Change in impulsivity is prospectively associated with treatment outcomes for binge-eating disorder

Psychological Medicine ◽

10.1017/s003329172100475x ◽

2021 ◽

pp. 1-9

Author(s):

Rebecca G. Boswell ◽

Ralitza Gueorguieva ◽

Carlos M. Grilo

Keyword(s):

Eating Disorder ◽

Binge Eating ◽

Treatment Outcomes ◽

Binge Eating Disorder ◽

Pharmacological Treatment ◽

Rapid Change ◽

Post Treatment ◽

Controlled Clinical Trial ◽

Eating Disorder Psychopathology

Abstract Background Impulsivity may be a process underlying binge-eating disorder (BED) psychopathology and its treatment. This study examined change in impulsivity during cognitive-behavioral therapy (CBT) and/or pharmacological treatment for BED and associations with treatment outcomes. Methods In total, 108 patients with BED (NFEMALE = 84) in a randomized placebo-controlled clinical trial evaluating the efficacy of CBT and/or fluoxetine were assessed before treatment, monthly throughout treatment, at post-treatment (16 weeks), and at 12-month follow-up after completing treatment. Patients completed established measures of impulsivity, eating-disorder psychopathology, and depression, and were measured for height and weight [to calculate body mass index (BMI)] during repeated assessments by trained/monitored doctoral research-clinicians. Mixed-effects models using all available data examined changes in impulsivity and the association of rapid and overall changes in impulsivity on treatment outcomes. Exploratory analyses examined whether baseline impulsivity predicted/moderated outcomes. Results Impulsivity declined significantly throughout treatment and follow-up across treatment groups. Rapid change in impulsivity and overall change in impulsivity during treatment were significantly associated with reductions in eating-disorder psychopathology, depression scores, and BMI during treatment and at post-treatment. Overall change in impulsivity during treatment was associated with subsequent reductions in depression scores at 12-month follow-up. Baseline impulsivity did not moderate/predict eating-disorder outcomes or BMI but did predict change in depression scores. Conclusions Rapid and overall reductions in impulsivity during treatment were associated with improvements in specific eating-disorder psychopathology and associated general outcomes. These effects were found for both CBT and pharmacological treatment for BED. Change in impulsivity may be an important process prospectively related to treatment outcome.

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Targeting binge eating in bulimia nervosa and binge eating disorder using inhibitory control training and implementation intentions: a feasibility trial

Psychological Medicine ◽

10.1017/s0033291720002494 ◽

2020 ◽

pp. 1-10

Author(s):

Rayane Chami ◽

Valentina Cardi ◽

Natalia Lawrence ◽

Pamela MacDonald ◽

Katie Rowlands ◽

...

Keyword(s):

Eating Disorder ◽

Bulimia Nervosa ◽

Binge Eating ◽

Binge Eating Disorder ◽

Implementation Intentions ◽

Effect Sizes ◽

Post Intervention ◽

Eating Frequency ◽

Eating Disorder Psychopathology

Abstract Background This trial examined the feasibility, acceptability, and effect sizes of clinical outcomes of an intervention that combines inhibitory control training (ICT) and implementation intentions (if-then planning) to target binge eating and eating disorder psychopathology. Methods Seventy-eight adult participants with bulimia nervosa or binge eating disorder were randomly allocated to receive food-specific, or general, ICT and if-then planning for 4 weeks. Results Recruitment and retention rates at 4 weeks (97.5% and 79.5%, respectively) met the pre-set cut-offs. The pre-set adherence to the intervention was met for the ICT sessions (84.6%), but not for if-then planning (53.4%). Binge eating frequency and eating disorder psychopathology decreased in both intervention groups at post-intervention (4 weeks) and follow-up (8 weeks), with moderate to large effect sizes. There was a tendency for greater reductions in binge eating frequency and eating disorders psychopathology (i.e. larger effect sizes) in the food-specific intervention group. Across both groups, ICT and if-then planning were associated with small-to-moderate reductions in high energy-dense food valuation (post-intervention), food approach (post-intervention and follow-up), anxiety (follow-up), and depression (follow-up). Participants indicated that both interventions were acceptable. Conclusions The study findings reveal that combined ICT and if-then planning is associated with reductions in binge eating frequency and eating disorder psychopathology and that the feasibility of ICT is promising, while improvements to if-then planning condition may be needed.

