Inhibitory Control Training Enhanced by Transcranial Direct Current Stimulation to Reduce Binge Eating Episodes: Findings from the Randomized Phase II ACCElect Trial.

INTRODUCTION: Binge eating disorder (BED) is characterized by recurrent binge eating (BE) episodes with loss of control. Inhibitory control impairments, including alterations in dorsolateral prefrontal cortex (dlPFC) functioning, have been described for BED. A targeted modulation of inhibitory control circuits by the combination of inhibitory control training and transcranial brain stimulation could be promising. OBJECTIVE: The aim of the study was to demonstrate feasibility and clinical effects of a transcranial direct current stimulation (tDCS)-enhanced inhibitory control training to reduce BE episodes and to generate an empirical basis for a confirmatory trial. METHODS: We performed a monocentric clinical phase II double-blind randomized trial with two parallel arms. Forty-one adult outpatients with full-syndrome BED according to DSM-5 received six sessions of food-related inhibitory control training, randomly combined with 2 mA verum or sham tDCS of the right dlPFC. The main outcome was BE frequency within a 4-week interval after treatment termination (T8; primary) and at 12-week follow-up (T9; secondary) as compared to baseline. RESULTS: BE frequency was reduced in the sham group from 15.5 to 5.9 (T8) and to 6.8 (T9); in the verum group, the reduction was 18.6 to 4.4 (T8) resp. 3.8 (T9). Poisson regression with the study arm as the factor and baseline BE frequency as the covariate revealed a p value of 0.34 for T8 and 0.026 for T9. Sham and real tDCS differed at T9 in BE frequency. CONCLUSIONS: Inhibitory control training enhanced by tDCS is safe in patients with BED and results in a substantial and sustainable reduction in BE frequency which unfolds over several weeks post-treatment. These results constitute the empirical basis for a confirmatory trial.

Enriching a randomized controlled treatment trial for anorexia nervosa by lived experience-Chances and effects of a lived experience council in the SUSTAIN study.

BACKGROUND: The development and advancement of treatment and care options is one priority in the field of eating disorders. The inclusion of persons with lived experience with eating disorders into clinical research could enrich and accelerate this endeavor, as they can add different perspectives on the disease and its treatment. Although lived experience perspectives are increasingly part of eating disorder research, they have not been widely or structurally implemented into clinical trials and there is limited information on the practice of participatory research, its framework and consequences. AIMS: The present work outlines the participatory collaboration with a lived experience council in the randomized controlled treatment trial SUSTAIN. MATERIALS & METHODS: The manuscript is a participatory publication co-written by individuals with lived experience with anorexia nervosa and eating disorder researchers. RESULTS: We report on motivations for this approach, our collaboration principles, structures and shared experience of working together in the trial, the potential burdens and benefits related to participation for people with lived experience. DISCUSSION: We outline future directions and perspectives to integrate a participatory framework into clinical eating disorder research. CONCLUSION: The involvement of people with experiential knowledge is complex, but possible in clinical research on ED and bears huge potential for the development of more effective care. PUBLIC SIGNIFICANCE: Incorporating perspectives of people with lived experience into a participatory framework of mental health research bears huge potential on a societal level. This includes more relevant research topics and designs, more tailored and effective interventions, and facilitated implementation, as well as dissemination, higher credibility, destigmatization of mental illness, and patient empowerment. Participatory clinical research, however, needs structural anchorage within science and society.

Food-related reward sensitivity across the spectrum of body weight and impulsive eating: Pilot findings from a multi-method approach.

Overweight with and without comorbid binge-eating disorder (BED) has been associated with increased reward sensitivity, though evidence is heterogeneous. To disentangle this heterogeneity and gain insights into mechanisms of impaired reward processing, this study applied multi-method neuro-behavioural techniques. Reward sensitivity was investigated in N = 49 participants allocated to three subgroups: overweight individuals with BED (BED+, n = 17), overweight individuals without BED (BED-, n = 15), and normal-weight controls (NWC, n = 17). Applying a free exploration paradigm (food vs. non-food stimuli), eye tracking and electroencephalographic data were gathered. A valid cue before stimulus onset indicated the position of food, and the end points analysed after the cue and stimulus onset were attentional approach, attention allocation, and conflict processing (e.g., conflict between looking at the potentially rewarding food stimulus or not). The effect of negative mood was tested using mood induction. The study's main hypothesis was that individuals with overweight, particularly under negative mood, would have increased food-related reward sensitivity. All participants showed increased food-specific attentional approach (p < .001). BED + allocated more attention to food stimuli than non-food stimuli compared to the healthy control (p = .045). For individuals with overweight but without BED (BED-), results indicate that conflict processing might be prolonged after the stimulus onset (p = .011). No group-specific effect of negative mood was found. Preliminary results in overweight individuals with and without comorbid BED suggest that food stimuli are generally rewarding stimuli, but even more so for participants with binge eating psychopathology. Prolonged conflict processing during the confrontation with competing food and non-food stimuli was solely found in the BED- sample and might indicate a compensation mechanism. Replication is warranted. The multi-method approach seems to be promising to give indications for the development of psychotherapeutic treatment.

