Combining Cognitive Training and Brain Stimulation: A Novel Approach to Address Disordered Eating and Antipsychotic‐Induced Weight Gain in People With Severe Mental Illness

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.