Browsing by Author "Yilmazer, Eda"

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Attenuated Rightward Hemispheric Asymmetry in ADHD: Structural MRI Evidence from a Normalized Asymmetry Index and Its Association with Cognitive Performance
(Frontiers Media SA, 2026) Tarlaci, Sultan; Cinaroglu, Metin; Yilmazer, Eda; Ulker, Selami Varol
Background Altered hemispheric asymmetry has been proposed as a potential neurodevelopmental feature of Attention-Deficit/Hyperactivity Disorder (ADHD). However, findings remain inconsistent, and the functional relevance of structural asymmetry patterns is not well established. This study examines volumetric and cortical-thickness asymmetries across cortical and subcortical regions in children and adolescents with ADHD compared to typically developing controls and evaluates their association with objective cognitive performance. Methods Forty participants with ADHD and 30 age- and sex-matched controls underwent high-resolution T1-weighted MRI. Bilateral regional volumes and cortical thickness were quantified using the volBrain pipeline, and asymmetry indices (AI = [R-L]/[(R + L)/2]) were computed for lobar and subcortical structures. Group differences were assessed using independent t-tests. Within the ADHD group, associations between asymmetry indices and MOXO-d-CPT performance (Attention, Timing, Impulsivity, Hyperactivity) were examined using Pearson correlations with correction for multiple comparisons. Results ADHD participants showed significantly reduced rightward asymmetry in frontal lobe volume, cerebellar hemispheres, caudate, putamen, and amygdala (ps < 0.05). Cortical-thickness asymmetry was also diminished in the frontal and parietal lobes and the anterior cingulate cortex. Temporal and occipital asymmetries were preserved. Within the ADHD group, greater rightward frontal and ACC thickness asymmetry correlated with better attention performance (r = 0.45 and 0.40), rightward parietal asymmetry associated with more accurate timing (r = 0.38), reduced rightward IFG asymmetry related to greater impulsivity (r = -0.42), and amygdala asymmetry correlated with lower hyperactivity (r = 0.36). Conclusion Children with ADHD exhibit a consistent attenuation of typical right-hemisphere dominance across frontal, striatal, cerebellar, and limbic systems. These altered asymmetry patterns are meaningfully associated with attentional control, timing accuracy, impulsivity, and hyperactivity, suggesting that hemispheric imbalance may serve as a structural may represent a neurodevelopmental characteristic associated with ADHD. Findings support models emphasizing right-hemisphere developmental lag and highlight hemispheric asymmetry as a clinically relevant dimension of ADHD neurobiology.
Case Report: Physiological and Psychological Underpinnings of Muscle Dysmorphia Using EEG, GSR, and Eye-Tracking
(Frontiers Media SA, 2025) Cinaroglu, Metin; Ulker, Selami Varol; Yilmazer, Eda; Sayar, Goekben Hizli; Hızlı Sayar, Gökben
Background Muscle dysmorphia (MD), a subtype of Body Dysmorphic Disorder (BDD), involves an obsessive preoccupation with perceived insufficient muscularity despite an objectively muscular physique. While its psychological features are well-documented, physiological and attentional underpinnings remain underexplored.Objective This exploratory, proof-of-concept case series examines the psychological, physiological, and attentional characteristics of individuals with varying experiences of MD using a multimodal approach combining electroencephalography (EEG), galvanic skin response (GSR), and eye-tracking technologies.Methods Three male participants were purposefully selected to represent distinct clinical profiles: one with active MD and steroid use, one in sustained remission from MD, and one with no MD history. Participants completed validated psychological scales (MDDI, BIDQ, STAI, RSES) and were exposed to personalized visual stimuli (past, current, and idealized body images). A triangulated recording protocol was used to capture EEG, GSR, and eye-tracking data during stimulus exposure.Results Participants with current and past MD showed elevated beta wave activity, increased skin conductance, and attentional biases toward muscular regions, corresponding with higher self-reported distress and anxiety. In contrast, the control participant exhibited stable physiological responses and emotionally neutral reactions. Triangulated data revealed coherent patterns across subjective and physiological domains, supporting the internal validity of the findings despite the small sample.Conclusion These findings illustrate the potential of multimodal assessment in identifying candidate psychophysiological markers of MD. While not generalizable, this case-series provides a valuable framework for future hypothesis-driven research and supports the need for gender-specific diagnostic and intervention strategies in muscle dysmorphia.
