The ABBA study - approach bias modification in bulimia nervosa and binge eating disorder: study protocol for a randomised controlled trial.
BACKGROUND
The core symptoms of bulimia nervosa (BN) and binge eating disorder (BED) are recurrent episodes of binge eating. Despite negative psychological and physical consequences, BN/BED patients show uncontrollable approach tendencies towards food. This cognitive bias occurs at an early stage of information processing. Cognitive bias modification (CBM) directly targets such biases and has been shown to be effective in treating several mental disorders. In alcohol addiction, automatic action tendencies towards alcohol cues and relapse rates were successfully reduced by a specific form of CBM, termed approach bias modification. Based on these findings and data from a proof-of-concept study in people with high levels of food craving, CBM is considered a promising new treatment approach for BN/BED. Given the similarities between BN/BED and addictive disorders, the rationale for using approach bias modification appears to be particularly strong. The aim of the present study is to examine whether, compared to a sham training, computerised approach bias modification (10 sessions) can reduce binge-eating episodes in BN/BED patients from pre-treatment to follow-up. Additionally, we will investigate whether this CBM programme also reduces global eating disorder psychopathology, trait and cue-elicited food craving, food intake as well as approach and attentional bias towards visual food cues. Treatment acceptance will be determined by attrition rates and responses on a feedback form.


METHODS
This is a double-blind, randomised, placebo-controlled, parallel-group superiority trial with two parallel arms. A total of 54 BN/BED patients will be recruited. Approach bias towards food will be retrained by a computer task adopting an implicit learning paradigm. Patients in the control condition (sham) will conduct a similar task but will not be trained to avoid food cues. Methods against bias include public registration, randomisation by a central study office, standardisation of the treatments and blinding of assessors. Furthermore, the session number and duration will be equivalent in the two conditions.


CONCLUSIONS
This is the first registered randomised controlled trial of approach bias modification in a clinical BN/BED sample. Results from this study will provide an indication of the efficacy of approach bias modification training for BN/BED and the potential mechanisms of action underlying this treatment.


BACKGROUND
DRKS00010231 (retrospectively registered on 24 March 2016; first version).
Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany. timo.brockmeyer@med.uni-heidelberg.de.|Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK. timo.brockmeyer@med.uni-heidelberg.de.
Timo
T
Brockmeyer
Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
Ulrike
U
Schmidt
Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany.|Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany.
Hans-Christoph
HC
Friederich
Approach avoidance training; Bulimic eating disorders; Cognitive bias modification; Computer training
Psychol Bull. 2011 Nov;137(6):940-58
21728399
Genes Brain Behav. 2009 Feb;8(1):101-6
19016889
Appetite. 2016 Apr 1;99:46-51
26725150
Biol Psychiatry. 2010 Dec 1;68(11):982-90
20887977
Behav Pharmacol. 2012 Sep;23(5-6):603-8
22772335
J Clin Psychol. 2014 Dec;70(12):1133-57
24652823
Clin Psychol Rev. 2003 Feb;23(1):57-74
12559994
Biol Psychiatry. 2010 Apr 15;67(8):793-5
20060105
Arch Intern Med. 2006 May 22;166(10):1092-7
16717171
Alcohol Clin Exp Res. 2014 Feb;38(2):587-94
24164417
J Pers Soc Psychol. 2007 Oct;93(4):651-66
17892337
Behav Res Ther. 2000 Nov;38(11):1125-38
11060941
Eur Eat Disord Rev. 2013 Nov;21(6):464-74
24002738
Eat Behav. 2011 Apr;12(2):126-30
21385642
Addiction. 2010 May;105(5):883-90
20148790
J Consult Clin Psychol. 2007 Aug;75(4):629-38
17663616
Appetite. 2009 Apr;52(2):299-306
19027808
PLoS One. 2013 Dec 31;8(12):e83412
24391763
J Abnorm Psychol. 2002 Feb;111(1):107-23
11866165
Addiction. 2010 Feb;105(2):279-87
20078486
Eur Eat Disord Rev. 2013 Nov;21(6):425-7
24123463
J Clin Psychiatry. 2007 May;68(5):738-46
17503983
J Exp Psychol Appl. 2013 Mar;19(1):30-8
23421423
Appetite. 2009 Aug;53(1):1-8
19500625
J Consult Clin Psychol. 2009 Oct;77(5):961-973
19803575
Psychol Bull. 2011 Jul;137(4):660-681
21574678
Appetite. 2015 Dec;95:197-202
26184338
Psychol Med. 2006 Sep;36(9):1327-35
16790080
Appetite. 2016 Jan 1;96:219-224
26375357
Eur Eat Disord Rev. 2010 Sep-Oct;18(5):341-51
20821736
Appetite. 2015 Feb;85:58-65
25447011
Lancet. 2010 Feb 13;375(9714):583-93
19931176
Addict Behav. 1998 Jul-Aug;23(4):463-75
9698975
Appetite. 2010 Aug;55(1):30-6
20298730
Am J Psychiatry. 2009 Dec;166(12):1342-6
19833789
Psychol Sci. 2011 Apr;22(4):490-7
21389338
Addiction. 2001 Jan;96(1):15-31
11177517
J Abnorm Psychol. 2006 Aug;115(3):567-79
16866597
Appetite. 2012 Feb;58(1):88-97
21983051
Biol Psychiatry. 2012 Oct 1;72(7):572-9
22579509
Nat Neurosci. 2005 Nov;8(11):1458-63
16251988
Med Care. 2008 Mar;46(3):266-74
18388841
Br J Psychiatry. 2015 Jan;206(1):7-16
25561486
Appetite. 2010 Feb;54(1):134-42
19815043
Int J Eat Disord. 2013 Jul;46(5):496-500
23658099
Clin Psychol Rev. 2011 Feb;31(1):37-51
21130935
Eur Eat Disord Rev. 2015 Sep;23(5):352-60
26136357
Addiction. 2008 Nov;103(11):1875-82
19032536
Neurosci Biobehav Rev. 2015 Feb;49:125-34
25530255
Dev Cogn Neurosci. 2013 Apr;4:38-51
23218805
J Pers Soc Psychol. 2000 Jul;79(1):39-48
10909876
Behav Ther. 2012 Dec;43(4):724-40
23046776
J Gen Intern Med. 2001 Sep;16(9):606-13
11556941