The traces of imagination: early attention bias toward positively imagined stimuli.

Positively imagined activities may capture visual attention due to an increase in positive value. Increasing attention toward activities, in turn, may prove useful for clinical interventions aiming to motivate behavioral engagement. Employing a within-subject experimental design, we examined the effect of positive imagery on attention using a visual probe task with concurrent eye tracking. Adults from the general population (N = 54) imagined performing activities involving visually presented objects in a positive (focusing on the positive emotional impact) or neutral (focusing on a neutral circumstance) manner. They then completed a visual probe task using picture stimuli depicting one object per type of imagery. Positive compared to neutral imagery increased self-reported behavioral motivation and biased the direction, but not the duration, of gaze toward objects associated with the imagined activities. An exploratory analysis showed a positive association between the direction bias and depressive symptoms. Our findings build on existing literature on positive imagery as a motivational amplifier by highlighting early attention as an underlying cognitive mechanism.

Healthy cravings? Impact of imagined healthy food consumption on craving for healthy foods and motivation to eat healthily - Results of an initial experimental study.

Craving for high-calorie foods predicts consumption of high-calorie foods thereby contributing to unhealthy eating habits and, potentially in the long term, to the development of overweight, obesity, and eating disorder pathology. Thus, effective interventions tackling craving for unhealthy foods and motivating healthy eating behavior are needed. This initial study tested if an experimental mental imagery procedure could induce craving for healthy foods and increase the motivation to eat healthily. Participants (N = 82) were randomized to either a healthy craving mental imagery condition or to a neutral mental imagery control condition. Craving for healthy foods and motivation to eat healthily was assessed before and after the experimental manipulation via self-report. A (disguised) food choice for healthy versus unhealthy food was added as a behavioural measure at the end of the experiment. Repeated measures of variance analyses with time (pre vs. post experimental manipulation) and condition (healthy craving mental imagery versus neutral mental imagery) yielded significant interactions for healthy craving and motivation to eat healthily: Post-hoc tests showed that craving for healthy foods and motivation to eat healthily increased significantly after the experimental manipulation in the healthy craving mental imagery condition, but not in the neutral mental imagery condition. Results of this initial study suggest that an experimental mental imagery induction of craving for healthy food leads to an increase in healthy craving and motivation to eat healthily. Further experimental research is needed to rule out priming effects, to test the underlying mechanisms of this effect, and evaluate the potential of this mental imagery procedure in a clinical context.

The outcomes of mindfulness-based interventions for Obesity and Binge Eating Disorder: A meta-analysis of randomised controlled trials.

BACKGROUND: Mindfulness Based Interventions (MBIs) for weight loss and overeating-related behaviours have recently gained popularity. Previous systematic reviews and meta-analyses included studies of variable quality, which hinders interpretation of results. This meta-analysis examined only randomised controlled trials (RCTs) comparing the efficacy of MBIs with control groups primarily encouraging either dietary or exercise-based behavioural change in individuals with overweight/obesity and/or binge eating disorder (BED). METHODS: Using PRISMA guidelines, we systematically reviewed relevant articles in Medline, Psychinfo and EMBASE. Twelve eligible RCTs were identified, with three random-effects meta-analyses conducted on primary outcome measures of body mass (N = 11), mindfulness (N = 7) and BED symptoms (N = 3). RESULTS: MBIs were more efficacious than control in increasing mindfulness scores and decreasing BED symptoms from pre-to post-treatment. However, they were no more efficacious than control in reducing body mass which may be attributed to variability in the duration of interventions. Based on intervention duration, exploratory cumulative meta-analyses revealed that while shorter interventions (i.e., 6 weeks) showed greater reductions in body mass compared to longer interventions (i.e., 24 weeks), longer interventions led to greater improvements in mindfulness scores and BED symptoms. CONCLUSIONS: These results highlight the potential of MBIs to improve obesity-related behaviours compared to lifestyle interventions, but their effects on short-term weight loss remain unclear. Future research with a rigorous methodology should consider long-term follow-ups including body mass and mindfulness-related outcome measures in order to establish the clinical potential of MBIs.

