Imagine to Remember: An Episodic Future Thinking Intervention to Improve Medication Adherence in Patients with Type 2 Diabetes

Translational science approaches for food insecurity research

Food insecurity is a pervasive problem that impacts health and well-being across the lifespan. The human research linking food insecurity to poor metabolic and behavioral health outcomes is inherently correlational and suffers from a high degree of variability both between households and even within the same household over time. Further, food insecurity is impacted by societal and political factors that are largely out of the control of individuals, which narrows the range of intervention strategies. Animal models of food insecurity are being developed to address some of the barriers to mechanistic research. However, animal models are limited in their ability to consider some of the more complex societal elements of the human condition. We believe that understanding the role that food insecurity plays in ingestive behavior and chronic disease requires a truly translational approach, and that understanding the health impacts of this complex social phenomenon requires understanding both its psychological and physiological dimensions. This brief review will outline some key features of food insecurity, highlighting those that are amenable to investigation with controlled animal models and identifying areas where integrating animal and human studies can improve our understanding of the psychological burden and health impacts of food insecurity. In the interest of brevity, this review will largely focus on food insecurity in the United States, as the factors that contribute to food insecurity vary considerably across the globe.

Relationship Between Delay Discounting and Clinical Diabetes Outcomes: A Systematic Review

OBJECTIVE

To evaluate the evidence on the relationship between delay discounting and clinical diabetes outcomes, identify current measures, and recommend areas for future work.

METHODS

A reproducible search using OVID Medline, PsycINFO, PubMed, Science Direct, and Scopus was conducted. Articles published from database creation up to March 2024 were searched. Medical Subject Heading (MeSH) terms and keywords representing delay discounting and diabetes were used. Outcomes included hemoglobin A1c (HbA1c), LDL, body mass index (BMI), blood pressure, quality of life (QOL), psychosocial factors, self-care behaviors, and diabetes complications.

RESULTS

A total of 15 articles met the inclusion criteria and were included for final synthesis. Overall, 14 studies included in this review found a significant relationship between delay discounting and diabetes-related outcomes, such that higher delay discounting is significantly related to worse diabetes outcomes for HbA1c, self-care behaviors, BMI, stress, and quality of life across self-reported measures of delay discounting and delay discounting tasks.

CONCLUSIONS

Evidence supports the relationship between delay discounting and diabetes-related outcomes and self-care behaviors across measures of delay discounting and type of diabetes. To understand delay discounting as a mechanism driving diabetes outcomes and to develop targeted interventions, additional work using a multidisciplinary approach is needed to validate the construct, identify pathways, and refine intervention approaches that can be tested to improve population health.

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.

Perceptions and effectiveness of episodic future thinking as digital micro-interventions based on mobile health technology

Objective

Delay discounting denotes the tendency for humans to favor short-term immediate benefits over long-term future benefits. Episodic future thinking (EFT) is an intervention that addresses this tendency by having a person mentally "pre-experience" a future event to increase the perceived value of future benefits. This study explores the feasibility of using mobile health (mHealth) technology to deliver EFT micro-interventions. Micro-interventions are small, focused interventions aiming to achieve goals while matching users' often limited willingness or capacity to engage with interventions. We aim to explore whether EFT delivered as digital micro-interventions can reduce delay discounting, the users' perceptions, and if there are differences between regular EFT and goal-oriented EFT (gEFT), a variant where goals are embedded into future events.

Method

A randomized study was conducted with 208 participants allocated to either gEFT, EFT, or a control group for a 21-day study.

Results

Results indicate intervention groups when combined achieved a significant reduction of Δ log k = - .80 in delay discounting (p = .017 ) compared to the control. When split into gEFT and EFT separately only the reduction of Δ log k = .96 in EFT delay discounting was significant (p = .045 ). We further explore and discuss thematic user perceptions.

Conclusions

Overall, user perceptions indicate gEFT may be slightly better for use in micro-interventions. However, perceptions also indicate that audio-based EFT micro-interventions were not always preferable to users, with findings suggesting that future EFT micro-interventions should be delivered using different forms of multimedia based on user preference and context and supported by other micro-interventions to maintain interest.

Preferences and Adherence of People with Prediabetes for Disease Management and Treatment: A Systematic Review

Objective

To comprehensively summarize the evaluation, preference, and expectations of people with prediabetes regarding the management and treatment of pre-diabetes.

