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Psychological and Cortisol Responses to and Recovery From Exposure to a Body Image Threat:

Psychological and Cortisol Responses to and Recovery From Exposure to a Body Image Threat: The majority of body image research has failed to measure what occurs beyond the immediate presentation of a body image threat, or after a body image threat is no longer present. This is particularly true for physiological outcomes. The present study examined psychological and cortisol responses to, and recovery from, a body composition assessment as a social-evaluative body image threat. Women (N = 64) were randomized into either a control or threat group. Participants completed a measure of social physique anxiety and provided a sample of saliva (to assess cortisol) at baseline, and immediately following and 20 min following their condition. The threat group reported higher social physique anxiety following the threat in comparison with both baseline levels and recovery levels. Cortisol was higher immediately following the threat in comparison with baseline levels. Findings support the inclusion of a recovery time point in body image research to provide a more complete picture of the psychobiology of body image experiences. Keywords body image, cortisol, body threat, women, social self-preservation theory Body image is an individual’s internal representation of his also shown that situations that maximize social evaluation of or her outer self (Thompson, Heinberg, Altabe, & Tantleff- one’s body elicit body image concerns (Cloudt, Lamarche, & Dunn, 1999). Body image concerns are associated with a Gammage, 2014; Gammage, Martin Ginis, & Hall, 2004; number of negative outcomes including lower self-esteem, Hart et al., 1989; Van Raalte, Cunningham, Cornelius, & increased risk of depression, social anxiety, and eating Brewer, 2004). In addition, situations in which body image pathologies (Kostanski & Gullone, 1998; Levine & Smolak, concerns are elicited (i.e., viewing media images of the thin 2002; McCaulay, Mintz, & Glenn, 1988; Stice, 2002). Given ideal, situations of heightened self-objectification) have been the potential negative implications of body image concerns, shown to have lingering effects (Hausenblas, Janelle, identifying situations or the contextual factors of situations Gardner, & Hagan, 2003; Quinn, Kallen, & Cathey, 2006). in which these concerns arise is important. Examples of spe- Recently, physiological measures have been incorporated cific situations that exacerbate body image concerns include into body image research to gain an understanding of the being seen in a bathing suit, being next to someone with an psychobiology of body image (Anderson, Shapiro, Lundgren, attractive/ideal physique, or having body composition Spataro, & Frye, 2002; Cloudt et al., 2014; Lamarche, Bailey, assessed (Carron & Prapavessis, 1997; Hart, Leary, & & Gammage, 2015; Lamarche, Gammage, Kerr, Faulkner, & Rejeski, 1989). Klentrou, 2014; Martin Ginis, Strong, Arent, & Bray, 2012; Qualitative research has explored situations of heightened McLean, Barr, & Prior, 2001; Putterman & Linden, 2006; body image concerns (Bain, Wilson, & Chaikind, 1989; Lamarche, Kerr, Faulkner, Gammage, & Klentrou, 2012; University of Toronto, Ontario, Canada Myers & Rosen, 1999). For example, in their qualitative McMaster University, Hamilton, Ontario, Canada study, Lamarche and colleagues (2012) examined comfort- Brock University, St. Catharines, Ontario, Canada able and uncomfortable body experiences in young adult Corresponding Author: women. These authors found that the situations described Larkin Lamarche, Assistant Professor (part-time), Research Coordinator, were social-evaluative in nature and included an element of Health TAPESTRY, Department of Family Medicine, McMaster University, body exposure. Furthermore, coping mechanisms such as 1280 Main Street West, McMaster Health Campus, 5th Floor, Hamilton, avoidance or concealing behaviors were initiated to manage Ontario, Canada L8S 9Z9. those uncomfortable situations. Experimental studies have Email: lamarche@mcmaster.ca Creative Commons CC-BY: This article is distributed under the terms of the Creative Commons Attribution 3.0 License (http://www.creativecommons.org/licenses/by/3.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). 2 SAGE Open Sabiston, Castonguay, Barnett, O’Loughlin, & Lambert, and emphasized that “actual threat exposure in an ethical and 2009). The most commonly assessed in this recent literature ecologically valid manner is necessary to test this hypothe- is cortisol (a stress hormone thought to represent hypotha- sis” (Martin Ginis et al., 2012, p. 1004). Lamarche et al. lamic-pituitary-adrenal axis activation; Sapolsky, 2003). (2015) examined psychological and heart rate responses to Given this recent interest in physiological variables in a an imagined social-evaluative body image threat. Findings body image context, social self-preservation theory (SSPT; showed that the highest levels of body shame and social phy- Dickerson, Gruenewald, & Kemeny, 2004), in contrast to sique anxiety were reported in the social-evaluative com- other theories of body image, may be particularly useful in pared with the non-social-evaluative body image condition. the examination of responses to social-evaluative body However, no differences in heart rate were found between image threats. SSPT suggests that when a social-evaluative groups. In agreement with Martin Ginis et al. (2012), it was threat is present, negative self-conscious emotions and phys- noted that actual threat exposure may be necessary to capture iological responses are elicited concurrently (Dickerson, more robust physiological changes under social-evaluative Gruenewald, & Kemeny, 2004). Shame and cortisol are par- body image threat, and fully understand the psychobiology ticularly responsive to such threats, although other psycho- of body image. logical (i.e., guilt) and physiological (heart rate, The implications of the potential differences in responses proinflammatory cytokines) outcomes have been examined to anticipating and actually facing a threat are important. For within SSPT (Dickerson, Gable, Irwin, Aziz, & Kemeny, example, responses to the mere anticipation of a threatening 2009; Dickerson, Kemeny, Aziz, Kim, & Fahey, 2004). situation particularly negative may cause people to avoid Generally, research has supported the contentions of SSPT engaging in specific body-related situations (e.g., swimming, by examining psychobiological responses to the Trier Social having sex, exercising); however, if such responses can be Stress Test, a performance-based social-evaluative task overcome, some people may feel that the situation was not as (Kirschbaum, Pirke, & Hellhammer, 1993). Recently, SSPT bad (or threatening) as originally believed (Lamarche et al., has been applied to a body image context (Bailey, Lamarche, 2012; Mills, Fuller-Tyszkiewicz, & Holmes, 2014). & Gammage, 2014; Cloudt et al., 2014; Lamarche et al., One recent study developed a novel weight stigma para- 2015; Lamarche et al., 2014; Lamarche et al., 2012; Martin digm in which participants were actually exposed to an inter- Ginis et al., 2012). personal rejection based on weight stigma (Himmelstein, Martin Ginis et al. (2012) provided the first empirical sup- Belsky, & Tomiyama, 2015). Specifically, the authors manip- port of a cortisol response to a social-evaluative body image ulated weight stigma to examine its impact on cortisol reac- threat. In the first experiment, women thought they would be tivity. In addition, body mass index (BMI) and self-perceived exercising in a high social-evaluative threatening setting (in weight were examined as potential moderators of the rela- a public, mirrored exercise facility while wearing revealing tionship between stigma and cortisol reactivity. These exercise attire) or a low social-evaluative threatening setting authors found that the weight stigma situation elicited (alone, in a private, non-mirrored room while wearing non- changes in cortisol, and that those who perceived themselves revealing exercise attire). In their second experiment, partici- as “heavy” (regardless of their actual BMI) exhibited higher pants were asked to go behind a screen into a changing area cortisol in response to the weight stigma situation compared to try on exercise clothing and complete a questionnaire rat- with those who perceived themselves as average weight. ing the exercise clothing (e.g., color, fabric). In the high Although growing evidence suggests that cortisol may be social-evaluative condition, participants were led to believe elicited under body-related threats, the majority of the body that after completing the questionnaire, a video camera image literature has examined only immediate responses to would record the participant in the clothing so that a panel of such threats and still ignores what occurs after the body judges could evaluate how well the clothing fit at a later date. image threat is removed. Recent evidence examining Participants in the low social-evaluative condition were responses to a social-evaluative non-body image threat sug- instructed to change into the exercise clothing behind the gests that failing to examine a recovery phase may lead to screen and complete the same questionnaire package; how- erroneous conclusions regarding the distress of the individ- ever, they were told that no one would see them. Across both ual (Juster, Perna, Marin, Sindi, & Lupien, 2012). experiments the results indicated that cortisol levels were Furthermore, there is some, albeit limited, evidence of the higher post-manipulation for those in the high versus low lingering negative effects of body-related situations social-evaluative condition. (Hausenblas et al., 2003; Quinn et al., 2006). Thus, to gain a Although these authors were the first to provide evidence more complete picture of the response-recovery profile to a of a cortisol response to a social-evaluative body image body image threat, the current study measured outcomes threat, they noted significant limitations regarding their immediately following the threat and after a rest period in threat. Given their ethics board guidelines, they were unable which the threat was no longer present. to actually expose participants to the social-evaluative body The threat used in the present study was a three-site skin- image threat. They predicted that cortisol responses would fold assessment while wearing a two-piece bathing suit. This have been greater had participants actually faced the threat threat was selected for several theoretical and methodological Lamarche et al. 3 Table 1. Means (and SDs), Maximum and Minimum Values for variables would not return to baseline levels after the threat Age, Body Mass, Height, Percent Body Fat, BMI, and Exercise was removed (i.e., levels would remain significantly higher Frequency for Final Sample. than baseline levels). The hypothesis with respect to the recovery of variables is based on Quinn et al.’s (2006) find- Variable M (SD) Maximum Minimum ing of the lingering effects of body-related thoughts after Age 19.92 (2.10) 17.00 26.00 being exposed to a situation designed to heighten body image Body mass 63.34 kg (11.35) 39.74 kg 96.34 kg concerns. It was also hypothesized that participants in the Height 1.66 m (0.06) 1.52 m 1.83 m control condition would report no differences in body image % body fat 23.01% (5.40) 10.07% 35.18% variables or cortisol levels across their testing visit. BMI 22.98 (3.54) 16.75 34.06 Frequency of exercise 3.17 (1.52) 0.00 6.00 