Evaluation of an approach–avoidance training intervention for children and adolescents with obesity: A randomized placebo‐controlled prospective trial

Abstract

This study evaluated the efficacy of approach-avoidance training as an additional treatment for children and adolescents with obesity seeking inpatient treatment. Two hundred thirty-two participants (8-16 years, 53.9% girls) were randomly assigned either to multisession approach-avoidance (IG) or to placebo training (CG). As outcomes, cognitive biases post intervention, body mass index, eating behaviour, food intake, self-regulation, and weight-related quality of life were assessed, also at 6- and 12-month follow-up. Modification of approach-avoidance bias was observed, but lacked in transfer over sessions and in generalization to attention and association bias. After 6 months, the IG reported less "problematic" food consumption, higher self-regulation, and higher quality of life; effects did not persist until the 12-month follow-up; no significant interaction effects were observed regarding weight course. Despite there was no direct effect on weight course, approach-avoidance training seems to be associated with promising effects on important pillars for weight loss. Further research concerning clinical effectiveness is warranted.

Cognitive training on eating behaviour and weight loss: A meta‐analysis and systematic review

“…As Table illustrates, the most consistent effects on weight loss were seen in food‐specific inhibition training, with four of six inhibition training studies finding that inhibition training contributed to weight loss. In contrast, all three studies examining the effects of working memory training on weight loss, two of three studies examining the effects of attention bias modification training on weight loss, all three studies examining the effects of approach/avoidance training on weight loss, and one study examining the effects of episodic future thinking training on weight loss did not find that the respective intervention contributed to weight loss. In addition, seven of nine studies did not find that the effects of the cognitive trainings on weight loss persisted after the cognitive training intervention was complete (eg, in follow‐up assessments).…”

“…In contrast, all three studies examining the effects of working memory training on weight loss, two of three studies examining the effects of attention bias modification training on weight loss, all three studies examining the effects of approach/avoidance training on weight loss, and one study examining the effects of episodic future thinking training on weight loss did not find that the respective intervention contributed to weight loss. In addition, seven of nine studies did not find that the effects of the cognitive trainings on weight loss persisted after the cognitive training intervention was complete (eg, in follow‐up assessments). In sum, current research provides preliminary support for the beneficial effect of food‐specific inhibition training on weight loss from pre‐intervention to post intervention, but more research is needed to test the cognitive training effect on weight loss before it can be recommended to include cognitive trainings for weight loss in a clinical context.…”

Approach and avoidance bias for thin‐ideal and normal‐weight body shapes in anorexia nervosa

“…Another potential avenue could be the use of computerised cognitive bias modification trainings, capitalizing on approach bias paradigms such as the AAT, as add-on treatment modules that target automatic/implicit preferences in patients with AN, for example, by systematically training approach behaviour towards the own body depicted as normal-weight or avoidance behaviour towards the own body depicted as underweight. Similar trainings have been used successfully to reduce alcohol consumption in patients with alcohol dependence (Eberl et al, 2013) and, somewhat less successfully, to reduce food intake and body weight in patients with bulimic type eating disorders and obesity, respectively (D. Becker, Jostmann, Wiers, & Holland, 2015;Brockmeyer et al, 2019;Ferentzi et al, 2018;Warschburger, Gmeiner, Morawietz, & Rinck, 2018). ORCID Timo Brockmeyer https://orcid.org/0000-0003-2544-7610…”

Measuring approach–avoidance tendencies towards food with touchscreen-based arm movements

“…For example, while joystick-based trainings (e.g., repeatedly avoiding appetitive stimuli in terms of push movements) have been found to reduce approach tendencies towards appetitive stimuli, effects on actual intake are less consistent (Becker, Jostmann, & Holland, 2018;Kakoschke, Kemps, & Tiggemann, 2017). That is, several studies did not find that an avoidance training reduced actual consumption of alcoholic beverages (Leeman et al, 2018), soft drinks (Krishna & Eder, 2018), or high-calorie foods (Becker, Jostmann, Wiers, & Holland, 2015;Dickson et al, 2016;Ferentzi et al, 2018;Warschburger, Gmeiner, Morawietz, & Rinck, 2018). Among other explanations, one reason may be that these tasks do not involve naturalistic approach and avoidance behaviors, which may hinder translation of training effects into real-world behavior.…”