Search

Abstract Purpose Emotional eating during negative emotions might underlie disordered eating behavior (i.e., binge eating and food restriction). Positive emotions, by contrast, seem to promote healthier eating behavior. Naturalistic research on the links between emotions and eating across individuals with binge-eating disorder (BED), bulimia nervosa (BN), binge-purge anorexia nervosa (AN-BP), and restrictive anorexia nervosa (AN-R) is, however, lacking. Methods Individuals without eating disorders (comparison group, CG, n = 85), and patients with BED (n = 41), BN (n = 50), AN-BP (n = 26), and AN-R (n = 29) participated in an ecological momentary assessment study. Six daily notifications over eight days prompted ratings of momentary food craving and emotional states differing in valence and arousal. Results Results supported specific emotion-food-craving patterns in each group. Compared to the CG, arousing negative emotions and higher cravings co-occurred in patients with BN. In patients with AN-BP (at trend level also in patients with AN-R) less arousing negative emotions and lower cravings co-occurred. In patients with AN, positive emotions and higher cravings co-occurred whereas in patients with BED less arousing positive emotions and lower cravings co-occurred. Conclusion The found emotion-craving associations may underlie group-specific (dys-)functional eating behaviors, i.e., binge eating and food restriction during negative emotions in patients with BN and AN, and normalized appetitive responses during positive emotions in patients with BED and AN. Therapeutic efforts could target arousing negative emotions in patients with BN, and less arousing negative emotions in patients with AN. Positive emotions could be used in a salutogenetic approach in patients with BED and AN.

Objective: This study investigated the impact of war exposure on post-traumatic stress symptoms (PTSS) and sleep disturbance across Ukraine. Subjective and objective indicators of war exposure were modelled as predictors of these symptoms.Methods: We created two predictors: first, we used governmental and crowd-sourced data to create an objective war exposure index for each of the 21 non-occupied regions of Ukraine, based on the number of air raid alarms, explosions, and proximity to frontline; and second, we obtained self-report cross-sectional data, using convenience sampling, from a nation-wide survey (N = 991) on subjective experience of threat triggered by the war. The survey also measured the outcome variables of PTSS and sleep disturbance. Hierarchical multilevel regressions modelled the relationship of this objective war exposure index with the two outcome variables, after accounting for demographics. A final regression step modelled subjective threat as predictor of these symptoms.Results: We observed strongly elevated levels of PTSS and sleep disturbance and strong regional differences in objective and subjective war indicators. Objective war exposure predicted PTSS but not sleep disturbance, whereas subjective threat predicted both symptom domains.Conclusion: The study demonstrates the utility of objective war exposure data for predicting the prevalence of PTSS in the different regions. The results further underscore the prominent role of subjective appraisal processes in the symptomatology of PTSS and sleep disturbance, thus informing theories on trauma-related disorders. Our results can guide the allocation of mental health services by identifying highly affected regions.

Abstract Background Problematic drinking is common among college students and associated with various somatic and mental health problems. Given significant evidence for the efficacy of smartphone-based interventions and the frequent use of smartphones among college students, it can be assumed that such interventions have great potential to facilitate access to evidence-based interventions for students suffering from problematic drinking. Thus, we developed a brief intervention that combined a counseling session with an app that utilizes approach-avoidance modification training to reduce alcohol consumption. Methods To test the feasibility and explore the potential efficacy of the intervention, we conducted a before-after single-arm study with N = 11 participants reportedly engaging in problematic drinking, who were instructed to practice with the app for 14 days. Feasibility was assessed with the System Usability Scale (SUS). Outcomes included the reduction of self-reported problematic drinking behavior, dysfunctional attitudes about alcohol, and craving, as well as implicit associations between alcohol and self during the training period. Additionally, self-reported problematic drinking behavior was assessed at a 4-week follow-up. Results On average, participants rated app usability on the SUS (possible range: 0 to 100) with M = 84.32 (SD = 6.53). With regard to efficacy, participants reported a significant reduction of problematic drinking behavior (d pre vs. post = 0.91) which was sustained at follow-up (d follow-up vs. baseline = 1.07). Additionally, participants reported a significant reduction of dysfunctional attitudes about alcohol (d pre vs. post = 1.48). Results revealed no significant changes in craving nor in implicit associations regarding alcohol. Conclusions Findings from this feasibility study provide preliminary evidence that smartphone-based interventions might help reduce problematic drinking in college students. Further research needs to replicate these findings with larger samples in randomized controlled trials. Trial registration DRKS00014675 (retrospectively registered).

