Dialectical Behavior Therapy and Cognitive Behavior Therapy in Individuals With Binge-Eating Disorder: What Works for Whom?

objectiveTo evaluate moderators and predictors of response to cognitive behavioral therapy (CBT) and dialectical behavior therapy (DBT) for binge-eating disorder (BED).

methodModerators/predictors of treatment outcome, central to CBT and to DBT treatment, were chosen from an aggregated dataset of two clinical outcome studies with non-random allocation to treatment groups (N = 203). Both studies compared DBT-BED (n = 71) to a more intensive outpatient CBT program (CBT+, n = 132) in individuals with BED. Generalized linear models examined moderators and predictors of objective binge-eating (OBE) frequency at end of treatment (EOT) and six-month follow up (FU).

resultsBaseline shape/weight overvaluation, shape concerns and low self-esteem significantly predicted and moderated reductions in OBE frequency at EOT whereas difficulty in identifying feelings predicted and moderated outcome at FU. Emotional eating predicted outcome at FU (medium effect) and moderated outcome at EOT (large effect). Depression levels predicted, but not moderated, treatment outcome at both EOT and FU. For shape/weight overvaluation, shape concerns and low self-esteem, low levels were related to fewer reductions in outcome in DBT-BED than in CBT+. Individuals with the highest levels of emotional eating and difficulty identifying feelings showed more decrease in OBE episodes with DBT-BED than with CBT+ at EOT and FU respectively. DISCUSSION: Findings suggest that BED treatment outcomes could be enhanced by matching individuals with certain symptom presentations to treatment overall, and to DBT-BED or CBT+ specifically. DBT-BED may be a promising alternative to CBT+ for those with more severe psychopathology.