Brief guided imagery and body scanning interventions reduce food cravings

Nature-based experience in Venetian lagoon: Effects on craving and wellbeing in addict residential inpatients

Introduction

It is known that exposure to the natural environment may positively modulate mental processes and behaviors; in particular, it can reduce stress, anxiety, and depressive symptoms. This suggests a potential integration of "nature experience" into the treatment for substance use disorder (SUD) since various types of addiction are associated with anxiety and depression. Considering that only one study has been reported to date in patients with alcohol use disorder, the effect of nature experience in SUD patients' needs to be further investigated. This study aimed to test the effects of exposure to a natural lagoon environment on craving and measures of wellbeing in SUD patients in comparison to exposure to an urban environment.

Methods

Twenty-four SUD patients were divided into three groups of eight participants and exposed to two walking sessions (interspersed with a 1-week wash-out period) in a natural environment typical of the Venetian lagoon, an Urban walk, or staying at the residential center based on a Latin-square design. Before and after each session, drug craving, mood, wellbeing, agency, openness to the future, and restorativeness were assessed.

Results

The Nature walk significantly decreased craving in participants compared to their pre-walk values, and compared to craving after the Urban walk, with the latter significantly increased vs. pre-walk values. The Nature walk significantly decreased negative mood and increased wellbeing and agency. Openness to the future and restorativeness measures showed significant improvement after the Nature walk compared to the Urban walk. On the other hand, craving scores after the Urban Walk positively correlated with negative mood and a Sense of Negative Agency values and negatively correlated with wellbeing scores.

Discussion

Our results confirm that "nature experience" may improve mood, wellbeing, attention, stress relief, openness, and sense of being active in SUD patients. Moreover, we also showed a specific effect on drug craving-a key symptom of SUD.

Mindfulness for voices: An experimental analogue study of the effect of manipulating response style to simulated voices in a non-clinical population

OBJECTIVES

We aimed to investigate the effects of directly manipulating response style to simulated voice hearing on emotional and cognitive outcomes in a non-clinical population.

DESIGN

A between-subjects design with one independent variable, response style (with two levels: mindful acceptance vs attentional avoidance). The dependent variables were subjective distress and anxiety (primary outcomes) and performance on a sustained attention task (secondary outcomes).

METHODS

Participants were randomly assigned to one of two response styles (mindful acceptance vs. attentional avoidance). They completed a computerised attention task (continuous performance task) whilst listening to a simulation of voice hearing. Participants rated their experience of anxiety and distress before and after completing the sustained attention task which was used to measure their accuracy and response times.

RESULTS

One hundred and one participants took part (mindful acceptance (n = 54); attentional avoidance (n = 47)). There were no statistically significant group differences on post-test distress and anxiety scores, correct response rate or response times on the computerised attention task. Participants reported a range of different response styles along the spectrum of avoidance to acceptance, but this had no association with their assigned experimental condition. Adherence to task instructions was therefore low.

CONCLUSIONS

We are unable to conclude from this study whether experimentally inducing people to respond to voices under cognitively demanding conditions in an avoidant or accepting way has an impact on their emotional or cognitive outcomes. Further research should focus on the development of more robust and reliable procedures for inducing differences in response style under experimental conditions.

Healthy cravings? Impact of imagined healthy food consumption on craving for healthy foods and motivation to eat healthily - Results of an initial experimental study

