Exploring tailored virtual emotion regulation approaches for individuals with emotional eating

BACKGROUND

Emotional eating is a complex problem fostering obesity and resulting from maladaptive emotion regulation. Traditional behavioural weight loss interventions have shown insignificant effect. They can be improved by targeting the specific needs of individuals with emotional eating.

OBJECTIVE

The current study explored a tailored online approach with the aim to positively influence affect (positive and negative) and emotion regulation by applying one of three exercises: body scan, opposite action, and positive reappraisal.

DESIGN

An embedded mixed-method design (questionnaire data (t0, t1, t2) and perceived usefulness of exercises in t2) was used to evaluate the effects of a two-week online quasi-experimental pilot study.

SUBJECTS/SETTING

In total, 80 participants with self-reported emotional eating difficulties (DEBQ-E; Memo = 3.48, SD = .64, range 1.62-4.92) finished baseline measurements; 15 completed the intervention. The study sample was predominantly female (95%), from 18 till 66 (Mage = 38,0 ± SD = 14.25).

RESULTS

Participants reported that the exercises helped them to pay attention to their physical sensations, and to see positive aspects in negative matters. The exercises were considered difficult by the participants, with too little explanation, and dull, due to minor variation. The observed changes revealed small, and moreover, not significant improvements of the three exercises on positive and negative affect and overall emotion dysregulation. Although the quantitative results did not reach significance, the qualitative data highlighted which aspects of the tailored exercises may have contributed to mood and emotion regulation outcomes. A notable observation in the present study is the substantial dropout rate, with the number of participants decreasing from 80 at baseline (T0) to 15 at the post-intervention stage (T2).

CONCLUSIONS

Future studies should identify tailored online exercises in emotion regulation skills in more detail and explore the contexts in which they are most effective in a personalized virtual coach virtual coach to be developed for individuals with emotional eating. Given the high dropout rate, more emphasis should be given to a proper presentation of the exercises, as well as more explanation of their usefulness and how to perform them.

One SMS a day keeps the stress away? A just-in-time planning intervention to reduce occupational stress among apprentices

BACKGROUND

Occupational stress is one of the main sources of stress in apprentices with physical and psychological health consequences. Just-in-time planning interventions (JITPIs) are one opportunity to deliver intervention components at the right times and locations to optimally support apprentices in stressful situations. The aim of this study was to test the proximal effect of a mobile phone-delivered JITPI to reduce occupational stress in 386 apprentices within a planning intervention.

METHODS

An AB/BA crossover design in which participants were randomly allocated to (A) the planning intervention or (B) the assessment only condition was implemented.

RESULTS

The analyses of the study "ready4life", multilevel modeling, revealed no significant effect of the planning intervention on occupational stress reduction.

CONCLUSIONS

Possible reasons for the missing effect might be the low stress level of participants or the type of the intervention delivery. Since apprenticeships in Switzerland differ considerably, future studies should enable more adapted interventions for the apprentices and consider individual circumstances of stress. Further, the intervention should focus on apprentices with high occupational stress levels or a high-risk of stress. Studies should investigate exactly when and why a person needs support regarding her/his occupational stress. Therefore, objective measurements of stress could be helpful.

Cultivating Disgust: Prospects and Moral Implications

Is disgust morally valuable? The answer to that question turns, in large part, on what we can do to shape disgust for the better. But this cultivation question has received surprisingly little attention in philosophical debates. To address this deficiency, this article examines empirical work on disgust and emotion regulation. This research reveals that while we can exert some control over how we experience disgust, there’s little we can do to substantively change it at a more fundamental level. These empirical insights have revisionary implications both for debates about disgust’s moral value and for our understanding of agency and moral development more generally.

Up-regulating Sexual Arousal and Down-regulating Disgust while Watching Pornography: Effects on Sexual Arousal and Disgust

Sexual response occurs when sexual excitatory factors outweigh inhibitory factors. Problems with sexual arousal may occur when sexual excitation is too low and/or inhibitory influences such as feelings of disgust are too strong. To explore interventions that may help overcome decreased sexual responding, we examined if sexual responding could be amplified by instructions to up-regulate sexual arousal and/or down-regulate disgust. Women with no sexual difficulties (N = 255; µ_age = 20.55; SD = 2.23) were randomly assigned to a sexual arousal up-regulation, disgust down-regulation, or passive control condition. Participants were instructed to use the assigned regulation strategy while viewing pornography. To prevent floor effects due to low disgust responsivity in a non-clinical sample, half of the participants were presented with a prime that was designed to make the contaminating properties of sex more salient. Instruction to up-regulate sexual arousal successfully enhanced feelings of sexual arousal in the unprimed group, yet the increase in sexual arousal was not paralleled by reductions in feelings of disgust. Instruction to down-regulate disgust successfully decreased disgust; however, this decrease was not paralleled by increases in sexual arousal. Overall, findings indicate that emotion regulation techniques could facilitate affective control in sexual contexts.

