Objective Internet‐based guided self‐help (GSH) programs increase accessibility and utilization of evidence‐based treatments in binge‐eating disorder (BED). We evaluated acceptance and short as well as long‐term efficacy of our 8‐session internet‐based GSH program in a randomized clinical trial with an immediate treatment group, and two waitlist control groups, which differed with respect to whether patients received positive expectation induction during waiting or not. Method Sixty‐three patients (87% female, mean age 37.2 years) followed the eight‐session guided cognitive‐behavioural internet‐based program and three booster sessions in a randomized clinical trial design including an immediate treatment and two waitlist control conditions. Outcomes were treatment acceptance, number of weekly binge‐eating episodes, eating disorder pathology, depressiveness, and level of psychosocial functioning. Results Treatment satisfaction was high, even though 27% of all patients dropped out during the active treatment and 9.5% during the follow‐up period of 6 months. The treatment, in contrast to the waiting conditions, led to a significant reduction of weekly binge‐eating episodes from 3.4 to 1.7 with no apparent rebound effect during follow‐up. All other outcomes improved as well during active treatment. Email‐based positive expectation induction during waiting period prior to the treatment did not have an additional beneficial effect on the temporal course and thus treatment success, of binge episodes in this study. Conclusion This short internet‐based program was clearly accepted and highly effective regarding core features of BED. Dropout rates were higher in the active and lower in the follow‐up period. Positive expectations did not have an impact on treatment effects.

Background Binge Eating Disorder (BED) represents a common eating disorder associated with marked health impairments. A subclinical variant, loss of control eating (LOC) is prevalent in youth. LOC is associated with similar mental distress as full-blown BED, increases the risk to develop a BED and promotes continuous weight gain. The etiology of LOC is not yet fully understood and specialized treatment for youth is scarce. Methods The i-BEAT study includes a cross-sectional and longitudinal online questionnaire study (N = 600), an App based daily-life approach and a laboratory virtual reality study in N = 60 youths (14–24 years) with and without LOC as well as a controlled randomized online treatment trial to investigate the feasibility, acceptance and efficacy of a CBT and an interpersonal emotion regulation module for youth (N = 120). The primary outcomes include self-reported as well as measured (heart rate variability, gaze behavior, reaction times in stop signal task) associations between emotion regulation problems (such as dealing with RS), psychological impairment and binge eating in a healthy control group and youth with LOC. Secondary outcomes encompass general eating disorder pathology, social anxiety, body mass index, hyperscanning behavior and therapists’ rating of patients’ condition pre and post treatment. Epigenetic correlates of RS are assessed in healthy controls and youth with LOC and explored before and after treatment. Discussion The expected findings will specify the role of interpersonal emotion regulation problems such as coping with the experience of social exclusion and rejection sensitivity (RS) in LOC and clarify, whether including a training to cope with RS adds to the efficacy of a cognitive behavioral treatment (CBT). Trial registration: German Clinical Trial Register: DRKS00023706. Registered 27 November 2020, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00023706

Zusammenfassung. Das Hauptmerkmal der Binge-Eating-Störung (BES) sind Essanfälle, bei denen Betroffene das Gefühl des Kontrollverlusts erleben und große Mengen an Nahrung in einem abgrenzbaren Zeitraum zu sich nehmen. Essanfälle sind bei der BES nicht gefolgt von ­Kompensationsverhalten, führen zu einem hohen Leidensdruck und sind in vielen Fällen assoziiert mit Übergewicht. Manualisierte kognitiv-­verhaltenstherapeutische Behandlungsprogramme im Einzel- und Gruppensetting zur Therapie der BES haben sich in kontrollierten Studien als wirksam erwiesen. Auf der Grundlage eines etablierten Behandlungsmanuals wurde ein Selbsthilferatgeber für Betroffene publiziert und in der vorliegenden Studie in Rahmen eines buchbasierten angeleiteten Selbsthilfeprogramms (ASH-Programm) unter natürlichen klinischen ­Rahmenbedingungen überprüft. 22 Patienten (21 Frauen, 1 Mann; Durchschnittsalter 35.82 Jahre (SD = 10.35 Jahre)) nahmen am 8-wöchigen ­ASH-Programm zur Behandlung der BES gefolgt von drei Auffrischungssitzungen über 6 Monate teil. Zwei Patienten (9.1 %) beendeten das ­ASH-Programm während der aktiven Behandlungsphase vorzeitigt (Dropout). Die Anzahl wöchentlicher Essanfälle und die Essstörungspsychopathologie (restriktives Essverhalten, Figursorgen, Gewichtssorgen, essensbezogene Sorgen) reduzierten sich bis zum Ende der aktiven Behandlungsphase signifikant. In den Auffrischungssitzungen konnte eine Stabilisierung der erreichten Abnahme an wöchentlichen Essanfällen und Essstörungspsychopathologie verzeichnet werden. Bis zum Ende der Auffrischungssitzungen, 1, 3 und 6 Monate nach dem Ende der aktiven Behandlungsphase nahm zudem auch die allgemeine Psychopathologie (depressive- und Angstsymptomatik) signifikant ab. Die Ergebnisse legen nahe, dass das vorliegende ASH-Programm wirksam für die Behandlung der BES ist.

This study examined the consequences of media exposure to thin ideals compared to pictures of landscapes in healthy young women and women with eating and mixed mental disorders and investigated whether appearance-related cognitive factors and cognitive distortions moderate the effects. Two hundred seventy-five women in a multisite laboratory trial (174 in- or outpatients and 101 healthy women; M age 22.87 years, SD = 3.94) were exposed to either thin ideals or to landscape pictures and guided through a vivid imagery of these pictures thereafter. Changes in body image dissatisfaction, mood, eating behavior, and physiological markers were assessed. After thin ideal exposure and even more after guided imagery, women’s body image dissatisfaction increased and mood declined. The effect on mood was most pronounced in women with eating disorders, less in women with mixed disorders, and smallest in healthy controls. No effects were found on physiological measures. Higher values of appearance-related cognitive factors moderated the effect of thin ideal exposure and guided imagery on all psychological outcomes. Cognitive distortions moderated the effect of thin ideal exposure and guided imagery on mood. Findings indicate an overall susceptibility to viewing thin ideal pictures in magazines in young and especially in women with eating disorders. Though exposure in the laboratory resulted in psychological effects, it did not lead to a physiological stress response. The impact of thin ideal exposure on mood is in line with affect-regulation models in eating disorders, with appearance-related cognitive factors and cognitive distortions potentially accelerating such effects.

Essstörungen treten bei Frauen häufiger auf als bei Männern. Jedoch wird der Anteil an Männern in dieser Patientengruppe vermutlich unterschätzt, da Messinstrumente oft anhand von Daten weiblicher Betroffener entwickelt werden. In Symptomatik und Ätiologie zeigen sich zwischen den Geschlechtern mehr Gemeinsamkeiten als Unterschiede. Im Gegensatz zum Streben nach schlankem Körper ist für Männer aber ein Streben nach einem muskulösem Körper typisch.