mental skills as protective attributes against eating disorder risk in dancers

JOURNAL OF APPLIED SPORT PSYCHOLOGY, 25: 209–222, 2013Copyright C© Association for Applied Sport PsychologyISSN: 1041-3200 print / 1533-1571 onlineDOI: 10.1080/10413200.2012.712081

Mental Skills as Protective Attributes Against Eating DisorderRisk in Dancers

ELENA ESTANOL

University of Utah and Synapse Counseling LLC

CAITLIN SHEPHERD AND TIARE MACDONALD

Colorado State University

The aim of this study was to determine whether negative affect (anxiety and depression)mediates the relationship between environmental weight pressures and eating disorder risk(measured by the Eating Disorder Inventory-3rd Edition [EDI-3]—risk composite); and fur-thermore, whether mental skills (Athletic Coping Skills Inventory-28 [ACSI-28]) can decreasestrength of said relationship (serving as protective factors) in dancers. Our study revealed thatnegative affect partially mediated the relationship between environmental pressure and eatingdisorder (ED) risk, and that mental skills did serve a protective factor, thus, decreasing therisk. Specifically, coping with adversity, freedom from worry, and self-confidence emerged asthe most protective skills against eating disorders.

Researchers in the eating disorder (ED) field have focused on identifying risk and protectivefactors to aid with treatment and prevention programs (Haines, Kleiman, Rifas-Shiman, Field,& Austin, 2010; Striegel-Moore & Bulik, 2007). Research efforts have also sought to determinespecific groups who are at increased risk based on environmental pressures so as to target thoseindividuals in most need. Athletes have been found to be at greater risk for the developmentof EDs because they live in a culture that promotes and even rewards the acquisition ofa thin body (Powers, 2000; Smolak, Murnen, & Ruble, 2000). Individuals participating inathletic fields that emphasize aesthetics (e.g., dance, gymnastics, figure skating) are at highestrisk for developing EDs due to the importance of having a thin body not only for physicalfitness but also to create ideal bodylines and positions (Abraham, 1996; Sundgot-Borgen &Torstveit, 2004; Torstveit, Rosenvinge, & Sundgot-Borgen, 2007). In addition to this focus onthinness, the competitive nature of the athletic environment may place individuals at increasedrisk for EDs due to heightened stress and pressure. Thus, dancers, as aesthetic athletes, areexposed to high pressure for thinness, an emphasis on leanness and appearance, and an intense

Received 8 March 2012; accepted 12 July 2012.Special thanks are extendend to University Dance Department Chairs for their collaboration, and

dancers who freely gave their time and effort in the completion of this study.Address correspondence to Elena Estanol, Ph.D., M.F.A., at Synapse Counseling LLC, 506 S. College

Ave. Ste. A2, Fort Collins, CO, 80524. E-mail: [email protected]

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210 E. ESTANOL ET AL.

competitive environment, placing them in a high-risk category for the development of EDs(Abraham, 1996; Hamilton, Brooks-Gunn, & Warren, 1985).

Eating Disorders in Dancers

Prevalence rates of EDs in dance companies and schools have been reported to be as high as45% as compared to average, non-dancer students with rates estimated around 28% (Abraham,1996). In one empirical study, results revealed that dancers had greater weight preoccupation,body dissatisfaction and drive for thinness than non-dancers (Anshel, 2004). Anshel (2004)also discovered that the psychopathology among dancers in this study was comparable toindividuals presenting with clinically significant disordered eating behaviors. Another studyexamining ballet dancers found them to be more similar to individuals diagnosed with EDsin terms of eating pathology than to control participants (Ringham et al., 2006). Furthermore,83% of the dancers in this sample met lifetime criteria for an ED diagnosis such as eatingdisorder not otherwise specified (EDNOS), bulimia nervosa (BN), or anorexia nervosa (AN).Likewise, Herbrich, Pfeiffer, Lehmkuhl, and Schneider (2011) confirmed that dancers weremore likely to develop an ED compared to their non-dancer counterparts. In sum, these resultsillustrate that dancers have elevated levels of eating pathology and are at increased risk for thedevelopment of a clinically significant, diagnosable ED.

Risk FactorsAs knowledge has spread regarding the prevalence of EDs among dancers, researchers have

attempted to isolate the specific contributing risk factors (Striegel-Moore & Bulik, 2007; Toro,Guerrero, Sentis, Castro, & Puertolas, 2009). One of the risk factors of interest has been thedance environment itself and the inherent pressures associated with the competitive nature ofthe environment and the pursuit of a thin body for aesthetic purposes.

