Comparing the Effectiveness of Metacognitive Therapy and Cognitive Behavioral Therapy in Improving Binge-Eating Symptoms and Metacognitive Beliefs among Individuals with Binge-Eating Disorder

Roya  Masoumi; Azam Davoodi; Marjan  Albehbahani; Najmeh Fath

Authors

Roya Masoumi Department of Psychology, Shi.C., Islamic Azad University, Shiraz, Iran Author https://orcid.org/0000-0002-9430-7489
Azam Davoodi Department of Psychology, Shi.C., Islamic Azad University, Shiraz, Iran Corresponding author https://orcid.org/0000-0003-3898-2372
Marjan Albehbahani Department of Psychology, Shi.C., Islamic Azad University, Shiraz, Iran Author https://orcid.org/0000-0002-7926-5428
Najmeh Fath Department of Psychology, Shi.C., Islamic Azad University, Shiraz, Iran Author https://orcid.org/0000-0001-7347-351X

Keywords:

Metacognitive Therapy, Cognitive Behavioral Therapy, Binge, Eating Symptoms, Metacognitive Beliefs, Eating Disorder

Abstract

Purpose: This study aimed to compare the effectiveness of metacognitive therapy and cognitive behavioral therapy in reducing binge-eating symptoms and dysfunctional metacognitive beliefs among individuals with binge-eating disorder.

Methods and Materials: This quasi-experimental study employed a pretest–posttest design with a two-month follow-up and two intervention groups. The statistical population comprised all individuals with binge-eating disorder who attended the Tehran Binge Eating Association in 2025. Thirty eligible participants were selected through purposive sampling and randomly assigned to either a metacognitive therapy group or a cognitive behavioral therapy group, with 15 participants in each group. Both groups received 12 group-therapy sessions. Data were collected using the Binge Eating Scale developed by Gormally et al. (1982) and the Metacognitions Questionnaire developed by Wells and Cartwright-Hatton (2004). After removing two outlier scores, data from 28 participants were analyzed using analysis of covariance in SPSS version 27.

Findings: Metacognitive therapy produced a significantly greater reduction in binge-eating symptoms than cognitive behavioral therapy at posttest, and this superiority was maintained at the two-month follow-up (p < .001). Metacognitive therapy also resulted in a significantly greater reduction in the total score of dysfunctional metacognitive beliefs at posttest; however, the between-group difference was not significant at follow-up. Component-level analyses indicated that metacognitive therapy was significantly more effective in reducing positive beliefs about worry, the need to control thoughts, cognitive confidence, and cognitive self-consciousness at both posttest and follow-up (p < .001). Nevertheless, no significant difference was observed between the two treatments in negative beliefs concerning the uncontrollability and danger of thoughts (p > .05).

Conclusion: Metacognitive therapy appears to be more effective than cognitive behavioral therapy in reducing binge-eating symptoms and modifying several dimensions of dysfunctional metacognitive beliefs in individuals with binge-eating disorder. However, booster sessions and longer follow-up periods may be necessary to consolidate changes in overall metacognitive beliefs.

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References

Aghababaei, P., & Khalatbari, J. (2019). Comparison of the Effectiveness of Cognitive Behavioral Therapy and Schema Therapy on Food Craving in Women with Binge Eating Disorder Proceedings of the Fifth National Conference on Recent Innovations in Psychology, Applications, and Empowerment with an Emphasis on Psychotherapy, Tehran.

Aloi, M., Carcione, A., Lo Coco, G., Rania, M., Carbone, E. A., de Filippis, R., Segura-Garcia, C., & Liuzza, M. T. (2024). Metacognition as a Transdiagnostic Factor Across Eating Disorders: A Latent Profile Analysis Study. Frontiers in psychology, 15, 1391715. https://doi.org/10.3389/fpsyg.2024.1391715

Aloi, M., Rania, M., Carbone, E. A., Caroleo, M., Calabrò, G., & Zaffino, P. (2021). Metacognition and Emotion Regulation as Treatment Targets in Binge Eating Disorder: A Network Analysis Study. Journal of eating disorders, 9, 22. https://doi.org/10.1186/s40337-021-00388-x

Andersson, E., Aspvall, K., Schettini, G., Kraepelien, M., Särnholm, J., Wergeland, G. J., & Öst, L. G. (2025). Efficacy of Metacognitive Interventions for Psychiatric Disorders: A Systematic Review and Meta-Analysis. Cognitive behaviour therapy, 54(2), 276-302. https://doi.org/10.1080/16506073.2024.2425549

Atwood, M. E., & Friedman, A. M. (2020). A Systematic Review of Enhanced Cognitive Behavioral Therapy (CBT-E) for Eating Disorders. International Journal of Eating Disorders, 53(3), 311-330. https://doi.org/10.1002/eat.23206

Borhani Naeini, P. S., Khaleghipour, S., & Arizi Samani, H. (2024). Comparison of the Effectiveness of Cognitive Behavioral Therapy and Schema Therapy on Emotional Eating and Perceived Maternal Rejection in Women with Binge Eating Disorder. Journal of Disability Studies.

