Stimulus variability improves generalization following response inhibition training.

The present study examined the effect of stimulus variability and practice order on generalization to novel stimuli following a single session of response inhibition training. Ninety-six young adults practiced the Go/No-go task online in three training conditions: (1) constant (N = 32)-inhibition practiced on one stimulus; (2) variable-blocked (N = 32)-inhibition practiced on 6 stimuli, each in a separate block; and (3) variable-random (N = 32)-inhibition practiced on 6 stimuli in random order. Generalization was measured by comparing groups on inhibition of novel stimuli and a trained stimulus immediately and 24 h after training. Consistent with our hypothesis, the variable-random and the variable-blocked groups showed better generalization to the novel items than the constant group, demonstrating the benefit of stimulus variability. The variable-random group also showed better generalization than the variable-blocked group, demonstrating the benefit of presenting stimuli in random order. Participants' capacity for working memory maintenance was found to modulate the effect of practice order. While the benefit of variability was retained 24 h after training, the effect of order was not. Results also show generalization to (1) different type of stimuli using the same task and (2) the same stimuli on a different response inhibition task (the Stop-Signal Task), however, the effect of variable practice and order were not evident in these cases. The study findings illustrate the advantage of using variable stimuli presented in random order for generalization and suggest that these principles of motor learning can be applied to learning of cognitive skills.

Mechanisms underlying food devaluation after response inhibition to food.

Multiple studies reveal that a requirement to stop a response to appetitive food stimuli causes devaluation of these stimuli. However, the mechanism underlying food devaluation after stopping is still under debate. The immediate-affect theory suggests that an increase in negative affect after stopping a response is the driving force for food devaluation. A competing value-updating theory presumes that food devaluation after stopping occurs through the need to align behavior with goals. The current study assessed how food devaluation after response inhibition is influenced by negative emotional reactivity and behavior-goal alignment on a trial-by-trial basis. The study included 60 healthy participants who completed a Food-Stop-Signal-Emotion task. Participants categorized high vs. low-calorie food stimuli and stopped their response upon encountering a stop signal. Subsequently, participants made subjective negativity ratings of negative- or neutral-valenced emotional images, and rated their desire to eat the previously depicted food. In contrast to predictions made by the immediate-affect account, food devaluation after stopping was not mediated nor moderated via changes in negative emotional reactivity after stopping. In support of the value-updating account, food devaluation was modulated by behavior-goal alignment, indicated by larger food devaluation after successful vs. failed stopping. In agreement with this theory, the findings indicate that devaluation occurs more strongly when performance aligns with the task requirement. This study sheds light on the mechanism that likely underlies food devaluation after stopping. Implications regarding applied use of food-inhibition trainings are discussed.

Negative and positive interpretations of emotionally neutral situations modulate the desire to eat personally craved foods.

Emotions play an important role in modulating food craving. Previous studies demonstrated that exposure to negative or positive stimuli can subsequently influence the desire to eat. However, in many daily situations, individuals self-generate their emotions, for example, by interpreting emotionally-neutral situations as positive or negative. So far, no studies have examined if and how positive and negative interpretations of emotionally-neutral situations modulate food craving. In this study, 65 healthy participants were asked to interpret emotionally-neutral images negatively or positively or observe the images naturally. Subsequently, participants rated their state negative/positive affect and their desire to eat their personally craved foods. The results demonstrate a lower desire to eat craved foods after negative interpretations and a higher desire to eat after positive interpretations, compared to an observe-naturally condition. Additionally, the impact of emotional interpretations on the desire to eat was mediated by participants' state negative/positive affect. These findings suggest that self-generated emotion as a result of negative/positive interpretations plays a significant role in modulating food craving. The results highlight the potential of modifying affective interpretations for the treatment of disorders that are characterized by both dysregulated food craving and emotion.

The influence of inhibitory control on reappraisal and the experience of negative emotions.

