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Bulimia nervosa (BN) is characterized by a pattern of binge eating and compensatory behaviors as well as an overemphasis on body weight and shape in self-evaluation. Although cognitive behavioral therapy (CBT) is efficacious, recent reviews suggest that only 30% of patients reach abstinence at posttreatment. One potential reason for these poor outcomes is that CBT fails to adequately reduce elevated negative affect (NA) and shape and weight concern, which have been shown to be correlated with poorer treatment outcomes in BN. Therefore, novel treatment components that focus on improving NA and shape and weight concern are needed in order to enhance outcomes. Promoting physical activity (PA) is a promising avenue through which to reduce NA and improve body image in healthy individuals, other clinical populations (e.g., individuals with depression or anxiety), and individuals with eating disorders. While prescribing PA for individuals with BN has been controversial (due to concerns that exercise maybe be used to compensate for binge episodes or become driven or compulsive), this approach may have many benefits, including promoting healthy lifetime exercise habits that reduce likelihood of relapse through the improvement of emotion regulation skills and weight regulation. Given the promise of PA for targeting key maintenance factors of BN, we developed a 12-session healthy PA promotion intervention for BN and tested initial feasibility, acceptability, and preliminary target engagement in an iterative case series design (n = 3). The treatment provided cognitive-behavioral skills designed to identify, practice, and achieve behavioral goals while asking patients to engage in up to 150 minutes of moderate-to-vigorous PA per week, which was preplanned during each session with the client’s therapist. Results suggested that the healthy PA promotion intervention was both feasible and acceptable to deliver. In addition, the intervention resulted in a clinically significant decrease in BN symptom frequency in each participant. Further, participants showed clinically significant decreases in NA and shape and weight concern. The current study demonstrates that healthy PA interventions can have beneficial effects on BN symptoms, NA, and shape and weight concern. However, due to the small sample size, conclusions must be treated with caution. Future research should investigate additional approaches for promoting healthy PA and include a larger sample in order to further test initial efficacy of this treatment approach.

BACKGROUND Binge eating (BE), characterized by eating a large amount of food accompanied by a sense of loss of control over eating, is a public health crisis. Negative affect is a well-established antecedent for BE. The affect regulation model of BE posits that elevated negative affect increases momentary risk for BE, as engaging in BE alleviates negative affect and reinforces the behavior. The eating disorder field’s capacity to identify moments of elevated negative affect, and thus BE risk, has exclusively relied on ecological momentary assessment (EMA). EMA involves the completion of surveys in real time on one’s smartphone to report behavioral, cognitive, and emotional symptoms throughout the day. Although EMA provides ecologically valid information, EMA surveys are often delivered only 5-6 times per day, involve self-report of affect intensity only, and are unable to assess affect-related physiological arousal. Wearable, psychophysiological sensors that measure markers of affect arousal including heart rate, heart rate variability, and electrodermal activity, may augment EMA surveys to improve accurate real-time prediction of BE. These sensors can objectively and continuously measure biomarkers of nervous system arousal that coincide with affect, thus allowing them to measure affective trajectories on a continuous timescale, detect changes in negative affect before the individual is consciously aware of them, and reduce user burden to improve data completeness. However, it is unknown whether sensor features can distinguish between positive and negative affect states, given that physiological arousal may occur during both negative and positive affect states. OBJECTIVE The aims of the present study are: 1) test the hypothesis that sensor features will distinguish positive and negative affect states in individuals with BE with > 60% accuracy and 2) test the hypothesis that a machine learning algorithm using sensor data and EMA-reported negative affect to predict the occurrence of BE will predict BE with greater accuracy than an algorithm using EMA-reported negative affect alone. METHODS This study will recruit 30 individuals with BE who will wear Fitbit Sense 2 wristbands to passively measure heart rate and electrodermal activity and report affect and BE on EMA surveys for four weeks. Machine learning algorithms will be developed using sensor data to distinguish instances of high positive and high negative affect (aim 1) and to predict engagement in BE (aim 2). RESULTS This project will be funded from November 2022-October 2024. Recruitment efforts will be conducted from January 2023 through March 2024. Data collection is anticipated to be completed in May 2024. CONCLUSIONS The present study will provide new insight into the relationship between negative affect and BE by integrating wearable sensor data to measure affective arousal. Findings from this study will set the stage for future development of more effective digital ecological momentary interventions for BE.

