Targeting transdiagnostic self-regulatory factors and eating disorder pathology among adults with binge-spectrum eating disorders: A mHealth interoceptive exposure intervention

Project Summary/Abstract Binge-spectrum eating disorders (BSED; bulimia nervosa, binge eating disorder) are associated with a high risk of mortality and debilitating health outcomes. Yet, over half of people who receive empirically- supported BSED treatments remain symptomatic and relapse is common. Existing treatments target symptoms (e.g., binge eating) vs. core BSED maintenance factors, such as poor interoception (the ability to accurately sense and connect with bodily sensations like hunger, satiety, heartbeat) and heartrate variability (HRV; a generalized neurobiological indicator of interoception and autonomic nervous system functioning). New treatments targeting these core biobehavioral mechanisms are urgently needed to reduce the burden of BSED. This research will be the first to use a multiphase optimization strategy (MOST) design to develop, refine, and assess whether a new mobile health (mHealth) interoceptive exposure intervention maps onto improvements in interoception and eating disorder (ED) symptoms among adults with BSED. Aim 1 of the K99 study is to test the feasibility, acceptability, and initial efficacy of targeting a generalized sensation (HRV) via a mHealth HRV biofeedback intervention (HRV-Bio) vs. sensations often feared by people with BSED (e.g., hunger, satiety, bloating) via a mHealth just-in-time adaptive intervention (ED-JITAI). Adults randomized to HRV-Bio (n=40) will learn to use their HRV data (assessed via sensors: Holter monitors, smartwatches) to improve their HRV via app-guided breathing tasks. Adults in ED-JITAI (n=40) will engage in body scans targeting feared sensations at times when they report worse interoception than usual (i.e., more distancing from feared sensations) via ecological momentary assessment (EMA). Data will be collected via EMA and sensors pre- and post- treatment. It is hypothesized that: (1) The feasibility and acceptability of both interventions will be evidenced by >75% treatment compliance and <20% attrition from pre- to post-treatment, with better rates expected for HRV-Bio vs. ED-JITAI; (2) Improvements in binge eating, purging, self-reported interoception (assessed via EMA), and HRV (via sensors) will be greater for ED-JITAI vs. HRV-Bio. K99 results will inform (e.g., by refining tasks) an optimized R00 study that will (Aim 2) examine the incremental benefits of targeting both generalized (HRV) and feared ED sensations among non-responders to initial interventions on short- and longer-term changes in interoception and ED symptoms. Under the guidance of expert mentors at a top-10 institution with robust resources, the applicant will work towards her career goals of launching a high-impact translational ED research program that aims to improve the understanding of associations among transdiagnostic self- regulatory processes (e.g., interoception) and ED symptoms, and translate this research into effective interventions. Training will focus on improving her skills in innovative methods (sensors, MOST design), advanced statistics, and developing mHealth interventions. This research may improve the health of adults with high morbidity and mortality risk, in line with NIMH Strategic Goal 3 (Strive for Prevention and Cures).