A role for mental imagery in the experience and reduction of food cravings

How Can Imaginal Retraining for Modifying Food Craving be Improved?

Imaginal retraining (IR) is an emerging intervention technique in which people imagine avoidance behaviors towards imagined foods or other substances, such as throwing them away. Although IR shows promise in reducing initial craving for a range of substances, including alcohol and tobacco, effects appear less robust for craving for energy-dense foods. This raises the question of how IR for food craving can be improved. Here, we address this question informed by emerging findings from IR dismantling studies and the field of regular cognitive bias modification training paradigms. Based on current insights, we suggest the most optimal 'craving-reduction' effects for energy-dense food can likely be expected for IR that includes an overt motor movement. While it is not yet clear what movement works best for food, we suggest a tailored movement or Go/No-Go-based stop movement has the potential to be most effective. The most likely mechanism in reducing craving is cue-devaluation of trained vivid craving images regarding specific energy-dense food products. Future work is needed that investigates and assess the underlying mechanisms (e.g., updating beliefs; cue-devaluation), task characteristics (e.g., IR instructions; specific motor movements) and individual characteristics (e.g., perceived craving; vividness of food imagination) that determine IR effects.

What's in the mind's eye of individuals with bipolar disorders: an exploration of the content and characteristics of mental images in different thymic phases

BACKGROUND

Mental imagery, or 'seeing with the mind's eye' (Kosslyn et al. ), provokes strong emotional responses (Ji et al., ). To date, there is a lack of data on the content and clinical characteristics (e.g. vividness, likelihood, emotional effects) of spontaneous mental images (MI) in people with bipolar disorder (BD) according to their thymic states.

AIM

The current study sought to assess the characteristics associated with the contents of MI in people with BD.

METHOD

Forty-two euthymic individuals diagnosed with BD (American Psychiatric Association, ) were asked to self-report their MI during depression, (hypo)mania and euthymia. Participants also rated levels of vividness, likelihood and emotional activation related to MI (i.e. valence, arousal, type of emotion).

RESULTS

The contents of the MI revealed phenomenological aspects of BD. Different themes were associated with each thymic phase. In (hypo)mania and in euthymia, the mental images were assessed as being as vivid as probable (p>.05). (Hypo)manic and euthymic-related MI activated more pleasure than displeasure (p<.001) and were mainly associated with joy. In depression, MI were assessed as more vivid than likely (p<.05). In depression, MI activated more displeasure than pleasure (p<.0001) and induced mainly sadness.

DISCUSSION

Overall, a congruence between the contents of images and the three thymic phases was found. The content of the MI was related to self-reported emotional effects that were congruent with the thymic phases concerned. The results add new clinical information for the use of imagery-based cognitive therapy in individuals with BD.

Romance Scams: Romantic Imagery and Transcranial Direct Current Stimulation

Love has an enormous effect on mental health. One does not need an actual romantic relationship to be in love. Indeed, romantic love can be built upon without frequent or real-life encounters, such as with a stranger from a matching website. With the advancement of the Internet and the influence of coronavirus disease, it is believed that these distant romantic relationships and related romance scams are burgeoning. Often, the victims of scams keep emotionally attached to the scammer even after the lie is revealed, which is hypothesized to be attributed to the aberrantly exaggerated romantic imagery of the victims. It is observed that many victims suffer from symptoms similar to a post-traumatic stress disorder, and some even consider suicide. However, there is scant literature on this topic. In this article, it is further postulated that the aberrant romantic imagery might be associated with impulsive acts such as suicide once the ideal but fake romantic relationship is dissolved. Thereafter, it is further speculated that manipulation of the visual network, possibly by transcranial direct current stimulation (tDCS), might be a promising treatment.

