87 Dialectical behavior therapy compared to cognitive behavior therapy in binge eating disorder 4 six months follow-up, progress was reviewed and skills were refreshed in a single group session. In total, 13 DBT-BED groups were run. Intensive outpatient cognitive behavior therapy (CBT+) We used an adapted version of CBT in group format of the manual developed by Fairburn and colleagues (1993; the protocol is available from M.L.). This intensive program had been treatment as usual (TAU) at the center when the present study was initiated. The main objective is to help patients regain control over eating and to diminish the influence of shape and weight on self-esteem. Over the course of 20 consecutive weeks, 20 days of therapy are delivered in a half-open group format; every 10th week new patients enter the group with a maximum group total of nine patients. Each day comprises weighing and three modules of 75 minutes each with a different focus: 1) discuss self-monitoring of eating behavior, 2) challenge thoughts and conduct behavioral experiments, and 3) increase body-awareness and promote regular exercise. By discussing how to deal differently with triggers, some attention is paid to emotion regulation. Each treatment-cycle was led by a team consisting of a psychologist, a psychiatric nurse and a psychomotor therapist. The latter is trained to systematically use body experiences and physical activities to achieve specific therapeutic goals. This approach has been appreciated as providing added value in the treatment for eating disorders in the Netherlands (e.g. to improve body-image and to decrease avoidance of regular exercise; Akwa GGZ, 2017) and is easily integrated within the CBT-model (Probst et al., 2010). In the present protocol, the therapist offers practice within the therapy session of what is usually only given as homework between sessions (e.g. look at the whole body instead of at parts of the body, go for a swim). If patients missed more than two days, they were excluded from the program. In addition, patients and their partners were encouraged to participate in six supportive group meetings of 90 minutes each. After treatment, six monthly group sessions were offered to consolidate the changes made and to deal with setbacks. Six months after treatment, progress was reviewed in one individual follow-up session. Therapist training All therapists were well trained and experienced in eating disorder specific CBT, as this is TAU at the center. Because a randomized study was running at the center at the same time, procedures to optimize treatment adherence were conducted including the training of DBT-BED therapists. This training was initially provided by an independent senior psychologist, well trained in this specific protocol. Later on, the initially trained therapists trained the co-therapist. Monthly supervision was provided by a leading expert in DBT. For the CBT+ therapists, peer-consultation was ensured. Each therapist was assigned to a single treatment to avoid content or procedural overlap. Sessions
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