Researchers: Swen Hesse (PI), MD, Anja Hilbert (PI), PhD, Franziska Zientek, PhD, Michael Rullmann, PhD, Kerstin Mayer-Carius, PhD
Cooperation partner: Adrienne S. Juarascio, PhD, Guido K. W. Frank, MD
The neurobehavioral underpinnings of binge-eating disorder (BED), which co-occurs with obesity (OB), are largely unknown. This research project conceptualizes BED as a disorder with dysfunctional emotion regulation (ER) linked with changes in central noradrenaline (NA) transmission and NA-modulated neuronal networks. To assess the role of NA transmission in BED, we aim to quantify changes of NA transporter (NAT) availability using the highly NAT-specific [11C]methylreboxetin (MRB) and positron emission tomography-magnetic resonance imaging (PET-MRI) technology that allows to measure molecular and functional (neuronal) changes simultaneously before and after an ER intervention. Acceptance-based behavioral therapy augmented by ecological momentary intervention via smartphone application will be applied for the improvement of ER. By obtaining biological and behavioral markers, the proposed study will further disentangle the involvement of NAT and central NA system in the modulation of neuronal networks that influence eating behavior. We expect abnormalities in NA activity in both BED and OB as a key molecular target of pathological overeating, which is likely to be most pronounced in BED. We further expect that these abnormalities are modifiable through state-of-the-art ER intervention, specifically in individuals with BED. Individuals with OB and BED (OB+BED), individuals OB without BED (OB-BED), and individuals with normal weight (NW) will undergo assessments of NAT availability and of neuronal network activity under rest and stimulated conditions as well as behavioral assessments including clinical interviews and self-report questionnaires on eating behavior, ER, mental and physical health, and quality of life, and neuropsychological tests on executive function. Thereafter, in an experimental randomized-controlled trial, individuals with OB+BED and OB-BED will be randomized to smartphone-supported ER intervention versus waitlist and will be re-assessed after 10 weeks. These data will provide a molecular signature beyond functional imaging biomarkers as a marker towards precision medicine tailoring treatments for individuals with BED and OB. Neurobehavioral mechanisms of change in ER intervention will be determined.
Funding: German Research Foundation
Project number: 933100-042
Duration: 04/2022 – 03/2025
Researchers: Anja Hilbert (PI), PhD, Claudia Hübner, PhD, Rebekka Ried, MSc
Cooperation partner: Adrienne S. Juarascio, PhD
Behavioral weight loss (BWL) treatment is the standard treatment for severe obesity (SO; body mass index ≥ 35 kg/m²), a common chronic health condition. BWL leads to moderate weight loss, which often, however, cannot be maintained in the long term. How successfully a patient loses weight depends on the extent to which therapeutic weight loss skills are used in daily life. For optimal weight loss, it is therefore central to support skills use in everyday life, for example, regarding lifestyle and emotion regulation. The exploratory clinical trial SmartBWL aims to apply a cognitive-behavioral smartphone application (app) to BWL treatment that supports a patient individually when he/she needs it most. Following a patient-oriented approach, the app, originally developed for cognitive-behavioral therapy of eating disorders (bulimia nervosa, binge-eating disorder), will be adapted, piloted, and optimized for BWL treatment in patients with SO. In a randomized-controlled exploratory trial with adults with SO, it will be examined if the use of the app adjunctive to BWL treatment improves weight loss, skills use, and well-being compared to BWL treatment alone and if it is feasible and acceptable for patients. Positive results of this study will form the basis for a large-scale clinical trial investigating the app's long-term efficacy, which is a prerequisite for making it widely available to people with SO in BWL treatment.
Funding: German Federal Ministry of Education and Research
Project number: 933100-038
Duration: 04/2021 – 03/2024
Researchers: Anja Hilbert (PI), PhD, Carl Bartl, MSc
Cooperation partner: Adrienne S. Juarascio, PhD
Binge-eating disorder (BED) is the most common clinical eating disorder characterized by recurrent binge-eating episodes in the absence of extreme compensatory behaviors to prevent weight gain. It is associated with severe eating disorder and general psychopathology, mental comorbidity, obesity and related medical conditions as well as significant impairment of quality of life and psychosocial functioning, resulting in increased health care costs. Cognitive-Behavioral Therapy (CBT) is the most well established treatment for BED and leads to sustained remission of eating disorders in 50% of patients. A further increase in the efficacy of CBT for BED is therefore urgently needed. To ensure that patients benefit optimally from CBT, it is essential to support them in using the skills they have learned during CBT in everyday life. New mobile health (mHealth) technologies, such as smartphone applications (apps), make it possible to offer personalized support in everyday life when the patient needs it most (e.g., in a very negative mood, which often leads to binge eating). A prerequisite for such an app support is the recording and timely evaluation of psychological symptoms and skills use in everyday life in order to offer personalized assistance via smartphone in critical situations (e.g., guidance on the use of therapeutic skills for emotion regulation). The aim of this research project is to specify and expand a smartphone app developed and tested for bulimia nervosa for patients with BED and to evaluate feasibility, acceptance, and skills use in an exploratory randomized-controlled treatment study, as well as to assess the additional efficacy compared to CBT alone. This research is essential for optimizing the efficacy of psychotherapy for BED and improving the outpatient care of these patients cost-effectively. In addition, it has the potential to significantly advance medical technology progress in the development of personalized health-related smartphone apps using artificial intelligence.
