm to aroused (arousal rating) (IAPS Self-Assessment Manikin [SAM]:Bradley & Lang, 1994). Participants completed an emotion regulation strategy questionnaire68consisting of open-ended questions regarding strategies used for each of the regulationconditions (similar to that described by Jackson et al., 2000; see Appendix A). Electromyographic recording: startle blink and corrugator activityElectromyographic (EMG) data was acquired with a Brain Products Inc, QuickAmp 72System. Data was recorded with Brain Vision Recorder and was processed offline with BrainVision Analyzer (Brain Products, GmbH, Munich, Germany). The ground electrode was placedat the AFz site. Two Ag-AgCl 4-mm electrodes were placed on the orbicularis oculi musclebelow the left eye to measure the startle blink response, and two were placed on the corrugatorsupercilii muscle above the left eye to measure corrugator activity. Data was sampled at 1000Hz; target impedance was below 20kΩ (e.g. Larson, Ruffalo, Nietert, & Davidson, 2000);however, for participants for which this was unattainable, the study proceeded so long as therewas a detectable signal. Signals were digitally filtered offline with butterworth zero phase filterswith 30 Hz low cut off and 500 Hz high cut off, (startle: 48dB/octave roll-off startle; corrugator24 dB/octave roll-off) with a 60 Hz Notch filter. Data processingStartle EMG was rectified then smoothed with a 20 ms moving average window. Thestartle data was baseline corrected using 50 ms prior to the startle probe. Startle magnitudes weremanually scored as the peak activity between 15 and 120 ms after the startle probe. Trials wereexcluded if the blink began prior to 15 ms following the probe, if there was visible artifact, or ifexcessive noise was present during the baseline period or during the trial either obscuringaccurate detection of the startle peak or resulting in failure of baseline correction. Trials with nodetectable startle were scored as zero. Participants were excluded if there were <4 useable startletrials in each condition. Raw startle blink magnitudes were converted to within subject z-scores69prior to statistical analysis (Blumenthal et al., 2005). Any differences between the z-score andraw startle results are noted.Corrugator EMG was rectified and visually inspected for artifact. Emotion reactivity wascalculated as the mean activity (µV) in the 3 s post-image onset minus the mean activity 1 spreceding image onset. Emotion regulation was calculated as the mean activity in the 3 s post-emotion regulation cue minus the mean activity 1 s preceding image onset. Trials with a pre-emotion regulation cue startle probe were excluded from the corrugator emotion regulationanalysis to prevent interference of the startle probe on the ongoing emotional response.3.3 Results3.3.1 DemographicsAfter removal of participants with unusable data due to startle non-response (HealthyControl group=1, Binge Eating group=3, Binge-Combined group=1), less than four startle trialsper condition (Healthy Control group=6, Binge Eating group=6, Binge Drinking group=1,Binge-Combined group=1), computer error (Healthy Control group=2), corrugator recordingissues (Healthy Control group=3), fatigue/inattention (Healthy Control group=3, Binge Eatinggroup=1), and task confusion (Binge-Combined group=1), the final sample consisted of 90participants (Healthy Control group=23, Binge Eating group=15, Binge Drinking group=24 andBinge-Combined group=28). Self-identified ethnicity was 58.9% European, 31.1% East Asian,8.9% Indian-South Asian, and <5% African, Middle Eastern, Latin American-Hispanic; ageM=21.33 years, SD=1.87. Based on the EDDS, in the Binge Eating group possible diagnoseswere as follows: BN n=1; subthreshold BN n=10; BED n=1; subthreshold BED n=1; missingdata n=2. In the Binge-Combined group: possible BN n=5; subthreshold BN n=18; possible BEDn=2; subthreshold BED n=2; missing data n=1 (See Table 3.1 for binge endorsement). Separate70ANOVAs with significant effects followed up with pairwise comparisons were conducted usingdata from the EDE-Q, DASS-21, DMQ and EMQ to evaluate for potential group differences.EDE-Q scores tended to be higher in the Binge Eating and Binge-Combined groups compared tothe Healthy Control and Binge Drinking groups (See Table 3.2). Body Mass Index (BMI), basedon self-reported height and weight, was significantly higher in the Binge-Combined groupcompared to all other groups.Table 3.1 Binge DataBinge DaysPast Month Past YearGroup (n) FoodM (SD)AlcoholM (SD)FoodM (SD)AlcoholM (SD)Healthy Control (23) 0 0 0.52 (0.73) 0.20 (0.52)Binge Eating (15) 7.47 (6.03) 0.20 (0.41)1 129.53 (98.75) 1.73 (2.25)Binge Drinking (24) 0 3.58 (2.04) 0.31 (0.62) 42.92 (31.73)Binge-Combined (28) 5.50 (5.65) 5.00 (2.91) 75.25 (66.82) 65.89 (49.56)1Two participants endorsed one past month alcohol binge.Table 3.2 Eating Disorder Examination-Questionnaire ScoresGroupEDE-Q ScalesM(SD)Healthy Control(n=23)Binge Eating(n=13)Binge Drinking(n=24)Binge-Combined(n=28)BMI (kg/m2)1 20.86 (3.20) 19.72 (3.15) 20.32 (2.07) 23.65 (5.66)4Restraint2 0.71 (1.11) 1.88 (1.73) 0.93 (1.18) 2.65 (1.84)Eating Concern3 0.44 (0.73) 2.00 (1.90) 0.31 (0.62) 2.22 (1.55)Shape Concern3 1.59 (1.34) 3.31 (1.58) 1.67 (1.46) 4.23 (1.51)Weight Concern3 1.34 (1.37) 2.66 (1.91) 0.98 (1.20) 3.74 (1.54)EDE-Q Total3 1.02 (1.00) 2.46 (1.62) 0.97 (0.98) 3.21 (1.42)1Group Main Effect, p<0.05, Binge-Combined > Healthy Control, Binge Eating & Binge Drinking.2Group Main Effect, p<0.05, Binge Eating>Healthy Control; Binge-Combined>Healthy Control & Binge Drinking.3Group Main Effect, p<0.05, Binge Eating & Binge-Combined > Healthy Control & Binge Drinking.4BMI data missing for two Binge-Combined participants.In the final sample, one participant from the Binge Eating group and two from the Binge-Combined group endorsed anti-depressant/anti-anxiety medication use. As assessed by the71DASS-21, the Healthy Control group and the Binge Drinking group tended to score lower onDepression, Anxiety and Stress compared to the Binge Eating and Binge-Combined groups.Lower stress endorsed by the Healthy Control group compared with the Binge Drinking groupapproached significance, p=0.074 (see Table 3.3).Table 3.3 DASS-21 ScoresGroupDASS ScaleM (SD)Healthy Control(n=23)Binge Eating(n=15)Binge Drinking(n=24)Binge-Combined(n=28)Depression1 7.22 (7.97) 12.40 (10.37) 5.33 (4.89) 11.00 (10.03)Anxiety2 4.26 (4.80) 10.00 (7.64) 4.00 (3.37) 10.21 (8.75)Stress2 8.17 (8.28) 17.60 (8.63) 12.42 (6.78) 17.14 (8.46)1Main effect of Group, p=0.029, Binge Drinking < Binge Eating & Binge-Combined.2Main effect of Group, p<0.001, Healthy Control & Binge Drinking < Binge Eating & Binge-Combined.. See Table 3.4 for consumption motives. Groups with binge eating (Binge Eating andBinge-Combined) endorsed higher levels of coping and conformity eating motives compared tothe non-binge eating groups (Healthy Control and Binge Drinking). The binge drinking groups(Binge Drinking and Binge-Combined) endorsed greater coping, social and enhancementdrinking motives compared to the non-binge drinking groups (Healthy Control and BingeEating). Within the binge drinking groups (Binge Drinking and Binge-Combined), social andenhancement motive endorsement was significantly greater than coping and conformity motives.72Table 3.4 Eating and Drinking MotivesGroupEMQM (SD)HealthyControl(n=23)Binge Eating(n=13)BingeDrinking(n=24)Binge-Combined(n=28)Coping1 1.78 (0.78) 2.98 (1.27) 1.93 (0.68) 3.18 (0.90)Social 3.07 (1.20) 3.42 (0.81) 3.30 (0.86) 3.16 (1.02)Conformity2 1.38 (0.55) 2.14 (1.14) 1.40 (0.64) 2.10 (0.90)Pleasure 2.96 (1.06) 3.38 (0.77) 3.17 (0.69) 3.49 (0.75)DMQ (n=13) (n=10) (n=23) (n=28)Coping3 1.15 (0.23) 1.34 (0.44) 2.06 (0.72) 2.79 (0.88)Social4 2.12 (0.89) 2.64 (0.95) 3.61 (0.69) 3.72 (0.94)Conformity 1.26 (0.44) 1.68 (1.26) 1.59 (0.71) 1.73 (0.79)Enhancement4 1.29 (0.47) 1.46 (0.72) 3.50 (0.91) 3.46 (0.89)1Main Effect of Group, p<0.001; Binge Eating & Binge-Combined > Healthy Control & Binge Drinking2Main Effect of Group, p=0.002; Binge Eating & Binge-Combined > Healthy Control & Binge Drinking3Main Effect of Group, p<0.001; Binge-Combined > Binge Drinking > Healthy Control & Binge Eating4Main Effect of Group, p<0.001; Binge-Combined & Binge Drinking > Healthy Control & Binge Eating3.3.2 Emotion reactivityTo examine emotion reactivity within and across groups, two separate mixed designANOVAs with Valence (Negative, Neutral, Positive) as the within subject factor and Group(Healthy Control, Binge Eating, Binge Drinking, Binge-Combined) as the between subject factorwere conducted with z-score startle (from 3s probe) and mean corrugator activity (from the 3speriod post-image onset)5 as the respective dependent variables. In both analyses, there was asignificant main effect of Valence, Startle: Wilk’s lambda=0.51, F(2,85)=40.19, p<0.001,ηp2=0.49; Corrugator: Wilk’s lambda=0.49, F(2,76)=40.37, p<0.001, ηp2=0.52. Pairwise5 Corrugator outliers, defined as raw data scores greater than three times the inter-quartile range, were excludedfrom all corrugator analyses (HC=3, BD=2, BC=4).73comparisons for both dependent measures were significant between Valence conditions, withNegative>Neutral>Positive, p<0.001, (See Figure 3.3 top panels). The main effects of Group andthe Group by Valence interactions were non-significant, p>0.05.6Figure 3.3 a) Startle Blink b) Corrugator ActivityNote: HC=Healthy Control group; BE= Binge Eating group; BD=Binge Drinking group; BC=Binge-Combinedgroup. Error bars represent standard error. Significant Valence main effect for both Startle and Corrugator EmotionReactivity: Negative>Neutral>Positive. Significant Regulation main effect for Startle: Maintain Emotion > Decrease6 There were no outliers for the z-score startle analysis. For the raw startle analysis with exclusion of startleoutliers, final n=84, there was a significant main effect of Group for emotion reactivity, F(3,80)=2.72, p=0.05,ηp2=0.09, and emotion regulation, F(3,80)=2.67, p=0.05, ηp2=0.09. Follow-up tests indicated that BE and BD hadlarger raw startle responses compared to HC.74Emotion; Significant Regulation by Valence interaction for Corrugator: Maintain Negative Emotion > DecreaseNegative Emotion. No significant Group main or interaction effects for Reactivity or Regulation measures.3.3.3 Emotion regulationTwo three way mixed-design ANOVAs were conducted to evaluate the effect of Group(Healthy Control, Binge Eating, Binge Drinking, Binge Combined), Valence (Negative, Positive)and Regulation Condition (Decrease, Maintain) on emotion regulation as assessed by the z-scorestartle (7 s probe) and mean corrugator activity (3 s period post-regulation cue). The neutralvalence condition was excluded as, across participants, responses on the emotion regulationstrategy questionnaire reflected confusion about how to regulate a neutral emotion. For the startleanalysis, there was a significant main effect of Valence, Wilk’s lambda=0.47, F(1,86)=98.68,p<0.001, ηp2=0.53, with Negative>Positive, p<0.001. The main effect of Regulation was alsosignificant, Wilk’s lambda=0.77, F(1,86)=25.86, p<0.001, ηp2=0.23. Pairwise comparisonrevealed that Maintain>Decrease, p<0.001 (See Figure 3.3a bottom left panel). There were nosignificant main or interaction effects with Group. For the corrugator analysis, the main effect ofValence was also significant, Wilk’s lambda=0.57 F(1,77)=58.89, p<0.001, ηp2=0.43, withNegative>Positive, p<0.001. The main effect of Regulation was non-significant, p>0.05. Therewas a significant Valence by Regulation interaction, Wilk’s lambda=0.93, F(1,77)=5.44,p=0.022, ηp2=0.07. A follow-up ANOVA within Negative Valence revealed a significant maineffect of Regulation, Wilk’s lambda=0.93, F(1,77)=5.94, p=0.017, ηp2=0.07 withMaintain>Decrease (see Figure 3.3b bottom right panel). The main effect of Group and Group byRegulation interaction were non-significant. A follow-up ANOVA within Positive Valence hadno significant main or interaction effects.753.3.4 Regulation strategiesThe open-ended responses on the emotion regulation strategy questionnaire wereclassified into the following categories: visual attention (e.g. focusing visual gaze on more/lesssalient aspects of image, looking at details versus taking in the whole image), lookingaway/closing eyes, cognitive reappraisal (e.g. changing self-relevance, changing perspective,objectifying image, imagining outcome), focusing on emotions/thoughts (e.g. labelling emotions,thinking of cause of emotions, repetition of thoughts pertaining to the emotion),ignoring/suppressing emotions/thoughts, manipulating facial expression, breathing, other (e.g.self-talk, self-calming without specifying specific strategy) or none (e.g. continuing to respondnaturally). As the ability to decrease negative emotions or maintain positive emotions pertainedto our hypotheses, strategies for these conditions are presented in Table 3.5. For DecreaseNegative, chi-square tests indicated that strategies did not significantly differ between groups;cognitive reappraisal was most often endorsed followed by visual attention and breathing. ForMaintain Positive, chi-square tests indicated that strategies did not significantly differ betweengroups, focusing on the emotion/thought followed by visual attention were the main strategiesidentified.76Table 3.5 Emotion Regulation StrategiesHealthyControl(n=23)Binge Eating(n=15)BingeDrinking(n=24)Binge-Combined(n=28)Strategy Decrease Negative EmotionVisual Attention 5 5 11 10Look Away 3 2 3 1Cognitive Reappraisal 11 10 11 15Focused on Emotion or Thought 0 0 0 2Ignored / Suppressed Emotion orThought2 2 8 6Facial Expression 2 2 1 0Breathing 5 2 7 9Other 4 1 0 2Strategy Maintain Positive EmotionVisual Attention 7 5 11 10Cognitive Reappraisal 3 3 2 4Focused on Emotion or Thought 8 5 13 11Facial Expression 1 2 3 4Breathing 1 0 0 0Other 1 2 0 1None 5 1 1 5Note: Values represent the number of participants endorsing that strategy. Participants could provide multipleresponses.3.3.5 Image ratingsValence and arousal ratings were examined with two separate two-way mixed-designANOVAs to evaluate the effect of Group (Healthy Control, Binge Eating, Binge Drinking, BingeCombined) and Valence (Negative, Neutral, Positive) for both dependent variables (valence andarousal).7 There was a main effect of Valence on valence ratings, Wilk’s lambda=0.05,F(2,84)=764.44, p<0.001, ηp2=0.95. There were no significant Group main or interaction effects.Across groups, valence ratings followed the expected pattern of Negative<Neutral<Positive (see7 Image rating data was missing for one BE participant who completed the SAM ratings incorrectly, markingvalence and arousal ratings on the same scale.77Figure 3.4 upper panel). The main effect of Valence on Arousal ratings was also significant,Wilk’s lambda=0.12, F(2,84)=315.28, p<0.001, ηp2=0.88, with Negative>Positive>Neutral(Figure 3.4 lower panel).Figure 3.4 Image RatingsNote: HC=Healthy Control group; BE=Binge Eating group; BD=Binge Drinking group; BC=Binge-Combinedgroup3.4 DiscussionThe current study aimed to elucidate emotion reactivity and regulation in response togeneral emotional stimuli in women with binge behaviours. Self-reported levels of recentdepression, anxiety and stress indicated that the groups characterized by binge eating (BingeEating & Binge-Combined) tended to have a higher level of affective distress compared to thenon-binge eating groups (Binge Drinking & Healthy Control). This is in line with prior reports of78higher trait neuroticism in college students who binge eat with/without co-morbid binge drinkingcompared to binge drinking and non-bingeing individuals (Rush, Becker & Curry, 2009).Differences in general distress did not translate into differences in level of evokednegative emotion in the current study. As predicted, emotion reactivity was comparable acrossgroups on psychophysiological measures and self-report. Startle blink magnitudes and corrugatoractivity followed a linear pattern with the largest responses to images of negative valence and thesmallest for images of positive valence. Similarly, valence ratings were lowest for negativeimages and highest for positive images. These findings are in line with prior reports in eatingdisordered and college drinking samples (Drobes et al., 2001; Drobes et al., 2009; Mauler et al.,2006) and indicate that women with bingeing behaviour demonstrate comparable intensity ofemotional response to general emotional stimuli in physiological and subjective domains. Thissuggests that the lack of emotional clarity identified in eating disordered and problematicdrinking samples in prior work may pertain to a deficit in labelling of emotional experiencebeyond the general categorization of degree of pleasure versus displeasure (Kashdan, FeldmanBarrett, & McKnight, 2015). Alternatively, the lack of clarity may be limited to emotional statesgenerated by internal phenomena such as rumination or those evoked in interpersonal situations.Hypothesized group differences in emotion regulation ability were not supported;emotion regulation ability as indexed by startle blink magnitude, corrugator activity or self-reported strategy did not differ between groups. The pattern of startle blink regulation followedthe arousal dimension with larger startle magnitudes observed for Maintain versus Decreasetrials for negative and positive valence images in line with prior work (Bernat et al., 2011; Dillon& LaBar, 2005). For corrugator activity, across groups successful regulation was limited tonegative valence images; regulation of positive emotion was not supported. Limited prior work79using the corrugator to assess positive emotion regulation suggests that a larger discrepancy inevoked emotion (i.e. a comparison between an enhanced and suppressed emotional state) may berequired for detectable differences (Baur et al., 2015; Bernat et al., 2011; Reynaud, El-Khoury-Malhame, Blin, & Khalfa, 2009). Emotion elicitation methods that evoke a greater level ofpositive emotion in the laboratory may be needed to help overcome this limitation in the use ofcorrugator as a measure of positive emotion regulation.Contrary to expectation, emotion regulation strategies also did not differ between groups,with cognitive reappraisal endorsed most frequently followed by visual attention and breathingstrategies for the down-regulation of negative emotion. In contrast to the trait-based literature onemotion regulation strategies, expressive suppression was not favoured by the binge groups. Thissuggests that the strategies utilized in our laboratory task may have limited generalizability ormay pertain to different emotions than those implicated in binge behaviour. It is also possiblethat the overall level of psychopathology in our primarily sub-clinical sample was insufficient toimpact regulation strategy choice. Greater recent distress was endorsed by the groups with bingeeating compared to the other groups, and their overall level of eating pathology was also higher.However, with the exception of anxiety in the Binge Eating group (with 53% of participantsendorsing Moderate to Extremely Severe levels of anxiety), the majority of participants withinthe disordered groups scored within the normal to mild range on the DASS scales. Though themajority of participants fell below the clinical cut-off of 4 on the EDE-Q Total scale (Luce,Crowther, & Pole, 2008), within the Binge-Combined group, 64% scored above the cut off onShape Concern and 57% were above the clinical cut off on Weight Concern, suggesting thepresence of significant ED pathology in this group. However, averages for all groups were belowclinical levels for Depression. Therefore, if severity of depressive symptoms, rather than80symptoms of eating pathology, had a greater influence on emotion regulation strategies, then oursample would not be expected to demonstrate group differences. Further work is needed toidentify the relative contributions of depression versus eating pathology on self-reported emotionregulation strategies. Furthermore, an experience sampling methodology may also provideinformation about the type of strategies used in daily life (rather than in the lab) and the extent towhich strategy choice is affected by depression versus eating pathology (Brans, Koval, Verduyn,Lim, & Kuppens, 2013; Heiy & Cheavans, 2014).In contrast to the lack of group differences in emotion regulation strategies andpsychophysiological emotion regulation indices, hypotheses for eating and drinking motiveswere supported. In line with expectation, the binge eating groups endorsed greater coping andconformity motives. While the endorsement of coping motives is in keeping with emotionregulation theories of binge eating, the lack of other significant group differences in emotionregulation variables in the current study suggests that future psychophysiological investigationsshould consider emotion type and the context of regulation efforts. In keeping with prior work(Kunstche et al., 2005), the binge drinking groups tended to endorse social and enhancementmotivations for drinking; however, these differences did not translate into positive emotionregulation differences in the laboratory.3.4.1 Limitations and future directionsSignificant variability in startle magnitude and corrugator activity within groups, andstartle data loss due to excessive blinking, movement, high impedance and non-response mayhave limited our ability to detect significant group differences. Examination of group meanssuggest two avenues to be explored in future research. First, as evident in Figure 3.3, the bingegroups appeared to retain emotional intensity from the emotion reactivity assessment (at 3 s) to81the Maintain Negative emotion assessment (at 7 s) whereas in the Healthy Control group therewas a large decline in intensity of response between the 3 and 7 second probes. As such, theHealthy Control group appeared to experience a natural attenuation of emotional intensity overthe course of the trial while the response duration was extended in binge groups. If thisspeculation is supported, while the intensity of initial response may not differ by binge status,women who binge may experience more enduring emotional responses. The natural decline inemotional intensity in the Healthy Control group likely limited our ability to detect groupdifferences in effortful regulation later in the course of the picture viewing period. Therefore,future work should systematically vary the startle probe times and use more fine-grainedsubjective ratings presented at multiple time points following image onset to ascertain theduration of response and timing of emotion regulation efforts.Second, given previous findings that startle regulation follows the arousal dimension andcorrugator regulation follows the valence dimension (Bernat et al., 2011; Dillon & LaBar, 2005),the different patterns between startle and corrugator regulation suggest that binge eating womenmay differ in their ability to specifically regulate the arousal compared to the valence dimensionof emotional response. As such, negative emotion regulation as assessed by corrugator wassuggestive of a lack of regulation in the Healthy Control group and in the two groups with bingeeating. As mentioned above, we speculate that in the Healthy Control group this likely reflects afloor effect due to a natural decrease in intensity over time such that there was minimal emotionto be regulated by the time of the regulation probe. In the binge eating groups, it appears thatthey were able to