🟠 Moderate Evidence
Difficulties in emotion regulation are significantly associated with lower body appreciation among Lebanese adults, with psychological distress playing a crucial mediating role, according to a cross-sectional study published in PLOS Global Public Health. The research, conducted among 682 Lebanese adults aged 18–65 years, provides evidence that emotional dysregulation does not directly diminish body appreciation but rather operates through heightened psychological distress—a finding with implications for mental health interventions in non-Western populations.
Key takeaways
- Emotion regulation difficulties are significantly linked to lower body appreciation among Lebanese adults, mediated through psychological distress
- Psychological distress emerged as a statistically significant mediator, accounting for the pathway between emotion regulation and body image
- The study included 682 Lebanese adults (73.9% female, mean age 27.5 years, 87.5% with university-level education)
- Targeting psychological distress may be more effective than directly addressing emotion regulation in body image interventions
Study at a Glance
| Source | PLOS Global Public Health |
| Study type | Cross-sectional observational study |
| Sample size | N = 682 Lebanese adults |
| Population | Adults aged 18–65 years (73.9% female, 87.5% university-educated) |
| Country | Lebanon |
Study Sample Characteristics: Demographics and Educational Attainment
Distribution of 682 Lebanese adults by gender, age group, and educational background
Source: Alhourani et al., PLOS Global Public Health, 2024 | Georgian Medical Journal News
The Three-Path Relationship: Emotion Regulation, Distress, and Body Image
The research team, led by Mohamad Alhourani and colleagues at Lebanese institutions, sought to clarify how emotion regulation difficulties affect body appreciation—a critical dimension of positive body image. Rather than examining these as separate phenomena, the investigators tested whether psychological distress mediates the relationship between these constructs. This approach moves beyond simple correlation to reveal the mechanism through which one factor influences another.
Body appreciation—the acceptance and respect of one’s body regardless of appearance—is increasingly recognized as a protective factor against mental health problems. However, the pathways linking emotional dysregulation to diminished body appreciation have received limited research attention, particularly in the Eastern Mediterranean region. The Lebanese population, facing ongoing psychosocial stressors including political instability and economic hardship, provides a relevant context for understanding these relationships.
Mediation Analysis Reveals Psychological Distress as a Key Mechanism
Participants completed three validated instruments: the Body Appreciation Scale–2 (BAS-2), the Difficulties in Emotion Regulation Scale–16 (DERS-16), and the Beirut Distress Scale–10 (BDS-10). The analysis, conducted using IBM SPSS Statistics version 27.0 with PROCESS Macro Model 4 and 5,000 bootstrap samples, revealed three critical findings. First, higher emotion regulation difficulties were significantly associated with lower body appreciation. Second, higher emotion regulation difficulties were linked to greater psychological distress. Third, and most importantly, psychological distress significantly mediated the relationship between emotion regulation and body appreciation—meaning that the pathway operates through distress rather than as a direct effect.
The mediation model controlled for age, gender, body mass index (BMI), and self-reported mental health disorders, strengthening confidence in the findings. This methodological rigor ensures that observed associations are not confounded by demographic or clinical variables. The use of bootstrap resampling with 5,000 iterations provides robust statistical inference about the indirect effect.
Psychological distress significantly mediated the relationship between emotion regulation difficulties and body appreciation, indicating that greater emotion regulation difficulties were linked to lower body appreciation through increased psychological distress, not through direct pathways.
— Mohamad Alhourani and colleagues, Lebanese researchers (PLOS Global Public Health, 2024)
Implications for Mental Health Interventions in Non-Western Contexts
These findings have practical relevance for clinical and public health practice. If emotion regulation difficulties influence body appreciation primarily through psychological distress, then interventions targeting distress reduction—such as cognitive-behavioral therapy, mindfulness-based approaches, or community mental health support—may be more effective than interventions focused narrowly on emotion regulation skills alone. This suggests a more integrated approach to promoting positive body image in populations experiencing high levels of psychological adversity.
The study’s focus on a Lebanese population is significant because most body image research originates from Western, educated, industrialized, rich, and democratic (WEIRD) countries. The authors highlight that their findings address an important gap in understanding how psychological constructs interact in non-Western populations facing distinct sociocultural and environmental stressors. Lebanon’s ongoing economic and political crises create a context where both emotion regulation difficulties and psychological distress are likely elevated, making this research timely and contextually relevant.
What this means
Frequently asked questions
What is body appreciation, and why does it matter for mental health?
Body appreciation refers to acceptance, respect, and positive regard for one’s body and its functioning, independent of appearance or societal beauty standards. Research published in multiple psychology journals shows that higher body appreciation is associated with lower rates of depression, anxiety, and disordered eating, and with better overall psychological well-being. It is considered a protective factor that buffers against mental health problems.
How do emotion regulation difficulties differ from general anxiety or stress?
Emotion regulation difficulties refer specifically to challenges in understanding, accepting, and managing emotional responses—including difficulty controlling impulsive behavior when distressed, lack of emotional clarity, and limited access to coping strategies. While related to anxiety and stress, emotion dysregulation is a distinct construct measured by the DERS scale. In this study, emotion regulation difficulties were shown to affect body image partly through their influence on broader psychological distress.
Can these findings be applied to populations outside Lebanon?
While the study was conducted in Lebanon, the underlying psychological mechanisms linking emotion regulation, distress, and body image are likely relevant across diverse populations. However, the specific strength of these associations and the sociocultural context may vary. Research in other non-Western and Western populations would help clarify the generalizability of the mediation model. Readers interested in cross-cultural body image research should explore Global Health coverage on news.gmj.ge for additional perspectives.
As mental health research increasingly recognizes the importance of understanding psychological pathways rather than single risk factors, studies like this one contribute crucial evidence for intervention development. The finding that psychological distress mediates the relationship between emotion regulation and body appreciation opens new avenues for more precise, targeted therapeutic approaches—particularly in non-Western populations where culturally adapted mental health services remain limited. Future research exploring how cultural values, socioeconomic factors, and trauma exposure shape these pathways would further enhance our understanding and inform equitable, effective interventions across diverse contexts.
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Medically reviewed by Prof. Giorgi Pkhakadze, MD, MPH, PhD. Spotted an error? Contact the editorial team.