Dance environment. Regardless of body type, ability, and vulnerability, dancers feel the pres-sure to maintain strong, limber, and lithe bodies (Abraham, 1996; Hamilton, 1997; Schnitt &Schnitt, 1987). Studies have shown that exposure to weight pressures is related to increasedlikelihood of developing body image concerns and ED symptomology in dancers (Annus &Smith, 2009; Reel, Jamieson, SooHoo, & Gill, 2005; Toro et al., 2009). Weight pressures canbe characterized by any environmental factor that places an extreme emphasis on appearance,achievement and maintenance of a lean physique and low body weight. College dance studentsidentified mirrors, costumes, being lighter to gain performance advantages in casting, betterperformances (when thinner) and comparison with peers among the most extreme pressuresexperienced (Reel et al., 2005). Additionally, these dancers indicated that dance partners,instructors, and audiences also contributed to their body image concerns. In subsequent inter-views, many of these dancers voiced that they had been pressured to switch to a modern danceemphasis because they felt their body was inappropriate for ballet, or were clearly told theywere not fit for classical ballet.

In addition to these specific weight pressures, the dance environment, as Schnitt and Schnitt(1987) point out, is focused on obedience, correctness and perfection, adding to the pressureto conform to the ideal body type. Awareness has increased about the impressionability ofyoung dancers and the impact that this stressful environment has on their health (Buckroyd,2000; Hamilton et al., 1985). Many researchers in the dance domain have voiced concernsregarding the pressures felt by dancers and the consequences in the form of disordered eatingand other maladaptive behaviors (Bettle, Bettle, Neumarker, & Neumarker, 1998; Buckroyd,

MENTAL SKILLS REDUCE EATING DISORDER RISK IN DANCE 211

2000; Hamilton, 1997). Cases of EDs in dancers, such as the highly publicized death ofHeidi Guenther, serve as a clear example of the potential risks associated with the danceenvironment (Van Boven & Cowley, 1997). The preoccupation with body weight and shapebecomes integral to achieving the ideal aesthetic, performing the appropriate movements,creating the correct lines and ultimately obtaining and maintaining a career (Schnitt & Schnitt,1987). Thus, dancers view being thin as necessary to maintain their livelihood (Bettle et al.,1998; Buckroyd, 2000; Hamilton et al., 1985).

Negative affect. This evidence suggests that the pressures of the dance environment are animportant risk factor to consider in the development of EDs in dancers; however, although alldancers are exposed to this type of environment to some extent, not all dancers develop EDs.Therefore, researchers have also examined psychological factors that might make dancers morevulnerable to EDs (Hamilton et al., 1985). Within the ED literature in the general population,studies have established a relationship between psychological distress and maladaptive eatingbehaviors (Blodgett Salafia, Gondoli, Corning, McEnery, & Grundy, 2007; McCabe & Vincent,2003; Sawdon, Cooper, & Seabrook, 2007). Disordered eating behavior appears to be acoping mechanism to deal with internalized negative emotions (Stice, 2002). More specifically,research has supported the link between negative affect, mainly depression and anxiety, andeating disturbance as well as subsequent EDs (McCabe & Vincent, 2003).

Studies have highlighted the association between depression and symptoms of eating pathol-ogy (Zucker, Womble, Williamson, & Perrin, 1999). A recent study found that 56% of thosewith AN and 71% of those with BN also met criteria for a mood disorder (Jordan et al., 2008).Several studies have also indicated that depressive symptoms are significant early predictorsof later dieting behaviors and EDs (Bearman, Presnell, Martinez, & Stice, 2006; Sinton &Birch, 2005).

Anxiety is also believed to contribute to the etiology and maintenance of EDs and co-morbidity of anxiety disorders has been reported in both AN and BN (Garner, 2004; Jordanet al., 2008; O’Brien & Vincent, 2003). Supporting this point, the study by Jordan andcolleagues also revealed that 55% of those with AN and 50% of those with BN qualifiedfor an anxiety disorder diagnosis. Several studies have demonstrated the presence of anxietysymptoms prior to the emergence of eating symptoms suggesting that anxiety is a psychologicalrisk factor pre-dating the emergence of eating disorder behaviors (Bulik, Sullivan, Fear, &Joyce, 1997; Thornton & Russell, 1997; Wagner, Aizenstein, & Venkatraman, 2007). Suchfindings imply that anxiety, similar to depression, may represent a pathway to EDs by enhancingvulnerability (Bulik et al.; Kaye et al., 2004; Thornton & Russell, 1997).

