Micro-level de-coupling of negative affect and binge eating in relationship to macro-level outcomes in binge eating disorder treatment

Kathryn E. Smith, Tyler B. Mason, Lauren M. Schaefer, Lisa M. Anderson, Vivienne M. Hazzard, Ross D. Crosby, Scott G. Engel, Scott J. Crow, Stephen A. Wonderlich, Carol B. Peterson

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


BACKGROUND: While negative affect reliably predicts binge eating, it is unknown how this association may decrease or 'de-couple' during treatment for binge eating disorder (BED), whether such change is greater in treatments targeting emotion regulation, or how such change predicts outcome. This study utilized multi-wave ecological momentary assessment (EMA) to assess changes in the momentary association between negative affect and subsequent binge-eating symptoms during Integrative Cognitive Affective Therapy (ICAT-BED) and Cognitive Behavior Therapy Guided Self-Help (CBTgsh). It was predicted that there would be stronger de-coupling effects in ICAT-BED compared to CBTgsh given the focus on emotion regulation skills in ICAT-BED and that greater de-coupling would predict outcomes.

METHODS: Adults with BED were randomized to ICAT-BED or CBTgsh and completed 1-week EMA protocols and the Eating Disorder Examination (EDE) at pre-treatment, end-of-treatment, and 6-month follow-up (final N = 78). De-coupling was operationalized as a change in momentary associations between negative affect and binge-eating symptoms from pre-treatment to end-of-treatment.

RESULTS: There was a significant de-coupling effect at follow-up but not end-of-treatment, and de-coupling did not differ between ICAT-BED and CBTgsh. Less de-coupling was associated with higher end-of-treatment EDE global scores at end-of-treatment and higher binge frequency at follow-up.

CONCLUSIONS: Both ICAT-BED and CBTgsh were associated with de-coupling of momentary negative affect and binge-eating symptoms, which in turn relate to cognitive and behavioral treatment outcomes. Future research is warranted to identify differential mechanisms of change across ICAT-BED and CBTgsh. Results also highlight the importance of developing momentary interventions to more effectively de-couple negative affect and binge eating.

Original languageEnglish (US)
Pages (from-to)140-148
Number of pages9
JournalPsychological medicine
Issue number1
Early online dateJun 29 2020
StatePublished - Jan 29 2022

Bibliographical note

Publisher Copyright:
Copyright © The Author(s), 2020. Published by Cambridge University Press.


  • Binge eating disorder
  • ecological momentary assessment
  • emotion regulation

PubMed: MeSH publication types

  • Journal Article


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