Chapter 4 78 of physiological symptoms associated with hunger and satiety), poor emotional awareness (resulting in difficulty identifying and describing emotions, also referred to as alexithymia) [20], and difficulty with regulating emotions [21-22]. Poor satiety awareness and alexithymia were indeed shown to be associated with higher degrees of emotional eating [23-25]. A longitudinal study evidenced a significant serial mediation between parenting quality in infancy and emotional eating at 12 years and at 16 years through the two mediators, suppression of emotions and alexithymia [26]. Emotional eating is perceived as a strategy to regulate negative emotions [27], and there is some experimental evidence that it helps people with emotional eating re- duce their negative emotions during food intake [28]. After an emotional eating episode, they can, however, be overwhelmed by feelings of shame and disgust over their behaviour [29]. These strong emotions can merge into a negative cycle and can cause relapse of the problem behaviour. According to our model of emotional eating behaviour (Fig. 1), there seem to be two tipping points at which interventions might be most effective: A. Before emotional eating, when experiencing 1) negative emotions and distress, and 2) cravings; and B. After giving in to emotional eating, when experiencing negative emotions (undergoing feelings of shame and disgust). Coaching strategies There is increasing consensus that people with emotional overeating who are overweight are not helped by diets or cognitive behavioural therapy [30-31], because these treatments focus on behavioural changes in food intake and physical activity instead of emotion regulation abilities [32]. Instead, people with emotional eating benefit from learning to recognize, structure/restructure, and self-manage their emotions. Research shows that dialectical behaviour therapy (DBT) may be successful in treating emotional eating behaviour [33-39]. The coaching strategies within DBT are based on validation, focus-onchange, and dialectics – a fusion of the first two strategies [40]. People with emotional eating tend to be hard on themselves [41]. After each emotional eating episode they see confirmation of their own failure, with the ensuing shame and disgust [42]. Validation strategies suggest responding empathetically, by hearing the other person’s viewpoints and accepting them (and their emotions) without judging. Focus-onchange strategies present the receiver with a practical change-oriented focus on problem behaviour. Dialectics is a combination of acceptance of strong feelings and emotions on the one hand, and focus-on-change through adaptation of those feelings and emotions on the other [43].
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