Funding: Roland Ernst Foundation for Health Care
Project number: 933100-032
Duration: 04/2020 – 09/2022
Study center Leipzig: Anja Hilbert, PhD, Wieland Kiess, MD, Lisa Koziel, MSc, Dagny Kühner, MSc, Skadi Beblo, MD, Alena Thiele, PhD
Consortium management at University Medical Center Hamburg-Eppendorf: Silke Wiegand-Grefe (PI), PhD, Jonas Denecke, MD
About two million children and adolescents in Germany live with a rare chronic disease. Their families are often affected by fears, insecurities, and worries. CARE-FAM-NET is a multicenter study aimed at improving the psychosocial care of these children and their families. Within this study, families receive comprehensive psychological diagnostics, early detection, and treatment of mental illness. Two new interventions are being evaluated for this purpose. CARE-FAM is a family-oriented intervention with 6-8 sessions per family over a period of six months, including consultations with the parents, with the affected child and its siblings, and the whole family. The structure of the sessions and the general procedure follow a treatment manual. WEP-CARE is based on the principles of cognitive-behavioral writing therapy and is directed to the parents of affected children. Parents complete ten standardized writing tasks within ten weeks and receive regular feedback from trained specialists. We expect that the interventions will lead to a sustainable improvement in mental health and health-related quality of life of the families.
Funding: Innovation Fund
Project number: IFBADI-034
Duration: 10/2018 – 09/2022
Researchers: Anja Hilbert (PI), PhD, Ricarda Schmidt, PhD, Birgit Fuchs, MSc, Rika Otsubo, MSc, Pia Schermaul, MSc, Marius Huber, MSc
Cooperation partner: Ann-Christine Ehlis, PhD
Binge-eating disorder (BED) is the most prevalent eating disorder in the adult population. Patients with BED suffer from recurrent binge-eating episodes, defined as eating large amounts of food accompanied by a sense of loss of control over eating, which occurs in the absence of regular inappropriate compensatory behaviors to prevent weight gain. Research indicated that patients with BED show impairment in dealing with food, for instance, an increased food-related impulsivity. These deficits are mirrored neurologically in a differential activation of particular brain areas related to reward sensitivity and self-control in response to disorder-relevant cues, such as food stimuli. Until recently, there has been no specific brain-directed treatment targeting food-related impulse control so far in patients with BED, which could improve impulsive symptoms and weight management. Neurofeedback is a computer-based training method, which allows participants to perceive and to regulate their own brain activity. Electroencephalography (EEG) is a frequently used non-invasive imaging method, which visualizes electrical activity of the brain. Initial evidence exists on the efficacy of EEG neurofeedback using food stimuli to improve binge eating in patients with BED. A novel approach of neurofeedback uses functional near-infrared spectroscopy (fNIRS), an optical imaging method, which allows for non-invasive in vivo measurement of changes in the concentration of oxygenated and deoxygenated hemoglobin in brain tissue. Studies using fNIRS neurofeedback in the treatment of BED are lacking so far. Hence, the goal of this randomized-controlled trial is to evaluate the feasibility and efficacy of fNIRS neurofeedback compared to EEG neurofeedback in patients with BED and overweight or obesity.
Funding: Federal Ministry of Education and Research
Project number: AD2-7110
Duration: 11/2017 – 12/2020
Researchers: Anja Hilbert (PI), Arne Dietrich, MD, Ricarda Schmidt, PhD, Tina Schwalbe, BSc, Claudia Hübner, PhD, Lisa Schäfer, MSc
Bariatric surgery maximizes long-term weight loss and psychosocial functioning. However, a significant proportion of patients experience poor weight-loss outcome and weight regain over time. Although there is first evidence that maladaptive eating and lifestyle behaviors (e.g., loss of control eating) or general psychopathology are associated with bariatric surgery outcome, longitudinal bariatric surgery cohorts with a long-term follow-up of a comprehensive assessment of psychosocial aspects are widely lacking. Based on the multicenter longitudinal Psychosocial Registry for Bariatric Surgery (PRAC) established in 2012, the present research project aims at extending the data record and the long-term assessments for up to 8 years following surgery. All bariatric surgery candidates at the Integrated Research and Treatment Center AdiposityDiseases will be approached for first inclusion in PRAC prior to surgery and repeated bi-annual or annual follow-up assessments. For the in-depth examination of diverse psychosocial aspects, state-of-the-art interviews and self-report questionnaires are used, for example, on forms of non-normative eating behaviors, psychopathology, personality characteristics, such as impulsivity, self-esteem, and experiences of weight stigma. In order to minimize attrition, extensive effort is placed on retention strategies. The overarching goal of PRAC is to elucidate the association between psychosocial factors and bariatric surgery outcome in the long term and to allow for identification of patients at increased need for post-bariatric behavioral treatment.
Funding: Federal Ministry of Education and Research
Project number: AD2-6C90
Duration: 5/2015 – ongoing