Craving for high-calorie foods predicts consumption of high-calorie foods thereby contributing to unhealthy eating habits and, potentially in the long term, to the development of overweight, obesity, and eating disorder pathology. Thus, effective interventions tackling craving for unhealthy foods and motivating healthy eating behavior are needed. This initial study tested if an experimental mental imagery procedure could induce craving for healthy foods and increase the motivation to eat healthily. Participants (N = 82) were randomized to either a healthy craving mental imagery condition or to a neutral mental imagery control condition. Craving for healthy foods and motivation to eat healthily was assessed before and after the experimental manipulation via self-report. A (disguised) food choice for healthy versus unhealthy food was added as a behavioural measure at the end of the experiment. Repeated measures of variance analyses with time (pre vs. post experimental manipulation) and condition (healthy craving mental imagery versus neutral mental imagery) yielded significant interactions for healthy craving and motivation to eat healthily: Post-hoc tests showed that craving for healthy foods and motivation to eat healthily increased significantly after the experimental manipulation in the healthy craving mental imagery condition, but not in the neutral mental imagery condition. Results of this initial study suggest that an experimental mental imagery induction of craving for healthy food leads to an increase in healthy craving and motivation to eat healthily. Further experimental research is needed to rule out priming effects, to test the underlying mechanisms of this effect, and evaluate the potential of this mental imagery procedure in a clinical context.

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.

"I see myself": Craving imagery among individuals with addictive disorders

Craving has been put forward as a core feature of addictive disorders.

The present qualitative study investigated the experience of craving among individuals with addictive disorders and recent experiences of cravings.

Eleven individuals with Gambling Disorder and ten with Alcohol Use Disorder (n = 21) were recruited. A semi-structured interview explored: (1) modes of thought during craving (mental imagery or verbal thoughts), (2) craving content, (3) coping strategies and (4) craving context.

The thematic analysis showed that cravings were initially dominated by imagery, with a subsequent conflict between imagery and verbal thoughts. Craving content included imagery of preparative rituals, anticipation, and sensory activation, imagery of the addictive behavior "me, there and then imagery" and anticipating that "something good will come out of it." Some participants related to craving as a symptom of sickness, and coping with craving were through distraction, reminding oneself of negative consequences, or via sensory control: avoiding stimuli associated with the addiction. Craving contexts included typical settings of drinking or gambling and engagement of both positive and negative emotions. Alcohol craving was described as an expected relief from internal stimuli, such as anxiety or stress, whereas gambling craving was more often described as an expectancy of financial reward.

Craving was experienced mainly through imagery containing the preparative routines and expected outcomes. Future research and clinical practice should incorporate mode of thought in cravings to better understand its role in the maintenance of the disorders and their treatment.

Supplemental data for this article is available online at https://doi.org/10.1080/10550887.2022.2058299 .

Beyond thirst: Cravings for non-alcoholic beverages including soft drink

Cravings for a range of substances including drugs, alcohol, and food have been shown to predict subsequent consumption or use. However, this link has not yet been systematically examined for beverages other than alcohol. The present study aimed to provide a comprehensive investigation of cravings for non-alcoholic beverages and their link to consumption. Participants were 128 undergraduate students (17-25 years) who completed a craving diary and daily consumption measure over a period of a week. Cravings were reported for a range of beverages, including tea, juice, and flavoured milk, but by far the most craved beverages were water, coffee, and soft drink. Stronger cravings were associated with a greater likelihood of drinking and drinking more of the craved beverage. This was particularly the case for soft drink. Unlike water, cravings for coffee and soft drink were triggered by factors other than thirst, and the number of cravings predicted the total amount drunk over the week. The findings demonstrate the existence of cravings for non-alcoholic beverages such as soft drink, and point to these cravings as a potential target for reducing consumption.

Mindfulness-Informed Guided Imagery to Target Physical Activity: A Mixed Method Feasibility and Acceptability Pilot Study

