The effects of three mindfulness skills on chocolate cravings

The moderating role of food cravings in the relationship between weight suppression and eating disorder psychopathology in college students

Weight suppression (WS), the difference between an individual's current and highest adult weight, is predictive of eating-related pathology across diagnostic categories and poor eating disorder treatment outcomes, but findings from non-clinical samples have been mixed. Cravings are strong urges for specific foods that are subjectively difficult to resist. Food cravings are now widely conceptualized as cognitive-affective states characterized by intrusive thoughts that are perceived as distressing and can interfere with adaptive functioning. Food cravings are known antecedents of binge eating, but little is known about how they interact with WS. We examined the obsessive-compulsive aspects of food cravings as potential moderators of the association between WS and eating disorder symptoms in general, and binge eating specifically in a cross-sectional study of college students. Participants (n = 144, 60.4% female) self-reported their height and current and past highest adult weight and completed the Binge Eating Scale (BES), Eating Disorder Examination-Questionnaire (EDE-Q), and Obsessive Compulsive Eating Scale (OCES). Main and interactive effects of WS and OCES scores on EDE-Q global and BES scores were examined in regression models. There were significant main effects of OCES scores on overall eating disorder symptom severity as well as binge frequency, with those endorsing more craving-related intrusive thoughts and compulsive urges engaging in maladaptive behaviors more frequently. WS alone did not consistently cross-sectionally predict eating disorder psychopathology. Findings suggest that food cravings are significantly associated with disordered eating symptoms and specifically binge eating frequency and should be accounted for in future research on WS in clinical and non-clinical samples.

A clinical trial protocol of a single-session self-guided acceptance-based online intervention targeting food cravings as predictors of disordered eating in pregnant people

BACKGROUND

Pregnancy is a time of heightened risk for disordered eating behaviors, which are linked to adverse health outcomes in gestation, delivery, and the postpartum. These adverse outcomes may be partially mediated by greater rates of deviation from recommended weight gain trajectories, especially in those who engage in binge and loss of control (LOC) eating. Food cravings are powerful and highly modifiable triggers of binge and LOC eating in non-pregnant populations with preliminary evidence linking cravings to disordered eating behaviors in pregnancy as well. Acceptance-based approaches have been shown to be feasible and effective in reducing the adverse impact of cravings on behavior.

PURPOSE

To test the feasibility, acceptability, and preliminary efficacy of a single-session, self-guided, acceptance-based online workshop targeting food cravings as predictors of binge and LOC eating in pregnancy.

METHODS

We will conduct a pilot randomized controlled trial of a single-session, self-guided online acceptance-based workshop targeting food cravings in pregnancy. Pregnant individuals in the second trimester (n ≥ 74) endorsing current food cravings will be randomly assigned to the intervention or an untreated control group. The intervention group will participate in a one-hour workshop that imparts skills grounded in Acceptance and Commitment Therapy, including acceptance, defusion, and present-moment awareness. Both groups will complete comprehensive self-report assessments of primary outcomes and hypothesized mediators and moderators of intervention efficacy at baseline, one-month follow-up, and at full-term.

CONCLUSION

Results will inform integration of acceptance-based skills targeting food cravings into routine prenatal care to prevent adverse outcomes associated with disordered eating behaviors in pregnancy.

TRIAL REGISTRATION

ClinicalTrials.gov identifier NCT06129461; registered on November 10, 2023.

Mindful acceptance, not awareness, associated with lower food susceptibility

PURPOSE

Food susceptibility refers to an individual's thoughts, feelings, and motivations when highly palatable foods are available. Mindfulness, or the practice of paying attention, non-judgmentally, in the present moment, is a key element in acceptance-based programs, which have been shown to benefit those with high food susceptibility. This study examined the relationship between food susceptibility and (1) trait mindfulness and (2) mindfulness facets (i.e., awareness, acceptance) in daily life.

METHODS

Participants were 108 adults with overweight/obesity (45.56 ± 11.41 years old, 75.9% white, 72.2% female) enrolled in a weight loss trial (Clinical Trials.gov Identifier: NCT02786238). Food susceptibility was measured with the Power of Food Scale (PFS). Mindfulness was assessed using the Philadelphia Mindfulness Scale (PHMS) and its two subscales: PHMS-Awareness and PHMS-Acceptance. Two regressions examined the associations of (1) total PHMS on PFS, and (2) simultaneous PHMS subscales on PFS. Covariates were age, sex, race, and education.

RESULTS

Regression results revealed, after adjustment for covariates, that Total PHMS was significantly negatively associated with PFS scores (β = - 0.258, p = 0.001), but only one of the PHMS subscales, Acceptance, was significantly associated with PFS scores (β = - 0.328, p < 0.001). PHMS-Awareness was not related to PFS scores.