effectively regulate their negative emotional responses on the arousaldimension (based on their startle regulation) whereas the level of negative valence as measuredby corrugator remained high across Maintain and Decrease negative emotion conditions. Future82work should examine the natural time course of valence and arousal response in binge eatinggroups and how these dimensions are altered by voluntary emotion regulation attempts.The lack of group differences may also have been due to the type of emotion elicited andthe absence of food or alcohol as an alternate means of regulating the evoked emotional states.The startle blink is considered most useful for the assessment of highly arousing emotionalstates, particularly fear and disgust (Bernat et al., 2006). Other emotional states, which were notlikely elicited by the picture viewing task, such as anger, guilt, shame, or loneliness may have amore prominent role in eating disorder pathology (Overton et al., 2005; Zeeck, Stelzer, Linster,Joos, & Hartman, 2011). Future work focused on these emotional states using different emotionelicitation methods may identify disruption in conscious emotion regulation as indexed bypsychophysiological measures. The lack of group differences in emotion regulation may alsoindicate that the binge stimulus (food or alcohol) may need to be present in concert with anegative or positive mood state to create a desire to binge and disrupt or subvert adaptiveemotion regulation strategies. This speculation is supported by prior findings of an increase inself-reported urge to eat following negative mood induction that was only found when afavourite food was presented following mood induction in women with a disinhibited eatingstyle (Loxton, Dawe, & Cahill, 2011). In regards to binge drinking, the interaction betweenemotional state and the physiological effect of consuming alcoholic beverages may be requiredto disrupt cognitive processes (Curtin & Lang, 2007), possibly including cognitive regulationstrategies. Thus, future work should explore the ability to continue to engage in cognitivereappraisal strategies when the binge stimulus is administered or is available as an alternatemethod to regulate emotional state.83Finally, the current study did not track visual gaze, therefore, the extent to which emotionactivation may have been reduced during the Maintain emotion condition due to deliberate orinadvertent shifting of gaze from arousing aspects of negative images is undetermined (Urry,2010). Unaccounted for differences in visual gaze may have resulted in smaller differences inresponse magnitudes between maintenance and emotion reduction conditions; however, there isno a priori reason to expect that gaze would differ across groups.3.4.2 ConclusionThe current study utilized a previously validated paradigm to examine emotion reactivityand regulation in young women with binge eating and drinking behaviour. Results suggest thatintensity of emotional response is not affected in women who binge; however, the duration ofresponse warrants further investigation. A broad deficit in emotion regulation ability was notsupported. Future work should employ more finely grained timing of psychophysiological probesand emotion elicitation materials associated with interpersonally-relevant emotions and higherintensity positive emotion, to ascertain whether, and under what circumstances, emotionregulation is disrupted in women with binge behaviour.84Chapter 4: Study Three4.1 IntroductionEmotions are conceptualized as coordinated responses across behavioural, experientialand physiological systems. Response coherence amongst these systems has been investigated inrelation to psychopathology such as alcohol use (Chaplin, Hong, Bergquist, & Sinha, 2008;Glautier et al., 2001; Miranda et al., 2002; Miranda et al., 2003), disordered eating (Hilbert et al.,2011; Tuschen-Caffier & Vogele, 1999), borderline personality disorder (Elices et al., 2012),alexithymia (Eastabrook et al., 2013), generalized anxiety disorder (GAD; Hubert & DeJongMeyer, 1990), major depressive disorder (Gehricke & Shapiro, 2000), phobic fear (Schaefer etal., 2014) and internalizing symptoms (Lanteigne et al., 2014). Response coherence varies bytype of psychopathology and the response systems assessed. Whereas low coherence betweenexperience and physiology is implicated in alexithymia (e.g. Eastabrook et al., 2013), disorderedeating (Hilbert et al., 2011; Tuschen-Caffier & Vogele, 1999) and borderline personality disorder(Elices et al., 2012), greater coherence amongst response systems is implicated inpsychopathology characterized by intense fear or anxiety (e.g. Hubert & DeJong Meyer, 1990;Schaefer et al., 2014). Strength of coherence may also pertain to trait tendencies to utilizespecific emotion regulation strategies or to experience negative affect (Lanteigne et al., 2014).These findings suggest that examination of response coherence in young women with bingebehaviour may help to clarify the relationship between emotional states and engagement in thesebehaviours.Coherence between subjective experience and the psychophysiological measures utilizedin study two, namely startle blink magnitude and corrugator activity, and an additional measure(the late positive potential; LPP) has yet to be examined in young women with binge behaviour.85The current study investigated response coherence between these psychophysiological measures,and their subjective experience counterparts of self-reported pleasure-displeasure (i.e. valence)and intensity of activation (i.e. arousal) in this population. Prior work utilizing autonomicreactivity measures or trait-based assessments of emotional awareness and expression suggestthat emotion response coherence may be disrupted in women who engage in binge eatingepisodes (e.g. Danner et al., 2014; Hilbert et al., 2011; Whiteside et al., 2007). A lack ofcoherence between subjective experience and psychophysiological processes could help explainthe commonly reported difficulty identifying feelings in this population and contribute tosusceptibility to engage in maladaptive behaviour during negative affective states (Whiteside etal., 2007). Anticipated relationships amongst psychophysiology and subjective experience inbinge drinking young women are less clear due to mixed findings in this population. As emotioninduction context and measurement technique influence response coherence (Bradley & Lang,2007), the current study examined coherence within the context of a picture viewing paradigm.This paradigm is one of the most frequently utilized in prior studies of response coherence.Anticipated relationships amongst the psychophysiological measures and subjective experienceare reviewed in the subsequent sections.In regards to the valence dimension of the emotional response, corrugator muscle activityhas small to medium associations with self-reported valence across a variety of emotional stimuli(Brown & Schwartz, 1980; Jäncke, 1996; Johnson, et al., 2010; Lang et al., 1993; Larsen et al.,2003). Corrugator activity appears to reflect the degree of displeasure-pleasure evoked by thepicture stimulus and emotional expression (Dimberg et al., 2002; Lee et al., 2009). Attenuatedresponse coherence between valence ratings and corrugator activity may, therefore, reflect adiscrepancy between subjective experience and emotional expression.86Similar to corrugator, image valence modulates the startle blink response. However,startle blink magnitude is also affected by arousal, which is considered indicative of the extent ofactivation in aversive and appetitive motivational systems (Bradley et al., 2001; Cuthbert et al.,1996). Intensity, a combination of rated valence and arousal, was developed by some researchers(Bernat et al., 2006). Associations between intensity and startle blink were generally small, buttended to be larger and more consistent within the negative valence condition than within thepositive valence condition. Overall, these findings suggest that startle modulation withinnegative and positive valence conditions correlates with rated arousal. Therefore, attenuatedcoherence between startle magnitude and arousal ratings may reflect low coherence betweensubjective experience and activation of basic motivational systems.The third index of response coherence examined in this study is between arousal ratingsand a positive-going centro-parietal ERP waveform beginning 300-400 ms post-picture onsettermed the LPP (Cuthbert et al., 2000). The LPP is thought to be an index motivationalsignificance as it is larger for emotional compared to neutral stimuli and for images which areassociated with higher arousal ratings and sympathetic arousal (Codispoti et al., 2007; Cuthbertet al., 2000; Lang & Bradley, 2009; Leite et al., 2012; Schupp et al. 2000). Neuroimagingfindings suggest that the LPP may reflect elaborated processing in the extra-striate visual cortexwith re-entrant processing from the amygdala (see Lang & Bradley, 2010 for review). LPPmagnitude is affected by emotion regulation efforts (see Hajcak et al., 2010 for review) and isreduced in individuals with heightened anxiety in response to aversive stimuli, which is thoughtto reflect avoidance of the aversive stimulus (vigilance-avoidance model; Mogg et al.; Weinberg& Hajcak, 2011). Attenuated coherence between LPP magnitude and rated arousal may,87therefore, reflect attentional disengagement and decreased perceptual processing of arousingstimuli.Findings from self-report and autonomic reactivity measures suggest that coherenceamongst measures reviewed in the preceding sections may be attenuated in women who engagein binge eating behaviour. Trait-based questionnaires indicate that women who engage in bingeeating have difficulty identifying and describing their emotional experiences (Vine & Aldao,2014; Wheeler et al., 2005; Whiteside et al., 2007). This suggests that they may have difficultyinterpreting and imputing meaning to the physiological changes associated with emotionalresponses. Studies utilizing interpersonal stressor tasks have reported a divergence betweenphysiological response (cardiac reactivity and electrodermal activity) and self-reported feelingsin eating disordered populations; eating disordered women tended to provide higher ratings ofnegative affect while their physiological responses generally did not differ from non-eatingdisordered women (e.g. Hilbert et al., 2011; Tuschen-Caffier & Vogele, 1999). An attenuation ofcoherence between corrugator activity and valence rating is also suggested by prior findings of atendency to suppress emotional expression in women who binge eat (Danner et al., 2014; Svaldiet al., 2012).Contrary to the findings reviewed above, emotion reactivity indexed by startle response,corrugator activity and self-report image ratings has not been found to differ between bingeingand non-bingeing women based on comparisons of group means (Drobes et al., 2001; Mauler etal., 2006; study two). Such group comparisons may lack sensitivity to detect alterations incoherence. A correlational approach rather than a group-based comparison may provide a moresensitive method to examine coherence.88The evidence for emotion response coherence amongst young women with bingedrinking behaviour is mixed. Findings from two prior startle blink investigations providediscrepant accounts of response coherence and alcohol use based on comparisons of groupmeans. In a university sample, Miranda and colleagues (2002) found that participants with apositive family history of alcoholism had reduced startle potentiation during negative imageviewing compared to participants with a negative family history. In contrast, subjective reportsof valence and arousal were similar across family history status. The lack of