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Multimodal Assessment of Exercise in Eating Disorders (MAXED) - Study Procedures and Measures

5 Self-Report Measures (Shared across MAXED and MAXED R21MH131787)

5.1 Compulsive Exercise Test (CET)

The Compulsive Exercise Test measures cognitive, affective, and behavioral components of excessive exercise in individuals (Taranis et al., 2011). There are 24 items that contain 5 subscales which are avoidance and rule-driven behavior, weight control exercise, mood improvement, lack of exercise enjoyment, and exercise rigidity. Each statement is rated on a Likert scale of 0 (never true) to 5 (always true), and the score of each subscale is determined by averaging the items for that factor. Higher scores indicate greater pathology of excessive exercise.

Scoring Scoring for the CET includes: 1. selects only variables that are relevant for the current measure

  1. Recode all variables (e.g. changing “never true = 1” to “never true = 0”), renamed necessary variables (e.g. cet_week_repeat to cet_week)

  2. Creates a symptom sum score, which gives a count of the number of compulsive exercise symptoms (0-5) that are present for each individual

Key Variables cet_sum (defines the severity of compulsive exercise based on number of symptoms)

MR21: cet_total: sum of all items

cet_clinical: meets clinical cutoff

cet_avoid_subscale : avoidance and rule-driven behavior subscale score

cet_weight_subscale : weight control exercise subscale score

cet_mood_subscale : mood improvement subscale score

cet_enjoy_subscale : lack of exercise enjoyment subscale score

cet_rigid_subscale : exercise rigidity subscale score

All Variables

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Click to expand CET Table
Click to expand CET MR21 Table

5.2 Drive for Muscularity (DFM)

The Drive for Muscularity Scale is a 15 item questionnaire that assesses the perceptions and behaviors surrounding the desire to gain muscles (McCreary & Sasse, 2000). Questions are rated on a Likert scale from 1 (Always) to 6 (Never). The items are then reversed scored and higher sum scores indicating higher drive for muscularity.

MR21 variables are already reverse coded: 0 being Never and 5 being Always.

Scoring 1. Selects only variables that are relevant for the current measure

  1. Items are re-coded to be reversed coded (“1=5, 2=4, 3=3, 4=2, 5=1, 6=0”)

  2. Creates a symptom average score, which gives an average count of the number of symptoms (0-5) that are present for each individual

Key Variables MAXED: muscularity_average (average score of all items) MR21: dfm_average (average score of all items)

All Variables

Click to expand DFM Table
Click to expand DFM MR21 Table

5.3 Intolerance of Uncertaint-Short Form (IUS-S)

The IUS-S is a 12 item scale that Carleton et al. (2007) adapted from the original 27-item Intolerance of Uncertainty Scale from Freeston et al. (1994). It assesses the worry that an individual has about the possibility of negative events or outcomes, and there are two subscales that address anxious and avoidant aspects of the intolerance. Each item is scored using a 5-point Likert scale, and the scores are summed, with higher scores signifying a greater intolerance of uncertainty.

MR21 codes items on a scale of 0-4, with 0 being “not at all characteristic of me” and 4 being “entirely characteristic of me”.

Scoring 1. Selects only variables that are relevant for the current measure

  1. Recoded all necessary variables (e.g. changing “not at all characteristic of me = 1” to “not characteristic of me = 0”)

  2. Creates a symptom average score, which gives an average count of the number of symptoms (0-5) that are present for each individual

Key Variables MAXED: iuss_sum (defines average score of symptoms)

              MR21: `iuss_prospective_score` (Prospective Anxiety Subscale Score)
                    `iuss_inhibitory_score` (Inhibitory Anxiety Subscale Score)
                    `iuss_sum_score` (Total Score)

All Variables

Click to expand IUS Table
Click to expand IUS MR21 Table

5.4 The Mini Mental State Examination (MMSE)

The Mini Mental State Examination (MMSE) assesses cognitive ability and is frequently used to screen for dementia and examine the severity and progression of cognitive impairment (Kurlowicz & Wallace, 1999). The five categories measured are orientation, registration, attention and calculation, recall, and language. There are 11 items on the examination, and the scores range from 0-30, with a score 23 or below signaling cognitive impairment.

