eBEfree: Combining Psychoeducation, Mindfulness, and Self-Compassion in an App-Based Psychological Intervention to Manage Binge-Eating Symptoms: A Randomized Controlled Trial

Objective: To develop and test the effectiveness of the eBEfree program, a 12-session app-based version of a previously tested psychological intervention (BEfree) that combines psycho-education, self-compassion, mindfulness, and Acceptance and Commitment Therapy to reduce binge-eating symptoms. Method: Two-hundred participants with recurrent elevated binge-eating symptoms and a higher body weight were enrolled in a remote parallel-group randomized trial, of which 142 completed the initial assessment (70 in the intervention group). The end-of-treatment and follow-up assessments were conducted 12 weeks after the initial assessment and 26 weeks after the end of treatment, respectively. Intention-to-treat (ITT) analyzes were undertaken using frequentist linear mixed models and Bayesian hierarchical models to test the intervention effectiveness. Results43 (waitlist control) and 29 (intervention) participants completed the end-of-treatment assessment, showing a high attrition rate (51%). ITT analyzes showed the eBEfree program to be associated with a significant reduction in binge eating symptomatology from baseline to end-of-treatment (beta = -9.49, rho < 0.0001, g = -1.17), and from end-of-treatment to 26-weeks follow-up (beta = -6.01, rho = 0.04, g = -1.08). At end-of-treatment, the intervention was also associated with a decrease in body mass index and depression symptomatology, as well as an improvement in dimensions of self-criticism and mindfulness. More than 80% of participants rated the quality of the program as positive and helpful. Discussion: This trial suggests potential benefits of the eBEfree program to help individuals manage symptoms of binge-eating more effectively, reduce weight, and improve well-being and mental health. The intervention benefits should be confirmed in future larger trials. Public Significance: Treating binge-eating (BE) symptoms and associated comorbidities might be challenging for mental health services. Digital and app-based interventions can be a valuable resource to help people manage symptoms and improve well-being and mental health. The current trial suggests the potential benefits of an app-based intervention (eBEfree program) to help people reduce BE symptoms and develop psychological strategies to promote well-being and mental health.