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Managing Risk of Non-Communicable Diseases in Women with Bulimia Nervosa or Binge Eating Disorders: A Randomized Trial with 12 Months Follow-Up

Nutrients ◽

10.3390/nu10121887 ◽

2018 ◽

Vol 10 (12) ◽

pp. 1887 ◽

Cited By ~ 2

Author(s):

Therese Mathisen ◽

Jorunn Sundgot-Borgen ◽

Jan Rosenvinge ◽

Solfrid Bratland-Sanda

Keyword(s):

Eating Disorder ◽

Bulimia Nervosa ◽

Physical Fitness ◽

Binge Eating ◽

Binge Eating Disorder ◽

Communicable Diseases ◽

Post Treatment ◽

Dietary Therapy ◽

Non Communicable Diseases

Persons with bulimia nervosa (BN) or binge eating disorder (BED) have an elevated risk of non-communicable diseases (NCDs). However, lowering this risk is rarely addressed in standard cognitive-behavioral treatment (CBT). We aimed to compare CBT with an intervention combining physical exercise and dietary therapy (PED-t), and hypothesized that the PED-t would do better than CBT in lowering the risk of NCD both initially and longitudinally. In this study, 164 women with bulimia nervosa or binge eating disorder were randomly assigned to 16-weeks of outpatient group therapy with either PED-t or CBT. Body composition (BC) was measured by dual-energy X-ray absorptiometry. Measures of physical fitness (VO2peak and one repetition maximum (1RM) in squats, bench press, and seated row) were also recorded. All measurements were completed baseline, post-treatment, and at 6- and 12-month follow-ups, respectively. Our results showed that PED-t improved more than CBT on mean (99% CI) absolute Vo2peak; 57,2 (84.4, 198.8) mL (g = 0.22, p < 0.001) post-treatment. There were small to medium long-term differences in 1RM after PED-t compared to CBT. BC deteriorated in both groups during follow-up. Neither the PED-t nor the CBT lowered the risk for NCDs. Clearly, other approaches need to be considered to promote physical fitness and lower the risk of NCDs among individuals with BN and BED.

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Rapid response predicts 12-month post-treatment outcomes in binge-eating disorder: theoretical and clinical implications

Psychological Medicine ◽

10.1017/s0033291711001875 ◽

2011 ◽

Vol 42 (4) ◽

pp. 807-817 ◽

Cited By ~ 33

Author(s):

C. M. Grilo ◽

M. A. White ◽

G. T. Wilson ◽

R. Gueorguieva ◽

R. M. Masheb

Keyword(s):

Weight Loss ◽

Eating Disorder ◽

Binge Eating ◽

Binge Eating Disorder ◽

Prognostic Significance ◽

Post Treatment ◽

Rapid Response ◽

Stepped Care ◽

Clinical Implications ◽

Eating Disorder Psychopathology

BackgroundWe examined rapid response in obese patients with binge-eating disorder (BED) in a clinical trial testing cognitive behavioral therapy (CBT) and behavioral weight loss (BWL).MethodAltogether, 90 participants were randomly assigned to CBT or BWL. Assessments were performed at baseline, throughout and post-treatment and at 6- and 12-month follow-ups. Rapid response, defined as ⩾70% reduction in binge eating by week four, was determined by receiver operating characteristic curves and used to predict outcomes.ResultsRapid response characterized 57% of participants (67% of CBT, 47% of BWL) and was unrelated to most baseline variables. Rapid response predicted greater improvements across outcomes but had different prognostic significance and distinct time courses for CBT versus BWL. Patients receiving CBT did comparably well regardless of rapid response in terms of reduced binge eating and eating disorder psychopathology but did not achieve weight loss. Among patients receiving BWL, those without rapid response failed to improve further. However, those with rapid response were significantly more likely to achieve binge-eating remission (62% v. 13%) and greater reductions in binge-eating frequency, eating disorder psychopathology and weight loss.ConclusionsRapid response to treatment in BED has prognostic significance through 12-month follow-up, provides evidence for treatment specificity and has clinical implications for stepped-care treatment models for BED. Rapid responders who receive BWL benefit in terms of both binge eating and short-term weight loss. Collectively, these findings suggest that BWL might be a candidate for initial intervention in stepped-care models with an evaluation of progress after 1 month to identify non-rapid responders who could be advised to consider a switch to a specialized treatment.

