Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, Minnesota, USA.
Sanford Research, Fargo, North Dakota, USA.
Int J Eat Disord. 2020 Sep;53(9):1418-1427. doi: 10.1002/eat.23324. Epub 2020 Jun 25.
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.
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.
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%).
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.
需要创新的治疗方法和结果评估来治疗暴食障碍（BED）。本随机对照试验比较了整合认知-情感治疗（ICAT-BED），一种针对暴食行为的即时行为和情绪促发因素的个体心理治疗，以及一种使用标准和生态瞬时评估（EMA）结果评估的已建立的认知行为自助指导（CBTgsh）治疗。
共有 112 名参与者被随机分配到 17 周的治疗中（ICAT-BED 为 21 次治疗，CBTgsh 为 10 次治疗）。使用饮食障碍检查（EDE）以及在治疗结束时（EOT）和 6 个月随访时使用基于手机的实时自然评估（EMA）来评估暴食频率。使用自我报告问卷评估假设的维持机制。
EDE 和实时评估测量的暴食频率在 EOT 和随访时均显著降低，治疗之间无显著差异。假设的维持机制，包括情绪调节、认知自我差异、自我导向风格，以及相关饮食障碍精神病学、抑郁、焦虑、冲动和负性情绪的测量，在 EOT 和随访时也显示出相似的改善，治疗之间无差异。EOT（ICAT-BED：57.1%；CBTgsh：42.9%）和 6 个月随访（ICAT-BED：46.4%；CBTgsh：42.9%）的戒断率无显著差异。ICAT-BED 的治疗保留率（87.5%）明显高于 CBTgsh（71.4%）。
这些发现表明，ICAT-BED 和 CBTgsh 在暴食、精神病学和假定的维持机制方面均与传统的自我报告和实时自然评估测量的相似改善相关，并且这些变化在 6 个月随访时通常持续存在。
