Mechanisms of Choice Behavior Shift Using Cue-approach Training

When not responding to food changes food value: The role of timing

Establishing behavior change toward appetitive foods can be crucial to improve people's health. Food go/no-go training (GNG), in which people respond to some food items and not to other food items depending on the presentation of a go or no-go cue, is a means to establish behavior change. GNG changes the perceived value of food items and food consumption. After GNG, no-go items are rated as less attractive than go and/or untrained items, an empirical phenomenon called the NoGo-devaluation-effect. This effect is not always found, however. One theory-based explanation for these inconsistent results may be found in the timing of the go and no-go cues, which is also inconsistent across studies. Hence, in the present work we conducted two experiments to examine the possible role of go and no-go cue presentation timing in eliciting the NoGo-devaluation-effect. In Experiment 1, we presented the food items before the presentation of go/no-go cues, whereas we reversed this order in Experiment 2. As predicted, the NoGo-devaluation-effect was obtained in Experiment 1. This effect was absent in Experiment 2. Moreover, recognition memory for stimulus-action contingencies moderated the devaluation effect in Experiment 1, but not in Experiment 2. These results show that NoGo devaluation is dependent on the timing of the NoGo cue, which has theoretical and applied implications for understanding how and when go/no-go training influences food consumption. We propose that the value of food items is updated during go/no-go training to minimize prediction errors, and that this updating process is boosted by attention.

Neural correlates of changing food choices while bypassing values

Current theories suggest that altering choices requires value modification. To investigate this, normal-weight female participants' food choices and values were tested before and after an approach-avoidance training (AAT), while neural activity was recorded during the choice task using functional magnetic resonance imaging (fMRI). During AAT, participants consistently approached low- while avoiding high-calorie food cues. AAT facilitated low-calorie food choices, leaving food values unchanged. Instead, we observed a shift in indifference points, indicating the decreased contribution of food values in food choices. Training-induced choice shifts were associated with increased activity in the posterior cingulate cortex (PCC). In contrast, the medial PFC activity was not changed. Additionally, PCC grey matter density predicted individual differences in training-induced functional changes, suggesting anatomic predispositions to training impact. Our findings demonstrate neural mechanisms underlying choice modulation independent of valuation-related processes, with substantial theoretical significance for decision-making frameworks and translational implications for health-related decisions resilient to value shifts.

Memory for individual items is related to nonreinforced preference change

It is commonly assumed that memories contribute to value-based decisions. Nevertheless, most theories of value-based decision-making do not account for memory influences on choice. Recently, new interest has emerged in the interactions between these two fundamental processes, mainly using reinforcement-based paradigms. Here, we aimed to study the role memory processes play in preference change following the nonreinforced cue-approach training (CAT) paradigm. In CAT, the mere association of cued items with a speeded motor response influences choices. Previous studies with this paradigm showed that a single training session induces a long-lasting effect of enhanced preferences for high-value trained stimuli, that is maintained for several months. We hypothesized that CAT increases memory of trained items, leading to enhanced accessibility of their positive associative memories and in turn to preference changes. In two preregistered experiments, we found evidence that memory is enhanced for trained items and that better memory is correlated with enhanced preferences at the individual item level, both immediately and 1 mo following CAT. Our findings suggest that memory plays a central role in value-based decision-making following CAT, even in the absence of external reinforcements. These findings contribute to new theories relating memory and value-based decision-making and set the groundwork for the implementation of novel nonreinforced behavioral interventions that lead to long-lasting behavioral change.

Enhanced Bottom-Up and Reduced Top-Down fMRI Activity Is Related to Long-Lasting Nonreinforced Behavioral Change

Behavioral change studies and interventions focus on self-control and external reinforcements to influence preferences. Cue-approach training (CAT) has been shown to induce preference changes lasting months by merely associating items with neutral cues and speeded responses. We utilized this paradigm to study neural representation of preferences and their modification without external reinforcements. We scanned 36 participants with fMRI during a novel passive viewing task before, after and 30 days following CAT. We preregistered the predictions that activity in memory, top-down attention, and value-processing regions will underlie preference modification. While most theories associate preferences with prefrontal regions, we found that “bottom-up” perceptual mechanisms were associated with immediate change, whereas reduced “top-down” parietal activity was related to long-term change. Activity in value-related prefrontal regions was enhanced immediately after CAT for trained items and 1 month after for all items. Our findings suggest a novel neural mechanism of preference representation and modification. We suggest that nonreinforced change of preferences occurs initially in perceptual representation of items, putatively leading to long-term changes in “top-down” processes. These findings offer implementation of bottom-up instead of top-down targeted interventions for long-lasting behavioral change.