Barriers and facilitators affecting treatment uptake behaviours for patients with eating disorders: A systematic review synthesising patient, caregiver and clinician perspectives.

OBJECTIVE: A significant treatment gap exists between persons affected by eating disorders (ED), and those engaging with treatment services. This systematic review aims to provide a thorough understanding of the barriers and facilitators affecting eating disorder treatment engagement, including a synthesis of the perspectives of patients, caregivers and healthcare professionals. METHOD: This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies were retrieved from three databases (PubMed, PsycInfo, Web of Science) and were screened and assessed independently by two raters. A thematic analysis was completed to determine the key barriers and facilitators reported by the included studies. RESULTS: A total of 73 studies were included. From these studies, 12 barriers and 13 facilitators were identified. Patients reported stigma, shame and guilt as the most prominent barrier affecting their engagement with treatment services. Meanwhile, caregivers and healthcare professionals reported a lack of eating disorder knowledge of clinicians as the most important barrier. Positive social support was cited as the most prominent facilitator to promote help-seeking. DISCUSSION: Patients, caregivers and healthcare professionals experience a variety of barriers and facilitators to treatment uptake for ED. Interventions addressing barriers and facilitators could increase treatment engagement, including anti-stigma campaigns and positive peer-support interventions.

Behavioural biases in the interaction with food objects in virtual reality and its clinical implication for binge eating disorder.

Cognitive processes play a central role in the development, maintenance and remission in mental disorders, like in Binge Eating Disorder (BED). Insights into cognitive mechanisms reflected by embodied interaction with food and its connections to clinically relevant psychopathology offer new possibilities for translational diagnostics and interventions. We longitudinally investigated the manual interaction with food in a virtual reality (VR) in 31 patients with BED. Patients were assessed at baseline before participating in a randomized-controlled trial (RCT) investigating a computer-based inhibitory control training programme enhanced by transcranial direct current stimulation (tDCS) and at a 6-week follow-up. At both assessments, an experimental VR paradigm was conducted and patients were characterized concerning eating disorder psychopathology, eating behaviour, general impulsivity and food craving. In the experimental task, one of two simultaneously presented objects (food vs. office tools) had to be collected. Food was recognized faster than office tools and subsequent approach behaviour was initiated faster, whereas thereafter, food was collected slower than office tools. Exploratory, we could not find a modulatory effect of applied tDCS on the interaction with food. No relationship between behavioural biases and sample characterizations could be detected. Two different stages in the manual interaction with food were found: a faster first stage that comprises recognition and movement initiation and a slower second stage that comprises controlled handling and may reflect aversive motivational processes. As the behavioural patterns do not change with an ameliorated BED-psychopathology at the second assessment, the task seems insensitive in detecting translational interconnections between behavioural biases and BED-characteristics.Level of evidence: Level I, experimental study.

Combined antisaccade task and transcranial direct current stimulation to increase response inhibition in binge eating disorder.

Binge eating disorder (BED) is associated with deficient response inhibition. Malfunctioning response inhibition is linked to hypoactivation of the dorsolateral prefrontal cortex (dlPFC), where excitability could be increased by anodal transcranial direct current stimulation (tDCS). Response inhibition can be assessed using an antisaccade task which requires supressing a dominant response (i.e. saccade) towards a newly appearing picture in the visual field. We performed a double-blind, randomised, placebo-controlled proof-of-concept-study in which we combined a food-modified antisaccade task with tDCS in people with BED. We expected task learning and modulatory tDCS effects. Sixteen people were allocated to a 1 mA condition, 15 people to a 2 mA condition. Each participant underwent the food-modified antisaccade task at three measurement points: baseline without stimulation, anodal verum and sham stimulation at the right dlPFC in a crossover design. The error rate and the latencies of correct antisaccades decreased over time. No tDCS effect on the error rate could be observed. Compared to sham stimulation, 2 mA tDCS decreased the latencies of correct antisaccades, whereas 1 mA tDCS increased it. Self-reported binge eating episodes were reduced in the 2 mA condition, while there was no change in the 1 mA condition. Participants demonstrated increased response inhibition capacities by a task learning effect concerning the error rate and latencies of correct antisaccades over time as well as a nonlinear tDCS effect represented by ameliorated latencies in the 2 mA and impaired latencies in the 1 mA condition. The reduction of binge eating episodes might indicate a transfer effect to everyday life. Given that the reduction in binge eating was observed before tDCS administration, this effect could not be the result of neuromodulation. Randomized clinical trials are needed to fully understand this reduction, and to explore the efficacy of a combined antisaccade and tDCS training for BED.