Investigating properties of imagery-induced flash-forwards and the effect of eye movements on the experience of desire and craving in gamers

Vivid and emotionally laden imagery is a symptom across a wide range of psychiatric disorders. Flash-forwards describe the mental simulation of anticipated future events which might also be relevant in the context of gaming disorder. The aim of this laboratory study was to investigate flash-forwards and the experience of desires and craving in gamers, and to examine the effect of eye movements on their vividness and related desires. A sample of 77 gamers formed a mental picture of themselves gaming in the future and rated the vividness and emotionality of this imagination, and their current desire and craving for gaming. Thereafter, one half of the gamers conducted a dual task (i.e., horizontal eye movements while retrieving the picture), whereas the other half let their eyes rest on the middle of the computer screen while retrieving the picture (non-dual task). Vividness of the flash-forward and intensity of desire and craving were again measured after the dual or non-dual task. In the overall sample, more imagery-related desire correlated positively with associated positive affect and vividness of flash-forwards. However, in a subsample of problematic gamers, flash-forwards are experienced less vivid and less pleasurable with increasing symptom severity. Eye movements while retrieving the flash-forwards led to significantly decreased ratings of imagery-related desire intensity, which was not the case for the non-dual condition. Results suggest different properties of flash-forwards between recreational and problematic gamers. Moreover, an attention-demanding task taxing the working memory seems beneficial for reducing desires related to imagery-induced flash-forwards.

Effects of working memory on naturally occurring cravings

Elaborated Intrusion (EI) theory posits a key role for visuospatial working memory (WM) in craving. In line with the predictions of EI theory, several studies have found that WM and craving show mutually interfering effects - for example, performance of visuospatial WM tasks has been found to attenuate naturally occurring cravings. However, the extent to which these effects are driven specifically by visuospatial processing remains unclear. We conducted two experiments to investigate the effects of WM on naturally occurring cravings in more detail. In experiment 1, we examined whether such effects are driven specifically by visuospatial WM processes or can also be induced by a verbal WM task. Subjective craving ratings were attenuated equally by performance of visuospatial and verbal WM tasks, suggesting that craving is not dependent specifically on visuospatial processing. In experiment 2, we examined whether effects of visuospatial WM on craving could be driven by simple distraction. Naturally occurring cravings were attenuated in a control condition with minimal WM demands (watching a video). However, the magnitude of attenuation was significantly greater in a visuospatial WM condition. Taken together, these findings highlight a key role for WM in the attenuation of naturally occurring craving, but do not support the hypothesis that such effects are dependent specifically on visuospatial processing.

Cue-Reactive Imagery Mediates the Relationships of Reward Responsiveness with Both Cue-Reactive Urge to Gamble and Positive Affect in Poker-Machine Gamblers

Previous research has demonstrated that gambling cues (e.g., flashing lights on poker-machines) can trigger an urge to gamble in poker-machine gamblers. However, the psychological mechanisms that promote the urge to gamble remain poorly understood. The present study explored whether reward responsiveness predicted urge to gamble and positive affect, and whether cue-reactive rationality, volitional control and imagery mediated these relationships. Ninety-three (45% male and 55% female) Australian regular poker-machine gamblers aged between 18 and 77 participated in an online cue-reactivity experiment. Participants initially completed the Problem Gambling Severity Index and Reward Responsiveness scale. Subsequently, at three time points (i.e., baseline, directly after a neutral cue and directly after a gambling cue) participants completed the rationality, volitional control and imagery subscales of the Phenomenology of Consciousness Inventory and two visual analogue scales that measured urge to gamble and positive affect. Analyses indicated that gambling cues triggered statistically significant increases in both urge to gamble and positive affect and these variables were statistically significantly positively correlated with reward responsiveness. Furthermore, only cue-reactive imagery mediated the relationships between reward responsiveness and the two outcome variables (i.e., cue-reactive urge to gamble and positive affect). These findings highlight the potential importance of targeting reward responsiveness and cue-reactive mental imagery in the context of exposure therapies for poker-machine problem gamblers.

