(PS14-6) Self-criticism and Punishment Feelings Predict Driven Exercise at Post-treatment in Adults with Binge-spectrum Eating Disorders

Existing literature highlights how individuals with comorbid binge-spectrum eating disorders (BSEDs) and depression have poorer treatment outcomes overall compared to individuals with BSEDs alone. Depression also predicts treatment outcomes for specific behaviors in BSEDs, such as binge eating frequency, self-induced vomiting, and driven exercise. Additionally, specific depressive factors, such as self-criticism (SC) and punishment feelings (PF), are known to predict poorer treatment outcomes in individuals with eating disorders, specifically anorexia nervosa. Previous cross-sectional research highlights how SC and PF closely relate to “core low self-esteem” in the transdiagnostic model of eating disorders, although little is known about how these factors may predict treatment outcomes over time in individuals with BSEDs. To address this gap, further research is needed to understand how these factors may predict treatment outcomes in other eating disorder populations. The current study examines the role of baseline SC and PF as predictors of treatment outcomes in individuals who received enhanced cognitive behavioral therapy (CBT-E) for BSEDs. We hypothesized that baseline SC and PF would predict higher scores of binge eating frequency, self-induced vomiting, and driven exercise. Participants (N = 165) with BSEDs between the ages of 18 and 70 years old took part in one of four research studies (M age = 38.70, SD = 12.84; 87.3% female; 73.3% white). Participants received between 12 and 20 sessions of CBT-E and had clinically significant binge eating at baseline (i.e., experienced ≥ 12 loss-of-control eating (LOC) episodes in the past three months). We conducted five separate multiple linear regressions with pooled data using SC and PF to predict each treatment outcome. These analyses controlled for study and baseline eating disorder pathology. Baseline SC and PF items from the Beck Depression Inventory-II (BDI-II) were used to predict past month post-treatment Eating Disorder Examination (EDE) Global score, total objective bulimic episodes (OBEs), total LOC episodes, self-induced vomiting episodes, and driven exercise days. Baseline SC and PF did not significantly predict the post-treatment EDE scores, self-induced vomiting episodes, OBE episodes, or LOC episodes. However, PF (𝛽 = .784, p = .031) and SC (𝛽 = -.811, p = .025) were significant positive predictors of driven exercise, such that higher baseline values were associated with increased post-treatment driven exercise days. These findings establish a preliminary link between baseline PF, SC, and driven exercise. Therefore, it may be useful for future research to examine the benefit of intervening on SC and PF early in treatment for individuals with BSEDs. This information could help inform more personalized treatments and consequently improve overall treatment outcomes. Future studies could also examine whether more severe BDI-II scores predict more severe BSED pathologies, as well as how other BDI-II items predict treatment outcomes.