Physical activity offers substantial mind-body health benefits and reduced mortality, yet many individuals are chronically underactive. Physical activity interventions may benefit from integrative approaches that join components of mindfulness and neurobiological models of behavior. Mindfulness increases one’s awareness of cognitions and physical sensations to potentially facilitate self-regulation, while neurobiological models such as the dual system model of health behavior offer guidance on improving physical activity intervention targets. This 2-phase study includes an initial development process to create brief (∼4 min) mindfulness informed guided imagery audio files that target distinct cognitive and affective processes to promote physical activity. In the second phase, participants completed a 2-week pilot intervention study to gather qualitative and quantitative data on intervention feasibility and acceptability. Participants endorsed the mindfulness informed guided imagery as easy to use, enjoyable and helpful. Over a 2-week intervention period participants reported positive shifts in behavior change, physical activity enjoyment, increased mindfulness during physical activity, and increased physical exercise self-efficacy and satisfaction. Interview data revealed that participants increased their frequency of physical activity and tended to experience positive affect during physical activity, engaged in future oriented thinking and were able to view physical activity in a more positive light. Findings support the feasibility and acceptability of an integrative online mindfulness informed guided imagery intervention to promote physical activity enjoyment and engagement. This study extends health behavior change intervention research and provides supporting evidence for a flexible and tailorable online mindfulness-based intervention.

The effect of visualisation and mindfulness-based decentering on chocolate craving

According to the elaborated intrusion (EI) theory of desire, loading visual working memory should help prevent and reduce cravings because cravings occur when intrusive thoughts are elaborated upon in working memory, often as vivid mental images. Mindfulness-based decentering strategies may also help prevent and reduce cravings since they may divert attention away from craving-related thoughts and mental imagery. To compare the effects of visualisation versus decentering on cravings, participants (N = 108) were randomly assigned to one of three conditions: (a) decentering, (b) visualisation, (c) mind-wandering control. Participants in each condition received two audio exercises: (1) a 2-min exercise, preceding a craving induction but after initial deprivation and cue exposure, (2) a 4-min exercise, following a craving induction. The audios instructed participants to look at a plate of chocolate that was in front of them whilst either (a) decentering from their thoughts and feelings, (b) engaging in visualisation or (c) letting their mind wander. Participants were asked to rate the strength of their cravings at four time points (Time 1, baseline; Time 2, after the 2-min audio; Time 3, post-craving induction; Time 4, post-4 minute audio). Frequency of craving-related thoughts was also measured at Time 4. Compared to the control condition, results showed a significant reduction in strength of cravings for the decentering condition after both the 2-min audio and the 4-min audio. Decentering was superior to visualisation only after the 2-min audio. Participants in both the visualisation and decentering conditions also had significantly lower frequencies of craving-related thoughts compared to control participants. The findings support EI theory and suggest that mindfulness-based decentering strategies may be useful for both the prevention and reduction of cravings. Pre-registration: https://osf.io/jv3pq.

Characterising binge eating over the course of a feasibility trial among individuals with binge eating disorder and bulimia nervosa

Binge eating disorder and bulimia nervosa are eating disorders that are characterized by recurrent binge eating episodes. The highly contextualized nature of binge eating makes naturalistic research a particularly suitable means of understanding the context within which binge eating occurs. The present study aimed to characterise binge eating days with regards to the frequency and probability of negative affect, food craving, meal skipping, and dietary restriction. In addition, it aimed to examine whether a combined intervention that targets the experience of 'loss of control' over eating can decrease these potential maintenance factors that often precede binge eating episodes. Seventy-eight participants with bulimia nervosa (N = 40) or binge eating disorder (n = 38), who were randomly allocated to a food-specific or general intervention combining inhibitory control training and implementation intentions, completed mood and food diaries over four weeks. Results suggest that negative affect and food craving were elevated on binge eating days, but that dietary restraint and meal skipping did not characterise binge eating days. Moreover, meal skipping, binge eating, restriction, and compensation decreased throughout the intervention period, while negative affect and food craving did not. This suggests that some interventions may successfully reduce binge eating frequency without necessarily decreasing negative affect or food craving, thus pointing to the different routes to targeting binge eating and providing implications for future interventions.

