بهبود انتخاب های غذایی جدید در کودکان پیش دبستانی با استفاده از درمان مبتنی بر پذیرش و تعهد
|کد مقاله||سال انتشار||مقاله انگلیسی||ترجمه فارسی||تعداد کلمات|
|36639||2014||8 صفحه PDF||سفارش دهید||7100 کلمه|
Publisher : Elsevier - Science Direct (الزویر - ساینس دایرکت)
Journal : Journal of Contextual Behavioral Science, Volume 3, Issue 4, October 2014, Pages 228–235
The present study examined the effects of a novel treatment package consisting of Acceptance and Commitment Therapy (ACT)-based activities with and without contingent rewards on children׳s consumption of low-preferred healthy foods. Participants were 6 children, age 3–5, who attended a local day care center. The effects of the two treatment packages on children׳s tasting and approach of foods were assessed using a multiple baseline design across food categories. During the ACT-based mindfulness condition, the experimenter led a set of four ACT activities prior to the presentation of food. This condition produced a mean increase in foods tasted of 7.4% for fruits but 0% for vegetables, and mean increases in foods approached of 18.6% for fruits and 8.7% for vegetables. A second condition consisting of the same ACT condition with an added emphasis on values and committed action. Through the use of rewards delivered contingent upon tasting the foods produced mean increases in foods tasted of 69.2% for vegetables, 25.3% fruits, and 43.2% for beans, and increases for foods approached of 54.7% for vegetables, 16.2% for fruits, and 44.6% for beans. The results suggest that the values and committed action components of ACT are critical for behavior change at young ages.
Over 60% of American children do not eat enough fruits, vegetables, beans, and whole grains to satisfy nutritional guidelines, putting them at risk for nutritional deficiencies (U.S.D.A & U.S.D.H.H.S, 2010). A variety of factors impact what children eat at any given opportunity. They include (a) genetic predispositions to eat sweet and energy dense foods (Desor et al., 1975 and Birch and Ventura, 2009), (b ) avoidance of novel food items (Rozin, 1976), (c) selective eating (Levin & Carr, 2001), picky eating (Carruth et al., 2003 and Dubois et al., 2007), and (d) food refusal (Bandini et al., 2010). Neophobia, or selective/picky eating, has been reported to affect between 16% and 20% of all children 3–5-years-old (Carruth et al., 2003). Considering children׳s predisposition to avoid novel foods and their tendency to eat sweet and fatty foods, it is possible to see how these predispositions interact to develop unhealthy eating patterns that can cause lifetime health concerns. Despite children׳s frequent avoidance of novel foods, research has shown that children can learn to eat new and non-preferred foods. Techniques have included peer modeling (Birch, 1980) and peer-modeling coupled with social reinforcers (Hendy, 2002). However caution needs to be taken to reduce the risk of negative peer-models (Greenhalgh et al., 2009). Other interventions have included visual and taste exposures (Birch, McPhee, Shoba, & Steinberg, 1987) and contingent rewards (Horne et al., 1995, Horne et al., 1998, Horne et al., 2004, Horne et al., 2009, Horne et al., 2011 and Lowe et al., 2004). The Food Dudes program of Lowe and colleagues has received a fair amount of popular media attention but several limitations may apply, including not employing a systematic method to determine relative food preferences, and the need for trained models and video production for incorporation into a typical classroom (Hendy, Williams, & Camise, 2005). Albeit the limitations, Horne et al., 1995, Horne et al., 1998, Horne et al., 2004 and Horne et al., 2011 present an interesting conceptualization of how the social influence of language plays a part in controlling behavior in the Food Dudes program. In particular, the authors described how children׳s own verbalizations and categorization of stimuli into classes influenced their behavior. Horne et al. (1998) argue the following: “Once [they] are verbally adept, children no longer react to foods merely as particular objects with inherent qualities of taste, smell, appearance, etc., but respond to them as named classes of items and respond to the verbalizations that they themselves and others make about those named classes” (p.133). Horne et al. (1998) argued that by inserting positive verbalizations from peer models into the children׳s eating context, negative conceptualizations occurring in children׳s eating contexts were circumvented. Relational Frame Theory (RFT; Hayes, Barnes-Holmes, & Roche, 2001) describes how language