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Introduction
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August 2007 - July 2008
March 1986 - present
Publications
Publications (362)
Background
Anxiety is a core characteristic of anorexia nervosa and a potential target of exposure therapy, which requires a profound understanding of the patients’ fears in order to be successful. The knowledge about fears in anorexia nervosa that should be targeted during exposure therapy can be enriched by laboratory research to the precise emot...
Previous research has shown that food avoidance can be learned via classical and operant conditioning. This leads to the question of whether learning deficits could contribute to the harmful food avoidance seen in individuals with anorexia nervosa. Accordingly, we tested whether healthy women with increased levels of anorexia nervosa symptoms and c...
Background
Anxiety is a core characteristic of anorexia nervosa and a target of exposure therapy, which can be optimized if we know more about the emotional and behavioral responses during exposure to anorexia nervosa relevant fear stimuli.
Methods
We exposed patients with anorexia nervosa and healthy controls to anorexia nervosa related fear stim...
Background:
In today's obesogenic environment high-caloric palatable foods are omnipresent, making it hard for many to reach and maintain a healthy body weight. This study investigates the effects of a health versus hedonic mindset on daily-life snacking behaviour. The hypothesis is that a health mindset leads to reduced snacking behaviour compare...
When evaluating ambiguous situations, humans sometimes use their behavior as a source of information (behavior-as-information effect) and interpret safety behaviors as evidence for danger. Accordingly, we hypothesized that eating disorder safety behaviors (restrictive eating, body checking, etc.) might aggravate fear and anxiety in individuals with...
The restriction of energy intake is a central and persistent symptom of anorexia nervosa. Recent models of the disorder suggest that food restrictions are learned avoidance behaviours, which are acquired and maintained by classical and operant conditioning. The present study aims to test this learning model of food restriction. It investigates whet...
Exposure therapy is known to be an effective intervention in the treatment of anxiety-related disorders. In eating disorders, such as anorexia nervosa, anxiety and avoidance are identified as maintenance factors. Therefore, they may constitute an important treatment target, suitable for the use of exposure therapy. Remarkably, exposure techniques t...
Brain responses to food are thought to reflect food's rewarding value and to fluctuate with dietary restraint. We propose that brain responses to food are dynamic and depend on attentional focus. Food pictures (high-caloric/low-caloric, palatable/unpalatable) were presented during fMRI-scanning, while attentional focus (hedonic/health/neutral) was...
Background
Treating disordered feeding at a young age reduces risks of future feeding problems, but not all children profit equally; can we define predictors of a worse prognosis?
Objectives
In 252 children, with a mean age of 4; 7 years (SD = 3 years; range 5 months to 17; 10 years), who had undergone behavioral day treatment in the past, several...
Background
Fears and avoidance behaviors are common symptoms of eating disorders. It was investigated whether different eating disorder diagnoses are equally characterized by similar fears and avoidance behaviors.
Methods
Individuals with self-reported eating disorders (n = 250) and healthy controls (n = 95) completed online questionnaires assessi...
Adopting a healthier lifestyle includes replacing long-standing unhealthy eating habits with new healthier ones and maintaining these newly acquired healthy eating habits. A permanent behavior change appears to be difficult to maintain, which may follow from some basic learning processes. In the last decades, a lot was learned about the learning me...
Evidence for attention bias (AB) for food in restrained eaters is inconsistent. A person's mindset related to food - that is, whether someone focuses on the hedonic or health aspects of food - might be an overlooked influence on AB for food, possibly explaining the inconsistency in the literature. Fluctuations between a hedonic versus a health mind...
Background: Anxiety and avoidance behaviors are common maintenance symptoms of anorexia nervosa. It was investigated whether those behaviors are transdiagnostic eating disorder characteristics.
Methods: Eating disorder patients (n=250) and healthy controls (n=111) completed online questionnaires assessing general anxieties, eating disorder specific...
Obesity reached pandemic proportions and weight-loss treatments are mostly ineffective.
The level of brain activity in the reward circuitry is proposed to be proportionate to the reward value of food stimuli, and stronger in people with obesity. However, empirical evidence is inconsistent. This may be due to the double-sided nature of high caloric...
Brain responses to food are thought to reflect food’s rewarding value. We propose that brain responses to food are more dynamic and hypothesize that brain responses to food depend on attentional focus. Food pictures (high-caloric/low-caloric, palatable/unpalatable) were presented during fMRI-scanning, while attentional focus (hedonic/health/neutral...
Background
Young children with disordered feeding may be at increased risk for problematic eating in the future. This retrospective study attempts to identify predictors of later feeding problems.
Objectives
Children ( N = 236) with disordered feeding, who refrained from behavioral treatment after consultation at a tertiary treatment center for fe...
