Affective responses to overeating episodes in women participating in a behavioral weight loss program

abstinence violation effect weight loss

Depression and other co-morbid mental illnesses are common in youth with BE/LOC and further research is needed to examine how this influences BE/LOC and weight loss (71, 72). One included study found that the presence of at least one psychological disorder showed negative predictive value for weight loss four months after the start of the program (48). Additionally, some studies hypothesized that disordered psychological symptoms may predict risk for BE/LOC behavior, although others postulate that BE/LOC behaviors may predict these symptoms. One study found that overweight adolescents who report more symptoms of depression are more at risk of developing LOC in the future (47). Similarly, pediatric LOC often predicts both worsening disordered eating and disordered mood symptoms (45).

Obesity: Understanding and treating a serious, prevalent, and refractory disorder

In the multifaceted journey of overcoming addiction and living a healthier life, individuals often encounter a psychological phenomenon known as the abstinence violation effect (AVE). It sheds light on the challenges individuals face when attempting to maintain abstinence and how a single lapse can trigger a surge of negative emotions, potentially leading to a full relapse or a return to unhealthy living (Collins & Witkiewitz, 2013; Larimer, Palmer, & Marlatt, 1999). A common pattern of self-regulation failure occurs for addicts and chronic dieters when they ‘fall off the wagon’ by consuming the addictive substance or violating their diets [5]. Marlatt coined the term abstinence violation effect to refer to situations in which addicts respond to an initial indulgence by consuming even more of the forbidden substance [11]. In one of the first studies to examine this effect, Herman and Mack experimentally violated the diets of dieters by requiring them to drink a milkshake, a high-calorie food, as part of a supposed taste perception study [27]. Although non-dieters ate less after consuming the milkshakes, presumably because they were full, dieters paradoxically ate more after having the milkshake (Figure 1a).

  • Motivation may relate to the relapse process in two distinct ways, the motivation for positive behaviour change and the motivation to engage in the problematic behaviour.
  • Her research interests include addictions, posttraumatic stress disorder, sexuality, and relationships.
  • This is an inherent issue for event assessments, raising concerns for social desirability and non‐compliance.

Relapse road maps

One significant limitation is a result of the range of BE/LOC measures used across studies. While this allowed for analysis of both BE and LOC behaviors, it is important to recognize that these are different concepts, and thus could benefit from separate analysis. This review, and most of the included studies, did not assess related eating disorder pathology, such as weight or shape concerns, bulimia nervosa or other purging behaviors. However, some studies did report this, including Braet et al. 2004 which found that those who reported BE at baseline, when compared to those who did not, had greater improvement in bulimia, body dissatisfaction, and shape concerns following treatment. Similarly, Carnier et al. 2008 found that short-term therapy was effective in significantly reducing the prevalence of both BE and bulimia nervosa symptoms in their sample, attributing this to the encouragement of normal eating behaviors.

abstinence violation effect weight loss

Supporting information

  • Demographics and characteristics of health practitioners and persons who regained weight.
  • They assume a distinction between stress coping skills, which are responses intended to deal with general life stress, and temptation coping skills, which are coping responses specific to situations in which there are temptations for substance which could contribute to relapse13.
  • Carels et al.20 found hunger was higher during temptations and lapses, fullness was lower during temptations (but not lapses), and satisfaction with a previous meal was lower during lapses (but not temptations).
  • Another distinction between these groups of studies is that nearly all the studies that found no significant association had relatively short follow-up times, either 5 months, 9 months, 1 year, 2 years, or no follow-up.

The expected drug effects do not necessarily correspond with the actual effects experienced after consumption. Based on operant conditioning, the motivation to use in a particular situation is based on the expected positive or negative reinforcement value of a specific outcome in that situation5. Both negative and positive expectancies are related to relapse, with negative expectancies being protective against relapse and positive expectancies being a risk factor for relapse4. Those who drink the most tend to have higher expectations regarding the positive effects of alcohol9. In high-risk situations, the person expects alcohol to help him or her cope with negative emotions or conflict (i.e. when drinking serves as “self-medication”).

Advances in behavioral treatment of obesity

Her work focuses on implicit (i.e. nonconscious or automatic) cognitive processes that contribute to the development and maintenance of maladaptive behavior and psychopathology. Support for her work has been provided by the National Institute on Alcohol Abuse and Alcoholism and the University of Washington’s Alcohol and Drug Abuse Institute. The FDA encourages consumers and health care professionals to report any adverse events to the agency’s MedWatch Adverse Event Reporting program so the agency can take action to protect the public from any unsafe products. The FDA is also committed to protecting consumers from the risks of buying medicines online and helping them be more aware of how to buy online safely. Additionally, consumers should search for product information from sources other than sellers and ask a doctor for help distinguishing between reliable and questionable information.

  • Along with the client, the therapist needs to explore past circumstances and triggers of relapse.
  • One included study found that the presence of at least one psychological disorder showed negative predictive value for weight loss four months after the start of the program (48).
  • These findings indicate that monitoring changes in sensations during dieting could help identify the crucial moments when coping strategies are most effective for aiding with dietary adherence.
  • Critical for craving and relapse is the process of associative learning, whereby environmental stimuli repeatedly paired with drug consumption acquire incentive-motivational value, evoking expectation of drug availability and memories of past drug euphoria15.

The on-site concept mapping session for the health practitioners lasted 1.5 h and the session for the persons who regained weight lasted two hours. The difference in sorting and rating methods between stakeholder groups (online vs print) was based on recommendations given by the health practitioners, who believed sorting statements on paper would be easier than doing it online. As participants came up with new statements during the brainstorm session, a portable label printer was used to print new cards for the persons who regained weight. For the health practitioners, all new statements were directly entered into the online software.

Lapse-Activated Pattern and Abstinence Violations

abstinence violation effect weight loss

(a) When restrained eaters’ diets were broken by consumption of a high-calorie milkshake preload, they subsequently show disinhibited eating (e.g. increased grams of ice-cream consumed) compared to control subjects and restrained eaters who did not drink the milkshake (figure based on data from [30]). (b) Restrained eaters whose diets were broken by a milkshake preload showed increased activity in the nucleus accumbens (NAcc) compared to restrained eaters who did not consume the preload and satiated non-dieters [64]. On Dec. 8, 2021, the FDA warned consumers not to purchase or use nine potentially dangerous sexual enhancement products available for purchase from

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Study Selection

abstinence violation effect weight loss

Because relapse is the most common outcome of treatment for addictions, it must be addressed, anticipated, and prepared for during treatment. The RP model views relapse not as a failure, but as part of the recovery process and an opportunity for learning. Marlatt (1985) describes an abstinence violation effect (AVE) that leads people to respond to any return to drug or alcohol use after a period of abstinence with despair and a sense of failure. By undermining confidence, these negative thoughts and feelings increase the likelihood that an isolated “lapse” will lead to a full-blown relapse.

These key stakeholders include adults attempting weight loss and health practitioners. Preventing people from relapsing into unhealthy habits requires insight into predictors of relapse in weight loss maintenance behaviors. We aimed to explore predictors of relapse in physical activity and dietary behavior from the the abstinence violation effect refers to perspectives of health practitioners and persons who regained weight, and identify new predictors of relapse beyond existing knowledge. Last, it would be of interest to develop a theoretical framework, consisting of various predictors of relapse in weight loss maintenance behaviors and its dynamic interactions.

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