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Zhu X, Gu S, Li J. How do gamified digital therapeutics work on obesity self-management? Metabol Open 2024; 23:100314. [PMID: 39290343 PMCID: PMC11406243 DOI: 10.1016/j.metop.2024.100314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2024] [Revised: 08/28/2024] [Accepted: 08/28/2024] [Indexed: 09/19/2024] Open
Abstract
Obesity management can effectively reduce the risks and complications associated with obesity and improve the quality of life of patients. After assessing the advantages and limitations of various obesity management approaches, self-management has been strongly recommended due to the advantages of minimal side effects and lower costs compared to treatment via drugs and surgery. However, successfully implementing lifestyle intervention strategies requires scientific guidance and strong determination. With the development of electronic and information technology, lifestyle intervention has transformed considerably. A new concept, called Gamified Digital Therapeutics (GDTx), represents a gaming format with Digital Therapeutics (DTx). It can effectively enhance patient compliance and accessibility to chronic disease management. Here, we review recent studies on the application of GDTx for the self-management of obesity and discuss three aspects surrounding its completion rates, satisfaction levels, and effectiveness. In contrast to traditional approaches to obesity self-management, implementing GDTx effectively corrects unhealthy dietary and lifestyle habits, markedly enhancing the dissemination of nutritional and exercise-related health knowledge. Of particular significance is the evident improvement in the adherence of obese patients to weight loss programs. Despite numerous studies indicating that GDTx may offer an effective solution for obesity self-management, there are still several limitations in the medicalization of GDTx for self-management of obesity. This review aimed to provide a reference for subsequent studies and promote the widespread application of GDTx in obesity self-management to help reduce the obesity rate and alleviate the burden on obese patients.
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Affiliation(s)
- Xuejuan Zhu
- Department of Endocrinology, Tongji Hospital Affiliated to Tongji University, School of Medicine, Tongji University, Shanghai 200092, China
| | - Shuneng Gu
- BOKE Digital Health Research Institute, BOKE Medical Technology (Shanghai) Co., Ltd., Shanghai 200333, China
- BOKE Technology Group Co.,Ltd., Shanghai 200333, China
| | - Jian Li
- Department of Endocrinology, Tongji Hospital Affiliated to Tongji University, School of Medicine, Tongji University, Shanghai 200092, China
- BOKE Digital Health Research Institute, BOKE Medical Technology (Shanghai) Co., Ltd., Shanghai 200333, China
- BOKE Technology Group Co.,Ltd., Shanghai 200333, China
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2
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Średnicka-Tober D, Góralska-Walczak R, Kopczyńska K, Kazimierczak R, Oczkowski M, Strassner C, Elsner F, Matthiessen LE, Bruun TSK, Philippi Rosane B, Zanasi C, Van Vliet M, Dragsted LO, Husain S, Damsgaard CT, Lairon D, Kesse-Guyot E, Baudry J, Leclercq C, Stefanovic L, Welch A, Bügel SG. Identifying Future Study Designs and Indicators for Somatic Health Associated with Diets of Cohorts Living in Eco-Regions: Findings from the INSUM Expert Workshop. Nutrients 2024; 16:2528. [PMID: 39125406 PMCID: PMC11314491 DOI: 10.3390/nu16152528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2024] [Revised: 07/26/2024] [Accepted: 07/30/2024] [Indexed: 08/12/2024] Open
Abstract
Diets, but also overall food environments, comprise a variety of significant factors with direct and indirect impacts on human health. Eco-Regions are geographical areas with a territorial approach to rural development, utilizing organic food and farming practices, and principles and promoting sustainable communities and food systems. However, so far, little attention has been given to quantifying aspects of the health of citizens living in these sustainable transition territories. The project "Indicators for Assessment of Health Effects of Consumption of Sustainable, Organic School Meals in Eco-Regions" (INSUM) aims to identify and discuss research approaches and indicators that could be applied to effectively measure the somatic, mental, and social health dimensions of citizens in Eco-Regions, linked to the intake of organic foods in their diets. In this paper, we focus on the somatic (physical) health dimension. A two-day workshop was held to discuss suitable methodology with an interdisciplinary, international group of experts. The results showed the limitations of commonly used tools for measuring dietary intake (e.g., relying on the memory of participants), and nutritional biomarkers (e.g., variations in correlations with specific intakes) for research understanding dietary intake and the health effects of diets. To investigate the complexity of this issue, the most suitable approach seems to be the combination of traditional markers of physical and mental health alongside emerging indicators such as the microbiome, nutrigenomics, metabolomics, or inflammatory biomarkers. Using new, digital, non-invasive, and wearable technologies to monitor indicators could complement future research. We conclude that future studies should adopt systemic, multidisciplinary approaches by combining not only indicators of somatic and mental health and social wellbeing (MHSW) but also considering the potential benefits of organic diets for health as well as aspects of sustainability connected to food environments.
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Affiliation(s)
- Dominika Średnicka-Tober
- Department of Functional and Organic Food, Institute of Human Nutrition Sciences, Warsaw University of Life Sciences, 02-776 Warsaw, Poland; (R.G.-W.); (K.K.); (R.K.)
| | - Rita Góralska-Walczak
- Department of Functional and Organic Food, Institute of Human Nutrition Sciences, Warsaw University of Life Sciences, 02-776 Warsaw, Poland; (R.G.-W.); (K.K.); (R.K.)
| | - Klaudia Kopczyńska
- Department of Functional and Organic Food, Institute of Human Nutrition Sciences, Warsaw University of Life Sciences, 02-776 Warsaw, Poland; (R.G.-W.); (K.K.); (R.K.)
| | - Renata Kazimierczak
- Department of Functional and Organic Food, Institute of Human Nutrition Sciences, Warsaw University of Life Sciences, 02-776 Warsaw, Poland; (R.G.-W.); (K.K.); (R.K.)
| | - Michał Oczkowski
- Department of Dietetics, Institute of Human Nutrition Sciences, Warsaw University of Life Sciences, 02-776 Warsaw, Poland;
| | - Carola Strassner
- Department of Food—Nutrition—Facilities, FH Münster University of Applied Sciences, 48149 Münster, Germany; (C.S.); (F.E.); (S.H.)
| | - Friederike Elsner
- Department of Food—Nutrition—Facilities, FH Münster University of Applied Sciences, 48149 Münster, Germany; (C.S.); (F.E.); (S.H.)
| | - Lea Ellen Matthiessen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 Frederiksberg, Denmark; (L.E.M.); (B.P.R.); (L.O.D.); (C.T.D.); (S.G.B.)
| | - Thea Steenbuch Krabbe Bruun
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 Frederiksberg, Denmark; (L.E.M.); (B.P.R.); (L.O.D.); (C.T.D.); (S.G.B.)
| | - Beatriz Philippi Rosane
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 Frederiksberg, Denmark; (L.E.M.); (B.P.R.); (L.O.D.); (C.T.D.); (S.G.B.)
| | - Cesare Zanasi
- Department of Agricultural and Food Sciences, University of Bologna, 40127 Bologna, Italy;
| | - Marja Van Vliet
- Stichting Institute for Positive Health, 3521 AL Utrecht, The Netherlands;
| | - Lars Ove Dragsted
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 Frederiksberg, Denmark; (L.E.M.); (B.P.R.); (L.O.D.); (C.T.D.); (S.G.B.)
| | - Sarah Husain
- Department of Food—Nutrition—Facilities, FH Münster University of Applied Sciences, 48149 Münster, Germany; (C.S.); (F.E.); (S.H.)
| | - Camilla Trab Damsgaard
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 Frederiksberg, Denmark; (L.E.M.); (B.P.R.); (L.O.D.); (C.T.D.); (S.G.B.)
| | - Denis Lairon
- Inserm, INRAE, C2VN, Aix Marseille Université, 13331 Marseille, France;
| | - Emmanuelle Kesse-Guyot
- Inserm, INRAE, Cnam, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center—Paris Cité University (CRESS), Sorbonne Paris Nord University, 93000 Bobigny, France; (E.K.-G.); (J.B.)
| | - Julia Baudry
- Inserm, INRAE, Cnam, Nutritional Epidemiology Research Team (EREN), Epidemiology and Statistics Research Center—Paris Cité University (CRESS), Sorbonne Paris Nord University, 93000 Bobigny, France; (E.K.-G.); (J.B.)
| | - Catherine Leclercq
- Food and Nutrition Center, Council for Research in Agriculture and the Analysis of the Agriculture Economy (CREA), 00178 Rome, Italy
| | - Lilliana Stefanovic
- Section of Organic Food Quality, Faculty of Organic Agriculture Sciences, University of Kassel, 37213 Witzenhausen, Germany;
| | - Ailsa Welch
- Norwich Medical School, Centre for Population Health Research, Faculty of Health, University of East Anglia, Norwich, Norfolk NR4 7TJ, UK;
| | - Susanne Gjedsted Bügel
- Department of Nutrition, Exercise and Sports, University of Copenhagen, 1958 Frederiksberg, Denmark; (L.E.M.); (B.P.R.); (L.O.D.); (C.T.D.); (S.G.B.)
