Double up! Examining the effects of adding inhibition training to food cue exposure in chocolate-loving female students.

In the present we study investigated whether addition of a Go/No Go training enhanced the effects of food cue exposure. We assessed desire to eat, salivation, CS-US expectancies, and eating in the absence of hunger (EAH) during and after cue exposure. Participants (N = 71) were chocolate-loving female students who tried to eat less chocolate in daily life. They received two sessions of either cue exposure with Go/No Go training (EXP + GNG), cue exposure with a sham training (EXP + shamGNG), or a control procedure with sham training (CON + shamGNG). Results showed that the exposure groups had higher desire to eat and higher levels of salivation during exposure compared to the control group during the control intervention, and that within session and between session habituation occurred in all conditions. In contrast to our hypotheses, lower levels of desire and salivation in the EXP + GNG compared to the EXP + shamGNG group at the end of exposure were not found. In addition, there was an overall decrease in CS-US expectancies with no group differences, and these beliefs were unrelated to EAH. Furthermore, groups did not differ on intake of either the exposed chocolate, non-exposed chocolate or other snack food items. It is concluded that a short Go/No Go training does not have an effect on two sessions of cue exposure treatment.

Validation of prospective portion size and latency to eat as measures of reactivity to snack foods.

In experimental studies that investigate reactivity to the sight and smell of highly palatable snack foods, ad libitum food intake is commonly used as a behavioural outcome measure. However, this measure has several drawbacks. The current study investigated two intake-related measures not yet validated for food cue exposure research involving common snack foods: prospective portion size and latency to eat. We aimed to validate these measures by assessing prospective portion size and eating latencies in female undergraduate students who either underwent snack food exposure or a control exposure. Furthermore, we correlated prospective portion size and latency to eat with commonly used measures of food cue reactivity, i.e., self-reported desire to eat, salivation, and ad libitum food intake. Results showed increases in prospective portion size after food cue exposure but not after control exposure. Latency to eat did not differ between the two conditions. Prospective portion size correlated positively with desire to eat and food intake, and negatively with latency to eat. Latency to eat was also negatively correlated with desire to eat and food intake. It is concluded that the current study provides initial evidence for the prospective portion size task as a valid measure of reactivity to snack foods in a Dutch female and mostly healthy weight student population.

The mediating role of dichotomous thinking and emotional eating in the relationship between depression and BMI.

Obesity and depression have important health implications. Although there is knowledge about the moderators of the depression-obesity association, our understanding of the potential behavioral and cognitive mediators that may explain the relationship between depression and obesity, is scarcely researched. The aim of this study is to investigate the mediating role of emotional eating and dichotomous thinking in the depression-obesity relationship. Data on 205 individuals from a community-based study conducted at Maastricht University, Netherlands were used. Self-reported data on depression, emotional eating and dichotomous thinking were collected and BMI scores were calculated in a cross-sectional research design. Correlations between variables were calculated. The primary analysis tested the hypothesis that depression has an effect on BMI through dichotomous thinking and emotional eating. A two-mediator model was used to predict the direct and indirect effects of emotional eating and dichotomous thinking on the depression-BMI relationship. Depression was positively correlated with BMI (r=0.21, p=0.005), emotional eating (r=0.38, p<0.001) and dichotomous thinking (r=0.49, p<0.001). Dichotomous thinking and emotional eating were positively correlated with BMI (r=0.35, p<0.001; and r=0.45, p<0.001 respectively). Both dichotomous thinking (Z=2.54, p=0.01, 95% confidence intervals=0.01-0.17) and emotional eating (Z=3.92 p<0.001, 95% confidence intervals=0.06-0.19) could explain the depression-BMI relationship. The assessment of emotional eating and dichotomous thinking might be useful in guiding assessment and treatment protocols for weight management. The present study adds to the existing literature on the role of dysfunctional cognitions and emotions on eating behavior, and particularly to the factors that may impede people's ability to control their eating.