Cognitive Behavioral Therapy for Muscle Dysmorphia and Anabolic Steroid-Related Psychopathology: A Randomized Controlled Trial
(MDPI, 2025) Cinaroglu, Metin; Yilmazer, Eda; Ulker, Selami Varol; Sayar, Gokben Hizli; Hızlı Sayar, Gökben
Background/Objectives: Muscle dysmorphia (MD), a subtype of body dysmorphic disorder, is prevalent among males who engage in the non-medical use of anabolic-androgenic steroids (AASs) and performance-enhancing drugs (PEDs). These individuals often experience severe psychopathology, including mood instability, compulsivity, and a distorted body image. Despite its clinical severity, no randomized controlled trials (RCTs) have evaluated structured psychological treatments in this subgroup. This study aimed to assess the efficacy of a manualized cognitive behavioral therapy (CBT) protocol in reducing MD symptoms and associated psychological distress among male steroid users. Results: Participants in the CBT group showed significant reductions in MD symptoms from the baseline to post-treatment (MDDI: p < 0.001, d = 1.12), with gains sustained at follow-up. Large effect sizes were also observed in secondary outcomes including depressive symptoms (PHQ-9: d = 0.98), psychological distress (K10: d = 0.93), disordered eating (EDE-Q: d = 0.74), and exercise addiction (EAI: d = 1.07). No significant changes were observed in the control group. Significant group x time interactions were found for all outcomes (all p < 0.01), indicating CBT's specific efficacy. Discussion: This study provides the first RCT evidence that CBT significantly reduces both core MD symptoms and steroid-related psychopathology in men engaged in AAS/PED misuse. Improvements extended to mood, body image perception, and compulsive exercise behaviors. These findings support CBT's transdiagnostic applicability in addressing both the cognitive-behavioral and affective dimensions of MD. Materials and Methods: In this parallel-group, open-label RCT, 59 male gym-goers with DSM-5-TR diagnoses of MD and a history of AAS/PED use were randomized to either a 12-week CBT intervention (n = 30) or a waitlist control group (n = 29). CBT sessions were delivered weekly online and targeted distorted muscularity beliefs, compulsive behaviors, and emotional dysregulation. Primary and secondary outcomes-Muscle Dysmorphic Disorder Inventory (MDDI), PHQ-9, K10, EDE-Q, EAI, and BIG-were assessed at the baseline, post-treatment, and 3-month follow-up. A repeated-measures ANOVA and paired t-tests were used to analyze time x group interactions. Conclusions: CBT offers an effective, scalable intervention for individuals with muscle dysmorphia complicated by anabolic steroid use. It promotes broad psychological improvement and may serve as a first-line treatment option in high-risk male fitness populations. Future studies should examine long-term outcomes and investigate implementation in diverse clinical and cultural contexts.
Comparing Cognitive Behavioral Therapy and Ericksonian Hypnotherapy for Subclinical Depression and Anxiety: A Randomized Controlled Trial
(Routledge Journals, Taylor & Francis Ltd, 2025) Cinaroglu, Metin; Yilmazer, Eda; Odabasi, Cemre; Ulker, Selami Varol; Sayar, Gokben Hizli; Hızlı Sayar, Gökben
This randomized controlled trial examined the effectiveness of Cognitive Behavioral Therapy (CBT) and Ericksonian Hypnotherapy (EH) in reducing symptoms of depression and anxiety among individuals with subclinical levels of distress. A total of 150 participants were screened, and 45 eligible participants were randomized into three groups: CBT (n = 15), EH (n = 15), and a waitlist control group (n = 15). Interventions consisted of 12 weekly sessions, with assessments conducted at baseline, mid-intervention, and post-intervention using the Beck Depression Inventory-II (BDI-II) and Beck Anxiety Inventory (BAI). Both CBT and EH significantly reduced symptoms of depression and anxiety compared to the control group, with no significant differences in efficacy between the two interventions. CBT's structured approach demonstrated consistent improvements across both depression and anxiety, while EH showed a slightly faster reduction in anxiety symptoms at mid-intervention, highlighting its potential for addressing somatic and cognitive dimensions of anxiety. This study extends previous findings by focusing on a non-clinical population, emphasizing the potential of these interventions as early strategies for preventing symptom escalation. Unlike prior work primarily targeting diagnosed populations, this research underscores the applicability of CBT and EH in addressing subthreshold distress. Limitations include a small sample size, lack of follow-up assessments, and reliance on self-reported measures. Future research should explore long-term outcomes, larger samples, and the integration of CBT and EH. These findings contribute to the growing body of evidence supporting diverse psychotherapeutic modalities for early mental health intervention.