Food-related attentional bias and its associations with appetitive motivation and body weight: A systematic review and meta-analysis.

Theoretical models suggest that food-related visual attentional bias (AB) may be related to appetitive motivational states and individual differences in body weight; however, findings in this area are equivocal. We conducted a systematic review and series of meta-analyses to determine if there is a positive association between food-related AB and: (1.) body mass index (BMI) (number of effect sizes (k) = 110), (2.) hunger (k = 98), (3.) subjective craving for food (k = 35), and (4.) food intake (k = 44). Food-related AB was robustly associated with craving (r = 0.134 (95% CI 0.061, 0.208); p < .001), food intake (r = 0.085 (95% CI 0.038, 0.132); p < .001), and hunger (r = 0.048 (95% CI 0.016, 0.079); p = .003), but these correlations were small. Food-related AB was unrelated to BMI (r = 0.008 (95% CI -0.020, 0.035); p = .583) and this result was not moderated by type of food stimuli, method of AB assessment, or the subcomponent of AB that was examined. Furthermore, in a between-groups analysis (k = 22) which directly compared participants with overweight/obesity to healthy-weight control groups, there was no evidence for an effect of weight status on food-related AB (Hedge's g = 0.104, (95% CI -0.050, 0.258); p = .186). Taken together, these findings suggest that food-related AB is sensitive to changes in the motivational value of food, but is unrelated to individual differences in body weight. Our findings question the traditional view of AB as a trait-like index of preoccupation with food and have implications for novel theoretical perspectives on the role of food AB in appetite control and obesity.

Same, same but different: Attention bias for food cues in adults and adolescents with anorexia nervosa.

OBJECTIVE: Attention processing for food may be biased in people with Anorexia Nervosa (AN). However, previous studies have had inconsistent results. This is likely to be due to indirect assessment of attention, which does not inform on the underlying attention processes, and/or the heterogeneity of participants across studies, testing either adults or adolescents with AN, that is, people at very different developmental and illness stages. METHOD: Eye-tracking was employed as a direct assessment of attention during a visual probe task with food versus non-food pictures. Attention bias for food was measured in 39 adults and 34 adolescents with AN and in 53 adults and 31 adolescents without AN. RESULTS: All participants had a direction bias for food, specifically for high-calorie food. However, adults with AN subsequently avoided maintaining attention on food versus non-food cues, compared to adults without AN. Adolescents with or without AN demonstrated increased attention maintenance on food versus non-food cues, and, contrary to our hypothesis, did not differ in their attention bias for food cues. Accordingly, adults with AN differed significantly from adolescents with AN in attention maintenance for food cues: while adolescents with AN showed significantly increased attention maintenance on food stimuli, adults avoided maintaining attention on food cues. DISCUSSION: Adults with AN may apply attention strategies to facilitate restrictive eating. This strategy is absent in adolescents with AN. This difference in food-related attention bias between adolescents and adults with AN suggests that attention biases develop over time as the illness progresses.

Dynamics of attentional bias for food in adults, children, and restrained eaters.

OBJECTIVE: Empirical evidence of attentional bias (AB) for food in obese and restrained eaters is contradictory. It has been suggested that AB for food in obese people might reflect both food craving and food-related concerns. Thus, AB for food may be a dynamic process. METHODS: A new computational methodology (Zvielli, Bernstein, & Koster, 2015) was adopted to reanalyze the reaction time (RT) and dwell time of three food-related dot-probe task with eye-tracking studies (Werthmann et al., 2015; Werthmann et al., 2011, 2013). This new computing method uses a sequence of bias scores to express the dynamic changes of AB. Moreover, the variability of RT on filler trials was also calculated. The critical groups in these studies were overweight/obese adults, obese children, and healthy-weight restrained eaters. RESULTS: Both the variability of AB for food stimuli and the variability of RT on filler could significantly predict the variance in body mass index (BMI). When controlling for the variability of RT on filler trials and mean AB score, larger variability of AB for food stimuli still existed in obese children and aggregated dataset. The variability of AB for food stimuli demonstrated no significant correlation with restrained eating scores and dwell time variability. CONCLUSIONS: Overweight/obese individuals are characterized by more variability in attention, and this variability is mainly unspecific. It probably reflects less effective executive control ability.

