Novel assessment of affective distress intolerance: Behavioral paradigm development and ecological momentary assessment in individuals with binge eating

Distress intolerance is defined as the inability and/or unwillingness to endure negative emotional or physical experiences, specifically by engaging in maladaptive behaviors to alleviate the experience. Affective distress intolerance (pertaining specifically to negative emotional experiences) is theorized to be a key dimension underlying a wide range of maladaptive behaviors, such as loss-of-control (LOC) eating. Those with poor affective distress tolerance engage in behaviors that achieve temporary relief from negative affect, despite the potential long-term negative consequences of such behaviors. As such, affective distress intolerance is a key theoretical target for change in the development and evaluation of promising new psychological treatments. However, nearly all examinations in the current literature have relied on retrospective self-report measurement of affective distress intolerance, which is laden with problematic biases that may halt treatment development and evaluation. As such, the current project aimed to (1) iteratively develop a novel behavioral paradigm that tapped specifically into affective distress intolerance and (2) use ecological momentary assessment (EMA) to examine the interaction between momentary distress tolerance and negative affect in predicting subsequent episodes of LOC eating. We recruited 69 individuals with (n=39) and without (n=30) LOC eating to test seven iterations of the behavioral paradigm developed in the current study. A subset of individuals with LOC eating (n=12; data collection ongoing) completed an EMA protocol over the course of two weeks. While the iterations of the behavioral paradigm developed were largely successful in inducing dysphoric emotional experiences, qualitative and quantitative data suggested we were unable to successfully tap into behavioral affective distress intolerance with any iteration of the paradigm. EMA results provided preliminary support for the model that the relation between momentary changes negative affect and subsequent episodes of LOC is strongest for those with lower levels of affective distress tolerance. Ideas for future iterations of the behavioral paradigm, including methods for increasing distress induced by the task, alternative mood induction paradigms, and ways of assessing behavioral escape, are discussed.Ph.D., Psychology -- Drexel University, 201

An investigation of the neurocognitive profile of binge eating disorder

Although current interventions for BED are moderately effective, long-term binge abstinence and weight control are a challenge. Adding neurocognitive targets to intervention has the potential to improve treatment for BED, but the neurocognition of binge eating and binge eating disorder (BED) is currently poorly understood. Very preliminary evidence suggests that executive functions (EF), which are comprised of diverse, overlapping frontal lobe processes that enable an individual to engage in self-initiated, healthy, and adaptive behavior may be weak in individuals with BED. Weaknesses in specific processes that may be associated with binge eating are inhibitory control (inhibiting a prepotent response towards a stimuli), cognitive flexibility (the ability to flexibly generate strategies), decision-making (prioritizing immediate versus delayed reward), and working memory (the ability to keep goal-relevant information online). However, at this time, evidence is mixed as to whether individuals with BED show deficits in these areas, potentially due to significant methodological weaknesses in the studies that comprise the current literature. The current study compared several dimensions of EF in a sample of overweight women with (n=31) and without (n=43) full and sub-threshold BED, with the aim of conducting a thorough investigation of the neurocognitive profile of binge eating. A neuropsychological battery (including tests of inhibitory control, cognitive flexibility, delayed discounting, and working memory), a palatable-foods implicit attitudes task, and a self-report measure of food reactivity were administered to all participants before entry into either a behavioral weight loss program or cognitive-behavioral treatment for BED. Results indicate that after controlling for IQ and age, individuals with BED displayed poorer performance on tasks of executive planning and inhibitory control, and also displayed higher prioritization of immediate versus delayed rewards compared to the control group. The pattern of results remained unchanged when depression was added as a covariate. Full and sub-threshold BED groups did not differ in performance on any executive functioning tasks. Additionally, the combination of less positive implicit attitudes towards highly palatable food and poor inhibitory control was associated with higher frequency of binge episodes in the BED sample. Results suggest a distinct neurocognitive profile associated with binge eating, independent of weight status and frequency and size of binge episodes. Implications include testing of treatment components that target such executive functioning deficits, and future research should examine what deficits predict or moderate outcome in psychological treatments.M.S., Psychology -- Drexel University, 201

Computerized neurocognitive training for improving dietary health and facilitating weight loss

