Episodic Future Thinking for Health Behaviors

Overseen By Ashley Kucera, MPH

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Henry Ford Health System

Disqualifiers: Untreated psychosis, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 1

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores a new approach called episodic future thinking (EFT) to assist individuals in substance use recovery after recent incarceration. The researchers aim to determine if imagining positive future scenarios can improve treatment outcomes, such as maintaining motivation and reducing substance use. Participants will engage in a brief intervention and receive follow-up calls to support this method. Ideal participants are those who have been in jail or prison within the last year and are currently in recovery from substance use. As an unphased trial, this study offers a unique opportunity to contribute to innovative research that could enhance recovery strategies for others in similar situations.

Do I have to stop taking my current medications for this trial?

The trial protocol does not specify whether you need to stop taking your current medications.

What prior data suggests that this intervention is safe?

Research has shown that thinking about future events (EFT) can safely help people make better decisions, particularly those with substance use issues. One study demonstrated that EFT helped individuals with cocaine use disorder make less impulsive choices, suggesting its potential benefits without causing harm.

The treatment under study, Elongating Time Horizons for Reentry (ETHoR), builds on this concept. Trained peers guide participants to vividly imagine positive future events. This approach aims to help individuals focus on long-term goals, potentially reducing negative behaviors.

No reports of harmful effects from using EFT exist, making it a low-risk option for participants. Since this method doesn't involve medication or physical procedures, it is generally easy to manage. Participants engage in mental exercises and discussions, which are safe and non-invasive. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about this trial because it explores how thinking about the future can impact health behaviors. The Elongating Time Horizons for Reentry (ETHoR) approach encourages participants to vividly imagine positive future events, helping them focus on long-term goals rather than immediate temptations. This is different from most current treatments, which often focus on managing immediate behaviors rather than future planning. Meanwhile, the Standardized Episodic Thinking (SET) method acts as a control by having participants recall positive current events. By comparing these methods, researchers hope to find out how focusing on future outcomes might better decrease undesirable behaviors like substance use.

What evidence suggests that this trial's interventions could be effective for substance use disorders?

Research has shown that Episodic Future Thinking (EFT) can help individuals with cocaine use disorder make less impulsive decisions, potentially aiding in the treatment of substance use disorders (SUD). EFT encourages individuals to imagine and focus on positive future events, improving their ability to think ahead. This method has shown promise in enhancing decision-making and reducing negative behaviors associated with addiction. Studies also suggest that EFT can boost participation in treatment programs for individuals returning to the community with SUD. In this trial, participants will be assigned to different treatment arms. The Elongating Time Horizons for Reentry (ETHoR) treatment is one specific type of EFT being tested to support these goals. Another arm will involve Standardized Episodic Thinking (SET), which serves as a control to compare the effects of focusing on current versus future events. ^{1 2 3 4 6}

Are You a Good Fit for This Trial?

This trial is for adults over 18 who identify as being in recovery from substance use, can engage with English-language materials, have been incarcerated within the last year, and are open to participating in assessments and follow-up calls or messages.

Inclusion Criteria

I am willing to receive calls, emails, and texts for study updates.

Identify as an individual in substance use recovery

I am willing to participate in the study.

Exclusion Criteria

Individuals ineligible or unwilling to participate in study activities and assessments

Self-reporting of active and untreated psychosis

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Intervention

Participants engage in a single-episode brief intervention of Episodic Future Thinking (EFT) followed by tailored phone call follow-ups

1 week

1 visit (in-person), multiple follow-up calls

Follow-up

Participants are monitored for changes in delay discounting, treatment retention, treatment motivation, and substance use

12 weeks

Regular follow-up assessments

What Are the Treatments Tested in This Trial?

Interventions

• Elongating Time HOrizons for Reentry (ETHoR)
• Standardized Episodic Thinking (SET)

Trial Overview The study tests a brief intervention called Episodic Future Thinking (EFT) for people with substance use disorders. It looks at how well EFT works when delivered by peers and its impact on treatment motivation, retention, decision-making about immediate versus future rewards (delay discounting), and actual substance use.

How Is the Trial Designed?

Group I: Elongating Time HOrizons for Reentry (ETHoR) Experimental Treatment 1 Intervention

Episodic Future Thinking (EFT) utilizes participant-generated descriptions of future events to elongate an individual's temporal horizon. In EFT paradigms, the participant is asked to create and envision vivid descriptions of specific, positively valanced, events that could happen in the future. Recent research suggests that directing EFTs to focus on specific goals (i.e. evoking images of oneself engaging in activities consistent with a desired future outcome) are associated with stronger decreases in undesirable health behaviors. Thus, as part of the ETHoR condition, participants will be asked to verbally describe and imagine four specific events reflecting positive activities in which the participant engages in substance and incarceration-free activities, corresponding to predetermined future timepoints. The PRC will encourage participants to include as many contextual and emotional details as possible.

