Metacognition and emotion regulation as treatment targets in binge eating disorder: a network analysis study

Abstract

Background This study aims to examine the underlying associations between eating, affective and metacognitive symptoms in patients with binge eating disorder (BED) through network analysis (NA) in order to identify key variables that may be considered the target for psychotherapeutic interventions. Methods A total of 155 patients with BED completed measures of eating psychopathology, affective symptoms, emotion regulation and metacognition. A cross-sectional network was inferred by means of Gaussian Markov random field estimation using graphical LASSO and the extended Bayesian information criterion (EBIC-LASSO), and central symptoms of BED were identified by means of the strength centrality index. Results Impaired self-monitoring metacognition and difficulties in impulse control emerged as the symptoms with the highest centrality. Conversely, eating and affective features were less central. The centrality stability coefficient of strength was above the recommended cut-off, thus indicating the stability of the network. Conclusions According to the present NA findings, impaired self-monitoring metacognition and difficulties in impulse control are the central nodes in the psychopathological network of BED whereas eating symptoms appear marginal. If further studies with larger samples replicate these results, metacognition and impulse control could represent new targets of psychotherapeutic interventions in the treatment of BED. In light of this, metacognitive interpersonal therapy could be a promising aid in clinical practice to develop an effective treatment for BED.

Network-Based Methods for Psychometric Data of Eating Disorders: A Systematic Review

“…In line with the application to other mental disorders, various research goals can be identified among the existing literature about network approaches to EDs, namely: validation of the transdiagnostic model of eating disorders by comparing network characteristics across ED diagnoses (DuBois et al, 2017; Forrest et al, 2018; Goldschmidt et al, 2018; Mares et al, 2021; Monteleone, Tzischinsky, et al, 2022; Solmi et al, 2018; Solmi et al, 2019); estimation of the symptom network of EDs and identification of the core symptoms (Beauchamp et al, 2021; Forbush et al, 2016; Forrest et al, 2018; Forrest, Perkins, et al, 2019; Rodgers et al, 2018; Wang et al, 2019); identification and interaction with nonspecific ED symptoms (i.e., the external field) like general psychiatric symptoms, personality traits and other clinical variables (Monteleone, Mereu, et al, 2019; Solmi et al, 2018; Solmi et al, 2019), embodiment dimensions (Cascino et al, 2019), childhood maltreatment (Liebman et al, 2021; Monteleone, Cascino, et al, 2019; Monteleone, Tzischinsky, et al, 2022; Rodgers et al, 2019), mentalizing and empathy (Monteleone et al, 2020), vulnerability factors (Vervaet et al, 2021), suicidal thoughts and behaviors (Smith et al, 2020), perfectionism and interoceptive sensibility (Martini et al, 2021), affective and metacognitive symptoms (Aloi et al, 2021; Wong et al, 2021), interoceptive awareness (Brown et al, 2020), sleep disturbance (Ralph-Nearman et al, 2021), well-being domains (de Vos et al, 2021), inflexible and biased social interpretations, socioemotional functioning (Bronstein et al, 2022); assessment of psychiatric comorbidities such as depression and anxiety (Bronstein et al, 2022; Elliott et al, 2020; Kenny et al, 2021; Levinson et al, 2017; Sahlan, Williams, et al, 2021; Smith et al, 2019), posttraumatic stress disorder (Liebman et al, 2021; Vanzhula et al, 2019), social anxiety disorder (Levinson et al, 2018a; Sahlan, Keshishian, et al, 2021), obsessive-compulsive disorder (Giles et al, 2022; Kinkel-Ram et al, 2021; Meier et al, 2020; Vanzhula et al, 2021), trait anxiety disorder (Forrest, Sarfan, et al, 2019), autism spectrum disorder (Kerr-Gaffney et al, 2020), borderline personality disorder (De Paoli et al, 2020), and alcohol misuse (Cusack et al, 2021); comparison of estimated network structures among clinical and nonclinical (Vanzhula et al, 2019),...…”

“…identification and interaction with nonspecific ED symptoms (i.e., the external field) like general psychiatric symptoms, personality traits and other clinical variables (Monteleone, Mereu, et al, 2019; Solmi et al, 2018; Solmi et al, 2019), embodiment dimensions (Cascino et al, 2019), childhood maltreatment (Liebman et al, 2021; Monteleone, Cascino, et al, 2019; Monteleone, Tzischinsky, et al, 2022; Rodgers et al, 2019), mentalizing and empathy (Monteleone et al, 2020), vulnerability factors (Vervaet et al, 2021), suicidal thoughts and behaviors (Smith et al, 2020), perfectionism and interoceptive sensibility (Martini et al, 2021), affective and metacognitive symptoms (Aloi et al, 2021; Wong et al, 2021), interoceptive awareness (Brown et al, 2020), sleep disturbance (Ralph-Nearman et al, 2021), well-being domains (de Vos et al, 2021), inflexible and biased social interpretations, socioemotional functioning (Bronstein et al, 2022);…”

“…Hence, results about these metrics should be interpreted with care. As an additional proof about this fact, many articles reported betweenness and closeness centrality as not satisfying the minimum stability results and did not include their estimation in the network description (Aloi et al, 2021; Calugi et al, 2021; Forrest et al, 2018; Monteleone et al, 2020; Rodgers et al, 2018; Smith et al, 2019; Vanzhula et al, 2019). Others decided instead to take these measures into account but did not assess their stability (Forbush et al, 2016; Olatunji et al, 2018).…”

“…A. validation of the transdiagnostic model of eating disorders by comparing network characteristics across ED diagnoses (DuBois et al, 2017;Forrest et al, 2018;Goldschmidt et al, 2018;Mares et al, 2021;Monteleone, Tzischinsky, et al, 2022;Solmi et al, 2018;Solmi et al, 2019); B. estimation of the symptom network of EDs and identification of the core symptoms (Beauchamp et al, 2021;Forbush et al, 2016;Forrest et al, 2018;Forrest, Perkins, et al, 2019;Rodgers et al, 2018;Wang et al, 2019); C. identification and interaction with nonspecific ED symptoms (i.e., the external field) like general psychiatric symptoms, personality traits and other clinical variables (Monteleone, Mereu, et al, 2019;Solmi et al, 2018;Solmi et al, 2019), embodiment dimensions (Cascino et al, 2019), childhood maltreatment (Liebman et al, 2021;Monteleone, Tzischinsky, et al, 2022;Rodgers et al, 2019), mentalizing and empathy (Monteleone et al, 2020), vulnerability factors (Vervaet et al, 2021), suicidal thoughts and behaviors (Smith et al, 2020), perfectionism and interoceptive sensibility (Martini et al, 2021), affective and metacognitive symptoms (Aloi et al, 2021;Wong et al, 2021), interoceptive awareness (Brown et al, 2020), sleep disturbance (Ralph-Nearman et al, 2021), well-being domains (de Vos et al, 2021, inflexible and biased social interpretations, socioemotional functioning (Bronstein et al, 2022); D. assessment of psychiatric comorbidities such as depression and anxiety (Bronstein et al, 2022;Elliott et al, 2020;…”

Efficacy of a Group Psychoeducation Treatment in Binge Eating Disorder: An Open-Label Study

“…The unidimensional score obtained ranges from 0 to 46 and a score ≥17 has been proposed as an optimal cut- off to identify BED ( 27 , 28 ). In an Italian sample of patients with BED, an α of 0.88 was reported ( 29 ).…”