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Contains fulltext : 228160.pdf (Publisher’s version ) (Open Access) Binge eating disorder (BED) and bulimia nervosa (BN) are characterized by binge eating. Frequently related to negative affect, binge eating is considered unwanted eating behavior. It is often preceded by a shift away from the goal of a healthy eating pattern. Implementation intentions are 'if-then' plans that may prevent such shifts in goals. In a students' sample with subthreshold binge eating, two implementation intention conditions were compared to a control condition in which only goals were formed. In the behavior-focused condition, implementation intentions targeted binge eating; in the emotion-focused condition, implementation intentions targeted negative affect preceding binge eating. All participants received three sessions and kept food diaries for four weeks, followed by a post-test and a one-month, three-months, and six-months follow-up. Compared to the control condition, both implementation intention conditions showed significant and large reductions in binge eating lasting for six months. Effects did not differ between both implementation intention conditions. Three implementation intention sessions reduced subthreshold binge eating. This continued for six months after the final session. Contrary to expectations, behavior-focused and emotion-focused implementation intentions were equally effective, possibly due to other triggers than negative affect. Future research should address their usefulness in BED and BN. 15 p.

Background Clinical guidelines suggest that psychological interventions specifically aimed at reducing suicidality may be beneficial. We examined the impact of two depression treatments, cognitive therapy (CT) and interpersonal psychotherapy (IPT) on suicidal ideation (SI) and explored the temporal associations between depression and SI over the course of therapy.Methods Ninety-one adult (18-65) depressed outpatients from a large randomized controlled trial who were treated with CT (n = 37) and IPT (n = 54) and scored at least >= 1 on the Beck Depression Inventory II (BDI-II) suicide item were included. Linear (two-level) mixed effects models were used to evaluate the impact of depression treatments on SI. Mixed-effects time-lagged models were applied to examine temporal relations between the change in depressive symptoms and the change in SI.Results SI decreased significantly during treatment and there were no differential effects between the two intervention groups (B = -0.007, p = .35). Depressive symptoms at the previous session did not predict higher levels of SI at the current session (B = 0.016, p = .16). However, SI measured at the previous session significantly predicted depressive symptoms at the current session (B = 2.06, p < .001).Conclusions Both depression treatments seemed to have a direct association with SI. The temporal association between SI and depression was unidirectional with SI predicting future depressive symptoms during treatment. Our findings suggest that it may be most beneficial to treat SI first.

Objective: Optimizing treatment selection may improve treatment outcomes in depression. A promising approach is the Personalized Advantage Index (PAI), which predicts the optimal treatment for a given individual. To determine the generalizability of the PAI, models needs to be externally validated, which has rarely been done. Method: PAI models were developed within each of two independent trials, with substantial between-study differences, that both compared CBT and IPT for depression (STEPd: n = 151 and FreqMech: n = 200). Subsequently, both PAI models were tested in the other dataset. Results: In the STEPd study, post-treatment depression was significantly different between individuals assigned to their PAI-indicated treatment versus those assigned to their non-indicated treatment (d = .57). In the FreqMech study, post-treatment depression was not significantly different between patients receiving their indicated treatment versus those receiving their non-indicated treatment (d = .20). Cross-trial predictions indicated that post-treatment depression was not significantly different between those receiving their indicated treatment and those receiving their non-indicated treatment (d = .16 and d = .27). Sensitivity analyses indicated that cross-trial prediction based on only overlapping variables didn't improve the results. Conclusion: External validation of the PAI has modest results and emphasizes between-study differences and many other challenges.

BackgroundPsychotherapies for depression are equally effective on average, but individual responses vary widely. Outcomes can be improved by optimizing treatment selection using multivariate prediction models. A promising approach is the Personalized Advantage Index (PAI) that predicts the optimal treatment for a given individual and the magnitude of the advantage. The current study aimed to extend the PAI to long-term depression outcomes after acute-phase psychotherapy.MethodsData come from a randomized trial comparing cognitive therapy (CT, n = 76) and interpersonal psychotherapy (IPT, n = 75) for major depressive disorder (MDD). Primary outcome was depression severity, as assessed by the BDI-II, during 17-month follow-up. First, predictors and moderators were selected from 38 pre-treatment variables using a two-step machine learning approach. Second, predictors and moderators were combined into a final model, from which PAI predictions were computed with cross-validation. Long-term PAI predictions were then compared to actual follow-up outcomes and post-treatment PAI predictions.ResultsOne predictor (parental alcohol abuse) and two moderators (recent life events; childhood maltreatment) were identified. Individuals assigned to their PAI-indicated treatment had lower follow-up depression severity compared to those assigned to their PAI-non-indicated treatment. This difference was significant in two subsets of the overall sample: those whose PAI score was in the upper 60%, and those whose PAI indicated CT, irrespective of magnitude. Long-term predictions did not overlap substantially with predictions for acute benefit.ConclusionsIf replicated, long-term PAI predictions could enhance precision medicine by selecting the optimal treatment for a given depressed individual over the long term.

There is an established relationship between acceptance of cosmetic surgery and psychological factors, including body image. However, qualitative research among diverse cultural groups is needed to provide a more fine-grained understanding of the influences on women's attitudes towards cosmetic surgery. In this study, 20 Chinese and 20 Dutch women aged 18-50 years (MChinese = 34.20; MDutch = 34.70) participated in one-on-one semi-structured interviews. Data were analyzed using reflexive thematic analysis. We identified three themes that captured the factors that women perceived to foster favorable attitudes towards cosmetic surgery: (a) sociocultural pressures (e.g., normalization of cosmetic surgery, appearance-focused peers); (b) intrapersonal characteristics (e.g., beauty-ideal internalization, social comparison); and (c) benefits of beauty (e.g., attracting men, socioeconomic benefits). Conversely, two themes captured the factors perceived to reduce favorable attitudes towards cosmetic surgery: (a) intrapersonal characteristics (e.g., unconditional body acceptance, self-confidence); and (b) external considerations (e.g., health risks, financial costs). Overall, Chinese and Dutch participants shared many similarities in their opinions about what might affect cosmetic surgery consideration. The most striking cross-cultural differences concerned perceived socioeconomic benefits of beauty (mainly Chinese women) and women's conceptualization of body appreciation. This study may enable a more comprehensive understanding about the factors influencing Chinese and Dutch women's attitudes towards cosmetic surgery, and the nuances in these relationships across these cultures.

The hippocampus and dorsal striatum are both associated with temporal processing, but they are thought to play distinct roles. The hippocampus has been reported to contribute to storing temporal structure of events in memory, whereas the striatum contributes to temporal motor preparation and reward anticipation. Here, we asked whether the striatum cooperates with the hippocampus in processing the temporal context of memorized visual associations. In our task, participants were trained to implicitly form temporal expectations for one of two possible time intervals associated to specific cue-target associations, and subsequently were scanned using 7T functional magnetic resonance imaging. During scanning, learned temporal expectations could be violated when the pairs were presented at either the learned or not-learned time intervals. When temporal expectations were not met during testing trials, activity in hippocampal subfields CA3/CA2 and CA1 decreased while right putamen activity increased, compared to when temporal expectations were met. Further, psycho-physiological interactions showed that functional connectivity between left CA1 and caudate, as well as between putamen and caudate, decreased when temporal expectations were not met. Our results indicate that the hippocampus and striatum cooperate to process implicit temporal expectation from mnemonic associations, with different but complementary contributions from caudate and putamen. Our findings provide further support for a hippocampal-striatal network in temporal associative processing.

