114 Chapter 5 is paid to a balanced eating pattern and regular physical exercise. One follow-up session was planned, six months after the end of treatment. Intensive outpatient cognitive behavior therapy (CBT+) CBT+ is based on CBT for binge eating as developed by Fairburn and colleagues (1993). The aim is to stop binge eating by implementing a balanced eating pattern (regular, sufficient, varied) and by diminishing the influence of body shape and weight on self-esteem. This intensive, adapted CBT+ program consists of 20 weekly group sessions, comprising weekly weighing and three modules of 75 minutes each (total 3h 45 min): 1) Discuss self-monitoring of eating behavior; 2) challenge thoughts and conduct behavioral experiments; 3) increase body-awareness and promote regular exercise. A group is formed by a maximum of nine patients, with new patients starting every 10th week (i.e. a half open group format). Some attention is paid to emotion regulation. Also, six supportive group meetings for patients and their partners were advised (90 minutes each). At least one follow-up session was planned for all participants, six months after treatment. If evaluated as necessary on clinical grounds, six monthly group sessions were offered to help prevent relapse. Therapists Therapists were all well trained and experienced in eating disorder specific CBT, as this is the treatment as usual (TAU) at the center. In the CBT-program, each treatment-cycle was led by a team of a psychiatric nurse (module 1), a psychologist (module 2) and a psychomotor therapist (module 3). Peer consultation was provided to ensure adherence to the program. DBT-BED training was initially provided by an independent senior psychologist, well trained in this specific protocol. Also, a three-day DBT-training was followed by the principal therapist, leading almost all DBT-groups. Later on, the initially trained therapists trained the co-therapist. Two trained psychologists/psychotherapists conducted each DBT treatment-cycle. They were supervised monthly by a leading DBT-expert. To assess treatment adherence, sessions were audiotaped and rated. However, therapists were blind to treatment adherence. For more details, see Lammers et al. (2020). Measures Self-report measures at baseline were used to assess moderator variables central to the CBT- and DBT-based treatment models of BED. Overvaluation of shape/weight on self-esteem Consistent with earlier studies (Grilo et al. 2012; Masheb & Grilo, 2008), two specific items from the Eating Disorder Examination Questionnaire (EDE-Q: Fairburn & Beglin, 2008) were used to assess overvaluation of shape (i.e.: ‘Over the past 4 weeks, has your
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