Although extensive research has been conducted on the relationship between negative affectand EDs, little research has specifically looked at this connection in dancers. In one recentstudy of female adolescent dancers, perceived pressures regarding weight and appearance,depressive symptoms and eating pathology were all positively correlated (Toro et al., 2009).Several articles have described the high prevalence and potentially negative consequences ofanxiety symptoms in dancers; however, few have specifically explored anxiety in relation toeating pathology (Buckroyd, 2000; Hays, 2002). One study that did examine this connectionfound that dancers with high trait anxiety used more maladaptive coping strategies thanthose with lower trait levels of anxiety. Additionally, results showed that stressors in thedance environment increased state anxiety among dancers, thus, amplifying risk for EDs(Barrell & Terry, 2003). The role of anxiety and depression as meditational factors betweenstressors, such as, weight pressures and ED risk in dancers has not yet been investigated.


Such information may help to explain why certain dancers are more vulnerable to developingEDs.

Protective Factors

The relationship between stressful situations, maladaptive coping, and eating pathologyhas been established in numerous studies (Ball & Lee, 2002; Bloks, Van Furth, Callewaert,& Hoek, 2004; Yager, Rorty, & Rossotto, 1995). Just as maladaptive coping might make anindividual more vulnerable to developing an ED, positive coping skills might serve a protectivefunction. Investigating protective factors that distinguish dancers who do not develop EDs fromdancers that do is imperative. Several ED researchers have taken the initiative to introduce theconcept of protective factors into the field (McVey, Pepler, Davis, Flett, & Abdolell, 2002).These studies have shown that recovered individuals tend to use more positive coping skillsincluding less avoidance, more active tackling, use of rational thinking and gaining controlof emotional responses (Bloks et al., 2004; D’Abundo & Chally, 2004). Although no studieshave examined resiliency (defined broadly as using adaptive coping) against the developmentof EDs via adaptive coping skills within the dance population, researchers have generallyexplored the positive effects of coping skills utilization by athletes and dancers.

Although some researchers have posed the possibility of endogenous personal resiliencyattributes that may buffer against risk factors, few studies have targeted EDs from a protectivefactor standpoint (McVey et al., 2002; Steck, Abrams, & Phelps, 2004; Zucker et al., 1999).Moreover, no studies have looked at risk and protective factors as an explanation for thevariability in ED outcomes observed in dancers.

Mental skills in athletes. Sport psychologists emphasize the importance of teaching positivecoping skills, referred to as mental skills, principally for the purpose of performance en-hancement (Greenspan & Feltz, 1989; Hall & Rodgers, 1989). These skills have been derivedfrom common cognitive behavioral techniques, which are also often used in the treatment ofEDs (Meyers, Whelan, & Murphy, 1996). Using this cognitive behavioral framework, Smith,Schutz, Smoll, and Ptacek (1995) created the Athletic Coping Skills Inventory (ACSI-28) toassess skills thought to influence performance in athletes. This measure examines the follow-ing mental skills: confidence/achievement motivation, coping with adversity, freedom fromworry, peaking under pressure, goal-setting/mental preparation, concentration, and coacha-bility. Smith et al. suggested that training athletes to use these mental skills can help themdeal with stress, set achievable standards of personal excellence, develop self-awareness, andinhibit perfectionism. Therefore, these skills are not only useful for enhancing performancebut, may also provide athletes with the tools they need to better cope with stressful situations,hence preventing EDs.

Mental skills in dancers. Although sporting and dance environments are similar, especially interms of competitiveness, there are also a number of differences that exist. For example, Smith(1998) contends that compared to other athletes, aesthetic performers, including dancers,have unique concerns. For dancers, performance is based on subjective opinion rather thanobjective numbers (i.e., points scored), which can lead to increased anxiety and excessiveconcern about evaluation. Additionally, body type and appearance play a significant role indetermining performance quality and add to the stress of the dance environment. Last, dancers,like other artistic athletes, need to not only have proper technique but also must incorporateartistry, grace, and expressiveness into their performance. As a result of these added pressures,


it is important to further explore the use of mental skills among dancers rather than applyinginformation gathered from the general sports psychology field.