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Chew HSJ, Rajasegaran NN, Chng S. Effectiveness of interactive technology-assisted interventions on promoting healthy food choices: a scoping review and meta-analysis. Br J Nutr 2023; 130:1250-1259. [PMID: 36693631 DOI: 10.1017/s0007114523000193] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Making healthy food choices is crucial for health promotion and disease prevention. While there are an increasing number of technology-assisted interventions to promote healthy food choices, the underlying mechanism by which consumption behaviours and weight status change remains unclear. Our scoping review and meta-analysis of seventeen studies represents 3988 individuals with mean ages ranging from 19·2 to 54·2 years and mean BMI ranging from 24·5 kg/m2 to 35·6 kg/m2. Six main outcomes were identified namely weight, total calories, vegetables, fruits, healthy food, and fats and other food groups including sugar-sweetened beverages, saturated fats, snacks, wholegrains, Na, proteins, fibre, cholesterol, dairy products, carbohydrates, and takeout meals. Technology-assisted interventions were effective for weight loss (g = -0·29; 95 % CI -0·54, -0·04; I2 = 65·7 %, t = -2·83, P = 0·03) but not for promoting healthy food choices. This highlights the complexity in creating effective interactive technology-assisted interventions and understanding its mechanisms of influence and change. We also identified that there needs to be greater application of theory to inform the development of technology-assisted interventions in this area as new and improved interventions are being developed.
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Affiliation(s)
- Han Shi Jocelyn Chew
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Nagadarshini Nicole Rajasegaran
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Samuel Chng
- Lee Kuan Yew Centre for Innovative Cities, Singapore University of Technology and Design, Singapore, Singapore
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Naets T, Vermeiren E, Vervoort L, Van Eyck A, Ysebaert M, Verhulst S, De Winter B, Van Hoorenbeeck K, Bruyndonckx L, Tanghe A, De Guchtenaere A, Verbeken S, Braet C. Self-control training supplementing inpatient multidisciplinary obesity treatment in children and adolescents. Behav Res Ther 2023; 167:104335. [PMID: 37327533 DOI: 10.1016/j.brat.2023.104335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 03/31/2023] [Accepted: 05/15/2023] [Indexed: 06/18/2023]
Abstract
Research points to self-control as a possible mechanism for facilitating health behaviour and weight loss. The dual pathway model underpins the role of strong bottom-up reactivity towards food and weak top-down executive functions in obesity. Despite flourishing lab studies on attention bias modification or inhibition trainings, relatively few focused on training both processes to improve self-control in children and adolescents in inpatient multidisciplinary obesity treatment (MOT). Being part of the WELCOME project, this study investigated the effectiveness of Brain Fitness training (using the Dot Probe and Go/No-Go) as an adjunct to inpatient MOT in 131 Belgian children and adolescents. Changes in self-control (performance-based inhibitory control and attention bias as well as self-reported eating behaviour) in the experimental group were compared to sham training. Multiple Imputation was used to handle missing data. Inhibitory control and external eating improved over time (pre/post/follow-up), but we found no evidence for a significant interaction between time and condition. Future research should pay more attention to the role of individual variability in baseline self-control, sham training, and ecological validity of self-control training to improve real-life health behaviour and treatment perspectives for children and adolescents with weight problems.
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Affiliation(s)
- Tiffany Naets
- Department of Developmental, Personality and Social Psychology, Ghent University, Ghent, Belgium.
| | - Eline Vermeiren
- Lab of Experimental Medicine and Pediatrics, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Leentje Vervoort
- Department of Developmental, Personality and Social Psychology, Ghent University, Ghent, Belgium; Department of Developmental Psychology, Radboud University, Nijmegen, the Netherlands
| | - Annelies Van Eyck
- Lab of Experimental Medicine and Pediatrics, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Antwerp University Hospital, Antwerp, Belgium
| | | | - Stijn Verhulst
- Lab of Experimental Medicine and Pediatrics, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Antwerp University Hospital, Antwerp, Belgium
| | - Benedicte De Winter
- Lab of Experimental Medicine and Pediatrics, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Antwerp University Hospital, Antwerp, Belgium
| | - Kim Van Hoorenbeeck
- Lab of Experimental Medicine and Pediatrics, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Antwerp University Hospital, Antwerp, Belgium
| | - Luc Bruyndonckx
- Lab of Experimental Medicine and Pediatrics, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Antwerp University Hospital, Antwerp, Belgium
| | | | | | - Sandra Verbeken
- Department of Developmental, Personality and Social Psychology, Ghent University, Ghent, Belgium
| | - Caroline Braet
- Department of Developmental, Personality and Social Psychology, Ghent University, Ghent, Belgium
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Moore H, White MJ, Finlayson G, King N. Exploring acute and non-specific effects of mobile app-based response inhibition training on food evaluation and intake. Appetite 2022; 178:106181. [PMID: 35870536 DOI: 10.1016/j.appet.2022.106181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/30/2022] [Accepted: 07/16/2022] [Indexed: 11/27/2022]
Abstract
Previous studies have demonstrated that response inhibition training can modify the appeal of palatable and energy-dense foods, thus serving as a potential intervention for weight management, via changes in food selection and intake. However, empirical findings of efficacy have been inconsistent across studies due to heterogenous approaches to measuring salient appetitive outcomes, training implementation strategies, and sample recruitment. Systematic assessment of both affective and motivational components of food reward may help characterise to what extent devaluation can be generalised to nutritionally similar foods post-training. In this mixed factorial experiment, a non-clinical, adult sample completed time-matched single sessions with mobile app-based response inhibition training and control tasks of short (12 min; n = 27) or long (20 min; n = 25) duration. Participants were assessed on two discrete facets of food reward pre- and post-training: pleasure (i.e., explicit liking) and desire (i.e., implicit wanting) for non-specific (i.e., novel) food stimuli differing in energy-density. Consumption of snacks categorised by energy density was also assessed in a laboratory ad libitum taste test post-training. No significant differences were found between intervention and control sessions on explicit liking or implicit wanting for non-specific energy-dense foods. Moreover, participants ate a similar volume of snack foods during both sessions. Training duration did not significantly moderate differences between intervention and control sessions in primary outcomes. Variance between intervention and control sessions in chocolate intake and frequency of choice for energy-dense foods, but not explicit liking, was associated with a higher BMI. Methodological and theoretical implications for appropriate intervention implementation and underlying mechanisms, respectively, are discussed.
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Affiliation(s)
- Halim Moore
- Queensland University of Technology, School of Exercise and Nutrition Sciences, Kelvin Grove, 4059, Australia.
| | - Melanie J White
- Queensland University of Technology, School of Psychology and Counselling, Kelvin Grove, 4059, Australia
| | | | - Neil King
- Queensland University of Technology, School of Exercise and Nutrition Sciences, Kelvin Grove, 4059, Australia
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6
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Solier-López L, González-González R, Caracuel A, Kakoschke N, Lawrence N, Vilar-López R. A Program for the Comprehensive Cognitive Training of Excess Weight (TRAINEP): The Study Protocol for A Randomized, Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148447. [PMID: 35886296 PMCID: PMC9324504 DOI: 10.3390/ijerph19148447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 07/06/2022] [Accepted: 07/08/2022] [Indexed: 02/06/2023]
Abstract
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.
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Affiliation(s)
- Lucía Solier-López
- Mind, Brain and Behavior Research Center (CIMCYC), University of Granada, 18070 Granada, Spain; (L.S.-L.); (R.G.-G.); (R.V.-L.)
| | - Raquel González-González
- Mind, Brain and Behavior Research Center (CIMCYC), University of Granada, 18070 Granada, Spain; (L.S.-L.); (R.G.-G.); (R.V.-L.)
| | - Alfonso Caracuel
- Mind, Brain and Behavior Research Center (CIMCYC), University of Granada, 18070 Granada, Spain; (L.S.-L.); (R.G.-G.); (R.V.-L.)
- Correspondence:
| | - Naomi Kakoschke
- Nutrition and Health Program (Health & Biosecurity) at CSIRO, Adelaide, SA 5000, Australia;
| | - Natalia Lawrence
- Department of Psychology, University of Exeter, Exeter EX4 4PY, UK;
| | - Raquel Vilar-López
- Mind, Brain and Behavior Research Center (CIMCYC), University of Granada, 18070 Granada, Spain; (L.S.-L.); (R.G.-G.); (R.V.-L.)
