Development and preliminary validation of the Salzburg Stress Eating Scale

Stress-related eating has long been a focus of study in several disciplines. Currently available psychometric scales conflate stress-related eating with emotional eating despite that not all stress states can be subsumed under some form of specific emotion. Moreover, existing measures primarily assess increased food intake in response to emotions and stress, thus ignoring evidence of decreased food intake in response to stress. Therefore, we drew from established stress concepts to develop the first genuine stress-related eating scale (Salzburg Stress Eating Scale [SSES]) in both German and English versions. In the SSES higher scores indicate eating more when stressed and lower scores indicate eating less when stressed. In study 1 (n = 340), the German SSES was found to have a one-factor structure (a = .89). SSES scores were weakly or moderately correlated with other eating-related constructs (e.g., emotional eating, body mass index [BMI]), and weakly correlated or uncorrelated with non-eating-related constructs (e.g., impulsivity, perceived stress); in addition, women had higher scores than men. Perceived stress moderated the association between stress eating and BMI, such that higher SSES scores were significantly related to higher BMI in individuals with high perceived stress, but not in individuals with low perceived stress. In studies 2 (n = 790) and 3 (n = 331), factor structure, internal consistency, and associations with sex and BMI were replicated for both German and English versions of the SSES. Hence, the SSES represents a psychometrically sound tool for the measurement of stress-related eating

Effects of Chocolate Deprivation on Implicit and Explicit Evaluation of Chocolate in High and Low Trait Chocolate Cravers

Diet failures are often attributed to an increase in cravings for attractive foods. However, accumulating evidence shows that food cravings actually decrease during energy-restricting weight-loss interventions. The current study aimed at elucidating possible mechanisms that may explain how and under which circumstances food cravings in- or decrease during dieting. Specifically, decreases in food cravings during weight-loss diets may be due to effects of energy restriction (homeostatic changes) and to effects of avoiding specific foods (hedonic changes). Thus, we used a selective, hedonic deprivation (i.e., restricting intake of a specific food in the absence of an energy deficit) that precludes homeostatic changes due to energy restriction. Furthermore, interindividual differences in food craving experiences might affect why some individuals are more prone to experience cravings during dieting than others. Thus, we investigated whether a selective deprivation of chocolate would in- or decrease craving and implicit preference for chocolate as a function of trait-level differences in chocolate craving. Participants with high and low trait chocolate craving (HC, LC) refrained from consuming chocolate for 2 weeks but otherwise maintained their usual food intake. Both groups underwent laboratory assessments before and after deprivation, each including explicit (i.e., state chocolate craving) and implicit measures (i.e., Single Category Implicit Association Test, SC-IAT; Affect Misattribution Procedure, AMP). Results showed that hedonic deprivation increased state chocolate craving in HCs only. HCs also showed more positive implicit attitudes toward chocolate than LCs on the SC-IAT and the AMP irrespective of deprivation. Results help to disambiguate previous studies on the effects of dieting on food cravings. Specifically, while previous studies showed that energy-restricting diets appear to decrease food cravings, the current study showed that a selective, hedonic deprivation in the absence of an energy deficit increases food cravings. However, this effect can only be observed for individuals with high trait craving levels. Thus, if attractive foods are strictly avoided through a selective deprivation, HCs are at risk to experience craving bouts in the absence of an energy deficit. As implicit preference was unaffected by chocolate deprivation, strong implicit preference for chocolate likely characterize a stable mechanism that drives consumption in HCs

Exploring Changes in Event-Related Potentials After a Feasibility Trial of Inhibitory Training for Bulimia Nervosa and Binge Eating Disorder