Method Note. Final sample = 64 participants. BMI = body mass index; frequency of exercise = times per week. Participants Upon institutional ethics clearance, participants were reasons. First, this threat is based on characteristics under recruited through posters placed around a university campus which perceptions of, and responses to, social-evaluative and announcements made in undergraduate classes. To dis- threatening situations are most likely to occur as supported by guise the true purpose of the study, the recruitment materials SSPT (Rohleder, Beilen, Chen, Wolf, & Kirschbaum, 2007). indicated the study was examining the relationship between Specifically, it involves a social-evaluative element (i.e., self-perceptions, anthropometric measurements, and corti- evaluates body composition by a trained technician and assis- sol. Furthermore, the reason given to participants regarding tant), involves a domain of importance (i.e., body fat is an the required clothing for the research session (described important characteristic associated with the North American below) was that it was standard clothing used in the labora- thin ideal), and the potential loss of social acceptance from a tory for anthropometric tests. The estimated required sample negative evaluation (i.e., a poor body composition may serve size of 60 was based on Martin Ginis et al. (2012) showing as a reminder that one does not meet the thin ideal standard). large effects of social-evaluative body image threats on cor- Second, a qualitative study framed within SSPT identified tisol in women (Cohen’s d = 0.81-1.16; Cohen, 1992). After being seen in a bathing suit by others as the most uncomfort- data screening (detailed below), the final sample consisted of able situation (Lamarche et al., 2012)—being in a bathing suit 64 healthy, young adult women attending university (see or increasing the level of body exposure has been an impor- Table 1 for sample characteristics). It should be noted that all tant aspect of manipulations designed to elicit body image but one participant were Caucasian. Varsity athletes, smok- concerns (Carron & Prapavessis, 1997; Gammage et al., ers, individuals with a history of a clinical eating disorder, or 2004; Hart et al., 1989; Martin Ginis et al., 2012). Third, those on medications that influence cortisol secretion (e.g., anticipation of this specific threat has been shown to elicit corticosteroids) were excluded from participation. social physique anxiety and body shame responses (Cloudt Participants were also excluded if they ate, drank, or partici- et al., 2014; Lamarche et al., 2014), thus it is possible that pated in physical activity within 1 hr prior to testing. actually exposing an individual to this threat would also elicit a cortisol response, similar to responses to a weight stigma situation (Himmelstein et al., 2015). Fourth, a skinfold assess- Measures ment was originally used to validate a questionnaire measur- Participants completed demographic information (age, fre- ing social physique anxiety (Hart et al., 1989). Fifth, a body quency of exercise) and answered a series of questions ensur- composition assessment through skinfold measurements is ing that they had complied with study requirements with commonly used in clinical and research settings, making it respect to food, drink, and physical activity participation. acceptable to the research ethics boards. Finally, as reported Next, a measure of state social physique anxiety was admin- by Lamarche et al. (2014), self-rating of perceived evaluative istered (see description below). threat in anticipation of this exact situation was significantly higher than a control group in a similar sample of women compared with the present study. Social physique anxiety. The nine-item State Social Physique Specifically, the purpose of the current study was to Anxiety Scale (SPAS; Kruisselbrink, Dodge, Swanburg, & examine psychobiological responses to, and recovery from, MacLeod, 2004) assessed anxiety associated with others’ actually undergoing (i.e., facing) a body image threat in evaluations of one’s body. The items were measured on a women. Based on the findings of Gammage et al. (2004) and 5-point scale ranging from 1 (not at all characteristic of me) Hart et al. (1989), and the work of Martin Ginis et al. (2012) to 5 (extremely characteristic of me). Participants were with respect to cortisol changes from a body image threat, it instructed to respond to each item by indicating how they felt was hypothesized that the body image threat would elicit at that moment. A sample item is “Unattractive features of increased social physique anxiety and cortisol and that these my physique/figure make me nervous in this setting.” This 4 SAGE Open questionnaire has demonstrated satisfactory reliability and cortisol response (Dickerson & Kemeny, 2004). Participants validity in young adult women in past research (Kruissel- in the threat group then changed back into their street clothes. brink et al., 2004; Martin Ginis, Murru, Conlin, & Strong, After completing their condition (i.e., quiet rest or threat), 2011). Internal consistency for the present study was deemed participants sat quietly for 15 more minutes (i.e., threat was adequate for each time point (αs range = .88-.93). no longer present), and then completed the same measure of state social physique anxiety followed by a final saliva sam- Salivary cortisol. Measuring cortisol in saliva is a reliable, ple (recovery measures). The recovery saliva sample was stress-free, non-invasive technique that does not require a completed approximately 50 min following the onset of the trained technician (Vinning, McGinley, Maksvytis, & Ho, threat/quiet rest (Dickerson & Kemeny, 2004). Upon com- 1983). Several studies have used salivary cortisol in their pletion of all questionnaires and saliva samples, objective protocols (e.g., Dickerson & Kemeny, 2004; Martin Ginis measures of height, weight, and body composition were et al., 2012; Rohleder et al., 2007). Saliva was collected taken for participants in the control group using the same using salivettes specific for cortisol measurement (Sarstedt, standard protocol described below, except that participants Germany). Participants placed the dental cotton piece in their wore shorts and a t-shirt for the body composition assess- mouths and left it there for 1 min, then placed the cotton back ment and only the technician was present. Participants were into the test tube and sealed it. Samples were centrifuged debriefed as to the true purpose of the study and given immediately and then placed in a −80 °C freezer until being US$10.00 as compensation for their time. Given the circa- assayed. Salivary cortisol concentration was measured in dian rhythm of cortisol, all data collection took place at the duplicate by commercial enzyme-linked immunosorbent same time of day (15:00-18:00) when levels are relatively assay kits according to the manufacturer’s instructions (Sali- constant (Dickerson & Kemeny, 2004; Vinning et al., 1983). metrics, 2010). The inter-assay and intra-assay coefficients of variability were calculated and deemed acceptable (<15% Social-evaluative body image threat. A body composition and <10%, respectively). assessment completed while participants wore a two-piece bathing suit was selected as the social-evaluative body image threat. Specifically, a standard three-site (triceps, iliac crest, Procedures thigh) skinfold measurement was performed to assess per- Interested participants contacted the principal investigator cent body fat (Jackson, Pollack, & Ward, 1980). The same and a mutually convenient time for participation was set. trained technician read measurements aloud to the same After confirming a test session, participants were randomly research assistant, who verbally repeated each value, then assigned to either the control or threat group by drawing a recorded it, thus allowing participants’ body composition to number out of a hat. Participants assigned to the control be evaluated by the researchers. The presence of the assistant group were asked to bring shorts and a t-shirt to their visit, who recorded the values ensured there was an evaluative whereas participants in the threat group were asked to bring audience, aside from the technician, increasing the likeli- a two-piece bathing suit. Participants in both groups were hood that a threat would be induced. This body image threat told that this clothing was standard laboratory attire to allow maximized body exposure and evaluation of the body, but for the accuracy of anthropometric measures, which would was also acceptable to the research ethics board as these be completed during the testing session. Upon arrival at the anthropometric measures are typically taken for research, laboratory, participants provided informed consent and com- clinical, athletic performance assessment, and educational pleted demographic information. Next, participants com- purposes. Furthermore, instructions for participants about pleted a measure of state social physique anxiety. This time clothing (particularly the bathing suit) were also considered served as a baseline rest period prior to cortisol collection. realistic, as some body composition testing done at the uni- Participants then provided a baseline saliva sample. versity requires participants to bring a bathing suit with Next, participants completed the threat/control condition, them. depending on their group assignment. Participants in the control condition were asked to sit quietly alone for 15 min. Results Quiet rest served as a control condition to be consistent with past research measuring cortisol responses to a social-evalu- Nine participants (all randomized into the threat group) who ative threat in the non-body image literature (Kirschbaum confirmed their eligibility, scheduled a testing appointment et al., 1993; Nater et al., 2007). Those in the threat condition and had knowledge of the clothing needed for participation, faced the social-evaluative body image threat (see descrip- did not attend their appointment. Of the 71 participants who tion below). Participants were then asked to sit while they completed the study, five participants were removed for not completed the same measure of state social physique anxiety complying with study requirements or for feeling unwell. and provided another saliva sample (response measures). Independent t tests showed no significant differences The response saliva sample was completed approximately 25 between participants removed and the final sample on key min after the onset of the threat/quiet rest, capturing the peak variables (all ps > .05). Data for cortisol were positively Lamarche et al. 5 Table 2. Means (and SDs) for SPA and Cortisol by Group. Control (n = 33) Threat (n = 31) Variable Baseline Response Recovery Baseline Response Recovery SPA 2.60 (0.86) 2.56 (1.01) 2.63 (1.05) 2.60 (0.81) 2.88 (0.87) 2.65 (0.86) Cortisol 3.49 (3.36) 2.94 (2.42) 2.66 (2.29) 2.48 (1.56) 2.88 (1.94) 2.98 (2.32) Note. SPA = social physique anxiety, ranges 1 to 5, higher scores represent higher SPA; cortisol = untransformed cortisol values, nmol/L. skewed so values were log-transformed for all analyses, sim- were no significant time, F(2, 61) = 2.14, p = .126, η = .07 ilar to previous studies investigating cortisol responses to or group main effects, F(1, 62) = .36, p = .549, η = .01. See social-evaluative body image threats (Cloudt et al., 2014; Table 2 for means and standard deviations for social physique Lamarche et al., 2014; Martin Ginis et al., 2012). For cortisol anxiety. data, non-transformed data are provided