Emotional eating and Pavlovian learning: evidence for conditioned appetitive responding to negative emotional states.

Appetitive learning has been demonstrated several times using neutral cues or contexts as a predictor of food intake and it has been shown that humans easily learn cued desires for foods. It has, however, never been studied whether internal cues are also capable of appetitive conditioning. In this study, we tested whether humans can learn cued eating desires to negative moods as conditioned stimuli (CS), thereby offering a potential explanation of emotional eating (EE). Female participants were randomly presented with 10 different stimuli eliciting either negative or neutral emotional states, with one of these states paired with eating chocolate. Expectancy to eat, desire to eat, salivation, and unpleasantness of experiencing negative emotions were assessed. After conditioning, participants were brought into a negative emotional state and were asked to choose between money and chocolate. Data showed differential conditioned responding on the expectancy and desire measures, but not on salivation. Specific conditioned effects were obtained for participants with a higher BMI (body mass index) on the choice task, and for participants high on EE on the unpleasantness ratings. These findings provide the first experimental evidence for the idea that negative emotions can act as conditioned stimuli, and might suggest that classical conditioning is involved in EE.

Emotional Eating Is Not What You Think It Is and Emotional Eating Scales Do Not Measure What You Think They Measure.

In eating research, it is common practice to group people into different eater types, such as emotional, external and restrained eaters. This categorization is generally based on scores on self-report questionnaires. However, recent studies have started to raise questions about the validity of such questionnaires. In the realm of emotional eating, a considerable number of studies, both in the lab and in naturalistic settings, fail to demonstrate increased food intake in emotional situations in self-described emotional eaters. The current paper provides a review of experimental and naturalistic studies investigating the relationships between self-reported emotional eater status, mood, and food consumption. It is concluded that emotional eating scales lack predictive and discriminative validity; they cannot be assumed to measure accurately what they intend to measure, namely increased food intake in response to negative emotions. The review is followed by a discussion of alternative interpretations of emotional eating scores that have been suggested in the past few years, i.e., concerned eating, uncontrolled eating, a tendency to attribute overeating to negative affect, and cue-reactive eating.

From lab to clinic: Extinction of cued cravings to reduce overeating.

Food cue reactivity is a strong motivation to eat, even in the absence of hunger. Therefore, food cue reactivity might sabotage healthy eating, induce weight gain and impede weight loss or weight maintenance. Food cue reactivity can be learned via Pavlovian appetitive conditioning: It is easily acquired but the extinction of appetitive responding seems to be more challenging. Several properties of extinction make it fragile: extinction does not erase the original learning and extinction is context-dependent. These properties threaten full extinction and increase the risk of full relapse. Extinction procedures are discussed to reduce or prevent the occurrence of rapid reacquisition, spontaneous recovery, renewal and reinstatement after extinction. A translation to food cue exposure treatment is made and suggestions are provided, such as conducting the exposure in relevant contexts, using occasional reinforcement and targeting expectancy violation instead of habituation. A new hypothesis proposed here is that the adding of inhibition training to strengthen inhibition skills that reduce instrumental responding, might be beneficial to improve food cue exposure effects.

'Emotional' does not even start to cover it: Generalization of overeating in emotional eaters.

Based on recent studies indicating that emotional eating is not the clearly defined problem it is often thought to be, the present study investigated whether emotional eaters overeat merely in response to negative emotional cues, or to other cues as well. It was hypothesized that emotional eaters would overeat after a variety of food cues, not limited to negative emotions. Participants took part in four conditions (negative mood manipulation, positive mood manipulation, food exposure and a control condition) divided over two sessions. Each condition was followed by a bogus taste test, after which food intake was measured. Results showed strong correlations between food intake after all four conditions, indicating that increased intake after one type of cue is related to increased intake after other cues. Participants were identified as emotional or non-emotional eaters based on food intake in the negative mood condition, and based on self-reported emotional eating scores. Both measures of emotional eating were significantly related to food intake after all cues. Based on the current findings, we conclude that individuals who show increased food intake when in a negative emotional state also overeat when experiencing other food-signalling cues. This indicates that 'emotional eating' may not fully capture the eating behaviour of individuals currently identified as 'emotional eaters'.

