82 Chapter 4 Abstract Objective: To evaluate whether the results of a quasi-randomized study, comparing dialectical behavior therapy for binge eating disorder (DBT-BED) and an intensive, outpatient cognitive behavior therapy (CBT+) in individuals with BED, would be replicated in a non-randomized study with patients who more closely resemble everyday clinical practice. Method: Patients with (subthreshold) BED (N = 175) started one of two group treatments: DBT-BED (n = 42) or CBT+ (n = 133), at a community eating disorder service. Measures of eating disorder pathology, emotion regulation and general psychopathology were examined at end of treatment (EOT) and at six-month follow-up using generalized linear models with multiple imputation. Results: Both treatments lead to substantial decreases on primary and secondary measures. Statistically significant, medium-size differences between groups were limited to global eating disorder psychopathology (d = -0,62; 95% CI .231, .949) at EOT and depressive symptoms at follow-up (d = -0.45; 95% CI .149, 6.965), favoring CBT+. Dropout of treatment included 15.0% from CBT+ and 19.0% from DBT-BED (difference non-significant). Discussion: Decreases in global eating disorder psychopathology were achieved faster with CBT+. Overall, improvements in DBT-BED were comparable to those observed in CBT+. Findings of the original trial, favoring CBT+ on the number of OBE episodes, emotional dysregulation and self-esteem at EOT, and on eating disorder psychopathology and self-esteem at follow-up, were not replicated. With similar rates of treatment dropout and about half of the therapy time used in CBT+, DBT-BED can be considered a relevant treatment for BED in everyday clinical practice. Keywords Binge eating disorder, cognitive behavior therapy, dialectical behavior therapy, group therapy, effectiveness
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