for ease of interpre- tation. Two participants were removed as outliers due to Cortisol implausible cortisol levels (>82.77 nmol/L; Salimetrics, 2010). Thus, the final data set included 64 participants. To compare the cortisol response with, and recovery from, a Some research has demonstrated a relationship between social-evaluative body image threat, a 2 (group: control, measures of body composition and social physique anxiety threat) × 3 (time: baseline, response, recovery) repeated-mea- (Hart et al., 1989), thus bivariate correlations were conducted sures ANOVA was conducted with log-transformed cortisol as to examine BMI, weight, and percent body fat as potential the dependent variable. A Bonferroni correction factor was covariates for analyses. No relationship was found (p > .05). applied for follow-up analyses. The Mauchly’s test of spheric- To investigate baseline group differences on demographic ity was significant; therefore, the Huynh–Feldt correction for variables and state social physique anxiety and cortisol at degrees of freedom is reported. There was a significant group- baseline, a series of t tests were conducted. The results indi- by-time interaction, F(2, 108) = 6.78, p < .01, η = .10. To cated no significant between-group differences on demo- examine the nature of the time effects within each group, three graphic variables or baseline variables (all ps > .05). sets of paired t tests were conducted (baseline vs. response, Relationships between social physique anxiety and cortisol response vs. recovery, baseline vs. recovery). Comparisons at all three time points were also examined. Results indicated made within the control group showed that there was a signifi- a significant positive relationship between state social phy- cant difference in levels of cortisol between baseline and sique anxiety and cortisol at the response time point (r = .25, recovery time points, t(32) = 2.93, p = .006 (Cohen’s d = .18; p < .05) and between cortisol at response and state social Cohen, 1992), indicating a decrease in cortisol from baseline physique anxiety at the recovery time point (r = .28, p < .05). to recovery time points. There was no significant change in cortisol levels from baseline to response, t(32) = 1.79, p = .084 or response to recovery, t(32) = 2.33, p = .026 in the control State Social Physique Anxiety group. In the threat group, comparisons showed that there was To compare the responses with, and recovery from, a social- a significant increase in cortisol from baseline to response evaluative body image threat, a 2 (group: control, threat) × 3 time point, t(30) = −2.58, p = .015 (Cohen’s d = .18; Cohen, (time: baseline, response, recovery) repeated-measures 1992). No differences were found in cortisol levels between ANOVA was conducted for social physique anxiety. There response and recovery, t(30) = −.02, p = .986 time points or was a significant group-by-time interaction, F(2, 61) = 4.36, baseline and recovery, t(30) = −1.46, p = .155 time points. p = .017, η = .13. To examine the nature of the time effects There were no significant main effects for time, F(2, 108) = .69, 2 2 within each group, three sets of paired t tests were conducted p = .485, η = .01 or group, F(1, 62) = .01, p = .907, η < .001. p p (baseline vs. response, response vs. recovery, baseline vs. See Table 2 for means and standard deviations for cortisol. recovery). A Bonferroni correction factor was applied for In addition, area under the curve with respect to increase follow-up analyses such that a p value < .017 would be (AUCi) was also calculated for each group (Pruessner, deemed significant. No differences were found within the Kirschbaum, Meinlschmid, & Hellhammer, 2003). AUCi control group. Comparisons made within the threat group assesses baseline-corrected cortisol responses and accounts showed that the level of social physique anxiety at response for the difference between single measurements from each was significantly higher than both baseline, t(30) = −3.64, other or the change over time (Pruessner et al., 2003). It p = .001 (Cohen’s d = .29; Cohen, 1992) and recovery levels, should be noted that a negative value represents an index of t(30) = 3.70, p = .001 (Cohen’s d = .34; Cohen, 1992). Levels decrease rather than an area under the curve. To examine of social physique anxiety were not different between base- whether a social-evaluative body image threat elicited a line and recovery time points, t(30) = −1.27, p = .22. There cortisol response, a one-way ANOVA was conducted using 6 SAGE Open group as the independent variable (control, threat) and AUCi More important, to our knowledge, the present study is as the dependent variable. The results showed a significant the first to measure psychobiological outcomes after the group difference for AUCi, F(1, 62) = 11.03, p < .01, social-evaluative threat is removed, highlighting the second η = .15. Inspection of means indicated that the control contribution to the body image literature. Findings show group showed an overall decrease (index of decrease) of that, when faced with a social-evaluative body image threat, −.09 (SD = 0.22), whereas the threat group showed an overall women report an immediate increase in social physique anx- increase in cortisol of .08 (SD = 0.18). iety and have higher cortisol, but perhaps more important, social physique anxiety and cortisol return to baseline levels when the threat is no longer present. This is an important and Discussion encouraging finding that extends what we currently know This study compared psychobiological responses with, and about situations that elicit body image concerns. For exam- recovery from, actual exposure to a social-evaluative body ple, the negative effects of viewing media images of the thin image threat in women. Significant increases in social phy- ideal, a non-social-evaluative body image threat, have been sique anxiety scores were found in the threat group, with found to persist 1 to 2 hr after viewing (Hausenblas et al., scores highest immediately following the body composition 2003). In addition, unlike a self-objectifying situation after assessment. By contrast, the control group showed no changes which body-related thoughts persist (Quinn et al., 2006), in social physique anxiety. Our findings also showed a sig- quick recovery from a social-evaluative body image threat as nificant group-by-time interaction for cortisol and a signifi- shown in the present study is possible. Although the reasons cant group difference in AUCi indicating that the threat for these differences can only be speculated, this finding elicited a cortisol response. These findings are consistent with could be considered positive for two reasons. First, outcomes our hypotheses that a social-evaluative body image threat returning to baseline levels after 15 min from a laboratory- would lead to increased social physique anxiety and cortisol. based threat may indicate that women are capable of recover- Contrary to our hypotheses, social physique anxiety and cor- ing from a similar acute threat in real life, although tisol returned to baseline levels after the threat was removed; psychobiological responses to a real life body image threat no significant differences were found between recovery and have yet to be examined. Second, quick, efficient psychobio- baseline levels of social physique anxiety and cortisol. logical responses are adaptive (Gruenewald, Dickerson, & Kemeny, 2007). Recent evidence examining responses to a social-evaluative non-body image threat suggests that failing Implications for Research to examine a recovery phase may lead to erroneous conclu- Arguably the most significant implication of the present sions regarding the distress of the individual (Juster et al., study is support for examining not only the responses to 2012). In the present study, the quick reactivity and recovery social-evaluative body image threats, but also the recovery of social physique anxiety and cortisol may have acted as a from such threats to provide a more complete picture of the key signaling emotion to make the participant aware that a psychobiology of body image experiences. Furthermore, it social-evaluative threat existed and then passed. However, should be highlighted that a skinfold assessment elicited a caution should be taken in drawing any conclusion about the psychobiological response consistent with SSPT. The find- temporal quality of this type of response. More research is ings from the present study complement those of Himmelstein needed examining what occurs when the threat is removed. et al. (2015) from which future research questions can build In addition, potential moderators and mediators of responses and test tenets of SSPT. In agreement with Martin Ginis et al. and recovery need to be explored. For example, Himmelstein (2012), we highlight the challenges of designing an ethical et al. (2015) found that perceived weight (regardless of their threat that can be tested in a laboratory setting. Despite the actual BMI) was a moderator of cortisol responses to the fact that some information regarding the study was required weight stigma situation. Findings suggest that perceptions to be included in the consent material, we still found signifi- (and not objective variables) have potential moderating cant differences in psychobiological outcomes. effects. Variables such as body image coping or body image investment may be important variables to examine, particu- larly with respect to efficient recovery. Contributions to Body Image Literature The present findings contribute to the body image literature Limitations in two significant ways. First, they complement those of Martin Ginis et al. (2012) who found that women who antici- Several limitations to this study should be noted. Results can pated a body image threat had higher cortisol levels post- only generalize to healthy, young Caucasian adult women. manipulation than women in a non-social-evaluative threat Furthermore, all but two participants fell within “normal/rec- condition. Our findings, in agreement with Himmelstein ommended” ranges for BMI and percent body fat. As some et al. (2015), show that actual exposure to a threat resulted in examples, results in men or individuals who have a clinical small but significant increases in cortisol. eating disorder may display different responses as they have Lamarche et al. 7 different body image concerns. Second, it is important to Roberts, 1997) may highlight the difficulty in designing a note that individuals volunteered for this study, and that all suitable control group in studies comparing groups’ varying participants in the threat group went through with the body level of social-evaluative threat in body image—any study composition assessment indicating they were comfortable about body image may initiate self-objectification, leading to enough to have their percent body fat measured. This may heightened self-conscious outcomes (i.e., body shame). present the issue of demand characteristics within the sam- Research framed in objectification theory has found that ple. We can only speculate why those nine participants ran- women trying on a swimsuit in front of a mirror (with no one domized into the threat group did not show up to their testing else present) reported body shame (Fredrickson, Roberts, appointment. However, it should be emphasized that even Noll, Quinn, & Twenge, 1998). Similarly, Martin Ginis et al. though the sample was comfortable enough to complete a (2012) noted that trying on clothing may initiate the social body composition assessment, we still found a significant comparison