Abstract Background Maintaining a healthy body weight and reaching long-term dietary goals requires ongoing self-monitoring and behavioral adjustments. How individuals respond to successes and failures is described in models of self-regulation: while cybernetic models propose that failures lead to increased self-regulatory efforts and successes permit a reduction of such efforts, motivational models (e.g., social-cognitive theory) make opposite predictions. Here, we tested these conflicting models in an ecological momentary assessment (EMA) context and explored whether effort adjustments are related to inter-individual differences in perceived self-regulatory success in dieting (i.e., weight management). Methods Using linear mixed effects models, we tested in 174 diet-interested individuals whether current day dietary success or failure (e.g., on Monday) was followed by self-regulatory effort adjustment for the next day (e.g., on Tuesday) across 14 days. Success vs. failure was operationalized with two EMA items: first, whether food intake was higher vs. lower than usual and second, whether food intake was perceived as more vs. less goal-congruent than usual. Trait-level perceived self-regulatory success in dieting was measured on a questionnaire. Results Intended self-regulatory effort increased more strongly after days with dietary success (i.e., eating less than usual / rating intake as goal-congruent) than after days with dietary failure (i.e., eating more than usual / rating intake as goal-incongruent), especially in those individuals with lower scores on perceived self-regulatory success in dieting. Conclusions Findings support mechanisms proposed by social-cognitive theory, especially in unsuccessful dieters. Thus, future dietary interventions could focus on preventing the decrease in self-regulatory effort after instances of dietary failures and thereby mitigate the potential risk that a single dietary failure initiates a downward spiral into unhealthy eating.

Abstract Purpose Emotional eating (EE) refers to eating in response to (negative) emotions. Evidence for the validity of EE is mixed: some meta-analyses find EE only in eating disordered patients, others only in restrained eaters, which suggest that only certain subgroups show EE. Furthermore, EE measures from lab-based assessments, ecological momentary assessment (EMA), and psychometric measures often diverge. This paper tested whether the covariance of these three different EE methods can be modeled through a single latent variable (factorial validity), and if so, how this variable would relate to restrained eating (construct validity), Body-Mass-Index (BMI), and subclinical eating disorder symptomatology (concurrent validity). Methods 102 non-eating disordered female participants with a wide BMI range completed EE measures from three methods: psychometric questionnaires, a laboratory experiment (craving ratings of food images in induced neutral vs. negative emotion) and EMA questionnaires (within-participant correlations of momentary negative emotions and momentary food cravings across 9 days). Two measures for each method were extracted and submitted to confirmatory factor analysis. Results A one-factor model provided a good fit. The resulting EElat factor correlated positively with subclinical eating disorder symptoms and BMI but not with restrained eating. Conclusions The one-factor solution shows that the EE construct can validly be assessed with three different methods. Individual differences in EE are supported by the data and are related to eating and weight problem symptomatology but not to restrained eating. This supports learning accounts of EE and underscores the relevance of the EE construct to physical and mental health. Level of evidence II (Evidence obtained from well-designed controlled trials without randomization).

BackgroundFood craving relates to unhealthy eating behaviors such as overeating or binge eating and is thus a promising target for digital interventions. Yet, craving varies strongly across the day and is more likely in some contexts (external, internal) than in others. Prediction of food cravings ahead of time would enable preventive interventions.ObjectiveThe objective of this study was to investigate whether upcoming food cravings could be detected and predicted from passive smartphone sensor data (excluding geolocation information) without the need for repeated questionnaires.MethodsMomentary food craving ratings, given six times a day for 14 days by 56 participants, served as the dependent variable. Predictor variables were environmental noise, light, device movement, screen activity, notifications, and time of the day recorded from 150 to 30 min prior to these ratings.ResultsIndividual high vs. low craving ratings could be predicted on the test set with a mean area under the curve (AUC) of 0.78. This outperformed a baseline model trained on past craving values in 85% of participants by 14%. Yet, this AUC value is likely the upper bound and needs to be independently validated with longer data sets that allow a split into training, validation, and test sets.ConclusionsCraving states can be forecast from external and internal circumstances as these can be measured through smartphone sensors or usage patterns in most participants. This would allow for just-in-time adaptive interventions based on passive data collection and hence with minimal participant burden.

Abstract Background Valence and motivational direction are linked. We approach good things and avoid bad things, and experience overriding these links as conflicting. Positive valence is more consistently linked with approach than negative valence is linked with avoidance. Therefore, avoiding positive stimuli should produce greater behavioral and neural signs of conflict than approaching negative stimuli. Methods In the present event‐related potential study, we tested this assumption by contrasting positive and negative conflict. We used the manikin task, in which we read positive and negative words that they needed to approach and avoid. Results Consistent with our prediction, positive conflict prolonged reaction times more than negative conflict did. A late (500–1000 ms following word onset) event‐related potential that we identified as the Conflict slow potential, was only sensitive to positive conflict. Conclusion The results of this study support the notion that avoiding positive stimuli is more conflicting than approaching negative stimuli. The fact that the conflict slow potential is typically sensitive to response conflict rather than stimulus conflict suggests that the manikin task primarily requires people to override prepotent responses rather than to identify conflicting stimuli. Thus, the present findings also shed light on the psychological processes subserving conflict resolution in the manikin task.

Introduction Unhealthy eating behaviour is a major contributor to obesity and related diseases and is associated with a behavioural bias to approach rather than avoid desired foods, as measured with reaction time tasks. Approach-avoidance interventions (AAIs) have been proposed as a way to modify food evaluations and help people to eat in accordance with their dietary goals. Mobile implementations of AAI might be easily accessible, low threshold interventions, but their effectiveness has not been established yet.Methods and analysis Participants who aim to change their eating behaviour are randomised to intervention or control groups. They complete six sessions of a smartphone-based AAI, in which they push (ie, avoid) or pull (ie, approach) personalised food images. Intervention group participants always avoid foods that they personally want to eat less often and approach foods that they personally want to eat more often. In the control group, images are paired equally often with both response directions. To evaluate contextual and dynamic intervention effects, ecological momentary assessment (EMA) is measured throughout, with questions about food intake, hunger, stress, emotions, eating intentions, food craving and impulsivity twice a day. Additional EMA preintervention and postintervention measures are administered before and after the intervention phase (4 days each) with a 1-day follow-up EMA 4 weeks after the intervention. Multilevel models will examine the temporal covariance between approach bias and self-reported variables as well as short-term and long-term intervention effects on approach bias, food intake and craving.Ethics and dissemination The study was approved by the Ethics Committee of the University of Salzburg. Results will be published in peer-reviewed scientific journals and presented at scientific conferences.Trial registration number German Clinical Trials Register DRKS, registration number DRKS00030780.

