Does Microlevel Decoupling of Negative Affect and Binge Eating Impact Treatment Outcomes?

eating, binge eating, fast food.
Stronger de-coupling effects were anticipated in using integrated cognitive affective therapy for treatment of eating disorders, as compared to cognitive behavioral therapy guided self-help.

Both integrated cognitive affective therapy (ICAT) and cognitive behavioral therapy guided self-help (CBT-GSH) are associated with decoupling of momentary negative affect and binge eating symptoms, according to study findings published in Psychological Medicine.

Extensive research reveals that binge eating disorders are associated with a heightened negative affect intensity, dysregulation of averse emotions, and a range of psychiatric and medical morbidities. Treatment outcomes for binge eating disorders, however, are often less than optimal, placing an increased importance on identifying interventions that disrupt momentary affect-binge-eating associations.

To assess the changes in the momentary association between negative affect and subsequent binge-eating symptoms, as well as potential differences in decoupling with both ICAT and CBT-GSH treatment groups, investigators identified a sample of participants (n=78), all of whom met the full criteria for DSM-5 binge eating disorder and study inclusion criteria. Participants were majority women (86.4%) and non-Hispanic white (92.6%), with a mean age of 40.01±13.21 years (range, 18-64) and a mean body mass index of 34.14±8.69 kg/m2. Participants were randomly assigned to undergo either ICAT or CBT-GSH, and all were administered an eating disorder examination for the evaluation of binge eating disorder diagnoses and symptoms at pretreatment, end of treatment, and follow-up.

ICAT consisted of a 4-phase treatment regimen that emphasized psychoeducation, motivational enhancement, and self-monitoring; meal planning and emotional awareness; identifying precipitants of negative affect, possible functionality of binge eating behavior, and implementation of skills; and relapse prevention and healthy lifestyle planning. It included twenty-one 50-minute individual sessions over the course of 17 weeks. CBT-GSH utilized an empirically supported self-help intervention that highlighted the development of regular eating patterns, self-monitoring, identification of alternatives to avoid binge eating, and relapse prevention. It included 10 sessions, with 1 initial 60-minute session and nine 30-minute sessions over the course of 17 weeks.

Participants were also prompted to complete end-of-treatment ecological momentary assessment (EMA) protocol in response to 5 semi-random signals, as well as a final assessment at bedtime. The average number of signals completed per person during each

EMA period demonstrated adequate compliance to the protocol (pre-treatment, M =30.28±8.77 signals/person [68.9% including eating episode reports]; end of treatment, M =25.99±8.39 signals/person [68.4% including eating episode reports]; follow-up, M =27.52±8.48 signals/person [66.0% including eating episode reports]).

Study results indicated a significant decoupling effect observed at follow-up, but not at the end of treatment. Further, decoupling did not differ between the ICAT and CBT-GSH treatment groups. Less decoupling was also associated with higher end-of-treatment eating disorder examination global scores at end-of-treatment and higher binge frequency at follow-up.

Investigators highlighted a few notable study limitations. There was no nontreatment control group included, which makes the correlation between treatment and binge-eating symptoms, as well as decoupling of negative affect, relatively unclear. Other limitations of the study include a lack of generalizability based on the relatively homogenous sample, that only signal-contingent EMA recording was used, and the short study span, which may have also introduced missing data points and eating behaviors.

“This study lends further evidence that the micro-temporal association between affect and binge eating is an important mechanism to target in order to reduce symptoms and relapse risk. These data also demonstrate the utility of applying statistical approaches that can provide a more nuanced understanding of person-specific symptom dynamics, in line with precision medicine initiatives to develop personalized interventions,” the researchers concluded.


Smith KE, Mason TB, Schaefer LM, et al. Microlevel de-coupling of negative affect and binge eating in relationship to macro-level outcomes in binge eating disorder treatment. [published online June 29, 2020]. Psychol Med. doi: 10.1017/S0033291720001804