Restraint, inhibition and extinction of appetite. Anita Jansen Professor of Psychology Maastricht

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1 Restraint, inhibition and extinction of appetite Anita Jansen Professor of Psychology Maastricht

2 Eating disorders eating restraint restraint BED BN Binge eating Low weight AN-R AN-BP

3 It would be better to not eat it, but it smells so good EATING RESTRAINT fuzzy concept intention to restrain very strict diet rules Eating it is an absolutely no-go

4 Successful eating restraint depends on *Food cue reactivity *Inhibition skills

5 imagine that you eat one or two

6 Food Cue Reactivity Is a normal and healthy response Prepares the body Stimulates eating Associative learning: S1 predicts S2 e.g., Boswell & Kober, 2015; Jansen et al, 1998, 2003, 2011; Ferriday & Brunstrom, 2008, 2010; Wardle, 2010, Carnell et al 2008; Llewellyn et al 2010; vd Akker et al 2014, Schyns et al., 2016

7 Food Cue Reactivity is stronger in concerned eaters (binge eaters, dieters, obese people) Increases risk of overeating & weight gain e.g., Boswell & Kober, 2015; Jansen et al, 1998, 2003, 2011; Ferriday & Brunstrom, 2008, 2010; Wardle, 2010, Carnell et al 2008; Llewellyn et al 2010; vd Akker et al 2014, Schyns et al., 2016

8 Dieters overeat after 15 food cue exposure control dieters non-dieters exposure Jansen et al., Addictive Behaviors 1991

9 BUT: DEPENDENT ON INHIBITION SKILLS

10 INHIBITION SKILLS MAKE THE DIFFERENCE Only dieters with weak inhibition skills overeat Jansen et al., 2009, BRAT

11 DO NOT EAT YOU WILL GAIN WEIGHT.. CONTROLLED TEMPTATIONS YUMMIE.. YUMMIE.. I WANT IT!!! AUTOMATIC INHIBITION SKILLS FOOD CUE REACTIVITY

12 TEMPTATIONS YUMMIE.. YUMMIE.. I WANT IT!!! AUTOMATIC INHIBITION SKILLS WEAK FOOD CUE REACTIVITY STRONG; SABOTAGES DIETING

13 DO NOT EAT YOU WILL GAIN WEIGHT.. CONTROLLED TEMPTATIONS YUMMIE.. YUMMIE.. I WANT IT!!! AUTOMATIC INHIBITION SKILLS STRONG; FACILITATES RESTRICTION FOOD CUE REACTIVITY WEAK

14 BINGE EATERS / OVEREATERS: STRENGTHEN INHIBITION SKILLS WEAKEN FOOD CUE REACTIVITY AN-RESTRICTERS: WEAKEN INHIBITION SKILLS STRENGTHEN FOOD CUE REACTIVITY

15 BN, BED, OB: FOOD CUE EXPOSURE UNREINFORCED EXPOSURE TO CUES THAT PREDICT INTAKE: E.G., SMELL OF FOODS, SPECIFIC CONTEXTS NO EATING EXTINCTION OF CUE REACTIVITY (DECREASED DESIRES) INCREASED INHIBITION SKILLS

16 3 CUE EXPOSURE EXPERIMENTAL STUDIES Obese Women / Adolescents Food Cue Exposure vs. Control (Lifestyle) 1 or 2 sessions Main Measures: - Desire to eat - If S1 then S2 Expectancies: If I have tasty food in front of me, then I can not resist to eat it (DISINHIBITION BELIEFS) - Eating in the absence of hunger

17 eating in the absence of hunger

18 Cue exposure ; favourite foods

20 Study 2: desire to eat 2 * 60 exposures

21 Study 3: desire to eat 2 * 60 exposures

22 DISINHIBITION BELIEFS e.g., If there is a lot of my food in front of me (S1), I cannot resist eating (S2) Schyns et al., Behaviour Research and Therapy, 2016

23 Expectanmcy violation DISINHIBITION BELIEFS / EXPECTANCY VIOLATION e.g., If I eat one piece of my favourite food (S1), I cannot stop eating (S2) 0.00 Post-measurement Follow-up Cue exposure Control Schyns, van den Akker & Jansen, under review