Abstract Background Eating plays an important role in mental and physical health and is influenced by affective (e.g., emotions, stress) and appetitive (i.e., food craving, hunger) states, among others. Yet, substantial temporal variability and marked individual differences in these relationships have been reported. Exploratory data analytical approaches that account for variability between and within individuals might benefit respective theory development and subsequent confirmatory studies. Methods Across 2 weeks, 115 individuals (83% female) reported on momentary affective states, hunger, and food craving six times a day. Based on these ecological momentary assessment (EMA) data we investigated whether latent class vector-autoregression (LCVAR) can identify different clusters of participants based on similarities in their temporal associations between these states. Results LCVAR allocated participants into three distinct clusters. Within clusters, we found both positive and negative associations between affective states and hunger/food craving, which further varied temporally across lags. Associations between hunger/food craving and subsequent affective states were more pronounced than vice versa. Clusters differed on eating-related traits such as stress-eating and food craving as well as on EMA completion rates. Discussion LCVAR provides novel opportunities to analyse time-series data in affective science and eating behaviour research and uncovers that traditional models of affect-eating relationships might be overly simplistic. Temporal associations differ between subgroups of individuals with specific links to eating-related traits. Moreover, even within subgroups, differences in associations across time and specific affective states can be observed. To account for this high degree of variability, future research and theories should consider individual differences in direction and time lag of associations between affective states and eating behaviour, daytime and specific affective states. In addition to that, methodological implications for EMA research are discussed.

BackgroundPrevention of binge eating through just-in-time mobile interventions requires the prediction of respective high-risk times, for example, through preceding affective states or associated contexts. However, these factors and states are highly idiographic; thus, prediction models based on averages across individuals often fail. ObjectiveWe developed an idiographic, within-individual binge-eating prediction approach based on ecological momentary assessment (EMA) data. MethodsWe first derived a novel EMA-item set that covers a broad set of potential idiographic binge-eating antecedents from literature and an eating disorder focus group (n=11). The final EMA-item set (6 prompts per day for 14 days) was assessed in female patients with bulimia nervosa or binge-eating disorder. We used a correlation-based machine learning approach (Best Items Scale that is Cross-validated, Unit-weighted, Informative, and Transparent) to select parsimonious, idiographic item subsets and predict binge-eating occurrence from EMA data (32 items assessing antecedent contextual and affective states and 12 time-derived predictors). ResultsOn average 67.3 (SD 13.4; range 43-84) EMA observations were analyzed within participants (n=13). The derived item subsets predicted binge-eating episodes with high accuracy on average (mean area under the curve 0.80, SD 0.15; mean 95% CI 0.63-0.95; mean specificity 0.87, SD 0.08; mean sensitivity 0.79, SD 0.19; mean maximum reliability of rD 0.40, SD 0.13; and mean rCV 0.13, SD 0.31). Across patients, highly heterogeneous predictor sets of varying sizes (mean 7.31, SD 1.49; range 5-9 predictors) were chosen for the respective best prediction models. ConclusionsPredicting binge-eating episodes from psychological and contextual states seems feasible and accurate, but the predictor sets are highly idiographic. This has practical implications for mobile health and just-in-time adaptive interventions. Furthermore, current theories around binge eating need to account for this high between-person variability and broaden the scope of potential antecedent factors. Ultimately, a radical shift from purely nomothetic models to idiographic prediction models and theories is required.

Abstract Background Studies on food cue reactivity have documented that altered responses to high-calorie food are associated with bulimic symptomatology, however, alterations in sexual motivations and behaviors are also associated clinical features in this population, which justify their inclusion as a research target. Here, we study responses to erotic cues—alongside food, neutral and aversive cues—to gain an understanding of specificity to food versus a generalized sensitivity to primary reinforcers. Methods We recorded peripheral psychophysiological indices –the startle reflex, zygomaticus, and corrugator responses—and self-reported emotional responses (valence, arousal, and dominance) in 75 women completing the Bulimia Test-Revised (BULIT-R). Multiple regression analysis tested whether BULIT-R symptoms were predicted by self-reported and psychophysiological responses to food versus neutral and erotic versus neutral images. Results The results showed that individuals with higher bulimic symptoms were characterized by potentiated eye blink startle response during binge food (vs. neutral images) and more positive valence ratings during erotic (vs. neutral) cues. Conclusions The results highlight the negative emotional reactivity of individuals with elevated bulimic symptoms toward food cues, which could be related to the risk of progression to full bulimia nervosa and thereby addressed in prevention efforts. Results also point to the potential role of reactivity to erotic content, at least on a subjective level. Theoretical models of eating disorders should widen their conceptual scope to consider reactivity to a broader spectrum of primary reinforcers, which would have implications for cue exposure-based treatments. Plain English summary We examined appetitive and aversive cue responses in college women to investigate how bulimic symptoms relate to primary reinforcers such as food and erotic images. We recorded peripheral psychophysiological indices (the startle reflex, zygomaticus, and corrugator responses) and self-reported emotional responses (valence, arousal, and dominance) in 75 college women that were presented with the Spanish version of the Bulimia Test-Revised. The results showed that bulimic symptoms increase both psychophysiological defensiveness toward food cues and subjective pleasure toward erotic cues. The findings suggest a generalized sensitivity to primary reinforcers in the presence of bulimic symptoms, and emphasize the relevance of adopting a wider framework in research and treatment on bulimia nervosa.

