A feasibility randomised sham-controlled trial of concurrent self-administered transcranial direct current stimulation (tDCS) and attention bias modification training in binge eating disorder

Abstract

Background: Binge eating disorder (BED) is a common and disabling condition, typically presenting with multiple psychiatric and obesity-related comorbidities. Evidence-based treatments are either resource-intensive (psychotherapies) or have side-effects (medications) and achieve remission in only about 50%. Novel treatments are needed. We conducted a randomised sham-controlled trial of concurrent self-administered transcranial direct current stimulation (tDCS) and attention bias modification training (ABMT) in adults with BED to assess feasibility, acceptability, and preliminary efficacy.Method: Trial registration: NCT04424745 at www.clinicaltrials.gov. Eighty-two participants with BED were randomly allocated to real tDCS with ABMT, sham tDCS with ABMT, ABMT only, or waitlist control. Intervention groups received 10 sessions of their allocated treatment over 2-3 weeks. tDCS (2mA, 20 min) was self-administered using a bilateral (anode right/cathode left) montage targeting the dorsolateral prefrontal cortex. Outcomes were assessed at baseline, post-treatment, and 6-week follow-up. Results: Pre-specified feasibility criteria (recruitment ≥ 5/month and retention rate ≥ 75%) were exceeded, and treatment completion rates were high (98.7%). All interventions reduced episodes of objective binge eating, eating disorder symptoms and related psychopathology between baseline and follow-up, relative to waitlist control (medium-to-large between-group effect sizes for change scores). Small-to-medium effect sizes for change scores favoured real tDCS with ABMT, versus comparators, suggesting the verum intervention produces superior outcomes. Conclusion: At-home self-administered tDCS with ABMT is feasible and acceptable, and preliminary data on efficacy are promising. As this approach could be a useful and scalable alternative or adjunct to established treatments, confirmatory trials can and should be pursued.

Acute Augmentations to Psychological Therapies in Eating Disorders: A Systematic Review and Meta-Analysis

“…A nal 29 studies met inclusion criteria and were included in the systematic review [19,. Of these, 17 randomised trials that had eating disorder outcomes were included in the meta-analysis [19,[26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41].…”