The dance psychology literature provides information to support the use of these skills withdancers based on anecdotal and correlational evidence. Confidence/achievement motivationhas received much attention in the dance field, as there is agreement among professionals thatconfidence plays a large role in successful performers (Hanrahan, 2005). Suggested efforts toimprove confidence in dancers include developing constructive and positive ways of thinking,using helpful attributions and positive imagery (Estanol, 2004; Hanrahan, 2005; Nordin, &Cumming, 2008; Tremayne & Ballinger, 2008).

Some of the coping skills examined have focused on actively dealing with stress, emotionalarousal and negative affect (i.e., relaxation, use of positive self-talk, and mind control) (Smith,Schutz, Smoll, & Ptacek, 1995). Professionals have supported using emotional regulationstrategies, meditation, deep breathing and positive self-talk to enhance performance and re-duce stress for dancers (Hanrahan, 2005; Smith, 1998; Tremayne & Ballinger, 2008). Thesecomponents have been found to enhance the consistency and quality of performance, improvethe ability to learn new dance sequences, correct errors and focus attention, reduce anxiety,eliminate distractions, and enhance confidence. It should be noted that when defining realisticgoals, the focus should not be on perfection, as this can lead to EDs (Smith, 1998).

Purpose and Hypotheses

Given that so few studies have actually looked at the presence of both risk and protectivefactors in the development of eating disorders; the present study aims to determine if negativeaffect and mental skills mediate the relationship between weight pressure and ED risk. Fur-thermore, it aims to determine whether protective factors can decrease the vulnerability thatthe risk factors pose in the development of eating disorders. In order to achieve this purpose,the following hypotheses were tested: (a) there will be a positive correlation between riskfactors (weight pressure, depression, anxiety) and ED symptoms, (b) there will be a negativecorrelation between risk factors (weight pressure, depression, anxiety) and coping skills, (c)negative affect (depression and anxiety) will mediate the relationship between weight pressuresand ED symptoms, (d) protective factors (mental skills) will mediate the relationship betweennegative affect (depression and anxiety) and ED symptoms.

METHODS

Participants

Data were collected from 205 female (n = 205) participants located in four states across thecountry: Utah, Ohio, Oklahoma, and Pennsylvania. Dancers ranged in age from 17 to 25 years(M = 19.95, SD = 1.81) and had been training for an average of 12.46 (SD = 4.23) years. Themajority of participants were European American collegiate ballet dancers; however, collegiatemodern and professional ballet dancers were also included in the sample.

The ethnic composition of the sample is as follows: European American (88.3%), AsianAmerican (4.9%), Latina (1.0%), African American (1.0%), American Indian (.5%), Multi-ethnic (3.4%), and Other (1.0%). With regard to class standing, the most surveyed group werefirst-year students (40.8%) followed by sophomores (20.4%), juniors (14.6%), seniors (14.6%),graduate students (2.9%), and 5th year seniors (2.4%). The remaining 4.4% of participantswere non-student professional dancers. More than half of the participants were from Utah(59.7%), with a smaller minority from Ohio (18.0%), Oklahoma (15.0%), and Pennsylvania


(7.3%). Participants were primarily from university ballet programs (84.0%) with 11.2% fromuniversity modern dance programs and 4.9% from professional ballet companies. The majorityof participants reported that they had never been diagnosed with an ED (92.2%) although overhalf indicated dissatisfaction with their current weight (56.3%) and 25.8% met classificationfor ED risk (i.e., typical clinical or elevated clinical) according to the EDI-3.

Measures

Demographic information was collected concerning the participant’s age, sex, ethnicity,years of dancing, and both the setting and type of dance practiced. Participants were alsoasked to indicate satisfaction with their current weight and past or present diagnoses of EDs.

Environmental PressurePressure in the dance environment was measured via the Weight Pressures in Dance scale

(WPD; Reel et al., 2005). The WPD is a questionnaire created to measure the pressures felt bydancers as related to body weight, shape, and size. It is the only measurement of its kind and itwas modified from CHEER, a previous inventory assessing weight pressures in cheerleaders(Reel & Gill, 1996). The inventory is a 16-item questionnaire with a Likert format with scoresranging between 1 and 6 on each with higher scores number indicating higher perceivedpressures. The internal consistency estimate (Cronbach’s alpha) has been reported at .89 (Reelet al., 2005).

