High-definition turns timing-dependent: Different behavioural consequences during and following cathodal high-definition transcranial direct current stimulation (HD tDCS) in a magnitude classification task.

Neuromodulation with transcranial direct current stimulation (tDCS) can transiently alter neural activity, but its spatial precision is low. High-definition (HD) tDCS was introduced to increase spatial precision by placing additional electrodes over the scalp. Initial evaluations of HD tDCS indicated polarity-specific neurophysiological effects-similar to conventional tDCS albeit with greater spatial precision. Here, we compared the effects of cathodal tDCS or HD tDCS in a 4 × 1 configuration over prefrontal cortex (PFC) regions on behavioural outcomes in a magnitude classification task. We report results on overall performance, on the numerical distance effect as a measure of numerical processing, and on the spatial-numerical associations of response codes (SNARC) effect, which was previously affected by prefrontal tDCS. Healthy volunteers (n = 68) received sham or cathodal HD tDCS at 1 mA over the left dorsolateral prefrontal cortex (DLPFC) or the left inferior frontal gyrus (IFG). Results were compared to an identical protocol with conventional cathodal tDCS to the left PFC versus sham (n = 64). Mixed effects models showed performance gains relative to sham tDCS in all conditions after tDCS (i.e. 'offline'), whereas montages over PFC and DLPFC already showed performance gains during tDCS (i.e. 'online'). In contrast to conventional tDCS, HD tDCS did not reduce the SNARC effect. Neither condition affected numerical processing, as expected. The results suggest that HD tDCS with cathodal polarity might require further adjustments (i.e. regarding tDCS intensity) for effective modulations of cognitive-behavioural performance, which could be achieved by individualised current density in electric field modelling.

Regional specificity of cathodal transcranial direct current stimulation effects on spatial-numerical associations: Comparison of four stimulation sites.

Neuromodulation with transcranial direct current stimulation (tDCS) is an increasingly popular research tool to experimentally manipulate cortical areas and probe their causal involvements in behavior, but its replicability and regional specificity are not clear. This registered report investigated cathodal tDCS effects on spatial-numerical associations (i.e., the SNARC effect), the numerical distance effect (NDE), and inhibitory control (i.e., stop-signal reaction time; SSRT). Healthy adults (N = 160) were randomly assigned to one of five groups to receive sham tDCS or 1 mA cathodal tDCS to one of four stimulation sites (left/right prefrontal cortex [PFC], left/right posterior parietal cortex) with extracephalic return. We replicated that cathodal tDCS over the left PFC reduced the SNARC effect compared to sham tDCS and to tDCS over the left parietal cortex. However, neither NDE nor SSRT were modulated in the main analyses. Post hoc contrasts and exploratory analyses showed that cathodal tDCS over the right PFC had a time-dependent effect by delayed practice-related improvements in SSRT. Math anxiety moderated changes in the NDE in the groups receiving tDCS to the right parietal cortex. With few exceptions, the replicability and regional specificity of tDCS effects on behavior were weak and partially moderated by individual differences. Future research needs to characterize the parameter settings for effective neuromodulation.

Modifying biased attention towards food stimuli in binge eating disorder: A multi-session training study.

Individuals with binge eating disorder (BED) exhibit a biased attention towards food stimuli. Against this backdrop, the present study with pre-registered design (ID: DRKS00012984) tested whether (a) a training designed to reduce attentional food processing indeed modifies this bias, (b) this reduction is evident in several measures of food-related attention and (c) this is associated with reductions in craving, binge frequency over the past 28 days and calories eaten in a laboratory based bogus taste test. Individuals with BED were randomly allocated to four sessions of either an attentional bias modification training (ABMT; n = 39) or a comparable no-modification control training (CT; n = 27). In all measures assessed via eye-tracking - dwell time bias, dwell time bias variability and first fixation bias - food-related bias decreased in the ABMT relative to the CT. Against our hypothesis, no differential between-group effects were found for reaction time (RT) bias and its variability as well as for calories consumed in a bogus taste test. By contrast, reductions in binge frequency and subjective craving were found for both groups. Taken together, the tendency to preferentially process food seems a modifiable phenomenon in individuals with BED. However, modifying this selective viewing pattern does not seem a prerequisite for a successful reduction of binge frequency.

