A comparison of acceptance- and control-based strategies for coping with food cravings: An analog study
Abstract
The present study utilized an analog paradigm to investigate the effectiveness of two strategies for coping with food cravings, which was theorized to be critical to the maintenance of weight loss. Ninety-eight undergraduate students were given transparent boxes of chocolate Hershey's Kisses and instructed to keep the chocolates with them, but not to eat them, for 48 h. Before receiving the Kisses, participants were randomized to receive either (a) no intervention, (b) instruction in control-based coping strategies such as distraction and cognitive restructuring, or (c) instruction in acceptance-based strategies such as experiential acceptance and defusion techniques. Measures included the Power of Food Scale (PFS; a measure of psychological sensitivity to the food environment), self-report ratings of chocolate cravings and surreptitiously recorded chocolate consumption. Results suggested that the effect of the intervention depended on baseline PFS levels, such that acceptance-based strategies were associated with better outcomes (cravings, consumption) among those reporting the highest susceptibility to the presence of food, but greater cravings among those who scored lowest on the PFS. It was observed that craving self-report measures predicted chocolate consumption, and baseline PFS levels predicted both cravings and consumption. Results are discussed in terms of the implications for weight loss maintenance strategies.
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ACT technology has not always been more successful than other approaches.
“indeed it has not been (e.g., Forman, Hoffman, et al., 2007).”
From Acceptance and Commitment Therapy and Contextual Behavioral Science: Examining the Progress of a Distinctive Model of Behavioral and Cognitive Therapy (2013) · cites this paper as Forman, Hoffman, et al., 2007
Changes in important outcomes in acceptance-based interventions are mediated by experiential avoidance, mindfulness, and defusion.
“several studies have demonstrated that changes in important outcomes in acceptance-based interventions are mediated by EA (e.g., [23–25]), mindfulness [26] and defusion [27]”
From Psychological inflexibility explains distress in parents whose children have chronic conditions (2018) · cites this paper as [26]
Mindfulness has been found to reduce emotional reactivity, improve behavioral inhibition, and improve the ability to differentiate and label emotions.
“Mindfulness has been found to reduce emotional reactivity (Britton, Shahar, Szepsenwol, & Jacobs, 2012), improve behavioral inhibition (Forman et al., 2007), and improve the ability to differentiate and label emotions (Creswell, Baldwin, Naomi, Eisenberger, & Lieberman, 2007; Hill & Updegraff, 2012).”
From A randomized controlled trial of strong minds: A school-based mental health program combining acceptance and commitment therapy and positive psychology (2016) · cites this paper as Forman et al., 2007
For the first-stage main effect, under a within-person correlation of 0.50 and 10% dropout, N=122 (61 per arm) is required to detect d=0.5 with 85% power and 5% type-I error.
“Therefore, assuming a within-person correlation of 0.50 in longitudinal weight, and a study drop-out rate of 10 %, a total sample size of at least N=122 (i.e., 61 in group A+B+C vs 61 in group D+E+F) would be needed in order to detect a medium effect size [58] (Cohen's d=0.5) with at least 85 % power and type-I error of 5 %.”
From Introduction to SMART designs for the development of adaptive interventions: with application to weight loss research (2014) · cites this paper as [58]
Initial support for the idea that acceptance-based interventions are particularly effective for these individuals comes from analog craving studies and open trial results.
“In fact, some initial support for this theoretical notion is found in the analog craving studies15–17 and open trial results20 reported above.”
From The mind your health project: a randomized controlled trial of an innovative behavioral treatment for obesity (2013) · cites this paper as [15]
Analog studies show acceptance-based approaches are advantageous over standard cognitive-behavioral approaches for coping with food cravings, especially among people with high emotional eating, responsivity to the food environment, or disinhibited eating.
“Several analog studies have demonstrated the advantages of acceptance-based versus standard cognitive-behavioral approaches for coping with food cravings, especially among those showing high emotional eating, responsivity to the food environment or disinhibited eating.15–17”
From The mind your health project: a randomized controlled trial of an innovative behavioral treatment for obesity (2013) · cites this paper as [15]
In an earlier analog study, the authors found that an acceptance-based intervention for food cravings outperformed a standard intervention among people more responsive to their food environment.