Coping Strategies and Psychological Outcomes Following the 2023 Kahramanmaraş Earthquakes: A Systematic Review with Meta-Analytic Synthesis
(Frontiers Media SA, 2026) Cinaroglu, Metin; Yilmazer, Eda
Background The 2023 Kahramanmara & scedil; earthquakes caused unprecedented devastation across southern T & uuml;rkiye, resulting in widespread psychological distress among survivors. Identifying coping strategies linked to better mental health outcomes is essential for guiding post-disaster support. Objective To systematically synthesize quantitative evidence on associations between coping strategies and psychological outcomes (PTSD/trauma symptoms, depression, anxiety, and posttraumatic growth [PTG]) among adult survivors of the 2023 earthquakes, and to meta-analyze associations reported in at least two independent studies. Methods Following PRISMA 2020 guidelines and a preregistered OSF protocol (osf.io/7z2pe), four databases (Web of Science, Scopus, PubMed, and DergiPark) were searched for quantitative studies published in Turkish or English. Ten cross-sectional studies (total N = 6,223) met inclusion criteria. Data were extracted using a standardized form, study quality was appraised with an adapted Newcastle-Ottawa Scale, and random-effects meta-analyses were conducted for coping-outcome pairs reported in >= 2 studies; remaining associations were summarized descriptively. Results Meta-analytic evidence indicated that resilience was consistently associated with lower psychological distress, including post-earthquake trauma severity (pooled r = -0.44), depression (r = -0.41), anxiety (r = -0.43), and overall distress across four studies (r = -0.42). Perceived social support/support-seeking coping was moderately associated with lower PTSD/trauma-related symptoms (pooled r = -0.31). Religious coping (pooled r = -0.21) and positive reappraisal (pooled r = -0.19) showed small inverse associations with PTSD symptoms but with substantial heterogeneity. In single-study analyses, meaning-centered coping and self-compassion were associated with higher PTG, suggesting potentially important pathways that require replication. Conclusion Coping processes are meaningfully linked to psychological adjustment after the Kahramanmara & scedil; earthquakes. The most robust evidence supports resilience and social support as protective correlates of lower distress. Evidence for religious coping and positive reappraisal is suggestive but heterogeneous, and PTG-related findings remain preliminary due to limited replication. Longitudinal and intervention-based research is needed to clarify causal mechanisms and inform culturally responsive disaster mental health programs.
Effects of Ericksonian Hypnotherapy Versus Cognitive Behavioral Therapy on Prolonged Grief Among University Students: A Randomized Clinical Trial
(Routledge Journals, Taylor & Francis Ltd, 2025) Cinaroglu, Metin; Yilmazer, Eda; Ulker, Selami Varol; Cinar, Fadime
This study evaluates the comparative effectiveness of Ericksonian Hypnotherapy (EH) and Cognitive Behavioral Therapy (CBT) in addressing prolonged grief among university students in Istanbul. Transitioning through critical developmental phases, 39 students who had experienced significant loss and demonstrated symptoms of prolonged grief participated in this randomized controlled trial. They were divided equally into three groups: those receiving EH, those undergoing CBT, and a control group placed on a waiting list. Assessments utilized the Prolonged Grief Scale and the Beck Depression Inventory to measure the interventions' impact on grief. Findings revealed significant improvements in both EH and CBT groups compared to the control, with EH showing marginally higher effectiveness in reducing grief symptoms. This research underlines EH's potential as a culturally adaptable and effective treatment for prolonged grief in a diverse academic setting, advocating for its broader application and further exploration across various populations.
Effects of Mindfulness on Test Anxiety: A Meta-Analysis
(Frontiers Media Sa, 2024) Yilmazer, Eda; Hamamci, Zeynep; Turk, Fulya
Objective: This meta-analysis evaluated the effectiveness of mindfulness-based interventions (MBIs) on test anxiety across diverse age groups and intervention modalities. Methods: Rigorous inclusion criteria were applied to select studies focusing on MBIs as the independent variable, with test anxiety as the outcome. A comprehensive search across multiple databases yielded 18 primary studies, contributing 20 comparisons. Data were extracted on study characteristics, sample sizes, and intervention details, and were analyzed using a random-effects model. Results: The analyses incorporated 1,275 participants, with MBIs demonstrating a moderate to large negative effect on test anxiety (effect size = -0.716; 95% CI: -1.383 to -0.049). Moderation analysis indicated that mean age, number of sessions, and intervention delivery mode did not significantly influence effect sizes. Publication bias assessment suggested the presence of bias via Egger's regression (p = 0.025), though Begg and Mazumdar's test and Duval and Tweedie's trim and fill method indicated no missing studies. Conclusion: MBIs are effective in reducing test anxiety, though results should be interpreted with caution due to potential publication bias and unexplained heterogeneity. The impact of MBIs did not vary significantly with participant age, number of sessions, or delivery mode.