Inhibitory control (IC) enables goal-directed behaviour by reducing the interference of irrelevant information. Studies have shown that IC can downregulate performance-based behavioural and physiological measures of emotional reactivity. This study examined whether transient recruitment of IC can modulate self-reported negative feelings after exposure to negative or neutral content. Furthermore, it was tested if triggering IC can improve the ability to reduce the negativity of unpleasant content by reinterpreting its meaning (cognitive reappraisal). For this purpose, a combined flanker and cognitive reappraisal task was performed by 49 participants. The flanker task was used to prime IC before participants reappraised or observed negative and neutral content. Priming IC before negative images reduced self-reported negative feelings compared to when IC was not primed. In contrast, priming IC before neutral images increased negative feelings. Priming IC had no influence on the ability to reappraise negative emotional content. Finally, trait rumination was associated with higher emotional reactivity only when IC was not primed. These results illustrate the importance of IC in decreasing emotional reactivity after being exposed to negative content. IC is revealed as a mechanism that can dynamically modulate subjective emotional reactivity as a function of emotional context.

The momentary interplay of affect, attention bias, and expectancies as predictors of binge eating in the natural environment.

OBJECTIVE: Affect regulation, eating expectancies, and attention toward food-related cues are interrelated constructs that have been implicated in the maintenance of binge eating. While these processes show considerable temporal variability, the momentary associations between these domains have not been elucidated. This study examined a model that posited momentary fluctuations in affect, eating expectancies, and attention bias (AB) would interact to predict subsequent binge eating. METHOD: Forty women who endorsed recurrent binge eating completed a 10-day ecological momentary assessment protocol with ambulatory measures of AB (i.e., dot-probe task with palatable food and neutral cues) and self-report assessments of positive and negative affect, eating expectancies (i.e., the belief that eating would improve one's mood), and binge-eating symptoms. RESULTS: Generalized linear mixed models indicated higher momentary AB toward palatable food was associated with increased risk of subsequent binge eating, and a two-way interaction showed that moments of higher eating expectancies and negative affect were associated with increased likelihood of subsequent binge eating. Also, a three-way interaction emerged, in that the association between eating expectancies and subsequent binge eating was strongest at lower levels of positive affect and higher AB. DISCUSSION: Together, findings partially supported hypotheses and demonstrate meaningful within-person fluctuations in AB that precede binge eating. Further, results demonstrate that the momentary influence of eating expectancies on binge eating depends on both affective state and attentional processes.

Performance and brain activity during the Wisconsin Card Sorting Test in adolescents with obsessive-compulsive disorder and adolescents with weight-restored anorexia nervosa.

Anorexia nervosa (AN) and obsessive-compulsive disorder (OCD) both show a peak age of onset during adolescence and share a number of phenotypic features, such as rigid rule-bound behavior and perseverative thinking. There is evidence of difficulties with set shifting or task switching in adults with each disorder, but evidence in adolescents is limited. Furthermore, no studies have previously directly compared AN and OCD on this cognitive process or examined comparative neural correlates. This study provides exploratory analyses to address this gap by measuring brain activity with functional magnetic resonance imaging (fMRI) during a computerized version of the Wisconsin Card Sorting Test (WCST) in female adolescents with weight-restored AN (WR-AN) (n = 14), OCD (n = 11), and healthy controls (n = 24). Results revealed greater perseverative errors in the OCD group than healthy controls and WR-AN, but no difference between WR-AN and healthy controls. Greater activity in the right front pole, inferior frontal gyrus, and middle frontal gyrus during the task (compared to a control matching task) was associated with more perseverative errors in the OCD group, but not healthy controls. The correlation between perseverative errors and brain response to the task in the WR-AN group was not different from either comparison group. These findings propose a hypothesis that behavioral similarities between OCD and AN, as well as difficulties with set shifting in adults with AN, are driven by obsessive-compulsive features present in AN rather than a shared underlying neurocognitive signature. This notion should be tested in larger samples in future studies.

Beyond uncertainty: A broader scope for "incentive hope" mechanisms and its implications.

We propose that food-related uncertainty is but one of multiple cues that predicts harsh conditions and may activate "incentive hope." An evolutionarily adaptive response to these would have been to shift to a behavioral-metabolic phenotype geared toward facing hardship. In modernity, this phenotype may lead to pathologies such as obesity and hoarding. Our perspective suggests a novel therapeutic approach.

The effect of food-related stimuli on inhibition in high vs. low restrained eaters.

