目标:暴食症(BED)成人,与那些没有床的人相比,在大脑的奖励相关区域显示出较高的血氧水平依赖性(BOLD)对食物提示的反应。尚不清楚认知行为疗法(CBT)是否可以逆转这种奖励系统的过度激活。这项随机对照试验(RCT)评估了CBT与等待列表对照(WLC)后对暴饮暴食线索的BOLD反应的变化。
方法:将患有BED的女性(N=40)随机分为CBT或WLC。参与者在基线和16周时完成评估,包括饮食和食欲的测量以及功能磁共振成像(fMRI)以测量BOLD反应,同时聆听暴饮暴食和中性放松线索的个性化脚本。使用具有混合效应的一般线性模型分析数据。
结果:总保留率为87.5%。与WLC相比,CBT在暴饮暴食发作方面的减少幅度明显更大(平均值±标准误差下降14.6±2.7与过去28天5.7±2.8发作,分别为;p=0.03)。在fMRI过程中,CBT和WLC对暴饮暴食刺激的神经反应变化没有显着差异。与WLC相比,CBT在基于奖励的饮食驱动方面有了更大的改进,去抑制,和通过问卷评估的饥饿(ps<0.05)。
结论:CBT可有效减少暴饮暴食,但是,与我们的假设相反,CBT并不能改善大脑奖励区域对听觉暴饮暴食刺激的BOLD反应。需要进一步的研究来评估BEDCBT改善的潜在机制。
背景:ClinicalTrials.gov标识符:NCT03604172。
OBJECTIVE: Adults with binge-eating disorder (BED), compared with those without BED, demonstrate higher blood-oxygen-level-dependent (BOLD) response to food cues in reward-related regions of the brain. It is not known whether cognitive behavioral therapy (CBT) can reverse this reward system hyperactivation. This randomized controlled trial (RCT) assessed changes in BOLD response to binge-eating cues following CBT versus wait-list control (WLC).
METHODS: Females with BED (N = 40) were randomized to CBT or WLC. Participants completed assessments at baseline and 16 weeks including measures of eating and appetite and functional magnetic resonance imaging (
fMRI) to measure BOLD response while listening to personalized scripts of binge-eating and neutral-relaxing cues. Data were analyzed using general linear models with mixed effects.
RESULTS: Overall retention rate was 87.5%. CBT achieved significantly greater reductions in binge-eating episodes than WLC (mean ± standard error decline of 14.6 ± 2.7 vs. 5.7 ± 2.8 episodes in the past 28 days, respectively; p = 0.03). CBT and WLC did not differ significantly in changes in neural responses to binge-eating stimuli during the
fMRI sessions. Compared with WLC, CBT had significantly greater improvements in reward-based eating drive, disinhibition, and hunger as assessed by questionnaires (ps < 0.05).
CONCLUSIONS: CBT was effective in reducing binge eating, but, contrary to our hypothesis, CBT did not improve BOLD response to auditory binge-eating stimuli in reward regions of the brain. Further studies are needed to assess mechanisms underlying improvements with CBT for BED.
BACKGROUND: ClinicalTrials.gov identifier: NCT03604172.