Comparing integrative cognitive‐affective therapy and guided self‐help cognitive‐behavioral therapy to treat binge‐eating disorder using standard and naturalistic momentary outcome measures: A randomized controlled trial

• Published in: The International journal of eating disorders 2020-09, Vol.53 (9), p.1418-1427
• Main Authors: Peterson, Carol B., Engel, Scott G., Crosby, Ross D., Strauman, Timothy, Smith, Tracey L., Klein, Marjorie, Crow, Scott J., Mitchell, James E., Erickson, Ann, Cao, Li, Bjorlie, Kayla, Wonderlich, Stephen A.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Behavior modification; Binge eating; Binge-Eating Disorder - psychology; Binge-Eating Disorder - therapy; Clinical trials; Cognitive behavioral therapy; Cognitive Behavioral Therapy - methods; Cognitive therapy; Eating disorders; Female; Humans; Male; Middle Aged; Outcome Assessment, Health Care - methods; Psychopathology; psychotherapy; Psychotherapy - methods; Self help; Self-Help Groups - standards; Treatment Outcome; Young Adult
• ISSN: 0276-3478; 1098-108X
• DOI: 10.1002/eat.23324

Objective Innovative treatments and outcome measures are needed for binge‐eating disorder (BED). This randomized controlled trial compared Integrative Cognitive‐Affective Therapy (ICAT‐BED), an individual psychotherapy targeting momentary behavioral and emotional precipitants of binge eating, with an established cognitive‐behavioral guided self‐help (CBTgsh) treatment using standard and ecological momentary assessment (EMA) outcome measures. Method A total of 112 participants were randomized to 17 weeks of treatment (21 sessions for ICAT‐BED and 10 sessions for CBTgsh). Binge‐eating frequency was assessed with the Eating Disorder Examination (EDE) as well as EMA using cell phone‐based real‐time, naturalistic assessment at end of treatment (EOT) and 6‐month follow‐up. Hypothesized maintenance mechanisms were assessed using self‐report questionnaires. Results Binge‐eating frequency as measured by the EDE and real‐time assessment showed significant reductions at EOT and follow‐up, with no significant differences between treatments. Hypothesized maintenance mechanisms, including emotion regulation, cognitive self‐discrepancy, self‐directed style, as well as measures of associated eating disorder psychopathology, depression, anxiety, impulsivity, and negative affect, showed similar improvement at EOT and follow‐up with no differences between treatments. Abstinence rates at EOT (ICAT‐BED: 57.1%; CBTgsh: 42.9%) and 6‐month follow‐up (ICAT‐BED: 46.4%; CBTgsh: 42.9%) were not significantly different. Treatment retention was significantly higher for ICAT‐BED (87.5%) than CBTgsh (71.4%). Discussion These findings suggest that ICAT‐BED and CBTgsh were associated with similar improvements in binge eating, psychopathology, and putative maintenance mechanisms as measured by traditional self‐report and momentary, naturalistic assessments and that these changes were generally sustained at 6‐month follow‐up.