Combining Digital Cognitive Behavioral Therapy With Mindfulness Training for Binge Eating Disorder: Protocol for a Feasibility Trial
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Abstract
Background: Cognitive behavioral therapy (CBT) is the most effective treatment for binge eating disorder (BED) but is limited by modest efficacy and low reach of in-person delivery. Combining mindfulness training with CBT could enhance efficacy by targeting emotion dysregulation, a key factor in BED that CBT does not adequately target. Digital delivery can enhance the reach of treatment. Accordingly, we developed CBT-based Mindful Courage, a 16-session digital intervention combining CBT and mindfulness training for BED. Objective: The aim of this study is to conduct a pilot randomized controlled trial to evaluate the feasibility (intervention and assessment completion) and acceptability (usability, overall satisfaction, engagement, visual appeal of content, understandability of program content, desire to continue the program, perceived skill acquisition, perceived confidence in implementing skills, and perceived helpfulness) of CBT-based Mindful Courage. We will also evaluate changes in outcomes (binge eating frequency, eating disorder symptoms, clinical impairment, and depression symptoms) and mechanisms (emotion dysregulation, dietary overrestriction, and trait mindfulness). Methods: This is a parallel-group, single-blinded, randomized controlled trial with a 1:1 allocation ratio. It will be conducted from November 2025 to November 2026, with study assessments at baseline, midtreatment, end-of-treatment, and 2-month follow-up. We will recruit a volunteer sample of adults with BED (N=40) aged 18 to 75 years via online advertisements. Exclusion criteria include a BMI <18.5, current anorexia or bulimia nervosa, and current treatment for BED or weight loss. Participants will be randomly allocated to an active control that includes coached self-monitoring (self-monitoring of food intake in Recovery Record and coaching calls by a research assistant) or to CBT-based Mindful Courage+coached self-monitoring. Both conditions will have a duration of 18 weeks. All study sessions will take place over Zoom. Results: The study was funded in April 2023. Data collection began in November 2025, and we anticipate recruitment to be completed by November 2026. Results are expected to be analyzed by May 2027 and published by May 2028. Conclusions: This will be an important first step in creating a scalable and efficacious treatment for BED. Trial Registration: ClinicalTrials.gov NCT07212673; https://clinicaltrials.gov/study/NCT07212673 International Registered Report Identifier (IRRID): DERR1-10.2196/91761
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- Authors
- Sala, M., Roos, C., Ascarrunz, D., Stern, C. M., Bricker, J., Feldman, J. M., Levinson, C., Aslan, M., Hay, J. L., & Kober, H.
- Affiliations
- Yeshiva University (US)
- Yale University (US)
- Albert Einstein College of Medicine (US)
- University of Washington (US)
- University of Louisville (US)
- Memorial Sloan Kettering Cancer Center (US)
- Corresponding author
- Sala, Margaret
- ORCID
- Venue
- JMIR Research Protocols
- Publisher
- JMIR Publications Inc.
- Published
- 2026-04-17
- Volume
- 15
- Pages
- e91761
- ISSN
- 1929-0748 (ISSN-L)
- PMC
- PMC13135158
- OpenAlex
- W7134927003
- Cited by
- 0
- References
- 28
- FWCI
- 0.00
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- JMIR Research Protocols (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- National Institutes of Health
- National Center for Complementary and Integrative Health (K23AT012126)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
- Keywords
- binge eating disorder, digital cognitive behavioral therapy, mindfulness training, emotional dysregulation, trait mindfulness, self-monitoring, treatment acceptability, feasibility, depressive symptoms, eating disorder symptoms, telehealth intervention, eating disorder prevention
- MeSH terms
- Adolescent, Adult, Feasibility Studies, Female, Humans, Male, Middle Aged, Pilot Projects, Cognitive Behavioral Therapy, Randomized Controlled Trials as Topic, Single-Blind Method, Treatment Outcome, Young Adult, Binge-Eating Disorder, Mindfulness
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