Guided imagery targeting exercise, food cravings, and stress: a multi-modal randomized feasibility trial

The purpose of this randomized wait-list controlled trial was to test the feasibility and preliminary efficacy of a guided imagery based multi-behavior intervention intended to address psychological stress, food cravings, and physical activity. Personalized guided imagery scripts were created and participants were instructed to practice guided imagery every day for 35 consecutive days. Of 48 women who enrolled, we report comparisons between 16 randomized to treatment with 19 who were wait-listed (overall Mage = 45.50; Mbodymassindex = 31.43). Study completers reported 89% compliance with practicing guided imagery during the intervention. A significant time-by-group interaction was observed with reductions in food cravings and increases in physical activity compared with wait-list controls. Telephone-based multi-behavior interventions that utilize guided imagery to address food cravings and exercise behavior appear to be acceptable for overweight and obese women. Future phone-based guided imagery research testing this skill to address multiple health behaviors is justified.

A Scoping Review of Health Outcomes Examined in Randomized Controlled Trials Using Guided Imagery

INTRODUCTION

Guided imagery involves the controlled visualization of detailed mental images. This integrative health technique is used for healing, health maintenance, or the treatment of specific conditions. Guided imagery is an integral part of mindfulness meditation, hypnosis, and various relaxation exercises. However, evidence to support the widespread use and dissemination of guided imagery interventions has been lacking. The purposes of this scoping review were to document the scope of health outcomes and disease processes examined by guided imagery researchers and the journal outlets where this work has been published. Secondary purposes were to review the efficacy of guided imagery, risk of bias from studies published in selected integrative health journals, and gain feedback from clinicians in a practiced-based research network (PBRN) about potential barriers for use in clinical settings.

METHODS

Ten bibliographic databases were searched for randomized controlled trials (RCTs) published between 1960 and 2013 that included adult participants. Descriptive and analytic methods were employed to document the journal outlets, diseases, and health outcomes investigated.

RESULTS

320 RCTs that included more than 17,979 adult participants were reviewed. The published studies appeared in 216 peer-reviewed journals from diverse disciplines largely representing psychology, the sport sciences, rehabilitation, nursing, and medicine. Major outcomes observed were coping with pain, stroke recovery, anxiety, coping with stress, and sport skills. Practitioner feedback from the PBRN revealed some interest but skepticism and time constraints were discussed as barriers.

CONCLUSIONS

Ongoing research and creative dissemination techniques are warranted.

Caffeine cravings impair memory and metacognition

Cravings for food and other substances can impair cognition. We extended previous research by testing the effects of caffeine cravings on cued-recall and recognition memory tasks, and on the accuracy of judgements of learning (JOLs; predicted future recall) and feeling-of-knowing (FOK; predicted future recognition for items that cannot be recalled). Participants (N = 55) studied word pairs (POND-BOOK) and completed a cued-recall test and a recognition test. Participants made JOLs prior to the cued-recall test and FOK judgements prior to the recognition test. Participants were randomly allocated to a craving or control condition; we manipulated caffeine cravings via a combination of abstinence, cue exposure, and imagery. Cravings impaired memory performance on the cued-recall and recognition tasks. Cravings also impaired resolution (the ability to distinguish items that would be remembered from those that would not) for FOK judgements but not JOLs, and reduced calibration (correspondence between predicted and actual accuracy) for JOLs but not FOK judgements. Additional analysis of the cued-recall data suggested that cravings also reduced participants' ability to monitor the likely accuracy of answers during the cued-recall test. These findings add to prior research demonstrating that memory strength manipulations have systematically different effects on different types of metacognitive judgements.

People trying to lose weight dislike calorie counting apps and want motivational support to help them achieve their goals

BACKGROUND

Two thirds of UK adults are overweight or obese and at increased risk of chronic conditions such as heart disease, diabetes and certain cancers. Basic public health support for weight loss comprises information about healthy eating and lifestyle, but internet and mobile applications (apps) create possibilities for providing long-term motivational support.

AIMS

To explore among people currently trying to lose weight, or maintaining weight loss, (i) problems, experiences and wishes in regards to weight management and weight loss support including e-health support; (ii) reactions to Functional Imagery Training (FIT) as a possible intervention.

