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The purpose of this study is to examine the effects of noninvasive prefrontal cortex (PFC) neurofeedback during eating in women with bulimia nervosa (BN) using wearable brain imaging, functional near-infrared spectroscopy (fNIRS), together with a brain-based 4-week text-messaging intervention. The investigators will examine how these interventions may influence inhibitory control and eating disorder symptoms in women with bulimia nervosa.
The purpose of this study is to examine the effects of PFC neurofeedback during eating in women with bulimia nervosa (BN) using fNIRS and a 4-week text messaging intervention. Specifically, the study aims 1) to use neurofeedback during eating to evaluate the causal role of PFC function in BN; and 2) to test individualized, neuro-based text messaging for treatment of BN. Data will be collected from women with BN who will be randomly assigned to one of two group conditions (real or sham-control neurofeedback during eating and text-messaging intervention). Participation includes a phone screening assessment, psychodiagnostic assessment, one in-person assessment, six in-person neurofeedback training sessions, 4 weeks of text-message intervention, behavioral tasks, online questionnaires, and online symptom assessments (before the neurofeedback visits and following the 4-week text message intervention), and a follow-up remote assessment.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Real fNIRS Neurofeedback and SmartPhone Intervention Arm | Experimental | Participants assigned to the experimental arm will see their true, real-time brain activation (i.e., active real-time neurofeedback) during the neurofeedback session. This activation will be displayed to the participant as a thermometer that will increase as brain activation in the target region increases. During the 4 week text-messaging intervention after neurofeedback, the active real-time neurofeedback group will be prompted to use neurofeedback strategies that increased their real PFC activation. Participants will also be directed to use these strategies in response to any unexpected urges each day. |
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| Sham-Control fNIRS Neurofeedback and SmartPhone Intervention Arm | Sham Comparator | Participants assigned to the sham-control arm will see false feedback (or a fake signal) during the neurofeedback session. During the 4 week text-messaging intervention after neurofeedback, the sham neurofeedback group will be prompted to use neurofeedback strategies they reported using when the sham feedback they saw was highest. Participants will also be directed to use these strategies in response to any unexpected urges each day. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Real fNIRS Neurofeedback | Other | Participants will be instructed to use real-time fNIRS neurofeedback to non-invasively regulate neural activation associated with symptoms in individuals with bulimia nervosa. During the training, participants will view images on a computer screen, listen to sounds, and consume a shake. |
| Measure | Description | Time Frame |
|---|---|---|
| Functional near-infrared spectroscopy (fNIRS)-measured neural activation and connectivity | The investigators will evaluate changes in PFC neural activation and connectivity as a function of neurofeedback. | Approximately 6 weeks |
| Go/no-go task performance | Participants will complete a go/no-go task four times to measure inhibitory control. Participants' behavioral performance on the go/no-go task will be determined by the percentage of incorrect responses made as they are prompted to react to different pictorial stimuli. Participants' percentages of error can range from 0% to 100%. A higher percentage indicates lower behavioral performance on the task. | Baseline through study completion, including 1-month follow-up (around 20 weeks) |
| Loss-of-control eating and compensatory behavior frequencies | Frequency of loss-of-control eating and compensatory episodes in the past 28 days assessed via the EDE-Q. Participants will self-report on how often loss-of-control eating and compensatory episodes occur before and after each phase of intervention (neurofeedback training and 4-week text messaging intervention) and at follow-up. | Baseline through study completion, including 1-month follow-up (around 20 weeks) |
| Eating Loss of Control Severity Subscale Score | Participants will rate the severity of their feelings of loss of control over eating in the past 28 days before and after each phase of intervention (neurofeedback training and 4-week text messaging intervention) and at follow-up on a Likert-type scale from 0-10. Higher score indicates greater severity of loss of control. | Baseline through study completion, including 1-month follow-up (around 20 weeks) |
| Measure | Description | Time Frame |
|---|---|---|
| Loss-of-control eating and compensatory behavior frequencies | Participants will report how often loss-of-control eating and compensatory episodes occur using electronic surveys throughout each phase of the intervention and at follow-up. | Baseline through study completion, including 1-month follow-up (around 20 weeks) |
| Measure | Description | Time Frame |
|---|---|---|
| Intensity of urges to eat and binge eat | Participants will rate the intensity of their urges to engage in eating and binge eating using daily electronic surveys before the start of the neurofeedback intervention and after the end of the smartphone intervention on a Likert-type scale from 1-5. Higher scores indicate greater intensity. | 4 weeks |
Inclusion criteria:
Exclusion criteria:
The prevalence of bulimia nervosa is substantially greater in women than in men. Moreover, prior research suggests that men and women show different neural response patterns during the engagement of inhibitory control, and that satiety differentially impacts the neural function of males and females.
