Stephanie M. Manasse

Objective Individuals with bulimia nervosa (BN) engage in both maladaptive (i.e., compulsive and/or compensatory) and adaptive exercise (e.g., for enjoyment). No research has examined whether those who engage in adaptive, compulsive, and/or compensatory exercise exhibit differences in BN pathology or treatment outcome compared to those not engaging in exercise, limiting intervention efficacy. Method We examined associations of baseline exercise engagement with baseline and posttreatment BN pathology among 106 treatment‐seeking adults ( M age = 37.4, SD age = 12.95, 87.74% female, 68.87% White) enrolled across four clinical trials of outpatient enhanced cognitive behavioral therapy for BN (range: 12–16 sessions). Analysis of covariances examined associations between baseline exercise type and baseline/posttreatment global eating pathology, dietary restraint, loss‐of‐control (LOC) eating, and purging frequency. Results Those engaging in only adaptive exercise reported lower global eating pathology compared to those engaging in compulsive‐only exercise (Est = −1.493, p = .014, M diff = −.97) while those engaging in baseline compulsive exercise reported less LOC eating compared to those not engaging in exercise (Est = −22.42, p = .012, M diff = −12.50). Baseline engagement in compulsive‐only exercise was associated with lower posttreatment global eating pathology compared to baseline engagement in no exercise (Est = −.856, p = .023, M diff = −.64) and both compulsive and compensatory exercise (Est = .895, p = .026, M diff = −1.08). Discussion Those engaging in compulsive, compensatory, adaptive, and no exercise exhibit different patterns and severity of BN pathology. Future research is needed to position treatments to intervene on maladaptive, while still promoting adaptive, exercise. Public significance statement No research to date has examined whether those who engage in adaptive, compulsive, and/or compensatory exercise exhibit differences in BN pathology or treatment outcome compared to those not engaging in exercise, limiting targeted intervention efforts. We found that those engaging in compulsive, compensatory, and adaptive exercise exhibit different patterns of BN pathology and that adaptive exercise engagement was related to lower cognitive eating disorder symptoms at baseline.

Objective Low reward response to conventionally rewarding stimuli and high reward response to food (i.e., reward imbalance), has been supported as a maintenance factor for eating disorders characterized by binge eating. The current study was a pilot randomized controlled trial testing a novel treatment approach for binge eating targeting reward imbalance, called Reward Re‐Training (RRT), in comparison to a therapeutic attention control condition (supportive psychotherapy; ST). Method Fifty‐nine participants were randomly assigned to receive either 10 group sessions of RRT or ST via videoconferencing software. Assessments of eating pathology and hypothesized treatment targets were completed at pretreatment, mid‐treatment, and posttreatment, and 3‐month following the end of treatment. Results Feasibility and acceptability success benchmarks were achieved. Results found a significant indirect effect of RRT on lower posttreatment global eating pathology through decreases in reward to food from pretreatment to mid‐treatment. No significant differences were observed between groups in terms of change in hypothesized treatment mechanisms or outcomes at posttreatment or 3‐month follow‐up. Discussion The current study supports the feasibility and acceptability of RRT, and the preliminary efficacy of both RRT and ST. Further research comparing these approaches to CBT would help to inform who might benefit from non‐CBT based treatment approaches. Public Significance The current pilot study supports the feasibility and acceptability of Reward Re‐Training (RRT) as a treatment for binge eating (BE). RRT produced large, but similar, reductions in overall eating pathology and BE frequency compared to supportive psychotherapy (ST) by 3‐month follow‐up. This study supports further testing of indirect treatments such as RRT for binge eating.