3 - (SYM 36) Uniting Couples in the Treatment of Binge-eating Disorder (BED): Primary Outcomes from a Randomized Controlled Trial Comparing a Couple-based Cognitive-behavioral Treatment for BED with CBT-E

Abstract Body
Binge-eating disorder (BED) is the most common eating disorder (ED) and has high comorbidity and elevated suicide risk. While individual treatments show efficacy, challenges remain in completion rates, relapse prevention, and achieving sustained binge-eating abstinence. Incorporating romantic partners into BED treatment is encouraging, as interpersonal stressors often trigger binge-eating, partners express a desire to help but lack guidance, and partners are a promising recovery resource.
Therefore, authors developed UNITE-BED, a 16-week cognitive-behavioral couple therapy that addresses BED by improving couple communication regarding the ED, building problem-solving skills, and engaging partner-assisted emotion regulation. Following a successful open trial, the present study is a randomized controlled trial comparing UNITE to an efficacious individual treatment, Cognitive-Behavioral Therapy-Enhanced (CBT-E). Couples (N=21; 10% same-sex) in which one partner had a current DSM-5 BED diagnosis participated in UNITE (couple) or CBT-E (patient only). Measures included treatment satisfaction, ED symptoms, depression, anxiety, and couple functioning at pre-, mid-, post-, and 3-and 6-months post-treatment. Multilevel models tested the efficacy of UNITE compared to CBT-E.

Results showed ED symptom improvement at post-treatment (28-day binge-eating abstinence: UNITE = 50%; CBT-E = 71%), with more improvement in the UNITE group at 6-months post-treatment (UNITE = 86%; CBT-E = 67%). Patients’ depression and anxiety significantly decreased from pre-treatment to 6-month follow-up. None of the ED, depression, or anxiety improvements differed between conditions. Relationship satisfaction was high at pretest and did not change or differ between groups. While treatment completion (UNITE = 80%; CBT-E = 73%) and satisfaction were high overall, partners randomized to UNITE were significantly more satisfied than partners in CBT-E.

This study introduces a novel interpersonal approach to BED treatment, which has the potential to expand treatment options. Couple-based cognitive-behavioral treatment for BED shows promise as an effective alternative to the gold standard treatment (CBT-E), including similar improvements in binge-eating abstinence and co-morbid depression and anxiety. Patients were highly satisfied with both treatments, but partners were more satisfied when they were included in treatment. UNITE-BED may prove especially beneficial for those seeking a couples-based approach to BED recovery.