Predictors and moderators of treatment outcome in a randomized clinical trial for binge-eating disorder

Area of Science:

• Psychiatry and Behavioral Science
• Clinical Psychology
• Eating Disorders Research

Background:

• Binge-eating disorder (BED) is a significant mental health condition characterized by recurrent episodes of excessive food consumption.
• Existing treatments for BED include cognitive-behavioral therapies, but identifying predictors of treatment response is crucial for personalized care.
• Understanding individual differences can optimize therapeutic strategies for BED.

Purpose of the Study:

• To examine predictors and moderators of treatment response in adults with BED.
• To compare the efficacy of integrative cognitive-affective therapy for BED (ICAT-BED) and guided self-help cognitive-behavioral therapy (CBTgsh).
• To identify patient characteristics that predict differential outcomes between the two interventions.

Main Methods:

• 112 adults diagnosed with BED were randomly assigned to either ICAT-BED or CBTgsh.
• Generalized linear models were used to analyze predictors and moderators of objective binge-eating episode (OBE) frequency and abstinence.
• Assessments were conducted at end-of-treatment (EOT) and 6-month follow-up (FU).

Main Results:

• Lower baseline dietary restraint and emotion regulation difficulties predicted greater reductions in OBE frequency.
• Greater pretreatment self-control, low shape/weight overvaluation, and high actual-ideal self-discrepancy predicted greater OBE frequency reductions in ICAT-BED compared to CBTgsh at EOT.
• High actual-ideal self-discrepancy predicted greater OBE frequency reductions in ICAT-BED versus CBTgsh at both EOT and FU.

Conclusions:

• Two general predictors (dietary restraint, emotion regulation difficulties) and four moderators (self-control, shape/weight overvaluation, actual-ideal self-discrepancy) of BED treatment response were identified.
• Actual-ideal self-discrepancy emerged as a key moderator, indicating ICAT-BED may be particularly beneficial for individuals with high levels of this characteristic.
• Findings suggest ICAT-BED may offer specific and lasting improvements in binge-eating episodes for individuals with high actual-ideal self-discrepancy.