Group II: Standardized Recent Thinking (ERT) Active Control 1 Intervention

Individuals in the control group utilizes SET; an approach that controls for activation of episodic thinking but does not engage prospection (the hypothesized mechanism of episodic future thinking, future outcome) are associated with stronger decreases in undesirable health behaviors. Thus, as part of the SET condition, participants will be asked to verbally describe and imagine four current events reflecting positive activities in which the participant engages in substance and incarceration-free activities, corresponding to current experiences. The PRC will encourage participants to include as many contextual and emotional details as possible.

Who Is Running the Clinical Trial?

Henry Ford Health System

Lead Sponsor

Trials

334

Recruited

2,197,000+

Michigan State University

Collaborator

Trials

202

Recruited

687,000+

Detroit Recovery Project INC

Collaborator

Trials

1

Recruited

40+

University of Kansas

Collaborator

Trials

157

Recruited

332,000+

Published Research Related to This Trial

Episodic future thinking (EFT) is a promising behavioral intervention that can help reduce delay discounting and improve health behaviors, but there is significant variability in how EFT is implemented across studies.

The review highlights the need for standardized methods in generating EFT cues and suggests best practices, while also identifying gaps in research that need to be addressed to enhance the efficacy and effectiveness of EFT as an intervention.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Putting prospection into practice: Methodological considerations in the use of episodic future thinking to reduce delay discounting and maladaptive health behaviors. Brown, JM., Stein, JS.[2023]

The cognitive-existential fear of recurrence therapy (FORT) significantly reduced fear of cancer recurrence (FCR) in breast and gynecological cancer survivors compared to an attention placebo control group, with a medium effect size maintained for three months post-treatment.

Participants in the FORT group also showed improvements in related areas such as coping with FCR triggers, cognitive avoidance, and overall mental health quality of life, suggesting that FORT could be an effective new treatment strategy for managing FCR.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Correction to Maheu et al. (2023). [2023]

A smartphone-based intervention designed to enhance future-oriented thinking and personal goal achievement is being tested on 166 first-year university students, comparing its effectiveness to a goal-setting control group over a three-week period.

The study aims to evaluate user experiences, adherence to the app, and the impact of different intervention modules on outcomes like self-defeating behavior and future self-identification, with follow-up assessments at three months to measure lasting effects.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Stimulating a future-oriented mindset and goal attainment through a smartphone-based intervention: Study protocol for a randomized controlled trial. Mertens, ECA., van der Schalk, J., Siezenga, AM., et al.[2022]

Episodic future thinking (EFT) using both drawn and written cues significantly reduces delay discounting (DD) in adults, indicating that thinking about positive future events can help people make better long-term choices.

The study found that drawn cues may be particularly effective for individuals with an immediate time perspective, suggesting flexibility in how EFT can be applied in clinical settings to improve decision-making related to health behaviors.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Written or drawn episodic future thinking cues improves delay discounting in adults. Carr, KA., Hollis-Hansen, K., Austin, K., et al.[2022]

The pilot goal-oriented episodic future thinking (GoEFT) intervention was well-accepted by low-income overweight or obese mothers, with participants appreciating the structured approach to setting and evaluating goals.

The intervention demonstrated significant efficacy in promoting weight loss, increasing fruit and vegetable intake, and improving emotional control, along with reducing fat and sugar intake and alleviating stress, indicating its potential as an effective weight management strategy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A Pilot Goal-Oriented Episodic Future Thinking Weight Loss Intervention for Low-Income Overweight or Obese Young Mothers. Chang, MW., Tan, A., Wegener, DT., et al.[2023]

The Fear of Cancer Recurrence Inventory-Child version (FCRI-C) and the Parent version (FCRI-P) were successfully adapted for childhood cancer survivors aged 8-18 years, showing strong reliability with internal consistency scores of 0.88 and 0.83, respectively.

Initial validity testing indicated that higher fear of cancer recurrence in both children and parents was linked to greater intolerance of uncertainty and increased health-related behaviors, such as more frequent medical consultations for the child.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Measuring fear of cancer recurrence in survivors of childhood cancer: Development and preliminary validation of the Fear of Cancer Recurrence Inventory (FCRI)-Child and Parent versions. Tutelman, PR., Chambers, CT., Heathcote, LC., et al.[2022]

The Fear of Progression Questionnaire - Rapid Screener (FoP-Q-RS) was developed and tested with 1,002 cancer survivors, showing good psychometric properties and better fit indices than the longer FoP-Q-SF, making it suitable for routine care.

