Smartphone Technology and CBT-GSH in Binge Eaters

Bulimia nervosa (BN) and Binge Eating Disorder (BED) are both characterized by the primary
symptoms of binge eating and by significant levels of impairment and psychiatric
co-morbidity, affecting approximately 3-5% of the US population. Guided self-help cognitive
behavioral (CBT-GSH) therapy has been shown to be an efficacious treatment to reduce binge
eating, performing comparatively to full-scale psychotherapy interventions and is a
cost-effective empirically supported treatment that has been demonstrated to reduce total
health care costs when delivered by trained professionals in primary care settings. Despite
the evidence that CBT-GSH offers an effective and financially advantageous treatment for BN
and BED, there is evidence of limited uptake for CBT-GSH among both clients and therapists
as evidenced by high dropout rates and perceived impediments to therapeutic change. The
primary intervention in the CBT-GSH is self-monitoring, which is uniquely effective at
reducing binge eating episodes and is packaged with other behavioral strategies including
regular eating, using alternatives to binges or purging, problem solving, eliminating rigid
dietary practices, and regular weighing. Self-monitoring in CBT-GSH is both time-intensive
and cumbersome in its traditional paper format and behavioral strategies require a high
degree of engagement outside of session. These burdens lead to reduced therapeutic
adherence, which is essential to the efficacy of CBT-GSH. Initial evidence with text
messaging interventions suggest increased treatment and self-monitoring adherence for BN. A
yet unexplored advantage of mobile application technology is the ability to synthesize
real-time data to provide feedback on patient progress. Providing therapists with direct
feedback about patient progress has a well-documented effect on treatment outcome and
adherence. Thus, mobile application technology offers an innovative opportunity to increase
client and therapist uptake of CBT-GSH by (1) reducing the burden of self-monitoring and
de-stigmatizing the act of real-time meal recording, (2) offering between-session
application of CBT-GSH principles , (3) facilitating feedback to therapists about patient
progress. This study proposes to develop a commercial product, the "Noom Monitor," to
capitalize on emerging mobile application technology thus enhancing the acceptability and
efficacy of CBT-GSH. This will be accomplished by adapting Noom Inc.'s current commercial
mobile product, Noom, into a therapy transfer application for individuals with BN. The
acceptability, treatment adherence, and preliminary efficacy of the adapted application will
be examined through a randomized control trial comparing CBT-GSH + Noom Monitor with
traditional CBT-GSH conducted at the Mount Sinai School of Medicine's Eating and Weight
Disorders Program. The innovative utilization of technology to assist in mental health
interventions has widespread implications outside of this proposal, which will be used to
strategize the further development and commercialization of this product.

Inclusion Criteria:

- meet criteria for DSM-V BN or BED or must have objective binge episodes with
sub-threshold BN or BED criteria

- an upper limit BMI of 40

- between the ages of 18 and 55

- are medically stable for outpatient treatment as determined by their primary care
physician

- free of psychiatric medications for at least 2-weeks prior to study, or on a stable
dose of medication for 4 weeks prior to the study

Exclusion Criteria:

- prior lap band or other bariatric procedure completed

- meeting current of drug or alcohol dependence or bipolar disorder

- active psychotic symptoms by SCID-I screen questions

- current suicidal ideation

- prior Cognitive behavioral therapy for eating disorders

- concurrent psychological treatment of any type

- Previously read Chris Fairburn's Overcoming Binge Eating