Emotional eating and Pavlovian learning: does negative mood facilitate appetitive conditioning?

OBJECTIVE: Emotional eating has been suggested to be a learned behaviour; more specifically, classical conditioning processes might be involved in its development. In the present study we investigated whether a negative mood facilitates appetitive conditioning and whether trait impulsivity influences this process. METHOD: After undergoing either a negative or neutral mood induction, participants were subjected to a differential classical conditioning procedure, using neutral stimuli and appetizing food. Two initially neutral distinctive vases with flowers were (CS+) or were not (CS-) paired with chocolate mousse intake. We measured participants' expectancy and desire to eat (4 CS+ and 4 CS- trials), salivation response, and actual food intake. The BIS-11 was administered to assess trait impulsivity. RESULTS: In both mood conditions, participants showed a classically conditioned appetite. Unexpectedly, there was no evidence of facilitated appetitive learning in a negative mood with regard to expectancy, desire, salivation, or intake. However, immediately before the taste test, participants in the negative mood condition reported a stronger desire to eat in the CS+ compared to the CS- condition, while no such effect occurred in the neutral group. An effect of impulsivity was found with regard to food intake in the neutral mood condition: high-impulsive participants consumed less food when presented with the CS+ compared to the CS-, and also less than low-impulsive participants. DISCUSSION: An alternative pathway to appetitive conditioning with regard to emotions is that it is not the neutral stimuli, but the emotions themselves that become conditioned stimuli and elicit appetitive responses.

Being impulsive and obese increases susceptibility to speeded detection of high-calorie foods.

OBJECTIVE: Overeating and obesity are associated with impulsivity. In studies among patients with a substance use disorder, impulsivity was found to be associated with substance-related attentional bias. This study examined whether obesity, impulsivity and food craving are associated with an attentional bias for high-calorie food. METHODS: Obese (n = 185, mean BMI = 38.18 ± 6.17) and matched healthy-weight (n = 134, mean BMI = 22.35 ± 1.63) men (27.9%) and women (72.1%), aged 18-45 years, took part in the study. Participants were tested on several self-report and behavioral measures of impulsivity (i.e., response inhibition and reward sensitivity) and self-reported trait craving. In addition, they performed a visual search task to measure attentional bias for high- and low-caloric foods. RESULTS: Self-reported impulsivity influenced the relationship between weight status and detection speed of high- and low-caloric food items: High-impulsive participants with obesity were significantly faster than high-impulsive healthy-weight participants in detecting a high-caloric food item among neutral items, whereas no such difference was observed among low-impulsive participants. No significant effects were found on low-caloric food items, for trait craving or any of the behavioral measures of impulsivity. CONCLUSION: Self-reported impulsivity, but not trait craving or behavioral measures of impulsivity, is associated with an attentional bias for high-caloric foods, but only in people with obesity. It is in particular the speedy detection of high-caloric foods in the environment that characterizes the impulsive person with obesity, which in turn may cause risky eating patterns in a society were high-caloric food is overly present.

Happy eating: the single target implicit association test predicts overeating after positive emotions.

For many years, questionnaires have been considered the standard when examining emotional eating behavior. However, recently, some controversy has arisen about these questionnaires, and their usefulness in identifying emotional eaters has been questioned. The current study aimed to investigate the Single Target Implicit Association Test (ST-IAT) as a measure of emotional eating. Two ST-IATs (assessing food-positive and food-negative associations respectively) and the Dutch Eating Behaviour Questionnaire (DEBQ) were compared in undergraduate students. A positive, negative or neutral mood was induced by means of a film clip, and milkshake consumption was measured during and after the mood induction. It was hypothesized that participants with strong emotion-food associations on the ST-IATs (i.e., IAT-emotional eaters) would consume more food in the emotion induction condition corresponding to that emotion, as compared to those with weak emotion-food associations as well as to those in the neutral condition. Participants who scored high on both the positive and negative ST-IATs ate more during a positive mood induction than during a negative mood induction. This effect did not extend to milkshake consumption after the mood induction procedure. In addition, IAT-positive emotional eaters consumed more food than IAT-non-emotional eaters. No effects of the DEBQ on milkshake consumption were found. It is concluded that the ST-IAT has potential as a measure of emotional eating.