Objective\ud \ud The coronavirus pandemic has led to a dramatically different way of working for many therapists working with eating disorders, where telehealth has suddenly become the norm. However, many clinicians feel ill equipped to deliver therapy via telehealth, while adhering to evidence‐based interventions. This article draws together clinician experiences of the issues that should be attended to, and how to address them within a telehealth framework.\ud \ud \ud \ud Method\ud \ud Seventy clinical colleagues of the authors were emailed and invited to share their concerns online about how to deliver cognitive‐behavioral therapy for eating disorders (CBT‐ED) via telehealth, and how to adapt clinical practice to deal with the problems that they and others had encountered. After 96 hr, all the suggestions that had been shared by 22 clinicians were collated to provide timely advice for other clinicians.\ud \ud \ud \ud Results\ud \ud A range of themes emerged from the online discussion. A large proportion were general clinical and practical domains (patient and therapist concerns about telehealth; technical issues in implementing telehealth; changes in the environment), but there were also specific considerations and clinical recommendations about the delivery of CBT‐ED methods.\ud \ud \ud \ud Discussion\ud \ud Through interaction and sharing of ideas, clinicians across the world produced a substantial number of recommendations about how to use telehealth to work with people with eating disorders while remaining on track with evidence‐based practice. These are shared to assist clinicians over the period of changed practice.

Anorexia nervosa (AN) is a life‐threatening eating disorder, characterised by persistent pathological weight loss behaviours and an intense fear of weight gain and food consumption. Although there is an abundance of scientific theories on the neurobiological, psychological and sociocultural factors thought to be involved in the maintenance of AN, there is little experimental research testing these ideas. The need for theory firmly grounded in empirical evidence becomes strikingly clear when we consider that current treatments for patients with AN are limited in their effectiveness, and relapse after treatment is common.

This paper describes a Chinese translation and validation of the Acceptance of Cosmetic Surgery Scale (ACSS; Henderson-King & Henderson-King, 2005), a questionnaire for assessing attitudes towards cosmetic surgery. Chinese adults (335 women, 240 men; Mage = 33.65) completed the Chinese ACSS and - to investigate construct validity - measures of body appreciation, facial appearance concerns, sociocultural attitudes towards appearance (i.e., internalization of appearance ideals and appearance pressures), and demographics. Exploratory factor analysis revealed that the Chinese ACSS comprised two factors, which were invariant across sex, mirroring results among other non-Western samples. The Chinese ACSS also demonstrated good internal consistency (Cronbach's alphas > .90) and convergent validity via its positive associations with facial appearance concerns and overall sociocultural attitudes toward appearance. Chinese ACSS scores were higher among women, and were positively correlated with age among men. Chinese ACSS scores were not associated with body appreciation or other demographic factors. The ACSS seems to be a valid instrument for use in Chinese adults, and could bring more insight into attitudes toward cosmetic surgery from a cross-cultural perspective.

Contains fulltext : 241320.pdf (Publisher’s version ) (Closed access) Objective: One of the prevailing theories of eating disorders (ED) is the transdiagnostic cognitive behavioural theory of eating disorders, which suggests that certain ED symptoms, such as over-valuation of eating, shape, and weight, may be more central than others. In the present study, network analyses were used to evaluate these assumptions in a patient sample. Methods: Participants were 336 individuals receiving treatment at an expert center for ED in the Netherlands. Eating disorder symptoms were used to create transdiagnostic and diagnosis-specific networks and assess symptom centrality and density of the networks. Results: Networks for patients with bulimia nervosa and binge eating disorder confirmed that over-valuation of shape, weight, and eating is the most central symptom in the network. A transdiagnostic network of ED symptoms and separate networks for patients with anorexia nervosa and bulimia nervosa showed that strict dieting was an additional central ED symptom. An exploratory analysis revealed that, although eating disorder symptoms decreased, there were no differences in density of the eating disorder networks before and after treatment with cognitive behavioural therapy. Discussion: In conclusion, the current study confirmed that over-valuation of shape, weight, and eating is a central symptom across eating disorders, in agreement with the transdiagnostic cognitive behavioural model of eating disorders. Specifically targeting this symptom in treatment could lead to other symptoms improving as a result. 8 p.

Nearly 70% of Americans are overweight, in large part because of overconsumption of high-calorie foods such as sweets. Reducing sweets is difficult because powerful drives toward reward overwhelm inhibitory control (i.e., the ability to withhold a prepotent response) capacities. Computerized inhibitory control trainings (ICTs) have shown positive outcomes, but impact on real-world health behavior has been variable, potentially because of limitations inherent in existing paradigms, e.g., low in frequency, intrinsic enjoyment, personalization, and ability to adapt to increasing ability. The present study aimed to assess the feasibility, acceptability, and efficacy of a gamified and non-gamified, daily, personalized, and adaptive ICT designed to facilitate weight loss by targeting consumption of sweets. Participants (N=106) were randomized to one of four conditions in a 2 (Gamified versus Non-Gamified) by 2 (ICT versus Sham) factorial design. Participants were prescribed a no-added-sugar diet and completed 42 daily, at-home trainings, followed by two weekly booster trainings. Results indicated that the ICTs were feasible and acceptable. Surprisingly, compliance to the 44 trainings was excellent (88.8%) and equivalent across both gamified and non-gamified conditions. As hypothesized, the impact of ICT on weight loss was moderated by implicit preference for sweet foods (F(1,95)=6.17, p=.02) such that only those with higher-than-average implicit preference benefited (8-week weight losses for ICT were 3.1% versus 2.2% for Sham). A marginally significant effect was observed for gamification to reduce the impact of ICT. Implications of findings for continued development of ICTs to impact health behavior are discussed.

Fruit and vegetable consumption is worldwide too low, resulting in poor diet quality and health-related problems. A cognitive factor that might contribute to this low consumption is confirmation bias. Confirmation bias has been established in anxiety research and comprises the tendency to search for reinforcing negative information, while ignoring counter attitudinal information. If applicable to food, asking for negative food information reinforces the negative attitude and decreases the willingness to try (novel) food. The aim of the current study was twofold. First, to examine if confirmation bias translates to food stimuli. Second, to investigate if this bias is exaggerated in persons with higher levels of food neophobia. To this end, 117 participants (age M = 21.45, SD = 4.48) carried out an online study. They filled in the food neophobia scale (FNS) and performed a search for additional information scale (SAIS) task. Four novel fruits were used, two looking tasteful (pomelo and rose apple) and two looking non-tasteful (black sapote and noni fruit). Participants rated their willingness to eat these fruits and subsequently could indicate how eager they were to receive positive or negative information regarding that fruit. The results indicated that the participants were more willing to try the tasteful looking fruits than the non-tasteful. Additionally, higher levels of food neophobia coincided with less willingness to eat all fruits. Confirmation bias was observed, more negative information was requested for the non-tasteful than for the tasteful fruits. This bias was not related to levels of food neophobia. These results are important as confirmation bias might make people even more negative towards novel foods and could contribute to even less fruit and vegetable consumption, especially when they look less appetizing.

