Schmidt Ricarda, Schewe Danielle, Herpertz Stephan, Zipfel Stephan, Tuschen-Caffier Brunna, Friederich Hans-Christoph, Mayr Andreas, de Zwaan Martina, Hilbert Anja
Integrated Research and Treatment Center AdiposityDiseases, Behavioral Medicine Research Unit, Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany.
Department of Psychosomatic Medicine and Psychotherapy, LWL-University, Bochum, Germany.
Int J Eat Disord. 2025 Sep;58(9):1701-1709. doi: 10.1002/eat.24469. Epub 2025 May 21.
Cognitive-behavioral therapy (CBT) is the most well-established treatment for binge-eating disorder (BED), but the mechanisms of change remain poorly understood. This study investigated in CBT for BED the effects of overvaluation of shape and weight and dietary restraint on subsequent objective binge-eating episodes (OBEs).
In a multicenter randomized-controlled trial, 84 patients diagnosed with full- or subsyndromal BED were offered 20 individual sessions of CBT over 4 months. Dynamic structural equation modeling (DSEM) was used to disentangle within- and between-patient associations of overvaluation of shape and weight, dietary restraint, and OBEs.
Between the first and last week of therapy, there were significant reductions in overvaluation of shape and weight, dietary restraint, and OBEs. DSEM showed significant within-patient effects of overvaluation of shape and weight on the subsequent number of OBEs. Weeks with lower overvaluation of shape and weight levels were followed by weeks with fewer OBEs. Although no within-patient effect of dietary restraint on OBEs was found, within-patient dietary restraint levels positively predicted subsequent overvaluation of shape and weight levels.
The findings suggest that reductions in overvaluation of shape and weight may precede improvements in binge eating during CBT for BED, supporting its role as a potential mechanism of change. While dietary restraint did not show a direct temporal link to binge eating, its association with overvaluation points to a potential indirect role. These results underscore the value of targeting cognitive features of BED in CBT and highlight the need for more temporally sensitive assessments in mechanisms research.
认知行为疗法（CBT）是治疗暴饮暴食症（BED）最成熟的方法，但改变机制仍知之甚少。本研究调查了在针对BED的CBT中，体型和体重的过度重视以及饮食限制对随后客观暴饮暴食发作（OBE）的影响。
在一项多中心随机对照试验中，84名被诊断为完全型或亚综合征型BED的患者在4个月内接受了20次CBT个体治疗。动态结构方程模型（DSEM）用于解析患者内部和患者之间体型和体重过度重视、饮食限制与OBE之间的关联。
在治疗的第一周和最后一周之间，体型和体重的过度重视、饮食限制以及OBE均有显著降低。DSEM显示患者内部体型和体重过度重视对随后OBE次数有显著影响。体型和体重过度重视水平较低的周数之后是OBE次数较少的周数。虽然未发现患者内部饮食限制对OBE有影响，但患者内部饮食限制水平正向预测随后的体型和体重过度重视水平。
研究结果表明，在针对BED的CBT中，体型和体重过度重视的降低可能先于暴饮暴食的改善，支持其作为一种潜在改变机制的作用。虽然饮食限制与暴饮暴食没有直接的时间联系，但其与过度重视的关联表明了一种潜在的间接作用。这些结果强调了在CBT中针对BED认知特征的价值，并突出了在机制研究中进行更具时间敏感性评估的必要性。