CONCLUSION

Greater levels of mindfulness were associated with lower food susceptibility in treatment-seeking adults with overweight/obesity. Mindful acceptance may be the driving factor in this relationship, suggesting that awareness alone is not sufficient for promoting healthier appetite regulation. Interventions aimed to reduce food susceptibility and improve coping with cravings may benefit from an enhanced focus on teaching mindful-acceptance skills.

LEVEL OF EVIDENCE

Level III, observational cohort study.

Cognitive Defusion as Strategy to Reduce the Intensity of Craving Episodes and Improve Eating Behavior

The elaborated intrusion theory of desire proposes that craving is a cognitive motivational process involving intrusive thoughts. Changing the way we react to them, cognitive defusion (CD), should limit thought elaboration and craving. We induced chocolate craving in female chocolate cravers before CD (Study 1). A decrease in craving measured by a single-item scale, Visual Analogical Scale (VAS; p < .001, ηp2 = .449) and as a state, State Food Craving Questionnaire (FCQ-S; p = .029, ηp2 = .106) were found in the experimental group, while similar results were also found in group control. The reduction in craving (VAS) in group CD correlated negatively with chocolate consumption on a bogus taste test (r = –.439, p = .036), while the correlation was positive in the case of group control (r = .429, p = .047). Food craving as a trait, measured by the Trait Food Craving Questionnaire (FCQ-T), showed negative correlations with measures of CD and mindfulness skills (lowest r = –.313, p = .018). In Study 2 participants made use of a smartphone application implementing the CD procedure in real contexts whenever they experienced food craving. A corresponding decline in self-reported craving was found, as well as in consumption of the craved food (indulgence) compared with the control condition. Our findings indicate that CD may be a promising intervention for tackling the elaboration of intrusive thoughts and eating behavior in young female food cravers, both in a controlled laboratory environment after a cue-food exposure craving induction procedure, as well as responding to naturally occurring food cravings in real-life settings.

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.

"The thought is gonna come and the thought is gonna go": A qualitative study on how non-meditators learn and apply brief mindfulness-based instructions for food cravings

While brief mindfulness-based interventions have emerged as tools to modulate automatic responding in various domains of health and wellbeing, findings are primarily based on quantitative experimental research. However, these group-level findings do not capture the rich subjective experiences of individuals learning mindfulness. In the following qualitative study, we explored how non-meditators learn and apply brief mindfulness instructions in the domain of food cravings. Ten non-meditators listened to 'normal viewing' instructions, which asked them to view foods in the way that they normally would. They then viewed a video of attractive foods, and were interviewed about their experiences of learning and applying the instructions. Next, participants listened to a 5-min recording of mindfulness instructions, viewed another food video while applying the mindfulness instructions, and were interviewed again. The data were analysed using thematic analysis. When participants applied brief mindfulness, their relationship to the food stimuli changed such that they started perceiving their experiences as transient. Certain factors (e.g., use of visual metaphors) and processes (e.g., listening to the 'normal viewing' instructions first) facilitated this change. The ease of applying the instructions fluctuated with food preferences and perceived strength of cravings. Participants reported that they would apply the instructions in daily life if they felt a need for this, including in domains other than food. However, they anticipated challenges such as remembering and finding time to apply. Our findings highlight the specific aspects that influence how brief mindfulness instructions are learned and applied. These insights may change how brief mindfulness is studied empirically, and may inform the development of simple and empowering techniques that can promote wellbeing in daily life.

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.

An Eight-Week Mindful Eating Program Applied in a Mediterranean Population With Overweight or Obesity: The EATT Intervention Study

BACKGROUND

Overweight and obesity are important public health priorities. Mindful eating can contribute in preventing automatic eating behavior and emotional dysregulation, both being primary causes of overeating and negative body image. This research outlines an eight-week mindful eating intervention (i.e., project EATT) focusing on people with overweight or obesity in assisting positive behavioral, psychological and physiological change.

METHODS

Fifty-seven people residing in Athens were recruited to participate in this research, where participants were allocated to either an experimental or a waitlist condition. Changes in body weight, and eating attitude, mindfulness, self-compassion, anxiety questionnaires were administered at baseline and post-intervention, and at a 14-month follow-up.

RESULTS

Results indicated that mindfulness and self-compassion increased significantly, while anxiety symptoms decreased. Significance was also observed in reduction of overeating symptoms and oral control. While a negative relationship was observed between anxiety and mindfulness, and anxiety and self-compassion, self-compassion was negatively associated with overeating episodes.

CONCLUSIONS

The intervention improved participants' relationship with food and enabled changes towards successful weight regulation.