startle potentiationin family history positive participants was partially accounted for by self-reported psychologicaldistress. A second study comparing men without alcohol dependence to men with alcoholdependence with and without co-morbid anti-social personality disorder found that startlepotentiation during negative image viewing was reduced only in the group with alcoholdependence and co-morbid personality disorder (Miranda et al., 2003). No group differences inself-reported valence or arousal were found suggesting low coherence between startle responseand subjective experience only in men with greater psychopathology.Regarding coherence between corrugator and self-reported valence, Glautier andcolleagues (2001) found a trend for greater corrugator activity in participants classified as heavydrinkers compared to light drinkers with comparable self-reported valence across groups.Turning to the trait-based literature, alexithymia, which includes difficulty identifying feelings,has been inconsistently associated with binge drinking in young college-age women. Bauer andCeballos (2014) did not find a difference in alexithymia between college women who frequentlyversus infrequently binge drank. It has also been suggested that binge drinking and alexithymiamay only be associated in a subset of young women, such as those who are high in positive or89negative urgency (Shishido et al., 2013) or who endorse drinking to cope with negative affect(Lyvers et al., 2012).In study two, we did not find evidence of dissimilarity in psychophysiological orsubjective report of emotion reactivity between groups based on examination of group means. Aswell, endorsement of inhibition of facial expressions of emotion as an emotion regulationstrategy did not differ by binge group. However, the extent of dimensional association betweensubjective experience and emotional reactivity and the spontaneous inhibition of facialexpressions is unclear from the results of study two. As such, the current study aimed to identifywhether women who provided higher valence or arousal ratings also tended to show higherlevels of activity in corresponding psychophysiological indices. To address this issue,correlations between the psychophysiological measures and subjective experience ratingsoutlined above were examined within the four groups described in study two. Specifically, non-bingeing healthy control women, binge eating women, binge drinking women and women withboth binge eating and binge drinking behaviour (binge-combined). Within the Healthy Controlgroup, the following hypotheses were put forth:1) Corrugator activity would be negatively associated with valence ratings within valencecategories (i.e. larger corrugator activity would be associated with higher unpleasantnessratings and smaller corrugator activity would be associated with higher pleasantnessratings).2) Startle activity would be positively associated with arousal ratings within valencecategories (i.e. larger startle responses would be associated with higher arousal ratings).3) The late positive potential evoked during viewing of negative and positive valenceimages would positively correlate with arousal ratings within negative and positive90valence categories (i.e. higher arousal ratings would be associated with greater LPPmagnitudes).Given previous reports of lack of emotional clarity in binge eating women, it washypothesized that the correlations between self-report ratings of emotional experience andpsychophysiological emotion measures outlined above would be attenuated in women with bingeeating compared to non-bingeing women. For binge drinking women, it was hypothesized thatonly the association between startle and arousal ratings would be attenuated based on the priorstartle findings in young adults with a family history of alcoholism (Miranda et al., 2002).4.2 Methods4.2.1 ParticipantsData from the 90 participants meeting criteria for one of the four groups (HealthyControl, Binge Eating, Binge Drinking or Binge-Combined) with useable startle and corrugatordata in study two was evaluated for inclusion in the current study. After removal of corrugatoroutliers (Healthy Control group=3; Binge Drinking group=1), bivariate outliers (Healthy Controlgroup=1; Binge Drinking group=1; Binge-Combined group=1), image rating outliers (BingeDrinking group=1), incorrectly completed image ratings (Binge Eating group=1), and EEGrecording issues (Binge Eating group=1; Binge-Combined group=1), the final sample consistedof Healthy Control group=19, Binge Eating group=13, Binge Drinking group=21 and Binge-Combined group=25. The mean age of the sample was 21.35 years (SD=1.92). Endorsedethnicity was 60.3% European, 33.3% East Asian, 9% Indian-South Asian, other ethnicities(Middle Eastern, Latin American-Hispanic) were endorsed at <5%. Based on the EDDS (Stice etal., 2000), in the Binge Eating group possible diagnoses included: BN n=0; subthreshold BNn=10; BED n=1; subthreshold BED n=1 and missing data n=1. In the Binge-Combined group91possible diagnoses were as follows: BN n=4; subthreshold BN n=16; BED n=2; subthresholdBED n=2 and missing data= ProcedureThe experimental procedure was the same as described in study two (section 3.2.3 and3.2.3.1). In brief, participants completed a startle probe picture viewing task consisting of ninety-six images (32 of each valence: positive, neutral and negative) from the International AffectivePicture System (IAPS; Center for the study of emotion and attention [CSEA-NIMH], 1999). Thestartle probe consisted of a 50 ms burst of 95 db white noise with near instantaneous rise-timegenerated using Audacity 1.3 Beta (Unicode) software. The startle probe was presentedbinaurally through ear insert head phones. The three picture valences (negative, neutral, positive)were crossed with two emotion regulation instructions (decrease and maintain) and three probeconditions (no probe, 3 s and 7 s). The 3 s probe time assessed emotion reactivity and the 7 sprobe time assessed emotion regulation. Only the 3 s emotion reactivity probe was evaluated inthe current study. Nine practice trials preceded the start of the task to allow for initial habituationto the startle probe. Each trial consisted of picture presentation (8 s duration) with a 100 msvisual regulation cue appearing at 4 s post-image onset, which consisted of a solid black boxwith a central red minus sign (decrease emotion) or a white equal sign (maintain emotion). Eachpicture presentation was followed by a blank screen (4 s duration; a startle probe occurred duringfour of these screens to increase startle unpredictability), a screen with the word “RELAX” (4 sduration) and a screen prompting participants to push a button to view the next picture. SeeFigure 3.2 for a sample trial sequence. Corrugator electromyography and electroencephalographywere recorded during the picture viewing task.92No subjective ratings of the images were recorded during the startle task; after the startletask was completed and psychophysiological recording equipment removed, participants viewedthe images a second time and provided ratings for each image using a nine-point visual analoguescale with figures depicting displeasure to pleasure (valence rating) and calm to aroused (arousalrating) (IAPS Self-Assessment Manikin [SAM]: Bradley & Lang, 1994). Psychophysiological RecordingCorrugator EMG and startle blink data were recorded and processed as described inchapter three sections and The startle blink z-score data was transformed to T-scores (T=(z*10)+50) to allow for clearer interpretation of correlations (e.g. Bernat et al., 2006).EEG data was acquired with a Brain Products Inc, QuickAmp 72 System (Brain Products,GmbH, Munich, Germany) with Brain Vision Recorder and Brain Vision Analyzer used forrecording and processing, respectively. Brain activity was recorded using Ag/Ag Cl electrodesfrom the F3, FZ, F4, CZ, P3, PZ, P4 and Oz scalp sites with the ground at the AFz site.Impedance was kept under 5kΩ and recordings were referenced offline to averaged mastoids.Electrooculographic (EOG) data was recorded with Ag/Ag Cl electrodes, placed above andbelow the right eye to detect blinks, and placed to the side of each eye to detect horizontal eyemovement. Impedance was kept under 10kΩ. Both EEGs and EOGs were sampled at 1000 Hzcontinuously, between 0.01-499 Hz with a 60 Hz Notch filter. Data reduction offline consisted offiltering (Butterworth zero order 0.01 high pass, 30 Hz low pass filters), correction for ocularmovement (Gratton, Coles & Donchin, 1983), baseline correction (i.e. subtraction of the averagevalue of the 500 ms baseline period prior to each image from all time points in the segment), andautomatic artifact rejection. The LPP was scored as the mean amplitude over 600-1000 ms post-picture onset. Mean amplitude was averaged across electrode sites Cz, Pz, P3 and P4, as LPP93amplitude was maximal at these centro-parietal sites, in line with other studies employing similarparadigms (e.g. Cuthbert et al., 2000).4.3 ResultsThe event-related potentials across scalp sites for the Healthy Control group are depictedin Figure 4.1. As the LPP is maximum at centro-parietal sites, the average LPP amplitude acrossCz, Pz, P3 and P4 was used in all subsequent analyses.An ANOVA was conducted with LPP as the dependent measure, Valence as the withinsubject factor and Group as the between subject factor prior to evaluation of the correlations todetermine whether there were overall group differences in LPP based on binge status. See Figure4.2 for ERP waveforms for each group. Differences were not anticipated based on the similarityof responses between groups on the other emotion reactivity measures (self-report, startle andcorrugator) in study two. There was a significant main effect of Valence, Wilk’s lambda=0.24,F(2,73)=115.83, p<0.001, ηp2=0.76. The main effect of Group and Group by Valence interactionwere non-significant. Pairwise comparisons indicated that LPP was largest for negative valence(M=12.82, SE=0.71), intermediate for positive valence (M=10.96, SE=0.59) and smallest forneutral valence (M=5.72, SE=0.61) images.94Figure 4.1 ERP Waveforms in the Healthy Control Group95Figure 4.2 Late Positive Potential Pooled Across Cz, Pz, P3 & P4 Electrode SitesNote: HC = Healthy Control; BE = Binge Eating; BD = Binge Drinking; BC = Binge-CombinedWithin negative and positive valence image categories separately, between subjectPearson correlation coefficients were computed between startle magnitude and arousal ratings,corrugator activity and valence ratings, LPP and arousal ratings. Correlations for negativevalence images are presented in Table 4.1. Significant positive correlations between startlemagnitude and arousal ratings were observed in the Binge Eating group and Binge-Combinedgroup, indicating that participants in these groups who rated the images as more arousing tendedto have larger blink magnitudes. These correlations were near zero and non-significant in the96Healthy Control group and Binge Drinking group. Corrugator activity and valence ratings weresignificantly negatively correlated in the Healthy Control and Binge Eating groups, indicatingthat participants in these groups who rated the images as more unpleasant tended to have largercorrugator activity. A negative relationship was also observed in the Binge Drinking group;however, it was non-significant. LPP and arousal ratings were positively correlated though non-significant in the Healthy Control group and Binge Drinking group, suggesting that participantswho rated the images as more arousing tended to have larger LPP activity. Correlations werenegative and non-significant in the Binge Eating and Binge-Combined groups.Table 4.1 Correlation Summary: Negative Valence