Culbert, K. M., Racine, S. E., & Klump, K. L. (2021). Research Review: What We Have Learned About the Causes of Eating Disorders. Journal of Child Psychology and Psychiatry, 62(5), 567-583.

Estévez, A., Momeñe, J., Macía, L., Iruarrizaga, I., Olave, L., & Aonso-Diego, G. (2024). The Mediating Effect of Coping Strategies and Emotion Regulation in the Relationship Between Impulsivity, Metacognition, and Eating Disorders. Nutrients, 16(12), 1884. https://doi.org/10.3390/nu16121884

Fioravanti, G., Nicolis, M., MacBeth, A., Dimaggio, G., & Popolo, R. (2023). Metacognitive Interpersonal Therapy-Eating Disorders Versus Cognitive Behavioral Therapy for Eating Disorders for Non-Underweight Adults with Eating Disorders. Research in Psychotherapy. https://doi.org/10.4081/ripppo.2023.690

Giel, K. E., Bulik, C. M., Fernandez-Aranda, F., Hay, P., Keski-Rahkonen, A., Schag, K., & Zipfel, S. (2022). Binge Eating Disorder. Nature Reviews Disease Primers, 8(1), 16. https://doi.org/10.1038/s41572-022-00344-y

Jung, S., Lee, Y., & Kim, D. (2020). A Randomized Trial of Enhanced Cognitive Behavioral Therapy for Eating Disorders. International Journal of Eating Disorders, 53(9), 1450-1460.

Normann, N., & Morina, N. (2018). The Efficacy of Metacognitive Therapy: A Systematic Review and Meta-Analysis. Frontiers in psychology, 9, 2211. https://doi.org/10.3389/fpsyg.2018.02211

Palmieri, S., Gentile, N., & Da Ros, A. (2021). Profiling Metacognition in Binge Eating Disorder. Journal of Rational-Emotive & Cognitive-Behavior Therapy, 39(2), 163-171. https://doi.org/10.1007/s10942-020-00364-1

Palmieri, S., Mansueto, G., Marchant, A. P., Sassaroli, S., Caselli, G., Ruggiero, G. M., & Spada, M. M. (2023). The Metacognitions About Binge Eating Questionnaire. Clinical Psychology & Psychotherapy, 30(4), 780-794. https://doi.org/10.1002/cpp.2839

Raevuori, A., Suokas, J., Haukka, J., Gissler, M., Linna, M., Grainger, M., & Suvisaari, J. (2015). Highly Increased Risk of Type 2 Diabetes in Patients with Binge Eating Disorder and Bulimia Nervosa. International Journal of Eating Disorders, 48(6), 555-562. https://doi.org/10.1002/eat.22334

Robertson, S., & Strodl, E. (2020). Metacognitive Therapy for Binge Eating Disorder. Clinical Psychologist, 24(2), 143-154. https://doi.org/10.1111/cp.12213

Saadatmand, K., Bassak-Nejad, S., & Hashemi, S. E. (2023). Effectiveness of Emotion-Focused Cognitive Behavioral Therapy on Body Compassion and Reduction of Binge-Eating Symptoms in Women with Binge Eating Disorder: A Case Study. Clinical Psychology, 15(2), 29-44.

Serra, R., Kiekens, G., Tarsitani, L., Vrieze, E., Bruffaerts, R., Loriedo, C., Adriaens, A., & Vanderlinden, J. (2020). The Effect of Trauma and Dissociation on the Outcome of Cognitive Behavioural Therapy for Binge Eating Disorder. European Eating Disorders Review, 28(3), 309-317. https://doi.org/10.1002/erv.2722

Torres, S., Vieira, F. M., & Sigulem, D. (2020). Emotion-Focused Cognitive Behavioral Therapy for Obese Women with Binge Eating Disorder. Eating and Weight Disorders, 25, 849-858.

Trace, S. E., Baker, J. H., Peñas-Lledó, E., & Bulik, C. M. (2020). The Genetics of Eating Disorders. Annual Review of Clinical Psychology, 16, 17-41.

van Riel, L., van den Berg, E., Polak, M., Geerts, M., Peen, J., Ingenhoven, T., & Dekker, J. (2023). Exploring Effectiveness of CBT in Obese Patients with Binge Eating Disorder. BMC psychiatry, 23(1), 136. https://doi.org/10.1186/s12888-023-04626-x

Watson, H. J., Jangmo, A., Smith, T., Thornton, L. M., von Hausswolff-Juhlin, Y., & Madhoo, M. (2018). A Register-Based Case-Control Study of Health Care Utilization and Costs in Binge-Eating Disorder. Journal of psychosomatic research, 108, 47-53. https://doi.org/10.1016/j.jpsychores.2018.02.011

Wells, A. (2013). Advances in Metacognitive Therapy. International Journal of Cognitive Therapy, 6(2), 186-201. https://doi.org/10.1521/ijct.2013.6.2.186