Negative AffectNegative affect was assessed using both the Beck depression inventory II (BDI-II) and

the state and trait anxiety inventory (STAI). The BDI-II is a widely used 21-item self-reportmeasure of depression (Beck, Steer, & Brown, 1996). Items are rated on a 4-point Likerttype scale. The items assess affective, cognitive, motivational, and physiological symptomsthat have been linked with mood. Psychometric analyses have revealed excellent test-retestreliability (α = .93), as well as, good convergent and discriminant (r = .71) with othermeasures of depression (Riskind, Beck, Brown, & Steer, 1987). Mean internal consistencyestimates have been reported at .91.

The STAI is a well-known tool used to measure both trait and state anxiety (Spielberger,Gorsuch, Lushene, Vagg, & Jacobs, 1983). Trait anxiety is believed to measure individualdifferences in the perception of stress and consistent response patterns to anxiety-provokingsituations, while the state scale is used to measure more transient situations. Both the traitanxiety subscale (STAI-T) and the state anxiety subscale (STAI-Y) contain 20 items eachthat assess proneness to anxiety in general (trait) and situationally (state), with higher scoresindicating greater anxiety. The test has been found to have adequate test-retest reliability (.73to .86), validity (.70 to .86), and Internal consistency (.89 to .90) (Spielberger et al., 1983).In addition, intercorrelations between the state and trait subscales examined in seven differentsamples have ranged from .59 to .75. Both the state and the trait components of the STAI wereused as indicators to the variable negative affect as separate measures of trait and state anxiety.

Eating Disorder RiskED risk was evaluated with the eating disorder inventory-third edition (EDI-3; Garner,

2004). The EDI-3 is a 91-item questionnaire that assesses psychological and behavioral traitscommon in anorexia nervosa and bulimia nervosa. The EDI-3 items are scored on a 4 pointLikert-type scale ranging in value from 0 to 3, with 3 representing greater symptomatology.Internal consistency estimates have ranged from .79 to .93. Factor analyses of the EDI haveprovided evidence for the factorial integrity of this instrument with factor loadings ranging


from .41 to .83 within the eight subscales. For the present study, only the scores from thebulimia (B), drive for thinness (DT), and body dissatisfaction (BD) subscales were used asthese comprise the eating disorder risk composite (Welch, Hall, & Walkey, 1988). Thesesubscales specifically measure attitudes and behaviors that involve eating behavior, weight andshape, which are necessary for the diagnosis of an ED as opposed to personality characteristicsthat are common signs of general psychological distress such as low self-esteem (Garner, 2004).

Mental SkillsMental skills were assessed with the athletic coping skills inventory (ACSI-28; Smith

et al., 1995) The ACSI-28 is a widely used measure of psychological skills thought to influ-ence performance in athletes. It is a 28-item, 7-factor instrument that measures psychologicalskills related to sports. The subscales include: coping with adversity, peaking under pressure,goal-setting/mental preparation, concentration, freedom from worry, confidence/achievementmotivation, and coachability. The items are scored on a 4-point Likert scale. Internal con-sistency has been reported between .84 and .88. The 7-factor structure has been empiricallyconfirmed, yielding a confirmatory factor index (CFI) of .91 (Smith et al., 1995). High test-retest reliability as well as convergent and discriminant validity have also been established.In the present study, the ACSI-28 was slightly modified to be more appropriate for the danceenvironment. For example, the word sports was changed to dance, and competition and gamewere changed to performance. In addition, the scale was referred to as the survey of danceperformance experiences in the participants’ questionnaire packet.

Procedures

Following IRB approval from the primary investigator’s (PI) university, authorization torecruit dancers was requested from dance department chairs and professional ballet companydirectors. Participants were recruited in person in three major professional ballet companiesand in four dance departments in the United States. In order to ascertain a sample more orless representative of the U.S. population, the companies and universities were selected basedon geographic location (east coast, midwest and western states). Selection of universities wasalso made by locating programs that had pre-professional or elite dance programs. Dancerswho consented to participate completed a questionnaire packet that took between 1 to 2 hr. ThePI introduced the questionnaire and then either collected the packet (from university dancers)or provided participants with self-addressed, stamped envelopes to return the packet (fromprofessional dancers). Confidentiality was assured as individual results were not shared andonly the PI had access to participants’ names. Participation was voluntary and participantswere offered the opportunity to have their name entered into a drawing for a $50.00 gift card.

RESULTS

Data were managed and analyzed using SPSS 20.0 and AMOS 19.0.

Descriptive Data

Frequencies and descriptive statistics were calculated for the demographic and ED-relatedcharacteristics of the sample.