ImagesHealthyControl(n=19)Binge Eating(n=13)BingeDrinking(n=21)CombinedBinge(n=25)Startle & Arousal -0.08 0.58* -0.08 0.43*Corrugator & Valence -0.47* -0.70* -0.28 0.22LPP & Arousal 0.42+ -0.25 0.35 -0.21+p=0.07*p<0.05Correlations within the positive valence image category are presented in Table 4.2. Noneof the correlations were significant within any of the groups.Table 4.2 Correlation Summary: Positive Valence ImagesHealthyControlBinge Eating BingeDrinkingBingeCombinedStartle & Arousal 0.13 -0.23 0.36 0.28Corrugator & Valence 0.02 -0.01 0.22 -0.30LPP & Arousal -0.19 0.18 -0.04 -0.04974.4 DiscussionThe current study examined emotion response coherence amongst psychophysiologicalmeasures and subjective experience in women with binge eating, binge drinking or both forms ofbingeing behaviour. The pattern of associations were compared with a group of non-bingeingwomen. The first hypothesis that startle magnitudes would be associated with arousal ratingswithin the Healthy Control group was not supported. The association between these variableswas near zero in the negative valence condition for the Healthy Control and Binge Drinkinggroups. The lack of coherence between startle magnitudes and arousal ratings is in keeping withour hypothesis for the Binge Drinking group; however, the similarity of coherence with thecontrol group suggests that this low coherence does not underlie the association betweenemotional states and binge drinking behaviour previously reported in the literature.In contrast, and contrary to our hypotheses, there was a significant positive associationbetween rated arousal and startle blink magnitude in the two groups with binge eating (BingeEating and Binge Combined). Examination of the range of startle magnitudes within each groupsuggests that a restricted startle response range in the Healthy Control and Binge Drinkinggroups may, in part, account for the lack of significant correlations in these groups (rangeHealthy Control=12.67, Binge Drinking=11.48 whereas Binge Eating=18.47 and Binge-Combined=20.31). The greater levels of anxiety endorsed in the Binge Eating and the Binge-Combined groups (as reported in study two) may also account for the greater response coherencein binge eating women. A prior study reported greater response coherence amongst individualswith generalized anxiety disorder compared to healthy controls (Hubert & DeJong Meyer, 1990).Therefore, greater responsivity of the motivational systems indexed by startle magnitude mayconfer stronger coherence between psychophysiological reactivity and self-reported arousal. This98is in fitting with prior reports that coherence tends to be greater for emotions of higher intensity(Mauss, Levenson, McCarter, Wilhelm, & Gross, 2005).The second hypothesis that corrugator activity would be associated with valence ratingsin the Healthy Control group was supported for negative valence images. Non-bingeing womenwho rated the images as more negative also tended to have greater corrugator activity. Counter toexpectation this effect was also observed in the Binge Eating group and to a lesser extent theBinge Drinking group. This indicates that for women in these groups their perceived emotionalexperience was reflected in their facial expressions to negative stimuli. The opposite direction ofeffect was found in the Binge-Combined group though it was non-significant. Replication of thisfinding for the combined binge group would help to elucidate whether this pattern of coherencereflects a tendency for women with more disordered consumption (binge eating and drinkingbehaviour) to spontaneously suppress expressions of negative emotions.The final index of coherence was the association between LPP and subjective arousal.The expected positive correlation was found in the Healthy Control and the Binge Drinkinggroups (though non-significant) whereas the two groups with binge eating behaviour (BingeEating and Binge-Combined) had associations in the opposite direction. We speculate that thebinge eating women who found the images more arousing (i.e. gave them higher SAM arousalratings) may have disengaged from further elaborative perceptual processing of the negativestimuli resulting in a smaller LPP. This is consistent with the vigilance-avoidance model foundin individuals with higher levels of anxiety. Reduced cognitive processing of aversive stimuli bybinge eaters may negatively impact their ability to describe the emotional experience andrespond in an adaptive manner. However, this interpretation is offered with caution as thecorrelations were non-significant and were observed in groups with small sample sizes.99None of our hypotheses were supported in relation to positive valence images as none ofthe correlations were significant. These findings are in keeping with a prior report of variabilityin coherence between image intensity and startle magnitudes during viewing of positive images(Bernat et al., 2006). The lack of coherence amongst indexes for positive emotion highlights theissue previously raised in study two regarding the intensity and reliability of positive affectelicited in laboratory picture viewing tasks. This difficulty has lead other researchers to excludepositive affect from their investigations (e.g. Jackson et al., 2000). Future work should explorealternate positive emotion induction methods such as imagery or film clips.4.4.1 Limitations and future directionsReplication will be important to determine the robustness of observed relationships giventhat the relatively small sample size may limit the stability of observed correlations. It should benoted, however, that prior work has examined coherence within samples of similar size (e.g.n=12, Hubert & DeJong Meyer, 1990). The intensity of emotions evoked by a picture viewingtask may also limit the amount of coherence that may be detected. Greater coherence isanticipated with emotions of higher intensity (Mauss et al., 2005; Reisenzein, Studtmann, &Horstmann, 2013).As is standard practice with this experimental paradigm (e.g. Jackson et al., 2000),subjective ratings were acquired upon a second viewing of the images so as not to interfere withinitial emotion induction. Therefore, the full intensity of the initial response that is indexed bythe psychophysiological measures may not be fully captured by the subjective ratings. However,prior work found comparable ratings when obtained immediately after initial viewing or aftersecond viewing (Mauss et al., 2005), suggesting that this procedural issue likely did not have asignificant impact on the patterns of response coherence. Finally, due to the method of100psychophysiological data collection, correlations could only be computed between-individuals.This likely attenuated the ability to detect coherence between psychophysiological and self-report measures as this method of analysis is generally considered less sensitive compared towithin-individual associations (Hollenstein & Lanteigne, 2014; Mauss et al., 2005). Future workshould extend the examination of response coherence in this population to other emotioninduction contexts.4.4.2 ConclusionThe present findings suggest binge drinking young women have similar patterns ofresponse coherence as non-bingeing women. In contrast, response coherence appeared to differin binge eating women compared to non-bingeing women. If replicated, this may help to explainpreviously documented lack of clarity of emotional responding and maladaptive responses toemotions in a subset of this population. Replication and extension to other emotion inductioncontexts is required to determine the robustness of these findings and their potential clinicalsignificance.101Chapter 5: General Discussion5.1 Summary of ResultsThe overall aim of this dissertation was to identify unique personality contributions tobinge eating and drinking behaviour and to apply psychophysiological methods to informemotion regulation theories of these behaviours. Study one addressed the question of whetherReinforcement Sensitivity Theory (RST)-derived traits (Reward Sensitivity and PunishmentSensitivity) have unique associations with binge eating and binge drinking beyond theassociations of these behaviours with impulsivity facets assessed by the UPPS-P ImpulsiveBehaviour Scale (Negative Urgency, Positive Urgency, Sensation Seeking, Lack of Perseveranceand Lack of Premeditation). Differential relationships between the traits and the two types ofbinge behaviors were found. Regarding the RST-derived traits, Reward Sensitivity had a positiverelationship with both types of bingeing. Whereas, Punishment Sensitivity differed in itsrelationship with the two types of bingeing; it had a positive relationship with binge eating whileit was negatively associated with binge drinking. As anticipated, Negative Urgency was thestrongest predictor of binge eating while Sensation Seeking was the greatest predictor of bingedrinking across the entire sample. Relationships with Positive Urgency were more complex andsuggested that further consideration of this facet may be required. When only women with bingeeating or binge drinking were considered (i.e. when non-bingeing women were excluded), Lackof Perseverance was uniquely associated with both types of bingeing behaviour.Study two study addressed the question of whether binge eating, binge drinking orcombined bingeing women differ from non-bingeing women in emotion reactivity and emotionregulation in response to general emotional stimuli. Emotion reactivity was comparable acrossgroups in terms of response intensity based on the startle blink, corrugator and self-report ratings102of valence and arousal. However, the results suggested that bingeing women may experiencemore enduring emotional responses to negative emotional stimuli. In regards to emotionregulation, the pattern of startle blinks did not differ between groups. Larger startle magnitudeswere observed for maintenance compared to decrease emotion conditions for negative andpositive valence images; this indicates that emotion regulation efforts followed the arousaldimension in line with previous reports (Bernat et al., 2011; Dillon & LaBar, 2005). Forcorrugator activity, emotion regulation efforts resulted in a measurable change in response tonegative emotional stimuli only; larger responses were noted for the maintain emotion conditionscompared to the decrease emotion condition. Although the interaction effect with group was non-significant, the pattern of results suggested that the regulation effect was driven primarily by thebinge drinking group. It was speculated that the lack of regulation in non-bingeing women likelyreflected a floor effect due to a natural decrease in emotional intensity over time such that therewas minimal emotion to be regulated by the time of the emotion regulation assessment period.The binge eating groups appeared able to effectively regulate their negative emotional responsesalong the arousal dimension (based on their startle blink responses) whereas the level ofdispleasure as measured by corrugator activity remained high across negative emotion regulationconditions. Across all groups, corrugator activity was not sensitive to regulation of positiveemotions. Counter to expectation, similar emotion regulation strategies, as assessed via self-report, were implemented across groups.Study three examined emotion response coherence between the psychophysiologicalindices of emotional reactivity and subjective ratings of valence or arousal. Non-bingeingwomen and women who binge drink had similar patterns of correlations across measures ofnegative emotion. This consisted of a lack of association between startle blink magnitude and103arousal rating, greater corrugator activity associated with higher unpleasantness ratings andlarger LPP associated