Background Cognitive impairment is highly prevalent in COPD and is associated with a sedentary lifestyle, unhealthy diet and increased cognitive stress susceptibility. Enhancement of cognitive performance by working memory training (WMT) may reverse these effects. Therefore, this study aimed to investigate the efficacy of WMT in COPD on cognitive performance, healthy lifestyle behaviours and cognitive stress susceptibility. Methods The double-blind randomised, placebo-controlled Cogtrain trial consisted of a 12-week training phase comprising 30 active or sham WMT sessions, followed by a second 12-week maintenance phase with 12 sessions. Measurements took place at baseline and after the first and second phases. The primary outcome was cognitive performance. Secondary outcomes were the recall of prespecified healthy lifestyle goals, physical capacity and activity, dietary quality and cognitive stress susceptibility. Motivation towards exercising and healthy eating and psychological wellbeing were exploratory outcomes. Results Sixty-four patients with moderate COPD (45% male, aged 66.2±7.2 years, median forced expiratory volume in 1 s 60.6% predicted) were randomised. WMT significantly increased patients’ performance on the trained tasks in the first phase, which remained stable in the second phase. Of the 17 cognitive outcome measures, only one measure of memory improved after the first phase and one measure of reaction time after the second phase. This intervention did not influence physical capacity and activity, recall of prespecified healthy lifestyle goals, psychological wellbeing or cognitive stress susceptibility. Conclusion WMT improved performance on the trained tasks but not overall cognitive performance, healthy lifestyle behaviours or cognitive stress susceptibility in patients with COPD., Working memory training improves performance on the trained tasks but not overall cognitive performance, healthy lifestyle behaviours or cognitive stress susceptibility in patients with COPD https://bit.ly/3ErjIx2

Serotonin is an important neuromodulator involved in many physiological processes including mood and satiety. In the brain, serotonin is manufactured from tryptophan, as serotonin itself cannot cross the blood–brain barrier. Previous research has shown that blood-tryptophan levels increase upon ingestion of carbohydrates and decrease upon protein consumption. How this translates into serotonin availability is as yet under-researched. Therefore, we examined the effect of fasting versus consuming carbohydrates or protein on central serotonergic activity using a repeated-measures crossover design in a sample of 37 healthy men. The loudness dependence of auditory-evoked potentials (LDAEP) serves as a noninvasive method to study central serotonergic activity. Blood-glucose levels and mood changes were also monitored before and after the nutritional intervention. The intervention had a significant nutrition-specific effect on LDAEP and blood-glucose levels. A significant difference emerged between the fasting condition and satiety, with LDAEP being lower during satiety, irrespective of the type of food. Thus, this indicator of serotonergic activity increased after food consumption, which was further related to mood improvement. Moreover, the LDAEP differed between the 2 measurements only for the carbohydrate testing day, suggesting that LDAEP can be selectively modulated by the type of nutrition consumed. Our data further indicate a high intraindividual stability of LDAEP, as the electrophysiological signals were very similar in the fasting condition across the 2 testing days. Together, these findings demonstrate that the LDAEP can serve as a biological marker for central serotonergic activity, while at the same time being sensitive to nutritional changes.

© 2021 Association for the Advancement of Psychotherapy Inc.. All rights reserved.Objective: Patient choice is recognized as a factor that influences clinical outcomes and treatment evaluation in mental health care. However, research on how having a choice affects patients with depression has been rare. This Dutch study examined whether patients randomly selected to choose between two types of depression psychotherapy benefited more from treatment than patients randomly assigned to an intervention. Methods: Data were derived from a trial of outpatients with depression who were randomly assigned to cognitive therapy (CT), interpersonal psychotherapy (IPT), or a 2-month waitlist control condition followed by the patient's choice of CT or IPT. Treatment groups were combined into a no-choice condition (N5151), with the waitlist as the choice condition (N531). Multilevel regression was used to compare depression severity (measured with the Beck Depression Inventory-II [BDI-II]) and general psychological distress (measured with the Brief Symptom Inventory [BSI]) posttreatment and at the 5-month followup. Differences in patients' pretreatment expectations, beliefs about treatment credibility, and posttreatment evaluation were examined. Results: No significant differences in clinical outcomes were found between the choice and no-choice conditions (mean difference: BDI-II posttreatment5-0.55, 95% confidence interval [CI]5-5.25 to 4.15; follow-up52.10, 95% CI5-4.01 to 8.20; BSI posttreatment5-1.89, 95% CI5-15.35 to 11.58; follow-up53.13, 95% CI5-12.32 to 18.57). Patients in both groups reported comparable scores on pretreatment expectations, credibility beliefs, and posttreatment evaluation. Neither expectations nor credibility beliefs were predictive of clinical outcomes. Conclusions: Our findings did not support the value of patient choice. Considering the exploratory nature of the trial, future studies designed to examine the effects of choice in depression treatment are recommended.

BACKGROUND: The present study examined food cravings in daily life by comparing overweight and normal-weight participants right before eating events and at non-eating moments. It was hypothesised that overweight participants would have (i) more frequent, (ii) stronger and (iii) a greater variety of high-caloric palatable food cravings, and also would (iv) consume more high-caloric palatable foods, than normal-weight participants.METHODS: Ecological momentary assessment (EMA) was used to assess food craving strength and frequency, variety of specific food cravings, and food intake. Fifty-seven overweight and 43 normal-weight adult participants were assessed at eating events and at an average of eight random non-eating moments per day for 2 weeks. Foods were categorised as: high-caloric high palatable foods (HCHP), fruits and salads, staple food dishes and sandwiches, and soups and yoghurts.RESULTS: Overweight participants reported more frequent HCHP food cravings specifically at non-eating moments than did normal-weight participants. Normal-weight participants reported more food cravings for staple foods, specifically at eating events. Moreover, overweight participants craved a greater variety of HCHP foods than normal-weight participants at both eating events and random non-eating moments. No other significant between-group differences were found.CONCLUSIONS: The results highlight the importance for obesity interventions (i) to specifically target high-caloric palatable food cravings that are experienced during the day and are not tied to eating moments and (ii) to aim for a reduction in the variety of high-caloric palatable food cravings. It might be fruitful to deliver treatment aimed at reducing cravings via mobile devices because this allows for easy individual tailoring and timing of interventions.

In this study, it was examined whether overweight is associated with food-related obsessions and compulsions. Participants with a healthy weight ( n = 27) and participants who were overweight ( n = 33) filled out the Yale-Brown-Cornell Eating Disorder Scale, the Eating Obsessive-Compulsive Scale, and the Emotional and Behavioral Reactions to Intrusions Questionnaire to assess frequency, distress, control, and reactance associated with food-related preoccupations and compulsions. Overweight participants showed increased food-related preoccupations, compulsive eating, and heightened emotional and behavioral reactance compared to participants with a healthy weight. Increased food-related obsessive-compulsiveness was also associated with unhealthy eating patterns.

