Two inhibitory control training interventions designed to improve eating behaviour and determine mechanisms of change

Stimulus variability improves generalization following response inhibition training

The present study examined the effect of stimulus variability and practice order on generalization to novel stimuli following a single session of response inhibition training. Ninety-six young adults practiced the Go/No-go task online in three training conditions: (1) constant (N = 32)-inhibition practiced on one stimulus; (2) variable-blocked (N = 32)-inhibition practiced on 6 stimuli, each in a separate block; and (3) variable-random (N = 32)-inhibition practiced on 6 stimuli in random order. Generalization was measured by comparing groups on inhibition of novel stimuli and a trained stimulus immediately and 24 h after training. Consistent with our hypothesis, the variable-random and the variable-blocked groups showed better generalization to the novel items than the constant group, demonstrating the benefit of stimulus variability. The variable-random group also showed better generalization than the variable-blocked group, demonstrating the benefit of presenting stimuli in random order. Participants' capacity for working memory maintenance was found to modulate the effect of practice order. While the benefit of variability was retained 24 h after training, the effect of order was not. Results also show generalization to (1) different type of stimuli using the same task and (2) the same stimuli on a different response inhibition task (the Stop-Signal Task), however, the effect of variable practice and order were not evident in these cases. The study findings illustrate the advantage of using variable stimuli presented in random order for generalization and suggest that these principles of motor learning can be applied to learning of cognitive skills.

The effectiveness of Go/No-Go and Stop-Signal training in reducing food consumption and choice: A systematic review and meta-analysis

The Go/No-Go and Stop-Signal tasks have been used to reduce excess food intake via repeated pairing of food cues with response inhibition. A meta analysis of 32 studies was conducted to determine whether, and under which conditions, the Go/No-Go and Stop-Signal training tasks are effective in reducing food consumption or choice. Moderators included task parameters (e.g., number of sessions, stop signal), sample differences (e.g., age, weight), and the measure of food consumption or choice. Overall, there was a small effect for Go/No-Go and Stop-Signal training in reducing food consumption or choice, g = -0.21, CI95 = [-0.31, -0.11], p < .001, with this holding individually only for a single session of the Go/No-Go Task, g = -0.31, CI95 = [-0.45, -0.18], p < .001. Comprehensive investigation of the impact of varying moderators indicated that the effect for Go/No-Go training was robust. Nevertheless, there was significant variation in the specific parameters of the task. Overall, the present meta-analysis extends previous findings by providing comprehensive evidence that the Go/No-Go Task is effective in reducing food consumption and choice, as well as providing optimal parameter recommendations for the task.

Effectiveness of cognitive retraining intervention on weight loss and lifestyle-related behaviours among adults: A systematic review and meta-analysis

INTRODUCTION

The review explores the potential benefits of cognitive retraining interventions in improving healthy lifestyle-related behaviours, and its possible use as an alternative or complementary approach to traditional weight loss interventions.

METHOD

Studies were selected using different electronic databases (PubMed, Web of Science, Scopus, Embase), to identify RCTs published in the last 23 years on cognitive retraining interventions for weight loss. A total of 12 studies were finalized for systematic review and six for meta-analysis based on the inclusion criteria. The risk of bias was assessed by the two reviewers independently using the criteria outlined in the Joanna Briggs Institute Critical Appraisal Tool for RCTs. The R software was used to perform meta-analysis.

RESULT

The overall effect estimates slightly favoured the intervention group, with a standardised mean difference (SMD) of -0.26 [95% CI (-0.58- 0.06) P < 0.05; I2 = 0.00%]. This suggests that although the effect was not statistically significant, cognitive retraining interventions may have a small effect on weight loss. The findings of the systematic review revealed that cognitive retraining interventions may be effective in modifying lifestyle behaviours and these changes may contribute in achieving and maintaining weight loss in the long run.

CONCLUSION

Interventions exhibited a positive effect on weight loss. These interventions demonstrated promise in modifying lifestyle behaviours, suggesting a potential role in achieving and sustaining long-term weight loss. Further research is warranted to refine and validate these findings.

Comparing the effects of inhibitory control training and evaluative conditioning for unhealthy food behaviours

Cognitive Bias Modification (CBM) is hypothesised to reduce unhealthy food preference and consumption through the completion of computerised cognitive training tasks. While there is evidence to suggest that two popular CBM paradigms (Inhibitory Control Training (ICT) and Evaluative Conditioning (EC)) can have a positive influence on food-related outcomes, issues (and inconsistencies) related to task standardisation and control group design make it difficult to evaluate their standalone efficacy. In a pre-registered laboratory study using a mixed experimental design, our aim was to directly compare a single session of ICT and EC on implicit preference, explicit choice and ad-libitum food intake, while ensuring appropriate active control groups were utilised for each training type (in addition to a passive control group). The results revealed that there were no significant differences in terms of implicit preferences, ad-libitum food consumption or food choice. These results provide limited evidence to support the use of CBM as a psychological intervention for unhealthy food choice or consumption. Further work is needed to isolate mechanisms of effect for successful training and identify the most effective CBM protocols for implementation in future studies.

Inhibitory Control Training Improves Attention Deficit-Hyperactivity Disorder Symptoms and Externalizing Behavior

BACKGROUND

Based on dysexecutive function theory of Attention deficit-hyperactivity disorder (ADHD), inhibitory control plays a crucial role in ADHD symptoms and respective behavioral problems.

METHODS

In the present study, 30 preschoolers with ADHD were recruited in a random clinical trial design in two control and intervention groups. The Flanker and Go/No-Go tasks, Swanson, Nolan, and Pelham Rating Scale, and Child Behavior Checklist were used for assessment at baseline, after the intervention, and 1-month follow-up sessions. The program for attentive rehabilitation of inhibition and selective attention (PARISA) was used for intervention in 10-12 sessions.