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Sila Sozeri, B.A. | Contact | (212) 201-2679 | sila.sozeri@mssm.edu | |
| Laura A. Berner, Ph.D. | Contact | laura.berner@mssm.edu |
| Name | Affiliation | Role |
|---|---|---|
| Laura A. Berner, Ph.D. | Icahn School of Medicine at Mount Sinai | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Center for Computational Psychiatry at the Icahn School of Medicine at Mount Sinai | New York | New York | 10027 | United States |
Individual participant data that underlie the results reported in this article, after deidentification (text, tables, figures, and appendices).
Immediately following publication and ending 5 years following article publication.
To maximize the appropriate sharing of scientific data and protect research participants' privacy and confidentiality, all researchers who wish to analyze and publish the data must sign an agreement ensuring that: the requesting institution's IRB or equivalent body has approved the requested use; the dataset will only be used for studying health, medical, or biomedical conditions and does not include the study of population origins or ancestry; the funding agency (One Mind) will be acknowledged appropriately for their financial support of the original data collection. Data are available for 5 years after article publication via direct request to the investigator (laura.berner@mssm.edu).
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| ID | Term |
|---|---|
| D052018 | Bulimia Nervosa |
| D001068 | Feeding and Eating Disorders |
| D001523 | Mental Disorders |
| D002032 | Bulimia |
| ID | Term |
|---|---|
| D012817 | Signs and Symptoms, Digestive |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D006963 | Hyperphagia |
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Participants will be assigned to one of two conditions, either the experimental or sham-control arm.
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| Sham-Control fNIRS Neurofeedback | Other | Participants will be instructed to use sham-control fNIRS neurofeedback to non-invasively regulate neural activation associated with symptoms in individuals with bulimia nervosa. During the training, participants will view images on a computer screen, listen to sounds, and consume a shake. |
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| SmartPhone Intervention | Other | Over the subsequent 4 weeks, at the specific times when each individual is most likely to engage in eating disorder symptoms, participants will receive personalized messages to use mental strategies from their real-time or their sham-control fNIRS neurofeedback. |
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| Severity of loss-of-control eating |
Participants will rate the severity of their feelings of loss of control over eating throughout each phase of the intervention and at follow-up on a Likert-type scale from 1-5. Higher score indicates greater severity of loss of control. |
| Baseline through study completion, including 1-month follow-up (around 20 weeks) |
| Intensity of food cravings |
Participants will rate the intensity of their food cravings using daily electronic surveys before the start of the neurofeedback intervention and after the end of the smartphone intervention on a Likert-type scale from 1-5. Higher scores indicate greater intensity. |
| 4 weeks |
| Sense of control over behavior in general | Participants will rate their sense of control over their behavior in general using daily electronic surveys before the start of the neurofeedback intervention and after the end of the smartphone intervention on a Likert-type scale from 1-5. Lower scores indicate greater control. | 4 weeks |
| Sense of control over eating | Participants will rate their sense of control over their eating using daily electronic surveys before the start of the neurofeedback intervention and after the end of the smartphone intervention on a Likert-type scale from 1-5. Lower scores indicate greater control. | 4 weeks |
| Changes in urges to binge eat following strategy use | Participants will rate the effect of prompted or unprompted daily life neurofeedback strategy use on urges to binge eat using daily electronic surveys throughout the smartphone intervention on a Likert-type scale from 1-5. Higher scores indicate greater reduction in urges. | 4 weeks |
| Changes in food cravings following strategy use | Participants will rate the effect of prompted or unprompted daily life neurofeedback strategy use on food cravings using daily electronic surveys throughout the smartphone intervention on a Likert-type scale from 1-5. Higher scores indicate greater reduction in cravings. | 4 weeks |
| Changes in sense of control in general following strategy use | Participants will rate changes in their sense of control in general following prompted or unprompted use of neurofeedback strategies in daily life using daily electronic surveys throughout the smartphone intervention on a 1-5 Likert-type scale. Higher scores indicate greater control. | 4 weeks |
| Changes in sense of control over eating following strategy use | Participants will rate changes in their sense of control over eating following prompted or unprompted use of neurofeedback strategies in daily life using daily electronic surveys throughout the smartphone intervention on a 1-5 Likert-type scale. Higher scores indicate greater control. | 4 weeks |
| Prevention and termination of loss-of-control eating episodes following strategy use | Participants will report on prevented or terminated loss-of-control eating episodes following prompted or unprompted use of neurofeedback strategies in daily life using daily electronic surveys throughout the smartphone intervention on a binary (yes/no) response scale. | 4 weeks |
| Prevention of compensatory behaviors following strategy use | Participants will report on the prevention of compensatory behavior engagement following prompted or unprompted use of neurofeedback strategies in daily life using daily electronic surveys throughout the smartphone intervention on a binary (yes/no) response scale. | 4 weeks |