60 Chapter 3 borderline personality disorder and ongoing self-harm or suicidal behaviors, has been adapted to treat BED (DBT-BED: e.g. (Safer et al., 2009). DBT-BED aims to improve adequate emotion regulation skills in order to replace binge eating as a way of coping with negative affect (Telch et al., 2001). To date, two randomized controlled trials have compared DBT-BED in patients with a primary diagnosis of BED to a waitlist control group, showing significantly less eating disordered behavior for DBT-BED at post-treatment and at six month follow-up (Masson et al., 2013; Telch et al., 2001). When compared to an active comparison group treatment (ACGT), post-treatment abstinence rates were favorable for DBT-BED (64% compared to 36% for ACGT), but there were no significant differences between the groups at any time during the 12-month follow-up period (Safer et al., 2010). A fourth study (Chen et al., 2017) compared a more intensive version of DBT-BED to an adjusted, dose-matched, CBT-program in a mixed bulimia nervosa and BED sample of early weak responders to guided self-help cognitive behavior therapy. Although both treatments were helpful in reducing objective binge eating (OBE) episodes, no differences were found between treatments. These data support the idea that DBT can be a viable alternative to CBT in patients with binge eating. However, evidence is scarce and the available data do not favor one treatment over the other. There are several reasons to assume that a certain subset of patients with BED is more likely to benefit from DBT. All eating disorders are characterized by emotion regulation difficulties, and although some studies suggest that individuals with BED may show these difficulties to a lesser extent than patients with anorexia nervosa or bulimia nervosa, patients with BED show marked emotion regulation difficulties when compared to healthy controls (Brockmeyer et al., 2014; Svaldi et al., 2012). Individuals who report to eat in response to negative emotions (emotional eating) have been shown to have higher levels of emotion regulation difficulties in comparison to groups without emotional eating (Sultson & Akkerman, 2019). Also, there is evidence suggesting that binge eating in overweight adults with BED is particularly associated with negative affect and not so much with dietary restraint (which is associated with binge eating in normal weight adults with BED (Carrard et al., 2012; Goldschmidt et al., 2011; Welsh & King, 2016). Therefore, DBT might improve outcome in individuals with BED who are overweight and engage in emotional eating. This study aimed to add to the current literature by comparing a DBT-BED group treatment to an intensive outpatient CBT-treatment (CBT+) in overweight individuals with BED who report above average levels of emotional eating. Although this CBT ‘treatment as usual’ comprised significantly more treatment time than the DBT intervention, and as such may have advantaged the CBT group, we hypothesized that DBT would be superior to CBT on measures related to eating disorder pathology and on measures related to emotion regulation. The reason for this is that we optimized chances for DBT-BED by
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