Attention under control? Modification and modulation of attentional bias toward food in binge eating

Attentional processes are thought to play a role in binge eating by shaping responses to food cues and contributing to the maintenance of the disordered eating behavior. A central construct in this context is attentional bias toward food – the tendency to orient attention more quickly toward food cues or to dwell on them longer than on neutral stimuli. Such biases may heighten craving, strain self-control, and increase the likelihood of overeating. If so, modifying attentional processes could represent a promising intervention. Yet evidence for attentional bias modification training is mixed: effects are often small, unstable, and rarely translate into symptom improvement. Further complicating the picture, attentional bias is not static but fluctuates with situational and motivational states such as stress. The dynamics of attentional bias in binge eating remain insufficiently understood. Against this background, this dissertation addressed three overarching questions: (1) Can attentional bias toward food be modified, either at the trait level through repeated training or at the state level under acute stress? (2) Do changes in attentional bias covary with changes in binge eating, craving, or intake, thereby supporting a causal role of attentional bias in binge eating? (3) Do dynamic indices of attention, such as attentional bias variability, differ between individuals with and without binge eating? Study 1, a randomized controlled trial, tested whether a four-session attentional bias modification training could reduce attentional bias in individuals with binge eating disorder. The training did not produce sustained or generalized reductions one week after completion. Decreases in initial dwell time bias and reaction time variability occurred in both training and control groups but were nonspecific. Changes in attentional bias were unrelated to changes in binge eating frequency or craving. Exploratory analyses suggested that reaction time attentioanl bias variability was elevated in binge eating disorder and associated with greater symptom severity. Before Study 2, a pilot study was conducted in which two adapted methods were successfully validated: the snacktest, a more credible alternative to the bogus taste test, and the videoconference Trier Social Stress Test, a resource-efficient stress induction paradigm. Both methods were implemented in the subsequent study. Study 2 used an experimental within-person design to examine whether acute psychosocial stress modulates attentional processing of food cues in individuals with and without binge eating. Stress significantly increased craving in the group with binge eating but did not increase laboratory food intake. Mean attentional bias indices (dwell time, direction, reaction time) were unaffected, whereas dwell time bias variability increased under stress and was higher in participants with binge eating than in those without. Taken together, targeted modification of mean attentional bias was not successful in either study, and changes in attentional bias did not covary with changes in eating behavior, providing little support for a causal role of attentional bias in binge eating. Instead, it is discussed that attentional bias may reflect the interplay of relatively stable incentive salience and flexible top-down control, making it a secondary, context-dependent marker rather than a mechanistic driver of binge eating. Variability in attentional bias, which was associated with binge eating in both studies, may index attentional control and regulatory dynamics, although its psychometric properties and theoretical meaning require further clarification. Overall, these findings highlight the need for a broader perspective on attentional processes in individuals with binge eating. Future research should examine how attentional bias arises from the interaction of incentive salience and attentional control, and how both are expressed in dynamic patterns of attention. Progress in this field will depend on more reliable measures, designs that capture context dependence, and rigorous evaluations of how attentional processes contribute to the persistence of binge eating.