96 Chapter 4 Effect sizes indicate that, like in Lammers et al., (2020), small to medium differences on primary measures were in favor of CBT+ at EOT. In contrast to our earlier study, these differences were not retained at follow-up. The only statistically significant difference was on global eating disorder psychopathology at EOT. The present findings are more in line with Chen et al. (2017). They found no differences between DBT and CBT regarding the number of objective binge eating days and EDE global score from end of treatment up to 12-month follow-up. Interestingly, the CBT+ group in the present study showed a trend towards relapse on eating disorder psychopathology between end of treatment and six-month follow-up; in contrast, the DBT-BED group continued to improve. Longer term follow-up data are needed to see how this trend evolves. On secondary measures, effect sizes indicate that overall differences between the two treatments favored CBT+; however, in contrast to Lammers et al. (2020), most differences were statistically non-significant and small. The only significant and medium difference was on depressive symptoms at follow-up (d = 0.45). Concurrently, within both groups, BDI-II scores dropped significantly from moderate levels at baseline to minimal/mild levels at EOT and follow-up. Based on these findings, we may conclude that both CBT+ and DBT-BED lead to substantial decreases in depressive symptoms with the CBT+ group showing lower scores at follow-up. These findings are broadly in line with Lammers et al. (2020) and in keeping with studies showing that eating disorder specific CBT reduces depressive symptoms (Fairburn et al., 2015; Turner et al., 2016). Concurrently, these findings positively contrast with studies showing limited levels of change in mood in DBT-BED treatment groups (Blood et al., 2020; Safer et al., 2010; Telch et al., 2000). Dropout rates were comparable in CBT+ and DBT-BED (19% vs 15%; Fisher’s Exact p = .63). Dropout from CBT+ was higher than in Lammers et al., (2020; 6%) but still relatively low when compared to other controlled CBT-treatment studies (e.g. 11.7 to 37%, Peterson et al., 2009; Chen et al., 2017). In DBT-BED, dropout rates were high when compared to the efficacy study of Safer and colleagues (2010; 4%), but comparable to studies conducted in everyday clinical practice (16.1% and 17,1%: Blood et al., Lammers et al., 2020). In contrast to our controlled study (Lammers et al., 2020), where CBT+ favored DBT-BED on emotional dysregulation at the end of treatment, no differential treatment effects were found on measures assessing emotion regulation, an hypothesized maintenance mechanism in DBT-BED. The current findings are in line with studies that compared emotion regulation-based treatments for binge-type eating disorders, to a supportive control group (Safer et al., 2010) and CBT (Peterson et al., 2020; Wonderlich et al., 2014). This suggests that improvements in emotion regulation in this study might be attributable to therapeutic elements shared across various treatments and not to the specific emotion regulation strategies taught in DBT-BED. The current study highlights
RkJQdWJsaXNoZXIy MjY0ODMw