This study assessed internal reliability and test-retest reliability of attention bias scores for food derived from the dot probe task. A visual dot probe task with food and non-food pictures (presented for 3000 ms) was administered to 53 healthy women on two occasions. Attention bias scores for food were calculated based on manual response latencies (reaction time bias) and concurrent assessment of eye-movements (direction bias and dwell-time bias). Subjective hunger and blood glucose levels were measured on both testing occasions. Dietary restraint and eating disorder symptoms were assessed during the second session. Results showed that direction bias had poor internal and test-retest reliability. Dwell time bias had excellent internal and acceptable test-retest reliability. Reaction time bias had acceptable internal and good test-retest reliability. Exploratory correlational analyses found that hunger, blood glucose, dietary restraint and eating disorder symptoms were not consistently significantly correlated with indices of attention bias for food. Overall, these findings contradict previous studies that reported low reliability of attention bias indices derived from the visual dot probe task. The implications are that a longer stimulus presentation time (i.e. ≥ 3000 ms), the use of eye-tracking and the use of appetizing stimuli can yield reliable attention bias scores for food. However, the interpretation of dot-probe scores of attention bias for food based on a dot probe task with 3000 ms presentation time and the score's relationship to theoretically relevant constructs such as hunger, eating restraint and eating disorder symptoms, require further clarification.

BackgroundAlthough equally efficacious in the acute phase, it is not known how cognitive therapy (CT) and interpersonal psychotherapy (IPT) for major depressive disorder (MDD) compare in the long run. This study examined the long-term outcomes of CT v. IPT for MDD.MethodsOne hundred thirty-four adult (18–65) depressed outpatients who were treated with CT (n = 69) or IPT (n = 65) in a large open-label randomized controlled trial (parallel group design; computer-generated block randomization) were monitored across a 17-month follow-up phase. Mixed regression was used to determine the course of self-reported depressive symptom severity (Beck Depression Inventory II; BDI-II) after treatment termination, and to test whether CT and IPT differed throughout the follow-up phase. Analyses were conducted for the total sample (n = 134) and for the subsample of treatment responders (n = 85). Furthermore, for treatment responders, rates of relapse and sustained response were examined for self-reported (BDI-II) and clinician-rated (Longitudinal Interval Follow-up Evaluation; LIFE) depression using Cox regression.ResultsOn average, the symptom reduction achieved during the 7-month treatment phase was maintained across follow-up (7–24 months) for CT and IPT, both in the total sample and in the responder sample. Two-thirds (67%) of the treatment responders did not relapse across the follow-up period on the BDI-II. Relapse rates assessed with the LIFE were somewhat lower. No differential effects between conditions were found.ConclusionsPatients who responded to IPT were no more likely to relapse following treatment termination than patients who responded to CT. Given that CT appears to have a prophylactic effect following successful treatment, our findings suggest that IPT might have a prophylactic effect as well.

BACKGROUND: Insufficient weight loss and weight regain is seen in 20-30% of the post-bariatric population. More knowledge about the effect of physical activity and eating style on weight change after Roux-en-Y gastric bypass is essential since behaviour can be modified and thereby results improved. The goal of this study is to determine the relationship between weight change, self-reported physical activity and eating style.METHODS: Weight, physical activity (PA) and eating style (ES) were assessed before surgery and 15, 24, 36 and 48 months after surgery. A linear mixed model was performed to assess the association between the change in PA and ES and percentage total weight loss (% TWL).RESULTS: There were 4569 patients included. Preoperative PA and ES were not related to weight change. Change in PA was positively associated with % TWL at 15, 36 and 48 months follow-up. Change in emotional eating was negatively related to % TWL at all follow-up moments. Change in external eating was only negatively related to weight loss at 24 months follow-up. Change in restrained eating was negatively associated with weight loss up to 36 months follow-up. More restrained eating at 36 months follow-up was related to higher weight regain, and more emotional eating at 48 months to 48-month weight regain.CONCLUSION: Preoperative self-reported PA and ES did not predict weight change after RYGB. Being are more physically active and showing less emotional and restrained eating was related to a higher weight loss. Emotional and restrained eating were related to higher weight regain.

The aim was to investigate whether a computer-based evaluative conditioning intervention improves body image in adolescents with an eating disorder. Positive effects were found in earlier studies in healthy female students in a laboratory and a field setting. This study is the first to test evaluative conditioning in a clinical sample under less controlled circumstances.Fifty-one adolescent girls with an eating disorder and a healthy weight were randomly assigned to an experimental condition or a placebo-control condition. The computerized intervention consisted of six online training sessions of 5 min, in which participants had to click on pictures of their own and other people's bodies. Their own pictures were systematically followed by portraits of friendly smiling faces. In the control condition, participants were shown the same stimuli, but here, a stimulus was always followed by another stimulus from the same category, so that own body was not paired with smiling faces. Before, directly after, three weeks after, and 11 weeks after the intervention, self-report measures of body image and general self-esteem were administered. Automatic self-associations were also measured with an Implicit Association Test.In contrast to our hypotheses, we did not find an effect of the intervention on self-report questionnaires measuring body satisfaction, weight and shape concern, and general self-esteem. In addition, the intervention did not show positive effects on implicit associations regarding self-attractiveness.These findings do not support the use of evaluative conditioning in its present form as an intervention for adolescents in clinical practice. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

It is often believed that attentional bias (AB) for food is a stable trait of certain groups, like restrained eaters. However, empirical evidence from this domain is inconsistent. High-calorie foods are double-faceted, as they are both a source of reward and of weight/health concern. Their meaning might depend on the food-related context (i.e., focus on health or on enjoyment), which in turn could affect AB for food. This study primed 85 females with hedonic, healthy, and neutral contexts successively and examined whether food-related context affected AB for food and if effects were moderated by dietary restraint. Both the mean tendencies of AB for food and variability of AB for food were assessed in a food dot-probe task with a recording of both reaction times and eye movements. Contrary to our hypotheses, AB for food was not significantly affected by either context or the interaction between context and dietary restraint. Instead, liking of the presented food stimuli was related to longer initial fixations and longer dwell time on the food stimuli. In addition, in line with prior research, body mass index (BMI) was correlated with variability of AB for food instead of mean AB for food. In conclusion, this study did not find any support that AB for food is dependent on food-related context, but interestingly, reaction time-based variability of AB for food seems to relate to BMI, and eye movement-based mean AB seems to relate to appetitive motivation.

Objective Weight stigma is prevalent across multiple life domains, and negatively affects both psychological and physical health. Yet, research into weight stigma reduction techniques is limited, and rarely results in reduced antipathy toward higher-weight individuals. The current pre-registered study investigated a novel weight stigma reduction intervention. We tested whether a writing exercise focusing on body functionality (i.e., everything the body can do, rather than how it looks) of another person leads to reductions in weight stigma. Method Participants were 98 women (Mage = 23.17, Range = 16–63) who viewed a photograph of a higher-weight woman, “Anne,” and were randomised to complete a writing exercise either describing what “Anne’s” body could do (experimental group) or describing her home (active control group). Facets of weight stigma were assessed at pretest and posttest. Results At posttest, the experimental group evidenced higher fat acceptance and social closeness to “Anne” compared with the active control group. However, no group differences were found in attribution complexity, responsibility, and likeability of “Anne”. Conclusions A brief body functionality intervention effectively reduced some, but not all, facets of weight stigma in women. This study provides evidence that functionality-focused interventions may hold promise as a means to reduce weight stigma.