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7
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Tang WSW, Ng TJY, Wong JZA, Ho CSH. The Role of Serious Video Games in the Treatment of Disordered Eating: A Systematic Review (Preprint). J Med Internet Res 2022; 24:e39527. [PMID: 36036967 PMCID: PMC9468918 DOI: 10.2196/39527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 07/18/2022] [Accepted: 07/29/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Wymann S W Tang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Tricia J Y Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Joseph Z A Wong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Cyrus S H Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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8
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Liu ZN, Jiang JY, Cai TS, Zhang DL. A Study of Response Inhibition in Overweight/Obesity People Based on Event-Related Potential. Front Psychol 2022; 13:826648. [PMID: 35310211 PMCID: PMC8929195 DOI: 10.3389/fpsyg.2022.826648] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 02/03/2022] [Indexed: 11/13/2022] Open
Abstract
Objective To investigate the characteristics of response inhibition of overweight/obese people, using behavior experiments combine with neural electrophysiological technology and discussing the difference in impulse level between obesity/overweight and normal-weight people through EEG data, questionnaire, and behavior experiment. Method (1) All participants completed the Go/Nogo task; meanwhile, behavior data and 64 channel EEG data were recorded. (2) Participants completed the Stop-Signal task and behavior date was recorded. Results (1) During Go/Nogo task, no significant differences were found in reaction time, omission errors of the Go task between the two groups, while commission errors of the Nogo task of the control group were significantly greater than the overweight/obesity group. (2) About SSRT during the Stop-Signal Task, the interaction of stimulus type (high-calorie food picture, low-calorie food picture) and group (control group, overweight/obesity group) was significant (p = 0.008). (3) No significant differences were found between the two groups in amplitude and latency of N2. About the amplitude of P3, the interaction of task type (Go task, Nogo task), electrode point (Cz, CPz, Pz), and groups were significant (p = 0.041), the control group P3 amplitude was significantly greater than overweight/obesity group during the Nogo task. Regarding about latency of P3, the interaction of group and electrode point were not significant (p = 0.582), but the main effect of task type was significant (p = 0.002). Conclusion (1) In terms of behavioral outcomes, overweight-obese subjects had lower dominant response inhibition and response cessation compared to normal-weight subjects. (2) In terms of EEG results, overweight-obese subjects showed no difference in processing speed and level of conflict monitoring for early inhibitory processing compared to normal-weight subjects, but there was a deficit in behavioral control for late inhibitory processing.
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Affiliation(s)
- Ze-Nan Liu
- The Medical Psychological Institute, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Jing-Yi Jiang
- The Medical Psychological Institute, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Tai-Sheng Cai
- The Medical Psychological Institute, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Dai-Lin Zhang
- The Medical Psychological Institute, The Second Xiangya Hospital of Central South University, Changsha, China
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9
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Warsinsky S, Schmidt-Kraepelin M, Rank S, Thiebes S, Sunyaev A. Conceptual Ambiguity Surrounding Gamification and Serious Games in Health Care: Literature Review and Development of Game-Based Intervention Reporting Guidelines (GAMING). J Med Internet Res 2021; 23:e30390. [PMID: 34505840 PMCID: PMC8463952 DOI: 10.2196/30390] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/11/2021] [Accepted: 06/17/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND In health care, the use of game-based interventions to increase motivation, engagement, and overall sustainability of health behaviors is steadily becoming more common. The most prevalent types of game-based interventions in health care research are gamification and serious games. Various researchers have discussed substantial conceptual differences between these 2 concepts, supported by empirical studies showing differences in the effects on specific health behaviors. However, researchers also frequently report cases in which terms related to these 2 concepts are used ambiguously or even interchangeably. It remains unclear to what extent existing health care research explicitly distinguishes between gamification and serious games and whether it draws on existing conceptual considerations to do so. OBJECTIVE This study aims to address this lack of knowledge by capturing the current state of conceptualizations of gamification and serious games in health care research. Furthermore, we aim to provide tools for researchers to disambiguate the reporting of game-based interventions. METHODS We used a 2-step research approach. First, we conducted a systematic literature review of 206 studies, published in the Journal of Medical Internet Research and its sister journals, containing terms related to gamification, serious games, or both. We analyzed their conceptualizations of gamification and serious games, as well as the distinctions between the two concepts. Second, based on the literature review findings, we developed a set of guidelines for researchers reporting on game-based interventions and evaluated them with a group of 9 experts from the field. RESULTS Our results show that less than half of the concept mentions are accompanied by an explicit definition. To distinguish between the 2 concepts, we identified four common approaches: implicit distinction, synonymous use of terms, serious games as a type of gamified system, and distinction based on the full game dimension. Our Game-Based Intervention Reporting Guidelines (GAMING) consist of 25 items grouped into four topics: conceptual focus, contribution, mindfulness about related concepts, and individual concept definitions. CONCLUSIONS Conceptualizations of gamification and serious games in health care literature are strongly heterogeneous, leading to conceptual ambiguity. Following the GAMING can support authors in rigorous reporting on study results of game-based interventions.
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Affiliation(s)
- Simon Warsinsky
- Department of Economics and Management, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | | | - Sascha Rank
- Department of Economics and Management, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Scott Thiebes
- Department of Economics and Management, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Ali Sunyaev
- Department of Economics and Management, Karlsruhe Institute of Technology, Karlsruhe, Germany
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10
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Forman EM, Manasse SM, Dallal DH, Crochiere RJ, Berry MP, Butryn ML, Juarascio AS. Gender differences in the effect of gamification on weight loss during a daily, neurocognitive training program. Transl Behav Med 2021; 11:1015-1022. [PMID: 32945860 DOI: 10.1093/tbm/ibaa091] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
A major contributor to the obesity epidemic is the overconsumption of high-calorie foods, which is partly governed by inhibitory control, that is, the ability to override pre-prepotent impulses and drives. Computerized inhibitory control trainings (ICTs) have demonstrated qualified success at affecting real-world health behaviors, and at improving weight loss, particularly when repeated frequently over an extended duration. It has been proposed that gamification (i.e., incorporating game-like elements such as a storyline, sounds, graphics, and rewards) might enhance participant interest and thus training compliance. Previous findings from a mostly female sample did support this hypothesis; however, it might be expected that the effects of gamification differ by gender such that men, who appear more motivated by gaming elements, stand to benefit more from gamification. The present study evaluated whether gender moderated the effect of a gamified ICT on weight loss. Seventy-six overweight individuals received a no-sugar-added dietary prescription and were randomized to 42 daily and 2 weekly ICTs focused on sweet foods that were either gamified or nongamified. Results supported the hypothesis that gamification elements had a positive effect on weight loss for men and not women (p = .03). However, mechanistic hypotheses for the moderating effect (in terms of enjoyment, compliance, and improvements in inhibitory control) were generally not supported (p's > .20). These results suggest that gamification of ICTs may boost weight loss outcomes for men and not women, but further research is needed to determine the specific mechanisms driving this effect and to arrive at gamification elements that enhance effects for both men and women.
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Affiliation(s)
- Evan M Forman
- Center for Weight, Eating, and Lifestyle Sciences (WELL Center), Drexel University, Philadelphia, PA, USA
| | - Stephanie M Manasse
- Center for Weight, Eating, and Lifestyle Sciences (WELL Center), Drexel University, Philadelphia, PA, USA
| | - Diane H Dallal
- Center for Weight, Eating, and Lifestyle Sciences (WELL Center), Drexel University, Philadelphia, PA, USA
| | - Rebecca J Crochiere
- Center for Weight, Eating, and Lifestyle Sciences (WELL Center), Drexel University, Philadelphia, PA, USA
| | - Michael P Berry
- Center for Weight, Eating, and Lifestyle Sciences (WELL Center), Drexel University, Philadelphia, PA, USA
| | - Meghan L Butryn
- Center for Weight, Eating, and Lifestyle Sciences (WELL Center), Drexel University, Philadelphia, PA, USA
| | - Adrienne S Juarascio
- Center for Weight, Eating, and Lifestyle Sciences (WELL Center), Drexel University, Philadelphia, PA, USA
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11
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Najberg H, Rigamonti M, Mouthon M, Spierer L. Modifying food items valuation and weight with gamified executive control training. ROYAL SOCIETY OPEN SCIENCE 2021; 8:191288. [PMID: 34084536 PMCID: PMC8150012 DOI: 10.1098/rsos.191288] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 05/07/2021] [Indexed: 05/16/2023]
Abstract
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.
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Affiliation(s)
- Hugo Najberg
- Neurology Unit, Medicine Section, Faculty of Science and Medicine, University of Fribourg, PER 09, Chemin du Musée 5, 1700 Fribourg, Switzerland
| | - Maurizio Rigamonti
- Neurology Unit, Medicine Section, Faculty of Science and Medicine, University of Fribourg, PER 09, Chemin du Musée 5, 1700 Fribourg, Switzerland
| | - Michael Mouthon
- Neurology Unit, Medicine Section, Faculty of Science and Medicine, University of Fribourg, PER 09, Chemin du Musée 5, 1700 Fribourg, Switzerland
| | - Lucas Spierer
- Neurology Unit, Medicine Section, Faculty of Science and Medicine, University of Fribourg, PER 09, Chemin du Musée 5, 1700 Fribourg, Switzerland
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12
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Aulbach MB, Knittle K, van Beurden SB, Haukkala A, Lawrence NS. App-based food Go/No-Go training: User engagement and dietary intake in an opportunistic observational study. Appetite 2021; 165:105315. [PMID: 34015308 DOI: 10.1016/j.appet.2021.105315] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 05/04/2021] [Accepted: 05/11/2021] [Indexed: 12/21/2022]
Abstract
Food Go/No-Go training aims to alter implicit food biases by creating associations between perceiving unhealthy foods and withholding a dominant response. Asking participants to repeatedly inhibit an impulse to approach unhealthy foods can decrease unhealthy food intake in laboratory settings. Less is known about how people engage with app-based Go/No-Go training in real-world settings and how this might relate to dietary outcomes. This pragmatic observational study investigated associations between the number of completed app-based food Go/No-Go training trials and changes in food intake (Food Frequency Questionnaire; FFQ) for different healthy and unhealthy food categories from baseline to one-month follow-up. In total, 1234 participants (m(BMI) = 29 kg/m2, m(age) = 43years, 69% female) downloaded the FoodT app and completed food-Go/No-Go training at their own discretion (mean number of completed sessions = 10.7, sd = 10.3, range: 1-122). In pre-registered analyses, random-intercept linear models predicting intake of different foods, and controlled for baseline consumption, BMI, age, sex, smoking, metabolic syndrome, and dieting status, revealed small, significant associations between the number of completed training trials and reductions in unhealthy food intake (b = -0.0005, CI95= [-0.0007;-0.0003]) and increases in healthy food intake (b = 0.0003, CI95 = [0.0000; 0.0006]). These relationships varied by food category, and exploratory analyses suggest that more temporally spaced training was associated with greater changes in dietary intake. Taken together, these results imply a positive association between the amount of training completed and beneficial changes in food intake. However, the results of this pragmatic study should be interpreted cautiously, as self-selection biases, motivation and other engagement-related factors that could underlie these associations were not accounted for. Experimental research is needed to rule out these possible confounds and establish causal dose-response relationships between patterns of engagement with food Go/No-Go training and changes in dietary intake.
