Investigating the Role of Metacognition in Mindfulness-Based Prevention for Eating Disorders

Several effective prevention programmes for eating disorders use mindfulness-based training, intended to improve the ability to exercise the skill of mindfulness. Studies have shown that mindfulness-training can reduce risk factors for eating disorders, such as body image concerns and negative affect. It can also improve protective factors, such as body appreciation and self-compassion. However, there has been minimal focus on the precise mechanisms that produce benefit in the context of eating disorder prevention, which is important for guiding targeted intervention.

Mindfulness is a psychological process comprised of two components: the self-regulation of attention towards the current here-and-now experience, including thoughts, feelings, and sensations, and the orientation of attention in a manner that is open and accepting. Since it involves the monitoring and control of one's own cognitive processes, mindfulness may be conceptualised as a metacognitive skill.

Dysfunctional metacognition has been shown to predict patterns of disordered eating and eating disorder symptoms have also been conceptualised as responses to avoid distressing cognitions and internal states that are perceived as out of control. Researchers have therefore theorised that metacognition may be an overarching mechanism that leads to change in mindfulness-based prevention for eating disorders. Nevertheless, metacognitive processes have not been empirically tested in this context.

My proposed research will investigate the extent to which key metacognitive processes are associated with change in key risk and protective factors for disordered eating, following mindfulness training. It will provide avenues for optimising existing intervention approaches for eating disorders by focusing on critical processes, which is significant given the prioritisation of eating disorder care and prevention within the NHS.

In the first phase of the project, I will conduct a systematic literature review of evidence for metacognition in the context of body image, disordered eating, and mindfulness-based prevention for psychological disorders more generally, in order to inform constructs of interest. The second phase will involve a lab-based randomised-controlled dismantling study with an experimental design intended to isolate and test individual components of existing mindfulness-based interventions. Existing interventions are multifaceted and therefore it is important to identify the critical elements for change. These data will be analysed using an innovative network analysis technique, which will reveal the connectivity of different metacognitive processes and identify those central to symptom reduction for eating disorders.

The third phase will involve a longitudinal randomised controlled trial to evaluate a refined mindfulness-based prevention intervention that focuses on the key elements identified in the previous phases. The longitudinal nature of this experiment builds upon the limitations of studies that have used cross-sectional data to show that dysfunctional metacognition predicts binge eating because these data lend no grounds for causal inference. Moreover, while previous studies have administered weekly sessions, this intervention will be delivered to males and females aged 16-25 years in daily bite-sized chunks to encourage integration into daily life and facilitate lasting improvements. Experience sampling methods will be used to capture fluctuations over time and clarify the dynamic relationship between training, potential triggers for disordered eating, and change.

My research aims align with the mental health priority of the ESRC because they take an evidence-based approach to clarify and enhance the mechanisms of change underlying health interventions, to improve how mental health problems can be prevented and treated.