Means, standard deviations, and internal consistencies were calculated for variables of in-terest to examine the psychometric properties of the measurements used in this study (Table 1).Coefficient estimates revealed that the coachability subscale of the ASCI-28 had poor relia-bility (α = .61). This suggests that the utility of this scale with a dance population should be


Table 1Means, Standard Deviations, Range, and Reliability Estimates for Variables

Variable M SD Min Max α

1. WPD 57.37 14.10 22 88 .852. BDI-II 10.05 8.46 0 58 .913. STAI-Y 40.63 12.83 20 79 .944. STAI-T 41.81 11.28 20 77 .935. EDR 35.42 11.36 5 66 .846. Coping 6.31 2.36 0 12 .707. Peaking 5.60 2.81 0 12 .818. Goal 6.89 2.55 1 12 .699. Conc. 7.38 2.33 2 12 .7019. Freedom 5.53 2.60 0 12 .6811. Conf. 7.94 2.36 1 12 .7012. Coach. 9.68 1.89 1 12 .6113. ACSI 49.34 10.14 15 78 .84

WPD = weight pressures in dance; BDI = Beck depression inventory-II; STAI = state trait anxiety inventory; EDR =eating disorder risk; Coping = coping with adversity; peaking = peaking under pressure; Goal = goal setting/mentalpreparation; Conc. = concentration; Freedom = freedom from worry; Conf. = confidence/achievement motivation;Coach = coachability; ACSI = athletic coping skills inventory.

further evaluated. All of the other scales had adequate to excellent internal consistency (i.e.,α >.65).

Correlation Analyses

Correlation analyses were conducted for weight pressure, negative affect, ED risk andmental skills (Table 2). Hypothesis 1, that there would be a positive correlation between riskfactors and ED symptoms was supported. Correlations between ED risk (EDR) and weightpressure (WPD), depression (BDI-II), and anxiety (STAI-Y and STAI-T) were all positive,significant and moderate to strong in nature (i.e., p < .01, r > .30). Hypothesis 2, stating thatthere would be a negative correlation between risk factors and mental skills was also supported.

Table 2Intercorrelations for Variables

Variable 2 3 4 5 6 7 8 9 10 11 12 13

1. WPD .40∗∗ .25∗∗ .34∗∗ .69∗∗ −.26∗∗ .02 .16∗ −.14∗ −.39∗∗ −.23∗∗ −.22∗∗ −.24∗∗2. BDI-II — .56∗∗ .68∗∗ .50∗∗ −.31∗∗ .10 .07 −.26∗∗ −.37∗∗ −.32∗∗ −.25∗∗ −.31∗∗3. STAI-Y — — .82∗∗ .37∗∗ −.36∗∗ −.07 −.02 −.32∗∗ −.39∗∗ −.27∗∗ −.21∗∗ −.38∗∗4. STAI-T — — — .48∗∗ −.44∗∗ −.06 −.02 −.40∗∗ −.45∗∗ −.38∗∗ −.27∗∗ −.47∗∗5. EDR — — — — −.25∗∗ .05 .13 −.19∗∗ −.41∗∗ −.23∗∗ −.17∗ −.25∗∗6. Coping — — — — — .36∗∗ .24∗∗ .59∗∗ .27∗∗ .26∗∗ .35∗∗ .77∗∗7. Peaking — — — — — — .32∗∗ .32∗∗ .04 .21∗∗ .12 .60∗∗8. Goal — — — — — — — .25∗∗ −.17∗ .35∗∗ .08 .51∗∗9. Conc. — — — — — — — — .12 .56∗∗ .28∗∗ .73∗∗

10. Freedom — — — — — — — — — .14∗ .21∗∗ .36∗∗11. Conf. — — — — — — — — — — .31∗∗ .71∗∗12. Coach. — — — — — — — — — — — .52∗∗13. ACSI — — — — — — — — — — — —

∗p < .05. ∗∗p < .01.


Most notably, negative, significant, moderate to strong correlations were identified betweenWPD and freedom from worry; BDI-II and coping with adversity, freedom from worry, andconfidence/achievement motivation; STAI-Y and coping with adversity, concentration, andfreedom from worry; STAI-T and coping with adversity, concentration, freedom from worry,and confidence/achievement motivation. Additionally, BDI-II, STAI-Y and STAI-T were allfound to have negative, significant, moderate-to-strong correlations with overall mental skillsas measured by the ACSI.