Background: The frequency and clinical impact of Sudden Gains—large symptom improvements during a single between-session interval—in psychotherapy for depression have been well established. However, there have been relatively few efforts to identify the processes that lead to sudden gains.Aim: To explore therapy processes associated with sudden gains in cognitive therapy for depression by examining changes in the sessions surrounding the gains, and the session preceding the gain in particular.Methods: Using ratings of video-recordings (n = 36), we assessed the content, frequency and magnitude of within-session cognitive-, behavioral-, and interpersonal change, as well as the quality of the therapeutic alliance in the session prior to the gain (pre-gain session), the session after the gain (post-gain session) and a control session. After that, we contrasted scores in the pre-gain session with those in the control session. In addition, we examined changes that occurred between the pre- and post-gain session (between-session changes) and explored patients' attributions of change.Results: Although not statistically significant, within-session changes were more frequent and stronger in the pre-gain session compared to the control session. The largest difference between the pre-gain and control session was found in the behavioral domain, and reached the level of trend-significance. There were more, and more impactful between-session changes in the interval during which the gain occurred as compared to a control interval. Exploratory analysis of attributions of change revealed eight subcategories, all corresponding with the cognitive-, behavioral- and interpersonal- domain. The quality of the therapeutic alliance was high and almost identical in all sessions.Conclusion: In spite of its small sample size, our study provides relevant descriptive information about potential precipitants of, themes related to, and attributions given for sudden gains. Furthermore, our study provides clear suggestions for future research. A better understanding of session content in the sessions surrounding sudden gains may provide insight into the mechanisms of change in psychotherapy, hereby suggesting treatment-enhancing strategies. We encourage researchers to conduct research that could clarify the nature of these mechanisms, and believe the methods used in this study could serve as a framework for further work in this area.

Background: Although depression and personality disorders (PDs) often co-occur, less is known about the impact of PDs on health-related quality of life (HRQOL) in patients with depression. This study explores the differences in HRQOL of depressed patients with and without PD.Methods: Baseline data of 397 patients with depression from two randomised controlled trials were used for this analysis. HRQOL was measured with the EuroQol-5D (EQ-5D). Differences were examined between three groups: patients with 1) depression-only, 2) depression and comorbid PD and 3) PD and comorbid depression. The EQ-5D scores of the groups were compared with linear regression.Results: HRQOL scores were lower in the depression-only group than the depression + PD group, even though depression severity was higher in patients with PD. HRQOL in the PD +/- depression group did not differ from the other groups. In addition, no associations were found between the type or severity of PD and HRQOL. Discussion: These findings could indicate that patients with PD are less affected by the impact of depression on HRQOL. In addition, the EQ-5D might not adequately capture the impact of PD on quality of life. Further research is needed to compare the EQ-5D with quality of life instruments that include more life domains.Limitations: Two study samples are combined, and therefore not designed to compare the three groups directly. Generalisation of the results should be done with caution.Conclusion: Depressed patients with PD report higher HRQOL than depression-only patients. Although higher HRQOL, patients with PD report more severe depressions than depressed-only patients.

BACKGROUND: Optimizing treatment selection is a way to enhance treatment success in major depressive disorder (MDD). In clinical practice, treatment selection heavily depends on clinical judgment. However, research has consistently shown that statistical prediction is as accurate - or more accurate - than predictions based on clinical judgment. In the context of new technological developments, the current aim was to compare the accuracy of clinical judgment versus statistical predictions in selecting cognitive therapy (CT) or interpersonal psychotherapy (IPT) for MDD.METHODS: Data came from a randomized trial comparing CT (n=76) with IPT (n=75) for MDD. Prior to randomization, therapists' recommendations were formulated during multidisciplinary staff meetings. Statistical predictions were based on Personalized Advantage Index models. Primary outcomes were post-treatment and 17-month follow-up depression severity. Secondary outcome was treatment dropout.RESULTS: Individuals receiving treatment according to their statistical prediction were less depressed at post-treatment and follow-up compared to those receiving their predicted non-indicated treatment. This difference was not found for recommended versus non-recommended treatments based on clinical judgment. Moreover, for individuals with an IPT recommendation by therapists, higher post-treatment and follow-up depression severity was found for those that actually received IPT compared to those that received CT. Recommendations based on statistical prediction and clinical judgment were not associated with differences in treatment dropout.LIMITATIONS: Information on the clinical reasoning behind therapist recommendations was not collected, and statistical predictions were not externally validated.CONCLUSIONS: Statistical prediction outperforms clinical judgment in treatment selection for MDD and has the potential to personalize treatment strategies.

Anorexia Nervosa is a severe and disabling mental disorder and a huge challenge to treat. Intense fears of e.g., food, eating, weight gain and social evaluation are core features of anorexia nervosa and obstacles during treatment. The perceived threats trigger avoidance and safety behaviors like highly restrictive eating, strict eating rules, vomiting and body checking, to minimize feared outcomes. The role of avoidance in anorexia nervosa is however hardly studied experimentally. In the present article, the focus is on a new transdiagnostic research agenda featuring both basic and clinical experimental research into avoidance as a most important mechanism maintaining the eating disorder. Avoidance learning and the generalization of learned avoidance behaviors are discussed, as well as safety behaviors and the need for inhibitory learning as a treatment target during exposure therapy.

This study investigated the effects of yoga on functionality appreciation, and the potential mechanisms that could explain the impact of yoga on additional facets of positive body image. Young adult women (N = 114; Mage = 22.19) were randomised to a 10-week Hatha yoga programme or waitlist control group. Participants completed measures of functionality appreciation, body appreciation, body compassion, appearance evaluation, self-objectification, and embodiment at Pretest, Midtest, Posttest, and 1-month Follow-Up. Follow-up data could not be analysed due to high levels of attrition. The remaining data showed that, compared to the control group, women in the yoga programme experienced lower self-objectification at Midtest and greater embodiment over time. Further, all participants experienced improvements in body appreciation, body compassion, and appearance evaluation over time, regardless of their assigned group. Lower self-objectification contributed to improvements in body appreciation and body compassion. In addition, greater embodiment contributed to improvements in body appreciation, body compassion, and appearance evaluation. Contrary to our expectations, yoga did not lead to increased functionality appreciation, nor was functionality appreciation a mediator of the impact of yoga on positive body image. Instead, lower self-objectification, and greater embodiment, drove improvements in positive body image.

Background: Bariatric surgery requires long-term changes in eating behavior. Bariatric patients can experience difficulties adhering to postsurgical dietary guidelines. Long-term data are scarce. Methods: Individuals (N = 101) who had undergone bariatric surgery (mean 4.6 years ago) completed a survey collecting data on weight, changes in eating patterns, compensatory behavior, and compliance with postsurgical dietary guidelines. The associations between healthy and unhealthy behaviors, weight loss, and patient satisfaction were analyzed. Results: A substantial number of patients mentioned nonadherence to the guidelines. In particular, postoperative restrained eating, nonvitamin use, and excessive exercise more than three times per week. These behaviors were associated with less weight loss, but only the association with postoperative restrained eating was statistically significant. In addition, reporting of unhealthy behaviors was associated with less satisfaction with respect to the bariatric surgery trajectory. Conclusion: Adherence to postoperative behavioral guidelines remains essential at follow-up similar to 5 years after bariatric surgery and should remain a focus of clinical follow-up to prevent negative impacts on weight, health, and satisfaction with the trajectory after bariatric surgery. The present results need to be replicated, and more research is necessary to unravel the effect of unhealthy behaviors on long-term outcomes following bariatric surgery.

