Do process simulations during episodic future thinking enhance the reduction of delay discounting for middle income participants and those living in poverty?

Two studies examined whether episodic future thinking (EFT; pre-experiencing future events) reduces discounting of future rewards (DD). No studies have investigated whether process simulations (i.e., simulating the process of executing a future event) amplify EFT's reduction of DD. Study 1 examined the effect of incorporating process simulations into EFT (N = 42, M age = 43.27; 91% female, family income = $75,976) using a 2 × 2 factorial design with type of episodic thinking (process, nonprocess/general) and temporal perspective (EFT, episodic recent thinking) as between-subjects factors. Study 2 replicated Study 1 in a sample of adults living in poverty (N = 36; M age = 38.44, 88% female; family income = $25,625). The results of both studies showed EFT reduced DD, but process-oriented EFT did not amplify the effect of EFT. Our findings suggest the key ingredient in EFT's effect on DD is self-projection into the future. This was also the first study to show EFT improves DD in a sample living in poverty.

Unstuck in time: episodic future thinking reduces delay discounting and cigarette smoking.

RATIONALE: Delay discounting, or the devaluation of delayed outcomes, appears to play an etiological role in tobacco and other substance-use disorders. OBJECTIVES: No human studies to our knowledge have been designed to examine whether experimental reductions in delay discounting produce concomitant reduction in drug use. METHODS: Using methods from prior studies on delay discounting and obesity, we examined the effects of episodic future thinking (EFT; a form of mental prospection) on delay discounting and cigarette self-administration in smokers. RESULTS: Consistent with prior data, EFT significantly reduced both delay discounting (Cohen's d effect size = 0.65) and the number of cigarette puffs earned in a cigarette self-administration task (d = 0.58). CONCLUSIONS: The effects of EFT on delay discounting generalize to smokers; EFT also reduces laboratory-based cigarette self-administration. Potential mechanisms of EFT's effects are discussed as well as implications of EFT for clinical treatment of substance-use disorders.

Episodic future thinking reduces eating in a food court.

Episodic future thinking (EFT) is the psychological process of vividly imagining a future event, and this process has been shown to reduce overeating in the laboratory. To assess the efficacy of EFT in the natural environment, twenty-nine overweight or obese women who wanted to improve their eating habits were randomly assigned to one of two smartphone-implemented interventions--EFT or control episodic recent thinking (ERT)--while they ate dinner in a public food court. Results showed a reduction in consumption of total calories, a reduction in percent calories from fat, and an increase in percent calories from protein for EFT versus ERT. These data suggest EFT may be used to modify eating habits in natural eating environments, and may show potential as a component of behavioral obesity interventions.

Web-Based and Mobile Delivery of an Episodic Future Thinking Intervention for Overweight and Obese Families: A Feasibility Study.

BACKGROUND: The bias toward immediate gratification is associated with maladaptive eating behaviors and has been cross-sectionally and prospectively related to obesity. Engaging in episodic future thinking, which involves mental self-projection to pre-experience future events, reduces this bias and energy intake in overweight/obese adults and children. To examine how episodic future thinking can be incorporated into clinical interventions, a Web-based system was created to provide training for adults and children in their everyday lives. OBJECTIVE: Our study examined the technical feasibility, usability, and acceptability of a Web-based system that is accessible by mobile devices and adapts episodic future thinking for delivery in family-based obesity interventions. METHODS: We recruited 20 parent-child dyads (N=40) from the surrounding community and randomized to episodic future thinking versus a nutritional information thinking control to test the feasibility of a 4-week Web-based intervention. Parents were 44.1 (SD 7.8) years of age with BMI of 34.2 (SD 6.8) kg/m(2). Children were 11.0 (SD 1.3) years of age with BMI percentile of 96.0 (SD 1.8). Families met weekly with a case manager for 4 weeks and used the system daily. Adherence was collected through the Web-based system, and perceived acceptance of the Web-based system was assessed postintervention. Measurements of body composition and dietary intake were collected at baseline and after the 4 weeks of intervention. RESULTS: All 20 families completed the intervention and attended all sessions. Results showed parents and children had high adherence to the Web-based system and perceived it to be easy to use, useful, and helpful. No differences between conditions were found in adherence for parents (P=.65) or children (P=.27). In addition, results suggest that basic nutrition information along with episodic future thinking delivered through our Web-based system may reduce energy intake and weight. CONCLUSIONS: We showed that our Web-based system is an accepted technology and a feasible utility. Furthermore, results provide initial evidence that our system can be incorporated into family-based treatments targeting behaviors related to weight control. These results show promising utility in using our Web-based system in interventions.

Episodic future thinking reduces delay discounting and energy intake in children.

Discounting of larger future rewards in favor of smaller immediate rewards is known as delay discounting. High delay discounting or a bias towards immediate gratification impedes self-regulation and is associated with maladaptive eating behaviors. Children in general show greater delay discounting than adults. Obese children in particular, have greater difficulty delaying gratification for edible rewards. Episodic future thinking (EFT) which is mental self-projection to pre-experience future events reduces delay discounting and reduces energy intake in overweight/obese adults. However, these EFT effects have not been examined in children. We evaluated the effects of EFT versus control episodic recent thinking (ERT) on delay discounting and ad libitum energy intake while thinking about episodic cues in 42 overweight/obese 9 to 14year olds. Results showed that EFT led to less delay discounting and lowered energy intake, and EFT had the greatest effect on reducing energy intake in children with a higher desire to restrict food intake. This suggests that EFT may be useful in pediatric obesity treatment programs to help children regulate energy intake.