Restrained eaters constantly limit their eating behavior to avoid gaining weight. Previous research suggests that fundamental deficits in response inhibition might play a role in the development of disinhibited eating among restrained eaters. The current study focuses on the impact of food vs. non-food stimuli on response inhibition in high vs. low restrained eaters. Seventy-five females (38 high and 37 low restrained eaters) completed a novel food stop-signal task in which they were required to discriminate between food and non-food images while inhibiting their response when a stop-signal appeared. The ability to inhibit a response was assessed separately for food and non-food trials, which were used to assess specific inhibition to food and general inhibitory abilities, respectively. Overall, high restrained eaters exhibited poorer response inhibition to non-food stimuli compared to low restrained eaters. Most importantly, high restrained eaters were better able to inhibit a response following presentation of food compared to non-food stimuli. In contrast, low restrained eaters were better at inhibiting a response following non-food compared to food stimuli. We suggest that this pattern is due to fast and strong activation of the response inhibition system in high restrained eaters when facing food stimuli - an activation which might later lead to a paradoxical breakdown of control over eating behavior.

Attention networks in adolescent anorexia nervosa.

Anorexia nervosa (AN) usually develops during adolescence when considerable structural and functional brain changes are taking place. Neurocognitive inefficiencies have been consistently found in adults with enduring AN and were suggested to play a role in maintaining the disorder. However, such findings are inconsistent in children and adolescents with AN. The current study conducted a comprehensive assessment of attention networks in adolescents with AN who were not severely underweight during the study using an approach that permits disentangling independent components of attention. Twenty partially weight-restored adolescents with AN (AN-WR) and 24 healthy adolescents performed the Attention Network Test which assesses the efficiency of three main attention networks-executive control, orienting, and alerting. The results revealed abnormal function in the executive control network among adolescents with AN-WR. Specifically, adolescents with AN-WR demonstrated superior ability to suppress attention to task-irrelevant information while focusing on a central task. Moreover, the alerting network modulated this ability. No difference was found between the groups in the speed of orienting attention, but reorienting attention to a target resulted in higher error rates in the AN-WR group. The findings suggest that adolescents with AN have attentional abnormalities that cannot be explained by a state of starvation. These attentional dysregulations may underlie clinical phenotypes of the disorder such as increased attention of details.

Feasibility Study Combining Art Therapy or Cognitive Remediation Therapy with Family-based Treatment for Adolescent Anorexia Nervosa.

Adolescents with anorexia nervosa who have obsessive-compulsive (OC) features respond poorly to family-based treatment (FBT). This study evaluated the feasibility of combining FBT with either cognitive remediation therapy (CRT) or art therapy (AT) to improve treatment response in this at-risk group. Thirty adolescents with anorexia nervosa and OC features were randomized to 15 sessions of FBT + CRT or AT. Recruitment rate was 1 per month, and treatment attrition was 16.6% with no differences between groups. Suitability, expectancy and therapeutic relationships were acceptable for both combinations. Correlations between changes in OC traits and changes in cognitive inefficiencies were found for both combinations. Moderate changes in cognitive inefficiencies were found in both groups but were larger in the FBT + AT combination. This study suggests that an RCT for poor responders to FBT because of OC traits combining FBT with either CRT or AT is feasible to conduct. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.

Weak central coherence in weight-restored adolescent anorexia nervosa: Characteristics and remediation.

OBJECTIVE: Weak central coherence (WCC) refers to a bias towards processing details (local processing) at the expense of paying attention to the bigger picture (global processing). Multiple studies reported WCC in adults with anorexia nervosa (AN). Evidence for WCC in adolescents with AN has been inconsistent. The current study characterizes WCC in weight-restored adolescents with AN (WR-AN) using a direct measure of WCC, and examines whether WCC can be remediated by increasing alertness level-a manipulation that was found useful in enhancing global processing in healthy individuals and clinical populations. METHODS: 40 adolescents (18 WR-AN and 22 healthy adolescents) performed a global/local processing task (Navon task). Auditory alerting cues that elevate alertness level were integrated into the task. RESULTS: Both groups processed global information faster than local information. However, compared with controls, adolescents with WR-AN were better at ignoring an irrelevant bigger picture while attending to details (smaller global interference) and had greater difficulty ignoring irrelevant details while attending to the bigger picture (larger local interference). These differences were attenuated when adolescents with WR-AN were under a state of high alertness. Additionally, the local interference effect was positively correlated with three independent self-report questionnaires assessing eating disorders symptomatology. DISCUSSION: This study suggests that abnormal interference by irrelevant global and local information is a central characteristic of WCC in adolescents with WR-AN that cannot be accounted for by enduring illness or malnourishment. Additionally, this study demonstrates that WCC can be temporarily remediated by encouraging a state of high alertness.

