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Randomized Controlled Trial
. 2023 May;53(7):2789-2797.
doi: 10.1017/S003329172100475X. Epub 2021 Nov 23.

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

Rebecca G Boswell  1   2 , Ralitza Gueorguieva  1   3 , Carlos M Grilo  1   4
Affiliations
Randomized Controlled Trial

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

Rebecca G Boswell et al. Psychol Med. 2023 May.

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 disorder; cognitive-behavioral therapy; eating disorders; fluoxetine; impulsivity; obesity; treatment.

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Conflict of interest statement

Conflicts of Interest

The authors (Boswell, Gueorguieva, and Grilo) report no conflicts of interest. Drs. Grilo and Gueorguieva report several broader interests which did not influence this research or paper. During the past 12 months, Dr. Grilo’s broader interests include Honoraria for lectures and CME activities and Royalties from Guilford Press and Taylor & Francis Publishers for academic books. Dr. Gueorguieva discloses consulting for Cohen Veterans Biosciences and a provisional patent submission by Yale University: Chekroud, AM., Gueorguieva, R., & Krystal, JH. “Treatment Selection for Major Depressive Disorder” [filing date 3rd June 2016, USPTO docket number Y0087.70116US00], and Royalties from Taylor & Francis for an academic book.

Figures

Figure 1.
Figure 1.. Change in Impulsivity During Treatment and Follow-up.
Note. Impulsivity changes from baseline throughout treatment and 12-month follow-up after treatment (effects of Time; Model 1A & 1B). Least squares means and standard errors are represented graphically. CBT = Cognitive Behavioral Therapy; M0 = Baseline, M1 = Month 1; M2 = Month 2; M3 = Month 3; Post = Month 4; 12M F/U = 12 Month Follow-up.
Figure 2.
Figure 2.. Rapid Change in Impulsivity and Treatment Outcomes
Note. Values represent slope of the association between rapid change in impulsivity (baseline – month 1) and change in outcome for the respective timepoint (Models 2A & 2B). Slope is expected change in outcome per unit change in impulsivity. Significant slopes are different than 0 (see Supplementary Table S2). Error bars depict standard error. Y-Axis: b-value representing slope of the effect of rapid change in impulsivity on change in outcome variables; X-Axis: Time. M1 = Month 1; M2 = Month 2; M3 = Month 3; Post = Month 4; 12M F/U = 12 Month Follow-up; ED Psychopathology = Eating Disorder Psychopathology.
Figure 3.
Figure 3.. Change in Impulsivity During Treatment and Treatment Outcomes
Note. Values represent slopes of the association between change in impulsivity (baseline - post) and change in outcome for the respective timepoint (Models 3B). Positive values at post are greater than zero, indicating significant effects of decrease in impulsivity during treatment on outcomes (see Supplementary Table S4). Slope is expected change in outcome per unit change in impulsivity. Error bars depict standard errors. Y-Axis: b-value representing slope of the effect of change in impulsivity during treatment on change in outcome variables; X-Axis: Time. Post = Month 4; 12M F/U = 12 Month Follow-up; ED Psychopathology = Eating Disorder Psychopathology.
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