Mindfulness-Based Emotional Eating Intervention Program

This study aims to develop and evaluate a mindfulness-based intervention program (MB-EER) designed to reduce emotional eating behavior. The program was structured based on needs analyses conducted with experts and individuals with emotional eating experiences.

The MB-EER Program consists of 7 weekly sessions, each lasting approximately 2 hours, conducted online. Each session includes psychoeducational content, mindfulness-based practices (e.g., breath awareness, body scan), experiential activities, and group sharing.

Session Overview:

Focus on How You Eat - Differentiating emotional eating from physical hunger; raisin exercise

Recognizing Autopilot - Emotional triggers and automatic eating behaviors

Attention to Cues - Internal and external stimuli influencing eating behavior

Hunger and Fullness Signals - Awareness of body signals; water-drinking practice

Body Awareness and Self-Compassion - Developing supportive attitudes toward the body

Cultural Beliefs and Eating History - Social rules and learned eating habits

Maintenance and Reflection - Ensuring sustainability of skills, personal awareness

Research Design:

This study used a mixed-methods design, including both the development and experimental evaluation of the program:

Program Development Phase

Experimental Evaluation Phase

Quantitative design:

The experimental phase used a true experimental pre-test-post-test-follow-up control group design. Qualitative data were embedded throughout the process using semi-structured forms.

Participant Selection and Assignment:

Out of 135 initial applicants, Emotional Eating Scale (EES) scores were calculated and converted into Z scores using SPSS, since the scale lacks a clinical cut-off. 91 participants falling within ±2 SD were considered eligible and assessed for exclusion criteria.

8 individuals were excluded due to diagnosed eating disorders (e.g., bulimia, binge eating)

12 were excluded due to chronic conditions affecting appetite regulation (e.g., Hashimoto's, diabetes, thyroid)

2 individuals could not commit to the program

From the remaining 69 eligible participants, 40 were randomly assigned into experimental and control groups (20 each). However, due to dropouts during the process:

15 participants in the experimental group

15 participants in the control group completed the full study process and provided data at all time points.

Implementation:

The MB-EER program was delivered to the experimental group by the lead researcher.

Sessions were held online (Zoom) over 7 weeks, once per week.

The control group received no intervention.

All participants completed measurements at three points:

Pre-test (before the intervention)

Post-test (end of Week 7)

Follow-up test (3 months later)

Data Collection Instruments:

Emotional Eating Scale (EES-30)

Mindful Eating Scale (MES-30)

Emotional Appetite Questionnaire (EAQ-22)

Data Analysis:

Quantitative data were analyzed using SPSS v26.0

Parametric tests were used as normality assumptions were met

Statistical procedures included:

Two-factor mixed ANOVA

Wilks' Lambda multivariate repeated measures (MANOVA)

Bonferroni-adjusted pairwise comparisons

Qualitative data were evaluated using content and descriptive analysis

Findings:

The main hypothesis of the study was that the MB-EER Program is effective in reducing emotional eating and emotional appetite and improving mindful eating. This hypothesis was tested by comparing pre-, post-, and follow-up scores between experimental and control groups.

• Mindfulness-Based Emotional Eating Reduction Program (MB-EER) (Behavioral), also known as MB-EER: The MB-EER program was delivered to participants in the intervention arm over 7 weeks. Each session lasted 2 hours and was conducted weekly via Zoom. Participants attended in small groups, and sessions were led by trained facilitators. The intervention focused on guided mindfulness practices, mindful eating exercises, and group discussions.

Primary outcomes

• Change in Emotional Eating Score (EES-30) from Baseline to Follow-up [Change from Baseline (Week 0) to Post-test (Week 7) and Follow-up (Week 12)]: The scale developed by Bilgen (2018) was adapted to reveal the relationship between emotions and eating. The scale consists of 4 sub-dimensions (Eating in Tense Situations, Eating to Cope with Negative Emotions, Self-Control, and Control in the Face of Stimuli). The scale is scored on a 5-point Likert scale, and the items consist of "Never (1)", "Rarely (2)", Sometimes (3)", 'Often (4)' and 'Always (5)' options. Both the sub-dimensions and the whole scale give a total score, and it is concluded that the higher the score obtained from the scale, the higher the emotional eating tendencies. The highest score that can be obtained from the scale is 150, and the lowest score is 30. The scale has a total of 30 items and three reverse-coded items. The Cronbach's Alpha internal consistency coefficient of the scale for this study was calculated as .92.
• Mindful eating questionnaire (MEQ-30) [Change from Baseline (Week 0) to Post-test (Week 7) and Follow-up (Week 12)]: The Mindful Eating Questionnaire (MEQ) is a 30-item self-report scale adapted to Turkish by Köse et al. (2016). It includes seven subscales: Disinhibition, Emotional Eating, Eating Control, Focusing, Eating Discipline, Mindfulness, and Interference. Items are rated on a 5-point Likert scale (1 = Never, 5 = Always). Higher scores indicate greater mindful eating. Twenty items are reverse-coded. Cronbach's alpha = .72.
• Emotional appetite questionnaire (EAQ-22) [Change from Baseline (Week 0) to Post-test (Week 7) and Follow-up (Week 12)]: The Emotional Appetite Questionnaire (EAQ-22), validated in Turkish by Demirel et al. (2014), is a 22-item self-report scale assessing appetite changes in response to emotional states and situations. Items are rated from 1 to 9: 1-4 = less appetite, 5 = no change, 6-9 = more appetite. Subscales include emotions (14 items) and situations (8 items), each split into positive and negative categories. Higher scores indicate greater emotional appetite. Cronbach's alpha = .71.

Sex: All, ages: 18 Years to any, accepts healthy volunteers

Inclusion Criteria:

* Adults aged 18 and older

Individuals reporting high levels of emotional eating

Willingness to participate in a 7-week online intervention program

Access to a computer and stable internet connection

Completion of informed consent form

Exclusion Criteria:

* Current diagnosis of an eating disorder (e.g., bulimia nervosa, binge eating disorder)

Diagnosis of a chronic medical condition that affects appetite (e.g., diabetes, thyroid disorders such as Hashimoto's disease)

Pregnancy

Inability to commit to regular attendance in the 7-week program

Participation in another psychological intervention during the study period

• Study Protocol and Statistical Analysis Plan (PDF, 2023-05-21)
• Informed Consent Form (PDF, 2023-05-21)

• Tuğba Seda Çolak Turan, Principal investigator, tugbacolak@duzce.edu.tr