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Affiliation(s)
- Matthias Burkard Aulbach
- Faculty of Social Sciences, Department of Social Research, University of Helsinki, Unioninkatu 37, 00014, Helsinki, Finland.
| | - Keegan Knittle
- Faculty of Social Sciences, Department of Social Research, University of Helsinki, Unioninkatu 37, 00014, Helsinki, Finland
| | | | - Ari Haukkala
- Faculty of Social Sciences, Department of Social Research, University of Helsinki, Unioninkatu 37, 00014, Helsinki, Finland; Helsinki Collegium for Advanced Studies, University of Helsinki, Fabianinkatu 24, 00014, Helsinki, Finland
| | - Natalia S Lawrence
- School of Psychology, College of Life and Environmental Sciences, University of Exeter, EX4 4QG, Exeter, United Kingdom
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13
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Veit R, Schag K, Schopf E, Borutta M, Kreutzer J, Ehlis AC, Zipfel S, Giel KE, Preissl H, Kullmann S. Diminished prefrontal cortex activation in patients with binge eating disorder associates with trait impulsivity and improves after impulsivity-focused treatment based on a randomized controlled IMPULS trial. NEUROIMAGE-CLINICAL 2021; 30:102679. [PMID: 34215149 PMCID: PMC8102655 DOI: 10.1016/j.nicl.2021.102679] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 04/14/2021] [Accepted: 04/15/2021] [Indexed: 01/18/2023]
Abstract
Persons with binge eating disorder show increased impulsivity. We investigated cognitive control to food cues using fNIRS. Compared to healthy controls, binge eaters show weaker activation of the prefrontal cortex. After behavioral therapy, binge eaters increase prefrontal cortex activation.
Background Behavioral and cognitive control are vital for healthy eating behavior. Patients with binge eating disorder (BED) suffer under recurrent binge eating episodes accompanied by subjective loss of control that results, among other factors, from increased impulsivity. Methods In the current study, we investigated the frontal network using functional near-infrared spectroscopy (fNIRS) during a food specific go/nogo task to assess response inhibition in 24 patients with BED (BMI range 22.6–59.7 kg/m2) compared to 12 healthy controls (HC) (BMI range 20.9–27 kg/m2). Patients with BED were invited to undergo fNIRS measurements before an impulsivity-focused cognitive behavioral group treatment, directly after this treatment and 3 months afterwards. As this was a planned subgroup analysis of the randomized controlled IMPULS trial, patients with BED were randomized either to the treatment group (n = 14) or to a control group (n = 10). The treatment group received 8 weekly sessions of the IMPULS treatment. Results We found a significant response inhibition effect (nogo minus go), in terms of an increased oxygenated hemoglobin response in the bilateral prefrontal cortex in both groups. The greatest response was observed when participants were instructed to go for healthy and withhold their response to unhealthy high caloric food cues. The healthy nogo condition failed to show a significant prefrontal inhibitory response, which was probably related to the task design, as the condition was considered more demanding. BED patients, especially those with higher trait impulsivity, showed a weaker activation of the prefrontal cortex during response inhibition, predominantly in the right hemisphere. Interestingly, three months after the treatment, patients of the treatment group increased their right prefrontal cortex activity during response inhibition. Likewise, increased prefrontal cortex activation correlated with decreased trait impulsivity after treatment. Conclusions Our results suggest that patients with BED have limited resources to activate the prefrontal cortex when asked to inhibit a reaction onto food-specific stimuli. However, this effect could be partly driven by differences in BMI between the HC and BED group. Cognitive-behavioral therapy targeting impulsive eating behavior may improve prefrontal cortex recruitment during response inhibition.
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Affiliation(s)
- Ralf Veit
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, Tübingen, Germany; German Center for Diabetes Research (DZD), Tübingen, Germany
| | - Kathrin Schag
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Germany; Center of Excellence for Eating Disorders Tübingen (COMET), Tübingen, Germany
| | - Eric Schopf
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, Tübingen, Germany
| | - Maike Borutta
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, Tübingen, Germany; German Center for Diabetes Research (DZD), Tübingen, Germany
| | - Jann Kreutzer
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, Tübingen, Germany
| | - Ann-Christine Ehlis
- Department of Psychiatry and Psychotherapy, University Hospital Tübingen, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Germany; Center of Excellence for Eating Disorders Tübingen (COMET), Tübingen, Germany
| | - Katrin E Giel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Germany; Center of Excellence for Eating Disorders Tübingen (COMET), Tübingen, Germany
| | - Hubert Preissl
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, Tübingen, Germany; German Center for Diabetes Research (DZD), Tübingen, Germany; Department of Internal Medicine IV, Division of Diabetology, Endocrinology and Nephrology, University Hospital Tübingen, Germany; Institute for Diabetes and Obesity, Helmholtz Diabetes Center at Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany; Institute of Pharmaceutical Sciences, Department of Pharmacy and Biochemistry, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - Stephanie Kullmann
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, Tübingen, Germany; German Center for Diabetes Research (DZD), Tübingen, Germany; Department of Internal Medicine IV, Division of Diabetology, Endocrinology and Nephrology, University Hospital Tübingen, Germany.
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14
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Schroeder PA, Lohmann J, Ninaus M. Preserved Inhibitory Control Deficits of Overweight Participants in a Gamified Stop-Signal Task: Experimental Study of Validity. JMIR Serious Games 2021; 9:e25063. [PMID: 33709936 PMCID: PMC8092187 DOI: 10.2196/25063] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/29/2021] [Accepted: 02/12/2021] [Indexed: 12/29/2022] Open
Abstract
Background Gamification in mental health could increase training adherence, motivation, and transfer effects, but the external validity of gamified tasks is unclear. This study documents that gamified task variants can show preserved associations between markers of behavioral deficits and health-related variables. We draw on the inhibitory control deficit in overweight populations to investigate effects of gamification on performance measures in a web-based experimental task. Objective This study tested whether associations between inhibitory control and overweight were preserved in a gamified stop-signal task (SST). Methods Two versions of an adaptive SST were developed and tested in an online experiment. Participants (n=111) were randomized to 1 of the 2 task variants and completed a series of questionnaires along with either the gamified SST or a conventional SST. To maximize its possible effects on participants’ inhibitory control, the gamified SST included multiple game elements in addition to the task itself and the stimuli. Both variants drew on the identical core mechanics, but the gamified variant included an additional narrative, graphical theme, scoring system with visual and emotional feedback, and the presence of a companion character. In both tasks, food and neutral low-poly stimuli were classified based on their color tone (go trials), but responses were withheld in 25% of the trials (stop trials). Mean go reaction times and stop-signal reaction times (SSRT) were analyzed as measures of performance and inhibitory control. Results Participants in the gamified SST had longer reaction times (803 [SD 179] ms vs 607 [SD 90] ms) and worse inhibitory control (SSRT 383 [SD 109] ms vs 297 [SD 45] ms). The association of BMI with inhibitory control was relatively small (r=.155, 95% CI .013-.290). Overweight participants had longer reaction times (752 [SD 217] ms vs 672 [SD 137] ms) and SSRTs (363 [SD 116] ms vs 326 [SD 77] ms). Gamification did not interact with the effect of overweight on mean performance or inhibitory control. There were no effects of gamification on mood and user experience, despite a negative effect on perceived efficiency. Conclusions The detrimental effects of heightened BMI on inhibitory control were preserved in a gamified version of the SST. Overall, the effects of overweight were smaller than in previously published web-based and laboratory studies. Gamification elements can impact behavioral performance, but gamified tasks can still assess inhibitory control deficits. Although our results are promising, according validations may differ for other types of behavior, gamification, and health variables.