METHOD

Six focus groups (N = 24 in total) were recruited from a public pool of people who had expressed an interest in helping with research. The topics considered were barriers to weight loss, desired support for weight loss and acceptability of FIT including the FIT app. The focus group discussions were transcribed and thematically analysed.

RESULTS

All groups spontaneously raised the issue of waning motivation and expressed the desire for motivational app support for losing weight and increasing physical activity. They disliked calorie counting apps and those that required lots of user input. All groups wanted behavioural elements such as setting and reviewing goals to be included, with the ability to personalise the app by adding picture reminders and choosing times for goal reminders. Participants were positive about FIT and FIT support materials.

CONCLUSION

There is a mismatch between the help provided via public health information campaigns and commercially available weight-loss self-help (lifestyle information, self-monitoring), and the help that individuals actually desire (motivational and autonomous e-support), posing an opportunity to develop more effective electronic, theory-driven, motivational, self-help interventions.

Dieting and Food Cue-Related Working Memory Performance

Executive functioning (e.g., working memory) is tightly intertwined with self-regulation. For example, food cue-elicited craving has been found to impair working memory performance. Furthermore, current dieters have been found to show lower working memory performance than non-dieters. Recent research, however, suggests that it is crucial to consider dieting success in addition to current dieting status or restrained eating in order to reveal cognitive mechanisms that are associated with successful eating-related self-regulation. The current study investigated food cue-related working memory performance as a function of dieting status and dieting success in female students. Participants performed an n-back task with pictures of food and neutral objects. Reaction time in response to food pictures was slower than in response to neutral pictures, whereas omission errors did not differ between picture types. Current food craving was increased after performing the food block, but not after the neutral block. There was an indirect effect of current dieting status on higher food craving after the food block, which was mediated by slower reaction time to food vs. neutral pictures. Furthermore, higher dieting success was associated with fewer omission errors in the food vs. neutral block in current dieters. There were no relationships of restrained eating with current food craving and task performance. Results further highlight the need to differentiate between successful and unsuccessful dieting in addition to current dieting status or restrained eating when examining possible mechanisms of overeating or successful restraint. Although palatable food cues induce food craving regardless of dieting success, they may boost executive functioning in successful dieters, which helps them to overcome these temptations.

Effects of repetitive imagination of alcohol consumption on craving in alcohol-dependent patients: A pilot study

BACKGROUND

In the majority of patients with alcohol use disorder (AUD), the clinical course is characterized by multiple relapses to drinking, frequently preceded by intense craving for alcohol. The present pilot study aimed to assess the effects of a repetitive imaginary cue-exposure protocol in reducing craving in recently abstinent alcohol-dependent patients.

METHODS

Sixty-four patients were randomly assigned to six intervention groups and were instructed to repetitively imagine: i) drinking a glass of their preferred alcoholic drink (low vs. high number of repetitions); or ii) drinking a glass of water (low vs. high number of repetitions); or iii) performing an analogous movement or performed no imagination. Additionally, 10 healthy controls were instructed to repetitively imagine drinking a glass of their preferred alcoholic drink (high number of repetitions). The levels of craving before and after intervention were measured using the Alcohol Urge Questionnaire (AUQ) and the Visual Analogue Scale for Craving (VASC).

RESULTS

Repetitive imagination of alcohol consumption did not lead to a significant decrease in craving in alcohol-dependent patients as measured by the AUQ and VASC. In contrast, healthy controls showed a nearly significant decrease of the urge to drink alcohol after applying the protocol with a high number of repetitions.

CONCLUSIONS

The findings of this pilot study might indicate an aberrant ability to habituate to alcohol-related stimuli in patients with AUD compared to healthy subjects. Future studies in larger samples are needed to further explore the effectiveness of imaginary cue-exposure interventions in alcohol dependence.