Scoring 1. selects only the variables that are relevant for the current measure

  1. Renames raw variables

Key Variables mmse_total (sum of a participant’s score)

All Variables

Click to expand MMSE Table
Click to expand MMSE MR21 Table

5.5 Brief Fear of Negative Evaluation Scale (BFNE)

Leary (1983) shortened the Fear of Negative Evaluation Scale (Watson & Friend, 1969) to create the BFNE. It measures the tolerance to the possibility of judgment from others. There are 12 items that use a Likert scale (1 ‘Not at all’ to 5 ‘Extremely’) to rate how characteristic each statement is of the respondent. The items are summed to create a total score where higher scores indicate greater fear of negative evaluation.

Scoring 1. Selects raw variables being used for the current measure

  1. Re-code variables to new variable names and values (e.g. ‘Not at all characteristic of me =1’ to ‘Not at all characteristic of me =0’)

  2. Sum the total scores

Key Variables MAXED: bfnes_sum (Total BFNES score) MR21: bfnes_sum_score (Total BFNES score) bfnes_clinical (clincal cutoff criteria met)

Click to expand BFNES Table
Click to expand BFNES MR21 Table

5.6 BIS/BAS Scale

The Behavioral Avoidance/Inhibition Scale scales were developed by Carver and White (1994) to assess how individuals respond to situations. Each statement is rated on a 4-point scale of how strongly one thinks that the statement applies to themselves. The BAS, which is the extent to which someone acts to gain rewards or positive outcomes, has three sub-scales: reward responsiveness, drive and fun seeking. There is one sub-scale for BIS, which is the extent to which someone acts to avoid negative outcomes.

Scoring 1. Selects all relevant variables

  1. Adds variables bis_ambitious bis_all_out bis_act_now bis_no_hold get bas_drive.
  2. Adds variables bis_explore bis_fun bis_spontaneous bis_crave_excite to get bas_fun_seeking
  3. Adds variables bis_love_doing bis_excitement bis_opportunity_excite bis_positive_effect bis_excite_win to get bas_reward_responsiveness
  4. Adds variables bis_negative_event_fear bis_criticism bis_angry bis_worked_up bis_worry_poor_perform bis_no_fear bis_worry_for_mistake to get bis_sum

Key Variables bis_sum bas_drive bas_fun_seeking bas_reward_responsiveness

Click to expand BIS/BAS Table
Click to expand BIS/BAS MR21 Table

5.7 The Body Image States Scale (BISS)

The Body Image States Scale (BISS) is a six-item measure of individuals’ evaluation and affect about their body image at the current moment of time. The questions are answered on a 9-point Likert scale.

These questions are asked in our NVS Self-Report States pre and mid and post surveys AND our PVS pre and post questionnaires. They are also asked during both Rest tasks and exercise tasks and can be found in the Data Collection Forms for Day A, B, and C.

Scoring 1. Selects raw variables being used for the current measure

  1. Renames variables to be easily identified

  2. Recode variables so that the least impaired = 0 and the most impaired = 8

  3. Sum the total scores and rename this summary as biss_sum

Key Variables biss_appearance_pre biss_body_size_pre biss_weight_pre biss_attractive_pre biss_looks_pre biss_average_looks_pre

Click to expand BISS Table

5.8 The Difficulties in Emotion Regulation Scale (DERS)

The Difficulties in Emotion Regulation Scale (DERS) is an instrument measuring emotion regulation problems developed by K.L. Gratz and L. Roemer.The self-report scale is comprised of 36 items asking respondents how they relate to their emotions in order to produce scores on 6 different subscales. These subscales include:

  1. Nonacceptance of emotional responses (Nonacceptance)
  2. Difficulties engaging in goal-directed behavior (Goals)
  3. Impulse control difficulties (Impulse)
  4. Lack of emotional awareness (Awareness)
  5. Limited access to emotion regulation strategies (Strategies)
  6. Lack of emotional clarity (Clarity)

Scoring 1. Selects raw variables being used for the current measure 2. Renames MAXED (Phase 1) variables to be easily identified (rename them to match MR21 variables listed below) 3. For MAXED variables only: add subscale variables Nonacceptance: ders_11, ders_12, ders_21, ders_23, ders_25, ders_29 Goals: ders_13, ders_18, ders_20_rs, ders_26, ders_33 Impulse: ders_3, ders_14, ders_19, ders_24_rs, ders_27,ders_32 Lack of emotional awareness: ders_2_rs, ders_6_rs, ders_8_rs, ders_10_rs, ders_17_rs, ders_34_rs Limited access to emotion regulation strategies: ders_15, ders_16, ders_22_rs, ders_28, ders_30, ders_31, ders_35, ders_36 Lack of emotional clarity: ders_1_rs, ders_4, ders_5, ders_7_rs, ders_9

Key Variables For MR21: ‘ders_nonacceptance_score’ ‘ders_goal_direct_score’ ‘ders_impulse_score’ ‘ders_emotion_aware_score’ ‘ders_limited_strat_score’ ‘ders_clarity_score’

Click to expand DERS Table

5.9 ED History ***(MAXED-PHASE 1 only- only from participants ids 17-42)

The Eating Disorder History form is a self-report questionnaire that assess participants history of eating disorder symptoms and behaviors. Questions vary from yes/no to text entry to Likert scale.

Scoring 1. Selects raw variables being used for the current measure

  1. Renames variables to be easily identified

  2. Sum the total scores and rename this summary as edhistory_sum

Key Variables edhistory_weightloss edhistory_fear_fat edhistory_feel_fat edhistory_thin edhistory_danger edhistory_limit_food edhistory_concentrate edhistory_binge edhistory_not_hungry edhistory_alone edhistory_guilt edhistory_upset edhistory_self_vomit edhistory_laxatives edhistory_diuretics edhistory_fast

Click to expand ED History Table

5.10 Food Craving Questionnaire

The FCQ used in our study is a self report questionnaire that is adapted to measure an individuals desire to engage in certain eating disorder behaviors like binging, restricting, and exercising. The questions are rated on a 5-point Likert scale from 1 (strongly disagree) to 5 (strongly agree). These set of 18 questions can be found in the NVS pre, mid, and post questionnaires and the PVS pre and post questionnaires.

Scoring 1. Selects raw variables being used for the current measure

  1. Renames variables to be easily identified

  2. Recode variables so that “strongly disagree” = 0 and “strongly agree” = 4

  3. Sum the total scores and rename this summary as fcq_sum

Key Variables fcq_desire_restrict_pre fcq_desire_fast_pre fcq_desire_vomit_pre fcq_desire_laxatives_pre fcq_desire_exercise_pre fcq_desire_binge_pre

Click to expand FCQ Table

5.11 Frost Multidimensional Perfectionism Scale (FMPS)

The Frost Multidimensional Perfectionism Scale (FMPS) is a 35 question self-report measure with four sub-scales of perfectionism. There are four subscales: Concern over mistakes and doubts about actions, Excessive concern with parents’ expectations and evaluation, Excessively high personal standards, Concern with precision, order and organisation. Each item is scored on a 5-point Likert-style scale (1 = strongly disagree; 5= strongly agree) to describe how well each item describes the participant experiences. Scores are derived by summing responses across the questions included in each subscale.

MR21 only has 20 of the 35 questions (contains Concerns over mistakes and doubts about actions and Excessive concern with parents’ expectations and evaluations), while MAXED has all 35.