Efficacy of Cognitive-Behavioral Therapy in Reducing Muscle Dysmorphia Symptoms Among Turkish Gym Goers: A Pilot Study
(Elsevier, 2024) Cinaroglu, Metin; Yilmazer, Eda; Ulker, Selami Varol; Ahlatcioglu, Esra Noyan; Sayar, Gokben Hizli
Muscle dysmorphia (MD) is a disorder marked by an obsessive focus on muscularity, often leading to excessive exercise, rigid dieting, and use of performance-enhancing drugs (PEDs). While Cognitive-Behavioral Therapy (CBT) is known to be effective for various body image disorders, its specific effects on individuals with MD have been less studied. This qualitative case series involved seven male participants, aged 35-55, all diagnosed with MD and with a history of anabolic steroid use, undergoing a 12-week manualized CBT intervention. The study aimed to explore how CBT impacts their body image perceptions, exercise behaviors, steroid use, and emotional responses. Data were collected through participant feedback during therapy sessions, with thematic analysis revealing significant shifts in body image perception and reductions in compulsive behaviors and steroid use. Despite these improvements, participants experienced feelings of loss and anxiety as they modified their routines, and some reported relapses under stress, indicating the chronic nature of MD. The findings suggest that CBT effectively reshapes cognitive and behavioral patterns in MD sufferers but also highlight the need for ongoing support to manage the disorder's emotional complexities and prevent relapses. Future research should focus on long-term and individualized therapeutic approaches to better support those with muscle dysmorphia.
Emotion Regulation and Visual Attention in Body Dysmorphic Disorder: A Multimodal Study Using EEG, GSR, and Eye-Tracking
(BMC, 2026) Ulker, Selami Varol; Cinaroglu, Metin; Yilmazer, Eda; Sayar, Gokben Hizli
BackgroundBody Dysmorphic Disorder (BDD) is a psychiatric condition characterized by obsessive preoccupation with perceived physical flaws, often accompanied by emotional dysregulation and attentional biases. Despite increasing clinical recognition, the neurophysiological and attentional mechanisms underlying BDD remain poorly understood.MethodsThis study employed a multimodal experimental design to compare individuals with BDD (n = 27) and healthy controls (n = 27). Participants completed standardized psychometric assessments and were exposed to emotionally valenced facial and body-related images while undergoing electroencephalography (EEG), galvanic skin response (GSR), and eye-tracking. Group-by-valence interactions were analyzed using mixed-model ANOVAs.ResultsThe BDD group showed significantly higher depression, anxiety, body image disturbance, and suppression scores, alongside reduced cognitive reappraisal and self-efficacy. EEG analyses revealed increased N170 amplitudes, attenuated P300 amplitudes, and greater right-sided frontal alpha asymmetry, suggesting early hypervigilance, reduced evaluative processing, and affective withdrawal. GSR data indicated heightened sympathetic arousal and delayed physiological recovery. Eye-tracking data descriptively indicated gender-specific attentional patterns within the BDD group, with females allocating greater visual attention to facial and lower-body regions and males showing increased fixation on muscular upper-body features; such patterns were not observed in the control group.ConclusionBDD is associated with dysregulated multisystem responses to appearance-related stimuli, characterized by neural hyperreactivity, impaired cognitive-emotional regulation, and gender-related patterns of visual attention. These findings support the utility of integrating psychophysiological and attentional markers into individualized assessment and intervention strategies for BDD.Clinical trial numberNot applicable.
Exploring the Psychological and Social Dynamics of Steroid and Performance-Enhancing Drug (PED) Use Among Late Adolescents and Emerging Adults (16-22): A Thematic Analysis
(MDPI, 2025) Cinaroglu, Metin; Yilmazer, Eda; Noyan Ahlatcioglu, Esra
Background: Performance-enhancing drug (PED) use has become increasingly prevalent among adolescents and emerging adults, not solely for athletic advantage but as a psychological and sociocultural coping mechanism. In T & uuml;rkiye, where Westernized body ideals intersect with traditional values, the emotional and symbolic meanings of PED use among youth remain underexplored. Methods: This qualitative study employed semi-structured interviews and reflexive thematic analysis to examine the subjective experiences of 26 Turkish adolescents and emerging adults (19 males, 7 females; ages 16-22) in Istanbul who reported non-medical use of steroids or other PEDs. Participants were recruited through snowball sampling in gym-adjacent communities across six urban districts. Interviews were conducted online, recorded, transcribed, and analyzed to identify emergent psychological themes. Results: Six interconnected themes were identified: (1) body-based insecurity and the fantasy of reinvention; (2) emotional regulation through bodily control; (3) secrecy as autonomy; (4) compulsive enhancement and dissatisfaction; (5) psychological dependency and regret; and (6) PED use as agency and protest. While male and female participants differed in aesthetic goals and social narratives, both groups framed PED use as a means of identity construction, emotional survival, and social validation. Participants did not perceive themselves as deviant but as strategic actors navigating a performance-driven culture. Conclusions: PED use among youth in urban T & uuml;rkiye emerges as a psychologically embedded coping mechanism rooted in emotional regulation, self-concept, and perceived control. Rather than a deviant behavior, it reflects an adaptive but precarious strategy for managing insecurity and achieving recognition during a critical developmental stage.