RESULTS

Findings showed an improvement in prepotent inhibition and interference control in the intervention group. Furthermore, the hyperactivity/impulsivity symptoms were ameliorated, and the externalizing behavioral problems were improved after the intervention.

CONCLUSION

Inhibitory control in preschoolers with ADHD is trainable, and the training gain could be transferred to ADHD symptoms and externalizing behavior.

Supplementing a widely available weight loss program with gamified inhibitory control training: A randomized pilot study

Background

Increasing evidence suggests that targeting self-regulatory processes may improve obesity treatment outcomes. Incorporating gamification principles in inhibitory control training may promote sustained training adherence and resulting benefits. This pilot study evaluated the preliminary efficacy of supplementing an evidence-based weight management program (WW) with sustained gamified inhibitory control training (PolyRules!) on change in Body Mass Index (BMI) among adults with overweight/obesity.

Methods

30 adults with overweight/obesity (M age 49.9 ± 12.4, 86.7% female; 23.3% Hispanic, mean BMI 35.3 ± 6.3) were randomly assigned to receive WW with or without PolyRules! for 12 weeks. The primary outcome was change in BMI from baseline to post-intervention across study arms. Implementation and process indicators were captured to inform larger trials.

Results

Average change in BMI was -0.9 in the WW arm and -1.2 in the WW + PolyRules! arm (Cohen's d = 0.26). In the WW + PolyRules! arm, increased training was associated with greater decreases in BMI (r = -0.506, p = 0.0454). WW + PolyRules! participants completed an average of 60.4% sessions and reported positive experiences. There was no difference in frequency of food (d = -0.02) and weight tracking (d = -0.19) between arms.

Conclusions

Studies in larger samples should evaluate training-related effects on weight. Supplementing WW with gamified inhibitory training appears feasible, with no detrimental effect on engagement.

Efficacy of a food response and attention training treatment for obesity: A randomized placebo controlled trial

Elevated brain reward and attention region response, and weaker inhibitory region response to high-calorie foods has predicted future weight gain, suggesting that an intervention that reduces reward and attention region response and increases inhibitory region response to such foods might reduce overeating. We conducted a randomized controlled trial to test whether a multi-faceted food response and attention training protocol with personalized high- and low-calorie food images would reduce body fat and valuation and reward region response to high-calorie foods compared to a placebo control training protocol with non-food images in an effort to replicate findings from two past trials. Participants were community-recruited adults with overweight/obesity (N = 179; M age = 27.7 ± 7.0) who completed assessments at pretest, posttest, 3-month, 6-month, and 12-month follow-ups. Participants randomized to the food response inhibition and attention training showed significantly greater increases in palatability ratings of low-calorie foods than controls (d = 0.27) at posttest, but did not show body fat loss, reductions in palatability ratings and monetary valuation, or reward region response, to high-calorie foods. The lack of expected effects appears to be related to weaker learning compared to the learning in past trials, potentially because we used more heterogenous high-calorie and low-calorie food images in the present training.

Efficacy of a combined food-response inhibition and attention training for weight loss

This Current Opinion in Behavioral Sciences article reviews trials that evaluated an obesity treatment that combines response-inhibition training with high-calorie foods and training designed to reduce attention for high-calorie foods. Two randomized controlled trials suggest that food-response inhibition and attention training produced significant body-fat loss, along with a reduction in valuation of, and reward-region response to, high-calorie foods. However, these effects did not emerge in a third trial, potentially because this trial used more heterogeneous food images, which reduced inhibition learning and attentional learning. Collectively, results suggest that food-response inhibition and attention training can devalue high-calorie foods and result in weight loss, but only if a homogeneous set of high-calorie and low-calorie food images is used.

A Program for the Comprehensive Cognitive Training of Excess Weight (TRAINEP): The Study Protocol for A Randomized, Controlled Trial

Background: The available treatments for people with excess weight have shown small effects. Cognitive training has shown promising results, but most of the research focused on normal-weight university students and reported immediate results after a single training session. This parallel group, randomized, controlled trial aims to study the efficacy of a program for the comprehensive cognitive treatment of excess weight. Methods and Analysis: Participants will be 150 people with excess weight recruited through social media, who will be randomized into three groups: cognitive intervention, sham cognitive intervention, and treatment as usual. All assessment and intervention sessions will be online in groups of 5–6 participants. The three groups will attend a motivational interviewing session, and they will receive individualized diet and physical exercise guidelines throughout the program. The cognitive training will consist of four weekly sessions of approximately 60–90 min, each based on approach–avoidance bias training, inhibitory control training, implementation of intentions, and episodic future thinking, respectively. The main outcome measure will be a change in Body Mass Index (kg/m2). Secondary outcomes include changes in cognitive measures, eating and physical exercise behaviors, and anthropometric measures. Assessments will be conducted up to 6 months after the end of the program. In addition, data on the use of the health system will be collected to analyze the cost-effectiveness and the cost-utility of training. Linear mixed models will be used for statistical analysis. Findings of this study will expand the available evidence on cognitive interventions to reduce excess weight.

The Counteractive Effect of Self-Regulation-Based Interventions on Prior Mental Exertion: A Systematic Review of Randomised Controlled Trials

BACKGROUND

Many investigations have been performed on the effects of mental exertion that consumes self-regulatory resources and then affects physical and/or cognitive performance later on. However, the effect of manipulating self-regulation and interventions to attenuate this negative effect remains unclear. Moreover, there is continuous controversy regarding the resource model of self-regulation.

OBJECTIVE

We conducted a systematic review to assess the literature on manipulating self-regulation based on four ingredients (standard, monitoring, strength, and motivation) in order to counter mental exertion and improve physical and/or cognitive performance. The results provide more insight into the resource model.

