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Outcomes from cognitive behavioral therapy (CBT) for bulimia nervosa (BN) and binge-eating disorder (BED) are suboptimal. One potential explanation is that CBT fails to adequately target inhibitory control (i.e., the ability to withhold an automatic response), which is a key maintenance factor for binge eating. Computerized inhibitory control training (ICT) is a promising method for improving inhibitory control but is relatively untested in BN/BED. The present study will evaluate a computer-based ICT as an adjunct to CBT for BN/BED. Participants with BN (n = 30) or BED (n = 30) will be randomized to 12 weeks of either CBT + ICT or CBT + a sham training. Trainings will be completed daily for 4 weeks and weekly for 8 weeks. Primary aims include the following: (a) confirm target engagement (evaluate whether ICT improves inhibitory control), (b) test target validation (evaluate whether improvements in inhibitory control are associated with improvements in binge eating), and (c) evaluate the incremental efficacy of ICT on binge eating. Secondary aims include the following:(a) evaluate ICT feasibility and acceptability and (b) assess the moderating effects of approach tendencies on highly palatable food, dietary restraint, and diagnosis. Data will be used to shape a fully powered clinical trial designed to assess efficacy and dose-response effects of ICT for BN/BED. K E Y W O R D S binge-eating disorder, bulimia nervosa, cognitive behavioral therapy, inhibitory control training

Objective: Individuals with eating disorders (EDs) often engage in maladaptive exercise (e.g., feeling driven, or to "compensate" for eating) which maintains eating pathology.Maladaptive exercise has been theorized to help individuals with EDs regulate emotions by enhancing positive affect (PA) and reducing negative affect (NA) associated with binge episodes and poor body image. However, no research has considered the presence of non-maladaptive exercise or evaluated this theory in binge-spectrum EDs.Methods: This study evaluated affective trajectories pre-and post-exercise and examined exercise type (maladaptive or non-maladaptive) as a moderator. We recruited adults with binge-spectrum EDs (N = 107; n = 84 endorsed exercise) to complete a 7-to 14-day ecological momentary assessment protocol assessing NA (anxiety, guilt, and sadness), PA (excitement and cheerfulness), and exercise.Results: There was a significant quadratic trajectory of PA pre-exercise, suggesting that the upward trajectory of PA leveled out as it moved closer to an exercise episode. Exercise type significantly moderated the cubic trajectory of PA post-exercise, such that the upward trajectory of PA accelerated in the hours following nonmaladaptive exercise episodes while the downward trajectory of PA accelerated in the hours following maladaptive exercise episodes. No trajectories of NA demonstrated significant effects.Conclusions: Pre-exercise trajectories of PA may reflect positive expectancies around exercise. Post-exercise trajectories of PA suggest that non-maladaptive exercise promotes increased PA. Future research should evaluate when, and for whom, exercise serves to regulate affect and examine other momentary risk factors of exercise in EDs.Public Significance: Individuals with EDs often engage in maladaptive exercise (e.g., feeling driven, or to "compensate" for eating). Maladaptive exercise has been theorized to help individuals with EDs regulate emotions. This study evaluated affective trajectories pre-and post-exercise and examined whether exercise type (maladaptive or non-maladaptive) changed these trajectories. Pre-exercise trajectories of PA may reflect positive expectancies around exercise. Post-exercise trajectories of PA suggest that non-maladaptive exercise promotes increased PA.

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Objective: Fear of weight gain (FOWG) is increasingly implicated in the maintenance of binge-spectrum eating disorders (EDs; e.g., bulimia nervosa [BN], binge-eating disorder [BED]) through the pathway of increased dietary restriction. However, particularly in binge-spectrum EDs, research is nascent and based on retrospective selfreport. To improve treatment outcomes, it is critical to better understand the momentary relations between FOWG and dietary restriction.Method: Sixty-seven adults with binge spectrum EDs completed a 7-14-day ecological momentary assessment protocol that included items regarding FOWG, ED behaviors, and types of dietary restriction (e.g., attempted restraint vs. actual restriction) several times per day. Multilevel models were used to evaluate reciprocal associations between FOWG and dietary restriction, and to evaluate the indirect of effects of dietary restriction on the relation between FOWG and binge eating.Results: While main effects were not statistically significant, ED presentation significantly moderated the association between increases in FOWG at time1 and both attempted and actual avoidance of enjoyable foods at time2 such that those with BN-spectrum EDs were more likely to avoid enjoyable foods following increased FOWG compared to those with BED-spectrum EDs. Engagement in restriction at time1 was not associated with decreased FOWG at time2. Discussion: Prospective associations between FOWG and restriction suggest that individuals with BN may be more likely to restrict their eating following increased FOWG. These findings suggest FOWG may be an important target for future treatments.

Inhibitory control, the ability to inhibit one’s automatic responses to desirable stimuli, may be inadequately targeted in interventions for loss-of-control eating. Promising evidence has identified inhibitory control trainings (ICTs) as an avenue to target inhibitory control directly; however, effects of ICTs on real-world behavior are limited. Compared to typical computerized trainings, virtual reality presents several potential advantages that may address key shortcomings of traditional ICTs, i.e. poor approximation to everyday life. The present study utilized a 2x2 factorial design of treatment type (ICT vs sham) by treatment modality (VR vs standard computer) to examine 1) the feasibility and acceptability of six weeks of daily training; 2) the main and interactive effects of treatment type and modality on target engagement and efficacy (i.e., training compliance, change in LOC eating episodes, inhibitory control, and implicit liking of foods). Participants (N = 35) with ≥ 1x/weekly LOC eating were assigned to one of four conditions and completed ICTs daily for six weeks. The treatment was feasible and acceptable, which was supported by high retention and compliance across time and condition. Although completing daily trainings across treatment types and modalities was associated with large decreases in LOC, there were no significant effects of either treatment type or modality, nor a significant interaction effect, on LOC or mechanistic variables. The mechanism driving overall improvements in LOC may be increased goal salience; future research should test whether goal salience interventions may be an effective and highly disseminable treatment option for LOC eating.

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