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Treating the overlooked majority: quantitative outcomes from an NHS adaptation of Interpersonal Group Psychotherapy for binge eating disorder

Mental Health Review Journal ◽

10.1108/mhrj-08-2020-0056 ◽

2021 ◽

Vol 26 (1) ◽

pp. 55-70

Author(s):

Zoë Meropi Hepburn ◽

Emily Rose Rothwell ◽

Julia Ann Fox-Clinch

Keyword(s):

Eating Disorder ◽

Binge Eating ◽

Group Psychotherapy ◽

Binge Eating Disorder ◽

Repeated Measures ◽

Attachment Anxiety ◽

Post Treatment ◽

Content Type ◽

Psychosocial Impairment

Purpose To evaluate the effectiveness of an adaptation of Interpersonal Group Psychotherapy (IPT-G), in facilitating short- and longer-term improvements in eating disorder symptomology, psychosocial impairment, anxiety, depression and attachment difficulties among adults living with overweight and diagnosed with binge eating disorder (BED). Design/methodology/approach In total, 24 participants completed measures at the start of IPT-G, mid-treatment, discharge and six-month follow-up. Quantitative outcomes were analysed utilising one-way repeated measures analysis of variance. Findings Treatment retention was 100%. Significant improvements in binge-eating frequency, psychosocial impairment and depression were achieved at mid-treatment and maintained at post-treatment and six-month follow-up, and with large effect sizes. Attachment anxiety had reduced significantly at post-treatment and was maintained at six-month review. Body mass index (BMI) had stabilised by mid-treatment and was maintained at post-treatment and six-month follow-up. All hypotheses were supported, with the exception that attachment avoidance did not improve significantly and following a post-treatment reduction, anxiety symptoms deteriorated slightly by six-month follow-up, such that they were no longer significantly different from pre-treatment levels. Practical implications Despite being the most prevalent of the eating disorders (compared to anorexia nervosa and bulimia nervosa), BED is under-recognised and under-treated in clinical settings. Results indicate the sustained effectiveness of IPT-G in improving eating disorder and comorbid symptomology associated with BED. Originality/value This is the first UK study to investigate the effectiveness of IPT-G at treating BED. Unlike previous studies in the field, this study did not exclude participants based on age, BMI or psychiatric comorbidity.

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CLINICAL PERFECTIONISM: A CASE REPORT

Behavioural and Cognitive Psychotherapy ◽

10.1017/s1352465804001420 ◽

2004 ◽

Vol 32 (3) ◽

pp. 353-357 ◽

Cited By ~ 21

Author(s):

Roz Shafran ◽

Michelle Lee ◽

Christopher G. Fairburn

Keyword(s):

Eating Disorder ◽

Case Report ◽

Binge Eating ◽

Binge Eating Disorder ◽

Behavioural Analysis ◽

Cognitive Behavioural ◽

Eating Disorder Psychopathology ◽

The Impact

The aim of this case report is to describe the impact of an intervention for clinical perfectionism, derived from a new cognitive-behavioural analysis, in a patient with binge-eating disorder. It was hypothesized that clinical perfectionism was contributing to the maintenance of the eating disorder, and on this basis it was predicted that reducing clinical perfectionism would improve her eating disorder psychopathology. Standardized independent assessments were found to be consistent with this hypothesis, in that clinical perfectionism and eating disorder psychopathology improved over an eight-session intervention and improvements were largely maintained at 5-month follow-up.

