Binge-Eating Disorder: Prevalence, Predictors, and Management in the Primary Care Setting

Mindfulness- and Meditation-Based Therapies

Treatment outcome studies utilizing mindfulness-based therapies, including mindfulness-based stress reduction (MBSR) and acceptance and commitment therapy (ACT), make up a small but promising body of literature. Reasoning that negative affect, eating in the absence of hunger, and emotional eating may comprise one pathway to binge eating [153,154], it follows that mindfulness-based therapies may act through their effects on emotion regulation, acceptance strategies for tolerating negative affect, and awareness of bodily cues. A recent review identified 19 studies exploring the effects of mindfulness-based interventions on binge eating severity and frequency as well as a number of related indicators, observing positive effects for this form of treatment [155]. For example, MB-EAT [156] is a group treatment for BED that is primarily based on MBSR. Treatment is targeted at cultivating mindfulness, mindful eating, emotional balance, and self-acceptance[157]. The treatment also places particular emphasis on developing self-awareness of internal hunger and satiety cues. A recent randomized controlled trial of MB-EAT produced significant improvements in binge eating frequency and BE-related psychopathology [158]. Furthermore, process variables including hunger awareness, satiety awareness, and mindfulness were correlated with positive outcomes. In addition, a small study (n = 39) that compared ACT to standard follow-up utilized by a bariatric surgery team demonstrated significantly greater improvements in disordered eating, body satisfaction, and quality of life for clients who participated in ACT [159]. In brief, results suggest that mindfulness-based interventions represent an additional treatment approach with supporting but limited evidence to date.

Self-Help Interventions

Self-help interventions for BED are categorized as pure self-help or guided self-help. In treatment outcome studies, pure self-help is generally conducted with a self-help manual, although several studies have examined more novel formats such as the internet, video, and CD-ROM. GSH also uses a self-help manual (or other format) with the addition of brief sessions with health care providers who have varying degrees of expertise with the type of therapy being utilized. CBT is the most commonly utilized therapeutic modality in treatment outcome studies of self-help interventions, and they most often utilize Fairburn’s Overcoming Binge Eating self-help manual [160].

Two studies have directly compared pure and guided self-help with Fairburn’s manual and produced conflicting results. Carter and Fairburn [161] found that in a sample of primarily white women with BED, pure self-help (CBTsh; n = 24) and guided self-help (CBTgsh; n = 24) were equally effective, and both were superior to wait-list controls at 6-month follow-up in producing BE abstinence (CBTsh = 40%, CBTgsh = 50%), reducing binge eating, ED-related psychopathology, and general psychiatric symptoms. In contrast, a study comparing CBTsh and CBTgsh in 40 primarily white women with recurrent binge eating (82.5% diagnosed with BED), guided self-help was superior to pure self-help at the end of treatment in reducing BE frequency, eating concern, and restraint [162]. CBTgsh and CBTsh were equally effective in producing BE abstinence (50% and 30%, respectively), and reducing shape concern, weight concern, and general psychiatric symptoms [162]. Higher levels of general psychiatric symptoms were predictive of higher BE frequency post-treatment for both treatments. It should be noted that participants in both conditions experienced statistically significant improvements on all variables as compared to baseline.