63 Dialectical behavior therapy adapted for binge eating compared to cognitive behavior therapy in obese adults with binge eating disorder 3 Treatment Dialectical behavior therapy for binge eating disorder (DBT-BED) A Dutch prepublication version of the DBT-BED session-to-session protocol (courtesy of C. Telch and D. Safer; Safer et al., 2009) was used. DBT-BED teaches skills to help patients regulate emotions in an adaptive way. This is done from a ‘dialectical’ stance: accept patients as they are and at the same time stimulate them to change in order to help them reach their goals. Treatment included 20 group-sessions of 2 hours each, over the course of 20 weeks. In the first two sessions the rational and the goals of therapy were reviewed comprehensively, and an explicit commitment to change was made. The use of diary cards and chain analyses was introduced as well as the concept of therapy interfering behavior. The second phase (sessions 3 – 18) comprised three modules in which skills in mindfulness, emotion regulation and distress tolerance were taught. The emotion regulation module incorporates lifestyle interventions (i.e. education on a balanced eating pattern and regular physical exercise) to diminish the sensitivity for negative emotions. The third phase focused on the review and enhancement of learned skills, and on plans for the future. During treatment, patients monitored their weight weekly at the treatment center in order to help them face the consequences of (changes in) their eating behavior. A maximum of nine patients could participate in each round, in a closed group format. Six months after the end of treatment, progress was reviewed and skills were refreshed in a single follow-up group session. At that time, further treatment was offered in case this seemed necessary. Each treatment-cycle of 20 weeks was led by two trained psychologists/psychotherapists. Several therapist-pairs were formed as the treatment was provided over a substantial period of time. Intensive outpatient cognitive behavior therapy (CBT+) The CBT intervention was an extended version in group format of the manual developed by Fairburn and colleagues (1993), addressing binge eating as behavior maintained by dietary restraint and other behavior, like body avoidance, originating from the overvaluation of weight and shape. The session-to-session protocol is available from ML. Treatment included 20 days of group therapy, one day per week during 20 consecutive weeks. Each day comprised three modules of 75 minutes each: 1) discuss daily self-monitoring of eating behavior and related situations, thoughts and feelings, 2) challenge thoughts and conduct behavioral experiments related to food and eating and 3) challenge thoughts and conduct behavioral experiments related to body image. Over the course of treatment, several topics were covered in all three modules: motivation to change, eating regularly and sufficiently, dealing with triggers for binge eating (including some emotion regulation strategies), body image, body satisfaction, life-style and relapse prevention. In addition, patients monitored their weight weekly at the treatment center in order to diminish the obsession with weight or to break the avoidance of weight, and
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