Happy eating: the underestimated role of overeating in a positive mood.

Emotional eaters are often presumed to eat in response to negative emotions, while positive emotions have been largely neglected. The current study induced a positive, negative, or neutral mood in a student sample and subsequently measured food intake. In addition, the relation between caloric intake and mood improvement was assessed. It was expected that emotional eaters would consume more food than non-emotional eaters in the emotional conditions, and also more than in the neutral condition. Moderated regression analyses indeed showed a significant increase in food intake for emotional eaters in the positive compared to the neutral condition, and a trend towards higher food consumption than non-emotional eaters. No effects were found in the negative condition. With regard to mood changes during food intake, Pearson correlations demonstrated an association between amount of calories consumed and mood improvement after 5min of food consumption. However, there was no evidence for differences between emotional and non-emotional eaters. The current findings underline the importance of positive emotions in emotional eating, and provide new insights on the relationship between eating and mood melioration.

Higher levels of trait impulsiveness and a less effective response inhibition are linked to more intense cue-elicited craving for alcohol in alcohol-dependent patients.

RATIONALE: Cue-elicited craving is a well-researched phenomenon in alcohol literature. However, not all alcohol-dependent people display the same reactivity to alcohol cues. Personality factors such as multiple impulsivity traits may be responsible for individual differences in cue reactivity by modulating its intensity. Nevertheless, there has been a scarcity of empirical studies testing this assumption in alcohol literature. OBJECTIVES: The aim of the present study was to investigate the effects of response inhibition and trait impulsiveness on cue-elicited craving for alcohol in alcohol-dependent drinkers. METHODS: Participants (n = 41) were inpatients of the private clinic U-Center, Netherlands. Alcohol exposure took place in a real bar-restaurant close to the premises of the clinic, and participants were exposed to real alcohol cues. Response inhibition was assessed with the stop-signal task and trait impulsiveness with the Barratt impulsivity scale version 11. RESULTS: The cue exposure was successful as alcohol-dependent patients experienced higher craving for alcohol when exposed to alcohol rather than to neutral cues. Additionally, both response inhibition and trait impulsiveness predicted cue-elicited craving for alcohol. Trait impulsiveness predicted both the absolute craving in the bar-restaurant and the increase in cue-elicited craving during the whole alcohol cue exposure, while response inhibition predicted only the former. CONCLUSIONS: The results clearly implicate both trait impulsiveness and response inhibition in the modulation of cue-elicited craving in alcohol dependence. Theoretical and methodological issues in the findings and their clinical implications in alcohol treatment and relapse are discussed.

The proof of the pudding is in the eating: is the DEBQ-external eating scale a valid measure of external eating?

OBJECTIVE: To test the construct validity and discriminative validity of the widely used Dutch Eating Behavior Questionnaire's (DEBQ) External Eating (EE) subscale. METHOD: After being exposed to food cues or not participants completed a bogus taste test. Subjective cue reactivity during food exposure and actual food intake after food exposure were measured. RESULTS: EE scores were unrelated to food intake. A robust main effect of food cue exposure was found but contrary to what was predicted, low EE scorers ate more after food cue exposure than without whereas high EE scorers did not. The actual eating behavior of high and low scorers on the other DEBQ subscales - emotional and restrained eating - demonstrated that the EE also lacks discriminative validity. DISCUSSION: The EE showed no predictive validity and no discriminative validity. The usefulness of the distinction of different types of concerned eaters is questioned.