Food cue reactivity is a strong motivation to eat, even in the absence of hunger. Therefore, food cue reactivity might sabotage healthy eating, induce weight gain and impede weight loss or weight maintenance. Food cue reactivity can be learned via Pavlovian appetitive conditioning: It is easily acquired but the extinction of appetitive responding seems to be more challenging. Several properties of extinction make it fragile: extinction does not erase the original learning and extinction is context-dependent. These properties threaten full extinction and increase the risk of full relapse. Extinction procedures are discussed to reduce or prevent the occurrence of rapid reacquisition, spontaneous recovery, renewal and reinstatement after extinction. A translation to food cue exposure treatment is made and suggestions are provided, such as conducting the exposure in relevant contexts, using occasional reinforcement and targeting expectancy violation instead of habituation. A new hypothesis proposed here is that the adding of inhibition training to strengthen inhibition skills that reduce instrumental responding, might be beneficial to improve food cue exposure effects.

The present study investigated whether a single-session of food cue exposure for overweight women would decrease 'if CS then US' expectancies, cue reactivity and eating in the absence of hunger (EAH). EAH was measured in a behavioural paradigm that enabled to also investigate whether the cue exposure effects were specific for exposed foods or would generalise to food items that were not present during exposure. Overweight women were randomly assigned to either the cue exposure intervention or a control intervention that focused on body image. In line with the hypotheses, results showed that cue exposure induced a significant decrease in 'if CS then US' expectancies, in contrast to the control intervention. It was also found that, compared to the control intervention, desires to eat initially increased during cue exposure while gradual extinction was observed towards the end of the intervention. No extinction of increased salivation responses was found. Regarding EAH, the intake of the exposed food item was significantly less in the exposure condition than in the control condition, whereas total caloric food intake was not different between conditions, indicating that cue exposure was effective in reducing intake but did not generalise to the intake of other food items.

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Food cue exposure was effective to reduce EAH of exposed and non-exposed food items, indicating generalisability of the exposure effect. In line with exposure effects in anxiety disorders, habituation was not found to benefit outcome, though the present data do also not provide evidence that CS-US expectancy violation predicts EAH.

Purpose of ReviewThis review provides an overview of recent findings relating to the role of Pavlovian conditioning in food cue reactivity, including its application to overeating and weight loss interventions.Recent FindingsBoth in the laboratory and in real life, cue-elicited appetitive reactivity (e.g., eating desires) can be easily learned, but (long-term) extinction is more difficult. New findings suggest impaired appetitive learning in obesity, which might be causally related to overeating. The clinical analogue of extinction—cue exposure therapy—effectively reduces cue-elicited cravings and overeating. While its working mechanisms are still unclear, some studies suggest that reducing overeating expectancies is important.SummaryPavlovian learning theory provides a still undervalued theoretical framework of how cravings and overeating can be learned and how they might be effectively tackled. Future studies should aim to elucidate inter-individual differences in Pavlovian conditioning, study ways to strengthen (long-term) extinction, and investigate the working mechanisms of cue exposure therapy.