“For example, we have previously shown greater efficacy of an analog acceptance-based intervention for copying for food cravings, compared to a standard intervention, in those with greater responsivity to their food environment.15”
From The mind your health project: a randomized controlled trial of an innovative behavioral treatment for obesity (2013) · cites this paper as [15]
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How Relevant is Food Craving to Obesity and Its Treatment?
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Initial Validation of the Mindful Eating Scale
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“…in this domain-specific manner is especially important because of the recent tentative evidence that certain sub-components of mindfulness might be especially impactful with regard to certain types of eating behaviours and certain types of eating disorders (Adams 2007; Forman et al. 2007b).”
Acceptance, Cognitive Restructuring, and Distraction as Coping Strategies for Acute Pain
Kohl, A., Rief, W., & Glombiewski, J. A. (2013) · The Journal of Pain · doi:10.1016/j.jpain.2012.12.005 · Cited by 99 · see citing works
A randomized controlled trial of brief interventions for body dissatisfaction.
Wade, T. D., George, W. M., & Atkinson, M. J. (2009) · Journal of Consulting and Clinical Psychology · doi:10.1037/a0016879 · Cited by 97 · see citing works
Techniques for modifying impulsive processes associated with unhealthy eating: A systematic review.
van Beurden, S. B., Greaves, C. J., Smith, J. R., & Abraham, C. (2016) · Health Psychology · doi:10.1037/hea0000337 · Cited by 95 · see citing works
Hedonic hunger and binge eating among women with eating disorders
Witt, A. A., & Lowe, M. R. (2013) · International Journal of Eating Disorders · doi:10.1002/eat.22171 · Cited by 96 · see citing works
Self-citationComparing thought suppression and acceptance as coping techniques for food cravings
Hooper, N., Sandoz, E. K., Ashton, J., Clarke, A., & McHugh, L. (2012) · Eating Behaviors · doi:10.1016/j.eatbeh.2011.10.002 · Cited by 94 · see citing works
“Food fusion involves susceptibility to food-related cues in the environment, and predicts cravings, consumption of avoided foods, and sensitivity to acceptance-based interventions (Forman et al., 2007).”
BackgroundMethodManaging temptation in obesity treatment: A neurobehavioral model of intervention strategies
Appelhans, B. M., French, S. A., Pagoto, S., & Sherwood, N. E. (2015) · Appetite · doi:10.1016/j.appet.2015.09.035 · Cited by 99 · see citing works
“Both temptation resistance and prevention strategies are commonly featured in lifestyle interventions (Diabetes Prevention Program Research Group, 2002; Forman et al., 2009; Forman et al., 2007; Gorin et al., 2013; Poelman et al., 2015), however, their uptake and utilization by subjects and their impact on diet adhere…”
BackgroundThe Application of Acceptance and Commitment Therapy to Obsessive-Compulsive Disorder
Twohig, M. P. (2009) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2008.02.008 · Cited by 89 · see citing works
“…heart rate when participants are exposed to an emotion-provoking film (Campbell-Sills, Barlow, Brown, & Hofmann, 2006), increases pain tolerance (Masedo & Esteve, 2007), increases tolerance of food cravings (Forman et al., 2007), and makes it easier to have unwanted thoughts (Marcks & Woods, 2005).”
Lillis, J., Levin, M. E., & Hayes, S. (2010) · Journal of Health Psychology · doi:10.1177/1359105310388321 · Cited by 110 · see citing works
“, 2009), and the ability to deal effectively with food cravings (Forman et al., 2007).”
BackgroundJärvelä-Reijonen, E., Karhunen, L., Sairanen, E., Muotka, J., Lindroos, S., Laitinen, J., Puttonen, S., Peuhkuri, K., Hallikainen, M., Pihlajamäki, J., et al. (2018) · International Journal of Behavioral Nutrition and Physical Activity · doi:10.1186/s12966-018-0654-8 · Cited by 85 · see citing works
“Using ACT is supported by the promising results of ACT-based interventions on food cravings [6] and weight loss [7–13].”
