Mechanisms of Change in Cognitive-Behavioral Therapy for Adults With Binge-Eating Disorder: A Dynamic Structural
Ricarda Schmidt1, Danielle Schewe1, Stephan Herpertz2
1Integrated Research and Treatment Center AdiposityDiseases, Behavioral Medicine Research Unit, Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany.
The International Journal of Eating Disorders
|May 21, 2025
Summary
Reductions in overvaluing shape and weight may improve binge eating in cognitive-behavioral therapy (CBT) for binge-eating disorder (BED). Dietary restraint may indirectly influence binge eating by affecting overvaluation.
Area of Science:
- Psychiatry
- Clinical Psychology
- Behavioral Science
Background:
- Cognitive-behavioral therapy (CBT) is a leading treatment for binge-eating disorder (BED).
- Mechanisms driving CBT's effectiveness in BED require further elucidation.
- Understanding how specific cognitive factors influence binge eating is crucial for treatment optimization.
Purpose of the Study:
- To investigate the impact of overvaluation of shape and weight and dietary restraint on objective binge-eating episodes (OBEs) within CBT for BED.
- To examine the temporal relationships between these cognitive factors and OBEs.
- To identify potential mechanisms of change in CBT for BED.
Main Methods:
- A multicenter randomized-controlled trial involving 84 patients with BED.
- Patients received 20 individual CBT sessions over 4 months.
- Dynamic structural equation modeling (DSEM) was employed to analyze within- and between-patient associations.
Main Results:
- Significant reductions in overvaluation of shape and weight, dietary restraint, and OBEs were observed during therapy.
- Overvaluation of shape and weight significantly predicted subsequent OBEs at the within-patient level.
- Dietary restraint did not directly predict OBEs but was associated with subsequent increases in overvaluation.
Conclusions:
- Decreased overvaluation of shape and weight appears to be a key mechanism preceding symptom improvement in CBT for BED.
- Dietary restraint may play an indirect role in binge eating through its influence on overvaluation.
- Targeting cognitive distortions, particularly overvaluation, is vital in CBT for BED, necessitating temporally sensitive research methods.
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