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 self-report. 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.

PURPOSE: Maladaptive exercise (i.e., exercise that is either driven or compensatory) is thought to momentarily down-regulate elevated fear of weight gain (FOWG). However, little research has examined associations between FOWG and exercise, and no research has measured FOWG at a momentary level or considered exercise type (i.e., maladaptive vs. adaptive). Thus, we examined both within- and between-subject associations between FOWG and exercise among individuals with transdiagnostic binge eating. METHODS: We recruited treatment-seeking adults (N = 58, 82.9% female) to complete a 7–14-day ecological momentary assessment protocol which assessed levels of FOWG and exercise engagement and type. Mixed models and generalized estimating equations assessed within-subject associations, and linear regression assessed between-subject associations. RESULTS: There was no main effect of FOWG on exercise engagement at the next survey. However, unexpectedly, exercise type moderated this relationship such that the relationship between FOWG and exercise was strongest for episodes of adaptive exercise. Overall exercise frequency accounted for 10.4% of the variance in FOWG and exercise type explained an additional 1.7% of the variance in FOWG. CONCLUSION: The findings of the current study indicate that momentary levels of FOWG are associated with subsequent adaptive exercise episodes, while higher overall levels of maladaptive exercise were associated with higher levels of FOWG. Future treatments should place a greater emphasis on reducing the frequency of maladaptive exercise by providing strategies for reducing FOWG. LEVEL OF EVIDENCE: Level IV: Evidence obtained from multiple time series analysis such as case studies.

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.

The relationship of dietary restraint in increasing risk for binge eating among individuals with binge-spectrum eating disorders (B-EDs) is well established. However, previous research has not yet identified whether these individuals exhibit heterogeneous profiles of dietary restraint and whether these profiles are associated with differences in eating pathology.Individuals with B-EDs (N = 290) completed the Eating Disorder Examination. Latent profile analysis was conducted on dietary restraint frequency data, including restriction of overall amount of food consumed, avoidance of eating, desire for an empty stomach, food avoidance, and dietary rules. Identified latent profiles were compared on binge eating frequency, compensatory behaviors frequency, and ED pathology using the three-step procedure.A four-class model of dietary restraint best fit the data. Classes significantly differed in frequency of compensatory behaviors (F[3, 286] = 31.01, p .001), EDE Eating Concern (F[3, 286] = 14.36, p .001), EDE Shape Concern (F[3, 286] = 7.06, p .001), EDE Weight Concern (F[3, 286] = 6.83, p .001), and ED Pathology (F[3, 286] = 12.86, p .001), but did not differ in frequency of objective (F[3, 286] = 2.45, p = .06) or subjective binge episodes (F[3, 286] = 1.87, p = .14).Individuals with B-EDs exhibit distinct profiles of dietary restraint, which are associated with frequency of compensatory behaviors and severity of ED pathology.Individuals with binge-spectrum eating disorders have different patterns of restrictive eating symptoms. These profiles of restrictive eating behaviors are associated with differences in severity of compensatory behaviors and cognitive eating disorder symptoms, like shape and weight dissatisfaction. Understanding the relationships between profiles of restrictive eating behaviors and other eating disorder symptoms may allow for personalization of treatment and improvements in treatment efficacy.