Abstract Background Many people aim to eat healthily. Yet, affluent food environments encourage consumption of energy dense and nutrient-poor foods, making it difficult to accomplish individual goals such as maintaining a healthy diet and weight. Moreover, goal-congruent eating might be influenced by affects, stress and intense food cravings and might also impinge on these in turn. Directionality and interrelations of these variables are currently unclear, which impedes targeted intervention. Psychological network models offer an exploratory approach that might be helpful to identify unique associations between numerous variables as well as their directionality when based on longitudinal time-series data. Methods Across 14 days, 84 diet-interested participants (age range: 18–38 years, 85.7% female, mostly recruited via universities) reported their momentary states as well as retrospective eating episodes four times a day. We used multilevel vector autoregressive network models based on ecological momentary assessment data of momentary affects, perceived stress and stress coping, hunger, food craving as well as goal-congruent eating behaviour. Results Neither of the momentary measures of stress (experience of stress or stress coping), momentary affects or craving uniquely predicted goal-congruent eating. Yet, temporal effects indicated that higher anticipated stress coping predicted subsequent goal-congruent eating. Thus, the more confident participants were in their coping with upcoming challenges, the more they ate in line with their goals. Conclusion Most eating behaviour interventions focus on hunger and craving alongside negative and positive affect, thereby overlooking additional important variables like stress coping. Furthermore, self-regulation of eating behaviours seems to be represented by how much someone perceives a particular eating episode as matching their individual eating goal. To conclude, stress coping might be a potential novel intervention target for eating related Just-In-Time Adaptive Interventions in the context of intensive longitudinal assessment.

Food craving (FC) peaks are highly context-dependent and variable. Accurate prediction of FC might help preventing disadvantageous eating behavior. Here, we examine whether data from 2 weeks of ecological momentary assessment (EMA) questionnaires on stress and emotions (active EMA, aEMA) alongside temporal features and smartphone sensor data (passive EMA, pEMA) are able to predict FCs ~2.5 h into the future in N = 46 individuals. A logistic prediction approach with feature dimension reduction via Best Item Scale that is Cross-Validated, Weighted, Informative and Transparent (BISCWIT) was performed. While overall prediction accuracy was acceptable, passive sensing data alone was equally predictive to psychometric data. The frequency of which single predictors were considered for a model was rather balanced, indicating that aEMA and pEMA models were fully idiosyncratic.

Approach biases to foods may explain why food consumption often diverges from deliberate dietary intentions. Yet, the assessment of behavioural biases with the approach-avoidance tasks (AAT) is often unreliable and validity is partially unclear. The present study continues a series of studies that develop a task based on naturalistic approach and avoidance movements on a touchscreen (hand-AAT). In the hand-AAT, participants are instructed to respond based on the food/non-food distinction, thereby ensuring attention to the stimuli. Yet, this implies the use of instruction switches (i.e., ‘approach food – avoid objects’ to ‘avoid food – approach objects’), which introduce order effects. The present study increased the number of instruction switches to potentially minimize order effects, and re-examined reliability. We additionally included the implicit association task (IAT) and several self-reported eating behaviours to investigate the task’s validity. Results replicated the presence of reliable approach biases to foods irrespective of instruction order. Evidence for validity, however, was mixed: biases correlated positively with external eating, increase in food craving and aggregated image valence ratings but not with desire to eat ratings of the individual images considered within participants or the IAT. We conclude that the hand-AAT can reliably assess approach biases to foods that are relevant to self-reported eating patterns.

Introduction: Coronavirus 2019 (COVID-19) quickly evolved into a global pandemic in early 2020, and most countries enforced social confinements to reduce transmission. This seems to dovetail with increasing, potentially problematic, screen use habits, such as gaming and “binge-watching.” Yet, the subjective experience of the common confinements may vary not only between individuals depending on age, sex, and living conditions (i.e., living alone) but also within individuals from day to day: confinements might interfere with habitual activity schedules more strongly on some days than on others. Such dynamic confinement experience has not been studied in relation to screen use yet but might guide targeted intervention.Method: In total, 102 participants (n = 83 female, n = 80 university students) completed 14 days of ecological momentary assessment during a COVID-19-related lockdown in Germany and Austria. Each evening, they indicated the extent to which they felt restricted by confinements in their social and work lives and whether they engaged in unusually high and intense levels of television watching, social media use, news consumption, internet surfing, and gaming. They also reported on how much they experienced their day to be structured.Results: Experienced work confinements were positively associated with social media usage. Further, work confinements were positively associated with gaming in males and with news consumption, especially in individuals living alone. Social confinements were positively associated with watching television especially in younger participants and with social media consumption in younger participants. Higher experienced day structure was related to less television watching, gaming, and internet surfing but more news consumption.Discussion: Screen use behaviors increased with higher confinements within person, dependent on sex, age, and living situation. Such knowledge allows tailoring on the person level (who should be addressed?) and the time level (when should interventions be scheduled?) as the negative consequences of excessive screen use behaviors on mental and physical health are well-documented. One potential low-threshold intervention might be day-structuring.