Interhemispheric EEG Coherence as a Candidate Biomarker in Gambling Disorder: Evidence of Frontal Hyperconnectivity and Posterior Disconnectivity
(Frontiers Media SA, 2025) Yilmazer, Eda; Cinaroglu, Metin; Ulker, Selami Varol; Tarlaci, Sultan
Background Gambling Disorder (GD) is a behavioral addiction marked by impaired decision-making and poor impulse control. We investigated whether resting-state interhemispheric quantitative EEG (qEEG) coherence-a measure of functional connectivity between homologous cortical regions-could serve as a biomarker of GD.Methods Twenty-nine male patients with GD and 45 healthy male controls underwent resting-state qEEG recording. Coherence was computed for homologous electrode pairs across delta, theta, alpha, and beta bands. Group differences were analyzed using independent-samples t-tests; associations with disorder duration were assessed via age-controlled partial correlations.Results Consistent with our hypothesis, GD participants exhibited frontal pole hypercoherence (Fp1-Fp2) across delta, theta, and beta bands, which is likely influenced by prefrontal/orbitofrontal generators. In contrast, GD showed hypocoherence in temporal (T3-T4, T5-T6), central (C3-C4), and parietal (P3-P4) regions across these frequencies. Greater disorder duration was associated with lower beta coherence at F3-F4 and Fp1-Fp2, and higher delta coherence at O1-O2.Conclusions These findings reveal a dual pattern of interhemispheric connectivity disruption in GD-hypercoherence at frontal pole sites and hypocoherence in sensorimotor and attentional posterior networks-supporting theoretical models of addiction neurocircuitry. Resting-state qEEG coherence holds promise as a clinically relevant biomarker for GD and may inform the development of neuromodulatory interventions aimed at network rebalancing.
The Mediating Role of Cognitive Emotion Regulation Skills in the Relationship Between Romantic Relationship Satisfaction and Eating Attitudes
(Springer Nature, 2025) Yilmazer, Eda; Turk, Fulya; Hamamci, Zeynep
Background Romantic relationship satisfaction has been linked to psychological outcomes, including emotional well-being and eating behaviors. However, the mechanisms underlying this relationship remain unclear. This study examines the mediating role of cognitive emotion regulation strategies-particularly catastrophizing-in the relationship between romantic relationship satisfaction and eating attitudes. Methods A cross-sectional study was conducted with 355 university students. Participants completed the Relationship Satisfaction Scale, the Cognitive Emotion Regulation Questionnaire (CERQ), and the Eating Attitudes Test-26 (EAT-26). Structural equation modeling (SEM) was performed using AMOS and R with robust maximum likelihood estimation. Model fit was evaluated using chi 2/df, CFI, GFI, RMSEA, and SRMR. Results Catastrophizing significantly mediated the relationship between romantic relationship satisfaction and eating attitudes. Romantic relationship satisfaction was negatively associated with catastrophizing (beta = -0.18, p = .028), and catastrophizing was positively associated with problematic eating attitudes (beta = 0.35, p < .001). The direct effect of romantic relationship satisfaction on eating attitudes was not statistically significant (beta = -0.12, p = .104), indicating full mediation. Acceptance did not significantly mediate the relationship (p = .348). Gender differences were observed: women scored significantly higher on rumination, dieting, and bulimia/food preoccupation (p < .05). Conclusions These findings highlight the role of maladaptive cognitive emotion regulation-specifically catastrophizing-in linking romantic relationship dissatisfaction with disordered eating attitudes. Targeting catastrophizing in interventions may improve both relationship satisfaction and eating behaviors.
Multimodal Neurophysiological Responses to Body Image Stimuli in Men with Muscle Dysmorphia and Steroid Use
(Elsevier, 2025) Cinaroglu, Metin; Yilmazer, Eda; Ulker, Selami Varol; Sayar, Gokben Hizli
Muscle dysmorphia (MD), a subtype of body dysmorphic disorder (BDD), involves a pathological preoccupation with muscularity and is commonly linked to anabolic steroid and performance-enhancing drugs (PEDs) use. Despite its rising prevalence, the neurophysiological and affective mechanisms underlying MD, particularly in steroid users, remain underexplored. This study examined 71 male strength-training participants (35 with BDD/ steroid use; 36 controls) during a passive viewing task of muscular, average, and slender male physiques while recording electroencephalography (EEG), electrodermal activity (EDA), and eye-tracking data. Psychometric assessments captured muscularity concerns (Muscle Dysmorphic Disorder Inventory, MDDI), anxiety (State-Trait Anxiety Inventory, STAI), obsessive-compulsive symptoms (Obsessive-Compulsive Inventory-Revised, OCI-R), appearance-related anxiety (Social Appearance Anxiety Scale, SAAS; Social Physique Anxiety Scale, SPAS), and selfesteem (Self-Liking/Self-Competence Scale-Revised, SLCS-R). The BDD/MD group showed significantly heightened responses to muscular stimuli across all modalities. EEG results revealed increased P300 and late positive potential (LPP) amplitudes, along with greater left-lateralized frontal alpha asymmetry. Eye-tracking indicated longer fixation durations and more frequent fixations on muscular images. EDA results showed elevated levels of autonomic arousal. Between-group differences in psychometric measures were substantial, with large effect sizes. Correlational analyses demonstrated significant associations between MD severity and neurophysiological markers, including LPP amplitude, frontal asymmetry, and EDA reactivity. These findings suggest that men with MD and steroid/PEDs use exhibit amplified attentional, emotional, and physiological reactivity to muscular body images. The integration of EEG, EDA, and eye-tracking provides novel insights into the neurocognitive-affective profile of BDD/MD, emphasizing the salience of idealized physiques in this population. Results support the potential utility of multimodal measures as objective indicators for assessing body image disturbance and underscore the need for targeted interventions addressing perceptual and emotional dysregulation in BDD/MD.