MethodGiuliani, N. R., & Berkman, E. T. (2015) · Psychological Inquiry · doi:10.1080/1047840x.2015.955072 · Cited by 84 · see citing works
“This route is the central feature of interventions including or based on mindfulness acceptance, which uncouples craving from consumption and changes the valuation of the craving from harmful to innocuous (e.g., Alberts, Mulkens, Smeets, & Thewissen, 2010; Forman et al., 2007).”
BackgroundWojnarowska, A., Kobylinska, D., & Lewczuk, K. (2020) · Frontiers in Psychology · doi:10.3389/fpsyg.2020.00242 · Cited by 82 · see citing works
“What is crucial is that acceptance is not explicitly present within the most influential model of emotion regulation, i.e., Gross’s process model (Gross, 1998), although it is present in others (Gratz and Roemer, 2004; Berking et al., 2008).”
BackgroundMethodResisting chocolate temptation using a brief mindfulness strategy
Jenkins, K., & Tapper, K. (2013) · British Journal of Health Psychology · doi:10.1111/bjhp.12050 · Cited by 82 · see citing works
Moore, W. J., McGrievy, M. E., & Turner‐McGrievy, G. M. (2015) · Eating Behaviors · doi:10.1016/j.eatbeh.2015.06.011 · Cited by 81 · see citing works
Batra, P. J., Das, S. K., Salinardi, T. C., Robinson, L. M., Saltzman, E. J., Scott, T. M., Pittas, A. G., & Roberts, S. B. (2013) · Appetite · doi:10.1016/j.appet.2013.05.002 · Cited by 79 · see citing works
“…(Forman et al., 2007; Moreno, RodrÃ-guez, Fernandez, Tamez, & Cepeda-Benito, 2008; Steel, Kemps, & Tiggemann, 2006), lack of success in weight loss (Forman et al., 2007; Hill, 2007; Jakubowicz, Froy, Wainstein, & Boaz, 2011; Lowe, 2003), and early drop-out from obesity treatment programs (Lim,…”
BackgroundInfluentialBarnes, R. D., & Tantleff‐Dunn, S. (2010) · Eating Behaviors · doi:10.1016/j.eatbeh.2010.03.001 · Cited by 79 · see citing works
The development and validation of the food craving acceptance and action questionnaire (FAAQ)
Juarascio, A., Forman, E., Timko, C. A., Butryn, M., & Goodwin, C. (2011) · Eating Behaviors · doi:10.1016/j.eatbeh.2011.04.008 · Cited by 76 · see citing works
“Current research has shown the promise of acceptance-based interventions at increasing physical activity (Butryn, Forman, Hoffman, Shaw, & Juarascio, 2011),managing food cravings (Forman et al., 2007), and maintaining weight loss (Forman, Butryn, Hoffman, & Herbert, 2009).”
BackgroundSelf-citationLillis, J., Niemeier, H. M., Thomas, J. G., Unick, J. L., Ross, K. M., Leahey, T. M., Kendra, K. E., Dorfman, L. R., & Wing, R. R. (2016) · Obesity · doi:10.1002/oby.21680 · Cited by 74 · see citing works
“Consistent with the literature on experiential avoidance, recent studies have suggested that cognitive and emotional control-focused strategies could paradoxically make it more difficult for individuals with obesity to cope with food cravings and instead lead to greater caloric consumption (16,17).”