process (which Dickerson & Kemeny, 2004, increase in social physique anxiety and cortisol in response reported as one characteristic increasing social evaluation) to to the threat. Future research could minimize self-selection societal body image standards and, therefore, serve as a form by withholding study details in recruitment materials of social evaluation itself leading to slight increases in corti- although restrictions do apply based on ethical consider- sol responses. In turn, this makes it more difficult to detect ations. Third, our group was relatively active. Research has differences between the control and threat groups at the provided evidence that exercisers generally have a more response time point. Although we acknowledge the design of positive body image than non-exercisers (Hausenblas & our control group as a limitation, it should be noted that the Fallon, 2006), yet we were able to elicit a response including present study did find a significant increase in cortisol, even higher social physique anxiety similar to findings reported with the control group knowing their anthropometric mea- by Gammage et al. (2004) in a similar sample. surements would be taken eventually while wearing shorts Also, given that it is not possible to discern which of the and a t-shirt. Nevertheless, this limitation highlights the chal- factors of the manipulation was associated with the increase lenges in designing an equivalent body image control condi- in cortisol, future research could explore specific contextual tion void of social evaluation in a research topic with inherent factors and their sole and additive effects on the psychobiol- tendencies for social comparison and/or self-objectification. ogy of body image experiences. Finally, although timing of the cortisol measurements in the present study was based on Conclusion meta-analytic evidence, it should be noted that this support comes from studies examining the response to, and recovery The present findings contribute to the body image literature from, a performance-based (and not body image-related) by providing a more complete understanding of the psycho- social-evaluative threat (Dickerson & Kemeny, 2004); thus, biological aspects of body image. The findings also highlight timing of the peak response and full recovery may not be the the importance of measuring outcomes beyond the time point same across all types of social-evaluative threats. immediately after the body image threat is removed to evalu- Another limitation that should be noted relates to the ate any lingering effects on psychobiological outcomes. design of the control group. This challenge is illustrated by Furthermore, they emphasize the need to study both anticipa- the findings of a significant group-by-time interaction for tion of a body image threat and actually facing such threats; cortisol and a significant group difference in AUCi. However, it is possible that negative responses that occur in anticipa- visual inspection of the mean cortisol values at the response tion of these threats are actually decreased when actually time point shows that the control group had a higher cortisol experiencing such threats (Lamarche et al., 2012; Mills et al., level (although not significantly) than the threat group. We 2014). used a control group to represent a non-threatening condition Acknowledgments with respect to the body, similar to Himmelstein et al. (2015; rejection but not for weight-related reasons) and to past stud- Thanks to Jenn Romero and Izabella Ludwa for help with data col- ies examining cortisol responses to a social-evaluative non- lection and analysis. body image threat (Kirschbaum et al., 1993; Nater et al., 2007); however, it was not matched on body image content. Declaration of Conflicting Interests Martin Ginis et al. (2012) noted the difficulty in designing an The author(s) declared no potential conflicts of interest with respect equivalent control group when examining cortisol responses to the research, authorship, and/or publication of this article. to body image threats. In their second experiment, these authors had control participants believe they would try on Funding exercise attire alone, in private. The control and experimen- The author(s) disclosed receipt of the following financial support tal conditions were matched with respect to content of the for the research and/or authorship of this article: Funding for the manipulation (about the body), but differed on social evalua- researcher was provided by the Social Sciences and Humanities tion (alone, in private vs. evaluated on fit of clothing by Research Council of Canada and a grant from the North American another person). Objectification theory (Fredrickson & Society for the Psychology of Sport and Physical Activity. 8 SAGE Open Note performance. Journal of Personality and Social Psychology, 75, 269-284. 1. A moderation analysis following Baron and Kenny’s (1986) Gammage, K. L., Martin Ginis, K. A., & Hall, C. R. (2004). Self- recommendations was conducted to examine the potential presentational efficacy: Its influence on social anxiety in an moderating effects of body fat percent, body mass index exercise context. Journal of Sport & Exercise Psychology, 26, (BMI), or body weight on cortisol and social physique anxiety 179-190. responses. Results showed no evidence of moderation for body Gruenewald, T. L., Dickerson, S. S., & Kemeny, M. E. (2007). fat percent, BMI, or weight on cortisol or social physique anxi- A social function for the self-conscious emotions: Social- ety responses. These analyses were repeated for cortisol and self preservation theory. In J. L. Tracy, R. W. Robins, & J. social physique anxiety at the recovery time point, and similar P. Tangney (Eds.), The self-conscious emotions (2nd ed., (non-significant) results were found. Furthermore, no signifi- pp. 68-90). New York, NY: Guilford Press. cant correlations were found between any dependent variable Hart, E. A., Leary, M. R., & Rejeski, W. J. (1989). The measure- and BMI or body weight, in addition to body fat percent (all ment of social physique anxiety. Journal of Sport & Exercise ps > .05). Moderation analyses for social physique anxiety on Psychology, 11, 94-104. cortisol recovery were also found to be not significant. Hausenblas, H. A., & Fallon, E. A. (2006). Exercise and body image: A meta-analysis. Psychology & Health, 21, 33-47. References Hausenblas, H. A., Janelle, C. M., Gardner, R. E., & Hagan, A. Anderson, D. A., Shapiro, J. R., Lundgren, J. D., Spataro, L. E., & (2003). Affective responses of high and low body satisfied men Frye, C. A. (2002). Self-reported dietary restraint is associated to viewing physique slides. Eating Disorders: The Journal of with elevated levels of salivary cortisol. Appetite, 38, 13-17. Treatment & Prevention, 11, 101-113. Bailey, K. A., Lamarche, L., & Gammage, K. L. (2014). Coping Himmelstein, M. S., Belsky, A. C. I., & Tomiyama, A. J. (2015). with body image threats among college women: The swimsuit The weight of stigma: Cortisol reactivity to manipulated weight problem. International Journal of Psychological Studies, 6, stigma. Obesity, 23, 368-374. doi:10.1002/oby.20959 19-30. doi:10.5539/ijps.v6n2p19 Jackson, A. S., Pollack, M. L., & Ward, A. (1980). Generalized Bain, L. L., Wilson, T., & Chaikind, E. (1989). Participant percep- equations for predicting body density of women. Medicine & tions of exercise programs for overweight women. Research Science in Sports & Exercise, 12, 175-182. Quarterly for Sport and Exercise, 60, 134-143. Juster, R., Perna, A., Marin, M., Sindi, S., & Lupien, S. J. (2012). Baron, R. M., & Kenny, D. A. (1986). The moderator-mediator vari- Timing is everything: Anticipatory stress dynamics among corti- able distinction in social psychological research: Conceptual, sol and blood pressure reactivity and recovery in healthy adults. strategic, and statistical considerations. Journal of Personality Stress, 15, 569-577. doi:10.3109/10253890.2012.661494. and Social Psychology, 51, 1173-1182. Kirschbaum, C., Pirke, K. M., & Hellhammer, D. H. (1993). The Trier Carron, A. 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Social-evaluative threat and proinflammatory settings on the social physique anxiety and exercise intentions cytokine regulation. Psychological Science, 20, 1237-1244. of males and females. Journal of Sport & Exercise Psychology, Dickerson, S. S., Gruenewald, T. L., & Kemeny, M. E. (2004). 26, 616-622. When the social self is threatened: Shame, physiology, and Lamarche, L., Bailey, K. A., & Gammage, K. L. (2015). Use your health. Journal of Personality, 72, 1191-1216. doi:10.1111/ imagination: College women’s responses to a social-evaluative j.1467-6494.2004.00295.x body image threat. Journal of Applied Biobehavioral Research, Dickerson, S. S., & Kemeny, M. E. (2004). Acute stressors and 20, 137-150. cortisol responses: A theoretical integration and synthesis of Lamarche, L., Gammage, K. L., Kerr, G., Faulkner, G., & Klentrou, laboratory research. Psychological Bulletin, 130, 355-391. P. (2014). 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That swimsuit becomes you: Sex dif- A handbook of theory, research, and clinical practice (pp. 74- ferences in self-objectification, restrained eating, and math 82). New York, NY: Guilford Press. Lamarche et al. 9 Martin Ginis, K. A., Murru, E., Conlin, C., & Strong, H. A. (2011). adolescents. International Journal of Obesity, 33, 597-600. Construct validation of a state version of the Social Physique doi:10.1038/ijo.2009.28 Anxiety Scale among young women. Body Image, 8, 52-57. Salimetrics. (2010). Expanded range high sensitivity salivary corti- doi:10.1016/j.bodyim.2010.10.001 sol EIA kit insert. State College, PA. Martin Ginis, K. A., Strong, H. A., Arent, S. M., & Bray, S. R. Sapolsky, R. M. (2003). Stress and plasticity in the limbic system. (2012). The effects of threatened social evaluation of the phy- Neurochemical Research, 28, 1735-1742. sique on cortisol activity. Psychology & Health, 27, 990-1007. Stice, E. (2002). Risk and maintenance factors for eating pathology: doi:10.1080/08870446.2011.652111 A meta-analytic review. Psychological Bulletin, 128, 825-848. McCaulay, M., Mintz, L., & Glenn, A. A. (1988). Body image, self- doi:10.1037/0033-2909.128.5.825 esteem, and depression-proneness: Closing the gender gap. Sex Thompson, J. K., Heinberg, L. J., Altabe, M., & Tantleff-Dunn, Roles, 18, 381-391. S. (1999). Exacting beauty: Theory, assessment, and treat- McLean, J. A., Barr, S. I., & Prior, J. C. (2001). Cognitive dietary ment of body image disturbance. Washington, DC: American restraint is associated with higher urinary cortisol excretion in Psychological Association. healthy premenopausal women. American Journal of Clinical Van Raalte, J. L., Cunningham, J., Cornelius, A. E., & Brewer, B. Nutrition, 73, 7-12. W. (2004). Environmental effects on social physique anxiety. Mills, J., Fuller-Tyszkiewicz, M., & Holmes, M. (2014). State body Kinesiologia Slovenica, 10, 86-95. dissatisfaction and social interactions: An experience sampling Vinning, R., McGinley, R., Maksvytis, J., & Ho, K. (1983). study. Psychology of Women Quarterly, 38, 551-562. Salivary cortisol: A better measure of adrenal cortisol func- Myers, A., & Rosen, J. C. (1999). Obesity stigmatization and cop- tion than serum cortisol. Annals Clinical Biochemistry, 20, ing: Relation to mental health symptoms, body image, and self- 329-335. esteem. International Journal of Obesity, 23, 221-230. Nater, U. M., Moor, C., Okere, U., Stallkamp, R., Martin, M., Author Biography Ehlert, U., & Kliegel, M. (2007). Performance