Problematic Social Media Use, Self-Objectification, and Body Image Disturbance: The Moderating Roles of Physical Activity and Diet Intensity
(Dove Medical Press Ltd, 2025) Cinaroglu, Metin; Yilmazer, Eda
Purpose: This study examines the relationship between problematic social media use, self-objectification, and body image disturbance in women, with physical activity and diet intensity as moderators. It also explores the psychological outcomes of depression and anxiety.
Methods: A cross-sectional study was conducted with 594 women aged 18- 65 in Istanbul, T & uuml;rkiye. Participants completed validated measures assessing social media use, self-objectification, body image disturbance, physical activity, diet intensity, depression, and anxiety. A moderated mediation analysis was performed.
Results: Self-objectification significantly mediated the relationship between problematic social media use and body image disturbance (b = 0.14, SE = 0.03, 95% CI [0.10, 0.21], p < 0.01, R-2 = 0.18). Physical activity buffered this effect (b = - 0.12, SE = 0.05, p = 0.02, d = 0.36), while diet intensity exacerbated it (b = 0.15, SE = 0.04, p < 0.01, d = 0.42). Body image disturbance also mediated the association between social media use and depression (b = 0.18, SE = 0.05, p < 0.01, R-2 = 0.22) and anxiety (b = 0.16, SE = 0.04, p < 0.01, R-2 = 0.19).
Conclusion: The findings highlight the dual roles of physical activity and diet intensity in shaping body image outcomes. The study underscores the need for targeted interventions to mitigate the negative impact of social media-driven self-objectification on body image and mental health.
Psychological Correlates of Performance-Enhancing Drug Use: Emotional, Cognitive, and Social Functioning in Long-Term and Short-Term Users
(Frontiers Media SA, 2025) Cinaroglu, Metin; Yilmazer, Eda
Introduction Performance-enhancing drug (PED) use-particularly anabolic-androgenic steroids (AAS)-has expanded from competitive sport into mainstream fitness settings. Although PED use is associated with emotional, cognitive, and social difficulties, less is known about how duration of use or psychosocial factors shape these outcomes. Understanding these dynamics is essential for identifying individuals at greater risk for psychological impairment.Methods A total of 285 adult gym-goers (87 long-term users, 95 short-term users, 103 non-users) completed validated measures of depression (BDI-II), anxiety (BAI), muscle dysmorphia (MDDI), self-efficacy (GSE), social support (MSPSS), and social functioning (SASS), along with the Stroop test assessing executive function. Group comparisons, multiple regressions, and PROCESS-based mediation and moderation analyses were conducted, controlling for demographic covariates.Results Long-term PED users reported significantly higher depression, anxiety, and muscle dysmorphia than short-term users and non-users, and showed poorer Stroop interference performance. Mediation analysis revealed that depression and anxiety partially explained the link between PED use and poorer social functioning. Moderation results indicated that stronger self-efficacy and higher perceived social support buffered depressive and anxious symptoms among users.Discussion Chronic PED use is associated with heightened emotional distress and reduced executive functioning, which in turn contribute to impaired social functioning. However, psychosocial resources such as self-efficacy and social support may mitigate these adverse effects. These findings underscore the need for routine psychological assessment and the development of supportive, prevention-oriented interventions for individuals engaged in PED use.