BackgroundPaquet, C., Daniel, M., Knaüper, B., Gauvin, L. I., Kestens, Y., & Dubé, L. (2010) · American Journal of Clinical Nutrition · doi:10.3945/ajcn.2009.28648 · Cited by 72 · see citing works
Food cravings in pregnancy: Preliminary evidence for a role in excess gestational weight gain
Orloff, N. C., Flammer, A., Hartnett, J., Liquorman, S., Samelson, R., & Hormes, J. M. (2016) · Appetite · doi:10.1016/j.appet.2016.04.040 · Cited by 72 · see citing works
“…obesity, and binge eating 361 outside of pregnancy (Dalen et al., 2010; Daubenmier et al., 2011; Kristeller & Wolever, 2010) suggests 362 that these interventions might also be helpful in reducing overconsumption during pregnancy 363 specifically via a reduction in cravings (Forman et al., 2007).”
BackgroundLowe, M. R., Arigo, D., Butryn, M. L., Gilbert, J. R., Sarwer, D. B., & Stice, E. M. (2015) · Health Psychology · doi:10.1037/hea0000291 · Cited by 70 · see citing works
“In a study where participants carried chocolates with them for two days but were instructed not to eat them, the PFS predicted the frequency and intensity of chocolate cravings – and the degree of distress associated with them (Forman et al., 2007).”
BackgroundSelf-citationYu, Y., Mo, P. K. H., Zhang, J., Li, J., & Lau, J. T. F. (2021) · Journal of Medical Internet Research · doi:10.2196/26810 · Cited by 74 · see citing works
“…of alternative sources of rewards (eg, outdoors activities) to reduce perceived rewards of internet gaming, removal of sources of temptations and stimuli (eg, gaming devices), and introduction of distraction skills to reduce perceived urges or unwillingness to stop playing internet games [70,71].”
Gardner, B., Rebar, A. L., & Lally, P. J. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.041 · Cited by 69 · see citing works
Bradley, L. E., Forman, E. M., Kerrigan, S. G., Butryn, M. L., Herbert, J. D., & Sarwer, D. B. (2016) · Obesity Surgery · doi:10.1007/s11695-016-2125-0 · Cited by 66 · see citing works
Self-citationForman, E. M., Tronieri, J. S., Goldstein, S. P., Butryn, M. L., Martin, L., Meiran, N., Crosby, R. D., & Manasse, S. M. (2016) · Appetite · doi:10.1016/j.appet.2016.04.014 · Cited by 68 · see citing works
“, 2013) and help individuals cope with food cravings (Forman, Hoffman, Juarascio, Butryn, & Herbert, 2013; Forman et al., 2007).”
Self-citationThe independent and interacting effects of hedonic hunger and executive function on binge eating
Manasse, S. M., Espel‐Huynh, H., Forman, E. M., Ruocco, A. C., Juarascio, A. S., Butryn, M. L., Zhang, F., & Lowe, M. R. (2015) · Appetite · doi:10.1016/j.appet.2015.01.013 · Cited by 65 · see citing works
“Acceptance-based behavioral interventions may be indicated, due to preliminary evidence that strategies to accept, and gain psychological distance from, intense food cravings are effective for individuals with elevated hedonic hunger (Baer, Fischer, & Huss, 2005; Forman, Hoffman, Juarascio, Butryn, & Herbert, 2013; Fo…”
BackgroundSelf-citationPsychological inflexibility explains distress in parents whose children have chronic conditions
Sairanen, E., Lappalainen, P., & Hiltunen, A. (2018) · PLoS ONE · doi:10.1371/journal.pone.0201155 · Cited by 60 · see citing works
Dalton, M., Finlayson, G., Walsh, B., Halseth, A. E., Duarte, C., & Blundell, J. E. (2017) · International Journal of Obesity · doi:10.1038/ijo.2017.89 · Cited by 60 · see citing works
Changing Behavior Using Social Cognitive Theory
Łuszczyńska, A., & Schwarzer, R. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.003 · Cited by 71 · see citing works
Eating behaviors as predictors of weight loss in a 6 month weight loss intervention
Batra, P. J., Das, S. K., Salinardi, T. C., Robinson, L. M., Saltzman, E. J., Scott, T. M., Pittas, A. G., & Roberts, S. B. (2013) · Obesity · doi:10.1002/oby.20404 · Cited by 57 · see citing works
“61 Gender Male, n (%) 20 (27) 3 (14) Female n (%) 54 (73) 18 (86) Obesity Eating Behavior Constructs and Weight Loss Batra et al.”