Nearly 70% of Americans are overweight, in large part because of overconsumption of high-calorie foods such as sweets. Reducing sweets is difficult because powerful drives toward reward overwhelm inhibitory control (i.e., the ability to withhold a prepotent response) capacities. Computerized inhibitory control trainings (ICTs) have shown positive outcomes, but impact on real-world health behavior has been variable, potentially because of limitations inherent in existing paradigms, e.g., low in frequency, intrinsic enjoyment, personalization, and ability to adapt to increasing ability. The present study aimed to assess the feasibility, acceptability, and efficacy of a gamified and non-gamified, daily, personalized, and adaptive ICT designed to facilitate weight loss by targeting consumption of sweets. Participants (N = 106) were randomized to one of four conditions in a 2 (gamified vs. non-gamified) by 2 (ICT vs. sham) factorial design. Participants were prescribed a no-added-sugar diet and completed 42 daily, at-home trainings, followed by two weekly booster trainings. Results indicated that the ICTs were feasible and acceptable. Surprisingly, compliance to the 44 trainings was excellent (88.8%) and equivalent across both gamified and non-gamified conditions. As hypothesized, the impact of ICT on weight loss was moderated by implicit preference for sweet foods [F(1,95) = 6.17, p = .02] such that only those with higher-than-average implicit preference benefited (8-week weight losses for ICT were 3.1% vs. 2.2% for sham). A marginally significant effect was observed for gamification to reduce the impact of ICT. Implications of findings for continued development of ICTs to impact health behavior are discussed

Heart rate variability and emotion regulation among individuals with obesity and loss of control eating

Autonomic nervous system functioning, measured with heart rate variability (HRV), is associated with emotion regulation and likely contributes to binge eating. This study examined the link between HRV and binge eating severity and analyzed changes in HRV as a marker of emotion regulation in individuals with binge eating. Participants (n = 28) with obesity and loss of control eating reported overeating and loss of control episodes and completed an HRV assessment at rest and during a mental stressor. At rest, lower time-domain HRV was linked to more severe loss of control (SDNN B = -0.18, p = 0.03). Frequency-domain HRV was associated with more severe overeating (LFn B = 14.92, p = 0.03; HFn B = -14.81, p = 0.04). Frequency-domain HRV differed between resting and stressed conditions (p's < 0.001). Findings contribute to understanding emotion regulation in binge eating and guide future research and novel intervention development

Slowing down and taking a second look: Inhibitory deficits associated with binge eating are not food-specific

Poor inhibitory control may contribute to the maintenance of binge eating (BE) among overweight and obese individuals. However, it is unknown whether deficits are general or specific to food (versus other attractive non-food stimuli), or whether observed deficits are attributable to increased depressive symptoms in BE groups. In the current study, we hypothesized that individuals with BE would display inhibitory control deficits, with more pronounced deficits occurring when food stimuli were used. Overweight or obese participants with (n=25) and without (n= 65) BE completed a Stop Signal Task (SST) with distinct task blocks featuring food-specific stimuli, positive non-food stimuli, or neutral stimuli. The BE group exhibited poorer inhibitory control across SST stimuli types (p = .003, η(2)(p) = .10), but deficits did not differ by stimuli type (p = .68, η(2)(p) <.01). Including depression as a covariate did not significantly alter results. Results suggest individuals with BE display inhibitory control deficits compared to controls; however, deficits do not appear to be specific to stimuli type. Furthermore, inhibitory control deficits do not appear to be associated with mood disturbance in the BE group. Replication and further research is needed to guide treatment targets

Using Continuous Glucose Monitoring to Detect and Intervene on Dietary Restriction in Individuals With Binge Eating: The SenseSupport Withdrawal Design Study

