84 Chapter 4 completers (Erb et al., 2013 and Telch et al., 2000 respectively), and none of these studies included a comparison group. One other study (Lammers et al., 2020; 2021) combined both efficacy elements (quasi-randomization, training and monitoring of therapists, use of a treatment manual) and effectiveness elements (clinically representative setting and therapists, few exclusion criteria). DBT-BED was compared to a more intensive outpatient group CBT program (CBT+) in 74 individuals with BED, combined with high levels of emotional eating and obesity. At end of treatment, CBT+ performed better on the number of OBE episodes, emotional dysregulation and self-esteem. At six-month follow-up, the only retained difference was for self-esteem, although eating disorder psychopathology scores were lower in the CBT+ group. Concurrently, the less costly DBT-BED program lead to robust improvements, without significant differences between the groups on one important primary measure (the number of OBE episodes) at follow-up. This may warrant a closer look into the effectiveness of DBT-BED. The present study aims to evaluate whether the results of the quasi-randomized study (Lammers et al., 2020) would be replicated in patients with BED who were treated at the same center over the same period but were not eligible for that treatment trial. The key differences are in the present study patients are not randomized to treatment, inclusion and exclusion criteria are less restrictive, and those with subthreshold BED, lower levels of emotional eating, and BMI below 30 are now included. Thus, the current study more closely reflects everyday clinical practice. Unlike most effectiveness studies, we include a large sample and unlike the study by Blood et al. (2020) we include a CBT-comparison group. In line with Lammers et al. (2020) we expect to find that CBT+ outperforms DBT-BED on eating disorder specific measures, emotional dysregulation and self-esteem. Method Study design This is an open, quasi-experimental study with two arms: an intensive outpatient CBT-program (CBT+) and DBT-BED. All study participants provided written informed consent, allowing us to use their routinely gathered data anonymously for scientific purposes. Whether patients started in CBT+ or DBT-BED was the result of a non-standardized decision making process in which both therapist/team variables (e.g. ideas about which treatment fits which case conceptualization best), availability and, ultimately, patient preference (e.g. for a certain treatment day, treatment intensity or treatment content) played a part. Participants were assessed on the first and last day of treatment as well as six months after the end of treatment. All participants reported for intake between October 2011 and December 2016, and started treatment between the beginning of 2012 and the beginning of 2017.
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