111 Dialectical behavior therapy and cognitive behavior therapy in individuals with binge eating disorder: what works for whom? 5 Introduction Individuals with binge eating disorder (BED) suffer from uncontrollable episodes of overeating (American Psychiatric Association [APA], 2013). BED has been linked to psychiatric and medical comorbidities as well as impaired social functioning (Brownley et al., 2016; Grucza et al., 2007; Welch et al., 2016). Even with the most effective guideline treatments, cognitive behavior therapy (CBT) and interpersonal psychotherapy (IPT), about 50% of patients remain symptomatic (Linardon, 2018). Consequently, new treatments for BED have been developed with the goal of improving abstinence rates. Of these relatively new therapies, dialectical behavior therapy (DBT) has so far been the most widely studied (Ben Porath et al., 2020; Linardon, Fairburn et al., 2017). DBT was originally developed to treat ongoing self-harm and suicidal behaviors in patients with borderline personality disorder. The adapted form for BED (DBT-BED) teaches emotion regulation skills in order to replace binge eating as a way of coping with negative affect (Safer et al., 2009; Telch et al., 2001). The therapy leads to large pre-post symptom improvements (e.g. Blood et al., 2020) and is consistently more efficacious than waitlist controls (Masson et al., 2013; Rahmani et al., 2018; Telch et al., 2001). However, studies show no superiority for DBT-BED when compared to an active comparison group (Safer et al., 2010) or to CBT (Chen et al., 2017; Lammers et al., 2020, 2021; Lammers et al, 2022). In fact, CBT may more effectively reduce OBE episodes in the short-term (Lammers et al., 2020). Yet, these findings were not replicated and in the longer term, differences in OBE reduction between treatments were consistently non-significant (Lammers et al., 2020; 2022). Nevertheless, subsets of patients, with certain symptom presentations or characteristics, may be likely to profit more from one treatment or another. The identification of baseline variables that moderate responses to treatment could help clinicians make well-informed, effective decisions about what works for whom (Kraemer, 2016; Kraemer et al., 2002). To date, most of the limited available research on moderators of treatment outcomes for BED tested moderators of manualized CBT-outcome relative to other treatments including IPT, CBT-guided self-help (CBT-gsh), behavioral weight loss and medication (Grilo, Gueorguieva & Pittman, 2021; Linardon, de la Piedad Garcia & Brennan, 2017). Most tested moderators (e.g., demographics, global eating disorder psychopathology and depression scores) did not affect CBT-outcome relative to these other treatments. Some moderators (e.g. age of binge eating onset, weight concern and overvaluation of weight and shape) did differentially predict outcome in some studies, but no consistent pattern emerged across studies (Grilo, Thompson-Brenner et al., 2021; Linardon, de la Piedad Garcia & Brennan, 2017). Only two studies evaluated moderators of response to an emotion-focused intervention for BED relative to other treatments. In the first study
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