Chapter 4 90 inviting them to conduct a cause-effect analysis of the chain of events that ultimately lead to emotional eating behaviour. Such analysis could help people with emotional eating identify and describe their feelings, as well as provide essential information for understanding the events and the resulting emotions that led up to the problem behaviour [40]. Chain analysis is a powerful tool in DBT [63]. By conducting repeated chain analyses a person can identify the pattern linking different components of a behaviour. These analyses were an integral part of several studies on people with binge eating disorder (BED) or eating disorders in general [33, 64-70]. The publications indicated that the deployment of dialectical behaviour therapy in these target groups can undoubtedly be considered successful, but unfortunately the effect of specific deployment of the chain analysis was un- known. The virtual coach could provide tools to help users analyse the entire chain of cause-and-effect. Such a self-management tool can be used as a standalone or as a preparatory blended care element in DBT chain analysis [40, 50]. A new view on “wrong eating behaviour” The majority of participants disapproved of validating the eating behaviour “after emotional eating”. The fact that the virtual coach showed understanding for the person finding comfort in food at the end of a disappointing day was considered unacceptable. The person’s behaviour was deemed “wrong” by the participants. Feelings of guilt may have predominated [71-72] – participants apparently considered the emotional eating behaviour to be a greater transgression than allowing themselves the ephemeral comfort of food. Our results revealed that participants did not consider food as something comforting. Most people are brought up with the notion of comfort food – consumed in periods of distress, evoking positive emotions and associated with “significant social relationships” [73] or “a specific food consumed under a specific situation to obtain psychological comfort” [74]. The same holds for people with a high degree of emotional eating, who according to Van Strien derive comfort from palatable food [28]. Consumption of highly palatable food induced by negative emotions stimulates the reward center [59], albeit only on a temporary basis. Research among people with binge eating disorder shows that any potential positive affect decreases as soon as the binge episode ends [75]. And this is where the paths appear to separate: where comfort food leaves most people with feelings of contentment, people with emotional eating will feel overwhelmed by feelings of shame and regret, and consequently possible relapse [76]. Feelings of regret are probably triggered by the amount of food that was consumed. Such individuals consume more energy-dense foods in response to negative emotions than people without emotional eating [10]. Plus, eating comfort food may not fit within their regime of calorie
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