A dismantling study on imaginal retraining in overweight or obese women

Janina Wirtz,Steffen Moritz,Josefine Gehlenborg,Leonie Ascone,Simone Kühn

doi:10.1038/s41398-021-01595-1

Abstract

Imaginal retraining is a variant of approach bias modification and transfers the method into one’s own mind. As the technique contains multiple elements, this pilot study aimed to dismantle which of its components is most efficient in reducing craving for high-calorie food. A total of 113 women were randomly allocated to one out of six conditions containing a short intervention to mentally manipulate a picture displaying high-calorie foods. Four of the interventions involved different combinations of elements of the imaginal retraining technique, while the remaining two conditions comprised thought suppression or merely observing a picture. Participants rated their level of craving, as well as three pictures containing healthy and unhealthy foods regarding their pleasantness before and after the interventions took place. Within-group changes were assessed with paired t-tests (in case of non-normal data Wilcoxon paired t-tests) and between-group differences with one-way ANOVAs (non-parametric Kruskal–Wallis tests). A trend level reduction in craving was found in the imaginal retraining condition with and without a movement. A post hoc analysis of both conditions joint together showed a statistically significant reduction in craving. In addition, positive picture appraisal for unhealthy foods was significantly reduced in both imaginal retraining conditions (with and without movement) with medium to large effect sizes. This study demonstrated that imaginal retraining with an arm movement can reduce craving and picture appraisal for high-calorie foods significantly in a one-time application. It is a promising technique to reduce appraisal for unhealthy high-calorie foods. Future studies should repeat the experiment in situations of high craving and allow for a personalized selection of stimuli.

Highlights

Obesity poses an immense risk on health and is the origin of a wide variety of diseases [1]
Three food-related pictures were shown one by one in fixed order; the first picture displaying a range of healthy foods such as fruits and vegetables, the second displaying a smiling woman biting into a chocolate bar, and the third picture showing a large variety of unhealthy foods such as popcorn, fries, coke, burgers, donuts and crisps
−17.1%; t(34) = 6.09; ptwo-tailed < 0.001; d = 1.03) and for picture 3

Summary

Introduction

Obesity poses an immense risk on health and is the origin of a wide variety of diseases [1]. According to the World Health Organization [2], obesity is the result of an excessive increase in weight caused by an imbalance between consumed and expended calories. This is usually driven by increased intake of high-calorie foods, accompanied by physical inactivity [2]. Craving plays a significant role in addictive behaviours and can be conceptualized as a psychological or physiological motivational state that advocates the consumption of a desired substance [6, 7]. Craving occurs even when satisfied, can pass with time, can decrease in intensity, and is usually directed at high-calorie (sweet or savoury) ‘comfort’ foods. What type of food is craved can depend on a number of physical and mental factors ranging from nutritional imbalance, learned/conditioned behaviour, acquired habit and being subjected to food cues in the environment [8]

Objectives

Methods

Results