# Target Engagement of a Novel Dissonance-Based Treatment for DSM-5 Eating Disorders R33 Phase

> **NIH NIH R33** · STANFORD UNIVERSITY · 2023 · $562,875

## Abstract

ABSTRACT
Only 3-20% of people with eating disorders (EDs) receive treatment, and they often do not receive evidence-
based treatments because they are intensive and costly, and few clinicians deliver them. These factors have
hindered broad implementation, implying that a brief frontline outpatient treatment for a range of EDs that could
be easily, cheaply, and widely implemented would address a key public health problem. There are also limited
experimental data regarding factors that maintain EDs and mechanisms of action for ED treatments. We
hypothesize that EDs are maintained by (1) excessive valuation of the thin ideal, which prompts caloric
restriction and other unhealthy weight control behaviors (vomiting, laxative/diuretic use, excessive exercise)
that increase risk for binge eating, and (2) excessive valuation of high-calorie foods, which maintains binge
eating. We propose to evaluate a group treatment that efficiently targets these 2 maintenance factors. We
created a novel 8-session dissonance-based treatment (Counter Attitudinal Therapy; CAT) wherein women
with any ED complete verbal, written, and behavioral activities in which they discuss costs of pursuing the thin
ideal and the ED behaviors they use to purse this ideal, which putatively creates dissonance about engaging in
these behaviors that reduces valuation of the thin ideal and high-calorie binge foods. In two pilot trials CAT
reduced behaviorally-assessed valuation of thin models and binge foods, and blinded interviewer-assessed ED
symptoms versus unstandardized (d=.94) and standardized usual care (d=.53), resulting in a 70% remission by
2-6 month follow-up across the two trials. Effect sizes compare favorably to those produced by 20-session
individual therapies for EDs. Women who completed the dissonance-inducing activities regarding pursuit of the
thin ideal showed a reduction in fMRI-assessed reward region response to thin models (Stice et al., 2015)
providing further evidence of target engagement. The R61 randomized trial (N=60) will (1) validate whether
CAT produces larger pre-post reductions in objective fMRI-assessed reward region response to thin models
and binge foods (intervention target measures) versus waitlist controls in women with DSM-5 EDs; (2)
generate preliminary data regarding the clinical effects of reducing the targets on ED symptom domains and
functioning (outcomes); and (3) test whether reductions in targets and outcomes show a linear decrease over
the 8 sessions or plateau earlier and correlate with greater session attendance and homework completion, to
examine dose-response relations. If the R61 confirms that CAT sufficiently engages intervention targets and
that the 8-session format produces optimal response, the fully-powered R33 randomized trial (N=120) will test
whether (4) CAT produces greater reductions in the two fMRI-assessed targets than a usual care group
treatment; (5) CAT produces greater reductions in ED symptoms and functional impairment th...

## Key facts

- **NIH application ID:** 10868785
- **Project number:** 3R33MH111782-06S1
- **Recipient organization:** STANFORD UNIVERSITY
- **Principal Investigator:** ERIC M STICE
- **Activity code:** R33 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2023
- **Award amount:** $562,875
- **Award type:** 3
- **Project period:** 2017-07-10 → 2024-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10868785

## Citation

> US National Institutes of Health, RePORTER application 10868785, Target Engagement of a Novel Dissonance-Based Treatment for DSM-5 Eating Disorders R33 Phase (3R33MH111782-06S1). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10868785. Licensed CC0.

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