Persistent avoidance of virtual food in anorexia nervosa-restrictive type: Results from motion tracking in a virtual stopping task.

OBJECTIVE: Food avoidance is central to patients with anorexia nervosa-restrictive type (AN-R). Competing accounts in experimental psychopathology research suggest that food avoidance may result from automatic, habitual responses or from elevated inhibitory control abilities. This study investigated behavioral trajectories of food avoidance in a novel virtual reality stopping task. METHOD: Sixty patients with AN-R and 29 healthy controls with normal weight were investigated using a novel, kinematic task in virtual reality. We recorded spatial displacement in stop- and go-trials to virtual food and control objects. Inhibitory control abilities were operationalized by the VR task in stopping performance (i.e., interrupted movement in stop-trials), whereas we also measured habitual avoidance of virtual food across both go- and stop-trials (i.e., delayed movement relative to nonfood objects). RESULTS: In patients with AN-R, hand displacements were shorter to food versus nonfood across stop- and go-trials, reflected in a Stimulus × Group interaction. Healthy controls showed no differences. Importantly, the food-specific effect in AN-R was identical across stop- and go-trials, indicating habitual food avoidance. Moreover, stop error rates (i.e., stop-trials with response) were lower in patients with AN-R. DISCUSSION: The findings suggest food-specific habitual avoidance and heightened generalized inhibitory control in AN-R. The continuously delayed displacements during active hand movements across stop- and go-trials indicated the persistence of patients' avoidance of food. PUBLIC SIGNIFICANCE: Experimental research investigates the mechanisms underlying mental disorders such as anorexia nervosa. In this study, we measured interrupted hand movements in response to food pictures or neutral pictures (shoes) in patients with anorexia nervosa and healthy controls. A virtual reality scenario was used. Findings indicated that patients were slower at approaching food, interrupted or not. Key mechanisms of food avoidance can be translated into habit-based treatment options in future research.

Modal and amodal cognition: an overarching principle in various domains of psychology.

Accounting for how the human mind represents the internal and external world is a crucial feature of many theories of human cognition. Central to this question is the distinction between modal as opposed to amodal representational formats. It has often been assumed that one but not both of these two types of representations underlie processing in specific domains of cognition (e.g., perception, mental imagery, and language). However, in this paper, we suggest that both formats play a major role in most cognitive domains. We believe that a comprehensive theory of cognition requires a solid understanding of these representational formats and their functional roles within and across different domains of cognition, the developmental trajectory of these representational formats, and their role in dysfunctional behavior. Here we sketch such an overarching perspective that brings together research from diverse subdisciplines of psychology on modal and amodal representational formats so as to unravel their functional principles and their interactions.

Practice makes perfect: Restrained eaters' heightened control for food images.

OBJECTIVE: Restrained eaters (RE) show behaviourally unregulated food intake, which is often explained by a deficit in inhibitory control. Despite evidence for general inhibitory deficits in RE, it remains unclear how the variety of (food) cues in our environment can influence cognitive control. METHOD: In this re-analysis, we explored the inhibitory capacity of RE and unrestrained eaters (URE) on a stop-signal task with modal (pictures) and amodal (word) food and non-food stimuli. RESULTS: Although we did not find the expected inhibitory deficits in RE compared to URE, we found a significant Group × Modality × Stimulus Type interaction. This indicated that RE have relatively good inhibitory control for food, compared to non-food modal cues, and that this relationship is reversed for amodal cues. CONCLUSIONS: Hence, we showed differential processing of information based on food-specificity and presentation format in RE. The format of food cues is thus an important new avenue to understand how the food environment impedes those struggling with regulating their eating behaviour.