Scoring 1. selects only the variables that are relevant for the current measure

  1. creates six additional variables based on sum scores reflecting four subscales of the questionnaire:

Concern over mistakes and doubts about actions:

MR21: ‘fmps_mistakes_actions_score’

MAXED: fmps_mistake_upset + fmps_work_failure + fmps_worse_fail + fmps_partial_fail + fmps_careful + fmps_less_best + fmps_negative_mistake + fmps_inferior + fmps_respect + fmps_doubt + fmps_repeat + fmps_long_time + fmps_mistake_likeness

Excessively high personal standards score

MR21: fmps_standards_score MAXED: fmps_self_standard + fmps_competent + fmps_higher_goal + fmps_focus + fmps_extreme_goal + fmps_lower_standard + fmps_high_perform

Click to expand FMPS Table

5.12 Functional Assessment of Driven Exercise (FADE)/ Functional Assessment of Maladaptive Behaviors (FAMB)

MAXED: The FAMB, adapted by the lab for exercise, is a 22 item questionnaire that assess for maladaptive exercise behavior. Items include : ” I exercise to cope/relieve stress” or Questions are scored on a 5-point Likert scale from 1 (never) to 5 (always).

MR21: The FADE is a 28 item questionnaire that assesses for driven exercise similar to the FAMB. The questions also include assessement of control. Questions are scored on a 4-point Likert scale from 0 (never) to 3 (often). There are four subscales: Autonomic Positive Reinforcement, Autonomic Negative Reinforcement, Social Positive Reinforcement, and Social Negative Reinforcement.

Key Variables For MR21: ‘fade_apr_score’ ‘fade_anr_score’ ‘fade_spr_score’ ‘fade_snr_score’

Click to expand FAMB Table
Click to expand FADE Table

5.13 Menstrual Cycle Information (MCI ***MAXED only)

The MCI is a questionnaire that assesses an individual’s menstrual cycle and pubertal development. It consists of 21 total items.

5.14 Physical activity affect scale (PAAS)

The PAAS is a 12-item self-report measure that assesses momentary affect response to exercise. Both phases of the study have adapted a shorter scale. MAXED has four items asking how 1) Enthusiastic 2) Crummy 3) Fatigued 4) Calm they feel at the moment. MR21 added in the middle of the study a fifth item, Anxious (Starting from id MR21-1_028 and onwards). Items are rated from 0 (Do Not Feel) to 4 (Feel Very Strongly).

These questions can be found in the NVS pre, mid, and post questionnaires and the PVS pre and post questionnaires. They are also asked during both Rest tasks and exercise tasks and can be found in the Data Collection Forms for Day A, B, and C.

Scoring 1. Selects raw variables being used for the current measure

  1. Renames variables to be easily identified

  2. Sum the total scores and rename this summary as paas_sum

Key Variables paas_enthusiastic_pre paas_crummy_pre paas_fatigued_pre paas_calm_pre

5.15 State Trait Anxiety Inventory is a self-evaluation (STAI)

The State Trait Anxiety Inventory is a self-evaluation questionnaire developed by Charles D. Spielberger. It can be used in clinical settings to diagnose anxiety and to distinguish it from depressive syndromes. Form Y, its most popular version, has 20 items for assessing trait anxiety and 20 for state anxiety. All items are rated on a 4-point scale, and higher scores indicate greater anxiety.

Scoring

Key Variables

5.16 Yale-Brown Obsessive Compulsive Scale (YBOCS)

The Yale-Brown Obsessive Compulsive Scale was developed by Wayne Goodman Dennis Charney, and is designed to rate the types of symptoms in patients with Obsessive Compulsive Disorder and their severity. This rating scale is intended for use as a semi-structured interview. The interview should assess the items in the listed order and use the questions provided. The total score is usually computed from the subscales for obsessions (items 1-5) and compulsions (items 6-10).

Scoring

Key Variables

5.17 EMA

Lab generated measures to assess eating disorder behaviors and cognitions both immediately before and after attending study visits.