116 Chapter 5 was questionable (α = .651). The 7-item subscale Difficulty Identifying Feelings of the Toronto Alexithymia Scale (TAS-20: Bagby et al, 1994a, b) was used to assess difficulties in identifying feelings and distinguishing between emotional and physical sensations. Items are answered on a 5-point Likert scale whereby 1 = strongly disagree and 5 = strongly agree. Subscale scores are calculated by summing the individual item-scores. Higher scores indicate more difficulties. Although the TAS-20 has been subject to considerable debate as a measure of alexithymia, this specific subscale has reasonably good internal consistency (α = .792 in the current sample) and the test–retest reliability in psychiatric outpatients was satisfactory (Kooiman et al., 2002). Negative affect The BDI-II consists of 21 items assessing the severity of depressive symptoms over the last week. The questions are answered on a scale ranging from 0 to 3. The 21 items are summed for a total score with higher scores indicating higher levels of depression. The reliability and validity of the BDI are good (Beck et al., 1996). Internal consistency in the current sample was good (α = .903). The SCL-90 Anxiety subscale assesses the severity of anxiety symptoms over the last week (Arrindell & Ettema, 2003). The scale consists of 10 items that are answered on a 5-point Likert scale, ranging from 1 (not at all) to 5 (extremely). The 10 items are summed for a subscale score. Higher scores indicate higher levels of anxiety. SCL-90 Anxiety denoted good internal consistency in this study (α = .873). Emotional eating The subscale Emotional Eating (EE: 13 items) of the Dutch Eating Behavior Questionnaire (DEBQ: Van Strien et al., 1986) was used to assess the desire to eat in response to negative emotions. Items are answered on a 5-point Likert scale, with scores ranging from 1 (never) to 5 (very often). Individual item scores are summed and divided by the number of items for a subscale-score. Higher scores reflect higher levels of emotional eating. Internal consistency and factorial validity of the DEBQ are good (e.g. Barrada et al., 2016). Also, the reliability and validity of the DEBQ are rated as good (enough) (COTAN, 2013). Internal consistency of the EE-subscale in the current sample was good (α = .904). Outcome Baseline, EOT and six-month FU reports of the number of OBE episodes on the EDE-Q, were used to assess outcome: the reduction in OBE episodes from baseline. Statistical Analysis / Analytic Approach Generalized linear models based on a negative binomial distribution (for count data) with log link were used to evaluate predictors and moderators of treatment outcome for objective binge episodes at EOT and FU. Separate models were run for each moderator.
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