Body Dissatisfaction Directs Avatar Perception: Embodiment and Selective Visual Attention in Body Mass-Modified Self-Avatars.

Human agents immersed in metaverse technologies such as virtual reality (VR) are routinely disconnected from their actual physical appearance and embodied in another virtual body, referred to as self-avatar. Such body transformations can have implications for patients with eating disorders, or persons with extreme body dissatisfaction (BD). Changes in BD, weight anxiety, or body image are theoretically linked to visual selective attention, which can be measured with eye tracking. In the present study, 43 women with high or low BD were immersed in animated body weight-manipulated self-avatars in VR. Before a brief mirror exposure with their self-avatars, they experienced synchronous visuomotor and visuo-tactile contingencies in VR to increase embodiment, delivered through small movement exercises with real-time animation from first-person perspective and passive haptics. In a crossover study design, self-avatar weight was manipulated (normal weight vs. overweight) in both groups (low BD vs. high BD), and subjective experience was assessed before and after exposure. In contrast to our hypotheses, BD was not affected by the self-avatar condition. Embodiment decreased during mirror exposure, possibly due to the avatars wearing head-mounted displays. Interestingly, disembodiment was stronger in women with low BD. Furthermore, eye tracking showed that participants with high BD looked longer at weight-related body parts when immersed in the overweight self-avatar, whereas participants with low BD looked longer at weight-related body parts when immersed in the normal weight self-avatar. Overall, the results support body-specific visual attention and suggest that particularly participants with low BD show stronger disembodiment during self-avatar mirror exposure, possibly alleviating momentary body experience. Preregistration: https://doi.org/10.23668/psycharchives.4949.

Does inhibitory control spill over to eating behaviors? Two preregistered studies of inhibitory spillover effects on food intake and reactions to food stimuli.

Overweight and obesity are worldwide conditions associated with detrimental medical and psychosocial outcomes. As inhibitory control deficits are thought to contribute to weight gain, they are a worthwhile target for new approaches. Previous research has shown that the execution of inhibitory control in one domain leads to a concurrent increase of inhibitory control in another domain, an effect denoted as inhibitory spillover effect (ISE). Therefore, we assumed that exertion of inhibitory control in a food-unrelated domain in overweight and normal weight individuals will decrease food intake in a simultaneous bogus taste test (BTT; study 1) as well as increase food-specific response inhibition ability in a stop signal task (SST; study 2). We assumed stronger effects in overweight individuals. In both studies ISE was induced via cognitive priming and compared to a neutral condition in a group of overweight (OW: n = 46 for study 1, n = 46 for study 2) and normal weight (NW: n = 46 for study 1, n = 46 for study 2) individuals. In the ISE condition with an inhibitory control priming task, participants had to learn and retain control-related words while simultaneously performing a BTT (study 1) or SST (study 2). In the neutral condition, participants followed the same protocol, albeit memorizing neutral (i.e., control-unrelated) words. There was no significant interaction of weight group × cognitive priming condition neither regarding food intake (study 1) nor regarding food-related response inhibition (study 2). Cognitive priming, as implemented in the present studies, does not instigate an ISE strong enough to improve inhibitory control during food intake or food-related response inhibition. Relevant practical and theoretical aspects as well as implications for future research on the ISE are discussed.

Application of the National Comprehensive Cancer Network-distress thermometer in pediatric patients during autologous and allogeneic hematopoietic stem cell transplantation and relationship to blood parameters of the stress axis.

