Guided Self-Help for Binge Eating Disorder

The focus of this proposal is on BED among an adult population. Guided self-help treatments
(GSH) for BED appear promising and may be more readily disseminated than efficacious
specialty treatments such as Cognitive Behavioral Therapy (CBT) and Interpersonal
Psychotherapy (IPT) given the latter's administration costs and time requirements. The
proposed study uses a new group-based, guided self-help BED treatment called Integrative
Response Therapy (IRT). IRT is primarily based upon the affect regulation theory of binge
eating (e.g., binge eating is an attempt to alter distressing emotional states), while adding
cognitive restructuring techniques. IRT teaches effective ways to cope with aversive emotions
and reframe faulty cognitions while reducing vulnerabilities that are likely to lead to
problematic emotional responding & cognitions such as physical needs (e.g., hunger, sleep
deprivation), interpersonal conflict, and, when possible, unpleasant external events. IRT's
primary goal is to significantly decrease episodes of binge eating and associated eating
disorder pathology.

CBT-GSH is a frequently used manual-based form of GSH that has demonstrated efficacy. CBT,
based on the restraint model, intervenes via behavioral techniques to replace restrained
eating with more regular eating patterns and cognitive techniques to restructure an
individual's problematic thoughts that over-evaluate shape and weight. Research literature
indicates that CBT-GSH is a viable self-help BED treatment that appears to be superior to
wait-list control conditions, equivalent to IPT, a specialty treatment, and superior to
Behavioral Weight Loss treatment at 2-year follow-up. There are then, a number of reasons for
further research on GSH in general and CBT-gsh specifically.

The proposed study will lay the groundwork for identifying which GSH treatment should be
investigated in a subsequent, larger trial that would evaluate a clinically relevant
algorithm for the treatment of BED.

Inclusion Criteria:

- Meet DSM-IV research criteria for Binge Eating Disorder (although frequency criteria
will be lessened to that proposed in DSM-V;1 time per week for 3 months).

- Be male or female between 18 and 75 years.

- Be available and committed to attend full treatment and follow-up

- Adequate transportation to the clinic.

- Be literate in English (this is required for inclusion because sessions will be
conducted in English and written and visual materials are in English).

- Have a Primary Health Care Provider.

Exclusion Criteria:

- Current psychosis or severe depression with suicidal risk; a severity that would
likely require additional psychotherapeutic or psychopharmacologic treatment or
interfere with participation in this group therapy or with day to day functioning.
Depressive disorders not meeting the intensity factor of the exclusion criteria may be
entered to the study.

- Current Anorexia or Bulimia Nervosa or purging behaviors over the past six months.

- Current drug and/or alcohol abuse/dependence.

- Current medication primarily indicated for its effect on appetite or weight, unless
the participant is willing to withdraw from such medications under supervision of
their primary care physician.

- Current chemotherapy.

- Current participation in psychotherapy, unless the participant is willing to
discontinue treatment.

- Psychotropic medication use, including antidepressants, are acceptable if doses were
stable for at least 1 month prior to assessment.

- Pregnant or plans to become pregnant within the next 12 months.

- BMI greater than 45.

- Planning to have Bariatric surgery within the next 12 months.

- No transportation