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Change in impulsivity is prospectively associated with treatment outcomes for binge-eating disorder

Published online by Cambridge University Press:  23 November 2021

Rebecca G. Boswell Open the ORCID record for Rebecca G. Boswell [Opens in a new window] ,
Ralitza Gueorguieva  and
Carlos M. Grilo
Rebecca G. Boswell*
Affiliation:
Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA Princeton Center for Eating Disorders, Penn Medicine, Princeton, NJ, USA
Ralitza Gueorguieva
Affiliation:
Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA
Carlos M. Grilo
Affiliation:
Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA Department of Psychology, Yale University, New Haven, CT, USA
*
Author for correspondence: Rebecca G. Boswell, E-mail: rebecca.boswell@pennmedicine.upenn.edu
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Abstract

Background

Impulsivity may be a process underlying binge-eating disorder (BED) psychopathology and its treatment. This study examined change in impulsivity during cognitive-behavioral therapy (CBT) and/or pharmacological treatment for BED and associations with treatment outcomes.

Methods

In total, 108 patients with BED (NFEMALE = 84) in a randomized placebo-controlled clinical trial evaluating the efficacy of CBT and/or fluoxetine were assessed before treatment, monthly throughout treatment, at post-treatment (16 weeks), and at 12-month follow-up after completing treatment. Patients completed established measures of impulsivity, eating-disorder psychopathology, and depression, and were measured for height and weight [to calculate body mass index (BMI)] during repeated assessments by trained/monitored doctoral research-clinicians. Mixed-effects models using all available data examined changes in impulsivity and the association of rapid and overall changes in impulsivity on treatment outcomes. Exploratory analyses examined whether baseline impulsivity predicted/moderated outcomes.

Results

Impulsivity declined significantly throughout treatment and follow-up across treatment groups. Rapid change in impulsivity and overall change in impulsivity during treatment were significantly associated with reductions in eating-disorder psychopathology, depression scores, and BMI during treatment and at post-treatment. Overall change in impulsivity during treatment was associated with subsequent reductions in depression scores at 12-month follow-up. Baseline impulsivity did not moderate/predict eating-disorder outcomes or BMI but did predict change in depression scores.

Conclusions

Rapid and overall reductions in impulsivity during treatment were associated with improvements in specific eating-disorder psychopathology and associated general outcomes. These effects were found for both CBT and pharmacological treatment for BED. Change in impulsivity may be an important process prospectively related to treatment outcome.

Keywords

Binge-eating disordercognitive-behavioral therapyeating disordersfluoxetineimpulsivityobesitytreatment
Type
Original Article
Information
Psychological Medicine , Volume 53 , Issue 7 , May 2023 , pp. 2789 - 2797
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Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

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