with higher arousal ratings. Binge eating women had a different pattern ofresponse; women who rated the images as more arousing tended to have greater startlemagnitudes. Binge eating women with higher arousal ratings also tended to have smalleramplitude LPP though this effect was non-significant. A speculative interpretation of this findingis that the women who found the images more arousing may have disengaged from elaborativeperceptual processing of the negative stimuli, as indexed by the late positive potential. This isconsistent with the vigilance-avoidance model of information processing in individuals withanxiety. However, the stability of this association may be limited given that these correlationswere non-significant and observed in a small sample. Finally, amongst women endorsing bothtypes of bingeing, the relationship between corrugator activity and valence ratings wasattenuated. If replicated, this finding could be indicative of a tendency for women with greaterlevels of disinhibited behaviours to mask their facial expressions of negative emotion. There wasa lack of significant coherence across measures for positive emotional stimuli for all groups.5.2 Personality Contributions to Binge BehaviourThe results from study one support trait emotion regulation conceptualizations of bingeeating through negative and positive reinforcement pathways (Pearson et al., 2014). Prior traitconceptualizations have tended to focus on either the role of Negative Urgency (Cyders & Smith,2008; Fischer et al., 2012; Pearson et al., 2014) or Reward Sensitivity and PunishmentSensitivity (Loxton & Dawe, 2001, 2006, 2007). For example, in a recent model of bulimicsymptoms proposing state and trait-based pathways, the trait-based pathway focused solely onNegative Urgency (Pearson et al., 2014). Study one suggests that this model is incomplete asRST-derived traits also provide small, but significant contributions to binge eating behaviour.104High Reward Sensitivity may confer a desire for high caloric foods and high PunishmentSensitivity/Negative Urgency may confer a tendency to engage in binge eating to distract fromnegative emotional states. The amount of variance accounted for by Negative Urgency andPunishment Sensitivity decreased when the sample was limited to women with binge eatingbehaviour, suggesting that these facets are commonly elevated across women who endorse bingeeating. High Punishment Sensitivity may reflect a tendency to experience heightened or morefrequent negative affect when aversive cues are encountered such as undesired weight gain,criticism or social rejection (Loxton & Dawe, 2001). Binge eating may be an expression of highNegative Urgency, such that the young woman loses control over her food intake during states ofheightened negative affect resulting in rapid overconsumption (Cyders & Smith, 2008). In thisway, young women with more reactive motivational systems or higher Negative Urgency maylearn to use binge eating to reduce their emotional distress (Fischer et al., 2004).In keeping with motivational accounts of alcohol use, the binge drinking resultssupported trait emotion regulation models for negative and positive emotions (Cooper, Agocha,& Sheldon, 2000). The current study helps to address a gap in the literature by identifying aunique role for Negative Urgency in alcohol consumption in the form of binge drinkingspecifically. Similar to binge eating, binge drinking may be an expression of high NegativeUrgency such that the young woman loses control over alcohol consumption during negativeemotional states. However, others have argued that high Negative Urgency may be aconsequence rather than a cause of alcohol use (Gullo et al., 2014). They suggest that negativeaffect is increased due to problems arising from heavy alcohol use. There is limited prospectivework examining the relationship between drinking and Negative Urgency while also accountingfor the effects of the other UPPS-P facets (Cyders et al., 2009; Settles, Cyders, & Smith, 2010;105Stojek & Fischer, 2013). Cyders and colleagues (2009) found that Negative Urgency did notpredict significant increases in drinking frequency or quantity over the first semester of college.As well, increases in alcohol use disorder symptoms were best predicted by baseline alcoholdependence symptom levels whereas Negative Urgency was only predictive in those with highcoping motives for drinking (Stojek & Fischer, 2013). Neither of these studies included RST-derived traits. As study one is the first to identify unique associations with binge drinking andReward Sensitivity and Punishment Sensitivity beyond Negative Urgency, prospective researchincorporating all of these traits is required to clarify whether Negative Urgency is a contributorto and/or consequence of binge drinking.The relationships between binge drinking and impulsivity facets associated with positiveemotions differed from expectation. Whereas unique positive associations with SensationSeeking and Positive Urgency were expected, such a relationship was only found for SensationSeeking. When relationships with the other facets were accounted for, the positive bivariaterelationship with Positive Urgency became negative. Others have drawn distinctions betweenSensation Seeking and Positive Urgency in terms of risk for increased frequency of consumptionand increased quantity of consumption, respectively (Cyders et al., 2009). Our binge drinkingmeasure does not differentiate between these aspects of drinking behavior making it difficult todirectly compare the present results with prior work. However, it is likely that prior findings of apositive relationship between Positive Urgency and drinking outcomes may be accounted for, inpart, by conceptual overlap with Sensation Seeking, Negative Urgency and Reward Sensitivity.Sensation Seeking may be of greater relevance than Positive Urgency for the regulation ofpositive emotions by binge drinking. This is in keeping with prior findings of partial mediationof the relationship between Sensation Seeking and drinking outcomes by enhancement motives106in the absence of a significant positive relationship with Positive Urgency (Adams et al., 2012).Sensation Seeking may confer risk to seek out stimulating social contexts or activities wherealcohol consumption is more likely to occur (Cyders et al., 2009). Higher Reward Sensitivitymay be associated with increased risk of excessive alcohol consumption whether the bingedrinking episode occurs in negative or positive emotional contexts through sensitized rewardpathways (Gullo et al., 2014). Women with low Punishment Sensitivity may have decreasedmotivation to avoid the negative consequences, which may occur with this form of drinking.Lack of Perseverance was uniquely associated with both forms of bingeing across theentire sample and when analyses were restricted to women with binge behaviour. Thus, Lack ofPerseverance appears to pertain to both risk of engagement and frequency of engagement inbingeing. In the presence of potentially reinforcing substances like food and alcohol, youngwomen who are low in conscientiousness may experience disinhibited behaviour reflective ofpoor executive control. Alternatively, this may reflect a tendency to consume these substances asa form of immediate reinforcement in place of reinforcers requiring sustained, long-term focus(e.g., academic or occupational pursuits) (Magid & Colder, 2007). Women who lackperseverance may be more susceptible to boredom, which may be experienced as an intolerablenegative emotional state (Anestis et al., 2007; Wiser & Telch, 1999). Bingeing may be the resultof attempts to reduce this perceived negative emotional state in individuals high in NegativeUrgency or to increase stimulation in individuals high in Sensation Seeking.As reflected in our findings and in the literature more broadly, there is someinconsistency regarding the direction of the relationship between Positive Urgency anddisinhibited behaviour. There is a high amount of overlap between Negative Urgency andPositive Urgency (r > 0.60 in our sample; >0.70 in other prior work, e.g. Carlson et al., 2013).107This has led some researchers to exclude one or the other facet from their analyses. However,this is problematic if both facets are considered necessary to fully capture the impulsivityconstruct as conceptualized by the emotion-based disposition framework. It has led others toquestion the necessity and utility of the Positive Urgency construct (e.g. Gullo et al., 2014). Theresults of study one suggest that in the absence of a measure of positive affect, Positive Urgencymay act as a proxy for this variable. Therefore, future work should include the UPPS-P facets,RST-derived traits and a measure of negative and positive affect to further delineate the role ofPositive Urgency. Given that positive and negative emotional states may tend to be associatedwith contexts in which eating or drinking behaviour are likely to occur (i.e. positive emotionalstates may be associated with drinking/eating in social settings whereas negative emotional statesmay be associated with drinking/eating alone; Birch et al., 2007; Cooper, 1994; Mohr et al.,2001), the addition of the context of the behaviour (e.g. alone versus in social settings) to trait-based models may also prove useful in further clarifying the construct of Positive Urgency.5.3 Implications for Emotion Regulation Theories of Binge EatingStudies two and three examined emotional processes in the laboratory to inform emotionregulation theories of binge eating. In regards to emotion reactivity, the magnitude of theemotional response based on startle blink, corrugator and self-report ratings did not differ inbinge eating women. This is in line with prior studies using similar methodology (Drobes et al.,2001; Mauler et al., 2006). However, the laboratory findings were suggestive of a longerduration emotional response to negative emotional stimuli in bingeing women; this novel findingfits with the relationship between Punishment Sensitivity and binge eating found in study one.Heightened Punishment Sensitivity may present as a lingering of emotional arousal. This is alsoin keeping with prior findings of a positive relationship between long lasting feelings of distress108and binge eating on self-report (Whiteside et al., 2007). This underscores the importance ofevaluating different aspects of emotion reactivity (i.e. rise time, magnitude, duration) to identifyhow the emotional experience of binge eating women may differ from non-binge eating women.A more fine-grained analysis of the rise time, magnitude, and duration of the response may helpto further elucidate what underlies greater self-reported emotion intensity on trait measures inwomen with ED (Svaldi et al., 2012).Emotion regulation theories of binge eating suggest that women binge eat to reduceemotional distress in place of more adaptive emotion regulation strategies (Telch & Wiser,1999). An emotion regulation account of binge eating was supported by the trait-based measuresin study one. In contrast, the results of study two suggest that women with binge eatingbehaviour are able to generate and apply emotion regulation strategies to effectively reduce theiremotional arousal to acute negative stimuli in a laboratory setting. As effortful emotionregulation ability has not been previously examined in this way in bingeing women, this novelfinding identifies a potential discrepancy between trait-level endorsements and actual ability toregulate physiological responses. This discrepancy is reflective of a previously reporteddivergence between a trait-based self-report assessment (Multidimensional EmotionalIntelligence Assessment; Tett, Fox, & Wang, 2005) and an ability-based emotion