Does Episodic Future Thinking Repair Immediacy Bias at Home and in the Laboratory in Patients With Prediabetes?

Abstract

Objective: This study aimed to determine if episodic future thinking (EFT) can decrease delay discounting (DD) among adults with prediabetes both in and out of the laboratory. DD measures how much the value of a reinforcer decreases as a function of the delay to receive it.

Methods: Adults with prediabetes (n = 67) completed a three-session study. At session 1, baseline measures (including DD) were collected. At sessions 2 and 3, participants were prompted to engage in either EFT or control episodic thinking (CET) while completing DD and other measures. In addition, between the completion of sessions 2 and 3, participants engaged in EFT or CET at home and completed DD tasks remotely via smartphones or other Internet-connected devices.

Results: Results showed significant -1.2759 (-20.24%) reductions in DD in the EFT group compared with a + 0.0287 (+0.46%) DD increase in the CET group (p = .0149) in the laboratory; and -0.4095 (-8.85%) reduction in DD in the EFT group compared with a + 0.2619 (+5.64%) increase in the CET group (p = .011) at home. Working memory (measured by Backwards Corsi and Digit Span) was found to moderate the effects of EFT on some measures of DD. EFT did not change measures from the food purchase task or a food ad libitum procedure.

Conclusions: Results show that EFT decreases DD in and out of the laboratory and supports the further exploration of EFT as an intervention for prediabetes and related chronic diseases.

Clinical trial registration: NCT03664726.

Conflict of interest statement

Conflicts of Interest

Although the following activities/relationships do not create a conflict of interest pertaining to this article, in the interest of full disclosure, Dr. Bickel would like to report the following:W.K. Bickel is a principal of HealthSim, LLC; Notifius, LLC; and BEAM Diagnostics, Inc.; and a partner for Red 5 Group, LLC. In addition, he serves on the scientific advisory board for Sober Grid, Inc.; Ria Health; and US WorldMeds, LLC; and is a consultant for Alkermes, Inc. and Nektar Therapeutics. Dr. Mastrandrea received research funding from the Juvenile Diabetes Research Foundation, NovoNordisk, Sanofi Aventis, and AstraZeneca. Dr. Mastrandrea received research funding from Juvenile Diabetes Research Foundation, NovoNordisk, Sanofi Aventis, and AstraZeneca. Dr. Quattrin received research funding from Opko, ProventionBIO, and Janssen. She has received consulting fees from Janssen. Dr. Epstein was a consultant and had equity in Daltri when the study was implemented. The other authors do not declare any conflict of interest with respect to the authorship or publication of this article.

Figures

Figure 1.

CONSORT Diagram

FIGURE 2.

Discount rate (ln k) for $1000 in the adjusting-amount task across sessions in the EFT and CET control groups. Session 1 was completed under baseline conditions, whereas sessions 2 and 3 were completed during the presentation of episodic cues. Error bars represent standard error of the mean. EFT = episodic future thinking; CET = control episodic thinking

FIGURE 3.

Discount rate (ln k) for $100 in the adjusting-delay task at session 1 and after at-home training in the EFT and CET control groups. Session 1 was completed under baseline conditions, whereas at-home assessment was completed after the presentation of episodic cues. Error bars represent standard error of the mean. EFT = episodic future thinking; CET = control episodic thinking.