Test-retest reliability of attention bias for food: Robust eye-tracking and reaction time indices.

This study assessed internal reliability and test-retest reliability of attention bias scores for food derived from the dot probe task. A visual dot probe task with food and non-food pictures (presented for 3000 ms) was administered to 53 healthy women on two occasions. Attention bias scores for food were calculated based on manual response latencies (reaction time bias) and concurrent assessment of eye-movements (direction bias and dwell-time bias). Subjective hunger and blood glucose levels were measured on both testing occasions. Dietary restraint and eating disorder symptoms were assessed during the second session. Results showed that direction bias had poor internal and test-retest reliability. Dwell time bias had excellent internal and acceptable test-retest reliability. Reaction time bias had acceptable internal and good test-retest reliability. Exploratory correlational analyses found that hunger, blood glucose, dietary restraint and eating disorder symptoms were not consistently significantly correlated with indices of attention bias for food. Overall, these findings contradict previous studies that reported low reliability of attention bias indices derived from the visual dot probe task. The implications are that a longer stimulus presentation time (i.e. ≥ 3000 ms), the use of eye-tracking and the use of appetizing stimuli can yield reliable attention bias scores for food. However, the interpretation of dot-probe scores of attention bias for food based on a dot probe task with 3000 ms presentation time and the score's relationship to theoretically relevant constructs such as hunger, eating restraint and eating disorder symptoms, require further clarification.

Make up your mind about food: A healthy mindset attenuates attention for high-calorie food in restrained eaters.

Attention bias for food could be a cognitive pathway to overeating in obesity and restrained eating. Yet, empirical evidence for individual differences (e.g., in restrained eating and body mass index) in attention bias for food is mixed. We tested experimentally if temporarily induced health versus palatability mindsets influenced attention bias for food, and whether restrained eating moderated this relation. After manipulating mindset (health vs. palatability) experimentally, food-related attention bias was measured by eye-movements (EM) and response latencies (RL) during a visual probe task depicting high-calorie food and non-food. Restrained eating was assessed afterwards. A significant interaction of mindset and restrained eating on RL bias emerged, ß = 0.36, t(58) = 2.05, p = 0.045: A health mindset - as compared to a palatability mindset - attenuated attention bias for high-caloric food only in participants with higher eating restraint. No effects were observed on EM biases. The current results demonstrate that state differences in health versus palatability mindsets can cause attenuated attention bias for high-calorie food cues in participants with higher eating restraint. Our findings add to emerging evidence that state differences in mindsets can bias attention for food, above the influence of trait differences.

Bits and pieces. Food texture influences food acceptance in young children.

BACKGROUND: Picky or fussy eating is common in early childhood and associated with a decreased preference for a variety of foods. The aim of the current study was to test experimentally which sensory food feature influences food acceptance, which, in turn is an indication for fussy eating, in young children (32 - 48 months). Another aim was to evaluate if the behavioural measurement of food acceptance is related to parental reports of their child's fussy eating behaviour, parental feeding styles and children's BMI. METHOD: In a repeated-measures-design, three sensory features were manipulated separately (i.e., colour, texture and taste) while keeping the other two features constant. The baseline measurement consisted of a well-liked yoghurt, which was presented before each manipulation variant. The number of spoons that children (N = 32) consumed from each variant were registered as behavioural indication for food acceptance. Parental reports of children's eating behaviour and parental feeding styles; and children's BMI were also measured. RESULTS: The manipulation of food texture caused a significant decrease in intake. Colour and taste manipulations of the yoghurt did not affect children's intake. Parental reports of children's fussy eating behaviour and parental feeding styles were not related to the behavioural observation of food acceptance. The behavioural measurement of food acceptance and parental accounts of fussy eating were not related to children's BMI. CONCLUSION: Food texture but not taste or colour alternations affected food acceptance, at least when consuming variations of a well-liked yoghurt. This knowledge is important for further research on picky-eating interventions. Parental reports of fussy eating did not concur with the behavioural observation of food acceptance. Further research is warranted to test whether these findings generalize to other food types.

