App-based food-specific inhibitory control training as an adjunct to treatment as usual in binge-type eating disorders: A feasibility trial

TY - JOUR

T1 - App-based food-specific inhibitory control training as an adjunct to treatment as usual in binge-type eating disorders

T2 - A feasibility trial

AU - Keeler, Johanna Louise

AU - Chami, Rayane

AU - Cardi, Valentina

AU - Hodsoll, John

AU - Bonin, Eva

AU - MacDonald, Pamela

AU - Treasure, Janet

AU - Lawrence, Natalia

N1 - Funding Information: Rayane Chami received funding from the Psychiatry Research Trust (PRT). Dr Valentina Cardi, Dr John Hodsoll, and Professor Janet Treasure are funded by the National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London . A special thank you to the eating disorders charity Beat for their support in advertising this research. Funding Information: Participants were recruited through UK-based eating disorder charity websites, social media, flyers, and the South London and Maudsley NHS Trust eating disorder services. Eligibility required that participants met full-threshold criteria for bulimia nervosa or binge eating disorder according to the Structured Clinical Interview for DSM-5, were currently receiving a form of treatment for their eating disorder (one or more of: psychotherapies such as CBT, nutritional support, and/or psychiatric medications such as anti-depressants), had a body mass index (BMI) of at least 18.5 kg/m2, were between the ages of 18 and 60, and were fluent in written/spoken English. The mean ± SD age of the sample was 31.8 ± 11.2 and the mean ± SD BMI was 29.2 ± 10.5 kg/m2. Most participants were female (n = 77; 96%). See Table 1 for a summary of the demographic characteristics of each group. Participants were excluded if they were currently pregnant, had a visual impairment that could not be repaired with eyewear, a neurological impairment, alcohol or drug dependence, or psychosis.This study also supports our previous finding that food-specific ICT reduces eating disorder psychopathology in the short-term. However, we did not find between-group differences in binge eating frequency in the present study as within our previous study (Chami et al., 2020). In the present study, both the FoodT + TAU and TAU groups showed reductions in binge frequency that were of a similar magnitude to those reported in the intervention group in Chami et al. (2020). Therefore, it is possible that the conjunctive TAU may have been beneficial to both groups in reducing binge eating episodes, separately from the FoodT intervention. However, the discrepancies between studies could also be due to a number of differences. First, the intervention was different (computer-delivered ICT combined with implementation intentions previously vs. app-delivered ICT here). Second, participants in the present trial were required to be receiving treatment and are likely to constitute a more treatment-resistant and complex clinical sample than in Chami et al. (2020). A larger proportion had bulimia nervosa and of these, some fulfilled the criteria of the atypical anorexia nervosa binge-purge subtype, who are more resistant to treatment. These clinical differences may have influenced which specific ED symptoms were most sensitive to specific intervention effects here (EDE-Q total score) vs. in our previous study (binge frequency).Rayane Chami received funding from the Psychiatry Research Trust (PRT). Dr Valentina Cardi, Dr John Hodsoll, and Professor Janet Treasure are funded by the National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London. A special thank you to the eating disorders charity Beat for their support in advertising this research.This paper presents independent research funded by the NIHR under its Research for Patient Benefit (RfPB) Programme (PB-PG-1216-20044). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. Funding Information: This paper presents independent research funded by the NIHR under its Research for Patient Benefit ( RfPB ) Programme ( PB-PG-1216-20044 ). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. Publisher Copyright: © 2021 The Authors

