98 Chapter 4 way) and may therefore not be completely representative for ‘everyday clinical practice’. However, treatment integrity per se was only assessed after the completion of the data collection. There was no regular feedback during treatment. Despite the limitations, the present study has several strengths. To our knowledge this is the first study that evaluates the effectiveness of DBT-BED in direct comparison to an active CBT control condition in everyday clinical practice. With follow-up until six months after treatment, conclusions can be drawn about the medium-long term effectiveness of the interventions. Also, compared to most other DBT-BED effectiveness studies, this study had a relatively large sample size. Another strength is the use of a manualized treatment (DBT-BED) by clinicians who did not develop the manual. In conclusion: Although decreases in global eating disorder psychopathology were achieved faster with CBT+ and the CBT+ group showed less depressive symptomatology at six-month follow-up, the less costly DBT-BED program lead to robust improvements, without significant differences between the groups on primary measures at follow-up. Findings from the original study (Lammers et al., 2020), favoring CBT+ more distinctively, were not replicated. With similar rates of treatment dropout and about half of the therapy time used in CBT+, DBT-BED can be considered a relevant treatment for BED in everyday clinical practice. Future research should include both dose-matched comparisons between CBT and DBT-BED in everyday clinical practice, and longer term follow-up to see how trends evolve over time. It could also include the use of shared decision making and the identification of mediator and moderator variables, preferably only for those with BED who show weak initial response to effective and less intensive treatments like CBT-guided self-help. This could inform a more effective use of limited resources.
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