Comparison of IRT and CBT-gshG for Binge Eating Disorder

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DESCRIPTION (provided by applicant): The candidate's long-term career goal is to establish herself as an independent clinical researcher specializing in eating disorder treatment outcome research and facilitating the translation of such research into clinical practice. Binge Eating Disorder (BED), a proposed diagnostic category in DSM-IV and a chronic condition characterized by a combination of eating disorder pathology, co-occurring physical and psychiatric conditions, impaired psychosocial functioning, and association with overweight and obesity, is an eating disorder of clinical severity and a significant public health problem. Guided self-help treatments (GSH) for BED appear promising and may be more readily disseminable than efficacious specialty treatments such as Cognitive Behavioral Therapy (CBT) and Interpersonal Psychotherapy (IPT) given the latter's administration costs and time requirements. The proposed study uses a new group-based, guided self-help BED treatment called Integrative Response Therapy (IRT), an approach for which the candidate wrote the preliminary treatment manual and pilot tested the intervention. IRT is primarily based upon the affect regulation theory of binge eating (e.g., binge eating is an attempt to alter distressing emotional states), while adding cognitive restructuring techniques. IRT teaches effective ways to cope with aversive emotions and reframe faulty cognitions while reducing vulnerabilities that are likely to lead to problematic emotional responding & cognitions such as physical needs (e.g., hunger, sleep deprivation), interpersonal conflict, and, when possible, unpleasant external events. IRT's primary goal is to significantly decrease episodes of binge eating and associated eating disorder pathology. [The proposed study will employ a randomized design to evaluate the efficacy of two group-based guided self- help treatments: IRT and CBT Guided Self-Help, a treatment of known efficacy, in group-format (CBT-gshG), and explore (1) moderators and mediators of treatment,] (2) the relative cost-effectiveness of the two treatments, and (3) between group differences on secondary measures (e.g., eating disorder and general psychopathology). The proposed study will lay the groundwork for identifying which GSH treatment should be investigated in a subsequent, larger trial that would evaluate a clinically relevant algorithm for the treatment of BED. The candidate's aims for this K23 award are to: (1) participate in instrumental eating disorder research and cost-effectiveness analysis training, (2) actively collaborate with and learn from mentor and consultants, (3) engage in Principal Investigator responsibilities for a randomized clinical trial (i.e., develop, implement, monitor, and evaluate study protocol), (4) contribute meaningfully to the literature on efficacious BED treatments, and (5) prepare to become a successful and independent investigator capable of obtaining future RO1 support for patient-oriented eating disorder research. This award represents a critical combination of training and application ideal for maturing and advancing the candidate's current career stage. PUBLIC HEALTH RELEVANCE: BED, a chronic condition characterized by eating disorder psychopathology and physical and social disability, represents a significant public health problem. Guided Self Help (GSH) treatments for BED appear promising and may be more readily disseminable to mental health care providers, accessible to patients, and cost- effective than existing, efficacious BED specialty treatments which are limited in public health utility and impact given their time and expense demands. This study proposes to compare two GSH treatments, IRT (a new, group-based approach based on the affect regulation model of binge eating) to CBT-gshG (a treatment of known efficacy, in group format, and based on the restraint model of binge eating) to ascertain which treatment is more efficacious or establish their equivalence, and explore (a) moderators and mediators of treatment, (b) the relative cost-effectiveness of the treatments, (c) between group differences on secondary measures (e.g., eating disorder and general psychopathology).