Laboratory-based interventions targeting food craving: A systematic review and meta-analysis

This systematic review and meta-analysis aimed to quantify the effects of laboratory-based interventions targeting specific mechanisms of food craving, to identify moderators of effects, and to qualitatively summarize findings. The study was conducted and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Sixty-nine studies were included in the quantitative synthesis, and separate meta-analyses were conducted for the outcomes self-reported craving and objective food intake. Results show small to medium positive effects across specific craving interventions on both outcomes. Effect sizes were partly moderated by intervention type. The most effective intervention regarding food intake was in sensu cue exposure. For subjective craving, the most robust evidence was found for beneficial effects of cognitive regulation strategies (ie, reappraisal, suppression, and distraction). Results further indicate that training inhibitory control through behavioral inhibition might be more effective than approach-avoidance training when considering its effect on subjective craving and food intake. People with external eating habits, overeating, or loss-of-control eating might benefit from these types of specific craving interventions. Future research should focus on long-term effects, transferability, and effectiveness in clinical samples.

Understanding Desire for Food and Drink: A Grounded-Cognition Approach

How does desire for food and drink arise in the human mind? We suggest that rewarding simulations, which are based on previous experiences, play a key role. In other words, people think about food and drink in terms of what it feels like to consume them, and this leads to desire. We illustrate this with research using behavioral, physiological, and neuroimaging methods. This work shows that food and drink cues (e.g., words, eating contexts, labels) trigger spontaneous eating and drinking simulations (e.g., thoughts about taste, texture, and enjoyment) and that these simulations affect desire and eating experiences (e.g., cravings, salivation, taste ratings). These simulations can be disrupted or diffused through working memory load or through mindfulness, thus reducing desire. We discuss these findings in the context of simulations in motivated behavior more generally and suggest directions for future research.

Mental imagery in psychiatry: conceptual & clinical implications

Mental imagery refers to the experience of perception in the absence of external sensory input. Deficits in the ability to generate mental imagery or to distinguish it from actual sensory perception are linked to neurocognitive conditions such as dementia and schizophrenia, respectively. However, the importance of mental imagery to psychiatry extends beyond neurocognitive impairment. Mental imagery has a stronger link to emotion than verbal-linguistic cognition, serving to maintain and amplify emotional states, with downstream impacts on motivation and behavior. As a result, anomalies in the occurrence of emotion-laden mental imagery has transdiagnostic significance for emotion, motivation, and behavioral dysfunction across mental disorders. This review aims to demonstrate the conceptual and clinical significance of mental imagery in psychiatry through examples of mood and anxiety disorders, self-harm and suicidality, and addiction. We contend that focusing on mental imagery assessment in research and clinical practice can increase our understanding of the cognitive basis of psychopathology in mental disorders, with the potential to drive the development of algorithms to aid treatment decision-making and inform transdiagnostic treatment innovation.

The effect of a mindfulness-based decentering strategy on chocolate craving

According to the elaborated-intrusion theory of desire, strategies that load visual working memory will reduce cravings. According to the grounded cognition theory of desire, cravings will be reduced with mindfulness-based decentering strategies that encourage individuals to see their thoughts as thoughts. However, decentering strategies also tend to load visual working memory making it difficult to test the latter prediction. This study addressed this issue by matching visualization across decentering and guided imagery tasks. Male and female participants (n = 101) underwent a chocolate craving induction before listening to a 4-min audio recording that guided them to (a) decenter from their thoughts and feelings, (b) engage in visualization, or (c) let their mind wander. Participants reported on chocolate craving before and after the craving induction and following the 4-min recording. They also provided retrospective reports of craving during the recording, reported on the extent to which they had adhered to the audio instructions and briefly indicated what they had been thinking about during the recording. Results showed a significant reduction in cravings to baseline following the recording across all three conditions (p < .001), but no significant differences between conditions or in the retrospective reports of craving. There was some evidence to suggest that participants in the mind wandering condition had been thinking about alternate goals, which may have inhibited thoughts about chocolate and been just as effective at reducing craving as the imagery and decentering strategies. Exploratory analyses showed a trend toward decentering being more effective than imagery where participants reported higher task adherence throughout the 4 min (p = .067). This raises the possibility that decentering effects may be improved with better strategy adherence, which might be achieved through practice or increased motivation.