regulationassessment (Mayer–Salovey–Caruso Emotional Intelligence Test Version 2.0 (MSCEIT); Mayer,Salovey, & Caruso, 2002). In this study, the trait-assessment predicted subclinical binge eatingwhile the ability measure did not (Gardner et al., 2014). The laboratory task used in our secondstudy differed from the ability measure used by Gardner et al. in that our participants wereactively involved in regulating their physiologically-based emotional response whereas Gardneret al.’s ability measure assessed participants’ knowledge of the efficacy of different actions for109regulating specific emotional states given hypothetical scenarios. This raises the question of whatmight underlie the discrepancy between trait-based assessments and ability measures of emotionregulation. Four possible explanations are discussed below.The first possibility is that the measures assess different types of emotions. A variety ofemotional triggers have been associated with binge eating behaviour (Wiser & Telch, 1999).However, negative emotions pertaining to interpersonal situations may be of particular relevancebased on the emotions identified as preceding binge eating episodes (e.g. Zeeck et al., 2011) andthe efficacy of interpersonal treatment approaches (e.g. Hilbert et al., 2012). EMA investigationshave suggested that interpersonal stressors lead to increases in negative affect and subsequentbinge eating amongst women with BN (Goldschmidt et al., 2014). As well, changes in guilt overthe binge cycle remain even when controlling for other negative emotions (e.g. fear, hostility,and sadness), suggesting that self-relevant emotions may play a more central role in bingebehaviour (Berg et al., 2013). The emotions evoked by our negative emotional images werelikely predominantly fear, disgust and sadness. The advantage of using these stimuli is theavailability of normative ratings and the large body of empirical work measuringpsychophysiological responses to these stimuli. The disadvantage is that the emotions evoked bythese stimuli may differ from emotions typically preceding binge episodes. On questionnairemeasures, participants may draw from emotional experiences that are qualitatively different fromthose tapped by our laboratory task and ability measures such as that used by Gardner andcolleagues. Stimuli that evoke interpersonally-relevant emotions such as anger, guilt, shame, orloneliness may, therefore, be more sensitive to physiological differences in emotion reactivityand regulation in binge eating.110The second possibility is that trait-based reports are influenced to a greater extent bystable elevations in negative affect, such as anxiety and depression, than measures assessingphysiological changes in emotional response. In this case, questionnaire measures may be biasedby an overall negative self-evaluation, leading to an underestimation of emotion regulationability (Lundh et al., 2002). This is supported by prior findings of correlations betweendepression and endorsement of specific emotion regulation strategies (Danner et al., 2014), theloss of significant differences in emotional awareness between ED groups when controlling fordepression and anxiety (Corcos et al., 2000; Gilboa-Schechtman et al., 2006) and highly similarendorsement of emotion regulation difficulties across diagnoses of ED, major depression andborderline personality disorder (Svaldi et al., 2012). Thus, the perception of emotion regulationability may be reduced in women with binge eating while their actual ability to regulate reactionsto acute emotional stimuli remains preserved.The third possibility is that women who binge eat have knowledge of different emotionregulation strategies and can implement them effectively when asked to do so, but have difficultyimplementing the strategies during daily life. This possibility is supported by the trait findingsfrom study one and the similarity of emotion regulation strategies endorsed across groups in thesecond study. Heightened reward sensitivity in combination with lack of perseverance maythwart adaptive emotion regulation efforts when food is available as an immediate negativereinforcer. This would not be reflected in our laboratory task as food was unavailable as analternate emotion regulation method. Low emotional awareness may also make it difficult forbinge eating women to identify when to utilize emotion regulation strategies (Whiteside et al.,2007).111The fourth possibility is that emotion regulation efforts may not be effective in alteringthe emotional response across different response systems in women who binge eat. Whileregulation efforts resulted in changes in the magnitude of the startle blink, corrugator activityremained high across maintain and decrease emotion conditions. This suggests that binge eatingwomen were able to effectively lower their emotional arousal, but their level of displeasureremained high. Their regulation efforts may have moved them from a high arousal, highlyunpleasant negative emotional state to a low arousal, highly unpleasant negative emotional state.If this finding is replicated and found to be significant in a larger sample, it could providesupport for a more nuanced deficit in emotion regulation ability in binge eating women. Womenwho binge eat may be able to divert their attention from negative emotional events resulting in apartial decrease in emotional response, but they may continue to experience significantdispleasure.5.4 Implications for Emotion Regulation Theories of Binge DrinkingStudies two and three examined emotional processes in the laboratory to inform emotionregulation theories of binge drinking. In regards to emotion reactivity, the magnitude of theemotional response based on startle blink, corrugator and self-report ratings did not differ inbinge drinking women compared to non-bingeing and binge eating women. This informs priorwork which reported a relative lack of potentiation of the startle blink in individuals with afamily history of alcoholism (Miranda et al., 2002) and typical potentiation of the startle blink inindividuals with alcohol dependence with co-morbid anti-social personality disorder (Miranda etal., 2003).In regards to emotion regulation, binge drinking women were able to effectively regulatetheir emotional responses to negative stimuli as indexed by the startle blink and by corrugator112activity. This suggests that women who binge drink without significant co-morbidpsychopathology may be able to effectively regulate their emotions to acute negative stimuli.The association of binge drinking with Negative Urgency in study one may pertain to co-morbidity with binge eating or may, as previously speculated, reflect an elevation of negativeemotion in binge drinkers who have experienced problems associated with their use. Thefindings from study two did not support a deficit in the ability of binge drinking women toregulate reactions to positive emotional stimuli. Binge drinking women were able to effectivelyregulate their responses to positive emotional stimuli based on startle blink responses. The lackof corrugator regulation for positive images was found across groups and was not specific tobinge drinkers. We did not assess the ability to enhance positive emotion beyond the leveloriginally evoked by the image. Therefore, it remains possible that women who binge drink maydo so due to difficulty increasing positive emotion through more adaptive means. The findings ofsignificant prediction from Sensation Seeking in study one and the high endorsement of socialdrinking motives in study two suggest that the tendency to seek out social drinking contexts maybe of greater relevance for binge drinking in this young sample, than a specific deficit in theability to regulate positive emotions. This is in line with prior findings of high endorsement ofsocial drinking motives amongst young adults who binge drink more than once a month (VanDamme et al., 2013) and higher rates of binge drinking during specific occasions (Beets et al.,2009).The level of overall recent distress, as assessed by the DASS-21, did not differ betweenbinge drinking and non-binge drinking women. Therefore, binge drinking does not appear totypically be associated with significant distress in young college-aged women. When bingedrinking co-occurred with binge eating, however, distress tended to be higher. Moreover, women113with combined binge behaviour tended to endorse coping motives for eating and drinking in linewith prior work (Birch et al., 2007; Luce et al., 2007). The women who endorsed binge eatingand drinking tended to appear more similar to the women who endorsed only binge eating interms of their pattern of responses on individual psychophysiological measures (e.g. corrugator)and in the relationships between psychophysiology and self-report. Overall, while binge drinkingmay put women at risk for immediate negative consequences (Wechsler et al., 1994; 2000), in aprimarily student sample such as ours it does not appear to be associated with significant distressin the absence of other psychopathology.5.5 Clinical ImplicationsClinical implications of these studies are offered with caution due to the subclinical levelof disordered behaviour in our sample. Overall, the results support emotion regulation treatmentapproaches to binge eating, such as DBT. The personality findings suggest that helpingindividuals to identify their negative emotional states and the corresponding impulsive urges mayhelp to break the link between negative emotions and binge eating. Behavioural chain analysis asin DBT appears to address this (Wiser & Telch, 1999). Given heightened reward and punishmentsensitivity, identification of alternate reinforcing activities may be helpful, particularly self-soothing techniques that are not associated with negative consequences. In our subclinicalsample, binge eating women were able to implement what are considered to be adaptive emotionregulation strategies in the context of the laboratory task. This suggests that support may beneeded in helping to determine when to implement adaptive strategies in everyday life ratherthan the teaching of strategies per se. However, this may not extend to women with a higherlevel of psychopathology who may also benefit from learning new emotion regulation strategies.114At the level of binge drinking assessed in these studies, school interventions aimed atproviding alternate means of increasing arousal or social engagement that do not involve theconsumption of alcohol appear indicated. Increasing the salience of potential negativeconsequences may also be an effective approach, given lower punishment sensitivity in bingedrinking individuals. The small amount of variance accounted for in regards to binge drinking instudy one and the lack of significant findings for emotion reactivity and regulation in study two,suggest that situational factors may play a greater role in binge drinking amongst young college-age women. Taken together the findings for binge drinking add to a growing body of literaturethat endorsement of binge drinking amongst college populations may not be a sensitive indicatorof problematic alcohol use (Alexander & Bowen, 2004; Moorhouse, Soule, Hinson, & Barnett,2014; Read, Beattie, Chamberlain, & Merril, 2008). Other indices of alcohol use in addition toassessment of binge drinking, such as the occurrence of problems associated with use, may provemore useful in prediction of those at risk for progression to a clinical level of disorderedconsumption (Moorhouse et al.).5.6 LimitationsAlthough this dissertation had several strengths, there are some limitations that need to betaken into consideration. Limitations regarding the sample and experimental design are outlinedbelow.The sample was restricted to