مقابله با هوس غذایی؛ بررسی پتانسیل مداخله مبتنی بر ذهن آگاهی

The present study examined whether mindfulness-based strategies can effectively reduce food cravings in an overweight and obese adult population. Individuals participating in a dietary group treatment for overweight received an additional 7-week manual based training that aimed to promote regulation of cravings by means of acceptance. The control group did not receive this additional training program. The results showed that participants in the experimental group reported significantly lower cravings for food after the intervention compared to the control group. The findings are discussed in terms of possible mechanisms like prevention of goal frustration, disengagement of obsessive thinking and reduction of automatic relations between urge and reaction.

Food cravings, defined as an intense desire or urge to eat a specific food (Weingarten & Elston, 1990) are not essentially pathological, but can nevertheless lead to a diverse range of negative outcomes. For instance, past research has demonstrated a relation between food cravings and the development of obesity (Schlundt, Virts, Sbrocco, & Pope-Cordle, 1993) and eating disorders (Mitchell, Hatsukami, Eckert, & Pyle, 1985). Establishing what constitutes effective food craving regulation can be therefore considered as an important challenge. Coping with food cravings is often accomplished by means of control-based strategies such as suppression or distraction. These strategies aim to decrease the frequency and intensity of cravings and strongly rely on active self-regulation. Self-regulation has been identified as a process in which one attempts to reduce the discrepancy between a current state and a desired goal state (Carver & Scheier, 1981). A novel alternative to control-based craving strategies is acceptance-based strategies. Acceptance-based regulation entails an important aspect of mindfulness-based interventions. That is, individuals who practice mindfulness experience and accept their cravings fully without actively attempting to change, avoid or control them (Hayes, Strosahl, & Wilson, 1999). Acceptance involves a nonjudgmental attitude towards cravings and requires willingness to stay in contact with the uncomfortable, often negative feelings that accompany craving. In this respect, acceptance is fundamentally different from the self-regulation process underlying control-based strategies, since it is not primarily aimed at altering responses or inner states. It does not involve the reduction of a discrepancy between current and goal state. Instead, acceptance is aimed at promoting willingness to experience the current state, the craving, without acting upon it. Recently, a treatment study by Tapper et al. (2009) illustrated the potential of applying acceptance-based practice in the context of eating behaviour. Participants who actively engaged in a mindfulness-based weight loss intervention showed greater reductions in BMI and greater increases in physical activity than control participants. Today, however, only few studies have addressed the effectiveness of acceptance as a strategy to cope with food cravings specifically. A study by Forman et al. (2007) showed that for participants who were highly susceptible to the presence of food, acceptance was more effective in reducing food cravings compared to control-based strategies such as distraction and cognitive restructuring. However, acceptance was found to cause greater cravings among those with the lowest susceptibility to presence of food. Moreover, a recent study by Alberts and Papies (2010)1 showed that hungry participants who were instructed to accept their cravings during exposure to tempting food, reported significantly higher cravings compared to those who suppressed their cravings. At first sight, these findings may seem incompatible with the positive effects of acceptance-based coping found in other domains such as social anxiety (Goldin, Ramel, & Gross, 2009), depression (Coelho, Canter, & Ernst, 2007) and chronic pain (Vowles, Wetherell, & Sorrell, 2009). It has to be noted however, that most studies highlighting the benefits of acceptance concern interventions with several sessions. In contrast, studies on acceptance and food cravings so far have only used single session interventions and did not involve training. Since acceptance requires people to overcome the automatic tendency to avoid internal states such as negative emotions, thoughts or bodily sensations (Hayes et al., 1999), repeated and more extensive exercise may be necessary in order to successfully acquire this skill (Oaten & Cheng, 2006). The present study was designed to address this issue and tested whether food cravings can be reduced by training acceptance-based regulation. In doing so, a training program was developed that used mindfulness-based strategies to increase awareness of food cravings and foster willingness to accept these cravings. This program consisted of an instruction manual that required participants to work through independently. Method Participants A total of 19 participants (2 men; aged from 28 to 74, M = 51.88, SD = 12.76) participated in the study. Participants enlisted for a dietary group treatment for overweight and obesity in a Dutch community Centre (GroeneKruis Domicura, “Green Cross Care”). The mean weight of the participants was 85.4 kg (SD = 14.2; range 68.1–116.8) and the mean body mass index (BMI) was 31.3 (SD = 4.1; range 25.3–40.9). All participants received the same dietary treatment. This treatment consisted of 10 weekly meetings of 1.5 h each. During these meetings, information on healthy food choices was provided by a dietician. After receiving this information, participants also performed physical exercise for 1 h. In addition to this standard treatment, the experimental group (n = 10) received a 7-week manual based training that aimed to teach regulation of cravings by means of acceptance. Participants were randomly assigned to one of the two groups. The control group did not receive this additional training program. The experimental and control group did not differ significantly with respect to age, t(17) = 1.90, p = .08, weight, t(17) < 1 (M experimental group = 86.86, SD = 17.04, control group = 83.86, SD = 10.12), or BMI, t(17) = 1.15, p = .27 (M experimental group = 32.51, SD = 5.96, control group = 30.01, SD = 2.35). In order to gain insight in the dieting behaviour of participants, they completed a Dutch version of the Restraint Scale before onset of the intervention period (RS; Herman & Polivy, 1980). The RS is a 10-item questionnaire that assesses dieting and weight fluctuation. Scores on the Restraint Scale can range from 0 (least restrained) to 35 (most restrained). No significant differences in RS score between both groups were found, t(17) < 1 (M experimental group = 13.60, SD = 3.06, control group = 14.77, SD = 5.36). The study was approved by the standing ethical committee of the Faculty of Psychology and Neuroscience (Maastricht University).