Testing a mobile mindful eating intervention targeting craving-related eating: feasibility and proof of concept

Proof-of-concept testing of a mobile application-delivered mindfulness exercise for emotional eaters: RAIN delivered as a step-by-step image sequence

Background

Over fifty percent of individuals with overweight and obesity are emotional eaters. Emotional eating can be theorized as a conditioned response to eat for reasons that are not associated with physiological hunger. We conducted this proof-of-concept study to gather evidence that a mobile app that delivers a common non-meditative mindfulness exercise called RAIN, in a step-by-step image sequence can improve emotional eating and other outcomes over a 3-week period.

Methods

Forty-nine Canadian adults who self reported as emotional eaters (mean age =30.7 years) were recruited through social media and participated in a workshop in which RAIN and its use on the app were introduced. Participants were asked to use the app every time that they experienced a non-homeostatic craving to eat for three weeks. Emotional eating, reactivity to food cravings, perceived loss of control around food, distress tolerance, and eating-specific mindfulness were assessed pre- and post-intervention.

Results

Improvements on all outcomes were found (r-range, -0.58 to -0.28). The feasibility of the mobile application was demonstrated by a low attrition rate (8%), high user satisfaction, and strong app engagement metrics.

Conclusions

The data provide proof-of-concept evidence that a mobile app that delivers a mindfulness exercise in a step-by-step image sequence has potential to be effective and thus identifies a new approach that may reduce emotional eating in an accessible and affordable manner.

Mindfulness, mental health, and motives for eating tasty foods when not in metabolic need

Habitual consumption of highly palatable foods when not in metabolic need (HPF eating) is linked to obesity. High HPF consumption is also linked to mental health disorder (MHD) symptoms. Mindfulness-based interventions are popular treatments for obesity and MHDs, but little is known about the relationship between trait mindfulness and motive-based HPF eating. Therefore, a total of 927 young adults completed a survey that included the Palatable Eating Motives Scale-7 (which identifies Coping-, Reward enhancement-, Social-, and Conformity-eating), the Mindful Attention Awareness Scale, the Perceived Stress Scale, and demographic and body mass index (BMI) questions. An MHD questionnaire allowed a comparison of HPF eating between participants with and without various MHDs. Regressions revealed that Coping-eating was independently associated with lower mindfulness and also greater perceived stress, higher BMI, and female sex. Of these variables, only lower mindfulness was independently associated with Reward-, Social-, and Conformity-eating. Coping- and Reward-eating were more frequent in participants with versus without an anxiety disorder, depression, ADD/ADHD, and PTSD. Coping-eating was also more frequent in participants with body dysmorphic disorder. These findings warrant investigations in participants with clinically validated diagnoses for DSM-specific MHDs. Results from such investigations and the uncovered nature of associations between motive-specific HPF eating and trait mindfulness could provide novel targets to improve mindfulness-based interventions for obesity and MHDs.

Mind Your Heart: A Mindful Eating and Diet Education eHealth Program

OBJECTIVE

Examine user perceptions of the Mind Your Heart (MYH) program, a mindful eating and nutrition education program delivered via an eHealth system.

METHODS

Sixteen participants (41.5 ± 13.1 years) completed sample MYH lessons over 3 weeks. We examined changes in mindfulness from the State Mindfulness Scale via text messages sent 3 times per week. We assessed MYH user perceptions in a semistructured interview after 3 weeks. Analyses included Spearman's correlation, repeated measures ANOVA, and thematic analysis.

RESULTS

State Mindfulness Scale scores were significantly improved (F[1,15] = 5.35, P = 0.01) from week 1 (M = 2.28 ± 0.80) to week 3 (M = 2.75 ± 1.04). Four themes emerged: (1) MYH is supportive of health goals, (2) text messages act as an intervention, (3) facilitators or inhibitors of use, and (4) enhancing engagement.

CONCLUSIONS AND IMPLICATIONS

Based on participant feedback, the final version of MYH should include example-based learning to translate abstract concepts like mindful eating into action.

Exploring the association between self-compassion, mindfulness and mindful eating with eating behaviours amongst patients with obesity

Background: People who have obesity often experience problematic eating behaviours, contributing towards their excessive weight gain. Aims: Understanding problematic eating behaviours and their association to self-compassion, mindfulness and mindful eating is important for the development of future interventions that improve weight-loss and weight-regulation. Methods: One hundred and one participants attending their first session of a 6-session dietetic programme within a Tier 3 medical weight management service in the West Midlands, UK were recruited to complete questionnaires on self-compassion, mindfulness, mindful eating and eating behaviours, such as, emotional, restrained, external, fat and sugar consumption and grazing. Results: The findings suggested all three constructs, self-compassion, mindfulness and mindful eating were significantly and negatively associated with grazing and emotional eating, but mindful eating was the only construct that also displayed a significant and negative association with other eating behaviours that are often barriers to successful weight regulation, such as external eating and fat consumption. Further investigation suggested mindful eating had an indirect effect on fat consumption and grazing via external eating. Conclusion: Whilst, self-compassion, mindfulness and mindful eating displayed a negative relationship with grazing and emotional eating, mindful eating also displayed a negative relationship with fat consumption and external eating. Possible explanations and directions for future work are discussed with an emphasis on the need for more empirical work.

Comparative efficacy of remotely delivered mindfulness-based eating awareness training versus behavioral-weight loss counseling during COVID-19

Introduction

Dysregulated eating (emotional eating, cue-elicited eating, and dietary restraint and restriction) has been linked to being overweight or obese. The present investigation used a random controlled trial (RCT) to test the differential efficacy of remotely delivered Mindfulness-Based Eating Awareness Training (MB-EAT) and Behavioral Weight Loss (BWL) counseling.

Methods

The sample was recruited through advertisements that offered help to people "with problems controlling their eating" or "interested in improving their relationship with food" (n = 135).

Results

Retention was low in both groups (42%), but not dissimilar to retention rates reported in related clinical trials delivered "in person." Among the participants who completed treatment, we found no between-group differences in any of the treatment outcomes, but participants in both groups experienced significant increases in eating-related mindfulness [Mindful Eating Questionnaire (MEQ) and awareness [Multidimensional Assessment of Interoceptive Awareness (MAIA), and significant decreases in unhealthy eating patterns [Dutch Eating Behavior Questionnaire (DEBQ); Binge Eating Scale (BES), and weight over the course of treatment. Participants in both groups also experienced increases in self-reported depression and anxiety symptoms [Hospital Anxiety and Depression Scale (HADS)], although these increases likely reflected normative changes observed in the population at large during COVID-19.

Discussion

Overall, the results suggest that dysregulated eating and weight loss intervention delivered remotely via teleconference can be effective.

Effect of a novel telehealth device for dietary cognitive behavioral intervention in overweight or obesity care

Obesity has become a major public health issue which relate to numerous physical problems and highly comorbid with depression and anxiety. Recently, some studies of technology-based interventions for weight reduction emerged to overcome the barriers from time, cost and distance. Mood component and eating behavior related to obesity are less discussed so far with technology-based intervention though. This pilot study was aimed to investigate the effect of telehealth assisted intervention on weight reduction, mood status, and eating behavior change under a smartphone application (app) with novel 3D food picture recognition and incorporated with cognitive behavioral training programs. Adult aged 30-60 years old with overweight were recruited and randomly assigned to control-first group and intervention-first group. In period 1, control-first group had regular life and intervention-first group underwent app intervention; in period 2, two groups went crossover. Body composition and psychological/behavioral questionnaires were collected at baseline, end of period 1, and end of period 2. Nonparametric statistics was performed for data analyzing. A total of 20 participants were enrolled. In control-first group, there were statistically significant reduction in body weight (- 0.55 kg, p = 0.02) and change of body weight percentage (- 0.6%, p = 0.02) after App use. In intervention-first group, the fat percentage decreased by 0.4% after App use in period 1, and increased by 0.05% in period 2. The integrated crossover data revealed that subjects of App group had significant improvements in mindful eating behavior. This pilot study showed the effectiveness in using CogniNU app for weight control and eating behavior. The difference of short-term and long-term effectiveness of technology-based weight control intervention deserves more investigation in the future.Clinical Trial Registration: ISRCTN16082909.

A randomised controlled feasibility study of food-related computerised attention training versus mindfulness training and waiting-list control for adults with overweight or obesity: the FOCUS study

BACKGROUND

In a feasibility randomised controlled trial in people with overweight/obesity with and without binge eating disorder (BED) symptoms, we assessed eight weekly sessions of attention bias modification training (ABMT) and mindfulness training (MT) versus waiting list (WL) and explored potential mechanisms.

