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Background: Food craving refers to an intense desire to consume a specific kind of food of which chocolate is the most often craved one. It is this intensity and specificity that differentiates food craving from feelings of hunger. Although food craving and hunger often co-occur, an energy deficit is not a prerequisite for experiencing food craving, that is, it can also occur without being hungry. Food craving often precedes and predicts over- or binge eating which makes it a reasonable target in the treatment of eating disorders or obesity. One of the arguably most extensively validated measures for the assessment of food craving are the Food Cravings Questionnaires (FCQs), which measure food craving on a state (FCQ-S) and trait (FCQ-T) level. Specifically, the FCQ-S measures the intensity of current food craving whereas the FCQ-T measures the frequency of food craving experiences in general. The aims of the present thesis were to provide a German measure for the assessment of food craving and to investigate cognitive, behavioral, and physiological correlates of food craving. For this purpose, a German version of the FCQs was presented and its reliability and validity was evaluated. Using self-reports, relationships between trait food craving and dieting were examined. Cognitive-behavioral correlates of food craving were investigated using food-related tasks assessing executive functions. Psychophysiological correlates of food craving were investigated using event-related potentials (ERPs) in the electroencephalogram and heart rate variability (HRV). Possible intervention approaches to reduce food craving were derived from results of those studies.
Methods: The FCQs were translated into German and their psychometric properties and correlates were investigated in a questionnaire-based study (articles #1 & #2). The relationship between state and trait food craving with executive functioning was examined with behavioral tasks measuring working memory performance and behavioral inhibition which involved highly palatable food-cues (articles #3 & #4). Electrophysiological correlates of food craving were tested with ERPs during a craving regulation task (article #5). Finally, a pilot study on the effects of HRV-biofeedback for reducing food craving was conducted (article #6).
Results: The FCQs demonstrated high internal consistency while their factorial structure could only partially be replicated. The FCQ-T also had high retest-reliability which, expectedly, was lower for the FCQ-S. Validity of the FCQ-S was shown by positive relationships with current food deprivation and negative affect. Validity of the FCQ-T was shown by positive correlations with related constructs. Importantly, scores on the subscales of the FCQ-T were able to discriminate between non-dieters and successful and unsuccessful dieters (article #1). Furthermore, scores on the FCQ-T mediated the relationship between rigid dietary control strategies and low dieting success (article #2). With regard to executive functioning, high-calorie food-cues impaired working memory performance, yet this was independent of trait food craving and rarely related to state food craving (article #3). Behavioral disinhibition in response to high-calorie food-cues was predicted by trait food craving, particularly when participants were also impulsive (article #4). Downregulation of food craving by cognitive strategies in response to high-calorie food-cues increased early, but not later, segments of the Late Positive Potential (LPP) (article #5). Few sessions of HRV-biofeedback reduced self-reported food cravings and eating and weight concerns in high trait food cravers (article #6).
Conclusions: The German FCQs represent sound measures with good psychometric properties for the assessment of state and trait food craving. Although state food craving increases during cognitive tasks involving highly palatable food-cues, impairment of task performance does not appear to be mediated by current food craving experiences. Instead, trait food craving is associated with low behavioral inhibition in response to high-calorie food-cues, but not with impaired working memory performance. Future studies need to examine if trait food craving and, subsequently, food-cue affected behavioral inhibition can be reduced by using food-related inhibition tasks as a training. Current food craving and ERPs in response to food-cues can easily be modulated by cognitive strategies, yet the LPP probably does not represent a direct index of food craving. Finally, HRV-biofeedback may be a useful add-on element in the treatment of disorders in which food cravings are elevated. To conclude, the current thesis provided measures for the assessment of food craving in German and showed differential relationships between state and trait food craving with self-reported dieting behavior, food-cue affected executive functioning, ERPs and HRV-biofeedback. These results provide promising starting points for interventions to reduce food craving based on (1) food-cue-related behavioral trainings of executive functions, (2) cognitive craving regulation strategies, and (3) physiological parameters such as HRV-biofeedback.