METHOD

A thorough search was conducted to extract the relevant literature from several databases, as well as Google Scholar, and the sources from the references were included as grey literature. A self-regulation intervention compared to a control condition, a physical and/or cognitive task, and a randomised controlled trial were selected.

RESULT

A total of 39 publications were included. Regarding the four components of self-regulation, the interventions could mainly be divided into the following: (i) standard: implementation intervention; (ii) monitoring: biofeedback and time monitoring; (iii) strength: repeated exercise, mindfulness, nature exposure, and recovery strategies; (iv) motivation: autonomy-supportive and monetary incentives. The majority of the interventions led to significant improvement in subsequent self-regulatory performance. In addition, the resource model of self-regulation and attention-restoration theory were the most frequently used theories and supported relevant interventions.

CONCLUSION

In line with the resource model, manipulating the four components of self-regulation can effectively attenuate the negative influence of mental exertion. The conservation proposed in the strength model of self-regulation was supported in the current findings to explain the role of motivation in the self-regulation process. Future studies can focus on attention as the centre of the metaphorical resource in the model.

Can Self-Regulatory Strength Training Counter Prior Mental Exertion? A Systematic Review of Randomized Controlled Trials

Background

Prior mental exertion consumes self-regulation and influences any subsequent physical or cognitive performance according to the strength model of self-regulation. However, the counteractive effect of self-regulatory strength training remains unclear.

Objective

This study aims to report a comprehensive systematic review investigating self-regulatory strength training programmes on physical or cognitive performance.

Methods

To select relevant studies from the available literature, a thorough search was conducted on PubMed, Web of Science, EBSCOhost (CENTRAL, Psychology and Behavioral Sciences Collection, SPORTDicus), Scopus, and Google Scholar, as well as the sources of reference for gray literature. Only randomized controlled trials involving healthy humans, strength-based self-regulation training programmes with comparable protocols, and a physical or cognitive task associated with the study were selected for the current review. The Grading of Recommendations Assessment Development and Evaluation (GRADE) framework was used to develop the summary of findings.

Results

Twelve articles were included based on the selection criteria. Evidence certainty for outcomes was graded as either low or very low level. The majority of the studies reported that self-regulatory strength training programmes can significantly counter prior mental exertion and decrement of performance, while only one study did not find such improvement. According to the strength model, a period of training increased the ‘self-regulatory muscle.'

Conclusion

Strength is an important ingredient in the resource model of self-regulation and can be trained to counter prior mental exertion and improve subsequent physical and cognitive performance. The training effects are cross-domain (e.g., emotional and cognitive domains; higher and lower levels of executive functions). However, motivation plays a key role to mobilize this resource. Future studies should examine the mechanism that underlies the strength.

Systematic Review Registration

https://inplasy.com/inplasy-2022-1-0060/, identifier: INPLASY202210060.

Effectiveness of Response Inhibition Training and Its Long-Term Effects in Healthy Adults: A Systematic Review and Meta-Analysis

Objective

This study aims to evaluate the effectiveness and long-term effects of response inhibition training as a therapeutic approach in healthy adults.

Methods

The PubMed, Embase, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang, and China Science and Technology Journal Database (VIP) were searched for studies. Data on the improvement of Cognitive function and its long-term effect were extracted by two authors independently. The pooled data were meta-analyzed using a random-effects model, and the quality of each eligible study was assessed by The Cochrane Collaboration’s tool.

Results

Nine articles were included. 1 of the articles included 2 trials, so 10 eligible trials (response inhibition training group vs. control group) were identified. A total of 490 patients were included. Response inhibition training has beneficial effects on improving cognitive function in healthy adults compared to control treatment (SMD, −0.93; 95% CI, −1.56 to −0.30; Z = 2.88, P = 0.004), the subgroup analysis results showed that either GNG training alone (SMD, −2.27; 95% CI, −3.33 to −1.21; Z = 4.18, P < 0.0001) or the combination of both SST and GNG significantly improved cognitive function in healthy adults (SMD, −0.94; 95% CI, −1.33 to −0.56; Z = 4.80, P < 0.0001), whereas SST training alone did not have such an effect (SMD, −0.15; 95% CI, −0.76 to 0.47; Z = 0.47, P = 0.64). But its long-term effects are not significant (SMD, −0.29; 95% CI, −0.68 to 0.10; Z = 1.45, P = 0.15). The subgroup analysis results showed that neither GNG training alone (SMD, −0.25; 95% CI, −0.75 to 0.24; Z = 0.99, P = 0.32) nor SST training alone (SMD, 0.03; 95% CI, −0.42 to 0.48; Z = 0.14, P = 0.89) could improve the cognitive function of healthy adults in the long term. In contrast, the combination of both training (SMD, −0.95; 95% CI, −1.46 to −0.45; Z = 3.68, P = 0.0002) can have long-term effects on the improvement of cognitive function in healthy adults.

Conclusion

The findings of our study indicate that response inhibition training can improve the cognitive function of healthy adults and that more RCTs need to be conducted to validate their usefulness in clinical cases.

The evidential value of research on cognitive training to change food-related biases and unhealthy eating behavior: A systematic review and p-curve analysis

Cognitive bias modification (CBM), which retrains implicit biases towards unhealthy foods, has been proposed as a promising adjunct to improve the efficacy of weight loss interventions. We conducted a systematic review of research on three CBM approaches (i.e., cue-specific inhibitory control, approach bias modification, and attentional bias modification) for reducing unhealthy eating biases and behavior. We performed a p-curve analysis to determine the evidential value of this research; this method is optimally suited to clarify whether published results reflect true effects or false positives due to publication and reporting biases. When considering all CBM approaches, our results suggested that the findings of CBM trials targeting unhealthy eating are unlikely to be false positives. However, only research on attentional bias modification reached acceptable levels of power. These results suggest that CBM interventions may be an effective strategy to enhance the efficacy of weight loss interventions. However, there is room for improvement in the methodological standards of this area of research, especially increasing the statistical power can help to fully clarify the clinical potential of CBM, and determine the role of potential moderators.