Desire lies in the eyes: attention bias for chocolate is related to craving and self-endorsed eating permission.

The present study tested the impact of experimentally manipulated perceived availability of chocolate on attention for chocolate stimuli, momentary (state) craving for chocolate and consumption of chocolate in healthy weight female students. It was hypothesized that eating forbiddance would be related to attentional avoidance (thus diminished attention focus on food cues in an attempt to prevent oneself from processing food cues) and that eating motivation would be related to attentional approach (thus maintained attentional focus on food cues). High chronic chocolate cravers (n=40) and low cravers (n=40) participated in one of four perceived availability contexts (required to eat, forbidden to eat, individual choice to eat, and 50% chance to eat) following a brief chocolate exposure. Attention for chocolate was measured using eye-tracking; momentary craving from self-report; and the consumption of chocolate was assessed from direct observation. The perceived availability of chocolate did not significantly influence attention allocation for chocolate stimuli, momentary craving or chocolate intake. High chocolate cravers reported significantly higher momentary craving for chocolate (d=1.29, p<.001), and showed longer initial duration of gaze on chocolate, than low cravers (d=0.63, p<.01). In contrast, participants who indicated during the manipulation check that they would not have permitted themselves to eat chocolate, irrespective of the availability instruction they received, showed significantly less craving (d=0.96, p<.01) and reduced total dwell time for chocolate stimuli than participants who permitted themselves to eat chocolate (d=0.53, p<.05). Thus, this study provides evidence that attention biases for food stimuli reflect inter-individual differences in eating motivation--such as chronic chocolate craving, and self-endorsed eating permission.

A randomised controlled feasibility study of food-related computerised attention training versus mindfulness training and waiting-list control for adults with overweight or obesity: the FOCUS study.

BACKGROUND: In a feasibility randomised controlled trial in people with overweight/obesity with and without binge eating disorder (BED) symptoms, we assessed eight weekly sessions of attention bias modification training (ABMT) and mindfulness training (MT) versus waiting list (WL) and explored potential mechanisms. METHODS: 45 participants were randomly allocated to one of three trial arms. Primary outcomes were recruitment, retention and treatment adherence rates. Secondary outcomes included measures of eating behaviour, mood, attention and treatment acceptability. Assessments were conducted at baseline, post-intervention (week 8), and follow-up (week 12). RESULTS: Participant retention at follow-up was 84.5% across groups. Session completion rates in the laboratory were 87% for ABMT and 94% for MT, but home practice was much poorer for ABMT. Changes in BMI and body composition were small between groups and there was a medium size BMI reduction in the MT group at follow-up. Effect sizes of eating disorder symptom changes were not greater for either intervention group compared to WL, but favoured ABMT compared to MT. Hedonic hunger and mindful eating scores favoured MT compared to ABMT and WL. ABMT reduced attention biases towards high-calorie food cues, which correlated with lower objective binge eating days at post-intervention. No significant changes were observed in the MT, or WL conditions. CONCLUSIONS: Both ABMT and MT have potential value as adjuncts in the treatment of obesity and BED, and a larger clinical trial appears feasible and indicated. TRIAL REGISTRATION: ISRCTN Registry, ISRCTN15745838. Registered on 22 May 2018.

In this small research study, people who were classified as overweight or living with obesity (with or without symptoms of binge eating disorder) received either a mindfulness intervention, a "subconscious" attention-based intervention called attention bias modification training (ABMT) or were put on a waiting list for 8 weeks. People in the mindfulness group experienced improvements in emotional eating, mindful eating, and "impulsive" eating. Those who received the attention-based training paid less attention to highly caloric food after the intervention which correlated with fewer binge eating episodes. Results from this study suggest that both types of interventions have potential as add-on treatments for obesity and binge eating disorder, but larger studies are necessary to assess their clinical impact.