enables humans to use derived learning to relate, evaluate, and compare events without directly experiencing the contingencies of those events (Hayes & Wilson, 2003). At times, this relational behavior is an enormously adaptive trait, as it allows humans to quickly identify possible outcomes of certain events and to behave to produce the preferred outcome. At others times, rigid patterns of avoidance can result from over-reliance on verbal rules based on derived learning instead of learning based on direct-acting contingencies (Hayes & Plumb, 2007). Procedures based in Acceptance and Commitment Therapy (ACT; Hayes, Stroshal, & Wilson, 2012) may offer a novel method for creating a context that undermines verbal rules and negative conceptualizations that occur in the presence of healthy foods. ACT is a form of psychotherapy developed from the concepts of behavior analysis and RFT whose goal is to create behavior change in accordance with individual values. In ACT, mindfulness is described as a collection of four inter-related processes: acceptance, defusion, contact with the present moment, and self as context (Fletcher & Hayes, 2005). These processes function clinically to produce non-evaluative contact with stimuli and to help to bring about responses under appropriate contextual control of the present environment rather than verbal rules (Hayes & Wilson, 2003). Further, committed action and values, the other two processes within ACT, are relevant to treatment contexts that involve motivating individuals to engage in valued, but previously avoided, behavior. Within ACT treatment, committed action consists of engaging in deliberate acts towards goals that are consistent with values (Fletcher & Hayes, 2005). ACT interventions may be particularly relevant to young populations with food selectivity behaviors for several reasons. First, children often make verbalizations that attach verbal, rather than formal functions, to food (Horne et al., 1995, Horne et al., 1998, Horne et al., 2004 and Horne et al., 2011). In the context of ACT, children may be more likely to attend to the formal features of the food, rather than any verbal rules or negative conceptualizations about food, which in turn may result more acceptance of previously avoided food. Second, rather than extrinsic contingent reinforcement for eating less preferred foods, an ACT intervention with a focus on values and present moment contact may better link current eating behavior to temporally distant valued consequences such as greater health. For instance, if eating spinach is maintained only by access to other edibles or attention, when those contingencies are no longer in effect, spinach may again be avoided, but if committed action is directed by health-related values, eating spinach may be more likely maintained. Overall, ACT interventions in regard to food selectivity in a younger population may be of value to proactively promote a lifetime of healthy behavior before problems develop. However, research with ACT and preschool populations has been sparse. For example, three to five year old children have demonstrated increased attention, delay to gratification, and inhibitory control following the introduction of a mindfulness yoga activity (Razza, Bergen-Cico, & Raymond, 2013), but research and implementation of ACT protocols featuring values and committed action are rare with younger children, but have yielded positive results with older school children and adolescents (see Coyne, McHugh, & Martinez, 2011). Despite this gap in the literature, ACT was derived from RFT and behavioral principles, and, theoretically, such systems should apply so long as children respond verbally to the environment. In other words, once children develop a verbal repertoire and begin to relate stimuli, which has been observed in children less than two years old (Luciano, Becerra, & Valverde, 2007), they should respond to interventions that target these relations similar to older populations. As young children may experience negative effects of verbal relations (e.g., “Peas are sick!”), ACT interventions should be extended to young, verbally capable populations. The purpose of the present study was to examine the effect of mindfulness as conceptualized within ACT as an alternative to modeling within a treatment package on children׳s consumption of previously avoided healthy foods. To test this question, this study examined a set of four ACT-based mindfulness activities based on the processes identified by Fletcher and Hayes (2005) with and without rewards on the percent of foods tasted and approached.