Can sweet food-specific inhibitory control training via a mobile application improve eating behavior in children with obesity?

OBJECTIVES

Consumption of excess sugar, a common energy-dense nutrient-poor food, is a risk factor for obesity in school-aged children. Food-specific inhibition training, where responses to palatable food stimuli, such as sweet foods, are consistently and repeatedly inhibited, reduces sweet food intake in adults. However, no studies have yet examined the effectiveness of inhibitory control training specifically targeting sweet foods among children with high sugar cravings. We examined whether sweet food-specific inhibitory control training (SF-ICT), administered via a mobile app, reduced choice and consumption of sweet foods, and weight in a sample of children aged 7-11 with overweight or obesity and who had high sugar cravings (N = 46).

DESIGN

This study was designed as a 2 × 3 between-within design.

METHODS

Participants were randomly allocated to a single-blind design with two conditions: they either received 7 sessions of active or control go/no-go training in which either sweet foods or non-food cues were paired with no-go signals. Participants' weight, sweet food choice, and consumption were measured pre and post-training, and at three-month follow-up.

RESULTS

The results revealed that participants in the active group showed a significant reduction in sweet food choice and intake from pre to post-training relative to the control group. The effects of the training on reducing sweet food intake persisted over the 3-month follow-up No significant changes in weight loss were observed.

CONCLUSIONS

These results provide preliminary evidence that sweet food-specific inhibitory control training (SF-ICT) via a mobile app is effective in modifying eating behavior among children with excessive consumption of sugary foods. Further research is required to clarify under what conditions the benefits of training would expand to weight loss.

The relationship between autistic characteristics, social engagement and executive function in a typical sample

Purpose

This study aims to represent a first attempt to examine in a non-clinical population the interplay between social engagement, executive function (EF) and theory of mind (ToM) within a social motivation theory framework.

Design/methodology/approach

A total of 170 participants (135 female; mean age = 19.01 and standard deviation = 1.27) completed measures of ToM (Faux Pas task), autistic traits (Autism Spectrum Quotient), social engagement (reward dependence subscale of the Temperament and Character Inventory), sociability and EF (both subscales of the Adult Temperament Questionnaire).

Findings

Path analyses found that EF, sociability and social engagement were negatively associated with autistic traits both directly and indirectly. Results indicate that EF may impact sociability and social engagement and their interaction may relate to the degree of autistic traits shown in a typical sample. However, ToM (as measured by the Faux Pas test) was not related to any of the other variables.

Originality/value

Sociability, social engagement and effortful control deficits may be linked to higher levels of autistic traits. These factors appear to form a hierarchy of factors underpinning autism spectrum disorder, with EF contributing to all aspects, followed by sociability and social engagement at a higher level. Future research examining in clinical populations the utility of a more integrated model of social motivation that incorporates EF appears warranted.

Modifying food items valuation and weight with gamified executive control training

Recent lines of research suggest that repeated executive control of motor responses to food items modifies their perceived value and in turn their consumption. Cognitive interventions involving the practice of motor control and attentional tasks have thus been advanced as potential approach to improve eating habits. Yet, their efficacy remains debated, notably due to a lack of proper control for the effects of expectations. We examined whether a one-month intervention combining the practice of Go/NoGo and Cue approach training modified the perceived palatability of food items (i.e. decrease in unhealthy and increase in healthy food items' palatability ratings), and in turn participants' weights. We assessed our hypotheses with a parallel, double-blind, randomized controlled trial. Motivation and adherence to the intervention were maximized by a professional-level gamification of the training tasks. The control intervention differed from the experimental intervention only in the biasing of the stimulus-response mapping rules, enabling to balance expectations between the two groups and thus to conclude on the causal influence of motoric control on items valuation. We found a larger decrease of the unhealthy items' palatability ratings in the experimental (20.6%) than control group (13.1%). However, we did not find any increase of the healthy items' ratings or weight loss. Overall, the present registered report confirms that the repeated inhibition of motor responses to food cues, together with the development of attentional biases away from these cues, reduces their perceived value.

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.

Executive Functions in Predicting Weight Loss and Obesity Indicators: A Meta-Analysis

While previous studies have suggested that there exists a relationship between obesity and executive function (EF), the mechanisms and causal relationship between them remain unclear. There are important clinical implications of determining whether EF can predict and treat obesity. We conducted a multilevel meta-analysis of randomized controlled trials (RCTs) and longitudinal studies. Specifically, we investigate (a) whether EF interventions have an effect on weight loss, (b) whether baseline EF can be a predictor of future weight loss through obesity intervention, and (c) whether early-life EF can predict future weight loss. Eight RCTs and 17 longitudinal studies with a total of 11,393 participants were identified. We found that (a) EF interventions may not have an effect on weight loss, (b) baseline inhibition (β = 0.259, p = 0.03) and delay discounting (β = −0.17, p = 0.04) significantly predict future weight loss through obesity intervention, (c) age (F = 13.666, p = 0.005) moderates the relationship between working memory and weight loss through intervention, but not weight status, type of intervention, and percentage of female, and (d) early life inhibition (β = 0.185, p = 0.07) is a marginally significant predictor of future weight loss. Our results seem to support the assumption that the relationship between EF and obesity is not direct, and a higher-order factor, such as genes, may link obesity and EF. Building on the preliminary findings, further studies focusing on EF and obesity are needed in the future.