Psychological Distress, Resilience, and Well-Being Among Survivors of the 2023 Kahramanmaraş Earthquakes: A Multi-Site Cross-Sectional Study
(Frontiers Media SA, 2025) Yilmazer, Eda
Background The 2023 Kahramanmara & scedil; earthquakes were among the most devastating disasters in modern T & uuml;rkiye, with severe consequences for survivors' mental health. While post-disaster psychopathology has been widely studied, less is known about positive psychological outcomes such as resilience and well-being in this context.Objective This study examined levels of depression, anxiety, post-traumatic stress symptoms, well-being, and resilience among earthquake survivors, explored group differences, and identified predictors of key psychological outcomes.Methods A cross-sectional survey was conducted with 642 adult survivors across 11 heavily affected cities, nearly 2 years after the earthquakes. Data were collected between September 2024 and January 2025, corresponding to 19-22 months after the earthquakes. Participants completed validated self-report measures: BDI-II, BAI, PCL-5, WEMWBS, and CD-RISC. Analyses included group comparisons, correlations, hierarchical regressions predicting well-being and resilience, and logistic regression predicting probable PTSD (PCL-5 >= 47).Results Survivors reported moderate depression (M = 22.1), mild-moderate anxiety (M = 19.4), and near-threshold PTSD symptoms (M = 40.0). Overall, 31.0% of participants exceeded the PCL-5 cut-off for probable PTSD (95% CI: 27.4-34.8%). Well-being (M = 35.6) and resilience (M = 56.0) were below normative values. Women reported higher depression than men, while trauma-exposed participants had significantly worse outcomes across all measures. Bivariate correlations showed strong associations between distress, reduced well-being, and diminished resilience. Hierarchical regressions indicated that depression and PTSD symptoms were the primary predictors of both lower well-being (R2 = 0.45) and resilience (R2 = 0.32). Logistic regression revealed that female gender (OR = 1.80, p = 0.024) and depression severity (OR = 1.10, p = 0.001) significantly increased the likelihood of probable PTSD.Conclusion Nearly 2 years after the earthquakes, survivors experienced substantial psychological distress alongside reduced well-being and resilience. Clinical symptoms, particularly depression and PTSD, more strongly associated with outcomes than sociodemographic or exposure variables. These findings highlight the need for interventions that both alleviate trauma-related psychopathology and strengthen resilience and well-being as part of long-term disaster recovery.
Psychological Impact of the 2023 Kahramanmaras Earthquakes on Non-Victims: A Cross-Sectional Study
(BMC, 2025) Cinaroglu, Metin; Yilmazer, Eda; Sayar, Gokben Hizli
The 2023 Kahramanmara & scedil; earthquakes, with magnitudes of 7.7 and 7.6, caused extensive destruction and psychological distress across southeastern Turkey. This study explores the psychological impact on non-victims, particularly Istanbul residents, focusing on mental health outcomes and coping mechanisms. A cross-sectional survey was conducted from March to May 2024 with 721 participants from various Turkish cities, including a significant portion from Istanbul. Validated psychological scales such as the Beck Depression Inventory-II (BDI-II), Beck Anxiety Inventory (BAI), Warwick-Edinburgh Mental Well-being Scale (WEMWBS), and PTSD Checklist for DSM-5 (PCL-5) measured depression, anxiety, well-being, and PTSD symptoms. Sociodemographic factors like age, gender, occupation, income, education level, and previous earthquake experience were also analyzed. Results showed significant psychological distress among non-victims: 51.9% reported high levels of distress, with 24% meeting PTSD criteria, 30% exhibiting moderate to severe depression, and 28% experiencing significant anxiety. Higher income and education levels correlated with better mental health outcomes. Higher education levels were linked to lower PTSD risk (beta = -0.20, p < 0.01) and fewer depression symptoms (beta = -0.15, p < 0.05). Higher income was associated with lower depression scores (beta = -0.20, p < 0.01) and fewer PTSD symptoms (beta = -0.15, p < 0.05). Age positively correlated with well-being (r = 0.68, p < 0.001) and negatively with PTSD symptoms (r = -0.15, p < 0.05). Comparisons with victim studies of major earthquakes, such as the 1995 Great Hanshin-Awaji earthquake, the 1999 Marmara earthquake, the 2008 Wenchuan earthquake, and the 2000 Iceland earthquakes, revealed similar profound psychological impacts. This highlights the need for comprehensive mental health interventions for both direct and indirect exposures. This study underscores the necessity for inclusive mental health strategies to enhance resilience and well-being, ensuring robust recovery after catastrophic events.