Mental imagery in dentistry: Phenomenology and role in dental anxiety

Dental anxiety is a prevalent problem with marked psychological, physical and public health implications. Based on cognitive theory and evidence, we hypothesized that vivid, sensory image-based cognitions play a role in dental anxiety. A quantitative online survey (N = 306) and qualitative semi-structured interviews (N = 18) found that vivid sensory images were common irrespective of dental anxiety levels, but that their content, associated distress and responses varied. Participants reporting higher anxiety experienced intense and intrusive fear-provoking dental imagery focusing on unpleasant sensations, which were associated with the intrusive recollection of negative past experiences and avoidance of dentistry. Participants with lower anxiety ratings, reported images that were less distressing and centered around reassuring aspects and positive appointment outcomes, potentially acting as protective factors against dental anxiety and facilitating appointment attendance. The inclusion of components aimed at reducing intrusive memories and dental imagery rescripting may help improve interventions for dental anxiety.

A Pilot Study on the Effects of Slow Paced Breathing on Current Food Craving

Heart rate variability biofeedback (HRV-BF) involves slow paced breathing (approximately six breaths per minute), thereby maximizing low-frequent heart rate oscillations and baroreflex gain. Mounting evidence suggests that HRV-BF promotes symptom reductions in a variety of physical and mental disorders. It may also positively affect eating behavior by reducing food cravings. The aim of the current study was to investigate if slow paced breathing can be useful for attenuating momentary food craving. Female students performed paced breathing either at six breaths per minute (n = 32) or at nine breaths per minute (n = 33) while watching their favorite food on the computer screen. Current food craving decreased during a first resting period, increased during paced breathing, and decreased during a second resting period in both conditions. Although current hunger increased in both conditions during paced breathing as well, it remained elevated after the second resting period in the nine breaths condition only. Thus, breathing rate did not influence specific food craving, but slow paced breathing appeared to have a delayed influence on state hunger. Future avenues are suggested for the study of HRV-BF in the context of eating behavior.

A structured literature review on the role of mindfulness, mindful eating and intuitive eating in changing eating behaviours: effectiveness and associated potential mechanisms

The role of mindfulness, mindful eating and a newer concept of intuitive eating in modulating eating habits is an area of increasing interest. In this structured literature review, a summary of the current evidence is presented, together with details of interventions undertaken and the tools to measure outcomes. It is broad in scope given the emerging evidence base in this area. The review yielded sixty-eight publications: twenty-three interventions in obese/overweight populations; twenty-nine interventions in normal-weight populations; sixteen observational studies, three of which were carried out in overweight/obese populations. Mindfulness-based approaches appear most effective in addressing binge eating, emotional eating and eating in response to external cues. There is a lack of compelling evidence for the effectiveness of mindfulness and mindful eating in weight management. Mindfulness-based approaches may prevent weight gain. Reduced food intake was seen in some of the studies in overweight and obese populations, but this was less apparent in the studies in normal-weight populations. The evidence base for intuitive eating is limited to date and further research is needed to examine its potential in altering eating behaviours. Mindfulness appears to work by an increased awareness of internal, rather than external, cues to eat. Mindfulness and mindful eating have the potential to address problematic eating behaviours and the challenges many face with controlling their food intake. Encouraging a mindful eating approach would seem to be a positive message to be included in general weight management advice to the public.

Mind-Body Practice and Body Weight Status in a Large Population-Based Sample of Adults

INTRODUCTION

In industrialized countries characterized by a high prevalence of obesity and chronic stress, mind-body practices such as yoga or meditation may facilitate body weight control. However, virtually no data are available to ascertain whether practicing mind-body techniques is associated with weight status. The purpose of this study is to examine the relationship between the practice of mind-body techniques and weight status in a large population-based sample of adults.