Eating behaviour and symptom trajectories in patients with a history of binge eating disorder during COVID-19 pandemic.

OBJECTIVE: A history of an eating disorder (ED) might constitute a risk for symptom deterioration and relapse during COVID-19 pandemic. This longitudinal study investigates ED symptom trajectories until the first COVID-19 lockdown in Spring 2020 in patients with a history of binge eating disorder (BED). METHOD: Participants of the randomised-controlled BED treatment trial IMPULS participated in a re-assessment directly after the first COVID-19 lockdown in Germany. We used expert-rated clinical interviews and self-report to investigate binge eating (BE) frequency, ED and general psychopathology, distress, emotion regulation and sense of coherence. Symptom trajectories were analysed for baseline when entering the trial, end of trial participation and the time point directly after lockdown. BE frequency was assessed on a recall basis for 4 weeks directly before lockdown and 4 weeks during lockdown. RESULTS: BE frequency, general ED pathology and depressive symptoms markedly increased after as compared to before the COVID-19 outbreak. Individuals scoring high on reappraisal as emotion regulation strategy and sense of coherence scored lower on general ED pathology. CONCLUSION: Individuals with a history of an ED are at risk for symptom deterioration and relapse during the pandemic. Intervention and service dissemination strategies are needed to support vulnerable groups throughout the pandemic.

Attention allocation to illness-compatible information discriminates women with active versus weight-recovered anorexia nervosa.

OBJECTIVE: Biased attention for disorder-relevant information plays a crucial role in the maintenance of different mental disorders including eating disorders and might be of use to define recovery beyond symptom-related criteria. METHOD: We assessed attention deployment using eye tracking in a cued choice viewing paradigm to two different categories of disorder-relevant stimuli in 24 individuals with acute anorexia nervosa (AN), 20 weight-recovered individuals with a history of AN (WRAN) and 23 healthy control participants (CG). Picture pairs consisted of a food stimulus or a picture depicting physical activity and a matched control stimulus (household item/physical inactivity). Participants rated the valence of stimuli afterwards. RESULTS: The groups did not differ in initial attention deployment. In later processing stages, AN patients showed a generalized attentional avoidance of food and control pictures as compared to CG, while WRAN individuals were in between. AN patients showed an attentional bias toward physical activity pictures as compared to WRAN individuals, but not the CG. AN individuals rated the food pictures and the pictures showing physical inactivity as less pleasant than the CG, while WRAN individuals were in between. DISCUSSION: Attention deployment is partly changed in WRAN as compared to the acute AN group, especially with regard to a shift away from illness-compatible stimuli (physical activity), and this might be a useful recovery criterion. Valence rating of food stimuli might be an additional useful tool to distinguish between acutely ill and weight-recovered individuals. Attentional biases for illness-compatible stimuli might qualify as a valuable approach to defining recovery in AN.

[Non-Invasive Brain Stimulation in the Treatment of Eating Disorders - A Narrative Review]. / Nicht-invasive Hirnstimulation als Behandlungsverfahren bei Essstörungen ­ ein narrativer Überblick.

OBJECTIVE: Treatment success in many patients with eating disorders (ED) is not substantial and sustainable. Therefore, there is an urgent need for the advancement of existing treatment approaches and novel innovative interventions. Non-invasive brain stimulation (NIBS) is such an innovative approach which has recently been introduced to the treatment of ED patients. This article is a narrative review concerning the most frequently used brain stimulation techniques in ED and the current evidence concerning the efficacy of treatment. METHODS: We conducted a literature search in the PubMed database concerning the topic NIBS in ED and identified 32 relevant articles. Only 9 of these articles described empirical studies in patients with ED. RESULTS: The studies were conducted in patients with different ED diagnoses, regarding different treatment targets, used different stimulation techniques and showed differences in frequency, duration and intensity of the stimulation. Some, but not all of these studies suggest ameliorations of ED symptoms, e. g. reduction of food craving, restrictive eating and ED-related cognitions. DISCUSSION: Evidence is scarce and heterogeneous, but overall, the evidence suggests that NIBS is a promising treatment approach in ED.