BackgroundAssociations of reward sensitivity with food consumption, activity pattern, and BMI in children
Decker, A. D., Sioen, I., Verbeken, S., Braet, C., Michels, N., & Henauw, S. D. (2016) · Appetite · doi:10.1016/j.appet.2016.02.028 · Cited by 57 · see citing works
“It has been shown that some individuals are more 69 reactive to the palatable food environment (Paquet et al., 2010), and noteworthy, Forman et al. 70 reported that this reactivity codetermined the effect of the obesity prevention approaches used in 71 their study (Forman et al., 2007).”
Application of Machine Learning to Predict Dietary Lapses During Weight Loss
Goldstein, S. P., Zhang, F., Thomas, J. G., Butryn, M. L., Herbert, J. D., & Forman, E. M. (2018) · Journal of Diabetes Science and Technology · doi:10.1177/1932296818775757 · Cited by 56 · see citing works
Self-citationBlau, L. E., Orloff, N. C., Flammer, A., Slatch, C., & Hormes, J. M. (2018) · Eating Behaviors · doi:10.1016/j.eatbeh.2018.09.004 · Cited by 56 · see citing works
Yu, Y., Mo, P. K. H., Zhang, J., Li, J., & Lau, J. T. F. (2022) · Addictive Behaviors · doi:10.1016/j.addbeh.2022.107239 · Cited by 55 · see citing works
Warner, L. M., & French, D. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.032 · Cited by 53 · see citing works
Moffitt, R., Brinkworth, G., Noakes, M., & Mohr, P. (2012) · Psychology & Health · doi:10.1080/08870446.2012.694436 · Cited by 51 · see citing works
“engaging in counterproductive behaviours to alleviate these experiences (Forman et al., 2007; Hayes et al., 2006; Juarascio et al., 2010).”
BackgroundMethodInfluentialBraun, T. D., Park, C. L., & Conboy, L. A. (2012) · International Journal of Yoga Therapy · doi:10.17761/ijyt.22.1.y47k2658674t1212 · Cited by 51 · see citing works
Palmeira, L., Pinto‐Gouveia, J., & Cunha, M. I. V. A. (2016) · Appetite · doi:10.1016/j.appet.2016.07.015 · Cited by 55 · see citing works
“17 Forman, E. M., Hoffman, K. L., McGrath, K. B., Herbrt, J. D., Brandsma, L. L., Lowe, 18 M. R. (2007).”
Changing Behavior Using Ecological Models
Salmon, J., Hesketh, K. D., Arundell, L., Downing, K. L., & Biddle, S. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.017 · Cited by 51 · see citing works
Fisher, N. R., Lattimore, P. J., & Malinowski, P. (2015) · Appetite · doi:10.1016/j.appet.2015.12.009 · Cited by 48 · see citing works
Effects of addictive-like eating behaviors on weight loss with behavioral obesity treatment
Chao, A. M., Wadden, T. A., Tronieri, J. S., Pearl, R. L., Alamuddin, N., Bakizada, Z. M., Pinkasavage, E., Leonard, S. M., Alfaris, N., & Berkowitz, R. I. (2019) · Journal of Behavioral Medicine · doi:10.1007/s10865-018-9958-z · Cited by 48 · see citing works
Mujica-Parodi, L. R., Renelique, R., & Taylor, M. K. (2008) · International Journal of Obesity · doi:10.1038/ijo.2008.218 · Cited by 47 · see citing works
Sairanen, E., Tolvanen, A., Karhunen, L., Kolehmainen, M., Järvelä-Reijonen, E., Lindroos, S., Peuhkuri, K., Korpela, R., Ermes, M., Mattila, E., et al. (2017) · Public Health Nutrition · doi:10.1017/s1368980017000441 · Cited by 44 · see citing works
“Successful ACT mediators include general or specific measures of acceptance and psychological flexibility, defusion((25,28,29)), values((25)) and mindfulness((16)).”