METHODS

A total of 61,704 individuals aged ≥18 years participating in the NutriNet-Santé study (2009-2014) were included in this cross-sectional analysis conducted in 2014. Data on mind-body practices were collected, as well as self-reported weight and height. The association between the practice of mind-body techniques and weight status was assessed using multiple linear and multinomial logistic regression models adjusted for sociodemographic, lifestyle, and dietary factors.

RESULTS

After adjusting for sociodemographic and lifestyle factors, regular users of mind-body techniques were less likely to be overweight (OR=0.68, 95% CI=0.63, 0.74) or obese (OR=0.55, 95% CI=0.50, 0.61) than never users. In addition, regular users had a lower BMI than never users (-3.19%, 95% CI=-3.71, -2.68).

CONCLUSIONS

These data provide novel information about an inverse relationship between mind-body practice and weight status. If causal links were demonstrated in further prospective studies, such practice could be fostered in obesity prevention and treatment.

Reduced reward-driven eating accounts for the impact of a mindfulness-based diet and exercise intervention on weight loss: Data from the SHINE randomized controlled trial

Many individuals with obesity report over eating despite intentions to maintain or lose weight. Two barriers to long-term weight loss are reward-driven eating, which is characterized by a lack of control over eating, a preoccupation with food, and a lack of satiety; and psychological stress. Mindfulness training may address these barriers by promoting awareness of hunger and satiety cues, self-regulatory control, and stress reduction. We examined these two barriers as potential mediators of weight loss in the Supporting Health by Integrating Nutrition and Exercise (SHINE) randomized controlled trial, which compared the effects of a 5.5-month diet and exercise intervention with or without mindfulness training on weight loss among adults with obesity. Intention-to-treat multiple mediation models tested whether post-intervention reward-driven eating and psychological stress mediated the impact of intervention arm on weight loss at 12- and 18-months post-baseline among 194 adults with obesity (BMI: 30-45). Mindfulness (relative to control) participants had significant reductions in reward-driven eating at 6 months (post-intervention), which, in turn, predicted weight loss at 12 months. Post-intervention reward-driven eating mediated 47.1% of the total intervention arm effect on weight loss at 12 months [β = -0.06, SE(β) = 0.03, p = .030, 95% CI (-0.12, -0.01)]. This mediated effect was reduced when predicting weight loss at 18 months (p = .396), accounting for 23.0% of the total intervention effect, despite similar weight loss at 12 months. Psychological stress did not mediate the effect of intervention arm on weight loss at 12 or 18 months. In conclusion, reducing reward-driven eating, which can be achieved using a diet and exercise intervention that includes mindfulness training, may promote weight loss (clinicaltrials.gov registration: NCT00960414).

Psychometric properties of the English Food Cravings Questionnaire-Trait-reduced (FCQ-T-r)

Food cravings have been implicated in the development and maintenance of a range of eating- and weight-related pathology. The rapid and accurate assessment of food cravings is thus critical in clinical and research settings. Existing measures of specific food cravings are often not suitable for capturing the multiple facets of the craving experience. A short version of the Food Cravings Questionnaire-Trait (FCQ-T), the most widely used measure of general food cravings, was recently developed in German and shown to be a one-factorial, internally reliable measure. Other recent studies validated an Italian and Spanish version of the FCQ-T-reduced (FCQ-T-r) and successfully replicated its basic psychometrics. This study sought to examine the psychometric properties of the English version of the FCQ-T-r. Undergraduate students (n=610, 51.0% female, 53.9% white/Caucasian) completed a battery of questionnaires containing the FCQ-T-r and measures of specific food cravings, eating style, eating disorder symptoms, weight dissatisfaction, and impulsivity. Even though results of a confirmatory factor analysis suggested poor fit with a one-factorial model, the FCQ-T-r was found to be a one-factorial measure in both principal component and parallel analysis. The FCQ-T-r demonstrated excellent internal consistency reliability (Cronbach's α=.94), and scores were significantly and positively correlated with measures of specific food cravings, restrained eating, eating disorder symptoms, and impulsivity. More work is needed to confirm the factor structure of the English FCQ-T-r, but preliminary findings suggest that it constitutes a valid and reliable alternative to lengthier measures of general food cravings.