In a feasibility trial comparing two forms of combined inhibitory control training and goal planning (i.e., food-specific and general) among patients with bulimia nervosa (BN) and binge eating disorder (BED), we found evidence of symptomatic benefit, with stronger effects among participants receiving a food-specific intervention. The aim of the present study was to examine changes in behavioral outcomes and event-related potentials (ERPs; N2 and P3 amplitudes) from baseline to post-intervention that might suggest the mechanisms underpinning these effects. Fifty-five participants completed go/no-go tasks during two electroencephalography (EEG) sessions, at baseline and post-intervention. The go/no-go task included "go" cues to low energy-dense foods and non-foods, and "no-go" cues to high energy-dense foods and non-foods. Datasets with poor signal quality and/or outliers were excluded, leaving 48 participants (N= 24 BN;N= 24 BED) in the analyses. Participants allocated to the food-specific, compared to the general intervention group, showed significantly greater reductions in reaction time to low energy-dense foods, compared to non-foods, by post-intervention. Commission errors significantly increased from baseline to post-intervention, regardless of stimulus type (food vs. non-food) and intervention group (food-specific vs. general). There were no significant changes in omission errors. P3 amplitudes to "no-go" cues marginally, but non-significantly, decreased by post-intervention, but there was no significant interaction with stimulus type (high energy-dense food vs. non-food) or intervention group (food-specific vs. general). There were no significant changes in N2 amplitudes to "no-go" cues, N2 amplitudes to "go" cues, or P3 amplitudes to "go" cues from baseline to post-intervention. Training effects were only marginally captured by these event-related potentials. We discuss limitations to the task paradigm, including its two-choice nature, ease of completion, and validity, and give recommendations for future research exploring ERPs using inhibitory control paradigms

Predicting food craving in everyday life through smartphone-derived sensor and usage data

BackgroundFood craving relates to unhealthy eating behaviors such as overeating or binge eating and is thus a promising target for digital interventions. Yet, craving varies strongly across the day and is more likely in some contexts (external, internal) than in others. Prediction of food cravings ahead of time would enable preventive interventions.ObjectiveThe objective of this study was to investigate whether upcoming food cravings could be detected and predicted from passive smartphone sensor data (excluding geolocation information) without the need for repeated questionnaires.MethodsMomentary food craving ratings, given six times a day for 14 days by 56 participants, served as the dependent variable. Predictor variables were environmental noise, light, device movement, screen activity, notifications, and time of the day recorded from 150 to 30 min prior to these ratings.ResultsIndividual high vs. low craving ratings could be predicted on the test set with a mean area under the curve (AUC) of 0.78. This outperformed a baseline model trained on past craving values in 85% of participants by 14%. Yet, this AUC value is likely the upper bound and needs to be independently validated with longer data sets that allow a split into training, validation, and test sets.ConclusionsCraving states can be forecast from external and internal circumstances as these can be measured through smartphone sensors or usage patterns in most participants. This would allow for just-in-time adaptive interventions based on passive data collection and hence with minimal participant burden

Emotional reactivity to binge food and erotic cues in women with bulimia nervosa symptoms

This work was supported by the MECD [grant numbers FPU16/01200], 'Doctoral College "Imaging the Mind" (FWF; W1233-B)', a grant from Junta de Andalucia, Spain [Grant Code P12.SEJ.391], and a grant from the Spanish Ministry of Economy and Competitiveness/MINECO (Grant Code: PSI2013-43777-P).Background: Studies on food cue reactivity have documented that altered responses to high-calorie food are associated with bulimic symptomatology, however, alterations in sexual motivations and behaviors are also associated clinical features in this population, which justify their inclusion as a research target. Here, we study responses to erotic cues—alongside food, neutral and aversive cues—to gain an understanding of specificity to food versus a generalized sensitivity to primary reinforcers. Methods: We recorded peripheral psychophysiological indices –the startle reflex, zygomaticus, and corrugator responses—and self-reported emotional responses (valence, arousal, and dominance) in 75 women completing the Bulimia Test-Revised (BULIT-R). Multiple regression analysis tested whether BULIT-R symptoms were predicted by selfreported and psychophysiological responses to food versus neutral and erotic versus neutral images. Results: The results showed that individuals with higher bulimic symptoms were characterized by potentiated eye blink startle response during binge food (vs. neutral images) and more positive valence ratings during erotic (vs. neutral) cues. Conclusions: The results highlight the negative emotional reactivity of individuals with elevated bulimic symptoms toward food cues, which could be related to the risk of progression to full bulimia nervosa and thereby addressed in prevention efforts. Results also point to the potential role of reactivity to erotic content, at least on a subjective level. Theoretical models of eating disorders should widen their conceptual scope to consider reactivity to a broader spectrum of primary reinforcers, which would have implications for cue exposure-based treatments. Plain English summary: We examined appetitive and aversive cue responses in college women to investigate how bulimic symptoms relate to primary reinforcers such as food and erotic images. We recorded peripheral psychophysiological indices (the startle reflex, zygomaticus, and corrugator responses) and self-reported emotional responses (valence, arousal, and dominance) in 75 college women that were presented with the Spanish version of the Bulimia Test-Revised. The results showed that bulimic symptoms increase both psychophysiological defensiveness toward food cues and subjective pleasure toward erotic cues. The findings suggest a generalized sensitivity to primary reinforcers in the presence of bulimic symptoms, and emphasize the relevance of adopting a wider framework in research and treatment on bulimia nervosa.MECD FPU16/01200Doctoral College "Imaging the Mind" (FWF) W1233-BJunta de Andalucia European Commission P12.SEJ.391Spanish Ministry of Economy and Competitiveness/MINECO PSI2013-43777-