Obesity is a worldwide pandemic and theories propose that attentional bias (AB) for food triggers craving and overeating, especially for people with obesity. However, empirical evidence is inconsistent, which may be due to methodological diversity and the double-sided nature of high-caloric palatable foods. That is, these foods simultaneously have...
A person can alternate between food-related mindsets, which in turn may depend on one's emotional state or situation. Being in a certain mindset can influence food-related thoughts, but interestingly it might also affect eating-related physiological responses. The current study investigates the influence of an induced ‘loss of control’ mindset as c...
Anorexia Nervosa is a severe and disabling mental disorder and a huge challenge to treat. Intense fears of e.g., food, eating, weight gain and social evaluation are core features of anorexia nervosa and obstacles during treatment. The perceived threats trigger avoidance and safety behaviors like highly restrictive eating, strict eating rules, vomit...
Learning theorists suggest extinction learning to be a central mechanism in weight loss success; however, empirical studies are scarce. In this pilot study, it was examined whether individual differences in extinction learning predict outcome after weight loss treatment. Overweight and obese individuals first completed a laboratory conditioning tas...
Background
People with overweight have stronger reactivity (e.g., subjective craving) to food cues than lean people, and this reactivity is positively associated with food intake. Cue reactivity is a learned response that can be reduced with food cue exposure therapy.Objectives
It was hypothesized that participants after food cue exposure therapy w...
Calorie-reduced diets to combat obesity do work, but they only work when one sticks to the diet and the - relatively small - weight loss usually is short-lived. It is argued that calorie-reduced diets should converge with enduring lifestyle changes: the diet is just the start of a lifelong new eating pattern. Getting people to change their lifestyl...
Research investigating neural responses to visual food stimuli has produced inconsistent results. Crucially, high-caloric palatable foods have a double-sided nature - they are often craved but are also considered unhealthy - which may have contributed to the inconsistency in the literature. Taking this double-sided nature into account in the curren...
Findings of a few recent studies suggest that obesity is characterized by deficits in appetitive learning about food cues. This could point towards an increased tendency in obese individuals to overgeneralize appetitive responding to stimuli that resemble the conditioned food cue - possibly explaining frequent eating desires and overeating in obesi...
Background:
The present study examined food cravings in daily life by comparing overweight and normal-weight participants right before eating events and at non-eating moments. It was hypothesised that overweight participants would have (i) more frequent, (ii) stronger and (iii) a greater variety of high-caloric palatable food cravings, and also wo...
In dit artikel wordt het standaard medische model van eetstoornissen kritisch beschouwd en een veelbelovend alternatief geïntroduceerd: de netwerkbenadering van eetstoornissen. De centrale assumptie in de netwerkbenadering is – in tegenstelling tot het medische model – dat symptomen geen inwisselbare indicatoren van de onderliggende oorzaak zijn, m...
Objective
Avoidant/restrictive food intake disorder (ARFID) is a new diagnosis in the DSM‐5 Feeding and Eating Disorders section, for which very limited treatment research has been carried out, yet. A new, 4‐week exposure based cognitive behavioral therapy (CBT) day treatment, which integrated the inhibitory learning principles, was developed for a...
Background
Insufficient weight loss and weight regain is seen in 20–30% of the post-bariatric population. More knowledge about the effect of physical activity and eating style on weight change after Roux-en-Y gastric bypass is essential since behaviour can be modified and thereby results improved. The goal of this study is to determine the relation...
Background:
Body contouring surgery (BCS) improves quality of life, weight loss and body image after bariatric surgery. It is unclear why only a minority of the post-bariatric population undergoes BCS. In this study, we assess overhanging skin, body satisfaction and qualification for reimbursement of BCS in a Dutch post-bariatric population and st...
In dit hoofdstuk bespreken wij de basis van cognitieve therapie voor anorexia nervosa, boulimia nervosa, eetbuistoornis en obesitas. Eerst volgt een korte beschrijving van de eetstoornissen. Vervolgens wordt het cognitieve model gepresenteerd, waarna niet alleen voorbeelden van cognitieve therapie, maar ook van ‘cognitive behavior therapy – enhance...
Background and objectives:
Learning models of overeating predict that exposure therapy is effective in reducing food cue reactivity and overeating. This pilot study tested an eight-session exposure therapy aimed at inhibitory learning vs. an active control condition aimed at lifestyle improvement for obesity (treatment-as-usual). Main outcomes are...
Obesity rates are rising worldwide. Executive function and delay discounting have been hypothesized to play important roles in the self-regulation of behavior, and may explain variance in weight loss treatment success. First, we compared individuals with obesity (n = 82) to healthy weight controls (n = 71) on behavioral and self-report measures of...