on a declarative Larkin Lamarche is an assistant professor (part-time) and a memory task is better in high than low cortisol responders to research coordinator for Health TAPESTRY. Her research focuses psychosocial stress. Psychoneuroendocrinology, 32, 758-763. on body-related experiences, exercise, and coping responses to doi:10.1016/j.psyneuen.2007.05.006 body image situations. Pruessner, J. C., Kirschbaum, C., Meinlschmid, G., & Hellhammer, D. H. (2003). Two formulas for computation of the area under Kimberley L. Gammage is an associate professor whose research the curve represent measures of total hormone concentration focuses on body image across the lifespan. She also has expertise in versus time-dependent change. Psychoneuroendocrinology, the examination of social-cognitive factors associated with exercise 28, 916-931. doi:10.1016/S0306-4530(02)00108-7 and health behaviours. Putterman, E., & Linden, W. (2006). Cognitive dietary restraint and Gretchen Kerr is a professor and vice-dean (Academic Affairs). cortisol: Importance of pervasive concerns with appearance. Her expertise is harassment and abuse in youth sport, athlete-cen- Appetite, 47, 64-76. doi:10.1016/j.appet.2006.02.003 tred coaching practices, and retirement transition from sport. Quinn, D. M., Kallen, R. W., & Cathey, C. (2006). Body on my mind: The lingering effect of state self-objectification. Sex Guy Faulkner is a professor whose research focuses on the promo- Roles, 55, 869-874. doi:10.1007/s11199-006-9140-x tion of physical activity in communities and rehabilitation settings. Rohleder, N., Beilen, S. E., Chen, E., Wolf, J. M., & Kirschbaum, He also has expertise in the relationship between physical activity C. (2007). Stress on the dance floor: The cortisol stress and mental health in children and adults. response to social-evaluative threat in competitive ballroom dancers. Personality and Social Psychology Bulletin, 33, 69- Panagiota Klentrou is a professor and associate dean (Research 84. doi:10.1177/01461672062293986 and Graduate Studies). She is an applied physiologist whose inter- Sabiston, C., Castonguay, A., Barnett, T., O’Loughlin, J., & ests include pediatric physiology, health and performance of youth Lambert, M. (2009). Body image and C-reactive protein in and musculoskeletal development. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png SAGE Open SAGE

Psychological and Cortisol Responses to and Recovery From Exposure to a Body Image Threat:

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Abstract

The majority of body image research has failed to measure what occurs beyond the immediate presentation of a body image threat, or after a body image threat is no longer present. This is particularly true for physiological outcomes. The present study examined psychological and cortisol responses to, and recovery from, a body composition assessment as a social-evaluative body image threat. Women (N = 64) were randomized into either a control or threat group. Participants completed a measure of social physique anxiety and provided a sample of saliva (to assess cortisol) at baseline, and immediately following and 20 min following their condition. The threat group reported higher social physique anxiety following the threat in comparison with both baseline levels and recovery levels. Cortisol was higher immediately following the threat in comparison with baseline levels. Findings support the inclusion of a recovery time point in body image research to provide a more complete picture of the psychobiology of body image experiences. Keywords body image, cortisol, body threat, women, social self-preservation theory Body image is an individual’s internal representation of his also shown that situations that maximize social evaluation of or her outer self (Thompson, Heinberg, Altabe, & Tantleff- one’s body elicit body image concerns (Cloudt, Lamarche, & Dunn, 1999). Body image concerns are associated with a Gammage, 2014; Gammage, Martin Ginis, & Hall, 2004; number of negative outcomes including lower self-esteem, Hart et al., 1989; Van Raalte, Cunningham, Cornelius, & increased risk of depression, social anxiety, and eating Brewer, 2004). In addition, situations in which body image pathologies (Kostanski & Gullone, 1998; Levine & Smolak, concerns are elicited (i.e., viewing media images of the thin 2002; McCaulay, Mintz, & Glenn, 1988; Stice, 2002). Given ideal, situations of heightened self-objectification) have been the potential negative implications of body image concerns, shown to have lingering effects (Hausenblas, Janelle, identifying situations or the contextual factors of situations Gardner, & Hagan, 2003; Quinn, Kallen, & Cathey, 2006). in which these concerns arise is important. Examples of spe- Recently, physiological measures have been incorporated cific situations that exacerbate body image concerns include into body image research to gain an understanding of the being seen in a bathing suit, being next to someone with an psychobiology of body image (Anderson, Shapiro, Lundgren, attractive/ideal physique, or having body composition Spataro, & Frye, 2002; Cloudt et al., 2014; Lamarche, Bailey, assessed (Carron & Prapavessis, 1997; Hart, Leary, & & Gammage, 2015; Lamarche, Gammage, Kerr, Faulkner, & Rejeski, 1989). Klentrou, 2014; Martin Ginis, Strong, Arent, & Bray, 2012; Qualitative research has explored situations of heightened McLean, Barr, & Prior, 2001; Putterman & Linden, 2006; body image concerns (Bain, Wilson, & Chaikind, 1989; Lamarche, Kerr, Faulkner, Gammage, & Klentrou, 2012; University of Toronto, Ontario, Canada Myers & Rosen, 1999). For example, in their qualitative McMaster University, Hamilton, Ontario, Canada study, Lamarche and colleagues (2012) examined comfort- Brock University, St. Catharines, Ontario, Canada able and uncomfortable body experiences in young adult Corresponding Author: women. These authors found that the situations described Larkin Lamarche, Assistant Professor (part-time), Research Coordinator, were social-evaluative in nature and included an element of Health TAPESTRY, Department of Family Medicine, McMaster University, body exposure. Furthermore, coping mechanisms such as 1280 Main Street West, McMaster Health Campus, 5th Floor, Hamilton, avoidance or concealing behaviors were initiated to manage Ontario, Canada L8S 9Z9. those uncomfortable situations. Experimental studies have Email: lamarche@mcmaster.ca Creative Commons CC-BY: This article is distributed under the terms of the Creative Commons Attribution 3.0 License (http://www.creativecommons.org/licenses/by/3.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). 2 SAGE Open Sabiston, Castonguay, Barnett, O’Loughlin, & Lambert, and emphasized that “actual threat exposure in an ethical and 2009). The most commonly assessed in this recent literature ecologically valid manner is necessary to test this hypothe- is cortisol (a stress hormone thought to represent hypotha- sis” (Martin Ginis et al., 2012, p. 1004). Lamarche et al. lamic-pituitary-adrenal axis activation; Sapolsky, 2003). (2015) examined psychological and heart rate responses to Given this recent interest in physiological variables in a an imagined social-evaluative body image threat. Findings body image context, social self-preservation theory (SSPT; showed that the highest levels of body shame and social phy- Dickerson, Gruenewald, & Kemeny, 2004), in contrast to sique anxiety were reported in the social-evaluative com- other theories of body image, may be particularly useful in pared with the non-social-evaluative body image condition. the examination of responses to social-evaluative body However, no differences in heart rate were found between image threats. SSPT suggests that when a social-evaluative groups. In agreement with Martin Ginis et al. (2012), it was threat is present, negative self-conscious emotions and phys- noted that actual threat exposure may be necessary to capture iological responses are elicited concurrently (Dickerson, more robust physiological changes under social-evaluative Gruenewald, & Kemeny, 2004). Shame and cortisol are par- body image threat, and fully understand the psychobiology ticularly responsive to such threats, although other psycho- of body image. logical (i.e., guilt) and physiological (heart rate, The implications of the potential differences in responses proinflammatory cytokines) outcomes have been examined to anticipating and actually facing a threat are important. For within SSPT (Dickerson, Gable, Irwin, Aziz, & Kemeny, example, responses to the mere anticipation of a threatening 2009; Dickerson, Kemeny, Aziz, Kim, & Fahey, 2004). situation particularly negative may cause people to avoid Generally, research has supported the contentions of SSPT engaging in specific body-related situations (e.g., swimming, by examining psychobiological responses to the Trier Social having sex, exercising); however, if such responses can be Stress Test, a performance-based social-evaluative task overcome, some people may feel that the situation was not as (Kirschbaum, Pirke, & Hellhammer, 1993). Recently, SSPT bad (or threatening) as originally believed (Lamarche et al., has been applied to a body image context (Bailey, Lamarche, 2012; Mills, Fuller-Tyszkiewicz, & Holmes, 2014). & Gammage, 2014; Cloudt et al., 2014; Lamarche et al., One recent study developed a novel weight stigma para- 2015; Lamarche et al., 2014; Lamarche et al., 2012; Martin digm in which participants were actually exposed to an inter- Ginis et al., 2012). personal rejection based on weight stigma (Himmelstein, Martin Ginis et al. (2012) provided the first empirical sup- Belsky, & Tomiyama, 2015). Specifically, the authors manip- port of a cortisol response to a social-evaluative body image ulated weight stigma to examine its impact on cortisol reac- threat. In the first experiment, women thought they would be tivity. In addition, body mass index (BMI) and self-perceived exercising in a high social-evaluative threatening setting (in weight were examined as potential moderators of the rela- a public, mirrored exercise facility while wearing revealing tionship between stigma and cortisol reactivity. These exercise attire) or a low social-evaluative threatening setting authors found that the weight stigma situation elicited (alone, in a private, non-mirrored room while wearing non- changes in cortisol, and that those who perceived themselves revealing exercise attire). In their second experiment, partici- as “heavy” (regardless of their actual BMI) exhibited higher pants were asked to go behind a screen into a changing area cortisol in response to the weight stigma situation compared to try on exercise clothing and complete a questionnaire rat- with those who perceived themselves as average weight. ing the exercise clothing (e.g., color, fabric). In the high Although growing evidence suggests that cortisol may be social-evaluative condition, participants were led to believe elicited under body-related threats, the majority of the body that after completing the questionnaire, a video camera image literature has examined only immediate responses to would record the participant in the clothing so that a panel of such threats and still ignores what occurs after the body judges could evaluate how well the clothing fit at a later date. image threat is removed. Recent evidence examining Participants in the low social-evaluative condition were responses to a social-evaluative non-body image threat sug- instructed to change into the exercise clothing behind the gests that failing to examine a recovery phase may lead to screen and complete the