The effects of episodic future thinking interventions on cardiovascular health behaviors: A meta-analysis

Background: Cardiovascular diseases remain the leading cause of morbidity and mortality worldwide. Although engagement in cardiovascular health behaviors is essential for cardiovascular disease prevention and management, adherence to these behaviors remains suboptimal. Intertemporal decision-making, which involves weighting immediate versus future consequences, has been proposed as a mechanism underlying poor health behavior engagement. Episodic future thinking, a strategy that encourages individuals to vividly imagine future events, may enhance future-oriented decision-making and promote healthier behaviors. However, its effectiveness in promoting cardiovascular health behaviors in naturalistic settings remains unclear. Objective: To systematically evaluate the effectiveness of episodic future thinking in promoting cardiovascular health behaviors and modifying delay discounting in naturalistic settings. Methods: Nine electronic databases (four Chinese and five English) were searched from inception to February 2026. Randomized controlled trials evaluating episodic future thinking interventions for behavior change in naturalistic settings were included. Two reviewers independently conducted title screening, data extraction, and risk-of-bias assessment using the Risk of Bias 2.0 (RoB2) tool. Meta-analyses were performed using Review Manager 5.3. Results: Sixteen randomized controlled trials involving 881 participants were included. Compared with control conditions, episodic future thinking significantly reduced energy purchased (SMD = −0.57, 95% CI: [−0.96, −0.17], P = 0.005), alcohol consumption (SMD = −0.46, 95% CI: [−0.88, −0.05], P = 0.03), and increased physical activity (SMD = 0.29, 95% CI: [0.03, 0.55], P = 0.03). Episodic future thinking also significantly reduced delay discounting (SMD = −0.35, 95% CI: [−0.59, −0.11], P = 0.004), suggesting improved future-oriented decision-making. Conclusions: Episodic future thinking appears to be a promising behavioral intervention for improving cardiovascular health behaviors and reducing delay discounting in naturalistic settings. Further research is needed to determine the optimal intervention characteristics and evaluate its long-term effectiveness across diverse population. Registration: www.crd.york.ac.uk CRD420251014181, registered 01/04/2025. © 2026 Elsevier Ltd. All rights are reserved, including those for text and data mining, AI training, and similar technologies.