Combining Cognitive Training and Brain Stimulation: A Novel Approach to Address Disordered Eating and Antipsychotic‐Induced Weight Gain in People With Severe Mental Illness
- 1Centre for Research in Eating and Weight Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience King's College London London UK
- 2Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience King's College London London UK
- 3South London and Maudsley NHS Foundation Trust Maudsley Hospital London UK
Abstract
Background: Antipsychotic‐induced weight gain is a distressing side effect that most often occurs within the first 3–6 months of pharmacological initiation, significantly increasing cardiometabolic risk and mortality in individuals with severe mental illness.
Aims: To assess the feasibility of reducing food craving and binge eating using Approach Bias Modification Training (ABMT) combined with real or sham Transcranial Direct Current Stimulation (tDCS).
Method: In this double‐blind, parallel‐group, two‐arm, sham‐controlled trial, adults with schizophrenia/schizoaffective disorder on stable doses of antipsychotics were randomly allocated to a total of five ABMT sessions together with either real or sham tDCS administered over 3 weeks. Assessments were made at baseline (T0), post‐treatment (T1) and at a 2‐week follow‐up (T2). Feasibility outcomes included recruitment, attendance, retention, tDCS safety, acceptability, tolerability, and blinding. Secondary outcomes were changes in food craving, binge eating, approach bias to food, body mass index, and psychological symptoms.
Results: Twenty‐eight participants were recruited (93% of target). Retention was high (T1 = 85.7% and T2 = 78.6%); blinding accuracy was 46.4%. Medium effect sizes favoured ‘ABMT + real tDCS’ for reducing binge eating (d = −0.6, 95% CI −1.5, 0.3), and ‘ABMT + sham tDCS’ for reducing food cravings (d = 0.5, 95% CI −0.4, 1.4). Within‐groups, only the ‘ABMT + real tDCS’ arm showed reduced approach bias to food and approach‐avoidance bias to food, and increased avoidance bias to food (all p < 0.05). This was followed by reduced binge eating episodes (p < 0.05). Both groups reported frequent binge‐eating episodes (‘ABMT + tDCS’ = 43%; ‘ABMT + sham tDCS’ = 28.6%).
Conclusion: The initiation of antipsychotic therapy is a critical clinical window for early intervention to mitigate the long‐term metabolic and psychiatric consequences of antipsychotic‐induced weight gain. Combining ABMT + tDCS is acceptable and may help reduce binge eating in individuals on antipsychotics, with a potential synergistic effect between cognitive training and brain stimulation. A confirmatory trial is needed to assess its effectiveness and should include BED diagnosis as a stratification criterion.
Trial Registration: ISRCTN Identifier: 13280178
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BibTeX
@article{lopes2026combining,
title = {{Combining Cognitive Training and Brain Stimulation: A Novel Approach to Address Disordered Eating and Antipsychotic‐Induced Weight Gain in People With Severe Mental Illness}},
author = {Mariana Lopes and Dina Monssen and Luiza Grycuk and Gemma Gordon and Fiona Gaughran and Iain C. Campbell and Ulrike Schmidt},
journal = {Early Intervention in Psychiatry},
year = {2026},
month = oct,
doi = {10.1111/eip.70275},
url = {https://doi.org/10.1111/eip.70275},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Combining Cognitive Training and Brain Stimulation: A Novel Approach to Address Disordered Eating and Antipsychotic‐Induced Weight Gain in People With Severe Mental Illness
AU - Mariana Lopes
AU - Dina Monssen
AU - Luiza Grycuk
AU - Gemma Gordon
AU - Fiona Gaughran
AU - Iain C. Campbell
AU - Ulrike Schmidt
PY - 2026
DA - 2026/10/26
JO - Early Intervention in Psychiatry
DO - 10.1111/eip.70275
UR - https://doi.org/10.1111/eip.70275
AB - Background: Antipsychotic‐induced weight gain is a distressing side effect that most often occurs within the first 3–6 months of pharmacological initiation, significantly increasing cardiometabolic risk and mortality in individuals with severe mental illness. Aims: To assess the feasibility of reducing food craving and binge eating using Approach Bias Modification Training (ABMT) combined with real or sham Transcranial Direct Current Stimulation (tDCS). Method: In this double‐blind, parallel‐group, two‐arm, sham‐controlled trial, adults with schizophrenia/schizoaffective disorder on stable doses of antipsychotics were randomly allocated to a total of five ABMT sessions together with either real or sham tDCS administered over 3 weeks. Assessments were made at baseline (T0), post‐treatment (T1) and at a 2‐week follow‐up (T2). Feasibility outcomes included recruitment, attendance, retention, tDCS safety, acceptability, tolerability, and blinding. Secondary outcomes were changes in food craving, binge eating, approach bias to food, body mass index, and psychological symptoms. Results: Twenty‐eight participants were recruited (93% of target). Retention was high (T1 = 85.7% and T2 = 78.6%); blinding accuracy was 46.4%. Medium effect sizes favoured ‘ABMT + real tDCS’ for reducing binge eating (d = −0.6, 95% CI −1.5, 0.3), and ‘ABMT + sham tDCS’ for reducing food cravings (d = 0.5, 95% CI −0.4, 1.4). Within‐groups, only the ‘ABMT + real tDCS’ arm showed reduced approach bias to food and approach‐avoidance bias to food, and increased avoidance bias to food (all p < 0.05). This was followed by reduced binge eating episodes (p < 0.05). Both groups reported frequent binge‐eating episodes (‘ABMT + tDCS’ = 43%; ‘ABMT + sham tDCS’ = 28.6%). Conclusion: The initiation of antipsychotic therapy is a critical clinical window for early intervention to mitigate the long‐term metabolic and psychiatric consequences of antipsychotic‐induced weight gain. Combining ABMT + tDCS is acceptable and may help reduce binge eating in individuals on antipsychotics, with a potential synergistic effect between cognitive training and brain stimulation. A confirmatory trial is needed to assess its effectiveness and should include BED diagnosis as a stratification criterion. Trial Registration: ISRCTN Identifier: 13280178
SN - 1751-7885
SN - 1751-7893
ER -