The Elaborated Intrusion Theory of desire: a 10-year retrospective and implications for addiction treatments

INTRODUCTION

Ten years after the publication of Elaborated Intrusion (EI) Theory, there is now substantial research into its key predictions. The distinction between intrusive thoughts, which are driven by automatic processes, and their elaboration, involving controlled processing, is well established. Desires for both addictive substances and other desired targets are typically marked by imagery, especially when they are intense. Attention training strategies such as body scanning reduce intrusive thoughts, while concurrent tasks that introduce competing sensory information interfere with elaboration, especially if they compete for the same limited-capacity working memory resources.

CONCLUSION

EI Theory has spawned new assessment instruments that are performing strongly and offer the ability to more clearly delineate craving from correlated processes. It has also inspired new approaches to treatment. In particular, training people to use vivid sensory imagery for functional goals holds promise as an intervention for substance misuse, since it is likely to both sustain motivation and moderate craving.

Pickles and ice cream! Food cravings in pregnancy: hypotheses, preliminary evidence, and directions for future research

Women in the United States experience an increase in food cravings at two specific times during their life, (1) perimenstrually and (2) prenatally. The prevalence of excess gestational weight gain (GWG) is a growing concern due to its association with adverse health outcomes in both mothers and children. To the extent that prenatal food cravings may be a determinant of energy intake in pregnancy, a better understanding of craving etiology could be crucial in addressing the issue of excessive GWG. This paper reviews the available literature to corroborate and/or dispute some of the most commonly accepted hypotheses regarding the causes of food cravings during pregnancy, including a role of (1) hormonal changes, (2) nutritional deficits, (3) pharmacologically active ingredients in the desired foods, and (4) cultural and psychosocial factors. An existing model of perimenstrual chocolate craving etiology serves to structure the discussion of these hypotheses. The main hypotheses discussed receive little support, with the notable exception of a postulated role of cultural and psychosocial factors. The presence of cravings during pregnancy is a common phenomenon across different cultures, but the types of foods desired and the adverse impact of cravings on health may be culture-specific. Various psychosocial factors appear to correlate with excess GWG, including the presence of restrained eating. Findings strongly suggest that more research be conducted in this area. We propose that future investigations fall into one of the four following categories: (1) validation of food craving and eating-related measures specifically in pregnant populations, (2) use of ecological momentary assessment to obtain real time data on cravings during pregnancy, (3) implementation of longitudinal studies to address causality between eating disorder symptoms, food cravings, and GWG, and (4) development of interventions to ensure proper prenatal nutrition and prevent excess GWG.

A brief mindfulness intervention reduces unhealthy eating when hungry, but not the portion size effect

OBJECTIVE

The present research examined the effects of a mindfulness-based intervention to foster healthy eating. Specifically, we tested whether a brief mindfulness manipulation can prevent the portion size effect, and reduce overeating on unhealthy snacks when hungry.

METHODS

110 undergraduate participants (MAge=20.9±2.3; MBMI=22.3±2.5) were served a small or a large portion of chocolate chip cookies after listening to an audio book or performing a mindfulness exercise (i.e., body scan). Current level of hunger was assessed unobtrusively on a visual analog scale before the eating situation.

MAIN OUTCOME MEASURE

Calorie intake from chocolate chip cookies.

RESULTS

When presented with a large compared to a small portion, participants consumed more cookies (+83kcal). This was not affected by the mindfulness intervention or by hunger. However, while control participants ate more unhealthy food when hungry than when not hungry (+67kcal), participants in the mindfulness condition did not (+1kcal).

CONCLUSIONS

Findings confirm the prevalence and robustness of the portion size effect and suggest that it may be independent from awareness of internal cues. Prevention strategies may benefit more from targeting awareness of the external environment. However, mindfulness-based interventions may be effective to reduce effects of hunger on unhealthy food consumption.