PY - 2022/1/1

Y1 - 2022/1/1

N2 - Current treatments for binge eating disorder (BED) and bulimia nervosa (BN) only show moderate efficacy, warranting the need for novel interventions. Impairments in food-related inhibitory control contribute to BED/BN and could be targeted by food-specific inhibitory control training (ICT). The aim of this study was to establish the feasibility and acceptability of augmenting treatment for individuals with BN/BED with an ICT app (FoodT), which targets motor inhibition to food stimuli using a go/no-go paradigm. Eighty patients with BED/BN receiving psychological and/or pharmacological treatment were randomly allocated to a treatment-as-usual group (TAU; n = 40) or TAU augmented with the 5-min FoodT app daily (n = 40) for 4 weeks. This mixed-methods study assessed feasibility outcomes, effect sizes of clinical change, and acceptability using self-report measures. Pre-registered cut-offs for recruitment, retention, and adherence were met, with 100% of the targeted sample size (n = 80) recruited within 12 months, 85% of participants retained at 4 weeks, and 80% of the FoodT + TAU group completing ≤8 sessions. The reduction in binge eating did not differ between groups. However, moderate reductions in secondary outcomes (eating disorder psychopathology: SES = −0.57, 95% CI [-1.12, −0.03]; valuation of high energy-dense foods: SES = −0.61, 95% CI [-0.87, −0.05]) were found in the FoodT group compared to TAU. Furthermore, small greater reductions in food addiction (SES = −0.46, 95% CI [-1.14, 0.22]) and lack of premeditation (SES = −0.42, 95% CI [-0.77, −0.07]) were found in the FoodT group when compared to TAU. The focus groups revealed acceptability of FoodT. Participants discussed personal barriers (e.g. distractions) and suggested changes to the app (e.g. adding a meditation exercise). Augmenting treatment for BED/BN with a food-specific ICT app is feasible, acceptable, and may reduce clinical symptomatology with high reach and wide dissemination.

AB - Current treatments for binge eating disorder (BED) and bulimia nervosa (BN) only show moderate efficacy, warranting the need for novel interventions. Impairments in food-related inhibitory control contribute to BED/BN and could be targeted by food-specific inhibitory control training (ICT). The aim of this study was to establish the feasibility and acceptability of augmenting treatment for individuals with BN/BED with an ICT app (FoodT), which targets motor inhibition to food stimuli using a go/no-go paradigm. Eighty patients with BED/BN receiving psychological and/or pharmacological treatment were randomly allocated to a treatment-as-usual group (TAU; n = 40) or TAU augmented with the 5-min FoodT app daily (n = 40) for 4 weeks. This mixed-methods study assessed feasibility outcomes, effect sizes of clinical change, and acceptability using self-report measures. Pre-registered cut-offs for recruitment, retention, and adherence were met, with 100% of the targeted sample size (n = 80) recruited within 12 months, 85% of participants retained at 4 weeks, and 80% of the FoodT + TAU group completing ≤8 sessions. The reduction in binge eating did not differ between groups. However, moderate reductions in secondary outcomes (eating disorder psychopathology: SES = −0.57, 95% CI [-1.12, −0.03]; valuation of high energy-dense foods: SES = −0.61, 95% CI [-0.87, −0.05]) were found in the FoodT group compared to TAU. Furthermore, small greater reductions in food addiction (SES = −0.46, 95% CI [-1.14, 0.22]) and lack of premeditation (SES = −0.42, 95% CI [-0.77, −0.07]) were found in the FoodT group when compared to TAU. The focus groups revealed acceptability of FoodT. Participants discussed personal barriers (e.g. distractions) and suggested changes to the app (e.g. adding a meditation exercise). Augmenting treatment for BED/BN with a food-specific ICT app is feasible, acceptable, and may reduce clinical symptomatology with high reach and wide dissemination.

KW - Binge eating disorder

KW - Bulimia nervosa

KW - FoodT application

KW - Inhibitory control training

KW - mHealth intervention

UR - http://www.scopus.com/inward/record.url?scp=85118582613&partnerID=8YFLogxK

U2 - 10.1016/j.appet.2021.105788

DO - 10.1016/j.appet.2021.105788

M3 - Article

AN - SCOPUS:85118582613

SN - 0195-6663

VL - 168

JO - Appetite

JF - Appetite

M1 - 105788

ER -