69 Dialectical behavior therapy adapted for binge eating compared to cognitive behavior therapy in obese adults with binge eating disorder 3 Table 2: Percentage of Participants that went from above to below the Cutoff of 2.47 on the EDE-Q Global Score CBT+ DBT-BED Fisher’s Exact p End of Treatment 69.6% (16/23) 52.9% (18/34) .275 Follow-up 65.0% (13/20) 45.8% (11/24) .238 Treatment adherence Mean session integrity was 79.1% (SD = 15.0) for DBT-BED and 63.5% (SD = 24.1) for CBT+ with a statistically significant difference in favor of DBT (p < .001). To establish interrater reliability, five raters rated four tapes independently. The average kappa coefficient across raters and tapes was .628 (p < .001) suggesting good agreement. Discussion This controlled study compared an emotion regulation treatment adjusted for BED with an intensive eating disorders-focused form of CBT in obese individuals with BED. Contrary to our expectations, DBT-BED was not superior to and was in fact less efficacious than CBT+ on primary outcome measures, especially on reductions in eating disorder psychopathology at follow-up. The greater reductions in OBE episodes in CBT+ at end of treatment were not retained six months after treatment. Reductions on all secondary measures were consistently in favor of the CBT+ group, with self-esteem reaching statistical significance and a medium effect at follow-up. The failure to support our primary hypothesis may be due to differences in dosage between treatments: CBT+ contained more face-to-face contact time per day (3.75 hours versus 2 hours per week), offered six group meetings of 90 minutes to patients with a partner and incorporated six follow-up sessions for some patients (versus one for all patients in DBT-BED). Thus, this latter group received twice-weekly sessions during six weeks. Dose-response research in psychotherapy shows that, more than the number of sessions and the total contact time, the frequency of treatment schedules seems to be a relevant factor as more frequent treatment schedules (e.g. twice per week instead of once per week) are found to be more effective (Bell et al., 2017; Cuijpers et al., 2013; Robinson et al., 2020). Therefore, patients in CBT+, especially those that participated in the ‘partner-group’, have this advantage1. As Chen and colleagues (2017) found no 1 On the other hand, one could also say that we have advantaged DBT-BED as we selected a sample that we assumed could optimally benefit from the DBT-BED treatment.
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