Executive functioning and treatment outcome among adolescents undergoing cognitive-behavioral therapy for binge-eating disorder

IF 6.5 1区医学 Q1 PSYCHIATRY

Journal of Child Psychology and Psychiatry Pub Date : 2024-06-28 DOI:10.1111/jcpp.14031

Andrea B. Goldschmidt, Kwonho Jeong, Lan Yu, Amy H. Egbert, Ricarda Schmidt, Anja Hilbert

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Abstract

Background

Cognitive-behavioral therapy (CBT) is an evidence-supported treatment for adolescents with binge-eating disorder (BED). Executive dysfunctions, which are associated with binge eating and elevated body weight in youth, may undermine CBT outcomes by making it difficult for youth to engage with or adhere to treatment, including recalling and/or implementing intervention strategies in real-world contexts.

Methods

We assessed 73 adolescents [82.2% female; M_age = 15.0 ± 2.5 year; M baseline standardized body mass index (zBMI) = 1.9 ± 1.0 kg/m²] with BED at baseline, posttreatment, 6-, 12-, and 24-month follow-up. Linear mixed models examined the effects of baseline executive functioning (EF) on loss of control (LOC) eating and weight change following CBT. Linear and logistic regressions probed associations between EF, attendance, and attrition.

Results

More impulsive decision-making, as reflected in higher baseline scores on the Iowa Gambling Task, predicted better attendance (β = .07; p = .019) and more frequent LOC eating following treatment (β = .12; p = .017). Lower cognitive flexibility, as reflected in lower baseline T-scores on the Comprehensive Trail Making Test complex sequencing index, predicted higher zBMI following treatment (β = −.03; p = .003). Inhibition, concentration, attention, and parent-reported EF behavior symptoms were not associated with outcome, attendance, or attrition.

Conclusions

More impulsive decision-making and lower cognitive flexibility were associated with suboptimal response to CBT for BED, although findings should be interpreted with caution in light of the sample size and waitlist control design. Future research should examine whether strengthening EF could improve eating and weight outcomes among adolescents with BED who have lower pre-treatment EF.

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接受认知行为疗法治疗暴饮暴食症的青少年的执行功能和治疗效果

背景认知行为疗法（CBT）是一种针对暴饮暴食症（BED）青少年的有证据支持的治疗方法。青少年的执行功能障碍与暴饮暴食和体重增加有关，它可能会使青少年难以参与或坚持治疗，包括在现实环境中回忆和/或实施干预策略，从而影响 CBT 的治疗效果。方法我们评估了 73 名青少年（82.2% 为女性；年龄 = 15.0 ± 2.5 岁；M 基线标准化体重指数 (zBMI) = 1.9 ± 1.0 kg/m2）在基线、治疗后、6 个月、12 个月和 24 个月随访时的暴饮暴食情况。线性混合模型检验了基线执行功能（EF）对失控饮食（LOC）和CBT后体重变化的影响。结果爱荷华州赌博任务的基线分数越高，表明患者的决策冲动性越强，这预示着患者的出勤率越高（β = .07; p = .019），治疗后的失控饮食频率越高（β = .12; p = .017）。较低的认知灵活性（反映在较低的 "综合寻迹测验 "复杂排序指数基线 T 分数上）预示着治疗后较高的 zBMI（β = -.03；p = .003）。结论更冲动的决策和更低的认知灵活性与CBT治疗BED的次优反应有关，但考虑到样本量和候补对照设计，对研究结果的解释应谨慎。未来的研究应探讨加强EF是否能改善治疗前EF较低的BED青少年的饮食和体重结果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Child Psychology and Psychiatry 医学-精神病学

CiteScore

13.80

自引率

5.30%

发文量

169

审稿时长

1 months

期刊介绍： The Journal of Child Psychology and Psychiatry (JCPP) is a highly regarded international publication that focuses on the fields of child and adolescent psychology and psychiatry. It is recognized for publishing top-tier, clinically relevant research across various disciplines related to these areas. JCPP has a broad global readership and covers a diverse range of topics, including: Epidemiology: Studies on the prevalence and distribution of mental health issues in children and adolescents. Diagnosis: Research on the identification and classification of childhood disorders. Treatments: Psychotherapeutic and psychopharmacological interventions for child and adolescent mental health. Behavior and Cognition: Studies on the behavioral and cognitive aspects of childhood disorders. Neuroscience and Neurobiology: Research on the neural and biological underpinnings of child mental health. Genetics: Genetic factors contributing to the development of childhood disorders. JCPP serves as a platform for integrating empirical research, clinical studies, and high-quality reviews from diverse perspectives, theoretical viewpoints, and disciplines. This interdisciplinary approach is a key feature of the journal, as it fosters a comprehensive understanding of child and adolescent mental health. The Journal of Child Psychology and Psychiatry is published 12 times a year and is affiliated with the Association for Child and Adolescent Mental Health (ACAMH), which supports the journal's mission to advance knowledge and practice in the field of child and adolescent mental health.