METHODS

45 participants were randomly allocated to one of three trial arms. Primary outcomes were recruitment, retention and treatment adherence rates. Secondary outcomes included measures of eating behaviour, mood, attention and treatment acceptability. Assessments were conducted at baseline, post-intervention (week 8), and follow-up (week 12).

RESULTS

Participant retention at follow-up was 84.5% across groups. Session completion rates in the laboratory were 87% for ABMT and 94% for MT, but home practice was much poorer for ABMT. Changes in BMI and body composition were small between groups and there was a medium size BMI reduction in the MT group at follow-up. Effect sizes of eating disorder symptom changes were not greater for either intervention group compared to WL, but favoured ABMT compared to MT. Hedonic hunger and mindful eating scores favoured MT compared to ABMT and WL. ABMT reduced attention biases towards high-calorie food cues, which correlated with lower objective binge eating days at post-intervention. No significant changes were observed in the MT, or WL conditions.

CONCLUSIONS

Both ABMT and MT have potential value as adjuncts in the treatment of obesity and BED, and a larger clinical trial appears feasible and indicated.

TRIAL REGISTRATION

ISRCTN Registry, ISRCTN15745838. Registered on 22 May 2018.

Lace Up and Mindfulness: A Randomized Controlled Trial Intervention to Reduce Emotional Eating, Anxiety, and Sleep Disturbances in Latinx and Black Youth

This study assessed the effects of a 12-week afterschool mindfulness-based diet and exercise intervention on mental and physical health in Latinx and Black youth. One hundred forty-eight boys and girls (average age = 10.1 years, SD = 1.3 years; 52% girls; 72.3% Latinx) were randomized to either the experimental group (n = 80) or the control group (n = 68). The experimental group participants engaged in fitness yoga, kickboxing, and/or spinning sessions, and mindfulness practices (e.g., breathing, meditation, and mindful eating) twice per week for 12 weeks. The control group participants engaged in a recreational play session once per week for 12 weeks. All participants completed surveys (demographics, acculturation, anxiety, emotional eating, sleep, and food intake) and had their height, weight, and percent body fat measured pre- and post-intervention. Participants wore an accelerometer for 7 days pre- and post-intervention. Repeated measures analysis of covariance indicated that the experimental group participants reported lower scores in emotional eating, anxiety, and sleep latency post-intervention compared to the control group participants. Conversely, no significant differences were observed in physical activity between the experimental and control group participants post-intervention. These findings indicate that a mindfulness-based intervention has a positive effect on emotional eating, anxiety, and sleep latency among youth of color.

Emotional Eating Interventions for Adults Living with Overweight or Obesity: A Systematic Review and Meta-Analysis

BACKGROUND

Emotional eating (EE) may be defined as a tendency to eat in response to negative emotions and energy-dense and palatable foods, and is common amongst adults with overweight or obesity. There is limited evidence regarding the effectiveness of interventions that address EE.

OBJECTIVES

To synthesize evidence on the effectiveness of EE interventions for weight loss and EE in adults living with overweight or obesity.

METHODS

This is a systematic review and meta-analysis. Adhering to the PRISMA guidance, a comprehensive electronic search was completed up to February 2022. Random effects meta-analysis was carried out to determine the percentage change in weight and EE scores.

RESULTS

Thirty-four studies were included. The combined effect size for percentage weight change was -1.08% (95% CI: -1.66 to -0.49, I² = 64.65%, n = 37), once adjusted for publication bias. Similarly, the combined effect size for percentage change in EE was -2.37%, (95% CI: -3.76 to -0.99, I² = 87.77%, n = 46). Cognitive Behavioural Therapy showed the most promise for reducing weight and improving EE.

CONCLUSIONS

Interventions to address EE showed promise in reducing EE and promoted a small amount of weight loss in adults living with overweight or obesity.

How Effective Are Mindfulness-Based Interventions for Reducing Stress and Weight? A Systematic Review and Meta-Analysis

Stress contributes to the development and maintenance of obesity. Mindfulness-based therapies are being used to reduce stress and promote weight reduction and maintenance. This study aimed to determine the efficacy of mindfulness-based interventions for stress and weight reduction in the short, medium, and long term. Searches on PsycINFO, Medline, CINAHL, Scopus, WOS, and Science Direct were conducted until March 2021. Intervention studies with a sample of adults were included; these evaluated a mindfulness-based intervention and used stress and weight or body mass index as outcome variables. These criteria were met by 13 articles. A meta-analysis of 8 of the 13 articles was performed with a random-effects or fixed-effects model, depending on the level of heterogeneity between studies. Mindfulness-based interventions had a small effect on stress reduction over a 3-month period: effect size (standardized mean difference) = -0.29 (95% CI: -0.49, -0.10). However, no significant evidence was found for stress reduction from 3 months onwards, nor for weight or body mass index reduction in any period. Mindfulness-based interventions are effective in reducing stress in the short term, but not in the medium or long term, nor are they effective for weight or body mass index. More robust and longer study designs are needed to determine their effects.

Examining socio-cognitive factors and beliefs about mindful eating in healthy adults with differing practice experience: a cross-sectional study

Background

Mindful eating (ME), defined as a “non-judgmental awareness of bodily and emotional sensations regarding food consumption”, may be a promising strategy to promote healthy eating behaviors. However, little is known about the psychosocial factors and underlying beliefs that explain ME adoption.

Methods

Participants (N = 282; M_age = 43.2) responded to an online questionnaire based on the I-Change Model. Groups with different frequencies of prior engagement in ME, i.e., low (n = 82; LME), medium (n = 96), and high (n = 104), were compared via (M)ANOVAs on factors and individual beliefs regarding predisposing (i.e., habits, experience with mindfulness, emotional eating, facets of ME), pre-motivational (i.e., knowledge, behavioral cognizance, risk perception, cues to action), and motivational factors (i.e., attitudes, self-efficacy, social influence) as well as their intentions and action planning. Bivariate correlations and a forward-stepwise regression with ICM constructs were conducted to examine model fit.

Results

LME had a greater habit of mindless eating and significantly lower internal awareness, cognizance, cues, and less favorable attitudes, self-efficacy, engagement and support by their social environment, intention, and action plans about engaging in ME than the other two groups. Less habitual mindless eating, and greater experience, internal awareness, cognizance, susceptibility, support, and intention explained 54% of the variance in ME.

Discussion and conclusion

Results indicate that individuals need to be treated differently when promoting ME with respect to their psychosocial characteristics, rather than as a single group with homogenous baseline beliefs, abilities, support, and motivation. Future longitudinal research should examine which determinants are predictors of ME to better tailor program contents.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40359-022-00977-4.

Delivery of Complementary and Integrative Health Using Virtual Health Resources: A Scoping Review

Introduction: Complementary and integrative health (CIH) modalities promote overall health and well-being and can be beneficial for individuals with a range of conditions. Traditionally, CIH has been delivered in person. COVID-19 created a need to identify sustainable remote delivery options to assure access to CIH while practicing public health recommendations. This scoping review maps the opportunities and challenges to remotely delivered CIH. Materials and methods: A scoping review was conducted between June 2020 and October 2020 using the following search engines: PubMed, Academic Search Premier, PsycINFO, CINAHL, Cochrane Reviews, and the Cochrane Clinical Trial Collections. Search results investigating remote CIH delivery were restricted to articles written in English, published after 1990. Results: Of the 10,884 articles identified, after review for content and methods, 330 articles were included. Most articles were randomized controlled trials (n = 170), applied mindfulness (n = 203), and targeted mental and behavioral health conditions (n = 182). Interventions were primarily delivered through mobile applications (n = 151) and web-based platforms (n = 86). Most commonly reported barriers were adherence (n = 24), resource requirements (e.g., time and space) (n = 23), and technology-related issues (n = 21). Although most studies did not report facilitators (n = 217), most commonly reported facilitators were social and technologic supports, accessibility, usability, perceptions, and rewards. Participant outcomes measured were broad and included movement (n = 88), stress (n = 68), and pain (n = 54). Intervention characteristic outcomes most often measured were satisfaction and usability (n = 5). Conclusions: This scoping literature review identified many articles addressing remote delivery of CIH, but few reporting on the implementation of remotely delivered CIH. Findings suggest remotely delivered CIH, specifically mindfulness and meditation-based modalities, is a viable treatment option for a diverse range of health conditions. Feasibility studies and larger sample sizes are recommended to strengthen the scientific evidence.

Analyzing the Impact of Mobile App Engagement on Mental Health Outcomes: Secondary Analysis of the Unwinding Anxiety Program

BACKGROUND

App-based interventions provide a promising avenue for mitigating the burden on mental health services by complimenting therapist-led treatments for anxiety. However, it remains unclear how specific systems' use of app features may be associated with changes in mental health outcomes (eg, anxiety and worry).