same questionnaire package; how- erroneous conclusions regarding the distress of the individ- ever, they were told that no one would see them. Across both ual (Juster, Perna, Marin, Sindi, & Lupien, 2012). experiments the results indicated that cortisol levels were Furthermore, there is some, albeit limited, evidence of the higher post-manipulation for those in the high versus low lingering negative effects of body-related situations social-evaluative condition. (Hausenblas et al., 2003; Quinn et al., 2006). Thus, to gain a Although these authors were the first to provide evidence more complete picture of the response-recovery profile to a of a cortisol response to a social-evaluative body image body image threat, the current study measured outcomes threat, they noted significant limitations regarding their immediately following the threat and after a rest period in threat. Given their ethics board guidelines, they were unable which the threat was no longer present. to actually expose participants to the social-evaluative body The threat used in the present study was a three-site skin- image threat. They predicted that cortisol responses would fold assessment while wearing a two-piece bathing suit. This have been greater had participants actually faced the threat threat was selected for several theoretical and methodological Lamarche et al. 3 Table 1. Means (and SDs), Maximum and Minimum Values for variables would not return to baseline levels after the threat Age, Body Mass, Height, Percent Body Fat, BMI, and Exercise was removed (i.e., levels would remain significantly higher Frequency for Final Sample. than baseline levels). The hypothesis with respect to the recovery of variables is based on Quinn et al.’s (2006) find- Variable M (SD) Maximum Minimum ing of the lingering effects of body-related thoughts after Age 19.92 (2.10) 17.00 26.00 being exposed to a situation designed to heighten body image Body mass 63.34 kg (11.35) 39.74 kg 96.34 kg concerns. It was also hypothesized that participants in the Height 1.66 m (0.06) 1.52 m 1.83 m control condition would report no differences in body image % body fat 23.01% (5.40) 10.07% 35.18% variables or cortisol levels across their testing visit. BMI 22.98 (3.54) 16.75 34.06 Frequency of exercise 3.17 (1.52) 0.00 6.00 Method Note. Final sample = 64 participants. BMI = body mass index; frequency of exercise = times per week. Participants Upon institutional ethics clearance, participants were reasons. First, this threat is based on characteristics under recruited through posters placed around a university campus which perceptions of, and responses to, social-evaluative and announcements made in undergraduate classes. To dis- threatening situations are most likely to occur as supported by guise the true purpose of the study, the recruitment materials SSPT (Rohleder, Beilen, Chen, Wolf, & Kirschbaum, 2007). indicated the study was examining the relationship between Specifically, it involves a social-evaluative element (i.e., self-perceptions, anthropometric measurements, and corti- evaluates body composition by a trained technician and assis- sol. Furthermore, the reason given to participants regarding tant), involves a domain of importance (i.e., body fat is an the required clothing for the research session (described important characteristic associated with the North American below) was that it was standard clothing used in the labora- thin ideal), and the potential loss of social acceptance from a tory for anthropometric tests. The estimated required sample negative evaluation (i.e., a poor body composition may serve size of 60 was based on Martin Ginis et al. (2012) showing as a reminder that one does not meet the thin ideal standard). large effects of social-evaluative body image threats on cor- Second, a qualitative study framed within SSPT identified tisol in women (Cohen’s d = 0.81-1.16; Cohen, 1992). After being seen in a bathing suit by others as the most uncomfort- data screening (detailed below), the final sample consisted of able situation (Lamarche et al., 2012)—being in a bathing suit 64 healthy, young adult women attending university (see or increasing the level of body exposure has been an impor- Table 1 for sample characteristics). It should be noted that all tant aspect of manipulations designed to elicit body image but one participant were Caucasian. Varsity athletes, smok- concerns (Carron & Prapavessis, 1997; Gammage et al., ers, individuals with a history of a clinical eating disorder, or 2004; Hart et al., 1989; Martin Ginis et al., 2012). Third, those on medications that influence cortisol secretion (e.g., anticipation of this specific threat has been shown to elicit corticosteroids) were excluded from participation. social physique anxiety and body shame responses (Cloudt Participants were also excluded if they ate, drank, or partici- et al., 2014; Lamarche et al., 2014), thus it is possible that pated in physical activity within 1 hr prior to testing. actually exposing an individual to this threat would also elicit a cortisol response, similar to responses to a weight stigma situation (Himmelstein et al., 2015). Fourth, a skinfold assess- Measures ment was originally used to validate a questionnaire measur- Participants completed demographic information (age, fre- ing social physique anxiety (Hart et al., 1989). Fifth, a body quency of exercise) and answered a series of questions ensur- composition assessment through skinfold measurements is ing that they had complied with study requirements with commonly used in clinical and research settings, making it respect to food, drink, and physical activity participation. acceptable to the research ethics boards. Finally, as reported Next, a measure of state social physique anxiety was admin- by Lamarche et al. (2014), self-rating of perceived evaluative istered (see description below). threat in anticipation of this exact situation was significantly higher than a control group in a similar sample of women compared with the present study. Social physique anxiety. The nine-item State Social Physique Specifically, the purpose of the current study was to Anxiety Scale (SPAS; Kruisselbrink, Dodge, Swanburg, & examine psychobiological responses to, and recovery from, MacLeod, 2004) assessed anxiety associated with others’ actually undergoing (i.e., facing) a body image threat in evaluations of one’s body. The items were measured on a women. Based on the findings of Gammage et al. (2004) and 5-point scale ranging from 1 (not at all characteristic of me) Hart et al. (1989), and the work of Martin Ginis et al. (2012) to 5 (extremely characteristic of me). Participants were with respect to cortisol changes from a body image threat, it instructed to respond to each item by indicating how they felt was hypothesized that the body image threat would elicit at that moment. A sample item is “Unattractive features of increased social physique anxiety and cortisol and that these my physique/figure make me nervous in this setting.” This 4 SAGE Open questionnaire has demonstrated satisfactory reliability and cortisol response (Dickerson & Kemeny, 2004). Participants validity in young adult women in past research (Kruissel- in the threat group then changed back into their street clothes. brink et al., 2004; Martin Ginis, Murru, Conlin, & Strong, After completing their condition (i.e., quiet rest or threat), 2011). Internal consistency for the present study was deemed participants sat quietly for 15 more minutes (i.e., threat was adequate for each time point (αs range = .88-.93). no longer present), and then completed the same measure of state social physique anxiety followed by a final saliva sam- Salivary cortisol. Measuring cortisol in saliva is a reliable, ple (recovery measures). The recovery saliva sample was stress-free, non-invasive technique that does not require a completed approximately 50 min following the onset of the trained technician (Vinning, McGinley, Maksvytis, & Ho, threat/quiet rest (Dickerson & Kemeny, 2004). Upon com- 1983). Several studies have used salivary cortisol in their pletion of all questionnaires and saliva samples, objective protocols (e.g., Dickerson & Kemeny, 2004; Martin Ginis measures of height, weight, and body composition were et al., 2012; Rohleder et al., 2007). Saliva was collected taken for participants in the control group using the same using salivettes specific for cortisol measurement (Sarstedt, standard protocol described below, except that participants Germany). Participants placed the dental cotton piece in their wore shorts and a t-shirt for the body composition assess- mouths and left it there for 1 min, then placed the cotton back ment and only the technician was present. Participants were into the test tube and sealed it. Samples were centrifuged debriefed as to the true purpose of the study and given immediately and then placed in a −80 °C freezer until being US$10.00 as compensation for their time. Given the circa- assayed. Salivary cortisol concentration was measured in dian rhythm of cortisol, all data collection took place at the duplicate by commercial enzyme-linked immunosorbent same time of day (15:00-18:00) when levels are relatively assay kits according to the manufacturer’s instructions (Sali- constant (Dickerson & Kemeny, 2004; Vinning et al., 1983). metrics, 2010). The inter-assay and intra-assay coefficients of variability were calculated and deemed acceptable (<15% Social-evaluative body image threat. A body composition and <10%, respectively). assessment completed while participants wore a two-piece bathing suit was selected as the social-evaluative body image threat. Specifically, a standard three-site (triceps, iliac crest, Procedures thigh) skinfold measurement was performed to assess per- Interested participants contacted the principal investigator cent body fat (Jackson, Pollack, & Ward, 1980). The same and a mutually convenient time for participation was set. trained technician read measurements aloud to the same After confirming a test session, participants were randomly research assistant, who verbally repeated each value, then assigned to either the control or threat group by drawing a recorded it, thus allowing participants’ body composition to number out of a hat. Participants assigned to the control be evaluated by the researchers. The presence of the assistant group were asked to bring shorts and a t-shirt to their visit, who recorded the values ensured there was an evaluative whereas participants in the threat group were asked to bring audience, aside from the technician, increasing the likeli- a two-piece bathing suit. Participants in both groups were hood that a threat would be induced. This body image threat told that this clothing was standard laboratory attire to allow maximized body exposure and evaluation of the body, but for the accuracy of anthropometric measures, which would was also acceptable to the research ethics board as these be completed during the testing session. Upon arrival at the anthropometric measures are typically taken for research, laboratory, participants provided informed consent and com- clinical, athletic performance assessment, and educational pleted demographic information. Next, participants com- purposes. Furthermore, instructions for participants about pleted a measure of state social physique anxiety. This time clothing (particularly the bathing suit) were also considered served as a baseline rest period prior to cortisol collection. realistic, as some body composition testing done at the uni- Participants then provided a baseline saliva sample. versity requires participants