Mirror Exposure Training for Adolescents With Anorexia Nervosa (MIRADAN): Cognitive Mechanisms of Body Disturbance - A Study Protocol.

Background: Anorexia Nervosa (AN) is a severe mental illness, which typically develops in adolescence and, if left untreated, often becomes chronic. Body dissatisfaction is a core characteristic of AN. Mirror exposure (ME) is an effective therapeutic technique to tackle body dissatisfaction in adult patients with eating disorders, but there is limited evidence for the effects of ME in adolescence. One potential mechanism underlying effects of ME on body dissatisfaction is change in body-related attention bias. However, this mechanism remains to be empirically tested. Accordingly, the aim of the current study is twofold: primarily, we aim to test if ME can reduce body dissatisfaction and associated symptoms in adolescent patients with AN. Additionally, we aim to investigate whether change in biased body-related attention due to ME is a possible mechanism of action. Method: Adolescent patients with AN are randomized to either 12 sessions of ME (3 ME-sessions/week) or wait-list within four weeks. Main outcomes include body dissatisfaction and associated symptoms of AN. Moreover, body-related attention bias is assessed at baseline and post-treatment by means of eye-tracking with two paradigms. Further, process variables are collected weekly. In addition, 12 weeks after end of the study, the acceptability of the ME is assessed. Discussion: The main aim of the study is to evaluate high-frequency and high-intense ME for treating body dissatisfaction in adolescents with AN. In addition, we would like to clarify whether change in attentional bias for body stimuli is a mechanism underlying change in body dissatisfaction due to ME.

Skill Improvement Through Learning in Therapy (SKILT): A Study Protocol for a Randomized Trial Testing the Direct Effects of Cognitive Behavioral Therapy Skill Acquisition and Role of Learning Capacity in Depression.

Background: To improve psychological treatments for major depressive disorder (MDD), a better understanding on how symptoms ameliorate during treatment is essential. In cognitive behavioral therapy (CBT), it is unclear whether procedures focused on the acquisition of CBT skills play a causal role in the improvement of CBT skills. In this randomized trial, we isolate a single CBT Skill Acquisition Procedure (CBTSAP) and test its direct effects on CBT skills and related therapy processes (i.e., change in (idiosyncratic) dysfunctional thinking and reward processing). We hypothesize that the CBTSAP causes improvements in CBT skills and related therapy processes compared to an active control condition. In addition, we hypothesize that individual differences in attentional bias and memory functioning (defined as learning capacity) moderate the effects of CBTSAP on outcomes and that using mental imagery as a cognitive support strategy to strengthen the effects of the CBTSAP will be most beneficial for patients with low learning capacity. Method: 150 patients with MDD will be randomized to one of three conditions: 1. an active control condition, 2. CBTSAP, 2. CBTSAP plus mental imagery, all consisting of three sessions. Primary outcomes will be change in CBT skills, changes in (idiosyncratic) dysfunctional thoughts and behaviors, reward processing. Depressive symptoms are a secondary outcome. Measures of learning capacity will be conducted at baseline and tested as a potential moderator. Discussion: Knowing whether and for whom the acquisition of CBT skills leads to change in therapy processes and a subsequent reduction of depressive symptoms will inform on how to personalize and optimize psychotherapy outcomes for depression. Trial registration: The trial is registered at the German Clinical Trial Register (DKTR; registration number: DRKS00024116).

Body Exposure, its Forms of Delivery and Potentially Associated Working Mechanisms: How to Move the Field Forward.

Background: Body image disturbance (BID) is a hallmark feature of eating disorders (EDs) and has proven to be involved in their etiology and maintenance. Therefore, the targeting of BID in treatment is crucial, and has been incorporated in various treatment manuals. One of the most common techniques in the treatment of BID is body exposure (BE), the confrontation with one's own body. BE has been found to be effective in individuals with EDs or high body dissatisfaction. However, BE is applied in a multitude of ways, most of which are based on one or a combination of the hypothesized underlying working mechanisms, with no differential effectiveness known so far. Method: The aim of this paper is to selectively review the main hypothesized working mechanisms of BE and their translation into therapeutic approaches. Results and Conclusion: Specifically, we underline that studies are needed to pinpoint the proposed mechanisms and to develop an empirically informed theoretical model of BE. We provide a framework for future studies in order to identify working mechanisms and increase effectiveness of BE.