PURPOSE: Hematopoietic stem cell transplantations (HSCT) are extremely stressful procedures for pediatric patients. The activation of the hypothalamic pituitary adrenocortical axis (HPA) can influence the immune system negatively and therefore the overall outcome. The distress thermometer (DT) is an easy to use tool for the self-assessment of perceived distress. METHODS: In this prospective study, a DT with an attached problem list was used in 40 pediatric patients undergoing HSCT and in one parent of each patient. The patients were aged 10-18 years. The patients' cortisol, thyroid stimulating hormone, free triiodothyronine and thyroxine levels were measured regularly during the in-patient stay. RESULTS: After admission to the hospital, the stress levels of the pediatric patients and their parents increased and reached their maximum on the day of HSCT. The overall stress values of the parents were higher than those of their children. There was a significant difference in the parents' stress levels on the day of HSCT, as compared to their stress levels on other days. The mean cortisol values of the pediatric patients also increased after admission, reaching significant elevated levels above the upper normal limit 1 week after HSCT and on discharge day. Although the pediatric patients experienced mainly exhaustion, especially on the day of transplantation, their parents mainly felt worry and anxiety. Interestingly, the rate of worry among children increased in the post-transplant period and reached its maximum on the day of discharge. CONCLUSIONS: In summary, a significantly increased stress level is shown for both the patients and their parents. This is reflected for the patients both in the DT scores and in the increased cortisol values. For the parents, the focus is primarily on worry and anxiety, for the patients primarily on exhaustion and worry.

Reliability of gamified reinforcement learning in densely sampled longitudinal assessments.

Reinforcement learning is a core facet of motivation and alterations have been associated with various mental disorders. To build better models of individual learning, repeated measurement of value-based decision-making is crucial. However, the focus on lab-based assessment of reward learning has limited the number of measurements and the test-retest reliability of many decision-related parameters is therefore unknown. In this paper, we present an open-source cross-platform application Influenca that provides a novel reward learning task complemented by ecological momentary assessment (EMA) of current mental and physiological states for repeated assessment over weeks. In this task, players have to identify the most effective medication by integrating reward values with changing probabilities to win (according to random Gaussian walks). Participants can complete up to 31 runs with 150 trials each. To encourage replay, in-game screens provide feedback on the progress. Using an initial validation sample of 384 players (9729 runs), we found that reinforcement learning parameters such as the learning rate and reward sensitivity show poor to fair intra-class correlations (ICC: 0.22-0.53), indicating substantial within- and between-subject variance. Notably, items assessing the psychological state showed comparable ICCs as reinforcement learning parameters. To conclude, our innovative and openly customizable app framework provides a gamified task that optimizes repeated assessments of reward learning to better quantify intra- and inter-individual differences in value-based decision-making over time.

Impact of a mental training program for pediatric cancer patients after allogeneic hematopoietic stem cell transplantation or high-dose chemotherapy - Results of a randomized controlled trial.

OBJECTIVES: Hematopoietic stem cell transplantation (HSCT) or intensive chemotherapy for the treatment of malignant diseases is a highly distressing experience. The affected person's resilience is crucial to coping with this challenging experience. Experience with resilience-enhancing interventions in children and young adults during cancer therapy is scarce. The major objective of this work was developing and evaluating an effective psycho-oncological mental training that complements the standard psychosocial care. METHODS: In this prospective, randomized single-center study, a total of 30 patients (12 to 22 years of age) who underwent HSCT or high-dose chemotherapy received either the standard psychosocial care (control group [CG]) or additionally underwent a novel and specifically developed resilience-enhancing 14-session mental training (therapy group [TG]). The patients were observed over an 8-month period and were screened for distress, thyroid, and immune function parameters, as well as generalized anxiety, affect, and sports orientation. RESULTS: Patients of the TG showed significantly greater improvements in all assessed mental aspects, including anxiety, affect, competitiveness, win orientation, goal orientation, self-optimization, self-blocking, and loss of focus, as well as cortisol levels within 8 months, as opposed to patients of the CG (effect size range ξ: 0.74-1.00). SIGNIFICANCE OF RESULTS: Patients who underwent the mental training displayed less anxiety, better affect, and improved mental performance with less self-blocking. This resulted in improved goal orientation, competitiveness, self-optimization, and focus when compared to the CG patients. However, larger prospective trials are necessary to substantiate these findings.

Body exposure and vocal analysis: validation of fundamental frequency as a correlate of emotional arousal and valence.