The goal of this special issue is to highlight examples of translational research, wherein findings or principles from basic science are translated into efficacious prevention and treatment interventions for a public health problem. Bridging the gap between basic research and clinical practice has several advantages. First, basic science findings o...
Purpose of review:
The dominant view in the literature is that increased neural reactivity to high-caloric palatable foods in the mesocorticolimbic system is a stable-specific characteristic of obese people. In this review, we argue that this viewpoint may not be justified, and we propose that the neural response to food stimuli is dynamic, and in...
Purpose of review:
This review provides an overview of recent findings relating to the role of Pavlovian conditioning in food cue reactivity, including its application to overeating and weight loss interventions.
Recent findings:
Both in the laboratory and in real life, cue-elicited appetitive reactivity (e.g., eating desires) can be easily lear...
Background:
Overhanging skin in postbariatric patients leads to a negative body image. In patients with obesity, negative body image is related to more depressive symptoms and a higher weight. This relationship might also be important in postbariatric patients, because improvement of body image via body contouring surgery (BCS) could lead to bette...
Background
Knowledge is limited on the role the ability to self-regulate plays in the long-term outcome of obesity treatment in children and adolescents with severe obesity. The purpose of this study was to determine whether the ability to self-regulate after an one year intensive, partly inpatient, combined lifestyle intervention is associated wit...
Objective:
This study tested the role of habituation of eating desires and violation of overeating expectancies during food cue exposure in obese women.
Method:
52 obese females were randomised into a two-session exposure condition aimed at habituation, a two-session exposure condition aimed at expectancy violation, or a no-treatment control con...
In the present we study investigated whether addition of a Go/No Go training enhanced the effects of food cue exposure. We assessed desire to eat, salivation, CS-US expectancies, and eating in the absence of hunger (EAH) during and after cue exposure. Participants (N = 71) were chocolate-loving female students who tried to eat less chocolate in dai...
Background and objectives:
This study tested whether two sessions of food cue exposure therapy reduced eating in the absence of hunger (EAH), specified for exposed and non-exposed food, in overweight and obese adolescents, and whether habituation of food cue reactivity and reduced CS-US expectancies predicted a decrease in EAH.
Methods:
41 overw...
Overweight and obese individuals show increased psychological and physiological reactivity to food cues and many of them have difficulties in achieving long-term weight loss. The current study tests whether abnormalities in the learning and extinction of appetitive responses to food cues might be responsible for this. Overweight/obese and healthy w...
Studies on human appetitive conditioning using food rewards can benefit from including psychophysiological outcome measures. The present study tested whether the skin conductance response can function as a measure of differential responding in an appetitive conditioning paradigm including an acquisition and extinction phase, and examined which time...
Introduction:
Effect of bariatric surgery on health-related quality of life (HRQOL) varies greatly. This might be caused by the diversity in questionnaires used to assess HRQOL and the weight loss of the studied population. This study assesses the relationship between weight loss and HRQOL in primary Roux-en-Y gastric bypass (RYGB) patients by usi...
Working Memory (WM) plays a crucial role in successful self-regulation of behavior, including weight regulation. Improving WM might therefore be a promising strategy to support weight loss. In the present study, overweight individuals with a desire to lose weight (N = 91) received an online lifestyle intervention, in conjunction with either 25 sess...
Human laboratory studies have shown that eating desires are easily learned through classical conditioning: after a few pairings of an initially neutral stimulus (e.g., a box) with the intake of palatable food (e.g., chocolate), the stimulus elicits increased eating expectancies and eating desires (acquisition). After repeated non-reinforced present...
In experimental studies that investigate reactivity to the sight and smell of highly palatable snack foods, ad libitum food intake is commonly used as a behavioural outcome measure. However, this measure has several drawbacks. The current study investigated two intake-related measures not yet validated for food cue exposure research involving commo...
High-sugar/high-fat foods are related to binge-eating behaviour and especially people with low inhibitory control may encounter elevated difficulties to resist their intake. Incentive sensitization to food-related cues might lead to increased motivated attention towards these stimuli and to cue-induced craving. To investigate the combined influence...
Obesity and depression have important health implications. Although there is knowledge about the moderators of the depression-obesity association, our understanding of the potential behavioral and cognitive mediators that may explain the relationship between depression and obesity, is scarcely researched. The aim of this study is to investigate the...
In this study, it was examined whether overweight is associated with food-related obsessions and compulsions. Participants with a healthy weight (n = 27) and participants who were overweight (n = 33) filled out the Yale-Brown-Cornell Eating Disorder Scale, the Eating Obsessive-Compulsive Scale, and the Emotional and Behavioral Reactions to Intrusio...
In eating research, it is common practice to group people into different eater types, such as emotional, external and restrained eaters. This categorization is generally based on scores on self-report questionnaires. However, recent studies have started to raise questions about the validity of such questionnaires. In the realm of emotional eating,...
