Reward Re-Training: A new treatment to address reward imbalance during the COVID-19 pandemic

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PROJECT SUMMARY Public health approaches to reducing the spread of COVID-19 such as social distancing, shelter-in-place orders, quarantine, telework, and remote learning have produced a sudden and widespread disruption to social networks. The observed disruptions to social networks are leading to increases in social isolation and loneliness and limited opportunities to obtain sufficient reward from day-to-day life activities. Reduced exposure to day-to- day sources of reward can lead to a hypo-reward response to conventionally rewarding stimuli and reduce an individual’s motivation to engage in activities that they usually find pleasurable. When insufficient pleasure is experienced from day-to-day life activities, some individuals may be more likely to seek out stimuli that can immediately and powerfully activate neural reward pathways. A hyper-reward response to disorder specific stimuli may develop as individuals seek out larger quantities or more frequent exposure to a limited range of intensely stimulating sources of reward. Collectively, this may produce a reward imbalance such that individuals achieve very little reward from typically enjoyable day-to-day life activities and instead achieve most of their reward from behaviors or substances that have high potential for adverse consequences. While the reward imbalance is likely a relevant maintenance factor for numerous mental health conditions, there is a strong body of literature suggesting that individuals with an eating disorders (ED) characterized predominately by binge eating experience a reward imbalance. Prior to the COVID-19 pandemic, our team began to develop a novel group-based treatment approach for transdiagnostic binge eating that we call Reward Re-Training (RRT). RRT is designed to indirectly change disordered eating behaviors by directly focusing on building a more rewarding life. RRT hypothesizes that reductions in binge eating will occur as life becomes more rewarding because individuals will no longer need to rely on binge eating as a primary source of momentary reward. RRT notes that in order to live a satisfying life, individuals need to experience an adequate amount of reward in two overlapping yet distinguishable domains: momentary reward (i.e., the active experience of pleasure in the moment) and sustained reward (i.e., a deeper and more long-lasting sense of fulfillment and meaning that arises from building a personally valued life). A key aspect of RRT is an emphasize on building lasting and meaningful social relationships given the clear evidence that social activities and social connection can enhance both momentary reward and sustained reward. In the current study, we will revise our existing 10-session group RRT treatment manual to specifically address the challenges in enhancing both momentary and sustained reward during the COVID-19 pandemic. We will conduct a small pilot RCT that will randomize individuals to receive either 10-sessions of RRT (n=30) or supportive therapy (n=30), both delivered as group-treatments via videoconferencing software, to evaluate the feasibility, acceptability, target engagement and preliminary estimates of efficacy for RRT.