Backgroundvan Dillen, L. V., & Andrade, J. (2016) · Appetite · doi:10.1016/j.appet.2015.09.013 · Cited by 54 · see citing works
Flexibility in weight management
Sairanen, E., Lappalainen, R. I., Lapveteläinen, A. T., Tolvanen, A. J., & Karhunen, L. J. (2014) · Eating Behaviors · doi:10.1016/j.eatbeh.2014.01.008 · Cited by 44 · see citing works
Changing Behavior Using Self-Determination Theory
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Iturbe, I., Echeburúa, E., & Maíz, E. (2021) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.2695 · Cited by 48 · see citing works
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“This assumption is supported by recent studies (Forman et al., 2007; Goosens, Braet, Vlierberghe, & Mels, 2008).”
ResultThe BestFIT trial: A SMART approach to developing individualized weight loss treatments
Sherwood, N. E., Butryn, M. L., Forman, E. M., Almirall, D., Seburg, E. M., Crain, A. L., Kunin‐Batson, A., Hayes, M. G., Levy, R. L., & Jeffery, R. W. (2016) · Contemporary Clinical Trials · doi:10.1016/j.cct.2016.01.011 · Cited by 44 · see citing works
“Empirical support for incorporating acceptance-based principles into SBT is building [49–54]; acceptance-based behavioral weight loss treatment (ABT) is particularly effective for certain individuals (e.”
BackgroundSelf-citationGetting Our Act Together: Toward a General Model of Self-Control
Magen, E., & Gross, J. J. (2010) · doi:10.1093/acprof:oso/9780195391381.003.0018 · Cited by 44 · see citing works
Ciarrochi, J., Sahdra, B., Marshall, S., Parker, P., & Horwath, C. (2014) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2014.07.002 · Cited by 42 · see citing works
“Control strategies may make it more difficult to cope with food cravings and lead to consumption of craved foods, whereas acceptance-based strategies may reduce craving-based consumption (Forman et al., 2007; Hooper, Sandoz, Ashton, Clark, & Mchugh, 2012).”
BackgroundCattivelli, R., Castelnuovo, G., Musetti, A., Varallo, G., Spatola, C. A. M., Riboni, F. V., Usubini, A. G., Tosolin, F., Manzoni, G. M., Capodaglio, P., et al. (2018) · Trials · doi:10.1186/s13063-018-2968-x · Cited by 41 · see citing works
“tory diseases, not to mention musculoskeletal and metabolic problems [22, 23, 29, 41, 42, 55, 58, 75, 82].”
Background
- Authors
- Forman, E. M., Hoffman, K. L., McGrath, K. B., Herbert, J. D., Brandsma, L. L., & Lowe, M. R.
- Affiliations
- Drexel University (US)
- Chestnut Hill College (US)
- Corresponding author
- Forman, Evan M.
- Venue
- Behaviour Research and Therapy
- Publisher
- Elsevier BV
- Published
- 2007-10
- Volume
- 45
- Issue
- 10
- Pages
- 2372-2386
- ISSN
- 0005-7967 (ISSN-L)
- OpenAlex
- W2012540132
- Cited by
- 295
- References
- 38
- Citations by year
- 2026: 6 · 2025: 3 · 2024: 8 · 2023: 4 · 2022: 8 · 2021: 11 · 2020: 58 · 2019: 12 · 2018: 22 · 2017: 13 · 2016: 18 · 2015: 26 · 2014: 20 · 2013: 16 · 2012: 18
- FWCI
- 13.04
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Behaviour Research and Therapy (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
- Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
- Keywords
- food cravings, weight loss maintenance, Power of Food Scale, chocolate consumption, distraction, cognitive restructuring, experiential acceptance, defusion, dietary habits
- MeSH terms
- Adaptation, Psychological, Adolescent, Adult, Behavior, Diet, Reducing, Feeding Behavior, Female, Food Preferences, Humans, Middle Aged, Obesity, Cognitive Behavioral Therapy, Multivariate Analysis
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