OBJECTIVE

This study was a secondary analysis of engagement data from a stage 1 randomized controlled trial testing the impact of the Unwinding Anxiety mobile app among adults with generalized anxiety disorder. The aims of this study were 2-fold: to investigate whether higher microengagement with the primary intervention feature (ie, educational modules) is associated with positive changes in mental health outcomes at 2 months (ie, anxiety, worry, interoceptive awareness, and emotional reactivity) and to investigate whether the use of adjunctive app features is also associated with changes in mental health outcomes.

METHODS

We analyzed the intervention group during the stage 1 trial of the Unwinding Anxiety mobile app. The total use of specific mobile app features and the use specific to each feature were calculated. We used multivariate linear models with a priori significance of α=.05 to investigate the impact of cumulative app use on anxiety, worry, interoceptive awareness, and emotional regulation at 2 months, controlling for baseline scores, age, and education level in all models. Significant relationships between system use metrics and baseline participant characteristics were assessed for differences in use groupings using between-group testing (ie, 2-tailed t tests for continuous data and chi-square analyses for categorical data).

RESULTS

The sample was primarily female (25/27, 93%), and the average age was 42.9 (SD 15.6) years. Educational module completion, the central intervention component, averaged 20.2 (SD 11.4) modules out of 32 for the total sample. Multivariate models revealed that completing >75% of the program was associated with an average 22.6-point increase in interoceptive awareness (b=22.6; SE 8.32; P=.01; 95% CI 5.3-39.8) and an 11.6-point decrease in worry (b=-11.6; SE 4.12; P=.01; 95% CI -20.2 to -3.1). In addition, a single log unit change in the total number of meditations was associated with a 0.62-point reduction in the Generalized Anxiety Disorder-7 scale scores (b=0.62; SE 0.27; P=.005; 95% CI -1.2 to -0.6), whereas a single log unit use of the stress meter was associated with an average of a 0.5-point increase in emotional regulation scores (Five Facet Mindfulness Questionnaire; b=0.5; SE 0.21; P=.03; 95% CI 0.1-0.9).

CONCLUSIONS

This study offers a clearer understanding of the impact of engagement with app features on broader engagement with the health outcomes of interest. This study highlights the importance of comprehensive investigations of engagement during the development of evidence-based mobile apps.

Change in craving and frequency of consuming palatable foods for non-homeostatic motives after a gut-cued eating intervention

INTRODUCTION

Little is known regarding consumption of palatable foods (PFs) for non-homeostatic reasons after weight-loss interventions and if baseline or change in frequency of this kind of eating can predict weight-loss outcomes. Little is also known of the relationship between PF eating for non-homeostatic motives and PF craving. Addressing these gaps is important because cravings and habitual consumption of PFs in the absence of homeostatic need contribute to obesity.

METHODS

N = 30 adults with a mean 34.8 BMI completed a seven-response choice version of the PEMS (PEMS-7) before and after Gut-Cued Eating (GCE), an intervention that did not ban PFs but instructed them to eat only when stomach-hungry and stop eating before feeling too full. Photos of PFs were also rated pre- and post-GCE.

RESULTS

Frequency of eating PFs for social, reward enhancement, and coping, but not conformity motives, decreased after GCE. The decreases predicted amount of weight loss independent of initial weight and demographics. PF craving also decreased and, while correlated with decreasing PF intake, it did not predict weight loss.

DISCUSSION

The study is preliminary because GCE was uncontrolled. However, results warrant a controlled investigation. That craving and frequency of consuming PFs for non-homeostatic motives declined with an intervention that did not ban PFs suggests a method that may voluntarily decrease one's intake of PFs. This should facilitate weight-loss and healthy-weight maintenance. Finally, decreased eating for non-homeostatic motives suggests that individuals were no longer using PFs to cope, socialize, and enhance reward, a change with benefits beyond weight loss.

Feasibility of a multiple-component mindfulness intervention for Chinese adolescents living with overweight: A pilot randomized trial

The prevalence of obesity among Chinese adolescents is rising rapidly, and theoretically informed, scalable weight management interventions are needed. We developed and evaluated the feasibility and preliminary effects of an mHealth nutrition education and mindful snacking intervention for weight loss and improved dietary practices among Chinese adolescents with overweight. We examined whether including implementation intention formation (using if-then plans) improved outcomes. With user consultation, we created a 3-week mindful eating intervention delivered as 10 videos to user smartphones. Participants (n = 55) were randomly assigned to mindful eating or mindful eating + planning. Forty-six (83.6%) participants (age = 16.35 ± 0.48 years; body mass index [BMI] = 25.79 ± 2.05 kg/m² ) completed the intervention. Both groups exhibited significant pre- to post-intervention weight loss (M = 1.42 and 1.79 kg, respectively); decreases in snacking frequencies, emotional eating, external eating, and trait craving; and significant increases in mindful eating and eating self-efficacy. No significant intervention group differences were observed. User experience data (n = 16) indicated acceptability and meaningful behavior change. Findings suggest that a smartphone-delivered mindfulness-based intervention for Chinese adolescents living with overweight is feasible and efficacious.

Brief Remote Intervention to Manage Food Cravings and Emotions During the COVID-19 Pandemic: A Pilot Study

As a result of the COVID-19 pandemic people have endured potentially stressful challenges which have influenced behaviors such as eating. This pilot study examined the effectiveness of two brief interventions aimed to help individuals deal with food cravings and associated emotional experiences. Participants were 165 individuals residing in United Kingdom, Finland, Philippines, Spain, Italy, Brazil, North America, South Korea, and China. The study was implemented remotely, thus without any contact with researchers, and involved two groups. Group one participants were requested to use daily diaries for seven consecutive days to assess the frequency of experience of their food cravings, frequency of giving in to cravings, and difficulty resisting cravings, as well as emotional states associated with their cravings. In addition to completing daily food diaries, participants in group two were asked to engage in mindful eating practice and forming implementation intentions. Participants assessed their perceived changes in eating, wellbeing, and health at the beginning and end of the intervention. Repeated measures MANOVAs indicated that participants experienced significantly less food cravings (i.e., craving experience, acting on cravings, difficulty resisting), as well as lower intensities of unpleasant states associated with cravings across time (T1 vs. T7). In contrast to our hypothesis, the main effects of the group (food craving diary vs. food craving diary and mindful eating practice) were not significant. Participants reported less eating and enhanced wellbeing at the end of the study (T7 vs. T1). Our findings can be used to inform future remote interventions to manage food cravings and associated emotions and highlight the need for alternative solutions to increase participant engagement.

Targeting Anxiety to Improve Sleep Disturbance: A Randomized Clinical Trial of App-Based Mindfulness Training

OBJECTIVE

Sleep disturbance is experienced by nearly 20% of Americans and is highly comorbid with anxiety. Sleep disturbances may predict the development of anxiety disorders. Mindfulness training (MT) has shown efficacy for anxiety yet remains limited by in-person-based delivery. Digitally delivered MT may target habitual worry processes, yet its effects on sleep have not been studied. This study tested if app-based MT for anxiety could reduce worry and improve sleep and examined the underlying mechanisms.

METHODS

Individuals reporting worry interfering with sleep were randomized to treatment as usual (TAU; n = 40) or TAU + app-based MT (n = 40). Treatment-related changes in worry-related sleep disturbances (WRSDs), worry, nonreactivity, and anxiety were evaluated via self-report questionnaires at 1 and 2 months after treatment initiation. Fitbit devices were used to record total sleep time and estimate sleep efficiency. At 2 months, TAU received access to app-based MT, and both groups were reassessed at 4 months.

RESULTS

In a modified intent-to-treat analysis, WRSD scores decreased by 27% in TAU + MT (n = 36) and 6% in TAU (n = 35) at 2 months (median [IQR] change = 11 [4.3] versus 15 [5.0], p = .001). These WRSD reductions were mediated by decreased worry, particularly improved nonreactivity (p values < .001). At 4 months, TAU reported a significant 29% reduction after beginning app-based MT at 2 months and TAU + MT maintained its gains. No significant between-group differences in average estimated total sleep time or sleep efficiency were found after 2 months of using the app.

CONCLUSIONS

Few mindfulness-related apps have been evaluated for clinical efficacy and/or mechanism. Results from this study demonstrate a mechanistic link between MT and increased emotional nonreactivity, decreased worry, and reduction in reported sleep disturbances, suggesting that app-based MT may be a viable option to help individuals who report that worry interferes with their sleep.Trial Registration: ClinicalTrials.gov identifier: NCT03684057.