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Affiliation(s)
| | - Johannes Lohmann
- Department of Computer Science, Cognitive Modeling, University of Tübingen, Tübingen, Germany
| | - Manuel Ninaus
- Department of Psychology, University of Innsbruck, Innsbruck, Austria.,Leibniz-Institut für Wissensmedien, Tübingen, Germany.,LEAD Graduate School and Research Network, University of Tübingen, Tübingen, Germany
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15
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Dias SB, Diniz JA, Konstantinidis E, Savvidis T, Zilidou V, Bamidis PD, Grammatikopoulou A, Dimitropoulos K, Grammalidis N, Jaeger H, Stadtschnitzer M, Silva H, Telo G, Ioakeimidis I, Ntakakis G, Karayiannis F, Huchet E, Hoermann V, Filis K, Theodoropoulou E, Lyberopoulos G, Kyritsis K, Papadopoulos A, Depoulos A, Trivedi D, Chaudhuri RK, Klingelhoefer L, Reichmann H, Bostantzopoulou S, Katsarou Z, Iakovakis D, Hadjidimitriou S, Charisis V, Apostolidis G, Hadjileontiadis LJ. Assistive HCI-Serious Games Co-design Insights: The Case Study of i-PROGNOSIS Personalized Game Suite for Parkinson's Disease. Front Psychol 2021; 11:612835. [PMID: 33519632 PMCID: PMC7843389 DOI: 10.3389/fpsyg.2020.612835] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 12/22/2020] [Indexed: 11/13/2022] Open
Abstract
Human-Computer Interaction (HCI) and games set a new domain in understanding people's motivations in gaming, behavioral implications of game play, game adaptation to player preferences and needs for increased engaging experiences in the context of HCI serious games (HCI-SGs). When the latter relate with people's health status, they can become a part of their daily life as assistive health status monitoring/enhancement systems. Co-designing HCI-SGs can be seen as a combination of art and science that involves a meticulous collaborative process. The design elements in assistive HCI-SGs for Parkinson's Disease (PD) patients, in particular, are explored in the present work. Within this context, the Game-Based Learning (GBL) design framework is adopted here and its main game-design parameters are explored for the Exergames, Dietarygames, Emotional games, Handwriting games, and Voice games design, drawn from the PD-related i-PROGNOSIS Personalized Game Suite (PGS) (www.i-prognosis.eu) holistic approach. Two main data sources were involved in the study. In particular, the first one includes qualitative data from semi-structured interviews, involving 10 PD patients and four clinicians in the co-creation process of the game design, whereas the second one relates with data from an online questionnaire addressed by 104 participants spanning the whole related spectrum, i.e., PD patients, physicians, software/game developers. Linear regression analysis was employed to identify an adapted GBL framework with the most significant game-design parameters, which efficiently predict the transferability of the PGS beneficial effect to real-life, addressing functional PD symptoms. The findings of this work can assist HCI-SG designers for designing PD-related HCI-SGs, as the most significant game-design factors were identified, in terms of adding value to the role of HCI-SGs in increasing PD patients' quality of life, optimizing the interaction with personalized HCI-SGs and, hence, fostering a collaborative human-computer symbiosis.
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Affiliation(s)
- Sofia Balula Dias
- Faculdade de Motricidade Humana, Centro Interdisciplinar de Performance Humana, Universidade de Lisboa, Lisbon, Portugal
| | - José Alves Diniz
- Faculdade de Motricidade Humana, Centro Interdisciplinar de Performance Humana, Universidade de Lisboa, Lisbon, Portugal
| | | | - Theodore Savvidis
- Lab of Medical Physics, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vicky Zilidou
- Lab of Medical Physics, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Panagiotis D Bamidis
- Lab of Medical Physics, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Athina Grammatikopoulou
- Centre for Research and Technology Hellas, Information Technologies Institute, Thessaloniki, Greece
| | - Kosmas Dimitropoulos
- Centre for Research and Technology Hellas, Information Technologies Institute, Thessaloniki, Greece
| | - Nikos Grammalidis
- Centre for Research and Technology Hellas, Information Technologies Institute, Thessaloniki, Greece
| | - Hagen Jaeger
- Fraunhofer Institute Intelligent Analysis and Information Systems, Sankt Augustin, Germany
| | - Michael Stadtschnitzer
- Fraunhofer Institute Intelligent Analysis and Information Systems, Sankt Augustin, Germany
| | - Hugo Silva
- PLUX, Wireless Biosignals, Lisbon, Portugal
| | | | | | | | | | | | | | | | | | | | - Konstantinos Kyritsis
- Multimedia Understanding Group, Information Processing Laboratory, Department of Electrical and Computer Engineering, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Alexandros Papadopoulos
- Multimedia Understanding Group, Information Processing Laboratory, Department of Electrical and Computer Engineering, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anastasios Depoulos
- Multimedia Understanding Group, Information Processing Laboratory, Department of Electrical and Computer Engineering, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dhaval Trivedi
- International Parkinson Excellence Research Centre, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Ray K Chaudhuri
- International Parkinson Excellence Research Centre, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | | | - Heinz Reichmann
- Department of Neurology, Technical University Dresden, Dresden, Germany
| | | | - Zoe Katsarou
- Third Neurological Clinic, G. Papanikolaou Hospital, Thessaloniki, Greece
| | - Dimitrios Iakovakis
- Department of Electrical and Computer Engineering, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stelios Hadjidimitriou
- Department of Electrical and Computer Engineering, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vasileios Charisis
- Department of Electrical and Computer Engineering, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - George Apostolidis
- Department of Electrical and Computer Engineering, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Leontios J Hadjileontiadis
- Department of Electrical and Computer Engineering, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Department of Electrical Engineering and Computer Science/Biomedical Engineering, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
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16
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Carbine KA, Muir AM, Allen WD, LeCheminant JD, Baldwin SA, Jensen CD, Kirwan CB, Larson MJ. Does inhibitory control training reduce weight and caloric intake in adults with overweight and obesity? A pre-registered, randomized controlled event-related potential (ERP) study. Behav Res Ther 2021; 136:103784. [DOI: 10.1016/j.brat.2020.103784] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 10/08/2020] [Accepted: 11/30/2020] [Indexed: 12/16/2022]
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17
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Chung T, Witkiewitz K, Ruddock H, Franken I, Verbruggen F, Field M. Does alcohol cue inhibitory control training survive a context shift? PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2020; 34:783-792. [PMID: 32281817 PMCID: PMC7650386 DOI: 10.1037/adb0000580] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Inhibitory control training (ICT) is a novel psychological intervention that aims to improve inhibitory control in response to alcohol-related cues through associative learning. Laboratory studies have demonstrated reductions in alcohol consumption following ICT compared with control/sham training, but it is unclear if these effects are robust to a change of context. In a preregistered study, we examined whether the effects of ICT would survive a context shift from a neutral context to a seminaturalistic bar setting. In a mixed design, 60 heavy drinkers (40 female) were randomly allocated to receive either ICT or control/sham training in a neutral laboratory over 2 sessions. We developed a novel variation of ICT that used multiple stop signals to establish direct stimulus-stop associations. The effects of ICT/control were measured once in the same context and once following a shift to a novel (alcohol-related) context. Our dependent variables were ad libitum alcohol consumption following training, change in inhibitory control processes, and change in alcohol value. ICT did not reduce alcohol consumption in either context compared with the control group. Furthermore, we demonstrated no effects of ICT on inhibitory control processes or alcohol value. Bayesian analyses demonstrated overall support for the null hypotheses. This study failed to find any effects of ICT on alcohol consumption or candidate psychological mechanisms. These findings illustrate the difficulty in training alcohol-inhibition associations and add to a growing body of literature suggesting that ICT holds little evidential value as a psychological intervention for alcohol use disorders. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
| | | | | | - Ingmar Franken
- Department of Psychology, Education and Child Studies, Erasmus University
| | | | - Matt Field
- Department of Psychology, University of Sheffield
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18
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Chami R, Treasure J, Cardi V, Lozano-Madrid M, Eichin KN, McLoughlin G, Blechert J. Exploring Changes in Event-Related Potentials After a Feasibility Trial of Inhibitory Training for Bulimia Nervosa and Binge Eating Disorder. Front Psychol 2020; 11:1056. [PMID: 32536891 PMCID: PMC7269126 DOI: 10.3389/fpsyg.2020.01056] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 04/27/2020] [Indexed: 12/11/2022] Open
Abstract
In a feasibility trial comparing two forms of combined inhibitory control training and goal planning (i.e., food-specific and general) among patients with bulimia nervosa (BN) and binge eating disorder (BED), we found evidence of symptomatic benefit, with stronger effects among participants receiving a food-specific intervention. The aim of the present study was to examine changes in behavioral outcomes and event-related potentials (ERPs; N2 and P3 amplitudes) from baseline to post-intervention that might suggest the mechanisms underpinning these effects. Fifty-five participants completed go/no-go tasks during two electroencephalography (EEG) sessions, at baseline and post-intervention. The go/no-go task included "go" cues to low energy-dense foods and non-foods, and "no-go" cues to high energy-dense foods and non-foods. Datasets with poor signal quality and/or outliers were excluded, leaving 48 participants (N = 24 BN; N = 24 BED) in the analyses. Participants allocated to the food-specific, compared to the general intervention group, showed significantly greater reductions in reaction time to low energy-dense foods, compared to non-foods, by post-intervention. Commission errors significantly increased from baseline to post-intervention, regardless of stimulus type (food vs. non-food) and intervention group (food-specific vs. general). There were no significant changes in omission errors. P3 amplitudes to "no-go" cues marginally, but non-significantly, decreased by post-intervention, but there was no significant interaction with stimulus type (high energy-dense food vs. non-food) or intervention group (food-specific vs. general). There were no significant changes in N2 amplitudes to "no-go" cues, N2 amplitudes to "go" cues, or P3 amplitudes to "go" cues from baseline to post-intervention. Training effects were only marginally captured by these event-related potentials. We discuss limitations to the task paradigm, including its two-choice nature, ease of completion, and validity, and give recommendations for future research exploring ERPs using inhibitory control paradigms.