Prospective Mental Imagery in Depression: Impact on Reward Processing and Reward-Motivated Behaviour.

Background: Mental imagery has long been part of cognitive behavioural therapies. More recently, a resurgence of interest has emerged for prospective mental imagery, i.e. future-directed imagery-based thought, and its relation to reward processing, motivation and behaviour in the context of depression. Method: We conducted a selective review on the role of prospective mental imagery and its impact on reward processing and reward-motivated behaviour in depression. Results: Based on the current literature, we propose a conceptual mechanistic model of prospective mental imagery. Prospective mental imagery of engaging in positive activities can increase reward anticipation and reward motivation, which can transfer to increased engagement in reward-motivated behaviour and more experiences of reward, thereby decreasing depressive symptoms. We suggest directions for future research using multimodal assessments to measure the impact of prospective mental imagery from its basic functioning in the lab to real-world and clinical implementation. Conclusion: Prospective mental imagery has the potential to improve treatment for depression where the aim is to increase reward-motivated behaviours. Future research should investigate how exactly and for whom prospective mental imagery works.

Study protocol of a randomised controlled feasibility study of food-related computerised attention training versus mindfulness training and waiting-list control for adults with overweight or obesity.

BACKGROUND: Obesity is a highly prevalent condition with multiple adverse health consequences. Widely available first-line treatments for obesity, such as dietary and other lifestyle interventions, typically have only short-term effects. Thus, new treatment approaches are needed. Novel interventions such as Attention Bias Modification Training (ABMT) and mindfulness-based interventions focus on modifying different maladaptive cognitive patterns typically present in people with obesity (e.g. attention bias to food cues); however, their mechanisms of action remain largely unknown. We describe the theoretical basis and the rationale for a study protocol of a feasibility randomised controlled trial (RCT) comparing two attention trainings (ABMT vs Mindfulness Training [MT]) in people with overweight or obesity. The aim of this study is to inform the development of a large-scale RCT in relation to acceptability and attendance rates and to identify preliminary evidence for the interventions' clinical efficacy and potential underlying mechanisms. DESIGN: Forty-five adults who are either overweight or obese (minimum body mass index of 25 kg/m2) will be randomly allocated to receive eight sessions over eight weeks of either computerised ABMT or MT or be on a waiting list. Clinical and cognitive outcomes will be assessed at baseline, post-treatment (8 weeks) and follow-up (12 weeks post-randomisation). These include mood, body composition and attention biases. Credibility and acceptability of the trainings will be assessed using questionnaires, and recruitment and retention rates will be recorded. DISCUSSION: Findings will inform the feasibility of developing a large-scale RCT that takes into consideration effect sizes for primary outcome measures and the acceptability of the design. The study will also provide preliminary evidence on the clinical efficacy of two different attention trainings for people with obesity and associated underlying mechanisms. TRIAL REGISTRATION: ISRCTN Registry, ISRCTN15745838. Registered on 22 May 2018.

Food related attention bias modification training for anorexia nervosa and its potential underpinning mechanisms.

Treatment outcomes in anorexia nervosa (AN) remain suboptimal, evidencing the need for better and more targeted treatments. Whilst the aetiology of AN is complex, cognitive processes such as attention bias (AB) have been proposed to contribute to maintaining food restriction behaviour. Attention bias modification raining (ABMT) has been investigated in other eating disorders (EDs) such as binge eating disorder (BED) as a means of modifying AB for food and of changing eating behaviour. Promising findings have been reported, but the mechanisms underlying ABMT are poorly understood. We hypothesise that in AN, ABMT has the potential to modify maladaptive eating behaviours related to anxiety around food and eating and propose two mechanistic models; (1) ABMT increases general attentional control (which will improve control over disorder-relevant thoughts) or (2) ABMT promotes stimulus re-evaluation. In this second case, the effects of ABMT might arise via changes in the subjective value of food stimuli (i.e. reward processing) or via habituation, with both resulting in a reduced threat response. Investigating the clinical potential of ABMT in AN holds the promise of a novel, evidence-based adjunctive treatment approach. Importantly, understanding ABMT's underlying mechanisms will help tailor treatment protocols and improve understanding of the cognitive characteristics of AN and other EDs.