Objective: Brain Computer Interfaces (BCI) provide a muscle independent interaction channel making them particularly valuable for individuals with severe motor impairment. Thus, different BCI systems and applications have been proposed as assistive technology (AT) solutions for such patients. The most prominent system for communication utilizes event-related potentials (ERP) obtained from the electroencephalogram (EEG) to allow for communication on a character-by-character basis. Yet in their current state of technology, daily life use cases of such systems are rare. In addition to the high EEG preparation effort, one of the main reasons is the low information throughput compared to other existing AT solutions. Furthermore, when testing BCI systems in patients, a performance drop is usually observed compared to healthy users. Patients often display a low signal-to-noise ratio of the recorded EEG and detection of brain responses may be aggravated due to internally (e.g. spasm) or externally induced artifacts (e.g. from ventilation devices). Consequently, practical BCI systems need to cope with mani-fold inter-individual differences. Whilst these high demands lead to increasing complexity of the technology, daily life use of BCI systems requires straightforward setup including an easy-to-use graphical user interface that nonprofessionals can handle without expert support. Research questions of this thesis: This dissertation project aimed at bringing forward BCI technology toward a possible integration into end-users' daily life. Four basic research questions were addressed: (1) Can we identify performance predictors so that we can provide users with individual BCI solutions without the need of multiple, demanding testing sessions? (2) Can we provide complex BCI technology in an automated, user-friendly and easy-to-use manner, so that BCIs can be used without expert support at end-users' homes? (3) How can we account for and improve the low information transfer rates as compared to other existing assistive technology solutions? (4) How can we prevent the performance drop often seen when bringing BCI technology that was tested in healthy users to those with severe motor impairment? Results and discussion: (1) Heart rate variability (HRV) as an index of inhibitory control (i.e. the ability to allocate attention resources and inhibit distracting stimuli) was significantly related to ERP-BCI performance and accounted for almost 26% of variance. HRV is easy to assess from short heartbeat recordings and may thus serve as a performance predictor for ERP-BCIs. Due to missing software solutions for appropriate processing of artifacts in heartbeat data (electrocardiogram and inter-beat interval data), our own tool was developed that is available free of charge. To date, more than 100 researchers worldwide have requested the tool. Recently, a new version was developed and released together with a website (www.artiifact.de). (2) Furthermore, a study of this thesis demonstrated that BCI technology can be incorporated into easy-to-use software, including auto-calibration and predictive text entry. Naïve, healthy nonprofessionals were able to control the software without expert support and successfully spelled words using the auto-calibrated BCI. They reported that software handling was straightforward and that they would be able to explain the system to others. However, future research is required to study transfer of the results to patient samples. (3) The commonly used ERP-BCI paradigm was significantly improved. Instead of simply highlighting visually displayed characters as is usually done, pictures of famous faces were used as stimulus material. As a result, specific brain potentials involved in face recognition and face processing were elicited. The event-related EEG thus displayed an increased signal-to-noise ratio, which facilitated the detection of ERPs extremely well. Consequently, BCI performance was significantly increased. (4) The good results of this new face-flashing paradigm achieved with healthy participants transferred well to users with neurodegenerative disease. Using a face paradigm boosted information throughput. Importantly, two users who were highly inefficient with the commonly used paradigm displayed high accuracy when exposed to the face paradigm. The increased signal-to-noise ratio of the recorded EEG thus helped them to overcome their BCI inefficiency. Significance: The presented work at hand (1) successfully identified a physiological predictor of ERP-BCI performance, (2) proved the technology ready to be operated by naïve nonprofessionals without expert support, (3) significantly improved the commonly used spelling paradigm and (4) thereby displayed a way to effectively prevent BCI inefficiency in patients with neurodegenerative disease. Additionally, missing software solutions for appropriate handling of artifacts in heartbeat data encouraged development of our own software tool that is available to the research community free of charge. In sum, this thesis significantly improved current BCI technology and enhanced our understanding of physiological correlates of BCI performance.
The aim of this project was to investigate whether reflex-like innate facial reactions to tastes and odors are altered in patients with eating disorders. Qualitatively different tastes and odors have been found to elicit specific facial expressions in newborns. This specificity in newborns is characterized by positive facial reactions in response to pleasant stimuli and by negative facial reactions in response to unpleasant stimuli. It is, however, unclear, whether these specific facial displays remain stable during ontogeny (1). Despite the fact that several studies had shown that taste-and odor-elicited facial reactions remain quite stable across a human’s life-span, the specificity of research questions, as well as different research methods, allow only limited comparisons between studies. Moreover, the gustofacial response patterns might be altered in pathological eating behavior (2). To date, however, the question of whether dysfunctional eating behavior might alter facial activity in response to tastes and odors has not been addressed. Furthermore, changes in facial activity might be linked to deficient inhibitory facial control (3). To investigate these three research questions, facial reactions in response to tastes and odors were assessed. Facial reactions were analyzed using the Facial Action Coding System (FACS, Ekman & Friesen, 1978; Ekman, Friesen, & Hager, 2002) and electromyography.