to bring a bathing suit with Next, participants completed the threat/control condition, them. depending on their group assignment. Participants in the control condition were asked to sit quietly alone for 15 min. Results Quiet rest served as a control condition to be consistent with past research measuring cortisol responses to a social-evalu- Nine participants (all randomized into the threat group) who ative threat in the non-body image literature (Kirschbaum confirmed their eligibility, scheduled a testing appointment et al., 1993; Nater et al., 2007). Those in the threat condition and had knowledge of the clothing needed for participation, faced the social-evaluative body image threat (see descrip- did not attend their appointment. Of the 71 participants who tion below). Participants were then asked to sit while they completed the study, five participants were removed for not completed the same measure of state social physique anxiety complying with study requirements or for feeling unwell. and provided another saliva sample (response measures). Independent t tests showed no significant differences The response saliva sample was completed approximately 25 between participants removed and the final sample on key min after the onset of the threat/quiet rest, capturing the peak variables (all ps > .05). Data for cortisol were positively Lamarche et al. 5 Table 2. Means (and SDs) for SPA and Cortisol by Group. Control (n = 33) Threat (n = 31) Variable Baseline Response Recovery Baseline Response Recovery SPA 2.60 (0.86) 2.56 (1.01) 2.63 (1.05) 2.60 (0.81) 2.88 (0.87) 2.65 (0.86) Cortisol 3.49 (3.36) 2.94 (2.42) 2.66 (2.29) 2.48 (1.56) 2.88 (1.94) 2.98 (2.32) Note. SPA = social physique anxiety, ranges 1 to 5, higher scores represent higher SPA; cortisol = untransformed cortisol values, nmol/L. skewed so values were log-transformed for all analyses, sim- were no significant time, F(2, 61) = 2.14, p = .126, η = .07 ilar to previous studies investigating cortisol responses to or group main effects, F(1, 62) = .36, p = .549, η = .01. See social-evaluative body image threats (Cloudt et al., 2014; Table 2 for means and standard deviations for social physique Lamarche et al., 2014; Martin Ginis et al., 2012). For cortisol anxiety. data, non-transformed data are provided for ease of interpre- tation. Two participants were removed as outliers due to Cortisol implausible cortisol levels (>82.77 nmol/L; Salimetrics, 2010). Thus, the final data set included 64 participants. To compare the cortisol response with, and recovery from, a Some research has demonstrated a relationship between social-evaluative body image threat, a 2 (group: control, measures of body composition and social physique anxiety threat) × 3 (time: baseline, response, recovery) repeated-mea- (Hart et al., 1989), thus bivariate correlations were conducted sures ANOVA was conducted with log-transformed cortisol as to examine BMI, weight, and percent body fat as potential the dependent variable. A Bonferroni correction factor was covariates for analyses. No relationship was found (p > .05). applied for follow-up analyses. The Mauchly’s test of spheric- To investigate baseline group differences on demographic ity was significant; therefore, the Huynh–Feldt correction for variables and state social physique anxiety and cortisol at degrees of freedom is reported. There was a significant group- baseline, a series of t tests were conducted. The results indi- by-time interaction, F(2, 108) = 6.78, p < .01, η = .10. To cated no significant between-group differences on demo- examine the nature of the time effects within each group, three graphic variables or baseline variables (all ps > .05). sets of paired t tests were conducted (baseline vs. response, Relationships between social physique anxiety and cortisol response vs. recovery, baseline vs. recovery). Comparisons at all three time points were also examined. Results indicated made within the control group showed that there was a signifi- a significant positive relationship between state social phy- cant difference in levels of cortisol between baseline and sique anxiety and cortisol at the response time point (r = .25, recovery time points, t(32) = 2.93, p = .006 (Cohen’s d = .18; p < .05) and between cortisol at response and state social Cohen, 1992), indicating a decrease in cortisol from baseline physique anxiety at the recovery time point (r = .28, p < .05). to recovery time points. There was no significant change in cortisol levels from baseline to response, t(32) = 1.79, p = .084 or response to recovery, t(32) = 2.33, p = .026 in the control State Social Physique Anxiety group. In the threat group, comparisons showed that there was To compare the responses with, and recovery from, a social- a significant increase in cortisol from baseline to response evaluative body image threat, a 2 (group: control, threat) × 3 time point, t(30) = −2.58, p = .015 (Cohen’s d = .18; Cohen, (time: baseline, response, recovery) repeated-measures 1992). No differences were found in cortisol levels between ANOVA was conducted for social physique anxiety. There response and recovery, t(30) = −.02, p = .986 time points or was a significant group-by-time interaction, F(2, 61) = 4.36, baseline and recovery, t(30) = −1.46, p = .155 time points. p = .017, η = .13. To examine the nature of the time effects There were no significant main effects for time, F(2, 108) = .69, 2 2 within each group, three sets of paired t tests were conducted p = .485, η = .01 or group, F(1, 62) = .01, p = .907, η < .001. p p (baseline vs. response, response vs. recovery, baseline vs. See Table 2 for means and standard deviations for cortisol. recovery). A Bonferroni correction factor was applied for In addition, area under the curve with respect to increase follow-up analyses such that a p value < .017 would be (AUCi) was also calculated for each group (Pruessner, deemed significant. No differences were found within the Kirschbaum, Meinlschmid, & Hellhammer, 2003). AUCi control group. Comparisons made within the threat group assesses baseline-corrected cortisol responses and accounts showed that the level of social physique anxiety at response for the difference between single measurements from each was significantly higher than both baseline, t(30) = −3.64, other or the change over time (Pruessner et al., 2003). It p = .001 (Cohen’s d = .29; Cohen, 1992) and recovery levels, should be noted that a negative value represents an index of t(30) = 3.70, p = .001 (Cohen’s d = .34; Cohen, 1992). Levels decrease rather than an area under the curve. To examine of social physique anxiety were not different between base- whether a social-evaluative body image threat elicited a line and recovery time points, t(30) = −1.27, p = .22. There cortisol response, a one-way ANOVA was conducted using 6 SAGE Open group as the independent variable (control, threat) and AUCi More important, to our knowledge, the present study is as the dependent variable. The results showed a significant the first to measure psychobiological outcomes after the group difference for AUCi, F(1, 62) = 11.03, p < .01, social-evaluative threat is removed, highlighting the second η = .15. Inspection of means indicated that the control contribution to the body image literature. Findings show group showed an overall decrease (index of decrease) of that, when faced with a social-evaluative body image threat, −.09 (SD = 0.22), whereas the threat group showed an overall women report an immediate increase in social physique anx- increase in cortisol of .08 (SD = 0.18). iety and have higher cortisol, but perhaps more important, social physique anxiety and cortisol return to baseline levels when the threat is no longer present. This is an important and Discussion encouraging finding that extends what we currently know This study compared psychobiological responses with, and about situations that elicit body image concerns. For exam- recovery from, actual exposure to a social-evaluative body ple, the negative effects of viewing media images of the thin image threat in women. Significant increases in social phy- ideal, a non-social-evaluative body image threat, have been sique anxiety scores were found in the threat group, with found to persist 1 to 2 hr after viewing (Hausenblas et al., scores highest immediately following the body composition 2003). In addition, unlike a self-objectifying situation after assessment. By contrast, the control group showed no changes which body-related thoughts persist (Quinn et al., 2006), in social physique anxiety. Our findings also showed a sig- quick recovery from a social-evaluative body image threat as nificant group-by-time interaction for cortisol and a signifi- shown in the present study is possible. Although the reasons cant group difference in AUCi indicating that the threat for these differences can only be speculated, this finding elicited a cortisol response. These findings are consistent with could be considered positive for two reasons. First, outcomes our hypotheses that a social-evaluative body image threat returning to baseline levels after 15 min from a laboratory- would lead to increased social physique anxiety and cortisol. based threat may indicate that women are capable of recover- Contrary to our hypotheses, social physique anxiety and cor- ing from a similar acute threat in real life, although tisol returned to baseline levels after the threat was removed; psychobiological responses to a real life body image threat no significant differences were found between recovery and have yet to be examined. Second, quick, efficient psychobio- baseline levels of social physique anxiety and cortisol. logical responses are adaptive (Gruenewald, Dickerson, & Kemeny, 2007). Recent evidence examining responses to a social-evaluative non-body image threat suggests that failing Implications for Research to examine a recovery phase may lead to erroneous conclu- Arguably the most significant implication of the present sions regarding the distress of the individual (Juster et al., study is support for examining not only the responses to 2012). In the present study, the quick reactivity and recovery social-evaluative body image threats, but also the recovery of social physique anxiety and cortisol may have acted as a from such threats to provide a more complete picture of the key signaling emotion to make the participant aware that a psychobiology of body image experiences. Furthermore, it social-evaluative threat existed and then passed. However, should be highlighted that a skinfold assessment elicited a caution should be taken in drawing any conclusion about the psychobiological response consistent with SSPT. The find- temporal quality of this type of response. More research is ings from the present study complement those of Himmelstein needed examining what occurs when the threat is removed. et al. (2015) from which future research questions can build In addition, potential moderators and mediators of responses and test tenets of SSPT. In agreement with Martin Ginis et al. and recovery need to be explored. For example, Himmelstein (2012), we highlight the challenges of designing an ethical et al. (2015) found that perceived weight (regardless of their threat that can be tested in a laboratory setting. Despite the actual BMI) was a moderator of cortisol responses to the fact that some information regarding the study was required weight stigma situation. Findings suggest that perceptions to be included in the consent material, we still found signifi- (and not objective variables) have potential moderating cant differences in psychobiological