Online Mindfulness Intervention for Inflammatory Bowel Disease: Adherence and Efficacy

The impact of stress and other psychological variables on Inflammatory Bowel Disease (IBD) prognosis, treatment response, and functional level is well-established; however, typical IBD treatment focuses on the physiological pathology of the disease and neglects complementary stress-reducing interventions. Recent pilot studies report the benefits of mindfulness-based interventions (MBIs) in people living with IBD, but are limited by small sample sizes. Recruitment challenges to in-person studies may be in part due to the difficulty IBD patients often have adhering to fixed schedules and travel as a result of IBD symptoms such as pain, fatigue, and incontinence. The current study aimed to address this barrier by offering participants access to online mindfulness training, allowing individuals to engage with intervention materials to fit their own schedule. Online mindfulness programs have gained popularity in recent years, as they increase access and flexibility and decrease cost to the user; however, the dropout rate tends to be high. The current study compared the rate of adherence and efficacy of mindfulness training as a function of level of support: self-guided versus supported. Analysis revealed no significant difference in the benefits received between participants in the two groups; however, a significant difference group (χ2 = 15.75; p = 0.000, r = 0.38) was found in terms of rate of completion, with 44.1% of the supportive group completing the protocol compared to 11.7% of the self-guided. Common challenges to meditation were measured, but did not significantly predict adherence to the intervention, and experience of these challenges did not significantly change (increase or decrease) over the duration of the study. Implications of the current research, future directions for the use of MBI for IBD patients, and a discussion of methodological considerations are provided.

A Conceptual Model of the Influence of Mindfulness-Based Interventions on Stress and Quality of Life in Patients With Chronic Conditions

Individuals with chronic conditions are susceptible to stress-related health complications. Left unattended, chronic stress exacerbates inflammation, diminishes quality of life (QOL), and increases all-cause mortality. Here, we suggest a theoretical framework promoting the use of mindfulness-based interventions (MBIs) in patients with chronic conditions and a conceptual model of how MBIs may influence stress and QOL.

Exploring perceptions about Mindfulness and Mindful Eating Programs for low-income women with overweight in primary health care

Background: Obesity and overweight are public health problems of multifactorial etiology, aggravated by the challenge that is maintaining weight loss. Used in the context of general health, mindfulness-based interventions (MBIs) have also showed positive effects when targeting changes to overweight-related eating behaviors. Methods: This study consists of a pragmatic randomized controlled trial conducted with 284 women from primary health care units. Data were collected from the last session with 16 focus groups, considering each intervention group (mindfulness or mindful eating) Aim: This article aims to present the perceptions of low-income overweight women who participated in Mindfulness and Mindful Eating intervention groups in primary health care according to each type of intervention. Results: Seven themes were identified: course challenges; valorization of the teacher's attitudes; mindfulness understanding; self-awareness development; change of expectations; development of a different food-weight relationship; and discover of a wide range of benefits. Conclusion: Mindfulness and Mindful eating interventions affect not only an individual's relationship with body and food, but also life and human relations. The results indicate the feasibility of the intervention, which addresses a large number of patients who lack treatment options for overweight or emotional and psychological issues associated with this condition. MBIs such as mindful eating are applicable in primary health care facilities, targeting overweight women and supporting treatment by addressing a repressed demand in the system. Similar to mind-body therapies, these interventions allow for comprehensive care.ClinicalTrials.gov, (NCT02893150) on 30 March 2017.

Mindfulness-Based Programs: Why, When, and How to Adapt?

This paper provides a framework for understanding why, when and how to adapt mindfulness-based programs (MBPs) to specific populations and contexts, based on research that developed and adapted multiple MBPs. In doing so, we hope to support teachers, researchers and innovators who are considering adapting an MBP to ensure that changes made are necessary, acceptable, effective, cost-effective, and implementable. Specific questions for reflection are provided such as (1) Why is an adaptation needed? (2) Does the theoretical premise underpinning mainstream MBPs extend to the population you are considering? (3) Do the benefits of the proposed adaptation outweigh the time and costs involved to all in research and implementation? (4) Is there already an evidenced-based approach to address this issue in the population or context? Fundamental knowledge that is important for the adaptation team to have includes the following: (1) essential ingredients of MBPs, (2) etiology of the target health outcome, (3) existing interventions that work for the health outcome, population, and context, (4) delivery systems and settings, and (5) culture, values, and communication patterns of the target population. A series of steps to follow for adaptations is provided, as are case examples. Adapting MBPs happens not only by researchers, but also by MBP teachers and developers, who endeavor to best serve the populations and contexts they work within. We hope that these recommendations for best practice provide a practical framework for skilfully understanding why, when, and how to adapt MBPs; and that this careful approach to adaptation maximizes MBP safety and efficacy.

The Synthesis of Europium-Doped Calcium Carbonate by an Eco-Method as Free Radical Generator Under Low-Intensity Ultrasonic Irradiation for Body Sculpture

Body sculpture is a common method to remove excessive fat. The diet and exercise are the first suggestion to keep body shape; however, those are difficult to keep adherence. Ultrasound has been developed for fat ablation; however, it could only serve as the side treatment along with liposuction. In the study, a sonosensitizer of europium-doped calcium carbonate (CaCO₃: Eu) would be synthesized by an eco-method and combined with low-intensity ultrasound for lipolysis. The crystal structure of CaCO₃: Eu was identified by x-ray diffractometer (XRD). The morphology of CaCO₃: Eu was analyzed by scanning electron microscope (SEM). The chemical composition of CaCO₃: Eu was evaluated by energy-dispersed spectrophotometer (EDS) and inductively coupled plasma mass spectrometer (ICP-MS). The electronic diffraction pattern was to further check crystal structure of the synthesized individual grain by transmission electron microscope (TEM). The particle size was determined by Zeta-sizer. Water-soluble tetrazolium salt (WST-1) were used to evaluate the cell viability. Chloromethyl-2′,7′-dichlorofluorescein diacetate (CM-H₂DCFDA) and live/dead stain were used to evaluate feasibility in vitro. SD-rat was used to evaluate the safety and efficacy in vivo. The results showed that CaCO₃: Eu had good biocompatibility and could produce reactive oxygen species (ROS) after treated with low-intensity ultrasound. After 4-weeks, the CaCO₃: Eu exposed to ultrasound irradiation on SD rats could significantly decrease body weight, waistline, and subcutaneous adipose tissue. We believe that ROS from sonoluminescence, CO₂-bomb and locally increasing Ca²⁺ level would be three major mechanisms to remove away adipo-tissue and inhibit adipogenesis. We could say that the combination of the CaCO₃: Eu and low-intensity ultrasound would be a non-invasive treatment for the body sculpture.

Clinical Efficacy and Psychological Mechanisms of an App-Based Digital Therapeutic for Generalized Anxiety Disorder: Randomized Controlled Trial

Background

Current treatments for generalized anxiety disorder (GAD) often yield suboptimal outcomes, partly because of insufficient targeting of underlying psychological mechanisms (eg, avoidance reinforcement learning). Mindfulness training (MT) has shown efficacy for anxiety; yet, widespread adoption has been limited, partly because of the difficulty in scaling in-person–based delivery. Digital therapeutics are emerging as potentially viable treatments; however, very few have been empirically validated.

Objective

The aim of this study is to test the efficacy and mechanism of an app-delivered MT that was designed to target a potential mechanism of anxiety (reinforcement learning), based on which previous studies have shown concern regarding feedback and the perpetuation of anxiety through negative reinforcement.

Methods

Individuals with GAD were recruited using social media advertisements and randomized during an in-person visit to receive treatment as usual (n=33) or treatment as usual+app−delivered MT (Unwinding Anxiety; n=32). The latter was composed of 30 modules to be completed over a 2-month period. Associated changes in outcomes were assessed using self-report questionnaires 1 and 2 months after treatment initiation.

Results

We randomized 65 participants in this study, and a modified intent-to-treat approach was used for analysis. The median number of modules completed by the MT group was 25.5 (IQR 17) out of 30; 46% (13/28) of the participants completed the program. In addition, the MT group demonstrated a significant reduction in anxiety (GAD-7) compared with the control group at 2 months (67% vs 14%; median change in GAD-7: –8.5 [IQR 6.5] vs –1.0 [IQR 5.0]; P<.001; 95% CI 6-10). Increases in mindfulness at 1 month (nonreactivity subscale) mediated decreases in worry at 2 months (Penn State Worry Questionnaire; P=.02) and decreases in worry at 1 month mediated reductions in anxiety at 2 months (P=.03).

Conclusions

To our knowledge, this is the first report on the efficacy and mechanism of an app-delivered MT for GAD. These findings demonstrate the clinical efficacy of MT as a digital therapeutic for individuals with anxiety (number needed to treat=1.6). These results also link recent advances in our mechanistic understanding of anxiety with treatment development, showing that app-delivered MT targets key reinforcement learning pathways, resulting in tangible, clinically meaningful reductions in worry and anxiety. Evidence-based, mechanistically targeted digital therapeutics have the potential to improve health at a population level at a low cost.