Ecological momentary assessment (EMA) studies preliminarily support the transactional model of emotion regulation in eating disorders, such that heightened stress appraisal (i.e., the cognitive evaluation of an event’s demands) results in increased negative affect (NA) and subsequent binge eating (BE). However, the temporal relationships between these variables and the magnitude of stress appraisal that is clinically significant require clarification. The current study aimed to extend previous research by (1) examining the temporal relationship between stress appraisal, changes in NA, and BE using three timepoints, (2) exploring what magnitude of momentary stress appraisal results in clinically significant increases in NA and BE, and (3) characterizing what stressors are associated with clinically significant stress appraisal. 37 adult females completed an EMA protocol assessing momentary stressors, stress appraisal, NA, and BE over 2 week duration. Multilevel mediation models were used to test the study aims. Momentary increases in stress appraisal significantly predicted binge eating through increases in NA. Stress appraisal ratings of 0.50 SD higher relative to one’s average stress appraisal began to significantly predict the likelihood of BE through increases in NA, and the likelihood of BE occurrence increased with every 0.25 increments in momentary stress appraisal. Work/school stressors and interpersonal stressors were the most commonly endorsed stressors of clinically significant stress appraisal. The current study supported the transactional model of emotion dysregulation in a binge eating sample and supports the use of momentary interventions at times of clinically significant stress appraisal to reduce BE risk. Level II, controlled trial without randomization.

Caregivers and healthcare professionals (HPs) are increasingly concerned about childhood obesity. A critical consideration of caregivers and HPs is discussing weight status without provoking disordered eating. Given the complexity of these interacting concerns, major health advocacy groups have independently published guidelines for having conversations with children about overweight/obesity. The current investigation represented the first-ever systematic review of these guidelines to analyze their content, consistency, actionability, or scientific support. To conduct a systematic review, the authors performed a web-based search using the terms parent/HP, guidelines, child, and overweight/obesity that identified 59 guidelines on childhood obesity broadly, of which 13 provided explicit direction on how the caregiver or HP should approach a conversation about overweight with a child. Within these 13 guidelines, nine topic domains were identified: attitude modeling (covered by 31% of guidelines), behavior modeling (61%), dietary recommendations (54%), physical activity (46%), body acceptance and self-esteem (69%), conversation advice (92%), contact with HP (46%), talking about “weight” versus “overall health” (54%) and external factors (e.g., bullying, media) (54%). Although guidelines presented similar content, several inconsistencies in recommendations emerged. Notably, only three of the 13 guidelines referenced any scholarly sources and only a small minority of advice was actionable by caregivers or HPs. It is evident that guidelines for caregivers and HPs on speaking to children about obesity offer inconsistent advice, minimally based on empirical evidence. Future guidelines should aim to unify their messages for caregivers and HP and be better supported by empirical data.

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.

Objective Dietary lapses drive weight loss failure, and specific factors influence risk of lapse. Physical activity (PA) may be one such risk factor, though whether PA increases or decreases appetite, and thus risk of lapse, is unclear. In fact, most studies examining the relation between PA and energy intake are limited by use of laboratory-based settings, intensive PA manipulations, and healthy-weight samples. This study aimed to maximize ecological validity by examining the extent to which free-living PA of various intensities prospectively predicts same-day dietary lapses among individuals enrolled in a weight loss program. Method Participants were 130 adults with overweight/obesity in a behavioral weight loss treatment instructed to follow a PA and dietary prescription. At midtreatment, moderate-to-vigorous PA (MVPA) and light PA were measured using hip-worn Actigraph GT3X+ accelerometers (Actigraph, Pensacola, FL). Lapses were assessed using ecological momentary assessment. Within-subject total PA (b = -0.012, SE = 0.005, p = .01) and light PA (b = -0.014, SE = 0.006, p = .01) negatively predicted lapse. MVPA followed the same pattern, but the effect was not statistically significant (b = -0.013, SE = 0.009, p = .12). Conclusion This study was the first to investigate if objectively measured PA prospectively predicts lapse from a weight loss program. Results suggested that for every additional 10 min of total PA one engaged in, the risk of lapse decreased by 1%. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Sensor technologies offer exciting potential to objectively measure psychopathological correlates of eating pathology and eating disorder (ED) research utilizing sensors has rapidly proliferated in the past several years. The aims of the present review are: (1) characterize the types of sensors that have been utilized in ED research, (2) identify the psychopathological factors relevant to EDs that have been assessed using sensors, (3) describe the data supporting the validity and reliability of these sensors, (4) discuss limitations associated with these sensors, and (5) identify gaps that persist within the ED literature with regard to use of sensor technologies.A systematic search was conducted of PubMed, PsycINFO, Web of Science, ProQuest, and "gray" literature sources. Eligible publications were empirical studies that utilized sensors to measure at least one psychological variable among clinical ED populations.Sensors have been utilized with ED samples to measure eating behaviors, physical activity, sleep, autonomic nervous system activity, eyeblink startle response, visual attention, and visual-haptic object integration. The reliability and validity of these sensors varies widely and there are a number of significant gaps that remain in the literature with regard to the types of sensors utilized, context in which sensors have been used, and populations studied.The existing literature utilizing sensors within ED research largely support the feasibility and acceptability of these tools. Sensors should continue to be utilized within the field, with a specific focus on examining the reliability and validity of these tools within ED samples and increasing the diversity of samples studied.Sensor technologies, such as those included in modern smartwatches, offer new opportunities to measure factors that may maintain or contribute to symptoms of eating disorders. This article describes the types of sensors that have been used in eating disorders research, challenges that may arise in using these sensors, and discusses new applications of these sensors that may be pursued in future research.