The Water Load Test As a Measure of Gastric Interoception: Development of a Two-Stage Protocol and Application to a Healthy Female Population

The sensitivity for one’s own internal body signals (i.e., interoception) has been demonstrated to play an important role in the pathogenesis of eating and weight disorders. Most previous measures assessing interoceptive processing have not, or only partly, captured perception of hunger and satiety cues, which is a core aspect of interoceptive deficits in eating disorders. In addition, methods used to measure sensitivity to gastric signals are heterogeneous and findings inconsistent. The primary aim of the present study was to establish a standardised test to measure gastric interoception, and to provide normative data using a non-clinical adult sample. The two-step Water Load Test (WLT-II) involves ingestion of non-caloric water until perceived satiation (step 1) and until maximum fullness (step 2). The WLT-II consists of several variables: Besides volumes of water ingested until satiation and maximum fullness expressed in ml, percentage of satiation to maximum fullness is calculated as an individual index of gastric interoception that is not confounded with stomach capacity. Ninety-nine healthy women participated in the study. Measures included the WLT-II, the heartbeat tracking test, a self-report questionnaire assessing subjective sensations, and the Eating Disorder Inventory-2. Twenty-eight participants underwent test-retest of the WLT-II. Results suggest that the WLT-II is a valid and reliable measure of gastric interoception. Importantly, satiation volume and percentage of satiation to maximum fullness were strongly positively related to self-reported bulimic symptoms, indicating that the WLT-II could emerge as a useful clinical tool to measure interoceptive processing in the field of eating disorders

Reappraisal facilitates extinction in healthy and socially anxious individuals

a b s t r a c t Background and objectives: Cognitive behavioral therapy (CBT) combines cognitive restructuring with exposure to feared stimuli in the treatment of anxiety disorders. Due to the complexities of cognition eemotion interactions during ongoing CBT, the underlying mechanisms remain unclear, which hinders treatment optimization. Methods: We created a laboratory analogue by combining reappraisal, a key ingredient of cognitive restructuring, with Pavlovian conditioning, a key ingredient in behavioral treatments. The novel differential Pavlovian acquisition and extinction task featured social stimuli as conditioned and unconditioned stimuli under unregulated and reappraisal instructions. Results: Findings indicated that reappraising the conditioned stimuli attenuated acquisition (Study 1) and facilitated extinction (Study 2) of conditioned negative valence. In Study 3, highly socially anxious individuals showed deficient extinction learning relative to low socially anxious individuals but compensated for this by using reappraisal. Limitations: Diagnostic status of participants was not assessed in structured clinical interviews. Conclusions: Reappraisal of feared stimuli could be useful in prevention and treatment of social anxiety

Time to make a change:A call for more experimental research on key mechanisms in anorexia nervosa

Anorexia nervosa (AN) is a life‐threatening eating disorder, characterised by persistent pathological weight loss behaviours and an intense fear of weight gain and food consumption. Although there is an abundance of scientific theories on the neurobiological, psychological and sociocultural factors thought to be involved in the maintenance of AN, there is little experimental research testing these ideas. The need for theory firmly grounded in empirical evidence becomes strikingly clear when we consider that current treatments for patients with AN are limited in their effectiveness, and relapse after treatment is common