Cognitive Training: Associations and Implications for Weight Management and Translational Research

Behavioral weight loss programs combining energy restriction and increased physical activity (PA) are generally successful in producing clinically significant weight loss (≥5%) over 3-6 mos. However, weight maintenance (≥ 2 yrs.) continues to be problematic, due in part to an inability of individuals to continue adherence to diet and PA recommendations. It is hypothesized that neurocognitive processes, specifically executive functions (EFs, i.e., inhibition, working memory, mental flexibility), underlie self-regulation, self-efficacy, and are essential for the adoption and maintenance of health behaviors. Behavioral weight loss programs generally attempt to improve self-regulation; however, these skills are difficult to implement long-term. Strengthening EFs through cognitive training may improve weight maintenance by improving self-efficacy and self-regulation, resulting in improved program attendance and improved adherence to dietary and PA recommendations. Although randomized trials have not been conducted to specifically evaluate this hypothesis, results from the available literature suggest the potential for cognitive training to improve weight maintenance.

Examining cognitive bias modification interventions for reducing food value and choice: Two pre-registered, online studies

There is considerable interest in Cognitive Bias Modification (CBM) as a potential treatment for overweight/obesity. Inhibitory Control Training (ICT: also known as motor response training) and Evaluative Conditioning (EC) are two popular paradigms which rely on associatively learned responses (unhealthy food - > inhibition, or unhealthy food- > negative stimulus, respectively) through repeated cue-response contingencies. Both ICT and EC have demonstrated some effectiveness for reducing food intake, value and/or choice, when administered in the laboratory and online. However, studies have been criticised for inconsistencies in design (e.g. use of inadequate control groups) which makes it difficult to draw robust conclusions. In two pre-registered, online studies our aim was to examine active ICT (study 1: N = 170) and EC (study 2: N = 300) in multiple groups where the cue- > response contingencies were systematically varied (100%, 75%, 50%, 25%), before examining food-cue valuations and hypothetical food choice. In both studies varying the cue- > response contingencies did not lead to significant changes in food-cue devaluation following training. ICT did not substantially influence hypothetical food choice, whereas there was weak evidence that EC reduced choice for unhealthy foods, compared to a control group with 50% cue-response contingencies. Taken together both studies provide limited evidence for online CBM as a viable psychological treatment - at least through the mechanism of food-cue devaluation or changes in healthy and unhealthy food choice. Future research is needed to investigate the factors that contribute towards successful CBM training to critically evaluate the potential for these strategies within interventions.

The impact of self-control training on neural responses following anger provocation

Self-control training (SCT) is one way to enhance self-controlled behavior. We conducted a novel and exploratory functional magnetic resonance imaging experiment to examine how SCT affects neural responses in a situation that elicits a self-control response: anger provocation. Forty-five healthy young men and women completed two-weeks of SCT or a behavioral monitoring task and were then insulted during scanning. We found significant changes in functional activation and connectivity using a lenient error threshold, which were not observed using a stricter threshold. Activation in the posterior insula was greater for the control compared to the SCT group at post-provocation, trait aggression correlated with neural responses to SCT, and SCT was associated with specific amygdala-cortical connections. Neural changes occurred even though SCT did not affect participants' performance on an inhibition task, reports of trying to control their anger, or their experience of anger. This dissociation prevented clear interpretation about whether the neural changes were indicative of specific anger or anger control processes. Although replication with high-powered studies is needed, we provide evidence that SCT affects neural responses in the context of anger provocation.

Go/no-go for food: Attention bias and intention to eat unhealthy food

OBJECTIVE

The current research evaluated whether Go/No-go training for highly palatable (HP) food affected attention bias for HP food (an automatic/implicit outcome) and intention to eat unhealthy food (a controlled/explicit outcome).

METHOD

A sample of Australian adults representative for age, gender and Body Mass Index (BMI) (N = 561, M_age = 46.31 years, SD = 16.75, 52.3% women, M_BMI = 27.11, SD = 6.34) completed self-report measures of dietary psychological constructs and food image modified Stroop tasks as measures of pre- and post-test attention bias for HP food. After random assignment of participants to two conditions, a Go/No-go intervention was used to train HP food targeted inhibitory control in the experimental group, or general inhibitory control in the control group. All research tasks were delivered online.

RESULTS

The experimental, HP food inhibitory control training group reported intention to eat less unhealthy food than the control group, F (1, 637) = 4.81, R² = 0.09, p = .029. Counter to expectations, the experimental group exhibited a heightened attention bias to HP food images after the training, F (1, 637) = 9.48, R² = 0.39, p = .002.

CONCLUSION

Go/No-go training for food may improve both top-down and bottom-up inhibitory control, using both automatic and controlled processes. Further, it may not be effective in lowering attention bias for HP food, but may be effective in lowering unhealthy food intake despite raising attention bias for HP food. Further research that tests these effects using varied reaction time tasks is needed to confirm these results and to explore possible alternative explanations.

Cognitive training on eating behaviour and weight loss: A meta-analysis and systematic review

Cognitive deficits play a role in the development and maintenance of overeating and obesity, and cognitive training in obesity refers to a family of interventions aimed at reducing overeating and obesity by improving these cognitive deficits. In this review, we synthesize the current literature on these issues by conducting a meta-analysis of studies investigating the effects of cognitive trainings on eating behaviour and presenting a systematic review of studies investigating the effects of cognitive trainings on weight loss. We examined 66 independent experiments that examined the effects of cognitive training aimed at reducing cognitive bias or improving executive control on eating behaviour and weight loss. Overall, inhibition training, attention bias modification training, and episodic future thinking training significantly influenced eating behaviour; however, approach/avoidance training did not significantly influence eating behaviour. Moderator analyses indicated that the effect of inhibition training on eating behaviour was moderated by training task and food novelty, the effect of approach/avoidance training was moderated by food type, and the effect of episodic future thinking training was moderated by type of episodic future thinking. Literature reviewed on cognitive training and weight loss provided preliminary support for the effects of food-specific inhibition training on weight loss from pre-intervention to post intervention. However, because most of the included studies focused on short-term outcomes in normal-weight samples, longer duration studies in clinical populations (eg, individuals with obesity) are needed to examine the generalizability of these results.