Methods

Search PubMed, Embase, Web of Science, Cochrane Library and CNKI for articles about prediabetes, preferences, and expectations from inception of the database to June 2023.

Results

A total of 18 studies involving 17,240 participants with prediabetes were included. Although the preferences and views of people with prediabetes vary widely, there are certain trends: 1) Compared with drug therapy, people with prediabetes prefer exercise and nutrition therapies. 2) People with prediabetes expect intensive lifestyle interventions guided by professionals. 3) Effective communication between doctors and people with prediabetes is crucial for promoting the development and implementation of treatment plans.

Conclusion

The results of this systematic review showed that people with prediabetes prefer intensive lifestyle interventions due to concerns about drug side effects, dependency, and other factors. In addition, drug acceptance and lifestyle interventions options differed among different populations, which emphasized the significance of individualized therapy.

Episodic future thinking in type 2 diabetes: Further development and validation of the Health Information Thinking control for clinical trials

Episodic Future Thinking (EFT) reduces delay discounting and may have the potential as a clinical tool to increase the likelihood of health-promoting behaviors. However, evaluations of EFT in clinical settings require control conditions that match the effort and frequency of cue generation, as well as participants' expectations of improvement. The Health Information Thinking (HIT) control addresses these issues, but how this control affects delay discounting in individuals with diabetes and obesity when utilizing diabetes-management specific health-information vignettes is unknown. Moreover, little research has explored whether EFT reduces delay discounting in individuals with type 2 diabetes. To this end, we examined the impact of EFT, HIT, and a secondary no-cue control condition (NCC; assessments as usual) on delay discounting in 434 adults with self-reported type 2 diabetes and obesity recruited using Amazon Mechanical Turk. After completing an initial screening questionnaire, eligible participants reported demographics, then were randomized to EFT, HIT, or NCC conditions. Following the generation of seven EFT or HIT cues, participants assigned to EFT or HIT conditions completed a delay discounting task while imagining EFT or HIT cues; no-cue participants completed the task without cues. EFT participants demonstrated significantly lower delay discounting levels than HIT or NCC participants; no differences in delay discounting between HIT and NCC participants were observed. These results suggest that engaging in EFT, but not diabetes-specific HIT, results in lower delay discounting in adults with type 2 diabetes and obesity. This provides further evidence for the appropriateness of the HIT control for clinical trials examining the effect of EFT on delay discounting in adults with self-reported type 2 diabetes.

Putting prospection into practice: Methodological considerations in the use of episodic future thinking to reduce delay discounting and maladaptive health behaviors

In recent years, episodic future thinking (EFT) has emerged as a promising behavioral intervention to reduce delay discounting or maladaptive health behaviors; however, considerable methodological heterogeneity in methods for eliciting engagement in EFT has been observed in prior research. In this narrative review, we briefly describe methods for generating EFT cues, the content of EFT cues, common control conditions for experiments utilizing EFT, and considerations for cue delivery and implementation. Where possible, we make suggestions for current best practices in each category while identifying gaps in knowledge and potential areas of future research. Finally, we conclude by using the NIH Stage model to better frame the current state of the literature on EFT and propose gaps to be addressed if EFT is to be both an efficacious and effective behavioral intervention.

Delay discounting, probability discounting, and interdental cleaning frequency

Background

Interdental cleaning is recommended by dentists but many people do not floss regularly. The health benefits of interdental cleaning are delayed, and sensitivity to delay is an important factor in many health behaviors. Thus, the present studies explore the relationship between frequency of flossing, and sensitivity to delayed and probabilistic outcomes.

Method

Crowd-sourced subjects were recruited in two studies (n = 584 and n = 321, respectively). In both studies, subjects reported their frequency of flossing and completed delay discounting and probability discounting tasks. Discounting was measured with area under the curve, and linear regression was used to analyze the results.

Results

Findings show that higher levels of delay discounting were associated with less frequent flossing (p < 0.001, both studies). In contrast, probability discounting was not significantly associated with flossing frequency (ns, both studies).

Conclusion

The findings are consistent with prior studies involving other health behaviors such as attendance at primary care and medication adherence. Results suggest that interventions that reduce delay discounting may help promote regular interdental cleaning, and that delay discounting is a more robust predictor of health behaviors than probability discounting. In addition, interdental cleaning appears to be a reasonable target behavior for evaluating potentially generalizable behavioral health interventions. Thus, interventions that are successful in promoting oral health behaviors should be considered as candidates for evaluation in other health behavior domains.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-022-02328-6.