15 General introduction 1 disorder psychopathology and depression scores) did not affect CBT-outcome relative to these other treatments. Some moderators (e.g. age of binge eating onset, weight concern and overvaluation of weight and shape) did differentially predict outcome in some studies, but no consistent pattern emerged across studies (Grilo, Thompson-Brenner et al., 2021; Linardon, de la Piedad Garcia & Brennan, 2017). No study so far, has tested moderators of response comparing CBT and DBT-BED. All in all, we expect that DBT-BED will lead to better outcome (i.e. more decrease in OBE episodes and in general eating disorder pathology as well as in emotion regulation difficulties) than CBT in individuals with BED in general. Also, we expect that DBT-BED will result in greater symptom improvement than CBT for patients with more distinct emotion regulation problems at baseline. Furthermore, we expect that patients with greater baseline difficulties in areas related to dieting and overvaluation of body shape and weight, and maybe also self-esteem, will show greater improvement in CBT+ compared to DBT-BED. Another way to improve treatment outcome is to explore and assess variables that predict outcome regardless of treatment type (non-specific predictors, Kraemer et al., 2002). This provides prognostic information on an individual’s likely success in treatment (Linardon, de la Piedad Garcia, & Brennan, 2017). This information can be used to positively impact clinical decision making and thereby augment successful outcomes. Past studies have explored a broad range of predictors of BED treatment outcome. For instance, higher levels of eating disorder pathology at baseline (such as binge eating frequency, global eating disorder psychopathology and shape and weight concern) have been associated with more eating disorder pathology at end of treatment (EOT) and follow-up (FU) (Castellini et al., 2011; Grilo et al., 2012; Hilbert et al., 2007; Masheb & Grilo, 2008; Thompson-Brenner et al., 2013). Also, DSM-IV Axis I and II comorbidity has been associated with worse treatment outcome (Castellini et al., 2011; Fichter et al., 2008; Masheb & Grilo, 2008; Wilson et al., 2010). Others on the other hand, find no predictive value for any Axis I or II disorder (Grilo et al., 2012; Ricca et al., 2010). Taken together, the body of research is fragmented and findings are partly inconsistent (Linardon, de la Piedad Garcia & Brennan, 2017). Therefore, more research is needed. Aims and outline of this thesis The aim of this thesis is to improve the effectiveness of treatment for individuals with BED by identifying variables that predict outcome regardless of treatment type and, most importantly, by exploring the potential added value of an alternative treatment, i.e. DBT-BED, to the current first line treatment, CBT.
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