The worldwide spread of the coronavirus disease (COVID-19) and the resulting lockdown has affected the whole world and the maintenance of healthy eating behavior might be an additional challenge. Self-compassion (SC) interventions emphasize not only treating oneself in a caring way regarding personal weaknesses, e.g., diet lapses, but also the recognition of shared human suffering. Thus, self-compassion might be particularly valuable during the current worldwide crisis due to COVID-19. In this study, N = 65 participants that wanted to lose weight or develop a healthier eating behavior were randomized to either a 14-day self-compassion intervention arm or a waitlist control arm. The intervention consisted of daily journaling exercises and meditations via smartphone with a focus on improving eating behavior. Before and after the intervention phase, questionnaires on self-compassion, eating, dieting, health behavior, stress, and emotion regulation were completed and body weight was determined. Participants in the treatment arm (n = 28) showed an increase in self-compassion, a decrease in perceived stress, eating in response to feeling anxious, and, on trend level, body mass index (BMI). Changes in self-compassion fully mediated changes in stress. No such effects were found in the waitlist control group (n = 29). Thus, self-compassion might help to maintain well-being and healthy eating habits in times of increased stress and isolation. Future studies should replicate these findings outside of the COVID-19 crisis and test the effect of self-compassion in samples with eating disorders or weight problems.

In today’s society, obesity rates are rising as food intake is no longer only a response to physiological hunger signals that ensure survival. Eating can represent a reward, a response to boredom, or stress reduction and emotion regulation. While most people decrease food intake in response to stress or negative emotions, some do the opposite. Yet, it is unclear who shows emotional overeating under which circumstances. Emotion regulation theories describe emotional overeating as a learned strategy to down-regulate negative emotions. Cognitive theories, by contrast, attribute emotional overeating to perceived diet breaches in individuals who chronically attempt to diet. After consuming “forbidden foods”, they eat more than individuals who do not restrict their food intake. This laboratory study investigated emotional overeating by exposing individuals to a personalized emotion induction while showing images of palatable foods. Outcome variables indexed cue reactivity to food images through picture ratings (valence, desire to eat), facial expressions (electromyography of the corrugator supercilii muscle), and brain reactivity by detecting event-related potentials (ERPs) by means of electroencephalography (EEG). The influence of emotion condition (negative, neutral) and individual differences (self-reported trait emotional and restrained eating) on outcome variables was assessed. Valence ratings and appetitive reactions of the corrugator muscle to food pictures showed a relative increase in the negative condition for individuals with higher emotional eating scores, with the opposite pattern in lower scores. Desire to eat ratings showed a similar pattern in individuals who showed a strong response to the emotion induction manipulation, indicative of a dose-response relationship. Although no differences between conditions were found for ratings or corrugator activity with restrained eating as a predictor, an ERP at P300 showed increased activation when viewing food compared to objects in the negative condition. Findings support emotion regulation theories: Emotional eaters showed an appetitive reaction in rating patterns and corrugator activity. EEG findings (increased P300) suggest a motivated attention toward food in restrained eaters, which supports cognitive theories. However, this did not translate to other variables, which might demonstrate successful restraint. Future studies may follow up on these findings by investigating eating disorders with emotion regulation difficulties.

In a feasibility trial comparing two forms of combined inhibitory control training and goal planning (i.e., food-specific and general) among patients with bulimia nervosa (BN) and binge eating disorder (BED), we found evidence of symptomatic benefit, with stronger effects among participants receiving a food-specific intervention. The aim of the present study was to examine changes in behavioral outcomes and event-related potentials (ERPs; N2 and P3 amplitudes) from baseline to post-intervention that might suggest the mechanisms underpinning these effects. Fifty-five participants completed go/no-go tasks during two electroencephalography (EEG) sessions, at baseline and post-intervention. The go/no-go task included “go” cues to low energy-dense foods and non-foods, and “no-go” cues to high energy-dense foods and non-foods. Datasets with poor signal quality and/or outliers were excluded, leaving 48 participants (N = 24 BN; N = 24 BED) in the analyses. Participants allocated to the food-specific, compared to the general intervention group, showed significantly greater reductions in reaction time to low energy-dense foods, compared to non-foods, by post-intervention. Commission errors significantly increased from baseline to post-intervention, regardless of stimulus type (food vs. non-food) and intervention group (food-specific vs. general). There were no significant changes in omission errors. P3 amplitudes to “no-go” cues marginally, but non-significantly, decreased by post-intervention, but there was no significant interaction with stimulus type (high energy-dense food vs. non-food) or intervention group (food-specific vs. general). There were no significant changes in N2 amplitudes to “no-go” cues, N2 amplitudes to “go” cues, or P3 amplitudes to “go” cues from baseline to post-intervention. Training effects were only marginally captured by these event-related potentials. We discuss limitations to the task paradigm, including its two-choice nature, ease of completion, and validity, and give recommendations for future research exploring ERPs using inhibitory control paradigms.

