147 Summary and general discussion 6 Unfortunately, we did not record whether patients had received any prior psychological treatment. This might have helped to provide some insight into whether DBT-BED could be a viable option for patients who have not sufficiently improved with other treatment approaches. Another limitation is the fact that this thesis’ sample is mostly white and female. This may make the sample not representative for all BED patients. However, moderator analyses of race/ethnicity in BED patients have been found to be nonsignificant (Thompson-Brenner et al., 2013) and sex has not been found to be a significant moderator of any treatment outcomes (Lydecker et al., 2019; Shingleton et al., 2015). Therefore, it may well be that our results do generalize to also male and non-white individuals with BED. Recommendations for future research In order to strengthen the evidence that DBT-BED may be an effective alternative to CBT in the treatment of BED, future research should include dose-matched comparisons of CBT and DBT-BED in a sufficiently powered randomized controlled trial (RCT) and include longer term follow-up to see how trends develop. In line with our findings, other newly developed therapies for binge type eating disorders did not show preferable outcome compared to CBT. Indeed, statistically significant outcome differences were not found (Linardon, Fairburn et al., 2017). Therefore, I believe that we should rather aim at fine-tuning current efficacious treatments, than at developing yet another new treatment that will solve all problems. Thus, in line with this thesis, we recommend that in future RCT’s a selection of predictors/moderators be included, based on the conceptual models underlying the treatments of interest. Also, a better understanding of the mechanisms that drive the process of recovery in individuals with BED would help to improve treatment outcome. Identifying mediators of treatment outcome could help to find out why and how treatments are effective (Kraemer et al., 2002). To date, little is known about what mediates change in BED-treatment. One study showed that, in CBT for BED, abstinence of binge eating at EOT was mediated by changes in weight concern and was marginally mediated by changes in eating and shape concerns, depressive symptoms and global severity of general psychopathology (Dingemans et al., 2007). Together with our findings, additional work is warranted to determine the extent to which changes in identifying internal sensations/feelings, shape/weight concern, shape/ weight overvaluation, depressive symptoms and emotional eating might positively impact treatment outcomes. We recommend to embed mediation studies, with attention to these variables, within RCTs to better understand how treatments work.
RkJQdWJsaXNoZXIy MjY0ODMw