Trial Registration

ClinicalTrials.gov NCT03683472; https://clinicaltrials.gov/ct2/show/NCT03683472

(Re)defining mindful eating into mindful eating behaviour to advance scientific enquiry

BACKGROUND

Mindful eating has exceeded two decades of scientific enquiry but defining mindful eating has proven to be quite challenging.

AIM

The inability to clearly define mindful eating led to variations in the description in academic and clinical literature, different psychometric tools and the development of a field that is lacking the preciseness that is needed to advance mindful eating - and the associated interventions - onto a level that is simple to comprehend and implement in practice.

METHODS

Drawing from traditional and contemporary mindfulness and mindful eating literature, this manuscript will attempt to define and describe mindful eating in the context of eating behaviours.

RESULTS

The review of the literature has resulted in challenging areas around the main principles that should be included in defining the term mindful eating, and highlights the distinction between mindfulness and mindful eating, as well as behaviour and decision making within the context of mindful eating.

CONCLUSION

In a field that is lacking transparency and methodological rigour, mindful eating behaviour is detailed as a new beginning in conducting precise experimental research and evidence-based interventions for clinical and non-clinical use.

Effects of internet-delivered eating disorder prevention on reward-based eating drive: A randomized controlled trial

OBJECTIVE

This study is a secondary analysis testing the effects of an internet eating disorder prevention program on reward-based eating drive in a high-risk sample of college-aged women.

METHOD

We analyzed data from 278 women who were randomized to internet dissonance-based intervention (DBI-I), internet cognitive-behavioral treatment (CBTI), or no intervention (NI). Both active conditions consisted of self-guided activities completed over the course of four weeks. Linear mixed effects modeling was used to test the effect of internet intervention on reward-based eating drive.

RESULTS

DBI-I was associated with greater reductions in reward-based eating over time than NI. No other Condition × Time effects were found.

DISCUSSION

The results provide preliminary support for DBI-I as a strategy for reducing reward-based eating drive in a high-risk population relative to no intervention.

Mindfulness and Behavior Change

Initiating and maintaining behavior change is key to the prevention and treatment of most preventable chronic medical and psychiatric illnesses. The cultivation of mindfulness, involving acceptance and nonjudgment of present-moment experience, often results in transformative health behavior change. Neural systems involved in motivation and learning have an important role to play. A theoretical model of mindfulness that integrates these mechanisms with the cognitive, emotional, and self-related processes commonly described, while applying an integrated model to health behavior change, is needed. This integrative review (1) defines mindfulness and describes the mindfulness-based intervention movement, (2) synthesizes the neuroscience of mindfulness and integrates motivation and learning mechanisms within a mindful self-regulation model for understanding the complex effects of mindfulness on behavior change, and (3) synthesizes current clinical research evaluating the effects of mindfulness-based interventions targeting health behaviors relevant to psychiatric care. The review provides insight into the limitations of current research and proposes potential mechanisms to be tested in future research and targeted in clinical practice to enhance the impact of mindfulness on behavior change.

The Mindfulness Map: A Practical Classification Framework of Mindfulness Practices, Associated Intentions, and Experiential Understandings

When considering the numerous mindfulness-based and mindfulness-informed programs that have flourished in the past decades it is not always clear that they all refer to the same "mindfulness. " To facilitate more clarity and precision in describing, researching and teaching mindfulness in the secular settings, we propose a classification framework of mindfulness practices, intentions behind them and the experiential understandings the practices may aim to develop. Accordingly, the proposed framework, called the Mindfulness Map, has two axes. The first axis outlines mindfulness practices (and associated instructions) classified into four groups (MGs), e.g. the MG1 focuses on cultivating attention to the present moment somatic and sensory experience while the MG4 focuses on cultivating the ability to recognize and deconstruct perceptual, cognitive and emotional experiences and biases. The second axis outlines possible intentions (INTs) to cultivate particular experiential understanding (EU) via teaching and practicing the MGs, e.g., the INT1 designates the intention to gain EU of how our relationship to experience contributes to wellbeing, the INT2 refers to the intention to gain EU of the changing nature of body, mind and external phenomenon. We suggest that the same MG can lead to different EUs outcomes based on the specific INTs applied in their teaching or practice. The range of INTs and EUs included here is not exhaustive, there are further types the Map could be expanded toward. Aside from encouraging more fine-grained distinctions of mindfulness practices, the proposed Map aims to open discussions about interactions between MGs, INTs, EUs and practice outcomes. The Map may facilitate more nuanced and precise approaches to researching the range of outcomes cultivated by mindfulness practices, help bridge contradictory findings, and catalyze further debate and research into ethical aspects of mindfulness. The Map also highlights the need for further teaching development and research on longer-term trajectories of mindfulness practice. While the proposed Mindfulness Map organises the mindfulness practice territory along two axes, it is aimed as a starting point for further discussion and can be further revised and/or expanded by other axes.

Negative Mood and Food Craving Strength Among Women with Overweight: Implications for Targeting Mechanisms Using a Mindful Eating Intervention

Objectives

When experiencing negative mood, people often eat to improve their mood. A learned association between mood and eating may cultivate frequent food cravings, detracting from health goals. Training in mindful eating may target this cycle of emotion-craving-eating by teaching individuals to manage urges when experiencing negative mood. We examined the impact of a mobile mindful eating intervention on the link between negative mood and food cravings among overweight women.

Methods

In a single-arm trial, participants (n = 64, M age = 46.1 years, M BMI = 31.5 kg/m²) completed ecological momentary assessments of negative mood and food cravings 3 times/day for 3 days pre- and post-intervention, as well as 1-month post-intervention. Using multilevel linear regression, we compared associations between negative mood and food craving strength at pre- vs. post-intervention (model 1) and post-intervention vs. 1-month follow-up (model 2).

Results

In model 1, negative mood interacted with time point (β =  − .20, SE = .09, p = .02, 95% CI [− .38, − .03]) to predict craving strength, indicating that the within-person association between negative mood and craving strength was significantly weaker at post-intervention (β = 0.18) relative to pre-intervention (β = 0.38). In model 2, negative mood did not interact with time point to predict craving strength (β = .13, SE = .09, p = .10, 95% CI − .03, .31]); the association did not significantly differ between post-intervention and 1-month follow-up.

Conclusions

Training in mindful eating weakened the mood-craving association from pre- to post-intervention. The weakened association remained at follow-up. Our findings highlight the mood-craving link as a target-worthy mechanism of mindful eating that should be assessed in clinical trials.

Trial Registration

NCT02694731

Supplementary Information

The online version contains supplementary material available at 10.1007/s12671-021-01760-z.

Development and Validation of the Four Facet Mindful Eating Scale (FFaMES)

OBJECTIVES

Previous mindful eating scales stress the attentional domains of eating-specific mindfulness, such as present-moment attention to homeostatic cues of hunger and satiety while discounting other important domains such as non-judgment and decentering. The purpose of the series of studies was to develop and evaluate a multifaceted mindful eating scale that assesses several domains of eating-specific mindfulness.

METHODS

A multistep process was used to construct the Four Facet Mindful Eating Scale (FFaMES). Study 1 outlined the initial scale construction and the development of a novel item pool (N = 480). Study 2 examined the internal structure of the observed variables using exploratory analysis (N = 445) and confirmatory analysis in a separate sample (N = 445). Reliability and validity were assessed in Study 3 (N = 166).

RESULTS

The final scale consists of 29 items with 4 factors: Non-Reactance, Non-Judgment, External Awareness, and Internal Awareness. The FFaMES demonstrated good internal consistency, retest reliability as well as preliminary convergent and divergent validity.

CONCLUSIONS

Our findings provide reliability evidence and initial support for the construct validity of the FFaMES and the continued study of multiple facets of eating-specific mindfulness. Future research should continue to investigate the differential effects of various aspects of eating-specific mindfulness in the prevention and treatment of obesity and its comorbidities.

Can Approaching Anxiety Like a Habit Lead to Novel Treatments?

Anxiety disorders make up the most prevalent class of mental illnesses. Given the growing prevalence of anxiety in the United States and beyond, there is an urgent clinical need to develop nonpharmacologic treatments that effectively treat and reduce its core symptoms (eg, worry). A leading theory posits that although worrying may be unpleasant, the immediate emotions that are avoided by concentrating on worry are often perceived as more aversive (eg, fear, anger, grief). From a mechanistic perspective, worry is thought to be learned and reinforced in a similar manner to other types of positively and negatively reinforced behaviors: habits. Mindfulness training, a practice that brings awareness to cognitive, affective, and physiological experiences, when delivered in-person via programs such as mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy (MBCT), has demonstrated effectiveness in reducing anxiety, but is difficult to scale in this manner. In this review, we explore novel approaches to using mindfulness training to specifically target the theoretical mechanisms underlying the perpetuation of anxiety (eg, worry as a habit), and the emergence of mobile health platforms (eg, digital therapeutics) as potential vehicles for remote delivery of treatment.