A disturbed body image with fluctuating behavioral patterns of body related avoidance (BA) and body checking (BC) characterizes individuals with eating disorders (EDs) such as anorexia (AN) or bulimia nervosa (BN). So far, these behavioral body image components are mostly assessed via self-report instruments thereby neglecting their behavioral and partially automatic characteristics. Therefore, behavioral measures of BA and BC are needed. The present study investigates a behavioral assessment task for BA and BC in a sample of patients with diagnosed EDs and healthy controls. The sample consisted of 40 women diagnosed with either BN (N = 19) or AN (N = 21; ED sample) and 24 non-eating disordered, healthy female controls (HC). Within the Body Image Approach Task (BIAT) participants viewed photos of their own body (self-image) and a matched control body (other-image) by zooming the photos closer toward them (image became more focused) on the screen. The BIAT yields zoom-levels recorded separately for self- relative to other-images. Further measures were attractiveness ratings of these body images as well as questionnaire measures of BA, BC, and general ED symptomatology. Results showed that despite strong body dissatisfaction and clearly negative ratings of self- relative to other-images in both EDs, no group differences were found in approach to self-images on zoom-level as measured with the BIAT. Correlational analysis in each group indicated that zoom-level was positively related to BA scores in the HC group only. Yet, stepwise regression analyses revealed that attractiveness ratings explained most of the variance accounted by BA in predicting zoom-level. In sum, the BIAT seems suitable to assess BA and self-rated body attractiveness, but only in healthy individuals with subclinical levels on these constructs. It does not seem to capture the body image satisfaction or the behavioral components of body image disturbances in AN or BN or it conflates the opposed influences of BA and BC. Further experimentation is needed to adapt measures of behavioral body image components to the processes evoked in patients with ED during confrontation with body images.

Our current environment is characterized by the omnipresence of food cues. The taste and smell of real foods—but also graphical depictions of appetizing foods—can guide our eating behavior, for example, by eliciting food craving and anticipatory cephalic phase responses. To facilitate research into this so-called cue reactivity, several groups have compiled standardized food image sets. Yet, selecting the best subset of images for a specific research question can be difficult as images and image sets vary along several dimensions. In the present report, we review the strengths and weaknesses of popular food image sets to guide researchers during stimulus selection. Furthermore, we present a recent extension of our previously published database food-pics, which comprises an additional 328 food images from different countries to increase cross-cultural applicability. This food-pics_extended stimulus database, thus, encompasses and replaces food-pics. Normative data from a predominantly German-speaking sample are again presented as well as updated calculations of image characteristics.

Existing self-report questionnaires for the assessment of emotional eating do not differentiate between specific types of emotions and between increased or decreased food intake in response to these emotions. Therefore, we developed a new measure of emotional eating—the Salzburg Emotional Eating Scale (SEES)—for which higher scores indicate eating more than usual in response to emotions and lower scores indicate eating less than usual in response to emotions. In study 1, a pool of items describing 40 emotional states was used. Factor analysis yielded four factors, which represented both positive (happiness subscale) and negative emotions (sadness, anger, and anxiety subscales). Subsequently, the scale was reduced to 20 items (5 items for each subscale) and its four-factor structure was replicated in studies 2 and 3. In all three studies, internal consistencies of each subscale were α > 0.70 and mean subscale scores significantly differed from each other such that individuals reported the strongest tendency to eat more than usual when being sad and the strongest tendency to eat less than usual when being anxious (sadness > happiness > anger > anxiety). Higher scores on the happiness subscale related to lower scores on the negative emotions subscales, lower body mass index (BMI), and lower eating pathology. In contrast, higher scores on the negative emotions subscales related to lower scores on the happiness subscale, higher BMI, and higher eating pathology. The SEES represents a useful measure for the investigation of emotional eating by increasing both specificity (differentiation between specific emotional states) and breadth (differentiation between increase and decrease of food intake) in the assessment of the emotion–eating relationship.

Individuals with bulimia nervosa (BN) or binge-eating disorder (BED) experience more frequent and intense food cravings than individuals without binge eating. However, it is currently unclear whether they also show larger food cue-induced increases in craving (i.e., food cue reactivity) than those without binge eating, as suggested by conditioning theories of binge eating. A group of individuals with BN or BED (binge-eating group, n = 27) and a group of individuals with low trait food craving scores and without binge eating (control group, n = 19) reported their current food craving before and after a food cue exposure. Although food craving intensity significantly increased in both groups, this increase was significantly stronger in the binge-eating group than in the control group. This result is in line with conditioning models of binge eating that propose that food cues are conditioned stimuli that elicit a conditioned response (e.g., food craving) and that this association is stronger in individuals with binge eating. As food craving increased in individuals with low trait food craving scores as well-although to a lesser extent-previous null results might be explained by methodological considerations such as not screening control participants for trait food craving.