Introduction: Vocal analysis of fundamental frequency (f0) represents a suitable index to assess emotional activation. However, although f0 has often been used as an indicator of emotional arousal and different affective states, its psychometric properties are unclear. Specifically, there is uncertainty regarding the validity of the indices of f0mean and f0variabilitymeasures (f0dispersion, f0range, and f0SD) and whether higher or lower f0 indices are associated with higher arousal in stressful situations. The present study therefore aimed to validate f0 as a marker of vocally encoded emotional arousal, valence, and body-related distress during body exposure as a psychological stressor. Methods: N = 73 female participants first underwent a 3-min, non-activating neutral reference condition, followed by a 7-min activating body exposure condition. Participants completed questionnaires on affect (i.e., arousal, valence, body-related distress), and their voice data and heart rate (HR) were recorded continuously. Vocal analyses were performed using Praat, a program for extracting paralinguistic measures from spoken audio. Results: The results revealed no effects for f0 and state body dissatisfaction or general affect. F0mean correlated positively with self-reported arousal and negatively with valence, but was not correlated with HRmean/maximum. No correlations with any measure were found for any f0variabililtymeasures. Discussion: Given the promising findings regarding f0mean for arousal and valence and the inconclusive findings regarding f0 as a marker of general affect and body-related distress, it may be assumed that f0mean represents a valid global marker of emotional arousal and valence rather than of concrete body-related distress. In view of the present findings regarding the validity of f0, it may be suggested that f0mean, but not f0variabilitymeasures, can be used to assess emotional arousal and valence in addition to self-report measures, which is less intrusive than conventional psychophysiological measures.

Does a white bear help you eat less? The impact of the inhibitory spillover effect on eating behaviour.

OBJECTIVE: Overweight and obesity are global problems with negative physical, social, and psychological outcomes. Besides other factors, inhibitory control deficits contribute to weight gain and development of overweight. The inhibitory spillover effect (ISE) improves inhibitory control through transfer of inhibitory control capacity from one domain to an unrelated, second domain. For ISE to occur, one inhibitory control task is executed simultaneously with a second, non-control related task thereby increasing inhibitory control in this task. METHOD: In this preregistered study, we tested the ISE induced through thought suppression in contrast to a neutral task in participants with normal weight and overweight (N = 92). A simultaneously conducted bogus taste test served as outcome measure for food intake. RESULTS: We found neither an interaction effect between group affiliation and condition nor an effect of group affiliation. However, contrary to our expectations, we found higher food intake in participants with active ISE compared to the neutral task. CONCLUSIONS: This result might indicate rebound effects of applied thought suppression which led to the experience of loss of control and therefore undermined maintenance and function of the ISE. This main result was robust to all moderator variables. We elaborate further factors for the finding, theoretical implications, and future research directions.

Screening for distress and quality of life in pediatric patients after allogeneic or autologous hematopoietic stem cell transplantation using a self-reporting instrument, blood stress biomarkers and an expert rating scale (PO-Bado).

OBJECTIVE: Hematopoietic stem cell transplantation (HSCT) is highly distressing and potentially traumatizing for pediatric and young adult patients (PYAP). At present, there is little evidence on their individual burdens. METHODS: In this prospective cohort study, the course of the psychological and somatic distress was investigated on eight observation days (day -8/-12, -5, 0 (day of HSCT), +10, +20, and + 30 before/after HSCT), using the PO-Bado external rating scale and the EORTC-QLQ-C15-PAL self-assessment questionnaire. Stress-associated blood parameters were determined and correlated with the results of the questionnaires. RESULTS: A total of 64 PYAP with a median age of 9.1 years (range 0-26 years) who underwent autologous (n = 20; 31%; autoHSCT) or allogeneic (n = 44; 69%; alloHSCT) HSCT were analyzed. Both were associated with a significant reduction in QOL. The reduction in self-assessed QOL correlated with somatic and psychological distress as assessed by medical staff. While somatic distress was similar in both groups with a maximum around day+10 (alloHSCT 8.9 ± 2.4 vs. autoHSCT 9.1 ± 2.6; p = 0.69), a significantly higher level of psychological distress was seen during alloHSCT (e.g. day0 alloHSCT 5.3 ± 2.6 vs. day0 autoHSCT 3.2 ± 1.0; p < 0.0001). CONCLUSIONS: The maximum of psychological and somatic distress, as well as the lowest quality of life, ranges between day 0 and + 10 after both allogeneic and autologous pediatric HSCT. While somatic distress is similar during autologous and allogeneic HSCT, the allogeneic group seems to be affected by higher psychological distress. Larger prospective studies are needed to evaluate this observation.