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Affiliation(s)
- Rayane Chami
- Section of Eating Disorders, Department of Psychological Medicine, King’s College London, London, United Kingdom
| | - Janet Treasure
- Section of Eating Disorders, Department of Psychological Medicine, King’s College London, London, United Kingdom
| | - Valentina Cardi
- Section of Eating Disorders, Department of Psychological Medicine, King’s College London, London, United Kingdom
| | - María Lozano-Madrid
- Department of Psychiatry, Bellvitge University Hospital-Institut d’Investigacio Biomedica de Bellvitge (IDIBELL), Barcelona, Spain
- CiberObn, Madrid, Spain
| | - Katharina Naomi Eichin
- Department of Psychology, Centre for Cognitive Neuroscience, Paris-Lodron-University of Salzburg, Salzburg, Austria
| | - Grainne McLoughlin
- Social, Genetic, and Developmental Psychiatry Department, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, United Kingdom
| | - Jens Blechert
- Department of Psychology, Centre for Cognitive Neuroscience, Paris-Lodron-University of Salzburg, Salzburg, Austria
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19
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Hoffmann A, Faust-Christmann CA, Zolynski G, Bleser G. Toward Gamified Pain Management Apps: Mobile Application Rating Scale-Based Quality Assessment of Pain-Mentor's First Prototype Through an Expert Study. JMIR Form Res 2020; 4:e13170. [PMID: 32452803 PMCID: PMC7284405 DOI: 10.2196/13170] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 01/22/2020] [Accepted: 01/28/2020] [Indexed: 01/01/2023] Open
Abstract
Background The use of health apps to support the treatment of chronic pain is gaining importance. Most available pain management apps are still lacking in content quality and quantity as their developers neither involve health experts to ensure target group suitability nor use gamification to engage and motivate the user. To close this gap, we aimed to develop a gamified pain management app, Pain-Mentor. Objective To determine whether medical professionals would approve of Pain-Mentor’s concept and content, this study aimed to evaluate the quality of the app’s first prototype with experts from the field of chronic pain management and to discover necessary improvements. Methods A total of 11 health professionals with a background in chronic pain treatment and 2 mobile health experts participated in this study. Each expert first received a detailed presentation of the app. Afterward, they tested Pain-Mentor and then rated its quality using the mobile application rating scale (MARS) in a semistructured interview. Results The experts found the app to be of excellent general (mean 4.54, SD 0.55) and subjective quality (mean 4.57, SD 0.43). The app-specific section was rated as good (mean 4.38, SD 0.75). Overall, the experts approved of the app’s content, namely, pain and stress management techniques, behavior change techniques, and gamification. They believed that the use of gamification in Pain-Mentor positively influences the patients’ motivation and engagement and thus has the potential to promote the learning of pain management techniques. Moreover, applying the MARS in a semistructured interview provided in-depth insight into the ratings and concrete suggestions for improvement. Conclusions The experts rated Pain-Mentor to be of excellent quality. It can be concluded that experts perceived the use of gamification in this pain management app in a positive manner. This showed that combining pain management with gamification did not negatively affect the app’s integrity. This study was therefore a promising first step in the development of Pain-Mentor.
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Affiliation(s)
- Alexandra Hoffmann
- Junior Research Group wearHEALTH, Department of Computer Science, Technische Universität Kaiserslautern, Kaiserslautern, Germany
| | - Corinna A Faust-Christmann
- Junior Research Group wearHEALTH, Department of Computer Science, Technische Universität Kaiserslautern, Kaiserslautern, Germany
| | - Gregor Zolynski
- Junior Research Group wearHEALTH, Department of Computer Science, Technische Universität Kaiserslautern, Kaiserslautern, Germany
| | - Gabriele Bleser
- Junior Research Group wearHEALTH, Department of Computer Science, Technische Universität Kaiserslautern, Kaiserslautern, Germany
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20
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Wolz I, Nannt J, Svaldi J. Laboratory-based interventions targeting food craving: A systematic review and meta-analysis. Obes Rev 2020; 21:e12996. [PMID: 31944559 DOI: 10.1111/obr.12996] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 12/09/2019] [Accepted: 12/10/2019] [Indexed: 12/29/2022]
Abstract
This systematic review and meta-analysis aimed to quantify the effects of laboratory-based interventions targeting specific mechanisms of food craving, to identify moderators of effects, and to qualitatively summarize findings. The study was conducted and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Sixty-nine studies were included in the quantitative synthesis, and separate meta-analyses were conducted for the outcomes self-reported craving and objective food intake. Results show small to medium positive effects across specific craving interventions on both outcomes. Effect sizes were partly moderated by intervention type. The most effective intervention regarding food intake was in sensu cue exposure. For subjective craving, the most robust evidence was found for beneficial effects of cognitive regulation strategies (ie, reappraisal, suppression, and distraction). Results further indicate that training inhibitory control through behavioral inhibition might be more effective than approach-avoidance training when considering its effect on subjective craving and food intake. People with external eating habits, overeating, or loss-of-control eating might benefit from these types of specific craving interventions. Future research should focus on long-term effects, transferability, and effectiveness in clinical samples.
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Affiliation(s)
- Ines Wolz
- Clinical Psychology and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Julia Nannt
- Clinical Psychology and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Jennifer Svaldi
- Clinical Psychology and Psychotherapy, University of Tübingen, Tübingen, Germany
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21
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Milne-Ives M, Lam C, De Cock C, Van Velthoven MH, Meinert E. Mobile Apps for Health Behavior Change in Physical Activity, Diet, Drug and Alcohol Use, and Mental Health: Systematic Review. JMIR Mhealth Uhealth 2020; 8:e17046. [PMID: 32186518 PMCID: PMC7113799 DOI: 10.2196/17046] [Citation(s) in RCA: 141] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 12/03/2019] [Accepted: 01/26/2020] [Indexed: 01/16/2023] Open
Abstract
Background With a growing focus on patient interaction with health management, mobile apps are increasingly used to deliver behavioral health interventions. The large variation in these mobile health apps—their target patient group, health behavior, and behavioral change strategies—has resulted in a large but incohesive body of literature. Objective This systematic review aimed to assess the effectiveness of mobile apps in improving health behaviors and outcomes and to examine the inclusion and effectiveness of behavior change techniques (BCTs) in mobile health apps. Methods PubMed, EMBASE, CINAHL, and Web of Science were systematically searched for articles published between 2014 and 2019 that evaluated mobile apps for health behavior change. Two authors independently screened and selected studies according to the eligibility criteria. Data were extracted and the risk of bias was assessed by one reviewer and validated by a second reviewer. Results A total of 52 randomized controlled trials met the inclusion criteria and were included in the analysis—37 studies focused on physical activity, diet, or a combination of both, 11 on drug and alcohol use, and 4 on mental health. Participant perceptions were generally positive—only one app was rated as less helpful and satisfactory than the control—and the studies that measured engagement and usability found relatively high study completion rates (mean 83%; n=18, N=39) and ease-of-use ratings (3 significantly better than control, 9/15 rated >70%). However, there was little evidence of changed behavior or health outcomes. Conclusions There was no strong evidence in support of the effectiveness of mobile apps in improving health behaviors or outcomes because few studies found significant differences between the app and control groups. Further research is needed to identify the BCTs that are most effective at promoting behavior change. Improved reporting is necessary to accurately evaluate the mobile health app effectiveness and risk of bias.
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Affiliation(s)
- Madison Milne-Ives
- Digitally Enabled Preventative Health Research Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Ching Lam
- Digitally Enabled Preventative Health Research Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Caroline De Cock
- Digitally Enabled Preventative Health Research Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Michelle Helena Van Velthoven
- Digitally Enabled Preventative Health Research Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Edward Meinert
- Digitally Enabled Preventative Health Research Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom.,Department of Primary Care and Public Health, Imperial College London, London, United Kingdom
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Chami R, Cardi V, Lautarescu A, Mallorquí-Bagué N, McLoughlin G. Neural responses to food stimuli among individuals with eating and weight disorders: a systematic review of event-related potentials. Int Rev Psychiatry 2019; 31:318-331. [PMID: 31246114 DOI: 10.1080/09540261.2019.1622515] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
A systematic review was conducted to investigate event-related potentials (ERPs) in response to food and non-food stimuli among individuals with eating and weight disorders. Limiting the search to studies that have analysed ERPs relating to motivated attention and inhibitory control, 19 research papers were extracted from a systematic search in PubMed, Ovid, and Web of Science (2000-2018). An enhanced attentional bias towards food over non-food images (as indexed by P3(00) and LPP amplitudes) was evident for all populations. Individuals with binge eating disorder showed an enhanced attentional response to food cues compared to healthy controls. Inhibitory control-related ERP components (N2(00) and P3a) increased during food-specific no-go trials, but did not differentiate overweight from 'healthy' weight groups. The N2 amplitude to food pictures were positively correlated with caloric intake and food craving among individuals with obesity and binge eating disorder, respectively, while P3(00) was sensitive to hunger levels among overweight and obese females. The heterogeneity of stimuli/paradigms adopted, component timescales extracted, ERPs analysed, and data presented has challenged this review's ability to produce a robust synthesis of results. Some recommendations for future research are discussed.
