Does cognitive bias modification prior to standard brief cognitive behavior therapy reduce relapse rates in hair pulling disorder?: A double-blind randomized controlled trial

Background: In line with previous research in alcohol addiction, we tested whether an Approach-Avoidance Training (AAT) prior to standard six-session Cognitive Behavior Therapy (CBT) for Hair Pulling Disorder (HPD) reduced problematic relapse, commonly found in this population. Method: Prior to CBT, 54 outpatients with a primary diagnosis of HPD were randomly assigned (double-blind) to either a training condition (n = 27), learning to avoid hair-pulling-related stimuli, or to a control condition (n = 27). Symptom severity was assessed with the Massachussetts General Hospital Hairpulling Scale, Severity Urge Resistance Frequency Scale, Self-Control Cognition Questionnaire, and Alopecia Scale. Results: In line with existing research, CBT showed to be an effective treatment for HPD in the short-term. There was no significant symptom increase after one and three months, but effect sizes were reduced approximately by half at the twelve-month measurement. The AAT training prior to CBT did not result in enhanced symptom reduction or reduced relapse after CBT. Conclusions: AAT training could not resolve the substantial relapse after successful CBT. Future research should take into account the complexity of stimuli that elicit hair pulling (e.g., tactile stimuli) and consider investigating other types of biases

Does a dieting goal affect automatic cognitive processes and their trainability?

This study investigated implicit self-control dispositions—implicit approach tendencies towards low-caloric food rather than towards high-caloric food—in dieters. Action tendencies were assessed and trained using the Approach-Avoidance Task (AAT). Additionally, positive/negative affective associations [Brief Implicit Association Test (BIAT)], approach/avoidance associations (BIAT), and attentional biases [Dot Probe Task (DPT)] were assessed before and after training. Before training, dieters showed a more negative affective association with high-caloric food than non-dieters (positive/negative BIAT), consistent with the presence of self-control dispositions. On the AAT, all participants, not just dieters, showed more approach of low-caloric food than of high-caloric food. Results of neither the approach/avoidance BIAT nor the DPT showed any indication of implicit self-control dispositions. This study also investigated whether implicit self-control dispositions interfered with AAT training effects. This did not seem to be the case, as action tendencies could be strengthened even further. Moreover, training effects generalized to the DPT. Keywords: Implicit self-control dispositions, Dieting goal, Action tendencies, Associations Attentional bia

Reducing binge eating through behavioral-focused versus emotion-focused implementation intentions in patients with binge eating disorder or bulimia nervosa:An experimental approach

Binge eating disorder (BED) and bulimia nervosa (BN) are characterized by recurrent binge eating, episodes of consuming large amounts of food in a discrete period of time associated with a loss of control. Implementation intentions are explicit if-then plans that engender goal-directed action, and rely less on cognitive control than standard treatment options. In a sample with BED and BN, we compared two implementation intention conditions to a control condition. In the behavior-focused condition, implementation intentions targeted binge eating behaviors. In the emotion-focused condition, implementation intentions targeted negative affect preceding binge eating. In the control condition, only goal intentions were set. Each condition comprised three sessions. Participants kept food diaries for four weeks. Compared to the control condition both implementation intention conditions showed significant and large reductions of binge eating that persisted for six months. Effects did not differ between the behavior-focused and emotion-focused implementation intention conditions. These results demonstrate that three sessions on implementation intention formation can lead to long-term reductions in binge eating in patients with BED or BN. Learning how to form implementation intentions seems a recommendable addition to the current standard treatment. Future research could investigate the added value of fully personalized implementation intentions