143 Summary and general discussion 6 shape and weight, and maybe also self-esteem, would show greater improvement in CBT compared to DBT-BED, was not confirmed. Moderator analyses (Chapter 5) tentatively revealed a pattern in which for shape/weight overvaluation, shape concerns and low self-esteem, low levels were related to better EOT outcome in CBT+ than DBT-BED. Interestingly, those with higher levels of shape/weight overvaluation, shape concerns and low self-esteem, tend to do as well in DBT-BED as in CBT+. Again, this could mean that several roads lead to Rome. In CBT (as in CBT-E, i.e. body-image module, Fairburn, 2008), several specific strategies have been developed to achieve a reduction of body-image related problems. Maybe, in DBT-BED, a similar reduction occurs through more general mindfulness skills and radical acceptance. Or, again, common factors could be responsible for the change achieved. Given their counterintuitive nature, results suggest more work is needed to better understand how shape/weight-related constructs and low self-esteem might influence symptom change in BED treatments. Depression levels, dietary restraint, weight concerns, emotion dysregulation and anxiety did not moderate treatment outcome, suggesting that baseline levels are not differentially related to outcome. Again, this suggests that improvements might largely be attributable to therapeutic elements shared across various treatments. Prediction Apart from variables that differentially predict outcome in specific BED-treatments, we reported on variables that may predict outcome regardless of treatment type (non-specific predictors). We did so in two studies (Chapters 2 and 5). The first study, in a CBT+ only sample, had an explorative nature, while the variables chosen in the second study, in a combined CBT+ / DBT-BED-sample, were theory-based. A variety of variables was investigated, three of which were explored in both studies. They were operationalized by various measures, assessing related constructs: 1) body dissatisfaction, 2) depressive symptoms, and 3) difficulty in identifying internal sensations (both emotions and physical sensations). Findings of interest will be discussed successively. Several body related constructs, including shape/weight overvaluation and shape concern, predicted outcome in the short term in the CBT+ / DBT-BED group. In the CBT+ group, body dissatisfaction predicted outcome in the short term for women and was an overall post-treatment predictor in the longer term. Less problems predicted less binge eating pathology. This indicates that achieving lowered body dissatisfaction by EOT could contribute to less binge eating pathology in the longer term. Overall, our results add to previous findings that body dissatisfaction may be of special importance in predicting who will benefit more, or less, from BED treatment (Anderson et al., 2020; Grilo et al., 2012; Grilo, Thompson-Brenner et al., 2021). This could inform treatment plans.
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