IMPULS: Impulsivity-Focused Group Intervention to Reduce Binge Eating Episodes in Patients with Binge Eating Disorder - A Randomised Controlled Trial.

BACKGROUND: Impulsivity is a risk factor for binge eating disorder, and binge eating (BE) equates to impulsive eating behaviour. Hence, we developed IMPULS, a cognitive behavioural group intervention focusing on impulsive eating. METHODS: We randomised 41 patients to the IMPULS group and 39 to the control group. The IMPULS group participated in the IMPULS treatment, while both groups completed weekly self-observations. We compared both groups concerning BE episodes in the past 4 weeks at the end of treatment (primary outcome). As secondary outcomes, we investigated eating pathology, depression, general impulsivity and body mass index (BMI) at the end of treatment and in a 3-month follow-up. RESULTS: The primary outcome failed, because BE episodes in the past 4 weeks were reduced in both groups at the end of treatment. At follow-up, the IMPULS group showed further improvement, contrary to the control group. The BE days/episodes in the 2 months before were overall reduced in both groups. Eating pathology was reduced in the IMPULS group at the end of treatment and partly in both groups at the follow-up. Depression was only reduced in the IMPULS group. General impulsivity and BMI did not change. CONCLUSIONS: The IMPULS study has a negative primary outcome. However, secondary outcomes indicate that the IMPULS treatment might be promising, as BE, eating pathology and depression were reduced in the IMPULS group. The initially reduced BE in the control group might represent a short-term effect from the self-observations. General impulsivity and BMI might need a longer time or more intensive treatment to change.

Food specific inhibitory control under negative mood in binge-eating disorder: Evidence from a multimethod approach.

OBJECTIVE: Inhibitory control has been discussed as a developmental and maintenance factor in binge-eating disorder (BED). The current study is the first aimed at investigating inhibitory control in a negative mood condition on a psychophysiological and behavioral level in BED with a combination of electroencephalography (EEG) and eye tracking (ET). METHOD: We conducted a combined EEG and ET study with overweight individuals with BED (BED+, n = 24, mean age = 31, mean BMI = 35 kg/m2 ) and without BED (BED-, n = 23, mean age = 28, mean BMI = 35 kg/m2 ) and a normal-weight (NWC, n = 26, mean age 28, mean BMI = 22 kg/m2 ) control group. We assessed self-report data regarding impulsivity and emotion regulation as well as the processing of food stimuli under negative mood in an antisaccade task. Main outcome variables comprise event-related potentials (ERP) regarding conflict processing (N2) and performance monitoring (error-related negativity [ERN/Ne]) assessed by EEG and inhibitory control (errors in the first and second saccade) assessed by ET. RESULTS: BED+ patients reported increased impulsivity and higher emotion regulation difficulties compared with the other groups. The eye tracking data revealed impaired inhibitory control in BED+ compared with both control groups. Further, we found preliminary evidence from EEG recordings that conflict processing might be less thorough in the BED+ sample as well as in the NWC sample. In the BED+ sample this might be connected to the inhibitory control deficits on behavioral level. While the BED- sample showed increased conflict processing latencies (N2 latencies), which might indicate a compensation mechanism, the BED+ sample did not show such a mechanism. Performance monitoring (ERN/Ne latencies and amplitudes) was not impaired in the BED+ sample compared with both control samples. DISCUSSION: Participants with BED reported higher impulsivity and lower emotion regulation capacities. The combined investigation of electrocortical processes and behavior contributes to an advanced understanding of behavioral and electrocortical processes underlying inhibitory control in BED. Inhibitory control and negative mood, probably amplified by emotion regulation deficits, should be addressed further in the investigation and treatment of BED.

Effects of a food-specific inhibition training in individuals with binge eating disorder-findings from a randomized controlled proof-of-concept study.