Implicit process interventions in eating behaviour: a meta-analysis examining mediators and moderators

Dual-process models integrate deliberative and impulsive mental systems and predict dietary behaviours better than deliberative processes alone. Computerised tasks such as the Go/No-Go, Stop-Signal, Approach-Avoidance, and Evaluative Conditioning have been used as interventions to directly alter implicit biases. This meta-analysis examines the effects of these tasks on dietary behaviours, explores potential moderators of effectiveness, and examines implicit bias change as a proposed mechanism. Thirty randomised controlled trials testing implicit bias interventions (47 comparisons) were included in a random-effects meta-analysis, which indicated small cumulative effects on eating-related behavioural outcomes (g = -0.17, CI₉₅ = [-0.29; -0.05], p = .01) and implicit biases (g = -0.18, CI₉₅= [-0.34; -0.02], p = .02). Task type moderated these effects, with Go/No-Go tasks producing larger effects than other tasks. Effects of interventions on implicit biases were positively related to effects on eating behaviour (B = 0.42, CI₉₅= [0.02; 0.81], p = .03). Go/No-Go tasks seem to have most potential for altering dietary behaviours through implicit processes. While changes in implicit biases seem related to the effects of these interventions on dietary outcomes, more research should explore whether repeated exposure to implicit bias interventions may have any practical intervention value in real world settings.

A randomized controlled trial of inhibitory control training for the reduction of alcohol consumption in problem drinkers

OBJECTIVE

We conducted a randomized controlled trial to compare the effects of three types of Internet-delivered Inhibitory Control Training (ICT) with each other and with an active control intervention on alcohol consumption in a community sample of problem drinkers.

METHOD

Two hundred and 46 heavy drinkers, who were motivated to reduce their alcohol consumption (mean age 41.32, 130 female) self-monitored their alcohol consumption for 1 week before being randomized to receive 1 of 3 variants of ICT (Associative No-Go, Associative Stop Signal, General Inhibition) or an active control. Participants then completed up to 14 ICT/control sessions on the Internet over a 4-week period, while regularly recording their alcohol consumption.

RESULTS

There were significant reductions in alcohol consumption across all groups over the 4-week training period (main effect of time, F(2, 402) = 77.12, p < .01, ηp2 = .28, BF10 > 99), however there were no differences between ICT groups, or between ICT groups and the active control group (Group × Time interaction, F(6, 402) = 1.10, p = .36, ηp2 = .02, BF10 = 0.03). Contrary to hypotheses, there were no changes in general inhibitory control, the disinhibiting effects of alcohol cues, or alcohol affective associations after ICT.

CONCLUSIONS

In this study, which attempted to translate findings from proof-of-concept laboratory studies into a viable behavior change intervention, we found that multiple sessions of ICT delivered over the Internet did not help heavy drinkers to reduce their alcohol consumption beyond nonspecific effects associated with taking part in a trial. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Behavioral interventions for obesity in children and adults: Evidence base, novel approaches, and translation into practice

Obesity in adults has nearly doubled in the past 30 years and has risen similarly in children and adolescents. Obesity affects all systems of the body, and the serious health consequences of obesity include an increased risk for cardiovascular disease, such as Type 2 diabetes or high blood pressure, which are occurring at ever younger ages. The present article introduces traditional behavioral weight loss strategies designed to change energy-balance behaviors (i.e., dietary and physical activity behaviors) and the contexts within which these interventions have typically been delivered. The applicability of findings from behavioral economics, cognitive processing, and clinical research that may lead to more potent weight loss and weight loss maintenance interventions are also considered. Given the pervasiveness of obesity, this article concludes with a discussion of efforts toward wider scale dissemination and implementation of behavioral treatments designed to address obesity and to reduce the risk of cardiovascular disease. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Executive function in childhood obesity: Promising intervention strategies to optimize treatment outcomes

Executive functions (EFs) are hypothesized to play a role in the development and maintenance of obesity due to their role in self-regulatory processes that manage energy-balance behaviors. Children with obesity have well-documented deficits in EF, which may impede effectiveness of current, evidence-based treatments. This review examines top-down EF processes (e.g., inhibitory control, working memory, cognitive flexibility), as well as bottom-up automatic processes that interact with EFs (e.g., attentional bias, delay discounting) and their relation to weight-loss treatment success in children. It then evaluates EF-related interventions that may improve treatment response. Empirical studies that included an intervention purported to affect EF processes as well as pre-post measurements of EF and/or relative weight in populations ages 19 or younger with overweight/obesity were reviewed. Findings indicate that poorer EF may hinder treatment response. Moreover, there is preliminary evidence that behavioral weight loss intervention and physical activity may positively affect EF and that improvements in EF are related to enhanced weight loss. Finally, novel intervention strategies, such as computer training of core EFs, attention modification programs, and episodic future thinking, show promise in influencing both EFs and EF-related skills and weight. Further research is needed to provide more conclusive evidence of the efficacy of these interventions and additional applications and settings should be considered.

The effect of combined avoidance and control training on implicit food evaluation and choice

BACKGROUND

Continual exposure to food cues in the environment contributes to unhealthy eating behaviour. According to dual-process models, such behaviour is partly determined by automatic processing of unhealthy food cues (e.g., approach bias), which fails to be regulated by controlled processing (e.g., inhibitory control). The current study aimed to investigate the effect of combined avoidance and control training on implicit evaluation (liking), choice, and consumption of unhealthy snack food.