Cue-Reactive Rationality, Visual Imagery and Volitional Control Predict Cue-Reactive Urge to Gamble in Poker-Machine Gamblers

Poker-machine gamblers have been demonstrated to report increases in the urge to gamble following exposure to salient gambling cues. However, the processes which contribute to this urge to gamble remain to be understood. The present study aimed to investigate whether changes in the conscious experience of visual imagery, rationality and volitional control (over one's thoughts, images and attention) predicted changes in the urge to gamble following exposure to a gambling cue. Thirty-one regular poker-machine gamblers who reported at least low levels of problem gambling on the Problem Gambling Severity Index (PGSI), were recruited to complete an online cue-reactivity experiment. Participants completed the PGSI, the visual imagery, rationality and volitional control subscales of the Phenomenology of Consciousness Inventory (PCI), and a visual analogue scale (VAS) assessing urge to gamble. Participants completed the PCI subscales and VAS at baseline, following a neutral video cue and following a gambling video cue. Urge to gamble was found to significantly increase from neutral cue to gambling cue (while controlling for baseline urge) and this increase was predicted by PGSI score. After accounting for the effects of problem-gambling severity, cue-reactive visual imagery, rationality and volitional control significantly improved the prediction of cue-reactive urge to gamble. The small sample size and limited participant characteristic data restricts the generalizability of the findings. Nevertheless, this is the first study to demonstrate that changes in the subjective experience of visual imagery, volitional control and rationality predict changes in the urge to gamble from neutral to gambling cue. The results suggest that visual imagery, rationality and volitional control may play an important role in the experience of the urge to gamble in poker-machine gamblers.

Effects of olfactory sense on chocolate craving

In the present study, we assessed the effect of the olfactory sense on chocolate craving in college females. Building on previous research by Kemps and Tiggemann (2013), we hypothesized that a fresh scent would decrease one's craving level for chocolate food. While the precursor study only addressed the decrease of chocolate craving, we also hypothesized that a sweet scent would increase one's craving level for chocolate foods. In the present experiment, participants rated their craving levels after viewing images of chocolate foods and inhaling essential oils: one fresh (Slique™ essence), and one sweet (vanilla). Results supported both of the hypotheses: inhaling a fresh scent reduced females' craving levels; similarly, when a sweet scent was inhaled, the participants' craving levels for chocolate food increased. These findings are particularly beneficial for women seeking weight loss and the findings can be applied in contexts such as weight loss programs, therapy, and maintenance programs, even beyond college settings. The results are particularly useful for helping women regarding stimuli that might serve as triggers for chocolate cravings.

Desensitizing Addiction: Using Eye Movements to Reduce the Intensity of Substance-Related Mental Imagery and Craving

Eye movement desensitization and reprocessing (EMDR) is an effective treatment for posttraumatic stress disorder. During this treatment, patients recall traumatic memories while making horizontal eye movements (EM). Studies have shown that EM not only desensitize negative memories but also positive memories and imagined events. Substance use behavior and craving are maintained by maladaptive memory associations and visual imagery. Preliminary findings have indicated that these mental images can be desensitized by EMDR techniques. We conducted two proof-of-principle studies to investigate whether EM can reduce the sensory richness of substance-related mental representations and accompanying craving levels. We investigated the effects of EM on (1) vividness of food-related mental imagery and food craving in dieting and non-dieting students and (2) vividness of recent smoking-related memories and cigarette craving in daily smokers. In both experiments, participants recalled the images while making EM or keeping eyes stationary. Image vividness and emotionality, image-specific craving and general craving were measured before and after the intervention. As a behavioral outcome measure, participants in study 1 were offered a snack choice at the end of the experiment. Results of both experiments showed that image vividness and craving increased in the control condition but remained stable or decreased after the EM intervention. EM additionally reduced image emotionality (experiment 2) and affected behavior (experiment 1): participants in the EM condition were more inclined to choose healthy over unhealthy snack options. In conclusion, these data suggest that EM can be used to reduce intensity of substance-related imagery and craving. Although long-term effects are yet to be demonstrated, the current studies suggest that EM might be a useful technique in addiction treatment.