Functional Decoupling of Emotion Coping Network Subsides Automatic Emotion Regulation by Implementation Intention

Automatic emotion regulation (AER) plays a vital role in the neuropathology underlying both suicide and self-harm via modifying emotional impact effortlessly. However, both the effortless account and the neural mechanisms of AER are undetermined. To investigate the neural changes at AER, we collected functional MRI (fMRI) in 31 participants who attended to neutral and disgust pictures in three conditions: watching, goal intention (GI), and reappraisal by implementation intention (RII). Results showed that RII (but not GI) decreased negative feelings and bilateral amygdala activity without increasing cognitive efforts, evidenced by the reduced effort rating and less prefrontal engagement during RII compared with during watching and GI. These emotion-regulatory effects of RII cannot be explained by emotional habituation, as the supplementary experiment (N = 31) showed no emotional habituation effects when the same disgust pictures were presented repeatedly three times for each watching and GI condition. Task-based network analysis showed both RII and GI relative to watching increased functional connectivities (FCs) of the ventral anterior cingulate cortex to the left insula and right precuneus during conditions, two FCs subserving goal setup. However, RII relative to GI exhibited weaker FCs in brain networks subserving effortful control, memory retrieval, aversive anticipation, and motor planning. In these FCs, the FC intensity of putamen-operculum/lingual and paracentral-superior temporal gyri positively predicted regulatory difficulty ratings. These findings suggest that the setup of implementation intention automatizes emotion regulation by reducing the online mobilization of emotion-coping neural systems.

Automatic Suppression Reduces Anxiety-Related Overestimation of Time Perception

Anxiety has been found to lengthen time perception, especially the time perception of negative stimuli. This anxiety-related time overestimation is thought to be mainly associated with massively increased arousal. Suppression, which can be achieved either deliberately or automatically, has been demonstrated to be effective in reducing arousal. Consequently, the present study explored the effectiveness of both deliberate suppression (Experiment 1) and automatic suppression (Experiment 2) in reducing the time distortion in anxiety. A temporal bisection task (TBT), featuring negative and neutral pictures, was used to measure time perception, while the self-reported arousal was used to assess arousal. The deliberate suppression was manipulated by asking participants to suppress their emotional expressions; while automatic suppression was manipulated through a sentence-unscrambling task featuring suppression-related words, which can unconsciously prime suppression. The results of Experiment 1 showed that deliberate suppression did not reduce the anxiety-related time overestimation and arousal. However, Experiment 2 showed that automatic suppression significantly reduced the anxiety-related time overestimation, with significant arousal reduction being observed. In conclusion, automatic suppression, but not deliberate suppression, is effective for reducing the effect of anxiety on time perception.

Emotion regulation by implementation intention is generalizable to unspecified situations: The nature of the underlying goal matters

Implementation intentions (II), which specify how to respond in a given situation based on the goal, is known for its automaticity of regulating emotion to the specified situation. However, it is unknown whether such regulatory effects can be generalized to unspecified situations. For this purpose, we performed four experiments, each consisting of specified (bloody) and unspecified (non-bloody) stimuli with the goal of disgust (Exp.1-2) or unpleasant (Exp.3) regulation. Results showed that II reduced negative feelings for both bloody and non-bloody situations (Exp.1). This generalization effect was absent for goal-unrelated, frightening situations (Exp.2). However, broadening the goal extended the generalization effect to the frightening situation, an effect further amplified when a flexible response was used (Exp.3). Moreover, the II buildup did not disrupt feelings for pleasant situations (Exp.4). These results provide the first evidence that II-based emotion regulation is generalizable to unspecified, goal-related situations and that increasing goal coverage expands the generalization.

Automatic self-focused and situation-focused reappraisal of disgusting emotion by implementation intention: an ERP study

Detachment (self-focused) and positive reinterpretation (situation-focused) are two important forms of cognitive reappraisal during emotion regulation. Previous research shows situation-focused reappraisal to be more effective than self-focused reappraisal for intentional emotion regulation. How the two differ in emotional consequences as components of automatic emotion regulation is however unclear. In the current study, event-related potentials were recorded to clarify this problem, while participants passively viewed disgusting or neutral scenes or formed implementation intentions based on self-focused or situation-focused reappraisal. Behavioural results showed fewer negative emotions during self-focused reappraisal than during either situation-focused reappraisal or free viewing (which had similar emotion ratings). In addition, self-reported cognitive cost was not enhanced during the two forms of reappraisal compared to passive viewing. Late positive potential (LPP) amplitudes for disgusting stimuli were larger than those elicited for neutral stimuli, at both frontal and posterior-parietal regions. This amplitude enhancement effect, irrespective of whether frontal or parietal LPP were involved, was found to be weaker during self-focused reappraisal than when participants were engaged in situation-focused reappraisal or passive viewing. The latter two conditions showed similar amplitude enhancement. These findings suggest that automatic self-focused reappraisal by implementation intention produces more favourable emotion regulation than situation-focused reappraisal, without enhancing cognitive cost.