Emotion regulation (ER) deficits are associated with illness severity in individuals with bulimia nervosa. We examined whether baseline ER abilities are associated with remission following enhanced cognitive behavioural therapy for eating disorders (CBT-E).Participants (N = 50, 85.0% female) receiving CBT-E completed a measure (yielding a global score and six subscale scores) of ER pre-treatment. Remission was assessed by the Eating Disorder Examination at post-treatment and follow-up. Analyses tested associations between baseline ER and behavioural, cognitive, or full remission at post-treatment and three-month follow-up.Lower global ER abilities, measured by the Difficulties in Emotion Regulation Scale, were associated with lower likelihood of behavioural and full, but not cognitive, remission at post-treatment. Specifically, individuals low in emotional clarity and impulse control were less likely to be behaviourally remitted. Those low in emotional acceptance, awareness, clarity, or strategies to manage emotion were less likely to be fully remitted. Global ER scores were not associated with any remission type at follow-up.Baseline ER deficits were associated with lower likelihood of behavioural or full remission at post-treatment. However, ER was less associated with remission at follow-up, indicating that ER is most important during treatment. Findings highlight a need for targeted treatments aimed at improving ER.

Specific characteristics of sleep (e.g., duration, quality, and fatigue) are positively associated with (ED) behaviors, specifically binge eating (BE) potentially through decreased self-regulation and increased appetite. However, prior work has been largely cross-sectional and has not examined temporal relationships between sleep characteristics and next-day ED behaviors. Thus, the present study examined daily relationships between sleep and ED behaviors among individuals with binge-spectrum EDs.Participants (N = 96) completed 7 daily ecological momentary assessment (EMA) surveys over 7-14 days; morning surveys assessed sleep characteristics and 6 randomly timed surveys each day captured ED behaviors. Analyses examined within-subject and between-subject effects of sleep quality, duration, and fatigue on BE, compensatory purging behaviors, and maladaptive exercise.Within-subject sleep quality was significantly negatively associated with engagement in maladaptive exercise later that day. Additionally, between-subject sleep duration was significantly negatively associated with engagement in compensatory purging behaviors.Within- and between-subjects associations between sleep quality and duration and compensatory behavior engagement indicate that sleep plays an important role in ED behaviors. Future research should incorporate sensor-based measurement of sleep and examine how specific facets of sleep impact BE and treatment response.Level II: Evidence obtained from controlled trial without randomization.