Playing with temptation: Stopping abilities to chocolate are superior, but also more extensive.

Cue-specific inhibitory control is assumed to support balanced food intake, but previous studies with established measures showed inconsistent results. We developed a novel kinematic stop task in virtual reality (VR) and report results from trajectory recordings. The primary objective of this explorative study was to assess the interrelationships between validated measures of food-related inhibitory control and novel measures from the VR task. We hypothesized that healthy female participants show worse inhibitory control when grasping attractive virtual chocolate, compared to non-edible color-and-shape matched objects. We further aimed to quantify the construct validity of kinematic measures (e.g., reaching extent/spatial displacement, movement time after stop-signal, velocity) with established measures of inhibitory control in a keyboard-based adaptive stop-signal task (SST). In total, 79 females with varying levels of chocolate craving participated in an experimental study consisting of self-report questionnaires, subjective chocolate craving, the conventional SST and the kinematic task in VR. Results showed superior stopping ability to chocolate in both tasks. In VR, participants successfully interrupted an initiated approach trajectory but terminated slightly closer to chocolate targets. Stop-signal delay (SSD) was adapted relative to movement onset and appeared later in chocolate trials, during which participants still stopped faster, as was also confirmed by shorter stop-signal reaction time (SSRT) in the conventional task. Yet, SSRT did not correlate with stopping in VR. Moreover, SSRT was related to depressive symptoms whereas measures from VR were related to chocolate craving and subjective hunger. Thus, VR stopping can provide deeper insights into healthy weight individuals' capacity to inhibit cue-specific approach behavior towards appetitive stimuli in simulated interactions. Furthermore, the results support a multi-faceted view of food-specific inhibitory control and behavioral impulsivity.

Increased insula and amygdala activity during selective attention for negatively valenced body parts in binge eating disorder.

Previous studies indicate that participants with eating disorders show an attentional bias for the negatively valenced body parts of their own body. However, the neural basis underlying these processes has not been investigated. We conducted a preregistered combined functional MRI (fMRI)/eye tracking study and presented 35 women with binge eating disorder (BED) and 24 weight-matched control subjects (CG) with body part images of their own body and a weight-matched unknown body. After the fMRI examination, participants rated the attractiveness of the presented body parts. As expected, women with BED responded with significantly higher insula and amygdala activity when viewing the negatively valenced body parts of their own body (compared to all other combinations). However, individuals with BED did not deviate from the CG in the processing of these stimuli in the ventromedial prefrontal cortex, the extrastriate body area or the fusiform body area. Our results indicate that the negative valued body parts carry a particularly strong emotional valence in individuals with BED. These results further emphasize the relevance of processing bias for negatively valenced body parts in the pathology of BED. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Facilitation of simultaneous control? A meta-analysis of the inhibitory spillover effect.