24 STUDY 3: VIOLATION OF DISINHIBITION BELIEFS

25 Intake study 1 & study 2 (1 vs 2 sessions) Kcal exposed food item chocolate mousse Study I Study II cue exposure control 0.00 cue exposure control Kcal non-exposed food items generalisation Study I Study II cue exposure control Study 1: Schyns, Roefs, Mulkens, & Jansen (2016), BRAT cue exposure control Study 2: Schyns, Roefs, & Jansen (under review)

26 Kcal intake no generalisation - Study ExpEV ExpH Con Exposed food item Non-exposed food item After 2 sessions of Exposure (study 3)

27 CONTEXT CUE EXPOSURE INTERVENTIONS 1. N = 19 OVERWEIGHT / OBESE WOMEN 8 sessions N = 14 BULIMIA NERVOSA PATIENTS 10 sessions 60

28 Eating desires STUDY OB: HABITUATION OF DESIRE TO EAT Peak End Peak End Peak End Peak End Peak End Peak End Peak End Peak End S1 S2 S3 S4 S5 S6 S7 S8

29 Eating desires WITHIN SESSION HABITUATION Peak End Peak End Peak End Peak End Peak End Peak End Peak End Peak End S1 S2 S3 S4 S5 S6 S7 S8

30 Eating desires BETWEEN SESSION HABITUATION Peak End Peak End Peak End Peak End Peak End Peak End Peak End Peak End S1 S2 S3 S4 S5 S6 S7 S8

31 Pilot study n= 14: context cue exposure BN EXTINCTION OF CRAVINGS minutes

32 OB : Sign less intake exposed food item No generalisation 250 Intake (kcal) Cue Exposure Post Lifestyle Post Cue Exposure FU Lifestyle FU exposed non-exposed

33 Reduction % binge eating BN

% weight loss % weight loss OBESE SAMPLE 1.50 1.00 0.50 0.00-0.50-1.00-1.

34 % weight loss % weight loss OBESE SAMPLE Post-measurement FU-measurement Cue exposure Control Post: t(36) = 2.48, p =.018 FU: t(37) = 2.28, p =.029

35 BN, BED, OB: FOOD CUE EXPOSURE LEARNING: S1 DOES NOT PREDICT S2 EXTINCTION =/= UNLEARNING S1 BECOMES AMBIGIOUS S1 PREDICTS EATING & NOT EATING EXTINCTION = INHIBITORY LEARNING INHIBITS THE OLD ASSOCIATION BUT DOES NOT ERASE IT THE OLD ASSOCIATION STILL EXISTS AND CAN EASILY BE RE-ACTIVATED: RELAPSE

36 AN RESTRICTERS AN-R : frequent exposures without eating very effective extinction procedure extinction of appetitive responding

37 N=18 STUDENTS SMELLING CHOCOLATE FOR 20 MINUTES

38 Self-reported Craving Frankort et al., 2014, Cerebral Cortex Extinction of brain reward responding during chocolate exposure in chocolate lovers NS NS

39 SELF-IMPOSED EXTINCTION in AN-R WEAK or ABSENT food cue reactivity Extinction =/= unlearning AN-R still know the old association tasty foods pleasure of eating Extinction adds a new memory: tasty foods restriction / abstinence New memory might become much stronger than the old one in severe AN

40 CONTEXT DEPENDENCY -- CLINIC Extinction = context-dependent (=home, school, and so on for AN-R) After eating and gaining weight in a clinic: return to extinction contexts extinction memory is re-activated: inhibition of appetite Practice cued eating in extinction contexts to activate the original associations (renewal)

41 KEY ISSUE AN = FEAR OF WEIGHT GAIN Exposure modules (a la Craske) to reduce fear of weight gain disconfirmation of uncontrollable and exponential weight gain expectancies after eating See Murray et al (2016) Behaviour Research and Therapy See Norman session 1

reduce overeating. Physiology & Behavior, 162, 174-180.

Behaviour Research and Therapy, 86, 2-10. *Murray et al.

42 Further reading: *Jansen et al (2016). From lab to clinic: Extinction of cued cravings to reduce overeating. Physiology & Behavior, 162, *Jansen et al (2015). A Cognitive Profile of Obesity and Its Translation into New Interventions. Frontiers in Psychology, 6 (S), 282. *Jansen, A. (2016). Eating disorders need more experimental psychopathology. Behaviour Research and Therapy, 86, *Murray et al. (2016). Extinction theory & anorexia nervosa: deepening therapeutic mechanisms.behaviour Research and Therapy, 87, A big thank you:

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