Dutch courage? Effects of acute alcohol consumption on self-ratings and observer ratings of foreign language skills.

AIMS: A popular belief is that alcohol improves the ability to speak in a foreign language. The effect of acute alcohol consumption on perceived foreign language performance and actual foreign language performance in foreign language learners has not been investigated. The aim of the current study was to test the effects of acute alcohol consumption on self-rated and observer-rated verbal foreign language performance in participants who have recently learned this language. METHODS: Fifty native German speakers who had recently learned Dutch were randomized to receive either a low dose of alcohol or a control beverage that contained no alcohol. Following the experimental manipulation, participants took part in a standardized discussion in Dutch with a blinded experimenter. The discussion was audio-recorded and foreign language skills were subsequently rated by two native Dutch speakers who were blind to the experimental condition (observer-rating). Participants also rated their own individual Dutch language skills during the discussion (self-rating). RESULTS: Participants who consumed alcohol had significantly better observer-ratings for their Dutch language, specifically better pronunciation, compared with those who did not consume alcohol. However, alcohol had no effect on self-ratings of Dutch language skills. CONCLUSIONS: Acute alcohol consumption may have beneficial effects on the pronunciation of a foreign language in people who have recently learned that language.

Randomised controlled feasibility trial of real versus sham repetitive transcranial magnetic stimulation treatment in adults with severe and enduring anorexia nervosa: the TIARA study.

OBJECTIVE: Treatment options for severe, enduring anorexia nervosa (SE-AN) are limited. Non-invasive neuromodulation is a promising emerging intervention. Our study is a feasibility randomised controlled trial of repetitive transcranial magnetic stimulation (rTMS) in individuals with SE-AN, which aims to inform the design of a future large-scale trial. DESIGN: Double-blind, parallel group, two-arm, sham-controlled trial. SETTING: Specialist eating disorders centre. PARTICIPANTS: Community-dwelling people with anorexia nervosa, an illness duration of ≥3 years and at least one previous completed treatment. INTERVENTIONS: Participants received 20 sessions (administered over 4 weeks) of MRI-guided real or sham high-frequency rTMS to the left dorsolateral prefrontal cortex in addition to treatment-as-usual. OUTCOMES: Primary outcomes were recruitment, attendance and retention rates. Secondary outcomes included body mass index (BMI), eating disorder symptoms, mood, quality of life and rTMS safety and tolerability. Assessments were conducted at baseline, post-treatment and follow-up (ie, at 0 month, 1 month and 4 months post-randomisation). RESULTS: Thirty-four participants (17 per group) were randomly allocated to real or sham rTMS. One participant per group was withdrawn prior to the intervention due to safety concerns. Two participants (both receiving sham) did not complete the treatment. rTMS was safe and well tolerated. Between-group effect sizes of change scores (baseline to follow-up) were small for BMI (d=0.2, 95% CI -0.49 to 0.90) and eating disorder symptoms (d=0.1, 95% CI -0.60 to 0.79), medium for quality of life and moderate to large (d=0.61 to 1.0) for mood outcomes, all favouring rTMS over sham. CONCLUSIONS: The treatment protocol is feasible and acceptable to participants. Outcomes provide preliminary evidence for the therapeutic potential of rTMS in SE-AN. Largest effects were observed on variables assessing mood. This study supports the need for a larger confirmatory trial to evaluate the effectiveness of multi-session rTMS in SE-AN. Future studies should include a longer follow-up period and an assessment of cost-effectiveness. TRIAL REGISTRATION NUMBER: ISRCTN14329415; Pre-results.