Increase in prefrontal cortex oxygenation during static muscular endurance performance is modulated by self-regulation strategies

Enduring physical strain is an important ability and prototypically required in athletic activities. However, little is known about the psychological determinants of endurance performance and their underlying neural mechanisms. Here, we investigated self-regulation as one such factor. We recruited 60 participants who hold intertwined rings for as long as possible while avoiding contacts between them, either with a goal intention or an implementation intention to perform well. Performance was measured in terms of time-to-failure and contact errors. Additionally, we repeatedly assessed ratings of perceived exertion (RPE) and pain (RPP) and used functional near-infrared spectroscopy (fNIRS) to continuously monitor cerebral oxygenation in dorsal and ventral parts of the lateral prefrontal cortex (LPFC), brain regions associated with effortful attentional control and response inhibition, respectively. Performance, RPE and RPP were similar in the goal and the implementation intention condition. LPFC activity increased over time, but its activation level was generally lower in the implementation intention condition. Both effects were particularly pronounced in the dorsal LPFC. Moreover, the balance between effortful and more automatic regulation seems to differ between self-regulation strategies. Our results indicate that self-regulation plays an important role in endurance performance and that self-regulatory processes during endurance performance might be reflected in LPFC activation.

How to bridge the intention-behavior gap in food parenting: Automatic constructs and underlying techniques

Although parents often report positive intentions to promote and create a healthy food environment for their children (e.g., setting limits to snacks offered), they also experience difficulties in translating these intentions into actual behaviors. In this position paper, we argue that automatic processes explain an important part of the gap between parents' intentions and their actual food parenting behaviors. We provide a conceptual framework in which we hypothesize that automatic effects on food parenting occur through two key interrelated constructs: habits (key outcome construct) and volitional regulation behaviors (key mediating construct). Moreover, we discuss potentially important impulse-focused techniques that may directly change habits (e.g., nudging; inhibitory control training) or indirectly through volitional regulation behaviors (e.g., implementation intentions; mental contrasting). We make use of the literature on the role of intention-behavior discordance in general health behaviors and discuss implications for food parenting practices. Our framework provides a dual process view towards food parenting and may help to explain when and why parents are likely to engage in (un)healthy food parenting behaviors. In addition, this framework may hopefully stimulate research on (combinations of old and) new techniques to promote good food parenting behaviors.

The down-regulation of disgust by implementation intentions: experiential and physiological concomitants

Emotion regulation plays a key role in mental health and psychopathology. Therefore, it seems important to develop effective forms of emotion regulation. Implementation intentions are if-then plans that help people attain their self-regulatory goals. Perspective-taking and response-focused implementation intentions have been shown to reduce feelings of unpleasantness and arousal, respectively, in response to briefly presented disgusting pictures. The present study addressed the open research questions whether forming these types of implementation intentions is effective in regulating affect during prolonged presentation of disgusting pictures, and whether it is associated with changes in physiological arousal. Eighty-one participants viewed disgusting, neutral, and pleasant pictures of 6 s duration under four instructions: the goal intention to not get disgusted, this goal intention furnished with a perspective-taking or a response-focused implementation intention, and no emotion regulation instructions. The dependent variables were ratings of disgust, valence, arousal, and electrodermal activity. Only perspective-taking implementation intention participants significantly reduced their disgust and unpleasantness as compared to goal-intention and control participants. Arousal and skin conductance did not significantly differ between conditions. The effectiveness of response-focused but not perspective-taking implementation intentions seems to be substantially reduced during sustained exposure duration.