Reliability and validity of an equanimity questionnaire: the two-factor equanimity scale (EQUA-S)

Background

Many studies have revealed the positive impact of mindfulness training on mental health and proposed equanimity as a general outcome in contemplative research. Despite recent interest, relatively few studies have empirically examined equanimity and measurement instruments are still lacking. The main goal of this study was to develop an Equanimity Scale (the EQUA-S) in a Western population with or without meditation experience, based on previous definitions of equanimity, in order to investigate its relations with the relevant psychological constructs and health outcomes.

Methods

Adults from the general population (N = 265; M _age = 34.81) completed various measures: the EQUA-S, mindfulness, hyper-sensitivity, avoidance and fusion, impulsivity, personality, alexithymia, sensitivity to punishment and reward and frequency of problematic addictive behaviors. The dimensionality of the EQUA-S was examined using Factor Analyses. The convergent validity of this new scale was investigated using Pearson's Correlations.

Results

The results of a factor analysis revealed two dimensions of equanimity: an even-minded state of mind (E-MSM) and a hedonic independence (HI) component. While the E-MSM was positively related to emotional stability, adaptive emotional regulation and several mindfulness-related abilities, HI was found to correlate negatively with addictive issues.

Discussion

The relations with personality constructs and possible related cognitive processes are discussed.

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.

Does immersion or detachment facilitate healthy eating? Comparing the effects of sensory imagery and mindful decentering on attitudes and behavior towards healthy and unhealthy food

Many people would like to reduce indulging in unhealthy foods, but find it difficult to do so. Previous research shows that individuals eat smaller portions of unhealthy hedonic food if they first imagine the sensory properties of tempting food (sensory imagery; Cornil & Chandon, 2016). Similarly, they show less preference for such food if they think about food in a detached way (decentering; Papies, Barsalou, & Custers, 2012; Papies, Pronk, Keesman, & Barsalou, 2015). Given that these two mindsets are seemingly at odds with each other, we compared them across two studies to examine their effects on the preference for (Experiment 1) and consumption of (Experiment 2) hedonic healthy and unhealthy food. Although sensory imagery and decentering had largely different effects for preferences towards healthy and unhealthy foods, they had comparable effects on the consumption of both types of foods, serving to reduce the effects of consumption in participants affected by hunger and emotional eating. These results suggest that while sensory imagery and decentering are based on different mechanisms, they produce similar results when it comes to the consumption of hedonic food, regardless of how healthy the food is.

A Mindfulness-Based Decentering Technique Increases the Cognitive Accessibility of Health and Weight Loss Related Goals

Previous research has shown that a mindfulness-based decentering technique can help individuals resist eating chocolate over a 5-day period. However, it is unclear how this technique exerts its effect. This study explored one potential mechanism; that decentering increases the cognitive accessibility of relevant goals. Male and female participants (n = 90) spent 5 min practicing either a decentering or relaxation (control) technique. They then viewed a picture of a chocolate bar for 3 min whilst either applying the decentering technique or letting their mind wander (control). Finally, all participants completed 20 letter strings, rated their motivation for weight loss and for healthy eating, and indicated whether or not they were dieting to lose weight. As predicted, those who had applied the decentering technique produced a greater number of health and weight loss related words when completing the letter strings, compared to those who had simply let their mind wander (p < 0.001). However, contrary to predictions, these effects were not significantly greater amongst those who were more motivated to lose weight or eat healthily, or amongst those who were dieting to lose weight, though the means were in the predicted directions. The results suggest that this particular mindfulness technique may increase the accessibility of relevant goals. Further research would be needed to (a) compare effects with other strategies that prompt individuals to remember their goals, (b) examine other potential mechanisms of action, and (c) confirm that effects on self-control are mediated by increased goal accessibility.

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.

Mindfulness Reduces Reactivity to Food Cues: Underlying Mechanisms and Applications in Daily Life

PURPOSE OF REVIEW

Mindfulness-based interventions are becoming increasingly popular as a means to facilitate healthy eating. We suggest that the decentering component of mindfulness, which is the metacognitive insight that all experiences are impermanent, plays an especially important role in such interventions. To facilitate the application of decentering, we address its psychological mechanism to reduce reactivity to food cues, proposing that it makes thoughts and simulations in response to food cues less compelling. We discuss supporting evidence, applications, and challenges for future research.

RECENT FINDINGS

Experimental and correlational studies consistently find that the adoption of a decentering perspective reduces subjective cravings, physiological reactivity such as salivation, and unhealthy eating.

SUMMARY

We suggest that the decentering perspective can be adopted in any situation to reduce reactivity to food cues. Considering people's high exposure to food temptations in daily life, this makes it a powerful tool to empower people to eat healthily.

