Neural Responses to Auditory Food Stimuli Following Cognitive Behavioral Therapy for Binge‐Eating Disorder

ABSTRACT Objective Adults with binge‐eating disorder (BED), compared with those without BED, demonstrate higher blood‐oxygen–level‐dependent (BOLD) response to food cues in reward‐related regions of the brain. It is not known whether cognitive behavioral therapy (CBT) can reverse this reward system hyperactivation. This randomized controlled trial (RCT) assessed changes in BOLD response to binge‐eating cues following CBT versus wait‐list control (WLC). Method Females with BED (N = 40) were randomized to CBT or WLC. Participants completed assessments at baseline and 16 weeks including measures of eating and appetite and functional magnetic resonance imaging (fMRI) to measure BOLD response while listening to personalized scripts of binge‐eating and neutral‐relaxing cues. Data were analyzed using general linear models with mixed effects. Results Overall retention rate was 87.5%. CBT achieved significantly greater reductions in binge‐eating episodes than WLC (mean ± standard error decline of 14.6 ± 2.7 vs. 5.7 ± 2.8 episodes in the past 28 days, respectively; p = 0.03). CBT and WLC did not differ significantly in changes in neural responses to binge‐eating stimuli during the fMRI sessions. Compared with WLC, CBT had significantly greater improvements in reward‐based eating drive, disinhibition, and hunger as assessed by questionnaires (ps