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The Effects of an Attentional Bias Modification Program On CAN WE BE TRAINED TO EAT HEALTHY? THE EFFECTS OF AN ATTENTIONAL BIAS MODIFICATION PROGRAM ON EATING BEHAVIOR A DISSERTATION IN Psychology Presented to the Faculty of the University of Missouri-Kansas City in partial fulfillment of the requirements for the degree DOCTOR OF PHILOSOPHY by ASHLEIGH ANNE PONA B.S., John Carroll University, 2013 M.A., University of Missouri-Kansas City, 2015 Kansas City, Missouri 2018 © 2018 ASHLEIGH ANNE PONA ALL RIGHTS RESERVED CAN WE BE TRAINED TO EAT HEALTHY? THE EFFECTS OF AN ATTENTIONAL BIAS MODIFICATION PROGRAM ON EATING BEHAVIOR Ashleigh Anne Pona, Candidate for the Doctor of Philosophy Degree University of Missouri-Kansas City, 2018 ABSTRACT The prevalence of overweight (OW) and obesity (OB) has significantly increased over the past four decades. OW and OB are complex in nature and arise from a multitude of factors and their interactive effects. Based on etiological models of OW and OB, interventions to reduce excess body weight have been developed, including population- and individual-level approaches. Current interventions are limited, however, in that they lack focus on how environmental factors (e.g., food cues) interact with biology (e.g., neural reward systems) to influence individual health-related behaviors (e.g., food consumption) through mechanisms such as attentional bias. Attentional bias modification (ABM) programs have been developed to train individuals to either attend to or avoid certain food cues in the environment, yet research in this area is underdeveloped. The purpose of this dissertation was to evaluate the effect of a single-session ABM training designed to promote healthy eating on eating behavior as a potential intervention that targets an individual’s response to the obesogenic environment. This dissertation addressed the limitations of previous ABM studies in that it examined differential effects of the program on attention to food cues and eating behavior among individuals with varying body mass indices (i.e., healthy weight vs. OW/OB). iii APPROVAL PAGE The faculty listed below, appointed by the Dean of the College of Arts and Sciences, have examined a dissertation titled “Can We Be Trained to Eat Healthy? The Effects of an Attentional Bias Modification Program on Eating Behavior,” presented by Ashleigh A. Pona, candidate for the Doctor of Philosophy degree, and certify that in their opinion it is worthy of acceptance. Supervisory Committee Jennifer D. Lundgren, Ph.D., Committee Chair Department of Psychology Seung-Lark Lim, Ph.D. Department of Psychology Diane L. Filion, Ph.D. Department of Psychology Oh-Ryeong Ha, Ph.D. Department of Psychology Meredith L. Dreyer Gillette, Ph.D. Developmental and Behavioral Sciences Children’s Mercy-Kansas City iv CONTENTS ABSTRACT ....................................................................................................................... iii LIST OF ILLUSTRATIONS ............................................................................................. ix LIST OF TABLES ...............................................................................................................x ACKNOWLEDGMENTS ................................................................................................. xi Chapter 1. INTRODUCTION ................................................................................................1 Definition of Overweight and Obesity .........................................................1 Morbidity and Mortality of OW and OB .....................................................1 Prevalence and Prevalence Trends of OW and OB .....................................2 Factors Contributing to the Development of OW and OB ..........................3 Genetic and Hormonal Factors ........................................................3 Obesogenic Environment .................................................................6 Other Individual Factors ..................................................................7 Summary ......................................................................................................9 2. REVIEW OF THE LITERATURE ....................................................................11 Status of Non-Biological OW/OB Treatment Outcome Research ............11 Population-Level Interventions for OW and OB ...........................11 Individual-Level Interventions for OW and OB ............................15 Limitations of Current Non-Biological Interventions for OW and OB ...........................................................................................17 Food Cue Exposure and Attentional Bias ..................................................19 Measurement of Attentional Bias to Food Cues ............................20 v Studies on Attentional Bias to Food Cues .....................................24 Comparing BMI categories with the dot probe task ..........24 Comparing BMI categories with the Stroop task ...............25 Predicting change in BMI with attentional bias measures .26 Other factors that may influence attention to food cues ....27 Summary of studies on attentional bias to food cues .........28 Attentional Bias and Consumption Behavior ............................................31 Attentional Bias Modification for Unhealthy Food Cues ..........................32 Limitations of Studies on ABM for Unhealthy Food Cues ...........36 Summary ....................................................................................................36 Dissertation Aims.......................................................................................38 3. METHODOLOGY .............................................................................................42 Participants .................................................................................................42 Recruitment and Screening Procedures .....................................................42 Screening Measures .......................................................................43 Demographics questionnaire ..............................................43 Eating questionnaire...........................................................43 SCOFF eating disorder screener ........................................43 Pre-Experiment Procedures .......................................................................44 Pre-Experiment Measures ..............................................................45 Demographics questionnaire ..............................................45 Three-Factor Eating Questionnaire ....................................45 Experiment Procedures ..............................................................................46 vi Stimuli ............................................................................................46 Visual Dot Probe Task Procedure ..................................................47 Pretest .................................................................................47 Training ..............................................................................48 Posttest ...............................................................................49 Measurement of Attentional Bias ..................................................49 Post-Experiment Procedures ......................................................................49 Laboratory-Based Taste Test .........................................................49 Measurement of consumption ............................................50 Height and Weight .........................................................................51 Debriefing ......................................................................................51 Statistical Analysis .....................................................................................51 Power Analysis ..........................................................................................53 4. RESULTS ...........................................................................................................57 Demographics and Baseline Measurements ..............................................57 Demographics ................................................................................57 Baseline Measurements .................................................................58 TFEQ..................................................................................58 Hunger level .......................................................................60 Food ratings .......................................................................61 Pre-training attentional bias scores ....................................61 Pre-training reaction times .................................................63 vii Aims and Hypotheses Results ....................................................................64 Specific Aim 1 ...............................................................................64 Sub-Aim 1.1 ...................................................................................70 Specific Aim 2 ...............................................................................72 Sub-Aim 2.1 ...................................................................................74 5. DISCUSSION ....................................................................................................77 Summary of Aims and Overall Findings ...................................................77 Discussion of Baseline Attentional Bias Findings .....................................78 Discussion of ABM Training on Attentional Bias Findings ......................80
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