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Psychiatric comorbidity as predictor and moderator of binge-eating disorder treatment outcomes: an analysis of aggregated randomized controlled trials

Psychological Medicine ◽

10.1017/s0033291721001045 ◽

2021 ◽

pp. 1-9

Author(s):

Janet A. Lydecker ◽

Carlos M. Grilo

Keyword(s):

Weight Loss ◽

Eating Disorder ◽

Binge Eating ◽

Treatment Outcomes ◽

Binge Eating Disorder ◽

Psychiatric Comorbidity ◽

Controlled Trials ◽

Eating Frequency ◽

Randomized Controlled ◽

Eating Disorder Psychopathology

Abstract Background Psychiatric comorbidity is common in binge-eating disorder (BED) but effects on treatment outcomes are unknown. The current study aimed to determine whether psychiatric comorbidity predicted or moderated BED treatment outcomes. Methods In total, 636 adults with BED in randomized-controlled trials (RCTs) were assessed prior, throughout, and posttreatment by doctoral research-clinicians using reliably-administered semi-structured interviews, self-report measures, and measured weight. Data were aggregated from RCTs testing cognitive-behavioral therapy, behavioral weight loss, multi-modal (combined pharmacological plus cognitive-behavioral/behavioral), and/or control conditions. Intent-to-treat analyses (all available data) tested comorbidity (mood, anxiety, ‘any disorder’ separately) as predictors and moderators of outcomes. Mixed-effects models tested comorbidity effects on binge-eating frequency, global eating-disorder psychopathology, and weight. Generalized estimating equation models tested binge-eating remission (zero binge-eating episodes during the past month; missing data imputed as failure). Results Overall, 41% of patients had current psychiatric comorbidity; 22% had mood and 23% had anxiety disorders. Psychiatric comorbidity did not significantly moderate the outcomes of specific treatments. Psychiatric comorbidity predicted worse eating-disorder psychopathology and higher binge-eating frequency across all treatments and timepoints. Patients with mood comorbidity were significantly less likely to remit than those without mood disorders (30% v. 41%). Psychiatric comorbidity neither predicted nor moderated weight loss. Conclusions Psychiatric comorbidity was associated with more severe BED psychopathology throughout treatment but did not moderate outcomes. Findings highlight the need to improve treatments for BED with psychiatric comorbidities but challenge perspectives that combining existing psychological and pharmacological interventions is warranted. Treatment research must identify more effective interventions for BED overall and for patients with comorbidities.

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Translating Virtual Reality Cue Exposure Therapy for Binge Eating into a Real-World Setting: An Uncontrolled Pilot Study

Journal of Clinical Medicine ◽

10.3390/jcm10071511 ◽

2021 ◽

Vol 10 (7) ◽

pp. 1511

Author(s):

Katherine Nameth ◽

Theresa Brown ◽

Kim Bullock ◽

Sarah Adler ◽

Giuseppe Riva ◽

...

Keyword(s):

Virtual Reality ◽

Eating Disorder ◽

Binge Eating ◽

Real World ◽

Exposure Therapy ◽

Post Treatment ◽

Cue Exposure ◽

Treatment Gains ◽

Intent To Treat

Binge-eating disorder (BED) and bulimia nervosa (BN) have adverse psychological and medical consequences. Innovative interventions, like the integration of virtual reality (VR) with cue-exposure therapy (VR-CET), enhance outcomes for refractory patients compared to cognitive behavior therapy (CBT). Little is known about the feasibility and acceptability of translating VR-CET into real-world settings. To investigate this question, adults previously treated for BED or BN with at least one objective or subjective binge episode/week were recruited from an outpatient university eating disorder clinic to receive up to eight weekly one-hour VR-CET sessions. Eleven of 16 (68.8%) eligible patients were enrolled; nine (82%) completed treatment; and 82% (9/11) provided follow-up data 7.1 (SD = 2.12) months post-treatment. Overall, participant and therapist acceptability of VR-CET was high. Intent-to-treat objective binge episodes (OBEs) decreased significantly from 3.3 to 0.9/week (p < 0.001). Post-treatment OBE 7-day abstinence rate for completers was 56%, with 22% abstinent for 28 days at follow-up. Among participants purging at baseline, episodes decreased from a mean of one to zero/week, with 100% abstinence maintained at follow-up. The adoption of VR-CET into real-world clinic settings appears feasible and acceptable, with a preliminary signal of effectiveness. Findings, including some loss of treatment gains during follow-up may inform future treatment development.

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