Examining changes in binge‐eating disorder network centrality and structure in patients treated with cognitive‐behavioral therapy versus interpersonal psychotherapy

Abstract

Objective: A sizeable minority of patients with binge-eating disorder (BED) do not fully respond to evidence-based treatments. Evidence to guide refinements of treatments is needed. Conceptualizing BED as arising from a network of symptomto-symptom interactions allows for identification of the most strongly connected symptoms, which could inform intervention targets. This study estimated networks of BED features at pretreatment and posttreatment to assess whether cognitive behavioral therapy (CBT) and interpersonal psychotherapy (IPT) differentially impacted the interrelationships of BED symptoms/features. Methods: Participants were 392 adults (83% women, 88% white) with BED who received CBT (n = 236) or IPT (n = 156) and assessed at pretreatment and posttreatment. Networks were estimated across timepoints and treatments. Expected influence (EI) was calculated; symptoms with the highest EI have the most strong and frequent associations with other symptoms. We also assessed whether the symptoms with the highest and lowest EI predicted posttreatment remission indicators. Results: In the CBT and IPT networks, shape concern, weight concern, and eating concern had the highest EI at pretreatment and posttreatment. EI significantly increased from pretreatment to posttreatment for some symptoms in CBT but did not change for any symptoms in IPT. Shape concern significantly and positively predicted BED remission indicators in CBT and IPT. Conclusions: CBT and IPT similarly impacted interrelations among BED features. Pretreatment EI predicted posttreatment remission indicators, indicating that pretreatment centrality could signal meaningful intervention targets. Clinical implications and avenues for future research are discussed including how personalized network analysis may advance the understanding of the clinical utility of centrality. Public Significance: Cognitive behavioral therapy and interpersonal therapy for binge-eating disorder, which are two leading evidence-based treatments for bingeeating disorder that are quite different in their models and approaches, similarly impacted interrelations among binge-eating disorder symptoms. In addition, the most strongly interconnected symptom predicted indicators of remission. Studying

Investigating change in network structure of eating disorder symptoms after delivery of a smartphone app-based intervention

“…At the global level, network theory-predicted reductions in network connectivity in response to treatment were found for one study (Calugi, Dametti, Chimini, Dalle Grave, & Dalle Grave, 2021), yet non-significant differences (Forrest & Grilo, 2022 baseline v. post-intervention comparison;Forrest et al, 2023;Smith et al, 2019) or increases in overall connectivity (Forrest & Grilo, 2022 baseline v. follow-up comparison;Hilbert et al, 2020) were found in others. Smith et al (2019) also found in a transdiagnostic sample that treatment non-responders had greater network connectivity at pre-intervention relative to responders, but this effect was not found by Hilbert et al (2020) among a binge eating disorder sample.…”

“…increased connections to other symptoms in the network) rather than a reduction in line with diminished impact of the symptoms in response to treatment. These variables with increased strength include dissatisfaction with weight and shape, BMI, shape concerns, eating concerns, binge eating, and depressive symptoms (Forrest & Grilo, 2022;Forrest, Franko, Thompson-Brenner, & Grilo, 2023;Hilbert et al, 2020).…”

Current Discoveries and Future Implications of Eating Disorders

“…Interpersonal psychotherapy: It can help reduce binge eating triggered by bad communication abilities and relationships [108][109][110].…”