Correlates of interpersonal emotion regulation problems in Loss of Control eating (LOC) in youth: study protocol of the combined online and App based questionnaire, laboratory and randomized controlled online intervention i-BEAT trial

Background Binge Eating Disorder (BED) represents a common eating disorder associated with marked health impairments. A subclinical variant, loss of control eating (LOC) is prevalent in youth. LOC is associated with similar mental distress as full-blown BED, increases the risk to develop a BED and promotes continuous weight gain. The etiology of LOC is not yet fully understood and specialized treatment for youth is scarce. Methods The i-BEAT study includes a cross-sectional and longitudinal online questionnaire study (N = 600), an App based daily-life approach and a laboratory virtual reality study in N = 60 youths (14–24 years) with and without LOC as well as a controlled randomized online treatment trial to investigate the feasibility, acceptance and efficacy of a CBT and an interpersonal emotion regulation module for youth (N = 120). The primary outcomes include self-reported as well as measured (heart rate variability, gaze behavior, reaction times in stop signal task) associations between emotion regulation problems (such as dealing with RS), psychological impairment and binge eating in a healthy control group and youth with LOC. Secondary outcomes encompass general eating disorder pathology, social anxiety, body mass index, hyperscanning behavior and therapists’ rating of patients’ condition pre and post treatment. Epigenetic correlates of RS are assessed in healthy controls and youth with LOC and explored before and after treatment. Discussion The expected findings will specify the role of interpersonal emotion regulation problems such as coping with the experience of social exclusion and rejection sensitivity (RS) in LOC and clarify, whether including a training to cope with RS adds to the efficacy of a cognitive behavioral treatment (CBT). Trial registration: German Clinical Trial Register: DRKS00023706. Registered 27 November 2020, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00023706

Daily Diary Study of Emotion, Motivation, and Eating Expectancies in Loss of Control Eating

Loss-of-control eating (LOCE) is a component of binge eating, which involves the subjective inability to refrain from eating or cease eating once started. LOCE behavior is highly prevalent and associated with adverse consequences, even without objective over-eating, and has also been found to be highly affect-driven. Affect-related eating motives, as well as eating expectancies, have also been found to be significant contributors to LOCE behavior in binge eating contexts. However, little is known about how motives and expectancies contribute to LOCE regardless of quantity of food eaten, much less the impact of motives on LOCE behaviors, or the role of expectancies on daily-level contributions to LOCE. The current study assessed the role of eating expectancies and motives on the relationship between affective states and LOCE behavior at the daily level. A national sample of United States (U.S.) adults (n = 109), who reported an average of two or more LOCE episodes per week, were recruited via social media for a ten-day dairy study. Participants completed two surveys per day regarding eating behaviors, affect, and eating motives. Data were analyzed at the within- and between-subject levels utilizing a Bayesian approach to examine pathways from mood to LOCE, mediated by eating motives and accounting for a moderating impact of trait-level eating expectancies measured at baseline. At the within-subjects level, negative mood predicted LOCE, a relationship that was partially mediated by coping motives. Between-subjects, coping motives fully mediated the relationship between negative mood and LOCE. Furthermore, an indirect effect between positive mood and LOCE was found at the within-subjects level, which was moderated by reward expectancy. This study provides useful insight into the role of daily-level motives and expectancies influencing LOCE behavior. Findings and directions for future research are discussed.

Affect Dysregulation in Context: Implications and Future Directions of Experience Sampling Research on Affect Regulation Models of Loss of Control Eating

Loss of control eating is a core, transdiagnostic eating disorder symptom associated with psychological distress, functional impairment, and reduced quality of life. However, the factors that contribute to persistent loss of control eating despite negative consequences are not fully understood. Understanding the mechanisms that maintain loss of control eating is crucial to advance treatments that interrupt these processes. Affect regulation models of loss of control eating hypothesize that negative emotions trigger loss of control eating, and that loss of control eating is negatively reinforced because it temporarily decreases negative affect. Several variations on this basic affect regulation model have been proposed, including theories suggesting that negative affect decreases during loss of control eating rather than afterwards (escape theory), and that loss of control eating replaces one negative emotion with another that is less aversive (trade-off theory). Experience sampling designs that measure negative affect and eating behavior multiple times per day are optimally suited to examining the nuanced predictions of these affect regulation models in people's everyday lives. This paper critically reviews experience sampling studies examining associations between negative affect and loss of control eating, and discusses the implications for different affect regulation models of loss of control eating. The review concludes by proposing an expanded affect-focused model of loss of control eating that incorporates trait-level individual differences and momentary biological and environmental variables to guide future research. Clinical implications and recommendations are discussed.

Greater negative affect reduction expectancies moderate the interactive relationship between emotion regulation difficulties and distress tolerance in predicting loss-of-control eating

Loss-of-control eating (LOCE) is often conceptualized as a negative reinforcement mechanism. However, LOCE does not consistently reduce negative affect (NA). One explanation for continued LOCE, despite a lack of NA reduction, may be expectations of NA reduction. Emotion regulation difficulties and low distress tolerance often predict LOCE, but have not been examined in the context of NA reduction expectancies. This study examined the main and interactive relationships between emotion regulation difficulties, distress tolerance, and NA reduction expectancies on LOCE in US adults (n =3331). Results indicate NA reduction expectancies are robust, eclipsing the predictive effects of other emotion regulation variables.