64 Chapter 3 to monitor the consequences of (changes in) eating behavior. Each treatment-cycle of 20 weeks was led by a team of three: a psychologist, a psychiatric nurse and a psychomotor therapist. Psychomotor therapists addressed maintaining factors like body-avoidance and comparison-making by in-session exercises (e.g. body-exposure) and related homework assignments (see also Probst et al, 2010). Several therapist-combinations were formed as the treatment was provided over a substantial period of time. A maximum of nine patients could participate in each round. New patients entered every 10th week (i.e. a half open group format). In addition, six group meetings of 90 minutes each were offered to patients and their partners to enhance mutual understanding and support during the process of change. After treatment, if deemed necessary on clinical grounds, six monthly group sessions were offered to help prevent relapse. Therapist qualifications/training All therapists were well trained and experienced in CBT for eating disorders, as this is the treatment as usual at the treatment center. Training in DBT-BED was initially provided by a senior psychologist, independent from this study, and well trained in this specific protocol. Later on, the initially trained therapists trained the co-therapist. Therapists in the DBT-BED-condition were supervised once a month by a leading expert in DBT. Therapists in the CBT-condition did not receive supervision, although peer consultation was ensured. No therapist worked in two treatments at the same time in order to avoid content or procedural overlap. Treatment adherence was assessed (see Supplementary material). Assessment Except for demographic information and height (collected at baseline only), all assessment instruments were administered at baseline, at post-treatment and at follow-up. All the assessed psychopathology measures were self-report questionnaires. Staff conducting the assessments was aware of the treatment condition that patients were assigned to. Eating disorder pathology The Eating Disorder Examination Questionnaire (EDE-Q; Fairburn & Beglin, 2008) was used to assess the number of OBE episodes and global levels of eating disorder psychopathology over the past 28 days. Higher scores indicate greater severity. The EDE-Q is considered reliable for patients with BED (Reas et al., 2006) and has acceptable to high internal consistency and overall test-retest reliability (Berg et al., 2012). However, empirical support for the subscales (restraint, eating concern, shape concern and weight concern) is questionable (Aardoom et al., 2012; Carrard et al., 2015).
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