BackgroundCognitive‐behavioral therapy (CBT) is an evidence‐supported treatment for adolescents with binge‐eating disorder (BED). Executive dysfunctions, which are associated with binge eating and elevated body weight in youth, may undermine CBT outcomes by making it difficult for youth to engage with or adhere to treatment, including recalling and/or implementing intervention strategies in real‐world contexts.MethodsWe assessed 73 adolescents [82.2% female; Mage = 15.0 ± 2.5 year; M baseline standardized body mass index (zBMI) = 1.9 ± 1.0 kg/m2] with BED at baseline, posttreatment, 6‐, 12‐, and 24‐month follow‐up. Linear mixed models examined the effects of baseline executive functioning (EF) on loss of control (LOC) eating and weight change following CBT. Linear and logistic regressions probed associations between EF, attendance, and attrition.ResultsMore impulsive decision‐making, as reflected in higher baseline scores on the Iowa Gambling Task, predicted better attendance (β = .07; p = .019) and more frequent LOC eating following treatment (β = .12; p = .017). Lower cognitive flexibility, as reflected in lower baseline T‐scores on the Comprehensive Trail Making Test complex sequencing index, predicted higher zBMI following treatment (β = −.03; p = .003). Inhibition, concentration, attention, and parent‐reported EF behavior symptoms were not associated with outcome, attendance, or attrition.ConclusionsMore impulsive decision‐making and lower cognitive flexibility were associated with suboptimal response to CBT for BED, although findings should be interpreted with caution in light of the sample size and waitlist control design. Future research should examine whether strengthening EF could improve eating and weight outcomes among adolescents with BED who have lower pre‐treatment EF.

中文翻译：

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接受暴食症认知行为治疗的青少年的执行功能和治疗结果


背景认知行为疗法（CBT）是针对患有暴食症（BED）的青少年的一种有证据支持的治疗方法。执行功能障碍与青少年暴饮暴食和体重增加有关，可能会导致青少年难以参与或坚持治疗，包括在现实世界中回忆和/或实施干预策略，从而损害 CBT 的结果。方法我们评估了73 名青少年 [82.2% 为女性；中号年龄= 15.0 ± 2.5 年；中号基线标准化体重指数 (zBMI) = 1.9 ± 1.0 kg/m 2 ] 基线、治疗后、6、12 和 24 个月随访时使用 BED。线性混合模型检查了基线执行功能 (EF) 对 CBT 后饮食失控 (LOC) 和体重变化的影响。线性和逻辑回归探讨了 EF、出勤率和流失率之间的关联。结果 正如爱荷华州赌博任务的基线分数较高所反映的，更冲动的决策预示着更好的出勤率（ β = .07； p = .019）以及治疗后更频繁的LOC饮食（ β = .12； p =.017）。较低的认知灵活性，反映在较低的基线上时间‐综合试验测试复杂测序指数的得分，预测治疗后 zBMI 更高（ β =−.03； p =.003）。抑制、注意力集中、注意力和家长报告的 EF 行为症状与结果、出勤或流失无关。结论 尽管根据样本量和候补名单控制设计应谨慎解释研究结果，但更冲动的决策和较低的认知灵活性与 BED 的 CBT 反应不佳有关。未来的研究应该探讨加强 EF 是否可以改善治疗前 EF 较低的暴食症青少年的饮食和体重结果。