METHOD

Participants were 240 undergraduate women who were randomly allocated to one of four experimental conditions of a 2 (avoidance training: training versus control) x 2 (control training: training versus control) between-subjects design.

RESULTS

The combined training group had a more negative implicit evaluation of unhealthy food than either of the two training conditions alone or the control condition. In addition, participants trained to avoid unhealthy food cues subsequently made fewer unhealthy snack food choices. No significant group differences were found for food intake.

LIMITATIONS

Participants were women generally of a healthy weight. Overweight or obese individuals may derive greater benefit from combined training.

CONCLUSIONS

Results lend support to the theoretical predictions of dual-process models, as the combined training reduced implicit liking of unhealthy food. At a practical level, the findings have implications for the effectiveness of interventions targeting unhealthy eating behaviour.

Cognitive training as a potential treatment for overweight and obesity: A critical review of the evidence

The aim of this review is to critically evaluate the effectiveness and candidate mechanisms of action of psychological interventions which aim to either (a) improve the capacity for self-regulatory, reflective processes or (b) reduce the impact of automatic appetitive processes, in an attempt to influence food intake and associated weight-gain. Our aim was to examine three important issues regarding each type of intervention: i) whether the intervention influenced behaviour in the laboratory, ii) whether the intervention influenced behaviour and/or body mass index in the real world, and iii) whether the proposed mechanism of action was supported by evidence. We systematically searched three commonly used databases and identified 32 articles which were relevant to at least one of these issues. The majority of studies attempted to manipulate food intake in the laboratory using associative learning paradigms, in normal-weight female participants. Most of the laboratory studies demonstrated the predicted effects of interventions on behaviour in the laboratory, but studies that attempted to translate these interventions outside of the laboratory yielded more mixed findings. The hypothesised mechanisms of action received inconsistent support across studies. We identified several limitations which may complicate interpretation of findings in this area, including heterogeneity of study methods, small sample sizes, and absence of adequate control groups. We provide recommendations for future studies that aim to develop and evaluate these promising interventions for the reduction of overweight and obesity.

Pilot test of a novel food response and attention training treatment for obesity: Brain imaging data suggest actions shape valuation

Elevated brain reward and attention region response, and weaker inhibitory region response to high-calorie food images have been found to predict future weight gain. These findings suggest that an intervention that reduces reward and attention region response and increases inhibitory control region response to such foods might reduce overeating. We conducted a randomized pilot experiment that tested the hypothesis that a multi-faceted food response and attention training with personalized high- and low-calorie food images would produce changes in behavioral and neural responses to food images and body fat compared to a control training with non-food images among community-recruited overweight/obese adults. Compared to changes observed in controls, completing the intervention was associated with significant reductions in reward and attention region response to high-calorie food images (Mean Cohen's d = 1.54), behavioral evidence of learning, reductions in palatability ratings and monetary valuation of high-calorie foods (p = 0.009, d's = 0.92), and greater body fat loss over a 4-week period (p = 0.009, d = 0.90), though body fat effects were not significant by 6-month follow-up. Results suggest that this multifaceted response and attention training intervention was associated with reduced reward and attention region responsivity to food cues, and a reduction in body fat. Because this implicit training treatment is both easy and inexpensive to deliver, and does not require top-down executive control that is necessary for negative energy balance obesity treatment, it may prove useful in treating obesity if future studies can determine how to create more enduring effects.

What Is Trained During Food Go/No-Go Training? A Review Focusing on Mechanisms and a Research Agenda

Purpose of Review

During food go/no-go training, people consistently withhold responses toward no-go food items. We discuss how food go/no-go training may change people’s behavior toward no-go food items by comparing three accounts: (a) the training strengthens ‘top-down’ inhibitory control over food-related responses, (b) the training creates automatic ‘bottom-up’ associations between no-go food items and stopping responses, and (c) the training leads to devaluation of no-go food items.

Recent Findings

Go/no-go training can reduce intake of food and choices for food and facilitate short-term weight loss. It appears unlikely that food go/no-go training strengthens top-down inhibitory control. There is some evidence suggesting the training could create automatic stop associations. There is strong evidence suggesting go/no-go training reduces evaluations of no-go food items.

Summary

Food go/no-go training can change behavior toward food and evaluation of food items. To advance knowledge, more research is needed on the underlying mechanisms of the training, the role of attention during go/no-go training, and on when effects generalize to untrained food items.

Training response inhibition to reduce food consumption: Mechanisms, stimulus specificity and appropriate training protocols

Training individuals to inhibit their responses towards unhealthy foods has been shown to reduce food intake relative to a control group. Here we aimed to further explore these effects by investigating the role of stimulus devaluation, training protocol, and choice of control group. Restrained eaters received either inhibition or control training using a modified version of either the stop-signal or go/no-go task. Following training we measured implicit attitudes towards food (Study 1) and food consumption (Studies 1 and 2). In Study 1 we used a modified stop-signal training task with increased demands on top-down control (using a tracking procedure and feedback to maintain competition between the stop and go processes). With this task, we found no evidence for an effect of training on implicit attitudes or food consumption, with Bayesian inferential analyses revealing substantial evidence for the null hypothesis. In Study 2 we removed the feedback in the stop-signal training to increase the rate of successful inhibition and revealed a significant effect of both stop-signal and go/no-go training on food intake (compared to double-response and go training, respectively) with a greater difference in consumption in the go/no-go task, compared with the stop-signal task. However, results from an additional passive control group suggest that training effects could be partly caused by increased consumption in the go control group whereas evidence for reduced consumption in the inhibition groups was inconclusive. Our findings therefore support evidence that inhibition training tasks with higher rates of inhibition accuracy are more effective, but prompt caution for interpreting the efficacy of laboratory-based inhibition training as an intervention for behaviour change.