Awareness drives changes in reward value which predict eating behavior change: Probing reinforcement learning using experience sampling from mobile mindfulness training for maladaptive eating

BACKGROUND AND AIMS

Maladaptive eating habits are a major cause of obesity and weight-related illness. The development of empirically-based approaches, such as mindfulness training (MT) that target accurate mechanisms of action to address these behaviors is therefore critical. Two studies were conducted to examine the impact of MT on maladaptive eating and determine the involvement of reinforcement learning mechanisms underlying these effects.

METHODS

In Study1, maladaptive eating behaviors were assessed using self-report questionnaires at baseline and 8 weeks after an app-based MT intervention (n = 46). A novel mindful eating craving tool was embedded in our intervention to assess: eating behaviors (intake frequency/magnitude), and reward (contentment ratings) experienced after eating. Using a well-established reinforcement learning (Rescorla-Wagner) model, expected reward values (EV) were estimated as a function of contentment levels reported after eating. In Study2 (n = 1,119), craving tool assessments were examined in an independent sample using the app in a real-world naturalistic context.

RESULTS

Study 1's results revealed a significant decrease in EV and eating behaviors across craving tool uses. In addition, changes in reward values predicted decreases in eating behaviors. Finally, Study 1's results revealed significant pre-post intervention reductions in self-reported eating behaviors. In Study2, we observed a significant decrease in EV, but not in eating behaviors, across craving tool uses. Study 2 also revealed a predictive relationship between EV and eating behaviors.

DISCUSSION AND CONCLUSIONS

These results support the implementation of MT to prevent and treat maladaptive eating behaviors, which target reinforcement learning processes as mechanisms of action.

Effectiveness of eHealth Nutritional Interventions for Middle-Aged and Older Adults: Systematic Review and Meta-analysis

BACKGROUND

The risk of development of chronic diseases related to poor nutrition increases with age. In the face of an aging population, it is important for health care sectors to find solutions in delivering health services efficiently and effectively to middle-aged and older adults.

OBJECTIVE

The aim of this systematic review and meta-analysis was to consolidate the literature that reported the effectiveness of eHealth apps in delivering nutritional interventions for middle-aged and older adults.

METHODS

A literature search from five databases (PubMed, CINAHL, Cochrane, Web of Science, and Global Health) from the past 5 years was performed. Studies were selected for inclusion that used eHealth to deliver nutritional interventions to adults aged 40 years and above, and reported health and behavioral outcomes. Two independent reviewers searched for research articles and assessed the eligibility of studies to be included in the review. A third reviewer resolved disagreements on study inclusion. We also assessed the quality of the included studies using the CONSORT 2010 checklist.

RESULTS

A total of 70 studies were included for analysis. The study quality ranged from 44% to 85%. The most commonly used eHealth intervention type was mobile apps (22/70, 31%). The majority of studies (62/70, 89%) provided multicomponent health interventions, which aimed to improve nutrition and other health behaviors (eg, exercise, smoking cessation, medication adherence). Meta-analysis results indicated high and significant heterogeneity; hence, conclusions based on these results should be considered with caution. Nonetheless, the results generally showed that eHealth interventions improved anthropometric and clinical outcomes, but not behavioral outcomes such as fruit and vegetable consumption.

CONCLUSIONS

The use of eHealth apps to deliver health interventions has been increasing in recent years, and these apps have the potential to deliver health services to a larger group of people. Our findings showed that the effectiveness of eHealth apps to deliver health interventions for middle-aged to older adults was supported by the improvement of anthropometric and clinical outcomes. Future work could aim to develop research frameworks in administering eHealth interventions to address heterogeneity in this field of research.

Stages of a transtheoretical model as predictors for the decline of estimated glomerular filtration rate: a retrospective cohort study

Background

The transtheoretical model (TTM) is composed of the multiple stages according to patient’s consciousness and is believed to lead people to realize the importance of healthier behaviors. We examined the association of TTM stages with the decline of estimated glomerular filtration rate (eGFR).

Methods

We used the annual health checkup data and health insurance claims data of the Japan Health Insurance Association in Kyoto Prefecture between April 2012 and March 2016. TTM stages of change obtained from questionnaires at the first health checkup and categorized into six groups. The primary outcome was defined as a more than 30% decline in eGFR from the first health checkup. We fitted multivariable Cox proportional-hazards model for time-to-event analyses adjusting for age, sex, eGFR, body mass index, blood pressure, blood sugar, dyslipidemia, uric acid, urinary protein, and existence of kidney diseases at first health checkup.

Results

We analyzed 239,755 employees and the mean follow-up was 2.9 (standard deviation, 1.2) years. As compared with the stage 1 group, the risk of eGFR decline was significantly low in the stage 3 group (hazard ratio [HR] 0.77; 95% confidence interval [CI], 0.65–0.91); stage 4 group (HR 0.80; 95% CI, 0.65–0.98); and stage 5 group (HR 0.79; 95% CI, 0.66–0.95).

Conclusion

Compared with the precontemplation stage (stage 1), the preparation, action and maintenance stages (stages 3, 4, and 5), were associated with a lower risk of eGFR decline.

Eating patterns and unhealthy weight control behaviors are associated with loss-of-control eating following bariatric surgery

BACKGROUND

Loss-of-control (LOC) eating is associated with poor weight-loss outcomes following bariatric surgery. It is not clear whether eating patterns (e.g., total number of daily meals/snacks, eating after suppertime, eating when not hungry) and unhealthy weight control behaviors (e.g., smoking, using laxatives) are associated with or predictive of LOC eating.

OBJECTIVES

To examine whether eating patterns and unhealthy weight-control behaviors are associated with LOC eating and, if so, whether they predict LOC eating in bariatric patients.

SETTING

Multicenter study, United States.

METHODS

This is a secondary analysis of the Longitudinal Assessment of Bariatric Surgery-2 study. Assessments were conducted before surgery and at 12, 24, 36, 48, 60, and 84 months after surgery. Logistic mixed models were used to examine the longitudinal associations between eating patterns, unhealthy weight-control behaviors, and LOC eating. Time-lag techniques were applied to examine whether the associated patterns and behaviors predict LOC eating.

RESULTS

The participants (n = 1477) were mostly women (80%), white (86.9%), and married (62.5%). At the time of surgery, the mean age was 45.4 ± 11.0 years and the mean body mass index was 47.8 ± 7.5 kg/m². The total number of daily meals/snacks, food intake after suppertime, eating when not hungry, eating when feeling full, and use of any unhealthy weight-control behaviors were positively associated with LOC eating (P < .05). Food intake after suppertime, eating when not hungry, and eating when feeling full predicted LOC eating (P < .05).

CONCLUSION

Meal patterns and unhealthy weight control behaviors may be important intervention targets for addressing LOC eating after bariatric surgery.

Can mindfulness mechanistically target worry to improve sleep disturbances? Theory and study protocol for app-based anxiety program

OBJECTIVE

Anxiety is associated with sleep disturbance and insomnia. Mindfulness-based interventions, such as mindfulness-based stress reduction, have shown consistent anxiety reduction. Mindfulness training has been theorized to affect reinforcement learning, affecting habitual behaviors such as smoking and overeating, but a direct mechanistic link between the use of mindfulness training for anxiety reduction and improvement in sleep has not been studied. Moreover, the mechanisms by which mindfulness might affect worry and subsequent sleep disturbances have not been elucidated. This study protocol evaluates the impact an app-based mindfulness training program for anxiety might have on decreasing worry and improvement in sleep.

METHOD

A randomized controlled study will be conducted in approximately 80 adults with worry that interferes with their sleep. Participants will be randomly allocated (1:1) to two groups: treatment-as-usual (TAU) or TAU + App-Based Mindfulness Training (Unwinding Anxiety app). The primary outcomes will be the non-reactivity subscale of the Five Facet Mindfulness Questionnaire and Patient-Reported Outcomes Measurement Information System sleep quality measures (Baer et al., 2008; Yu et al., 2011). Secondary outcomes will include the Penn State Worry Questionnaire, Generalized Anxiety Disorder-7, and Multidimensional Assessment of Interoceptive Awareness Scale (Mehling et al., 2012; Meyer, Miller, Metzger, & Borkovec, 1990; Spitzer, Kroenke, Williams, & Löwe, 2006).