Generalization of food devaluation following food-specific go/no-go training.

The benefit of food-specific inhibition training on modulating food valuation and eating behaviors has been established, but generalization to untrained foods is seldomly examined. This study investigated whether stimulus variability and practice order, found to effect generalization in motor learning, can improve generalization following food-specific inhibition training. Ninety-three young adults practiced the Go/No-Go task online in three training conditions: 1) Constant (N = 30): inhibition practiced on one food stimulus; 2) Variable-Blocked (N = 32): inhibition practiced on 6 food stimuli, each in a separate block; and 3) Variable-Random (N = 31): inhibition practiced on 6 food stimuli in random order. Consistent with our hypothesis, the Variable-Random group showed better generalization of inhibition to untrained foods than the Constant and the Variable-Blocked groups immediately after training, demonstrating the benefit of stimulus variability and random practice order. This effect was not present 24 h after training. The Variable-Random group also showed decreased desire to eat untrained foods, exhibiting generalization of food devaluation. However, this effect was only present 24 h after training. The Constant group showed increased desire to eat untrained foods immediately and 24 h after training. The Variable-Blocked group did not differ from either group in the desire to eat to untrained foods, suggesting that random order is important for exposing the benefit of variability. The findings illustrate that presenting various training items in random order can improve generalization of food-specific inhibition training. However, inconsistencies found in the timing of generalization effects and modest effect sizes warrant additional investigation into generalization principles of food-specific inhibition training.

Fostering positive attitudes toward food in individuals with restrained eating: the impact of flexible food-related inhibition.

Individuals exhibiting restrained eating behaviors demonstrate increased inhibitory control when exposed to food-related stimuli, indicating the presence of an automatic food-inhibition association. Existing literature proposes that this association contributes to the devaluation of food within this population. Efforts to disrupt this association by promoting the complete elimination of the inhibition of food responses have resulted in increased food consumption but have also led to heightened food-related anxiety in individuals with restrained eating behaviors. In the current investigation, we investigated whether a novel flexible food response/inhibition computerized task could yield favorable changes in attitudes toward food in individuals with restrained eating. We randomly assigned 78 females who engage in restrained eating to one of three training groups. In the flexible response/inhibition group, participants were instructed to equally inhibit or respond to food stimuli. In the response group, participants consistently responded to food stimuli, while in the inhibition group, participants consistently inhibited their response to food cues. Implicit attitudes toward food were assessed both before and after the manipulation. To examine the stability of the effect of the training, participants also engaged in a seemingly unrelated bogus taste test. Our results revealed that only the flexible response/inhibition group demonstrated a significant improvement in positive attitudes toward high-calorie foods after eating, while there were no observable changes in negative attitudes among the other two groups. These findings suggest that promoting a balance between the responding and inhibiting responses to food stimuli can increase positive attitudes toward food amongst individuals with restrained eating.

Automatic pro-thin/anti-fat biases can develop without previous visual exposure to body shapes.

Endorsement of the thin beauty ideal increases risk for future body dissatisfaction and eating disorders among women. Visual-based media is theorized to be a central pathway through which the thin ideal is internalized. This internalization process results in formation of automatic pro-thin and anti-fat attitudes. However, it is often difficult to separate the contribution of visual-based media and other forms of communication in the creation of such attitudes. Using a novel auditory implicit association test, we show that women with congenital blindness with no previous exposure to body shapes develop automatic pro-thin and anti-fat attitudes to the same extent as sighted women. This result was replicated in studies conducted in two countries involving a combined total of 62 women with blindness and 80 sighted women. Results suggest that internalization of the thin ideal can occur without visual exposure to images of the thin beauty ideal or visual exposure to one's own body.

Does acceptance lead to change? Training in radical acceptance improves implementation of cognitive reappraisal.