Psychological Impact of the 2023 Kahramanmaraş Earthquakes: A Systematic Review and Meta-Analysis of PTSD, Depression, and Anxiety Among Turkish Adults
(Frontiers Media SA, 2025) Cinaroglu, Metin; Yilmazer, Eda; Ahlatcioglu, Esra Noyan; Ulker, Selami Varol; Sayar, Gokben Hizli; Hızlı Sayar, Gökben; Noyan Ahlatcıoğlu, Esra
Background The twin earthquakes that struck Kahramanmara & scedil;, T & uuml;rkiye, on February 6, 2023, caused widespread devastation and loss of life. Beyond the physical destruction, such large-scale disasters often result in significant psychological trauma. This study systematically reviewed and meta-analyzed the prevalence and severity of probable post-traumatic stress disorder (PTSD), depression, and anxiety among adult Turkish survivors during the first 18 months post-disaster. Methods Following PRISMA 2020 guidelines, a systematic search of Web of Science, PubMed, and Scopus was conducted for peer-reviewed studies published between February 6, 2023, and May 30, 2025. Eligible studies included quantitative assessments of PTSD, depression, or anxiety using validated Turkish-language scales, with general adult population samples (N >= 370). Eight studies (N = 5,965) met inclusion criteria. A random-effects meta-analysis was conducted for studies reporting prevalence of probable PTSD, while depression and anxiety outcomes were synthesized descriptively due to limited and heterogeneous data. Risk factors for psychological morbidity were also extracted and analyzed. This review was registered with PROSPERO (CRD42025644127). Results The pooled prevalence of probable PTSD was 41% (95% CI: 32-52%). Reported PTSD rates ranged from 29 to 54%, and symptom severity remained high throughout the first year. Depression and anxiety were also widespread, with up to 40% screening positive for depression and 40-50% reporting moderate-to-severe anxiety symptoms. Comorbidity between PTSD, depression, and anxiety was common. Significant risk factors included female gender, bereavement, home destruction, displacement, job loss, and low social support. Resilience was protective in some studies, though findings were inconsistent. Conclusion Eighteen months after the 2023 Kahramanmara & scedil; earthquakes, Turkish adult survivors continued to experience high levels of probable PTSD, depression, and anxiety. These findings highlight a prolonged mental health crisis and underscore the urgent need for sustained, targeted psychosocial interventions. Integrating mental health support into disaster preparedness and long-term recovery efforts is essential for mitigating psychiatric morbidity in future disasters.Systematic review registration https://www.crd.york.ac.uk/PROSPERO/view/CRD42025644127.
Psychometric Properties and Validation of the Metacognitive Self-Assessment Scale (MSAS) in a Turkish Sample
(Frontiers Media Sa, 2024) Yilmazer, Eda; Hamamci, Zeynep; Tuerk, Fulya; Türk, Fulya
Objective: Metacognition, a multifaceted psychological construct, encompasses recognising and explaining one's cognitive processes and those of others. Notably, deficits in metacognitive abilities are linked with diminished social performance, reduced quality of life, and increased severity of Personality Disorders (PD). While there are other assessment tools available in Turkish for evaluating metacognition, none offer the same combination of speed, simplicity, flexibility, and multidimensionality for screening metacognitive abilities as the Metacognition Self-Assessment Scale (MSAS).The Metacognitive Self-Assessment Scale (MSAS) was designed to evaluate various metacognitive functions-namely, Monitoring, Integration, Differentiation, and Disintegration-as described by the Metacognitive Multifunction Model. This study aims to translate and validate the MSAS for Turkish culture. Method: To check the factor structure's suitability for the Turkish population, 467 non-clinical participants (67.7% female, ranged from 18 to 31, mean 24.18; 3.25) were included. Results: Initial analyses confirm that the scale is a valid and dependable instrument for Turkish culture. Construct validity, represented by the 18 items and four subscales, was confirmed through Confirmatory Factor Analysis (CFA) and criterion validity assessments. As well as the test-retest reliability of the scale was confirmed. Based on these findings, it was concluded that the scale is valid and reliable for use in Turkey. The model aligns well with empirical data, highlighting its strong construct validity and indicating good reliability of the scale. Conclusion: The Turkish version of the MSAS, developed to measure metacognition and its associated components, has proven to be a credible and reliable tool, especially in non-clinical settings.
Redefinition of EEG Frequency Bands: A Fractal Model Inspired by Blagg’s Titius-Bode Law
(Frontiers Media SA, 2026) Tarlaci, Sultan; Cinaroglu, Metin; Yilmazer, Eda; Ulker, Selami Varol
The canonical frequency bands used to categorize human electroencephalographic (EEG) activity-delta, theta, alpha, beta, and gamma-have historically been defined using pragmatic and variably applied thresholds rather than a unifying mathematical principle. In this theoretical study, we propose a geometric framework for redefining EEG frequency bands based on logarithmic scaling, drawing on the exponential formulation introduced in Mary Blagg's refinement of the Titius-Bode law. Using the mean adult alpha rhythm as a reference frequency and applying a constant scaling ratio (R = 1.7275), we derive a mathematically ordered hierarchy of EEG band centers and boundaries within a continuous log-spaced spectrum. Unlike descriptive models of spectral 1/f scaling, the present framework provides an explicit generative rule for discrete band centers and transition frequencies. The resulting segmentation produces band definitions numerically consistent with commonly reported EEG frequency ranges while offering a fully proportional, non-overlapping structure. The model further introduces principled subdivisions within the alpha and gamma ranges and redefines the beta-gamma transition using geometric rather than conventional criteria. As a descriptive quantitative observation, the model-derived theta-alpha transition (similar to 7.98 Hz) lies in numerical proximity to the Earth's fundamental Schumann resonance (similar to 7.83 Hz); this correspondence arises from the predefined geometric rule and does not imply causal interaction. Overall, the proposed framework reframes EEG band organization as a mathematically explicit, scale-invariant system and provides a hypothesis-generating basis for future empirical evaluation of oscillatory structure.