Modifying food items valuation and weight with gamified executive control training

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

How can food choice best be trained? Approach-avoidance versus go/no-go training

Behavior toward appetitive stimuli can be changed by motor response training procedures in which participants approach or respond to some stimuli and avoid or inhibit behavior to other stimuli. There is discussion in the literature whether effects are different when participants approach versus avoid stimuli during approach-avoidance training compared to when they respond versus not respond to stimuli during go/no-go training. Here, we directly compared effects of approach-avoidance training and go/no-go training on food choice within the same rigorous experimental protocol. Results showed that both training procedures influence food choice such that participants preferred Approach over Avoidance food items, and Go over NoGo food items, and these training effects were not statistically different. The present work suggests any inconsistencies in the literature on possible differences in effectiveness of these training procedures may be explained by differences in methods employed. The present work also raises new theoretical and applied questions about motor response training as a means to change behavior.

Does alcohol cue inhibitory control training survive a context shift?

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).

Training choices toward low value options

Food decisions are driven by differences in value of choice alternatives such that high value items are preferred over low value items. However, recent research has demonstrated that by implementing the Cue-Approach Training (CAT) the odds of choosing low value items over high value items can be increased. This effect was explained by increased attention to the low value items induced by CAT. Our goal was to replicate the original findings and to address the question of the underlying mechanism by employing eye-tracking during participants’ choice making. During CAT participants were presented with images of food items and were instructed to quickly respond to some of them when an auditory cue was presented (cued items), and not without this cue (uncued items). Next, participants made choices between two food items that differed on whether they were cued during CAT (cued versus uncued) and in pre-training value (high versus low). As predicted, results showed participants were more likely to select a low value food item over a high value food item for consumption when the low value food item had been cued compared to when the low value item had not been cued. Important, and against our hypothesis, there was no significant increase in gaze time for low value cued items compared to low value uncued items. Participants did spend more time fixating on the chosen item compared to the unchosen alternative, thus replicating previous work in this domain. The present research thus establishes the robustness of CAT as means of facilitating choices for low value over high value food but could not demonstrate that this increased preference was due to increased attention for cued low value items. The present research thus raises the question how CAT may increase choices for low value options.

Enhanced striatal and prefrontal activity is associated with individual differences in nonreinforced preference change for faces

Developing effective preference modification paradigms is crucial to improve the quality of life in a wide range of behaviors. The cue‐approach training (CAT) paradigm has been introduced as an effective tool to modify preferences lasting months, without external reinforcements, using the mere association of images with a cue and a speeded button response. In the current work for the first time, we used fMRI with faces as stimuli in the CAT paradigm, focusing on face‐selective brain regions. We found a behavioral change effect of CAT with faces immediately and 1‐month after training, however face‐selective regions were not indicative of behavioral change and thus preference change is less likely to rely on face processing brain regions. Nevertheless, we found that during training, fMRI activations in the ventral striatum were correlated with individual preference change. We also found a correlation between preference change and activations in the ventromedial prefrontal cortex during the binary choice phase. Functional connectivity among striatum, prefrontal regions, and high‐level visual regions was also related to individual preference change. Our work sheds new light on the involvement of neural mechanisms in the process of valuation. This could lead to development of novel real‐world interventions.

Is ventromedial prefrontal cortex critical for behavior change without external reinforcement?

Cue-approach training (CAT) is a novel paradigm that has been shown to induce preference changes towards items without external reinforcements. In the task, the mere association of a neutral cue and a speeded button response has been shown to induce a behavioral choice preference change lasting for months. This paradigm includes several phases: after the training of individual items, behavior change is manifested in binary choices of items with similar initial values. Neuroimaging data have implicated the ventromedial prefrontal cortex (vmPFC) in the choice phase of this task. However, the neural mechanisms underlying the preference changes induced by training remain unclear. Here, we asked whether the ventromedial frontal lobe (VMF) is critical for the non-reinforced preference change induced by CAT. For this purpose, 11 participants with focal lesions involving the VMF and 30 healthy age-matched controls performed the CAT. The VMF group was similar to the healthy age-matched control group in the ranking and training phases. As a group, the healthy age-matched controls exhibited a training-induced behavior change, while the VMF group did not. However, on an individual level analysis we found that some of the VMF participants showed a significant preference shift. Thus, we find mixed evidence for the role of VMF in this paradigm. This is another step towards defining the mechanisms underlying the novel form of behavioral change that occurs with CAT.

•

We tested participants with focal lesions involving ventromedial frontal lobe (VMF).

•

Participants performed a behavioral change task without external reinforcements.

•

The VMF group did not exhibit behavior change but some individuals in it did.

•

We find mixed evidence for the role of VMF in this paradigm.

Gaze Amplifies Value in Decision Making

When making decisions, people tend to choose the option they have looked at more. An unanswered question is how attention influences the choice process: whether it amplifies the subjective value of the looked-at option or instead adds a constant, value-independent bias. To address this, we examined choice data from six eye-tracking studies ( Ns = 39, 44, 44, 36, 20, and 45, respectively) to characterize the interaction between value and gaze in the choice process. We found that the summed values of the options influenced response times in every data set and the gaze-choice correlation in most data sets, in line with an amplifying role of attention in the choice process. Our results suggest that this amplifying effect is more pronounced in tasks using large sets of familiar stimuli, compared with tasks using small sets of learned stimuli.