Third-wave cognitive behavioral treatments such as dialectical behavioral therapy (DBT) theorize that emotional acceptance facilitates cognitive change. However, empirical evidence to support this notion is scarce. This study assessed how a two-week online training in using acceptance or cognitive change DBT skills influences the implementation of these strategies in an emotion regulation task. During six training sessions, 120 healthy individuals recorded personal negative events. In a Radical Acceptance group, participants implemented a DBT skill aimed to promote acceptance of the negative events they described. In a Check the Facts group, participants reappraised their interpretations of the described events. A Control group described negative events but did not use any DBT skill. Results supported our preregistered hypotheses showing that following the training, participants who practiced Radical Acceptance improved in their ability to implement both emotional acceptance and cognitive reappraisal (cognitive change) in an emotion regulation task. In contrast, the Check the Facts group improved only in the ability to use cognitive reappraisal, but not emotional acceptance. The control group did not improve in either strategy. The findings provide empirical evidence to support the notion that cultivating acceptance can subsequently improve the ability to reinterpret reality for coping adaptively with negative events.

Cognitive Reappraisal Reduces the Influence of Threat on Food Craving.

Cognitive reappraisal is perhaps the most researched emotion regulation strategy. It involves reinterpreting emotional content to reduce its impact. While many studies have demonstrated that cognitive reappraisal reduces negative affect, the utility of cognitive reappraisal in buffering against the consequences of negative affect on subsequent behaviors and attitudes is not clear. To address this issue, the present study assessed whether cognitive reappraisal mitigates the influence of immediate threat on food craving. In Experiment 1, 80 women performed a novel combination of a cognitive reappraisal task with a food-rating task. Participants were exposed to threat-provoking or neutral images and were instructed to either reappraise or observe the images. Subsequently, they rated their desire to eat different types of foods. As expected, the desire to eat decreased after exposure to threat-provoking content. However, after reappraising the threat-provoking images, the desire to eat increased relative to when participants merely observed these images. These results were replicated in Experiment 2 (N = 46) which also showed that the effect of reappraisal on the desire to eat was fully mediated by the subjective emotional reactions to the threat-provoking content. These findings show that cognitive reappraisal can modulate links between emotion and food craving by buffering against the consequences of negative affect on basic human processes.

The effect of mood on food versus non-food interference among females who are high and low on emotional eating.

BACKGROUND: Emotional eating refers to overeating triggered by emotional experiences and may cause significant psychological distress and health problems. Thus, it is important to better understand its underlying mechanisms. The study examined if the ability to ignore task-irrelevant information, namely, interference control, is modulated by mood and exposure to food stimuli among females who are high and low on emotional eating. METHOD: The study's sample included 80 women who were high (N = 40) or low (N = 40) on an emotional eating scale. Participants were divided to a negative or neutral mood induction group. Following the mood induction, they completed a food-flanker task that allowed assessing attentional interference caused by food and non-food stimuli separately. RESULTS: The low emotional eating group had significantly greater food compared to non-food interference, suggesting difficulty at ignoring food stimuli while attending a neutral target. In the high emotional eating group, there was no difference between food and non-food interference. However, higher levels of emotional eating predicted lower levels of food interference. CONCLUSION: The pattern of results suggests a food-avoidance attentional tendency among those with higher levels of emotional eating. The mood manipulation did not influence food-related interference in either group. The lack of an effect of mood on food-related interference questions the impact of negative emotions on basic attentional processes among individuals with emotional eating.

Emotional eating is characterized by overeating following the experience of negative emotions. Emotional eating may cause significant psychological distress and health problems. Thus, it is important to better understand its underlying mechanisms. The study assessed how negative mood influences the ability to ignore the presence of high-calorie food images among females who are high or low on an emotional eating scale. Participants' mood was manipulated by an autobiographic writing task (half of the participants described negative events and the other half emotionally neutral events). Then, they completed a computer task in which they were required to indicate whether a centrally presented image was of food or a non-food item as fast as possible. Next to the central image, there were additional images that were used for distraction. These images were also images of food or non-food items. Participants in the low emotional eating group showed greater distraction when food items were used for distraction. In contrast, those in the high emotional eating group were not distracted by food items. In fact, higher levels of emotional eating were associated with diversion of attention away from food stimuli, irrespective of mood. We suggest that these results reflect a broader avoidant strategy that is activated in response to emotionally negative content among individuals with emotional eating.