Purpose Up to 44% of individuals with bulimia nervosa (BN) experience worsening of symptoms after cognitive behavior therapy (CBT). Identifying risk for post-treatment worsening of symptoms using latent trajectories of change in eating disorder (ED) symptoms during treatment could allow for personalization of treatment to improve long-term outcomes Methods Participants (N = 56) with BN-spectrum EDs received 16 sessions of CBT and completed digital self-monitoring of eating episodes and ED behaviors. The Eating Disorder Examination was used to measured ED symptoms at post-treatment and 3-month follow-up. Latent growth mixture modeling of digital self-monitoring data identified latent growth classes. Kruskal–Wallis H tests examined effect of trajectory of change in ED symptoms on post-treatment to follow-up symptom change. Results Multi-class models of change in binge eating, compensatory behaviors, and regular eating improved fit over one-class models. Individuals with high frequency-rapid response in binge eating (H(1) = 10.68, p =0 .001, η2 = 0.24) had greater recurrence of compensatory behaviors compared to individuals with low frequency-static response. Individuals with static change in regular eating exhibited greater recurrence of binge eating than individuals with moderate response (H(1) = 8.99, p = 0.003, η2 = 0.20). Conclusion Trajectories of change in ED symptoms predict post-treatment worsening of symptoms. Personalized treatment approaches should be evaluated among individuals at risk of poor long-term outcomes. Level of evidence IV, evidence obtained from multiple time series. Trial registration ClinicalTrials.gov registration number NCT03673540, registration date: September 17, 2018. Supplementary Information The online version contains supplementary material available at 10.1007/s40519-021-01348-5.

Maladaptive exercise is common among individuals with binge-spectrum eating disorders. One mechanism that may drive engagement in exercise in this population is state body dissatisfaction. However, no studies to date have examined prospective, momentary relationships between state body dissatisfaction and exercise.Adults with binge-spectrum eating disorders (N = 58) completed a 7-14-day ecological momentary assessment protocol assessing exercise and state body dissatisfaction several times per day. Multilevel models were used to evaluate prospective reciprocal associations between state body dissatisfaction and exercise. Mixed models examined trajectories of change in state body dissatisfaction pre- and post-exercise. Additional models examined exercise type (maladaptive vs. adaptive) as a moderator.Momentary increases (i.e., greater than one's average levels) in state body dissatisfaction at any given timepoint did not prospectively predict engagement in exercise at the next nearest timepoint. Exercise at any given timepoint did not prospectively predict momentary increases in state body dissatisfaction. State body dissatisfaction was found to increase in the initial hours preceding an exercise episode (linear estimate, β = - 0.012, p = 0.004). State body dissatisfaction did not significantly change in the hours following engagement in exercise. Exercise type did not moderate these associations.If replicated, our results may suggest that momentary increases in state body dissatisfaction may not be associated with exercise behaviors in individuals with binge-spectrum eating disorders.Level V: Opinions of authorities, based on descriptive studies, narrative reviews, clinical experience, orreports of expert committees.

Binge eating (BE) often develops during adolescence and is associated with deleterious psychological and physical consequences. Current treatments for adolescents achieve suboptimal results, likely due to failure to adequately address fear of weight gain (FOWG) which maintains BE. Thus, exposure treatment (the most powerful intervention for fear) may be a promising approach. However, exposure treatment has only minimally tested in adults with BE and never tested in adolescents. Thus, the current study is the first to evaluate a 4-session exposure module within a 12-session standard cognitive behavioral therapy for adolescents with BE. We recruited adolescents with BE ( N = 5) and examined treatment feasibility, acceptability, and preliminary effects on FOWG and eating pathology. Overall, the 4-session exposure module was feasible and acceptable and showed preliminary evidence that it could reduce FOWG. However, several participants did not endorse significant fears of weight gain; rather, these participants reported that fears of deprivation or social judgment were more related to their BE. Future research should test higher doses of exposure and further examine the role of fear of deprivation/social judgment. Finally, future iterations of this treatment could include more parent involvement or test exposure in combination with treatments other than cognitive behavioral therapy, such as family-based treatment.

