The Reward Re-Training protocol: A novel intervention approach designed to alter the reward imbalance contributing to binge eating during COVID-19

The Impact of Stress from Social Isolation during the COVID-19 Pandemic on Psychiatric Disorders: An Analysis from the Scientific Literature

The COVID-19 pandemic generated, in addition to severe symptoms, hospitalizations and deaths worldwide, as well as stress from the fear of the disease and social uncertainties, from restriction measures and social isolation. Stress from social isolation impacts mental health, aggravating existing conditions and triggering neuropsychiatric symptoms in individuals with biopsychosocial vulnerability. During and immediately after the period of social restriction imposed by the pandemic, the scientific community carried out several research protocols. These revealed results that relevantly demonstrate the harmful effect of the stress induced by the pandemic situation. This narrative review reports and discusses research results demonstrating impairments in psychiatric disorders such as autism spectrum disorder, dementia, eating disorders, schizophrenia, anxiety, and depression. In this sense, the community has identified a significant negative influence of social isolation on the mental health of individuals through the modification of individual routines and the absence of social interactions. Moreover, the community identified perceived differences related to the impacts on men and women. In addition to studies showing the effect of social isolation on disorders, an evaluation of protocols with some possible therapeutic intervention strategies during times of social restriction was developed.

A Pilot Open Trial of a Digital Mindfulness-Based Intervention for Anorexia Nervosa

Anorexia nervosa (AN) is a chronic and debilitating psychiatric disorder. Unfortunately, current treatments are lacking, with only 30-50% of individuals with AN recovering after treatment. We developed a beta-version of a digital mindfulness-based intervention for AN called Mindful Courage-Beta, which includes: (a) one foundational multimedia module; (b) 10 daily meditation mini-modules; (c) emphasis on a core skill set called the BOAT (Breathe, Observe, Accept, Take a Moment); and (d) brief phone coaching for both technical and motivational support. In this open trial, we aimed to evaluate (1) acceptability and feasibility; (2) intervention skill use and its association with state mindfulness in daily life; and (3) pre-to-post changes in target mechanisms and outcomes. Eighteen individuals with past-year AN or past-year atypical AN completed Mindful Courage-Beta over 2 weeks. Participants completed measures of acceptability, trait mindfulness, emotion regulation, eating disorder symptoms, and body dissatisfaction. Participants also completed ecological momentary assessment of skill use and state mindfulness. Acceptability ratings were good (ease-of-use: 8.2/10, helpfulness: 7.6/10). Adherence was excellent (100% completion for foundational module and 96% for mini-modules). Use of the BOAT in daily life was high (1.8 times/day) and was significantly associated with higher state mindfulness at the within-person level. We also found significant, large improvements in the target mechanisms of trait mindfulness (d = .96) and emotion regulation (d = .76), as well as significant, small-medium to medium-large reductions in eating disorder symptoms (ds = .36-.67) and body dissatisfaction (d = .60). Changes in trait mindfulness and emotion regulation had medium-large size correlations with changes in global ED symptoms and body dissatisfaction (rs = .43 - .56). Mindful Courage-Beta appears to be promising and further research on a longer, refined version is warranted.

Impact of Final Phase Social Isolation and the COVID-19 Pandemic on Eating Behavior, Sleep Quality, and Anxiety Level

The coronavirus disease 2019 (COVID-19) pandemic has resulted in economic, social, and behavioral changes in people, which may favor several long-term consequences. This study evaluated the effects of the COVID-19 pandemic on eating behavior and mental health in the final phase of social isolation. This cross-sectional study included 756 adults that completed an online questionnaire. Individuals were stratified into those who had been infected with COVID-19 (GCOV) and those who did not (GNCOV). The GCOV group had higher weight (p = 0.013), body mass index (BMI) (p = 0.005), anxiety levels (p = 0.040), sleep disorders (p = 0.009), and poorer sleep quality (p = 0.0028). In the GCOV, the consumption of ultra-processed foods was associated with higher anxiety levels and poorer sleep quality. A higher proportion of individuals who consumed more than five servings of in natura food was observed in the group with taste and olfactory dysfunction than in the group without. Obesity contributes to uncontrolled and emotional eating disorders, increased anxiety, and worsened sleep. Therefore, COVID-19 impaired mental health and eating behavior even in the long term. These changes were potentiated by the presence of obesity and consumption of ultra-processed foods, evidencing the importance of monitoring these individuals even after the resolution of COVID-19.

