Discussion
obesity, NCC, T2DM-related, prediabetes, T2DM, HIT
OBESITY, EVENTS, EPSTEIN, PREDIABETES
In this online experiment, we made two contributions to the literature: 1) the HIT control (using cues generated in response to T2DM related health-information) does not result in lower delay discounting compared to a no-cue control condition in adults with self-reported obesity and T2DM, and 2) brief engagement in EFT does result in lower delay discounting compared to the HIT control and a no-cue control in adults with self-reported obesity and T2DM. We will discuss both contributions, study limitations, and future directions.Health Information Thinking appears to be a suitable control for clinical trials involving repeated engagement in EFT as an intervention to reduce delay discounting. In this clinical sample (adults with self-reported obesity and T2DM), engaging in HIT using cues generated from T2DM-related health-information vignettes did not result in lower delay discounting relative to participants engaging in EFT. Participants engaging in EFT exhibited significantly greater ordinal AUC (i.e., lower delay discounting) than HIT and NCC conditions. No differences in ordinal AUC were observed between HIT and NCC participants, suggesting that HIT is an inert intervention concerning delay discounting. These results are consistent with Rung and Epstein [These results suggest that EFT may be an efficacious intervention to reduce delay discounting in adults with obesity and T2DM. To date, only one multiple-baseline small-Although the present study is the first large-scale examination of EFT in adults with self-reported T2DM, other studies have shown that acute and repeated EFT reliably reduces or results in lower delay discounting compared to control conditions in adults with prediabetes [This study is not without limitations that should be addressed in future research. First, while we are reasonably confident that our screening strategies limited the number of participants who completed the study but do not have a diagnosis of T2DM or obesity, it is likely some unknown number who did not meet our qualifications were able to meet the screening criteria by chance. However, this number is likely to be low, as we implemented emerging best practices for online research utilizing Amazon Mechanical Turk [Second, we observed significantly higher attrition rates in participants randomized to the EFT group compared to participants randomized to HIT or NCC groups; this difference may be due to the increased effort required to generate EFT cues and engage in EFT during the delay discounting task. Importantly, no significant group differences in demographic variables related to delay discounting were observed (i.e., age, BMI, income, education, HbA1c), which suggests that the observed differences in attrition did not introduce bias related to any measured participant characteristic. We note, however, this differential attrition may be less likely to occur in a sample of motivated participants enrolled in a clinical trial using behavioral interventions and EFT to manage T2DM better.Thirdly, one other potential benefit of HIT was elucidated by Rung and Epstein [Fifth, we observed significantly different average participant ratings of EFT and HIT cues on excitement and liking/enjoyment characteristics, although no differences in ratings of importance were observed. While differences in cue ratings between active and control groups are not ideal, EFT vs. HIT cue generation are, by design, different exercises resulting in qualitatively different written descriptions (i.e., a narrative about personal engagement in possible future events vs. a personal reaction to health information). Therefore, differences in EFT and HIT cues on ratings of excitement and liking/enjoyment may be related to the expected differences in content between EFT vs. HIT. Nonetheless, when applied in a long-term RCT involving repeated, daily engagement in EFT or HIT, these content differences may reduce adherence to HIT and, therefore, its suitability as a control condition. Future research should examine possible differences in intervention adherence between EFT and HIT in long-term RCTs.In conclusion, the present experiment increases our confidence in using the HIT control for clinical examinations of the effect of EFT on delay discounting. The HIT control cues can be generated using health-information vignettes directly relevant to the clinical sample; engaging in HIT using these cues does not result in lower delay discounting relative to a standard delay discounting task. HIT control is a promising candidate for long-term clinical trials involving EFT as an intervention to reduce delay discounting and change health behaviors.