Diet failures are often attributed to an increase in cravings for attractive foods. However, accumulating evidence shows that food cravings actually decrease during energy-restricting weight-loss interventions. The current study aimed at elucidating possible mechanisms that may explain how and under which circumstances food cravings in- or decrease during dieting. Specifically, decreases in food cravings during weight-loss diets may be due to effects of energy restriction (homeostatic changes) and to effects of avoiding specific foods (hedonic changes). Thus, we used a selective, hedonic deprivation (i.e., restricting intake of a specific food in the absence of an energy deficit) that precludes homeostatic changes due to energy restriction. Furthermore, interindividual differences in food craving experiences might affect why some individuals are more prone to experience cravings during dieting than others. Thus, we investigated whether a selective deprivation of chocolate would in- or decrease craving and implicit preference for chocolate as a function of trait-level differences in chocolate craving. Participants with high and low trait chocolate craving (HC, LC) refrained from consuming chocolate for 2 weeks but otherwise maintained their usual food intake. Both groups underwent laboratory assessments before and after deprivation, each including explicit (i.e., state chocolate craving) and implicit measures (i.e., Single Category Implicit Association Test, SC-IAT; Affect Misattribution Procedure, AMP). Results showed that hedonic deprivation increased state chocolate craving in HCs only. HCs also showed more positive implicit attitudes toward chocolate than LCs on the SC-IAT and the AMP irrespective of deprivation. Results help to disambiguate previous studies on the effects of dieting on food cravings. Specifically, while previous studies showed that energy-restricting diets appear to decrease food cravings, the current study showed that a selective, hedonic deprivation in the absence of an energy deficit increases food cravings. However, this effect can only be observed for individuals with high trait craving levels. Thus, if attractive foods are strictly avoided through a selective deprivation, HCs are at risk to experience craving bouts in the absence of an energy deficit. As implicit preference was unaffected by chocolate deprivation, strong implicit preference for chocolate likely characterize a stable mechanism that drives consumption in HCs.

Obesity is heterogeneous condition with obese individuals displaying different eating patterns. Growing evidence suggests that there is a subgroup of obese adults that is marked by frequent and intense food cravings and addiction-like consumption of high-calorie foods. Little is known, however, about such a subgroup of obese individuals in childhood and adolescence. In the present study, a sample of children and adolescents with a wide range in body mass was investigated and trait food craving, liking for and intake of high- and low-calorie foods was measured. One-hundred and forty-two children and adolescents (51.4% female, n = 73; Mage = 13.7 years, SD = 2.25; MBMI-SDS = 1.26, SD = 1.50) completed the Food Cravings Questionnaire - Trait, then viewed pictures of high- and low-calorie foods and rated their liking for them, and subsequently consumed some of these foods in a bogus taste test. Contrary to expectations, higher body mass was associated with lower consumption of high-calorie foods. However, there was an interaction between body mass and trait food craving when predicting food consumption: in obese participants, higher trait food craving was associated with higher consumption of high-calorie foods and this association was not found in normal-weight participants. The relationship between trait food craving and high-calorie food consumption within obese individuals was mediated by higher liking for high-calorie foods (but not by liking for low-calorie foods). Thus, similar to adults, a subgroup of obese children and adolescents - characterized by high trait food craving - seems to exist, calling for specific targeted treatment strategies.

Impulsivity has been suggested to be associated with obesity. However, findings are fairly inconsistent and it appears that only specific facets of impulsivity are related to overeating and body mass. In this study, relationships between scores on a short form of the Barratt Impulsiveness Scale and body mass index were examined in a heterogeneous sample ( N = 3073). After controlling for age and sex, only scores on attentional and motor impulsivity, but not non-planning impulsivity, were predictive of higher body mass index. The magnitude of these relationships, however, was very small. Thus, future research needs to address possible mediators and moderators of the relationship between impulsivity and body mass in order to explain why only specific facets of impulsivity appear to play a role in obesity and under which circumstances heightened impulsivity levels are associated with higher body weight.

The sensitivity for one's own internal body signals (i.e., interoception) has been demonstrated to play an important role in the pathogenesis of eating and weight disorders. Most previous measures assessing interoceptive processing have not, or only partly, captured perception of hunger and satiety cues, which is a core aspect of interoceptive deficits in eating disorders. In addition, methods used to measure sensitivity to gastric signals are heterogeneous and findings inconsistent. The primary aim of the present study was to establish a standardised test to measure gastric interoception, and to provide normative data using a non-clinical adult sample. The two-step Water Load Test (WLT-II) involves ingestion of non-caloric water until perceived satiation (step 1) and until maximum fullness (step 2). The WLT-II consists of several variables: Besides volumes of water ingested until satiation and maximum fullness expressed in ml, percentage of satiation to maximum fullness is calculated as an individual index of gastric interoception that is not confounded with stomach capacity. Ninety-nine healthy women participated in the study. Measures included the WLT-II, the heartbeat tracking test, a self-report questionnaire assessing subjective sensations, and the Eating Disorder Inventory-2. Twenty-eight participants underwent test-retest of the WLT-II. Results suggest that the WLT-II is a valid and reliable measure of gastric interoception. Importantly, satiation volume and percentage of satiation to maximum fullness were strongly positively related to self-reported bulimic symptoms, indicating that the WLT-II could emerge as a useful clinical tool to measure interoceptive processing in the field of eating disorders.