Stay calm! Regulating emotional responses by implementation intentions: Assessing the impact on physiological and subjective arousal

Implementation intention (IMP) has recently been highlighted as an effective emotion regulatory strategy. Most studies examining the effectiveness of IMPs to regulate emotion have relied on self-report measures of emotional change. In two studies we employed electrodermal activity (EDA) and heart rate (HR) in addition to arousal ratings (AR) to assess the impact of an IMP on emotional responses. In Study 1, 60 participants viewed neutral and two types of negative pictures (weapon vs. non-weapon) under the IMP "If I see a weapon, then I will stay calm and relaxed!" or no self-regulatory instructions (Control). In Study 2, additionally to the Control and IMP conditions, participants completed the picture rating task either under goal intention (GI) to stay calm and relaxed or warning instructions highlighting that some pictures contain weapons. In both studies, participants showed lower EDA, reduced HR deceleration and lower AR to the weapon pictures compared to the non-weapon pictures. In Study 2, the IMP was associated with lower EDA compared to the GI condition for the weapon pictures, but not compared to the weapon pictures in the Warning condition. ARs were lower for IMP compared to GI and Warning conditions for the weapon pictures.

Attenuating the Escalation of Commitment to a Faltering Project in Decision-Making Groups

When groups receive negative feedback on their progress toward a set goal, they often escalate rather than temper their commitment. To attenuate such escalation, we suggest initiating a self-distancing response (i.e., taking the perspective of a neutral observer) by forming implementation intentions when, where, and how to act (i.e., making if-then plans). Implementation intentions should help groups to translate a self-distancing intention into action. In line with this reasoning, only groups that had added implementation intentions to their goal to make optimal investment decisions reduced their high levels of investment (Study 1) or maintained their moderate levels of investment (Study 2) after negative feedback. Groups that had merely formed goal intentions, however, escalated even when their decision goal was supplemented with self-distancing instructions (Study 1), and they escalated as much as control groups without such a goal (Study 2). Implications for improving group decision making by implementation intentions are discussed.

Combining motivational and volitional strategies to promote unsupervised walking in patients with fibromyalgia: study protocol for a randomized controlled trial

Background

Fibromyalgia patients are often advised to engage in regular low- to moderate-intensity physical exercise. The need of fibromyalgia patients to walk has been stressed in previous research. Behavioral self-regulation theories suggest that a combination of motivational aspects (to develop or strengthen a behavioral intention: Theory of Planned Behavior) and volitional aspects (engagement of intention in behavior: implementation intentions) is more effective than a single intervention. In this paper, we describe a protocol for identifying the motivational processes (using the Theory of Planned Behavior) involved in the practice of walking (phase I) and for studying the efficacy of an intervention that combines motivational and volitional contents to enhance the acquisition and continuation of this exercise behavior (phase II). The paper also shows the characteristics of eligible individuals (women who do not walk) and ineligible populations (women who walk or do not walk because of comorbidity without medical recommendation to walk). Both groups consist of members of any of four patients’ associations in Spain who are between 18 and 70 years of age and meet the London Fibromyalgia Epidemiology Study Screening Questionnaire criteria for fibromyalgia. Furthermore, using this study protocol, we will explore the characteristics of participants (eligible women who agreed to participate in the study) and nonparticipants (eligible women who refused to participate).

Methods/design

Two studies will be conducted: Phase I will be a cross-sectional study, and phase II will be a triple-blind, randomized longitudinal study with two treatment groups and one active control group. The questionnaires were sent to a total of 2,227 members of four patients’ associations in Spain. A total of 920 participants with fibromyalgia returned the questionnaires, and 582 were ultimately selected to participate.

Discussion

The first data gathered have allowed us to identify the characteristics of the study population and they support the appropriateness of the inclusion criteria.. When the study is complete, the results will enable us to establish whether this kind of intervention can be used as a self-regulation tool for increasing and maintaining walking as unsupervised physical exercise of low to moderate intensity in fibromyalgia patients.

Trial registration

Trial registration number: ISRCTN68584893

Implementation intention and action planning interventions in health contexts: state of the research and proposals for the way forward

The purpose of this paper is to provide an overview of the literature on two planning intervention techniques in health behaviour research, implementation intentions and action planning, and to develop evidence-based recommendations for effective future interventions and highlight priority areas for future research. We focused our review on four key areas: (1) definition and conceptualisation; (2) format and measurement; (3) mechanisms and processes; and (4) design issues. Overall, evidence supports the effectiveness of planning interventions in health behaviour with advantages including low cost and response burden. There is, however, considerable heterogeneity in the effects across studies and relatively few registered randomised trials that include objective behavioural measures. Optimally effective planning interventions should adopt "if-then" plans, account for salient and relevant cues, include examples of cues, be guided rather than user-defined, and include boosters. Future studies should adopt randomised controlled designs, report study protocols, include fidelity checks and relevant comparison groups, and adopt long-term behavioural follow-up measures. Priority areas for future research include the identification of the moderators and mediators of planning intervention effects. Future research also needs to adopt "best practice" components of planning interventions more consistently to elucidate the mechanisms and processes involved.