Ultra-brief non-expert-delivered defusion and acceptance exercises for food cravings: A partial replication study

Food cravings are a common barrier to losing weight. This article presents a randomised comparison of non-expert group-delivered ultra-brief defusion and acceptance interventions against a distraction control. A total of 63 participants were asked to carry a bag of chocolates for a week while trying to resist the temptation to eat them. A behavioural rebound measure was administered. Each intervention out-performed control in respect of consumption, but not cravings. These techniques may have a place in the clinical management of food cravings. We provide tentative evidence that the mechanism of action is through decreased reactivity to cravings, not through reduced frequency of cravings.

Health goal priming as a situated intervention tool: how to benefit from nonconscious motivational routes to health behaviour

Recent research has shown the limited effects of intentions on behaviour, so that novel methods to facilitate behaviour change are needed that do not rely on conscious intentions. Here, it is argued that nonintentional effects on health behaviour, such as the effects of habits, impulses, and nonconscious goals, occur through the activation of cognitive structures by specific situations. Interventions should therefore be situated to change these effects, either by changing the critical cognitive structures (training interventions), or by changing which cognitive structures get activated (cueing interventions). The current article presents this framework for situated interventions, as well as examples of interventions of each type. Then, it introduces goal priming as a cueing intervention tool to activate health goals and thus facilitate healthier behaviour, even in tempting situations that typically activate short-term hedonic goals. Following a review of empirical evidence, five principles for the effective application of health goal primes are proposed, namely (1) to target individuals who value the primed goals, (2) by activating their specific motivation, (3) through effective cues (4) that attract attention at the right time. Finally, (5) an effective goal-directed behaviour needs to be known and accessible to the primed individual. These principles are illustrated with examples of different health behaviours in order to facilitate their application for successful behaviour change.

Food-Specific Decentering Experiences Are Associated with Reduced Food Cravings in Meditators: A Preliminary Investigation

This study examined the association of food-specific decentering experiences with food cravings in a sample of meditators. Decentering refers to viewing one's thoughts as transient mental events and thus experiencing them as less subjectively real. This process has been suggested to be a key mechanism underlying the effects of mindfulness and many contemplative practices. Although most earlier studies have focused on the effects of decentering with regard to negative affect, some studies have shown that brief inductions of decentering among non-meditators reduce food cravings as well as unhealthy food choices. Here, we report a preliminary investigation of whether the food-specific decentering experiences that meditators have in daily life are associated with fewer food cravings. A small sample of meditators (N = 33, female = 15) answered a number of questions about decentering experiences with regard to thoughts about food, and they completed the short version of the Food Cravings Questionnaire-Trait and a measure of meditation experience. Results confirmed that both more meditation experience and more food-specific decentering experiences were associated with fewer food cravings in daily life. In addition, results suggested that when participants had stronger decentering experiences, they experienced fewer food cravings, regardless of their level of meditation experience. Exploratory analyses further revealed that decentering was more strongly associated with reduced cravings in women than in men. These preliminary findings suggest that food-specific decentering experiences indeed help meditators deal with food desires, and thus extend the evidence for decentering effects into the domain of reward. Future research might investigate this in larger samples, validate a food-specific measure of decentering, and consider the broader implications of decentering experiences in daily life.

Randomized controlled trial of a 12-month computerized mindfulness-based intervention for obese patients with binge eating disorder: The MindOb study protocol

BACKGROUND

Mindfulness-based interventions for healthy behaviors such as exercise and dietary modifications have aroused growing interest. This study aims to test the effectiveness of a mindfulness-based intervention for the reduction of impulsive eating and the improvement of motivation to exercise among obese individuals.

METHODS

One-hundred and twenty obese outpatients, aged 18 to 65years, diagnosed with a binge eating disorder, will be randomly assigned to one of the three following groups: mindfulness practice, sham meditation, or treatment as usual control. The tested intervention consists of a 1-year computerized mindfulness-based program. Mindfulness sessions are audio recordings that the patients are asked to listen to, 10min every day. Self-reported questionnaires measuring impulsive eating, motivation to exercise, physical activity level, mood, and mindfulness skills are filled in at baseline, 1, 6, and 12months. Physical activity, calories consumption, and biomarkers are measured with more objective measurement tools at baseline, 6months and 12months.

CONCLUSION

Mindfulness, as both a de-automation element and as a moderator of motivation to exercise, can lead to the reduction of impulsive eating and also to an increase in levels of physical activity. These effects could cause weight loss in obese patients suffering from binge eating disorder.

TRIAL REGISTRATION

clinicaltrials.gov: NCT02571387.