Metacognition and emotion regulation as treatment targets in binge eating disorder: a network analysis study

Matteo Aloi,Mariarita Caroleo,Paolo Zaffino,Antonino Carcione,Giuseppe Nicolò,Carlo Cosentino,Gianluca Lo Coco,Marianna Rania,Cristina Segura-Garcia,Elvira Anna Carbone,Giuseppina Calabrò

doi:10.1186/s40337-021-00376-x

Abstract

BackgroundThis study aims to examine the underlying associations between eating, affective and metacognitive symptoms in patients with binge eating disorder (BED) through network analysis (NA) in order to identify key variables that may be considered the target for psychotherapeutic interventions.MethodsA total of 155 patients with BED completed measures of eating psychopathology, affective symptoms, emotion regulation and metacognition. A cross-sectional network was inferred by means of Gaussian Markov random field estimation using graphical LASSO and the extended Bayesian information criterion (EBIC-LASSO), and central symptoms of BED were identified by means of the strength centrality index.ResultsImpaired self-monitoring metacognition and difficulties in impulse control emerged as the symptoms with the highest centrality. Conversely, eating and affective features were less central. The centrality stability coefficient of strength was above the recommended cut-off, thus indicating the stability of the network.ConclusionsAccording to the present NA findings, impaired self-monitoring metacognition and difficulties in impulse control are the central nodes in the psychopathological network of BED whereas eating symptoms appear marginal. If further studies with larger samples replicate these results, metacognition and impulse control could represent new targets of psychotherapeutic interventions in the treatment of BED. In light of this, metacognitive interpersonal therapy could be a promising aid in clinical practice to develop an effective treatment for BED.

Highlights

This study aims to examine the underlying associations between eating, affective and metacognitive symptoms in patients with binge eating disorder (BED) through network analysis (NA) in order to identify key variables that may be considered the target for psychotherapeutic interventions
Plain English summary This study sought to examine the key symptoms for the psychotherapy of patients with binge eating disorder (BED)
The current study suggests a link between reduced ability to identify and describe mental states and the lack of emotion awareness and clarity among patients with BED

Summary

Introduction

This study aims to examine the underlying associations between eating, affective and metacognitive symptoms in patients with binge eating disorder (BED) through network analysis (NA) in order to identify key variables that may be considered the target for psychotherapeutic interventions. The guidelines recommend cognitive behavioural therapy (CBT) as the first-line treatment option for BED [2, 3]. A possible explanation could be that only a small portion of patients with BED report the overvaluation of body shape and weight that forms the core of the CBT protocol [7]. Other treatments such as dialectical behaviour therapy [8, 9] and interpersonal psychotherapy [10, 11] have shown promising results but failed to bridge the efficacy gap in treating BED. The available data do not favour one treatment over the other

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