122 Chapter 5 Discussion The original comparisons of DBT-BED and CBT+ in terms of reductions in OBE frequency (Lammers et al., 2020; 2022) revealed few differences at EOT or six-month FU. The present study broadened this work by identifying subgroups that might profit more, or less, from one treatment or the other. Also, it is the first study to examine moderators of CBT and DBT for BED, thereby extending the work on identifying baseline characteristics in BED patients that predict which treatment works for whom. When analyzing moderators, we also looked at their predictive main effects as this provides prognostic information on who will be likely to profit more or less from treatment in general, irrespective of treatment type (Kraemer et al., 2002). Predictor/moderator variables were selected based on the conceptual models underlying DBT-BED and CBT. Analyses revealed seven significant predictor effects and five significant moderator effects across treatments. In line with previous BED studies, predictor main effects were found for shape/weight overvaluation at EOT (Anderson et al., 2020; Grilo et al., 2012; Masheb & Grilo 2008) and for emotional eating in the longer term (Ricca et al., 2010). In line with Wilson et al.(2010), but unlike several other studies (Grilo et al., 2012; Masheb & Grilo, 2008; Peterson et al, 2000), self-esteem was predictive of outcome at EOT in the current sample. Also different from earlier findings (Grilo, Thompson-Brenner et al., 2021), shape concern predicted outcome at EOT. In line with two other studies that tested ‘interoceptive awareness’ (Fichter et al., 2008; Lammers et al., 2015), difficulties in identifying feelings predicted BED outcome at FU. Finally, depression levels consistently predicted binge eating outcome at both EOT and FU. This adds to the mixed evidence regarding the predictive value of baseline depression-scores in BED treatment (e.g. Dingemans et al. 2007, 2020; Grilo, Gueorguieva & Pittman, 2021). All significant predictor effects were in the same direction: higher baseline values predicted less decrease in OBE episodes. Only emotional eating showed a medium main effect at FU (IRR = 2.33). All other effects are (very) small. Dietary restraint, weight concern, emotional dysregulation and anxiety baseline levels were not predictive, implying that these characteristics do not influence binge eating outcome across treatments. Our main interest concerned the moderating effects of the selected characteristics. Analyses revealed that overvaluation, shape concerns, low self-esteem and emotional eating interacted with treatment type to differentially predict a decrease in OBE frequency at EOT (but not at FU) and difficulties identifying feelings moderated outcome at FU (but not at EOT). Thus, findings support the short-term, but not the longer term, benefit of matching patients with specific symptom presentations on overvaluation, shape concerns, low self-esteem or emotional eating to CBT+ or DBT-BED. Also, findings support the longer term benefit of matching patients with specific symptom
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