61 Dialectical behavior therapy adapted for binge eating compared to cognitive behavior therapy in obese adults with binge eating disorder 3 including only individuals with BED who might be most likely to profit from an emotion regulation intervention. Method Study design This study is an open, quasi-randomized, controlled trial with two arms: CBT+ and DBT-BED. When the study was designed, the CBT+ program had been treatment as usual at our center for ten years. The program has shown to lead to substantial reductions in eating disorder pathology (Lammers et al., 2015). For pragmatic reasons we chose to compare DBT-BED with this more intensive program. We reasoned that, given the difference in dosage, we would be able to consider DBT-BED an important alternative to CBT+ if DBT-BED would at least equal the results of CBT+. All patients that met the inclusion/exclusion criteria (described below) and provided written informed consent to participate in the study were allocated to either CBT+ or DBT-BED. An employee not involved in the clinical trial, randomized eligible patients by flipping a coin. If a treatment group was about to start with only one open slot, the patient to enter the study was assigned to that group rather than randomized. After allocation, participants completed assessments on the first day of treatment (baseline), on the last day of treatment (end of treatment) and six months after treatment (followup). Enrollment started in October 2011, and was finished by the end of 2016. The design of the study was approved on October 10th 2011 by the Institution of Mental Health Medical Ethics Committee (METiGG: 11.109; CMO Radboud UMC: 2013/226) and was registered retrospectively in the Netherlands Trial Register (NTR4154) on August 28, 2013. Prior to conducting any analyses, given the modest sample size, we made the decision to compare outcome between treatments only on core eating disorder variables. Participants Participants were individuals from 18 years upward, who were referred to an expertise center for eating disorders in the Netherlands. If, during a telephone screening, BED seemed plausible, patients were asked to fill out the Dutch Eating Behavior Questionnaire (DEBQ; van Strien, 2015). Subsequently, either a licensed psychologist or psychiatrist conducted a clinical interview, designed a case formulation and determined the presence or absence of BED according to DSM-5 (APA, 2013). The case formulation and the DSM-5 classification were then reviewed in a multidisciplinary team. Because individuals with BED who are overweight and engage in emotional eating are arguably most likely to benefit from an emotion regulation intervention, we only included patients with a BMI ≥ 30 and an above average urge to eat in response to negative emotions (score ≥ 2.38
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