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Unhealthy yet Avoidable—How Cognitive Bias Modification Alters Behavioral and Brain Responses to Food Cues in Individuals with Obesity

by Nora Mehl 1,2,†, Filip Morys 1,3,†, Arno Villringer 1,3,4 and Annette Horstmann 1,3,4,5,*
Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, 04103 Leipzig, Germany
MaxNetAging Research School, 18057 Rostock, Germany
Leipzig University Medical Centre, IFB Adiposity Diseases, 04103 Leipzig, Germany
Leipzig University Medical Centre, Collaborative Research Centre 1052-A5, 04103 Leipzig, Germany
Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, 00014 Helsinki, Finland
Author to whom correspondence should be addressed.
These authors contributed equally to this work.
Nutrients 2019, 11(4), 874;
Received: 10 March 2019 / Revised: 12 April 2019 / Accepted: 15 April 2019 / Published: 18 April 2019
Obesity is associated with automatically approaching problematic stimuli, such as unhealthy food. Cognitive bias modification (CBM) could beneficially impact problematic approach behavior. However, it is unclear which mechanisms are targeted by CBM in obesity. Candidate mechanisms include: (1) altering reward value of food stimuli; and (2) strengthening inhibitory abilities. Thirty-three obese adults completed either CBM or sham training during functional magnetic resonance imaging (fMRI) scanning. CBM consisted of implicit training to approach healthy and avoid unhealthy foods. At baseline, approach tendencies towards food were present in all participants. Avoiding vs. approaching food was associated with higher activity in the right angular gyrus (rAG). CBM resulted in a diminished approach bias towards unhealthy food, decreased activation in the rAG, and increased activation in the anterior cingulate cortex. Relatedly, functional connectivity between the rAG and right superior frontal gyrus increased. Analysis of brain connectivity during rest revealed training-related connectivity changes of the inferior frontal gyrus and bilateral middle frontal gyri. Taken together, CBM strengthens avoidance tendencies when faced with unhealthy foods and alters activity in brain regions underpinning behavioral inhibition. View Full-Text
Keywords: cognitive bias modification; obesity; approach–avoidance task; fMRI cognitive bias modification; obesity; approach–avoidance task; fMRI
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Mehl, N.; Morys, F.; Villringer, A.; Horstmann, A. Unhealthy yet Avoidable—How Cognitive Bias Modification Alters Behavioral and Brain Responses to Food Cues in Individuals with Obesity. Nutrients 2019, 11, 874.

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