The Sequential Binge, a New Therapeutic Approach for Binge Eating: A Pilot Study

The sequential approach in eating disorders: A scoping systematic review

OBJECTIVE

The sequential model has been defined as an intensive, two-stage approach that comprises administering two types of treatment consecutively to improve treatment outcomes in cases of non-optimal or absence of treatment response. A psychiatric population that would potentially benefit from the application of the sequential model is the eating disorders (EDs) population. The current scoping review aimed to explore the emerging literature on the application of sequential treatments in EDs.

METHOD

Using PRISMA and Population intervention comparison outcomes study guidelines, Pubmed and PsycINFO were systematically searched for studies which applied temporally sequential treatments in patients diagnosed with EDs from inception to April 2022 using a combination of keywords. Studies utilising combined or integrated approaches were excluded.

RESULTS

A total of 12 studies were selected and reviewed. Studies included Bulimia Nervosa, Binge Eating Disorder (BED), or mixed ED samples with a majority of female patients. No studies on AN samples were identified. The majority of studies contained a Cognitive-Behavioural Therapy module of treatment, were conducted on BED patients, were in outpatient settings, and included a group format in one or more treatment conditions. Studies varied in number of comparison groups and study design. Secondary and sequentially applied treatment modules were consistent with treatment recommendations of clinical guidelines.

CONCLUSIONS

The available data on sequential treatments in EDs is scarce and exhibits methodological limitations that should be addressed in future studies. Definition of sequential treatments in EDs should be further developed to guide robust clinical research and improve empirical support of sequential treatment for complex ED cases and for non-optimal ED treatment response.

Goal Directed and Self-Control Systems in Bulimia Nervosa: An fMRI Study

Background

Binge eating is apparently the opposite of the strict control over food intake typically set by “maladaptive dieters”. Using functional magnetic resonance imaging (fMRI), we investigated the role of goal-directed behaviors, and the related use of self-control, in binge-related food choices in patients with Bulimia Nervosa (BN).

Method

While undergoing fMRI, women aged 18–35 with BN (N = 35) and healthy control women (N = 26) rated foods for healthiness and tastiness and then made food choices on a 5 points Likert scale between two conflicting options: one food with lower healthiness and higher tastiness (defined as uncontrolled choice) than the other food (defined as controlled choice).

Results

BN and healthy participants made more uncontrolled than controlled choices (63% vs 24% and 65% vs 18% respectively). While healthy participants used only food tastiness (chose tastier foods more often) to make food choices (p < .001), BN patients used both food healthiness (chose unhealthy food more often, p < .001) and food tastiness (p < .001) to make binge-related food choices. Activity in the ventromedial prefrontal cortex (vmPFC), which correlated with food choices (p_FWE = 0.02), reflected this difference in the integration of food healthiness and food tastiness into a decision value. Functional connectivity analysis showed that the activity in the dorsolateral prefrontal cortex was coupled with vmPFC activity in uncontrolled food choices (p_FWE = 0.03).

Interpretation

Contrary to what might be expected, not only food tastiness but also unhealthiness (a more abstract cognitive-based attribute than food tastiness) plays a role in uncontrolled choices in BN. These choices are likely goal-directed behaviors and recruit self-control.

Cognitive behavioral therapy to aid weight loss in obese patients: current perspectives

Obesity is a chronic condition associated with risk factors for many medical complications and comorbidities such as cardiovascular diseases, some types of cancer, osteoarthritis, hypertension, dyslipidemia, hypercholesterolemia, type-2 diabetes, obstructive sleep apnea syndrome, and different psychosocial issues and psychopathological disorders. Obesity is a highly complex, multifactorial disease: genetic, biological, psychological, behavioral, familial, social, cultural, and environmental factors can influence in different ways. Evidence-based strategies to improve weight loss, maintain a healthy weight, and reduce related comorbidities typically integrate different interventions: dietetic, nutritional, physical, behavioral, psychological, and if necessary, pharmacological and surgical ones. Such treatments are implemented in a multidisciplinary context with a clinical team composed of endocrinologists, nutritionists, dietitians, physiotherapists, psychiatrists, psychologists, and sometimes surgeons. Cognitive behavioral therapy (CBT) is traditionally recognized as the best established treatment for binge eating disorder and the most preferred intervention for obesity, and could be considered as the first-line treatment among psychological approaches, especially in a long-term perspective; however, it does not necessarily produce a successful weight loss. Traditional CBT for weight loss and other protocols, such as enhanced CBT, enhanced focused CBT, behavioral weight loss treatment, therapeutic education, acceptance and commitment therapy, and sequential binge, are discussed in this review. The issue of long-term weight management of obesity, the real challenge in outpatient settings and in lifestyle modification, is discussed taking into account the possible contribution of mHealth and the stepped-care approach in health care.