PURPOSE: Impulsivity might contribute to the development and maintenance of obesity and eating disorders. Patients suffering from binge eating disorder (BED) show an impulsive eating pattern characterized by regular binge eating episodes. Novel behavioral interventions increasing inhibitory control could improve eating behavior in BED. We piloted a novel food-specific inhibition training in individuals with BED. METHODS: N = 22 BED patients according to SCID-I were randomly assigned to three sessions of a training or control condition. In both conditions, pictures of high-caloric food items were presented in peripheral vision on a computer screen while assessing gaze behavior. The training group had to suppress the urge to turn their gaze towards these pictures (i.e., to perform antisaccades). The control group was allowed to freely explore the pictures. We assessed self-reported food craving, food addiction, and wanting/liking of food pictures pre- and post-intervention. RESULTS: Twenty participants completed the study. The training proved to be feasible and acceptable. Patients of the training group significantly improved inhibitory control towards high-caloric food stimuli. Both groups reported a significantly lower number of binge eating episodes in the last four weeks after termination of the study. No changes were found in food craving, food addiction, liking, and wanting ratings. CONCLUSIONS: A food-specific inhibition training could be a useful element in the treatment of BED and other eating disorders; however, larger efficacy studies in patient samples are needed to investigate the efficacy of this and similar training approaches.

A Putative Association of COMT Val(108/158)Met with Impulsivity in Binge Eating Disorder.

OBJECTIVE: This study aims to investigate the influence of the COMT Val(108/158)Met polymorphism on trait and behavioural impulsivity in binge eating disorder (BED). COMT Val(108/158)Met has been related to impulsivity in previous studies, but so far no study has investigated the role of this polymorphism in the context of BED. METHOD: Impulsivity was assessed via a questionnaire (trait) and on a behavioural level via the antisaccade task in a sample of 69 participants classified into one out of three age-matched groups: (1) obese individuals with BED according to DMS-IV (BED+); (2) obese individuals without BED, matched with the BED+ sample according to body weight (OBED-); and (3) normal-weight healthy controls (NWC). The COMT Val(108/158)Met polymorphism was genotyped in all samples. RESULTS: As expected, the BED+ sample showed higher trait and behavioural impulsivity. Furthermore, within the BED+ group, COMT Met/Met homozygous individuals showed stronger deficits in inhibitory control. DISCUSSION: COMT Met/Met homozygous individuals with BED might represent a specific group in the BED spectrum, which shows a higher behavioural impulsivity. The association between COMT Val(108/158)Met with inhibitory control should be interpreted with caution because of the small sample size. Larger replication studies are needed to further elucidate the role of the COMT Val(108/158)Met polymorphism in the regulation of disordered eating behaviour.

[Impulsivity-focused Group Intervention to reduce Binge Eating Episodes in Patients with Binge Eating Disorder - A Group Training Program]. / Impulsivitätsbezogene Verhaltensmodifikation zur Reduktion von Essanfällen bei Patienten mit Binge-Eating-Störung ­ Ein Trainingsprogramm für Gruppen.

Binge Eating Disorder (BED) is an eating disorder where cognitive behavioural therapy (CBT) could already show reliable efficacy. Relying on basic research, CBT interventions which especially focus on impulsivity could be effective, because binge eating episodes represent highly impulsive eating behaviour. For this reason, we developed a treatment concept about an impulsivity-focused behavioural group intervention for patients with BED, called IMPULS. The efficacy of IMPULS is currently investigated in a randomised controlled trial 1. IMPULS is drafted as a weekly group training programme with 5-6 participants per group. The essential interventions are food-related cue exposure with response prevention and the development of self-control strategies. These interventions are adapted onto the impulsivity concept from conventional treatment of addictive disorders and BED.

High Levels of Physical Activity in Anorexia Nervosa: A Systematic Review.

High level physical activity is a frequent symptom in patients with anorexia nervosa (AN), influencing the development, maintenance, complications, treatment success, relapse rate and severity of the disease. Accelerometry is assumed to be an objective method to assess physical activity (PA) in AN. We aimed to review objectively measured levels of PA in AN and to give an overview for clinical practice and future research. Data were searched in PubMed and PsychINFO until April 2015 following the preferred reporting items for systematic reviews and meta-analyses statement. Twenty studies fulfilled the inclusion criteria. A notable heterogeneity of measurements, outcomes, participants and settings was found. Overall, HLPA is not adressed enough by current evidence. A common valid terminology of HLPA is not available, and accurate criteria of different levels of PA must be defined to create comparability of future studies. Further objective PA assessments are needed to improve treatment outcome and relapse rate.