BackgroundDietary restraint is a key factor for maintaining engagement in binge eating among individuals with binge eating disorder (BED) and bulimia nervosa (BN). Reducing dietary restraint is a mechanism of change in cognitive behavioral therapy (CBT) for individuals with BN and BED. However, many individuals who undergo CBT fail to adequately reduce dietary restraint during treatment, perhaps owing to difficulty in using treatment skills (eg, regular eating) to reduce dietary restraint during their daily lives. The SenseSupport system, a novel just-in-time, adaptive intervention (JITAI) system that uses continuous glucose monitoring to detect periods of dietary restraint, may improve CBT to reduce dietary restraint during treatment by providing real-time interventions. ObjectiveThis study aimed to describe the feasibility, acceptability, and initial evaluation of SenseSupport. We presented feasibility, acceptability, target engagement, and initial treatment outcome data from a small trial using an ABAB (A=continuous glucose monitoring data sharing and JITAIs-Off, B=continuous glucose monitoring data sharing and JITAIs-On) design (in which JITAIs were turned on for 2 weeks and then turned off for 2 weeks throughout the treatment). MethodsParticipants (N=30) were individuals with BED or BN engaging in ≥3 episodes of ≥5 hours without eating per week at baseline. Participants received 12 sessions of CBT and wore continuous glucose monitors to detect eating behaviors and inform the delivery of JITAIs. Participants completed 4 assessments and reported eating disorder behaviors, dietary restraint, and barriers to app use weekly throughout treatment. ResultsRetention was high (25/30, 83% after treatment). However, the rates of continuous glucose monitoring data collection were low (67.4% of expected glucose data were collected), and therapists and participants reported frequent app-related issues. Participants reported that the SenseSupport system was comfortable, minimally disruptive, and easy to use. The only form of dietary restraint that decreased significantly more rapidly during JITAIs-On periods relative to JITAIs-Off periods was the desire for an empty stomach (t43=1.69; P=.049; Cohen d=0.25). There was also a trend toward greater decrease in overall restraint during JITAs-On periods compared with JITAIs-Off periods, but these results were not statistically significant (t43=1.60; P=.06; Cohen d=0.24). There was no significant difference in change in the frequency of binge eating during JITAIs-On periods compared with JITAIs-Off periods (P=.23). Participants demonstrated clinically significant, large decreases in binge eating (t24=10.36; P<.001; Cohen d=2.07), compensatory behaviors (t24=3.40; P=.001; Cohen d=0.68), and global eating pathology (t24=6.25; P<.001; Cohen d=1.25) from pre- to posttreatment. ConclusionsThis study describes the successful development and implementation of the first intervention system combining passive continuous glucose monitors and JITAIs to augment CBT for binge-spectrum eating disorders. Despite the lower-than-anticipated collection of glucose data, the high acceptability and promising treatment outcomes suggest that the SenseSupport system warrants additional investigation via future, fully powered clinical trials. Trial RegistrationClinicalTrials.gov NCT04126694; https://clinicaltrials.gov/ct2/show/NCT0412669

Set-shifting among adolescents with bulimic spectrum eating disorders.

ObjectiveSet-shifting difficulties are observed among adults with bulimia nervosa (BN). This study aimed to assess whether adolescents with BN and BN spectrum eating disorders exhibit set-shifting problems relative to healthy controls.MethodsNeurocognitive data from 23 adolescents with BN were compared with those from 31 adolescents with BN-type eating disorder not otherwise specified and 22 healthy controls on various measures of set-shifting (Trail Making Task [shift task], Color-Word Interference, Wisconsin Card Sorting Test, and Brixton Spatial Anticipation Task).ResultsNo significant differences in set-shifting tasks were found among groups (p &gt;.35), and effect sizes were small (Cohen f &lt; 0.17).ConclusionsCognitive inflexibility may develop over time because of the eating disorder, although it is possible that there is a subset of individuals in whom early neurocognitive difficulty may result in a longer illness trajectory. Future research should investigate the existence of neurocognitive taxons in larger samples and use longitudinal designs to fully explore biomarkers and illness effects.Trial registrationclinicaltrials.gov NCT00879151

Gamification and neurotraining to engage men in behavioral weight loss : Protocol for a factorial randomized controlled trial

Over 70% of men are overweight, and most desire weight loss; however, men are profoundly underrepresented in weight loss programs. Gamification represents a novel approach to engaging men and may enhance efficacy through two means: (1) game-based elements (e.g., streaks, badges, team-based competition) to motivate weight control behaviors and (2) arcade-style “neurotraining” to enhance neurocognitive capacities to resist the temptation of unhealthy foods and more automatically select healthy foods. This study will use a 2 × 2 factorial design to examine the independent and combinatory efficacy of gamification and inhibitory control training (ICT). Men with overweight/obesity (N = 228) will receive a 12-month mobile weight loss program that incorporates behavioral weight loss strategies (e.g., self-monitoring, goal setting, stimulus control). Men will be randomly assigned to a non-gamified or gamified version, and an active or sham ICT. A game design company will create the program, with input from a male advisory panel. Aims of the project are to test whether a gamified (versus non-gamified) weight loss program and/or ICT (versus sham) promotes greater improvements in weight, diet, and physical activity; whether these treatment factors have combinatory or synergistic effects; to test whether postulated mechanisms of action (increased engagement, for gamification, and inhibitory control, for ICT) mediate treatment effects; and whether baseline gameplay frequency and implicit preferences for ICT-targeted foods moderate effects. It is hoped this study will contribute to improved mHealth programs for men and enhance our understanding of the impact of gamified elements and neurocognitive training on weight control