Background:
Problematic alcohol use is common among university students and personality might account for individual differences in developing this maladaptive behavior. Two personality dispositions implicated in problematic alcohol use are negative urgency and neuroticism. However, the relationship of these traits to problematic alcohol use is un...
Working memory (WM) plays a critical role in cognitive control by shielding self-regulatory goals from distraction by desire-related thoughts and emotions. This study examined whether training WM increases self-regulation in overweight participants. It was hypothesized that WM training would decrease psychopathological eating-related thoughts, (ove...
The prevalence of overweight and obesity has increased substantially over the last decades. Weight loss attempts in overweight individuals are common, though they seldom result in successful long-term weight loss. One very promising treatment is food cue exposure therapy, during which overweight individuals are repeatedly exposed to food-associated...
Attention bias for food could be a cognitive pathway to overeating in obesity and restrained eating. Yet, empirical evidence for individual differences (e.g., in restrained eating and body mass index) in attention bias for food is mixed. We tested experimentally if temporarily induced health versus palatability mindsets influenced attention bias fo...
Long-term weight loss maintenance is difficult to achieve. Effectiveness of obesity interventions could be increased by providing extended treatment, and by focusing on person-environment interactions. Ecological Momentary Intervention (EMI) can account for these two factors by allowing an indefinite extension of a treatment protocol in everyday li...
Although eating desires can be easily learned, their extinction appears more difficult. The present two-session study aimed to investigate the role of eating expectancies in the short and longer-term extinction of eating desires. In addition, the relationship between eating desires and conditioned evaluations was examined to test whether they might...
Change your lifestyle: decrease your energy intake and increase your energy expenditure, is what obesity experts tell people who need to lose weight. Though the advice might be correct, it appears to be extremely difficult to change one’s lifestyle. Unhealthy habits usually are ingrained and hard to change, especially for people with an “obese cogn...
Appetitive learning has been demonstrated several times using neutral cues or contexts as a predictor of food intake and it has been shown that humans easily learn cued desires for foods. It has, however, never been studied whether internal cues are also capable of appetitive conditioning. In this study, we tested whether humans can learn cued eati...
Background and objectives
Successful long-term dieting appears to be difficult, and part of its difficulty might be explained by processes related to classical appetitive conditioning. Increasing the speed of extinction of appetitive responses to food cues and decreasing the magnitude of returns of these responses could help increase the long-term...
Obesity seems related to a preference for immediate gratification. By changing this focus on short term benefits to a more future-oriented outlook, delay discounting (impulsive decision making) can be changed by a manipulation of episodic future thinking (EFT). EFT comprises a vivid mental simulation of general future experiences. EFT may also affe...
This study tested Expand Your Horizon, a programme designed to improve body image by training women to focus on the functionality of their body using structured writing assignments. Eighty-one women (Mage=22.77) with a negative body image were randomised to the Expand Your Horizon programme or to an active control programme. Appearance satisfaction...
Obesity prevalence among children is high and knowledge on cognitive factors that contribute to children's reactivity to the "obesogenic" food environment could help to design effective treatment and prevention campaigns. Empirical studies in adults suggest that attention bias for food could be a risk factor for overeating. Accordingly, the current...
Women with a negative body evaluation display covariation bias: They overestimate the relation between their own body and negative social feedback. This study aimed to develop a more fine-grained understanding of this covariation bias and to determine whether it could be diminished.
Seventy women completed a computer task wherein three categories o...
Background
Children's picky eating behaviour has been linked both to being overweight and underweight. However, the role of parenting practices in this relationship has rarely been investigated. The present study aimed to clarify the direction of the association between picky eating and weight status and to examine the moderating role of food paren...
Time orientation could play an important role in eating behavior. The current study investigated whether eating behavior is associated with the Consideration of Future Consequences scale (CFC). Specifically, it was examined whether unhealthy eaters consider the future less and are more concerned with immediate gratification. A related measure of ti...
Emotional eating has been suggested to be a learned behaviour; more specifically, classical conditioning processes might be involved in its development. In the present study we investigated whether a negative mood facilitates appetitive conditioning, and whether trait impulsivity influences this process.
After undergoing either a negative or neutra...
Earlier research has demonstrated that food-specific inhibition training wherein food cues are repeatedly and consistently mapped onto stop signals decreases food intake and bodyweight. The mechanisms underlying these training effects, however, remain unclear. It has been suggested that consistently pairing stimuli with stop signals induces automat...
Feelings of body dissatisfaction are common in Western society, especially in women and girls. More than innocent discontent, body dissatisfaction can have serious consequences such as depression and eating disorders. The current article discusses the nature of body dissatisfaction, how it develops and how it is currently being treated. We also dis...