Mediation Analyses

Observed IndicatorsIn order to conduct Structural Equation Modeling (SEM) analyses, each latent variable must

be comprised of multiple indicators. Following SEM recommendations, observed indicatorswere created for each of the latent variables that were not already composed of subscales.Thus, three observed indicators (WPD1, WPD2, WPD3) were created for the WPD variable.

Structural Equation ModelingThe proposed mediated structural models in Hypotheses 3 and 4 were tested using the

maximum likelihood method in AMOS 19.0. In accordance with current recommendations,the comparative fit index (CFI), the incremental git index (IFI) and the standardized root meansquare residual (SRMR) are included as measures of goodness of fit.

For Hypothesis 3, negative affect (BDI-II, STAI-Y and STAI-T) was examined as a potentialmediator of WPD (WPD1, WPD2, WPD3) and EDR (B, DT, BD). As predicted, negative affectemerged as a statistically significant mediator and the structural model provided a good fit tothe data: χ2 (24, N = 205) = 44.10, p < .05; CFI = .98; IFI = .98; SRMR = .06. All pathswere significant (see Figure 1). However, WPD still significantly accounted for EDR even inthe presence of negative affect, suggesting that negative affect is only a partial mediator of thisrelationship.

For Hypothesis 4, mental skills (subscales of the ASCI-28) were examined as a potentialmediator of negative affect and EDR Contrary to the hypothesis, the structural model didnot provide a good fit to the data: χ2 (62, N = 205) = 188.82, p < .05; CFI = .89; IFI =.86; SRMR = .11. It was suspected that the lack of fit was due to the inclusion of too manyindicators of mental skills or skills that were not making significant contributions. Thus, asecond model was hypothesized using only the mental skills that were highly and significantly

WPD1

WPD2

WPD3

WPD EDR

B

DT

BD

1.59*

.83* .26*

Negative Affect

BDI-II

STAI-Y

STAI-T

Figure 1. Parameter estimates of the mediated model testing whether the relationship betweenweight pressures in dance and eating disorder risk is mediated by negative affect. ∗p < .05.


correlated with both negative affect and EDR (coping with adversity, freedom from worry,and confidence/achievement motivation). As predicted, using these three indicators, mentalskills emerged as a statistically significant mediator and the structural model was a better fitto the data: χ2 (24, N = 205) = 69.75, p < .05; CFI = .95; IFI = .95; SRMR = .07. Thepath between negative affect and mental skills as well as the path between mental skills andEDR were significant (see Figure 2). However, the path between negative affect and EDRwas not significant with mental skills included as a mediator in the model. Therefore, whenmental skills were included into the model, negative affect no longer appeared to contributesignificantly to EDR.

DISCUSSION

The purpose of this study was to determine whether negative affect and protective mentalskills mediate the relationship between weight pressures in the dance environment and EDsymptoms. The results of this study supported the researchers’ hypotheses. Negative affect(depression and anxiety), and weight pressures in the dance environment were positivelyassociated with ED symptoms. Second, mental skills were found to be negatively associatedwith ED symptoms. Consistent with predictions, it was found that negative affect partiallymediated the relationship between weight pressures and ED symptoms. Furthermore, mentalskills, specifically coping with adversity, freedom from worry, and confidence/achievementmotivation, fully mediated the relationship between negative affect and ED symptoms.

Results from this study provide additional evidence that pressure to be thin in the danceenvironment is associated with negative affect (Barrell & Terry, 2003) and ED symptomatology(Annus & Smith, 2009; Reel et al., 2005; Toro et al., 2009). Additionally, although studieshave highlighted the psychological benefits of using athletic coping skills (Estanol, 2004;Hanrahan, 2005; Smith, 1998; Taylor & Taylor, 1995; Tremayne & Ballinger, 2008), this studyclarified which mental skills appear to have the most benefit in a sample of dancers with regardto coping with negative affect and ED symptoms.

Findings from this study suggest environmental pressures and negative affect have a largecontribution to ED risk in dancers and, that we can increase protective factors in individualsby teaching them specific strategies that may enable them to cope better. This study found

WPD EDR

B

DT

BD

Mental Skills

Negative Affect

Coping

Freedom

Conf.

