148 Chapter 6 Of relevance here is the notable finding that early symptom change consistently mediates better treatment outcomes across diagnoses and treatments (Aderka et al. 2012; Crits-Christoph et al. 2001; Szegedi et al. 2009). This includes all eating disorders as well as both CBT (Linardon, de la Piedad Garcia & Brennan, 2017) and DBT-BED (Safer & Joyce, 2011). Our data support CBT as a first line treatment for BED overall. But what if there is no rapid response to CBT? Should we adjust CBT for the early weak responders? And if yes, in what way? Or could DBT-BED be an effective next step? Given the overlap in treatment outcome between CBT and DBT-BED, and the limited number of specific moderators, tentatively in favor of DBT-BED, it is unlikely that the general answer to this last question would be yes. It is more likely that those with a specific profile may profit from DBT-BED after initial weak response to CBT. Future research is warranted that looks into those patients that do not show early change in existing efficacious treatments i.e. CBT. Chapters 2 and 5 touch upon several important challenges in prediction research. There are two large, highly comparable groups of treatment-seeking individuals with (subthreshold) BED, treated at the same center between 2003 and 2011 (Chapter 2), and between 2012 and 2017 (Chapter 5). This is a potential replication goldmine. However, only three baseline variables were studied in both studies (depressive symptoms, body dissatisfaction, and difficulty in identifying internal sensations) of which only ‘depressive symptoms’ was operationalized by the same measure. Also, a consistent definition of outcome was lacking. As variables may have predictive value related to one outcome measure, but not necessarily to another, a consistent definition of outcome would have made comparisons more straightforward and overall conclusions more robust. In a nutshell, this illustrates what is encountered in the eating disorder field as a whole (Bardone-Cone et al., 2018; Linardon, de la Piedad Garcia & Brennan, 2017). To be able to compare findings across studies and build on former studies, consensus on which instruments to choose in operationalizing the construct under investigation is needed. Also, an agreed-upon definition of recovery, as advocated and proposed by several colleagues (Austin et al., 2023; Bardone-Cone et al., 2018) is warranted. This calls for more intensive and world-wide collaborations. Clinical implications · CBT should remain the treatment of choice for individuals with BED in general, as CBT has the most solid evidence base to date (e.g. Linardon, Fairburn et al., 2017) and our data do not show preferable outcome of DBT-BED over CBT. · However, our data support the evidence that DBT-BED could likely be an alternative to CBT.
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