The Influence of Response Inhibition Training on Food Consumption and Implicit Attitudes toward Food among Female Restrained Eaters.

Restrained eaters display difficulties engaging in self-control in the presence of food. Undergoing cognitive training to form associations between palatable food and response inhibition was found to improve self-control and influence eating behaviors. The present study assessed the impact of two such response inhibition trainings on food consumption, food-related anxiety, and implicit attitudes toward food among female restrained eaters (Dutch Eating Behavior Questionnaire-restrained eating subscale ≥ 2.5). In Experiment 1, 64 restrained eaters completed either one of two training procedures in which they were asked to classify food vs. non-food images: a food-response training, in which stop cues were always associated with non-food images, or a balanced food-response/inhibition training, in which participants inhibited motor actions to food and non-food stimuli equally. The results revealed reduced snack consumption following the food-response/inhibition training compared to the food-response training. The food-response training was associated with increased levels of food-related anxiety. In Experiment 2, the same training procedures were administered to 47 restrained eaters, and implicit attitudes toward palatable foods were assessed. The results revealed an increase in positive implicit attitudes toward palatable foods in the food-response/inhibition group but not in the food-response training group. The results suggest that balancing response inhibition and execution across food and non-food stimuli may reduce overeating while retaining positive attitudes toward food among female restrained eaters.

Superior response inhibition to high-calorie foods in adolescents with anorexia nervosa.

Anorexia nervosa (AN) is a severe eating disorder that is characterized by significant weight loss as a result of self-starvation. Little is known about the mechanisms that allow these patients to endure self-starvation for long periods of time. It has been suggested that the neurocognitive mechanism responsible for stopping inappropriate actions (i.e., response inhibition) may contribute to this process. However, empirical evidence to support this notion is lacking. The goal of the current study was to assess if exposure to high-calorie food stimuli may trigger response inhibition to a greater extent in adolescents with AN compared to healthy adolescents. Thirty adolescents with restrictive type AN (AN-R) and 30 healthy adolescents completed a food-stop signal task wherein their ability to inhibit prepotent responses was assessed following exposure to high- and low-calorie food images. The results revealed superior ability of adolescents with AN-R to inhibit actions following exposure to high-calorie food images compared with controls. No such difference was found between the groups following exposure to low-calorie foods. The results indicate that high-calorie foods automatically trigger stronger activation of response inhibition in adolescents with AN compared to healthy adolescents. Such activation is likely a unique feature of AN that potentially contributes to patients' ability to severely restrict eating.

Examining intra-individual variability in food-related inhibitory control and negative affect as predictors of binge eating using ecological momentary assessment.

Binge eating presents in the context of several eating disorders (EDs) and has been shown to be associated with negative affectivity and inhibitory control deficits. While considerable ecological momentary assessment (EMA) work in EDs has demonstrated the importance of intra-individual variability in affect in predicting binge episodes, no research has considered how fluctuations in inhibitory control and negative affect together influence binge eating, or the extent to which these relationships may differ across ED diagnoses. Therefore, the present EMA study assessed the extent to which daily inhibitory control moderated momentary associations between negative affect and binge eating, and whether the presence of regular compensatory behaviors influenced these associations. Participants were 40 women reporting regular binge eating (anorexia nervosa binge-purge type [AN-BP], bulimia nervosa [BN], binge-eating disorder [BED]/subthreshold BED) who completed a 10-day EMA protocol that included measures of affect, eating, and a daily ambulatory Go/No-go task that included palatable food and neutral stimuli. Results of generalized estimating equations indicated greater between-person food-related inhibitory control deficits were associated with greater binge likelihood, and there was a three-way interaction between momentary negative affect, daily food-related inhibitory control, and compensatory behavior group. For individuals with BN or AN-BP, the relationship between momentary negative affect and subsequent binge eating was stronger on days characterized by reduced inhibitory control, whereas no main or interactive effects of negative affect or inhibitory control were observed for those with BED/subthreshold BED. Together these results demonstrate the importance of intra-individual variability in executive functioning and affective processes that underlie binge eating, as well as meaningful individual differences in these momentary associations.