Reducing variety enhances effectiveness of family-based treatment for pediatric obesity.

Basic research has shown that increasing variety increases energy intake, and repeated consumption of the same food increases habituation to those foods and reduces consumption. Twenty-four families with overweight/obese 8-12 year-old children and overweight/obese parents were randomly assigned to 6months of usual family based treatment (FBT) or FBT plus reduced variety of high energy-dense foods (FBT+Variety). Intention to treat mixed model ANOVA showed between group differences in child percent overweight (FBT+Variety-15.4% vs. FBT-8.9%, p=0.017) and parent BMI (FBT+Variety-3.7kg/m(2) vs. FBT-2.3kg/m(2); p=0.017). Positive relationships were observed between child zBMI and parent BMI changes (r=0.51, p=0.018), and between reductions in food variety of high energy-dense foods and reductions in child zBMI (r=0.54, p=0.02) and parent BMI (r=0.45, p=0.08). These pilot data suggest that reducing the variety of high energy dense foods and repeating meals within the context of FBT resulted in improved child and parent weight changes at six months. This represents easy to implement changes that reduce choice and may reduce response burden on families. Reducing variety may be a complement to standard FBT that enhances weight loss. Long term studies are needed to assess maintenance of these changes.

Cost-effectiveness of family-based group treatment for child and parental obesity.

BACKGROUND: Obesity runs in families, and family-based behavioral treatment (FBT) is associated with weight loss in overweight/obese children and their overweight/obese parents. This study was designed to estimate the costs and cost-effectiveness of FBT compared to separate group treatments of the overweight/obese parent and child (PC). METHODS: Fifty overweight/obese 8- to 12-year-old children with overweight/obese parents were randomly assigned to 12 months of either FBT or PC treatment program. Assessment of societal costs (payer plus opportunity costs) were completed based on two assumptions: (1) programs for parent and child were available on separate days (PC-1) or (2) interventions for parent and child were available in the same location at sequential times on the same day (PC-2). Cost-effectiveness was calculated based on societal cost per unit of change using percent overBMI for children and weight for parents. RESULTS: The average societal cost per family was $1,448 for FBT and $2,260 for PC-1 (p < 0.001) and $2,124 for PC-2 (p < 0.001). Child cost-effectiveness for FBT was $209.17/percent overBMI, compared to $1,036.50/percent overBMI for PC-1 and $973.98/percent overBMI for PC-2. Parent cost-effectiveness was $132.97/pound (lb) for FBT and $373.53/lb (PC-1) or $351.00/lb (PC-2). CONCLUSIONS: For families with overweight/obese children and parents, FBT presents a lower cost per unit of weight loss for parents and children than treating the parent and child separately. Given the high rates of pediatric and adult obesity, FBT may provide a unique cost-effective platform for obesity intervention that alters weight in overweight/obese parents and their overweight/obese children.

The future is now: comparing the effect of episodic future thinking on impulsivity in lean and obese individuals.

The choice of small immediate rewards as opposed to larger delayed rewards, or delay discounting, is an important dimension of impulsive decision making. The inability to delay gratification is related to obesity, as well as other maladaptive behaviors such as substance abuse, problem drinking, smoking, pathological gambling, and risky HIV behaviors. One way to reduce delay discounting (DD) may be to use prospective imagery in the form of episodic future thinking (EFT) during inter-temporal decision making. We have recently shown that EFT reduces DD and ad libitum energy intake in obese individuals. However, no studies have examined whether the magnitude of the EFT effect differs between lean and overweight/obese individuals. We conducted a within-subject design experiment to compare the efficacy of EFT versus a control task in reducing DD between lean (N=24) and overweight/obese (N=24) women. Participants attended two sessions in which they engaged in either EFT or control episodic thinking during a DD task. We also examined whether individual differences such as trait time perspective, behavioral inhibition or behavioral activation moderated the EFT effect on DD. Results showed EFT reduced DD similarly for lean and overweight/obese individuals. The EFT effect was moderated by behavioral activation. This suggests EFT is just as effective in reducing impulsive decision making in obese individuals as it is in lean individuals and may be useful in reducing other impulsive obesity related behaviors.

The built environment moderates effects of family-based childhood obesity treatment over 2 years.

BACKGROUND: Research suggests the neighborhood built environment is related to child physical activity and eating. PURPOSE: The purpose of this study was to determine if characteristics of the neighborhood environment moderate the relationship between obesity treatment and weight loss, and if outcomes of particular treatments are moderated by built environment characteristics. METHOD: The relationship between the built environment and standardized BMI (zBMI) changes for 191 8-12-year-old children who participated in one of four randomized, controlled trials of pediatric weight management was assessed using mixed models analysis of covariance. RESULTS: At 2-year follow-up, greater parkland, fewer convenience stores, and fewer supermarkets were associated with greater zBMI reduction across all interventions. No treatments interacted with characteristics of the built environment. CONCLUSIONS: Activity- and eating-related built neighborhood characteristics are associated with child success in behavioral obesity treatments. Efficacy may be improved by individualizing treatments based on built environment characteristics.

Reinforcement pathology and obesity.

Obesity is, in part, a result of positive energy balance or energy intake exceeding physiological needs. Excess energy intake is determined by a series of food choices over time. These choices involve both motivational and executive function processes. Problems arise when there is excessive motivation to eat and low impulse control, a situation we have termed reinforcement pathology. Motivational and executive function processes have also been implicated in the development of drug dependence and addiction. In this review we discuss the application of reinforcement pathology to obesity, and implications of this approach for obesity treatment.