Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Department of Occupational and Consumer Psychology, University of Freiburg, Freiburg, Germany.
Transl Psychiatry. 2019 Nov 28;9(1):319. doi: 10.1038/s41398-019-0655-7.
Overweight and obesity are epidemic conditions. Obesity is associated with somatic and psychological sequelae, including serious life-shortening disorders (e.g., diabetes). This study aimed to evaluate the efficacy of a newly developed imaginal variant of approach bias modification (i.e., imaginal retraining) for the reduction of craving for high-calorie food. In a randomized controlled trial, 384 women with a body mass index above 25 were allocated to a wait-list control group or to two variants of imaginal retraining (ratio: 1; 0.5; 0.5). The two intervention groups were sent a manual on imaginal retraining. One group was explicitly encouraged and instructed to use electronic reminders (R); the standard retraining group (R) was not encouraged to use electronic reminders. Assessments were 6 weeks apart and were carried out online. Craving for high-calorie food represented the primary outcome (based on the Visual Analog Scale, VAS). Secondary outcomes included the Food Cravings Questionnaire (FCQ-T-R). The study was registered as DRKS00017220. Women in the R group utilized the retraining technique more often than those in the R condition, and utilization frequency in turn was associated with improvement on craving and eating behavior scales. Both intention-to-treat and per-protocol analyses showed a favorable effect of the R group, which achieved significance on the primary outcome, as well as on several other outcomes relative to controls at a small to medium effect size. For those participants who measured their weight before and after the assessment using a scale, weight loss in the R group was significantly greater compared to the control group. Both retraining groups (R: 39.4%; R: 31.1%) reduced their subjective amount of eating relative to controls (24.2%). Approximately two-thirds of the sample (68.3%) performed the exercises at least once during the study period. The present results show that, when used regularly, imaginal retraining may reduce craving for high-calorie food in overweight and obese women. Of note, there was also evidence suggestive of weight reduction, although no diet or lifestyle change was recommended in the manual. Because a large subgroup neither read the manual nor performed the exercises, we recommend that future imaginal retraining be conveyed via short video clips.
超重和肥胖是普遍存在的健康问题。肥胖与躯体和心理后遗症有关，包括严重缩短寿命的疾病（如糖尿病）。本研究旨在评估新开发的表象趋近偏差修正（即表象再训练）在减少对高热量食物的渴望方面的疗效。在一项随机对照试验中，384 名身体质量指数（BMI）超过 25 的女性被分配到等待名单对照组或两种表象再训练变体组（比例：1；0.5；0.5）。两个干预组都收到了一份关于表象再训练的手册。一组被明确鼓励并指导使用电子提醒（R）；标准再训练组（R）则没有被鼓励使用电子提醒。评估相隔 6 周，在线进行。对高热量食物的渴望是主要结果（基于视觉模拟量表，VAS）。次要结果包括食物渴望问卷（FCQ-T-R）。该研究在 DRKS00017220 上注册。R 组的女性比 R 条件组更频繁地使用再训练技术，而使用频率反过来又与渴望和饮食行为量表的改善相关。意向治疗和方案分析都显示 R 组有良好的效果，在主要结果以及相对于对照组的其他几个结果上都达到了小到中等效果量的显著水平。对于那些在评估前后使用秤测量体重的参与者，R 组的体重减轻明显大于对照组。两个再训练组（R：39.4%；R：31.1%）与对照组相比，主观进食量减少。大约三分之二的样本（68.3%）在研究期间至少进行了一次练习。本研究结果表明，当定期使用时，表象再训练可能会减少超重和肥胖女性对高热量食物的渴望。值得注意的是，虽然手册中没有推荐饮食或生活方式的改变，但也有体重减轻的证据。由于一个大的亚组既没有阅读手册也没有进行练习，我们建议未来的表象再训练通过短视频来传达。