Impaired inhibitory control is a core transdiagnostic mechanism in psychopathology. Directly targeting inhibitory control in intervention studies has, however, produced only little improvement. Recently, promising improvements in inhibitory control were shown by capitalizing on the inhibitory spillover effect (ISE). The central requirement of ISE is a simultaneous execution of two tasks, allowing for improved inhibitory control in the target task when control is simultaneously recruited in an induction task. The magnitude of the ISE remains to be assessed. In this preregistered meta-analysis, we synthesized eligible data from studies across psychology with the central requirement of simultaneity; thus, we deliberately included also studies meeting this requirement without the explicit aim to investigate the ISE. Results confirmed previous evidence of the ISE and documented a statistically significant small effect size (g = 0.27). Of the different induction types, cognitive induction showed the largest effects, whereas physiological and attentional induction tasks were less effective. In contrast, motor induction did not result in a significant ISE. Due to high between-study heterogeneity, we analyzed several preregistered and exploratory moderators, out of which only duration of the experimental sequence, group affiliation, and planned investigation of the ISE were significant. Sensitivity analyses yielded no indication of a publication bias. Taken together, this meta-analysis suggests that the ISE is a small, but substantial and robust effect. Future research should investigate how the ISE is applied best to reap its practical value in new treatment approaches for individuals with inhibition impairments. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Anodal stimulation of inhibitory control and craving in satiated restrained eaters.

OBJECTIVES: Eating and weight disorders are severe and complex clinical conditions which, among other behaviors, include (attempts at) restrained eating, food avoidance, following dietary rules, and overeating. Comparable to women with obesity, restrained eaters (RE) without formal eating disorder diagnosis are worse at inhibiting their motor responses than unrestrained eaters (URE). According to neuroimaging studies, the right inferior frontal gyrus (rIFG) is involved in inhibitory control which, in turn, could be improved by neuromodulation such as anodal transcranial direct current stimulation (tDCS) across rIFG. METHODS: This double-blind sham-controlled cross-over study was conducted after a standardized breakfast. Normal-weight female RE und URE performed a stop-signal task (SST) with food and non-food stimuli during sham or anodal tDCS. Food craving, hunger, and satiety were self-reported before and after tDCS. We employed a mixed between-subjects (group: RE vs. URE) and within-subjects factorial design (tDCS: anodal tDCS vs. sham; stimuli: food vs. control pictures). RESULTS: Breakfast consumption was comparable for RE and URE, as well as craving, hunger, and thirst. Regarding inhibitory control, a significant two-way interaction between group and tDCS ermerged: RE had longer stop-signal reaction times (SSRTs) during sham tDCS, but they improved to the level of URE by application of anodal tDCS. DISCUSSION: Results replicated an inhibitory control deficit in RE with longer SSRTs compared to URE without stimulation. During anodal tDCS to the rIFG, reduced SSRTs in RE indicated an improvement in inhibitory control. The findings suggest a specificity of rIFG stimulation in at-risk groups with regards to inhibitory control irrespective of craving.

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.

Efficacy and mechanisms of change in exposure-based and cognitive stand-alone body image interventions in women with overweight and obesity.

OBJECTIVE: Body dissatisfaction is highly prevalent in overweight and obesity, while evidence for the efficacy of body image interventions is still scarce. This interventional pilot study investigates the efficacy and mechanisms of change of two stand-alone body image interventions in women with overweight and obesity. METHODS: Women with overweight and obesity (n = 76) were randomly assigned to five weekly sessions of either a mirror exposure (ME) or a cognitive restructuring intervention (CR) or to a wait-list control group (WCG). Primary outcome measures were self-reported body dissatisfaction and interview-based shape concerns; depression, self-esteem and emotional eating served as secondary outcome measures. Experimental paradigms were used prior to and after the interventions to analyze possible mechanisms of change: (a) Implicit Associations Tests to assess weight-related attitudes (b) eye-tracking experiments to assess visual processing of body pictures and (c) a thought-sampling procedure to assess body-related cognitions and arousal. RESULTS: According to intent-to-treat analyses using linear mixed-models, both interventions lead to significant improvements in body image, while there were no changes in the WCG. Different mechanisms of change were identified. CONCLUSIONS: Both types of interventions might be effective in the reduction of self-reported body dissatisfaction and interview-based shape concerns in overweight and obesity. However, as different mechanisms drive the effects, future research should clarify which individual might best benefit from which intervention.