Emotion-Focused Cognitive Behavioral Therapy in Comorbid Obesity With Binge Eating Disorder: A Pilot Study of Feasibility and Long-Term Outcomes

Abstract

Obesity coupled with binge eating disorder (BED) is an increasing problem. Incorporation of treatment strategies that address both problems in people with comorbid symptoms is of major interest. This study aimed to investigate the feasibility and preliminary long-term outcomes of a brief emotion-focused cognitive behavioral therapy (EF-CBT) program. Seven out of 10 women with obesity and BED completed the intervention. Standardized outcome measures to assess the intensity of distress caused by complaints, psychological distress, emotional processing, eating behavior, and weight loss were completed at baseline, end-of-treatment, 6-and 18-month followups. Individualized outcome measures were also applied to describe the personal experiences during the intervention. Findings suggest the program's long-term efficacy for improving psychological distress, emotional processing, and alexithymia. Positive reliable changes in emotional processing and alexithymia were observed in almost all participants. The mean intensity of distress caused by complaints also decreased at the end of the intervention, with a large effect size (d = 0.89). Reliable changes in these outcome measures were observed at all time-points, despite the mean scores for the 18-month follow-up suggest a retraction in improvement. Weight loss was below expectations at all time-points, as were changes in emotional and external eating. Restrained eating mean scores remained stable throughout the study. Participants perceived the program to be useful in improving emotional awareness and eating control. Program feasibility was supported by the retention rate (70%) and the average number of attended sessions (M = 9.71; SD = 2.06). Further studies are needed to examine the effectiveness of EF-CBT interventions.

The Efficacy of Psychological Intervention on Body Image in Breast Cancer Patients and Survivors: A Systematic-Review and Meta-Analysis

“…Perceptual (i.e., accuracy of estimated body size), attitudinal (i.e., subjective satisfaction about one's own body), cognitive (i.e., involvement in appearance belief about the body), affective (i.e., sensations and emotions), and behavioral dimensions (i.e., compensatory behaviors such as dieting and physical activity) are involved (Cash and Smolak, 2011 ). BI construct is indeed relevant because of impacts on the quality of life (Torres et al, 2020 ). Consequently, breast cancer patients and survivors' evaluation of their own physical appearance as well as attitudes toward the body notably change, especially in terms of femininity and sexuality (Maass et al, 2015 ; Sherman et al, 2018 ).…”

The feasibility of emotion-focused therapy for binge-eating disorder: a pilot randomised wait-list control trial

“…Using GPower with this effect size, alpha at .05, power at .95, using repeated measures ANOVA between groups design with 3 time points, yielded a required total sample size of just 6 participants. Binge eating disorder treatment pilot study sample sizes vary, e.g., 7 [ 27 ], 10 [ 50 ], 36 [ 51 ], and 41 [ 52 ]. We chose a sample size clearly larger than what was required by our power analysis from the initial case series, and at the mid-point of the aforementioned pilot studies.…”

“…Given that the experience of negative emotions is amongst the best predictors for the occurrence of binge eating episodes in BED [25], outcomes could be improved by psychological treatments with a more specific focus on the role of emotion. Indeed, innovative treatments for BED with a more specific focus on emotion are emerging, including integrative cognitive-affective therapy [26] and emotion-focused cognitive-behavioural therapy [27]. Emotion-focused therapy (EFT) is a compelling treatment for eating disorders and offers a unique framework for understanding the pathogenesis of emotional difficulties (either under-regulating or overregulating affect) in this population [28].…”

The Feasibility of Emotion-Focused Therapy for Binge-Eating Disorder: A Pilot Randomised Waitlist Control Trial

“…Indeed, innovative treatments for BED with a more speci c focus on emotion are emerging, including integrative cognitiveaffective therapy (26) and emotion-focused cognitive-behavioural therapy (27). Emotion-focused therapy (EFT) is a compelling treatment for eating disorders and offers a unique framework for understanding the pathogenesis of emotional di culties (either under-regulating or over-regulating affect) in this population (28).…”