The optimal cut-off score for identifying significant fear of progression was found to be ≥12, balancing sensitivity (72%) and specificity (70%), while a lower cut-off of ≥10 increased sensitivity to 86%, indicating its effectiveness in screening for this issue.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Rapid screener for the assessment of fear of progression in cancer survivors: The Fear of progression-Questionnaire Rapid Screener. Youssef, Y., Mehnert-Theuerkauf, A., Götze, H., et al.[2021]

Episodic future thinking (EFT) shows promise as an intervention for reducing problematic substance use and substance use disorders, based on a systematic review of 16 studies that demonstrated benefits in self-reported and task-based outcomes.

The review highlights the need for further research to assess the feasibility, generalizability, and long-term effects of EFT, as well as to identify factors that influence its effectiveness.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Imagining the future can shape the present: A systematic review of the impact of episodic future thinking on substance use outcomes. Collado, A., Stokes, A.[2023]

Episodic future thinking (EFT) effectively reduces delay discounting (DD), which is the tendency to prefer smaller immediate rewards over larger future ones, as shown in a study with 160 participants.

The study found that the effectiveness of EFT in reducing DD was not dependent on whether the future events were matched to the time delays of the DD task, indicating that any positive and vivid future event can help promote healthier long-term choices.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Mix and Match: An Investigation into Whether Episodic Future Thinking Cues Need to Match Discounting Delays in Order to Be Effective. O'Donnell, S., Hollis-Hansen, K., Epstein, LH.[2021]

In a study of 222 long-term breast cancer survivors and their partners, cognitive processing was found to mediate the relationship between social constraints and fear of cancer recurrence, indicating that how individuals think about their social environment can influence their emotional responses.

The findings suggest that interventions designed to improve cognitive processing may help reduce fear of recurrence in breast cancer survivors and their partners, highlighting the importance of addressing psychological factors in cancer care.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Long-term fear of recurrence in young breast cancer survivors and partners. Cohee, AA., Adams, RN., Johns, SA., et al.[2022]

The article proposes that fostering Hope should be a key goal in the clinician-patient relationship, as it helps both parties find meaning in the treatment journey.

A new 'Hope Checklist' for clinicians is introduced, which includes steps to clarify patient goals, demonstrate support, and outline realistic pathways to enhance patient confidence in achieving positive outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Giving Hope as a High Reliability Function of Health Care. Mylod, D., Lee, TH.[2023]

Episodic Future Thinking (EFT) was found to significantly reduce delay discounting, which is the tendency to devalue future rewards, compared to a novel control group using health information thinking (HIT) in a study of 254 participants.

The study suggests that while EFT is effective in reducing maladaptive health behaviors, further research is needed to establish the HIT procedure as a reliable control for other outcomes in clinical settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Translating episodic future thinking manipulations for clinical use: Development of a clinical control. Rung, JM., Epstein, LH.[2023]

The targeted eHealth intervention 'FoRtitude' significantly reduced fear of recurrence (FoR) in breast cancer survivors, with scores decreasing from an average of 53.1 to 41.9 after the intervention, indicating its efficacy in addressing this prevalent concern.

Telecoaching enhanced participant adherence to the program and reduced dropout rates, suggesting that remote support can improve engagement in eHealth interventions for cancer survivors.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Targeted eHealth Intervention to Reduce Breast Cancer Survivors' Fear of Recurrence: Results From the FoRtitude Randomized Trial. Wagner, LI., Tooze, JA., Hall, DL., et al.[2022]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC8062282/

Evaluating effects of episodic future thinking on valuation ... These preliminary findings suggest that EFT can reduce impulsive decision-making in cocaine use disorder and may therefore have therapeutic value.

2. jcoinctc.org jcoinctc.org/peer-delivered-episodic-future-thinking-to-improve-moud-treatment-engagement-among-returning-citizens-070/

Peer Delivered Episodic Future Thinking to Improve MOUD ... The modified intervention, Elongating Time HOrizons for Reentry (ETHoR), will be delivered by a peer recovery coach (PRC) with lived experience in substance use ...

3. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC11629441/

Examining the role of reinforcing activities and time horizon in ... The authors mention only one approach to extending temporal windows, episodic future thinking. Good therapy for externalizing adolescents ...

4. sciencedirect.com sciencedirect.com/science/article/abs/pii/S0740547220303020

Acute and extended exposure to episodic future thinking in ... Individuals with addictive disorders commonly exhibit a shortened temporal window (shortened period of time an individual can imagine into their own future) ...

5. researchgate.net researchgate.net/publication/321399824_Extending_Future_Time_Perspective_Theory_through_Episodic_Future_Thinking_Research_A_Multidisciplinary_Approach_to_Thinking_About_the_Future

A Multidisciplinary Approach to Thinking About the Future This chapter considers expanding the work on time perspective to include both imagining and planning for the future. Specifically, the authors argue that ...

6. journals.sagepub.com journals.sagepub.com/doi/10.1177/17470218211066282

A meta-analysis of the effects of episodic future thinking on ... Episodic future thinking (EFT) is the act of vividly imagining events that may happen in the future. Studies have shown that EFT could reduce DD ...