Psychosocial treatments for binge-eating disorder (BED) and bulimia nervosa (BN) have demonstrated efficacy in specialty settings, yet, most treatment for BED/BN occurs in outpatient settings with more limited resources. In response to RFA-MH-16-410, we propose to test the preliminary effectiveness of a couple-based intervention for BED/BN (UNiting couples In the Treatment of Eating disorders [UNITE]) relative to an established evidence-based individual treatment (cognitive-behavioral therapy-enhanced; CBT-E) in a community clinic setting. One strategy to bolster effectiveness is to activate resources in the patient?s environment (e.g., include partners in treatment). Unless partners understand BED/BN and how to be of assistance, relationships can be a stressor. Indeed, relationship stressors are common binge/purge triggers and adverse interpersonal environments contribute to illness maintenance. Individuals with BED/BN report high levels of relationship distress, negative interactions, and poor communication skills. Including a partner in treatment can transform the relationship from a stressor into an agent of positive change. We propose to augment effectiveness of BED/BN treatment by addressing interpersonal factors directly by including partners in treatment. We will test the preliminary effectiveness of UNITE in a small randomized controlled trial (RCT) of 28 adult patients and their partners (24 completing couples) in a community clinic. We hypothesize that results will yield evidence supporting enhanced outcomes in UNITE compared with CBT-E on the primary outcome of binge abstinence (and purge abstinence in BN) and other measures of psychopathology and general functioning, and significantly greater treatment satisfaction. Moreover, we propose that treatment gains will be achieved and maintained by engaging eating disorder-related relationship targets, including improved (T1) communication around BED/BN, (T2) problem-solving/behavioral change skills specific to BED/BN, and (T3) partner-assisted emotion regulation. Assessment will include observational and speech prosody measures during couples? clinic interactions and self-reports reflecting functioning outside of the clinic. The Data Monitoring Group will oversee recruitment, assessments, and human subject protections. If we demonstrate preliminary effectiveness and target engagement in a community clinic setting, we will plan a larger RCT isolating our relationship targets and, if effective, progress towards implementation science. Our ultimate is to expand the community clinician?s armamentarium for treating BED and BN and increase the available treatment options for individuals with these illnesses.
Section We have developed and piloted a novel cognitive-behavioral, couple-based intervention for binge- eating disorder (BED) and bulimia nervosa (BN) that targets and harnesses the power of close interpersonal relationships in achieving and sustaining recovery. We aim to demonstrate preliminary comparative effectiveness in an outpatient community setting by isolating relationship targets with the ultimate goal of expanding the community clinician?s tools for treating these illnesses and increasing the available treatment options for individuals with BED or BN.