Spacing of cue-approach training leads to better maintenance of behavioral change

The maintenance of behavioral change over the long term is essential to achieve public health goals such as combatting obesity and drug use. Previous work by our group has demonstrated a reliable shift in preferences for appetitive foods following a novel non-reinforced training paradigm. In the current studies, we tested whether distributing training trials over two consecutive days would affect preferences immediately after training as well as over time at a one-month follow-up. In four studies, three different designs and an additional pre-registered replication of one sample, we found that spacing of cue-approach training induced a shift in food choice preferences over one month. The spacing and massing schedule employed governed the long-term changes in choice behavior. Applying spacing strategies to training paradigms that target automatic processes could prove a useful tool for the long-term maintenance of health improvement goals with the development of real-world behavioral change paradigms that incorporate distributed practice principles.

The Cue-Approach Task as a General Mechanism for Long-Term Non-Reinforced Behavioral Change

Recent findings show that preferences for food items can be modified without external reinforcements using the cue-approach task. In the task, the mere association of food item images with a neutral auditory cue and a speeded button press, resulted in enhanced preferences for the associated stimuli. In a series of 10 independent samples with a total of 255 participants, we show for the first time that using this non-reinforced method we can enhance preferences for faces, fractals and affective images, as well as snack foods, using auditory, visual and even aversive cues. This change was highly durable in follow-up sessions performed one to six months after training. Preferences were successfully enhanced for all conditions, except for negative valence items. These findings promote our understanding of non-reinforced change, suggest a boundary condition for the effect and lay the foundation for development of novel applications.

The role of value in the attentional boost effect

Focusing attention on one item typically interferes with the ability to process other information. Yet, target detection can both facilitate memory for items paired with the target (the attentional boost effect) and increase the perceived value of those items (cued approach). Because long-term memory is better for valuable items than for neutral items, we asked whether the attentional boost effect is due to changes in the perceived value of items that are paired with targets. In three experiments, participants memorised a series of briefly presented images that depicted valuable (e.g., food) or neutral (e.g., children's toys) items. Whenever an item appeared, a square flashed in its centre. Participants pressed a button if the square was a target colour but not if it was a distractor colour. Consistent with previous research, target-paired items were remembered better than distractor-paired items and were rated as more valuable. Importantly, if memory for target-paired items is enhanced because they increased in perceived value, then valuable items should have been better remembered than neutral items. However, we found no evidence that value enhanced memory for the items in this task. Thus, it is unlikely that the attentional boost effect is due to changes in perceived value.

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

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

Psychological and neural contributions to appetite self-regulation

OBJECTIVE

This paper reviews the state of the science on psychological and neural contributions to appetite self-regulation in the context of obesity.

METHODS

Three content areas (neural systems and cognitive functions; parenting and early childhood development; and goal setting and goal striving) served to illustrate different perspectives on the psychological and neural factors that contribute to appetite dysregulation in the context of obesity. Talks were initially delivered at an NIH workshop consisting of experts in these three content areas, and then content areas were further developed through a review of the literature.

RESULTS

Self-regulation of appetite involves a complex interaction between multiple domains, including cognitive, neural, social, and goal-directed behaviors and decision-making. Self-regulation failures can arise from any of these factors, and the resulting implications for obesity should be considered in light of each domain. In some cases, self-regulation is amenable to intervention; however, this does not appear to be universally true, which has implications for both prevention and intervention efforts.

CONCLUSIONS

Appetite regulation is a complex, multifactorial construct. When considering its role in the obesity epidemic, it is advisable to consider its various dimensions together to best inform prevention and treatment efforts.

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

Purpose of Review

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

Recent Findings

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

Summary

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

Neural mechanisms of cue-approach training

Biasing choices may prove a useful way to implement behavior change. Previous work has shown that a simple training task (the cue-approach task), which does not rely on external reinforcement, can robustly influence choice behavior by biasing choice toward items that were targeted during training. In the current study, we replicate previous behavioral findings and explore the neural mechanisms underlying the shift in preferences following cue-approach training. Given recent successes in the development and application of machine learning techniques to task-based fMRI data, which have advanced understanding of the neural substrates of cognition, we sought to leverage the power of these techniques to better understand neural changes during cue-approach training that subsequently led to a shift in choice behavior. Contrary to our expectations, we found that machine learning techniques applied to fMRI data during non-reinforced training were unsuccessful in elucidating the neural mechanism underlying the behavioral effect. However, univariate analyses during training revealed that the relationship between BOLD and choices for Go items increases as training progresses compared to choices of NoGo items primarily in lateral prefrontal cortical areas. This new imaging finding suggests that preferences are shifted via differential engagement of task control networks that interact with value networks during cue-approach training.