Improving motivation and treatment uptake behaviors of patients with eating disorders using patient narrative videos: study protocol of a pilot randomized controlled trial.

BACKGROUND: Patients with eating disorders (ED) typically report delays between the onset of symptoms and engagement with treatment services. Personal barriers including stigma, shame, and guilt, as well as the availability of social support may influence patients' decisions to engage with treatment services. Patient narratives are personalized stories discussing the illness and recovery of previously affected persons. Such narratives can reduce self-stigma and provide current patients with hope for their own recovery. METHOD: This pilot study will examine the effects of patient narrative videos on the treatment motivation and uptake of treatment services for patients with ED. Three narrative videos were developed from the perspectives of (a) a former patient with an ED, (b) an ED specialist, and (c) the same former patient discussing a somatic condition unrelated to ED. Patients will be randomized into three video viewing and one treatment-as-usual group. Effects on treatment motivation will be assessed using the University of Rhode Island Change Assessment Scale (URICA-S) immediately after viewing the videos, as well as one-week and three-month follow-ups. Treatment uptake will be assessed during follow-up using a questionnaire listing possible treatment interactions. A post-intervention questionnaire and semi-structured interviews will be used to assess the feasibility and acceptability of patient narrative videos for this population. DISCUSSION: There is an urgent need to encourage patients with ED to engage with specialized treatments as soon as possible. Patient narratives may be a pivotal approach to implementing cost effective and easy to disseminate early intervention programs to future patients with ED.

Inhibitory control and decision making under risk in bulimia nervosa and binge-eating disorder.

OBJECTIVE: To investigate neuropsychological mechanisms of impulsivity in patients with bulimia nervosa (BN) and binge-eating disorder (BED). METHOD: Nineteen BN patients and 31 age- and body-mass-index (BMI)-matched healthy controls (c-BN) as well as 54 overweight and obese BED patients and 43 age- and BMI-matched healthy controls (c-BED) were investigated using an inhibitory control task (stop signal task, SST) and a decision-making under risk task (game of dice task, GDT). RESULTS: Compared to c-BN, BN patients demonstrated significant greater stop signal reaction times in the SST, but no differences for the frequency of risky decisions in the GDT. BED patients did not differ from c-BED in the SST or the GDT. DISCUSSION: BN but not BED patients differed from their respective control groups concerning the "stopping" component of impulsivity. These differences in motor inhibition may contribute to the behavioral distinctions in binge-eating behavior between BN and BED.

Antisaccadic training to improve impulsivity in binge eating disorder.

Patients with binge eating disorder (BED) show generally increased impulsivity and especially increased food-related impulsivity. Both are closely linked to the core pathology of BED, which relates to regular binge eating episodes with experienced loss of control. The antisaccade task is an established paradigm assessing response inhibition as a pivotal component of impulsivity. It requires participants to execute antisaccades; that is, they are supposed to look in the opposite direction of a stimulus that automatically catches attention by appearing in the peripheral visual field. High rates of prosaccades to the peripheral stimuli are considered indicators of increased impulsivity. Presenting food pictures as peripheral stimuli, this task can be used to investigate food-related impulsivity. We propose modifications of this task in order to design it as an antisaccadic training in which BED patients practise the suppression of food-related responses, which should result in enhanced control over their eating behaviour.

Process Analyses of Impulsive Behavior in Binge-Eating Disorder During the Randomized Controlled IMPULS Trial.

Impulsivity represents a risk factor for patients with binge-eating disorder, and we therefore investigated the treatment process of impulsive behaviors including binge-eating episodes in the randomized controlled IMPULS trial. Using 8 weekly online questionnaires throughout the assessment period, we compared 41 patients participating in the IMPULS program, which emphasized impulsive eating behavior (IG), with 39 control patients who received no intervention (CG). We assessed the frequency of binge eating, other impulsive behaviors, situations in which such behaviors could be inhibited, and the execution of alternative behaviors. Results indicate a stronger binge-eating reduction in the IG compared to the CG at the fifth, seventh, and eighth treatment weeks. Overall, both groups reduced other impulsive behaviors. They did not differ in the amount of inhibited impulsive behaviors and showed similar alternative behaviors, "distraction" most frequently used. IG patients evaluated the IMPULS program as very helpful. The stronger reduction of binge eating in the IG and positive evaluation of the treatment indicate a specific treatment effect regarding impulsive eating behavior. The reduction of other impulsive behaviors across both groups, and the initial reduction of binge eating within the CG, could be explained by an increased degree of self-observation.