young women who endorsed primarily subclinical levels ofengagement in the disordered behaviours, thereby limiting the generalizability of the studies’findings to this demographic. The extent to which the findings generalize to men, other agegroups and individuals with clinically diagnosed eating or alcohol use disorders will need to bedetermined. Generalizability to diagnosed alcohol use disorders is likely limited given the115differential endorsement of binge drinking in situations involving relief from negative emotionsin clinical versus non-clinical samples (Birch et al., 2007; Carrigan, Samoluk, & Stewart, 1998).Women with possible AN were excluded from the dissertation studies; therefore, future workwill need to address the relationship between emotion regulation and binge behaviour within thecontext of AN. The small sample size of studies two and three likely limited the power to detectgroup effects. Although the size of the sample was within range of prior startle studies (e.g.Dillon & Labar, 2005; Driscoll et al., 2009; Piper & Curtin, 2006) and the sample size calculateda priori to detect a medium effect (n=18 per group), significant variability on response measuresand data loss due to psychophysiological recording issues contributed to lower than expectedpower to detect group effects. Finally, while significant group differences on measures of generaldistress and motives for the two types of consumption support a differentiation between thegroups based on the binge behaviours of interest, use of a standardized, structured clinicalinterview to assess disordered eating, alcohol use and co-morbid depressive and anxiouspsychopathology would increase the reliability of assessment. This may be of particularimportance for binge eating given the well-replicated finding that binge eating prevalence differsbetween self-report versus interview-based assessment (e.g. Black & Wilson, 1996). In an effortto address this issue, participants were provided with examples of binge eating episodes.Provision of these examples was previously demonstrated to improve reliability of binge eatingassessment amongst a sample with BED (Goldfein et al., 2005).Studies two and three utilized a picture viewing paradigm with normative visual stimuli.While this approach has strong empirical support, the findings may be limited to similar emotioninduction contexts (Bradley & Lang, 2007). Replication and extension to other emotions andinduction procedures is important. Idiographic stimuli are likely of greater relevance to the116individual and may produce higher intensity emotional responses. As such, they may have highersensitivity to detect emotion regulation deficits. Use of such stimuli could be advantageous forthe examination of response coherence in particular, as it may allow for a greater range ofemotion intensity, and should be considered in future work. Given the diversity of potentialemotional triggers associated with binge behaviour, the studies undertaken in this dissertationapproached emotion regulation from a dimensional rather than discrete emotion perspective.Dimensional (or biphasic) approaches consider emotions as ranging in valence (the degree ofpleasantness-unpleasantness) and arousal (calm-excited/agitated) whereas discrete emotionperspectives focus on specific emotional states, such as fear, sadness, or disgust (Bradley &Lang, 2007). A focus on discrete emotional states which have been consistently identified asantecedents of binge behaviour may reveal unique relationships with bingeing that are notdetected by a dimensional approach.A prior investigation into the test-retest reliability of corrugator activity and the startleblink indicate that replication of emotion regulation effects will be important. Test-retestreliability is high for corrugator activity, while the reliability of the startle response as a measureof emotion regulation is less consistent (Lee et al., 2009). Using the startle blink, emotionregulation effects are detectable across multiple testing sessions; however, the stability of theamount of change in physiological response brought about by regulation efforts may be low (Leeet al.).In regards to disordered eating behaviour, the current dissertation focused specifically onbinge eating and its possible role in emotion regulation. However, other aspects of disorderedeating behaviour, such as dieting and purging, have also been associated with emotion regulationprocesses. Some have suggested that a larger cycle of restraint, binge eating and purging may117serve to regulate emotions (Haedt-Matt & Keel, 2011). As a pure dietary restraint pathway tobinge eating has also been proposed (Stice, 2001), sample selection based on endorsement ofnegative mood states as antecedents to binge episodes may increase sensitivity to detectalterations in emotion regulation processes. Therefore, future work should incorporate otheraspects of disordered eating behaviour to develop a more in-depth conceptualization of potentialintersections between these behaviours and different aspects of emotional experience. Aspertains to binge drinking, our sample was selected based on binge drinking frequency. A morestringent selection process including only those with binge drinking and endorsement ofproblems associated with their alcohol use, may result in a different pattern of findings.The amount of variance accounted for by the impulsivity facets was relatively small inthe first study. While the findings were in line with prior work and advanced our understandingof the unique influence of different impulsivity facets on binge behaviours, other variables suchas other eating disorder pathology, peer group, context for the behaviours and ethnicity may playa greater role in determining risk for bingeing. As well, the questionnaire measures used wereguided by the former conceptualization of Reinforcement Sensitivity Theory. Therefore,replication using measures developed in line with revised-Reinforcement Sensitivity Theory,such as the Jackson-5 (Jackson, 2009) will be important to determine whether the relationshipsidentified by the old and new measures remain consistent.5.7 Conclusions and Future DirectionsFuture work should extend the current findings by using the startle blink, corrugatoractivity and LPP to examine emotion reactivity and regulation of discrete emotional states thathave been implicated in binge eating. For example, film clips depicting social rejection or losscould be used to induce interpersonally-relevant emotional states (Tuschen-Caffier & Vogele,1181999). Another approach would be to use mental imagery to invoke these more complexemotional states in a personally-relevant manner. Different timing of the emotion regulation cueis also indicated to allow for more sensitive measurement of the latency and duration of theemotional response. For example, the emotion regulation cue could be administered prior to thecommencement of the trial as has been done in prior work (Bernat et al., 2011). Replacement ofthe “Maintain” emotion condition with “Enhance” and “Respond Naturally” conditions wouldbroaden the range of regulated responses that could be assessed (Bernat et al). Such alterations ofprocedures will likely increase the sensitivity to detect the subtle differences in emotionregulation and response coherence suggested by the current studies.In regards to binge drinking, future work should include a broader assessment of thecontexts and consequences of binge drinking. As the link between positive emotional states andbinge drinking does not appear to pertain to a deficit in maintenance or down-regulation ofpositive emotion, the ability to enhance positive emotions beyond the level naturally evokedcould be explored. Examination of the influence of positive emotional states on inhibitorycontrol and decision making processes may help to identify a mechanism linking these stateswith binge drinking behaviour (Xiao et al., 2013).Overall, this dissertation extended prior work by identifying unique contributions ofimpulsive personality traits to binge eating and drinking behaviour. The trait findings supportedemotion regulation models of these behaviours. The psychophysiological measures did notsupport a deficit in emotion regulation ability across emotion response systems to generalemotional stimuli. However, subtle, mainly non-significant, differences in emotional response,such as the response duration, response coherence and a potential differential effect of emotionregulation on arousal versus valence dimensions were observed. These differences may119contribute to the link between negative emotional states and binge eating. The binge drinkingwomen in our sample appeared fairly similar to non-bingeing women with the exception of thosewho also had disordered eating. Binge drinking in a primarily student sample such as oursappears more reflective of a tendency to drink in social situations to enhance stimulation. Bingedrinking was not associated with significant distress whereas women who binged on foodendorsed greater distress compared to binge drinking and non-bingeing women in this study, andreported being motivated to eat to relieve distress. The results highlight the importance ofassessment of both trait and ability measures of emotion regulation and the need for furtherconsideration of potential discrepancies between assessment methods.120BibliographyAdams, Z. W., Kaiser, A. J., Lynam, D. R., Charnigo, R. J., & Milich, R. (2012). Drinkingmotives as mediators of the impulsivity-substance use relation: Pathways for negativeurgency, lack of premeditation, and sensation seeking. 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European Eating Disorders Review, 19(5), 426-437.163Appendix A: Emotion Regulation Strategy QuestionnaireSubject ID:___________Strategy QuestionnaireDuring the task you just completed you viewed pictures and while viewing the pictures, youwere asked to alter your emotional response by either decreasing the intensity of the emotion youwere feeling or by keeping the intensity at about the same level.  We are interested in the ways inwhich you tried to follow these instructions.  In other words, we would like to find out thestrategies you used to try follow the instructions to decrease or maintain the intensity of theemotion you felt while viewing the pictures.  Decrease is what you did in response to the redminus sign. Maintain is what you did in response to the white equal sign.1. Please describe the strategies you used to decrease your negative emotions.  If you usedmore than one strategy, please indicate the percentage of time you used each strategy.2. Please describe the strategies you used to maintain your negative emotions.  If you usedmore than one strategy, please indicate the percentage of time you used each strategy.3. Please describe the strategies you used to decrease your positive emotions.  If you usedmore than one strategy, please indicate the percentage of time you used each strategy.4. Please describe the strategies you used to maintain your positive emotions.  If you usedmore than one strategy, please indicate the percentage of time you used each strategy.1645. Please describe the strategies you used to decrease your emotions for pictures thatevoked minimal or no emotional response.  If you used more than one strategy, pleaseindicate the percentage of time you used each strategy.6. Please describe the strategies you used to maintain your emotions for pictures thatevoked minimal or no emotional response.  If you used more than one strategy, pleaseindicate the percentage of time you used each strategy.7. If you used different strategies for the first set of images compared to the second set,please describe.


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