BackgroundThe neuroplasticity hypothesis of major depressive disorder proposes that a dysfunction of synaptic plasticity represents a basic pathomechanism of the disorder. Animal models of depression indicate enhanced plasticity in a ventral emotional network, comprising the amygdala. Here, we investigated fear extinction learning as a non-invasive probe for amygdala-dependent synaptic plasticity in patients with major depressive disorder and healthy controls.MethodsDifferential fear conditioning was measured in 37 inpatients with severe unipolar depression (International Classification of Diseases, 10th revision, criteria) and 40 healthy controls. The eye-blink startle response, a subcortical output signal that is modulated by local synaptic plasticity in the amygdala in fear acquisition and extinction learning, was recorded as the primary outcome parameter.ResultsAfter robust and similar fear acquisition in both groups, patients with major depressive disorder showed significantly enhanced fear extinction learning in comparison to healthy controls, as indicated by startle responses to conditioned stimuli. The strength of extinction learning was positively correlated with the total illness duration.ConclusionsThe finding of enhanced fear extinction learning in major depressive disorder is consistent with the concept that the disorder is characterized by enhanced synaptic plasticity in the amygdala and the ventral emotional network. Clinically, the observation emphasizes the potential of successful extinction learning, the basis of exposure therapy, in anxiety-related disorders despite the frequent comorbidity of major depressive disorder.

Many individuals restrict their food intake to prevent weight gain. This restriction has both homeostatic and hedonic effects but their relative contribution is currently unclear. To isolate hedonic effects of food restriction, we exposed regular chocolate eaters to one week of chocolate deprivation but otherwise regular eating. Before and after this hedonic deprivation, participants viewed images of chocolate and images of high-calorie but non-chocolate containing foods, while experiential, behavioral and eyeblink startle responses were measured. Compared to satiety, hedonic deprivation triggered increased chocolate wanting, liking, and chocolate consumption but also feelings of frustration and startle potentiation during the intertrial intervals. Deprivation was further characterized by startle inhibition during both chocolate and food images relative to the intertrial intervals. Individuals who responded with frustration to the manipulation and those who scored high on a questionnaire of impulsivity showed more relative startle inhibition. The results reveal the profound effects of hedonic deprivation on experiential, behavioral and attentional/appetitive response systems and underscore the role of individual differences and state variables for startle modulation. Implications for dieting research and practice as well as for eating and weight disorders are discussed.

Intrusive memories--a hallmark symptom of posttraumatic stress disorder (PTSD)--are often triggered by stimuli possessing similarity with cues that predicted or accompanied the traumatic event. According to learning theories, intrusive memories can be seen as a conditioned response to trauma reminders. However, direct laboratory evidence for the link between fear conditionability and intrusive memories is missing. Furthermore, fear conditioning studies have predominantly relied on standardized aversive stimuli (e.g. electric stimulation) that bear little resemblance to typical traumatic events. To investigate the general relationship between fear conditionability and aversive memories, we tested 66 mentally healthy females in a novel conditioned-intrusion paradigm designed to model real-life traumatic experiences. The paradigm included a differential fear conditioning procedure with neutral sounds as conditioned stimuli and short violent film clips as unconditioned stimuli. Subsequent aversive memories were assessed through a memory triggering task (within 30 minutes, in the laboratory) and ambulatory assessment (involuntary aversive memories in the 2 days following the experiment). Skin conductance responses and subjective ratings demonstrated successful differential conditioning indicating that naturalistic aversive film stimuli can be used in a fear conditioning experiment. Furthermore, aversive memories were elicited in response to the conditioned stimuli during the memory triggering task and also occurred in the 2 days following the experiment. Importantly, participants who displayed higher conditionability showed more aversive memories during the memory triggering task and during ambulatory assessment. This suggests that fear conditioning constitutes an important source of persistent aversive memories. Implications for PTSD and its treatment are discussed.

Recent studies have begun to carve out a specific role for the rostral part of the dorsal medial prefrontal cortex (dmPFC) and adjacent dorsal anterior cingulate cortex (dACC) in fear/anxiety. Within a novel general framework of dorsal mPFC/ACC areas subserving the appraisal of threat and concomitant expression of fear responses and ventral mPFC/ACC areas subserving fear regulation, the rostral dmPFC/dACC has been proposed to specifically mediate the conscious, negative appraisal of threat situations including, as an extreme variant, catastrophizing. An alternative explanation that has not been conclusively ruled out yet is that the area is involved in fear learning. We tested two different fear expression paradigms in separate fMRI studies (study 1: instructed fear, study 2: testing of Pavlovian conditioned fear) with independent groups of healthy adult subjects. In both paradigms the absence of reinforcement precluded conditioning. We demonstrate significant BOLD activation of an identical rostral dmPFC/dACC area. In the Pavlovian paradigm (study 2), the area only activated robustly once prior conditioning had finished. Thus, our data argue against a role of the area in fear learning. We further replicate a repeated observation of a dissociation between peripheral-physiological fear responding and rostral dmPFC/dACC activation, strongly suggesting the area does not directly generate fear responses but rather contributes to appraisal processes. Although we succeeded in preventing extinction of conditioned responding in either paradigm, the data do not allow us to definitively exclude an involvement of the area in fear extinction learning. We discuss the broader implications of this finding for our understanding of mPFC/ACC function in fear and in negative emotion more generally.