.10

-.10* -4.3*

BDI-II

STAI-Y

STAI-T

Figure 2. Parameter estimates of the mediated model testing whether the relationship betweennegative affect and eating disorder risk is mediated by mental skills (coping with adversity, free-dom from worry, confidence/achievement motivation). ∗p < .05.


that specifically coping with adversity, freedom from worry, and confidence and achievementmotivation were important factors mediating the relationship between negative affect and EDsymptoms. This information can be used to inform clinical practice and prevention programsfor dancers. Specifically, learning skills such as arousal regulation, positive self-talk, imagery,cognitive reframing techniques, and developing a strong confidence in abilities and strengthsmay all serve to protect dancers against the negative effect associated with weight pressures.It is hoped that having a strong set of mental skills will offer alternative coping strategies toeating disordered attitudes and behaviors.

It is important to highlight that negative affect did not completely mediate the relationshipbetween weight pressures and ED risk. This implies that negative affect may be only a partialcognitive mediator to the internalization of these pressures that may exacerbate the risk of thedevelopment of ED symptoms. It may also mean that there might be other mediators to thisrelationship that have not been tested in this study. Such as biological, other psychological,trauma, and other environmental factors as outlined in previous research. However, it alsosuggests that environmental pressures alone are a very strong risk factor to EDR. It maybe important to acknowledge that perhaps prevention efforts may be best aimed at teachinginstructors, choreographers and directors how the perpetuation of traditional practices mayincrease the risk for their dancers to develop ED.

The strongest protective factors that emerged against negative affect (coping with adversity,freedom from worry, and confidence) highlighted the usefulness of these skills with dancers.However, many other mental skills had a significant contribution to this variable (mentalskills) both in the correlational analyses and mediational models, yet too many variables oftendecrease the fit in SEM analyses. It is worth mentioning that concentration had a significantnegative relationship to anxiety, depression, and ED risk. This is interesting in lieu of recentresearch indicating that individuals with EDs lack cognitive flexibility and therefore increasingthis skill may decrease the obsessive-compulsive type thoughts often associated with EDs(Tchanturia et al., 2004).

Finally, the total score for the ASCI (that yields a personal coping resources), was sig-nificantly negatively correlated with WPD, anxiety, depression, and EDR. This means thatteaching dancers all of the mental skills associated with performance enhancement may infact also serve as protective factors to their negative environment. Given the nature of SEM,(too many indicators reduce model fit) it was difficult to include all of the mental skills in themodel. Perhaps alternate analyses may allow for the inclusion of more indicators to test thisassertion.

One limitation of this study was that the sample was predominantly white and female.Results from this study may therefore not be generalizable to a more ethnically diverse sampleor to male dancers. Furthermore, this study lacked a comparison group of non-dancers, whichwould have enabled the researchers to more objectively compare the impact of the danceenvironment with a non-dance environment. Additional studies are needed to explore how otherprotective factors (i.e., satisfaction with life, optimism, self-esteem, humor, and spirituality)may further explain variations in ED symptoms in dancers and contribute to this mediationmodel identified. Future research that looks at variables in the context of high-risk groups byproviding profiles of resilient dancers vs. at-risk dancers is also needed in order to furtherclarify the relationship between risk and resilience factors and ED outcomes. Furthermore,including demographic variables in the analyses would help us to better understand if certainsubpopulations of dancers may be more at risk or protected from pressures in the danceenvironment. Finally, studies should include the use of alternative methods in addition toself-report to more thoroughly explore variables relating to the dance environment.


In summary, the purpose of this study was to examine the relationship between weight pres-sures in dance, and negative affect (as risk factors) to eating disorder risk, to determine whethernegative affect was a cognitive mediator to internalized pressures from the environment. Al-though negative affect emerged as a significant risk factor, it was only a partial mediator to therelationship between weight pressures and eating disorder risk, implying that environmentalpressures alone can contribute to EDR. Secondly, mental skills were examined as protectivefactors that could mediate the relationship between negative affect and EDR. The most mean-ingful contribution of this study was identifying the specific mental skills that emerged as fullmediators to this relationship implying that they may serve as protective factors and decreasethe risk for EDs posed by negative affect. The specific mental skills (as measured by theACSI-28) were freedom from worry, coping with adversity, and confidence/achievement mo-tivation. This suggests that relaxation/arousal regulation, imagery, positive self-talk, cognitiverestructuring, and skills aimed at increasing confidence may be some of the most importantmental skills to teach dancers not only for performance enhancement but to decrease theirvulnerability to environmental pressures, anxiety, depression, and ED symptoms.

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mental skills as protective attributes against eating disorder risk in dancers

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