DISCUSSION

This study will be the first to test the mechanism of app-based mindfulness training on worry and sleep disturbance. Testing the mechanistic effects of mindfulness training using the science of behavior change framework will help move the field forward both in further elucidation of potential mechanisms of mindfulness (e.g., targeting reinforcement learning) and determining whether such a platform might be a viable method for delivering high-fidelity treatment at scale and for a low cost. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Self-Regulation Without Force: Can Awareness Leverage Reward to Drive Behavior Change?

To reach longer-term goals and live aligned with their values, people typically must regulate their behavior. Effortful self-control is one way to achieve this and is usually framed as a forceful struggle between lower-level impulses and higher-level cognitive control processes. For example, people may restrain themselves from eating cake in order to lose weight. An alternative avenue of self-regulation draws on autonomous motivation: Individuals eat healthfully because it is values-congruent or intrinsically satisfying. Recent advances in the understanding of reward valuation on a neural level (e.g., ventromedial prefrontal cortex/orbitofrontal cortex) and emerging treatments on a clinical level (e.g., mindfulness training) suggest a possible mechanistic convergence between brain and behavior that is consistent with a shift from forced to unforced behavior change. Here we propose how an overlooked aspect of reinforcement learning can be leveraged using a simple yet critical feature of experience that is not reliant on willpower: Bringing awareness to one's subjective experience and behavior can produce a change in valuation of learned but unhealthy behaviors, leading to self-regulatory shifts that result in sustainable behavior change without force.

Using health action process approach to determine diet adherence among patients with Type 2 diabetes

INTRODUCTION

Diet adherence may cause diabetes complications to be diminished.

OBJECTIVES

This study aimed at identifying determinants of diet adherence among patients with Type 2 diabetes based on the health action process approach (HAPA).

METHODS

In this cross-sectional study, 734 patients with Type 2 diabetes, attending to South Tehran health centers, were recruited during June-December 2018. The dietary regimen scale (nine items) and a researcher-designed questionnaire consisting of HAPA constructs were used to gather the data. Data were analyzed using the Mann-Whitney test, Pearson Chi-squared test, Fisher's exact test, and linear regression test. All statistical tests were assessed using SPSS (IBM Corp. Released 2017. IBM SPSS Statistics for Windows, Version 25.0. Armonk, NY, USA: IBM Corp.).

RESULTS

The level of nonadherence to diet was 91.1%. Diet adherence was significantly associated with family income (P = 0.005), level of education (P < 0.001), and age (P = 0.009). The linear regression showed that 55% of the variance of diet adherence was determined by HAPA variables. Diet adherence was associated with intention (P < 0.001), action planning (P = 0.005), and barriers (P = 0.003).

CONCLUSION

Most of the patients did not adhere to their diet. Appropriate programs should be designed to promote diet adherence among the patients, especially those with low literacy and patients living in poor communities.

Women's Experiences with a Mindful Eating Program for Binge and Emotional Eating: A Qualitative Investigation into the Process of Change

Objectives: Mindfulness-based interventions (MBIs) have been shown to reduce engagement in disordered eating behaviors, although how these interventions engender change remains unclear. The objective of this exploratory qualitative study was to describe the experiences and perceived attitudinal and behavioral changes of women participating in a mindful eating program. Design: Focus group discussions were held with women participating in a community-based mindful eating program for binge and emotional eating. A semistructured interview guide was used to explore participants' conceptualizations of mindfulness-based attitudinal and behavior change, as related to food, eating, and body image. The focus group discussions were audio-recorded, transcribed, and analyzed using thematic analysis to identify salient concepts. Settings/Location: Focus group discussions were held at the Center for Mindfulness at the University of Massachusetts Medical School (UMMS) (United States). Participants: A sample of nine women who were enrolled in the mindful eating program at UMMS for problems with self-reported binge and/or emotional eating participated in this study. Results: Four themes were constructed that described a process of mindfulness-based behavior change, including (1) Learning Through Self-Awareness, (2) Self-Empowerment, (3) Mindful Choice-Making, and (4) Resilient Self-Care. An overarching description of the participants' perceived attitudinal and behavior changes was developed: "unforced freedom of choice, emerging from embodied awareness." Conclusions: These findings suggest that MBIs reduce may disordered eating behaviors through empowering women to make positive choices about food, eating, and coping, without focusing on weight control. Future research is needed to examine whether these findings replicate in larger and more diverse samples, and how they can be used to optimize and implement eating-specific MBIs in community-based settings.

Mindfulness-based emotional eating awareness training: taking the emotional out of eating

PURPOSE

Emotional eating is important to study and address because it predicts poor outcome in weight loss interventions. Interventions have only touched the surface in terms of addressing emotional eating. Mindfulness approaches can address emotional eating by modification of emotion regulation and appetitive traits. The current study involved development of an emotional eating-specific mindfulness intervention and assessment of its effect on appetitive traits associated with emotional eating.

METHODS

Participants (n = 14; age M = 29 years; 90% female) completed baseline and end-of-intervention self-report measures of emotional eating, food-cue reactivity, mindfulness, intuitive eating, emotional impulse regulation, stress, and a behavioural measure of inhibitory control. During the 6-week intervention, mindfulness meditation skills were taught weekly embedded in a psycho-educational curriculum about emotional eating.

RESULTS

Paired t tests, controlled for type 1 error, revealed significant improvements in food-cue reactivity, intuitive eating, emotional impulse regulation, inhibitory control and stress (ps < 0.05; d: 0.58-1.54). Changes in emotional eating approached significance (p = 0.075, d = 0.66).

CONCLUSION

The intervention purposefully did not focus on weight loss and recruited participants who had self-declared difficulties with emotional eating. The positive outcomes suggest that intervening with mindfulness training before weight loss is attempted has the potential to change psychological factors that underpin overeating and undermine weight loss efforts. The study provides proof of principle as a basis to design a randomized control trial to assess rigorously the effectiveness of the intervention as a precursor to a weight loss intervention.

LEVEL OF EVIDENCE

Level IV, uncontrolled trial.

Brain activation and affective judgements in response to personal dietary images: An fMRI preliminary study

Emerging evidence from functional magnetic resonance imaging (fMRI) brain activation studies associated with dietary behavior reveals significant interaction of biological and behavioral mechanisms in response to visualized food stimuli. Because food intake is influenced by neurosensory stimulation and memory cues, personalized food images may be useful in prompting appropriate affective responses to food intake, which may subsequently lead to healthier eating behaviors. The current study used a cross-sectional mixed methods approach to explore neural responses and self-perceptions of eating behavior during review of personalized food images. A sample of college students (N = 16; 9 females; M age = 21.44) used cell-phone cameras and an online dietary tracking website to collect and report three days of diet. Within 2-3 weeks of completing dietary tracking activity, participants underwent an fMRI scan while reviewing recorded personal images and text descriptions of their diet. They also responded to three questions related to memory for the food items and future eating intentions. Post-scan interviews explored how participants felt after reviewing personal food images and the possible impact that such review might have on future food choices. Whole brain analyses suggested, compared to a written dietary record, that the visualization of personal images of diet evoked greater brain activation in memory regions (e.g., superior frontal gyrus) along with mediating emotion (e.g., thalamus, putamen, anterior cingulate cortex), imagery and executive functions (e.g., inferior orbitofrontal gyrus, fusiform, and parietal lobe). This study offers preliminary support for the use of personal food images to strengthen dietary monitoring.

Physician Anxiety and Burnout: Symptom Correlates and a Prospective Pilot Study of App-Delivered Mindfulness Training

BACKGROUND

Physician burnout is on the rise, yet little is known about its relationship to anxiety. Mindfulness-based stress reduction has demonstrated decreases in anxiety, yet physicians have reported reluctance to engage in it due to significant time commitments.

OBJECTIVE

The aims of this study are to assess whether app-based mindfulness training can reduce anxiety in physicians and to explore if anxiety and burnout are correlated, thus leading to a reduction in both anxiety and burnout.

METHODS

This was a nonrandomized pilot study comprised of 34 physicians who worked in a large US health care network and reported having anxiety. The intervention was an app-based mindfulness program. The main outcome measure was anxiety, measured by the Generalized Anxiety Disorder-7 (GAD-7). The secondary outcome measures assessed burnout: cynicism and emotional exhaustion items from the Maslach Burnout Inventory.

RESULTS

GAD-7 scores decreased significantly at posttreatment (1 month after treatment initiation, 48% reduction, P<.001) and at the 3-month follow-up (57% reduction, P<.001). There was a significant correlation between anxiety and burnout (cynicism: r=.43; P=.01; emotional exhaustion: r=.71; P<.001). There was also a significant decrease in cynicism (50% reduction, P=.003 at posttreatment; 50% reduction, P=.009 at follow-up) and emotional exhaustion at both time points (20% reduction, P<.001 at posttreatment; 20% reduction, P=.003 at follow-up).