Introduction: Reimbursement of body-contouring surgery (BCS) is a worldwide problem: there is no objective instrument to decide which postbariatric patients should qualify for reimbursement. The British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS) has developed a screening tool for this purpose. In this study, we used a modified version of this screening tool in a postbariatric population and describe which patients would qualify for reimbursement using this tool. Methods: In this cross-sectional study postbariatric patients were asked to fill in an online questionnaire based on the BAPRAS screening tool with questions regarding complaints of overhanging skin and medical history. Weight loss data were extracted from a prospective database. The BODY-Q was added to assess patient-reported outcomes. Results: Patients who wanted to undergo BCS (n = 90) had higher screening tool scores and lower BODY-Q scores compared to patients who did not want BCS (n = 24). In total, 25 patients (26%) qualified for reimbursement, these patients had higher weight loss (33.5% versus 29.2%, p = 0.008), lower BMI (27.3 kg/m2 versus 30.4 kg/m2, p = 0.014) and more medical (4.0 versus 2.0, p = 0.004) and psychological complaints (88% versus 61%, p = 0.009). There was a significant, negative correlation between the screening tool scores and almost all BODY-Q scales. Conclusions: Patients with a desire for BCS have more complaints of excess skin, which negatively impacts their well-being. With the modified BAPRAS screening tool, patients with the best weight (loss) and most medical and psychological complaints of excess skin qualified for referral and reimbursement of BCS.

Background: People with overweight have stronger reactivity (e.g., subjective craving) to food cues than lean people, and this reactivity is positively associated with food intake. Cue reactivity is a learned response that can be reduced with food cue exposure therapy.Objectives: It was hypothesized that participants after food cue exposure therapy would show reduced neural activity in brain regions related to food cue reactivity and increased neural activity in brain regions related to inhibitory-control as compared to participants receiving a control lifestyle intervention.Method: Neural activity of 10 women with overweight (BMI ≥ 27 kg/m2) in response to individually tailored visually presented palatable high-caloric food stimuli was examined before vs. after a cue exposure intervention (n = 5) or a control lifestyle (n = 5) intervention. Data were analyzed case-by-case.Results: Neural responses to food stimuli were reduced in food-cue-reactivity-related brain regions after the lifestyle intervention in most participants, and generally not after the cue exposure therapy. Moreover, cue exposure did not lead to increased activity in inhibitory-control-related brain regions. However, decreased neural activity after cue exposure was found in most participants in the lateral occipital complex (LOC), which suggests a decreased visual salience of high-caloric food stimuli.Conclusion: Receiving a cue exposure therapy did not lead to expected neural responses. As cue exposure relies on inhibitory learning mechanisms, differences in contexts (e.g., environments and food types) between the intervention setting and the scanning sessions may explain the general lack of effect of cue-exposure on neural activity.

BackgroundIt is unclear what session frequency is most effective in cognitive–behavioural therapy (CBT) and interpersonal psychotherapy (IPT) for depression.AimsCompare the effects of once weekly and twice weekly sessions of CBT and IPT for depression.MethodWe conducted a multicentre randomised trial from November 2014 through December 2017. We recruited 200 adults with depression across nine specialised mental health centres in the Netherlands. This study used a 2 × 2 factorial design, randomising patients to once or twice weekly sessions of CBT or IPT over 16–24 weeks, up to a maximum of 20 sessions. Main outcome measures were depression severity, measured with the Beck Depression Inventory-II at baseline, before session 1, and 2 weeks, 1, 2, 3, 4, 5 and 6 months after start of the intervention. Intention-to-treat analyses were conducted.ResultsCompared with patients who received weekly sessions, patients who received twice weekly sessions showed a statistically significant decrease in depressive symptoms (estimated mean difference between weekly and twice weekly sessions at month 6: 3.85 points, difference in effect size d = 0.55), lower attrition rates (n = 16 compared with n = 32) and an increased rate of response (hazard ratio 1.48, 95% CI 1.00–2.18).ConclusionsIn clinical practice settings, delivery of twice weekly sessions of CBT and IPT for depression is a way to improve depression treatment outcomes.

Learning theorists suggest extinction learning to be a central mechanism in weight loss success; however, empirical studies are scarce. In this pilot study, it was examined whether individual differences in extinction learning predict outcome after weight loss treatment. Overweight and obese individuals first completed a laboratory conditioning task in which individual differences in extinction learning were assessed. Next, they were randomised to one of two weight loss interventions: cue exposure therapy (CET), which is considered the clinical analogue of laboratory extinction, or a control lifestyle intervention. In line with expectations, better extinction learning in the laboratory task was associated with more weight loss at both post‐treatment (CET only) and follow‐up (both interventions) measurements. In contrast, two other indices of treatment success (reduction in overeating expectancies and ad libitum food intake during a laboratory taste test) showed no associations with pre‐treatment extinction learning. It is suggested that extinction learning may be a core mechanism underlying weight loss success, and hence, an important target for new obesity interventions.

The current study examined the relationships among dynamics of attentional bias for food, executive control and adjusted BMI% among children. 106 Dutch (8-12 years old, 56.60% female) and 99 Chinese children (9-13 years old, 44.44% female) participated in the study. All participants first completed a self-report hunger questionnaire, and then the food dot-probe task and attention network task were administered. Both mean attentional bias and the variability of attentional bias were computed as people often experience the opposite goals to approach and avoid palatable food. We hypothesized that only the variability of attentional bias for food would be positively related to adjusted BMI%. In addition, such association would be moderated by the executive control, which would be also negatively related to adjusted BMI%. The results showed that adjusted BMI% was only positively associated with the variability of attentional bias for food in Dutch children. However, such association did not exist in Chinese children and executive control was not a significant moderator of the relation between the variability of attentional bias for food and adjusted BMI% in both Dutch and Chinese children. Unexpected, compared with Dutch children, Chinese children had stronger executive control, which was directly related to a lower adjusted BMI%. This study emphasized both TL-BS variability for food and executive control might have an effect on adjusted BMI%, in addition, culture possibly serve as a reason for the inconsistent results between Dutch and Chinese children.

BACKGROUND AND OBJECTIVES:Anorexia Nervosa (AN) patients are characterized by an excessive restriction of their food-intake. Prior research using an Affective Simon Task (AST) with food as a task-irrelevant feature, provided evidence for the view that AN patients' ability to refrain from food is facilitated by reduced automatic approach tendencies towards food. However, because food was task-irrelevant (i.e., participants had to base their reaction on the perspective of the picture and not on its content), the findings may in fact reflect a relatively strong ability to ignore the content of the food stimuli rather than weakened approach towards food per se. Therefore, this study also included a Stimulus Response Compatibility (SRC) task with food as task-relevant feature that could not be ignored, because the required response depended on the [food vs non-food] content of the pictures.METHODS:AN spectrum patients (n = 63), and a comparison group of adolescents without eating pathology (n = 57) completed both a SRC task with food as task-relevant feature, and an Affective Simon Task AST with food as task-irrelevant feature.RESULTS:AN patients showed reduced approach tendencies for high caloric food. Only the SRC uniquely predicted the presence of AN.LIMITATIONS:Comparison between tasks was hampered because the SRC only included high caloric food stimuli, whereas the AST included high and low caloric food stimuli.CONCLUSION:Patients with AN are characterized by weakened automatic approach of high caloric food. This might 'help' restrict their food-intake even in a condition of starvation.