Reward retraining: A pilot randomized controlled trial of a novel treatment approach for transdiagnostic binge eating

OBJECTIVE

Low reward response to conventionally rewarding stimuli and high reward response to food (i.e., reward imbalance), has been supported as a maintenance factor for eating disorders characterized by binge eating. The current study was a pilot randomized controlled trial testing a novel treatment approach for binge eating targeting reward imbalance, called Reward Re-Training (RRT), in comparison to a therapeutic attention control condition (supportive psychotherapy; ST).

METHOD

Fifty-nine participants were randomly assigned to receive either 10 group sessions of RRT or ST via videoconferencing software. Assessments of eating pathology and hypothesized treatment targets were completed at pretreatment, mid-treatment, and posttreatment, and 3-month following the end of treatment.

RESULTS

Feasibility and acceptability success benchmarks were achieved. Results found a significant indirect effect of RRT on lower posttreatment global eating pathology through decreases in reward to food from pretreatment to mid-treatment. No significant differences were observed between groups in terms of change in hypothesized treatment mechanisms or outcomes at posttreatment or 3-month follow-up.

DISCUSSION

The current study supports the feasibility and acceptability of RRT, and the preliminary efficacy of both RRT and ST. Further research comparing these approaches to CBT would help to inform who might benefit from non-CBT based treatment approaches.

PUBLIC SIGNIFICANCE

The current pilot study supports the feasibility and acceptability of Reward Re-Training (RRT) as a treatment for binge eating (BE). RRT produced large, but similar, reductions in overall eating pathology and BE frequency compared to supportive psychotherapy (ST) by 3-month follow-up. This study supports further testing of indirect treatments such as RRT for binge eating.

Reward mediates the association between engagement in noneating activities and state body dissatisfaction: An ecological momentary assessment study

OBJECTIVE

Momentary worsening (i.e., greater than one's average levels) of state body dissatisfaction (BD) has been implicated as a proximal risk factor for eating disorder (ED) behaviors in binge-spectrum EDs. Yet, research exploring the prospective association between noneating activities in daily life (e.g., chores, self-care/coping) and momentary state BD remains limited. Understanding the momentary link between engagement in noneating activities and state BD, and pathways through which engagement in said activities influences momentary state BD is critical to informing treatments. The current ecological momentary assessment (EMA) study examined whether (1) engagement in noneating activities at Time 1 prospectively predicted momentary state BD at Time 2 and (2) reward drawn from noneating activities at Time 1 mediates the prospective association between engagement in noneating activities at Time 1 and momentary state BD at Time 2.

METHOD

Sixty-six adults with transdiagnostic binge eating completed an EMA protocol over 7-14 days. Participants received six EMA signals per day (total EMA observations = 4038). Multilevel modeling was used to examine the research questions.

RESULTS

Engagement in an indoor hobby, outdoor recreation, socializing, and self-care/coping strategies prospectively predicted momentary state BD improvements, while using TV/social media and cooking prospectively predicted momentary state BD worsening. Reward drawn from engagement in these noneating activities mediated the associations.

DISCUSSION

If replicated, these findings suggest that increasing the frequency of certain noneating activities and enhancing their rewarding aspects to improve state BD and decrease ED behavior risk during treatment may be worthy of further exploration.

PUBLIC SIGNIFICANCE

Momentary worsening of state body dissatisfaction (BD) is a risk factor for eating disorder behaviors in individuals with binge eating. This study found that engaging in certain noneating activities (e.g., socializing) prospectively predicted momentary improvements in state BD, while other noneating activities (e.g., cooking) predicted momentary worsening of state BD. Reward drawn from activities mediated these relations. To improve state BD, treatments should target the frequency of, and reward obtained from these noneating activities.

Anhedonia in cognitive behavioral therapy for binge eating spectrum disorders

Anhedonia is theorized as being relevant to binge eating spectrum disorders (BESDs) by palatable foods substituting the pleasure typically obtained from day-to-day activities. The current study examined whether anhedonia is associated with eating pathology at baseline and whether it predicts cognitive behavioral therapy (CBT) outcomes alone and when controlling for non-anhedonia depression symptoms. Ninety-three individuals from two randomized controlled trials completed the Eating Disorder Examination and Beck Depression Inventory-II at pre-, mid-, and post-treatment. Results showed that anhedonia was positively associated with global eating pathology at baseline, and larger pre- to mid-treatment anhedonia and non-anhedonia reductions predicted larger pre- to post-treatment global eating pathology reductions, though the anhedonia association was no longer significant when controlling for non-anhedonia depression. Anhedonia appears to be related to global eating pathology in CBT for BESDs, but not loss of control eating. Further research is needed to elucidate the relationship between anhedonia and BESDs.