CONCLUSIONS

This pilot study is the first to test an app-based mindfulness training program targeted at reducing anxiety with physicians and to demonstrate that in physicians, anxiety is correlated with burnout. These findings suggest that this may be an effective tool to reduce anxiety and burnout in physicians.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04137081; https://www.clinicaltrials.gov/ct2/show/NCT04137081.

Twenty Years of the Food Cravings Questionnaires: a Comprehensive Review

Purpose of Review

The Food Cravings Questionnaires (FCQs; Cepeda-Benito, Gleaves, Williams, & Erath, 2000) are among the most widely used instruments for measuring food cravings. In addition to the Food Cravings Questionnaire–Trait (FCQ–T) and the Food Cravings Questionnaire–State (FCQ–S), several modified versions have been developed as well. For their 20th anniversary, this article provides a comprehensive description of the FCQs and reviews studies on their psychometric properties and correlates.

Recent Findings

The FCQs and their modified versions have excellent internal reliability. Expectedly, the FCQ–T (and its derivatives) has higher retest-reliability than the FCQ–S as the FCQ–S is sensitive to situational changes such as food deprivation and food intake. However, while the FCQ–T is largely unaffected by such momentary states, it is also sensitive to change during weight-loss treatments and other interventions. Factor structure of the FCQ–T and FCQ–S has only partially been replicated. Construct validity of the FCQs is supported by experimental and longitudinal studies that measured food craving and food consumption in the laboratory and with ecological momentary assessment.

Summary

Numerous studies support reliability and validity of the FCQs and their modified versions, yet findings about their factor structures are inconsistent. Thus, using total scores or the short versions of the FCQs may be preferable.

Study protocol of a randomised controlled feasibility study of food-related computerised attention training versus mindfulness training and waiting-list control for adults with overweight or obesity

Background

Obesity is a highly prevalent condition with multiple adverse health consequences. Widely available first-line treatments for obesity, such as dietary and other lifestyle interventions, typically have only short-term effects. Thus, new treatment approaches are needed. Novel interventions such as Attention Bias Modification Training (ABMT) and mindfulness-based interventions focus on modifying different maladaptive cognitive patterns typically present in people with obesity (e.g. attention bias to food cues); however, their mechanisms of action remain largely unknown. We describe the theoretical basis and the rationale for a study protocol of a feasibility randomised controlled trial (RCT) comparing two attention trainings (ABMT vs Mindfulness Training [MT]) in people with overweight or obesity. The aim of this study is to inform the development of a large-scale RCT in relation to acceptability and attendance rates and to identify preliminary evidence for the interventions’ clinical efficacy and potential underlying mechanisms.

Design

Forty-five adults who are either overweight or obese (minimum body mass index of 25 kg/m²) will be randomly allocated to receive eight sessions over eight weeks of either computerised ABMT or MT or be on a waiting list. Clinical and cognitive outcomes will be assessed at baseline, post-treatment (8 weeks) and follow-up (12 weeks post-randomisation). These include mood, body composition and attention biases. Credibility and acceptability of the trainings will be assessed using questionnaires, and recruitment and retention rates will be recorded.

Discussion

Findings will inform the feasibility of developing a large-scale RCT that takes into consideration effect sizes for primary outcome measures and the acceptability of the design. The study will also provide preliminary evidence on the clinical efficacy of two different attention trainings for people with obesity and associated underlying mechanisms.

Trial registration

ISRCTN Registry, ISRCTN15745838. Registered on 22 May 2018. 

A Randomised Experiment Evaluating the Mindful Raisin Practice as a Method of Reducing Chocolate Consumption During and After a Mindless Activity

The present study investigated the impact of the mindful raisin exercise on overeating during and after the experiment while controlling for wellbeing. One-hundred and twenty-eight participants were recruited and completed a questionnaire on wellbeing (i.e. depression, anxiety and stress) and state mindfulness. Participants were randomly allocated to either the mindful raisin exercise or a newspaper reading control condition. The State Mindfulness Scale was then completed again, and participants watched a neutral video while exposed to chocolate for 10 min. For those 10 min, results showed that the mindfulness condition translated into lower food consumption during the mindless activity when compared to the control condition. Post experiment, participants were asked to wait for 5 min, and any extra chocolate consumption during this time was recorded. Post-consumption was non-significantly different between the two groups, with those in the mindfulness condition consuming 1.3 g less than those in the control group. Controlling for wellbeing did not alter the impact of the mindfulness intervention on consumption. Implications for future work and practical applications for weight regulation are discussed.

Do stress eating or compulsive eating influence metabolic health in a mindfulness-based weight loss intervention?

OBJECTIVE

We aimed to understand the associations of compulsive eating (CE) and stress eating (SE) with metabolic health among adults with obesity and whether mindfulness-based weight loss training may buffer these associations.

METHOD

We used data from a trial in which we randomized 194 participants with obesity to a diet-exercise weight loss intervention with either mindful eating training plus mindfulness-based eating awareness and stress management training (n = 100) or active control components (n = 94). We measured CE, SE, weight, and fasting blood glucose (FBG) at baseline, and 6, 12 months, and 18 months. We tested CE and SE as both moderators and mediators of intervention effects on changes in metabolic health.

RESULTS

Participants higher (+ 1 SD) in CE at baseline randomized to the mindfulness (vs. control) intervention had greater improvements in FBG at 18 months (p = .05). Twelve-month reductions in CE mediated the effect of the intervention on changes in FBG and weight at 12 and 18 months postbaseline (p ≤ .05). Furthermore, those higher (+ 1 SD) in SE at baseline were nearly 2 BMI points higher than those lower (-1 SD) in SE (p < .01). Decreases in SE (B = 3.42; p < .001; 95% CI [2.55, 4.30]) and CE (B = 0.45; p < .001; 95% CI [0.36, 0.54]) in all participants at 6 months were associated with greater weight loss at 18 months.

CONCLUSIONS

Those with greater compulsive eating may reduce risk for metabolic decline by participating in a mindfulness-based weight loss program. Future obesity interventions should consider tailoring treatment toward trait-level characteristics, such as compulsive eating. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Novel Methodological Considerations Regarding the Use of Visual Analog Scale (VAS) Appetite Questionnaires in Tightly Controlled Feeding Trials

Visual analog scale (VAS) questionnaires are widely used in nutrition research to assess appetite and subsequent food intake. However, a number of methodological considerations exist. The study aims were to test whether 1) appetite VASs alter subsequent food intake and 2) viewing previous appetite responses influences subsequent responses. Twelve healthy adults (age: 22 ± 3 y; BMI: 22.0 ± 3.1 kg/m2) completed the randomized crossover study. On separate days, participants were provided breakfast preloads and completed appetite VASs every 30 min for 4 h or did not complete the questionnaires. When completing VASs, the participants were shown their previous responses (PR) or were not (No-PR). After 4 h, an ad libitum lunch was provided. Hunger, fullness, desire to eat, and prospective food consumption were not different between PR and No-PR. All data are reported as mean ± SEM. VASs did not affect lunch intake (484 ± 50 kcal) compared with no VASs (500 ± 53 kcal, nonsignificant). Thus, neither past appetite responses nor the use of appetite VASs influenced ingestive behavior in healthy adults. This trial was part of a larger acute, randomized crossover trial registered at clinicaltrials.gov as NCT03154606.

Mobile Health Applications in Weight Management: A Systematic Literature Review

CONTEXT

Weight management is an effective strategy for controlling chronic disease and maintaining physical health, and research on this topic has risen dramatically over the past four decades. The present systematic literature review aimed to identify existing evidence on the efficacy of mobile health technology in facilitating weight management behaviors, such as healthy food consumption and physical activity.

EVIDENCE ACQUISITION

A systematic search was conducted in Ovid MEDLINE and Ovid PsycINFO databases with the aim to identify studies published in peer-reviewed journal articles between 2012 and 2017.

EVIDENCE SYNTHESIS

A total of 39 studies were analyzed in spring 2018 and are presented here in terms of participant characteristics, effective technology components, additional treatments, impact on health-related behaviors, and treatment efficacy. Indicators of study quality and social validity are also provided.

CONCLUSIONS

Mobile health apps are widely considered as satisfactory, easy to use, and helpful in the pursuit of weight loss goals by patients. The potential of mobile health apps in facilitating weight loss lies in their ability to increase treatment adherence through strategies such as self-monitoring. These findings indicate that satisfactory treatment adherence and consequent weight loss and maintenance are achieved in the presence of high levels of engagement with a mobile health app. The research quality assessment of RCTs reveals a great need for following international standards both when conducting and reporting research.