Executive functioning and dietary intake: Neurocognitive correlates of fruit, vegetable, and saturated fat intake in adults with obesity

Obesity is a significant public health issue, and is associated with poor diet. Evidence suggests that eating behavior is related to individual differences in executive functioning. Poor executive functioning is associated with poorer diet (few fruits and vegetables and high saturated fat) in normal weight samples; however, the relationship between these specific dietary behaviors and executive functioning have not been investigated in adults with obesity. The current study examined the association between executive functioning and intake of saturated fat, fruits, and vegetables in an overweight/obese sample using behavioral measures of executive function and dietary recall. One-hundred-ninety overweight and obese adults completed neuropsychological assessments measuring intelligence, planning ability, and inhibitory control followed by three dietary recall assessments within a month prior to beginning a behavioral weight loss treatment program. Inhibitory control and two of the three indices of planning each independently significantly predicted fruit and vegetable consumption such that those with better inhibition and planning ability consumed more fruits and vegetables. No relationship was found between executive functioning and saturated fat intake. Results increase understanding of how executive functioning influences eating behavior in overweight and obese adults, and suggest the importance of including executive functioning training components in dietary interventions for those with obesity. Further research is needed to determine causality as diet and executive functioning may bidirectionally influence each other.

A Serious Game to Increase Healthy Food Consumption in Overweight or Obese Adults: Randomized Controlled Trial

BACKGROUND

Obesity is a growing global issue that is linked to cognitive and psychological deficits.

OBJECTIVE

This preliminary study investigated the efficacy of training to improve inhibitory control (IC), a process linked to overeating, on consumption and cognitive control factors.

METHODS

This study utilized a multisession mobile phone-based intervention to train IC in an overweight and obese population using a randomized waitlist-control design. A combination of self-assessment questionnaires and psychophysiological measures was used to assess the efficacy of the intervention in terms of improved general IC and modified food consumption after training. Attitudes toward food were also assessed to determine their mediating role in food choices. A total of 58 participants (47 female) completed 2 assessment sessions 3 weeks apart, with 2 weeks of intervention training for the training group during this time. The groups did not differ in baseline demographics including age, body mass index, and inhibitory control.

RESULTS

Inhibitory control ability improved across the training sessions, with increases in P3 amplitude implying increased cognitive control over responses. Inhibitory control training was associated with increased healthy and reduced unhealthy food consumption in a taste test and in the week following training, as measured by the Healthy Eating Quiz and the food consumption test. Cognitive restraint was enhanced after training for the training but not the waitlist condition in the Three-Factor Eating Questionnaire, implying that attempts to avoid unhealthy foods in the future will be easier for the training group participants.

CONCLUSIONS

Inhibitory control training delivered via a purpose-designed mobile phone app is easy to complete, is convenient, and can increase cognitive restraint and reduce unhealthy food consumption.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry ACTRN12616000263493; http://www.ANZCTR.org.au/ACTRN12616000263493.aspx (Archived by WebCite at http://www.webcitation.org/6ioHjGING).

Neurocognitive Processes and Pediatric Obesity Interventions: Review of Current Literature and Suggested Future Directions

Childhood obesity is a significant problem in the United States, but current childhood obesity prevention approaches have limited efficacy. Self-regulation processes organize behavior to achieve a goal and may shape health behaviors and health outcomes. Obesity prevention approaches that focus on the cognitive and behavioral mechanisms that underlie self-regulation early in life may therefore lead to better outcomes. This article reviews the development of executive functioning (EF), identifies influences on EF development, discusses aspects of EF relating to increased risk for childhood obesity, and considers how EF-weight associations may change across development. Implications for intervention are discussed.

A systematic review of the relationship between eating, weight and inhibitory control using the stop signal task

Altered inhibitory control (response inhibition, reward-based inhibition, cognitive inhibition, reversal learning) has been implicated in eating disorders (EDs) and obesity. It is unclear, however, how different types of inhibitory control contribute to eating and weight-control behaviours. This review evaluates the relationship between one aspect of inhibitory control (a reactive component of motor response inhibition measured by the stop signal task) and eating/weight in clinical and non-clinical populations. Sixty-two studies from 58 journal articles were included. Restrained eaters had diminished reactive inhibitory control compared to unrestrained eaters, and showed greatest benefit to their eating behaviour from manipulations of inhibitory control. Obese individuals may show less reactive inhibitory control but only in the context of food-specific inhibition or after executive resources are depleted. Of the limited studies in EDs, the majority found no impairment in reactive inhibitory control, although findings are inconsistent. Thus, altered reactive inhibitory control is related to some maladaptive eating behaviours, and hence may provide a therapeutic target for behavioural manipulations and/or neuromodulation. However, other types of inhibitory control may also contribute. Methodological and theoretical considerations are discussed.

A Cognitive Profile of Obesity and Its Translation into New Interventions

Change your lifestyle: decrease your energy intake and increase your energy expenditure, is what obesity experts tell people who need to lose weight. Though the advice might be correct, it appears to be extremely difficult to change one’s lifestyle. Unhealthy habits usually are ingrained and hard to change, especially for people with an “obese cognitive profile.” Knowledge of the cognitive mechanisms that maintain unhealthy eating habits is necessary for the development of interventions that can change behavior effectively. This paper discusses some cognitive processes that might maintain unhealthy eating habits and make healthier eating difficult, like increased food cue reactivity, weak executive skills and attention bias. An effort is also done to translate these basic scientific findings into new interventions which aim to tackle the sabotaging cognitive processes. Preliminary studies into the effectiveness of these interventions, if available, are presented.