Findings of a few recent studies suggest that obesity is characterized by deficits in appetitive learning about food cues. This could point towards an increased tendency in obese individuals to overgeneralize appetitive responding to stimuli that resemble the conditioned food cue – possibly explaining frequent eating desires and overeating in obesity. The current study aimed to investigate whether obese individuals 1) indeed exhibit appetitive learning deficits and 2) show overgeneralization of conditioned appetitive responses. Obese and matched healthy-weight females (N = 85) completed a differential appetitive conditioning task using food as rewards. First, appetitive responding to a novel stimulus was learned (acquisition phase), after which stimuli with varying resemblance to the food-associated stimulus were presented (generalization phase). Cue-elicited eating expectancies, eating desires, stimulus evaluations, and actual food intake were examined. Results indicated successful acquisition of appetitive responding across all outcome measures. The acquired responses also generalized, indicating that generalization can function as an additional mechanism by which learned food cues can promote food consumption. The data further suggested that overweight and obesity are not characterized by appetitive learning deficits nor by overgeneralization, but that a subgroup of obese individuals (those high in trait anxiety) may be more prone to overgeneralization of appetitive responding.

Obesity rates are rising worldwide. Executive function and delay discounting have been hypothesized to play important roles in the self-regulation of behavior, and may explain variance in weight loss treatment success. First, we compared individuals with obesity (n = 82) to healthy weight controls (n = 71) on behavioral and self-report measures of executive function (working memory, inhibition and shifting) and delay discounting. Secondly, the individuals with obesity took part in a multidisciplinary weight loss program and we examined whether executive function and delay discounting predicted weight change. Individuals with obesity displayed weaker general and food-specific inhibition, and weaker self-reported executive function. Better behavioral working memory and better self-reported inhibition skills in daily life were predictive of greater weight loss. As findings are correlational, future studies should investigate the causal relationship between executive function and weight loss, and test whether intervening on executive function will lead to better prevention and treatment of obesity.

BackgroundAnxious depression is an important subtype of Major Depressive Disorder (MDD) defined by both syndromal (anxiety disorders) and dimensional (anxiety symptoms) criteria. A debated question is how anxiety affects MDD treatment. This study examined the impact of comorbid anxiety disorders and symptoms on the effectiveness of and dropout during Cognitive Therapy (CT) and Interpersonal Psychotherapy (IPT) for MDD.MethodsDepressed individuals were randomized to CT (n = 76) or IPT (n = 75). Outcome was depression severity measured with the Beck Depression Inventory-II (BDI-II) at the start of each therapy session, post treatment, and monthly up to five months follow-up. Anxiety disorders were assessed with the Structured Clinical Interview for DSM-IV Axis I disorders, (phobic) anxiety symptoms were assessed with Brief Symptom Inventory subscales.ResultsApproximately one third of participants had a comorbid anxiety disorder. Comorbid anxiety disorders and anxiety symptoms were associated with less favorable depression change during IPT as compared to CT in the treatment phase, but not in the trial follow-up phase. Individuals with a comorbid anxiety disorder had significantly higher treatment dropout during both treatments.LimitationsNot all therapists and participants were blind to the assessment of comorbid anxiety disorders and the assessments were performed by one rater.ConclusionsA preference for CT over IPT for MDD is justifiable when comorbid anxiety is present, although long-term differences are not established and replication of this finding is needed. Clinicians should be aware of the risk of dropout for depressed individuals with an anxiety disorder.

Working Memory (WM) plays a crucial role in successful self-regulation of behavior, including weight regulation. Improving WM might therefore be a promising strategy to support weight loss. In the present study, overweight individuals with a desire to lose weight (N = 91) received an online lifestyle intervention, in conjunction with either 25 sessions of gamified WM training (experimental condition) or a sham training (control). Primary outcomes were Body Mass Index (BMI) and food intake at posttest. Secondary outcomes were executive functioning, self-control, eating style, eating psychopathology and healthy eating. Data were analyzed with mixed regression analyses with condition as between-subjects factor (experimental versus control) and time as within-subjects factor (baseline, posttest, FU1 after one month and FU2 after six months). Results revealed that the experimental condition increased their WM span more than control from pretest to posttest, and these gains were retained at FU1, though lost at FU2. No transfer effects of WM training to other executive functioning measures were found. During the bogus taste test at posttest, participants in the experimental condition consumed significantly less than participants in the control condition. However, both conditions showed a small reduction in BMI, improved eating style, reduced eating disorder pathology, and reported more self-control and a healthier eating pattern. In conclusion, the current results provide some evidence that WM training can improve eating behavior at the short term. However, the WM gains were short-lived, and the added value of WM training as an intervention to promote weight loss could not be established. Future studies should test the added value of WM training booster sessions to promote weight loss over a prolonged period of time. (C) 2017 Elsevier Ltd. All rights reserved.

Obesity is a widespread problem that starts from an early age. Previous studies suggest that obese youngsters have an attentional bias and an automatic approach tendency towards high-calorie food and display difficulties inhibiting impulses, which may result in a higher intake of (high-calorie) food. An interesting idea for improvement of the current obesity treatment is adding a program that enables to train their difficulties. Subjects were 36 youngsters aged 9-15 years old from an inpatient treatment program for obesity, randomized over a training group and an active control group. The training consisted of six training sessions with cognitive tasks aimed at enhancing inhibition towards unhealthy food items (with a go/no-go task), as well as decreasing a food approach bias (using an approach/avoidance task) and a food attentional bias (using a dot-probe task). The current study evaluated the feasibility, acceptability and initial effectiveness of the training and explores if these characteristics helps obese youngsters to maintain weight-loss once they return home at the end of their inpatient treatment program. Results on the cognitive performances were investigated during two measurement sessions, spread over 5 weeks while weight evolution was followed over 13 weeks. Results showed that the training program was feasible and acceptable to the majority of participants and clinicians. Furthermore, the preliminary findings suggest that the training tasks used were ineffective in this group of obese children. Lessons learned and suggestions for future research are discussed.

BACKGROUND AND OBJECTIVES: This study tested whether two sessions of food cue exposure therapy reduced eating in the absence of hunger (EAH), specified for exposed and non-exposed food, in overweight and obese adolescents, and whether habituation of food cue reactivity and reduced CS-US expectancies predicted a decrease in EAH.METHODS: 41 overweight adolescents (aged 12-18 years) were randomly assigned to a cue exposure intervention or a lifestyle intervention (control condition). Habituation of food cue reactivity (self-reported desire to eat and salivation) and CS-US expectancy were measured during both sessions, and EAH was measured at the end of session two.RESULTS: Compared to the control condition, the cue exposure condition showed less EAH for the exposed food item as well as for the non-exposed food items. Larger within-session (WSH) and between-session habituation (BSH) of cue reactivity were not related to less EAH, change in CS-US expectancy was unrelated to EAH.LIMITATIONS: The study was underpowered, and compliance to homework instructions between sessions was poor, intervention effects might have been larger when participants adhered to daily homework exercises.CONCLUSIONS: Food cue exposure was effective to reduce EAH of exposed and non-exposed food items, indicating generalisability of the exposure effect. In line with exposure effects in anxiety disorders, habituation was not found to benefit outcome, though the present data do also not provide evidence that CS-US expectancy violation predicts EAH.

