145 Summary and general discussion 6 has received little attention in prediction research for BED. However, our data are in line with Ricca and colleagues (2010) who found lower baseline emotional eating predictive for full recovery at 3-year follow-up and high emotional eating predictive of treatment resistance at EOT. Thus, more (explicit) attention to emotional eating in BED treatment could possibly help to further enhance treatment outcome. One possible way to do this is, is by formulating explicit if-then plans that generate goal-directed action. “If I sense the desire to eat in between meals, I will …. “. Or: “If I feel sad, I will ……”. A short intervention, learning how to form and carry out these so called implementation intentions, has shown to lead to significant and large reductions of binge eating that persisted for six months in a group of individuals with BN and BED (Tanis et al., 2023). In fact, the behavior chain analysis in DBT-BED provides input to formulate these implementation intentions. Taken together, more or more specific interventions related to affect regulation (i.e. learn to identify and regulate internal sensations, emotions and depressive symptoms) and body dissatisfaction rather than restraint may lead to better binge eating outcome in BED treatment. When and how this should be done has yet to be studied. Certainly, future research should look into the causal relationship between these variables and treatment outcome, but given our data we strongly recommend to integrate these findings in the treatment plan. Strengths of this thesis To our knowledge, this thesis contains the first two studies in individuals with (subthreshold) BED evaluating the effectiveness of DBT-BED directly to a CBT-program in a BED-only sample. It is also the first study to evaluate moderators of response to DBT-BED and CBT. This thesis is therefore a step forward in evaluating the effectiveness of DBT-BED. A definite strength is that generalizability was optimized by conducting the studies in routine clinical practice, with few exclusion criteria, and making use of various therapist-pairs (which enables us to generalize beyond the present therapist samples). The six-month follow-up period of all studies is another strength, as it provides insight in the medium-long term effects of both CBT+ and DBT-BED. This is important, as relapse after successful treatment is not uncommon in BED treatment (9.7% - 28%) (Castellini et al., 2011; Ricca et al., 2010; Safer et al., 2002). Also, both prediction studies (Chapters 2 and 5) constituted a large sample size at baseline (N = 304 and N = 203). And finally, DBT-BED was conducted by clinicians that were not related to the research group that developed the intervention (Safer et al., 2009).
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