112 Chapter 5 (Robinson & Safer, 2012), an earlier onset of overweight and dieting (< 15 years old) and avoidant personality disorder both signaled poorer outcome when treated with a non-specific supportive psychotherapy versus DBT-BED. In the second study, low shape/ weight overvaluation, greater pretreatment self-control and greater baseline actual-ideal self-discrepancy predicted greater reductions in OBE frequency at end of treatment (EOT) in integrative cognitive affective therapy for BED (ICAT-BED) than in CBT-gsh (Anderson et al., 2020). So far, no study has tested moderators of response comparing CBT and DBT-BED. The present study aims to add to the existing literature by filling this gap. The current study This study explored whether individual characteristics differentially predict treatment outcome for DBT-BED and CBT at end of treatment and at six-month follow-up (FU) in individuals with BED or subthreshold BED. Predictor main effects for these characteristics were also considered. Available data from a quasi-randomized controlled trial (Lammers et al., 2020; 2021) and an effectiveness study (Lammers et al., 2022) were used. Both studies compared group DBT-BED to a more intensive outpatient CBT group-program (CBT+), based on CBT for binge eating as developed by Fairburn and colleagues (1993). In the CBT-model for BED, derived from the transdiagnostic model of eating disorders (Fairburn, 2008), binge eating is maintained by dieting and possible other non-compensatory weight-control behavior which follows from the overvaluation of body shape and/ or body weight. This, in turn, can be maintained by low self-esteem. Although binge eating may also be maintained by stressful events and associated mood changes, the main focus in CBT is on the link between overvaluation, dieting and binge eating. The DBT-model assumes that binge eating serves as a way to regulate negative affect via negative reinforcement (Safer et al., 2009; Telch et al., 2001). The focus of DBT is on the improvement of adaptive emotion regulation skills in order to replace binge eating as a way of dealing with aversive emotional states. We hypothesized that emotion regulation difficulties would moderate treatment outcomes for DBT-BED and CBT. Specifically, patients with more distinct emotion regulation problems at baseline would demonstrate greater symptom improvements in DBT-BED. We also hypothesized that, to patients who report greater difficulties in areas related to dieting and overvaluation of shape or weight, CBT might offer incremental benefit over DBT-BED when compared to patients with lower levels of problems in areas related to dieting or overvaluation. Because the CBT-model (Fairburn et al., 2003) posits a more indirect link between self-esteem and overeating, we tentatively hypothesized that for those with lower self-esteem, CBT might lead to better outcome.
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