OBJECTIVE: This study tested the role of habituation of eating desires and violation of overeating expectancies during food cue exposure in obese women.METHOD: 52 obese females were randomised into a two-session exposure condition aimed at habituation, a two-session exposure condition aimed at expectancy violation, or a no-treatment control condition. Eating in the absence of hunger of foods included during cue exposure (i.e., exposed foods) and foods not included during cue exposure (i.e., non-exposed foods), and duration of exposure were measured.RESULTS: Both cue exposure conditions ate significantly less of the exposed foods compared to the control condition, though there were no differences between both types of exposure. No differences were found between conditions regarding the eating of non-exposed foods. In addition, the duration of exposure was not different between both cue exposure conditions.CONCLUSIONS: While food cue exposure in obese women led to less eating of exposed foods, focusing on either habituation of eating desires or expectancy violation did not matter. It is discussed why exposure works.

The Still-Face Paradigm (SFP) enables researchers to examine the quality of mother-infant interactions. In typical infants, a classic still-face effect (SFE) has been confirmed whereby infants demonstrate reduced positive affect (PA), reduced gaze (GA), and increased negative affect (NA). Recently, the SFP has been used to examine the effect of maternal depression upon infant behaviour. However, the nature and consistency of the behavioural responses of infants of depressed mothers during the SFP remains unclear. In the current meta-analysis, we examined whether or not infants of depressed mothers demonstrate the classic SFE, as well as whether or not these infants display the same levels of PA, NA, and GA as their counterparts with non-depressed mothers. Results revealed that infants of depressed mothers display the classic SFE like infants of their non-depressed counterparts. However, infants of depressed mothers also demonstrated significantly higher levels of PA during the still-face episode. One potential interpretation of this finding is that infants prior experience of similar, depressed interactions with their mothers, encourages them to amplify their positive attachment signals in order to engage maternal attention and response. Alternatively, or additionally, infants of depressed mothers could be using PA in order to regulate their own NA.

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.

The texture of food can be a reason why children reject it: It matters if food is crispy, slimy, smooth or has pips and bits in it. In general, mere exposure is the best method to increase acceptance of food: becoming more familiar with a food by repeated exposure increases liking for it. However, exposure to texture can be difficult, as children can be reluctant to try tasting it. In the current study, it is tested if acceptance of a food with a specific texture is improved after exposure to the feel of it, with hands only. Sixty-six children (between 3 and 10 years old) were randomly assigned to either the exposure or control condition. In the exposure condition, children played with an colourless and odourless jelly with their hands and in the control group, children played a board game. Afterwards, children were asked to taste 3 desserts (in balanced order): smooth strawberry yoghurt, strawberry yoghurt with pieces and strawberry jelly. Results showed that the children in the exposure condition ate specifically more of the jelly dessert - the texture of which they had been pre-exposed to - compared to the children in control condition. No group differences were found for the other two desserts. The results imply that feeling the texture of a food with hands increases the acceptance of food with the same texture. Playing with food with hands seems therefore be a first step in getting familiar with food and might help to increase variety of food intake.

Item does not contain fulltext Objective: Serious games are a promising venue to increase children's nutritional knowledge in an entertaining format. The aim of this study was to test the short-term effectiveness of the Alien Health Game, a videogame designed to teach elementary school children about nutrition and healthy food choices. Materials and Methods: To examine the effects of the Alien Health Game, an experimental design with a single between-subjects factor (experimental condition vs. active control condition) was used. A total of 108 Dutch children (10-13 years; 58 boys) were randomly assigned to either play Alien Health using the Kinect sensor for two consecutive days, for 1 hour of gameplay (experimental condition; n = 50), or a web-based nutrition game for the same period (active control condition; n = 58). Participants' nutritional knowledge was assessed at pretest, immediate, and at 2-week follow-up. Food intake was assessed at immediate and 2-week follow-up. Results: Participants who played Alien Health had better knowledge of the five most important macronutrients of foods at immediate posttest, but not at follow-up. Participants were better able to distinguish the healthier food item out of two options over time, but this effect did not differ for those in the experimental versus the active control condition. No differences in food intake, neither in the consumption of nutrient-dense or energy-dense foods, were found between children playing both games. Conclusion: A brief game-based intervention like the Alien Health Game has the potential to improve children's nutritional knowledge in the short term, but may not be strong enough to increase nutritional knowledge and actual eating behavior in the long term. Further investigation is warranted before this game is applied in future nutrition education programs. 11 p.

Realfit is a 13-week weight-reduction programme for adolescents. This study investigated the programme’s long-term effectiveness regarding the psychological outcomes of self-esteem and food craving. Methods: the study had a quasi-experimental design. Body mass index, self-esteem and food craving were assessed at baseline (t0), immediately after realfit (t1), and after five months (t2) and one year (t3) of follow-up. Control participants (n = 32) were overweight adolescents who received no treatment. Results: comparison between the intervention (n = 86) and control groups showed a significant difference for the self-esteem domain of global self-worth (1.63; 95% confidence interval: 0.28 to 2.99) in favour of the intervention group. The differences regarding overall self-esteem and the physical appearance domain showed a trend towards improvement. No significant difference was found for food craving. Conclusions: taking all results and limitations into account, it may cautiously be concluded that realfit has beneficial long-term effects on some domains of self-esteem, but no substantial effect on food craving. The appropriate duration and delivery of cue-exposure sessions in groups of overweight adolescents to decrease food craving should be investigated to further improve the realfit intervention.

Individual differences in extinction learning have attracted ample attention of researchers and are under investigation as a marker for the onset of anxiety disorders and treatment response. Unfortunately, the common paradigm for obtaining the extinction rate, which entails aversive stimulus pairings, is subject to practical limitations. Therefore, the present study assessed whether the use of an aversive stimulus is actually needed to get a good estimate of the extinction rate. A total of 161 undergraduate students completed a conditioning task with both an aversive and a non-aversive stimulus. Using latent class growth analysis (LCGA), distinct trajectories, representing normal and stunted extinction learning, were identified for both these stimulus types. Participants’ membership in these classes largely overlapped for aversive and non-aversive stimulus pairings and respective extinction indices were significantly correlated. Thereby, findings suggest that the use of a non-aversive stimulus could suffice for successfully capturing individual differences in extinction learning. However, future studies are needed to confirm that conditioning with a non-aversive stimulus may serve to predict clinically relevant outcomes.

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

The rise of internet and mobile technologies (such as smartphones) provide a harness of data and an opportunity to learn about peoples' states, behavior, and context in regard to several application areas such as health. Eating behavior is an area that can benefit from the development of effective e-coaching applications which utilize psychological theories and data science techniques. In this paper, we propose a framework of how machine learning techniques can effectively be used in order to fully exploit data collected from a mobile application (``Think Slim'') which is designed to assess eating behavior using experience sampling methods. The overall goal is to analyze individual states of a person status (emotions, location, activity, etc.) and assess their impact on unhealthy eating. Building on data collected from different participants, a classification algorithm (decision tree tailored to longitudinal data) is used to warn people prior to a possible unhealthy eating event and a clustering algorithm (hierarchical agglomerative clustering) is used for profiling the participants and generalize for new users of the application. Finally, a framework to offer feedback via adaptive messages (intervention) and recommendations prior to possible unhealthy eating events is presented. Results from applying our methods reveal that participants can be clustered to six robust groups based on their eating behavior and that there are specific rules that discriminate which conditions lead to healthy versus unhealthy eating. Consequently, these rules can be utilized to provide adaptive semi-tailored feedback to users who, through this method, are assisted in learning under which conditions are more prone to unhealthy eating. Effectiveness of the approach is confirmed by observing a decreasing trend in rule activation towards the end of intervention period.