(PS14-65) Weekly Associations Between Fear of Weight Gain, Emotion Dysregulation, and Binge Eating During Cognitive Behavioral Therapy for Binge-spectrum Eating Disorders

Objective. Among individuals with binge-spectrum eating disorders, fear of weight gain (FOWG) and emotion dysregulation each play a role in the maintenance of binge eating. However, associations between these factors during receipt of cognitive behavioral therapy (CBT) is understudied and it is unclear to what extent they interfere with treatment progress session-to-session. Thus, the present study examined weekly associations between FOWG, emotion dysregulation, and frequency of binge eating episodes during the same week and following week. We expected that FOWG and emotion dysregulation one week would each independently predict frequency of binge eating the same week and the following week. We also expected emotion dysregulation to moderate the association between FOWG and binge eating, such that the association between FOWG and binge eating would be stronger for participants with greater emotion dysregulation.

Method. Participants were 63 adults (11.1% male) with clinically significant binge-spectrum eating disorders, namely binge eating disorder (57.14%) and bulimia nervosa (including subthreshold; 42.86%). Participants received 12 weekly sessions of the enhanced version of CBT (CBT-E) to address eating disorder psychopathology. Prior to each session, participants completed brief versions of the Goldfarb Fear of Fat Scale (GFFS) and Difficulties in Emotion Regulation (DERS) to measure FOWG and emotion dysregulation. During sessions, therapists recorded the number of binge episodes participants reported experiencing in the past week. Linear mixed effects models were used to examine same-week and next-week associations of FOWG and emotion dysregulation on binge eating.

Results. Results indicated that FOWG and emotion dysregulation were each independently associated with greater frequency of binge eating during the same week (FOWG: B= 0.33, 95% CI [0.21, 0.45], p < 0.001; emotion dysregulation: B = 0.26, 95% CI [0.20, 0.32], p < 0.001)  and the following week (FOWG: B = 0.24, 95% CI [0.12, 0.35], p < 0.001; emotion dysregulation: B = 0.16, 95% CI [0.10, 0.22], p < 0.001). Emotion dysregulation significantly moderated the relationship between FOWG and same-week binge eating, such that the association between FOWG and binge eating was stronger for participants with greater emotion dysregulation (B = 0.04, 95% CI [0.00, 0.08], p = .026). This association was weaker and not statistically significant for next-week binge eating (p = .082).

Conclusions. Results suggest that FOWG and emotion dysregulation continue to predict binge eating episodes even while treatment is occurring. Given that extant works suggests only modest reductions in FOWG following CBT, it is critical to identify strategies to more effectively reduce FOWG and to leverage emotion regulation skills as buffer against FOWG, thereby optimizing treatment outcomes. Future research should examine the predictive ability of FOWG and emotion dysregulation on subsequent binge eating on a shorter time-scale (e.g., the day-level) and assess whether momentary interventions can be leveraged to intervene in the instance of need.