outcomes. effects. Variables such as body image coping or body image investment may be important variables to examine, particu- larly with respect to efficient recovery. Contributions to Body Image Literature The present findings contribute to the body image literature Limitations in two significant ways. First, they complement those of Martin Ginis et al. (2012) who found that women who antici- Several limitations to this study should be noted. Results can pated a body image threat had higher cortisol levels post- only generalize to healthy, young Caucasian adult women. manipulation than women in a non-social-evaluative threat Furthermore, all but two participants fell within “normal/rec- condition. Our findings, in agreement with Himmelstein ommended” ranges for BMI and percent body fat. As some et al. (2015), show that actual exposure to a threat resulted in examples, results in men or individuals who have a clinical small but significant increases in cortisol. eating disorder may display different responses as they have Lamarche et al. 7 different body image concerns. Second, it is important to Roberts, 1997) may highlight the difficulty in designing a note that individuals volunteered for this study, and that all suitable control group in studies comparing groups’ varying participants in the threat group went through with the body level of social-evaluative threat in body image—any study composition assessment indicating they were comfortable about body image may initiate self-objectification, leading to enough to have their percent body fat measured. This may heightened self-conscious outcomes (i.e., body shame). present the issue of demand characteristics within the sam- Research framed in objectification theory has found that ple. We can only speculate why those nine participants ran- women trying on a swimsuit in front of a mirror (with no one domized into the threat group did not show up to their testing else present) reported body shame (Fredrickson, Roberts, appointment. However, it should be emphasized that even Noll, Quinn, & Twenge, 1998). Similarly, Martin Ginis et al. though the sample was comfortable enough to complete a (2012) noted that trying on clothing may initiate the social body composition assessment, we still found a significant comparison process (which Dickerson & Kemeny, 2004, increase in social physique anxiety and cortisol in response reported as one characteristic increasing social evaluation) to to the threat. Future research could minimize self-selection societal body image standards and, therefore, serve as a form by withholding study details in recruitment materials of social evaluation itself leading to slight increases in corti- although restrictions do apply based on ethical consider- sol responses. In turn, this makes it more difficult to detect ations. Third, our group was relatively active. Research has differences between the control and threat groups at the provided evidence that exercisers generally have a more response time point. Although we acknowledge the design of positive body image than non-exercisers (Hausenblas & our control group as a limitation, it should be noted that the Fallon, 2006), yet we were able to elicit a response including present study did find a significant increase in cortisol, even higher social physique anxiety similar to findings reported with the control group knowing their anthropometric mea- by Gammage et al. (2004) in a similar sample. surements would be taken eventually while wearing shorts Also, given that it is not possible to discern which of the and a t-shirt. Nevertheless, this limitation highlights the chal- factors of the manipulation was associated with the increase lenges in designing an equivalent body image control condi- in cortisol, future research could explore specific contextual tion void of social evaluation in a research topic with inherent factors and their sole and additive effects on the psychobiol- tendencies for social comparison and/or self-objectification. ogy of body image experiences. Finally, although timing of the cortisol measurements in the present study was based on Conclusion meta-analytic evidence, it should be noted that this support comes from studies examining the response to, and recovery The present findings contribute to the body image literature from, a performance-based (and not body image-related) by providing a more complete understanding of the psycho- social-evaluative threat (Dickerson & Kemeny, 2004); thus, biological aspects of body image. The findings also highlight timing of the peak response and full recovery may not be the the importance of measuring outcomes beyond the time point same across all types of social-evaluative threats. immediately after the body image threat is removed to evalu- Another limitation that should be noted relates to the ate any lingering effects on psychobiological outcomes. design of the control group. This challenge is illustrated by Furthermore, they emphasize the need to study both anticipa- the findings of a significant group-by-time interaction for tion of a body image threat and actually facing such threats; cortisol and a significant group difference in AUCi. However, it is possible that negative responses that occur in anticipa- visual inspection of the mean cortisol values at the response tion of these threats are actually decreased when actually time point shows that the control group had a higher cortisol experiencing such threats (Lamarche et al., 2012; Mills et al., level (although not significantly) than the threat group. We 2014). used a control group to represent a non-threatening condition Acknowledgments with respect to the body, similar to Himmelstein et al. (2015; rejection but not for weight-related reasons) and to past stud- Thanks to Jenn Romero and Izabella Ludwa for help with data col- ies examining cortisol responses to a social-evaluative non- lection and analysis. body image threat (Kirschbaum et al., 1993; Nater et al., 2007); however, it was not matched on body image content. Declaration of Conflicting Interests Martin Ginis et al. (2012) noted the difficulty in designing an The author(s) declared no potential conflicts of interest with respect equivalent control group when examining cortisol responses to the research, authorship, and/or publication of this article. to body image threats. In their second experiment, these authors had control participants believe they would try on Funding exercise attire alone, in private. The control and experimen- The author(s) disclosed receipt of the following financial support tal conditions were matched with respect to content of the for the research and/or authorship of this article: Funding for the manipulation (about the body), but differed on social evalua- researcher was provided by the Social Sciences and Humanities tion (alone, in private vs. evaluated on fit of clothing by Research Council of Canada and a grant from the North American another person). Objectification theory (Fredrickson & Society for the Psychology of Sport and Physical Activity. 8 SAGE Open Note performance. Journal of Personality and Social Psychology, 75, 269-284. 1. A moderation analysis following Baron and Kenny’s (1986) Gammage, K. L., Martin Ginis, K. A., & Hall, C. R. (2004). Self- recommendations was conducted to examine the potential presentational efficacy: Its influence on social anxiety in an moderating effects of body fat percent, body mass index exercise context. Journal of Sport & Exercise Psychology, 26, (BMI), or body weight on cortisol and social physique anxiety 179-190. responses. Results showed no evidence of moderation for body Gruenewald, T. L., Dickerson, S. S., & Kemeny, M. E. (2007). fat percent, BMI, or weight on cortisol or social physique anxi- A social function for the self-conscious emotions: Social- ety responses. These analyses were repeated for cortisol and self preservation theory. In J. L. Tracy, R. W. Robins, & J. social physique anxiety at the recovery time point, and similar P. Tangney (Eds.), The self-conscious emotions (2nd ed., (non-significant) results were found. Furthermore, no signifi- pp. 68-90). New York, NY: Guilford Press. cant correlations were found between any dependent variable Hart, E. A., Leary, M. R., & Rejeski, W. J. (1989). The measure- and BMI or body weight, in addition to body fat percent (all ment of social physique anxiety. Journal of Sport & Exercise ps > .05). 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State body Kinesiologia Slovenica, 10, 86-95. dissatisfaction and social interactions: An experience sampling Vinning, R., McGinley, R., Maksvytis, J., & Ho, K. (1983). study. Psychology of Women Quarterly, 38, 551-562. Salivary cortisol: A better measure of adrenal cortisol func- Myers, A., & Rosen, J. C. (1999). Obesity stigmatization and cop- tion than serum cortisol. Annals Clinical Biochemistry, 20, ing: Relation to mental health symptoms, body image, and self- 329-335. esteem. International Journal of Obesity, 23, 221-230. Nater, U. M., Moor, C., Okere, U., Stallkamp, R., Martin, M., Author Biography Ehlert, U., & Kliegel, M. (2007). Performance on a declarative Larkin Lamarche is an assistant professor (part-time) and a memory task is better in high than low cortisol responders to research coordinator for Health TAPESTRY. Her research focuses psychosocial stress. Psychoneuroendocrinology, 32, 758-763. on body-related experiences, exercise, and coping responses to doi:10.1016/j.psyneuen.2007.05.006 body image situations. Pruessner, J. C., Kirschbaum, C., Meinlschmid, G., & Hellhammer, D. H. (2003). Two formulas for computation of the area under Kimberley L. Gammage is an associate professor whose research the curve represent measures of total hormone concentration focuses on body image across the lifespan. She also has expertise in versus time-dependent change. Psychoneuroendocrinology, the examination of social-cognitive factors associated with exercise 28, 916-931. doi:10.1016/S0306-4530(02)00108-7 and health behaviours. Putterman, E., & Linden, W. (2006). Cognitive dietary restraint and Gretchen Kerr is a professor and vice-dean (Academic Affairs). cortisol: Importance of pervasive concerns with appearance. Her expertise is harassment and abuse in youth sport, athlete-cen- Appetite, 47, 64-76. doi:10.1016/j.appet.2006.02.003 tred coaching practices, and retirement transition from sport. Quinn, D. M., Kallen, R. W., & Cathey, C. (2006). Body on my mind: The lingering effect of state self-objectification. Sex Guy Faulkner is a professor whose research focuses on the promo- Roles, 55, 869-874. doi:10.1007/s11199-006-9140-x tion of physical activity in communities and rehabilitation settings. Rohleder, N., Beilen, S. E., Chen, E., Wolf, J. M., & Kirschbaum, He also has expertise in the relationship between physical activity C. (2007). Stress on the dance floor: The cortisol stress and mental health in children and adults. response to social-evaluative threat in competitive ballroom dancers. Personality and Social Psychology Bulletin, 33, 69- Panagiota Klentrou is a professor and associate dean (Research 84. doi:10.1177/01461672062293986 and Graduate Studies). She is an applied physiologist whose inter- Sabiston, C., Castonguay, A., Barnett, T., O’Loughlin, J., & ests include pediatric physiology, health and performance of youth Lambert, M. (2009). Body image and C-reactive protein in and musculoskeletal development.

Journal

SAGE Open – SAGE

Published: Apr 14, 2016

Keywords: body image; cortisol; body threat; women; social self-preservation theory

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