Ecological momentary assessment (EMA) studies preliminarily support the transactional model of emotion regulation in eating disorders, such that heightened stress appraisal (i.e., the cognitive evaluation of an event's demands) results in increased negative affect (NA) and subsequent binge eating (BE). However, the temporal relationships between these variables and the magnitude of stress appraisal that is clinically significant require clarification. The current study aimed to extend previous research by (1) examining the temporal relationship between stress appraisal, changes in NA, and BE using three timepoints, (2) exploring what magnitude of momentary stress appraisal results in clinically significant increases in NA and BE, and (3) characterizing what stressors are associated with clinically significant stress appraisal.37 adult females completed an EMA protocol assessing momentary stressors, stress appraisal, NA, and BE over 2 week duration. Multilevel mediation models were used to test the study aims.Momentary increases in stress appraisal significantly predicted binge eating through increases in NA. Stress appraisal ratings of 0.50 SD higher relative to one's average stress appraisal began to significantly predict the likelihood of BE through increases in NA, and the likelihood of BE occurrence increased with every 0.25 increments in momentary stress appraisal. Work/school stressors and interpersonal stressors were the most commonly endorsed stressors of clinically significant stress appraisal.The current study supported the transactional model of emotion dysregulation in a binge eating sample and supports the use of momentary interventions at times of clinically significant stress appraisal to reduce BE risk.Level II, controlled trial without randomization.

Objective: One reason for limited efficacy of treatments for binge eating disorder (BED) and bulimia nervosa (BN) is a failure to directly target deficits in inhibitory control (i.e., the ability to withhold a pre-potent response). Inhibitory control trainings (ICTs; computerized tasks meant to improve inhibitory control) have shown promise but appear not to be powerful enough to generalize to real-word eating behavior or engaging enough for to sustain long-term compliance. Delivering an ICT through virtual reality (VR) technology should increase intervention power because 3D imagery and actual real hand/arm movements are lifelike and may improve compliance because the VR environment is highly engaging. Thus, we created the first-ever VR-based ICT to test its initial feasibility, acceptability, and impact on binge eating.Method: We recruited participants (N = 14) with once-weekly loss-of-control (LOC) eating to use the VR ICT daily, at home, for two weeks, and measured feasibility, acceptability and change in LOC eating at postintervention and 2-week follow-up.Results: The VR ICT was feasible to construct and deploy, and demonstrated high acceptability and compliance (i. e., 86.8% of daily trainings completed). Users of the VR ICT experienced large decreases in LOC eating at postintervention and 2-week follow-up.Discussion: Results from this initial pilot indicate that delivering ICT through VR is feasible, acceptable, and is associated with reductions in binge eating. Future study is warranted and should examine whether a VR ICT can serve as a useful adjunct to standard treatment for BN and BED.

Although 40–60% of individuals with eating disorders (EDs) report engaging in maladaptive exercise, self-reported reasons for engaging in exercise vary. Further, no studies have examined momentary reasons for exercise and whether reasons for exercising could be both adaptive and maladaptive for any episode. Examining reasons for exercise can inform interventions which more effectively target maladaptive exercise. The current study recruited adults with binge-spectrum EDs (N = 58, 89.2% Female) and assessed self-reported reasons for exercise using ecological momentary assessment over 7–14 days. Exercise episodes were categorized as maladaptive if the participant endorsed exercising to compensate for eating or feeling driven to exercise. On average, participants reported exercising 8 times (SD = 8) over the 7–14 days. On average, 73% of exercise episodes were maladaptive. Participants most frequently stated exercising to control shape or weight (67.2% of episodes), feeling driven (62.9%), and exercising as part of a routine (52.9%). Participants least endorsed exercising so that they could eat more later (9.8%). Participants reported a mean of 3.6 reasons for exercising at each episode (SD = 1.85, mode = 1.0). As hypothesized, individuals with EDs were exercising for several reasons at each exercise episode. Further, the extent to which each exercise episode is maladaptive varied between participants and even within a single participant's exercise episodes. These findings underscore the importance of research evaluating when, and for whom, exercise becomes maladaptive, as well as research examining other characteristic features of maladaptive and adaptive exercise in EDs.