Effects of an attentional bias modification training on eating behavior in binge eating disorder

暴饮暴食的发作是暴饮暴食症（BED）的核心症状。进食障碍的认知模型表明，进食障碍的典型刺激，如高热量食物，激活了选择性记忆、解释和注意过程，这些过程被认为是维持病态进食行为的重要因素。相应地，与没有BED的超重女性相比，有BED的女性对食物刺激的注意力增加（Schag等人，2013;Schmitz, Naumann, Trentowska, & Svaldi, 2014; Svaldi, Tuschen-Caffier, Peyk, & Blechert, 2010）。然而，到目前为止，尚不清楚：(a)这些机制是否可以改变，以及(b)所描述的注意力过程的改变是否可以减少被诊断为BED的患者暴食发作的频率。为此，在以往研究的基础上（Schmitz et al., 2014; Svaldi et al., 2010），本项目计划利用眼动追踪和脑电图两项实验，评估患有和不患有BED的超重个体在观看食物图片时对典型障碍刺激和中性刺激的注意加工。实验范式将在注意偏差修正训练（AMT; Amir & Conley, 2014）之前和之后进行，该训练基于点探测任务。在这个任务中，个体被要求通过按键尽可能快速和准确地对命令刺激（探针，通常是一个点）的外观（右，左）进行分类。在AMT中，强制性刺激通常（约占所有试验的70%）过度地取代中性刺激。因此，培训的目的是减少典型偏见的障碍。因此，参与者被认为是隐性地学会了将注意力从混乱的典型刺激中转移开来。目前，AMT正在<s:1>宾根和弗莱堡的中心进行试点。AMT控制条件（AMT- c）将与AMT条件进行比较，不同之处在于，在与进食相关刺激的试验中，在AMT- c条件下，探针将同样频繁地出现在食物和中性刺激的一侧。在该项目中，每个中心将招募50名诊断为BED （DSM-5）的患者和25名超重对照参与者。在这两个中心，只有BED参与者将接受AMT。中心结果测量是(a)注意力分配的变化（由实验范式评估），(b)在虚假味觉测试中摄入的卡路里，以及(c)由专家访谈评估的饮食相关病理（EDE；前，后，3个月随访）。

Objective episodes of binge eating are the central symptom of binge eating disorder (BED). Cognitive models of eating disorders suggest that disorder-typical stimuli such as high caloric food activate selective memory, interpretation and attentional processes, assumed to substantially contribute to the maintenance of pathological eating behavior. In accordance, women with BED compared to overweight women without BED display an increased attention towards food stimuli (Schag et al., 2013; Schmitz, Naumann, Trentowska, & Svaldi, 2014; Svaldi, Tuschen-Caffier, Peyk, & Blechert, 2010). To date it is unclear, though, (a) whether these mechanisms are modifiable, and (b) whether a modification of the described attentional processes reduces the frequency of binge eating episodes in patients diagnosed with BED. To this end, based on previous studies (Schmitz et al., 2014; Svaldi et al., 2010) the present project plans to assess the attentional processing of disorder-typical and neutral stimuli when looking at food pictures in two experiments using eye tracking and EEG in overweight individuals with and without BED. The experimental paradigms will be administered prior to and after an attentional bias modification training (AMT; Amir & Conley, 2014), which is based on a dot probe task. In this task, individuals are required to classify the side of appearance (right, left) of an imperative stimulus (the probe; usually a dot) by key press as fast and as accurately as possible. In the AMT, the imperative stimulus over-proportionally often (about 70% of all trials) replaces the neutral stimulus. As such, the training aims at a reduction of the disorder typical bias. Participants are thereby thought to implicitly learn to divert their attention away from disorder typical stimuli. Currently the AMT is piloted at the centers of Tübingen and Freiburg. The AMT control condition (AMT-C) will be carried out comparably to the AMT condition, with the difference that in the AMT-C condition in trials with eating related stimuli the probe will appear equally often at the side of the food and neutral stimulus.In the project 50 patients with a diagnosis of BED (DSM-5) and 25 overweight control participants will be recruited at each center. In both centers, only BED participants will receive the AMT. Central outcome measures are (a) changes in the attention allocation (as assessed by the experimental paradigms), (b) eaten calories in a bogus taste test, and (c) eating-related pathology as assessed by an expert interview (EDE; pre, post, 3 months follow-up).