149 Summary and general discussion 6 · For specific subgroups, i.e. those with very high emotional eating and problems in areas related to interoceptive awareness and/or difficulties in identifying feelings, DBT-BED might be the treatment of choice. · We recommend to more specifically address difficulties in identifying internal sensations, depressive symptoms, emotional eating and body-dissatisfaction in BED treatment. In conclusion The findings of this thesis suggest that generally effective BED-treatments could possibly be enhanced by addressing specific patient characteristics before or during treatment, especially emotional eating, body-related constructs like shape concern and shape/weight overvaluation, interoceptive awareness and depressive symptoms. Findings also indicate that both CBT+ and DBT-BED lead to considerable, and in many ways comparable, symptom reductions. The significant differences that do show up are inconsistent, but favor the more intensive CBT+ over DBT-BED. This may lead to the conclusion that DBT-BED should be put aside as an inferior treatment for BED. However, the substantial symptom reductions in DBT-BED are reached with about half the therapy time of CBT+, which makes DBT-BED a more cost-effective treatment. In addition, we consistently did not find differences in the longer term when looking at OBE episodes, an important (defining) outcome measure. So, our findings are encouraging for DBT-BED as a candidate for BED-treatment. Concurrently, CBT should remain the preferred treatment for individuals with BED overall. Only for specific subgroups, i.e. those with very high emotional eating and problems in areas related to interoceptive awareness and/or difficulties in identifying feelings, DBT-BED could likely be the treatment of choice from the outset. Future research should focus on a better understanding of why treatments work and of what works best for whom. This could lead to the reasoned improvement of established effective treatments and/or to the development of a new treatment that could improve outcome for individuals with (subthreshold) BED. Specifically, we should look into those patients who do not show early change in established first line treatments (i.e. CBT/ CBT-E). Also, (outcome) measures should be better aligned internationally so we can build on each other’s efforts more easily.
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