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Affiliation(s)
- Rayane Chami
- a Department of Psychological Medicine, Section of Eating Disorders , Institute of Psychiatry, Psychology, & Neuroscience (IoPPN), King's College London , London , UK
| | - Valentina Cardi
- a Department of Psychological Medicine, Section of Eating Disorders , Institute of Psychiatry, Psychology, & Neuroscience (IoPPN), King's College London , London , UK
| | - Alexandra Lautarescu
- b Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology, & Neuroscience (IoPPN) , King's College London , London , UK
| | - Nuria Mallorquí-Bagué
- c Department of Psychiatry , Bellvitge University Hospital-IDIBELL , Barcelona , Spain.,d Ciber Fisiopatología Obesidad y Nutrición , Istituto Salud Carlos III , Madrid , Spain.,e Addictive Behaviours Unit, Department of Psychiatry, Hospital de la Santa Creu I Sant Pau , Biomedical Research Institute Sant Pau , Barcelona , Spain
| | - Grainne McLoughlin
- f Social, Genetic, and Developmental Psychiatry Centre (SGDP) , King's College London , London , UK
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23
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Computerized neurocognitive training for improving dietary health and facilitating weight loss. J Behav Med 2019; 42:1029-1040. [PMID: 30891657 DOI: 10.1007/s10865-019-00024-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Accepted: 03/02/2019] [Indexed: 12/21/2022]
Abstract
Nearly 70% of Americans are overweight, in large part because of overconsumption of high-calorie foods such as sweets. Reducing sweets is difficult because powerful drives toward reward overwhelm inhibitory control (i.e., the ability to withhold a prepotent response) capacities. Computerized inhibitory control trainings (ICTs) have shown positive outcomes, but impact on real-world health behavior has been variable, potentially because of limitations inherent in existing paradigms, e.g., low in frequency, intrinsic enjoyment, personalization, and ability to adapt to increasing ability. The present study aimed to assess the feasibility, acceptability, and efficacy of a gamified and non-gamified, daily, personalized, and adaptive ICT designed to facilitate weight loss by targeting consumption of sweets. Participants (N = 106) were randomized to one of four conditions in a 2 (gamified vs. non-gamified) by 2 (ICT vs. sham) factorial design. Participants were prescribed a no-added-sugar diet and completed 42 daily, at-home trainings, followed by two weekly booster trainings. Results indicated that the ICTs were feasible and acceptable. Surprisingly, compliance to the 44 trainings was excellent (88.8%) and equivalent across both gamified and non-gamified conditions. As hypothesized, the impact of ICT on weight loss was moderated by implicit preference for sweet foods [F(1,95) = 6.17, p = .02] such that only those with higher-than-average implicit preference benefited (8-week weight losses for ICT were 3.1% vs. 2.2% for sham). A marginally significant effect was observed for gamification to reduce the impact of ICT. Implications of findings for continued development of ICTs to impact health behavior are discussed.
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24
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Vergani L, Marton G, Pizzoli SFM, Monzani D, Mazzocco K, Pravettoni G. Training Cognitive Functions Using Mobile Apps in Breast Cancer Patients: Systematic Review. JMIR Mhealth Uhealth 2019; 7:e10855. [PMID: 30888326 PMCID: PMC6444278 DOI: 10.2196/10855] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 07/02/2018] [Accepted: 07/16/2018] [Indexed: 12/20/2022] Open
Abstract
Background Breast cancer is an invalidating disease and its treatment can bring serious side effects that have a physical and psychological impact. Specifically, cancer treatment generally has a strong impact on cognitive function. In recent years, new technologies and eHealth have had a growing influence on health care and innovative mobile apps can be useful tools to deliver cognitive exercise in the patient’s home. Objective This systematic review gives an overview of the state-of-the-art mobile apps aimed at training cognitive functions to better understand whether these apps could be useful tools to counteract cognitive impairment in breast cancer patients. Methods We searched in a systematic way all the full-text articles from the PubMed and Embase databases. Results We found eleven studies using mobile apps to deliver cognitive training. They included a total of 819 participants. App and study characteristics are presented and discussed, including cognitive domains trained (attention, problem solving, memory, cognitive control, executive function, visuospatial function, and language). None of the apps were specifically developed for breast cancer patients. They were generally developed for a specific clinical population. Only 2 apps deal with more than 1 cognitive domain, and only 3 studies focus on the efficacy of the app training intervention. Conclusions These results highlight the lack of empirical evidence on the efficacy of currently available apps to train cognitive function. Cognitive domains are not well defined across studies. It is noteworthy that no apps are specifically developed for cancer patients, and their applicability to breast cancer should not be taken for granted. Future studies should test the feasibility, usability, and effectiveness of available cognitive training apps in women with breast cancer. Due to the complexity and multidimensionality of cognitive difficulties in this cancer population, it may be useful to design, develop, and implement an ad hoc app targeting cognitive impairment in breast cancer patients.
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Affiliation(s)
- Laura Vergani
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.,Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology (Istituto di Ricovero e Cura a Carattere Scientifico), Milan, Italy
| | - Giulia Marton
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.,Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology (Istituto di Ricovero e Cura a Carattere Scientifico), Milan, Italy
| | - Silvia Francesca Maria Pizzoli
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.,Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology (Istituto di Ricovero e Cura a Carattere Scientifico), Milan, Italy
| | - Dario Monzani
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.,Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology (Istituto di Ricovero e Cura a Carattere Scientifico), Milan, Italy
| | - Ketti Mazzocco
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.,Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology (Istituto di Ricovero e Cura a Carattere Scientifico), Milan, Italy
| | - Gabriella Pravettoni
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.,Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology (Istituto di Ricovero e Cura a Carattere Scientifico), Milan, Italy
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25
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Holzmann SL, Dischl F, Schäfer H, Groh G, Hauner H, Holzapfel C. Digital Gaming for Nutritional Education: A Survey on Preferences, Motives, and Needs of Children and Adolescents. JMIR Form Res 2019; 3:e10284. [PMID: 30758290 PMCID: PMC6391648 DOI: 10.2196/10284] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 10/04/2018] [Accepted: 11/25/2018] [Indexed: 12/19/2022] Open
Abstract
Background Use of novel information and communication technologies are frequently discussed as promising tools to prevent and treat overweight and obesity in children and adolescents. Objective This survey aims to describe the preferences, motives, and needs of children and adolescents regarding nutrition and digital games. Methods We conducted a survey in 6 secondary schools in the southern region of Germany using a 43-item questionnaire. Questions referred to preferences, motives, and needs of children and adolescents regarding nutrition and digital games. In addition, knowledge regarding nutrition was assessed with 4 questions. We collected self-reported sociodemographic and anthropometric data. Descriptive statistical analyses were performed using SPSS. Results In total, 293 children and adolescents participated in the study, with ages 12-18 years (137 girls, 46.8%), weight 30.0-120.0 (mean 60.2 [SD 13.2]) kg, and height 1.4-2.0 (mean 1.7 [SD 0.1]) m. A total of 5.5% (16/290) correctly answered the 4 questions regarding nutrition knowledge. Study participants acquired digital nutritional information primarily from the internet (166/291, 57.0%) and television (97/291, 33.3%), while school education (161/291, 55.3%) and parents or other adults (209/291, 71.8%) were the most relevant nondigital information sources. Most participants (242/283, 85.5%) reported that they regularly play digital games. More than half (144/236, 61.0%) stated that they play digital games on a daily basis on their smartphones or tablets, and almost 70% (151/282, 66.5%) reported playing digital games for ≤30 minutes without any interruption. One-half of respondents (144/280, 51.4%) also stated that they were interested in receiving information about nutrition while playing digital games. Conclusions This survey suggests that nutrition knowledge in children and adolescents might be deficient. Most children and adolescents play digital games and express interest in acquiring nutritional information during digital gameplay. A digital game with a focus on sound nutrition could be a potential educational tool for imparting nutrition knowledge and promoting healthier nutrition behaviors in children and adolescents.
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Affiliation(s)
- Sophie Laura Holzmann
- Institute for Nutritional Medicine, Else Kroener-Fresenius-Center for Nutritional Medicine, University Hospital "Klinikum rechts der Isar", Technical University of Munich, Munich, Germany
| | - Felicitas Dischl
- Institute for Nutritional Medicine, Else Kroener-Fresenius-Center for Nutritional Medicine, University Hospital "Klinikum rechts der Isar", Technical University of Munich, Munich, Germany
| | - Hanna Schäfer
- Research Group Social Computing, Department of Informatics, Technical University of Munich, Garching, Germany
| | - Georg Groh
- Research Group Social Computing, Department of Informatics, Technical University of Munich, Garching, Germany
| | - Hans Hauner
- Institute for Nutritional Medicine, Else Kroener-Fresenius-Center for Nutritional Medicine, University Hospital "Klinikum rechts der Isar", Technical University of Munich, Munich, Germany.,Nutritional Medicine Unit, Institute for Food and Health, Technical University of Munich, Freising, Germany
| | - Christina Holzapfel
- Institute for Nutritional Medicine, Else Kroener-Fresenius-Center for Nutritional Medicine, University Hospital "Klinikum rechts der Isar", Technical University of Munich, Munich, Germany
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26
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Jones A, McGrath E, Robinson E, Houben K, Nederkoorn C, Field M. A randomized controlled trial of inhibitory control training for the reduction of alcohol consumption in problem drinkers. J Consult Clin Psychol 2018; 86:991-1004. [PMID: 30507225 PMCID: PMC6277130 DOI: 10.1037/ccp0000312] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 12/15/2017] [Accepted: 04/12/2018] [Indexed: 01/06/2023]
Abstract
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).
