Food Cravings Clinical Trial
Official title:
The Emotional Freedom Technique (EFT) Versus a Waitlist for Food Cravings: A Randomized Clinical Trial
This pilot study will examine one issue only in weight loss - food cravings in overweight
(i.e. BMI between 25-29.9) or obese (BMI greater than 30) consumers. Food craving is
hypothesized to be an important intervening causal variable and the development of obesity.
This randomized clinical trial will explore whether a relatively under researched energy
based therapeutic procedure, Emotional Freedom Techniques (EFT), can reduce food cravings in
participants under laboratory-controlled conditions, and compare this to a waitlist group.
The following foods will be tested: chocolate, salty foods (e.g. chips, crisps, salted
nuts), sweet carbohydrate foods (eg. cakes, biscuits, soft/soda drinks), carbohydrate foods
which are neither sweet nor salty such as white refined foods such as bread), and
caffeinated items.
Research examining energy based procedures (e.g. EFT) combines cognitive strategies with
somatic procedures adapted from acupuncture and related systems for altering the cognitive,
behavioural, and neurochemical foundations of psychological problems. It is often referred
to as "psychological acupuncture". Few adequately controlled studies have been conducted on
EFT however acupuncture has been quite extensively studied, with hundreds of research
reports published (see attached references).
Screening will occur over the telephone with one of the chosen self report questionnaires -
the Food Craving Inventory (FCI; White et al., 2002). The FCI is a reliable and valid
measure for the assessment of cravings for specific types of foods: High Fats, Sweets,
Carbohydrates/Starches, and Fast Food Fats, all of which comprise the higher order construct
of "food craving" or the FCI Total score (White et al., 2002). Higher numbers for each of
the subscales reflect greater cravings for that food type with the highest score being 185.
Scores of 93 or higher during the screen will be used to admit subjects to the next
diagnostic interview phase of the trial. In addition, subjects will be asked their weight
and height in order to ascertain their BMI and this will be confirmed in the diagnostic
interview with a standardized weight machine.
The Structured Clinical Interview (SCID-II; Spitzer, Williams, Gibbon, & First, 1990) has 12
groups of questions corresponding to12 personality disorders and will be used as a
diagnostic tool in a face-to-face interview with subjects who are suitable from the
telephone screen. The aim is to exclude any active diagnoses from the DSM-IV in order to
obtain the purest non clinic sample possible. All subjects will be notified by letter of the
outcome of their diagnostic interview and those unsuitable for the trial will be told they
did not meet selection criteria. Suitable practitioners who would be able to provide
individual support for the food cravings will be provided in written format. Subjects who
meet a diagnostic category will be informed of this and appropriate referral will be
offered.
Participants will be randomly assigned (using the NHMRC Clinical Trials Centre service) to a
free group EFT treatment condition or a non treatment waitlist control condition of the same
duration (4 weeks). This design ensures that potential treatment gains are neither due to
the mere passage of time nor regression to the mean. To limit attrition from waitlist
conditions, several contacts will be made with the waiting clients. Prescheduled phone
contacts, for example, may maintain adherence to the waitlist condition.
Prior to treatment all subjects will be weighed and height measured for their BMI status and
food craving outcome measures (pre, post and follow-up) will be measured using:
1. SUDS rating (subjective) in daily food diaries (food diaries were chosen as a method
that best measures real-life eating behaviour)
2. Power of Food Scale (Didie, 2003)
3. Food Craving Inventory (White et al., 2002)
Three aspects of eating behaviour will be measured using the Revised Restraint Scale (Herman
& Polivy, 1980). The items are summed for a total score that ranges from 0 to 40. High
scores indicate chronic dieting in which the individual is constantly cycling on and off the
diet, typically without any substantial weight loss. Dietary restraint appears to play a
causal role in the development of eating disorders and obesity and loss of control over
intake. Food cravings may trigger these eating behaviours.
The Symptom Assessment 45 (SA-45, Strategic Advantage, 1998) will be used to assess
symptomatology across nine psychiatric domains and as measures of the outcome of the
psychological intervention.
Demographic information will be collected in questionnaire format at the beginning of the
study.
The EFT intervention will consist of 4 sessions (2 hours duration) with homework and will be
based on standard delivery of EFT, as per founder Gary Craig's training for level 1 EFT
certification ( see http://www.emofree.com/WorkShop/workshop-guidelines.htm#Level%201).
Participants will be recruited through community announcements in print advertisements,
radio, and television. Inclusion and exclusion criteria will be highlighted in the
advertising. Criteria will consist of: participants being (l) over 18 years old and under 60
years and not suffering any severe psychological impairment, (2) not currently receiving
treatment (psychological or medical) for their food cravings, (3) agree to be contacted for
follow-up testing. Women and men will be included, and (4) active diagnoses from the SCID II
and subjects taking 'heavy' psychotropic (see attached list) which can suppress feelings,
cravings and sensitivity will be excluded.
Known sufferers of diabetes (Type I and II) and hypoglycemia will be excluded due to any
physiological aetiology (effects related) to food cravings.
Eligible applicants will be offered participation in the study through an informed consent
procedure. Self report questionnaires will be issued as part of the study and a demographic
questionnaire will be included in this. All identifying information will be destroyed once
data has been analysed.
Unsuitable participants will be advised in letter form that they did not meet selection
criteria, and a list of suitable practitioners will be included should they wish to address
their food craving.The study will use a Research Assistant to screen participants,
administer questionnaires and collate data. Separate qualified clinicians to the
investigating researchers will be used to deliver the EFT treatment condition.
The treatments will be delivered in a number of appropriate venues. Analysis will examine
pre versus post effects for each intervention to highlight any differences in self report,
and a repeated measures ANOVA will examine the effect of time on all the self report scores.
The following questions will be addressed: does EFT reduce food cravings and weight more
than no intervention? It is anticipated that because this is a pilot study, results may
indicate positive direction for these questions only. Due to anecdotal suggestion that EFT
has long lasting effects (see http://www.emofree.com/articles.aspx?id=19), it is
hypothesised that food cravings will reduce significantly with the EFT intervention and
remain consistent at follow-up points. It is expected that the waitlist condition will
remain unaffected prior to any treatment condition. Increases in eating restraint and
decreases in SUDS ratings and general psychopathology are expected with the EFT intervention
post treatment and are expected to stay constant at 3-, 6- and 12-month follow-up. Gender
and age will be examined.
A standard process will be used for informed consent, including a general information sheet
for subjects and consent form indicating any areas of psychological risk, benefits of the
study, self report questionnaire details and follow-up procedures. Detailed information
about what constitutes a food craving will be given to all subjects as well as information
about voluntary involvement and study withdrawal.
;
Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Single Group Assignment, Masking: Single Blind (Caregiver), Primary Purpose: Treatment
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