Episodic future thinking improves intertemporal choice and food choice in individuals with higher weight: A systematic review and meta-analysis

Episodic future thinking (EFT) strengthens self-regulation abilities by increasing the perceived value of long-term reinforcements and reducing impulsive choice in delay discounting tasks. As such, EFT interventions have the potential to improve dietary and eating-related decision-making in individuals with obesity or binge eating symptoms, conditions associated with elevated delay discounting. Here, we meta-analyzed evidence from 12 studies that assessed whether EFT interventions improve delay discounting and real-world food choice compared to control interventions. Included studies involved 951 adults with overweight or obesity (body mass index [BMI] ≥25). There were no studies involving participants with binge eating disorder. EFT intervention pooled effects were significant, improving delay discounting with a medium effect, g = 0.55, p < 0.0001, and subsequent food choice outcomes with a small effect, g = 0.31, p < 0.01. Notably, our review is the first to analyze mechanisms of effect in this population, demonstrating that improvements were greater when temporal horizons of EFT episodes were aligned with delay discounting tasks and more distant horizons predicted far-transfer to subsequent dietary and eating-related choices. Our findings thus show that EFT is an effective intervention for individuals with higher weight at risk of adverse health consequences.

Effectiveness and feasibility of the self-administered and repeated episodic future thinking exercises in smoking cessation

Delay discounting (DD) is associated with smoking behavior and relapses. Episodic future thinking (EFT) is one of the leading interventions shown to reduce DD. The 1-month follow-up study with 60 participants that employed EFT as active intervention and episodic recent thinking (ERT) as control intervention was conducted in participants receiving smoking cessation treatment. In EFT group, there was significant decrease in DD rates from pre-intervention to post-intervention (p = 0.009), whereas no significant change was observed in ERT group (p = 0.497). DD rates in EFT group did not change significantly over 1 month (p = 0.059), while decrease was detected in ERT group (p = 0.011). Smoking cessation rates between groups were similar (p = 0.486). Adherence with completing follow-up evaluation forms and performing relevant exercises was higher in EFT group (p = 0.038, p = 0.006). Adding EFT to usual smoking cessation treatment did not increase smoking cessation rates, however feasibility of the self-administered exercises needs to be improved to clarify clinical effects.

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.

A meta-analysis of the effects of episodic future thinking on delay discounting

Delay discounting (DD) refers to the phenomenon in which the subjective value of future rewards is reduced over time. There are individual differences in the DD rate, and increased discounting has been observed in those with various psychiatric disorders. Episodic future thinking (EFT) is the act of vividly imagining events that may happen in the future. Studies have shown that EFT could reduce DD, although inconsistent results have been reported. The aim of this meta-analysis was to clarify the efficacy with which EFT reduces DD and to identify potential moderators. Forty-seven studies (including 63 contrasts) were included in the final analysis. EFT was found to significantly reduce DD (Hedges' g = 0.52). Moderator analysis showed that positive EFT (g = 0.64) was more effective in reducing DD than EFT with the valence not specifically mentioned (g = 0.28) and EFT with neutral or negative valence (g = -0.03). In addition, several factors related to the control task and DD task were related to the efficacy of EFT to reduce DD. These findings have implications for using EFT to reduce DD in the future.

Temporal discounting as a candidate behavioral marker of obesity

Although obesity is a result of processes operating at multiple levels, most forms result from decision-making behavior. The aim of this review was to examine the candidacy of temporal discounting (TD) (i.e. the reduction in the value of a reinforcer as a function of the delay to its receipt) as a behavioral marker of obesity. For this purpose, we assessed whether TD has the ability to: identify risk for obesity development, diagnose obesity, track obesity progression, predict treatment prognosis/outcomes, and measure treatment effectiveness. Three databases (Pubmed, PsycINFO, and Web of Science) were searched using a combination of terms related to TD and obesity. A total of 153 papers were reviewed. Several areas show strong evidence of TD's predictive utility as a behavioral marker of obesity (e.g., distinguishing obese from non obese). However, other areas have limited and/or mixed evidence (e.g., predicting weight change). Given the positive relationship for TD in the majority of domains examined, further consideration for TD as a behavioral marker of obesity is warranted.

The Time Is Ripe: Thinking about the Future Reduces Unhealthy Eating in Those with a Higher BMI

Research suggests that being oriented more towards the future (than the present) is correlated with healthier eating. However, this research tends to be correlational, and thus it is unclear whether inducing people to think about their future could increase healthy eating. Therefore, we investigated whether inducing people to think about their lives in the future versus the present would influence their intake of healthy (muesli) and unhealthy (Maltesers) food. Across two experiments, the effect of thinking about the future versus the present interacted with participants’ body mass index (BMI) to influence their consumption of unhealthy food, but no reliable effects were found for the consumption of healthy food. Among individuals with a higher BMI, thinking about their lives in the future resulted in lower consumption of the unhealthy food compared to thinking about their lives in the present. However, this effect was reversed for those with a lower BMI. In Experiment 2, we found no evidence that this effect was due to reduced impulsivity (as measured by a delay discounting task and a stop-signal task). This suggests that thinking about the future can reduce unhealthy eating among heavier people.