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Affiliation(s)
| | | | | | - Katrijn Houben
- Faculty of Psychology and Neuroscience, Maastricht University
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27
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When winning is losing: A randomized controlled trial testing a video game to train food-specific inhibitory control. Appetite 2018; 129:143-154. [DOI: 10.1016/j.appet.2018.06.039] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 06/23/2018] [Accepted: 06/29/2018] [Indexed: 12/19/2022]
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28
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Schakel L, Veldhuijzen DS, van Middendorp H, Dessel PV, Houwer JD, Bidarra R, Evers AWM. The effects of a gamified approach avoidance training and verbal suggestions on food outcomes. PLoS One 2018; 13:e0201309. [PMID: 30048511 PMCID: PMC6062074 DOI: 10.1371/journal.pone.0201309] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 07/12/2018] [Indexed: 01/24/2023] Open
Abstract
There is initial support for the effectiveness of approach-avoidance trainings in altering food-related health behaviors. Furthermore, outcome expectancies induced by verbal suggestions might optimize the effectiveness of these interventions, as shown in placebo research. The present study investigated the effectiveness of a gamified approach-avoidance training on food-related outcomes and whether verbal suggestions could strengthen those effects. A total of 120 participants were randomly assigned to 1 of 4 conditions: serious gaming only, verbal suggestions only, serious gaming combined with verbal suggestions, or a gaming control condition. Virtual food preference and food choice were assessed with a food choice task, with pairs differing in healthiness or in healthiness and attractiveness. Implicit food preference was assessed with an Implicit Association Test and food intake with a bogus taste test. Participants in both serious gaming conditions made healthier food choices for pairs differing in healthiness and attractiveness and had healthier implicit food preferences compared to gaming control. No effects were found on food intake. These findings provide the first preliminary support for the effects of a gamified approach-avoidance training on virtual food choice and implicit food preference. Future studies should further elucidate these effects, also in other health domains such as physical activity.
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Affiliation(s)
- Lemmy Schakel
- Faculty of Social and Behavioural Sciences, Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden University, Leiden, The Netherlands
- Leiden Institute for Brain and Cognition, Leiden University, Leiden, the Netherlands
| | - Dieuwke S. Veldhuijzen
- Faculty of Social and Behavioural Sciences, Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden University, Leiden, The Netherlands
- Leiden Institute for Brain and Cognition, Leiden University, Leiden, the Netherlands
| | - Henriët van Middendorp
- Faculty of Social and Behavioural Sciences, Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden University, Leiden, The Netherlands
- Leiden Institute for Brain and Cognition, Leiden University, Leiden, the Netherlands
| | - Pieter Van Dessel
- Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Jan De Houwer
- Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Rafael Bidarra
- Department of Intelligent Systems, Delft University of Technology, Delft, The Netherlands
| | - Andrea W. M. Evers
- Faculty of Social and Behavioural Sciences, Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden University, Leiden, The Netherlands
- Leiden Institute for Brain and Cognition, Leiden University, Leiden, the Netherlands
- Department of Psychiatry, Leiden University Medical Centre, Leiden, The Netherlands
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Forman EM, Goldstein SP, Flack D, Evans BC, Manasse SM, Dochat C. Promising technological innovations in cognitive training to treat eating-related behavior. Appetite 2018; 124:68-77. [PMID: 28414042 PMCID: PMC5641227 DOI: 10.1016/j.appet.2017.04.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 04/12/2017] [Accepted: 04/13/2017] [Indexed: 01/30/2023]
Abstract
One potential reason for the suboptimal outcomes of treatments targeting appetitive behavior, such as eating and alcohol consumption, is that they do not target the implicit cognitive processes that may be driving these behaviors. Two groups of related neurocognitive processes that are robustly associated with dysregulated eating and drinking are attention bias (AB; selective attention to specific stimuli) and executive function (EF; a set of cognitive control processes such as inhibitory control, working memory, set shifting, that govern goal-directed behaviors). An increasing body of work suggests that EF and AB training programs improve regulation of appetitive behaviors, especially if trainings are frequent and sustained. However, several key challenges, such as adherence to the trainings in the long term, and overall potency of the training, remain. The current manuscript describes five technological innovations that have the potential to address difficulties related to the effectiveness and feasibility of EF and AB trainings: (1) deployment of training in the home, (2) training via smartphone, (3) gamification, (4) virtual reality, and (5) personalization. The drawbacks of these innovations, as well as areas for future research, are also discussed. The above-mentioned innovations are likely to be instrumental in the future empirical work to develop and evaluate effective EF and AB trainings for appetitive behaviors.
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30
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Hoffmann A, Christmann CA, Bleser G. Gamification in Stress Management Apps: A Critical App Review. JMIR Serious Games 2017; 5:e13. [PMID: 28592397 PMCID: PMC5480012 DOI: 10.2196/games.7216] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 03/17/2017] [Accepted: 04/06/2017] [Indexed: 01/15/2023] Open
Abstract
Background In today’s society, stress is more and more often a cause of disease. This makes stress management an important target of behavior change programs. Gamification has been suggested as one way to support health behavior change. However, it remains unclear to which extend available gamification techniques are integrated in stress management apps, and if their occurrence is linked to the use of elements from behavior change theory. Objective The aim of this study was to investigate the use of gamification techniques in stress management apps and the cooccurrence of these techniques with evidence-based stress management methods and behavior change techniques. Methods A total of 62 stress management apps from the Google Play Store were reviewed on their inclusion of 17 gamification techniques, 15 stress management methods, and 26 behavior change techniques. For this purpose, an extended taxonomy of gamification techniques was constructed and applied by 2 trained, independent raters. Results Interrater-reliability was high, with agreement coefficient (AC)=.97. Results show an average of 0.5 gamification techniques for the tested apps and reveal no correlations between the use of gamification techniques and behavior change techniques (r=.17, P=.20), or stress management methods (r=.14, P=.26). Conclusions This leads to the conclusion that designers of stress management apps do not use gamification techniques to influence the user’s behaviors and reactions. Moreover, app designers do not exploit the potential of combining gamification techniques with behavior change theory.
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Affiliation(s)
- Alexandra Hoffmann
- Junior research group wearHEALTH, Department of Computer Science, University of Kaiserslautern, Kaiserslautern, Germany
| | - Corinna A Christmann
- Junior research group wearHEALTH, Department of Computer Science, University of Kaiserslautern, Kaiserslautern, Germany
| | - Gabriele Bleser
- Junior research group wearHEALTH, Department of Computer Science, University of Kaiserslautern, Kaiserslautern, Germany
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Veling H, Lawrence NS, Chen Z, van Koningsbruggen GM, Holland RW. What Is Trained During Food Go/No-Go Training? A Review Focusing on Mechanisms and a Research Agenda. CURRENT ADDICTION REPORTS 2017; 4:35-41. [PMID: 28357193 PMCID: PMC5350201 DOI: 10.1007/s40429-017-0131-5] [Citation(s) in RCA: 96] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
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.
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Affiliation(s)
- Harm Veling
- Behavioural Science Institute, Radboud University Nijmegen, Montessorilaan 3, 6525 HR Nijmegen, The Netherlands
| | - Natalia S Lawrence
- School of Psychology, College of Life and Environmental Sciences, University of Exeter, Exeter, UK
| | - Zhang Chen
- Behavioural Science Institute, Radboud University Nijmegen, Montessorilaan 3, 6525 HR Nijmegen, The Netherlands
| | | | - Rob W Holland
- Behavioural Science Institute, Radboud University Nijmegen, Montessorilaan 3, 6525 HR Nijmegen, The Netherlands.,Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
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32
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Adams RC, Lawrence NS, Verbruggen F, Chambers CD. Training response inhibition to reduce food consumption: Mechanisms, stimulus specificity and appropriate training protocols. Appetite 2017; 109:11-23. [PMID: 27838443 PMCID: PMC5240656 DOI: 10.1016/j.appet.2016.11.014] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Revised: 11/05/2016] [Accepted: 11/08/2016] [Indexed: 01/22/2023]
Abstract
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.
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Affiliation(s)
- Rachel C Adams
- School of Psychology and Cardiff University Brain Research Imaging Centre, Cardiff University, Park Place, Cardiff CF10 3AT, UK.
| | - Natalia S Lawrence
- School of Psychology and Cardiff University Brain Research Imaging Centre, Cardiff University, Park Place, Cardiff CF10 3AT, UK; School of Psychology, College of Life and Environmental Sciences, University of Exeter, Exeter EX4 4QG, UK.
| | - Frederick Verbruggen
- School of Psychology, College of Life and Environmental Sciences, University of Exeter, Exeter EX4 4QG, UK.
| | - Christopher D Chambers
- School of Psychology and Cardiff University Brain Research Imaging Centre, Cardiff University, Park Place, Cardiff CF10 3AT, UK.
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